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Wallhagen MI, Strawbridge WJ. Positive Impact of an Educational Brochure on Follow-Up for a Formal Hearing Evaluation. Innov Aging 2024; 8:igae036. [PMID: 38660115 PMCID: PMC11037270 DOI: 10.1093/geroni/igae036] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 04/26/2024] Open
Abstract
Background and Objectives Half of older persons experience serious hearing loss, yet it remains under-assessed in primary care clinics. Providers note time constraints as barriers and patients often minimize or deny their hearing loss. We tested the effectiveness of a simple hearing screen in primary care settings and whether including a brochure describing hearing loss, its consequences, and treatment would increase referrals for formal audiometric assessments. Research Design and Methods We designed a longitudinal effectiveness study assessing three interventions: Screening alone; Screening plus a brochure handed to the person testing positive; and Screening plus the brochure with a brief review. The screening was accomplished by intake personnel. The results of a positive screen were given to the primary care practitioner. The approach was designed to enable its use across a range of primary care settings. Follow-ups occurred at 4 and 8 months. Results A total of 111 older adults attending 7 primary care clinics screened positive for having possible hearing loss by intake personnel. A total of 46 received the educational brochure. Physicians discussed test results with two-thirds yet recommended further testing for only half of the participants. Physician recommendations were strongly motivating (OR = 9.12, 95% CI: 3.54-23.52) and those receiving the brochure were still more likely to seek further testing (OR = 2.61, 95% CI: 1.07-6.36) even when physician recommendations were controlled. Additionally, when combined, the 2 options were strongly motivating: all participants receiving both a referral and a brochure sought further testing. Discussion and Implications A simple screen and educational brochure on hearing loss improved follow-up for a formal hearing evaluation which may improve hearing health care and minimize negative outcomes. The study also identified barriers to implementation, including how to motivate practitioners and assist intake personnel in integrating hearing screening into their routine intake procedures, supporting further research. Clinical Trials Registration Number: NCT0203713 9.
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Affiliation(s)
- Margaret I Wallhagen
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - William J Strawbridge
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, USA
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Binford S, Wallhagen MI, Leutwyler H. Role Identity Transition: A Conceptual Framework for Being the Spouse of a Person With Early Onset Dementia. J Gerontol Nurs 2023; 49:27-34. [PMID: 37523337 DOI: 10.3928/00989134-20230707-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Informal caregivers of persons with early onset dementia (PWEOD) are usually the spouses of affected individuals. These caregivers face unique challenges related to the unexpected nature of disease onset at this early life stage along with the accompanying symptoms, which can be different from those in late onset dementia. The current study explores the meanings these caregivers make of their situations and actions in response to their experiences. Findings provide a basis for development of a conceptual framework illustrating the basic, psychosocial processes underlying their shared situation. Grounded theory methodology was used. Qualitative data were collected through semi-structured interviews with 15 participants. Data were analyzed using constant comparative techniques and situational analysis. A distinction was made across participants between identifying as spouse versus caregiver for their PWEOD. Each participant had made or was making an identity transition from viewing their role as becoming more caregiver-like toward an eventual, complete shift to that of caregiver in a stepwise fashion. Incremental shifts in identity reflected challenges to the notion held of what it means to be a spouse. Results support prior research highlighting the unique experiences of caregivers of PWEOD while providing a framework for understanding the unique situations of these care-givers. Findings also inform nursing interventions tailored for spouses of PWEOD. [Journal of Gerontological Nursing, 49(8), 27-34.].
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Maidment DW, Wallhagen MI, Dowd K, Mick P, Piker E, Spankovich C, Urry E. New horizons in holistic, person-centred health promotion for hearing healthcare. Age Ageing 2023; 52:7049630. [PMID: 36821645 PMCID: PMC9949576 DOI: 10.1093/ageing/afad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Indexed: 02/24/2023] Open
Abstract
Over the course of a lifetime, the risk of experiencing multiple chronic conditions (multimorbidity) increases, necessitating complex healthcare regimens. Healthcare that manages these requirements in an integrated way has been shown to be more effective than services that address specific diseases individually. One such chronic condition that often accompanies ageing is hearing loss and related symptoms, such as tinnitus. Hearing loss is not only highly prevalent in older adults but is also a leading cause of disability. Accumulating evidence demonstrates an interplay between auditory function and other aspects of health. For example, poorer cardiometabolic health profiles have been shown to increase the risk of hearing loss, which has been attributed to microvascular disruptions and neural degeneration. Additionally, hearing loss itself is associated with significantly increased odds of falling and is a potentially modifiable risk factor for cognitive decline and dementia. Such evidence warrants consideration of new possibilities-a new horizon-for hearing care to develop a holistic, person-centred approach that promotes the overall health and wellbeing of the individual, as well as for audiology to be part of an interdisciplinary healthcare service. To achieve this holistic goal, audiologists and other hearing healthcare professionals should be aware of the range of conditions associated with hearing loss and be ready to make health promoting recommendations and referrals to the appropriate health practitioners. Likewise, healthcare professionals not trained in audiology should be mindful of their patients' hearing status, screening for hearing loss or referring them to a hearing specialist as required.
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Affiliation(s)
- David W Maidment
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | | | - Paul Mick
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Erin Piker
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
| | - Christopher Spankovich
- Department of Otolaryngology - Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MI, USA
| | - Emily Urry
- Research and Development, Sonova AG, Staefa, Switzerland
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Brenowitz WD, Wallhagen MI. Does Hearing Impairment Affect Physical Function?: Current Evidence, Potential Mechanisms, and Future Research Directions for Healthy Aging. JAMA Netw Open 2021; 4:e2114782. [PMID: 34170308 DOI: 10.1001/jamanetworkopen.2021.14782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Willa D Brenowitz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Wallhagen MI, Strawbridge WJ, Tremblay K. Leveraging the age friendly healthcare system initiative to achieve comprehensive, hearing healthcare across the spectrum of healthcare settings: an interprofessional perspective. Int J Audiol 2021; 60:80-85. [PMID: 33415999 DOI: 10.1080/14992027.2020.1853263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Hearing loss is associated with multiple physical, cognitive, and psychosocial co-morbidities. Achievement of safe healthcare in the context of these complex co-morbidities necessitates accurate hearing and coordination across specialties. This paper discusses the potentials for and barriers to an interprofessional approach to integrating hearing screening and treatment across all healthcare settings. DESIGN The paper reviews the relationship between hearing loss and other health care concerns to emphasise the need for an inclusive, coordinated, interprofessional approach; discusses interprofessional and patient/family centred coordinated care as essential to achieving quality care; and introduces the Age Friendly Health System initiative as a framework that could be leveraged to move towards comprehensive hearing healthcare. RESULTS The literature highlights prior work identifying gaps in quality care and the need for new and innovative approaches to evolve interdisciplinary and interprofessional collaborations to achieve comprehensive healthcare. The literature also provides support for using the Age-Friendly initiative as a point of leverage. CONCLUSION Bringing together thought leaders from the health care provider community, World Health Organisation, age-friendly cities movement, and field of architecture to coordinate the integration of hearing healthcare into Age Friendly Health Systems initiatives has potential to achieve comprehensive hearing healthcare across healthcare settings. (198).
