Research Institute on Aging

New York City, NY, United States

Research Institute on Aging

New York City, NY, United States
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Reinhardt J.P.,Research Institute on Aging | Reinhardt J.P.,Mount Sinai School of Medicine | Chichin E.,Mount Sinai School of Medicine | Posner L.,Mount Sinai School of Medicine | Kassabian S.,VA Hudson Valley Health Care System
Journal of Social Work in End-of-Life and Palliative Care | Year: 2014

Family members of persons with advanced dementia may be asked to make complex treatment decisions without having adequate knowledge regarding the risks and benefits. This 6-month, prospective, randomized trial tested the effect of an intervention consisting of a face-to-face, structured conversation about end-of-life care options with family members of nursing home residents with advanced dementia. A comparison group received only social contact via telephone. Structured conversations between a palliative care team and intervention group family members included goals of care and how best to achieve those goals, and provision of psychosocial support. Psychosocial support was also provided via telephone at three 2-month intervals. Family members participated in three telephone interviews: baseline, 3, and 6 months. Specific advance directives for persons with dementia were extracted from medical records. Results showed that intervention families had higher satisfaction with care than comparison families at the 6-month time point, and they were more likely to have decided on medical options listed in residents' advance directives (Do Not Resuscitate, Intubate, Hospitalize) over time. Study findings reinforce the need for increased education and support for families around issues of end-of-life care decisions for advanced dementia. © 2014 Copyright Taylor & Francis Group, LLC.


Cherubini C.,Biomedical University of Rome | Cherubini C.,University of Rome La Sapienza | Filippi S.,Biomedical University of Rome | Filippi S.,University of Rome La Sapienza | And 2 more authors.
Physical Review E - Statistical, Nonlinear, and Soft Matter Physics | Year: 2012

Spiral waves in excitable biological media are associated with pathological situations. In the heart an action potential vortex pinned by an obstacle has to be removed through defibrillation protocols fine-tuned theoretically by using electrophysiological nonlinear mathematical models. Cardiac tissue, however, is an electroelastic medium whose electrical properties are strongly affected by large deformations. In this paper we specifically investigate the electroelastic pinning-unpinning mechanism in order to include cardiac contraction in the preexisting theoretically modeled defibrillation scenarios. Based on a two-dimensional minimal electromechanical model, we show numerically the existence of an unpinning band characterized by the size of the obstacle, the pacing site, and the frequency. Similar numerical simulations, performed in the absence of elastic coupling, show small differences in comparison with the electroelastic studies, suggesting for this specific scenario of pinning-unpinning dynamics a nonprominent role of elasticity. © 2012 American Physical Society.


Popivker L.,Research Institute on Aging | Wang S.-W.,University of California at Los Angeles | Boerner K.,Research Institute on Aging
Clinical Rehabilitation | Year: 2010

Objective: To investigate implications of vision loss in midlife, identify life goals that are important to middle-aged adults and assess how vision loss interferes with goal pursuit. Design: Cross-sectional exploratory study. Setting: Vision rehabilitation agency. Subjects: Two hundred and sixteen middle-aged adults with visual impairment. Methods: Telephone interviews composed of structured and open-ended assessments of life goals (i.e. priorities, plans, or hopes people have in their lives) and goal interference due to vision loss. Results: Across the three assessed domains, functional goals were reported most often (N = 214), followed by social goals (N = 72) and psychological goals (N = 28). Among functional goals, career, daily tasks and mobility goals were identified by the highest percentage of participants. Family goals were identified most frequently for social goals, and life quality was identified most often for psychological goals. Vision-related goals occurred throughout the three domains, representing the majority of functional goals, a third of social goals, and almost half of psychological goals. Participants reported highest interference in functional and social goals and least in psychological goals. While participants reported moderate interference for most goals, markedly high interference was reported for daily tasks, mobility, independence and leisure goals. Goal identification was related to timing of onset of vision loss primarily for functional goals. Conclusions: Findings illuminate multifaceted goals held by middle-aged adults with vision impairment and how visual disability can interfere with goal pursuits. These findings suggest that identifying clients' life goals and the vision-related interference they experience in goal pursuits may be a helpful step in vision rehabilitation services. © 2010 The Author(s).


