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- Doctor of Science in Nursing (DSN) School of Nursing (19)
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- Advance Care Directives;End of Life Care;Institutional Theory;Nursing home ownership (1)
- Advanced cancer (1)
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The Impact Of Nursing Home Ownership On The Election Of Advance Care Directives, Natasha Elie
The Impact Of Nursing Home Ownership On The Election Of Advance Care Directives, Natasha Elie
All ETDs from UAB
Approximately 1.3 million people reside in nursing homes/facilities. Annually, this population represents 25% of mortalities in the United States. The enactment of the Patient Self Determination Act (PSDA) required nursing homes/facilities to educate patients, staff, and the community on the right to advance care directives. This study aimed to evaluate the impact of nursing home ownership on the election of ACDs and end-of-life care services by examining how nursing homes ownership in New York, California, and Ohio compared regarding residents' election of ACD and whether there was a variation in the these states. This paper contributes to the literature by …
Exploring The Lived Experiences Of Persons Living With Hiv Who Are Homebound Due To One Or More Comorbidities Within A Southern State Using Photovoice, Anthony Alyn "Deek" Cunningham
Exploring The Lived Experiences Of Persons Living With Hiv Who Are Homebound Due To One Or More Comorbidities Within A Southern State Using Photovoice, Anthony Alyn "Deek" Cunningham
All ETDs from UAB
At the end of 2022, there were 1,109,418 adults and adolescents with HIV in the United States and the six dependent areas of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands (CDC, 2024). Due to ongoing advances in medications and treatments, people who have been diagnosed with HIV are living longer and healthier lives, making this a chronic health condition. Yet, there are gaps in the literature that focuses on this population growing older and aging in place. This dissertation investigated the lived experiences of individuals fifty years and older …
Regulatory Factors Associated With Discriminatory Behaviors Among Federally Qualified Health Centers, Miranda Leah Sedillo
Regulatory Factors Associated With Discriminatory Behaviors Among Federally Qualified Health Centers, Miranda Leah Sedillo
All ETDs from UAB
REGULATORY FACTORS ASSOCIATED WITH DISCRIMINATORY BEHAVIORS AMONG FEDERALLY QUALIFIED HEALTH CENTERS MIRANDA SEDILLO Executive Doctor of Science (DSc) in Healthcare Leadership Abstract Background Socially constructed classism restricts access to human rights, including employment and growth opportunities. The civil rights and labor movements have intersected throughout United States’ history as many civil rights leaders championed equal rights in employment opportunities. For several decades, the U.S. government has used laws and regulations to promote a healthy workplace free of discrimination. The influence of legal regulation on behavior change enforces punitive actions for discriminatory behaviors in the workplace. Yet, in 2020, the U.S. …
Factors Impacting Serious Illness Care In Alabama: An Assessment Of The Current State Of Hospital Palliative Care, Amy M. Beasley
Factors Impacting Serious Illness Care In Alabama: An Assessment Of The Current State Of Hospital Palliative Care, Amy M. Beasley
All ETDs from UAB
BACKGROUND: Palliative care (PC) use has been shown to offer many benefits to patients and families. Hospital PC has expanded in the United States, though growth has been limited within hospital types and geographic locations. According to the Center to Advance Palliative Care (CAPC), Alabama was rated a “D,” indicating that significant improvements in PC are needed. The purpose of this study was to develop a thorough description of access to palliative care in Alabama hospitals. METHODS: A mixed methods multiple case study was employed with quantitative data embedded into a qualitative case study approach. Four hospitals were selected based …
The Association Of Availability And Accessibility Of Federally Qualified Health Centers On Hospitals' Reported Charity Care, Philip Cendoma
The Association Of Availability And Accessibility Of Federally Qualified Health Centers On Hospitals' Reported Charity Care, Philip Cendoma
All ETDs from UAB
Hospitals are facing financially challenging times. Each year, billions of dollars are spent by hospitals to provide care to patients that, ultimately, will go unreimbursed. How to effectively provide accessible and affordable health care to the uninsured population continues to be a topic of discussion for policymakers, healthcare administrators, as well as healthcare-based consortiums, and consultant. The cost of charity care consists largely of the care provided to the uninsured population. Federally Qualified Health Centers (FQHCs) play an important role in providing primary care to the uninsured population, regardless of the patient’s ability to pay. Based on the 5 A’s …
