Tina Sadarangani

Abstract

Adult day care (ADC) centers provide community-based care (including meals) to frail, ethnically diverse older adults, many of whom are at risk for malnutrition. To support the development of interventions to benefit ADC users, the authors aimed to identify barriers and facilitators of healthy nutrition among ADC users born in Vietnam and China. Semi-structured qualitative interviews were conducted among ADC stakeholders to identify barriers and facilitators. Data were analyzed using Braun and Clarke’s six-step method and organized within the framework of the Social Ecological Model. Facilitators of good nutrition included adherence to traditional diet at the ADC center, peer networks, and access to ethnic grocers. Poor health, family dynamics, and loneliness all contributed to poor nutrition, as did the restrictive nature of nutrition programs serving ADC users in the United States. Individual, relationship, organizational, community, and policy level factors play a role in ADC users’ nutritional status. Targeted nutrition interventions should leverage culturally congruent relationships between ADC users and staff and include advocacy for enhancement of federal programs to support this population. [Research in Gerontological Nursing, 13(3), 146-157.].

Abstract

Purpose: It is reported that while immigrants are, initially, healthier than the native-born upon resettlement, this advantage erodes over time. In the United States, uninsured aging immigrants are increasingly experiencing severe complications of cardiovascular disease (CVD). The purpose of this study was to compare overall CVD risk and explore the importance of health insurance coverage on CVD risk relative to other health access barriers, from 2007 to 2012, in recent and long-term immigrants >50 years of age. Methods: This study was based on secondary cross-sectional analysis of the National Health and Nutrition Examination Survey (N = 1,920). The primary outcome, CVD risk category (high or low), was determined using the American College of Cardiology and American Heart Association Pooled Cohort equation. Differences between immigrant groups were examined using independent-samples t tests and chi-square analysis. The association between insurance and CVD risk was explored using a hierarchical block logistic regression model, in which variables were entered in a predetermined order. Changes in pseudo R 2 measured whether health insurance explained variance in cardiac risk beyond other variables. Results: Recent immigrants had lower overall CVD risk than long-term immigrants but were twice as likely to be uninsured and had higher serum glucose and lipid levels. Based on regression models, being uninsured contributed to CVD risk beyond other health access determinants, and CVD risk was pronounced among recent immigrants who were uninsured. Conclusions: Health insurance coverage plays an essential part in a comprehensive approach to mitigating CVD risk for aging immigrants, particularly recent immigrants whose cardiovascular health is susceptible to deterioration. Clinical Relevance: Nurses are tasked with recognizing the unique social and physical vulnerabilities of aging immigrants and accounting for these in care plans. In addition to helping them access healthcare coverage and affordable medication, nurses and clinicians should prioritize low-cost lifestyle interventions that reduce CVD risk, especially diet and exercise programs.

Abstract

Multimorbidity affects 75% of older adults (aged 65 years and older) in the United States and increases risk of poor medical outcomes, especially among the poor and underserved. The creation of a Medicaid option allowing states to establish health homes under the Affordable Care Act was intended to enhance coordinated care for Medicaid beneficiaries with multimorbidity. The Community-Based Health Home (CBHH) model uses the infrastructure of the Adult Day Health Center (ADHC) to serve as a health home to improve outcomes for medically complex vulnerable adults. Between 2017 and 2018, we used a sequential explanatory mixed-methods approach to (a) quantitatively examine changes in depression, fall risk, loneliness, cognitive function, nutritional risk, pain classification, and health care utilization over the course of 12 months in the program and (b) qualitatively explore the perspectives of key stakeholders (registered nurse navigators, participants, ADHC administrators, and caregivers) to identify the most effective components of CBHH. Using data integration techniques, we identified components of CBHH that were most likely driving outcomes. After 12 months in CBHH, our racially diverse sample (N = 126), experienced statistically significant (p < .05) reductions in loneliness, depression, nutritional risk, poorly controlled pain, and emergency department utilization. Stakeholders who were interviewed (n = 40) attributed positive changes to early clinical intervention by the registered nurse navigators, communication with providers across settings, and a focus on social determinants of health, in conjunction with social stimulation and engagement provided by the ADHC. CBHH positions the ADHC as the locus of an effective health home site and is associated with favorable results. CBHH also demonstrates the unique capacity and skill of registered nurses in integrating health and social services across community settings. Continued exploration of CBHH among diverse populations with multimorbidity is warranted.

