Patient‐reported preventive care practices in older adults with diabetes

Nonresponse to exercise has been extensively examined in young athletes but is seldom reported in studies of aerobic exercise interventions in older adults. This study examined the prevalence of nonresponse and poor response to exercise in functional and quality of life outcomes and response patterns between and among older adults undergoing 12-weeks of supervised exercise therapy for the management of peripheral artery disease ( N = 44, mean age 72.3 years, 47.7% female). The prevalence of nonresponse (no change/decline in performance) in walking distance was 31.8%. The prevalence of poor response (lack of a clinically meaningful improvement) was 43.2%. Similar patterns of response were observed in both objective and patient-reported measures of physical function. All participants improved in at least one outcome; only two participants improved in all measured outcomes. Additional research should examine modifiable predictors of response to inform programming and maximize an individual’s potential benefit from exercise therapy.

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Apathy Measures in Older Adults and People with Dementia: A Systematic Review of Measurement Properties Using the COSMIN Methodology

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000515678 ◽

2021 ◽

pp. 1-13

Author(s):

Clare Burgon ◽

Sarah Elizabeth Goldberg ◽

Veronika van der Wardt ◽

Catherine Brewin ◽

Rowan H. Harwood

Keyword(s):

Systematic Review ◽

Older Adults ◽

Rating Scale ◽

Measurement Properties ◽

Evaluation Procedure ◽

Measurement Instruments ◽

Health Measurement ◽

Eligibility Criteria ◽

People With Dementia ◽

Patient Reported

Background: Apathy is highly prevalent in dementia and is also seen in mild cognitive impairment and the general population. Apathy contributes to failure to undertake daily activities and can lead to health problems or crises. It is therefore important to assess apathy. However, there is currently no gold standard measure of apathy. A comprehensive systematic review of the measurement properties of apathy scales is required. Methods: A systematic review was registered with PROSPERO (ID: CRD42018094390). MEDLINE, Embase, PsycINFO, and CINAHL were searched for studies that aimed to develop or assess the validity or reliability of an apathy scale in participants over 65 years, living in the community. A systematic review was conducted in line with the COnsensus-based Standards for the selection of health Measurement INstruments procedure for reviewing patient-reported outcome measures. The studies’ risk of bias was assessed, and all relevant measurement properties were assessed for quality. Results were pooled and rated using a modified Grading of Recommendations Assessment, Development, and Evaluation procedure. Results: Fifty-seven publications regarding 18 measures and 39 variations met the eligibility criteria. The methodological quality of individual studies ranged from inadequate to very good and measurement properties ranged from insufficient to sufficient. Similarly, the overall evidence for measurement properties ranged from very low to high quality. The Apathy Evaluation Scale (AES) and Lille Apathy Rating Scale (LARS) had sufficient content validity, reliability, construct validity, and where applicable, structural validity and internal consistency. Conclusion: Numerous scales are available to assess apathy, with varying psychometric properties. The AES and LARS are recommended for measuring apathy in older adults and people living with dementia. The apathy dimension of the commonly used Neuropsychiatric Inventory should be limited to screening for apathy.

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0489 Initial Results from the Hypertension with Unsatisfactory Sleep Health (HUSH) Clinical Trial for Primary Care Patients with Insomnia and Comorbid Hypertension (INS-HTN)

SLEEP ◽

10.1093/sleep/zsaa056.486 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A187-A188

Author(s):

D J Buysse ◽

L M Ritterband ◽

J G Yabes ◽

B L Rollman ◽

P J Strollo ◽

...

Keyword(s):

