bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERDISCIPLINARY WELLNESS CLINICS IN LOW-INCOME SENIOR HOUSING COMMUNITIES
Authors: Holmes Sarah
Published: December 2023

Low-income older adults may qualify to live in subsidized housing via the Housing and Urban Development (HUD) Section 202 program. Established in 1959, Section 202 is the only HUD program that provides housing exclusively for older adults. More than 1.8 million older adults receive this type of federal housing assistance. Older adults living in low-income senior housing communities are mostly people of color, socioeconomically disadvantaged, and at risk for poor physical and mental health and adverse health outcomes. Additionally, they have limited access to healthcare services and other resources such as internet use, healthy food options, opportunities for physical activity, and safe indoor and outdoor physical environments. Further they are at increased risk of high emergency room utilization and transfer to nursing home settings. The purpose of this project was to develop Interdisciplinary Wellness Clinics for older adults living in low-income senior housing communities and provide direct services including such things as blood pressure monitoring, medication management, hearing evaluation and cerumen removal, foot and nail care, pain management, management of acute medical problems, immunizations, and Medicare Annual Wellness Visits. Interdisciplinary Wellness Clinics are provided monthly to four low-income senior housing communities and serve approximately 500 residents living in these communities. This symposium will provide a review of residents seen and services provided with a focus on findings identified and interventions implemented; a description of the Medicare Annual Wellness services; and a review of approaches used to engage residents in using these services.
EFFECTIVE STRATEGIES FOR PREPARING STRONG CAREER DEVELOPMENT AWARD (“K”) APPLICATIONS
Authors: Lahvic Jamie
Published: December 2023

In this presentation, Dr. Lahvic will present critical policies, best practices, and resources to consider when preparing mentored career development award (“K”) applications. Dr. Lahvic will emphasize 1) Starting the process early; 2) Developing an application strategy, including reaching out to relevant program officials, identifying appropriate mentors and collaborators, and evaluating if the career development award will add value to your professional development trajectory; and 3) Understanding the application requirements. Using real, successful and unsuccessful career development applications as examples, Dr. Lahvic will highlight best practices in planning the research and career development strategy, including avoiding proposing an overly ambitious project and ensuring the project is a vehicle towards future independence and is distinct from mentor’s research. Knowledge of these practices and available resources to implement them will optimize the application process for individuals.
RISK FACTORS FOR DISABLEMENT WITH AGING IN CENTRAL MEXICO
Authors: Caudillo-Ortega Lucia , Blozis Shelley , Blanco-Arroyo Nancy , Harrison Tracie
Published: December 2023

Health, function, and social participation (e.g., disablement) were studied among community living men and women with mobility limitations living in central Mexico. Psychological (i.e., depression and activity effort), cultural (i.e., attitudes toward assistive devices) and social (i.e., personal resources) variables were tested with the goal to identify differential risk for worse health (Charlson Comorbidity Index) outcomes. We hypothesized significant differences based on psychological, social, and cultural influences. Data was collected using in-person, Spanish language surveys from 2019-2020. Measures were reliable and valid. The sample (N=257) were an average of 70.98 years (std 7.72) with an education of 6.97 years (std 7.22) and onset of functional limitation at 62.5 (std 15.07). Most reported female sex (51%). Using machine learning regression technique, statistically significant interactions were found: (1) Age was an important predictor of health; individuals clustered according to different age groups; those below 65 years had the best health; followed by those between 65 and 70 years, followed next by those between 70 and 75 years, and those over 75 years having the worst health, on average. (2) Age, biological sex, and depression were important predictors of function. Further, for those below 83 years, depression was related to function; specifically, for these individuals, those with depression levels above 18.3 had worse functioning relative to those who depression score was below 18.3. (3) age was an important predictor of social participation. For those with mobility limitations, age, sex, and depression were risks factors for disablement in Mexico.
POLICY SERIES: BUILDING TRUST, ADDRESSING BURNOUT AND EXPANDING THE DIRECT CARE WORKFORCE; THE 2022 REPORT TO DHSS AND CONGRESS
Authors: Pandya Naushira , Lindberg Brian
Published: December 2023

This symposium will review the key points and recommendations of the 2022 report to the Secretary of DHSS and Congress, prepared by the federally appointed Advisory Committee on Interdisciplinary and Community-Based Linkages in a blended didactic and interactive format. Clinician burnout following the Covid-19 pandemic is examined and root causes identified. Erosion of the patient trust in the public healthcare system and the consequences thereof are discussed, enhanced role of Community Health workers as the future primary care workforce is explored to prepare the system to prepare for future challenges.
BLUEPRINT TO TARGET THE SPINAL CORD MOTOR CIRCUITRY TO PRESERVE AND RESTORE MOBILITY IN OLD AGE
Authors: Valdez Gregorio
Published: December 2023

