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418
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Introduction
Skills and Expertise
Education
October 1984 - October 1986
Publications
Publications (418)
INTRODUCTION
Many persons with dementia are undiagnosed or unaware of dementia, which may affect hospitalization outcomes.
METHODS
We evaluated differences in length of stay, days not at home, discharge destination, and 30‐day readmissions over 1 year in 6296 older adults in the National Health and Aging Trends Study with linked Medicare claims. M...
This study aimed to evaluate the efficacy of The Residential Care Transition Module (RCTM), a six-session, psychosocial, and psychoeducational telehealth intervention for family caregivers of cognitively impaired relatives living in a residential long-term care (RLTC) setting. Eligible participants (including care recipients, regardless of time sin...
Population-based cohort studies offer unique opportunities to study characteristics of people at greatest risk for cognitive decline. Harmonizing large, well-characterized cohorts powers investigations into subgroups or rare exposures/outcomes in their associations with cognitive decline. We derived a harmonized cognition score based on cognitive t...
Although continuous positive airway pressure (CPAP) is an efficacious treatment for obstructive sleep apnea (OSA), suboptimal adherence is common, reducing its effectiveness. OSA co-occurs with chronic health conditions that may impact adherence to CPAP. This study evaluated health conditions as predictors of CPAP discontinuation over 2 years. Data...
Importance
Primary care is a key setting for advance care planning (ACP).
Objective
To test the effects of a multicomponent primary care–based ACP intervention (SHARING Choices) on documented end-of-life preferences and potentially burdensome care at end of life.
Design, Setting, and Participants
This pragmatic cluster randomized clinical trial i...
Background
Adult caregiving can be demanding and stressful, especially when the caregiver is employed. As the age of the U.S. population and workforce increases, more adults are providing care to aging family members.
Objective
To understand the prevalence and aspects of the caregiving experience and caregiving strain among department of medicine...
Family caregiving may affect purpose in life, defined as the sense that life has meaning and intentionality. Few studies have compared caregivers to non-caregivers or examined the characteristics of caregivers associated with purpose in life. Using data from the Caregiving Transitions Study ( n = 486), we conducted multiple linear regression analys...
INTRODUCTION
Best practices for conducting advance care planning (ACP) among persons with cognitive impairment exist, but evidence‐based models are lacking for the primary care setting.
METHODS
We tested a remote multicomponent ACP model (SHARE) versus minimally enhanced usual care in 273 person–family dyads from eight primary care practices.
RES...
Background
Self‐care for adults with hypertension includes adherence to lifestyle behaviors and medication. For unpaid caregivers with hypertension, the burden of family caregiving may adversely impact self‐care. We examined the association between caregiver strain and hypertension self‐care among caregivers with hypertension.
Methods and Results...
Background
Cognitive impairment after stroke is common and is present in up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of 2 stroke s...
The purpose of this study was to evaluate the efficacy of the Residential Care Transition Module, a six-session, psychosocial, and psychoeducational telehealth intervention for family caregivers of cognitively impaired relatives living in a residential long-term care setting. Eligible participants (including care recipients, regardless of time sinc...
Background: Adult caregiving can be demanding and stressful, especially when the caregiver is employed. As the age of the U.S. population and workforce increases, more adults are providing care to aging family members.
Objective: To understand the prevalence and aspects of caregiving experience and caregiving strain among department of medicine fac...
Introduction
Sleep apnea and insomnia often co-occur in older adults, complicating treatment and worsening outcomes. More research is needed to characterize sleep apnea patients with and without co-morbid insomnia. We characterized differences in demographic and clinical characteristics between individuals with co-morbid insomnia and sleep apnea (C...
Introduction
Sleep apnea is associated with several health conditions known to increase the use of health services that may otherwise be preventable (e.g., hospitalization). We investigated the association of sleep apnea and the subsequent use of health services, independent of health conditions and other potential confounders.
