bluuebunny/crossref_metadata_2025 huggingface dataset:
Outpatient Physical Therapists Should be Competent in Care of Older Adults: A Total Population Register-Based Study
Authors: Arnadottir Solveig
Published: December 2020

In Iceland, outpatient physical therapy (OPT) is traditionally not focused on older clients. Yet, the Icelandic population is aging as other populations in the world, and national policies endorse aging in place. The objective of this study was to explore 17 years of demographic information on OPT clients and to identify if this information reflects the total population aging. The research was built on 17 years (1999-2015) of complete data from: the Icelandic Health Insurances register with information on the total population of OPT clients (N=172071), and the Statistics Iceland register with demographic information on the total general population. The results revealed that in 1999, older adults comprised 18.3% of all OPT clients, and in 2015 it had increased to 23.5% Therefore, OPTs were 23% more likely to treat an older adult in 2015, compared to 1999 (Risk Ratio [RR] 1.23; 95% Confidence Interval [CI] 1.19-1.27). In the same time period older people became 15% more prevalent in the general population (RR 1.15; 95%CI 1.10-1.21). Linear modelling revealed a yearly 3.45% (95%CI 3.05-3.85) increase from 1999 to 2015 in the overall proportion of older OPT clients. This yearly trend, however, varied depending on age group and sex with the highest yearly increase in the ≥ 85 years old men (9.1%; 95%CI 7.90-10.35). This case of Iceland presents 17 years of continuous growth in older adults seeking OPT service. These findings reinforce an urgent need to enhance the geriatric competence of OPTs, who in their clinical practice frequently encounter older adults.
Effectiveness of a 6-Month Multicomponent Training on Physical Frailty in Older Adults With Cognitive Impairment
Authors: Ribeiro Oscar , Borges-Machado Flavia , Barros Duarte , Carvalho Joana
Published: December 2020

Multicomponent training (MT) that combines aerobic, strength, postural, and balance exercises seems to be safe and effective to prevent and even reverse early stages of frailty, as well as counteract the physical consequences of cognitive impairment. This study analyzes the effectiveness of MT on physical frailty in older adults diagnosed with cognitive impairment. Forty-nine subjects (34 women) diagnosed with mild cognitive impairment (MCI) or dementia were allocated into exercise group (EG; 75.80±6.60 years; age range: 61-90) or a control group (CG; 82.56±5.45 years; age range: 73-90). EG was submitted to a 6-month MT intervention (2x/week, 50min). CG had a monthly recreational session. Sample mean of MMSE at baseline was 21.02 (±4.98). Participants were categorized as frail, pre-frail and robust according to a validated physical performance battery - Short Performance Physical Battery (SPPB). Overall, in baseline there were 12.5% frail and 37.5% pre-frail individuals in the EG group; in the CG there were 36% and 32%, respectively. Data from SPPB total score revealed that EG group increased the performance over time [t(23)=3,94; Δ=1.21 (±1.50); p<0.001], as opposite to CG individuals [t(24)=-2.26; Δ=-0.92 (±2.04); p=0.034]; also, there were 8.3% frail and 29.2% pre-frail in EG, and 40% and 32% in CG after intervention. By improving lower extremity functionality of patients diagnosed with cognitive impairment, MT intervention may be an important non-pharmacological strategy to improve physical frailty status and modify subjects’ condition from frail to pre-frail or even robust. Supported by IPDJ & FCT: CIAFEL (FCT/UIDB/00617/2020), “Body and Brain” (POCI-01-0145-FEDER-031808), PhD Grant (SFRH/BD/136635/2018).
Frailty Change Scores Over Long-Term Follow Up in Patients With Coronary Artery Disease
Authors: Gharacholou Shahyar , Flock Carolyn , Lennon Ryan , Slusser Joshua , Cooper Leslie , Singh Mandeep
Published: December 2020

Background: Frailty assessment has often been performed only at baseline in cohort studies. Little is known regarding factors associated with changes in frailty indices over follow up in patients with coronary artery disease (CAD). Methods: Between 11/2008 - 8/2012, 142 community-dwelling adults ≥65 years of age with prior history of CAD (angina or revascularization) participated in a study of frailty assessment at Mayo Clinic Health System in La Crosse, WI. A sample of participants (n=45) were included for frailty re-assessment using the Fried frailty criteria approximately 5 years after their baseline measures. Frailty classification was based on absence of deficits (non-frail), 1-2 deficits (intermediately frail), or 3 or more deficits (frail). Factors associated with a change in frailty indices were studied. Results: There were 45 patients that had a second assessment of frailty indices. At baseline, 24 patients (60%) were not frail while 16 patients (40%) had at least 1 frail feature. At follow up, 20 patients (50%) were not frail while 20 patients (50%) had a frail feature. Those improving were more often being married, had prior revascularization, and were without angina. Interval development of slower gait speed (r = 0.46; p=0.004) and decreased grip strength (r = -0.39; p = 0.01) were associated with worsening frailty. Conclusions: Older adults with CAD are not often frail by standard criteria; however, incident deficits develop during long term follow-up. Spousal support, absence of angina, and change in functional indices are less often associated with frailty features.
Qigong Exercise in Frailty, Psychological Health, and Spiritual Well-Being of Middle-Aged and Older Blacks
Authors: Chang Pei-Shiun , Lu Yvonne , Ofner Susan , Nguyen Chi
Published: December 2020

