bluuebunny/crossref_metadata_2025 huggingface dataset:
BUILDING COHESIVE CONVOYS: IMPROVING STABILITY AND PREPAREDNESS OF DIRECT CARE WORKERS IN ASSISTED LIVING
Authors: Morgan Jennifer C , Burgess Elisabeth , Barmon Christina , Kemp Candace L
Published: November 2019

Person-centered collaborative care arrangements that empower residents, families, and care partners require supports for resident and their “care convoys”—the evolving collection of individuals who provide formal and informal care. Direct care workers (DCWs) are essential in supporting resident needs within the complex and dynamic environment of assisted living. The stability and preparedness of this workforce is central to improving quality of life for residents. This paper identifies key factors influencing the integration of DCWs in the convoys and explore supportive employment practices to strengthen the convoy. This analysis uses data from a 5-year mixed-method qualitative study of eight assisted living communities. Time pressures, AL policies and practices, work overload, lack of training, and turnover impact whether direct care workers are empowered as full members of the care convoy. Supportive employment practices (e.g. training, onboarding, career opportunities, rewards and recognition) are discussed as potential solutions for building consensus and collaboration.
A VOICE-INTERACTION-MEDIATED SMART HOME TO SUPPORT AGING IN PLACE: A NEW PARADIGM TO ENGAGE WITH HEALTH-RELATED DATA
Authors: Choi Yong K , Thompson Hilaire J , Demiris George
Published: November 2019

Current tools for health management such as personal health records (PHR), mobile applications, and wearable devices rely on conventional interfaces such as keyboard and mouse with screens for reading information. More recently, Internet-of-things (IoT) voice-activated smart speakers and embedded Artificial Intelligence (AI) assistants have emerged that may provide an effective user interaction platform to support healthy aging, creating a hands-free, conversational way to access and share health related data. We conducted an exploratory study with nineteen older adults (65+) who chose to evaluate a smart speaker for a 2-month as part of a larger IoT feasibility study. Three interview sessions were conducted to gather attitudes towards this technology. Participants provided feedback on future improvements or desirable features for health maintenance. A content analysis was performed to extract common themes. In general, participants expressed a positive experience with the voice interface and discussed its potential as an integral tool for their home health management. Based on these findings, we propose a voice interaction smart home platform to support healthy aging. This platform provides an intuitive voice user interface to execute commands to access, record, and query data from IoT sensors, a PHR and a hospital EHR. For example, the voice interaction platform will help individuals to dynamically explore their own health data thus eliminating manual and tedious searching of PHR data. We demonstrate how this platform can potentially improve usability issues including difficulties navigating charts and entering or retrieving health data using conventional interfaces. Finally, we highlight ethical and technical considerations.
BETTER LIVING THROUGH TECH: TECHNOLOGY-MEDIATED RECREATION AND LONG-TERM CARE FACILITY RESIDENTS’ QUALITY OF LIFE
Authors: McMahan Ethan A , Godoy Marion , Awosanya Abiola , Winningham Robert , Vilmorin Charles De , McMahon Meaghan
Published: November 2019

Empirical research on long-term care facility resident engagement has consistently indicated that increased engagement is associated with more positive clinical outcomes and increased quality of life. The current study adds to this existing literature by documenting the positive effects of technologically-mediated recreational programing on quality of life and medication usage in aged residents living in long-term care facilities. Technologically-mediated recreational programming was defined as recreational programming that was developed, implemented, and /or monitored using software platforms dedicated specifically for these types of activities. This study utilized a longitudinal design and was part of a larger project examining quality of life in older adults. A sample of 272 residents from three long-term care facilities in Toronto, Ontario participated in this project. Resident quality of life was assessed at multiple time points across a span of approximately 12 months, and resident engagement in recreational programming was monitored continuously during this twelve-month period. Quality of life was measured using the Resident Assessment Instrument Minimum Data Set Version 2.0. Number of pharmacological medication prescriptions received during the twelve-month study period was also assessed. Descriptive analyses indicated that, in general, resident functioning tended to decrease over time. However, when controlling for age, gender, and baseline measures of resident functioning, engagement in technologically-mediated recreational programming was positively associated with several indicators of quality of life. The current findings thus indicate that engagement in technology-mediated recreational programming is associated with increased quality of life of residents in long-term care facilities.
BUILDING A CONTINUOUS DEMENTIA MANAGEMENT MODEL IN COMMUNITIES OF SHANGHAI
Authors: Li Xia , Qiu Qi , Yang Yinghua , Sun Ling , Jiang MinJun , Gu chunling , Cui Ming , Lin Xiang
Published: November 2019

Over 10 million people with Alzheimer’s disease or related dementias (ADRD) live in China. In Shanghai, the prevalence of ADRD is about 3-4% among aged 60 or older, and approximately 70-85% have never been diagnosed. This study reported the pilot testing results of a dementia management model launched by Shanghai Mental Health Center to build dementia friendly communities. The dementia management model links screening, diagnosis, care planning, treatment, and services, to improve dementia literacy and standard diagnosis rate. About 3,786 senior residents were screened using the AD 8 and MoCA scales. The cognitively intact group was suggested for annual check-up, while at -risk groups were referred to formal diagnosis and intervention. About 125 older adults with a mild cognitive impairment diagnosis were provided referrals for cognitive training, and 109 diagnosed with dementia were provided medical and social interventions. This management model adds to dementia awareness and education.
CREATING DEMENTIA-FRIENDLY COMMUNITIES IN CENTRAL FLORIDA IN THE UNITED STATES
Authors: Wharton Tracy , Paulson Daniel , Wagner Courtney
Published: November 2019

