1
|
Gately ME, Waller DE, Metcalf EE, Moo LR. Caregivers' Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners. JMIR Rehabil Assist Technol 2024; 11:e52049. [PMID: 38483462 PMCID: PMC10979337 DOI: 10.2196/52049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/20/2023] [Accepted: 01/12/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Older adults face barriers to specialty care, such as occupational therapy (OT), and these challenges are worse for rural older adults. While in-home video telehealth may increase access to OT, older adults' health- and technology-related challenges may necessitate caregiver assistance. OBJECTIVE This study examines caregiver assistance with in-home OT video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA). METHODS A web-based national survey of VHA OT practitioners about caregivers' role in video telehealth was conducted between January and February 2022. Survey items were developed with input from subject matter experts in geriatrics and OT and identified patient factors that necessitate caregiver participation; the extent to which caregivers assist with different types of tasks (technological and clinical tasks); and the perceived facilitators of, benefits of, and barriers to caregiver involvement. RESULTS Of approximately 1787 eligible VHA OT practitioners, 286 (16% response rate) participated. Not all survey items required completion, resulting in different denominators. Most respondents were female (183/226, 81%), White (163/225, 72.4%), and occupational therapists (275/286, 96.2%). Respondents were from 87 VHA medical centers, the catchment areas of which served a patient population that was 34% rural, on average (SD 0.22). Most participants (162/232, 69.8%) had >10 years of OT experience serving a patient cohort mostly aged ≥65 years (189/232, 81.5%) in primarily outpatient rehabilitation (132/232, 56.9%). The top patient factors necessitating caregiver involvement were lack of technical skills, cognitive impairment, and advanced patient age, with health-related impairments (eg, hearing or vision loss) less frequent. Technological tasks that caregivers most frequently assisted with were holding, angling, moving, repositioning, or operating the camera (136/250, 54.4%) and enabling and operating the microphone and setting the volume (126/248, 50.8%). Clinical tasks that caregivers most frequently assisted with were providing patient history (143/239, 59.8%) and assisting with patient communication (124/240, 51.7%). The top facilitator of caregiver participation was clinician-delivered caregiver education about what to expect from video telehealth (152/275, 55.3%), whereas the top barrier was poor connectivity (80/235, 34%). Increased access to video telehealth (212/235, 90.2%) was the top-rated benefit of caregiver participation. Most respondents (164/232, 70.7%) indicated that caregivers were at least sometimes unavailable or unable to assist with video telehealth, in which case the appointment often shifted to phone. CONCLUSIONS Caregivers routinely assist VHA patients with in-home OT video visits, which is invaluable to patients who are older and have complex medical needs. Barriers to caregiver involvement include caregivers' challenges with video telehealth or inability to assist, or lack of available caregivers. By elucidating the caregiver support role in video visits, this study provides clinicians with strategies to effectively partner with caregivers to enhance older patients' access to video visits.
Collapse
Affiliation(s)
- Megan Elizabeth Gately
- VA Bedford Health Care System, Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, United States
- Boston University School of Medicine, Division of Geriatrics, Boston, MA, United States
| | - Dylan E Waller
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States
| | - Emily E Metcalf
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States
- Oregon Medical Research Center, Portland, OR, United States
| | - Lauren R Moo
- VA Bedford Health Care System, Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, United States
- Massachusetts General Hospital, Cognitive Behavioral Neurology Unit, Boston, MA, United States
| |
Collapse
|
2
|
Abstract
This Viewpoint describes the positive role that primary care teams can play in the lives of patients with dementia and the families that care for them.
Collapse
Affiliation(s)
- Lauren R Moo
- New England Geriatric Research, Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
- Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| |
Collapse
|
3
|
Pimentel CB, Dryden EM, Nearing KA, Kernan LM, Kennedy MA, Hung WW, Riley J, Moo LR. The role of Department of Veterans Affairs community-based outpatient clinics in enhancing rural access to geriatrics telemedicine specialty care. J Am Geriatr Soc 2024; 72:520-528. [PMID: 38032320 DOI: 10.1111/jgs.18703] [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: 07/26/2023] [Revised: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Half of the 4.7 M veterans who reside in rural communities and rely on U.S. Department of Veterans Affairs (VA) health care are older (≥65). Their rurality presents unique challenges, including a shortage of clinicians skilled in geriatric medicine. Community-based outpatient clinics (CBOCs) help extend VA's geographic reach but are typically located in under-resourced settings. Telemedicine may increase access to care, but little is known about CBOCs' capacity to leverage telemedicine to meet older patients' needs. We identified organizational barriers and facilitators to the use of geriatric telemedicine specialty care from the perspective of rural clinicians and staff. METHODS From February-April 2020, we interviewed CBOC clinicians and staff (N = 50) from 13 rural CBOCs affiliated with four VA Geriatric Research Education and Clinical Centers. Semi-structured interviews addressed patient population characteristics; CBOC location, staffing, and in-house resources; use of VA specialty care services; and telemedicine use. We developed a codebook using an iterative process and Gale's Framework Method thematically organize and analyze data. RESULTS Respondents perceived that their CBOCs serve a predominantly older patient population. Four characteristics enabled CBOCs to offer geriatric telemedicine specialty care: partnerships with larger VA Medical Center teams; social worker/telehealth clinical technician knowledge of geriatrics and telehealth resources; periodic outreach/education from geriatric specialists; and routine use of other telehealth services. Barriers included: constraints on clinic space and unstable internet for telemedicine visits; staffing challenges leading to limited familiarity with telemedicine resources; and clinician and staff perceptions of older veterans' preference for in-person visits. CONCLUSIONS Telemedicine is an important modality to enhance access to care for an increasingly older and medically complex patient population. Although rural CBOCs provide a large portion of care to VA's growing geriatric population, staff are insufficiently trained in geriatrics, work in resource-poor settings, and are largely unaware of VA telemedicine programs designed to support them.
Collapse
Affiliation(s)
- Camilla B Pimentel
- New England Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Eileen M Dryden
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Kathryn A Nearing
- Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura M Kernan
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - William W Hung
- Bronx Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
- Icahn School of Medicine, Mount Sinai, New York, USA
| | - Jessica Riley
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Lauren R Moo
- New England Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Harvard Medicine School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Quach ED, Franzosa E, Zhao S, Ni P, Hartmann CW, Moo LR. Home and Community-Based Service Use Varies by Health Care Team and Comorbidity Level of Veterans with Dementia. J Gerontol Soc Work 2024; 67:242-257. [PMID: 37584150 DOI: 10.1080/01634372.2023.2246520] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
Home and community-based services (HCBSs) such as home care and adult day centers are vital to supporting adults with dementia in community settings. We investigated whether HCBS use (use of both home care and adult day, use of one service, and use of neither service) varied between adults receiving care from three types of health-care teams with case management from social workers and nurses, and by comorbidity level, using 2019 data of 143,281 patients with dementia in the Veterans Health Administration. We compared HCBS use by patients' type of case-managed team (Home-Based Primary Care, geriatrics-based primary care, and dementia-focused specialty care) to patients in none of these teams, stratified by patients' non-dementia comorbidities (<4 or ≥4). Each type of health-care team was associated with both home care and adult day services, at each level of comorbidity. Home-Based Primary Care was most consistently associated with other forms of HCBS use, followed by Dementia Clinics and geriatrics-based primary care, for patients with ≥4 non-dementia comorbidities. Our findings suggest that case management in primary and specialty care settings is a contributor to the use of critical community supports by patients with the most complex needs.
Collapse
Affiliation(s)
- Emma D Quach
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System (152), Bedford, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Pengsheng Ni
- Health Law, Policy & Management, Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Lauren R Moo
- New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA
- Harvard Medical School, Neurology, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Tanev KS, Camprodon JA, Caplan DN, Dickerson BC, Chemali Z, Eldaief MC, Kim DD, Josephy-Hernandez SE, Kritzer MD, Moo LR, Newhouse A, Perez DL, Ramirez Gomez LA, Razafsha M, Rivas-Grajales AM, Scharf JM, Schmahmann JD, Sherman JC. Telemedicine-Based Cognitive Examinations During COVID-19 and Beyond: Perspective of the Massachusetts General Hospital Behavioral Neurology & Neuropsychiatry Group. J Neuropsychiatry Clin Neurosci 2023; 36:87-100. [PMID: 38111331 DOI: 10.1176/appi.neuropsych.20220154] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Telehealth and telemedicine have encountered explosive growth since the beginning of the COVID-19 pandemic, resulting in increased access to care for patients located far from medical centers and clinics. Subspecialty clinicians in behavioral neurology & neuropsychiatry (BNNP) have implemented the use of telemedicine platforms to perform cognitive examinations that were previously office based. In this perspective article, BNNP clinicians at Massachusetts General Hospital (MGH) describe their experience performing cognitive examinations via telemedicine. The article reviews the goals, prerequisites, advantages, and potential limitations of performing a video- or telephone-based telemedicine cognitive examination. The article shares the approaches used by MGH BNNP clinicians to examine cognitive and behavioral areas, such as orientation, attention and executive functions, language, verbal learning and memory, visual learning and memory, visuospatial function, praxis, and abstract abilities, as well as to survey for neuropsychiatric symptoms and assess activities of daily living. Limitations of telemedicine-based cognitive examinations include limited access to and familiarity with telecommunication technologies on the patient side, limitations of the technology itself on the clinician side, and the limited psychometric validation of virtual assessments. Therefore, an in-person examination with a BNNP clinician or a formal in-person neuropsychological examination with a neuropsychologist may be recommended. Overall, this article emphasizes the use of standardized cognitive and behavioral assessment instruments that are either in the public domain or, if copyrighted, are nonproprietary and do not require a fee to be used by the practicing BNNP clinician.
