bluuebunny/crossref_metadata_2025 huggingface dataset:
Virtual Reality Based Interventions Among People With Dementia: Applications and Health-Related Outcomes
Authors: Chang Yu-Ping , Zhou Yanjun , Zhang Hanbin
Published: December 2020

The use of virtual reality (VR) technology to improve health among older adults has been receiving increased attention. VR technology has many applications and can produce benefits for people with various medical conditions such as symptom reduction or improving the diagnostic process. Despite the increase in the number of research studies of VR technology, little is known about how it has been used to improve health-related outcomes among people with dementia. This systematic review aimed to synthesize research evidence regarding the scope and impact of VR based interventions among people with dementia. Five databases, CINAHL, Embase, PsychINFO, PudMed, and Web of Science were searched to identify studies leveraging VR to facilitate interventions designed for people with dementia. Multiple keywords were used in combination including: dementia, Alzheimer’s, VR, virtual reality, and Virtual Reality Exposure Therapy. Articles were screened if they were published between 2000 through 2020. Fifteen studies met the criteria, with ten utilizing a randomized controlled trial. The VR based interventions in those studies included virtual physical exercises, virtual forests or natural landscapes, and virtual basic living activities. The results of these studies show that VR as a display medium can greatly improve decision-making, hearing, vision, motor ability, and memory in people with dementia residing either in the community or in long term care settings. Our review demonstrated that VR showed positive benefits through various applications for people with dementia. Future research is needed to make VR interventions more customized toward effectively meeting the needs of people with dementia.
Effect of Perceived Social Support on Mortality Rate Among Older Chinese Americans
Authors: Verma Charu , Li Mengting , Dong XinQi
Published: December 2020

Most existing studies have examined the relationship between social support and health in cross-sectional data. However, the changing dynamics of social support over time and its relationship with all-cause mortality have not been well explored. Using data from the Pine Study (N = 3,157), this study examined whether social support was associated with time of death at an 8 years follow-up among older Chinese Americans. Social support from a spouse, family members and friend were collected at the baseline using an HRS social support scale. Perceived social support and time of death were ascertained from the baseline through wave 4. Cox proportional hazard models were used to assess associations of perceived support with the risk of all-cause mortality using time-varying covariate analyses. Covariates included age, sex, education, income, and medical comorbidities. All study participants were followed up for 8 years, during which 492 deaths occurred. In multivariable analyses, the results showed that positive family support [HR 0.91; 95% CI (0.86, 0.98)] and overall social support [HR 0.95; 95% CI (0.92,0.98)] were significantly associated with a lower risk of 8-year mortality. Results demonstrate robust association in which perceived positive family and overall social support over time had a protective effect on all-cause mortality risk in older Chinese Americans. Interventions could focus on older adults with low social support and protect their health and well-being. Future studies could further explore why social support from family is different from social support from other sources regarding mortality risk in older Chinese Americans.
Attitudes of Older Adults With Chronic Musculoskeletal Pain Toward Virtual Reality
Authors: Nakad Lynn , Rakel Barbara
Published: December 2020

Older adults are especially susceptible to chronic musculoskeletal (MSK) pain. Pharmacological treatment often provides inadequate relief and overuse can lead to adverse events. Preliminary research has demonstrated the effectiveness of virtual reality (VR) distraction therapy for chronic pain. Understanding attitudes of older adults towards VR distraction therapy will help develop and optimize this therapy for this population. Therefore, the purpose of this study is to explore the attitudes and treatment acceptability towards the use of immersive VR distraction therapy of older adults suffering from chronic MSK pain. This descriptive, exploratory study used mixed methods. Data collection consisted of a consent process, eligibility screening, survey completion, 2 VR simulations (passive and active) lasting 10-minutes each, and either a focus group or interview. Survey data was used to measure: pain intensity and interference, pain catastrophizing, treatment acceptability, usability, and side effects. A total of 21 older adults completed the study. Treatment acceptability was high with an average score of 32.5 out of 40. However, average usability scores (62.9 out of 100) indicated a need for system improvements. Few participants (14%) experienced moderate to severe side effects. The following themes were identified: 1) VR is an enjoyable distraction; 2) Perceived effectiveness depends on chronic pain experience; 3) VR simulation experiences should be individualized; 4) Design considerations to improve usability in older adults; 5) Recommendations for future directions. The findings from this study can inform intervention design considerations and future directions for the use of VR technology for chronic pain management in older adults.
Back Pain and Heart Failure in Older Adults: Findings From the Health ABC Study
Authors: Chen Jie , Zhang Yiming , Simonsick Eleanor , Starkweather Angela , Chen Ming-Hui , McCauley Paula , Maas Kendra , Cong Xiaomei
Published: December 2020