The Dementia Care & Cure Initiative in Florida is a statewide movement to advance dementia friendly communities. With 25% of the state over the age of 65, Florida has one of the highest rates of dementia in the nation. The taskforce based in Orlando involves a partnership of representatives from social service agencies, law enforcement, healthcare providers, and research partners, as well as consumers. The task force commissioned a series of five focus groups with 43 consumers. These focus groups produced short and long-term recommendations, identifying such issues as needed training for emergency personnel and law enforcement, improving inter-provider communication, and providing culturally competent programming for a diverse region. The taskforce has been planning with the Mayor’s office and law enforcement to initiate training and support for community engagement, and planning for implementation of these goals. Recommendations from the groups and from the taskforce to community leaders will be discussed.
BUILDING DEMENTIA-FRIENDLY COMMUNITY IN MICHIGAN: THE EXPERIENCES OF BATTLE CREEK
Authors: Fales Karla
Published: November 2019

Alzheimer’s disease is now the 6th leading cause of death in Calhoun County – a mostly rural county of 156,000 people in southwest Michigan. In 2017, a cross-sector collaborative launched Dementia Friendly Battle Creek led by CareWell Services Area Agency on Aging. This study focuses on evaluation of the progress and outcomes of this initiative. The goal is to create a community that features high awareness of dementia, coordinated systems of care, and an environment that promotes dignity and engagement of PWD. Using participatory community planning, three Pillars of Impact were developed: Awareness, Coordination, and Environment. More than 500 people have engaged in the effort through trainings, educational programs, expanded supportive services, and the creation of integrated pathways of care for PWD. Additionally, more than $100,000 has been leveraged to support the effort. Challenges included sustaining momentum & gaining buy-in from local municipalities and health care providers.
HEARING LOSS AND HEALTH CARE SATISFACTION
Authors: Reed Nicholas , Reed Nicholas , Willink Amber , Deal Jennifer , lin Frank R
Published: November 2019

Hearing loss (HL) impacts two-thirds of adults over 70 years and affects patient-provider communication which could limit satisfaction. We used two cross-sectional cohorts, The Atherosclerosis Risk in Communities Study (ARIC, n=250) and the Medicare Current Beneficiaries Survey (MCBS, n=12,311) to examine the relationship between HL (subjective and objective measures) and self-report satisfaction with quality of health care using multivariable-adjusted logistic regression. In ARIC, there was an interaction between HL and age such that HL had a greater impact on odds of dissatisfaction as age increased. In an 85-year-old, for every 10 dB increase in HL, the odds of being dissatisfied increased 1.33 (95% Confidence Interval [CI]:0.96-1.83). In MCBS, compared to participants with no trouble hearing, those with a lot of trouble hearing had 1.7 times the odds ( 95% CI = 1.150-2.623) of being dissatisfied. This has implications for patient-centered care planning given that Medicare ties reimbursement to patient-reported satisfaction.
GERIATRIC MEASURES AS PREDICTORS OF 1-YEAR MORTALITY IN MAJOR SURGERY PATIENTS
Authors: Tang Victoria L , Covinsky Kenneth , Finlayson Emily , Jing Bocheng , Boscardin John , Ngo Sarah
Published: November 2019

A growing proportion of older adults are undergoing major surgery despite the higher risk of post-operative mortality. Geriatric measures (i.e. physical, cognitive, and psychosocial function) are often not included in studies evaluating post-operative outcomes in older adults. Our goal was to determine the association of geriatric measures and 1-year mortality in older adults after major surgery. We analyzed longitudinal data from the Health and Retirement Study linked to Medicare claims (N=1364 participants), age ≥ 65 and who underwent abdominal aortic aneurysm [AAA] repair, coronary artery bypass graft [CABG], or colectomy. Our outcome was mortality within 1 year of the major operation. Predictors included the following geriatric measures: dependence in activities of daily living (ADL), dependence in independent activities of daily living (IADL), mobility ability, and dementia, and depression. We analyzed using multivariate cox proportional hazard models. Mean participant age was 76±6 years, 56% were women, 11% underwent a AAA repair, 50% CABG, 40% colectomy; 18% died within 1 year of their major operation. After adjusting for age, comorbidity burden, surgical type, gender, race, wealth, income, and education, the following measures were significantly associated with 1-year mortality: depression (adjusted HR (aHR): 1.53, p=0.03), dementia (aHR: 1.90, p=0.03), >1 ADL dependence (aHR: 2.35, p<0.01), >1 IADL dependence (aHR: 1.95, p<0.01), and inability to walk several blocks (aHR: 1.69, p<0.01). In this cohort, 18% of participants who underwent major surgery died within 1 year and function, cognition, and psychological well-being were significantly associated with mortality. These measures should be incorporated into pre-operative assessment.
WORKING BACK TO NORMAL FUNCTION FOLLOWING HOSPITALIZATION: A GROUNDED THEORY STUDY
Authors: Liebzeit Daniel , Bratzke Lisa , King Barbara
Published: November 2019

