bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE IMPACT OF MEDICARE ADVANTAGE ON SKILLED NURSING FACILITY FINANCIAL PERFORMANCE, STAFFING, AND QUALITY
Authors: Bowblis John R , Huang Sean 
Published: November 2019

Abstract
Since the mid-2000s, skilled nursing facilities (SNFs) face an increasing percentage of post-acute care patients enrolled in Medicare Advantage (MA), yet our understanding the of how this affects SNFs is limited. Managed care may provide better coordination and continuous care that enhances SNF quality, but MA plans can also negotiate lower payments, providing SNFs with fewer financial resources to invest in staffing and quality. We use data from 2011-2015 from Medicare Beneficiary Summary File, Minimum Data Set, Certification and Survey Provider Enhanced Reporting, and Medicare Cost Reports to estimate linear fixed effect panel regressions with instrumental variables. We find that SNFs with greater MA share of post-acute care admissions have worse financial performance, lower nursing staff levels, and worse quality as measured by deficiency scores. Our finding favors the hypothesis that MA creates downward financial pressure and strong MA presence in local markets can potentially to spillover to non-MA residents.
IS BEING HOME GOOD FOR YOUR HEALTH? OUTCOMES OF MEDICAID HOME- AND COMMUNITY-BASED SERVICES
Authors: Konetzka R Tamara , Gorges Rebecca J , Jung Daniel H , Sanghavi Prachi H 
Published: November 2019

Abstract
Expanding home- and community-based services (HCBS) alternatives to nursing homes has become a priority for many state Medicaid programs. Dramatic policy changes affecting diverse patient and family populations are being made on the basis of surprisingly little evidence about the outcomes of HCBS relative to the alternatives. Our study is designed to address that gap, providing the first national estimates of plausibly causal health outcomes for recipients of Medicaid HCBS relative to nursing home care. We also examine heterogeneity of these effects by several important subgroups. Results indicate that HCBS users have rates of hospitalization similar to their nursing home counterparts, and rates are higher for those with dementia. Furthermore, disparities by race and ethnicity that have been well-documented in nursing homes also appear to extend to the HCBS setting. The costs of potentially poor outcomes need to be part of the policy equation.
EFFECTS OF MEDICAID MANAGED CARE ENROLLMENT ON HOSPITALIZATION RISK AMONG DUAL-ELIGIBLES
Authors: Gorges Rebecca 
Published: November 2019

Abstract
Many state Medicaid agencies have recently expanded Medicaid managed care (MMC) to include low-income older adults that are Medicare-Medicaid dually enrolled (duals). While little evidence exists regarding the effects of these expansions on health outcomes, duals may be especially vulnerable to low-quality or low-intensity care delivered by MMC due to their high use of services and the fragmentation inherent in the two-payer system. Using difference-in-differences (DID) and instrumental variables estimation, this study provides the first national examination of the impact of MMC on hospitalization for duals using claims data. DID results indicate that managed long-term services and supports (LTSS) expansions among duals are associated with increased rates of hospitalization while comprehensive managed care results in no change in hospital use. Further analyses exploring heterogeneity shed light on how these managed care payment models affect older adults and individuals using LTSS.
FORECASTING AND COPING WITH FUTURE STRESSORS PREDICTS DAILY SUBJECTIVE AGE
Authors: Neupert Shevaun D , Neupert Shevaun D , Zhu Xianghe 
Published: November 2019

Abstract
Stressors are associated with higher subjective ages, but the role of forecasting and coping with future stressors is unknown. 223 adults (107 aged 18-36, 116 aged 60-90) reported their subjective age, forecasts of next-day health stressors, and anticipatory coping with next-day health stressors each day for eight consecutive days. There was no main effect of forecasting, but increases in plan rehearsal coping were associated with increases in felt age. In contrast, increases in problem analysis coping were associated with decreases in felt age. Daily forecasting and coping also interacted with each other. On days with low plan rehearsal or low problem analysis, there was no association between forecasting of health stressors and subjective age. However, on days with high plan rehearsal or high problem analysis, increases in forecasting ratings were associated with increases in subjective age. Forecasting and coping with future stressors may play a role in subjective aging.
ENERGY EXPENDITURE AND PHYSICAL ACTIVITY AMONG OLDER PARTICIPANTS FROM THE MULTICENTER AIDS COHORT STUDY (MACS)
Authors: Schrack Jennifer A , Brown Todd T , Margolick Joseph B 
Published: November 2019

