A5079321105- Palliative Care and End-of-Life Issues
- Health Systems, Economic Evaluations, Quality of Life
- Geriatric Care and Nursing Homes
- Patient Dignity and Privacy
- Chronic Disease Management Strategies
- Family and Patient Care in Intensive Care Units
- Patient-Provider Communication in Healthcare
- Frailty in Older Adults
- Pharmaceutical Practices and Patient Outcomes
- Grief, Bereavement, and Mental Health
- Health disparities and outcomes
- Childhood Cancer Survivors' Quality of Life
- Ethics and Legal Issues in Pediatric Healthcare
- Patient Satisfaction in Healthcare
- Dementia and Cognitive Impairment Research
- Ethics in medical practice
- Healthcare cost, quality, practices
- Heart Failure Treatment and Management
- Emergency and Acute Care Studies
- Medication Adherence and Compliance
- Intergenerational Family Dynamics and Caregiving
- Pelvic floor disorders treatments
- Family Support in Illness
- Obstructive Sleep Apnea Research
- Antibiotic Use and Resistance
Yale University
2016-2025
VA Connecticut Healthcare System
2016-2025
Center for Innovation
2024
Hartford Financial Services (United States)
2019
Dartmouth College
2015
Dartmouth Institute for Health Policy and Clinical Practice
2015
Institute on Aging
2011-2015
Yale Cancer Center
2014
Brown University
1993-2013
American College of Surgeons
2011-2012
The questions patients are asked about their preferences with regard to life-sustaining treatment usually focus on specific interventions, but the outcomes of and likelihood affect patients' preferences.
The most common chronic condition experienced by adults is multimorbidity, the coexistence of multiple diseases or conditions. In patients with coronary disease, for example, it sole in only 17% cases.1 Almost 3 4 individuals aged 65 years and older have conditions, as do 1 younger than who receive health care.2 Adults conditions are major users care services at all adult ages, account more two-thirds spending.2 Despite predominance however, reimbursement remains linked to discrete...
OBJECTIVES: To examine caregiver burden over time in caregivers of patients with advanced chronic disease. DESIGN: Observational cohort interviews 12 months. SETTING: Community. PARTICIPANTS: Caregivers 179 community‐living persons aged 60 and older cancer, heart failure (HF), or obstructive pulmonary disease (COPD). MEASUREMENTS: Caregiver was assessed using a short‐form the Zarit Burden Inventory to measure psychosocial distress. RESULTS: At baseline, median 5 (interquartile range (IQR)...
To examine factors associated with caregiver burden from a multifactorial perspective by examining and care recipient characteristics full range of caregiving tasks.Nationally representative surveys community-dwelling older adults their family caregivers residing in the United States.2011 National Health Aging Trends Study Caregiving.Community-dwelling caregivers.Caregiver burden, comprising emotional, physical, financial difficulties caregiving.An estimated 14.9 million assisted 7.6...
To estimate the number of caregivers providing assistance to community-dwelling older persons with and without dementia or substantial disability; describe characteristics care recipients in these groups; characterize health-related tasks that provide; associations between numbers caregiver burden.Nationally representative surveys adults United States.2011 National Health Aging Trends Study Caregiving.Community-dwelling their family caregivers, who were selected on basis having assisted...
Background:The rapidly expanding proportion of the US population 65 years and older is anticipated to have a profoundeffectonhealthcareexpenditures.Whetherthechanging health status Americans will modulate this effect not well understood.This study sought determine relationship between functional governmentreimbursed care services in persons.Methods: Longitudinal cohort representative sample community-dwelling persons 72 or older.Clinical data were linked with on 2-year expenditures for...
To examine agreement between patients, caregivers, and clinicians regarding prognosis communication to patients' caregivers' desire for prognostic information.Cross-sectional survey.Participants' homes.Two hundred fourteen persons aged 60 older with a limited life expectancy secondary cancer, congestive heart failure, or chronic obstructive pulmonary disease; caregivers; clinicians.Patient-clinician caregiver-clinician about the occurrence of discussions patient caregiver information.In 46%...
OBJECTIVES: To explore whether models of health behavior change can help to inform interventions for advance care planning (ACP). DESIGN: Qualitative cross‐sectional study. SETTING: Community. PARTICIPANTS: Sixty‐three community‐dwelling persons aged 65 and older 30 caregivers with experience as surrogate decision‐makers. MEASUREMENTS: In focus groups conducted separately caregivers, participants were asked discuss ways they had planned future declines in why or not engaged such planning....
