Publications

Abstract

Objectives: Individuals with motoric cognitive risk (MCR) syndrome have a high dementia risk. However, a knowledge gap exists in the measurement procedure for slow gait speed, which is a crucial component of MCR diagnosis. The study aimed to systematically review slow gait speed measurement practices in MCR diagnosis to identify critical constructs in gait speed measurement procedure. Design: Systematic review. Setting and Participants: Included studies were conducted in clinical and community settings, involving participants with MCR receiving gait speed measurement. Methods: A systematic search across PubMed, Medline, Embase, CINHAL (EBSCO), Web of Science, Cochrane Library, and ProQuest Dissertation from inception until January 2024 for articles with detailed MCR diagnosis. Study quality was evaluated with the Joanna Briggs Institute (JBI) Critical Appraisal Checklists and slow gait speed measurement methods were summarized through narrative synthesis. Results: From 27,600 unique entries, 50 relevant studies with 55 cohorts were identified and included in the review. Slow gait speed measurement methods in existing MCR studies showed heterogeneity in measurement tools, start/end protocols and buffer distance, walking test distance, number of tests, calculation methods, and cutoff values. Commonly, manual stopwatches and 4-meter walking test distance with a 2-meter buffer at each end at a usual pace were used, averaging 2 tests for gait speed analysis, with the need for cohort-specific slow gait cutoff values. Conclusions and Implications: The measurement practices of slow gait speed in MCR diagnosis were heterogeneous. A relatively comprehensive gait speed measurement procedure with 7 constructs was initially delineated in this study based on synthesis analysis, with the potential to improve diagnostic accuracy and consistency of MCR, although further validation is still needed.

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Objective The purpose of study was to explore family caregiver perspectives on work-life balance while caring for adults with Parkinson's disease. Methods The study was performed using a convergent mixed methods design and a revised adaptation of the Work-Life Conflict model. Caregivers completed surveys followed by semistructured interviews (n = 40). Results Work-life balance is bidirectionally influenced by time, stress, and behavior across the working and caregiving role. Caregiver burden was offset by higher decision latitude at work. Supervisor support and coworker support were positively associated with work-life balance. Barriers included physical, emotional, and financial stress, and speech and cognitive changes of the care recipient. Conclusions The results of this study identify the influence of work-life imbalance on caregiver burden and stress, and generate discussion of potential solutions that optimize well-being and health of this working population.

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Ensuring equitable care and health outcomes for all populations is essential in nursing science. However, achieving health equity in nursing science necessitates a multifaceted approach to address the complex factors influencing health disparities. This paper presented the keynote address delivered at the Advanced Methods Conference hosted by the Council for Advancement of Nursing Science in 2023. We identified critical gaps in health equity within nursing science, emphasizing the need for innovative recruitment strategies, comprehensive data analysis, and targeted dissemination efforts. This paper underscores the importance of equity in artificial intelligence research, highlighting issues such as biases in machine learning models and the underrepresentation of minoritized groups. Bridging the current gaps in health equity research within nursing science requires a systematic and forward-thinking approach.

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BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare medical condition presenting as idiopathic heart failure. The aim of this study was to (1) examine the contribution of neighborhood disinvestment to PPCM risk and to racial and ethnic disparities in PPCM; (2) examine the extent to which sociodemographic factors and chronic hypertension explain these outcomes; and (3) describe severe maternal morbidity cases and the timing of PPCM. METHODS: We conducted an observational cohort study using vital records longitudinally linked with hospital discharge records for mothers and infants up to 9 months postpartum for births in California from 1997 to 2019. Using the Neighborhood Deprivation Index as a proxy measure for neighborhood disinvestment, we sequentially adjusted multivariable logistic regression models to estimate the association of Neighborhood Deprivation Index and race and ethnicity with PPCM. RESULTS: Our study included 7 354 662 births and 918 (0.012%) PPCM cases. Those residing in neighborhoods with higher disinvestment had an increased odds of PPCM (OR [95% CI] Quartile 2: 1.2 [1.0–1.5]; Quartile 3: 1.7 [1.4–2.1]; Quartile 4: 1.5 [1.2–1.9]). When considering the contribution of Neighborhood Deprivation Index to racial and ethnic disparities in PPCM, the odds ratio slightly decreased for Non-Hispanic Black births from 3.8 (3.1–4.6) to 3.4 (2.8–4.1). For chronic hypertension in Non-Hispanic Black births there was a slight decrease in odds from 3.4 (2.8–4.1) to 3.1 (2.6–3.8). The severe maternal morbidity indicator with the highest frequency was pulmonary edema/acute heart failure. CONCLUSIONS: Our results show that neighborhood deprivation and pre-pregnancy hypertension partially explain PPCM risk but does not explain the racial or ethnic disparity. Future research should examine the impact of specific measures of neighborhood deprivation on the racial and ethnic disparity in outcomes such as PPCM.