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Affiliation(s)
- Margaret I Wallhagen
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
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Horstman MJ, Miltner RS, Wallhagen MI, Patrician PA, Oliver BJ, Roumie CL, Dolansky MA, Perez F, Naik AD, Godwin KM. Developing Leaders and Scholars in Health Care Improvement: The VA Quality Scholars Program Competencies. Acad Med 2021; 96:68-74. [PMID: 32769476 DOI: 10.1097/acm.0000000000003658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the need for leaders in health care improvement across health professions, there are no standards for the knowledge and skills that should be achieved through advanced interprofessional health care improvement training. Existing health care improvement training competencies focus on foundational knowledge expected of all trainees or for specific career pathways. Health care improvement leaders fill multiple roles within organizations and promote interprofessional improvement practice. The diverse skill set required of modern health care improvement leaders necessitates the development of training competencies specifically for fellowships in applied health care improvement. The authors describe the development of the revised national Veterans Affairs Quality Scholars (VAQS) Program competencies. The VAQS Program is an interprofessional, postdoctoral training program whose mission is to develop leaders and scholars to improve health care. An interprofessional committee of VAQS faculty reviewed and revised the competencies over 4 months beginning in fall 2018. The first draft was developed using 111 competencies submitted by 11 VAQS training sites and a review of published competencies. The final version included 22 competencies spanning 5 domains: interprofessional collaboration and teamwork, improvement and implementation science, organization and system leadership, methodological skills and analytic techniques for improvement and research, and teaching and coaching. Once attained, the VAQS competencies will guide the skill development that interprofessional health care improvement leaders need to participate in and lead health care improvement scholarship and implementation. These broad competencies are relevant to advanced training programs that develop health care improvement leaders and scholars and may be used by employers to understand the knowledge and skills expected of individuals who complete advanced fellowships in applied health care improvement.
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Affiliation(s)
- Molly J Horstman
- M.J. Horstman is assistant professor, Department of Medicine, Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, investigator, Center for Innovations in Quality, Effectiveness, and Safety, and core faculty, VA Quality Scholars Coordinating Center, Houston, Texas
| | - Rebecca S Miltner
- R.S. Miltner is associate professor, University of Alabama at Birmingham School of Nursing, and associate faculty scholar, VA Quality Scholars Fellowship Program, Birmingham VA Medical Center site, Birmingham, Alabama
| | - Margaret I Wallhagen
- M.I. Wallhagen is professor, Department of Physiological Nursing, director, UCSF Hartford Center of Gerontological Nursing Excellence, and senior nurse faculty scholar, VA Quality Scholars Fellowship Program, San Francisco VA Medical Center site, San Francisco, California
| | - Patricia A Patrician
- P.A. Patrician is professor and Rachel Z. Booth Endowed Chair in Nursing, University of Alabama at Birmingham School of Nursing, and senior faculty scholar, VA Quality Scholars Fellowship Program, Birmingham VA Medical Center site, Birmingham, Alabama
| | - Brant J Oliver
- B.J. Oliver is associate professor, Departments of Community and Family Medicine, Psychiatry, and Dartmouth Institute at Dartmouth-Hitchcock Medical Center, and Geisel School of Medicine at Dartmouth, adjunct associate professor, MGH Institute of Health Professions School of Nursing, Hanover, New Hampshire, and faculty senior scholar, VA Quality Scholars Fellowship Program, White River Junction VAMC site, White River Junction, Vermont
| | - Christianne L Roumie
- C.L. Roumie is associate professor of internal medicine and pediatrics, Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System, Geriatrics Research and Education Clinical Center, Nashville, Tennessee
| | - Mary A Dolansky
- M.A. Dolansky is associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, associate director, VA Quality Scholars Fellowship Program, senior nurse faculty, Cleveland VA Quality Scholars Fellowship Program site, and director, Quality and Safety Education for Nurses Institute, Cleveland, Ohio
| | - Federico Perez
- F. Perez is associate professor, Department of Medicine, Case Western Reserve University School of Medicine, faculty scholar, VA Quality Scholars Fellowship Program, Cleveland VA Medical Center site, and investigator, VISN-10 Geriatrics Research, Education, and Clinical Center, Cleveland, Ohio
| | - Aanand D Naik
- A.D. Naik is investigator, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, senior advisor for the VA Quality Scholars Coordinating Center, and associate professor, Department of Medicine, Sections of Health Services Research and Geriatrics, Baylor College of Medicine, Houston, Texas
| | - Kyler M Godwin
- K.M. Godwin is assistant professor, Department of Medicine, Section of Health Services Research, Baylor College of Medicine, investigator, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, and director, VA Quality Scholars Coordinating Center, Houston, Texas
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Hunter MM, Huang AJ, Wallhagen MI. "I'm going to stay young": Belief in anti-aging efficacy of menopausal hormone therapy drives prolonged use despite medical risks. PLoS One 2020; 15:e0233703. [PMID: 32469976 PMCID: PMC7259599 DOI: 10.1371/journal.pone.0233703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Over a third of menopausal hormone therapy (HT) prescriptions in the US are written for women over age 60. Use of HT more than 5 years is associated with increased risk for cardiovascular disease; breast, ovarian, and endometrial cancers; thromboembolic stroke; gallbladder disease; dementia; and incontinence. OBJECTIVES To explore older women's perceptions of the benefits and risks of long-term HT and examine factors influencing their decisions to use HT > 5 years despite medical risks. METHODS A qualitative approach was selected to broadly explore thought processes and social phenomena underlying long-term users' decisions not to discontinue HT. Interviews were conducted with 30 women over age 60 reporting use of systemic HT more than 5 years recruited from an urban area in California and a small city in the Rocky Mountain region. Transcripts of interviews were analyzed using conventional grounded theory methods. RESULTS Women reported using HT to preserve youthful physical and mental function and prevent disease. Gynecologists had reassured participants regarding risk, about which all 30 expressed little concern. Participants, rather than providers, were the principal drivers of long-term use. CONCLUSIONS Participants perceived estrogen to have anti-aging efficacy, and using HT imparted a sense of control over various aspects of aging. Maintaining this sense of control was prioritized over potential risk from prolonged use. Our findings provide an additional perspective on previous work suggesting the pharmaceutical industry has leveraged older women's self-esteem, vanity, and fear of aging to sell hormones through marketing practices designed to shape the beliefs of both clinicians and patients. Efforts are needed to: 1) address misconceptions among patients and providers about medically supported uses and risks of prolonged HT, and 2) examine commercial influences, such as medical ghostwriting, that may lead to distorted views of HT efficacy and risk.
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Affiliation(s)
- Mary M. Hunter
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Alison J. Huang
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Margaret I. Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
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Joo Y, Cruickshanks KJ, Klein BEK, Klein R, Hong O, Wallhagen MI. The Contribution of Ototoxic Medications to Hearing Loss Among Older Adults. J Gerontol A Biol Sci Med Sci 2020; 75:561-566. [PMID: 31282945 PMCID: PMC7328195 DOI: 10.1093/gerona/glz166] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Ototoxicity may interact with the effects of aging, leading to a more severe hearing loss than that associated with age alone. The purpose of this study was to explore the associations between ototoxic medication use and the incidence and progression of hearing loss in older adults with a population-based longitudinal study. METHODS Epidemiology of Hearing Loss Study participants (n = 3,753) were examined. Medication use was assessed using a standardized questionnaire by the examiners at each examination every 5 year. The ototoxic medications include loop diuretics, nonsteroidal anti-inflammatory drugs, antibiotics, chemotherapeutic agents, quinine, and acetaminophen in this study. Generalized estimating equations model was used as a proportional hazard discrete time analysis. RESULTS Number of ototoxic medications was associated with the risk of developing hearing loss during the 10-year follow-up period (hazard ratio [HR] = 1.15, 95% confidence interval [CI] = 1.06, 1.25) after adjusting for age, sex, smoking, and body mass index. Loop diuretics (HR = 1.40, 95% CI = 1.05, 1.87) were associated with the 10-year incidence of hearing loss. Nonsteroidal anti-inflammatory drugs (HR = 1.45, 95% CI = 1.22, 1.72) and loop diuretics (HR = 1.33 95% CI = 1.08, 1.63) were associated with risk of progressive hearing loss over 10 years. CONCLUSION These ototoxic medications are commonly used in older adults and should be considered as potentially modifiable contributors to the incidence and severity of age-related hearing loss.
