bluuebunny/crossref_metadata_2025 huggingface dataset:
Health, Quality of Life, and Economic Impacts of Home Care Vouchers for Middle-Income Adults With Disabilities
Authors: Spetz Joanne , Miller Jacqueline , Kwong Connie , Wagner Laura
Published: December 2020

The Support at Home pilot program provided financial support for the purchase of home care services by middle-income adults with disabilities in San Francisco to support aging in place. Enrollees had income below the area median and made copayments based on household income. The mixed-methods evaluation of the program incorporated administrative records, surveys of clients and comparison group members, surveys of unpaid caregivers, surveys of paid care providers, and focus groups with clients and unpaid caregivers. Outcome measures included the Older People’s Quality of Life Questionnaire, Patient Health Questionnaire-2, an adapted Burden Scale for Family Caregivers, and self-reported falls, emergency department visits, and hospitalizations. Analyses included pre-post chi-squared and t-test comparisons between client and comparison groups and multivariate regressions. An economic analysis was conducted to learn whether changes in costs associated with reduced health care utilization were greater than the costs of the program. Results indicated statistically significant positive changes in client ratings of personal and financial stress, but not in the composite quality of life score. There were statistically significant reductions in attendance at medical appointments, falls, emergency department visits, and hospitalizations. Similar changes were not found in the comparison group. The focus group data supported the findings regarding personal and financial stress and indicated that clients and their caregivers perceived quality of life benefits. The economic analysis indicated substantial cost savings from the program due to reduced use of medical services. Due to its positive impacts, San Francisco has made Support at Home a permanent program.
Oral Health Disparities Among Chinese Older Adults: Evidence From CHARLS
Authors: Han Chengming
Published: December 2020

This paper explored the effect of the type of health insurance on dentist visits among older adults in China. The data were drawn from the CHARLS-II (2013). The sample included older adults aged 60 and older (N= 6767, n(urban)=3272, n(rural)=3495). Multivariate logistic regression models indicated that in urban and rural places, respondents with a governmental/civil servants’ insurance and those with an urban-employee insurance are more likely to visit a dentist in the survey year. Household registration status (hukou) does not play a significant role in dentist visits when insurance types are adjusted for. In other words, employment status, and the coverage of health insurance presented more significant effects on dentist visits. Differing from previous studies about urban-rural health disparities, this study disclosed substantial institutional influences on dental care access among older adults.
Sex-specific BDNF and APOE ε4 genotype interactions on white matter hyperintensity volume
Authors: Pitts Brandon
Published: December 2020

The apolipoprotein E (APOE) gene is the strongest genetic risk factor for late-onset Alzheimer’s disease (AD). One variant of the brain-derived neurotrophic factor (BDNF) gene also confers higher risk of AD. APOE and BDNF genotypes may have interactive effects on AD pathology. The aim of this study was to determine whether APOE and BDNF genotype differentially impact white matter hyperintensity volume (WMHV). We used data from 212 cognitively unimpaired individuals from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) We used generalized linear models to predict WMHV from BDNF genotype and an interaction with APOE. Sex, age, education, vascular risk, and imaging-based amyloid load (Florbetapir SUVR) were used as covariates. . WMHV was derived by using the Lesion Segmentation Toolbox (LST) in SPM12 with a threshold of k = 0.15. We used the Hachinski Ischemic Scale to measure for vascular risk. We found no significant interaction of BDNF-APOE on WMHV (β = 0.40, 95% CI: (-0.39, 1.20), p = 0.32). In sex-stratified analyses the BNDF-APOE interaction was significantly associated with WMHV in males (β = 1.14, 95% CI:(0.17, 2.11), p = 0.02), but not in females (β = -0.37, 95% CI: (-1.47, 0.76), p = 0.50). For males, carriers of both BDNF Met and APOE ε4 alleles had the highest WMHV. Sex-specific differences in BDNF expression may be related to hormonal differences, and BDNF genotype might underlie these differences. Given the continued interest in using BDNF as a treatment target for AD, understanding complex genotype interactions may aid in future therapeutic studies.
An International Environmental Scan of Social Housing for Older Adults
Authors: Hitzig Sander , Sheppard Christine , Holt Ariana , Austen Andrea , Glenn Miller
Published: December 2020

The City of Toronto is creating a standalone housing corporation to focus on the specific needs of low-income older adults living in social housing. A key focus of this new corporation will be to provide housing, health and community support services needed to optimize older adult tenants’ ability to maintain their tenancy and age in place with dignity and in comfort. To support this work, we conducted an environmental scan of service delivery models that connect low-income older adults living in social housing with health and support services. Desktop research was undertaken to identify relevant programs. For each model, key details were extracted including housing type, services offered, provider information, rent structure and funding sources. The scan identified 34 examples of social housing programs for older adults run by public, private and non-profit agencies across Canada, the United States and Europe that integrated health and supportive services. Successful models were those that understood the needs of tenants and developed collaborative partnerships with health and social service providers to create flexible place-based programs. A common challenge across jurisdictions was privacy legislation that made it difficult to share health and tenancy data with program partners. The presence of on-site staff that focused on building trust and community among tenants was considered key for identifying tenants requiring additional supports in order to age in place. These insights offer important considerations on how integrated supportive housing service models promote housing stability and support better health and wellbeing among older adults residing in social housing.
Effects of COVID-19 Pandemic on the Lived Experience of Diverse Older Adults Living Alone With Cognitive Impairment
Authors: Portacolone Elena , Chodos Anna , Halpern Jodi , Covinsky Kenneth , Keiser Sahru , Fung Jennifer , Rivera Elizabeth , Johnson Julene K
Published: December 2020

