Faika Zanjani

Introduction: Falls are a major source of morbidity in older adults and pose particular concern in cancer survivors who may experience treatment related neurological and functional decline. Dementia is a known risk factor for falls, yet its contribution to fall risk among breast cancer survivors has not been well defined. Methods: This retrospective cohort study used de identified electronic health records from the TriNetX Research Network, which includes more than 100 health care organizations. Women aged 65 years or older with stage 1 to stage 3 breast cancer were eligible. Dementia was identified using ICD 10 code F03 recorded on or after the first qualifying cancer diagnosis. Propensity score matching used a 1 to 1 nearest neighbor approach. The primary outcome was incident fall events identified by ICD 10 codes for unspecified falls, initial fall encounters, history of falling, and repeated falls. Multivariable Cox proportional hazards models estimated independent predictors of falls. Follow up began 1 day after diagnosis and continued through the last recorded encounter. Results: A total of 49,576 breast cancer survivors met inclusion criteria, of whom 1683 (3.4%) had dementia. Before matching, fall related diagnoses were significantly more common in patients with dementia, including unspecified falls (26% vs. 2%, p < 0.0001) and history of falling (15% vs. 1%, p < 0.0001). After 1 to 1 matching, 1 602 survivors remained in each cohort with standardized mean differences < 0.06 across all variables. During follow up, 17.8% of survivors with dementia experienced a fall compared with 6.5% without dementia. This corresponded to an absolute risk difference of 11.3% (95% CI 9.1% to 13.6%), a risk ratio of 2.74 (95% CI 2.41 to 3.12), and an odds ratio of 3.12 (95% CI 2.67 to 3.65). The Kaplan Meier analysis showed significantly lower fall free survival in the dementia cohort (log rank p < 0.0001). The adjusted Cox model showed that dementia remained an independent predictor of falls (hazard ratio 1.43, 95% CI 1.25 to 1.63). Additional strong predictors included long term drug therapy (hazard ratio 2.62, 95% CI 2.41 to 2.84), osteoporosis (hazard ratio 1.48, 95% CI 1.34 to 1.62), polyneuropathy (hazard ratio 1.58, 95% CI 1.34 to 1.85), and depressive episode (hazard ratio 1.78, 95% CI 1.60 to 1.98). Conclusions and Relevance: Dementia was associated with a substantially elevated fall risk among older breast cancer survivors, even after extensive adjustment for comorbidity, neurological conditions, psychiatric disorders, and medication burden. Recognition of this risk may help clinicians identify a subgroup of survivors who require closer monitoring and more precise evaluation during routine care.

BACKGROUND The COVID-19 pandemic accelerated telehealth adoption, particularly for older adults, yet end-user non-acceptance of digital health tools remains a persistent barrier. This evaluation engaged the Mobile Health and Wellness Program (MHWP), a nurse-led mobile clinic serving urban-dwelling older adults with chronic conditions, to implement Health Recovery Solutions (HRS) Remote Patient Monitoring (RPM) devices to extend its reach and boost health equity. OBJECTIVE This pre-implementation research project aimed to identify the strongest predictors of the intention to use technology among MHWP care delivery providers and participants. Using the constructs from the Technology Acceptance Model (TAM) to inform implementation of HRS RPM devices within MHWP. METHODS Two cross-sectional surveys were administered to MHWP providers (n = 31) and participants (n = 18). Reliability of the constructs was assessed via Cronbach’s α, and multiple linear and ridge regression models were fit to predict Behavioral Intention (IN). Analyses were exploratory given the small sample sizes and should be interpreted as hypothesis-generating. RESULTS For MHWP providers, the model explain 70% of variance in intention to use telemonitoring (R2 = .697, P < .001), with Perceived Usefulness (PU) and Perceived Ease of Use (PEU) as the strongest predictors of IN. For MHWP participants, the model was not statistically significant (R2 = .527, P = .24), with Availability emerging as the most influential construct in exploratory ridge regression. CONCLUSIONS Provider-focused implementation should prioritize demonstrating practical benefits and ensuring user-friendly operation. For participants, unobstructed access to telehealth technology appears most critical for fostering adoption intent. These cross-stakeholder findings offer preliminary exploratory insights to guide equitable RPM implementation in community-based care. CLINICALTRIAL N/A

Background: The development of the Richmond Brain Health Initiative (RBHI) was guided by the need to address local brain health service gaps to improve Alzheimer's/Dementia health disparities in racially diverse communities. This paper describes the establishment of RBHI through 1) community and provider stakeholder input and 2) community brain health screening/intake development and testing. Methods: Phase 1 involved provider and community stakeholder questionnaires to gather feedback as part of the Plan–Do–Study–Act cycle. Subsequently, stakeholder findings directed the RBHI structure and screening/intake registration testing in the community. Results: Based on the stakeholder responses from fifteen providers and twenty community members, there was strong consensus in the need for local brain health services. The most highly recommended screening needs were for caregiving, cognitive status, and lifestyle risks. Thereafter the RBHI screening/intake was developed and completed by 45 community participants. Participants showed hypertension (62%) as the most prevalent brain health risk factor, followed by depression/anxiety (56%), and loneliness (44%). The intake also indicated cognitive and functional deficits, with the Montreal Cognitive mean equaling 18.4 and the Functional Activities mean equaling 14.9. Additionally, 73% of participants reported experiencing subjective cognitive decline. Conclusions: This study showcases a model for promoting brain health in racially diverse communities to improve access to Alzheimer's disease and related dementia resources and services.