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Affiliation(s)
- Yoonmee Joo
- School of Nursing, University of California San Francisco
| | | | - Barbara E K Klein
- School of Medicine and Public Health, University of Wisconsin–Madison
| | - Ronald Klein
- School of Medicine and Public Health, University of Wisconsin–Madison
| | - OiSaeng Hong
- School of Nursing, University of California San Francisco
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Blustein J, Wallhagen MI, Weinstein BE, Chodosh J. Time to Take Hearing Loss Seriously. Jt Comm J Qual Patient Saf 2019; 46:53-58. [PMID: 31732478 DOI: 10.1016/j.jcjq.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
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Abstract
Objectives: To assess the experiences of people with hearing loss in healthcare environments to characterize miscommunication and unmet needs, and guide recommendations for improving outcomes and access. Methods: Anonymous survey developed by subject-matter experts was posted on a large national hearing-loss consumer and advocacy organization website and email listserv. Data were collected and managed via RedCAP. Results: Responses were received from 1581 individuals. Respondents reported moderate or significant difficulty communicating with all listed providers. Three communication situations emerged as often presenting communication difficulties: hearing one's name when called in the waiting room, hearing when the speaker's back was turned, and hearing when communicating by telephone. Despite 93% of respondents indicating they sometimes or often let providers know about their hearing loss, 29.3% of all respondents still reported that no arrangements were made to improve communication. Conclusions: This study clearly demonstrates the ongoing difficulties faced by individuals with hearing loss, particularly older adults, as they attempt to navigate both providers and situations associated with a typical primary care office visit. Clinical Implications: Inexpensive and efficient changes to improve communication include (1) Improving one-on-one provider communication by facing the individual with good lighting, clear speaking, and not obstructing one's mouth; (2) Environmental changes such as using visual or tactile alerting devices in waiting rooms and adding noise-dampening carpeting and curtains; and (3) Avoiding telephones and conveying health information in writing.
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Affiliation(s)
- Madelyn N Stevens
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center , Durham , North Carolina , USA
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina , Charleston , South Carolina , USA
| | - Margaret I Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California San Francisco , San Francisco , California , USA
| | - Debara L Tucci
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center , Durham , North Carolina , USA
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Wallhagen MI, Ritchie CS, Smith AK. Hearing Loss: Effect on Hospice and Palliative Care Through the Eyes of Practitioners. J Pain Symptom Manage 2019; 57:724-730. [PMID: 30630051 DOI: 10.1016/j.jpainsymman.2018.12.340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 09/27/2018] [Revised: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 11/25/2022]
Abstract
CONTEXT Discussions regarding values and goals of care are central to providing quality palliative care. An inability to hear during these sensitive discussions may significantly impair the quality of care provided, yet hearing loss (HL) is not formally addressed in these settings or in programs designed to assist practitioners gain advanced communication skills. OBJECTIVE To gain an understanding of hospice and palliative care practitioners' experiences with HL and its impact on the care provided. METHOD SurveyMonkey questionnaire eliciting whether and how HL impacted care provided with an open-ended question asking for descriptions of a situation where HL created a problem in communication with an older patient. Responses were analyzed using constant comparative techniques. RESULTS Of 510 respondents, 464 (91%) reported HL had some or great impact on the quality of care provided, 449 (88%) noted encountering a situation where HL impaired communication with an older adult, and 99 of these participants (22%) provided a specific example. The overarching theme was "Diagnostic and Treatment Uncertainty." Nonmutually exclusive categories underpinning this theme included the following: unable to get needed information, misinterpreting level of understanding, patient misunderstanding of instructions, and goals-of-care errors. CONCLUSION HL impacts the quality of care provided to persons with serious illness by disrupting the identification, assessment, and treatment of the physical, psychosocial, and spiritual symptoms an individual is experiencing. HL should be formally addressed in programs designed to develop skills in conducting sensitive conversations. Practitioners should screen for HL, use practices that facilitate comprehension, and use assistive listening devices as needed.
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Affiliation(s)
- Margaret I Wallhagen
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, California, USA.
| | - Christine S Ritchie
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA; Jewish Home San Francisco, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA; Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, California, USA
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Abstract
Hearing loss (HL) becomes increasingly common with age and can lead to multiple negative outcomes, including isolation, falls, depression, altered social relationships, and altered cognitive functioning. HL also can affect patient-provider communication and lead to misunderstandings. Despite the negative effects that HL has on multiple domains, less than 20% to 25% of individuals who might benefit from amplification devices and/or hearing aids own them. Barriers to use include stigma, cost, and access. Nurses can play a critical role in promoting appropriate care for individuals with HL and providing access for those who need hearing aids. The current article (a) briefly reviews how history and policies, especially Medicare and Medicaid, but also those defining the practice of audiology and dispensing of hearing aids, affect insurance coverage for hearing care; (b) reviews how a combination of forces brought the need for accessible and affordable hearing care to national attention and resulted in the Over-the-Counter (OTC) Hearing Aid Act; and (c) discusses the implications of the OTC Act for nurses and nursing practice. [Journal of Gerontological Nursing, 44(9), 9-14.].
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Dudley N, Ritchie CS, Rehm RS, Chapman SA, Wallhagen MI. Facilitators and Barriers to Interdisciplinary Communication between Providers in Primary Care and Palliative Care. J Palliat Med 2018; 22:243-249. [PMID: 30383468 DOI: 10.1089/jpm.2018.0231] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Community-based palliative care (CBPC) plays an integral role in addressing the complex care needs of older adults with serious chronic illnesses, but is premised on effective communication and collaboration between primary care providers (PCPs) and the providers of specialty palliative care (SPC). Optimal strategies to achieve the goal of coordinated care are ill-defined. OBJECTIVE The objective of this study was to understand the facilitators and barriers to optimal, coordinated interdisciplinary provision of CBPC. METHODS This was a qualitative study using a constructivist grounded theory approach. Thirty semistructured interviews were conducted with primary and palliative care interdisciplinary team members in academic and community settings. RESULTS Major categories emerging from the data that positively or negatively influence optimal provision of coordinated care included feedback loops and interactions; clarity of roles; knowledge of palliative care, and workforce and structural constraints. Facilitators were frequent in-person, e-mail, or electronic medical record-based communication; defined role boundaries; and education of PCPs to distinguish elements of generalist palliative care (GPC) and more complex elements or situations requiring SPC. Barriers included inadequate communication that prevented a shared understanding of patients' needs and goals of care, limited time in primary care to provide GPC, and limited workforce in SPC. CONCLUSIONS Our findings suggest that processes are needed that promote communication, including structured communication strategies between PCPs and SPC providers, clarification of role boundaries, enrichment of nonspecialty providers' competence in GPC, and enhanced access to CBPC.
