Facilitating Volunteer Engagement Among Older Adults in Social Services: A Case Study of an Innovative Timebank Program in a Chinese Society

BACKGROUND AND OBJECTIVES

Exploring the roles of older adults as volunteers in social care settings has attracted wide attention to facilitate healthy aging and tackle care workforce constraints. However, there is little knowledge of the mechanism of engaging older adults as volunteers in the social care sector.

RESEARCH DESIGN AND METHODS

The study applies a case study to describe the features of an innovative timebank project, Good Hands, and explore the underlying mechanism of engaging older adults as volunteers in the social care sector. Three focus groups were conducted with 12 older adult volunteers and 6 advisory group members. Thematic analysis was applied to code and analyze the content of the focus group interviews.

RESULTS

Three emergent themes were identified as critical components: strong cross-sector collaboration, meaningfulness in voluntary work comprising 4 subthemes (including capacity optimization, care capacity enhancement, cultivating belonging, and value recognition), and a coproducing environment.

DISCUSSION AND IMPLICATIONS

Volunteer engagement of older adults in the provision of welfare for community-based care for frail peers is discussed, and practice implications are presented.

Sad Mood Bridges Depressive Symptoms and Cognitive Performance in Community-Dwelling Older Adults: A Network Approach

Background and Objectives

Depression and cognitive impairment are common and often coexist in older adults. The network theory of mental disorders provides a novel approach to understanding the pathways between depressive symptoms and cognitive domains and the potential "bridge" that links and perpetuates both conditions. This study aimed to identify pathways and bridge symptoms between depressive symptoms and cognitive domains in older adults.

Research Design and Methods

Data were derived from 2,792 older adults aged 60 years and older with mild and more severe depressive symptoms from the community in Hong Kong. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and cognition using the Montreal Cognitive Assessment 5-minute protocol (MoCA-5min). Summary descriptive statistics were calculated, followed by network estimation using graphical LASSO, community detection, centrality analysis using bridge expected influence (BEI), and network stability analyses to assess the structure of the PHQ-9 and MoCA-5min items network, the pathways, and the bridge symptoms.

Results

Participants (mean age = 77.3 years, SD = 8.5) scored 8.2 (SD = 3.4) on PHQ-9 and 20.3 (SD = 5.4) on MoCA-5min. Three independent communities were identified in PHQ-9 and MoCA-5min items, suggesting that depression is not a uniform entity (2 communities) and has differential connections with cognition. The network estimation results suggested that the 2 most prominent connections between depressive symptoms and cognitive domains were: (1) anhedonia with executive functions/language and (2) sad mood with memory. Among all depressive symptoms, sad mood had the highest BEI, bridging depressive symptoms and cognitive domains.

Discussion and Implications

Sad mood seems to be the pathway between depression and cognition in this sample of older Chinese. This finding highlights the importance of sad mood as a potential mechanism for the co-occurrence of depression and cognitive impairment, implying that intervention targeting sad mood might have rippling effects on cognitive health.

How do forms and characteristics of Asian public housing neighbourhoods affect dementia risk among senior population? A cross-sectional study in Hong Kong

BACKGROUND

Public housing estate is a key determinant of community health risk in American/European cities. However, how forms/characteristics of compact/hilly public housing's neighbourhoods affect dementia among Asian seniors was underestimated.

DESIGN

This was a cross-sectional study.

METHODS

A total of 2,077 seniors living in Hong Kong's public housing estates were included. Dementia was measured by a Cantonese version of Montreal - Cognitive Assessment. Built environment was measured based on three dimensions (greenery, walkability, accessibility), including 11 metrics. Circular buffers (without walking paths) and service areas (considering walking paths) with two-dimensional/three-dimensional (terrain) adjustment were applied to quantify forms/characteristics of neighbourhoods. Two spatial buffers were applied: immediate distance (200 m) and walkable distance (500 m). Exposure-by-exposure regressions were applied to evaluate the associations between form/characteristics of neighbourhood and dementia.

RESULTS

Forms/characteristics without considering walking paths may overestimate health benefits from built environment. For circular buffers, higher percentage of building coverage, higher land use mix and more community/transportation/leisure facilities were negatively associated with dementia. All measures of greenery were positively associated with dementia. For service areas, measures of walkability and accessibility became insignificant except more community facilities at the immediate distance. Furthermore, terrain effect was insignificant when it was compared with the impacts of walking paths.