Interventions are needed to address the frailty and psychological health in middle-aged and older African Americans. Qigong, a traditional medicine exercise, consists of gentle body movements, breathing exercise, and meditation. The benefits of Qigong exercise have been widely reported in Asian adults but there have been no known studies testing Qigong exercise in the African American population. The purpose of this pilot study was to evaluate the potential benefits of an 8-week Qigong exercise in physical and functional ability, balance, frailty, depression and anxiety, and spiritual well-being in community-dwelling middle-aged African Americans using a single group design. Fifteen African Americans aged 45 to 85 years were recruited to receive Qigong exercise over 16 bi-weekly, one-hour sessions. The Layers Module that unfolds the complex multidimensional benefits of Qigong exercise on physical, mental, and spiritual dimensions was used to guide the outcome measures. Data were collected at baseline and 14 days post intervention. Results showed positive trends in repeat chair stands, physical function, and spiritual well-being (p<0.05) with effect sizes ranging from 0.45 to 0.87. Despite no significance, over 52% of the participants showed improved depression scores, fast gait speed, and standing balance than baseline. Nearly 42% demonstrated some levels of frailty improvement than the baseline. No adverse events related to Qigong exercise intervention was reported. Qigong exercise is a potentially promising intervention which needs further testing in a randomized clinical trial.
Mealtime Care for People With Dementia: What Do Nursing Home Staff Think?
Authors: Faraday James , Abley Clare , Exley Catherine , Patterson Joanne
Published: December 2020

More and more people with dementia are living in nursing homes (NH). Often, they depend on NH staff for help with eating and drinking. It is important that staff have the skills and support they need to provide good care at mealtimes. This qualitative study explores mealtime care for people with dementia, from the perspective of NH staff. Semi-structured interviews with NH staff (n=16) were carried out in two nursing homes. The homes were chosen to have diverse characteristics: one home had a large number of beds and was part of a small local organization; the other had a small number of beds and was part of a large national organization. Various staff members were interviewed, including direct care staff, senior carers, nurses, managers, and kitchen staff. Interviews were audio-recorded and transcribed verbatim. A constant comparison approach was taken, so that data from early interviews were explored in more depth subsequently. From the analysis, five themes emerged as important in mealtime care for people with dementia living in nursing homes: Setting the right tone; Working well as a team; Knowing the residents; Promoting autonomy and independence; Gently persevering. This work forms part of a larger ethnographic study on the topic, which includes data from residents with dementia, and family carers. Results will inform the development of a staff training intervention to optimize mealtime care for this population.
Measuring Adoption of Patient Priorities-Aligned Care Using Natural Language Processing
Authors: Razjouyan Javad , Freytag Jennifer , Odom Edward , Dindo Lilian , Naik Aanand
Published: December 2020

Patient Priorities Care (PPC) is a model of care that aligns health care recommendations with priorities of older adults with multiple chronic conditions. Social workers (SW), after online training, document PPC in the patient’s electronic health record (EHR). Our goal is to identify free-text notes with PPC language using a natural language processing (NLP) model and to measure PPC adoption and effect on long term services and support (LTSS) use. Free-text notes from the EHR produced by trained SWs passed through a hybrid NLP model that utilized rule-based and statistical machine learning. NLP accuracy was validated against chart review. Patients who received PPC were propensity matched with patients not receiving PPC (control) on age, gender, BMI, Charlson comorbidity index, facility and SW. The change in LTSS utilization 6-month intervals were compared by groups with univariate analysis. Chart review indicated that 491 notes out of 689 had PPC language and the NLP model reached to precision of 0.85, a recall of 0.90, an F1 of 0.87, and an accuracy of 0.91. Within group analysis shows that intervention group used LTSS 1.8 times more in the 6 months after the encounter compared to 6 months prior. Between group analysis shows that intervention group has significant higher number of LTSS utilization (p=0.012). An automated NLP model can be used to reliably measure the adaptation of PPC by SW. PPC seems to encourage use of LTSS that may delay time to long term care placement.
The Action Project Method Applied in Nursing Home Settings
Authors: Jensen Charlotte , Gruneir Andrea , Hoben Matthias , Tompalski Jaclyn , Easterbrook Adam , Keefe Janice , Estabrooks Carole , Marshall Sheila
Published: December 2020

