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2011 Publication Abstracts

  1. Ramirez, M., Ahluwalia, K.P., and Teresi, J.A. (2011). Correlates of dental visits among community-residing Latino elders: a public health alert. Gerodontology; 28: 12-18.


     Objectives: To examine oral service utilization in a probability sample of community-residing Latino elders.

     Background: Older Latinos are at a potential increased risk of oral diseases, given their higher prevalence of co-morbidities and lower rate of dental service utilization.

     Methods: A prevalence survey was conducted among a random sample of Latino (largely Puerto Rican) elders (n=205; mean age=75.8; SD±5.3) in New York City during 2001-2002. A systematic random sample was drawn from the Centers for Medicare and Medicaid Services Beneficiary tape files. Current use of oral health services and self-reported health conditions was obtained. Functional and cognitive impairment were assessed.

     Results: Less than half of the sample reported a dental visit in the previous year. The average time since the last dental visit was 54 months (SD ± 84.5). Last year dental visit compliers were more likely to be unmarried, living alone, with higher levels of education, health conditions and less impairment with activities of daily living. In multivariate analyses, problem-oriented behaviour. Medicaid beneficiary, education, livig alone, chronic health conditions and mobility impairment explained 14% of the 'time since last dental visit' variance.

     Conclusions: Given that socio-demographic and level of functioning determination appear to influence the frequency of dental visits, a multilevel approach to oral health promotion is imperative.


  2. Weinstock, R.S., Brooks, G., Palmas, W., Morin, P., Eimicke, J.P., Silver, S., Teresi, J.A., Izquierdo, R., Goland, R., Shea, S.  (2011). Lessened Decline in Physical Activity and Impairment of Older Adults with Diabetes with telemedicine and pedometer use: Results from the IDEATel study. Age and Ageing.40:98-105.  


    Objective:  To examine the effects of the Informatics for Diabetes Education and Telemedicine (IDEATel) telemedicine intervention and pedometer use on physical activity (PA) and impairment in older adults with diabetes.

     Design:  Randomized clinical trial.

     Subjects:  Ethnically diverse medically underserved Medicare beneficiaries with diabetes (n=1,650).

    Methods:  Participants received home videovisits with a diabetes educator every 4-6 weeks or usual care. All received a pedometer. Annual measurements included hemoglobin A1c, Comprehensive Assessment and Referral Evaluation Activities of Daily Living, Diabetes Self-Care Activities, Charlson Comorbidity Index, Luben Social Support and pedometer use. Mixed model analyses were performed using random effects to adjust for clustering within primary care physicians.

    Results:  In the telemedicine group compared with the usual care group, the rate of decline in PA (P=0.0128) and physical impairment (PI) (P=0.0370) was significantly less over time. Significant mean endpoint differences were observed for PA (P=0.003). Pedometer use was significantly associated with PA (P=0.0006) and PI (P<0.0001). Baseline characteristics associated with greater PA included having fewer comorbid conditions (P=0.0054), less depression (P<0.0001), more social networking (P<0.0001), lower BMI (P<0.0001) and lower hemoglobin A1c level (P=0.0045).Similar predictors were observed for PI, except duration of diabetes also predicted increased impairment (P<0.0001). Significant indirect effects were observed through use of the pedometer on reduced decline in PA (P=0.0024, 0.0013) and PI (P=0.0024, P<0.0001).

    Conclusions:  This telemedicine intervention reduced rates of decline in PA and impairment in older adults with diabetes. Pedometers may be a helpful inexpensive adjunct to diabetes initiatives delivered remotely with emerging technologies.

  3. Gibbons, L.E., Crane, P.K., Mehta, K.M., Pedraza, O., Tang, Y., Manly, J.J., ...Mungas, D. (2011).  Multiple, correlated covariates associated with differential item functioning (DIF): Accounting for language DIF when education levels differ across languages. Ageing Research, 3:e4: 19-25.


     Differential item functioning (DIF) occurs when a test item has different statistical properties in subgroups, controlling for the under-lying ability measured by the test. DIF assessment is necessary when evaluating measurement bias in tests used across different language groups. However, other factors such as educational attainment can differ across language groups, and DIF due to these other factors may exist. How to conduct DIF analyses in the presence of multiple, correlated factors remains largely unexplored. This study assessed DIF related to Spanish versus English language in a 44-item object naming test. Data come from a community-based sample of 1,755 Spanish- and English-speaking older adults. We compared simultaneous accounting, a new strategy for handling differences in educational attainment across language groups, with existing methods. Compared to other methods, simultaneously accounting for language- and education-related DIF yielded salient differences in some object naming scores, particularly for Spanish speakers with at least 9 years of education. Accounting for factors that vary across language groups can be important when assessing language DIF. The use of simultaneous accounting will be relevant in other cross-cultural studies in cognition and in other fields, including health-related quality of life.



