bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Increasing State Minimum Wage on Family Caregiving
Authors: Jutkowitz Eric , Lake Derek , Shewmaker Peter
Published: December 2021

Paid long-term care workers, such as personal care aides, compliment family caregivers in the delivery of care for people with long-term care needs. Nearly 12% of paid long-term care workers live in poverty. There is a call to raise the federal minimum wage from $7.25/hr to $15/hr. Long-term care workers may financially benefit from an increase in minimum wage, but families that rely on paid long-term care may be unable to afford higher wages. We obtained Health and Retirement Study (HRS; 2006-2014) respondents’ state of residence which we linked with state minimum wage data. Between 2006 and 2010 the federal minimum wage increased from $5.15 to $7.25. We identified 25 states in which the 2006 to 2010 (pre period) increases in federal minimum wage increased the state’s effective minimum wage (higher of state and federal minimum wage). Seven of these states continued to increase their minimum wage from 2010 to 2014 (post period). The remaining 18 matching control states did not increase their minimum wage after 2010. We used a difference-in-differences design and ordinary least squares regression to compare hours of unpaid and paid caregiving HRS respondents received in treatment and control. There was no statistically significant change in unpaid (-2.15; 95%CI: -8.53, 4.23) or paid (2.42; 95%CI: -1.33, 6.20) caregiving hours received between HRS respondents that lived in states that did and did not increase their minimum wage. Increasing state minimum wage may improve the economic wellbeing of long-term care workers without adversely affecting people with long-term care needs.
Providing Nursing Home Care in an Era of Increasing Scarcity: The Case of Pennsylvania
Authors: Simpson Elizabeth , Miller Edward , Wylie Molly , Cohen Marc
Published: December 2021

Medicaid financing of nursing home (NH) care provides the strongest safety net for low income older adults, persons who have high-intensity long-term care (LTC) needs, and consumers with exorbitant LTC costs. Yet, NHs currently face serious threats to their financial viability, particularly in the context of the COVID-19 pandemic, where the costs of caring for residents in a safe way have increased significantly, even as the ability to recoup these costs from the Medicaid program has been constrained. The purpose of this study is to assess key demand and supply factors affecting the performance of the NH industry in Pennsylvania over time. It draws from several large, national data sources, including NH Compare, LTCFocus.org, the U.S. Bureaus of the Census and Labor Statistics, and Certification and Survey Provider Enhanced Reports, as well as state-level population projections and Departments of Health and Human Services data. An aggregate database was constructed with historical data points at the facility, regional, and state level. Annual total and regional trends were examined from 2010 to 2020. Findings suggest a growing gap between what NHs require to meet the needs of residents and the level of reimbursement paid by the largest funder: Medicaid. Considering demographic trends, this gap will only grow over time in the absence of policy change. The pandemic has further highlighted the existing challenges resulting from an underfunded service infrastructure and the need for additional investment if NHs are to provide high quality care to a growing cohort of older adults requiring support.
Using Population-Level Data to Assess Need for and Use of Long-Term Services and Supports in California
Authors: Kietzman Kathryn , Chen Lei , Allen Rebecca
Published: December 2021

In response to aging and disability stakeholder advocacy in California, the state’s 2018-19 budget included support for the development of a study of Californians with needs for long-term services and supports (LTSS). Existing data on LTSS most typically represents those who already use specific programs or services. Yet many programs do not uniformly collect and report data, or have little capacity to share data across different delivery systems. In response to these gaps, we developed a 15-minute follow-on survey to the 2019-2020 California Health Interview Survey (CHIS), gathering statewide population-level data to assess LTSS needs and use by Californians 18 years of age and older. This paper reports on preliminary findings from the 2019 CHIS-LTSS survey conducted with a sample of 1097 respondents. Screening questions identified respondents reporting difficulties with concentrating, remembering, or making decisions (60%), performing basic daily activities such as dressing or bathing (26%), or getting out of the house to shop or to see the doctor (52%). Nearly half of respondents (45%) reported needing help with routine care needs while 16% needed help with personal care needs. Additional findings illustrate specific LTSS needs, service use, consequences of unmet needs, financial concerns, and consumer experiences. At a time when California policy makers, program planners, and advocates are engaged in implementing a 10-year Master Plan for Aging, these findings can be used to identify and address gaps in the types of services and supports that are essential to meet the LTSS needs of older adults and people with disabilities.
TBD
Authors: Brown Cynthia
Published: December 2021

Chair: Lori Simon-Rusinowitz;Panelists: Representatives of GSA Sections - Phillip Rozario (SRPP), Stephen Helfand (BS), Tamara Baker (BSS), Cynthia Brown (HS), Judith Howe (AGHE), Darina Petrovsky (ESPO); Discussant: Brian Lindberg. This interactive session is an interdisciplinary look at policy issues in aging with the speakers representing views from their sections. This session, organized by the GSA Public Policy Panel, will provide both GSA section leadership and attendees an opportunity to have an open dialogue on important public policy issues of significance in the field of aging. Presentations will likely address the COVID-19 pandemic, how GSA, each section and its members, and the federal government responded during the past year; how the policy work has been influenced by the increased acknowledgement of institutional and societal racism; and member experiences with the influx of additional economic relief, research funding, and funding for aging supports and services programs.
The Cannabis and Older Persons Study: Has Science Caught Up With Practice Yet?
Authors: Kaskie Brian
Published: December 2021

