Dear Friends,
As we enter 2023, the start of the 4th year marked by COVID, we are reminded of the remarkable and rapid changes that have occurred since 2019. We were forced to expand our use of technology for work, education, and healthcare. We have become much more aware of how disparities impact the health and well-being of some of our most vulnerable populations. The inadequate structure of our long-term care system was exposed by COVID-related deaths across nursing homes and in congregate centers for older adults. The mental health crisis grew, partly driven by social isolation and depression.
This month our newsletter focuses on healthcare in rural America, where the impact of COVID was different than in large urban areas. The lack of broadband to access the internet for work, education and healthcare impacted swaths of our rural areas. Access to healthcare became even more challenging as healthcare facilities, often far away, were stretched by patient volume and staff shortages. Social isolation and depression, already problems in rural America, became more profound. To help address some of these issues, HIGN is launching a new series available on its eLearning Center addressing health and healthcare for older adults in rural America. This work was done in partnership with University of Memphis and funded by one of their HRSA grants.
Many challenges have become more pronounced over the past 3+ years, but at HIGN, we believe that challenges provide opportunities. Through our research, advocacy and education, we will continue to further our mission of serving the most vulnerable older adults.
Warm Regards,
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Tara A. Cortes, PhD, RN, FAAN
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Health and Older Adults in Rural America
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Larry Z. Slater, PhD, RN-BC, CNE, FAAN
Associate Dean for Academic Programs Clinical Professor
Loewenberg College of Nursing
The University of Memphis
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The population of those 65 years of age and older in the United States continues to grow, with the country seeing faster growth in rural areas. In a report from the US Census Bureau on “The Older Population in Rural America” (Smith & Trevelyan, 2019), older adults comprise 17.5% of the rural population, while in urban areas it is 13.8%. In 1980, older adults only comprised 10.9% of the rural population (Smith & Trevelyan). As baby boomers started turning 65 in the last decade, it is expected that these numbers will continue to rise over the next few decades at a rate faster than what has been seen since 1980. Given the increase in older adults living in the rural US, it is imperative that the country proactively address the health and wellness of this growing population, understanding the impacts of social determinants of health that have led to rural health disparities, and supporting innovative solutions to improving rural older adult health.
In the 1980s, the rural older adult population had similar health outcomes to their urban older adult counterparts, but since then the gap in health outcomes has widened (Harrington et al., 2020). Rural adults see a 20% higher all-cause mortality rate, life expectancy more than 3 years below their urban counterparts, 11% higher rate of hypertension, 40% higher rate of diabetes, 40% higher rate of heart disease, 30% higher rate of stroke, and a 100% higher rate of chronic obstructive pulmonary disease (Harrington et al., 2020; Croft et al., 2018). They also experience higher rates of depression, suicide, and drug-related deaths (Harrington et al., 2020).
These disparities can be attributed to several risk and social determinant factors. Tobacco use is higher in rural populations, residents are less physically active, and more obese (Harrington et al., 2020). Rural residents tend to have lower incomes, a lower education level, are less insured, poorer housing options, and limited access to supermarkets and healthy food options. They also have fewer healthcare and mental health providers, critical specialty provider shortages (e.g., oncologists, cardiologists, pulmonologists), less emergency medicine and hospital options, and fewer skilled nursing facilities. This lack of access is compounded by transportation issues, often including no available public transportation options (CDC).
So how do we reverse these trends, including addressing social determinants of health, to improve the health of rural older adults? One current target area has been critical access and provider shortages. The Human Resources and Services Administration, Department of Labor, and other government entities have increased funding aimed at improving the pipeline of the healthcare and public health workforce in rural communities (addressing nursing, mental health, primary care, oral care, and others). While these funding opportunities are a start, it will be essential that these agencies review outcomes to develop proven solutions to continue to grow the rural health workforce.
In addition to addressing access and provider shortages, it is imperative that we look to develop team-based care models focused on rural populations. Such models can address not only rural delivery sites, but an increase in telehealth and digital health options that can impact health promotion, disease prevention, and chronic disease management.
