Publications

Abstract

This study examined how adult children’s divorce affected their financial support to older parents in rural China and how that relationship was dependent on children’s gender. The sample was from rural Anhui Province and the working sample included 1629 older parents who reported their interactions with 6210 children across six waves of observations in 14 years (2001–2015). Generalized Estimating Equations showed that divorced sons provided less financial support to their parents than married sons. In contrast, divorced daughters did not necessarily provide less financial support than married daughters. This gender difference was statistically significant. The findings were discussed in the context of changing rural Chinese families, where the norm of filial piety is still strong but patrilineal tradition and gender ideology have experienced desynchronized changes.

Abstract

In 2016, China launched long-term care insurance (LTCI) pilot programs in 15 cities across the country. In this Commentary, we provide an overview of these pilots regarding the target insured population, sources of financing, beneficiary eligibility criteria, and benefit design. We offer perspectives on the strengths and limitations, implementation challenges, and future prospects of these ongoing pilots. Also, we highlight the needs for addressing several key policy issues and challenges before further expanding these programs toward national implementation. These include solidifying the LTCI financing pool for independence and self-sustainability, balancing national priorities and local needs in LTCI design, reducing coverage gaps and disparities, ensuring quality of care through pay-for-performance and regulatory oversight, and strengthening independent evaluation of LTCI implementation and impacts.

Abstract

The Hospital Elder Life Program (HELP) is a multicomponent delirium prevention program targeting delirium risk factors of cognitive impairment, vision and hearing impairment, malnutrition and dehydration, immobility, sleep deprivation, and medications. We created a modified and extended version of the program, HELP-ME, deployable under COVID-19 conditions, for example, patient isolation and restricted staff and volunteer roles. We explored perceptions of interdisciplinary clinicians who implemented HELP-ME to inform its development and testing. This was a qualitative descriptive study of HELP-ME among older adults on medical and surgical services during the COVID-19 pandemic. Participants included HELP-ME staff at 4 pilot sites across the United States who implemented HELP-ME.We held five 1-hour video focus groups (5-16 participants/group) to review specific intervention protocols and the overall program. We asked participants open-endedly about positive and challenging aspects of protocol implementation. Groups were recorded and transcribed. We used directed content analysis to analyze data. Participants identified general, technology-related, and protocol-specific positive and challenging aspects of the program. Overarching themes included the need for enhanced customization and standardization of protocols, need for increased volunteer staffing, digital access to family members, patient technological literacy and comfort, variation in the feasibility of remote delivery among intervention protocols, and preference for a hybrid program model. Participants offered related recommendations. Participants felt that HELP-ME was successfully implemented, with some modifications needed to address limitations of remote implementation. A hybrid model combining remote and in-person aspects was recommended as the preferred option.

Abstract

Editor's note: This is the 17th article in a series on clinical research by nurses. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice - from research design to data interpretation. To see all the articles in the series, go to https://links.lww.com/AJN/A204.

Abstract

Co-occurrence of injection drug use (IDU) and hepatitis C virus infection (HCV) is common in people living with HIV (PLWH) and leads to significantly increased mortality. Epigenetic clocks derived from DNA methylation (DNAm) are associated with disease progression and all-cause mortality. In this study, we hypothesized that epigenetic age mediates the relationships between the co-occurrence of IDU and HCV with mortality risk among PLWH. We tested this hypothesis in the Veterans Aging Cohort Study (n = 927) by using four established epigenetic clocks of DNAm age (i.e., Horvath, Hannum, Pheno, Grim). Compared to individuals without IDU and HCV (IDU-HCV-), participants with IDU and HCV (IDU+HCV+) showed a 2.23-fold greater risk of mortality estimated using a Cox proportional hazards model (hazard ratio: 2.23; 95% confidence interval: 1.62–3.09; p = 1.09E–06). IDU+HCV+ was associated with a significantly increased epigenetic age acceleration (EAA) measured by 3 out of 4 epigenetic clocks, adjusting for demographic and clinical variables (Hannum: p = 8.90E–04, Pheno: p = 2.34E–03, Grim: p = 3.33E–11). Furthermore, we found that epigenetic age partially mediated the relationship between IDU+HCV+ and all-cause mortality, up to a 13.67% mediation proportion. Our results suggest that comorbid IDU with HCV increases EAA in PLWH that partially mediates the increased mortality risk.