Both back pain and heart failure (HF) have negative influence on all aspects of life. Little is known about the impact of back pain on older adults with HF. We include 1295 older adults who had data collected in the 11th year (2007-2008) of the Health, Aging and Body Composition (Health ABC) study to evaluate the effect of back pain on health status among older adults with and without HF. The participants aged 79-91, 54.8% were female and 34.8% were African American. Among 94 participants with HF, 63 (67.0%) had back pain; among 1201 participants without HF, 649 (54.0%) had back pain. Females reporting back pain had 4.76 (95% CI: 1.83, 12.37) times the odds of having HF compared to those without back pain. Male with back pain, compared to those without back pain, had 1.14 times (95% CI: 0.65, 2.02) the odds of having HF. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CES-D) scale. Performance and functions were measured by the Established Populations for Epidemiologic Studies in the Elderly (EPESE) performance score, the Health ABC performance battery score and self-reported difficulty with functional tasks. These symptom and performance measures were significantly associated with both back pain and HF, but not the interaction terms of back pain and HF after adjusting demographic variables including gender, race, smoking status and BMI category. The high incidence and negative impact of back pain highlighted the needs of developing strategies in pain management among older adults with and without HF.
A Wasteful and Harmful Practice: Sliding Scale Insulin Use Among Nursing Home Veterans
Authors: Lam Kenneth , Gan Siqi , Jing Bocheng , Nguyen Brian , Lee Sei
Published: December 2020

The American Medical Directors Association and the American Diabetes Association discourage the use of sliding scale insulin (SSI) in nursing home residents with diabetes due to its association with hypoglycemia, hyperglycemia, nursing burden, and patient discomfort. However, prevalence of SSI use is unclear. We used Veterans Affairs (VA) data from October 2013 to September 2016 to determine the weekly prevalence of SSI among 22,847 veterans with diabetes admitted to VA nursing homes (NHs). Average age was 75.3 (SD 8.3) years, mean A1c was 7.3% (SD 1.6%) and 57% were admitted from hospital. We first identified residents receiving any short-acting insulin. We then classified short-acting insulin use into three mutually exclusive regimens: (1) fixed scheduled doses, (2) SSI, defined as a variable dose of short-acting insulin without a concurrent fixed dose or (3) bolus with correction (BWC), defined as a variable dose given concurrently with a fixed dose that day. During the first week of NH admission, 64.7% of residents with diabetes received no short-acting insulin, 7.4% received fixed scheduled doses, 6.3% received BWC and 21.4% were on SSI. At week 12, the prevalence of fixed dose and BWC regimens was unchanged from baseline (fixed dose = 8.4%; BWC = 7.0%). In contrast, the prevalence of SSI decreased weekly to 15.8% (p for linear trend < 0.0001). Although SSI prevalence decreased from week 1 to week 12, 51% of residents on short-acting insulin were still using SSI in their 12th week of their NH stay.
Nurse Practitioners’ Experiences of Polypharmacy in Community-Dwelling Older Adults
Authors: Pariseault Christine , Sharts-Hopko Nancy , Blunt Elizabeth
Published: December 2020

Numerous studies exist that define polypharmacy and its impact on health. Additionally, the literature is rich in studies documenting the benefits of care provided by nurse practitioners. A gap in research exists at the intersection of the value of nurse practitioners in caring for older adults and their management of polypharmacy. Coinciding with a growth of America’s older adult population and the need for adequate care, the purpose of this study was to explore the experiences of nurse practitioners caring for older adults experiencing polypharmacy. A qualitative descriptive study was conducted using a purposive sampling of nurse practitioners who care for older adults. Interviews were conducted and data was analyzed for themes. Four themes emerged: defining polypharmacy, communicating and collaborating, clinical judgement of nurse practitioners in relation to polypharmacy, and medication issues of older adults. Major themes emerged that depict the complexity of medication management in older adults as well as the important role of NPs in providing care to older adults. The significance of the study findings to future practice includes improving communication and collaboration of prescribing health care providers, better identification and management of polypharmacy, and improving the health care delivered to older adults. Safe and effective prescribing for older adults requires NPs consider the unique needs of each older adult while utilizing technology to support collaboration and decision making.
Nurse Staffing and Nursing Home Deficiency of Care for Inappropriate Psychotropics Use in Residents With Dementia
Authors: Yoon Jung Min , Trinkoff Alison , Storr Carla , Galik Elizabeth
Published: December 2020

Psychotropics use to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs) has been the focus of policy attention due to their adverse effects. We hypothesized that NHs with lower nursing staffing would have greater reliance on psychotropics use to control BPSD. A NH deficiency of care can be cited for inappropriate psychotropics use (F-tag 758). The association between the occurrence of F-758 tags and nurse staffing in residents with dementia was examined using the 2017-18 Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs). Staffing measures included nursing hours per resident day (HPRD) and registered nurse (RN) skill-mix. Generalized linear mixed models that included covariates (NH location, bed size, ownership, proportion of residents with dementia/depression/psychiatric disorders and with Medicare/Medicaid) estimated the magnitude of the associations. There were 1,872 NHs with F-758 tags indicating inappropriate psychotropics use for NH residents with dementia. NHs with greater RN and certified nurse assistant (CNA) HPRD had significantly lower odds of F-758 tags (OR=0.59 54, 95% CI=0.47 44-0.73 66; OR=0.87, 95% CI=0.77-0.99, respectively) and similar findings were found in NHs with greater RN skill-mix (OR=0.14 10, 95% CI=0.05 04-0.37 25). There were no significant associations between the occurrence of F-758 tags and licensed practice nurse and unlicensed nurse aide HPRD. This study found that RN and CNA staffing had inverse associations with inappropriate psychotropic use citations among residents with dementia. NHs with higher RN staffing ratios may be better able to implement alternatives to pharmacological approaches for BPSD. It is suggested that NHs be equipped with adequate nurse staffing levels to reduce unnecessary psychotropics use.
The Invisible Epidemic: A Spotlight on the Opioid Crisis Among Older Adults
Authors: Hsieh Jessica , McDonald Lynn , Shnall Adriana , Mirza Raza , Sinha Samir , Austen Andrea , Watts Laura Tamblyn , Klinger Christopher
Published: December 2020

