Book Summary: Recognized as two of the world's leading authorities on the subject, Susan Herdman and Richard Clendaniel, joined by a team of expert contributors, deliver the 4th Edition of the field's definitive text on the management of vestibular diseases and disorders. From assessment through therapy, they present the scientific and clinical knowledge you need to distinguish between vestibular and non-vestibular dizziness and to plan and implement the appropriate treatments.

Abstract available through Orthapaedic & Sport Physical Therapy.

Background: Substance abuse by either victim or perpetrator has long been associated with violence and abuse. Sparse research is available regarding elder abuse and its association with substance abuse. Objective: The objective of this study was to evaluate the association of state-reported domestic elder abuse with regional levels of substance abuse. Methods: Census demographic and elder abuse data were sorted into substate regions to align with the substance use treatment-planning regions for 2269 US counties. From the 2269 US counties there were 229 substate regions in which there were 213,444 investigations of abuse. For the other Ns (reports and substantiations) there were fewer counties and regions. See first sentence of data analyses and first sentence of results. Results: Elder abuse report rates ranged from .03 to .41% (80 regions), investigation rates .001 to .34% (229 regions), and substantiation rates 0 to .22% (184 regions). Elder abuse investigations and substantiations were associated with various forms of substance abuse. Higher investigation rates were significantly associated with a higher rate of any illicit drug use in the past month, a lower median household income, lower proportion of the population graduated high school, and higher population of Hispanics. Higher substantiation rates were significantly associated with higher rate of illicit drug use in the past month and higher population of Hispanics. Conclusion: It may be worthwhile for administrators of violence programs to pay particular attention to substance abuse among their clients and in their community’s environment, especially if older persons are involved. Scientific Significance: Measures of documented elder abuse at the county level are minimal. To be able to associate substance abuse with elder abuse is a significant finding, realizing that the substance abuse can be by the victim or the perpetrator of elder abuse.

Define the SLP role with patients commonly seen in primary care Duplicate SLP knowledge to help in primary care Evaluate the role of the SLP as part of the multidisciplinary team

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The rising cost of health care and changes in healthcare delivery have prompted a need to improve continuity from the hospital to home. This scholarly project was initiated to assess the impact on patient outcomes related to initiation of a nurse practitioner-led transitional care program (TCP). Using the Diffusion of Innovations and Health Belief Models, the purpose of this study was to identify the impact of a TCP on improving the health of patients with congestive heart failure (CHF), diabetes mellitus Type II (DM II), and chronic obstructive pulmonary disorder (COPD). The impact of the TCP was evaluated by a review of patient satisfaction results, reduction in patient readmission rate, and emergency room consults. Two years of data from a community-based health care program were collated from a sample of 819 individuals with chronic disease between 65- and 85-years-old who had a 30-day hospital readmission after a nurse practitioner home visit and a 30- day readmission for an exacerbation of their CHF, DM II, or COPD. The secondary data were analyzed, using SPSS, to determine changes in rates of readmission. Descriptive statistics were used to represent and compare changes in rates. After implementation of the nurse practitioner home visit program, the 30-day readmission demonstrated an 81.07% reduction and the 30-day readmission for exacerbation of COPD, CHF, and DM II was reduced by 36.77%. The project findings contribute to social change by identifying how a reduction in the frequency of hospitalizations could contribute to decreased health care expenses and improved health outcomes. Home care and chronic health care organizations, as well as advanced-practice nurses working in home care settings, may use the results of the study to establish effective community interventions that reduce health care costs.

At least two studies have been found conducted in the area of audiological in-services and their impact on the people to whom they were presented. In 1981, Dancer and Keiser studied the effects of empathy training on geriatric-care nurses and in 1985, Dampier, Dancer, and Keiser studied changing attitudes of college students toward older persons with hearing loss. Both of the studies investigated the effect of in-service training on empathy, rather than using the traditional academicallyoriented in-service program approach. Both studies found statistical results indicating a significant positive change in the subjects' feelings toward hearing impaired geriatrics. Additionally, Dancer et al. (1981) found a positive significant change in the subjects' perceptions of hearing impaired elderly persons. This study investigated the effect of an in-service training program on nursing home personnel. The in-service that was developed included both empathy training and factual information. It was hypothesized that both elements are important and the inclusion of both could result in a greater change in people's attitude. The empathy portion of this in-service included a taped interview with a hearing impaired older person, a tape dramatizing interactions between hearing impaired and normal hearing individuals, simulated high frequency hearing loss, an "unfair listening test" and suggestions for interacting with hearing impaired people. The factual information included anatomy and physiology of the ear, types of hearing loss, common characteristics of hearing loss among older people, and the impact of hearing loss on speech understanding.