Abstract

This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted. The Pan American Health Organization (PAHO), the World Health Organization (WHO) Office in the Americas, oversees collaborating centres in the Region. Established in 1999, PANMCC consists of 17 centres situated in universities and schools of nursing. These centres provide crucial nursing and midwifery input to PAHO/WHO. The network supports global engagement and capacity building via collaboration, resource sharing and research colloquia. The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members.

Abstract

Background Cardiovascular disease (CVD) prevalence is high in Ghana-but awareness, prevention, and treatment is sparse, particularly in rural regions. The nurse-led Community-based Health Planning and Services program offers general preventive and primary care in these areas, but overlooks CVD and its risk factors. Methods We conducted in-depth interviews with 30 community members (CM) in rural Navrongo, Ghana to understand their knowledge and beliefs regarding the causes and treatment of CVD and the potential role of community nurses in rendering CVD care. We transcribed audio records, coded these data for content, and qualitatively analyzed these codes for key themes. Results CMs described CVD as an acute, aggressive disease rather than a chronic asymptomatic condition, believing that CVD patients often die suddenly. Yet CMs identified causal risk factors for CVD: not only tobacco smoking and poor diet, but also emotional burdens and stressors, which cause and exacerbate CVD symptoms. Many CMs expressed interest in counseling on these risk factors, particularly diet. However, they felt that nurses could provide comprehensive CVD care only if key barriers (such as medication access and training) are addressed. In the interim, many saw nurses' main CVD care role as referring to the hospital. Conclusions CMs would like CVD behavioral education from community nurses at local clinics, but feel the local health system is now too fragile to offer other CVD interventions. CMs believe that a more comprehensive CVD care model would require accessible medication, along with training for nurses to screen for hypertension and other cardiovascular risk factors-in addition to counseling on CVD prevention. Such counseling should build upon existing community beliefs and concerns regarding CVD-including its behavioral and mental health causes-in addition to usual measures to prevent CVD mortality such as diet changes and physical exercise.

Abstract

Background: CommunityRx is an evidence-based social care intervention delivered to family and friend caregivers (“caregivers”) at the point of healthcare to address health-related social risks (HRSRs). Two CommunityRx randomized controlled trials (RCTs) are being fielded concurrently on Chicago’s South Side, a predominantly African American/Black community. CommunityRx-Hunger is a double-blind RCT enrolling caregivers of hospitalized children. CommunityRx-Dementia is a single-blind RCT enrolling caregivers of community-residing people with dementia. RCTs with caregivers face recruitment barriers, including caregiver burden and lack of systematic strategies to identify caregivers in clinical settings. COVID-19 pandemic-related visitor restrictions exacerbated these barriers and prompted the need for iteration of the protocols from in-person to remote operations. This study describes these protocols and methods used for successful iteration to overcome barriers. Methods and findings: CommunityRx uses individual-level data to generate personalized, local community resource referrals for basic, health and caregiving needs. In early 2020, two in-person RCT protocols were pre-tested. In March 2020, when pandemic conditions prohibited face-to-face clinical enrollment, both protocols were iterated to efficient, caregiver-centered remote operations. Iterations were enabled in part by the Automated Randomized Controlled Trial Information-Communication System (ARCTICS), a trial management system innovation engineered to integrate the data collection database (REDCap) with community resource referral (NowPow) and SMS texting (Mosio) platforms. Enabled by engaged Community Advisory Boards and ARCTICS, both RCTs quickly adapted to remote operations. To accommodate these adaptations, launch was delayed until November (CommunityRx-Hunger) and December (CommunityRx-Dementia) 2020. Despite the delay, 65% of all planned participants (CommunityRx-Hunger n = 417/640; CommunityRx-Dementia n = 222/344) were enrolled by December 2021, halfway through our projected enrollment timeline. Both trials enrolled 13% more participants in the first 12 months than originally projected for in-person enrollment. Discussion: Our asset-based, community-engaged approach combined with widely accessible institutional and commercial information technologies facilitated rapid migration of in-person trials to remote operations. Remote or hybrid RCT designs for social care interventions may be a viable, scalable alternative to in-person recruitment and intervention delivery protocols, particularly for caregivers and other groups that are under-represented in traditional health services research. Trial registration: ClinicalTrials.gov: CommunityRx-Hunger (NCT04171999, 11/21/2019); CommunityRx for Caregivers (NCT04146545, 10/31/2019).

