Faculty Bibliography

OBJECTIVES/OBJECTIVE:To assess the causal directions of interaction between depression and decline in will to live (WTL) over 2 years in community-dwelling older adults. DESIGN/METHODS:Community-based longitudinal study. SETTING/METHODS:Three large cities in Israel. PARTICIPANTS/METHODS:Individuals aged 75 and older (N=870). MEASUREMENTS/METHODS:We tested a cross-lagged structural equation model in which WTL and depressive symptoms (DS) were tested as latent variables at each of three annual points of measurement. RESULTS:Of the health and sociodemographic covariates examined, only self-rated health predicted WTL and DS, and age predicted WTL. WTL predicted DS at each point of measurement. In addition to these cross-sectional effects, WTL also predicted DS 12 months later at the second and third year. In other words, the direction of prediction was exclusively from WTL to DS, concomitantly and over time. CONCLUSION/CONCLUSIONS:Our results indicate that WTL predicts DS rather than vice versa, suggesting that decline in WTL contributes and leads to depression at present and in future. Health strategies designed to promote WTL in older adults may help forestall depression. Moreover, psychotherapeutic interventions targeting WTL might be effective in the treatment of depression.

PURPOSE: Superstorm Sandy forced the evacuation and extended shutdown of New York University Langone Medical Center. This investigation explored how nurses were impacted by the disasters and how they can best be supported in their nursing responsibilities. DESIGN: Sequential mixed methods were used to explore the psychosocial issues nurses experienced throughout the course of this natural disaster and its lingering aftermath. METHODS: In-depth interviews were conducted from April to June 2013 with a subsample of nurses who participated in the evacuation deployment (n = 16). An anonymous, Internet-based cross-sectional survey sent to all registered nurses employed at the hospital at the time of the storm explored storm impact and recovery. Between July and September 2013, 528 surveys were completed. FINDINGS: The qualitative data revealed challenges in balancing professional obligations and personal concerns. Accounts described dealing in the immediate recovery period with unexpected job changes and resultant work uncertainty. The storm's lingering aftermath did not signify restoration of their predisaster lifestyle for some, but necessitated coping with this massive storm's long-lasting impact on their personal lives and communal loss. CONCLUSIONS: Nurses working under the rapidly changing, uncontrolled, and potentially dangerous circumstances of a weather-related disaster are also experiencing concerns about their families' welfare and worries about personal loss. These multiple issues increase the psychosocial toll on nurses during a disaster response and impending recovery. CLINICAL RELEVANCE: Awareness of concerns and competing demands nurses experience in a disaster and aftermath can inform education and services to enable nurses to perform their critical functions while minimizing risk to patients and themselves.

PURPOSE: Weather-related disasters have increased dramatically in recent years. In 2012, severe flooding as a result of Hurricane Sandy necessitated the mid-storm patient evacuation of New York University Langone Medical Center. The purpose of this study was to explore, from the nurses' perspective, what the challenges and resources were to carrying out their responsibilities, and what the implications are for nursing education and preparation for disaster. DESIGN: This mixed-methods study included qualitative interviews with a purposive sample of nurses and an online survey of nurses who participated in the evacuation. METHODS: The interviews explored prior disaster experience and training, communication, personal experience during the evacuation, and lessons learned. The cross-sectional survey assessed social demographic factors, nursing education and experience, as well as potential challenges and resources in carrying out their disaster roles. FINDINGS: Qualitative interviews provided important contextual information about the specific challenges nurses experienced and their ability to respond effectively. Survey data identified important resources that helped nurses to carry out their roles, including support from coworkers, providing support to others, personal resourcefulness, and leadership. Nurses experienced considerable challenges in responding to this disaster due to limited prior disaster experience, training, and education, but drew on their personal resourcefulness, support from colleagues, and leadership to adapt to those challenges. CONCLUSIONS: Disaster preparedness education in schools of nursing and practice settings should include more hands-on disaster preparation exercises, more "low-tech" options to address power loss, and specific policies on nurses' disaster roles. CLINICAL RELEVANCE: Nurses play a critical role in responding to disasters. Learning from their disaster experience can inform approaches to nursing education and preparation.

