bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Peer Specialists in Engaging Aging Adults in Recovery and Wellness Behaviors
Authors: Peeples Amanda , Wray Laura 
Published: December 2020

Abstract
Peer specialists are individuals who have a lived experience with a mental health condition and who have received formal training to provide peer support and services to others. This symposium will examine the role of peer specialists in supporting aging adults’ recovery, quality of life, health behaviors, and health outcomes. Peer specialists have increasingly been integrated as formal service providers in health care systems in a wide variety of settings. In the Veterans Health Administration (VHA), over 1,110 Veterans work as peer specialists across the country. Findings from both VHA and community studies will be presented. First, Amanda Peeples will present findings from a mixed-methods evaluation study on the implementation of peer specialists to primary care teams in the VHA. Next, Anjana Muralidharan will present on the role of peer specialists in promoting health and wellness among aging veterans with serious mental illness using data from three VHA studies on peer-led interventions. Finally, Karen Fortuna will present on PeerTECH, a digital peer support self-management intervention that teaches older adults with mental health conditions how to co-manage psychiatric illness and chronic health conditions. Together, these three presentations will explore the ways in which “peerness” is defined in different populations and in diverse contexts. Laura Wray, geropsychologist and Executive Director of the VHA Center for Integrated Healthcare, will serve as discussant. She will comment on the role of peer specialists in supporting the recovery and wellness of aging persons in VHA and beyond.
Loneliness and Patterns of Health Service Usage: Evidence From Healthy Ageing in Scotland
Authors: Douglas Elaine , Bell David 
Published: December 2020

Abstract
Loneliness is associated with poorer health status and health outcomes. Yet, little is known about how loneliness in ageing populations is associated with health service usage. Loneliness (UCLA-3) was measured in older people in Scotland (Healthy Ageing in Scotland, HAGIS, n = 1,057). We analysed socio-demographic, perceived health, and health behaviour characteristics using descriptive statistics and logistic regression. The survey data (HAGIS, 2016/17) were linked to retrospective administrative health data to investigate patterns of health service usage (from 2005), such as the number of hospital visits and mean length of stay, and their associated costs. Two-part models were used to highlight variation i) in those who had ever vs never been admitted to hospital, and ii) between those who had been admitted. Our results highlight the variation in hospital service usage in those experiencing loneliness and opens discussion on the implications for older people and hospital services.
Children Raised by Grandparents or Nongrandparents: Which Have Greater Odds of High Academic Performance?
Authors: Shovali Tamar , Bright Melissa , Emerson Kerstin 
Published: December 2020

Abstract
There is a 19-fold greater likelihood that children removed from parental care will be raised by a grandparent than any other caregiver. Theorists and practitioners highlight the importance of monitoring academic progress to understand the benefits of at-risk youth living in grandfamilies. Using a nationally representative dataset we examined academic performance for children in three caregiver (N = 814) categories: Grandparent (73.1%), Foster parent (12.7%), Other (nonfoster, nonkin/nonfoster; 14.2%), with significance testing across groups. Children were between 6-17 years with grandfamilies and foster families caring for significantly younger children compared to the “other” group. Overall, 76% of children were reported to have high academic performance in math and 79.6% had high academic performance in reading/writing. Grandparents were caring for a significantly higher proportion of non-Hispanic White children with statistically significantly higher reported academic performance in math and reading/writing compared to nongrandparents. Logistic regression model A showed for both foster parent (AOR 0.57, CI: .35-.91) and other (AOR 0.55, CI: .35-.86) caregiver groups were significantly negatively correlated with high math performance compared to grandparents. Model B showed the same statistically significant and negative relationship to reading/writing performance outcomes for foster parent (AOR 0.56, CI: .02-.35) and other (AOR 0.51, CI: .01-.32) caregivers compared to grandparents. Controlling for relevant caregiver and child variables both models suggest that children living with grandparents have 55% greater odds of high academic performance compared to children raised by nongrandparents. Findings support placement of children with grandparents. Supporting grandfamilies with appropriate social services will be reviewed.
Factors Related to Family Caregivers Quitting Their Work
Authors: Shirasawa Masakazu , Takemoto Yoshihito , Masuda Kazutaka , Hata Ryousuke 
Published: December 2020

