Bei Wu

Dr. Wu is Dean’s Professor in Global Health and Vice Dean for Research at the NYU Rory Meyers College of Nursing. She is an inaugural Co-Director of the NYU Aging Incubator. Prior to joining NYU, she was the Pauline Gratz Professor of Nursing at Duke University School of Nursing. Prof. Wu is an internationally-known leader in gerontology.

As a principal investigator, Prof. Wu has led numerous projects supported by federal agencies and private foundations, including the NIH and CDC. She is currently leading several NIH-funded projects including a clinical trial to improve oral health for persons

with cognitive impairment, and a large secondary data analysis to examine how the co-occurrence of diabetes and poor oral health may lead to the development of dementia and cognitive decline. She co-leads the newly funded Rutgers-NYU Center for Asian Health Promotion and Equity. Through this center, she also leads a 5-year intervention study that focuses on supporting Chinese and Korean dementia caregivers who are at increased risk for high blood pressure and diabetes due to the physical and emotional demands of caregiving. She is a director of the Research and Education Core for the NIA-funded Asian Resource Center for Minority Aging Research (RCMAR).

As a scholar, Prof. Wu is an internationally known leader in gerontology. Her scholarship has been distinguished by interdisciplinary collaborations with researchers in various disciplines, including nursing and dentistry, in the US and abroad. Her research areas cover a wide range of topics related to aging and global health, including oral health, long-term care, dementia, and caregiving. She is one of the first in the nation to study the linkages between oral health and cognitive decline in older adults. Her research has also addressed knowledge gaps in the linkages between oral health and diabetes.

Prof. Wu has devoted much of her time to training the next generation of aging and nursing scientists from dozens of academic institutions in the U.S. and abroad. She has mentored hundreds of faculty members, visiting scholars, and students from various disciplines, including nursing, gerontology, dentistry, medicine, social work, demography, public health, sociology, public policy, geography, and economics. She is successful in mentoring several dozens of early-stage faculty members in receiving competitive funding from NIH, Robert Wood Johnson Scholars, the Alzheimer’s Society (UK), National Science Foundation of China, China Medical Board, National Medical Research Council (Singapore), and many others.

Prof. Wu is a productive researcher. She has published more than 600 peer-reviewed papers, books, reports, and conference abstracts. Her extensive publications cover a wide range of topics related to aging and global health. She has delivered presentations at hundreds of conferences as an invited speaker. Her work has been widely recognized in the field. Research findings from her team have been featured by the National Institute on Aging, and in numerous media outlets, including the New York Times, CNN, BBC, U.S. News and World Report, MarketWatch, CBS News, Reuters, AARP Bulletin, China Daily, Daily Mail, South China Morning Post, and Financial Review.

Her achievement has been recognized by many international and national organizations and she is a fellow of the Gerontological Society of America, the Association for Gerontology in Higher Education, and the New York Academy of Medicine. She is an honorary member of the Honor Society of Nursing, Sigma Theta Tau International, and is the former president of the Geriatric Oral Research Group of the International Association for Dental Research. She has served on a number of NIH review panels and is a frequent reviewer for multiple international funding agencies. She was honored as the 2017 IADR Distinguished Scientist in Geriatric Oral Research. She is the recipient of the 2022 Wei Hu Inspiration Award from the China Health Policy and Management Society.

PhD - Gerontology Center, University of Massachusetts, Boston

MS - Gerontology Center, University of Massachusetts, Boston

BS - Shanghai University

Gerontology

Global

Honorary Member, Sigma Theta Tau International - Honor Society of Nursing

Distinguished Scientist Award for Geriatric Oral Research, International Association for Dental Research (2017)

Pauline Gratz Professorship, Duke University School of Nursing (2014)

J. Morita Junior Investigator Award in Geriatric Oral Health, International Association for Dental Research (2007)

Fellow, Gerontological Society of America

Fellow, New York Academy of Medicine

Fellow, Association for Gerontology in Higher Education

Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial

Lin, S. Y., Schneider, C. E., Bristol, A. A., Clancy, M., Sprague, S. A., Aldridge, M., Cortes, T., Goldfeld, K. S., Kutner, J. S., Mitchell, S. L., Shega, J. W., Wu, B., Zhu, C. W., & Brody, A. A. (2022). Gerontologist, 62(2). 10.1093/geront/gnaa220