Spinal motor neurons are central for the initiation and modulation of all voluntary movements. Within the spinal cord, motor neurons form tens of thousands of excitatory (glutamatergic and cholinergic) and inhibitory (GABAergic and glycinergic) synapses along their dendritic arbor and soma. These synapses contain the information required to execute fine and complex motor commands and are together referred to as the motor circuitry. Once activated, motor neurons drive muscle contraction by releasing neurotransmitters from their axon terminals at neuromuscular junctions (NMJs). Thus, either the death of motor neurons or their disconnection from other neurons are skeletal muscles during aging would undoubtedly compromise motor function. We will show that motor neurons do not die in old female and male mice, rhesus monkeys, and humans. Instead, these neurons selectively and progressively shed excitatory synaptic inputs throughout the soma and dendritic arbor during aging. Thus, aged motor neurons contain a motor circuitry with a reduced ratio of excitatory to inhibitory synapses that may be responsible for the diminished ability to activate motor neurons to commence movements. Additionally, we will show that aged motor neurons present with aberrant changes in genes and molecular pathways with roles in glia-mediated synaptic pruning, inflammation, axonal regeneration, and oxidative stress. I will bring these findings together to suggest that motor neurons at a minimum contribute to the loss of their own synapses with advancing age and discuss possible avenues for therapeutic intervention.
MEASUREMENT MATTERS IN EPIDEMIOLOGIC STUDIES OF SENSORY HEALTH AND AGING
Authors: Deal Jennifer , James Bryan , Abraham Alison
Published: December 2023

Valid and reliable measurement is a cornerstone of epidemiologic data collection and analysis. Sensory health is important for maintaining cognitive, physical and social function with age, but multiple measures of sensory health exist, and not all are the same. For example, audiometric hearing loss reflects the cochlea’s ability to process sound, while self-report captures an individual’s perception of their hearing ability within their social and environmental context. How we measure sensory function has important ramifications for prevalence estimates and results from association studies, and therefore, public health and clinical decision-making. Sensory loss may also have important implications for the measurement of other factors in aging research. For example, neurocognitive tests are administered aurally or on paper, which could present a challenge for older adults with sensory loss. This session, jointly sponsored by the Sensory Health and Epidemiology of Aging Special Interest Groups, focuses on the intersection of measurement and sensory health. We will report on vison and hearing measures in a large, nationally representative study of Medicare Beneficiaries, with a focus on the recent addition of objective measures of vision and hearing loss, and their implications for sensory loss prevalence estimates, particularly for the oldest old. We will also discuss how sensory loss impacts cognitive testing, including best practices for measuring cognitive function in older adults. Finally, we will present on how choice of hearing measure (self-report vs. audiometry) has important ramifications for population attributable fraction estimates, with direct implications for public health intervention for dementia prevention. This is a collaborative symposium between the Epidemiology of Aging and Sensory Health Interest Groups.
ASSOCIATION BETWEEN PAIN AND FALL WORRY AMONG COMMUNITY-DWELLING OLDER PEOPLE WITH DEMENTIA IN THE UNITED STATES
Authors: Zhou Yuanjin , Sadak Tatiana , Ghosh Nayanika , Phelan Elizabeth
Published: December 2023

Previous studies have found that pain is associated with fall worry among community-dwelling older adults. However, both pain and fall worry are poorly understood and under-addressed among community-dwelling older people with dementia (cd-OPWD). We thus sought to examine the association between pain and fall worry among this vulnerable subgroup. We used data from the 2015 National Health and Aging Trends Study (analytic sample: cd-OPWD who were self-interviewed, n=1103; mean age: 79; age range: 65-107). The number of pain sites in the prior month was assessed by presenting the cd-OPWD with a card listing common pain sites (e.g., back, knees). Past-month fall worry was assessed by two questions, “did you worry about falling down” and “did this worry ever limit your activities”. Fall worry was endorsed by 34%; activity-limiting fall worry was endorsed by 39% of those with fall worry. Twenty percent reported a single site of pain, and 53% reported multisite pain. Those who endorsed fall worry were more likely to have a higher number of pain sites, and those who reported activity-limiting fall worry were more likely to report knee, hand, or leg pain. In multinomial logistic regression analyses, adjusting for sociodemographic and health characteristics, a higher number of pain sites was significantly associated with activity-limiting fall worry. These findings suggest pain and fall worry are common among cd-OPWD and can be elicited directly from them. Fall prevention for cd-OPWD should prioritize pain management to mitigate activity-limiting fall worry, since activity limitation increases the risk of falls.
THE MODERATING ROLE OF RACE AND ETHNICITY BETWEEN NEGATIVE FAMILY INTERACTIONS AND MENTAL HEALTH AMONG OLDER ADULTS
Authors: Wang Fei , nguyen Ann , Lincoln Karen , Qin Weidi , Hamler Tyrone
Published: December 2023