Background and Objectives: Even before the COVID-19 pandemic, older adults with cognitive impairment living alone (an estimated 4,3 million individuals in the United States) were at high risk for negative health outcomes. There is an urgent need to learn how this population is managing during the pandemic. Research Design and Methods: This is a qualitative study of 24 adults aged 55 and over living alone with cognitive impairment from diverse racial/ethnic backgrounds. Participants’ lived experiences during the pandemic were elicited via 59 ethnographic interviews conducted over the phone either in English, Spanish, or Cantonese. Using a qualitative content analysis approach, interview transcripts and fieldnotes were analyzed to identify codes and themes. Results: Qualitative analysis of transcripts revealed five themes: 1) fear generated by the pandemic; 2) distress stemming from feeling extremely isolated; 3) belief in misinformation, 4) strategies for coping during the pandemic; and 5) the importance of access to essential services. Discussion and Implications: This pandemic put a spotlight on the precarity and unmet needs of older adults living alone with cognitive impairment living. Findings underscore the need to expand access to home care aides and mental health services for this population.
Everyday Remembering During a Global Pandemic in Caring Dyads
Authors: Lustig Emily , Naran Alysha , Pearman Ann , Hertzog Christopher
Published: December 2020

During the COVID-19 global pandemic people’s lived experiences and day-to-day lives have been tremendously impacted. This impact is believed to be more severe in people with a memory-impaired partner at home. As part of an ongoing cognitive intervention project with the Emory-Georgia Tech Cognitive Empowerment Program (CEP), we conducted interviews with dyads (one person with diagnosed amnestic mild cognitive impairment (aMCI) and one person, in this case, a spouse who is an identified care partner). To address the COVID-19 pandemic, we supplemented the existing interview about everyday cognition with several questions about the dyadic experience during the pandemic. To date, we have conducted 5 qualitative interviews with dyads. Preliminary results indicate that the COVID-19 pandemic has created additional everyday challenges and cognitive burden for care partners of people diagnosed with aMCI. Some of these challenges include the need to manage pandemic precautionary behaviors, such as mask wearing and maintaining social distancing, for both themselves and the care recipient. In contrast, some aspects of everyday remembering among these dyads have improved (e.g. more advance planning of things like grocery shopping and outings). The results of these interviews will provide additional unique insights into the everyday cognitive challenges of the pandemic on caregivers and persons with aMCI.
Front-line Experiences and Perspectives of Older and Younger Registered Nurses during the COVID-19 Pandemic
Authors: Raveis Victoria , VanDevanter Nancy , Kovner Christine , Yu Gary , Ridge Laura Jean , Glassman Kimberly
Published: December 2020

Having an experienced and trained healthcare workforce available during public health emergencies, such as the COVID-19 pandemic, is critical. While all healthcare workers are at risk of contracting COVID-19, older workers are at increased risk of serious or fatal illness. This investigation explores the front-line experiences and perspectives of registered nurses (RNs) at a major New York City medical center during the COVID-19 pandemic, focusing on two age cohorts: older (50+) and younger (20-49) RNs. An anonymous internet-based survey was sent to all RN’s employed at the center. Data collection was initiated in May 2020, following the initial surge in NYC’s COVID-19 related hospitalizations and deaths; 1,483 surveys were completed. This investigation found that in comparison to younger RNs (n=1,067), older RNs’ (n=416) psychosocial well-being was significantly better -- fewer depression, anxiety, and PTSD symptoms (p<.001). They were less stressed caring for COVID-19 patients (p <.001) and less worried about work-related exposure risk (p<.001). They also reported higher job satisfaction (p<.001), less work-home stress (p<.001), a higher commitment to choosing the nursing profession (p<.001), were more confident in the profession (p<.001) and to meeting its’ expectations (p<.001). Overall, although older RNs represent a smaller proportion of the nursing workforce, their collective expertise and clinical experience in healthcare delivery are significant. The older RN workforce is a seasoned resource to draw upon during public health emergencies and a valuable role model for younger RNs, particularly given their continued adherence to nursing, during this COVID-19 time of uncertainty and personal health risk.
Resilience to Loneliness Amongst Older Adults Living in the Bronx, NY, During the COVID-19 Pandemic
Authors: Harrington Karra , Zhaoyang Ruixue , Scott Stacey , Graham-Engeland Jennifer , Sliwinski Martin
Published: December 2020

