bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in subjective age by filial caregiving status among US adults in mid and later life
Authors: Choi Hyojin , Litzelman Kristin
Published: December 2021

Subjective age is an important indicator of age identity and is associated with both psychological and physical well-being. Previous studies have revealed that older adults who feel younger than their chronological age show better health status, better life satisfaction, and less risk of mortality. Considerable evidence shows that stress contributes to feeling older than one’s chronological age. Given the fact that taking a caregiving role involves stress, it is expected that caregiving might accelerate subjective aging. This study examined the association between the stressor of caregiving and subjective age in mid and later life. Data were drawn from the Health and Retirement Study in 2014 and 2016. Participants aged 50 years and over (n=1,087) were identified according to adult-child caregiver status at across the two waves: those who provided care consecutively (long-term caregivers), those who became caregivers in 2016 (new caregivers), those who were no longer providing care in 2016 (recent caregivers), or those who did not report providing care in both 2014 and 2016 (non-caregivers). Linear regression analysis showed that new caregivers reported feeling older than their chronological age compared to non-caregivers. However, long-term or recent caregivers did not show significant differences in subjective age compared to non-caregivers. The finding is consistent with the stress process theory and adaptation hypothesis. Although the onset of caregiving stress may accelerate subjective aging, this deleterious effect may decrease over time due to family caregivers’ adaptability. Future research will examine the role of support, resilience and mastery in this pathway.
A Randomized Placebo-Controlled Trial of Metformin for Frailty Prevention in Older Adults
Authors: Tavabi Amir , Wang Chen-pin , Michalek Joel , Cortes Tiffany , Leonard Ethan , Powers Becky , Musi Nicolas , Espinoza Sara
Published: December 2021

Frailty is a progressive physical decline leading to higher morbidity and mortality in older adults. Previous studies have demonstrated shared mechanisms between insulin resistance, inflammation, and frailty. The purpose of this trial is to determine whether metformin prevents frailty in non-frail, community-dwelling older adults (≥65 years) with pre-diabetes, determined by 2-hour oral glucose tolerance test (OGTT). Frail individuals (Fried criteria) and those with renal impairment (glomerular filtration rate <45 mL/min) are excluded. Eligible participants are randomized to metformin or placebo and followed for two years. The primary outcome is frailty; secondary outcomes include physical function (short physical performance battery), systemic and skeletal muscle inflammation (plasma and muscle inflammatory markers), muscle insulin signaling (muscle biopsy), insulin sensitivity (insulin clamp), glucose tolerance (OGTT), and body composition (dual-energy x-ray absorptiometry) measurements. Participants are followed every 3 months for safety assessments, every 6 months for frailty assessment and OGTT, and every 12 months for muscle biopsy. Currently, 99 participants, including 53 (53.5%) male and 91 (91.9%) white, are active (54) or have completed the study (35). At baseline, mean age was 72.3 ± 5.5 years, body mass index was 30.7 ± 5.9 kg/m2, and Hemoglobin A1c was 5.73 ± 0.37%. Mean frailty score was 0.5 ± 0.6 and the proportion of non-frail and pre-frail participants were 58.6% (n = 58) and 41.5% (n = 41), respectively. Findings of this clinical trial may have future implications for the use of metformin in older adults with pre-diabetes in order to prevent the onset of frailty.
Frailty and Dementia: Differences in Health Care Utilization and Costs
Authors: Sison Stephanie Denise , Oh Gahee , Shi Sandra , Olivieri-Mui Brianne , McCarthy Ellen , Kim Dae
Published: December 2021

Frailty and dementia are associated with poor health outcomes and increased health care utilization. A more nuanced understanding of this dynamic may be useful in improving care and developing policies. This retrospective cohort study was conducted using 5% random sample of Medicare fee-for-service beneficiaries (n=1,132,367; mean age 76.2 years; 57.9% female) in 2014-2016. We compared average 1-year home time (number of days alive outside of the hospital and SNF), mean total cost per beneficiary, and number of incident ICU stays per 100 person-years (PY) across four groups: frailty and dementia, dementia alone, frailty alone or neither. Frailty and dementia were identified using validated claims-based algorithms. We also determined differences in costs per group across different regions within the United States. Beneficiaries with both frailty and dementia had a high 1-year mortality rate of 21.9% (vs. dementia alone [9.7%], frailty alone [9.4%] or neither [2.1%]), while having less home time (306 days; difference of 36 days, 31 days, and 53 days, respectively), and more incident ICU stays per 100 PY (29.9 vs 9.5, 25.8, and 5.6, respectively). Mean total costs for beneficiaries with both was $26,030 compared to other groups ($12,096, $24,693, and $9,029, respectively). Across the United States, range of costs varied the most for beneficiaries with both frailty and dementia ($13,244-31,987 vs $4,621-15,364, $20,090-30,965, and $7,672-10,450, respectively). Increase in health care utilization and wide geographic variation in costs associated with patients with frailty and dementia suggests room for improvement in health care delivery to improve outcomes of this group.
Functional Trajectories and Quality of Life in Post-Acute Skilled Nursing Facility care after hospitalization
Authors: Shi Sandra , Olivieri-Mui Brianne , McCarthy Ellen , Kim Dae Hyun
Published: December 2021

