Browsing by Author "Floyd, Alex"

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    An Analysis of Palliative Care Provider Nursing Home Consultations for Patients with Cognitive Impairment
    (Oxford University Press, 2024-12-31) Nesvet, Matthew; Floyd, Alex; Cagle, John; Elftmann, Hanley; Unroe, Kathlee; Medicine, School of Medicine
    Nursing homes (NH) are important sites of care for people with serious illnesses in need of end-of-life care. Extant studies have shown NH residents with dementia struggle to receive high quality care. There is some evidence that palliative care (PC) interventions may improve quality of life (QOL) and care. There is little prior description of PC consults conducted in the nursing home setting. We examined notes PC providers wrote after initial consults with 197 residents of 8 nursing homes enrolled in UPLIFT, an NIH-funded clinical trial evaluating implementation of a PC model of care. Residents enrolled in UPLIFT who screened positive for PC needs were referred for consultations. We analyzed initial consult notes to learn about the residents referred and content of the consultative visits, including recommendations made. Mean age of the residents was 75 years. 70% were White, 19% Black/African American, and 52% female. Goals of care were discussed in 83% of the PC consults, the most commonly observed intervention. The most frequent types of recommendations by PC providers were: 1) medication-related (n=207); 2) referrals to other clinical services (n=103); 3) non-pharmacologic symptom relief (n=53); and 4) specific recommendations for NH staff-based activities (n=40). In total, PC providers averaged three recommendations when at least one family member, friend, or guardian was present during the clinical encounter in person (n=127) or by phone (n=38), and two when only the resident participated in the encounter (n=33).
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    Family Involvement and Symptom Burden in Nursing Home Residents with Cognitive Impairment
    (Oxford University Press, 2024-12-31) Tucker, Gretchen; Cagle, John; Stump, Timothy; Tu, Wanzhu; Zhang, Peiyuan; Floyd, Alex; Ersek, Mary; Unroe, Kathleen; Medicine, School of Medicine
    Research suggests that family involvement improves the quality of life of nursing home residents. Using baseline data from an on-going multisite clinical trial (UPLIFT-AD), we examined the association between family involvement and staff-reported accounts of resident symptom burden. Symptom burden was measured as a composite of frequency and intensity of symptoms, using items from the End-of-Life Dementia (EOLD) scale. Higher scores indicate greater burden. Family involvement was measured by the family-reported average weekly in-person visit frequency over the past month (range 0-7 days). Data on 198 residents were collected, 61.9% of whom were in Indiana, with the remainder (38.1%) in Maryland. Of the 198 residents, 60.3% were female. The Brief Interview for Mental Status score, which indicates cognitive impairment level, was 6.5 (SD=3.9). Most family members were an adult child (58.7%), 7.9% were spouses, and 38.8% were “other.” On average, spouses visited 5 days a week, children 2 days a week, and other family members 1.5 days a week. In 53.5% of cases, the reporting staff member knew the resident for >1 year. Linear regression analysis was used to examine the associations between the frequency of in-person family visits and EOLD scores while adjusting for resident demographics, mental status, family relationship to the resident, and facility location. Visit frequency was associated with higher EOLD scores (B=0.18, p=.037). Findings suggest family involvement may sensitize nursing home staff to the presence of a resident’s burdensome symptoms, which may become more discernible to families with increased involvement.
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    Symptom Burden and Quality of Life for Nursing Home Residents with Dementia: Uplift Trial Early Data
    (Oxford University Press, 2022-12-20) Cagle, John; Orth, Jessica; Becker, Todd; Zhang, Peiyuan; Ersek, Mary; Tu, Wanzhu; Floyd, Alex; Unroe, Kathleen; Biostatistics, School of Public Health
    Communication difficulties in nursing home (NH) residents with dementia make valid assessment of symptoms and quality-of-life (QOL) challenging. Thus, researchers and clinicians frequently rely on proxy-based measures. The End-of-life Dementia-Comfort Assessment in Dying (EOLD-CAD) and two single-item QOL measures (7-point item; 5-point item) have been used in several studies, though evaluation of their psychometric properties is limited. We used baseline data from an ongoing multi-site randomized trial (UPLIFT) to describe symptoms and QOL and examine the measures’ validity and reliability in 138 residents with moderate to severe dementia living at 16 facilities. Descriptive data and assessments of convergent validity and inter-rater reliability are provided. Based on assessments by 134 staff and 45 family, physical symptoms, physical distress, and emotional distress were reported as infrequent by staff and family; indications of well-being were more frequently observed. Median QOL was the same for staff and family observers (4=“Life is so-so” [7-point item]; 3=“Fair” [5-point item]). Inter-observer assessments of resident QOL (staff vs. family) were correlated (7-point item: r=0.47, ICC=.643; 5-point item: r=0.48, ICC=.645, p<.05 for all). Seven of 18 EOLD-CAD symptoms were significantly positively correlated. ICC values varied between high or moderately high: shortness-of-breath (ICC=.74), choking (ICC=.65), gurgling (ICC=.81), agitation (ICC=.51), fear (ICC=.46), crying (ICC=.65), peace (ICC=.57), and care resistance (ICC=.68) (p<.05 for all). Choking and gurgling were the most prominently reported symptoms by both groups.Early findings provide a contemporary assessment of QOL and symptoms among NH residents with dementia. Measurement properties affirm general reliability and validity of study instruments.