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Background: Because early recognition of symptoms and timely treatment of stroke can reduce mortality and the long-term effects of such events, efforts to make many people both aware of these symptoms and knowledgeable about what to do when recognising them are critical for reducing impacts from stroke. Objectives: To assess the impact of a stroke preparedness film (intervention) and stroke preparedness pamphlets (usual care) on self-efficacy for stroke recognition and action. Design: Two-arm cluster randomised trial conducted between July 2013 and August 2018. Setting: A total of 13 church sites located in economically disadvantaged urban neighbourhoods in New York. Of the 883 churchgoers approached, 503 expressed interest, 375 completed eligibility screening and 312 were randomised. Participant inclusion criteria were Black or Hispanic churchgoers, aged 34 years or older, without stroke history, but at a high risk for stroke. The intervention consisted of two 12-minute stroke films: Gospel of Stroke, in English for Black participants, and Derrame Cerebral, in Spanish for Hispanic participants. Method: Participants were pre–post-tested (at baseline, 6-month follow-up and 12-month follow-up) for self-efficacy. Descriptive analysis, a linear mixed model and t tests were used to assess the effects of a stroke preparedness film and stroke preparedness pamphlets on self-efficacy. Results: Findings are based on intention-to-treat analysis. A total of 310 participants completed the study (99% retention rate). About half (53.8%) of participants were Black and 46.2% Hispanic in the intervention group; 48.3% were Black and 51.7% were Hispanic in the usual care group. Overall, both groups evidenced higher self-efficacy (i.e. lower predicted means) over time ( p < .0001), although a significant benefit was not observed for the intervention relative to usual care. Conclusion: Both stroke preparedness films and stroke preparedness pamphlets improved self-efficacy with respect to stroke recognition and action among minority churchgoers.

Although family satisfaction is recognized as a critical indicator of quality care for persons with serious illness, Spanish-language measures are limited. The study aims were to develop a Spanish translation of the short-form Family Satisfaction With End-of-Life Care (FAMCARE), investigate its psychometric properties in Hispanic caregivers to patients with Alzheimer’s disease and related dementias (ADRD; N = 317; 209 interviewed in Spanish), and add parameters to an existing item bank. Based on factor analyses, the measure was found to be essentially unidimensional. Reliabilities from a graded item response theory model were high; the average estimate was 0.93 for the total and Spanish-language subsample. Discrimination parameters were high, and the model fit adequate. This is the first study to examine the performance of the short-form FAMCARE measure among Hispanics and caregivers to patients with ADRD. The short-form measure can be recommended for Hispanics and caregivers to patients with ADRD.

Background: Although home hospice organizations provide essential care for and support to terminally ill patients, many day-to-day caregiving responsibilities fall to informal (ie, unpaid) caregivers. Studies have shown that caregivers value receiving clear information about end-of-life (EoL) care. Meeting the information needs of this group is critical in improving their experience in hospice. Objectives: To identify the information needs of informal home hospice caregivers. Design: One hundred five semi-structured phone interviews with informal caregivers were conducted. Study data were analyzed using a standard qualitative method (ie, content analysis). Participants: Informal home hospice caregivers whose loved ones have been discharged (death or live discharge) from an urban, nonprofit hospice organization. Measured: Participants’ information needs were ascertained by assessing whether information regarding hospice was or was not fully explained or whether there was information they wished they knew prior to the hospice transition. Results: Among study participants, 48.6% had unmet information needs related to (1) general information about hospice (n = 17, 16.2%), (2) what to expect at the EoL (n = 19, 18.1%), and (3) support provided by hospice (n = 30, 28.6%). Specifically, caregivers expressed the need for more information on what hospice is, caring for a dying patient, and the day-to-day care hospice provides. Conclusion: Our study indicates that approximately half of the informal caregivers had unmet information needs. Further research is needed to identify efficacious strategies to best meet the information needs of this group. Specific topics that need emphasis include what hospice care is, what to expect at the EoL, and what level of support hospice offers.