Studies generally show that negative social interactions are detrimental to mental health for older adults. Furthermore, empirical evidence suggests that negative interactions may function differently in relation to mental health across racial/ethnic groups given their unique life circumstances and social conditions. This study examines whether the association between negative family interactions and mental health outcomes varies by race and ethnicity. Samples of older African Americans, Caribbean Blacks, and non-Latino Whites aged 55 and older were drawn from the National Survey of American Life (N = 1,439). Mental health variables included depressive symptoms, any lifetime disorder according to The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and number of lifetime DSM-IV disorders. Regression models were used to test the study aim. Analyses indicated that negative interactions with family were positively associated with all 3 mental health outcomes. Several racial/ethnic differences emerged. The association between negative family interactions and depressive symptoms was stronger among Whites than African Americans. While negative family interactions were positively associated with number of disorders among Caribbean Blacks, negative interactions were unrelated to number of disorders among African Americans. This study demonstrates the racial and ethnic differences in diverse aging populations and the importance of recognizing the heterogeneity of the Black American population in minority research. Clinical practice should focus on reducing negative family interactions, and future research should examine whether psychosocial resources (e.g., stress appraisals, neighborhood social cohesion) can attenuate the association between negative family interactions and mental health for older African Americans.
USABILITY AND PSYCHOMETRIC PROPERTIES OF THE MOBITEC-GP APP FOR REAL-LIFE MOBILITY ASSESSMENT
Authors: Giannouli Eleftheria , Kim Eun-Kyeong , Fu Cheng , Weibel Robert , Sofios Alexandros , Schmidt-Trucksäss Arno , Zeller Andreas , Hinrichs Timo
Published: December 2023

Modern technologies such as the Global Navigation Satellite System and accelerometers which are integrated in every smartphone enable tracking mobility patterns over time, which in turn enables early detection of mobility impairments. Aim of the MOBITEC-GP project was to develop a mobile app which measures walking speed and spatial mobility under everyday conditions. Reliability and validity of the application was tested first (Study 1). The applicability in everyday life and the acceptance by older adults (Study 2) was also investigated. In study 1, participants underwent several supervised walking speed assessments as well as a 1-week life-space assessment during two assessment sessions 9 days apart. Fifty-seven older adults (47.4% male, mean age= 75.3 years) were included in the study. The app showed moderate to excellent test-retest reliability and validity of walking speed measurements of 50 meters and above and of most 1-week life-space parameters, including life-space area, time spent out-of-home, and action range. Study 2 revealed a good usability of the app (mean System Usability Scale score=77.18) among older adults (N=60 with ≥2 chronic conditions) for a 1-week usage of the app including both, a 1-week life space assessment and at least one gait speed measurement in a 30-minute stroll. The MOBITEC-GP app is a reliable, valid and usable tool for the assessment of real-life walking speed (at distances of 50 metres and above) and life-space parameters of older adults. Future studies should look into technical issues more systematically in order to avoid invalid measurements.
DEVELOPMENT AND PRODUCTION OF AN ORIGINAL MUSICAL WITHIN A RETIREMENT COMMUNITY
Authors: Sloane Philip
Published: December 2023

In 2021-23 residents of a continuing care retirement community (CCRC) conceptualized, wrote, produced, and presented an original musical about life in a senior community. This presentation will describe that process, illustrating it with a video presentation by the 83-year-old CCRC resident who organized and coordinated the process, video clips of rehearsals and of interviews with the songwriters and performers, and video performances of four songs from the musical. Among the gerontological issues to be highlighted include: deciding which song topics the community would deem acceptable and unacceptable to address in the production; accommodating the physiological limits of the cast (e.g., reduced vocal ranges with age) and audience (e.g., hearing impairment and limited bladder capacity); and adjusting to absences due to illnesses, medical appointments, family events, and travel among the organizers and performers. A portion of this presentation will center around four original songs written and performed by seniors as part of the musical: “Rules of the Road” (about the informal “do’s and don’ts” of living in a retirement community); “The Ladies of Lavender Lane” (about groups of widows who have banded together for support); “The Rhythm of our Lives” (about how the community deals with the high frequency of resident deaths); and “I’m Just a Little Worried about Eddie” (about early dementia). The development of each song will be summarized, including the process by which the song went from idea to production, and a video of the song during a performance.
MEASURING GOALS, PRIORITIES, AND PREFERENCES: REFORM EFFORTS FOR TRANSPARENCY AND EMPOWERMENT
Authors: McMullen Tara , Fisher Anna
Published: December 2023

Longstanding evidence suggests that the goals, preferences, and priorities (GPP) of individual nursing facility residents may not be adequately addressed during episodes of care. Aligning care with residents’ GPP represents an opportunity to improve outcomes and reduce disparities associated with race, ethnicity, gender orientation, and other characteristics of the resident population. The 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report recommended improvement in quality measures under the domain of resident and family experience, along with reporting of these measures on Care Compare to improve shared decision-making and transparency. The subcommittee on quality improvement and measurement is focused primarily on measures of GPP as a useful addition to CMS’ plans to expand the Quality Reporting Program (QRP) measure set, which was signaled in the recently issued Skilled Nursing Facility Prospective Payment System (SNF PPS) rule. In this presentation, committee members will discuss the identification and testing plan for one or more resident experience of care measures that assess the experience of care specific to processes of care and the resident’s GPP. This presentation will also discuss the development of a care concordant measure, assessing the relationship between the care provided to the resident and the resident GPPs.
IDENTIFYING, DEVELOPING, AND IMPLEMENTING CARE PLANS CONSISTENT WITH GOALS, PRIORITIES, AND PREFERENCES
Authors: Roberts Tonya , Cornelison Laci , Shippee Tetyana , Ciolfi Mary Lou , Ryan Susan , Cook Penny
Published: December 2023

