Publications
Publications
Assessing Older Adults Who Have Experienced Homelessness: Findings from an Exploratory Study
Breder, K., Jacob, C., & Yu, V. (2025). Journal of Applied Gerontology. 10.1177/07334648251333845
Abstract
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.
Assessing Racial/Ethnic Variation and Trends in Vaginal Birth after Cesarean in California: A Retrospective Cohort Study Using Linked Birth Certificate and Hospital Discharge Records
Rubashkin, N., Teal, E. N., Baer, R. J., Vedam, S., Kuppermann, M., Lanouette, G., Jelliffe-Pawlowski, L. L., & Rosenstein, M. G. (2025). American Journal of Perinatology. 10.1055/a-2593-0555
Abstract
Objective Increasing the vaginal birth after cesarean (VBAC) rate to 18% was a Healthy People 2020 goal. Detailed data on racial/ethnic differences in VBAC rates is lacking and can inform efforts to equitably increase VBAC rates. This study aimed to assess racial/ethnic variation in VBAC rates and to describe group trends in VBAC rates in California between 2011 and 2021. Study Design This retrospective cohort study used a database of birth certificates linked to hospital discharge records. We analyzed singleton, term live births among people who had a history of at least one prior cesarean birth, no identified contraindications to a vaginal birth, and self-identified their racial/ethnic group as Hispanic or non-Hispanic (American Indian-Alaskan Native (AIAN), Asian, Black, Hawaiian/Pacific Islander, or white). VBAC births were identified from birth certificate records. Differences between VBAC rates were assessed using univariable and multivariable Poisson log-linear regression while adjusting for potential confounders. Results A total of 607,808 birthing people were included (2,234 AIAN, 84,899 Asian, 34,217 Black, 2,559 Hawaiian/Pacific Islander, 334,116 Hispanic, 149,783 white). Over the study period, Hawaiian/Pacific Islander birthing people had the highest average VBAC rate at 11.5% (AIAN, 6.5%; Asian, 8.8%; Black, 8.0%; Hispanic, 7.4%; white, 9.5%). In adjusted models, Black (aRR = 1.06, 95% CI: 1.01-1.11) and Hawaiian/Pacific Islander (aRR = 1.43, 95% CI: 1.27-1.61) birthing people were more likely to have a VBAC compared with white birthing people, while Hispanic birthing people were less likely (aRR = 0.96, 95% CI: 0.93-0.98). VBAC rates increased significantly (p < 0.001) over time for all groups except AIAN birthing people. Conclusion VBAC rates increased for most racial/ethnic groups in California. With the exception of the Hawaiian/Pacific Islander group, there were small and likely not clinically significant differences in the chances for a VBAC across groups. No group in California met the Healthy People 2020 goal VBAC rate of 18%. Key Points VBAC rates increased for most racial/ethnic groups. The VBAC rate for AIAN birthing people did not increase. No group met the Healthy People 2020 goal VBAC rate of 18%.
Assistance with oral hygiene care among family dementia caregivers in Chinese American Communities in New York City
Mao, W., Wu, B., & Pei, Y. (2025). Aging and Health Research, 5(1). 10.1016/j.ahr.2024.100210
Abstract
Background: Oral hygiene care is instrumental to maintaining optimal oral health. As dementia progresses, individuals face challenges performing adequate oral hygiene care and become dependent on their caregivers. The role of family caregivers in assisting with oral hygiene care becomes increasingly critical. This study explored the association between caregiving circumstances, care recipient characteristics, and assistance in oral hygiene care among dementia caregivers in Chinese American communities. Methods: Data came from a pilot study on Chinese dementia caregivers in New York City collected between November 2021 and June 2022. Purposive sampling was used to recruit family caregivers to participate in a survey (online or via telephone). Current caregivers (n = 76) were included. Caregiver assistance with oral hygiene care was measured by assistance with toothbrushing (yes or no) and assistance with flossing (yes or no). Descriptive analyses, group comparisons, and logistic regressions were conducted. Results: Female caregivers tended to assist with toothbrushing. Caregivers with an average of 2.4 years in providing care tended to assist with flossing. Care recipients with tooth pain were 5.12 times more likely to receive assistance with toothbrushing. Care recipients with more natural teeth were 1.07 times more likely to receive assistance with toothbrushing. Care recipients with severe dementia were 94 % less likely to receive assistance with flossing. Conclusions: The findings underscore the importance of understanding the factors that influence caregivers’ assistance with oral hygiene care. This study is a crucial first step toward developing effective, caregiver-led interventions to improve the oral hygiene of individuals with dementia.
