Smart Technology for Aging and Reducing Disability (STAReD): Study protocol for a randomized pragmatic clinical trial.

BACKGROUND: There is a critical need to improve quality of life for community-dwelling older adults with disabilities. Prior research has demonstrated that a smart, in-home sensor system can facilitate aging in place for older adults living in independent living apartments with care coordination support by identifying early illness and injury detection. Self-management approaches have shown positive outcomes for many client populations. Pairing the smart, in-home sensor system with a self-management intervention for community-dwelling older adults with disabilities may lead to positive outcomes. METHODS: This study is a prospective, two-arm, randomized, pragmatic clinical trial to compare the effect of a technology-supported self-management intervention on disability and health-related quality of life to that of a health education control, for rural, community-dwelling older adults. Individuals randomized to the self-management study arm will receive a multidisciplinary (nursing, occupational therapist, and social work) self-management approach coupled with the smart-home sensor system. Individuals randomized to the health education study arm will receive standard health education coupled with the smart-home sensor system. The primary outcomes of disability and health-related quality of life will be assessed at baseline and post-intervention. Generalizable guidance to scale the technology-supported self-management intervention will be developed from qualitatively developed exemplar cases. CONCLUSION: This study has the potential to impact the health and well-being of rural, community-dwelling older adults with disabilities. We have overcome barriers including recruitment in a rural population and supply chain issues for the sensor system. Our team remains on track to meet our study aims.

A qualitative study of unpaid caregivers of persons living with dementia and their interactions with health and community-based services and providers.

BACKGROUND AND OBJECTIVES: Unpaid caregivers frequently feel underprepared and without adequate training, support, or access to services and resources to care for persons living with dementia. Health and community-based services and providers are critical to support persons living with dementia and their unpaid caregivers. The objective of this research is to understand how unpaid caregivers of persons living with dementia interact with health and community-based services and providers. RESEARCH DESIGN AND METHODS: We used a qualitative descriptive approach to analyze data from one-on-one semi-structured interviews with unpaid caregivers of persons living with dementia (N = 25). We used framework analysis to organize themes and sub-themes within the systems approach to healthcare delivery. FINDINGS: Participants described a need for additional guidance, information, and support from health and community-based services and providers. This need was described by participants at 4 levels: individual, care team, organization, and political and economic environment. Participants were active in proposing potential solutions to challenges at all 4 levels, including improving provider awareness and training in dementia, opportunities to provide resources and referrals upon dementia diagnosis, a central clearinghouse for information and resources for persons living with dementia and caregivers, and opportunities to close service gaps. DISCUSSION AND IMPLICATIONS: Findings of this study highlight the need for increased involvement of caregivers of persons living with dementia as community stakeholders for improving care and services. Recommendations to promote high quality care and better support unpaid caregivers by developing interventions to address multiple aspects of healthcare delivery are consistent with recent legislation and are important areas of future research.

Social Interactions between Family and Community-Based Service Providers in Dementia Caregiving.

Objectives: This study aimed to evaluate the psychosocial experiences in community-based dementia caregiving by assessing the characteristics of social interactions between family caregivers and community-based service providers and associated psychological responses.Methods: Two independent groups of participants (family caregivers and community-based service providers) completed a one-time survey to report their social interactions and psychological states. A linear regression model was fit for each outcome (satisfaction, 10-item CES-D) while controlling for significant relevant covariates.Results: Higher perceived levels of collaboration were associated with higher job satisfaction and lower depression score among service providers, and higher satisfaction with providers among family caregivers. Higher perceived social support from the provider was associated with higher satisfaction among family caregivers.Conclusions: Participants reported varying levels of provider-family collaboration. The extent of collaborations and support exchange may have implications on the psychological well-being of those providing care to individuals with dementia including families and providers.Clinical implications: It may be beneficial to identify providers and families who perceive low levels of collaboration and implement intervention to facilitate positive social interactions. Developing organizational culture and payment systems that value high-quality social interactions may help enhance the psychological well-being of service providers and satisfaction among families who receive their services.

Tracking personalized functional health in older adults using geriatric assessments.

