bluuebunny/crossref_metadata_2025 huggingface dataset:
AN ACTING AND IMPROV CLASS: WELL-BEING AND COMMUNITY BELONGING FOR OLDER AFRICAN AMERICANS IN LOW-INCOME HOUSING
Authors: Sutherland Laura , Dunkle Ruth E , Pace Garrett T , Kennedy Ariel , Baldwin Pat
Published: November 2019

Arts-based interventions can enhance the quality of life of older adults, but community-dwelling older adults may have reduced access to such interventions. The purpose of this study was to examine whether a creative arts program can improve the overall health and well-being of older adults in low-income housing. A university social work department and community agency collaborated in establishing a professionally run theater group of older adults in two low-income housing buildings in an urban area. All residents were encouraged to participate. The study consisted of three twelve-week acting and improvisation courses, focusing on either staged reading of monologues and dialogues, co-writing a script, or staged reading of a complete play. Each class culminated in a public performance for the building. Fourteen participants enrolled, all African American (11 women, 3 men; mean age 66 years; mean ADL = 1.4 (range of 1-2.5)). Attendance on average was 8 classes. Data were collected through pre- and post-test questionnaires, participant observation of class sessions, semi-structured interviews with building managers, and post-session participant reflections. Thematic analysis was performed, and revealed key themes of increased community belonging, increased confidence, and increased daily coping abilities. Additional themes included the gaining of new artistic skills and interest in continuing classes. Barriers to participation included difficulty in recruitment and absence due to ongoing health conditions and caregiving responsibilities. This project has implications for the potential of arts-based programming to increase well-being for underrepresented community-dwelling older adults.
DOES PARTICIPATING IN SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM IMPROVE THE SLEEP OF OLDER ADULTS?
Authors: Chukwurah Queendaleen C , Chaparro M Pia
Published: November 2019

Food insecurity among lower income adults is associated with adverse health outcomes including sleep disorders. Using data from the National Health and Nutrition Examination Survey (NHANES), 2005-2008, we explored the association between participation in the Supplemental Nutrition Assistance Program (SNAP), a safety net program addressing food insecurity, and sleep outcomes among older adults. Total sleep duration (<7 hours inadequate sleep, ≥7 hours adequate sleep) and sleep latency (10-20 mins normal sleep latency, ≤ 9 mins and ≥ 21mins abnormal sleep latency) were available for 805 participants 50 years and older and eligible for SNAP participation (≤130% federal poverty level). SNAP participation (yes/no) was assessed for the previous year. Sleep inadequacy was higher among SNAP participants (46.5%) compared to SNAP-eligible non-participants (36.3%), whereas the corresponding numbers for abnormal sleep latency were 71.8% and 64.1%. Binary logistic regression analysis showed no significant association between SNAP participation and inadequate sleep duration (OR=1.19, 95% CI 0.84-1.70) after adjusting for age, gender, race/ethnicity, education, and food security status. SNAP participation was also not associated with abnormal sleep latency (adjusted OR=1.49, 95% CI 1.00-2.23). SNAP participation was not protective against poor sleep outcomes among a sample of low-income, at risk of food insecurity older adults.
GERIATRICS PREVENTABLE ADMISSIONS CARE TEAM (GERIPACT): A HIGH-RISK INTENSIVE AMBULATORY GERIATRICS PROGRAM
Authors: Chow Stephanie W , Munoz Lizette , Lavayen Susana , Fani Shamsi , MacKenzie Blair , Chun Audrey
Published: November 2019

The Geriatrics Preventable Admissions Care Team (GERIPACT) is an inter-professional team of 2 clinicians, 1 social worker, and 1 care coordinator, dedicated to offering temporary intensive ambulatory care services to complex older patients at high-risk for incurring expensive health care (ie. frequent emergency room visits or hospitalizations). GERIPACT services include frequent office visits for medical and social work needs, frequent telephone contact, home visits, specialty visit accompaniment, and a 24/7 telephone hotline. Use of this innovative model aims to serve communities lacking in geriatrician and geriatric social work providers, with a main goal of serving the highest risk older population. We reviewed the healthcare utilization of GERIPACT enrollees 6 months prior-to-enrollment and compared with 6 months following graduation from GERIPACT from 2016 to 2018. 78 patients were evaluated, with 49 total ED visits prior to enrollment and 35 post-graduation, saving 14 ED visits for a ratio of 18 saved ED visits per 100 GERIPACT patients. There were 45 hospitalizations prior to enrollment with 29 hospitalizations post-graduation, saving 16 hospitalizations, or 20 hospitalizations per 100 GERIPACT patients. Hospital days were reduced by 237 days post-graduation. An intensive ambulatory program for high risk geriatrics patients may be shown to be an efficient model of care for targeting those older patients who potentially incur greater expenses to the health care system. This focused team may be deployed to primary care communities with complex elderly patients in need of geriatricians and geriatric social workers, and may reduce unnecessary emergency room visits and inpatient stays.
THE IMPACT OF SOCIOECONOMIC STATUS ON AGE TRAJECTORY OF BODY MASS INDEX AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: Lin Yu-Chun , Chang Yu-Hung
Published: November 2019