Canada is facing an opioid crisis, with more than 3,900 related deaths occurring in 2017. Almost 30% of those deaths were among seniors; older adults also have the highest rates of opioid hospitalization and poisoning. Despite these statistics, little is known about the specifics. A comprehensive scoping review following Arksey and O’Malley’s (2005) framework was conducted to establish the magnitude of the problem, describe treatment approaches alongside prevention, and identify implications for practice, policy and research. Eight major electronic databases in medicine and the social sciences were searched alongside the grey literature, and a stakeholder consultation convened to validate results. A total of 6,814 articles, reports and thesis were identified. Forty-five sources met inclusion criteria, the majority stemming from the United States. Most were literature reviews, cohort and cross-sectional studies, with almost half also taking a gendered approach. Four predominant themes emerged from the thematic content analysis: 1) Medical Applications of Opioids; 2) Problematic Opioid Use; 3) Treatment and Prevention Strategies; and 4) Recommendations. Data highlighted ‘the invisible epidemic’, with treatment strategies to be specifically tailored to this population in light of metabolic differences and drug interactions as part of aging. Seniors are part of the current epidemic, with tailored approaches needed to ensure adequate, evidence-based counteraction – including seniors’ voices alongside further research in this regard. Education and training for prescribers needs to be enhanced alongside cross-jurisdictional drug monitoring programs to avoid drug interactions and misuse/fraud.
Long Life Family Study Shows Reduced Coronary Artery Disease Despite High Polygenic Hazard Scores
Authors: Feitosa Mary , Kuipers Allison , Wojczynski Mary , Wang Lihua , Perls Thomas , Christensen Kaare , Zmuda Joseph , Province Michael
Published: December 2020

Polygenic hazard scores (PHS) for coronary artery disease (CAD) quantify individuals with age-specific genetic risk for CAD. We evaluated how well the PHS predict age at onset of CAD in the Long Life Family Study (LLFS; families selected for exceptional longevity), compared to the Family Heart Study (FamHS; random families and high CAD-risk families). LLFS contains 4572 European ancestry (EA) individuals from 581 families (age: 74.0 ± 14.3, range: 22-110 years). FamHS Random has 1806 EA individuals from 454 families (age: 56.2 ± 13.5, range: 22-91 years), while FamHS High CAD-risk has 2301 EA individuals from 553 families (age: 53.2 ± 12.8, range: 21-93 years). We generated the PHS from 176 published SNPs from GWAS for CAD (p< 5.0 x 10-8, r2< 0.2). In each of the extremes of the CAD PHS distributions (75%), Kaplan-Meier method showed that the LLFS presented significant delayed age at onset of CAD compared to FamHS (random and High CAD-risk: P<0.0001). A Cox proportional hazards regression model accounting for CAD age at onset, using family bootstrap (N= 1000) to correct for family relatedness, replicated these results. For example, in the top-25% CAD-PHS when comparing to FamHS high-risk, the LLFS CAD hazards ratio was 0.127 (95% CI: 0.099, 0.164). Our findings suggest that, while PHS captured some of the risk of CAD in LLFS, part of the predisposition remains to be determined. Other relevant factors, including additional genetic discoveries and lifestyle-environment influences are needed to fully determine CAD risk in extreme samples.
The Decreased Complexity of Blood Pressure Dynamics Is Associated With Higher White Matter Lesions in Older Adults
Authors: Jiang Xin , Gao Xia , Zhang Hui , Deng Wuhong , Fu Wen , Manor Brad , Lipsitz Lewis , Zhou Junhong
Published: December 2020