Collapse
Affiliation(s)
- Kaloyan S Tanev
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Joan A Camprodon
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - David N Caplan
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Bradford C Dickerson
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Zeina Chemali
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Mark C Eldaief
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - David Dongkyung Kim
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Sylvia E Josephy-Hernandez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Michael D Kritzer
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Lauren R Moo
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Amy Newhouse
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - David L Perez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Liliana A Ramirez Gomez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Mahdi Razafsha
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Ana Maria Rivas-Grajales
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Jeremiah M Scharf
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Jeremy D Schmahmann
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Janet C Sherman
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| |
Collapse
|
6
|
Hawley CE, Wagner C, Venegas MD, Genovese N, Triantafylidis LK, McCullough MB, Beizer JL, Hung WW, Moo LR. Connecting the disconnected: Leveraging an in-home team member for video visits for older adults. J Am Geriatr Soc 2023. [PMID: 37960887 DOI: 10.1111/jgs.18663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Older adults are interested and able to complete video visits, but often require coaching and practice to succeed. Data show a widening digital divide between older and younger adults using video visits. We conducted a qualitative feasibility study to investigate these gaps via ethnographic methods, including a team member in older participants' homes. METHODS This ethnographic feasibility study included a virtual medication reconciliation visit with a clinical pharmacist for Veterans aged 65 and older taking 5 or more medications. An in-home study team member joined the participant and recorded observations in structured fieldnotes derived from the Updated Consolidated Framework for Implementation Research and Age-Friendly Health Systems. Fieldnotes included behind-the-scenes facilitators, barriers, and solutions to challenges before and during the visits. We conducted a thematic analysis of these observations and matched themes to implementation solutions from the Expert Recommendations for Implementing Change. RESULTS Twenty participants completed a video visit. Participants were 74 years old (range 68-80) taking 12 daily medications (range 7-24). Challenges occurred in half of the visits and took the in-home team member and/or pharmacist an average of 10 minutes to troubleshoot. Challenges included notable new findings, such as that half of the participants required technology assistance for challenges that would not have been able to be solved by the pharmacist virtually. Furthermore, although many participants had a device or had used video visits before, some did not have a single device with video, audio, Internet, and access to their email username and password. CONCLUSIONS Clinicians may apply these evidence-based implementation solutions to their approach to video visits with older adults, including having a team member join the visit before the clinician, involving tech-savvy family members, ensuring the device works with the visit platform ahead of time, and creating a troubleshooting guide from our common challenges.
Collapse
Affiliation(s)
- Chelsea E Hawley
- New England Geriatric Research Education and Clinical Center, Bedford VA Medical Center, Bedford, Massachusetts, USA
- Department of Medicine, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Caroline Wagner
- New England Geriatric Research Education and Clinical Center, Bedford VA Medical Center, Bedford, Massachusetts, USA
- Pharmacy Department, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Maria D Venegas
- New England Geriatric Research Education and Clinical Center, Bedford VA Medical Center, Bedford, Massachusetts, USA
- Department of Medicine, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA
| | - Nicole Genovese
- Pain Management, Opioid Safety, and Prescription Drug Monitoring Program, Veterans Affairs New Jersey Healthcare System, East Orange, New Jersey, USA
| | | | - Megan B McCullough
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Judith L Beizer
- College of Pharmacy and Health Sciences, St. John's University, New York, New York, USA
| | - William W Hung
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren R Moo
- New England Geriatric Research Education and Clinical Center, Bedford VA Medical Center, Bedford, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Gately ME, Metcalf EE, Waller DE, McLaren JE, Chamberlin ES, Hawley CE, Venegas M, Dryden EM, O’Connor MK, Moo LR. Caregiver Support Role in Occupational Therapy Video Telehealth: A Scoping Review. Top Geriatr Rehabil 2023; 39:253-265. [PMID: 37901356 PMCID: PMC10601380 DOI: 10.1097/tgr.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Caregiver involvement may facilitate patient participation in occupational therapy (OT) video telehealth. However, little is known about the extent to which caregivers participate and what they do. This scoping review aims to, 1) describe the caregiver role supporting patient participation in OT video telehealth, and, 2) identify barriers and facilitators to caregiver involvement. Findings reveal caregiver involvement in a range of OT evaluation and intervention processes, with details on what caregivers did overall lacking. Barriers and facilitators are also described. This study underscores the need for clear and robust descriptions of caregiver participation to increase best practices in video telehealth.
Collapse
Affiliation(s)
- Megan E. Gately
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- Boston University School of Medicine, Department of Medicine, Division of Geriatrics, Boston, MA, USA
| | - Emily E. Metcalf
- VA Palo Alto Health Care System, National Center for PTSD, Dissemination and Training Division, Menlo Park, CA, USA
| | - Dylan E. Waller
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
| | - Jaye E. McLaren
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
| | - Elizabeth S. Chamberlin
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- VA Bedford Health Care System, VISN 1 Mental Illness Research, Education, and Clinical Center (MIRECC), Bedford, MA, USA
| | - Chelsea E. Hawley
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- Boston University School of Medicine, Department of Medicine, Division of Geriatrics, Boston, MA, USA
| | - Maria Venegas
- Boston University School of Medicine, Department of Medicine, Division of Geriatrics, Boston, MA, USA
- VA Bedford Health Care System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
| | - Eileen M. Dryden
- VA Bedford Health Care System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
| | - Maureen K. O’Connor
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- Boston University School of Medicine, Neurology Department, Boston, MA, USA
| | - Lauren R. Moo
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- Massachusetts General Hospital, Cognitive Behavioral Neurology Unit, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Dinesh D, Shao Q, Palnati M, McDannold S, Zhang Q, Monfared AAT, Jasuja GK, Davila H, Xia W, Moo LR, Miller DR, Palacios N. The epidemiology of mild cognitive impairment, Alzheimer's disease and related dementia in U.S. veterans. Alzheimers Dement 2023; 19:3977-3984. [PMID: 37114952 DOI: 10.1002/alz.13071] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 04/29/2023]
Abstract
INTRODUCTION US veterans have a unique dementia risk profile that may be evolving over time. METHODS Age-standardized incidence and prevalence of Alzheimer's disease (AD), AD and related dementias (ADRD), and mild cognitive impairment (MCI) was estimated from electronic health records (EHR) data for all veterans aged 50 years and older receiving Veterans Health Administration (VHA) care from 2000 to 2019. RESULTS The annual prevalence and incidence of AD declined, as did ADRD incidence. ADRD prevalence increased from 1.07% in 2000 to 1.50% in 2019, primarily due to an increase in the prevalence of dementia not otherwise specified. The prevalence and incidence of MCI increased sharply, especially after 2010. The prevalence and incidence of AD, ADRD, and MCI were highest in the oldest veterans, in female veterans, and in African American and Hispanic veterans. DISCUSSION We observed 20-year trends of declining prevalence and incidence of AD, increasing prevalence of ADRD, and sharply increasing prevalence and incidence of MCI.
Collapse
Affiliation(s)
- Deepika Dinesh
- Department of Public Health, University of Massachusetts at Lowell, Zuckerberg College of Health Sciences, Lowell, Massachusetts, USA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Qing Shao
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Madhuri Palnati
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Sarah McDannold
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Quanwu Zhang
- Easai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
| | - Amir Abbas Tahami Monfared
- Easai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
- McGill University, Epidemiology, Biostatistics, and Occupational Health, Montreal, Quebec, Canada
| | - Guneet K Jasuja
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather Davila
- Center for Access & Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa, USA
- General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Weiming Xia
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren R Moo
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Donald R Miller
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Natalia Palacios
- Department of Public Health, University of Massachusetts at Lowell, Zuckerberg College of Health Sciences, Lowell, Massachusetts, USA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
| |
Collapse
|
9
|
Powers BB, Van Zuilen RM, Schwartz AW, Dang S, McLaren JE, Hoang-Gia D, Moo LR. Competencies for video telemedicine with older adult patients. J Am Geriatr Soc 2023; 71:1283-1290. [PMID: 36951209 DOI: 10.1111/jgs.18246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 03/24/2023]
Abstract
BACKGROUND Telemedicine has recently become a part of mainstream clinical practice. Many curricula have been developed to teach general and specialty-specific video telemedicine skills; however, a lack of defined best practices for translating comprehensive interprofessional geriatric care to the virtual setting presents a unique challenge to educators and clinicians. This manuscript introduces and describes the development of competencies for video telemedicine with older adults for all health professionals who treat them. METHODS A modified Delphi process was used in competency development. In 2019, interprofessional clinicians and educators who had expertise in telemedicine formed a competency development workgroup. The aim was to draft competencies for interprofessional video telemedicine with older adults while not duplicating existing competencies in geriatrics, interprofessional care, or general telemedicine. Draft competencies were circulated among experts in geriatric telemedicine and geriatric education for two rounds of comments. The competencies incorporated comments from 41 clinicians representing 7 professions. RESULTS Twenty-three competencies were created spanning six domains. A temporal organization by domain was used: (1) Overarching considerations, (2) Pre-visit preparation, (3) Beginning of the visit, (4) History taking and communication during the visit, (5) Exam during the visit (organized by the 5Ms: Mind, Mobility, Medication, Multicomplexity, and Matters Most), and (6) Post-visit coordination. CONCLUSIONS These newly developed competencies fill a gap left by those developed for specific disciplines or that do not address considerations for older adults. They lay the groundwork for curriculum development and the development of virtual Age-Friendly care.
Collapse
Affiliation(s)
- Becky B Powers
- Division of Geriatrics Gerontology and Palliative Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
- South Texas Veterans Health Care System Geriatric Research Education and Clinical Center, San Antonio, Texas, USA
| | - Rose Maria Van Zuilen
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrea Wershof Schwartz
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
| | - Stuti Dang
- Departmet of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- VA Miami Health Care System, Geriatric Research Education and Clinical Center, Miami, Florida, USA
| | - Jaye E McLaren
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Bedford Health Care System, Boston, Massachusetts, USA
| | - Dat Hoang-Gia
- VA Palo Alto Health Care System, Geriatric Research Education and Clinical Center, Palo Alto, California, USA
| | - Lauren R Moo
- VA Miami Health Care System, Geriatric Research Education and Clinical Center, Miami, Florida, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
10
|
McLaren JE, Shin MH, Moo LR. Poor insight and future thinking in early dementia limit patient projections of potential utility of technological innovations and advanced care planning. Front Med (Lausanne) 2023; 10:1123331. [PMID: 36993808 PMCID: PMC10040527 DOI: 10.3389/fmed.2023.1123331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
IntroductionCognitive psychology posits that thinking about the future relies on memory such that those with memory impairment may have trouble imaging their future technology and other needs.MethodsWe conducted a content analysis of qualitative data from interviews with six patients with MCI or early dementia regarding potential adaptations to a mobile telepresence robot. Using a matrix analysis approach, we explored perceptions of (1) what technology could help with day-to-day functioning in the present and future and (2) what technology may help people with memory problems or dementia stay home alone safely.ResultsVery few participants could identify any technology to assist themselves or other people with memory problems and could not provide suggestions on what technology may help them stay home alone safely. Most perceived that they would never need robotic assistance.DiscussionThese findings suggest individuals with MCI or early dementia have limited perspectives on their own functional abilities now and in the future. Consideration of the individuals’ diminished understanding of their own future illness trajectory is crucial when engaging in research or considering novel technological management solutions and may have implications for other aspects of advanced care planning.
