bluuebunny/crossref_metadata_2025 huggingface dataset:
A POLICY COMPARISON OF THE EVOLUTION OF COMMUNITY-BASED LONG-TERM CARE POLICY BETWEEN TAIWAN AND THE UNITED STATES
Authors: Peckham Allie , Liu Li-Chuan , Schmid Laura
Published: December 2023

Governments globally have been facing pressure to develop and implement effective policies to support population aging. This approach was historically rooted in a perception that as we age we become increasingly incapacitated. This research seeks to understand how policies in two countries valuing unpaid care differently, developed and implemented Long-term services and supports (LTSS). We compare the federal level efforts of implementing LTSS within the United States (U.S.) and Taiwan. Relying on a pre-established comparative framework developed by Richard Rose, we utilized a deductive analytical approach to assess the differences in policy options and timelines across Taiwan and the U.S.. After attending this session, participants will develop a deeper understanding of how Taiwan and the U.S. are working to offer home and community-based long-term care services. It wasn’t until the 1980s for the U.S. and late 1990s for Taiwan that LTSS were introduced with the intention of supporting people to live as independently as possible in their own homes for as long as possible (e.g., Department of Health and Human Services, 3-year Care Service Development Plan). It is likely that the delay in LTSS delivery between the two countries is rooted in the role that unpaid support is expected to play. There is increasing evidence that countries are shifting their policy efforts to focus less on aging as a social dependency and more on policies that encourage healthy longevity.
DEMENTIA-FOCUSED ADULT DAY CARE IN AN URBAN SETTING: PROGRAM STAKEHOLDERS’ VIEWS OF CRUCIAL COMPONENTS
Authors: Ernst Joy , Hopp Faith
Published: December 2023

Dementia focused adult day centers (ADCs) provide socialization, physical activity, and cognitive activities for participants, and respite for caregivers. This study reports findings from a process evaluation of an ADC serving a predominantly African American population in a large midwestern city. The evaluation examined whether the program was being implemented as intended, what was working/not working, and participant engagement. We conducted in-depth interviews of staff, volunteers, and student interns and surveyed caregivers (n=17). Thematic analysis of the interviews revealed themes such as “structured flexibility” in running the daily activities, an ethos of care that mixes encouragement of participation with respect for autonomy, ongoing and positive activity, and individualized attention to participants. Other findings revealed the value of consistent and experienced staff and reliance upon and benefits for students and volunteers. Quantitative and qualitative responses to caregiver surveys supported the interview themes. Caregivers valued the socialization and creative stimuli provided to participants. Guidance from program personnel included modeling communication strategies and being “in the moment” with the participants. The findings suggest that further work to inform the development of quality care and programming to improve the quality of life of older African Americans with dementia and their caregivers is needed. Specifically, there is a need to 1) identify essential components of ADCs; 2) document the ways that key ADC service philosophies are realized and communicated; and 3) explore the key role of volunteers and students in terms of their roles, activities, and motivations for working with older adults with dementia.
HELPING SENIORS AGING IN PLACE: ADULT GUARDIANSHIP AND ITS ROLE IN GERIATRIC SOCIAL WORK PRACTICE IN CHINA AND JAPAN
Authors: Yan Zi
Published: December 2023

As the most aging society in East Asia, a renewed adult guardianship system for the idea of respect for self-determination, practical use of remaining abilities, and re-socialization have been practiced in Japan for 20 years. While, compared with Japan, in lieu of a comprehensive adult guardianship regime, not until 2017, voluntary guardianship notarization has become the main alternative for supported decision-making and self-determination for incapacitated adults and a tool for mitigating the social risks of the frail elderly in China. Based on secondary data and semi-structured interviews, this study is the first attempt that demonstrates a comprehensive comparison of the recent developments and current forms of adult guardianship initiatives in mainland China and Japan. Besides highlighting the difficulties and challenges faced by these two countries, this article also outlined the types of guardians under their current legal framework, identified the social functions of guardians, the notary office in adult guardianship socialization, and the emerging geriatric social work initiatives adopted. The geriatric social work practices in China and Japan’s adult guardianship point in particular toward the potential provocativeness: adult guardianship in the eastern context—a context marked by a strict family system that emphasizes the virtues of filial piety and discourages outside intervention in family matters. As the number of people with dementia is projected to reach 82 million in 2030, China and Japan’s experience potentially holds wide significance for countries that lack substantial policies and programs for caring for the frail elderly.
PERSONS AGING WITH A PHYSICAL DISABILITY: EVALUATING PARTICIPATION CHANGE USING A TOOL FOR COMMUNITY CARE PROVIDERS
Authors: Putnam Michelle , Morgan Kerri , Hollingsworth Holly , Heeb Rachel , Chen Szu-Wei , Stark Susan L
Published: December 2023