The action-project method (APM), developed in counselling psychology and used in various disciplines, has been shown to be useful for understanding major life transitions in different contexts. We argue that the APM is beneficial for studying the impact of nursing home (NH) home admission and daily life of residents and their families/friends. The APM enables researchers to explore how residents and their families/friends experience NH-life at individual and supraindividual levels of analysis. We applied the APM to solicit the views of residents and individuals close to them to understand their priorities for quality care. The APM data collection consisted of three stages. First, a resident and family member or other caregiver met with the interviewer who initiated a conversation about their experience in the NH. The interviewer then left the room but video-recorded the conversation. Second, the interviewer met with each participant to review the video with each participant offering reflection on the original conversation. These sessions were also recorded. Following transcription and analysis of the conversations, 3 lay-language narratives were created: 1 for each individual and 1 for the pair. Third, participants reviewed their own and the pair’s narrative for additional comments. The APM offers a means to give a voice to NH residents and allows for people to talk about their experiences without the presence of a researcher. By using the APM, researchers can break down individual actions of participants and how these actions come together to form the project of navigating care in NHs.
The Columbia Behavior Scale for Dementia: Validity and Reliability in Long-Term Care Settings
Authors: Mansbach William , Mace Ryan
Published: December 2020

Numerous neuropsychiatric inventories have been created for behavioral and psychological symptoms of dementia (BPSD). These inventories are seldom used in long-term care (LTC) settings due to questionable psychometrics, lengthy administration, and reliance on knowledgeable informants. The Columbia Behavior Scale for Dementia (CBS) is a rapidly administered BPSD rating tool that was developed for LTC residents. The 11-item CBS can be completed in less <5 minutes independently, with nursing staff, or in conjunction with interdisciplinary care teams. LTC residents (N = 350) participated in a validation study in Maryland, USA (M age = 78.38, SD = 10.82). Internal consistency (⍺ = 0.75) and inter-rater reliability (r = 0.99) for the CBS were strong. CBS scores were not biased by informant type (p > 0.05): GNAs/CNSs (40.69%), nurses (36.10%), other facility staff (23.21%). Diagnostic validity was confirmed by significantly higher CBS scores (p < 0.001; large effect, d = .63) for LTC residents with dementia (n = 197, M = 4.63, SD = 4.58) versus those without dementia (n = 145, M = 2.17, SD = 2.87). Higher CBS scores were significantly associated with greater impairment on cognitive instruments (r range = -0.25, -.36) and increased mood dysfunction (r range = 0.20, 0.26), indicating convergent validity. Principal components analysis produced three CBS factors, psychosis, aggression, and non-aggressive motor disinhibition, which significantly identified LTC residents with greater odds for antipsychotic use. Results will be discussed in terms of right-sizing antipsychotic utilization, improving nonpharmacological behavior management, and enhancing the dementia literacy of nursing staff.
Association Between Activity Diversity and Frailty in Community-Dwelling Older Japanese: A Cross-Sectional Study
Authors: Takahashi Junta , Obuchi Shuichi , Kawai Hisashi , Ishii Kaori , Oka Koichiro , Fujiwara Yoshinori , Hirano Hirohiko , Ihara Kazushige
Published: December 2020

In addition to intensity and quality, diversity of activity will be an important factor to explain health outcomes among older adults. Few studies, though, examined an association between activity diversity and health outcomes. This study aimed to examine the association between activity diversity and frailty among community-dwelling older Japanese. Participants were community-dwelling older adults who participated in a cohort study, the “Otassya-Kenshin” in 2018 . The participants were asked frequency of 20 daily activities, inside/outside chores, leisure activities with/without physically, direct/indirect contact with friends and so on, in a week and activity diversity score were calculated using the formula of Shannon’s entropy. Frailty was defined by the Japanese version of the Cardiovascular Health Study criteria. The difference in diversity score between frail and non frail were examined by t-test. Logistic regression analysis with covariates, age, sex, economic status, living alone, BMI, Mini-Mental State Examination, and IADL was adopted to find association between activity diversity score and presence of frailty. Of 652 participants (age: 72.8±6.3, women: 60.6%) analyzed, 27 (4.1%) were defined as frail. Frailty group revealed significantly lower activity diversity score than non-frailty group (0.66±0.11 vs 0.75±0.08, P<0.01). 0.2 point of decrease in diversity score increase 5 times chance of frailty after controlling covariates. We found significant relationship between activity diversity and health outcome among older subjects. The activity diversity may provide additional information to number or intensity of activity.
Feasibility of a Group Version of the Lifestyle-Integrated Functional Exercise Program
Authors: Jansen Carl-Philipp , Nerz Corinna , Labudek Sarah , Klenk Jochen , Clemson Lindy , Becker Clemens , Schwenk Michael
Published: December 2020

