Anti-Asian Hate and the Health of Older Asian Individuals.

This qualitative study assesses the association of anti-Asian hate with older Asian individuals' health and the clinician's role in addressing hate incidents.

Surrogate decision-makers from historically marginalized populations have lower levels of preparedness for care planning.

BACKGROUND: Surrogate preparedness for medical decision-making is an important part of care planning. This study examined preparedness and engagement among historically marginalized surrogates. METHODS: Surrogates were included if they were named medical decision-makers by patients ≥55 years at a San Francisco safety-net and Veterans Affairs hospital. We assessed preparedness for medical decision-making by asking if surrogates had been formally asked to be the medical decision-maker, if patients had discussed medical wishes with surrogates, and if the surrogate role and these medical wishes had been documented. We assessed surrogate confidence and readiness using a modified Surrogate ACP Engagement Survey. We used Wilcoxon rank-sum tests to measure the association of engagement scores with surrogate characteristics. RESULTS: Of 422 surrogates, their mean age was 53 years (SD ±14.5), 73% were from minoritized groups, 38% were Spanish-speaking, and 15% had limited health literacy. For preparedness outcomes, 13% of surrogates were not formally asked to play this role, 46% reported the patient had not discussed end-of-life medical wishes, and 51% reported there had been no formal documentation of the surrogate role. Surrogates reported higher confidence 4.43/5 (SD ± 0.64) than readiness 3.70 (1.22) for decision-making (p < 0.001). Confidence and readiness scores were lower among historically marginalized participants. CONCLUSION: More resources are needed to prepare surrogate decision-makers from historically marginalized communities for discussing patient's goals of care and treatment preferences.

The remediation potential and kinetics of Pb2+ adsorbed by the organic frameworks of Cladophora rupestris.

Cladophora rupestris is ubiquitous in many kinds of waterbodies, and C. rupestris biomass can serve as a carrier for adsorbing and transferring heavy metals. Batch experiments and characterization were performed. Results showed that the organic frameworks of C. rupestris (CROF) had a specific surface area of 2.58 m2/g and an external surface area of 2.06 m2/g. Many mesopores were present in CROF, mainly distributed in 2.5-7.5 nm. The zeta potentials were within the range of - 4.46 to - 13.98 mV in the tested pH of 2.0-9.0. CROF could effectively adsorb Pb2+ in large pH range. The maximum adsorption capacity (qmax) of Pb2+ on CROF was 15.02 mg/g, and 97% of Pb2+ was adsorbed onto CROF after 25 min. CROF had a preferential adsorption of Pb2+. The protein secondary structures and carbon skeletons of CROF all worked in adsorption. The main Pb2+ adsorption mechanisms were pore filling, electrostatic attraction, Pb-π interaction, and surface complexation. Therefore, it is valuable as a biosorbent for the removal of Pb2+ from waterbodies.

"At the End I Have a Say": Engaging the Chinese Community in Advance Care Planning.

CONTEXT: Despite the association of advance care planning (ACP) with improved patient and caregiver outcomes, Chinese American elders have low rates of ACP. OBJECTIVES: Assess ACP facilitators/barriers in the San Francisco (SF) Chinese community and codesign, implement, and test community-based ACP-promoting pilot events. METHODS: A Chinese Community Committee (N = 19 community-based organization leaders, health system representatives, community members) conducted focus groups in Cantonese and English with Chinese older adults (age ≥55), caregivers, and community leaders. The Committee designed and implemented pilot events in-person and online. We analyzed focus group data using thematic analysis; assessed pre-to-post-event readiness to engage in ACP (validated survey; 14 scale, 4 = most ready); and assessed event acceptability. RESULTS: A total of 34 people participated in six focus groups. Themes described Chinese community-specific importance of ACP (e.g., reduces family burden), barriers (e.g., younger generations lack tools to discuss ACP with elders and vice versa), and facilitators (e.g., intergenerational events, culturally/linguistically appropriate materials). Based on focus groups findings, the Committee developed a novel ACP tool and designed intergenerational events. A total of 195 participants attended 10 events; 95% were Chinese, 90% spoke Chinese languages, 80% were women. ACP readiness increased significantly (1.66 [SD 0.84] vs. 2.03 [SD 0.85]; P < 0.001); 94% of participants were comfortable attending and 96% would recommend events. CONCLUSION: Community-developed intergenerational events that highlight the value of ACP and address barriers are acceptable and increase ACP engagement in the Chinese community.

