bluuebunny/crossref_metadata_2025 huggingface dataset:
EXPLORING TRANSITIONAL CARE UNITS IN ONTARIO CANADA: A QUALITATIVE STUDY
Authors: McGilton Katherine , Krassikova Alexandra , Yeung Lydia , McKay Sandra , Puts Martine , Guilcher Sara , Kuluski Kerry , Bethell Jennifer
Published: January 2025

Transitional care units (TCUs) provide short-term, low-intensity, restorative care to older adults who are medically fit to leave the hospital but cannot do so due to various factors, such as the availability of home care support or long-term care beds. TCUs are similar to skilled nursing facilities in the US, also referred to as intermediate care models, post-acute care or alternate care units depending on the country of origin. In Ontario, Canada, TCUs were introduced in the past decade, and little is known about them. The objectives of this study were to examine the processes of care of TCUs in Ontario employing an exploratory qualitative design. Semi-structured interviews were conducted with seven TCU managers. A five-step inductive thematic analysis adapted from Braun and Clarke was applied to the data to identify themes. Interviewees were on average 43 years of age; four identified as men and three as women. Years of experience as a TCU manager at the time of the interview ranged from 2 months to 5 years. Four themes were identified: a) going above and beyond; 2) managing patients’ expectations; 3) creating a team that works together; 4) navigating a constantly changing environment. Qualitative findings demonstrate the important role of TCUs in helping patients transition from acute care to other settings. TCUs are filling in a gap in the healthcare system of Ontario and need to be recognized as a core service. Qualitative findings may be used by healthcare organizations and unit managers to guide the operation of TCUs.
FEASIBILITY OF SMART AMBIENT BRIGHT LIGHT (SABL) FOR NURSING HOMES RESIDENTS WITH DEMENTIA
Authors: Liao Yo-Jen , Jao Ying-Ling , Boltz Marie
Published: January 2025

Ambient bright lighting interventions have shown some positive benefits on nursing home (NH) residents with dementia. A feasible implementation approach and stakeholder buy-in have not been well evaluated. This study examined NH staff’s perspectives on the feasibility of implementing the Smart Ambient Bright Light (SABL). The SABL was installed in participants’ bedrooms and common areas in two NHs to automatically deliver bright light during the day and dim light during the night. This convergent mixed methods study enrolled 22 participants, including nursing, activity, maintenance, and administrative staff. Quantitative data were collected using the Acceptability of Intervention Measure, Feasibility of Intervention Measure, and Intervention Appropriateness Measure. Qualitative data were collected via semi-structured interviews and analyzed using content analysis. Quantitative results showed good feasibility (mean=4.4, SD=0.51), acceptability (mean=4.1, SD=0.9), and appropriateness (mean=4, SD=0.7) on a 1-5 scale. Qualitative results were categorized in installation, light brightness, automatic system, and resident responses categories. Maintenance staff reported that installing the SABL was relatively easy. Brightness wise, some reported that the lights were too bright while others thought it made people more awake during the day. Most staff reported that the lighting system was easy to use while others preferred manual control to better accommodate residents’ various routine. Some reported that residents showed improved neurobehavioral symptoms, sleep, mood, and engagement. Overall, staff perspectives on SABL were positive, but some improvements to the light brightness and automatic system are needed. Limitations on the facility’s building structure and lighting fixtures should be considered in future studies.
FUNCTIONAL IMPROVEMENT AMONG NURSING HOME RESIDENTS WITH DEMENTIA AFTER SKILLED NURSING FACILITY STAY
Authors: Montoya Ana , Park Pil , Jensen Megan , Bynum Julie
Published: January 2025

Dementia is associated with decline in physical function that may be exacerbated during a hospitalization. Physical function is potentially modifiable through physical therapy during a short-term skilled nursing facility (SNF) stay after hospitalization. While many nursing home (NH) residents experience functional improvement after a SNF stay, some experience no improvement or even decline. It remains unclear whether long-stay NH residents with dementia benefit from a SNF stay prior to transitioning back to long-term care. This study aimed to determine if NH residents with dementia are as likely to experience functional improvement in activities of daily living (ADL) as those without dementia after a SNF admission. Using Michigan state Minimum Data Set (MDS) data from 2017-2019, we identified long-stay NH residents with Medicare-covered SNF stay in 2018 and qualifying ADL variables (n=2,127 residents with dementia; n=1,595 residents without dementia). We analyzed NH residents’ assessments within 120 days after SNF admission and calculated the Long-Form ADL Self-Performance score. We defined functional improvement as one point decrease in ADL score from the first SNF assessment. Almost two thirds of residents experienced functional improvement (61.2% with dementia vs. 63.3% without dementia; p=0.189). The median time to achieve improvement did not differ between the two groups (16 vs. 14 days, respectively; p=0.063). Cox proportional-hazards models revealed no effect of dementia on functional improvement after incorporating demographic characteristics and clinical indicators (HR=0.94, 95%CI [0.85-1.04]). These results support prior findings that NH residents with dementia achieve similar benefit from a SNF stay compared to those without dementia.
GIS ANALYSIS OF PHYSICAL ACTIVITY AND FALL RISK AMID GLOBAL WARMING: ROLES OF COMMUNITY ENVIRONMENTS
Authors: Li Yingru , Thiamwong Ladda , Kim Dahee , Emrich Christopher , Xie Rui , Crook Jennifer , Zhong YunYing
Published: January 2025

