Site last updated: August 15, 2017

About

Contact

Registration

e-Newsletter

CNYGEC Team

 

GEC Partner Programs >> Hebrew Home

The Research Division of the Hebrew Home of Riverdale (RD-HHAR)

The Research Division of the Hebrew Home at Riverdale (RD-HHAR)

The Research Division of the Hebrew Home at Riverdale (RD-HHAR) is at the forefront of elder care research, committed to improving the quality of life of older persons. Founded in the mid-1980s, the RD-HHAR is internationally known for its contributions to long term health care. The division is funded by grants from both the federal and state governments and from foundations. The RD-HHAR is uniquely positioned to develop new approaches to address the needs of the elderly, including those with Alzheimer’s Disease and their caregivers.

The RD-HHAR has approximately 20 full and part-time staff, including three at the Ph.D. level, and several persons with Masters' Degrees (Public Health, and Biostatistics). It maintains collaborative relationships with major academic and government institutions such as Columbia University Medical Center, Faculty of Medicine, Stroud Center and Biomedical Informatics; The Albert Einstein College of Medicine, Department of Neurology; Georgetown University, Lombardi Comprehensive Cancer Center; Mount Sinai Medical Center, Division of Geriatrics and Palliative Medicine; New York University Center for Healthful Behavior Change, College of Nursing; Northwestern University, Medical Social Sciences; Weill Cornell Medical College, Division of Geriatrics and Palliative Care; Yale University, School of Medicine; and the New York State Department of Health.

The RD-HHAR obtains funding from federal, foundation and state grants, primarily through federally-funded subcontracts to major medical centers. Federal funding sources have included: the Agency for Healthcare, Research and Quality (AHRQ), the Centers for Disease Control (CDC), the Centers for Medicare and Medicaid Services (CMS), the Health Resources and Services Administration (HRSA), the National Institute on Aging (NIA), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Cancer Institute (NCI), National Heart, Lung and Blood Institute (NHLBI), National Institute of Justice (NIJ), National Institute on Minority Health and Health Disparities (NIMHD), National Institute of Neurological Disorders and Stroke (NINDS), and the National Institute for Nursing Research (NINR). Foundation grants have included: The Fan Fox and Samuels Foundation, the Fetzer Institute, and the Brookdale Institute. State funding has been received through the New York State Department of Health.

The division has been the coordinating center for ten studies on special dementia care funded by the National Institute of Aging. Currently, the RD-HHAR is the Coordinating Center for 15 NIH funded studies. Over the past two decades, the RD-HHAR has been the Coordinating Center to over 200 studies of health conditions such as cognition and Alzheimer’s Disease, cardiovascular disease and hypertension, colorectal cancer, end stage renal disease, diabetes, stroke and stroke-related illness, and mental health including depression. The RD-HHAR is at the forefront in the study of telehealth and bioinformatics; as well as minority health, disparities, discrimination, social determinants, minority caregivers to elders in the community, and indigenous community health workers; and social issues such as elder abuse and mistreatment. The RD-HHAR collaborates with the Weinberg Center in studies of elder abuse. Finally, the RD-HHAR in collaboration with Weill Cornell Medical Center Division of Geriatrics and Palliative Care is conducting the first prevalence study of resident-to-resident mistreatment.

The RD-HHAR is also affiliated with multi-site Centers that aim to reduce health care disparities between minority and non-minority older adults: National Institutes of Health, Resource Centers for Minority Aging Research (RCMAR), and Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training (EXPORT). Two additional multi-site Centers examine pain management and palliative care for older adults: National Institute on Aging (NIA) Roybal Center- Cornell-Columbia Institute for Translational Research on Aging, NIA Mount Sinai Pepper Older Americans Independence Center.

The Research Division has been at the forefront of development and applications of statistical methods related to culture fair assessment. Experts have conducted psychometric analyses for a variety of measures used to assess chronic care populations. Several members are consultants to the Statistical Coordinating Center to Patient Reported Outcomes Measurement and Information System (PROMIS), the NIH roadmap initiative that aims to provide infrastructure for establishing item banks and computerized adaptive testing in health.

The Research Division produced an award-winning training video sponsored by a grant from the New York State Department of Health titled, "Freedom of Sexual Expression: Dementia and Resident Rights in Long Term Care Facilities." The training video has received national media attention. The Research Division has produced training programs on recognizing and working with long-term care residents with dementia and depression titled, “Depression in Nursing Homes, Assisted Living and Other Long-Term Care Settings” and on recognizing and working with residents with vision problems in long-term care settings titled, “Vision Awareness: A Staff Training Program.” Most recently, the Research Division produced a training program titled “Resident-to-Resident Elder Mistreatment Training and Education Guide” narrated by distinguished journalist Charles Osgood that was distributed to all New York State nursing homes and is available through the NYS Department of Health website.

