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Light SW, Sideman AB, Vela A, Wolf MS. Introducing a brain health literacy framework to promote health equity for Latinos: A discussion paper. Patient Educ Couns 2024; 124:108254. [PMID: 38493527 PMCID: PMC11070285 DOI: 10.1016/j.pec.2024.108254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Sophia W Light
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin, San Francisco, CA, USA; Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Alyssa Vela
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael S Wolf
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Sideman AB, Razon N. Extra/ordinary medicine: Toward an anthropology of primary care. Soc Sci Med 2024; 346:116707. [PMID: 38430873 PMCID: PMC10978222 DOI: 10.1016/j.socscimed.2024.116707] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Primary care is at the forefront of healthcare delivery. It is the site of disease prevention and health management and serves as the bridge between communities and the health care system As ethnographers of primary care, in this article we discuss what is gained by situating anthropological inquiry within primary care. We articulate how anthropologists can contribute to a better understanding of the issues that emerge in primary care. We provide a review of anthropological work in primary care and offer empirical data from two ethnographic case studies based in the United States, one focused on social risk screening in primary care and the other examining the diagnosis and care of people with dementia in primary care. Through these cases, we demonstrate how research of and within primary care can open important avenues for the study of the multidimensionality of primary care. This multidimensionality is apparent in the ways the medical field addresses the social and structural experiences of patients, scope of practice and disciplinary boundaries, and the intersection of ordinary and extraordinary medicine that emerge in the care of patients in primary care.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Global Brain Health Institute, Department of Neurology, University of California, San Francisco, USA; Department of Humanities & Social Sciences, University of California, San Francisco, USA.
| | - Na'amah Razon
- Department of Family and Community Medicine, University of California, Davis, USA
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Light SW, Tomasino F, Wescott A, Sideman AB, Vela A, Possin KL, Penedo FJ, Wolf MS. Perceptions, beliefs, attitudes, and knowledge of US Latino adults pertaining to dementia and brain health: a systematic review. Aging Ment Health 2024; 28:396-407. [PMID: 37874117 PMCID: PMC10983845 DOI: 10.1080/13607863.2023.2268050] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES Latinos in the USA are 1.5 times more likely to develop Alzheimer's Disease and Related Dementias (ADRD) than non-Latino Whites. This systematic review aims to summarize current understanding of the perceptions, knowledge, beliefs, and attitudes about ADRD and brain health of Latinos to inform public health efforts addressing disparities. METHODS Searches were completed across six databases (Medline, PsycINFO, WoS, LILACS, ProQUEST, and CINAHL). Studies were required to capture attitudes and/or knowledge of ADRD or brain health among US-based Latino adults who were not cognitively impaired and were not caregivers or healthcare providers. Results were synthesized narratively. RESULTS A total of 5528 unique records were identified. Following de-duplication and screening, 24 articles met the inclusion criteria for this review. Overall, knowledge about brain health and ADRD among Latinos is quite mixed. A consistent finding was that participants recognized memory loss as a symptom of cognitive impairment, but demonstrated limited recognition of other signs of impairment. The studies also highlighted variable knowledge of protective factors for maintaining brain health. CONCLUSIONS Opportunities exist to increase knowledge of ADRD signs and symptoms, and awareness of risk and protective factors. Given the heterogeneity of Latinos in the USA, more research is warranted to better elucidate nuances in conceptualizations of brain health and aging among diverse Latino subgroups.
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Affiliation(s)
- Sophia W. Light
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Francesca Tomasino
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annie Wescott
- Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Alyssa Vela
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine L. Possin
- Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin, San Francisco, CA, USA
- Weill Institute for Neurosciences, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Frank J. Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, USA
| | - Michael S. Wolf
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kaur M, Bridi L, Kaki D, Albahsahli B, Bencheikh N, Saadi A, Bandoli G, Anderson CA, Sideman AB, Al-Rousan T. Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020. JAMA Netw Open 2024; 7:e2350837. [PMID: 38198139 PMCID: PMC10782235 DOI: 10.1001/jamanetworkopen.2023.50837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024] Open
Abstract
Importance The US has historically resettled more refugees than any other country, with over 3.5 million refugees since 1980. The National Institutes of Health (NIH) is the largest public funder of biomedical research and development, but its role in mitigating many health disparities refugees experience through its funded research remains unknown. Objective To examine the NIH's research funding patterns on refugee health research over the last 2 decades. Design, Setting, and Participants Secondary analysis of NIH-funded grants between 2000 and 2020 using a cross-sectional study design. The NIH Research Portfolio Online Reporting Tools database was used to find relevant grants. Data were analyzed from November 2021 to September 2022. Main Outcomes and Measures NIH grants awarded by year, state, grant type, research area, funding institute, grant duration, and amount funded. Results Of 1.7 million NIH grants funded over the 20-year study period, only 78 addressed refugee health. Funded grants were mostly training grants (23 grants [29%]), followed by hypothesis-driven research (R01 grants; 22 grants [28%]), pilot or preliminary investigation proposals (13 grants [17%]), and other types of grants (20 grants [26%]). The most studied research domain was mental health (36 grants [46%]), followed by refugee family dynamics and women's and children's health (14 grants [18%]). A total of 26 grants (33%) were funded by the National Institute of Mental Health and 15 (19%) were funded by the National Institute of Child Health and Human Development. Most grants were US-based (60 grants [76%]) and the state of Massachusetts received the greatest amount of funding ($14 825 852 [18%]). In 2020, the NIH allocated about $2.3 million to refugee health research, or less than 0.01% of its $42 billion budget that year. The number of grants funded in each time period did not always reflect changes in the number of refugees resettled in the US over the years. Conclusions and Relevance This cross-sectional study found that there remain significant gaps in the understanding of and interventions in the health research needs of refugees locally and along the migratory route. To close these gaps, the NIH should increase its investments in comprehensive studies assessing the physical, mental, and social well-being of this expanding population. This can be achieved by ensuring that all NIH institutes allocate budgets specifically for refugee health research and extend support for the training of refugee researchers.
