bluuebunny/crossref_metadata_2025 huggingface dataset:
Telehealth Use in a Home-Based Dementia Care-Coordination Program
Authors: Johnston Deirdre , Reuland Melissa , Marshall Kelly , Antonsdottir Inga , Bunting Morgan , Samus Quincy
Published: December 2020

In the coming decades, greater numbers of people will either have Alzheimer’s Disease or a related dementia or will take care of a family member with dementia. The dementia syndromes are associated with increased risk of medical, social, and behavioral complications in both the person with dementia (PWD) and the caregiver (CG), many of which are preventable. These complications, and the dementia itself, can impede access to care and ultimately hasten residential care placement, which can be both undesirable and costly. A nearly universal unmet need in PWD/CG dyads is dementia-specific education. Therefore, it is vital we find ways to support and provide education to CG/PWD dyads to manage dementia in the community and home setting. MIND at Home is a dementia-care model developed and tested at Johns Hopkins University School of Medicine to minimize dementia complications and delay institutionalization by training non-clinical Memory Care Coordinators (MCCs) working under clinical supervision to support and guide PWD/CG dyads in the community. MCCs collaborate with CGs and PWDs in the community using an individualized care plan structured around the dyads’ specific dementia-related needs. This presentation will describe how the MIND at Home team used handheld tablets to connect MCCs to clinicians from participants’ homes, and will report on challenges encountered, strategies to address them, and participant and caregiver satisfaction with the telehealth experience.
Use of Video-Enabled Tablet for Virtual Care Among Older Veterans
Authors: Yefimova Maria , Hu Jiaqi , Slightam Cindie , Greene Liberty , Chaudhary Camila , Hayworth Leonie , Zulman Donna
Published: December 2020

With the proliferation of virtual care, healthcare systems are exploring ways to bridge the digital divide among vulnerable patients. Department of Veterans Affairs (VA) is distributing devices for qualifying Veterans to enable video visits with medical providers at home, yet their use among older patients is unknown. This retrospective cohort study used administrative data to characterize the use of VA-loaned iPads among older Veterans compared to younger Veterans and identify demographic predictors of utilization. Among 16,385 patients who were shipped a VA-loaned iPad in 2014-2019, 33.66% (n=5,516) were over 65 years old, and 3.1% (n=503) were over the age of 85. Two thirds (n=6799) of younger patients had a video visit (mean=3 visits) with provider using iPad in the 6 months since shipment, compared to 50% (n=253) of 85+ year-olds (mean=1.8 visits). Most common types of virtual visits for the oldest old patients were for geriatrics or home-based primary care, compared to mental health visits among younger patients. Logistic regression identified characteristics of older patients who were more likely to use iPads, such a marital status, urban location, and lower disease burden, which is similar to their younger counterparts. While older age groups used VA-loaned tablets less frequently, those who engaged with the devices were similar in demographics as their younger counterparts. Older patients used iPads differently, with higher engagement in geriatric and primary care services. Providing devices for virtual care may allow health systems to more easily reach older patients in the comfort of their home.
If You Don’t Use It, You Lose It: Perspectives of Older Adults on Aging in Place in Subsidized Housing
Authors: Reyes-Farias David , Jahan Momana , Pandit Sonia , Reid Carolina , Resnick Barbara , Brown Rebecca
Published: December 2020

Nearly 3 million older Americans with low incomes live in subsidized housing. This population has disproportionate rates of functional impairment, cognitive impairment, and nursing home admission. Patient-centered interventions are needed to improve aging in place for this population, but little is known about resident perspectives on this topic. We interviewed 58 residents aged 62 or older and 8 caregivers from 7 housing sites. We analyzed transcripts using qualitative thematic analysis. Participants reported that several factors impacted their ability to age in place. First, most participants noted the importance of physical environment, including the design and location of their apartment building. Physical accessibility and proximity to community resources facilitated aging in place, while features such as heavy doors and smoke in communal areas posed challenges. Second, most participants identified the importance of the building’s social environment; support received from other residents and on-site staff facilitated aging in place, while gossip and unpleasant residents were barriers. Third, participants noted that health issues such as arthritis limited their ability to function independently, regardless of environment. Participants emphasized the importance of physical activity for preventing functional decline, stating, “if you don’t use it, you lose it.” Older adults living in subsidized housing view their environment as central to their ability to age in place. Our findings suggest that interventions to improve aging in place in these settings must focus not only on optimizing residents’ physical function, but also on using the environment to promote resident independence and quality of life.
The Factors Associated With Daily Life Support for Single Older Adults to Remain at Their Home
Authors: Sakurai Rika , Inagaki Asa , Komazawa Yukitsugu , Kimata Mari , Goto Jun
Published: December 2020

