scholarly journals The Hidden Role of Racial Wealth Disparities in Older Adults’ Vulnerability to COVID-19

2021 ◽  
Author(s):  
Ruth Winecoff ◽  
Padmaja Ayyagari ◽  
Melissa McInerney ◽  
Kosali Simon ◽  
M. Kate Bundorf
Keyword(s):  
Older Adults ◽  
Financial Risk ◽  
Long Term Care ◽  
Ethnic Disparities ◽  
Term Care ◽  
Older Americans ◽  
Racial And Ethnic Differences ◽  
Health Related ◽  
Rich Data

Abstract Background: To examine racial and ethnic differences in wealth and other economic, exposure and baseline health-related risks of COVID-19 among older adults in the U.S. Methods: Using rich data on wealth and long-term care use among older Americans unique to the 2016 Health and Retirement Study, we quantify differences in COVID-19 vulnerability among non-Hispanic white, non-Hispanic Black and Hispanic respondents aged 50+. We measure wealth, other economic (insurance, income); exposure (long-term care, employment, telework, household size); and health (chronic conditions, smoking) risk stratified by age (50-64, 65+). Results: Blacks and Hispanics face dramatically greater financial risk that potentially increases exposure to COVID-19, relative to whites; Blacks and Hispanics are four to five times more likely to have no financial wealth. Blacks are also more likely than whites to use long-term care. Blacks and Hispanics also are less likely to have health insurance and face greater risk of exposure to COVID-19 because they are less likely to telework, and Hispanic older adults reside in larger households. Black and Hispanic older adults are also more likely to have a chronic condition associated with worse COVID-19 outcomes. Conclusions: Our results suggest that wealth differences may play a substantial role in contributing to the very large racial and ethnic disparities in the health burden of COVID-19. Racial disparities in long-term care, where COVID-19 risks are higher, contribute to make older Black Americans even more vulnerable to COVID-19.

scholarly journals A Comparison of Long-Term Care Use by Community-Dwelling Older Adults With and Without Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 349-349
Author(s):  
Ya-Mei Chen ◽  
Kuo-Piao Chung ◽  
Hsiu-Hsi Chen ◽  
Yen-Po Yeh ◽  
Yuchi Young
Keyword(s):  
Older Adults ◽  
Long Term Care ◽  
Community Dwelling ◽  
Term Care ◽  
Related Services ◽  
People With Dementia ◽  
Centered Care ◽  
Health Related ◽  
Community Dwelling Older Adults

Abstract Introduction. This study compares long-term care (LTC) use among community-dwelling older adults with and without dementia. Methods. Participants (n=14,483) were aged 65+ residents of Changhua County, Taiwan who qualified for LTC services. Data were collected (4/1/2017-10/26/2018) through health assessments. Multivariate logistic regression quantifies the study aim. Results. Preliminary results show that on average participants with dementia are older than people without dementia (81.1 vs. 80.5; p<.001), more females (13.4% vs. 8.0%; p<.001), higher mean ADL (12,4 vs. 9.8; p< .001) and IADL (21.4 vs. 17.8; p<.001), and lower mean comorbidity (2.5 vs. 2.8; p<.001). Multivariate regression results indicate people with dementia use twice the health-related LTC services than their counterpart (OR= 2.0; 95% CI 1.90–2.14). Discussion. People with dementia use more health-related LTC services. Future dementia studies should examine the pattern of non-health-related LTC services concomitant with health-related services, so that person-centered care can be tailored to foster aging-in-community.

scholarly journals Addressing Systemic Factors Related to Racial and Ethnic Disparities among Older Adults in Long-Term Care Facilities

2021 ◽  
Author(s):  
Rebecca L. Mauldin ◽  
Shellye L. Sledge ◽  
Ebonie K. Kinney ◽  
Sarah Herrera ◽  
Kathy Lee
Keyword(s):  
Older Adults ◽  
Long Term Care ◽  
Ethnic Disparities ◽  
The United States ◽  
Racial And Ethnic Disparities ◽  
Structural Racism ◽  
Term Care ◽  
Care Facilities ◽  
Systemic Factors

