Monitoring Older Adult Blood Pressure Trends at Home as a Proxy for Brain Health

Even when older adults monitor hypertension at home, it is difficult to understand trends and share them with their providers. MyHealthNetwork is a dashboard designed for patients and providers to monitor blood pressure readings to detect hypertension and ultimately warning signs of changes in brain health. A multidisciplinary group in a Digital Health course at Tufts University School of Medicine used Design Thinking to formulate a digital solution to promote brain health among older adults in the United States (US). Older adults (aged 65 and over) are a growing population in the US, with many having one or more chronic health conditions including hypertension. Nearly half of all American adults ages 50-64 worry about memory loss as they age and almost all (90%) wish to maintain independence and age in their homes. Given the well-studied association between hypertension and dementia, we designed a solution that would ultimately promote brain health among older adults by allowing them to measure and record their blood pressure readings at home on a regular basis. Going through each step in the Design Thinking process, we devised MyHealthNetwork, an application which connects to a smart blood pressure cuff and stores users’ blood pressure readings in a digital dashboard which will alert users if readings are outside of the normal range. The dashboard also has a physician view where users’ data can be reviewed by the physician and allow for shared treatment decisions. The authors developed a novel algorithm to visually display the blood pressure categories in the dashboard in a way straightforward enough that users with low health literacy could track and understand their blood pressure over time. Additional features of the dashboard include educational content about brain health and hypertension, a digital navigator to support users with application use and technical questions. Phase 1 in the development of our application includes a pilot study involving recruitment of Primary Care Providers with patients who are at risk of dementia to collect and monitor BP data with our prototype. Subsequent phases of development involve partnerships to provide primary users with a rewards program to promote continued use, additional connections to secondary users such as family members and expansion to capture other health metrics.

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Design and rationale for a pragmatic cluster randomized trial of the Cardiovascular Health Awareness Program (CHAP) for social housing residents in Ontario and Quebec, Canada

Trials ◽

10.1186/s13063-019-3806-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Gina Agarwal ◽

Magali Girard ◽

Ricardo Angeles ◽

Melissa Pirrie ◽

Marie-Thérèse Lussier ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Social Housing ◽

Cardiovascular Health ◽

Primary Care Providers ◽

Care Providers ◽

Health Awareness ◽

Awareness Program ◽

Ed Visits ◽

Cluster Randomized

Abstract Background The Cardiovascular Health Awareness Program (CHAP) uses volunteers to provide cardiovascular disease (CVD) and diabetes screening in a community setting, referrals to primary care providers, and locally available programs targeting lifestyle modification. CHAP has been adapted to target older adults residing in social housing, a vulnerable segment of the population. Older adults living in social housing report poorer health status and have a higher burden of a multitude of chronic illnesses, such as CVD and diabetes. The study objective is to evaluate whether there is a reduction in unplanned CVD-related Emergency Department (ED) visits and hospital admissions among residents of social seniors’ housing buildings receiving the CHAP program for 1 year compared to residents in matched buildings not receiving the program. Methods/design This is a pragmatic, cluster randomized controlled trial in community-based social (subsidized) housing buildings in Ontario and Quebec. All residents of 14 matched pairs (intervention/control) of apartment buildings will be included. Buildings with 50–200 apartment units with the majority of residents aged 55+ and a unique postal code are included. All individuals residing within the buildings at the start of the intervention period are included (intention to treat, open cohort). The intervention instrument consists of CHAP screens for high blood pressure using automated blood pressure monitors and for diabetes using the Canadian Diabetes Risk (CANRISK) assessment tool. Monthly drop-in sessions for screening/monitoring are held within a common area of the building. Group health education sessions are also held monthly. Reports are sent to family doctors, and attendees are encouraged to visit their family doctor. The primary outcome measure is monthly CVD-related ED visits and hospitalizations over a 1-year period post randomization. Secondary outcomes are all ED visits, hospitalizations, quality of life, cost-effectiveness, and participant experience. Discussion It is anticipated that CVD-related ED visits and hospitalizations will decrease in the intervention buildings. Using the volunteer-led CHAP program, there is significant opportunity to improve the health of older adults in social housing. Trial registration ClinicalTrials.gov,NCT03549845. Registered on 15 May 2018. Updated on 21 May 2019.