Assessing the wellbeing of family caregivers of multimorbid and homebound older adults-A scoping literature review.

BACKGROUND: The prevalence of homebound older adults in the United States more than doubled during the COVID-19 pandemic with greater burden on family caregivers. Higher caregiver burden, more specifically higher treatment burden, contributes to increased rates of nursing home placement. There exist a multitude of tools to measure caregiver well-being and they vary substantially in their focus. Our primary aim was to perform a scoping literature review to identify tools used to assess the facets of caregiver well-being experienced by caregivers of persons with multiple chronic conditions (MCC) with a special focus on those caregivers of homebound adult patients. METHODS: The search was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. After refining search terms, searches were performed of the peer-reviewed and gray literature. RESULTS: After removal of duplicate studies, a total of 5534 total articles were screened for relevance to our study. After all screening and review were completed, 377 total articles remained for full review which included 118 different quantitative tools and 20 different qualitative tools. We identified the 15 most commonly utilized tools in patients with MCC. The Zarit Burden Interview was the most commonly used tool across all of the studies. Of the 377 total studies, only eight of them focused on the homebound population and included 13 total tools. CONCLUSIONS: Building on prior categorization of well-being tools, our work has identified several tools that can be used to measure caregiver well-being with a specific focus on those caregivers providing support to older adults with MCC. Most importantly, we have identified tools that can be used to measure caregiver well-being of family caregivers providing support to homebound older adults, an ever-growing population who are high cost and high utilizers of health care services.

What does the word healing mean to you? Perceptions of patients with life-limiting illness.

INTRODUCTION: There is a growing consensus that patient-centered care is more effective in treating patients than a strictly biomedical model, where there are known challenges to involving the patient in assessments, treatment goals, and determining preferred outcomes. OBJECTIVES: The current study seeks to integrate patient values and perspectives by exploring how people diagnosed with a life-limiting disease define healing in their own words. METHODS: As a part of a larger study that included cognitive interviewing, we asked the question "what does the word healing mean to you?" Data were collected during face-to-face interviews with patients from three metropolitan healthcare facilities. RESULTS: Thirty participants responded to the question "what does healing mean to you?" Seven themes were identified through the data analysis. These themes include acceptance, feeling better, pain, social support, process, religion/spirituality, and make whole. The feeling better, pain, and process themes have subthemes. SIGNIFICANCE OF RESULTS: Probing to understand patient perspectives and how to provide a holistic approach to care is essential to patient treatment. Patients defined healing in a broader way than how it is typically defined in literature. The patients' definitions provide greater insight into perceptions and expectations regarding the healing process.

A room-temperature ultrasonic hydrogen sensor based on a sensitive layer of reduced graphene oxide.

It is challenging to increase the sensitivity of a hydrogen sensor operating at room temperature due to weak sorption and tiny mass of hydrogen. In this work, an ultrasonic sensor is presented for detecting hydrogen, which is composed of a 128° YX-LiNbO3 substrate and a reduced graphene oxide (RGO) sensitive layer with a platinum catalyzer. By optimizing the depositing parameters of RGO and platinum, a considerably high sensitivity is achieved at room temperature. A frequency shift of 308.9 kHz is obtained in 100 ppm hydrogen mixed with argon, and a frequency shift of 24.4 kHz is obtained in 1000 ppm hydrogen mixed in synthetic air. It is demonstrated that in addition to strong sorption of the sensitive layer, the coaction of mass load and conductivity variation is key to high sensitivity of the sensor. By establishing the original conductivity of the sensitive layer within the "conductivity window" for enhancing electrical response, we improve the sensitivity of the ultrasonic sensor, which is available for detecting hydrogen with an extremely low concentration of 5 ppm.

Characterizing the subtype of anhedonia in major depressive disorder: A symptom-specific multimodal MRI study.

