Faculty Bibliography
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188
Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia
OBJECTIVES/OBJECTIVE:The end-of-life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:A large not-for-profit agency in New York City. PARTICIPANTS/METHODS:A total of 2629 hospice patients with dementia age 65 years and older. MEASUREMENTS/METHODS:Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). RESULTS:Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34-4.38; Hispanic: aOR = 2.99; 95% CI = 1.81-4.94). Home hospice (aOR = 7.57; 95% CI = 4.04-14.18), longer length of service (aOR = 1.04; 95% CI = 1.04-1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56-2.21) were also associated with live discharge. CONCLUSION/CONCLUSIONS:To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end-of-life trajectory of patients with dementia.
PMID: 31750935
ISSN: 1532-5415
CID: 4215292
A Descriptive Analysis of an Ambulatory Kidney Palliative Care Program
PMID: 31295050
ISSN: 1557-7740
CID: 3976762
Sojourn's Scholars Present: In the Expert's Studio [Meeting Abstract]
ISI:000509464700180
ISSN: 0885-3924
CID: 4304882
Pilot Testing of Aliviado Dementia Care-Hospice Edition-A Quality Assurance and Performance Improvement Program for Better Hospice Dementia Care [Meeting Abstract]
ISI:000509464700153
ISSN: 0885-3924
CID: 4304872
Improving Support for Family Caregivers of People with a Serious Illness in the United States: Strategic Agenda and Call to Action
PMCID:8241318
PMID: 34223450
ISSN: 2689-2820
CID: 5079882
A Scoping Review of Dementia Symptom Management in Persons with Dementia Living in Home-based Settings
Background/UNASSIGNED:A large proportion of our older adults live with Alzheimer's Disease and Related Dementias and the number of those diagnosed in the future is expected to increase dramatically as the population ages. Persons with dementia bring unique healthcare challenges due to the manifestation of behavioral and psychological symptoms associated with the disease. The lack of geriatric clinicians as well as a properly trained non-geriatric specialist workforce capable of addressing the symptoms persons with dementia exacerbate the challenge of providing effective care. Pharmacological interventions are contraindicated for treatment of most behavioral psychological symptoms of dementia (BPSD). The Centers for Medicare and Medicaid Services now requires that nonpharmacological interventions be used as a first-line treatment. It has not been determined what nonpharmacological intervention for BPSD are most effective and what the infrastructure would entail for such interventions for PWD living at home. Purpose of Review/UNASSIGNED:The purpose of this study is to examine the literature focusing on interventions aimed towards managing persons' symptoms of dementia living in home-based settings. A scoping review examining the literature published on this topic over the last three years was conducted. Recent Findings/UNASSIGNED:One thousand twenty four articles were found, of which nine met inclusion criteria. Five articles used occupational based therapy, two used exercise therapy and one article was found utilizing aromatherapy and music therapy.
PMCID:7864153
PMID: 33552845
ISSN: 2196-7865
CID: 4785142
Racial Disparities in Nutritional Risk among Community-Dwelling Older Adults in Adult Day Health Care
Information regarding nutritional risk among users of American adult day health centers (ADHCs), 60% of whom are racial minorities, is scant. This study examined nutritional risk and associated factors in a diverse sample ADHC users aged 50+ using secondary cross-sectional analysis of data collected between 2013 and 2017. Risk was assessed using the DETERMINE checklist, and results were stratified by race. The majority of the sample (N = 188) was at moderate (45.2%) or high (38.5%) nutritional risk, with statistically significant racial differences. Blacks were at greater risk than any other group: 65% had high nutritional risk; 76.5% ate <5 servings of fruits, vegetables, or milk daily; 21% ate <2 meals daily, 48.5% reported involuntary weight loss/gain, and 41.2% had tooth loss/mouth pain. Older adults in ADHCs are at elevated risk of malnutrition, disproportionately so amongst blacks. Both routine nutrition screening and population-specific approaches are needed to attenuate risk.