Methods
We studied...
This paper presents the main outcomes of a cluster randomized hybrid trial (type I) involving 34 adult day services (ADS) in the US. Eighteen sites were randomized to control (ADS as usual); 16 sites provided ADS and caregiver support (ADS Plus). Trained staff met with caregivers onsite to provide dementia education, support/validation, referrals/l...
A cluster randomization approach was applied to 55 primary care practices across two health systems. A 1:2 randomization design resulted in 19 practices being randomized to the SHARING Choices intervention condition and 36 practices randomized to a usual care control condition. The primary outcome variables include documentation of an advance direc...
The purpose of this study is to examine intervention processes including session completion and content of the ADS Plus program. Interventionists completed an investigator-developed delivery assessment form following completion of each ADS Plus session with participating caregivers. Additionally, information on care challenges addressed and strateg...
This presentation will introduce SHARE, a randomized-controlled trial to proactively engage family caregivers and normalize advance care planning in primary care. The objective of the study is to engage family caregivers in longitudinal interactions with primary care clinicians and stimulate and support ACP discussions in primary care. We focus on...
2. Conducting high-quality advance care planning (ACP) conversations with persons living with ADRD and their family members is inherently challenging. Differing levels of cognitive function, judgment, ability to engage, and care partner involvement adds to the complexity of such ACP conversations, necessitating flexible fidelity monitoring to accom...
The Porchlight Project (PLP) is a 5-year study designed to evaluate the real-world efficacy of dementia capable training and respite delivered by volunteers for older people living in the community throughout Minnesota and in select regions of North Dakota. Volunteer regions managed by the Lutheran Social Services of Minnesota (LSS-MN) throughout M...
This paper groups persons who have transitioned into family caregiving using a latent class analysis and examines class differences on measures of well-being. Latent classes were identified for a sample of 251 participants who became family caregivers while participating in a longitudinal national study, and linear regression analyses compared aver...
Objective: Cognitive impairment after stroke is common, present in 30-50% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of two stroke severity...
Objectives
This study examined the malleability of a tri-partite cluster of purported mechanistic variables targeted in a 4-week intervention program designed to improve adults’ engagement in physical activity. The targeted cluster of purported mechanisms consisted of negative views of aging (NVOA), self-efficacy beliefs, and behavioral intentions....
Background and Objectives
Adult day services (ADS) provide quality-of-life benefits to people with dementia , but few provide systematic caregiver support. We report outcomes of a multi-site, national trial testing a staff-delivered caregiver program, ADS Plus.
Research Design and Methods
Cluster randomized trial involving 34 ADS: 18 sites provide...
Chronic stress is associated with negative health outcomes, including poorer cognition. Some studies found stress from caregiving associated with worse cognitive functioning; however, findings are mixed. The present study examined the relationship between caregiving, caregiving strain, and cognitive functioning. We identified participants in the Re...
Background:
Frailty and cognitive impairment (CI) are geriatric conditions that lead to poor health outcomes among older adults with cardiovascular disease. The association between their temporal patterns of development and cardiovascular risk is unknown.
Objectives:
This study aims to examine the 5-year cardiovascular outcomes by the pattern of...
Background:
Few advance care planning (ACP) interventions have been scaled in primary care.
Problem:
Best practices for delivering ACP at scale in primary care do not exist and prior efforts have excluded older adults with Alzheimer's Disease and Related Dementias (ADRD).
Intervention:
SHARING Choices (NCT#04819191) is a multicomponent cluster...
Objective:
Little is known about effective strategies to improve advance care planning (ACP) for persons with cognitive impairment in primary care, the most common setting of care. We describe a randomized controlled trial to test the efficacy of a multicomponent communication intervention, "Sharing Healthcare Wishes in Primary Care" (SHARE).
Par...
Background:
To assess whether vitamin D3 supplementation attenuates the decline in daily physical activity in low-functioning adults at risk for falls.