CONCLUSION

Dementia among seniors in hilly public housing estates was negatively associated with neighbourhood's walkability and accessibility and was influenced by walking paths. For healthy ageing, improved forms/characteristics of public housing neighbourhoods should include more accessible spaces and community facilities along walking paths for physical activities and basic daily needs.

URBAN ENVIRONMENT AND AFFECTIVE STATES IN REAL TIME: AN ECOLOGICAL MOMENTARY ASSESSMENT STUDY OF OLDER ADULTS

Older adults are more dependent on their surrounding environment. Extensive research has demonstrated beneficial effects of both nature and built environment on mental health of older people. However, most previous research used cross-sectional designs failed to test the intraindividual variability between environment, behavior, and mental wellness in daily life. We used ecological momentary assessment (EMA), activity sensors, and GPS tracking to examine the association between real-time environment, mobility and activity, and momentary affect among older adults in Hong Kong. Data collection and data processing was conducted from December 2021 to May 2022. 168 older adults aged 65 to 84 received seven EMA prompts per day during a fifteen-day period, and completed a total of 17,345 momentary assessments of affective states, mobility, and activities. A set of GPS-derived indicators were used to measure the real-time environment. To disaggregate the between- and within-person effects, we used multilevel models to estimate three dimensions of affect, i.e., valence, calmness, and energetic arousal, in EMA observations, nested within individual participants. Preliminary results indicate significant concurrent associations between environmental attributes and momentary affect at the within-person level, while the between-person differences appear to be either null or modest. Being out of home is associated with higher valence ratings (b=0.04, p=0.0427), while exposure to green is associated with a lower level of energetic arousal (b=-0.03, p=0.0163). Greater walkability is consistently associated with higher momentary affect ratings in three dimensions, but these associations are not statistically significant. Implications of these findings for promoting healthy aging will be discussed.

IMPACT OF COVID-19 PANDEMIC ON MENTAL HEALTH IN OLDER ADULTS: COMPARISON BETWEEN 2020 AND 2022

The COVID-19 pandemic had a major impact on older adults’ mental health, but less is known about its longer-term effect. We examined changes in depressive and anxiety symptoms among older adults between the onset and two years into the pandemic. Data were drawn from two cross-sectional telephone surveys conducted with older adults aged ≥ 60 years in Hong Kong in 2020 and 2022. Respondents were screened for depression and anxiety using Patient Health Questionnaire-2 (PHQ-2) and General Anxiety Disorders-2 (GAD-2) and, if screened positive (i.e. scoring ≥ 3 in PHQ-2 or GAD-2), evaluated with PHQ-9 and GAD-7 for symptom severity. After case-control matching baseline age, gender, living districts, and pre-existing mental health conditions based on the respondent ratio between the two surveys (i.e. 2:1 ratio), 4095 and 2099 respondents from the 2020 and 2022 surveys were included in the analysis. Respondents’ average baseline age was 75 years old, 77% were female, and 13% had a pre-existing mental health condition. There were significant increases in the proportion of older adults screened positive for depression (8.3% to 13.5%) and anxiety (6.9% to 11.4%) and a significant increase in depressive symptom severity (4.63 to 7.72) between 2020 and 2022 (p < .001). Logistic regression suggested that, over two years, older adults with pre-existing mental health conditions were 1.59 times more likely to screen positive for depression than those without such conditions. Linear regression suggested that males were associated with increased depressive (B=-2.42, p=.004) and anxiety (B=-2.49, p=.021) symptom severity than females over the years.

ASSOCIATIONS BETWEEN COVID-19 RELATED STRESS, COVID-19 EXPERIENCES, AND MENTAL HEALTH RISKS IN OLDER PEOPLE

There is increasing recognition of the need to understand the mechanism of psychological impact brought by COVID-19. The present research used the Delphi technique to develop a COVID-19-Related Stress Scale for older people in Hong Kong (CSS-old) (study one) and examined its associations with COVID-19 experiences and mental health risks (study two). In study one, 17 helping professionals and 20 service users co-developed an 8-item CSS-old through four rounds of Delphi. In study two, a cross-sectional telephone survey was conducted between April and June 2022 among 4,921 older people (age≥60) recruited through community centres. Respondents were assessed using Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder 2-item (GAD-2), and CSS-old; their experiences with COVID-19 (infection, close friend/family infection) and demographical information were collected. A three-factor solution of CSS-old was identified after dropping one item (X2(df) = 83.53(11), CFI=0.996, TLI=0.993, RMSEA=0.037): (1) disruption to routines; (2) fear of infecting families/friends; and (3) concern for the community’s health. Structural equation modelling analyses revealed that being female (B=0.45), having close friend/family infected (B=1.10) and having a pre-existing mental health condition (B=1.87) were positively associated with COVID-19-related stress. Infection of COVID-19 (BPHQ=0.22; BGAD=0.24) and a pre-existing mental health condition (BPHQ=0.71; BGAD=0.59) had direct associations with depressive and anxiety symptoms; COVID-19-related stress mediated the relationship between close friend/family infection with depressive (B=0.20) and anxiety symptoms (B=0.21, all p < 0.05). These results suggest that older people’s COVID-19-related stress is beyond infection of the disease, and different experiences with COVID-19 may increase depression and anxiety risks through different pathways.

