bluuebunny/crossref_metadata_2025 huggingface dataset:
DETERMINANTS OF QUALITY OF LIFE IN COMMUNITY-DWELLING OLD ADULTS
Authors: Ramel Alfons
Published: November 2019

Background: Quality of life (QoL) has been regarded as a critical predictor of successful aging in gerontological research. Aim: The aim of this study was to examine the associations between physical activity, muscle strength, body composition, physical-/cognitive function and disease with quality of life community-dwelling older adults. Methods: Participants (N=225, 73.7±5.7yrs, 58.2% female) from the Reykjavik capital area in Iceland took part in this cross-sectional study. Socioeconomics, QoL, body composition, muscular strength, timed up and go test (TUG), six minute walk for distance (6MWD) and disease related information were measured. Fasting blood samples were analyzed for routine clinical measures. Results: In our subjects, only 19.1% had QoL below the age and gender corrected norm score of 50. A simple comparison between subjects with QoL below 50 vs subjects with a score above 50 indicated that participants with higher QoL had higher physical and cognitive function, higher muscular strength, lower blood glucose, exercised more and used a lower number of medicines. Differences in education, smoking, alcohol consumption, dietary intake and gender distribution were not significant. According to age and gender corrected linear models, TUG (B=-0.54,P=0.022), number of drugs (B=-0.67,P=0.018) and fasting glucose (B=-0.96,P=0.025) were the strongest independent correlates of QoL. In the models insulin/glucose and TUG/6MWD were interchangeable. Conclusion: Physical function, number of drugs and glucose metabolism are independently related to QoL and represent therefore potentially modifyable targets for future interventions in order to improve QoL in community dwelling old adults.
LIVING ALONE IS ASSOCIATED WITH POORER PHYSICAL FUNCTION AND BONE MINERAL DENSITY IN ICELANDIC OLD ADULTS
Authors: Ramel Alfons
Published: November 2019

Background: Loneliness and living alone have been significant public health concerns among older adults given their association with a wide range of adverse health outcomes. Aim: The aim of this study was to examine whether living alone is associated with physical function and bone health in community-dwelling older adults. Methods: This was a secondary analysis of existing cross-sectional data of old adults (N=182, 73.7±5.7yrs, 58.2% female) from the Reykjavik capital area in Iceland. Information on socioeconomics, health, dietary intake and physical function was collected. 25-hydroxy-vitamin D (25OHD) and bone mineral density (BM were grouped retrospectively into “living alone” and into “in cohabitation”. Results: Of our subjects, 76.4% were in cohabitation and and 23.6% lived alone. Participants who lived alone were older (74.5±5.6 vs. 72.1±5.0,P=0.008) and more often female (74.4 vs. 53.2%,P=0.014), but there were no differences in education, smoking, number of medications, physical activity (PA) or body mass index (BMI). According to age and gender corrected analyses, participants in cohabitation had higher grip strength (6.2±2.4lb,P=0.011), higher 25OHD (13.1±6.3nmol/L,P=0.037) and higher BMD (z-score lumbal: 1.195±0.417,P=0.005; z-score femur: 0.421±0.219,P=0.054; z-score total: 0.846±0.290,P=0.004). Statistical correction for PA, BMI, education and fish oil intake did not change the results. Conclusion: In comparison to old adults who live in cohabitation, Icelandic old adults who live alone have poorer physical function, lower 25OHD and lower BMD, which increases their risk for wrist or hip fracture. These differences between groups were not explained by physical, dietary or social confounding variables.
LONGITUDINAL RELATIONSHIP BETWEEN ENERGY UTILIZATION AND PHYSICAL AND COGNITIVE PERFORMANCE AS A FUNCTION OF AGE
Authors: Kuo Pei-Lun , An Yang , Gross Alden , Simonsick Eleanor M , Resnick Susan M , Schrack Jennifer A
Published: November 2019

Energy utilization, which becomes more inefficient with age and is measured by a ratio of energy-cost-to-energy-capacity (“cost-ratio”), has been associated with functional decline. However, the interplay between longitudinal changes in energy efficiency and physical/cognitive functioning remains unclear. We investigated this relationship in 1020 participants of the Baltimore Longitudinal Study of Aging (baseline age: 68.9 (IQR: 59.8, 80.5), male: 44.7%). In linear mixed effects models adjusted for baseline age, sex, and height, an increasing cost-ratio was associated with faster decline in usual gait speed among those aged 50-64 years (beta = -0.20 m/s, p = 0.003), and >=65 years (beta = -0.16 m/s, p less than 0.001), but not those less than 50 years (beta = -0.22 m/s, p = 0.178). In models adjusted for baseline age, sex, race, and years of education, higher cost-ratio was associated with faster declines in executive function, as measured by time to finish Trail B, among those aged >=65 years (beta = 22.96 seconds, p = 0.020), but not <50 years (beta = -13.65 seconds, p = 0.557) or 50-64 years (beta = -15.61 seconds, p = 0.353). Together, these results suggest that energy utilization becomes more inefficient in the two to three decades prior to change in physical and cognitive functioning, implying it may act as an early marker of physiological aging. Further research is needed to understand the drivers of energy inefficiency, which may shed light on the biological mechanisms contributing to these declines.
SENSITIVITY OF SELF-REPORTED COMORBIDITIES COMPARED TO MEDICARE CLAIMS IN OLDER ADULTS WITH TRAUMATIC BRAIN INJURY
Authors: Vadlamani Aparna , Albrecht Jennifer
Published: November 2019

