Publications by authors named "Lana Sargent"

27 Publications

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Frailty Risks of Prescription Analgesics and Sedatives across Frailty Models: the Health and Retirement Study.

Drugs Aging 2022 May 20. Epub 2022 May 20.

Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.

Introduction: Limited evidence for incident frailty risks associated with prescription analgesics and sedatives in older (≥ 65 years) community-living adults prompted a more comprehensive investigation.

Methods: We used data from older Health and Retirement Study respondents and three frailty models (frailty index, functional domain, frailty phenotype with 8803, 10,470, and 6850 non-frail individuals, respectively) and estimated sub-hazard ratios of regular prescription drug use (co-use, analgesic use, and sedative use), by frailty model. We addressed confounding with covariate adjustment and propensity score matching approaches.

Results: The baseline prevalence of analgesic and sedative co-use, analgesic use, and sedative use among non-frail respondents was 1.8%, 12.8%, and 4.7% for the frailty index model, 4.2%, 16.2%, and 5.3% for the functional domain model, and 4.3%, 15.4%, and 6.1% for the frailty phenotype model, respectively. Cumulative frailty incidence over 10 years was 39.3%, 36.1%, and 14.2% for frailty index, functional domain, and frailty phenotype models, respectively; covariate-adjusted sub-hazard ratio estimates were 2.00 (1.63-2.45), 1.83 (1.57-2.13), and 1.68 (1.21-2.33) for co-use; 1.72 (1.56-1.89), 1.38 (1.27-1.51), and 1.51 (1.27-1.79) for analgesic use; and 1.46 (1.24-1.72), 1.25 (1.07-1.46), and 1.31 (0.97-1.76) for sedative use. Frailty risk ranking (co-use > analgesic use > sedative use) persisted across all model sensitivity analyses.

Discussion: Consistently significant frailty risk estimates of regular prescription analgesic and sedative co-use and of prescription analgesic use support existing clinical, public health, and regulatory guidance on opioid and benzodiazepine co-prescription, on opioid prescription, and on NSAID prescription. Frailty phenotype measurement administration limited power to detect significant frailty risks. Research into specific pharmaceutical exposures and comparison of results across cohorts will be required to contribute to the deprescribing evidence base.
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http://dx.doi.org/10.1007/s40266-022-00941-2DOI Listing
May 2022

Non-Latinx Healthcare Provider's Knowledge and Awareness of Latinx Geriatric Clinical Health Needs.

Clin Gerontol 2022 Apr 28:1-12. Epub 2022 Apr 28.

VCU Institute for Inclusion, Inquiry and Innovation (iCubed), Richmond, Virginia, USA.

Objectives: Due to the exponential growth in the Latinx older adult population, culturally responsive services are needed, especially since most healthcare providers are non-Latinx with limited Spanish or bilingual skills. One place to start is by drawing a formative assessment of the healthcare providers' knowledge and awareness of the healthcare needs of Latinx older adults.

Methods: Focus groups were conducted to explore the healthcare providers' knowledge and awareness of cultural and structural barriers and facilitators to accessing health care services for Latinx older adults.

Results: Results note that healthcare providers perceived the healthcare needs for Latinx older adults to be underutilized for healthcare services, preventive interventions for healthy diet/lifestyle, and healthcare knowledge. Providers reported Latinx family over-involvement, religiosity, immigration, and language/lack of interpreters as barriers to seeking timely healthcare. Finally, healthcare providers said that family support, the location of healthcare services, and community-based partnerships were all facilitators for seeking healthcare.

Conclusions: Findings suggest providers' conflicting perspectives toward the Latinx communities.

Clinical Implications: Healthcare services can consider implementing trainings for non-Latinx providers to recognize conflicting perspectives and reduce implicit bias toward the Latinx communities.
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http://dx.doi.org/10.1080/07317115.2022.2065943DOI Listing
April 2022

Multi-modality machine learning predicting Parkinson's disease.

NPJ Parkinsons Dis 2022 Apr 1;8(1):35. Epub 2022 Apr 1.

Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA.

