bluuebunny/crossref_metadata_2025 huggingface dataset:
UNDERSTANDING CHALLENGES AND SOLUTIONS FOR DEAF OLDER ADULTS
Authors: Shende Shraddha , Koon Lyndsie , Singleton Jenny , Rogers Wendy
Published: December 2023

The Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) project explores everyday activity challenges and solutions experienced by U.S. older adults as they age with a lifelong disability involving vision, motor, or hearing. Here, we report our findings from our community-engaged research with older adults who self-identify as members of the U.S. Deaf Community and who use American Sign Language (ASL) as their primary language. Using trained Deaf interviewers, we conducted semi-structured interviews in ASL with 60 Deaf participants (age 60-79 years) to understand their challenges performing various everyday activities (e.g., doing things around the home, activities outside the home, transportation, and managing health). Overall, our thematic analyses revealed that Deaf older adults navigate everyday tasks quite well. However, they experience particular challenges with technology, communication, and accessibility; specifically, fragile or inaccessible technology systems. For instance, technology alerting systems at home (e.g., smoke alarms) or airports (e.g., gate change announcements) are typically auditory. Accessibility is also poor when healthcare or wellness providers fail to provide an ASL interpreter. When probed about their responses to these challenges, Deaf older adults often reported frustration or resignation when experiencing barriers; the need for constant vigilance and self-advocacy; or reliance on hearing family members when systems fail them. Improving communication access and technologies that Deaf older adults rely on is critical and requires the inclusion of individuals from the Deaf community to identify the challenges and potential avenues for solutions.
USE OF THE EXERCISE FEATURE OF A HEALTHCARE APP AND CHANGE IN THE PREVALENCE OF LOWER BACK PAIN
Authors: Takase Mai , Odagami Kishimori , Eguchi Hisashi , Mori Koji , Itabashi Masako , Kono Sei , Shimizu Yosuke , Iijima Katsuya
Published: December 2023

Lower back pain among older adults has been associated with serious conditions, such as depleted cognitive function, and can accordingly limit the degree to which older adults can live independently. Therefore, it is extremely important to engage in exercise and conditioning activities from an early age. We developed a healthcare app with an AI engine that recommends personalized stretch, muscle training, and aerobic exercise programs. These programs were constructed by care prevention exercise experts and are personalized based on the user’s physical balance and the locations of their body pain. This study examined the association between the use of the exercise feature of this app and the change in the prevalence of lower back pain among users. A three-month longitudinal survey with three model companies in Japan (n=730) was conducted from the fall of 2022 to the winter of 2023. Online questionnaire surveys were administered to track the participants’ levels of lower back pain and app logs were retrieved to assess the users’ exercise records. Use of the exercise feature (not used vs. used) was the independent variable and change in the level of lower back pain (none to mild vs. mild to severe) was the dependent variable. A binary logistic regression analysis (n=331, female=34.1%, over 50 years old=43.5%) revealed that the use of the exercise feature led to lower level of back pain (OR = 0.37, 95%CI = 0.29-0.67). This result suggests that the use of this kind of exercise app may help alleviate lower back pain.
USER-CENTERED DESIGN FOR SOCIALLY ASSISTIVE ROBOTIC ACTIVITIES WITH OLDER ADULTS IN LONG TERM CARE
Authors: Maxwell Cathy , Ghosh Ritam , Khan Nibraas , Migovich Miroslava , Tate Judith , Latshaw Emily , Mion Lorraine , Sarkar Nilanjan
Published: December 2023

Apathy is common among older adults (OAs) in long term care (LTC) and associated with adverse outcomes. Engaging residents in socially interactive multimodal activities is resource intensive. Socially assistive robots (SARs) may supplement LTC staff resources. However, few studies have involved OAs in the design of SAR activity. We conducted a multi-step user-centered design process to design and evaluate SAR activities that a) used different robots (humanoid, puppy), b) a virtual reality interface, and c) required dyadic interaction between residents. Phase 1 (system design) focused on prototype development with input from literature and an advisory panel of LTC adults and staff. Phase 2 focused on determining usability measures. Phase 3 (iterative testing) focused on field testing at two LTC sites. Multiple sessions were conducted that required looping back to earlier stages of prototype development for refinement and improvement of both the activity and the system until end users deemed them usable.

Results: 12 residents (ages 72-92, 9 women) and 5 LTC staff participated in the design of four SAR activities (music, fishing, painting, and spelling). Perceived comfort and confidence improved from baseline (d=0.708). Interaction between pairs increased from 0.16/min to 1.14/min. LTC staff were able to administer the system.

