Department of Geriatrics and Palliative Medicine
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Item Behavioral health as a palliative care priority in long-term services and supports: A cross-sectional study of staffNowels, M.A.; Carlson, R.L.; Saraiya, M.; Riffin, C.A.; Plys, E.; Reid, M.C.; Mirza, T.; Adelman, R.D.; Unruh, M.A.; Shalev, D. (Cambridge University Press, 2025-11-04)OBJECTIVES: Behavioral health needs are highly prevalent among individuals receiving long-term services and supports (LTSS), yet palliative care (PC) models in these settings often underemphasize psychiatric symptom management. This study explores interdisciplinary staff perspectives on behavioral health as a core domain of PC across nursing home and Program of All-Inclusive Care for the Elderly (PACE) sites. METHODS: We conducted a secondary analysis of a multi-site survey assessing PC needs across 13 LTSS sites within a large health system in New York State. We examined 5 survey items related to psychiatric symptom management, analyzing frequency, comfort, perceived benefit, and training interest. Multivariable logistic regression was used to assess associations between staff characteristics and behavioral health-related outcomes. RESULTS: Among 597 respondents, 60.5% reported that over half of their patients could benefit from psychiatric symptom management, and nearly half (49.2%) reported managing such symptoms weekly or more. Forty percent identified psychiatric symptom management as one of the top three ways PC specialists could help their patients, and 44.6% expressed interest in further behavioral health training as part of further PC training. Prior professional experience with PC was associated with greater recognition of behavioral health needs among patients (aOR 1.6), greater likelihood of managing psychiatric symptoms (aOR 2.0), and greater comfort doing so (aOR 1.5). SIGNIFICANCE OF RESULTS: Behavioral health emerged as a salient and frequently encountered domain of serious illness care among LTSS staff, particularly in nursing home and PACE settings. Staff with prior PC experience were more engaged and confident in addressing psychiatric symptoms. Findings underscore the need for PC models in LTSS to better integrate behavioral health - through training, interdisciplinary collaboration, and care delivery redesign - to meet the complex needs of medically and psychiatrically vulnerable populations.Item Health Patterns of Dementia Caregivers With Chronic Pain: Latent Profile Analysis of the PROMIS-29 MeasureTurner, S.G.; Witzel, D.D.; Garza, S.; Pillemer, K.; Reid, M.C. (SAGE Publications, 2025-07-30)We identified patterns of health and functioning in a national sample of dementia family caregivers experiencing chronic pain (N = 273). Utilizing latent profile analysis of the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), we identified three discrete groups: an average group (48%), a low health challenges group (30%), and a high health challenges group (22%). Women were more likely to be in the high (vs. low) health challenges group. There are discrete health patterns of caregivers with chronic pain, with over 20% reporting comorbid poor health and functioning that may negatively affect caregiving quality. Screening caregivers for high impact pain in clinical settings should be considered and prioritizing these caregivers for interventions may be an efficient use of resources.Item Pain Prevalence and Intensity Among Older Family Caregivers Versus Non-Caregivers in the United States.Turner, S.G.; Reid, M.C.; Pillemer, K.A. (SAGE Publications, 4/10/25)Objective: We compared pain prevalence and intensity between caregivers and non-caregivers, as well as between different types of caregivers.Method: Using two rounds of data from the National Social Life, Health, and Aging Project, we used regression models to analyze differences in pain prevalence and intensity between caregivers and non-caregivers at baseline (2010-2011) and follow-up (2015-2016). The sample consisted of 2332 participants aged 62 and older (352 caregivers and 1980 non-caregivers).Results: Cross-sectionally, caregivers were more likely than non-caregivers to report pain. Longitudinally, caregivers with pain at baseline were more likely to report the presence of pain and greater pain intensity five years later compared to non-caregivers who also reported pain at baseline. More hours of care per week was associated with greater pain intensity at baseline and follow-up among caregivers with pain.Discussion: Caregivers' pain is a public health concern, with efforts to mitigate the effects of caregiving on pain needed.Item The Potential Role of Palliative Care and Hospice in Addressing Prolonged Grief Disorder in the United States.Magoon, C.; Shalev, D. (Elsevier, 5/12/25)Item Integrating Psychotherapeutic Concepts to Enhance Serious Illness Communication: Assessment of a Model Curriculum.Chammas, D.; Brenner, K.; Moment, A.; Byrne-Martelli, S.E.; Rosenberg, L.B.; Shalev, D. (Mary