Performance Intervention Evaluation: Depression in Nursing Homes, Assisted Living and Other Long-Term Care Settings

Performance Intervention Evaluation: Depression in Nursing Homes, Assisted Living and Other Long-Term Care Settings

Refinement of the training modules

The three session training program, “Depression in the Nursing Home”, was selected as the NYGEC PIE intervention. This program was developed in the 1990’s by The Research Division of the Hebrew Home at Riverdale (RD-HHAR) in conjunction with Robert Abrams MD, a geriatric psychiatrist at Weill Cornell Medical College, New York Presbyterian Hospital. The development of these materials was supported, in part, by grants from the New York State Department of Health, from the National Institute for Nursing Research (1 RO1 NR 03508), and by the National Institute on Aging (2 R01 AG014299-06A2). This program was evaluated by examining rates of recognition and prevalence estimates for depression in ten nursing homes. 1,2  Prior estimates indicated that approximately 4% - 5% of residents with dementia were depressed; in this study, based on psychiatric appraisal, the prevalence estimate for probable and/or definite major depressive disorder among testable subjects was 14.4% (95% CI of 10.6%-19.3%). The estimate for minor depression was 16.8% (95% CI of 12.6%-21.9%). The prevalence of significant depressive symptomatology (including the category of possible depression) was 44.2% (95% CI of 38.2%-50.3%). The corresponding estimates of any depression were 19.7% for social workers, 29% for nurses and 32.1% for nurse aides. Depression recognition was relatively low, with only 37%-45% of cases diagnosed by psychiatrists recognized as depressed by staff. African Americans were generally seen by psychiatrists as having less depressive symptomatology than residents from other ethnic groups. The data suggest that nurse aides, perhaps because they see residents more often or because they are less influenced by demographic characteristics, may be the most valid source of information about residents’ depression.

With support from HRSA for the New York Geriatric Education Center, the RD-HHAR, in conjunction with leading geriatric psychiatrists, Dr. Abrams (original author), and Mark Nathanson, MD, Columbia University Stroud Center, New York Presbyterian Hospital, reviewed the content of the modules and knowledge tests and updated the content based on current literature and knowledge. In addition, the target audience was expanded to include front-line staff in all types of long-term care facilities, not just the nursing home. Thus, the title of the training program was updated to “Depression in Nursing Homes, Assisted Living and Other Long-Term Care Settings”. The updated script for presenters and education guide was reviewed and vetted by experts in the field. A slide presentation to accompany the training guide was created in 2012.

This training is geared for front line care staff (e.g., nurses, social workers, certified nursing assistants). Session 1 is titled: Recognizing Depression and Dysthymia; Session 2: Factors Related to the Diagnosis of Depression and/or Dementia in Long-Term Care; Session 3: The Tactics of Intervention: Tips on how Best to Work with Long Term Care Residents with Dementing Illness and Depression (including behavioral activation).

An additional module covering administering the PHQ-9 was developed specifically for this project. Working with our GEC consortium partners in Los Angeles and the Pacific Islands, a fifth module related to cultural competency and team training was developed.

All modules were shared with our GEC consortium partners for use in their PIE projects.

Evaluation

In order to evaluate the new version of the training program, a two- arm cluster randomized controlled trial (RCT) at the Bronx campus of Jewish Home Lifecare (JHL) and HHAR was performed, coordinated by the RD-HHAR in conjunction with the research division at JHL. A total of 300 residents on 12 units at JHL and 9 units at HHAR (150 per arm) were recruited. Staff on the selected units at the intervention site received the 5 training modules provided by professional trainers, while those assigned to usual care did not receive any additional training. Resident level evaluations occurred at baseline, 6-months and 12-months. 

The primary outcomes evaluated at the resident level include increase in: a) number of depression assessments (PHQ-9, Cornell Depression in Dementia, FTQ); b) percent depression recognition; c) percent of care plans for depression; d) percentage of referrals for psychiatric consults.

 

1Teresi, J.A., Abrams, R., Holmes, D., Ramirez, M. & Eimicke, J.  (2001). Prevalence and depression recognition in nursing homes. Social Psychiatry and Psychiatric Epidemiology,(36), 613-620.

2Teresi, J. A., Abrams, R., Holmes, D., Ramírez, M., Shapiro, C., & Eimicke, J. (2002). Influence of cognitive illness, gender and African-American status on psychiatric ratings and staff recognition of depression. American Journal of Geriatric Psychiatry, 10(5), 506-514.

 

GEC Partners

 

Follow us!   Like Us on Facebook  

Copyright 2013 The Consortium of New York Geriatric Education Centers