Abraham Aizer Brody

• PhD, RN, FAAN, FPCN
• Associate Director and Associate Professor of Nursing and Medicine at New York University

Assisted living (AL) and residential care (RC) settings are experiencing substantial growth as older adults with lower care needs seek alternatives to nursing homes. Despite this trend, there is a lack of skilled nursing care to support palliative care (PC) in these environments. Primary PC delivered by AL staff has emerged as a potential model to...

Background and Objectives Goal-concordant transition to hospice is an important facet of end-of-life care for people living with dementia. The objective of this integrative review was to appraise existing evidence and gaps focused on interventions and predictors of transition to hospice and end-of-life care for persons living with dementia across h...

Background Chronic kidney disease (CKD) impacts more than 800 million people. It causes significant suffering and disproportionately impacts marginalized populations in the United States. Kidney palliative care has the potential to alleviate this distress, but has not been tested. This pilot study evaluates the feasibility of a randomized clinical...

Objective Examine the relationship between race and ethnicity and area-level social deprivation and Medicare home health care (HHC) agency quality for seriously ill older adults receiving HHC. Methods A linear probability fixed effects model analyzed the association between patient-level predictors and HHC agency quality (star-rating), controlling...

Importance The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness. Objective To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-lim...

Racially and ethnically minoritized persons living with dementia (PLWD) use hospice at disparately low rates and home healthcare (HHC), a preferred setting of end-of-life care, is a key intervention point for increasing hospice transitions. We conducted qualitative interviews with diverse care partners of PLWD to explore views about barriers to hos...

Black American caregivers of older adults living with dementia are at high risk for caregiving-related physical, emotional, spiritual, and psychosocial challenges. Culturally responsive interventions are needed to improve caregiving outcomes. Peer mentorship, a relationship-centered person-to-person approach may support caregiving mastery via cultu...

Over 50% of persons living with dementia (PLWD) seek emergency department (ED) care annually. However, the ED is not optimized to care for PLWD; those discharged back to the community experience adverse events. Through a recently-funded NIA Cooperative Award, we will implement an 80-site embedded pragmatic factorial designed trial of three independ...

Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals' perspectives of how SDOH affected the delivery of high-quality ho...

Background Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. Objectives Develop and validate criteria that identify appropriate HBPC target populations. Research Design A modified Delphi pro...

Background and Objectives The COVID-19 pandemic severely disrupted hospice care, yet there is little research regarding how widespread disruptions affected clinician and family decision-making. We aimed to understand how the pandemic affected structures, processes, and outcomes of end-of-life care. Research Design and Methods Retrospective narrati...

Purpose: Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and their care partners, local outdoor professionals, and healthcare providers. Methods: Participants were recruited via convenience and snowball sampling in the Bronx, New York...

Digital health implementations and investments continue to expand. As the reliance on digital health increases, it is imperative to implement technologies with inclusive and accessible approaches. A conceptual model can be used to guide equity-focused digital health implementations to improve suitability and uptake in diverse populations. The objec...

The purpose of this article was to analyze the concept of “the fighter in the intensive care unit (ICU)” per the scientific literature and the impact this mentality has on care administered in the ICU. A literature review and a concept analysis based on Rodger's evolutionary method were performed to identify surrogate terms, antecedents, attributes...

Asian Americans account for approximately 161,000 cases of Alzheimer’s disease and related dementias (AD/ADRD) among adults ages 65 and older in the United States. Chinese Americans have among the highest incidences of AD/ADRD, and have experienced underdiagnosis, cultural stigmas, and less access to dementia care. In New York City specifically, 28...

African American caregivers of older adults living with Alzheimer’s disease or a related dementia are at high risk for physical, spiritual, and psychosocial challenges. Peer mentorship, a relationship-centered person-to-person approach may reduce healthcare decision-making burden among African American caregivers through cultural tailoring by promo...

People living with Dementia (PLWD) utilize Home Health Care (HHC) services such as Physical Therapy (PT) and Occupational Therapy (OT), but little is known about service utilization patterns among PLWD from different socioeconomic backgrounds. We aimed to identify disparities in service utilization in PLWD in a HHC setting across socioeconomic back...