DIFFERENTIAL ROLES OF COVID-19-RELATED STRESSORS IN MENTAL HEALTH PROBLEMS: A NETWORK APPROACH

COVID-19-related stress is heterogeneous and associated with increased mental health conditions in older adults. This study is to investigate relationships between different stressors and how different stressors may increase risks for mental health conditions through a network approach. A telephone survey was conducted among 4,921 older adults (age≥60) from April to June 2022 during the biggest community outbreak of COVID-19 in Hong Kong. The validated 8-item COVID-19-Related Stress Scale (CSS-old) (Cronbach’s α: 0.91) was used to investigate the different stressor for older people in Hong Hong. Respondents were screened for depression using the Patient Health Questionnaire-2 (PHQ-2), anxiety using the Generalized Anxiety Disorder 2-item (GAD-2), and stressors with the CSS-old, 4708 responded to all questions. A regularized partial correlation network via graphical LASSO procedure was computed to analyze the relationship between 8 stressors; a directed acyclic graph (DAG) via a Bayesian hill-climbing algorithm was generated from CSS-old and comorbidity network with PHQ-2 and GAD-2 items. Network analyses identified CSS-old item 6 (families or friends infected), item 3 (daily life interrupted), item 5 (fear of infection affecting the family), and item 8 (worry for community’s health) as the core stressors. DAG analysis found a key triggering role for item 1 (suspension of community services), and the activation of the mental health problems occurred through item 1, which bridged the COVID-19-related stress and mental health problems. These findings suggested that providing support for families with COVID-19 patients and alternative services during community service suspension may reduce mental health problems risks.

USING COMMUNITY-BASED PARTICIPATORY RESEARCH TO PROMOTE MENTAL HEALTH LITERACY IN OLDER CHINESE

Whilst traditional mental health literacy programmes utilized a top-down approach, no bottom-up community-based participatory research (CBPR) model had been used to promote mental health literacy among older adults. Moreover, the existing CBPR model was developed in the West and might not be applicable in Chinese communities given different socio-cultural contexts. This research aimed to fill the gap by implementing a CBPR project to promote mental health literacy among older adults and developing a CBPR model in Chinese context. A year-long CBPR project was conducted in five Hong Kong districts from May 2021 to August 2022. A district advisory group was formed in each district, which comprised 50 community older adults, 2 NGO social workers, and 2 researchers. Each district had their own promotional activities that were initiated and designed by older adults, including street booths, art workshops, videos and photos to promote mental health and introduce relevant information and resources. Researchers recorded field observations in each district activity and conducted focus group discussions with stakeholders. Collected data suggested that specific elements are important for a CBPR model in Chinese context, including participant empowerment, technical support, stakeholder expectation management and potential community contribution. Following the implementation of district promotional activities, a territory-wide advisory group was formed to promote mental health literacy on a territory level in the coming year. This is the first large-scale CBPR project that promoted mental health literacy among older adults in Chinese context. Implications for future research and practice will be discussed.

Depressive Symptoms and Coping Strategies in Community-Dwelling Older People Amidst the COVID-19 Pandemic: A Mixed-Method Study

This study aimed to examine depressive symptoms of community-dwelling older people amidst COVID-19 and explore how naturally occurring coping strategies were associated with depression. A mixed-method cross-sectional telephone survey was conducted with 375 older people aged 60 years and above between March and May 2020 in Hong Kong. Trained social workers interviewed participants and assessed depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). Attribute coding and thematic analysis were adopted for qualitative data analyses. Generalized linear models (GLM) were used to examine the effects of demographics, self-reported risk factors and coping strategies on PHQ-9 scores. Participants' average PHQ-9 score was 1.9 (SD = 2.9), suggesting a low risk for depression in general. Over half of the participants reported adaptive coping strategies, including learning new things, staying physically, mentally, and socially active, and having a positive mind-set. GLM results indicated that living with family members (other than spouse) and/or others, maladaptive coping, and self-reported risk factors were significantly associated with higher PHQ-9 scores, while adaptive coping was significantly associated with lower PHQ-9 scores. Our study contributed to the growing literature on older people's resilience and adaptive coping during the pandemic, and the results may have implications for mental health promotion and community care.