Transitions older adults experience post hospital discharge have primarily focused on the process of moving care from one setting to another (e.g. hospital to home). Older adults often experience a significant transition in terms of losing functional status after a hospital stay. Little is known about how older adults regain their functional ability, the type of work they engage in to recover, and conditions that influence their ability to work after a hospital stay. The objective of this Grounded Theory study was to understand strategies older adults use post discharge as they work to regain their functional status and what conditions facilitate or limit their ability to work toward returning to normal. A qualitative study was conducted. Adults aged 65 and older discharged from a large Midwestern teaching hospital (N = 14) were interviewed using in-depth one-on-one interviews. Data were analyzed using open, axial, and selective coding. Participants described key strategies they employed to regain their normal function following hospitalization and illness: doing exercises, expanding physical space, resuming prior activities and daily cares, and tracking improvement with benchmarks. Several conditions such as, presence of informal (family, friends) and formal (healthcare providers) support, perceived threats (relocation), and having poor physical or physiologic function, acted as barriers and facilitators to participants ability to work back to normal function. This study provides empirical data on work older adults engage in to transition back to normal function during the post discharge period. It presents opportunities for better supporting their work of regaining function.
SYMPTOM EXPERIENCES OF HOSPITALIZED OLDER ADULTS ON ADMISSION AND FUNCTIONAL OUTCOMES 1 MONTH POST-DISCHARGE
Authors: Zisberg Anna , Shulyaev Ksenya , Liberty Anat , Gur-Yash Nurit , Agmon Maayan , Pud Dorit
Published: November 2019

The aims of this study were to identify subgroups of older adults admitted to hospital based on their experience with multiple symptoms and to explore if these subgroups differed on physical and cognitive characteristics at time of admission, and on functional outcomes one-month post-discharge. The study included 331 older adults (mean age 75.5±7.1), admitted to hospital and were hospitalized in internal-medicine units. Demographic, functional, cognitive, psychological and mobility characteristics and symptoms’ disturbance were assessed within the first 24 hours of admission and one moth following discharge. Cluster analysis identified three distinct subgroups based on patients’ experiences with five highly prevalent symptoms (tiredness, dyspnea, dizziness, sleep disturbance and pain): Low or high levels of all five symptoms (70%, 14%, respectively), and moderate levels of four symptoms with high dyspnea (14%). “All high” cluster was characterized by the worst cognitive and instrumental function, and highest anxiety and depression levels. The “moderate with high dyspnea” subgroup expressed the highest comorbidity score. Multivariate Logistic regression showed that the odds of decline in instrumental ADL one month post-discharge was 3.28 (95% CI 3.21-3.25, p=.021) for “all high” and 2.35 (95% CI 2.33-2.36, p=.043) for “all low” symptom-subgroups compared to “medium with high dyspnea” subgroup adjusted for pre-morbid function, health conditions and demographic characteristics. Belonging to certain symptom-subgroups is an important risk factor in predicting negative consequences of hospitalization. These findings emphasize the importance of evaluating and subgrouping broad range of symptoms among hospitalized older adults.
WELL-BEING AND ADVANCE DIRECTIVES AMONG PROLONGED MECHANICAL VENTILATION PATIENTS AT HOME VERSUS HOSPITAL
Authors: Stessman Jochanan , Marcus Esther-Lee , Jacobs Jeremy M
Published: November 2019

Despite increasing numbers of older patients requiring Prolonged Mechanical Ventilation (PMV), little is known concerning their mood, well-being, distressing symptoms and attitudes towards ventilation. Furthermore differences may exist according to place of care- whether Home Hospital or Hospital Long Term Care (HLTC). These issues were addressed using the revised Edmonton Symptom Assessment System (r-ESAS)(10 items, max severity score=100), and Short Geriatric Depression Scale, in a study of the majority of PMV patients (n=120/123) aged ≥18 (range 18-96 years) all Clalit Health Service insurees, in Jerusalem. Communicative patients were interviewed (40/46 at home, 22/74 in HLTC, average age 54 vs.73 years, p<0.01). The following symptoms (dichotomized to “not-a-problem”/“problematic”) were frequently reported as “not-a-problem” among patients (Home,HLTC): tiredness (59%,58%), poor appetite (95%,90%), pain (69%,84%), drowsiness (77%,90%), nausea (85%,84%), and shortness of breath (82%,90%). General well-being (categorized to good/mild/moderate/severe impairment) was reported more frequently as good or mildly impaired at Home vs. HLTC (54% vs.26%), as was lower frequency of depression (34.4% vs. 44.4%, p=0.049). The total r-ESAS score was similar irrespective of setting: Home-24.9/100 (inter quartile range {IQR} 13.5-32.5) vs. HLTC-23.7/100 (IQR 17.5-32),p=0.74. The majority (119/120) of patients were without advanced directives prior to initiation of PMV. When asked if they had to choose again, 82% and 91% of communicative patients at home vs. HLTC would opt again for ventilation, as would 75% of caregivers of uncommunicative patients. Our findings emphasize the resilience and low levels of distressing symptoms among PMV patients, and may contribute to the decision-making process concerning advanced directives.
COST-BENEFIT ANALYSIS OF HEARING CARE SERVICES AMONG MEDICARE BENEFICIARIES WITH HEARING AIDS
Authors: Willink Amber , Willink Amber , Reed Nicholas S , Lin Frank R
Published: November 2019