Frailty predicts readmissions and mortality after acute hospitalizations. Understanding whether frailty predicts functional recovery after acute hospitalizations may help guide post-acute care and rehabilitation. This feasibility study enrolled 24 adults aged ≥65 years from a skilled nursing facility (SNF) after acute hospitalization. We calculated a deficit-accumulation frailty index (FI range: 0-1; non-frail [≤0.25], mild frailty [0.26-0.35], moderate [0.36-0.45], and severe [>0.45]) via in-person assessment on SNF admission. We measured weekly functional improvement with modified Barthel Index, as well as quality of life. Modified Barthel Index and quality of life were measured weekly by Patient-Reported Outcome Measurement Information System (PROMIS) (standardized score with mean 50 and SD 10, higher is better). The mean age was 83.3 years [SD 8.0], and 17 (71.8%) were female. Length of stay for those with severe frailty (FI>0.45) was 26.8 days [10.7] compared to those who were not frail, mildly frail, or moderately frail (13.3 [7.3], 9.4 [4.4], and 15.2 [4.9] respectively). Those with severe frailty also had delayed functional improvement (mean Barthel Index 48.6, 53.4, and 56.6 on admission, week 1, and week 2 of SNF admission respectively), compared to those with moderate frailty (mean Barthel Index 47.5, 69, 73) or mild frailty (68.3, 86, 90.5). Self-reported mental and physical health-related quality of life was relatively unchanged across SNF episode for all frailty categories. These findings suggest that older adults with moderate or severe frailty may experience a typical course of delayed functional recovery and that further monitoring may be necessary for prognostication.
Effectiveness of the dementia nursing competence e-learning program for nurses in acute care hospitals in Japan
Authors: Suzuki Mizue , Ishihara Tetsuro , Sasaki Nanayo , Yoshimura Hiromi , Sakai Ikuko , Mastushita Kimiyo , Mimuro Soichiro , Sawaki Keisuke
Published: December 2021

Objective: The number of older patients with dementia hospitalised in acute care hospitals increased and these patients underwent physical restrictions leading to a degeneration of essential mental and physical function. The dementia nursing competence e-learning program with audio-visual materials has been developed in acute care hospitals. Methods: An application form that explained the research was distributed to 1,944 registered nurses from seven hospitals, and 110 people applied. Nurses used an e-learning program for a month in May and practiced applying the knowledge learned from programs June through November 2020. The nurses completed a questionnaire survey at four periods: first (before program/baseline), second (after program), third (three months later), and fourth (six months later). In the second, third, and fourth periods, ‘Technical knowledge of the dementia nursing’ and ‘dementia nursing intervention’ were significantly improved as compared with the first. In the fourth period, ‘confidence of reduce of physical restriction’ showed significant improvement compared to the first. In ‘Ethical sensitivity scale of nurses’, the first of the four sub-scales significantly increased as compared with the first period. In ‘Self-assessment Scale of Nursing Practice for Elderly Patients with Cognitive Impairment with the Aim of Person-centred Care in Acute Care Hospitals’, the fourth sub-scale showed significant improvement compared to the first. In the ‘Personhood’ sub- scale of the Japanese version of Approaches to Dementia　Questionnaire, the fourth period showed a significant increase compared to the first. Conclusion: The results suggest that this program was effective and led to reduced physical restrictions in nursing practice.
Experience of Physical Therapy Students Mentoring Older Adults with Health Literacy Tools
Authors: Milidonis Mary , Keehan Jane , Montgomery Katherine , Deuley Rebecca , Formoso Sara , Kopera-Frye Karen
Published: December 2021

Health literacy is a top priority for Healthy People 2030. Healthy People 2030 defines personal health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” The purpose is to understand the experience of physical therapy students using health literacy tools with older adults to promote the adoption of health literacy tools in healthcare encounters. This project analyzes the reflection responses from students using qualitative methods. The qualitative methods included student reflection papers, word clouds, and focus groups. Twelve students participated in focus groups/ reflections. Thirty-seven students participated in word clouds. Health literacy tools included plain language, teaching teach back and “Ask me 3”®. Students were taught by student leaders and faculty about the meaning of health literacy and oral communication tools. Pairs of students provided health education with health literacy tools to older adults. Students then participated in a small group reflection to create word clouds. Students answered questions and provided five words that best answer each question. Students believed the benefits of health literacy tools for older adults includes better learning, participation and engagement. Reasons to use health literacy in the future were improved older adult independence, education and adherence. Students completed reflections and interviews at the end of the year to detail their experience with the health literacy tools. The pedagogical approach highlighted the value of experiential learning for the students while mentoring older adults.
Older Adults' Perceptions and Use of Patient Portals: A Comparative Analysis of Two Samples
Authors: Son Hyojin , Nahm Eun-Shim , Zhu Shijun , Galik Elizabeth , Van de Castle Barbara , Seidl Kristin , Russomanno Vince
Published: December 2021