Abstract

Background and Objectives: Cognitive impairment is associated with poor oral health outcomes. Oral hygiene tasks are an essential target of interventions aiming to improve oral health for older adults with cognitive impairment. We aimed to examine whether experiences in an oral health intervention based on the Adaptive Leadership Framework for Chronic Illness differed between individuals with mild cognitive impairment (MCI) or mild dementia (MD) and their respective care partners. Research Design and Methods: This was a secondary analysis using directed content analysis and then an interpretive-description approach to analyze the data from a theory-driven intervention study. We included 10 people with MCI and their care partners (n = 20) and 8 people with MD and their care partners (n = 16) in the treatment arm of the intervention. For each participant, we analyzed audio recordings of 4 intervention coaching sessions, each ranging between 30 and 45 min. We managed the data and coding using ATLAS.TI software. Results: Participants in both the MCI and MD groups experienced similar challenges in adapting to changes in oral hygiene techniques, and both groups worked on learning new oral hygiene techniques taught by the dental hygienist and meeting individualized goals developed with their care partner, interventionist, and hygienist. On the other hand, there were subtle differences in technical challenges between participants in MCI and MD groups; participants in the MCI group reacted more actively to dental hygienist suggestions than the MD group. Discussion and Implications: Study findings provide information about how researchers and clinicians might tailor interventions to meet the learning needs of individuals and care partners in each group.

Abstract

Understanding the complex care needs of seriously ill adults with multiple chronic conditions with and without cancer is critical for the delivery of high-quality serious illness and palliative care at the end of life. The objective of this secondary data analysis of a multisite randomized clinical trial in palliative care was to elucidate the clinical profile and complex care needs of seriously ill adults with multiple chronic conditions and to highlight key differences among those with and without cancer at the end of life. Of the 213 (74.2%) older adults who met criteria for multiple chronic conditions (eg, 2 or more chronic conditions requiring regular care with limitations of daily living), 49% had a diagnosis of cancer. Hospice enrollment was operationalized as an indicator for severity of illness and allowed for the capture of complex care needs of those deemed to be nearing the end of life. Individuals with cancer had complex symptomatology with a higher prevalence of nausea, drowsiness, and poor appetite and end of life and lower hospice enrollment. Individuals with multiple chronic conditions without cancer had lower functional status, greater number of medications, and higher hospice enrollment. The care of seriously ill older adults with multiple chronic conditions requires tailored approaches to improve outcomes and quality of care across health care settings, particularly at the end of life.

Abstract

Aims: A discussion of the personal and social contexts for Millennial family caregivers and the value of including complex identity and intersectionality in Millennial family caregiving research with practical application. Design: Discussion paper. Data sources: This discussion paper is based on our own experiences and supported by literature and theory. Implications for Nursing: Millennial family caregivers have distinct generational, historical and developmental experiences that contribute to the care they provide as well as their own well-being. Complex identity, the integration of multiple identities, and intersectionality, systems and structures that disempower and oppress individuals with multiple identities, need to be addressed in nursing research so intervention tailoring and health equity can be better supported in this population. From research conceptualization and design to data analysis, data must be used intentionally to promote equity and reduce bias. The inclusion of diverse Millennial caregivers throughout all stages of the research process and having a diverse nursing research workforce will support these efforts. Conclusion: Millennial family caregivers comprise one-quarter of the family caregiving population in the United States, and they are more diverse than previous family caregiving generational cohorts. Their needs will be more fully supported by nursing scientists with the adoption of methods and techniques that address complex identity and intersectionality. Impact: Nursing researchers can use the following research approaches to address complex identity and intersectionality in Millennial caregivers: inclusion of qualitative demographic data collection (participants can self-describe); data disaggregation; data visualization techniques to augment or replace frequencies and descriptive statistics for demographic reporting; use of researcher reflexivity throughout the research process; advanced statistical modelling techniques that can handle complex demographic data and test for interactions and differential effects of health outcomes; and qualitative approaches such as phenomenology that centre the stories and experiences of individuals within the population of interest.

Abstract

High blood pressure is an important predictor of atherosclerotic cardiovascular disease (ASCVD), particularly among South Asians, who are at higher risk for ASCVD when compared to other population groups. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is established as the best proven nonpharmacological approach to preventing hypertension in adults. Using data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we calculated a DASH dietary score to examine the association between adherence to the DASH diet and its components, and prevalent and incident hypertension and systolic and diastolic blood pressure, after five years of follow-up. We found that the relative risk ratio (RRR) of incident hypertension was 67% lower among participants in the highest DASH diet score category (aRRR: 0.33; 95% CI: 0.13, 0.82; ptrend = 0.02) compared with those in the lowest DASH diet score category in fully adjusted models. These findings are consistent with previous clinical trials and large prospective cohort studies, adding to evidence that supports the diet-disease relationship established between DASH diet and hypertension. This study is the first to examine DASH diet adherence and hypertension among South Asian adults in the U.S.