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Affiliation(s)
- Mehak Kaur
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Lana Bridi
- School of Medicine, University of California, San Diego, La Jolla
| | - Dahlia Kaki
- School of Medicine, University of California, San Francisco
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, La Jolla
| | - Altaf Saadi
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Gretchen Bandoli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Cheryl A.M. Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | | | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
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Sideman AB, Ma M, Hernandez de Jesus A, Alagappan C, Razon N, Dohan D, Chodos A, Al-Rousan T, Alving LI, Segal-Gidan F, Rosen H, Rankin KP, Possin KL, Borson S. Primary Care Pracitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care. JAMA Netw Open 2023; 6:e2336030. [PMID: 37768660 PMCID: PMC10539983 DOI: 10.1001/jamanetworkopen.2023.36030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Although the barriers to dementia care in primary care are well characterized, primary care practitioner (PCP) perspectives could be used to support the design of values-aligned dementia care pathways that strengthen the role of primary care. Objective To describe PCP perspectives on their role in dementia diagnosis and care. Design, Setting, and Participation In this qualitative study, interviews were conducted with 39 PCPs (medical doctors, nurse practitioners, and doctors of osteopathic medicine) in California between March 2020 and November 2022. Results were analyzed using thematic analysis. Main Outcomes and Measures Overarching themes associated with PCP roles in dementia care. Results Interviews were conducted with 39 PCPs (25 [64.1%] were female; 16 [41%] were Asian). The majority (36 PCPs [92.3%]) reported that more than half of their patients were insured via MediCal, the California Medicaid program serving low-income individuals. Six themes were identified that convey PCPs' perspectives on their role in dementia care. These themes focused on (1) their role as first point of contact and in the diagnostic workup; (2) the importance of long-term, trusting relationships with patients; (3) the value of understanding patients' life contexts; (4) their work to involve and educate families; (5) their activities around coordinating dementia care; and (6) how the care they want to provide may be limited by systems-level constraints. Conclusions and Relevance In this qualitative study of PCP perspectives on their role in dementia care, there was alignment between PCP perspectives about the core values of primary care and their work diagnosing and providing care for people living with dementia. The study also identified a mismatch between these values and the health systems infrastructure for dementia care in their practice environment.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Humanities and Social Sciences, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco
| | - Melissa Ma
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | | | - Cecilia Alagappan
- Global Brain Health Institute, University of California, San Francisco
| | - Na'amah Razon
- Department of Family and Community Medicine, University of California, Davis, Sacramento
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Anna Chodos
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Loren I Alving
- California Alzheimer's Disease Center, University of California, San Francisco at Fresno
| | - Freddi Segal-Gidan
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Howie Rosen
- Department of Neurology, University of California, San Francisco
| | | | | | - Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles
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Antoniou R, Hausermann T, Sideman AB, Fong KC, Callahan P, Miller BL, Kramer JH, Chiong W, Rankin KP. Moral reasoning through the eyes of persons with behavioral variant frontotemporal dementia. Front Neurol 2023; 14:1197213. [PMID: 37492849 PMCID: PMC10365271 DOI: 10.3389/fneur.2023.1197213] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Persons with behavioral variant frontotemporal dementia (bvFTD) can exhibit apparently antisocial behaviors. An example is their tendency to adopt utilitarian choices in sacrificial moral dilemmas, i.e. harmful actions to promote overall welfare. Moral cognition models interpret such tendencies as deriving from a lack of emotional engagement and selective impairment in prosocial sentiments. Methods We applied a qualitative approach to test those theoretical assumptions and to further explore the emotional experiences and values of people with bvFTD while they contemplate moral scenarios. We conducted semistructured interviews with 14 participants: 7 persons with bvFTD and 7 older healthy controls. Transcripts were coded using ATLAS.ti 5.0. Results During the moral reasoning task, persons with bvFTD reported more positive emotions than negative and showed significantly less cognitive precision in their moral reasoning compared to controls. Persons with bvFTD also organized their choices predominantly around kindness and altruism, and their responses reflected higher rule compliance. Our study showed that bvFTD persons' utilitarian responses to moral dilemmas did not arise from an emotionally disengaged or antisocial perspective. Instead, they were underpinned by positive emotionality and prosocial values. Discussion These findings enrich current understandings of moral cognition and highlight the importance of incorporating mixed methods approaches in dementia research that take into consideration the viewpoint of cognitively impaired individuals.
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Affiliation(s)
- Rea Antoniou
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Tobias Hausermann
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Alissa Bernstein Sideman
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
| | - Kristina Celeste Fong
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Patrick Callahan
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
| | - Joel H. Kramer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Katherine P. Rankin
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
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Sideman AB, Merrilees J, Dulaney S, Kiekhofer R, Braley T, Lee K, Chiong W, Miller B, Bonasera SJ, Possin KL. "Out of the clear blue sky she tells me she loves me": Connection experiences between caregivers and people with dementia. J Am Geriatr Soc 2023; 71:2172-2183. [PMID: 36917135 PMCID: PMC10500033 DOI: 10.1111/jgs.18297] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Dementia can impede the relationship and connection between the person with dementia (PWD) and their caregiver. Yet, caregiving in dementia also offers opportunities for connection, which has implications for caregiver and PWD well-being. In this qualitative study, we describe and characterize ways caregivers felt connected to the person with dementia they care for. METHODS We conducted a telephone-based survey with caregivers of people with dementia. For this paper, we analyzed responses to an open-ended question focused on when caregivers feel most connected to the person they are caring for. Responses were analyzed and coded and themes were identified through an iterative process involving a multidisciplinary team of researchers and clinicians. RESULTS 437 caregivers participated in this study. We identified two domains of connection: activity-based and emotion-based connections. Within activity-based connections, the following themes emerged: everyday activities; reminiscing; activities of caregiving; novel experiences; and time with family and friends. Within emotional connections, the following themes emerged: expressions of love, appreciation, and gratitude; physical affection; sharing an emotion or emotional experience; and times when the PWD seems like "themself" again. CONCLUSIONS Findings provide insights into ways caregivers experience a sense of connection with the person they care for. There is a call to shift away from focusing on reducing stress and toward optimizing positive experiences as a way to better support caregivers' health and well-being. Interventions that leverage these insights to foster caregiver - PWD connection could lead to better health and well-being for both members of the dyad. The amplification of a positive experience may be particularly important for caregivers who are struggling with limited support or respite. Clinicians may be interested in using a question about connection as a way to more fully understand a caregiver's current experience.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Sarah Dulaney