Schilling O.K.,University of Heidelberg | Wahl H.-W.,University of Heidelberg | Boerner K.,Research Institute on Aging | Reinhardt J.P.,Research Institute on Aging | And 2 more authors.
Journals of Gerontology - Series B Psychological Sciences and Social Sciences | Year: 2013

Objectives.The life-span theory of control is applied to study change in vision-specific control strategies in visually impaired older individuals, depending on performance in instrumental activities of daily living (IADL) and depressed mood.Method.Longitudinal data from visually impaired individuals (at baseline: N = 364; mean age = 82.8 years; visual acuity less than 20/60) measured at three occasions with 1-year intervals in-between were analyzed. A newly established vision-specific control scale to assess selective primary control (SPC), selective secondary control (SSC), compensatory primary control (CPC), and compensatory secondary control (CSC) was used. Linear and nonlinear (quadratic and piecewise) generalized mixed models with gamma response distribution to fit the skewed data were applied.Results.CPC progressively increased as IADL capacity decreased up to a turning point, at which CPC plateaued, whereas all other strategies declined linearly with IADL decrease. Controlling for depressed mood did not change these relationships for CPC, SPC, and SSC but absorbed IADL-related decline of CSC. Higher depression was associated with less SPC, SSC, and CSC, but only slightly with less CPC.Discussion.IADL plays an important role triggering a shift in adaptational strategies from selective control to CPC in visually impaired older adults and possibly other disabled populations. © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.


Boerner K.,Research Institute on Aging | Boerner K.,Mount Sinai School of Medicine | Burack O.R.,Research Institute on Aging | Jopp D.S.,Fordham University | Mock S.E.,University of Waterloo
Journal of Pain and Symptom Management | Year: 2015

Context Patient death is common in long-term care (LTC). Yet, little attention has been paid to how direct care staff members, who provide the bulk of daily LTC, experience patient death and to what extent they are prepared for this experience. Objectives To 1) determine how grief symptoms typically reported by bereaved family caregivers are experienced among direct care staff, 2) explore how prepared the staff members were for the death of their patients, and 3) identify characteristics associated with their grief. Methods This was a cross-sectional study of direct care staff experiencing recent patient death. Participants were 140 certified nursing assistants and 80 homecare workers. Standardized assessments and structured questions addressed staff (e.g., preparedness for death), institutional (e.g., support availability), and patient/relational factors (e.g., relationship quality). Data analyses included bivariate group comparisons and hierarchical regression. Results Grief reactions of staff reflected many of the core grief symptoms reported by bereaved family caregivers in a large-scale caregiving study. Feelings of being "not at all prepared" for the death and struggling with "acceptance of death" were prevalent among the staff. Grief was more intense when staff-patient relationships were closer, care was provided for longer, and staff felt emotionally unprepared for the death. Conclusion Grief symptoms like those experienced by family caregivers are common among direct care workers after patient death. Increasing preparedness for this experience via better training and support is likely to improve the occupational experience of direct care workers and ultimately allow them to provide better palliative care in nursing homes and homecare. © 2015 American Academy of Hospice and Palliative Medicine.


Cohen-Mansfield J.,Tel Aviv University | Cohen-Mansfield J.,George Washington University | Cohen-Mansfield J.,Research Institute on Aging | Marx M.S.,Tel Aviv University | And 2 more authors.
Journal of Clinical Psychiatry | Year: 2011