Collapse
Affiliation(s)
- Jaye E. McLaren
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- *Correspondence: Jaye E. McLaren,
| | - Marlena H. Shin
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Lauren R. Moo
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| |
Collapse
|
11
|
Fritch HA, Moo LR, Sullivan MA, Thakral PP, Slotnick SD. Impaired cognitive performance in older adults is associated with deficits in item memory and memory for object features. Brain Cogn 2023; 166:105957. [PMID: 36731194 DOI: 10.1016/j.bandc.2023.105957] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/02/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Amnestic mild cognitive impairment (aMCI) is associated with damage to the perirhinal/entorhinal cortex, and consequently, deficits in item/object memory. However, cognitive assessments commonly used to identify individuals with aMCI require a clinician to administer and interpret the test. We developed a novel self-administered global cognitive assessment, called the Cognitive Assessment via Keyboard (CAKe). To assess the relationship between CAKe performance and perirhinal/entorhinal cortex-dependent memory function, participants completed the CAKe, a feature source memory task, and a context memory task. During the memory tasks, participants studied line drawings with either a green or orange internal color (feature memory runs) or external color (context memory runs) and then classified each item as old and previously presented with a "green" or "orange" color, or "new". CAKe scores were correlated with item memory accuracies and source memory accuracies on both tasks. Participants with 'impaired' CAKe performance had worse item memory and worse feature source memory accuracies than those with 'normal' CAKe performance. These results demonstrate specific deficits in item memory and feature source memory and suggest that our assessments may be a valid predictor of aMCI memory deficits.
Collapse
Affiliation(s)
- Haley A Fritch
- Department of Psychology and Neuroscience, Boston College, United States.
| | - Lauren R Moo
- New England Geriatrics Research Education and Clinical Center, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | - Preston P Thakral
- Department of Psychology and Neuroscience, Boston College, United States
| | - Scott D Slotnick
- Department of Psychology and Neuroscience, Boston College, United States
| |
Collapse
|
12
|
Dryden EM, Kennedy MA, Conti J, Boudreau JH, Anwar CP, Nearing K, Pimentel CB, Hung WW, Moo LR. Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers. Health Serv Res 2023; 58 Suppl 1:26-35. [PMID: 36054487 PMCID: PMC9843069 DOI: 10.1111/1475-6773.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value. DATA SOURCES In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits. STUDY DESIGN A cross-sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges. DATA COLLECTION We conducted 30 semi-structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach. PRINCIPAL FINDINGS Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow-up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age-Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi-complexity). CONCLUSIONS Alignment of patient and caregiver experiences with widely-used models of comprehensive geriatric care indicates that high-quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine.
Collapse
Affiliation(s)
- Eileen M. Dryden
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Meaghan A. Kennedy
- New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of Family MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Jennifer Conti
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Chitra P. Anwar
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Kathryn Nearing
- Eastern Colorado VA Geriatric Research Education and Clinical CenterAuroraColoradoUSA,Division of Geriatric MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Camilla B. Pimentel
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA,New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of Public Health, Zuckerberg College of Health SciencesUniversity of Massachusetts LowellLowellMassachusettsUSA
| | - William W. Hung
- Bronx Geriatric Research Education and Clinical CenterJames J. Peters VA Medical CenterBronxNew YorkUSA,Department of Geriatrics and Palliative MedicineIcahn School of MedicineNew York CityNew YorkUSA
| | - Lauren R. Moo
- New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
13
|
Abstract
The current article examines the role of caregivers to support patient participation in video telehealth, using data from interviews with occupational therapy practitioners at Veterans Health Administration. We found that caregiver participation allowed patients who might otherwise not be able to access video telehealth to do so, with patient factors, such as low technical literacy, contributing to caregiver involvement. In addition, caregiver participation varied by type of task performed. There were also benefits and barriers to caregiver participation. This study enhances our understanding of caregivers' role enabling patients to access video telehealth, which has implications for nursing professionals. [Journal of Gerontological Nursing, 48(10), 15-20.].
Collapse
|
14
|
Abstract
Objectives: This pilot project aimed to explore a new model of healthcare delivery to older adult medically complex Veterans by combining telehealth technology with an interdisciplinary medical team operating in real time.Methods: The Geriatric-Interdisciplinary Mobile Patient Access Team (G-IMPACT) was comprised of a field team including a nurse practitioner and technology assistant who visited enrolled patients in their homes using synchronous video to link to a suite of geriatric specialists in a video-enabled room at a Veterans Affairs hospital. Clinicians interacted with patients, caregivers, and each other to develop mutually agreed upon treatment plans that were then immediately implemented in the field.Results: 11 total visits were conducted with 9 Veteran patients aged 55-91 (mean = 75.3 years). Both patients and clinicians reported a high level of satisfaction across multiple metrics, including visit quality, and positive indirect indicators of effectiveness were apparent from qualitative data.Conclusions: Nurse practitioner facilitated video visits allowed geriatric patients to meet with multiple specialists simultaneously with both high patient satisfaction and increased real-time care coordination.Clinical Implications: This project identified challenges and opportunities afforded by this type of real-time telehealth care delivery and can inform the development of future interdisciplinary mobile medical teams.
Collapse
Affiliation(s)
- Erica R Appleman
- Edith Nourse Rogers Memorial Veterans Hospital, Department of Psychology, Bedford, Massachusetts, USA
| | - Maureen K O'Connor
- Edith Nourse Rogers Memorial Veterans Hospital, Department of Psychology, Bedford, Massachusetts, USA.,Boston University School of Medicine, Department of Neurology, Boston, Massachusetts, USA
| | - Whitney Rockefeller
- Department of Veterans Affairs Office of Healthcare Transformation, Washington, District of Columbia, USA
| | - Peter Morin
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA
| | - Lauren R Moo
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA.,Harvard Medical School, Department of Neurology, Cambridge, Massachusetts, USA
| |
Collapse
|
15
|
Gately ME, Tickle-Degnen L, McLaren JE, Ward N, Ladin K, Moo LR. Factors Influencing Barriers and Facilitators to In-home Video Telehealth for Dementia Management. Clin Gerontol 2022; 45:1020-1033. [PMID: 34096477 DOI: 10.1080/07317115.2021.1930316] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Quality dementia care, which recognizes caregivers as vital care partners, is a scarce resource. Innovative solutions like video telehealth may increase the reach of extant clinicians; however, little is known about perceived barriers and facilitators to in-home video telehealth for dementia management from the perspectives of caregivers. METHODS Twenty-four caregivers of community-dwelling Veterans with dementia participated in semi-structured interviews. Questions gathered perceived facilitators and barriers to in-home video telehealth for dementia management through experience with related technology. Transcripts were analyzed using directed content analysis which was guided by factors previously identified as influencing older adults' adoption of technology. RESULTS Caregiver experience with related technology was mostly facilitative to video telehealth, which was thought best suited for follow-up care. Increased access and decreased patient-caregiver stress were potential benefits. Barriers included perceived limitations of video and the belief that persons with dementia would have limited ability to manage technological aspects and to engage in video telehealth on their own. CONCLUSIONS This study improves our understanding of the factors that caregivers perceive as barriers and facilitators to in-home video telehealth for dementia management. CLINICAL IMPLICATIONS Strategies to optimize video telehealth include capitalizing on caregivers' social network and providing targeted training.
Collapse
Affiliation(s)
- Megan E Gately
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Linda Tickle-Degnen
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, USA.,Department of Psychology, Tufts University, Medford, Massachusetts, USA
| | - Jaye E McLaren
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Nathan Ward
- Department of Psychology, Tufts University, Medford, Massachusetts, USA
| | - Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, USA.,Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Lauren R Moo
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Miller DR, Jasuja G, Davila HW, Palnati M, Shao Q, Dinesh D, McDannold S, Zhang Q, Monfared AAT, Xia W, Palacios N, Moo LR. Care processes related to clinical detection of Alzheimer's disease in the U.S. Veterans Affairs Health Care System. Alzheimers Dement 2022. [PMID: 34971227 DOI: 10.1002/alz.054149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a debilitating, progressive brain disorder that diminishes quality of life and represents immense burden of public health. This study characterizes healthcare utilization related to clinical detection of AD and care for AD patients in the US Veterans Affairs (VA) Healthcare System. METHODS Using the VA Corporate Data Warehouse (2000-2019), we studied Veterans aged ≥50 years who received ≥2 ICD-10 codes (G30) for AD, with first code appearing in fiscal year 2018. We identified prior related ICD-10 codes and summarized care processes during the years before and the year after the first AD code, including referrals to dementia-related medical specialists (neurologists, geriatricians, geriatric psychiatrists), assessments by neuropsychological tests and radiological brain imaging, dementia medication prescriptions (donepezil, galantamine, memantine, rivastigmine), community-based services (home health, adult day programs), and placements in institutional long-term care in VA or community nursing homes. RESULTS The study cohort consisted of 6,046 Veterans (mean age of 80 years; 3% women; 22% non-White race/ethnicity). Prior to the first ICD coding, 53.1% received codes for non-specific dementia and 29.4% for mild cognitive impairment (MCI), with the first code appearing an average of 3 years before the first AD code. In the year before the first AD code, 51.1% visited specialists, 25.7% received neuropsychological assessments, 31.3% had brain imaging (but only 1.3% had a fluorodeoxyglucose-PET scan), 30.2% received prescriptions for dementia medication, 45.8% received community-based services, and 15.0% were admitted to institutional long-term care. In the year following the initial AD code, 73.2% had specialty visits, 60.5% received dementia prescriptions, 63.6% received community-based services, and 44.2% were admitted for institutional long-term care. CONCLUSIONS Medical and pharmacy utilization for non-specific dementia or MCI begins years before AD detection, marked by the first AD-specific clinical encounter in VA. Many AD patients do not receive specialty care and very few undergo a PET scan before AD detection. Community-based home or day care and institutional nursing care increase with AD detection suggesting a substantial need for healthcare resources.