Association between behavioural risk factors for hypertension and concordance with the Dietary Approaches to Stop Hypertension dietary pattern among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study
Hussain, B. M., Deierlein, A. L., Kanaya, A. M., Talegawkar, S. A., O’Connor, J. A., Gadgil, M. D., Needham, B. L., Lin, Y., & Parekh, N. (2025). Journal of Nutritional Science, 14. 10.1017/jns.2025.8
Abstract
South Asians are among the fastest-growing immigrant population group in the United States (U.S.) with a unique disease risk profile. Due in part to immigration and acculturation factors, South Asians engage differently with behavioural risk factors (e.g. smoking, alcohol intake, physical activity, sedentary behaviour, and diet) for hypertension, which may be modified for the primary prevention of cardiovascular disease. Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, we conducted a cross-sectional analysis to evaluate the association between behavioural risk factors for cardiovascular disease and diet. We created a behavioural risk factor score based on smoking status, alcohol consumption, physical activity, and TV watching. We also calculated a Dietary Approaches to Stop Hypertension (DASH) dietary score based on inclusion of relevant dietary components. We used both scores to examine the association between engaging with risk factors for hypertension and the DASH diet among a cohort of South Asian adults. We found that participants with 3–4 behavioural risk factors had a DASH diet score that was 3 units lower than those with no behavioural risk factors (aβ: –3.25; 95% CI: –4.28, –2.21) and were 86% less likely to have a DASH diet score in the highest category compared to the lowest DASH diet score category (aOR: 0.14; 95% CI: 0.05, 0.37) in the fully adjusted models. These findings highlight the relationship between behavioural risk factors for hypertension among South Asians in the U.S.
Association Between Oral Hygiene Behaviours and Cognitive Decline in Adults: A Systematic Review and Meta-Analysis
Zhu, Z., Yang, Z., Qi, X., Mao, W., Pei, Y., & Wu, B. (2025). Journal of Advanced Nursing, 81(5), 2277-2289. 10.1111/jan.16525
Abstract
Aim: To evaluate the association between oral hygiene behaviour and cognitive decline in adults. The outcomes include changes in global cognitive function, visual attention, task switching and the risk of dementia. Design: We conducted a systematic review following the preferred reporting items for systematic reviews and meta-analyses guidelines. Data Sources: A systematic search of 11 databases and grey literature sources was conducted from inception to January 2024. We included interventional trials or cohort studies that investigated the effect of oral hygiene behaviours (e.g., toothbrushing, mouth washing, flossing, using toothpicks and cleaning dentures) on cognitive decline in adults. Methods: Data extraction and risk of bias assessment were performed by two independent reviewers with expertise in conducting systematic reviews. Meta-analyses were conducted using random-effects models, and heterogeneity was assessed with the I2 statistic and χ2 test. Results: A total of eight studies (six intervention studies and two cohort studies) met inclusion criteria, including 261,772 participants. Follow-up periods ranged from 30 days to 48 months for interventions and 9 to 18 years for cohorts. Toothbrushing was associated with a significantly slower decline in global cognitive overtime. Toothbrushing in older adults with moderate/severe dementia could achieve significant changes in cognitive decline. There was no significant difference between the effectiveness of toothbrushing performed by professionals and caregivers. Other oral hygiene behaviours, including dental flossing, using mouthwash, using toothpicks and cleaning dentures, were not associated with the risk of dementia. Conclusions: Toothbrushing is linked to a decreased risk of dementia and improved global cognitive function. Promoting toothbrushing at least twice daily may significantly reduce the risk of cognitive decline and dementia. Impact: These findings highlight the urgent need for programmes that encourage daily toothbrushing, particularly in nursing home settings and among older adults with moderate-to-severe dementia.
Association between personality profiles and motoric cognitive risk syndrome in community-dwelling older adults: a person-centered approach
Zhang, J., Wang, L., Zhang, C., Wang, X., Sun, X., Wang, C., Liu, G., Shi, L., & Wu, B. (2025). BMC Psychiatry, 25(1). 10.1186/s12888-025-06634-5
Abstract
Background: Motoric cognitive risk (MCR) syndrome is a predementia syndrome characterized by subjective cognitive complaints and slow gait in the absence of dementia and mobility disability. Although past research has suggested that personality traits could play a significant role in the onset and progression of MCR among older adults, the exact relationships between specific personality profiles and MCR remain unclear. This study aimed to examine the relationship between personality profiles and MCR among community-dwelling older adults. Methods: A cross-sectional study was conducted from March 2021 to January 2022. Personality traits, including openness, extraversion, agreeableness, conscientiousness and neuroticism, were measured using the 40-item brief version of the Chinese Big Five Inventory. The Latent profile analysis was used to identify personality profiles among these older adults who shared similar patterns of personality traits. The Lanza, Tan, and Bray’s approach was employed to investigate the personality profile-specific differences in MCR prevalence. Furthermore, a stepwise multinomial logistic regression revealed unique population characteristics for different personality profiles. Results: A total of 538 eligible participants were included in this study. The mean age was 73.25 years (SD = 9.0) and 62.50% were females. This study identified four distinct personality profiles: the resilient, ordinary, reserved, and anti-resilient profiles. The resilient profile exhibited the lowest prevalence of MCR (mean = 6%, SE = 0.024), whereas the anti-resilient profile had the highest (mean = 20.3%, SE = 0.043). The prevalence of MCR differed among personality profiles (overall χ2 = 14.599, p = 0.002). Personality profile membership was characterized by different population characteristics. Notably, the anti-resilient profile was association with symptoms of depression (OR = 28.443, 95%CI = 11.095–72.912), while the reserved profile was linked with advanced age (OR = 1.031, 95%CI = 1.003–1.061). Overall, a low education level and poor sleep quality were the robust attribution factors. Conclusions: This study revealed that personality profiles may assist in identifying older adults at greater risk of MCR. Increased awareness and management of personality profiles may contribute to the prevention of MCR.