Older adults can benefit from using patient portals. Little is known whether the perceptions and use of patient portals differ among diverse older adult populations. The aim of this study was to assess the difference in perceived usability of patient portals, self-efficacy for using patient portals, and patient portal use between two adult samples aged 65 years or older. One sample was recruited from a health care system, including hospitals and clinics (n = 174), and the other sample was recruited from nationwide communities (n = 126). Conducting a secondary data analysis using two survey datasets, this study performed a series of linear and ordinal logistic regression analyses. The health care system sample had a higher mean number of chronic diseases and proportion of recent hospitalization than the community sample. The health care system sample showed higher perceived usability, self-efficacy, and usage frequency of patient portals compared to the community sample. eHealth literacy was a significant predictor of perceived usability and self-efficacy. Perceived usability was another significant predictor of self-efficacy. Self-efficacy and health condition variables significantly predicted the more frequent use of patient portals. Compared to the health care system sample, the relationship between perceived usability and use of patient portals was stronger and significant in the community sample. These findings suggest that approaches for promoting patient portal use should consider personal characteristics and health conditions of diverse older adult populations. Future research needs to focus on assessing the impact of using patient portals on older adults’ health care outcomes.
The Positive and Negative Affect Relation in the Context of Stress and Age
Authors: Blaxton Jessica , Nelson Niccole , Bergeman Cindy
Published: December 2021

Research suggests that the within-person inverse relationship between negative affect (NA) and positive affect (PA) indicates poorer emotional well-being, and this interaffect correlation fluctuates in relation to the context of the individual. Specifically, age, stress, and global PA all relate to changes in the interaffect correlation. The current study uses comprehensive data from the Notre Dame Study of Health & Well Being (NDHWB), which allows us to uniquely examine between-person differences in within-person change and variability in the interaffect correlation, thereby examining these constructs from a process-oriented perspective. Midlife and later life participants (N = 965) completed daily questionnaires assessing stress, NA, and PA. Three-level multi-level models illustrated that the interaffect correlation becomes more negative during times of stress, adults with greater global PA experience a stronger inverse interaffect correlation during times of stress, and days of higher stress relate to a stronger inverse interaffect correlation for older adults compared to midlife adults. The findings illustrate the idiographic nature of these relationships and suggest that later life adults and adults with high levels of global PA undergoing higher than typical stressful situations experience stronger inverse interaffect correlations.
Asset Transfers among those Accessing the Medicaid Program: Are Wealthy Older Adults Gaming the System?
Authors: Tavares Jane , Cohen Marc
Published: December 2021

Medicaid is the largest payer of long-term services and supports and millions of older Americans rely on the means-tested program for health care coverage. There has been longstanding concern that wealthy older adults are taking advantage of the program by divesting assets in order to qualify for coverage. The existing research on the issue is somewhat dated, does not focus on the question of asset transfer, and often lacks a significant longitudinal view. Thus, questions remain about whether states need to tighten asset eligibility rules to prevent the wealthier older adults from accessing the program. This analysis explores longitudinal data from the Health and Retirement Study (1998 to 2016) to determine the extent to which wealthier Americans age 50 and older engage in asset transfer to access Medicaid. Our findings demonstrate that this may occur among a relatively small proportion of wealthy older adults, and that tightening Medicaid eligibility criteria would likely have a small to modest impact on the financial status of the program.
Differential Effectiveness of the Minnesota Safe Patient Handling Act by Health Care Setting
Authors: Rosebush Christina , Schofield Katherine
Published: December 2021

The Minnesota Safe Patient Handling (SPH) Act requires nursing homes, hospitals, and outpatient facilities to develop comprehensive SPH programs and acquire mechanical lifts. The law was designed to prevent the adverse outcomes of manual patient handling among workers (e.g., musculoskeletal injuries) and care recipients (e.g., falls, skin tears). Reducing manual handling is of particular concern in nursing homes where residents’ care needs necessitate frequent lifts and transfers. To date, research has focused on the effects of SPH laws separately in nursing homes and hospitals. Our study aimed to assess whether change in worker injury rate differed between nursing homes and other health care settings following enactment of the 2007 Minnesota law. We used 2005-2017 claims data from a large workers’ compensation insurer and assessed the effects of time, health care setting, and their interaction on claim rate using negative binomial regression models. The claim rate for patient handling injuries was highest in nursing homes (2.8/million payroll), followed by hospitals (1.4/million payroll), and outpatient facilities (0.04/million payroll). Across settings, patient handling claims declined by 38% (95% CI 19-53%) between pre-law (2005-2007) and post-implementation (2014-2017). The decline in claims over time did not differ by health care setting (Wald χ2 for interaction=3.40, p=0.758). Our results suggest that nursing homes are successfully addressing the unique mobility needs of their residents in their mandated SPH programs. Future work should seek to describe the magnitude and nature of care recipient injuries caused by lifting and transferring and evaluate trends in care recipient injuries over time.
Support for Adjusting the Intentions of Family Members and Users Regarding Care Service Use: Aimed at Care Management
Authors: Masuda Kazutaka
Published: December 2021