Since 2016, the Cannabis and Older Persons Study has examined the increasing use of cannabis among Americans over 60 years old. Our current work dives into particular groups of cannabis users and explores outcomes related to medical conditions and symptoms. This symposium also features a range of methodological approaches from an analysis of the BRFSS caregiving and cannabis modules, a convenience sample of more than 4,000 older cannabis users enrolled in the Illinois Medical Cannabis Program and qualitative interviews conducted with aging veterans. Kanika Arora examines the association between informal caregiving and marijuana use and whether this association varies by age. Julie Bobitt shares findings from 32 interviews with older Veteran cannabis users. Alton Croker examines cannabis use as a complement or alternative to palliative care. HyoJung Kang clusters negative outcomes experienced by older persons who use cannabis. Brian Kaskie compares cannabis use among persons with Multiple Sclerosis (N=135) and persons diagnosed with arthritis (N=582) or cancer (N=622). While we certainly find reason to remain concerned that cannabis use alone and co-occurring use with prescription opioids may contribute to increased rates of substance misuse and other undesirable outcomes among older adults, we find it increasingly difficult to overlook the benefits many persons derive when taking cannabis as a method to manage pain or address other medical conditions. At this point, public policy officials and program administrator should strive to strike a balance between addressing cannabis harms relative to promoting benefits such as opioid reduction and diversion.
Negative Clusters Associated With Cannabis Use: Tangled Up in Blues
Authors: Kang Hyojung
Published: December 2021

Previous studies concerning older adults have focused on whether cannabis use leads to positive or negative outcomes. In this study, we identified clusters of negative health outcomes associated with medical cannabis use. In total, we examined eight health outcomes: pain, sleep, falls, memory, digestive issues, mental health conditions, exercise, and general productivity reported by 2,968 persons over 60 who participated in the Illinois Medical Cannabis Program. We used association analysis to simultaneously identify groups of negative outcomes reported by participants. The distribution of non-positive outcomes shows a bell-shaped curve: 1.4% of participants responded that cannabis use improved all outcomes, while 4.1% of participants answered that cannabis use did not. When looking at negative outcomes, 86% of participants reported none worsened, and 11% reported one of the outcomes was affected. Only a small fraction of the participants (3%) claimed more than one negative outcomes after cannabis use.
Effects of Caloric Restriction on the Epigenetic Landscape of Hematopoietic Stem Cells
Authors: Beerman Isabel
Published: December 2021

During aging, alterations of hematopoietic stem cells are associated with functional decline of the blood system. Caloric restriction (CR) interventions have been reported to improve adult stem cells in other tissue types during aging so we sought to evaluate the effects of CR on the aged HSC compartment. We find significant epigenetic alterations in HSCs isolated from aged mice after life-long CR compared to ad libitum fed aged mice. We further evaluated the epigenetic landscapes and functional potential of aged HSCs shortly after allowing life-long CR mice access to ad libitum food. We uncover epigenetic modification associated with functional alterations of the HSCs, defining potential mechanisms by which restrictions in food consumption affect the aging hematopoietic compartment.
COVID-Related Perceptions of the Future and Well-Being Among Older Canadian Women
Authors: Newton Nicky , Huo Hua (Poppy) , Hytman Lauren , Ryan Cara
Published: December 2021

Socioemotional Selectivity Theory (SST; Carstensen, 1993) posits that time horizons - or Future Time Perspective (FTP) - change with age and/or the priming of endings. Fung and Carstensen (2006) found that SARS-CoV in 2003 naturalistically primed fragility, with consequences for both FTP and well-being. The current SARS-CoV-2 (COVID-19) pandemic provides a similar context: During the early months of COVID-19, age and time horizon were related to greater emotional well-being for American adults (Carstensen et al., 2020); Dozois (2020) found that, for Canadian adults, anxiety and depression rose. The current study examines relationships between FTP, COVID-19 impact, and psychological well-being in older Canadian women (N = 190; Mage = 70.38). We found that COVID-19 impact and FTP were both related to well-being; additionally, COVID-19 impact moderated the relationship between FTP and well-being. The complexity of what remains or becomes increasingly important for older women during a global health crisis is discussed.
A Model to Transform Communities Toward Becoming Dementia Inclusive
Authors: Drost Jennifer , Sanders Margaret
Published: December 2021

