bluuebunny/crossref_metadata_2025 huggingface dataset:
EMPOWERMENT AMONG FORMAL CAREGIVERS WORKING WITH PERSONS WITH DEMENTIA IN HOME CARE
Authors: McIlveen Heather A , Savundranayagam Marie Y , Orange J B , Kloseck Marita
Published: November 2019

There is significant literature on workplace empowerment that focuses on individuals in positions of power rather than those who lack it. However, there is limited research on empowerment of home care workers, such as personal support workers (PSW) who work in dementia care. Empowerment is an active process based on a multifaceted model consisting of four components: meaning, self-determination, impact and competence. This study explored the roles of education and employer support in empowering PSWs to care for persons with dementia who live at home. Empowerment was investigated using semi-structured interviews with PSWs (N=15). A phenomenological approach was to understand the lived experiences of home-care based PSWs who work with persons with dementia. Components of empowerment were reflected through five emerging themes: “providing best care”, “autonomy”, “employer support”, “career long learning”, and “experiential learning”. The theme “providing best care possible” support the component of meaning, which included the motivation for training among PSWs and their value of aging in place. The theme “autonomy” supported the component of self-determination, which focused on PSW workload and feelings regarding their control working in home care versus long term care. The theme “employer support” supported the component impact, which included both PSW compensation and their perceived lack of emotional support. Finally, the themes “career-long learning” and “experiential learning”, were linked with impact and competence components, respectively. Overall, these findings support relationships between education and employer support in empowering PSWs who care for persons with dementia who live at home.
REJECTION OF CARE, AGGRESSION, AND AGITATION IN PERSONS WITH DEMENTIA: A REVIEW OF DEFINITIONS IN DEMENTIA MEASURES
Authors: Choi Scott , Cajita Maan , Gitlin Laura N
Published: November 2019

Objective: To provide a systematic review of how rejection of care, aggression, and agitation are described and operationalized in existing measures of dementia-related behaviors with a particular focus on whether these behaviors are conceptualized as separate phenomena in rating scales. Methods: We reviewed two systematic reviews of behavioral measures in dementia to evaluate their definitions and operationalization of rejection, aggression, and agitation. Additionally, we conducted a systematic review of English-language peer-reviewed articles published from 1980 to 2017 to update the previous list instruments and identify additional measures that were not captured in previous reviews. Results: 43 instruments (23 general behavior measures, 20 symptom-specific measures) developed to measure behavioral symptoms were included. Of these, 25 (58.1%) included items related to rejection of care; 32 (74.4%) included aggression items; and 35 (81.4%) had agitation items. Descriptions and definitions of the behaviors were highly variable across instruments. 13 of 23 general measures and 3 of 20 symptom specific measures included items separately representing all three behaviors while the rest of the measures lacked items measuring one or two behaviors of our interest. Conclusions: The review demonstrated that rejection, aggression, and agitation are measured in most scales yet their measurement is highly variable and they are often not distinguished from each other. Researchers and clinicians need to consider each symptom in its own right and revise existing instruments to address possible misnomers to improve measurement of dementia behaviors.
SLOW WAVE SLEEP AND PAIN AFTER BEHAVIORAL INSOMNIA TREATMENT IN ADULTS OVER AGE 50 WITH KNEE OSTEOARTHRITIS
Authors: Heffner Kathi L , Heffner Kathi L , France Christopher R , Pigeon Wilfred R
Published: November 2019

Sleep disturbance can aggravate pain, and we recently found that insomnia treatment improved osteoarthritis (OA) pain, lowered inflammation, and improved quality of life in middle-to-older aged adults. Inadequate slow wave sleep (SWS), known as deep or restorative sleep, can decline with aging and is linked to pain and inflammation. We examined how insomnia treatment affects SWS, and the relationship between SWS and pain. In a pilot trial, 33 adults, ages 51 to 74 years with OA-related knee pain and insomnia, were randomized to 6-session CBTi (n=16) or a weekly phone contact control group (n=17). The CBT-I group showed significantly more laboratory-measured SWS across a study night than controls after controlling for baseline SWS. Greater SWS intensity was associated with lower OA-related pain among the CBT-I group, but not among controls. These preliminary data suggest that behavioral sleep treatment may strengthen the beneficial influence of restorative sleep on pain.
RACIAL DISPARITIES IN HIP FRACTURE CARE
Authors: Ali Iman , Jang Jessica , Vattigunta Sanjana , Bansal Ankit , Srikumaran Uma
Published: November 2019

Hip fractures are associated with significant morbidity and mortality. Delaying surgery for more than 24 hours after presentation results in more complications, higher 30-day mortality rate, and longer stays in the hospital. As such, high-quality care should be provided consistently to an increasingly diverse patient population. We determined if race characteristics influence the quality of care provided to patients with hip fractures. We conducted a retrospective analysis on patients at our institution between January 2015 and December 2017. Patients were categorized as white, Black, Asian, and other. The primary outcome variable was the time between presentation to surgery. Other outcomes included length of hospital stay and narcotic pain medication consumption in the first 24 hours postoperatively. Adjusted analysis was performed, controlling for sex, age, body mass index (BMI), American Society of Anesthesiologists’ (ASA) classification of health, and Charlson Comorbidity Index (CCI). There were 1544 hip fracture patients included in the study. The majority of patients were white (84.1%) followed by Black (7.6%), Asian (4.5%), and other (3.7%). Most patients were female (69.6%). After adjusting for patient characteristics, Black patients experienced a significantly greater delay to surgery after presentation than white patients (42.1 vs. 34.9 hours). In addition, Black patients experienced significantly longer length of hospital stays compared to their white counterparts (6.9 vs. 5.8 days). Racial disparities in the quality of care provided to hip fracture patients persist even after adjusting for patient characteristics. Addressing these disparities can possibly enhance outcomes for minority patients.
SERUM 25-HYDROXYVITAMIN D LEVELS IMPACT RISK OF EXTENSIVE ASSISTANCE NEEDED BY OLDER ADULTS TO WALK
Authors: Jenney Krista N , Robbins Ronna , Sweitzer Sara , Ranjit Nalini , Briley Margaret
Published: November 2019

