1
|
Gitlin LN, Roth DL, Marx K, Parker LJ, Koeuth S, Dabelko-Schoeny H, Anderson K, Gaugler JE. Embedding Caregiver Support Within Adult Day Services: Outcomes of a Multisite Trial. Gerontologist 2024; 64:gnad107. [PMID: 37549428 PMCID: PMC10943495 DOI: 10.1093/geront/gnad107] [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: 02/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Adult day services (ADS) provide quality-of-life benefits to people with dementia, but few provide systematic caregiver support. We report outcomes of a multisite, national trial testing a staff-delivered caregiver program, ADS Plus. RESEARCH DESIGN AND METHODS Cluster-randomized trial involving 34 ADS: 18 sites provided ADS (controls) and 16 provided ADS and ADS Plus (intervention). Trained staff met with caregivers to provide dementia education, support/validation, referrals/linkages, and strategies for care challenges and self-care over 12 months. Main outcomes included depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D]) and well-being at 6 and 12 months, and client attendance over 12 months. RESULTS Of 203 caregivers (Intervention = 102; Control = 101), 5.9% at 3 months, 12.8% at 6 months, and 22.7% at 12 months were lost to follow-up. Caregivers were predominantly female (80.3%), with 76.4% identifying as White/Caucasian, 14.8% Black/African American, and 12.3% Hispanic/Latino. Most (88.2%) had ≥college education and were 65.0 years old (SD = 13.46). For those with 6-month data, 40.4% control and 40.2% ADS Plus caregivers had depressed symptoms (≥16 CES-D) at baseline. By 6 months, 43.6% control versus 34.2% ADS Plus caregivers had ≥16 scores (odds ratio = 0.38, p = .072). By 12 months, after covariate adjustments, ADS Plus caregivers reported reduced total depression scores versus controls (p = .013) and lower depressed affect scores (p = .015). Of 18 sites providing 12-month client attendance data, 9 intervention sites reported 126.05 days attended versus 78.49 days for 9 control sites (p = .079). DISCUSSION AND IMPLICATIONS Compared with ADS alone, by 12 months, ADS Plus improved caregiver mood and increased ADS utilization by 60.6%. Results support ADS staff delivering evidence-based caregiver support to enhance ADS benefits. CLINICAL TRIAL REGISTRATION NCT02927821.
Collapse
Affiliation(s)
- Laura N Gitlin
- AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - David L Roth
- Center on Aging and Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine Marx
- Center for Equity in Aging, School of Nursing, John Hopkins University, Baltimore, Maryland, USA
| | - Lauren J Parker
- Department of Health, Behavior and Society, School of Public Health, Johns Hopkins Bloomberg, Baltimore, Maryland, USA
| | - Sokha Koeuth
- AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Holly Dabelko-Schoeny
- Age-Friendly Innovation Center, College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | - Keith Anderson
- Department of Social Work, School of Applied Sciences, University of Mississippi, Oxford, Mississippi, USA
| | - Joseph E Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
2
|
Gaugler JE, Baier RR, Baker ZG, Boltz M, Fortinsky RH, Gustavson AM, Hodgson NA, Jutkowitz E, McPhillips MV, Parker LJ, Sefcik JS, Gitlin LN. Using Hybrid Effectiveness Studies to Facilitate Implementation in Community-Based Settings: Three Case Studies in Dementia Care Research. J Am Med Dir Assoc 2024; 25:27-33. [PMID: 37643720 PMCID: PMC10840611 DOI: 10.1016/j.jamda.2023.07.025] [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: 03/18/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/31/2023]
Abstract
The pipeline from discovery to testing and then implementing evidence-based innovations in real-world contexts may take 2 decades or more to achieve. Implementation science innovations, such as hybrid studies that combine effectiveness and implementation research questions, may help to bridge the chasm between intervention testing and implementation in dementia care. This paper describes hybrid effectiveness studies and presents 3 examples of dementia care interventions conducted in various community-based settings. Studies that focus on outcomes and implementation processes simultaneously may result in a truncated and more efficient implementation pipeline, thereby providing older persons, their families, health care providers, and communities with the best evidence to improve quality of life and care more rapidly. We offer post-acute and long-term care researchers considerations related to study design, sampling, data collection, and analysis that they can apply to their own dementia and other chronic disease care investigations.
Collapse
Affiliation(s)
- Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA; College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.
| | - Rosa R Baier
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; Center for Long-Term Care Quality & Innovation and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Zachary G Baker
- School of Public Health, University of Minnesota, Minneapolis, MN, USA; College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Marie Boltz
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Richard H Fortinsky
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Allison M Gustavson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Administration Healthcare System, Minneapolis, MN, USA; Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA; National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA
| | - Nancy A Hodgson
- National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA; Biobehavioral Health Sciences Department, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric Jutkowitz
- Center for Long-Term Care Quality & Innovation and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA
| | - Miranda V McPhillips
- National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren J Parker
- National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA
| |
Collapse
|
3
|
Gaugler JE, Borson S, Epps F, Shih RA, Parker LJ, McGuire LC. The intersection of social determinants of health and family care of people living with Alzheimer's disease and related dementias: A public health opportunity. Alzheimers Dement 2023; 19:5837-5846. [PMID: 37698187 PMCID: PMC10840787 DOI: 10.1002/alz.13437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/22/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
In this Perspective article, we highlight current research to illustrate the intersection of social determinants of health (SDOHs) and Alzheimer's disease and related dementia (ADRD) caregiving. We then outline how public health can support ADRD family caregivers in the United States. Emerging research suggests that family care for persons with ADRD is influenced by SDOHs. Public health actions that address these intersections such as improved surveillance and identification of ADRD caregivers; building and enhancing community partnerships; advancing dementia-capable health care and related payment incentives; and reducing the stigma of dementia and ADRD caregiving can potentially enhance the health and well-being of dementia caregivers. By engaging in one or all of these actions, public health practitioners could more effectively address the myriad of challenges facing ADRD caregivers most at risk for emotional, social, financial, psychological, and health disruption.
Collapse
Affiliation(s)
- Joseph E. Gaugler
- Building Our Largest Dementia Infrastructure (BOLD) Public Health Center of Excellence on Dementia Caregiving, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Soo Borson
- BOLD Public Health Center of Excellence on Early Detection, NYU Grossman School of Medicine, New York, New York, USA
| | - Fayron Epps
- BOLD Public Health Center of Excellence on Dementia Caregiving, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Regina A. Shih
- BOLD Public Health Center of Excellence on Dementia Caregiving, RAND Social and Behavioral Policy Program, RAND Corporation, Santa Monica, California, USA
| | - Lauren J. Parker
- BOLD Public Health Center of Excellence on Dementia Caregiving, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa C. McGuire
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Parker LJ, Marx KA, Nkimbeng M, Johnson E, Koeuth S, Gaugler JE, Gitlin LN. It's More Than Language: Cultural Adaptation of a Proven Dementia Care Intervention for Hispanic/Latino Caregivers. Gerontologist 2023; 63:558-567. [PMID: 35951488 PMCID: PMC10028233 DOI: 10.1093/geront/gnac120] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 04/04/2022] [Indexed: 11/12/2022] Open
Abstract
Although Hispanic/Latino older adults are at disproportionate and increased risk for Alzheimer's disease and related dementias, few evidence-based supportive care interventions are specifically developed for or adapted for this population. Adapting a supportive care intervention requires more than Spanish language translation; it necessitates an understanding of cultural nuances and care preferences of Hispanic/Latino families and staff who implement the intervention. This article describes the cultural adaptation of the Adult Day Service Plus intervention for delivery by staff to Hispanic/Latino caregivers, which was guided by the cultural adaptation process model. Also, using the Framework for Reporting Adaptations and Modifications-Enhanced, we discuss (a) when modifications were made, (b) who determined the modifications needed, (c) what aspects of the intervention were modified, (d) the relationship to fidelity and how fidelity was maintained, and (e) reasons for modifications. Modifications to the delivery and content were changed to reflect the values and norms of both the Hispanic/Latino staff and the caregivers they serve. As supportive interventions for caregivers are developed and implemented into real-world settings, inclusion of cultural elements may enhance research participation among Hispanic/Latino provider sites, people living with dementia, and their caregivers. Cultural adaptation is an essential consideration when developing, adapting, and implementing previously tested evidence-based interventions. Cultural adaptation offers an important lens by which to identify contextual factors that influence successful adoption to assure equity in the reach of evidence-based programs.