Regularly engaging in physical activity (PA) may reduce fall risk among older adults. However, hot weather amid global warming and/or less walkable community environments may negatively impact their participation in PA, especially those who live in low-income or otherwise socially vulnerable areas. This study aims to visualize spatial variations of PA and fall risk among low-income older adults (LOAs) across four communities in Orlando, Florida, during the summer months and to examine the roles of community environments on fall risk and PA. This study used data from 63 LOAs collected from May to September 2023. Self-reported fall risk was measured using the CDC STEADI fall risk checklist. PA was assessed through average active and sedentary minutes recorded by FitBit over five months. Community environments were assessed using walk scores and 31 different social vulnerability index characteristics. This study employed ArcGIS pro to visualize spatial variations and SPSS Amos to examine the roles of community environments. LOAs’ PA and fall risk varied across the four communities. Higher PA and lower fall risk were observed among LOAs in communities with higher walk scores and lower social vulnerability indexes. The results of path analysis revealed recursive relationships: higher community social vulnerability was associated with lower community walkability, which led to less active and more sedentary time among LOAs, contributing to their higher fall risk. These findings highlight the impact of community environments on LOAs’ health and well-being and suggest that actions should be taken to improve community walkability, particularly in socially vulnerable communities.
GUIDING FUTURE AUTONOMY-SUPPORTIVE BEHAVIOR BASED ON HISTORICAL KNOWLEDGE OF NURSING THEORIES
Authors: Bleijlevens Michel , Gronek Melissa Botana , Vluggen Stan , Moonen Esmee , van Dijk Aileen , Hamers Jan , Meijers Judith
Published: January 2025

Autonomy in care provision is central to providing person-centered, ethically sound care that meets the needs and preferences of older people. By stimulating autonomy, nurses can help maintain dignity, enhance quality of life, and promote overall well-being. Nevertheless, there remains a lack of knowledge on what autonomy is and how nurses could show autonomy-supportive behavior. This review examines the concept of autonomy and how nurses can effectively foster it in their ADL practice. In this scoping review, leading nursing theories that shaped the nursing profession and mentioned autonomy or related terms were selected from nursing textbooks, internet searches, and expert consultations. Two researchers independently conducted the screening and analysis using inductive coding. Ultimately, nine theories were included that mentioned related concepts to autonomy such as self-governance. None of the theories explicitly described autonomy or autonomy-supportive behaviors. However, we did find themes related to autonomy such as: being oneself, having a sense of freedom and control, expressing and making choices, and engaging deliberately in actions. Furthermore, six actions were identified to guide nurses in enhancing autonomy: being aware of their own behavior; respecting individual uniqueness; fostering interpersonal connections; facilitating open communication; allowing patients to choose the best course of action; and providing collaborative guidance and assistance. While nursing theories may lack explicit guidelines on autonomy-supportive behaviors, the actions identified in this review offer a practical framework for enhancing autonomy in long-term care. However, further knowledge development in this area is essential in order to stimulate autonomy-supportive behavior.
HELPING AGING VETERANS PLAN AHEAD (HAVE)
Authors: Sullivan Dennis , Dawson Bonnie , McFadden Angela , Rhodes Ramona , Sawyer Linda , Crawford Christina
Published: January 2025

It is estimated that up to 60% of older Veterans (OVs) do not have an Advance Directive (AD). The HAVE clinical program initiative was developed to address this problem by helping OVs understand the importance of having an ACP. Initially, OVs at high risk for institutionalization (per Office of GEC PLI List) were invited (by letter and phone call) to participate in HAVE. At the first visit (conducted in-person or by VVC), the OV (and Caregiver) met with a HAVE lay health advisor (HLHA) who conducted a baseline assessment including administration of Brief Health Literacy, Knowledge of Care options, and Quality of Life rating questionnaires. Education focused on incorrect responses was provided and AD materials were provided for home review. The HLHA then used motivational interviewing techniques to help the OV articulate his/her desires for ACP and to indicate what he/she thought was important that he/she could do to ensure these wishes were honored and to then create SMART goals for doing this. Up to three follow-up phone visits were conducted. In the first four months of the program, 218 eligible OVs were identified. Of these, 17 refused or could not be contacted, 40 already had an AD, and 55 were scheduled for a first visit. To date, 16 of the 17 OVs completing the HAVE program created a new AD and 6 OVs updated their older AD. Given the early success of HAVE, the program is being expanded to Veterans over age 60.
IDENTIFYING UNKNOWN STAGED CANCER IN THE UNITED STATES BY SELECTED VARIABLES DEPENDS ON THE TYPE OF REPORTING SOURCE
Authors: Merrill Ray
Published: January 2025