As the US population ages, the prevalence of people living with dementia will also increase. It is estimated that by 2050, 13.8 million American’s 65 and older will be diagnosed with dementia, and currently only 40% of those living with dementia receive an official diagnosis. 70% of people living with dementia live in the community. In order to optimize quality of life and extend each person’s ability to remain living in their homes for as long as possible, it is important for communities to educate consumers and providers alike about Alzheimer’s Disease and related dementias, focusing on behaviors and interventions. This education must cross multiple sectors to effectively increase awareness, decrease stigma, and enable participation in community living for people living with dementia and their caregivers. Dementia Friends USA offers a framework for implementation of dementia friendly inclusive community initiatives that spans professions and incorporates patient and caregiver perspectives. The four symposia will 1) lead us through the evidence that supports the Dementia Friends USA approach, 2) demonstrate how this approach can be operationalized in a truly integrated fashion at the community level using HRSA’s Geriatric Workforce Enhancement Program (GWEP), 3) provide step-by-step instructions for implementing Dementia Friends Community sessions, focusing on one sector at a time (in this case the Developmental Disability population), and 4) discuss the individual and community level outcomes of Dementia Friends implementation.
Occupational Differences in Metabolic Syndrome Incidence Among Older Workers
Authors: Runge Katharina , van Zon Sander K R , Bültmann Ute , Henkens Kène
Published: December 2021

This study investigates whether the incidence of metabolic syndrome (MetS), and its components, differs by occupational group among older workers (45-65 years) and whether health behaviors (smoking, leisure-time physical activity, diet quality) can explain these differences. We analyzed data from older workers (N=23 051) from two comprehensive measurement waves of the Lifelines Cohort Study and Biobank. MetS components were determined by physical measurements, blood markers, medication use, and self-reports. Occupational group and health behaviors were assessed by questionnaires. The association between occupational groups and MetS incidence was examined using Cox regression analysis. Health behaviors were subsequently added to the model to examine whether they can explain differences in MetS incidence between occupational groups. Low skilled white-collar (HR: 1.25, 95% CI: 1.13, 1.39) and low skilled blue-collar (HR: 1.45, 95% CI: 1.25, 1.69) workers had a significantly higher MetS incidence risk during 3.65 years follow-up than high skilled white-collar workers. Health behaviors reduced the strength of the association between occupational group and MetS incidence most among low skilled blue-collar workers (i.e. 10.3% reduction) as unhealthy behaviors were more prevalent in this occupational group. Similar occupational differences were observed on MetS component level. To conclude, MetS incidence in older workers differs between occupational groups and health behaviors only explain a small part of these differences. Health promotion tailored to occupational groups may be beneficial specifically among older low skilled blue-collar workers. Research into other factors that contribute to occupational differences is needed, as well as studies spanning the entire working life course.
Heart Failure and Hospital Utilization Trajectories Before and After Hip Fracture Surgery
Authors: Wei Sijia , Pan Wei , Lee Chiyoung , Tsumura Hideyo , Xue Tingzhong (Michelle) , McConnell Eleanor
Published: December 2021

Long-term hospital utilization trajectories in the context of surgery are understudied. Heart Failure (HF) is associated with an increased risk for rehospitalization after hip fracture surgery. This study aimed to examine whether older adults (>= 65 years old) have distinct patterns of long-term hospital utilization trajectories and whether HF influences these trajectories before and after hip fracture surgery. An initial cohort of 1,172 older adults hospitalized for hip fracture surgery between October 2015 and December 2018 was extracted from electronic health records. To adjust selection bias in baseline characteristics, we used propensity score 1:1 ratio matching to identify a final cohort of older adults with (n = 288) and without (n = 288) HF. Monthly frequencies of emergency department (ED) and inpatient encounters 1-year before and after the hip fracture surgery were used to identify distinct utilization trajectories from group-based trajectory analysis. Logistic regression models were used to compare the differences in ED and inpatient trajectories among patients with and without HF. High ED users (9.5%) had constant high ED use, and high inpatient users (20.1%) had significantly higher inpatient usage around the index hip fracture surgery hospitalization. Both low ED (90.5%) and inpatient (79.9%) users had low but slightly increased use around the index hospitalization. Compared with older adults without HF, older adults with HF were more likely to be long-term high inpatient user (OR = 1.94, 95% CI 1.25-3.01, p = 0.003), but not significantly different in long-term ED utilization (OR=1.87, 95% CI 0.97-3.59, p = 0.62).
Psychometric Properties of the Health Literacy Survey European Questionnaire-12
Authors: Bae Suyeong , Park Sung-Ji , Woo Hee-Soon , Hong Ickpyo
Published: December 2021