Alzheimer Disease Special Care Units And Nursing Homes' Organizational Performance, Giovanna Pilonieta Ortiz
Alzheimer Disease Special Care Units And Nursing Homes' Organizational Performance, Giovanna Pilonieta Ortiz
All ETDs from UAB
Alzheimer’s disease special care units (AD SCUs) have been adopted to provide specialized care for people with dementia in nursing homes. However, the effects of environmental and organizational factors on AD SCUs adoption by nursing homes and their influence on nursing homes' organizational performance remains unclear. Guided by Resource Dependence Theory, Donabedian’s Structure-Process-Outcome (SPO) framework and the Resource-Based View of Firms perspective, the purpose of the three papers included in this dissertation was to provide empirical evidence of the contextual and organizational factors that influence AD SCUs adoption among nursing homes and how the adoption of AD SCUs impact nursing …
Assessing The Impact Of The Covid-19 Pandemic On Metastatic Lung Cancer Time To Treatment Initiation, Health Care Resource Utilization, And Costs In The United States, Teresa M. Zyczynski
Assessing The Impact Of The Covid-19 Pandemic On Metastatic Lung Cancer Time To Treatment Initiation, Health Care Resource Utilization, And Costs In The United States, Teresa M. Zyczynski
All ETDs from UAB
The COVID-19 pandemic has derailed normal operations in the health care delivery systems in the United States (US) and globally, providing prioritized care to patients seeking acute management of the novel coronavirus and its complications. Simultaneously, cancer screening tests have decreased, resulting in decreased rates of cancer diagnoses and referrals to oncologists. The purpose of this study was to assess time to treatment initiation (TTI) with systemic cancer therapy in patients with newly diagnosed metastatic lung cancer, metastatic lung cancer-related and total healthcare resource utilization (HCRU) and costs during the pandemic/post-pandemic period compared with the pre-pandemic period. The retrospective claims …
Predicting Change In Quality Of Life In Patients With Advanced Cancer And Family Caregivers Using Gps Data, Kyungmi Lee
Predicting Change In Quality Of Life In Patients With Advanced Cancer And Family Caregivers Using Gps Data, Kyungmi Lee
All ETDs from UAB
Patients with advanced cancer and their family caregivers often experience poor quality of life. Measuring patient and caregiver physical and mental quality of life is typically performed using participant reported outcome measures, especially validated questionnaires. However, this self-report approach has several limitations, including recall bias, respondent burden, and social desirability bias. One potential solution to these limitations may be to use passive data collected by personally owned smartphones (e.g., GPS data) to model and assess the quality of life in family caregivers and patients with advanced cancer. Yet, there is no evidence to date that passively collected smartphone data is …
Palliative Care Experiences And Educational Needs Of Healthcare Interprofessionals In Jamaica: A Mixed Methods Study, Rebecca L. Edwards
Palliative Care Experiences And Educational Needs Of Healthcare Interprofessionals In Jamaica: A Mixed Methods Study, Rebecca L. Edwards
All ETDs from UAB
Universal access to palliative care (PC) is a human right that much of the world has not accomplished and educating a PC workforce is critical to PC advancement. Higher PC disparities exist in low-and-middle income countries, such as Jamaica. The World Health Organization Public Health Model and the International PC Initiative’s PC roadmap emphasize the importance of PC education. The purpose of this mixed methods dissertation study was to investigate the PC experiences and educational needs of healthcare interprofessionals who provide care for patients with late-stage serious illnesses in Jamaica. Three specific aims incorporated quantitative investigation of physicians’, nurses’, and …
Risk Of Delirium With Opioid Use Among Older Adults In The Emergency Department, Rachel Michelle Skains
Risk Of Delirium With Opioid Use Among Older Adults In The Emergency Department, Rachel Michelle Skains
All ETDs from UAB