White matter lesions (WML) are highly prevalent in older adults and thought to represent cerebral microvascular disease, contributing to slow gait and dementia. Hypertension is associated with WML. However, the underlying mechanism of this association is unclear. The complex beat-to-beat BP fluctuations represent the influence of BP regulatory mechanisms over multiple time scales. The association between WML and abnormalities in BP regulation may be manifest as a loss of complexity in BP dynamics. The aim of this study is thus to explore the relationships between hypertension, BP complexity, and WML in older adults. Twenty-two older adults with hypertension (SBP>140 mmHg) and 19 age-matched older adults without hypertension (i.e., control) completed this study. Their whole-brain WML were assessed by two neurologists using the Fazekas Scale. Greater score reflects higher WML grade. Each participant completed a 10-minute BP assessment when sitting quietly following the MRI. The continuous SBP and DBP series were recorded, and the complexity of them was quantified using multiscale entropy (MSE). Lower MSE reflects lower complexity. Compared to the controls, hypertensives had significantly greater Fazekas scores (i.e., higher WML grade) (F=4.8, p=0.02) and lower complexity of SBP and DBP (F>3.7, p<0.01), after adjusting for age. Across two cohorts, those with lower SBP and DBP complexity had higher Fazekas score (r<-0.51, p<0.01), and this association was independent of age and group. These results suggest that WML are associated with a loss of complexity in BP dynamics. Future longitudinal studies are needed to examine the causal relationship between WML and BP.
A Conceptual Framework for Engaged Communication at Adult Day Services: A Mixed-Methods Study
Authors: Mamo Sara , Wheeler Kara , Perry Olivia
Published: December 2020

Adult Day Services provide an opportunity for social engagement for older adults who might otherwise become isolated. Communication environments at many Adult Day Centers can be difficult for participants due to the high prevalence of hearing loss and poor acoustics in large activity rooms. The purpose of this study is to understand the hearing and social health status of participants across multiple group care settings as well as participants’ challenges and motivations to engage in social communication. A mixed methods approach was undertaken. Seventy-two participants from two Programs for All-inclusive Care for the Elderly (PACE®) completed quantitative measures: hearing test, cognitive screener (MOST™), IOM Social and Behavioral Determinants of Health, UCLA Loneliness Scale, and Instrumental Activities of Daily Living. Using maximum variation sampling based on hearing status and UCLA loneliness scores, ten participants were invited to complete one-on-one semi-structure interviews. Interviews aimed to learn more about how and why participants did and/or did not engage in social communication with other PACE participants. Transcripts were coded and thematic analysis was used to identify common barriers and motivations to communication. A conceptual framework was developed by integrating quantitative and qualitative findings to recognize what contributes to meaningful interactions or engaged communication. The findings from this study will contribute to the development of an intervention to address hearing loss and support communication for older adults in group care settings. In order to maximize the potential benefit of attending group-based day services, the communication barriers and motivations of older adults need to be addressed.
Hearing Loss Health Literacy Discrepancy Between Younger and Older Adults
Authors: Squires Erika , Ou Hua
Published: December 2020

Increasing the accessibility and affordability of hearing healthcare is a public health concern. Because low health literacy is a significant barrier to the use of existing effective healthcare services, it is critical to assess and understand health literacy deficits specific to hearing loss before implementing interventions. The purpose of this cross-sectional study was to identify differences in hearing loss health literacy among older and young adults, which is warranted because older adults are at-risk for lower levels of health literacy compared to their younger counterparts. Adults across the lifespan (n = 170) completed the Hearing Loss Health Literacy Assessment Tool, which includes self-rated ability to access/obtain, understand, and appraise hearing health information, as well as apply information to manage life with hearing loss. Results from an independent samples t-test indicated that older adults (M = 6.3, SD = 1.45, n = 54) self-reported significantly higher overall hearing health literacy than younger adults (M = 5.37, SD = 1.27, n = 116), t(168) = 4.22, p < 0.0001. Participants rated their ability to access/obtain information significantly lower than the other subscales. Age-differences in self-rated hearing health literacy exist. Findings from this study receive support from evidence indicating that the readability and suitability of the majority of patient education materials on hearing loss are not appropriate for the average U.S. adult. This investigation provides further evidence that the availability and accessibility of patient education materials on hearing loss is an important barrier that contributes to the limited use of hearing health care.
Understanding Medical Students’ Knowledge of Opioid Use Disorder: A Preliminary Study
Authors: Tewary Sweta , Kidron Ariel , Pandya Naushira , Howell Jim , Florent-Caree Marie , Ishmael Annisah , Cherner Rebecca
Published: December 2020

The rise of the opioid epidemic over the last two decades has increased the mortality rate, healthcare cost, and drug overdose deaths across the country. Practicing physicians are lacking in education regarding non-opioid alternatives to pain management, prevention, diagnosis, and treatment of opioid use disorder (OUD). Existing literature suggest a link between knowledge discrepancy and opioid use among clinicians resulting in patient’s abuse of opioids. Therefore, it is important to educate medical students at the start of their career. This preliminary study assesses the current knowledge and perceived skills of medical students regarding (OUD)/opioid misuse and related content in order to identify gaps and provide necessary education. The study used a pre-post survey method to understand the demographics, medical, and clinical knowledge about opioid use, abuse, and clinical knowledge regarding patient opioid overdose. The self-administered survey was administered to all students 18 years or older, M1- M4 enrolled in NSU-KPCOM. A total of 1164 students met these criteria. However, only 137 students participated in the Pre-survey collected from August 2019 to September 2019. Approximately 12% of the eligible students participated in the pre-survey. Data was analyzed using frequencies and percentages. Results of the pre-survey suggest a progressive increase in opioid knowledge from M1 to M4 years. Results of the study suggest investigating a relationship between medical education and knowledge of opioid usage, with a specific lens aimed at assessing the efficacy of opioid education during second and third years of medical school
Evidence for the Effectiveness of Health and Social Services Partnerships
Authors: Wilson Traci , Kunkel Suzanne , Brewster Amanda , Straker Jane , Blair Elizabeth , Scala-Foley Marisa
Published: December 2020