Collapse
Affiliation(s)
- Lauren J Parker
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine A Marx
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Manka Nkimbeng
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elma Johnson
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sokha Koeuth
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Abstract
OBJECTIVES We examine associations between use of paid help and caregiving-related experiences (emotional, financial, and physical difficulty) of Black family and unpaid caregivers of older adults. METHODS We examine a sample of N = 572 non-Hispanic Black caregivers of community-dwelling older adults receiving help with daily activities from the 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC). Guided by Pearlin's Stress Process Model, logistic regression models examine associations between assisting with finding paid help and caregiver experiences. RESULTS Black caregivers who helped care recipients find paid help more often had a college degree or higher, were helping older adults who received assistance with three or more self-care/mobility activities or who were living in poverty and were not receiving help with caregiving from family and friends. In fully-adjusted models, assisting with finding paid help was associated with emotional (AOR 1.92, 95% CI 1.27, 2.92 p < .01) and physical (AOR 2.16, 95% CI 1.04, 4.51; p = .04) difficulty. CONCLUSIONS Greater efforts are needed to support Black family and unpaid caregivers who are caring for older adults using paid help. CLINICAL IMPLICATIONS Future interventions that target Black caregivers of older adults using paid help could be useful for improving caregiving experiences.
Collapse
Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management (Fabius), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren J Parker
- Department of Health Policy and Management (Fabius), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
6
|
Gitlin LN, Marx K, Piersol CV, Hodgson NA, Parker LJ, Cidav T, Roth DL. Differential race effects of the tailored activity program (TAP) on dementia-related behaviors: A randomized controlled trial. J Am Geriatr Soc 2022; 70:3105-3115. [PMID: 35932186 PMCID: PMC10414755 DOI: 10.1111/jgs.17981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although nonpharmacological approaches are considered first-line treatments for dementia-related behaviors, it is unclear as to their effectiveness for different racial groups. We evaluated the effects of the Tailored Activity Program (TAP) on agitated and aggressive behaviors in Black and White families. METHODS We conducted a single-blind, two-arm randomized controlled trial involving Black (N = 90) and White (N = 145) families. TAP involved eight home sessions by occupational therapists who provided activities tailored to abilities and interests and instructed caregivers in their use over 3 months. An attention control group received eight sessions by research assistants who provided disease education and home safety tips. Measures included caregiver ratings of frequency by severity for the agitation and aggression subscales of the Neuropsychiatric Inventory-Clinician (NPI-C) at 3 months (main trial primary outcome), number of completed sessions and time spent, changes in behavioral subcomponents of the subscales (frequency, severity, caregiver distress), and percent improving/worsening. RESULTS Black and White families completed similar numbers of treatment sessions, but White dyads averaged nearly two contact hours more than Black dyads (p = 0.008). At 3 months, an interaction effect (treatment by race) indicated significantly greater reductions in frequency by severity scores for the agitation and aggression subscales for Black TAP dyads versus White TAP dyads and White and Black attention control dyads. Also, significant interaction effects favoring TAP Black dyads were observed for select behavioral components. For TAP dyads with elevated baseline agitation/aggression levels (N = 71), 34.5% of Black versus 11.9% of White dyads improved; whereas 2.6% of Black versus 16.7% of White dyads had worsened agitation/aggression scores. CONCLUSION Black families compared to White families derived greater behavioral benefits from TAP for PLWD at 3 months despite having less treatment exposure. Examining differential race effects may enhance precision in using nonpharmacological approaches and promote equity in dementia care for underserved populations.
Collapse
Affiliation(s)
- Laura N. Gitlin
- Drexel University, College of Nursing and Health Professions, Philadelphia, PA
| | - Katherine Marx
- Johns Hopkins University, School of Nursing, Baltimore, Maryland
| | | | | | - Lauren J. Parker
- Johns Hopkins University, School of Public Health, Baltimore, Maryland
| | - Tom Cidav
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - David L. Roth
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| |
Collapse
|
7
|
Parker LJ, Fabius C. Who's Helping Whom? Examination of Care Arrangements for Racial and Ethnic Diverse People Living With Dementia in the Community. J Appl Gerontol 2022; 41:2589-2593. [PMID: 35960528 DOI: 10.1177/07334648221120247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To address notions around care arrangements for Black and Hispanic people living with dementia (PLwD), the study examined if racial and ethnic differences exist for community-dwelling PLwD. Methods: Using cross-sectional data from the 2015 National Health and Aging Trends Study, we used Pearson's chi-square and mean comparison to examine differences among a sample of n = 863 community-dwelling White, Black, and Hispanic older PLwD. Results: Black PLwD were less likely than White PLwD to use paid help (26.8% vs. 32.6%), but Hispanic PLwD were most likely to use paid help (46.2%, p < 0.05). Black and Hispanic older adults were more often receiving help from a child (65.8% and 72.2%, respectively; p = 0.01) or other family member (40.3% and 31.0%, respectively; p < 0.01). Discussion: Our findings highlight the important role of familial support in care provision for Black and Hispanic communities. Caregiving supports should be intentional in centering services on the family, not a sole caregiver.
Collapse
Affiliation(s)
- Lauren J Parker
- Department of Health, Behavior, and Society, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chanee Fabius
- Department of Health, Policy, and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
Parker LJ, Gaugler JE, Gitlin LN. Use of Critical Race Theory to Inform the Recruitment of Black/African American Alzheimer's Disease Caregivers into Community-Based Research. Gerontologist 2022; 62:742-750. [PMID: 34999789 PMCID: PMC9154262 DOI: 10.1093/geront/gnac001] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Indexed: 01/09/2023] Open
Abstract
Nearly 30 years after the 1993 National Institute of Health (NIH) Revitalization Act, which required the inclusion of women and racial/ethnic minority groups into government-funded clinical trials, minority groups remain underrepresented in research, and disparities in health outcomes and longevity remain. These problematic trends are particularly evident when considering Black and community-based research in Alzheimer's disease and related dementia (ADRD). Deeply rooted historical race-based mistreatment in research and in the health care system at large along with ineffective recruitment approaches persists as barriers to the low participation of Black participants in dementia care studies. In this article, we explore Critical Race Theory, its tenets, and applicability to inform national strategies to encourage participation of Black participants in ADRD research. We describe how Critical Race Theory constructs (e.g., race consciousness, storytelling, and praxis) can be used to inform recruitment strategies of Black caregivers for people living with dementia into community-based research. We provide a case example that draws upon our NIH-funded Adult Day Service Plus randomized trial and its engagement of Black caregivers into a community-based biomarker research arm of the main trial. Although the contribution of this article is primarily theoretical, in the spirit of Critical Race Theory it is also a call for action to transform dementia care research by offering a conceptual tool to assure inclusivity of Black participants, who are disproportionately affected by dementia when compared to other racial groups.