Nature activities can improve well-being and may modify risk factors for cognitive decline. There is a gap between nature activities offered within a person’s community and their ability to participate in them, including Hispanic/Latino persons living with memory challenges (MCI and mild dementia) in urban lower-resourced areas. An occupational the...

The COVID-19 pandemic caused widespread delays and disruption in end-of-life services. We examined the impact of these disruptions among patients in a large, NYC health system who were referred to hospice and died between March 1, 2020 and March 1, 2021. We linked the electronic health records (EHR) of 124 patients cared for by a geriatric outpatie...

Over 16 million care partners (CPs) in the U.S. provide more than 17 billion hours of unpaid care for family and friends living with dementia. Yet, significant inequities and access issues exist in assisting CPs to receive high quality support. Thus, this study aimed to tailor our existing evidence-based Aliviado Dementia Care mHealth app for diver...

Many patients and families rely on paid aides to provide personal care services at the end of life, but the COVID-19 pandemic caused widespread delays and disruption in this care. Our study examined COVID-related care disruptions among patients in a large, New York City health system who died between March 1, 2020 and March 1, 2021. We linked the e...

The provision of care to older adults with serious illness through home hospice visits was extremely challenging for interdisciplinary teams during the COVID-19 pandemic in NYC. We interviewed 20 interdisciplinary providers (nurses, managers, administrators, physicians, medical directors, social workers, and clergy) from three organizations that pr...

Public health containment and mitigation policies in response to the COVID-19 pandemic, including social distancing, infection control, and self-quarantine led to a substantial reduction in transmission of COVID-19. Yet they also brought about significant disruptions in healthcare, particularly care at the end of life. These challenges were amplifi...

COVID-19 illuminated many of the inequities that exist in the current healthcare system, especially for those who are most vulnerable and facing the end of life. Social determinants of health (SDOH) directly and indirectly influence access to the quality of care received by patients enrolled on the hospice benefit. We interviewed 20 interdisciplina...

Background Medicare-funded Home Health Care (HHC) delivers skilled nursing, therapy, and related services through visits to the patient’s home. Nearly one-third (31%) of HHC patients have diagnosed dementia, but little is currently known regarding how HHC utilization and care delivery differs for Persons Living with Dementia (PLwD). Methods We dre...

Background We sought to describe neuropsychiatric symptoms (NPS) among people living with dementia (PLWD) from diverse racial and ethnic groups receiving home health services while accounting for dementia severity, individual symptom prevalence, and neighborhood disadvantage. Methods A prospective study using cross‐sectional data from n = 192 PLWD...

Objective: To investigate mental health needs and barriers to seeking mental health support in Medicaid-funded Assisted Living Facility (M-ALF). Design: A multimethod, qualitative-dominant descriptive design using questionnaires and semistructured interviews. Setting and participants: The study occurred at a M-ALF in the Bronx, New York. A res...

Persons living with advanced cancer have intensive symptoms and psychosocial needs that often result in visits to the Emergency Department (ED). We report on program engagement, advance care planning (ACP), and hospice use for a 6-month longitudinal nurse-led, telephonic palliative care intervention for patients with advanced cancer as part of a la...

Understanding the complex care needs of seriously ill adults with multiple chronic conditions with and without cancer is critical for the delivery of high-quality serious illness and palliative care at the end of life. The objective of this secondary data analysis of a multisite randomized clinical trial in palliative care was to elucidate the clin...

This editorial comments on the article by Mao et al.

Background As more Americans age in place, it is critical to understand care delivery in the home. However, data on the range of home-based services provided by Medicare is limited. We define a taxonomy of clinical care in the home funded through fee-for-service Medicare and methods to identify receipt of those services. Methods We analyzed Fee-fo...

Introduction: Poor sleep is ubiquitous in skilled nursing facilities (SNFs) and is associated with a myriad of negative symptoms. Non-pharmacological interventions can improve sleep, yet sustainability has not been demonstrated. The Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER) trial will test whether a staff...

Most persons living with dementia receive home health or hospice aide services during their hospice stay. To equip aides with essential knowledge and skills to effectively communicate with and care for persons living with dementia, we developed a 17-video dementia care expert program for aides, available in both English and Spanish. The objective o...

