bluuebunny/crossref_metadata_2025 huggingface dataset:
INCREMENTAL COST AND READMISSIONS ASSOCIATED WITH COLECTOMY PATIENTS UNDERGOING HOME HEALTH SERVICES
Authors: Kamdar Neil , Mahmoudi Elham
Published: November 2019

Home health services has been considered a recommended form of post-discharge management of older patients undergoing surgery. In this study, we examined total 30-day episode payments and 30-day readmission rates for those who were and were not utilizers of home health services following colectomies. We utilized administrative claims data (2012-2017) from the Michigan Value Collaborative across 77 hospitals in Michigan. Post-acute care includes skilled nursing facility, inpatient/outpatient rehabilitation, emergency department visits, home health services, and other outpatient visits. All payments were risk adjusted using generalized linear models using Hierarchical Condition Categories, age, sex, insurance type, and prior 6-month payments. Controlling for selection bias for those utilizing home health services, we performed propensity score matching at a caliper of 0.001 without replacement. We identified 15,531 colectomies with 4,397 (28.3%) utilizing home health services within 30 days. There were 4,197 home health users and non-users with home health users having significantly higher adjusted 30-day episode payments ($33,254 vs. $30,463, 95% CI Diff: ($2,097, $3,486)). While there were only slight differences in adjusted index surgical base payments between home health users ($21,531, 95% CI: ($21,279, $21,783) and non-users ($20,703, 95% CI: ($20,409, $20,998)), there were substantially larger post-discharge payments for home health users ($3,617 vs, $1,839, 95% CI Diff: ($1,597, $1,959)). Colectomy patients utilizing home health services had a higher readmission rate (21.5% vs. 15.6%, p <0.0001). Colectomy patients utilizing home health services are more resource intensive in the post-discharge period. Recommendation for home health services increases costs and readmission.
UNDERSTANDING NON-MEDICAL COSTS FOR HEALTH CARE: EVIDENCE FROM INPATIENT CARE FOR OLDER PEOPLE IN CHINA
Authors: Yang Wei
Published: November 2019

Non-medical costs can constitute a substantial part of total health care costs, especially for older people. Costs associated with carers, travel, food and accommodation for family members accompanying and caring for older people during their medical visits can be hefty. This study seeks to examine the effects of non-medical costs on catastrophic health payments and health payment-induced poverty among older people in rural and urban China. Using data from the China Health and Retirement Longitudinal Survey 2015, this study finds that inpatient costs account for a significant proportion of household expenditure, and non-medical costs can account for approximately 18% of total costs. That share is highest for those who belong to the lowest wealth groups. Non-medical costs increase the chances of older people incurring catastrophic health payments and suffering from health payment-induced poverty. Such effects are more concentrated among the poor than the rich. The results also show that the rural population are more likely to incur catastrophic health payments and suffer from health payment induced poverty compared to the urban population. This paper urges policy makers to consider reimbursing the non-medical costs of patient care, improving health care systems in general and for the rural populations specifically.
EPIGENETICS OF STRESS AND ADAPTATION ACROSS HEALTHSPAN AND LIFESPAN
Authors: Ferrucci Luigi , Salimi Shabnam , Ferrucci Luigi
Published: November 2019

Any stimulus that endangers body integrity (stressor) results in an adaptive response to resolve stressful state and determine adaptive or and maladaptive responses. Both chronic extrinsic and intrinsic stressors can produce long-lasting, epigenetic changes in various organs that can eventually result in accelerated changes in bio-physio-pathology. There is initial evidence that stress response involves mechanisms of the epigenetic basis of adaptation and stress response to biological aging and chronic diseases. With aging, homeostasis stability declines causing augmented vulnerability to the external and internal stress. Individuals in whom vulnerability trespass a certain threshold experience accelerated aging and deterioration of health and/ or “secondary aging” phenomena such as premature mortality. Because of substantial heterogeneity of the rate of decline in homeostatic stability, there is inter-individual variability in the age of appearance of chronic diseases and the increased risk of disability and mortality. Thus, tools for the quantification of a stress response would be clinically valuable. Therefore, this symposium suggests approaches to study the epigenetic basis of molecular adaptations across various age, organs’ health-span, and life-span.
EPIGENETICS MARKERS OF AGING AND EXPOSURES
Authors: Murabito Joanne
Published: November 2019

Widespread changes to the epigenome occur with aging. DNA methylation is one of the most commonly studied epigenetic mechanisms, reflects lifetime exposures that impact aging, and is associated with age-related disease risk. Many longitudinal cohort studies have existing cross-sectional or longitudinal DNA methylation data along with genotype and expression data permitting investigation of relationships between DNA methylation markers, exposures, and disease. The data can be leveraged to conduct large epigenome-wide association studies (EWAS) of aging and age-related disease to identify DNA methylation biomarkers and lead to insights into novel biologic pathways for development of interventions to delay aging. DNA methylation age measures robustly predict chronologic age and associate with both healthspan and lifespan. During the workshop, examples from cohort studies and the CHARGE consortium will be presented.
GENERAL AND GENDER-SPECIFIC DYNAMICS DETERMINING THE HEALTH STATUS OF WORKING INFORMAL CAREGIVERS
Authors: Schwartz Abby , Clark-Shirley Leanne J , Rainville G
Published: November 2019