Anhedonia is a core symptom of major depressive disorder (MDD). Two subtypes of anhedonia: anticipatory anhedonia and consummatory anhedonia has been recognized in MDD patients. However, our knowledge regarding the distinction of anticipatory anhedonia and consummatory anhedonia in MDD remains limited. This study aimed to characterize the anticipatory anhedonia and consummatory anhedonia in first-episode, drug-naïve MDD patients. Resting-state functional MRI and T1-structural MRI were acquired for 38 MDD patients and 65 matched healthy controls (HCs). The ALFF and cortical surface indexes were compared between MDD and HCs. Then the correlations between the ALFF and cortical surface indexes alternations and the scores of anticipatory and consummatory pleasure measured by Temporal Experience of Pleasure Scale were evaluated. The elevated ALFF of left dorsal anterior cingulate cortex (dACC) and the reduced cortical thickness (CT) of left rostral ACC and lateral orbitofrontal cortex (lOFC) were respectively correlated with anticipatory anhedonia and consummatory anhedonia in MDD patients. These findings suggested the dissociated pathophysiological basis and imaging characteristics of anticipatory anhedonia and consummatory anhedonia. The ALFF and CT values of ACC and lOFC might serve as the imaging biomarker of the subtypes of anhedonia in early onset of MDD.

A systematic literature review of the assessment of treatment burden experienced by patients and their caregivers.

BACKGROUND: Many older adults with multiple chronic conditions, particularly those who are functionally impaired, spend considerable time juggling the competing demands of managing their conditions often assisted by caregivers. We examined methods of assessing the treatment burden experienced by this population as a first step to identifying strategies to reduce it. METHODS: Systematic searches were performed of the peer-reviewed and grey-literature (PubMed, Cochrane library, CINAHL, EMBASE, Web of Science, SCOPUS, New York Academy of Medicine Grey Literature Review, NLM catalog and ProQuest Digital Theses and Dissertations). After title and abstract screening, both qualitative and quantitative articles describing approaches to assessment of treatment burden were included. RESULTS: Forty-five articles from the peer reviewed and three items from the grey literature were identified. Most articles (34/48) discussed treatment burden associated with a specific condition. All but one examined the treatment burden experienced by patients and six addressed the treatment burden experienced by caregivers. Qualitative studies revealed many aspects of treatment burden including the burdens of understanding the condition, juggling, monitoring and adjusting treatments, efforts to engage with others for support as well as financial and time burdens. Many tools to assess treatment burden in different populations were identified through the qualitative data. The most commonly used instrument was the Treatment Burden Questionnaire. CONCLUSIONS: Many instruments are available to assess treatment burden, but no one standardized assessment method was identified. Few articles examined approaches to measuring the treatment burden experienced by caregivers. As people live longer with more chronic conditions healthcare providers need to identify patients and caregivers burdened by treatment and engage in approaches to ameliorate treatment burden. A standard and validated assessment method to measure treatment burden in the clinical setting would help to enhance the care of people with multiple chronic conditions, allow comparison of different approaches to reducing treatment burden, and foster ongoing evaluation and monitoring of burden across conditions, patient populations, and time.

How Surrogate Decision-Makers for Patients With Chronic Critical Illness Perceive and Carry Out Their Role.

OBJECTIVES: Family members commonly make medical decision for patients with chronic critical illness. This study examines how family members approach this decision-making role in real time. DESIGN: Qualitative analysis of interviews with family members in the intervention arm of a randomized controlled communication trial. SETTINGS: Medical ICUs at four U.S. hospitals. PARTICIPANTS: Family members of patients with chronic critical illness (adults mechanically ventilated for ≥ 7 d and expected to remain ventilated and survive for ≥ 72 hr) who participated in the active arm of a communication intervention study. INTERVENTIONS: Family members participated in at least two content-guided, informational, and emotional support meetings led by a palliative care physician and nurse practitioner. MEASUREMENTS AND MAIN RESULTS: Grounded theory was used for qualitative analysis of 66 audio recordings of meetings with 51 family members. Family members perceived their role in four main ways: voice of the patient, advocate for the patient, advocate for others, and advocate for oneself. Their decision-making was characterized by balancing goals, sharing their role, keeping perspective, remembering previous experiences, finding sources of strength, and coping with various burdens. CONCLUSIONS: Family members take a multifaceted approach as they participate in decision-making. Understanding how surrogates perceive and act in their roles may facilitate shared decision-making among clinicians and families during critical care.

