The COVID-19 pandemic created new barriers to accessing primary care services, particularly among... more The COVID-19 pandemic created new barriers to accessing primary care services, particularly among older adults who has faced barriers related to access to care, transportation, health literacy, and social isolation. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) partnered with primary care clinics and a local community partner to conduct wellness calls to older adult patients identified through clinic EHR. This project aimed to provide educational and telehealth support to vulnerable adults with limited resources in the Tri-County region of Florida. Wellness calls were made to determine educational and technical support needs of the older adults designated as underprivileged. We identified 44 participants to receive telehealth devices. Samsung tablets were mailed with educational resources, developed by NSU SFGWEP related to COVID-19 pandemic. The information included health, vaccine education, and instructions to access telehealth se...
It is well established that the health professional workforce is not adequately prepared to meet ... more It is well established that the health professional workforce is not adequately prepared to meet the demands of an aging older population. Caregivers are often the backbone supplemental workforce for seniors, providing daily care with assistance with activities of daily living, with little training. Part of the mission of the South Florida Geriatric Workforce Enhancement Program (SFGWEP) is to support and empower caregivers through community based training programs. Between January 1 2020 to January 31, 2021 SFGWEP provided education to more than 340 caregivers on topics related to opioid use, effective communication with individuals with dementia and other topics. Attendees responded to a short evaluation survey, which included three multiple-choice questions on if attending was a good use of their time, if they gained knowledge and if they plan to apply material, and two open-ended questions to identify opportunities for improvement in future trainings. Responses were overwhelming...
The COVID-19 pandemic created new barriers and challenges to accessing primary care services, par... more The COVID-19 pandemic created new barriers and challenges to accessing primary care services, particularly among older adults who already faced barriers related to access to care, including transportation, health literacy, and self-management support. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) partnered with primary care clinics to conduct wellness calls to older adult patients identified through clinic EHR. The wellness calls’ objectives were to 1) discuss COVID-19 protective measures; 2) assess wellness needs and access to care barriers; and 3) screen for telehealth support. From September 2020 to February 2021, the team (including medical students, public health students, and SFGWEP staff) contacted 200 patients via telephone and conducted a comprehensive wellness survey developed by the study team, informed by validated surveys. Among the 200 patients called, 60% (n=34) were very concerned about the Covid-19 pandemic, 33% (n=3...
Age Friendly Health Systems (AFHS) commit to evidence-based, low-risk, coordinated care that is c... more Age Friendly Health Systems (AFHS) commit to evidence-based, low-risk, coordinated care that is centered on what matters most to older adults, their families and caregivers. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) has partnered with multiple primary care clinics to provide dedicated AFHS training and support to increase AFHS transformation in Broward and Miami-Dade Counties. As part of the initiative, SFGWEP provide didactic training, clinic on-site brief demonstration, and infographic guidance for EHR documentation. NSU SFGWEP activities are conducted through training surveys, provider feedback, and e-clinical measures that align with CMS MIPS measures. Three participating health systems report annually on seven e-clinical measures that, collectively, provide indicators of the 4Ms of AFHS (what matters, medication management, mentation and mobility.) From baseline to Year 1, NSU SFGWEP saw improvement in controlled hypertensio...