PMID: 31361195
ISSN: 2155-1200
CID: 4015052
Primary Palliative Care for Emergency Medicine (PRIM-ER): Protocol for a Pragmatic, Cluster-Randomised, Stepped Wedge Design to Test the Effectiveness of Primary Palliative Care Education, Training and Technical Support for Emergency Medicine
INTRODUCTION/BACKGROUND:Emergency departments (ED) care for society's most vulnerable older adults who present with exacerbations of chronic disease at the end of life, yet the clinical paradigm focuses on treatment of acute pathologies. Palliative care interventions in the ED capture high-risk patients at a time of crisis and can dramatically improve patient-centred outcomes. This study aims to implement and evaluate Primary Palliative Care for Emergency Medicine (PRIM-ER) on ED disposition, healthcare utilisation and survival in older adults with serious illness. METHODS AND ANALYSIS/UNASSIGNED:This is the protocol for a pragmatic, cluster-randomised stepped wedge trial to test the effectiveness of PRIM-ER in 35 EDs across the USA. The intervention includes four core components: (1) evidence-based, multidisciplinary primary palliative care education; (2) simulation-based workshops; (3) clinical decision support; and (4) audit and feedback. The study is divided into two phases: a pilot phase, to ensure feasibility in two sites, and an implementation and evaluation phase, where we implement the intervention and test the effectiveness in 33 EDs over 2 years. Using Centers for Medicare and Medicaid Services (CMS) data, we will assess the primary outcomes in approximately 300 000 patients: ED disposition to an acute care setting, healthcare utilisation in the 6 months following the ED visit and survival following the index ED visit. Analysis will also determine the site, provider and patient-level characteristics that are associated with variation in impact of PRIM-ER. ETHICS AND DISSEMINATION/UNASSIGNED:Institutional Review Board approval was obtained at New York University School of Medicine to evaluate the CMS data. Oversight will also be provided by the National Institutes of Health, an Independent Monitoring Committee and a Clinical Informatics Advisory Board. Trial results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER/BACKGROUND:NCT03424109; Pre-results.
PMID: 31352424
ISSN: 2044-6055
CID: 4010352
Racial Disparities in Nutritional Risk and Its Association with Chronic Disease and Health Outcomes Among Community-Dwelling Older Adults in the Adult Day Health Setting (P04-121-19)
Objectives/UNASSIGNED:Adult day health centers (ADHCs) serve >260,000 chronically ill individuals annually and are a preferred long-term care source for racial minorities, who also experience diet related disparities. Evidence regarding prevalence of nutritional risk is needed to inform dietary intervention planning in ADHCs. This study (1) identified prevalence of nutritional risk and associated factors, in a diverse sample of older ADHC users, (2) stratified differences in nutritional risk by race, and (3) explored associations between nutritional risk, chronic illness, and healthcare utilization. Methods/UNASSIGNED: < .05) differences among White Non-Hispanics, Blacks, Hispanics, and Asians aged >50. Bivariate chi-square tests were used to explore associations between nutritional risk and chronic disease, as well as healthcare utilization. Results/UNASSIGNED: = .01) were significant. Among blacks, 76.5% ate < 5 servings of fruits, vegetables, or milk daily, compared to 39.5% of whites; 21% of blacks ate <2 meals a day, compared to 2% of whites and Hispanics. Blacks (48.5%) more often reported involuntary weight loss/gain compared to whites (23.3%), and had the highest prevalence of tooth loss/mouth pain (41.2%) of any racial group. Conclusions/UNASSIGNED:Older adults in ADHCs are at elevated risk of malnutrition, and blacks disproportionately so. Routine nutritional screening in ADHCs should be considered, but customized population specific approaches are needed to address unique drivers of malnutrition risk. Funding Sources/UNASSIGNED:New York University Center for the Study of Asian American Health Pilot Project Program for Alzheimer's Disease & Thomas J. Long Foundation. Supporting Tables Images and/or Graphs/UNASSIGNED/:
PMCID:6573918
PMID: 31223775
ISSN: 2475-2991
CID: 3939442
Analgesic prescribing trends in a national sample of older veterans with osteoarthritis: 2012-2017
Few investigations examine patterns of opioid and nonopioid analgesic prescribing and concurrent pain intensity ratings before and after institution of safer prescribing programs such as the October 2013 Veterans Health Administration system-wide Opioid Safety Initiative (OSI) implementation. We conducted a quasi-experimental pre-post observational study of all older U.S. veterans (≥50 years old) with osteoarthritis of the knee or hip. All associated outpatient analgesic prescriptions and outpatient pain intensity ratings from January 1, 2012 to December 31, 2016, were analyzed with segmented regression of interrupted time series. Standardized monthly rates for each analgesic class (total, opioid, nonsteroidal anti-inflammatory drug, acetaminophen, and other study analgesics) were analyzed with segmented negative binomial regression models with overall slope, step, and slope change. Similarly, segmented linear regression was used to analyze pain intensity ratings and percentage of those reporting pain. All models were additionally adjusted for age, sex, and race. Before OSI implementation, total analgesic prescriptions showed a steady rise, abruptly decreasing to a flat trajectory after OSI implementation. This trend was primarily due to a decrease in opioid prescribing after OSI. Total prescribing after OSI implementation was partially compensated by continuing increased prescribing of other study analgesics as well as a significant rise in acetaminophen prescriptions (post-OSI). No changes in nonsteroidal anti-inflammatory drug prescribing were seen. A small rise in the percentage of those reporting pain but not mean pain intensity ratings continued over the study period with no changes associated with OSI. Changes in analgesic prescribing trends were not paralleled by changes in reported pain intensity for older veterans with osteoarthritis.
PMID: 30913167
ISSN: 1872-6623
CID: 5079842