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Rachel Kiekhofer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Tamara Braley
- Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kirby Lee
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Bruce Miller
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Stephen J. Bonasera
- Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Medicine, Division of Geriatrics and Palliative Care, Baystate Health, Springfield, Massachusetts, USA
| | - Katherine L. Possin
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
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Shin SY, Goode CA, Bui NM, Premkumar M, Hill-Sakurai LE, Bernstein Sideman A, Kiekhofer RE, Chodos AH, Dulaney S, Wynn MJ, Barreto Chang OL, Possin KL. Addressing gaps in primary care diagnosis of cognitive impairment via a telephone-based nurse consultation. J Am Geriatr Soc 2023; 71:2002-2005. [PMID: 36705443 PMCID: PMC10258125 DOI: 10.1111/jgs.18258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023]
Affiliation(s)
- So Young Shin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
- College of Nursing, Inje University, Busan, Korea
| | - Collette A. Goode
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Nhat M. Bui
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Mukund Premkumar
- Family Medicine Center at Lakeshore, Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Laura E. Hill-Sakurai
- Family Medicine Center at Lakeshore, Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Rachel E. Kiekhofer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Anna H. Chodos
- Division of Geriatrics, University of California, San Francisco, USA
| | - Sarah Dulaney
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew J. Wynn
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Odmara L. Barreto Chang
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine L. Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Light SW, Dohan D, Possin KL, Wolf MS, Rankin KP, Lanata S, Sideman AB. Perceptions of and Knowledge Acquisition about Brain Health and Aging among Latin American Immigrants:A QualitativePaper. Clin Gerontol 2023; 46:180-194. [PMID: 35713396 PMCID: PMC9758275 DOI: 10.1080/07317115.2022.2088324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Older immigrants of Latin American descent are disproportionately impacted by dementia, yet little is known about their dementia- and brain health-related knowledge. We explored perspectives on brain health and aging in this population to inform the development of culturally-relevant interventions. METHODS Individual, semi-structured interviews were conducted with 30 Spanish-speaking immigrants over 60. Questions addressed knowledge about the brain, perceptions of healthy and unhealthy aging, ideas of how to take care of one's brain, and where knowledge was acquired. Responses were analyzed using thematic analysis. RESULTS The following themes emerged: (1) Descriptions of the brain varied, from anatomy, cognition, and psychology to disease. (2) Perceptions of healthy aging included independence, memory, emotions, and orientation. (3) Ideas of how to care for the brain included physical, social, and cognitive engagement. (4) Knowledge was acquired in childhood, communities, healthcare settings, careers, and media. CONCLUSIONS Results showed significant variability in knowledge. Findings may be leveraged to improve interventions that address brain health literacy disparities among older Latin American immigrants. CLINICAL IMPLICATIONS Takeaways involve increasing education about the structure and functions of the brain, promoting realistic understandings of what nonnormative brain aging entails, and increasing knowledge of empirically-supported maintenance approaches. Dissemination may be increased via healthcare providers, community centers, churches, and media.
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Affiliation(s)
- Sophia W. Light
- Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Katherine L. Possin
- Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin
| | - Michael S. Wolf
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katherine P. Rankin
- Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco
| | - Serggio Lanata
- Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin
- Department of Humanities and Social Sciences, University of California, San Francisco
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Al-Rousan T, Kamalyan L, Bernstein Sideman A, Miller B, AlHeresh R, Moore A, Marquine MJ, Argeros G, Ajrouch KJ. Migration and Cognitive Health Disparities: The Arab American and Refugee Case. J Gerontol B Psychol Sci Soc Sci 2023; 78:111-123. [PMID: 36056890 PMCID: PMC9890904 DOI: 10.1093/geronb/gbac129] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES This study investigates whether the year of arrival to the United States (U.S.) and birthplace relate to postmigration cognitive difficulties among foreign- and U.S.-born Arab Americans in later life. METHODS We analyzed 19 years (2000-2019) of data from the American Community Survey Public Use Microdata Samples (weighted N = 393,501; ages ≥ 50 years). Cognitive difficulty was based on self-reported data, and weighted means, percentages, adjusted prevalence estimates, and adjusted odds ratio were calculated. RESULTS Controlling only for demographics, foreign-born Arabs reported higher odds of cognitive difficulty compared to U.S.-born Arabs across all arrival cohorts (p < .001). After accounting for economic and integration factors, those who arrived between 1991 and 2000 had higher odds (odds ratio [OR] = 1.06, 95% confidence interval [CI] =1.00, 1.19, p < .01), while those who arrived after 2001 had lower odds (OR = 0.87, 95% CI = 0.78, 0.97, p < .001) of cognitive difficulty. Lacking English proficiency (OR = 1.90, 95% CI = 1.82, 1.98, p < .001) was related to higher odds, whereas not being a U.S. citizen was significantly associated with lower odds (OR = 0.89, 95% CI = 0.52, 0.94, p < .001) of cognitive difficulty. Yet, results varied by birthplace. Migrants born in Iraq consistently reported the highest odds of cognitive difficulty across all arrival cohorts. DISCUSSION Migration history and birthplace may be important factors explaining cognitive disparities among the diverse group of Arab migrants and Arab Americans. Future research examining mechanisms underlying these associations and the impact of migration on cognitive health is needed to address cognitive disparities in migrants.