Collapse
Affiliation(s)
- Lauren J Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Fabius CD, Parker LJ, Thorpe RJ. The Influence of Race and Gender on Receiving Assistance with Daily Activities among Older Americans. Innov Aging 2021; 6:igab060. [PMID: 35233471 PMCID: PMC8874838 DOI: 10.1093/geroni/igab060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives Nearly 8.2 million community-dwelling, older Medicare beneficiaries receive support from long-term services and supports (LTSS) with routine daily activities. Prior work demonstrates disability-related disparities; however, it is unclear whether these patterns persist among LTSS recipients and across specific sets of activities. We examine race and gender differences in receiving help with self-care (e.g., eating), mobility (e.g., getting around the house), and household (e.g., shopping) activities in a nationally representative sample of community-dwelling Medicare beneficiaries receiving LTSS. Research Design and Methods Cross-sectional analysis of 1,808 White and Black older adults receiving assistance with routine daily activities in the 2015 National Health and Aging Trends Study. Bivariate statistics were used to describe the sample and provide comparisons of characteristics by race and gender. Logistic regression models examined race and gender differences in receiving assistance with self-care, mobility, and household activities after adjusting for sociodemographic and health characteristics. Results Race and gender differences were observed across all sociodemographic and health characteristics, as well as for all forms of assistance. Relative to White men, Black men had lower odds of receiving help with self-care activities. White and black women had higher odds and Black men had lower odds of getting help with mobility activities than White men. Black men and White and Black women all had higher odds of receiving assistance with household tasks compared to White men. Discussion and Implications Our findings indicate that, despite prior evidence of disability-related disparities, the receipt of help with self-care, mobility, and household activities varies by race and gender. Findings reveal several target areas for future research. Future work should examine the role of cultural and social preferences for care, as well as the appropriateness of help, as evidenced by health service use and changes in quality of life.
Collapse
Affiliation(s)
- Chanee D Fabius
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lauren J Parker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roland J Thorpe
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
10
|
Parker LJ, Marx K, Gaugler JE, Gitlin LN. Implications of the COVID-19 Pandemic on Adult Day Services and the Families They Serve. Am J Alzheimers Dis Other Demen 2021; 36:15333175211050152. [PMID: 34647482 PMCID: PMC8745481 DOI: 10.1177/15333175211050152] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The COVID-19 pandemic forced adult day services (ADS) to close and abruptly end in-person services to clients. To understand the effect of the pandemic on ADS, a 20-item survey was used to examine services provided, staffing, finances, and plans to reopen. Data came from 22 sites participating in the Adult Day Service Plus a national randomized controlled trial. Of the 22 ADS sites responding to the survey, most (86.4%, n = 19) closed due to COVID-19 with nearly half closing due to a state mandate (52.6%, n = 10). Most sites reported the need to furlough or terminate staff (63.6%, n = 14). Services that sites continued to provide included telephone support (n = 22, 100%), delivery of food (n = 8, 36.4%), medical check-ins (n = 9, 40.1%), and activity via Zoom or YouTube (n = 14, 63.6%). Most of these services were provided without reimbursement. Adult day services have considerable potential as a platform for service innovation in community-based services.
Collapse
Affiliation(s)
- Lauren J Parker
- Department of Health, Behavior and Society, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine Marx
- 15851Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Laura N Gitlin
- 15775College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
11
|
Abstract
BACKGROUND AND OBJECTIVES Despite adult day services (ADS) being the most racially diverse home- and community-based service (HCBS), there is a paucity of research that has examined the impact of ADS on well-being measures among Black caregivers of people living with dementia. To address this gap, this study examined the association between the use of ADS and depressive symptoms among Black dementia caregivers. RESEARCH DESIGN AND METHODS Using baseline data from 2 behavioral intervention trials, Advancing Caregiver Training (n = 72) and Care of Persons with Dementia in their Environments (n = 63), we conducted ordinary least squares regression to examine the association between ADS use in the past 6 months and depressive symptoms (n = 135). The dependent variable, depressive symptoms, was assessed by the 10-item Center for Epidemiologic Studies-Depression (CES-D) scale. The independent variable was assessed by self-report of ADS use in the past 6 months. RESULTS Nearly 36% of the sample used ADS in the past 6 months. After controlling for caregiver characteristics associated with depression (burden, social support, self-rated health, caregiving relationship status, years caregiving, religious/spiritual coping, and demographic characteristics), caregivers who utilized ADS had a lowered CES-D score (B = -1.97, p = .03) compared to those who did not use ADS. DISCUSSION AND IMPLICATIONS Black dementia caregivers who utilized ADS had lower depressive symptoms compared to those who did not utilize ADS. ADS may be a critical HCBS that can provide relief to Black caregivers. Research is needed to examine additional benefits of ADS use among Black caregivers and the policy and programming needed to enhance access to ADS.
Collapse
Affiliation(s)
- Lauren J Parker
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
12
|
Scerpella DL, Bouranis NG, Webster MJ, Dellapina M, Koeuth S, Parker LJ, Kales HC, Gitlin LN. Using Geographic Information Systems (GIS) for Targeted National Recruitment of Community-Dwelling Caregivers Managing Dementia-Related Behavioral and Psychological Symptoms: A Recruitment Approach for a Randomized Clinical Trial. J Geogr Inf Syst 2021; 13:302-317. [PMID: 34484851 PMCID: PMC8415725 DOI: 10.4236/jgis.2021.133017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Over 16 million caregivers of people living with dementia require support in a range of issues, including self-care, disease education, and guidance for how to manage behavioral and psychological symptoms of dementia (BPSD). Non-pharmacological interventions are needed to address these areas, and online applications have been shown to be safe and effective. To ensure the efficacy of such interventions, racially, ethnically, geographically, and socioeconomically diverse participants must be recruited to increase the generalizability of study outcomes. This protocol paper describes a recruitment plan using Geographic Information Systems (GIS) to reach a representative sample of caregivers across the United States for a national Phase III clinical study. Using publicly available census data from the American Community Survey (ACS), combined with location data for local aging resources such as Area Agencies on Aging (AAA), recruitment will be derived from data analysis conducted in ESRI ArcGIS v10.7.1. Datasets including age, gender, income, and education will be assessed nationally at the county and census tract spatial scale in a nine-step process to develop recruitment priority areas containing high concentrations of eligible participants living in the community. Overall, the current protocol will demonstrate the value of GIS in tailoring targeted outreach strategies to recruit community-dwelling populations through local resource institutions. This novel approach may have far-reaching implications in future recruitment initiatives and help to secure racially/ethnically diverse samples.
Collapse
Affiliation(s)
| | - Nicole G Bouranis
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Melinda J Webster
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Maria Dellapina
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Sokha Koeuth
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Lauren J Parker
- School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Helen C Kales
- Department of Psychiatry, University of California-Davis, Sacramento, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| |
Collapse
|
13
|
Parker LJ, Fabius C, Rivers E, Taylor JL. Is Dementia-Specific Caregiving Compared With Non-Dementia Caregiving Associated With Physical Difficulty Among Caregivers for Community-Dwelling Adults? J Appl Gerontol 2021; 41:1074-1080. [PMID: 34041929 DOI: 10.1177/07334648211014352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study is to identify whether dementia caregiving is associated with physical difficulty among informal caregivers. METHODS This cross-sectional retrospective cohort study design used data from the 2015 National Health and Aging Trends Study and the National Study of Caregiving. Binary logistic regression was used to examine the association between substantial physical difficulty and dementia caregiving among 1,871 caregivers. RESULTS Nearly 14% of the caregivers reported substantial physical difficulty. Dementia caregivers were 1.5 times more likely to report caregiving-related substantial physical difficulty (adjusted odds ratio [AOR] = 1.58, p = .04) than non-dementia caregivers. Factors associated with substantial physical difficulty included caregiver gender, self-rated health, depressive symptoms, pain, and caring for someone receiving assistance with three or more self-care or mobility activities. DISCUSSION Future studies should identify strategies to mitigate the physical demands on dementia caregivers. Early monitoring of caregivers' self-rated health, depressive symptoms, and pain may identify those more likely to experience physical difficulty.