Integration of health and social services is touted as a key method to address social needs and improve population health. We will share the latest evidence on how Area Agency on Aging (AAA) partnerships with health care entities and other organizations improve health outcomes for older adults, while reducing health care costs. AAAs are community leaders in cross-sectoral partnerships that effectively address social determinants of health for older adults, who account for a substantial share of overall health care spending. Results of a longitudinal study (2008 – 2016) which links data from four waves of the National Surveys of AAAs to data on county-level health outcomes show that AAA–health care partnerships and programs reduced health care utilization and costs. AAA partnerships with hospitals reduced Medicare spending by $136 per beneficiary. AAA involvement in evidence-based health promotion programs decreased potentially avoidable nursing home use by nearly one percentage point (representing a change of 6.5%). Finally, we will describe the prevalence and nature of contracting relationships between community-based organizations and health care entities, based on data from the 2020 CBOs and Health Care Contracting Request for Information, the third national RFI of AAAs, Centers for Independent Living, and other aging and disability community-based organizations.
What Accounts for Physical and Emotional Health? Influence of Health, Personality, and Health Activation
Authors: Kim Joseph , Cone Nicholas , Arieli Rotem , Martin Peter
Published: December 2020

The purpose of this study was to identify associations among health personality, health activation, and emotional and physical health, and to identify direct and indirect effects. Participants in the study consisted of 3907 older adults, 65 years of age and older. Measures used in the analyses were the Health Personality Assessment, the Consumer Health Activation Index, and The Veterans RAND 12-Item Health Survey. Structural equation modeling with bootstrap sampling estimation was conducted to examine direct and indirect effects. The measurement model, X2(307)=2142.34, CFI=0.96, RMSEA=0.04, and structural model, X2(313)=2167.36, CFI=0.96, RMSEA=0.04 yielded an acceptable fit. Significant direct paths were observed between health personality factors and health activation, and in turn health activation to emotional and physical health. The results indicate that older adults with lower levels of Health Neuroticism, lower Health Openness, higher Health Agreeableness, and higher Health Conscientiousness had higher levels of health activation. In addition, older adults with higher levels of health activation had higher emotional and physical health. Also, direct paths from health personality to emotional and physical health were observed. Lastly, significant indirect effects were health activation had a significant positive indirect effect on physical health through Health Agreeableness. Health activation had a significant negative indirect effect on emotional health through Health Neuroticism and Health Openness. The implication of this study is that health activation has a significant role in the emotional and physical health of older adults through health personality dispositions. In addition, health personality factors directly influence the emotional and physical health of older adults.
Disability During the Last Years of Life Among Nonagenarians: The Vitality 90+ Study 2001-2014
Authors: Enroth Linda , Soo Pheck Hwa , Nosraty Lily , Tiainen Kristina , Raitanen Jani , Jylhä Marja , Aaltonen Mari
Published: December 2020

Increasing life expectancy has postponed the last years of life to older ages. Previous studies have demonstrated that disability is determined by age, age at death and closeness to death but only few have focused on oldest old population. We examined disability during the last years of life among people aged 90 years and older between 2001 and 2014 and assessed whether it varied by age at death, sex and study year. We used population-based survey data from the Vitality 90+ Study years 2001, 2003, 2007, 2010 and 2014 (N=5711, response rate 77-86%) linked with dates of death from Statistics Finland. Disability was defined as dependency in daily activities (dressing, getting in and out of bed) and mobility (moving indoors, walking 400m, using stairs). We analyzed disability stratified by closeness to death and age at death for men and women in each study year with logistic regression method. Disability in daily activities and mobility increased systematically with closeness to death (>4, 3-3.99, 2-2.99, 1-1.99 and 1> years to death) for both sexes in each study year. Also higher age at death (90-91 vs. 94+ years) was associated with disability. These associations remained consistent throughout the study period. This study shows that in the oldest old population both closeness to death and age at death determine the level of disability. We suggest that the complex and resource-draining care needs at the end of life will increase with growing number of people living their last years of life in very old age.
Motor and Pulmonary Function and Mobility Disability Among Black and White Older Adults With and Without HIV
Authors: Lange-Maia Brittney , Buchman Aron , Leurgans Sue , Lynch Elizabeth , Lamar Melissa , Erlandson Kristine , Barnes Lisa , Maia Brittney Lange
Published: December 2020

