bluuebunny/crossref_metadata_2025 huggingface dataset:
IT’S BETTER TO GIVE THAN RECEIVE, OR IS IT? THE EFFECT OF SOCIAL SUPPORT ON THE PSYCHOLOGICAL WELL-BEING OF OLDER PARENTS
Authors: Blanco Erik
Published: November 2019

The longevity revolution has led to more years of shared lives between older parents and adult children. Having these extra years together can be offset by the stressful life transitions of widowhood, health declines, and increased level of disability experienced by older parents. These transitions can lower older parents’ psychological well-being. Although social support to/from adult children has the potential to buffer these effects, most older parents wish to remain independent, even in later life, making them reluctant to accept social support from their adult children. The purpose of this paper is to examine whether the provision or receipt of social support between older parents and adult children, influences positive mood and negative mood. Secondary data on older adults (n = 461) with adult children who participated in the 2004 wave of the LSOG were used. The results revealed that the provision of social support by older parents to adult children significantly increased parents’ positive mood showing that it is better to give than receive. The results for the receipt of social support were more complex. Results suggest that when someone has a higher level of disability and does not receive social support their negative mood increases, but when someone has a high level of disability and does receive social support there is no effect on negative mood. This proposes that the receipt of social support is particularly important when the parent is in need of support and it is better to receive than give when parents are in need.
LOWER URINARY TRACT AND BOWEL SYMPTOMS PREDICT QUALITY OF LIFE IN GAY AND BISEXUAL PROSTATE CANCER SURVIVORS
Authors: Talley Kristine M , Polter Elizabeth , Capistrant Benjamin D , West William G , Konety Badrinath , Rosser B R Simon
Published: November 2019

Little is known about disparities in prostate cancer survivorship experienced by gay and bisexual men (GBM). However, early evidence suggests GBM may experience worse urinary and bowel symptoms than heterosexual men. This cross-sectional Internet-based survey describes the prevalence of lower urinary tract (LUTS) and bowel symptoms and their associations with physical and mental health related quality of life (QOL) in GBM treated for prostate cancer. This study enrolled 193 men who identified as gay or bisexual and had received prostate cancer treatment. The Expanded Prostate Cancer Index Composite instrument measured LUTS and bowel symptoms. The MOS SF-12 measured physical and mental QOL. Participants had a mean age of 63.4 years, were 5.6 years past treatment, and were treated with prostatectomy (52%), radiation (19%), or combined or systemic treatment (29%). The most common symptoms were nocturia (77%), urinary frequency (67%), urinary leakage (59%), bowel urgency (45%), bowel frequency (35%), and watery bowel movements (34%). Mean scores were 81.4±19.2 for urinary function, 74.5±20.7 for urinary bother, 88.9±12.1 for bowel function, 84.5±16.3 for bowel bother, 52.5±8.8 for physical QOL, and 46.0±11.4 for mental QOL. In multivariable models adjusted for age, race, treatment type, and time since diagnosis, urinary bother was associated with worse physical QOL (Adjusted Mean Difference (AMD): 0.11, 95%CI: 0.02-0.21), and bowel bother was associated with worse mental QOL (AMD: 0.23, 95%CI: 0.05-0.42). LUTS and bowel symptoms were common. Symptom bother rather than function predicted QOL. Understanding these disparities will help tailor treatments for this underserved population.
THE ATTITUDE OF MEDICAL PRACTICES TOWARD LGBTQ OLDER ADULTS BEFORE AND AFTER INTERVENTION
Authors: Kim Mackenzi , Wilson Lynn M , Biery Nyann , Frutos Brenda
Published: November 2019

Individuals who identify as lesbian, gay, bisexual, transgender or other non-heterosexual or binary gender identifiers (LGBTQ) face tremendous obstacles in search of quality healthcare. Older LGBTQ adults face these obstacles in the setting of more complex health problems with few social services and support. Negative treatment from healthcare professionals has proven to be one of the most pervasive barriers to care faced by older LGBTQ adults. Sensitization training with the film, Gen Silent, is one way knowledge gaps and biases of healthcare professionals has been addressed. By utilizing the survey previously validated by Porter et al., health professionals’ knowledge, perceptions, and attitudes toward LGBTQ older adults before and after viewing Gen Silent were assessed in Lehigh Valley Health Network (LVHN)-affiliated primary care practices. The principle outcome of this study was a statistically significant change in responses. Primary care practices were recruited for 45-minute sessions that included the showing of an educational, abbreviated version of Gen Silent to available staff. It was preceded by administration of a pretest survey and followed by a posttest survey and discussion. A paired t-test was conducted to determine significance of differences between pre- and posttest responses. Seventeen individuals (N=17) viewed the film and finished pre- and posttest surveys. Nearly all questions exhibited changes between pre- and posttests. Significantly, respondents indicated increased awareness of additional barriers to care faced by LGBTQ older adults compared to heterosexual peers. While limited, these results indicate that primary care professionals would benefit from training specific to the aging LGBT population.
CONNECTING PROVIDER TO HOME: BRIDGING GAPS IN CARE
Authors: Weir Melanie , Moreno Gerardo , Loza Rosaneli , Desai Lisa , Tseng Chi Hong
Published: November 2019