Background: Antibiotic overuse/misuse has been documented in several reports to increase the risk of Clostridioides difficile (C.diff) infection and antibiotic resistance. The older adult population is more prone to use antibiotic medications than any other age group due to decreased immune function, use of urinary catheters, ventilation during hospitalization and other factors. Antibiotic resistance and C.diff are major public health problems. However, studies examining the trends of antibiotic use and the association between the antibiotic use and negative health outcomes among older adults in the outpatient and emergency department settings are limited. Objectives: The main objectives of this dissertation were to: 1) calculate the national antibiotic trends among community-dwelling older adults in the United State; 2) evaluate the antibiotic trends and antibiotic appropriateness among older adult patients visiting the geriatrics clinic and adult internal ambulatory care clinic at VCU Health; and 3) examine the antibiotic trends and antibiotic appropriateness among older adult patients and middle-aged patients visiting the emergency department at VCU Health. Methods: For the first objective, data were obtained from Medical Expenditure Panel survey (MEPS) a nationally representative dataset (2011-2015). Descriptive analyses were conducted and multiple logistic regression was performed to assess the association between the antibiotic use and demographic and sociodemographic characteristics. In the second objective, data were obtained from VCU Health outpatient clinics (geriatrics, and Internal medicine ambulatory care clinic only). Descriptive statistics were calculated and multiple logistic regression was performed to assess the association between antibiotic appropriateness and type of clinics and other demographic characteristics. In the third objective, the emergency department electronic medical records at VCU were used. Trend analysis was performed across the dissertation studies using the Cochran–Armitage test. All variables were considered statistically significant at an α level of 0.05. All the statistical analyses were conducted using the Statistical Analysis Software Version 9.4 (SAS v.9.4), (SAS Institute Inc, Cary, NC). Results: There were 105,762,134 prescriptions dispensed to older adults in the outpatient setting in the US from 2011 to 2015. Antibiotic prescriptions were more common among women (18%) compared to men (12%). White participants received more antibiotics (27%) than African Americans (1.77%) and others (1.4%). Among the 3,515 patients who visited either Geriatrics or Internal Medicine ambulatory clinic at VCU Health from 2012-2017, 1,534 antibiotics were prescribed. Potentially inappropriate antibiotic prescriptions were similar between the two clinics (30% in Geriatrics clinic and 28% in Internal Medicine ambulatory clinic) with p-value of 0.08. In addition, 6,343 middle-aged or older adult patients were dispensed and prescribed an antibiotic in the ED at VCU Health from (2012 to 2017). Eighteen percent of the antibiotic prescriptions received by middle age group were considered potentially inappropriate, compared to 9% among the older adult patient (p < 0.0001). Conclusions: The rate of antibiotic use overall remains unchanged despite the national and international efforts to reduce antibiotic prescriptions and eventually to reduce antibiotic resistance. The changes in the patterns of use in some of the antibiotic categories appear to be driven more by the safety concerns rather than reducing overall use. Future research is needed to strengthen antibiotic stewardship programs for older adults in outpatient settings.

As individuals age, their likelihood of experiencing mental and physical problems increases, as does their risk of developing social isolation. Behavioral, physiological, and/or psychological changes are common manifestations of social isolation. Increased morbidity and mortality are the outcome. Ecological systems theory and social baseline theory provided the framework to explore 10 older individuals' perceptions of risk for social isolation and their perceived barriers to social integration. Data for this interpretive phenomenological study were collected from participant diaries, interviews, the 6-item de Jong Gierveld Loneliness Scale (DJGLS-6), the Lubben Social Network Scale 6 (LSNS-6), a demographic survey, and a social support profile. The Colaizzi method and interpretive phenomenological analysis were used to analyze diaries and interviews. Participant demographics, DJGLS-6, LSNS-6, and social support profile data were used to enrich descriptions of the participants and find other themes. Results indicated that most participants like living alone. However, more than half reported periods of loneliness and 4 reported estrangement from an offspring. Experiences of negative age-related treatment were described by many participants and most reported that transportation and mobility issues were the biggest barriers to social integration. Additionally, many participants reported that access to planned social activities would alleviate social isolation. Implications for positive social change arise from this research in the form of increased awareness of the experiences and perceptions of older individuals at risk for social isolation. Additionally, these findings can inform future research, policy change, and strategies for social isolation interventions and prevention.

Objective: The purpose of this study was to assess the influence of three single nucleotide polymorphisms (SNP) previously associated with Alzheimer's disease on specific domains of cognition, when controlling for Apolipoprotein E gene (APOE), in a sample of individuals with Alzheimer's disease. Methods: The data were drawn from the Alzheimer's Disease Neuroimaging Initiative database, a comprehensive, longitudinal database of controls, persons with mild cognitive impairment, and persons with mild Alzheimer's disease. Each subject has a full neuropsychological assessment, neuroimaging, genetic sequencing, and physical evaluation. For the purposes of this study, individuals were selected based on the presence of the three SNPs of interest: CR1 (rs3818361_T), CLU (rs11136000_T), and PICALM (rs3851179_A). Each SNP was then measured against the available tests of the ADNI neuropsychological battery that measured immediate and long delay memory, semantic fluency, and confrontation naming. Results: Only the CR1 SNP (rs3818361_T) had significant findings. The presence of the CR1 SNP associated with lower performance on logical memory recall total score, AVLT immediate recall trials 2 and 4, AVLT delayed recall, and confrontation naming in the 12-month control group. Logical memory and AVLT delayed recall were also negatively associated with CR1 in the 12-month AD case group. Discussion: These results support previous findings that the CR1 SNP rs3818361_T is a risk factor for cognitive impairment in individuals with and without AD. Such findings can aid in the earlier detection of Alzheimer's disease, risk for domain specific cognitive impairment, and novel targets for personalized pharmacotherapy.