Patient reported history of comorbid illness may be the only information available to the treatment team during an acute injury admission. Nevertheless, acute injury, particularly traumatic brain injury (TBI) which affects cognition, may decrease the patient’s ability to accurately report medical history. Thus, the objective of this study was to evaluate the accuracy of patient-reported comorbid illness burden compared to the patient’s Medicare administrative claims. Records of older adults treated for TBI at an urban level 1 trauma center 2006-2010 were linked to their Medicare administrative. Comorbidities were recorded in Medicare claims based on ICD9 codes and were reported in the trauma registry (TR) based on patient medical history recorded by a physician or nurse. Prevalence of each of the following comorbidities was calculated using information from the TR and claims: Alzheimer’s disease and related dementias, chronic kidney disease, COPD, heart failure, diabetes, depression, stroke, and hypertension. Sensitivity of each patient-reported comorbidity was calculated using Medicare claims as the gold standard. We identified patient factors associated with accurate self-report using logistic regression. Among 408 older adults with TBI that linked to their Medicare claims, prevalence of each comorbidity was higher in Medicare claims compared to the TR, except for hypertension. Sensitivity for detecting these comorbidities using the TR ranged from 2% to 68%, with the highest sensitivity observed for hypertension. Older age and race were predictors of less accurate reported medical history. Reconciling self-reported patient history of these comorbidities with those reported in claims can better inform decisions regarding treatment.
TOWARD AN OPERATIONAL DEFINITION OF COGNITIVE LIFESTYLE: MODELING RESERVE ACROSS THE LIFESPAN
Authors: Swann Lisa , Matthews Fiona E
Published: November 2019

A recent systematic review of current definitions of cognitive reserve across the lifespan was undertaken by our group and five reserve constructs were identified: Educational attainment, sociological position, occupational complexity, cognitive ability, and engagement in leisure activities. The aim of this study was to test whether the different constructs are predictive of cognitive performance in older adults. A theoretical model of cognitive lifestyle was designed to assess reserve across the lifespan and the different measures were mapped in individuals aged >=65 years (N=7,762; 54.47% women) from the Cognitive Function and Ageing Study (CFAS II). Multivariable logistic regression analyses, controlling for age and sex, were used to determine the relationship between later life cognitive function and the five identified measures of reserve. In support of previous findings, the results show that risk of cognitive decline decreases with additional education (OR=0.89; 95% CI= 0.86, 0.94), increasing fluid intelligence (OR=1.00; 95% CI= 0.99, 1.00), and participation in leisure activities (OR= 0.27; 95% CI=0.17, 0.42), and that the lower the hierarchical position of a person’s social strata, the greater their odds of cognitive impairment in later life (OR=1.02; 95% CI=1.00, 1.05). However, though greater occupational complexity with data (OR=1.11; 95% CI=1.03, 1.19) and with people (OR=1.10; 95% CI= 1.03, 1.19) was found to be protective of cognitive decline as expected, greater occupational complexity with things was associated with greater decline (OR=0.98; 95% CI=0.93, 1.04). Given the cross-sectional nature of the present study, further longitudinal work is needed to ascertain what is driving these results.
HOW NETWORKS OF MEDICARE BENEFICIARY PATIENT TRANSFERS AFFECT HOSPITAL C. DIFFICILE OUTBREAK RISK
Authors: Cohen Catherine C , Muggy Timothy Luke
Published: November 2019

Clostridium difficile (CDI) is the most common healthcare associated infection (HAI), and it causes particularly high morbidity and mortality among older adults. While risk factors for this deadly HAI have been explored at the patient and facility levels, less is known about transmission between facilities. Recent literature suggests that more patient transfers to a hospital are correlated with elevated CDI levels. However, this work excludes skilled nursing facilities (SNFs), although SNFs are a major contributor of older adult patients to hospitals. We use multiple large data sets to make progress in filling several existing knowledge gaps. First, we construct and analyze healthcare facility networks using transfers of Medicare beneficiaries in the Minimum Data Set 3.0 and Medicare claims data from New Mexico, New York, Connecticut, and Colorado. We evaluate the role of SNFs in networks through the volume and frequency of patient flows in and out of individual hospitals. We also assess the level of interaction (i.e., transfers) between facilities of different sizes, locations, and types. Second, using the Healthcare Cost and Utilization Project State Inpatient Databases, we examine whether a hospital CDI outbreak is predictive of CDI incidence across a network of hospitals, using multiple existing metrics of CDI incidence, noting strengths and weaknesses for each. These two aims lay the foundation for future work to examine the relationship between patient transfers and the distribution of outbreaks. Such work may be able to identify facilities that present the greatest CDI risk to older adults across a facility network.
TEMPORAL TRENDS IN INCIDENCE RATES OF VISION IMPAIRMENT AMONG MIDDLE-AGED AND OLDER CHINESE
Authors: Cao Gui-Ying , Yao Shan-Shan , Chen zi-shuo , Huang Zi-Ting , Xu Beibei
Published: November 2019