Life perceptions of patients receiving palliative care and experiencing psycho-social-spiritual healing.

BACKGROUND: It is important to identify, from the patients' perspectives, the different factors that contribute toward psycho-social-spiritual healing. METHODS: This was a qualitative study that took place at a large research center, an underserved clinic, and a community hospital. We used a needs assessment questionnaire and open-ended questions to assess the constituents of psycho-social-spiritual healing: (I) how previous life experiences affected patients' present situations in dealing with their illnesses; (II) barriers to palliative care, and (III) benefits of palliative care. RESULTS: Of a total of 30 participants from 3 different study sites, 24 (80%) were receiving inpatient or outpatient palliative care at a research center. Thirteen (43%) participants were female, 10 (33%) were Black/African American, and 16 (53%) reported being on disability. While the initial shock of the diagnosis made participants feel unprepared for their illnesses, many looked to role models, previous work experiences, and spiritual as well as religious support as sources of strength and coping mechanisms. Barriers to palliative care were identified as either external (lack of proper resources) or internal (symptom barriers and perceived self-limitations). The feeling of "being seen/being heard" was perceived by many participants as the most beneficial aspect of palliative care. CONCLUSIONS: The needs assessment questionnaire and open-ended questions presented in this study may be used in clinical settings to better help patients achieve psycho-social-spiritual healing through palliative care and to help clinicians learn about the person behind the patient.

The Studying Multiple Outcomes After Aural Rehabilitative Treatment Study: Study Design and Baseline Results.

Hearing loss may affect critical domains of health and functioning in older adults. This article describes the rationale and design of the Studying Multiple Outcomes After Aural Rehabilitative Treatment (SMART) study, which was developed to determine to what extent current hearing rehabilitative therapies could mitigate the effects of hearing loss on health outcomes. One hundred and forty-five patients ≥50 years receiving hearing aids (HA) or cochlear implants (CI) were recruited from the Johns Hopkins Department of Otolaryngology-HNS. A standardized outcome battery was administered to assess cognitive, social, mental, and physical functioning. Of the 145 participants aged 50 to 94.9 years who completed baseline evaluations, CI participants had significantly greater loneliness, social isolation, and poorer hearing and communicative function compared with HA participants. This study showed that standardized measures of health-related outcomes commonly used in gerontology appear sensitive to hearing impairment and are feasible to implement in clinical studies of hearing loss.

An assessment of meaning in life-threatening illness: development of the Healing Experience in All Life Stressors (HEALS).

CONTEXT: Patients with life-threatening or chronic illness report an experience of increased positive psychological, social, and/or spiritual change during diagnosis and/or treatment of their illness, even in the face of unfavorable prognosis. This transformation begins through the ability to make their life meaningful by forming meaningful connections that emerge through self-introspection and relationships with a divine entity, nature, and other people. The Healing Experience in All Life Stressors (HEALS) assessment provides a way to identify distress-causing changes that may interfere with the development of meaning and psycho-social-spiritual homeostasis. OBJECTIVE: Preliminary examination of responses to items on the HEALS and examination of the factor structure. METHOD: The 48-item HEALS questionnaire was developed using a multistep process: literature review for concept development, item generation from qualitative data, and face and content validity by expert panel. In the current study, HEALS was completed by 100 patients diagnosed with life-limiting disease and seen by the palliative care team at a large research institution in the US. Exploratory factor analysis techniques were used to determine scale structure of the instrument. RESULTS: Outcome testing of sample adequacy using Kaiser-Meyer-Olkin statistic was 0.75, which exceeds the recommended value of 0.60. The HEALS show very good internal consistency with a Cronbach's a of 0.94. Overall results of the exploratory factor analysis established a four-factor questionnaire: 1) religion; 2) spirituality, demonstrated by a) interaction with a religious community and b) belief in higher power; 3) intrapersonal; and 4) interpersonal relationships expressed through psychological changes resulting in enhanced outlook and improvement in relationships with family and friends. CONCLUSION: This study involved the initial step to commence the process of scale validation, with promising outcomes identifying subscales as an effective way to assess the construct of healing. These findings support further examination using cognitive appraisal and confirmatory factor analysis.