Black-White disparities in gait speed have been observed in studies of adults reporting HIV, consistent with work among older adults without HIV. However, it is unknown if racial differences exist among adults with HIV for other mobility-related factors. We aimed to determine if racial differences exist in mobility disability among older adults with and without HIV and assess if pulmonary and motor function contribute to mobility disability. We examined older adults age 50+ with HIV (N=177; 72% Black) and without HIV (N=191; 68% Black). Motor function summarized 10 motor performances including gait speed; pulmonary function summarized 3 measures assessed using hand-held spirometry. Mobility disability was based on self-report. In regression models adjusted for age, sex, medical conditions, and smoking, neither race nor HIV status were associated with mobility-related factors. However, in models stratified by HIV status, Blacks with HIV had worse motor (β=-4.3, p=0.04) and pulmonary function (β=-50.5, <0.001) and higher odds of mobility disability (odds ratio [OR]=2.9, 95% confidence interval [CI]=1.01-8.2) compared to Whites with HIV. Racial differences were not apparent among uninfected participants in motor function, pulmonary function, or mobility disability. In subsequent models, racial differences in mobility disability were attenuated and no longer significant in HIV when adjusting for motor function (OR=0.88 per/% higher motor composite, 95% CI=0.84-0.93). Racial differences in mobility disability in HIV were unaffected when controlling for pulmonary function. Results suggest that Blacks with HIV have greater mobility disability compared to Whites with HIV, and these differences are due to differences in motor function.
Fall Prevention in Dutch Physician Practices: A Descriptive Study
Authors: Meekes Wytske , Leemrijse C J , Korevaar J C , van de Goor L A M
Published: December 2020

Falls are an important health threat among frail older people. Physicians are often the first to contact for health issues and can be seen as designated professionals to provide fall prevention. However, it is unknown what they exactly do and why regarding fall prevention. This study aims to describe what physicians in the Netherlands do during daily practice in regards to fall prevention. About 65 physicians (34 practices) located throughout the Netherlands were followed up for 12 months. When a physician entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the physician received a pop-up asking if the patient is frail. If so, the physician subsequently completed a questionnaire. The physicians completed 1396 questionnaires. More than half (n=726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF) and 37% of these patients received fall prevention. Physicians did not know of 20% of the patients if they had experienced a fall and of 29% of the patients if they had a FOF. The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors. The results show that physicians are not always aware of a patient’s fall history and/or FOF and that only part of these patients receives fall prevention. Hence, it might be important to develop and implement strategies for systematic fall risk screening and fall prevention provision in the primary care setting to reduce falls among frail older people.
Four Eating Behaviors That Might Prevent Metabolic Syndrome Onset in Older Adults: Cohort Study
Authors: Wada Sayori , Hamaguchi Masahide , Nakabe Nami , Ueda Miho
Published: December 2020

Metabolic syndrome (MetS) is associated with cardiovascular disease and cancer, the leading causes of mortality and morbidity. Although eating behaviors may have an impact on the risk of MetS, exactly which behaviors can prevent MetS is not fully elucidated. We evaluated the onset of MetS in relation to eating behaviors among Japanese older adults aged 65 to 93. We enrolled individuals who underwent health check-ups between April 2008 and March 2019, and performed a nine-year follow-up in this cohort study. Cox regression models were used to compare hazard ratios for MetS onset. Among the 2,661 older adults included, the mean age was 70.21 ± 0.089 years and 46% were women. During a mean follow-up of 1567.3 ± 19.3 months, 499 candidates (18%) developed MetS. The risk of MetS was significantly low in subjects in the “often eat vegetables” and “eat more than 30 items daily” groups (hazard ratio (HR) (95% confidence interval (CI)): 0.721 (0.595–0.872), p = 0.001; and 0.690 (0.545–0.874), p = 0.002, vs without the behavior, respectively). On the contrary, the risk of MetS was significantly higher in subjects in the “eat quickly” and “eat out more than twice a day” groups (HR (95% CI): 1.442 (1.208–1.721), p < 0.001; and 1.534 (1.245–1.890), p < 0.001, vs without the behavior, respectively). Four eating behaviors—regular vegetable consumption, eating more than 30 items daily, eating slowly, and refraining from eating out too often—might be beneficial with regard to preventing the onset of MetS.
Clinician Distress: A Concept Clarification
Authors: Foxwell Anessa
Published: December 2020

In 2017, The National Academy of Medicine created the Action Collaborative on Clinician Well-Being and Resilience given the staggering statistics around distress and burnout, which is particularly high while caring for seriously ill older adults. This distress may be physical, emotional, spiritual, moral, ethical, existential or in degrees and combinations of multiple forms. Many crossover concepts are present in the literature, including moral distress, role stress, compassion fatigue, empathy, emotional labor, post-traumatic stress disorder, vicarious traumatization, and second victim. Because of the number of crossover concepts, we employed the Norris concept clarification method examining similar concepts to create an operational definition, construct a model, and develop possible research hypotheses of clinician distress. Articles were identified through PubMed, CINAHL, PsyhINFO, and SCOPUS with the expert assistance of a nurse librarian. Similar concepts in the literature were compared and contrasted with an emphasis on what encompasses clinician distress. Based on synthesis of the literature and existing concepts, clinician distress is defined as experiencing one or more negative emotions before, during, or after a clinical encounter that impacts the quality of care the clinician is able to provide to the patient. The result of this analysis provides some clarity around clinician distress and its surrogate terms, which presents opportunities for further investigation.
A Virtual Health Library for Dementia Patients and Caregivers to Improve Quality of Information and Communication
Authors: Mengell Kirsten , Indelicato Alyssa , Lawler Sarah , Smith Nancy , Brangman Sharon , Stewart Telisa
Published: December 2020