Objectives: Delirium affects 7-17% of older Emergency Department (ED) patients. Inadequate pain control and opioid pain management have been reported to increase risk for delirium. The aim of this study was to evaluate the association between pain severity, opioid exposure, and delirium among older ED patients.Methods: A single-center retrospective cohort study was conducted in an academic Geriatric ED. Patients aged ≥65 years with an Identification of Seniors at Risk (ISAR) score ≥2 and an Emergency Severity Index (ESI) level 3 were enrolled into the Geriatric ED Pathway. Those who received a delirium screening using the Nursing Delirium Screening Scale (NuDESC) …
Developing A Core Set Of Nursing-Sensitive Indicators For International Pediatric Oncology Nursing Practice, Courtney Erin Sullivan
Developing A Core Set Of Nursing-Sensitive Indicators For International Pediatric Oncology Nursing Practice, Courtney Erin Sullivan
All ETDs from UAB
Although nursing sensitive indicators (NSIs) have been developed to measure factors influencing nursing care quality and patient outcomes in general and in select specialty areas, a core set of NSIs for international pediatric oncology nursing practice does not exist. Quality nursing care delivery in pediatric oncology is essential to achieving optimal patient outcomes and closing the 50% survival gap between high-income and low- and middle-income countries. To enhance global childhood cancer outcomes influenced by nursing, this dissertation research was conducted with the purpose of developing a preliminary core set of NSIs for international pediatric oncology nursing that is important, actionable, …
A Stress Process Approach To Assessing Caregiver Burden, Depressive Symptoms, And Quality Of Life: The Role Of Attachment In Adult Relationships, Ghislaine Celine Atkins
A Stress Process Approach To Assessing Caregiver Burden, Depressive Symptoms, And Quality Of Life: The Role Of Attachment In Adult Relationships, Ghislaine Celine Atkins
All ETDs from UAB
Aging adults (65 years and older) are projected to be the largest age group in the United States by around the year 2030. Importantly, the population of aging adults is expected to outnumber their adult children for the first time by the year 2033. The extant literature posits that the majority of carer-care-recipient relationships are between adult children/in law and their aging parent or a spouse/partner. Familial carers dealing with these multiple stressors are more likely to exhibit depressive symptoms, have higher appraisals of stress and have worse quality of life. This dissertation project utilized sociologist Pearlin’s Stress Process Model …
Financial Performance Of Participating Hospitals In Accountable Care Organizations, Abdulrhman Alzhrani
Financial Performance Of Participating Hospitals In Accountable Care Organizations, Abdulrhman Alzhrani
All ETDs from UAB
The study examines the influence of accountable care organizations ACO participation on hospital financial performance. It poses two research questions: 1) how does ACO participation influence hospital financial performance? 2) How do organizational factors- hospital size, electronic health records (EHR) utilization, and ambulatory services- moderate the relationship between hospital ACO participation and financial performance? The study used longitudinal sample of general and surgical hospitals operating in United States from 2009 to 2017. The data were obtained from several sources including American Hospital Association (AHA), AHA survey of care system and payment, hospital cost reports, AHA information technology and Area Health …
The Association Between Post-Stroke Delirium And Mortality Among Stroke Patients In Long-Term Facilities, Nuo Xu
All ETDs from UAB
Delirium is a common neurobehavioral complication following a stroke. Patients who have post-stroke delirium (PSD) are more likely to have severe prognoses, such as physical function decline, high mortality and an increased need for long-term care. Nursing home residents as one of the fragile and special populations sharing the attributes of old age, and high prevalence of chronic diseases and limited mobility. However, there only a few studies have investigated the association between PSD and mortality among individuals admitted to a long-term care facility. This retrospective cohort study aimed to examine the association between PSD and mortality among the participants …
The Luckiest Girl In The World: A Texan Seeks Her Birth Parents, Ardell Taylor Fleeson
The Luckiest Girl In The World: A Texan Seeks Her Birth Parents, Ardell Taylor Fleeson
All ETDs from UAB
This creative nonfiction thesis combines memoir with documentary research to tell the story of the adoptive parents of the author, and the author’s successful search for her birth parents. The adoptive mother’s story starts and finishes the narrative, spanning fifty-five years of her life, from her rise from poverty to prosperity in mid-20th century Texas. The middle of the article is the author’s discovery of her birth parents, the key event for which is the Texas court’s unsealing the author’s adoption file. Names and dates empowered the author to find four half-siblings and speak with her birth mother on the …