Personalized medicine promises individualized disease prediction and treatment. The convergence of machine learning (ML) and available multimodal data is key moving forward. We build upon previous work to deliver multimodal predictions of Parkinson's disease (PD) risk and systematically develop a model using GenoML, an automated ML package, to make improved multi-omic predictions of PD, validated in an external cohort. We investigated top features, constructed hypothesis-free disease-relevant networks, and investigated drug-gene interactions. We performed automated ML on multimodal data from the Parkinson's progression marker initiative (PPMI). After selecting the best performing algorithm, all PPMI data was used to tune the selected model. The model was validated in the Parkinson's Disease Biomarker Program (PDBP) dataset. Our initial model showed an area under the curve (AUC) of 89.72% for the diagnosis of PD. The tuned model was then tested for validation on external data (PDBP, AUC 85.03%). Optimizing thresholds for classification increased the diagnosis prediction accuracy and other metrics. Finally, networks were built to identify gene communities specific to PD. Combining data modalities outperforms the single biomarker paradigm. UPSIT and PRS contributed most to the predictive power of the model, but the accuracy of these are supplemented by many smaller effect transcripts and risk SNPs. Our model is best suited to identifying large groups of individuals to monitor within a health registry or biobank to prioritize for further testing. This approach allows complex predictive models to be reproducible and accessible to the community, with the package, code, and results publicly available.
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http://dx.doi.org/10.1038/s41531-022-00288-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8975993PMC
April 2022

Socioeconomic Effects on Psychosocial Factors Among Low-Income Older Adults.

Gerontol Geriatr Med 2022 Jan-Dec;8:23337214221084866. Epub 2022 Mar 12.

School of Nursing, Virginia Commonwealth University, Richmond, VA, USA.

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 (=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, <.05) and positive change (f = 8.40, <.01), and education effects for COVID History (f = 4.20, <.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.
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http://dx.doi.org/10.1177/23337214221084866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8921758PMC
March 2022

COVID in Context: The Lived Experience of Richmond's Low-Income Older Adults.

Gerontol Geriatr Med 2022 Jan-Dec;8:23337214221079208. Epub 2022 Feb 25.

School of Nursing, Virginia Commonwealth University, Richmond, VA, USA.

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.
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http://dx.doi.org/10.1177/23337214221079208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8891881PMC
February 2022

Anticholinergic Medication Burden in Parkinson's Disease Outpatients.

J Parkinsons Dis 2022 ;12(2):599-606

Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA.

Background: Individuals with Parkinson's disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications.

Objective: To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients.

Methods: We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients.

Results: Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55).

Conclusion: A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.
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http://dx.doi.org/10.3233/JPD-212769DOI Listing
April 2022

Antimuscarinic Anticholinergic Medications in Parkinson Disease: To Prescribe or Deprescribe?

Mov Disord Clin Pract 2021 Nov 8;8(8):1181-1188. Epub 2021 Oct 8.

Department of Neurology University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA.

The relative importance of antimuscarinic anticholinergic medications for Parkinson's disease (PD) declined after the introduction of levodopa, such that anticholinergic medications are now much more likely to be prescribed for clinical indications other than parkinsonism. Recent studies have found an association between anticholinergic medication exposure and future risk of dementia in older individuals and those with PD. These findings provide a further reason to avoid the use of anticholinergic medications to treat motor symptoms of PD. More importantly, they raise the question of whether one of the goals of PD treatment should be to deprescribe all medications with anticholinergic properties, regardless of their indication, to reduce dementia risk. In this review, we discuss the use of anticholinergic medications in PD, the evidence supporting the association between anticholinergic medications and future dementia risk, and the potential implications of these findings for clinical care in PD.
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http://dx.doi.org/10.1002/mdc3.13347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8564829PMC
November 2021

Evidence for connecting multiple neurodegenerative diseases.

Brain Commun 2021 1;3(2):fcab095. Epub 2021 May 1.

Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA.

