bluuebunny/crossref_metadata_2025_split huggingface dataset:
Embedding Age-Friendly Care using the 4Ms Framework in the Convenient Care Setting
Authors: Greenberg Sherry , Pino Lilia , McCormack Mary , Duffy Evelyn , Zimmermann Elizabeth , Hughes Robin , Pohnert Anne , Dolansky Mary 
Published: December 2020

Abstract
This late-breaker presentation highlights the implementation science plan for Age-Friendly care in CVS Health MinuteClinic’s convenient care clinics. This project, a partnership between MinuteClinic, Case Western Reserve University Frances Payne Bolton School of Nursing, and the Institute for Healthcare Improvement, funded by The John A. Hartford Foundation, increases the number of care providers trained in the provision of Age-Friendly care using the 4Ms Framework: What Matters, Medication, Mentation, and Mobility. The implementation team learned the MinuteClinic usual processes, then developed strategies for successful Age-Friendly care implementation. Data from 21 nurse practitioner, 5 patient interviews, educator focus groups and 14 site visits revealed time, resources, and perceived value as barriers to implementation. Most reported increased knowledge and willingness to change practice. Based on the Plan-Do-Study-Act change process data, the implementation team developed solutions that addressed gaps leading to the development of practice-based tools for successful Age-Friendly care project adoption and implementation.
Supporting relationships, providing presence: Arts-informed approaches to LTC staff dementia care literacy
Authors: O’Neil Kelly , Redden Marco , Aubrecht Katie 
Published: December 2020

Abstract
Early findings and insights are shared from an interpretive analysis of interviews with 15 leaders in arts-based approaches in dementia care. This was conducted as part of a larger project that has the goal of operationalizing ‘good’ literacy in social and relational care in long-term care (LTC). Interviews aimed to identify promising directions in arts-based approaches in education and training for LTC staff provincially, nationally, and internationally, and understand how they contribute to ‘good’ mental health and dementia literacy. Participants were recruited using a purposive snowball sampling method and semi-structured interview guide. Interviews were conducted in-person, via telephone and Zoom, and digitally recorded. Arts-making enhances mental health and dementia literacy of LTC staff by: 1) supporting relationships by generating trust and collaboration among persons living with mental health conditions and/or dementia, arts facilitators, and family members; 2) creating alternative communication spaces that allow people to see themselves and be seen by others from new perspectives; 3) fostering an artistic sensibility that: encourages imagination and empathy, brings spontaneity and playfulness to interactions, and disrupts restrictive expectations entrenched in typical caregiver/care receiver relationships. ‘Good’ literacy involves a relational and spatial awareness which manifests in the form of an artistic sensibility. Arts-based approaches can be used to enhance quality care by capacitating staff in the art of being open and curious, nimble and flexible, in how they know and make connections on an interpersonal level, in the moment.
Power Dynamics in a Triad Relationship: Advance Care Planning for Older Adults with Dementia in China
Authors: Lou Yifan , Liu Jinyu , Wu Bei 
Published: December 2020

Abstract
Objective: Primary family caregiver (CG), other family members (FM), and medical professionals (MP) play important roles in medical decision-making for older adults with dementia, who often have lost the capacity to make decisions on their own. Power dynamics within the CG-FM-MP triad relationship determine the process and outcome of the decision-making. Guided by Rahl’s relational power model, this study is among the first to understand the experiences of advance care planning among Chinese. Method: This study includes a total of 25 primary CGs or FMs and 5 MPs from 3 neurology departments. Hybrid grounded theory method was used to analyze the preliminary data we had so far. Based on the dimensions of power, we analyzed the power base, means, and scope of each agent in each interview to determine the power comparability. Results: Three types of triadic power relations were categorized: 1) shared-power with shared-decision, in which three agents shared the power of decision-making and CG as the lawful decision-maker makes the final decisions; 2) balanced-power with reversed-patriarchal decisions, in which FM’s power is over both CG and MP and become the actual decision-maker; and 3) unbalanced power with conflicting decisions, in which neither CG and FM has absolute power over each other and MP becomes the actual decision-maker implicitly. Conclusion: The study provides a framework for researchers and practitioners to understand the ACP process for Chinese older adults, which helps develop intervention strategies to improve surrogates’ ACP knowledge and reduce potential conflicts during the stressful process for the population.
The Enduring Strength of Biology and Gender: Care for Aging Parents Among Adult Children
Authors: Patterson Sarah , Schoeni Robert , Freedman Vicki , Seltzer Judith 
Published: December 2020