Conclusion: Older LTC adults are pivotal in informing technology development and capable of providing essential information in use and acceptance of technology. Next steps include large scale feasibility and effectiveness testing in a clinical trial among diverse older adults residing in LTC facilities.
UTILIZING ADVANCED DRIVER ASSISTANCE SYSTEMS IN LATER LIFE: INSIGHTS FROM A LONGITUDINAL STUDY ON AGING DRIVERS
Authors: Louis Renee St , Eby David , Kostyniuk Lidia , Molnar Lisa , Zakrajsek Jennifer , Zanier Nicole , Nyquist Linda , Yung Raymond
Published: December 2023

Level 1 and 2 Advanced Driver Assistance System (ADAS) technologies (e.g., adaptive cruise control, blind spot warning, lane keep assist) are predicted to be available in approximately three-fourths of all vehicles worldwide by 2025. To realize the potential of these systems in extending safe mobility for aging adults, it is critical that the driver understands the functionality of the technology and uses the system appropriately. The current study examined demographic and vehicle technology questionnaire data from the Longitudinal Research on Aging Drivers (LongROAD) cohort study which concluded in December 2022. A total of 1,417 participants changed their vehicle throughout the study. There were statistically significant increases in the prevalence of all 15 ADAS technologies examined. Despite increases in prevalence, frequency of using the technologies remained unchanged across 5 years. Frequency of use also varied by functionality of the technology whereby participants reported higher frequency of using technologies that provide alerts, such as blind spot warning, than technologies that take action to assist drivers with vehicle operations, such as adaptive cruise control. Results showed differences in prevalence and use of technologies by income and education, suggesting disparities in access to vehicles with technologies that could help to create a safer driving experience. In consideration of the rapid proliferation of ADAS into the vehicle fleet, increased research into how older drivers learn about and use ADAS technologies will assist in efforts to develop tailored and accessible programs for training older adults to properly utilize ADAS available in their own vehicles.
WALKING CADENCE AS A MEASURE OF ACTIVITY INTENSITY AND THE IMPACT ON FUNCTIONAL CAPACITY FOR OLDER ADULTS WITH FRAILTY
Authors: Rubin Daniel , Hung Anthony , Hedeker Donald , Conroy David , Huisingh-Scheetz Megan , Brach Jennifer , Glynn Nancy , Danilovich Margaret
Published: December 2023

Background

Walking cadence has been suggested as a measure of activity intensity; however, it remains uncertain if prefrail and frail older adults can increase their walking cadence and if doing so leads to improvements in functional capacity. We aimed to determine if cadence can be increased and if this leads to improvement in functional capacity in prefrail and frail older adults.

Methods

We performed a secondary data analysis of a walking intervention in prefrail and frail older adults living in retirement communities. Patients were randomized to Casual Speed Walking (CSW) and High-Intensity Walking (HIW) groups. Our primary outcome was improvement in 6-minute walk test (6MWT) distance above the minimally clinical important difference (MCID). We performed linear and logistic mixed-effects regressions to analyze our aims.

Results

102 participants were included in the final analysis with 56 in the CSW group and 46 in the HIW group. Participants in the HIW group increased their walking cadence as compared to the CSW group during the intervention (HIW 100[88, 111] steps/min vs. CSW 77[65, 86] steps/min; P < 0.001). Participants that increased their walking cadence demonstrated an increased odds of improvement in their 6MWT MCID (OR: 0.11, 95% CI: 0.033, 0.18; p=0.005).

Conclusions

Older adults can increase their walking cadence and walking cadence can serve as a surrogate measure of activity intensity during walking interventions. An increase of 14 steps/minute from their comfortable walking cadence increased the odds of improvement in 6MWT MCID.
EXTREME WEATHER AND HEALTH AMONG OLDER POPULATIONS: INDIVIDUAL AND CONTEXTUAL-LEVEL VULNERABILITY AND RESILIENCE
Authors: Choi Eunyoung , Wu Bei , Ailshire Jennifer
Published: December 2023

Intense, frequent extreme weather events pose a significant public health threat, particularly for middle-aged and older adults who may be at elevated health risk. Yet, the social and environmental factors that determine their vulnerability and resilience remain largely unexplored. This study investigates individual and contextual determinants associated with exposure to and the health effects of extreme weather. Data were from the 2021 California Health Interview Survey of adults aged 50+ (N=14,726). Respondents were asked whether they had experienced any hazardous weather events such as heat waves, floods, and wildfires in the past two years and whether mental or physical health was harmed by these events. About 53% were exposed to extreme weather events. Among the exposed group, 18% and 17% reported harm to mental and physical health, respectively. Logistic regression analysis revealed increased exposure risk among middle-aged adults (age 50-64), those with chronic conditions, people living alone, and residents of rural and unsafe neighborhoods. Similarly, mental and physical health harms were more prevalent among these groups, along with females and those with unstable housing conditions. Conversely, living in cohesive neighborhoods was identified as a resilient factor, associated with reduced mental (OR=0.78, p< 0.05) and physical health risks (OR=0.70, p< 0.01). This study reveals pronounced vulnerabilities to climate change risks among populations identified as socioeconomically disadvantaged. Moreover, the findings emphasize the role of contextual conditions in shaping vulnerability and resilience. Our study contributes valuable insights to develop targeted climate change mitigation strategies, fostering resilience among older populations and supportive communities.
EXPLORING PERCEPTIONS OF A SOCIALLY ASSISTIVE ROBOT IN ASSISTED LIVING: RECOMMENDATIONS FROM FAMILY CARE PARTNERS
Authors: Power Shannon , Smith Kasey , Burton Lydia , Abedine Reuben , Beer Jenay , Adams Anne
Published: December 2023

