Application of Blockchain in E-Healthcare Systems

The e-healthcare system maintains sensitive and private information about patients. In any e-healthcare system, exchanging health information is often required, making privacy and security a primary concern for e-healthcare systems. Another major issue is that existing e-healthcare systems use centralized servers. These centralized servers require high infrastructure and maintenance costs for day-to-day services. Along with that, server failure may affect the working of e-healthcare systems drastically and may create life-threatening situations for patients. Blockchain technology is a very useful way to provide decentralized, secure storage for healthcare information. A blockchain is a time-stamped series of immutable records of data that is managed by a cluster of computers not owned by any single entity. These blocks create a chain of immutable, tamper-proof blocks in a ledger. This chapter will discuss the different aspects of blockchain and its application in different fields of the e-healthcare system.

Contextualising English generalist day centres for older people: operational characteristics and typical days. Findings from case study research

Reports of Covid-19 pandemic related day centre closures impacting negatively on their attenders and family carers have fuelled a resurgence of interest in day centres, a common, but often ‘invisible’, preventive service. The absence of detailed descriptions of these services from the literature limits the evidence base since outcomes data without context are less meaningful. This descriptive article aims to further understanding of these diverse and multi-faceted settings for potential collaborators and social care and health professionals, particularly in the context of rising social prescribing initiatives in England with their focus on linking older people to asset-based community resources. Using data from documentation provided by managers of four purposively selected English day centres for older people, interviews with 23 centre managers, staff and volunteers, and notes made during 56 full-day visits, this article presents a rich, contemporary, non-interpretative, pre-Covid pandemic picture of four purposively selected English day centres for older people.This baseline data will support conversations concerning optimisation of such services in the post-pandemic recovery period and beyond: how buildings may be regarded as valuable community assets with potential, and how other parts of the health and care system may better interact with day services to improve older people’s, carers’ and others’ health and wellbeing, and to benefit of staff working elsewhere in health and care.

Weekend Admissions for Somatic Symptom and Related Disorders and Length of Stay

OBJECTIVES: To evaluate whether admission on weekends affects the length of stay (LOS) for patients hospitalized with somatic symptom and related disorders (SSRDs). METHODS: Data from 2012–2018 was obtained for all patients aged 4 to 21 years (N = 5459) with a primary discharge diagnosis of SSRDs from 52 tertiary care pediatric hospitals in the United States. We obtained patient demographics, admission date and/or time, LOS, procedure count, and comorbid conditions. We defined a weekend as 3 pm Friday to 3 pm Sunday. The Wilcoxon rank test was used for unadjusted analysis. Multiple logistic regression was used to estimate the odds of having LOS >1 day, >2 days, >3 days, and >4 days in weekend versus weekday groups. RESULTS: Weekend admission significantly correlated with increased LOS (P < .001). Compared with weekdays, a weekend admission was associated with increased odds of having LOS >1, >2, and >3 days. This remained statistically significant while adjusting for the number of chronic conditions, procedures, and individuals with Black or Hispanic ethnicity compared with White ethnicity. LOS was not associated with sex or age of the patients. CONCLUSIONS: Patients with SSRDs admitted on the weekend have an increased LOS compared with those admitted on a weekday. This may be due to a decrease in multidisciplinary care available during weekends. In future studies, researchers should aim to better understand the specific factors that contribute to this disparity and test interventions that may close the gap in care, including expanding to 7-day services, increasing mental health resources, and working to decrease the need for inpatient admissions.

Temporal Patterns of Daily Behavioral and Psychological Symptoms of Dementia Throughout the Day

Behavioral and psychological symptoms of dementia (BPSD) are taxing for both the person with dementia (PWD) and their family caregivers. Yet, little is known about how BPSD fluctuates throughout the day (i.e., morning, daytime, evening, and night; e.g., sundowning) and how caregivers perceive BPSD at different times of the day. Using 8-day daily diary data from 173 family caregivers whose relatives were using Adult Day Services (ADS), this study investigated temporal patterns of BPSD and caregivers’ stress responses to BPSD throughout the day. Overall, the number of BPSD was highest in the evening, and caregivers’ stress reactivity to BPSD increased throughout the phases of the day (i.e., most stressful at night). However, caregivers showed lower reactivity to BPSD in the mornings and at night on days when the PWD used ADS. Our findings about fluctuations of (caregiver reactions to) BPSD throughout the day suggest target windows for just-in-time adaptive intervention.