The importance of health literacy has increased as the public awareness of health has increased. Health Literacy Survey European Questionnaire-47 (HLS-EU-Q47) is a representative assessment tool for evaluating health literacy, and its psychometric properties have been examined in various countries. This study analyzed the item-level psychometric properties of a short version of the HLS-EU-Q47 using a Rasch measurement model. We collected 254 Korean adults who completed the 12 items of the HLS-EU-Q47 in hospital settings. We used confirmation factor analysis (CFA) to examine the unidimensionality assumption of the HLS-EU-Q12. We analyzed item fit, precision, and differential item functioning (DIF) across sex, age and education groups. The CFA model confirmed that HLS-EU-Q12 satisfies the unidimensionality assumption (CFI = 0.96, TLI = 0.96, RMSEA = 0.09) and no local independence in the 12 test items (residual correlations ranged from -0.16 to 0.19). The HLS-EU-Q12 demonstrated high reliability (Cronbach’s α = 0.90) and no DIF across sex, age and education groups (p > 0.05). The person strata by the instrument were 3.80, which is equivalent to a traditional reliability value of 0.87. In short, the study findings indicate that the HLS-EU-Q12 has good psychometric properties with the 254 Korean adults. Since the HLS-EU-Q12 can accurately and precisely evaluate the health literacy of Korean adults, this instrument could be used in clinical settings.
Activity Space and Functional Outcomes in Frail Older Persons Using GPS analysis
Authors: Lau Sandra , von Aschwege Frerk Mueller- , Zieschang Tania , Bauer Juergen , Hein Andreas , Diekmann Rebecca
Published: December 2021

With increasing age, walking becomes a main functional ability to participate in activities of daily living and supports independence and mobility. Frailty in older, multimorbid patients has a negative impact on physical activity and may reduce the personal activity space (AS). In this pilot study, GPS data were used to identify walking tracks to define individual AS and to compare functional performance in frail older persons. GPS data of 20 community-dwelling adults (84.5(±5.2)years, 85% women, mean frailty phenotype 1.9 (70% ≥2)points) were analyzed using a customized software to assess individual AS over a ten-months period. A geriatric home assessment including Short Physical Performance Battery (SPPB), gait speed (GS) and Timed-up-and-Go (TUG) was conducted monthly. GPS analysis revealed three different walking types presenting AS similarities: Type A walkers prefer smaller short walks nearby the home while Type B can be characterized by taking larger regular walks. Type C presents the widest AS using different transportation modes, but only a moderate number of walks. Mean group difference in functional performance of Type A walkers showed significantly reduced GS (0.45(±0.1)m/s), TUG (23.4s(±4.9)) and SPPB scores (3.8(±0.8) points; p<0.05) compared to Type C (0.82(±0.1)m/s (GS); 13.2(±1.4)s (TUG); 7.0(±1.3) points (SPPB)). Functional performance of Type B walkers (0.63(±0.2)m/s (GS); 17.1(±4.4)s (TUG); 6.5(±2.4)points (SPPB)) revealed significantly higher SPPB scores compared to Type A (p<0.05). Walks and individual AS can be mapped via GPS under everyday conditions. High heterogeneity within frail older people was observed. Persons with lower functional performance showed a reduced AS and physical activity.
Implementing Age-Friendly University Principles: Institutional Supports, Barriers, and Outcomes
Authors: Felsted Katarina , Eaton Jacqueline
Published: December 2021

The University of Utah Gerontology Interdisciplinary Program received an Age-Friendly University (AFU) seed grant through GSA’s Academy of Gerontology in Higher Education, funded by AARP, to develop a model for promoting lifelong learning in partnership with university and community stakeholders. We designed and instituted a targeting marketing campaign that supported our goals: 1) to implement AFU principles; 2) to promote awareness of HB60, a legislative bill allowing people 62+ to audit courses at public universities for a minimal cost; 3) to enhance HB 60 enrollment through increased communication of online course options and tuition waiver support; and 4) to improve university and community stakeholder engagement. This presentation describes project benefits, including increased awareness of AFU initiatives, promoting age diversity, safe participation through online coursework, and enhanced community partnerships. The initiative garnered strong departmental support for marketing, communications, and structure for the post-award process. Barriers occurred due to a lack of HB60 infrastructure at the university level, which inadvertently obstructs organizational engagement. This initiative targeted AFU principles while supporting the university’s strategic goal of engaging communities and preparing to pursue membership in the AFU Global Network. Future AFU goals include developing advocacy channels within the university to improve organizational support.
Characteristics of Our Patient Population
Authors: Hill Kyrsten
Published: December 2021

To date, 106 patients have completed behavioral health assessments across three sites: a rural primary care clinic (n = 32), urban federally qualified health center (n = 33), and state-certified residential rehabilitation facility (n = 41). Patients ranged from 18 to 65 years of age (M = 38.6, SD = 11.4). Approximately 51% were female and 75% were non-Hispanic White (followed by 22% African American). Over 60% had a high school degree or less and found it at least somewhat difficult to pay for basic needs. Most patients endorsed substantial (44%) or severe (39%) drug use, with 40% endorsing opioid use. There were no significant differences in substance use by age group. Moderate to severe symptoms of depression (43%) and anxiety (49%) were common. Approximately 70% endorsed adverse childhood experiences, and 44% reported clinically significant post-traumatic stress symptoms. Measures of cognitive functioning and objective health literacy are currently being collected.
Diversity and Variation in Assisted Living Care, Nationally and Over Time
Authors: Cornell Portia , Shippee Tetyana
Published: December 2021

