bluuebunny/crossref_metadata_2025 huggingface dataset:
USE OF SENSOR TECHNOLOGY TO MAP THE SOCIAL NETWORKS OF PEOPLE LIVING WITH DEMENTIA: A FEASIBILITY STUDY
Authors: Wright-Freeman Kayla , Wei Sijia , McConnell Eleanor , Caves Kevin , Davis Leighanne , Hawkes Adrienne , Moninger Sarah , Corazzini Kirsten N
Published: November 2019

For older adults living with dementia, social network quality influences health outcomes. However, current social network measurement methods are time consuming and mentally draining for people living with dementia. This study aimed to accurately measure social networks using sensor technology. Bluetooth and radio-frequency identification (RFID) sensors were used to collect social network data in a simulation of a falling nursing home resident living with dementia. Participants wore sensors on their clothing, and video recordings were compared to sensor data. Bluetooth data reflected general direction of movement and instances of idling but were neither precise or accurate. RFID data was accurate after applying data filters. Both systems detected multiple sensors simultaneously. The Bluetooth system is not feasible for clinical use, but the RFID system shows potential for clinical application and accurate measurement of social network factors as interaction frequency and duration.
RELATIONSHIP-CENTERED CARE: ADULT DAY CARE FOR PERSONS LIVING WITH DEMENTIA AND THE SENSES FRAMEWORK
Authors: Woog Samantha , McConnell Eleanor , Gold Deborah , Corazzini Kirsten
Published: November 2019

Relationship-centered dementia care (RCDC) has been related to improved quality of residential long-term care for persons living with dementia (PLWD). The senses framework supports accomplishing RCDC, whereby PLWD meet fundamental needs or senses through caregiving relationships. This study explored the application of the senses framework to a non-residential, long-term care setting, and included relationships across formal and informal caregivers. The study design is a qualitative, descriptive study of PLWD (N=3), with matched formal (N=3) and informal (N=3) caregivers in one adult day care setting in North Carolina. Semi-structured individual interviews explored each of the six senses of security, belonging, continuity, purpose, achievement, and significance. Interviews were analyzed using both inductive and deductive thematic analysis. Themes elucidate convergence and divergence of how senses are met or not met across triads of caregiving relationships. Findings inform our understanding of how to integrate the larger social network of PLWD for relationship-centered care.
REDUCING AVOIDABLE FACILITY TRANSFERS: THE RAFT MODEL
Authors: Stadler Daniel
Published: November 2019

Reducing Avoidable Facility Transfers (RAFT) is a Dartmouth-developed program that identifies and honors “what matters most” to patients residing in skilled nursing facilities in a value-based, sustainable way. RAFT aims to reduce avoidable facility transfers of older adults from long-term care and post-acute care facilities to emergency departments (ED). Key components of RAFT presently include (1) systematically eliciting goals of care for all skilled nursing facility residents, (2) translating these goals into orders using the Physician Orders for Life-Sustaining Treatment form, (3) documenting patient wishes about hospitalization, and (4) ensuring that these wishes inform decision-making during acute crises. Data from a pilot program, begun in 2016 with three rural skilled nursing facilities in collaboration with the Dartmouth-Hitchcock Medical Center geriatric practice, showed a 35% reduction in monthly ED transfers, a 30.5% reduction in monthly hospitalizations, and a 50.7% reduction in monthly ED and hospitalization-related charges.
THE CARE RECIPIENT’S PERSPECTIVE ON QUALITY OF CARE: DIFFERENT APPROACHES IN NURSING HOMES
Authors: Verbeek Hilde , Van Haitsma Kimberly
Published: November 2019

In long-term care, there has been an ongoing shift focused on person-centered care, positioning the care recipient at the core of good quality of care. This has resulted in more emphasis on care recipients’ preferences and experiences with the care they receive. In the Netherlands, Germany and the United States the need to focus on and assess quality from the care recipient’s perspective has emerged. This symposium presents four different approaches to quality of care from the care recipient’s perspective. The first speaker will focus on a narrative approach to assess experienced quality of care in nursing homes. The second speaker will present an observational method to assess the level of autonomy provided to people with dementia in nursing homes. The third speaker will present findings about the use of specialist health care in nursing homes as an indicator for quality of care. The last presentation will address the importance of preferences in quality of care. Defining, assessing and improving experienced quality of care from the care recipient’s perspective is an ongoing challenge, as each care recipient’s preferences and needs differ. It is important to assess in order to monitor that care is being tailored to the care recipient and to identify possible interventions that can enhance experienced quality of care.
NOT READY FOR PRIME TIME: A FAILED STUDY TESTING A TECHNOLOGICAL INTERVENTION IN NURSING HOME CARE
Authors: Williams Kristine N , Shaw Clarissa
Published: November 2019

