Mild Visual Impairment and Its Impact on Self-Care Among Older Adults

Objective: To determine the prevalence of mild visual impairment (MVI) among urban older adults in primary care settings, and ascertain whether MVI was a risk factor for inadequate performance on self-care health tasks. Method: We used data from a cohort of 900 older adults recruited from primary care clinics. Self-management skills were assessed using the Comprehensive Health Activities Scale, and vision with corrective lenses was assessed with the Snellen. We modeled visual acuity predicting health task performance with linear regression. Results: Normal vision was associated with better overall health task performance ( p = .004). Individuals with normal vision were more likely to recall health information conveyed via multimedia ( p = .02) and during a spoken encounter ( p = .04), and were more accurate in dosing multi-drug regimens ( p = .05). Discussion: MVI may challenge the performance of self-care behaviors. Health care systems and clinicians should consider even subtle detriments in visual acuity when designing health information, materials, and devices.

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Discussion of “Representation of People’s Decisions in Health Information Systems: A Complementary Approach for Understanding Health Care Systems and Population Health”

Methods of Information in Medicine ◽

10.3414/me16-15-0001 ◽

2017 ◽

Vol 56 (S 01) ◽

pp. e20-e29 ◽

Cited By ~ 1

Author(s):

Najeeb Al-Shorbaji ◽

Elizabeth Borycki ◽

Michio Kimura ◽

Christoph Lehmann ◽

Nancy Lorenzi ◽

...

Keyword(s):

Health Care ◽

Information Systems ◽

Health Information ◽

Population Health ◽

Health Care Systems ◽

Health Information Systems ◽

Letters To The Editor ◽

Discussion Section ◽

Complementary Approach ◽

Care Systems

SummaryThis article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper “Representation of People’s Decisions in Health Information Systems: A Complementary Approach for Understanding Health Care Systems and Population Health” written by Fernan Gonzalez Bernaldo de Qui-ros, Adriana Ruth Dawidowski, and Silvana Figar. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of de Quiros, Dawidowski, and Figar. In subsequent issues the discussion can continue through letters to the editor.

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A NOVEL TOOL FOR THE EARLY IDENTIFICATION OF FRAILTY IN ELDERLY PEOPLE: THE APPLICATION IN PRIMARY CARE SETTINGS

Journal of Frailty & Aging ◽

10.14283/jfa.2019.41 ◽

2019 ◽

pp. 1-6

Author(s):

M. Maggio ◽

M. Barbolini ◽

Y. Longobucco ◽

L. Barbieri ◽

C. Benedetti ◽

...

Keyword(s):

Primary Care ◽

Construct Validity ◽

Predictive Value ◽

Community Health Centers ◽

Health Care Systems ◽

Cross Sectional Study ◽

Criterion Validity ◽

Cross Sectional ◽

Care Systems ◽

The One

Objectives: Frailty is a pre-disability condition in older persons providing a challenge to Health-Care Systems. Systematic reviews highlight the absence of a gold-standard for its identification. However, an approach based on initial screening by the General Practitioner (GP) seems particularly useful. On these premises, a 9-item Sunfrail Checklist (SC), was developed by a multidisciplinary group, in the context of European Sunfrail Project, and tested in the Community. Objectives: – to measure the concordance between the judgments of frailty (criterion-validity): the one formulated by the GP, using the SC, and the one subsequently expressed by a Comprehensive Geriatric Assessment Team (CGA-Team); – to determine the construct-validity through the correspondence between some checklist items related to the 3 domains (physical, cognitive and social) and the three tools used by the CGA-Team; – to measure the instrument’s performance in terms of positive predictive value (PPV) and negative predictive value (NPV). Design: Cross-sectional study, with a final sample-size of 95 subjects. Setting: Two Community-Health Centers of Parma, Italy. Participants: Subjects aged 75 years old or more, with no disability and living in the community. Measurements: We compared the screening capacity of the GP using the SC to that one of CGA-Team based on three tests: 4-meter Gait-Speed, Mini-Mental State Examination and Loneliness Scale. Results: 95 subjects (51 women), with a mean age of 81±4 years were enrolled. According to GPs 34 subjects were frail; the CGA-Team expressed a frailty judgment on 26 subjects. The criterion-validity presented a Cohen’s k of 0.353. Construct-validity was also low, with a maximum contingency-coefficient of 0.19. The analysis showed a PPV of 58.1% and a NPV equal to 84.6%. Conclusions: Our data showed a low agreement between the judgements of GP performed by SC and CGA-Team. However, the good NPV suggests the applicability of SC for screening activities in primary-care.