Objective: To examine how presentation of different stimuli impacts affect in nursing home residents with dementia. Method: Participants were 193 residents aged 60 to 101 years from 7 Maryland nursing homes who had a diagnosis of dementia (derived from the medical chart or obtained from the attending physician). Cognitive functioning was assessed via the Mini-Mental State Examination (MMSE), and data pertaining to activities of daily living were obtained through the Minimum Data Set. Affect was assessed using observations of the 5 moods from Lawton's Modified Behavior Stream. Baseline observations of affect were performed for comparisons. During the study, each participant was presented with 25 predetermined engagement stimuli in random order over a period of 3 weeks. Stimuli were categorized as live social, simulated social, manipulative, work/task-related, music, reading, or individualized to the participant's self-identity. The dates of data collection were 2005-2007. Results: Differences between stimulus categories were significant for pleasure (F6,144 = 25.137, P < .001) and interest (F6,144 = 18.792, P < .001) but not for negative affect. Pleasure and interest were highest for the live social category, followed by self-identity and simulated social stimuli for pleasure, and for manipulative stimuli in terms of the effect on interest. The lowest levels of pleasure and interest were observed for music. Participants with higher cognitive function had significantly higher pleasure (F1,97 = 6.27, P < .05). Although the general trend of the impact of the different categories was similar for different levels of cognitive function, there were significant differences in pleasure in response to specific stimuli (interaction effect: F6,92 = 2.31, P < .05). Overall, social stimuli have the highest impact on affect in persons with dementia. Conclusions: The findings of the present study are important, as affect is a major indicator of quality of life and this study is the first to systematically examine the impact of specific types of stimuli on affect. As live social stimuli are not always readily available, particularly in busy nursing home environments, simulated social stimuli can serve as an effective substitute, and other stimuli should have a role in the activity tool kit in the nursing home. The relative ranking of stimuli was different for interest and pleasure. The findings demonstrate the differential effect of presentation of different types of stimuli on the affect of persons with dementia, and that, while the impact is greater on persons with higher levels of cognitive function, there is a different effect of varying stimuli even in persons with MMSE scores of 3 or lower. Future research should attempt to ascertain a person's degree of interest in stimuli prior to developing an intervention. © Copyright 2011 Physicians Postgraduate Press, Inc.


Cohen-Mansfield J.,Research Institute on Aging | Cohen-Mansfield J.,George Washington University | Cohen-Mansfield J.,Tel Aviv University | Marx M.S.,Research Institute on Aging | And 4 more authors.
Journal of the American Geriatrics Society | Year: 2010

Objectives: To assess the relative effect of different types of stimuli on agitated behaviors of nursing home residents with dementia. Design: Repeated-measures design with randomized assignment of conditions. Setting: Seven Maryland nursing homes. Participants: One hundred eleven nursing home residents with a diagnosis of dementia who exhibited agitation. Intervention: Different types of stimuli (music, social stimuli, simulated social stimuli, and individualized stimuli based on the person's self-identity) were presented. Measurements: Agitation was directly observed and recorded using the Agitation Behavior Mapping Instrument. Results: All stimulus categories were associated with significantly less physical agitation than baseline observations, and all except for manipulative stimuli were associated with significantly less total agitation. Live social stimuli were associated with less agitation than music, self-identity, work, simulated social, and manipulative stimulus categories. Task and reading stimulus categories were each associated with significantly less agitation than work, simulated social, and manipulative stimulus categories. Music and self-identity stimuli were associated with less agitation than simulated social and manipulative stimuli. Conclusion: Providing stimuli offers a proactive approach to preventing agitation in persons with dementia, with live social stimuli being the most successful. © 2010 The American Geriatrics Society.


Burack O.R.,Research Institute on Aging | Weiner A.S.,Research Institute on Aging | Reinhardt J.P.,Research Institute on Aging | Annunziato R.A.,Fordham University
Journal of the American Medical Directors Association | Year: 2012

Objective: A growing number of nursing homes across the country are embarking on culture change transformations that focus on maximizing elder residents' quality of life (QOL). Challenges to culture change implementation include the wide range of possible interventions as well as a lack of research-based evidence to guide these choices. The purpose of this study was to determine those components of nursing home QOL that are associated with elder satisfaction so as to provide direction in the culture change journey. Design: A cross-sectional study using a survey administered face-to-face. Setting: Three large urban nursing homes within a long term care system in New York State. Participants: Sixty-two elder nursing home residents participated in face-to-face interviews. All elders had resided in their nursing communities for at least 3 months before participation. Measurements: The survey included the Quality of Life Scales for Nursing Home Residents, which examines elder QOL in 11 domains: autonomy, dignity, food enjoyment, functional competence, individuality, meaningful activity, physical comfort, privacy, relationships,security, and spiritual well-being. Elder satisfaction with the nursing home and nursing home staff were also examined. Results: After accounting for cognitive and physical functioning, among the QOL domains, dignity, spiritual well-being, and food enjoyment remained predictors of overall nursing home satisfaction. Additionally, dignity remained a significant predictor of elder satisfaction with staff. Conclusion: These results provide one possible path in the culture change journey based on empirical findings. © 2012 American Medical Directors Association, Inc.