Community participation measures for persons aging with disability were developed and evaluated to support community-based organizations (CBOs) with efficient assessment of change in participation and need for supports/services to facilitate participation. This study aimed to evaluate a set of 9 activity domain measures to broadly assess community participation and change in participation over time. A community-based sample (N=323) of persons ages 45-65 responded to a survey with repeated measures three times annually (T1, T2, T3) between 2019-2022. Nine activity domain measures were developed based on extant research and evaluated with assistance from community-based support service providers. Statistical analyses employed T-tests and Chi-square tests to assess change in participation over time, perceptions of participation satisfaction, and assistance needed to facilitate participation. Participants were asked if they thought changes were attributable to aging, the COVID pandemic, or other factors. Findings showed varying levels of participation across the 9 activity domains, with the lowest participation rate for employment and the highest participation rates for personal leisure and managing medications across T1, T2, and T3. Change in participation over the 3-year period was limited; most change was reported as activity reduction. In general, respondents indicated that reduction was due to their aging or the COVID-19 pandemic. Personal assistance, transportation, environmental modifications, and improved health were identified as factors needed to help increase participation levels. Conclusions were that activity domain measures demonstrated efficiency in identifying participation rates and change. CBOs may deem them useful for assessing support and service needs to facilitate participation.
A STUDY ON COOPERATION BETWEEN COMMUNITY COMPREHENSIVE SUPPORT CENTERS AND DV SUPPORT AGENCIES TO SOLVE ELDER ABUSE
Authors: Katsumata Asako , Tsukada Noriko
Published: December 2023

The purpose of this study was to examine current and future cooperation between Community Comprehensive Support Centers (CCSCs) and Domestic Violence (DV) support agencies in dealing with elder abuse cases among older couples in Japan. The data used in this study are from a nationwide survey from Certified Social Workers (CSWs) at CCSCs in November 2022. A structured questionnaire survey was provided to a randomly selected 3,563 out of 5400 CCSCs, and a total of 1,472 responses from CSWs were obtained (response rate of 41.3%). Preliminary analyses revealed about 70% of the respondents felt that the cooperation with DV support agencies was important (36.8% “important”, 32.6% “somewhat important“). Reasons for why respondents felt the cooperation was “not very important” (2.2%), “not important at all”(0.1%), or “neutral”(28.3%) included “have never cooperated with DV support agencies before” (62.1%), “CCSCs are supposed to deal with abuse cases with people aged more than 65“ (55%), “don’t know about roles of DV support agencies” (42.5%) , followed by “staff members at DV support agencies were not very helpful” (28.1%). Moreover, among 443 respondents (30.1%) who have dealt with elder abuse cases that have continued from their younger age, 25% of CSWs sought for cooperation with DV support agencies, got help and shared information to solve those cases. Findings suggest that professional staff members at both CCSCs and DV support agencies need to be trained to be aware of importance of exchanging their knowledge and resources regarding how to solve elder abuse cases effectively and efficiently.
DETECTING UNDUE HARM ARISING FROM ELDER ABUSE SCREENING: INNOVATIVE METHODS FROM THE EASI-LTC© PILOT STUDY
Authors: Ballard Stephanie , Wilchesky Machelle
Published: December 2023

Screening for elder abuse can cause victims to experience feelings of unpleasantness and/or relive painful memories which can be an ethical concern. Ensuring the safety of all participants/users, in our case long-term care (LTC) residents, is of the utmost importance. Drawing from approaches used in the intimate partner violence and clinical trials literature, we developed a novel typology of harm and a series of procedures to evaluate any negative consequences that might be incurred as a result of participating in the Piloting the Elder Abuse Suspicion Index-long term care©: A Mixed Methods Feasibility Study. Our typology includes subjective and objective reporting from a multitude of sources, including: 1) Interviews with LTC residents using a modified Consequences of Screening Tool, adapted from MacMillan et al, 2009; Opinions of the 2) Study social worker conducting validation assessments and 3) LTC residents and institutional stakeholders; 4) Feedback from study research assistants who administer the tool using a specialized Adverse Events Form; and 5) Chart reviews. Procedures include the creation of an independent interdisciplinary pilot study safety committee, chaired by a geriatric psychiatrist and convened to conduct interim evaluations after the first 5, 10, and 20 residents have participated, the liberation of social work teams, who are to be on standby and available to intervene as necessary, and the creation of participant resource cards displaying pertinent phone numbers for immediate assistance. To our knowledge, this is the first elder abuse study to conduct a thorough analysis of study-induced harm.
HIDING IN PLAIN SITE: LOW BACK PAIN RATES IN OLDER ADULTS WITH LUMBAR SPINAL STENOSIS
Authors: Hogans Beth , Siaton Bernadette , Goldman Stuart , Sorkin John
Published: December 2023

Introduction

Lumbar spinal stenosis (LSS) is highly prevalent in older adults, negatively impacting mobility and quality of life. Typically associated with progressive impairment of walking distance and pain which radiates into the legs, there is persistent controversy regarding the extent to which low back pain (LBP) is associated with LSS.

Objectives

To evaluate population-level evidence for and strength of an association of LBP with LSS in older adults. Data Source: Medicare Part B Carrier and Outpatient claims data, 5% standard analytical file for 2017.

Methods

Unadjusted and adjusted analysis of cross-sectional data, combined with condition process analysis

Results

Several hundred thousand older adults met criteria for inclusion in this study. Lumbar spinal stenosis was common in both older adult males and females, but slightly more commonly diagnosed in females. Low back pain was prevalent in older adults but more so in females. A majority of older adults with LSS were diagnosed with LBP. Unadjusted and adjusted analyses demonstrated that LBP was present at increased rates in older adults with LSS.