NASEM’s first recommendation to reform nursing home (NH) care is to deliver comprehensive, person-centered, equitable care that ensures residents’ health, quality of life, and safety, promotes autonomy, and manages risks. The NH Code of Federal Regulations requires person-centered care (PCC). However, while there are existing structures (i.e. MDS 3.0) to support care planning clinical needs, most NHs lack tools and procedures to systematically identify and provide care that aligns with resident goals, priorities, and preferences (GPPs). This is especially true for GPPs that reflect personhood and the human desire for autonomy. Our subcommittee aims to change the culture of care planning in NHs to integrate residents and families in co-developing holistic, person-centered care plans that centralize residents’ GPPs in ways that promote and support personhood. Our subcommittee will develop and test a) a standardized GPP care planning process that includes enhanced approaches to identification, documentation, communication, and implementation of resident GPPs; b) a repository of tools to support identification and documentation of resident GPPs; and c) training to prepare staff to understand and recognize resident GPPs. We will collaborate with other Moving Forward Committees to develop approaches to evaluating and measuring quality in care planning with inclusion of health information technology . When completed, the proposed work will provide evidence of successful and feasible quality improvement approaches to care planning resident GPPs that can augment existing federal requirements and can inform future policy changes or guidance to surveyors.
STATE-LEVEL INITIATIVES FOR DIRECT CARE WORKERS
Authors: Brekke Bailee
Published: December 2023

As problems surrounding recruitment and retention of direct care workers continue to worsen, changes have been made at both the state and national level to accommodate for these challenges. This paper provides a literature review of various state-level initiatives and innovations aimed at improving recruitment and retention strategies for direct care workers in both facility-based long-term care and home and community-based long-term services across the country. Research revealed three themes, 1) strategies to improve wages and benefits, 2) education and training, and 3) community support. To improve wages and benefits, many states increased compensation and benefits for DCWs with the implementation of wage pass-throughs, minimum wage increases, and earmarked funds. Education and training efforts were identified as another way to enhance recruitment and retention efforts for the direct care workforce, such as through credential and certification opportunities for workers, as well as standardizing current training requirements. Lastly, increasing community support was identified through advocacy and research efforts specifically aimed at understanding and supporting DCWs. This study seeks to inform policymakers and providers of current initiatives that can be used to address the ongoing workforce crisis.
PARADOXICAL FINDINGS AND OTHER SURPRISES IN PROVIDING STREET MEDICINE TO UNSHELTERED HOMELESS OLDER ADULTS
Authors: Kogan Alexis Coulourides , Mittal Anuva , Lowe Enya , Feldman Corinne
Published: December 2023

Older adults constitute the fastest-growing segment of the homeless population in the US. Previous research has found older homeless adults to have more chronic conditions, greater odds of physical disability, and experience accelerated aging compared to housed populations. Little is known about the role of street medicine in providing care and support to aged and aging patients experiencing unsheltered homelessness. The purpose of this study was to elicit the perspective of clinicians and unsheltered homeless patients on aging and managing serious illness. We conducted interviews with patients receiving street medicine and their clinicians. Interviews were guided by a semi-structured protocol, audio recorded, and transcribed verbatim. Data were analyzed following a thematic analysis approach. Eight clinicians and eight patients were interviewed. On average, clinicians were 41 years old, white (50%), and female (50%) with 1-16yrs street medicine experience. Patients were commonly male (63%), had 3+ chronic conditions (100%), and aged 56 years. Thematic analysis revealed four major paradoxical themes around: End-of-life, shelter, durable medical equipment, and community. The clinician and patient perspective on aging and managing serious illness while living outside offer insight into the significant and paradoxical challenges each face when balancing restrictions from the healthcare system, social services, and patient/self needs. Results highlight constraints placed on clinicians and patients by the rigid healthcare system and its incompatibility with the unique circumstances of unsheltered older adults. Findings from this study suggest actionable strategies that hold implications for policy and practice to better meet the needs of unsheltered homeless older adults.
CREATING A UNIFIED NATIONAL STRUCTURE FOR SAVVY’S DISSEMINATION AND SUSTAINABILITY
Authors: Hobday John , Sherman Carey Wexler
Published: December 2023