In Japan, there are key healthcare professionals for home nursing care for elderly people called Care Managers. The care manager coordinates the service while adjusting the family situation and the user's intentions. The purpose of this study was to examine the practical structure of support for adjusting the intentions of family members and users regarding care service use. Data from seven cases, where family members and users have different intentions regarding care service use, were analyzed using the grounded theory approach. The phenomenon of "confirmation of discrepancies" was discovered with six sub-categories: adjusting the intentions of users and their families, effort to restore relationships, expression of intention to refuse involvement, expression of desire for adjustment, arrangement of opportunities for adjustment of intentions, and appropriate service adjustment. Four patterns occurred in the process of "confirmation of discrepancies": smooth adjustment, restoration and promotion of mutual relationships, failure to reach an agreement, and negative feedback loops. These patterns were based on a combination of the care managers' degree of understanding strength, the managers' degree of insistence, the managers' degree of representation of mutual feelings, the degree of managers' prediction of life prospects, the degree of trust in care managers, and the degree of expression of family anxiety.
Influence of Depression and Personality on Social Functioning in Older Adults
Authors: Freedman David , Lederer George , Atlas Lauren , Waldman Rachel , Ho Jennifer , Geramian Helene , Francois Dimitry , Zweig Richard
Published: December 2021

Among older adults there is significant comorbodity between depression and personality pathology and both are associated with poorer social functioning. Personality pathology is associated with greater prevalence, poorer recovery, and a higher likelihood of recurrence of depression in older adults. This study is a secondary analysis examining the relationships between personality traits associated with personality pathology (i.e. high neuroticism and low agreeableness), depression, and social functioning across older adults surveyed in primary care and psychiatric inpatient settings (N = 227). Individual variable as well as interaction models were examined. Higher neuroticism (FChange [1,217] = 40.119, p < .001), lower agreeableness (FChange [1,217] = 20.614, p < .001), and clinical status (i.e. primary care vs. psychiatric inpatient) (FChange [1,217] = 19.817, p < .001) were associated with poorer social functioning. Clinical status moderated the relationships between neuroticism and social functioning (B = -.0147, p = . 0341) and between agreeableness and social functioning (B = .0268, p = .0015). Interaction effects were not observed between neuroticism and depression or agreeableness and depression as they relate to social functioning. However, depression severity was observed to mediate the relationship between neuroticism and social functioning [Indirect effect = .0212, 95% CI = .0141, .0289]. These findings highlight the importance of accounting for depression and clinical status in the assessment and treatment of older adults with personality pathology. Findings warrant future research focused upon mechanisms through which personality pathology and depression influence functional status in older adults.
Protective Effects of Perceived Control on Prescription Drug Misuse 10-years Later in the MIDUS Study
Authors: Miller Sara , Almeida David
Published: December 2021

The current study examined if control beliefs predict prescription drug misuse (PDM) 10-years later and how problem drinking status moderates this relationship. PDM refers to taking medications without a prescription or in a manner not intended by the prescriber. Older adults are especially vulnerable to PDM due to drug sensitivity, comorbid health conditions, and high rates of polypharmacy. Participants were adults (n=2162, 56% female, mean age=54, range=30-84) who completed Waves 2 and 3 of the Midlife Development in the United States (MIDUS) study. At Wave 2, participants reported on two subscales of perceived control (personal mastery and constraints) and past 12-month problem drinking behaviors. At Wave 3, participants reported past 12-month PDM of five substances (painkillers, sedatives, stimulants, tranquilizers, and depression medications). Results indicated that at Wave 3, 10% of the sample reported misusing at least one prescription drug in the past year. Logistic Regression analysis revealed that problem drinking was associated with higher odds of PDM (p<0.001), and perceived control was associated with lower odds of PDM (p<0.05) after controlling for previous PDM and sociodemographic, health behavior, and health status covariates. However, there was an interaction effect such that perceived control was not protective for those individuals who engaged in problem drinking at Wave 2 (p<0.05). Future analyses will explore the meaning of this interaction. Identifying psychosocial protective factors, such as perceived control, predicting PDM will be critical for designing interventions that prevent the adverse consequences of PDM among this population.
Saving fall-injured older adults from depressive symptoms: The mediating role of social participation
Authors: Zhang Yalu , Zhang Lei , Sun Jiling , Zhang Xinhui , Sun Jingjing , Song Xinming , Chen Gong
Published: December 2021

