This article analyzes cross-sectional data collected from 1,585 employed caregivers of parents and parents-in-law. Hierarchical regression models were used to examine the additive and multiplicative effects of relationship status (parent or parent-in-law) and gender on caregiving activities, resources, and costs. Findings indicate that both the caregiver's gender and the elder's gender are associated with care provided to and from parents and parents-in-law. Results also show that daughters-in-law are especially vulnerable because they receive few resources from elders. Practice implications and directions for future research are discussed.
Background and ObjectivesFalls are the leading cause of injury-related deaths in older adults. Objectives include describing implementation of the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help primary care providers (PCPs) identify and manage fall risk, and comparing a 12-item and a 3-item fall screening questionnaire.Design and MethodsWe systematically incorporated STEADI into routine patient care via team training, electronic health record tools, and tailored clinic workflow. A retrospective chart review of patients aged 65 and older who received STEADI measured fall screening rates, provider compliance with STEADI (high-risk patients), results from the 12-item questionnaire (Stay Independent), and comparison with a 3-item subset of this questionnaire (three key questions).ResultsEighteen of 24 providers (75%) participated, screening 773 (64%) patients over 6 months; 170 (22%) were high-risk. Of these, 109 (64%) received STEADI interventions (gait, vision, and feet assessment, orthostatic blood pressure measurement, vitamin D, and medication review). Providers intervened on 85% with gait impairment, 97% with orthostatic hypotension, 82% with vision impairment, 90% taking inadequate vitamin D, 75% with foot issues, and 22% on high-risk medications. Using three key questions compared to the full Stay Independent questionnaire decreased screening burden, but increased the number of high-risk patients.Discussion and ImplicationsWe successfully implemented STEADI, screening two-thirds of eligible patients. Most high-risk patients received recommended assessments and interventions, except medication reduction. Falls remain a substantial public health challenge. Systematic implementation of STEADI could help clinical teams reduce older patient fall risks.
Many women quit smoking during pregnancy but postnatal relapse rates are high, averaging 50-80% in the first year after delivery.1 2 Previous work suggests that provider based relapse intervention in the context of well-baby visits may lead to a decrease in postnatal relapse rates.3 However, prior research also suggests that the majority of postnatal providers do not take a systematic approach to obtaining a smoking history from all new mothers, and thus may miss opportunities for cessation and relapse counselling. In the present study we examined whether: (1) a relapse prevention intervention, implemented during the hospital stay during the period soon after delivery and at well-baby visits, would reduce the rate of relapse to smoking six months postpartum; (2) the time of delivery was an opportune moment to obtain a smoking history; (3) the history could be transmitted quickly to the infant's pediatric provider; and (4) transmission would lead to increased rates of relapse advice. MethodsAll women delivering babies at six participating Portland, Oregon, metropolitan area hospitals received an in-hospital screening and were deemed eligible for the study if they reported smoking during the 30 days before the pregnancy and quitting during pregnancy, and were willing to speak with a Visiting Nurse Association (VNA) nurse about having quit smoking. Women were not eligible to be screened if there was a maternal or child illness that would prevent them from attending the paediatric well-baby visits; if the baby was being adopted; or if the woman did not speak English.When an eligible woman agreed to participate in the study, the delivery nurse or the birth certificate clerk contacted the VNA. A VNA nurse informed the woman about the study, obtained informed consent, collected a saliva sample for cotinine verification of non-smoking status, and conducted the baseline assessment interview, preferably while the participant was still in the hospital. However, because of short postpartum hospital stays, just over half of the participants were interviewed in the hospital. The average time to interview for those interviewed in the hospital was 1.5 days postpartum (range 0-8 days), while the interview took place an average of 8.9 days postpartum (range 2-28 days) for those seen after discharge.The baseline interview took approximately 20-30 minutes. Upon completion of the interview, the participant was randomised into either a control or relapse prevention intervention group. Controls received no intervention from the VNA nurse, and standard care from their paediatric provider. Women in the intervention group received a 15-30 minute relapse prevention intervention from the VNA nurse which included counselling about reasons for maintaining cessation and help in developing a plan for doing so. At the two week, and two and four month well-baby visits with the paediatric provider they received reinforcement if they had done so and if not, given encouragement and a plan to try to quit again.After the VNA intervention, the princip...
A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.
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