Study objective is to determine the association between deficient 25-hydroxyvitamin D [25(OH)D] serum levels and the amount of assistance needed to walk in a room by older adults living in long-term care (LTC) communities. Participants (age ≥ 65) from five LTC communities in Central Texas were recruited for a multi-site, cross-sectional study (n=169). Double-blinded data abstraction protocols were used to collect a one-year medical history. Laboratory blood draws measured serum 25(OH)D levels. Level of assistance was measured by the activities of daily living score for walking in room from section G of the Minimum Data Set (MDS). To determine the association between deficient 25(OH)D serum levels (≤20 ng/ml) and assistance with walking, adjusted logistic regression was used. Total vitamin D per day (supplementation and meals), therapy and/or restorative programs, body mass index, race, gender, age, and years living in the community were used as confounders. Of the 169 participants (mean age=83) 27.17% had deficient serum 25(OH)D and 9.25% required extensive assistance to walk in a room. The mean serum level and supplementation rate of participants was 32.61 ng/ml and 1,160.64 IU per/d, respectively. Participants with deficient 25(OH)D serum levels had significantly elevated odds (OR=8.73; CL: 1.28, 8.54; p=0.027) of requiring extensive assistance to walk in a room compared to those with adequate serum levels (>20 ng/ml). Deficient 25(OH)D serum levels are associated with increased assistance to walk in a room indicating that adequate serum levels in LTC residents could potentially decrease burden on staff.
ABILITY OF THE PHYSIOLOGICAL PROFILE ASSESSMENT TO CLASSIFY FALLER TYPE: A PROSPECTIVE COHORT STUDY
Authors: Jehu Deborah A , Davis Jennifer C , Velsey Kristin , Cheung Winnie , Liu-Ambrose Teresa
Published: November 2019

Accurately identifying older adults who will experience subsequent falls is important for the provision of secondary fall prevention. The purpose of this study was to determine the accuracy of the Physiological Profile Assessment (PPA) – a valid and reliable fall-risk assessment [1] – in predicting subsequent falls over a 12-month period in older adults who sought for medical attention after an index fall. Seven hundred thirty-seven community-dwelling adults, aged 70 years and older, who were seen at the Vancouver General Hospital Fall Prevention Clinic, completed the PPA at their initial visit. Falls over the subsequent 12 months were tracked prospectively via monthly falls calendars. All individuals received geriatric care at baseline. Binary logistic regressions were performed to determine the accuracy of classifying two prospective faller types: 1) no additional falls; 2) one or more additional fall(s). Baseline PPA, age, and sex were entered as independent variables. During the 12 month observation period, 345 participants had no additional falls (Age:81.3±6.6yrs;Female=251) and 392 fell one or more times (Age:82.3±6.5yrs;Female=230). The classification accuracy was 51.3% for those who had no additional falls and 64.8% for those with one or more additional fall(s) (Overall:58.5%;χ2=29.0;PPA:β=-0.21;Age:β=-0.01;Sex:β=-60). The PPA was not able to accurately differentiate between those who did and did not subsequently fall. Fall-risk assessment sensitivity and specificity should be improved in older adults seeking medical attention following an index fall to inform secondary fall prevention. [1] Lord SR, et al., 2003. Phys Ther.
CHANGES OVER TIME IN DAYTIME SLEEPINESS AMONG OLDER ADULTS RECEIVING LONG-TERM SERVICES AND SUPPORTS
Authors: Petrovsky Darina V , Hirschman Karen B , Brewster Glenna , Hanlon Alexandra L , Huang Liming , McPhillips Miranda Varrasse , Hodgson Nancy A , Naylor Mary D
Published: November 2019

The purpose of this study was to examine the predictors of excessive daytime sleepiness (EDS) over the first two years of long-term services and supports (LTSS) for 470 older adults in assisted living communities (ALCs), nursing homes (NHs), or their homes. Mixed effects linear regression modeling using a backward elimination process was used to build a final multivariable model. In the final model, being female (p<0.001) and fewer functional deficits (p<0.001) at baseline were associated with decreases in EDS, while higher baseline measures of BMI (p=0.004) and number of symptoms (p<0.001) were associated with higher EDS. Compared to older adults living in the community and receiving LTSS, those in NHs and ALCs had higher EDS (p<0.001). Greater feelings of belonging and depressive symptoms at baseline were associated with slower rates of increase in EDS over time (both p<0.001). Modifiable predictors of EDS and clinical implications will be discussed.
ABERRANT FUNCTIONAL CONNECTIVITY UNDERPINNING CHANGES IN LIFE-SPACE MOBILITY IN OLDER ADULTS
Authors: Hsu Chun Liang , Best John R , Crockett Rachel A , Chan Patrick , Liu-Ambrose Teresa
Published: November 2019