Older adults may be particularly vulnerable to experiencing loneliness as a result of stay-at-home and social distancing orders during the COVID-19 pandemic. This study evaluated change in loneliness following the COVID-19 outbreak, using a longitudinal design and a validated loneliness measure, in a well-characterized sample who are at heightened risk for COVID-19 due to both age and location. The study included n = 226 older adults aged 70-90 years old, living in the Bronx, New York City, who had completed the 3-item Loneliness Scale prior to and during the peak of the COVID-19 outbreak in New York City. There was no evidence of significant increases in mean loneliness from pre- to post-COVID-19 outbreak. Multiple regression analyses were used to identify risk and protective factors for change in loneliness during the COVID-19 outbreak, adjusting for pre-outbreak loneliness. Living alone, higher levels of education, greater worry about contracting the coronavirus, and limiting of daily exercise activities were risk factors for greater loneliness after the outbreak. In contrast, Black race, older age, greater social support and frequent social interactions via video call, all related to lower levels of loneliness after the outbreak.The outcomes of this study demonstrate substantial resilience among older adults to loneliness in response to the COVID-19 pandemic, and highlight key risk and protective factors that may play an important role in individual differences in loneliness as pandemic-driven isolation continues.
Assessing Housing Accessibility for Older Adults in Japan: A Content Validity Study
Authors: Tsuchiya-Ito Rumiko , Slaug Björn , Sano Tomonori , Tajima Miki , Itoh Sakiko , Uda Kazuaki , Yamanaka Takashi , Iwarsson Susanne
Published: December 2020

Scientifically validated tools to assess housing accessibility for older adults in Japan have been lacking. To address this, a rigorous procedure of adapting an existing housing assessment tool—the Housing Enabler, developed in Sweden—for valid use in Japan was conducted. The original tool was translated into the Japanese language, using established translation procedures. In the process, researchers checked the appropriateness of technical terms and adjusted specifications to be in accordance with Japanese standards. An expert panel approach was used to validate the content of the Japanese Housing Enabler. Thirteen certified occupational therapists, architects and care-managers (average experience=14.5 years) participated as experts in the content validity study. They rated each item with regard to relevance for assessing housing accessibility in Japan, on a scale from 1(=Not relevant) to 4(= Highly relevant). They suggested adjustments and additions that they found to be relevant to capture particularities of Japanese housing and building design. After individual ratings, the experts gathered for consensus discussions on suggested revisions of the item list. As a result, the number of items was substantially increased (from 161 to 283). A content validity index (CVI) was calculated for each item (i.e., the proportion of experts rating the relevance as at least 3). Using a recommended threshold of CVI ≥0.78, more than 90% of the items were considered relevant, thus supporting the content validity. However, the large amount of items might jeopardize the feasibility of the instrument. Further studies are needed to evaluate feasibility, criterion-related validity and aspects of reliability.
Becoming an Autologous Stem Cell Transplant Patient
Authors: Halpin Sean , Konomos Michael , Jowers Ivey
Published: December 2020

In the current study, we sought to examine how older patients incorporate the identity of a patient receiving autologous stem cell transplant (ASCT) for multiple myeloma (MM) into their daily lives. In this ethnographic study using interpretative phenomenological analysis, we observed pre-transplant education visits with 30 MM patients, followed by semi-structured interviews in their hospital rooms during transplant. The experience of receiving ASCT for MM required effort by patients to not only maintain their past identity but also establish a new patient identity. Reconciling these two identities required deliberate and emotionally draining effort from the patient. Results were organized into two overarching themes of social relationships and aesthetics with subthemes for each. Patients experienced challenges reconceptualizing their social support network to meet their changing needs; often with a spouse or child taking on a caregiving role. In regard to aesthetics, patients contended with the physical reminders of their new diseased identity, adopting various aesthetic strategies to either embrace or conceal bodily changes. Understanding methods MM patients who are receiving ASCT use to negotiate normalcy during treatment may be helpful for developing interventions for alleviating distress during this difficult time.
Cell-Based and Pharmacologic Hormone Therapy Maintain Diastolic Function After Ovariectomy in Hypertensive Rats
Authors: Groban Leanne , Sun Xuming , Sivanandane Sittadjody , Hodge Hunter , Wang Hao , Lin Marina , Opara Emmanuel
Published: December 2020

The role for hormone therapy in the maintenance of diastolic function upon ovarian senescence has not been clinically tested due to concerns for off-target health risks. We developed a cell-based hormone therapy (cHT) approach that recapitulates native cell–cell interactions between ovarian granulosa and theca cells in a 3D bioengineered construct to mimic the dynamic release of sex hormones. Our first report in ovariectomized (OVX) rats shows that cHT ameliorates various adverse somatic effects of hormone deficiency (e.g. bone loss). To extend these findings to cardiac health, we sought to determine the efficacy of cHT in preserving diastolic function in OVX-spontaneously hypertensive rats (SHR). 14 SHRs underwent bilateral OVX while 5 SHRs received sham surgery at 12 weeks of age. Following an 8-week washout, OVX rats were randomized to cHT or pharmacologic hormone therapy (pHT: E2 (10 mcg/kg/day) and P4 (2 mg/kg/day, s.c.) for 10 weeks and compared to OVX-vehicle and Sham. While uterine atrophy by OVX was minimized by cHT and pHT, hormone levels across OVX groups were not overtly different. Systolic blood pressure increased progressively over time (P<0.01), without a treatment effect. Even so, cHT and pHT prevented OVX-related reductions in myocardial relaxation and increases in Doppler-derived filling (P<0.05); paralleling the diastolic profile of Sham. Alongside superior diastolic function, 25% increases in cardiac interferon regulatory factor-4 (Irf-4) gene expression levels occurred in both hormone-treated OVX groups and Sham when compared to OVX-vehicle, suggesting a link between sex hormones and local immune modulation in the regulation of female cardiac health.
Initial Derivation of Positive Dementia-Related Observational Measures: A Descriptive Ethnography
Authors: Staehler Maya , Benson Clark , Madden Jordan , Block Laura , Gilmore-Bykovskyi Andrea
Published: December 2020