Body weight tends to decrease along with age. Weight loss and low body mass index (BMI) in the elderly, associated with socioeconomic status, are both strong predictors of subsequent mortality.This study aims to investigate the relation between income and BMI changes in later life. We used data from the Taiwan Longitudinal Study in Aging (TLSA) from 1999 to 2007. There were 5,131 participants aged 50 and over, who were excluded for those without primary study variables. Income was evaluated by asking the amount of annual income, including salary, pension, rent, interest, welfare benefit, etc. Participants’ BMI were assessed in each survey. General estimating equation models were performed to examine the association between age, annual income, and their interaction with BMI adjusting for covariates including sex, education, marital status, smoking, exercise frequency, appetite, and number of comorbidities. Totaling 11,350 person-times was in three follow-up surveys, which left 9,723 person-times of observations after exclusion. After adjusted for covariates, the low income group compared to the higher income, would have higher estimated BMI at age of 50 (BMI= 24.75 kg/m2 and 24.19 kg/m2 respectively), and more rapid reduction (-0.08 kg/m2 per year), while relatively stable BMI was found in higher income group (0.01 kg/m2 per year, slope difference= 0.10 kg/m2 per year, 95% confidence interval [CI] = 0.03-0.17). In conclusion, compared to invariable BMI observed among individuals with higher financial status, the economically disadvantaged experienced BMI decline with age among middle-aged and older adults.
LIFE HABITS AND LIPID PEROXIDATION OF WOMEN OVER 40 YEARS OLD
Authors: Oliveira Renata F , Mota Maria , Soares Jorge , Santos Zirlene , Rosa Bianca , Santana Caroline , Pessoa-Filho Dalton , Neiva Cassiano M
Published: November 2019

Oxidative stress is involved in degenerative processes, aging, and diseases. Lifestyle can be change oxidative stress. One of reactive oxygen species targets is polyunsaturated fatty acid, an important cellular membrane component. The aim of this study is to analyse the contribute of lifestyle in lipid peroxidation in over fourty years old women. Were included 60 women whith age ranged between 41 and 82 years old (53.3 ± 9.1 years). Lifestyle were explored doing a food frequency questionnaire, Perceptive Stress Scale (PSS) and International Physical Activity Questionnaire (IPAQ). The functional capacity was determinate by 6-min walking test (cardiorespiratory capacity) and Squat-jump (leg strength and power). Parameters of oxidative stress were determinate from plasma during fasting, lipid peroxidation was evaluated by TBARs, and antioxidant capacity was evaluated by catalase activity and ABTS. Spearman correlation and Multiple Linear Regression model, through Stepwise method, considering TBARs as dependent variable, and age, weight, body mass index, waist circumference, stress perception, physical activity level, total antioxidant capacity, catalase activity, cardiorespiratory capacity, leg strength and power, daily caloric intake, daily fruit, vegetables, coffee/tea, vitamin E and alcohol intake, as independent variable, was performed. Negative correlations were obtained between TBARs and cardiorespiratory capacity (r= -0.35; p=0.026) and between TBARS and ABTS (r= -0.33; p=0.038). Total antioxidant capacity was the model’s first variable (F= 5.50; p = 0.013), explaining 15.3% of TBARS, then cardiorespiratory capacity (F= 5.50; p = 0.047), explaining 10.5% of TBARs The results revealed total antioxidant capacity and cardiorespiratory capacity as predictors to lipid peroxidation damage.
USE OF COMPLEMENTARY THERAPIES BY SEXUAL MINORITY OLDER ADULTS: FINDINGS FROM THE NATIONAL HEALTH INTERVIEW SURVEY
Authors: Anderson Joel G , Flatt Jason D , Jabson Jennifer , Wharton Whitney
Published: November 2019

Sexual minority (lesbian, gay, bisexual; LGB) older adults age 50+ experience a higher prevalence of chronic disease and disability, as well as a poorer physical and mental health status. Many adults use complementary and integrative therapies, particularly mind-body therapies, as health-enhancing approaches and to support wellbeing. However, no study to date has examined the use of mind-body therapies among sexual minority older adults. We examined data from the 2017 National Health Interview Survey to determine the use of mind-body therapies by sexual minority older adults (aged 50+), as well as the influence of health and wellbeing characteristics on mind-body therapy use, compared with their non-LGB counterparts. Sexual minority older adults overall reported higher usage (36%) of mind-body therapies compared with their non-LGB counterparts (22%), with lesbians reporting the highest use (41%). Sexual minority identity was a significant predictor of mind-body therapy use, with LGB adults roughly two times more likely to use a mind-body therapy after controlling for chronic disease status and other wellbeing measures. Future research is needed to explore the reasons sexual minority older adults use complementary and integrative therapies, as well as potential development of mind-body interventions targeted toward this population to address stress and quality of life.
IMPLEMENTING THE AGE-FRIENDLY HEALTH SYSTEM INTO CVSMINUTE CLINICS
Authors: Dolansky Mary A , pohnert Anne
Published: November 2019