Association of Gum Treatment with Cognitive Decline and Dementia Risk among Older Adults with Periodontal Symptoms: A 12-Year Prospective Cohort Study
Zhu, Z., Wang, K., Zheng, Y., Li, A., Wu, B., & Qi, X. (2025). Neuroepidemiology, 59(4), 1-10. 10.1159/000540086
Abstract
INTRODUCTION: This study examines the associations of gum treatment with cognitive decline and dementia risk among older adults with periodontal symptoms in the USA.METHODS: A cohort of 866 adults aged ≥50 with periodontal symptoms was recruited for the 2008 Health and Retirement Study "Dental Health Experimental Module" and followed until 2020. Cognitive function was assessed with the Telephone Interview for Cognitive Status (TICS). Dementia status was ascertained with the Langa-Weir algorithm based on TICS scores and proxy assessments. Linear mixed-effects model and multivariable Cox regression models were utilized to analyze the associations of gum treatment with cognitive decline and the risk of dementia, respectively.RESULTS: Of 866 participants (mean age 67.7, 61.4% women), 105 (12.1%) developed dementia with a median follow-up of 9 (IQR, 6-10) years. The dementia incidence rates were lower in the group with gum treatment (7.4 vs. 12.9 per 1,000 person-years). Compared with participants who did not have gum treatment, those with gum treatment experienced a decline in TICS score that was on average 0.025 (95% CI, 0.005-0.044) points less per year and a 38% lower incidence of dementia (hazard ratio, 0.62; 95% CI, 0.41-0.93). These associations were consistent across participants with a different severity of periodontal symptoms and sociodemographic characteristics (age, sex, race, ethnicity, and education) except for income levels.CONCLUSION: Prompt gum treatment for older adults with periodontal symptoms may be beneficial for their cognitive health.
Associations Between Nursing Students' Knowledge, Skills, and Attitudes and Participation in Experiential Learning on Care for People With Disabilities
Ozkara San, E., Marx, K. A., Robertiello, G., Nahum, J. L., Hu, J., Pasklinsky, N., & Latimer, B. (2025). Nurse Educator, 50(2), 73-78. 10.1097/NNE.0000000000001761
Abstract
Background: Experiential learning activities on care for people with disabilities (PWD) would help nursing students develop the knowledge, skills, and attitudes (KSAs) needed to provide quality care for PWD. Purpose: The purpose of this study was to evaluate the perceived changes in nursing students' KSAs related to the care for PWD following participation in health assessment and prevention (HAP) experiential learning activities. Methods: This was a quasi-experimental, pre- and posttest educational intervention study. Nursing students (n = 160) attended multiple experiential learning activities as a required part of their HAP coursework and completed a pre and posttest survey to assess changes in their KSAs. Results: Participation in experiential learning activities on care for PWD was associated with significant increases in perceived knowledge, skills and positive attitudes toward PWD. Conclusions: Experiential learning activities aligned with core competencies for health care providers caring for PWDs have the potential to change nursing care and address health inequities for this population.
Barriers to Timely Dementia Diagnosis in Older Latinos With Limited English Proficiency: An Integrative Review
Fernandez Cajavilca, M., Squires, A., Wu, B., & Sadarangani, T. (2025). Journal of Transcultural Nursing, 36(1), 57-72. 10.1177/10436596241268456
Abstract
Introduction: Timely diagnosis is critical for persons with Alzheimer’s disease and related dementias (ADRD) to ensure they receive adequate services; however, timely diagnosis may be prevented by a person’s English language skills. The purpose of this integrative review was to understand how limited English proficiency (LEP) impacts older Latino’s ability to access a timely ADRD diagnosis. Methods: Whittemore and Knafl’s methodological approach guided the review. Searches in five databases yielded 12 articles for inclusion. Results: Lack of culturally congruent health care systems, health care providers, and knowledge of ADRD resulted in delays in obtaining a timely ADRD diagnosis among older Latinos with LEP. Discussion: Latinos with LEP and risk for ADRD benefit from language assistance and support in navigating the health care system. Nurses must be advocates, even when a language barrier is present, and recognize that interpreters are not a single source solution.