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Affiliation(s)
- Nancy Dudley
- 1 Department of Social and Behavioral Sciences, School of Nursing, University of California , San Francisco, California.,2 San Francisco Veterans Affairs Medical Center , Geriatrics, Palliative, and Extended Care, San Francisco, California
| | - Christine S Ritchie
- 3 Division of Geriatrics, Department of Medicine, University of California , San Francisco, California
| | - Roberta S Rehm
- 4 Department of Family Health Care Nursing and School of Nursing, University of California , San Francisco, California
| | - Susan A Chapman
- 1 Department of Social and Behavioral Sciences, School of Nursing, University of California , San Francisco, California
| | - Margaret I Wallhagen
- 5 Department of Physiological Nursing, School of Nursing, University of California , San Francisco, California
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15
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Phelps SM, Drew-Nord DC, Neitzel RL, Wallhagen MI, Bates MN, Hong OS. Characteristics and Predictors of Occupational Injury Among Career Firefighters. Workplace Health Saf 2018; 66:291-301. [PMID: 29251258 PMCID: PMC6097705 DOI: 10.1177/2165079917740595] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to assess occupational injury characteristics and predictors among career firefighters. A total of 249 firefighters from central Texas and northern California participated in this Internet-based survey. Approximately 27% of firefighters had reported an occupational injury within the previous 12 months. The majority of injuries occurred on the scene of a non-fire call while performing an activity that required lifting, pushing, or pulling. Firefighters' backs were most frequently injured. Of the reported injuries, approximately 18% returned to work on modified duty, but 46% were not allowed to work due to their occupational injuries. Firefighters who reported occupational injuries were more likely to be older and experiencing occupational stress compared with their coworkers who did not report occupational injuries. Injured firefighters were also more likely to report fewer job rewards (money/salary), overcommitment, less esteem (respect and support), and fewer promotional prospects. These injury factors should be incorporated into interventions to reduce or prevent workplace injuries.
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Affiliation(s)
| | | | | | | | - Michael N Bates
- 3 University of California, Berkeley School of Public Health
| | - Oi Saeng Hong
- 1 University of California, San Francisco School of Nursing
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Pairé S, Broglio K, Wallhagen MI. Response to Research Brief Vol. 20(12):1313: Models of Palliative Care Team Composition. J Palliat Med 2018; 21:586-587. [PMID: 29742047 DOI: 10.1089/jpm.2018.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- Shreda Pairé
- 1 Supportive and Palliative Care, Houston Methodist San Jacinto Hospital , Baytown, Texas
| | - Kathleen Broglio
- 2 Section of Palliative Care, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
| | - Margaret I Wallhagen
- 3 Department of Physiological Nursing, UCSF John A. Hartford Center of Gerontological Nursing Excellence , San Francisco VA Quality Scholars Fellowship Program, San Francisco, California
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Dudley N, Ritchie CS, Wallhagen MI, Covinsky KE, Cooper BA, Patel K, Stijacic Cenzer I, Chapman SA. Characteristics of Older Adults in Primary Care Who May Benefit From Primary Palliative Care in the U.S. J Pain Symptom Manage 2018; 55:217-225. [PMID: 28916294 DOI: 10.1016/j.jpainsymman.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Received: 07/04/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT Older adults with advanced illness and associated symptoms may benefit from primary palliative care, but limited data exist to identify older adults in U.S. primary care to benefit from this care. OBJECTIVES To describe U.S. primary care visits among adults aged 65 years and older with advanced illness. METHODS Cross-sectional analysis of the National Ambulatory and Hospital Ambulatory Medical Care Surveys (2009-2011) was conducted using Chi-squared tests to compare visits without and with advanced illness with U.S. primary care defined by National Committee for Quality Assurance Palliative and End-of-Life Care Physician Performance Measurement Set International Classification of Diseases, Ninth Revision (ICD-9) codes for end-stage illness. RESULTS Among visits by older adults to primary care, 7.9% visits were related to advanced illness. A higher proportion of advanced illness visits was among men vs. women (8.9% vs. 7.2%; P = 0.03) and adults aged 75 years and older, non-Hispanic whites (8.3%) and blacks (8.2%) vs. Hispanic (6.7%) and non-Hispanic other (2.5%) (P = 0.02), dually eligible for Medicare and Medicaid, and from patient ZIP Codes with lower median household incomes (below $32,793). A higher percentage of visits with advanced illness conditions to primary care was chronic obstructive pulmonary disease, congestive heart failure, dementia, and cancer, and symptoms reported with these visits were mostly pain, depression, anxiety, fatigue, and insomnia. CONCLUSION In the U.S., approximately 8% primary care visits among older adults was related to advanced illness conditions. Advanced illness visits were most common among those most likely to be socioeconomically vulnerable and highlight the need to focus efforts for high-quality palliative care for these populations.
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Affiliation(s)
- Nancy Dudley
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA; San Francisco Veterans' Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, California, USA.
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Margaret I Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Kenneth E Covinsky
- San Francisco Veterans' Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, California, USA; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- Dean's Office, School of Nursing, University of California, San Francisco, California, USA
| | - Kanan Patel
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Irena Stijacic Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Susan A Chapman
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
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18
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Abstract
OBJECTIVES To compare hearing loss screening results of four simple tests with those of hand-held audiometry. DESIGN Cross-sectional study of individuals screened during intake for physicals and other routine procedures. SETTING Two primary care clinics in the San Francisco Bay area. PARTICIPANTS Older adults not wearing hearing aids (N = 125, mean age 72.9, 63% female). MEASUREMENTS Direct question about hearing loss, indirect question, finger-rub test, whisper test, and audiometric results using a hand-held audiometer. RESULTS Sensitivity was 91% for the finger-rub test compared with 89% for the direct question, 85% for the indirect question, and 79% for the whisper test. For specificity, the whisper test was highest, followed by the finger rub, indirect, and direct. CONCLUSION Simple screening procedures can be used to identify older adults with hearing loss in primary care and facilitate early referral for additional testing and treatment.
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Affiliation(s)
- William J Strawbridge
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California
| | - Margaret I Wallhagen
- School of Nursing, University of California, San Francisco, San Francisco, California
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19
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Bleijenberg N, Imhof L, Mahrer-Imhof R, Wallhagen MI, de Wit NJ, Schuurmans MJ. Patient Characteristics Associated With a Successful Response to Nurse-Led Care Programs Targeting the Oldest-Old: A Comparison of Two RCTs. Worldviews Evid Based Nurs 2017. [PMID: 28632933 DOI: 10.1111/wvn.12235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND To improve the effectiveness of community-based care programs, especially those targeting the oldest-old population (80+), data are needed that elucidate those factors associated with a successful response to the intervention. Two comparable nurse-led care programs have been evaluated in two large randomized controlled trials (RCTs), one in Switzerland and one in the Netherlands. AIMS To identify common patient characteristics that are related to a successful response to proactive nurse-led care, we explored if and to what extent, identical factors were present in both study populations. METHODS A secondary data analysis using trial data from the intervention group of both RCTs was conducted. The study sample consisted 461 older adults, 230 from the U-PROFIT trial (the Netherlands) and 231 from the HPC trial (Switzerland). The mean age of the total sample was 85.1 years (SD 3.7). The UPROFIT intervention, delivered by registered nurses, included a frailty assessment and a comprehensive geriatric assessment (CGA) at home followed by an individualized evidence-based care plan, care coordination, and follow-up. The HCP intervention was delivered by advanced practice nurses consisting of four home visits and three phone calls, and was guided by the principles of health promotion, empowerment, partnership, and family-centeredness. A successful response was defined as "stable" or "no decline" in daily functioning at follow-up. Daily functioning was measured with 13 items of activities of daily living and instrumental activities of daily living. Multivariate logistic regression models were applied to calculate the association between individual characteristics and a successful response. RESULTS Almost half of the participants in the U-PROFIT trial (50.9%), and two-thirds (65.7%) of the participants in the HCP trial had a successful response at follow-up. Fewer comorbidities and a better self-rated health had the strongest predictive value for benefiting from the intervention (OR = 0.83 [95% CI 0.66-1.03], and OR = 1.5 [95% CI 0.92-2.45]), respectively. LINKING EVIDENCE TO ACTION Two large RCTs demonstrated that a preventive nurse-led care program can preserve daily functioning in the oldest-old population. Older people with few comorbidities and higher self-rated health had a higher likelihood of a positive outcome. Unraveling the characteristics associated with a successful response provides important information for further refining and targeting an intervention to obtain maximum effectiveness. More effort is needed to modify interventions for the oldest-old with multiple morbidities and low levels of education.