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Implementation of an Opioid and Benzodiazepine Deprescribing Program for Older Adults in an Outpatient Setting

Innovation in Aging ◽

10.1093/geroni/igaa057.3334 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 906-906

Author(s):

Lori Armistead ◽

Jan Busby-Whitehead ◽

Stefanie Ferreri ◽

Cristine Henage ◽

Tamera Hughes ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

At Risk ◽

Older Adult ◽

Adult Population ◽

Primary Care Providers ◽

The United States ◽

Outpatient Setting ◽

Care Providers ◽

Risk Of Falls

Abstract The United States spends $50 billion each year on 2.8 million injuries and 800,000 hospitalizations older adults (age 65 years and older) incur as the result of falls. Chronic use of central nervous system (CNS)-active medications, such as opioid and/or benzodiazepine (BZD) medications, increases the risk of falls and falls-related injuries in this older adult population. This Centers for Disease Control and Prevention (CDC)-funded randomized control trial uses electronic health record (EHR) data from primary care outpatient clinics to identify older adult patients at risk for falls due to chronic opioid or BZD use. The primary program aim is to test the efficacy of a targeted consultant pharmacist service to reduce the dose burden of these medications in the targeted population. Impact of this intervention on the risk of falls in this population will also be assessed. Licensed clinical pharmacists will review at-risk patients’ medical records weekly and make recommendations through the EHR to primary care providers for opioid or BZD dose adjustments, alternate medications, and/or adjunctive therapies to support deprescribing for approximately 1265 patients in the first two cohorts of intervention clinics. One thousand three hundred eighty four patients in the control clinics will receive usual care. Outcome measures will include reduction or discontinuation of opioids and BZDs and falls risk reduction as measured by the Stop Elderly Accidents, Death and Injuries (STEADI) Questionnaire. Primary care provider adoption of pharmacists’ recommendations and satisfaction with the consult service will also be reported.

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Quantifying the social distancing privilege gap: a longitudinal study of smartphone movement

10.1101/2020.05.03.20084624 ◽

2020 ◽

Cited By ~ 8

Author(s):

Nabarun Dasgupta ◽

Michele Jonsson Funk ◽

Allison Lazard ◽

Benjamin Eugene White ◽

Stephen W. Marshall

Keyword(s):

Negative Binomial ◽

Disease Incidence ◽

External Validation ◽

Primary Care Providers ◽

The United States ◽

Care Providers ◽

Location Services ◽

Social Distancing ◽

Incidence And Mortality ◽

At Home

BackgroundIn response to the coronavirus pandemic, social distancing became a widely deployed countermeasure in March 2020. We examined whether healthier and wealthier places more successfully implemented social distancing.MethodsMobile device location data were used to quantify declines in movement by county (n=2,633) in the United States of America, comparing April 15–17 (n=65,544,268 traces) to baseline of February 17 - March 7. Negative binomial regression was used to estimate gradients of privilege across eleven healthcare and economic indicators, adjusting for rurality and stay-at-home mandates. External validation used separate venue-specific data from Google Location Services.FindingsCounties without stay-at-home orders showed a mobility decline of −52·3% (95% CI: −50·3%, −54·3%), slightly less than the decline in mandated areas (−60·8%; 95% CI: −60·0%, −61·6%). Strong linear gradients in privilege were observed. After adjusting for rurality and stay-at-home orders, counties in the highest quintile of social distancing mobility restriction had: 52% less uninsured, 47% more primary care providers, 29% more exercise space, 27% less food insecurity, 26% less child poverty, 17% higher incomes, 14% less overcrowding, 9·6% more racial segregation, 8·2% less youth, 7·4% more elderly, and 6·2% less influenza vaccination, compared to least social distancing areas.InterpretationHealthier and wealthier counties displayed a social distancing privilege gap, measured via smartphone mobility change. Structural inequities in this key countermeasure will influence immunity, and disease incidence and mortality.FundingNone

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Design Thinking to Support the Development of a Safe Web-Based Health Information Seeking Platform for Older Adult Populations

10.36227/techrxiv.16679776 ◽

2021 ◽

Author(s):