Finally, a major focus also needs to be on the economic development of rural communities. Many see the federal government’s recent $1.5 trillion infrastructure bill as a start, but this will not necessarily address some of the general transportation and physical environment issues that impact the health of rural older adults. A multi-pronged approach requiring innovative solutions will be required to address the health of rural older adults over the next several decades.
We must see collaboration from the interprofessional health, mental health, and public health workforce, communities, businesses, and government, who together can build a happier, healthier future for our rural older adults.
Sources:
Croft, J. B., Wheaton, A. G., Liu, Y., Xu, F., Lu, H., Matthews, K. A., Cunningham, T. J., Wang, Y, & Holt, J. B. (2018). Urban-rural county and state differences in chronic obstructive pulmonary disease: United States, 2015. Morbidity and Mortality Weekly Report, 67(7), 205-211. doi: 10.15585/mmwr.mm6707a1
Harrington, R. A., Califf, R. M., Baslamurugan, A., Brown, N., Benjamin, R. M., Braund, W. E., Hipp, J., Konig, M. Sanchez, E., & Joynt Maddox, K. E. (2020). Call to action: Rural health: A presidential advisory from the American Heart Association and American Stroke Association. Circulation, 141(10), e615-e644. doi: 10.1161/CIR.0000000000000753
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Care of Older Adults in Rural America Series
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The Care of Older Adults in Rural America (COA-RA) Series was created through a partnership between HIGN and University of Memphis. This series examines factors that impact the well-being of rural older adults and provides strategies to decrease health disparities and improve health outcomes. Nursing CEs are available for each course.
Courses:
Click here to learn more.
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Fixing the Mental Health Crisis in Long-Term Care
HIGN Executive Director Tara Cortes penned a guest column for McKnights Long-Term Care News titled Fixing the Mental Health Crisis in Long-Term Care. In this column, Prof. Cortes highlights the urgent need to address mental health in long-term care through workforce education, partnerships between mental health specialty care networks and long-term care organizations, and federal investment.
Click here to read the column.
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New HIGN Affiliated Faculty
Prof. Kevin Hook, DNP, MSB, MA, AGPCNP-BC, ACHPN, APN is a Clinical Assistant Professor and Program Director of the Adult-Gerontology Primary Care master's program at NYU Rory Meyers College of Nursing. He is board-certified by the American Nurses Credentialing Center as an Adult-Gerontology Primary Care Nurse Practitioner.
Before joining Rory Meyers College of Nursing, Hook held numerous leadership positions in the post-acute care domain as well as spending several years as a critical care nurse before starting his graduate nurse practitioner studies. His research and practice interests are focused on the care of elders, palliative care, organizational and medical ethics, and nursing leadership and innovation. His DNP work focused on nursing leadership and self-efficacy.
In leadership positions, Hook has focused on evidence-based programming to initiate transitional care, palliative care, and policy analysis and planning using nursing leadership at all levels.
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Health and Aging Policy Fellows
Call for 2023-2024 Applications
The Health and Aging Policy Fellows Program aims to create a cadre of leaders who will serve as change agents in health and aging policy to ultimately improve the health care of older adults. The year-long fellowship offers a rich and unique training and enrichment program that is focused on current policy issues, communication skills development, and professional networking opportunities to provide Fellows with the experience and skills necessary to help affect policy.
The program has a broad interdisciplinary focus, and Fellowship cohorts have included physicians, nurses, social workers, psychologists, food scientists, city planners, healthcare administrators, epidemiologists, economists, and lawyers from academic and practice settings, spanning career stages from newly minted PhDs to senior professors and community leaders
The one-year Fellowship runs from October 1 – September 30 and has full-time and part-time tracks. It is conducted as a hybrid program of mentoring, networking, learning and practicum experiences. The submission deadline is April 17th.
Click here to learn more and apply
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HIGN Highlights
Prof. Komal was the recipient of the 2022 NIA IMPACT Collaboratory Career Development Award in November for the project "Barriers to Hospice Care Transitions for Diverse Persons Living with Dementia."
Prof. Lim wrote an essay titled On Nursing Documentation, for the American Nurses Association's American Nurse online journal.