Falls are the second primary cause of unintentional injury deaths globally. Prior studies found that fall incidences are associated with depressive symptoms among older adults, which could reversely lead to repeated fall incidences. However, few have investigated the role of social interventions in saving fall-injured older adults from experiencing depressive symptoms among older adults. Using the Chinese Health and Retirement Longitudinal Study (CHARLS) 2011-2018 data and multiple levels of fixed-effect analysis, this study examined the potential mediating role of social participation in alternating the effect of fall injuries on depressive symptoms. For the first time, this study specified the fall-injured older adults among those who had fall incidences. It also implemented the current literature by removing the bias caused by unobservable confounding variables at provincial and city levels. The descriptive results show that 22.2% and 20.6% of rural (n=4,972) and urban (n=3,258) older adults (65+), respectively, experienced fall incidences, among whom 45.1% needed one or more times of medical treatment. The fixed-effect results show that for urban older adults, social participation accounted for partial effects (17.2%) of fall injuries on their depressive symptoms. For rural older adults, fall injuries are significantly associated with more depressive symptoms, but social participation no longer functions as the mediator. Findings from this study emphasize the necessity of collecting efforts from multiple levels to improve the social engagement of urban older adults who had fall injuries. Future studies could further specify what types of social participation would be more helpful in buffering the intervention effects.
Geographic variation in gender gap among older adults in India and China: Application of a new ageing measure
Authors: Balachandran Arun , Chen Feinian
Published: December 2021

A continuous rise in the life expectancy of females above that of the males among older adults in India and China may give an impression that the gender gap in health is decreasing. However, given the systemic bias against females in these countries across multiple facets, and the diversity across provinces, a fuller understanding of gender gap calls for (a) understanding the gender gap in multiple dimensions of health, and (b) understanding the variations across provinces. We estimate a multi-dimensional old-age threshold (MOAT) across provinces in India and China, that specifies different old-age thresholds for female and male populations after simultaneously accommodating for multiple dimensions related to their health. These aspects of health include remaining life expectancy, intellectual and functional health. We estimate the gender gap across provinces in these countries by differencing the MOAT of males against that of females. In addition, we also illustrate the gender gap across individual dimensions of health. Our results show that females in almost all the provinces of India and China have a lower MOAT than their male counterparts, showing an earlier advent of ‘old-age’ among females compared to males. The estimates based on remaining life expectancy shows gender gap in favor of females, but the estimates of multi-dimensional gender gap are higher and biased against females. A huge variation is seen across provinces, with Karnataka and Hubei showing lower levels of gender gap and Rajasthan and Yunnan showing higher gender gaps in India in China respectively.
The Relationship between Social Isolation and Sense of Community among Older Adults in Puerto Rico
Authors: Buckley Thomas , Burnette Denise
Published: December 2021

Psychological sense of community (SOC) is linked to key health and wellbeing outcomes for older adults and among Latin American populations. Prior research shows that social factors may affect SOC, but this has yet to be studied among Puerto Rican older adults. This study draws on Social Resource Theory to test the hypothesis that social isolation is associated with SOC among older adults in Puerto Rico. We collected data through face-to-face interviews in a non-probability sample of community dwelling adults aged 60+ throughout Puerto Rico in 2019-2020 (N = 154). We measured social isolation with the Spanish translation of the LSNS-6 (range 0-30, mean= 14.00, SD= 5.99), where higher scores indicate less isolation, and SOC with the Spanish translation of the Brief Sense of Community Scale (range 0-32, mean= 24.75, SD= 6.04). This cross-sectional study used multiple linear regression to test the association between social isolation and SOC, while controlling for gender, age, income and living arrangement. Higher scores on the LSNS-6 were associated with higher SOC (β=0.31, SE=0.08, p<0.001). Among the sociodemographic covariates, increased age was associated with higher SOC (β=0.12, SE=0.05, p<0.05). This study demonstrates that older adults in Puerto Rico who are more socially isolated have lower SOC, and that SOC increases with age. In order to promote SOC in this population, interventions should focus on reducing social isolation and may benefit from targeting young-old older adults. Future research should continue to examine these relationships and extend to other Latin American cultures.
Risk Factors of Walking While Talking Decline in Older Adults: Central Control of Mobility and Aging Study
Authors: Jayakody Oshadi , Blumen Helena , Ayers Emmeline , Verghese Joe
Published: December 2021

