Reaching late adopters: factors influencing COVID-19 vaccination of Marshallese and Hispanic adults.

BACKGROUND: Marshallese and Hispanic communities in the United States have been disproportionately affected by COVID-19. Identifying strategies to reach late vaccine adopters is critical for ongoing and future vaccination efforts. We utilized a community-engaged approach that leveraged an existing community-based participatory research collaborative of an academic healthcare organization and Marshallese and Hispanic faith-based organizations (FBO) to host vaccination events. METHODS: Bilingual Marshallese and Hispanic study staff conducted informal interviews with 55 participants during the 15-minute post-vaccination observation period and formal semi-structured interviews with Marshallese (n = 5) and Hispanic (n = 4) adults post-event to assess the implementation of community vaccine events at FBOs, with a focus on factors associated with the decision to attend and be vaccinated. Formal interview transcripts were analyzed using thematic template coding categorized with the socio-ecological model (SEM). Informal interview notes were coded via rapid content analysis and used for data triangulation. RESULTS: Participants discussed similar factors influencing attitudes and behaviors toward receiving the COVID-19 vaccine. Themes included: (1) intrapersonal - myths and misconceptions, (2) interpersonal - protecting family and family decision-making, (3) community - trust of community location of events and influence of FBO members and leaders, (4) institutional - trust in a healthcare organization and bilingual staff, and (5) policy. Participants noted the advantages of vaccination delivery at FBOs, contributing to their decision to attend and get vaccinated. CONCLUSIONS: The following strategies may improve vaccine-related attitudes and behaviors of Marshallese and Hispanic communities not only for the COVID-19 vaccine but also for other preventive vaccinations: 1) interpersonal-level - develop culturally-focused vaccine campaigns targeting the family units, 2) community-level - host vaccination events at convenient and/or trusted locations, such as FBOs, and engage community and/or FBO formal or lay leaders as vaccine ambassadors or champions, and 3) institutional-level - foster trust and a long-term relationship with the healthcare organization and provide bilingual staff at vaccination events. Future research would be beneficial to investigate the effects of replicating these strategies to support vaccine uptake among Marshallese and Hispanic communities.

Differences in Habitual and Maximal Gait Velocity Across Age Groups: A Cross-Sectional Examination.

Prior work, primarily focusing on habitual gait velocity, has demonstrated a cost while walking when coupled with a cognitive task. The cost of dual-task walking is exacerbated with age and complexity of the cognitive or motor task. However, few studies have examined the dual-task cost associated with maximal gait velocity. Thus, this cross-sectional study examined age-related changes in dual-task (serial subtraction) walking at two velocities. Participants were classified by age: young-old (45-64 years), middle-old (65-79 years), and oldest-old (≥80 years). They completed single- and dual-task walking trials for each velocity: habitual (N = 217) and maximal (N = 194). While no significant Group × Condition interactions existed for habitual or maximal gait velocities, the main effects for both condition and age groups were significant (p < .01). Maximal dual-task cost (p = .01) was significantly greater in the oldest-old group. With age, both dual-task velocities decreased. Maximal dual-task cost was greatest for the oldest-old group.

Characteristics of nursing homes with high percentages of falls and falls with injuries among residents with obesity.

BACKGROUND: Obesity among United States nursing home (NH) residents is increasing. These residents have special care needs, which increases their risk for falls and falls with injuries. NH are responsible for ensuring the health of their residents, including minimizing falls. However, given the special care needs of residents with obesity, different factors may be important for developing programs to minimize falls among this group. AIM: We aimed to identify NH characteristics associated with falls and falls with injuries among residents with obesity. METHOD: We used resident assessment data and logistic regression analysis. RESULTS: We found that rates of falls and falls with injuries among residents with obesity varied significantly based on for-profit status, size, acuity index, obesity rate among residents, and registered nurse hours per patient day. CONCLUSION: Recommendations are made as to how NH may be able to lower risk for falls and falls with injuries among their residents with obesity.

Characteristics of Nursing Homes with High Rates of Urinary Tract Infections among Their Residents with Obesity.

Nursing home residents with obesity are at high risk for contracting urinary tract infections. In this research study, we found nursing homes in multi-facility chain organizations, for-profit status, nursing home size, obesity rate of resident population, and market competition were significantly associated with rates of urinary tract infections among residents with obesity.

Associations between physical activity and functional limitations in Native Hawaiian and Pacific Islander middle-aged and older adults in the United States.