Person-centered caregiving approaches emphasize efforts to protect and maintain the personhood of people living with dementia (PLWD). The influence on person-centered caregiving approaches on PLWD have predominantly focused on deficit-oriented outcomes, such as absence or reduction of behavioral symptoms. While important to quality of life, the absence of measurable “positive” responses to person-centered caregiving approaches limit opportunities to specify sensitive and meaningful outcome measures that more holistically represent PLWD’s care experiences as more than the absence of a negative outcome. To address these gaps, we conducted a secondary analysis of video-observations of PLWD (N=9) surrounding mealtime cares using a descriptive ethnographic approach. Our objectives were to descriptively summarize specific responsive behaviors demonstrated by PLWD surrounding person-centered caregiving interactions, specifying observable features of these responses and consider their utility in future video-observational research. Findings indicate PLWD contribute both verbal and non-verbal communication surrounding person-centered approaches which can be characterized as conversational (starting conversation, answering or asking questions), expressing preferences (indicating needs and preferences, agreeing or disagreeing, complying with or refusing caregiver requests, permission granting), emotional responses (mirroring caregivers’ emotions, demonstrating emotion e.g. smiling), and reflexive (mirroring of caregiver’s actions), with overlap between categories. Findings suggest that PLWD not only contribute and respond in meaningful ways to person-centered interactions, but also initiate a significant number of these interactions. This study contributes to a growing body of research and advocacy that examines the personhood and abilities of PLWD and establishes the utility of observational data in studying PLWD contributions.
Influence of Frailty on Discharge Setting for Older Adults With Hip Fracture at Inpatient Rehabilitation Facilities
Authors: Tocchi Christine , Shakya Shamatree , Amarasekara Sathya , Cary Michael
Published: December 2020

Inpatient rehabilitation Facilities (IRFs) provide intensive rehabilitation therapy to patients to reduce functional impairment, enhance independence and return patients back to the community. Determination of eligibility for IRF is currently based on a preadmission screening. Frailty, a pervasive characteristic in older adults with hip fractures has not been examined as a clinical factor influencing function and discharge destination IRF outcomes. This study purpose was to determine the prevalence of frailty among older adult IRF patients with hip fractures and determine the association between frailty and function and discharge destination among IRF hip fracture patients. A retrospective cohort study design using CMS 2014 Inpatient Rehabilitation Facility-Patient Assessment Instrument file. Frailty was measured using a Frailty Index of 30 items. The final sample included 26,134 patients. Frailty, pre-frailty, and nonfrailty were present in 0.92% (n=24043), 3.3% (n=862), and .076% (n=199) of hip fracture patients, respectively. The majority (65%) of the patients were discharged home. There were significantly greater proportion of females than males discharged home and those of white race, 65 to 74 years of age, and those with higher functional status. Regression analysis showed significantly lower functional status at discharge (p < .0001) for males and those of non-white race, older age and frail. Study implications include the use of frailty status to identify hip fracture patients at high risk for adverse outcomes and need for future studies to explore the potential of frailty to provide value-added utility to IRF clinical settings and identify ongoing opportunities to guide person-centered care.
Acceptability and Feasibility of ActivPAL Activity Tracker for Pre-Frail African American Older Adults
Authors: Hu Yi-Ling , Valenzuela Camila Rodriguez , Jones Ryan , Gamalski Natalie , Fritz Heather
Published: December 2020

Frailty is more prevalent among African American (AA) older adults compared to their White counterparts. Physical activity (PA) interventions are effective to attenuate frailty progression. The Activpal is adhered to the thigh and allows unobtrusive PA measurement for up to 14 days. However, few studies have tested the acceptability and feasibility of activity trackers among older pre-frail AA. In this study, pre-frail AA older adults were asked to wear the ActivPAL tracker on their thigh for 7 consecutive days. Acceptability was measured by compliance. Feasibility was evaluated by the valid number of days and programing errors. Intraclass correlation coefficients were used to assess the agreement of light to vigorous PA level between ActivPAL and the Community Healthy Activities Model Program for Seniors (CHAMPS). In a sample of 28 pre-frail AA older adults (mean age= 73.21,SD= 9.37, 100% female), 24 completed the 7-day data tracking. Reasons for non-compliance included skin irritation (n=1), and fear of causing other health issues (n=3). The number of valid days was= 6.9 0.33 with 1 incident of programming error. The agreement between ActivPAL and CHAMPS was fair (ICC =0.57, [95%CI]= -.08 -.85) with most participants (61.6%) over-reporting PA on CHAMPS. The ActivPAL accelerometer was acceptable and feasible to use among pre-frail AA older adults. Communication prior to applying the accelerometer is crucial to prevent non-compliance. The results confirm prior studies, which suggest that older adults may over-report PA levels. ActivPAL offers a feasible and accurate approach to assess PA among older AA.
Novel Analytic Approaches to Investigate Minute-Level Actigraphy and Associations With Physical Function
Authors: Hua Kaiyuan , Luo Sheng , Hall Katherine , Morey Miriam , Cohen Harvey
Published: December 2020

