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Caroline Madrigal

Caroline Madrigal
Providence VA Medical Center · Research

About

50
Publications
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519
Citations

Publications

Publications (50)
Article
Adaptation of interventions to local contexts is often required for sustainable implementation. Yet maintaining and measuring fidelity to an intervention’s core components is necessary during pragmatic clinical trials. We systematically addressed this inherent tension across two studies of Montessori approaches for person-centered care in Departmen...
Article
Providing choice and accommodation of preferences is fundamental to delivery of person-centered care in nursing homes (NH). Studies indicate variability in NH residents’ preferences around a range of daily care routines and activities (i.e., involvement of family, meal choices, morning or nighttime routines) and the widespread challenges NHs face i...
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Purpose Delivery of person-centered care (PCC) is the standard in nursing homes (NHs) and demonstrates a positive impact on resident quality of life (QOL). PCC inherently recognizes and prioritizes resident preferences; however, preferences, and their degree of importance among residents, demonstrate a variable relationship with QOL that remains un...
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Full-text available
Effectively adapting evidence-based interventions for nursing home (NH) implementation is a critical, yet under-examined, component of improving care quality. Montessori-based activity programming (MAP) is an evidence-based intervention that promotes person-centered care, engages persons living with dementia, and mitigates distress behaviors. Curre...
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Full-text available
Background and Objectives Person-centered care practices are essential to providing high-quality care for nursing home (NH) residents. A key component of implementing person-centered care is the assessment and fulfillment of residents’ preferences. However, few NHs consistently assess and implement residents’ preferences into care. From 2015 to 201...
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The purpose of the current study was to describe nursing home (NH) staff's perceived learning and practice competency needs to facilitate effective delivery of person-centered care (PCC) when older adult residents' care preferences involve perceived risks. This needs assessment included a survey of NH staff and leaders (N = 87) and two focus groups...
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The Checklist for Evidence of Person-Centered Care Approaches for Behavioral and Psychological Symptoms of Distress (BPSD) in Care Plans was developed to assess the person-centeredness of care plans for nursing home residents living with behavioral and psychological symptoms associated with dementia. The purpose of the current study was to evaluate...
Article
To encourage person-centered care, the Centers for Medicare and Medicaid require nursing homes to measure resident preferences using the Preferences Assessment Tool (PAT). No known research has examined the implications of respondent type (i.e., resident, proxy, staff) on preference importance; therefore, the purpose of this study was to compare th...
Article
Background and Objectives Effectively adapting evidence-based interventions for nursing home (NH) implementation is a critical, yet under-examined, component of improving care quality. Montessori-based activity programming (MAP) is an evidence-based intervention that promotes person-centered care, engages persons living with dementia, and mitigates...
Article
Background Nursing homes (NHs) are required to provide person-centered care, efforts often folded into broader culture change initiatives. Despite the known benefits of culture change, it is difficult to measure. This study aims to assess the criterion validity of the Preferences for Everyday Living Inventory (PELI) Implementation Indicator with ot...
Article
Nursing home (NH) providers would benefit from adopting evidence-based measures for gathering and utilizing resident preference information in their daily care activities. However, providers face barriers when implementing assessment tools used to promote person-centered care (PCC). Although Agile methodology is not commonly used in NH settings, th...
Article
Long-term stability of nursing home (NH) residents’ everyday preference remains unknown. We examined 1-year stability in reports of importance of 34-recreational activity preferences (8-MDS 3.0 Section F items; 26- Preferences for Everyday Living Inventory-NH items) by NH residents ( N = 161). We examined mean differences on demographic and clinica...
Article
The Centers for Medicare and Medicaid Services mandate the provision of person-centered care (PCC), but there is limited evidence on how PCC impacts nursing home (NH) residents' care experiences. This study examined the relationship between n = 163 NH residents' ratings of satisfaction with care related to their preferences and their satisfaction w...
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In residential care communities (CCs), implementation strategies can improve the use of person-centered approaches for residents' behavioral symptoms of distress. We examined staff perceptions of how well their organizational goals for achieving person-centered care (PCC) were met following implementation of the strategy, Evidence Integration Trian...
Article
The work environment is a modifiable construct associated with the quality of nursing home care. This article describes and explains variables known to be associated with the work environment of nurses in nursing homes, including the history and characteristics of nursing homes; the nature of nursing work; the nursing skill mix, and care delivery....