Abstract
Family complexity in the form of step-relationships are increasing across cohorts. Filial obligation, or the social norm that adult children should care for aging parents, are generally weaker in stepfamilies. Further, gender continues to be a main axis of stratification of who provides care within families. Taken together, we test whether biological versus step ties, the gender of the adult child, and the interaction between these two factors are associated with helping aging parents (ages 65 and older) with functional or health limitation based care needs. We use Round 5 (2015) of the National Health and Aging Trends Study. Results illustrate the enduring strength of both biological and gendered ties, with biological daughters being the most likely to help an aging parent, followed by biological sons, step-daughters, and lastly step-sons. This pattern holds even when we control for important characteristics of both the adult child and the care receiver. As families become more complex, these findings could mean that gaps in unmet care needs will emerge, especially for older adults who only have stepchildren.
Improvement in ADLs during a Nursing Home Stay for Older Adults with Stroke, Joint Replacement or Hip Fracture
Authors: Mathuba Warona , Downer Brian , Deer Rachel 
Published: December 2020

Abstract
Regularly assessing the health and function of older adults who are in the hospital is important for preventing poor outcomes. Such information may also be useful in post-acute care settings, such as skilled nursing facilities (SNFs) to identify older adults who are high risk for poor outcomes. This study had two objectives: Map items from the Acute Care for the Elderly (ACE) Tracker to items from the Minimum Data Set (MDS). (2) Examine the association between ACE Tracker items and improvement in activities of daily living (ADLs) during a SNF stay. We identified Medicare fee-for-service beneficiaries admitted to a SNF within 3 days of hospital discharge for a hip fracture (n=118,790), joint replacement (n=245,845), or stroke (n=64,153). Items from the ACE Tracker were matched to patients’ first MDS assessment. The first and last MDS assessments were used to calculate a total score for self-performance on seven ADLs. Multivariable logistic regression models were used to identify patient characteristics associated with the odds for improvement in ADL function. Severe ADL limitations at admission and greater hours of physical and occupational therapy were associated with significantly higher odds of ADL improvement. Cognitive impairment, vision limitations, indwelling catheters, and unhealed pressure ulcers were associated with significantly lower odds of ADL improvement. The characteristics associated with improved ADL function were similar between patients with joint replacement, hip fracture, and stroke. Many of the health and functional characteristics routinely measured in hospital settings are also collected in SNFs and are associated with improvement in ADL function.
Caregiver’s Relationship Type and Race/Ethnic Group Comparisons in a Community-based Caregiver Support Program
Authors: Cho Jinmyoung , Smith Donald , Stevens Alan 
Published: December 2020