Dombrowski W.,Jewish Home Lifecare | Yoos J.L.,Research Institute on Aging | Neufeld R.,Jewish Home Lifecare | Tarshish C.Y.,Research Institute on Aging
Archives of Physical Medicine and Rehabilitation | Year: 2012

Dombrowski W, Yoos JL, Neufeld R, Tarshish CY. Factors predicting rehospitalization of elderly patients in a postacute skilled nursing facility rehabilitation program. Objective: To examine potential risk factors for rehospitalization of skilled nursing facility (SNF) rehabilitation patients. Design: Retrospective review of rehabilitation charts. Setting: SNF rehabilitation beds (n=114) at a 514-bed urban, academic nursing home that receives patients from tertiary care hospitals. Participants: Consecutive rehabilitation patients (n=50) who were rehospitalized during days 4 to 30 of rehabilitation, compared with a matched group of rehabilitation patients (n=50) who were discharged without rehospitalization. Interventions: Not applicable. Main Outcome Measure: Data on potential risk factors were collected: demographics, medical history, conditions associated with preceding hospitalization, and initial rehabilitation examination and laboratory values. The clinical conditions precipitating rehospitalizations were noted. Results: Sixty-two percent of rehospitalizations were related to complications or recurrence of the same medical condition that was treated during the preceding hospitalization. The rehospitalized group had significantly more comorbidities including anemia (P=.001) and malignant solid tumors (P<.001), index hospitalizations involving a gastrointestinal condition (P=.001), needed more assistance with eating (P=.001) and walking (P=.03), and had lower hemoglobin (P=.002) and albumin levels (P<.001). A logistic regression model found that the strongest predictors for rehospitalization are a history of a malignant solid tumor (odds ratio [OR]=10.10), a recent hospitalization involving gastrointestinal conditions (OR=4.62), and a low serum albumin level (with each unit decrease in albumin, the odds of rehospitalization are 4 times greater [OR=.24, P=.005]). Conclusions: Comorbid conditions, reasons for index hospitalization, and laboratory values are associated with an increased risk for rehospitalization. Further studies are needed to identify high-risk elderly patients and target interventions to minimize rehospitalizations. © 2012 American Congress of Rehabilitation Medicine.


Burack O.R.,Research Institute on Aging | Weiner A.S.,Jewish Home Lifecare | Reinhardt J.P.,Research Institute on Aging
Journal of the American Medical Directors Association | Year: 2012

Objectives: Distressing behavioral symptoms often associated with dementia are not uncommon in the long term care setting. Culture change with its " person-centered approach to care" provides a potential nonpharmacological intervention to reduce these symptoms. The purpose of this study was to examine the relationship between a culture change initiative and nursing home elders' behavioral symptoms. Design: Seven long term care communities (nursing units in 3 skilled nursing facilities) participated in a culture change intervention designed to transform the nursing home experience from a traditional hospital-model of care to one that is person-centered. Six comparison communities were matched to the intervention communities and continued to function along the typical nursing home organizational structure. Data were collected at baseline and 2 years later. Methods: Subjects were 101 elders (intervention group n = 50, comparison group n = 51). Each elder's primary day certified nursing assistant completed the Cohen-Mansfield Agitation Inventory, examining frequency of behavioral symptoms, including verbal and physical agitation as well as more forceful behaviors (eg, hitting, kicking) at both data collection periods. Results: After controlling for functional status and race, a significant condition by time interaction was found for physical agitation and forceful behaviors with the person-centered group maintaining levels of behavioral symptoms as compared with a significant increase over time among the comparison group. A trend with the same pattern was found for verbal agitation. Conclusions: Person-centered care demonstrated potential as a nonpharmacological intervention for distressing behavioral symptoms. The positive impact of culture change appears to extend to elders with cognitive impairment who are less obvious beneficiaries of this model, featuring the central principals of autonomy and person-centered care. © 2012 American Medical Directors Association.

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