Degree of personalisation in tailored activities and its effect on behavioural and psychological symptoms and quality of life among people with dementia: a systematic review and meta-analysis

OBJECTIVES

To understand and assess the degree of personalisation of tailored activities for people with dementia (PWD); and to estimate the magnitude of the effects of levels of personalisation on reducing behavioural and psychological symptoms of dementia (BPSD), improving quality of life (QoL) and level of engagement.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

ProQuest, PubMed, Ovid, Cochrane Library, Web of Science and CINAHL were searched from the start of indexing to May 2020.

ELIGIBILITY CRITERIA

We included randomised controlled trials and quasi-experimental studies assessing the effects of tailored activities for people aged 60 years or older with dementia or cognitive impairment on the outcomes of BPSD, QoL, depression and level of engagement with control groups.

DATA EXTRACTION AND SYNTHESIS

Two researchers screened studies, extracted data and assessed risks of bias. A rating scheme to assess the degree of personalisation of tailored activities was developed to classify tailored activities into high/medium/low groups. Effect sizes were expressed using standardised mean differences at 95% Confidence Interval (CI). Subgroup analyses were conducted to assess whether the degree of personalisation of tailored activities affected outcomes of interest.

RESULTS

Thirty-five studies covering 2390 participants from 16 countries/regions were identified. Studies with a high-level of personalisation interventions (n=8) had a significant and moderate effect on reducing BPSD (standardised mean differences, SMD=-0.52, p<0.05), followed by medium (n=6; SMD=-0.38, p=0.071) and low-level personalisation interventions (n=6; SMD=-0.15, p=0.076). Tailored activities with a high-level of personalisation had a moderate effect size on improving QoL (n=5; SMD=0.52, p<0.05), followed by a medium level (n=3; SMD=0.41, p<0.05) of personalisation.

CONCLUSIONS

To develop high-level tailored activities to reduce BPSD and improve QoL among PWD, we recommend applying comprehensive assessments to identify and address two or more PWD characteristics in designed tailored activities and allow modification of interventions to respond to changing PWD needs/circumstances.

PROSPERO REGISTRATION NUMBER

CRD42020168556.

COVID-19 DIAGNOSIS BY POINT OF CARE LUNG ULTRASOUND: A NOVEL DEEP LEARNING ARTIFICIAL INTELLIGENCE METHOD

BACKGROUND

METHODS AND RESULTS

CONCLUSION

COVID-19 and Long-Term Care Policy for Older People in Hong Kong

Hong Kong is a major international travel hub and a densely populated city geographically adjacent to Mainland China. Despite these risk factors, it has managed to contain the COVID-19 epidemic without a total lockdown of the city. Three months on since the outbreak, the city reported slightly more than 1,000 infected people, only four deaths and no infection in residential care homes or adult day care centers. Public health intervention and population behavioral change were credited as reasons for this success. Hong Kong's public health intervention was developed from the lessons learned during the SARS epidemic in 2003 that killed 299 people, including 57 residential care residents. This perspective summarizes Hong Kong's responses to the COVID-19 virus, with a specific focus on how the long-term care system contained the spread of COVID-19 into residential care homes and home and community-based services.

COST-EFFECTIVENESS ANALYSIS OF THE COLLABORATIVE STEPPED CARE INTERVENTION FOR LATE-LIFE DEPRESSION

Late-life depression is a burden on society because it is costly and have a significant adverse effect on the quality of life. The aim of this study is to evaluate the cost-effectiveness of the collaborative stepped care intervention for depression among community-dwelling older adults compared to care as usual from a societal perspective. The intervention was piloted from 2016-2019 in Hong Kong. The study used a two-armed quasi-experimental design. Eventually, 412 older people were included (314 collaborative stepped care, 98 care as usual). Baseline measures and 12-month follow-up measures were assessed using questionnaires. We applied the 5-level EQ-5D version (EQ-5D-5L) and the Client Service Receipt Inventory (CSRI) respectively measuring quality-adjusted life-year (QALY) and health care utilization. The average annual direct medical cost in the intervention group was USD 6,589 (95% C.I., 4,979 to 8,199) compared to US$ 6,167 (95% C.I., 3,702 to 8,631) in the care as usual group. The average QALYs gained was 0.036 higher in the collaborative stepped care group, leading to an incremental cost-effectiveness ratio (ICER) of US$ 11,722 per QALY, lower than the cost-effectiveness threshold suggested by The National Institute for Health and Clinical Excellence. The study showed that collaborative stepped care was a cost-effective intervention for late-life depression over service as usual.