Japan aims to enable older adults to remain at home in their familiar environment. However, the factors associated with daily life support for older adults who require medical and nursing care to remain at home are unclear. This study aimed to clarify the factors associated with daily life support for single older adults needing medical and nursing care to remain at home. Our participants were single older adults aged 65-94 years receiving medical and nursing care and their care providers. First, we analyzed records, which were written by care providers, regarding ten older adults who received medical and nursing care from 2014 to 2018. We categorized occurrences which exert single older adults’ life on change into six factors, such as gradual frailty and loss of a loved one. Then, to consider how they experience these factors, we conducted semi-structured interviews with three additional older adults who were single and received home visiting nursing care service in 2020. During this process, four multidisciplinary researchers discussed the factors associated with daily life support for single older adults; finally, three factors were derived. The first one pertained to health conditions: receiving sufficient medical and nursing care maintain older adults’ physical condition. The second related to the environment: maintaining social interactions (neighbors and friends). The third pertained to older adults’ values and meanings to remain at home. This study suggests that care providers focus on these three factors to help older adults who received medical and nursing care to remain at their home.
A Systematic Review of Missouri Lymphedema Symptom Assessment Tools in Original Research and Review Articles
Authors: Oyewusi Christiana , Armer Jane
Published: December 2020

Despite advances in cancer treatment, many survivors face a significant challenge of cancer-related lymphedema, together with aging. Aging results in structural changes in the lymphatic system. Beginning in 1998, tools have been developed at the University of Missouri to assess symptoms of lymphedema in cancer patients. The objective of this review was to synthesize evidence regarding use of Missouri lymphedema symptom assessment tools in original research and review articles. A search of six electronic databases was conducted for articles published within 1998 and 2018 on review and use of the tools which are Lymphedema and Breast Cancer Questionnaire (LBCQ), Melanoma and Lymphedema Questionnaire (MELQ), and Gynecologic Cancer and Lymphedema Questionnaire (GCLQ). In all, 210 articles were retrieved, and 32 full-text articles meeting the inclusion criteria were reviewed. The studies reported a cumulative number of 5,872 study participants. Most manuscripts (70.97%) reported data on breast cancer lymphedema, 19.35% on gynecological cancer lymphedema, 3.23% on breast cancer and melanoma lymphedema, and 6.45% on melanoma. The use of LBCQ was reportedly more than the use of GCLQ and MELQ. Tool reliability ranged from r = 0.785 - 0.82 for LBCQ and 0.95 for internal reliability for GCLQ. The tools have been used in many countries including the United States of America. The importance of using valid and reliable quantitative measures in lymphedema symptom assessment across diverse populations and sites cannot be overstated. The tools have been modified and used over the past 20 years in various settings and across languages and cultures.
Physician Attitudes and Confidence Toward Dementia Capability: Screening, Diagnoses, and Referrals
Authors: Herrick Tamara , Ward Michelle
Published: December 2020

The MaineHealth Alzheimer’s Disease Partnership is working to improve integration between the healthcare system and community partners through training and a referral network. Primary care providers are often the first to assess cognitively impaired patients, so it is important to understand their attitudes and confidence in dealing with dementia. The objective of this study is to determine barriers to care and evaluate healthcare providers’ attitudes towards their dementia capability, which includes screening for cognitive impairment, disclosing diagnoses, and making referrals to community-based organizations or specialists. A 27-item survey was developed and sent to 474 providers from MaineHealth practices via email. Fifty-three providers responded to the survey. Five healthcare professionals also took part in a focus group; looking more specifically at challenges encountered throughout the dementia care system. This poster will present the findings from the survey and focus group. There was strong agreement that much can be done to improve the quality of life for patients with dementia (86% agreed/strongly agreed) and that screening all patients over age 65 is important (85% agreed/strongly agreed). Confidence levels in ability to diagnose dementia, provide memory loss information, and refer patients to specialists were significantly associated with training (p<.05). The majority of providers identified barriers to cognitive screening and referring patients to community-based organizations, showing that improvements are needed at the system level to remove these barriers. Overall, the results suggest that dementia specific training can improve confidence in care and allow physicians to provide more information about memory loss to patients.
Polypharmacy in the Older Adult: Medication Review in the Community
Authors: Pacetti Staci , Avallone Margaret , Perweiler Elyse
Published: December 2020

Polypharmacy remains a significant healthcare issue in the United States, resulting in drug interactions, adverse drug reactions, and potentially dangerous complications. Polypharmacy, often defined as the simultaneous use of five or more medications, may lead to adherence problems and an increased risk of hospitalizations and death, particularly in the older population. Medication management was incorporated into undergraduate nursing clinical experience in an affordable housing urban community as part of the New Jersey Geriatric Workforce Enhancement Program (NJGWEP), a 5-year grant supported by DHHS-HRSA. This paper will describe the first phase of this project, which involved the determination of the prevalence of polypharmacy and high-risk medications in this setting. The charts of sixty residents were reviewed and along with demographic information, the following data was collected: total number of medications (prescription, non-prescription and herbal supplements), high-risk medications using Beers criteria and identification of common themes or issues. The average age of the residents was 72 years, with cardiovascular diseases and diabetes mellitus being the most common comorbidities. Fifty-two of the sixty residents (86%) received five or more medications daily, meeting the definition of polypharmacy. The average number of medications taken on a daily basis was 8.9. Among the residents, centrally-active agents such as gabapentin, tramadol and lorazepam were the most commonly prescribed medications. The second phase of this project will include implementation of a medication reconciliation process to identify potential issues using the Beers criteria and implement appropriate interventions to ensure safe medication practices in this high-risk population.
Prescribing Trends of Anticholinergic Drugs Between 1989 and 2017: A UK Biobank Study
Authors: Mur Jure , Cox Simon , Marioni Riccardo , Russ Tom , Terrera Graciela Muniz
Published: December 2020