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Affiliation(s)
- Nienke Bleijenberg
- Assistant Professor, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lorenz Imhof
- Head of Research Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Romy Mahrer-Imhof
- Professor, Research Institute of Nursing Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland
| | - Margaret I Wallhagen
- Director, John A. Hartford Center of Gerontological Nursing Excellence, University of California San Francisco, School of Nursing, Department of Physiological Nursing, San Francisco, CA, USA
| | - Niek J de Wit
- Professor, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J Schuurmans
- Professor, Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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20
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Abstract
Although hearing loss is common in old age and associated with a variety of negative outcomes, hearing aids and related services are not covered by Medicare or many other forms of insurance. Out-of-pocket costs are expensive and thus serve as a barrier for many individuals. Efforts at the national level to broaden coverage can confront surprising or unexpected opposition from a variety of groups. This article discusses how an experience as an Atlantic Philanthropies Health and Aging Policy Fellow helped inform how gaining an understanding of the positions held by such stakeholder groups is critical to developing strategies to promote a more effective payment structure that would improve access to hearing care. The implications for nurses desiring to influence policy are also highlighted.
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Abstract
OBJECTIVES To explore how older adults in the community with a limited life expectancy make healthcare decisions and the processes used when they are not in an acute crisis. DESIGN Grounded theory. SETTING Medical programs and geriatrics clinics at the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center. PARTICIPANTS Community-dwelling adults aged 67 to 98 with a life expectancy of less than 1 year (N = 20). MEASUREMENTS In-depth semistructured interviews in participants' homes. Constant comparative analysis was used to develop codes and identify themes. RESULTS Participants generally delegated decisions to others, expressing their wishes by describing desired end-of-life outcomes and highlighting meaningful aspects of their lives. They did this in the belief that the delegate would make appropriate decisions on their behalf. In this way, participants were able to achieve a sense of control without being in control of decisions. Four themes emerged from the analysis that reflect the various approaches participants used to articulate their goals and maintain a sense of control: direct communication, third-party analogies, adaptive denial, and engaged avoidance. CONCLUSION These findings challenge the prevailing view of personal autonomy. These older adults suggest a path to decision-making that focuses on priorities and goals, allowing them to take a more-passive approach to decision-making while still maintaining a sense of control.
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Affiliation(s)
- Rafael D Romo
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California.,Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Theresa A Allison
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California.,Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California.,Geriatrics, Palliative and Extended Care, San Francisco Veterans Affair Medical Center, San Francisco, California
| | - Margaret I Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California
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22
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Abstract
Previous longitudinal studies assessing relative mortality risks associated with fair or poor self-rated health have differed in the extent to which observed relative risks are explained by disease burden and health risk factors. Gender and ethnic differences have rarely been assessed. The authors used proportional hazards models with time-dependent covariates to examine associations between fair or poor self-rated health and mortality over 28 years for 5,976 Alameda County Study respondents age 21 to 94 at baseline. Adjustments for a number of demographic variables, chronic conditions, mobility impairment, and health risk factors accounted for about half of the unadjusted relative risk. No gender or ethnicity differences in relative risk comparisons were found, but consistent with other studies, lower relative risks associated with increasing age were found. The authors conclude that self-rated health is a deceptively simple variable that likely measures a great deal more than disease burden.
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23
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Abstract
This study explores how cultural values affect the meaning and experiences of daughter (or daughter-in-law) caregivers of elderly persons with dementia by comparing caregivers in the United States and Japan. Nine American and seven Japanese caregivers were interviewed twice at 6-month intervals. Interviews were audiotaped and analyzed using constant-comparative techniques. Data suggest that moral obligation to care and intense loss are two universal themes of caregiving. However the experiences and perceptions of the role of caregivers from these two cultures differed in select ways that were captured within three categories: reasons for caregiving, caregiving as a career, and caregiving as a life phase or detour. Findings suggest that American caregivers may need greater anticipatory socialization regarding the caregiving role, whereas Japanese caregivers may benefit from assistance in accepting needed services.
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24
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Cenzer IS, Tang V, Boscardin WJ, Smith AK, Ritchie C, Wallhagen MI, Espaldon R, Covinsky KE. One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. J Am Geriatr Soc 2016; 64:1863-8. [PMID: 27295578 DOI: 10.1111/jgs.14237] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains. DESIGN Retrospective cohort study. SETTINGS Health and Retirement Study (HRS). PARTICIPANTS HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857). MEASUREMENTS Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism. RESULTS Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10% risk and 7 to 9 points predicting 66% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting. CONCLUSION The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture.
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Affiliation(s)
- Irena S Cenzer
- Division of Geriatrics, University of California at San Francisco, San Francisco, California. .,San Francisco Veterans Affairs Medical Center, San Francisco, California.
| | - Victoria Tang
- Division of Geriatrics, University of California at San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - W John Boscardin
- Division of Geriatrics, University of California at San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Alexander K Smith
- Division of Geriatrics, University of California at San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Christine Ritchie
- Division of Geriatrics, University of California at San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California.,Jewish Home of San Francisco, San Francisco, California
| | - Margaret I Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California at San Francisco, San Francisco, California
| | - Roxanne Espaldon
- Division of Geriatrics, University of California at San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California at San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
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25
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Affiliation(s)
- Margaret I. Wallhagen
- Department of Physiological Nursing; University of California at San Francisco; San Francisco California
| | - William J. Strawbridge
- Institute for Health and Aging; University of California at San Francisco; San Francisco California
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26
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Abstract
Research focused on understanding that the nature of hospice decision making has both described the characteristics of those who do and do not utilize hospice and identified many factors related to choosing hospice. However, this literature has not explored the underlying decision-making processes, limiting our understanding. We examine the extant literature and propose a framework that views hospice decisions as an evolving process, identify key factors that bear directly on this process, and discuss the contextual environment, including the idea of a decision maker triad. We end with a discussion of how this framework can be used to support clinical practice and future research. Our goal is to provide a framework from which to understand the end-of-life needs of all patients, no matter where they receive care.
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Affiliation(s)
- Rafael D. Romo
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
- San Francisco Veterans’ Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, CA, USA
| | - Margaret I. Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Alexander K. Smith
- San Francisco Veterans’ Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, CA, USA
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
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27
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Abstract
Despite contributing substantially to disability in the United States, age-related hearing loss is an underappreciated public health concern. Loss of hearing sensitivity has been documented in two-thirds of adults aged 70 years and older and has been associated with communication difficulties, lower health-related quality of life, and decreased physical and cognitive function. Management strategies for age-related hearing loss are costly, yet the indirect costs due to lost productivity among people with communication difficulties are also substantial and likely to grow. Hearing aids can improve health-related quality of life, but the majority of people with documented hearing loss do not report using them. Uncovering effective means to improve the utilization of hearing health care services is essential for meeting the hearing health care demands of our aging population. The importance of hearing for general well-being warrants an effort to enhance awareness among the general population of the indications of hearing loss and options for assistance.