As the gender divide among family caregivers closes, it is important to understand whether and how men and women differently experience caregiving. For example, literature suggests that employed family caregivers experience burden and health outcomes differently than unemployed caregivers, but less is known about how these factors affect men and women differently. Using data from Caregiving in the U.S., 2015 (source: AARP and NAC), this study reliably modelled the effect of multiple threats to good health within the caregiving role (e.g. physical, financial, and emotional strain). In the analysis, several moderated relationships were observed using data from 816 working caregivers. In the full sample, the relationship between objective caregiving burden (hours of care and counts of ADLs/IADLs) and self-reported health status was altered by financial strain. In the high burden condition, relatively poor health was progressively related to increasing levels of financial strain controlling for traditional covariates. In separate analyses for males and females, this moderated relationship was discovered to be limited to female caregivers. Physical and emotional strain did not moderate the relationship between burden and health. Several covariates related to employment conditions (e.g., caregiver-friendly workplace policies) behaved differently across models and are presented and discussed in relation to financial strain as a determinant of caregiver health. These findings shed light on gender-based differences in caregiver outcomes, and suggest that interventions aimed at assessing and improving caregiver health should account for the financial strain experienced particularly by women.
THE CENTRALITY OF GENDER EXPRESSION FOR TRANSGENDER ELDERS AND CONCEPTUALIZATIONS OF SUCCESSFUL AGING
Authors: Sloan Steffany , Benson Jacquelyn
Published: November 2019

Successful aging is a construct regularly addressed in the gerontological literature, most typically referred to as living in the best physical and cognitive health possible, experiencing the least amount of disease, and engaging actively within one’s social environment. There are, however, conceptually distinct aspects of aging for older adults who identify as transgender, particularly given lifelong experiences of marginalization and stigma. In order to identify factors transgender older adults consider most relevant to successful aging, a Theory-Generating Qualitative Meta-synthesis was conducted. The study utilized systematic methods and thematic analysis with qualitative data from empirical studies focusing on transgender aging experiences, particularly drawing upon data that amplified the transgender older adult point of view. Findings of this study indicate that although trans older adults do not minimize unique challenges inherent to aging as a gender minority, successful aging rests on the relief and resilience offered by authentic gender expression. As such, data from this study informed the development of a model of successful aging that centralizes the importance of gender expression. Understanding the central role of gender expression in later life can be especially impactful for social and health service providers, as it emphasizes gender affirming experiences as highly salient to one’s own assessment of quality aging. Furthermore, conceptualizing aging for transgender elders in a way that prioritizes the importance of identity can aid in preventing an unnecessarily deficits-based perspective for service providers, and supports the necessity of amplifying a culturally specific understanding of successful aging.
KNOWLEDGE OF LGBT CULTURAL SENSITIVITY AMONG AGING SERVICE PROVIDER NETWORKS
Authors: Oswald Austin , Gardner Daniel S , Johnston Tim R , Alford Sabretta G , Giunta Nancy
Published: November 2019

The population of lesbian, gay, bisexual, and transgender (LGBT) adults aged 50 or above is rapidly aging, posing distinct challenges to aging service providers who work to meet their complex health and social needs. In 2011, Services and Advocacy for GLBT Elders (SAGE), home of the National Resource Center on LGBT Aging (NRC), developed and implemented a suite of trainings designed to sensitize aging service providers to the needs and experiences of LGBT elders. This descriptive study examines baseline (pre-test) survey data from individuals trained between 2013 and 2018 (N=10,500). Training participants represent all states throughout the U.S. and vary widely in race/ethnicity, age, and job title. Preliminary results indicate that knowledge measured prior to trainings shows substantial variation across geographic regions, suggesting the need for more geographically targeted approaches to training delivery. Implications for practice, research, and policy with LGBT adults in later life will be discussed.
THE ECONOMIC VALUE OF FAMILY CAREGIVING: NEW NATIONAL ESTIMATES AND STATE VARIATION
Authors: Houser Ari , Houser Ari
Published: November 2019

The economic value of family caregiving, by any measure, dwarfs actual expenditures on formal long-term services and supports (LTSS). This presentation discusses new estimates of the number of caregivers, intensity of caregiving, and the total economic value of family caregiving in 2017 in the United States, and in every state, the District of Columbia, Puerto Rico, and the Virgin Islands, based on a meta-analysis of recent nationally representative surveys of family caregivers. Previous analyses of this type have found that the total economic value of family caregiving has increased steadily from $350 billion in 2005 to $470 billion in 2013. State variation in the incidence, intensity, and economic value of caregiving will be discussed, and key predictors of this variation will be identified.
WORKSHOP PANEL REPORT ON EVIDENCE GAPS AND RESEARCH OPPORTUNITIES
Authors: Allore Heather
Published: November 2019