Primary Care ◽

Sleep Disturbance ◽

Intervention Group ◽

Self Report ◽

Apnea Hypopnea Index ◽

Dissemination And Implementation ◽

Patient Reported ◽

Primary Care Patients ◽

Care Practices ◽

Primary Care Practices

Abstract Introduction Insomnia is commonly comorbid with, and may contribute to, hypertension. Cognitive-behavioral treatments improve insomnia, but their effects on hypertension are uncertain, and they are often unavailable in primary care practices, where most INS-HTN patients are treated. We evaluated the efficacy of Brief Behavioral Treatment for Insomnia (BBTI) and Sleep Healthy Using the Internet (SHUTi) compared to enhanced usual care (EUC) on insomnia and home blood pressure (HBP) in primary care patients with INS-HTN. Methods Patients were recruited via electronic health records from 67 primary care practices and randomized 2:2:1 to BBTI delivered via telephone/videoconferencing; SHUTi, an automated, web-based CBT-I program; or EUC including a patient education video. Assessments included self-report questionnaires, home sleep apnea testing, and one week of sleep diary and HBP, measured at Baseline and 9 weeks/ 6 months post-treatment. The primary outcome was the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance scale. Linear mixed models were fitted for continuous variables on the intent-to-treat sample (n=548), adjusting for age and sex. Chi-square tests were used for proportions. Results Patients were 61.8±11.3 years old, 67.2% female, and 55.9% were taking hypnotics. Insomnia Severity Index (ISI) was 15.4±4.4, Apnea-Hypopnea Index 9.8±11.4, and HBP 130±14/81±9. BBTI and SHUTi were significantly better than EUC (p≤.002) at 9 weeks and 6 months on PROMIS Sleep Disturbance and Sleep-Related Impairment scales, ISI, and diary sleep efficiency, but had inconsistent effects on PROMIS depression and anxiety scales (p=0.001-0.9). Greater proportions of BBTI and SHUTi vs. EUC-treated patients had 9-week and 6-month ISI scores <8 (p=.01, p=.04) and ISI changes scores ≥7 (p=.002, p=.003). HBP did not significantly differ by intervention group. Conclusion BBTI and SHUTi improved insomnia, but did not reduce HBP in patients with INS-HTN. These interventions appear suitable for dissemination and implementation in primary care, but may have limited effects on comorbid symptoms and conditions. Support NHLBI UH2/UH3 HL125103

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Social Representations of the Body and Bodily Care Practices of Older Adults

Psico-USF ◽

10.1590/1413-82712021260207 ◽

2021 ◽

Vol 26 (2) ◽

pp. 279-290

Author(s):

Anderson da Silveira ◽

Brigido Vizeu Camargo holds ◽

Andreia Giacomozzi

Keyword(s):

Older Adults ◽

Social Relationships ◽

Social Representations ◽

Physical Activities ◽

The Body ◽

Health Concerns ◽

Care Practices ◽

Biological Functionality ◽

Body Care ◽

Body Practices

Abstract This study analyzed the relations between social representations of the body and the body care practices of older adults. Forty older adults, with ages varying from 60 to 84 years (M = 69; SD = 7), matched by sex, took part in the study. The data were collected by means of in-depth thematic interviews, with the corpus analyzed using the IRaMuTeQ software. Differences between men and women were verified in representational contents and body practices. The male participants’ social representations of the body were associated with biological functionality and health concerns, while the women emphasized the importance of physical appearance in their social relationships. Regarding body care practices, there was a higher incidence of food concerns in the men and the performance of physical activities in the women. Therefore, the results indicated that the body care practices vary according to the socials representations of the body and the sex of the participant.

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A qualitative study of high-performing primary care practices during the COVID-19 pandemic

BMC Family Practice ◽

10.1186/s12875-021-01589-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Stephanie L. Albert ◽

Margaret M. Paul ◽

Ann M. Nguyen ◽

Donna R. Shelley ◽

Carolyn A. Berry

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Service Delivery ◽

Preventive Care ◽

Chronic Disease Management ◽

High Performing ◽

Care Processes ◽

Care Practices ◽

Primary Care Practices

Abstract Background Primary care practices have remained on the frontline of health care service delivery throughout the COVID-19 pandemic. The purpose of our study was to understand the early pandemic experience of primary care practices, how they adapted care processes for chronic disease management and preventive care, and the future potential of these practices’ service delivery adaptations. Methods We interviewed 44 providers and staff at 22 high-performing primary care practices located throughout the United States between March and May 2020. Interviews were transcribed and coded using a modified rapid assessment process due to the time-sensitive nature of the study. Results Practices reported employing a variety of adaptations to care during the COVID-19 pandemic including maintaining safe and socially distanced access through increased use of telehealth visits, using disease registries to identify and proactively outreach to patients, providing remote patient education, and incorporating more home-based monitoring into care. Routine screening and testing slowed considerably, resulting in concerns about delayed detection. Patients with fewer resources, lower health literacy, and older adults were the most difficult to reach and manage during this time. Conclusion Our findings indicate that primary care structures and processes developed for remote chronic disease management and preventive care are evolving rapidly. Emerging adapted care processes, most notably remote provision of care, are promising and may endure beyond the pandemic, but issues of equity must be addressed (e.g., through payment reform) to ensure vulnerable populations receive the same benefit.