Background. Functional decline in conjunction with low levels of physical activity has implications for health risks in older adults. Previous studies have examined the associations between accelerometry-derived activity and physical function, but most of these studies reduced these data into average means of total daily physical activity (e.g., daily step counts). A new method of analysis “functional data analysis” provides more in-depth capability using minute-level accelerometer data. Methods. A secondary analysis of community-dwelling adults ages 30 to 90+ residing in southwest region of North Carolina from the Physical Performance across the Lifespan (PALS) study. PALS assessments were completed in-person at baseline and one-week of accelerometry. Final analysis includes 669 observations at baseline with minute-level accelerometer data from 7:00 to 23:00, after removing non-wear time. A novel scalar-on-function regression analysis was used to explore the associations between baseline physical activity features (minute-by-minute vector magnitude generated from accelerometer) and baseline physical function (gait speed, single leg stance, chair stands, and 6-minute walk test) with control for baseline age, sex, race and body mass index. Results. The functional regressions were significant for specific times of day indicating increased physical activity associated with increased physical function around 8:00, 9:30 and 15:30-17:00 for rapid gait speed; 9:00-10:30 and 15:00-16:30 for normal gait speed; 9:00-10:30 for single leg stance; 9:30-11:30 and 15:00-18:00 for chair stands; 9:00-11:30 and 15:00-18:30 for 6-minute walk. Conclusion. This method of functional data analysis provides news insights into the relationship between minute-by-minute daily activity and health.
Perceived Value of Using a Digital Tool to Screen for Elder Mistreatment in the Emergency Department
Authors: Abujarad Fuad , Gill Thomas , Pantalon Michael , Jubanyik Karen , Dziura James , D’Onofrio Gail , Choo Esther
Published: December 2020

A major barrier to reducing Elder Mistreatment (EM) is an inability to accurately identify victims. We conducted a qualitative study to evaluate stakeholders’ perceived value and likelihood of adopting a tablet-based digital health tool to facilitate screening and prompt self-disclosure of EM in emergency departments (ED). The interactive tool utilizes virtual coaching, interactive multimedia libraries (graphics, animations, etc.), electronic screening, and brief motivational interviewing designed to enhance identifying EM among older adults. We conducted 3 focus groups with stakeholders, including 24 adults 60+ years, 2 social workers, 2 caregivers, and 2 ED clinicians. Two focus groups included only older adults, while one included representatives of all stakeholders. The main findings include: using a female voice for the tool narrator, larger font size, more multimedia, and headphones for privacy; and making a person available during screening if assistance is needed. Stakeholders indicated that it is difficult for victims to ask for help and any type of mistreatment screening would be helpful. On a 7-point Likert scale ranging from “1=Very Comfortable” to “ 7=Very Uncomfortable”, older adults scored 2.8 on average for whether they would feel comfortable using a tablet to screen for EM. Some said digital screening would maintain privacy and anonymity. Stakeholders highlighted the need to explain community resources available to older adults once EM is disclosed, especially resources offering help to the caregiver. In summary, this qualitative study supported using tablet-based screening for EM and highlighted the need to target stigma related to EM disclosure and fear of retaliation.
Developing a Questionnaire to Assess Opinions Regarding the Importance of Bathing and Washing Without Water
Authors: Groven Fabian , Hamers Jan , Odekerken-Schröder Gaby , Zwakhalen Sandra
Published: December 2020

Bathing is one of the most performed activities among nurses. Although care recipients experience bathing as an important activity in daily living, nurses often undervalue this care task. We developed a questionnaire to measure nurses’ opinions regarding 1) the importance of the bed bath, and 2) a bathing innovation known as Washing Without Water. Construction of the questionnaire items was based on literature and interviews with nursing home residents (n=8), their family (n=5) and nurses (n=6). After items construction, nurses and nursing students (n=124) completed the questionnaire to assess the questionnaire’s internal consistency (IC) and construct validity. Cronbach’s alpha coefficients were analyzed as an indicator for IC and items were deleted if this resulted in improved IC. To analyze the construct validity, a Principal Component Analyses (PCA) with Direct Oblimin Factor rotation was performed. The final scale consists of two subscales. The first subscale measures nurses’ opinions about the importance of the bed bath and consists of 12 items. The second subscale consists of 17 items and aims to inventory nurses’ opinions about the Washing Without Water innovation. The Cronbach’s alpha coefficients are high (.81 for the first and .89 for the second subscale). The PCA results show a one factor loading for both subscales, explaining 33,20% and 37,08% of the variance for the first and second subscale respectively. Results indicate a reliable and valid questionnaire to measure nurses’ opinions related to the bed bath, which can support health care institutions in evaluating the bed bathing process.
Caregivers’ Perspectives of Medication Management Advice for People With Dementia at Hospital Discharge
Authors: Sawan Mouna , Jeon Yun-Hee , Bond Christine , Chen Timothy , Hilmer Sarah , Gnjidic Danijela
Published: December 2020