Brief Mindfulness-Based Cognitive Therapy in Women With Myocardial Infarction: Results of a Multicenter Randomized Controlled Trial
Spruill, T. M., Park, C., Kalinowski, J., Arabadjian, M. E., Xia, Y., Shallcross, A. J., Visvanathan, P., Smilowitz, N. R., Hausvater, A., Bangalore, S., Zhong, H., Park, K., Mehta, P. K., Thomas, D. K., Trost, J., Bainey, K. R., Heydari, B., Wei, J., Dickson, V. V., … Reynolds, H. R. (2025). JACC: Advances, 4(2). 10.1016/j.jacadv.2024.101530
Abstract
Background: Elevated perceived stress is associated with adverse outcomes following myocardial infarction (MI) and may account for poorer recovery among women vs men. Objectives: This randomized controlled trial tested effects of a mindfulness-based intervention on stress levels among women with MI. Methods: Women with elevated stress (Perceived Stress Scale [PSS-4]≥6) at least 2 months after MI were enrolled from 12 hospitals in the United States and Canada and via community advertising. Participants were randomized to a remotely delivered mindfulness intervention (MBCT-Brief) or heart disease education, both 8 weeks long. Follow-up was 6 months. Changes in stress (PSS-10; primary outcome) and secondary outcomes (depressive symptoms, anxiety, quality of life, disease-specific health status, actigraphy-assessed sleep) were compared between groups. Results: The sample included 130 women with MI (mean age 59.8 ± 12.8 years, 34% racial/ethnic minorities). In intention-to-treat analysis, PSS-10 scores declined in the MBCT-Brief arm (−0.52 [95% CI: −0.77 to −0.28]) but not the heart disease education arm (−0.19 [95% CI: −0.45 to 0.06]; group×time interaction P = 0.070). The effect was stronger in per-protocol analysis of participants who completed ≥4 intervention sessions (P = 0.049). There were no significant differences in secondary outcomes in intention-to-treat or per-protocol analyses. Within the MBCT-Brief arm, more frequent mindfulness practice was associated with greater reductions in stress (P = 0.007), depressive symptoms (P = 0.017), and anxiety (P = 0.036). Conclusions: MBCT-Brief was associated with greater 6-month reductions in stress than an active control among adherent participants. More frequent mindfulness practice was associated with greater improvements in psychological outcomes. Strategies to engage women with MI in mindfulness training and support regular home practice may enhance these effects.
Business entrepreneurship in nursing care facilities in Brazil: an ecological study
Silva, M. M., Menegaz, J. D. C., Ferreira, G. R. O. N., Costa, J. D. J. Q. T., Martins, M. E. L., & Squires, A. (2025). Revista Latino-Americana de Enfermagem, 33. 10.1590/1518-8345.7657.4585
Abstract
Objective: to characterize and describe the spatial and temporal distribution of nursing care establishments in Brazil according to the National Registry of Health Establishments. Method: ecological study, using secondary data from the National Register of Health Establishments, aggregated by year, state and region. The variables extracted were: year of registration, gender of the nurse manager or administrator, number of nurses per establishment, type of establishment, main activity, level of care, legal nature and agreement. Descriptive statistics and temporal analysis were carried out using the Jointpoint program. Results: between 2003 and 2023, 340 nursing establishments were found with active registrations. The South and Southeast concentrated most of the establishments. There was a predominance of practices, specialized clinics and home care services. The temporal analysis indicated that between 2003 and 2021, there was an annual growth of 30.07% (p= 0.00). Considering the total period (2003-2023), there was an annual growth of 25.01%, indicating an upward trend in businesses over the years. Conclusion: formalization and registration reflect the professionalization of nursing management. There has been an increase in registrations following the publication of resolutions by the Federal Nursing Council that support autonomous and/or liberal practice.
Business entrepreneurship in nursing care facilities in Brazil: an ecological study
Silva, M. M., Menegaz, J. D. C., Ferreira, G. R. O. N., Costa, J. D. J. Q. T., Martins, M. E. L., & Squires, A. (2025). Revista Latino-Americana de Enfermagem, 33, e4584. 10.1590/1518-8345.7657.4584
Abstract
to characterize and describe the spatial and temporal distribution of nursing care establishments in Brazil according to the National Registry of Health Establishments. ecological study, using secondary data from the National Register of Health Establishments, aggregated by year, state and region. The variables extracted were: year of registration, gender of the nurse manager or administrator, number of nurses per establishment, type of establishment, main activity, level of care, legal nature and agreement. Descriptive statistics and temporal analysis were carried out using the Jointpoint program. between 2003 and 2023, 340 nursing establishments were found with active registrations. The South and Southeast concentrated most of the establishments. There was a predominance of practices, specialized clinics and home care services. The temporal analysis indicated that between 2003 and 2021, there was an annual growth of 30.07% (p= 0.00). Considering the total period (2003-2023), there was an annual growth of 25.01%, indicating an upward trend in businesses over the years. formalization and registration reflect the professionalization of nursing management. There has been an increase in registrations following the publication of resolutions by the Federal Nursing Council that support autonomous and/or liberal practice.