Collapse
Affiliation(s)
- Lauren J Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chanee Fabius
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | |
Collapse
|
14
|
Abstract
Objectives: To examine racial differences in respite utilization among a nationally representative sample of caregivers for persons living with dementia (PLwD). A secondary aim identified factors associated with respite utilization. Methods: Using data from the 2015 National Health and Aging Trends Study and National Study of Caregiving, we conducted binary logistic regression to examine racial difference in respite use among Black and white caregivers ( n = 750). Results: 22% of the sample used respite for PLwD. Black dementia caregivers were 69% less likely (odds ratio: .31, p = .001) to use respite compared to white caregivers. Other factors associated with utilization included education, receiving help with caregiving, and providing care for more self-care/mobility tasks or to a Medicaid-enrollee. Discussion: Findings suggest that Black dementia caregivers may be at risk for less frequent use of respite and highlight the need to identify factors that promote respite use.
Collapse
|
15
|
Epps F, Alexander K, Brewster GS, Parker LJ, Chester M, Tomlinson A, Adkins A, Zingg S, Thornton J. Promoting dementia awareness in African-American faith communities. Public Health Nurs 2020; 37:715-721. [PMID: 32557783 PMCID: PMC7811358 DOI: 10.1111/phn.12759] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alzheimer's disease and other dementia-related disorders are affecting the African-American community at alarming rates. African-American churches have traditionally been places of refuge where families go for support. However, many churches lack programs or resources to support families affected by dementia. In response, a nurse-led interdisciplinary collaborative partnered with churches to promote dementia awareness through education. PURPOSE The purpose of this analysis was to (a) describe the demographics of those seeking dementia education in African-American faith communities; (b) identify prior knowledge of dementia community resources; and (c) determine the preliminary usefulness of the education provided. METHODS Over the course of 16 months, 202 individuals attended nine educational sessions hosted by five churches across metropolitan Atlanta. Quantitative surveys were used to collect demographics and evaluate the educational sessions. RESULTS The majority of attendees were African-American adults (91%), women (75%), and unaware of dementia resources (66%). Several attendees identified themselves as church leaders, community/church members, caregivers, and/or healthcare professionals. Attendees expressed the educational content was applicable to themselves or their families. CONCLUSION Results help identify ways to alter and/or strengthen the educational content and serve as a guide for developing culturally relevant, faith-based community programs.
Collapse
Affiliation(s)
- Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Karah Alexander
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Lauren J Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mia Chester
- School of Nursing, Georgia State University, Atlanta, GA, USA
| | | | - Aisha Adkins
- Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Sabrina Zingg
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | |
Collapse
|
16
|
Samuel LJ, Szanton SL, Wolff JL, Ornstein KA, Parker LJ, Gitlin LN. Socioeconomic disparities in six-year incident dementia in a nationally representative cohort of U.S. older adults: an examination of financial resources. BMC Geriatr 2020; 20:156. [PMID: 32370792 PMCID: PMC7201761 DOI: 10.1186/s12877-020-01553-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/23/2019] [Accepted: 04/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background Less educational training is consistently associated with incident dementia among older adults, but associations between income and financial strain with incident dementia have not been well tested in national samples. This is an important gap because, like education, financial resources are potentially modifiable by policy change and strengthening the social safety net. This study tested whether financial resources (income and financial strain) predict six-year incident dementia independent of education and occupation. Methods The National Health and Aging Trends Study is a prospective cohort study that recruited a nationally representative sample of U.S. Medicare beneficiaries aged ≥65 years. Incident dementia (2013 to 2018) was classified based on diagnosis, cognitive test scores or proxy-reported changes among participants dementia-free in 2012 (n = 3785). Baseline socioeconomic measures included income to poverty ratio (analyzed separately for those < 500% vs. ≥500% poverty threshold), financial strain, education and history of professional occupation. Discrete time survival analysis applied survey weights to account for study design and nonresponse. Coefficients were standardized to compare the strength of associations across the four socioeconomic measures. Results Adjusting for socioeconomic measures, demographic characteristics, home ownership, retirement, chronic conditions, smoking, BMI and depressive symptoms, higher income (hazard OR = 0.84, 95% CI: 0.74, 0.95 among those < 500% poverty) and higher education (hOR = 0.73, 95% CI: 0.65, 0.83) were associated with lower odds, and financial strain with higher odds (hOR = 1.20, 95% CI: 1.09, 1.31), of incident dementia. Conclusion Low income and greater financial strain predict incident dementia among older adults and associations are comparable to those of low education among U.S. older adults. Interventions to mitigate financial strain through improving access to economic opportunity and strengthening safety net programs and improving access to them in low income groups may complement other ongoing efforts to prevent dementia.
Collapse
Affiliation(s)
- Laura J Samuel
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.,Johns Hopkins Bloomberg School of Public Health Department of Health Policy and Management, Baltimore, USA
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health Department of Health Policy and Management, Baltimore, USA
| | - Katherine A Ornstein
- Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, New York, USA
| | - Lauren J Parker
- Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior and Society, New York, USA
| | - Laura N Gitlin
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.,Drexel University College of Nursing and Health Professions, Philadelphia, USA
| |
Collapse
|
17
|
Cobb RJ, Parker LJ, Thorpe RJ. Self-reported Instances of Major Discrimination, Race/Ethnicity, and Inflammation Among Older Adults: Evidence From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2020; 75:291-296. [PMID: 30508069 PMCID: PMC8127073 DOI: 10.1093/gerona/gly267] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study examines the relationship between self-reported instances of major discrimination and inflammation among older adults, and explores whether this relationship varies in accordance with race/ethnicity. We hypothesized that self-reported instances of major discrimination would be associated with higher levels of high-risk inflammation and that this relationship would be stronger for racial/ethnic minorities than whites. METHODS Data from the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative sample of older adults in the United States, were used to collect measures of self-reported instances of major discrimination and high-risk C-reactive protein (CRP), which was assayed from blood samples. Modified Poisson regression with robust standard errors was applied to estimate the prevalence ratios of self-reported instances of major discrimination, as it relates to high-risk CRP (CRP ≥ 22 kg/m2), and test whether this relationship varies by race/ethnicity. RESULTS Respondents who experienced any instances of major discrimination had a higher likelihood of high-risk CRP (prevalence ratio [PR]: 1.14, 95% confidence interval [CI] = 1.07-1.22) than those who did not report experiencing any instances of major discrimination. This association was independent of differences in newly diagnosed health conditions and socioeconomic status. The relationship between any self-reported instance of major discrimination and high-risk CRP was weaker for blacks than whites (PR: 0.81, 95% CI = 0.69-0.95). CONCLUSIONS Our study confirms that self-reported instances of major lifetime discrimination is a psychosocial factor that is adversely associated with high-risk CRP among older adults; this association is especially pronounced among older whites. Future studies among this population are required to examine whether the relationship between self-reported instances of major discrimination and high-risk CRP changes over time.
Collapse
Affiliation(s)
- Ryon J Cobb
- School of Social Work, University of Texas at Arlington, Baltimore, Maryland
| | - Lauren J Parker
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Roland J Thorpe
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
| |
Collapse
|
18
|
Marx KA, Marx KA, Parker LJ, Huang J, Scerpella D, Rose K, Piersol CV, Gitlin LN. FAMILY CAREGIVER READINESS: RACIAL DIFFERENCES AND RELIABILITY OF THE CAREGIVER READINESS SCALE. Innov Aging 2019. [PMCID: PMC6846438 DOI: 10.1093/geroni/igz038.649] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The success of any intervention for caregivers of persons with dementia is dependent on the caregiver’s readiness to enact the strategies. This presentation explores the reliability of the new 17-item Caregiver Readiness Scale (CRS) and also to examine the differences by race in readiness. Participants were caregivers in the Dementia Behavior Study who completed the CRS at baseline (n=129). Caregivers were on average 65.8 years old (sd = 12.2, range 28-88), the majority reported their race as non-Hispanic white (64.3%, n=83) and 33.4% (n=43) reported their race as African American or other. The average CRS score was 57.63 (sd=5.72, 40-68) (α=0.73). The only significant interaction with race was negative communication (p=0.026) with negative communication scores having little effect on readiness in whites, but in non-white caregivers, there was an inverse relationship. Knowing the caregiver’s level of readiness and communication style may help improve the acceptability and success of an intervention.
