Threading the Needle: When a Cranial Burr Hole Is Palliative Therapy.

Subdural hematoma (SDH) impacts up to 58.1 per 100,000 individuals aged ≥65 years. Some patients or proxies elect to focus exclusively on comfort care treatments, whereas others may consider surgical procedures such as a craniotomy or cranial trephination (burr hole) to relieve intracranial pressure.

Planning for Older Adult Day Programs in an Arab American Community: Perceptions From Older Adults, Caregivers, and Professional Providers.

This study explored Arab American stakeholders' perceptions about potential future adult day programming to inform geriatric service providers about relevant services for culturally diverse older adults. Participants ( = 28) in five focus groups were recruited through a social service provider in Metropolitan Detroit, Michigan. Results were analyzed using thematic analysis.

Informal Support, Health, and Burden Among Parents of Adult Children With Autism.

Background And Objectives: Many adults with autism spectrum disorders require lifelong reliance on caregiver support. As these caregivers age and experience health challenges, social support can be critical. This study seeks to understand if caregiver health moderates the relationship between informal social support and caregiver burden.

Self-Care Among Older Adults With Heart Failure.

It is estimated that 5.7 million Americans are living with heart failure (HF) today. Despite the fact that HF is one of the most common reasons people aged 65 years and older are admitted into the hospital, few studies describe the self-care in this older adult population.

Results of a Hospital-Based Palliative Care Intervention for Patients With an Acute Exacerbation of Chronic Heart Failure.

Background: Palliative interventions are an important part of advanced heart failure (HF) care. However, these interventions are historically underutilized, particularly by African Americans.

Methods And Results: We performed a prospective randomized intervention trial in patients with advanced HF who were hospitalized for acute decompensation at 3 urban hospitals, comparing the effect of palliative care consultation (PCC) with that of usual care.

Addressing Heart Failure Challenges through Illness-Informed Social Work.

This article describes the role of social workers in addressing the needs of people with heart failure. Although previous studies have explored the role of social workers in health care settings, few studies have addressed the challenges of specific chronic diseases such as heart failure. To address this gap in the literature, this study used qualitative interviews with health care social workers (n = 8) to obtain in-depth information about activities and challenges related to heart failure care.

Cost analysis of a novel interdisciplinary model for advanced illness management.

Purpose: This research project evaluated cost outcomes for patients in the @HOMe Support program, a novel interdisciplinary home-based program for patients and caregivers facing advanced illness drawing on the Chronic Care Model.

Methods: Cost analysis involved paired sample t-tests to examine pre-post differences in health care expenditures obtained from Health Maintenance Organization (HMO) claims data for program participants.

Results: Average 6-month costs per month significantly declined for patients older than 65 years of age from 1 HMO (US$9300-US$5900, P = .

Go to the hospital or stay at home? A qualitative study of expected hospital decision making among older African Americans with advanced heart failure.

To address the need for more information concerning hospital decision making, we conducted in-depth interviews among African Americans with heart failure and their family caregivers (n = 11 dyads). Using a case scenario, we asked participants about their anticipated hospitalization decisions. Most patients indicated that they would seek care to avoid further deterioration or death from their worsening condition.

Enhancing aging services through evidence-based health promotion: a training for service providers.

During the next several decades, increasing numbers of older Americans will suffer chronic illnesses and many will face challenges due to growing racial and economic health disparities. Agencies serving older adults need to respond by creating and promoting evidence-based health promotion (EBHP) practices to address the growing diversity among older adults in urban areas. One such agency, the Detroit Area Agency on Aging recently partnered with the Wayne State University School of Social Work to conduct an EBHP educational program for service providers.

Life disruption, life continuation: contrasting themes in the lives of African-American elders with advanced heart failure.

This study addresses the need for more information about how urban African-American elders experience advanced heart failure. Participants included 35 African Americans aged 60 and over with advanced heart failure, identified through records from a community hospital in Detroit, Michigan. Four focus groups (n = 13) and 22 individual interviews were conducted.

Fidelity of implementation: development and testing of a measure.

Background: Along with the increasing prevalence of chronic illness has been an increase in interventions, such as nurse case management programs, to improve outcomes for patients with chronic illness. Evidence supports the effectiveness of such interventions in reducing patient morbidity, mortality, and resource utilization, but other studies have produced equivocal results. Often, little is known about how implementation of an intervention actually occurs in clinical practice.

The lived experience of heart failure at the end of life: a systematic literature review.

The growing number of older adults with heart failure (HF) suggests the need for more information about how people with this condition experience their illness and strategies for coping with this condition. To address this need, the authors conducted a systematic review of the literature and an in-depth, thematic analysis of qualitative first-person accounts on the lived experience of HF. Results suggest that people with HF face many challenges, including those associated with the formal health care system, life disruption, social isolation, symptoms, and uncertainty about prognosis and symptoms.

Community-based tele-health systems for persons with diabetes: development of an outcomes model.

The purpose of this study was to obtain information on the perceptions of persons with diabetes regarding participation in a tele-health program. We conducted three focus groups among diabetics who had used a monitoring and messaging device (MMD), a commonly used tele-health care system. Analysis involved open and axial coding to identify major themes and relationships.

Diagnostic classifications and resource utilization of decedents served by the Department of Veterans Affairs.

Background: Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA).

Methods: A retrospective computerized record review was conducted of 20,933 VHA patients who died as inpatients between October 1, 2001 and September 30, 2002. Diagnoses were aggregated into one of five classification patterns of death and analyzed in terms of health care resource utilization (mean number of inpatient days and cumulative outpatient visits in the year preceding the patient's death).

The use of telehealth for diabetes management: a qualitative study of telehealth provider perceptions.

Background: Monitoring and Messaging Devices (MMDs) are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use.

Methods: We conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States.