Full Code to Do-Not-Resuscitate: Culturally Adapted Palliative Care Consultations and Code Status Change Among Seriously Ill Hispanic Patients.

BACKGROUND: Palliative care and hospice services are disproportionately underutilized by ethnic minority patients. Addressing barriers to utilization of these services is critical to reducing disparities. The purpose of this study was to assess the impact of a culturally adapted palliative care consultation service for Hispanics on end-of-life decisions, specifically likelihood of changing from full code to do-not-resuscitate (DNR) status during index admission for serious illness. METHODS: A cross-sectional study design was applied to data extracted from electronic health records (EHR) of patients seen by a Geriatric Palliative Care service during inpatient stays between 2018 and 2019. The majority of referrals came from critical care sites. Culturally adapted palliative care consultations using the SPIKES tool featured a Spanish-speaking team member leading discussions, involvement of multiple and key family members, and a chaplain who is a Catholic Priest. RESULTS: The analytic sample included 351 patients who were, on average, 72 years old. 54.42% were female, 59.54% were Hispanic, and of Hispanic patients, 47.37% spoke primarily Spanish. Culturally adapted consults resulted in higher rates of conversion to DNR status in palliative cases of the target population. Both primary language and ethnicity were associated with likelihood of change from full code to DNR status, such that Spanish speakers and those of Hispanic ethnicity were more likely to switch to DNR than non-Hispanics and English-Speakers. CONCLUSION: This study illustrates how culturally adapted palliative care consultations can help reduce barriers and improve end-of-life decision-making, and can be applied with similar populations of seriously ill Hispanic patients.

Engaging multi-stakeholder perspectives to identify dementia care research priorities.

OBJECTIVES: The purpose of this study was to partner with stakeholders to identify gaps in care for persons living with dementia and their family caregivers and from this list, identify priorities for dementia care research. METHODS: Using a community-engaged research approach, a Stakeholder Advisory Council (SAC) consisting of diverse membership including persons living with dementia and family caregivers was convened. Through our work with the SAC, along with input from the wider network through a symposium, webinars, and an online learning community, gaps in dementia care and a list of topics for dementia care research was generated. This list was reduced to 46 topics for dementia care research and sent to stakeholders (persons living with dementia, family caregivers, and health/social care professionals in dementia care) to be prioritized by rating each of the 46 topics as "Not so important," "Important," or "Very important." Priorities for dementia care were summarized by frequencies and proportions. RESULTS: A total of 186 participants completed the survey from August through October 2020, including 23 (12.4%) persons living with dementia, 101 (54.3%) family caregivers, and 62 (33.3%) health/social care professionals. Consistent across stakeholder groups was the focus on research on how best to support families following a diagnosis of dementia. Among persons living with dementia, research focused on support for continuing to live in their own homes was ranked as the highest priority, rated by 91.3% as "Very Important". High priority research areas for family caregivers included interventions to slow cognitive decline (76.3%) as well as non-pharmacological approaches to manage behavioral symptoms (74.7%). The highest priority research topics for health/social care professionals were focused on the diagnosis including benefits of an early diagnosis (71.4%), how best to deliver the diagnosis (70.9%), and supports needed following a diagnosis (78.6%). CONCLUSIONS: This project draws on the strengths of its multi-stakeholder perspective to support patient-centered outcomes research. Findings are intended to inform those who conduct research and those who fund research about which research topics stakeholders believe are most important and thus have greatest potential to improve the quality of life among people living with dementia and their families.

Higher levels of physical activity buffered the negative effect of pain severity on physical frailty in older Latinx adults.

This cross-sectional study examined whether and to what extent physical activity (PA) mediated the effect of chronic pain on physical frailty in a sample of predominantly older Latinx adults. Study participants were 118 community-dwelling older adults in southwest United States. Physical frailty was measured by a summary score of physical function tests. Pain severity and pain interference were measured by the Brief Pain Inventory. PA levels were defined as meeting the PA recommendation by 7-day accelerometry. Pain outcomes and PA were associated with physical frailty, respectively. Hierarchical regression analysis revealed that PA mediated the relationship between pain severity and physical frailty. However, no mediation effect of PA was found in the relationship between pain interference and physical frailty scores. Higher levels of PA buffered the negative effect of pain severity on physical frailty. Future studies should pay attention to PA promotion to prevent the negative consequences of frailty in older minority adults.