Cardiovascular Health in the Transition From Adolescence to Emerging Adulthood: A Scientific Statement From the American Heart Association
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Abstract
Abstract
Cardiovascular disease remains a leading cause of death in the United States, with an alarming rise in the proportion of young adults experiencing cardiovascular events. Many adolescents enter adulthood with significant cardiovascular disease risk factors. This scientific statement addresses the critical need for cardiovascular health promotion during emerging adulthood, a transitional stage between the ages of 18 and 25 or 29 years of age. We discuss the significance of social determinants of health and the interplay between individual-level risk factors and developmental changes, including shifts in substance use, social connections, and emotional well-being. We conclude by outlining strategies for optimizing cardiovascular health promotion and disease prevention, underscoring the importance of primordial prevention, early intervention, and tailored approaches to address the unique needs of emerging adults. Addressing these multifaceted factors is crucial for mitigating the burden of cardiovascular disease risk factors among emerging adults and promoting long-term cardiovascular well-being.
Classifying Continuous Glucose Monitoring Documents From Electronic Health Records
Zheng, Y., Iturrate, E., Li, L., Wu, B., Small, W. R., Zweig, S., Fletcher, J., Chen, Z., & Johnson, S. B. (2025). Journal of Diabetes Science and Technology. 10.1177/19322968251324535
Abstract
Background: Clinical use of continuous glucose monitoring (CGM) is increasing storage of CGM-related documents in electronic health records (EHR); however, the standardization of CGM storage is lacking. We aimed to evaluate the sensitivity and specificity of CGM Ambulatory Glucose Profile (AGP) classification criteria. Methods: We randomly chose 2244 (18.1%) documents from NYU Langone Health. Our document classification algorithm: (1) separated multiple-page documents into a single-page image; (2) rotated all pages into an upright orientation; (3) determined types of devices using optical character recognition; and (4) tested for the presence of particular keywords in the text. Two experts in using CGM for research and clinical practice conducted an independent manual review of 62 (2.8%) reports. We calculated sensitivity (correct classification of CGM AGP report) and specificity (correct classification of non-CGM report) by comparing the classification algorithm against manual review. Results: Among 2244 documents, 1040 (46.5%) were classified as CGM AGP reports (43.3% FreeStyle Libre and 56.7% Dexcom), 1170 (52.1%) non-CGM reports (eg, progress notes, CGM request forms, or physician letters), and 34 (1.5%) uncertain documents. The agreement for the evaluation of the documents between the two experts was 100% for sensitivity and 98.4% for specificity. When comparing the classification result between the algorithm and manual review, the sensitivity and specificity were 95.0% and 91.7%. Conclusion: Nearly half of CGM-related documents were AGP reports, which are useful for clinical practice and diabetes research; however, the remaining half are other clinical documents. Future work needs to standardize the storage of CGM-related documents in the EHR.
Clinical risk factors and adverse perinatal outcomes among U.S. and African-born Black women in California
McKenzie-Sampson, S., Baer, R. J., Costello, J., Karasek, D., Torres, J. M., Riddell, C. A., Jelliffe-Pawlowski, L. L., & Blebu, B. E. (2025). Journal of Perinatology. 10.1038/s41372-025-02361-7
Abstract
Objective: Examine the association between clinical risk factors for preterm birth (PTB) and small for gestational age delivery (SGA) among United States (US)- and African-born Black women. Study design: Population-based study of singleton births to 171,051 US- and 19,269 African-born women in California (2011–2020). Associations between PTB and SGA with 14 clinical risk factors were examined. Adjusted Poisson regression models estimated the association between each clinical factor and the outcomes, while assessing interaction by nativity. Results: The prevalence of PTB, SGA, and clinical factors was greater among US-born Black women, with the exception of gestational diabetes. On average, the risk of PTB and SGA among women with each clinical risk factor was significantly higher for African- compared to US-born Black women. Conclusions: Clinical risk factors were higher among US-born women, however associations between each factor and adverse perinatal outcomes were stronger for African-born women.
Comprehensive Dementia Care Models: State of the Science and Future Directions
Murali, K. P., Carpenter, J. G., Kolanowski, A., & Bykovskyi, A. G. (2025). Research in Gerontological Nursing, 18(1), 7-16. 10.3928/19404921-20241211-02
Abstract
The rising prevalence of Alzheimer's disease and Alzheimer's disease-related dementias has led to renewed public discourse and policy changes in response to the care needs of persons living with dementia and their care partners. Comprehensive dementia care models are central to many recent policy initiatives, most notably the Centers for Medicare & Medicaid Services Guiding an Improved Dementia Experience model. Gerontological nursing research is uniquely positioned to design and lead research investigating the effectiveness of these initiatives, as well as the dissemination and scaling of existing comprehensive dementia care models. The current Annual State of the Science Review provides an overview of the current state of comprehensive dementia care models in the United States and relevant policies. Challenges and opportunities for nursing education, research, and implementation across the translational research continuum are also outlined. [Research in Gerontological Nursing, 18(1), 7-16.].
