Assessing Alzheimer's Disease Knowledge and Cognitive Risk Among a Rural Older Afro-Caribbean Cohort

PURPOSE

Older, rural Afro-Caribbeans are a growing subset of the Black population who face increased risk for Alzheimer's disease and related dementias (ADRD), but research targeting ADRD is scarce in this group. The purpose of this study was to investigate dementia risk among older Afro-Caribbeans living in a rural area. We also examined age, sex, and years of education, and knowledge about Alzheimer's disease as potential predictors of dementia risk.

DESIGN

A pre-post, correlational design was employed.

METHODS

Cognitive screenings were conducted using Nasreddine's Mini-MoCA, with tests of language fluency/orientation/recall, and linear regression analysis. A basic knowledge of Alzheimer's disease survey (BKAD) was also administered.

FINDINGS

A total of 55 Afro-Caribbean participants (67.0 +10.8y (M ± SD), 65.5% with 10y or less of education residing in a rural area within the last 20 years were included.Over 50% of the convenience sample scored in the cognitive risk range. Significant associations were found between Mini-MoCA Total and Language scores and education (p < 0.01). Further, there was a significant change from pretest to posttest in BKAD scores. BKAD pretest and posttest scores were also significantly higher for those without dementia risk based on the Mini-MoCA Total.

CONCLUSION

While the Mini-MoCA showed good reliability in less-educated older Afro-Caribbeans, scores were strongly dependent on years of education. Offering a limited intervention resulted in increased BKAD scores in this Afro-Caribbean sample, and a low BKAD score was associated with a higher dementia risk category.

CLINICAL EVIDENCE

This study contributes to the limited but growing body of research about Alzheimer's disease knowledge, cognitive risk, and dementia detection among Afro-Caribbeans. The use of language-neutral cognitive assessments is recommended among rural older immigrants.

Online Chair Yoga and Digital Learning for Rural Underserved Older Adults at Risk for Alzheimer's Disease and Related Dementias

OBJECTIVES

We evaluated the feasibility and preliminary efficacy of a home-based online chair yoga (OCY) program for racially and ethnically diverse rural community-dwelling older adults.

METHODS

We randomly assigned participants to OCY or a computer brain game (CBG). After a computer literacy training led by high school students, participants engaged in remotely supervised OCY or CBG in twice-weekly 45-minute sessions for 12 weeks. Outcome data (pain interference, cognitive function, mobility, computer skills) were collected at baseline, post-intervention, and 3-month follow-up.

RESULTS

A total of 32 eligible residents with mean age of 71 years participated in this intervention study. The interventions were feasible (100% recruitment rate, 96.8% retention rate, 100% safety rate). There were significant improvements in pain interference, cognitive function, mobility, and computer skills from baseline to follow-up among participants in both OCY and CBG but no significant differences in outcomes between groups.

CONCLUSIONS

Preliminary results indicated that the CBG was as effective as online OCY in clinical outcomes in these participants. However, this should be confirmed in future studies.

CLINICAL IMPLICATIONS

This telehealth-based intervention is feasible for older adults in rural and digitally underserved communities and could provide a strategy for delivering health-promoting interventions for home-bound older adults at risk for Alzheimer's disease and related dementias (ADRD) and connect caregivers to online resources.

End-of-Life Care Planning in Diverse Individuals Across Age Groups: A Proposed Conceptual Model of Nursing

BACKGROUND

End-of-life planning helps nurses meet the needs of their patients at a crucial time of life.

PURPOSE

This article presents a conceptual model of end-of-life care planning for nurses, especially those in palliative and hospice care, focusing on holistic nursing views.

METHODS

Based on a literature review, we developed a new conceptual model illustrating the concepts and dimensions of end-of-life care planning among diverse individuals across countries, life spans and age groups, ethnographies, and residential statuses.

RESULTS

This conceptual model includes 3 concepts: personal factors, stakeholders, and environmental and social factors. Each concept encompasses multiple dimensions. The concepts are interrelated and directly related to end-of-life care planning.

CONCLUSION

This work addresses the need for a comprehensive end-of-life care planning model and can help enhance the quality of end-of-life care. This article identifies implications for nursing education, practice, and research.

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

INTRODUCTION

Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators.

METHODS

An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings.

RESULTS

A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions.

DISCUSSION

A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities.

HIGHLIGHTS

Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.

Perceptions About Discrimination in a Rural, Older, Racially and Ethnically Diverse Cohort

Purpose

The purpose of this pilot study was to examine perceptions of discrimination among a small cohort of rural older, retired minority Florida farmworkers. Potential sources of discrimination were explored, such as health literacy, age, sex, gender, racial/ethnic background, or rural residency.

Sample

The study occurred in a rural area that is designated as a "hot zone" due to its HRSA designation as a medically underserved area (MUA), health provider shortage area (HPSA), and medically underserved population, despite lying only 50 miles due west of the affluent town of Palm Beach, Florida. More than 40% of residents live below the poverty level, and only 65% have received a high school diploma.

Method

A descriptive, correlational pilot study was conducted to investigate potential contributors to discrimination. Independent variables examined were age, sex, gender, rural residency, racial/ethnic background, and health literacy, using the Rapid Estimate of Health Literacy in Medicine, short form (REALM-SF) (Arozullah, 2007). The incidence of self-reported discrimination was investigated. Chi-square and Pearson correlation analysis were employed to examine survey results. Findings were supplemented with a brief narrative inquiry, and responses were analyzed using Saldaña's (2015) model of cyclical coding.