Assisted living is generally understood to offer a greater degree of privacy and independence than a nursing home; most residents pay privately, with some receiving support from state subsidies and Medicaid; regulation and oversight are the purview of state agencies. Within these broad parameters, however, one assisted living community may look quite different from another across the country, or down the street, in its resident population and the regulations that govern its operating license. The purpose of this symposium is to explore that variation. The papers leverage an in-depth review of changes in assisted-living regulation from 2007 to 2019 and a methodology to identify Medicare beneficiaries in assisted living using ZIP codes. To set the stage, the first paper examines variation across assisted living licenses to identify six regulatory types and compare their populations’ characteristics and health-care use. The second paper analyzes trends over time in the clinical acuity of assisted living residents associated with changes in nursing home populations. The third paper investigates racial disparities in assisted living associated with memory-care designations and proportions of Medicaid recipients. The fourth investigates how regulation of hospice providers in assisted living affect end-of-life care and place of death. The final paper describes requirements related to care for the residents with mental illness in seven states. The symposium concludes with an expert in long-term care disparities and quality discussing the implications for policymakers, providers, and the population needing long-term care in assisted living.
Trends in Acuity of Residents in Assisted Living
Authors: Hua Cassandra
Published: December 2021

Assisted living serves as a substitute for nursing home residents with low care needs, especially in markets with a high proportion of dually eligible Medicare beneficiaries. This study examines trends in the acuity of residents in assisted living communities over time in comparison to nursing homes to characterize how substitution has affected the resident compositions of both settings. We also examine how trends in acuity are shaped by dual eligibility. Using Medicare claims data, we identify cross-sectional samples of beneficiaries in each setting from 2007-2017. The proportion of residents in assisted living with high care needs has increased 18% in assisted living communities compared to 8.7% in nursing homes. Acuity levels are higher among dually eligible assisted living residents compared to assisted living residents who are not dually eligible. Policy makers and administrators should examine whether assisted living is prepared to provide care for an increasingly acute population.
Place of Death Among Assisted Living Residents as a Factor of Hospice Regulations
Authors: Belanger Emmanuelle , Teno Joan , Dosa David , Zhang Wenhan , Gozalo Pedro , Thomas Kali
Published: December 2021

Our objective was to examine the likelihood of dying in RC/AL among a national cohort of fee-for-service Medicare beneficiaries who died in 2018 (N=31,414) as a factor regulations allowing hospice care. We estimated multivariable logistic regression models to examine the association between RC/AL as place of death and supportive hospice regulations, controlling for demographic characteristics, dual Medicare/Medicaid eligibility, years in AL, and hospital referral region (HRR) to control for hospice practice patterns. A majority of beneficiaries in our cohort died in RC/AL; more than half while receiving hospice services. In unadjusted models, the odds of remaining in RC/AL communities until death were significantly higher in the presence of regulations supportive of hospice care. This relationship was no longer significant once adjusting for covariates and an HRR fixed effect, suggesting important variation in end-of-life experiences for AL residents not explained by hospice regulations.
Measuring Dyadic Interactions and Dining Environment in Dementia Mealtime Care: A Systematic Review of Instruments
Authors: Liu Wen , Kim Sohyun
Published: December 2021

It is critical to use validated instruments to assess mealtime dyadic interactions and dining environment for people with dementia to evaluate the process and efficacy of mealtime interventions. However, the quantity and psychometric quality of such instruments are unknown. This systematic review aimed to synthesize the quantity and quality of instruments that assess dyadic interactions, physical environment, and/or social environment during dementia mealtime care. We searched Pubmed, CINAHL, AgeLine, PsychINFO, and Cochrane Library for records published between 1980-2020. Records were eligible if they included any instrument assessing concepts of interest (i.e., mealtime dyadic interactions, physical and/or social dining environment). From eligible records, eligible instruments originally developed or later modified to measure concepts of interest were identified, and instruments’ characteristics were extracted: 1) development process, 2) concept/construct assessed, 3) sample/setting, 4) administration method, 5) item description, 6) scoring format/interpretation, 7) reliability, and 8) validity. A newly developed tool was used to evaluate instruments’ psychometric quality. In total, 26 eligible instruments were identified. Seventeen instruments assessed dyadic interactions, 1 assessed only physical environment, and 8 assessed physical & social environment. All instruments were observational tools and scored as having low psychometric quality. Reasons for low psychometric quality included use of small sample size compared to the number of items, limited psychometric testing, and inadequate estimates. A number of instruments were developed and/or used to assess dyadic interactions, physical and/or social environment in dementia mealtime care. All instruments warrant further testing to accumulate psychometric evidence in larger diverse samples in different care settings.
Residents' Wayfinding Challenges and Environmental Interventions in a Care Home
Authors: Elkes Shelby , Chaudhury Habib
Published: December 2021