Hearing care services for older adults with hearing aids are underutilized and are not covered by the Medicare program. Little information exists to the value of hearing care services for older adults with hearing aids. Using the Medicare Current Beneficiary Survey 2013, we conducted a cross-sectional analysis of the impact of hearing care services use on Medicare spending among those with hearing aids. Older Medicare beneficiaries with hearing aids that received hearing care services in the previous 12 months were propensity score matched to those who did not receive services. Average annual Medicare spending was $8196 (CI:$6670-$9723) among Medicare beneficiaries who used hearing care services and $10,709 (CI:$8878-12541) among matched controls. Spending differences were driven by higher skilled nursing facility and home health spending among matched controls. Increasing access to hearing care services among Medicare beneficiaries with hearing aids may provide value to the health care system and Medicare program.
GENERALIZABILITY OF CLINICAL TRIALS OF DELIRIUM INTERVENTIONS
Authors: DiBlasio Christina , Fowler Mackenzie E , Martin Roy , Zhang Yue , Kennedy Richard E
Published: November 2019

Delirium, or acute confusional state, affects up to 7 million hospitalized older adults annually, and is associated with increased risk of mortality, institutionalization, and cognitive and functional impairment. There has been a proliferation of both pharmacological and nonpharmacological clinical trials to reduce the incidence and sequelae of delirium. In other neuropsychiatric disorders, exclusion criteria prevent up to 75% of individuals with the condition under study from participating. It is unclear how well these trial samples represent the population of older adults with delirium. We selected all intervention trials registered at ClinicalTrials.gov containing the keyword “delirium” (N=131), regardless of type of intervention. We manually examined study descriptions to restrict analysis to studies with delirium as a primary or secondary outcome (N=92). Of these 92 studies, 76% enrolled only adults, with 45% enrolling only older adults. 38% of studies were restricted to surgical units, 27% to intensive care units, and 7.6% to medical units. Only 1 study examined nursing homes and 4 studies examined palliative care. 50% of studies excluded individuals with pre-existing dementia, 28% excluded individuals with psychiatric disorders, and 30% excluded individuals with neurological disorders. 34% of studies excluded individuals with alcohol or drug abuse. Overall, many intervention studies for delirium are limited to the surgical and ICU populations, and they exclude individuals with common comorbidities associated with an increased risk of delirium. Similar to other neuropsychiatric disorders, these findings raise significant concerns about the generalizability of clinical trials in delirium to the hospitalized older adult population.
ELDER SELF-NEGLECT: REPORTING AND RESPONSE WITHOUT APS OVERSIGHT
Authors: Melekis Kelly A
Published: November 2019

Self-neglect is generally considered a geriatric phenomenon and subsumed within the category of elder abuse and neglect. In the U.S., self-neglect is the most commonly reported form of elder abuse and neglect and has been linked to decreased physical and psychological well-being, higher mortality rate, and increase health care services utilization. While self-neglect typically falls under the purview of a state’s adult protective service (APS) system, there are several states where this is not codified and/or practiced. This study examined the state of existing laws, policies and programs that address elder self-neglect in the U.S. in an effort to better understand how self-neglect reporting and response is handled, particularly in states where APS does not have oversight. A 50-state review of existing policies and laws addressing elder self-neglect was followed by key stakeholder interviews with those who oversee self-neglect reporting and response in states where APS does not have oversight. Findings indicate that a range of rationales explain variation in responsibility for self-neglect cases, including a lack of specificity in statutes, concerns that self-neglect does not fit into legal/criminal models due to the lack of perpetrator/victim relationship, and strong sentiments that those engaging in self-neglect need human services and support rather than investigatory or legal approaches. While the inclusion of self-neglect into the broad category of elder abuse and neglect is often perceived as vital for the provision of services, findings indicate it may exacerbate the complex challenges inherent in defining and conceptualizing both the term and its response.
DEMENTIA KNOWLEDGE, ATTITUDES, AND BELIEFS: A 3-YEAR UPDATE
Authors: Santos Pedro M , Paúl Constança , Alvarez Catarina , Cavaleiro Ana Margarida , Nunes Tatiana , Paules Silvana
Published: November 2019

Objective: To characterise and analyse beliefs, knowledge, and attitudes regarding dementia three years after the first Portuguese survey (2015), in order to inform mental health research and policy-making, and establish the baseline to assess “Dementia Friends” campaign impact. Method: An advisory group, including academics and representatives of Alzheimer Portugal and Alzheimer Society UK, drafted the survey based on previous international research and the first national survey. The survey was uploaded to the Directorate-General of Health website and disseminated through relevant stakeholders and social networks. The survey was cascaded by inviting recipients to further share it. Data were collected during July 2018. Results: 1716 individuals completed the survey: median age 43y, 83.4% female, 25.1% professionals working in the field of dementia. 31.7% of respondents know someone close with dementia, and 42.5% have/had relatives with dementia. 14.7% consider people with dementia must leave/stop to attend ceremonies and social events, but this percentage increased to over one-third (37.3%) when asked about the opinion of most people living in their community. Regarding the key messages of “Dementia Friends” campaign, results reveal that 25.6% of respondents consider dementia is a natural part of ageing, 21.3% that it is not caused by diseases of the brain and 17.4% that it is just about losing memory. Conclusions: The second survey results reinforce the need for initiatives to change people’s perceptions of dementia, that build up on evidence-based decision-making and international learning and cooperation as part of “Dementia Friends” global movement.
COGNITIVE IMPAIRMENT AND SLEEP DIFFICULTIES OVER 10 YEARS IN A NATIONAL SAMPLE OF OLDER ADULTS
Authors: Robbins Rebecca , Sonnega Amanda , Turner II Robert W , Jean-Louis Girardin , Langa Kenneth
Published: November 2019