Conclusions

Low back pain is diagnosed in the majority of older adults diagnosed with lumbar spinal stenosis. It is important to recognize that the symptom profile of older adults with spinal stenosis includes low back pain and treatment should be adjusted to respond to this management need.
IMPACTS OF CHANGE FROM 27 TO 30 CHRONIC CONDITIONS ALGORITHM ON PREVALENCE OF DIABETES AND DEMENTIA
Authors: Kim Hyosin , Zafar Anum , Lin Haiqun , Setoguchi Soko , Jarrín Olga
Published: December 2023

The Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Warehouse (CCW) algorithm used to identify the presence of chronic conditions recently changed. Not only was the number of chronic conditions changed, but also the diagnosis codes and look-back period. Accompanying documentation encourages researchers to empirically assess the change in algorithm for their studies. The purpose of this study is to highlight the impacts of switching to the 30 CCW Chronic Conditions file on the prevalence of selected chronic conditions (diabetes and dementia) in an end-of-life cohort of Medicare beneficiaries (n=2,182,092), with sub-analysis by insurance type. Data sources included the Master Beneficiary Summary File base file and chronic conditions segments (27 vs. 30). The study population was all U.S. Medicare beneficiaries over age 18 who died in 2019. This retrospective observational study summarizes the change in prevalence of diabetes, dementia, and stroke/transient ischemic attack resulting from the new chronic conditions algorithm (27 to 30), stratified by insurance type. Among Medicare beneficiaries who died in 2019, using the 30 vs. 27 Chronic Conditions algorithm decreased the prevalence of diabetes (45% vs. 32%) and dementia (41% vs. 31%). This change may pose challenges for longitudinal and end-of-life research. A decrease in the counting of dementia, diabetes, and stroke cases could lead to an underestimation of their burden on society and be misleading for policymakers and the public. This could result in inadequate policies and resources to address prevention and treatment, which could result in inadequate healthcare services for the affected population.
AGING WITH HIV: ASSOCIATION OF ART REGIMEN AND ADHERENCE TO VIRAL SUPPRESSION
Authors: Manalel Jasmine , Kaufman Jennifer , Fusaris Ethan , Correa Arlene , Ernst Jerome , Brennan-Ing Mark
Published: December 2023

Adherence to antiretroviral therapy (ART) is essential to effective management of HIV among an increasing population of older adults. Newer ART regimens are more “forgiving” of poor adherence allowing for viral suppression at lower adherence levels (i.e., < 90%). This is especially promising for some older adults who may struggle with adherence due to high rates of multimorbidity and polypharmacy. We aimed to determine how ART forgiveness varies depending on ART type and adherence. Data came from 2017-2019 claims and clinical records of 1,044 HIV-positive members of a Medicaid managed care plan who were 50 to 65 years of age. Pharmacy fill data were examined on a quarterly basis to characterize ART medications using latent class analysis (LCA), which captures the complexity of real-world ART usage (i.e., multiple medications, ART switching). LCA yielded five distinct ART utilization patterns over three years, mostly characterized by recent medications and formulations of ART, though they varied in number of tablets and in medication class (e.g., boosted protease inhibitors). Logistic regression models adjusting for demographics and health-related covariates revealed that ART medication patterns did not consistently differ in odds of maintaining viral suppression across adherence levels (< 50%, 50% to < 80%, 80% to < 85%, 85% to < 90%, and >=90%). In contrast, other factors, including nadir CD4 count and behavioral health conditions, were related to viral suppression across models. This highlights the importance of life-course illness trajectories when considering disease management and treatment strategies for older adults living with HIV, especially those with difficulty maintaining near-perfect adherence.
HOW PERSON-CENTERED SERVICE DELIVERY SUPPORT QUALITY OF LIFE: WHAT NCI-AD TELLS US
Authors: Giordano Stephanie , Plasencia Rosa
Published: December 2023

COVID-19 left a broad impact - for many older adults the pandemic led to changes in perceptions of person-centered services and experience with LTSS. Person-centered service delivery is widely accepted as a gold standard to supporting better outcomes, experience, and satisfaction; yet, there remains a gap in understanding person-centeredness from the perspective of people receiving the service. NCI-AD surveyors hear directly from older adults and people with physical disabilities on satisfaction with service delivery and quality of life. Using 2021-22 data, we’ll discuss the perception of responsiveness and person-centered service delivery among other important measures. For example, older adults who were satisfied with provider response were more likely than those who were not satisfied to have more positive outcomes related to access to the community, ability to maintain relationships, and fewer unmet service needs. This session will delve further into this relationship between person-centered service delivery and quality of life outcomes, addressing what this means for policy and practice. Data presented come from the 2021-2022 National Core Indicators® Aging and Disabilities (NCI-AD™) Adult Consumer Survey (ACS). The ACS includes two main survey sections. The Background Information provides key data about survey participants, including demographics, service-related characteristics, and clinical diagnoses, typically collected from administrative records about the person. The main survey section includes questions on a range of topics that address the quality of the service delivery system; including responsiveness of services and supports, availability of needed services, and quality of life outcomes.
IMPACT OF HOME HEALTH VALUE-BASED PURCHASE MODEL ON OWNERSHIP OF HOME HEALTH AGENCY: A LONGITUDINAL ANALYSIS
Authors: Ma Chenjuan
Published: December 2023