Prescription drugs with anticholinergic properties are commonly prescribed and negatively impact physical performance, cognitive function, and increase the risk of falls and dementia. The prevalence of anticholinergic drugs is high in later life, when there is an increased risk of adverse drug effects. Recent, in-depth longitudinal analyses of specifically anticholinergic prescribing in Europe is lacking. Prescriptions for the UK-Biobank participants (n=222,122) were ascertained from primary care electronic patient records. We assigned anticholinergic activity to each drug by using a composite score. We used linear regression to study the association between current anticholinergic burden and time period, explore secular trends in anticholinergic use, and various demographic factors. We further explored the results in the context of different classes of prescriptions drugs. 74 distinct drugs in the sample (1.1%) had anticholinergic effects. An individual’s overall anticholinergic burden increased nonlinearly (linear estimate=0.474, quadratic estimate = 0.094, both p<2.2x10-16) between 1989 (mean=0.09, σ=0.009) and 2000 (mean=0.22, σ=0.006) and increased nonlinearly (linear estimate=0.282, quadratic estimate=0.074, both p<2.2x10-16) from 2000 to 2016 (mean=0.27, σ=0.009). The proportion of patients prescribed at least one anticholinergic drug per month increased from 6.1% to 16.7% from 1989 to 2000 and increased to 18.6% by 2016. When adjusted for sex and polypharmacy, age was negatively associated with recent cross-sectional anticholinergic burden (estimate=-0.042, p<2.2x10-16). Our results demonstrate an increase in prescribing of anticholinergic drugs over the past 30 years and indicate contemporary deprescribing of anticholinergic drugs in the later decades of life.
Attitudes of Graduating Medical and Nursing Students Toward Older Persons in Ghana
Authors: Karikari Grace , Lesa Huber , Lohrmann David , Adamek Margaret , Omodior Karo
Published: December 2020

Purpose: Differences in attitudes between graduating medical and nursing students toward older persons in Ghana were compared. Additionally, the association between the overall quality of students’ experiences with older persons and their attitudes was examined. Materials and Methods: A sample of 135 final year medical and nursing students from a public institution in Ghana participated in a cross-sectional study by completing a web-based self-administered questionnaire consisting of the 14-item University of California at Los Angeles Geriatric Attitudes (UCLA-GA) scale, and demographic questions. Data analysis involved a two-sample t-test and a one-way ANOVA. Results: Most participants (82.2%) held positive attitudes towards older persons. The mean score for the UCLA-GA scale that assessed attitudes of students towards older persons was 3.41 ± 0.41 (min: 2.29, max: 4.64); differences in attitudes between the two groups was significant (p = 0.001). Medical students had more positive attitudes toward older persons than nursing students. The association between students’ attitudes and the overall quality of their experiences with older persons was significant (p = .001). Students whose experiences with older persons were negative had the least positive attitudes. Conclusion: Considering the impact negative experiences with older persons may have on students’ attitudes, attention should be given to creating positive experiences through clinical and community-based exposures. Direct interactions with older persons who are active and living independently may challenge some common stereotypes such as older persons are infirm and senile, and foster positive attitude development.
Older Adults Aging With HIV: A Growing Population Experiencing Comorbidities and Social Isolation
Authors: Treston Carole
Published: December 2020

Significantly more than half of people living with HIV in the United States are over age 50 and at least half of that number are over 70 years old. Advances in antiretroviral treatments continue to extend the lifespan of people with HIV. However, people aging with HIV, particularly those diagnosed earlier in the epidemic, known as “long term survivors” are likely to face a myriad of challenges: clinical, psychosocial, financial, and logistical. Aging with HIV is a complex mix of long-term treatment effects, early onset of general aging, comorbidities and other confounding factors including mental health and psycho-social factors that affect quality of life. Older persons living with HIV have experienced tremendous loss, stigma and discrimination, including within the healthcare system. Now, renewed losses amplified by the emergence of multiple comorbidities including cardiovascular and metabolic disease, HIV associated neurocognitive disease, other neurological disability, diminished bone health and frailty and other conditions can impair quality of life significantly. A review of the common comorbidities experienced by people aging with HIV and the intersection with social isolation, stigma and loss will be presented. Strength based, holistic care that focuses on resilience, and includes advocacy, social networks and care coordination delivered by nurses and nurse practitioners as part of a collaborative inter-professional education program at the Association of Nurses in AIDS Care to address the unique challenges experienced by PLWH will be described.
Sequential Patterns of Multimorbidity in a Nationally Representative Cohort Study of Aging
Authors: Schiltz Nicholas , Hu Yicheng , Foradori Megan , Bailey Jessica Cooke
Published: December 2020