This study evaluated the role of the built environment on residents’ wayfinding behaviours at Louis Brier Home in Vancouver, British Columbia, Canada. The goal of this study was to explore baseline mobility challenges for the residents traveling between their bedrooms and social spaces. In response to this, low-cost environmental interventions were proposed and implemented to support safe and independent wayfinding for the residents. The project consisted of three phases. First phase involved a mixed methods approach using behavior mapping and spatial observations of the residents interacting with their physical environment, combined with one focus group with the staff members. In the second phase, researchers presented actionable environmental interventions for the care home administration to consider and implement. The final phase involved post-implementation behaviour mapping, spatial observations and a focus group session. The implemented environmental interventions influenced in improved resident wayfinding and orientation in the long-term care home.
Construction and Validation of a Frailty Index in Primary Care in Italy: The Health-Search Frailty Index
Authors: Vetrano Davide , Zucchelli Alberto , Onder Graziano , Bernabei Roberto , Fratiglioni Laura , Marengoni Alessandra , Lapi Francesco
Published: December 2021

Recognizing frailty in primary care is important to implement personalized care pathways and for prognostication. The aim of this study was to build and validate a frailty index based on routinely collected primary care data in Italy. We used clinical data from 308,280 Italian primary care patients 60+ with at least 5 years of follow-up, part of the Health Search Database. A heuristic algorithm was used to select the deficits to be included in a highly performant frailty index. The fitness of the index was assessed through the c-statistics derived by survival models. Results were externally validated using the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). After testing 3.4 million of deficits combinations, 25 deficits were selected to be included in the Health Search Frailty Index (HS-FI). After adjusting by sex, age and geographical area, the HS-FI was associated with 5-year mortality (HR per 0.1 increase 1.99; 95%CI 1.95-2.02) and hospitalization rate (HR per 0.1 increase 1.25; 95%CI 1.23-1.27). In the external validation cohort, HS-FI independently predicted mortality, hospitalization, incident disability, incident dementia, and incident falls. This is the first frailty index built following a data-driven approach, using national representative primary care data. The implementation of such tool – derived by routinely collected data – in primary care software will ease the prompt, comparable and reliable recognition of frailty at the population level.
Patient-Rated Performance of Home Health Agencies and Hospitalization Risk: A Propensity-Score Matched Analysis
Authors: Ma Chenjuan , Groom Lisa , Lin Shih-Yin , David Daniel , Brody Abraham
Published: December 2021

Home health care is the most commonly used home- and community-based service to older adults “Aging in Place”. Patient experience of healthcare services is a critical aspect of patient-centered care. Indeed, policymakers have linked patient-rated quality of care to payment to healthcare providers. This study aimed to examine the association between patient-rated care performance of home health agencies and risk for hospitalization among Medicare beneficiaries. This study used several national datasets from 2016 and included 491,718 individuals from 8,459 home health agencies. Home health agencies’ performance was measured using patient experience star rating from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). Propensity score matching was used to balance the differences in patient characteristics at baseline between those receiving care from high-performing home health agencies and those in lower-performing agencies. On average, patients were 80.5 years old, 65% female, 81% White, 10% Black, and 6% Hispanic, with 90% taking 5 or more medications. Patients had a mean score of 1.73 (SD=1.69) on the Charlson Index. Respectively, 10% and 16% of patients were hospitalized within 30 and 60 days of home health care initiation. Estimates of logistic regression after propensity score matching found that patients receiving care from lower-performing agencies were at similar risk for both 30-day (OR=0.99, p=0.817) and 60-day (OR=1.02, p=0.616) hospitalization following the start of home health care, compared to those in high-performing agencies. Our findings suggest discrepancies (or no relationship) between patient experience and objective outcomes of home health care.
Who Provides Care in a Crisis? Family Caregivers’ Experiences of Home Care During the COVID-19 Pandemic
Authors: Reckrey Jennifer , Perez Sasha , Ornstein Katherine
Published: December 2021

Many homebound individuals with dementia rely on both paid caregivers (e.g., home health aides, home attendants, other homecare workers) and family caregivers to live safely at home. We conducted semi-structured interviews with 15 family caregivers of individuals with severe dementia receiving home-based primary care in NYC to explore how caregiving changed during the COVID pandemic. Most individuals with long-standing paid caregivers experienced infrequent home care disruptions. In fact, paid caregivers were often the primary and sometimes only individuals to provide direct care; family caregivers themselves often stayed away and managed care from a distance. While most family caregivers described heightened attention to infection control, guidance about COVID prevention and safety rarely came from home-based primary care providers or home care agencies and instead was considered “common sense.” These findings confirm the essential role paid caregivers play in home-based dementia care teams.
Aging Into Disability: A Conceptual Challenge for Gerontology
Authors: Kahana Jeffrey , Goler Timothy , Force Lawrence
Published: December 2021