Previous research using genome-wide association studies has identified variants that may contribute to lifetime risk of multiple neurodegenerative diseases. However, whether there are common mechanisms that link neurodegenerative diseases is uncertain. Here, we focus on one gene, , encoding progranulin, and the potential mechanistic interplay between genetic risk, gene expression in the brain and inflammation across multiple common neurodegenerative diseases. We utilized genome-wide association studies, expression quantitative trait locus mapping and Bayesian colocalization analyses to evaluate potential causal and mechanistic inferences. We integrate various molecular data types from public resources to infer disease connectivity and shared mechanisms using a data-driven process. Expression quantitative trait locus analyses combined with genome-wide association studies identified significant functional associations between increasing genetic risk in the region and decreased expression of the gene in Parkinson's, Alzheimer's and amyotrophic lateral sclerosis. Additionally, colocalization analyses show a connection between blood-based inflammatory biomarkers relating to platelets and expression in the frontal cortex. expression mediates neuroinflammation function related to multiple neurodegenerative diseases. This analysis suggests shared mechanisms for Parkinson's, Alzheimer's and amyotrophic lateral sclerosis.
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http://dx.doi.org/10.1093/braincomms/fcab095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134835PMC
May 2021

Factors Affecting Quality of Life in Patients Receiving Autologous Hematopoietic Stem Cell Transplantation.

Cancer Nurs 2022 Mar-Apr 01;45(2):E552-E559

Author Affiliations: Department of Adult Health and Nursing Systems (Drs Mohanraj, Sargent, and Swift-Scanlan); Department of Family and Community Health Nursing (Dr Elswick), School of Nursing; and Department of Internal Medicine, School of Medicine (Dr Toor), Virginia Commonwealth University, Richmond.

Background: Hematopoietic stem cell transplant (HSCT) is a potentially curative treatment for hematologic malignancies, with 22 000 HSCTs performed annually in the United States. However, decreased quality of life (QoL) is a frequent and concerning state reported by HSCT recipients.

Objectives: We sought to determine if measurements of frailty and cognitive impairment were associated with fatigue and QoL in adult HSCT recipients after autologous HSCT.

Methods: Using a longitudinal study design, 32 participants 18 years or older receiving autologous HSCT were recruited from a bone marrow transplant clinic. Each participant completed 2 visits: pre-HSCT and post-HSCT. At each visit, participants completed assessment tools to measure frailty, cognitive impairment, fatigue, and QoL (assesses physical, social/family, emotional, functional, and transplant-related well-being).

Results: Participants with increased fatigue scores reported decreased QoL pre- and post-HSCT. Participants with increased frailty showed decreased functional well-being before HSCT and showed correlations with decreased physical, social, and transplant-related well-being post-HSCT. As expected, fatigued participants also showed increased frailty post-HSCT. Participants showed significant changes in physical well-being and fatigue between pre-HSCT and post-HSCT visits.

Conclusion: Data analyses from this pilot study show significant correlations between subsets of QoL with fatigue and frailty in autologous HSCT participants pre- and post-HSCT.

Implications For Practice: Understanding the impact of frailty on fatigue and QoL in HSCT recipients is critical to assist nurses in initiating educational and behavioral interventions to help mitigate the effects of HSCT.
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http://dx.doi.org/10.1097/NCC.0000000000000990DOI Listing
April 2022

Understanding the preference for receiving mental health and substance use support in African Americans 50 and older.

J Prev Interv Community 2021 May 31:1-19. Epub 2021 May 31.

Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA.

Objective: 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 Americans ages 50 and older.

Methods: Data from 368 African American individuals (aged 50+) who participated in a community-based needs assessment survey were used. Preferences included community-based (e.g., health centers) and traditional settings (e.g., doctor's office). SU was measured as a categorical variable detailing past-month use of conventional cigarettes and alcohol graded by risk levels. Logistic regression models tested the associations between SU and setting preference before and after adjusting for the influence of self-reported MH diagnoses.

Results: Prior to adjustment for the influence of MH outcomes, high-risk use of tobacco and alcohol in the past month was associated with a lower odds of preferring MH/SU support in traditional settings (OR = 0.23, 95% CI = 0.06-0.85) compared to participants engaged in no-/low- risk substance use. This association was no longer significant after accounting for the influence of mental health symptoms and covariates.

Discussion: These results provide preliminary evidence that mental health outcomes mediate the association between substance use and setting preference for seeking MH/SU support in traditional settings.

Translational Significance: This exploratory study encourages additional investigation of the association between substance use, setting preferences, and the likelihood of seeking treatment in community health centers using larger sample sizes. Additional opportunities to offer mental health/substance use support to African American older adults within clinical settings should be explored.
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http://dx.doi.org/10.1080/10852352.2021.1930820DOI Listing
May 2021

Creating structural community cohesion: Addressing racial equity in older adult homelessness.