The systemic and chronic nature of diabetes places frail older adults at higher risk of foot prob... more The systemic and chronic nature of diabetes places frail older adults at higher risk of foot problems, including ulceration, gangrene, osteomyelitis, and amputation. Early detection and treatment of foot problems can prevent more serious problems that could otherwise lead to reduced quality of life and costly hospitalizations. Residents of nursing homes are at high risk of developing foot problems because they are more likely to have multiple comorbidities, complex pharmacologic regimens, limited caregiver support, and cognitive impairment. Few studies document the prevalence and assessment of foot problems in nursing homes. The authors conducted a retrospective chart review that included three nursing homes in southern Florida to determine the prevalence of foot problems among persons with diabetes at these facilities and to learn how nursing home staff assessed these problems. The medical charts were stratified by dementia diagnosis to examine whether cognitive status impacted foot evaluations and care. The authors found that almost 70% of the total patient population had some type of foot problem, with 38% of patients with concomitant dementia having significant foot problems, including calluses, edema, and amputations. The authors found that the assessment of foot problems and follow-up treatment was inconsistently documented in patient charts. Results of this study indicate a need for interprofessional training programs that focus on foot assessment and foot care, tailored patient education, better protocols for regularly evaluating and managing foot problems, and adoption of better documentation systems, like electronic health records. - See more at: http://www.annalsoflongtermcare.com/article/prevalence-foot-problems-nursing-home-diabetes-dementia#sthash.4GffibUP.dpu
The rise of the opioid epidemic over the last two decades has increased the mortality rate, healt... more The rise of the opioid epidemic over the last two decades has increased the mortality rate, healthcare cost, and drug overdose deaths across the country. Practicing physicians are lacking in education regarding non-opioid alternatives to pain management, prevention, diagnosis, and treatment of opioid use disorder (OUD). Existing literature suggest a link between knowledge discrepancy and opioid use among clinicians resulting in patient’s abuse of opioids. Therefore, it is important to educate medical students at the start of their career. This preliminary study assesses the current knowledge and perceived skills of medical students regarding (OUD)/opioid misuse and related content in order to identify gaps and provide necessary education. The study used a pre-post survey method to understand the demographics, medical, and clinical knowledge about opioid use, abuse, and clinical knowledge regarding patient opioid overdose. The self-administered survey was administered to all students...
As the prevalence of diabetes continues to rise, it is imperative to provide healthcare professio... more As the prevalence of diabetes continues to rise, it is imperative to provide healthcare professionals with the training they need to manage the disease and to prevent complications. However, preventive care of foot problems can be particularly challenging in the long-term care (LTC) population. In this article, the authors describe a study that evaluated the efficacy of an evidence-based program for training nurses in LTC facilities that had two objectives: (1) to increase the knowledge and skills of nurses about foot care in residents with diabetes to prevent and manage diabetic foot lesions; and (2) to encourage nurses to incorporate regular foot examinations in clinical practice. The results of the study show that implementation of the training program can heighten awareness of the barriers involved when executing quality improvement initiatives in LTC environments. - See more at: http://www.annalsoflongtermcare.com/article/diabetes-foot-complications-education-study-long-term-care#sthash.yLU8Ro9n.dpu
UNSTRUCTURED Objective: Loneliness, social isolation, and lack of technical literacy are associat... more UNSTRUCTURED Objective: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the Covid-19 pandemic, Nova Southeastern University’s South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources for promoting telehealth services. Methods: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls with 44 participants moving on to complete tablet usage. All the tablets were preloaded with educational information on using the device, COVID-19 resources, and accessing telehealth services for patients, caregivers, and families. Results: Feedback from wellness assessments suggest a significant need for telehealth support. The main usage of the tablets includes 11% (n=5) for telehealth, 7% (n=3) to connect with friends and family, and 7% (n=3) to connect...
We define, map, and analyze geodemographic patterns of socially and medically vulnerable older ad... more We define, map, and analyze geodemographic patterns of socially and medically vulnerable older adults within the tri-county region of South Florida. We apply principal components analysis (PCA) to a set of previously identified indicators of social and medical vulnerability at the census tract level. We create and map age-stratified vulnerability scores using a geographic information system (GIS), and use spatial analysis techniques to identify patterns and interactions between social and medical vulnerability. Key factors contributing to social vulnerability in areas with higher numbers of older adults include age, large household size, and Hispanic ethnicity. Medical vulnerability in these same areas is driven by disease burden, access to emergency cardiac services, availability of nursing home and hospice beds, access to home health care, and available mental health services. Age-dependent areas of social vulnerability emerge in Broward County, whereas age-dependent areas of medical vulnerability emerge in Palm Beach County. Older-adult social and medical vulnerability interact differently throughout the study area. Spatial analysis of older adult social and medical vulnerability using PCA and GIS can help identify age-dependent pockets of vulnerability that are not easily identifiable in a populationwide analysis; improve our understanding of the dynamic spatial organization of health care, health care needs, access to care, and outcomes; and ultimately serve as a tool for health care planning.