Prior studies suggest that sleep difficulties (e.g., trouble falling asleep) may be associated with cognitive impairment. We used a large, nationally representative longitudinal survey of adults over the age of 50 in the US to examine the relationship between sleep difficulties and cognitive functioning. Generalized estimation equation (GEE) linear regression models were used to analyze data from the 2004-2014 waves of the Health and Retirement Study. We examined sleep difficulties and cognitive functioning within participants and across time (n=17,642). Sleep difficulty was measured as trouble falling asleep, nocturnal awakenings, and waking too early scored as 1= rarely/never, 2=sometimes, and 3=most of the time. A summary score indicated cognitive functioning (range 0-27). Models controlled for age, gender, race/ethnicity, marital status, education, chronic medical conditions, depressive symptoms, and body mass index (BMI). Compared to those with no sleep difficulties, those who reported difficulty falling asleep [“sometimes” OR=0.83,95%CI:0.71-0.96 and “most of the time” OR=0.79,95%CI: 0.64-0.98] and waking too early [“most of the time” OR=0.79,95%CI: 0.63-0.98] had worse cognitive functioning. Compared to those with no sleep difficulties, those who reported nocturnal awakenings [“most of the time” OR=1.29,95%CI:1.08-1.54] had higher cognitive functioning. Over time, lower cognitive function was more likely among those reporting difficulty falling asleep (OR=0.73,95%CI:0.54-0.97), nocturnal awakenings (OR=0.77,95%CI:0.61-0.97) and waking too early (OR=0.65,95%CI: 0.47-0.88). In this nationally representative, longitudinal sample of older US adults, we found that over time lower cognitive function was more likely among those who reported difficulty falling asleep, nocturnal awakenings, and waking too early.
ACCURACY AND USABILITY OF A MOBILE ALERT SYSTEM FOR COMMUNITY CITIZENS TO LOCATE PERSONS WITH DEMENTIA WHO GET LOST
Authors: Daum Christine H , Neubauer Noelannah , Oliva Carlo , Beleno Ron , Liu Lili
Published: November 2019

Three out of five persons with dementia wander. While the literature supports community engagement in the location of lost older adults, publically funded Silver Alert programs are associated with jurisdictional issues and alert fatigue. In collaboration and consultation with key stakeholders (older adults living with dementia, care partners, service providers, advocates, police organizations), we developed Community ASAP, an alert system (mobile website and app) that mobilizes community citizens who volunteer to keep watch for persons with dementia reported to be lost. The purpose of this study was to evaluate usability and functionality of the Community ASAP app. Thirteen participants from six regions in Canada received a total of 130 missing person notifications. They recorded the time and content of these notifications, completed the Website Usability Questionnaire, and provided written feedback or participated in a group interview about their experiences using the app and suggestions for improvements. The Community ASAP app delivered notifications with 100% accuracy and received messages from participants with 98% accuracy. Overall, participants thought the interface was easy to navigate, graphics were pleasing, easy to use, and was clearly organized. Suggestions for improvements to increase usability included: 1) Multi-sensory alerts to make them more noticeable and increase readability; 2) Clearer navigation within the home screen and preferences; 3) User support (instructions, demo video, technical support). Evaluation results for this innovative app were favourable; suggestions will be used to further improve usability, particularly for end users who are novices at using mobile applications.
TOTAL AND POST-DISCHARGE 30-DAY EPISODE PAYMENTS FOR BENEFICIARIES WITH ALZHEIMER’S AND DEMENTIA
Authors: Kamdar Neil , Mahmoudi Elham
Published: November 2019

There exists lack of evidence regarding incremental post-discharge cost and utilization of healthcare services for older adults with Alzheimer’s and dementia (AD). We quantified episode payments associated with AD vs. non-AD 30 days after medical or surgical procedures. We utilized administrative claims between January 2012 and June 2017 from the Michigan Value Collaborative (MVC) across 31 different medical and surgical services. We identified all patients with any AD diagnosis code throughout their enrollment using ICD-9-CM, ICD-10-CM codes. We price standardized 30-day episode payments and split them based on patient setting. Payments were risk adjusted and winsorized at the 99th /1st percentile. Propensity score matching using calipers without replacement adjusted for clinically relevant surgical and medical procedures, HCCs, insurance type, and age to control for selection bias. We identified 66,676 AD episodes and 656,235 non-AD episodes. After propensity score matching, there were 58,485 AD and non-AD episodes with significant differences in total episode payments of ($22,378 vs. $19,595, 95% CI Diff: ($2,658, $2,910)). Post-acute care and readmission payments were significant ($4,561 vs. $3,272, 95% CI Diff: ($1,235, $1,342)) and ($1,807 vs. $1,165, 95% CI Diff: ($595, $691)), respectively. AD episodes had a higher readmission rate (21.6% vs. 14.8%, p<0.0001). County variation in payments for AD episodes was substantial (Median: $4,370, Range: $3,881). AD patients are at higher risk of readmission and more resource intensive to hospitals and health systems. Examining drivers of post-discharge cost variation can influence practice pattern changes in management of AD patients.
ASSOCIATION OF SENSORY AND COGNITIVE IMPAIRMENT WITH HEALTHCARE UTILIZATION AND COST IN MEDICARE BENEFICIARIES
Authors: Deardorff William , liu Phillip , Sloane Richard , Van Houtven Courtney , Hastings Susan N , Cohen Harvey J , Whitson Heather E
Published: November 2019

