Kathleen C Insel

Interests

Teaching

Teaching quantitative research methods is a passion and a lifelong learning endeavor. Maintaining expertise in new methods, for example, the challenges in "big data" continue to move my expertise forward.I have taught and I am happy to teach Quantitative Methods for Nursing Research, Behavioral Interventions and faculty role.

Research

Cognitive function and changes related to age, disease and treatment and the consequences of these changes.

Courses

Scholarly Contributions

Journals/Publications

• Al-Saleh, S., Conley, S., Pace, T., & Insel, K. (2024). A Cross-Sectional Study of Cognitive Function, Illness Perceptions, and Immunosuppression Medication Adherence After Heart Transplantation. Western Journal of Nursing Reseach, 46(3), 164-171. doi:10.1177/01939459231220283
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  Background: There are few studies that examine relationships between cognitive function, illness perceptions, and medication adherence after heart transplantation, limiting the development of effective adherence-promoting interventions. Objective: The purpose of this study was to describe relationships between cognitive function, illness perceptions, and medication adherence among heart transplant recipients. Methods: A cross-sectional, observational design was used. Measures included the telephone-Montreal Cognitive Assessment (t-MoCA©), Patient Health Questionnaire-9, Brief Test of Adult Cognition by Telephone, Basel Assessment of Adherence to Immunosuppressive Medications Scale, and the Brief Illness Perceptions Questionnaire. Descriptive statistics, point-biserial correlations, Pearson’s correlations, and logistic regression were used to describe relationships. Results: Of the 35 participants (mean age: 61 years [SD: 10.3], 71.4% male, 71.4% white), 31.4% (n = 11) were classified as nonadherent to their immunosuppression medications. Higher immediate word recall, indicating better episodic memory (memory for autobiographical and recent events), and higher illness coherence scores were associated with not missing doses of medication. Higher t-MoCA© total scores, indicating normal cognitive function, and lower depression scores were associated with taking medications on time. More than 22% (n = 8) of participants scored less than 19 on the t-MoCA©, an indication of mild cognitive impairment. Conclusion: Cognitive impairment may be more common among heart transplant recipients than what is currently recognized, and specific domains of cognitive function were related to medication adherence after transplantation in this study. Future studies should include longitudinal evaluations of cognitive function, depression, and medication adherence. Consideration of these relationships is needed when designing adherence-promoting interventions for this population.
• Azevedo, R. F., Hale, T., Warren, T., Baby, E., Lee, J., Insel, K., Rogers, W., & Mudar, R. (2023). ASSESSING USABILITY OF A MEDICATION ADHERENCE SYSTEM FOR PERSONS WITH MILD COGNITIVE IMPAIRMENT. Innovation in Aging, 7(Supplement_1), 83-83. doi:10.1093/geroni/igad104.0266
• Al-Saleh, S., Insel, K. C., Lee, J. K., & Rogers, W. A. (2022). Translation of a Successful Behavioral Intervention to a Digital Therapeutic Self-Management System for Older Adults. Ergonomics in Design: The Quarterly of Human Factors Applications, 32(2), 106480462110664. doi:10.1177/10648046211066409
• Al-Saleh, S., Lee, J. K., Rogers, W., & Insel, K. C. (2022). Translation of a Successful Behavioral Intervention to a Digital Therapeutic Self-Management System for Older Adults.. Ergonomics in Design: The Quarterly of Human Factors Applications. doi:10.1177/10648046211066409
• Azevedo, R. F., Insel, K., Lee, J., Nicholas, J., & Rogers, W. (2022). A TRANSDISCIPLINARY TEAM APPROACH TO TECHNOLOGY DEVELOPMENT TO SUPPORT HEALTH AND WELL-BEING. Innovation in Aging, 6(Supplement_1), 310-310. doi:10.1093/geroni/igac059.1226
• Miller, S. M., Taylor-Piliae, R. E., & Insel, K. C. (2019). The association of physical activity, cognitive processes and automobile driving ability in older adults: A review of the literature. Geriatric nursing (New York, N.Y.), 37(4), 313-20.
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  As the number of older adults in the United States grows, the number of automobile drivers over the age of 65 will also increase. Several cognitive processes necessary for automobile driving are vulnerable to age-related decline. These include declines in executive function, working memory, attention, and speed of information processing. The benefits of physical activity on physical, psychological and particular cognitive processes are well-documented; however few studies have explored the relationship between physical activity and driving ability in older adults or examined if cognitive processes mediate (or moderate) the effect of physical activity on driving ability. The purpose of this paper is to review the existing literature regarding physical activity, cognition and automobile driving. Recommendations for further research and utility of the findings to nursing and the health care team are provided.
• Reed, P. G., Moore, K., Insel, K. C., Hinds, P. S., Bajjani-gebara, J. E., & Badger, T. A. (2019). Well-being, Self-transcendence, and Resilience of Parental Caregivers of Children in Active Cancer Treatment: Where Do We Go From Here?. Cancer nursing, 42(5), E41-E52. doi:10.1097/ncc.0000000000000662
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  Childhood cancer profoundly impacts the well-being of many parental caregivers in the United States yearly. Empirical evidence is extensive for negative well-being and scarce for positive well-being in this population..Study aims were to (1) describe resilience, self-transcendence, and positive (general well-being) and negative well-being (depression and anxiety); (2) examine if caregiver-related personal factors (resilience and/or demographic characteristics) and/or child-related contextual factors (child's cancer and/or demographic characteristics) are associated with well-being; and (3) test if self-transcendence mediates the relationship between resilience and well-being..A cross-sectional study whereby 80 caregivers of children diagnosed with childhood cancer for at least 2 months completed study questionnaires. Descriptive statistics explored sample demographics, well-being, self-transcendence, and resilience levels. Bivariate correlations examined factors associated with well-being. One-way analysis of variance and independent-samples t tests explored differences in well-being across levels of independent variables. Baron and Kenny's mediation analysis tested if self-transcendence mediated the relationship between resilience and well-being..Positive well-being and negative well-being coexist in parental caregivers. No child-related contextual factors related to caregivers' well-being. Parental caregivers' resilience and self-transcendence positively related to their general well-being and negatively related to their depression and anxiety. Satisfaction with current financial status positively related to general well-being and negatively related to depression. Self-transcendence mediated the relationship between resilience and well-being..Findings confirm the importance of focusing on both positive and negative well-being, their associated factors, and mediators..The authors discuss practice implications to enhance self-transcendence such as journaling, mindfulness techniques, activities to connect with nature, and others.
• Sonney, J., & Insel, K. C. (2019). Exploring the intersection of executive function and medication adherence in school-age children with asthma.. The Journal of asthma : official journal of the Association for the Care of Asthma, 56(2), 179-189. doi:10.1080/02770903.2018.1441870
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  Asthma is one of the most common chronic diseases of childhood. For children with persistent asthma, asthma control is largely related to controller medication adherence. With increasing calls for children to be involved in their own asthma management, there is a gap in our knowledge about the executive functioning of children with asthma..The purpose of this study was to explore the relationship between executive function, asthma, and medication adherence among school-age children with asthma..Thirty-one children ages 7 to 11 years (M = 8.9 ± 1.51) and one of their parents were enrolled in this study. Parents reported on asthma control while children reported on asthma control, medication beliefs, medication adherence, and completed an executive function battery that assessed inhibition, updating, shifting and planning..Compared to the reference sample, children in this study had significantly lower composite scores in inhibition, t (31) = -3.84, p =. 001, and shifting, t (30) = -3.73, p =. 001. Controlling for age and asthma control, hierarchical regression analyses revealed that shifting accounted for 16% of the variance in child-reported medication adherence..This study revealed lowered executive functioning scores among school-age children with persistent asthma. Furthermore, it appears executive functioning and controller medication adherence are intertwined and warrant future exploration.