Multimorbidity – the presence of two or more chronic health conditions – is common among older adults. Despite this, relatively little is known about the epidemiology of specific sequences of disease onset that occurs in mid-life and older adults over time. This may be attributed to the sheer number of possible permutations, which is difficult to handle with traditional methods. This is a retrospective cohort study using the Health & Retirement Study (HRS), a nationally-representative panel survey of aging. The study population included all adults age 50 and older that had no reported chronic disease at baseline (n=5567). We use a data mining algorithm, Sequential Pattern Discovery using Equivalence classes (SPADE), to identify all possible sequences of eight self-reported age-related chronic diseases: hypertension, arthritis, diabetes, cancer, stroke, heart disease, chronic lung disease, and psychiatric disorders. There were 67 unique sequences of disease identified that occurred in at least 1% of the study population. The most common two event sequence was Arthritis=>Hypertension (15.5% of all subjects), and the second most common was Hypertension=>Arthritis (9.6%). The most common three-way sequence was Arthritis=>Hypertension=>Heart Disease (1.8%). Arthritis=>Stroke occurred in 1.5% of subjects and was associated with the highest mortality rate (71.3% of subjects died). Sequential pattern mining allows for the discovery of longitudinal patterns of disease that frequently occur in older adults and advancements in our understanding of the epidemiology of multimorbidity. Future applications may include predicting a given patient's disease trajectory based on their life course and disease history.
Reciprocal Effects Between Life Satisfaction and Sleep Duration in Chinese Older Adults
Authors: Liu Qian , Pan Haimin , Pei Yaolin
Published: December 2020

Sleep problems are prevalent among older adults. It is evident that sleep duration, as an important indicator of sleep quality, is closely associated with life satisfaction. However, it remains unclear as to whether sleep duration influences life satisfaction, or whether lower levels of life satisfaction increase the likelihood of sleep duration decline. This study examined the directional relationship between life satisfaction and sleep duration among Chinese older adults. Data were derived from the China Health and Retirement Longitudinal Study (2011, 2013, 2015 waves; age≥60 year; n = 5689). A cross-lagged panel model (path analysis) with three time points was used to jointly examine the longitudinal reciprocal effects between life satisfaction and sleep duration. This model achieved acceptable indices of goodness of fit. The results revealed that sleep duration were positively associated with life satisfaction at all time points (2011 to 2013: B=.06,SE=.01,p<.0001; 2013 to 2015: B=.05,SE=.01,p<.0001), and life satisfaction also positively predicted sleep duration across timepoints (2011 to 2013: B=.07,SE=.01,p<.0001; 2013 to 2015: B=.03,SE=.01,p<.05).These associations remained unchanged when taking demographics, and noontime napping into account. The findings indicate that the relationship between life satisfaction and sleep duration is bidirectional. Sleep duration may present as a mechanism for the relationship between life satisfaction and health, and suggests that effective treatment of sleep duration may improve life satisfaction.
Disability and Symptom Burden Among the Very Old: Comparison of Survivors and Decedents
Authors: Liu Xinran , Albert Steven
Published: December 2020

How does disability and symptom burden among the very old differ between those who die and those who do not die over 12 months? We explored patterns of disability and symptom burden in the Health ABC cohort study, which involved quarterly phone interviews in 2011-14 (years 15-17). A proxy completed the interview when the proband was unable to participate. We identified a sample of 291 decedents with at least 1-year of follow-up before death and matched a 1:1 sample of survivors at the time of death by race, sex, and age (within ±3 years). 252 decedents (age 90.0±3.03, 65.1% Black, 52.4% female) and 288 survivors (age 90.1±3.03, 64.9% Black, 52.4% female) with at least 3 quarterly interviews were included for analysis. Decedents had a higher proportion of proxy-reported interviews compared to survivors (40.9%vs16.0%, P<0.01). Disability prevalence among decedents was significantly higher (P<0.01) compared to survivors (using an assisted walking device, 62.3%vs37.4%; difficulty getting in/out of bed, 32.0%vs19.4%; difficulty bath/shower, 28.9%vs10.0%; difficulty dressing, 19.0%vs8.7%). Decedents and survivors differed significantly (P<0.05) in self-reported number of symptoms (2.35vs1.78), severity of disability due to shortness of breath (4.09vs2.04), constipation (3.97vs1.74), and difficulty concentrating (1.98vs1.25). Decedents also had a significant higher score (P<0.01) on self-reported loss of appetite (2.24vs1.91) and worse global quality of life rating (3.04vs2.64), compared to survivors. The patterns were similar in proxy-reported group and in the group with a combination of self-and proxy-reported interviews. Even in very late old age, disability and symptom burden increase with the approach of death.
Mobility Matters: A Pilot Study on Increasing Health Literacy Among Fall-Risk Elders
Authors: Milidonis Mary , Keehan Jane , Deuley Rebecca , Formoso Sara , Montgomery Katherine , Kopera-Frye Karen
Published: December 2020

