QUANTIFYING OLDER BLACK AMERICANS’ EXPOSURE TO STRUCTURAL RACIAL DISCRIMINATION: A MIXED METHODS INSTRUMENT DESIGN STUDY

Background: Racism and racial discrimination are fundamental causes of health disparities. Exposure to racial discrimination is typically assessed using self-report measures or using indicators of residential segregation. Current approaches do not allow for assessment of exposure to discrimination at the structural level so the relationship between racial discrimination and health is likely underestimated. Purpose: The purpose of this study was to design and feasibility-test an instrument that can quantify older Black Americans’ exposure to structural racial discrimination across contexts, across the lifecourse, and across levels of geographic granularity. Methods: We used an exploratory mixed methods instrument design. Phases included: a systematic literature review to identify foundational theory and to identify specific measurement gaps; a Think Tank with discrimination researchers to theorize contexts; qualitative interviews with older Black adults to assess fit of theory and contexts; context-specific focus groups with discrimination researchers and other key stakeholders to identify potential instrument items; item drafting and revision based on previous phases and review of publicly available datasets; and an online feasibility pilot of the instrument with 220 older adults. Results: We identified 27 indicators of structural racial discrimination across nine theorized contexts. We linked childhood and late adulthood home addresses of 220 participants to indicators from publicly available datasets (e.g., census tract cancer risk based on air quality, childhood school term length, Black-white disparities in preventable hospital admissions). The general structure of the participant-facing survey and the methods used to link addresses to indicators are promising approaches but further indicator refinement is needed. Conclusion: This is the first study we are aware of that is grounded in theory and in the lived experience of intended participants, and that presents a framework for assessing structural racial discrimination across contexts, the lifecourse, and levels of geographic granularity. Leading researchers in the field have called for improved measures of structural racism and discrimination and specifically for a lifecourse approach to measurement. This study is a step in that direction

Attention control group activities and perceived benefit in a trial of a behavioral intervention for older adults

Researchers trialing behavioral interventions often use attention control groups, but few publish details on attention control activities or perceived benefit. Attention control groups receive the same dose of interpersonal interaction as intervention participants but no other elements of the intervention, to control for the benefits of attention that may come from behavioral interventions. Because intervention success is analyzed compared to control conditions, it is useful to examine attention control content and outcomes. The purpose of this study is to report on attention control visit activities and their perceived benefit in a randomized control trial. The trial tested an aging-in-place intervention comprised of a series of participant goal-directed visits facilitated by an occupational therapist, nurse, and handyman. The attention control group participants received visits from a lay person. We report on the number and length of visits received, types of visit activities that participants chose, and how much visit time was spent on each activity, based on the attention visitor's records. We report on participant perceptions of benefit based on a 10-item Likert-scale survey. The attention control group participants (n = 148) were cognitively intact, at least 65 years old, with at least one Instrumental Activities of Daily Living. Attention control group participants most often chose conversation (20.1% of visit time), and playing games (18.7%), as visit activities. The majority of attention control group participants (63.4%) reported “a great deal” of perceived benefit. Attention control group visits may be an appropriate comparison in studies of behavioral interventions for community-dwelling older adults

Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults

Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants’ homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample (N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible

Cost-effectiveness of a Digital Health Intervention for Acute Myocardial Infarction Recovery.

BACKGROUND: Acute myocardial infarction (AMI) is a common cause of hospital admissions, readmissions, and mortality worldwide. Digital health interventions (DHIs) that promote self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction may improve health outcomes in this population. The Corrie DHI consists of a smartphone application, smartwatch, and wireless blood pressure monitor to support medication tracking, education, vital signs monitoring, and care coordination. We aimed to assess the cost-effectiveness of this DHI plus standard of care in reducing 30-day readmissions among AMI patients in comparison to standard of care alone. METHODS: A Markov model was used to explore cost-effectiveness from the hospital perspective. The time horizon of the analysis was 1 year, with 30-day cycles, using inflation-adjusted cost data with no discount rate. Currencies were quantified in US dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). The results were interpreted as an incremental cost-effectiveness ratio at a threshold of $100,000 per QALY. Univariate sensitivity and multivariate probabilistic sensitivity analyses tested model uncertainty. RESULTS: The DHI reduced costs and increased QALYs on average, dominating standard of care in 99.7$2750 per patient, use of the DHI leads to a cost-savings of $7274 per patient compared with standard of care alone. CONCLUSIONS: Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs