bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSESSING BALANCE INTERVENTION OUTCOMES IN OLDER ADULTS WITH HEARING LOSS
Authors: Price Caitlin , Hardison Holland , Spradley Laura
Published: December 2023

Previous studies reveal individuals with hearing loss are more likely to experience falls and fall-related injury. Fall risk exponentially increases with more severe degrees of hearing loss. Because both the risk of falls and the incidence of hearing loss increase with age, investigating the efficacy of balance intervention programs in older adults with hearing loss is vital to enhancing clinical outcomes and reducing heightened risk of falls in these individuals. Various balance intervention and physical exercise programs have been shown to reduce fall rates. However, which individuals achieve the greatest benefit from these programs remains unclear. Do those at greater risk of falls demonstrate more or less benefit from balance intervention? The current study aimed to (1) assess the impact of the A Matter of Balance (AMOB) program on older adults’ fall risk and balance measures and (2) evaluate which measures (e.g., postural stability, balance confidence, fall risk, physical activity, degree of hearing loss) best predict balance intervention outcomes. Pre- and post-intervention balance and fall risk in older adult participants (60-90 years) with hearing loss were assessed via measures of postural sway and subjective questionnaires. Results revealed balance-related benefits following the completion of the AMOB program. Older adults initially identified as having higher fall risk demonstrated the most significant benefits as observed in fall risk reduction. Our results inform clinical practice by clarifying which individuals may benefit most from balance intervention programs and thus improve targeted intervention approaches for older adults at greater risk for falls and fall-related injury.
ANTIHYPERTENSIVE DEPRESCRIBING AND DISABILITY IN VA NURSING HOME RESIDENTS WITH AND WITHOUT DEMENTIA
Authors: Liu Xiaojuan , Graham Laura , Jing Bocheng , Dave Chintan , Li Yongmei , Fung Kathy , Odden Michelle
Published: December 2023

Deprescribing antihypertensives is of growing interest in geriatric medicine, yet clinical trial evidence is lacking. We leveraged the Veterans Affairs (VA) electronic health data and emulated a target trial of antihypertensive deprescribing on longitudinal change in disability, measured by activities of daily living (ADL), ranging 0-28. Residents included were ≥65 years with long-term stays ≥12 weeks from 2006-2019 (n=42537). We excluded those not on antihypertensives and with very high blood pressure or heart failure. The eligible residents (n=13041) were divided into newly deprescribed (reduced number of antihypertensives or dose of ≥30% after a 4-week washout) and stable users and followed up for 2 years or censored at death, discharge, or non-adherence. We used linear mixed-effects regressions to estimate per-protocol effects, with inverse probability of treatment weighting (IPTW) to adjust for confounders and additional inverse probability of censoring weighting to account for informative censoring. Analysis was stratified by dementia (yes/no) to examine the potential modification. In non-dementia subgroup (n=5954), newly deprescribed residents (n=561) had a worse ADL score (βtreat [95% CI] = 1.36 [0.82, 1.91]) compared to stable users (n=5393). Over time, ADL scores increased (worsened) 0.13 per 3 months (βtime = 0.13 [0.09, 0.17]) while antihypertensive deprescribing statistically significantly attenuated this increase by 0.25 per 3 months (βtime × treat = -0.25 [-0.48, -0.03]). The dementia subgroup showed imprecise effect (βtime × treat = -0.0003 [-0.13, 0.12]). More evidence is needed on the benefits and harms of deprescribing in long-term care populations and the importance of dementia in these relationships.
NURSE STAFFING AND VETERAN OUTCOMES IN THE VETERANS HEALTH ADMINISTRATION’S COMMUNITY LIVING CENTERS
Authors: Brown Lana , Gauss C Heath , Billings Pamela , Moore Jade , Sawyer Linda , Sparks Diane , Sullivan Sheila Cox
Published: December 2023

Higher nurse staffing levels have been associated with better outcomes for patients in the acute care setting and for residents in the long-term care setting. There are several publications available linking nurse staffing to improved quality measures. Conversely, minimal research has occurred examining associations between nurse staffing and Veteran outcomes. The purpose of this research study was to assess for associations between nursing hours per patient day (NHPPD) and Veteran outcome measures in the Veterans Health Administration Community Living Centers. A retrospective data review was completed for NHPPD and quality measures for 134 Community Living Centers. Descriptive statistics were used to analyze the average total NHPPD for each of six Minimum Data Set, version 3.0, quality measures. Linear regression was utilized to assess for a linear association between average total NHPPD and the defined quality measures. This study found no linear association between average total NHPPD and the following Veteran outcome measures: improvement in function (p=0.15), ability to move independently worsened (p=0.13), catheter in bladder (p=0.48), and UTI (p=0.48). However, a statistically significant linear association was found between average total NHPPD and the following Veteran outcome measures: falls with major injury (p=0.02) and help with ADLs (p=0.01). As the average total NHPPD increased, the mean for falls with major injury and the mean for help with ADLs decreased. This study adds to the body of literature regarding the impact of nurse staffing on quality measures in the long-term care setting.
RELATED FACTORS ON HOSPITALIZATION OF NURSING HOME RESIDENTS IN KOREA USING QUASI-POISSON REGRESSION
Authors: Shin Juh , Jung Sun Ok , Min Eun Jeong , Kim Jung Eun
Published: December 2023

