Sarah L Szanton

Sarah L Szanton
Johns Hopkins University | JHU · School of Nursing

PhD ANP

About

274
Publications
21,243
Reads
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4,408
Citations
Additional affiliations
January 2017 - June 2017
Johns Hopkins University
Position
  • Professor
July 2007 - present
Johns Hopkins University
Position
  • Professor (Associate)

Publications

Publications (274)
Article
To address the gap of lacking research on the association between coping self-efficacy and loneliness, this study examined this relationship to inform future research and intervention on loneliness. Using data from 151 community-dwelling older adults ages 65 and older, we estimated multivariate logistic regression models with age, race/ethnicity, s...
Article
Background Individuals living with heart failure often require informal caregiving assistance for optimal self-care maintenance. The influence of caregiver burden and resilience on dyadic congruence is not well understood. Objective To compare how dyadic congruence is influenced by level of burden and resilience expressed by caregivers of patients...
Article
Sleep plays a vital role in older adults’ health. The Community Aging in Place—Advancing Better Living for Elders (CAPABLE) trial, conducted in Maryland between 2012 and 2016, is a 5-month biobehavioral environmental intervention study to reduce functional disabilities in 300 low-income older adults. Individual and environmental factors impacting s...
Preprint
BACKGROUND The COVID-19 pandemic increased the importance of technology for all Americans, including older adults. Obtaining knowledge regarding previously hospitalized older adults’ technology use, before and during the pandemic, could inform the appropriateness of technology-based interventions for vulnerable older adults. OBJECTIVE This study h...
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Background Nearly 50% of Americans aged 65 and above have been diagnosed with arthritis and an estimated 80% of adults experience low back pain (LBP). Little is known about the experience of LBP in older adults with arthritis and its relationships with mental and physical health. Objective In this study, we examined the relationships between LBP a...
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Background Despite known socioeconomic disparities in aging-related outcomes, the underlying physiologic mechanisms are understudied. This study applied propensity score weighting to estimate the effect of financial strain on inflammation-related aging biomarkers among a national sample of older adults. Methods Financial strain severe enough to la...
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Background and Objectives Despite evidence linking financial challenges to poor health among older adults, effective interventions are lacking. This study examined the experience of living with financial challenges, useful strategies to handle them, and social norms that may constrain options and decision-making. Research Design and Methods This t...
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Background For caregivers of people with heart failure, addressing a range of care recipient needs at home can potentially be burdensome, but caregivers may also gain meaning from caregiving. The Caregiver Support Program, a multicomponent strengths-based intervention, is designed to improve outcomes of heart failure caregivers. Objectives 1) Test...
Article
Background: Heart failure (HF) affects ~6 million people in the US and is associated with marked morbidity and adverse clinical outcomes. Among HF patients, fatigue is common and distressing symptoms that significantly impacts patient quality of life and function. Current literature primarily examines fatigue as a single and generalized symptom. Fa...
Article
Background: Caregivers of persons with heart failure must manage high levels of patient health care utilization, treatment complexity and often unpredictable stressors associated with intermittent symptom exacerbations and mortality. Interventions have often focused on the needs of the person with HF, not the caregiver. Therefore, we developed an i...
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Background: Despite profound financial challenges during the COVID-19 pandemic, there is a gap in estimating their effects on mental health and well-being among older adults. Methods: The National Health and Aging Trends Study is an ongoing nationally representative cohort study of U.S. older adults. Outcomes included mental health related to CO...
Article
As technologies continue to revolutionise health care, the nursing industry must examine how effectively we utilise technology to prepare nurses to thrive and lead. The emergence of the fourth industrial revolution (Industry 4.0) has yielded technologies that have and will continue to revolutionise health care through the use of digital transformat...
Article
Background: Multiple factors may influence the risk of being homebound, including social isolation and race. This study examines the relationship between social isolation and homebound status by race over 9 years in a sample of adults. Methods: Utilizing a representative sample of 7788 Medicare beneficiaries aged 65+ from 2011-2019, we assessed...
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The USA was built on legalized racism that started with enslavement and continues in the form of structural racial discrimination. This discrimination is difficult to measure because its many manifestations are hard to observe and dynamic. A useful tool would measure across settings, institutions, time periods in a person’s life and the country’s h...
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Objective: The objectives of this study are to 1) describe changes in in-person communication/activity and changes in older adult technology use during the COVID-19 pandemic and 2) examine whether less in-person communication/activity mediates the relationship between pandemic-related mental health and technology use. Method: Linear regressions...
Article
Objectives This study examined the published works related to healthcare robotics for older people using the attributes of health, nursing, and the human-computer interaction framework. Design An integrative literature review. Methods A search strategy captured 55 eligible articles from databases (CINAHL, Embase, IEEE Xplore, and PubMed) and hand...