Although varied in treatment regimens and outcomes assessment, trials show safe and effective osteoporosis drug therapies up to 5 years in reducing the incidence of vertebral fractures. Trials provide evidence mainly for white postmenopausal women, while other populations (e.g., men, spectrum of race and ethnicities, residents in facilities, and people with advanced and multiple comorbid conditions) were absent or underrepresented. Evidence for osteoporosis drug therapies is lacking for people who meet neither bone mineral density nor fracture criteria for osteoporosis but are at elevated risk due to other health, genetic, or medication use factors. Fewer studies have shown that some osteoporosis drug therapies reduce the incidence of non-vertebral, including hip fractures. Notably, the workshop participants emphasized the importance of fracture on patient morbidity and survival; however, the trial results presented no data on non-fracture patient outcomes or sequelae of fractures, such as functional status, mobility, hospitalizations, and nursing home placement.
INVESTIGATING SOCIAL NETWORKS OF OLDER SINGAPOREAN LEARNERS: THE MIXED-METHODS SOCIAL NETWORK APPROACH
Authors: Ko Pei-Chun
Published: November 2019

Lifelong learning has been regarded as an important factor of promoting active engagement in later life for researchers and policy makers. Most of the studies tend to illustrate old learners as a homogeneous and self-resilient group of people to engage in lifelong learning. Few studies address older learners’ social capital in affecting their decision of engagement and in sustaining their motivation. The study documented the existing social networks of older Singaporeans in lifelong learning programs and illustrated how social networks contributed their participation in learning. The mixed methods consist of in-depth interviews and two network instruments (Name Generator and Position Generator) based on 30 older Singaporeans (between 50 and 79 years old) who attended lifelong learning courses between 2016 and 2018. Interviews are transcribed and analyzed. The network instruments of are quantified and visualized. The findings show that older learners’ networks included a mixture of social ties from family and friends. Learners’ closeness with network members and their living arrangement with them influenced learners’ involvement in learning and future planning. Single respondents who had more non-kin members in the networks reported to be more active due to their weak ties. Overlapping networks among couple learners increase the spousal support for learning. Learners who had wider ranges of social resources are associated with their interest in learning activities. The study suggests that advocating lifelong learning needs to take older adults’ networks into considerations as networks represent the social forces that influence their decisions and motivations.
OLDER VETERANS’ PERSPECTIVES ON MEASURING FUNCTIONAL STATUS IN VA PRIMARY CARE CLINICS
Authors: Nicosia Francesca , Spar Malena J , Neumann Alicia , Silvestrini Molly C , Barrientos Maureen , Brown Rebecca T
Published: November 2019

Little is known about older adults’ perspectives on measuring functional status (i.e., ability to perform basic and instrumental activities of daily living). This study used a qualitative design to understand older Veterans’ perspectives on measuring function in primary care settings. Thematic analysis of interviews conducted with 28 Veterans ≥65 years and 5 caregivers from one VA Medical Center identified several themes including: 1) importance and relevance of discussing function; 2) preferences for assessment method (e.g., provider- or self-assessment;) and 3) wording of questions (i.e., needing help vs. having difficultly). These findings suggest that effective approaches to measuring function must consider patient preferences on content and format and ensure that measurement is used to inform care. We applied these findings to develop an interprofessional intervention to improve functional status measurement for older Veterans in primary care.
WE ARE NOT CURING A LOT OF THINGS, BUT WE ARE CARING: GERIPACT PATIENT NEEDS SHAPE TEAM NEEDS
Authors: Solimeo Samantha , Steffen Melissa J , Gardner Ellen E , Adjognon Omonyele , Shin Marlena , Moye Jennifer , Sullivan Jennifer L
Published: November 2019

This study used a qualitative observational design to identify the team-, clinic-, and system-level resources necessary for effective geriatric medical home (i.e., GeriPACT) implementation and to differentiate the needs of GeriPACT compared to traditional PACT. Analysis of 80 interviews conducted with team members from 8 geographically dispersed GeriPACTs identified needs that may be unrecognized by primary care leadership, including: clinical space to accommodate caregivers and patients with impaired visual, mobility, cognitive, or hearing acuity; greater utilization of caregiver support programs and social workers to facilitate aging-in-place; age-sensitive clinical reminders; team member continuity and direct phone lines to reduce patient anxiety; and longer standard appointment lengths to reflect clinical complexity. In contrast to traditional primary care teams, GeriPACTs are not simply “PACTs for older adults”: GeriPACT members articulate population-specific resources that require support from facility leadership to accommodate the complex, age- clinical and social resources needed to support aging-in-place.
CLINICIAN-PERCEIVED CHALLENGES OF OSTEOPOROSIS CARE IN AN INTEGRATED HEALTHCARE DELIVERY SYSTEM
Authors: Seaman Aaron T , Steffen Melissa J , Miller Karla , Solimeo Samantha
Published: November 2019