Abstract
In the past decades, a number of evidence-based interventions has been implemented to improve caregiver outcomes; however, limited attention to specific subgroups (e.g., racial/ethnic groups) still exists in dementia caregiver support interventions in community settings. The purpose of this study is to examine the effect of caregiver’s race/ethnicity and relationship type to the care-recipient on the quality of life among caregivers. This study included 354 informal caregivers enrolled in REACH-TX, a community-based caregiver program, provided by the Alzheimer’s Association North Central Texas Chapter’s from November 2011 to June 2019. Propensity score matching extracted a subset of participants who enrolled in REACH-TX to balance caregivers from three race/ethnic groups (White: 171; African American: 103; Hispanic: 80). Five dimensions of quality of life (depression, caregiving burden, social support, self-care, and problem behaviors) were assessed at baseline and 6-month follow-up among spousal and adult-child caregivers by race/ethnic group. Generalized linear models showed that significant improvement on the five domains of quality of life among White child caregivers, whereas neither spousal nor child caregivers in African American group showed improvement on any domains after adjusting covariates (age, gender, risk levels, number of therapeutic contacts), These findings indicate that the responses to intervention components vary by race/ethnic group and relationship type. Advancing tailored dementia caregiver interventions to specific subgroup needs and unique context, especially for non-White caregivers, is needed to maximize the benefit of community resources and support for diverse caregivers.
Fear of Falling and Walking Quality: What Your Walking Reveals
Authors: Suri Anisha , Rosso Andrea , VanSwearingen Jessie , Torres-Oviedo Gelsy , Coffman Leslie , Redfern Mark , Brach Jennifer , Sejdic Ervin 
Published: December 2020

Abstract
Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk. In this cross-sectional study we examined the relationships between FOF and factors associated with fall-risk such as gait quality, cognition, and walking-confidence. Using baseline data from older adult participants in a randomized exercise trial (N=232; age 77±6; 65% females; 40% reported FOF), we quantified the following outcome measure for (1) gait quality: harmonic ratio (smoothness) and time-frequency spatiotemporal variables from triaxial accelerometry during 6 minute walk; gait speed, step-time CoV (variability) and walk-ratio (step-length/cadence) on an instrumented walkway; (2) cognition: Trails A and B (3) walking-confidence: Gait efficacy Scale. Mann Whitney U-tests indicated individuals without FOF had better gait quality (p&lt;0.05): greater smoothness (2.38±.58 vs 1.14±.73), speed (1.10±.15 vs 1.04±.17 m/s) and walk-ratio (.56±.07 vs .53±.08 cm/steps/min), lower step-time CoV (3.72±1.24 vs 4.17±1.66), and greater walking-confidence (89±11 vs 79±13). A random forest classifier predicted FOF with 64% (gait only) and 70% (additional variables: cognition, walking-confidence) accuracy; Gini-index based ranking indicated gait quality (smoothness vertical (V) direction, walking speed) were consistently important variables. Linear Support Vector Machine learning yielded accuracies of 60% (only gait) and 68% (with additional measures): smoothness V, mediolateral frequency bandwidth, gait speed among top 4 ranked variables in both models, and walking-confidence in the additional measures model; smoothness-V the highest weighted coefficient (-0.52). Based on these findings, interventions targeted for gait quality and walking-confidence may be important to overcome FOF and reduce fall risks.
Food and Nutrient Intake and Diet Quality among Older Americans
Authors: Choi Yeon Jin , Crimmins Eileen , Kim Jung Ki , Ailshire Jennifer 
Published: December 2020

Abstract
A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality. For this study, data from a nationally representative sample of 5,614 community-dwelling older adults over age 54 in the Health and Retirement Study – Health Care and Nutrition Survey were used. Descriptive analyses were conducted to assess average intake of 17 food groups and nutrients and the percentage of respondents who consumed an optimal amount of food and nutrients. Differences in diet quality by sociodemographic, psychosocial, environmental, and geographic factors were assessed using chi-square and OLS regression was used to identify risk and protective factors for good quality diet. Overall, only 10.7% of respondents had a good quality diet (HEI score 81 and above); the majority had diets considered poor or needing improvement. Less than 50% of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socioeconomic status, fewer psychosocial resources, and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality. Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality.
Stressors and Pain Over the Late-Life Course: Findings from Two Parent Longitudinal Studies of Aging and Health
Authors: Brennan Penny 
Published: December 2020