Collapse
Affiliation(s)
| | | | - Lauren J Parker
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Jin Huang
- Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Karen Rose
- Widener University, Chester, Pennsylvania, United States
| | | | - Laura N Gitlin
- Drexel University, Philadelphia, Pennsylvania, United States
| |
Collapse
|
19
|
Fabius CD, Parker LJ, Thorpe Jr. RJ. RACE AND GENDER DIFFERENCES IN PHYSICAL FUNCTIONING AMONG COMMUNITY-DWELLING OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6845247 DOI: 10.1093/geroni/igz038.2868] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Prior work has demonstrated that there are race and gender disparities in the prevalence of need for assistance with tasks such as self-care, mobility, and household activities. Research has historically shown that older black Americans and women experience greater prevalence of physical functioning declines. It is unclear whether these differences persist among those receiving assistance. Using data from the 2015 National Health and Aging Trends Study (NHATS), a nationally representative study of Medicare beneficiaries aged 65 and older, and after adjusting for covariates, black men received less assistance with self-care and mobility activities, and white and black women received more help with mobility and household activities, compared to white men. Findings are critical to advancing our understanding of the needs of vulnerable older adults receiving assistance. More research is needed to understand the implications of these differences on long-term services and supports provided by both informal and formal caregivers.
Collapse
Affiliation(s)
- Chanee D Fabius
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Lauren J Parker
- Johns Hopkins University, Baltimore, Maryland, United States
| | | |
Collapse
|
20
|
Abstract
Employment status is a key social determinant of health, and many populations in the United States that are impacted by HIV have unequal access to education and employment opportunities which contributes to HIV-related disparities. Black men who have sex with men (BMSM) are one of the groups most heavily burdened by HIV. With improved health outcomes associated with advancements in HIV treatment, research suggests that more people living with HIV want to work. This study describes employment among BMSM living in Baltimore, assesses differences in employment by HIV status and assesses predictors of full-time employment among BMSM. The study found that BMSM have limited access to full-time employment and that this disparity is even more pronounced among BMSM living with HIV. Men living with HIV were less likely to be employed full-time compared to men not living with HIV controlling for education and social contextual factors (OR 0.40 95% CI (0.22-0.73)). HIV will most likely have important implications for employment patterns and trajectories of BMSM over the life course. Additional research is needed among BMSM living with HIV to understand work histories and experiences, facilitating factors, and the impact of various work experiences on the health and wellbeing.
Collapse
Affiliation(s)
- Catherine Maulsby
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren J Parker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jordan J White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Mugavero
- School of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Colin P Flynn
- Infectious Disease and Environmental Health Administration, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
21
|
Parker LJ, Gaugler JE, Samus Q, Gitlin LN. Adult Day Service Use Decreases Likelihood of a Missed Physician's Appointment Among Dementia Caregivers. J Am Geriatr Soc 2019; 67:1467-1471. [PMID: 31219175 DOI: 10.1111/jgs.15995] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND/OBJECTIVE Adult day services (ADSs) that provide community-based supervised support for persons with dementia (PWD) may also function as a respite for familial caregivers to attend to self-care needs. Guided by a revised version of the Andersen Healthcare Utilization Model, the objective of this study was to identify the association between use of ADSs and a missed physician's appointment among family caregivers for community-dwelling familial PWD. A secondary objective was to identify other predisposing, enabling, and need factors associated with a missed physician's appointment. DESIGN Secondary analysis of baseline, cross-sectional data from two randomized controlled trials (Advancing Caregiver Training, n = 272; and Care of Persons With Dementia in Their Environments, n = 237). SETTING Community. PARTICIPANTS Community-dwelling caregivers for PWD (n = 509). MEASUREMENTS Missed physician's appointment was measured using the caregivers' self-report of one or more missed physician's appointments (yes/no) in the past 6 months. ADS use was measured using the caregivers' self-report of ADS use (yes/no). RESULTS Over a third of the caregivers utilized ADSs for their PWD. Caregivers who utilized ADSs for their familial PWD were 49% less likely (95% confidence interval = 0.32-0.81) to miss a physician's appointment in the past 6 months. More black compared to white caregivers missed appointments regardless of ADS use. Caregivers with increased chronic health conditions were more likely to miss a physician's appointment compared to those with fewer conditions. CONCLUSION ADSs' provision of respite enables caregivers the time to address self-care needs by decreasing the likelihood that caregivers miss a physician's appointment. Findings suggest that ADSs may promote positive health behaviors for caregivers and should be expanded as part of comprehensive dementia care for families. Factors associated with missed physician appointments need further examination and intervention to support black caregivers.
Collapse
Affiliation(s)
- Lauren J Parker
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph E Gaugler
- Long-Term Care and Aging, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Quincy Samus
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
| |
Collapse
|
22
|
Parker LJ, Taylor JL, Szanton SL. PSYCHOSOCIAL STRESSORS AND HEALTH DURING MIDIFE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2942] [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: 11/13/2022] Open
Affiliation(s)
- L J Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryl
| | - J L Taylor
- Johns Hopkins University School of Nursing, Baltimore, Maryl
| | - S L Szanton
- Johns Hopkins School of Nursing, Baltimore, Maryl
| |
Collapse
|
23
|
Nkimbeng M, Taylor JL, Parker LJ, Szanton SL. THE RELATIONSHIP BETWEEN DISCRIMINATION AND PAIN IN AFRICAN AMERICANS: EVIDENCE FROM THE MIDUS MILWAUKEE COHORT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2944] [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: 11/14/2022] Open
Affiliation(s)
- M Nkimbeng
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - J L Taylor
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - L J Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore,MD,USA
| | - S L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| |
Collapse
|
24
|
Parker LJ, Taylor JL, Samuel L, Szanton SL, Gitlin LN. DISCRIMINATION AND EXECUTIVE FUNCTIONING AMONG A RACIALLY DIVERSE SAMPLE OF COMMUNITY-DWELLING ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2943] [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: 11/14/2022] Open
Affiliation(s)
- L J Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - J L Taylor
- RN Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - L Samuel
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - S L Szanton
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - L N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA
| |
Collapse
|
25
|
Parker LJ, Gitlin LN. THE IMPACT OF ADULT DAY SERVICES ON HEALTH APPOINTMENTS OF DEMENTIA FAMILY CAREGIVERS WITH A CHRONIC HEALTH CONDITION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1593] [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: 11/14/2022] Open
Affiliation(s)
- L J Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,United States
| | - L N Gitlin
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| |
Collapse
|
26
|
Taylor JL, Parker LJ, Szanton SL, Thorpe RJ. The association of pain, race and slow gait speed in older adults. Geriatr Nurs 2018; 39:580-583. [PMID: 29752144 DOI: 10.1016/j.gerinurse.2018.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/02/2018] [Accepted: 04/09/2018] [Indexed: 01/08/2023]
Abstract
Gait speed is an important indicator of mobility and quality of life in older adults. Pain is related to gait speed; however, it is unknown if this relationship varies by race in a population based national sample. The aim of this study was to examine if the association between slow gait speed and pain differed between 7,025 older African Americans and non Hispanic Whites in the National Health and Aging Trends Study. Those with pain in the last month had higher odds of slow gait speed (odds ratio = 1.38, 95% confidence interval = 1.10 - 1.73) than those without pain. The relationship between pain and slow gait speed did not vary by race (interaction p = 0.6). This is important because it points to the underlying racial disparities in pain and gait speed being factors such as disparate opportunities and living conditions, and healthcare rather than attributes intrinsic to race.