The burden of osteoporosis, both on the health care system and individuals, is high. Despite this, a high percentage of patients with or at risk of osteoporosis are not identified, screened and treated appropriately. Delivering osteoporosis care to at-risk patients is complicated by a fractured health care delivery system. In this presentation, we present data from interviews with VA clinicians in order to identify challenges of osteoporosis care within the VA health care system. While clinicians reported initiating a range of bone health care delivery interventions, they identified challenges that inhibited long-term sustainability: 1) low prioritization of bone health among national and facility leadership; 2) fragmentation of clinical responsibility and care delivery; and 3) barriers endemic to the osteoporosis care delivery system. Our results indicate that, even within an integrated health care delivery system, significant coordination challenges exist.
SPREAD AND SUSTAINMENT OF QUALITY IMPROVEMENTS IN VA RURAL PRIMARY CARE CLINICS
Authors: Kramer Josea , O’Hanlon Claire , Douglas Joe , Mitchell Michael N , McClean Michael , Clarke Shawn , Callaway-Lane Carol
Published: November 2019

The VA has invested in developing the skills of its primary care workforce through the longitudinal Geriatric Scholars Program. Now in its 11th year, the program has increased career satisfaction and job retention, standardized provider behaviors, improved clinical decision-making and reduced dispensing of potentially inappropriate medications. The program consists of: intensive coursework in geriatrics; workshop in quality improvement (QI); and initiation of a micro QI projects in the Scholar’s clinic. Electives enable learners to tailor the program to self-identified gaps in knowledge, skills and competencies. This presentation focuses on the sustainment and spread of these QI projects based on a recent survey of Scholars. Differences between rural and urban QI projects are compared. Commonality among rural QI projects is explored based on topic, team composition, and the types of efficiencies gained in clinical and/or organizational processes to improve care for older Veterans living in rural areas.
PERCEPTIONS OF DEMENTIA
Authors: Kingston Paul , Taylor Louise , Eost-Telling Charlotte , Bailey and Jan
Published: November 2019

This paper considers narratives of 143 respondents (“Observers”) to a Mass Observation Project Directive exploring individuals’ perceptions of dementia. Perceptions of dementia held by “Observers” with experience of dementia and those without differed sharply. “Observers” with experience of dementia offered insight into living with and caring for a person with dementia, and the impact this had on their lives and personal relationships. Whereas, “Observers” with no direct experience of dementia focused more on common disease symptoms such as memory loss and reflected idealised views of care. “Observers” often feared being diagnosed with dementia themselves. This suggests education to facilitate care planning and ameliorate fears held by the public is required.
HOW CLINICAL SETTING AND EXPERIENCES INFLUENCE NURSING STUDENTS’ ATTITUDES TOWARD OLDER ADULTS
Authors: Hovey Susan
Published: November 2019

This study is significant because older healthcare consumers continue to rise with estimations that nearly 72.1 million persons in the United States will be over the age of 65 by 2030. A fundamental question remains, will the future nursing workforce possess the attitude and knowledge to competently provide age-friendly care to older adults. The aim of this study explores how clinical setting, previous experiences with older adults, and previous work experiences in long-term care settings influence the attitudes of first year prelicensure nursing students toward this population. Six baccalaureate nursing schools from a Midwest state in the United States participated in this descriptive, cross-sectional, correlational study. One hundred and nine participants who completed their first clinical experience participated in the study. An understanding of this experience may provide nurse educators with insight into how to design clinical learning activities so nursing students’ acquire interest in care of older adults.
SAFER MEDICATION MANAGEMENT FOR HOME-DWELLING OLDER ADULTS
Authors: Verloo Henk , Gunten Armin von , Wernli Boris , SANTIAGO-DELEFOSSE Marie , MARTINS Maria Manuela , Pereira Filipa
Published: November 2019

Taking several medications at the same time can lead to adverse effects and dangerous situations for home-dwelling older adults with chronic conditions. Accurate medication management can be a difficult challenge, especially for people living at home. However, little research has been carried out into the experience of older adults and their informal caregivers with medication management. The aim of the study is, first, to identify factors that can cause undesirable side effects and make taking multiple medications potentially dangerous for home-dwelling older adults. Second, the study will investigate the experiences of this group of patients with medication management. Third, the role of both professional and informal caregivers will be examined. Recommendations will be made on how to improve the safety of medication management for home-dwelling older adults with chronic conditions and should help to prevent the adverse effects and dangerous situations that can lead to hospitalization, institutionalization or premature death
MHEALTH PROTOTYPE AND PILOT PROTOCOL TO ENHANCE SOCIAL SUPPORT FOR PERSONS LIVING WITH DEMENTIA
Authors: Corazzini Kirsten , Bailey Donald (chip) , Wright-Freeman Kayla , McConnell Eleanor
Published: November 2019

An emerging component of mHealth is the use of tailored mobile applications (app) to facilitate self-management of chronic illnesses, including the mapping of social networks to assist adults living with chronic illnesses to help them be able to identify sources of social support. The purpose of this study is to describe a prototype app to support persons living with dementia (PLWD) in the community and their informal caregivers to map social networks and identify sources of emotional, instrumental, informational, and appraisal of social support. Adapting the Network Canvas open-source software and drawing upon a previously-developed mobile application for adults to self-manage chronic illnesses, we share the key specifications, including health care provider output, preliminary end user feedback, and the pilot protocol designed to test the feasibility. Findings illustrate the importance of leveraging social network data in novel ways to enhance self-management and well-being among PLWD and their caregivers
IDENTIFYING COMMUNITY PARTICIPATION CHALLENGES FOR ADULTS AGING WITH MOBILITY AND VISION DISABILITIES
Authors: Harris Maurita T , Koon Lyndsie M , Remillard Elena T , Rogers Wendy A
Published: November 2019