Research has shown that socially assistive robots are effective in delivering health and behavioral interventions to persons with and at-risk for dementia living in assisted living facilities. However, to gain a more comprehensive understanding on the potential benefits of socially assistive robots, family care partners should also be consulted for design recommendations. Thus, we conducted semi-structured virtual focus groups to investigate family care partners’ (N=10) perceived benefits, concerns, and design recommendations of a socially assistive robot for their loved ones with or at-risk for dementia. Robot interactions (e.g., activity reminders, trivia entertainment, health prompts) were presented to participants via video, followed by in-depth questions and discussion. Thematic qualitative analysis (intercoder agreement = 87.5%) resulted in most recommendations on usefulness and function (30%), followed by engagement and entertainment (18%), social attributes (15%), customization (14%), health promotion, education, and behavior (9%), appearance (7%), and other (7%). Family care partners recommended improvements to build interactivity, social connection, and usefulness, such as improvements to robot appearance, customization and adaptability in robot capability that matches disease progression, and considerations for ethical implementation (i.e., the robot as supplement, not replacement, of human caregiving). Our findings represent the personal perspective of care partners intimately acquainted with dementia and caregiving, and from this perspective, yield specific recommendations for useful design of socially assistive robots.
UNLOCKING PAIN MANAGEMENT FOR PEOPLE LIVING WITH DEMENTIA: AN INTERVENTION TO BE TAILORED
Authors: Na Annalisa , Sefcik Justine , Kwok Amy , Drazon Molly , Gitlin Laura
Published: December 2023

Effective pain management for persons living with dementia (PLWD) is critical to quality of life and could be achieve through rehabilitative care. However, it’s not well understood how physical therapists (PTs) and occupational therapists (OTs) develop and deliver treatment plans for PLWD, as most pain studies and evidence-based guidelines explicitly exclude those with cognitive impairment. In this qualitative descriptive study, we explored clinicians’ perceptions of pain management in PLWD as recommended by available guidelines. Semi-structured virtual interviews of 6 PTs and 4 OTs from 4 outpatient facilities were all female, with an average age of 36.7 (SD 8.78) years and an average clinical experience of 7.01 (SD 4.81) years. We analyzed transcripts using conventional content analysis and identified a consistent theme that rehabilitative-based interventions for pain management among PLWD need to be “carefully tailored.” Clinicians explained that the plan of care they designed for PLWD need to be tailored to the patient’s underlying pain mechanism, physical function, and comorbidities that can affect their participation in therapy, to avoid activities that exacerbate pain symptoms, and take into consideration the extent of memory loss that the person is experiencing and their preferences. This study highlights the important factors practicing clinicians take into consideration when developing rehabilitative programs to manage pain among PLWD. These findings can guide the updating of current pain management guidelines so they are more inclusive and tailored to PLWD.
IS EDUCATION ENOUGH? SEATED YOGA AND FALLS PREVENTION FOR OLDER ADULTS
Authors: Kemeny Betsy , Bright Heather , Digman Leanne , McCormack Krista , Page Riley , Setto Madison
Published: December 2023

Falls impact 25% of older adults 65+ annually (Bergen et al., 2016) with 1 in 5 falls resulting in trauma (CDC, 2020). Standing yoga can reduce falls by 48% (Hamrick et al., 2017), but some older adults cannot participate in these poses/inversions due to pain, lack of balance, and endurance. Seated yoga can reduce pain, fear of falling, mobility, and balance ( Yao & Tseng, 2019). Ong et al. (2021) found that falls education improves intention to engage in prevention. Although CDC (2022) suggests multi-modal interventions , no known research compares a combination of falls prevention education and seated yoga intervention with an education-only control group. This controlled study compared fifteen older adults living in HUD housing who received both an 8-week “Get Fit While You Sit” seated yoga (LVSY, 2021) and falls prevention education to those who only received falls prevention education. Physical testing (Timed Up and Go (TUG), chair stand test, 4-point balance test) and attitude/participation measures were measured in both groups. Wilcoxon signed rank and Kruskal-Wallis were used to compare pre-to-post and between groups. Results suggest that the multi-modal intervention (combined education and chair yoga) resulted in improvements in TUG and chair stand test but other measures (e.g. self-efficacy for falls) did not change over time. The education-alone group did not improve over time. Between groups, a sig. difference was found in TUG and Chair stand. More research is needed but older adults in LTC settings may benefit from combining seated yoga with prevention education.
THE MULTI-DIMENSIONAL ROLE OF GRATITUDE IN FAMILY MEMBERS OF PEOPLE WITH EARLY-STAGE ALZHEIMER’S
Authors: McGee Jocelyn , Morgan Davie , Meraz Rebecca
Published: December 2023