A synthesis of the last decade of literature on elder abuse in residential long-term care (i.e., Nursing Homes and Assisted Living) is discussed. Presented are definitions of abuse, theoretical and conceptual models, prevalence rates of abuse, outcomes and costs, and sources of abuse. The synthesis represents an update to the literature in the influential 2003 National Research Council report. We identify many of the same issues and concerns exist that were surfaced in this prior report. Many theoretical and conceptual models need further elaboration. Conflicting definitions of abuse are pervasive. Rates of abuse are generally inaccurate, and probably under-reported. However, we also identify progress in many areas. An increase in empirical studies that exist in this area (although very few in Assisted Living). Other forms and types of abuse have also been identified as important, such as resident-to-resident abuse. These areas are discussed, along with potential suggestions for additional research.

Objective: To examine the effects of electronic health information technology (HIT) on nursing home residents. Methods: The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. Results: No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents’ subjective assessment of the HIT intervention were generally positive. Discussion: The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on resident behavior.

This project assessed the extent to which modern technology (Vigil) can augment or substitute for direct staff intervention in nonacute late-evening and nighttime situations in a nursing home setting. Vigil was implemented for dementia residents of a special care unit (SCU) in a large nursing home. An SCU matched in terms of unit-wide case mix and cognition was used for comparison. Results showed that there was no significant reduction in falls and injuries, but there was a significant improvement in affective disorder in the intervention group as contrasted with the comparison group. There was no significant increase in staff-perceived burden, despite the significant increase in the amount of direct care time logged. Additional time spent in staff care was significantly related to decreased affective disorder. The findings related to Vigil are generally mixed. The question remains as to whether the improvement in affect was due to Vigil or vigilance.

Recent advances in health information technologies promise to significantly improve the quality of care and quality of life for individuals who are chronically ill. However, significant challenges exist in targeting Digital Divide populations who are likely to be older, less educated, and novice computer users. This article presents a framework for understanding and reducing barriers for older adults to effectively use health information systems designed for disease management. The research is illustrated in the context of the IDEATel project, a large-scale telemedicine diabetes management and education program. The framework has three interdependent foci: hardware and software systems, tasks supported by the system, and user profiles. These foci are addressed in the context of usability and training studies. The studies document the challenges faced in facilitating patients’ access to Web resources supporting disease management. The article discusses system design changes that are intended to increase participants’ productive use of system resources.

An item with differential item functioning (DIF) displays different statistical properties, conditional on a matching variable. The presence of DIF in measures can invalidate the conclusions of medical outcome studies. Numerous approaches have been developed to examine DIF in many areas, including education and health-related quality of life. There is little consensus in the research community regarding selection of one best method, and most methods require large sample sizes. This article describes some approaches to examine DIF with small samples (e.g., less than 200).

This study examined the outcomes associated with an intervention for residents of two nursing homes who had low vision and cognitive impairments that included diagnosis, optical correction, ensuring that the participants wore their eyeglasses, and staff training in recognizing vision problems. It found that a significantly decreased decline in function was associated with the provision of both eyeglasses and Croakies to the residents and staff training to recognize vision problems and provide reinforcement techniques, rather than only the provision of eyeglasses and Croakies.

Item response theory was used to examine the psychometric properties of a cognitive screening measure used in several epidemiological surveys among Latino, African American, and White non-Latino elderly. Estimates of precision (reliability) examined across several values of Θ (the estimate of degree of cognitive impairment) were good (.70s to .90s) in the range representing most respondents. Overall reliability, although adequate, was lower among the White non-Latino and high-education subgroups relative to other racial/ethnic and education subgroups. Differential item functioning (DIF) was examined using several area- and model-based tests. Tests of the magnitude of DIF showed the measure to be relatively free of DIF for the racial/ethnic subgroup and education subgroups examined. However, one item related to remembering the telephone number was more difficult for Latinos than for other racial/ethnic subgroups. Several other items evidenced mild DIF, and one (difficulty remembering words or names) was a poorly discriminating item. The subjective memory items, intended to provide additional information at the earlier, “borderzone” stages of cognitive impairment, did provide more information at the mild to moderate levels of impairment, although maximum information was not provided at these borderzone ranges.