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Affiliation(s)
- Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Global Brain Health Institute, University of California, San Francisco, California, USA
| | - Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, California, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Bruce Miller
- Global Brain Health Institute, University of California, San Francisco, California, USA
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Rawan AlHeresh
- Mass General Health Institute of Health Professions, Boston, Massachusetts, USA
| | - Alison Moore
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California, San Diego, California, USA
| | - María J Marquine
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California, San Diego, California, USA
| | - Grigoris Argeros
- Department of Sociology, Anthropology, and Criminology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Kristine J Ajrouch
- Department of Sociology, Anthropology, and Criminology, Eastern Michigan University, Ypsilanti, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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11
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Haeusermann T, Lechner CR, Fong KC, Sideman AB, Jaworska A, Chiong W, Dohan D. Closed-Loop Neuromodulation and Self-Perception in Clinical Treatment of Refractory Epilepsy. AJOB Neurosci 2023; 14:32-44. [PMID: 34473932 PMCID: PMC9007331 DOI: 10.1080/21507740.2021.1958100] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Newer "closed-loop" neurostimulation devices in development could, in theory, induce changes to patients' personalities and self-perceptions. Empirically, however, only limited data of patient and family experiences exist. Responsive neurostimulation (RNS) as a treatment for refractory epilepsy is the first approved and commercially available closed-loop brain stimulation system in clinical practice, presenting an opportunity to observe how conceptual neuroethical concerns manifest in clinical treatment.Methods: We conducted ethnographic research at a single academic medical center with an active RNS treatment program and collected data via direct observation of clinic visits and in-depth interviews with 12 patients and their caregivers. We used deductive and inductive analyses to identify the relationship between these devices and patient changes in personality and self-perception.Results: Participants generally did not attribute changes in patients' personalities or self-perception to implantation of or stimulation using RNS. They did report that RNS affected patients' experiences and conceptions of illness. In particular, the capacity to store and display electrophysiological data produced a common frame of reference and a shared vocabulary among patients and clinicians.Discussion: Empirical experiences of a clinical population being treated with closed-loop neuromodulation do not corroborate theoretical concerns about RNS devices described by neuroethicists and technology developers. However, closed-loop devices demonstrated an ability to change illness experiences. Even without altering identify and self-perception, they provided new cultural tools and metaphors for conceiving of epilepsy as an illness and of the process of diagnosis and treatment. These findings call attention to the need to situate neuroethical concerns in the broader contexts of patients' illness experiences and social circumstances.
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12
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Antoniou R, Toli DG, Lerner H, Callahan P, Coble R, Ortiz B, Sideman AB, Shdo SM, Levenson RW, Ferreira N, Moskowitz JT, Rankin KP. A mindfulness-based intervention adapted to dementia caregivers: A study protocol for a randomized clinical control trial. Front Psychol 2022; 13:1062452. [PMID: 36605275 PMCID: PMC9808397 DOI: 10.3389/fpsyg.2022.1062452] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Dementia caregiving, besides encompassing various challenges in tandem to the diagnosis of the care recipient, is associated with decreased psychological well-being and mental health. Accordingly, caregivers' wellbeing has an impact on the quality of care they provide and on the relationship quality with the person in their care. The aim of the present study is to examine the effectiveness of a mindfulness-based intervention on relational and psychological wellbeing, tailored to the needs of dementia caregivers. This clinical trial (NCT04977245) will apply a randomized controlled mixed method design. Caregivers will be randomly allocated to either the mindfulness intervention or the active control group. The intervention arm is based on experiential learning and is targeted to promote caregivers' well-being and empowerment. Assessments will include, standardized self-report questionnaires, task performance measures, and qualitative measures. All assessments will be held at three time points (baseline; t0, 0 months, post-intervention; t1, 2 months, and after maintenance; t2, 3 months) focused on three core domains (1. relational well-being, 2. psychological well-being, and 3. dementia patient's lifestyle/activities). The primary outcome will be relational well-being, and data will be analyzed using linear mixed modelling.
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Affiliation(s)
- Rea Antoniou
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States,*Correspondence: Rea Antoniou,
| | - Despoina Georgakopoulou Toli
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Hannah Lerner
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Patrick Callahan
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Roger Coble
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Bailey Ortiz
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Alissa Bernstein Sideman
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States,Department of Humanities & Social Sciences, University of California San Francisco, San Francisco, CA, United States,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
| | - Suzanne M. Shdo
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States,Department of Psychology, University of California Berkeley, Berkeley, CA, United States
| | - Robert W. Levenson
- Department of Psychology, University of California Berkeley, Berkeley, CA, United States
| | - Nuno Ferreira
- Department of Social Sciences, School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
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13
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Al‐Rousan T, Awad M, Sideman AB, Moore AA. A qualitative study of older refugees’ perception and attitudes towards dementia and dementia risk reduction during the COVID‐19 pandemic. Alzheimers Dement 2022. [DOI: 10.1002/alz.066710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Mina Awad
- University of Califronia san diego La Jolla CA USA
| | - Alissa Bernstein Sideman
- Global Brain Health Institute San Francisco CA USA
- University of California San Francisco San Francisco CA USA
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14
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Possin KL, Sideman AB, Dulaney S, Lee K, Merrilees J, Bonasera S, Chiong W, Hooper SM, Kiekhofer R, Robinson‐Teran J, Allen IE, Braley T, Guterman E, Rosa TD, Harrison KL, Hunt L, Kahn JG, Lanata S, Miller BL, LaRoche A, Sawyer RJ, Brungardt A, Lum H, Hess M, Ward K, Kuebrich MB, Hodges M, Olney N, Barclay M, Rosenbloom MH. The Care Ecosystem: The Effectiveness and Implementation of Telephone‐Based Collaborative Dementia Care. Alzheimers Dement 2022; 18 Suppl 9:e063938. [DOI: 10.1002/alz.063938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Sarah Dulaney
- University of California San Francisco San Francisco CA USA
| | - Kirby Lee
- University of California San Francisco San Francisco CA USA
| | | | | | - Winston Chiong
- University of California San Francisco San Francisco CA USA
| | - Sarah M Hooper
- University of California Hastings College of the Law San Francisco CA USA
| | | | | | - Isabel Elaine Allen
- University of California San Francisco San Francisco CA USA
- Global Brain Health Institute San Francisco CA USA
| | | | - Elan Guterman
- University of California San Francisco San Francisco CA USA
| | - Talita D Rosa
- University of California San Francisco San Francisco CA USA
| | | | - Lauren Hunt
- University of California San Francisco San Francisco CA USA
| | - James G Kahn
- University of California San Francisco San Francisco CA USA
| | - Serggio Lanata
- Global Brain Health Institute San Francisco CA USA
- University of California San Francisco, Memory and Aging Center San Francisco CA USA
| | | | | | | | | | - Hillary Lum
- University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Mailee Hess
- Los Angeles County Department of Health Services Los Angeles CA USA
| | - Katie Ward
- Los Angeles County Department of Health Services Los Angeles CA USA
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15
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Razon N, Sideman AB. The work of reform: a critical examination of health policy. Anthropol Med 2022; 29:414-429. [PMID: 36621780 PMCID: PMC10075328 DOI: 10.1080/13648470.2022.2144805] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Anthropologists have critically examined a range of reforms from education and land to finance and health. Yet the predominant way of looking at reforms has been through a lens focused on neoliberal governance. For example, prior studies of health reforms focus on insurance, financing, and access to care. Yet, seeing reform in this way fails to attend to other types of cultural work at play when calling a policy or law a reform. In this paper, we draw on ethnographic research on health policy reforms in Israel and Bolivia to examine the concept of reform and the work it does within national movements. We argue that while the language of reform often signals change or novelty, reforms also carry forward historical continuities and reifications of the past. By delving into the past and its relationship with ongoing health reforms, we attend to how reforms can reinforce and maintain health inequities in some cases, while creating a national language for new possibilities in others. Reform, as we will discuss in this paper, is not only about political ideology, neoliberal governance, or on-the-ground policy implementation, but centrally it is about representations of aspirations, and about crafting relationships between past, present, and future.