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Background: With China's aging population and rising prevalence of chronic conditions, it is crucial to understand the factors shaping aging attitudes. Satisfaction with the neighborhood physical environment may play an important role, particularly among those with chronic health issues. To examine the association between neighborhood physical environment satisfaction and aging attitudes among older Chinese adults, and to explore differences across groups with and without chronic conditions. Methods: We analyzed data from 11,395 participants aged 60 and above from the 2020 China Longitudinal Aging Social Survey (CLASS). Stratified multiple regression analyses were conducted, comparing subgroups with chronic conditions (n = 8405, 73.76 %) and without chronic conditions. Results: Among participants with chronic conditions, higher satisfaction with road conditions (β = 0.382, P = 0.001), environmental sanitation (β = 0.286, P = 0.007), and road/street lighting (β = 0.288, P = 0.005) was significantly associated with more positive attitudes toward aging. No significant associations were found among participants without chronic conditions. Conclusions: Age-friendly neighborhood environments are important for promoting positive aging attitudes, particularly among older adults living with chronic conditions. These findings offer valuable insights for policymakers, researchers, and service providers aiming to support healthy aging in rapidly aging societies like China.

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Objective: This cross-sectional study investigated the associations of neighborhood-level factors with immune activation, systemic inflammation, and leukocyte telomere length in 110 sexual minority men with human immunodeficiency virus. Method: From 2013 to 2017, sexual minority men with human immunodeficiency virus who used stimulants were recruited in San Francisco, California and provided blood samples to measure the markers of immune activation, systemic inflammation, and leukocyte telomere length. To measure neighborhood-level indices, the home address for each participant was geocoded and linked to data from the Centers for Disease Control and Prevention. Hierarchical linear modeling was employed to investigate the associations of neighborhood-level factors with systemic inflammation and leukocyte telomere length. Results: After adjusting for age, stimulant use, self-reported income, level of education, and race and ethnicity, residing in neighborhoods with greater percentages of poverty (β=.33, p,.001) and a higher proportion of racial/ethnic minority residents (β =.26, p,.05) were independently associated with higher levels of interleukin-6. Additionally, residing in neighborhoods with higher percentage of uninsured individuals was independently associated with higher tumor necrosis factor-alpha (β =.24, p,.05). Indices of neighborhood-level adversity were additionally associated with providing a urine sample that was reactive for stimulants (OR= 1.31, p=.002), which was, in turn, associated with shorter leukocyte telomere length (β=−.31, p,.05). Conclusions: Future longitudinal research should examine the biobehavioral pathways linking neighborhood-level factors and stimulant use with systemic inflammation and cellular aging.

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Minimal progress has been made in narrowing disparities between patients with and without limited English proficiency (LEP). Using 2016 data from RN4CAST-US, New Jersey Discharge Data Collection System, and AHA Annual Hospital Survey, multivariable logistic regression models were employed to examine whether and to what extent the hospital nurse work environment, defined as the conditions that nurses work in, is associated with decreased disparities in 7-day hospital readmissions between patients with and without LEP. Existing literature has established associations between nurse work environments and outcomes disparities of various minoritized populations; however, no literature has examined this relationship in the context of hospitalized patients with LEP. In a sample of 424,745 hospitalized adults (n = 38,906 with LEP), patients with LEP, compared to those without LEP, were younger (63.4 vs 64 years old, p < 0.001), more likely to be insured by Medicaid (8.9% vs 5.5%) or uninsured (7.5% vs 2%, p < 0.001), and readmitted (4.5% vs 3.9%, p < 0.001). Adjusting for patient and hospital characteristics, LEP patients had 33% higher odds of a 7-day readmission, as compared to patients without LEP (OR 1.33, 95% CI [1.19–1.47]). A significant interaction was found between patients' LEP status and the nurse work environment (OR 0.83, 95% CI [0.70–0.99]), such that patients with LEP experienced lower odds of 7-day readmission in more favorable nurse work environments, compared to patients without LEP. Hospitals dedicated to providing equitable healthcare may consider enhancing nurses' working conditions as a potential way to reduce disparities in readmission rates.