In a randomised noninferiority trial, it is investigated whether a group version of the Lifestyle-integrated Functional Exercise program (gLiFE) is non-inferior to the individually delivered LiFE in terms of feasibility and effectiveness. While effectiveness evaluation is ongoing, feasibility results are already available. Participants (>70 years; confirmed fall risk) were randomized in either LiFE or gLiFE and participated in the same strength and balance exercises, however, based on different approaches of delivery. LiFE participants received seven home visits; gLiFE was delivered in seven group sessions. Feasibility was defined as willingness to participate, adherence to group/home visits, and drop-outs. Predictors for intention to participate were calculated using regression. N=310 participants were randomized to LiFE (n=156) or gLiFE (n=154). n=51 (16%) of the participants dropped out after baseline. Attendance analyses showed that when excluding drop-outs, 100% (iLiFE) and 88% (gLiFE) took part in at least 5 of the 7 meetings. Self-efficacy and outcome expectancies, but not risk perception, were predictors of the intention to participate (F(3,193)=24.84, p<.001). In this first study comparing a group-based LiFE format with the original LiFE, feasibility of both formats was shown in terms of high attendance and less drop-outs than expected in this target group. Compared to other studies involving group based training, compliance to intervention (defined as having absolved at least 5 sessions) was high in both formats. Lower attendance in gLiFE can be explained by inflexible scheduling as compared to making individual home visit appointments. Whether lower gLiFE adherence translates into lower effectiveness is currently analysed.
Satisfaction With Outdoor Activities Over Time Among Long-Term Services and Supports Recipients
Authors: Sefcik Justine , Hirschman Karen , Petrovsky Darina , Huang Liming , Hodgson Nancy , Behrens Liza , Naylor Mary
Published: December 2020

Approximately 85% of older adults have at least one chronic health condition. The onset of chronic health conditions and mobility issues can constrain activities, including outdoor recreation. There is limited knowledge of older adults receiving long-term services and supports (LTSS) and their satisfaction with outdoor activities over time after enrolling in services. This study examined predictors of change in ratings of satisfaction with outdoor activities. A secondary analysis was conducted of data involving structured interviews with older adults (N=470) over the first two years of receiving LTSS (Health-Related Quality of Life: Elders in Long-Term Care; R01AG025524). Participants lived in assisted living communities, nursing homes, or their home. A single item on satisfaction with outdoor activities (assessed using a 5-point Likert scale: not at all to extremely satisfied) was the primary outcome. Mixed effects linear regression modeling using a backward elimination process was used for building a final multivariable model. In the final model, older age (p<0.001) and higher overall quality of life ratings (p<0.001) at baseline were associated with slower rates of increase in outdoor satisfaction over time. Higher education level (p=0.035) at baseline was associated with a faster rate of increase in outdoor satisfaction over time. Additionally, those who moved into an assisted living community (p=0.024) or nursing home (p=0.016) at baseline were associated with faster rates of increase in outdoor satisfaction over time compared to those in the home. Knowledge of factors influencing satisfaction with outdoor activities can assist interdisciplinary teams implement interventions for individual or organizational changes.
Ambulatory Care Preferences of Older People Age 80 and Over: A Systematic Review of Qualitative Studies
Authors: Herrler Angélique , Kukla Helena , Vennedey Vera , Stock Stephanie
Published: December 2020

According to the United Nations, the number of people aged 80 and over is expected to treble by 2050 globally. But research on the preferences for care of this age group grows slowly. To achieve high-quality patient-centered care, we need to understand the oldest people’s specific living circumstances, care preferences and goals. The aim of the study was to synthesize findings about ambulatory care preferences, experiences and expectations of people aged 80 and over. We systematically searched Medline, CINAHL, PsycInfo, Web of Science Core Collection and Google Scholar for qualitative studies published until October 2019 and additionally conducted forward and backward citation search for included studies. Two independent reviewers assessed studies for eligibility criteria and quality. We performed a thematic synthesis of study findings as developed by Thomas and Harden using MAXQDA-20 content analysis software. Twenty-three studies were included. They were mainly conducted in Europe, used face-to-face interviews, reported on ambulatory home care and used qualitative content or thematic analysis. The meta-synthesis revealed two fundamental themes from the perspective of older people: feeling safe and feeling valued in their relationships with caregivers and in their care environment. This was shown, for instance, in preferences for coordinated care, high continuity of caregivers, personal attention and interactions based on trust and respect. In practice, the older persons’ preferences should be integrated into care planning and policies to ensure patient-centered care.
Care Managers Have Few Options for Home Modification Because They Are Not Specified in Architecture
Authors: Yoshida Kazunori , Harazono Yoritaka , Funaki Toko , Nishino Akiko
Published: December 2020

In this paper, we aim to clarify the cause of the difficulty in home modification. The aging society becomes larger where older people have difficulty in living home because of weakened body functions. To maintain quality of life, it is important to modify houses. In Japan, home modification is conducted by care managers, who are originally from nurses, helpers, and so on. However, to modify houses, we hypothesized that it is needed to have knowledge about not only body function but also architecture. Because of this, home modification should be difficult for care managers. For this problem, we aim to clarify the difficulty in home modification. In November 2018, we took part in the teaching course for care managers about home modification and asked care managers the number of home modification they conducted and what they have difficulty in. As a result, we asked for 57 care managers, who have experience as care managers for 39 months in average. Home modification was mainly conducted for setting handrails (four for a care manager in average). It was also revealed that experience of modification for handrails and doors are larger when the experience of care manager becomes longer, but other modification is not the case. The care managers told us that they cannot understand architecture. This result indicates that care managers cannot think of many options for modification because of their little knowledge about architecture. Therefore, it should be needed to combine the architects and care managers for appropriate home modification.
Urban-Rural Differences in Geodetic Distance Between Home and the Nearest Pharmacy Among Older Pennsylvania Adults
Authors: Khan Shivani , Heller Debra , Latty Leroy , LaSure Michelle , Brown Theresa
Published: December 2020