The interest in and scientific understanding of the multifaceted construct of gratitude has grown in recent years. However, research on the role gratitude plays in the lives of family members of persons with early-stage Alzheimer’s disease is limited. The purpose of this study, therefore, was to uncover the ways gratitude is experienced and expressed in family members of persons with early-stage Alzheimer’s. Interpretative phenomenological analysis, a qualitative methodology, was employed to analyze the narratives of 27 family members. Expressions of gratitude were universal in the study but varied in the dispositional gratitude factors of frequency, intensity, span, and density. Relational conceptions of gratitude were expressed across three subthemes: (1) intrapersonal (e.g., family member grateful for how their own personal strengths and resources had aided them and allowed for growth while caring for their loved one with early-stage Alzheimer’s; family member grateful for the individual strengths their family member with early-stage Alzheimer’s had retained); (2) interpersonal (e.g., family member expressed gratitude for people who had positively influenced them such as prior role models for giving care to a person with Alzheimer’s and people who had shown the family compassion); and 3) transpersonal (e.g., gratitude for God or a divine entity or force that was deemed benevolent and helpful when it came to the experience of living with Alzheimer’s). Findings indicate that professionals should attend to gratitude in family members of persons with Alzheimer’s and leverage this multifaceted resource to improve health and well-being.
ADVANCING POSITIVE SOCIAL CONNECTIONS FOR OLDER ADULTS IN SUBSIDIZED HOUSING: A HUMAN-CENTERED DESIGN APPROACH
Authors: Pubien Sheena , Slogeris Becky , Bazurto Elizabeth , McDaniel Kennedy , Ulset Vilde , Latkin Carl , Boyd Cynthia , Cudjoe Thomas
Published: December 2023

Social isolation is a complex problem that impacts many community-dwelling older adults and has detrimental impacts on mental and physical wellbeing of older adults. This research aims to utilize Human-Centered Design (HCD) to develop and implement tools and design ideas that advance positive social connections of older adults residing in subsidized housing. HCD is a collaborative process used to understand and define social problems, identify opportunities, generate ideas, and design interventions to support positive change. We sought to capture the perspectives and insights from older adults living in two federally subsidized housing communities in Baltimore, Maryland. During a five-month period, we held listening and brainstorming sessions with over 50 residents, service coordinators and members of management. Valuable insights and ideas were recorded during each of these facilitated engagements and synthesized. Through our engagements we identified six themes that influence the social connections of older adults living in subsidized housing: feelings of exclusion, lack of community connections, burdensome transitions to communal living, changes to building policies, and concerns about the physical environment. These themes led to the creation of interventions such as providing physical materials to residents, facilitating cultural inclusion and connections, implementing effective engagement strategies for community coordinators and promoting resident leadership. HCD can be employed to develop tools and innovative opportunities that specifically target and address social isolation in older adults living in subsidized housing. HCD can be utilized to drive changes to policies that impact older adults in subsidized housing leading to social transformations to improve health.
PROMOTING MENTAL HEALTH LITERACY AMONG OLDER ADULTS IN THE EAST: AN INTEGRATIVE FRAMEWORK
Authors: Yau Jessie Ho-Yin , Kanagawa Hotinpo Sky , Lo Maggie Wai-Shan , Wong Stella Lai-Kuen , Wong Gloria Hoi-Yan , Lum Terry , Liu Tianyin
Published: December 2023

Although mental health literacy is of considerable importance to advance the welfare of older adults, previous research has shown that the public has a poor understanding of mental health and recognition of mental health symptoms. Traditional mental health literacy promotion programmes utilized a top-down approach; no bottom-up model had been used. Moreover, the existing participatory research paradigms were developed in the West and might not be applicable in the East, given different socioeconomic and cultural contexts. This research aimed to fill the gap by co-creating an integrative framework with stakeholders to promote mental health literacy among older adults in the East using a community-based participatory approach as a case illustration. We conducted a mental health literacy promotion pilot project in five Hong Kong districts from May 2021 to August 2023, spanning over 2 years. Each district formed an action committee, which comprised 5-10 community older adults and 2 social workers, and 2 researchers. Each district had its own promotional activities initiated and designed by older adults, including street booths, art workshops, and publicity materials to promote mental health and introduce relevant information and resources. We conducted six focus groups (n=25) with stakeholders, and we recorded our experiences on reflection notes. Collected data suggested specific elements are important for an integrative framework in the East, including participant empowerment, stakeholders’ role and expectation management, and potential community contribution. We advance gerontological research and practice by providing an integrative framework to promote mental health literacy in the East. Implications will be discussed further.
ADMIRATION, SKEPTICISM, INDECISIVENESS? ATTITUDES TOWARD AI IN CHINESE MIDDLE-AGED AND OLDER ADULTS
Authors: Lau Bobo Hi-po , Shum Eric Ngai Yin , Lui Fan Yin-Fong , Lam Gigi , Kwok Alex Pak-Ki , Tsang Chung-Kin
Published: December 2023

In recent years, AI is increasingly visible in daily lives from chatbots in banking apps and SIRI, and generative AI such as ChatGPT, to more controversial usage concerning facial recognition, online surveillance, and even self-driving cars. Attitudes toward AI may predict acceptance of AI-facilitated applications and the Web 3.0 at-large. In June 2023, we conducted a survey with 750 smartphone users aged 45 years or older (Max = 78) in Hong Kong as a part of a wider effort to elucidate the digital divide post-pandemic. Using principal component analysis with varimax rotation, we found three components from the General Attitude to Artificial Intelligence Scale - Negative, Positive, and Powerful (compared to humans). Subsequently, with latent profile analysis we revealed three profiles: (i) Admiration (18.4%; high on positive and powerful but low on negative); (ii) Skepticism (12.3%; high on negative but low on positive and powerful), and (iii) Indecisiveness (69.3%; moderate on all three components). Admiration was more likely to be male, with higher income, better self-rated health, and greater mobile device proficiency, optimism, innovativeness, but also insecurity with technology, compared to Indecisiveness, and then Skepticism. Corroborating these quantitative findings, AI, or generative AI in specific, were only sparsely featured in a concurrent focus group study on smartphone usage with a similar cohort of smartphone users. Those who mentioned were appreciative of their superior power to provide information beyond traditional search engines; yet apprehension toward associated fraud and deception was also highlighted.
REDUCING BENEVOLENT AGEISM AMONG UNDERGRADUATE HEALTHCARE MAJOR STUDENTS IN A GERONTOLOGY CLASS
Authors: Cao Jiawei , Cui Jialin
Published: December 2023