When the physician has limited knowledge of the patient’s condition and functioning at home it may result in non-adherence to treatment plans, goals of care not being met and avoidable utilization. Connecting Provider to Home (CP2H) deployed teams of a social worker and community health worker to act as the eyes and ears of the doctor in patients’ homes and close the information gap in primary care. Study objectives were to 1) reduce unnecessary utilization, 2) increase provider and patient satisfaction, and 3) Improve communication between patient/caregiver and the healthcare team. A total of 416 adult patients were enrolled with a mean age of 76 years, and 58% were female. CP2H participants demonstrated statistically significant reductions in acute hospitalizations and ER use when compared to 700 controls. Acute hospitalizations were reduced by 216 and ER visits by 531 in the intervention group. The average per patient per year reduction in acute hospitalizations was 0.67. The average per patient reduction in ER use was 0.58. CP2H patients reported high levels of satisfaction and rated the program favorably. Stakeholder interviews found that physicians and staff believed the program improved clinical outcomes, provided valuable insight about patients’ social barriers to self-care and added value. CP2H study results provide evidence that social workers and community health workers can be successfully and cost-effectively incorporated into the primary care team to address patient needs and priorities, observe the patient in the home environment and assist the physician in adapting treatment plans to optimize patient care.
DOMICILIARY SERVICES IMPROVE ACCESS TO DENTAL CARE FOR FUNCTIONALLY DEPENDENT OLDER ADULTS
Authors: Lim Mathew A , Borromeo Gelsomina L
Published: November 2019

There is growing evidence demonstrating links between oral diseases and general health. The increased retention of teeth among functionally-dependent older adults presents a unique challenge in maintaining the oral health of these individuals from basic oral hygiene to accessing dental services. The results of our cross-sectional study demonstrate the important role domiciliary dental services play in reducing the barriers to accessing oral health care in this cohort. In our study, most individuals treated by domiciliary services lived in residential aged care facilities and were significantly older than those treated by hospital and community-based dental services dedicated to the specialized care of individuals with additional health care needs. A significantly higher number of those receiving domiciliary care were unable to self-consent for treatment compared to those managed in other settings. 27.4% of these patients had a diagnosis of dementia. More than half (56.9%) of patients treated by domiciliary services received some form of treatment with almost half (48.1%) of these requiring a dental extraction. Only two of these patients were not diagnosed with a chronic condition known to affect oral health (dementia, Parkinson’s disease, diabetes mellitus, arthritis, stroke, osteoporosis). 23.7% of domiciliary appointments were used for denture fabrication. The results depict the worrying level of unmet treatment need in residents of aged care facilities. However, they also demonstrate the potential for domiciliary dental services to play a role in developing partnerships between carers and oral health professionals to improve the oral health of functionally-dependent older adults.
HEALTH CARE AND SOCIAL CARE AMONG FRAIL OLDER ADULTS IN SWEDEN: A REGISTRY-BASED STUDY
Authors: Bravell Marie Ernsth , Finkel Deborah G , Johansson Linda
Published: November 2019

In 2010 the Swedish government made a large investment to improve the quality of care for the “frailest older adults” but there have been few follow-ups of the care of this group. The aim of this study is to therefore describe use of care over the time in 2010-2014. Methods: In 2014, 9 National Quality Registries, 3 Care Registries (drug-, patient and death-registers) and the registry for care and social services for older persons (SOL) were individually matched to an older population in the Swedish Twin Registry (n≈45000). Identification of the “frailest older adults” was achieved via SOL and the Patient Registry. Results: 280 persons were identified as “frailest” in 2010 these were followed over time. About two thirds (60,7%) were women, mean age: 81.2±7.7, about one third (35%) lived in a nursing home, one third (34%) had more than three hospitals stays, almost three quarters (72.5%) had more than 19 hospital days and almost one third (28%) had more than seven outpatient care visits. By the end of 2012, 119 persons (42.5%) were deceased. Among those alive (n=161) 42 persons did not receive any inpatient care between 2010-2012, but more than 85% received outpatient care and 44.1% were living in nursing homes. In 2014, 90 persons (32.1%) were still alive and half of them lived in a nursing home. In conclusion, over time the use of care as well as the risk of mortality was high confirming the need of further improvement of the care for these persons.
CHALLENGES IN RECEIVING, ORGANIZING, AND PROVIDING CARE IN ACTIVITIES OF DAILY LIVING: A WORLD-CAFé DIALOGUE
Authors: Cremer Svenja , Bleijlevens Michel , Metzelthin Silke F , Ginkel Janneke M de Man-van , Zwakhalen Sandra M
Published: November 2019