Home health care serves over 5 million Americans “aging in place”. In January 2016, home health value-based purchasing model (HHVBP) was introduced and piloted in 9 states in the US with a purpose of improving care quality and efficiency, and expanded nationwide in 2023. This study aimed to examine the impact of HHVBP on business operation of home health agencies (HHA), including ownership changes. This is a longitudinal study using 7 years (2013-2019) of data from two national data sources. A dummy variable was used to indicate whether an HHA is in a state with HHVBP or not. Ownership measures included both the type and changes of ownership between 2013-2017. A total of 14,334 HHAs (95,137 agency-years) were included in analysis. Of the 14,334 agencies, about 19% were in HHVBP states, 88% continued business in all study years, 1679 were new agencies and 49 agencies discontinued business. In HHVBP states, 363 out of 2781 (13%) were newly added, compared to 1316 out of 11,553 (11%) in non-HHVBP states. Agencies in HHVBP states were more likely to be public agencies (e.g., 6.08% vs. 4.97% in 2013; 5.62% vs. 4.60% in 2018), though it slightly decreased over time; and experience changes in ownership and particularly the years after the implementation of HHVBP (e.g.,2.44% vs. 2.38% in 2013; 7.03% vs. 4.39% in 2018). The HHVBP can have a significant impact on the operation and ownership type of home health agency, which in turn may impact availability and quality of home health care.
ISSUES OF LIFE-SUSTAINING TREATMENT DECISION ACT IN CLINICAL PRACTICE FOR INDIVIDUALS AT THE END OF LIFE
Authors: Song Eunjeong , Shin Dongsoon , Lee Jooseon , Eom Minjeong , Oh Suhee , Yun Seon Young , Lee Heejung , Song Rhayun
Published: December 2023

This study aimed to investigate the status and issues related to the patient’s decision-making regarding life-sustaining treatment (LST) in clinical practice and to provide strategic suggestions to improve the hospital policy. The retrospective observational study was conducted with adult patients, admitted between Jan 1 and Dec 31, 2021, who went through the end-of-life process and died in a university hospital in Korea. The electronic data included age, gender, admission date, expiration date, and Do-not-attempt-resuscitation (DNAR) and LST-related data (date to sign, who signed, and clinical state when signed). A total of 916 patients were included. Only 4.1% of the patients decided on LST by themselves, while the decision was made mainly by the family, specifically children (54.2%). The time of signing DNAR consent was before eight days from the date of death (33.7%) and the previous day of the death (27.6%). While early warning score was used to predict the critical state of the patients, the period from the date of sign to the date of death was 8.9 (SD=25.7) days for DNAR and 2.76 (SD=6.95) days for LST. Strategic suggestions were made to facilitate the timing of signing the consent form for LST based on the early warning score, and encourage patient involvement in the decision-making process. Further efforts are required to improve the awareness of patients and medical staff on the implementation of LST and to clarify the ambiguity of the timing of document preparation.
ASSOCIATIONS BETWEEN GAIT MEASURES AND QUADRICEPS MUSCLE THICKNESS AS MEASURED BY POINT-OF-CARE ULTRASOUND
Authors: Ganbat Uyanga , Feldman Boris , Arishenkoff Shane , Meneilly Graydon , Madden Kenneth
Published: December 2023

Gait parameters and sarcopenia predict falls risk which is one of the major causes of both mortality and morbidity among older adults. Our objective was to evaluate whether anterior thigh muscle measured by point-of-care ultrasound is significantly associated with standard gait measures. All subjects were referred from ambulatory geriatric medicine clinics at an academic center. Quadriceps muscle thickness was measured by a portable ultrasound device. Gait variables were measured by the patient walking for 6 minutes. The primary response variables were gait variables, and the predictor variables were age, biological sex, body mass index, and MT. Univariate and multivariate regression analyses were performed. A total of 150 participants were recruited from geriatric medicine clinics. Muscle thickness was measured in 149 participants and the mean (SD) was 1.91 (0.52) (median 1.82 cm, 0.96 to 3.68 cm). Among all the gait variables, average swing time (P = 0.010) and average stance time (P = 0.010) were correlated significantly with muscle thickness. Muscle thickness also showed a negative association with step time variability percent (P = 0.005). Muscle thickness (P = 0.046), age (P = 0.025), and gender (P = 0.047) had a statistically significant association with present step time variability. PoCUS showed a significant association with average swing time, average stance time, and step time variability all of which are predictive of future falls risk. Although more work needs to be done, PoCUS is a reliable and feasible muscle measurement method, which could lead to faster clinical decision-making and falls risk assessment.
GERIATRIC RENAL TRANSPLANT CO-MANAGEMENT: EVALUATION OF FRAIL OLDER ADULTS FOR TRANSPLANT ELIGIBILITY
Authors: Doan Jared , Chow Stephanie , Baim-Lance Abigail , Blum Moritz , Lerner Susan , Rosen Greta , Hung William , Ko Fred
Published: December 2023

