Jeannie Kim Lee

Vietnamese Americans commonly experience a variety of chronic medical conditions. Social support can play a salient role in chronic disease management, but little is known about these dynamics among Vietnamese Americans. A mixed-methods study aimed to understand medication adherence, health literacy, and cultural beliefs among Vietnamese American patients at a Massachusetts federally qualified health center. One hundred participants completed self-report surveys and pill counts, for which frequencies and descriptive analyses were conducted. A linear regression analysis was performed between social support and medication adherence. A sub-sample of participants completed in-depth interviews, chronic disease diaries, and home observations. All qualitative data underwent thematic analysis. No statistically significant association was found between social support and medication adherence. Qualitative findings highlighted substantial social support related to chronic disease management. Participants received instrumental support from their adult children, home health aides, and community organizations. Friends were a key source of affective and confidant support. Community organizations addressed instrumental needs, while also facilitating affective and confidant support among participants and their friends. While the quantitative data concluded that participants had low satisfaction with social support and that social support had no significant impact on medication adherence, the qualitative data revealed an extensive relationship between social support and the broader scope of chronic disease management. When possible, providers should engage patients’ adult children, home health aides, and community organizations as important members of their social support networks.

Background: Falls resulting from or related to opioid use are a major concern for morbidity and mortality in the United States. The Centers for Disease Control and Prevention’s Clinical Practice Guideline for Prescribing Opioids for Pain – United States 2022 seeks to enhance the effectiveness and safety of pain treatment by improving function and quality of life for patients with pain while reducing opioid-related risks. The American College of Surgeons’ Best Practices Guidelines in Geriatric Trauma Management and the 4 M’s Framework of an Age-Friendly Health System both recommend incorporating fall prevention and safe mobility strategies into healthcare for older adults. In line with these guidelines and our review questions, this scoping review protocol aims to better understand the research on opioid prescribing practices and subsequent falls by identifying and mapping (1) the types of available evidence about opioid prescribing practices and subsequent falls and (2) the key characteristics of treatment and continuing care of falls with specific emphasis on opioid prescribing practices. Methods: Electronic database searches will be conducted in PubMed, Embase, CINAHL, and Scopus to identify evidence published in the United States from January 1, 2016, onward. This scoping review will consider primary literature, observational, quasi-experimental, and experimental, implementation, and quality improvement studies, as well as systematic reviews and meta-analyses. Eligible studies will focus on adults aged 18 years and older who have been prescribed opioids and subsequently experienced a fall. Discussion: There is a gap in our understanding about opioid prescribing and subsequent falls. This scoping review will help fill this gap by mapping the recent available evidence—aligned with clinical guidelines about (1) prescribing practices and subsequent falls and (2) key characteristics of the treatment and continuing care of falls. Systematic review registration: Open Science Framework ID: https://doi.org/10.17605/OSF.IO/JP49Y . https://osf.io/jp49y .

Introduction: Adherence to hypertension medications is low among older people, and there is limited guidance on the safety of taking a missed medication. Knowing the window of time when an older individual can safely take a missed medication could improve adherence and reduce the fear of overdosing. We developed and implemented a decision support algorithm for missed hypertension medications in a digital therapeutic system designed to facilitate self-management of hypertension medications and blood pressure among older adults.Methods: The medication formulary included hypertension medications and doses available in the United States that are safe for use by older people. The decision support algorithm was developed through a literature review of clinical and pharmacokinetic studies and knowledge of the pharmacology of aging (pharmacokinetics and pharmacodynamics). The algorithm was peer-reviewed and checked against available provider and patient instructions about missed hypertension medications. Case scenarios were used to code the algorithm into the app.Results: A total of 117 hypertension medications and combination products were included in the formulary of the Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM^©) system, a mobile digital therapeutic. The formulary contains medication names and dose options available for selection at onboarding or when medication changes occur. The safe window for taking missed/overdue medication was programmed into the MEDSReM^© app for each medication and dosing frequency. The users are presented with “take, snooze, and skip” options when they receive a reminder and open the app to take the medication. If they open the app past the safe window hours, a recommendation to skip that dose and take the next dose at the regular time is presented. If the user decides to take the missed dose, a decision to take or skip the next dose is shown.Discussion: The MEDSReM^© decision support algorithm provides a safe window of time for each hypertension medication for older adults when they need to take their medication after the intended target time has passed. The interdisciplinary collaboration of clinical, technology, and research teams resulted in a novel, older adult-centered, time-specific digital therapeutic intervention to support decision-making about taking missed hypertension medications.