• Bajjani-Gebara, J., Hinds, P., Insel, K., Reed, P., Moore, K., & Badger, T. (2018). Well-being, Self-transcendence, and Resilience of Parental Caregivers of Children in Active Cancer Treatment: Where Do We Go From Here?. Cancer nursing.
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  Childhood cancer profoundly impacts the well-being of many parental caregivers in the United States yearly. Empirical evidence is extensive for negative well-being and scarce for positive well-being in this population.
• Gallagher, S. P., Insel, K., Badger, T. A., & Reed, P. (2018). Antidepressant adherence in United States active duty Army Soldiers: A small descriptive study. Archives of psychiatric nursing, 32(6), 793-801.
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  While much is known about depression and antidepressant adherence associations with illness perceptions, medication beliefs, social support, and stigma in the general population, there is a dearth of knowledge among United States active duty Army Soldiers. The study objective was to explore antidepressant adherence and correlations between antidepressant adherence and illness perceptions, medication beliefs, social support, stigma and select demographic variables among Army Soldiers with depression. Results indicated age and gender were significantly correlated with and predictive of adherence. Low adherence was found. Findings suggest Soldiers who are younger and those who are female are more likely to report higher levels of adherence.
• Moore, I. M., Koerner, K. M., Gundy, P. M., Montgomery, D. W., Insel, K. C., Harris, L. L., Taylor, O. A., & Hockenberry, M. J. (2018). Changes in Oxidant Defense, Apoptosis, and Cognitive Abilities During Treatment for Childhood Leukemia. Biological research for nursing, 20(4), 393-402.
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  Aggressive central nervous system (CNS)-directed treatment for acute lymphoblastic leukemia (ALL), the most prevalent cancer among children and adolescents, prevents metastasis of leukemia cells into the brain. Up to 60% of survivors experience cognitive problems, but knowledge about risk factors for and mechanisms of neurologic injury is lacking. Objectives of the present study were to (1) quantify changes in oxidant defense and apoptosis over the course of ALL therapy and (2) elucidate risk factors for long-term cognitive problems. The sample included 71 children with ALL. Cerebrospinal fluid (CSF) samples were collected at diagnosis and during intrathecal chemotherapy administration. Oxidant defense was measured by reduced glutathione (GSH), oxidized glutathione (GSSG), and the ratio of GSH:GSSG. Apoptosis was measured by activity of several cysteine-dependent aspartate-specific protease (abbreviated as caspase) enzymes that initiate (caspases 8 and 9) or execute (caspases 3/7) apoptosis. Cognitive abilities were assessed by standardized measures of short-term memory, visual-motor integration, and attention 3 years after ALL diagnosis. GSH and GSSG concentration increased significantly during ALL therapy, and a low GSH:GSSG ratio was indicative of an oxidized extracellular environment. Caspase enzyme activity increased significantly, and caspases 3/7 activity was significantly and negatively associated with performance on measures of cognitive abilities. Younger age at time of ALL diagnosis was associated with some measures of attention. Efflux of glutathione into CSF maintains oxidant defense by scavenging free radicals and other reactive oxygen species and is an early event in apoptosis. These mechanisms may be involved in neurologic injury associated with CNS-directed treatment and subsequent cognitive problems.
• Rogers, W. A., Nie, Q., Lee, J. K., Insel, K. C., Blocker, K. A., & Ajuwon, A. M. (2018). User insights for design of an antihypertensive medication management application. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 62(1), 1077-1081. doi:10.1177/1541931218621247
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  Hypertension is the most common chronic disease affecting older adults (65+) in the United States. Unfortunately, many struggle to adhere to their antihypertensive medications as only about half diagnosed with the disease have it controlled. Therefore, there is a need for designing supportive medication management systems to aid this population with their antihypertensive medications, especially using increasingly adopted technologies such as smartphones. The preferences of older adults with hypertension must be considered when designing such systems for this population. Six older adults participated in structured interviews to inform the design of the Medication Education, Decision Support, Reminding and Monitoring System (MEDSReM). Results revealed management needs, design insights, and reminder preferences, as well as mostly positive opinions regarding technology use for medication management. These findings informed the development of MEDSReM with the goal of supporting older adults in successfully ma...
• Sonney, J., & Insel, K. C. (2018). Exploring the intersection of executive function and medication adherence in school-age children with asthma. The Journal of asthma : official journal of the Association for the Care of Asthma, 1-11.
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  Asthma is one of the most common chronic diseases of childhood. For children with persistent asthma, asthma control is largely related to controller medication adherence. With increasing calls for children to be involved in their own asthma management, there is a gap in our knowledge about the executive functioning of children with asthma.
• Insel, K. C., Hockenberry, M. J., Harris, L. L., Koerner, K. M., Lu, Z., Adkins, K. B., Taylor, O. A., Gundy, P. M., & Moore, I. M. (2017). Declines Noted in Cognitive Processes and Association With Achievement Among Children With Leukemia. Oncology nursing forum, 44(4), 503-511.
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  To assess change in specific cognitive processes during treatment with chemotherapy only among children with acute lymphoblastic leukemia (ALL). .
• Rogers, W. A., Koerner, K. M., Insel, K. C., & Blocker, K. A. (2017). Understanding the medication adherence strategies of older adults with hypertension. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 61(1), 11-15. doi:10.1177/1541931213601498
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  Many older adults are living with at least one chronic disease and must adhere to prescribed medication to mitigate and control its impact. Hypertension is one chronic disease that affects a significant portion of the world’s population, especially older adults, and is responsible for a high number of annual deaths. It is asymptomatic, meaning that there are no perceptible symptoms and, as such, older adults may struggle with adhering to their prescribed antihypertensive medications. How one internalizes the disease may influence the degree of success in managing the condition. The current study analyzed archival data from a multifaceted prospective memory intervention for older adults with hypertension who were nonadherent to their medication. We coded their responses to self-management interview questions to identify the common themes regarding the knowledge and sense of control the older adults held relevant to managing their illness. Participants’ responses revealed how they internalized hypertension ...
• Sonney, J., Insel, K. C., Segrin, C., Gerald, L. B., & Ki Moore, I. M. (2017). Association of Asthma Illness Representations and Reported Controller Medication Adherence Among School-Aged Children and Their Parents. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 31(6), 703-712.
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  This study examined the relationship between asthma illness representations and reported controller medication adherence of school-aged children (6-11 years) with persistent asthma and their parents. Thirty-four parent-child dyads independently reported on asthma controller medication adherence and asthma illness representations. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of reported medication adherence. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported adherence (β = .55, p < .01), and child treatment control was also a significant predictor of parent-reported adherence (β = -.50, p < .01). Child beliefs about medication necessity versus concerns was a significant predictor of child-reported adherence (β = .50, p < .01), and no parent variables reached significance. Although there are similarities between parent and child asthma illness representations, findings indicate that school-aged children develop illness representations somewhat independently from their parents and, therefore, are critical participants in both asthma care and research.