Disparities In End-Of-Life Care In Children Dying Of Cancer In Alabama: A Cross Sectional Study, Elizabeth Statham Davis
Disparities In End-Of-Life Care In Children Dying Of Cancer In Alabama: A Cross Sectional Study, Elizabeth Statham Davis
All ETDs from UAB
Regional studies show that children dying of cancer receive medically intense end-of-life care but there is limited information about end-of-life care in the Deep South and limited information about hospice and palliative care involvement at EOL. We conducted a retrospective electronic medical record review of children (0-x years) that died of cancer between 2010-20199 who received cancer directed therapy at Children’s of Alabama. We collected patient clinical and sociodemographics factors, including sex, race, and area deprivation index, cancer diagnosis and treatment, palliative care and hospice involvement, location of death, and medical care in the last 30d of life, including chemotherapy …
Denervation Supersensitivity Of Βeta-Adrenergic Receptors In A Prodromal Model Of Alzheimer's Disease, The Tgf344-Ad Rat, Anthoni Goodman
Denervation Supersensitivity Of Βeta-Adrenergic Receptors In A Prodromal Model Of Alzheimer's Disease, The Tgf344-Ad Rat, Anthoni Goodman
All ETDs from UAB
The central noradrenergic (NA) system is critical for maintenance of attention, behavioral flexibility, spatial navigation, and learning and memory, those cognitive functions lost first in early Alzheimer’s disease (AD). In fact, the locus coeruleus (LC), the major source of norepinephrine (NE) in brain, is the first site of pathological tau accumulation in human AD associated with axon loss throughout forebrain, including hippocampus. The dentate gyrus (DG) is heavily innervated by LC-NA axons, where released norepinephrine (NE) acts on β adrenergic receptors (ARs) at excitatory synapses from entorhinal cortex (EC) to facilitate long-term synaptic plasticity and memory formation. These synapses show …
An Exploratory Study Of The Influence Of Perceived Organizational Support, Coworker Social Support, The Nursing Practice Environment, And Nurse Demographics On Burnout In Palliative Care Nurses, Marcia Ann Lowe
All ETDs from UAB
AN EXPLORATORY STUDY OF THE INFLUENCE OF PERCEIVED ORGANIZATIONAL SUPPORT, COWORKER SOCIAL SUPPORT, THE NURSING PRACTICE ENVIRONMENT, AND NURSE DEMOGRAPHICS ON BURNOUT IN PALLIATIVE CARE NURSES MARCIA A. LOWE SCHOOL OF NURSING ABSTRACT Burnout, a condition characterized by emotional exhaustion, depersonalization, and decreased personal accomplishment, has been studied in many disciplines in healthcare, including nursing, medicine, and social work. Working with palliative care patients and their families is innately challenging and may predispose nurses to burnout. The purpose of this study is to examine the influence of perceived organizational support (POS), coworker social support, the nursing practice environment, and nurse …
African American Caregivers’ Decision To Use Hospice Services For A Loved One: A Grounded Theory Study, Paula M. Gordon
African American Caregivers’ Decision To Use Hospice Services For A Loved One: A Grounded Theory Study, Paula M. Gordon
All ETDs from UAB
This qualitative grounded theory study explored the process of decision making for African American family caregivers in the southeastern United States, as they make hospice decisions for their loved ones, Although hospice use in the United States has grown over the last decade, a disparity continues to exist between African American and Caucasian populations. African Americans represent a small percentage of hospice users in the United States, despite research that has found that patients who use hospice experience improved symptom control, fewer unmet needs, and better end of life care. Research has identified many reasons for this disparity; however, little …
Financial Distress – Causes And Consequences: An Examination Of The Nursing Home Industry, Justin Caleb Lord
Financial Distress – Causes And Consequences: An Examination Of The Nursing Home Industry, Justin Caleb Lord
All ETDs from UAB
Nursing homes operate in a tumultuous and changing environment and are under increasing financial pressure, risk of closure, and financial distress. The issue of financial distress has been explored tangentially within the nursing home industry. This study is the first to validate the Altman Z-Score, a financial distress prediction model, within the nursing home context. The Altman Z-Score model uses multiple discriminate analysis (MDA) to examine multiple financial ratios (liquidity, efficiency, profitability and net worth) simultaneously to predict the likelihood of a firm’s financial distress. After calculating the Z-Score, clustering was used to classify the observations into three groups, distressed, …