Older transplant patients have higher rates of adverse post-transplant outcomes. The Renal Transplant Co-Management (RCOM) program is a collaboration of surgeons, geriatricians, and social workers to medically and psychosocially optimize older renal transplant candidates by providing comprehensive geriatric-centered vulnerability assessments with corresponding medical and psychosocial interventions. The RCOM assessment aids the surgical team in deciding patient transplant eligibility, and greater clarity on its role may be clinically valuable. Fifty-five patients from a single metropolitan hospital were evaluated during the study period (1/1/22 to 6/16/22). Assessments included frailty (Clinical Frailty Scale/CFS), functional status (Karnofsky Score, Katz Index, Lawton-Brody Scale) and cognition (Montreal Cognitive Assessment/MoCA) – factors that the renal transplant team considers in listing a patient for surgery (i.e., listed/transplanted) or not (i.e., ineligible/removed from the list). Twenty patients (36.4%) were female. Mean age of ineligible/removed (n=10) and listed/transplanted (n=45) patients was 74.7 (4.8) and 72.5 (3.8), respectively, with no differences in age, gender, race, education, or health insurance between groups. Patients who were listed/transplanted had a higher Lawton-Brody instrumental activities of daily living (IADL) score than those not listed (p=0.025, t-test). CFS (p=0.118), Karnofsky (p=0.09), Katz (p=0.074), and MoCA (p=0.094) were similar but approached statistical significance despite a small sample size. Functional status as measured by IADL may be a significant factor considered in determining the transplant eligibility of older adults. Ongoing study and a larger sample size may provide greater clarity on the physical and cognitive functions that impact eligibility for transplant listing in frail older adults.
RELATIONSHIPS BETWEEN PAIN AND OPTIMISM AMONG COMMUNITY DWELLING OLDER ADULTS
Authors: Rivera Lucia , Mancilla Isabel , Bergstrom Jaclyn , Molina Anthony
Published: December 2023

Measures of life outlook in older adults have been investigated in connection to pain, as both pain management and outlook are important factors of successful aging. Positive outlook helps promote healthy aging while depression is associated with higher pain levels and interference, which negatively contribute to the aging process. Thus, we hypothesized that higher pain levels are associated with lower optimism among community-dwelling older adults. We utilized data from the UC San Diego Successful Aging Evaluation (SAGE), a prospective longitudinal cohort study initiated in 2010, to evaluate the relationship between pain and optimism in 378 community-dwelling adults aged ≥50 years. We used the revised Life Orientation Test (LOT-R) to measure optimism and three pain subscales, PROMIS Pain Interference, PROMIS Pain Intensity, and MOS 36-Item Short-Form Health Survey (SF-36), as pain measures. Regression analyses reveal negative relationships between pain and optimism for all three pain scales, with regression coefficients of -0.277 (p< 0.0001), -0.246 (p< 0.0001), and 0.269 (p< 0.0001) respectively. The correlations were strongest among men, Caucasians, and college graduates. The correlations remained significant when adjusting for gender, age, completion of college, marriage status, and household income, but not for race/ethnicity. This study was limited by the underrepresentation of non-Caucasian participants (N=87) and by the self-reported nature of the SAGE data. These findings indicate value in considering physical and psychological elements together when encouraging healthy aging. Future research can investigate whether interventions that increase optimism can decrease pain in older adults or whether pain management interventions can increase optimism in this population.
THE IMPACT OF HEALTH-RELATED QUALITY OF LIFE ON CLINICAL OUTCOMES IN ATRIAL FIBRILLATION POPULATIONS
Authors: Pierre-Louis Isabelle , Bamgbade Benita , Lopez-Pintado Sara , Forrester Sarah , Wang Weijia , McManus David , Saczynski Jane
Published: December 2023

Although there is a large body of literature linking atrial fibrillation (AF) to adverse clinical outcomes, little is known with regards to the potential links between health-related quality of life (HRQoL) and AF related clinical events. To address this gap, individuals with AF aged ≥ 65 years were recruited from clinics in Massachusetts and Georgia between 2016-18 and followed until 2020. HRQoL was assessed via the Atrial Fibrillation Effect on Quality of Life (AFEQT). The AFEQT is a validated HRQoL measure that quantifies the effect of AF on patients’ daily life on a scale of 0 to 100. AFEQT scores < 80 indicated poor HRQoL and ≥ 80 indicated good HRQoL. The clinical events included major bleeding, stroke, and death. Of the 1,244 participants, the mean age was 75.5 (SD: 7.1), 49% identified as female, 13% were non-White, and 57% were married. After 2 years, 105 major bleeding events (49% poor HRQoL), 19 strokes (42% poor HRQoL) and 108 deaths (59% poor HRQoL) occurred. Our composite outcome included 200 participants (53% poor HRQoL). After adjusting for key covariates, poor HRQoL was associated with an increased risk of our composite outcome (adjusted hazard ratio [AHR]= 1.34, 95% CI: 1.00, 1.80) and death (AHR= 1.58, 95% CI: 1.05, 2.38). We found no significant differences between poor and good HRQoL in major bleeding and strokes. HRQoL is important when assessing health of AF patients. Health providers who treat patients with AF should consider HRQoL when evaluating the risk of death and other adverse outcomes.
EFFECTS OF MARITAL STATUS AND ETHNICITY ON NEUROCOGNITIVE FUNCTIONING IN A RURAL OLDER POPULATION
Authors: Elliott Lauren , Singer Jonathan , Rerick Peter , Fadalla Carol , McLean Elisabeth , Jump Alayna , Molinar-Lopez Veronica , Neugebauer Volker
Published: December 2023