Recent guidelines point to lifestyle as a tool for decreasing Alzheimer’s disease (AD) risk. To address the limited practice and availability of AD risk reduction interventions, this study aimed to explore the feasibility of a community-level lifestyle intervention targeting high-risk groups. Diverse older adults (60+) living in the Richmond, VA local area, with the following risk factors, incomes below $12,000/year and managing diabetes or cardiovascular disease, were offered weekly lifestyle telephone health coaching for 12 weeks in 2019-2020 (intervention group). The health coaching sessions provided AD lifestyle risk reduction education and goal setting/planning. The intervention sample (n=40, mean age 68 years (range: 60-76 years)) was 90% African American/Black (n=36) and 45% male (n=18). Thereafter in 2021-2022, n=37 individuals in the same area were recruited as a comparison group and not given health coaching (control group), mean age 65.5 years (range: 57-83 years), 92% African American/Black (n=34), and 50% male (n=18). Repeated measures intervention effects were seen for cognitive ability, indicating greater improvement in the intervention group (p<.01). Significant difference scores indicated greater cognitive ability (p<.01) and physical activity (p<.001) gains in the intervention group, with intervention subjects with reported memory problems showed relatively less physical activity gains (p<.05). This work creates the impetus for future large-scale AD risk reduction investigations to mitigate and improve modifiable risk among diverse older adults. Our positive trends in AD risk reduction support telephone-based health coaching as a feasible AD risk reduction intervention.

Objectives: Older adults have been disproportionately affected by COVID-19. The primary goal of this study is to determine the socioeconomic effects on psychosocial factors among low-income independent-living older adults, in an urban setting, during the COVID-pandemic. Methods: Participants were recruited through Virginia Commonwealth University’s Richmond Health and Wellness Program. Telephone surveys ( n=100) were conducted using the Epidemic – Pandemic Impacts Inventory Geriatric with the Racial/Ethnic Discrimination addendum. Responses were analyzed for income and education effects across seven domains: home life, social activities/isolation, economic, emotional health-wellbeing, physical health, COVID-infection history, and positive change behaviors/experiences. Results: The sample population was between 51 and 87 years of age, 88% were Black, 57% reported incomes of $10,000/year or less, and 60% reported a high-school education or less. There were income effects for social activities/isolation (f = 3.69, p<.05) and positive change (f = 8.40, p<.01), and education effects for COVID History (f = 4.20, p <.04). Discussion: Overall results highlight the social patterns for a diverse sample of low-income urban older adults; education and income are identified as risk factors for social losses, COVID-infection experiences, racial/ethnic discrimination during the COVID-pandemic, and positive change behaviors.

Taking a phenomenological approach, this qualitative study describes the lived experiences of low-income older adults during the COVID-19 pandemic. A socio-ecological model was used to organize the five identified themes describing the lived experience: socio-economic context, Black Lives Matter and the politics of race, COVID and polarized views of COVID, interpersonal context (social connections), and individual context (feelings, beliefs, and behaviors). Study findings illustrate the intersectionality of contextual influences on the experience of low-income older adults. Study participants demonstrated remarkable resilience and coping strategies developed in response to the challenges they experienced throughout their lifetime which benefited them when faced with the pandemic, social unrest, and political events that took place in 2020. This study highlights the importance of understanding the larger context of COVID-19 which has significant implications for policy makers and public health leaders.

This study aims to determine whether current tobacco and/or alcohol use is associated with setting preferences for seeking support for substance use (SU) and mental health (MH) services to African ...

Community-level health promotion programs offer opportunities to improve the lives of older adults and improve the cultural narrative about aging. However, age-discrimination, ageism, and negative attitudes about aging, across the systematic ecological community levels have undermined older adult health. While the longevity of a society is a marker for success worldwide, age-discrimination and ageism, seen through limited community-level health advancement opportunities, have thwarted progress toward societal elderhood, even in the most developed and advanced nations. As a society, we need to continue to push for community-level prevention and intervention across the older age spectrum, to continue human advancement through late life.

Older adults and racial minorities are overrepresented in homeless populations. Shelter and housing options for homeless older adults who have complex health and social needs are necessary, but not readily available. Older homeless adults that require, but do not receive, health-sensitive, age-sensitive, and racial equity housing, remain vulnerable to poor outcomes and premature mortality. Accordingly, this study examines the development of a coalition to better address older adult homelessness within a racial equity framework. A community coalition was established to better address older adult homelessness within the lens of age-sensitivity and racial equity, due to a disconnect between healthcare and senior housing placement programs, creating unaddressed multifaceted health issues/complications. The community coalition development is described, including the coalition process, activities, and outcomes. Local rehoused older adults are also interviewed and described to better understand their central life circumstances.

Substance use and mental health problems are associated with academic difficulties among high school and undergraduate students, but little research has been conducted on these relationships among graduate students. The sample consisted of 2683 graduate students attending two large, public universities. Standard measures were used to collect data on demographic and program characteristics, mental health, substance use, advisor satisfaction, and burnout (i.e., exhaustion, cynicism, and inefficacy). Linear regression models evaluated the relationships between each mental health and substance use variable with burnout, as well as the moderating role of advisor satisfaction. Students with a greater number of substance use and mental health problems had higher levels of exhaustion, cynicism, and inefficacy. No statistically significant relationships between substance use and burnout were found. High levels of stress, moderate or severe anxiety symptoms, and moderate or severe depressive symptoms were associated with increased levels of burnout. Advisor support moderated the relationships between stress and both cynicism and inefficacy such that the effects of stress on these dimensions of burnout were lower among those who were satisfied with their advisor. Graduate students with mental health problems might be at increased risk for burnout; however, having a supportive advisor might buffer this association.