Collapse
Affiliation(s)
- Donald R Miller
- Center for Healthcare Organization and Implementation Research, VA Bedford Health Care System, Bedford, MA, USA.,Center for Population Health, University of Massachusetts at Lowell, Lowell, MA, USA
| | - Guneet Jasuja
- Center for Healthcare Organization and Implementation Research, VA Bedford Health Care System, Bedford, MA, USA
| | - Heather W Davila
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Madhuri Palnati
- Center for Healthcare Organization and Implementation Research, Bedford, MA, USA
| | - Qing Shao
- Center for Healthcare Organization and Implementation Research, Bedford, MA, USA
| | - Deepika Dinesh
- Center for Population Health, University of Massachusetts at Lowell, Lowell, MA, USA
| | - Sarah McDannold
- Center for Healthcare Organization and Implementation Research, Bedford, MA, USA
| | | | | | - Weiming Xia
- Boston University, Boston, MA, USA.,Geriatric Research Education Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
| | - Natalia Palacios
- Center for Population Health, University of Massachusetts at Lowell, Lowell, MA, USA
| | - Lauren R Moo
- Harvard Medical School, Boston, MA, USA.,Geriatric Research Education Clinical Center, VA Bedford Health Care System, Bedford, MA, USA
| |
Collapse
|
17
|
Gately ME, Muccini S, McLaren JE, Moo LR. Dementia caregivers identify challenges and facilitators to attending health care visits. Alzheimers Dement 2022. [PMID: 34971242 DOI: 10.1002/alz.051842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers identified the need for person-centered dementia care throughout the care continuum. Challenges include adapting health care to meet the complex needs of persons with dementia and their caregivers across a variety of settings. METHOD To understand dementia caregivers' experience of the health care system, we conducted qualitative interviews with twenty-four middle-to-older age caregivers of community-dwelling people with dementia. Data were analyzed using conventional content analysis whereby the coding team sought to identify barriers and facilitators to person-centered dementia care. RESULT We identified three categories and associated sub-categories related to caregiver experience: 1) Preparing for the Visit, with sub-categories Physical Challenges and Emotional Preparation; 2) Visit-Related Time and Travel, with sub-categories General Travel Challenges, Physical Limitations, Cognitive Limitations, and Benefits; and, 3) In-visit Experience, with sub-categories Physical Challenges and Emotional Preparation. Preparing for visit statements revealed barriers, such as patient resistance to attending visits due to not understanding the need. Visit-related time and travel statements reflected a balance of challenges and facilitators, including general challenges such as traffic and dementia-specific challenges such as patient agitation around visit wait times. Facilitators reflected the benefit of visits as opportunities for social participation. In-visit experience statements reflected a mix of challenges and facilitators. Challenges included person with dementia difficulty participating in the health care visit due to poor insight and inability to answer questions, while facilitators included caregivers' positive engagement with the care team. Across categories, caregivers assumed high-level responsibility to accommodate for person with dementia physical and cognitive challenges. CONCLUSION Categories underscore the complexity of health care management for a person with dementia both in and around actual clinic appointments, highlighting both challenges related to person with dementia cognitive deficits and perceived benefits related to visits as opportunities for social participation and accessing resources. This study offers relevant insights about tailoring health care to accommodate for person with dementia deficits while supporting their caregivers.
Collapse
Affiliation(s)
| | | | | | - Lauren R Moo
- Geriatric Research Education Clinical Center, VA Bedford Health Care System, Bedford, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
18
|
Affiliation(s)
- Lauren R Moo
- New England Geriatrics Research Education and Clinical Center, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, Massachusetts
- New England Geriatrics Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| |
Collapse
|
19
|
Moo LR, Martinez E, Padala K, Dunay MA, Scali RR, Chen S, Thielke SM. Unexpected Findings During Double-blind Discontinuation of Acetylcholinesterase Inhibitor Medications. Clin Ther 2021; 43:942-952. [PMID: 34127273 DOI: 10.1016/j.clinthera.2021.05.010] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The long-term effects of acetylcholinesterase inhibitors (AChEIs) used in the treatment of patients with various types of dementia remain unclear, largely due to challenges in the study of their discontinuation. We present several unexpected results from a discontinuation trial that might merit further investigation. METHODS This double-blind, placebo-controlled study of the discontinuation of AChEI medications was conducted in 62 US veterans. Participants were randomized to receive continued treatment with their medication (sham-taper group) or to treatment discontinuation via tapering (real-taper group), over a period of 6 weeks. The primary end point was the patient's/family caregiver's decision to discontinue the study medication. FINDINGS The study was underpowered to detect a significant between-group difference in the primary end point, but examination of the discontinuation process generated several unexpected results: (1) recruitment proved extremely challenging for a variety of reasons, with <5% of potentially eligible participants enrolled; (2) all 3 patients with Parkinson disease-associated dementia showed a worsening of symptoms when they discontinued their AChEI medication, but they showed improvement after they restarted it; (3) changes in symptom-scale scores varied quite broadly across participants, regardless of treatment arm; (4) unusual effects were noted in the sham-taper arm; and (5) the only significant predictor of the decision to discontinue the study medication was a worsening in the caregiver's mood. IMPLICATIONS These findings argue for the use of caution in discontinuing AChEIs in patients with Parkinson disease-associated dementia, although there may be potential benefits of a "drug holiday." The findings also urge the consideration of distress on the part of the caregiver while making medication treatment decisions in dementia. Future research must address challenges with recruitment and symptom fluctuations. (Clin Ther. 2021;43:XXX-XXX) © 2021 Elsevier Inc.
Collapse
Affiliation(s)
- Lauren R Moo
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Erica Martinez
- Puget Sound Veterans Affairs Medical Center, Seattle, Washington.
| | - Kalpana Padala
- Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Megan A Dunay
- Boise Veterans Affairs Medical Center, Boise, Idaho.
| | - Rachael R Scali
- The Department of Biomedical Sciences, Tufts University School of Medicine, Medford, Massachusetts.
| | - Sunny Chen
- Puget Sound Veterans Affairs Medical Center, Seattle, Washington.
| | - Stephen M Thielke
- Puget Sound Veterans Affairs Medical Center, Seattle, Washington; The Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
| |
Collapse
|
20
|
Gately ME, Tickle-Degnen L, Voydetich DJ, Ward N, Ladin K, Moo LR. Video Telehealth Occupational Therapy Services for Older Veterans: National Survey Study. JMIR Rehabil Assist Technol 2021; 8:e24299. [PMID: 33904825 PMCID: PMC8114160 DOI: 10.2196/24299] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 01/01/2023] Open
Abstract
Background Occupational therapy (OT) is a vital service that supports older adults’ ability to age in place. Given the barriers to accessing care, video telehealth is a means of providing OT. Even within Veterans Health Administration (VHA), a pioneer in telehealth, video telehealth by OT practitioners to serve older adults is not well understood. Objective This study examines VHA OT practice using video telehealth with older veterans using an implementation framework. Methods A web-based national survey of VHA OT practitioners conducted between September and October 2019 contained a mix of mostly closed questions with some open-text options. The questions were developed using the Promoting Action on Research Implementation in Health Services model with input from subject matter experts. The questions gathered the extent to which VHA OT practitioners use video telehealth with older veterans; are comfortable with video telehealth to deliver specific OT services; and, for those using video telehealth with older veterans, the barriers, facilitators of change, and perceived benefits of video telehealth. Results Of approximately 1455 eligible VHA OT practitioners, 305 participated (21.0% response rate). Most were female (196/259, 75.7%) occupational therapists (281/305, 92.1%) with a master’s degree (147/259, 56.8%) and 10 years or fewer (165/305, 54.1%) of VHA OT practice. Less than half (125/305, 41.0%) had used video telehealth with older veterans, and users and nonusers of video telehealth were demographically similar. When asked to rate perceived comfort with video telehealth to deliver OT services, participants using video telehealth expressed greater comfort than nonusers, which was significant for 9 of the 13 interventions: activities of daily living (P<.001), instrumental activities of daily living (P=.004), home safety (P<.001), home exercise or therapeutic exercise (P<.001), veteran or caregiver education (P<.001), durable medical equipment (P<.001), assistive technology (P<.001), education and work (P=.04), and wheelchair clinic or seating and positioning (P<.001). More than half (74/125, 59.2%) of those using video telehealth reported at least one barrier, with the most frequently endorsed being Inadequate space, physical locations and related equipment. Most (92/125, 73.6%) respondents using video telehealth reported at least one facilitator, with the most frequently endorsed facilitators reflecting respondent attitudes, including the belief that video telehealth would improve veteran access to care (77/92, 84%) and willingness to try innovative approaches (76/92, 83%). Conclusions Most VHA OT survey respondents had not used video telehealth with older veterans. Users and nonusers were demographically similar. Differences in the percentages of respondents feeling comfortable with video telehealth for specific OT interventions suggest that some OT services may be more amenable to video telehealth. This, coupled with the primacy of respondent beliefs versus organizational factors as facilitators, underscores the need to gather clinicians’ attitudes to understand how they are driving the implementation of video telehealth.
Collapse
Affiliation(s)
- Megan E Gately
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Bedford, MA, United States
| | - Linda Tickle-Degnen
- Department of Occupational Therapy, Tufts University, Medford, MA, United States.,Department of Psychology, Tufts University, Medford, MA, United States
| | - Deborah J Voydetich
- Department of Veterans Affairs, Veterans Affairs Central Office, Washington, DC, United States
| | - Nathan Ward
- Department of Psychology, Tufts University, Medford, MA, United States
| | - Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, MA, United States.,Department of Community Health, Tufts University, Medford, MA, United States.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Lauren R Moo
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Bedford, MA, United States.,Department of Neurology, Harvard Medical School, Cambridge, MA, United States
| |
Collapse
|
21
|
Jeye BM, Kark SM, Spets DS, Moo LR, Kensinger EA, Slotnick SD. Support for an inhibitory model of word retrieval. Neurosci Lett 2021; 755:135876. [PMID: 33831498 DOI: 10.1016/j.neulet.2021.135876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/31/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
Word retrieval may involve an inhibitory process in which a target word is activated and related words are suppressed. In the current functional magnetic resonance imaging (fMRI) study, we examined the inhibition of language processing cortex by the left dorsolateral prefrontal cortex (DLPFC) during word retrieval using an anagram-solving paradigm. Participants were presented with a distractor that was read aloud followed by a to-be-solved anagram. Distractor types were defined relative to orthographic overlap with the subsequent anagram solution and included related words with one letter different (e.g., "gripe" for the anagram of "price"), related pseudo-words, and unrelated words (i.e., all five letters were different). The anagram solution reaction time was slower in both the related word and related pseudo-word distractor conditions as compared to the unrelated word distractor condition, which can be attributed to greater inhibition following related distractors. The contrast of related words and unrelated words produced one activation in the left DLPFC, a region that has been associated with memory inhibition. To identify the regions that were negatively correlated with activity in the left DLPFC for related distractors, we conducted a functional connectivity analysis between this left DLPFC region and the rest of the brain. We found negatively correlated activity between the DLPFC and language processing cortex for the related word distractor condition (and the related pseudo-word distractor condition at a relaxed threshold). These findings suggest that that the left DLPFC may inhibit related word (and pseudo-word) representations in language processing cortex.