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Reflection is essential in the formation and ethical comportment of nurses. The COVID-19 pandemic brought extraordinary challenges to nursing practice and education of nurses. A pilot collaboration between a college of nursing and a department of dramatic writing at a research-intensive urban university aimed to promote the esthetic pattern of knowing through the dramatic presentation of the experiences of nursing students and frontline nurses during the height of the COVID-19 pandemic. The playwrights wrote two short plays based on interviews with two nursing students and three experienced nurses. The project sought to enhance narrative competence and empathy development of nurses and playwrights, and to promote reflection-on-action.

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Importance: The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness. Objective: To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness. Design, Setting, and Participants: Cluster randomized, stepped-wedge, clinical trial including patients aged 66 years or older who visited 1 of 29 EDs across the US between May 1, 2018, and December 31, 2022, had 12 months of prior Medicare enrollment, and a Gagne comorbidity score greater than 6, representing a risk of short-term mortality greater than 30%. Nursing home patients were excluded. Intervention: A multicomponent intervention (the Primary Palliative Care for Emergency Medicine intervention) included (1) evidence-based multidisciplinary education; (2) simulation-based workshops on serious illness communication; (3) clinical decision support; and (4) audit and feedback for ED clinical staff. Main Outcome and Measures: The primary outcome was hospital admission. The secondary outcomes included subsequent health care use and survival at 6 months. Results: There were 98922 initial ED visits during the study period (median age, 77 years [IQR, 71-84 years]; 50% were female; 13% were Black and 78% were White; and the median Gagne comorbidity score was 8 [IQR, 7-10]). The rate of hospital admission was 64.4% during the preintervention period vs 61.3% during the postintervention period (absolute difference, -3.1% [95% CI, -3.7% to -2.5%]; adjusted odds ratio [OR], 1.03 [95% CI, 0.93 to 1.14]). There was no difference in the secondary outcomes before vs after the intervention. The rate of admission to an intensive care unit was 7.8% during the preintervention period vs 6.7% during the postintervention period (adjusted OR, 0.98 [95% CI, 0.83 to 1.15]). The rate of at least 1 revisit to the ED was 34.2% during the preintervention period vs 32.2% during the postintervention period (adjusted OR, 1.00 [95% CI, 0.91 to 1.09]). The rate of hospice use was 17.7% during the preintervention period vs 17.2% during the postintervention period (adjusted OR, 1.04 [95% CI, 0.93 to 1.16]). The rate of home health use was 42.0% during the preintervention period vs 38.1% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of at least 1 hospital readmission was 41.0% during the preintervention period vs 36.6% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of death was 28.1% during the preintervention period vs 28.7% during the postintervention period (adjusted OR, 1.07 [95% CI, 0.98 to 1.18]). Conclusions and Relevance: This multicomponent intervention to initiate palliative care in the ED did not have an effect on hospital admission, subsequent health care use, or short-term mortality in older adults with serious, life-limiting illness.

Abstract

Health care providers (HCPs) report a low willingness to discuss "undetectable equals untransmittable"(U=U) with patients, despite its recognized importance for both public health and the well-being of persons with HIV (PWH). To better understand the barriers and facilitators associated with providing the U=U message, we conducted 16 face-to-face in-depth interviews with HCPs working with PWH in Hunan, China, from October 2021 to May 2022. Data collection was guided by a social-ecological framework. Participants reported reluctance to provide clear U=U information to PWH. The barriers included inaccurate knowledge, doubt about the reliability, ethical concerns, population-related informing biases and lack of a guideline or consensus, and so on. However, some facilitators were also noted, such as confirmed clinical benefits, individuals' desires to have children, and the effect of the international U=U campaign. These findings provide valuable insights into designing and developing targeted training and policy to promote U=U implementation in China.