Findings

Twenty-five residents in a subsidized housing unit agreed to participate in this study. This convenience sample was 96% racially/ethnically diverse (68% African American, 24% Haitian Creole, and 4% Hispanic American.) Most (78%) were retired field workers, and largely self-identified as female (72%). The residents' average reading level was 4th-6th grade. Health literacy (44%) and rural residency (24%) were the greatest sources of discrimination. Female gender discrimination was associated with ethnicity discrimination (r = 0.6, p = .002).

Conclusions

Providers are strongly encouraged to assess their patients' health literacy levels and experiences with discrimination to inform effective care delivery.

Does self-directed learning address gaps in nursing student knowledge of Alzheimer's disease?

In the past two decades, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from age-related Alzheimer's disease (AD) have increased. Future nurses will be caring for the rapidly escalating number of older adults facing increased AD risk, yet nursing students' knowledge has been shown to be limited regarding the age-related disease of Alzheimer's (and the most common dementia type) (Aljezawi et al., 2022; Mattos et al., 2015). In this pilot study, a quasi-experimental approach was used to examine undergraduate baccalaureate nursing students' basic knowledge about AD among two cohorts (N = 146). Testing occurred following an assigned self-directed learning activity as a means of providing the most current information regarding dementia. Pearson correlation and t-tests were applied in comparing student results in pre- and posttest surveys and investigating possible correlations between sociodemographic variables. Students in the 2020 group scored lower on ten of the thirty test items than the earlier 2018 cohort, suggesting that the method of self-directed learning, despite offering the most recent information, may be inadequate. To prepare nursing students to care for the increasing numbers of older adults at risk for Alzheimer's disease, curricula that are inclusive of the most recent advances in science surrounding dementia-related illnesses, and supplemented by faculty lectures, is recommended. This requires faculty themselves to be knowledgeable of the most recent advances in dementia risk, prevention, detection and management.

Remotely supervised home-based online chair yoga intervention for older adults with dementia: Feasibility study

BACKGROUND

and Purpose: Social isolation and caregiver burden call for an innovative way to deliver a chair yoga (CY) intervention to older adults with dementia who cannot travel to a community center. During a remotely supervised CY session, the yoga instructor can monitor each participant's pose and correct poses to optimize efficacy of CY and reduce chances of injury. This study assessed the feasibility of a remotely supervised online CY intervention for older adults with dementia and explored the relationship between CY and clinical outcomes: pain interference, mobility, risk of falling, sleep disturbance, autonomic reactivity, and loneliness.

METHODS

Using a one-group pretest/posttest design, a home-based CY intervention was delivered remotely to 10 older adults with dementia twice weekly in 60-minute sessions for 8 weeks. Psychosocial and physiological (i.e., cardiac) data were collected remotely at baseline, mid-intervention, and post-intervention.

RESULTS

The results indicated that remotely supervised online CY is a feasible approach for managing physical and psychological symptoms in socially isolated older adults with dementia, based on retention (70%) and adherence (87.5%), with no injury or other adverse events. While there were no significant findings for pain interference, mobility, sleep, or social loneliness longitudinally, emotional loneliness showed a significant increase, F(1.838, 11.029) = 6.293, p = .016, η² = 0.512, from baseline to post-intervention. Although participants were socially connected to other participants via a videoconferencing platform, emotional loneliness increased during the pandemic period.

CONCLUSION

A home-based remotely supervised online CY is a feasible approach for socially isolated older adults with dementia who are unable to travel to a facility.

Employing the Moca‐T (telephone) as a means of cognitive screening in a rural, ethnically diverse population during Covid‐19 restrictions

Background

Rural, ethnically diverse older adults face a heightened risk of Alzheimer’s disease and related dementias (ADRD), but experience disparities in dementia education, detection, and treatment. The Covid‐19 pandemic struck during a rural, faith‐based outreach to address this gap. In‐person research activities were redesigned to employ a telephone approach.

Method

The revised research question targeting a rural community of 89% African American, Hispanic, and Haitian Creole residents was adapted to “Is the telephone an effective method for a) increasing AD knowledge, and b) detecting cognitive risk, in a rural underserved setting?” Faith‐based health educators, trained using online Alzheimer’s Association resources, contacted church congregants who responded to announcements during virtual worship services. Participants completed a measure of basic dementia knowledge (BKAD; Wiese et al., 2020), and MoCA‐T with a cut point of 11 indicating need for referral (Nasreddine, 2019) .

Result

Of the estimated 120 persons across five churches who received an invitation, 75% (n = 90) participated in dementia education and memory screening via telephone. Dependent samples t‐test showed a significant increase in dementia knowledge: t(89) = ‐6.3, p < .001), and paired samples pre/post; t(24) = ‐2.23, p = < 004). Of the 60 who completed cognitive screening using the MoCA‐T, 15 (25%) were found to be at risk for memory impairment. Twelve (80%) of the 15 participants assessed as being at risk did follow‐up with their provider.

Conclusion

Rural residents were willing to participate in telephone‐based health‐seeking activities during quarantine, and the Moca‐T was useful in identifying cognitive risk.