The appropriateness of hospitalization for nursing home (NH) residents is still debated, with factors such as timeliness, available treatment, healthcare staff, medication options in hospitals, and safety issues determining appropriateness. Although factors impacting hospitalization have been studied expansively, research has been limited to nurse staffing. This study aims to investigate how organizational factors, nurse staffing, and government incentives impact hospitalization due to infection among NH residents in Korea. A cross-sectional design was used, and data were collected via survey from a total of 51 NHs from August 27, 2021 to March 25, 2022 using quota sampling. A total of 35 explanatory variables were included, and the response variable was the count of hospitalized residents due to infection. We analyzed data using quasi-Poisson regression. The average number of residents of hospital transfers due to infection was 5.22 (SD 7.99) per nursing home. The number of residents with Alzheimer’s or dementia increased by 1 person, and the number of hospitalized residents due to infection increased by 1.01. Moreover, we found that in NHs that did not receive top-grade incentives due to good performance, the number of residents admitted to the hospital due to infection decreased by Exp (b) 0.5133. More stable, specialized advanced nursing staff and leaders specializing in high-quality care for residents with Alzheimer’s or dementia were more effective in decreasing hospitalization. The measure of hospitalization in the future should focus on quality improvement, as hospitalization is universal use for many countries by extricating necessary versus avoidable hospitalization.
THE PREVALENCE AND PREDICTORS OF APATHY AMONG CANADIAN LONG-TERM CARE RESIDENTS: A SECONDARY DATA ANALYSIS
Authors: Agboji Aderonke , Freeman Shannon
Published: December 2023

Apathy, defined as a reduction in interest or motivation to engage in goal directed activities, is a frequent and persistent health concern among persons residing in long term care facilities. Research showed that apathy is associated with rapid cognitive decline, impaired functional ability, and increased mortality risk. To prevent or mitigate the negative impacts of apathy on persons living in long term care facilities, there is need for better understanding of the risk factors associated with it. Therefore, the aim of this study was to determine the prevalence of apathy and its risk factors in a large sample of Canadian long-term care residents (N=332,454). We performed cross-sectional analysis of data from MDS 2.0 assessments completed between 2015 and 2019 fiscal year. Results from descriptive and inferential analyses showed that apathy was more prevalent among persons aged 65 or younger and speak English. The strongest predictors of apathy were province of residence (OR 4.09 (CI 2.99-5.59) followed by resistance to care (OR 2.43 CI 2.38-2.49), conflict with family (OR 2.30 CI 2.2-2.4), and insomnia (OR 2.16 CI 2.11-2.2). These findings highlight the important role of environmental contextual factors including the physical and social environment as well as personal factors in the development of or recovery from apathy. Strategies for combating apathy in long term care facilities should take into account the individual, institutional and provincial variances.
USING PROCESS EVALUATION TO IMPROVE DOCUMENTATION OF LIFE-SUSTAINING TREATMENTS FOR VETERANS
Authors: Haverhals Leah , Magid Kate , Kononowech Jennifer , Beltran Jazmin , Lane Amber , Levy Cari
Published: December 2023

The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) intervention began in 2021 to support United States Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) clinicians in completing life-sustaining treatment (LST) templates for Veterans. In PERSIVED, HBPC clinicians partner with the PERSIVED team for 15 months, with clinicians routinely receiving coaching from the PERSIVED team. To assess participation in PERSIVED and to inform coaching sessions, the PERSIVED team conducted process evaluation interviews from August-November 2022 with N=24 clinicians across the country from seven HBPC sites. Interviews were conducted between months six-seven of PERSIVED implementation. Two PERSIVED team members conducted interviews, one acting as interviewer and the other as notetaker. Following interviews, the notetaker cleaned up the notes and the interviewer reviewed them, with the two reaching consensus on summaries on individual interviews and ultimately summarizing interview data by site. Two PERSIVED coaches then reviewed the summaries to brainstorm how to adapt coaching based on process evaluation findings. Coaches noted site-specific barriers and facilitators to improving LST template completion rates; positives of PERSIVED coaching; suggestions to improve PERSIVED; and goals for the remaining nine months of the PERSIVED intervention. Strategies suggested based on the process evaluation analyses included how to integrate checking for the LST template into existing processes, adapting note templates, discussing LST templates during team meetings, and improving education around LST template completion. The rapid integration of process evaluation findings into PERSIVED coaching sessions proved beneficial for participating HBPC teams.
INCREASED SUPPORT FOR OLDER VETERANS AND THEIR CAREGIVERS USING TELEHEALTH SERVICES
Authors: Flores Bertha , Arevalo-Flechas Lyda , Jiwani Rozmin , Romo Enelda , Zaragoza Gabriela , Powers Becky , Sanchez-Reilly Sandra , Espinoza Sara
Published: December 2023