EFFECTIVENESS OF A COLLABORATIVE STEPPED-CARE MODEL FOR OLDER ADULTS WITH DEPRESSION

Background: Depression is common among older adults and creates a substantial burden on individuals, caregivers, and healthcare system. This paper presents an innovative collaborative stepped care intervention that promotes the coordination between elderly center and community mental health center to provide nonpharmacological intervention to elders with mild to moderate level of depression. Methods: The stepped care model were implemented in four districts in Hong Kong between September 2017 and February 2019. In each district, one community mental health center and one elderly center worked together to implement this stepped care model. A quasi-experimental design was used to study the effectiveness of this intervention. Findings: A total of 853 older adults completed the intervention and additional 500 elders were recruited as control. The average age of intervention participants was 76.3 years. Their levels of depression and anxiety were measured by Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) respectively. The average intervention lasted for 10 months. Their average PhQ9 score reduced from 7.2 before intervention to 2.7 after intervention (t= 34.7, p < .001). Their level of anxiety was lowered from 4.9 to 2.0 (t=16.9, p < .001). The different between the intervention and control groups were statistically significant. Conclusion: The stepped care model was effective in reducing the levels of depression and anxiety among Chinese older people. This paper will give detailed information about the stepped care model and its implementation.

THE ROLE OF SENSE OF COMMUNITY IN CHANGING THE HEALTH-PROMOTING EFFECT OF BUILT ENVIRONMENT: A COMMUNITY SURVEY

Previous research that studies the impact of built environment on health often attribute the enabling effects of environment on physical activity participation and opportunities for social interaction. Few studies have explored how the role of subjective feeling, such as the feeling of connectedness with the community, affects the association between built environment and physical and mental health. We conducted a cross-sectional survey with 2,247 residents aged 50 years or above in five districts in Hong Kong. We tested the mediation effect of sense of community in the relationship between physical environment and health using the path analysis. We administered a questionnaire to assess the residents’ perceived age-friendliness of outdoor spaces and buildings in the district. We used the Brief Sense of Community Scale and the 12-item Short-form Health Survey to measure sense of community and physical and mental health. We found that age-friendliness of outdoor spaces was modestly correlated with mental health (r = 0.10, P < 0.001) but not with physical health (r = 0.02, P = 0.4), whereas age-friendliness of buildings correlated with both (r = 0.05, P = 0.01; r = 0.06, P = 0.004). Sense of community mediated 25.9% of the total effect between outdoor space and physical health, 20.4% between outdoor space and mental health, and 42.5% between service and building on physical health. To conclude, sense of community was a partial mediator of the environment-health relationship. Future design of built environment should take into consideration its potential influence on sense of community and health.

DUAL IMPACTS ON MEANING IN LIFE IN OLDER PERSONS VOLUNTEERING FOR ELDERLY MENTAL HEALTH PROGRAM

Volunteering provides sense of meaning in life. The impact of volunteering on different dimensions of meaning in life and the mechanisms explaining the effects have been rarely researched. This study examined the effects and the mechanism of a formal volunteering program for mental health in older persons, including training, service provision, and supervision, on two dimensions of meaning in life — presence of meaning and searching for meaning — among senior volunteers. A mixed method study was conducted. 103 volunteers (average age=63.3±6.6) completed assessments at three time points: before and after the training, and one-year after service provision. They self-assessed Meaning in Life Questionnaire (MLQ) and reported time use in different tasks. 26 of them participated in focus groups discussing their experience in the program. Volunteers’ search for meaning differed between time points (F(1.87,173.81)=3.20, p<.01) while presence of meaning persisted. Search for meaning reduced from before the training to after service provision (p<.05) as revealed by post-hoc tests. Proportion of home visit during service provision explained 2.7% of the variance of presence of meaning before and after service provision (R2=0.05, F(6,74)=1.376, p<.05). Findings from focus groups revealed that application of trained skills and building trusting relationship with their clients via home visits are sources of meaning. Formal volunteering may have dual impacts on meaning in life in older age: reducing search for meaning and maintaining presence of meaning. For senior volunteers, being able to apply what they learn and building social connects are the key factors for attaining meaning.