Abstract
Energy utilization becomes more inefficient with age and is linked to low physical activity and functional decline. Persons aging with HIV exhibit accelerated functional decline, but the effect of chronic HIV infection on energy utilization and free-living physical activity remains unclear. We investigated cross-sectional associations between age and: resting metabolic rate, peak walking energy (VO2), and 7-day physical activity by accelerometry in 100 men in the MACS (age: 60.8+/-6.8 years, 35% black, 46.1% HIV+, 94% virally suppressed). In multivariable regression models adjusted for age, BMI, race, chronic conditions, and HIV viral load, HIV+ men had a higher resting metabolic rate (β=103.2 kcals/day, p=0.03) and lower peak walking VO2 (β=-1.8 ml/kg/min, p&lt;0.02) than HIV- men. Moreover, HIV+ men demonstrated lower physical activity, overall and by time of day (p&lt;0.05). These results suggest that energy utilization differs by HIV serostatus, which may contribute to lower physical activity and function with aging.
MEASURING EFFECT OF PERSONALIZED MUSIC TO REDUCE BEHAVIORS IN NURSING HOME RESIDENTS WITH DEMENTIA
Authors: McCreedy Ellen , Yang Xiaofei , Baier Rosa , Thomas Kali S , Rudolph James , Mor Vincent 
Published: November 2019

Abstract
The purpose of this six-month pilot study was to identify an optimal measurement strategy for assessing the effects of a personalized music program, MUSIC & MEMORY, on agitated and aggressive behaviors among 45 nursing home residents with moderate to severe dementia. Dementia-related behaviors were measured before and after the intervention with three methods 1) observationally using the Agitation Behavior Mapping Instrument (ABMI); 2) staff report using the Cohen-Mansfield Agitation Inventory (CMAI); and 3) administratively using Minimum Data Set - Aggressive Behavior Scale (MDS-ABS). ABMI score was 4.4 (standard deviation, SD: 2.3) while not listening to the music and 1.6 (SD: 1.5) while listening to music (p&lt;.01). CMAI score was 61.24 (SD: 16.32) before the music and 51.24 (SD: 16.05) after the music (p&lt;.01). MDS-ABS score was .8 (SD: 1.6) before music and .7 (SD: 1.4) after music (p=.59). Direct observations were most likely to capture behavioral responses, followed by staff interviews. No effect was found using exclusively available administrative data. There is growing interest in identifying and testing non-pharmaceutical alternatives to managing agitated and aggressive behaviors in nursing home residents with dementia. Measurement occurring closest in time to the intervention was most likely to capture responses, but was also most costly, least pragmatic, and most subject to confirmation bias. These findings will inform a large pragmatic trial, beginning Spring 2019.
PEAK RESIDENT SATISFACTION OUTCOMES AND RESEARCH
Authors: Poey Judy , Cornelison Laci 
Published: November 2019

Abstract
Outcomes related to person-centered care in nursing homes have been difficult to ascertain. Much of the extant literature has suffered from differing definitions of what it means to be person-centered, variation in the levels of implementation of person-centered care that an organization has achieved, and small sample sizes. The PEAK program provides a unique opportunity to control for these variables across a large sample of nursing homes throughout the state of Kansas. This presentation will discuss the methodological advantages of evaluating the PEAK program and the findings from an evaluation of resident satisfaction in nursing homes at varying levels of implementation of person-centeredness.
PARTNERSHIPS THAT WORK: AN ACADEMIC AND STATE COLLABORATION IN KANSAS
Authors: Doll Gayle , Kaup Migette , Cornelison Laci 
Published: November 2019

Abstract
Academic partnership with state government may be a researcher’s dream or a tremendous burden. This presentation demonstrates the perspectives of university personnel as well as government leaders when contracts and grants are issued for the provision of research and services. Opportunities and barriers for researchers will be discussed.
THE SOCIOCULTURAL STRESS PROCESS MODEL APPLIED TO LONG-DISTANCE CAREGIVING
Authors: Cimarolli Verena R , Horowitz Amy , Jimenez Danielle , Shi Xiaomei , Falzarano Francesca , Minahan Jillian 
Published: November 2019