Aim: We examined differences in geodetic or straight line distance between home and the nearest community pharmacy among rural and urban older adults in Pennsylvania. Method: The addresses of 241,398 older adults (≥65 years) and 2,880 community pharmacies enrolled in Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) program in 2018 were geocoded. We identified pharmacies in the same or adjacent counties for each enrollee and measured the geodetic distance between home and those pharmacies. The pharmacy with the shortest distance from home was identified as the nearest pharmacy for each enrollee. Enrollees’ home addresses were categorized as urban or rural at the county level, based on the Center for Rural Pennsylvania’s definitions. T-tests and chi-squared tests were used for analyses. Results: Overall, 37% were rural older adults and the mean distance between home and the nearest pharmacy was 1.60 ± 2.21 miles. The mean distance between home and the nearest pharmacy was significantly greater in rural compared to urban older adults (2.78 ± 2.93 versus 0.91 ± 1.19; p<.0001). A higher proportion of rural older adults resided >5 miles away from the nearest pharmacy compared to urban older adults (19.19% versus 1.80%; p<.0001). Moreover, 2.96% of rural older adults resided >10 miles away from the nearest pharmacy compared to 0.08% of urban older adults (p<.0001). Conclusion: Older patients in rural counties need to travel longer distances for pharmacy access than in urban counties. Efforts to provide convenient access to medications and pharmacy services for rural older patients are necessary.
Examination of Advanced Function and Its Correlates in a Cohort of Community-Dwelling Older Adults
Authors: Liebzeit Daniel , Kuo Wan-chin , Carlson Beverly , Mueller Kimberly , Bratzke Lisa
Published: December 2020

Function in older adults includes multiple domains, from basic to “advanced,” but we remain limited in detection of advanced function (engagement in social, leisure, and productive activities). The objective is to describe advanced function and examine relationships with basic function and health outcomes in community-dwelling older adults aged 55-65 years. This is an analysis of existing data from a large, ongoing cohort study, The Wisconsin Registry for Alzheimer’s Prevention (WRAP R01 AG027161). We used a 1:1 prospective case–control design to examine whether older adults with lower advanced function (lower functioning group) at wave 3 showed lower IADLs and poorer health outcomes in wave 4, compared to those with higher advanced function (higher functioning group). The lower functioning group had a mean advanced function score of 74.4 (SD = 10.1), compared to 98.7 (SD = 11.1) in the higher functioning group. The mean IADL scores were similar in the two groups (p = 0.123). The lower functioning group had significantly lower self-rated health (mean = 3.52; SD = .79) than higher functioning group (3.70; 0.79) and a significantly lower proportion of individuals with unimpaired, stable cognition (77%) than the higher functioning group (85%). The lower functioning group had higher rates of comorbidities (4.25 vs. 3.96), mortality (4 vs. 1), and depressive symptoms (CES-D: 7.17 vs. 6.09), although results were not significant at α=0.05. This study provides a foundation for examining advanced function, which may be an early indicator of poor health outcomes in older adults.
Developing an RAI-MDS Behavior-Based Pain Scale for Long-Term Care Residents With Advanced Dementia
Authors: Knopp-Sihota Jennifer , Hoben Matthias , Poss Jeff , Estabrooks Carole
Published: December 2020

In Canadian and many international long-term care (LTC) facilities, pain assessment frequently relies on data from the Resident Assessment Instrument – Minimum Data Set 2.0 (RAI-MDS). The RAI-MDS produces a two-item scale, measuring both pain frequency and pain intensity. This scale correlates well with self-reported pain in cognitively intact LTC residents, but despite repeated testing, is less valid for use in residents with more advanced cognitive impairment who are unable to self-report their pain. In this study we aimed to develop and validate a behaviour-based pain assessment scale for long-term care residents using data available in the RAI-MDS. To construct our initial scale, we reviewed the literature and compiled a list of observable indicators of pain (e.g., grimacing) and linked these with 28 similar items available in the RAI-MDS. Using Delphi techniques, we further refined this to 20 items. We then evaluated the psychometric properties of our scale using two independent, representative samples, of urban LTC residents in Western Canada. Exploratory factor analyses were conducted in sample one (n=16,282) and confirmatory factor analyses (CFA) were then conducted in sample two (n=15,785) in order to test, and confirm, our model. A two-factor solution was identified grouping RAI-MDS items into subscales 1) change in status (e.g., new onset restlessness) and 2) behaviours (e.g., crying). Commonly recognized model fit indices were acceptable suggesting the adequacy of the two-factor solution. Results provide preliminary support for the use of behavioural-based pain assessment scale using RAI-MDS data. Further evaluation and validation of our scale is warranted.
Ideal Cardiovascular Health Is Associated With Slowness Among Community-Dwelling Older Adults
Authors: Jung Heeeun , Kim Miji , Shim Hayoung , Seo Yuri , Lee Seoyoon Jane , Won Chang Won
Published: December 2020

