U.S. Asian populations may have different risk profiles for common geriatric conditions like cognitive and physical decline

Newswise, July 10, 2017– U.S. Asian populations may have different risk profiles for common geriatric conditions like cognitive and physical decline. Researchers from the PINE study—the first ever longitudinal study of U.S. Chinese older adults in the greater Chicago area—found the cognitive and physical function of U.S. Chinese immigrants may be greatly impacted by their social and cultural context more than non-immigrant populations, according to three studies published in the special issue of the Journals of Gerontology: Medical Sciences.

Each of the three studies focused on different components of geriatric syndromes: physical function decline, cognitive decline, and the relationship between social support and cognitive function.

The PINE Study from Rush University Medical Center was initiated in 2011 with over 3,000 U.S. Chinese older adults, who were surveyed 2 years after their first interview.

The status of physical function and cognitive function was examined, and profiles of socio-demographic characteristics were collected at each visit. In total, these studies provide an in-depth understanding of U.S. Chinese older adults and their health and present the need for more in-depth studies into the health of U.S. Asian communities to further efforts toward health equity.

Contrary to existing research, the PINE Study showed mixed findings regarding the effect of socioeconomic status on functional decline over time.

 Researchers had previously theorized that lower education and income were risk factors for rapid functional decline, but the PINE Study showed that only lower education was associated with worse physical function, and these effects diminished over time. Income was not related to physical performance or rate of decline in age.

“Our findings showed the unique characteristics of Chinese older immigrants. For example, lower income is usually associated with faster rate of physical performance decline in other populations, but we did not find a significant relationship in the U.S. Chinese aging population,” said Dr. XinQi Dong, MD, MPH, professor of Rush University Medical Center, and the principal investigator of the PINE study.

“In our population, individual income may not fully capture an individual’s socioeconomic status. There is also significant socioeconomic variability within the category of Asian Americans, contrary to the Model Minority conception, which may obfuscate the association between socioeconomic status and physical function decline.”

These findings regarding the complexities of the U.S. Chinese population were reflected in a study regarding cognitive function trajectory among Chinese older adults. Dr. Lydia Li, PhD, Associate Professor at the School of Social Work, University of Michigan, found that the change of different cognitive abilities, which represent components of cognitive function, varies greatly between individuals. For example, more highly educated individuals have clear advantages in all types of cognitive abilities at baseline, they have more decline in episodic and global memory in two years.

Further, men performed better than women in most cognitive abilities at baseline but had faster rates of decline in working memory.

“The sex differences in baseline and the change of cognition over a two-year period may be explained by a recent study indicating that older women are more resilient than their male counterparts in cognitive decline. However, they found women to perform better in some cognitive domains at baseline, and that study was based on a sample of primarily White adults with higher level of education,” Li continued.

“It may be gender inequality in Chinese society that renders older women at disadvantages in cognitive testing.”

Building on the idea that Chinese culture and context may influence cognitive status in late life, the PINE Study researchers also found that social relationships, in the form of both more social support and more social strain, were associated with better cognitive function.

“We were surprised that social strain was positively associated with cognitive function. This is not common in other populations. Social support and social strain are important facets in older adults' social life,” said Shaoqing Ge, MPH, PhD candidate at Duke University School of Nursing.

The reason, Ge noted, may be culturally-based: “this finding may be the result of the unique appraisals among Chinese older adults. Reporting higher social strain may reflect a more socially engaged lifestyle.

Influenced by the traditional Chinese culture and norm, the U.S. Chinese older adults view their active engagement in the family as indications of self-value. Consequently, U.S. Chinese older adults may interpret social strain in a positive way.”

These articles are part of a special issue in the Journals of Gerontology: Medical Sciences to be fully released in July, 2017. Electronic version can be accessed through JGMS website.

For more information about the PINE study, please visit the PINE Study Wikipedia page or our website.

Physician’s Near-Death Experience Inspires Campaign to Boost More Effective Patient Communication

Newswise, February 13, 2017 – In an article to be published in the Jan. 5 edition of the New England Journal of Medicine, a Henry Ford Hospital critical care medicine physician describes in candid detail about how her own near-death experience inspired an organizational campaign to help health professionals communicate more effectively and demonstrate more empathy to their patients.

Rana Awdish, M.D., director of the hospital’s Pulmonary Hypertension Program, writes in “A View from the Edge: Creating a Culture of Caring” that as a patient “I learned that though we do many difficult, technical things so perfectly right, we fail our patients in many ways.”

In 2008 Dr. Awdish nearly died when a tumor ruptured in her liver, leading to multisystem organ failure. The care team worked frantically to save her but could not save the baby she was carrying. Her recovery would include five major surgeries and multiple hospitalizations in intensive care. She also experienced something unexpected: a kind of casual indifference.

“I was privy to failures that I’d been blind to as a clinician,” she says. “There were disturbing deficits in communication, dis-coordinated care, occasionally an apparently complete absence of empathy. I recognized myself in many of those failures.”

Dr. Awdish says her patient experience inspired her to champion a shift in culture for helping health professionals talk more effectively with their patients at Henry Ford Hospital and throughout its parent organization, the Detroit-based Henry Ford Health System. She used her experience to drive home the point to leaders and others that “everything matters, always. Every person, every time.”

Henry Ford’s Physician Communication and Peer Support curriculum, launched in 2013, is guided by empathy and compassion, beginning with an understanding of what matters most to patients and aligning them with patient values. It’s geared for physicians, residents, fellows, nurses and other health professionals. Courses include:

• CLEAR Conversations. CLEAR stands for Connect, Listen, Empathize, Align and Respect. A course in which health care workers test their communication skills in stimulated conversation exercises with Detroit-based improvisational actors who portray patients and family members. It teaches how to navigate difficult questions and respond to expressions of emotion. These exercises are videotaped, allowing for immediate feedback. A mobile app offers easy access to tips and videos for effective communication.
• A skilled communication workshop based on the 4 Habits of Effective Physician Communication model.
• Real-time shadowing. A trained observer shadows the provider during a series of patient interactions. Best practice behaviors and empathic communication skills are evaluated, and best practice feedback is shared during a one-on-one debriefing.
• New-hire orientation, during which employees are taught their value and purpose within the organization, not just to their job. Discussions emphasize learning to recognize avoidable and unavoidable forms of patient suffering. New employees are tasked with reducing avoidable suffering.

“My experience changed me,” says Dr. Awdish, who also serves as medical director of Care Experience, which directs the patient communications initiative across the health system. “It changed my vision of what I wanted our organization to be, to embody.”

She says her experience is a teachable moment across the spectrum of health care as the focus shifts to respecting patients as more than just someone with an illness or disease.

“By focusing on our missteps, we can ensure that the path ahead is one of compassionate, coordinated care,” Dr. Awdish says.

“When we are ashamed, we can’t tell our stories. In the wake of painful experience, we all seek meaning. It is the human thing to do, but it is also the job of great organizations. The stories we tell do more than restore our faith in ourselves. They have the power to transform.”