Abstract

Background:Poor sleep and frailty are prevalent among aging women with HIV (WWH). Although poor sleep quality has been associated with frailty in general aging populations, these relationships are not well characterized among WWH.Methods:Among 1001 WWH and 371 women without HIV (WWoH) over age 40 years with Pittsburgh Sleep Quality Index (PSQI) and Fried Frailty Phenotype data, we analyzed relationships of poor sleep quality (PSQI>5) and sleep quality components with frailty. Separate hierarchical regression models evaluated associations between sleep and frailty status (prefrail vs. robust, frail vs robust) adjusting for: (1) study site and HIV status, (2) demographics, (3) substance use/Central Nervous System active medications, (4) comorbidities, and (5) depressive symptoms.Results:Median age was 53 years; 9.2% were frail while 52.8% were prefrail. Poor sleep quality was frequent (52% WWH vs. 47% WWoH; p=0.07) and associated with double the frailty odds independent of HIV status, after adjusting for depressive symptoms (fully adjusted odds ratio AOR 1.99, 95% CI:1.14, 3.50, p=0.016). Sleep-associated daytime dysfunction and very poor sleep efficiency were independently associated with being frail. Poor self-rated sleep quality and higher use of sleep medications were independently associated with being prefrail.Conclusions:Among midlife WWH and WWoH, poor subjective sleep measures are independently associated with higher frailty odds. Longitudinal studies are needed to understand how aspects of sleep may impact progression from prefrailty to frailty after accounting for comorbidities and to elucidate the complex relationships between comorbidities and frailty, with sleep quality among midlife PWH.

Abstract

Background: A tendency to obstruct the upper airway is markedly increased in supine sleep. Positional obstructive sleep apnea (OSA) (POSA) occurs predominantly in the supine position. The implication of POSA in terms of future cardiovascular (CV) risk is unknown. We hypothesized that patients with POSA have decreased future CV risks compared to OSA patients without POSA (non-POSA). Methods: This single-center study included patients who underwent clinically indicated polysomnography. POSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/hour and supine AHI at least twice as high as non-supine AHI (nsAHI). Exclusive POSA (ePOSA) includes the additional requirement that the nsAHI normalizes to an AHI of < 5/hour. A Cox proportional hazard model was used to assess the future risk of new CV events in patients with POSA compared to non-POSA (reference group). Results: There were 3,779 patients (mean age 51, female 59.7%), consisting of 35.9% POSA, 38.4% non-POSA, and 25.7% no OSA. Using the ePOSA definition, 17.3% had ePOSA, 57.1% had non-ePOSA, and 25.7% had no OSA. Over a median 8.4 years, there were 1,297 composite events. Patients with POSA had a lower risk of CV events compared to non-POSA (HR 0.85, CI:0.74–0.96; p = 0.010). There was a non-significant trend towards lower risk of CV events in patients with ePOSA compared to non-ePOSA (HR 0.86, CI:0.73–1.01; p = 0.061). Conclusions: POSA is associated with lower CV risk than non-POSA. Future studies should consider POSA as a distinct subtype when studying OSA and CV outcomes.

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Editor's note: This is the 25th article in a series on clinical research by nurses coordinated by the Heilbrunn Family Center for Research Nursing at Rockefeller University. 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

Background: Sexual and gender diverse (SGD) people in the United States (US) experience health inequities due to societal stigma and marginalisation. The nursing workforce must provide evidence-based affirming, inclusive and culturally responsive care for SGD people to meet individual and community health needs and eliminate disparities. Aims: The purpose of this scoping review was to synthesise what is known about (1) nurses' knowledge, skills and attitudes related to caring for SGD people in the US and (2) the existence, development and evaluation of SGD-related educational offerings available to practicing nurses in the US to develop the knowledge and skills needed to promote the health and wellbeing of SGD individuals, families and communities. Methods: This review followed the scoping review methodology and PRISMA for Scoping Reviews (PRISMA-ScR). Data Sources: In conjunction with a health librarian, an electronic literature search was conducted using PubMed, LGBT Health, CINAHL, ERIC and Health Source-Nursing. Results: Thirty-two studies were included in this review, including quantitative and qualitative studies that sought to understand the knowledge, attitudes and clinical experiences of nurses related to the care of SGD people; studies that tested educational interventions and studies that identified educational barriers and facilitators. Major gaps in education, practice and research, as well as methodological limitations of existing studies, were noted. Conclusion: Nurses would benefit from expanded access to effective standardised foundational SGD-related health continuing education to help prepare them to care for diverse patient populations. Equity, inclusivity and dignity are key values of the nursing profession. It is imperative that nurses have the knowledge and skills to apply these values consistently in day-to-day professional practice across populations and settings. Impact: There is an urgent need to develop standardised, easily accessible evidence-based educational content to address nurses' knowledge of and attitudes towards caring for SGD people. Reporting Method: This study adhered to the PRISMA-ScR reporting guidelines. Patient or Public Contribution: There was no patient or public contribution to this study.