The purpose of this sleep study manual is to describe the procedures and format for implementing ... more The purpose of this sleep study manual is to describe the procedures and format for implementing a caregiver-focused intervention aimed at reducing sleep disturbances among persons with Alzheimer's disease (AD) and other dementing illnesses. The program includes a non-pharmacologic intervention delivered to caregivers in a group format with individual reinforcement, and aims to improve sleep through bright light exposure, exercise, and sleep hygiene practices. The program includes three brief (one hour) classes, one review class, and two phone calls. Group classes will be provided at Adult Day Care settings either before pickup , after drop-off, or at another convenient time for the caregivers. Session by Session Outline Week-1-Session 1 (Education Session-1) • Overview of this week's session: Today we will • Introduce the group • Talk about proposed intervention • Discuss sleep norms/circadian rhythms/effect of aging and Alzheimer's disease on sleep • Introduce the importance of goal setting Introductions: Script We are doing this project because we recognize how difficult it can be for persons with dementia to get a good night's sleep. The purpose of this project is to try an intervention to help people with
Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients wi... more Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients with diabetes. Patient-centered medical home (PCMH) models can lead to improvements in health for patients with chronic conditions and cost savings for providers. Therefore, FQHCs are increasingly moving to PCMH models of care. The study objective was to examine the effects of initial transformation to a level 3 National Committee for Quality Assurance (NCQA) certified PCMH in 2011, on clinical diabetes outcomes among 27 clinic sites from a network of FQHCs in Florida. We used de-identified, longitudinal electronic health record (EHR) data from 2010-2012 and multivariate logistic regression to analyze the effects of initial transformation on the odds of having well-controlled HbA1c, body mass index (BMI), and blood pressure (BP) among vulnerable patients with diabetes. Models controlled for clustering by year, patient, and organizational characteristics. Overall, transformation to a PCMH w...
We define, map, and analyze geodemographic patterns of socially and medically vulnerable older ad... more We define, map, and analyze geodemographic patterns of socially and medically vulnerable older adults within the tri-county region of South Florida. We apply principal components analysis (PCA) to a set of previously identified indicators of social and medical vulnerability at the census tract level. We create and map age-stratified vulnerability scores using a geographic information system (GIS), and use spatial analysis techniques to identify patterns and interactions between social and medical vulnerability. Key factors contributing to social vulnerability in areas with higher numbers of older adults include age, large household size, and Hispanic ethnicity. Medical vulnerability in these same areas is driven by disease burden, access to emergency cardiac services, availability of nursing home and hospice beds, access to home health care, and available mental health services. Age-dependent areas of social vulnerability emerge in Broward County, whereas age-dependent areas of medical vulnerability emerge in Palm Beach County. Older-adult social and medical vulnerability interact differently throughout the study area. Spatial analysis of older adult social and medical vulnerability using PCA and GIS can help identify age-dependent pockets of vulnerability that are not easily identifiable in a populationwide analysis; improve our understanding of the dynamic spatial organization of health care, health care needs, access to care, and outcomes; and ultimately serve as a tool for health care planning.
