58 research outputs found
Supplemental Material - Vision Impairment and Frailty Among Mexican American Older Adults: A Longitudinal Study
No full textSupplemental Material for Vision Impairment and Frailty Among Mexican American Older Adults: A Longitudinal Study by Mandi L. Sonnenfeld, Monique R. Pappadis, Timothy A. Reistetter, Mukaila A. Raji, Kenneth Ottenbacher, and Soham Al Snih in Journal of Applied Gerontology.</p
Supplemental Material - Risk Factors for Post-Discharge Adverse Outcomes Following Hospitalization Among Older Adults Diagnosed With Elder Mistreatment
No full textSupplemental Material for Risk Factors for Post-Discharge Adverse Outcomes Following Hospitalization Among Older Adults Diagnosed With Elder Mistreatment by Monique R. Pappadis, Leila Wood, Allen Haas, Jordan Westra, Yong-Fang Kuo, and Charles P. Mouton in Journal of Applied Gerontology</p
Estimating the Burden of Hypertension and Diabetes Among Persons with Traumatic Brain Injury (TBI)
No full textA Mixed Methods Investigation of the Impact of Neurocognition, Gender Role Conflict and Self-Identity on Psychosocial Adjustment to Traumatic Brain Injury
No full textMany persons with traumatic brain injury (TBI) experience substantial emotional distress and psychosocial adjustment difficulties. The contribution of alterations in gender roles and self-identity to psychosocial adjustment has been hypothesized, but not empirically investigated. To address this gap in the research, the current study: (1) assessed experiences of gender role conflict and changes in sense of self after TBI, (2) assessed gender and racial/ethnic differences on gender role conflict and changes in sense of self (3) investigated the mediation effects of cognitive functioning and avoidant coping, and (4) tested a moderated-mediation model of psychosocial adjustment by gender and race/ethnicity. Using an equal-status, concurrent mixed-method approach, 60 persons with TBI, who were at least 3 months post injury, participated in a semi-structured interview regarding the gender role conflict and self-identity after TBI, brief neuropsychological assessments of cognitive functioning, and self-report measures on gender roles, gender role conflict, sense of self, coping, acceptance of disability, anxiety, and depression. Using quota sampling of men and women, forty-eight of the sixty participants completed qualitative interviews based on their racial make-up and stage of recovery. An overall model using structural regression modeling was utilized to test meditational and moderated mediation effects of factors influencing psychosocial adjustment to TBI. Persons with TBI reported gender role conflict and changes in sense of self, which impacted their adjustment to TBI. Avoidant coping fully mediated the relationship between self-identity and psychosocial adjustment. A theory of Reconstructing Identity after TBI emerged from the data, which has implications for clinical practice, service delivery and identifying key factors associated with psychosocial adjustment of a diverse sample of persons with TBI.Social Work, Graduate College o
Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS): A Case Study in Implementing Clinical Decision Support Tools to Improve Older Adult Health
No full textElectronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS) is a research study
designed to reduce falls in community-based older adults through implementation of
electronic-health record clinical decision support tools. The parent site, Massachusetts
General Brigham, is conducting a randomized controlled trial to investigate if adults aged
65+ at high falls risk benefit from computerized alerts and evidence-based, exerciseoriented
order sets to reduce falls and falls-related injuries compared to usual care. The
University of Texas Medical Branch (UTMB) was selected as a replication site to further
test the clinical decision support tools in a pre-post implementation design. This report
outlines the strategies used by UTMB to implement the eSTEPS tools within its primary
care practices caring for high-risk older adults. Following the RE-AIM framework, we
report on the early reach, adoption, and implementation of (or adherence to) the
program (reserving effectiveness and maintenance reporting to later project phases).
The eSTEPS tools were implemented in April 2023. After excluding a two-month wash-in
v
period, we provide project outcomes from July 2023 through January 2024. In total, we
identified 3472 community-dwelling older adults at high falls risk within UTMB primary
care practices. The eSTEPS clinical alert fired for 3210 patients (92.5% of expected).