Collapse
Affiliation(s)
- Brittany M Jeye
- Department of Psychology, Worchester State University, United States.
| | - Sarah M Kark
- Center for Neurobiology of Learning and Memory, University of California, Irvine, United States
| | - Dylan S Spets
- Department of Psychology, Boston College, United States
| | - Lauren R Moo
- Department of Neurology, Massachusetts General Hospital, United States
| | | | | |
Collapse
|
22
|
Gately ME, Tickle-Degnen L, Trudeau SA, Ward N, Ladin K, Moo LR. Caregiver Satisfaction with a Video Telehealth Home Safety Evaluation for Dementia. Int J Telerehabil 2020; 12:35-42. [PMID: 33520093 PMCID: PMC7757646 DOI: 10.5195/ijt.2020.6337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/20/2022] Open
Abstract
Family caregivers are vital to telehealth-delivered dementia care. The objective of this mixed methods descriptive study conducted in the VA Bedford Healthcare System was to examine caregiver satisfaction with a video telehealth dementia home safety occupational therapy evaluation. Ten caregivers of Veterans with dementia participated. Ratings of caregiver satisfaction, measured by nine Likert scale items including ability to see and hear, were examined in relation to person and visit-related contextual factors extracted from research assistants' field notes, to develop an in-depth understanding of caregiver experience. Person factors included caregiver age and gender and Veteran cognitive status. Visit-related contextual factors included occurrence of technical glitches. Caregiver visit satisfaction was overall positive, with exceptions related to technological glitches and the presence of the person with dementia during the visit. Veteran cognitive status appeared to influence caregiver satisfaction. Implications of the study are that proactively addressing technical glitches and incorporating dementia stage-specific approaches may optimize caregivers' telehealth experience.
Collapse
Affiliation(s)
- Megan E Gately
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, United States
| | - Linda Tickle-Degnen
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, United States
- Department of Psychology, Tufts University, Medford, Massachusetts, United States
| | - Scott A Trudeau
- American Occupational Therapy Association, Bethesda, Maryland, United States
| | - Nathan Ward
- Department of Psychology, Tufts University, Medford, Massachusetts, United States
| | - Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, United States
- Department of Community Health, Tufts University, Medford, Massachusetts, United States
| | - Lauren R Moo
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, United States
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, United States
| |
Collapse
|
23
|
Abstract
Telehealth visits using a video-to-home format are opportunities for virtual house calls. Embracing the benefits of the format allows a patient-centered approach to care that can reveal things that in-person clinic visits may miss.
Collapse
Affiliation(s)
- Lauren R Moo
- New England Geriatric Research Education and Clinical Center, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Hawley CE, Genovese N, Owsiany MT, Triantafylidis LK, Moo LR, Linsky AM, Sullivan JL, Paik JM. Rapid Integration of Home Telehealth Visits Amidst COVID-19: What Do Older Adults Need to Succeed? J Am Geriatr Soc 2020; 68:2431-2439. [PMID: 32930391 DOI: 10.1111/jgs.16845] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Our objective was to identify and address patient-perceived barriers to integrating home telehealth visits. DESIGN We used an exploratory sequential mixed-methods design to conduct patient needs assessments, a home telehealth pilot, and formative evaluation of the pilot. SETTING Veterans Affairs geriatrics-renal clinic. PARTICIPANTS Patients with scheduled clinic visits from October 2019 to April 2020. MEASUREMENTS We conducted an in-person needs assessment and telephone postvisit interviews. RESULTS Through 50 needs assessments, we identified patient-perceived barriers in interest, access to care, access to technology, and confidence. A total of 34 (68%) patients were interested in completing a home telehealth visit, but fewer (32 (64%)) had access to the necessary technology or were confident (21 (42%)) that they could participate. We categorized patients into four phenotypes based on their interest and capability to complete a home telehealth visit: interested and capable, interested and incapable, uninterested and capable, and uninterested and incapable. These phenotypes allowed us to create trainings to overcome patient-perceived barriers. We completed 32 home telehealth visits and 12 postvisit interviews. Our formative evaluation showed that our pilot was successful in addressing many patient-perceived barriers. All interviewees reported that the home telehealth visits improved their well-being. Home telehealth visits saved participants an average of 166 minutes of commute time. Five participants borrowed a device from a family member, and five visits were finished via telephone. All participants successfully completed a home telehealth visit. CONCLUSIONS We identified patient-perceived barriers to home telehealth visits and classified patients into four phenotypes based on these barriers. Using principles of implementation science, our home telehealth pilot addressed these barriers, and all patients successfully completed a visit. Future study is needed to understand methods to deploy larger-scale efforts to integrate home telehealth visits into the care of older adults.
Collapse
Affiliation(s)
- Chelsea E Hawley
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Nicole Genovese
- Department of Pharmacy, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Montgomery T Owsiany
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | | | - Lauren R Moo
- New England Geriatric Research, Education and Clinical Center, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy M Linsky
- Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA.,General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie M Paik
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Renal Section, VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
25
|
Abstract
Objectives: Persons with dementia face barriers to attending in-person medical care. Despite the potential for video telemedicine to ameliorate these barriers, little is known about in-home video telemedicine for dementia.Methods: Outpatients of a dementia clinic were invited to participate in in-home video telemedicine, and reasons for enrolling or declining were tracked. Visit experience was directly compared between in-person and video visits.Results: Of 230 families invited to enroll in video telemedicine, 96% agreed to join or gave reasons for declining, with the primary reasons for participating being convenience and less disruption of routines. Lack of a computer was the main reason for declining. Those who agreed to participate and those who declined were demographically similar in terms of race and education, but slightly younger in the telemedicine group (patient mean age 79 v 84). Equivalent visit satisfaction was reported between in-person and video telemedicine.Conclusions: Persons with dementia and their families were willing to enroll in an in-home telemedicine clinic. Satisfaction with home visits was high and equal to in-clinic visits.Clinical implications: Video telemedicine is a promising dementia service delivery model for rural patients and others for whom travel to a specialty clinic is burdensome.Abbreviations: ADL: Activities of Daily Living; Home-CVT: Home Clinical Video Telehealth; iADL: Instrumental Activity of Daily Living; GRECC: The New England Geriatric Research Education and Clinical Center; IM: Instant Messaging; LTC: long term care; THT: Telehealth Technician; VA: Veterans Affairs; VAMC: Veterans Affairs Medical Center.
Collapse
Affiliation(s)
- Lauren R Moo
- Geriatric Research Education and Clinical Center, Bedford VAMC-GRECC, MA, USA
| | - Megan E Gately
- Geriatric Research Education and Clinical Center, Bedford VAMC-GRECC, MA, USA
| | - Zehra Jafri
- College of Human Ecology, Cornell University, Ithaca, USA
| | - Steven D Shirk
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Addiction and Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
26
|
Hebert CA, Trudeau SA, Sprinkle W, Moo LR, McConnell ES. Directed content analysis of Veterans Affairs policy documents: A strategy to guide implementation of a dementia home safety toolkit for Veterans to promote ageing in place. Health Soc Care Community 2020; 28:182-194. [PMID: 31523881 DOI: 10.1111/hsc.12852] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
Older adults' preference to age in place, coupled with an increasing prevalence of dementia, creates an imperative to address home safety risks that occur due to cognitive impairment. Providing caregivers with home safety items and education can facilitate ageing in place for older adults living with dementia. In 2015-2017, we examined barriers and facilitators within 17 policy documents and dementia guidelines of the United States (US) Veterans Health Administration pertinent to implementation of a home safety toolkit (HST) for Veterans living with dementia. The documents were issued from 2000 to 2015. Directed qualitative content analysis of these documents guided by themes from stakeholder interviews revealed two key implementation barriers: a focus on physical rather than cognitive risks when determining medical necessity for home equipment, and a focus on rehabilitation and treatment rather than prevention. Mandates for person-centred care planning, including comprehensive assessment, interdisciplinary collaboration, staff education and a focus on population health in primary care facilitate HST implementation. Content analysis can identify policy-level barriers that slow innovation and facilitators that can increase access to care that support ageing in place.
Collapse
Affiliation(s)
| | - Scott A Trudeau
- American Occupational Therapy Association, Inc., Bethesda, Maryland
- NE Geriatric Research Education and Clinical Center, Bedford, Massachusetts
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts
| | | | - Lauren R Moo
- New England GRECC, ENRM VAMC, Bedford, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Eleanor S McConnell
- Durham VA Geriatric Research, Education and Clinical Center (GRECC), Durham, North Carolina
- Duke University School of Nursing, Durham, North Carolina
| |
Collapse
|
27
|
Hatcher-Martin JM, Adams JL, Anderson ER, Bove R, Burrus TM, Chehrenama M, Dolan O'Brien M, Eliashiv DS, Erten-Lyons D, Giesser BS, Moo LR, Narayanaswami P, Rossi MA, Soni M, Tariq N, Tsao JW, Vargas BB, Vota SA, Wessels SR, Planalp H, Govindarajan R. Telemedicine in neurology. Neurology 2019; 94:30-38. [DOI: 10.1212/wnl.0000000000008708] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/06/2019] [Indexed: 11/15/2022] Open
Abstract
PurposeWhile there is strong evidence supporting the importance of telemedicine in stroke, its role in other areas of neurology is not as clear. The goal of this review is to provide an overview of evidence-based data on the role of teleneurology in the care of patients with neurologic disorders other than stroke.Recent findingsStudies across multiple specialties report noninferiority of evaluations by telemedicine compared with traditional, in-person evaluations in terms of patient and caregiver satisfaction. Evidence reports benefits in expediting care, increasing access, reducing cost, and improving diagnostic accuracy and health outcomes. However, many studies are limited, and gaps in knowledge remain.SummaryTelemedicine use is expanding across the vast array of neurologic disorders. More studies are needed to validate and support its use.