Abstract

Condom-related stigma is a frequently mentioned barrier to consistent condom use among men who have sex with men (MSM). Based on the concept and operational definition of condom-related stigma recently defined by our team, we developed the 20-item condom-related stigma scale (CRSS) and examined its psychometric properties among 433 MSM in China, following DeVellis’s scale development guidelines. The content validity, convergent validity, empirical validity, factorial validity, scale score reliability, split-half reliability, and test–retest reliability for the CRSS were all assessed. The scale consists of four domains: perceived distrust, perceived potential HIV/STI risk, perceived embarrassment, and perceived violation of the traditional understanding of sexual intercourse. The CRSS has good validity (the scale-level content validity index was 0.99; the empirical validity was greater than 0.70) and high reliability (the Cronbach’s alpha coefficient overall was 0.926; the split-half reliability overall was 0.795; the test–retest reliability overall was 0.950). This scale is recommended for assessing the level of condom-related stigma among Chinese MSM, which can serve as an evaluating indicator for safer-sex interventions to prevent HIV infection among the MSM population in a Chinese cultural context.

Abstract

Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection and is the leading nongenetic cause of sensorineural hearing loss and neurodevelopmental delays in the pediatric population. Despite its high prevalence and significant sequelae, congenital CMV in the pregnant woman and neonate often goes undiagnosed. We present the case of a 23-month-old child presenting with developmental delays and bilateral sensorineural hearing loss as a result of CMV and describe with this case report the clinical features, diagnosis, testing, management, and prognosis of congenital CMV.

Abstract

Background: Language concordance between health care practitioners and patients have recently been shown to lower the risk of adverse health events. Continuity of care also been shown to have the same impact. Objective: The purpose of this paper is to examine the relative effectiveness of both continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. Design: A multivariable logistic regression model using rehospitalization as the dependent variable was built. The variable of interest was created to compare language concordance and continuity of care. Participants: The final sample included 22,103 patients from the New York City area between 2010 and 2015 who were non-English-speaking and admitted to their home health site following hospital discharge. Measures: The odds ratio (OR) average marginal effect (AME) of each included variable was calculated for model analysis. Results: When compared with low continuity of care and high language concordance, high continuity of care and high language concordance significantly decreased readmissions (OR=0.71, 95% CI: 0.62-0.80, P<0.001, AME=-4.95%), along with high continuity of care and low language concordance (OR=0.80, 95% CI: 0.74-0.86, P<0.001, AME=-3.26%). Low continuity of care and high language concordance did not significantly impact readmissions (OR=1.04, 95% CI: 0.86-1.26, P=0.672, AME=0.64%). Conclusion: In the US home health system, enhancing continuity of care for those with language barriers may be helpful to address disparities and reduce hospital readmission rates.

Abstract

Background: A supportive home environment is critical to the safety and quality of life of older adults. Home modification is an effective way to build a supportive home environment for older adults’ aging in place. However, there is a lack of knowledge on older adults’ need for home modifications in China. Methods: We conducted a cross-sectional survey in three provinces of China (Hubei, Hunan, and Henan) using stratified and cluster sampling methods in 2021. A total of 5485 older adults aged 60 and over were included. The outcome variables were: need for home modifications, level of need, and type of modification needed. Exposure variables included: demographic and socioeconomic characteristics, as well as health conditions. Logistic and Poisson regressions were applied to examine the needs for home modifications and its associated factors. Results: Nearly 30% of the older adults needed home modifications. The most common choice of home modification was the need for handrails at the bedside, toilet, or threshold (31.64%), and paving un-slip tiles or vinyl flooring (17.45%). Age (IRR = 1.01, P < 0.001), education (IRR = 1.11, P < 0.01), and level of assistance (IRR = 2.31, P < 0.001) were more likely to be positively associated with needs for modification. Participants in the age group of 70 to 79 years, with primary school education, and low-level physically dependent had significantly higher needs for modifications than those of advanced age, lower level of education, or higher level of physically dependent (p < 0.01). Conclusions: The overall need for home modifications in China is low. Home modification programs are needed to tailor individuals’ needs and provide services to those with the most home modification need.

