Race and Sex Differences in Correlates of Systolic Blood Pressure in Community-Dwelling Older Adults

Objectives: To describe correlates of measured systolic blood pressure (SBP) among community-dwelling older African American and White Medicare beneficiaries. Methods: Participants completed an in-home assessment and factors significantly correlated with SBP were tested using multivariable models. Results: Among the 958 participants (mean age= 75.3 [SD = 6.8]; 49% African American; 49% female; 52% rural) African Americans were more often diagnosed with hypertension, more likely on anti-hypertensives, and on more anti-hypertensive medications. SBP was 2.7 mmHg higher in African Americans than Whites (p=.03). SBP was higher in women than men. Multivariable models revealed differences in the factors associated with SBP by race/sex specific groups. Having a history of smoking and reports of being relaxed and free of tension were associated with higher SBP among African American men. Discussion: Although more likely prescribed anti-hypertensives, mean SBP was higher for older African Americans than Whites. Results support the hypothesis that behavioral and psychosocial factors are more important correlates of SBP levels among older African Americans than among Whites

Alabama Veterans Rural Health Initiative: A Preliminary Evaluation of Unmet Health Care Needs

The Alabama Veterans Rural Health Initiative aims to better understand the health care needs, health status, and barriers to care for rural veterans. Following extensive community outreach, Veteran Community Outreach Health Workers assessed 203 veterans residing in rural counties of Alabama who either: 1) had never enrolled in VA health services, or 2) had not used those services in at least two years. While 71.4 percent of participants reported having utilized non-VHA primary care within the past year, 33.5 percent reported an inability or delay in obtaining needed health care for one or more services: primary care, specialty care, mental health care, addictions treatment, dental care, or prescription medication. The most commonly cited barrier was cost. Among all participants, 56 percent screened positive for at least one Axis I mental disorder. Rurally residing, non-VHA utilizing veterans appear to have fairly good access to primary care, but need dental care, prescription medication, and mental health care

Team-Based Learning: A Relevant Strategy in Health Professionals’ Education

For about a decade, team-based learning (TBL), as an educational strategy, has been growing in use in the US and in several other international medical schools. It is a learner-centered, small group instructional strategy with good academic outcomes and considerable potential to address many of the professional competencies that are critical for the practice of medicine. For it to be successful in a course or curriculum, its essential components must be used properly. This article explains the importance and relevance of TBL in healthcare education, supports its inclusion as an effective learning strategy, and encourages the reader to explore additional resources, including the recently published AMEE Guide in Medical Education related to the topic (Parmelee et al, 2012)

Team-Based Learning: A Relevant Strategy in Health Professionals’ Education

For about a decade, team-based learning (TBL), as an educational strategy, has been growing in use in the US and in several other international medical schools. It is a learner-centered, small group instructional strategy with good academic outcomes and considerable potential to address many of the professional competencies that are critical for the practice of medicine. For it to be successful in a course or curriculum, its essential components must be used properly. This article explains the importance and relevance of TBL in healthcare education, supports its inclusion as an effective learning strategy, and encourages the reader to explore additional resources, including the recently published AMEE Guide in Medical Education related to the topic (Parmelee et al, 2012)

Clinical Practice Guidelines, Process Improvement Teams, and Performance on a Quality Indicator for Urinary Incontinence: A Pilot Study

Background Previous work by the AMDA Foundation Long-Term Care (AMDA-F LTC) Research Network suggests that urinary incontinence (UI), while prevalent, is not a high priority in the nursing facility (NF) and that barriers to better continence care are discipline-specific. Other studies report that interventions for UI in the NF often are not individualized or are poorly implemented. Implementation of processes of care may be more dependent on facility characteristics than on the attitudes, knowledge, and skill of individual health care workers. We tested the hypothesis that better facility performance on a quality indicator (QI) for continence care (toileting) is associated with a more systematic approach to continence care. Methods This is a descriptive study of a cohort of 34 for-profit NFs in the AMDA-F LTC Research Network. Facilities were categorized as either good performers or poor performers based on percentile ranking during a 1-year period on the quality indicator for toileting. Good performers and poor performers were compared based on a number of characteristics. Results There were no significant differences between good performers (17 facilities) and poor performers (17 facilities) with respect to occupancy, turnover, performance on other QIs, and cost of continence products. The prevalence of pharmacotherapy for UI was between 7% and 8%, which is consistent with other reports and did not differ between good performers and poor performers. However, good performers were more likely to report the presence of a process improvement team (PIT) for UI (53% versus 18%, P = .03) and more likely to report using a clinical practice guideline (CPG) for UI along with a UI PIT (47% versus 6%, P = .007). Conclusions Facilities that are good performers on the quality indicator for toileting are more likely to report the presence of a process-improvement team for urinary incontinence. Better performance is even more strongly associated with both the presence of a process improvement team and reported use of a clinical practice guideline for urinary incontinence