Abstract
This study investigated the impact of LDC on mental health utilizing the Sociocultural Stress Process Model as a conceptual framework. A path analytic model tested the impact of caregiving stressors (i.e. distance, frequencies of visits, hours spent helping, burden) and sociocultural values (i.e. familialism) on LDCs’ mental health outcomes (i.e. depression, anxiety), and resources (i.e. coping strategies, social support) which can mediate the association between stressors and mental health outcomes while controlling for socio-demographics. Results show that resources did not mediate the effects of stressors on the mental health outcomes. However, both higher depression and anxiety were associated with living closer to the care recipient (CR), less frequent visits, higher burden, being younger, being female, and less optimal income adequacy. In addition, higher depression was associated with lower use of coping strategies and higher education. Higher anxiety was also associated with lower levels of social support and higher familialism.
LONG-DISTANCE CAREGIVERS’ INFORMAL CARE NETWORKS
Authors: Jimenez Danielle , Falzarano Francesca , Horowitz Amy , Cimarolli Verena , Minahan Jillian 
Published: November 2019

Abstract
The purpose of this study (N=304) was to examine the characteristics of LDCs’ informal caregiver (IC) network (Co-caregivers [Co-CG], other informal helpers) providing assistance to the care recipient (CR), and factors associated with more help received from ICs. The majority of LDCs in the sample reported working with at least one IC (81.9%) indicating the existence of a secondary care network. LDCs and Co-CGs were often siblings in comparison to other informal helpers that were more likely to be the CR’s friend. Results also show that CRs with children, living in the community, receiving no formal services, and lower levels of cognitive impairment receive more hours of help from ICs. In addition, more hours of help by ICs were associated with LDCs’ having higher scores of depression and anxiety, spending more hours per month helping the CR, and more frequent contact with CR. These seemingly discrepant findings are discussed.
PET OWNERSHIP HISTORY AND SUCCESSFUL AGING OUTCOMES IN COMMUNITY-LIVING OLDER ADULTS
Authors: Friedmann Erika , Gee Nancy R , Simonsick Eleanor M , Studenski Stephanie , Barr Erik , Resnick Barbara , Kitner-Triolo Melissa H , Hackney Alisha 
Published: November 2019

Abstract
Diminishing cognitive and physical function, worsening psychological symptoms and increased mortality risk and morbidity typically accompany aging. Health needs of the aging population will continue to increase as the proportion of the population aged 50 years and older increases. Pet ownership (PO) has been linked to better health outcomes in older adults, particularly those with chronic health conditions. However, much of the evidence is weak with little known about the contribution of PO to successful aging in community living older adults. This study examines associations between PO and cognitive performance, physical functioning, and psychological status in community living older adults. Participants in the Baltimore Longitudinal Study of Aging (&gt;50 years old, N=378) completed physical functioning, cognitive and psychological testing, and a ten-year PO history. Most participants (89%) had owned pets at some point and 24% currently have pets. Fourteen percent have 1-4 dogs, 12% have 1-4 cats, and 3% have others. PO was lower with older age (p&lt;.001). In regression analysis controlling for age decade, pet ownership within the past 10 years (PO10) independently predicted cognitive function [total verbal learning (p=.04), and short (p=.015) and long (p=.031) delay free recall, ] but not physical function or psychological status. PO was lower in older age groups as was cognitive, physical functional, and psychological status, while PO within the past 10 years was associated with better verbal learning and memory independent of age. Longitudinal analysis is required to disentangle the sequential associations between PO and change in health status over time..
INTEREST GROUP SESSION—NURSING CARE OF OLDER ADULTS: MAKING IT HAPPEN: PERSON-CENTERED DEMENTIA CARE FOR BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS
Authors: Kolanowski Ann M , Bowers Barbara 
Published: November 2019