Abstract

Purpose: Fear of recurrence (FoR) is a prevalent and difficult experience among cancer patients. Most research has focused on FoR among breast cancer patients, with less attention paid to characterizing levels and correlates of FoR among oral and oropharyngeal cancer survivors. The purpose was to characterize FoR with a measure assessing both global fears and the nature of specific worries as well as evaluate the role of sociodemographic and clinical factors, survivorship care transition practices, lifestyle factors, and depressive symptoms in FoR. Methods: Three hundred eighty-nine oral and oropharyngeal survivors recruited from two cancer registries completed a survey assessing demographics, cancer treatment, symptoms, alcohol and tobacco use, survivorship care practices, depression, and FoR. Results: Forty percent reported elevated global FoR, with similar percentages for death (46%) and health worries (40.3%). Younger, female survivors and survivors experiencing more physical and depressive symptoms reported more global fears and specific fears about the impact of recurrence on roles, health, and identity, and fears about death. Depression accounted for a large percent of the variance. Lower income was associated with more role and identity/sexuality worries, and financial hardship was associated with more role worries. Conclusions: FoR is a relatively common experience for oral and oropharyngeal cancer survivors. Many of its correlates are modifiable factors that could be addressed with multifocal, tailored survivorship care interventions. Implications for Cancer Survivors: Assessing and addressing depressive symptoms, financial concerns, expected physical symptoms in the first several years of survivorship may impact FoR among oral and oropharyngeal cancer survivors.

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Background: The growing prevalence of multiple chronic conditions (MCC) has significant impacts on health care systems and quality of life. Understanding the prevalence of MCC throughout adulthood offers valuable insights into the evolving burden of chronic diseases and provides strategies for more effective health care outcomes. Objective: This study estimated the prevalence and combinations of MCC among adult participants enrolled in the All of Us (AoU) Research Program, especially studying the variations across age categories. Methods: We conducted an exploratory analysis using electronic health record (EHR) data from adult participants (N=242,828) in the version 7 Controlled Tier AoU Research Program data release. Data analysis was conducted using Python in a Jupyter notebook environment within the AoU Researcher Workbench. Descriptive statistics included condition frequencies, the number of chronic conditions per participant, and prevalence according to age categories. The presence of a chronic condition was determined by documentation of one or more ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes for the respective condition. Age categories were established and aligned with diagnosis dates and stages of adulthood (early adulthood: 18-39 years; middle adulthood: 40-49 years; late middle adulthood: 50-64 years; late adulthood: 65-74 years; advanced old age: 75-89 years). Results: Our findings demonstrated that approximately 76% (n=183,753) of AoU participants were diagnosed with MCC, with over 40% (n=98,885) having 6 or more conditions and prevalence increasing with age (from 33.78% in early adulthood to 68.04% in advanced old age). The most frequently occurring MCC combinations varied by age category. Participants aged 18-39 years primarily presented mental health–related MCC combinations (eg, anxiety and depressive disorders; n=845), whereas those aged 40-64 years frequently had combinations of physical conditions such as fibromyalgia, chronic pain, fatigue, and arthritis (204 in middle adulthood and 457 in late middle adulthood). In late adulthood and advanced old age, hyperlipidemia and hypertension were the most commonly occurring MCC combinations (n=200 and n=59, respectively). Conclusions: We report notable prevalence of MCC throughout adulthood and variability in MCC combinations by age category in AoU participants. The significant prevalence of MCC underscores a considerable public health challenge, revealed by distinct condition combinations that shift across different life stages. Early adulthood is characterized predominantly by mental health conditions, transitioning to cardiometabolic and physical health conditions in middle, late, and advanced ages. These findings highlight the need for targeted, innovative care modalities and population health initiatives to address the burden of MCC throughout adulthood.