OBJECTIVES: Physical activity (PA) can help individuals maintain physical function and independence. The association between PA and functional limitations (FL) has not been explored in the Native Hawaiian and Pacific Islander (NHPI) population. The purpose of this study was to examine relationships between PA and FL among NHPI adults (age ≥ 45 years) living in the United States. DESIGN: Cross-sectional data from the 2014 NHPI-National Health Interview Survey (N = 628) was used to create three constructs of FL based on responses from the Functioning and Disability Survey Module: needing equipment/assistance, having difficulty walking, and having difficulty with performing self-care and other fine motor activities. We used 2-stage least squares regression to examine the relationship between PA and FL of NHPI adults while accounting for the potential endogeneity of PA to FL. RESULTS: Compared to NHPI adults who met the guideline for recommended levels of aerobic and strengthening PA, those who met only the strengthening guideline experienced less difficulty in two FL constructs (use of medical equipment/assistance and difficulty walking). Those who met the aerobic guideline reported even less difficulties in all three FL constructs. NHPI adults who met both the aerobic and strengthening guidelines experienced the least difficulties in all three FL constructs compared to those who met neither PA guidelines. CONCLUSIONS: PA is associated with function in this adult NHPI population. Aerobic guidelines alone may be more beneficial than meeting the strengthening guideline alone; however, meeting both the aerobic and strengthening guidelines is most protective against FL.

Nursing home directors of nursing experiences regarding safety among residents with obesity.

The prevalence of nursing home (NH) residents with obesity is rising. Perspectives of NH Directors of Nursing (DONs) who oversee care trajectories for residents with obesity is lacking. This study aimed to describe the experiences of NH DONs regarding care and safety for NH residents with obesity. An adapted version of Donabedian's structure-process-outcome model guided this qualitative descriptive study. Semi-structured interviews were conducted with 15 DONs. Data were analyzed using directed content analysis, and findings are presented under the model's constructs. We learned that admission decisions for NH referrals of patients with obesity are complex due to reimbursement issues, available space and resources, and resident characteristics. DONs described the need to coach and mentor Certified Nursing Assistants to provide safe quality care and that more staff education is needed. We identified novel findings regarding the challenges of short-term residents' experience transitioning out of care due to limited resources.

Older Adults' Experience With Fall Prevention Recommendations Derived From the STEADI.

The Centers for Disease Control and Prevention (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit is a national effort to prevent falls among older adults. Studies have been conducted on implementation of the STEADI, but no studies have investigated older adults' adherence to or perceptions of fall prevention recommendations delineated within the STEADI algorithm. Semistructured interviews were conducted with a purposive sample of older adults 6 months after attending a falls risk assessment. Seventy-nine percent accurately recalled their fall risk, 57% followed one or more recommendations, and 32% did not recall at least one recommendation correctly. The most common recommendation recalled and adhered to was exercise. No participants recalled or adhered to recommendations including medication review, taking time changing positions, vision check, podiatrist visit, or physical therapy. Thirty-two percent fell. Of these, 55.6% did not follow any recommendations. Interview transcripts were analyzed using comparative methodology following the tenets of thematic analysis. Three themes emerged: participating in fall prevention, barriers to following recommendations, and providers can encourage people to prevent falls. An unexpected facilitator to participation in fall prevention efforts emerged-older adults' perception that they were positively influencing society by participating in research and working with students and the university. This finding provides an opportunity for providers of health education to address the growing public health issue of falls among older adults while also creating opportunities for students to engage in community service and interdisciplinary service learning.

Comparison of Exercise Performance in Recreationally Active and Masters Athlete Women.