Activities of Daily Living are a series of basic activities performed by individuals on a daily basis necessary for independent living at home or in the community. ADL are part of basic nursing care which describe aspects of care that are fundamental to all patients’ health and well-being, regardless of diagnosis, cultural background or healthcare setting. In daily practice, nursing staff is confronted with challenges when providing ADL-care. In order to provide nursing professionals with practical tools to tackle daily challenges, a deeper insight into the perceived challenges by nursing staff, care receivers and informal caregivers is necessary. Therefore, two ‘world-café’ sessions were organized to explore daily challenges in ADL-care. In a World Café, participants are regarded as experts of their own lived experience and experiential knowledge. By creating a hospitable environment (i.e. a café-style ambience) individual and collective knowledge and ideas can be shared. Care receivers, informal caregivers and professionals including nurses, nursing-assistants, physical therapists, occupational therapist, and other stakeholders (N=53) participated in these ‘world-cafés’. The session’s output comprised ‘graphic recordings’ (paper tablecloths and post its) of the conversations that have been analyzed using content analysis. Findings showed reported challenges regarding receiving, providing and organizing ADL-care. Challenges on organizational level comprised for example both bilateral agreements and communication. Whereas reported care related issues related to challenges such as the assessment of care receivers’ needs and the use of assistive devices in the provision of ADL-care. The inventoried challenges will be addressed in an ADL-quality standard for nursing staff.
FUNCTIONAL INDEPENDENCE, ACCESS TO KIDNEY TRANSPLANTATION, AND WAITLIST MORTALITY
Authors: Chu Nadia M , Sison Stephanie , Muzaale Abimereki , Haugen Christine , Wang Jacqueline Garonzik , Norman Silas , Segev Dorry , McAdams-DeMarco Mara
Published: November 2019

Although functional independence is a health priority for patients with advanced CKD, 50% of those who progress to end-stage kidney disease (ESKD) develop difficulties carrying-out essential day-to-day activities. Functional independence is not routinely assessed at kidney transplant (KT) evaluation; therefore, it is unclear what percentage of candidates are functionally independent and whether independence is associated with access to KT and waitlist mortality. We studied a prospective cohort of 3,168 ESKD participants (1/2009-6/2018) who self-reported functional independence in basic Activities of Daily Living (ADL) and more complex Instrumental Activities of Daily Living (IADL). We estimated adjusted associations between functional independence (separately) and listing (Cox), waitlist mortality (competing risks), and transplant rates (Poisson). At evaluation, 92.4% were independent in ADLs, but only 68.5% were independent in IADLs. Functionally independent participants had a higher chance of listing for KT (ADL:aHR=1.55,95%CI:1.30-1.87; IADL:aHR=1.39,95%CI 1.26-1.52). Among KT candidates, ADL independence was associated with lower waitlist mortality risk (SHR=0.66,95%CI:0.44-0.98) and higher rate of KT (IRR=1.58,95%CI:1.12-2.22); the same was not observed for IADL independence (SHR=0.86,95%CI:0.65-1.12; IRR=1.01,95%CI:0.97-1.19). ADL independence was associated with better KT access and lower waitlist mortality; clinicians should screen KT candidates for ADL independence, and identify interventions to maintain independence to improve waitlist outcomes.
FALL INJURY CHARACTERISTICS ASSOCIATED WITH EMERGENCY DEPARTMENT VISITS AND HOSPITALIZATIONS AMONG OLDER ADULTS
Authors: Choi Namkee G , DiNitto Diana M , Kunik Mark E
Published: November 2019

Fall injuries and related healthcare use among older adults are increasing in the US. Based on the 2013-2017 US National Health Interview Survey public use data, this study examined fall injury characteristics that are associated with emergency department (ED) visits and hospitalizations among those aged ≥60 years who received medical attention for their fall injuries within a 91-day reference period (N=1,840). Our findings show that nearly a third of these older adults received care from emergency medical services (EMS), presumably for a “lift assist” to get off the floor and/or for ED or hospital transport; a little more than one-third had an ED visit only; and a little less than a fifth had an overnight hospital stay. Multivariable analysis showed that hip and head injuries, face injuries, and broken bones/fractures (from any type of injury) were likelier causes of hospitalization than injuries to other parts of the body. Fall injuries sustained inside the home, falls from loss of balance/dizziness, and living alone were also more likely to result in hospitalization, while fall injuries that occurred away from home and those with lung disease and memory problems were associated with higher risk of ED use only. These healthcare use data indicate the significant toll that fall injuries exact upon older adults and healthcare system. Fall prevention programs should target risk factors that are specific to serious injuries and be made more accessible. Strategies for implementing scalable, adaptable, and measurable fall prevention models by EMS providers and ED staff are also needed.
PHYSICAL ACTIVITY PREFERENCES OF OLDER ADULT MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER CLIENTS
Authors: Davila Victoria S , Pietzak Lauren , Rossi Danielle , Phipps Karen , Danilovich Margaret
Published: November 2019