Access to accurate health information is critical for patient decision making and health communication. Unfortunately, there is limited quality health information for dementia patients and their caregivers. A Virtual Health Library (VHL) provided access to credible health information through the electronic medical record (EMR) to reach the dementia patients and their caregivers. A VHL was created and brought together clinicians, caregivers, technology support personnel, public health professionals, and the health sciences library. The team identified areas of interest and met monthly to create VHL materials. Materials included voice-over slides and 1-page educational content that was uploaded to the EMR for patient and caregiver access. A baseline and final questionnaire assessed demographics, empowerment, and shared decision making for both the patient and the caregivers and a pre/post was created for each module to asses knowledge and stratification. Initially, 1331 patients with dementia were recruited for the project from a university geriatrics department. The population had a 28.3% enrollment in the EMR and only 3.8% used the EMR in the past six months. Of this pool, during the initial launch 32 patients and or caregivers completed the baseline within the first week. 98% of respondents were caregivers with an average age of 58.7. With the youngest caregiver 42 and the oldest 88. Of the caregiver’s relationships to the patients is 43.3% their child, 40% their spouse, 10% other family, and 6.7% friends. During the project, participants improved access to health information and became empowered to engage with their healthcare provider.
Circulating Procollagen Type III N-Terminal Peptide and Physical Function in the Long Life Family Study
Authors: Santanasto Adam , Cvejkus Ryan , Wojczynski Mary , Schupf Nicole , Marron Megan , Christensen Kaare , Thyagarajan Bharat , Zmuda Joseph
Published: December 2020

Circulating levels of procollagen type III N-terminal peptide (P3NP) may reflect increased fibrosis of skeletal muscle and other tissues with aging. In the current study, we tested if P3NP levels were associated with baseline and 7-year change in physical function among adults aged 39-104. Participants (n=400) were from the Long Life Family Study, a study of exceptional familial longevity. Plasma P3NP concentration was measured using a sandwich enzyme-linked immunosorbent assay (inter-assay CVs <3%). At baseline and 7-year follow-up visits, physical function was measured using the Short Physical Performance Battery (score 0-12), which consists of gait speed, balance, and chair-rise tests. Grip strength was measured using a handheld dynamometer. The association between log-transformed P3NP and physical function was examined using Generalized Estimating Equations adjusted for familial relatedness, age, sex, height, weight, lifestyle characteristics, chronic disease prevalence and inflammatory cytokines. Participants were aged 73.1 ± 15.2 years, 54% female, had a BMI of 26.6 ± 4.3 kg/m2, and a gait speed of 1.0 ± 0.3 m/s. One standard deviation higher P3NP concentration was related to worse baseline SPPB score (β=-0.9points), gait speed (β=-0.05m/s), chair-rise time (β=8.34seconds), and grip strength (β=-2.0kg; all p<0.001). Higher P3NP concentration was also associated with greater declines in gait speed (β=-1.41, p<.001) and chair-rise performance (β=0.41, p<.001). Plasma P3NP concentration may be a strong, novel biomarker of current and physical function changes with aging. Future research is needed to extend our findings to a larger population, and determine the mechanisms underlying these associations.
Doing the Right Thing: Caregivers and Medical or Nursing Tasks in the Post-Acute Home Care Setting
Authors: Chase Jo-Ana , Russell David , Kaplan Daniel , Bueno Michael , Khiewchaum Rungnapha , Feldman Penny
Published: December 2020

Family caregivers often manage complex medical/nursing tasks (MNTs) for older adults returning home after a hospitalization. The purpose of this qualitative study was to describe caregivers’ experiences leveraging diverse resources to manage MNTs for older adults receiving post-acute home health care services (HHC). In-depth telephone interviews were conducted with 20 caregivers of older adults who received HHC following hospitalization. Interviews were digitally audio-recorded, transcribed, and analyzed using directed content analysis. The Theory of Dependent-Care informed the analytical framework. We organized codes using three theoretical constructs related to managing older adults’ MNT care needs (“tasks related to the other”), accessing existing social/environmental resources (“tasks related to the situation of care”), and working with the healthcare system (“tasks related to the system of care”). Caregivers’ descriptions of MNTs included the complexity and socioemotional impact of assisting in these tasks (e.g., dependency, trust). When needed, caregivers’ accessed social (e.g., family, friends) and environmental (e.g., neighborhood, housing) resources to help address the older adults’ care needs. Caregivers also identified challenges and strategies for navigating and coordinating care and services within HHC and the larger healthcare system. Caregivers assisting with complex MNTs in the post-acute HHC setting need additional training and support. HHC providers can actively engage caregivers by tailoring training and support strategies, assessing social and environmental contexts and resources, and facilitating caregivers’ navigation of the healthcare system. Future research could elucidate social and environmental factors associated with successful collaborative relationships among providers, older adults and their caregivers in the post-acute HHC setting.
Rural-Urban Differences in Informal Caregiving, Caregiving Intensity, and Health-Related Quality of Life
Authors: Cohen Steven , McIlmail Julia , Greaney Mary
Published: December 2020