Eden Shaveet ◽

Marissa Gallegos ◽

Jonathan Castle ◽

Alison Bryant ◽

Lisa Gualtieri

Keyword(s):

Older Adults ◽

Health Information ◽

Older Adult ◽

Information Seeking ◽

Design Thinking ◽

Digital Health ◽

Age Groups ◽

The United States ◽

Health Information Seeking ◽

Information Platform

Abstract— The pervasiveness of online mis/disinformation escalated during the COVID-19 pandemic. To address the proliferation of online mis/disinformation, it is critical to build safety into the tools older adults use to seek health information. On average, older adult populations demonstrate disproportionate susceptibility to false messages under the guise of informative authority and were the most engaged with false information about COVID-19 across online platforms when compared to other age-groups. In a design-thinking challenge posed by AARP to graduate students in a Digital Health course at Tufts University School of Medicine, students leveraged existing solutions to develop a health information platform that is responsive to both passive and active health information-seeking methods utilized by older adults in the United States. This paper details the design-thinking process employed, results of primary research, an overview of the prototyped platform, and insights relating to the design of effective health information-seeking platforms for older adults.

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Design Thinking to Support the Development of a Safe Web-Based Health Information Seeking Platform for Older Adult Populations

10.36227/techrxiv.16679776.v1 ◽

2021 ◽

Author(s):

Eden Shaveet ◽

Marissa Gallegos ◽

Jonathan Castle ◽

Alison Bryant ◽

Lisa Gualtieri

Keyword(s):

Older Adults ◽

Health Information ◽

Older Adult ◽

Information Seeking ◽

Design Thinking ◽

Digital Health ◽

Age Groups ◽

The United States ◽

Health Information Seeking ◽

Information Platform

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Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers

British Journal of General Practice ◽

10.3399/bjgp18x696833 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X696833 ◽

Cited By ~ 1

Author(s):

Leah Ffion Jones ◽

Emily Cooper ◽

Cliodna McNulty

Keyword(s):

Older Adults ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Care Home ◽

Asymptomatic Bacteriuria ◽

Theoretical Domains Framework ◽

Antibiotic Use ◽

Primary Care Providers ◽

Care Providers ◽

Tract Infections

BackgroundEscherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.AimTo help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.MethodFocus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.ResultsCarers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurseConclusionA final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/

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Effects of Cardiovascular Disease and Related Risk Factors on Neurocognition

The Oxford Handbook of Adult Cognitive Disorders ◽

10.1093/oxfordhb/9780190664121.013.5 ◽

2019 ◽

pp. 83-116

Author(s):

Spencer W. Liebel ◽

Lawrence H. Sweet

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Cognitive Processing ◽

Health Care Providers ◽

The United States ◽

Research Literature ◽

Neurocognitive Functioning ◽

Care Providers ◽

Cardiac Events ◽

Related Risk

Cardiovascular disease (CVD) affects approximately 44 million American adults older than age 60 years and remains the leading cause of death in the United States, with approximately 610,000 each year. With improved survival from acute cardiac events, older adults are often faced with the prospect of living with CVD, which causes significant psychological, social, and economic hardship. The various disease processes that constitute CVD also exert a deleterious effect on neurocognitive functioning. Although existing knowledge of neurocognitive functioning in CVD and its subtypes is substantial, a review of these findings by CVD type and neurocognitive domain does not exist, despite the potential impact of this information for patients, health care providers, and clinical researchers. This chapter provides a resource for clinicians and researchers on the epidemiology, mechanisms, and neurocognitive effects of CVDs. This chapter includes a discussion of neurocognitive consequences of CVD subtypes by neuropsychological domain and recommendations for assessment. Overall, the CVD subtypes that have the most findings available on specific neurocognitive domains are heart failure, hypertension, and atrial fibrillation. Despite a large discrepancy between the number of available studies across CVD subtypes, existing literature on neurocognitive effects by domain is consistent with the literature on the neurocognitive sequelae of unspecified CVD. Specifically, the research literature suggests that cognitive processing speed, attention, executive functioning, and memory are the domains most frequently affected. Given the prevalence of CVDs, neuropsychological assessment of older adults should include instruments that allow consideration of these potential neurocognitive consequences of CVD.