• Insel, K. C. (2016). Health beliefs related to physical activity in patients living with implantable cardioverter defibrillators.. Journal of Cardiovascular Nursing, 31, 483-487. doi:10.1097/JCN.0000000000000363
• Insel, K. C. (2016). Multifaceted Prospective Memory Intervention to Improve Medication Adherence. Journal of the American Geriatrics Society, 64, 561-8. doi:10.1111/jgs14032
• Insel, K. C. (2016). Parent and child asthma illness representations: a systematic review. Journal of Asthma, 53(5), 510-516. doi:10.3109/02770903.2015.1116088
• Insel, K. C. (2016). The Association of Physical Activity, Cognitive Processes and Automobile Driving Ability in Older Adults: a Review of the Literature.. Geriatric Nursing, 37(4), 313-320.
• Insel, K. C. (2017). Decline in Verbal Working Memory during Treatment and Association with Achievement among Children with Acute Lymphoblastic Leukemia.. Oncology Nursing Forum.
• Insel, K. C., Einstein, G. O., Morrow, D. G., Koerner, K. M., & Hepworth, J. T. (2016). Multifaceted Prospective Memory Intervention to Improve Medication Adherence. Journal of the American Geriatrics Society, 64(3), 561-8.
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  To test whether a multifaceted prospective memory intervention improved adherence to antihypertensive medications and to assess whether executive function and working memory processes moderated the intervention effects.
• Loescher, L. J., Insel, K. C., Taylor-Piliae, R. E., & Webber-Ritchey, K. J. (2016). Physical Activity among African American Parents of Young Children: Roles of Personal and Environmental Factors.. International Journal of Sport Psychology, 47(6), 523-544. doi:doi: 10.7352/IJSP 2015.46.523
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  OBJECTIVES: To assess the factors that influence self-reported physical activity(PA).METHODS: African American (AA) parents/caregivers (n=96; M age=36years) completed an online survey to describe PA, personal (PA knowledge, exerciseself-efficacy-SE and outcome expectations-OE) and environmental factors (socialeconomic status-SES, neighborhood safety-NS, and culture).RESULTS: Moderate (30%, n=29) to high (54%, n=52) levels of PA werereported. There were significant correlations between PA and NS (rs=.25) and PAknowledge and PA (rs =-.30). Significant predictors of PA included SE (β=.21,t(84)=2.20, p=.030), NS (􀀀=.33, t(84)=3.56, p=.001), and an unexpected inverse ofPA knowledge (β=-.25, t(84)=-2.42, p=.018).CONCLUSIONS: Unlike prior studies, we found AA parents of young childrenwere physically active, knowledgeable of the PA guidelines, with moderate-highexercise SE, high SES, felt safe in their neighborhoods with a positive cultural identity.Future research examining the influence of AA parents’ PA on health indicatorsamong their children is needed next.
• Miller, S. M., Taylor-Piliae, R. E., & Insel, K. C. (2016). The Association of Physical Activity, Cognitive Processes and Automobile Driving Ability in Older Adults: A Review of the Literature.. Geriatric Nursing, 37(4), 313-20. doi:10.1016/j.gerinurse.2016.05.004.
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  Miller, S.M., Taylor-Piliae, R.E. & Insel, K. C. The Association of Physical Activity, Cognitive Processes and Automobile Driving Ability in Older Adults: A Review of the Literature. Geriatric Nursing, 37(4):313-20, 2016.
• Sonney, J. T., & Insel, K. C. (2016). Reformulating the Common Sense Model of Self-Regulation: Toward Parent-Child Shared Regulation. Nursing science quarterly, 29(2), 154-9.
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  Asthma is one of the most common chronic diseases of childhood with nearly 7 million children affected in the United States. Nonadherence to controller medication is a substantial issue that results in higher pediatric asthma disease morbidity. The common sense model of self-regulation is a useful theoretical framework to understand chronic disease self-management in adults, but has not been used in the context of pediatric chronic disease. Using Fawcett's framework, the authors analyze and evaluate the common sense model. To conclude, the authors propose a reformulation of the model that incorporates parent-child shared regulation of pediatric asthma.
• Sonney, J. T., Gerald, L. B., & Insel, K. C. (2016). Parent and child asthma illness representations: a systematic review. The Journal of asthma : official journal of the Association for the Care of Asthma, 53(5), 510-6.
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  The purpose of this article is to synthesize the current literature on parent and child asthma illness representations and their consequent impact on parent-child asthma shared management.
• Taylor, O. A., Pasvogel, A., Moore, I. M., Lupo, P. J., Koerner, K. M., Insel, K. C., Hockenberry, M. J., Harris, L. L., & Adkins, K. B. (2016). Neurocognitive Predictors of Academic Outcomes Among Childhood Leukemia Survivors.. Cancer nursing, 39(4), 255-62. doi:10.1097/ncc.0000000000000293
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  Acute lymphoblastic leukemia is the most common pediatric cancer, and survival approaches 90%. Acute lymphoblastic leukemia survivors are more likely than healthy peers or siblings to experience academic underachievement, yet little is known about neurocognitive predictors of academic outcomes..Objectives were to compare neurocognitive abilities to age-adjusted standardized norms, examine change over time in neurocognitive abilities, and establish neurocognitive predictors of academic outcomes..Seventy-one children were followed over the course of therapy. Cognitive abilities were assessed during induction when the child was in remission (baseline) and annually for 3 years (years 1, 2, and 3). Reading and mathematics abilities were assessed at year 3..Fine motor dexterity was significantly below age-adjusted norms at all data points but showed improvement over time. Baseline visual-motor integration was within the reference range but significantly declined by year 3, and mean scores at years 2 and 3 were significantly below age-adjusted norms. Verbal short-term memory was significantly below age-adjusted norms at all assessments. Visual-motor integration predicted reading and mathematics abilities. Verbal short-term memory predicted reading abilities, and visual short-term memory predicted mathematics abilities..Central nervous system-directed therapy is associated with specific neurocognitive problems. Visual-spatial skills and verbal and visual short-term memory predict academic outcomes..Early assessment of visual-spatial perception and short-term memory can identify children at risk of academic problems. Children who are at risk of academic problems could benefit from a school-based individual educational program and/or educational intervention.
• Webber-Ritchey, K. J., Taylor-Piliae, R. E., Insel, K. C., & Loescher, L. J. (2016). Physical Activity among African American Parents of Young Children: Roles of Personal and Environmental Factors.. International Journal of Sport Psychology, 46, 523-544. doi:doi: 10.7352/IJSP 2015.46.523
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  OBJECTIVES: To assess the factors that influence self-reported physical activity(PA).METHODS: African American (AA) parents/caregivers (n=96; M age=36years) completed an online survey to describe PA, personal (PA knowledge, exerciseself-efficacy-SE and outcome expectations-OE) and environmental factors (socialeconomic status-SES, neighborhood safety-NS, and culture).RESULTS: Moderate (30%, n=29) to high (54%, n=52) levels of PA werereported. There were significant correlations between PA and NS (rs=.25) and PAknowledge and PA (rs =-.30). Significant predictors of PA included SE (β=.21,t(84)=2.20, p=.030), NS (􀀀=.33, t(84)=3.56, p=.001), and an unexpected inverse ofPA knowledge (β=-.25, t(84)=-2.42, p=.018).CONCLUSIONS: Unlike prior studies, we found AA parents of young childrenwere physically active, knowledgeable of the PA guidelines, with moderate-highexercise SE, high SES, felt safe in their neighborhoods with a positive cultural identity.Future research examining the influence of AA parents’ PA on health indicatorsamong their children is needed next.
• Gatlin, P. K., & Insel, K. C. (2015). Severity of Type 2 Diabetes, Cognitive Function, and Self-Care. Biological research for nursing, 17(5), 540-8.