Article
Negative perceptions of aging and older adulthood, including the idealization of youth, are common in the United States. Past work has found that holding negative perceptions of aging is closely associated with poor mental and physical health consequences, yet few studies have examined how these perceptions impact day-to-day experiences. The curren...
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Full-text available
Aim: Heart failure (HF) outcomes are disproportionately worse in patients discharged to skilled nursing facilities (SNF) as opposed to home. We hypothesized that dementia and delirium were key factors influencing these differences. Our aim was to explore the associations of dementia and delirium with risk of hospital readmission and mortality in H...
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Background Multimorbidity and polypharmacy are common among individuals hospitalized for heart failure (HF). Initiating high-risk medications such as antipsychotics may increase the risk of poor clinical outcomes, especially if these medications are continued unnecessarily into skilled nursing facilities (SNFs) after hospital discharge.Objective Ex...
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Background Associations among psychological health and memory concerns in older adults are well-established, but much of this research is quantitative. Objectives This study examined how memory problems influence emotional well-being in older adults without dementia, and whether this differs by cognitive status and current depressive or anxiety sy...
Article
Frailty, a vulnerability to stressors, has been increasingly woven into the clinical understanding of older people who are unable to respond to the impact of diseases, disability, and age-related decline. While the literature has focused on physical frailty, social frailty has been conceptualized within the domains of social needs (social and emoti...
Article
Objectives Many older Veterans, like most adults, prefer to remain in their homes and communities as long as possible. Although targeted delivery of home- and community-based services for Veterans might delay long-term care placement, often, access to these services is inconsistently organized or delayed. To aid in early recognition of Veterans at...
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Full-text available
Importance A substantial number of patients discharged to skilled nursing facilities (SNFs) after heart failure (HF) hospitalization experience regression in function or do not improve. Delirium is one of few modifiable risk factors in this patient population. Therefore, understanding the role of delirium in functional recovery may be useful for im...
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Person-centered care (PCC) is the gold standard in care delivery for all people, including older adults. Key players, such as the National Academies of Sciences, Engineering, and Medicine, the Institute for Healthcare Improvement, and the Centers for Medicare & Medicaid, have highlighted PCC as a means to better meet people's needs and improve thei...
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Ongoing evidence of failures to provide cardiopulmonary resuscitation in skilled nursing facilities (SNFs) has resulted in the federal regulation - F678 Cardio-Pulmonary Resuscitation (CPR). Descriptions of CPR-related non-compliance and nursing practice failures are contained in Statements of Deficiencies (CMS-2567). These data provide a unique op...
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Full-text available
The US federal government mandates nursing homes (NHs) provide preference-based, person-centered care for residents. Yet only 2% of NHs successfully implement person-centered care. The Care Preference Assessment of Satisfaction (ComPASS) is a 16-item tool that facilitates residents’ preference fulfillment (i.e., satisfaction with quality of daily c...
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Full-text available
Nursing home (NH) staff perceptions of risks to residents’ health and safety is a major barrier to honoring resident preferences, the cornerstone of person-centered care delivery. This study examined direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents’ preferences for everyday living and...
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Full-text available
Preference-based care is required by the Centers for Medicare and Medicaid Services and is linked to improved quality of nursing home care. The federally mandated Minimum Data Set (3.0) Preference Assessment Tool (PAT) is a 16-item standardized measure used to facilitate preference-based care through rating how important residents’ daily and activi...
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Full-text available
Introduction/Background Frailty identifies patients that have vulnerability to stress. Acute illness and hospitalization are stressors that may result in delirium and further accelerate the negative consequences of frailty. Purpose The purpose of this study was to determine whether frailty, identified at hospital admission and as measured by a fra...
Article
Little literature exists examining the development and implementation of person-centered care (PCC) plans focused on behavioral and psychological symptoms of dementia (BPSD). The current study aimed to describe BPSD documented in nursing home (NH) residents' care plans, the types of approaches staff document in addressing those symptoms, and whethe...
Article
Background and objectives: Nursing home (NH) staff perceptions of risks to residents' health and safety is a major barrier to honoring resident preferences, the cornerstone of person-centered care delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents' prefere...
Article