J Prev Interv Community 2021 May 25:1-13. Epub 2021 May 25.

College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA.

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.
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http://dx.doi.org/10.1080/10852352.2021.1930819DOI Listing
May 2021

Frailty in Patients With Hematologic Malignancies and Those Undergoing Transplantation: A Scoping Review.

Oncol Nurs Forum 2021 05;48(3):291-307

Virginia Commonwealth University.

Problem Identification: Although frailty is an important parameter in treatment planning and in predicting prognosis and overall survival among patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation, frailty assessment tools are not standardized in clinical care settings. The purpose of this article is to provide an overview of the literature on frailty assessment tools in these patient populations.

Literature Search: A systematic search of CINAHL®, Embase®, MEDLINE®, PubMed®, and Web of Science was performed using keywords and controlled vocabulary for the concepts "bone marrow transplants," "hematologic neoplasms," and "frailty."

Data Evaluation: Extracted data included study type, diagnosis, transplantation status, frailty tools used, and outcome measures.

Synthesis: A systematic search resulted in 24 studies that met the inclusion criteria. There were significant differences in how various groups define and assess frailty.

Implications For Practice: Addressing the lack of standardized frailty assessments will assist healthcare providers to routinely integrate frailty measures in clinical assessments to identify those at risk for poor outcomes, improving personalized care.
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http://dx.doi.org/10.1188/21.ONF.291-307DOI Listing
May 2021

GPS Tracking Technologies to Measure Mobility-Related Behaviors in Community-Dwelling Older Adults: A Systematic Review.

J Appl Gerontol 2021 05 24;40(5):547-557. Epub 2020 Dec 24.

Virginia Commonwealth University, Richmond, USA.

Global positioning system (GPS) technology has been increasingly used in aging research as a tool for reliably capturing the level and patterns of mobility among older adults. This article aims to systematically review the current state of GPS-based mobility research with community-dwelling older adults. Twenty-nine studies from 2008 to 2019 are included. Included studies examined various forms of temporal and spatial mobility measures. This review provides a synthesis of the current evidence on the risk factors or correlates of GPS-driven mobility limitations, such as demographic, cognitive, physical, psychological, and environmental factors. There is variability in types of GPS technology and GPS-derived mobility measures, GPS recording methods, data processing, and correlates of mobility limitation across studies. Future research should focus on identifying meaningful GPS-derived mobility measures and developing standardized protocols for GPS administration and data analytics for comparison across studies.
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http://dx.doi.org/10.1177/0733464820979801DOI Listing
May 2021

Bringing Transdisciplinary Aging Research From Theory to Practice.

Gerontologist 2022 02;62(2):159-168

School of Nursing, Virginia Commonwealth University, Richmond, USA.

There is a growing emphasis to use a transdisciplinary team approach to accelerate innovations in science to solve complex conditions associated with aging. However, the optimal organizational structure and process for how to accomplish transdisciplinary team science is unclear. In this forum, we illustrate our team's experience using transdisciplinary approaches to solve challenging and persistent problems for older adults living in urban communities. We describe our challenges and successes using the National Institutes of Health four-phase model of transdisciplinary team-based research. Using a de-identified survey, the team conducted an internal evaluation to identify features that created challenges including structural incongruities, interprofessional blind spots, group function, and group dynamics. This work resulted in the creation of the team's Transdisciplinary Conceptual Model. This model became essential to understanding the complex interplay between societal factors, community partners, and academic partners. Conducting internal evaluations of transdisciplinary team processes is integral for teams to move beyond the multi- and interdisciplinary niche and to reach true transdisciplinary success. More research is needed to develop measures that assess team transdisciplinary integration. Once the process of transdisciplinary integration can be reliably assessed, the next step would be to determine the impact of transdisciplinary team science initiatives on aging communities.
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http://dx.doi.org/10.1093/geront/gnaa214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8827331PMC
February 2022

Influence of physiological and psychological factors on cognitive dysfunction in heart failure patients.

Appl Nurs Res 2020 12 24;56:151375. Epub 2020 Oct 24.

Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, Richmond, VA 23298, United States of America.

Aim: Our study aimed to examine factors that contribute to cognitive dysfunction in patients with heart failure (HF).

Background: Although a majority of patients with HF have mild to moderate cognitive impairment, little is known about factors that influence progressive cognitive decline in this population.

Methods: We examined the influence of physiological factors (NYHA functional class II - IV, ejection fraction, co-morbidity burden, polypharmacy), psychosocial factors (anxiety, depression, evaluation for advanced therapy), and associated toxicities (anticholinergic drug burden), on cognitive dysfunction. Data were analyzed using mean (SE) for continuous variables and frequency and percent for categorical variables. Differences between NYHA functional classification (Class II vs. Class III/IV) were examined using Chi Square. Linear regression models were used to assess associations among model variables.

Results: Of the 113 participants with HF, Class III-IV HF were more cognitively impaired than those with NYHA Class II (p < 0.0001), had higher anxiety (p = 0.002), and depression (p = 0.003), and lower EF (p = 0.041). A majority of participants had a moderate anticholinergic drug burden, and NYHA Class III/IV participants had significantly higher medication counts than Class II participants (p = 0.034). Regression analysis found that NYHA Class III/IV, anxiety, depression and evaluation for advanced therapy significantly influenced cognitive dysfunction.

Conclusions: Findings support a high prevalence of cognitive dysfunction, anxiety, and depression in NYHA class II-IV with a greater level of cognitive dysfunction in class III/IV patients.
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http://dx.doi.org/10.1016/j.apnr.2020.151375DOI Listing
December 2020

Sex and Age Differences in Ambulatory Blood Pressure Monitoring Tolerability.

Am J Hypertens 2021 04;34(4):335-338

Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA.

Background: Clinical practice guidelines endorse using ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension. However, ABPM is not always tolerated by patients, and differences between individuals according to age and sex remain unexplored.

Methods: This is a post hoc analysis of a prospective, single-arm clinical trial (NCT03920956) that evaluated the feasibility of an ABPM service provided at 2 community pharmacies. Tolerability was assessed using a previously published survey, which included 7 yes/no questions and 8 answered on a scale of 0-10. Descriptive statistics and Chi-square analyses were used to summarize the data for the patient surveys and to describe sex and age differences in device tolerability.

Results: Of the 52 subjects enrolled, 50 (96%) completed the survey; half were female with a mean (SD) age of 57.5 years (15.8). Chi-square analyses showed that compared with their male counterparts, females were more likely to find the monitor cumbersome to wear (76.2% vs. 40%, P = 0.014). Subjects under 55 years of age were more likely to be disturbed by the noise of the monitor during driving (38.1% vs. 4.2%, P = 0.005) and at other times (35.0% vs. 8.3%, P = 0.029), and to find the monitor embarrassing to wear (33.3% vs. 7.1%, P = 0.019).

Conclusions: Although ABPM was generally well-tolerated overall, we did identify age and sex differences in tolerability. These factors should be considered to ensure patient acceptance and tolerability of ABPM.
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http://dx.doi.org/10.1093/ajh/hpaa182DOI Listing
April 2021

A case study in rapid adaptation of interprofessional education and remote visits during COVID-19.

J Interprof Care 2020 Sep-Oct;34(5):702-705. Epub 2020 Aug 24.

School of Nursing, Virginia Commonwealth University , Richmond, VA, USA.

The Richmond Health and Wellness Program (RHWP) is an innovative interprofessional care coordination program that seeks to support the health and wellness of independent-living older adults and educate future practitioners. Since 2012, RHWP has provided community-based interprofessional training to students at Virginia Commonwealth University. The sudden suspension of clinical and community-based training due to the COVID-19 pandemic created the need to transform the traditional ways students received clinical education and support the vulnerable communities served by RHWP. This paper describes RHWP's rapid transition to a hybrid telephone-based program with a virtual learning component for students which allowed RHWP to continue serving its participants and provide interprofessional training experiences. Since the transition, RHWP has served 111 participants through over 400 telephonic visits, and 12 nurse practitioner and pharmacy students completed clinical hours to fulfill graduation requirements. To meet the needs of learners, interprofessional education models can be adapted to changing circumstances posed by COVID-19.
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http://dx.doi.org/10.1080/13561820.2020.1807921DOI Listing
November 2020

Shared mechanisms for cognitive impairment and physical frailty: A model for complex systems.