ENGAGEMENT MATTERS TO OPTIMIZE COGNITIVE BENEFITS OF COGNITIVELY IMPAIRED PEOPLE IN COGNITIVE STIMULATION THERAPY

Background Cognitive stimulation therapy (CST), a 14-session themed groupwork for people with cognitive impairment, shows effectiveness in maintaining cognitive functioning, quality of life and communication. However, its mechanism of optimizing individual cognitive benefits is little known. Engagement, a state of being occupied by meaningful external stimuli, may be an overlooked link. Individual constructive engagement is defined as the verbal or motor individual behavior exhibited for the meaningful purposed activities. Objective To investigate the individual experience of engagement in CST and its effect on cognitive benefits. Methods A total of 108 participants were recruited from 8 community centers, 2 daycare centers and 2 residential care units in Hong Kong. Trained assessors not involved in CST delivery conducted the pre-and-post assessments using Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog). Trained raters observed each participant’s engagement under six 5-minute observation windows in total during CST sessions by time sampling using the adapted Myers Institute Engagement Scale. Results Paired t-test shows significant improvement in ADAS-Cog (Pretest: M=22.71, SD=12.63; Posttest: M=19.06, SD=10.93; MD=3.65, SD=7.38, t=5.138, p<.000). Individual constructive engagement was exhibited 23.3% of activity time averagely. It correlated with the change in ADAS-Cog positively(r=.292, p<.002). Greater individual constructive engagement predicted lower post-intervention ADAS-Cog score (B=-14.98, β=-.192, p<.001), indicating a better cognitive functioning, after controlling baseline ADAS-Cog score (B=.707, β=.816, p<.000) in the multiple linear regression analysis (R2 = .698, F (2,105) =121.38, p<.000). Conclusion Engagement is the potential mechanism to maximize individual cognitive benefits. Future studies can investigate contributing factors of engagement to improve intervention effectiveness

DETECTION OF DEPRESSION USING THE UCLA THREE-ITEM LONELINESS SCALE IN OLDER CHINESE

Loneliness is a significant and independent risk factor for later life depression. This study aimed to validate the Chinese version of the UCLA 3-item Loneliness Scale and to ascertain the cut-off point in detecting depression in community-dwelling older adults. The English version of the UCLA was translated into Chinese by six experienced social workers, clinical psychologists and researchers, and content validity was established by consultation and revision with 10 older adults. 1,919 older adults aged 60 years and over (average age = 76.3±8.0) were recruited from local NGOs, they were interviewed for demographic information, and assessed using the 3-item loneliness scale and the Patient Health Questionnaire (PHQ-9). Cronbach’s α of the Chinese loneliness scale was 0.87; the average score was 4.0 ± 3.0 out of 9, and it significantly correlated with living alone (r = 0.18, p &lt; 0.001), unmarried (r = 0.12, p &lt; 0.001), no emotional support (r = 0.14, p &lt; 0.001), and depression (r = 0.41, p &lt; 0.001). Using PHQ-9 cut-off score of 5 for mild and above depression, the area under the curve (AUC) was 0.73 ± 0.1 (p &lt; .001, 95% CI 0.71-0.76) with 77% sensitivity and 61% specificity. We determined a cut-off point of 3 for loneliness using the Youden index, which revealed better sensitivity over alternative definitions of loneliness. A cut-off point of 3 in the Chinese UCLA 3-item loneliness scale can reliably identify possible depression in community-dwelling older Chinese.

Cultural Health Assets of Somali and Oromo Refugees and Immigrants in Minnesota: Findings from a Community-Based Participatory Research Project

This community-based participatory research study sought to identify the cultural health assets of the Somali and Oromo communities in one Minnesota neighborhood that could be mobilized to develop culturally appropriate health interventions. Community asset mappers conducted 76 interviews with Somali and Oromo refugees in in Minnesota regarding the cultural assets of their community. A community-university data analysis team coded data for major themes. Key cultural health assets of the Somali and Oromo refugee communities revealed in this study include religion and religious beliefs, religious and cultural practices, a strong culture of sharing, interconnectedness, the prominence of oral traditions, traditional healthy eating and healthy lifestyles, traditional foods and medicine, and a strong cultural value placed on health. These cultural health assets can be used as building blocks for culturally relevant health interventions.