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  Type 2 diabetes mellitus (T2DM) is associated with poorer performance on certain measures of cognitive function. However, little is known about the associations among working memory (WM), executive function (EF), and self-care in those with severe T2DM. This investigation explored these relationships among 67 middle-aged and older individuals with T2DM (mean age of 62.9 years). Severity of T2DM was measured with a health status composite (HSC) score from the Diabetes Care Profile, the number of prescribed medications, and the number of comorbid conditions. Cognitive assessments included the Working Memory Index and the Executive Interview 25 (EXIT 25). Self-care was measured using the Self-Care Inventory-Revised (SCI-R) and hemoglobin A1c (HgbA1c). WM was significantly correlated with all measures of severity of T2DM (HSC, r = .542, p < . 01; number of comorbidities, r = -.476, p < .01; and number of prescription medications, r = -.344, p < .01). EF was significantly correlated with all measures of severity of T2DM (HSC, r = -.504, p < .01; number of comorbidities, r = .492, p < .01; and number of prescription medications, r = .326, p < .01). The self-care measure HgbA1c was significantly correlated with WM (r = -.352, p < .01) and EF (r = .510, p < .01). The EXIT 25 score fully mediated the relationship between severity of T2DM and self-care as measured by HgbA1c (β = .431, p < .001). These findings provide preliminary evidence for the associations among severity of T2DM, WM, EF, and self-care.
• Hockenberry, M. J., Krull, K. R., Insel, K. C., Harris, L. L., Gundy, P. M., Adkins, K. B., Pasvogel, A. E., Taylor, O. A., Koerner, K. M., Montgomery, D. W., Ross, A. K., Hill, A., & Moore, I. M. (2015). Oxidative Stress, Motor Abilities, and Behavioral Adjustment in Children Treated for Acute Lymphoblastic Leukemia. Oncology nursing forum, 42(5), 542-9.
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  To examine associations among oxidative stress, fine and visual-motor abilities, and behavioral adjustment in children receiving chemotherapy for acute lymphoblastic leukemia (ALL).
• McHenry, J. C., Insel, K. C., Einstein, G. O., Vidrine, A. N., Koerner, K. M., & Morrow, D. G. (2015). Recruitment of Older Adults: Success May Be in the Details. The Gerontologist, 55(5), 845-53.
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  Describe recruitment strategies used in a randomized clinical trial of a behavioral prospective memory intervention to improve medication adherence for older adults taking antihypertensive medication.
• Moore, I. M., Lupo, P. J., Insel, K., Harris, L. L., Pasvogel, A., Koerner, K. M., Adkins, K. B., Taylor, O. A., & Hockenberry, M. J. (2015). Neurocognitive Predictors of Academic Outcomes Among Childhood Leukemia Survivors. Cancer nursing, 39(4), 255-62.
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  Acute lymphoblastic leukemia is the most common pediatric cancer, and survival approaches 90%. Acute lymphoblastic leukemia survivors are more likely than healthy peers or siblings to experience academic underachievement, yet little is known about neurocognitive predictors of academic outcomes.
• Hsiao, C. P., Moore, I. M., Insel, K. C., & Merkle, C. J. (2014). Symptom self-management strategies in patients with non-metastatic prostate cancer. Journal of clinical nursing, 23(3-4), 440-9.
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  To explore the association between symptoms, symptom distress and symptom self-management and to identify effective strategies of symptom self-management in men with non-metastatic prostate cancer following radical prostatectomy or radiation therapy.
• Morrow, D. G., Madison, A. M., Koerner, K. M., Insel, K. C., Falk, N. A., & Duwe, E. A. (2014). Defining older adults’ perceived causes of hypertension in the Brief Illness Perception Questionnaire. Health Education Journal, 73(6), 731-745. doi:10.1177/0017896913516096
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  Objectives:This study sought to make the Brief Illness Perception Questionnaire (BIPQ) to be more informative about illness representation among older adults with hypertension. The authors develope...
• Insel, K. C., Einstein, G. O., Morrow, D. G., & Hepworth, J. T. (2013). A multifaceted prospective memory intervention to improve medication adherence: Design of a randomized control trial. Contemporary Clinical Trials, 34(1), 45-52.
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  PMID: 23010608;Abstract: Adherence to prescribed antihypertensive agents is critical because control of elevated blood pressure is the single most important way to prevent stroke and other end organ damage. Unfortunately, nonadherence remains a significant problem. Previous interventions designed to improve adherence have demonstrated only small benefits of strategies that target single facets such as understanding medication directions. The intervention described here is informed by prospective memory theory and performance of older adults in laboratory-based paradigms and uses a comprehensive, multifaceted approach to improve adherence. It incorporates multiple strategies designed to support key components of prospective remembering involved in taking medication. The intervention is delivered by nurses in the home with an education control group for comparison. Differences between groups in overall adherence following the intervention and 6. months later will be tested. Systolic and diastolic blood pressure levels also will be examined between groups and as they relate to adherence. Intra-individual regression is planned to examine change in adherence over time and its predictors. Finally, we will examine the association between executive function/working memory and adherence, predicting that adherence will be related to executive/working memory in the control group but not in the intervention group. © 2012 Elsevier Inc.
• Insel, K. C., Einstein, G. O., Morrow, D. G., & Hepworth, J. T. (2013). A multifaceted prospective memory intervention to improve medication adherence: design of a randomized control trial. Contemporary clinical trials, 34(1), 45-52.
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  Adherence to prescribed antihypertensive agents is critical because control of elevated blood pressure is the single most important way to prevent stroke and other end organ damage. Unfortunately, nonadherence remains a significant problem. Previous interventions designed to improve adherence have demonstrated only small benefits of strategies that target single facets such as understanding medication directions. The intervention described here is informed by prospective memory theory and performance of older adults in laboratory-based paradigms and uses a comprehensive, multifaceted approach to improve adherence. It incorporates multiple strategies designed to support key components of prospective remembering involved in taking medication. The intervention is delivered by nurses in the home with an education control group for comparison. Differences between groups in overall adherence following the intervention and 6 months later will be tested. Systolic and diastolic blood pressure levels also will be examined between groups and as they relate to adherence. Intra-individual regression is planned to examine change in adherence over time and its predictors. Finally, we will examine the association between executive function/working memory and adherence, predicting that adherence will be related to executive/working memory in the control group but not in the intervention group.
• Ganzer, C. A., Insel, K. C., & Ritter, L. S. (2012). Associations between working memory, health literacy, and recall of the signs of stroke among older adults. Journal of Neuroscience Nursing, 44(5), 236-243.
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  PMID: 22955236;Abstract: Stroke remains a major cause of mortality and disability among older adults. Although early treatment after stroke is known to reduce both mortality and disability, the first step in seeking early treatment is dependent on the rapid recognition of the signs of stroke. Recall of the signs of stroke may be dependent on factors that exist before the stroke itself. Although it is known that both working memory and health literacy decline with advancing age, these factors have not been thoroughly examined with respect to recall of the signs of stroke. Therefore, the purpose of the current study was to investigate associations between working memory, health literacy, and recall of the signs of stroke among older adults. Community dwelling older adults (≥65years of age) were recruited from two senior centers. Fifty-six participants meeting inclusion criteria provided demographic and health information and were asked to read a public service brochure listing the five warning signs of stroke. Working memory was then assessed using the Wechsler Adult Intelligence Scale 3rd Edition Working Memory Index. Health literacy was assessed by the Short Test of Functional Health Literacy in Adults. Participants' recall of the five warning signs of stroke was evaluated. The mean age was 80.4 years. The mean number of the signs of stroke recalled was 2.9 ± 1.33. Working memory and health literacy were positively correlated with recall of the signs of stroke (r =.38, p < 0.01; r =.44, p < 0.01). In a simultaneous regression, only health literacy remained a significant predictor of recall. There was no statistically significant interaction between working memory and health literacy. Findings from this study indicate that working memory and health literacy were associated with successful recall of the warning signs of stroke in older adults. Further studies are needed to determine if programs that include cognitive and literacy assessments could identify older adults who need additional support to learn and recall the signs of stroke. Copyright © 2012 American Association of Neuroscience Nurses.