Hospice is a care model characterized by interdisciplinary team-based, person and family-centered care. To optimize agency-wide interdisciplinary team-based hospice dementia care, at least two levels of tailoring of the dementia care workforce training are imperative, first, by discipline, and second, by hospices’ local culture and needs. As of Feb...

Following stakeholder engagement in our pilot phase of a large-scale 2-phase NIA funded pragmatic clinical trial in hospice (HAS-QOL Trial) of Aliviado Dementia Care, we utilized a co-design process to develop over a 6-month period and rapidly scale an mHealth application to assist clinicians in performing best practices in care for persons living...

To build and sustain a dementia-capable clinical workforce and care delivery organizations, it is essential to systematically disseminate evidence-based, interdisciplinary dementia care programs. The outbreak of COVID-19, clinical staff shortages, and competing priorities experienced by healthcare organizations including staff vaccination and other...

It is well documented that knowledge improvement alone is not sufficient to sustain systems level changes. Through supporting dementia care workforce training and the embedding of Aliviado program tools (treatment algorithms, assessments, care plans, and caregiver education materials) into hospices’ clinical workflow across the U.S., we learned tha...

The relationship between dementia and neuropsychiatric symptoms is well documented. Yet, little is known about the prevalence of neuropsychiatric symptoms among diverse homebound persons living with dementia. Guided by an intersectionality framework we asked: 1) Is there an association between the presence of individual neuropsychiatric symptoms an...

Fostering diverse, equitable, and inclusive collaborative research networks is important for advancing the field of aging research. Despite sizeable investment in research consortia and career development programs, there has been only moderate progress toward diversifying the research workforce studying aging. Without critically examining what work...

This editorial comments on the article by Gorbenko et al.

In the current study, we conducted one-on-one interviews with primary care providers (PCPs) and family care partners (FCPs) and held focus groups with interdisciplinary adult day service center (ADSC) staff to understand the perspectives of care providers across community settings regarding early warning signs of acute illnesses in persons living w...

In order to reduce care partner strain and support aging in place for people living with Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD), adult day centers (ADCs) must manage behavioral and psychological symptoms of dementia (BPSD). The purpose of this paper is to identify person-centered care strategies used by center staff...

Background: Homebound older adults are medically complex and often have difficulty accessing outpatient medical care. Home-based primary care (HBPC) may improve care and outcomes for this population but data from randomized trials of HBPC in the United States are limited. Methods: We conducted a randomized controlled trial of HBPC versus office-...

Background There has been a call by both patients and health professionals for the integration of palliative care with nephrology care, yet there is little evidence describing the effect of this approach. The objective of this paper is to report the feasibility and acceptability of a pilot randomized controlled trial testing the efficacy of integra...

Outcomes 1. Understand how to conduct and measure outcomes of a pilot study in palliative care 2. Understand the impact of integrated palliative care and nephrology care on symptom burden in advanced kidney disease tested in pilot form 3. Understand how to evaluate the patient experience in a palliative care clinical trial Importance Patients with...

Objective This study aimed to examine the impact of COVID-19 on hospice Interdisciplinary team (IDT) members’ self-reported stress and identify possible sources of moral distress. Methods A cross-sectional survey was conducted using Qualtrics to understand the impact of COVID-19 on quality improvement initiative implementation and hospice IDT memb...

Outcomes 1. Gain insight into the approach to highly skilled communication 2. Demystify the process for practitioners 3. Improve understanding of the invisible process an expert takes when approaching a complicated situation Clinician/patient communication is a central skill of the HPM professional. Although a variety of methods are used to teach c...

Background: Hospice care was initially designed for seriously ill individuals with cancer. Thus, the model and clinicians were geared toward caring for this population. Despite the proportion of persons living with dementia (PLWD) receiving hospice care substantially increased over the past 10 years, and their longer lengths of stay, established h...

Introduction Well-being and turnover intent represent key aspects to the promotion of a healthy workforce. Alarming levels of burnout and low levels of well-being have been documented in health professionals across care settings. Not only do high levels of burnout, low well-being and high turnover affect health professionals, but they are associate...