Collapse
Affiliation(s)
- Janiece L Taylor
- School of Nursing, Johns Hopkins University, 525 North Wolfe St., Baltimore, MD 21205, USA.
| | - Lauren J Parker
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD 21205, USA
| | - Sarah L Szanton
- School of Nursing, Johns Hopkins University, 525 North Wolfe St., Baltimore, MD 21205, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD 21205, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD 21205, USA; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD 21205, USA
| |
Collapse
|
27
|
Kinlock BL, Parker LJ, Howard DL, Bowie JV, LaVeist TA, Thorpe RJ. Prevalence and Correlates of Major Depressive Symptoms among Black Men with Prostate Cancer. Ethn Dis 2017; 27:429-436. [PMID: 29225444 DOI: 10.18865/ed.27.4.429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 11/18/2022] Open
Abstract
Objectives The objectives of our study were to determine the prevalence of major depressive symptoms and identify factors that are associated with major depressive symptoms among Black men with prostate cancer (PCa). Design This study consisted of 415 Black men aged 40-81 years that entered the North Carolina Central Cancer Registry during the years 2007-2008. The primary outcome variable was depressive symptoms (CES-D). Factors included age, income, education, insurance status, treatment received, time between diagnosis and treatment, Gleason score, medical mistrust and experience with racism/discrimination. Logistic regression models were used to assess factors associated with the odds of having major depressive symptoms. Results The prevalence of major depressive symptoms (≥16 on CES-D) among our sample of Black men with PCa was approximately 33%. Approximately 15% of the study participants underwent radiation beam treatment. Age was significantly associated with the odds of reporting major depressive symptoms (OR= .95, CI .91-.99) among Black men. In addition, compared with all other forms of treatment, Black men who underwent radiation beam treatment had higher odds (OR=2.38, CI 1.02- 5.51) of reporting major depressive symptoms. Conclusion Nearly one-third of Black men with PCa in this study reported major depressive symptoms. Clinicians should pay closer attention to the mental health status of Black men with PCa, especially those who are younger and those who have undergone radiation beam treatment. Cancer survivorship, particularly quality of life, may be enhanced by opportunities for assessment, evaluation and intervention of depressive symptoms among these men disproportionately affected by PCa.
Collapse
Affiliation(s)
- Ballington L Kinlock
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lauren J Parker
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniel L Howard
- Public Policy Research Institute and Department of Sociology, Texas A&M University, College Station, TX
| | - Janice V Bowie
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas A LaVeist
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
28
|
Abstract
BACKGROUND Cigarette smoking poses a major public health problem that disproportionately affects Blacks and men. Religious attendance has been shown to be positively associated with health promotion and disease prevention among the Black population. In light of this evidence, this study examined if a similar relationship could be found for religious attendance and smoking in Black men. METHODS The National Survey of American Life (NSAL) study sampled 1,271 African American men and 562 Black Caribbean men. Multivariate logistic regression was used to determine the association between religious attendance and cigarette smoking. RESULTS After adjusting for age, marital status, household income, education, foreign born status, importance of prayer and major stress, men who reported attending religious services almost every day (odds ratio (OR) = 0.21, 95% confidence interval (CI) = 0.07, 0.62) and weekly (OR = 0.47, 95% CI = 0.29, 0.77) had lower odds of being a current smoker compared to men who reported never attending religious services. Conclusions/Importance: Findings suggest a health benefit in attending religious services on cigarette smoking among Black men in a nationally representative sample. In spite of lower church attendance in Black men in general, our results demonstrate that religious service attendance may still serve as a buffer against cigarette use. Given the emergent attention on faith-based health promotion among men, this conclusion is relevant and timely.
Collapse
Affiliation(s)
- Janice V Bowie
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Lauren J Parker
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Michelle Beadle-Holder
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,c Department of Sociology , University of Maryland , College Park , Maryland , USA
| | - Ashley Ezema
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,d Undergraduate Program in Public Health Studies, Johns Hopkins University , Baltimore , Maryland , USA
| | - Marino A Bruce
- e Center for Health of Minority Males, University of Mississippi Medical Center , Jackson , Mississippi , USA.,f Department of Sociology and Criminal Justice , Jackson State University , Jackson , Mississippi , USA
| | - Roland J Thorpe
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,d Undergraduate Program in Public Health Studies, Johns Hopkins University , Baltimore , Maryland , USA.,g Center for Biobehavioral Health Disparities Research, Duke University , Durham , North Carolina , USA
| |
Collapse
|
29
|
Abstract
UNLABELLED Previous research has demonstrated that experiencing interpersonal discrimination is associated with cigarette smoking. Few studies have examined the relationship between the effects of physical and emotional discrimination and cigarette usage, and none have examined this relationship among Black men. The aim of this study was to examine the association between the effects of physical and emotional discrimination and cigarette smoking. METHODS Data from the Indiana Black Men's Health Study, a community-based sample of adult Black men, was used to conduct multivariate logistic regression to examine the relationship between the physical and emotional effects of discrimination and smoking, net of healthcare and workplace discrimination, age, education, household income, and being married. RESULTS After adjusting for having an emotional response to discrimination, health care and workplace discrimination, age, education, household income, and being married, males who had a physical response to discrimination (e.g., upset stomach or headache) had higher odds of cigarette use (odds ratio (OR): 1.95, 95% confidence interval (CI): 1.15-3.30) than men who did not have a physical response to discrimination. CONCLUSION Findings from the study suggest that Black males may use cigarette smoking as a means to mitigate the stress associated with experiences of discrimination. Future research is needed further to explore if and how Black males use cigarette smoking to cope with unfair treatment.
Collapse
Affiliation(s)
- Lauren J Parker
- a Program for Research on Men's Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Haslyn Hunte
- b School of Public Health, Social & Behavioral Sciences , West Virginia University , Morgantown , West Virginia , USA
| | - Anita Ohmit
- c Indiana Minority Health Coalition , Indianapolis , Indiana , USA
| | - Debra Furr-Holden
- d Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Roland J Thorpe
- a Program for Research on Men's Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| |
Collapse
|
30
|
Kinlock BL, Parker LJ, Bowie JV, Howard DL, LaVeist TA, Thorpe RJ. High Levels of Medical Mistrust Are Associated With Low Quality of Life Among Black and White Men With Prostate Cancer. Cancer Control 2017; 24:72-77. [PMID: 28178717 DOI: 10.1177/107327481702400112] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Medical mistrust is thought to affect health care-based decisions and has been linked to poor health outcomes. The effects of medical mistrust among men with prostate cancer are unknown. Thus, the goal of the current study is to examine the association between medical mistrust and quality of life (QOL) among black and white men with prostate cancer. METHODS A total of 877 men (415 black, 462 white) with prostate cancer between the ages of 40 to 81 years who entered the North Carolina Central Cancer Registry during the years 2007 and 2008 were retrospectively recruited. The dependent variable was overall QOL measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The primary independent variable was medical mistrust. Multivariate regression analysis was used to assess the association between medical mistrust and overall QOL. RESULTS Compared with white men, black men reported a higher level of medical mistrust (black = 2.7, white = 2.4; P < .001) and lower QOL (black = 134.4, white = 139.5; P < 0.001). After controlling for demographical and clinical variables, higher levels of medical mistrust were associated with a reduction in overall QOL among men with prostate cancer (beta = -7.73; standard error = 1.54) CONCLUSIONS: Higher levels of medical mistrust are associated with reduced overall QOL among black and white men with prostate cancer. Interventions targeted to reduce medical mistrust may be effective in increasing the overall QOL of men with prostate cancer.