This pilot-study tested an adaptation of a successful family caregiver telehealth support intervention in nursing home settings. The goal was to support staff in managing challenging behaviors of residents with dementia. Nursing homes were provided with an iPad mini equipped with a special application to video record staff-resident challenging care situations. Videos were uploaded to a secure site for review by dementia care experts who provided feedback to improve care. Despite efforts to engage staff, only four videos were submitted. Factors including privacy, workload, and fear of documenting abuse contributed to implementation failure. The same intervention was successfully implemented in the home setting; differences in engagement and utilization will be discussed. Understanding the unique environments of nursing home dementia care is needed to successfully implement technology-based interventions to improve care. Evaluation of factors predicting the failure of this intervention may inform future research.
FACILITATING CARE: A NARRATIVE APPROACH TO ASSESS EXPERIENCED QUALITY OF CARE
Authors: Sion Katya , Verbeek Hilde , Odekerken-Schröder Gaby , Zwakhalen Sandra , Schols Jos , Hamers Jan
Published: November 2019

This study aimed to develop a method to assess experienced quality of care (QoC) in nursing homes from the resident’s perspective. A narrative approach “Facilitating Care” (FC) was developed based on the INDEXQUAL framework of experienced QoC and a needs assessment. FC assesses experienced QoC by training care professionals to perform individual conversations with residents, their family and their professional caregivers (triads) in another organization than where they are employed. FC consists of three phases: 1) training, 2) data collection and registration, and 3) analysis and reporting of the results. In 2018, 16 care professionals were trained and performed 148 conversations (47 residents, 44 family members, 57 professional caregivers) in 8 different nursing homes. Evaluation showed that FC teaches helpful conversation techniques and provides valuable insights into residents’ experienced QoC. Whilst the process was considered time consuming, all participants emphasized the added value of taking time for FC conversations.
GENERATIVITY ACROSS ADULTHOOD: THE EFFECTS OF AGE AND AFFECT
Authors: Nelson Niccole A , Bergeman Cindy
Published: November 2019

Generativity, or investment in the next generation, is heavily implicated in successful aging. Due to its benefits to both the individual and society, researchers have attempted to identify factors that contribute to generativity. Most studies on generativity, however, have been conducted in cross section, limiting established relations to those occurring between individuals, not within them. The identification of true within-person effects is vital, as between-person relations do not accurately describe within-person processes. One factor that may contribute to generativity within individuals is positive affect (PA), as experiencing PA seems to broaden individuals’ resources, and ultimately build human flourishing. This process may also be moderated by age or change over time. To test these ideas, the current study applied multilevel modeling to ten years of data from N = 1,117 mid-to-later life individuals. A main effects model indicated between-person effects such that younger individuals, as well as individuals with higher global PA, tended to report higher generativity, on average, than older individuals and individuals with lower global PA, respectively. Next, considering within-person effects, individuals tended to report higher generativity during years they experienced more PA. Finally, a two-way interaction effect indicated an age-related difference in a within-person process: although midlife individuals reported higher generativity during years they experienced more PA, later-life individuals did not show this effect. Theoretical implications, including age-graded goal strivings and the broaden-and-build theory, will be discussed.
IMPLEMENTATION OF PATIENT PRIORITIES CARE WITHIN A VA GERIATRICS CLINIC
Authors: Freytag Jennifer , Dindo Lilian , Catic Angela , Naik Aanand , Tinetti Mary
Published: November 2019

Patient Priorities Care (PPC) is an approach to decision-making for older adults with multiple chronic conditions (MCC). PPC trains facilitators to have structured conversations with patients to identify their priorities (the outcomes that matter most given what care they are willing/able to do or receive). Clinicians then align care to achieve patient priorities rather than focusing on multiple single-disease guidelines. We piloted PPC in a VA geriatrics clinic and compared it to usual care (UC) for multimorbid adults. This retrospective cohort study (n=36 PPC, 36 UC) describes changes made by clinicians after Veterans with MCC had facilitated conversations in a VA geriatric clinic. UC Veterans were matched by prognosis, same primary clinician, and timeframe. Coders used a standardized rubric to assess documented care within medical records. Changes to care examined include medications added/removed, referrals made/avoided, self-care recommendations, and recommendations for social engagement. Although PPC and UC patients were seen by the same clinicians, patients receiving PPC had fewer added medications (mean difference -.47, t(70)=-1.99, p=.05); received more recommendations for self-care aligned with priorities (mean difference .25, t(69)=2.14, p=.003); received more recommended consultations with desired care, including podiatry, transportation, and dermatology (mean difference .55, t(70)=2.06, p=.01), and more recommendations for care and services to facilitate social interactions (p<.0001). PPC produced documented changes in care that better align with patient priorities within the routine care workflow of a busy geriatrics clinic. Our results provide evidence that structured priorities conversations change the way clinicians provide care for older adults with MCC.
THE SUPPORT OF AUTONOMY FOR NURSING HOME RESIDENTS WITH DEMENTIA: OBSERVATION OF MORNING CARE
Authors: Hoek Linda J , Verbeek Hilde , Vries Erica De , Van Haastregt Jolanda C , Backhaus Ramona , Hamers Jan P
Published: November 2019

