Jennifer Dickman Portz

Assessing Capacity for Providing Culturally Competent Services to LGBT Older Adults

This qualitative, interview-based study assessed the cultural competence of health and social service providers to meet the needs of LGBT older adults in an urban neighborhood in Denver, Colorado, known to have a large LGBT community. Only 4 of the agencies were categorized as “high competency”; 12 were felt to be “seeking improvement” and 8 were considered “not aware.” These results indicate significant gaps in cultural competency for the majority of service providers. Social workers are well-suited to lead efforts directed at improving service provision and care competencies for the older LGBT community.

“Merging Yoga and Occupational Therapy (MY-OT): A feasibility and pilot study”

OBJECTIVE To examine the feasibility and benefits of the Merging Yoga and Occupational Therapy (MY-OT) intervention. DESIGN This is the primary analysis of a non-controlled pretest-posttest pilot study to understand the feasibility and impact of MY-OT on balance, balance self-efficacy, and fall risk factor management in people with chronic stroke. SETTING University research laboratory. PARTICIPANTS People with chronic stroke were included in the study if they: had sustained a fall or had fear of falling, were able to stand, and hand impaired balance and were at risk for falls (≤46 on the Berg Balance Scale (BBS)). INTERVENTIONS Individuals completed an 8 week intervention that included 16 sessions of both yoga and group occupational therapy (OT). Yoga included physical postures, breathing exercises, and meditation. OT focused on post-stroke fall risk factor management. MAIN OUTCOME MEASURES The BBS was used to assess balance, the Activities-specific Balance Confidence Scale (ABC) was used to measure balance self-efficacy. Five fall risk factor management scales were used. RESULTS Overall, the intervention was considered feasible, as individuals were able to safely complete the intervention with little attrition and high attendance. Balance improved by 30% (p=0.002). Balance self-efficacy improved by 15% (p=0.034). Each of the five fall risk factor management scales improved, but only two significantly improved (Fall Prevention and Management Questionnaire, 29%, p=0.004 and Fall Prevention Strategy Survey, 42%, p=0.032). CONCLUSION The results demonstrate that MY-OT is a potential intervention to improve multiple fall related outcomes for people with stroke. Therapists may consider these interventions for people with stroke, but additional research is warranted.

Patient reported outcomes for diabetic peripheral neuropathy

OBJECTIVE Multiple patient-reported outcomes (PROs) have been used to assess symptoms among patients with Diabetic Peripheral Neuropathy (DPN). However, there is little consistent application of measures in clinical or research settings. Our goal was to identify and compare patient reported outcome measures (PROs) specifically evaluated in neuropathy populations. METHODS Literature search, summary, and qualitative comparison of PROs validated in neuropathy populations. RESULTS We identified 12 studies of PROs evaluated in neuropathy populations that included DPN patients. Two assessed sleep quality, 5 assessed painful symptoms, and 5 assessed quality of life. The number of items per measure ranged from one to 97, and the number of domains ranged from one to 18. All had adequate internal consistency (Chronbachs Alpha>0.70). There was mild to moderate standardization of domains across measures and only a few instruments used common comparators. The spectrum of DPN symptoms addressed included: sensory symptoms, autonomic symptoms, and function, beliefs, role participation, sleep quality, and perceptions of illness. CONCLUSIONS There remains a need for a gold standard for DPN symptom assessment. Few existing instruments are adequately validated and the domains assessed are inconsistent. Current instrument selection should depend on the clinical and social context of the assessment.

Self-Management and Yoga for Older Adults with Chronic Stroke: A Mixed-Methods Study of Physical Fitness and Physical Activity

ABSTRACT Objective: This study investigated changes in physical fitness and physical activity among older patients with chronic stroke (stroke ≥ 6 months previous) after participation in a yoga infused self-management intervention. Methods: A mixed-methods secondary data analysis examined quantitative measures of endurance, strength, and gait speed and qualitative perspectives of intervention participants. Results: Based on Wilcoxon analysis, physical fitness outcome measures including endurance and lower and upper body strength significantly (p < .02) improved. Based on qualitative results of 2 focus groups and 14 individual interviews, participants expressed positive changes in endurance, strength, gait speed, flexibility, and balance. They also reported improvements in walking ability and duration, and expressed a desire to continue yoga and increase levels of exercise. Conclusions: With the objective of improving physical fitness and exercise for older adults with chronic stroke, it is important for self-management interventions to provide specific safe and feasible physical activity components, such as yoga. Clinical Implications: Health professionals may improve offered chronic stroke self-management interventions by incorporating yoga.