This study aimed to investigate temporal trends in the incidence rates (IRs) of vision impairment (VI) and explore its associated factors among middle-aged and older Chinese. Data were obtained from China Health and Retirement Longitudinal Study (CHARLS, 2011-2015) and Chinese Longitudinal Healthy Longevity Survey (CLHLS, 1998-2014). There were 20,467 participants with a mean age of 57.4 years from CHARLS and 21,210 participants with a mean age of 90.0 years from CLHLS. Distance and near vision were self-reported in CHARLS and performance-based vision was assessed in CLHLS. Crude and age-adjusted IRs per 1,000 person years (PY) of distance vision impairment (DVI), near vision impairment (NVI) and both distance and near vision impairment (DNVI) in CHARLS and VI in CLHLS were calculated for each wave of surveys. Risk factor adjusted temporal trends in the incidence were examined using regression models. Age-standardised IRs for DVI, NVI and DNVI significantly decreased from 79.4 to 41.2, 95.1 to 48.0 and 40.0 to 21.3 (P < 0.001) from 2013 to 2015, respectively. Male gender, higher education, no ADL disability, no depression, no multimorbidity were associated with lower IRs of DVI, NVI or DNVI. Younger age was associated with lower IRs of DVI and DNVI but higher IRs of NVI. Age-standardised IR of VI significantly decreased from 131.6 to 71.9 (P = 0.010) from 2000 to 2014, and higher education and living in the South were associated with lower IR of VI. Future studies may further investigate the causality of such phenomenon.
CHARACTERISTICS OF CAREGIVERS WITH FAMILY CONFLICT
Authors: Dieker JoAnna , Bacharz Kelsey , Weber Kendall , Qualls Sara H
Published: November 2019

The family environment is often overlooked in caregiver research and assessment, despite having implications for caregiver health and well-being (Zarit et al., 2019). The purpose of the present study was to examine differences on two types of family conflict (beliefs and support) among a diverse sample of caregivers. The present sample consisted of help-seeking (n = 375) and non-help-seeking (n = 415) caregivers (total n = 790). Caregivers filled out the Caregiver Reaction Scale (O’Malley & Qualls, 2017), a multidimensional assessment of the caregiver experience. Results of a 2 (adult children, spouse) x 2 (help-seeking, non-help-seeking) ANOVA indicated that help-seeking caregivers reported significantly more conflict over family beliefs than did non-help-seeking caregivers (M = 1.93 and 1.58, respectively), F(3,606) = 21.10 p < .001. Adult children caregivers reported significantly greater conflict over family beliefs (M = 1.91) than did spouse caregivers (M = 1.60), F(3,606) = 10.66, p < .001. Adult children caregivers also reported significantly greater conflict over family support (M = 1.87) than did spouse caregivers (M = 1.57), F(3,600) = 16.23, p < .001. Results highlight that certain caregiving contexts (e.g., adult children caring for a parent) potentially increase family conflict, which has implications for caregiver burden. Family conflict over beliefs is also related to help-seeking in caregivers. Findings inform appropriate assessment and intervention regarding the family environment in caregiving.
THE EVALUATION OF INTERPROFESSIONAL EDUCATION IN PRIMARY CARE: A SOCIAL NETWORK ANALYSIS
Authors: Smit Linda C , Dikken Jeroen , Moolenaar Nienke M , Schuurmans Marieke J , De Wit Niek J , Bleijenberg Nienke
Published: November 2019

Effective, safe, person-centred care relies on skilled interprofessional collaboration (IPC) and practice. Little is known about interprofessional education (IPE) to increase IPC in the context of care for frail older people in the community. This study evaluates the effectiveness of IPE on IPC of primary health and social care providers providing care to frail older people in three districts in the Netherlands. A before-after study among 55 health care professionals using social network analysis was performed. The number of contacts increased on average with two contacts. The reciprocity in the districts increased with 15%, 2% and 13%. The diversity of contacts increased between 6% and 10% (p <.001; p .055; p .371). The IPE effectuated a larger, more collaborative, and diverse interprofessional network of health and social care professionals providing care to frail older people suggesting a ripple-effect of networked interventions.
SOCIOECONOMIC DETERMINANTS OF INFORMAL CAREGIVING IN INDIA
Authors: Cheng Kent Jason G , Wilmoth Janet M
Published: November 2019

This study investigates the socio-economic determinants of informal caregiving for elderly parents in urban India, with a focus on caste differences. Bivariate and multivariate logistic regression models of caregiving are estimated with data from 2011 data of Osaka University’s Preference Parameters Study. Three types of caregiving are examined: helping with housework, financial assistance, and providing care. The control variables include: age, sex, marital status, wealth, religiosity, self-rated health, parents requiring care, number of siblings, and number of co-resident children. The bivariate analysis indicates that the highest caste is significantly less likely than the lowest caste to help with housework (OR=.734, SE=.127). In the fully specified models, there is not a significant difference between caste groups in the likelihood of helping with housework or providing financial assistance, but the highest caste is more likely than the lowest caste to provide care (OR=1.443, SE=.309). Being female and married significantly lowers the odds of each type of caregiving. Wealth increases the likelihood of providing help with housework and financial assistance. When both parents require care, children are more likely to provide financial assistance and help with housework, but when one parent requires care, children are more likely to provide care. Overall, sex, marital status, and wealth are the strongest predictors of helping with housework and financial assistance, whereas sex, marital status, and caste are the most important predictors of providing care. The implications of these findings for aging parents and adult children in urban India are discussed.
LONGITUDINAL CHANGES IN WELL-BEING OF PARENTS OF INDIVIDUALS WITH DEVELOPMENTAL OR MENTAL HEALTH PROBLEMS
Authors: Sloan Carlie J , Mailick Marsha R , Hong Jinkuk , Ha Jung-Hwa , Greenberg Jan S , Almeida David M
Published: November 2019