Five million Veterans live in rural areas in the U.S., and about half of those live in the South. Rural Veterans are more likely to be older and have a disability compared with non-rural Veterans. In Texas, Veterans comprise seven percent of the adult population with a median age of 50 years, of those 17% live in rural areas where access to care is a concern for many Veterans and their families. Technology-based services could help close this gap. The GRECC Connect program is one way to reach rural Veterans and their caregivers. GRECC Connect is a multi-disciplinary virtual geriatrics program that provides support for providers to help manage older, rural Veterans through telemedicine. Patient Tele- consultations follow the Age-Friendly Geriatrics 5 M’s framework (Medications, Mentation, Mobility, Multi-complexity, and what Matters most). As a demonstration project at the San Antonio GRECC, we partnered with the Geriatric Extended Care Services (GEC), and the Dementia Caregiver Program (DCP) to educate and support caregivers. We also partnered with the education department to conduct clinic outreach. In Fiscal year 2022, we served 72 Veterans, 66 of those had a caregiver, and the majority (51/66, 77%) were enrolled in the DCP. In Q4 (17/17, 100%) of caregivers were enrolled in the DCP. In addition, Veterans were referred to 248 additional services including palliative care and saved 5,934 miles. The GRECC Connect program decreases barriers experienced by older rural Veterans including transportation, assistance to navigate VA system and access to specialty geriatric and palliative care.
VIRTUAL COMPREHENSIVE GERIATRIC ASSESSMENT FOR VETERANS: AN INTERDISCIPLINARY QUALITY IMPROVEMENT PILOT PROJECT
Authors: Cervantes Maria , Dunlap Janette , Scott Robynn , Howell Teresa , Neal Amy , Bieber Heather , Tillmann Jacob
Published: December 2023

The Veterans Millennium Health Care and Benefits Act requires comprehensive geriatric assessments (CGA) to be provided to all older Veterans as part of the Veterans Medical Benefits Package. Access to a CGA may be difficult for Veterans with limited ability to travel. Currently, in the North Florida/South Georgia (NFSG) Veterans Health System, approximately 11,500 older Veterans are recognized to be at high risk for hospitalization or placement in a long-term care facility, yet only 0.09% of them have received a CGA. NFSG Geriatrics and Extended Care (GEC) developed a standardized virtual CGA process to increase access to geriatric specialty care utilizing VA Video Connect (VVC). The project design and implementation included: the development of a standard operating procedure using evidence-based screening tools, templates, clinic grids and flowcharts, communication channels, and the development of a dashboard for data collection. In addition, the VHA National CGA Template was piloted. This novel Tele-Geriatrics virtual interdisciplinary project allows older Veterans and/or caregivers to remain at their homes for all telehealth/virtual sessions completed by the CGA interdisciplinary team, including pharmacy, nursing, social work, occupational therapy, and geriatric providers. The project demonstrates increased access to comprehensive assessments, consequently closing the gap between current practice and the Veterans Millennium Health Care and Benefits Act requirements. The pilot also decreased the health disparities of rural Veterans. Furthermore, this project helped to increase Veteran knowledge of geriatric syndromes, VA resources, participation in telehealth, and access to durable medical equipment (DME) to help Veterans age in place.
AGE LOGICS IN SOCIAL WORK: THE CASE OF HARM REDUCTION FOR 50+ WITH LONG-TERM SUBSTANCE MISUSE
Authors: Jönson Håkan , Harnett Tove
Published: December 2023

Age is a commonly used criterion in social work: for entry and exit and in decisions on what actions being appropriate for different clients. This study introduces the concept of age logics in social work and do so by investigating the use of age in wet eldercare facilities, a type of harm reduction arrangements for older people. These settings are for people over 50 years of age with long term substance misuse. No treatment is provided, and residents can continue to consume alcohol and other substances at the facilities for the rest of their lives. Using wet eldercare facilities as a case, the aim of this article is: 1) to introduce age logics as an analytical tool for critical studies on age in social work and 2) to propose a method for how to reveal ageism embedded in locally used age logics. The empirical data consists of interviews with eleven caseworkers, 12 staff-members and 31 residents at two Swedish wet eldercare facilities. The analysis identified four age logics linking chronological age with four meanings: 1) Logic on changeability, 2) Logic on lifestyle 3) Logic on function and 4) Logic on administrative fit. Jointly these logics constructed an ideal type version of the “older addict” that justified existing arrangements. The analysis also served as a basis for a proposal of a “four-question method” that may be used to reveal and challenge ageism hidden in locally used age logics.
HOW ORGANIZATIONS CAN ADDRESS AGEISM AS PART OF THEIR DIVERSITY, EQUITY, AND INCLUSION INITIATIVES AND PROGRAMS
Authors: Perez Sasha , Javier Noelle Marie , Brown Katherine , Sanon Martine , Chow Stephanie , Andrade Allen , Goldstein Nathan
Published: December 2023

The Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai Health System created a diverse inter-disciplinary committee to advance and promote DEI activities centered in advocating for a socially just, diverse, equitable, inclusive, and anti-racist workplace. Research shows that anti-ageism is a largely neglected component of diversity, equity, and inclusion programs. Thus, many institutions are not learning how age biases and discrimination show up in the workplace and the intersection of age across other dimensions of diversity. Ageism is a vital workplace issue as over a third (37.3%) of the U.S. workforce are aged 50 and older. We aimed to address this by incorporating the topic of anti-ageism via our various DEI initiatives available to all faculty and staff: “Humanities, Arts, and Books Initiative” on Combatting Ageism - structured workday sessions designed to provide a safe virtual space for reflection, discussion, and learning. We also held “Learning Pathway series” on Reframing Aging as well as Caring for Older Adults with HIV – structured sessions focused on knowledge building, and expert-led discussion. Attendance ranged from 40 to 60 participants at each session. Quantitative and qualitative assessment revealed a steadfast interest to address ageism and bias; appreciation of the semi-structured format for dialogue and reflection on relevant topics and finally ongoing education to create a more informed and collegial department. This type of programming can potentially serve as an additional resource for other institutions that are planning in incorporating anti-ageism activities in their DEI programs and everyday practices.
HAS YOUR SMILE BEEN CHECKED?: CHARACTERISTICS OF DENTAL CARE UTILIZATION OF MEDICARE BENEFICIARIES
Authors: Agyemang Lillian , Bakk Louanne
Published: December 2023

Background

An area under researched is oral health disparities in the population of older adults residing in the United States. The current dental benefits offered through health insurance plans that older adults are likely to utilize, particularly Medicare and Medicaid, are inadequate. The deficiency harms this population’s physical and mental health and well-being. Additionally, insufficient oral health care has adverse outcomes, including tooth loss, poor self-esteem, malnutrition, and cardiovascular complications. While evidence suggests race and ethnicity can be predisposing factors impacting access to dental care, it is unclear the extent to which disparities in utilization exist.

Methods

This exploratory, cross-sectional study examined the relationship between dental care utilization and Medicare beneficiary characteristics. Data from the 2018 wave of the Health and Retirement Study were used. The sample consisted of 8,357 respondents aged 65 and older enrolled in Medicare.

Results

There was an association between dental care utilization and race, ethnicity, health status, education, and age. A much lower proportion of Black and Hispanic older adults reported seeing a dentist in two years than non-Hispanic White beneficiaries (p<.001). Dental care utilization was also less among respondents who were older (p<.01), in poorer health (p<.001), and had less education (p<.001).

Conclusions and Implications

Findings suggest disparities in dental care utilization exist and disproportionally impact vulnerable Medicare beneficiaries. This is concerning, particularly given racial and ethnic differences in health. The conclusions accentuate areas such as access to dental care services, coverage, and policy implementation concerning and impacting older adults.
MENOPAUSAL SYMPTOM EXPERIENCE OF MID-LIFE WOMEN FAMILY CAREGIVERS OF PERSONS LIVING WITH ALZHEIMER’S DISEASE
Authors: Kim Hyein , Kim Heejung , Brewster Glenna , Chee Wonshik , Im Eun-Ok
Published: December 2023

Midlife women experience a wide range of menopausal symptoms. Such symptoms may be different in midlife women who are family caregivers of persons living with chronic disease, particularly Alzheimer’s disease. Because the cultural stigma of dementia differs among racial/ethnic minority groups, midlife minority women tend to feel burdened with family caregiving and report negative health outcomes compared with White women. This study aimed to explore the racial/ethnic differences in menopausal symptom experienced by midlife women who were family caregivers of persons living with Alzheimer’s disease (MWPLAD). A secondary data analysis was conducted using the data of a cross-sectional online survey among 172 MWPLAD. Self-report questionnaires including the Midlife Women’s Symptom Index were used to gather the data on the women’s sociodemographic characteristics, health-related information, and menopausal symptom experience. Descriptive statistics, one-way analysis of variance and multiple linear regression were adopted for the data analysis. There were significant racial/ethnic differences in midlife women’s symptoms in the total scores (total frequencies and severity scores) and individual sub-scale scores. Psychological symptoms were reported to be more prevalent in Asian MWPLAD than in other racial/ethnic groups. After controlling for race/ethnicity, several factors were associated with the menopausal symptoms experienced by MWPLAD, such as household income, history of obstetrics and gynecology diseases, underweight, and restriction to perform daily activities. Our study findings support the racial/ethnic differences in menopausal symptoms experienced by MWPLAD. More culturally competent interventions should be established considering the significant factors that differently affect the women’s menopausal symptom experience in different racial/ethnic groups.
WORK PRECARITY AND THE AGING WORKFORCE: TRENDS IN HEALTH DISPARITY AMONG OLDER SERVICE SECTOR WORKERS
Authors: Goldberg Renada , Dill Janette , Kim Jiyeon
Published: December 2023

Work precarity may affect workers’ physical, mental, and social well-being as navigating uncertain and insecure work conditions interacts with factors such as housing, family caretaking, and personal relationships. In particular, the service sector has long been characterized by work precarity as compared to other industries in the US, where noncollege workers are far more vulnerable to non-standard and low-wage work and Black, Indigenous, and workers of color are overrepresented. For older adults, structural and systemic inequities may exacerbate health conditions and accelerates biological aging. In this study, we measure work precarity among noncollege older workers (55-75 years old) in three large and growing service sector industries in the US: health care, retail, and food service, to access the impact of work precarity on older low-wage worker’s health outcomes, exits from the formal wage labor workforce, and linkages between work precarity and health disability.
NEIGHBORHOOD COHESION, NEIGHBORHOOD PHYSICAL DISADVANTAGE, AND END-OF-LIFE CARE: HOW NEIGHBORHOOD MATTERS
Authors: Ding Kedong , Lou Yifan
Published: December 2023