Slowness is associated with increased disability and mortality in older people. However, the relation between ideal cardiovascular health (CVH) and slowness in community-dwelling older adults is uncertain. We examined the prevalence of ideal CVH in Korean older adults and its association with slowness in community-dwelling older adults. We analyzed 2,597 participants (mean age 76.0±3.9 years, 54.4% women) without cardiovascular disease from the Korean Frailty and Aging Cohort Study. The usual gait speed over a distance of 4 m was measured using an automatic timer, and slowness was defined as a speed <1.0 m/s. Ideal CVH was described as attainment of ideal health behaviors (no smoking, regular physical activity, ideal body mass index, and healthy diet) and optimal health factors (blood pressure, HDL-cholesterol, and glycated hemoglobin). Multiple logistic regression analysis was used to examine the association between the CVH score and slowness. Ideal CVH was present in 785(30.2%) subjects. Considering those with poor level of CVH were as the reference group, the odds ratios [OR] for slowness were 0.55 (95% confidence interval [CI], 0.39-0.77) for those with intermediate level of CVH, and 0.28 (95% CI, 0.17-0.45) for those with ideal level of CVH after adjustment for potential confounders. Among ideal CVH components, behavioral CVH score (OR 0.65, 95% CI 0.58-0.74) was significantly associated with slowness vs. the biological CVH score (OR 0.95, 95% CI 0.84-1.07). This study indicates that ideal CVH is significantly associated with a lower risk of slowness in community-dwelling older adults. A better CVH may help prevent slowness.
Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population-Based Survey
Authors: Sharma Rahul , Lalwani Anil , Golub Justin
Published: December 2020

The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aimed to model the progression and asymmetry of hearing loss in the older old using a representative, national database. This was a cross-sectional, multicentered US epidemiologic analysis using the National Health and Nutrition Examination Study (NHANES) 2005-2006, 2009-2010, and 2011-2012 cycles. Subjects included non-institutionalized, civilian adults 80 years and older (n=621). Federal security clearance was granted to access publicly-restricted age data. Outcome measures included pure-tone average air conduction thresholds and the 4-frequency pure tone average (PTA). 621 subjects were 80 years old or older (mean=84.2 years, range=80-104 years), representing 10,600,197 Americans. Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year2 (95% CI = 0.0049, 0.0055). Compounded over a lifetime, the velocity of hearing loss would increase five-fold, from 0.2 dB loss/year at age 20 to 1 dB loss/year at age 100. This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. There was no change in the asymmetry of hearing loss with increasing age over 80 years (linear regression coefficient of asymmetry over age=0.07 (95% CI=-0.01, 0.24). In conclusion, hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100, becoming near-universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.
Self-Reported Uptake of Clinical Preventive Services by Vision Impairment Status
Authors: Assi Lama , Shakarchi Ahmed , Sheehan Orla , Reed Nicholas , Swenor Bonnielin
Published: December 2020

Disease prevention is central to healthy aging. People with vision impairment are more likely than those without to report barriers to accessing health care and have unmet health care needs. We examined the association between functional vision impairment and preventive care uptake among adults aged 65 years and older in the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey. The outcome of interest was being up-to-date with the recommended core clinical preventive services, as defined by Healthy People 2020: influenza and pneumococcal vaccination, and colorectal cancer screening for men, with the addition of breast cancer screening for women. Self-reported vision impairment was defined as blindness or serious difficulty seeing, even when wearing glasses. In models adjusted for sociodemographic characteristics (including age), access to care, and health/functional status, there was no difference in the odds of reporting being up-to-date with the recommended core preventive services among men with vision impairment compared to those without (odds ratio [OR]=0.90, 95% confidence interval [CI]=0.8-1.01); however, men with vision impairment were 0.82 times (95% CI=0.71-0.94) less likely than those without to report being up-to-date with colorectal cancer screening. Women with vision impairment were less likely than those without to report being up-to-date with the recommended core preventive services (OR=0.77, 95% CI=0.69-0.87); among the different services, the odds were lowest for reporting breast and colorectal cancer screening. These findings suggest that to achieve higher rates of preventive care uptake, especially cancer screening, older adults with vision impairment may be a special group to target.
The Association of Sensory Impairment With Incident Disability-Related Cessation of Employment in Older Adults
Authors: Shakarchi Ahmed , Morales Emmanuel Garcia , Reed Nicholas , Swenor Bonnielin
Published: December 2020