People with dementia in nursing homes need their social environment in supporting their autonomy. This study explored how this relational autonomy is supported by staff for residents with dementia during morning care in nursing homes. Structured observations (n=1815) were carried out to assess how resident choice is supported within staff-resident interaction. Observation of morning care consisted of four main categories: ‘getting up’, ‘physical care’, ‘physical appearance’ and ‘breakfast’. In addition, qualitative field notes were taken to support observations. In total, 55 residents with dementia were included from eight nursing home wards in The Netherlands. Results indicated that resident autonomy during morning care was only limitedly supported. Individual staff members took over tasks, regardless of resident’s individual capabilities to make a choice. Staff controlled resident’s choice for almost all observed categories. The findings of this study implicate that person-centered care during morning routine can be improved by addressing individual needs
PAVING THE WAY FORWARD IN HOUSING WITH SERVICES: THE RIGHT CARE, RIGHT PLACE, RIGHT TIME PROGRAM
Authors: Miller Edward A , Nadash Pamela , Sanders Alisha
Published: November 2019

Older people living in congregate environments are obvious beneficiaries of supportive services. The potential for prevention is clear, particularly among low-income elders living in subsidized housing; it is this group that is at high risk for significant healthcare and other costs, and it is this group that suffers considerably from a fragmented healthcare system. Policymakers have long seen the advantages of reaching this population, but most existing housing with services programs have focused more on social than health-related supports. The Right Care, Right Place, Right Time initiative (R3) was launched in July 2017 to demonstrate the value of supportive services to seniors living independently in affordable housing in the Greater Boston area, while reducing health care costs. The R3 program consists of two on-site wellness teams, including a wellness nurse and wellness coordinator. Each team is responsible for about 200 participants across two housing sites. The R3 evaluation included both quantitative and qualitative components. The quantitative component entails pre/post comparison as well as a control group analysis, focusing on various health and health utilization outcomes. The qualitative component includes key informant interviews examining program development and implementation and focus groups capturing the resident experience. The purpose of this symposium is for evaluation team members to report on the experiences of program participants, administrators/staff, housing managers/staff, and community partners with the R3 program, and to assess program impact. Edward Miller and Pamela Nadash will serve as chair and co-chair, respectively; Alisha Sanders as the discussant.
COLLABORATION WITH FIRST RESPONDERS IN R3: THE CRITICAL ROLE OF COMMUNITY PARTNERS IN HOUSING WITH SERVICES
Authors: Nadash Pamela , Miller Edward , Simpson Elizabeth , Shellito Natalie
Published: November 2019

Because seniors represent a rising proportion of Emergency Medical Services (EMS) provider activity, there is a growing focus on determining how EMS providers can better serve the aging population. Multifamily senior housing properties benefit from reductions in resident turnover; EMS providers aim to improve community health and minimize unnecessary and low-priority callouts. Developing partnerships between the two service sectors can help both meet their individual goals while reducing health system costs. Drawing on experience with the R3 initiative, this study describes how a partnership between EMS providers and supported housing sites has led to reductions in ambulance transfers to hospitals and reinforced falls reduction programs within senior housing. The R3 program represented an effort to work closely with EMS providers and, by doing so, provides an example of how collaboration between the two sectors can work to the advantage of both parties by identifying residents who would benefit from intervention.
THE USE OF SPECIALIST HEALTH CARE IN NURSING HOMES AS AN INDICATOR FOR QUALITY OF CARE
Authors: Wolf-Ostermann Karin , Wolf-Ostermann Karin , Schmidt Annika , Gand Daniel , Gerhardus Ansgar , Rothgang Heinz
Published: November 2019

Needs-based medical care is essential for maintaining and promoting health and quality of life in long-term care. But still knowledge of medical needs and of needs-based medical care of nursing home (NH) residents is limited. However, individual studies, primarily based on secondary data, show that NH residents have significantly less contact with specialists than community-dwelling elderly. The aim of the study is therefore to gain knowledge about medical needs of NH residents as well as about the use of (specialist) medical care especially with respect to vision, hearing and oral health. Besides sociodemographic and care-related data we evaluated health status and utilization of medical care by means of standardized assessments for n=500 NH-residents. Results show that there are inequalities in (specialist) medical care: More experienced knowledge about unmet medical care needs will be used to generate ideas on how to improve the provision of medical care in nursing homes.
SLEEP QUALITY AS A MECHANISM LINKING PHYSICAL ACTIVITY AND COGNITIVE FUNCTIONING
Authors: Bisson Alycia N , Lachman Margie E
Published: November 2019

Modifiable health behaviors, such as physical activity and sleep quality are important for cognition throughout life. A growing body of research also suggests that engaging in enough physical activity is important to sleeping well. One recent study found that sleep efficiency mediates the relationship between physical activity and cognition. It is still unknown whether other metrics of sleep quality are mediators. The present study tested mediation in the second wave of the Midlife in the United States (MIDUS) study. Using the PROCESS macro for SPSS, we found that those who were more physically active fell asleep faster, and had better executive functioning. In addition, those who were more physically active reported waking up fewer times during the night, and had better executive functioning and self-rated memory. Discussion will focus on the moderating role of gender and distinctions between findings with different measures of sleep, physical activity, and cognition.
RACIAL DISPARITIES IN 30-DAY READMISSION RATES AMONG MEDICARE PATIENTS DISCHARGED TO SKILLED NURSING FACILITIES
Authors: Rivera-Hernandez Maricruz , Rivera-Hernandez Maricruz , Rahman Momotazur , Mor Vincent , Trivedi Amal N
Published: November 2019

