Older Adults' Live Demonstration of Electronic Personal Health Record Use: Factors Mediating Initial Proficiency.

Adoption of electronic personal health records by older adults offers multiple advantages to healthcare and is being encouraged by federal agencies and health associations. However, obstacles have limited older adults' rates of adoption to approximately 10%. This study examined the initial proficiency of older adults at entering 21 standard health elements into an electronic personal health record. Entry completeness, accuracy, elapsed time, and help requests were measured. A combination of standard technology adoption model and older adult characteristics accounted for 52% of variability in proficiency at entering electronic personal health record data. Automatic linear modeling identified three variables as primarily related to proficiency with electronic personal health record use: age, computer competency, and mental status. Interventions to increase electronic personal health record adoption and proficiency of use will require the consideration of variables specific to older adults, and may best focus on younger seniors with good mental status and computer competency. Efforts for older seniors with decreased mental status might better center on delegation to a primary caregiver.

Case Management in Prevention of 30-Day Readmission in Post-Coronary Artery Bypass Graft Surgery.

PURPOSE OF STUDY: Thirty-day readmission is associated with increased morbidity and mortality among postoperative coronary artery bypass graft (CABG) surgery patients. Interventions such as case management and follow-up care may reduce 30-day readmission. The purpose of this article is to report a study on modifiable factors that may have significant implications for case management in the prevention of readmission after CABG surgery. PRIMARY PRACTICE SETTINGS: The study population included all the adult patients who underwent first-time CABG surgery from January 1, 2013, to January 1, 2016, from a Mid-South hospital. METHODOLOGY AND SAMPLE: A retrospective case-control study was employed to examine 1,712 patients who underwent CABG surgery. RESULTS: The results revealed that patients readmitted within 30 days had a significantly shorter length of stay (LOS) (6 days vs. 10 days; p < .0001), more days in intensive care unit (6 days vs. 4 days; p = .0391), and significantly higher diabetes/renal (4% vs. 1%), infection (17% vs. 2%), and respiratory-related diagnoses (10% vs. 1%; p < .0001). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Among these factors, hospital LOS is a major factor that can be addressed through case management in addition to other modifiable risk factors. Understanding modifiable factors associated with higher readmission risk is crucial for effective intervention and case management planning.

A qualitative study of older adults' facilitators, barriers, and cues to action to engage in falls prevention using health belief model constructs.

BACKGROUND AND OBJECTIVES: Falls are the leading cause of fatal and nonfatal injuries among older adults. Decreasing falls is highly dependent on engagement in fall prevention activities. The Health Belief Model (HBM) theoretical framework was used to explore older adults' perceptions about falls prevention. RESEARCH DESIGN AND METHODS: An informed grounded theory approach was applied. Four focus groups were conducted using semi-structured interview guides based on the HBM with 27 community-dwelling older adults (average age = 78 years). Deductive content analysis was used to apply constructs of the HBM to the data and explain the findings. RESULTS: Potential reasons for not engaging in falls prevention included lack of self-perceived severity, susceptibility, and self-efficacy with a subtheme of lack of information about falls prevention from medical providers. Potential facilitators included older adults' knowledge and current engagement in falls prevention and socializing while engaging in falls prevention. Participants recommended cues to action to improve engagement in falls prevention from family, friends, physicians, pharmacists, and insurance companies; and using various modes to deliver cues to action, including print, audiovisual, online, and reminders. DISCUSSION AND IMPLICATIONS: In this study, the HBM was used to understand older adults' potential barriers, facilitators, and cues to action to support engagement in falls prevention. Engagement in fall prevention behaviors could be improved by addressing barriers such as lack of knowledge, and lack of self-perceived severity and susceptibility to falls. Reinforcing the benefits of fall prevention, and promoting cues to action to engage in falls prevention may also support engagement.

Older Adults' Perceptions Regarding the Role of Physical Therapists in Fall Prevention: A Qualitative Investigation.