Sensory impairment (SI) is common among older adults, and it is an increasingly important public health challenge as the population ages. We evaluated the association between SI and incident disability-related cessation of employment in older adults using the population-based Health and Retirement Study. Participants employed in 2006 completed biennial interviews until self-reported incident disability-related cessation of employment. Participants were censored at loss to follow-up, retirement, or 2018. Participants rated their vision and hearing, using eyeglasses or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, excellent). SI was defined as poor or fair ability, and SI was categorized as neither SI (NSI), vision impairment alone (VI), hearing impairment alone (HI), and dual SI (DSI). Cox proportional hazard regression assessed the association between SI and incident disability-related cessation of employment, adjusting for demographic and health covariates. Overall, 4726 participants were included: 421 (8.9%) were with VI, 487 (10.3) with HI, and 203 (4.3%) with DSI. Mean age was 61.0 ± 6.8 years, 2488 (52.6%) were women, and 918 (19.4) were non-White. In the fully adjusted model, incident disability-related cessation of employment over the 12-year follow-up period was higher in VI (Hazard Ratio (HR)=1.30, 95% confidence interval (CI)=0.92, 1.85), HI (HR=1.60, CI=1.16, 2.22), and DSI (HR=2.02, CI=1.38, 2.96). These findings indicate that employed older adults with SI are at increased risk of incident disability-related cessation of employment, and that older adults with DSI are particularly vulnerable. Addressing SI in older adults may lengthen their contribution to the workforce.
Attitudes and Intention to Work With Older Adults by USA and Israeli Nursing Students: Measure Adaptation and Testing
Authors: Van Son Catherine , Zisberg Anna , Shulyaev Ksenya
Published: December 2020

More nurses are needed to meet the healthcare needs of older adults. Valid and reliable measures are lacking that assess attitudes and intentions of nursing students to select a career in geriatrics. This paper discusses the applicability of the Carolina Opinions on Care of Older Adults (COCOA) instrument on attitudes towards and intention to work with older adults among nursing students. A cross-sectional survey design was used with samples of nursing students from the United States (N=122) and Israel (N=109). Students completed the COCOA instrument and the measure’s dimensionality, construct validity, reliability and equivalence among the nursing students was tested. Exploratory Factor Analysis (EFA) produced 5 factors explaining 59% of the variation with most of the items (17, 71%) loading above 0.40 on subscales according to the instrument’s original structure. Four items loaded on different subscales than originally described. One original subscale was eliminated (Value of Older Adults), and one new subscale was created (Older versus Younger Adults). The reliability scores were good to acceptable for all subscales (.60 - .80). Confirmatory FA supported the data’s fit to the modified COCOA instrument (CMIN/DF=1.55, CFI=.93, IFI=.93, RMSEA=.05). The analysis of model equivalence for USA and Israeli samples revealed significant differences attributed to Experience in Caring for Older Adults subscale. The modified COCOA instrument demonstrated good construct validity and reliability and can serve as estimation of nursing students’ attitudes towards older adults and intention to choose geriatrics as a career. Further studies are needed to test its predictive validity.
Leveraging Prehospital Care to Address Elder Mistreatment: Development of an Online Training for EMS
Authors: Haggerty Kristin Lees , Miller Melanie , Wardlaw Dana , Myint-U Athi , Campetti Randi , Cannell Brad , Lees Kristin
Published: December 2020

Elder abuse affects an estimated 1 in 10 older adults in the US and has devastating consequences for their health and well-being yet is widely under-recognized. Prehospital emergency medical service (EMS) providers are particularly well-positioned to identify older adults who are at risk of or experiencing mistreatment, and to report and intervene as appropriate. However, many EMS providers across the country lack the training and tools required to facilitate consistent identification and intervention. Recognizing the critical need for easily accessible, comprehensive, and relevant training, Education Development Center received funding from RRF Foundation for Aging to develop and pilot test the Elder Mistreatment EMS Training Curriculum (EM-ETC). The EM-ETC aims to improve identification, referral, and linkage to coordinated care and support services for older adults who are at risk of mistreatment. In this presentation, we will describe our iterative and collaborative process for developing an interactive online training program for EMS providers. The training leverages the unique circumstances of prehospital care to prepare EMS providers to recognize and respond effectively to elder abuse and help them to fulfill state licensing requirements. We will present findings from our formative research comprising consultation with subject matter experts and state offices of EMS education, focus groups with EMS and Adult Protective Services providers, and user testing with EMS providers.
Activity and Cognition in Older Adults With and Without Sleep Apnea
Authors: Mattek Nora , Kaye Jeffrey , Beattie Zachary
Published: December 2020

Many older adults have sleep apnea. It often goes undiagnosed. Sleep apnea is associated with decreased oxygen to the brain, fragmented sleep, shorter sleep duration, impaired cognition, increased risk for dementia, and less clearance of amyloid and tau. Little longitudinal data are available identifying objective measures of sleep apnea over time that may facilitate improved identification of affected persons. One hundred ninety-five participants age 57 or older were enrolled as part of Collaborative Aging Research using Technology (CART) initiative, a national study examining the feasibility of unobtrusive remote sensing and monitoring of cognitive, behavioral, physiological, and health-related activities. Nightly hours of sleep and total daily step count were acquired using a wrist worn device. Sixty (31%) reported having sleep apnea. Those with sleep apnea had a significantly lower MoCA total score than those without (22.9 vs. 24.2, p<0.01) and were more likely to be classified as MCI by MoCA cutoff <23 (49% vs. 24%, p<0.001). Volunteers who live alone were less likely to be diagnosed with sleep apnea (p<0.01). Males were much more likely to report having sleep apnea than females (p<0.0001). Of those with watch-derived activity data, sleep apnea cases had shorter mean sleep duration (7.2 vs. 7.8 hours, p=0.05) and fewer total daily steps than those without sleep apnea (2384 vs 3327, p=0.04). Sleep apnea may be identified by its association with mildly impaired cognition, with shorter sleep duration, and less total daily activity as measured at home via remote continuous monitoring techniques.
Moderating Effect of Age on the Relationship Between Patient Activation and Diabetes Self-Care Activities
Authors: Kim Suhyun
Published: December 2020