Intervention efforts, including established evidence-based programs (EBP), often can’t support or monitor programmatic fidelity or sustainability when external funding ends. Delivery can drift substantially or cease altogether. This paper describes the development of an authorized entity dedicated to sustain and scale Savvy Caregiver® with fidelity that was highly informed by efforts described in previous papers. The initial stage involved collaborating with the Offices of Technology Commercialization at University of Minnesota (primary copyright holder) and Emory University (lead adaptation institution). Inter-Institutional Agreements (IIA) outlined guidelines for copyright and trademark compliance, research, fidelity management, and content updates. Next, Savvy Systems, LLC, was launched to document current availability and reach of Savvy and manage the training and certification of Savvy interventionists and distribution curricula and materials through a single portal (www.savvycaregiver.com). Fidelity and essential program delivery skills are now assessed and supported via a new Savvy Fidelity Certification Exam and fidelity webinars. Finally, a flexible licensing plan for organizations and researchers ensures legal use of and access to updated authorized Savvy materials. Creation of the first national database of Savvy sites, featured on the website and the Best Practices Caregiving EBP portal (www.benrose.org), enables direct referrals and other support for Savvy sites and caregivers. Taken as a whole, this type of structure is expected to play an instrumental role in supporting the long-term fidelity, viability, and expansion of Savvy Caregiver. Adaptation and application of such processes may inform other translational and EBP efforts to ensure programmatic integrity and sustained use over time.
CAREER COMPETENCE IN LATE LIFE WORK
Authors: Holley Lyn
Published: December 2023

Career Competence in Late Life Work For most professionals, ageing manifests gradually – perhaps a practically imperceptible “slowing” of thought occurs sooner and sooner in the semester, perhaps a stiffness in joints or dozens of other cues from our gerontology lectures and texts; “natural” phenomena that signal we should be thinking of retirement. Self perceptions accumulate, their weight discouraging attempts to continue to teach energetically and creatively. Post-docs, pre-tenure faculty, and financially-challenged Deans withdraw, and the “voice in your head” agrees you are not what you were and should turn to figuring out how you can best spend the next ten to thirty years as your connectedness and career competence continue to dwindle. Meanwhile, the need for experienced faculty expands, and support to fund unemployed older adults edges nearer to financial collapse. A review of the literature on these phenomena suggests that excising the embedded ageist stereotypes is likely to unleash and focus energy on continuing to learn and contribute to society. Many colleges already have begun to provide support for late life learning, and to design opportunities for retirees and other older adults to contribute to the higher learning enterprise that enhance rather than shrink available “slots”, and expand capacity for research and education.
CAREER SELF-MANAGEMENT OF LATE LIFE WORK
Authors: Sterns Harvey
Published: December 2023

The choice to retire can be gradual or sudden depending on the planning, the opportunities presented, and crises encountered. Issues of self-management will be examined focusing on the challenges faced by older faculty members seeking to continue working. Present and future older academics are increasingly pressed to take active involvement and responsibility for career management. A multidimensional model for self-management of career and retirement will be presented.
EXPLORING THE LIVED EXPERIENCES OF BLACK INFORMAL CAREGIVERS: A SCOPING REVIEW
Authors: Alexander Ivana
Published: December 2023

Understanding the unique caregiving experiences of Black informal caregivers, most of whom are women, and how they are influenced by the historical and sociopolitical context of the Black experience in the America is critical to building an effective care infrastructure that is inclusive. Gaps in existing literature include a paucity of studies that explore in-group differences in the caregiving experiences of Black informal caregivers as well as a dearth of qualitative studies that center their voices and lived experiences. This scoping review explored current representations of the Black informal caregiving experience in qualitative literature. It sought to address the heterogeneity in the Black caregiver experience through amplification of caregivers’ voices. Specifically, it included studies that focused on varied informal caregiving arrangements which exist for Black informal caregivers who are caring for chronically or terminally ill adults. Overall, 65 studies were selected for full-text review. After data characterization of the full-text articles, nine studies remained and were included in the analysis. Four broad themes were identified: (1) cultural beliefs, (2) religion and spirituality, (3) systemic barriers (healthcare system and care structures), and (4) caregiver health and well-being (physical and mental health). Findings underscore the need for an intersectional lens in exploring the implications of the Black informal caregiving experience. Their cultural and religious/spiritual identities are linked to the historical experience of Black people in the United States. Their caregiving experiences often involve cultural obligations and expectations that create tension between fulfilling caregiver roles and providing for their own health and well-being.
FOSTERING COLLABORATION TO BENEFIT OLDER DRIVERS
Authors: Hemmy Laura , Morris Nichole , Shelton Kyle
Published: December 2023

Access to transportation is a fundamental contributor to independence and quality of life, and for many independent driver status is a seminally important part of agency and self-concept. Driving is a lifelong skill utilizing a variety of physical, sensory and cognitive abilities, but also influenced by the community in which one lives, built infrastructure, vehicle design and engineering, social and family networks, and driver insight. Because older drivers are at increased risk for negative crash outcomes, generating knowledge about how to promote safe driving in the older population, when to consider retirement from driving, and compensatory sources of transportation, are of the utmost importance. Faculty and trainees with interest in these questions come from disparate and often unconnected parts of academic research institutions. The University of Minnesota (UMN) Center for Healthy Aging Innovation (CHAI) Special Interest Group (SIG) structure, in collaboration with the UMN Center for Transportation Studies (CTS), has served as a platform for connection. SIG members will share how the opportunity to connect across disciplines, schools and departments has led to new collaborative work to promote safe driving in older adults, including a state funded intervention study.
THE ROLE OF MEDICAID HOME- AND COMMUNITY-BASED SERVICES IN USE OF MEDICARE POST–ACUTE CARE
Authors: Konetzka R Tamara , Wang Sijiu
Published: December 2023