Ann Liebert, 5/19/25)Background: Serious illness communication training often focuses on sharing medical information, discussing goals of care, and supporting patients and caregivers. Few communication frameworks explicitly integrate psychosocial concepts to improve therapeutic efficacy. Objectives: To develop, implement, and evaluate a half-day workshop that integrates psychotherapeutic concepts into palliative care communication across four professional settings. Methods: Using Kern's six-step curriculum development model, we created an interactive workshop focused on psychological formulation and countertransference. The workshop was delivered to four cohorts: a national conference, an international palliative care congress, a fellows' education day, and a social work-focused summit. Pre-, post-, and eight-week follow-up surveys were administered, assessing Kirkpatrick's four levels of training evaluation. Results: In total, 203 palliative care clinicians completed the presurvey, 168 completed the post-survey, and 79 completed the eight-week follow-up. Knowledge of formulation increased from a median of 3 (interquartile range [IQR] 2-4) preworkshop to 5 (IQR 4-5) at eight weeks (p < 0.001). Knowledge of countertransference increased from 4 (IQR 3-4) to 5 (IQR 4-5) (also p < 0.001). Satisfaction was high (92% satisfied or highly satisfied), and most participants reported meaningful impact on their clinical practice (89%), teaching (93%), and team collaboration (93%) at eight-week follow-up. Conclusions: A multisite, half-day workshop significantly enhanced palliative care clinicians' knowledge and perceived application of core psychotherapeutic concepts. Future work should explore remote and longitudinal modalities to support ongoing skill integration.
Item Prescription Pain Medication Misuse Among Family Caregivers: A Call to Action.Turner, S.G.; Lee, A.; Pillemer, K.A.; Reid, M.C. (Oxford University Press, 3/23/25)There is a high prevalence of physical pain among family caregivers to older adults, and pain is a prominent contributor to caregiving difficulty. Many family caregivers with pain search for strategies to cope with the dual stressors of caregiving and physical pain. We hypothesize that family caregivers may be at increased risk for prescription pain medication use and misuse in ways that lead to both prescription and non-prescription substance abuse. Yet, existing data sources to study this topic are quite limited, thus the full scope of the topic is undetermined. In this forum article, we advocate for immediate research into family caregivers' prescription pain medication use. To catalyze this research, we theorize why caregivers might be at higher risk for prescription pain medication misuse using existing research and theory, and highlight existing restrictions and challenges to studying this topic using existing secondary data sources. We conclude by offering future research and clinical recommendations and offer an agenda to advance the state of the science on this topic.Item A Pilot Trial Evaluating Collaborative Healthcare Encounters With Caregivers: A Checklist-Based Intervention for Primary Care.Riffin, C.; Brody, L.; Wolff, J.L.; Pillemer, K.A. (SAGE Publications, 2/27/25)This pilot trial aimed to evaluate the feasibility, acceptability, and preliminary efficacy of Collaborative Healthcare Encounters with Caregivers (CHEC), a checklist-based intervention designed to enhance caregiver participation in older adults' primary care visits. N = 52 older patient-caregiver dyads were randomized to CHEC (n = 28) or usual care (n = 24). Visits were audio-recorded and analyzed according to a standardized coding procedure. Post-visit questionnaires assessed caregivers' perceptions of the checklist, efficacy in primary care interactions and knowledge of relevant resources. CHEC caregivers perceived the checklist to be useful and easy to complete. Visit duration was comparable in CHEC and usual care visits (M = 31.4 minutes vs. M = 31.8 minutes; p = .55), but CHEC visits allocated a greater proportion of time to discussing caregivers' concerns about the patient (32.9% vs. 18.9%; p = .04). CHEC caregivers reported slightly higher post-visit self-efficacy and significantly greater knowledge of relevant resources. Findings suggest CHEC's potential as a clinically feasible intervention for primary care. Clinical Trials Identifier: NCT04946942.Item Adaptation of a sleep hygiene intervention for individuals with poor sleep and their companions: Results of a randomized controlled pilot trial.Mindlis, I.; Millar, B.M.; Chkhaidze, A.; Fernández Sedano, B.; Noel, J.; Revenson, T.A. (Oxford University Press, 1/16/25)Sleep is a major health issue for young adults. While sleep hygiene interventions have small-to-moderate effects, better outcomes might be achieved by delivering interventions individually to those reporting sleep difficulties, or in the presence of a supportive other or companion. To