Purpose: The purpose of the study was to identify the moderating effect of age on the relationship between patient activation and diabetes self-care activities among Korean patients with type 2 diabetes mellitus. Methods: For the cross-sectional correlational study utilizing secondary data analysis, 155 patients diagnosed with type 2 diabetes were divided into two age groups: < 65 and ≥ 65 years. Original data were collected in ambulatory endocrinology units of two tertiary hospitals in South Korea from September 2016 to July 2017. Multivariate regression analyses were used, including interaction variable to detect a moderating effect of age group. Results: The level of diabetes self-care activities was similar between patients aged 65 or over and those aged less than 65 (with the possible range from 0 to 7) (3.71±1.22 vs. 3.53±1.20, t = -0.58, p = .561). Patient activation level was lower for patients aged 65 or over than those aged less than 65 (with the possible range from 0 to 100), but there was no statistical difference (61.54±4.01 vs. 68.66±16.45, t =1.68, p = .095). In multiple linear regression analysis, there was a significant interaction effect of age group (≥ 65 vs. < 65 years) and patient activation on diabetes self-care activities, controlling for the demographic and clinical variables (standardized beta = -.69, p = .021, 95% CI [-.08, -.01]). Conclusion: To encourage diabetes self-care activities, it is necessary to consider the limited effect of patient activation level for patients with type 2 diabetes aged 65 or over.
The Acceptability of Technology in Health Care Among Older Korean Adults With Multiple Chronic Conditions
Authors: Ha Ji Yeon , Park Hyeyoung
Published: December 2020

Background: Although there are benefits in utilizing ICT in health care, older adults have challenges in employ technologies in their health care management due to the changes in cognitive and physical functions, low motivation to use technology, and low computer/internet literacy (Adebayo et al, 2017; Wildenbos et al, 2018). The purpose of this study is to investigate the acceptance of technology among older Korean adults with multiple chronic conditions and examine factors associating with the acceptance of the technology. Method: The participants were 226 community-dwelling older adults who have more than two chronic conditions. Directed by the senior technology acceptance model (Chen & Chan, 2014), demographics, gerontechnology self-efficacy, gerontechnology anxiety, facilitating conditions, self-reported health conditions, cognitive ability, social relationship, attitude to life and satisfaction, physical functioning, and acceptance of technology were surveyed using a self-reported questionnaire. Findings: Older Korean adults with multiple chronic conditions showed a moderately high technology acceptance score (M = 25.35, SD = 5.28). There were significant differences in the acceptance of technology depending on age (r=-0.241, p<.01), cognitive ability (r=0.225, p<.01), gerontechnology self-efficacy (r=0.323, p<.0001), and facilitating conditions (r=0.288, p<.0001). Conclusion: While older age were associated to the acceptance of technology, gerontechnology self-efficacy which is one’s judgment of their ability to perform a task successfully using gerontechnology and facilitating conditions which are environmental factors that help older adults use gerontechnology easier were positively associated with the acceptance of technology among older Korean adults with multiple chronic conditions.
Altered Febrile Responses in Older Adults: A Systematic Review
Authors: Holtzclaw Barbara
Published: December 2020

Human and animal studies support generalizations that older adults are less able than younger adults to mount an effective febrile response. Beyond difficulties this presents for assessing signs and symptoms of infection, concern exists that older adults may lack fever’s protective immuno-stimulant benefits. Fever is a systemic physiological host response to a pyrogen resulting in release of proinflammatory cytokines that produce a regulated elevation of thermoregulatory set-point. Heat is generated, by shivering and molecular activity, and conserved, by vasomotor activity, elevating and maintaining body temperature at the higher set-point level. Because immunological, vasomotor, and kinetic activities raise body temperature, age-associated alterations have been hypothesized to explain blunted febrile responses in older adults. Purpose: A systematic review was done to 1) determine factors underlying presumed origins and alterations in older adults’ febrile responses. 2) assess for gaps and controversies in emerging research that could inform care decisions. Comparisons of disciplinary assumptions, perspectives, and cross-disciplinary interpretations sought relevance to interdisciplinary care. Methods: Search of literature databases: Medline (OVID), and CINAHL (EBSCO). PubMed, and included relevant animal and human research findings since 2000 from physiology, gerontology, immunology, infectious disease, clinical medicine, and nursing. Findings: Altered innate immunity in sepsis shows early hyper-reactive response, prolonged inflammatory activity, and fever response contributing to cardiovascular and neurological morbidity, not temperature elevation. Morbidly was attributed to disease not age. Conclusions: Hazards of blunted febrile temperatures include undetected infections and possible loss of immune benefits. Significant evidence of age-related diminished febrile temperature’s immune consequences shown with animal models.