Despite the known effectiveness, physical activity (PA) is not currently offered to older adult clients receiving Medicaid Home and Community Based Services (HCBS). To optimize PA implementation within Medicaid HCBS, understanding client preferences for PA programming is needed. Thus, the objective of this exploratory qualitative study was to identify the PA preferences of HCBS clients including mode, duration, implementation strategy, and frequency, as well as barriers and motivators to PA. We recruited participants from the Illinois’ Department on Aging Community Care Program. We conducted semi-structured interviews in participants’ homes which were audio recorded, transcribed, and analyzed using Dedoose (version 7.0.23). We derived semi-structured interview questions from the Health Belief, Social Cognitive, and Health Action Process Approach framework. We used a structured coding approach using conventional content analysis to derive codes from the text, then applied these codes to each interview and examined the frequency to determine themes. The most frequently referenced theme was barriers to PA, primarily co-morbidities. The primary motivator was social support by a peer or instructor. The preferred PA program components were walking 2-3 days per week with duration varying from 20 minutes to 2 hours. Clients also preferred individualized PA instruction versus a passive strategy such as pamphlets or videotapes. Our findings show that individual-level factors most significantly influence PA participation and should be addressed among Medicaid HCBS clients. We recommend Medicaid HCBS consider a personalized approach of PA implementation with their clients.
VALIDATION OF A NEW FUNCTIONAL COGNITION SCREENING MEASURE
Authors: Edwards Dorothy F , heizan Muhammad O Al- , Marks Timothy , Giles Gordon M
Published: November 2019

Identification of cognitive deficits that contribute to functional dependence in acute and post-acute care settings is important. The Menu Task (MT) is a brief cognitive 12 item screening measure designed to identify older adults at risk for IADL impairment in community settings. The objective was to compare the psychometric properties of the Menu Task a series of neurocognitive and functional cognitive performance measures including the Brief Interview of Mental Status (BIMS), the Montreal Cognitive Assessment (MoCA) the Weekly Calendar Planning Activity (WCPA) and the Performance Assessment of Self-Care Skills (PASS) in a sample of 200 community dwelling older adults. Participants were administered the MT, BIMS, MoCA, WCPA, and the PASS checkbook and shopping tasks. ROC analysis identified an MT cut score, sensitivity and specificity. We computed Cronbach’s alpha, correlations among study measures and t-tests between groups impaired or unimpaired on the MT. Mean age of participants was 70.44(SD 8.3), the sample was predominately female ((76%), and white (81%). Mean MT score was 8.22 (SD 2.01) and the mean completion time was 185.5 sec (SD 108.11). The Menu Task has moderate internal consistency (α= 0.65). The AUC statistic was 0.83 with an optimal MT cut score of “7” and sensitivity of .90 and specificity of .70. Significant differences (p < 0.01) were observed between impaired and not impaired MT groups on BIMS, MoCA, WCPA, and PASS. The Menu Task has moderate to strong evidence supporting its psychometric properties and the value of screening for functional cognitive deficits.
THE INTERVIEW FOR DECISIONAL ABILITIES: DEVELOPING THE EVIDENCE BASE FOR ADULT PROTECTIVE SERVICES
Authors: Sivers-Teixeira Theresa , Stevens Gregory , Sadamitsu Kelly , Penate Christina , Olsen Bonnie
Published: November 2019

Adult Protective Services (APS) workers assess clients for abuse and neglect and are asked to determine the client’s understanding of risks they face. Yet, APS workers have little structured training in how to make such judgements. The Interview for Decisional Abilities (IDA 3.0-CA) is a tool designed for use by APS workers to assess the ability of suspected victims of elder mistreatment to make decisions about the risks they face. This study evaluates the impact of training and use of this tool on the knowledge, experiences and ability of APS workers to determine decisional ability. APS workers and supervisors were recruited from central and northern California APS programs and randomized into either control (n=94) or IDA 3.0-CA training groups (n= 95). Baseline surveys measure knowledge of, and experiences with, assessing decisional ability and determining next steps for case management. Additionally, respondents determine the decisional ability of three case scenarios. Three months post-training, controls and trained subjects complete the same survey with a new set of cases. Preliminary results at baseline indicate there were no statistically-significant differences between trained subjects (n=42) and controls (n=50) in their knowledge scores (78.6% correct vs. 81.0%, p=0.6641) or performance assessing decisional ability in the case scenarios (60.1% correct vs. 63.3%, p=0.3497). Reported experiences assessing decisional ability and determining next steps in case management were also similar for trained subjects and controls. Complete results will be presented regarding change in knowledge scores, experiences, and assessing decisional ability in case scenarios compared across trained subjects and controls.
PSYCHOMETRIC APPRAISAL OF THE GERIATRIC SOCIAL WORK COMPETENCY SCALE II WITH LIFELONG LEADERSHIP SKILLS
Authors: Wilks Scott E , Choate Sarah , Eugene Danielle , Du Xi
Published: November 2019