Background

Many studies have focused on the association between individual-level factors and end-of-life care. Yet neighborhood-level factors and end-of-life care are understudied and thus remain unclear. This study aims to examine the association between neighborhood characteristics and U.S. older adults’ end-of-life care to fulfill the existing research gaps. Method: Data were from the 2008 to 2016 Health and Retirement Study exit interview (n = 1,561) who answered left behind questionnaires. Participants included community-dwelling adults aged 55 years or older who died between waves. End-of-life care is measured from three dimensions: health service utilization, quality of life, and advance care planning; Neighborhood characteristics include neighborhood cohesion, which was assessed with 4 items to measure the extent to which respondents feel about the neighborhoods and neighbors’ trust; neighborhood physical disadvantage, which was assessed with 4 items to measure the extent to which respondents feel about the neighborhoods’ physical problems. Logistic regressions with sociodemographic and health controls were conducted.

Results

A higher level of perceived neighborhood cohesion and lower level of perceived neighborhood physical disadvantages are significantly associated with a lower likelihood of being admitted to the ICU, getting life support, and having trouble with pain. Higher neighborhood cohesion is also associated with increased odds of having a living will (OR= 1.10, p < 0.05). Neighborhood characteristics are not associated with end-of-life hospitalization, use of hospice, depression, and having end-of-life care conversations.

Conclusion

This study demonstrated how neighborhood characteristics will influence end-of-life care service utilization, quality of care, and advance care planning.
SOCIAL ENGAGEMENT AMONG COMMUNITY-DWELLING OLDER ADULTS: A QUALITY-OF-LIFE ANALYSIS
Authors: Thompson Alisha , Wilks Scott , Bardales Rhonda
Published: December 2023

Older adults are living longer without sufficient efforts from health and social service systems to improve their quality of life (QoL). QoL is a nuanced, dynamic aspect to analyze. Literature shows that higher levels of social engagement provide a range of benefits to physical, mental, and cognitive health, all broad indicators of overall QoL. Social engagement comprises the person’s subjective experience of the richness of their relationships. The purpose of this study was to examine empirically the connection among this richness of relationships — specifically social engagement and perceived quality of relationships — and overall QoL among older adults. The study used a large sample (N=746) of non-institutionalized adults, ages 65 and older, from the nationally representative, AARP Social Engagement and Brain Health Survey. Two primary independent variables (IVs) were quantifiable measures of social engagement and perceived quality of social relationships; covariance controlled for several demographic factors (e.g., sex, ethnicity, income) and general health measures of physical, mental, and emotional health. The outcome variable was a composite score from a popular QoL measure. Analyses involved bivariate regression for the primary IVs, then multivariate OLS regression with each IV to predict quality of life. Results showed that QoL significantly regressed with predictors of social engagement (positively); each health variable (positively); unmarried status; ethnicity of Black/African American or Asian; and male gender. These results enhance our understanding of the relationship between social engagement, relationship quality, and QoL in older adults, particularly those who identify within the aforesaid demographic brackets. Implications are discussed.
WHY ARE SOCIALLY ISOLATED OLDER ADULTS UNABLE TO ACCESS SERVICES IN JAPAN? A PRELIMINARY REVIEW OF FOUR FACTORS
Authors: Ikeuchi Tomoko , Kikuchi Kazunori , Taniguchi Yu , Hayashida Cullen , Ito Kae
Published: December 2023

The COVID-19 pandemic has made it difficult for health and social service agencies to provide the necessary support to community-based older adults. It is believed that the number of socially isolated older adults without the necessary support has increased, but the actual situation is unclear. In this study, we conducted a self-administered mail survey targeting all local municipal governments and social welfare councils throughout Japan from September to October 2022 to examine the actual situation. The response rate was 18.7% (682/3654). Nearly 52% of respondents reported an increase in the number of socially isolated older adults during the pandemic, and 43.6% reported that providing support services to them was difficult. We specifically asked about the difficulties encountered in providing support and coded the open-ended responses (n=275). Four primary themes were identified: (1) generalized refusal by isolated older adults (n=79); (2) difficulty in locating (n=72); (3) difficulty in face-to-face communication (n=40); and (4) difficulty in supporting (n=73). Among the reasons for the difficulty in supporting isolated older adults were their diverse needs and tendency to not recognize their need for support, which may be due to mental illness or dementia. Our findings suggest that a better attempt at classifying refusals among social isolates is a first step to improving the impact of social and health services intervention. Further research is needed to clarify the reasons for refusal of the support provided and to identify the specific types of support that isolated older adults require.
LGBITQ+ INCLUSIVITY IN GERIATRIC CARE IN NORWAY: ATTITUDES AND PRACTICES AMONG HEALTH CARE PERSONNEL
Authors: Bromseth Janne
Published: December 2023