One of the most fraught subjects facing a fast growing aging population is the subject of aging into disability. This paper examines the processes of aging into disability as a distinct challenge for not only older persons, but also for the field of gerontology, and public policy-makers. Disability in youth and in middle age has largely defined the disability rights agenda, and elders aging into disability have not been the subject of much attention from scholars in the field of disability. Surprisingly, however, scholars and policy-makers in gerontology have also by and large avoided the subject of older persons aging into disability—a complex process that involves impairment, environmental disablement, and changes in social relationships. This process accelerates with advancing age, and disproportionately affects women. Moreover, when older adults develop mobility limitations, experience falls, become hard of hearing, or experience other such impairments of age related disability, they do not think of themselves as aging into disability, or being disabled. This lack of disability identity may protect them from stigma and from low self-esteem. At the same time, it stands in the way of seeking accommodations and from developing a bond with other older adults who are aging into disability. This paper explores the dynamics of disability avoidance as an ideal that can harm older adults and their caregivers. It aims to bring disability more fully into the normal life-course, and to suggest lines of inquiry for gerontological research, to broaden the field, and to make service communities more inclusive .
Mental and Physical Health in Swiss Older Survivors of Enforced Child Welfare Practices
Authors: Thoma Myriam , Bernays Florence , Eising Carla , Maercker Andreas , Rohner Shauna
Published: December 2021

It is the purpose of child welfare practices to provide a protective environment for minors. However, welfare practices for children and adolescents have also been linked to a higher risk for maltreatment, trauma, and deprivation. Due to such early-life adversity, affected individuals often report a life course depicted by further trauma, socio-economic disadvantage, mental and physical ill-health. Examination of the long-term health correlates of enforced child welfare practices, as well as potential mediators, have previously been neglected in later life. It was therefore the purpose of these studies to examine the long-term correlates of enforced child welfare practices; the associated maltreatment, trauma, and deprivation; and the physical and mental health outcomes in Swiss older survivors (n=132, MAGE=71 years) and an age-matched control group (n=125). These studies further examined the mediating role of socio-economic factors (e.g., education, income), self-esteem, and self-compassion. Mental health was assessed with a structured clinical interview; physical health, self-esteem, and self-compassion with psychometric instruments. Survivors reported significantly more types and severity of childhood maltreatment, trauma, and deprivation than the control group. They also reported significantly more lifetime and current mental health disorders and more physical illnesses. Socio-economic factors and self-esteem, but not self-compassion, acted as significant mediators. Exposure to maltreatment, trauma, and deprivation in childhood and adolescence is linked to poorer mental and physical health in later life. Potential targets for intervention and health-protective measures include socio-economic factors and self-esteem, which were found to diminish the detrimental long-term impact of early-life adversity and disadvantage into later life.
Associations of Physical Function and Physical Activity With COVID-19-Like Symptoms
Authors: Saadeh Marguerita , Calderón-Larrañaga Amaia , Vetrano Davide , Von Rosen Philip , Welmer Anna-Karin
Published: December 2021

Physical function and physical activity have been associated with health outcomes related to the cardiopulmonary and immune systems, but the extent to which they are related to the risk of developing COVID-19-like symptoms remains unclear. We aimed to explore these associations among Swedish older adults. We analyzed data from 904 individuals aged ≥68 years from the population-based Swedish National study on Aging and Care in Kungsholmen. COVID-19-like symptoms were assessed by phone interview (March-June 2020) and included fever, cough, sore throat and/or a cold, headache, pain in muscles, legs and joints, loss of taste and/or odour, breathing difficulties, chest pain, gastrointestinal symptoms and eye inflammation. Muscle strength, mobility, and physical activity were objectively examined in 2016-2018. Data were analyzed using logistic regression models and stratifying by age. During the first outbreak of the pandemic, 325 (36%) individuals from our sample developed COVID-19-like symptoms. Those with longer time to perform the chair stand test had an odds ratio (OR) of 1.5 (95% confidence interval [CI] 1.1-2.1) for presenting with COVID-19-like symptoms compared to those with a faster time to perform the test, after adjusting for potential confounders. The risk was even higher among people aged ≥80 years (OR: 2.6; 95% CI 1.5-4.7). No significant associations were found for walking speed or moderate-to-vigorous physical activity. A weaker muscle strength, especially among the oldest-old adults, may contribute to higher odds of developing COVID-19-like symptoms, emphasizing the need to maintain sufficient levels of muscle strength in old age.
Back to Life, Back to Reality: Participation and Function After Acute Hospitalization in Older Adults
Authors: Arieli Maya , Kizony Racheli , Gil Efrat , Agmon Maayan
Published: December 2021