Concordance Between DASH Diet and Coronary Artery Calcification: Results From the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Prospective Cohort Study
Hussain, B. M., Deierlein, A. L., Talegawkar, S. A., Kanaya, A. M., O’Connor, J. A., Gadgil, M. D., Lin, Y., & Parekh, N. (2025). AJPM Focus, 4(1). 10.1016/j.focus.2024.100288
Abstract
Introduction: South Asian adults are at high risk for atherosclerotic cardiovascular disease, for which coronary artery calcification is an early predictor. Adherence to the Dietary Approaches to Stop Hypertension diet is a modifiable risk factor that may mitigate the progression of coronary artery calcification and atherosclerotic cardiovascular disease. Methods: Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, the authors calculated a Dietary Approaches to Stop Hypertension dietary score (categorized as low, moderate, and high) to examine the associations of Dietary Approaches to Stop Hypertension diet adherence with coronary artery calcification after a 5-year follow up. Results: The authors found that participants in the high Dietary Approaches to Stop Hypertension category were 41% less likely to have coronary artery calcification score >100 (age-adjusted incidence rate ratio=0.59; 95% CI=0.36, 0.95) than those in the low category; this association was attenuated in multivariable models. Differences were observed by sex. Men in the high Dietary Approaches to Stop Hypertension category were 51% less likely to have coronary artery calcification score >100 (adjusted incidence rate ratio=0.49; 95% CI=0.26, 0.95) and experienced 0.46-fold coronary artery calcification change (fold change=0.46; 95% CI=0.18, 0.90) in multivariable models. Conclusions: The findings indicate a relationship between Dietary Approaches to Stop Hypertension diet and early predictors of atherosclerotic cardiovascular disease risk among South Asians living in the U.S., particularly men.
Concurrent Validity of a Physical Activity Vital Sign Used in an Adult Preventive Cardiology Clinic
Mccarthy, M., Fletcher, J., Melkus, G., Vorderstrasse, A., Chehade, M., & Katz, S. (2025). Nursing Research, 74(4), 299-304. 10.1097/NNR.0000000000000818
Abstract
Background In clinical settings, counseling patients on physical activity starts by assessing patients' current physical activity levels. Self-report measures of PA are generally easy to administer; however, they may be too long to be convenient and are known to correlate poorly with objective measures of physical activity. Objective To assess the concurrent validity of a self-report three-question physical activity vital sign with objective Fitbit step counts and the distance walked during a 6-min walk test. Methods This pilot study tested a best practice advisory embedded in the Epic electronic health record, which was designed to prompt providers in a preventive cardiology clinic to counsel patients reporting low levels of physical activity. Patients were invited to participate in the remote patient monitoring phase to assess the change in their physical activity by wearing a Fitbit for 12 weeks and completing a 6-min walk test at baseline and 12 weeks. This analysis used the cross-sectional data collected in this phase. Pearson correlations were conducted between self-reported physical activity, Fitbit step counts, and the distance walked during the 6-min walk - a measure associated with current physical activity levels. Kappa coefficients were calculated to assess agreement between self-reported physical activity and step counts. Results Participants who enrolled in the Fitbit monitoring were approximately 50% female, with the majority identified as White non-Hispanic adults. Their most common cardiovascular risk factor was hypertension. The self-reported physical activity vital signs were significantly associated with step counts at baseline and 12 weeks but were not associated with the distance during the 6-min walk test. However, the distance walked was significantly associated with step counts at baseline and 12 weeks. The Kappa results demonstrate a poor level of agreement between two categories (meeting or not meeting current physical activity guidelines) of self-report physical activity vitals and the objective Fitbit step counts. Discussion There were moderate correlations between the self-reported physical activity vital signs and the Fitbit step counts, but there was lack of agreement when they were categorized. Further validation of this physical activity vital sign is warranted.
Connectedness: The Updated and Expanded Pillar of Lifestyle Psychiatry and Lifestyle Medicine
Merlo, G., Snellman, L., & Sugden, S. G. (2025). American Journal of Lifestyle Medicine. 10.1177/15598276251345455
Abstract
The field of Lifestyle Psychiatry aims to prevent, treat, and sometimes reverse chronic physical and mental health conditions through evidence-based interventions. The foundational pillars of this field are physical activity & exercise, nutrition, restorative sleep, stress management, toxic exposure reduction, and connectedness. Connection has been defined as “feeling part of something larger than yourself, feeling close to another person or group, feeling welcomed, and understood.” Within Lifestyle Psychiatry, however, we emphasize that connectedness encompasses not only our relationships with other individuals but also our connection to ourselves and with the world at large. We have identified these three relationships as three core or pivotal needs. Similarly, we have expanded our previous model of connectedness to include six domains: (1) Happiness, (2) Purpose in Life & Meaning-Making, (3) Empathy & Compassion, (4) Social Connection & Community, (5) Nature, and (6) Spirituality & Religion. In this paper, we present psychological and scientific data supporting the necessity of the six domains of connectedness. By combining the six domains with the three core needs, practitioners of lifestyle psychiatry can develop impactful and sustainable interventions that promote connectedness, decrease negative health outcomes, and promote psychological growth through increasing resilience, emotional development, and the ability to be alone without loneliness.