Mobility is important to sustain for older adults to live independently. The purpose of this project was to evaluate teach back and ask me 3 interventions with a health education program that included Otago strength and balance exercise and a walking program The pilot program, Mobility Matters, was completed with 16 older adults (mean age =76, range 63-87, SD = 8.6), 69% African American, 94% female. Older adults with moderate fall risk were recruited from community centers and participated in a 3-month program where they were paired with physical therapy students for pre- and post-intervention assessment. Participants were randomly assigned to a health literacy intervention group (HLG) (n=9) and received teach back and ask me 3 intervention twice a month for three months. The control group (n=7) received the same program of balance exercises/ walking program and after 3 months was given the health literacy intervention. Groups were not significantly different on age, gender and REALM scores. Assessment measures included: timed up and go, 30 second chair rise, 4 stage step test, 6 minute walk test, and activity balance confidence scale (ABC). Paired t-test analysis revealed mean significant differences on the measures of four stage balance test (p =.008), six-minute walk test (p=.026) and approached significance on ABC (p=.054). No significant differences were found for the non-health literacy group on all measures. The results suggest that health literacy intervention may improve outcomes for health education interventions with balance and aerobic exercise.
Improved Processing Speed Is a Potential Mechanism by Which Exercise Reduces Falls
Authors: Liu-Ambrose Teresa , Davis Jennifer , Falck Ryan , Khan Karim
Published: December 2020

A 12-month trial demonstrated the Otago Exercise Program (OEP), a home-based exercise program of strength and balance retraining exercises, significantly reduced the rate of subsequent falls among 344 older adults receiving care after a fall (JAMA, 2019). A significant improvement in processing speed, as measured by the Digit Symbol Substitute Test (DSST), was also observed. Given the DSST is a predictor of falls, we conducted mediation analyses to determine whether improved DSST mediated the effects of OEP on rate of: 1) total falls; 2) non-injurious falls; 3) mild injurious falls; and 4) severe injurious falls over the 12-month trial. Our causal mediation analyses were conducted using the mediation package in R, using quasi-Bayesian estimates and 95% confidence intervals. Compared with usual care, OEP significantly reduced the rate of total falls (IRR= 0.64; 95% CI: 0.44, 0.91; p= 0.013) and mild injurious falls (IRR= 0.49; 95% CI: 0.31, 0.77; p= 0.002). Improved DSST score was also associated with lower mild injurious fall rates (IRR= 0.95; 95% CI: [0.91, 0.99]; p= 0.014). Formal mediation analyses showed that improved DSST was a significant mediator of the effect of OEP on the rate of mild injurious falls (95% CI: -0.15, 0.00; p= 0.036). Improved processing speed may be a mechanism by which exercise reduces mild injurious falls.
Vitamin D Supplementation and Mortality in Older Adults: A Systematic Review and Meta-Analysis
Authors: Zhao Yunli , Jia Shuli , Ge Meiling , Dong Birong
Published: December 2020

Web of Science, Embase, Medline and Cochrane Central Register of Controlled Trails from their inception to 14 January 2020 were searched in this review. We included randomized controlled trials (RCTs), which compared vitamin D supplementation versus placebo or no intervention and reported mortality as one of outcomes in older adults. Two review authors extracted data independently. Fifty-one articles were included in the analysis, which generated a total pooled sample of 89,977 people and 9813 deaths. These trials were pooled in a meta-analysis, and the outcomes were expressed as risk ratios (RRs) and 95% confidence Intervals (CIs). Across all studies, vitamin D supplementation was not associated with all-cause mortality (RR 0.98, 95%CI 0.92 to 1.04, P=0.48, I2=14%; 89,977 participants; data from 51 trails). Vitamin D supplementation was significantly decreased cancer mortality ( RR 0.85, 95% CI 0.74 to 0.97, P= 0.02, I2=0%; 34364 participants; data from 6 trails). A subgroup analysis showed the associations between the length of vitamin D supplementation more than 3 years and all-cause mortality were statistically significance (RR 0.93, 95%CI 0.88 to 0.98, p = 0.01, I2=0%; 49336 participants; data from 17 trails). Subgroup analyses by vitamin D status, forms of vitamin D (vitamin D3, vitamin D2, alfacalcidol or calcitriol), dose showed no association with all-cause mortality. The evidence from pooled analysis of 51 RCTs undertaken in older adults shows vitamin D supplementation was not associated with all-cause mortality. More long-term trails are need to know weather vitamin D supplementation can decrease all-cause mortality in older adults.
Evaluating an Advance Care Planning Skills Training for Medical, Nursing, and Social Work Students
Authors: Becker Todd , Cagle John
Published: December 2020