While gerontologists have devoted continuing efforts to combating ageism through education and interventions, benevolent ageism remains to be a more subtle and covert concept to understand and recognize. This study aims to examine the effectiveness of an innovative pedagogy to reduce benevolent ageism among undergraduates majoring in healthcare with an aging focus. Two classes (36 students in the intervention group and 43 in the control group) that were both enrolled in an entry-level gerontology class were recruited. The intervention consisted of a semester-long synchronized lecture with pre-lecture quizzes, videos, examples, and in-class group projects regarding benevolent ageism, while the control group received a regular gerontology class with no additional emphasis on ageism. At the beginning and the end of the semester, all participants completed a questionnaire that was built upon the translated Ambivalent Ageism Scale (AAS) benevolent subscale. Mixed-design ANOVA was conducted to examine the effects of the pedagogy (intervention vs. control) and time (pre-test and post-test) on students’ benevolent score. The score for both groups did not differ at pre-test, and the results showed a significant interaction of group by time (F (1, 77) =13.24, p < .001). The benevolent subscale score of the intervention group decreased significantly over time, while the control group only showed a slight but insignificant decrease in the score. Findings from our study suggested that this innovative pedagogy may be useful in reducing benevolent ageism among healthcare major undergraduates. However, further randomized studies are needed to confirm our findings.
REFRAMING AGING FOR HIGHER EDUCATION IN HEALTH CARE PROFESSIONS
Authors: Coyle Caitlyn , Bui Cindy , Massihzadegan Setarreh , Ballout Suha , Mutchler Jan
Published: December 2023

As students in health care professions will serve older patients, it is critical to proactively reframe aging in their education, confront implicit biases, and encourage age-inclusivity before they enter the workforce. We developed a training to address the limited focus on aging and later life among undergraduate curricula in health care professional disciplines (e.g., nursing, health sciences). The 1-hour, online training was piloted among current undergraduate nursing students (N=69). The content uses data and real-person interviews to introduce demographic trends in aging, define and deconstruct ageism concepts, illustrate the impact of ageism on individual health and health care, and highlight the diverse experiences of aging. The training also includes communication tools and interactive activities, such as reflection questions and case studies, to engage students in their own aging experience and to garner empathy for others’ aging experiences. Pre- and post-training evaluations revealed that the training impacted students in expressing positive behavioral change towards age-inclusivity and awareness at internal, interpersonal and institutional levels. Evaluation results also showed statically significant evidence that the training increased students’ knowledge about facts versus stereotypes about aging, confidence in understanding ageism and its relevance to health care, and consideration of working with older adults in their career. This pilot research project encourages other higher education institutions to incorporate training and education in their curricula that distinctively focuses on later life and reframing aging in a long-term effort towards improving health care for older people and the experiences of health care professionals who serve them.
INNOVATING HOME HEALTH DELIVERY TO IMPROVE VETERANS’ ACCESS TO CARE AND CARE COORDINATION
Authors: Benzel Heather , Carter Jammie , Censky Dina , Janssen Daniel , Murphy Rachel , Putz Leann , Davila Heather , Roman Irene San
Published: December 2023

Nearly 350,000 Veterans receive home health services through the Veterans Health Administration (VA) annually. Historically, VA has purchased most home health services from contract agencies in the community. VA leaders have expressed growing concerns about Veterans’ access to home health, especially in rural areas. Coordinating care between VA and contract agencies is an ongoing challenge. To address these challenges, the VA Midwest Health Care Network (VISN 23) developed the VA Home Health (VAHH) pilot program. The program launched at the Iowa City VA and is currently operating at 4 sites in Iowa and South Dakota. Through VAHH, local VA Medical Centers hire home health staff directly (nurses, aides, physical and occupational therapists), rather than purchase these services through contract agencies. In this presentation, we describe program development, challenges, and early evaluation findings. In fiscal year (FY) 2022, 200 Veterans received VAHH. So far in FY2023, over 700 Veterans have been served. Pre/post comparisons involving Veterans receiving VAHH show modest reductions in emergency room visits (727 vs. 664 visits) and inpatient admissions (227 vs. 192 admissions). Overall hospital lengths of stay have reduced more dramatically (2132 vs. 1390 total days). VAHH staff note close communication with Veterans’ primary care teams, and Veterans describe being highly satisfied with the program. Interest in VAHH is growing nationally, particularly as access to home health in many regions is limited. Early lessons from the VAHH pilot program could inform VA decisions about home health delivery and assist other sites in improving care for Veterans.
THE PREDICTIVE EFFECT OF DIFFERENT MACHINE LEARNING ALGORITHMS FOR PRESSURE INJURIES: A NETWORK META-ANALYSES
Authors: Qu Chaoran , Yang Xiufen , Peng Weisi , Wang Xiujuan , Luo Weixiang
Published: December 2023

Objective

This review aims to systematically synthesize existing evidence to determine the effectiveness of applying machine learning algorithms for pressure injury management, to further evaluate and compare pressure injury prediction models constructed by numerous machine learning algorithms, and to derive evidence for the best algorithms for predicting and managing pressure injuries.