Clinicians used the evidence-based exercise-oriented order sets for 363 patients to
initiate referral for formal physical therapy or provide educational materials for a home
exercise program. Unfortunately, clinicians dismissed or deferred the clinical alert in 82%
of encounters for which it was fired. Preliminary data suggests the eSTEPS clinical
decision support tools promote accurate identification of older adults at high falls risk
within UTMB and effectively alert primary care clinicians to patients’ need for fallsreducing
interventions. We outline several steps necessary to improve project reach,
adoption, and adherence which will also enhance the project’s effectiveness to reduce
future falls and falls-related injuries. Our lessons learned can be applied across clinical
decision support tools intended to facilitate health assessment and promote evidencebased
interventions among community-based older adults
*Poster 34: Impact of Traumatic Brain Injury on Quality of Life and Self-Concept: Perspectives of Survivors in an Ethnically Diverse Sample
No full textExploring the Interrelationships of Cognition and Social Communication through Development of the Profile of Pragmatic Impairment in Communication in Individuals with Traumatic Brain Injury
No full textDeficits in social functioning are common following traumatic brain injury (TBI). Previous research suggests that there are multiple, complex factors which underlie such deficits, including cognition and social communication. Standardized measurement of social communication following TBI is challenging, and often involves the use of structured rating scales. The Profile of Pragmatic Impairment in Communication (PPIC) is one such scale that shows promise, though it requires further development and empirical testing to improve its utility in the TBI population. The current study is archival in nature. Data were obtained from two prior study samples in projects investigating social communication in the community dwelling adult TBI population: the social communication assessment measures study (SCA study, N = 121) and a randomized clinical trial for social communication intervention (IPR study, N = 83). In order to further develop the PPIC and examine the underlying cognitive abilities which impact social pragmatics, the 84 behavioral items of the PPIC were reduced to a set of 20 items deemed to be most characteristic of social communication difficulties following TBI. These 20 items were analyzed using exploratory factor analysis. Following an iterative process, a two factor solution accounting for 60.77% of the total variance was obtained, and it included 9 of the 20 originally selected items. These factors were labeled Partner Sensitivity (5 items) and Conversational Flow (4 items), and subscale scores were created by summing the item scores within each factor. The cognitive underpinnings of social pragmatics as measured by the new PPIC subscales were examined using hierarchical linear regression, using measures of attention, executive functioning, and affect perception as predictor variables and the new PPIC subscale scores, AIPSS Overall Sending score, and the TIRR Social Communication Rating Form (an experimental measure) as outcome variables. After adjusting for demographic and injury-related variables, performance on cognitive measures accounted for a unique 22% of the variance in PPIC Conversational Flow scores and 17% of the variance in AIPSS Overall Sending scores, while performance on cognitive measures did not account for a statistically significant amount of unique variance in PPIC Partner Sensitivity scores or TIRR Social Communication Rating Form scores. These results represent important preliminary steps in the development of the PPIC into a more parsimonious and useful tool and in developing a more sophisticated understanding of the relationship between cognition, social communication, and social functioning in TBI.Psychology, Department o
Arch Phys Med Rehabil
No full textObjective:To conduct a scoping review of mild stroke definitions based on stroke severity assessments and/or clinical signs and symptoms reported in the literature.Data Sources:Electronic searches of PubMed, PsycINFO (Ovid), and CINAHL (EBSCO) databases included keyword combinations of mild stroke, minor stroke, mini stroke, mild cerebrovascular, minor cerebrovascular, transient ischemic attack, or TIA.Study Selection:Inclusion criteria were limited to articles published between January 2003 and February 2018. Inclusion criteria included (1) a definition of either mild or minor stroke, (2) written in English, (3) participants aged 18 years and older. Animal studies, reviews, dissertations, blogs, editorials, commentaries, case reports, newsletters, drug trials, and presentation abstracts were excluded.Data Extraction:Five reviewers independently screened titles and abstracts for inclusion and exclusion criteria. Two reviewers independently screened each full-text article for eligibility. The five reviewers checked the quality of the included full-text articles for accuracy. Data were extracted by two reviewers and verified