scholarly journals Adaptive Health Coaching Technology for Tailored Interventions

2021 ◽  
Vol 18 (5) ◽  
pp. 2761
Author(s):  
Holly Jimison ◽  
Michael Shapiro ◽  
Misha Pavel
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
User Model ◽  
Health Coaching ◽  
Communications Technology ◽  
Message Content ◽  
Tailored Interventions ◽  
Age In Place ◽  
Health Coaches ◽  
Scalable Methods

Recent advances in sensor and communications technology have enabled scalable methods for providing continuity of care to the home for patients with chronic conditions and older adults wanting to age in place. In this article we describe our framework for a health coaching platform with a dynamic user model that enables tailored health coaching messages. We have shown that this can improve coach efficiency without a loss of message quality. We also discovered many lessons for coaching technology, most demonstrating the need for more coach input on sample message content, perhaps even requiring that individual coaches be able to modify the message database directly. Overall, coaches felt that the structure of the automated message generation was useful in remembering what to say, easy to edit if necessary and especially helpful for training new health coaches.

scholarly journals PLANNING FOR AGING IN PLACE IN RURAL AREAS: PERCEPTIONS AND NEEDS OF OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S252-S252
Author(s):  
Raven H Weaver ◽  
Cory Bolkan
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Rural Areas ◽  
Chronic Conditions ◽  
Family Care ◽  
Computer Assisted ◽  
Service Access ◽  
Community Resources ◽  
Care Needs ◽  
Age In Place

Abstract Most individuals prefer to live independently in their homes, but will need support to age-in-place safely. Rural-dwelling individuals historically have worse health, limited income, and restricted access to adequate services/supports compared to their urban counterparts. Community-based aging services organizations (i.e., Area Agency on Aging; AAA) offer in-home health, social support, and information/referral to community resources that support older adults in both urban and rural communities. A representative sample of adults aged 60+ (N=253, mean age=74) were surveyed via computer-assisted-telephone interviews about their health status, needs, and service utilization. Over half (54%) lived in rural counties, which was significantly associated with receiving insufficient health care services (X2=9.227, p=.002). Insufficient service access was also associated with experiencing a fall (X2=7.315, p=.007). While 53% reported having chronic conditions, most individuals still reported good health and their top reported needs included: yard work, interior/exterior house repairs, and housework. Content analysis of open-ended survey responses regarding future care needs revealed participants anticipate help from family/friends or neighbors; reliance on physicians for referrals; and expect insurance to cover their needs. Participants had varying awareness levels of available community resources and identified concerns about adequacy of services (e.g., mental health; transportation) and health insurance barriers (e.g., reimbursement; vision/dental coverage). Preparing for future needs and anticipating changing functional capacity is critical, especially among rural-dwelling older adults with chronic conditions. To improve ability for adults with diverse needs to age-in-place, preventive services/supports that span the continuum of care needs and that complement informal family care are necessary.

scholarly journals Using Medicare Data to Inform Intervention and Care Delivery for the Most Expensive Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 911-911
Author(s):  
Sam Amodeo ◽  
Henrik Kowalkowski ◽  
Halley Brantley ◽  
Lauren Bangerter ◽  
Nicholas Jones ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Care Delivery ◽  
Temporal Stability ◽  
Medicare Advantage ◽  
Complex Needs ◽  
Tailored Interventions ◽  
Medicare Data ◽  
Delivery Models ◽  
Global Population

Abstract Older adults with high medical spend require tailored interventions and care delivery models to meet their complex needs. Segmenting high-spend patients is a promising approach to designing such interventions. In this study we explored patient spend across 4 years (2016-2019) using claims from 799,205 patients continuously enrolled in UnitedHealth Group Medicare Advantage (mean age=73.7; S.E.=0.01). Patients with healthcare spend in the top decile were segmented into three subgroups: catastrophic, persistent, and semi-persistent. Catastrophic patients had more acute events (acute myocardial infarction and hip/pelvic fracture) driving their cost. Persistent patients were younger (mean age=67.8; S.E.=0.06) and had significantly more medications. Semi-persistent patients were older (mean age=76.6; S.E.=0.04) and had significantly more chronic conditions and frailty, indicating their cost was driven by medical complexity. These subgroups displayed different temporal stability in their healthcare costs over time. Each year, 79-81% of the catastrophic group dropped out of the top decile. In contrast, nearly 72% of the persistent group remained in the top decile whereas only 37% of the semi-persistent group remained year over year. As the global population continues to age, it will be necessary to design interventions and care delivery models that address the complex needs of older adults in the high-spend patient population. Our study suggests that segmenting high-spend patients into potentially actionable subgroups is an important first step in achieving these goals.