BACKGROUND AND PURPOSE: Falls are a leading cause of injury, morbidity, and mortality among older adults. Physical therapists are underutilized for fall prevention despite strong evidence and recommendations regarding their effectiveness. The purpose of this study was to explore older adults' awareness of and perceptions regarding the role of physical therapists for fall prevention. A secondary purpose of the study was to identify barriers to utilization of preventive rehabilitation services. METHODS: A qualitative, descriptive, phenomenological approach was used. Participant demographics and fall history were obtained with a standard questionnaire. Four focus groups were conducted with 27 community-dwelling older adults (average age = 78 years). Focus groups were recorded, transcribed, and coded using thematic analysis. RESULTS: Surveys indicated 37% of participants experienced a fall in the last year and 26% reported sustaining an injury. Four main themes and 5 subthemes about older adults' perceptions of physical therapy providers emerged: (1) awareness of fall prevention (subthemes: I can or have taken action to prevent falls, I don't think about it, and I am more careful); (2) learning how to fall and being able to get up from the floor; (3) limited knowledge regarding the role of physical therapists for fall prevention; and (4) a physical therapist should be seen for a specific problem, or after a fall (subthemes: perceived need and costs, and access requires a doctor's prescription). CONCLUSION: Older adults lack awareness about the role of physical therapists for fall prevention, believing they should only seek treatment from a physical therapist to address a specific problem, or after a fall. The profession should consider addressing misconceptions and underutilization by educating the public that physical therapists can and do play an important role in the prevention of falls. Being explicit about the prevention of falls throughout an older adults' episode of care may further help reinforce the role of physical therapists for fall prevention and improve dissemination of this knowledge.

Older Adults' Perceptions and Recommendations Regarding a Falls Prevention Self-Management Plan Template Based on the Health Belief Model: A Mixed-Methods Study.

Falls are the leading cause of fatal and non-fatal injuries among older adults. Self-management plans have been used in different contexts to promote healthy behaviors, but older adults' perceptions of a falls prevention self-management plan template have not been investigated. Using mixed methods, we investigated older adults' perceptions and recommendations of a falls prevention self-management plan template aligned with the Health Belief Model. Four focus groups (n = 27, average age 78 years) were conducted using semi-structured interview guides. Participants also ranked the written plan on paper with respect to each item by the level of importance, where item 1 was the most important, and 10 was the least important. Focus groups were transcribed and analyzed. Descriptive statistics were calculated for item rankings. Older adults felt that the plan would raise awareness and help them to engage in falls prevention behaviors. Participants recommended adding graphics and using red to highlight the risk of falling. Participants opined that ranking the items by level of importance was challenging because they felt all items were important. 'What might happen to me if I fall' was ranked as the most important item (average 2.6), while 'How will I monitor progress' was the least important (average = 6.6). Considering that older adults need support to engage in falls prevention, future research should investigate the impact of implementing an individually tailored falls prevention self-management plan on older adults' engagement in falls prevention behaviors and outcomes of falls and injuries.

Cluster analysis of women's prodromal and acute myocardial infarction symptoms by race and other characteristics.

BACKGROUND AND OBJECTIVE: Although research has identified women's prodromal and acute myocardial infarction (MI) symptoms, diagnosing coronary heart disease in women remains challenging. Knowing how individual symptoms cluster by race and other characteristics would provide key diagnostic information. We performed a secondary analysis to: (a) generate naturally occurring symptom clusters based on prodromal and acute MI symptom scores separately, (b) examine the association between women's characteristics and symptom clusters, and (c) describe the percentage of women who reported experiencing the same symptoms in both prodromal and acute MI phases. SUBJECT AND METHODS: The database contained retrospective self-reported data obtained by telephone survey from 1270 women (43% black, 42% white, 15% Hispanic) with a confirmed MI recruited from 15 geographically diverse sites. Data included frequency and severity of 33 prodromal symptoms, intensity of 37 acute MI symptoms, and comorbidities/risk factors. We used both bivariate and multivariate analyses to examine associations between cluster assignment and characteristics/risk factors. Because of the possibility of complex interactions, we explored nonlinear interactions with recursive partitioning. RESULTS: Cluster analysis yielded 3 naturally occurring clusters for each of the prodromal and acute symptom sets. Each cluster contained women who reported increasing frequency and severity of symptoms. Six characteristics (age, race, body mass index, personal history of heart disease, diabetes, smoking status) were strongly associated with the clusters. Body mass index was the most important factor in classifying prodromal symptoms, whereas age was for acute symptoms. CONCLUSIONS: Black women younger than 50 years were more likely to report frequent and intense prodromal symptoms, whereas older white women reported the least. Younger, obese, diabetic black women reported the most acute symptoms, whereas older nonobese, nondiabetic white women reported the fewest. Symptom clusters and characteristics of women in these clusters provide valuable diagnostic information. Further research with a control group is needed.

A Tristate Education Model to Prepare Nurses to Serve on Health-Promoting Boards.

BACKGROUND: The tristate Nurses on Boards Coalition (NOBC) education program prepares nurses to serve on boards that promote a culture of health, such as housing and transportation authorities, school wellness teams, mental health nonprofits, and planning commissions. METHOD: Three state nursing organizations developed an evidence-informed, innovative, interactive NOBC education model through a review of board service, leadership, and continuing education literature; key informant interviews with national NOBC experts; and evaluation data from previous NOBC education held in our individual states. RESULTS: Attendees in the 2018 and 2019 tristate education programs reported increased knowledge regarding the social determinants of health and how they can influence population health by serving on health-promoting boards. CONCLUSION: The tristate NOBC education is a successful model in preparing nurses to serve on boards that promote a culture of health. [J Contin Educ Nurs. 2020;51(11):528-532.].