Background: Few studies have examined physician–family caregiver communication at the end of life, despite important role families in end-of-life care decisions. We family reports physician about incurable illness, life expectancy, and hospice; timing these discussions; subsequent understanding issues. Design: Mixed methods study using a closed-ended survey 206 caregivers open-ended, in-depth interviews with 12 additional caregivers. Setting/Subjects: Two hundred eighteen primary patients...
Background-Clinicians are caring for an increasing number of older patients with multiple diseases, in the face uncertainty concerning benefits and harms associated guidelinedirected interventions.Understanding how primary care clinicians approach treatment decisionmaking these is critical to design improving decision-making process.Methods-Focus groups were conducted study forty (physicians, nurse-practitioners, physician assistants) academic, community, VA-affiliated practices.Participants...
OBJECTIVE : To determine the relationship between characteristics of older, long‐term stay nursing home patients and hospitalization. DESIGN A cohort study. SETTING One hundred three proprietary homes. PARTICIPANTS All residents these homes aged 65 or older admitted January 1, 1991, December 30, 1993, who had no transitions out during first 6 months their stay. MEASUREMENTS AND MAIN RESULTS Among 3782 residents, 931 (25%) were hospitalized at least once second In a logistic regression model,...
To examine the ways in which older persons with multiple conditions think about potentially competing outcomes order to gain insight into how processes elicit values regarding these can be grounded patient's perspective.Qualitative study consisting of purposefully sampled focus groups.Community.Persons aged 65 and taking five or more medications.Participants were asked their perceptions whether illnesses treatment interacted each other, goals treatment, decisions change stop...
Objectives: To examine the adequacy of caregiver‐patient communication in serious illness and its relationship to caregiver burden. Design: Cross‐sectional cohort study. Setting: Participants' homes. Participants: One hundred ninety‐three persons aged 60 older seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease their caregivers. Measurements: Communication concerns, measured terms agreement statements regarding desire for difficulty about patient's...
To identify factors associated with caregiver burden among those caring for terminally ill patients cancer.Cross-sectional study of interviews primary caregivers (n = 206) consecutive cancer enrolled in the largest hospice Connecticut.Data were collected on caregivers' sociodemographic characteristics, social network index, and number restrictions their own activities due to caregiving role. The outcome was a nine-item questionnaire adapted from Zarit Burden Inventory.The highest reported...
<h3>Background</h3> Little is known about the frequency and range of symptoms experienced by community-dwelling older persons with advanced chronic disease who are not enrolled in hospice. The objectives our study were to determine (1) prevalence a among (2) whether similar across diagnoses. <h3>Methods</h3> This was cross-sectional reported 226 60 years or obstructive pulmonary (COPD), cancer, congestive heart failure (CHF). Symptoms assessed using Edmonton Symptom Assessment System....
OBJECTIVES: To develop stages‐of‐change measures for advance care planning (ACP), conceptualized as a group of interrelated but separate behaviors, and to use these characterize older persons' engagement in factors associated with readiness participate ACP. DESIGN: Observational cohort study. SETTING: Community. PARTICIPANTS: Persons aged 65 recruited from physician offices senior center. MEASUREMENTS: Stages change six ACP behaviors: completion living will healthcare proxy, communication...
To determine whether preferences for future attempts at life-sustaining treatment change over time in a consistent and predictable manner.Observational cohort study.Community.One hundred eighty-nine community-dwelling persons ages 60 older with advanced cancer, heart failure, or chronic obstructive pulmonary disease.Participants were asked, if faced an illness exacerbation that would be fatal untreated, they undergo high-burden therapy chance to avoid death risk impaired health state death....
<h3>Background</h3> Symptoms are a central component of health status; however, little is known about the full range and trajectory symptoms experienced by persons with chronic diseases other than cancer. <h3>Methods</h3> Observational cohort study interviews performed at least every 4 months for up to 2 years among community-dwelling 60 or older obstructive pulmonary disease (COPD) heart failure (HF). Seven rated as absent, mild, moderate, severe were assessed each interview....
New approaches are needed to treat patients with stroke. Among acute ischemic stroke patients, our primary objectives were describe the prevalence of sleep apnea and demonstrate feasibility providing auto-titrating continuous positive airway pressure (auto-CPAP). A secondary objective was examine effect auto-CPAP on severity. Stroke randomized intervention group received 2 nights auto-CPAP, but only those evidence for remainder 30-day period. Intervention polysomnography 30 days post-stroke....