• Ganzer, C. A., Insel, K. C., & Ritter, L. S. (2012). Associations between working memory, health literacy, and recall of the signs of stroke among older adults. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 44(5), 236-43.
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  Stroke remains a major cause of mortality and disability among older adults. Although early treatment after stroke is known to reduce both mortality and disability, the first step in seeking early treatment is dependent on the rapid recognition of the signs of stroke. Recall of the signs of stroke may be dependent on factors that exist before the stroke itself. Although it is known that both working memory and health literacy decline with advancing age, these factors have not been thoroughly examined with respect to recall of the signs of stroke. Therefore, the purpose of the current study was to investigate associations between working memory, health literacy, and recall of the signs of stroke among older adults. Community dwelling older adults (≥65 years of age) were recruited from two senior centers. Fifty-six participants meeting inclusion criteria provided demographic and health information and were asked to read a public service brochure listing the five warning signs of stroke. Working memory was then assessed using the Wechsler Adult Intelligence Scale 3rd Edition Working Memory Index. Health literacy was assessed by the Short Test of Functional Health Literacy in Adults. Participants' recall of the five warning signs of stroke was evaluated. The mean age was 80.4 years. The mean number of the signs of stroke recalled was 2.9 ± 1.33. Working memory and health literacy were positively correlated with recall of the signs of stroke (r = .38, p < 0.01; r = .44, p < 0.01). In a simultaneous regression, only health literacy remained a significant predictor of recall. There was no statistically significant interaction between working memory and health literacy. Findings from this study indicate that working memory and health literacy were associated with successful recall of the warning signs of stroke in older adults. Further studies are needed to determine if programs that include cognitive and literacy assessments could identify older adults who need additional support to learn and recall the signs of stroke.
• Insel, K. C., Merkle, C. J., Hsiao, C. P., Vidrine, A. N., & Montgomery, D. W. (2012). Biomarkers for cognitive aging part I: telomere length, blood pressure and cognition among individuals with hypertension. Biological research for nursing, 14(2), 124-32.
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  Chronological age is used as a marker for age-associated changes in cognitive function. However, there is great interindividual variability in cognitive ability among people of the same age. Physiological age rather than chronological age should be more closely associated with age-related cognitive changes because these changes are not universal and are likely dependent on several factors in addition to the number of years lived. Cognitive function is associated with successful self-management, and a biological marker that reflects physiological age and is associated with cognitive function could be used to identify risk for failure to self-manage. The purpose of this study was to investigate the association between telomere length, a known biomarker of age; blood pressure; cognitive assessments; and adherence to antihypertensive medication among community-dwelling middle-aged and older adults. The authors administered a battery of cognitive assessments to 42 participants (M = 69 years of age), collected blood samples, and isolated peripheral blood mononuclear leukocytes for genomic DNA. The authors determined relative telomere length using Cawthon's method for real-time quantitative polymerase chain reaction (RT-qPCR) and measured medication adherence using an electronic medication monitoring system (MEMS by Aardex) over 8 weeks. Findings indicate that telomere length was inversely associated with systolic blood pressure (r = -.38, p < .01) and diastolic blood pressure (r = -.42, p < .01) but not with cognitive assessments or adherence. The authors discuss the nonsignificant findings between telomere length and cognitive assessments including the potential modifying role of gender.
• Insel, K. C., Moore, I. M., Vidrine, A. N., & Montgomery, D. W. (2012). Biomarkers for cognitive aging part II: oxidative stress, cognitive assessments, and medication adherence. Biological research for nursing, 14(2), 133-8.
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  The purpose of this study was to further examine potential biomarkers of cognitive aging by looking at the associations among oxidative stress, cognitive abilities, and medication adherence in a community-based sample of middle-aged and older adults (n = 42; mean age = 69 years) prescribed at least one medication for hypertension. In addition to measures described in Part I, "Biomarkers for Cognitive Aging," a 12-hr urine collection for F(2)-isoprostanes served as an indicator of oxidative stress. Participants completed a battery of cognitive assessments and 8 weeks of electronic medication monitoring for adherence to one antihypertensive agent. Oxidative stress was significantly associated with logical memory, immediate (r = -.38, p < .01) and delayed recall (r = -.42, p < .01), and recognition memory (r = -.42, p < .01) from the Wechsler Memory Scale III, number of perseveration errors (r = .26, p < .05) and categories achieved (r = -.26, p < .01) on the Wisconsin Card Sorting Test (WSCT), and medication adherence (r = -.34, p
• Liu, Y., Insel, K. C., Reed, P. G., & Crist, J. D. (2012). Family caregiving of older Chinese people with dementia: testing a model. Nursing research, 61(1), 39-50.
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  The process of taking care of older people with dementia at home is complex and influenced by cultural factors, necessitating a better understanding of the interrelationships of factors within the context of culture.
• Hsiao, C. P., Moore, I. M., Insel, K. C., & Merkle, C. J. (2011). High perceived stress is linked to afternoon cortisol levels and greater symptom distress in patients with localized prostate cancer. Cancer nursing, 34(6), 470-8.
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  Patients treated with radical prostatectomy (RP) or radiation therapy (RT) for prostate cancer can experience stress and symptoms that impact quality of life.
• O'Haver, J., Moore, I. M., Insel, K. C., Reed, P. G., Melnyk, B. M., & Lavoie, M. (2010). Parental perceptions of risk and protective factors associated with the adaptation of siblings of children with cystic fibrosis. Pediatric nursing, 36(6), 284-91; quiz 292.
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  When a child is diagnosed with a chronic, life-threatening illness, there is a significant impact on the healthy siblings. Few studies have addressed the adaptation of well siblings in diagnoses other than cancer. The purpose of this descriptive correlational study was to examine the relationships between the risk and protective factors that affect the psychological adaptation of healthy siblings of a child with cystic fibrosis. Findings from this study suggest family environment, especially parental stress and perceived social support, may affect the adaptation of the well sibling. Adolescent well siblings were more at risk for environmental influences than their younger counterparts.
• Choi, M., Belyea, M., Phillips, L. R., Insel, K., & Min, S. (2009). Testing women's propensities to leave their abusive husbands using structural equation modeling. Nursing Research, 58(6), 435-443.