Abstract
As the working population declines in Japan, preventing family caregivers from quitting their work has become a government priority. Approximately 100,000 people leave their jobs annually because of caregiving obligations. The present study examines the reasons behind caregivers’ resignation and the factors that prevent caregivers from quitting. In January 2018, 3,000 sites were randomly selected from care management institutions nationwide. Surveys were conducted by mail, first with one care manager from each institution, then with an elderly person requiring long-term care and who had a family caregiver overseen by that same manager. The second survey was contingent on the response to the first. A total of 1,719 valid responses were received in the first survey (response rate: 57.3%), and 594 in the second survey (response rate: 34.6%). The surveys found that 21.2% of family caregivers quit their jobs. Caregivers also quit their hobbies (23.6%), neighborhood associations (7.2%), and stopped volunteer activities (5.4% ). Eight items from the survey of people requiring long-term care and who were supported by their family caregivers, and 5 items from the survey of care managers were analyzed in binomial logistic regression analysis with continuation of work (yes/no) as the dependent variable. Caregivers are less likely to continue working if they are older and their dependents require extended care, and more likely to continue working if they and their dependents are satisfied with the care manager. Care managers could therefore play a crucial role in allowing caregivers to find a better balance between caregiving and work.
Older African Americans' Experience of the Opioid Crisis
Authors: Rainer Sharon 
Published: December 2020

Abstract
In 2017, over 1200 Philadelphians died from opioid overdoses and an estimated 50,000 -70,000 people in the city are addicted to opioids. The opioid crisis is a family crisis that touches all communities affecting those using opioids, their family members, and the community. As policymakers develop responses to the opioid crisis, a multigenerational perspective is critical. With much published on the opioid crisis, there remains little understanding of older adult’s perceptions or experiences to this public health emergency. Older adults bring a unique voice. They are grandparents, parents, opioid users, and people living with chronic pain and/or addictions. Center in the Park (CIP), a nationally accredited senior center in Philadelphia, Pennsylvania sought to understand older African Americans’ perceptions of the opioid crisis and how their experiences inform senior center programming. CIP leadership sought a community partnership with Thomas Jefferson University College of Nursing to respond to what some in their community called “a domino effect” of the opioid crisis. Using a Community-Based Participatory Research Model rooted in humanistic research theory, a qualitative study was designed. Three focus groups (n29) were convened. All focus group recordings were transcribed and checked for accuracy. An iterative axial coding process was used. All transcripts were coded using the qualitative software program NVivo12. Findings suggest older adults are concerned about younger generations and addictions. In addition, older adults lack knowledge of the use and safety of opioids and have a general mistrust of the medical community to adequately limit the opioid epidemic.
Understanding Nursing Home Responses to Minnesota’s New Value Based Reimbursement System
Authors: Hass Zachary , Abrahamson Kathleen , Xu Dongjuan , Cooke Valerie 
Published: December 2020

Abstract
Even though Value Based Reimbursement (VBR) systems for nursing homes (NH) continue to expand, we have little understanding of how NH respond to VBR. In 2016, Minnesota passed VBR legislation for NHs that increased care-related funding and tied increases to a facility’s composite quality score. While care-related expenditures increased with VBR, the incentive for quality did not work as intended. We investigated the differential responses of facilities in their care-related expenditures and quality scores. Data were derived from cost reports and quality measures for the years 2013-2017 from 300 free-standing Minnesota NHs. Latent Class Growth Analysis was used to cluster facilities by their joint care-related cost and quality score trajectories over the period. Three interpretable trajectory clusters emerged: medium-to-high cost and medium-to-high quality (n=172), low cost and medium-to-high quality (n=54), and low cost and low quality (n=74), all during the pre-VBR period. In all three clusters cost rose significantly with VBR, but only in the low cost and low quality cluster did quality also rise significantly. The quality improving cluster had the highest percentage of government-owned and rural facilities as well as the largest annual increase in care related spending. The medium-to-high cost and medium-to-high quality cluster had the highest concentration of urban facilities (Twin City Metro Area) and were the most likely to be non-profit and chain owned. Although the new VBR system appeared effective in achieving its goals for a subset of facilities with lowest cost and quality, the majority of facilities increased care-related costs without improved quality.
A Systematized Review of UTI Management Protocol for Long-Term Care Residents
Authors: Arora Akanksha , Little N Ruth Gaskins 
Published: December 2020