Younger adults often endorse age-based stereotypes which have repercussions on the health and well-being of younger and older adults. The purpose of this study was to measure and describe the influence of an intergenerational, artistic installation on younger adults’ attitudes toward aging and older adults. A convergent parallel mixed method design...
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Full-text available
How behavioral and psychological symptoms of dementia (BPSD) are understood and managed is important to person-centered care. No knowledge tests associated with dementia specifically address staff knowledge of person-centered behavioral approaches to BPSD. The Knowledge of Person-Centered Behavioral Approaches for BPSD Test was developed by our tea...
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Full-text available
Frailty is an accumulation of deficits that helps identify patients who are vulnerable to stressors. Acute illness and hospitalization are stressors that may result in delirium. Delirium is significant in older adults, resulting in increased hospital stays, institutionalization, morbidity, and mortality. This study aimed to determine if a frailty i...
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Full-text available
The Institute for Healthcare Improvement’s Triple Aim calls for measures of the ‘patient care experience’ to understand and improve the quality of care delivery. But, quality measures in the nursing home (NH) historically lack the resident perspective. Measuring whether residents are satisfied with the fulfillment of their care preferences using th...
Article
Knowledge of individuals' everyday preferences is a cornerstone of person-centered care (PCC). Initial evidence demonstrates the positive impact of honoring preferences in care for older adults receiving long-term services and supports (LTSS). Yet, the mechanisms through which preference-based care affects individual well-being remain poorly unders...
Article
Negative age-based stereotypes are pervasive in society. Younger adults (YA) are most likely to endorse negative age-based stereotypes. Thus, it is imperative to reach YA through innovative means in order to challenge negative stereotypes. The purpose of this study was to measure and describe YA experiences with and perceptions of a cross-generatio...
Article
The feasibility and acceptability of a two-step screening protocol for delirium identification was pilot tested. Step 1, a screening tool, comprises two items: "Please tell me the day of the week," and "Please tell me the months of the year backwards starting with December." If either/both items are incorrect, Step 2, a 3-minute diagnostic assessme...
Article
Apathy is prevalent in individuals with dementia. Lack of responsiveness to environmental stimulation is a key characteristic of apathy. The Person-Environment Apathy Rating (PEAR) scale consists of environment and apathy subscales, which allow for examination of environmental impact on apathy. The interrater reliability of the PEAR scale was exami...
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Background Apathy is prominent in persons with dementia and apathy assessment is challenging. It remains unclear who should conduct apathy assessments in long-term care settings for residents with moderate to advanced dementia. The Apathy Evaluation Scale (AES) is a widely used instrument and its use for long-term care residents with dementia needs...
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Purpose: The purpose of this study was to test the reliability and validity of the Care Plan Checklist for Evidence of Person-Centered Approaches for Behavioral and Psychological Symptoms Associated with Dementia (BPSD). Methods: This study used baseline data from the first cohort of a larger randomized clinical trial testing the implementation...
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Background Older adults with subjective cognitive impairment (SCI) experience increased affective symptoms, reduced engagement in a range of activities, as well as more functional problems when compared to those without SCI. These associations suggest that SCI may be detrimental to older adults’ quality of life (QoL). The purpose of this paper is t...
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Background: Technology-based attention training programs have demonstrated promise in improving cognitive functioning in older adults. Aims and objectives: The purpose of this study was to evaluate the usability and acceptability of a modified version of a mobile attention training application. Design: A descriptive, mixed-methods design was u...
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Delirium is prevalent, costly, and morbid, yet underdetected by clinicians. We tested feasibility and acceptability of a 2-step delirium identification protocol. Step 1, a screener, consists of “What is the day of the week?” and “Months of the year backwards.” If either/both items are incorrect, step 2, a 3-minute diagnostic assessment (3D-CAM) fol...
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Background: Individual perception of memory performance (i.e., subjective memory) is assessed using a variety of approaches. This article focuses on 2 such approaches: (1) self-comparison assessments that attempt to capture changes in memory ability over a period of time and (2) age-anchored comparisons that assess how an individual perceives thei...
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Support groups have demonstrated promising outcomes for individuals with mild cognitive impairment (MCI) and early-stage dementia (ESD) in previous literature reviews. However, evidence has not been updated since 2007. The current review aimed to update current evidence on the use and effects of support groups for individuals with MCI and ESD and t...

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