Imperatives for Integrating Culture of Health Concepts Into Nursing Education.

BACKGROUND: In all nursing care, nurses should address the social determinants of health that make it difficult for people to lead healthy lives. The Future of Nursing: Campaign for Action recommends transforming nursing education to prepare nurses to address social determinants through building a culture of health. Our study examined integration of culture of health/population health concepts into nursing education and assessed nursing deans' and directors' perceived barriers, facilitators, and readiness to incorporate culture of health into curricula. METHOD: Modified Delphi techniques were used in two neighboring southern states through two rounds of data collection to develop quantitative surveys in each state. RESULTS: Consensus emerged on the need to integrate population/culture of health concepts into nursing curricula. Deans and directors described barriers and facilitators to educational integration. CONCLUSION: Population/culture of health concepts must become a fundamental component of nursing education at all educational levels. [J Nurs Educ. 2020;59(11):605-609.].

Double jeopardy! Heart disease risk factors for older African American and Caucasian women.

Older women uniquely experience a "double jeopardy" for heart disease. Evidence-based risk factor information to enhance the prevention of coronary heart disease in older women is provided.

Key Strategies for Physical Activity Interventions Among Older Women: Process Evaluation of a Clinical Trial.

PURPOSE: To describe strategies salient to physical activity (PA) initiation and maintenance among older women who participated in a clinical trial that tested a PA intervention. DESIGN: A descriptive phenomenological, qualitative design for a process evaluation of a successful clinical trial. SETTING: Senior primary care clinics associated with a large medical center in a southern state. PARTICIPANTS: A total of 20 older women at least 60 years without advanced frailty. METHOD: Purposive sampling using maximum variation technique was used to select participants. A semi-structured interview guide facilitated individual, in-depth interviews lasting 45 to 90 minutes. Narratives were analyzed using content analysis with constant comparison technique to summarize the data. RESULTS: Eight African American and 12 white older women with a mean age of 68 from control and intervention arms participated. Five central themes described salient strategies to promote and maintain PA: sensed benefits, motivation, and self-efficacy were central to success, while a reduction in barriers was essential before maintaining PA. The last theme, a life-changing awareness indicated that PA had become a shared value. An explanatory model describing interrelationships is presented. CONCLUSIONS: This study suggests key strategies to include in PA interventions with older women. An unexpected finding was that PA became a shared value, an action promoted by the Culture of Health initiative to improve population health and well-being.

Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study.

BACKGROUND: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. OBJECTIVE: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. METHODS: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. RESULTS: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. CONCLUSIONS: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.

Women's prehospital delay associated with myocardial infarction: does race really matter?

UNLABELLED: BACKGROUND/RESEARCH OBJECTIVE: Well-documented disparities in cardiovascular health account for approximately one third of the difference in life expectancy between blacks and whites. Mortality from cardiovascular disease is greater among black women than among white women, and black women report longer delays in treatment seeking following onset of symptoms of acute myocardial infarction (AMI). Despite this disparate burden, there is little race-specific data on correlates of delay for black or white women. This secondary data analysis compares duration and correlates of delay in treatment seeking by race following onset of AMI symptoms. SUBJECTS/METHODS: We analyzed self-report data from 509 black and 500 white women, interviewed 4 to 6 months after AMI, using multivariable logistic and linear regression. RESULTS/CONCLUSIONS: Median delay time was nonsignificantly shorter for black than for white women (1.0 vs 1.5 hours). Equal proportions of black and white women (57% vs 54%) sought treatment within 2 hours of symptom onset. In multivariable analyses, correct attribution of symptoms to AMI was a significant predictor of treatment seeking within 2 hours of symptom onset for black and white women (odds ratios = 2.79 and 3.86, respectively); eligibility for public insurance was a significant predictor for black women only (odds ratio = 2.3). Common comorbidities, AMI risk factors, and other demographics were not significantly associated with delay time. Insurance coverage and the correct attribution of symptoms to cardiac causes are substantial and modifiable predictors of delay in seeking treatment of AMI.

Examining Exercise in Older Adults Using the Theory of Planned Behavior and Temporal Discounting.