Abstract
Clinical acuity for the elderly population has significantly intensified. This population is at heightened risk of infection, especially urinary tract infections (UTIs). Urinary tract infections exist as a clinical leviathan in the long-term care (LTC) industry and, despite its high prevalence rates, there exists a dearth of research on management protocol. The following review aims to summarize the current literature, identify, and comparatively analyze the current UTI management guidelines among LTC residents to guide provider leadership development of standards to prevent UTIs. The Joanna Briggs Institute’s approach to systematic reviews was implemented to search the following databases: ProQuest, PubMed, CINAHL, and MEDLINE. 538 citations were assessed, with 32 articles included in the review. Inclusion criteria comprised of clinical trial studies, a time frame of 2005 to current, and no restriction on the study country/region. Key results were collected and analyzed using a data extraction tool. Study findings show that consistent protocols are not followed by licensed staff to prevent, diagnose, and treat UTI’s among the elderly residing in long term care facilities. Inappropriate use of antibiotics is problematic due to the lack of specific practice guidelines for testing, diagnosis and, treatment. Studies implementing (1) successful clinical management strategies (i.e. antibiotic initiation, urinalysis frequency) and (2) facility administrative strategies (i.e. incontinence nurse specialist, DON/nurse leadership education) are needed to establish gold standard practice guidelines for the LTC industry.
Advanced Practice Clinicians Providing an Increased Share of Primary Care in Skilled Nursing Facilities, 2008-2016
Authors: White Elizabeth , Kosar Cyrus , Rahman Momotazur 
Published: December 2020

Abstract
Rising care complexity in skilled nursing facilities (SNFs), coupled with growing shortages of geriatricians and other primary care physicians able to see SNF patients, have increased demand for nurse practitioners and physician assistants (NP/PAs). We used 2008-2016 Medicare Part A and B claims and nursing home assessment data to describe longitudinal trends in NP/PA practice in SNFs. We identified 8,877,094 SNF post-acute primary care visits for 1,494,113 Medicare beneficiaries. The total number of visits increased from 850,285 in 2008 to 1,189,553 in 2016. The share of visits by NP/PAs rose significantly over time, from 24% of visits in 2008 to 43% in 2016. 71% of SNFs (n=10,139) used NP/PAs in 2016, up from 46% (n=6,696) in 2008. The number of NP/PAs practicing in SNFs more than doubled, from 4,472 clinicians in 2008 to 10,000 in 2016. The number of physicians practicing in SNFs declined from 26,297 in 2008 to 19,745 in 2016. NP/PAs represented 14% of all SNF medical providers in 2008 and 34% of providers in 2016. In 2016, 48% of NP/PAs were SNFists (i.e. &gt;90% of visits billed in SNF), vs. only 11% of physicians. SNFs with NP/PAs are on average larger, more likely urban, for profit, and care for larger populations of racial minorities, than SNFs without NP/PAs. SNFs with NP/PAs also have more short-stay Medicare residents, more admissions, higher nurse and rehab staffing levels, and higher case mix. These findings show that NP/PAs are taking on increasingly prominent roles as medical providers in SNFs.
Cognitive Health in Massachusetts, New Hampshire, and Rhode Island: Findings From the Healthy Aging Data Reports
Authors: Chunga Richard , Jansen Taylor , Lee Chae Man , Wang Shuangshuang , Wang Haowei , Silverstein Nina , Porell Frank , Dugan Beth 
Published: December 2020