Coping with cognitive decline in older adults with mild cognitive impairment or mild dementia: a scoping review
Cho, Y., Kamkhoad, D., Regier, N. G., Song, L., Anderson, R. A., Wu, B., Zou, B., & Beeber, A. S. (2025). Aging and Mental Health, 29(6), 951-960. 10.1080/13607863.2025.2453819
Abstract
Objectives: This scoping review aims to map out the coping strategies among Persons with Mild Cognitive Impairment (PwMCI) and Persons with Mild Dementia (PwMD), identifying the facilitators and the barriers to the use of the strategies. Method: We conducted a systematic search of peer-reviewed studies in PubMed, CINAHL, EMBASE, and PsycINFO. Under the guidance of the Coping Circumflex Model, we identified coping strategies and then conducted thematic synthesis. Results: Our review of 17 studies revealed 13 themes for coping strategies among PwMCI and PwMD, categorized into problem-solving, positive emotional, problem avoidance, and negative emotional strategies. The strategies included utilization of reminders, active engagement in daily tasks, acceptance, and concealing memory problems. The themes for facilitators and barriers encompassed social interactions, assistance from informal care partners, support from professionals, and the influence of emotion. Conclusion: The review revealed the practical types of coping strategies and the influence of context on their use and development, highlighting the need for personalized coping strategies. These insights are crucial for developing tailored interventions to improve quality of life in PwMCI and PwMD. Future research should focus on how PwMCI and PwMD develop their effective coping strategies, considering their trajectory of cognitive decline.
Cosmology of belonging: The role of community in the therapeutic use of psychedelics
Dorsen, C., Noero, L., Knapp, M., Arden, K., & Rosa, W. E. (2025). Palliative and Supportive Care, 23. 10.1017/S1478951524001688
Abstract
Background The recent wave of clinical trials of psychedelic substances among patients with life-limiting illness has largely focused on individual healing. This most often translates to a single patient receiving an intervention with researchers guiding them. As social isolation and lack of connection are major drivers of current mental health crises and group work is expected to be an important aspect of psychedelic assisted psychotherapy, it is essential that we understand the role of community in psychedelic healing. Objectives To explore how psychedelic guides in the United States discuss the role of community in naturalistic psychedelic groups. Methods This is a secondary qualitative data study of data from a larger modified ethnographic study of psychedelic plant medicine use in the US. Fifteen facilitators of naturalistic psychedelic groups were recruited via snowball sampling. Content analysis was used to identify themes. Results Participants viewed the concept of community as essential to every aspect of psychedelic work, from the motivation to use psychedelics, to the psychedelic dosing experience and the integration of lessons learned during psychedelic experiences into everyday life. Themes and subthemes were identified. Theme 1: The arc of healing through community (Subthemes: Community as intention, the group psychedelic journey experience, community and integration); Theme 2: Naturally occurring psychedelic communities as group therapy (Subthemes [as described in Table 2]: Belonging, authenticity, corrective experience, trust, touch). Significance Results suggest that existing knowledge about therapeutic group processes may be helpful in structuring and optimizing group psychedelic work. More research is needed on how to leverage the benefit of community connection in the therapeutic psychedelic context, including size and composition of groups, selection and dosing of psychedelic substances in group settings, facilitator training, and role of community integration. Psychedelic groups may provide benefits that individual work does not support.
Creating a Community of Safety in Black Maternal Health Research
Amore, A. D., Britt, A. J., Byfield, R., Cumberbatch, K., Wilson, O. F. T., Milton, K., Raheem, R., Gutierrez, S., Jones, T., Mullen, A., & Carlson, N. S. (2025). Nursing Research. 10.1097/NNR.0000000000000849
Abstract
Background: Health disparities in maternal health outcomes persist among Black birthing populations in the United States. Given the historical harms experienced by Black populations in research, culturally tailored approaches to ensure ethical research are needed. Community-engaged research strategies have been found to be effective in a variety of investigations; however, little has been documented regarding their use within biologically focused research among pregnant populations. Objective: The purpose of this paper is to describe the process of engaging with a community advisory board of a biologically focused research study focused on reducing perinatal health disparities and promoting health equity. Specifically, we outline the methods followed to meaningfully involve the community in each step of the research process. Methods: The research team utilized intentional team-building activities and feedback methods to relay information between the community and research partners regarding study protocols and community-led dissemination strategies. Online sessions with community partners were created utilizing community-engaged research principles to guide the sessions. Information obtained from the community advisory board (CAB) during these sessions was used to modify and optimize this study’s data collection protocol, recruitment strategies, and dissemination efforts. A quantitative and qualitative survey was conducted during the process to gather feedback from CAB members about their experiences. Results: The CAB (n = 8 community members) shared in the operation of the project and collaborated on everything from study onset, recruitment/retention strategies, informed consent processes, and dissemination to data sharing. Scores from the quantitative questionnaire (n = 5) about their experiences demonstrated that members overall reported good or excellent experiences as participants in the CAB. Additionally, feedback from community members about how they felt working within a research team included feeling that they were (a) making the research study better, (b) learning about research, (c) providing voice for the community, and (d) building a community of trust. Detailed feedback on each session resulted in changes in study protocols, recruitment practices, and dissemination activities. Discussion: Safety is a crucial tenant of all research investigations. When research focuses on populations who have experienced perpetual harm, utilization of community expertise is necessary to ensure just and equitable research experiences.