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A Study on Intelligent Dialogue Agent for Older Adults’ Preventive Care – Towards Development of a Comprehensive Preventive Care System –

Advances in Science Technology and Engineering Systems Journal ◽

10.25046/aj050602 ◽

2020 ◽

Vol 5 (6) ◽

pp. 09-21

Author(s):

Sho Hirose ◽

Daisuke Kitakoshi ◽

Akihiro Yamashita ◽

Kentarou Suzuki ◽

Masato Suzuki

Keyword(s):

Older Adults ◽

Preventive Care ◽

Care System

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Meaningful Change Estimates for the Late-Life Function and Disability Instrument in Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/gly230 ◽

2018 ◽

Vol 74 (4) ◽

pp. 556-559 ◽

Cited By ~ 2

Author(s):

Marla K Beauchamp ◽

Rachel E Ward ◽

Alan M Jette ◽

Jonathan F Bean

Keyword(s):

Older Adults ◽

Lower Extremity ◽

Community Dwelling ◽

Minimal Detectable Change ◽

Global Rating ◽

Mobility Limitations ◽

Meaningful Change ◽

Patient Reported ◽

Community Dwelling Older Adults ◽

Life Function

Abstract Background The Late-Life Function and Disability Instrument (LLFDI) is a well-validated and frequently used patient-reported outcome for older adults. The aim of this study was to estimate the minimal clinically important difference (MCID) of the LLFDI-Function Component (LLFDI-FC) and its subscales among community-dwelling older adults with mobility limitations. Methods We performed a secondary analysis of the Boston Rehabilitative Impairment Study of the Elderly, a longitudinal cohort study of older adults with mobility limitations residing in the community. The MCID for each LLFDI-FC scale over 1 year of follow-up was estimated using both anchor- and distribution-based methods, including mean change scores on a patient-reported global rating of change in function scale, the standard error of measurement (SEM), and the minimal detectable change with 90% confidence (MDC90). Results Data from 320 older adults were used in the analysis (mean age 76 years, 69% female, mean of four chronic conditions). Meaningful change estimates for “small change” based on the global rating of change and SEM were 2, 3, 4, and 4 points for the LLFDI-FC overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively. Estimates for “substantial change” based on the global rating of change and minimal detectable change with 90% confidence were 5, 6, 9, and 10 points for the overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively. Conclusion This study provides the first MCID estimates for the LLFDI-FC, a widely used patient-reported measure of function. These values can be used to interpret the outcomes of longitudinal investigations of functional status in similar populations of community-dwelling older adults.

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Managing Fecal Incontinence: SELF-CARE PRACTICES OF OLDER ADULTS

Journal of Gerontological Nursing ◽

10.3928/0098-9134-20050701-08 ◽

2005 ◽

Vol 31 (7) ◽

pp. 35-44 ◽

Cited By ~ 39

Author(s):

Donna Zimmaro Bliss ◽

Lucy Rose Fischer ◽

Kay Savik

Keyword(s):

Older Adults ◽

Fecal Incontinence ◽

Self Care ◽

Care Practices

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SENSITIVITY OF SELF-REPORTED COMORBIDITIES COMPARED TO MEDICARE CLAIMS IN OLDER ADULTS WITH TRAUMATIC BRAIN INJURY

Innovation in Aging ◽

10.1093/geroni/igz038.1796 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S483-S483

Author(s):

Aparna Vadlamani ◽

Jennifer Albrecht

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Medical History ◽

Acute Injury ◽

Administrative Claims ◽

Comorbid Illness ◽

Medicare Claims ◽

Patient Reported ◽

History Of

Abstract Patient reported history of comorbid illness may be the only information available to the treatment team during an acute injury admission. Nevertheless, acute injury, particularly traumatic brain injury (TBI) which affects cognition, may decrease the patient’s ability to accurately report medical history. Thus, the objective of this study was to evaluate the accuracy of patient-reported comorbid illness burden compared to the patient’s Medicare administrative claims. Records of older adults treated for TBI at an urban level 1 trauma center 2006-2010 were linked to their Medicare administrative. Comorbidities were recorded in Medicare claims based on ICD9 codes and were reported in the trauma registry (TR) based on patient medical history recorded by a physician or nurse. Prevalence of each of the following comorbidities was calculated using information from the TR and claims: Alzheimer’s disease and related dementias, chronic kidney disease, COPD, heart failure, diabetes, depression, stroke, and hypertension. Sensitivity of each patient-reported comorbidity was calculated using Medicare claims as the gold standard. We identified patient factors associated with accurate self-report using logistic regression. Among 408 older adults with TBI that linked to their Medicare claims, prevalence of each comorbidity was higher in Medicare claims compared to the TR, except for hypertension. Sensitivity for detecting these comorbidities using the TR ranged from 2% to 68%, with the highest sensitivity observed for hypertension. Older age and race were predictors of less accurate reported medical history. Reconciling self-reported patient history of these comorbidities with those reported in claims can better inform decisions regarding treatment.

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