Collapse
|
28
|
Pimentel CB, Gately M, Barczi SR, Boockvar KS, Bowman EH, Caprio TV, Colón-Emeric CS, Dang S, Espinoza SE, Garner KK, Griffiths PC, Howe JL, Lum HD, Markland AD, Rossi MI, Thielke SM, Valencia-Rodrigo WM, Moo LR, Hung WW. GRECC Connect: Geriatrics Telehealth to Empower Health Care Providers and Improve Management of Older Veterans in Rural Communities. Fed Pract 2019; 36:464-470. [PMID: 31768097 PMCID: PMC6837335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A telehealth program supports meaningful partnerships between urban geriatric specialists and rural health care providers to facilitate increased access to specialty care.
Collapse
Affiliation(s)
- Camilla B Pimentel
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Megan Gately
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Steven R Barczi
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Kenneth S Boockvar
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Ella H Bowman
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Thomas V Caprio
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Cathleen S Colón-Emeric
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Stuti Dang
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Sara E Espinoza
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Kimberly K Garner
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Patricia C Griffiths
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Judith L Howe
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Hillary D Lum
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Alayne D Markland
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Michelle I Rossi
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Stephen M Thielke
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Willy M Valencia-Rodrigo
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - Lauren R Moo
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| | - William W Hung
- is a Research Health Scientist at the Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center (GRECC), and is a Program Manager and is Site Director at the New England GRECC, Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. is a Physician at Madison GRECC, William S. Middleton Memorial Veterans Hospital in Wisconsin. is Associate Director (research), J is Deputy Director, and is Associate Director (clinical) at Bronx/NY Harbor GRECC, James J. Peters Veterans Affairs Medical Center in New York. is a Geriatrician and is Associate Director (clinical) at the Birmingham/Atlanta GRECC in Alabama. is a Geriatrician at the Canandaigua VA Medical Center in New York. is Associate Director (clinical) at the Durham GRECC, Durham VA Medical Center in North Carolina. and are Geriatricians at the Miami GRECC, Miami VA Healthcare System in Florida. is Associate Director (clinical) at the San Antonio GRECC, Audie L. Murphy Memorial VA Hospital in Texas. is Associate Director (education & evaluation) at the Little Rock GRECC, Central Arkansas Veterans Healthcare System. is a Research Health Scientist at the Birmingham/Atlanta GRECC, Atlanta VA Medical Center in Decatur, Georgia. is a Geriatrician at the Eastern Colorado GRECC, VA Eastern Colorado Health Care System in Denver. is Associate Director (clinical) at the Pittsburgh GRECC, VA Pittsburgh Healthcare System in Pennsylvania. is Associate Director (education & evaluation) at the Puget Sound GRECC, Puget Sound VA Medical Center in Seattle, Washington
| |
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW The progressive nature of dementia requires ongoing care delivered by multidisciplinary teams, including rehabilitation professionals, that is individualized to patient and caregiver needs at various points on the disease trajectory. Video telehealth is a rapidly expanding model of care with the potential to expand dementia best practices by increasing the reach of dementia providers to flexible locations, including patients' homes. We review recent evidence for in-home video telehealth for patients with dementia and their caregivers with emphasis on implications for rehabilitation professionals. RECENT FINDINGS Eleven studies were identified that involved video visits into the home targeting patients with dementia and/or their family caregivers. The majority describe protocolized interventions targeting caregivers in a group format over a finite, pre-determined period. For most, the discipline of the interventionist was unclear, though two studies included rehabilitation interventions. While descriptions of utilized technology were often lacking, many reported that devices were issued to participants when needed, and that technical support was provided by study teams. Positive caregiver outcomes were noted but evidence for patient-level outcomes and cost data are mostly lacking. SUMMARY More research is needed to demonstrate implementation of dementia best care practices through in-home video telehealth. Though interventions delivered using in-home video telehealth appear to be effective at addressing caregivers' psychosocial concerns, the impact on patients and the implications for rehabilitation remain unclear. Larger, more systematic inquiries comparing in-home video telehealth to traditional visit formats are needed to better define best practices.
Collapse
|
30
|
Abstract
Video telehealth can increase access to home-based care, thus allowing older adults to maintain functional independence and age-in-place. This is particularly salient for persons with dementia whose cognitive changes increase home safety risk. Little is known about the technological and safety challenges of in-home assessment via video. This feasibility study explored the process and resource requirements of a remotely delivered telehealth occupational therapy home safety evaluation from a Veterans Health Administration (VHA) site. A total of 10 caregivers of veterans with dementia received home safety evaluations using videoconferencing technology using a variety of portable computing devices. Most telehealth evaluations experienced technological difficulties, but formal technical support was only required twice. Videoconferencing is a feasible service delivery option for home safety evaluations; however, infrastructure must support technological needs and client or provider gaps in knowledge. Implications for non-VHA settings and other interventions using videoconferencing are discussed.
Collapse
Affiliation(s)
- Megan E Gately
- Bedford VA Medical Center, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
| | - Scott A Trudeau
- The American Occupational Therapy Association Inc., Bethesda, MD, USA
| | - Lauren R Moo
- Bedford VA Medical Center, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
| |
Collapse
|
31
|
Leeman-Markowski BA, Meador KJ, Moo LR, Cole AJ, Hoch DB, Garcia E, Schachter SC. Does memantine improve memory in subjects with focal-onset epilepsy and memory dysfunction? A randomized, double-blind, placebo-controlled trial. Epilepsy Behav 2018; 88:315-324. [PMID: 30449328 PMCID: PMC7261142 DOI: 10.1016/j.yebeh.2018.06.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 06/02/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Excitotoxic injury involving N-methyl-d-aspartate (NMDA) receptor hyperactivity contributes to epilepsy-related memory dysfunction (ERMD). Current treatment strategies for ERMD have limited efficacy and fail to target the underlying pathophysiology. The present pilot study evaluated the efficacy of memantine, an NMDA receptor antagonist, for the treatment of ERMD in adults with focal-onset seizures. METHODS Subjects underwent cognitive testing at baseline, after a 13-week randomized, parallel-group, double-blinded phase (of memantine titrated to 10 mg bid or placebo), and following a 13-week open-label extension phase (of memantine titrated to 10 mg bid). The selective reminding test (SRT) continuous long-term retrieval (CLTR) score and 7/24 Spatial Recall Test learning score served as the primary outcome measures. Secondary measures included tests of attention span, fluency, visual construction, and response inhibition, as well as assessments of quality of life, depression, sleepiness, and side effects. RESULTS Seventeen subjects contributed data to the blinded phase (n = 8 memantine, n = 9 placebo). No significant differences were seen between groups on the primary or secondary outcome measures. Pooled data at the end of the open-label phase from 10 subjects (initially randomized to memantine n = 3 or placebo n = 7) demonstrated statistically significant improvement from baseline in CLTR score, memory-related quality of life, spatial span, and response inhibition. No significant changes were evident in depression, sleepiness, side effects, or seizure frequency throughout the trial. SIGNIFICANCE Results demonstrated no significant effect of memantine on cognition when assessed at the end of the blinded period. Pooled data at the end of the open-label phase showed significant improvement over baseline performance in measures of verbal memory, frontal-executive function, and memory-related quality of life. These improvements, however, may be due to practice effects and should be interpreted cautiously. Findings suggest a favorable safety profile of memantine in the setting of epilepsy.
Collapse
Affiliation(s)
- Beth A. Leeman-Markowski
- Research Service, VA New York Harbor Healthcare System, New York, NY, USA,Department of Neurology, New York University Langone Medical Center, New York, NY, USA,Corresponding author at: 423 E. 23rd St., New York, NY 10010, USA. (B.A. Leeman-Markowski)
| | - Kimford J. Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lauren R. Moo
- Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Andrew J. Cole
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Daniel B. Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Eduardo Garcia
- Tufts University School of Medicine, Boston, MA, USA,Newton–Wellesley Neurology Associates, PC, Newton Lower Falls, MA, USA
| | - Steven C. Schachter
- Harvard Medical School, Boston, MA, USA,Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
32
|
Govindarajan R, Anderson ER, Hesselbrock RR, Madhavan R, Moo LR, Mowzoon N, Otis J, Rubin MN, Soni M, Tsao JW, Vota S, Planalp H. Developing an outline for teleneurology curriculum. Neurology 2017; 89:951-959. [DOI: 10.1212/wnl.0000000000004285] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 06/06/2017] [Indexed: 11/15/2022] Open
Abstract
The emerging field of teleneurology is delivering quality care to neurologic patients in increasingly numerous technologies and configurations. Teleneurology is well-positioned to address many of the logistical issues neurologists and their patients encounter today. However, formalized medical training has not caught up with this developing field, and there is a lack of formal education concentrating on the specific opportunities and challenges of teleneurology. Considering this, the American Academy of Neurology Telemedicine Work Group identified equivalencies with which any practitioner of teleneurology should be familiar. The purpose of this curriculum is not to define teleneurology or mandate where its use is appropriate, but rather to provide guidance on basic equivalencies that students, residents, and practitioners should know while practicing teleneurology. Comprehensive training in clinical bedside neurology is necessary to safely practice teleneurology and the components of this curriculum are an extension of that training. In this article, we offer a detailed discussion on the rationale for the contents of this curriculum and conclude by providing a model curriculum and an outline for evaluating residents in teleneurology.
Collapse
|
33
|
Moo LR, Jafri Z, Morin PJ. Home-Based Video Telehealth for Veterans With Dementia. Fed Pract 2014; 31:36-38. [PMID: 29398887 PMCID: PMC5794024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In-home video telehealth supplements office visits and offers comfort and convenience to patients with dementia and their caregivers.
