Shawkat Dhanani

Veteran identity and race/ethnicity: Influences on VA outpatient care utilization

Background. “Veteran identity” is defined as veterans’ self-concept that derives from his/her military experience within a sociohistorical context. Veteran identity may vary by race/ethnicity because the sociohistorical context of the military experience varies by race. Objectives. To explore veteran identity and how it varies by race/ethnicity, and to identify aspects of veteran identity that significantly influence preferences for, and use of, VA outpatient care. Research Design. Focus groups were conducted at community sites to explore concepts related to veteran identity, race/ethnicity, military experience, and health services use. The focus groups informed the development of a telephone survey, which was administered to veterans of four racial/ethnic groups in Southern California and Southern Nevada. Subjects. One hundred seventy-eight veterans participated in the focus groups, and 3,227 veterans completed the telephone survey. Measures. Dependent variables include: (1) preference for VA health services, (2) VA-only outpatient use, (3) Any VA outpatient use, and (4) number of outpatient visits within the previous 12 months. Independent variables include veteran identity, sociodemographic, and health-related characteristics. Results. All veteran identity variables were significantly associated with race/ethnicity. Race/ethnicity, eg, being black or Hispanic, in addition to veteran identity factors, significantly influenced preferences for VA outpatient care. Veteran identity factors, however, had less influence on VA outpatient service utilization than socioeconomic factors. Conclusions. Minority veterans who highly identify with their veteran status may prefer the VA to other systems of care. Factors associated with veteran identity may be useful for incorporation into interventions to improve access to VA care.

Interferon-alpha inhibits murine macrophage transforming growth factor-beta mRNA expression

Transforming growth factor-beta (TGF-β), a multifunctional polypeptide is produced by a wide variety of cells and regulates a broad array of physiological and pathological functions. TGF-β appears to play a central role in pulmonary fibrosis and may contribute to tumor-associated immunosuppression. Alveolar macrophages are a rich source of TGF-β and are intimately involved in lung inflammation. We therefore chose to study TGF-β regulation in murine alveolar macrophages as well as an immortalized peritoneal macrophage cell line (IC-21). Murine macrophages were incubated with cytokines to evaluate their role in regulating TGF-β mRNA expression. We conclude that IFN-α downregulates TGF-β mRNA expression in murine macrophages.

Feasibility study of home telerehabilitation for physically inactive veterans

The aim of this study was to develop a system for and determine the feasibility of monitoring home exercise for physically inactive older adults using a Health Buddy (HB) text messaging device (Robert Bosch Healthcare; Palo Alto, California). Questions and messages related to exercise adherence are displayed on the HB screen and participants choose a response by pressing the corresponding button on the device. Responses are transmitted through a landline connection and high-risk responses are highlighted by the system for follow-up. We developed the questions and messages based on input from patient and clinician focus groups. We evaluated feasibility by administering the intervention to inpatient and outpatient adults aged 60 or older. We gave participants a choice of exercise monitoring by HB (n = 20) or telephone (n = 18). The results showed that home exercise monitoring by HB and telephone is safe, as evidenced by low adverse event rates. We saw a decline in exercise adherence rates to both the HB and telephone after 8 weeks, although adherence was better for HB than telephone. Taken together, the results demonstrate the feasibility of using text messaging to monitor home exercise adherence in physically inactive older adults.

A Case of Elder Abuse and Undue Influence Assessment and Treatment From a Geriatric Interdisciplinary Team

Elder abuse is a pervasive problem that can have lasting emotional and physical consequences, increasing its victims’ risk of mortality. Healthcare providers are frequently involved in the detection and intervention of elder abuse. Because of the complexity of these cases, applying treatment interventions within an interdisciplinary care team has been recommended to ensure older adults’ safety and welfare. Psychologists in particular are frequently relied upon in these situations because of their expertise in cognitive, psychiatric, and capacity assessment, as well as their ability to intervene in a variety of difficult situations. The following is a report examining the case of Mr. B, who was a victim of elder abuse involving financial exploitation and undue influence. Assessment and treatment interventions were used within the context of an interdisciplinary care team, using a bio-psychosocial approach. A decision-tree model describing the steps to take in assessing and treating financial elder abuse is proposed.

The Influence of Depression and PTSD on Exercise Adherence in Older Veterans

The purposed of this study was to evaluate the impact of depression and post-traumatic stress disorder (PTSD) on adherence to an exercise program in a cohort of older veterans. Method used was a descriptive cross-sectional analysis of data from 30 older veterans participating in a study of home exercise monitoring. Participants were screened for depression and PTSD, and their one-month and eleven-week exercise adherence rates were obtained through participants’ daily reports of exercise performance. Participants with both depression and/or PTSD had lower one-month and eleven-week exercise adherence rates compared to participants without these conditions. Veterans who screened positive for both depression and PTSD had the lowest rates of exercise adherence compared to those with only depression or those with neither PTSD nor depression. Three out of four subjects with depression-PTSD comorbidity preferred exercising alone, whereas 77% of subjects without depression-PTSD comorbidity preferred exercising with others. Depression and PTSD may influence an individuals exercise adherence, as well as the types of exercise veterans choose. These results have implications for structuring exercise programs for older veterans with depression and PTSD to maximize exercise adherence.

Emergency Preparedness for Home Based Primary Care Senior Veterans: Lessons Learned from Previous Experience

Since 1972, the Veterans Health Administration (VHA) has provided primary care to patients in the setting of their homes. Disaster preparedness for Home Based Primary Care (HBPC) patients has been a program objective as well as a requirement mandated by the VHA and accrediting organizations such as The Joint Commission. Over time, HBPC programs have served patients through a variety of natural disasters and emergencies. This chapter provides background on the VHA HBPC experience with emergency planning, brief case studies from our practices, and the lessons learned from disaster exercises and actual emergencies.