Daily Cortisol Total Output Mediated Sleep and Affect Among Dementia Family Caregivers

Cortisol is a primary stress hormone associated with sleep. We examined daily cortisol as the potential mechanism linking prior night’s sleep and daily mood among 173 dementia family caregivers (M (SD) age = 61.97 (10.66)) who used adult day services (ADS) at least two days a week. Caregivers self-reported sleep characteristics (bed and wake time, sleep quality, care receiver’s night-time problems) and affect (anxiety, depressive symptoms) across eight consecutive ADS/non-ADS days. Salivary cortisol was collected five times each day. Multilevel mediation analysis suggested that daily cortisol total output (assessed as “area under the curve”) mediated prior nights’ total time in bed and daily anxiety, but only on high-stress (non-ADS) days. Mediation was non-significant on low-stress (ADS) days, and at the between-person level. ADS use is respite from a chronically stressful role. Reducing exposure to stress via respite may protect against harmful processes related to sleep, cortisol reactivity, and daily anxiety.

Caring for a Family Member Living With Dementia When Adult Day Services Close

Adult Day Service (ADS) centers play an important role in community services that help families keep a person living with dementia (PLWD) at home. We interviewed 33 family caregivers about their experience during the COVID-19 Pandemic and the shutdown of the ADS centers where the PLWD attends. All 33 (100%) reported that the ADS center was shut for a period of time (range: 2 weeks – remain closed). Caregivers reported a decline in their physical health (33%,n=11) and mental health (52%,n=17) and an increase in feelings of loneliness (48%,n=16). For the PLWD, the caregivers noted, a decline in physical (48%,n=16) and mental (55%,n=18) health and an increase in behaviors (39%,n=13). The shutdown of most ADS centers across the country due to the COVID-19 pandemic has had implications not only for the ADS sites but for the families that entrust them with the care for a family member.

Caregiver Stress: Biomarkers Linked to Disease Risk and the Psychobiology of Stress Reduction

Caregivers to older adults with chronic diseases frequently experience chronic stress which can negatively affect caregivers’ physical and mental health, and increase disease risk. This interdisciplinary symposium will highlight critical factors influencing caregiver stress, and the role of biomarkers in detecting caregiver disease risk. First, we will discuss the effects of stress and emotional experiences on risk for cardiovascular disease in caregivers of persons with dementia (PWD). In the first talk, Dr. Mausbach will examine relationships among perceived stress, blood glucose and risk of diabetes and cardiovascular disease in caregivers of PWD. Next, Dr. Losada-Baltar will discuss the degree to which caregivers’ ambivalent feelings towards providing care are associated with inflammatory markers of cardiovascular risk. Following this, two talks will investigate critical links between stress and caregiver emotional well-being. Dr. Liu will report relationships among the stress-related hormone cortisol, sleep, and anxiety in the context of adult day services. Dr. Beadle will examine the degree to which caregivers’ affiliative, empathetic interactions with others relate to their experience of stress through cortisol assessments and neuroimaging. The final talk by Dr. Jain will investigate the effects of a Mentalizing Imagery Therapy intervention for family PWD caregivers on stress, evidence for mindfulness as a causal mediator of stress reduction, and the relationship to brain networks associated with emotion regulation. Taken together, this symposium will identify relevant psychosocial and biological factors that contribute to caregiver stress, as well as discuss the psychobiology of amelioration of caregiver stress.

Geographic distribution of availability of adult day services in Missouri

Adult day service (ADS) is an important component of long-term supportive services. Geographic availability of ADS is an essential factor for aging in place especially for people with assistance needs. This study aims to examine the geographic distribution of availability of ADS and its relationship with the disadvantaged characteristics of neighborhoods. Data from the Missouri Department of Health and Senior Services and the American Community Survey were utilized. Geographic availability of ADS was measured as capacity (number of clients served) of ADS centers per week divided by the number of people who were 65 or older and under poverty at the census tract level. To examine neighborhood disadvantaged characteristics, principal component analysis was applied to construct a socioeconomic deprivation index (SDI). Using geographic information systems, we mapped ADS centers, geographic availability of ADS, and SDI scores. Pearson correlation coefficient was calculated between geographic availability of ADS and SDI scores. In 92.3% of the census tracts in Missouri, ADS centers are not available. Further, ADS centers are less likely to locate in rural areas or census tracts with higher numbers of residents 65 or older and poor. Also, lower availability of ADS was associated with higher levels of neighborhood disadvantage at a marginal level (r = - 0.163). Our findings suggested that strategies should be identified to provide ADS in rural areas, especially in the areas with higher levels of neighborhood disadvantage. Further investigation on the geographic distribution of ADS accessibility and its association with neighborhood characteristics is warranted.

Adult Day Services as an Essential Service and Support

Throughout the COVID-19 pandemic, the significant challenges and gaps related to the care of older people in the U.S. were made distressingly apparent. This summary presentation will consider the effects of COVID-19 and associated shutdowns on older persons who use ADS programs, their family caregivers, and programs/staff themselves. Among recommendations to consider are the classification of adult day services and similar community-based long-term care providers as essential (and clarifying their difference from senior centers). In addition, considering new financing approaches and utilizing ADS or similar community-based programs as incubators of evidence-based innovation are options to consider to better align ADS with optimal dementia care.