Methods

A systematic electronic search was conducted in the EBSCO, Embase, PubMed, and Web of Science databases. We included all retrospective diagnostic accuracy trials and prospective diagnostic accuracy trials constructing a predictive model by machine learning for pressure injuries up to December 2021. The network meta-analysis was conducted using statistical software R and STATA. The certainty of the evidence was rated using the QUADAS-2 tool.

Result

Twenty-five clinical diagnostic trials with a total of 237397 participants were identified in this review. The results of our study revealed that pressure injury machine learning models can effectively predict these injuries. Combining the algorithms separately yields the main

results

decision trees (sensitivity: 0.66, specificity: 0.90, AUC: 0.88), logistic regression (sensitivity: 0.71, specificity: 0.83, AUC: 0.84), neural networks (sensitivity: 0.73, specificity: 0.78, AUC: 0.82), random forests (sensitivity: 0.72, specificity: 0.96, AUC: 0.95), support vector machines (sensitivity: 0.81, specificity: 0.81, AUC: 0.88). According to the analysis of ROC and AUC values, random forest is the best algorithm for the prediction model of pressure injury.

Conclusions

This review revealed that machine learning algorithms are generally effective in predicting pressure injuries, the random forest algorithm is the best algorithm for pressure injury prediction.
FACTORS AFFECTING THE ACCEPTANCE OF CARE ROBOTS BY OLDER ADULTS: FOCUSING ON TECHNICAL FACTORS
Authors: Yoon Hee Jeong , Lee Hyun Ju , Ban Si Woo , Kim Ha Yul , Cha Eun Gyo , Lee Jung Wan , Shin Hye Ri , Kim Young Sun
Published: December 2023

Care robots have the potential to support the healthy and independent lives of older adults and alleviate the burden on care workers. However, the potential benefits of care robots can only be realized if they are accepted. Given that most older adults do not have experience with care robots and lack digital literacy, an understanding of the factors affecting the acceptance of care robots is important. The goal of this study was to analyze the factors that affect older adults’ acceptance of care robots by distinguishing the factors into sociodemographic, health, and technical factors. Data were collected from older adults aged 60 or over living in the community of Korea in 2022 (N= 506, mean age=70.11±7.74, women=54.55%). Hierarchical regression analysis was conducted to identify the factors related to acceptance of care robots. The results showed that factors influencing older adults’ acceptance of care robots were significant in sociodemographic factors (education and place of residence), health factors (self-reported health and instrumental activities for daily living), and technical factors (digital literacy and technostress). The findings indicate that interventions are needed to increase the acceptance of care robots by vulnerable groups with low levels of education, living in rural areas, and poor health conditions, and that it is also important to increase their digital literacy and lower their technostress. This study would provide valuable guidelines to stakeholders such as service providers, and policymakers to increase the acceptance of care robots and improve the quality of life of older adults.
IMPACT OF THE TEACHING NURSING HOME ON NURSING STUDENT’S COMPETENCIES AND WILLINGNESS TO WORK IN LONG-TERM CARE
Authors: Degenholtz Howard , Dunbar-Jacob Jacqueline , Ratliff Kim , Fick Donna , Dickson Chelsea , Kitt-Lewis Erin , Franke Emily , Campbell Kenna
Published: December 2023

The Teaching Nursing Home (TNH) is designed to improve the long-term care workforce and improve quality of care in nursing homes. The initiative has multiple components: enhanced clinical rotations for nursing students with partner schools of nursing, implementation of the Institute for Healthcare Improvement Age-Friendly Health System “4M” quality improvement model, and an online learning network. Nursing students at three schools of nursing participated in clinical rotations at four regional nursing homes. The experience was limited to students in one specific course at each school of nursing. At the beginning and end of the Spring 2023 semester, students rated their competence in: patient assessment, collaborating with the care team, gathering clinical information, medication review, eliciting resident values, and health promotion. Students also rated their preferences for working in long-term care and with older adults. Data from 165 responses at the start of semester (January 2023) and 155 responses to the end of semester (April 2023) survey were analyzed. Analysis of student responses found that students self-rated competencies improved in all areas. Prior to their clinical experience, students ranked working in long-term care and with older adults lower than other settings or populations. The rankings were unchanged after their clinical experiences. Qualitative analysis found that most student comments (50%) were about skills, while only 1.5% were about potential careers in nursing homes. These findings suggest that the Teaching Nursing Home Program is meeting the pedagogical goals, however attitudinal shifts may require different strategies.
UNDERUTILIZATION OF TRANSITIONAL CARE MANAGEMENT SERVICE AMONG MEDICARE BENEFICIARIES AT HIGH RISK OF READMISSION
Authors: Park Chan Mi , McCarthy Ellen , Shi Sandra , Olivieri-Mui Brianne , Jang Jieun , Kim Dae Hyun
Published: December 2023