Abstract

Background: The growing prevalence of multiple chronic conditions (MCC) has significant impacts on health care systems and quality of life. Understanding the prevalence of MCC throughout adulthood offers valuable insights into the evolving burden of chronic diseases and provides strategies for more effective health care outcomes. Objective: This study estimated the prevalence and combinations of MCC among adult participants enrolled in the All of Us (AoU) Research Program, especially studying the variations across age categories. Methods: We conducted an exploratory analysis using electronic health record (EHR) data from adult participants (N=242,828) in the version 7 Controlled Tier AoU Research Program data release. Data analysis was conducted using Python in a Jupyter notebook environment within the AoU Researcher Workbench. Descriptive statistics included condition frequencies, the number of chronic conditions per participant, and prevalence according to age categories. The presence of a chronic condition was determined by documentation of one or more ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes for the respective condition. Age categories were established and aligned with diagnosis dates and stages of adulthood (early adulthood: 18-39 years; middle adulthood: 40-49 years; late middle adulthood: 50-64 years; late adulthood: 65-74 years; advanced old age: 75-89 years). Results: Our findings demonstrated that approximately 76% (n=183,753) of AoU participants were diagnosed with MCC, with over 40% (n=98,885) having 6 or more conditions and prevalence increasing with age (from 33.78% in early adulthood to 68.04% in advanced old age). The most frequently occurring MCC combinations varied by age category. Participants aged 18-39 years primarily presented mental health–related MCC combinations (eg, anxiety and depressive disorders; n=845), whereas those aged 40-64 years frequently had combinations of physical conditions such as fibromyalgia, chronic pain, fatigue, and arthritis (204 in middle adulthood and 457 in late middle adulthood). In late adulthood and advanced old age, hyperlipidemia and hypertension were the most commonly occurring MCC combinations (n=200 and n=59, respectively). Conclusions: We report notable prevalence of MCC throughout adulthood and variability in MCC combinations by age category in AoU participants. The significant prevalence of MCC underscores a considerable public health challenge, revealed by distinct condition combinations that shift across different life stages. Early adulthood is characterized predominantly by mental health conditions, transitioning to cardiometabolic and physical health conditions in middle, late, and advanced ages. These findings highlight the need for targeted, innovative care modalities and population health initiatives to address the burden of MCC throughout adulthood.

Abstract

Assisted living (AL) and residential care (RC) settings are experiencing substantial growth as older adults with lower care needs seek alternatives to nursing homes. Despite this trend, there is a lack of skilled nursing care to support palliative care (PC) in these environments. Primary PC delivered by AL staff has emerged as a potential model to bridge this gap, focusing on symptom management and holistic support for individuals with serious illness. A metasynthesis of 88 qualitative studies was conducted to explore the provision of primary PC in AL/RC settings. The National Consensus Project Clinical Practice Guidelines for Quality Palliative Care was used to provide a holistic framework to identify unmet PC need and gaps in PC delivery. Studies published between 2012 and 2024 were analyzed to identify themes and categories related to PC domains, including physical, psychological, social, spiritual, cultural, end-of-life care, and ethical and legal considerations. Thematic synthesis revealed key findings across the identified PC domains within AL/RC settings. Studies highlighted challenges and opportunities for delivering primary PC in these environments, emphasizing the importance of addressing physical symptoms, psychological distress, social isolation, and spiritual needs among residents with serious illnesses. The metasynthesis underscores the critical role of primary PC in enhancing quality of life and care continuity for older adults residing in AL/RC settings. It also identifies gaps in current practices and emphasizes the need for tailored interventions and training to support care providers in delivering comprehensive PC to this population. By integrating qualitative research findings with the National Consensus Project guidelines, this metasynthesis provides a comprehensive overview of primary PC in AL/RC settings. The study underscores the necessity of enhancing PC delivery in these environments to meet the evolving needs of older adults with serious illnesses, thereby improving overall quality of care for residents with unmet palliative needs.