The purpose of the pilot program was to examine the adaptability and feasibility of a modified gr... more The purpose of the pilot program was to examine the adaptability and feasibility of a modified group-delivery sleep education program (NITE-AD) designed to reduce nocturnal disturbances in community-dwelling older adults with dementia. We recruited seven caregivers of persons with dementia from two adult day care centers in South Florida into a six-week group program at adult day care centers. A trained sleep educator taught caregivers about the impact of aging and dementia on sleep and how non-pharmacological interventions such as increasing light, regular exercise, and sleep hygiene strategies can improve sleep in persons with dementia. The curriculum incorporated ongoing problem solving and goal setting. Results suggest improvement in caregiver depression and persons with dementia sleep problems. Caregivers reported that the program provided them support and valuable strategies that they will continue to apply. Educating caregivers in a group setting about non-pharmacologic strat...
Journal of Human Behavior in the Social Environment, Jul 23, 2012
The systemic and chronic nature of rheumatoid arthritis (RA) impacts functional and emotional hea... more The systemic and chronic nature of rheumatoid arthritis (RA) impacts functional and emotional health of the individuals including marital, family, and work responsibilities. Due to the costs and side effects of drugs, proponents of arthritis management advocate for examining psychosocial factors that improve the disease management of RA. In this paper, we propose that marital quality is associated with perceived
Individuals with rheumatoid arthritis (RA) struggle to maintain improved functional ability and r... more Individuals with rheumatoid arthritis (RA) struggle to maintain improved functional ability and reduced pain levels. Health education emphasizing self-efficacy helps individuals to adjust with the disease outcome and progression. As a basis to develop comprehensive evidence-based patient education programs, the aim of the study was to examine the role of marriage as a predictor of pain and functional self-efficacy among individuals with RA. Review of the regression analysis did not provide support for the relationships between marital quality and self-efficacy. Relationships were not observed between marital quality, length of marriage, and self-efficacy as predicted by the first hypothesis. Additional regression analysis examination found that marital quality, length of marriage, pain, and health assessment together reported significant variance in self-efficacy. However, only health assessment significantly predicted self-efficacy. Other nonexamined variables could have influenced the independent marital quality effects. Future longitudinal studies with larger sample sizes can further validate the current findings.
The COVID-19 pandemic created new barriers to accessing primary care services, particularly among... more The COVID-19 pandemic created new barriers to accessing primary care services, particularly among older adults who has faced barriers related to access to care, transportation, health literacy, and social isolation. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) partnered with primary care clinics and a local community partner to conduct wellness calls to older adult patients identified through clinic EHR. This project aimed to provide educational and telehealth support to vulnerable adults with limited resources in the Tri-County region of Florida. Wellness calls were made to determine educational and technical support needs of the older adults designated as underprivileged. We identified 44 participants to receive telehealth devices. Samsung tablets were mailed with educational resources, developed by NSU SFGWEP related to COVID-19 pandemic. The information included health, vaccine education, and instructions to access telehealth se...
It is well established that the health professional workforce is not adequately prepared to meet ... more It is well established that the health professional workforce is not adequately prepared to meet the demands of an aging older population. Caregivers are often the backbone supplemental workforce for seniors, providing daily care with assistance with activities of daily living, with little training. Part of the mission of the South Florida Geriatric Workforce Enhancement Program (SFGWEP) is to support and empower caregivers through community based training programs. Between January 1 2020 to January 31, 2021 SFGWEP provided education to more than 340 caregivers on topics related to opioid use, effective communication with individuals with dementia and other topics. Attendees responded to a short evaluation survey, which included three multiple-choice questions on if attending was a good use of their time, if they gained knowledge and if they plan to apply material, and two open-ended questions to identify opportunities for improvement in future trainings. Responses were overwhelming...
The COVID-19 pandemic created new barriers and challenges to accessing primary care services, par... more The COVID-19 pandemic created new barriers and challenges to accessing primary care services, particularly among older adults who already faced barriers related to access to care, including transportation, health literacy, and self-management support. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) partnered with primary care clinics to conduct wellness calls to older adult patients identified through clinic EHR. The wellness calls’ objectives were to 1) discuss COVID-19 protective measures; 2) assess wellness needs and access to care barriers; and 3) screen for telehealth support. From September 2020 to February 2021, the team (including medical students, public health students, and SFGWEP staff) contacted 200 patients via telephone and conducted a comprehensive wellness survey developed by the study team, informed by validated surveys. Among the 200 patients called, 60% (n=34) were very concerned about the Covid-19 pandemic, 33% (n=3...