examine the feasibility, acceptability, and initial effects of an adapted sleep hygiene intervention for young adults with poor sleep, we conducted an ORBIT Phase IIb pilot randomized controlled trial (n = 51). Young adults with poor sleep were randomized to receive a sleep hygiene intervention individually or with a companion. Sleep patterns were measured at baseline and 4 weeks. Participants completed daily dairies and wore wearable devices for the month following the intervention. Attrition at follow-up was minimal (3.9%), and missing rates were low for diary data (8%), and in line with prior studies for wearable devices (14%). Participants expressed high levels of satisfaction with the study, with no differences between study arms. Significant effects were found postintervention for all participants, indicating improved sleep quality (t = 6.14, P < .001), greater sleep duration (t = 3.8, P < .001), and reduced daytime sleepiness (t = 2.13, P = .039). There were no significant differences in sleep efficiency pre and postintervention, or between study arms for any sleep outcome based on self-reported and objective data. Results from this pilot provide evidence for the feasibility and acceptability of a sleep hygiene intervention for young adults and lay the groundwork for a larger, fully powered study.Item Distribution of opioid analgesics by community racial/ethnic and socioeconomic profiles, 2011-2021.Hu, J. C.; Chakraborty, P.; Zhang, H.; Portenoy, R.; Rosa, W, E.; Zhang, Y.; Reid, M. C.; Tamimi, R. M.; Zhang, F.; Bruera, E.; Paice, J. A.; Bao, Y. (1/21/25)Rapid declines in opioid analgesics dispensed in American communities since 2011 raise concerns about inadequate access to effective pain management among patients for whom opioid therapies are appropriate, especially for those living in racial/ethnic minority and socioeconomically deprived communities. Using 2011 to 2021 national data from the Automated Reports and Consolidated Ordering System and generalized linear models, this study examined quarterly per capita distribution of oxycodone, hydrocodone, and morphine (in oral morphine milligram equivalents [MMEs]) by communities' racial/ethnic and socioeconomic profiles. Communities (defined by 3-digit-zip codes areas) were classified as "majority White" (less than or equal to 50% self-reported non-Hispanic White population) vs "majority non-White." Community socioeconomic deprivation was measured by quartiles of population-weighted Social Deprivation Index. Overall, majority non-White communities had at least 40% lower mean adjusted per capita distribution than majority White communities across all levels of socioeconomic deprivation. Among the least deprived communities, the adjusted mean per capita distribution was 46.0 (95% confidence interval [CI], 40.0-52.0) for majority non-White vs 82.8 (95% CI, 78.5-87.1) MMEs for majority White communities. Among the most deprived communities, the distribution was 78.0 (95% CI, 70.8-85.1) for majority non-White vs 134.4 (95% CI, 125.4-143.4) MMEs for majority White communities. The lower distribution in majority non-White communities was statistically significant across all socioeconomic deprivation levels and over all study years. Availability of commonly prescribed opioid analgesics was substantially lower in majority non-White communities than in majority White communities across all levels of socioeconomic deprivation. Policies governing opioid analgesic availability warrant careful consideration and potential adjustments.Item Illness Intrusiveness, Perceived Control, and Quality of Life in Older Adults with Arthritis and Multimorbidity.Joshi, S.; Reid, M. C.; Mindlis, I. (1/22/25)OBJECTIVES: Arthritis is associated with poor quality of life (QOL) among older adults; and QOL is even worse among those with arthritis and multimorbidity (MM). Illness intrusiveness and perceived control have been identified in studies of single illnesses as modifiable mechanisms for QOL, but are understudied in older adults with arthritis and MM. We investigated the role of these potential mechanisms with QOL among older adults with arthritis and MM. METHODS: Secondary analysis of a sample of older adults aged ≥ 62 years with arthritis and MM (N = 228) using PROCESS macro for SPSS. RESULTS: Participants were on average 72 years with 4 chronic illnesses, and high levels of pain intensity and illness intrusiveness. Perceived control was a significant mediator (but not moderator) in the relationship between illness intrusiveness and QOL, even after adjustment for pain intensity [β = -0.16, 95% CI (-0.13, -0.06)]. CONCLUSIONS: Lower levels of illness intrusiveness were associated with improved QOL through greater perceived control. Longitudinal studies are needed to further assess these mechanisms in older adults with arthritis and MM to adapt existing interventions. CLINICAL IMPLICATIONS: Perceived control may be a target for future behavioral interventions to improve QOL in this population.