Each day, 10,000 individuals in the United States turn 65 and nearly 30% of our nation’s 884 million ambulatory care visits involve patients ages 65 and older. With this trend, the use of convenient care settings for treatment for chronic conditions associated with aging such as diabetes and hypertension is emerging. The need for the delivery of age-friendly care in convenient care settings is essential to ensure high quality and safe care. CVS MinuteClinic® and the Institute for Healthcare Improvement (IHI) will present the plan and preliminary findings for the extension of the IHI’s Age-Friendly Health Systems initiative into the CVS MinuteClinic. The Age-Friendly Health System model includes 4 M’s: What Matters, Medications, Mentation, and Mobility as essential components for care delivery. The presentation will include (1) the partnership with the IHI’s Age-Friendly Health System Action Community, (2) a demonstration of the Age-friendly Virtual Clinic and learning platform that includes training modules and practice-based tools to facilitate assessment and action steps for the implementation of the 4Ms based on Age-Friendly Health System content, and (3) the evaluation logic model that will be implemented. The implementation plan will provide the framework to embed age-friendly process and outcome measures into the CVS MinuteClinic electronic health record platform, Epic. The project will impact all 1,100 CVS MinuteClinic locations across the nation.
SIGNIFICANT PREDICTORS OF INTEREST IN GERIATRICS AMONG LOW, MIDDLE, AND HIGH INCOME COUNTRIES
Authors: Karikari Grace , Lohrmann David K , Huber Lesa L
Published: November 2019

Even though the demands for physicians with geriatric related specialties are higher than the available experts around the world, some countries and economies seem to be more impacted by the workforce shortage than others. This systematic review consolidated scientific evidence reporting the significant predictors of interest in pursuing a geriatric career among medical students’ in different countries. A 20-year (1998 – 2018) systematic literature review of high-quality primary research articles was conducted using PubMed, ERIC (EBSCO), Embase and Cochrane Library. Eleven articles (n =11) met the eligibility and quality assessment criteria. For analysis, studies were categorized into (i) low- and middle-income countries and (ii) high income countries, based on the WHO and the World Bank’s income grouping for the 2019 fiscal year. Medical students involved in this review were n = 1,683 representing students from different fields of medicine and year groups. The two most significant predictors of interest in geriatrics in the high-income countries were (1) positive attitudes towards the elderly and (ii) participation in a geriatric related intervention. Lack of published peer-reviewed articles from the low and middle-income countries limited the researchers’ ability to evaluate the similarities and differences between the two income groups. There is an overall need to stimulate interest in geriatric specialization among medical students. Leaders of the LMICs should invest in geriatric education and research in order to promote interest in the field, increase the geriatric workforce, and ultimately, improve the quality of life of the elderly in their respective countries
THE IMPACT OF AN INTERPROFESSIONAL SIMULATION ON TEAM COMMUNICATION AT THE END OF LIFE
Authors: Halli-Tierney Anne , Lippe Megan E , Stanley Alexandra , Ricamato Allison , McKinney Robert E
Published: November 2019

It is increasingly important that healthcare professionals understand how to care for patients at the end of life, especially as 75% of hospital deaths occur in the geriatric population. Many new healthcare profession graduates feel under-prepared to provide end-of-life care. Healthcare education programs must provide education on interprofessional communication and end-of-life care. This study explored the effects of an interprofessional end-of-life simulation on medical, social work, and nursing students’ communication skills. Across three simulation phases, teams were required to communicate with the patient (high-fidelity manikin), family members (scripted actors), and team members about treatment option, change in patient’s condition, and withdrawal of life-sustaining measures. A total of 16 teams participated in the simulation, with each team comprised of nursing students (n=7-8), social work students (n=1), and medical students or residents (n=1). Team communication skills were assessed using the Gap Kalamazoo Communication Skills Assessment Form. The average communication score for teams reflected fair to good communication (M=28.81, SD=5.55). The best communication domains were “Shares information” (n=8), “Communicates accurate information” (n=6), and “Builds a relationship” (n=5). The worst domains were “Demonstrates empathy” (n=7), “Provides closure” (n=6), and “Builds a relationship” (n=5). This simulation provides an interactive educational mechanism by which to educate interprofessional healthcare students on communication and care of patients at the end of life.
AGING IS VERY PERSONAL: INTERPROFESSIONAL GERONTOLOGY COURSE IMPROVING STUDENT ATTITUDES TOWARD OLDER ADULTS
Authors: Garbarino Jason T
Published: November 2019

Educational programs that foster the development of a robust healthcare workforce committed to the provision of exemplary care of older adults is vital. The Aging is Very Personal (AIVP) service learning gerontology course has demonstrated the ability to foster future student interest and improved attitudes towards working with older adults. The AIVP program provides mutual benefit for undergraduate students from a variety of health science majors and older adult resident volunteers at local senior living facilities. For students, AIVP serves as direct insight into the lived experience of aging among community older adults. Students are provided the opportunity to practice communication skills, relationship-building skills, and gain an understanding of the multitude of diverse needs within this population. Older adults who volunteer to participate in the activity are provided with the opportunity to speak to and actively engage with students and feel empowered by the opportunity to provide valuable life guidance. This presentation will provide a curricular overview of the steps required to construct, implement, and evaluate an interprofessional gerontology course. A review of student learning objectives, service-learning program construction, selected course topics, and student assignments will be presented. Attitudes and future interest in working with older adults measured in the initial interprofessional student cohort (n=106) will be presented. A pre-established, validated tool utilized to effectively measure student attitudes and interest pre/post-course participation will be reviewed.
HOME CARE NURSES CLAIM MEDICARE IGNORES SOCIAL DETERMINANTS OF HEALTH
Authors: Cabin William D
Published: November 2019