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  PMID: 19918154;Abstract: Background: Many Korean women are just beginning to recognize that what they considered to be normal treatment is actually domestic violence. Many are becoming more intolerant of the abuse and more likely to desire to leave an abusive relationship. Objective: The aim of this study was to test, using the framework of sociostructural and psychological-relational power (PRP), a model of Korean women's propensities to leave their abusive husbands. Methods: Multigroup structural equation modeling was used to test relationships between variables chosen from the sociostructural power and PRP to explain intolerance to abuse. Married Korean women (n = 184) who self-identified as being abused physically, psychologically, sexually, or financially participated in the study. Results: The multigroup analysis revealed that the relationship of abuse and Hwa-Byung (a culture-bound syndrome that denotes Korean women's anger) with intolerance was supported for women with low education (defined as having an education of high school or less: ≤12 years); also for this group, particularly among the younger women, high power was related to high levels of reported abuse and abuse intolerance. For women in the high-education group (education beyond high school: ≥ 13 years), high power was related to abuse, Hwa-Byung, and abuse intolerance; age did not influence power. Overall, the multigroup model adequately fitted the sample data (χ = 92.057, degree of freedom = 50, p = .000; normal fit index = .926, comparative fix index = .964, root mean square error of approximation = .068, Hoelter's critical number = 152), demonstrating that education is a crucial moderator of Korean women's attitude toward the unacceptability of abuse and propensity to terminate the marriage. Discussion: This study found support for a model of abuse intolerance using the framework of sociostructural power and PRP, primarily for the low-education group. Hwa-Byung was a mediating factor that contributed to intolerance to abuse in women with low education. This study highlights the importance of understanding the cultural assumptions that guide Korean women's beliefs and behaviors about abuse intolerance, suggesting that effective intervention programs should be specific to age and education, including a focus on resource availability, which could clarify the variations in Korean women's responses to abuse intolerance. Copyright © 2009 Lippincott Williams & Wilkins.
• Choi, M., Belyea, M., Phillips, L. R., Insel, K., & Min, S. K. (2009). Testing women's propensities to leave their abusive husbands using structural equation modeling. Nursing research, 58(6), 435-43.
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  Many Korean women are just beginning to recognize that what they considered to be normal treatment is actually domestic violence. Many are becoming more intolerant of the abuse and more likely to desire to leave an abusive relationship.
• Choi, M., Phillips, L. R., Figueredo, A. J., Insel, K., & Min, S. K. (2008). Construct validity of the Korean Women's Abuse Intolerance Scale. Nursing research, 57(1), 40-50.
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  Domestic violence against married women has persisted throughout Korean history. However, very little empirical research has been conducted in Korea about domestic violence, its causes, or women's responses.
• Insel, K. C., Reminger, S. L., & Hsiao, C. (2008). White matter hyperintensities and medication adherence. Biological Research for Nursing, 10(2), 121-127.
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  PMID: 18829595;Abstract: White matter hyperintensities (WMH) are associated with hypertension, age, and cognitive function, but the association between WMH and medication adherence has not been examined. The intent of this investigation was to consider the potential implications of hypertension-related brain morphological changes on medication adherence and thereby improve understanding of the self-management consequences of hypertension. The associations between WMH, blood pressure, age, cognitive function (specifically assessments of prefrontal function), and medication adherence were examined in 16 middle-aged and older adults self-managing at least one prescribed antihypertensive agent. Magnetic resonance imaging using an axial fluid attenuated inversion recovery (FLAIR) sequence was used to assess the presence of WMH. Cognitive assessments included measures of executive function, working memory, attention, and immediate recall. Adherence was monitored for 8 weeks using electronic medication monitoring. More WMH were associated with poorer adherence (rs = -.25) and with higher systolic blood pressure (rs =.46), although these relationships were not statistically significant. WMH were associated with cognitive assessments in the expected direction including Digit Span Backward (rs = -.53, p
• Insel, K. C., Reminger, S. L., & Hsiao, C. P. (2008). White matter hyperintensities and medication adherence. Biological research for nursing, 10(2), 121-7.
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  White matter hyperintensities (WMH) are associated with hypertension, age, and cognitive function, but the association between WMH and medication adherence has not been examined. The intent of this investigation was to consider the potential implications of hypertension-related brain morphological changes on medication adherence and thereby improve understanding of the self-management consequences of hypertension. The associations between WMH, blood pressure, age, cognitive function (specifically assessments of prefrontal function), and medication adherence were examined in 16 middle-aged and older adults self-managing at least one prescribed antihypertensive agent. Magnetic resonance imaging using an axial fluid attenuated inversion recovery (FLAIR) sequence was used to assess the presence of WMH. Cognitive assessments included measures of executive function, working memory, attention, and immediate recall. Adherence was monitored for 8 weeks using electronic medication monitoring. More WMH were associated with poorer adherence (rs = -.25) and with higher systolic blood pressure (rs = .46), although these relationships were not statistically significant. WMH were associated with cognitive assessments in the expected direction including Digit Span Backward (rs = -.53, p < .05). Adherence was associated with immediate memory (rs = .54, p < .05) and inversely associated with failure to maintain set on the Wisconsin Card Sorting Test (WCST; rs = -.61, p < .05). These findings provide preliminary evidence for the association between WMH, assessments of prefrontal function, and medication adherence.
• Hess, L. M., & Insel, K. C. (2007). Chemotherapy-related change in cognitive function: A conceptual model. Oncology Nursing Forum, 34(5), 981-994.
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  PMID: 17878127;Abstract: Purpose/Objectives: To develop a conceptual model of chemotherapy-related changes in cognitive function. Data Sources: MEDLINE®, CINAHL®, HealthStar, and PsycINFO®, databases. Data Synthesis: Patients undergoing chemotherapy often complain of forgetfulness, absentmindedness, and an inability to focus when performing a variety of daily tasks. Changes in cognitive function have been referred to by the colloquial term "chemo-brain." The authors conducted an examination of the literature to investigate relationships among concepts and to synthesize current knowledge. Conclusions: Cognitive function, defined as higher-order mental processes, may be altered along two distinct and interacting pathways: (a) the cancer diagnosis, which can lead to anxiety, stress, distress, and depression: and (b) the direct physiologic effects of cancer treatment. The Chemotherapy-Related Change in Cognitive Function conceptual model is informed by a review of literature that illustrates antecedents, moderators, mediators, and consequences that may be relevant to this issue. Implications for Nursing: When a patient presents with cognitive complaints, the problems can be evaluated for intervention when an overall understanding exists of chemotherapy-related cognitive changes based on a conceptual model that continues to be informed through well-conceptualized and well-designed research.
• Insel, K., Hess, L. M., & Insel, K. C. (2007). Chemotherapy-related change in cognitive function: a conceptual model. Oncology nursing forum, 34(5).
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  To develop a conceptual model of chemotherapy-related changes in cognitive function.
• Insel, K. C., Reminger, S. L., & Hsiao, C. (2006). The negative association of independent personality and medication adherence. Journal of Aging and Health, 18(3), 407-418.