The Council on Social Work Education (CSWE) Gero-Ed Center and Hartford Partnership Program in Aging Education (HPPAE) emphasize five competency areas specific to social work practice with older adult clientele (i.e., gero social work), namely knowledge and skills applicable to (a) values, ethics and theories; (b) assessment; (c) intervention; (d) aging programs, services and policies; and (e) leadership in aging environments. Accordingly, CSWE/HPPAE created a standardized measure – Geriatric Social Work Competency Scale II with Life-long Leadership Skills (GSWCS II) – to assess empirically these practice competencies among social work students and gero social work practitioners. A scant amount of literature exists that reports properties of this measure. Consequently, the purpose of this study was to conduct a psychometric examination of the GSWCS II, namely its factor structure and reliability among the competency areas. The sample consisted of three, advanced year MSW cohorts (N=170) from a state flagship university in the southern United States. Almost one-third of the sample were enrolled in a gerontology specialization during their advanced year. The typical participant was a 27-year-old female enrolled full time, completing the 60-credit hour MSW program. Principal axis factor results indicated unidimensionality, using the traditional 1.0 eigenvalue threshold, for each competency scale. All items loaded moderately-to-strongly on their respective competency scales; loadings ranged from 0.569 to 0.906. Regarding internal consistency for each of the competency scales, Cronbach’s alphas ranged from 0.932 to 0.959; Guttman split-half coefficients (lambda-4) ranged from 0.896 to .941. Implications for gero practice competency assessment are discussed.
FACTORS INFLUENCING STAFF-RESIDENT INTERACTIONS IN NURSING HOMES
Authors: Paudel Anju , Galik Elizabeth , Resnick Barbara
Published: November 2019

Staff-resident interaction is an integral part of daily life of nursing home residents and has an influence on residents’ well-being. However, less is known about the factors that influence these interactions. The purpose of this study was to describe the quality of interaction between staff and residents with dementia in nursing homes, and explore the factors associated with ‘positive’ and ‘negative/neutral’ interactions. This cross-sectional analysis utilized baseline data from the first two cohorts in a randomized clinical trial, EIT-4-BPSD, including 338 residents from 35 nursing homes. Generalized linear mixed model (GLMM) was used to explore the factors associated with interactions. It was hypothesized that the resident factors (age, gender, race, marital status, cognition, comorbidities, depressive symptoms, agitation, functional status) and facility factors (facility ownership, facility size, RN hours, LPN hours, CNA hours, and star rating) would be associated with staff-resident interactions. The staff-resident interactions were mostly positive. Overall, the models for ‘positive interactions’ and ‘negative/neutral interactions’ correctly classified 82.8% and 85.3% of the cases respectively. Both ‘positive’ and ‘negative/neutral’ interactions were significantly associated with marital status, and profit status of the facility. Being married and living in a not for profit facility was associated with lower odds of positive interaction and higher odds of negative/neutral interaction. There is some evidence that marital status influences staff-resident interactions and that profit status of facilities are associated with staff resident interactions. Future studies could explore staff factors such as consistent assignment, job satisfaction, staff characteristics, and training.
THE STRUCTURE OF CARE MANAGERS’ PRACTICE RESPECTING THE AUTONOMY OF THE FRAIL ELDERLY IN JAPAN
Authors: Hata Chiemi , Kasahara Sachiko
Published: November 2019

The objectives of current study are to clarify the structure of practice respecting the autonomy of the frail elderly under the Long-Term Care Insurance system in Japan and to discuss the related factors to the practice. The mailed self-administered questionnaire survey was conducted on 1398 care managers who working in In-Home Long-Term Care Support Providers in A City in Osaka with the condition that “office with multiple care managers engaged and one care manager with more than 5 years’ experience”. The response rate was 51.0% (713persons) and no missing data 615 (44.0%) was analyzed. Analysis was carried out using Mplus.ver8. The structure of practice respecting the autonomy of the frail elderly and the rerated factors were examined as a causal model using structural equation modeling. As the result, it was confirmed the goodness of fit to the data (RMSEA=0.049, CFI=0.927). By the confirmatory factor analysis, the care manager’s practice respecting the autonomy of the elderly was confirmed associating with three-factors structure; (1)data collection and assessment, (2) strength perspective and (3) professional relationship. Furthermore the practice was significantly affected by self-esteem of care-managers performance (β=0.494) and self-reflection to own work (β=0.269). In conclusion, the current study supported the hypothetical consideration in which self-esteem and self-reflection in care manager’s practice significantly affected the practice respecting the autonomy of the frail elderly.
PERSON-CENTERED CARE, BURNOUT, AND BARRIERS AMONG DIRECT CARE PROFESSIONALS: TARGETED TRAINING INTERVENTION 360
Authors: Stratton Lauren , Dannewitz Hannah , Margrett Jennifer , Shelley Mack , Brown Linda , Drobot Ann C
Published: November 2019