Advance care planning (ACP) helps to ensure future healthcare is congruent with individual preferences. Curricula for health-focused professions rarely include ACP content. This is a repeated measures evaluation of an innovative, interprofessional student training to enhance the ability to lead ACP discussions. Outcomes were measured via self-report surveys at two timepoints (baseline = T1 [n = 35]; posttraining follow-up = T2 [n = 20]) and included validated measures of communication self-efficacy, ACP self-efficacy, and interprofessional teamwork. Data collection from a third timepoint (T3), following randomized group assignment is currently underway. The matched T1–T2 sample (N = 17) included students from medicine (64.7%), nursing (17.6%), and social work (17.6%). Participants were largely young (M=26 years), non-Hispanic (94.0%), White (59.0%), and female (71.0%). Paired t tests examined change from T1 to T2 for all outcomes. Despite worse communication self-efficacy (Mdiff=1.6, p<.001) and ACP self-efficacy (Mdiff=.92, p<.001), perceptions of interprofessional teamwork improved (Mdiff=3.0, p=.008). These T1–T2 findings mirror results from similar, prior research, which subsequently discovered that both self-efficacy outcomes and their effect sizes for change worsened at T2, but ultimately and substantially improved at T3. These fluctuations suggest participants initially overestimated their self-efficacy related to ACP at T1 and corrected their appraisals at T2. Other studies should account for this self-correction. Further replication is needed to understand the dip that appears to occur before anticipated improvements occur.
Hospice Family Caregivers’ Use of Audio Diaries
Authors: Cloyes Kristin , Porter Eliabeth , Reblin Maija , Mooney Kathi , Tay Djin , Ellington Lee
Published: December 2020

Previous work has shown that emotional processing as part of diary writing improves well-being during and after stress. The purpose of this study was to determine the feasibility of verbal/audio diaries for home hospice family caregivers (HFCGs). We also describe diary content. As part of an ongoing multi-site, prospective longitudinal study, HFCGs of cancer patients report daily fluctuations in patients’ and their own symptoms via an automated telephone system, including a recorded diary entry. HFCGs are randomly assigned instructions to either discuss additional symptoms or discuss their thoughts and feelings. Thirty-six (85.7%) participants to date have completed at least one audio diary. For this preliminary analysis, we selected the 14 longest diary recordings from each condition (n=28) to content analyze using Linguistic Inquiry and Word Count (LIWC) and NVivo 12. Participants are 78.6% female, 53 years of age on average, and most are spouse/partner (46.4%) or adult child (35.7%) caregivers. There was no difference in the overall positivity (23%) or negativity (77%) of words in either condition, but participants asked to express thoughts/feelings used significantly more anger-related terms (p=0.04) while those asked to describe symptoms used significantly more anxiety-related terms (p = 0.003). Time was the most common theme in both conditions but arose more frequently in the symptom condition (p=.08). Our findings suggest that most audio diaries are feasible for HFCGs, but varied prompts may facilitate different types of emotional expression. Future research should assess potential impact on emotional well-being and bereavement adjustment.
How Many People Need Palliative Care and How Many Miss Out?
Authors: Davis Esther , Westley-Wise Victoria , Moules Stephen , Masso Malcolm , Barclay Greg , Nangati Zivai , Davis Joanne , Eagar Kathy
Published: December 2020

With an ageing population and growing burden of chronic disease, the number of people requiring palliative or end-of-life care (P&EOLC) is set to rise. It is imperative to develop a comprehensive understanding of the quality and equity of P&EOLC provision to promote sustainable health systems. The aim of this presentation is to report an observational study of N=3,171 decedents across a Local Health Network to: 1) estimate the proportion who need, access and miss out on P&EOLC in the last 12 months of life, and 2) identify differences by clinical and sociodemographic characteristics. Analysis was performed on multiple integrated datasets containing routinely collected health and mortality data. Estimation methods based on underlying cause of death were applied to determine those decedents who could potentially benefit from P&EOLC. Results identified potential benefit to 75% of decedents, of which 62% received P&EOLC and 13% missed out. Decedents aged 85 years or more and from a residential aged care facility showed the lowest proportion of access. Decedents with diagnosis of liver or kidney failure and dementia received more P&EOLC than were expected to benefit. Multivariate logistic regression identified that diagnosis and no other clinical or sociodemographic factor was significantly associated with likelihood of accessing specialist palliative care, with cancer showing highest likelihood and heart failure lowest likelihood. This research highlights the value of population-based estimates to provide a ‘whole of system view’ of quality and equity of P&EOLC, with ready translation for service planners around resource allocation for need and likely benefit.
Rural and Indigenous Health Disparity in Medical Service Use for Dementia and Diabetes Mellitus in Minnesota
Authors: Rhew Sung Han , Bright Patrick , Lemieux Andrine , Warry Wayne , Jacklin Kristen
Published: December 2020