The 30-Day All-Cause Readmission Measure is part of the Skilled Nursing Facility Value-Based Purchasing (SNFVBP) beginning 2019. The objective of the study was to characterize racial and ethnic disparities in 30-day rehospitalization rates from SNF among fee-for-service (FFS) and Medicare Advantage (MA) patients using the Minimum Data Set. The American Health Care Association risk-adjusted model was used. The primary independent variables were race/ethnicity and enrollment in FFS and MA. The sample included 1,813,963 patients from 15,412 SNFs across the US in 2015. Readmission rates were lower for whites. However, MA patients had readmission rates that were ~1 to 2 percentage points lower. In addition, we also found that African-Americans had higher readmission rates than whites, even when they received care within the same SNF. The inclusion of MA patients could change SNF penalties. Successful efforts to reduce rehospitalizations in SNF settings often require improving care coordination and care planning.
IMPACT OF AN INTENSIVE MULTIDOMAIN LIFESTYLE INTERVENTION ON DEFICIT ACCUMULATION FRAILTY INDICES
Authors: Simpson Felicia , Pajewski Nicholas M , Bertoni Alain M , Ingram Frank , Nicklas Barbara M , Kritchevsky Stephen , Ojeranti Daniel , Espeland Mark M
Published: November 2019

Background: Type 2 diabetes and obesity increase accumulation of health deficits over time and may accelerate biological aging. It is unknown whether multidomain lifestyle interventions can mitigate against this. Methods: Within a large, randomized controlled clinical trial of intensive lifestyle intervention (ILI) including caloric restriction, increased physical activity, dietary counseling, and risk factor monitoring compared with diabetes support and education (DSE) we examined the trajectory of frailty across 8 years. We used two complementary frailty index (FI) definitions, one modeled on work in the Systolic Blood Pressure Intervention Trial; the other including additional deficits related to aging with obesity and type 2 diabetes mellitus. Differences between intervention groups and the consistency of these across clinical subgroups were assessed with re-randomization tests. Results: Data from 4859 adults (45-76 years at baseline, 59% female) were analyzed. Random assignment to ILI was associated with lower FI scores throughout 8 years of follow-up (p<0.001), over which time mean differences between intervention groups averaged 5.8% and 5.4% for the two indices. At year 8, the percentages of participants categorized as frail (FI>0.21) were lower among ILI (39.8% and 54.5%) compared with DSE (42.7% and 60.9%) for the two indices (both p<0.001). Intervention benefits were relatively greater for individuals who were older, not obese, and without history of cardiovascular disease at baseline. Conclusions: Eight years of multidomain lifestyle intervention slows the accumulation of health deficits over time in overweight or obese adults with type 2 diabetes.
PREDICTING ADVERSE OUTCOMES IN ED PATIENTS USING THE CLINICAL FRAILTY SCALE AND A FRAILTY INDEX
Authors: Rockwood Kenneth , Pulok Mohammad , van der Valk Alex , Theou Olga
Published: November 2019

Our aim was to use the Comprehensive Geriatric Assessment (CGA) database to investigate whether the Clinical Frailty Scale (CFS) measuring the baseline state, and a Frailty Index (FI) based on a CGA (current state, with acute illness) can predict adverse outcomes in acutely ill Emergency Department (ED) patients. It contains CFS and FI scores on 1028 ED patients referred to internal medicine at the Halifax Infirmary between 2009-2019 (Mage 80.69 ± SD 8.28, range 57-103; 54.9% female). The mean scores were 0.44±0.14 (FI) and 5.58±1.66 (CFS). Most patients (72%) arrived via ambulance. The average length of stay was 27.0±20.5 hours. Overall, 22% were discharged home, and 63.5% had died by December 2017 with a mean survival time of 1.98±2.01 years. Controlling for age, sex, and Canadian Triage Acuity Score, the odds ratio (95% Confidence Interval) of being discharged home and the hazard ratio (95% Confidence Interval) for mortality was 0.94 (0.92-0.95) and 1.02 (1.02-1.03), respectively per 0.01-point increase in FI. For the CFS, using score ≤4 as the reference, the odds ratio and the hazard ratio were 0.70 (0.42-1.16) and 2.02 (1.51-2.69), respectively for the CFS 5 group, 0.47 (0.27-0.81) and 2.72 (2.05-3.61), respectively for the CFS 6 group, and 0.38 (0.21-0.70) and 4.67 (3.51-6.20), respectively for the CFS 7-9 group. Even controlling for acuity, both the CFS and the FI independently predict adverse outcomes in ED patients. These add prognostic information to the routinely collected ED assessments, and establish targets for care plan based on recovery to baseline.
GEOGRAPHIC DISPARITIES IN COUNTY-LEVEL PREVALENCE OF ALZHEIMER’S DISEASE ACROSS THE UNITED STATES
Authors: Fowler Mackenzie E , DiBlasio Christina , Crowe Michael , Kennedy Richard E
Published: November 2019