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The intersection of race, gender, and age places older African American women at an increased risk for untreated physical pain and depression that can significantly diminish their quality of life. The objectives of this study were to (1) explore older African American women's perceptions of pain and depressive symptoms and how these symptoms influe...
Article
Context: Very few programs improve physical function among older adults and those that do should achieve farther reach. Methods: We used Force Field Analysis to examine drivers and restrainers for the CAPABLE program to impact the function of older adults throughout the United States. Findings: We found 19 distinct drivers for CAPABLE. These i...
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Doubling in size since the 1970s, the aging needs of the African immigrant population are not fully understood. This qualitative study examined experiences of aging and retirement planning for African immigrant older adults in the United States (U.S.). Specifically, it explored the factors, processes, and ultimate decision of where these older adul...
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We reviewed research that examines racism as an independent variable and one or more health outcomes as dependent variables in Black American adults aged 50 years and older in the USA. Of the 43 studies we reviewed, most measured perceived interpersonal racism, perceived institutional racism, or residential segregation. The only two measures of str...
Article
Background Studies of the relationship between vitamin D and physical functioning have had inconsistent results. Methods Physical functioning measures were collected for up to 2 years during a two-stage, Bayesian, response-adaptive, randomized trial of 4 doses of vitamin D3 supplementation (200 [control], 1000, 2000, and 4000 IU/d) to prevent fall...
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The needs and conceptualization of age-friendliness likely vary for immigrant older adults compared to native-born older adults. For example, Hispanic immigrant older adults often return to their home country following the development of ill health. Doubling in size since the 1970’s, the aging needs of African immigrants are not fully understood. T...
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Technology use is important for older adults, particularly in the pandemic. The pattern of technology use among older adults varies significantly. We hypothesized that limitations of activities of daily living (ADL), wellbeing, and community participation of community-dwelling older adults before the pandemic would predict technology use during the...
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Low socioeconomic status and disability are independent risk factors for disturbed sleep. The CAPABLE intervention used a multidisciplinary team approach of occupational therapist, nurse, and handyworker to reduce functional disability in low-income older adults. The 6-month intervention may benefit sleep as the intervention addressed multiple indi...
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African Americans experience high rates of undermanaged pain as they age. African Americans often become family or informal caregivers, and undermanaged pain may have implications for their overall health and ability to perform caregiving tasks. The purpose of this study was to examine if pain was related to overall health and number of caregiving...
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Physical distancing during the COVID-19 pandemic may impact the mental health of older adults, but technology use may buffer this impact. This study aimed to 1) examine changes in older adult technology use during the COVID-19 pandemic and 2) determine if technology use moderates the relationships between decreased in-person communication/activity...
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Nearly 50% of Americans aged 65 and above have been diagnosed with arthritis at any point in time, and an estimated 80% of adults experience low back pain (LBP) at some point in their lives. However, little is known about the experience of LBP in older adults with arthritis and whether or not it is related to adverse mental and physical health outc...
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The growing aging population with disabilities poses challenges to caregiving and health care services but there is little recent data on disability trends. Some studies have shown that disability is decreasing while others have shown it increasing. Understanding these trends among community-dwelling older adults is critical for communities to allo...
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The associations between hopefulness and function, loneliness, and sleep have not been explored in a nationally representative sample of older adults. Additionally, COVID19 dramatically increased stress burden, potentially influencing these relationships. This study used National Health and Aging Trends COVID19 Supplement data (N=2,894 adults aged...
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This study tested associations between income decline and financial difficulty with mental health (lack of feeling anxious/depressed, recurring thoughts/nightmares, avoiding activities/thoughts, feeling jumpy/on guard) and sleep quality during COVID-19 among a national sample of 3,188 older adults. Approximately 8% of US older adults reported incom...
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Housing quality is a recognized social determinant of health. Qualitative evidence suggests the ability of older adults to maintain their homes is affected by the domains of financial resources, social environment, and functional abilities, but this conceptualization has not been tested quantitatively. This cross-sectional study examined associatio...
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Within hearing care, significant disparities persist despite the highly prevalent nature of age-related hearing loss and relatively few trials include representation of racial/ethnic minorities. HEARS is an affordable, accessible hearing care intervention delivered by older adult peer mentors. The HEARS randomized controlled trial (NCT03442296) is...
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Older adults’ experiences using smartwatch technology for physical activity (PA) have not been well studied. We studied older adults’ acceptance, capacity, and experience using smartwatches for self-monitoring and promoting PA. We conducted individual interviews using semi-structured interview guides with 15 older adults who participated in two stu...