Abstract

Abstract

Background and Objectives: Many investigators of Alzheimer's disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure and implementation strategies developed in preparation for a nationwide AD/ADRD ePCT. Research Design and Methods: Two pilot trials were conducted in 2 hospices sequentially to refine and test Aliviado Dementia Care - Hospice Edition, a complex quality improvement intervention for advanced dementia symptom management. Readiness for the subsequent full-scale ePCT was assessed by three milestones: ≥80% training completion rate ("feasibility"), ≥80% posttraining survey respondents indicating intention for practice changes ("applicability"), and at least 1 Aliviado care plan/assessment instrument administered in ≥75% of dementia patients admitted to home hospice within 1-month posttraining ("fidelity"). Results: Participants included 72 interdisciplinary team members and 11 patients with AD/ADRD across the pilots. Feasibility, applicability, and fidelity outcomes (92%, 93%, and 100%, respectively) all surpassed the preestablished milestones (80%, 80%, and 75%). Main implementation challenges were related to hospice staff turnover, integration of the Aliviado toolbox materials within the electronic health records, and hospices' limited research experience and infrastructure. Discussion and Implications: This pilot phase demonstrated feasibility, applicability, and fidelity required to proceed to the full-scale ePCT. Our study findings and discussions of additional infrastructure and implementation strategies developed following the pilot phase can inform researchers and clinicians interested in conducting AD/ADRD-related pilot studies for ePTCs or quality improvement initiatives. Clinical Trials Registration Number: NCT03681119.

International migration and its influence on health

Squires, A., Thompson, R., Sadarangani, T., Amburg, P., Sliwinski, K., Curtis, C., & Wu, B. (2022). Research in Nursing & Health, 45(5), 503-511. 10.1002/nur.22262

Oral Health, Diabetes, and Inflammation: Effects of Oral Hygiene Behaviour

Luo, H., Wu, B., Kamer, A. R., Adhikari, S., Sloan, F., Plassman, B. L., Tan, C., Qi, X., & Schwartz, M. D. (2022). International Dental Journal, 72(4), 484-490. 10.1016/j.identj.2021.10.001

Abstract

Abstract

Introduction: The aim of this research was to assess the association between inflammation and oral health and diabetes, as well as the mediating role of oral hygiene practice in this association. Methods: Data were from the 2009–2010 National Health and Nutrition Examination Survey. The analytical sample consisted of 2,191 respondents aged 50 and older. Poor oral health was clinically defined by significant tooth loss (STL) and periodontal disease (PD). Diabetes mellitus (DM) was determined by glycemic levels. The outcome variable was serum C-reactive protein (CRP) level, dichotomised as ≥1 mg/dL (elevated CRP) vs <1 mg/dL (not elevated CRP). Two path models, one using STL and DM as the independent variable, the other using PD and DM as the independent variable, were estimated to assess the direct effects of having poor oral health and DM on elevated CRP and the mediating effects of dental flossing. Results: In path model 1, individuals having both STL and DM (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.30–2.82) or having STL alone (AOR, 2.30; 95% CI, 1.68–3.15) were more likely to have elevated CRP than those with neither STL nor DM; dental flossing (AOR, 0.92, 95% CI, 0.88–0.96) was associated with lower risk of elevated CRP. In path model 2, no significant association was found between having both PD and DM and elevated CRP; dental flossing (AOR, 0.91; 95% CI:, 0.86–0.94) was associated with lower risk of elevated CRP. Conclusions: Findings from this study highlight the importance of improving oral health and oral hygiene practice to mitigate inflammation. Further research is needed to assess the longer-term effects of reducing inflammation.