Long-term care staff outcomes, such as job satisfaction and providing personalized care, are positively influenced by person-centered interventions. Implemented in eight facilities across Iowa, the Targeted Training Intervention 360 (TTI) program aimed to increase person-centered care among direct care professionals (DCP). Throughout the course of TTI, three waves of data were collected from DCPs regarding person-centered care (Person-Centered Care Assessment Tool; P-CAT) and feelings of burnout (Maslach Burnout Inventory; MBI). Analysis of variance tests were employed to identify significant differences in subscale scores across the three waves. Between waves one and two, results revealed significant increases in the P-CAT Extent of Personalizing Care (p=0.03) and Amount of Organizational Support subscales (p=0.001). Additionally, significant decreases from waves one and two were found in the MBI Emotional Exhaustion subscale (p=0.04). Between waves two and three, there were no significant changes in the P-CAT subscales; however, there was a significant increase in the MBI Emotional Exhaustion subscale (p=0.04). To supplement these findings, in wave three DCPs indicated barriers to implementing person-centered care, which included lack of time (49.0%), lack of experience (29.4%), and lack of administrative support (21.6%). Though there were no significant changes in P-CAT scores between the last two waves as well as barriers that must be addressed, DCPs described positive organizational and personal changes regarding person-centered care in the facility, including consistent staffing, using person-centered techniques in care, and individualized activities. Discussion focuses on ways to address barriers to person-centered care and sustain efforts in implementing change.
SERVICE PROVISION IN RESIDENTIAL CARE COMMUNITIES FOR RESIDENTS WITH DEMENTIA AND DEPRESSION
Authors: Sengupta Manisha , Caffrey Christine
Published: November 2019

Assisted living and similar residential care communities (RCCs) are an important source of care for older adults, many of whom have dementia or depression. In 2016, 42% of residents in RCCs were diagnosed with dementia and 31% were diagnosed with depression. About two-thirds of RCCs (63%) provided social work and mental health services and 37% provided neither service. Using the 2016 National Study of Long-Term Care Providers, this study includes bivariate and ANOVA modeling to (1.) examine the variation in dementia and depression between RCCs that provide social work and mental health services and those that do not, and (2.) assess if there is an interaction between provision of services and RCC bed size in their association with dementia and depression. Bivariate results show that the prevalence of dementia does not vary by service provision, but the prevalence of depression does. The percent of residents with depression varied from 34% in RCCs that provided both social work and mental health services to 31% in RCCs that provided only one service to 28% in RCCs that provided neither service. The prevalence of dementia was around 4 in 10 residents, regardless of service provision. Fitting a two-way ANOVA model for dementia indicated that the effect was 4 percentage points higher for RCCs that provided services than those that did not, but only among small RCCs. Findings from this study can inform strategies to care for the needs of residents with dementia and depression across the various sizes of RCCs.
QUALITY OF CARE IN A LONG-TERM CARE COMMUNITY
Authors: Murray Laura A , Heinz Melinda
Published: November 2019

Older adults may need to reside in long-term care facilities for additional assistance. However, research indicates differences in the quality of care. The purpose of this study was to conduct a naturalistic observation, recording factors affecting the quality of care residents received in a long-term care community. Over a three-week period, observations took place in the nursing home, assisted living, and memory care portions of the community. We predicted that there would be more issues negatively impacting quality of care in the nursing home area due to its medical model philosophy. Open-observations were recorded, coded, and analyzed for themes. Results indicated that the most significant issue influencing quality of care in all areas of the long-term care facility was communication (N = 57 recorded instances). Approximately 66% of recorded communication issues in the nursing home were negative compared to positive (25%) or neutral (8%) instances. Elderspeak was prevalent with staff using high pitched voices or saying “hun” to residents. At times, staff spoke too loudly to residents who did not have hearing impairment or would talk about residents in front of other residents, not taking into consideration privacy. In the memory care environment, positive examples were noted. Staff was friendly and worked together as a team, creating a positive work environment. Overall, results indicated staff members may need professional development in the area of communication, particularly staff working in the nursing home. In addition, reminding staff while it is their workplace it is also the resident’s home would be beneficial.
MANAGEMENT OF NONCOGNITIVE NEUROPSYCHIATRIC SYMPTOMS OF DEMENTIA IN NURSING HOME RESIDENTS
Authors: Basnet Prasanna , Acton Gayle , Champion Jane D
Published: November 2019

Background: It is challenging for nursing home (NH) staff to manage non-cognitive neuropsychiatric symptoms (NPS) of dementia. There is a need for an assessment of staff knowledge regarding non-pharmacological approaches to manage NPS of dementia. This assessment will inform development of policies/procedures to assist NH staff for management of problematic behaviors in residents with dementia (RWD) using non-pharmacological approaches thereby complying with CMS directives to reduce psychotropic medication use. Methods: NH staff members were interviewed using semi-structured interview methods. Interviews continued until thematic saturation was reached. A total of 17 interviews were completed. Findings: Forgetfulness, hallucinations, anger, agitation, combativeness are the most common problematic dementia behaviors. Participants reported that these behaviors make activities of daily living (ADL) care challenging and time-consuming. Redirection, distraction, and recreational activities are the most common approaches identified by participants to manage non-cognitive NPS using non-pharmacological techniques. Participants reported rushing residents to get things done hinders cooperation and escalate problematic behavior. Some participants believed the use of a low dose PRN benzodiazepine is effective as this calms the resident with dementia and reduces NH staff time requirements for assistance with ADL care. Participants described adverse reactions such as weight loss, and general decline as an outcome of somnolence secondary to psychotropic medications use. Implications: NH staff who participated in this project had not received any formal education or instruction concerning non-pharmacological approaches for the management of non-cognitive NPS. NH protocols are indicated for non-pharmacologic behavior management techniques prior to the administration of psychotropic medications.
MEASURING CLIENT EXPERIENCE IN RESIDENTIAL AGED CARE TO INFORM AND SUPPORT CONSUMER CHOICE
Authors: Fetherstonhaugh Deirdre M , Wells Yvonne , Herd Angela
Published: November 2019