Disparities in older adults’ care and experiences in long-term care facilities (LTCFs) such as nursing homes and assisted living/residential care communities reflect disparities in the broader society. Various policies and institutional practices related to economic opportunity, education, housing, health care, and retirement financing have created and maintain inequitable social structures in the United States. This chapter describes racial and ethnic disparities among older adults in LTCFs in the United States and the systemic factors associated with those disparities. It presents a conceptual framework for understanding the role of structural racism in the racial and ethnic inequities experienced by LTCF residents. In the framework, structural racism directly contributes to racial and ethnic inequities among LTCF residents through LTCF-related policies and practices. Structural racism also indirectly causes disparities among LTCF residents through health and economic disparities. The chapter describes current efforts that address the effects of structural racism within LTCFs and concludes with practice and policy recommendations to redress racial and ethnic disparities among LTCF residents.

Vitamin B12 status in older adults living in Ontario long-term care homes: prevalence and incidence of deficiency with supplementation as a protective factor

2016 ◽  
Vol 41 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Kaylen J. Pfisterer ◽  
Mike T. Sharratt ◽  
George G. Heckman ◽  
Heather H. Keller
Keyword(s):  
Older Adults ◽  
Protective Factor ◽  
Long Term Care ◽  
Functional Independence ◽  
Term Care ◽  
Limited Perspective ◽  
Health Related ◽  
B12 Deficiency ◽  
One Year

Vitamin B12 (B12) deficiency, although treatable, impacts up to 43% of community-living older adults; long-term care (LTC) residents may be at greater risk. Recommendations for screening require further evidence on prevalence and incidence in LTC. Small, ungeneralizable samples provide a limited perspective on these issues. The purposes of this study were to report prevalence of B12 deficiency at admission to LTC, incidence 1 year post-admission, and identify subgroups with differential risk. This multi-site (8), retrospective prevalence study used random proportionate sampling of resident charts (n = 412). Data at admission extracted included demographics, B12 status, B12 supplementation, medications, diagnoses, functional independence, cognitive performance, and nutrition. Prevalence at admission of B12 deficiency (<156 pmol/L) was 13.8%; 47.6% had normal B12 (>300 pmol/L). One year post-admission incidence was 4%. Better B12 status was significantly associated with supplementation use prior to LTC admission. Other characteristics were not associated with status. This work provides a better estimate of B12 deficiency prevalence than previously available for LTC, upon which to base protocols and policy. Prospective studies are needed to establish treatment efficacy and effect on health related outcomes.

scholarly journals Examining Racial and Ethnic Disparities Among Older Adults in Long-Term Care Facilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 27-28
Author(s):  
Kathy Lee ◽  
Rebecca Mauldin ◽  
John Connolly ◽  
Weizhou Tang
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Racial Differences ◽  
Long Term Care ◽  
Ethnic Disparities ◽  
Term Care ◽  
Resident Care ◽  
Race Ethnicity

Abstract Background: Nearly half-million older adults from minority racial and ethnic groups in long term care face disparities in quality of life and quality of care. However, there is little information about the associations between a resident’s race/ethnicity and the types of official complaints lodged. Methods: This project was a mixed methods study using a sequential explanatory design to examine ethnic and racial differences in types of complaints and rates of complaint resolution in a local Ombudsman Program. First, resident race/ethnicity and complaint data were collected from the Ombudsman Program and analyzed. Then, we conducted focus groups with Ombudsman Program staff and volunteers to provide a more complete interpretation of findings from the first phase. Results: Residents from ethnic/racial minority groups were less likely to generate Resident Care complaints and more likely to generate Resident Rights complaints, compared to non-Hispanic White residents (p&lt;.05). Resident Rights, Quality of Life, and Administrative complaints were less likely to be disposed satisfactorily, compared to Resident Care complaints (p&lt;.05). Themes emerged from our qualitative findings include language barriers and more efforts required for residents’ rights due to concerns raised more frequently among minority residents. Implications: Cultural competence training for Ombudsmen as well as care professionals should focus on skills and knowledge that value diversity, understand and respond to their unique concerns. Ombudsmen play an important role as they create an avenue for the residents to discuss their concerns. Implementation research may improve our understanding of the development and delivery of the Ombudsman Program.