Exercise is one of the most important health behaviors to reduce and prevent the severity of many chronic diseases. The purpose of the current study was to determine if adding temporal discounting (TD) would affect the predictability of the Theory of Planned Behavior (TPB) in exercising among older adults. One hundred thirty-seven older adults were recruited from 11 churches in rural Arkansas using a cross-sectional design. Information regarding participants' exercise behavior, constructs of the TPB, TD rates, and demographics was collected. Path analysis was used to examine the relationships between and among each of the concepts of the TPB and TD. TD was not a significant predictor (p = 0.413) for exercise behavior after adjusting for intention. Adding TD to the existing TPB did not significantly affect the predictability of the model negatively or positively. [Res Gerontol Nurs. 2017; 10(6):252-259.].

New cardiovascular guidelines: Clinical practice evidence for the nurse practitioner.

PURPOSE: Guidelines for the prevention and treatment of cardiovascular disease (CVD) have recently changed. Goals of these guidelines have shifted to the promotion of health and control of risk rather than solely on treatment of CVD. This article summarizes the six new cardiovascular screening, prevention, and treatment guidelines for use in practice. DATA SOURCES: Published and peer-reviewed guidelines published jointly and in collaboration with the National Heart Lung and Blood Institute by the American Heart Association and the American College of Cardiology constitute the evidence base for this article. CONCLUSIONS: The potential for making lifestyle changes a way of life instead of a diet or program is an important point to make in clinical visits. If nurse practitioners (NPs) could promote a way-of-life lifestyle change to individuals in America, even change at a modest level, we could improve the health of the nation. IMPLICATIONS FOR PRACTICE: NPs need to be aware of new guidelines and best practices to improve the cardiovascular health of their patients. We summarized these new guidelines into an easy-to-interpret format for use in practice.

What's wrong with me? Women's coronary heart disease diagnostic experiences.

Most women are unaware that that they may experience atypical coronary heart disease (CHD) symptoms. Women's atypical presentation often results in women having difficulty being diagnosed with CHD or myocardial infarction. Investigating women's CHD diagnostic experiences may reveal vital areas amenable to intervention. This secondary analysis explored women's CHD diagnostic experiences. Forty women completed in-depth interviews in their homes that were audiotaped and lasted 2-3 hours. Using content analysis and constant comparison, five themes emerged: awareness, seeking treatment, frustration, treatment decisions, and anger. Despite numerous symptoms and visits with clinicians, most women were not diagnosed with CHD before myocardial infarction. During the infarction, women with typical symptoms were easily diagnosed while those with atypical symptoms received a delayed diagnosis. Those who repeatedly sought treatment were angry about not being diagnosed earlier. Further research is needed to promote early symptom recognition, timely diagnosis, and efficacious treatment-keys to improving women's CHD outcomes and to preventing similar negative diagnostic experiences.

Temporal discounting rates and their relation to exercise behavior in older adults.

UNLABELLED: As our nation's population ages, the rates of chronic illness and disability are expected to increase significantly. Despite the knowledge that exercise may prevent chronic disease and promote health among older adults, many still are inactive. Factors related to exercise behaviors have been explored in recent years. However, temporal discounting is a motivational concept that has not been explored in regard to exercise in older adults. Temporal discounting is a decision making process by which an individual chooses a smaller more immediate reward over a larger delayed reward. The aim of this study was to determine if temporal discounting rates vary between exercising and non-exercising older adults. DESIGN: This study used cross-sectional survey of 137 older adults living in the community. Older adults were recruited from 11 rural Arkansas churches. The Kirby delay-discounting Monetary Choice Questionnaire was used to collect discounting rates and then bivariate analysis was performed to compare temporal discounting rate between the exercisers and non-exercisers. Finally, multivariate analysis was used to compare discounting rate controlling for other covariates. RESULTS: The results indicated that exercising older adults display lower temporal discounting rates than non-exercising older adults. After controlling for education, exercisers still have lower temporal discounting rates than non-exercisers (p<0.001). CONCLUSIONS AND IMPLICATIONS: These findings are important as several chronic health conditions relate to lack of exercise especially in older adults. This research suggests that if we can find appropriate incentives for discounting individuals, some type of immediate reward, then potentially we can design programs to engage and retain older adults in exercise.

Perceived risk of heart attack: a function of gender?

TOPIC: The influence of gender on women's risk beliefs for heart attack. PURPOSE: To inform healthcare providers how women's beliefs and attitudes contribute to treatment-seeking delay in the event of a heart attack, and to establish the importance of risk beliefs in women. SOURCES: Published literature in MEDLINE and CINAHL computerized databases, reference lists of obtained articles. CONCLUSIONS: Women's perceived risk beliefs for heart attack are influenced by the effects of media, cultural, and gender roles and the modeling of bias in health care. There is a need for healthcare providers to change their focus from acting on (etic) a patient to interacting within (emic) the belief systems of their patients to optimize positive outcomes.