by a third reviewer.Data Synthesis:Sixty-two studies were included in the final review. Ten unique definitions of mild stroke using stroke severity assessments were discovered, and ten different cutoff points were used with the most widely used measure to classify stroke severity \u2013 the National Institutes of Health Stroke Scale (NIHSS). Synthesis also revealed variations in stroke severity across years, time since stroke, imaging, medical indicators, clinical signs and symptoms and settings.Conclusions:Inconsistencies in the classification of mild stroke are evident with varying use of stroke severity assessments, measurement cut-off scores, imaging tools, and clinical or functional outcomes. Continued work is necessary to develop a consensus definition of mild stroke, which directly impacts treatment receipt, referral for services, and health service delivery.R24 HS022134/HS/AHRQ HHSUnited States/P30 AG059301/AG/NIA NIH HHSUnited States/90SFGE0002/ACL/ACL HHSUnited States/U48 DP000028/DP/NCCDPHP CDC HHSUnited States/90DPTB0016/ACL/ACL HHSUnited States/P30 AG024832/AG/NIA NIH HHSUnited States
Arch Phys Med Rehabil
No full textObjectiveTo evaluate the effectiveness of an educational intervention designed to reduce traumatic brain injury (TBI)\u2013related misconceptions among blacks and Latinos with complicated mild to severe TBI.DesignRandomized controlled trial with masked 1-month follow-up.SettingCommunity.ParticipantsPersons (N = 52) with complicated mild to severe TBI (mean best day 1 Glasgow Coma Scale score, 11.27\ub13.89) were randomly recruited from 141 eligible participants (mean age, 37.71\ub113.88y; age range, 19\u201366y; mean months postinjury, 24.69\ub111.50); 25 participants (48.1%) of participants were black and 27 (51.9%) were Hispanic/Latino. Of the Hispanic/Latino participants, 18 (66.7%) were non-U.S. born and 12 (44.4%) spoke Spanish as their primary language. Twenty-seven individuals were randomized to the educational intervention group and 25 were randomized to the wait-list control group.InterventionsSingle-session educational intervention with written materials provided in English or Spanish.Main Outcome MeasuresForty-item Common Misconceptions about Traumatic Brain Injury Questionnaire administered at baseline and 1-month follow-up.ResultsAfter controlling for ethnic and language differences, a significant between-group main effect (P = .010) and a significant time-group interaction for the Common Misconceptions about Traumatic Brain Injury Questionnaire were noted (Wilks \u39b = .89; F1,46 = 6.00; P = .02). The intervention group showed a decrease in TBI misconception percentages, whereas the wait-list control group maintained similar percentages. At 1-month follow-up, the wait-list control group reported more misconceptions than did the intervention group (P = .019).ConclusionsAn educational intervention developed to address the recovery process, common symptoms, and ways to handle the symptoms provides promise as a tool to decrease TBI misconceptions among persons from ethnically and educationally diverse backgrounds. The effects of therapist characteristics and the client-therapist relation on outcomes should be further explored.P30 AG024832/AG/NIA NIH HHS/United StatesR24 HS022134/HS/AHRQ HHS/United StatesU48 DP000028/DP/NCCDPHP CDC HHS/United StatesU48 DP000060/DP/NCCDPHP CDC HHS/United State
Disabil Rehabil
No full textPurpose:To explore the impact of traumatic brain injury (TBI) on the quality of life (QoL) and self-concept of Spanish-speaking US Hispanic immigrants with TBI.Materials and methods:A prospective, qualitative study conducted in a county level I trauma center and community. Semi-structured interviews on QoL and self-concept following TBI were conducted with twenty-four Spanish-speaking US Hispanic immigrants with TBI living in the community at least 6 months following injury.Results:Perceived facilitators of QoL included faith, hopefulness in recovery, empathy for others, and support from others. Perceived barriers to QoL mentioned were symptoms/consequences of injury, employment/financial changes, loss of independence, fear/uncertainty, stigma/shame, lack of medical care, and decreased social integration. Participants described their self-concept after TBI as either a maintained self or loss of self. Those who viewed themselves differently reported physical and emotional changes, gender role conflict, loss of self-worth, and total loss due to the TBI.Conclusions:Spanish-speaking US Hispanic immigrants held a strong faith and positive outlook after TBI in spite of the significant barriers to recovery. A need exists for programs to support creatively the recovery of Spanish-speaking US Hispanic immigrants with limited access to care and resources.90RT5007/ACL/ACL HHSUnited States/P30 AG059301/AG/NIA NIH HHSUnited States/90DP0028/ACL/ACL HHSUnited States/U48 DP000028/DP/NCCDPHP CDC HHSUnited States/L60 MD009326/MD/NIMHD NIH HHSUnited States/K01 AG065492/AG/NIA NIH HHSUnited States/90DPTB0016/ACL/ACL HHSUnited States/P30 AG024832/AG/NIA NIH HHSUnited States
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