Person-centered care is the dominating care philosophical framework being used in geriatric care services in Norway today, as a point of departure for good practice. It implies that all care-receivers should be met from an empathic and individual perspective- and an increased focus on basic psychological needs. To be positively confirmed in relation to ones′ identities and to feel included in communities are central parts of this (Kitwood 1997). But is this also the case for older LGBTIQ+-adults? And which competence and knowledge on LGBTIQ+-adults′ life course experiences and aging conditions exist amongst health care staff working in long-term care facilities, home care services and day care activities? This paper is based on results from the interview study “Queer perspectives on geriatric care in Norway”, investigating experiences of person-centered care and inclusive practices from two perspectives; non-heterosexual care receivers and care providers in the Oslo-area. The analyzed material consists of: 1) interviews with 11 LGBQ-people between 61- 78 years old about their experiences with health care services over the life course 2) 3 focus groups and 2 individual interviews with health care staff working in a range of health and care services targeting 65+ adults. A majority of the interviewees had received training on LGBTIQ+-inclusive health care. The paper will mainly present results from the second study. What are leaders′ attitudes and knowledge regarding active work with gender and sexual diversity and equal access to care, and which experiences do they have from implementing LGBTIQ-awareness in policy and care practices?
PERSPECTIVES OF THE HOME HEALTH WORKFORCE ON TRAINING
Authors: Valdes Elise
Published: December 2023

As more older adults desire to age in place, home health workers are becoming a vital component of the healthcare workforce. The last large scale nationwide survey among home health workers was conducted in 2007. There has been a variety of research in this area since then; however, the majority of studies are small and qualitative in nature which may limit their generalizability. Understanding the opinions and perspectives of home health workers is vital to retaining this important part of the healthcare workforce. For the current study a broad sample of home health workers (n=1446) including home health aides, hospice health aides, personal care aides, CNAs, LVN/LPNs, and RNs completed an online self-report survey on how well their training prepared them for practice. Results indicated that most hospice health aides felt their training well prepared them for practice (80.3%), while only 56.6% of RNs reported that they felt well prepared. We also explored how prepared respondents felt on a variety of topics from patient care skills to dementia care to end of life skills. Again, hospice health aides reported the highest average scores for receiving excellent training across all topics (61.5%) and RNs reported the lowest average scores (42.6%). Feeling unprepared for a job, may lead to lower job satisfaction and higher turnover. Therefore, understanding how well-prepared home health workers feel is key to retaining this segment of the workforce. Future research should explore how to improve this training and preparation across all home health workers but particularly among RNs.
BUDDY-UP DYADIC PHYSICAL ACTIVITY (BUDPA) PROGRAM ON HEALTH OUTCOMES OF DEMENTIA CARE DYADS: A FEASIBILITY TRIAL
Authors: Yu Doris S F , Li Polly
Published: December 2023

Dementia is a challenging disease experience not only jeopardizes the health of the persons with the condition (PWD) and their family caregivers. In views of the health promoting effects of exercise and its high relevance to promote a meaningful encounter between the dementia care dyads, a pilot feasibility was conducted to examine the effects of a 12-week multi-component Buddy-Up Dyadic Physical Activity (BUDPA) Program. Thirty care dyads were randomized to receive the BUDPA program or wait-list control. Outcome evaluation at baseline, 6 weeks and 12 weeks showed greater improvement in most of the cognitive functional domains (Coden’s d = 0.30-0.87), neuro-psychiatric symptoms (Coden’s d = 0.22), overall mood status (Coden’s d = 0.30) and positive aspects of caregiving (Coden’s d=0.32) among the BUDPA group, though the limited statistical power did not identify significant difference. The qualitative findings from eight care dyads engaged in BUDPA program converged with the outcome evaluation, and BUDPA was described as a ‘physical-based social-cognitive training’. The PwDs were more engaging and attentive in daily life, with less irritability, delusive thoughts and repetitive behaviors. Caregivers reported feelings of vitality and enhanced mood. Converge with the 3-Phase Dyadic Adaptation Model, the care dyads felt more connected and their feeling of ‘being cared for by the PwD is very powerful to reward their effort in caregiving. This finding implies the dyadic exercise is of high fidelity, and a full-scale study is needed to evaluate its effect from a health-promoting, social-interactional and existential paradigms.
COMMUNICATION PREFERENCES FOR DEPRESCRIBING BISPHOSPHONATES IN NURSING HOME RESIDENTS WITH DEMENTIA
Authors: Fasth Lauren , Kelley Casey , Colón-Emeric Cathleen , Thorpe Carolyn , Gilliam Meredith , Lund Jennifer , Hanson Laura , Niznik Joshua
Published: December 2023