  4. Luchsinger, J.A., Palmas, W., Teresi, J. A., Silver, S., Kong, J., Eimicke, J. P., Weinstock, R.S., & Shea, S., (2011).  Improved diabetes control in the elderly delays global cognitive decline. The Journal of Nutrition, Health and Aging. 15(6), 445-449. PubMed PMID: 21623465. doi: 10.1007/s12603-0110057-x.

     Abstract:  Objectives: To examine improved diabetes control is related to better cognitive outcomes.

    Design:   Randomized control trial. Setting: A randomized trial of telemedicine vs. usual care in elderly persons with type 2 diabetes. Participants were 2169 persons 55 years and older with type 2 diabetes from New York City and Upstate New York. Intervention: The diabetes case management intervention was implemented by a diabetes nurse, via a telemedicine unit in the participant's home, and in coordination with the primary care physician. Measurement: Hemoglobin A1c (HbA1c), Systolic blood pressure (SBP), and low density lipoprotein cholesterol (LDL) were measured at a baseline visit and at up to 5 annual follow-up visits. Global cognition was measured at those visits with the Comprehensive Assessment and Referal Evaluation (CARE). Results: In mixed models the intervention was related to slower global cognitive decline in the intervention group (p=0.01). Improvements in HbA1c (p=0.03), but not SBP or LDL, mediated the effect of the intervention on cognitive decline. Conclusion: Improved diabetes control in the elderly following existing guidelines through a telemedicine intervention was associated with less global cognitive decline. The main mediator of this effect seemed to be improvements in HbA1c.


  5. Weinstock, R .S., Teresi, J.A.,  Goland, R., Izquierdo, R., Palmas, W., Eimicke, J. P.,  Ebner, S., Shea, S. (2011).  Glycemic control and health disparities in older ethnically diverse underserved adults with diabetes with telemedicine: 5-year results from the IDEATel study. Diabetes Care. 34(2), 274-279. doi: 10.2337/dc10-1346


    Objective:   The informatics for Diabetes Education and Telemedicine (IDEATel) project randomized ethnically diverse underserved older adults with diabetes to a telemedicine intervention or usual care. Intervention participants had lower A1C levels over 5 years. New analyses were performed to help better understand this difference.

    Research Design and Methods:   IDEATel randomized Medicare beneficiaries with diabetes (n= 1,665) to receive home video visits with a diabetes educator and upload glucose levels every 4-6 weeks or usual care (2000-2007). Annual measurements included BMI, A1C (primary outcome), and completion of questionnaires. Mixed-model analyses were performed using random effects to adjust for clustering within primary care physicians.   

    Results:  At baseline, A1C levels (mean ±SD) were 7.02 ± 1.25% in non-Hispanic whites (n=821), 7.58 ±1.78% in non-Hispanic black (n= 248), and 7.79 ± 1.68% in Hispanic (n=585). Over time, lower A1C levels were associated with more glucose uploads (p=0.02) and female sex (p=0.002). Blacks, Hispanic, and insulin-users had higher A1C levels than non-Hispanic whites (p<0.0001). BMI was not associated with A1C levels. Black and Hispanics had significantly fewer uploads the non-Hispanic whites over time. Hispanics had the highest baseline A1C levels and showed the greatest improvement in the intervention, but, unlike non-Hispanics whites, Hispanics did not achieve A1C levels <7.0% at 5 years.    

    Conclusions:  Racial/ethnic disparities were observed in this cohort of underserved older adults with diabetes. The IDEATel telemedicine intervention was associated with improvement in glycemic control, particularly in Hispanics, who had the highest baseline A1C levels, suggesting that telemedicine has the potential to help reduce disparities in diabetes management. 



  6. Teresi, J. A., Ramirez, M., Remler, D., Ellis, J., Boratgis, G., Silver, S., Lindsey, M., Kong, J., Eimicke, J. P., Dichter, E. (2011) Comparative effectiveness of implementing evidence-based education and best practices in nursing homes: Effects on falls, quality-of-life and societal costs. International Journal of Nursing Studies.XXXX. doi: 10,1016/j.ijnurstu.2011.07.003


    Objectives:    The aim was to conduct a comparative effectiveness research study to estimate the effects on falls, negative affect and behavior, and the associated societal costs of implementing evidence-based education and best practice programs in nursing homes (NHs).