The Australian Government Aged Care Quality and Safety Commission (prior to January 2019 known as the Australian Aged Care Quality Agency) is responsible for accreditation of Australian aged care services which are audited against the Australian Accreditation Standards. Accreditation reports are publicly available. Prior to 2017, some clients were interviewed about their experiences, but the resulting information could not represent the client experience within a service due to low numbers, biased sampling, and an unsystematic approach to asking questions. La Trobe University was engaged to develop and pilot an interview tool to measure client experience for use in accreditation. Potential questions were identified through a literature review, mapped against the Accreditation Standards, and workshopped with an expert reference group. Twenty-four questions and a visual analogue were then piloted. Consumer groups and groups of Indigenous and culturally diverse clients in residential aged care homes were consulted. The perspective of Quality Agency surveyors was sought on the questions’ usability. Statistical analyses sought to identify questions that minimised missing data, were responded to similarly by residents and their representatives, and elicited stable responses on retest. Twelve questions were identified as optimal. The 10 quantitative questions proved to reflect a single underlying dimension (consumer experience) and, when summed and explored through regression analyses, differentiated services significantly. The consumer experience interview tool is now used in all accreditation audits in Australia. Results are then used to generate consumer experience reports, which are published online and can support consumer choice of a residential aged care home.
NURSING ASSISTANTS’ OPINIONS ON CREATING THE PERFECT DINING EXPERIENCE FOR RESIDENTS WITH DEMENTIA
Authors: Ferguson Christine , Douglas Joy W , Jung Seung Eun , Noh Hyunjin , Ellis Amy
Published: November 2019

Feeding residents with dementia in long-term care settings can be challenging, partly related to environmental factors. Certified Nursing Assistants (CNAs) are primarily responsible for feeding residents with dementia who need assistance. Given that older adults with dementia have an increased risk of developing malnutrition, there is a need to develop standards in place for constructing an ideal dining environment to optimize residents’ dietary intake. This qualitative study was conducted to explore CNA’s perspectives of how dining areas could be enhanced to improve food intake of residents with dementia. Nine focus groups were conducted with a total of 53 CNAs who had at least one year of experience feeding residents. Focus groups were audio recorded and transcribed verbatim. Data were analyzed using directed content analysis guided by the Social Ecological Model. CNAs reported that distractions can significantly inhibit residents’ food intake; therefore, limiting distractions such as noise and crowding is important. CNAs also reported the benefit of playing music in the dining area depended on the individual resident. Additionally, CNAs emphasized the importance of offering a variety of appetizing menu choices tailored to residents’ preferences. CNAs have firsthand experience with residents with dementia and can provide valuable insights. Long-term care administration should consider interdisciplinary support to improve the mealtime experience of residents with dementia in an effort to enhance their dietary intake. In particular, providing a variety of menu choices in a well-lit, calm, spacious, and homelike dining environment can be beneficial.
IMPROVING SLEEP USING MENTORED BEHAVIORAL AND ENVIRONMENTAL RESTRUCTURING (SLUMBER)
Authors: Chodosh Joshua , Hernandez Diana , Mitchell Michael , Cadogan Mary , Brody Abraham A , Alessi Cathy , Smilowitz Jessica , Martin Jennifer
Published: November 2019

Sleep disturbances are common in skilled nursing facilities (SNF) affecting up to 70% of residents. Poor sleep is linked to depressed mood, cognitive impairment, increased pain, and functional disability. SNF residents depend on staff for basic day-to-day needs making it essential that staff be empowered in sleep improvement efforts. In SLUMBER, we are using a multi-site stepped-wedge design to implement a program for SNF staff to improve common sleep-disruptive factors. This three-month program includes four in-person staff meetings and three didactic webinars covering three content areas: 1) improving the nighttime sleep environment, 2) increasing daytime activities, light exposure, reducing daytime sleeping, and 3) helping individual residents having difficulty with sleep. In addition to mentoring staff on sleep improvement strategies, technology provides feedback on noise levels from decibel meters throughout the unit and weekly “sleep pearls” text messages sent to staff to reinforce teachings. We measured noise readings (in decibels) in one second increments. For sleeping hours, 10pm to 6am, we calculated the percentage of observations exceeding 60 decibels. Post intervention in the first of six study units, 78% of noise readings exceeded 60db during sleeping hours compared to three months later where 50.3% of noise readings exceeded 60db, suggesting benefits of noise-reduction efforts. SNF staff reported several instances of improving sleep among chronically poor sleepers and an improved work environment. This mentoring program can achieve important environmental improvements with perceived benefit to residents and staff. Whether this leads to objective symptom and physiological improvements awaits conclusion of this four-year trial.
EXAMINATION OF TRUST IN THE HEALTH CARE SYSTEM AMONG OLDER IMMIGRANTS RESIDING IN THE MIDWEST
Authors: Husa Robyn , Matsuo Hisako , Gallardo Jennifer Hale , Willoughby Lisa
Published: November 2019