Bisphosphonates are potential targets for deprescribing in nursing home residents with dementia as goals of care change from preventive to palliative. Yet, prescribers lack communication guidance to address deprescribing. We sought to characterize and compare communication preferences of prescribers and family/informal caregivers regarding bisphosphonate deprescribing. We conducted 23 semi-structured interviews with prescribers (12) and caregivers (11). Prescribers and caregivers were asked to provide their impressions of 7 conversation starters for discussing deprescribing bisphosphonates. A qualitative framework analysis was used to identify themes throughout the interviews across the following domains: content of communication, relationship between communicators, and preferred communication styles. Among prescribers, there were 10 physicians and 2 nurse practitioners; most (9) were female and White. Among caregivers, 8 were female, 7 were White, and 5 were Latino/a; most (9) had a post-secondary degree. The most preferred deprescribing conversation starter for prescribers focused on increased risk of adverse effects, while caregivers most preferred a discussion weighing risks versus benefits. The least preferred conversation starter for deprescribing across both groups focused on the extra effort and cost of continuing bisphosphonates. Similarities and differences between prescribers and caregivers regarding important topics for deprescribing conversations were identified, including quality of life, risk versus benefit, and shared decision-making. While caregivers and prescribers agreed on some communication preferences, this study highlights nuanced differences in preferred communication about deprescribing bisphosphonates. The results of this study may contribute to clinical guidance for prescribers and education materials for caregivers to facilitate more effective conversations about deprescribing bisphosphonates.
EMOTIONAL RESPONSES OF ADULTS LIVING WITH DEMENTIA TO AN INTERGENERATIONAL MUSIC INTERVENTION
Authors: Dorris Jennie , Raina Ketki , Neely Stephen , Rodakowski Juleen
Published: December 2023

Music interventions have shown promise to support emotional well-being in older adults living with dementia. Bolstering emotional well-being could improve the quality of life of the millions of older adults living with dementia. We implemented an intergenerational music intervention at Dementia360, a community program that serves older adults living with dementia. The music intervention featured adolescent musicians performing the preferred music of the older participants and engaging them in interactive musical activities via Zoom. 14 older adult participants attended an average of four sessions, 54 minutes each, of the intervention. We described their positive affect and pleasure as they engaged in the intervention. We compared participants’ scores on the Positive and Negative Affect Schedule (PANAS) pre- and post-intervention. We also assessed the participants’ emotions by rating them using the Observed Emotion Rating Scale (OERS). On average, the participants’ scores increased three points on the Positive Affect subscale of the PANAS. Our computed cohen’s d effect size was 0.5, a moderate effect size that correlates with self-report measures of feeling “a little more” to “much more” positive affect. On the OERS Pleasure subscale, we found that pleasure was shown for more than one minute of the ten-minute sample in over 87% of the observations. Intergenerational music interventions employ the safe, pleasurable, and scalable modality of music. These findings suggest that participation in such an intervention has the potential to influence positive affect and pleasure, critical supports for the emotional well-being of older adults living with dementia.
EMPOWERING STAFF TO MANAGE MEALTIME DIFFICULTIES AMONG RESIDENTS WITH DEMENTIA: A PILOT STUDY
Authors: Passos Lígia , Tavares João , Batchelor Melissa , Figueiredo Daniela
Published: December 2023

People in advanced stages of dementia may experience mealtimes difficulties and depend on others for feeding. This pilot study aimed to evaluate the feasibility, acceptability, and preliminary effects of an educational intervention on mealtime difficulties of people with dementia, in a sample of 16 direct care workers and 9 people with dementia and was conducted in a nursing home. The sessions provided information about dementia, mealtime difficulties, and training on strategies and techniques. Feasibility was assessed through screening, eligibility, consent, retention, completion, and intervention adherence rates; and acceptability through a satisfaction questionnaire. The staff assessment included: burnout, job satisfaction, and knowledge about dementia and mealtime difficulties. In people with dementia, eating and feeding problems, and food intake were assessed. The main findings show that all feasibility rates, except for screening (89%), were excellent (100%). Direct care workers appreciated the intervention and perceived educational and practical benefits, although they reported needing more time to provide better assistance. Burnout levels did not change (mean 58.9 versus 58.6), but job satisfaction showed a positive trend (mean 71 versus 74.5) at the end of the intervention. Knowledge increased 37.5% compared to baseline. EdFED’s score presented slight improvement, while the oral intake of people with dementia increased after the intervention (91.1% versus 98.1%). The intervention was found to be feasible and acceptable. However, the educational intervention content needs improvement, and further studies with robust designs and larger samples are needed to better understand its effects on both direct care workers and people with dementia.
THE DREAM TOOLKIT: CO-DEVELOPED TRAINING AND RESOURCES TO PROMOTE WELL-BEING OF PERSONS WITH DEMENTIA
Authors: Freeman Shannon , Middleton Laura , Pelletier Chelsea , Skinner Kelly , Regan Kayla , Donnelly Rachael , Keller Heather ,   DREAM Research Team
Published: December 2023