There are growing numbers of older adults with mobility and vision disabilities acquired in early to mid-life who are a part of a population described as “aging with disability”. For these individuals, the addition of normative age-related declines (e.g., vision loss, arthritis) on top of a long-term disability can create extensive barriers to community participation. We present findings on activity challenges with community participation among older adults with long-term vision and mobility disabilities (N=120) from the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) interview study. Results provide detailed insights on the specific task-based challenges experienced when engaging in one’s community (e.g., going to entertainment events, doing activities with a group or organization, and participating in religious services and activities) as well as the solutions and strategies employed to overcome those challenges. Findings provide guidance for the design of supportive technologies that promote participation and independence for this understudied population.
ELDER ABUSE AMID THE OPIOID EPIDEMIC: APS CASES IN RURAL AMERICA
Authors: Teaster Pamela B , Roberto Karen A , Savla Jyoti
Published: November 2019

Older adults are hidden victims of the opioid crises, suffering abuse at the hands of those who seek resources to support their addiction. Using APS data from 2015-2017 provided by the Kentucky Department for Community-Based Services, we used a logistic regression model with robust standard errors to examine whether substantiated cases of elder abuse were associated with opioid misuse by perpetrators. Overall, 9% of the 462 substantiated cases over the three-year period involved perpetrators were substance users. The percentage of these cases rose from 5% in 2015 to 13% in 2016 before dropping to 7% of elder abuse cases in 2017. Opioid use was most prevalent among perpetrators of financial abuse of older adults with cognitive and/or physical care needs. The current study offers a first look at empirical linkages between opioid misuse and elder abuse and revealed consistencies across cases that call for further investigation.
EXCLUSION SPOTTER: APPLYING ADVANCES IN AI TO IDENTIFY AGEISM IN ONLINE JOB POSTING
Authors: Palmarini Nicola , Martie Lee , Wasiak Mattie F , Zhang Gaoyuan
Published: November 2019

The landscape in which employers and candidates interact is changing as more job adverts are pushed online. Employment platforms (e.g., Indeed and LinkedIn) are now among the primary mechanisms for job posting, job search, and initial negotiations. Through such job platforms, a single job advert can now reach millions of people around the world. This exposure of a job advert has obvious benefits for the employer, but this exposure also has the power to alienate and exclude large portions of society. In particular, the word choice of a single job advert can, perhaps unintentionally, exclude thousands of people by their personal traits (e.g., gender or race). Age is a particular trait that garners more attention as ageism is often cited in the literature as going overlooked, not understood, and generally escaping social awareness. To begin tackling this problem, with the purpose of supporting older adults and enabling their contribution to society, we applied advances in AI to create a tool, called Exclusion Spotter, that gives feedback to recruiters and employers on which words in their advert are possibly excluding people by age. We applied Exclusion Spotter to 3660 job adverts, clustered by 372 job titles. We found a significant difference (p=.02) in the number of age-related words for engineering related positions versus all other job titles. Among 47 engineering related titles we matched 47.37 age related words per title and 2.8 per advert. Among the other 325 titles we matched 24.37 age related words per title and 2.1 per advert.
ORGANIZATIONAL PRACTICES FOR THE AGING WORKFORCE: DEVELOPMENT AND VALIDATION OF THE LATER-LIFE WORK INDEX
Authors: Wilckens Max R , Wöhrmann Anne M , Deller Jürgen , Wang Mo
Published: November 2019

Most developed countries face an ageing workforce. Extended working lives require organizations to employ older individuals successfully. It is, however, widely untapped, which organizational practices drive successful employment of an older and age-diverse workforce, because adequate measure are missing. We hence develop the Later Life Work Index (LLWI) as a multi-faceted measure for researchers and practitioners, combining the detailed level of assessment relevant in practice with thorough conceptual coverage. We build on an empirically derived taxonomy of organizational practices developed by Wöhrmann et al. (2018). Proposed taxonomy is based on qualitative expert interviews and consists of nine dimensions covering age-inclusive organizational climate and leadership, as well as practices regarding work design, health management, individual development, knowledge management, transition to retirement, continued employment options, and health and retirement coverage. Within a first study, we developed an inventory to operationalize the intentionally broad LLWI construct. Items were iteratively developed and pretested with 30-42 German human resource managers. The final inventory consists of 100 Likert scaled, sufficiently reliable items. Within a second study among 600 managers and older workers in Germany, we confirmed the factor structure proposed by the LLWI, and ensured construct validity regarding similar scales (convergent validity) and individual level health and motivation outcomes (criterion validity). Discriminant validity is shown among the index dimensions, and regarding positive and negative affect. This paper enhances the understanding and quantitative assessment of organizational practices for later life work. We further plan to reduce the number of items to increase practicability of the measure.
OVERVIEW: THE VA GERIATRIC SCHOLARS PROGRAM FOR PRIMARY CARE WORKFORCE DEVELOPMENT
Authors: Kramer Josea , Douglas Joe , Clarke Shawn , Melendez Luis
Published: November 2019