Abstract
Person-centered care is the standard of practice in communal living sites, yet many facilities struggle to make this a reality. Both direct care staff and administrators find residents’ behavioral and psychological symptoms of dementia (BPSD) particularly challenging. Our research team is conducting a pragmatic trial, the goal of which is to help staff use person-centered, non-pharmacological approaches for these symptoms. During the past three years we have gained insights into what may affect the ability of staff to deliver high quality person-centered care. We share these insights in this symposium. In the first paper, the investigators present data indicating that a high rate of psychotropic drug use among residents with dementia persists despite little association to BPSD, and bring into question the need for education around de-prescribing practices. In the second paper, the investigators discuss the conceptual basis and empirical evidence for using affect balance, in addition to symptom reduction, as an important and meaningful outcome for residents. The third paper examines gender differences in the expression of BPSD and how these differences may work to limit staff ability to identify treatment approaches for women who, nonetheless, have significant symptoms. In the final paper the psychometric properties and results of a new Knowledge of Person-centered Approaches for BPSD Test, that was developed by the team and given to staff, are examined and the implications of the findings for the delivery of person-centered care are considered. The discussant will reflect on these findings and provide direction for future research and practice.
RESIDENT, STAFF, AND FACILITY FACTORS ASSOCIATED WITH AFFECT BALANCE
Authors: Kolanowski Ann M , Behrens Liza , Haitsma Kimberly Van , Resnick Barbara 
Published: November 2019

Abstract
Affect balance is a concept that is measured by comparing the relative frequency of experiencing positive affect versus negative affect. A higher ratio of positive to negative affect has been associated with greater well-being, improved function and resilience. Baseline data from an ongoing pragmatic trial were used to determine the resident, staff and facility factors associated with affect balance in 325 nursing home residents with moderate to severe cognitive impairments. Measures of resident demographics, cognitive status (BIMS), function (Barthel Index), staff hours, staff knowledge of person-centered care approaches, facility policies and the facility environment were taken. Affect balance was measured using items from the Quality of Life in AD scale. Initial correlational analyses indicate that affect balance is associated with being male (p=0.03), having better function (P=0.04) and receiving a greater number of RN and CNA hours of care (p=0.003 and P=0.02 respectively).
FACTORS THAT INFLUENCE PSYCHOTROPIC MEDICATION USE
Authors: Resnick Barbara , Galik Elizabeth 
Published: November 2019

Abstract
Understanding the factors that influence psychotropic can guide reduction in use of these medications. This study described predictors of psychotropics use among residents with moderate to severe cognitive impairment. This was a secondary data analysis using baseline data from the first 341 residents in the EIT-4-BPSD trial. Predictive measures included demographics, agitation, resistiveness to care, depression, cognition, pain, facility factors and state. Overall 63% (n=211) received at least one psychotropic medication, 16% (n=52) an anti-seizure medication, 23% (n=77) an anxiolytic, 30% (n=99) an antidepressant, 2% (n=8) a sedative hypnotic, 28% (n=93) an antipsychotic medication, and 9% (n=29) an opioid. Model testing explained 9 to 15% of psychotropic medication use. There were high rates of psychotropic medication use and a limited association between demographic factors, behavioral symptoms, and psychotropic medication use. Continued research is needed to explore additional factors associated with psychotropic medication use such as beliefs of providers.
THE INTEGRATED MEMORY CARE CLINIC AS A HEALTHCARE NETWORK
Authors: Kovaleva Mariya A , Higgins Melinda , Jennings Bonnie Mowinski , Song Mi-Kyung , Clevenger Carolyn K , Griffiths Patricia C , Hepburn Kenneth W 
Published: November 2019

Abstract
The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide dementia and primary care. This presentation describes the experiences of persons living with dementia and their caregivers during their first year at the IMCC, through the lens of the IMCC as a healthcare network. Forty-two caregivers were evaluated in three survey-based assessments over nine months. Twelve caregivers completed qualitative interviews about their experience at the IMCC. Severity of depression and delusions and total symptom severity improved significantly for persons living with dementia. Caregivers described their sense of belonging to the IMCC healthcare team and valued direct telephone access to APRNs. By enhancing care access and engaging clients in their care, the IMCC serves as a reliable and professional healthcare network for patient-caregiver dyads who often receive suboptimal dementia care in mainstream healthcare.
ONE-TWO PUNCH OF HIGH WAGES AND EMPOWERING PRACTICES FOR MAINTAINING CARE NETWORKS IN NURSING HOMES
Authors: Kennedy Katherine , Bowblis John R , Abbott Katherine M 
Published: November 2019