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Teaching Family Nurse Practitioner Students to Provide Mental Health Care to Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.034 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 10-11

Author(s):

Victoria Grando ◽

Roy Grando

Keyword(s):

Mental Health ◽

Older Adults ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Treatment Plan ◽

Primary Care Providers ◽

Neurocognitive Disorders ◽

Mental Condition ◽

Care Providers

Abstract In recent years, FNPs have been challenged to deliver mental health services in the primary care setting. Over half of mental health services are provided in primary care, and one-quarter of all primary care patients have a mental disorder. Moreover, 20% of older adults have a mental or neurological disorder often not diagnosed. Nationally, it is estimated that 17% of older adults commit suicide, 15% have a mental condition, 11% have dementia, and 5% have a serious mental condition. There is a paucity of adequately prepared primary care providers trained in geropsychiatric treatment. A didactic course was developed to instruct FNP students in the skills needed to provide mental health treatment in primary care. We discuss mental illness in the context of culture to ensure that treatment is congruent with a patient’s unique cultural background and experiences. This shapes the patients’ beliefs and behaviors that influence the way they view their condition and what they perceive as acceptable solutions. We then go into detail about the common mental conditions that older adults exhibit. Through the case study method, students learn to identify the presenting problem, protocols for analyzing the case, which includes making differential diagnoses and a treatment plan including initial medications, non-medical treatments, and referral. Students are introduced to the DMS-5 to learn the criteria for mental health diagnosis with an emphasis on suicide, depressive disorders, anxiety disorders, bipolar disorders, substance use disorders, and neurocognitive disorders. We have found that students most often misdiagnose neurocognitive disorders.

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145. Monthly Antibiotic Prescribing Peer Comparison Combined with In-person Education Decreases Antibiotic Prescribing for Acute Respiratory Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.190 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S83-S83

Author(s):

Shelby J Kolo ◽

David J Taber ◽

Ronald G Washburn ◽

Katherine A Pleasants

Keyword(s):

Primary Care ◽

Respiratory Infections ◽

Primary Care Providers ◽

The United States ◽

Delivery Mode ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Care Providers ◽

Intervention Period ◽

Provider Education

Abstract Background Inappropriate antibiotic prescribing is an important modifiable risk factor for antibiotic resistance. Approximately half of all antibiotics prescribed for acute respiratory infections (ARIs) in the United States may be inappropriate or unnecessary. The purpose of this quality improvement (QI) project was to evaluate the effect of three consecutive interventions on improving antibiotic prescribing for ARIs (i.e., pharyngitis, rhinosinusitis, bronchitis, common cold). Methods This was a pre-post analysis of an antimicrobial stewardship QI initiative to improve antibiotic prescribing for ARIs in six Veterans Affairs (VA) primary care clinics. Three distinct intervention phases occurred. Educational interventions included training on appropriate antibiotic prescribing for ARIs. During the first intervention period (8/2017-1/2019), education was presented virtually to primary care providers on a single occasion. In the second intervention period (2/2019-10/2019), in-person education with peer comparison was presented on a single occasion. In the third intervention period (11/2019-4/2020), education and prescribing feedback with peer comparison was presented once in-person followed by monthly emails of prescribing feedback with peer comparison. January 2016-July 2017 was used as a pre-intervention baseline period. The primary outcome was the antibiotic prescribing rate for all classifications of ARIs. Secondary outcomes included adherence to antibiotic prescribing guidance for pharyngitis and rhinosinusitis. Descriptive statistics and interrupted time series segmented regression were used to analyze the outcomes. Results Monthly antibiotic prescribing peer comparison emails in combination with in-person education was associated with a statistically significant 12.5% reduction in the rate of antibiotic prescribing for ARIs (p=0.0019). When provider education alone was used, the reduction in antibiotic prescribing was nonsignificant. Conclusion Education alone does not significantly reduce antibiotic prescribing for ARIs, regardless of the delivery mode. In contrast, education followed by monthly prescribing feedback with peer comparison was associated with a statistically significant reduction in ARI antibiotic prescribing rates. Disclosures All Authors: No reported disclosures

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