Appropriate site-specific cancer treatment depends on the stage of disease at diagnosis. However, some cancer is unstaged, especially in older age. This study examines the level of unstaged cancer incidence for 24 cancer sites in the US according to type of reporting source and, for each source, the rate of unstaged cancer by sex, age, race, ethnicity, and household income. The rate of unstaged cancer according to cancer lethality is also investigated. Analyses were based on 2,719,800 male and 2,727,223 female malignant cancer cases diagnosed during 2015–2021. Data was collected by 22 population-based cancer registries in the National Cancer Institute’s SEER Program. Poisson regression estimated rate ratios adjusted for sex, age, race, ethnicity, and household income. Approximately 9.4% of males and 7.2% of females had unstaged cancer. The adjusted rate of unstaged cancer was 60% (95% CI 59%-61%) higher in males than females, significantly increased with age, decreased with household income, and was 11% (95% CI 10%-12%) higher in Blacks (vs. Whites) and 11 (95% CI 10%-12%) higher in Hispanics (vs. non-Hispanics). Several adjusted rate differences were identified according to the type of reporting source. Finally, there was a significant negative association between site-specific percentages of unstaged cancer and 5-year relative survival rates for males and females. Thus, the level of unstaged cancer is negatively associated with cancer lethality and depends on the type of reporting source. The type of reporting source should be considered when identifying the level of unstaged cancer according to selected variables.
IMPACTS OF HANDGRIP ON REVERSING FRAILTY PROGRESSION IN OLDER ADULTS: A TWO-YEAR FOLLOW-UP STUDY
Authors: Chou Wan Yun , Hou Su-I
Published: January 2025

Frailty is characterized by a significant decline in the functional reserves of multiple organ systems, which increases vulnerability to stressors and elevates the risk of adverse health outcomes. Addressing frailty is becoming crucial for both intervention and policymaking. This prospective cohort study, conducted between 2018 and 2020 at a medical center in Taiwan, aimed to assess the needs of individuals at risk of frailty within the community. The study involved 318 participants aged 65 and older who attended annual health examinations. Frailty was measured using Fried’s frailty scale, cumulative deficits, and physical risk variables, assessed through self-reported questionnaires and objective measures at admission, 6, 12, and 24 months. Based on frailty scores, participants were categorized into low-risk and high-risk groups, with 0 indicating low risk and 1 or higher indicating high risk. The study analyzed differences between these groups concerning the five criteria of Fried’s frailty scale: weight loss, low handgrip strength, exhaustion, slow walking speed, and physical inactivity. Wilcoxon signed-rank tests and Generalized Estimating Equation (GEE) models were employed for analysis. 60% (n=193) of participants were considered high-risk. Notably, the decline in grip strength was significantly greater in the high-to-low-risk group compared to the low-to-high-risk group at 12 and 24 months (p=0.036 and 0.016). GEE models revealed a borderline significant reduction in frailty risk associated with improvements in cognitive function (aOR=0.69, 95% CI=0.46-1.04). These findings suggest that enhancing grip strength and cognitive function can contribute to reversing frailty, highlighting the benefits of targeted interventions for older adults.
IMPLEMENTING THE LOOK AHEAD LIFESTYLE INTERVENTION IN PRACTICE AND COMMUNITIES: A SCOPING REVIEW
Authors: Du Yan , Ubaque Lina Paola Buitrago , Medrano Valeria , Finley Erin , Hazuda Helen , Espinoza Sara , Song Lixin , Volpi Elena
Published: January 2025

Diabetes is a public health concern as the population aging rapidly. The Look AHEAD study demonstrated that a lifestyle intervention could improve glucose and lipid control, mental health, physical function, quality of life, and the need for diabetes medications. We conducted a scoping review to explore the implementation of the Look AHEAD intervention in other populations and settings. We searched PubMed, Scopus and CINAHL in December 2023. Two researchers screened each article independently. The data extracted from the included studies were systematically tabulated and analyzed to identify study characteristics, key themes, trends, and gaps. The review included 21 articles from 8 study projects. Twelve articles reported on study methods or qualitative findings. Seven projects focused on adults (RCT), and one in older adults aged 65 and over (one arm, pre-and post- test). Interventions were delivered in clinical (4 projects), community (3 projects), and academic (1 project) settings, with sample sizes ranging from 20 to 331 participants. The number of educational sessions ranged from 10 to 60. Most studies incorporated self-monitoring, goal setting, psychological strategies, and social support for physical activity and diet. Three projects used meal replacements. Weight improved significantly in all intervention groups except one pilot trial. HbA1c improved across all groups, with only one study reporting significant results. Two studies assessed reduced diabetes medication use. The studies varied in sample size, intervention sessions, and settings. Overall, adapting Look AHEAD to other settings is feasible, but the effectiveness, adoption, and sustainability of implementing the adapted interventions warrant further investigation.
IMPROVE TECHNOLOGY AND EHEALTH LITERACY IN A RETIREMENT COMMUNITY VIA THE USE OF LLM-POWERED CHATBOT
Authors: Chung Ray-Yuan , Chen Feng , Jeon Yein , Zaslavsky Oleg
Published: January 2025