Introduction Rural areas in the US have a disproportionately high population of older adults and have reduced access to services. Older adults in rural areas are more reliant on family and friends for care. However, little is known about rural-urban disparities among the 40+ million caregivers nationwide. As rural-urban health disparities are pervasive among older adults, there is a need to understand how rural-urban disparities impact caregiving experiences and health-related quality of life (HRQoL). The objectives of this study were to examine rural-urban differences caregiving, caregiving intensity (caregiving hours/week and types of care provided), and caregiver HRQoL. Methods Data were abstracted from the 2009 Behavioral Risk Factor Surveillance System (latest dataset to include county of residence and caregiver module). The primary measure of rural-urban status was Index of Relative Rurality (IRR) decile. Associations between rural-urban status and caregiving and rural-urban differences in caregiving intensity and HRQoL were examined using generalized linear models, controlling for confounding and accounting for complex sampling. Results Rural respondents were more likely to be caregivers than urban respondents (IRR decile OR=1.015, 95%CI 1.014-1.016). Rural caregivers, on average, provided 2.43 hours/week more caregiving for each one-decile increase in IRR decile (95%CI 2.34-2.52) and had worse overall HRQoL (OR=1.34, 95%CI 1.33-1.35). Conclusion Rural informal caregivers offer higher levels of care than urban counterparts, and increased caregiving in rural areas is associated with reduced HRQoL. These results can inform policies designed to improve caregiver health, and facilitate the translation of existing programs and interventions to address rural caregivers’ needs.
The Half Life of Stress: Caregiver Stress Increases Next-Day Severity of Behavioral Symptoms of Dementia
Authors: Pickering Carolyn , Puga Frank , Wang Danny , Yefimova Maria
Published: December 2020

The progressively lowered stress threshold theory posits that behavioral symptoms of dementia (BSD) are reactions to environmental and care related stressors. In line with this theory, this study tests whether the stress experienced the caregiver impacts BSD expression. Caregivers to persons with dementia recruited online completed daily diary surveys for 21 days reporting on daily contextual and environmental factors of caregiving life. Using multi-level modeling of diaries (n=911) nested within participants (N=51), two daily caregiver stressors (conflict with someone other than the person with dementia, stress about own personal health) were examined as predictors of BSD. The outcome of BSD was measured as severity (a rating on a Likert scale of 1-5 that was then person-centered to represent deviations from average severity). Covariates in the model included relationship type, caregiver age, as well as stressors to the care recipient known to increase BSD. On days when a caregiver had a conflict with others the severity of the care recipient’s BSD increased by 1.44 points from average (p<.001, CI 1.05-1.75). In a time-lagged model, we observe that a caregiver having a conflict yesterday impacts today’s BSD severity by an increase of 0.43 points from average (p = 0.027, CI 0.05-0.81). Caregivers’ stress about their own health did not have a significant impact on the same day or next day BSD severity rating. These findings demonstrate that the well-being of the caregiver has measurable immediate impacts on the well-being of the person living with dementia, and suggests not all stress is equal.
Certified Nursing Assistants’ Experiences of Workplace Violence Caring for Persons With Dementia
Authors: Xiao Chunhong , Winstead Vicki , Townsend Corteza , Jablonski Rita
Published: December 2020

Problem: Certified nursing assistants (CNAs) are the primary providers of direct care to persons residing in long term care facilities (LTCFs), many of whom have dementia. The need to deliver direct and intimate care increases CNAs’ exposure to verbal and physical workplace violence. Purpose: To describe CNAs’ experiences of physical and verbal workplace violence experienced during direct care activities in LTCFs. Design: Qualitative. Sample & Procedure: Ten African-American CNAs (9 female, 1 male) were recruited using snowball sampling from multiple LTCFs. Interviews were recorded and transcribed. NVivo12 software was used to manage the thematic analyses. Results: The identified themes were: 1) CNAs’ perception that verbal and physical abuse was “part of the job” and unavoidable; 2) CNAs’ feelings of minimization of the abuse by administration; and 3) inadequate CNA training to recognize and de-escalate triggers of verbal and physical violence, notably care-resistant behavior. Conclusion: The combination of institutional tolerance of workplace violence, coupled with CNAs’ insufficient training in de-escalating volatile interactions with cognitively-impaired residents, is creating an unfavorable, possibly dangerous, workplace environment for CNAs. Implications: As more states elevate assaults on healthcare workers to felony crimes, there is an emerging risk of criminalizing dementia-related behavior in an attempt to address workplace violence. Interventions focused on helping CNAs recognize and de-escalate care-resistant behavior are necessary for violence prevention programs in LTCFs. Limitations: CNAs may have self-censored and under-described the severity of their experiences during face-to-face interviews, even with confidentiality protocols and the practice of off-site interviews.