Medicaid-funded long-term services and supports are increasingly provided through home and community-based services (HCBS) to promote continued community living. While an emerging body of evidence examines the direct benefits and costs of HCBS, there may also be unexplored synergies with Medicare-funded post-acute care (PAC). This study aims to provide empirical evidence on how the use of Medicaid HCBS influences Medicare PAC utilization among the dually enrolled. Using national Medicare claims, Medicaid claims (TAF), MDS, and OASIS data from 2014 to 2017, we estimated the relationship between prior Medicaid HCBS use and PAC utilization in a national sample of duals with qualifying index hospitalizations. We used inverse probability weights to create balanced samples on observed characteristics and estimated multivariable regression with hospital fixed effects and extensive controls. We also conducted stratified analyses for key subgroups and tested for interactions between HCBS use and three measures of states’ HCBS generosity. We found HCBS use was associated with a 5.2 percentage-point increase in use of any Medicare-funded PAC, a 7.2 percentage-point increase in home health use, a 2.1 percentage-point decrease in institutional PAC, and a 1.95-day reduction of skilled nursing facility length of stay. In other words, use of Medicaid-funded HCBS was associated with a shift in Medicare-funded PAC use toward home-based settings. These findings were stronger in states with more generous HCBS funding. As we found that use of Medicaid-funded HCBS may alter choices about Medicare-funded PAC use, this synergy with HCBS should be considered by policymakers when contemplating further HCBS expansions.
HOSPITALIZATIONS OF OLDER INCARCERATED ADULTS: HOW ARE THEY DIFFERENT?
Authors: Kaiksow Farah
Published: December 2023

By 2030, over one-third of the US prison population will be ≥55 years old. In addition to their biological age, incarcerated patients are at increased risk of geriatric conditions due to accelerated aging. As these individuals age, so will their need for community hospitalizations, which already account for 20% ($1.5 billion annually) of state correctional health spending. To date, there has been very limited data on these hospitalizations. This descriptive study provides the largest amount of information yet, comparing 10 years of data on male incarcerated patients (N=4,401 admissions) to a cohort of nonincarcerated males (N=22,150) from a tertiary care center. Incarcerated patients were more likely to be ≤55 than non-incarcerated (53.9% vs. 20.7%) and have shorter lengths of stay (4.7 vs. 5.8 days). The most common diagnosis for both groups was cardiac-related (ICD-10 Chapter 9), while mental health diagnoses (ICD-10 Chapter 5) were the second most common for incarcerated patients but not in the top five for non-incarcerated. Incarcerated patients had higher Charlson Comorbidity Index scores, with incarcerated patients having higher scores beginning at age 50 than non-incarcerated ≥80. Surprisingly, the one-year mortality rate for incarcerated patients was almost half that for non-incarcerated (56/1,000 vs. 101/1,000); one possible explanation for this disparity is that the community health system data on incarcerated patients may be incomplete. This study supports the theory of accelerated aging among incarcerated individuals and highlights the need for improved data on which to base policy changes to improve the care of this vulnerable population.
LOWER SOCIOECONOMIC STATUS PREDICTS NEGATIVE PREFERENCES FOR PALLIATIVE CARE
Authors: Nowels Molly , Kozlov Elissa , Nowels David , Duberstein Paul
Published: December 2023

With an aging US population, more people than ever live with serious illnesses. Although palliative care (PC) can improve outcomes in serious illness, there are inequities in PC utilization. People with low socioeconomic status (SES), men, and Black and Hispanic people are less likely to receive and benefit from PC services. Despite these established demographic differences in PC utilization, there is a dearth of relevant survey research on preferences for PC in the general population. To address this gap, we surveyed a random sample of 1,500 NJ adults. Respondents were given a brief definition of PC and asked to indicate how likely they would be to schedule, attend, and routinely attend PC visit(s) if they were diagnosed with a serious illness. Predictors included in logistic regression modeling were SES indicators (income, educational attainment, insurance status, employment status), gender, and race/ethnicity. Data were weighted to be representative of the population of NJ. Modeling results revealed that lower income and lower educational attainment were associated with significantly lower odds of endorsing willingness to schedule, attend, and routinely attend PC visits in the event that one would become seriously ill. Unexpectedly, there were no gender or race/ethnicity differences in preferences for PC. These findings highlight the importance of public health education for what PC is and its benefits for an aging population, especially among those with lower SES. Future research efforts are needed to understand discrepancies in reported PC preferences versus real-world PC utilization for men and Black and Hispanic individuals.
Sounds of Difference: A Typology of Reactions of People With Dementia to Individualized Music in the Presence of a Monitoring Person
Authors: Töpfer Nils F , Schön Lisa , Jakob Elisabeth , Hillebrand Mareike C , Reichertz Jo , Rother Doreen , Weise Lisette , Wilz Gabriele
Published: December 2023

Background and Objectives

Despite promising effects of individualized music listening (IML) for people with dementia, the individualized nature and heterogeneity of reactions to IML remain underexplored. We aimed to develop an empirically derived typology of directly observed reactions of people with dementia to IML and propose recommendations for tailoring the intervention to the respective types.