Small-area geographic disparities in health care delivery have been observed across multiple disorders, but remain poorly studied for Alzheimer’s disease (AD) and other dementias. While national and state estimates of the prevalence and incidence of AD are available, estimates across finer geographic regions offer an opportunity to tailor programs to the needs of the local population. We estimated prevalence of AD at the county level across the continental United States. We used prevalence rates of AD by age category and race among Medicare fee-for-service beneficiaries published by the Centers for Disease Control (CDC). These prevalence rates were projected onto bridged-race county-level population data for 2017 from the National Center for Health Statistics, with empirical Bayes spatial smoothing to reduce variability in rates due to small population sizes. Estimated prevalence of AD varied more than threefold across counties, from a low of 51.8 per 1,000 persons in Loving County, Texas to a high of 169.6 per 1,000 persons in Kalawao County, Hawaii. Higher prevalence of AD was seen in the Southeastern and Midwestern United States. However, we observed specific counties with low prevalence of AD within regions with high prevalence of AD, and vice versa. These small-area geographic variations may provide vital information about social and environmental influences on dementia care, yet little data have been available to date. Understanding geographic disparities in prevalence will be critical for addressing practice variation in the prevention and diagnosis of dementia.
MISCLASSIFICATION IN DEMENTIA DATA IN THE CARDIOVASCULAR HEALTH STUDY: A PROBABILISTIC BIAS ANALYSIS
Authors: Odden Michelle , Arnold Alice , Newman Anne B , Hazzouri Adina Zeki Al , Miller Lindsay , Lopez Oscar , Mukamal Kenneth , Rawlings Andreea
Published: November 2019

Data routinely collected in observational studies from phone calls, medical records, and death certificates can be used to categorize dementia, though there may be misclassification. We applied probabilistic bias analyses to assess the magnitude, direction, and uncertainty of the error due to misclassification of dementia data in the Cardiovascular Health Study (CHS). We categorized dementia among all participants (73,284 person-years) using medications, ICD-9 codes, use of proxy, and death certificates, and compared to the gold standard adjudicated dementia in the CHS Memory Studies (28,250 person-years). Using the gold standard, positive (PPV) and negative predictive values (NPV) of dementia categorization were estimated within strata defined by age and sex. In probabilistic bias analyses, we reclassified participants from the full study using estimated PPVs and NPVs in 5,000 replicates. We estimated the hazard ratio (HR) of dementia associated with age, race, sex, hypertension, diabetes, and APOE4 genotype in this bias analysis and compared these results to those using original data. ICD-9 codes had low specificity and were excluded in further analyses. The NPV was differential by sex (66% for females and 79% for males) and race (51% for blacks, 60% for whites). In bias analysis, the HR for black race was attenuated from 2.81 (95%CI:1.36-5.80) to 1.23 (95%CI:1.14-1.33). The estimate for hypertension was statistically significant only in bias analysis. Estimates and inferences for the other covariates were modestly different. Differential misclassification may lead to important biases of risk factors, but can be recognized and addressed using probabilistic bias analyses.
PROMIS COGNITIVE FUNCTION AND CONCERN SCALES: LINGUISTIC VALIDATION IN AMERICAN SIGN LANGUAGE FOR DEAF OLDER ADULTS
Authors: Kushalnagar Poorna
Published: November 2019

Objective: To culturally and linguistically validate PROMIS Cognitive Functions and Concerns Scales in American Sign Language (PROMIS-ASL) for use with deaf older adults over 50. Methods: We used the standard procedures developed at the U.S. National Center for Health Statistics Cognitive Survey Laboratory to culturally adapt and translate items from the cognitive scales of the Patient Reported Outcomes Measurement Information System (PROMIS). We describe cultural adaptation and linguistic translation procedures led by a team of primarily deaf investigators. Using multidimensional exploratory or confirmatory factor analyses, we identify or confirm the items most likely to comprise each subset. Once the PROMIS-ASL version is finalized, we will compute test-retest reliability using ICC (intraclass correlation coefficient) from two-way random effects ANOVA models. Results: We produced an accessible patient reported outcomes cognitive measure in American Sign Language and a culturally appropriate set of items that are relevant to the experiences of deaf older adult over 50 users of accessible technology and services. Conclusions: The final PROMIS-ASL product with cognitive domain will be distributed for public use.
MORAL GAIN OR DECAY? EXAMINING AGE-RELATED CHANGES IN MORAL JUDGMENT
Authors: Lu Minjie , Fung Helene H
Published: November 2019

The present study investigates age-related changes in moral judgment. In particular, we examined both cognitive and affective dimensions of morality in contributing to moral punishment. One hundred and twenty participants (aged from 22 to 75) recruited from Mturk were presented with 10 moral transgression stories (e.g. lying, harming), and reported their wrongness judgment, moral conviction, emotional experience, and moral punishment. Results revealed divergent patterns on the relationships between age and the evaluations on cognition and emotion. In terms of cognitive evaluation, compared to younger adults, older adults perceived immoral acts as more wrong and considered their stands as more connected to their moral conviction. However, older adults reported less intense negative emotions (anger, disgust, contempt), suggesting they were less aroused by immoral acts. In terms of moral punishment, age was negatively correlated with punishment, and this correlation was mediated by the age-related decrease in negative emotions.
THE ASSESSMENT OF VIEWS ON AGING: A REVIEW OF SELF-REPORT MEASURES AND INNOVATIVE EXTENSIONS
Authors: Notthoff Nanna , Beyer Ann-Kristin , Blawert Anne , Gabrian Martina , Klusmann Verena
Published: November 2019