Background: Slow gait speed during walking while talking (WWT-speed) is associated with an increased risk of falls and dementia. Age-related changes in WWT-speed and associated risk factors, however, are poorly understood. This study examined 1) change in WWT-speed over time 2) factors associated with change in WWT-speed. Methods: A total of 431 older participants (M Age=76.8±6.4 years; M follow-up 4.5±2.3 years) enrolled in the Central Control of Mobility in Aging study were examined. WWT-speed was measured with a computerized walkway while participants recited alternate letters of the alphabet while walking. The following baseline measures were examined as risk factors: demographic [age, sex, education], medical [hypertension, diabetes, cardiac arrhythmias, history of stroke, Parkinson’s disease, kidney disease, arthritis, depression], cognitive [global cognition, executive function, processing speed], sensorimotor [balance, grip strength, vision], falls and frailty. Linear mixed effect models were used to examine 1) change in WWT-speed over time 2) risk factors of WWT-speed change. Results: WWT-speed declined over time (b -1.06, 95%CI -1.45, -.68) independent of baseline age, sex and education. Rate of WWT-decline was modified by age (b -.10, 95%CI -.17, -.03) and poorer balance (b -1.12, 95%CI -1.95, -.28). Lower scores in tests of global cognition and processing speed and, kidney disease predicted slow WWT-speed on average. Conclusion: Greater age and poorer balance accelerate WWT-speed decline while poorer global cognition, slow processing speed and kidney disease predicts slow WWT-speed. These factors may provide potential targets for future interventions to prevent decline in WWT-speed and associated adverse health outcomes.
Do Daytime Activity, Mood at Bedtime and Unit Tumult Predict Nighttime Sleep Quality of Long-Term Care Residents?
Authors: Taani Murad , Kovach Christine
Published: December 2021

Sleep quality declines in old age and is particularly poor for long-term care (LTC) residents with dementia. Compromised sleep quality is associated with severe cognitive and neuropsychiatric symptoms, agitation, aggressiveness, and poor quality of life. Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, mood, and unit tumult were associated with sleep quality. A convenience sample of 53 LTC residents with dementia participated in this correlational study. Objective sleep quality and activity variables were measured using Actigraphy, and mood was measured by the Observed Emotion Rating Scale. Unit tumult was defined as events in the residents living area that are deviations from the typical day (i.e., census changes, being cared for by a certified nursing assistant from a temporary staffing agency, and lower than usual staffing level). Comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than .85 and were awake for more than 90 minutes at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor total sleep time and sleep efficiency. Findings suggest that daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality among LTC residents with dementia.
Factors Influencing Retention Intention of Nurses at Long-term Care Hospitals in Korea
Authors: Shin So Young , Kim Joo Hee
Published: December 2021

Purpose: This study aimed to investigate the levels and correlations of role conflict, nursing professionalism, nursing work environment and retention intention, and the factors influencing retention intention of nurses at long-term care hospitals. Methods: The subjects included 183 nurses at nine long-term care hospitals in one metropolitan city in Korea. A set of self-reported questionnaires was administered to assess general characteristics, role conflict, nursing professionalism, nursing work environment, and retention intention of the subjects. Collected data was analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearson correlation coefficients, and multiple linear regression. Results: 183 subjects with a mean (±SD) age of 41.66 (±12.29) years were included in the final analyses. Retention intention had a significant positive correlation with nursing professionalism (r=.39, p<.001) and nursing work environment (r=.51, p<.001). Nursing work environment had a significant negative correlation with role conflict (r=-.30, p<.001) and a significant positive correlation with nursing professionalism (r=.48, p<.001). In the final multiple regression analysis, the factors influencing retention intention of subjects were number of beds (β=-.15 p<.026), nursing professionalism (β=.19, p=.007) and nursing work environment (β=.36, p<.001). The explanatory power of number of beds, nursing professionalism and nursing work environment on retention intention was 34.0% (F=16.66, p<.001). Conclusion: Improving nursing professionalism and nursing work environment of nurses at long-term care hospitals will ultimately enhance their retention intention and positively impact on the quality of gerontological nursing service.
Potential Sources of Racial and Ethnic Disparities in Nursing Home Influenza Vaccination
Authors: Riester Melissa , Bosco Elliott , Bardenheier Barbara , Moyo Patience , Baier Rosa , Eliot Melissa , Zullo Andrew
Published: December 2021

Racial and ethnic disparities in influenza vaccination among nursing home (NH) residents are well-documented and have persisted over time, suggesting that new strategies are necessary to reduce disparities. We conducted a retrospective cohort study to examine the degree to which observable characteristics drove influenza vaccination disparities. We linked Minimum Data Set (MDS) assessments to facility-level data for short- and long-stay NH residents aged ≥65 years. We included residents with six-month continuous enrollment in Medicare and an MDS assessment during the influenza season (October 1, 2013 through March 31, 2014). Using nonlinear Oaxaca-Blinder decomposition, we decomposed the disparities in vaccination between White versus Black and White versus Hispanic residents. We analyzed short- and long-stay residents separately. Our study included 630,373 short-stay and 1,029,593 long-stay residents. Among short-stay residents, 67.2% of Whites, 55.1% of Blacks, and 54.5% of Hispanics were vaccinated against influenza; among long-stay residents, 84.2% of Whites, 76.7% of Blacks, and 80.8% Hispanics were vaccinated against influenza. Across the four comparisons, the crude disparity in influenza vaccination ranged from 3.4-12.7 percentage points. By equalizing 27 characteristics, these disparities could be reduced by 37.7%-59.2%. Living in a predominantly White facility and proxies for NH quality were important contributors to the disparity, although characteristics unmeasured in our data (e.g., NH staff attitudes and beliefs) contributed 40.8%-62.3% to the disparity across comparisons. Intervening on factors associated with NH quality may reduce racial/ethnic disparities in influenza vaccination. Qualitative research is essential to explore potential contributors not captured in our administrative data.
Technology Guided Assessment for Urinary Tract Infection: Creating a Common Interprofessional Language
Authors: Owen Donna , Ashcraft Alyce , Johnson Kyle , Song Huaxin , Culberson John
Published: December 2021