Americans near the end of life experience high rates of nonbeneficial, burdensome, and preventable hospital-based care. If patients' goals of care are unknown or unclear, they have higher rates of hospitalization at the end of life. The demand for palliative care has grown exponentially because of its impact on quality of life, symptom burden, and...

Objectives: Our study documented communication workflows across adult day care centers (ADCs) and primary care providers (PCPs) around complex needs of persons living with dementia (PLWD). We also identified barriers and facilitators to productive communication in clinical decision support and clinical information systems. Materials and methods:...

In adult day centers (ADCs), 58% of clients identify as racial/ethnic minorities, and at least 30% have Alzheimer’s Disease and related dementias (ADRD). ADCs offer culturally and linguistically congruent care to clients, making them well-positioned to address potential health disparities affecting persons with ADRD. We used data from 53 California...

COVID-19 infection control precautions (e.g., social distancing) and associated isolation and changes to routines can worsen dementia-related behavioral symptoms. A cross-sectional online survey was administered to 101 hospice staff (95% female; mean age 49) to investigate what dementia-related behavioral symptoms in their care recipients had chang...

Despite known benefits of hospice, inequities exist. Using data from a multi-site pragmatic trial in a representative groups of hospices, we examined inequities in length of stay (LOS) and general inpatient use (GIU) for 12,153 patients with dementia (primary and secondary diagnosis) using descriptive statistics and association tests. There were si...

Home-based primary care (HBPC) practices rapidly adapted to maintain care during the COVID-19 pandemic. This mixed-methods national online survey of HBPC practices probed responses to COVID-19 surges, COVID-19 testing, the use of telemedicine, practice challenges due to COVID-19, and adaptations to address these challenges. Seventy-nine practices a...

The COVID-19 pandemic accelerated the adoption of virtual care. In this qualitative study, we sought to determine provider perceptions of video telehealth during the first wave of COVID-19 in NYC to inform practice for home-based primary care providers nationwide. We conducted semi-structured interviews with clinical directors, program managers, nu...

ADCs are not uniformly regulated at the federal or state level, resulting in the absence of uniform data collection. The lack of large-scale data has resulted in a dearth of evidence on the role ADC services play in the health and well-being of their clients, particularly persons living with dementia (PLWD). The purpose of this study was to compare...

The interrelationships among dementia, concomitant disease, and social determinants of health are poorly understood and have critical implications for disease course, treatments, and caregiving needs. The aim of this study was to identify patterns of co-occurring chronic conditions among persons with dementia and the relationship of these patterns...

There are rising concerns of inequities in access to high-quality home health agencies (HHA). Using multiple national data sources that included 574,682 individuals from 8,634 HHA, we examined access to high-quality HHA care among racial and ethnic minorities with and without dementia. Approximately 9.9% of the individuals were Black, 6.2% Hispanic...

Most older adults with serious illness, including Alzheimer’s Disease and Related Dementias (ADRD) reside in community-based settings. These individuals and their care partners rely on Long Term Supportive Services (LTSS) including nursing home, home health, hospice, and adult day centers to provide support. LTSS are often under-resourced and reimb...

Home health care is the most commonly used home- and community-based service to older adults “Aging in Place”. Patient experience of healthcare services is a critical aspect of patient-centered care. Indeed, policymakers have linked patient-rated quality of care to payment to healthcare providers. This study aimed to examine the association between...

Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in the New York including medical/clinical directors, program managers, nurse practit...

Background Multiple sclerosis (MS) is an autoimmune disease leading to physical, emotional and cognitive disability. High body mass index (BMI) may impact cognitive function and brain volume in MS. Yet, there is paucity of evidence addressing the impact of BMI on cognitive function and brain volume in MS. Objectives The purpose of this study was t...

The objective of this study was to characterize multiple chronic conditions (MCCs) among seriously ill adults receiving palliative care at the end of life. A latent class analysis was conducted to identify latent subgroups of seriously ill older adults based on a baseline Charlson comorbidity index (CCI) measurement, a measure of comorbidity burden...