Methods:
Secondary data analyses of STURDY (Study to Understand Fall Reduction and Vitamin D in You), a response-adaptive randomized clinical trial. Participants included 571 adults aged 70 years...
Background:
Social isolation can influence whether older adults develop dementia. We examine the association between social isolation and incident dementia among older adults in a nationally representative sample of community dwelling older adults in the United States (U.S.). We also investigate whether this association varies by race and ethnicit...
The AgingPLUS program targets negative self-perceptions of aging (SPA) as one mechanism to increase physical activity (PA) in adults. This study utilized a mediation model to examine the effect of AgingPLUS on subsequent PA with SPA included as a mediator. Data came from 184 participants (Mage = 59.91 years; SDage = 8.14 years) from the ongoing tri...
Background:
The quality of communication (QOC) questionnaire has been widely used to assess foundational aspects of patient-clinician communication about end-of-life (EOL) care. However, this instrument has never before been fielded with primary care patients who have cognitive impairment and their caregivers, a population with unique communicatio...
Background:
Features of the physical environment may affect post-stroke recovery, but empirical evidence is limited. This study examines associations between features of the physical environment and post-stroke physical quality of life (PH-QOL).
Methods:
The study sample included stroke survivors enrolled in the Caring for Adults Recovering from...
Background:
Although nonpharmacological approaches are considered first-line treatments for dementia-related behaviors, it is unclear as to their effectiveness for different racial groups. We evaluated the effects of the Tailored Activity Program (TAP) on agitated and aggressive behaviors in Black and White families.
Methods:
We conducted a sing...
Background:
Advance care planning (ACP) and involving family are particularly important in dementia, and primary care is a key setting. The purpose of this trial is to examine the impact and implementation of SHARING Choices, an intervention to improve communication for older adults with and without dementia through proactively supporting ACP and...
Telomere length (TL) is widely studied as a possible biomarker for stress-related cellular aging and decreased longevity. There have been conflicting findings about the relationship between family caregiving stress and TL. Several initial cross-sectional studies have found associations between longer duration of caregiving or perceived stressfulnes...
Objectives
Higher inflammation has been linked to poor physical and mental health outcomes, and mortality, but few studies have rigorously examined whether changes in perceived stress and depressive symptoms are associated with increased inflammation within family caregivers and non-caregivers in a longitudinal design.
Design
Longitudinal Study....
Objectives: Cognitive abilities have been implicated as predictors of mortality in older adults. This study examines the effects of cognitive training on mortality 20 years post-intervention. Methods: Data come from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial (N = 2802). Participants were cogn...
Background:
Care at the end of life is commonly fragmented; however, little is known about commonly used measures of fragmentation of care in the last year of life (LYOL). We sought to understand differences in fragmentation of care by dementia status among seriously ill older adults in the LYOL.
Methods:
We analyzed data from adults ≥65 years i...
Circulating levels of inflammatory biomarkers may be influenced by chronic psychological stressors such as those experienced by family caregivers. However, previous studies have found mostly small and inconsistent differences between caregivers and control samples on individual measures of systemic inflammation. Latent variables of inflammation wer...
Background
Low serum 25-hydroxyvitamin D [25(OH)D] level is associated with a greater risk of frailty, but the effects of daily vitamin D supplementation on frailty are uncertain. This secondary analysis aimed to examine the effects of vitamin D supplementation on frailty using data from the Study To Understand Fall Reduction and Vitamin D in You (...
The stress of family caregiving may affect many health-related variables, including sleep. We evaluated differences in self-reported sleep quality between incident caregivers and matched non-caregiving controls from a national population-based study. Caregivers and controls were identified in the Reasons for Geographic and Racial Differences in Str...
Background
informal caregiving for family and friends is becoming increasingly common due to the rising prevalence of chronic conditions and a shortage of affordable care options. While the impact of caregiving on caregivers’ health is well-documented, nuances in caregivers’ experiences may not be captured in quantitative studies. We aimed to bette...