Abstract
Over time persons with Alzheimer’s disease (AD) have impaired health, lower quality of life, and increased mortality compared to those without AD. This study describes state and community rates of Alzheimer’s disease, self-rated cognitive difficulty, and the % of the population age 85+ in three New England states (MA, NH, RI). Data sources were the American Community Survey (2009-2013 RI, 2012-2016 MA/NH) and the CMS Medicare Current Beneficiary Summary File (2012-2013 RI, 2015 MA/NH). Small area estimation techniques were used to calculate age-sex adjusted community rates for Alzheimer’s disease and related dementias (ADRD), self-reported cognitive difficulties, percentage of older adults 85 years or older, and the percentage of adults age 65+ living alone. State rates (range) were: AD: RI 14.4% (8-23%), MA 13.6% (6-19.31%), and NH 12% (5.49-33.51%). Self-reported cognitive difficulty: MA 8.3% (0-25.16%), RI 7.8% (2-18%), and NH were 6.9% (0-34.21%). Adults 85 years and older: RI 17.6% (6-24%), MA 15.2% (0-32.23%), and NH 12.9% (0-27.91%). Living alone: RI 30.4% (12-45%), MA 30.2% (6.25-50%), and NH 26.1% (6.13-72.55%). While there was significant variation across states, Rhode Island had the highest state rate of ADRD, older adults 85 and older, and percentage of older adults living alone. Within-state disparities among AD rates, cognitive difficulties, and living alone was highest in NH, but MA had the largest variation for community rates of adults 85+. Understanding the prevalence of brain health is important to policy and practice efforts to promote age-friendly communities. This research was supported by the Tufts Health Plan Foundation.
2-deoxy-D-Glucose-(2-DG) Prevents Pathogen Driven Acute Inflammation and Associated toxicity
Authors: Pandey Sanjay , Anang Vandana , Singh Saurabh , Bhatt Anant Narayan , Natarajan K , Dwarakanath B S 
Published: December 2020

Abstract
Pathogen-associated molecular patterns (PAMPs) associated with viral and bacterial infections trigger multiple inflammatory pathways which may result in oxidative stress driven toxicity, tissue fibrosis organ dysfunction and ageing. Inflammatory events need high energy demands and predominantly depends on the glycolysis. Thus, energy metabolism of the inflammatory events can be targeted to reducing the magnitude of the PAMPs driven inflammation and preventing tissue toxicity. Here we propose that 2-DG, a glycolytic inhibitor, and a potential Energy Restriction Mimetic agent (ERMA) can modulate inflammatory events and can prevent the development of acute as well as chronic pathology. For this study we induced LPS (bacterial PAMP) induced endotoxemia in mice which models infection associated inflammatory acute inflammatory events, tissue damage and organ dysfunction. 2-DG fed mice (0.4% w/v in drinking water) showed reduced LPS driven oxidative stress and capillary damage in lungs. Administration of 2-DG also reduced LPS induced spike in inflammatory cytokines (TNF, IL6 and IL1β) in the BALF and serum. Lungs of 2-DG fed mice showed lesser infiltration of inflammatory cells and reduced inflammatory signaling activation. 2-DG also downregulated the ex-vivo and in-vivo migration of the PMNCs. Furthermore, 2-DG also reduced the activation of the macrophage cells (RAW264.7) which was seen with reduction and the glycolysis and increased mitochondrial functions. Our data suggest that 2-DG administration as ERMA in drinking water can prevent pathogenic exposure driven inflammatory events which may prevent acute as well as chronic inflammatory disorders.
A DNA Damage Response-Independent Mechanism for Telomere Shortening-Elicited Age-Related Pathologies
Authors: Stock Amanda , Wang Kun , Sun Chongkui , Liu Chengyu , Gong Yi , Liu Yie 
Published: December 2020