Disasters disproportionately impact certain segments of the population, including children, pregnant women, people living with disabilities and chronic conditions and those who are underserved and under-resourced. One of the most vulnerable groups includes the community-dwelling elderly. Post-disaster analyses indicate that these individuals have higher risk of disaster-related morbidity and mortality. They also have suboptimal levels of disaster preparedness in terms of their ability to shelter-in-place or evacuate to a shelter. The reasons for this have not been well characterized, although impaired health, financial limitations, and social isolation are believed to act as barriers to preparedness as well as to adaptability to changes in the environment both during and in the immediate aftermath of disasters. In order to identify strategies that address barriers to preparedness, we recently conducted a qualitative study of 50 elderly home care recipients living in San Francisco. Data were collected during in-home, in-person interviews using a semi-structured interview guide that included psychosocial constructs based on the social cognitive preparedness model and a new 13-item preparedness checklist. The mean preparedness score was 4.74 (max 13, range 1-11, SD. 2.11). Over 60 % of the participants reported that they had not made back-up plans for caregiver assistance during times of crisis, 74 % had not made plans for transportation to a shelter, 56 % lacked a back-up plan for electrical equipment in case of power outages, and 44 % had not prepared an emergency contacts list-the most basic element of preparedness. Impairments, disabilities, and resource limitations served as barriers to preparedness. Cognitive processes that underlie motivation and intentions for preparedness behaviors were lacking. There were limitations with respect to critical awareness of hazards (saliency), self-efficacy, outcome expectancy, and perceived responsibility. There was also a lack of trust in response agencies and authorities and a limited sense of community. Participants wanted to be prepared and welcomed training, but physical limitations kept many of them home bound. Training of home care aides, the provision of needed resources, and improved community outreach may be helpful in improving disaster outcomes in this vulnerable segment of the population.

OBJECTIVE: Although the epidemiology and prevention of falls has been well studied, the focus has been on indoor rather than outdoor falls. Older adults' knowledge of outdoor risk factors and their outdoor fall prevention practices have not been examined. To fill this gap, and to inform the development of a prevention program, we sought to explore the experiences and fall prevention knowledge and practices of older adults who had sustained an outdoor fall. METHODS: A cross-sectional study using random digit telephone dialing was used to survey community dwelling seniors (N=120) across the five boroughs of New York City. We used the Outdoor Falls Questionnaire (OFQ), a valid and reliable tool as the survey instrument. Perceived outdoor fall risks, strategies used for prevention, and outdoor fall experiences were examined. SPSS version 21 was used for descriptive analysis of participant characteristics and to determine frequencies of perceived outdoor fall risks and strategies used for prevention. Phenomenological analysis was used with the qualitative data. Qualitative and quantitative data were analyzed separately and a mixed methods matrix was used to interpret and integrate the findings. RESULTS: Analysis revealed diverse unmet education and training needs including the importance of using single vision glasses, understanding the fall risks associated with recreational areas and parking lots, safe outdoor walking strategies, safe carrying of items on level and uneven surfaces, as well as when walking up and down stairs, and safety in opening/closing doors. CONCLUSIONS: Study findings are informative for outdoor fall prevention programs as well as practice.