Abstract

Introduction: Caring for families experiencing perinatal loss is a fundamental component of midwifery practice, but little attention is paid to perinatal palliative care in midwifery curricula. Lack of educational preparation and self-care resources negatively impacts midwifery students and health care teams caring for families experiencing stillbirth. Process: A private, urban university conducted a curricular quality improvement project to integrate perinatal palliative care into the midwifery curriculum using a high-fidelity, branching simulation pedagogy. Simulation objectives were developed from curricular gap analyses and the Core Competencies for Basic Midwifery Practice. Development of the Unexpected Perinatal Loss Simulation was guided by the International Nursing Association for Clinical Simulation and Learning Outcomes and Objectives and Design Standards. The Unexpected Perinatal Loss Simulation was revised based on qualitative data from student focus groups and expert content validation. Outcomes: Qualitative data yielded 4 key domains: presimulation, simulation skills, prior experience/personal reflections, and recommendations. Simulation procedures and scenario content were revised, after which 8 expert clinicians in the fields of midwifery, palliative care, and psychiatry validated the scenario content using the Lynn method. Two items did not meet the content validity index (CVI) threshold of 0.78, necessitating review by stakeholders; however, the overall scenario CVI threshold was met (0.82). Discussion: Through this project, faculty integrated perinatal palliative care into the midwifery program using a novel approach of high-fidelity, branching simulation, structured debriefing, and an introductory self-care skills workshop. Potential clinical impact includes skillful perinatal palliative care with effective communication skills to mitigate how families experience and remember a traumatic loss and facilitate the grieving process. Students voiced insights into how they would process loss and seek support to mitigate their own grief as future midwives.

Abstract

Background: As more Americans age in place, it is critical to understand care delivery in the home. However, data on the range of home-based services provided by Medicare is limited. We define a taxonomy of clinical care in the home funded through fee-for-service Medicare and methods to identify receipt of those services. Methods: We analyzed Fee-for-service (FFS) Medicare claims data from a nationally-representative cohort of older adults, the National Health and Aging Trends Study (NHATS), to identify home-based clinical care. We included 6,664 NHATS enrollees age ≥ 70 and living in the community, observed an average of 3 times each on claims-linked NHATS surveys. We examined provider and service type of home-based clinical care to identify a taxonomy of 5 types: home-based medical care (physician, physician assistant, or nurse practitioner visits), home-based podiatry, skilled home health care (SHHC), hospice, and other fee-for-service (FFS) home-based care. We further characterized home-based clinical care by detailed care setting and visit types. Results: From 2011–2016, 17.8%-20.8% of FFS Medicare beneficiaries age ≥ 70 received Medicare-funded home-based clinical care. SHHC was the most common service (12.8%-16.1%), followed by other FFS home-based care (5.5%-6.5%), home-based medical care (3.2%-3.9%), and hospice (2.6%-3.0%). Examination of the other-FFS home-based care revealed imaging/diagnostics and laboratory testing to be the most common service. Conclusions: We define a taxonomy of clinical care provided in the home, serving 1 in 5 FFS Medicare beneficiaries. This approach can be used to identify and address research and clinical care gaps in home-based clinical care delivery.

Abstract

BACKGROUND: Disparities in hypertension outcomes persist among Black and Hispanic adults and persons living in poverty in the United States. The “LINKED-BP Program” is a multi-level intervention linking home blood pressure (BP) monitoring with a mobile health application, support from community health workers (CHWs), and BP measurement training at primary care practices to improve BP. This study is part of the American Heart Association RESTORE (AddREssing Social Determinants TO pRevent hypErtension) Network. This study aims to examine the effect of the LINKED-BP Program on BP reduction and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the intervention. METHODS: Using a hybrid type I effectiveness-implementation design, 600 adults who have elevated BP or untreated stage 1 hypertension without diabetes, chronic kidney disease, history of cardiovascular disease (stroke or coronary heart disease) and age < 65 years will be recruited from 20 primary care practices including community health centers in the Maryland area. The practices are randomly assigned to the intervention or the enhanced usual care arms. Patients in the LINKED-BP Program receive training on home BP monitoring, BP telemonitoring through the Sphygmo app, and CHW telehealth visits for education and counseling on lifestyle modification over 12 months. The primary clinical outcome is change from baseline in systolic BP at 6 and 12 months. DISCUSSIONS: The LINKED-BP Program tests a sustainable, scalable approach to prevent hypertension and advance health equity. The findings will inform implementation strategies that address social determinants of health and barriers to hypertension prevention in underserved populations.