Subtle, but observable, changes in mobility often exist among older adults. Life-space mobility defines the frequency and extent of movements in the environment, and lower life-space mobility is associated with adverse health outcomes and mild cognitive impairment (MCI). Currently, the underlying mechanism of this association is not well understood. The aim of this study was to examine the functional neural correlates of reduced life-space mobility over 12 months. Thirty-five older adults over the age of 65 years with MCI were recruited and enrolled into this 12-month prospective study. Resting-state functional magnetic resonance imaging was completed at study baseline. Clinical assessment of anthropometric, behavioural measurements, and life-space mobility was conducted at study baseline and at the 12-month period. Over the 12-month study, the 35 participants demonstrated a significant reduction in LSA scores (paired sample t-test mean change=-6.53, p=0.01); greater baseline connectivity between the default mode network and the sensorimotor network was significantly associated with lower life-space mobility (R2=0.44, p=0.04). These findings suggest reduced life-space mobility in older adults may be partially due to altered inter-network connectivity in the brain such that normal neuro-cognitive motor behaviours is disrupted. Therefore, the maintenance of functional architecture of the brain may be essential in preserving the extent and frequency of older individuals’ movement in their environment.
SYSTEMATIC REVIEW OF THE EFFECTS OF NON-VR EXERGAMING ON MOBILITY OUTCOMES OF OLDER ADULTS LIVING IN LONG-TERM CARE
Authors: Chu Charlene H , Biss Renee , Sultana Afroza , Gauthier-Beaupré Amelie , Talebzadeh Arezoo
Published: November 2019

Introduction: Institutionalized older adults have high-rates of mobility decline resulting in reduced quality of life and increased dependency. Given the ageing population, there has been a proliferation of exergaming technology targeting older adults to maintain their physical activity (PA) levels and prevent decline. However, it is unclear if exergaming is effective to maintain or improve the PA of institutionalized older adults. Method: Four databases (MEDLINE/CINAHL/PsycINFO/Compendex) were systematically searched (key terms like “nursing homes”, exergaming”). Quantitative manuscripts examining the effects of exergaming on PA measures of institutionalized older adults published in English between 2006-present were eligible. Virtual reality was excluded from the search. No meta-analysis was conducted due to hetereogeneity of the results. Results: 11 studies were included from a search that yielded 208 results. The exergaming platforms that were used the most were the Kinect and Wii. The most commonly used PA measures were the Berg Balance Scale and the Timed-up-and-Go (n=4 studies) with no other measures being used in more than one study. Interventions ranged in exercise (e.g. cognitive-motor training, strength training, balance, etc), frequency, duration, and modality. Study designs were also heterogeneous. Articles were of very poor to poor quality. There was minimal reporting on adverse events. Older adults with cognitive impairment were commonly excluded. Challenges in current technology and studying this group are highlighted. Conclusion: Exergaming may be promising to maintain PA but more robust research is needed. More exergaming technology designed for long-term care to meet the specific complex needs of this population is warranted.
CHARACTERISTICS OF THE GAIT INITIATION PHASE IN OLDER ADULTS WITH DIABETIC PERIPHERAL NEUROPATHY
Authors: Kang Gu Eon , Nguyen Hung , Zahiri Mohsen , Zhou He , Wang Changhong , Goel Rahul , Najafi Bijan
Published: November 2019

Impairment in steady-state gait in older adults with diabetic peripheral neuropathy (OADPN) is well-known, however little attention has been paid to the gait initiation phase in which postural transitions occur from upright standing to steady-state gait. Given the risk of falls in the gait initiation phase in older adults, knowing its characteristics may be as important as steady-state gait. The aim of this study was to investigate kinematic characteristics of the gait initiation phase in OADPN compared to healthy older adults (HOA). Thirteen OADPN (72.9±6.1 years; 33.0±4.8 kg/m2), and 11 HOA (71.8±2.7 years; 26.5±4.3 kg/m2; no cardiovascular, neurological or orthopedic condition, no history of falling) performed gait on level ground for minimum 10 meters at self-selected comfortable speed. We collected kinematic data using five wearable sensors (LEGSysTM, BioSensics LLC, Watertown, MA) attached on the shanks, thighs and lower back. We used previously validated algorithm to analyze kinematic parameters for the gait initiation phase. Our statistical model showed that the number of steps, stride velocity, gait cycle time, double limb support and mediolateral center-of-mass sway during the gait initiation phase is significantly different between HOA (2.4±0.7 steps; 1.16±0.15 m/s; 1.12±0.10 seconds; 20.3±4.8%; 4.0±1.5°, respectively) and OADPN (4.0±2.1 steps; 0.92±0.29 m/s; 1.23±0.12 seconds; 29.2±10.3%; 7.0±2.9°, respectively) (all p<0.05). The results suggest that OADPN take more, slower and more unstable steps to reach steady-state gait from upright standing compared to HOA. The results also provide implications for needs to develop new interventions targeting the gait initiation phase in OADPN.
ACADEMIC PARTNERING IN A COMMUNITY-BASED FALL PREVENTION PROGRAM
Authors: Klima Dennis W , Wehlandl Emily , Holmes Aspen , Weimert Jessica , Rhoten Nicholas , Wolfe Jestine , Avila Katherine , Austin Nate
Published: November 2019