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Background: Despite Asians being the fastest-growing ethnic group in the US, most studies have focused on Asian Americans as an aggregate racial/ethnic group. The burden of mental health problems is increasing among caregivers due to population aging, yet little is known about the distress experienced by Asian caregivers when examined by disaggregated ethnic groups. Methods: Using 2019–2020 California Health Interview Survey data, we examined disparities in psychological well-beings between non-Hispanic White and Asian American adult caregivers, with an emphasis on understudied Asian ethnic groups. Psychological distress was measured using the Kessler 6 scale, with scores ≥6 indicating mental distress and ≥13 indicating serious mental illness. Multivariable logistic regression adjusted for socio-demographics, physical health, caregiving relationship, intensity of care, and care recipients’ characteristics. Results: The study included 8,722 caregivers (mean age, 58.7 years; 61.3% women; 14.1% Asian [379 Chinese, 260 Filipino, 167 Japanese, 138 South Asian, 105 Korean, 101 Vietnamese, 78 other Asian], 85.9% White). Overall, 26.8% had mental distress, and 8.5% had serious mental illness. Compared to White caregivers, Korean American caregivers had higher odds of mental distress (Odds Ratio [OR], 2.37; 95% CI, 1.47–3.82) and serious mental illness (OR, 2.15; 95% CI, 1.17–3.92), while Chinese (OR, 0.72; 95% CI, 0.55–0.95) and Japanese (OR, 0.67; 95% CI, 0.45–0.99) American caregivers had lower odds of mental distress. Korean American caregivers had the highest prevalence of mental distress (43.1%) and serious mental illness (15.3%), compared with White and other Asian American caregivers. Conclusion: Disaggregating data reveals significant mental health disparities among ethnic subgroups of Asian American caregivers. Tailored resources should address the distinct needs of ethnic subgroups of Asian American caregivers, considering language barriers, acculturation, and cultural norms that may exacerbate psychological distress.

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Objective: Examine the relationship between race and ethnicity and area-level social deprivation and Medicare home health care (HHC) agency quality for seriously ill older adults receiving HHC. Methods: A linear probability fixed effects model analyzed the association between patient-level predictors and HHC agency quality (star-rating), controlling for neighborhood level fixed effects. Linear mixed regression modeled the relationship between area-level social deprivation and receiving care from a high-quality HHC agency. An interaction term between race and social deprivation index quartiles examined whether racial disparities in accessing high-quality HHC agencies depended on the level of neighborhood social deprivation. Results: The final sample consisted of 213 491 Medicare beneficiaries. Reduced access to high-quality HHC was associated with identifying as Black (1.2 % point lower, P <.001), having Medicaid (5.5 % point lower, P <.0001), and living in a neighborhood with high social deprivation (6.5% point lower, P <.001). The effect of race on access to high-quality HHC persisted regardless of the level of neighborhood social deprivation. Conclusions: For people living with serious illness, living in areas with higher social deprivation is associated with lower-quality HHC. Patient race and ethnicity has a consistent effect reducing access to high-quality HHC agencies, regardless of neighborhood. Future research must investigate ways to improve access to high-quality HHC for racial and ethnic historically marginalized populations who are seriously ill, especially in areas of high social deprivation. This includes understanding what policies, organizational structures, or care processes impede or improve access to high-quality care.

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Objectives: Home health care (HHC) plays a pivotal role in serving millions of US adults aging in place. Although the HHC population is growing rapidly in both size and diversity, driven by an aging US population and a changing demographic profile, there are increasing concerns of equity in HHC, particularly regarding how vulnerable populations are affected under current HHC practices. The purpose of this study was to examine the variations in accessing high-quality HHC in racial and ethnic minority groups and persons living with dementia. Design: Cross-sectional, secondary analysis. Setting and Participants: Older adults who received HHC in 2016 from agencies with a star rating of overall care quality from the Home Health Compare program. Methods: Start of care data from the 2016 HHC Outcome and Assessment Information Set was linked to Master Beneficiary Summary File, Home Health Compare, and Provider of Services file to address the aim. Multinomial regressions were used in analysis when risk-adjusting for individual and agency characteristics. Results: Our risk-adjusted estimates, based on data from 574,682 older adults aged ≥65 years served by 8634 HHC agencies nationwide (2290 offering high-quality care, 4023 providing moderate-quality care, and 2321 delivering low-quality care), revealed significant disparities. Non-Hispanic Blacks (relative risk ratio, 0.62; 95% CI, 0.61–0.64) and Hispanics (relative risk ratio, 0.72; 95% CI, 0.70–0.74) were significantly less likely to receive care from high-quality agencies. Additionally, having dementia exacerbated disparities in accessing high-quality HHC between racial and ethnic minorities and white Americans. Conclusions and Implications: Racial and ethnic minority individuals face significant disadvantages in accessing high-quality HHC, with persons living with dementia from these groups being the most disadvantaged. Further research is warranted to investigate the referral and admission processes for HHC. Our findings highlight the need for actions from clinicians and policymakers to tackle potential biases in the aforementioned care processes.