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Building Learning Health Care Systems in Primary Care

Quality Management in Health Care ◽

10.1097/qmh.0000000000000230 ◽

2019 ◽

Vol 28 (4) ◽

pp. 252-253

Author(s):

Maura J. McGuire

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Systems ◽

Care Systems

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Cardiovascular health and near visual impairment among older adults in the Republic of Congo: a population-based study

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa304 ◽

2020 ◽

Author(s):

Antoine Gbessemehlan ◽

Catherine Helmer ◽

Cécile Delcourt ◽

Farid Boumediene ◽

Bébène Ndamba-Bandzouzi ◽

...

Keyword(s):

Older Adults ◽

Visual Acuity ◽

Visual Impairment ◽

Cardiovascular Health ◽

Central Africa ◽

Population Based ◽

Sub Saharan Africa ◽

Logistic Regression Models ◽

Sub Saharan

Abstract Background Visual impairment (VI) and determinants of poor cardiovascular health are very common in sub-Saharan Africa. However, we do not know whether these determinants are associated to VI among older adults in this region. This study aimed at investigating the association between the determinants of poor cardiovascular health and near VI among older adults living in Congo. Methods Participants were Congolese older adults aged ≥ 65 years included in EPIDEMCA-FU (Epidemiology of Dementia in Central Africa - Follow-up) population-based cohort. Near VI was defined as visual acuity < 20/40 measured at 30 cm. Associations between determinants of poor cardiovascular health collected at baseline and near visual acuity measured at 1 st follow-up were investigated using multivariable logistic regression models. Results Among the 549 participants included, 378 (68.8% [95% Confidence Interval: 64.9%-72.7%]) had near VI. Of the determinants of poor cardiovascular health explored, we found that having high BMI ≥ 25 kg/m 2 (Odds Ratio= 2.15 [95% CI: 1.25–3.68]), diabetes (OR=2.12 [95% CI: 1.06–4.25]) and hypertension (OR=1.65 [95% CI: 1.02–2.64]) were independently associated with near VI. Conclusions Several determinants of poor cardiovascular health were associated to near VI in this population. This study suggests that promoting a good cardiovascular health could represent a target for VI prevention among older adults.

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USING COMMUNITY-BASED MODELS TO PROVIDE INTEGRATED CARE FOR RURAL OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.2038 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S553-S553

Author(s):

Martha R Crowther ◽

Cassandra D Ford

Keyword(s):

Older Adults ◽

Health Care ◽

Rural Communities ◽

Mental Health Problems ◽

Health Care Systems ◽

Physical And Mental Health ◽

Community Based ◽

Psychosocial Services ◽

Care Systems ◽

Rural Older Adults

Abstract Rural elders are one of the most at-risk populations for experiencing physical and mental health problems. In many rural communities, there are no psychosocial services available to meet the needs of the rural elderly. To provide rural older adults with integrated healthcare, we build upon our existing community-based infrastructure that has fostered community capacity for active engagement in clinical activities and has served as a catalyst to increase participation of rural older adults in clinical services. Our rural community model draws upon the role of culture in promoting health among rural older adults to provide rural service delivery. This model is built upon our network of partnerships with surrounding communities, including potential research participants, community-based organizations, community leaders, and community health-care systems and providers. By engaging the community we can create a sustainable system that will encourage rural older adults to utilize the health care system at a higher rate.