The VA has invested in developing the skills of its primary care workforce through the longitudinal Geriatric Scholars Program. The program consists of core components --- intensive course in geriatrics, intensive workshop in quality improvement (QI) and initiation of a micro QI projects in the Scholar’s clinic; electives allow learners to tailor the program to self-identified gaps in knowledge, skills and competencies. The program has demonstrated direct impacts of continuing education through a workforce development process that enhances skills and competencies at a pace and selection that meets clinicians’ self-identified gaps in training. Now in its 11th year, the program has been shown to increase career satisfaction and job retention, standardize provider behaviors, improve clinical decision-making and reduce dispensing of potentially inappropriate medications. This symposium further explores the impact of the program on individual clinicians and on clinical teams.
DYNAMICS OF HUMAN MUCOSAL-ASSOCIATED INVARIANT T CELL REPERTOIRES ACROSS THE HUMAN LIFE SPAN
Authors: Loh Liyen , Lappas Martha , Crowe Jane , Thomas Paul G , Eckle Sidonia , Godfrey Dale I , Kedzierska Katherine , Crawford Jeremy C
Published: November 2019

Mucosal-associated invariant T (MAIT) cells are innate-like lymphocytes and are important for immune responses against bacterial and viral infections. While MAIT cells are known to undergo marked numerical changes with age in humans, our understanding of how these cells alter during these different phases across the human lifespan is largely unknown. Here we investigated MAIT cells from umbilical cord, children, young-adults and elderly. Functional analyses across 18-90 y/o adults showed that their MR1-dependent polyfunctionality was robust throughout old age. Strikingly, elderly MAIT cells displayed upregulated basal inflammatory cytokines, which were reduced to the level of young-adult MAIT cells in the absence of the aged environment. T cell receptor αβ analyses of MAIT cells across the human lifespan showed narrowing with age and large clonal TCRαβ expansions in elderly. These data suggest that MAIT cells in the elderly display remarkable plasticity, highlighting MAIT cells as key players in aged immune responses.
IMPLEMENTING THE 4MS IN PRIMARY CARE: BUILDING AN AGE-FRIENDLY HEALTH SYSTEM
Authors: Flaherty Ellen , Fulmer Terry
Published: November 2019

The Age Friendly Health Systems initiative is a culture change movement funded by the John A. Hartford Foundation in collaboration with the Institute for Health Care Improvement. Transforming clinical training environments into integrated geriatrics and primary care systems to become Age-Friendly Health Systems must incorporate the principles of value-based care and alternative-payment models. This symposium will discuss how the implementation of the Geriatric Interprofessional Team Transformation in Primary Care (GITT-PC) model and the Reducing Avoidable Facility Transfer Model (RAFT) in primary care will improve patient outcomes focused on the 4M’s of the Age Friendly Health System. The success of the GITT-PC model focuses on 4 Medicare reimbursable services including the Annual Wellness Visit, Transitional Care Management, Chronic Care Management and Advance Care Planning. The RAFT model focuses on What Matters Most to residents of long term care facilities and reduces ED visits and hospital transfers through elicitation of goals of care and 24 hour virtual support from an interprofessional geriatric team.
LESSONS LEARNED FROM NURSING HOME CIVIL MONETARY PENALTY PROJECTS
Authors: Sturdevant Diana L , Buckwalter Kathleen C
Published: November 2019

Nursing homes must comply with numerous federal/state regulations to receive Medicare and Medicaid funding. Failure to comply with these regulations can result in deficiency citations, and depending on the severity of the deficiency, a resulting Civil Monetary Penalty (CMP). Through the Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty Reinvestment Program, CMP funds are reinvested to support activities that benefit nursing home residents and that protect or improve their quality of life or quality of care. This symposium presents some of the unique challenges, successes, failures, and surprise findings from CMP-funded nursing home quality improvement projects in two, predominantly rural Midwestern states: Oklahoma and Kansas. Dr. Williams presents findings of a pilot-study testing an adaptation of a successful family caregiver telehealth support intervention in the nursing home setting and implications for future research. Dr. Sturdevant shares successes, challenges, and unanticipated results from the “It’s Not OK to Fall” project, a comprehensive, 3 year fall prevention project implemented in Oklahoma nursing homes. Lastly, Ms. Round’s paper describes the implementation and findings of a Long-term Care Leadership Academy aimed at improving leadership and team building skills of three levels of nursing home staff, including Administrators/Directors’ of Nursing, RN/LPN charge nurses and certified nursing assistants. Discussant, Dr. Kathleen Buckwalter Ph.D., FAAN, RN, will discuss how principles of nursing home culture change provides a common framework for these projects and conclude by offering suggestions on how promotion of these principles might improve the quality of care provided by nursing homes.
BARRIERS AND FACILITATORS TO IMPLEMENTING COMMUNITY FIRST CHOICE
Authors: Beauregard Lisa , Miller Edward A
Published: November 2019