Stone, MS, Glenn, JM, Vincenzo, JL, and Gray, M. Comparison of exercise performance in recreationally active and masters athlete women. J Strength Cond Res 32(2): 565-571, 2018-Master athletes (MA) are an understudied, ever-growing cohort. As such, it is important to examine how age affects muscular power and fatigability. Of particular interest is muscular power maintenance and fatigue mitigation of MA compared with young, healthy adults. The purpose of this investigation was to examine the differences in peak power, average power, total work (WRK), and fatigue index (FI) between recreationally active (RA) younger adults and female MA during anaerobic cycling exercise. Two groups, RA (n = 15; 20.6 ± 0.8 years) and MA (n = 17; 50.5 ± 8.6 years), participated in this study. Peak power, APWR, WRK, and FI were measured during a 30-second Wingate maximum anaerobic cycling protocol at a predetermined resistance of 7.5% body mass. Peak power (p = 0.92; RA: 654.1 ± 114.5 W; MA: 658.6 ± 147.6 W), APWR (p = 0.09; RA: 429.8 ± 73.3 W; MA: 384 ± 73.8 W), WRK (p = 0.09; RA: 12,894.3 ± 2,198.3 J; MA: 18,044.3 ± 27,184.9 J), and FI (p = 0.30; RA: 11.8 ± 4.1 W·s; MA: 14 ± 5.2 W·s) were not significantly different between groups. Master athletes produce power and WRK comparable to rates of fatigue among RA. This suggests that MA can maintain physical ability similar to RA in multiple parameters of high-intensity exercise while mitigating fatigue comparably. These data allow for advancements in exercise training and performance outcomes in MA populations. Further research within the MA population is warranted regarding other aspects of exercise and sport performance.

Balance measured by the sway balance smart-device application does not discriminate between older persons with and without a fall history.

BACKGROUND: Clinical functional assessments of balance often lack specificity and sensitivity in discriminating and predicting falls among community-dwelling older adults. AIMS: We determined the feasibility of using a smart-device application measuring balance to discriminate fall status among older adults. We also evaluated differences between smart-device balance measurements when secured with or without a harness. METHODS: A cross-sectional study design to determine the ability of the Sway Balance smart-device application (SWAY) to discriminate older adults based on fall history. The Berg Balance Scale (BBS) and Activities-Specific Balance Confidence Scale (ABC) were used as comparative, clinically based assessments. Community-dwelling older adults with (n = 25) and without (n = 32) a history of fall(s) participated. Multivariate analysis of variance was used to determine differences among assessments based on fall history. Logistic regression models determined the ability of each assessment to discriminate fall history. RESULTS: Older adults with and without a history of falls were not significantly different on SWAY (P = 0.92) but were different on BBS (P = 0.01), and ABC (P < 0.001). Similarly, SWAY did not discriminate fall history (P = 0.92), while BBS and ABC both discriminated fall history (P < 0.01). Paired t tests between SWAY scores with and without a harness indicated no differences (P ≥ 0.05). CONCLUSION: Among the older adults studied, the BBS and ABC measures discriminated groups defined by fall history, while the SWAY smart-device balance application did not. Modifications to the application may improve the discriminating ability of the measure in the recognition of fall status in older adults.

Functional Lower-Body Power: A Comparison Study Between Physically Inactive, Recreationally Active, and Masters Athlete Late-Middle-Aged Adults.

Muscular power decreases with age, and lower-body power relates to overall functional fitness; however, functional lower-body power has not been evaluated in late-middle-aged (LMA) populations. PURPOSE: To evaluate average and peak lower-body functional power and velocity among sedentary (SED), recreationally active (RA), and masters athlete (MA) LMA adults. METHODS: Participants were SED (n = 13, age = 59.3 ± 4.5 years), RA (n = 35, age = 59.6 ± 5.0 years), and MA (n = 26, age = 56.7 ± 5.4 years). Five sit-to-stand trials were completed to assess lower-body functional power. Average/peak power and velocity were calculated for each trial. Power was expressed relatively to account for participant body weight. RESULTS: MA (13.44 ± 2.76 W/kg) had significantly (p < .01) greater peak power compared with SED (9.99 ± 2.70 W/ kg) and RA (9.93 ± 2.30 W/kg). Similar significant (p < .01) differences existed for peak velocity (SED = 1.02 ± 0.22 m/s, RA = 1.04 ± 0.22 m/s, MA = 1.25 ± 0.19 m/s). No differences existed for average power or velocity between groups. CONCLUSIONS: Maintaining a competitively active lifestyle results in greater lower-body functional power in LMA adults and may support longitudinal functionality.

Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes?

Falls are a leading cause of morbidity and mortality among adults aged 65 years and older (older adults) and are increasingly recognized as a chronic condition. Yet, fall-related care is infrequently provided in a chronic care context despite fall-related death rates increasing by 41% between 2012 and 2021. One of the many challenges to addressing falls is the absence of fall-focused chronic disease management programs, which improve outcomes of other chronic conditions, like diabetes. Policies, information systems, and clinical-community connections help form the backbone of chronic disease management programs, yet these elements are often missing in fall prevention. Reframing fall prevention through the Expanded Chronic Care Model (ECCM) guided by implementation science to simultaneously support the uptake of evidence-based practices could help improve the care of older adults at risk for falling. The ECCM includes seven components: (1) self-management/develop personal skills, (2) decision support, (3) delivery system design/re-orient health services, (4) information systems, (5) build healthy public policy, (6) create supportive environments, and (7) strengthen community action. Applying the ECCM to falls-related care by integrating health care delivery system changes, community resources, and public policies to support patient-centered engagement for self-management offers the potential to prevent falls more effectively among older adults.