The combination of sensory and cognitive impairment is increasingly prevalent among older adults and may be an important driver of healthcare cost due to functional disability and reduced self-care. This presentation focuses on the relationship between hearing and/or vision impairment and cognitive impairment with hospital admissions and healthcare cost using data from the Medicare Current Beneficiary Survey, a nationally representative sample of community-dwelling adults. We show that the presence of sensory impairment is associated with increased risk of hospitalization regardless of dementia status. In adjusted models, annual total healthcare costs were generally higher among those with sensory impairments compared to those without sensory impairments. We will also discuss work related to the development of a prognostic model that provides estimates of hospitalization risk among older adults with self-reported hearing and/or vision impairment. This model may help inform allocation of health care resources to those at highest risk for adverse outcomes.
CHANGES IN PERSONAL RESOURCES AND SUBJECTIVE AGE ACROSS 8 YEARS
Authors: Lothary Allura F , Hess Thomas M
Published: November 2019

Subjective age has been extensively researched as a predictor of physical and mental health outcomes in older adulthood. However, the mechanisms behind subjective age have not yet been established and reasons for longitudinal changes are unclear. Selective engagement theory (SET; Hess, 2014) proposes a connection between increases in objective and subjective cognitive costs and motivation to engage future resources. Costs are influenced by personal resources, mainly physical and mental health. These changes in costs may also influence subjective experiences of the aging process. For example, aging attitudes have been shown to partially mediate the associations between resources and both motivation and activity engagement (Hess et al., 2018). Using the Health and Retirement Study (HRS) data, changes in resources (physical and mental health) were hypothesized to predict changes in subjective age across 8 years. More specifically, reductions in resources were predicted to be associated with older subjective ages over time. This relationship was expected to be mediated through aging attitudes. Results indicate an association between changes in resources and changes in subjective age over time in the expected direction. Changes in resources were partially mediated by aging attitudes. However, resources function differently in predicting changes in subjective age based on the resource (physical and mental health) and chronological age of the participant. These findings provide more guidance as to the mechanisms behind subjective age and may offer theoretical guidance for future work looking at understanding changes in subjective age.
LIFE AS A JOURNEY: A VIEW OF LIFE AS A JOURNEY MODERATES THE RELATIONSHIP BETWEEN SUBJECTIVE AGE AND SUBJECTIVE HEALTH
Authors: Oh Ga-Eun (Grace)
Published: November 2019

Previous research has shown the relationship of subjective age and health status: feeling younger than one’s age is correlated with better health outcomes including both subjective and objective measures. This research investigates how the view of life as a journey might moderate the relationship between subjective age and subjective health. A view to look at life as a journey is a common metaphor to view life as an ongoing process. Prior work has suggested that people who went through difficult situations successfully tend to construe their life experience as a journey. This suggests that thinking of life as a journey might help people cope better with their negative experiences in general such as feeling older. Thus, we investigate to see if believing ‘life as a journey’ can buffer against the negative effect of feeling older on subjective health perception. To test this, we collected the data from American participants (N = 724) of various ages. The results showed that more life was viewed as a journey, smaller the detrimental effect of subjective age on subjective health. Although feeling older generally reduced subjective health, this negative effect of feeling older was smaller among those who thought life as a journey. This research suggests that thinking life as a journey might be used to reduce the negative impact of older subjective age on health perceptions.
AGE-BASED STEREOTYPE THREAT: A SYSTEMATIC REVIEW OF PRIMING TECHNIQUES AND THEIR EFFECTS
Authors: Riboni Francesco Vailati , Pagnini Francesco
Published: November 2019

Age-based stereotype threat (ABST) occurs when older adults are influenced by negative stereotypes about age-related decline and functional losses and ironically behave in disengaging and self-defeating ways that confirm the stereotype (Steele & Aronson, 1995). Aging stereotypes are found to be strong predictors of health and illness outcomes in later life, and are associated with performance in specific areas, mainly in cognitive and physical domains. The current study reviewed the experimental methods and their reported effects previously published in the literature to determine if there were different ABST methods were associated with different types of age-related outcomes. We conducted a systematic review, screening the scientific literature for papers that included experimental manipulation of age-related stereotypes as an independent variable, focusing on samples of older adults (1113 articles, most published after 2003). Through a classification of the common and distinctive characteristics of the different stereotype manipulation techniques, we were able to identify three specific types of experimental methods: by instruction, tests, and interpersonal exposure. Although the mechanism by which stereotypes are associated with functional outcomes in older adults remains unclear, our review suggests it is possible to experimentally control the activation of the stereotype by manipulating its specific characteristics and the way older participants are exposed to it. Findings also highlight the possibility that specific experimental methods used to induce ABST in older individuals may lead to unique and different consequences on functional performance variation.
INTERRELATIONSHIPS AMONG COLLECTIVE PERSONALITY, ATTITUDES TOWARD INTERGENERATIONAL SUPPORT, AND CO-RESIDENCE
Authors: Lee Yooumi
Published: November 2019