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Affiliation(s)
- Na'amah Razon
- Family and Community Medicine, University of California Davis, Sacramento, CA, United States
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
- ; Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
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16
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Sideman AB, Gilissen J, Harrison KL, Garrett SB, Terranova MJ, Ritchie CS, Geschwind MD. Caregiver Experiences Navigating the Diagnostic Journey in a Rapidly Progressing Dementia. J Geriatr Psychiatry Neurol 2022:8919887221135552. [PMID: 36412170 DOI: 10.1177/08919887221135552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION People with suspected Alzheimer's disease and related dementias (ADRD) and their families experience a burdensome process while seeking a diagnosis. These challenges are problematic in the most common dementia syndromes, but they can be even more distressing in rarer, atypical syndromes such as rapidly progressive dementias (RPDs), which can be fatal within months from onset. This study is an examination of the diagnostic journey experience from the perspective of caregivers of people who died from the prototypic RPD, sporadic Creutzfeldt-Jakob Disease (sCJD). METHODS eIn this mixed-methods study, qualitative data were drawn from interviews with former caregivers of 12 people who died from sCJD. Chart review data were drawn from research and clinical chart data about the person with sCJD. Data were analyzed by a multidisciplinary research team using qualitative and descriptive statistical analysis. RESULTS We identified 4 overarching themes that characterized the experience of the diagnostic journey in sCJD: clinician knowledge, clinician communication, experiences of uncertainty, and the caregiver as advocate. We also identified 4 phases along the diagnostic journey: recognition, the diagnostic workup, diagnosis, and post-diagnosis. Sub-themes within each phase include struggles to recognize what is wrong, complex processes of testing and referrals, delay and disclosure of diagnosis, and access to resources post-diagnosis. CONCLUSIONS Findings suggest that more work is needed to improve clinician diagnostic knowledge and communication practices. Furthermore, caregivers need better support during the diagnostic journey. What we learn from studying sCJD and other RPDs is likely applicable to other more common dementias.
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Affiliation(s)
- Alissa Bernstein Sideman
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, CA, USA.,Department of Humanities and Social Sciences, 8785University of California San Francisco, San Francisco, CA, USA.,Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
| | - Joni Gilissen
- Global Brain Health Institute, University of California, San Francisco, CA, USA.,Department Family Medicine & Chronic Care, 70493Vrije Universiteit Brussel(VUB), Belgium
| | - Krista L Harrison
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, CA, USA.,Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Sarah B Garrett
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Michael J Terranova
- Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
| | - Christine S Ritchie
- Global Brain Health Institute, University of California, San Francisco, CA, USA.,The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Michael D Geschwind
- Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
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17
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Harrison KL, Garrett SB, Halim M, Sideman AB, Allison TA, Dohan D, Naasan G, Miller BL, Smith AK, Ritchie CS. “I Didn’t Sign Up for This”: Perspectives from Persons Living with Dementia and Care Partners on Challenges, Supports, and Opportunities to Add Geriatric Neuropalliative Care to Dementia Specialty Care. J Alzheimers Dis 2022; 90:1301-1320. [DOI: 10.3233/jad-220536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In the United States, dementia specialty centers affiliated with centers of excellence for research hold promise as locations to develop innovative, holistic care in care systems otherwise siloed by discipline or payer. Objective: We conducted foundational research to inform development of patient-and family-centered palliative care interventions for dementia specialty centers. Methods: We interviewed persons living with dementia (PLWD), current, and former care partners (CP) recruited from a specialty dementia clinic and purposively selected for variation across disease syndrome and stage. A framework method of thematic analysis included coding, analytic matrices, and pattern mapping. Results: 40 participants included 9 PLWD, 16 current CPs, and 15 former CPs of decedents; 48% impacted by Alzheimer’s disease dementia. While help from family, support groups and adult day centers, paid caregiving, and sensitive clinical care were invaluable to PLWD, CPs, or both, these supports were insufficient to navigate the extensive challenges. Disease-oriented sources of distress included symptoms, functional impairment and falls, uncertainty and loss, and inaccessible care. Social and relational challenges included constrained personal and professional opportunities. The obligation and toll of giving or receiving caregiving were challenging. Clinical care challenges for PLWD and/or CPs included care fragmentation, insufficient guidance to inform planning and need for expert interdisciplinary clinical care at home. Conclusion: Findings highlight the breadth and gravity of gaps, which surpass the disciplinary focus of either behavioral neurology or palliative care alone. Results can inform the development of novel interventions to add principles of geriatrics and neuropalliative care to dementia care.