The negative impact of having a child with special needs on parental well-being is well documented. Previous research has suggested age attenuation of these impacts. However, this has not yet been examined longitudinally in late life. Therefore, it is unclear how the effect of having a child with a developmental disability or mental health problem changes as parents age and children become less likely to live at home. Using responses from the Study of Midlife in the United States (MIDUS), this study investigates: (1) longitudinal changes in the effect of having a child with a developmental or mental health problem on parental well-being, (2) age and gender moderations on these effects, and (3) the unique impact of factors directly related to the child’s condition. Multiple linear regressions revealed that having a child with a developmental disability was predictive of higher negative affect, more somatic symptoms, and lower psychological well-being longitudinally. Additionally, there was a main effect of having a child with a mental health problem in predicting higher negative affect. However, age moderations were revealed such that the effect of having a child with a developmental disability or mental health problem was diminished for older parents. Additionally, within-group analyses revealed that longer duration of developmental disabilities and later parental age of onset of mental health problems were predictive of better outcomes. Overall, results suggest that although having a child with special needs is related to poorer well-being, these effects can attenuate as parents age and adapt.
SUPPORTING FAMILY CAREGIVERS: HOW DO CAREGIVERS OF OLDER ADULTS COPE WITH ROLE STRAIN? A QUALITATIVE STUDY
Authors: Rath Laura , Meyer Kylie , Avent Elizabeth S , Nash Paul , Benton Donna , Gassoumis Zach , Wilber Kathleen
Published: November 2019

Qualitative research on positive coping approaches actually used by caregivers can inform interventions that can be feasibly implemented. Absent from previous qualitative research is how caregivers respond to strain in the relationship, specifically. Eight focus groups were conducted with a purposeful sample of racially and ethnically diverse family caregivers in Los Angeles (n=75). An additional 8 in-depth follow-up interviews were conducted. Content analysis was used to understand the mechanisms employed by caregivers to cope with strain and tension in the caregiving relationship. Preliminary results revealed twenty-two individual themes, which were subsequently grouped into four main superordinate themes: 1) Self-care; 2) Adaptation of behaviors and feelings; 3) Seeking and utilizing assistance and respite; and 4) Education and support groups. This work can help inform the design of programs to support caregivers and prevent potentially harmful behaviors, through understanding the experiences of caregivers in their own words.
NONTRADITIONAL VIEWS? HOW SIBLINGS MATTER FOR PERCEIVED PARENTAL CARE RESPONSIBILITY IN JAPAN
Authors: Hirayama Ryo , Wakui Tomoko
Published: November 2019

Our aim in this study was to explore whether and how siblings’ marital and work status influence Japanese adult children’s perceived responsibility for parental care. Within traditional familial institutions in Japan, married sons were expected to assume parental care responsibility. At the same time, such care arrangements built on gendered division of labor; sons served as family breadwinners, and their wives cared for their parents-in-law while out of the paid labor force. Yet, because of sociodemographic shifts such as a greater percentage of unmarried persons and a growing number of women who seek to maintain their job, it has been increasingly unclear which adult children can and should assume the role of parental caregiver. Using online survey data from 989 Japanese adult children who were all employees with no parental care experiences ever, we sought to clarify the influences of siblings’ circumstances on whether these children anticipated assuming responsibility for conducting different care tasks for their parents. In doing so, we focused on how siblings’ gender and work and marital status might combine to affect adult children’s anticipation of parental care responsibility. A series of logistic regression analyses revealed that having a married brother made it less likely for adult daughters to anticipate assuming responsibility for conducting typical care tasks (e.g., ADL assistance) whereas for adult sons, having a single sister declined such anticipation. We discuss our findings in terms of how traditional familial institutions still impinge on Japanese adult children’s views of parental care responsibility.
ASSOCIATION BETWEEN ELDER ABUSE AND TELOMERE LENGTH IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: FANG Boye , Yan Elsie , Tung Keith , Chen Gengzhen
Published: November 2019