「福祉科技與服務管理學刊」創辦於2012年12月，由中華福祉科技與服務管理學會發行，旨在提供老人福祉科技(gerontechnology)及高齡者照護服務與管理之相關學者、產業界和從業人員，以中文發表研發成果或實務經驗之平台，期能促進跨領域知識交流與傳播，提升整體研究水平與相關產業發展，進而為高齡化社會衍生之各種問題提出具體解決方案，提升高齡者之生活品質。

Background/Objectives: Concurrent opioid (OPI) and benzodiazepine (BZD) use may exacerbate injurious fall risk (e.g., falls and fractures) compared to no use or use alone. Yet, patients may need concurrent OPI-BZD use for co-occurring conditions (e.g., pain and anxiety). Therefore, we examined the association between longitudinal OPI-BZD dosing patterns and subsequent injurious fall risk. Methods: We conducted a retrospective cohort study including non-cancer fee-for-service Medicare beneficiaries initiating OPI and/or BZD in 2016–2018. We identified OPI-BZD use patterns during the 3 months following OPI and/or BZD initiation (i.e., trajectory period) using group-based multi-trajectory models. We estimated the time to first injurious falls within the 3-month post-trajectory period using inverse-probability-of-treatment-weighted Cox proportional hazards models. Results: Among 622,588 beneficiaries (age ≥ 65 = 84.6%, female = 58.1%, White = 82.7%; having injurious falls = 0.45%), we identified 13 distinct OPI-BZD trajectories: Group (A): Very-low OPI-only (early discontinuation) (44.9% of the cohort); (B): Low OPI-only (rapid decline) (15.1%); (C): Very-low OPI-only (late discontinuation) (7.7%); (D): Low OPI-only (gradual decline) (4.0%); (E): Moderate OPI-only (rapid decline) (2.3%); (F): Very-low BZD-only (late discontinuation) (11.5%); (G): Low BZD-only (rapid decline) (4.5%); (H): Low BZD-only (stable) (3.1%); (I): Moderate BZD-only (gradual decline) (2.1%); (J): Very-low OPI (rapid decline)/Very-low BZD (late discontinuation) (2.9%); (K): Very-low OPI (rapid decline)/Very-low BZD (increasing) (0.9%); (L): Very-low OPI (stable)/Low BZD (stable) (0.6%); and (M): Low OPI (gradual decline)/Low BZD (gradual decline) (0.6%). Compared with Group (A), six trajectories had an increased 3-month injurious falls risk: (C): HR = 1.78, 95% CI = 1.58–2.01; (D): HR = 2.24, 95% CI = 1.93–2.59; (E): HR = 2.60, 95% CI = 2.18–3.09; (H): HR = 2.02, 95% CI = 1.70–2.40; (L): HR = 2.73, 95% CI = 1.98–3.76; and (M): HR = 1.96, 95% CI = 1.32–2.91. Conclusions: Our findings suggest that 3-month injurious fall risk varied across OPI-BZD trajectories, highlighting the importance of considering both dose and duration when assessing injurious fall risk of OPI-BZD use among older adults.