Falls are a major cause of disability nationally are and linked to both fractures and fear of falling. The purpose of this study was to assess the effectiveness of a rural community-based fall prevention program using an academic partnership model with seven physical therapy students rotating through six senior centers. One hundred and fifty-four older adults (Mean age: 76.1+/- 8.5) completed Stepping On at six locations. A mixed-methods design was utilized. Physical therapy students partnered with older adult participants to teach exercises, strategize floor recovery techniques, and identify community safety barriers. A descriptive survey tool assessed demographic profiles, falls efficacy, and program effectiveness among participants. Students participated in a follow-up focus group to discuss perspectives on their role in the fall prevention program. Most participants were female (86.4%), lived alone (50.0%) and taking four or more medications (74%). Thirty-eight participants (24.7%) had fallen over the past year. Eighty-eight (57.1%) subjects noted they had less fear of falling following the community-based intervention; moreover, most subjects (74.7%) reported having an improved plan for floor rise after a fall. Major focus group themes underscored students’ enhanced ability to teach exercise and mobility activities with an increased awareness of interdisciplinary fall prevention. Following a collaborative community-based fall prevention program, seniors have a better understanding of fall causes and plan to seek floor recovery assistance. In turn, student teaching and communication skills are reinforced. Student partnering with seniors promotes fall prevention strategies and affords benefits to both students and participants.
RISING FROM THE FLOOR IN PERSONS WITH PARKINSON’S DISEASE
Authors: Klima Dennis W , Stewart Jeremy , Freijomil Frank , DiBartolo Mary
Published: November 2019

While considerable research has targeted gait, balance and preventing falls in individuals with Parkinson’s disease (PD), less in known about the ability to rise from the floor in this population. The aims of this study were to 1) Examine the relationship between locomotion and physical performance tests and the timed supine to stand performance measure and to 2) Identify both the time required and predominant motor patterns utilized by persons with PD to complete to floor rise transition. A cross-sectional design was utilized. Twenty community-dwelling older adults with PD (mean age 74.8+/-9.5 years; 13 men) performed a standardized floor rise test and locomotion tests in a structured task circuit. Subject demographic and anthropometric data were also collected. Statistical analyses included descriptive statistics and Pearson Product Moment correlations. Fifteen subjects (75%) demonstrated the crouch kneel pattern and fourteen (70%) used an all-4’s strategy to rise to stand. The mean time to rise from the floor was 14.9 (+/- 7.6) seconds and slower than published norms for persons without PD. Nine subjects required the use of a chair to perform floor recovery. Supine to stand performance time was significantly correlated with the: Dynamic Gait Index (r= - 0.66; p<0.002), Five Times Sit to Stand Test (r=0.78; p<0.001), Timed Up and Go Test (r=0.74; p<0.001), and gait velocity (r= -0.77; p<0.001). Rising from the floor demonstrates concurrent validity with locomotion and physical performance tests. Floor recovery techniques can be incorporated in fall prevention initiatives in conjunction with PD symptom management.
NOVEL INSIGHTS ON THE RELATIVE IMPORTANCE OF CLINICAL AND GAIT MEASURES FOR DETECTING FALL RISK IN OLDER ADULTS
Authors: Hundza Sandra , MacDonald Stuart , Commandeur Drew T , Klimstra Mark
Published: November 2019

We sought to extend recent research that explored model-based approaches for combining clinical and gait measures to determine the most sensitive grouping for retrospectively classifying fallers from non-fallers which resulted in a model with 92% sensitivity and 66% specificity and an overall model of 83%. In the present study, the clinical assessment battery was augmented by incorporating more challenging balance items while removing clinical measures characterized by ceiling effects and restricted range. Thirty-two community-dwelling older adults (>70yrs, 16 fallers, 16 non-fallers) completed a battery comprising 76 measures of more challenging clinical measures of mobility and balance, and retained gait (GaitRITE), postural sway and physiological measures. Within each domain, highly collinear and theoretically-redundant measures were removed. Next, a Principal Component Analysis (PCA) identified those clinical and gait variables that accounted for the most unique variance. Finally, a backward stepwise logistic regression was performed on the reduced set of variables from the PCA to develop predictive equations. The current analysis yielded improved specificity of 75%, but slightly lower sensitivity 81%. Interestingly, when the results for the PCA from the previous study were used with the current data, the model classified fallers with 87% sensitivity and 86% specificity and an overall model of 86%. Notably, in all analyses, gait variables were central in identifying fall risk, with single- vs. dual-task difference scores of particular predictive importance. The differences observed between the best-fitting models across the two cohorts implies that modelling methods should accommodate and harness individual differences (e.g., machine learning techniques).
CHALLENGES AND BARRIERS FOR SERVICE PROVIDERS IN RURAL SETTINGS: AN ELDER-ABUSE NEEDS ASSESSMENT
Authors: Peitz Louise , Lee Jeong Eun , Gilligan Megan , Meinertz Naomi R
Published: November 2019