Community First Choice is a program within the Affordable Care Act that encourages states to expand Medicaid home and community-based services (HCBS). Specifically, this Medicaid state plan benefit provides states with an additional 6% federal match to promote greater rebalancing of long-term services and supports. Through Community First Choice, states can offer services that assist with activities of daily living, instrumental activities of daily living, and health-related tasks. The program is optional for states, and, to date, eight states have pursued Community First Choice. The purpose of this study is to understand the barriers and facilitators to implementing Community First Choice in two states. Data was collected through semi-structured interviews with individuals involved in HCBS policy nationally and in Maryland and Texas, including government bureaucrats, consumer advocates, and provider representatives. The results suggest that communication with the Centers for Medicare and Medicaid Services, the enhanced federal match, and leveraging existing HCBS infrastructure facilitated implementation. Maryland and Texas encountered challenges implementing Community First Choice because of constraints posed by existing HCBS programs, ambitious timelines, limited staff resources, and insufficient engagement with external stakeholders. The findings suggest that implementing Community First Choice is a large undertaking, and states should ensure they have enough time and sufficient staffing for the implementation process. States should also understand how implementing Community First Choice will impact existing HCBS offerings and how leveraging HCBS infrastructure can facilitate implementation. The lessons from implementing Community First Choice can be informative to other states pursuing or contemplating this program.
PUBLIC REPORTING OF NH ANTIPSYCHOTIC USE: CHANGES IN THE REPORTING OF EXCLUSIONARY DIAGNOSES?
Authors: Lucas Judith A , Bowblis John R , Davis-Ajami Mary Lynn , Simon Kosali , Song Miyeon
Published: November 2019

Antipsychotics (APMs) are commonly used off-label to control behavioral symptoms of dementia in nursing home (NH) residents despite FDA warnings. As part of the Centers for Medicare and Medicaid Services’ (CMS) partnership to reduce the use of APMs in long-stay NH residents with dementia, CMS began publicly reporting an APM quality measure on the NH Compare website in July of 2012. This measure proxies for potentially “inappropriate” use by excluding residents with diagnoses in which APMs may be appropriate. While APM use as declined, some question if the quality measure creates an incentive to change documentation of exclusionary diagnoses to show improvements in the publicly reported APM quality measure. These exclusionary diagnoses include: Huntington’s disease, Tourette syndrome, and schizophrenia. Using Minimum Data Set (MDS) assessments from long-stay NH residents in freestanding NHs (2011-2015), we utilized a difference-in-differences framework to compared the proportion of assessments with exclusionary diagnoses in NHs that were required to report the APM quality measure (treatment) to NHs that were exempt from reporting the measure (control). We also stratified the results by grouping residents under and over 65 year of age. We find no change in exclusionary diagnoses immediately following the implementation of public reporting. However, starting in 2014, the use of exclusionary diagnoses increased in the treatment group, especially among residents aged 65+. While APM use declined for all groups over the study period, our results indicate that the reduction in APM use may not be as large as expected, especially after 2014.
RELATIONSHIP BETWEEN FAMILY INVOLVEMENT IN CARE PLANNING AND ESTABLISHING AN ADVANCE DIRECTIVE
Authors: McCreedy Ellen , Loomer lacey , Palmer Jennifer , Volandes Angelo , Mitchell Susan , Mor Vincent
Published: November 2019

The purpose of this research is to understand the effect of family participation in care planning assessments on the use of advance directives for newly admitted nursing home (NH) residents. This is a retrospective cohort study using data from 115 nursing homes involved in a pragmatic randomized clinical trial testing a video intervention for advance care planning (versus usual care). Data sources included the electronic health record and the Minimum Data Set (MDS). Competing risks regression analyses estimated the cumulative incidence of establishing an advance directive, after accounting for death, discharge from NH, and time censoring (12-month observation window). 18,978 residents admitted to eligible NHs without an advance directive (full code) between April 2, 2016 and August 31, 2017 were followed for one year. 11,905 (63%) died or were discharged without an advance directive; 4,155 (22%) remained in the NH without an advance directive; and 2,918 (15%) established an advance directive. Median time to establishing an advance directive was 75 days (SD: 72, 79). After adjusting for competing risks and resident factors known to be associated with advance directive use, each care planning assessment involving a family member was associated with a 6% increase in the cumulative incidence advance directive use. Involving family members of NH residents in routine care planning assessments may reduce the amount of futile care received by NH residents. As we test interventions to improve advance care planning for NH residents, focus should be placed upstream on the first 90 days after admission.
IMPACT OF THE BE EPIC: A PERSON-CENTERED COMMUNICATION INTERVENTION FOR HOME CARE WORKERS
Authors: Savundranayagam Marie Y , Williams Kristine N , Basque Shalane , Orange J B , Kloseck Marita , Schmall Vicki , Johnson Karen
Published: November 2019