    Design:   A quasi-experimental design, a variant of a cluster randomized trial of implementation research examining transfer of research findings into practice, was used to compare outcomes among three groups of residents in 15 nursing per group.

    Methods:  Forty-five NHs participated in one of three conditions: (1) standard training, (2)  training and implementation modules provided to facility staff, or  (3) staff training and  implementation modules augmented by surveyor training. After application of exclusion and matching criteria, nursing homes were selected at random within three regions of New York State . Outcomes were assessed using medical records and the Minimum Data Set (MDS).

    Results: The main finding was of a significant reduction of between 5 and 12 annual falls in a typical nursing home. While both intervention groups resulted in fall reduction, the larger and significant reduction occurred in the group without surveyor training. A significant reduction in negative affect associated with training staff and surveyors was observed.  Net cost savings from fall prevention was estimated.

    Conclusions:  A low cost intervention targeting dissemination of evidence-based best practices in nursing homes can result in the potential for fall reduction, and cost savings.



  7. Yang, F.M. Heslin, K.C., Mehta, K.M., Yang, C.W.,  Ocepek-Welikson, K., Kleinman, M., Morales, L.S., Hays, R.D., Stewart, A.L. Mungas, D., Jones, R.N., Teresi, J.A.(2011). A comparison of item response theory-based methods for examining differential item functioning in object naming test by language of assessment among older Latinos. Psychological Test and Assessment Modeling. 2011, 56(4), 440-460.

    Abstract:  Object naming tests are commonly included in neuropsychological test batteries. Differential Item functioning (DIF) in these tests due to cultural and language differences may compromise the validity of cognitive measures in diverse populations. We evaluated 26 object naming items for DIF due to Spanish and English language translations among Latinos (n=1,159), mean age of 70.5 years old (Standard Deviation (SD)±7.2), using the following four item response theory-based approaches: Mplus/Multiple Indicator, Multiple Causes (Mplus/MIMIC; Muthén & Muthén, 1998-2011), Item Response Theory Likelihood Ratio Differential Item Functioning (IRTLRDIF/MULTILOG; Thissen, 1991, 2001), difwithpar/Parscale (Crane, Gibbons, Jolley, & van Belle , 2006; Muraki & Bock, 2003), and Differential Functioning of Items and Test/MULTILOG (DFIT/MULTILOG; Flowers, Oshima, & Raju, 1999; Thissen, 1991). Overall, there was moderate to near perfect agreement across methods. Fourteen items were found to exhibit DIF and 5 items observed consistently across all methods, which were more likely to be answered correctly by individuals tested in Spanish after controlling for overall ability.


  8. Schoenthaler, A., Luerassi, L., Teresi, J.A., Silver, S., Kong J., Odedosu, T., Trilling, S., Errico, A., Uvwo, O., Sebek, K., Adekoya, A., Ogedegbe, O. (2011). A practice-based trial of blood pressure control in African Americans (TLC-Clinic): study protocol for a randomized controlled trial. Trials, 12, 265-277.


     Background:  Poorly controlled hypertension (HTN) remains one of the most significant public health problems in the United States , in terms of morbidity, mortality, and economic burden. Despite compelling evidence supporting the beneficial effects of therapeutic lifestyle changes (TLC) for blood pressure (BP) reduction, the effectiveness of these approaches in primary care practices remains untested, especially among African Americans, who share a disproportionately greater burden of HTN-related outcomes.

    Methods/Design:  This randomized controlled trial tests the effectiveness of a practice-based comprehensive therapeutic lifestyle intervention, delivered through group-based counseling and motivational interviewing (MINT-TLC) versus Usual Care (UC) in 200 low-income, African Americans with uncontrolled hypertension. MINT-TLC is designed to help patients, make appropriate lifestyle changes and develop skills to maintain these changes long-term. Patients in the MINT-TLC group attend 10 weekly group classes focused on healthy lifestyle changes (intensive phase); followed by 3 monthly individual motivational interviewing (MINT) sessions (maintenance phase). The intervention is delivered by trained research personnel with appropriate treatment fidelity procedures. Patients in the UC condition receive a single individual counseling session on healthy lifestyle changes and print versions of the intervention materials. The primary outcome is within-patient change in both systolic and diastolic BP from baseline to 6 months. In addition to BP control at 6 months, other secondary outcomes include changes in the following lifestyle behaviors from baseline to 6 months: a) physical activity, b) weight loss, c) number of daily servings of fruits and vegetables and d) 24-hour urinary sodium excretion.

    Discussion:  This vanguard trial will provide information on how to refine MINT-TLC and integrate it into standard treatment protocol for hypertensive African Americans as a result of the data obtained; thus maximizing the likelihood of its transition into clinical practice.