There has been concern about the increasing prevalence of elder abuse in the rural settings. This trend has called for more coordinated efforts to address elder abuse in the rural community. The current literature regarding elder abuse suggest there is more to learn about systematic obstacles service providers face. The framework applied in this study include elements of Bronfenbrenner’s Bioecological model, showing a multilevel application to the obstacles agencies encounter when supporting else abuse victims. Little research has been conducted on the providers who work with elders in the rural context. In this study, based on the needs assessment of Iowa, we have examined the perceived barriers service providers face. Our sample included 222 providers across Iowa who took an online survey. The survey was initially sent to members of the Coordinated Community Response team of Iowa. Our findings indicated that service providers revealed multilevel challenges (i.e., individual vs. organization level) in working with elder abuse cases. Service providers’ perceived effectiveness training was negatively associated with the quality of training they evaluated (β=.24, p<.05). The data also showed us that a large portion of agencies offered no training and education on elder abuse. Common themes described by the providers as barriers to addressing abuse was lack of education, social isolation, low awareness and ageism. These results highlight that training for elder abuse in the rural setting needs multilevel systematic efforts.
FINANCIAL DECISION MAKING SELF-EFFICACY IN COGNITIVELY AND FINANCIALLY VULNERABLE OLDER ADULTS
Authors: Gross Evan Z , Campbell Rebecca J , Hall LaToya , Lichtenberg Peter
Published: November 2019

Financial decision making self-efficacy (FDMSE) is a novel construct that may influence how older adults make financial decisions. Our previous research with a community sample of older adults demonstrated that cognitive functioning and suspected history of financial exploitation were both associated with low FDMSE. We sought to replicate these findings in two clinical samples of older adults: people with mild cognitive impairment (MCI) or probable Alzheimer’s disease (PAD) and current victims of scams or exploitation as determined by a financial coach. Samples were obtained from the Michigan Alzheimer’s Disease Center and a financial coaching intervention study. All participants completed a 4-item FDMSE measure. One-way ANOVAs, t-tests and chi-square tests were conducted to test for group differences with controls on demographics. There was a main effect of cognitive status on FDMSE, F(2,138) = 8.10, p < .001, which was driven by higher FDMSE in the healthy group (N = 63) than the MCI (N = 76) or PAD (N = 28) groups. Similarly, scam victims (N = 25) had significantly lower FDMSE than non-exploited (N = 25) peers, t(48)=2.33, p < 05. Cognitive impairment and current financial scams are both associated with low FDMSE levels. Low FDMSE may exacerbate cognitive and psychosocial vulnerabilities that contribute to risk for poor financial decisions among older adults. Future interventions to enhance FDMSE may help older adults make better decisions despite changes in thinking abilities or previous negative financial experiences.
TRENDS IN GERIATRIC PHYSICAL ASSAULT INJURIES TREATED IN U.S. EMERGENCY DEPARTMENTS, 2006-2015
Authors: Rosen Tony , Clark Sunday , Gassoumis Zach , Yonashiro-Cho Jeanine , Elman Alyssa , Lachs David , Bloemen Elizabeth , Hall Jeffrey
Published: November 2019

Trends in Geriatric Physical Assault Injuries Treated in US Emergency Departments, 2006-2015 Older adults are common victims of assault, many of which may result in severe injuries. Our objective was to understand temporal and demographic trends in geriatric assault injuries treated at U.S. Emergency Departments (EDs) and to compare these trends to assault injuries in younger adults. We conducted an analysis of assault injuries in patients aged ≥60 compared to patients aged 18-59 treated in EDs during 2006-2015 using the National Electronic Injury Surveillance System-All Injury Program Special Study of Assaults, which collects data from a nationally representative stratified probability sample of U.S. hospitals. Total geriatric assaults seen in EDs increased from 35,135 in 2006 to 69,657 in 2015, a 98% increase. These injuries increased as a percentage of all geriatric injuries treated from 0.9% to 1.1%. Assaults in older men increased 119%, while assaults in older women increased 68%. Among age groups, the biggest percentage increases were among adults aged 60-64 (138%) and aged 65-74 (89%). ED visits for injuries associated with physical elder abuse increased from 13,241 in 2006 to 27,406 in 2015, a 107% increase. During this period, number of younger adults treated for assault did not significantly change. We concluded that geriatric assault injuries, particularly in older men in younger age groups, are dramatically increasing. Further research is needed to better understand these assaults to develop prevention strategies.
USE OF EXPOSURE CROSSOVER DESIGN TO CONTROL FOR UNMEASURED BASELINE CONFOUNDING IN OBSERVATIONAL STUDIES
Authors: Han Ling , Kerns Robert D , Skanderson Melissa , Goulet Joseph L , Luther Stephen , Brandt Cynthia
Published: November 2019

Observational comparative effectiveness studies face the challenge of selection bias. Due to lack of randomization, an alleged treatment effect may reflect inherent differences in baseline characteristics between comparison groups, rather than the outcome of treatment. Propensity score methods were devised to “resample” a most comparable comparison group, under a strong yet untestable assumption of no unmeasured confounding. We present an “exposure crossover” study evaluating complementary and integrative health approaches (CIH) among 6,379 US veterans who received acupuncture, massage or chiropractic therapies between 10/1/2011-9/30/2013. Their average pain intensity ratings (PIRs) during the 12-months after CIH initiation (effect period, EP) were compared with the 12-months before (baseline period, BP). Through this built-in self-matching, veterans’ characteristics and other stable baseline confounding, measured and unmeasured, were presumably eliminated. After accounting for time-varying opioid use and within-subject correlations using a generalized estimating equation, we found that in comparison to the BP, the adjusted mean PIR during the EP was -0.40 (95% Confidence Interval (CI): -0.51, -0.29) points lower; while the adjusted rate ratio of moderate to severe pain (PIRs ≥ 4) was 34% lower [0.66 (95% CI: 0.62, 0.70)]. The effect sizes were greater among veterans older than 65 years, yet diminished to null after 6-9 months. Assuming a 3-month induction period, using alternative random-intercept model, and examining post-CIH opioid use as an alternative outcome, derived similar results. These observations echo some randomized trials suggesting a modest, short-term CIH benefit, and highlight the merits and usefulness of exposure-crossover design to observational studies of medical interventions.
MEDICAL COMPLICATIONS AND INJURY LEADING TO EMERGENCY DEPARTMENT USE AMONG OLDER ADULTS
Authors: Carter Mary W , Yang Bo Kyum , Engineer Cyrus Y
Published: November 2019