Abstract
Telomere attrition is associated with telomeropathies and age-related pathologies. In telomeropathies, telomere uncapping induces a DNA damage response (DDR) that drives apoptosis or senescence. However, a defined mechanism by which telomere attrition contributes to other age-related pathologies has not been determined. Telomere integrity is maintained by shelterin, a six-protein complex. Rap1 is the only shelterin member that is not essential for telomere capping but engages non-telomeric DNA and regulates gene transcription. We hypothesized that non-telomeric Rap1 accumulation could contribute to age-related pathologies in a DDR-independent manner. To test this, we used CRISPR/Cas9 editing to generate a Rap1 mutant mouse model in which Rap1 at telomeres is prevented, leaving only non-telomeric Rap1. Indirect immunostaining showed no differences in telomere dysfunction-induced DDR foci in Rap1 mutant compared to wild-type primary fibroblasts. Cell fractionation/western blotting of fibroblasts from Rap1 mutants demonstrated decreased Rap1 expression and Rap1 re-localization off telomeres, which mimics the same alteration of Rap1 in human cells with telomere attrition. Rap1 mutant mice exhibited increased body weight and altered metabolic and immune-response transcripts in various tissues, indicating that altered transcription could account for some of the observed phenotypes related to telomere attrition. In conclusion, telomere shortening may facilitate non-telomeric Rap1, which alters gene transcription and drives metabolic and immune dysfunction in a DDR-independent manner.
Communication in Home Care: The Experiences of Formal Caregivers in Communicating with Persons Living with Dementia
Authors: Kamalraj Pabiththa , Savundranayagam Marie , Orange J B , Kloseck Marita 
Published: December 2020

Abstract
There is limited literature on formal caregivers’ communication with persons living with dementia (PLWD) in home settings. Most research comes from studies of long-term care home settings or informal home care contexts. Yet, there are expected needs and rising demands for formal caregiver support within home care. The aim of this study was to understand better the lived experiences of personal support workers (PSWs) regarding their communication with PLWD in home settings. A hermeneutic phenomenological approach guided this research. Semi-structured interviews were conducted with 15 PSW participants. Three major themes were identified through thematic analysis: (1) challenged by dementia-related impairments; (2) valuing communication in care; and (3) home is a personal space. PSWs experienced difficulties in their communication with PLWD despite recognizing the importance of communication in providing optimal home care. This suggests that while PSWs possess good intentions, they do not possess the skills necessary to ensure effective interactions. Dementia-specific education and training are recommended to improve PSWs’ communication skills and to enhance quality of care. Findings highlight further the uniqueness of the personal home space itself on PSWs experiences with communication. Aspects of the home care environment can enable, but also complicate, successful communication between PSWs and PLWD. Consequently, findings also have implications for family members of PLWD and home care employers regarding optimizing practice and improving care.
The Connections of Elderly Characters and Taiwanese Society in Edward Yang’s Movie “Yi Yi” (A One and a Two)
Authors: Hsu Sheng-Chin 
Published: December 2020

Abstract
As an aging society, Taiwanese is facing the low birthrate and low death rate, and many policies and social systems are facing difficulties. According to the social atmosphere, young and senior groups have many conflicts in between. Finding an alternative approach to reveal the social value of aged people becomes an important mission. The Taiwanese’ movie “Yi-Yi”(A one and a two, 2000) is the final masterpiece of Director Edward Yang, and he won the best director in Festival de Cannes. The story is taken place in a traditional Taiwanese wedding party, and there is a grandma who was invited to this party before her pass out. The grandma did not weak up until the end of this story. The director Yang filmed this sick character in the story and he showed the family members were gathering around their grandma. This study adopts the narrative analysis on elders in “Yi Yi”. There are three findings. First, the elder character is speechless but her sickness drives family members coming home. Second, the long term care is a heavy duty for family, but it reflects the preparations of individual physically and emotionally. Third, the meaning of image of elders is not image itself but family solidarity and social connection. The narrative theory and gerontology build a perspective to understand the social values and narrative functions of elderly people in “Yi-Yi”. It shows the conflict between different age groups and enlarges the spectrum of understanding elders in both Taiwanese’ movie and Taiwanese society.