Research Design and Methods

An ideal-type analysis was conducted on 108 video recordings of 45 people with mainly severe dementia (78% female, mean age of 83.02 years, all White participants) listening to recorded individualized music. Dimensions were identified for capturing similarities and differences between types.

Results

The analysis yielded 10 types of reactions (“expressing and sharing joy,” “self-disclosure stimulated by music,” “concentrated, absorbed listening,” “blissful enjoyment,” “experience of the music as bittersweet,” “sharing memories,” “releasing tension,” “tensing up and rejecting,” “predominant search for social exchange,” “no interpretable reaction”) and 3 dimensions (“valence” from negative to positive, “arousal” from calm to activated, “communicative activity” from defensive/resistant to proactive), resulting in a three-dimensional coordinate system, providing a holistic representation and facilitating a systematic contrast of identified reaction types to IML.

Discussion and Implications

Reactions to IML were influenced by the interaction with the project staff, who monitored the sessions. Based on these observations, we propose recommendations for tailoring both the behavior of the monitoring person (e.g., engaging in synchronous activities like clapping along) and the setup of the intervention (e.g., communal vs individual listening) to each type, which may improve the effects of IML.
Endovascular treatment of a ruptured aortic pseudoaneurysm and its complications in an 8-year-old child with Ehlers-Danlos syndrome type VI
Authors: Kahraman Ümit , Akhundova Mahsati , Çınar Celal , Ertugay Serkan
Published: December 2023

The procollagen-lysine, 2-oxoglutarate 5-dioxygenase 1 (PLOD1) gene may affect arterial integrity through enzymatic roles and the modulation of vascular smooth muscle cells. We present a complicated vascular case of an 8-year-old male child with Ehlers-Danlos syndrome type VI. The patient was diagnosed with a ruptured pseudoaneurysm of the infrarenal abdominal aorta. Endovascular treatment was performed using a covered self-expandable endograft. However, complications arose at the vascular access sites during the procedure, highlighting arterial fragility. PLOD1 mutations can be associated with false abdominal aortic aneurysms or arterial fragility. Open repair poses a high risk for patients with Ehlers-Danlos syndrome. Although the long-term results are unknown, endovascular stent grafts may be a suitable option for emergency clinical scenarios such as ruptured abdominal aortic pseudoaneurysms.
Antimicrobial Metaphylaxis and its Impact on Health, Performance, Antimicrobial Resistance, and Contextual Antimicrobial Use in High-Risk Beef Stocker Calves
Authors: Credille Brent , Berghaus Roy D , Jane Miller Ella , Credille Allison , Schrag Nora F D , Naikare Hemant
Published: December 2023

The objective of this blinded, cluster-randomized, complete block trial was to evaluate the impact of metaphylaxis on health, performance, antimicrobial resistance, and contextual antimicrobial use (AMU) in high-risk beef stocker calves. Calves (n = 155) were randomly assigned to receive either saline or tulathromycin at the time of arrival processing. Deep nasopharyngeal swabs were collected from each calf at arrival and 14 d later. Calves were monitored for bovine respiratory disease (BRD) for 42 d. Body weights were obtained at arrival, days 14, 28, and 42. Contextual antimicrobial use (AMU) was calculated using dose and mass-based metrics. Calves given tulathromycin had a greater average daily gain (0.96 ± 0.07 kg vs. 0.82 ± 0.07 kg; P = 0.034) and lower prevalence of BRD than controls (17% vs. 40%; P = 0.008). Proportions of calves with BRD pathogens identified at arrival were similar between treatment groups [17%; P = 0.94]. Proportions of calves with BRD pathogens identified at day 14 were lower for calves receiving tulathromycin compared to controls (15% vs. 60%, P < 0.001). Overall, 81% of Pastuerella multocida isolates and 47% of Mannheimia haemolytica isolates were pansusceptible. When measured as regimens per head in, AMU in calves receiving tulathromycin was higher than calves receiving saline (P = 0.01). Under the conditions of this study, metaphylaxis had positive impacts on the health and performance of high-risk beef stocker calves, did not contribute to the selection of resistant bacterial isolates in the nasopharynx of treated cattle, and increased AMU.
Mindfulness, Social Support, and Psychological Distress Among Jordanian Burn Patients
Authors: Al-Ghabeesh Suhair Hussni , Mahmoud Mohannad , Rayan Ahmad , Alnaeem Mohammad , Algunmeeyn Abdullah
Published: December 2023