Abstract
With this study we sought to determine how older adults’ stressors influence their levels and rates of change in pain during the late-life span. We harmonized repeated measures data from two parent longitudinal studies of aging and health, Longitudinal Late-Life Health (LLLH; n=1,1884) and the Health and Retirement Study (HRS; n=7,703), to determine how participants’ stressor levels in the domains of finances, spouse, children, extended family, and friends, and in stressors overall, influenced their average levels and rates of change in painful conditions, pain severity, and pain interference over 13-year (LLLH) and 8-year (HRS) intervals. Participants’ within-person stressor levels declined somewhat, whereas their number of painful conditions, pain severity, pain interference, and prescription painkiller use increased steadily, over these intervals. In both the LLLH and HRS samples, participants who experienced higher average stressor levels over the 13- and 8-year intervals had more numerous painful conditions and higher pain severity over these intervals. In the HRS sample, they also experienced higher levels of pain interference. These effects occurred independent of the demographic characteristics of age, gender, and race. In general, participants’ stressor levels did not influence rates of increase in their pain. Gender and race had some moderating effects on associations between stressors and pain, but these occurred only within certain specific stressor and pain domains. These findings demonstrate an association between stressors and pain across the late-life course. Further research is needed to determine the mediating mechanisms that account for this association and the moderating factors that affect its strength.
The Effect of Technology Use in Reducing Social Isolation or Loneliness in Older Adults: A Systematic Review
Authors: Kim Yoon Chung , Kohn Gail , Davis Carenado , Saunders Pamela 
Published: December 2020

Abstract
The US population over 65 is projected to increase to 21% by 2050. Given mobility issues arising from health concerns, economic status changes, loss of friends and partners, older people are at a higher risk for social isolation and loneliness. Since the declaration of national emergency for COVID-19 on March 13, 2020, many older adults have not been able to connect with others in traditional ways. Instead, activities and contacts have been facilitated virtually via videoconferencing or phone calls to maintain physical and social distance. Amidst COVID-19, the transition to using technologies to connect socially and reduce loneliness has been a critical factor in preventing social isolation and loneliness. Identifying effective strategies involving the use of technology, designing new ways to deliver services virtually, and developing educational programs to promote technology is vitally necessary. This systematic review explored the relationship between technology use and social isolation or loneliness, and examined interventions that reduced social isolation in older adults. A unified strategy was used to systematically search seven databases (MEDLINE, PubMed, Embase, CINAHL, Web of Science, PsycInfo, and AgeLine) to examine qualitative and quantitative studies published in English between 2010 and 2020. Preliminary results indicate that technology can alleviate social isolation and loneliness in older adults despite some mixed results. The findings of this study will provide a foundation for policymakers and practitioners to shape policies and design programs that help older adults to alleviate social isolation and loneliness, particularly amidst the COVID-19 pandemic.
Age Does Not Predict Mortality in Hospitalized COVID-19+ Older Adults: Rethinking Resource Allocation Based on Age
Authors: Sinvani Liron , Marziliano Allison , Makhnevich Alex , Zhang Meng , Carney Maria , Diefenbach Michael , Davidson Karina , Burns Edith 
Published: December 2020