Objectives: Elder abuse is a stressful event that can lead to compromised psychological and physical health consequences. This study examines the association between elder abuse and telomere length (TL), a biomarker reflecting cellular aging and disease pathogenesis. Methods: Between 2015 and 2016, 1,002 older adults (aged≥55 years) with cognitive impairment were consecutively recruited from the geriatric and neurological departments of three Grade-A hospitals in Guangdong Province of People’s Republic of China. At two-year follow-up, 958 of these participants were reassessed and 600 of them were randomly selected for this study. The outcome variable is TL (measured in blood cells using a multiplex quantitative polymerase chain reaction) and the major independent variables were current experience of overall abuse, psychological abuse, physical abuse, caregiver neglect, and previous experience of domestic abuse in the past two years. Potential confounding variables include demographic variables and increased severity of cognitive impairment, neuropsychiatric symptoms, sleep disorders, and depressive symptoms. Results: Multivariate regression models show that current experience of overall domestic abuse (t= -5.116, β= -0.376, confidence interval[CI] -20.231–-9.006), psychological abuse (t= -4.431, β= -0.231, [CI] -13.023–-5.023), physical abuse (t= -2.474, β= -0.151, CI -14.116–-1.621), and caregiver neglect were associated with shorter TL (t= -4.470, β= -0.185, CI -10.457–-4.072). Other predictors of shorter TL were previous experience of domestic abuse and increased severity of depression. Discussion: Both current and previous experiences of elder abuse are associated with shorter TL. Multidisciplinary efforts were needed to prevent and intervene elder abuse.
NURSES’ OPINIONS AND BELIEFS ABOUT MALNUTRITION IN OLDER ADULTS: A CROSS-SECTIONAL STUDY
Authors: Cate Debbie Ten , Ettema Roelof , Schuurmans Marieke J , Schoonhoven Lisette
Published: November 2019

Malnutrition in older adults is a frequent and major problem. Despite the fact that nurses have an essential role in nutritional care, they fail to ensure appropriate delivery in preventing and treating malnutrition. For improvement, it is necessary to understand the perspective of nurses about malnutrition. The aim of this study was to gain insight into nurses’ opinions and beliefs about malnutrition in older adults. A cross-sectional study was conducted where nurses working in different health care settings were asked to fill in a survey with twelve questions regarding different aspects of malnutrition. Nurses (n = 557) frequently observe malnutrition in older care recipients, and they consider this as a serious health problem. They believe that prevention and treatment of malnutrition is important and they see screening of malnutrition as a relevant nursing activity. They also consider nutritional care as multidisciplinary. Nurses state their need for education to give adequate nutritional care. Nurses’ opinions and beliefs about malnutrition in older adults is positive, which enhances nurses’ behavior to give sufficient nutritional care to older adults. To gain more benefit in improving nursing activities within nutritional care for older adults, more education is needed targeting nurse professionals and nurse students.
THE SAFEST REVIEW: THE SHOCK-ABSORBING FLOORING EFFECTIVENESS SYSTEMATIC REVIEW IN CARE SETTINGS
Authors: Drahota Amy K , Keenan Bethany E , Lachance Chantelle , Felix Lambert , Raftery James P , Farrell-Savage Kirsten R , Mackey Dawn
Published: November 2019

Falls in hospitals and care homes are a major issue of international concern. Falls cost the US $34 billion a year, with injurious falls being particularly life-limiting and costly. Shock-absorbing flooring decreases the stiffness of the ground surface to reduce the impact of a fall. There is a growing body of evidence on flooring for fall-related injury prevention, however no systematic review exists to inform practice. We systematically reviewed the evidence on the clinical and cost-effectiveness of shock-absorbing flooring use for fall-related injury prevention in care settings. We searched six databases, clinical trial registries, conference proceedings, theses/dissertations, websites, reference lists, conducted forward citation searches, and liaised with experts in the field. We conducted study selection, data collection, and critical appraisal independently in duplicate. We evaluated the influence of shock-absorbing flooring on fall-related injuries, falls, and staff work-related injuries. We adopted a mixed methods approach considering evidence from randomised, non-randomised, economic, qualitative, and implementation studies. We assessed and reported the quality of outcomes using the GRADE approach and Summary of Findings Tables. This review, conducted over the course of 2019, summarises the certainty of the evidence on whether and which shock-absorbing floors influence injuries from falls, the chance of someone falling over, and work-related injuries in staff (e.g. from manoeuvring equipment across softer floors). Our findings are applicable to health and social care professionals, buildings and facilities managers, carers, older adults, architects, and designers. Funded by National Institute for Health Research, Health Technology Assessment (ref 17/148/11); registered in PROSPERO (CRD42019118834).
ASSISTED LIVING IMMUNIZATION PROJECT
Authors: Beck Maureen S
Published: November 2019

Influenza immunization rates in the United States hover around 60% for people 65 years of age and older. Healthy People 2020 set a target rate of 90% for flu immunization. The influenza vaccine can reduce disease and expense with approximately 7 million flu related diseases, 109,000 hospital admissions, and 8,000 deaths prevented. A local assisted living had an unusually low influenza immunization rate last year of 40%. The goal of the quality improvement project was to increase the rate of influenza immunizations in this facility. The rational was that by providing education, promoting the event, and increasing direct communication with families and residents through phone call and emails the rate would improve. A collaborative project was begun in the summer of 2018. Approval was received by IRB and the facility administrators. Plans were made for two presentations to family and residents, promotional advertisement, family communication, and a scheduled flu day with the pharmacy. The presentation provided flu history and facts and myths about the immunization. Correct answers were rewarded with bookmarks with flu information. The assisted living director provided follow-up immunization data. Compared to the previous year, the immunization rate increased to 90%, counting immunizations on flu shot day and records of outside immunizations. Data concerning flu incidence from the 2017-2018 and 2018-2019 seasons will be requested to determine project impact. A partnership between primary care providers and long term care facilities focused on improving standards or meeting metrics can enhance care for your patient and the community.
EXPLORING THE IMPACT OF RACE-ETHNICITY ON RESPONSE TO WEIGHT-LOSS TREATMENT: RESULTS FROM THE POWR-UP STUDY
Authors: Miller Marshall G , Germain Cassandra M , Starr Kathryn N Porter , Payne Martha E , Sloane Richard , Bales Connie W
Published: November 2019