Alzheimers Dement (N Y) 2020 15;6(1):e12027. Epub 2020 Jul 15.

Laboratory of Neurogenetics National Institute on Aging National Institutes of Health Bethesda Maryland USA.

Introduction: We describe findings from a large study that provide empirical support for the emerging construct of cognitive frailty and put forth a theoretical framework that may advance the future study of complex aging conditions. While cognitive impairment and physical frailty have long been studied as separate constructs, recent studies suggest they share common etiologies. We aimed to create a population predictive model to gain an understanding of the underlying biological mechanisms for the relationship between physical frailty and cognitive impairment.

Methods: Data were obtained from the longitudinal " (Aging in Chianti, InCHIANTI Study) with a representative sample (n = 1453) of older adults from two small towns in Tuscany, Italy. Our previous work informed the candidate 132 single nucleotide polymorphisms (SNPs) and 155 protein biomarkers we tested in association with clinical outcomes using a tree boosting, machine learning (ML) technique for supervised learning analysis.

Results: We developed two highly accurate predictive models, with a Model I area under the curve (AUC) of 0.88 (95% confidence interval [CI] 0.83-0.90) and a Model II AUC of 0.86 (95% CI 0.80-0.90). These models indicate cognitive frailty is driven by dysregulation across multiple cellular processes including genetic alterations, nutrient and lipid metabolism, and elevated levels of circulating pro-inflammatory proteins.

Discussion: While our results establish a foundation for understanding the underlying biological mechanisms for the relationship between cognitive decline and physical frailty, further examination of the molecular pathways associated with our predictive biomarkers is warranted. Our framework is in alignment with other proposed biological underpinnings of Alzheimer's disease such as genetic alterations, immune system dysfunction, and neuroinflammation.
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http://dx.doi.org/10.1002/trc2.12027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362211PMC
July 2020

Challenges in pharmacotherapy for older adults: a framework for pharmacogenomics implementation.

Pharmacogenomics 2020 06 19;21(9):627-635. Epub 2020 May 19.

Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA.

Older adults are at high risk for inappropriate prescribing, developing polypharmacy, adverse drug events and poor treatment outcomes due to multimorbidity and geriatric syndromes. Pharmacogenomics could allow healthcare professionals to provide optimal patient care while minimizing the risk of adverse drug events and simplifying complex medication regimens. The implementation of pharmacogenomics in geriatrics medicine requires a broad multilayered bottom-up approach. These include curriculum redesign, rethinking experiential education and patient and provider education. There are barriers associated with adopting pharmacogenomics into clinical practice. These barriers may include economic factors, workflow and informatics support. However, addressing these barriers primarily requires creating a culture of innovative practices in patient care, ongoing interprofessional continuing education and an interdisciplinary approach for patient care.
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http://dx.doi.org/10.2217/pgs-2019-0198DOI Listing
June 2020

An Interprofessional Workshop to Enhance De-prescribing Practices Among Health Care Providers.

J Contin Educ Health Prof 2020 ;40(1):49-57

Mrs. Zimmerman: Associate Professor, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA. Dr. Linsky: Assistant Professor, VA Boston Healthcare System, Department of Medicine, Center for Healthcare Organization and Implementation Research, and Assistant Professor, Boston University School of Medicine, Boston, MA. Dr. Donohoe: Associate Professor, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA. Dr. Hobgood: Associate Professor, Department of Internal Medicine, Division of Geriatric Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA. Dr. Sargent: Assistant Professor, Department of Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing, Richmond, VA. Dr. Salgado: Assistant Professor, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA.

Introduction: De-prescribing is a complex behavior that benefits from a multifaceted approach to learning. We sought to create and deliver a 1-day interprofessional workshop to enhance de-prescribing knowledge and skills among health care professionals.