Abstract

Daytime sleepiness is highly prevalent in middle-aged adults and has a detrimental impact on their quality of life. Our study examined the psychological and behavioral determinants of daytime sleepiness among adults aged 35 to 64 years. The main variables of interest were psychological factors (perceived stress and anxiety), physical activity factors (moderate-to-vigorous physical activity and sedentary behaviors), and dietary factors (fat, sugar, fruit, and vegetable intake). Partial correlation and multiple linear regression were conducted to determine their associations with daytime sleepiness, with adjustment for covariates. Our sample included 87 adults with a mean age of 47 ± 9 years. About 21% met the criterion for excessive daytime sleepiness. Greater anxiety, longer time spent in sedentary behaviors, and higher consumption of foods rich in trans fat, sugar, and calories were independently associated with higher daytime sleepiness levels. Targeted interventions or treatments are warranted to address the identified risk factors for middle-aged adults.

Abstract

Introduction: South Asians are an underrepresented population subgroup in the U.S., yet they have higher rates of chronic diseases. There is currently no tool that assesses the nutrition intake of South Asians in the U.S., despite their unique dietary profile that may be associated with disease outcomes. The objective of this preliminary study was to create a food list, inclusive of herbs and spices, that will be used in the development of the web-based South Asian Food Intake System for dietary assessment of South Asian adults living in the U.S. Methods: Authors used a Qualtrics survey to collect sociodemographic information (n=66), and 24-hour diet recall and Home Food Inventory interviews were conducted through Zoom (n=31). Grocery store tours and cookbook and existing food frequency questionnaire review were conducted. Results: A food list of 484 individual food items was generated. These items were sorted into 12 main food categories and condensed into 302 line items. Most respondents (68%) reported consuming South Asian meals regularly and utilizing herbs/spices during food preparation (83%). Conclusions: This pilot study describes the data collection to develop a food list for the South Asian Food Intake System, which can be utilized by educators, clinicians, and researchers to more accurately collect information about dietary intake among South Asian Americans.

Abstract

Background: State policy-making to address disparities in access to and quality of palliative care is increasing. Yet, there is no mechanism to systematically assess palliative care policies nationally. Methods: We describe the development of the Palliative Care Law and Policy GPS by the Center to Advance Palliative Care and the Yale Solomon Center for Health Law and Policy. The GPS is an online, searchable repository of national palliative care policies. We developed the GPS by conducting a systematic search of Lexis+, LegiScan, and state health departments for palliative care-related statutes and proposed legislation, categorizing policies into workforce, payment, quality/standards, clinical skill-building, public awareness, telehealth, and pediatric palliative care, and creating an interactive website. Conclusions and Implications: The GPS is a critical tool that can advance palliative care research, practice, and policy. Next steps include the expansion of data from 2010 onward as well as gathering state-level regulations and partially automating search and updating functions.

Abstract

Diabetes mellitus (DM) is a recognized risk factor for dementia, and increasing evidence shows that tooth loss is associated with cognitive impairment and dementia. However, the effect of the co-occurrence of DM and edentulism on cognitive decline is understudied. This 12-y cohort study aimed to assess the effect of the co-occurrence of DM and edentulism on cognitive decline and examine whether the effect differs by age group. Data were drawn from the 2006 to 2018 Health and Retirement Study. The study sample included 5,440 older adults aged 65 to 74 y, 3,300 aged 75 to 84 y, and 1,208 aged 85 y or older. Linear mixed-effect regression was employed to model the rates of cognitive decline stratified by age cohorts. Compared with their counterparts with neither DM nor edentulism at baseline, older adults aged 65 to 74 y (β = −1.12; 95% confidence interval [CI], −1.56 to −0.65; P < 0.001) and those aged 75 to 84 y with both conditions (β = −1.35; 95% CI, −2.09 to −0.61; P < 0.001) had a worse cognitive function. For the rate of cognitive decline, compared to those with neither condition from the same age cohort, older adults aged 65 to 74 y with both conditions declined at a higher rate (β = −0.15; 95% CI, −0.20 to −0.10; P < 0.001). Having DM alone led to an accelerated cognitive decline in older adults aged 65 to 74 y (β = −0.09; 95% CI, −0.13 to −0.05; P < 0.001); having edentulism alone led to an accelerated decline in older adults aged 65 to 74 y (β = −0.13; 95% CI, −0.17 to −0.08; P < 0.001) and older adults aged 75 to 84 (β = −0.10; 95% CI, −0.17 to −0.03; P < 0.01). Our study finds the co-occurrence of DM and edentulism led to a worse cognitive function and a faster cognitive decline in older adults aged 65 to 74 y.