Racial/ethnic differences in obesity prevalence and in responses to weight-loss treatment between Black and White women are well documented. Whether these differences influence responses to weight-loss treatment among older women is unknown. Therefore, we evaluated racial/ethnic differences among participants in a 6-month weight-loss study with traditional versus higher protein intake. Participants were obese (BMI ≥ 30 kg/m2) community-dwelling women, age 45 years or older, who self-identified as either Black or White. Change in body-weight, 6 minute walk test (6MWT), general health (SF-36), and satisfaction with life (SWL) were evaluated at 0, 4 and 6 months. Both racial groups reduced (ps < 0.01) body weight at 4 and 6 months, with a trend toward more weight loss among White women (p = 0.07), relative to Black women. Other racial/ethnic differences included greater improvements in general health (p = 0.05) and 6MWT (p < 0.05) for White versus Black women at 6 months; these differences persisted after adjusting for treatment group, age/education, and comorbidity. Although racial/ethnic differences in SWL were not observed, significant improvement was observed only among White women (p < 0.01). Interestingly, weight loss was associated with improved 6MWT only among Black women (r = -0.66, p < 0.05) and with general health only among White women (r = -0.44, p < 0.05). Overall, White women experienced greater improvements in health and physical function as a result of weight-loss than did Black women. Further research is needed to identify equitable intervention strategies for the treatment of sarcopenic obesity.
WHAT CAN COUNTY-LEVEL EMERGENCY MEDICAL SERVICES DATA TEACH PUBLIC HEALTH ABOUT OLDER ADULT FALLS
Authors: Ham Carolyn R , deGrauw Xinyao , Dorsey Scott
Published: November 2019

Fall-related injuries in older adults contribute to an increasing number of deaths, hospitalizations and Emergency Medical Services (EMS) responses. In Snohomish County, the third largest county in Washington State, EMS agencies with electronic health records cover 96% of the county’s population. This EMS data contains unique information on falls, which can estimate costs and clarify intervention priorities. We analyzed 2018 data from EMS in Snohomish County. Fall incidents were summarized by count, frequency, and rate per 1,000 population. Costs for transferring patients to emergency departments (ED) were estimated using 2015 Snohomish Community Paramedic Analysis, and direct medical costs averted by implementing a single intervention were estimated based on prior research by Stevens and Lee (2018). There were total 38,910 incidents in older adults, of those 4,777 incidents were caused by falls (1606 in males and 2906 in females). The mean age (SD) was 81.0 (±8.9). The incidence rate was 45.6 per 1000 (55.8 in females and 30.6 in males). There were 573 repeated falls (12%). Most of the falls happened at home (54.85%), followed by assisted living and nursing homes (27.84%). 85.53% of the falls were transferred to ED, at an estimated cost of 3.15 million dollars. We calculated that one million dollars in medical cost could be averted by implementing home modifications delivered by an occupational therapist (OT). This research demonstrates the utility of EMS data for describing fall injury and determining interventions. Fall prevention programs should focus on preventing repeated falls and addressing home safety risks.
IMPLEMENTATION CHALLENGES AND OPPORTUNITIES IN A COMMUNITY-BASED TRANSITIONAL CARE SERVICES PROGRAM
Authors: Weaver Raven H , Bolkan Cory
Published: November 2019

High-risk older adults (i.e., low-income, chronically ill) often have complex, costly healthcare needs and are at risk of re-hospitalization. Hospitals traditionally lead efforts to reduce readmissions, while community-based aging services organizations (e.g., Area Agency on Aging AAA) offer older adults in-home health, social support, and information/referral to community resources. Thus, creating, sustaining, and scaling up hospital-community partnerships can better meet older adults’ comprehensive needs. We evaluated efforts of a hospital-AAA project to develop and implement a local transitional care services program (TCSP) that provided in-home/phone support post-discharge for high-needs older adults. Over a four-year period, 1,921 individuals (mean= 75 years; 57% women) were referred from hospital as eligible for TCSP. After referral, however, only 22.8% were successfully connected to community-based services and men were more likely than women to complete TCSP (Χ2= 6.92; p= .009). Of those referred, only 4% were re-hospitalized, indicating potential success of TCSP. Data revealed most were unable to be contacted (27.9%), refused the program (21.6%) or utilized alternative services, including SNFs (20.3%); inconsistent data collection and procedures yielded problematic missing data and inability to assess reasons for low engagement. We also surveyed and interviewed AAA staff (n=16) and found most staff exhibited high readiness for evidence-informed practices, supported proactive data use to improve planning, advocating, and serving clients, and identified significance of multidisciplinary community partnerships. Our findings generated recommendations to enhance staff engagement in TCSP, improve data collection for transforming data utility beyond enrollment purposes, and consider programmatic modifications to reach vulnerable elders.
ELDER CARE COMPLEXITIES AND OUTCOMES: A MANDATE FOR INTERDISCIPLINARY GERIATRIC CLINICAL ASSESSMENT
Authors: Reed Peter S , Gibb Zebbedia
Published: November 2019