Change in loneliness after intervention with cochlear implants or hearing aids.

OBJECTIVE: To investigate the impact of hearing aid (HA) and cochlear implant (CI) use on loneliness in adults. STUDY DESIGN: Prospective observational cohort study. METHODS: One hundred and thirteen adults, aged ≥ 50 years, with postlingual hearing loss and receiving routine clinical care at a tertiary academic medical center, were evaluated with the University of California at Los Angeles Loneliness Scale before and 6 and 12 months after intervention with HAs or CIs. Change in score was assessed using linear mixed effect models adjusted for age; gender; education; and history of hypertension, diabetes, and smoking. RESULTS: Significant improvements in loneliness scores were observed in CI users from baseline to 6 months (-3.79 [95% confidence interval): -5.73, -1.85], P <.001) and baseline to 12 months (-3.26 [95% confidence interval: -5.66, -0.87], P =.007). We did not observe a significant improvement in loneliness scores in HA users from baseline to 6 months (-0.83 [95% confidence interval: -2.68, 1.02], P =.381) or baseline to 12 months (-0.34 [95% confidence interval: -2.77, -2.10], P = .007). The most substantial increases were observed in individuals with the lowest baseline scores. CONCLUSION: Treatment of hearing loss with CIs results in a significant reduction in loneliness symptoms. This improvement was not observed with HAs. We observed differential effects of treatment depending on the baseline loneliness score, with the greatest improvements observed in individuals with the most loneliness symptoms at baseline. LEVEL OF EVIDENCE: 2b. Laryngoscope, 127:1885-1889, 2017.

Association of Using Hearing Aids or Cochlear Implants With Changes in Depressive Symptoms in Older Adults.

IMPORTANCE: Hearing loss is a common health problem in older adults that is strongly associated with the development of depression. Previous cross-sectional studies have reported lower odds of depression among individuals who use hearing aids. However, there have been limited prospective studies investigating the effect of hearing loss treatments on depressive symptoms. OBJECTIVE: To investigate the association between treatment with a hearing aid or cochlear implant with depressive symptoms in older adults. DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study was conducted of 113 participants 50 years or older who received hearing aids (n = 63) or cochlear implants (n = 50). Participants were recruited from August 1, 2011, to January 31, 2014, at a tertiary care academic center. INTERVENTION: Hearing aid or cochlear implantation. MAIN OUTCOMES AND MEASURES: Depressive symptoms were evaluated by the 15-item Geriatric Depression Scale (GDS) at baseline and at 6 and 12 months after intervention. The score ranges from 0 to 15, and various scores between 3 and 10 have been used as being suggestive of depression. RESULTS: The median age of the 113 study participants was 69.6 years (interquartile range, 63.5-77.4 years). At baseline, the mean GDS score for the participants was 41% lower (95% CI, 7%-63%) among those receiving hearing aids (mean score, 1.5; 95% CI, 0.7-3.3) compared with those receiving cochlear implants (mean score, 2.6; 95% CI, 1.3-5.1). Cochlear implant recipients' GDS scores improved from baseline to 6 months after treatment by 31% (95% CI, 10%-47%) and from baseline to 12 months after treatment by 38% (95% CI, 18%-54%). Hearing aid recipients' GDS scores improved by 28% (95% CI, 0%-48%) at 6 months after treatment but were not significantly different from baseline at 12 months after treatment (16%; 95% CI, -24% to 43%). CONCLUSIONS AND RELEVANCE: There was a significant improvement in depressive symptoms at 6 months after treatment for patients receiving cochlear implants and hearing aids; this improvement persisted to 12 months for those who received cochlear implants. Further research is warranted to assess the long-term effect of hearing rehabilitation on mental health in older adults.