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Affiliation(s)
- Krista L. Harrison
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Madina Halim
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Theresa A. Allison
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Georges Naasan
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Mount Sinai Hospitals, Icahn School of Medicine, New York, NY, USA
| | - Bruce L. Miller
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Alexander K. Smith
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Christine S. Ritchie
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
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18
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Bernstein Sideman A, Wells JL, Merrilees J, Shdo SM, Yee CI, Possin KL, Levenson RW. Pronoun Use among Caregivers of People Living with Dementia: Associations with Dementia Severity Using Text Analysis of a Natural Language Sample. Dement Geriatr Cogn Dis Extra 2022; 12:60-68. [PMID: 35702160 PMCID: PMC9149456 DOI: 10.1159/000522122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Family caregivers of persons living with dementia (PLWDs) have extensive social, physical, emotional, and financial responsibilities. However, less is known about the relationship and interpersonal connection between caregivers and PLWDs. We examined caregiver pronoun use, as an index of the connection between the caregiver and PLWD and its associations with the caregiver's and PLWD's health and well-being. Methods Caregivers of PLWDs (N = 320) were asked to describe a recent time they felt connected to the PLWD in their care. Responses were transcribed and coded to quantify pronoun use by category (we-pronouns, I-pronouns, and they-pronouns). Caregivers also reported on their depression, burden, and the PLWD's dementia severity and marital satisfaction. Sixty-eight caregivers repeated the same survey 24 months after the initial survey. Results Caregivers used less we-pronouns when the PLWD's dementia was more severe, at both timepoints. Spousal caregivers used more we-pronouns and less I- and they-pronouns than nonspousal caregivers. There was an interaction between spousal relationship and dementia severity, such that spousal caregivers exhibited a stronger negative association between dementia severity and we-pronoun use. There were no associations between pronoun category and caregiver burden or depression. Discussion Caregivers may feel increasingly disconnected from the PLWD as their dementia becomes more severe, as reflected by less we-pronoun usage. This study highlights the opportunity to explore relationship connection through text analysis.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Department of Humanities & Social Sciences, University of California, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, California, USA
| | - Jenna L. Wells
- Department of Psychology, University of California, Berkeley, California, USA
| | - Jennifer Merrilees
- Department of Neurology, University of California, San Francisco, California, USA
| | - Suzanne M. Shdo
- Department of Psychology, University of California, Berkeley, California, USA
| | - Claire I. Yee
- Department of Psychology, University of California, Berkeley, California, USA
| | - Katherine L. Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, California, USA
| | - Robert W. Levenson
- Department of Psychology, University of California, Berkeley, California, USA
- *Robert W. Levenson,
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19
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Bernstein Sideman A, Al-Rousan T, Tsoy E, Piña Escudero SD, Pintado-Caipa M, Kanjanapong S, Mbakile-Mahlanza L, Okada de Oliveira M, De la Cruz-Puebla M, Zygouris S, Ashour Mohamed A, Ibrahim H, Goode CA, Miller BL, Valcour V, Possin KL. Facilitators and Barriers to Dementia Assessment and Diagnosis: Perspectives From Dementia Experts Within a Global Health Context. Front Neurol 2022; 13:769360. [PMID: 35418934 PMCID: PMC8997042 DOI: 10.3389/fneur.2022.769360] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 09/01/2021] [Accepted: 01/25/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives Dementia poses one of the greatest global health challenges, affecting 50 million people worldwide. With 10 million new cases each year, dementia is a growing burden, particularly in low- and middle-income countries (LMIC). This study aimed to identify the facilitators and barriers to providing quality dementia assessment and care in LMICs from a global health perspective. Methods/Design A qualitative semi-structured interview study with 20 dementia expert healthcare providers from 19 countries. To be included, providers had to: practice dementia assessment or care in LMICs where the population over age 60 is projected to more than double by 2050 and be recognized as a leading dementia expert in the region based on position, research publications, and/or policy leadership. Interviews were analyzed by a multidisciplinary team of researchers using thematic analysis. Results Barriers to dementia assessment and care included stigma about dementia, poor patient engagement in and access to healthcare, inadequate linguistic and cultural validation, limited dementia capable workforce, competing healthcare system priorities, and insufficient health financing. Facilitators included the rise in dementia awareness campaigns, dementia training for general practitioners, availability of family support and family caregivers, and national and international collaborations including coordinated policy efforts and involvement in international research initiatives. Conclusions Findings from this study provide insights for prioritizing dementia assessment and care capacity-building in LMICs as a global health priority and for tailored public health approaches to strengthen dementia assessment and care at the individual, community, national, and multi-national levels.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Tala Al-Rousan
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Herbert Wertheim School of Public Health, University of California, La Jolla, CA, United States
| | - Elena Tsoy
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Stefanie D Piña Escudero
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Maritza Pintado-Caipa
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Research Department, Peruvian Institute of Neurosciences, Lima, Peru
| | - Suchanan Kanjanapong
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Division of Geriatrics, Department of Preventive Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lingani Mbakile-Mahlanza
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychology, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Maira Okada de Oliveira
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Cognitive and Behavioral Neurology Unit, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil.,Hospital Santa Marcelina, São Paulo, São Paulo, Brazil
| | - Myriam De la Cruz-Puebla
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Neurosciences Institute, Autonomous University of Barcelona, Barcelona, Spain.,Cognition and Brain Plasticity Unit, University of Barcelona, Barcelona, Spain.,Bellvitge Institute for Biomedical Research, Barcelona, Spain.,Technical University of Ambato, Tungurahua, Ecuador
| | - Stelios Zygouris
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Centre for Research and Technology Hellas/Information Technologies Institute, Thessaloniki, Greece
| | - Aya Ashour Mohamed
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, Ain Shams University, Cairo, Egypt
| | - Hany Ibrahim
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Geriatric Medicine Department, Ain Shams University, Cairo, Egypt
| | - Collette A Goode
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce L Miller
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Victor Valcour
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine L Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
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20
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Harrison KL, Garrett SB, Gilissen J, Terranova MJ, Bernstein Sideman A, Ritchie CS, Geschwind MD. Developing neuropalliative care for sporadic Creutzfeldt-Jakob Disease. Prion 2022; 16:23-39. [PMID: 35239456 PMCID: PMC8896185 DOI: 10.1080/19336896.2022.2043077] [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: 11/24/2022] Open
Abstract
We aimed to identify targets for neuropalliative care interventions in sporadic Creutzfeldt-Jakob disease by examining characteristics of patients and sources of distress and support among former caregivers. We identified caregivers of decedents with sporadic Creutzfeldt-Jakob disease from the University of California San Francisco Rapidly Progressive Dementia research database. We purposively recruited 12 caregivers for in-depth interviews and extracted associated patient data. We analysed interviews using the constant comparison method and chart data using descriptive statistics. Patients had a median age of 70 (range: 60–86) years and disease duration of 14.5 months (range 4–41 months). Caregivers were interviewed a median of 22 (range 11–39) months after patient death and had a median age of 59 (range 45–73) years. Three major sources of distress included (1) the unique nature of sporadic Creutzfeldt-Jakob disease; (2) clinical care issues such as difficult diagnostic process, lack of expertise in sporadic Creutzfeldt-Jakob disease, gaps in clinical systems, and difficulties with end-of-life care; and (3) caregiving issues, including escalating responsibilities, intensifying stress, declining caregiver well-being, and care needs surpassing resources. Two sources of support were (1) clinical care, including guidance from providers about what to expect and supportive relationships; and (2) caregiving supports, including connection to persons with experience managing Creutzfeldt-Jakob disease, instrumental support, and social/emotional support. The challenges and supports described by caregivers align with neuropalliative approaches and can be used to develop interventions to address needs of persons with sporadic Creutzfeldt-Jakob disease and their caregivers.