BACKGROUND: Higher levels of functional health in older adults leads to higher quality of life and improves the ability to age-in-place. Tracking functional health objectively could help clinicians to make decisions for interventions in case of health deterioration. Even though several geriatric assessments capture several aspects of functional health, there is limited research in longitudinally tracking personalized functional health of older adults using a combination of these assessments. METHODS: We used geriatric assessment data collected from 150 older adults to develop and validate a functional health prediction model based on risks associated with falls, hospitalizations, emergency visits, and death. We used mixed effects logistic regression to construct the model. The geriatric assessments included were Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Short Form 12 (SF12). Construct validators such as fall risks associated with model predictions, and case studies with functional health trajectories were used to validate the model. RESULTS: The model is shown to separate samples with and without adverse health event outcomes with an area under the receiver operating characteristic curve (AUC) of > 0.85. The model could predict emergency visit or hospitalization with an AUC of 0.72 (95% CI 0.65-0.79), fall with an AUC of 0.86 (95% CI 0.83-0.89), fall with hospitalization with an AUC of 0.89 (95% CI 0.85-0.92), and mortality with an AUC of 0.93 (95% CI 0.88-0.97). Multiple comparisons of means using Turkey HSD test show that model prediction means for samples with no adverse health events versus samples with fall, hospitalization, and death were statistically significant (p < 0.001). Case studies for individual residents using predicted functional health trajectories show that changes in model predictions over time correspond to critical health changes in older adults. CONCLUSIONS: The personalized functional health tracking may provide clinicians with a longitudinal view of overall functional health in older adults to help address the early detection of deterioration trends and decide appropriate interventions. It can also help older adults and family members take proactive steps to improve functional health.

Technology for Healthy Independent Living: Creating a Tailored In-Home Sensor System for Older Adults and Family Caregivers.

Sensing technologies hold enormous potential for early detection of health changes that can dramatically affect the aging experience. In previous work, we developed a health alert system that captures and analyzes in-home sensor data. The purpose of this research was to collect input from older adults and family members on how the health information generated can best be adapted, such that older adults and family members can better self-manage their health. Five 90-minute focus groups were conducted with 23 older adults (mean age = 80 years; 87% female) and five family members (mean age = 64; 100% female). Participants were asked open-ended questions about the sensor technology and methods for interacting with their health information. Participants provided feedback regarding tailoring the technology, such as delegating access to family and health care providers, receiving health messages and alerts, interpreting health messages, and graphic display options. Participants also noted concerns and future likelihood of technology adoption. [Journal of Gerontological Nursing, 46(7), 35-40.].

A systematic review of interventions for older adults living in jails and prisons.

Objectives: The population of older adults in prison is the fastest growing demographic. Older inmates are more likely to have chronic medical conditions and cognitive decline, but these conditions occur earlier and may be more complex for older inmates. Specialized interventions to manage the unique health and mental health needs of older inmates are important to improve health and reduce burden on criminal justice systems. The aim of this research is to conduct a systematic review of empirically-tested interventions to improve the health or mental health of older adults living in jail or prison.Method: We conducted a systematic review of the literature to answer two research questions: (1) what interventions designed to improve the health or mental health of older adults living in jail or prison have been empirically tested? and (2) what are the effects of the interventions on inmates' physical or mental health?Results: Twenty-four articles were identified; seven met inclusion criteria. Several manuscripts discussed the same intervention, so the review identified five unique interventions for incarcerated older adults. The interventions are discussed including their main findings and limitations.Conclusion: Results support the need for research on interventions for incarcerated older adults. Intervention during incarceration can have a great impact on older adults' health and mental health during incarceration and upon reentry to the community. Directions for future research suggest the need for collaboration between practitioners and researchers in order to increase knowledge of what types of intervention work for older inmates living in jails and prisons.

Extramacrochaetae promotes branch and bouton number via the sequestration of daughterless in the cytoplasm of neurons.

The Class I basic helix-loop-helix (bHLH) proteins are highly conserved transcription factors that are ubiquitously expressed. A wealth of literature on Class I bHLH proteins has shown that these proteins must homodimerize or heterodimerize with tissue-specific HLH proteins in order to bind DNA at E-box consensus sequences to control tissue-specific transcription. Due to its ubiquitous expression, Class I bHLH proteins are also extensively regulated posttranslationally, mostly through dimerization. Previously, we reported that in addition to its role in promoting neurogenesis, the Class I bHLH protein daughterless also functions in mature neurons to restrict axon branching and synapse number. Here, we show that part of the molecular logic that specifies how daughterless functions in neurogenesis is also conserved in neurons. We show that the Type V HLH protein extramacrochaetae (Emc) binds to and represses daughterless function by sequestering daughterless to the cytoplasm. This work provides initial insights into the mechanisms underlying the function of daughterless and Emc in neurons while providing a novel understanding of how Emc functions to restrict daughterless activity within the cell.

It's okay to talk about death: Exploring the end-of-life wishes of healthy young adults.

Young adults (N = 80) participated in advance care planning (ACP) as part of a death and dying course and submitted reflection papers on their experiences. These papers were analyzed using directed qualitative content analysis methods. Among the findings, participants almost exclusively chose a parent or other family member as a Health Care Agent. Twenty-five percent expressed concern about placing burden on their agent, but felt their advance directives (AD) would ease that burden. For many, previous experiences with death helped shape their wishes. This research has practice implications for recruiting more healthy young adults in completing their AD.

What Could Total Worker Health® Look Like in Small Enterprises?