This study investigates if collective personality influences positive attitude towards family caregiving and support for elderly parents, which, in turn, engenders positive attitude toward intergenerational coresidence. To test the hypothesis, the author examines the interconnections among collective personality; attitude towards family caregiving, and attitude towards support for aged parents; and attitude towards intergenerational coresidence in the U.S. The survey data is collected from total 67 undergraduate students in classroom environment. Particular attention is given to their attitude towards family caregiving and aged parents support. Results show that those three predictors are positively correlated with the attitude towards intergenerational coresidence i.e. respondents with more positive attitude towards family caregiving and aged parents support and with collective personality are more likely to have positive attitude towards intergenerational coresidence. Among the three predictors, collective personality is positively connected to the attitudes towards family caregiving and support for aged parents. A positive correlation is also observed between two attitude predictors i.e. respondents with more positive attitudes towards the family caregiving are likely to have positive attitude towards the support for aged parents and vice versa. The results highlights the important influence of collective personality, and attitude towards family caregiving and support for older parents on the intergenerational coresidence, even in the individualistic society.
SLEEP IN LATE LIFE: RECENT RESEARCH ON PSYCHIATRIC CORRELATES AND TREATMENT
Authors: Dozier Mary E
Published: November 2019

Sleep is an often overlooked health factor, particularly in older adults. Sleep disturbance is associated with increased functional impairment as well as poorer cognitive, mental, and physical health trajectories. Understanding the clinical impact of disturbed sleep, and the optimal targets for intervention, is critical for the promotion of health and well-being in older adults. This symposium will highlight recent findings that advance the extant knowledge on the interplay of sleep disturbance and physical and psychiatric co-morbidities in older adults across a variety of settings. Darina V. Petrovsky will discuss the impact of medical, demographic, and contextual factors on excessive daytime sleepiness in older adults receiving long-term services and supports. Kathi L. Heffner will present data on a recent study examining change in slow wave sleep, and subsequent change in osteoarthritis pain, following insomnia treatment. Courtney Bolstad will discuss the differential impact of onset, maintenance, and terminal insomnia on anxiety and depression symptoms in community-dwelling older adults. Eliza Davidson will present research on the association between sleep disturbance and hoarding symptoms in older adults engaged in behavioral interventions for hoarding disorder. Finally, Christina McCrae will discuss the relationship between sleep and cognition in older adults with insomnia.
RECEIVING ELDERLY PRIVILEGE AND POSITIVE ATTITUDES ABOUT AGING: THE MEDIATING ROLE OF SUPPORT FROM CHILDREN
Authors: Zhao Lingya , Xu Ling
Published: November 2019

Objectives. This study investigated the influence of receiving elderly privilege on positive attitudes about aging, and examined the mediating roles of support from children in such associations among Chinese older adults. Methods. Data were derived from China Longitudinal Aging Social Survey (CLASS), a nationwide social survey project of Chinese older adults aged 60 or older (N = 7,184) conducted in 2014. The positive attitudes about aging were measured by Attitudes to Aging Questionnaire. Sum scores were calculated with higher scores indicating more positive attitudes about aging. Analyses were conducted by PROCESS v3.3 for SPSS 20.0. Results. Receiving elderly privilege was significantly associated with more financial support (b = 0.303, p＜.001) and instrumental support (b =0.225, p＜.001) from children. Financial support (b = 0.100, p < .05), instrumental support (b = 0.090, p < .05), and emotional support (b = 0.405, p＜.001) received from children were significantly correlated with more positive attitudes about aging. Financial support (b = 0.030, BCa CI [0.010, 0.057]) and instrumental support (b = 0.020, BCa CI [0.000, 0.042]) from children mediated the association between receiving elderly privilege and positive attitudes about aging. Conclusion. With the rapid increase of aging population in China, it’s important to help Chinese older adults maintain high quality of life by encouraging society and family to work together. To maintain higher levels of positive attitudes about aging among Chinese older adults, social program of providing elderly privilege and support from children are both needed.
GERIATRIC ASSESSMENT BEFORE HEMATOPOIETIC STEM CELL TRANSPLANT IDENTIFIES DEFICITS ACROSS ALL AGES
Authors: lowder yen p , Romero Kristi , Ren Yi , Pastva Amy M , Morey Miriam C , Cohen Harvey J , Chao Nelson J , Sung Anthony D
Published: November 2019