The Shared Meaning Model (SMM) is a grounded theory, derived in a previous study. This model demonstrates pathways for communication between nurse and primary care providers (PCPs) in the nursing home (NH), In this study we used the SMM for feasibility testing of a clinical decision support app (CDS app) using a descriptive, structured observational design. This study also provided a forum for initial testing of the SMM. The CDS app algorithm provided a common language to assess a resident with the goal of sharing this information with a PCP. The CDS app guided licensed vocational nurses (LVNs) (N=10) in assessing a standardized nursing home resident in a simulation setting experiencing symptoms of a potential urinary tract infection (UTI). Interviews with LVNs provided details of CDS app usability and concerns about using the CDS app with NH residents. Videos recorded LVNs interacting with the resident while using the CDS app on an iPad®. Time-stamps logged duration of the assessment. Bookmarked segments were used for discussion in LVN interviews. Videos were coded for eye contact, conversation, and touch between LVN and resident and documented personalized interactions. Findings indicated areas (lab values, drug names) for changes to language in the algorithm. In less than 12 minutes the CDS app enabled LVNs to collect information based on language used by PCPs to make decisions about the presence of a UTI. Relationships between initial constructs in the SMM were supported. This CDS app holds promise for building a common language to enhance interprofessional communication.
Attitudes and Beliefs of Older Black Americans Toward the COVID-19 Virus and Vaccine
Authors: Bass Dwana , Hanna Sophie , Shair Sarah , DiCerbo Loraine , Giordani Bruno , Kavcic Voyko
Published: December 2021

The COVID-19 pandemic, an unprecedented health emergency, has devastated the nation, and disproportionately affected persons of color, especially Black Americans. It has forced health officials to rapidly develop and distribute COVID-19 vaccines, resulting in the importance of understanding Black Americans’ attitudes and beliefs about COVID-19. We analyzed experiences of 167 Black Americans, ages 65 and older, recruited from Wayne State Institute of Gerontology Healthier Black Elders Center and surrounding communities. Participants were telephoned starting September 2020 and given the GAD-7 anxiety scale and a COVID-19 questionnaire measuring demographics, stressors, and emotional responses associated with the COVID-19 pandemic. A scale was also designed, adapted from the Health Belief Model, to measure fear of getting COVID-19, beliefs about the origins of COVID-19, uncertainty about vaccine safety, and intent to be vaccinated (5-point Likert scale). Of the 167 participants, 112 (67%) said they would agree to vaccination, 24 (14%) were ambivalent, and 31 (19%) said they would decline. T-tests comparing pro- and anti-vaccine participants showed that those not planning to get vaccinated expressed lower generalized anxiety (p=.002), COVID-19 fear (p<.001), and concerns about vaccine safety (p=.01), but greater belief that COVID-19 is man-made (p=.05). The current study provides a snapshot of urban Black American older adults who are in general eager to get vaccinated for COVID-19. Counterintuitively, those unwilling to accept the COVID-19 vaccine also had lower concerns for vaccine safety. More research is needed to fully understand the attitudes and beliefs of this underserved population regarding the COVID-19 virus and vaccine.
Factors Predicting Community-dwelling Older Adults’ COVID-19 Experiences in Central Texas
Authors: De Main Atami , Xie Bo , Shiroma Kristina , Davis Nathan
Published: December 2021

Older adults, disproportionally affected by the COVID-19 pandemic, face health, social and structural vulnerabilities. Their experiences require systematic examination. Our study aimed to examine factors predicting community-dwelling older adults’ experiences during COVID-19. We collected data via the telephone between June-August 2020 from a convenience sample of older adults in Central Texas (N= 200; age range=65-92 years; Mean=73.6, SD=6.33). We conducted multinomial logistic regression analyses to model relationships between self-reported COVID-19 experiences (positive, mixed, negative) and age, gender, race, income, education, frequency of communication with family and friends, feelings of loneliness and amount of COVID-19 information obtained. Factorial analysis revealed no statistically significant interaction effect. Multinomial logistic regression analysis revealed statistically significant main effects of annual household income, feelings of loneliness and amount of COVID-19 information obtained on predicting COVID-19 experiences. Age, gender, race, education, and frequency of communication with family and friends were not significant predictors. The odds of having a positive COVID-19 experience rather than negative experiences increased by 6.94 for an annual household of $60,000- $99,999, and by 6.02 for not feeling lonely. The odds of having a positive experience during COVID-19 rather than mixed increased by 9.90 for an annual household income of $100,000 or more. Participants who reported having “too much information” about COVID-19 were more likely to have mixed experiences compared to those with positive experiences. Our findings underscore the crucial role of financial security and social connections in reducing economic and emotional challenges older adults are facing during this crisis.
Perceived fear of COVID-19 among Nepali older adults
Authors: Ghimire Saruna , Yadav Uday Narayan , Yadav Om Prakash , Subedi Janardan
Published: December 2021