Age Friendly Health Systems (AFHS) commit to evidence-based, low-risk, coordinated care that is c... more Age Friendly Health Systems (AFHS) commit to evidence-based, low-risk, coordinated care that is centered on what matters most to older adults, their families and caregivers. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) has partnered with multiple primary care clinics to provide dedicated AFHS training and support to increase AFHS transformation in Broward and Miami-Dade Counties. As part of the initiative, SFGWEP provide didactic training, clinic on-site brief demonstration, and infographic guidance for EHR documentation. NSU SFGWEP activities are conducted through training surveys, provider feedback, and e-clinical measures that align with CMS MIPS measures. Three participating health systems report annually on seven e-clinical measures that, collectively, provide indicators of the 4Ms of AFHS (what matters, medication management, mentation and mobility.) From baseline to Year 1, NSU SFGWEP saw improvement in controlled hypertensio...
The systemic and chronic nature of diabetes places frail older adults at higher risk of foot prob... more The systemic and chronic nature of diabetes places frail older adults at higher risk of foot problems, including ulceration, gangrene, osteomyelitis, and amputation. Early detection and treatment of foot problems can prevent more serious problems that could otherwise lead to reduced quality of life and costly hospitalizations. Residents of nursing homes are at high risk of developing foot problems because they are more likely to have multiple comorbidities, complex pharmacologic regimens, limited caregiver support, and cognitive impairment. Few studies document the prevalence and assessment of foot problems in nursing homes. The authors conducted a retrospective chart review that included three nursing homes in southern Florida to determine the prevalence of foot problems among persons with diabetes at these facilities and to learn how nursing home staff assessed these problems. The medical charts were stratified by dementia diagnosis to examine whether cognitive status impacted foot evaluations and care. The authors found that almost 70% of the total patient population had some type of foot problem, with 38% of patients with concomitant dementia having significant foot problems, including calluses, edema, and amputations. The authors found that the assessment of foot problems and follow-up treatment was inconsistently documented in patient charts. Results of this study indicate a need for interprofessional training programs that focus on foot assessment and foot care, tailored patient education, better protocols for regularly evaluating and managing foot problems, and adoption of better documentation systems, like electronic health records. - See more at: http://www.annalsoflongtermcare.com/article/prevalence-foot-problems-nursing-home-diabetes-dementia#sthash.4GffibUP.dpu
The rise of the opioid epidemic over the last two decades has increased the mortality rate, healt... more The rise of the opioid epidemic over the last two decades has increased the mortality rate, healthcare cost, and drug overdose deaths across the country. Practicing physicians are lacking in education regarding non-opioid alternatives to pain management, prevention, diagnosis, and treatment of opioid use disorder (OUD). Existing literature suggest a link between knowledge discrepancy and opioid use among clinicians resulting in patient’s abuse of opioids. Therefore, it is important to educate medical students at the start of their career. This preliminary study assesses the current knowledge and perceived skills of medical students regarding (OUD)/opioid misuse and related content in order to identify gaps and provide necessary education. The study used a pre-post survey method to understand the demographics, medical, and clinical knowledge about opioid use, abuse, and clinical knowledge regarding patient opioid overdose. The self-administered survey was administered to all students...