Research indicates being married is related to better physical and psychological health. Yet, little is known regarding the relationship between marital status and neurocognitive functioning and whether it differs based on ethnicity (Hispanic vs. non-Hispanic). Data from 1864 participants (Mage=59.68, SD=12.21), who were mostly Hispanic (n=1053), women (n=1295), and married (n=1,125) from Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education, & Research) were analyzed. Neuropsychological testing comprised RBANS, Trails Making Test, and Clock Drawing. Participants were dichotomized into married and unmarried (i.e., widowed, divorced, separated, never married). There was a significant interaction between Hispanic identity and marital status on overall neurocognitive functioning (F(1,1480) =4.79, p < .05, ηp2=.003). For non-Hispanic individuals, married individuals had higher overall neurocognitive functioning compared to the unmarried individuals, whereas neurocognitive functioning for Hispanic individuals did not significantly differ between married and unmarried individuals. There were significant main effects as married individuals (M=84.95, SD=15.56) had greater overall neurocognitive functioning than unmarried individuals (M=83.47, SD=15.86; F(1,1480) = 14.67, p < .001, ηp2=.01), and Hispanic individuals (M=78.02, SD=14.25) had lower overall neurocognitive functioning than non-Hispanic individuals (M=91.43, SD=15.07; F(1,1480) = 284.99, p < .001, ηp2=.16). Hispanics living in rural areas experience additional stressors that could lead to worse neurocognitive functioning, which is supported by the Lifespan Biopsychosocial Model of Cumulative Vulnerability and Minority Health, which postulates that race/ethnicity/SES-related stressors exacerbate the impact of other life stressors. Reduction of stress on rural Hispanics should be a priority as it could positively affect their neurocognitive functioning.
INFLUENCE OF CHANGES IN MEMORY AND THINKING ON PREFERENCES AND SATISFACTION OF HEALTH CARE COMMUNICATIONS
Authors: Sillner Andrea , Boltz Marie , Berish Diane , Hill Nikki
Published: December 2023

Communication about changes in symptoms or healthcare management strategies is common between older adults and their healthcare providers, such as physicians and registered nurses. Healthcare communication can occur in the context of an in-person visit or using technology through telehealth or a healthcare portal. Understanding factors that influence preferences for healthcare communication and satisfaction are important for patients and providers. For example, changes in memory and thinking may impact older adults’ ability to communicate healthcare needs or to understand what is being told to them about their health conditions. The aim of this study was to understand the influence of cognitive changes on preferences and satisfaction with communications in a sample of adults over the age of 50, living in the community, who reported on changes in memory and thinking over the last 5 years (N=289). Results showed that older adults who reported a decline in their memory and thinking over the last 5 years were significantly more likely to report that their healthcare communication needs were not met. They were also significantly less likely to be satisfied with their healthcare communications. These important findings demonstrate the need to further explore relationships between self-reported cognitive changes and communication with healthcare providers. This can inform psycho-social intervention development, ultimately enhancing healthcare communication to meet older patient preferences and improve satisfaction with the overall goal of impacting healthcare outcomes.
LONGITUDINAL PATTERNS OF COGNITION CHANGES AMONG KOREAN OLDER ADULTS WITH NO PARTNERS: A LATENT PROFILE ANALYSIS
Authors: Kim Yeoju , Kim Giyeon
Published: December 2023

Cognitive function decline among older adults becomes a hot topic in South Korea, as the population of the older adults has been increasing dramatically. The purpose of this study was to explore the longitudinal patterns of the cognitive function and identify factors influencing these changes among Korean older adults without their partner, using latent profile analysis. The samples included 612 adults aged 60 and older without partner from the Korean Longitudinal Study of Aging (KLoSA) in 2016, 2018, and 2020. The logistical regression was used to identify factors influencing group classification. Result revealed four types of the latent profiles were derived based on the cognitive function: the mid-level group, the high-level maintenance group, the low-level maintenance group, and low-level decline group. Factors such as depressive symptoms, social activity participation, and age were significantly associated with cognitive function decline in the high-level maintenance group, and the age was associated with the cognitive function changes. The findings highlight the importance of interventions to prevent cognitive function changes among older adults, considering depressive symptoms, social activity participation, and age.
RATES OF VISION AND HEARING IMPAIRMENT RELATED TO COGNITIVE DIFFICULTIES AMONG OLDER ADULTS IN MISSISSIPPI COUNTIES
Authors: Su Yan-Jhu , Jansen Taylor , Lee Chae Man , Silverstein Nina , Dugan Elizabeth , Xu Shu , White Kina
Published: December 2023