Minnesota has shown relatively high growth of mortality from diabetes mellitus (DM) and dementia in recent years, especially in rural areas. Analysis of medical care utilization patterns may reveal the reasons for this trend. The goal of the present study was to characterize the Minnesota dementia and diabetes care landscape by rurality and geographic region. Specifically, we compared the Metro region to five other rural-urban regions. Disease-specific 2017 hospital admission and emergency department (ED) visit data was obtained from the State Center for Health Statistics and the Healthcare Cost and Utilization Project. We used the logistic regression analysis adjusted by multiple covariates to evaluate rural-urban differences in hospital admissions and ED visits. Age-adjusted rates of ED visits for both DM and dementia were significantly higher in rural zip code areas, especially in northeast regions. Rural areas had elevated odds for dementia hospital admissions (OR=1.05, p<0.0001) and ED visits (OR=1.24, p<0.0001), but decreased odds for DM hospital admission (OR=0.96, p<0.0001) and ED visits (OR=0.96, p<0.0001). This was particularly true in the northeast region (relative to Metro regions) where ED visits were less likely due to DM (OR=0.89, p<0.0001) but more likely related to dementia (ORs=1.42, p<0.0001). Geographic differences for ED visits due to DM were greater than those for dementia, with higher rates for rural as compared to urban regions (northeast MN compared to a large metropolitan region). This geographical mismatch between mortality rates and ED visit rates may illustrate the relative lack of access to health services in rural MN.
A Path to Early Diagnosis of MCI and Dementia: Integrating myMemCheck Into the Primary Care Workflow
Authors: Mansbach William , Mace Ryan , Frangiosa Theresa , Biggar Virginia , Comer Meryl , Simmons Steven
Published: December 2020

Barriers to the early detection of mild cognitive impairment (MCI) and dementia can delay diagnosis and treatment. myMemCheck® was developed as a rapid free cognitive self-assessment tool that can be completed in the practice setting or at home to identify older adults that would benefit from a more comprehensive cognitive evaluation for MCI and dementia. Two prospective cross-sectional studies (N = 59; N = 357) were conducted to examine the psychometric properties and clinical utility of myMemCheck®. myMemCheck® evidenced adequate reliability (test-retest, r = 0.67) and strong construct validity (η2 = 0.29, discriminating normal, MCI, dementia). Receiver operating characteristic analysis evidenced an optional myMemCheck® cut score for identifying older adults with MCI or dementia (sensitivity = 0.80, specificity = 0.67, positive predictive value = 0.91, negative predictive value = 0.43). myMemCheck® explained 25% of cognitive status beyond basic patient information. We provide specific suggestions for integrating myMemCheck® into practice to optimize workflow. Study results are further interpreted in the context of two national online surveys (healthcare professionals, N = 181; consumers, N = 1740). Healthcare professionals widely agreed on the need (94%) and importance (86%) of cognitive self-assessments. Public demand for cognitive self-assessment was confirmed by consumers who trialed myMemCheck® as part of their survey participation—86% agreed on the need for a tool like myMemCheck®. Mixed methods findings suggest that myMemCheck® could fast- track the diagnostic process, facilitate appropriate referrals for cognitive and neuropsychological evaluation, reduce assessment burden in healthcare, and prevent negative outcomes associated with undetected cognitive impairment.
Frailty Modifies Effects of Chair Yoga on Chronic Pain in Older Adults With Osteoarthritis
Authors: Park Juyoung , Liu Zuyun
Published: December 2020

As a secondary analysis, this study used data from our previous 8-week chair yoga (CY) intervention trial with two-arm, access-blinded randomized controlled trial to examine modifying effect of baseline frailty on intervention effects of CY on pain and pain interference (i.e., consequences of pain on relevant aspects of life). Using the cumulative frailty index (FI) approach, we constructed the FI using 82 comprehensive deficits, including physical function, balance, fatigue, emotional well-being, and social activity. We calculated FI at baseline, 4 weeks, and 8 weeks. A linear mixed-effects model with random intercept was used, adjusting for research sites, cohort effect, and time. To test for potential modifying effects of baseline FI on the intervention effect by CY, we added a three-way interaction term: intervention (CY vs. Health Education Program), time, and baseline FI. A total of 112 participants (M = 75.3[7.5] years; 76% female, 40% White, 46% Hispanic) completed the study. Each 0.01 increment in baseline FI was associated with higher pain (β = 0.28, p < .001) and pain interference (β = 0.51, p < .001). There was a significant interaction effect among intervention, time, and baseline FI (p = .02 for pain, p = .01 for pain interference), indicating that participants with higher levels of baseline FI had greater declines in pain and pain interference. Frailty modified the intervention effect of CY on pain in older adults with lower extremity osteoarthritis, underscoring the importance of assessing frailty to improve management of pain in the population.
Best Practices for Including Individuals With Dementia as Research Participants
Authors: Judge Katherine , Minyo Morgan , MacNeil Amanda , Grant Claire , Lucas Kaitlyn
Published: December 2020