Methods: Workshop development was based on the Adult Learning Theory and the Theoretical Domains Framework. The workshop addressed provider-related barriers, was created and delivered by an interprofessional team, and combined didactic and active learning techniques. Targeted participants included physicians, advanced practice providers (nurse practitioners and physician's assistants), pharmacists, and clinic staff. Interprofessional workgroups were created a priori. Participants were asked to complete a postprogram evaluation, including whether they would implement changes to practice, teaching, research, or administrative duties after participation.

Results: We created an in-person, 5.5 credit hour, interprofessional de-prescribing workshop that comprised six sessions: (1) polypharmacy and de-prescribing overview; (2) identification of potentially inappropriate medications; (3) prioritization of medications for de-prescribing; (4) design and implementation of a de-prescribing plan; (5) principles for a patient-centered approach; and (6) suggestions for successful collaboration. Forty-one participants attended the workshop, and 38 (92.7%) completed the postprogram assessment. Participants felt they were likely to implement changes in practice, teaching, research, or administrative duties, rating themselves with a mean of 9.2 (SD = 1.06) on a 1 to 10 scale. Ultimately, 96.6% would recommend the workshop to others.

Discussion: Based on participant feedback, the workshop catalyzed intention to change practice, teaching, research, or administrative duties. Other institutions seeking to change the complex behavior of de-prescribing may wish to model this development and delivery strategy.
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http://dx.doi.org/10.1097/CEH.0000000000000280DOI Listing
April 2021

Anticholinergic Drug Induced Cognitive and Physical Impairment: Results from the InCHIANTI Study.

J Gerontol A Biol Sci Med Sci 2020 04;75(5):995-1002

Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland.

Background: The aims of this study were to evaluate the relationship between anticholinergic drug burden (ACB) cognitive impairment, physical frailty, and cognitive frailty, and to determine if ACB is predictive of these phenotypes when modeled with biological and genomic biomarkers.

Methods: In a retrospective cohort study, a total of 1,453 adults aged 20-102 years were used to examine ACB as a predictor for cognitive impairment, physical frailty, and cognitive frailty. Anticholinergic burden is examined as a predictor for all phenotypes in a cross-sectional analysis using logistic, ordinal regression models, and Extreme Gradient Boosting for population predictive modeling.

Results: A significant association was found between ACB and cognitive decline (p = .02), frailty (p < .001), and cognitive frailty (p < .001). The odds of cognitive impairment increased by 1.21 (95% confidence interval [CI] = 1.06-1.37, p < .001), odds of being frail increased by 1.33 (95% CI = 1.18-1.50, p < .001), and odds of having cognitive frailty increased by 1.36 (95% CI = 1.21-1.54, p < .001). Population modeling results indicated ACB score as one of the stronger predictors for cognitive impairment, physical frailty, and cognitive frailty with area under the curves ranging from 0.81 to 0.88.

Conclusions: Anticholinergic medications are a potentially modifiable risk factor for the prevention of cognitive and physical decline. Identification of reversible causes for cognitive and physical impairment is critical for the aging population. These findings encourage new research that may lead to effective interventions for deprescribing programs for the prevention of cognitive and physical decline in older adults.
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http://dx.doi.org/10.1093/gerona/gly289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357452PMC
April 2020

Shared biological pathways for frailty and cognitive impairment: A systematic review.

Ageing Res Rev 2018 11 10;47:149-158. Epub 2018 Aug 10.

Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA.

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http://dx.doi.org/10.1016/j.arr.2018.08.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376483PMC
November 2018

Putative mechanisms of cognitive decline with implications for clinical research and practice.

Nurs Forum 2018 Jan 18. Epub 2018 Jan 18.

School of Nursing, Virginia Commonwealth University, Richmond, VA.

Multiple intrinsic and extrinsic mechanisms contribute to vulnerability of cognitive decline and nurses play a significant role in assisting individuals and families to use strategies for healthy cognitive aging. The objective of this narrative review is to provide a synthesis of the intrinsic and extrinsic mechanisms of cognitive decline and conditions that are associated with cognitive decline. Well-established intrinsic mechanisms of cognitive decline include aging, apolipoprotein E (APOE) ε4 carrier status, SORL1 mutations, neuroinflammation, mitochondrial dysfunction, amyloid deposition, and demyelination. Extrinsic risk factors include obesity, diabetes, hypertension, elevated lipid panel, metabolic syndrome, depression, traumatic brain injury, substance use, heart failure, and stroke. The various definitions of cognitive decline as well as the intrinsic and extrinsic factors that impact cognition as humans age should be incorporated in future clinical research studies. Nurses may use this information to help patients make lifestyle choices regarding cognitive health.
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http://dx.doi.org/10.1111/nuf.12247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438756PMC
January 2018

Progressive Assessment and Competency Evaluation Framework for Integrating Simulation in Nurse Practitioner Education.