Localized Multi-Site Knee Bioimpedance as a Predictor for Knee Osteoarthritis Associated Pain Within Older Adults During Free-Living

The drastic increase in the aging population has increased the prevalence of osteoarthritis in the United States. The ability to monitor symptoms of osteoarthritis (such as pain) within a free-living environment could improve understanding of each person's experiences with this disease and provide opportunities to personalize treatments specific to each person and their experience. In this work, localized knee tissue bioimpedance and self-reports of knee pain were collected from older adults ($N=20$) with and without knee osteoarthritis over 7 days of free-living to evaluate if knee tissue bioimpedance is associated with persons' knee pain experience. Within the group of persons' with knee osteoarthritis increases in 128 kHz per-length resistance and decreases in 40 kHz per-length reactance were associated with increased probability of persons having active knee pain ($p=0.038$ and $p=0.044$)

Clinical Practice Guidelines, Process Improvement Teams, and Performance on a Quality Indicator for Urinary Incontinence: A Pilot Study

Background Previous work by the AMDA Foundation Long-Term Care (AMDA-F LTC) Research Network suggests that urinary incontinence (UI), while prevalent, is not a high priority in the nursing facility (NF) and that barriers to better continence care are discipline-specific. Other studies report that interventions for UI in the NF often are not individualized or are poorly implemented. Implementation of processes of care may be more dependent on facility characteristics than on the attitudes, knowledge, and skill of individual health care workers. We tested the hypothesis that better facility performance on a quality indicator (QI) for continence care (toileting) is associated with a more systematic approach to continence care. Methods This is a descriptive study of a cohort of 34 for-profit NFs in the AMDA-F LTC Research Network. Facilities were categorized as either good performers or poor performers based on percentile ranking during a 1-year period on the quality indicator for toileting. Good performers and poor performers were compared based on a number of characteristics. Results There were no significant differences between good performers (17 facilities) and poor performers (17 facilities) with respect to occupancy, turnover, performance on other QIs, and cost of continence products. The prevalence of pharmacotherapy for UI was between 7% and 8%, which is consistent with other reports and did not differ between good performers and poor performers. However, good performers were more likely to report the presence of a process improvement team (PIT) for UI (53% versus 18%, P = .03) and more likely to report using a clinical practice guideline (CPG) for UI along with a UI PIT (47% versus 6%, P = .007). Conclusions Facilities that are good performers on the quality indicator for toileting are more likely to report the presence of a process-improvement team for urinary incontinence. Better performance is even more strongly associated with both the presence of a process improvement team and reported use of a clinical practice guideline for urinary incontinence

Center for epidemiologic studies depression scale (ces-d) factor structure among older adults with osteoarthritis: associations with pain and disability

This analysis evaluated the association of depressive factors with symptoms of osteoarthritis of the knee including pain and disability. Analyses used a sample of community-dwelling older adults. A comparison of potential confirmatory models for the Center for Epidemiologic Studies Depression (CES-D) Scale was performed. Resultant factors of depression were used to predict cross-sectional and longitudinal pain and disability after controlling for demographic and general health covariates. Results indicated a second-order four-factor model had the best fit in this population for the CES-D. In cross-sectional regressions the somatic/vegetative factor was the sole unique predictor of variance in pain of the CES-D factors individually. In addition, the CES-D factors as a group accounted for significant unique variance in both pain and disability. Longitudinal regressions found that CES-D factors as a group significantly predicted change in disability and change in pain over one year; however, none of the CES-D factors had significant coefficients. Results support a biopsychosocial evaluation of depression in osteoarthritis, suggest depression as a unidimensional construct predicts increased pain and disability, and support the continued use of the CES-D in community populations of older adults with osteoarthritis. (Published By University of Alabama Libraries