The low levels of technology and eHealth literacy of retirement community residents are a barrier to technology use and information retrieval. In response, we proposed the development of an LLM-powered chatbot to improve the technology and eHealth literacy of the residents. We adopted a human-centered design approach and aimed to complement the existing technological infrastructure of the community app by providing straightforward, conversational assistance. To enhance user accessibility, we emphasize the interface’s features including large text, white and black interface for vision support, voice interaction capabilities, and simplified navigation, catering to the varied technological proficiency levels within the community. The chatbot’s functionalities are divided into two primary goals: facilitating information navigation within the retirement community and enhancing technology and eHealth literacy among its residents. For information navigation, the chatbot allows users to easily access essential information such as dining menus and contact details. To improve technology literacy, the chatbot delivers simple, up-to-date guides and information on specific questions posed by the users, providing them with easy-to-follow instructions. To evaluate our chatbot, residents were asked to complete tasks during the trial session and complete a survey. The survey collected demographics, digital literacy scores, user satisfaction, and feasibility. Residents successfully utilized our chatbot to complete the tasks. Furthermore, they reported high levels of satisfaction and a strong likelihood of recommending it to peers. Therefore, we suggest that our chatbot may serve as a valuable tool for older adults with low technology and eHealth literacy.
INDOOR TEMPERATURES AND MENTAL HEALTH IN COMMUNITY-DWELLING OLDER ADULTS: A SYSTEMATIC REVIEW
Authors: Park Min Kyung , Hong Dahye , Yoon Seolah , Kim Yubeen , Kim Minsub , Kang Bada
Published: January 2025

The relationship between indoor temperature and mental health is becoming increasingly important as climate change leads to extreme temperature fluctuations. Older adults are particularly vulnerable to indoor temperature changes because of their diminished ability to regulate body temperature and because they spend a significant amount of time indoors. This systematic review examined the relationship between indoor temperature and mental health outcomes among community-dwelling older adults. A comprehensive search of seven electronic databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Google Scholar, and PROQUEST) was conducted on April 4, 2024. Of the 2,328 identified studies, 15 met the inclusion criteria. Mental health outcomes associated with indoor temperature were categorized into four groups: sleep problems such as insomnia and sleep disturbance; emotional problems such as emotional distress and negative mood; social interaction problems such as social exclusion and low social participation; and other mental health issues such as anxiety, agitation, and annoyance. Sleep problems were the most frequently reported mental health outcome related to indoor temperature (n=9). Older adults living in substandard housing conditions, those with economic difficulties, and those residing in urban areas were vulnerable to exposure to hot or cold indoor temperatures because of housing-related risks such as low energy efficiency, inadequate heating or cooling, and limited access to green spaces. These findings highlight the need for evidence-based guidelines to improve mental health by ensuring appropriate indoor temperatures in the community. Improving housing conditions through policy support could be an effective strategy for enhancing the mental health of community-dwelling older adults.
INSIGHTS FOR IMPROVING OLDER ADULT NUTRITION WITH MULTIVITAMIN/MINERAL SUPPLEMENTS
Authors: Fielding Roger , Blancato Robert , Starr Kathryn Porter , McDonald Shelley , Zimmer Rachel , Pettis Jennifer , Tracy Karen
Published: January 2025

In June 2024, GSA convened an expert roundtable to address the role of multivitamin/mineral supplements (MVMs) as part of complete nutrition for older adults. Older adults often do not obtain adequate amounts of micronutrients from their regular dietary patterns and are at risk for nutritional deficiencies. Reasons cited by experts included physiologic changes; comorbid conditions; conditions associated with aging (e.g., sarcopenia, frailty); socioeconomic factors; declines in physical function; and interrelated changes in cognition, functional capacity, mental health, and mobility. Nutrition has wide-ranging effects on health and well-being, and nutrition screening would aid in identifying deficiencies. However, nutritional status is not consistently assessed and documented in clinical practice. Experts proposed expanding interdisciplinary care and expanded payment opportunities as strategies to improve nutritional assessments and identified emerging care models that successfully address the nutritional needs of older adults. Expanded education and training opportunities related to nutrition for clinicians and implementing strategies for effectively educating older adults about nutrition were also cited as important needs. Experts noted that MVMs may be recommended to help meet nutritional needs in older adults. Providers should consider polypharmacy, potential medication/MVM interactions, and chronic conditions when making recommendations, and educational supports are needed to enhance acceptance of and adherence to recommendations. Experts also identified strategies for enhancing nutritional research and incorporating nutritional information into clinical practice guidelines to increase the clinician confidence around MVM recommendations.
INTRINSIC CAPACITY TRANSITION AND ITS ASSOCIATION WITH INCIDENT DISABILITY: FINDINGS FROM THE KFACS
Authors: Cho Hyunjin , Shin Hyung Eun , Jung Heeeun , Lee Daehyun , Jang Jae Young , Lim Nahyun , Won Chang Won , Kim Miji
Published: January 2025

Intrinsic capacity (IC) progressively decreases with age, accelerating the risk of disability. However, it is less known whether IC transition is associated with disability. We aimed to investigate the association between IC transition and incident disability among community-dwelling older adults. A retrospective analysis was conducted over a 6-year follow-up with biennial measurements, including 2,104 participants (52.7% women; mean age 76.1 ± 3.7 years) from the Korean Frailty and Aging Cohort Study. Participants were categorized based on the IC transition from the baseline to Wave 2: “Remained well and improved”, “Worsened”, and “Remained poor”. Disability was defined as a need for assistance in any items in activity of daily living. Incident disability was measured at Wave 3 and 4. Multivariate logistic regression was used to assess the relationship between IC transition and incident disability. The IC transition probability for “Remained well and improved” was the highest at 72.0%, followed by 15.8% for “Remained poor” and 12.2% for “Worsened”. Furthermore, over a 4-year follow-up, the incidence of disability among participants was 6.2% (n = 131). Compared with the “Remained well and improved”, the “Worsened” (odds ratio [OR]: 1.73, 95% confidence interval [CI]:1.01–2.98) and the “Remained poor” (OR: 2.34, 95% CI:1.45–3.79) had an increased risk of incident disability after adjusting covariates. Worsened IC and Remained poor groups were significantly associated with an increased risk of incident disability, compared to Remained well and improved group. Our findings suggest that early monitoring of IC is meaningful to prevent disability.
LONGITUDINAL ASSOCIATIONS OF HEARING IMPAIRMENT WITH SOCIAL ISOLATION AMONG BLACK AND WHITE OLDER ADULTS
Authors: Thoma Mary , Ferguson Erin , Torres Jacqueline , Armstrong Nicole , Yaffe Kristine , Brenowitz Willa
Published: January 2025