Assessing The Comparative Effect Of Tocilizumab On Risk Of Cardiovascular Disease Among Rheumatoid Arthritis Patients Using Claims Data: A Direct Comparison Among Biologic Disease-Modifying Antirheumatic Drugs, Fenglong Xie
All ETDs from UAB
ASSESSING THE COMPARATIVE EFFECT OF TOCILIZUMAB ON RISK OF CARDIOVASCULAR DISEASE AMONG RHEUMATOID ARTHRITIS PATIENTS USING CLAIMS DATA: A DIRECT COMPARISON AMONG BIOLOGIC DISEASEMODIFYING ANTIRHEUMATIC DRUGS FENGLONG XIE PhD-EPID ABSTRACT Tocilizumab is a humanized monoclonal anti-body against the interleukin-6 receptor and is effective in the treatment of rheumatoid arthritis (RA) [1]. Multiple studies have observed unfavorable changes in the lipid profile of tocilizumab-treated RA patients. Few studies have compared the cardiovascular disease (CVD) risk associated with tocilizumab to other biologic disease-modifying antirheumatic drugs (bDMARDS). Due to limitations in existing studies, the real-world association of tocilizumab with CVD risk remains uncertain. …
Statin Prescribing, Adherence, And Recurrent Vascular Events: A Study Of Ischemic Stroke Survivors, Karen C. Albright
Statin Prescribing, Adherence, And Recurrent Vascular Events: A Study Of Ischemic Stroke Survivors, Karen C. Albright
All ETDs from UAB
Due to increase in incidence and improvements in stroke mortality, the number of stroke survivors will increase over the next decade; each stroke survivor is at risk for recurrent stroke. Thus, identifying populations with the highest risk and ensuring they receive evidence-based secondary stroke prevention (SSP) is paramount. This includes ensuring access and adherence to statins. The American Heart Association (AHA)/American Stroke Association (ASA) Scientific Statement on Racial-Ethnic Disparities in Stroke Care reported that recurrent stroke risk is higher among blacks than whites and suggested that lower adherence to current standards of SSP in blacks might help explain these discrepancies. …
Home Healthcare And Performance: Development And Application Of A Typology For Home Health Agencies, Ronique Nechelle Evans
Home Healthcare And Performance: Development And Application Of A Typology For Home Health Agencies, Ronique Nechelle Evans
All ETDs from UAB
This three-paper dissertation sought to examine the existence of strategic groups in the home health industry, the application of Porter’s generic strategies (cost leader, differentiator, “stuck-in-the-middle” and both cost leader/differentiator) in identifying these groups, and the association of group membership with agency performance. The findings of this study will provide researchers and managers with a highlight of the current strategic makeup of the home health industry and its relationship with quality and financial performance. The results of this dissertation provide some evidence that strategic groups do exist in the home health industry and can be described along the basis of …
A Comparative Multiyear Assessment Of Care Utilization Between Existing And Newly Enrolled Medicaid Populations Within Washington State, Preston M. Simmons
A Comparative Multiyear Assessment Of Care Utilization Between Existing And Newly Enrolled Medicaid Populations Within Washington State, Preston M. Simmons
All ETDs from UAB
A COMPARATIVE MULTIYEAR ASSESSMENT OF CARE UTILIZATION BETWEEN EXISTING AND NEWLY ENROLLED MEDICAID POPULATIONS WITHIN WASHINGTON STATE ABSTRACT The study looks at 2012 through June of 2016 Medicaid data from the Washington State Health Care Authority, comparing claims utilization for newly enrolled patients each calendar year to continuously enrolled members. Mean number of emergency department, hospital, and ambulatory (office) claims per Medicaid member are compared to ascertain if they are the same or different between the groups. Differences in the mean number of ambulatory care sensitive conditions (ACSC) were additionally assessed between those continuously and newly enrolled. The results of …
The Relationship Of Lean Implementation And Patient Satisfaction (Hcahps) Scores In Acute Care Hospitals, Charles V. Hagood
The Relationship Of Lean Implementation And Patient Satisfaction (Hcahps) Scores In Acute Care Hospitals, Charles V. Hagood
All ETDs from UAB