OBJECTIVES: The aim of this study was to test a conceptual model designed to promote the understanding of factors influencing subjective well-being (SWB) in old age. Within this framework, we evaluated the relative influences on elderly Israelis' SWB of health and/or function, personal resources, coping behaviors (reactive and proactive), and changes in all of these factors over time. METHOD: At baseline, 1216 randomly selected elderly persons (75+) were interviewed at home (T1) and 1019 one year later (T2). The conceptual model was evaluated by Structural Equation Modeling (SEM) analysis using AMOS 18. RESULTS: After one year, a relatively high percentage of participants reported decline in health/function (DHF) and in personal resources. The effects of the study variables on T2-SWB were evaluated by a SEM analysis, resulting in a satisfying fit: chi2 = 279.5 (df = 102), p < .001, CFI = .970, NFI = .954, TLI = .955, RMSEA = .046. In addition to significant direct effects of health/function on T2-SWB, health/function was found to indirectly influence T2-SWB. Our analysis showed that health/function had a negative influence on the positive effects of personal resources (function self-efficacy, social support) and the diverse effects of the coping patterns (goal-reengagement - positive; expectations for future care needs - negative; having concrete plans for future care - positive). CONCLUSION: Personal resources and use of appropriate coping behaviors enable elderly people to control their well-being even in the presence of DHF. Evidence-based interventions can help older people to acquire and/or strengthen effective personal resources and coping patterns, thus, promoting their SWB.

Background/UNASSIGNED:Muslims are one of the fastest growing religious groups in the US. However, little is known about their health disparities, and how their unique cultural, religious, and social beliefs and practices affect health behaviors and outcomes. Studies demonstrate Muslim women may have lower rates of breast and cervical cancer screening compared to the overall population. Methods/UNASSIGNED:The purpose of this study was to: 1) conduct key-informant interviews with Muslim community leaders in New York City (NYC), to understand contextual factors that impact Muslim women's beliefs and practices regarding breast and cervical cancer screening; and 2) inform the development and implementation of a research study on breast and cervical cancer screening among Muslims. Twelve key-informant interviews were conducted. The sample included imams, female religious leaders, physicians, community-based organization leaders, and social service representatives. The interview guide assessed: 1) unique healthcare barriers faced by Muslim women; 2) cultural and social considerations in conducting research; 3) potential strategies for increasing screening in this population; and 4) content and venues for culturally tailored programming and messaging. Results/UNASSIGNED:Key informants noted structure and culture as barriers and religion as a facilitator to breast and cervical cancer screening. Themes regarding the development of targeted health campaigns to increase screening included the importance of educational and in-language materials and messaging, and engaging mosques and religious leaders for dissemination. Conclusion/UNASSIGNED:Although Muslim women face a number of barriers to screening, religious beliefs and support structures can be leveraged to facilitate screening and enhance the dissemination and promotion of screening.

Objective: Human immunodeficiency virus (HIV), a chronic illness for those accessing treatment, requires a paradigm shift moving from viral measurements alone to a perspective that encompasses quality of life as defined by the index person and his support system. HIV positive young men who have sex with men are at high risk for poor outcomes and for spreading disease, in part, because they are difficult to engage and retain in care. Outpatient staff themselves may be a contributing factor. We employed the palliative approach early (ePA) to assist non-palliative outpatient staff in improving outcomes for a difficult to engage and retain HIV population. Methods: Grounded in multidisciplinary, US-based didactic and iterative educational methods, we trained a multidisciplinary coaching team in elements of the palliative approach previously observed applicable to outpatient HIV disease management in international resource-constrained settings. On-site case discussion and coaching, with quarterly in-service educational sessions for all staff, then followed. An independent stakeholder advisory panel gave input at each step of the curriculum refinement. The curriculum was introduced in one US HIV clinic where a second HIV clinic served as the control. Results: The ePA attends to patients' holistic needs at critical life-course transitions. We introduced 8 PA skills: need for staff self-care when learning new skills; basic team building; respect for the individual; P2/S2 assessment (physical; psychoemotional; social; spiritual); communication skills about difficult to discuss topics; calendar driven goal-setting rather than crisis driven; symptom recognition and management; and reflection. Accepted behavior change techniques were employed and challenges observed. Discussion: External factors, such as a syndemic environment, may impact the ability of both patients and staff to form relationships. Point-of-service self-care strategies are critical when introducing new skills. The palliative approach used early may assist HIV staff in understanding the impact of care delivery upon specific patients and facilitate patients' engagement and retention in care