Background
Wearable devices have become widespread in research applications, yet evidence on whether they are superior to structured clinic-based assessments is sparse. In this manuscript, we compare traditional, lab-based metrics of mobility with a novel accelerometry-based measure of free-living gait cadence for predicting fall rates.
Methods
Us...
Positive aspects of caregiving (PAC) are positive appraisals that caregivers report about their role such as feeling appreciated or important, and may increase with caregiver adaptation over time. We aimed to examine differences in PAC by caregiving duration and social engagement, controlling for measures of distress. A total of 283 African America...
An increase in life expectancy and an aging population has resulted in increased risks and prevalence of age-related diseases. Previous studies have shown that factors, such as chronic stress, are associated with shorter telomere length. When telomeres become critically short, cells enter a state of senescence, which is a hallmark of aging. Several...
This study examined the effect of the AgingPLUS program on anticipated physical activity (PA) and PA engagement, along with the hypothesized mediator roles of self-efficacy (SE) and exercise intention (EI). Data came from 147 participants (Mage = 60.11 years; SD = 8.28 years) of the ongoing trial. Structural equation modeling tested the effects of...
The high levels of stress experienced by family caregivers may affect their physical and psychological health, including their sleep quality. However, there are few population-based studies comparing sleep between family caregivers and carefully-matched controls. We evaluated differences in sleep and identified predictors of poorer sleep among the...
This paper investigated whether the AgingPLUS program promotes physical activity in middle-aged and older adults by examining outcomes at weeks 4 and 8 with baseline scores included as covariates. The analyses assessed intervention effects on negative views of aging (NVOA), physical activity (CHAMPS), physical function (SPPB, VO2max), and accelerom...
The AgingPLUS program targets three psychological mechanisms that are known barriers to middle-aged and older adults’ engagement in physical activity (PA): Negative views of Aging (NVOA), low self-efficacy beliefs, and poor goal planning skills. These risk factors are addressed in a 4-week intervention program that is compared to a generic health e...
Low physical activity (PA) is a common phenotype of frailty, but whether disengagement of daily lifestyle PA signals impending frailty remains unexplored. Using STURDY (Study to Understand Fall Reduction and Vitamin D in You) data from 499 robust/prefrail adults (mean age=76 + 5 years; 42% women), we examined whether accelerometer patterns (activit...
Family caregiving requires activities and experiences that have negative and positive features, producing stress but also providing benefits. The Caregiving Transitions Study (CTS) enrolled 283 caregivers from a national epidemiologic study, of which 32 were caregivers prior to enrollment in the parent study, and 251 became caregivers while partici...
As people live longer, informal caregiving for family and friends is becoming increasingly common. Caregiver satisfaction with their role is now of greater importance to an increasing proportion of the U.S. population. Most research on caregivers has studied convenience samples, often restricted to caregivers of people with dementia. Various studie...
Accelerometers are widespread in research applications, yet whether they are superior to structured clinic-based assessments is unknown. Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-meter gait speed) with free-living gait cadence from wrist acceleromete...
Objectives
Positive caregiver adaptation over time may be associated with reports of positive aspects of caregiving (PAC). We examined differences in PAC by caregiving duration and social engagement, controlling for measures of distress.
Methods
Participants included 283 African American or White caregivers from the Caregiving Transitions Study wi...
Background:
Dementia is associated with increased risk of hospitalization and emergency department (ED) visits. Many persons with dementia are undiagnosed or unaware of their diagnosis, however. Our objective was to determine whether undiagnosed dementia or unawareness affects risk of hospitalization or ED visits.
Methods:
Retrospective longitud...
Background:
Social isolation is a risk factor for morbidity and mortality comparable to well-established risk factors including smoking, hypertension, and a sedentary lifestyle. The specific biological mechanisms that connect social isolation to morbidity and mortality remain unclear. Interleukin-6 (IL-6) and C-reactive protein (CRP) are biologica...