Medical injury consistently ranks among the most expensive hospital stay diagnoses and represents a frequent cause of hospital readmission. Although older adults are at greater risk of medical injury, in part, because of greater incidence of comorbidity and increased medical complexity, little is known about the burden of medical injury leading to ED use or the costs and outcomes associated with these events among older adults. In response, this study used nationally representative data from the 2014 Nationwide Emergency Department Survey to examine the epidemiology of older adult ED-visits for medical injury. Principal diagnosis codes were grouped using AHRQ’s Clinical Classification Software to identify medical injury-related visits. Results indicated that in 2014, 506,466 ED-visits for medical injuries occurred, comprising 2% of all older adult ED-visits. Leading causes of medical injury included malfunction of device, implant and grafts (24%); infection and inflammation of internal prosthetic device, implant, and graft (16%), and other complications of surgical and medical procedures (15%). Risk factors for medical injury included being male, Medicaid as primary payor, and number of chronic conditions. Multinominal logistic regression and multivariate regression results indicate that Medical injury-related ED visits were associated with higher hospitalization risk (RRR=2.08, p<0.000), 27% longer hospital stays, and 24% higher total charges relative to non-medical injury related visits. However, medical injury was not associated with risk of death after adjustment. Study findings suggest that ED-visits for medical injury occur frequently among older adults and are associated with significant burden and cost.
IN HIP FRACTURE, GENDER CONFOUNDS COGNITION ASSESSMENT, TIME TO DEATH, AND COGNITION-RELATED MORTALITY
Authors: Mutchie Heather L , Orwig Denise , Gruber-Baldini Ann
Published: November 2019

Of 300,000 annual hip fractures in the US, about 30% occur in men, over 30% experience cognitive impairment or dementia, and 30% die within one year. This study compares time-to-death and cognition-related cause of death (CR-COD) by gender after hip fracture using different methods of cognitive impairment ascertainment. Baseline hospital charts and Modified Mini-Mental State Examination (3MS) were from the Baltimore Hip Studies 7th cohort (2006-2011) (171 women, 168 men). National Death Index was obtained up to December 31, 2014. Cox models assessed dementia diagnosis in chart and 3MS<78 as predictors of mortality and CR-COD (died n=204). Men were more likely to fail the 3MS (Men:26.2%, Women:16.2%; p=0.025), die (Men:73.8%, Women:46.8%; p<.0001), and die sooner (Men:µ=30.8months, Women:µ=39.2months; p=0.0159). Significantly more women died with CR-COD (Men:17.7%, Women:31.2%, p=0.0253). Among men, those with any cognitive impairment (3MS:µ=21.5months, chart:µ=21.3months; both:µ=22.0months) died sooner than non-impaired (µ=22.0months). Among women only those with both chart and 3MS (µ=16.7months) died sooner than all other groups (3MS:µ=47.8months, chart:µ=35.1months, none:µ=42.9months). With respect to CR-COD, men with cognitive impairment from any source (3MS:µ=5.0months, chart:µ=43.4months, both:µ=30.5months) differed from non-impaired (µ=91.6months). While women with hospital chart alone (µ=14.0months) differed from non-impaired (µ=3.6months), 3MS alone (µ=8.5months) and both (µ=9.5months). Men had worse 3MS scores but similar chart diagnosis, indicating a potential underdiagnosis of men’s cognitive impairment. Gender confounds the relationship between cognition and death or CR-COD. In men, any impairment predicts death overall and CR-COD. In women, chart with 3MS impairment predicted overall death, but chart alone was more predictive for CR-COD.
EXPLORING ASSOCIATIONS BETWEEN FRAILTY AND ORAL HEALTH IN COMMUNITY-DWELLING OLDER PEOPLE
Authors: Everaars Babette , Jerković - Ćosić Katarina , Bleijenberg Nienke , de Wit Niek J , van der Heijden Geert j
Published: November 2019

This study explores associations between frailty and oral health in cross-sectional data of 1,202 community-dwelling older people. Two dichotomous outcomes were used: 1. Potential frailty, using routine primary care data; 2. Self-reported frailty, using a questionnaire. Oral health concerned dental record data and self-reported oral problems. Following exploration of univariate associations, age and sex adjusted multivariate logistic regressions were performed. For potential frailty and self-reported frailty associations were found with dental emergency visit (odds ratio (OR)= 2.0, 95% confidence Interval (CI)=1.33;3.02 respectively OR=1.58, 95% CI=1.00;2.49), experiencing oral problems (resp. OR=2.07, 95% CI=1.52;2.81 and OR=2.87, 95% CI= 2.07), making dietary adjustments (resp. OR=2.66, 95% CI= 1.31;5.41 and OR=5.49, 95% CI= 3.01;10.01). Additional associations were found for self-reported frailty with wearing dental prosthesis (OR=3.33, 95% CI=1.49;7.44) and missing periodontal information (OR=1.56, 95% CI=1.05;2.32). The cross-sectional data of this study show that in community dwelling older people oral health is associated with frailty.
NATIVITY AND DISABILITY TRAJECTORIES AMONG TWO COHORTS
Authors: Vasquez Elizabeth , Zhang Weihui , Botoseneanu Anda
Published: November 2019