Interdisciplinary geriatric assessment has long been considered best practice to identify the full range of elder care needs. In 2015, the Sanford Center for Aging launched an interdisciplinary comprehensive geriatric assessment clinic. This team-based assessment includes a geriatrician, social worker and pharmacist meeting together with each client to review all aspects of their health and well-being, resulting in a comprehensive care plan to coordinate care with the client’s primary care provider. To assess this approach, a survey was conducted with 415 randomly-selected clients prior to the clinical visit, with a 6-month follow-up survey completed for 170 clients (41%), gathering data on hospitalizations, long-term care utilization and quality of life. Combining these data with clinical assessment data provides a picture of clinical complexities of elder clients and offers a mandate for comprehensive interdisciplinary care. Baseline data showed 44% hospitalized in the prior year; an average of 4 chronic conditions and 10 medications; 44% with dementia or MCI and 29% with frailty. At 6-months post-assessment, 29% reported being hospitalized, 3.5% reported moving into long-term care, and there was a slight, non-significant decrease in quality of life. These data demonstrate the profound complexities that can be identified and addressed through comprehensive assessment and care, as well as the potential to reduce hospitalizations, enable people to age-in-place and maintain quality of life. Despite the well-documented value of these approaches, Medicare and other payers have not fully embraced the opportunity to achieve these positive outcomes and remain hesitant to adequately fund comprehensive approaches to care.
A LOGIC MODEL TO DESCRIBE ADULT PROTECTIVE SERVICES IN THE U.S
Authors: Gassoumis Zach , Urban Karl , Shusterman Gila , Eliason Stephanie Whittier
Published: November 2019

The adult protective services (APS) system in the U.S. serves as an investigative and service delivery system, targeting cases of reported abuse, neglect, and exploitation of older adults and adults with disabilities. APS developed from a piecemeal investigatory system, driven by state and local processes. This system has persisted, with little federal oversight or uniformity. In turn, little systematic information exists about the structure and process of the APS system nationwide. This poster presents an effort to construct a logic model for APS in the U.S., compiled jointly by researchers and practitioners under the auspices of the National APS Technical Assistance Resource Center. The process included initial drafting by six experts from various backgrounds and was reviewed by diverse stakeholders in three iterative rounds of review. Because of the unique nature of APS, the product has a partially non-traditional structure for a logic model, plotting context, inputs/resources, activities, activity metrics, and results. Inputs/resources are plotted across various sources: APS staff, consultative experts, community partners, operational supports, funding for services, and legal and ethical processes. Activities, activity metrics, and results are mapped across three stages of service provision—intake, investigation, and post-investigation services—and at the quality assurance level. The resultant logic model can be used at the national level to drive system change and evaluation; alternatively, it can be customized to specific state/local contexts to enable quality improvement and evaluation efforts. The pursuit of these efforts, coupled with existing national strategies, can contribute to continued system change and evolution within APS.
EXPLORING RELATIONSHIPS BETWEEN RELIGIOUS COPING AND GENERAL COPING STRATEGIES IN OLDER LONG-TERM CARE RESIDENTS
Authors: Andrew Nathaniel , Meeks Suzanne
Published: November 2019

Aging long-term care residents utilize a variety of coping strategies to manage stressors. While many older adults report religious faith is important in the coping process, it is unclear how religious coping appraisals and religious coping styles fit within a broader coping framework. This poster explores relationships between religious coping and general coping strategies in a convenience sample of older nursing home and assisted living residents (median age = 71.5). In this cross-sectional study, we interviewed residents (N = 102) from long-term care facilities (N = 11) in the Louisville metropolitan area and southern Indiana. Participants responded to questions about religious practices, religious coping, general coping, stress, life satisfaction, psychological distress, and health. The present analyses examined correlations between religious coping appraisals/styles and general coping strategies. We found: 1) small to moderate associations between theoretically adaptive religious coping appraisals/styles (e.g., positive appraisals, collaborative/deferring styles) and theoretically adaptive general coping strategies (e.g., positive reframing, instrumental support), and 2) small to moderate associations between theoretically maladaptive religious coping appraisals/styles (e.g., negative appraisals, self-directing styles) and theoretically maladaptive general coping strategies (e.g., denial, behavioral disengagement). Our results identify interesting conceptual relationships suggesting residents who report positive religious coping appraisals and less independent religious coping styles use adaptive coping strategies more frequently. These constructs may be explored in future research through examining their theoretical uniqueness and whether they independently account for variance in clinically-relevant outcomes. Further study of religious coping in these settings may help promote resilience and optimal aging for long-term care residents.
TECHNOLOGY REDUCES DISTRESS IN A GERIATRIC COHORT WITH DEPRESSION AND NEUROCOGNITIVE IMPAIRMENTS
Authors: Mazzone James A , Sills Jonathan , Ma Flora , Louras Peter , Alexander Erickson
Published: November 2019