Although coronavirus-disease-2019 (COVID-19) impacted everyone in some ways, it disproportionally impacted the older population. Given their increased vulnerability to severe illness and mortality, the ongoing pandemic has created greater distress, anxiety, and fear among the older population. In Nepal, a South Asian country nestled in the Himalayas between India and China, most stories of older adults are untold ̶ both in the pre-COVID-19 and the COVID-19 era. This study aimed to explore the perceived fear of COVID-19 among Nepali older adults. A cross-sectional study was conducted between July-September 2020 among 847 older adults (≥60years) residing in three districts of eastern Nepal. The seven-item Fear of COVID-19 Scale assessed the perceived fear of COVID-19; higher scores on the scale (ranges 7 to 35 indicated greater fear. A sizeable proportion of the participants' reported being afraid (35%), anxious (32%), uncomfortable (24%), clammy (14%), and sleepless (12%), while 28% were fearful of losing their life due to COVID-19. In adjusted regression analysis, older age group, Dalit (minority) ethnicity, and remoteness to the health facility were associated with greater fear of COVID-19. Surprisingly, pre-existing health conditions were inversely associated with fear of COVID-19. Greater fear of COVID-19 amidst the pandemic, although anticipated, urges us to reflect on the most vulnerable groups' psychological needs not just during COVID-19 but in the future events of pandemics and public health emergencies. Fear during emergencies could be battled with accurate and effective information as well as better preparedness and psychosocial interventions.
Sensory Health and Dementia Care: Understanding and Addressing Unmet Needs in ADRD
Authors: Nieman Carrie , Whitson Heather , Gitlin Laura
Published: December 2021

Sensory health in dementia stands at the intersection of two major public health challenges. Hearing and vision impairments are among the most common and disabling comorbidities in dementia and may worsen the trajectory of decline yet frequently go unrecognized and unaddressed. Improving sensory function may be an accessible and cost-effective nonpharmacological intervention to aid in the management of neuropsychiatric symptoms, improve quality of life for persons with dementia, and reduce burden for care partners. This symposium presents the latest evidence on the impact of sensory impairment in dementia and efforts to integrate sensory health into the care of persons with dementia. This symposium will cover emerging evidence of the impact of hearing loss and vision impairment on persons living with dementia, specifically around neuropsychiatric symptoms, disability, and cost. In moving toward solutions, we will discuss new approaches to provide vision and hearing care for persons with dementia in diverse settings, from audiology to specialized memory clinics to home-based care. This discussion will include findings from a systematic review of telehealth in dementia care, which highlights the limitations of existing literature on accounting for the sensory needs of persons with dementia and their care partners. Finally, we will share new international practice recommendations on vision and hearing impairment among persons living with dementia. The symposium highlights the large, yet often unrecognized, sensory health needs of persons with dementia and the multi-prong approach required to identify and support sensory health and, ultimately, healthy aging among persons with dementia.
Biomechanism and exercise effect of fitness walking using twin walking sticks
Authors: Yamauchi Ken , Ichikawa Tsutomu , Ogita Akira , Yoshida Hironori , Hasagawa Hiromichi , Matsui Hiroshi , kagawa Shota
Published: December 2021

In Japan, walking poles with pairs of sticks developed exclusively for fitness walking have been designed. A new concept of walking style (WS) has been conceived using these walking sticks to “effectively” walk around the city, comprehensive sports parks, or at rehabilitation hospitals. Stick manufacturers are promoting its health benefits; however, evidence supporting these claims is lacking. Hence, this study aimed to measure the influence of walking sticks and evaluate the exercise effect based on functional physical fitness related to WS characteristics. The participants were 12 WS instructors. They engaged in WS at a comfortable speed after walking normally at the same speed (WN) for ∼5 m (seven times), followed by WS again. The walking speed, step length, stride width, walk ratio, one-leg support time, and trajectory of the center of gravity (CG) (in the horizontal and vertical directions of one walking cycle) calculated from the whole-body skeleton model were analyzed. The gait of WS increased the step length, step width, and walking ratio as compared with that of WN (p<0.05). WS likely reduce cadence and one-leg support time (p<0.05). The CG locus in the left-right direction showed no significant differences between WS and WN. The maximum value of the CG locus in the vertical direction was high in WS (p<0.05). WS can be used as a navigation training tool that improves a walker's exercise efficiency and left-right leg coordination, thereby improving walking posture. This may help reduce the anxiety due to injuries and pain that may occur while walking.