There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. The current study is an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 37 home care nurses between January 2013 and May 2014 in the New York City metropolitan area. Results indicate nurses believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs.
INS, OUTS, AND UNINTENDED CONSEQUENCES OF THE CMS NURSING HOME QUALITY MEASURES
Authors: Davila Heather , Shippee Tetyana P , Park Young Shin , Brauner Daniel , Konetzka R Tamara
Published: November 2019

Ongoing concerns about the quality of care provided to nursing home (NH) residents have led the federal government to develop quality measures (QMs) for NHs. Many of these QMs are included in the NH 5-star ratings and reported online via Nursing Home Compare. However, we know little about how NH providers view the QMs, challenges they experience in addressing the measures, and strategies they use to achieve better scores. As part of a broader mixed-methods study to understand how NHs are responding to the 5-star ratings, we conducted interviews with NH personnel (n=110) and observed organizational processes in 12 NHs in three states. We also interviewed policy and industry leaders (n=34) to gain their perspectives. Interviews focused on perceptions of the 5-star ratings, organizational strategies to improve 5-star scores, experiences with the survey/regulatory process, and perceptions and responses to individual QMs. Key themes show that a) NH providers view the QMs as important indicators of quality, but there is variability across indicators; b) providers face challenges related to measurement and definitions for certain QMs (e.g., pain, restraints); and c) there are potentially conflicting goals, where some QMs aim to promote safety at the expense of resident autonomy and quality of life and vice versa. This work provides organizational context to the 5-star measures and the balancing act providers engage in to assess and improve their scores. The findings also identify several potentially unintended consequences related to the QMs, which can adversely affect residents, particularly those with more complex care needs.
PERCEPTIONS OF LONG-TERM CARE RESIDENTS AND THEIR FAMILY MEMBERS ABOUT USING THE CONVERSATION STARTER KIT
Authors: Kaasalainen Sharon , Sussman Tamara
Published: November 2019

The need for a palliative approach in long term care (LTC) is widely recognized. However, advance care planning (ACP) is still rare. The purpose of this study was to explore the perceptions of LTC residents and their families about using an ACP tool called The Conversation Starter Kit (CSK). This study utilized a mixed methods approach. Data was collected in four LTC homes in Ontario, Canada from 31 residents and family members during an interview after they had completed the CSK. Data was analyzed using thematic analysis and descriptive statistics. All participants read all sections but only 73% completed all sections of the toolkit. Participants spent an average of 36 minutes discussing it with their family members and/or LTC staff. Participants reported: a better understanding of ACP after using the tool (80%), that the tool helped clarify the available resources and/or choices (53%), and that they felt less apprehensive about ACP after using the tool (60%). Qualitative findings revealed many strengths (e.g., usefulness, ability to start difficult conversations, content and clarification), and weaknesses of the tool (e.g., redundant information, difficulty understanding the content and lack of information regarding medically assisted dying). Family members noted that the toolkit would have been helpful to receive earlier on in their family members’ disease trajectory, perhaps before being admitted into LTC. These study findings support the CSK for residents and family members to have ACP discussions in LTC. Future work is needed to evaluate the effectiveness of the tool with a larger sample.
LGBTQ PROGRAMMING AT SENIOR CENTERS IN MASSACHUSETTS
Authors: Somerville Ceara , Collins Saralyn , Coyle Caitlin E
Published: November 2019

LGBTQ seniors have some different needs for programs and services, are at a higher risk of social isolation, and are often underserved in the community. Senior centers serve as a hub of resources in a community and are purposefully situated to address the needs and interests of all seniors in a community; they are a natural outlet for targeted programming for LGBTQ seniors. The purpose of this project is to demonstrate what municipal senior centers across Massachusetts are doing to meet the needs of their LGBTQ seniors. A total of 24 senior centers were identified by the Massachusetts Association of Councils on Aging (MCOA) as providing LGBTQ programming. Semi-structured interviews were conducted with 14 senior center directors or programming staff from different communities across Massachusetts to learn more about their specific programming. For almost all senior centers in this study, the main LGBTQ-specific programming was a congregate meal with an activity. Activities included both recreational activities like a film-screening and educational engagements such as guest speakers or specialists on housing, legal services, and health promotion. Distinguishing characteristics included whether or not programming had an intergenerational component, type of recruitment methods, and geographic clustering of programs. For example, two regions emerged as having shared activities for LGBTQ seniors. Results from this study will be used to illustrate models of best practice when it comes to LGBTQ programming for older people.
DISPARITIES IN ACCESSING DIFFERENT TYPES OF LONG-TERM CARE SERVICES IN TAIWAN
Authors: Chen Ya-Mei , Lin Shih-Chi , Yu Hsiao-Wei , Wu Shwu-Chong , Wu Shih-Cyuan , Wang Ying-Chieh , Chiang Tung-Liang
Published: November 2019