Individual views on aging refer to either older people in general or to a person’s own age and aging. Classical approaches seem to hardly map the multidimensional, multidirectional, and highly individual nature of experiences as well as the malleability of perceptions of aging. For this paper, we reviewed existing measures of views of aging. These were categorized based on eight dimensions which were defined by an expert panel and based on current characterizations of views on aging in the literature. Results on 96 instruments call for a strengthening of the affective and the behavioral components in contrast to the apparently cognitive focus of the measures and argue for a stronger emphasis on the developmental nature of views on aging (time references, changes). This is particularly important when aiming to study the lifelong dynamics of views on aging. The suitability of innovative extensions will be discussed.
INCREASED PHYSIOLOGICAL VARIABILITY PREDICTS DECLINING HEALTH AND CRITICAL TRANSITIONS IN HEMODIALYSIS PATIENTS
Authors: Cohen Alan A , Nakazato Yuichi , Sugiyama Tomoko , Leung Diana L , Legault Véronique , Côté Anne-Marie
Published: November 2019

Increased variability in levels of several individual biomarkers has been shown to predict adverse outcomes, particularly in hemodialysis patients, for whom time series data is often available. Here, we evaluate the feasibility of using multivariate approaches to quantify global physiological variability as a potential predictor of adverse outcomes. We used data on 588 deaths and 1196 hospitalisations across ~38,000 visits of 591 hemodialysis patients at a Quebec hospital, as well as data on frailty and mortality in 580 patients assessed 20+ times within a one-year period at a hospital in Saitama, Japan. We use two approaches: principal components analysis (PCA) of the coefficients of variation (CVs) of the individual biomarkers over the previous year, and Mahalanobis distance (MD) of the biomarker profile relative to the same profile at the previous time point. We show that both methods provide substantial prediction of both impending mortality and impending hospitalisation, with hazard ratios across the 95% quantile range of the indices varying between 1.5 and 3.5 (p<0.0001). Each unit change on the first PCA axis (PC1) increased frailty odds by 2.34 (95% CI: 1.21-4.52). PCA performed substantially better than MD. CVs of various biomarkers were consistently positively correlated, and PC1 was a good predictor of frailty, mortality, and hospitalisation. Overall, these results confirm that complex physiological integration can break down, resulting in loss of homeostatic control and increasing variability, as predicted by complex systems theory. The resulting indices provide a predictive signal of impending critical health transitions, with both theoretical and clinical implications.
MULTIMORBIDITY PATTERNS ARE DIFFERENTLY ASSOCIATED WITH DEPRESSION IN MIDDLE-AGED AND OLDER CHINESE
Authors: Yao Shan-Shan , Cao Gui-Ying , Chen Zi-Shuo , Huang Zi-Ting , Xu Beibei
Published: November 2019

The associations of multiple physical conditions with depression are still unclear. This study examined the relationship between physical multimorbidity patterns and depression among middle-aged and older Chinese. Patterns of physical multimorbidity were identified using Exploratory Factor Analysis (EFA) among 21,933 participants ≥ 45 years from 2011 to 2015. Multiple logistic regressions were performed to assess the associations between multimorbidity, multimorbidity patterns (factor scores) and depression for each age group (45-60 years vs. ≥60 years). The overall prevalence of multimorbidity was 40% and it was higher among participants with depression (54%) than those without depression (33%). Middle-aged (OR: 1.45; 95%CI 1.16–1.80) and older (OR: 1.85; 95%CI 1.62–2.11) adults with multimorbidity were more likely to have depression compared with those without multimorbidity. Five multimorbidity patterns were identified: cardio-metabolic, respiratory, splanchnic, cardio-cerebrovascular, and tumor-and-degenerative. Middle-aged participants with higher respiratory pattern score had a higher odds to have depression (OR: 1.59; 95%CI 1.15–2.21). Among older adults, higher cardio-metabolic pattern score was significantly associated with lower odds of depression (OR: 0.78; 95% CI 0.63–0.97), while higher respiratory (OR: 1.32; 95%CI 1.04–1.68), splanchnic (OR: 1.22; 95%CI 1.01–1.47) and tumor-and-degenerative pattern scores (OR: 1.86; 95%CI 1.42–2.43) were all found to be significantly associated with higher risk of depression. The associations between physical multimorbidity patterns and depression differ by age. Future studies are needed to investigate the temporal nature of how physical multimorbidity patterns may induce depression and the underlying mechanisms.
RISK FACTORS FOR DISENROLLMENT AMONG HOME HOSPICE PATIENTS WITH DEMENTIA
Authors: Luth Elizabeth A , Russell David
Published: November 2019