Promoting wellbeing of persons with dementia is a priority. Engaging multi-perspective partners to co-develop interventions creates impactful solutions. We will describe the process, output, and lessons from the Dementia Resources for Eating, Activity, and Meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers. We aimed to increase supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: 1) Engaging/maintaining the DREAM Steering Team; 2) Setting/navigating ways of engagement; 3) Prioritizing audience and content of the toolkit; 4) Drafting content & format of toolkit; 5) Iterative co-development of tools/resources; 6) Usability testing; 7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and discussed and evolved content areas. An environmental scan identified existing, high-quality resources aligned with content areas. The DREAM Steering Team alongside additional community partners and external contractors iteratively co-developed new resources/tools to meet gaps. The DREAM toolkit includes a website, seven learning modules about dementia, healthy eating, and physical activity, a learning manual, six videos, nine handouts, and four wallet cards (www.dementiawellness.ca). Co-development participants rated the virtual co-development process highly in relation to the principles and enablers of Authentic Partnership in a process evaluation. Through the co-developed DREAM toolkit, we anticipate community service providers will learn to provide inclusive wellness programs and services to benefit persons with dementia and their families.
NETWORK ANALYSIS OF HEALTH PROBLEMS AMONG OLDER WORKERS AGED 65–75 IN KOREA
Authors: Kim Layoung , Kim Gwang Suk , Park Min Kyung , Lee Jae Jun
Published: December 2023

Korea’s effective age of labor market exit is 72.3 years the longest age among the Organisation for Economic Co-operation and Development (OECD). The increase in the number and age of older workers can result in the burden of workplace safety and health management. Health policies and programs can be efficient only when they are established based on a specific understanding of health problems by occupational groups. In this study, we identified older workers’ central health problems. Six health problems were reported by the 6th Korean Working Conditions Survey. The occupational characteristics were distributed into three groups: white-, blue-, and pink-collar. The data of older workers aged 65-75 who worked over 40 hours per week (N=1,086) was used for network analysis through the bootnet and qgraph packages in the R software. The health problems reported by older workers were: backache (39.9%); muscular pains in the shoulder, neck, and upper limb (39.7%); muscular pains in the lower limb (24.1%); fatigue (31.2%); headaches and eyestrain (17.3%); and anxiety (6.5%). The most central node of network was muscular pains in upper, which had significant relationships with backache, pains in lower, and fatigue. The correlation stability coefficient of strength was 0.672, which was preferable. In the subdivide, the pink-collar group showed muscular pains in the lower limb as the highest centrality. Since older people have simultaneous health problems, healthcare management should consider the relationships between problems. Additionally, centrality differed from occupational groups. These findings can be applicated to provide customized programs for the older workers.
RADIOTHERAPY NEEDS BY PORTUGUESE OLDER ADULTS IN 2040—A GLOBOCAN ANALYSIS
Authors: Rodrigues Edna Darlene , Almeida Paulo , Lopez Escarlata , Teixeira Laetitia
Published: December 2023

In Portugal, cancer is the second leading cause of death, accounting 28,544 deaths in 2018 (around 25% of all deaths). Radiotherapy (RT) is an effective cancer treatment. Around half of all cancer patients will require RT as part of their treatment. The European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project data states that Portuguese actual utilisation of RT relative to the evidence-based optimal use is between 50-60%. The aim of this study was to project RT use and resources to maintain RT accessibility for Portuguese older adults in 2040 for the most common types of cancers. The authors examined GLOBOCAN data to determine expected incidence of prostate, colon, rectum, lung, breast, and stomach cancers for those aged 70 and over. Results show that in 2040, new cancer cases in older adults are expected to account for around 60% of total cancer cases. Cancer incidence is estimated to increase between 30 to 40% in this population. In accordance with this projection, the authors used the optimal utilisation percentage of RT to calculate the number of RT courses anticipated to be needed for each cancer type and an increase of around 38% (8878 to 12729) is expected by 2040 to address the needs of this population. The ESTRO-HERO guidelines state that each RT machine should treat 400 to 450 patients per year. So, to cover the older patients’ demand, we estimate the need to install 8 to 10 additional RT machines by 2040.
THE RADIOTHERAPY USE BY OLDER CANCER PATIENTS IN PORTUGAL—2018 NATIONAL CANCER REGISTRY DATA
Authors: Rodrigues Edna Darlene , Bento Maria José , Calisto Rita , Rodrigues Jessica , Almeida Paulo , Lopez Escarlata , Teixeira Laetitia
Published: December 2023

In Portugal, cancer is the second leading cause of death, accounting for 28544 in 2018, around 25% of all deaths. Radiotherapy (RT) will be required by around half of the cancer patients. Older patients should be treated with ultrahipofractionation and highly precise/accurate technology to reduce the treatment sessions and to avoid side effects which are important for their quality of life. Nowadays, there is a global lack of RT infrastructure/investment that compromises cancer outcomes. The aim of this study was to evaluate the RT coverage by older patients in Portugal. The authors examined the 2018 national cancer registry data regarding the RT use stratified by cancer site and age groups. A total of 14448 cancer registries regarding patients aged 70 y/o or over were included. We calculated the optimal use through the application of the optimal utilisation percentage of RT for each cancer site, published by European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project. The ratio between optimal use and real RT use was 56%, 51%, 41%, and 36% for the patients aged 70-74, 75-79, 80-84, and 85+, respectively. We should interpret these results considering the complex older patients’ setting of multi-morbidity and geriatric syndromes. Furthermore, radiation oncologists face a lack of evidence that supports optimal treatment decisions for older patients. There is an urgent need for older adults’ inclusive clinical trials, measures to reduce ageism, improve access, and provide the cornerstone of quality cancer care for older adults - the geriatric assessment.