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Affiliation(s)
- Krista L Harrison
- Division of Geriatrics, University of California, San Francisco, USA.,Philip R. University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA
| | | | - Joni Gilissen
- Global Brain Health Institute, University of California, San Francisco, California, USA.,End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (Vub), Belgium
| | - Michael J Terranova
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA.,Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA
| | - Christine S Ritchie
- Division of Geriatrics, University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA.,The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA
| | - Michael D Geschwind
- Global Brain Health Institute, University of California, San Francisco, California, USA.,Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
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21
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Shafir A, Ritchie CS, Garrett SB, Bernstein Sideman A, Naasan G, Merrilees J, Widera E, Flint L, Harrison KL. "Captive by the Uncertainty"-Experiences with Anticipatory Guidance for People Living with Dementia and Their Caregivers at a Specialty Dementia Clinic. J Alzheimers Dis 2022; 86:787-800. [PMID: 35124641 DOI: 10.3233/jad-215203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND After a diagnosis of Alzheimer's disease and related disorders, people living with dementia (PWD) and caregivers wonder what disease trajectory to expect and how to plan for functional and cognitive decline. This qualitative study aimed to identify patient and caregiver experiences receiving anticipatory guidance about dementia from a specialty dementia clinic. OBJECTIVE To examine PWD and caregiver perspectives on receiving anticipatory guidance from a specialty dementia clinic. METHODS We conducted semi-structured interviews with PWD, and active and bereaved family caregivers, recruited from a specialty dementia clinic. Interviews were recorded, transcribed, and systematically summarized. Thematic analysis identified anticipatory guidance received from clinical or non-clinical sources and areas where respondents wanted additional guidance. RESULTS Of 40 participants, 9 were PWD, 16 were active caregivers, and 15 were bereaved caregivers. PWD had a mean age of 75 and were primarily male (n = 6/9); caregivers had a mean age of 67 and were primarily female (n = 21/31). Participants felt they received incomplete or "hesitant" guidance on prognosis and expected disease course via their clinicians and filled the gap with information they found via the internet, books, and support groups. They appreciated guidance on behavioral, safety, and communication issues from clinicians, but found more timely and advance guidance from other non-clinical sources. Guidance on legal and financial planning was primarily identified through non-clinical sources. CONCLUSION PWD and caregivers want more information about expected disease course, prognosis, and help planning after diagnosis. Clinicians have an opportunity to improve anticipatory guidance communication and subsequent care provision.
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Affiliation(s)
- Adi Shafir
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Veterans Affairs Medical Center, San Francisco, CA, USA.,Division of General Internal Medicine and Geriatrics, Oregon Health and Sciences University, Portland, OR, USA
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Palliative Care and Geriatric Medicine and the Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah B Garrett
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,UCSF Department of Humanities & Social Sciences, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Georges Naasan
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Mount Sinai, Icahn School of Medicine, New York, NY, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Merrilees
- UCSF Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Lynn Flint
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
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22
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Sideman AB, Chalmer R, Ayers E, Gershon R, Verghese J, Wolf M, Ansari A, Arvanitis M, Bui N, Chen P, Chodos A, Corriveau R, Curtis L, Ehrlich AR, Farias SET, Goode C, Hill-Sakurai L, Nowinski CJ, Premkumar M, Rankin KP, Ritchie CS, Tsoy E, Weiss E, Possin KL. Lessons from Detecting Cognitive Impairment Including Dementia (DetectCID) in Primary Care. J Alzheimers Dis 2022; 86:655-665. [PMID: 35124639 PMCID: PMC9048609 DOI: 10.3233/jad-215106] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Cognitive impairment, including dementia, is frequently under-detected in primary care. The Consortium for Detecting Cognitive Impairment, including Dementia (DetectCID) convenes three multidisciplinary teams that are testing novel paradigms to improve the frequency and quality of patient evaluations for detecting cognitive impairment in primary care and appropriate follow-up. Objective: Our objective was to characterize the three paradigms, including similarities and differences, and to identify common key lessons from implementation. Methods: A qualitative evaluation study with dementia specialists who were implementing the detection paradigms. Data was analyzed using content analysis. Results: We identified core components of each paradigm. Key lessons emphasized the importance of engaging primary care teams, enabling primary care providers to diagnose cognitive disorders and provide ongoing care support, integrating with the electronic health record, and ensuring that paradigms address the needs of diverse populations. Conclusion: Approaches are needed that address the arc of care from identifying a concern to post-diagnostic management, are efficient and adaptable to primary care workflows, and address a diverse aging population. Our work highlights approaches to partnering with primary care that could be useful across specialties and paves the way for developing future paradigms that improve differential diagnosis of symptomatic cognitive impairment, identifying not only its presence but also its specific syndrome or etiology.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Humanities & Social Sciences, University of California, San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA and Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Rachel Chalmer
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard Gershon
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joe Verghese
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Asif Ansari
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marina Arvanitis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nhat Bui
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pei Chen
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anna Chodos
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Roderick Corriveau
- National Institute of Neurological Disorders & Stroke, National Institute of Health, Bethesda, MA, USA
| | - Laura Curtis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amy R. Ehrlich
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Collette Goode
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Hill-Sakurai
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Cindy J. Nowinski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mukund Premkumar
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine P. Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elena Tsoy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Erica Weiss
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katherine L. Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA and Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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23
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Manivannan M, Heunis J, Hooper SM, Bernstein Sideman A, Lui KP, Braley TL, Possin KL, Chiong W. Use of Telephone- and Internet-Based Support to Elicit and Address Financial Abuse and Mismanagement in Dementia: Experiences from the Care Ecosystem Study. J Alzheimers Dis 2022; 86:219-229. [PMID: 35034900 PMCID: PMC10938943 DOI: 10.3233/jad-215284] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Financial mismanagement and abuse in dementia have serious consequences for patients and their families. Vulnerability to these outcomes reflects both patient and contextual factors. OBJECTIVE Our study aimed to assess how multidisciplinary care coordination programs assist families in addressing psychosocial vulnerabilities and accessing needed resources. METHODS Our study was embedded in a clinical trial of the Care Ecosystem, a telephone- and internet-based supportive care intervention for patients with dementia and caregivers. This program is built around the role of the Care Team Navigator (CTN), an unlicensed dementia care guide who serves as the patient and caregiver's primary point of contact, screening for common problems and providing support. We conducted a qualitative analysis of case summaries from a subset of 19 patient/caregiver dyads identified as having increased risk for financial mismanagement and abuse, to examine how Care Ecosystem staff identified vulnerabilities and provided support to patients and families. RESULTS CTNs elicited patient and caregiver needs using templated conversations to address common financial and legal planning issues in dementia. Sources of financial vulnerability included changes in patients' behavior, caregiver burden, intrafamily tension, and confusion about resources to facilitate end-of-life planning. The Care Ecosystem staff's rapport with their dyads helped them address these issues by providing emotional support, information on how to access financial, medical, and legal resources, and improving intra-familial communication. CONCLUSION The Care Ecosystem offers a scalable way to address vulnerabilities to financial mismanagement and abuse in patients and caregivers through coordinated care by unlicensed care guides supported by a multidisciplinary team.