Hospice delivers care to a substantial and growing number of individuals with primary and comorbid dementia diagnoses. Dementia diagnosis and racial/ethnic minority status are risk factors for hospice disenrollment. However, little research examines racial/ethnic disparities and other risk factors for hospice disenrollment among hospice patients with dementia. This paper uses multinomial logistic regression to explore sociodemographic and functional status risk factors for hospice disenrollment among 3,949 home hospice recipients with primary or comorbid dementia. Results indicate that patients with a primary dementia diagnosis, racial/ethnic minority groups, and those higher functional status have elevated risk of disenrollment due to hospitalization, disqualification, and electively leaving hospice care. Additional research is needed to understand why primary dementia diagnosis and underrepresented racial/ethnic status are associated with multiple kinds of hospice disenrollment so that hospice practice can be tailored to respond to the needs of these individuals.
PERSPECTIVES ON SETTING GOALS OF CARE AMONG HOSPICE PATIENTS WITH HEART FAILURE, THEIR FAMILIES, AND HEALTHCARE TEAM
Authors: Baik Dawon , Russell David , Jordan Lizeyka , Dooley Frances , Creber Ruth Masterson
Published: November 2019

Older adults with heart failure (HF) face many end-of-life care issues. Shared decision making (SDM) in hospice is an important process that allows HF patients and their family caregivers to discuss their preferences on goals of care (GOC) with their healthcare team. Yet, little research has explored how the values and preferences of HF patients and their family are integrated into their care plans through SDM process. This presentation examines facilitators and barriers to setting GOC among hospice HF patients. Qualitative interviews were conducted with HF patients/family caregivers (n=7) and providers (n=32) at a large not-for-profit hospice agency. Several facilitators emerged: building trust, active listening, helping patients and family caregivers understand hospice and prognosis. Barriers included acceptance, family conflict, language discordance between patients and providers and lack of communication about care transition. Findings confirmed the need for individually-tailored goal-setting approaches to navigating the end-of-life trajectory among HF patients.
FACETS OF CLOSE, ROMANTIC, AND INTIMATE RELATIONSHIPS IN LATER LIFE
Authors: Kolodziejczak Karolina , Gerstorf Denis , Rook Karen
Published: November 2019

Research on the role of close social relationships for physical health and well-being in later life has received increased attention over the past decades. Yet, we are still only beginning to understand potentially underlying mechanisms such as joint goals and affectionate touch. Likewise, we also know little about the relevance of particular social facets such as the role of friends and the nature of sexuality. In this symposium, we have compiled four empirical projects that showcase current and future endeavors to address some of these long-standing questions. Ungar et al. use dyadic data from older couples to examine how shared goals with the partners and positive illusions about these joint goals relate to goal progress and relationship satisfaction. Zhaoyang and Martire analyze long-term longitudinal dyadic data from older couples to examine if and how the frequency of affectionate touch between partners predicts physical health, well-being, and relationship satisfaction five years later. Fiori et al. make use of three-wave longitudinal data from a large and representative US sample to examine the unique roles that close social ties and weaker social ties have independently of one another for age-related changes in two central aspects of affective experience. Kolodziejczak et al. use time-lag data from two cohorts of adults in late midlife to capture historical changes in the perceived importance of sexuality and the evaluation of one’s sex life. Karen Rook will integrate the insights gained from these four papers, discuss their potential and limitations, and consider directions for future research.
AFFECTIONATE TOUCH AND RELATIONAL, MENTAL, AND PHYSICAL WELL-BEING IN OLDER COUPLES: A NATIONAL LONGITUDINAL STUDY
Authors: Zhaoyang Ruixue , Martire Lynn M
Published: November 2019

Recent theories suggest that non-sexual physical contact with close others plays a key role in promoting health and well-being in adulthood. However, the impact of non-sexual physical contact in later life, especially the affectionate touch between romantic partners, has been largely unexplored. Using two waves of dyadic data (N=953 couples, Mage=71 years) from National Social Life, Health, and Aging Project (NSHAP), we examined whether shared affectionate touch between spouses prospectively predicted both partners’ relational, mental and physical well-being five years later, independent of sex activity. Dyadic analyses results indicated that frequency of shared affectionate touch with the partner predicted increases in spouses’ own relationship satisfaction, life satisfaction and mental health, but not in physical health, over five years. No interpersonal (i.e., partner) effect of shared affectionate touch was found. Findings underscore the unique role of non-sexual physical contact between spouses in promoting relational and mental well-being for older couples.
DISSEMINATION STRATEGIES: ALIGNMENT WITH GERI-ED
Authors: Platts-Mills Tim , Rosen Tony , Stoeckle Rebecca Jackson , Dash Kim , Lees-Haggerty Kristin
Published: November 2019