Integrating STEADI for Falls Prevention in Outpatient Rehabilitation Clinics: An Outcomes Evaluation Using the RE-AIM Framework.

BACKGROUND AND OBJECTIVES: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to describe the implementation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Initiative (2018-2021) for screening and assessing all older adults ≥65 years for falls risk across 34 outpatient rehabilitation clinics within a large health system. RESEARCH DESIGN AND METHODS: We described the Implementation process and strategies. Using Electronic Health Records (EHRs), we identified Reach, Adoption, and Maintenance of screenings and physical assessments to identify fall risk among older adults. RESULTS: STEADI Implementation strategies included health system mandates, EHR revisions, email instructions, educational sessions and resources, clinical leads and champions, and chart audits. Reach: 76.4% (50,023) had a completed screening, and 44.1% screened at risk for falls. Adoption: Clinic-level adoption varied, with most performing screenings. Profession-level adoption was highest for physical therapists (PTs; 94.2% initiated, 80.6% completed) and lowest for speech-language pathologists (SLPs; 79.8% initiated, 55.9% completed). Reach and Adoption of functional outcomes measures (FOM): PTs completed an FOM on 59.5% of at-risk patients, occupational therapists on 11.6%, and SLPs on 7.9%. Maintenance: All measures declined 1%-10% annually between 2018 and 2021. DISCUSSION AND IMPLICATIONS: STEADI screening and FOMs were implemented systemwide in 34 outpatient rehabilitation clinics, reaching over 50,000 older adults. Screening adoption rates varied by clinic. PTs had the highest adoption rate. All adoption rates declined over time. Future research should consider an implementation science approach with input from key partners before implementation to identify barriers and develop strategies to support STEADI in outpatient rehabilitation.

Impact of Documented Fall-Risk, Self-Reported Health and Confidence to Prevent Falls on Concern About Falling Among Community-Dwelling Older Adults: Secondary Analysis of a Randomized Clinical Trial.

Purpose: Individuals identified as high fall risk are expected to have high concern about falling. However, perception and individual factors that influence concern about falling have yet to be thoroughly studied. We aimed to understand factors that influence concern about falling among older adults with increased risk for falling. Patients and Methods: This was a secondary analysis of a clinical trial among community-dwelling older adults (age ≥65 years old) at high risk for falls (n = 178). Descriptive and regression analyses were used. We analyzed the relationship between participants' baseline concern about falling - categorized into three groups: low (7-8), moderate (9-13), and high (≥14) - and factors that may impact their concern. Exploratory factors included age, sex, self-reported health status and confidence to address fall risks, fall risk scores, and physical performance measures. Results: Among these individuals, 15.2% reported low concern about falling. On average, individuals in higher concern about falling groups had higher fall risk scores (low [5.7], moderate [6.4], and high [8.0]; p < 0.001). Our regression model showed that the odds of being in a higher concern group increased by 21% for every one unit increase in fall risk score and increased by 67% for every one unit increase toward poorer health rating. Conversely, for every one unit increase in self-reported confidence, the odds of being in a higher concern group decreased by 27.5%. Conclusion: Knowledge of older adults' fall risk, health status, and concerns about falling can be used to assist in the personalization of fall prevention interventions for a more holistic approach.

Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation.