A growing body of evidence documents pervasive social and demographic factors relating to disparities in long-term care (LTC). In 2007, Taiwan implemented its Ten-year Long-Term Care Plan version 1.0 (TLTCP 1.0) that aimed to develop a home-and community-based (HCBS) LTC system. In 2016, Taiwan began to implement TLTCP 2.0. To continue providing effective LTC, this study aimed to assess the disparities in access to LTC services using Taiwan’s LTC claim database from 2010 to 2013. A total of 87,438 older adults who had applied for LTC services from the TLTCP 1.0 were included. The study assessed LTC disparities related to five sociodemographic factors, including age, gender, living status, urbanization, and income status. Sixteen types of LTC services, including HCBS, home-based professional care, meal services, transportation, and institutional services were assessed. After controlling for the level of disability, we found that those who were older-old (age 80> over), male, and low-income were less likely to use HCBS, but more likely to use institutions services (p < 0.001). We also found that those who lived in the city were more likely to use HCBS and transportation services (p < 0.001). Yet, older adults living alone were more likely to use home care and meal services but not other types of LTC services (p < 0.001). In conclusion, the social disparities in access to LTC services in Taiwan remains, suggesting LTC 2.0 should continue monitoring and placing the LTC equity issue on the top priority.
ADVANCE DIRECTIVES: STATE REQUIREMENTS, PRACTICES, AND PREVALENCE IN ADULT DAY SERVICES CENTERS
Authors: Lendon Jessica P , Caffrey Christine , Lau Denys
Published: November 2019

Advance directives (ADs) are documents that express a person’s healthcare preferences if he/she is unable to make decisions. Adult day service centers (ADSC) may serve as an entrée to advance care planning for many people. This study examined the relationships among: 1-state requirements on ADSCs to provide information on ADs; 2-ADSC’s awareness of their state requirement; 3-ADSC’s practice in providing AD information; and 4-the percentage of ADSC participants with an AD. From the 2016 National Study of Long-Term Care Providers, 3,300 ADSCs reported that they maintained documentation of ADs in participants’ files. Nine states required ADSCs to provide information on ADs; 22% of ADSCs were located in these states. About 24% of ADSCs did not know if their states had requirements; among the 76% of ADSCs that reported knowing, 62% were correct and 37% were incorrect. About 80% of ADSCs provided AD information to their participants, while 41% of ADSC participants had an AD on file. Regression models controlled for size, chain and profit statuses, Medicaid-licensing, medical or social care model, electronic health records use, and Census region. Having state requirements was not independently associated with ADSCs’ practice of providing AD information or with the percentage of participants with an AD. Instead, ADSCs that thought their state had a requirement had greater odds of providing information on ADs, regardless of state requirements. Similarly, ADSCs that thought their state had a requirement and that provided AD information had a higher percentage of participants with an AD, independent of state requirements.
STATE VARIATION IN NURSING HOME CIVIL MONEY PENALTY ENFORCEMENT ACTIONS FOR QUALITY DEFICIENCIES
Authors: Gammonley Denise L , Wang Xiaochuan (Sharon) , Bender Felicia
Published: November 2019

States vary in their overall rates of nursing home deficiency citations as well as deficiencies for actual harm or jeopardy (Harrington et al., 2018). Civil Money Penalty (CMP) fines collected by the Centers for Medicare and Medicaid Services (CMS) are one enforcement action imposed to promote nursing home compliance with regulations. Collected CMP funds are redistributed to states for the sole purpose of improving nursing home resident care and quality of life through reinvestment in quality improvement projects. Using CASPER data available for US skilled nursing homes in 2015 and 2016 through the CMS QCOR database we examined the distribution of quality of care (QOC) and quality of life (QOL) deficiencies and CMP enforcement action across states. Guided by the systems framework for evaluating nursing home quality (Unruh & Wan, 2004) we further explored how contextual factors such as state spending for nursing home care, structural characteristics of facilities in states, and inadequate care processes indicated by deficiencies contribute to CMP enforcement actions and fines. Findings indicate that 27% of enforcement actions resulting in a CMP between 2015 and 2016 were imposed for a QOL deficiency while 61.7% represented QOC deficiencies. QOL deficiencies represented only 8% of the highest severity deficiency category but 81.7% of enforcement actions for QOC were for those causing immediate harm or jeopardy. QOC deficiencies are a focus of enforcement actions as they represent critical care processes influencing resident basic needs for hydration, ambulation, skin integrity and care for other special physical and behavioral needs.
DOES THE PATIENT HEALTH QUESTIONNAIRE MEASURE MOOD-RELATED QUALITY OF LIFE IN NURSING FACILITY RESIDENTS?
Authors: Ng Weiwen , Duan Yinfei , Shippee Tetyana P
Published: November 2019