Uitbraak COVID-19 in de verpleeghuiszorg

2020 ◽  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Informal Caregivers ◽  
Rapid Review ◽  
Daily Routine ◽  
Term Care ◽  
Care Facilities

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study. Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems. The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.

scholarly journals Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chan Mi Park ◽  
Wonsock Kim ◽  
Hye Chang Rhim ◽  
Eun Sik Lee ◽  
Jong Hun Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Outcome ◽  
Long Term Care ◽  
Functional Decline ◽  
Tube Feeding ◽  
Term Care ◽  
Pneumonia Severity ◽  
Frailty Assessment ◽  
Nasogastric Tube Feeding

Abstract Background Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. Our purpose of the study was to investigate 30-day clinical course and functional outcomes of pneumonia in older adults with different levels of frailty. Methods A prospective cohort was conducted at a university hospital in Seoul, Korea with 176 patients who were 65 years or older and hospitalized with pneumonia. A 50-item deficit-accumulation frailty index (FI) (range: 0–1; robust < 0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, and severely frail ≥ 0.45) and the pneumonia severity CURB-65 score (range: 0–5) were measured. Primary outcome was death or functional decline, defined as worsening dependencies in 21 daily activities and physical tasks in 30 days. Secondary outcomes were intensive care unit admission, psychoactive drug use, nasogastric tube feeding, prolonged hospitalization (length of stay > 15 days), and discharge to a long-term care institution. Results The population had a median age 79 (interquartile range, 75–84) years, 68 (38.6 %) female, and 45 (25.5 %) robust, 36 (47.4 %) pre-frail, 37 (21.0 %) mild-to-moderately frail, and 58 (33.0 %) severely frail patients. After adjusting for age, sex, and CURB-65, the risk of primary outcome for increasing frailty categories was 46.7 %, 61.1 %, 83.8 %, and 86.2 %, respectively (p = 0.014). The risk was higher in patients with frailty (FI ≥ 0.25) than without (FI < 0.25) among those with CURB-65 0–2 points (75 % vs. 52 %; p = 0.022) and among those with CURB-65 3–5 points (93 % vs. 65 %; p = 0.007). In addition, patients with greater frailty were more likely to require nasogastric tube feeding (robust vs. severe frailty: 13.9 % vs. 60.3 %) and prolonged hospitalization (18.2 % vs. 50.9 %) and discharge to a long-term care institution (4.4 % vs. 59.3 %) (p < 0.05 for all). Rates of intensive care unit admission and psychoactive drug use were similar. Conclusions Older adults with frailty experience high rates of death or functional decline in 30 days of pneumonia hospitalization, regardless of the pneumonia severity. These results underscore the importance of frailty assessment in the acute care setting.

Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice

2021 ◽  
pp. 089801012110253
Author(s):  
Verónica G. Walker ◽  
Elizabeth K. Walker
Keyword(s):  
Older Adults ◽  
Life Course ◽  
Health Beliefs ◽  
Long Term Care ◽  
Life Course Theory ◽  
Nursing Research ◽  
Term Care ◽  
Holistic Nursing ◽  
Care Facilities

Older adults diagnosed with schizophrenia (OADWS) often enter long-term care facilities with unique challenges related to trauma and stress experienced throughout their life course. Health care workers often report that when they work with this population, they feel unprepared due to limited training. In this article, life course theory is presented as a lens for holistic nursing research and as a way for nurses to adapt interventions already used with cognitively impaired older adults (e.g., those diagnosed with Alzheimer's disease) for OADWS in long-term care. It is hoped that these ideas will facilitate discussion of ways to inform training for holistic long-term care of OADWS. Holistic principles of nursing addressed with life course theory as a lens include the following: (a) accounting for strengths and challenges; (b) honoring experiences, values, and health beliefs; (c) viewing interrelationships with the environment; and (d) nurturing of peace, wholeness, and healing.

LGBTQ Older Adults in Long-Term Care Settings: An Integrative Review to Inform Best Practices

2021 ◽  
pp. 1-16
Author(s):  
Katherine Fasullo ◽  
Erik McIntosh ◽  
Susan W. Buchholz ◽  
Todd Ruppar ◽  
Sarah Ailey
Keyword(s):  
Older Adults ◽  
Best Practices ◽  
Long Term Care ◽  
Integrative Review ◽  
Term Care
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