Purpose: Identify the prevalence and prevalence differences of fall risk factors by sex, clinic rurality, and race/ethnicity among older adults (≥65 years old) receiving outpatient rehabilitation. Patients and Methods: Our secondary analysis used Electronic Health Record data of 108,751 older adults attending outpatient rehabilitation (2018-2022) within a large health system across 7 states and completed the Stay Independent Questionnaire. The mean age was 73.3 (±6.36), 58.1% were female, 84.3% were non-Hispanic White, and 88.8% attended an urban clinic. Fall risks were identified via the Centers for Disease Control and Prevention's Stay Independent Questionnaire. Results: Older adults had a high prevalence of fall risks (44.3%), including history of falls (34.9%). The most prevalent fall-risk factors were impaired strength, gait, and balance. Compared to males, females had a higher prevalence of reporting a fall (4.3%), a fall with injury (9.9%), worrying about falling 9.1%), rushing to the toilet (8.5%), trouble stepping onto a curb (8.4%), taking medicine for sleep or mood (6.0%), feeling sad or depressed (5.3%), and feeling unsteady (4.6%). Males reported a higher prevalence of losing feeling in feet (9.4%), ≥1 fall in the past year (8.1%), and using hands to stand up (4.4%). Compared to White older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%), Hispanics had the highest prevalence of falls with injury (56.1%), and Hispanics and Blacks had a higher prevalence of reporting 11/12 Stay Independent Questionnaire risk factors. Conclusion: Older adults receiving outpatient rehabilitation have a high prevalence of fall risks, including falls and difficulties with strength, balance, or gait. Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire -related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks.

External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events.

Background: While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions. Methods: This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members (n = 17). Results: All participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators. Conclusions: Achieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants.

American Geriatrics Society response to the World Falls Guidelines.

Falls are a major cause of preventable death, injury, and reduced independence in adults aged 65 years and older. The American Geriatrics Society and British Geriatrics Society (AGS/BGS) published a guideline in 2001, revised in 2011, addressing common risk factors for falls and providing recommendations to reduce fall risk in community-dwelling older adults. In 2022, the World Falls Guidelines (WFG) Task Force created updated, globally oriented fall prevention risk stratification, assessment, management, and interventions for older adults. Our objective was to briefly summarize the new WFG, compare them to the AGS/BGS guideline, and offer suggestions for implementation in the United States. We reviewed 11 of the 12 WFG topics related to community-dwelling older adults and agree with several additions to the prior AGS/BGS guideline, including assessment and intervention for hearing impairment and concern for falling, assessment and individualized exercises for older adults with cognitive impairment, and performing a standardized assessment such as STOPPFall before prescribing a medication that could potentially increase fall risk. Notable areas of difference include: (1) AGS continues to recommend screening all patients aged 65+ annually for falls, rather than just those with a history of falls or through opportunistic case finding; (2) AGS recommends continued use of the Timed Up and Go as a gait assessment, rather than relying on gait speed; and (3) AGS recommends clinical judgment on whether or not to check an ECG for those at risk for falling. Our review and translation of the WFG for a US audience offers guidance for healthcare and other providers and teams to reduce fall risk in older adults.

Exploring the implementation potential of physical activity assessment and prescription tools in physical therapy practice: a mixed-method study.

BACKGROUND: Despite the benefits of physical activity (PA), especially related to aging, physical therapists do not perform regular PA prescriptions secondary to various barriers, including lack of tools. Therefore, we developed the Inventory of Physical Activity Barriers (IPAB). OBJECTIVE: Explore potential solutions that could address the current lack of PA prescription among United States-based physical therapists treating patients 50 years and older. METHOD: A convergent parallel mixed-method design consisting of focus groups and self-report questionnaires. Descriptive statistics were used for all quantitative variables. Focus groups were thematically coded. RESULTS: The 26 participants had 8.6 years (SD = 6.4) of clinical experience, 88.4% (n = 23) reported they regularly have PA conversations with patients, 65.4% (n = 17) regularly assess PA levels, and 19.2% (n = 5) regularly provide PA prescriptions. We identified three themes: 1) opportunities and challenges related to PA prescriptions; 2) lack of standardization in PA assessments and interventions; and 3) implementation potential for innovative solutions that address the current informal PA assessments and interventions. CONCLUSION: Physical therapists are amenable to incorporating innovative solutions that support physical activity prescription behavior. Therefore, we recommend the continued development and implementation of PA assessment and prescription tools.

Developing and Testing Implementation Strategies to support the Centers for Disease Control and Prevention's Initiative for Falls Risk Management in Outpatient Physical Therapy: A Protocol.