Collapse
Affiliation(s)
- Ballington L Kinlock
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Lauren J Parker
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Janice V Bowie
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniel L Howard
- Public Policy Research Institute and Department of Sociology, Texas A&M University, College Station, TX
| | - Thomas A LaVeist
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
31
|
Kinlock BL, Parker LJ, Bowie JV, Howard DL, LaVeist TA, Thorpe RJ. High Levels of Medical Mistrust Are Associated With Low Quality of Life Among Black and White Men With Prostate Cancer. Cancer Control 2017. [PMID: 28178717 DOI: 10.11.77/107327481702400112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Medical mistrust is thought to affect health care-based decisions and has been linked to poor health outcomes. The effects of medical mistrust among men with prostate cancer are unknown. Thus, the goal of the current study is to examine the association between medical mistrust and quality of life (QOL) among black and white men with prostate cancer. METHODS A total of 877 men (415 black, 462 white) with prostate cancer between the ages of 40 to 81 years who entered the North Carolina Central Cancer Registry during the years 2007 and 2008 were retrospectively recruited. The dependent variable was overall QOL measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The primary independent variable was medical mistrust. Multivariate regression analysis was used to assess the association between medical mistrust and overall QOL. RESULTS Compared with white men, black men reported a higher level of medical mistrust (black = 2.7, white = 2.4; P < .001) and lower QOL (black = 134.4, white = 139.5; P < 0.001). After controlling for demographical and clinical variables, higher levels of medical mistrust were associated with a reduction in overall QOL among men with prostate cancer (beta = -7.73; standard error = 1.54) CONCLUSIONS: Higher levels of medical mistrust are associated with reduced overall QOL among black and white men with prostate cancer. Interventions targeted to reduce medical mistrust may be effective in increasing the overall QOL of men with prostate cancer.
Collapse
Affiliation(s)
- Ballington L Kinlock
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Lauren J Parker
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Janice V Bowie
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniel L Howard
- Public Policy Research Institute and Department of Sociology, Texas A&M University, College Station, TX
| | - Thomas A LaVeist
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
32
|
Abstract
The objective of this study was to examine the association between discrimination and obesity among a U.S. nationally representative sample of African-American men. Data from the 2001-2003 National Survey of American Life (NSAL) were used to collect measures of everyday and major discrimination, and body mass index (BMI) taken from self-reports. Poisson regression with robust standard errors was applied to estimate the prevalence ratios of everyday and major discrimination as it relates to obesity (BMI ≥ 30 kg/m2), controlling for potential confounders. In the model that included both everyday and major discrimination, men who experienced any major discrimination had a higher likelihood of obesity (prevalence ratio [PR] = 1.33, 95% confidence interval [CI], 1.06, 1.66) than those who did not experience any major discrimination, controlling for age, marital status, income, education, major stressors, two or more chronic conditions, and physical activity. Exposure to any major discrimination was found to be associated with obesity in African-American men. Future studies among this population are needed to examine whether the observed changes in self-reports of major discrimination are associated with obesity, measured by BMI, over time. The health of African-American men must be a priority in reducing excess disparities in disease, disability, and death.
Collapse
Affiliation(s)
- Roland J. Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren J. Parker
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ryon J. Cobb
- Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Felicia Dillard
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Janice Bowie
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
33
|
Abstract
BACKGROUND Findings from previous research has demonstrated a positive relationship between interpersonal discrimination and cigarette smoking. Cigarette smoking is proposed to be an externalizing coping mechanism used to alleviate discrimination. At the national level, it is unclear if discrimination is associated with cigarette smoking among African American men. OBJECTIVE The aim of the study was to examine the association between discrimination and cigarette smoking among a national sample of African American men. METHODS Using data from the National Survey of American Life (n = 1,271), multivariable logistic regression was used to examine the relationship between discrimination and cigarette smoking. RESULTS Thirty-two percent of the men were current smokers. Controlling for everyday discrimination, major discrimination, major stress, depressive symptoms, age, being married, household income, and education, African American men who experienced major discrimination had a higher odd of being a current smoking (odds ratio: 1.11, 95% confidence interval: 1.02-1.21) than African American men who did not experience major discrimination. Conclusion/Importance: Findings suggest that African American men may use cigarette smoking as a mechanism to alleviate the experiences of discrimination. Future studies should continue to examine factors associated with African American men's smoking behavior in efforts to inform culturally relevant interventions.
Collapse
Affiliation(s)
- Lauren J. Parker
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Ballington Kinlock
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Dakarai Chisolm
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Sociology, Morgan State University
| | - Debra Furr-Holden
- Department of Mental Health, John Hopkins Bloomberg School of Public Health
| | - Roland J. Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
34
|
Abstract
Black men may use marijuana as an externalizing coping mechanism to handle the chronic stress of discrimination. The aim of the study was to examine the relationship between everyday and major discrimination and marijuana use among a national sample of Black men. Using the National Survey of American Life, logistic regression analyses was used to determine the association between recent marijuana use and everyday discrimination, major discrimination, and a fully adjusted model that include everyday and major discrimination among adult Black men ( n = 1,833). Additionally, a multinomial logistic regression was used to examine the association between the frequency of marijuana usage and everyday discrimination and major discrimination among men who used marijuana in the past year. Everyday discrimination was not associated with marijuana use. In the fully adjusted model, men who experienced major discrimination had a higher odds of marijuana use ( OR: 1.19, 95% CI [1.05, 1.34]), than those who did not control for everyday discrimination and covariates of interest. Among recent marijuana users, men who used almost every day had a decreased risks for major discrimination (RRR: 0.72, 95% CI [0.56, 0.92]), compared with men who used less than once a month. The findings suggest that recent marijuana use among Black men is associated with experiences of major discrimination. Interestingly, men who used almost every day had a decreased risk for major discrimination. Marijuana may be used as a coping mechanism.
Collapse
Affiliation(s)
| | | | - Paul Archibald
- 1 Johns Hopkins University, Baltimore, MD, USA.,2 Morgan State University, Baltimore, MD, USA
| | - Roland J Thorpe
- 1 Johns Hopkins University, Baltimore, MD, USA.,3 Duke University, Durham, NC, USA
| |
Collapse
|
35
|
Abstract
Black men are less likely to seek routine health care examinations or preventative care compared with their racial/ethnic and gender counterparts. Because of Black men's limited engagement with the health system, Black men's preference to receive health information is unclear. Guided by a revised version of the Andersen Healthcare Utilization Model, the aim of the study is to examine factors associated with Black men's preference for informal or formal health information. Findings from the study demonstrate that financial barriers to care (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.43-0.98) and higher income (OR = 2.44, 95% CI = 1.49-4.00) were most predictive of using a formal source for health information. Furthermore, age (OR = 1.02, 95% CI = 1.01-1.03) and having a college education (OR = 0.44, 95% CI = 0.26-0.76) were associated with using a formal place for health information. Interestingly, health care discrimination was not associated with preferred source or place for health information. Results from the study suggest that predisposing and enabling factors are most salient to the use of formal sources of health information among Black men.
Collapse
Affiliation(s)
- Lauren J Parker
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Anita Ohmit
- 3 Indiana Minority Health Coalition, Indianapolis, IN, USA
| | - Roland J Thorpe
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
36
|
Abstract
Using data from the Indiana Black Men's Health Study ( N = 455), a community-based sample of adult Black men, the primary aim of this study was to explore factors of health care discrimination, and to examine if such reports differed by age and the frequency of race thoughts. Approximately one in four men reported experiencing discrimination in the health care setting. Results from the multivariable logistic regression models suggested that frequent race thoughts (odds ratio [ OR]: 1.89, p < .05), not having health insurance ( OR: 1.80, p < .05), and increased depressive symptomology ( OR: 1.06, p < .01) were positively associated with reports of health care discrimination. A multiplicative interaction coefficient of age and frequency of race thoughts was included to determine if health care discrimination differed by age and frequency of race thoughts ( OR: 1.03, p = .08). Results from the predicted probability plot suggested that the likelihood of experiencing health care discrimination decreases with age ( OR: 0.97, p < .05). In particular, results suggested that between the ages of 33 and 53 years, Black men who experienced frequent race thoughts were more likely to report experiences of discrimination in the health care setting than men of the same age that did not experience frequent race thoughts. These results highlight the need for empirical work to better understand the experiences of Black men, a group less likely to utilize health care services than most adult groups within the health care setting.