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  PMID: 16648393;Abstract: Objectives: This investigation examines the association of personality factors and medication adherence among older adults. Method: The Six-Factor Personality Questionnaire was mailed to participants involved in a medication adherence investigation. Medication adherence was monitored with an electronic monitoring cap for 8 weeks for one prescribed daily medication. Results: Sixty older adults, mean age 77 years (range 67 to 93 years), returned the questionnaire (69% response rate). Stepwise regression analysis demonstrates that when age and level of education are controlled, independence predicts medication adherence. This factor demonstrates a negative relationship with adherence suggesting that higher levels of independence may be related to lower adherence to prescribed medication. The facet component self-reliance is predictive of poor medication adherence. Discussion: The finding that higher self-reliance is associated with lower adherence in an older population deserves further investigation and clinical consideration. © 2006 Sage Publications.
• Insel, K. C., Reminger, S. L., & Hsiao, C. P. (2006). The negative association of independent personality and medication adherence. Journal of aging and health, 18(3), 407-18.
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  This investigation examines the association of personality factors and medication adherence among older adults.
• Insel, K., Morrow, D., Brewer, B., & Figueredo, A. (2006). Executive function, working memory, and medication adherence among older adults. The journals of gerontology. Series B, Psychological sciences and social sciences, 61(2), P102-7.
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  The purpose of this study was to investigate the association between cognitive processes and medication adherence among community-dwelling older adults. Ninety-five participants (M = 78 years) completed a battery of cognitive assessments including measures of executive function, working memory, cued recall, and recognition memory. Medication adherence was examined over 8 weeks for one prescribed medicine by use of an electronic medication-monitoring cap. In a simultaneous regression, the composite of executive function and working memory tasks was the only significant predictor (beta =.44, p
• Shrago, L. C., Reifsnider, E., & Insel, K. (2006). The Neonatal Bowel Output Study: indicators of adequate breast milk intake in neonates. Pediatric nursing, 32(3), 195-201.
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  This study describes the bowel habits of neonates who were exclusively breastfed during the first 14 days following birth to determine whether bowel output (frequency and character) could be used as a proxy measure for adequate breast milk intake.
• Shrago, L. C., Reifsnider, E., & Insel, K. (2006). The Neonatal Bowel Output Study: indicators of adequate breast milk intake in neonates.. Pediatric nursing., 32(3), 195-201.
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  PMID: 16802675;Abstract: PURPOSE: This study describes the bowel habits of neonates who were exclusively breastfed during the first 14 days following birth to determine whether bowel output (frequency and character) could be used as a proxy measure for adequate breast milk intake. STUDY DESIGN: A prospective, descriptive study was conducted. During the 14-day study period, mothers kept a log of their infants' daily naked weight, number of feedings, number of daily bowel movements, and color of all bowel movements. PARTICIPANTS: One hundred thirty-one participants were enrolled in the study; 73 participants completed the study. FINDINGS: Findings indicate that more bowel movements per day during the first 5 days following birth were significantly associated with less initial weight loss, earlier transition to yellow bowel movements, earlier return to birth weight, and heavier weight at 14 days. CONCLUSIONS: These findings suggest that scant bowel output during the first 5 days following birth, or delayed transition of bowel movements to yellow, warrant weighing the infant in a health care professional's office.
• Insel, K. C., & Cole, L. (2005). Individualizing memory strategies to improve medication adherence. Applied Nursing Research, 18(4), 199-204.
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  PMID: 16298695;Abstract: Changes in cognitive processes are well documented among even essentially healthy community-dwelling older adults. Although these changes do not produce the level of cognitive impairment associated with dementia, they do have the capacity to influence the degree to which elderly individuals self-manage chronic conditions. This pilot investigation tested the effect of an intervention to improve remembering to take medications and tracking if medications were taken as intended. Twenty-seven older adults (age range = 67-89 years, M = 78 years) all self-managing prescribed medications had one medication electronically monitored for 8 weeks preintervention and then 8 weeks postintervention. The percentage of days the correct number of doses was taken increased from a mean of 64.5% to that of 78%. With the use of Wilcoxon's signed ranks test, this improvement in adherence is significant. When participants with dementia or mild cognitive impairment were eliminated from the analysis (n = 6), the intervention continued to improve adherence (70.6% to 86%), suggesting that many older adults have the potential to improve adherence through individualized implementation of memory strategies.
• Insel, K. C., Meek, P. M., & Leventhal, H. (2005). Differences in illness representation among pulmonary patients and their providers. Journal of Health Psychology, 10(1), 147-162.
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  PMID: 15576506;Abstract: This investigation examined how patient and provider groups represent 11 descriptors (concepts) of breathing and breathlessness. Two patient groups, those with chronic obstructive pulmonary disease (COPD) and those with asthma, and two provider groups, pulmonologists and nurse specialists (PNS), rated the dissimilarity between each of 55 pairs of concepts on visual analogue scales (VAS). The results demonstrate differences between the groups in illness representation. The findings have implications for understanding differences in illness representation between patient groups and providers.
• Insel, K. C., Palmer, R. F., Stroup-Benham, C. A., Markides, K. S., & Espino, D. V. (2005). Association between change in systolic blood pressure and cognitive decline among elderly Mexican Americans: Data from the hispanic established population for epidemiology study of the elderly. Experimental Aging Research, 31(1), 35-54.
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  PMID: 15842072;Abstract: The longitudinal association between the rate of change in blood pressure and cognitive decline was examined in an area probability sample from a population-based survey of elderly Mexican Americans, 65 years of age or older obtained in 1993-1994, 1995-1996, 1998-1999, and 2000-2001 (n = 2859). The sample was divided into two groups at baseline: hypertensives had a systolic blood pressure (SBP) ≥ 140 mm Hg, a diastolic blood pressure (DBP) ≥ 90 mm Hg, or indicated a prior diagnosis of hypertension, and the normotensive group. Cognition was indexed by the Mini-Mental State Examination (MMSE). Neither SBP nor DBP at baseline predicted cognitive decline. However, the mean slope for SBP in the normotensive group showed an increase of 4.55 mm Hg (increase from Time 1 to Time 2 was 123 mm Hg to 132 mm Hg) and was significant in a regression model predicting cognitive decline even after adjusting for covariates. These findings suggest an association between increasing SBP and cognitive decline for normotensive elderly in this study population.
• Insel, K. C., & Badger, T. A. (2002). Deciphering the 4 D's: Cognitive decline, delirium, depression and dementia - A review. Journal of Advanced Nursing, 38(4), 360-368.
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  PMID: 11985687;Abstract: Purpose. The purpose of this paper is to assist advanced practice nurses to recognize, identify, and diagnose cognitive change in older adults. Background/rationale. Optimal cognitive function is important for continued independence, and yet changes in cognition are frequently unrecognized among older adults. Cognitive change in older adults can be observed due to age-related cognitive decline, the development of acute confusion (delirium), depression, dementia and/or a combination of these. When the aetiological source for alterations in cognitive function is delirium or depression, the potential for reversibility mandates that the reason for the cognitive change be identified with steps taken to remedy the situation. Also, early recognition of dementia is an important factor in obtaining timely and appropriate care. These conditions can exist concurrently and may fluctuate making deciphering the reason for the cognitive change problematic. Conclusions. It is essential to understand how the 4 'D,s' are expressed and to recognize the potential contributing factors to an observable change in cognitive function for diagnosis and treatment. Recommendations for obtaining a person's history are included.