Abstract
Older adults are disproportionately affected by the coronavirus (COVID-19) pandemic. While age has been used to guide resource allocation based on studies implicating age as the main risk factor for COVID-19-related mortality, most did not account for critical factors such as baseline functional and cognitive status, or life-sustaining treatment preferences. The objective of this study was to determine whether age is independently associated with mortality in older adults hospitalized with COVID-19. We conducted a retrospective cohort study of adults age 65+ with confirmed COVID-19 hospitalized in the greater NY metropolitan area between 3/1/20-4/20/20. Primary outcome was in-hospital mortality, with age as the primary predictor. Multivariate logistic regression was used to evaluate association between age and in-hospital mortality after controlling for demographics, severity of acute illness, comorbidities, and baseline function, cognition, and life-sustaining treatment preferences. 4,969 patients were included, average age 77.3, 56.0% male, 46.8% White, 20.8% African American, 15.1% Hispanic. Common comorbidities included hypertension (61.1%), and diabetes (36.8%); average number of comorbidities was 3.4 (SD 2.8) and 13.0% had dementia. 20.8% arrived from a facility and 5.7% had early do-not-resuscitate orders. On arrival, the Modified Early Warning System score was 4.2 (SD 1.7) and 79.6% required oxygen therapy. 35.3% of patients expired. In multivariate analysis, age was not independently associated with mortality (p = .173). Functional status, multi-morbidity, life-sustaining treatment preferences, and illness severity, not age, were associated with mortality among older adults hospitalized with COVID-19, suggesting age should not be used as the main indicator to guide resource allocation.
Development of Serum Antibodies to SARS-CoV-2 and Evidence of Immunity in Older Adults Convalescing from COVID-19
Authors: Caffrey Rebecca , Wright James , Waltrip Nicole , Bostwick David 
Published: December 2020

Abstract
The presence and magnitude of SARS-CoV-2 IgG, IgM, and Neutralizing Antibody (NAbs) response was investigated in study cohort comprised of 58 volunteers who survived COVID-19 in a Virginia LTC facility. All subjects were confirmed positive by PCR nasal swab at least once and blood samples were drawn a minimum of 14 days post symptom onset or first positive COVID-19 test. The cohort was split between LTC residents (n=32, mean age 77.8 yrs, age range 48-97), and the LTC staff (n=26, mean age 41.3 yrs, range 23-61); the age difference between groups was statistically significant (P&lt;0.001). Serum IgG measurement was quantitative over 5 orders of magnitude (0.6-1250µg/mL) and IgM was qualitative, measured with sandwich ELISA; NAbs were measured with surrogate virus neutralization assay (sVNT) competition ELISA (both Genscript). The convalescent older adult LTC patients were fully immuno-competent and showed no significant difference in IgG, IgM, or NAbs compared to the younger staff group. All older adults developed NAbs and were positive for either IgG, IgM, or both. All study participants were then grouped by age range and IgG, IgM, and NAbs compared between the following groups: ≤ 50 yrs old(n=20), 51-60(n=6), 61-70(n=8), 71-80(n=14), 81-90(n=6), and ≥91(n=4). There was no significant difference in immune response parameters between the age groups. Furthermore, repeat testing at 3 months on a subset of participants showed that NAbs, IgG and IgM persist. We conclude that development of competent immune response was age-independent, and that presence of NAbs in serum suggests older adults may develop true immunity.
Differential Impact of the COVID-19 Pandemic on Students, Faculty and Staff at a Florida HBCU
Authors: Wheaton Felicia , Johnson Matilda , Cozart Thometta 
Published: December 2020

Abstract
The COVID-19 pandemic has caused major disruption to society, including education, the economy, daily life, etc. To understand the impact of the pandemic on both short-term and anticipated long-term mental and physical health, as well as potential period and cohort differences, surveys were emailed to all students, faculty and staff at a Florida HBCU. The survey included the GAD-7 anxiety scale, PHQ-9 scale of depression severity and the UCLA Revised Loneliness Scale (3rd revision), as well as questions about the pandemic’s impact on physical and mental wellbeing in the month of April and long-term physical and mental health. Although loneliness did not differ among groups, students reported the highest levels of moderate/severe depression (46.6%), followed by faculty (21.1%) and staff (6.9%). Students also reported the highest levels of moderate/severe anxiety (48.6%) compared with faculty (29.4%) and staff (12.1%). Students were more likely to say the pandemic moderately or very much impacted their overall physical and mental wellbeing in April. However, faculty were more likely to report that their long-term physical and mental health would be somewhat/greatly affected, followed by students, and then staff. Staff reported the highest levels of optimism about the future, followed by students and faculty. Taken together, these findings indicate substantial differences in the perceived impact of the COVID-19 pandemic.