The effects of yoga on physical functioning and health related quality of life in older adults: a systematic review and meta-analysis.

OBJECTIVE: The goal was to review systematically the comparative effectiveness of yoga, compared with other exercise interventions, for older adults as shown on measures of health and physical functioning. DESIGN: This was a systematic review with both narrative synthesis and meta-analysis. DATA SOURCES: Searches were conducted in MEDLINE®/PUBMED, PSYCINFO, CINAHL, Web of Science, and SCOPUS; bibliographies of selected articles; and one systematic review on the effects of yoga on cardiovascular disease. METHODS: Original studies from 1950 to November 2010 were sought, evaluating the effects of yoga on older adults. The search was restricted to randomized controlled trials of yoga in subjects ≥age 60, and published in English. Data were extracted and evaluated regarding setting, population size and characteristics, intervention type and duration, comparison group, outcome assessment, data analysis, follow-up, key results, and the quality of each study according to specific predetermined criteria. RESULTS: The search yielded 18 eligible studies (N=649). The studies reported on older adults across a range of settings, intervention intensity, and outcome measures. The majority of the studies had<35 participants (range 9-77). Quantitative and qualitative synthesis of the studies suggested that the benefits of yoga may exceed those of conventional exercise interventions for self-rated health status, aerobic fitness, and strength. However, the effect sizes were modest, and the evidence was mixed for yoga's effect on depression, sleep, and bone-mineral density. Studies did not find an effect on cognition. CONCLUSIONS: Small studies with mixed methodological quality suggested that yoga may be superior to conventional physical-activity interventions in elderly people. The precision of the estimates remains low. Larger studies are necessary to define better the intersection of populations, settings, and interventions in which yoga is most beneficial.

Cultural Considerations: Pharmacological and Nonpharmacological Means for Improving Blood Pressure Control among Hispanic Patients.

Cardiovascular disease is a leading cause of morbidity and mortality in the United States, and its prevention and treatment remain a priority for the medical community. Ethnic variations account for some differences in the prevalence of hypertension and blood pressure (BP) control rates among Hispanics, indicating the need for culturally appropriate management models. Aggressive treatment strategies are key to achieving optimal BP control in high-risk Hispanic patients. Hypertension in this ethnic group continues to be a major health concern. Of note, when provided access to comprehensive care, Hispanics demonstrate similar response rates to treatment as the majority of non-Hispanic whites. This highlights the importance of effective, culturally responsive hypertension management among high-risk Hispanic patients for achieving observable, positive health outcomes.

Transitional care of the long-term care patient.

This article reviews the literature on transitional care to and from the LTC environment, highlighting strategies to improve the quality of care transitions. Several factors are vital in the improvement of systems of care dealing with transitions. Key factors include communication with and among health care providers, effective medication reconciliation, advanced discharge planning, and timely use of palliative care.

The Chronic Care Model and Exercise Discussions during Primary Care Diabetes Encounters.

BACKGROUND: discussing self-care activities like exercise is challenging with the many competing demands during primary care encounters. Our objective was to study the relationship between the Chronic Care Model (CCM) score in the clinic and time spent by the physicians discussing exercise during encounters with diabetic patients. METHODS: consecutive patients with diabetes across 20 primary care clinics in South Texas were included. Time spent discussing exercise was determined using the Davis Observation Code on audio recordings of the visits. Clinicians completed the Assessment of Chronic Illness Care survey, a validated measure of the extent to which care delivered is consistent with the CCM. Data were analyzed using hierarchical linear models. RESULTS: a total of 162 transcribed recordings were analyzed. Age, the number of problems addressed, stage of change (SOC), and overall length of the visit were associated with time spent discussing exercise. There was a significant relationship between clinic CCM score and time spent by physicians advising about exercise, independent of SOC for exercise (P < .01). Also, a discussion about exercise was more likely to occur with patients who were in the contemplation SOC for exercise. CONCLUSIONS: discussions of exercise may be 18 to 33 seconds longer in clinics with full implementation of the CCM compared with those with basic implementation. Facilitating more complete CCM implementation in clinics with a basic level of CCM that serve a population of patients who are sedentary may realize the most benefit.