Proceedings Publications

• Morrow, D. G., Lee, J. K., Insel, K. C., & Einstein, G. O. (2015). Opportunities for Technology: Translating an Efficacious Intervention to Improve Medication Adherence Among Older Adults. In Human Aspects of IT for the Aged Population. Design for Everyday Life. Springer International Publishing Switzerland, 82-88.
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  We developed and tested the Multifaceted Prospective Memory Intervention (MPMI) to improve medication adherence among older adults (≥ 65 years of age) who were prescribed at least one daily medication for the control of high blood pressure. Blood pressure control is important because high blood pressure is a leading cause of stroke, heart failure, retinopathy, renal disease as well as pathology in other end organs including the brain. The MPMI resulted in improvement from 57 % at baseline to 78 % adherence to the inter-dose interval post intervention, but most of these gains were lost after 5 months. The control condition started at 68 %, was stable during the intervention, but dropped to 62 % after 5 months of additional monitoring. The intervention was successful, but the effects were not sustained. Continued investigation to find ways to enhance self-management among older adults using technology is needed in order to maintain health and function.

Presentations

• Rosenfeld, A. G., Taylor-Piliae, R. E., Carrington, J. M., Gephart, S. M., Insel, K. C., Loescher, L. J., Reed, P. G., Rosenfeld, A. G., Taylor-Piliae, R. E., Carrington, J. M., Gephart, S. M., Insel, K. C., Loescher, L. J., & Reed, P. G. (2016, January). Defying the skeptics! Strategies and successes of an online PhD program.. AACN Doctoral Education Conference. Florida: AACN.

Poster Presentations

• Tolentino, D. A., Insel, K. C., & Gephart, S. M. (2020, November). The relationship between task-technology fit and nurses’ performance in the EHR. AMIA. Virtual: AMIA.
• Insel, K. C. (2016, November, 16-20, 2016). Understanding the Medication Adherence Strategies of Older Adults with Hypertension. The Gerontological Society of America’s 69th Annual Scientific meeting. New Orleans, LA.
• Rosenfeld, A. G., Crawford, R. S., Insel, K. C., & Reed, P. G. (2016, Spring). Health beliefs related to physical activity in patients living with implantable cardioverter defibrillators.. Preventive Cardiovascular Nurses Association 22nd Annual SymposiumPreventive Cardiovascular Nurses Association.
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  Winning Abstracts: Poster Abstracts. Journal of Cardiovascular Nursing, 31, 483-487. doi:10.1097/JCN.0000000000000363

Others

• Jason, K., Wager, M., Robles, D., Insel, K. C., Verhougstraete, M., O'Neill, L. M., Phillips, L. R., Fain, M. J., Yuan, N. P., Yang, Y., Kenning, H., Butt, H., Sokan, A. E., & Chen, Z. (2021, November). Impact of COVID-19 on Older Employees of a Large State University: Findings From a Mixed-Methods Study.. Symposium - Gerontological Society of America annual conference.
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  Symposium