Collapse
Affiliation(s)
| | | | - Anita Ohmit
- 3 Indiana Minority Health Coalition, Indianapolis, IN, USA
| |
Collapse
|
37
|
Parker LJ, Hunte HER. Examining the relationship between the endorsement of racial/ethnic stereotypes and excess body fat composition in a national sample of African Americans and black Caribbeans. Ethn Dis 2013; 23:462-468. [PMID: 24392609] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Using the National Survey of American Life, a nationally representative household survey of non-institutionalized US Blacks, our study examined whether the endorsement of racial/ ethnic stereotypes was associated with excess body fat composition among African Americans (n = 3,265) and Black Caribbeans (n = 1,332) living in the United States. We used ordinary least squares and multinomial logistic regression analyses controlling for potential confounders. Results from the linear regression suggested that the endorsement of racial/ethnic stereotypes was associated with increased body mass index and weight among African American males (b = .57, P < .05) and females (b = .50 P < .05). Further, results from the adjusted multinomial logistic regression suggested that African American males who endorsed racial/ethnic stereotypes were more likely to be obese (odds ratio = 1.33, P < .05), than African American males who did not endorse racial/ethnic stereotypes. Surprising, a positive relationship was not found among Black Caribbeans. Future studies should examine the relationship between internalized discrimination and endorsements of negative racial/ethnic stereotypes and excess fat accumulation among ethnically heterogeneous samples of Blacks.
Collapse
Affiliation(s)
- Lauren J Parker
- Department of Health and Kinesiology, Purdue University, Morgantown VA, USA
| | - Haslyn E R Hunte
- School of Public Health; Social & Behavioral Sciences; Robert C. Byrd Health Sciences Centerm West Virginia University, PO Box 9190; Morgantown, WV 26506-9190, USA
| |
Collapse
|
38
|
Abstract
Gloves provide an essential barrier against contamination and are an important item of personal protective equipment. Gloves used in clinical practice do leak although there is no direct evidence that such leaks result in transmission of infection. Double-gloving is recommended in theatre as a means of reducing hand injury during surgical procedures. Biogel Reveal is a double-glove puncture indication system that shows punctures as a visible green colour when damaged.
Collapse
Affiliation(s)
- L J Parker
- Northern General Hospital NHS Trust, Sheffield
| |
Collapse
|
39
|
Abstract
On entering hospital, patients and visitors assume that they are in a safe environment. Maintaining a safe environment in hospitals depends on not only the infrastructure, but also the equipment and materials that are used on the premises. Complaints about hospitals often include comments on the environment, its lack of cleanliness, poor food and the general look of debilitation. Key legislation for managing a safe environment is the Health and Safety at Work Act 1974. Complementary guidance includes the Control of Substances Hazardous to Health Regulations 1999 and the Environmental Protection Act 1990. The Incorporation of such legislation into local policies and guidelines ensures that healthcare staff can set standards to maintain the integrity of the patient's environment. This article will consider aspects of hospital life involved in maintaining a safe environment.
Collapse
Affiliation(s)
- L J Parker
- Scunthorpe General Hospital, Cliff Gardens
| |
Collapse
|
40
|
Abstract
Attitudes have changed drastically over the centuries towards people with infections and how to contain them. Only as we approach the end of the 20th century are we starting to base our practices on scientific evidence and not on ritual, although rational thought is still not found in many practices and confusion surrounds the terminology used. With the introduction of clinical governance, and the statutory duty of health organizations to provide a quality service for patients supported by evidence-based practice, this article discusses isolation practices.
Collapse
|
41
|
Abstract
Although the importance of handwashing is routinely acknowledged, a religious application of this practice still does not exist. Discussion in modern medicine on the subject of handwashing always states that it is the single most important factor in preventing hospital-acquired infection. This article continues the series on infection control and practical procedures by looking at the evidence that supports the above statement and discusses various handwashing methods and how to increase compliance to handwashing in the healthcare setting.
Collapse
|
42
|
Abstract
With catheterization comes the risk of infection and therefore people should not be catheterized unless their clinical condition dictates that it is absolutely necessary. Nurses are responsible for both inserting catheters and the subsequent management of the catheterized patient. A high level of nursing knowledge and skill is required to achieve effective and safe management. This article continues the infection control series by reviewing the principles of catheter management with regard to controlling infection.
Collapse
Affiliation(s)
- L J Parker
- Scunthorpe General Hospital, Cliff Gardens
| |
Collapse
|
43
|
Abstract
With increased demands from the general public for healthcare professionals to be accountable for their actions, many are becoming familiar with clinical governance and other initiatives to improve clinical practice. Good infection control is central to nursing practice. To achieve higher standards of clinical practice, especially when thinking about how to reduce the risk of cross-infection, it is necessary to not only do the right thing, but also do the thing right. Safe practice should be uppermost in the minds of healthcare professionals when caring for patients. This new series of articles attempts to look at the practical aspects of infection control, highlighting the requirements for risk assessment and applying the principles of infection control to a variety of patient care situations. This article investigates the use of protective clothing and gloves. It looks at the types of gloves available for use, the importance of choosing the correct glove for the task to be undertaken, and the modern day problems of allergies to latex.
Collapse
Affiliation(s)
- L J Parker
- Scunthorpe General Hospital, Cliff Gardens
| |
Collapse
|
44
|
Abstract
OBJECTIVE To estimate the frequency of abnormal clinical symptoms, laboratory tests, and diagnostic imaging studies in the ED assessment of elderly (> or = 65 yr) patients with acute cholecystitis, and to compare these factors in young-old (65-74 yr), middle-old (75-84 yr), and old-old (> or = 85 yr) population groups. METHODS A retrospective, cross-sectional study was performed by review of ED records, hospital charts, and surgical operative reports of consecutive elderly ED patients determined at surgery to have acute cholecystitis. Records were reviewed between April 1990 and April 1995 at a large Midwestern tertiary care facility with 65,000 annual ED patient visits. Clinical signs and symptoms were compared in the young-old, middle-old, and old-old population groups. RESULTS Of the 168 patients reviewed, 141 (84%) had neither epigastric or right upper quadrant abdominal pain, and 8 (5%) had no pain whatsoever. Only 61 patients (36%) had back or flank pain radiation. Ninety-six (57%) experienced nausea, 64 (38%) had emesis, and 13 (8%) had visible jaundice. Ninety-four (56%) patients were afebrile and 69 (41%) had no increase of white blood cell count. Twenty-two (13%) patients had no fever and all tests were normal. No statistical difference was noted in any symptom or laboratory factor for the 3 age groups, except jaundice was more common among the patients aged > or = 85 years. Ultrasonography was diagnostic for 91%, and CT was beneficial for only 1 patient. Eight patients had normal results on their ultrasonographic and CT studies. CONCLUSION Classic symptoms and abnormal blood test results are frequently not present in geriatric patients with acute cholecystitis. Increasing age does not appear to affect the clinical and test markers used by clinicians to diagnose this illness. A high degree of awareness is essential for correct diagnosis of acute cholecystitis in geriatric patients.
Collapse
Affiliation(s)
- L J Parker
- Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA
| | | | | |
Collapse
|
45
|
Abstract
At high pressure the alkali metals potassium, rubidium, and cesium transform to metals that have a d1 electron configuration, becoming transition metal-like. As a result, compounds were shown to form between potassium and the transition metal nickel. These results demonstrate that the chemical behavior of the alkali metals under pressure is very different from that under ambient conditions, where alkali metals and transition metals do not react because of large differences in size and electronic structure. They also have significant implications for the hypothesis that potassium is incorporated into Earth's core.
Collapse
Affiliation(s)
- LJ Parker
- Department of Chemistry, Pennsylvania State University, University Park, PA 16802, USA
| | | | | |
Collapse
|