Many older adult Veterans with Depression and superimposed Neurocognitive Impairments may demonstrate behavioral agitation. To buffer patient agitation seen within a Veteran’s Affairs residential extended care facility, psychological services were expanded to include the use of mobile technologies. To evaluate the effectiveness of adding technology supported psychological services, outcomes were gathered as part of continuous process improvement efforts. 28 Veterans with Depression and NCI who received technology enhanced services were rated by staff on observed agitation behaviors prior and following clinical encounters. In addition, a subset of 17 Veterans also provided subjective unit of distress (SUD’s) ratings based on the Brief Interview for Mental Status inclusion criteria. Paired sample T-Tests were completed to assess if technology-enhanced interventions resulted in average reductions of clinician rated observations of Veteran agitation behaviors. Significant differences were found in observations of Veteran facial tension (t(27)=3.722, p=.001), agitated body movement (t(14)=2.020, p=.053), and threatening posture (t(27)=2.243, p=.044). Evaluation of a subset of those residents who also provided SUD’s ratings show a significant change in self-reported distress after intervention (t(16)=4.3, p=.001). Effect size for this difference was large (d=1.042). These results suggest that mobile technologies can help reduce agitation and Veteran self-reported distress among older Veterans with Depression and superimposed Neurocognitive Impairments.
TECHNOLOGY-ENHANCED PSYCHOTHERAPY IMPROVES LIFE SATISFACTION AMONG OLDER ADULT VETERANS IN LONG-TERM CARE
Authors: Sills Jonathan , Mazzone James A , Ma Flora , Louras Peter , Alexander Erickson
Published: November 2019

To buffer the risk of declining life satisfaction among a Veteran cohort residing within a Veteran’s Affairs long term care facility, a new model of care called Individualized Non-Pharmacological Services Integrating Geriatric Health and Technology (INSIGHT) therapy was developed and evaluated. Consistent with the INSIGHT therapy model, traditional psychotherapy interventions including reminiscence, behavioral activation, and relaxation exercises were modified such that they could be delivered on a digital platform. A paired sample T-test was performed to identify the effects INSIGHT Therapy had on Veteran satisfaction with life. Findings indicated that Veteran life satisfaction ratings the month prior (M= 19.6522) to the initiation of INSIGHT intervention and the month following three months of INSIGHT intervention (M=22.4783) show that the satisfaction with life increased among residents (t(22)=-2.334, p=.028). Effect size = 0.489. These results suggest that INSIGHT therapy interventions help to contribute to an increase in life satisfaction among an older adult Veteran cohort residing within a Veteran’s Affairs long term care facility.
GENDER DIFFERENCES IN NURSING HOME RESIDENT QUALITY OF LIFE: WHY WOMEN DO BETTER
Authors: Davila Heather , Shippee Tetyana P , Ng Weiwen , Akosionu Odichinma C , Virnig Beth
Published: November 2019

Despite research documenting gender differences in numerous outcomes in later life, we know little about gender differences in quality of life (QoL) for older adults who receive institutional long-term care. To address this gap, this study examines the relationship between gender and nursing home (NH) residents’ QoL, including possible reasons for differences observed. We used a mixed methods design including surveys with a random sample of Minnesota NH residents using a multidimensional measure of QoL (n=8,870), resident clinical data, facility-level characteristics, and qualitative interviews with NH residents (n=64). We used mixed models and thematic analysis of resident interviews to examine possible differences in resident QoL based on gender. After controlling for individual and facility characteristics, women reported higher overall QoL than men, with men reporting significantly lower QoL in 4 of 8 QoL domains. In interviews, men noted being especially dissatisfied with facility activities, whereas women more frequently described having friends in the facility and relying on family for support. Some women viewed the NH as a place of respite and described wanting to stay long-term, even though their families asked them to return home. In contrast, men more often described the NH as necessary due to physical needs, but undesirable for long-term living. Our findings provide preliminary evidence that men and women experience QoL differently, with men reporting lower QoL in several domains. Tailoring more activities for men and finding ways to strengthen relationships for men within the facility may help reduce the gender disparities in QoL we observed.
INDIVIDUAL AND INTERPERSONAL INFLUENCERS OF MEALTIME EXPERIENCES: PERSPECTIVES OF NURSING ASSISTANTS
Authors: Douglas Joy W , Jung Seung Eun , Noh Hyunjin , Ellis Amy , Ferguson Christine
Published: November 2019

In the United States, long-term care Certified Nursing Assistants (CNAs)’s central role is to provide direct care to residents, including mealtime assistance. It has been reported that employee turnover among CNAs is nearly 75% annually. High turnover rates of CNAs can increase the workload for remaining CNAs, interrupt quality of care for residents, and require extra resources for recruiting new staff. The aim of this qualitative study was to explore the individual and interpersonal barriers and facilitators CNAs experience when providing mealtime assistance to residents with dementia. Using purposive sampling, nine focus groups were conducted with a total of 53 CNAs who had at least one year of experience as a CNA working with older adults. Focus group questions were developed using the Social Ecological Model. All focus groups were audio recorded and transcribed verbatim. Data were analyzed using the directed content analysis approach. At the individual level, CNAs identified that communication skills with residents and coworkers, and the ability to accurately interpret resident behavior positively affected their ability to provide mealtime assistance. At the interpersonal level, interdisciplinary collaboration was identified as a significant facilitator. Reported barriers included negative interference from residents’ family members, unpredictable resident behaviors, and lack of support from coworkers. CNAs reported individual and interpersonal factors that may influence their ability to effectively feed residents with dementia. Our findings will inform future investigations regarding job turnover. Equally important, providing CNAs with the training and opportunity to perform their duties efficiently can ultimately benefit the residents’ mealtime experiences.