The CMS introduced transitional care management (TCM) service in 2013 to improve care transitions from hospital to home and reduce readmission. TCM uptake has been slowly increasing over time; however, it remains uncertain whether TCM is delivered to patients at the highest risk of readmission. We used a 5% random sample of 2015-2019 Medicare fee-for-service claims. TCM service was identified using CPT codes and demographic information, census region, diagnosis codes, and frailty were measured. Of 1,556,347 eligible discharges (mean [standard deviation] age, 78.3 [7.8] years, 56.7% female, 84.2% White), TCM was delivered in 169,536 (10.9%) discharges and 30-day readmission occurred in 123,796 (8.0%) discharges. The 30-day readmission risk was higher among beneficiaries who were < 75 years (8.1%) vs ≥75 years (7.9%), male (8.7%) vs female (7.4%), Black (9.3%) or Hispanic (8.7%) vs White (7.8%) and Asian or Pacific Islander (8.0%), with dementia diagnosis (8.2%) vs without (7.9%), or with greater frailty (robust to severe frailty: 6.1% to 14.1%). TCM use was not necessarily higher among those with high-risk characteristics. Notably, TCM was more likely to be delivered to beneficiaries who were ≥75 years (12.3%) vs < 75 years (8.8%), White (11.3%) and Asian or Pacific Islander (10.8%) vs Black (9.0%) and Hispanic (8.4%), without dementia (11.0%) vs with (10.6%), and pre-frail or mildly frail (11.4%) vs moderately or severely frail (10.0-10.5%). Our study found that TCM is not delivered effectively to Medicare beneficiaries at high risk of readmission, including racial and ethnic minority groups, and those with moderate-to-severe frailty.
PATIENT AGE AND SEX DO NOT APPEAR TO INFLUENCE DECISION MAKING AROUND BIOMARKER TESTING FOR COGNITIVE IMPAIRMENT
Authors: Monane Mark , Johnson Kim , Snider Joy , Turner R Scott , Drake Jonathan , Ortega Julia , Jiang Yan , Braunstein Joel
Published: December 2023

The QUIP I Study (ClinicalTrials.gov Identifier: NCT05477056) was a prospective, single-arm study which included 347 older persons (average age 74, 56% women) presenting with signs and symptoms of cognitive impairment. In a subgroup analysis, we measured the effect of a person’s age and sex on clinical decision making around the PrecivityAD® blood biomarker (BBM) test result. The test result was reported as the Amyloid Probability Score (APS), which measures the likelihood of a positive result on an amyloid PET scan. Clinical decision making was recorded by clinician survey pre- and post-BBM testing. Clinician-reported probability of Alzheimer’s disease (“AD”) changed pre-test to post-test from 58% to 23% (Low APS group) and from 71% to 89% (High APS group) (p < 0.0001 for all APS groups). The relationships between APS and change in diagnostic certainty were not significantly different as analyzed by age (p=0.344 for Low APS, p=0.292 for High APS) or sex (p=0.167 for Low APS, p=0.213 for High APS). Overall use of AD drug therapy decreased from 48% to 26% (Low APS group) and increased from 56% to 88% (High APS group) (p < 0.0001 for all APS groups). The relationships between APS and change in medication prescribing were not significantly different as analyzed by age (p=0.4534 for Low APS, p=0.9939 for High APS) or sex (p=1 for Low APS, p=0.931 for High APS). We believe that the current study results help to underscore the usefulness and generalizability of this BBM among older adults in clinical care pathways.
UNRAVELING COMORBIDITY PREVALENCE AND PM2.5 EXPOSURE AMONG MIDDLE-AGED AND ELDERLY: A SPATIAL-TEMPORAL ANALYSIS
Authors: Wei Linjiang , Zhang Liangwen , Fang Ya
Published: December 2023

Objective

This study describes regional differences and dynamic changes in the prevalence of comorbidities among middle-aged and elderly people with chronic diseases (PCMC) in China from 2011-2018, and explores distribution patterns and the relationship between PM2.5 and PCMC, aiming to provide data support for regional prevention and control measures for chronic disease comorbidities in China.

Methods

This study utilized CHARLS follow-up data for ≥45-year-old individuals from 2011, 2013, 2015, and 2018 as research subjects. Missing values were filled using the random forest machine learning method. PCMC spatial clustering investigated using spatial autocorrelation methods. The relationship between macro factors and PCMC was examined using Geographically and Temporally Weighted Regression, Ordinary Linear Regression, and Geographically Weighted Regression.

Results

PCMC in China showing a decreasing trend. Hotspots of PCMC appeared mainly in western and northern provinces, while cold spots were in southeastern coastal provinces. PM2.5 content was a risk factor for PCMC, the range of influence expanded from the southeastern coastal areas to inland areas, and the magnitude of influence decreased from the southeastern coastal areas to inland areas.

