Korean American Patients' and Family Caregivers' Sources of Social Support and Perceptions of Cancer and the Caregiving Role: A Theory-Driven Qualitative Study.

PURPOSE: To understand the sources of social support and perceptions of cancer and the caregiving role for Korean American patients with cancer and their family caregivers. PARTICIPANTS & SETTING: Using convenience sampling, Korean American patients with cancer and their family caregivers were recruited from Korean American churches and community health agencies. METHODOLOGIC APPROACH: Semistructured interviews guided by the sociocultural stress and coping model were conducted with 12 dyads (N = 24) of Korean American patients with cancer and their family caregivers. Data were analyzed using thematic analysis. FINDINGS: Patients' social support sources included Korean cancer support programs, family or friends, and religion. Family caregivers' sources of social support were limited to religion and friends. IMPLICATIONS FOR NURSING: Nurses can encourage patients with cancer in racial and ethnic minority groups to attend cancer support programs offered in their primary language to enhance their quality of life during cancer survivorship. Culturally tailored interventions are needed to support the patients' family caregivers.

Health effects of social connectedness in older adults living in congregate long-term care settings: A systematic review of quantitative and qualitative evidence.

BACKGROUND: The overall impact of social connectedness on health outcomes in older adults living in nursing homes and assisted living settings is unknown. Given the unclear health impact of social connectedness for older adults in congregate long-term care settings worldwide, a comprehensive systematic review is required to evaluate the overall relationship between social connectedness and health outcomes for them. OBJECTIVES: The purpose of this article was to synthesize the literature regarding the health impact of social connectedness among older adults living in nursing homes or assisted living settings. METHODS: Using PRISMA guidelines, we identified eligible studies from Scopus, MEDLINE, PsycINFO, CINAHL and Cochrane databases (1990-2021). Bias and quality reporting assessment was performed using standardized criteria for cohort, cross sectional and qualitative studies. At each stage, ≥ 2 researchers conducted independent evaluations. RESULTS: Of the 7350 articles identified, 25 cohort (follow-up range: 1 month-11 years; with two also contributing to cross sectional), 86 cross sectional, eight qualitative and two mixed methods were eligible. Despite different instruments used, many residents living in nursing homes and assisted living settings had reduced social engagement. Quantitative evidence supports a link between higher social engagement and health outcomes most studied (e.g. depression, quality of life). Few studies evaluated important health outcomes (e.g. cognitive and functional decline). Most cohort studies showed that lack of social connectedness accelerated time to death. CONCLUSIONS: Social connectedness may be an important modifiable risk factor for adverse health outcomes for older adults living in nursing homes and assisted living facilities. Most studies were cross sectional and focused on quality of life and mental health outcomes. Longitudinal studies suggest that higher social engagement delays time to death. Evidence regarding other health outcomes important to older adults was scant and requires further longitudinal studies.

Rising to the Occasion: A National Nursing Home Study Documenting Attempts to Address Social Isolation During the COVID-19 Pandemic.

OBJECTIVES: COVID-19-related policies introduced extraordinary social disruption in nursing homes. In response, nursing facilities implemented strategies to alleviate their residents' loneliness. This study sought to describe interventions nursing homes used, document the perceived effectiveness of efforts, and determine barriers to implementing strategies to mitigate social isolation and loneliness. DESIGN: National survey of nursing homes sampled in strata defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5). SETTINGS AND PARTICIPANTS: US Nursing Home Directors of Nursing/Administrators (n = 1676). METHODS: The survey was conducted between February and May 2022 (response rate: 30%; n = 504, weighted n = 14,506). Weighted analyses provided nationally representative results. RESULTS: One-third were extremely concerned about their home's ability to meet residents' medical and social needs during COVID-19 before vaccines were available and 13% after vaccines. Nearly all reported trying to mitigate residents' social isolation during the pandemic. Efforts tried, and perceived as most useful, included using technology (tablets, phones, emails), assigning staff as a family contact, and more staff time with residents. Most frequently cited barriers to implementation were related to staffing issues. CONCLUSIONS AND IMPLICATIONS: Despite multiple challenges, nearly all nursing homes tried to implement many different approaches to address residents' social needs, with some (eg, having an assigned family contact, use of tablets and phones) perceived as more useful than others. Staffing issues presented barriers for addressing the social needs of nursing home residents. Many strategies for addressing social isolation placed more demands on a workforce already stretched to the limit. While concerns about resident social isolation reduced after vaccine availability, administrators remained extremely concerned about staff burnout and mental health.

Friendship in Later Life: A Pathway Between Volunteering Hours and Depressive Symptoms.