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Interventions to reduce disability are crucial for older adults with disabilities to avert unnecessary hospitalizations or nursing home placements and improve daily life. Developed and tested at one research site, multiple health systems and community based organizations have since implemented CAPABLE. All published or peer reviewed tests of CAPABL...
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The fragile and improvised systems of care for older adults have been decimated by isolation and fragmented care during the pandemic. However, innovations are increasingly being offered to older adults to improve the fit between them and their environment. This includes fit within the home, the social environment, the policy environment, and with c...
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Objective To summarize the evidence for preoperative deprescribing and its effect on postoperative outcomes in older adults undergoing surgery. Design Systematic review. Setting and Participants All available studies. Methods We searched EMBASE, Cumulative Index of Nursing and Allied Health (CINAHL), and PubMed from inception to January 12, 2021...
Article
Objective: To examine the association of housing and neighborhood conditions with sleep among disadvantaged older adults. Methods: We used data from 136 low-income, predominantly Black older adults with disabilities. Predictors were indices of: interior housing conditions (eg, pests, tripping hazards); exterior housing conditions (eg, broken win...
Article
Objective Late-life sleep health has been tied to physical function, but little is known about these associations among socially disadvantaged populations. Design We determined cross-sectional associations of sleep with physical function in low-income, predominantly Black older adults with disabilities. Participants One hundred thirty-six older a...
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Objectives Before, during, and after their immigration to the United States, immigrants face stressful life circumstances that may render them at risk for depressive symptoms. However, there is a dearth of research on the mental health of African immigrants. We performed secondary data analyses of two studies in the Baltimore–Washington area to des...
Article
This randomized controlled pilot trial tested the preliminary effect of a 24-week mHealth-facilitated, personalized intervention on physical activity (PA) and sleep in 21 community-dwelling older adults. The intervention included a personalized exercise prescription, training, goal setting, and financial incentives. mHealth strategies, including se...
Article
Persons with mild cognitive impairment/early dementia have a possible 20-year trajectory of disability and dependence with little information on the effectiveness of interventions to improve function. This review investigates the literature of home/community-based interventions for physical and executive function in persons with mild cognitive impa...
Article
Background: Physical frailty is defined as a syndrome of decreased physiologic reserve conferring vulnerability to functional decline, mortality, and other adverse outcomes upon experiencing stressors. Self-efficacy, which is confidence in one's ability to perform well in a domain of life, is modifiable. Self-efficacy is associated with improved h...
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Background: Programs to reduce disability are crucial to the quality of life for older adults with disabilities. Reducing disability is also important to avert unnecessary and costly hospitalizations, relocation, or nursing home placements. Few programs reduce disability and few have been replicated and scaled beyond initial research settings. CAP...
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Despite interventions aiming to improve outcomes among older adults experiencing financial challenges, the challenges and strategies employed to handle them are poorly understood. This study examined the experiences of financial challenges among low-income adults aged ≥65 years. Eleven semi-structured interviews were analyzed using thematic analyse...
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Background Subjective age refers to how young or old individuals experience themselves to be and is associated with health status, behavioral, cognitive, and biological processes that influence frailty. However, little research has examined the relationship between subjective age and frailty among older adults. This study examined the bidirectional...
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Background Communities with more Black or Hispanic residents have higher coronavirus rates than communities with more White residents, but relevant community characteristics are underexplored. The purpose of this study was to investigate poverty-, race- and ethnic-based disparities and associated economic, housing, transit, population health and he...
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Background Residential environments are associated with older adult health, but underlying physiologic causal mechanisms are not well understood. As adults age, street blocks are likely more relevant to their health than the larger neighborhood environment. This study examined the effects of adverse street block conditions on aging biomarkers among...
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Background Fear of falling and previous falls are both risk factors that affect daily activities of older adults. However, it remains unclear whether they independently limit daily activities accounting for each other. Methods We used the data from Round 1 (Year 1) to Round 5 (Year 5) of the National Health and Aging Trends Study. We included a to...
Article
A 2009 Supplemental Nutrition Assistance Program (SNAP) policy change that expanded eligibility and increased benefit amounts has been associated with reduced food insecurity. This study tests the hypothesis that the SNAP policy change corresponds with improved stress- and nutrition-sensitive cardiometabolic markers. This study included non-pregnan...
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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...
Article
Introduction In an era of COVID-19, Black Lives Matter, and unsustainable healthcare spending, efforts to address the root causes of health are urgently needed. Research linking medical spending to variation in neighborhood resources is critical to building the case for increased funding for social conditions. However, few studies link neighborhood...
Article
Objectives: To examine social and physical environmental fall-risk factors in a nationally representative sample of community-living older adults overall and by racial group. Methods: We used data from the 2015 and 2016 rounds of the National Health and Aging Trends Study ( n = 5581) linked to census tract measures from the American Community Surve...