Conclusion

PM2.5 content, as a risk factor, should be given special attention, taking into account regional factors. In the future, policy-makers should develop stricter air pollution control policies based on different regional economic, demographic, and geographic factors, while promoting public education, increasing public transportation, and urban green coverage.
RELATIVE AND ABSOLUTE METABOLIC COST OF DAILY PHYSICAL ACTIVITIES ACROSS THE LIFESPAN
Authors: Manini Todd , Handberg Eileen , Mardini Mamoun , Sandesara Bhanu , Casanova Ramon , Corbett Duane , Wanigatunga Amal
Published: December 2023

Americans spend over 90% of their activity related energy expenditure performing common daily activities. However, there is a gap in knowledge pertaining to potential age-related differences in the metabolic cost of performing these activities which diminishes proper physical activity prescription. We hypothesized age differences in both the absolute and relative metabolic cost of performing common daily physical. Participants (n=248, age: 20-94 yrs) performed 33 activities (e.g. dressing, walking, making a bed, gardening, computer work) in a standardized setting. A portable indirect calorimeter was worn for approximately 6-10 minutes to achieve steady-state metabolic rate. A graded exercise treadmill test was performed to quantify peak metabolic rate. A metabolic equivalent (MET as a function of 3.5 milliliter•min-1•kg-1) and percentage of peak were used to express absolute and relative metabolic rate, respectively. Watching television (1.0+/-0.36 METs; 15.6+/-5.7% of peak) produced the lowest and climbing stairs (6.2+/-2.2 METs; 84.8+/-17.0% of peak) elicited the highest metabolic rate. Results from mixed effect regression models adjusting for health conditions, demographics and anthropometry showed no association between absolute MET and age. However, when expressed relative to peak, adjusted models showed a strong association with age (0.66+/-0.33% per year, p=0.006). As an example, adults < 40 yrs old worked at 34.1+/-14.8% of peak during a leisurely walk while those 80+ years old worked at 64.2+/-16.3%. Aging is associated with a substantial increase in the relative metabolic cost of performing common daily physical activities. These results could have implications on prescribing physical activity older adults to achieve higher fitness.
Loss of NDST1 N-sulfotransferase activity is associated with autosomal recessive intellectual disability
Authors: Khosrowabadi Elham , Mignon-Ravix Cécile , Riccardi Florence , Cacciagli Pierre , Desnous Béatrice , Sigaudy Sabine , Milh Mathieu , Villard Laurent , Kjellén Lena , Molinari Florence
Published: December 2023

Intellectual Disability (ID) is the major cause of handicap, affecting nearly 3% of the general population, and is highly genetically heterogenous with more than a thousand genes involved. Exome sequencing performed in two independent families identified the same missense variant, p.(Gly611Ser), in the NDST1 (N-deacetylase/N-sulfotransferase member 1) gene. This variant had been previously found in ID patients of two other families but has never been functionally characterized. The NDST1 gene encodes a bifunctional enzyme that catalyzes both N-deacetylation and N-sulfation of N-acetyl-glucosamine residues during heparan sulfate (HS) biosynthesis. This step is essential because it influences the downstream enzymatic modifications and thereby determines the overall structure and sulfation degree of the HS polysaccharide chain. To discriminate between a rare polymorphism and a pathogenic variant, we compared the enzymatic properties of wild-type and mutant NDST1 proteins. We found that the p.(Gly611Ser) variant results in a complete loss of N-sulfotransferase activity while the N-deacetylase activity is retained. NDST1 shows the highest and the most homogeneous expression in the human cerebral structures compared to the other members of the NDST gene family. These results indicate that a loss of NDST1 N-sulfation activity is associated with impaired cognitive functions.
Development of a breast cancer prognostic model based on vesicle-mediated transport-related genes to predict immune landscape and clinical drug therapy
Authors: Zhu Xiaotao , Wang Fan , Wang Mingzhen , Lv Lin , Fang Linghui , Song Jialu , Wang Xiaohui , Ding Fengsheng
Published: December 2023

Background

Vesicle-mediated transport, vital for substance exchange and intercellular communication, is linked to tumor initiation and progression. This work was designed to study the role of vesicle-mediated transport-related genes (VMTRGs) in breast cancer (BC)prognosis.

Methods

Univariate Cox analysis was utilized to screen prognosis-related VMTRGs. BC samples underwent unsupervised clustering based on VMTRGs to analyze survival, clinical factors, and immune cell abundance across different subtypes. We constructed a risk model using univariate Cox and LASSO regression analysis, with validation conducted using GEO datasets. Subsequently, we performed tumor mutational burden analysis, and immune landscape analysis on both groups. Ultimately, we conducted immunophenoscore (IPS) scoring to forecast immunotherapy and performed drug sensitivity analysis.

Results

We identified 102 VMTRGs associated with BC prognosis. Using these 102 VMTRGs, BC patients were classified into 3 subtypes, with Cluster3 patients showing significantly better survival rates. We constructed a prognostic model for BC based on 12 VMTRGs that effectively predicted patient survival. Riskscore was an independent prognostic factor for BC patients. According to median risk score, high-risk group (HRG) had higher TMB values. The immune landscape of the HRG exhibited characteristics of cold tumor, with higher immune checkpoint expression levels and lower IPS scores, whereas Gemcitabine, Nilotinib, and Oxaliplatin were more suitable for treating low-risk group.

Conclusion

We classified BC subtypes and built a prognostic model based on VMTRGs. The genes in the prognostic model may serve as potential targets for BC therapy.