People with dementia admitted to hospitals are more likely to be exposed to inappropriate polypharmacy and experience worse outcomes than people without dementia. Family and informal caregivers play an important role in managing medications across transitions of care; however, studies describing the experiences of medication guidance provided to caregivers at hospital discharge are limited. We have explored caregivers’ perceptions on the quality of and factors that influence caregiver participation in medication guidance at discharge. A qualitative approach using semi-structured interviews was conducted with 29 caregivers of people with dementia across Australia by telephone. Purposive sampling was used to ensure maximum variation of diverse perspectives. Content analysis was used to derive themes. Three themes were derived from analysis: inconsistent approaches to provision of medication information at discharge, caregiver awareness to advocate for the care recipient and managing competing priorities. Some caregivers reported inadequate information was provided because the information was communicated to the patient without the caregiver being present. Other caregivers stated a medication list, discharge summary and discussion with a healthcare profession provided useful information. Caregiver involvement in discussions on medication guidance at discharge was influenced by caregiver awareness to advocate for the care recipient to ensure medication safety and managing competing priorities at the time of discharge to manage stress. Caregivers flagged the need to establish structured caregiver education at discharge and community-based services to manage medications safely. Future studies are needed to explore development of resources to caregiver encourage participation during medication guidance at discharge.
Randomized Controlled Trial of Tailored Music Listening Intervention for Sleep in Dementia
Authors: Petrovsky Darina , Roan Shana , Gooneratne Nalaka , Bradt Joke , Gitlin Laura , Hodgson Nancy
Published: December 2020

Sleep disruption in older adults living with Alzheimer’s disease and related dementias (ADRD) is debilitating and contributes to increased institutionalization, reduced cognitive function, and accelerated disease progression. Given the potential harmful effects of pharmacologic treatment, non-pharmacologic approaches, such as music, may provide a safer alternative to improve sleep quality in this vulnerable population. No empirically validated music protocol exists to address sleep disruption in older adults with ADRD living at home. Therefore, the specific aims of this wait-list randomized controlled trial were to examine the 1) feasibility; 2) acceptability; and 3) preliminary efficacy of a tailored music intervention in home-dwelling older adults with ADRD with sleep disruption and their caregivers. This presentation focuses on baseline characteristics of dyads, which included persons with ADRD and their caregivers who have completed the clinical trial so far (N=28). The mean age of persons with ADRD was 71.6 (SD: 7.6). The mean age of caregivers was 58.7 (SD: 16.7). Sixty-eight percent (n=19) of persons with ADRD were female. Similarly, the majority of caregivers were female (n=20, 71.4%). Seventy-four percent of persons with ADRD scored 0.5 on the Clinical Dementia Rating instrument, indicative of very mild dementia. The majority of dyads identified themselves as non-Hispanic (>92%). Seventy-nine percent of persons with ADRD identified themselves as Black or African-American (n=22, 79%), while 82.1% of caregivers identified themselves as Black or African American. Preliminary analysis of qualitative data indicates high acceptability of the intervention. Results from this research study will inform a future efficacy trial.
Visual Impairment at Age 85 Predicts Subsequent Cognitive Decline at Age 90
Authors: Jacobs Jeremy , Stessman Jochanan
Published: December 2020

Although the impact of visual impairment (VI) upon functional status and mortality among older people is recognized, its relationship to cognitive function is unclear. We examined the association between VI and subsequent cognitive decline from age 85-90 among subjects from the Jerusalem Longitudinal Study (1990-2020), which follows a representative study sample born 1920-21. Assessment at age 85 (2005) and age 90 (2010) included Snellen visual testing and Mini Mental State Examination (MMSE) for 488 subjects. VI was defined as corrected best eye vision ≤ 40/60. Dementia was defined as MMSE ≤24/30, after visually-dependent items (drawing, writing, reading) were excluded from the MMSE, and the score (maximum=27) was corrected to a maximum of 30 by multiplying by a factor of 1.111. At age 85 frequency of VI was 40.1% (198/488) and 86.9% (424/488) of subjects were non-demented (MMSE ≥24/30). Between ages 85-90 the mean decline in MMSE among all subjects with VI vs. non-VI was 5.2±7.7 vs. 3.9±6.7 (p=0.053), among non-demented subjects was 5.2±7.8 vs. 3.5±6.3 (p=0.002), and the transition to dementia was 34% vs. 20% (p=0.004) respectively. In logistic regression analysis among non-demented subjects at age 85, the unadjusted odds ratio (OR) for transition to dementia by age 90 associated with VI at age 85 was OR 1.95, 95%CI 1.24-3.06, p<0.01, and after adjusting for gender, years of education, depression and diabetes, the adjusted OR was 1.74, 95%CI 1.09-2.76, p<0.05. In conclusion, visual impairment at age 85 is independently associated with subsequent cognitive decline and the development of dementia.
Weight Loss Motivation in Older Pre-Diabetics: Preliminary Evidence by Race in the Eggspdite Study
Authors: Miller Marshall , Borack Michael , Rincker Jamie , McDonald Shelley , Starr Kathyrn , Bales Connie
Published: December 2020