Social isolation has been declared an epidemic by the U.S. Surgeon General. Hearing impairment (HI) may be an important risk factor for isolation among older adults. Studies of HI and isolation have been inconclusive and use primarily cross-sectional and self-reported data. We used data from the HealthABC study (N=2227 Black and White adults aged 70-79 at recruitment) to examine associations of baseline objective HI (average pure-tone audiometry >40 dB, with and without use of hearing aids) with frequency of contact with family and friends (< weekly vs. at least weekly), depressive symptoms (CESD-10), and loneliness (frequency in past week; 1-4) across 6 visits (6-7 years). We used mixed effects models adjusted for demographic and clinical variables. Untreated objective HI was associated with increased odds of < weekly contact with friends (OR=1.47; 95% CI: 1.08,2.00) and more depressive symptoms (B=0.64; 95% CI: 0.26,1.01) across follow-up, but was not with frequency of family contact or loneliness. Objective HI treated with hearing aids was not associated with any outcome. We additionally found that self-reported HI (“hearing limits personal/social life”) was associated with more depressive symptoms (B=1.49; 95% CI: 1.03,1.95) and loneliness (B=0.09; 95% CI: 0.01,0.16) across follow-up. Our results provide novel evidence that untreated objective hearing loss is associated with social isolation and subjective HI is associated with psychosocial wellbeing. Treatment for HI may reduce the likelihood of social isolation.
LONGITUDINAL TRANSITIONS IN FRAILTY STATES OVER SIX-YEAR FOLLOW-UP: RESULTS FROM THE KFACS
Authors: Jung Heeeun , Shin Hyung Eun , Lee Daehyun , Jang Jae Young , Cho Hyunjin , Lim Nahyun , Won Chang Won , Kim Miji
Published: January 2025

The longitudinal nature of frailty reveals its dynamic process through transitions of frailty states over time. However, the transitions between frailty states, including their progression and reversibility, remain unclear in Korea. We investigated these longitudinal transitions in frailty states among Korean community-dwelling older adults. We conducted a 6-year follow-up analysis of 2,633 older adults (52.0% women; mean age 76.5 ± 3.9 years) from the Korean Frailty and Aging Cohort Study (KFACS). Participants who had frailty status measured at baseline and experienced at least one frailty state transition during follow-up were included. Frailty states are categorized as follows: robust, pre-frail, and frail according to the Fried frailty phenotype and death. Multi-state Markov models estimated 1-year transition probabilities and explored associations between sociodemographic factors (age, sex, education level) and frailty transitions. Over a mean follow-up period of 4.6 years, a total of 5,942 frailty state transitions were observed. Of these, 3,568 (61.5%) were maintained, 1,358 (22.9%) worsened, and 926 (15.6%) improved. The 1-year progression probability to pre-frail was higher than the probability of moving to frail (20.2% vs. 0.9%) in the robust state. Pre-frail individuals were more likely to revert to robust than frail individuals (17.7% vs. 2.6%). Furthermore, the 1-year transition to death was highest for those in the frail state compared to other states. Frailty progression was associated with older age, being female, and lower education level. In conclusion, understanding the dynamic changes between frailty states and the sociodemographic factors influencing these changes may offer opportunities to reverse frailty progression.
MACHINE LEARNING-BASED PREDICTION MODEL FOR IN-HOSPITAL MACCE IN OLDER PATIENTS WITH CHD
Authors: Tang Wen , Wang Xuedong , Yang Xuebing , Sun Ying
Published: January 2025

Objectives

Older patients with coronary heart disease (CHD) are at a higher risk of major adverse cardiac and cerebrovascular events (MACCE) during hospitalization. This study aims to develop a risk prediction model for in-hospital MACCE events in older patients with CHD using emerging machine learning methods.

Methods

The study included 885 older inpatients with CHD (74.68±6.89 years, 58.3% male). We created prediction models via XGBoost, Support Vector Machine(SVM), random forests, Histogram-Based Gradient Boosting Classifier(HGBC) and Gradient Boosting Decision Trees(GBDT) using 38 features, and evaluated its performance using five-fold cross-validation..

Results

MACCE was identified in 106 patients. The XGBoost model demonstrated the best performance, achieving an accuracy (ACC) of 93.56% and an area under the curve (AUC) of 0.8736 (95% confidence interval: 0.756–0.967). The SVM model achieved an ACC of 90.17% and an AUC of 0.8028 (95% CI: 0.684–0.906); the Random Forest model achieved an ACC of 91.53% and an AUC of 0.8675 (95% CI: 0.764–0.953); the HGBC model achieved an ACC of 93.45% and an AUC of 0.8550 (95% CI: 0.741–0.953); and the GBDT model achieved an ACC of 93.11% and an AUC of 0.8674 (95% CI: 0.756–0.957). Finally, SHAP analysis revealed that the top three most important features were troponin T, the FRAIL score, and the NYHA functional classification.