Burn is associated with psychological distress, anxiety, and depression. Social support and mindfulness are considered a strength source for postburn survivors to resume their daily living activities. There is a lack of literature that supported the direct impact of mindfulness on social support and psychological distress among burn survivors. The aim of this study is to examine the impact of mindfulness and social support in enhancing the psychological well-being of burn survivors in Jordan. A cross-sectional descriptive design and convenience sampling technique were utilized to meet the study goal. A self-reported questionnaire was completed by a sample of 212 burn survivors. The questionnaire consists of 3 tools to measure psychological distress, social support, and mindfulness. A significant correlation was found between social support and psychological distress among the Jordanian burn survivors. Mindfulness revealed a distinctive variance in psychological distress among the study participants. In addition, some sociodemographic and clinical data have a relationship with psychological distress. Several factors among burn survivors have influenced their psychological and social support status. Also, mindfulness is important for enhancing psychological well-being and affecting the social support among burn patients.
Insights Into Inflammatory Bowel Disease and Effects of Dietary Fatty Acid Intake With a Focus on Polyunsaturated Fatty Acids Using Preclinical Models
Authors: Smyth Matthew , Lunken Genelle , Jacobson Kevan
Published: December 2023

While the aetiology of inflammatory bowel disease (IBD) has been linked to genetic susceptibility coupled with environmental factors, the underlying molecular mechanisms remain unclear. Among the environmental factors, diet and the gut microbiota have been implicated as drivers of immune dysregulation in IBD. Indeed, epidemiologic studies have highlighted that the increase in incidence of IBD parallels the increase in dietary intake of omega-6 (n-6) polyunsaturated fatty acids (PUFAs) and the change in balance of intake of n-6 to n-3 fatty acids. Experimental evidence suggests that the increase in n-6 PUFA intake increases cell membrane arachidonic acid, which is accompanied by the production of pro-inflammatory mediators as well as increased oxidative stress; together, this contributes to the development of chronic inflammation. However, it is also increasingly clear that some of the n-6 PUFA-derived mediators exert beneficial effects depending on the settings and timing of ingestion. In contrast to n-6, when n-3 PUFA eicosapentaenoic acid and docosahexaenoic acid are incorporated into the cell membrane and are metabolized into less pro-inflammatory eicosanoids, as well as strong specialized pro-resolving mediators, which play a role in inflammation cessation. With a focus on preclinical models, we explore the relationship between dietary lipid, the gut microbiome, and intestinal inflammation.
Passerine sister clade comparisons reveal variable macroevolutionary outcomes of interhemispheric dispersal
Authors: Imfeld Tyler S , Barker F Keith
Published: December 2023

Dispersal events offer a unique window into macroevolutionary processes, especially with respect to the effects of competition on diversification. Empirical studies testing alternative predictions of competitive effects are often limited in either geographic or phylogenetic scale. Here, we tested some of these hypotheses by comparing an assemblage of 16 oscine passerine clades, representing independent dispersal events into the Western Hemisphere, to their sister clades in the Eastern Hemisphere. We also compared the diversity of this assemblage of clades to an older, incumbent passerine clade in the Western Hemisphere, the suboscines. Specifically, we tested for ecological opportunity and incumbency-mediated constraints by analysis of clade-specific morphological disparities and rates of evolution relative to dispersal history. While there was no consistent outcome of oscine dispersal and macroevolution in the Western Hemisphere relative to their Eastern Hemisphere sister groups, most clades supported a role for ecological opportunity or incumbency effects, and such effects were better explained by differences in species accumulation than by differences in rates of trait evolution or colonization timing. This general pattern was not evident when comparing the entire oscine assemblage of the Western Hemisphere to the incumbent suboscine radiation; oscines and suboscines occupy comparable regions of functional trait diversity and, despite higher rates of trait evolution in oscines, these observations were consistent with simulated null expectations. This result suggests that oscine and suboscine assemblages may have evolved in relative isolation for a significant fraction of their history.
Parallel shifts in flight-height associated with altitude across incipient Heliconius species
Authors: Rivas-Sánchez David F , Gantiva-Q Carlos H , Pardo-Díaz Carolina , Salazar Camilo , Montgomery Stephen H , Merrill Richard M
Published: December 2023

Vertical gradients in microclimate, resource availability, and interspecific interactions are thought to underly stratification patterns in tropical insect communities. However, only a few studies have explored the adaptive significance of vertical space use during the early stages of reproductive isolation. We analysed flight-height variation across speciation events in Heliconius butterflies, representing parallel colonizations of high-altitude forest. We measured flight-height in wild H. erato venus and H. chestertonii, parapatric lowland and mountain specialists, respectively, and found that H. chestertonii consistently flies at a lower height. By comparing our data to previously published results for the ecologically equivalent H. e. cyrbia (lowland) and H. himera (high altitude), we found that the species flying closest to the ground are those that recently colonized high-altitude forests. We show that these repeated trends largely result from shared patterns of ecological selection producing parallel trait-shifts in H. himera and H. chestertonii. Although our results imply a signature of local adaptation, we did not find an association between resource distribution and flight-height in H. e. venus and H. chestertonii. We discuss how this pattern may be explained by variations in forest structure and microclimate. Overall, our findings underscore the importance of behavioural adjustments during early divergence mediated by altitude-shifts.