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Affiliation(s)
- Kathleen E Bainbridge
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland 20892-9670;
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28
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Stephens C, Sackett N, Pierce R, Schopfer D, Schmajuk G, Moy N, Bachhuber M, Wallhagen MI, Lee SJ. Transitional care challenges of rehospitalized veterans: listening to patients and providers. Popul Health Manag 2013; 16:326-31. [PMID: 23560514 PMCID: PMC3780306 DOI: 10.1089/pop.2012.0104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 11/12/2022] Open
Abstract
Readmissions to the hospital are common and costly, often resulting from poor care coordination. Despite increased attention given to improving the quality and safety of care transitions, little is known about patient and provider perspectives of the transitional care needs of rehospitalized Veterans. As part of a larger quality improvement initiative to reduce hospital readmissions, the authors conducted semi-structured interviews with 25 patients and 14 of their interdisciplinary health care providers to better understand their perspectives of the transitional care needs and challenges faced by rehospitalized Veterans. Patients identified 3 common themes that led to rehospitalization: (1) knowledge gaps and deferred power; (2) difficulties navigating the health care system; and (3) complex psychiatric and social needs. Providers identified different themes that led to rehospitalization: (1) substance abuse and mental illness; (2) lack of social or financial support and homelessness; (3) premature discharge and poor communication; and (4) nonadherence with follow-up. Results underscore that rehospitalized Veterans have a complex overlapping profile of real and perceived physical, mental, and social needs. A paradigm of disempowerment and deferred responsibility appears to exist between patients and providers that contributes to ineffective care transitions, resulting in readmissions. These results highlight the cultural constraints on systems of care and suggest that process improvements should focus on increasing the sense of partnership between patients and providers, while simultaneously creating a culture of empowerment, ownership, and engagement, to achieve success in reducing hospital readmissions.
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Affiliation(s)
- Caroline Stephens
- Division of Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, California
- Department of Community Health Systems & Social and Behavioral Sciences, University of California, San Francisco, California
- Department of VA Quality Scholar, San Francisco VA Medical Center, San Francisco, California
- John A. Hartford Foundation/Atlantic Philanthropies Claire M. Fagin Fellow, San Francisco, California
| | - Nathan Sackett
- Division of Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, California
- University of California, Berkeley/University of California San Francisco Joint Medical Program, San Francisco, California
| | - Read Pierce
- Department of Hospital Medicine, San Francisco VA Medical Center, San Francisco, California
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California
| | - David Schopfer
- Department of VA Quality Scholar, San Francisco VA Medical Center, San Francisco, California
- Department of Cardiology, San Francisco VA Medical Center, San Francisco, California
| | - Gabriela Schmajuk
- Department of VA Quality Scholar, San Francisco VA Medical Center, San Francisco, California
- Division of Rheumatology, University of California San Francisco, San Francisco, California
- Department of Rheumatology, San Francisco VA Medical Center, San Francisco, California
| | - Nicholas Moy
- Division of Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, California
- Department of VA Quality Scholar, San Francisco VA Medical Center, San Francisco, California
| | - Melissa Bachhuber
- Department of Hospital Medicine, San Francisco VA Medical Center, San Francisco, California
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California
| | - Margaret I. Wallhagen
- Department of Physiological Nursing, San Francisco School of Nursing, University of California, San Francisco, California
- Department of VA Quality Scholar, San Francisco VA Medical Center, San Francisco, California
| | - Sei J. Lee
- Division of Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, California
- Department of VA Quality Scholar, San Francisco VA Medical Center, San Francisco, California
- Division of Geriatrics, University of California San Francisco, San Francisco, California
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29
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Wong CC, Wallhagen MI. Family caregivers of individuals with frontotemporal dementia: examining the relationship between coping and caregiver physical and mental health. J Gerontol Nurs 2013; 40:30-40. [PMID: 24015887 DOI: 10.3928/00989134-20130827-05] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/03/2013] [Indexed: 11/20/2022]
Abstract
To identify strategies to assist family caregivers of individuals with frontotemporal dementia (FTD) in dealing with their caregiving demands, nurses must understand these family members' unique needs and how they currently deal with their demands. The purpose of this study was to examine the relationship between coping and caregiver physical and mental health among FTD family caregivers. Participants were primary caregivers of individuals with FTD (with behavioral symptoms) living at home (N = 61). A small positive association was noted between problem-focused coping and caregiver physical health (r = 0.29, p < 0.05), and a small but nonsignificant positive correlation was noted between emotion-focused coping and caregiver mental health (r = 0.21, p = 0.10). However, multiple regression analysis showed that emotion-focused coping (β = 0.46, p < 0.05) made a statistically significant, unique contribution to caregiver mental health and explained approximately 14% of its variance. These findings support the potential value of emotion-focused coping strategies when dealing with behavioral symptoms manifested by individuals with FTD.
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30
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Abstract
Clinically significant hoarding behaviors (HB) have been defined as acquisition of, and failure to discard, large numbers of items, which limits the use of one's home and causes functional impairment or distress. HB disproportionally affect adults aged 55 and older, and although research on HB has accelerated in the past decade, few studies focus on older adults. This qualitative study, based on grounded theory methodology, utilized interview data from 22 older adults with HB to understand the dynamic interaction between HB and the aging process. Participants described the specific ways that their chronic HB were complicated by changes in their health status, social context, and home setting, resulting in greater functional impairment and distress. By identifying these changes that commonly occur with age and their synergistic relationship with HB, nurses and other health professionals can develop targeted interventions to improve home safety and support the independence of these older adults.
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Affiliation(s)
- Monika B Eckfield
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, USA
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31
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Katz PP, Shin SY, Wallhagen MI. Reply. Arthritis Care Res (Hoboken) 2013; 65:1390-1. [DOI: 10.1002/acr.22006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Romo RD, Wallhagen MI, Yourman L, Yeung CC, Eng C, Micco G, Pérez-Stable EJ, Smith AK. Perceptions of successful aging among diverse elders with late-life disability. Gerontologist 2012; 53:939-49. [PMID: 23231944 DOI: 10.1093/geront/gns160] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Researchers often use the term "successful aging" to mean freedom from disability, yet the perspectives of elders living with late-life disability have not been well described. The purpose of this study was to explore the meaning of successful aging among a diverse sample of community-dwelling elders with late-life disability. DESIGN AND METHODS Using qualitative grounded theory methodology, we interviewed 56 African American, White, Cantonese-speaking Chinese, and Spanish-speaking Latino disabled elders who participate in On Lok Lifeways, a Program of All-inclusive Care for the Elderly. Through semi-structured interviews with open-ended questions, we explored the elders' perceptions of what successful aging and being old meant to them. RESULTS Despite experiencing late-life disability, most participants felt they had aged successfully. An overarching theme was that aging results in Living in a New Reality, with two subthemes: Acknowledging the New Reality and Rejecting the New Reality. Participants achieved successful aging by using adaptation and coping strategies to align their perception of successful aging with their experiences. Themes were common across race/ethnic groups but certain strategies were more prominent among different groups. IMPLICATIONS Across race and ethnic groups, most of these participants with late-life disability felt they had aged successfully. Thus, successful aging involves subjective criteria and has a cultural context that is not captured in objective measurements. Understanding elders' perception will help establish common ground for communication between clinicians and elders and identify the most appropriate interventions to help elders achieve and maintain the experience of successful aging.