Publications:
Brody, A.A., Dorfman, E., Caspers, C. & Sadarangani, T.R. (In Press). What’s next for Hospital at Home Programs in the United States: Clarion call for permanent, person-centered solutions. JAGS. DOI: 10.1111/jgs.18089
Hu, J., Kline, D., Tan, A., Zhao, S., Brock, G., Mion, L. C., Efird, J. T., Wang, D., Sims, M., Wu, B., Mongraw-Chaffin, M., & Joseph, J. J. (2022). Association between Social Determinants of Health and Glycemic Control among African Americans with Type 2 diabetes: The Jackson Heart Study. Annals of Behavioral Medicine. https://doi.org/10.1093/abm/kaac026
Kong, D. X., Chen, A. F., Zhang, J. W., Xiang, X. L., Lou, V., Kwok, T. & Wu, B. (2022). Public Discourse and Sentiment Toward Dementia on Chinese Social Media: Machine Learning Analysis of Weibo Posts. Journal of Medical Internet Research. https://preprints.jmir.org/preprint/39805
Moreines LT, Gettel CJ, Hajduk AM, Kukulka S, Lai JM, Ouellet JA. Emergency department clinician satisfaction with an APRN-led geriatric emergency medicine service consult team. J Am Geriatr Soc. 2022 Nov 24. doi: 10.1111/jgs.18133. Epub ahead of print. PMID: 36420709.
Pei, Y., Qi, X., Cong, Z., & Wu, B. (2022). Chinese American Caregivers’ Attitudes Toward Tube Feeding for Persons with Dementia—USA, 2021–2022. China CDC Weekly, 4(47), 1051-1054.
Shi, Y., Howe, S. H., & Wu, B. (2022). The Impact of Illness Perceptions on Post-Stroke Activity Engagement and the Moderating Role of Gender. Archives of Physical Medicine and Rehabilitation. https://doi.org/10.1016/j.apmr.2022.08.963
Squires, A., Thompson, R., Sadarangani, T., Amburg, P., Sliwinski, K., Curtis, C., Batalova, J., & Wu, B. (2022). International migration and its influence on health. Research in Nursing & Health. https://doi.org/10.1002/nur.22262
Stevens, E., Brody, A.A., Epps, F., Sloan, D., Sherman, S. (In Press). Using meta-research to foster diverse, equitable, and inclusive collaborative research networks. Journal of the American Geriatrics Society. DOI: 10.1111/jgs.18217
Tang, X. P., Sun, H., Ge, S., Han, S. Y., Li, Y. & Wu, B. (2022). Experiences and Needs of Older Adults at Different Stages of Cerebral Infarction Based on the Trajectory Theory—A Qualitative Study. Nursing Open. https://doi.org/10.1002/nop2.1398
Qi, X., Ng, T. K. S., & Wu, B. (2023). Sex Differences in the Mediating Role of Chronic Inflammation on the Association between Social Isolation and Cognitive Functioning among Older Adults in the United States. Psychoneuroendocrinology, 106023.
Qi, X., Pei, Y., Malone, K.S., Wu, B. (2023). Social Isolation, Sleep Disturbance, and Cognitive Functioning (HRS): A Longitudinal Mediation Study, The Journals of Gerontology: Series A, 2023;, glad004, https://doi.org/10.1093/gerona/glad004
Wang J., Huang, Y. H., Zhang, Y. Q., Wu, F. Q., & Wu, B. (2022). Domestic helpers as frontline workers in home-based long-term care in China: Opportunities and challenges. Journal of Aging & Social Policy. DOI: 10.1080/08959420.2022.2120323
Zhu Z, Qi X, Pei Y, Wang J, Wu B. Longitudinal relationships in the psychopathology of depressive symptoms in middle-aged and older adults in China. Aging & Mental Health.2023. Doi: 10.1080/13607863.2022.2164253.
Zheng Zhu, Xiang Qi, Yaolin Pei, Jing Wang, Bei Wu, Causal Inference in Psychopathology of Depressive Symptoms in Middle-Aged and Older Adults, Innovation in Aging, Volume 6, Issue Supplement_1, November 2022, Page 735, https://doi.org/10.1093/geroni/igac059.2678
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