Background/Objectives: Concurrent opioid (OPI) and benzodiazepine (BZD) use may exacerbate falls/fractures risk compared to no use or use alone. Yet, patients may need concurrent OPI-BZD use for co-occurring conditions (e.g., pain and anxiety). Therefore, we examined the association between longitudinal OPI-BZD dosing patterns and subsequent injurious falls risk. Methods: We conducted a retrospective cohort study including non-cancer fee-for-service Medicare beneficiaries initiating OPI and/or BZD in 2016-2018. We identified OPI-BZD use patterns during the 3 months following OPI and/or BZD initiation (i.e., trajectory period) using group-based multi-trajectory models. We estimated time to first injurious fall within 3 months post-trajectory period using inverse-probability-of-treatment-weighted Cox proportional hazards models. Results: Among 622,588 beneficiaries (age≥65=84.6%, female=58.1%, White=82.7%; having injurious falls=0.45%), we identified 13 distinct OPI-BZD trajectories: Group(A):Very-low OPI-only (early discontinuation)(44.9% of the cohort); (B):Low OPI-only (rapid decline)(15.1%); (C):Very-low OPI-only (late discontinuation)(7.7%); (D):Low OPI-only (gradual decline)(4.0%); (E):Moderate OPI-only (rapid decline)(2.3%); (F):Very-low BZD-only (late discontinuation)(11.5%); (G):Low BZD-only (rapid decline)(4.5%); (H):Low BZD-only (stable) (3.1%); (I):Moderate BZD-only (gradual decline)(2.1%); (J):Very-low OPI (rapid decline)/Very-low BZD (late discontinuation)(2.9%); (K):Very-low OPI (rapid decline)/Very-low BZD (increasing)(0.9%); (L):Very-low OPI (stable)/Low BZD (stable)(0.6%); and (M):Low OPI (gradual decline)/Low BZD (gradual decline)(0.6%). Compared with Group(A), 6 trajectories had increased 3-month injurious fall risks: (C): HR, 95%CI=1.78, 1.58-2.01; (D): 2.24, 1.93-2.59; (E): 2.60, 2.18-3.09; (H): 2.02, 1.70-2.40; (L): 2.73, 1.98-3.76; and (M): 1.96, 1.32-2.91. Conclusions: Our findings suggest that 3-month injurious fall risk varied across OPI-BZD trajectories, highlighting the importance of considering both dose and duration when assessing fall risks of OPI-BZD use among older adults.

Psychological distress is common and problematic for older adults with comorbidities. Social media has great potential to help older adults engage in meaningful social activities and relationships that might improve mental health. However, little information exists about the actual use and the beneficial effects of the use of social media on mental health among this particular population. Using data from the 2019-2020 Health Information National Trends Survey (HINTS), we aimed to describe the prevalence of social media use, and whether social media use is related to better self-care confidence and thus related to better mental health among U.S. older adults with comorbidities. Data were analyzed using weighted logistic models and mediation analyses that considered the complex survey design with jackknife replications. Variables were assessed by self-reports. The prevalence of social media use increased rapidly from 41% in 2017 to 54% in 2020 among U.S. older adults with comorbidities. Those who were of younger age, women, higher education, or higher income were more likely to use social media, whereas those who were Hispanic or Black were less likely to use social media. Social media use was related to better self-care confidence (b=0.17, 95% CI=0.07-0.26, P< 0.001) and is further related to better mental health (b=1.07, 95% CI=0.86-1.28, P< 0.001). Our results suggest that social media is a beneficial supplement to traditional sources of social support for mental health. However, more attention is needed to those who are not only affected by commodities but also socially disadvantaged (e.g., Hispanic or Black with lower education).

To investigate the efficacy of melatonin and/or ramelteon reporting sleep outcomes for older adults with chronic insomnia, a systematic review and a meta-analysis of PubMed, EMBASE, Cochrane library, International Pharmaceutical Abstracts, PsycINFO, science citation index, center for reviews and dissemination, CINAHL, grey literature and relevant sleep journal searches were conducted from 1 January 1990 to 20 June 2021. Randomized controlled trials and other comparative studies with melatonin and/or ramelteon use among older patients with chronic insomnia were included. Funnel plot and Egger’s test was used to determine publication bias. A forest plot was constructed to obtain a pooled standardized mean difference using either a fixed or random effects model for each of the two broad categories of sleep outcomes: objective and subjective. Of 5247 studies identified, 17 studies met the inclusion criteria for MA. Study sample size ranged from 10 to 829 with the mean age ≥55 years. There were significant improvements in total sleep time (objective), sleep latency and sleep quality (objective and subjective) for melatonin and/or ramelteon users compared with placebo. Sleep efficiency was not significantly different. The effects of these agents are modest but with limited safe treatment options for insomnia in older adults, these could be the drugs of choice.