Obesity hastens functional decline and intensifies chronic health conditions among older adults. Late-life obesity is of particular concern for older African Americans, who are at increased risk for obesity and type 2 diabetes and for whom weight loss interventions can be less effective. However, obesity interventions have been under-studied in this population; little is known about potential differences in motivation for change by race. The ongoing Eggs PreDiabetes Intervention Trial (EGGSPDITe) is a randomized controlled trial of expedited weight loss in older (60+ years) Black and White adults with prediabetes. Participants completed both the Stages- and Processes of Change questionnaires in Weight Management (S-Weight and P-Weight) at baseline and end of 4-month intervention. Preliminary combined-group analysis indicates that, while White participants reported a higher average stage of change at baseline, there was no difference by race (ps < 0.05) in changes for body weight, fat mass, and hemoglobin A1c at endpoint. Reductions in weight consequences evaluation (WCE) and increases in weight management actions (WMA) subscales were observed in both races (ps < 0.05), with a trend toward decreased emotional re-evaluation (EmR; p = 0.06). Of the processes of change subscales, only WCE differed by race (p < 0.05), with White participants showing ≈13.5% higher utilization, relative to Black participants, at both time points. These preliminary findings suggest that weight loss interventions can be equally effective among black and white older adults, although motivations for weight loss may differ by race.
Identifying Medication Therapy Problems Related to Cognition Among Older Adults Followed by a Home-Based Care Team
Authors: Levine Allison , Emonds Erin , Smith Marie , Rickles Nathaniel , Fortinsky Richard , Ohlheiser Alis
Published: December 2020

Complications from dementia, depression, delirium (3Ds) and polypharmacy may accelerate patient decline. Cognitive vulnerabilities may be under-recognized and medication therapy problems (MTPs) overlooked, hindering optimal care. Clinical pharmacists on a multidisciplinary home-based care team (HBCT) being tested in a clinical trial were essential in identifying MTPs related to cognition. Medicare Advantage members >65 years old, living at home in Connecticut, with ICD-10 codes related to 3Ds were eligible. APRNs conducted in-home medication reconciliation along with medical and cognitive assessments. HBCT pharmacists assessed medication lists for MTPs related to indication, effectiveness, and safety (adverse events, interactions). After review by the HBCT APRN, geriatrician, and psychiatrist, salient pharmacist recommendations were forwarded to PCPs for consideration. Using retrospective analysis, MTPs and recommendations were classified based upon the Pharmacy Quality Alliance framework. MTP analysis included 105 patients enrolled from 2017-2019. We found 166 MTPs related to cognition, with a mean (SD) of 1.58 (1.35) (range 0-6) MTPs per patient. MTPs related to indication accounted for 34% (57/166) of total MTPs, of which 79% (45/57) were underuse and 21% (12/57) overuse; effectiveness represented 13% (22/166) of MTPs; safety represented over half (52%; 87/166) of total MTPs with benzodiazepines and anticholinergics commonly implicated. Common HBCT pharmacists’ recommendations included discontinuation (23%; 38/166) and dose reduction (19%; 32/166). MTPs related to cognition were found among the overwhelming majority (79%) of patients. This work is significant because it supports the value of pharmacists on multidisciplinary teams to address cognitively harmful medications, dementia treatment side effects, and untreated cognitive conditions.
Frailty Component Trajectories After Restoration of Kidney Function Among Kidney Transplant Recipients
Authors: Chu Nadia , Chen Xiaomeng , Segev Dorry , McAdams-DeMarco Mara
Published: December 2020

Frailty is associated with decreased access to kidney transplantation (KT) and poor post-KT outcomes. Little is known about how an acute stressor, like KT, can impact the five physical frailty phenotype (PFP) criteria. We conducted a two-center prospective cohort study (2009-2019) of adult patients undergoing KT. PFP criteria were measured at KT admission, 1 month, 3 months, 6 months, 1 year, and annually thereafter post-KT. We used adjusted mixed effects models with fixed and random effects for person and time to describe repeated measures of continuous criteria components (weight, gait speed, grip strength, activity). We used an adjusted generalized estimating equation to quantify longitudinal, binomial response patterns of exhaustion. Among 1,410 KT recipients (mean age=53) followed for a mean of 1.9 years (IQR=0.1-3.2), 46.8% had low activity, 46.7% weakness, 29.0% exhaustion, 16.1% slowness, and 14.3% unintentional weight loss at KT admission. Among continuous components, weight worsened (0.3lb/month, 95%CI:0.2,0.4), while grip strength (0.09kg/month, 95%CI: 0.07,0.11) and activity (5.8Kcal/month, 95%CI: 3.3, 8.2) improved post-KT; gait speed remained stable (-0.0004s/month, 95%CI: -0.01, 0.0005). Additionally, likelihood of transitioning from being exhausted did not change (OR=1.0, 95%CI: -0.01, 0.0005). Trajectories differed by age, such that improvements were observed among younger recipients (<65 years), but not among older recipients (≥65 years) (p-interactions<0.05). After undergoing a common surgical stressor, KT recipients demonstrated weight gain as well as improvements in strength and activity. Despite benefits of restoration of kidney function, clinicians should consider monitoring KT recipients for persistent weight gain, exhaustion, and slowness post-KT, particularly among older adults.
Bidirectional Relationship Between Subjective Age and Frailty: Findings From the NHATS
Authors: Li Yuxiao , Liu Minhui , Miyawaki Christina , Sun Xiaocao , Hou Tianxue , Tang Siyuan , Szanton Sarah
Published: December 2020