The current study assessed the impact of Be EPIC, an innovative, evidence-informed and theoretically-grounded 6-week person-centered communication intervention for personal support workers (PSWs) caring for persons with dementia. Be EPIC focuses on [E]nvironment contexts for using [P]erson-centered communication, while considering client relationships ([I] matter too), and [C]lients’ abilities, life history and preferences during routine care. A pre- post-Be EPIC comparative design included an intervention (n=13) and a 6-week waitlist control group (n=10) who completed the same communication-related questionnaire. A Two-Way Mixed ANOVA showed a significant group by time interaction for perceived communication skill (F(1, 21) = 4.67, p = .042, ηp2= .18). Simple main effects analysis showed that participants who completed Be EPIC reported feeling more confident in communicating with persons with dementia (Mpre = 13.46; SD = .76; Mpost = 16.31, SD = .85). There was no significant change in the control group. Similarly, there was a significant group by time interaction for perceived helpfulness of communication strategies (F(1, 21) = 6.23, p = .021, ηp2 = .23). Simple main effects analysis showed that participants who completed Be EPIC reported significant increases in the helpfulness of effective communication strategies (Mpre = 36.92; SD = 3.42; Mpost = 43.15, SD = 3.21), with no significant change among controls. Findings indicate that Be EPIC enhanced PSWs’ confidence in communicating with persons with dementia and enhanced their perception of the helpfulness of effective communication strategies.
OUT AND ABOUT? PARTICIPATION IN OUT-OF-HOME ACTIVITIES AND PLACES AMONG PEOPLE WITH DEMENTIA IN MULTIPLE COUNTRIES
Authors: Chaudhury Habib , Nygard Louise , Cutchin Malcolm
Published: November 2019

Maintaining participation in activities and places in the community can be challenging for people with dementia in the face of cognitive decline. These challenges could be related to driving cessation, accessing transit, ability to navigate in the community, socially uncomfortable situations and functionally difficult tasks. Consequently, people with dementia are at risk of progressively becoming isolated from the community and being unable to meaningfully age-in-place in the home and community. Familiar and responsive neighborhood built environmental features, public awareness of dementia and appropriate support, dementia-friendly transit systems, are among the potential socio-physical environmental factors to foster maintenance of participation and activities for persons living with dementia. Empirical literature exploring levels of participation outside the home, wayfinding and orientation issues, and the nature and prevalence of challenging circumstances for older adults with dementia in the community is scarce. This session will present four papers in this area based on empirical projects conducted in Sweden, Switzerland, U.K. and Canada. Three of these projects used the recently developed Participation in ACTivities and Places OUTside the Home (ACT-OUT) questionnaire to generate evidence on the levels of participation and perceptions of risks outside the home for people with and without dementia. A presentation will also summarize the theoretical bases for the ACT-OUT research discussed in the other presentations. One study will focus on the influence of Everyday Technology on participation patterns. Implications of the research findings to advance theoretical understanding, generate evidence-base and impact policy and practice, along with future research directions will be considered.
PARTICIPATION OUTSIDE HOME FOR PEOPLE LIVING WITH DEMENTIA: DO THEY REALLY EXPERIENCE A SHRINKING WORLD?
Authors: Margot-Cattin Isabel , Kühne Nicolas , Ludwig Catherine , Nygard Louise , Kottorp Anders
Published: November 2019

Accessing places outside home where activities are performed provides both benefits (e.g. participation in activities), and challenges (e.g. finding one’s way) for people with cognitive deficits. Participation in these places appears to depend on various factors such as the living situation of the person, availability of commodities and supporting social networks, or preserved ability to drive. However, clear patterns of participation remain scarcely documented. This study addresses the need for understanding of participation outside home among people with dementia through the places they visit. The aim is to describe how the outside world may be shrinking for them. People with and without dementia (n=70), aged 65+, were interviewed using the Participation in ACTivities and Places OUTside the Home (ACT-OUT) questionnaire across Switzerland. Results show that people with dementia participate significantly less in commercial, social and cultural places, but visit medical care places at a higher level, than those without dementia.
THE IMPACT OF THE R3 PROGRAM ON SERVICE UTILIZATION, COSTS, AND QUALITY OF LIFE
Authors: Cohen Marc A , Hefele Jennifer , Miller Edward , Nadash Pamela , Shellito Natalie , Simpson Elizabeth
Published: November 2019

Relatively few housing with services evaluations employ rigorous multiple group quasi-experimental designs rather than simple before/after research designs. This study employs a pre-post experimental design with a comparison group to analyze whether the R3 program led to reductions in certain key utilization measures, including emergency department visits, inpatient hospitalizations, ambulance usage, and skilled nursing facility admissions, over 18 months. Also examined is whether resident quality of life indicators changed over the period. Data derive from assessments with 410 residents in four intervention sites and 227 residents in five comparison group sites. Also obtained was data on emergency department transfers from first responder services and Medicare fee-for-service data from the local quality improvement organization. Results suggest that the program has positive implications for service utilization, costs, and quality of life. Early detection and intervention inherent in the R3 program may improve resident quality of life while lowering service utilization and costs.