Nativity is an important characteristic in the context of disability in older adults, as it may influence attitudes and behaviors that can delay or accelerate the disability process. This study aims to assess trajectories of disability (defined as lower-body functional limitations, limitations in daily and instrumental activities of daily living, and gross mobility) in foreign-born and US-born Mexican Americans between 1993 and 2013. We used eight waves (1993 -2013) from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE; N=3050, mean age at baseline=73.6 (±6.8). Disability was assessed using self-reported limitations in activities of daily living (ADL /IADL). Nativity and age-at-migration were collected by self-report. We used linear and quadratic growth curve models to evaluate the trajectory of ADL/IADL disability over a period of 20 years and assessed variations by nativity status while adjusting for potential confounders. Approximately 19% of foreign-born and 17% of US-born reported having at least one ADL, while 51.5% natives and 58.7% of foreign-born had at least one IADL. Our results showed that after controlling for age at baseline, sex, marital status, self-reported health, chronic conditions, and education, foreign-born older adults were less likely to have ADL/IADL disability at baseline, but exhibited a faster rate of increase in disability over time (β =0.31 for ADL, β=0.07 for IADL). Our findings show that foreign-born older adults are accumulating disability at faster compared with their native peers, highlighting the importance of evaluating nativity differences in the health outcomes of Hispanic population at old age.
POLYPHARMACY IN DIABETIC PEOPLE: EVIDENCE FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING (ELSA)
Authors: Huang Yun-Ting , Zaninotto Paola , Steptoe Andrew , Wei Li
Published: November 2019

Diabetes among older people is becoming more common worldwide, and usually accompanied by polypharmacy. However, the role of polypharmacy in older people with diabetes remains uncertain. A nationally representative cross-sectional study, ELSA 2012/2013, was used and 7729 participants aged 50-109 were investigated. Polypharmacy was defined as taking five to nine long-term used medications daily for chronic diseases or chronic symptoms, while using ten or more medications was excessive polypharmacy. The presence of illness was defined as either self-reported diagnosis or being prescribed specific medications for the condition. Data showed the prevalence of polypharmacy was 21.4%, and only 3% was excessive polypharmacy. 51.6% of diabetic people reported polypharmacy and 10.2% excessive polypharmacy. These rates were significantly higher than the 16.4% polypharmacy and 1.8% excessive polypharmacy among people without diabetes (p < 0.001). Among people with three or more comorbidities, polypharmacy was present in 61.5% of people with diabetes, compared with 36.0% in people without diabetes. Significant risk factors for polypharmacy were diabetes (Relative-risk ratios/RRR=4.06, 95% CI 3.38, 4.86), older age (RRR=1.02, 95% CI 1.01, 1.03), male (RRR=0.64, 95% CI 0.55, 0.75), more comorbidity (RRR=2.46, 95% CI 2.30, 2.62), living with a partner (RRR=1.20, 95% CI 1.01, 1.42), and less wealth (RRR=0.93, 95% CI 0.87, 0.98). However, age, cohabitation, and wealth were not significantly related to excessive polypharmacy. Diabetes and the number of comorbidities were predominant risk factors for excessive polypharmacy. Current evidences confirmed both health condition and socioeconomic status were associated with medication use in older adults.
POTENTIAL CLINICAL CONSEQUENCES OF ADMINISTRATIVE ISSUES REGARDING MEDICATION IN HOME CARE PATIENTS
Authors: Dijkstra Nienke E , Sino Carolien , Schuurmans Marieke J , Bouvy Marcel L , Bouwes Aline , Heerdink Rob R
Published: November 2019

Home care professionals observe drug-related problems (DRPs) as administrative problems (e.g. inconsistent registration of (changes in) drug prescription) and side effects which may have clinical consequences for older patients. This study aims to determine the potential clinical impact of administrative problems. A retrospective descriptive study was performed, using reports of home care professionals of the eHOME system (system that assist monitoring/reporting DRPs). Administrative problems of a one year period were assessed by three experts on potential discomfort/clinical deterioration using a 3-point scale. 309 DRPs of 120 out of 451 patients (age ≥65) were assessed. Problems involved undelivered medication administration record lists (n=103,33.3%), inconsistent registration of drug prescription (n=188,60.9%) and insufficient drug delivery (n=18,5.8%). 58.2% of the DRPs had the potential to cause moderate to severe discomfort or clinical deterioration. The results underlines the importance of the observation function of home care professionals and the need to improve pharmaceutical administration issues.
CARING FOR CHILDREN WITH DEVELOPMENTAL DISABILITIES: WHAT ARE THE OUTCOMES FOR HEALTH IN AGING?
Authors: Hoyle Jessica , Laditka James N , Laditka Sarah B
Published: November 2019