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Background: Adolescent mental health is a major public health concern in the United States and schools are an ideal location to offer mental health services. Objective: An examination of combined racial/ethnic disparities pertaining to socio-demographic and contextual factors associated with adolescent utilization of school based mental health services (SBMHS) was conducted to optimize the use and potential benefits of these services. Method: Data from the 2019 National Survey on Drug Use and Health was used to estimate multilevel and multivariable logistic regression models. Indicators included socio-demographics, depression, religiosity, parental monitoring and support, and school and academic engagement. Results: Asian adolescents were less likely to utilize SBMHS compared to their White counterparts (OR = 0.62; 95% CI = 0.41, 0.95). All five racial/ethnic groups reported a statistically higher likelihood of utilizing SBMHS as depressive symptoms increased (OR = 1.15–1.28). Black adolescents were the only racial/ethnic group who reported lower odds (OR = 0.93; 95% CI = 0.88, 0.98) of utilizing SBMHS as their religiosity increased. Parental monitoring and support was not associated with SBMHS use for any group. White, Black, and Asian adolescents reported greater odds of utilizing SBMHS as their school and academic engagement increased (OR = 1.12; 95% CI = 1.05, 1.19; OR = 1.15; 95% CI = 1.01, 1.31; OR = 1.43; 95% CI = 1.04, 1.95, respectively). Conclusion: Findings enhance understanding of the racial/ethnic disparities involved with adolescent utilization of SBMHS and may help identify those in need, tailor interventions, and optimize use of evidence-based treatments.

Abstract

AIMS: Compare racial/ethnic disparities in the prevalence of non-obese type 2 diabetes (T2D) and the proportion of non-obese individuals among T2D patients.METHODS: This cross-sectional study used ICD-9/10 codes to ascertain T2D. Participants were classified as non-obese by BMI (<25 kg/m2 for normal weight; <23 kg/m2 for Asian Americans), waist circumference (<102 cm for males, <88 cm for females), and waist-to-hip ratio (<0.9 for males, <0.85 for females). The statistical analysis used marginal standardization of predicted probabilities from multivariable logistic regression to calculate the prevalence.KEY RESULTS: Among 276,736 participants (mean age 51.7, 61.2% female), non-obese T2D prevalence varied: 6.85% (BMI), 4.17% (waist circumference), 3.63% (waist-to-hip ratio). Asian participants had the highest prevalence of normal-weight T2D (2.70% vs. 1.92% in White, OR 1.44, 95% CI: 1.22-1.69) and non-obese T2D by waist circumference (8.04% vs. 3.36%, OR 2.61, 95% CI: 2.35-2.89). Black participants had the highest prevalence using waist-to-hip ratio (5.37% vs. 2.91%, OR 1.91, 95% CI: 1.80-2.03).CONCLUSION: Asian Americans showed higher non-obese T2D prevalence by BMI and waist circumference, while Black adults had higher prevalence by waist-to-hip ratio, suggesting different fat distribution patterns.

Abstract

Background: The recent global pandemic posed extraordinary challenges for healthcare systems. Frontline healthcare workers required focused, immediate, practical, evidence-based instruction on optimal patient care modalities as knowledge evolved around disease management. Objective: This course was designed to provide knowledge to protect healthcare workers; combat disease spread; and improve patient outcomes. Methods: A team of global healthcare workers responded by rapidly creating a competency-based online course. To promote transcultural applicability, the course was developed by an international team of more than 45 educators from over 20 countries. Course delivery included a built-in language translation tool, routine updates, and several innovative course design elements. User feedback was collected to determine efficacy of course content, structure, unique delivery elements, and delivery options. Results: An initial population of online learners (n = 147) living in 23 different countries and representing 22 languages completed the course and participated in post-course surveys. An additional population of learners (n = 505) attended an in-person offering of course materials. Course participants gave positive feedback and several requested additional courses in similar formats. Conclusion: Global open access education courses may provide needed resources to empower healthcare professionals during health crises. Responsive course design can accommodate diverse learner resources and transcultural applicability.