Background
People living with dementia (PLWD) and caregivers are adversely impacted by lack of meaningful activity leading to worse symptoms and impaired quality-of-life. There is a critical need to develop effective and well-tolerated treatments that mitigate clinical symptoms, engage PLWD and support caregiver wellbeing. We tested whether, compar...
Background:
Effective communication between skilled home healthcare (SHHC) clinicians and physicians is critical to care coordination. No studies have examined this from the point of view of SHHC clinicians at the national level. The objective is to determine in national sample issues related to how SHHC agency clinicians communicate with physicia...
Background
Self-reported low physical activity is a defining feature of phenotypic frailty but does not adequately capture physical activity performed throughout the day. This study examined associations between accelerometer-derived patterns of routine daily physical activity and frailty.
Methods
Wrist accelerometer and frailty data from 638 part...
Background:
Prior stroke is one of the biggest risk factors for future stroke events. Effective secondary prevention medication regimens can dramatically reduce recurrent stroke risk. Guidelines recommend the use of antithrombotic, antihypertensive and lipid-lowering medications after stroke. Medication adherence is known to be better in the prese...
Importance
Guidelines recommend against routine breast and prostate cancer screenings in older adults with less than 10 years’ life expectancy. One study using a claims-based prognostic index showed that receipt of cancer screening itself was associated with lower mortality, suggesting that the index may misclassify individuals when used to inform...
Background/objectives:
To assess whether vitamin D supplementation prevents specific fall subtypes and sequelae (e.g., fracture).
Design:
Secondary analyses of STURDY (Study to Understand Fall Reduction and Vitamin D in You)-a response-adaptive, randomized clinical trial.
Setting:
Two community-based research units.
Participants:
Six hundred...
Background
Older adults are encouraged to use Medical Visit Companions (MVCs) for routine medical encounters; however, many vulnerable older adults attend alone or fail to attend. In the absence of available family or friends, community volunteers could potentially fill this gap. We aimed to understand the role and acceptability of volunteer MVCs a...
Background
Nearly one-third of medical school faculty members are age 55 + . As our population ages, the prevalence of family caregiving is increasing, yet we know very little about the caregiving experiences of aging faculty members in academic medicine. Faculty caregiving responsibilities coupled with projected physician shortages will likely imp...
Background
Pragmatic trials often consist of cluster-randomized controlled trials (C-RCTs), where staff of existing clinics or sites deliver interventions and randomization occurs at the site level. Covariate-constrained randomization (CCR) methods are often recommended to minimize imbalance on important site characteristics across intervention and...
Importance:
Caregiver strain has been shown to be associated with adverse effects on caregivers' health, particularly among those with cardiovascular disease. Less is known about the association of caregiver strain with health behaviors among caregivers with diabetes, a disease that requires a high degree of self-care.
Objective:
To examine the...
Background and Purpose
Life’s Simple 7 (LS7) is a metric for cardiovascular health based on the 7 domains of smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. Because they may be targeted for secondary prevention purposes, we hypothesized that stroke survivors would experience improvement in...
We examined caregiving relationships for individuals with vision impairment (VI) and dementia, using 2011 National Health and Aging Trends Study (NHATS) data, a survey of Medicare beneficiaries, linked to the National Study of Caregiving, a survey of family/unpaid helpers to NHATS participants. VI was defined as self-reported blindness or difficult...
Subjective well-being (SWB), comprised of cognitive and affective evaluations of life, is associated with better health outcomes and lower mortality, but mechanisms are poorly understood. We examine the associations between SWB and its subscales with two biomarkers: Interleukin-6 (IL-6) and C-Reactive Protein (CRP), both common inflammatory indicat...