Including individuals with dementia as participants in research studies can be a challenge given the cognitive symptoms experienced, including difficulties with attention, memory, language, and executive functioning and behavioral symptoms, such as agitation and frustration. Researchers, however, have begun to include individuals with dementia as more active participants in the research process. Specifically, individuals with dementia have provided self-report information about their illness experience, including how they cope and manage with their illness and how illness-related strains are related to psychosocial outcomes. Researchers also have starting using self-report data collection protocols instead of proxy-report measures to assess the impact of non-pharmacological interventions developed for individuals with dementia on well-being outcomes such as depressive symptoms, unmet needs, and relationship strain. To date, however, there are no clear guidelines or ‘best practices’ to assist researchers in developing study protocols that facilitate the inclusion and participation of individuals with dementia. This poster will present findings from a systematic literature review of studies that have successfully included individuals with dementia as research participants. Key areas examined include: 1) the focus and type of research question studied; 2) the use and type of cognitive screening tools for determining study eligibility; 3) implementation of qualitative versus quantitative research designs; 4) objective versus subjective measures; 5) data collection tools; 6) psychometric evidence of data obtained; and 7) how data have been analyzed. Findings highlight the importance of collecting data directly from individuals with dementia to further understand the illness experience and assess the impact of non-pharmacological interventions.
Social Engagement and Cognitive Health: The Mediating Role of Cognitive and Physical Activity
Authors: Amano Takashi , Morrow-Howell Nancy , Park Sojung , Carpenter Brian
Published: December 2020

This study aimed to assess the association between social engagement and conversion from Cognitive Impairment No Dementia (CIND) to dementia and to investigate the mediating role of cognitive and physical engagements on that relationship. Data from two waves (2010 and 2014) of the psychosocial and core modules of the Health and Retirement Study (HRS) were used. The sample consisted of 929 people who had CIND in 2010 and participated in the survey in 2014. Latent Class Analysis (LCA) with eight indicators of social engagement (activities with children, volunteering with youth/others, attending educational course/organization, meeting up, speaking on the phone, writing or emailing) found three groups: formal and informal social engagement (20.7%), informal social engagement only (48.9%), and low social engagement (30.5%). Binary logistic regression analysis showed sub groups with higher levels and greater variety of social engagements were associated with lower probability of conversion to dementia in four years. Path analysis with structural equation modeling (SEM) framework showed the relationship between patterns of social engagement and lower conversion to dementia was mediated by having higher engagement in cognitive activities (e.g. home maintenance, playing sports), but not by engagement in physical activities (e.g. playing games, using computer). Results from this study implied (1) promoting active social engagement may be a promising intervention to prevent or delay conversion from CIND to dementia, and (2) promoting social engagement may be a particularly effective and efficient strategy since it promotes other activity engagements that may itself prevent or delay conversion from CIND to dementia.
Cognitive Performance in Older Adults With Subjective Cognitive Decline
Authors: Taler Vanessa , Morrison Cassandra , Sheppard Christine
Published: December 2020

Subjective cognitive decline (SCD) refers to a perceived decline in cognitive function in the absence of neuropsychological deficits. Older adults with SCD are at increased of subsequent development of mild cognitive impairment or dementia. We had 224 adults aged 65+ complete questionnaires assessing their subjective appraisal of their cognitive function, including questions about word-finding difficulty, memory, and attention/concentration. Participants also completed the Montreal Cognitive Assessment (MoCA). All participants exhibited cognitive performance that was within normal limits for age and education. In total, 29.5% of participants reported word-finding difficulties, 16.5% reported difficulties with remembering things, and 8.5% reported difficulties with attention/concentration. We found that (1) self-reported word-finding difficulties were associated with lower performance on delayed word recall, and (2) self-reported difficulties in concentration/attention or memory were associated with lower performance on the abstraction subtask in the MoCA. No other MoCA subtasks were associated with self-reported cognitive function. A subset of the participants (n=69) also completed a battery of tasks assessing semantic function, including picture naming, associative matching tasks, identification of semantic features, and semantic questions. Again, self-reported word-finding difficulty predicted lower performance on semantic tasks. These results suggest that older adults may be aware of changes in their cognitive performance prior to objective neuropsychological impairment. Moreover, their awareness appears to be domain-specific: self-reported language difficulty is associated with lower performance on language-based tasks, while self-reported difficulty in memory, attention, or concentration is associated with lower performance on an abstraction task.
Exploring the Benefits of Assistive Devices Use in Older Adults With Impaired Lower Limb Function
Authors: Su Tai-Te , Mejia Shannon
Published: December 2020

Assistive technologies are an essential component of meeting the needs of an aging population. With advancing age, chronic conditions and physiological changes can result in impaired lower limb function among older adults, which may in turn limit their ability to perform daily activities or even walking. Informed by the continuity theory, we conceptualize assistive devices (ADs) as a resource that older adults with mobility limitations can leverage to remain active and mobile in late life. However, evidence remains scarce to determine the extent to which using ADs could create a measurable change in older people’s experienced well-being. Using data from the 2012 wave of the Health and Retirement Study, our study aimed to examine the potential psychological benefits that accompany ADs use in a sample of older adults with at least some limited lower limb mobility (n = 505, 59% female, 85.6% white, age = 75.8 ± 6.7). Results from multiple linear regression showed that although AD use was not directly associated with global well-being, those who used ADs reported more positive experience while walking (b = 0.65, SE = 0.23, p<.01) and traveling (b = 0.92, SE = 0.43, p<.05). Additionally, our results indicated that AD users had higher self-efficacy compared with nonusers (b = 0.40, SE = 0.20, p<.05) after controlling for age, gender, socioeconomic status, as well as physical function level. We suggest that AD provision should be considered in intervention strategies to increase well-being and quality of life in older adults with impaired lower limb function.