We studied the perceptions of primary care providers (PCPs) about the telemedicine intervention in a trial of telemedicine for management of diabetes in medically under-served areas of New York State. A survey was mailed to 206 rural and 159 urban PCPs. The response rates were 25% and 22%, respectively. Eighty percent of respondents believed that a diabetes telemedicine case management system would help their practice. An overall satisfaction score (possible range 0–80) suggested good acceptability (mean 66, SD 12). In multiple linear regression, the rural location and younger age of the PCPs were independent predictors of higher satisfaction (both P < 0.01). Within-PCP comparisons showed a higher perceived impact on patients, as compared to impact on PCP practices ( P < 0.001). However, the findings should be interpreted with caution due to the low response rates.

Some problems in the measurement of latent variables in structural equations causal models are presented, with examples from recent empirical studies. Latent variables that are theoretically the source of correlation among the empirical indica tors are differentiated from unmeasured variables that are related to the empirical indicators for other reasons. It is pointed out that these should also be represented by different analytical models, and that much published research has treated this distinction as if it had no analytic consequences. The connection between this theoretical distinction and disattenuation effects in latent variable models is shown, and problems with these estimates are discussed. Finally, recommendations are made for decisions about whether and how to measure latent variables when manifest variables are potentially available.

This paper addresses itself to issues related to data collection in survey research with a community population. Areas discussed relate to practical human problems in conducting a community survey of a stratified random sample of people sixty-five years of age and over in New York City. Some of these problems occur in most large scale community surveys, but some are a result of special features of this particular study. Topics covered include difficulties encountered in obtaining interviews, maintaining the staff, and coordinating the research team in the ongoing U.S.-U.K. Cross-National Project.

The authors address some of the methodological problems found in earlier investigations of the relationship between social networks and mortality. Of particular concern was the rise of rudimentary measures of social interaction in previous work. The authors interviewed 161 residents of 21 single-room occupancy hotels in a midtown sector of Manhattan. The mean age was 73. Using the Comprehensive Assessment and Referral Evaluation the authors determined physical and mental health and social functioning. THe variables used in the analysis were 1) needs 2) physical health symptoms 3) psychological symtoms 4) demographic variables and 5) medical compliance scale. The authors used the Network Analysis Profile (NAP) to obtain measures of social interaction. The NAP comprised 6 fields of interaction: 1) self-hotel 2) self-outside nonkin 3) self-kin 4) self-hotel staff 5) self-agency staff and 6) self-institution. The authors identified 4 dimensions of social interaction to examine social networks: 1) material and emotional exchanges 2) morphological features of the overall network 3) characteristics of the network members vis-a-vis the respondent and 4) those features of the environment which influence network formations and compositions. 28 of the original 161 hotel residents had died by the 3-year follow-up. The authors compared the mean values of all variables except the medical compliance scale for survivors and non-survivors. Age and sex were the strongest discriminators. Need fulfillment psychological symptoms and physical symptoms were not important discriminators of mortality. On the other hand 10 of 19 network variables were relatively strong discriminators. Those who had died had fewer exchanges between contacts fewer sustenance relationships fewer overall contacts and fewer important ties than those who had lived; they also had fewer network clusters fewer large cluster formations fewer dependent ties linkages that were known for shorter time and resided in hotels with disproportionately more elderly and more persons on public assistance. The authors found that in this population social networks did not play an important role in facilitating medical treatment. Perhaps there is a vitality factor which leads to social behavior and longevity.

In this study, utilizing 19 social network variables and 3 outcome measures (need fulfillment, psychological symptoms, and physical symptoms), we follow 133 elderly residents of mid-Manhatten hotels for one year. The findings indicate that social networks exert a direct effect on reducing subsequent symptoms and enhancing ability to meet needs. Moreover, social networks trigger a buffering response to stressors in that their ability to reduce symptoms and to promote need fulfillment was greatest among high-stress individuals.