THE RELATIONSHIP OF LEAN IMPLEMENTATION AND PATIENT SATISFACTION (HCAHPS) SCORES IN ACUTE CARE HOSPITALS CHARLES V. HAGOOD DOCTOR OF SCIENCE IN HEALTH SERVICES ADMINISTRATION ABSTRACT Background: The purpose of the study was to better understand the relationship of Lean implementation and patient satisfaction (HCAHPS) scores in acute care hospitals. Hospitals are under significant pressure to improve patient satisfaction, thus a number of hospitals are increasingly using Lean improvement methodologies to do so. However, the results that have been achieved are often reported as mixed at best and lack empirical proof, specifically the relationship of Lean methodologies and their impact on …
Use Of Medicare Inpatient Claims Data For The Identification Of Myocardial Infarction, Lisandro Damian Colantonio
Use Of Medicare Inpatient Claims Data For The Identification Of Myocardial Infarction, Lisandro Damian Colantonio
All ETDs from UAB
Claims are being used for the identification of myocardial infarctions (MI) in research studies, either as a complement of primary data collection or as the sole data source. However, few data are available to support these approaches. The current dissertation analyzes the use of claims for the identification of MIs in a large population-based cohort linked to Medicare data, the REasons for Geographic and Racial Differences in Stroke study. Analyses included 9,951 study participants ≥65 years of age with Medicare Part A (inpatient) fee-for-service coverage at baseline in 2003-2007. Participant self-report and Medicare inpatient claims with a diagnosis code for …
Administrative Challenges In Pediatric Long-Term Care, Holly Elaine Jarek
Administrative Challenges In Pediatric Long-Term Care, Holly Elaine Jarek
All ETDs from UAB
ABSTRACT This research used a Delphi methodology to solicit challenges that significantly impact the operational success of pediatric long-term care facilities. Further, this study sought to understand the ability of pediatrics administrators to impact, affect, overcome, or resolve these challenges. Round 1 accomplished the desired goal of eliciting a substantial amount of new qualitative information regarding administrative challenges in pediatric long-term care, which previously had been extant in the literature. In Round 2, data were distilled into categories and unique exemplars which in turn were validated by participants. In Round 3, administrators ranked and rated categories and individual challenges in …
Comparing The Quality Of End Of Life Cancer Care In The Medicare Population Prior To And After The Enactment Of The Medicare Prescription Drug, Improvement And Modernization Act Of 2003, Rene Jooste
All ETDs from UAB
Reimbursement for chemotherapy could account for two thirds of the income for oncologists in private practice. The Medicare prescription drug improvement and modernization act of 2003 (MMA) brought about a dramatic change in the way physicians were reimbursed for delivering chemotherapy in an attempt to slow the skyrocketing costs of drugs and Medicare costs for covering these drugs . The MMA reduced Medicare reimbursements for covered outpatient prescription drugs from 95% to 85% of the average wholesale price. In 2005, a new payment system was instituted that reimbursed fee-for-service providers for drugs at the national average sales price plus 6%. …
Rural Hos[Ital Closure In Alabama - Post Aca, Dennis Otto Mccay
Rural Hos[Ital Closure In Alabama - Post Aca, Dennis Otto Mccay
All ETDs from UAB
RURAL HOSPITAL CLOSURES IN ALABAMA: POST ACA DENNIS O. MCCAY HEALTH SERVICES ADMINISTRATION ABSTRACT Rural hospitals differ from their urban counterparts with regard to two main areas. First, rural hospital patients are usually older, of lower income, and less healthy than those in urban areas. Second, their facilities tend to be smaller, older, and more prone to staff shortages than those in an urban environment. Rural hospitals have been closing at higher rates than their urban counterparts for a number of years, but more so since the implementation of the Affordable Care Act in 2010. The objective of this research …
Dietary Patterns, Insulin Resistance, And Cognitive Outcomes In A Cohort Of Black And White Americans, Keith Pearson
Dietary Patterns, Insulin Resistance, And Cognitive Outcomes In A Cohort Of Black And White Americans, Keith Pearson
All ETDs from UAB
As life expectancy continues to increase and the number of elderly Americans rises, public health initiatives are seeking to identify modifiable risk factors to preserve cognitive function and increase quality of life in advanced ages. The primary objective of this dissertation was to investigate dietary patterns, carbohydrate consumption, and insulin resistance as modifiable risk factors that may contribute to the development of cognitive impairment and cognitive decline. Three separate studies were performed in the REasons for Geographic And Racial Differences in Stroke study, a prospective cohort containing 30,239 black and white participants. Cognitive impairment was defined using the Six-Item Screener. …