Article
Inflammation, particularly interleukin-6 (IL-6), is associated with chronic disease in older adults, but not all older adults have the same progression of poor health outcomes. Self-efficacy may play a role in buffering the inflammatory burden in chronic disease. To evaluate associations between self-efficacy and IL-6, 159 community-dwelling older...
Article
Objectives Unresolved pain is related to neuropsychiatric symptoms (NPS) in persons living with dementia (PLWD), and an increase in NPS is distressing for PLWD and their caregivers. Hence, we examined whether pain in PLWD was related to caregiver burden and whether caregiver upset with NPS mediated this relationship. Method We examined, cross-sect...
Article
Background Frailty is prevalent in older adults and has adverse effects on multiple health outcomes. Pain, insomnia, and depressive symptoms are commonly seen and treatable symptoms in older adults and are associated with frailty. However, it is unknown whether these symptoms are independently associated with frailty and how they interact with each...
Chapter
We examine factors which support or serve as barriers to aging in place, theoretical models that frame relocation decision-making, and innovative aging-in-place service models. Community-based models such as the Village concept, Naturally Occurring Retirement Communities, Cohousing, and Fureai Kippu or Time-banking are promising approaches. Profess...
Article
Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regr...
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Prior studies have linked household and community conditions to the health and functioning of older adults. However, few studies have investigated associations between household, block, and community environmental conditions with biomarkers of aging. This study used NHATS Round 7 (2017) data on 3,283 community-dwelling older adults to test cross-se...
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Subjective age refers to how young or old people experience themselves to be. It is associated with health status, physical function, and mental processes that influence the occurrence of fear of falling, which is a severe problem in older adults. The present study aims to contribute to existing knowledge by examining the relationships between subj...
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Research has shown an association between homebound status and falls among older adults. However, this association was primarily drawn from cross-sectional studies. Using the National Health and Aging Trends Study, we examined 1) whether prior-wave falls predicted homebound status in a later wave in 2,916 non-homebound participants in Wave 1 and 2)...
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Personality is associated with predictors of homebound status like frailty, incident falls, and depression. It has been rarely investigated whether personality predicts homebound status among older adults. Using the combining cross-sectional data of the Year 2013 and Year 2014 data from the National Health and Aging Trends Study (NHATS), this study...
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Favorite activities are usually meaningful and valuable to older adults. However, information on favorite activity patterns and their relationship with cognitive function from large samples is still limited. Using Round 1 data from the National Health and Aging Trends Study, we examined favorite activity patterns among community-dwelling older adul...
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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...
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Frailty is a clinical syndrome that becomes increasingly common as people age. Subjective age refers to how young or old individuals experience themselves to be. It is associated with many risk factors of frailty, such as increased depression, worse cognitive function, and poorer psychological wellbeing. In this study, we examined the relationship...
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Community Aging in Place-Advancing Better Living for Elders (CAPABLE) consists of an interprofessional team of a registered nurse (RN), occupational therapist (OT), and handyworker that delivers an in-home client-specific package of interventions to optimize function. CAPABLE aims to reduce functional impairment, home hazards, and acute medical ser...
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In FY 2018-2019, the National Institutes of Health devoted $2,387,505,711 to projects studying depression. Before and following their arrival into the United States stressful life circumstances may render African immigrants particularly at risk for depression. The objective of this study is to provide an estimate and identify correlates of depressi...
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Life-space and falls efficacy are essential to physical independence and consistently predict disabilities. However, it remains unknown whether the CAPABLE, a disability prevention program, improves life-space and falls efficacy in older adults. We evaluated the effects of a home-based disability prevention program on life-space (N=194) and falls e...
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Favorite activities are usually meaningful to older adults and may influence their homebound status and vice versa. Using Round 1 (R1, in 2011) and Round 5 (R5, in 2015) data from the National Health and Aging Trends Study, we examined the patterns of favorite activity by homebound status and investigated their relationship among community-dwelling...
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Lower income and financial strain (i.e. difficulty making ends meet) are associated with worse aging biomarkers, but evidence among nationally representative samples is limited. This cross-sectional study tested whether income to poverty ratio (analyzed separately for those <500% vs. ≥500% poverty threshold) and financial strain are associated with...
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This presentation reports on findings from the first phase of a mixed methods study aimed at developing an instrument to assess older African Americans’ exposure to structural racial discrimination. We conducted semi-structured interviews with older African Americans about their perspectives on and exposure to structural discrimination. Participant...
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Discrimination is implicated in the disproportionate burden of disease and health disparities in racial/ethnic minorities. This qualitative descriptive study explored the experiences of discrimination and its impact on the health of older African immigrants. Semi-structured interviews were conducted with 15 participants. Three main themes and six s...