scholarly journals Environmental Influences of Extreme Heat on the Health of Older Adults: A Retrospective Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 280-280
Author(s):  
Mei Liu ◽  
Carol Buller ◽  
Barbara Polivka ◽  
Terri Woodburn ◽  
Mark Jakubauskas ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Environmental Influence ◽  
Emergency Department Visits ◽  
Extreme Heat ◽  
Extreme Weather Events ◽  
Study Cohort ◽  
Outpatient Visits ◽  
Extreme Heat Event ◽  
Heat Event

Abstract Studies have suggested that extreme weather events have differential effects by age. By leveraging electronic medical records, we aim to analyze the environmental influence of extreme heat on the health of older adults. From our healthcare system’s de-identified data warehouse, we extracted a retrospective cohort of 108,192 patients who were ≥65 years of age as of 1/1/2018 with pre-existing chronic conditions including diabetes, COPD, cardiovascular disease, or kidney disease. Extreme heat event period was defined as 5/1/2018 to 9/1/2018 (79 days with temperature ≥90o; 15 days of moderately poor/poor air quality index (AQI) [≥75] values) and the comparison period was defined as 5/1/2019 to 9/1/2019 (51 days with temperature ≥90o; 0 days with moderately poor/poor AQI values) in the Kansas City area. We randomly partitioned the study cohort into two sets and demonstrated the two patient sets were statistically similar (p>0.05) with respect to their demographic and underlying health conditions. Finally, we compared the respiratory, cardiovascular, and renal health outcomes between the 2018 and the 2019 cohorts. Most patients were Caucasians, female and had comorbid conditions. Results showed significantly higher number of all-cause emergency department visits (p=0.04) and outpatient visits (p=<.001) during the extreme heat event period in 2018. Analyses also showed significantly higher number of outpatient visits due to upper respiratory diseases (p=0.008) and acute renal failure (p=0.01) in 2018. In conclusion, extreme heat increased use of healthcare services in older adults with chronic conditions.

scholarly journals Supporting Older Adults and Caregivers Through Integrative Service Learning During COVID

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 958-958
Author(s):  
Keith Chan ◽  
Sarah LaFave ◽  
Maggie Ratnayake ◽  
Christina Marsack-Topolewski ◽  
Jillian Graves ◽  
...  
Keyword(s):  
Older Adults ◽  
Service Learning ◽  
Community Resources ◽  
Learning Models ◽  
Process Data ◽  
Community Based ◽  
Age In Place ◽  
Home Based ◽  
Hands On ◽  
Hands On Learning

Abstract There is a growing population of older adults who are living longer and acquiring chronic illness and disabilities, making it difficult for them to complete everyday activities and age in place. More than 2 million of these older adults are homebound and 5 million need help leaving their homes. They experience social isolation, food insecurity, and lack of connection to community resources which has intensified since the pandemic. Integrative service learning models can provide home-based support to older adults while offering valuable, hands-on learning experiences for students. This study examined findings for a community-based program which trained university students to provide practical home-based support for older adults and their caregivers. Data was collected for 109 older adults who were connected with student trainees. Students provided services with groceries, companionship, and help accessing needed services. Findings from t-test results using the UCLA Loneliness Scale indicated that older adults reported less loneliness after engagement with students (mean difference = 6.15, t = 3.14, df = 82, p < 0.01). Qualitative process data suggested that older adults benefited from services and a connection to their assigned students prior to and during the pandemic. Student trainees reported that the experience enriched their learning and reaffirmed their commitment to working with older adults. Community-based service learning can address home-based needs of older adults and their caregivers and enhance learning opportunities for students. Policies and practice can support a pipeline of geriatric health professionals through innovative service learning models to benefit older adults, caregivers and students.