J Nurse Pract 2017 Jul-Aug;13(7):e301-e310. Epub 2017 May 12.

Ashley Foster, MS, ACNP-BC, is an adjunct faculty member at the Virginia Commonwealth University School of Nursing. In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

Competencies for nurse practitioner students have been published with the goal of preparing graduates who are ready to meet the challenges of an increasingly complex health care system. Standardized preclinical assessment of graduate-level competencies have been suggested as a means to optimize the student experience in clinical rotations and maximize the preceptor's time toward preparing students for the transition to independent practice. The main objectives of this study are to describe progressive assessment and competency evaluation as an integral framework for integration of simulation in graduate-level curriculum and present the feasibility and challenges to consider during implementation of Progressive Assessment and Competency Evaluation-directed simulations.
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http://dx.doi.org/10.1016/j.nurpra.2017.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397912PMC
May 2017

Community-Based Care of the Fibromyalgia Patient: Strategies to Promote Self-Management.

Home Healthc Now 2017 Jul/Aug;35(7):364-372

Kimberly Davis, MS, RN, CNE, is an Assistant Clinical Professor, School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Lana Sargent, MSN, RN, FNP-C, GNP-BC, is an Assistant Clinical Professor, School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Victoria Menzies, PhD, RN, PMHCNS-BC, FAAN, is an Associate Professor, School of Nursing, Virginia Commonwealth University, Richmond, Virginia.

Along with a variety of distressing symptoms, a diagnosis of fibromyalgia (FM) brings with it substantial physical, psychosocial, and financial costs. Research shows that self-management is an effective means to manage FM and can lead to fewer healthcare visits. Yet due to the complexity of this disorder, healthcare providers need to be able to tailor treatment to individual patients by understanding effective treatment interventions. Home healthcare nurses (HHNs) are in a unique position to assess and implement effective treatment recommendations in the home setting and as such could consider incorporating self-management strategies into the home visit with the FM patient. Therefore, the purpose of this article is to use a case study to describe the assessment of FM patient's functional ability and quality of life and how the HHN may integrate self-management teaching into the established home care visit. A review of the literature and discussion of self-management interventions for the FM patient is presented. A summary of the case study and proposed clinical implications is offered.
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http://dx.doi.org/10.1097/NHH.0000000000000570DOI Listing
April 2018

Transforming the Classroom With Tablet Technology.

Nurse Educ 2016 Nov/Dec;41(6):309-312

Author Affiliations: Faculty Instructor, PhD Candidate, (Ms Sargent) and eLearning Developer (Ms Miles), School of Nursing, Virginia Commonwealth University, Richmond.

Identifying the most effective models for integrating new technology into the classroom and understanding its effects on educational outcomes are essential for nurse educators. This article describes an educational intervention with tablet technology (iPads) using an innovative case-based learning model in a nursing program. Students reported positive learning outcomes when using the tablet technology for learning course content.
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http://dx.doi.org/10.1097/NNE.0000000000000278DOI Listing
April 2017

Meeting the needs of new-graduate nurse practitioners: a model to support transition.

J Nurs Adm 2013 Nov;43(11):603-10

Author Affiliations: Clinical Instructor (Ms Sargent), VCU School of Nursing, Richmond, Virginia; Family Nurse Practitioner Residency Director (Dr Olmedo), Family Health Center of Worcester Inc, Massachusetts.

The transition of newly graduated nurse practitioners (NPs) into practice can be challenging for the employer and the NPs. A new-graduate residency model for NPs along with evaluative criteria is presented from a primary care setting. Residency models are of benefit for new-graduate NPs to ease the transition to practice and promote patient care quality, and nurse retention, and satisfaction.
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http://dx.doi.org/10.1097/01.NNA.0000434506.77052.d2DOI Listing
November 2013
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