Defining and Validating Criteria to Identify Populations Who May Benefit from Home-Based Primary Care
Salinger, M. R., Ornstein, K. A., Kleijwegt, H., Brody, A. A., Leff, B., Mather, H., Reckrey, J., & Ritchie, C. S. (2025). Medical Care, 63(1), 27-37. 10.1097/MLR.0000000000002085
Abstract
Background: Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. Objectives: Develop and validate criteria that identify appropriate HBPC target populations. Research Design: A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria. Subjects: Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age above 70) enrolled in NHATS. Measures: Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims. Results: Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm's Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort. Conclusions: We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC.
Dementia prevalence and risk factors in people with and without HIV in Malawi: A medical record review
Lee, H., Mlombe, Y., Song, Y. E., Yang, H. S., Phiri, T., Maseke, J., Bauleni, E., Jun, G. R., Choi, Y. B., & Ngoma, J. (2025). Alzheimer’s and Dementia, 21(3). 10.1002/alz.70009
Abstract
BACKGROUND: Sub-Saharan Africa (SSA) is experiencing a rapid increase in its aging population, including people living with human immunodeficiency virus (HIV) (PLHIV). The purpose of this study was to determine the prevalence of dementia among PLHIV and people without HIV (POHIV) in Malawi. METHODS: We conducted a retrospective medical record review of 400 consecutive patients from a single tertiary health center (200 PLHIV from an HIV clinic and 200 POHIV from an outpatient clinic) in Lilongwe, Malawi. RESULTS: The overall rate of dementia was higher in PLHIV than that in POHIV (22% vs 10%; p = 1.4e). Older age, unknown employment or unemployed, and depression were significant risk factors for dementia for PLHIV, while older age and depression were significant among POHIV. DISCUSSION: Our study confirmed the increased risk of dementia in PLHIV and provides valuable groundwork for future dementia studies to accurately examine the prevalence and risk factors of dementia in SSA, including Malawi. Highlights: Malawians, in SSA, face the double burden of HIV AD and related dementias. We conducted a retrospective medical record review to assess dementia prevalence and risk factors. Dementia prevalence was higher in PLHIV than in POHIV. Older age, unknown employment or unemployed, and depression were risk factors for dementia in PLHIV. Our findings, reflecting the current diagnosing and medical documenting practice in Malawi, provide valuable groundwork for future dementia research in Malawi.
Development and validation of the Patient-Reported Outcome Measure–Older adult care Transitions from the Emergency Department (PROM-OTED) tool
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Abstract
Abstract
Background: Care transitions from the emergency department (ED) to the community represent a critical period that can significantly impact clinical outcomes of older adults, yet there is a lack of standardized tools to measure patient-reported experiences and outcomes during this transition. Our objective was to develop and validate the Patient-Reported Outcome Measure–Older adult care Transitions in the ED (PROM-OTED) tool to measure care transition outcomes within 4–10 days after ED discharge. Methods: Older adults (65+ years) discharged from four EDs were enrolled between November 2021 and April 2024 in a multiphase process: qualitative interviews, item generation, member checking, cognitive debriefing, technical expert panel review, and psychometric evaluation and validation. We employed descriptive statistics, item analysis, interitem correlation, and factor analyses to assess the tool‘s validity and reliability. Results: Across all phases, we enrolled 290 older adults. The final 18-item PROM-OTED tool included items that addressed understanding of discharge instructions, medication management, follow-up care, and quality of life. The tool demonstrated feasibility with a mean (±SD) completion time of 4.97 (±3.04) min and was able to be administered electronically or via telephone. The tool additionally demonstrated excellent internal consistency (Cronbach‘s alpha 0.9376, McDonald‘s omega 0.9988) and good test–retest reliability (r = 0.8437). Exploratory factor analysis supported a robust factor structure and significant correlations between the PROM-OTED tool with the Care Transitions Measure-3, a general measure of hospital discharge quality of care, support its concurrent validity. Conclusions: The PROM-OTED tool is a reliable and preliminarily valid instrument for use during the immediate post-ED period, with potential clinical applications in enhancing discharge practices and assessing care transition outcomes of older adults during observational or interventional studies.