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Affiliation(s)
- Madhumitha Manivannan
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Julia Heunis
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah M Hooper
- UCSF/UC Consortium on Law, Science & Health Policy, UC Hastings College of the Law, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Kristi P Lui
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Tamara L Braley
- University of Nebraska Medical Center, College of Nursing, Department of Community Based Health, Omaha, NE, USA
| | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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24
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Tsoy E, Sideman AB, Piña Escudero SD, Pintado-Caipa M, Kanjanapong S, Al-Rousan T, Mbakile-Mahlanza L, de Oliveira MO, De la Cruz Puebla M, Zygouris S, Mohamed AA, Ibrahim H, Goode CA, Miller BL, Valcour V, Possin KL. Global Perspectives on Brief Cognitive Assessments for Dementia Diagnosis. J Alzheimers Dis 2021; 82:1001-1013. [PMID: 34120897 DOI: 10.3233/jad-201403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Timely diagnosis of dementia is a global healthcare priority, particularly in low to middle income countries where rapid increases in older adult populations are expected. OBJECTIVE To investigate global perspectives on the role of brief cognitive assessments (BCAs) in dementia diagnosis, strengths and limitations of existing measures, and future directions and needs. METHODS This is a qualitative study of 18 dementia experts from different areas of the world. Participants were selected using purposeful sampling based on the following criteria: 1) practicing in countries with projected growth of older adult population of over 100%by 2050; 2) expertise in dementia diagnosis and treatment; 3) involvement in clinical practice and training; and 4) recognition as a national dementia expert based on leadership positions within healthcare system, research, and/or policy work. Participants were individually interviewed in their language of choice over secure videoconference sessions. Interviews were analyzed by a multidisciplinary team using theme identification approach. RESULTS Four domains with subthemes emerged illustrating participants' perspectives: 1) strengths of BCAs; 2) limitations of BCAs; 3) needs related to the use of BCAs; and 4) characteristics of an ideal BCA. While most experts agreed that BCAs were important and useful for dementia diagnosis, the themes emphasized the need for development and validation of novel measures that are sensitive, psychometrically sound, and culturally appropriate. CONCLUSION BCAs are important for guiding diagnosis and care for dementia patients. Findings provide a roadmap for novel BCA development to assist in diagnostic decision making for clinicians serving a rapidly growing and diverse dementia population.
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Affiliation(s)
- Elena Tsoy
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Stefanie D Piña Escudero
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Maritza Pintado-Caipa
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Suchanan Kanjanapong
- Division of Geriatrics, Department of Preventive Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tala Al-Rousan
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Lingani Mbakile-Mahlanza
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Maira Okada de Oliveira
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Myriam De la Cruz Puebla
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Stelios Zygouris
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Aya Ashour Mohamed
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Hany Ibrahim
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Collette A Goode
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Victor Valcour
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
| | - Katherine L Possin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Trinity College Dublin, Ireland
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25
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Bernstein Sideman A, Harrison KL, Garrett SB, Naasan G, Ritchie CS. Practices, challenges, and opportunities when addressing the palliative care needs of people living with dementia: Specialty memory care provider perspectives. Alzheimers Dement (N Y) 2021; 7:e12144. [PMID: 33969177 PMCID: PMC8087986 DOI: 10.1002/trc2.12144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Palliative care focuses on reducing suffering and improving quality of life for individuals with serious illness and their families. In an effort to develop palliative care interventions for specialty memory care clinics, this study characterizes memory care providers' perspectives on addressing palliative care needs of people living with dementia (PLWD). METHODS Qualitative interviews with specialty memory care providers were followed by thematic analysis by a multidisciplinary research team. RESULTS Provider approaches overlap with key domains of palliative care. Approaches unique to dementia include having a detailed understanding of dementia syndromes, behavioral symptoms, and caregiver burden. Challenges were identified related to disease progression, provider-level factors, and systems and cultural issues. Respondents identified training needed to strengthen a palliative care approach. DISCUSSION There are many strengths of using memory care teams to address palliative care needs of PLWD. However, they may require additional knowledge and training to strengthen their work.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of Humanities and Social SciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Krista L. Harrison
- Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Division of GeriatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Sarah B. Garrett
- Philip R. Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Georges Naasan
- NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Christine S. Ritchie
- Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Division of Palliative Care and Geriatric MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Mongan Institute Center for Aging and Serious IllnessMassachusetts General HospitalBostonMassachusettsUSA
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