As the prevalence of diabetes continues to rise, it is imperative to provide healthcare professio... more As the prevalence of diabetes continues to rise, it is imperative to provide healthcare professionals with the training they need to manage the disease and to prevent complications. However, preventive care of foot problems can be particularly challenging in the long-term care (LTC) population. In this article, the authors describe a study that evaluated the efficacy of an evidence-based program for training nurses in LTC facilities that had two objectives: (1) to increase the knowledge and skills of nurses about foot care in residents with diabetes to prevent and manage diabetic foot lesions; and (2) to encourage nurses to incorporate regular foot examinations in clinical practice. The results of the study show that implementation of the training program can heighten awareness of the barriers involved when executing quality improvement initiatives in LTC environments. - See more at: http://www.annalsoflongtermcare.com/article/diabetes-foot-complications-education-study-long-term-care#sthash.yLU8Ro9n.dpu
UNSTRUCTURED Objective: Loneliness, social isolation, and lack of technical literacy are associat... more UNSTRUCTURED Objective: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the Covid-19 pandemic, Nova Southeastern University’s South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources for promoting telehealth services. Methods: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls with 44 participants moving on to complete tablet usage. All the tablets were preloaded with educational information on using the device, COVID-19 resources, and accessing telehealth services for patients, caregivers, and families. Results: Feedback from wellness assessments suggest a significant need for telehealth support. The main usage of the tablets includes 11% (n=5) for telehealth, 7% (n=3) to connect with friends and family, and 7% (n=3) to connect...
We define, map, and analyze geodemographic patterns of socially and medically vulnerable older ad... more We define, map, and analyze geodemographic patterns of socially and medically vulnerable older adults within the tri-county region of South Florida. We apply principal components analysis (PCA) to a set of previously identified indicators of social and medical vulnerability at the census tract level. We create and map age-stratified vulnerability scores using a geographic information system (GIS), and use spatial analysis techniques to identify patterns and interactions between social and medical vulnerability. Key factors contributing to social vulnerability in areas with higher numbers of older adults include age, large household size, and Hispanic ethnicity. Medical vulnerability in these same areas is driven by disease burden, access to emergency cardiac services, availability of nursing home and hospice beds, access to home health care, and available mental health services. Age-dependent areas of social vulnerability emerge in Broward County, whereas age-dependent areas of medical vulnerability emerge in Palm Beach County. Older-adult social and medical vulnerability interact differently throughout the study area. Spatial analysis of older adult social and medical vulnerability using PCA and GIS can help identify age-dependent pockets of vulnerability that are not easily identifiable in a populationwide analysis; improve our understanding of the dynamic spatial organization of health care, health care needs, access to care, and outcomes; and ultimately serve as a tool for health care planning.
The purpose of this sleep study manual is to describe the procedures and format for implementing ... more The purpose of this sleep study manual is to describe the procedures and format for implementing a caregiver-focused intervention aimed at reducing sleep disturbances among persons with Alzheimer's disease (AD) and other dementing illnesses. The program includes a non-pharmacologic intervention delivered to caregivers in a group format with individual reinforcement, and aims to improve sleep through bright light exposure, exercise, and sleep hygiene practices. The program includes three brief (one hour) classes, one review class, and two phone calls. Group classes will be provided at Adult Day Care settings either before pickup , after drop-off, or at another convenient time for the caregivers. Session by Session Outline Week-1-Session 1 (Education Session-1) • Overview of this week's session: Today we will • Introduce the group • Talk about proposed intervention • Discuss sleep norms/circadian rhythms/effect of aging and Alzheimer's disease on sleep • Introduce the importance of goal setting Introductions: Script We are doing this project because we recognize how difficult it can be for persons with dementia to get a good night's sleep. The purpose of this project is to try an intervention to help people with
Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients wi... more Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients with diabetes. Patient-centered medical home (PCMH) models can lead to improvements in health for patients with chronic conditions and cost savings for providers. Therefore, FQHCs are increasingly moving to PCMH models of care. The study objective was to examine the effects of initial transformation to a level 3 National Committee for Quality Assurance (NCQA) certified PCMH in 2011, on clinical diabetes outcomes among 27 clinic sites from a network of FQHCs in Florida. We used de-identified, longitudinal electronic health record (EHR) data from 2010-2012 and multivariate logistic regression to analyze the effects of initial transformation on the odds of having well-controlled HbA1c, body mass index (BMI), and blood pressure (BP) among vulnerable patients with diabetes. Models controlled for clustering by year, patient, and organizational characteristics. Overall, transformation to a PCMH w...