Conclusion

Machine learning models can effectively predict in-hospital MACCE events in older patients with CHD. Troponin levels, frailty status, and cardiac function are strong predictive indicators.
MALNUTRITION RISK AMONG OLDER AMERICANS ACT (OAA) NUTRITION PROGRAM PARTICIPANTS IN 2022 AND 2023
Authors: Gahche Jaime , McGrath Lydia , Borth Laura , Chao Shirley , Simon Judy , Arensberg MaryBeth , Dwyer Johanna
Published: January 2025

Identifying older adults at risk for malnutrition is essential to combat poor outcomes associated with malnutrition. In 2022, the National Survey of Older Americans Act Participants (NSOAAP) included the Malnutrition Screening Tool (MST), a validated, self-report of unintentional weight loss and poor appetite. This provided the first opportunity to evaluate malnutrition risk (MR, defined as a score ≥2) consistently in a representative sample of Older Americans Act (OAA) program participants. In this cross-sectional analysis of 2022 (n=3531) and 2023 (n=4159) NSOAAP data, MR prevalence was estimated for total sample and within OAA programs included in NSOAAP (home-delivered meals (HDM), congregate meals (CM), homemaker (HM), case management (CS), transportation services (TR)). 2022 overall MR prevalence was 19.4%, with no significant differences between programs. 2023 overall MR prevalence remained fairly stable (17.2%) with no significant difference vs. 2022 (p< 0.0984). 2023 MR prevalence was 20.8% (HDM), 9.9% (CM), 26.6% (HM), 21.1% (CS), 17.7% (TR). 2023 MR prevalence among CM participants was significantly lower compared to MR risk in other OAA programs and also significantly lower compared to 2022 (9.9% vs. 16.7% p< 0.0195). Further research is needed to understand these trends, which may be partially affected by pandemic-related program changes. These data indicate a substantial proportion of OAA program participants were at MR in 2022—with very little change in 2023, except decreased prevalence in CM program participants. The findings highlight the continued need for including MR measures in the NSOAPP to evaluate program effectiveness and help reduce malnutrition in older adults.
MONITORING CHRONIC PAIN AND QUALITY OF LIFE USING TABLET SURVEYS IN OLDER ADULTS LIVING IN RURAL ARKANSAS
Authors: Gibson Regina , Azhar Gohar , Sharma Shakshi , Swafford Riley , Coker Karen , Wei Jeanne Y
Published: January 2025

Arkansas has the second highest legal opioid prescribing rate in the U.S. We did a pilot study to assess the feasibility of using tablets to measure chronic pain and its impact of cognition, sleep, depression, and quality of life in older adults. Seventy-one older adults were trained in the use of tablets to use at home for 90 days that were pre-loaded with surveys on opioids, daily pain diary, sleep Pittsburgh Sleep Quality Index (PSQI), and Geriatric Depression scale (GDS-15). 1,944 responses were recorded over three months by 71 participants with mean age ± SD 70 ± 8 years (range 55-91). Males 23%, females 50%. Of females, 51% were African American and 49% white. All but one male was white. 80% of participants reported some pain with most ratings between 5 or 6 out of 10 (10 being worst). None of the participants were on opioids during the period of the study. Memory symptoms were reported most frequently in 28% of respondents, followed by daytime sleepiness in 33%. PSQI scores indicated poor sleep quality in 28%. Only one participant’s GDS score suggested depression. The feasibility of using tablet-based assays in older adults living in rural regions was successfully demonstrated, showing that older adults are receptive to learning new information and recording their health parameters on a tablet. The data obtained can provide clinicians a broader picture of the older adults pain-associated symptomatology and thereby assist them in designing better personalized pain management programs.
NURSING HOME CONTEXTUAL FACTORS IMPACTING PALLIATIVE CARE CONSULTATION IMPLEMENTATION
Authors: Carpenter Joan , Oduro Elisha , Lopez Ruth , Unroe Kathleen
Published: January 2025

Palliative care (PC) consultation has been shown to improve the quality of life of nursing home (NH) residents. However, its implementation in NHs is uneven and poorly characterized. Grounded in the Integrated Promoting Action on Research Implementation in Health Services framework, we used a qualitative descriptive approach to explore how the inner context (organization leadership, staff, culture) and the outer context (policy, finances) impact the implementation of PC consultation in NHs. We conducted semi-structured interviews with key partners in fourteen NHs in the Eastern US. We used directed content analysis to analyze transcripts and identify key themes. Participants (N=33) were NH leaders, nurses, social workers, and palliative care agency leaders and nurse practitioners, predominantly female (93.9%), White (93.9%), and one-third had at least 20 years of experience working in NHs. Our findings reveal factors within the inner and outer contexts that either pull consultations toward or push consultations away from residents. In the inner context, factors that pull consultations toward residents were supportive organizational leadership, staff referrals with detailed residents’ information and assistance during consultations, and a welcoming NH environment. However, the absence of a reliable screening tool for staff to identify residents for consultation was seen as pushing away from residents. In the outer context, policies that levy monetary penalties for hospital readmission were seen to pull consultations toward residents while financial “burdens” and “drains” were seen as pushing consultations away from residents. These fndings will be used to develop a sustainable and scalable PC consultation model in NHs.
OUTCOMES OF A PALLIATIVE CARE INTERVENTION FOR ADULTS WITH DEMENTIA IN SKILLED NURSING FACILITIES
Authors: Oduro Elisha , Carpenter Joan , Hodgson Nancy , Hanson Laura , Zhu Shijun , Gurlu Merve , Ersek Mary
Published: January 2025