Allogeneic hematopoietic stem cell transplant (HCT) is a lifesaving procedure; however, it is associated with significant morbidity, and treatment-related mortality ranges from 10-30%. Morbidity and mortality have been associated with poor functional status. The geriatric assessment (GA) may allow identification of deficits pre-HCT, allowing intervention and improvement. While focused on older adults, we hypothesize that GA may also identify deficits in younger patients who may be debilitated by chemotherapy or cancer before HCT. We performed a GA in all adult patients at the time of initial evaluation for HCT (between 10/1/17-1/31/19) and again immediately before HCT. Deficits were identified and patients referred to specialists (physical therapy, neuropsychology, etc.) prior to HCT. Among 83 patients, the median age was 58 years (age range: 19-75), 59 (71%) had ≥1 deficits, including 41 (49%) had ≥2 deficits that required referral. The most common deficit was physical function (45, 54%), followed by cognitive function (29, 35%), nutrition (26, 31%), and mental health (7, 8%). Deficits were common across all age groups: 9/16 (56%) 60 years old. To date, 40 patients have undergone HCT; of the 24 with deficits at initial evaluation, 10 (42%) improved at least one deficit, 5 (21%) were unchanged, and 9 (38%) not evaluated. Physical and nutrition deficits were most responsive to intervention. These results suggest that there is a high degree of impairment prior to HCT among both older and younger patients; however, these deficits are amenable to improvement prior to HCT.
INTERVENTIONS TO REDUCE STIGMA OF DEMENTIA: FINDINGS FROM A SCOPING REVIEW
Authors: Bacsu Juanita R , Viger Marc , Johnson Shanthi , McIntosh Tom , Jeffery Bonnie , Novik Nuelle , Hackett Paul
Published: November 2019

Although there is significant stigma attached to dementia, there is a paucity of knowledge on stigma reduction interventions. Guided by a strength-based approach, this presentation consists of two objectives: 1) to identify the literature on interventions to reduce dementia-related stigma; and 2) to recognize the strength-based components of existing anti-stigma interventions. A five-stage scoping review process was used to examine peer-reviewed literature of anti-stigma interventions of dementia from 2008 to 2018. From 744 initial records, 21 articles matched our inclusion criteria and were reviewed. A stigma reduction framework was used for classifying interventions: education (to dispel myths with accurate information), contact (to provide interaction with people with dementia), mixed (education and contact interventions), and protest (to challenge negative attitudes of dementia). A range of education, contact, and mixed interventions were identified. Strength-based components of education interventions included using: facts to dispel myths, multiple mediums to support dementia information, and culturally-informed strategies for specific audiences. Key components of contact and mixed interventions included: showcasing the achievements of people with dementia, relationship-building, and engaging in purposeful learning. Findings from this study can help to inform future interventions to reduce stigma and improve the quality of life for people affected by dementia.
DOES IMPROVING SLEEP IMPROVE COGNITION IN OLDER INDIVIDUALS WITH INSOMNIA?
Authors: McCrae Christina
Published: November 2019

Late life insomnia is associated with worse cognitive performance. Behavioral/cognitive behavioral treatments for insomnia (BBT-I, CBT-I) improve sleep in older adults, but findings are mixed for cognition. This presentation examines the effects BBT-I and CBT-I on sleep and cognition across three RCTs involving older individuals (community-dwelling [N=62, Mage=69.45(SD=7.71)], chronic pain [N=64, Mage=53.2 (SD=13.7)], dementia caregiving [N=36, Mage=62.32 (SD=6.71]). Sleep was assessed using daily diaries and actigraphy for 1-2 weeks prior to randomization to treatment or control. Cognition was measured using standardized executive functioning, memory, and attention measures. Multiple regressions revealed improved executive functioning following treatment (caregivers), associations between improved executive performance and greater pain/sleep improvements (chronic pain), and associations between improved attention and processing speed and improved sleep 9-months following treatment (community-dwelling). BBT-I/CBT-I hold promise for improving cognition in older aged individuals with insomnia. Research is needed to determine what factors influence/which patients are most likely to experience cognitive benefits.
THE EPIDEMIOLOGY OF ALZHEIMER’S DISEASE AND RELATED DEMENTIAS AMONG ARAB AMERICANS
Authors: Dallo Florence , Kindratt Tiffany
Published: November 2019

In the United States (U.S.), Alzheimer’s Disease and Related Dementias (ADRD) afflict over 4.7 million individuals ages 65 or older. Most studies compare the prevalence of ADRD between minorities and whites. Arab Americans are a subgroup of whites, and ADRD is not understood among Arab Americans. The overall goal of this study is to estimate the prevalence of and risk factors for ADRD among Arab Americans ages 45 or older compared to non-Hispanic whites, non-Hispanic blacks, Hispanics and Asian Americans. Data for 2000-2017 from the National Health Interview Survey (NHIS) using the region of birth question was be used (N=222,219). Percents, chi-square and logistic regression will be estimated. Age- and sex-adjusted prevalence of ADRD was 10.3% for foreign-born Arab Americans compared to approximately 7.5% for US-born non-Hispanic whites (NHW), blacks and Asians. The prevalence of ADRD was 8.6% for Hispanics (all p-values <.0001). When controlling for age and sex, Arab Americans were 1.4 times (OR=1.02,1.93) more likely to have ADRD compared to US-born NHW. This is the first study to focus on ADRD among Arab Americans and the findings suggest ADRD is a burden in this population. Future studies should capture other generations of Arab Americans to better understand the trend of ADRD among this understudied, often invisible population.