We define, map, and analyze geodemographic patterns of socially and medically vulnerable older ad... more We define, map, and analyze geodemographic patterns of socially and medically vulnerable older adults within the tri-county region of South Florida. We apply principal components analysis (PCA) to a set of previously identified indicators of social and medical vulnerability at the census tract level. We create and map age-stratified vulnerability scores using a geographic information system (GIS), and use spatial analysis techniques to identify patterns and interactions between social and medical vulnerability. Key factors contributing to social vulnerability in areas with higher numbers of older adults include age, large household size, and Hispanic ethnicity. Medical vulnerability in these same areas is driven by disease burden, access to emergency cardiac services, availability of nursing home and hospice beds, access to home health care, and available mental health services. Age-dependent areas of social vulnerability emerge in Broward County, whereas age-dependent areas of medical vulnerability emerge in Palm Beach County. Older-adult social and medical vulnerability interact differently throughout the study area. Spatial analysis of older adult social and medical vulnerability using PCA and GIS can help identify age-dependent pockets of vulnerability that are not easily identifiable in a populationwide analysis; improve our understanding of the dynamic spatial organization of health care, health care needs, access to care, and outcomes; and ultimately serve as a tool for health care planning.
The purpose of the pilot program was to examine the adaptability and feasibility of a modified gr... more The purpose of the pilot program was to examine the adaptability and feasibility of a modified group-delivery sleep education program (NITE-AD) designed to reduce nocturnal disturbances in community-dwelling older adults with dementia. We recruited seven caregivers of persons with dementia from two adult day care centers in South Florida into a six-week group program at adult day care centers. A trained sleep educator taught caregivers about the impact of aging and dementia on sleep and how non-pharmacological interventions such as increasing light, regular exercise, and sleep hygiene strategies can improve sleep in persons with dementia. The curriculum incorporated ongoing problem solving and goal setting. Results suggest improvement in caregiver depression and persons with dementia sleep problems. Caregivers reported that the program provided them support and valuable strategies that they will continue to apply. Educating caregivers in a group setting about non-pharmacologic strat...
Journal of Human Behavior in the Social Environment, Jul 23, 2012
The systemic and chronic nature of rheumatoid arthritis (RA) impacts functional and emotional hea... more The systemic and chronic nature of rheumatoid arthritis (RA) impacts functional and emotional health of the individuals including marital, family, and work responsibilities. Due to the costs and side effects of drugs, proponents of arthritis management advocate for examining psychosocial factors that improve the disease management of RA. In this paper, we propose that marital quality is associated with perceived
Individuals with rheumatoid arthritis (RA) struggle to maintain improved functional ability and r... more Individuals with rheumatoid arthritis (RA) struggle to maintain improved functional ability and reduced pain levels. Health education emphasizing self-efficacy helps individuals to adjust with the disease outcome and progression. As a basis to develop comprehensive evidence-based patient education programs, the aim of the study was to examine the role of marriage as a predictor of pain and functional self-efficacy among individuals with RA. Review of the regression analysis did not provide support for the relationships between marital quality and self-efficacy. Relationships were not observed between marital quality, length of marriage, and self-efficacy as predicted by the first hypothesis. Additional regression analysis examination found that marital quality, length of marriage, pain, and health assessment together reported significant variance in self-efficacy. However, only health assessment significantly predicted self-efficacy. Other nonexamined variables could have influenced the independent marital quality effects. Future longitudinal studies with larger sample sizes can further validate the current findings.
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