Older adults living with Alzheimer’s disease and related dementias (ADRD) often receive disease-focused rehabilitative care in post-acute skilled nursing facilities (SNF) without access to palliative care (PC). To address this gap, our team developed a primary PC intervention and tested it among SNF patients with ADRD. We conducted a pilot pragmatic clinical trial comparing the primary PC intervention to usual care in 9 SNFs in the MidAtlantic US. Using a nonequivalent group design, SNF resident participants (n=18) were clustered by site and assigned to intervention or control group in a 2:1 (respectively) ratio. We measured patient quality of life with the Palliative Outcome Scale Version 2 (POSv2, range 0-40; higher scores reflect poorer quality of life) and analyzed data using linear mixed effects model. Patients (n=13 intervention, n=5 control) had a mean age 84 years, were mostly White (94%) and female (72%). Our results showed that quality of life had a trend of improvement for the intervention group (POSv2 baseline=12, follow up=10.5) but not for the control group (POSv2 baseline=6.6, follow up=9.3); the intervention demonstrated a clinically meaningful effect yet was not statistically significant (effect size=-.51, p=.20). Our findings suggest that a primary PC intervention is promising in its effect to improve quality of life among patients with ADRD during SNF care. Future work will focus on testing the intervention in a larger more diverse sample and exploring the most valuable intervention components as assessed by patients with ADRD and their care partners.
PAIN AND MOBILITY OF OLDER ADULTS IN MEDICAL AND SURGICAL UNITS: AN EHR-BASED DATA ANALYSIS
Authors: Snigurska Urszula , Ser Sarah , Prosperi Mattia , Bjarnadottir Ragnhildur , Lucero Robert , Manini Todd
Published: January 2025

Pain accelerates age-related decline in mobility. One in five hospitalized older adults have pain. Pain experience varies by the type of hospitalization. The purpose of this study was to describe pain and mobility in hospitalized older adults. We hypothesized that pain would be higher in patients with lower mobility. We analyzed electronic health record data from an academic health center in Florida between 2012 and 2021. We used the mean pain score and mean score on the mobility subscale of the Braden Scale for each encounter. We used the Wilcoxon Rank-Sum Test and Pearson’s correlation coefficient to measure the differences and relationship between pain and mobility. The cohort included 19,854 older adults (13,878 medical and 5,976 surgical patients). The mean mobility score was 3.05 ± 0.57 in medical and 2.88 ± 0.51 in surgical patients (W = 48697407, p < 0.001). The mean pain score was 1.93 ± 2.72 in medical and 2.25 ± 2.61 in surgical patients (W = 36893487, p < 0.001). There was no correlation between pain and mobility in either medical (r = 0.01, p = 0.427) or surgical patients (r = 0.02, p = 0.085). Mean pain intensity may not be associated with mobility in hospitalized older adults. Instead, the highest level of pain or uncontrolled pain may be associated with mobility decline. Our findings provide motivation for a future study to account for confounders of the relationship between pain and mobility, such as analgesics, and temporality of pain and mobility assessments in the hospital.
PAIN ASSESSMENT AND MANAGEMENT IN NURSING HOME RESIDENTS WITH ADRD: INSIGHTS FROM INTERDISCIPLINARY TEXT MESSAGES
Authors: Woods Ashley , Farmer Matthew , Popescu Mihail , Powell Kimberly
Published: January 2025

The study aims to evaluate the relationship between the representation of pain assessment and management in interdisciplinary text messages about older adults residing in Nursing Homes (NH) with and without Alzheimer’s Disease and Related Dementias (ADRD) before NH to hospital transfer. A retrospective cohort study and secondary data analysis of (n=21,000) text messages exchanged among healthcare team members caring for NH residents who transferred to the hospital from 2016 to 2020 was performed. Natural language processing was used to identify mentions of pain assessment, management, and pain medications in text messages. A two-sample independent T-test was used to test our hypothesis. A negative binomial generalized linear model was used to assess the association between pain mentions and various resident characteristics, including ADRD status. The analysis included 694 transfer events involving 414 residents, 39% of whom had ADRD. Significant differences were found in the t-test with pain assessment and management mentions, with ADRD residents having fewer mentions (t= 2.38, p=0.02) of pain assessment and management than those without ADRD. The generalized linear model identified statistically significant predictors (age, race, and specific comorbidities) of the number of text messages exchanged among NH residents, but interestingly, dementia stage and avoidable transfers were not significant. Our findings indicate that pain is underrepresented in communications regarding ADRD residents, as well as Black patients, potentially contributing to disparities in pain assessment and management in these populations.
PATIENT AND CARE PARTNER VALUES WHEN CONSIDERING DEMENTIA TREATMENT OUTCOMES
Authors: Butt Maayra , Drakes Josiah , Rosa Paola , Bahti Melanie , Harkins Kristin , Karlawish Jason , Halpern Scott , Auriemma Catherine
Published: January 2025