Quality of life after intervention with a cochlear implant or hearing aid.

OBJECTIVES/HYPOTHESIS: To investigate the impact of hearing aid and cochlear implant use on quality of life in adults. STUDY DESIGN: Prospective observational cohort study. METHODS: One hundred thirteen adults aged ≥50 years with postlingual hearing loss receiving routine clinical care at a tertiary academic medical center were evaluated with the Medical Outcome Study Short Form-36 before and 6 and 12 months after intervention with hearing aids or cochlear implants. Change in score was assessed using linear mixed effect models adjusted for age, gender, education, and history of hypertension, diabetes, and smoking. RESULTS: A significant increase in Mental Component Summary score was observed in both hearing aid and cochlear implant users from baseline to 12 months, with cochlear implant users increasing nearly twice that of hearing aid users (hearing aid: 2.49 [95% confidence interval: 0.11, 4.88], P = .041; cochlear implant: 4.20 [95% confidence interval: 1.85, 6.55], P < .001). The most substantial increases were observed in individuals with the lowest baseline scores. There was no significant difference in physical component summary score from baseline to 12 months. CONCLUSIONS: Treatment of hearing loss with hearing aids and cochlear implants results in significant increases in mental health quality of life. The majority of the increase is observed by 6 months post-treatment, and we observed differential effects of treatment depending on the level of baseline quality of life score with the greatest gains observed in those with the lowest scores. LEVEL OF EVIDENCE: 2b. Laryngoscope, 126:2110-2115, 2016.

Association of Hearing Loss and Loneliness in Older Adults.

OBJECTIVE: The objective of this study is to determine factors associated with loneliness in older adults presenting for hearing loss treatment. METHOD: A cross-sectional analysis was conducted of 145 participants (aged 50-94) who presented for hearing aids or cochlear implants and were enrolled in the Studying Multiple Outcomes After Aural Rehabilitative Treatment (SMART) study from 2011 to 2013. Social, communicative, physical, and mental health functioning were assessed using self-administered questionnaires, and loneliness using the University of California, Los Angeles (UCLA) Loneliness Scale. RESULTS: Younger age and greater hearing loss were significantly associated with greater loneliness. Metrics of depressive symptoms and hearing-related quality of life, communication difficulties, and emotional well-being, mental health, and 36-Item Medical Outcomes Study Short-Form (SF-36) scores were moderately or highly correlated with loneliness. DISCUSSION: Younger age and greater hearing loss are independently associated with higher levels of loneliness in older adults presenting to clinic for hearing loss treatment. Further studies needed to determine whether hearing treatment can reduce loneliness in older adults.

Assessing physical functioning in otolaryngology: feasibility of the Short Physical Performance Battery.

PURPOSE: Objective measures of physical functioning and mobility are considered to be the strongest indicators of overall health and mortality risk in older adults. These measures are not routinely used in otolaryngology research. We investigated the feasibility of using a validated physical performance battery to assess the functioning of older adults seen in a tertiary care otolaryngology clinic. MATERIALS AND METHODS: The Short Physical Performance Battery was performed on 22 individuals aged 50 years or older enrolled in the Studying Multiple Outcomes after Aural Rehabilitative Treatment (SMART) study at Johns Hopkins. RESULTS: We successfully administered the SPPB to 22 participants, and this testing resulted in minimal participant and provider burden with respect to time, training, and space requirements. The mean time to complete 5 chair stands was 13.0 ± 3.8 seconds. The mean times for the side-by-side, semi-tandem, and tandem stands were 10.0 ± 0.0, 9.5 ± 2.1, and 8.8 ± 3.2 seconds, respectively. Mean walking speed was 1.1 ± 0.3 meters per second, and composite SPPB scores ranged from 6 to 12 (mean = 10.45, S.D. = 1.6). CONCLUSIONS: Our results demonstrate the feasibility of implementing a standardized physical performance battery to assess physical functioning in a cohort of older adults seen in a tertiary otolaryngology clinic. We provide detailed instructions, references, and analytic methods for implementing the SPPB in future otolaryngology studies involving older adults.