OBJECTIVES: Friendships are essential in the face of social network changes in later life and friendships may be important for reducing depression risk. Social participation through volunteering is also associated with fewer depressive symptoms. What is less well-understood is whether friendships serve as a pathway in the link between volunteering and depression. METHODS: We used panel data from the Health and Retirement Study (2010, 2014, 2018). Negative binomial regression within the SEM modeling framework was employed to analyze the association between volunteering and friendship, focusing on the indirect effect of friendships for understanding the volunteering and depressive symptoms relationship. RESULTS: Volunteer hours were positively associated with friendship (1-99 hr: ß = 0.17, p < .001, 100-199 hr: ß = 0.15, p < .001, 200 hr and more: ß = 0.23, p < .001) and negatively associated with number of depressive symptoms (1-99 hr: ß = -0.07, p = .06, 100-199 hr: ß = -0.14, p < .001, 200 hr and more: ß = -0.17, p < .001). Friendship mediated the relationship between volunteer hours and depressive symptoms (indirect effects; 1-99 hr: ß = -0.01, 95% confidence interval [CI] = [-0.02, -0.00], p = .03), 100-199 hr: ß = -0.01, 95% CI = [-0.02, -0.00], p = .03), 200 hr and more: ß = -0.02, 95% CI = [-0.03, -0.00], p = .03). DISCUSSION: Our findings underscored the role of volunteering in generating and maintaining friendships, as well as for friendships as a pathway between volunteer hours and depressive symptoms. Providing opportunities to maintain and grow friendships in later life may be a possible intervention strategy for older adults at risk of depression.

Admission Medication Reconciliations in Pediatric Patients Admitted to an Inpatient Psychiatry Unit.

OBJECTIVE: Medication errors resulting in adverse drug events may occur during transition of care. Most can be prevented with a medication reconciliation. California Senate Bill 1254 requires a pharmacist to perform an admission medication reconciliation (AMR) to obtain an accurate medication list for each high-risk patient upon hospital admission. Adult patient literature reveals that antidepressant, antipsychotic, and mood-stabilizing drugs are high-risk medications likely to cause errors. Therefore, the purpose of this analysis is to determine if pediatric psychiatry inpatients should be considered high risk, meriting an additional AMR by the pharmacy team. METHODS: This was a retrospective, single-center analysis of pediatric patients admitted to the inpatient psychiatry unit at Rady Children's Hospital, San Diego between January 1 and 31, 2021. All newly admitted patients had an AMR performed by the medical team (physician-led AMR). High-risk patients (prescribed a high-risk medication or 3 or more medications of any kind prior to admission) had an additional AMR by the pharmacy team (pharmacy-led AMR). Differences between these 2 AMRs were examined. RESULTS: Of the 58 patients admitted during the study period, 39 (67.2%) were identified as high risk, warranting an AMR by the pharmacy team. From the 170 medications reviewed, 51 differences (30%) were found between physician-led and pharmacy-led AMR, with 4 (2.4%) of the differences involving high-risk medications. No medications were incorrectly ordered, and no adverse drug events occurred. CONCLUSIONS: Given that physician-led and pharmacy-led AMRs of high-risk prescription medications were only marginally different and no medications were incorrectly ordered, the existing AMR methodology used by psychiatrists at our institution is effective at creating a safe medication list.

Health effects of loneliness and social isolation in older adults living in congregate long term care settings: A systematic review of quantitative and qualitative evidence.

BACKGROUND: Mounting evidence of loneliness and negative health impacts has placed loneliness among the "geriatric giants" in need of intervention by the healthcare system. OBJECTIVE: To evaluate the literature regarding the health impact of loneliness among older adults living in congregate living settings (i.e., assisted living, nursing homes). MATERIALS AND METHODS: Five databases were searched for quantitative and qualitative studies from January 1990 through August 2021. Methodological quality was assessed using modified criteria specific to quantitative and qualitative studies. Dual review assured the quality of the systematic review conduct. RESULTS: Five qualitative, 3 mixed method, 19 cross-sectional, and 4 cohort articles were eligible. Despite different tools used to measure loneliness, loneliness appeared common among older residents in congregate living situations. In most studies, loneliness was associated with depression (regardless of scale used), albeit all but one came from cross-sectional studies. Few studies noted the association between loneliness and suicidal ideation and frailty. The three cohort studies that evaluated loneliness and mortality had mixed results. Resilience and activities appeared to mediate the association between loneliness and negative health outcomes and social support appeared to moderate associations. CONCLUSIONS: For older adults living in congregate long term care settings, loneliness is a common phenomenon, with cross-sectional studies suggesting links to depression, suicidal ideation, and frailty. Additional longitudinal studies to understand the impact of loneliness on health outcomes in older adults living in congregate settings are needed, as are rigorous evidence-based interventions to address loneliness and mitigate its harmful effects during life's final chapter.

Health-Related Difficulty in Internet Use Among Older Adults: Correlates and Mediation of Its Association With Quality of Life Through Social Support Networks.