Background: Serious illness is characterized by high symptom burden that negatively affects quality of life (QOL). While palliative care research has highlighted symptom burden in seriously ill adults with cancer, symptom burden among those with non-cancer serious illness and multiple chronic conditions has been understudied. Latent class analysis...

Background : Evaluation of usability and mobile health content is critical for ensuring effective implementation of technology utilizing interventions tailored to the needs of hospice care providers for people living with dementia (PLWD) in community-based settings. Intervention : The Aliviado app was created to support providers delivering hospic...

Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in New York City including medical/clinical directors, program managers, nurse practi...

Homebound older adults are a highly vulnerable population, yet little is known about their experiences with healthcare during the COVID-19 pandemic. We interviewed patients in home-based primary care (HBPC) in New York City by telephone in May and June of 2020. Interviews covered social supports, household activities, self-care, and medical care, a...

The rapid deployment of video visits during COVID-19 may have posed unique challenges for home-based primary care (HBPC) practices due to their hands-on model of care and older adult population. This qualitative study examined provider perceptions of video visits during the first wave of the COVID-19 crisis in New York City (NYC) through interviews...

Objectives: Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions. Methods: GEAR e...

Objectives Approximately 7.5 million US adults are homebound or have difficulty accessing office-based primary care. Home-based primary care (HBPC) provides such patients access to longitudinal medical care at home. The purpose of this study was to describe the challenges and adaptations by HBPC practices made during the first surge of the COVID-19...

Context: During the COVID-19 pandemic, community-based research studies experienced prolonged shutdowns unless able to pivot to remote study procedures. Objectives: To describe the revision of two National Institutes of Health funded community-based palliative-focused clinical trials serving underserved populations to accommodate remote subject enr...

Purpose: Telehealth's uptake has increased substantially in recent years, with an especially large jump in 2020 due to the emergence of COVID-19. This article provides background on and explores "telepresence" in healthcare literature. Telepresence strongly impacts the patient experience, but it is poorly defined in current research. The aim was t...

Context Persons from underrepresented racial and ethnic groups experience disparities in access to and quality of palliative and end-of-life care. Objectives To summarize and evaluate existing palliative and end-of-life care interventions that aim to improve outcomes for racial and ethnic underrepresented populations in the United States. Methods...

Objectives Telemedicine and telehealth are increasingly used in nursing homes (NHs). Their use was accelerated further by the COVID-19 pandemic, but their impact on patients and outcomes has not been adequately investigated. These technologies offer promising avenues to detect clinical deterioration early, increasing clinician's ability to treat pa...

Background The COVID-19 pandemic has resulted in a profound transformation of health care delivery toward telemedicine models. Purpose We present the structure of a nurse-led telephonic palliative program and operational metrics to influence further development of tele-palliative programs. Methods The nurses engage with seriously ill patients for...

Objectives The ideal clinical model to deliver palliative care to patients with advanced kidney disease is currently unknown. Internationally, ambulatory kidney palliative care clinics have emerged with positive outcomes, yet there is limited data from the United States (US). In this exploratory study we report perceptions of a US-based ambulatory...

Background and Objectives Many investigators of Alzheimer’s disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure...

Almost half of hospice patients currently have a diagnosis of dementia. However, few pragmatic, evidence-based, programs have been developed and tested in this setting overall, and targeting persons living with dementia and their caregivers specifically. Furthermore, limited academic-hospice research partnership exist. We thus undertook efforts to...

Many residents of Assisted Living (AL) confront serious illness and therefore might benefit from greater access to Palliative Care Services to improve quality of life. We surveyed resident records and AL nursing staff to identify patients in need of Palliative Care. Preliminary findings showed that nurses predicted 23% would not be alive and 49% wo...

Background/objectives: COVID-19 required rapid innovation throughout the healthcare system. Home-based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands-on, model of care to accommodate restrictions on in-person contact. Our aim was...

Background: Breast cancer-related lymphedema (BCRL) limits the movements of patients' limbs, which leads to a diminished ability to achieve essential activities of daily living (ADLs). The purpose of this study was to examine the associations between limb volume changes from the baseline before breast cancer surgery and self-reported difficulty in...