Frailty is a clinical syndrome that becomes increasingly common as people age. Subjective age refers to how young or old individuals experience themselves to be. It is associated with many risk factors of frailty, such as increased depression, worse cognitive function, and poorer psychological wellbeing. In this study, we examined the relationship between subjective age and frailty using the 2011-2015 waves of the National Health and Aging Trends Study. Participants were community-dwelling older adults without frailty in the initial wave (N=1,165). Subjective age was measured by asking participants, “What age do you feel most of the time?” Based on the Fried five phenotypic criteria: exhaustion, unintentional weight loss, low physical activity, slow gait, and weak grip strength, frailty was categorized into robust=0, pre-frail=1 or 2; frail=3 or more criteria met. Participants were, on average, 74.1±6.5 years old, female (52%), and non-Hispanic White (81%). Eighty-five percent of the participants felt younger, and 3% felt older than their chronological age, but 41% of them were pre-frail/frail. Generalized estimating equations revealed that an “older” subjective age predicted a higher likelihood of pre-frailty and frailty (OR, 95%CI= 1.01, 1.01-1.02). In contrast, frailty predicted an “older” subjective age (OR, 95%CI= 2.97, 1.65-5.35) adjusting for demographics and health conditions. These findings suggest a bidirectional relationship between subjective age and frailty. Older people who feel younger than their chronological age are at reduced risk of becoming pre-frail/frail. Intervention programs to delay frailty progression should include strategies that may help older adults perceive a younger subjective age.
Perceptions of Treatment Burden Among Elders With Diabetes and Comorbid Alzheimer’s Disease and Related Dementias
Authors: Dickson Victoria Vaughan , Melnyk Halia , Ferris Rosie , Chodosh Joshua , Blaum Caroline
Published: December 2020

Background: An estimated 25% of older adults with diabetes (DM) may have co-occurring Alzheimer’s Disease and Related Dementias (ADRD), complicated by multiple treatment plans and providers. Assessing treatment burden has been limited to patients’ perspectives; little is known about caregiver perceptions of treatment burden despite their important role in personal care and treatment adherence. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for older adults with DM-ADRD. Methods: This qualitative study was conducted in the formative phase of “Enhanced Quality in Primary care for Elders with DM-ADRD (EQUIPED-ADRD) a pragmatic randomized controlled trial in a large, diverse healthcare system. A diverse sample of caregivers (n=15) of patients enrolled in the RCT participated in interviews about their caregiver role and perceptions of treatment burden of DM-ADRD clinical management. Qualitative data were analyzed using content analysis and themes about treatment burden were compared to domains on the Treatment Burden Questionnaire (TBQ). Results: Caregivers reported high levels of burden related to treatment plans for patients with DM-ADRD. Themes related to complexity and burden of medication management, monitoring (e.g., blood pressure, glucose monitoring), dietary and physical activity regimens, navigating healthcare providers and financial burden were reported. Caregivers also described high levels of emotional burden that was associated with patient’s cognitive decline and family functioning stress. Conclusions: Interventions to reduce treatment burden for patients and caregiver should include activating social/nursing services, respite care and care coordination that may support caregivers especially as patient treatment increases in complexity over time.
Positive Behaviors and Strengths of People With Dementia
Authors: DiGasbarro Diana , Whitaker Courtney , Mast Benjamin
Published: December 2020

Assessment of and care for people with dementia is shifting away from a purely medical disease model toward a more holistic, biopsychosocial approach. Within this movement is growing interest in balancing the negative, symptom-based view of people with dementia with better understanding of strengths and positive behaviors exhibited by people with dementia. The aim of this qualitative study was to gather perspectives of professional caregivers regarding positive behaviors and strengths observed in people with dementia. Data were obtained from three focus groups conducted at a memory care unit within a large long-term care facility. Focus group participants (N=14) worked in nursing and the activities department. Inductive methods were used to code and analyze focus group transcripts and recordings. Five major themes were identified: enduring abilities and values, enduring traits and strengths, sense of purpose and meaning, desire to be helpful, and prosocial behavior. These themes illustrate many domains in which professional caregivers have observed positive behaviors and strengths in people with dementia living in a long-term care facility. The results of this study contribute to the growing literature pertaining to the intersection of positive psychology and dementia research and practice. Future directions include development of an assessment tool to measure positive behavior and strengths in people living with dementia.