The Patient Health Questionnaire-9 (PHQ-9) is a depressive symptom questionnaire administered to nursing facility (NF) residents in the Minimum Data Set (MDS). Does the PHQ-9 measure mood-related aspects of quality of life (QoL)? We assessed the PHQ-9’s convergent validity with negative and positive mood items from Minnesota’s QoL survey, which is administered annually to a random sample of residents. We also examined if scores on both instruments were associated with various psychiatric diagnoses on the MDS. Using item response theory (IRT) models, we estimated that depressive symptoms (PHQ-9) had a correlation of 0.546 with negative mood and -0.425 with positive mood. With explanatory IRT modeling, we estimated that diagnoses of anxiety, depression, and bipolar disorder were respectively associated with 0.261, 0.339, and 0.301 (all p < 0.001) standard deviation increases in (SD) depressive symptoms, and with 0.235, 0.261, and 0.306 SD increases in negative mood (all p < 0.001), thus indicating convergent validity. For positive mood, depression and bipolar disorder had associations of similar magnitude as the other two constructs. However, anxiety disorders were not associated with lower positive mood (-0.014 SD, p = 0.636). Thus, the PHQ-9 can measure mood-related aspects of QoL. However, the PHQ-9 appears to be sensitive to relatively serious depression, whereas the Minnesota items are more sensitive to lower levels of negative mood. Also, the PHQ-9 does not measure positive mood directly. Thus, the PHQ-9 is a more limited measure of mood-related QoL than the Minnesota items.
SERVICE ENVIRONMENTS AND PSYCHOLOGICAL WELL-BEING AMONG RESIDENTIAL CARE FACILITY AND NURSING HOME RESIDENTS
Authors: Choi Yeon Jin
Published: November 2019

One’s competence, or ability to cope, becomes lower as people age due to multiple factors, such as decreased physical and cognitive functioning, social isolation, and reduced income. Considering this change, providing appropriate services may help older adults to maintain their independence and improve their psychological well-being and quality of life. Therefore, this study aimed to investigate services that are positively associated with psychological well-being (i.e., mood, psychological health, self-efficacy) of older adults. For the analysis, observations were derived from the National Health and Aging Trends Study (NHATS), which includes a nationally representative sample of Medicare beneficiaries ages 65 and older. Service environments were assessed by (1) reflect availability and usage of 13 services (i.e., service unavailable, service available/ not being used, service available/ being used by residents) and (2) number of services available within three categories (i.e., help with ADL/IADL, transportation services, social and health-related services) Both having social events and activities available and participating in it were positively associated with older residents’ mood, while using housekeeping services and walking areas (e.g., outdoor walking path) were associated with better psychological health and self-efficacy. When models were estimated with service categories, having more social and/or health-related services available were associated with better psychological health and self-efficacy. Findings of this study suggests that social events and activities, housekeeping services, and areas to walk for pleasure or exercise would improve older residents’ psychological well-being. For Not only providing those services, residential facilities should encourage older residents to participation in or use the services.
WHEN LIFE DOESN'T GO AS PLANNED: UNMET EXPECTATIONS ABOUT RETIREMENT TIMING AND SUBSEQUENT DEPRESSIVE SYMPTOMS
Authors: Abrams Leah R , Mehta Neil
Published: November 2019

The 2008 Great Recession affected American’s retirement timing, but it remains unclear how unfulfilled expectations about retirement timing influence psychological well-being. This study examines how unmet expectations about working at age 62 relate to subsequent depressive symptoms, with special attention to sociodemographic differences in unmet expectations and their consequences. We use longitudinal data from 10,557 adults ages 51+ in the Health and Retirement Study (1994-2014). Mean expected probability of working full time at age 62 (ranging 0-100) was 40.5 (SD=54.65). We created quartiles: no chance (0 probability, 35% of sample), unlikely (1-30, 16%), unsure (33-80, 28%), and very likely (85-100, 21%). Expected probability and the association between expectations and reality were significantly lower for racial minorities compared to whites, low education compared to high, and pre-baby boomers compared to baby boomers. Those who were working at age 62 but expected to be retired did not experience elevated depressive symptoms compared to those who correctly expected to be working. In contrast, those who were unexpectedly not working experienced significantly higher depressive symptoms compared to those who correctly expected to be retired (Unsure: IRR=1.16 p=0.024, Very likely: IRR=1.19, p=0.010). This association was slightly attenuated after adjusting for declines in functioning, suggesting partial, but not complete, mediation by health status. The association was consistent by race, education, and birth cohort, but was larger in men than women. Taken together, our findings indicate that unexpected continued employment does not harm psychological well-being, but earlier than expected retirement may result in higher depressive symptoms.
OSTEOARTHRITIS AND DEPRESSION IN A MALE VA POPULATION
Authors: Burant Christopher J , Graham Gregory , Kresevic Denise M , Deimling Gary , Ibrahim Said , Kwoh Kent
Published: November 2019

Osteoarthritis (OA) is a leading cause of disability among older adults. By 2050, approximately 60 million will suffer from arthritis adding up to a total societal cost of $65 billion. Chronic illnesses resulting in pain, and functional decline have been associated with depression in previous studies. The primary goal of this study is to investigate whether OA severity, as measured by the Western Ontario McMasters Arthritis Composite (WOMAC), impacts reported levels of depression and to what degree clinical and sociodemographic variables play a part. A causal model was developed and tested examining the antecedents of OA disease severity and depression. Information on clinical, demographic, socioeconomic, and psychosocial variables was collected on 596 male Veterans with moderate to severe symptomatic OA of the knee\hip. A Confirmatory Factor Analysis was conducted to determine the factor structure of the WOMAC. A 2nd order three factor solution (pain, stiffness, and function) fit the data well (TLI of .94, a CFI of .94 and a RMSEA of .058). The results of the Structural Equation Model reveal a final model that fit the data well (TLI of .95, a CFI of .97 and a RMSEA of .047). Depression was predicted by higher WOMAC scores (beta=.37 , p<.01); higher levels of comorbidity (beta= .11, p<.05); younger age (beta= -.29, p<.01); being white (beta=-.11, p<.05); lower levels of income (beta= -.12, p<.05); lower levels of religiosity (beta= 11, p<.05). Clinicians should be aware of the impact of disease severity when treating OA patients with depression.
DIRECTIONALITY BETWEEN COGNITION AND DEPRESSIVE SYMPTOMS: A LONGITUDINAL CROSS-LAGGED PANEL ANALYSIS
Authors: Chan Randolph , Tang Jennifer Y M , Liu Tianyin , Wong Gloria H Y
Published: November 2019

