Improving outcomes
New studies explore stroke care, exercise and cognition, and self-driving technology
New study explores complex factors that may lead to health outcome disparities in stroke care
Despite improved access to post-stroke rehabilitation care, racial disparities in health outcomes persist. A new UF College of Public Health and Health Professions study intends to shed light on the factors that may contribute to the accessibility and quality of care African American patients receive following a stroke.
Charles Ellis, Ph.D., professor and chair of the department of speech, language, and hearing sciences, leads the five-year study funded by a grant from the National Institute on Deafness and Other Communication Disorders. The project focuses on two common conditions among people who have experienced a stroke: aphasia, which affects a person’s ability to express oral or written language, and dysphagia, which causes difficulty swallowing.
The new study examines the complex factors that may contribute to racial disparities along the stroke care continuum, from the initial hospital stay, to rehabilitation and finally, to discharge.
Prior research, including by members of the study team, has demonstrated that African American patients with aphasia have greater levels of impairment than their white counterparts, Ellis said. Yet, their research also suggests that this disparity is not due to African American patients receiving less care or differences in their health insurance coverage.
“Interestingly, our previous studies of service utilization and cost of care indicate that African American stroke survivors with aphasia have longer lengths of stays, receive more speech therapy rehabilitation visits, and have substantially greater cost of care in acute care settings than white patients,” Ellis said. “These findings suggest that disparities in aphasia and dysphagia outcomes are not simply the result of the quantity and timing of services provided.”
For the new study, the team will analyze Medicare claims data to examine clinical outcomes, health care service utilization patterns and measures of quality at the facilities where patients receive services. Findings will inform interventions that remove barriers to care so that African American patients who have had a stroke have the best possible health outcomes.
In addition to Ellis, UF investigators include Candice Adams-Mitchell, SLP.D., a clinical assistant professor of speech, language, and hearing sciences; Karen Hegland, Ph.D., an associate professor of speech, language, and hearing sciences; and Molly Jacobs, Ph.D., an associate professor of health services research, management and policy.
– By Jill Pease
Adults over 85 who exercise score higher on cognitive tests
Adults aged 85 to 99 years old who regularly do both aerobic and strength-training exercises scored higher on cognitive tests than those who are sedentary or limit their exercise to only cardio, according to research led by College of Public Health and Health Professions neuroscientists.
The study, published in the journal GeroScience, included 184 cognitively healthy participants who self-reported their exercise habits and general physical activities and then underwent a comprehensive battery of neuropsychological tasks to capture their cognitive abilities.
“We found that engagement in exercise in very old age appears related to better cognition, particularly for tasks requiring quick thinking and flexibility in approach,” said lead author Brian Ho, a Ph.D. candidate in clinical and health psychology. “In addition, the best performances on cognitive tasks were from individuals engaging in both aerobic exercises and strength training exercises.”
Nearly 70% of participants reported engaging in at least some form of physical exercise, a percentage that exceeded the researchers’ expectations, Ho said, adding the finding suggests that exercising in older age is certainly feasible when in consultation with one’s doctor. In addition to Ho and Ronald Cohen, Ph.D., his mentor, senior author of the paper and a professor of clinical and health psychology, the research team included neuroscientists from UF’s Center for Cognitive Aging and Memory Clinical Translational Research; the Evelyn F. McKnight Brain Institutes at the University of Arizona, University of Miami and University of Alabama at Birmingham; and the University of Southern California.
After controlling for years of education, the researchers found the cardio + strength-training group had the highest cognitive performances overall and scored significantly better on coding and symbol search compared with the sedentary group. The cardio + strength-training group also scored significantly better on symbol search, letter fluency and a color and word test compared to the cardio group.
– By Michelle Jaffee
New study examines older adults' acceptance of self-driving technology as transportation option
The autonomous
shuttle study
launched with
a route in The
Villages retirement
community in
Central Florida.
Jesse S. Jones
Autonomous vehicles or self-driving technology could play an important role in helping older adults remain independent as they age. But will older adults embrace the use of self-driving vehicles?
To find out, UF College of Public Health and Health Professions researchers and partners have launched a new study to understand older adults ’ perceptions and experiences with an autonomous shuttle in four Florida communities. The study is funded by the Florida Department of Transportation to support the goals of their Safe Mobility for Life program.
“Driving is a powerful facilitator to ensure that older adults fulfill their roles and activities in the community, such as going to the doctor, the hairdresser, places of worship or visiting grandchildren; but it’s also a very nice facilitator for continued independence and autonomy,” said the study’s lead investigator Sherrilene Classen, Ph.D., M.P.H., OTR/L, a professor and chair of the department of occupational therapy and director of UF’s Institute for Driving, Activity, Participation, and Technology.
Study team members also include co-principal investigator Carla VandeWeerd , Ph .D., professor and director of the UF Health Precision Health Research Center – The Villages, and Beep Inc., an autonomous mobility provider based in Lake Nona, Florida.
“With this study, we are looking at futuristic alternative transportation options for older adults and their acceptance and adoption of the technology. Specifically, if they don’t want to drive, can no longer drive, or just want to spend travel time more productively, such as sitting and chatting with somebody in a shuttle instead of concentrating on driving,” Classen said.
Over the course of the project, researchers are enrolling 250 participants in The Villages, Port St. Lucie, Altamonte Springs and Lake Nona before they ride in a multi-passenger driverless shuttle. Following their experience with the shuttle, participants will complete a post-assessment survey.
“This is the first study of its kind that is extending over multiple counties in the state of Florida, and we are looking at real-time, lived experiences of older adults as they engage with autonomous shuttles,” Classen said. “We won’t be just getting opinions via survey data, but also actual reported lived experiences, which is so much more powerful for helping researchers understand contextually relevant perceptions of older adults.”
– By Jill Pease