Measures of population health can be a tool to advance healthy equity, because they identify disparities that may otherwise go undetected. In this study, we examined if community rates of sensory impairments (vision and/or hearing difficulty) had any association with self-reported cognitive difficulties among older adults. Understanding the distribution of multiple conditions that impact function and independent living may identify geographic hotspots in need of supportive interventions. We describe the prevalence of visual difficulty and hearing difficulty among Mississippi adults age 65 years and older and examine the association of visual difficulty and hearing difficulty with cognitive difficulty in older adults at the community level in 82 counties in Mississippi. Small area estimation techniques were used to calculate age and gender adjusted community rates using three data sources: the American Community Survey (2016-2020), the Behavioral Risk Factor Surveillance System (2017-2020), and CMS Medicare Beneficiary Summary Files (2018). Results show there are 8.7% of older adults 65+ with self-reported vision difficulty and 15.5% with self-reported hearing difficulty. The multiple linear regression models after adjusting for age, gender, race, marital status, education, income, and chronic diseases, counties with higher rates of vision difficulty and hearing difficulty were significantly associated with higher rates of cognitive difficulty compared to those with lower prevalence (vision difficulty: β=0.36, p< 0.001, hearing difficulty: β=0.32, p< 0.001). Implications suggest the need for practitioners and policymakers to establish cognitive difficulty-related interventions targeted to service areas with a high prevalence of sensory difficulties.
THE COGNITION IN PRIMARY CARE PROGRAM: A STEP-BY-STEP CLINIC WORKFLOW PUTTING THE GSA KAER TOOLKIT INTO ACTION
Authors: Raetz Jaqueline , Fitzpatrick Annette , Belza Basia , McKiddy Sarah , Hsu Amy , Liao Joshua , Park Christina , Gaster Barak
Published: December 2023

In 2020 University of Washington (UW) Medicine began developing Cognition in Primary Care (CPC), a quality improvement program adapting the GSA KAER Toolkit to help primary care providers (PCPs) detect patients with cognitive impairment in their 16-clinic primary care network. The CPC consists of a 3-part training program to help PCPs diagnose, manage and counsel patients; a set of tools embedded into the electronic health record to facilitate cognitive evaluation; and an in-clinic workflow providing on-site support for providers within their own clinic setting. During this process we interviewed providers and developed a hybrid remote and in-person orientation for clinics to initiate a workflow to support improved cognitive evaluations. Utilizing pre-implementation input, the CPC in-clinic workflow was pilot-tested at two UW primary care clinics in 2021/2022. This presentation will describe content of the clinic orientation and implementation of CPC to include 1) the typical timeframe and content of orientation; 2) meetings with clinic leadership; 3) overview of provider/staff meetings; 4) in-person walk-through for placement of materials; 5) invitation to training; 6) a 12-page handbook outlining steps in the workflow; 7) other printed CPC materials, e.g., dementia warning signs, MoCA and AD8 forms, Alzheimer Association referral cards; and 8) follow-up focus group feedback. Evaluation of the pilot clinics following implementation found significant use of all tools by PCPs and an increase in diagnoses of mild cognitive impairment. This clinic workflow may be useful as a model for other health care systems to initiate cognitive evaluation programs in primary care.
THE RELATIONSHIP BETWEEN ORAL HEALTH AND COGNITIVE FUNCTION: EVIDENCE FROM THE LASI
Authors: Pan Xi , Kelekar Uma , Muhammad T
Published: December 2023

The present study aimed to examine the association between oral health and cognitive function among older adults in India. Data for the study were selected from the Longitudinal Aging Survey of India (LASI, 2017-2019) and the LASI Diagnostic Assessment of Dementia (LASI-DAD) and 4,096 respondents aged 60 and above were included. Oral health was measured by self-reported physician-diagnosed oral health problems including presence of painful teeth, ulcers for more than two weeks, bleeding gums, swelling gums, loose teeth, dental cavities or caries, soreness or cracks in the corners of the mouth, or other problems as well as edentulism (i.e., losing all natural teeth, some natural teeth, or no teeth). A higher number of these problems indicated a more complex oral health condition. Cognitive function was measured by the standardized total score of all cognitive tests in the Harmonized Cognitive Assessment Protocol (HCAP). Binomial logistic regression models were used to analyze the relationship between the diagnosis of oral health problems and cognitive function. Results showed that having one or more oral health problems was associated with lower scores on cognitive function (β=-0.16, p=0.04), after controlling for sociodemographic characteristics and health status. There was no significant association between edentulism and cognitive function. Findings of the study suggest that oral health is integral to long-term overall health, specifically cognitive function. Our findings highlight the importance of educating older individuals about the connection between oral health and cognitive function along with the need for broadening their access to oral health care in India.
THE TYPES AND CONSISTENCY OF PARTICIPANT-SPECIFIED PROXIES DURING THE SPRINT CLINICAL TRIAL
Authors: Coschigano Kat , Gaussoin Sarah , Jaeger Byron , Rapp Stephen , Williamson Jeff
Published: December 2023

Background

For clinical trials or patient care, reports from a person familiar with the trajectory of a participant’s cognition are needed to ascertain incident Mild Cognitive Impairment and dementia. Informants offer a more unbiased evaluation of cognitive status. Recent large clinical trials studies, such as SPRINT, provide information about the contributions and consistency of informants throughout extended follow-up.

Methods

SPRINT participants named proxies and relationship at study onset. Proxies provided information for the Functional Activities Questionnaire (FAQ) and Dementia Questionnaire (DQ). We collapsed proxy relationships into seven categories and evaluated the proportion of proxies in each category at baseline, how frequently the same proxy was retained to the last visit, and the frequency of successful proxy contact during the trial.

Results

Of the 9,361 randomized SPRINT participants, 7,586 participants listed a proxy relationship from which we identified 7 categories. Participants were 35.6% female, with baseline mean age of 67.9 years. The proportion of proxies in each category was spouse/partner (51.7%), child (23.6%), sibling (8.7%), other family member (6.2%), and unelated (8.8%). The overall consistency of proxy continuation between the baseline and final SPRINT visit (mean 5.1 years) was 90.11%. Proxy consistency from first visit to last visit for a child was 93.41%, spouse/partner (91.87%), other family member (80.1%), brother/sister (86.2%), non-related (84.65%), and parent (81.73%).

