Kelseanne Breder

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We report results of a workforce initiative to increase functional screenings for older adults with lived experiences of homelessness. Thirty-four healthcare practitioners screened 253 patients ages 50 years + using a battery of screening tools aligned with the 4 Ms. Using secondary analyses, we describe practitioners’ participation in the workforce initiative, patients’ functional scores, and a qualitative analysis of “what matters” to patients. Many practitioners did not complete all screenings. Among patient respondents, 6% reported moderate to severe ADL impairment; 24% scored positive cognitive impairment; 32% reported being unable to walk 250 feet; 46% reported moderate to severe pain. Resilience strategies developed during homelessness “matter.” Few participants reported impaired ADL performance, which may reflect levels of independence needed to survive homelessness or to maintain services while homelessness. Findings suggest a need for additional workforce training to increase functional screenings for older adults in this population.

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Montefiore-Einstein Division of Services for Addiction (DOSA) grand rounds presentation, virtual. 

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Invited speaker at Center for Urban Community Services grand rounds

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Introduction. The purpose of this research is to explore LGBT older adults’ uses of technology for social support during COVID-19, given their unique social support needs, and to identify strategies for improving social isolation in this population. Method. Semi-structured individual interviews were conducted with a racially and ethnically diverse sample of 15 LGBT older adults using technology for social support. Interview guides were developed according to The Convoy Model of Social Relations. Verbatim interview transcripts were inductively and deductively coded using conventional content analysis. Result.  Findings highlight the ways LGBT older adults used technology to meet social support needs, as well as gaps in technological fluency and efficacy that hinder social connectedness. Conclusion. Findings highlight gaps in social connectedness among aging LGBT adults that psychiatric clinicians may strategize to fill through targeted community programing and therapy. Resiliency strategies may optimize social and psychological wellbeing among the general aging population as well as minority racial and ethnic groups.

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Invited speaker to deliver lecture at Hunter School of Nursing

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Invited speaker at NYU Grossman School of Medicine.

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Symposium presentation and symposium co-organizer at the Gerontological Society of American annual international meeting.

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Telehealth offers an avenue for older adults to access providers, discuss care needs, and have serious illness conversations. However, telehealth is embraced by some and not by others. Urban-dwelling, low-income older adults have unique challenges in accessing continuous care, engaging with the healthcare system and receiving support to address serious illness care needs. To investigate telehealth acceptance in low-income older adults, we conducted individual semi-structured qualitative interviews with 46 residents of three Medicaid-funded assisted living facilities (MALFs) which provide social, functional, and clinical support to underserved populations. Interview transcripts were analyzed using conventional content analysis. Four qualitative themes describing telehealth acceptance in low-income assistant living communities were identified. Benefit: Telehealth offers convenience-participants highlighted how telehealth facilitates access to healthcare appointments, making it easier to receive care. Barrier: Technology fluency and access is not universal-many described physical and technological barriers that limit their ability to use telehealth effectively. Preference: general distaste for telehealth-this theme captures participants' overall attitudes and gut reactions to telehealth, ranging from enthusiasm to skepticism. Concern: mistrust in clinical connection-patients expressed concerns about trust, security, and the ability to build meaningful connections with providers through telehealth. While telehealth can make care more convenient, telehealth encounters may hinder trust in the therapeutic relationship between urban-dwelling low-income older adults and providers. For telehealth conversations discussing serious illness, additional efforts are needed to support engagement, foster trust, and provide patient-centered care in populations that have been historically marginalized. Keywords: Medicaid; Older adults; Poverty; Serious illness; Telehealth; Urban-dwelling.

Abstract

Telehealth offers an avenue for older adults to access providers, discuss care needs, and have serious illness conversations. However, telehealth is embraced by some and not by others. Urban-dwelling, low-income older adults have unique challenges in accessing continuous care, engaging with the healthcare system and receiving support to address serious illness care needs. To investigate telehealth acceptance in low-income older adults, we conducted individual semi-structured qualitative interviews with 46 residents of three Medicaid-funded assisted living facilities (MALFs) which provide social, functional, and clinical support to underserved populations. Interview transcripts were analyzed using conventional content analysis. Four qualitative themes describing telehealth acceptance in low-income assistant living communities were identified. Benefit: Telehealth offers convenience-participants highlighted how telehealth facilitates access to healthcare appointments, making it easier to receive care. Barrier: Technology fluency and access is not universal-many described physical and technological barriers that limit their ability to use telehealth effectively. Preference: general distaste for telehealth-this theme captures participants' overall attitudes and gut reactions to telehealth, ranging from enthusiasm to skepticism. Concern: mistrust in clinical connection-patients expressed concerns about trust, security, and the ability to build meaningful connections with providers through telehealth. While telehealth can make care more convenient, telehealth encounters may hinder trust in the therapeutic relationship between urban-dwelling low-income older adults and providers. For telehealth conversations discussing serious illness, additional efforts are needed to support engagement, foster trust, and provide patient-centered care in populations that have been historically marginalized. Keywords: Medicaid; Older adults; Poverty; Serious illness; Telehealth; Urban-dwelling.