This study aims to describe and compare functional trajectories (i.e., participation versus basic daily function) from pre-hospitalization period to one and three-months post-discharge, among older adults hospitalized for acute medical illness, of two age groups: ages 65-75, n=39, >75, n=38. A Prospective longitudinal study was conducted, starting during hospitalization in internal ward and followed by home visits (1 month) and telephone interviews (3 months). Participation was measured by the Activity Card Sort (ACS) that queries about instrumental (e.g. shopping), leisure (e.g. physical activity), and social activities. Basic daily function was measured by the Modified Barthel Index (mBI). Wilcoxon test was used to compare between the ACS and mBI total retained scores within age groups. A mixed model repeated measures ANCOVA was used to compare time by group effects in ACS total scores. The results showed that basic function in both age groups was preserved, and both groups experienced a significantly greater decrease in participation level compared with basic function at one month (z=-4.1, p=.001, z=-4.5, p=.001) and at three months (z=-4.1, p=.001, z=-4.1, p=.001) in the "younger" and "older" groups, respectively. Participation trajectories were similar among age groups, however, the "older" group experienced a significantly greater decrease in participation (F(1)=(4.3), p=.042, η2= .056). Findings indicate that the traditional measure of basic function does not capture the broad spectrum of older adults’ full life and overshadows the reduced participation in meaningful activities. Health care professionals should adopt a comprehensive approach toward functional assessment to encompass participation beyond basic daily function.
Comparisons of Different Multimorbidity Measures to Predict Physical Function Among Middle-Aged and Older Chinese
Authors: Xu Hui-wen , Luo Yan , Huang Zi-Ting , Chen zi-shuo , Su He-Xuan , Xu Beibei
Published: December 2021

Multimorbidity has been associated with declined physical function. Several methods have been used to measure multimorbidity. However, few studies have compared the associations between different multimorbidity measures and physical function. We aimed to examine and compare the associations between different multimorbidity measures and physical function. We included 16,117 participants aged ≥45 from China Health and Retirement Longitudinal Survey (CHARLS) 2011-2018. Multimorbidity was defined as the co-existence of two or more of fifteen chronic conditions in an individual and measured by condition count at penultimate, multimorbidity patterns at penultimate (examined by exploratory factor analysis) and multimorbidity trajectories from baseline to penultimate living interview (examined by the group-based trajectory model). Physical function was assessed by activities of daily living or instrumental activities of daily living at the last follow-up. Logistic regression models were conducted for establishing prediction models in the training set. We used c-statistic, Integrated Discrimination Improvements (IDI) and Net Reclassification Index (NRI) to compare the performance of different models in the testing set. After adjusting for age and gender, compared with those without any conditions, participants with multimorbidity measured by three methods all had higher risks of poor physical function in the training set. Compared with the model using condition count (c-statistic=0.749), models using multimorbidity trajectory (c-statistic=0.712, IDI=-0.03, NRI=-0.31) and the multimorbidity pattern (c-statistic=0.739, IDI=-0.01, NRI=-0.16) showed poor predictive power (all p<.05). In our study, condition count has the best predictive performance for poor physical function over short time period. It is a simple and useful tool to assess multimorbidity.
Changes in Momentary Experience Were Associated With the Onset of the COVID Pandemic
Authors: Stone Arthur , Mak Hio
Published: December 2021

We explored the COVID-19 pandemic’s effects on daily experience using momentary recordings of affect, activities, locations, and social interactions, documenting changes in the pandemic’s early stages. 123 individuals 50 years or older from an ongoing panel study completed 1-week bursts of Ecological Momentary Assessment (6/day) in March, May, and July. A pronounced spike in negative affect and decrease in positive affect was observed in late March compared with early March, which in May and June returned to early March levels. Levels of fatigue, however, did not follow this pattern. Being with one’s spouse/significant other and family also increased, then decreased. Working and interacting with others dropped from early to late March and then remained steady; doing chores had the opposite pattern. Regarding location, being at the workplace dropped from early to late March and remained steady, and being at home had the opposite pattern. Additional analyses explored these patterns.
Efficacy of a Timed Activity Intervention to Improve Sleep: Findings From the Healthy Patterns Study
Authors: Hodgson Nancy , McPhillips Miranda , Petrovsky Darina , Aryal Subhash
Published: December 2021

We conducted a two-arm RCT with dyads of 200 persons living at home with dementia (PLWD) who reported sleep disruption and family caregivers. Components of the Healthy Patterns intervention included: 1) assessing PLWD functional status, preferences and interests; 2) educating caregivers on environmental cues to promote activity and sleep; and 3) training caregivers in timed morning, afternoon, and evening activities. Outcomes included: PLWD quality of life, sleep, and neuropsychiatric symptoms. Sleep-wake patterns were assessed using wrist actigraphy and proxy-reported measures. The main intervention effects were tested using ANCOVA. The average age of participants was 73.4 years, 67% were female, 80% were African American/Black). At 4 weeks, the intervention group demonstrated less sleep-related impairment (p = 0.0031) and reported higher quality of life than the control group (p = 0.0074). These results provide new fundamental knowledge regarding the effects of timing activity on sleep and well-being.