Small enterprises have fewer resources, are more financially precarious, and have higher rates of occupational injury and illness compared with larger enterprises. Interventions that address the promotion of health and well-being in addition to traditional occupational safety and health hazards, a Total Worker Health® (TWH) approach, may be effective in reducing injuries and preventing illness. However, little research has examined the impact of TWH interventions in small enterprises. The aim of this research was to explore and characterize health and safety practices, policies, and programs in small Midwestern enterprises from a TWH perspective. Utilizing a case studies approach, site visits were conducted with small business, between 10 and 250 employees, from 2014 through 2016 and included workplace audits and interviews with multiple employees in varying roles within each organization. Both open and closed coding were used to identify specific themes. Eight themes emerged from the site visits: value and return on investment, organizational factors, program design, engaging employees, low-cost strategies, evaluation, and integration. These themes overlapped with both the National Institute for Occupational Safety and Health's (NIOSH) Essential Elements of TWH and the NIOSH Fundamentals. Industry sector and enterprise size also affect resources and integration of these resources. As TWH expands to organizations of all sizes, it is necessary to address the unique needs of smaller enterprises.

Disaster preparedness networks in rural Midwest communities: Organizational roles, collaborations, and support for older residents.

This study investigated the roles and interconnections among community organizations belonging to local disaster coalitions in Midwest in supporting older residents. Representatives from 44 organizations participated in one-time survey. Most were non-profit (68%) or federal/state/local government agencies (23%). The analyses of 761 relationships showed stronger collaborations in assessment (average strength=2.88 on a 5-point scale), emergency response (2.72), and planning (2.61); and weaker collaborations in co-sponsoring programs (1.71) and supporting older residents (2.03). The extent of collaboration (network density) to support older adults was also low. Coalitions may enhance network density and centralization by developing sub-committee structure and strengthening existing collaborations.

Personal Disaster and Emergency Support Networks of Older Adults in a Rural Community: Changes After Participation in a Preparedness Program.

OBJECTIVE: Personal disaster and emergency support networks of rural older adults are described before and after participation in a disaster preparedness intervention, PrepWise. METHODS: At baseline, a total of 194 disaster support network members were identified by 27 older adults in a rural Midwest community. After the intervention, these participants identified 232 support network members. Multilevel logistic regression models were constructed to identify characteristics of the network members and social interactions associated with support providers at baseline as well as newly added support sources after the PrepWise intervention. RESULTS: Member and interaction characteristics associated with being identified as emergency support sources at baseline were as follows: family, lived in close proximity, weekly or more frequent contact, and being someone whom participants shared concerns with, trusted, and exchanged emotional support with. After receiving PrepWise, participants on average identified 3 new sources of emergency support within their networks. Support sources added at follow-up tended to be nonfamily members and those participants trusted. CONCLUSIONS: Enhancements in personal emergency support networks occurred after the intervention. Understanding characteristics of the network members and social interactions may assist in identifying additional emergency support sources. Larger studies investigating the impacts of enhanced support networks on disaster-related behaviors and outcomes will be beneficial. (Disaster Med Public Health Preparedness. 2017;11:110-119).

Engaging College Undergraduates in Advance Care Planning.

Advance care planning (ACP) is a critical part of long-term health-care planning, as no one knows when the ability to make personal medical decisions may be impaired. Many assume ACP is only necessary for older adults or those with life-threatening health conditions; however, there are growing discussions about healthy, young adults also engaging in ACP, as they too suffer from unexpected medical events that limit their ability to make medical decisions. The current study examined the reactions of college students following the completion of their advance care plans and then sharing these plans with friends and family. The students reported that while completing their advance care plans created many emotions, they found the experience to be valuable and facilitated conversations with family and friends about end-of-life care that may not have occurred otherwise.

Motivating rural older residents to prepare for disasters: moving beyond personal benefits.

In the United States of America (USA), older adults in rural areas are at increased risk for adverse outcomes of disasters, partly due to medical needs, limited or long geographic distances from community resources, and less knowledge and motivation about preparedness steps. Older residents and ageing service providers in a rural community in the USA were interviewed regarding their perceptions about disasters and preparedness, and their reactions to the preparedness training programme using the concepts of the Extended Parallel Process Model. Participants generally indicated low motivation to engage in preparedness behaviours despite perceptions of personal risk and beliefs that preparedness behaviours were easy and could improve disaster outcomes. A theme of social relationships emerged from the data, with participants identifying social relationships as resources, barriers and motivators. People surrounding older adults can support or deter their preparedness behaviours, and sometimes elicit a desire to protect the wellbeing of others. Findings suggest two potential strategies to facilitate preparedness behaviours by moving beyond personal benefits: highlighting older adults' increased ability to protect the wellbeing of younger generations and their community by being prepared themselves, and engaging family, friends and neighbours in preparedness programmes to enhance the resilience of their social groups. Older adults in many cultures have a desire to contribute to their society. Novel and effective approaches to increase preparedness could target their social groups.