Background and Objectives: The relationship between objective and subjective cognitive function and depressive symptoms is complex and potentially multidirectional. This longitudinal prospective study examined the directionality of their relationship among a community sample of older people with no known diagnosis or treatment for dementia or depression. Research Design and Methods: We examined the temporal relationship between objective cognitive functioning, subjective cognitive complaints, and depressive symptoms in 1,814 community-dwelling older people at baseline and one-year follow-up using regression and two-wave cross-lagged panel analyses, after controlling for demographic and health confounders. Results: Cross-lagged analysis showed that depressive symptoms at follow-up were directly predicted by baseline subjective cognitive complaints, but not baseline objective cognitive functioning. The effect differed across objective cognitive functioning levels. In people with clinically significant cognitive impairment at baseline, objective cognitive decline but not baseline subjective cognitive complaints predicted depressive symptoms. In people with mild objective cognitive impairment at baseline, baseline subjective complaints but not objective cognitive decline predicted depressive symptoms. Discussion and Implications: The effects of objective and subjective cognitive decline on depressive symptoms varied across older people with different levels of cognitive impairment. Awareness and insight of one’s cognitive status may contribute to the development/progression in depressive symptom in people with mild cognitive impairment. Mechanisms unrelated to appraisal may be involved in increased depressive symptoms among older persons with significant objective cognitive impairment.
DEPRESSION SEVERITY AND OBSTRUCTIVE SLEEP APNEA IN OLDER ADULTS
Authors: Boston Nicholas C , Bennett Ryan , Cirillo Nikolas , Solow Andrew , Fornalski Nicole , Stripling Ashely M
Published: November 2019

Objective: The connection between obstructive sleep apnea and depression in older adults is well documented; however, to date the relationship between severity of these depressive symptoms in this population remains under-explored. As such, the current analysis examined a potential relationship between varying levels of depression severity among older adults with sleep apnea. Participants and Methods: Data was derived from a de-identified database of older adults (age>=65) from the National Alzheimer’s Coordinating Center (NACC). The sample (N=90; 50% female; 97.8% Caucasian; Mage=77 years; SDage=10.4 years) was sorted into three groups using the Neuropsychiatric Inventory Questionnaire (NPI-Q): 1) Mild Depression [n=56], 2) Moderate Depression [n=29], and 3) Severe Depression [n=5]. Results: A univariate analysis revealed an overall significant omnibus effect between sleep apnea and depression severity (F[2,4041])=16.231, p<.001), while controlling for age, race, and sex. Post-hoc comparison found that those with severe depression had significantly higher levels of sleep apnea compared to those with mild (Mdif =-.499, p = .029) and moderate (Mdif =-.597, p = .009). Conclusions: These data support the possible association between depression severity and obstructive sleep apnea. Results may be attributable to two different theories: that low serotonin levels may simultaneously influence depression, respiratory muscle-tone, and sleep disturbance, and that intermittent hypoxia may create a cascade effect of neurovascular pathology resulting in depressive symptoms. Implications of the current findings suggest it may prove beneficial to keep in mind the risks associated with sleep apnea, and more severe depression, should an individual present with either.
CLINICAL FACTORS ASSOCIATED WITH INCREASED SEDENTARY TIME IN VERY ACTIVE OLDER ADULTS
Authors: Madden Kenneth , Chase Jocelyn
Published: November 2019

Sedentary behavior (such as sitting) has been shown to be an independent risk factor for increased frailty and less successive aging, even in active individuals. Our study examined the clinical factors most associated with higher sedentary times (ST) in very active older adults. We recruited 54 adults from a Master’s ski team (Whistler, British Columbia; mean age 71.5±0.6 years, 55% female). Activity levels were measured using an accelerometer (SenseWear) worn continuously for 7 days. ST was defined as a lack of activity when not in the supine position, in order to exclude time spent sleeping. Potential predictor variables consisted of metabolic syndrome criteria (blood pressure, high density lipoprotein, waist circumference, triglyceride levels, fasting blood glucose), age, biological sex and heart rate. Predictors associated with ST (p<0.10) were entered into a stepwise multivariate regression model. Our subjects were extremely active, engaging in moderate to vigorous physical activity for 2.6±0.2 hours per day, greatly exceeding current activity guidelines. Despite these high activity levels, they were also sedentary for an average of 9.4±0.2 hours per day. Our final minimum effective model showed that waist circumference had a significant association with ST (Standardized β = 0.36±0.13, p=0.007), explaining 18% of the variation in ST. People are often subjectively unaware of how long they spend sedentary. Our study suggests, that in addition to promoting leisure time physical activity, physicians should also objectively measure ST in highly active older patients with high waist circumferences.
POOR PHYSICAL FUNCTION EXPLAINS INCREASED WRIST FRACTURE RISK IN COMMUNITY DWELLING OBESE ICELANDIC ADULTS
Authors: Ramel Alfons
Published: November 2019