Objectives: To develop and test implementation strategies to support implementing the Centers for Disease Control and Preventions' Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative for falls prevention and falls risk management in a novel setting, outpatient physical therapy. Design: A feasibility implementation study engaging key partners involved in or affected by the implementation throughout the study. Setting: Five outpatient physical therapy clinics embedded in a health system. Participants: Key partners (physical therapists, physical therapist assistants, referring physicians, administrative clinic staff, older adults, and caregivers) involved in or affected by the implementation (N=48) will participate in surveys and interviews to identify barriers and facilitators prior to implementation and post implementation. Twelve key partners representing at least 1 of each group will participate in evidence-based quality improvement panels to identify which barriers and facilitators are most important and feasible to address and to assist in choosing and designing implementation strategies to support the uptake of STEADI in outpatient rehabilitation. STEADI will be implemented in 5 outpatient physical therapy clinics as a standard of care for the ∼1200 older adults attending those clinics annually. Outcomes: Primary outcomes include clinic- and provider-level (physical therapists and physical therapist assistant) adoption and fidelity to STEADI screening, multifactorial assessment, and falls risk interventions for older adults (65 years or older) attending outpatient physical therapy. Key partners' perceived feasibility, acceptability, and appropriateness of STEADI in outpatient physical therapy will also be measured using validated implementation science questionnaires. Exploratory clinical outcomes of older adults' falls risk pre- and post rehabilitation will be investigated.

Views of in-person and virtual group exercise before and during the pandemic in people with Parkinson disease.

INTRODUCTION: Due to coronavirus disease 2019 (COVID-19), many health/wellness programs transitioned from in-person to virtual. This mixed-methods study aims to explore the perceptions of older adults with Parkinson disease (PD) regarding in-person versus virtual-based Parkinson-specific exercise classes (PDEx). OBJECTIVE: Explore experiences, perceptions, and perceived effect of participating in and transitioning from in-person to virtual PDEx in people with Parkinson disease (PwPD). DESIGN: Cross-sectional mixed-methods design using an online survey and focus groups. SETTING: PwPD who participated in an in-person and virtual PDEx (n = 26) were recruited to participate and completed online surveys and focus groups from their home during the COVID-19 pandemic. PARTICIPANTS: PwPD who participated in an in-person and virtual PDEx and agreed to participate completed an online survey (n = 16; male = 8; mean age = 74 years) and focus groups (n = 9; male = 4; mean age = 75 years). INTERVENTIONS: N/A MAIN OUTCOME MEASURES: Participants completed survey questions and participated in focus groups regarding their perceptions, attitudes, and perceived changes in PD-related symptoms since participating in the PDEx, as well as barriers and facilitators to participating in virtual PDEx. RESULTS: Participants felt PDEx was somewhat to very safe and beneficial. In the computer, comfort, and perceptions survey, participants reported perceived improved mobility (63%), balance (75%), and overall health (63%) since participating the PDEx, whereas some participants reported improved mental health (38%). Participants reported minimal difficulty with accessing virtual PDEx. Most participants stated that they would prefer to participate in a combination of in-person and virtual programming. Focus-group participants emphasized that virtual PDEx provided social and emotional support and improved confidence to perform and maintain an exercise regimen. CONCLUSION: PwPD who transitioned from an in-person to a virtual PDEx felt the program was safe, effective, and improved or prevented declines in their mobility and balance. PwPD who transitioned to a virtual PDEx also reported benefits in non-motor symptoms such as social isolation.

Quantifying care delivery team influences on the hospitalization outcomes of patients with multimorbidity: Implications for clinical informatics.

The primary objective was to quantify the influences of care delivery teams on the outcomes of patients with multimorbidity. Electronic medical record data on 68,883 patient care encounters (i.e., 54,664 patients) were extracted from the Arkansas Clinical Data Repository. Social network analysis assessed the minimum care team size associated with improved care outcomes (i.e., hospitalizations, days between hospitalizations, and cost) of patients with multimorbidity. Binomial logistic regression further assessed the influence of the presence of seven specific clinical roles. When compared to patients without multimorbidity, patients with multimorbidity had a higher mean age (i.e., 47.49 v. 40.61), a higher mean dollar amount of cost per encounter (i.e., $3,068 v. $2,449), a higher number of hospitalizations (i.e., 25 v. 4), and a higher number of clinicians engaged in their care (i.e., 139,391 v. 7,514). Greater network density in care teams (i.e., any combination of two or more Physicians, Residents, Nurse Practitioners, Registered Nurses, or Care Managers) was associated with a 46-98% decreased odds of having a high number of hospitalizations. Greater network density (i.e., any combination of two or more Residents or Registered Nurses) was associated with 11-13% increased odds of having a high cost encounter. Greater network density was not significantly associated with having a high number of days between hospitalizations. Analyzing the social networks of care teams may fuel computational tools that better monitor and visualize real-time hospitalization risk and care cost that are germane to care delivery.