Collapse
|
34
|
Shapiro KA, Moo LR, Caramazza A. Neural Specificity for Grammatical Operations is Revealed by Content-Independent fMR Adaptation. Front Psychol 2012; 3:26. [PMID: 22347206 PMCID: PMC3274744 DOI: 10.3389/fpsyg.2012.00026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 03/29/2011] [Accepted: 01/19/2012] [Indexed: 11/13/2022] Open
Abstract
The ability to generate novel sentences depends on cognitive operations that specify the syntactic function of nouns, verbs, and other words retrieved from the mental lexicon. Although neuropsychological studies suggest that such operations rely on neural circuits distinct from those encoding word form and meaning, it has not been possible to characterize this distinction definitively with neuroimaging. We used functional magnetic resonance imaging (fMRI) to show that a brain area engaged in a given grammatical operation can be identified uniquely by a monotonic decrease in activation as that operation is repeated. We applied this methodology to identify areas involved selectively in the operation of inflection of nouns or verbs. By contrast, areas involved in processing word meaning do not show this monotonic adaptation across stimuli. These results are the first to demonstrate adaptation in the fMR signal evoked not by specific stimuli, but by well-defined cognitive linguistic operations.
Collapse
Affiliation(s)
- Kevin A Shapiro
- Department of Psychology, Harvard University Cambridge, MA, USA
| | | | | |
Collapse
|
35
|
Willms JL, Shapiro KA, Peelen MV, Pajtas PE, Costa A, Moo LR, Caramazza A. Language-invariant verb processing regions in Spanish-English bilinguals. Neuroimage 2011; 57:251-261. [PMID: 21515387 PMCID: PMC3103832 DOI: 10.1016/j.neuroimage.2011.04.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [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: 01/10/2011] [Revised: 03/16/2011] [Accepted: 04/08/2011] [Indexed: 11/21/2022] Open
Abstract
Nouns and verbs are fundamental grammatical building blocks of all languages. Studies of brain-damaged patients and healthy individuals have demonstrated that verb processing can be dissociated from noun processing at a neuroanatomical level. In cases where bilingual patients have a noun or verb deficit, the deficit has been observed in both languages. This suggests that the noun-verb distinction may be based on neural components that are common across languages. Here we investigated the cortical organization of grammatical categories in healthy, early Spanish-English bilinguals using functional magnetic resonance imaging (fMRI) in a morphophonological alternation task. Four regions showed greater activity for verbs than for nouns in both languages: left posterior middle temporal gyrus (LMTG), left middle frontal gyrus (LMFG), pre-supplementary motor area (pre-SMA), and right middle occipital gyrus (RMOG); no regions showed greater activation for nouns. Multi-voxel pattern analysis within verb-specific regions showed indistinguishable activity patterns for English and Spanish, indicating language-invariant bilingual processing. In LMTG and LMFG, patterns were more similar within than across grammatical category, both within and across languages, indicating language-invariant grammatical class information. These results suggest that the neural substrates underlying verb-specific processing are largely independent of language in bilinguals, both at the macroscopic neuroanatomical level and at the level of voxel activity patterns.
Collapse
Affiliation(s)
- Joanna L Willms
- Harvard University, USA; Massachusetts General Hospital, USA
| | - Kevin A Shapiro
- Harvard University, USA; Massachusetts General Hospital, USA; Children's Hospital Boston, USA; Harvard Medical School, USA
| | - Marius V Peelen
- Harvard University, USA; Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy
| | - Petra E Pajtas
- Harvard University, USA; Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy
| | | | - Lauren R Moo
- Massachusetts General Hospital, USA; Harvard Medical School, USA
| | - Alfonso Caramazza
- Harvard University, USA; Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy.
| |
Collapse
|
36
|
Abstract
Human motion processing region MT + is retinotopically organized with perception of and attention to motion in the right visual field preferentially associated with left MT + activity and vice versa. However, the degree to which MT + is crucial for motion processing is uncertain. We report an epilepsy patient with visual symptoms early in his seizure evolution and a left temporal-occipital seizure onset electrographically in whom we hypothesized a functional left MT + lesion. The patient was impaired in his right but not left visual field on a hemifield motion attention task and demonstrated worse performance on a hemifield picture identification task when pictures implying motion were presented in the right as opposed to the left visual field. Functional MRI (fMRI) during a full-field motion detection task activated right MT + but failed to activate left MT + despite activating both left and right MT + in each of 10 controls. Furthermore, fMRI during a hemifield motion attention task also showed a lack of left MT + attention effects in the patient. Together these results suggest that MT + is necessary for normal motion processing.
Collapse
Affiliation(s)
- Lauren R Moo
- Neuropsychology Laboratory, Department of Neurology, Massachusetts General Hospital, Boston, MA02114, USA.
| | | | | |
Collapse
|
37
|
Abstract
In this study, we ask whether or not the involuntary capture of attention by a specific information type can produce domain-specific activation. Participants indicated the presence of a flicker in rapidly alternating letter-string masks presented in the periphery. Despite letters not being relevant to the task, we found, using functional MRI and a novel task that allowed us to contrast attended and unattended processing of the same visual information, a robust modulation by attentional capture in a localized letter-processing region. This finding suggests that the involuntary capture of attention is sufficient to produce domain-specific activation in early visual processing.
Collapse
Affiliation(s)
- Matthew Finkbeiner
- Macquarie Centre for Cognitive Science, Macquarie University, Sydney, Australia.
| | | | | | | |
Collapse
|
38
|
Ellis RJ, Evans SR, Clifford DB, Moo LR, McArthur JC, Collier AC, Benson C, Bosch R, Simpson D, Yiannoutsos CT, Yang Y, Robertson K. Clinical validation of the NeuroScreen. J Neurovirol 2006; 11:503-11. [PMID: 16338744 DOI: 10.1080/13550280500384966] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The NeuroScreen comprises two easily administered components: the Brief NeuroCognitive Screen (BNCS), designed to estimate the frequency of human immunodeficiency virus (HIV)-associated cognitive disorders; and the Brief Peripheral Neuropathy Screen (BPNS), for distal sensory polyneuropathy (DSPN) in HIV. In this study, both the NeuroScreen and a more extensive standardized validation neurodiagnostic evaluation were administered to HIV-positive subjects (N = 301) enrolled in two large cohort studies at multiple sites. BNCS performance was summarized in the form of a demographically adjusted mean z-score, the NPZ3. The area under the receiver-operating characteristic (ROC) curve for the BNCS as compared to the reference standard neuropsychological (NP) evaluation was 0.74 (95% confidence interval [CI] 0.69, 0.79). Using a cut-point of -0.33 on the NPZ3 provided a correct classification rate of 68%, with roughly balanced sensitivity (65%) and specificity (72%). Under the assumption of a 30% prevalence of cognitive impairment, the calculated positive predictive value (PPV) of the BNCS was 86%. Relative to its reference standard, a modified Total Neuropathy Score (TNS) administered by a neurologist, the BPNS gave a similar correct diagnostic classification rate of 78%; sensitivity 49% [95%, 60%]; specificity 88% [95% Cl82%, 91%]. Under the assumption of a 40% prevalence of DSPN, the PPV of the BPNS was 72%. These predictive values suggest that the NeuroScreen will be useful for tracking trends in the prevalence of HIV-associated neurologic disease in large cohorts in the era of combination antiretroviral therapy. However, because it yields substantial numbers of false positives and negatives, the NeuroScreen may be less useful in evaluating individual patients.
Collapse
Affiliation(s)
- Ronald J Ellis
- Department of Neurosciences, UCSD AntiViral Research Center and HIV Neurobehavioral Research Center, University of California, San Diego, California 92103, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Categories like "noun" and "verb" represent the basic units of grammar in all human languages, and the retrieval of categorical information associated with words is an essential step in the production of grammatical speech. Studies of brain-damaged patients suggest that knowledge of nouns and verbs can be spared or impaired selectively; however, the neuroanatomical correlates of this dissociation are not well understood. We used event-related functional MRI to identify cortical regions that were active when English-speaking subjects produced nouns or verbs in the context of short phrases. Two regions, in the left prefrontal cortex and left superior parietal lobule, were selectively activated for verb trials compared with noun trials; one region in the left inferior temporal lobe was more active during noun production than verb production. We propose that these regions are involved in representing core conceptual properties of nouns and verbs.
Collapse
Affiliation(s)
- Kevin A Shapiro
- Department of Psychology, Harvard University, 33 Kirkand Street, Cambridge, MA 02138, USA
| | | | | |
Collapse
|
40
|
Abstract
During visual spatial perception of multiple items, the left hemisphere has been shown to preferentially process categorical spatial relationships while the right hemisphere has been shown to preferentially process coordinate spatial relationships. We hypothesized that this hemispheric processing distinction would be reflected in the prefrontal cortex during categorical and coordinate visual spatial memory, and tested this hypothesis using functional magnetic resonance imaging (fMRI). During encoding, abstract shapes were presented in the left or right hemifield in addition to a dot at a variable distance from the shape (with some dots on the shape); participants were instructed to remember the position of each dot relative to the shape. During categorical memory retrieval, each shape was presented centrally and participants responded whether the previously corresponding dot was 'on' or 'off' of the shape. During coordinate memory retrieval, each shape was presented centrally and participants responded whether the previously corresponding dot was 'near' or 'far' from the shape (relative to a reference distance). Consistent with our hypothesis, a region in the left prefrontal cortex (BA10) was preferentially associated with categorical visual spatial memory and a region in the right prefrontal cortex (BA9/10) was preferentially associated with coordinate visual spatial memory. These results have direct implications for interpreting previous findings that the left prefrontal cortex is associated with source memory, as this cognitive process is categorical in nature, and the right prefrontal cortex is associated with item memory, as this process depends on the precise spatial relations among item features or components.
Collapse
Affiliation(s)
- Scott D Slotnick
- Department of Psychology, McGuinn Hall, Boston College, Chestnut Hill, MA 02467, USA.
| | | |
Collapse
|
41
|
Abstract
It has been conventionally assumed that cortically based quadrantic visual field deficits (homonymous quadrantanopias) are caused by lesions in striate cortex (V1), extending precisely to the horizontal meridian representation. A more recent model, supported by anatomic MRI evidence, consists of an exclusively extrastriate cortical basis (e.g. V2, V3, VP, V4v). Employing fMRI, we sought to distinguish between these models through retinotopic mapping of a patient with an upper right homonymous quadrantanopia. As expected, maps of the lower right quadrant and left hemifield were normal. The map corresponding to the impaired upper right quadrant was normal in V1 and V2, with little or no activity in VP and V4v. These results provide functional evidence that extrastriate cortical lesions can elicit homonymous quadrantanopias.