STURDY was a Bayesian, response-adaptive trial with dose-finding and confirmatory stages. Participants (n=688; ≥70years with serum 25(OH)D of 10-29ng/mL) were randomized to 200 (control), 1000, 2000, or 4000 IU/day of vitamin D3. The primary outcome was time to first fall or death over 2 years. During dose-finding, the best non-control dose was det...
Cross-sectional evidence suggests older adults with higher serum vitamin D are more physically active, but whether long-term vitamin D supplementation attenuates age-related declines in physical activity (PA) is undefined. We examined the association between vitamin D supplementation and daily PA in 639 STURDY participants (aged 77 (5.4) years; 44%...
Seven million adults in the United States are homebound and suffer the negative, powerful synergies of multiple chronic conditions, functional impairment, social stressors, and limited social capital. The prevalence of frailty in this vulnerable homebound population is unknown. Using representative data from the National Health and Aging Trends stu...
Participants in the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study were asked about family caregiving responsibilities at enrollment (2003-2007). Among the 88% of participants who were not caregivers at enrollment, 1,229 reported becoming caregivers before a follow-up interview 12 years later. The Caregiving Transi...
Evidence suggests Vitamin D supplementation may reduce fall risk in older adults, but effects on fall location and severity are less well described. We used STURDY trial data to examine whether Vitamin D supplementation reduces indoor, outdoor, “consequential” (falls resulting in injury or medical care), and repeat fall risk. Participants (77[SD=5....
Social isolation is a risk factor for morbidity and mortality comparable to well-established risk factors including smoking, hypertension, and a sedentary lifestyle. Specific mechanisms that connect social isolation to important health outcomes remain unclear. We examine the cross-sectional relationship between social isolation and two biological m...
Blood samples were collected from participants in the REGARDS study on two separate occasions. No participants in the Caregiving Transitions Study were caregivers at the first blood draw, but 251 became caregivers before the second blood draw 9 years later. These caregivers were matched with 251 noncaregiving controls. Six circulating biomarkers of...
The REGARDS study has provided a unique opportunity to study both disease-specific (stroke) and broader samples of family caregivers, and to examine the effect of transitions to caregiving over time. Using REGARDS has afforded many advantages over conventional caregiving research, including the availability of biomarker and mortality data, a large...
In recent years the popularity and application of both research- and consumer-grade wearable physical (PA) activity monitors have witnessed substantial growth in large observational studies and clinical trials. For example, the NHANES and UKBiobank, have collected accelerometry data on thousands of participants contributing to the reputation of wea...
Background
Administrative data sets lack functional measures.AimWe examined whether trajectories of cost can be used as a marker of functional recovery after hospitalization.Methods
Secondary analysis of the National Health and Aging Trends Study merged with Centers for Medicare and Medicaid Services data. Community-dwelling participants with a fir...
Background:
Vitamin D supplementation may prevent falls in older persons, but evidence is inconsistent, possibly because of dosage differences.
Objective:
To compare the effects of 4 doses of vitamin D3 supplements on falls.
Design:
2-stage Bayesian, response-adaptive, randomized trial. (ClinicalTrials.gov: NCT02166333).
Setting:
2 community...
Introduction:
Older adults present unique challenges to both emergency clinicians and health systems. These challenges are especially evident with respect to discharge after an emergency department (ED) visit as older adults are at risk for short-term, negative outcomes including repeat ED visits. The aim of this study was to evaluate characterist...
Background/objectives
Spousal concordance for cardiovascular risk factors and lifestyle behaviors may affect prevalence rates of diabetes, hypertension, and stroke. Spouses of stroke survivors, therefore, would be expected to have elevated mortality rates, but this has not been established. Thus, the aim of this study was to investigate whether coh...
Objectives:We aimed to compare incident family caregivers and matched controls on change in social network variables and satisfaction with social activities. Methods: A total of 479 participants from the Caregiving Transitions Study were included in the analysis, 244 (50.9%) of whom began substantial and sustained caregiving between baseline and fo...