The National Collaboratory to Address Elder Mistreatment’s model provides hospital emergency departments with training and tools to help recognize and respond to elder mistreatment. The Geriatric Emergency Department (GERI-ED) initiative, supported by The John A. Hartford Foundation and West Health, encourages hospitals to integrate best practices for older adults into their emergency departments by providing guidelines and options for accreditation (GED-A). Recognizing the importance of coordinating efforts to develop tools that can be shared and implemented widely, the Collaboratory has intentionally and strategically aligned itself with the GERI-ED by inviting members of the GED-A team to join the Collaboratory. In this presentation we will describe how aligning these two initiatives has the potential to achieve greater impact than either initiative alone. We will provide a case example of how the elder mistreatment care model is implemented in GERI-EDs, highlighting factors that facilitate and hinder model implementation in such settings.
PERSPECTIVES OF OLDER ADULT STAKEHOLDERS ON THE IMPACT OF COMMUNITY-BASED EXERCISE
Authors: Elhajjmoussa Lekaa , Mays Allison M , Rosales Katrina B , Rosen Sonja L
Published: November 2019

This focus-group study aims to identify the perceptions of older adults (>50 years) who participated in community-based exercise classes as part of the Leveraging Exercise to Age in Place (LEAP) Study. LEAP enrollees participate in community-based classes that include Tai Chi, EnhanceFitness, Arthritis Exercise, and the Healthier Living Workshops. Nine LEAP participants attended a focus group at Cedars-Sinai Medical Group. The focus group included quantitative and qualitative questions in both a verbal discussion format and a written questionnaire that examined the effects of liaisons, social connections, and incurred changes as a result of participating in LEAP classes. Participants endorsed liaisons within the healthcare system, including physician referrals and communication with a community health coach, as aiding in their decision to participate in health classes. Participants cited positive changes in their physical states, such as increases mobility and decreases in pain, and positive psychological changes, such as increases in energy and socialization, post LEAP completion. Among the ideas and critiques noted by the focus group attendees was the desire to have LEAP classes become part of communities permanently, and to have longer exercise class session duration. These findings suggest that direct merging of liaisons within the healthcare system and community-based exercise programs for older individuals, such as those offered by LEAP, is an effective way to positively influence older patient outcomes both physiologically and psychologically. These results call for future research that focuses on how healthcare systems and community programs can work together to maximize positive patient outcomes for older individuals.
RACIAL DIFFERENCES IN THE DAILY EXPERIENCES OF AFRICAN AMERICANS AND EUROPEAN AMERICANS PROVIDING CARE
Authors: Cichy Kelly E , Koumoutzis Athena
Published: November 2019

African Americans often report lower caregiver burden, however, few studies consider the broader daily context of African American caregivers’ lives. This study examines racial differences in the associations between providing care for a spouse or parent and daily health and well-being among African Americans and European Americans, including how other daily stressors moderate these associations. During eight days of interviews, respondents aged 34 to 84 years (N = 1,931) from the National Study of Daily Experiences (NSDE II) reported on their daily stressors, negative affect (NA), physical symptoms, and whether or not they provided support to a spouse or parent with a disability. Controlling for demographics, on caregiving days, NA was higher than on non-caregiving days (p < .05) for all respondents. On caregiving days with no work stressors, African Americans only reported more physical symptoms than on caregiving days with work stressors (p < .05). Implications will be discussed.
EXPOSURE AND EMOTIONAL REACTIVITY TO DAILY STRESS IN SAME-SEX AND DIFFERENT-SEX MARRIAGES
Authors: Garcia Michael , Donnelly Rachel , Umberson Debra
Published: November 2019

Recent work exploring links between stress processes and well-being within marriage suggest that women may be at an increased risk for exposure and emotional reactivity to daily stress. However, studies have focused primarily on heterosexual couples, raising questions concerning whether and how these gendered patterns might unfold differently for men and women in same-sex marriages. In the present study, we analyze 10 days of dyadic diary data from 756 midlife men and women in 378 gay, lesbian, and heterosexual marriages to consider how exposure and emotional reactivity to daily stress may differ across union types. We find that women are exposed to more daily stressors than men and that this exposure is especially detrimental to the well-being of women in different-sex marriages. These findings highlight the need to include same-sex couples when exploring gendered linkages between daily stress processes and well-being within marriage.
CONSISTENT ASSIGNMENT: AN UPDATE ON THE QUALITY IMPACT
Authors: Castle Nicholas , Harris John A
Published: November 2019

The association of consistent assignment of Nurse Aides (NAs) with nursing home quality indicators is examined. Consistent assignment is defined as the same caregivers consistently caring for the same residents almost (80% of their shifts) every time they are on duty. Data used came from a survey of nursing home administrators, Nursing Home Compare, the Certification and Survey Provider Enhanced Reporting (CASPER) data, and the Area Resource File. All of the data was from 2015, and included 3,550 facilities. Several multivariate logistic regression models (using GEE) were used, including staffing variables (turnover, agency use, staffing levels), facility factors (size, ownership, occupancy rate), and market characteristics (competition, Medicaid rates). An average of 77% of nursing homes reported using at least some level of consistent assignment; although some were at low levels. In the multivariate analyses, accepted levels of consistent assignment were used. Turnover and family satisfaction quality were significantly (p<.01) better in facilities with the highest levels of consistent NA assignment. 7 of the 9 Quality Measures and 3 of the 5 Five-Star measures examined were significantly (p<.01) better in facilities with the highest levels of consistent NA assignment. Consistent assignment has developed as a preferred practice in nursing homes based on little empirical evidence. The findings presented here provide substantial justification for the use of this staffing practice for NAs.