Collapse
Affiliation(s)
- Scott D Slotnick
- Department of Psychology, Harvard University, William James Hall, 33 Kirkland St, Cambridge, MA 02138, USA.
| | | |
Collapse
|
42
|
Slotnick SD, Moo LR, Segal JB, Hart J. Distinct prefrontal cortex activity associated with item memory and source memory for visual shapes. Brain Res Cogn Brain Res 2003; 17:75-82. [PMID: 12763194 DOI: 10.1016/s0926-6410(03)00082-x] [Citation(s) in RCA: 555] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In contrast to item memory, which refers to recognition or recall of previously presented information, source memory refers to memory for the context of previously presented information. The relatively few functional MRI (fMRI) source memory studies conducted to date have provided evidence that item memory and source memory are associated with differential activity in right and left prefrontal cortex, respectively. To both confirm this distinction in prefrontal cortex and to determine whether other differences in the neural substrates associated with these cognitive functions exist, an event-related fMRI study was conducted. In this study, item memory and source memory encoding phases were identical; participants viewed a series of abstract visual shapes presented on the left or right side of the screen and were instructed to remember each shape and its spatial location. During the item memory retrieval phase, shapes from the encoding phase were intermixed with new shapes and participants made an old-new judgment. During the source memory retrieval phase, all shapes were from the encoding phase and participants made a left-right judgment. An event-related analysis of item memory and source memory revealed a right and left prefrontal cortex distinction. Moreover, only item memory was associated with activity in the medial temporal lobes. These results confirm and extend previous findings that item memory and source memory are associated with distinct neural substrates.
Collapse
Affiliation(s)
- Scott D Slotnick
- Department of Psychology, Harvard University, William James Hall, 33 Kirkland Street, Cambridge, MA 02138, USA.
| | | | | | | |
Collapse
|
43
|
Abstract
This study sought to determine the utility of an interlocking finger task in screening for parietal lobe dysfunction. The ability of 69 patients to imitate a standardised set of four interlocking finger figures was compared with concurrent performance on formal neurocognitive tests. Poor interlocking finger test scores correlated most highly with standard measures of parietal lobe dysfunction. In addition, an analytical model of parietal dysfunction indicated the interlocking finger test was similar to, if not better than, standard tests of parietal lobe dysfunction. Attempts to imitate these figures should serve as a fast and simple screen of parietal lobe dysfunction.
Collapse
Affiliation(s)
- L R Moo
- Department of Neurology, Johns Hopkins School of Medicine, 600 N Wolfe Street, Meyer 100, Baltimore, MD, USA.
| | | | | | | | | |
Collapse
|
44
|
|
45
|
Abstract
PURPOSE The duration of the drug effect during the intracarotid amobarbital procedure (IAP) is an important factor when considering the prioritization of behavioral testing during the IAP. Previous studies of thiopental, a barbiturate similar to sodium amobarbital, found that age and gender significantly affect the dose required to induce anesthesia, such that younger patients require higher dosage. METHODS A total of 55 patients who underwent the IAP procedure at Johns Hopkins Hospital were included in the study (110 hemispheric injections). The patient group included 30 female and 25 male patients, ranging in age from 11 to 50 years. To determine if a higher dose of sodium amobarbital was needed for younger patients during the IAP, we analyzed the time to return to preinjection EEG baseline status and time to return to 5/5 strength as a function of patient age and gender. RESULTS We found that younger patients (11-20 years old) returned to preinjection baseline EEG status and full (5/5) strength faster than older patients. No gender difference was found. CONCLUSIONS The sodium amobarbital effect during IAP dissipates faster in young patients. Consideration of this difference in rate of recovery in 11-to 20-year-old patients has important clinical implications in terms of prioritizing behavioral testing.
Collapse
Affiliation(s)
- Jessica B Segal
- Department of Neurology, Division of Cognitive Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
| | | | | |
Collapse
|
46
|
Slotnick SD, Moo LR, Kraut MA, Lesser RP, Hart J. Interactions between thalamic and cortical rhythms during semantic memory recall in human. Proc Natl Acad Sci U S A 2002; 99:6440-3. [PMID: 11972063 PMCID: PMC122967 DOI: 10.1073/pnas.092514899] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2001] [Indexed: 11/18/2022] Open
Abstract
Human scalp electroencephalographic rhythms, indicative of cortical population synchrony, have long been posited to reflect cognitive processing. Although numerous studies employing simultaneous thalamic and cortical electrode recording in nonhuman animals have explored the role of the thalamus in the modulation of cortical rhythms, direct evidence for thalamocortical modulation in human has not, to our knowledge, been obtained. We simultaneously recorded from thalamic and scalp electrodes in one human during performance of a cognitive task and found a spatially widespread, phase-locked, low-frequency rhythm (7-8 Hz) power decrease at thalamus and scalp during semantic memory recall. This low-frequency rhythm power decrease was followed by a spatially specific, phase-locked, fast-rhythm (21-34 Hz) power increase at thalamus and occipital scalp. Such a pattern of thalamocortical activity reflects a plausible neural mechanism underlying semantic memory recall that may underlie other cognitive processes as well.
Collapse
Affiliation(s)
- Scott D Slotnick
- Department of Psychology, Johns Hopkins University, Baltimore, MD 21218, USA.
| | | | | | | | | |
Collapse
|
47
|
Abstract
A prospective study of motor recovery was undertaken in a patient scheduled to undergo multiple subpial transections (MST) of right sensorimotor cortex. Pre-transection, functional MRI (fMRI) and cortical stimulation mapping confirmed left hand motor control within right primary motor cortex. Immediately post-transection, behavioral testing demonstrated preserved strength bilaterally but decreased dexterity in the left hand. Seven weeks post-transection, dexterity returned to normal and left hand finger tapping corresponded with multiple bilateral foci of fMRI activation. At 16 weeks, fMRI activation returned to pre-transection levels. These data indicate that cortical injury due to MST resulted in the temporary recruitment of distant cortical sites which presumably subserved normal motor function during recovery.
Collapse
Affiliation(s)
- Lauren R Moo
- Department of Neurology, Meyer 100, 600 North Wolfe Street, Johns Hopkins University, Baltimore, MD 21287, USA
| | | | | | | |
Collapse
|
48
|
Kraut MA, Moo LR, Segal JB, Hart J. Neural activation during an explicit categorization task: category- or feature-specific effects? Brain Res Cogn Brain Res 2002; 13:213-20. [PMID: 11958964 DOI: 10.1016/s0926-6410(01)00117-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous lesion-deficit and functional imaging studies have suggested that there are distinct category-specific regions within the human brain. Using functional magnetic resonance imaging, we tested this claim with a task in which participants decided if two items, represented by words, were members of the same category. Signal changes detected for all pairs of items that were from the same category and for tool pairs were found in rostromedial BA 6, rostral cingulate, and at the BA 6/44 and BA 45/46 junctions. Activation was seen in BA 6 and the left BA 6/44 junction for fruits and vegetables pairs and only in rostromedial BA 6 for animal pairs. The common signal changes in the frontal lobes (BA 6/44) for the categories of fruits and vegetables and tools suggest that this region may be organized in a feature-specific, as opposed to a category-specific, manner.
Collapse
Affiliation(s)
- Michael A Kraut
- Division of Cognitive Neurology/Neuropsychology, Department of Neurology, The Johns Hopkins University, Baltimore, MD 21287, USA.
| | | | | | | |
Collapse
|
49
|
Moo LR, Murphy KJ, Gailloud P, Tesoro M, Hart J. Tailored cognitive testing with provocative amobarbital injection preceding AVM embolization. AJNR Am J Neuroradiol 2002; 23:416-21. [PMID: 11901011 PMCID: PMC7975295] [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: 02/24/2023]
Abstract
BACKGROUND AND PURPOSE Transarterial embolization of cerebral arteriovenous malformations (AVMs) has been associated with postprocedural neurologic complications in 7-39% of patients. We sought to determine whether a method of targeted neurologic and cognitive testing during AVM embolization reduces the incidence of focal cognitive and other neurologic deficits associated with the procedure. METHODS A cognitive neurologist extensively examined 12 patients prior to AVM embolization. In each patient, a battery of tests tailored to their specific abilities was developed by using stimuli selected from standard and experimental cognitive tests to probe specific brain regions related to the location of the AVM. In each feeder vessel to be embolized, a 50-mg bolus of sodium amobarbital was superselectively administered through a microcatheter; this was followed immediately by neurologic and cognitive testing with the tailored battery. After testing, the position of the microcatheter tip was checked with fluoroscopy. If the provocative test results were negative, the evaluated feeder was embolized with N-butyl cyanoacrylate glue. RESULTS Although results with 27 of 29 provocative amobarbital injections were negative, results with two injections in two different individuals revealed cognitive deficits during tailored provocative testing. In both, the evoked deficits resolved with dissipation of the amobarbital effect; the feeder vessels were not embolized. Neurologic and cognitive evaluation after each of 27 embolizations revealed no major or minor deficits. CONCLUSION In our experience, provocative amobarbital testing prior to AVM embolization was helpful in identifying vascular territories where embolization may lead to neurologic and cognitive deficits.
Collapse
Affiliation(s)
- Lauren R Moo
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | |
Collapse
|
50
|
Abstract
The aim of the current study was to determine the retinotopic organization of a patient with congenital cortical dysgenesis and normal visual function. Using functional magnetic resonance imaging (fMRI), detailed retinotopic maps corresponding to the four visual field quadrants were projected onto cortical surfaces. Similar to control subjects, the upper right visual field mapped onto ventral left hemisphere and was retinotopically organized. The lower right visual field's cortical representation was also retinotopically organized, yet was displaced many centimeters anteriomedially. Moreover, the entire left visual field was represented in non-retinotopically organized islands in both hemispheres. These results indicate retinotopic maps can shift in both location and topography illustrating cortical reorganization presumably due to either cortical dysgenesis or functional displacement. NeuroReport
Collapse
Affiliation(s)
- Scott D Slotnick
- Department of Psychology, Kirby Center for Functional Brain Imaging, Johns Hopkins University, Baltimore, MD 21218, USA
| | | | | | | |
Collapse
|