BACKGROUND AND OBJECTIVES: Internet use is increasingly a necessity. However, older adults may not use the internet due to either nonhealth reasons (e.g., lack of digital literacy or internet access) or health-related reasons (e.g., visual impairment or movement difficulties). While researchers have studied internet use among older adults, most do not discriminate whether nonuse is due to health-related reasons or otherwise. We therefore examine the key correlates of health-related difficulty in internet use among older adults, and how it may affect the quality of life (QoL) through their perceived social support networks. RESEARCH DESIGN AND METHODS: Data were from a national survey of older Singaporeans (N = 3,966) conducted in 2016-2017. Multinomial logistic regression and mediation analysis were used to identify older adult subgroups more likely to experience health-related difficulty in internet use, and whether such difficulty affected older adults' QoL through their social support networks. RESULTS: Those of male gender, of Malay ethnicity, with less education, and with more instrumental activity of daily living limitations were more likely to experience health-related difficulty in internet use. Social support networks mediated the relationship between health-related difficulty in internet use and QoL. DISCUSSION AND IMPLICATIONS: Disparities in internet use are not just shaped by access or skill, but also health. Health-related difficulties in internet use are related to older adults' social support networks and quality of life. As social connections become increasingly based around networked individuals due to technological advancements, more attention should be given to addressing these health-related difficulties.

Engineered T cells directed at tumors with defined allelic loss.

We describe an approach to cancer therapy based on exploitation of common losses of genetic material in tumor cells (loss of heterozygosity) (Basilion et al., 1999; Beroukhim et al., 2010). This therapeutic concept addresses the fundamental problem of discrimination between tumor and normal cells and can be applied in principle to the large majority of tumors. It utilizes modular activator/blocker elements that integrate signals related to the presence and absence of ligands displayed on the cell surface (Fedorov et al., 2013). We show that the targeting system works robustly in vitro and in a mouse cancer model where absence of the HLA-A*02 allele releases a brake on engineered T cells activated by the CD19 surface antigen. This therapeutic approach potentially opens a route toward a large, new source of cancer targets.

Fewer Bonuses, More Penalties At Skilled Nursing Facilities Serving Vulnerable Populations.

The first round of incentives and penalties under the Medicare Skilled Nursing Facility Value-Based Purchasing Program were distributed October 1, 2018. Our results show that facilities serving vulnerable groups were less likely to receive bonus payments and more likely to be penalized.

Lifelong learning and productive aging among the baby-boomers in Singapore.

Coined in 1982, the term productive aging is commonly associated with active participation in work, although it has since expanded beyond employment to include other dimensions of work, such as volunteering, caregiving and other activities that "produce(s) good/service for society, whether paid or unpaid" (Caro, Bass and Chen, 1993, p. 6). In this paper focusing on examining lifelong learning as one of the other activities in what comprises productive aging, we seek to explore the connections of lifelong learning to the notions of productive aging from the perspective of baby-boomers in Singapore. Using data from the qualitative study of Lifelong Learning among Older Adults in Singapore, which included 64 interviews with learners and non-learners of the baby-boomer generation (age 50-64), we first explore the grounded meanings of productive aging as articulated through lifelong learning. Next, we examine the benefits of lifelong learning as perceived by the baby-boomers, in particular, focusing on general wellbeing in enhancing productive aging. This is followed with a section examining barriers to lifelong learning to provide insight into deterrence to learning. Through the discussion of older adults' perceptions on lifelong learning and their engagement or lack of engagement especially with formal and non-formal learning, we hope to provoke a further re-thinking of what constitutes being productive in later life. Finally, we argue that beyond just another component to productive aging, lifelong learning should perhaps be further recognized as an enabler contributing to capacity-building of the other components including economic production, family care and volunteer services in enhancing productive aging.

Caprellid amphipods (Caprella spp.) are vulnerable to both physiological and habitat-mediated effects of ocean acidification.

Ocean acidification (OA) is one of the most significant threats to marine life, and is predicted to drive important changes in marine communities. Although OA impacts will be the sum of direct effects mediated by alterations of physiological rates and indirect effects mediated by shifts in species interactions and biogenic habitat provision, direct and indirect effects are rarely considered together for any given species. Here, we assess the potential direct and indirect effects of OA on a ubiquitous group of crustaceans: caprellid amphipods (Caprella laeviuscula and Caprella mutica). Direct physiological effects were assessed by measuring caprellid heart rate in response to acidification in the laboratory. Indirect effects were explored by quantifying caprellid habitat dependence on the hydroid Obelia dichotoma, which has been shown to be less abundant under experimental acidification. We found that OA resulted in elevated caprellid heart rates, suggestive of increased metabolic demand. We also found a strong, positive association between caprellid population size and the availability of OA-vulnerable O. dichotoma, suggesting that future losses of biogenic habitat may be an important indirect effect of OA on caprellids. For species such as caprellid amphipods, which have strong associations with biogenic habitat, a consideration of only direct or indirect effects could potentially misestimate the full impact of ocean acidification.