Abstract
Stabilizing certified nursing assistant (CNA) employment is necessary for maintaining care networks and providing high quality of care for nursing home (NH) residents. This study’s objective was to examine the relationship of high wages and empowerment practices on CNA retention. We used the 2015 Ohio Biennial Survey to construct a facility-level dataset of 547 NHs and estimated multivariable linear regressions. NHs that provided both high wages and high empowerment were associated with a 12.95 percentage-point improvement in the CNA retention rate (SE = 4.53, t-value = 2.86, p = 0.0045). High wages and a high empowerment score did not have significant effects individually (p &gt; .05). Retention rates were similar between NHs that lacked high wages and scored low on the empowerment scale, and NHs that provided one at a high level but not the other. Implications for better retaining CNAs require multiple empowerment practices combined with high hourly wages.
PETS PROVIDE SIGNIFICANT SUPPORT TO OLDER ADULTS LIVING ALONE: RESULTS FROM THE NATIONAL POLL ON HEALTHY AGING
Authors: Connell Cathleen M , Solway Erica , Malani Preeti , Singer Dianne , Kirch Matthias , Kullgren Jeff , Janevic Mary R 
Published: November 2019

Abstract
Human-animal interaction has been linked to health and social benefits for older adults. While pets can play a positive role in healthy aging, not all pet owners experience the same benefits. The present study uses data on how pets impact the well-being of older adults, including those living alone from the National Poll on Healthy Aging (NPHA), a nationally representative household survey conducted in October 2018. A randomly selected, stratified sample of adults age 50 to 80 (n=2,051) completed the survey online. Over half reported having a pet; the majority had dogs (70%) and cats (50%). Companionship was the main reason for getting a pet (52%); the majority believed their pets helped them enjoy life, reduce stress, and connect with others. Pet owners living alone were significantly more likely than pet owners living with others to report that their pet helps them cope with physical or emotional symptoms (72% vs. 58%), feel loved (94% vs. 85%), stick to a routine (76% vs. 60%), take their mind off pain (43% vs. 32%), and have a sense of purpose (82% vs. 72%; all p&lt;.05). Respondents living alone were also more likely to report that pet care strains their budget (26% vs. 17%) and that their pet’s needs take priority over their own (22% vs. 14%; p&lt;.05). Given the important role that pets play in the lives of older adults, efforts to support this relationship (e.g., pet-friendly housing policies, low-cost and mobile veterinary clinics, pet walking and pet sitting services) are warranted.
MULTIDISCIPLINARY EMERGING PERSPECTIVES ON BUILDING AND MAINTAINING NETWORKS IN AGING
Authors: Stephenson Eugenie 
Published: November 2019

Abstract
This presentation is a reflective piece on developing and staging of the inaugural Gerontology Student Workforce Day at the Georgia Capitol held in January 2016 through coordination with the state-level Council on Aging (GCOA: Georgia-Council-on-Aging). The aims of this initiative focused on bridging students’ gerontology education and career aims with current legislative concerns for older adults at the state level through networking and advocacy efforts. We also sought out to highlight to state legislators the necessity to support gerontology education. Results of this networking engagement included educating state legislators on both the role of gerontology education to support the needs of older residents at the community-level and highlighting to both parties the impact of gerontology professionals on the state’s workforce. As a result, we engaged gerontology students and early career aging professionals in high-impact networking opportunities focused on service and policy efforts with state legislators and local AAAs (area-agencies-on-aging).
GERI-MOBILE HEALTH: DEVELOPMENT AND FEASIBILITY OF A PROGRAM TO HELP OLDER VETERANS USE VA MENTAL HEALTH MOBILE APPS
Authors: Gould Christine E , Ma Flora , Scales Ashley N , Juang Christine , Carlson Chalise , Loup Julia , Sakai Erin 
Published: November 2019

Abstract
VA mental health self-management mobile applications (apps) teach evidence-based skills such as mindfulness and behavior activation. Older Veterans are likely to benefit from learning these skills, but many need assistance learning to use their mobile devices. To bridge this knowledge gap, we developed a clinical program (Geri-Mobile Health) and accompanying patient education materials to help older Veterans use apps to meet their mental health and well-being goals. The program provides personalized coaching support consisting of (1) teaching basic mobile device use; (2) selecting a goal-consistent app; and (3) encouraging behavior change using the app. The presentation will describe the preliminary outcomes and implementation process. Initial results suggest that the program is feasible, acceptable, and may increase mobile device proficiency for novice users. Additionally, we disseminated 1,418 sets of education materials to providers in 21 states. Challenges and successes at the local and national levels will be discussed.