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Mental Health and Primary Care: Contributing to Mental Health System Transformation in Canada

Canadian Journal of Community Mental Health ◽

10.7870/cjcmh-2017-033 ◽

2017 ◽

Vol 36 (4) ◽

pp. 33-67 ◽

Cited By ~ 2

Author(s):

Nick Kates

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Health Care Systems ◽

Primary Care Providers ◽

Health Providers ◽

Care Providers ◽

System Transformation ◽

Mental Health Systems ◽

Care Systems

For 20 years mental health and primary care providers across Canada have been working collaboratively together to improve access to care, provider skills, and patient experience. The new strategic plan of the Mental Health Commission of Canada (MHCC) offers many opportunities for collaborative care to play a role in the transformation of Canada’s mental health systems. To assist the plan, this paper presents principles underlying successful projects and ways that mental health and primary care services can work together more collaboratively, including integrating mental health providers in primary care. It integrates these concepts into a Canadian Model for Collaborative Mental Health Care that can guide future expansion of these approaches, and suggests ways in which better collaboration can address wider issues facing all of Canada’s health care systems.

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Primary Care Performance in Fee-for-Service and Prepaid Health Care Systems

JAMA ◽

10.1001/jama.1994.03510440039030 ◽

1994 ◽

Vol 271 (20) ◽

pp. 1579 ◽

Cited By ~ 62

Author(s):

Dana Gelb Safran

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Systems ◽

Fee For Service ◽

Care Systems ◽

Care Performance

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Alternative Healing as Magical Self-Care in Alternative Modernity

Numen ◽

10.1163/15685276-12341380 ◽

2015 ◽

Vol 62 (4) ◽

pp. 431-459

Author(s):

Anne Koch

Keyword(s):

Health Care ◽

Health Care Systems ◽

Self Care ◽

Spiritual Healing ◽

Medical Pluralism ◽

Medical Treatments ◽

Alternative Healing ◽

Alternative Modernities ◽

Care Systems ◽

Rational Knowledge

Alternative healing, including spiritual healing, unconventional, traditional/folk, and complementary medical treatments, is an increasingly relevant health-care resource in contemporary health-care systems, and a broad, constantly changing, and heterogeneous field of medical pluralism. Some suggestions for classifying spiritual healing as presented in the academic and gray literature are summarized and discussed. The findings are interpreted in terms of the paradigm of alternative modernities. In the direction of, but also in addition to, this paradigm, magic is introduced as a concept to denote certain highly ambiguous occurrences in the alternative modern. Magic is still very much alive and not easy to identify merely as a counterpart of rational, knowledge-generating, disembodying modernity. In this setting, spiritual healing might be seen as a form of magical self-care. Magic is neither modern nor traditional nor irrational per se, but has to be contextualized and described in terms of characteristics like holistic diagnosis, interpersonal congruence, the imaginations of agency, and efficacy.

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Human Factors and Health Information Technology: Current Challenges and Future Directions

Yearbook of Medical Informatics ◽

10.15265/iy-2014-0005 ◽

2014 ◽

Vol 23 (01) ◽

pp. 58-66 ◽

Cited By ~ 13

Author(s):

T. G. Kannampallil ◽

V. L. Patel

Keyword(s):

Information Technology ◽

Human Factors ◽

Health Information Technology ◽

Health Information ◽

Medication Errors ◽

Biomedical Informatics ◽

Health Care Systems ◽

Clinical Workflow ◽

Federal Mandates ◽

Care Systems

Summary Objectives: Recent federal mandates and incentives have spurred the rapid growth, development and adoption of health information technology (HIT). While providing significant benefits for better data integration, organization, and availability, recent reports have raised questions regarding their potential to cause medication errors, decreased clinician performance, and lowered efficiency. The goal of this survey article is to (a) examine the theoretical and foundational models of human factors and ergonomics (HFE) that are being advocated for achieving patient safety and quality, and their use in the evaluation of health-care systems; (b) and the potential for macroergonomic HFE approaches within the context of current research in biomedical informatics. Methods: We reviewed literature (2007-2013) on the use of HFE approaches in healthcare settings, from databases such as Pubmed, CINAHL, and Cochran. Results: Based on the review, we discuss the systems-oriented models, their use in the evaluation of HIT, and examples of their use in the evaluation of EHR systems, clinical workflow processes, and medication errors. We also discuss the opportunities for better integrating HFE methods within biomedical informatics research and its potential advantages. Conclusions: The use of HFE methods is still in its infancy - better integration of HFE within the design lifecycle, and quality improvement efforts can further the ability of informatics researchers to address the key concerns regarding the complexity in clinical settings and develop HIT solutions that are designed within the social fabric of the considered setting.

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