We sought to understand how persons living with dementia (PWD) and their family care partners value hypothetical treatment outcomes relative to one other using a point allocation task. Participants distributed 100 points across six potential outcomes based on perceived relative importance. Outcomes included slowed decline in brain function, reduced agitation and combativeness, reduced family caregiver stress, prolonged ability to perform activities of daily living, increased time living at home, and increased socialization and engagement. Equality of distributions between outcome scores and between subgroups were compared using Wilcoxon signed-rank and rank-sum tests, respectively. 201 individuals participated (n=154 (77%) care partners and n=47 (23%) PWD). Across all participants, slowing declines in brain function scored highest (20, IQR 10, 30, p< 0.05 for all pair-wise comparisons). Care partners compared to patients more highly valued reduced agitation and combativeness (15.5, (IQR 10, 25) vs 10 (IQR 3, 16), p< 0.001). Patients compared to care partners more highly valued reducing family caregiver stress (16 (IQR 10, 30) vs 10 (IQR 5,20), p=0.003). Among care partners, those whose loved one had mild dementia more highly valued slowing declines in brain function (20 (IQR 10, 37.5) vs 15 (IQR 10, 25), p=0.02). Conversely, care partners of those with moderate or severe dementia more highly valued reducing agitation and combativeness (20 (IQR 10, 25) vs 12.5 (7.5, 21) p=0.007). PWD and dementia care partners expressed differing values when considering treatment outcomes. The development of future treatments should consider the most valued outcomes and disease severity to enhance potential treatment satisfaction.
PHYSICAL ATTRIBUTES LINKED TO FRAILTY IN NURSING HOME RESIDENTS: INSIGHTS FROM A CROSS-SECTIONAL STUDY
Authors: Chan Francis Kin Tung , Fung Chi Tat , Chan Ka Po , Yang Yijian
Published: January 2025

Frailty is a complex geriatric condition characterized by reduced physiological reserve and increased risk of adverse outcomes. Older adults in nursing homes are generally frail and have poor mobility. However, research on frailty in nursing homes is scarce compared to community settings, particularly on its association with mobility and postural stability. A cross-sectional analysis of baseline data from a two-arm cluster randomized controlled trial was conducted, involving 133 participants aged 60 and above from 20 Hong Kong residential care homes. The FRAIL-NH scale was used to assess frailty through factors such as fatigue, mobility, and nutrition for nursing home residents. Walking speed was assessed by the GAITRite computerized walkway system, postural stability with the Swaymeter. Multiple regression statistical analysis was conducted to identify associations between FRAIL-NH and physical attributes. Walking speed (Standardized Coefficients = -0.38, p< 0.001), anterior-posterior body sway (Standardized Coefficients = -0.288, p=0.02), and BMI (Standardized Coefficients = -1.98, p=0.018) were significantly associated with FRAIL-NH, with walking speed as the strongest predictor account for 19.6% of total variance. However, medial-lateral body sway did not show significant association with FRAIL-NH. Additionally, no significant correlation was observed between specific muscle strength measures and FRAIL-NH. Our study highlights walking speed and anterior-posterior sway as key indicators of frailty in nursing home residents. These results identify the need for focused interventions that improve balance and mobility, which may potentially decrease frailty and risk of falling for this vulnerable population. Further research is crucial for developing effective frailty interventions in nursing homes.
PHYSICAL, COGNITIVE AND MENTAL CHARACTERISTICS AND DIGITAL HEALTH TECHNOLOGY USE AMONG PREFRAIL OLDER ADULTS
Authors: Ohta Takahisa , Hatanaka Sho , Shida Takashi , Kojima Narumi , Osuka Yosuke , Okamura Tsuyoshi , Hirano Hirohiko , Awata Shuichi
Published: January 2025

Remote interventions for prefrail older people are more feasible than for frail older people, but the benefits of using digital health technologies (DHT) have not been comprehensively investigated. This cross-sectional study examined whether DHT use in prefrail older people is associated with better physical/cognitive/mental function. Participants aged ≥70 years with prefrailty, as defined by the Japanese Cardiovascular Health Study criteria, were recruited from the Itabashi Longitudinal Study on Aging between 2022–2024. Exclusion criteria comprised impaired activities of daily living, Mini-Mental State Examination (MMSE) scores < 23, or physician-diagnosed dementia. DHT ownership and usage, such as messaging, searching, video calls, and video viewing, were self-reported. Physical characteristics included muscle strength, body mass index, and skeletal muscle mass index. Cognitive function was assessed by MMSE, and mental health was evaluated using WHO-5. Binomial logistic regression, adjusted for demographics, lifestyle, and socioeconomic status, calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), with non-DHT ownership as the reference. Among 2,681 participants, eligible 862 (mean age 77.0±4.5 years, 44.0% women) were analyzed. DHT ownership was inversely associated with lower handgrip strength (< 28kg for men, < 18kg for women) (aOR: 0.68; 95% CI: 0.47–1.00) and lower MMSE (< 27) scores (aOR: 0.65; 95% CI: 0.44–0.98). The use of searching (aOR: 0.49; 95% CI: 0.28–0.83) and video calls (aOR: 0.58; 95% CI: 0.38–0.88) were inversely associated with lower WHO-5 scores. These findings suggest DHT may support physical/cognitive/mental health in prefrail older adults.