Orofacial pain among Chinese older adults in the last year of life

Pei, Y., Qi, X., Chen, X., & Wu, B. (2022). Gerodontology, 39(4), 384-390. 10.1111/ger.12608

Abstract

Abstract

Objective: To examine the prevalence of orofacial pain and associated factors in Chinese older adults at the end of life. Methods: This cross-sectional study included 1646 participants (65 years or older) in their last year of life from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used the 6-month prevalence questions to measure two specific orofacial pain symptoms: toothache, and jaw or facial pain. Logistic regression analyses were used to examine factors, such as socioeconomic status, health behaviours and chronic diseases, that were associated with these two orofacial pain symptoms in the last year of life. Results: The 6-month prevalence estimates for toothache and jaw pain or facial pain for older adults in the last year of life were 14.1% and 4.5% respectively. Higher socioeconomic status was associated with lower odds of toothache and jaw pain or facial pain. Smoking was associated with high odds of toothache. Participants who brushed their teeth at least once a day were more likely to have toothache and jaw or facial pain than those who did not. Having any chronic conditions was associated with higher odds of toothache and jaw or facial pain. Older adults who had at least one tooth were more likely to have jaw or facial pain than those without any teeth. Conclusion: A considerable proportion of Chinese older adults in their last year of life reported toothache and/or jaw pain or facial pain. These findings suggest that appropriate measures need to be taken to address the oral health needs in these vulnerable individuals, especially those of low socioeconomic status and chronic conditions.

A Profile of Black and Latino Older Adults Receiving Care in Nursing Homes: 2011–2017

Travers, J. L., Dick, A. W., Wu, B., Grabowski, D. C., Robison, J., Agarwal, M., Perera, G. U., & Stone, P. W. (2022). Journal of the American Medical Directors Association, 23(11), 1833-1837.e2. 10.1016/j.jamda.2022.04.010

Abstract

Abstract

Objective: To identify if disparate trends in the access and use of nursing home (NH) services among Black and Latino older adults compared with White older adults persist. Access was operationalized as the NHs that served Black, Latino, and White residents. Use was operationalized as the utilization of NH services by Black, Latino, and White residents. Design: This was an observational study analyzing facility-level data from LTCfocus for 2011 to 2017. Setting and Participants: All NH residents present in US NHs participating in the Centers for Medicare and Medicaid Services program on the first Thursday in April in the years 2011 to 2017. NHs with fewer than 4500 bed-days per year are excluded in the LCTfocus dataset. Black, Latino, and White were the racial/ethnic groups of interest. Methods: We calculated the mean percentage of each racial/ethnic group in NHs (Black, Latino, White) annually along with the number of NHs that provided care for these groups. We conducted a simple trend analysis using ordinary least squares to estimate the change in NH access and use by racial/ethnic group over time. Results: Our NH sample ranged from 15,564 in 2011 to 14,956 in 2017. Latino residents' use of NHs increased by 20.47% and Black residents increased by 11.42%, whereas there was a 1.36% decrease in White residents’ use of NHs. In this 7-year span, there was a 4.44% and 6.41% decline in the number of NHs that serve any Black and Latino older adults, respectively, compared with a 2.26% decline in NHs that serve only White older adults (access). Conclusions and Implications: Our findings reveal a continued disproportionate rise in Black and Latino older adults’ use of NHs while the number of NHs that serve this population have declined. This work can inform federal and state policies to ensure access to long-term care services and supports in the community for all older adults and prevent inappropriate NH closures.

A qualitative analysis of communication workflows between adult day service centers and primary care providers

Zhong, J., Boafo, J., Brody, A. A., Wu, B., & Sadarangani, A. T. (2022). Journal of the American Medical Informatics Association, 29(5), 882-890. 10.1093/jamia/ocab284