Ethnic minority populations, such as immigrants, have demonstrated lower levels of trust in the health care system and their health care providers compared with non-migrant populations (Navaza et al., 2012; Renzaho, Polonsky, McQuilten, & Waters, 2013). This medical mistrust may adversely influence older adult immigrants’ use of and satisfaction with health services (Hong et al., 2018a; Jang, Kim, & Chiriboga, 2005). Thus, the current project aimed to characterize influences of medical mistrust (healthcare system and healthcare providers) in older adult immigrant populations living in the United States of America (U.S.). We interviewed 142 older adult immigrants and refugees (aged 60+ years) who identified as Bosnian, Chinese, Indian, Korean, Latino, and Vietnamese about their perceptions on living in the U.S., of the healthcare system, and healthcare utilization as a part of the Successful Aging among Immigrants in Midlife (SAIM) project. Linear regression models predicting trust in the healthcare system and trust in healthcare providers were tested with healthcare knowledge (measured with a single item about flu shots) , acculturation, length of time in the U.S. , and age as predictors. We found that older age and healthcare knowledge was predictive of higher levels of trust in healthcare providers for Chinese. Although healthcare knowledge was predictive of trust in the health care system for the Chinese participants, greater length of time and higher acculturation were associated with higher trust in the healthcare system among Indian participants. The implications of the different predictive variables in each of the hypothesized models will be discussed.
PAIRING STORIES AND EDUCATIONAL CONTENT FOR A CULTURALLY CELEBRATORY HEALTHY AGING COMMUNITY RESOURCE
Authors: Croff Raina L , Francois Edline , Lawrence Caroline , Rothberg Zoe , Towns Juell , Fuller Patrice , Pruitt Andre , Kaye Jeffrey
Published: November 2019

Culturally celebratory programming exceeds cultural relevancy, engaging participants in celebration-making and culture-creating. African Americans aged 55+ in the Sharing History through Active Reminiscence and Photo-imagery (SHARP) study celebrate their heritage in gentrifying neighborhoods through walking-reminiscence sessions; they create culture through discussing ideas, beliefs, norms, values, and shared experiences of the past while considering these aspects within presently changing cultural dynamics. The SHARP study’s narrative approach supports cognitively healthy behaviors and community priorities of cultural preservation in response to marginalization. The SHARP smartphone application houses 72 themed walking routes in Portland, Oregon’s historically Black neighborhoods. One-mile routes with GPS-triggered historical neighborhood images prompt conversational reminiscence among walking triads. Recorded narratives are organized in a process called storytabling and thematically coded. Selections referencing cognitively healthy behaviors are flagged for pairing with online brain health content tested by 12 African Americans aged 55+. Historical images and narratives anchor educational content to relatable life experiences, framing healthy aging in a culturally celebratory, neighborhood context to improve applicability. The online resource, routes, and recorded narratives are community deliverables. Currently, 254 walking narratives from 2016-2018 walkers (n=40; 8 with mild cognitive impairment) have been transcribed and 60 analyzed. Walkers found image prompts and walking within triads of similar sociocultural backgrounds as highly motivating, healthy ways of addressing change. Content testers found narratives lent depth, meaning, and a sense of cultural resilience to educational content. Narrative approaches situate cognitive health in participant-driven terms and experiences, informing brain health best practices for marginalized and minority populations.
WALKING AND TALKING ABOUT WHAT USED TO BE: THE SHARP NEIGHBORHOOD WALKING PROGRAM FOR OLDER AFRICAN AMERICANS
Authors: Towns Juell , Fuller Patrice , Francois Edline , Croff Raina L , Kaye Jeffrey
Published: November 2019

The Sharing History through Active Reminiscence and Photo-Imagery (SHARP) study aims to preserve African American cognitive health through neighborhood walking and social engagement in a way that celebrates Black culture. For 6 months, African Americans aged 55+ (2016 n=19; 2017 n=21) grouped in triads walked 1-mile routes accessible via the SHARP application. Routes included historical image prompts about Portland, Oregon’s historically Black neighborhoods. Participant focus groups at months 1, 3, and 6 drove program development and refinements, and provided valuable insight into the program’s meaning for participants. Discussions were thematically coded. Emergent themes included “suggested improvements,” “technology,” “mental health impact,” “cultural incongruence,” and “cultural significance.” Participants suggested improvements to the application’s navigational aspects and expressed willingness to engage technology despite initial apprehension. The triadic structure and place-based memory prompts aided reminiscence, allowing participants to make meaningful links between their own life experiences and their walking partners’. Neighborhood walking brought to the surface participant concerns about a lack of understanding between African American generations, and between long-time residents and whiter, wealthier demographics moving in. Some participants found it emotionally taxing to walk in the now gentrified historically Black neighborhoods, but still saw the program overall as useful, interesting, and necessary--to their physical and cognitive health, to their mental health as they processed neighborhood changes and community loss, and as an important contribution to preserving community history. Addressing individual health alongside pressing issues affecting older African Americans’ sense of well-being and community may make cognitive health programs more meaningful and applicable.