scholarly journals Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness–implementation randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e048350
Author(s):  
Monika Kastner ◽  
Julie Makarski ◽  
Leigh Hayden ◽  
Jemila S Hamid ◽  
Jayna Holroyd-Leduc ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Disease ◽  
Randomised Controlled Trial ◽  
Disease Management ◽  
Chronic Conditions ◽  
Controlled Trial ◽  
Management Tool ◽  
Self Management ◽  
Plain Language ◽  
Randomised Controlled

IntroductionIn response to the burden of chronic disease among older adults, different chronic disease self-management tools have been created to optimise disease management. However, these seldom consider all aspects of disease management are not usually developed specifically for seniors or created for sustained use and are primarily focused on a single disease. We created an eHealth self-management application called ‘KeepWell’ that supports seniors with complex care needs in their homes. It incorporates the care for two or more chronic conditions from among the most prevalent high-burden chronic diseases.Methods and analysisWe will evaluate the effectiveness, cost and uptake of KeepWell in a 6-month, pragmatic, hybrid effectiveness–implementation randomised controlled trial. Older adults age ≥65 years with one or more chronic conditions who are English speaking are able to consent and have access to a computer or tablet device, internet and an email address will be eligible. All consenting participants will be randomly assigned to KeepWell or control. The allocation sequence will be determined using a random number generator.Primary outcome is perceived self-efficacy at 6 months. Secondary outcomes include quality of life, health background/status, lifestyle (nutrition, physical activity, caffeine, alcohol, smoking and bladder health), social engagement and connections, eHealth literacy; all collected via a Health Risk Questionnaire embedded within KeepWell (intervention) or a survey platform (control). Implementation outcomes will include reach, effectiveness, adoption, fidelity, implementation cost and sustainability.Ethics and disseminationEthics approval has been received from the North York General Hospital Research and Ethics Board. The study is funded by the Canadian Institutes of Health Research and the Ontario Ministry of Health. We will work with our team to develop a dissemination strategy which will include publications, presentations, plain language summaries and an end-of-grant meeting.Trial registration numberNCT04437238.

scholarly journals Disease-related disability burden: a comparison of seven chronic conditions in middle-aged and older adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chieh-Ying Chou ◽  
Ching-Ju Chiu ◽  
Chia-Ming Chang ◽  
Chih-Hsing Wu ◽  
Feng-Hwa Lu ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Disability ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Disease Diagnosis ◽  
Rate Of Change ◽  
Middle Aged ◽  
Rates Of Change ◽  
Depression Status ◽  
Stage Disease

Abstract Background Although previous studies have explored the effect of chronic conditions on physical disability, little is known about the levels and rates of change in physical disability after a chronic condition diagnosis in middle-aged and older adults in the Asian population. The aim of this study is to ascertain the average levels and rates of change in the development of disability after disease diagnosis, as well as to determine the influences of sociodemographic and health-related correlates in the development of disability. Methods This is a retrospective cohort study analyzing data of nationally representative participants aged 50 and over with a chronic condition or having developed one during follow-ups based on data from the 1996–2011 Taiwan Longitudinal Study on Aging (TLSA) (n = 5131). Seven chronic conditions were examined. Covariates included age at initial diagnosis, gender, education level, number of comorbidities, and depression status. Physical disability was measured by combining self-reported ADL, IADL, and strength and mobility activities with 17 total possible points, further analyzed with multilevel modeling. Results The results showed that (1) physical disability was highest for stroke, followed by cancer and diabetes at the time of the initial disease diagnosis. (2) The linear rate of change was highest for stroke, followed by lung disease and heart disease, indicating that these diseases led to higher steady increases in physical disability after the disease diagnosis. (3) The quadratic rate of change was highest in diabetes, followed by cancer and hypertension, indicating that these diseases had led to higher increments of physical disability in later stage disease. After controlling for sociodemographic and comorbidity, depression status accounted for 39.9–73.6% and 37.9–100% of the variances in the physical disability intercept and change over time, respectively. Conclusions Despite the fact that a comparison across conditions was not statistically tested, an accelerated increase in physical disabilities was found as chronic conditions progressed. While stroke and cancer lead to disability immediately, conditions such as diabetes, cancer, and hypertension give rise to higher increments of physical disability in later stage disease. Mitigating depressive symptoms may be beneficial in terms of preventing disability development in this population.

Sign in / Sign up

Export Citation Format

Share Document