Abstract

Abstract

Objectives: Our study documented communication workflows across adult day care centers (ADCs) and primary care providers (PCPs) around complex needs of persons living with dementia (PLWD). We also identified barriers and facilitators to productive communication in clinical decision support and clinical information systems. Materials and Methods: We conducted 6 focus groups with ADC staff (N=33) and individual semistructured interviews with PCPs (N=22) in California. The eHealth Enhanced Chronic Care Model was used to frame the directed qualitative content analysis. Results: Our results captured cumbersome and ineffective workflows currently used to exchange information across PCPs and ADCs. Stakeholders characterized current communication as (1) infrequent, (2) delayed, (3) incomplete, (4) unreliable, (5) irrelevant, and (6) generic. Conversely, communication that was bidirectional, relevant, succinct, and interdisciplinary was needed to elevate the standard of care for PLWD. Discussion and Conclusion: ADCs possess a wealth of information that can support clinical decision-making across community-based providers involved in the care of PLWD, especially PCPs. However, effective information exchange is mired by complicated workflows that rely on antiquated technologies (eg, facsimile) and standard templates. Current information exchange largely focuses on satisfying regulatory guidelines rather than supporting clinical decision-making. Integrating community-based services into the health care continuum is a necessary step in elevating the standard of care for PLWD. In the absence of interoperable electronic health records, which may not be financially viable for ADCs, other options, such as mobile health, should be explored to facilitate productive information exchange of personalized relevant information.

Social isolation and psychological well-being among older Chinese Americans: Does resilience mediate the association?

Qi, X., Zhang, W., Wang, K., Pei, Y., & Wu, B. (2022). International Journal of Geriatric Psychiatry, 37(8). 10.1002/gps.5791

Abstract

Abstract

Objectives: Social isolation imposes risks to an individual's psychological well-being. However, few studies have examined the role of resilience on these associations among older Chinese Americans, the fastest-growing aging population across all racial/ethnic groups in the United States. We aim to examine the associations of social isolation with indicators of psychological well-being and the mediating role of resilience in these associations. Methods: Data were derived from 398 Chinese older adults aged over 55 residing in Honolulu, Hawaii, in 2018. Psychological well-being was measured by psychological distress, life satisfaction, and happiness. Multivariate linear regressions and ordered logistic regressions were conducted. Results: Social isolation was positively associated with psychological distress and negatively associated with life satisfaction and happiness (all p < 0.05). By contrast, resilience was associated with lower levels of psychological distress and higher levels of life satisfaction and happiness (all p < 0.05). Moreover, the findings supported our hypothesis that resilience mediated the association between social isolation and psychological well-being. With regard to social isolation, resilience contributed to 32.0% of its association with distress, 24.9% of the association with life satisfaction, and 16.3% of the association with happiness. Conclusion: Our findings revealed a significant association between social isolation and psychological well-being and the mediating role of resilience in the association of older Chinese Americans in Hawaii. The study findings expand our understanding of psychological resources in older Chinese Americans and emphasize the importance of developing intervention programs to foster social connection and resilience among an understudied population.

Assessment of Coronavirus Disease 2019 Infection and Mortality Rates Among Nursing Homes With Different Proportions of Black Residents

Travers, J. L., Agarwal, M., Estrada, L. V., Dick, A. W., Gracner, T., Wu, B., & Stone, P. W. (2021). Journal of the American Medical Directors Association, 22(4), 893-898.e2. 10.1016/j.jamda.2021.02.014

Abstract

Abstract

Objective: Coronavirus disease 2019 (COVID-19) has disproportionately impacted nursing homes (NHs) with large shares of Black residents. We examined the associations between the proportion of Black residents in NHs and COVID-19 infections and deaths, accounting for structural bias (operationalized as county-level factors) and stratifying by urbanicity/rurality. Design: This was a cross-sectional observational cohort study using publicly available data from the LTCfocus, Centers for Disease Control and Prevention Long-Term Care Facility COVID-19 Module, and the NYTimes county-level COVID-19 database. Four multivariable linear regression models omitting and including facility characteristics, COVID-19 burden, and county-level fixed effects were estimated. Setting and Participants: In total, 11,587 US NHs that reported data on COVID-19 to the Centers for Disease Control and Prevention and had data in LTCfocus and NYTimes from January 20, 2020 through July 19, 2020. Measures: Proportion of Black residents in NHs (exposure); COVID-19 infections and deaths (main outcomes). Results: The proportion of Black residents in NHs were as follows: none= 3639 (31.4%), <20% = 1020 (8.8%), 20%-49.9% = 1586 (13.7%), ≥50% = 681 (5.9%), not reported = 4661 (40.2%). NHs with any Black residents showed significantly more COVID-19 infections and deaths than NHs with no Black residents. There were 13.6 percentage points more infections and 3.5 percentage points more deaths in NHs with ≥50% Black residents than in NHs with no Black residents (P <.001). Although facility characteristics explained some of the differences found in multivariable analyses, county-level factors and rurality explained more of the differences. Conclusions and Implications: It is likely that attributes of place, such as resources, services, and providers, important to equitable care and health outcomes are not readily available to counties where NHs have greater proportions of Black residents. Structural bias may underlie these inequities. It is imperative that support be provided to NHs that serve greater proportions of Black residents while considering the rurality of the NH setting.