The association between long-term care setting and potentially preventable hospitalizations among older dual eligibles

OBJECTIVE

To compare the probability of experiencing a potentially preventable hospitalization (PPH) between older dual eligible Medicaid home and community-based service (HCBS) users and nursing home residents.

DATA SOURCES

Three years of Medicaid and Medicare claims data (2003-2005) from seven states, linked to area characteristics from the Area Resource File.

STUDY DESIGN

A primary diagnosis of an ambulatory care sensitive condition on the inpatient hospital claim was used to identify PPHs. We used inverse probability of treatment weighting to mitigate the potential selection of HCBS versus nursing home use.

PRINCIPAL FINDINGS

The most frequent conditions accounting for PPHs were the same among the HCBS users and nursing home residents and included congestive heart failure, pneumonia, chronic obstructive pulmonary disease, urinary tract infection, and dehydration. Compared to nursing home residents, elderly HCBS users had an increased probability of experiencing both a PPH and a non-PPH.

CONCLUSIONS

HCBS users' increased probability for potentially and non-PPHs suggests a need for more proactive integration of medical and long-term care.

Hospitalization of elderly Medicaid long-term care users who transition from nursing homes

OBJECTIVES

To compare hospitalizations of dually eligible older adults who had an extended Medicaid nursing home (NH) stay and transitioned out to receive Medicaid home- and community-based services (HCBS) with hospitalizations of those who remained in the NH.

DESIGN

Retrospective matched cohort study using Medicaid and Medicare claims and NH assessment data.

SETTING

Community (receiving Medicaid HCBS) or NH.

PARTICIPANTS

Dually eligible fee-for-service beneficiaries aged 65 and older in Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington from 2003 to 2005. Individuals who had a Medicaid NH stay of at least 90 days and transitioned to Medicaid HCBS (N = 1,169) were matched to individuals who had a Medicaid NH stay of at least 90 days and remained in the NH (N = 1,169).

MEASUREMENTS

Potentially preventable hospitalizations (defined according to ambulatory-care-sensitive conditions) and all hospitalizations were examined.

RESULTS

Cox proportional hazards models were used to compare the risk of hospitalization between the groups, accounting for the differing time at risk and censoring. Being a NH transitioner increased the hazard of experiencing a potentially preventable hospitalization by 40% (95% confidence interval (CI) = 1.01-1.93) over remaining in the NH. NH transitioners had a 58% (95% CI = 1.32-1.91) greater risk of experiencing any type of hospitalization than NH stayers.

CONCLUSION

Individuals who transitioned from the NH to HCBS had a greater risk of hospitalization. Most of the attention in long-term care transition programs has been focused on NH readmission, but programs encouraging NH transition should recognize that individuals may be at greater risk for hospitalization after returning to the community. Planning for the medical needs of individuals who transition from an extended NH stay may improve their posttransition outcomes.

Effect of long-term care use on Medicare and Medicaid expenditures for dual eligible and non-dual eligible elderly beneficiaries

BACKGROUND

Dual eligible Medicare and Medicaid beneficiaries consume disproportionate shares of both programs.

OBJECTIVES

To compare Medicare and Medicaid expenditures of elderly dual eligible beneficiaries with non-dual eligible beneficiaries based on their long-term care (LTC) use.

RESEARCH DESIGN

Secondary analysis of linked MAX and Medicare data in seven states.

SUBJECTS

Dual eligible adults (65+) receiving LTC in institutions, in the community, or not at all; and Medicare non-dual eligibles.

MEASURES

Medicaid acute medical and LTC expenditures per beneficiary year, Medicare expenditures.

RESULTS

Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs.

CONCLUSIONS

Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures.

EGFR mutant-specific immunohistochemistry has high specificity and sensitivity for detecting targeted activating EGFR mutations in lung adenocarcinoma

AIM

We assessed the diagnostic accuracy of epidermal growth factor receptor (EGFR) mutant-specific antibodies for detecting two common activating EGFR mutations.

METHODS

Immunohistochemical expression of mutation-specific antibodies against EGFR exon 19 deletion E746-A750 ((c.2235_2249del15 or c.2236_2250del15, p. Glu746_Ala750del) and exon 21 L858R point mutation (c.2573T>G, p.Leu858Arg) were assessed in a cohort of 204 resected early stage node negative lung adenocarcinomas, and protein expression was compared with DNA analysis results from mass spectrometry analysis.