The Development and Acceptability of a Mobile Application for Tracking Symptoms of Heart Failure Among Older Adults

PURPOSE Heart failure (HF) is common in older adults. With increases in technology use among older adults, mobile applications may provide a solution for older adults to self-manage symptoms of HF. This article discusses the development and acceptability of a HF symptom-tracking mobile application (HF app). METHODOLOGY The HF app was developed to allow patients to track their symptoms of HF. Thirty (N = 30) older adults completed an acceptability survey after using the mobile app. The survey used Likert items and open-ended feedback questions. RESULTS Overall, the acceptability feedback from users was positive with participants indicating that the HF app was both easy to use and understand. Participants identified recommendations for improvement including additional symptoms to track and the inclusion of instructions and reminders. CONCLUSION HF is common in older adults, and acceptability of mobile apps is of key importance. The HF app is an acceptable tool for older patients with HF to self-manage their symptoms, identify patterns, and changes in symptoms, and ultimately prevent HF readmission.

High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

To enhance understanding of the relationship between multimorbidity, symptom burden, and functional status in individuals with life‐limiting illness.

Perspectives of LGBTQ Older Adults on Aging in Place: A Qualitative Investigation

ABSTRACT This qualitative study conducted by a community-research partnership used multiple types of data collection to examine variables relevant for LGBTQ older adults who wished to age in place in their urban Denver neighborhood. Focus groups, interviews, and a town hall meeting were used to identify barriers and supports to aging in place. Participants (N = 73) identified primarily as lesbian or gay, aged 50–69, and lived with a partner. Ageism, heterosexism, and cisgenderism emerged as cross-cutting themes that negatively impact access to health care, housing, social support, home assistance, and legal services. Resilience from weathering a lifetime of discrimination was identified as a strength to handle aging challenges. Recommendations for establishing an aging in place model included establishing welcoming communities and resource centers and increasing cultural competence of service providers. This study provides a unique contribution to understanding the psychosocial, medical, and legal barriers for successfully aging in place.

Lessons learned from community-based participatory research: establishing a partnership to support lesbian, gay, bisexual and transgender ageing in place

Background Due to a history of oppression and lack of culturally competent services, lesbian, gay, bisexual and transgender (LGBT) seniors experience barriers to accessing social services. Tailoring an evidence-based ageing in place intervention to address the unique needs of LGBT seniors may decrease the isolation often faced by this population. Objective To describe practices used in the formation of a community-based participatory research (CBPR), partnership involving social workers, health services providers, researchers and community members who engaged to establish a LGBT ageing in place model called Seniors Using Supports To Age In Neighborhoods (SUSTAIN). Methods A case study approach was employed to describe the partnership development process by reflecting on past meeting minutes, progress reports and interviews with SUSTAINs partners. Results Key partnering practices utilized by SUSTAIN included (i) development of a shared commitment and vision; (ii) identifying partners with intersecting spheres of influence in multiple communities of identity (ageing services, LGBT, health research); (iii) attending to power dynamics (e.g. equitable sharing of funds); and (iv) building community capacity through reciprocal learning. Although the partnership dissolved after 4 years, it served as a successful catalyst to establish community programming to support ageing in place for LGBT seniors. Conclusion Multi-sector stakeholder involvement with capacity to connect communities and use frameworks that formalize equity was key to establishing a high-trust CBPR partnership. However, lack of focus on external forces impacting each partner (e.g. individual organizational strategic planning, community funding agency perspectives) ultimately led to dissolution of the SUSTAIN partnership even though implementation of community programming was realized.

Participant-perceived outcomes of merging yoga and occupational therapy: Self-management intervention for people post stroke

Introduction There is a need for development and validation of post-stroke fall-prevention programs. This qualitative study provides an inside look into participant-perceived outcomes of a new and innovative self-management intervention: Merging Yoga and Occupational Therapy. Method A qualitative approach was employed. Thirteen participants, who were more than 6 months post stroke and self-reported falling or a fear of falling, engaged in focus groups and individual interviews following participation in the intervention twice weekly for 8 weeks. Data from focus groups and individual interviews were analyzed using an iterative, inductive approach. Findings Five outcomes emerged from the line-by-line analysis: (1) improved abilities and capacities, (2) gained new knowledge, (3) enhanced engagement in activities, (4) improved relaxation, and (5) increased confidence and inspiration. Conclusion Participants experienced positive outcomes from engagement in a community-based multimodal fall-prevention self-management program for people post stroke.

Multidimensional Improvements in Health Following Hatha Yoga for Individuals with Diabetic Peripheral Neuropathy

The purpose of this study was to understand the lived experience of ten individuals with diabetic peripheral neuropathy (DPN) who completed an 8-week Hatha Yoga trial. The International Classification of Function, Disability, and Health (ICF) provided the framework for this study. Two focus groups were conducted following a twice-weekly, 60-minute yoga intervention that was designed for people with DPN. Interpretative phenomenological analysis was employed to analyze the data. Themes in the data emerged related to improvements in body functions, specifically neuromuscular and movement-based function and sensory functions, as well as stress management and sleep improvement via breathwork, and social support was an essential environmental factor. These data support the bidirectionality of the ICF and demonstrate that in individuals with DPN, yoga may affect health holistically by improving body functions, activities, participation, and environmental factors. Yoga may be a tool to improve general well-being in individuals with DPN. A larger, randomized trial should be conducted to extend the findings from the present trial.