Abstract

Information regarding nutritional risk among users of American adult day health centers (ADHCs), 60% of whom are racial minorities, is scant. This study examined nutritional risk and associated factors in a diverse sample ADHC users aged 50+ using secondary cross-sectional analysis of data collected between 2013 and 2017. Risk was assessed using the DETERMINE checklist, and results were stratified by race. The majority of the sample (N = 188) was at moderate (45.2%) or high (38.5%) nutritional risk, with statistically significant racial differences. Blacks were at greater risk than any other group: 65% had high nutritional risk; 76.5% ate <5 servings of fruits, vegetables, or milk daily; 21% ate <2 meals daily, 48.5% reported involuntary weight loss/gain, and 41.2% had tooth loss/mouth pain. Older adults in ADHCs are at elevated risk of malnutrition, disproportionately so amongst blacks. Both routine nutrition screening and population-specific approaches are needed to attenuate risk.

Abstract

Aim: This paper seeks to describe best practices for conducting cross-language research with individuals who have a language barrier. Design: Discussion paper. Data Sources: Research methods papers addressing cross-language research issues published between 2000–2017. Implications for Nursing: Rigorous cross-language research involves the appropriate use of interpreters during the research process, systematic planning for how to address the language barrier between participant and researcher and the use of reliably and validly translated survey instruments (when applicable). Biases rooted in those who enter data into “big data” systems may influence data quality and analytic approaches in large observational studies focused on linking patient language preference to health outcomes. Conclusion: Cross-language research methods can help ensure that those individuals with language barriers have their voices contributing to the evidence informing healthcare practice and policies that shape health services implementation and financing. Understanding the inherent conscious and unconscious biases of those conducting research with this population and how this may emerge in research studies is also an important part of producing rigorous, reliable, and valid cross-language research. Impact: This study synthesized methodological recommendations for cross-language research studies with the goal to improve the quality of future research and expand the evidence-base for clinical practice. Clear methodological recommendations were generated that can improve research rigor and quality of cross-language qualitative and quantitative studies. The recommendations generated here have the potential to have an impact on the health and well-being of migrants around the world.

Abstract

Background: In the United States, 16 million immigrants are 50 years and older, but little is known about their cardiometabolic health and how to best assess their cardiovascular disease (CVD) risk. Aging immigrants may therefore not be benefitting from advances in CVD prevention. Objective: In this study, we estimate and compare CVD risk in a nationally representative sample of aging immigrants using 3 different measures. Methods: This was a cross-sectional analysis using National Health and Nutrition Examination Survey data. Immigrants 50 years and older with no history of CVD were eligible. The Framingham Risk Score (FRS), the American College of Cardiology/American Heart Association Pooled Cohort Risk Equation, and presence of metabolic syndrome (MetS) were used to estimate risk. Bivariate statistics were analyzed using SPSS version 23.0 Complex Survey module to account for National Health and Nutrition Examination Survey unique weighting scheme. Results: The mean age of the sample was 61.3 years; 40% had hypertension, 17% had diabetes, 10% were smokers, and 95% did not meet the recommended physical activity guidelines. Proportions at an elevated CVD risk were as follows: American College of Cardiology/American Heart Association, 42% female and 76% male; FRS, 17.4% female and 76% male; and MetS, 22% female and 24% male. Conclusions: Immigrants had a lower overall risk using MetS and the American College of Cardiology/American Heart Association equation than has been found using these tools in similarly aged samples. The opposite was true for the FRS. The discrepancy between the proportion at risk and those being treated may reflect healthcare access gaps that warrant further investigation. A more holistic approach to risk measurement is needed that accounts for determinants of health that disproportionately affect immigrants, including language and socioeconomic status.

Abstract

Older adult immigrants are often socially isolated and vulnerable to poor health. Adult day service (ADS) centers could potentially facilitate social integration and address their long-term health care needs. The current review (a) identifies barriers to and facilitators of ADS use among immigrants, (b) explores how ADS programs impact older adult immigrants’ health and well-being, and (c) isolates the most effective culturally based components of ADS programs. An integrative review was conducted using Whittemore and Knafl’s methodology. Four databases were searched. Articles were critically appraised and data were organized within an ADS-specific framework. Functional impairment, race, gender, and degree of loneliness were all predictors of ADS use. ADS enhanced immigrants’ quality of life and provided fulfillment. Transportation, bilingual nurses, peer support, and cultural activities were deemed essential by participants. ADS can provide support to older adult immigrants by adding cultural elements to existing services and using nurses as cultural liaisons. More research is needed to assess the impact of ADS on disease outcomes, including dementia, and on immigrants in multi-ethnic settings.

Abstract

Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study (N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and allcause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.