RESULTS

Of seven cases with L858R point mutation, six were positive by immunohistochemistry (IHC). There were three false positive cases using L858R IHC (sensitivity 85.7%, specificity 98.5%, positive predictive value 66.7%, negative predictive value 99.5%). All seven E746-A750 exon 19 deletions identified by mutation analysis were positive by IHC. Four additional cases were positive for exon 19 IHC but negative by mutation analysis. The sensitivity of exon 19 IHC for E746-A750 was 100%, specificity 98.0%, positive predictive value 63.6% and negative predictive value 100%.

CONCLUSIONS

Mutant-specific EGFR IHC has good specificity and sensitivity for identifying targeted activating EGFR mutations. Although inferior to molecular genetic analysis of the EGFR gene, IHC is highly specific and sensitive for the targeted EGFR mutations. The antibodies are likely to be of clinical value in cases where limited tumour material is available, or in situations where molecular genetic analysis is not readily available.

Understanding the health beliefs and practices of East African refugees

OBJECTIVES

To explore East African refugees' perceptions, ideas, and beliefs about health and health care, as well as the ways in which health information is shared within their communities.

METHODS

This study consisted of 2 focus groups with a total of 15 participants, including East African community leaders and health professionals.

RESULTS

East African refugees in the United States have strong cultural, religious, and traditional health practices that shape their health behavior and influence their interactions with Western health care systems.

CONCLUSIONS

Health care providers who understand refugees' beliefs about health may achieve more compliance with refugee patients.

Mental Health Literacy in Hmong and Cambodian Elderly Refugees: A Barrier to Understanding, Recognizing, and Responding to Depression

This study aims to explore mental health literacy, specifically focusing on depression, among Southeast Asian (SEA) elderly refugees residing in the Twin Cities of St. Paul and Minneapolis, Minnesota. Three focus groups were held with nine mental health professionals who work with SEA elders. Jorm's mental health literacy framework guided the study theoretically. For data analysis, grounded theory was employed by utilizing MAX QDA2. Four themes emerged from the analysis: 1) lack of knowledge about specific mental disorders, 2) culture-specific knowledge and beliefs on the causes of depression, 3) lack of awareness about professional help, and 4) cultural attitudes toward seeking mental health services. The findings indicated that cultural beliefs of SEA elders impact their ability to understand, recognize, and respond to depression. Barriers to treatment were identified and recommendations were made to reduce mental health disparity in this elderly population.

Antibody-mediated enhancement of the rate, magnitude, and responsiveness of vesicular stomatitis virus induced alpha interferon production

A majority of adults without evidence of exposure to vesicular stomatitis virus (VSV) have serum IgG antibodies that interact with pro-inflammatory TLR7 in the presence of VSV, and enhance several aspects of VSV-induced IFN-alpha production. Enhancing IgG antibody enables human PBMC to make IFN-alpha more rapidly and in higher titers in response to a broad range of VSV-concentrations that include those too low to independently stimulate IFN-alpha production. These antibody-mediated functions compensate for the inherent delay in virus-induced IFN-alpha production in vitro, and have the potential to improve the in vivo IFN-alpha response and effectively terminate infection before the occurrence of clinically apparent disease. The frequent presence of enhancing antibody in persons without predictable VSV exposure has implications for naturally occurring infections with this and other viruses, and for the use of viruses as vaccine vectors and oncolytic agents.

The Quality of Care Under a Managed-Care Program for Dual Eligibles

PURPOSE

Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care.

DESIGN AND METHODS

Two control groups were used; one was drawn from nonenrollees living in the same area (Control-In) and another from comparable individuals living in another urban area where the program was not available (Control-Out). Cohorts living in the community and in nursing homes were included. Quality measures for both groups included mortality rates, preventable hospital admissions, and preventable emergency room (ER) visits. For the community group, nursing home admission rates were also tracked. For nursing home residents, quality measures included quality indicators derived from the Minimum Data Set.

RESULTS

There were no differences in mortality rates for either cohort. MSHO had fewer short-stay nursing home admissions but no difference for stays 90 days or longer. MSHO community and nursing home residents had fewer preventable hospital and ER visits compared to Control-In. There were no major differences in nursing home quality indicator rates.

IMPLICATIONS

The cost of changing the model of care for dual eligibles from a mixture of fee-for-service and managed care to a merged managed-care approach cannot be readily justified by the improvements in quality observed.