Background: The associations between obesity, physical function, falls and fractures are unclear. Aim: The aim was to investigate whether obese adults have poorer sensory function, physical function as well as higher fracture risk than normal weight peers; and whether confounders explain potential differences between body mass index (BMI) categories. Methods: A case-control study was conducted using 98 wrist fracture cases (50-75 years) and 48 matched controls. Measurements included among others: anthropometrics, sensory function (Semmes-Weinstein-Monofilaments), physical function (Five-times-sit-to-stand test (FTSTS), questionnaires on previous fractures and fall history, the Activities-Specific-Balance-Confidence (ABC) and the Dizziness-Handicap-Inventory (DHI) scales. Results: Obese participants had lower physical function (FTSTS: +2.8sec,P<0.001), lower tactile sensitivity (monofilaments:+3.4 g,P=0.013), poorer ABC score (14.0,P<0.001), higher DHI score (11.6,P<0.001) and experienced more falls the previous 12 months (+0.8,P=0.006) compared to normal weight subjects. According to crude logistic regression analysis, the hazard ratios for wrist fracture in overweight and obese subjects were 2.7 (P=0.012) and 5.6 (P=0.002), respectively. When FTSTS was included in the statistical model (HR:1.7,P=0.004), it reduced the hazard ratios of overweight and obesity close to 1. Lifetime fractures (HR:5.5,P<0.001) and fall history (HR:4.3,P<0.001) were associated with an increased fracture risk independently from the BMI categories. Conclusion: Obese individuals have poorer physical function, higher risk of falls and increased wrist fracture risk compared to normal weight peers. Lower physical function is the main driver for the increased risk in obese subjects. Lifetime fractures and fall history are associated with an fracture independently from obesity.
INERTIAL LOAD SPRINT TRAINING IMPROVES NEUROMUSCULAR POWER IN OLDER ADULTS
Authors: Allen Jakob R , Satiroglu Remzi , Vardarli Emre , Laico Anthony , Wolfe Anthony , Coyle Edward
Published: November 2019

PURPOSE: Maximal strength and neuromuscular power decline after the fourth decade of life. The physiological cause of this progression is partly a selective atrophy of Type II or “Fast-twitch” muscle fibers. The aim of this study was to determine the efficacy of a novel, time-efficient form of exercise training involving repeated sprints lasting 4 s on an inertial load cycle ergometer, to promote increased neuromuscular power in males and females aged 50-70y. METHODS: Three days a week, forty older adults performed 15, 20, and 30 sprints per day over weeks 1, 2-4 and 5-8 of the study respectively. Rest intervals were progressively reduced from 56s, 41s, and 26s over the same time periods. Subjects began each sprint while stationary and then were instructed to pedal as hard and as fast as possible for 4 s. Maximal power was reached after 1-4 s of sprinting and measured after a familiarization day (PRE), and then post-training (POST). RESULTS: The average increase in maximal power was 10.5±1.4% from PRE to POST (616±41 to 684±48 watts) (p<0.01). CONCLUSION: Only ~2 min of cycle sprinting per training session was able to increase maximal neuromuscular power, an important physiological component of tasks of daily living throughout the lifespan.
LIFESTYLE PHYSICAL ACTIVITY IN OLDER WOMEN: ASSOCIATIONS OF CHANGE, SELF-EFFICACY, AND WELL-BEING
Authors: Lefler Leanne L , Lensing Shelly Y , Garner Kimberly K
Published: November 2019

Reduction of cardiovascular disease risk in undeserved populations, such as older women, is a top priority of the U.S. Our innovative trial tested a new approach to PA promotion for older women—motivational interviewing (MI), shifting the paradigm from structured exercise to self-selected activities. We present data comparing stage of change (SOC), self-efficacy for exercise (SEE), and well-being: 8 dimensions (physical, social, role limitations, emotional, general mental health, vitality, health perceptions and pain) and associations with physical activity outcomes in the Lifestyle Physical Activity for Women (LPAW) clinical trial. Methods: 106 women, > 60 years old, who did not engage in regular PA, and were not frail, participated in a clinical trial of a tailored MI intervention to increase PA. We report baseline, 3 and 6 month repeated measures and PA associations with SOC, SEE, and well-being (SF36). Results: Of 106 women, 36% were Black and 63% White, with a mean age of 69. Significant improvement in SOC in both arms noted but the proportion in action/maintenance was significantly higher in the PA arm at 3 mos (78% vs. 55%, P=0.045) and 6 mos (79% vs. 50%, P= 0.019). A decrease in SEE for control (p=.001), but not for PA arm (p=.45); at 6 months, The PA arm had greater SEE compared to control. There were significant arm difference for physical component scores of SF36 (p=.02), but not for mental scores. Associations with PA will be tabulated. Conclusions: Preliminary results support the PA intervention, more data to be presented.