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Affiliation(s)
- Rafael D Romo
- *Address correspondence to Rafael D. Romo, RN, PHN, MSN, UCSF School of Nursing, Office of Student Affairs N319X, 2 Koret Way, San Francisco, CA 94143-0602. E-mail:
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Abstract
Purpose
To review the current literature on help seeking for hearing health care among older adults.
Method
The authors conducted a literature review regarding help seeking for hearing-related communication difficulties as well as for other chronic medical conditions.
Results
Untreated hearing loss can lead to numerous negative secondary consequences; uptake and use of hearing aids remain low, despite the fact that hearing aids provide an effective treatment option for older adults with hearing loss. The authors describe models relevant to understanding the help-seeking and decision-making behaviors of older adults with hearing loss and discuss recommendations for future research.
Conclusion
Because of the considerable overlap in factors associated with help-seeking behaviors across chronic medical conditions and because help-seeking behaviors are complex, help seeking should be examined within the framework of a multifactorial model, such as the health belief model or the transtheoretical stages of change model.
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Affiliation(s)
- Gabrielle H. Saunders
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR
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34
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Imhof L, Naef R, Wallhagen MI, Schwarz J, Mahrer-Imhof R. Effects of an advanced practice nurse in-home health consultation program for community-dwelling persons aged 80 and older. J Am Geriatr Soc 2012. [PMID: 23194103 PMCID: PMC3557710 DOI: 10.1111/jgs.12026] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate the effects of an advanced practice nurse (APN) in-home health consultation program (HCP) on quality of life, health indicators (falls, acute events), and healthcare utilization. Design Randomized clinical trial. Setting One urban area in the German-speaking part of Switzerland. Participants Four hundred sixty-one community-dwelling individuals aged 80 and older (mean age 85, 72.7% female, all Caucasian) participated in the intervention (n = 231) and control (n = 230) groups. Intervention After a comprehensive geriatric assessment, participants were randomly assigned to the 9-month HCP with four in-home visits and three phone calls from APNs or to a control group with standard care with no intervention. Measurements The primary outcome was quality of life at 3, 6, and 9 months. Secondary outcomes were incidence of falls, acute events due to health problems, and healthcare utilization measured for 3-month periods at 3, 6, and 9 months. Results The intervention and control groups did not differ significantly on any dimension of the World Health Organization Quality of Life questionnaire but differed significantly over 9 months in self-reported acute events (116 vs 168, relative risk (RR) = 0.70, P = .001), falls (74 vs 101, RR = 0.71, P = .003), consequences of falls (63.1% vs 78.7%, chi-square = 7.39, P = .007), and hospitalizations (47 vs 68, RR = .70, P = .03). Conclusion The in-home HCP provided by APNs and guided by the principles of health promotion, empowerment, partnership, and family-centeredness, can be effective in reducing adverse health outcomes such as falls, acute events, and hospitalizations.
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Affiliation(s)
- Lorenz Imhof
- School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland.
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Wong CC, Wallhagen MI. Frontotemporal dementia: the impact of patient behavioral symptoms on the physical and mental health of family caregivers. Dement Geriatr Cogn Dis Extra 2012; 2:516-28. [PMID: 23277784 PMCID: PMC3522453 DOI: 10.1159/000345082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Providing informal support to someone with frontotemporal dementia (FTD) could be very stressful. Clarifying the relationship between patient behavioral problems and caregiver health could spur future research on effective symptom management strategies. METHODS Sixty-one FTD family caregivers participated in a postal survey. RESULTS Patient symptom severity was negatively associated with caregiver mental health (r = -0.26, p < 0.05) but not significantly associated with caregiver physical health. In a regression analysis, caregiver emotional distress from patient behaviors made a statistically significant contribution to caregiver mental health, explaining approximately 10% of its variance. CONCLUSION This study underscores the importance of focusing on FTD caregivers' perceived emotional distress from patient behavioral problems and ensuring they are getting the appropriate support they need.
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Affiliation(s)
- Cindy C Wong
- School of Nursing, Dominican University of California, San Rafael, Calif., USA
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Li WW, Wallhagen MI, Froelicher ES. Factors predicting blood pressure control in older Chinese immigrants to the United States of America. J Adv Nurs 2010; 66:2202-12. [DOI: 10.1111/j.1365-2648.2010.05399.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Strawbridge WJ, Wallhagen MI, Shema SJ. Spousal interrelations in self-reports of cognition in the context of marital problems. Gerontology 2010; 57:148-52. [PMID: 20616528 DOI: 10.1159/000318637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Problems with cognitive function are common among older adults, yet there is little research assessing the extent to which the cognitive problems of older husbands and wives are related to those of their partners and whether any observed relationships are moderated by gender or marital quality. OBJECTIVES Our purpose was to analyze longitudinal relationships between older spouses' cognitive function and the cognitive function of their partners 5 years later, as well as to assess moderating roles of gender and marital quality. METHODS The subjects were 378 community-dwelling couples aged 46-89 years at baseline who were followed for 5 years. Cognitive function was measured with a scale assessing problems remembering names, finding the right word, misplacing things and paying attention. Marital quality was assessed by comparing those reporting marital problems often or sometimes with those reporting marital problems rarely or never. All data were collected by self-report. Statistical models adjusted for paired data where appropriate and included partner cognitive function, age, chronic conditions and financial hardship. Stratified models assessed moderating roles of gender and marital problems. RESULTS We found a negative relationship between husbands' baseline lower cognitive function and wives' subsequent cognitive function but only for the wives reporting marital problems. We found no comparable relationship between wives' baseline lower cognitive function and their husbands' subsequent cognitive function. CONCLUSIONS Our gender-specific finding for wives is consistent with the gender differences noted in 2 previous studies. The limitation to wives with problems in their marriages is a new finding and might follow increased stress and depression responding to changes in their husbands' cognitive functioning.
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Affiliation(s)
- William J Strawbridge
- Institute for Health and Aging, University of California, San Francisco, Calif., USA.
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Leutwyler HC, Wallhagen MI. Understanding Physical Health of Older Adults with Schizophrenia: Building and Eroding Trust. J Gerontol Nurs 2010; 36:38-45. [DOI: 10.3928/00989134-20091103-99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 08/04/2009] [Indexed: 11/20/2022]
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Abstract
Maximizing patients' cognitive functioning and quality of life is a key concern for nurses. Some data suggest that hearing loss may be associated with cognitive decline. To further assess this association, a 5-year longitudinal study was conducted using a community sample of 2,002 men and women ages 50 to 94. A relatively strong relationship between baseline hearing impairment and subsequent poorer cognitive function was found in both existing and new cases of cognitive impairment. These findings raise questions for nursing practice and support the need for increased dialogue and collaborative studies across specialties to both refine the understanding of the factors involved and develop clinical strategies to minimize sensory and cognitive loss.
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Affiliation(s)
- Margaret I Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143-0610, USA.