The development of a personalized symptom management mobile health application for persons living with hiv in China

Han, S., Pei, Y., Wang, L., Hu, Y., Qi, X., Zhao, R., Zhang, L., Sun, W., Zhu, Z., & Wu, B. (2021). Journal of Personalized Medicine, 11(5). 10.3390/jpm11050346

Abstract

Abstract

Persons living with HIV (PLWH) continuously experience symptom burdens. Their symptom prevalence and severity are also quite different. Mobile health (mHealth) applications (apps) offer exceptional opportunities for using personalized interventions when and where PLWH are needed. This study aimed to demonstrate the development process of the symptom management (SM) app and the structure and content of it. Our research team systematically searched for evidence-based resources and summarized up-to-date evidence for symptom management and health education. Our multidisciplinary research team that included physicians, nurses, software engineers, and nursing professors, evaluated the structure and content of the drafted app. Both quantitative data and qualitative results were collected at a group discussion meeting. Quantitative data were scores of sufficient evidence, situational suitability, practicability, cost-effectiveness, and understandability (ranged from one to four) for 119 items of the app contents, including the health tracking module, the self-assessment module, coping strategies for 18 symptoms (80 items), medication management, complementary therapy, diet management, exercise, relaxation techniques, and the obtaining support module. The SM app was comprised of eight modules and provided several personalized symptom management functions, including assessing symptoms and receiving different symptom management strategies, tracking health indicators, and communicating with medical staff. The SM app was a promising and flexible tool for HIV symptom management. It provided PLWH with personalized symptom management strategies and facilitated the case management for medical staff. Future studies are needed to further test the app’s usability among PLWH users and its effects on symptom management.

Dose-Response Meta-Analysis on Tooth Loss With the Risk of Cognitive Impairment and Dementia

Qi, X., Zhu, Z., Plassman, B. L., & Wu, B. (2021). Journal of the American Medical Directors Association, 22(10), 2039-2045. 10.1016/j.jamda.2021.05.009

Abstract

Abstract

Objectives: To quantify the dose-response associations between tooth loss and risk of cognitive impairment and dementia. Design: Longitudinal studies that examined the association between tooth loss and cognitive function were systematically searched on 6 databases through March 1, 2020. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Risk estimates were pooled using random-effects models. The dose-response associations were assessed using generalized least squares spline models. Setting and Participants: Adults from community, institution, outpatient or in-hospital were included in the meta-analysis. Measures: Cognitive impairment and dementia were defined by neuropsychological tests, diagnostic criteria, or medical records. Tooth loss was self-reported or assessed by clinical examinations. Results: Fourteen studies were entered into the meta-analysis, including 34,074 participants and 4689 cases with diminished cognitive function. Participants with more tooth loss had a 1.48 times higher risk of developing cognitive impairment [95% confidence interval (CI) 1.18–1.87] and 1.28 times higher risk of being diagnosed with dementia (95% CI 1.09–1.49); however, the association was nonsignificant for participants using dentures (relative risk = 1.10, 95% CI 0.90–1.11). Eight studies were included in the dose-response analysis, and data supported the use of linear models. Each additional tooth loss was associated with a 0.014 increased relative risk of cognitive impairment and 0.011 elevated relative risks of dementia. Edentulous participants faced a 1.54 times higher risk of cognitive impairment and a 1.40 times higher risk of being diagnosed with dementia. Conclusions and Implications: Moderate-quality evidence suggested tooth loss was independently associated with cognitive impairment and dementia; risk of diminished cognitive function increased with incremental numbers of teeth lost. Furthermore, timely prosthodontic treatment with dentures may reduce the progression of cognitive decline related to tooth loss.