Eight to ten percent of children have a developmental disability (DD). Caring for a child with DD can be rewarding. It can also be difficult, particularly for older parents or other caregivers (hereafter parents). Few studies have examined their experiences. We followed parents for 18 years using the nationally representative Panel Study of Income Dynamics (PSID). We defined DD with criteria used in research and education law, as: (1) autism, intellectual disability, learning disorder, epilepsy with seizures, attention deficit disorder/attention deficit hyperactivity disorder, cerebral palsy, or traumatic brain injury; and (2) qualification for professional services. We used three waves of the PSID’s Childhood Development Study, 1997-2007, linking children’s and parents’ PSID data (n=4,070) to study three outcomes: parents “not very” or “not at all” satisfied with “life as a whole”; nonspecific psychological distress; and reports that depressive feelings interfered with life or activities “a lot.” Discrete-time hazard models controlled for: child disability; children’s and parents’ age, sex, and education; survey design; and repeated measures. Among parents ages 47-61 at baseline (65-79 in 2015), those who cared for a child with DD were significantly more likely to report low satisfaction with life (hazard ratio, HR 4.6, 95% confidence interval, CI 1.6-13.2), distress (HR 2.8, CI 1.1-6.9) and, among women, depressive feelings (HR 1.3 CI 1.0-1.8). We found no such differences for parents less than age 65 in 2015. Results highlight the need to provide emotional support, respite, or other services for older adults caring for children with disabilities.
DEPRESSION IN CAREGIVERS OF VETERANS: THE INTERACTION OF PERCEIVED SOCIAL SUPPORT AND AGE
Authors: Scicolone Monica , Parmelee Patricia A
Published: November 2019

Caregiving is a risk factor for increased psychological stress and depression (Pinquart & Sörensen, 2003). Perceived social support (PSS) is strongly associated with emotional well-being and, for informal family caregivers, may be an important predictor of caregiver psychological outcomes. Although much is known about the effects of global PSS, there is a gap in research regarding numerous identified functional dimensions of support, particularly among family caregivers. Thus, this secondary data analysis examined how dimensions of PSS predict depression, and the moderating effects of age on this relationship, utilizing data from 240 family caregivers of elderly veterans receiving outpatient care at the Atlanta VA. The analysis utilizes a multidimensional measure of PSS (Sherbourne & Stewart, 1991) with four sub scales: emotional/informational, tangible, affectionate, and positive social interaction. Preliminary OLS regression analyses, regressing depression on relevant demographic variables and PSS domains, revealed a significant overall model (p < .001). All domains besides tangible support significantly predicted depression. Because age was the only demographic variable associated with depression, we tested hypotheses of an interaction of PSS and age with PROCESS macro (Hayes, 2017). Moderation analyses revealed a significant interaction of support and age on caregiver depression (p = .0145). Of unique social support dimensions, only emotional/informational social support interacted with age (p = .0075), demonstrating decreased depression at high levels of emotional/informational support, but a weaker effect for those of increased age. The original study was supported by the U.S. Department of Veterans Affairs Rehabilitation R&D Service.
STRESS, DEPRESSION, AND COGNITIVE FUNCTION IN ADRD FAMILY CAREGIVERS
Authors: Puga Frank , Meyer Kylie , Pickering Carolyn E
Published: November 2019

The rapidly growing number of individuals over the age of 55 stresses the need to identify unique factors to decrease older adults’ vulnerability to psychiatric and neurodegenerative disorders, especially among high-risk groups such as family caregivers to persons with Alzheimer’s disease or related dementias (ADRD). In this project, we investigated physiological stress responses, depression, and cognitive functioning. Using data from the Midlife in the United States database, we examined differences in physiological stress responses, depressive symptoms, and cognitive function (including working memory, episodic memory, verbal ability, processing speed, and executive functioning) between ADRD and non-ADRD caregivers. Results from the secondary analysis revealed a decrease in cognitive function, an increase in depressive symptoms and disrupted physiological responses in ADRD caregivers. These data suggest that the unique aspects of ADRD caregiving are a risk factor for the onset of psychiatric and neurodegenerative disorders. The results of this study support the development of targeted interventions to reduce the risk of depression and cognitive decline among ADRD caregivers. The specific focus on older adult ADRD caregivers, physiological processes, mental health, and dementia is unique in the field of aging and provides a critically needed new paradigm for identifying strategies to support ADRD caregivers and understanding the development of ADRD.
COGNITIVE ENHANCEMENT FOR GRANDPARENTING: REDUCED LONELINESS AS A MEDIATOR
Authors: Chang Yuanqing , Li Yin , Zhang Xin
Published: November 2019

Grand-parental care, an important form of family care in China, However, its health effect on older adults, including their physical and mental health and cognitive function, is often not well understood. In the present study, we investigated the differences in terms of physical and mental health (measured by SF-36 Quality of Life Scale), self-aging attitudes (measured by the Philadelphia Senior Center Morale Scale), and cognitive functions (measured by WAIS, the subscales of Wechsler Adult Intelligence Scale) between those who provide grand-parental care and those who do not. Two studies were conducted. The first study examined 150 older adults who provided grandparental care and another 150 older adults who did not. Six months later, we randomly selected 103 older adults to conduct a longitudinal follow-up, of which 53 were older adults who provided grandparental care, and another 50 older adults were those who didn’t. The results of both cross-sectional and longitudinal studies showed that, compared with older adults who did not provide grandparental care, those providing grandparental care has significantly better physical and mental health, more positive self-aging attitudes and even enhanced cognitive functions. Further path analysis showed that loneliness mediated the association between providing grandparental care and enhancement in functions, such that providing grandparental care can reduce loneliness of the older adults, which in turn can improve their physical and mental health and even enhance their cognitive functions. These results shed light on the practical implications of grandparenting in China for the society.