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Abstract
PURPOSE To explore dimensions of stigma experienced by older adults with hearing loss and those with whom they frequently communicate to target interventions promoting engagement and positive aging. DESIGN AND METHODS This longitudinal qualitative study conducted interviews over 1 year with dyads where one partner had hearing loss. Participants were naive to or had not worn hearing aids in the past year. Data were analyzed using grounded theory, constant comparative methodology. RESULTS Perceived stigma emerged as influencing decision-making processes at multiple points along the experiential continuum of hearing loss, such as initial acceptance of hearing loss, whether to be tested, type of hearing aid selected, and when and where hearing aids were worn. Stigma was related to 3 interrelated experiences, alterations in self-perception, ageism, and vanity and was influenced by dyadic relationships and external societal forces, such as health and hearing professionals and media. IMPLICATIONS Findings are discussed in relation to theoretical perspectives regarding stigma and ageism and suggest the need to destigmatize hearing loss by promoting its assessment and treatment as well as emphasizing the importance of remaining actively engaged to support positive physical and cognitive functioning.
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Affiliation(s)
- Margaret I Wallhagen
- GNP-AGSF, Department of Physiological Nursing, School of Nursing, University of California, San Francisco, 2 Koret Way, N631, San Francisco, CA 94143-0610, USA.
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Song Y, Dowling GA, Wallhagen MI, Lee KA, Strawbridge WJ, Hubbard EM. Rest-activity patterns in institutionalized Korean older adults with dementia: a pilot study. J Gerontol Nurs 2009; 35:20-8; quiz 30-1. [PMID: 19928708 DOI: 10.3928/00989134-20091109-99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 08/26/2009] [Indexed: 11/20/2022]
Abstract
This pilot study examined rest-activity patterns and related factors in institutionalized older adults with dementia in Korea. Twelve individuals, residing in either a nursing home or an assisted living facility, participated in the study. Actigraphic measurements were collected for seven consecutive 24-hour periods to assess rest-activity patterns. The participants' demographic characteristics, cognitive function, problematic behaviors, and light exposure were also assessed. The results indicated the participants experienced sleep disturbances, including multiple awakenings at night and excessive daytime napping. Those in the nursing home had significantly more interdaily stability and less intradaily variability, with higher relative amplitude in their rest-activity rhythms, indicating more stable and stronger rest-activity rhythms than those in the assisted living facility. These findings emphasize the importance of the institutional environment in care planning to improve sleep and rest-activity rhythm for older adults with dementia.
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Affiliation(s)
- Yeonsu Song
- University of California, San Francisco, San Francisco, California 94143, USA
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Strawbridge WJ, Wallhagen MI, Thai JN, Shema S. The influence of spouse lower cognitive function on partner health and well-being among community-dwelling older couples: moderating roles of gender and marital problems. Aging Ment Health 2009; 13:530-6. [PMID: 19629777 DOI: 10.1080/13607860802607330] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To analyze longitudinal relationships between older spouses' lower cognitive function and the health and well-being of their partners five years later and to assess the moderating roles of gender and marital problems. METHODS Subjects were 404 community-dwelling older couples from the Alameda County Study. Baseline cognitive function was measured with a scale assessing problems remembering names, finding the right word, misplacing things and paying attention. Follow-up measures included five health and well-being outcomes. Statistical models adjusted for paired data and included spouse and partner cognitive function as well as partner baseline values for each outcome. Interaction terms assessed gender differences; stratified models assessed the moderating roles of marital problems. RESULTS Husbands' lower cognitive function was associated with subsequent poorer health and well-being for their wives; however, these associations were significant only for the 52% reporting few or no marital problems. Wives' lower cognitive function was not associated with any outcomes for their husbands. CONCLUSION Our findings support early identification of cognitive decline and development of assistive strategies for wives dealing with relationship changes associated with lower cognitive function in their husbands. Although our finding that associations were limited to wives in marriages with few or no problems is consistent with a communication framework, further research is necessary to better understand this strong gender difference.
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Affiliation(s)
- William Joseph Strawbridge
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, United States.
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Mayo AM, Wallhagen MI. Considerations of Informed Consent and Decision-Making Competence in Older Adults with Cognitive Impairment. Res Gerontol Nurs 2009; 2:103-11. [DOI: 10.3928/19404921-20090401-08] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
AIM This paper is a report of a study to explore the relationship between demographic and cultural factors and antihypertensive medication adherence in older Chinese immigrants. BACKGROUND Hypertension is a well-known controllable risk factor for cardiovascular diseases worldwide, but only 20-80% of patients who take antihypertensive medications adhere adequately to their treatment regimen. METHODS A cross-sectional study was conducted between 2002 and 2003, with a convenience sample of 75 older men and 69 older women (n = 144, response rate 80%). Medication adherence was defined as > or =80% of the total score on the Morisky scale. FINDINGS Age (75.2 +/- 5.7 vs. 75.9 +/- 7.0 years, P = 0.51) and length of stay in the United States of America (12.7 +/- 6.4 vs. 12.7 +/- 6.6 years, P = 0.97) were similar for men and women. More men were married (85% vs. 46%, P < 0.01). A smaller proportion of men were poor (39% vs. 65%, P < 0.01), believed in religion (49% vs. 70%, P = 0.01), and could speak no English (32% vs. 57%, P < 0.01). Fewer men used Chinese herbs to treat hypertension (4% vs.13%). Hypertension control was low for men and women (53% and 48%, P = 0.51). Adherence in men and women was 69% and 75% (P = 0.42) respectively. For men, shorter length of stay in the United States of America was negatively associated with non-adherence (OR = 0.16; 95% CI: 0.05, 0.57). No association between length of stay and non-adherence was found for women. CONCLUSION More research, including gender-specific studies, is needed to understand better how to develop an effective and culturally sensitive strategy to help older Chinese immigrants manage their hypertension.
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Affiliation(s)
- Wen-Wen Li
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, USA.
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Strawbridge WJ, Wallhagen MI, Shema SJ. Impact of Spouse Vision Impairment on Partner Health and Well-Being: A Longitudinal Analysis of Couples. J Gerontol B Psychol Sci Soc Sci 2007; 62:S315-22. [PMID: 17906175 DOI: 10.1093/geronb/62.5.s315] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [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: 11/12/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the impact of older spouses' vision impairment on the health and well-being of their partners and to test for gender differences. METHODS Participants were 418 older couples from the Alameda County Study. Vision impairment was assessed in 1994 with a 9-point scale assessing difficulty seeing in everyday situations; outcomes were assessed in 1999. Longitudinal analyses included multivariate statistical models adjusting for paired data and partners' own vision impairment, age, gender, chronic conditions, and financial problems. We include results on outcomes for partners' own vision impairment for comparative purposes. We assessed gender differences with interaction tests. RESULTS Spouse vision impairment negatively impacted partner depression, physical functioning, well-being, social involvement, and marital quality; these effects were not greatly different in magnitude from those associated with partners' own vision impairment. Three of four outcomes with significant gender differences evidenced stronger impacts of husbands' vision impairment on wives' well-being and marital quality than the reverse. DISCUSSION Spouses do not live in isolation; characteristics of one impact the other. Both treatment and rehabilitation programs should include spouses and other family members of visually impaired patients. Why wives appear more sensitive to their husbands' vision impairment is unclear and warrants further study.
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Mayo A, Wallhagen MI. Healthcare Decision-Making Among Patients With Amnestic Mild Cognitive Impairment. CLIN NURSE SPEC 2007. [DOI: 10.1097/00002800-200703000-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
A decline in vision occurs naturally with age; more severe impairment can result from medical conditions such as age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Nurses can pick up signs of visual impairment and suggest certain environmental modifications to prevent injury, such as keeping floors free of clutter and rooms well lit. Although assistive technologies such as optical devices, magnifiers, telescopes, and electronic magnification can help, some forms of impairment, such as that caused by cataracts and uncorrected refractive error, can be corrected.
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