  9. Pillemer, K., Chen, E.K., Van Haitsma, K.S., Teresi, J., Ramirez, M., Silver, S., Sukha, G. & Lachs, M.S. (2011).. Resident-to-Resident aggression in nursing homes: Results from a qualitative event reconstruction study. The Gerontologist, 52(1), 24-33.

    Purpose:  Despite its prevalence and negative consequences, research on elder abuse has rarely considered resident-to-resident aggression (RRA) in nursing homes. This study employed a qualitative event reconstruction methodology to identify the major forms of RRA that occur in nursing homes. 

    Design and methods:  Events of RRA were identified within a 2-week period in all units (n = 53) in nursing homes located in New York City . Narrative reconstructions were created for each event based on information from residents and staff who were involved as well as other sources. The event reconstructions were analyzed using qualitative methods to identify common features of RRA events. 

    Results:  Analysis of the 122 event reconstructions identified 13 major forms of RRA, grouped under five themes. The resulting framework demonstrated the heterogeneity of types of RRA, the importance of considering personal, environmental, and triggering factors, and the potential emotional and physical harm to residents. 

    Implications:  These results suggest the need for person-centered and environmental interventions to reduce RRA, as well as for further research on the topic.



  10. Carle, A. C., Cella, D., Cai, L., Choi, S. W., Crane, P. K., Curtis, S. M., Gruhl, J., Lai, J., Mukherjee, S., Reise, S., Teresi, J. A., Thissen, D., Wu, E. J., & Hays, R. (2011). Advancing PROMIS's methodology: Results of the third patient-reported outcomes measurement information system (PROMIS) psychometric summit. Expert review of Pharmaco-economics Outcomes Research, 11(6), 677-684. doi:10.1586/erp.11.74. PMCID: PMC3312372. NIHMSID: NIHMS347926


     In 2002, the NIH launched the ‘Roadmap for Medical Research’. The Patient-Reported Outcomes Measurement Information System (PROMIS®) is one of the Roadmap’s key aspects. To create the next generation of patient-reported outcome measures, PROMIS utilizes item response theory (IRT) and computerized adaptive testing. In 2009, the NIH funded the second wave of PROMIS studies (PROMIS II). PROMIS II studies continue PROMIS’s agenda, but also include new features, including longitudinal analyses and more sociodemographically diverse samples. PROMIS II also includes increased emphasis on pediatric populations and evaluation of PROMIS item banks for clinical research and population science. These aspects bring new psychometric challenges. To address this, investigators associated with PROMIS gathered at the Third Psychometric Summit in September 2010 to identify, describe and discuss pressing psychometric issues and new developments in the field, as well as make analytic recommendations for PROMIS. The summit addressed five general themes: linking, differential item functioning, dimensionality, IRT models for longitudinal applications and new IRT software. In this article, we review the discussions and presentations that occurred at the Third PROMIS Psychometric Summit.


  11. Remler, D. K., Teresi, J. A., Weinstock, R. S., Ramirez, M., Eimicke, J. P., Silver, S. & Shea, S. (2011) Health care utilization and self-care behaviors of Medicare beneficiaries with diabetes: comparison of national and ethnically diverse underserved populations. Population Health Management, 14(1), 11-20. doi:10.1089/pop.2010.0003. PMCID: PMC313589


    Caring for persons with diabetes is expensive, and this burden is increasing. Little is known about service use, behaviors, and self-care of older individuals with diabetes who live in underserved communities. Information about self-care, informal care, and service utilization in urban (largely Latino, n = 695) and rural (mostly white, n = 819) Medicare beneficiaries with diabetes living in federally designated medically underserved area was  collected using computer-aided telephone interviews as part of the baseline assessment in the Informatics and Diabetes Education and Telemedicine (IDEATel) Project. Where items were comparable, service use was compared with that of a nationally representative group of Medicare beneficiaries with diabetes, using data from the Medical Expenditure Panel Survey. Compared to nationally representative groups, the underserved groups reported worse general health but similar health care service use, with the exception of home care. However, compared to the underserved rural group, the underserved, largely minority urban group, reported worse general health (p<0.0001); more inpatient nights (p = 0.003), emergency room visits (p < 0.001), and home health care (p < 0.001); spent more time on Self-care; and had more difficulty with housework, meal preparation, and personal care. Differences in service use between urban and rural groups within the underserved group substantially exceeded differences between the underserved and nationally representative groups. These findings address a gap in knowledge about older, ethnically diverse individuals with diabetes living in medically underserved areas. This profile of disparate service use and health care practices among urban minority and rural majority underserved adults with diabetes can assist in the planning of future interventions.



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