Conclusion

Immediate family members (spouse, child, or sibling) comprised the majority of proxies in SPRINT. Importantly, more than 90% of identified proxies at baseline continued to be available over the life of a 5-year trial.
BARRIERS AND FACILITATORS TO IMPLEMENTING MEDICARE’S CHRONIC CARE MANAGEMENT IN RURAL PRIMARY CARE
Authors: Punke Elizabeth , Dabrowski Barbara , Teply Abby , Richardson Katy , McKibbin Christine , Carrico Catherine
Published: December 2023

In 2015, the Centers for Medicare and Medicaid Services introduced Chronic Care Management (CCM) to provide reimbursement to practices for care coordination services necessary to manage chronic conditions among older adults. However, uptake of this program among primary care practices is low, and few Medicare beneficiaries actually receive this service. Implementation of CCM may be even more challenging in rural, low-resourced areas. The purpose of this study was to examine factors associated with more and less successful implementation of CCM within primary care practices located in a rural state. A qualitative study was conducted, which was guided by the Consolidated Framework for Implementation Research (CFIR). Employees of practices (n = 8) that have implemented CCM were approached for study participation. Members (n = 17) of various healthcare teams were included in the study. Participants completed sociodemographic, professional, and practice history measures and completed a qualitative interview. Participants (n = 17) were predominantly White (n = 16; 94%), female (n = 16; 94%), and represented care coordinators, primary care providers, allied health professionals, and administrators. CrossTX records were analyzed to categorize practices by high and low implementation success. Content analysis, guided by CFIR, identified domains associated with implementation success, including Intervention Characteristics (I.e., Relative Advantage), Outer Setting (e.g., Patient Needs and Resources), Inner Setting (e.g., Implementation Climate, Leadership Engagement), and Process (e.g., Champions). Strategies to address barriers include addressing characteristics of the Inner Setting (e.g., Available Resources). Developing training mechanisms to address staff turnover is critical to address barriers.
LEVERAGING IOT AND NATURAL LANGUAGE PROCESSING TO IMPROVE WELL-BEING OF CHRONIC PATIENTS
Authors: Mullachery Balakrishnan , Chatterjee Samir , Brahma Arindam
Published: December 2023

According to the Centers for Disease Control and Prevention, in the United States, about 80% of older adults - individuals aged 65 years and older, have at least one chronic health condition. Chronic diseases require ongoing medical attention or limit activities of daily living, which in turn, affects quality of life. Heart diseases, cancer, and diabetes are the leading chronic diseases. Literature shows that timely and frequent follow-ups by providers significantly reduce readmissions of chronic patients and contribute to their well-being. However, health care provides do not have adequate bandwidth for regular patient follow-ups, which is vital for chronic patients. One solution for this growing problem, is to leverage smart home monitoring technologies facilitating self-care, which in turn can contribute to patients’ well-being. The goal of this research is to build and leverage an IoT-based smart home monitoring platform and assess its impact on the well-being of chronic patients. The platform included an mHealth mobile app with daily journaling capability, which allowed patients to blog about their symptoms, daily activities, and feelings. Analyzing patients’ daily blog data with Natural Language Processing (NLP) methods, this research revealed a strong correlation between a patients’ blog entries and their well-being score. The results also demonstrated that patients’ well-being scores can be predicted from such journal entries analyzed at real time, collected remotely from their home environment, leading to timely diagnosis and intervention opportunities. A field trial was conducted involving five heart disease and eight cancer patients for 180 days to validate the conclusions.
WHOLE HEALTH(Y) AGING WITH GEROFIT: THE DEVELOPMENT OF A PILOT WELLNESS PROGRAM FOR OLDER VETERANS
Authors: Parker Elizabeth , Ortmeyer Heidi , Giffuni Jamie , Addison Odessa , Hall Katherine
Published: December 2023

The Veterans Health Administration (VHA) services over 9 million Veterans; approximately half are older than 65 years of age. Veterans are at a higher risk of comorbidities, including obesity and related chronic diseases, which contributes to higher health care costs, mobility disability, poor quality of life and even death. Gerofit is a VA Best Practice and Whole Health clinical exercise program for Veterans >65yrs that has positively impacted physical functioning, mental health symptoms, medication burden and 10-year mortality. This project describes the development of a comprehensive wellness and health promotion program incorporated into Gerofit, called Whole Healthy Aging Gerofit (WHAG). This novel program implemented wellness components to supplement the Gerofit in-person or virtual exercise options, including health education seminars, mindfulness classes, yoga classes, nutrition education classes, produce pick up service, and the Companion Dog Fostering program. WHAG deliverables included class attendance, individual Personal Health Inventories, observed physical function, self-reported physical activity levels, diet quality, perceived mental health, and Veteran satisfaction. The average Gerofit participant is approximately 73 years old, with obesity and multiple comorbid conditions (n=16), takes 10 medications, and is functionally impaired as assessed by gait speed (1.04 m/s). Programs that target healthy aging are needed to ensure the health of the population as it ages. This pilot program, WHAG, is one example of a comprehensive, patient centered wellness program that supports participants in setting their own goals and definitions of wellness to promote healthy aging.