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GEC Partner Programs >> Jewish Home Life Care

About the Jewish Home Lifecare Research Institute on Aging

About the Jewish Home Lifecare Research Institute on Aging

Jewish Home Lifecare is one of the few non-profit geriatric healthcare systems to have established a research institute. With a multi-disciplinary team of psychologists, physicians, and social workers, the Research Institute makes significant contributions to the field of geriatrics, with particular emphasis on best practice approaches to care.

Projects at the Research Institute on Aging are funded by competitive grants from government agencies, private foundations, and corporations, as well as by the support of generous individual donors. These funders include the Alzheimer's Association, The Eisner Foundation, The Fan Fox and Leslie R. Samuels Foundation, The Greenwall Foundation, Jewish Guild Healthcare, the National Institute on Aging and the National Institute of Mental Health. Contact us at research@jewishhome.org: 212-870-4849.

For more information about Jewish Home Lifecare healthcare services, please click here

Selected Studies (In Progress)

Aging and Vision

Addressing Low Vision in Post-Acute Rehabilitation
JHL Lead: Verena R. Cimarolli, PhD

With rehabilitation staff, researchers are implementing a project to address vision impairment in sub-acute patients (funded by the Guild Center for Vision and Aging, and the Estate of Edward A. Bragaline). Age-related vision loss is a common chronic condition increasing functional disability, risk for falls and injuries, depression, and hindering effective use of Occupational Therapy (OT). Components of the intervention include: [1] training Occupational Therapists (OTRs) in vision screening to identify patients with significant vision loss and integration of vision-specific therapy into the treatment plan, and [2] treatment by an OTR trained in low vision issues. Via review of medical record data, we are determining if patients with vision loss who have participated in the intervention have similar OT utilization and outcomes when compared to their sighted counterparts. Preliminary findings show that training is perceived as effective by providers and has created a more low-vision conscious work environment.

Dementia Care

Beliefs about Dementia-Related Symptoms Among African Americans
JHL Lead: Brent Gibson, PhD

A qualitative study using in-depth, ethnographic interviews with four groups of informants is being conducted to identify emergent themes and describe explanatory models of dementia among African Americans in their own words (Funded by the Alzheimer’s Association). Another goal is to explore the ways in which Africans Americans’ explanatory models can facilitate or inhibit help-seeking. In-depth interviews have been conducted with African American non-caregivers, African American dementia family caregivers, home health professionals (nurses and social workers), and clergy with predominantly African American congregations. Participants have been open and forthcoming in discussing their beliefs and experiences related to aging, illness, and memory loss. Final analyses and report writing are currently in progress.

Long-Term Care Work Force

Bereavement in Direct Care Workers: Quality of Care and Workforce Issues
JHL Lead: Kathrin Boerner, PhD

All but final data analyses and dissemination are complete for a study focusing on how to better understand the way direct care workers (i.e., certified nursing assistants in the nursing home, and home health aides in the community) respond to the death of a patient, and what kind of support they may need (funded by the National Institute on Aging and Trustee Gifts). This knowledge has important implications for delivery and quality of care provided in elder care, as well as for employment satisfaction and stability among direct care workers in nursing home and home care settings. Preliminary findings underscore the need for more training and preparation of front-line staff related to patient death and dying.

Transitions in Care Settings

Preventing Delirium in the Nursing Home
JHL Lead: Kenneth Boockvar, MD

Jewish Home Lifecare is currently implementing a delirium prevention program in the nursing home (Funders: Samuels Foundation, Mount Sinai School of Medicine Pepper Center, Parkinson’s Fund). Delirium is extremely prevalent ranging from 14-18% and occurs most frequently in the two weeks after an acute illness. Residents with delirium are more likely to experience falls, decline in function and are at increased risk of hospital admissions. We are modifying the Hospital Elder Life (HELP) program and implementing it at our Bronx nursing home campus with nursing home residents who are enrolled in Evercare, a nurse practitioner driven model. The approach involves adding a new staff role, an Elderlife Specialist, to help mitigate the risk of delirium by ensuring that residents have adequate fluid and food intake, maintain mobility, and receive adequate pain relief. We are testing the hypothesis that this intervention can prevent delirium and thereby reduce unnecessary hospitalizations and reduce medical and nursing costs.

Selected Studies (Completed)

Depression Identification and Treatment

Problem Solving Treatment for Depression
JHL Lead: Joann P. Reinhardt, PhD

Two studies have been completed that examine the use of problem solving treatment (PST) for depression. One study focused on older adults with vision impairment receiving out-patient vision rehabilitation and living in the community (funded by the National Institute of Mental Health). Findings showed PST participants had significantly lower depressive symptoms than a comparison group 3 months after the conclusion of 6 PST sessions. Another study focused on older adult residents of a subacute, long term care facility (funded by the Mount Sinai School of Medicine Pepper Center). Although not a significant difference likely due to small sample size, elders in the PST intervention group experienced a decline in depression scores that was 2 to 4 times that of the usual care group. Results for these studies support the integration of a mental health component into a rehabilitation setting.

Palliative and End of Life Care

Enhancing Life Quality for Residents with End-Stage Dementia and Families
JHL Lead: Joann P. Reinhardt, PhD

A 3-year project (funded by the Alzheimer’s Association) tested the benefits of a structured approach to palliative care for residents with advanced dementia and their family members compared to usual care with social contact. The palliative care intervention consisted of formalized interactions between palliative care team members and involved family members of residents to determine goals of care, work to achieve those goals, and provide psychosocial support to the family. Findings showed the majority of family members are in regular contact with their elder relatives, feel close to them, and converse with health care team members regarding their relatives’ care. Further, having discussions about end of life options and symptom management (addressing pain, trouble breathing) were related to better care rating scores by family and having a greater number of advance directives put in place (e.g., do not resuscitate, do not intubate, do not hospitalize) over a six-month period.

Palliative and End of Life Care

Integrated Palliative Care Nursing Home Program
Lead: Betty Lim, MD

In a retrospective review of medical charts (funded by the Fan Fox and Leslie R. Samuels Foundation), researchers examined the effect of an innovative model of palliative care delivery in the nursing home. This model provided direct exposure to frontline nursing home staff by embedding a palliative care physician into the communities. Clinical services to residents were provided through formal palliative care consultations, building upon the existing palliative care presence at the nursing home. Medical record data from patients who had received palliative care consultations were compared with data from those who had not. Residents who did not receive palliative care referrals were 16 times more likely to have their place of death be a hospital, rather than the nursing home where they had been residing. For residents who died, those who had a palliative care referral were more than 15 times more likely to receive pain medication. Because understanding a patient’s wishes can limit some invasive care measures, palliative care consultation may decrease hospitalization rates of residents at the end of life.

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.

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