bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cell-Based and Pharmacologic Hormone Therapy Maintain Diastolic Function After Ovariectomy in Hypertensive Rats
Authors: Groban Leanne , Sun Xuming , Sivanandane Sittadjody , Hodge Hunter , Wang Hao , Lin Marina , Opara Emmanuel 
Published: December 2020

Abstract
The role for hormone therapy in the maintenance of diastolic function upon ovarian senescence has not been clinically tested due to concerns for off-target health risks. We developed a cell-based hormone therapy (cHT) approach that recapitulates native cell–cell interactions between ovarian granulosa and theca cells in a 3D bioengineered construct to mimic the dynamic release of sex hormones. Our first report in ovariectomized (OVX) rats shows that cHT ameliorates various adverse somatic effects of hormone deficiency (e.g. bone loss). To extend these findings to cardiac health, we sought to determine the efficacy of cHT in preserving diastolic function in OVX-spontaneously hypertensive rats (SHR). 14 SHRs underwent bilateral OVX while 5 SHRs received sham surgery at 12 weeks of age. Following an 8-week washout, OVX rats were randomized to cHT or pharmacologic hormone therapy (pHT: E2 (10 mcg/kg/day) and P4 (2 mg/kg/day, s.c.) for 10 weeks and compared to OVX-vehicle and Sham. While uterine atrophy by OVX was minimized by cHT and pHT, hormone levels across OVX groups were not overtly different. Systolic blood pressure increased progressively over time (P&lt;0.01), without a treatment effect. Even so, cHT and pHT prevented OVX-related reductions in myocardial relaxation and increases in Doppler-derived filling (P&lt;0.05); paralleling the diastolic profile of Sham. Alongside superior diastolic function, 25% increases in cardiac interferon regulatory factor-4 (Irf-4) gene expression levels occurred in both hormone-treated OVX groups and Sham when compared to OVX-vehicle, suggesting a link between sex hormones and local immune modulation in the regulation of female cardiac health.
Initial Derivation of Positive Dementia-Related Observational Measures: A Descriptive Ethnography
Authors: Staehler Maya , Benson Clark , Madden Jordan , Block Laura , Gilmore-Bykovskyi Andrea 
Published: December 2020

Abstract
Person-centered caregiving approaches emphasize efforts to protect and maintain the personhood of people living with dementia (PLWD). The influence on person-centered caregiving approaches on PLWD have predominantly focused on deficit-oriented outcomes, such as absence or reduction of behavioral symptoms. While important to quality of life, the absence of measurable “positive” responses to person-centered caregiving approaches limit opportunities to specify sensitive and meaningful outcome measures that more holistically represent PLWD’s care experiences as more than the absence of a negative outcome. To address these gaps, we conducted a secondary analysis of video-observations of PLWD (N=9) surrounding mealtime cares using a descriptive ethnographic approach. Our objectives were to descriptively summarize specific responsive behaviors demonstrated by PLWD surrounding person-centered caregiving interactions, specifying observable features of these responses and consider their utility in future video-observational research. Findings indicate PLWD contribute both verbal and non-verbal communication surrounding person-centered approaches which can be characterized as conversational (starting conversation, answering or asking questions), expressing preferences (indicating needs and preferences, agreeing or disagreeing, complying with or refusing caregiver requests, permission granting), emotional responses (mirroring caregivers’ emotions, demonstrating emotion e.g. smiling), and reflexive (mirroring of caregiver’s actions), with overlap between categories. Findings suggest that PLWD not only contribute and respond in meaningful ways to person-centered interactions, but also initiate a significant number of these interactions. This study contributes to a growing body of research and advocacy that examines the personhood and abilities of PLWD and establishes the utility of observational data in studying PLWD contributions.
Influence of Frailty on Discharge Setting for Older Adults With Hip Fracture at Inpatient Rehabilitation Facilities
Authors: Tocchi Christine , Shakya Shamatree , Amarasekara Sathya , Cary Michael 
Published: December 2020

Abstract
Inpatient rehabilitation Facilities (IRFs) provide intensive rehabilitation therapy to patients to reduce functional impairment, enhance independence and return patients back to the community. Determination of eligibility for IRF is currently based on a preadmission screening. Frailty, a pervasive characteristic in older adults with hip fractures has not been examined as a clinical factor influencing function and discharge destination IRF outcomes. This study purpose was to determine the prevalence of frailty among older adult IRF patients with hip fractures and determine the association between frailty and function and discharge destination among IRF hip fracture patients. A retrospective cohort study design using CMS 2014 Inpatient Rehabilitation Facility-Patient Assessment Instrument file. Frailty was measured using a Frailty Index of 30 items. The final sample included 26,134 patients. Frailty, pre-frailty, and nonfrailty were present in 0.92% (n=24043), 3.3% (n=862), and .076% (n=199) of hip fracture patients, respectively. The majority (65%) of the patients were discharged home. There were significantly greater proportion of females than males discharged home and those of white race, 65 to 74 years of age, and those with higher functional status. Regression analysis showed significantly lower functional status at discharge (p &lt; .0001) for males and those of non-white race, older age and frail. Study implications include the use of frailty status to identify hip fracture patients at high risk for adverse outcomes and need for future studies to explore the potential of frailty to provide value-added utility to IRF clinical settings and identify ongoing opportunities to guide person-centered care.
Acceptability and Feasibility of ActivPAL Activity Tracker for Pre-Frail African American Older Adults
Authors: Hu Yi-Ling , Valenzuela Camila Rodriguez , Jones Ryan , Gamalski Natalie , Fritz Heather 
Published: December 2020

Abstract
Frailty is more prevalent among African American (AA) older adults compared to their White counterparts. Physical activity (PA) interventions are effective to attenuate frailty progression. The Activpal is adhered to the thigh and allows unobtrusive PA measurement for up to 14 days. However, few studies have tested the acceptability and feasibility of activity trackers among older pre-frail AA. In this study, pre-frail AA older adults were asked to wear the ActivPAL tracker on their thigh for 7 consecutive days. Acceptability was measured by compliance. Feasibility was evaluated by the valid number of days and programing errors. Intraclass correlation coefficients were used to assess the agreement of light to vigorous PA level between ActivPAL and the Community Healthy Activities Model Program for Seniors (CHAMPS). In a sample of 28 pre-frail AA older adults (mean age= 73.21,SD= 9.37, 100% female), 24 completed the 7-day data tracking. Reasons for non-compliance included skin irritation (n=1), and fear of causing other health issues (n=3). The number of valid days was= 6.9 0.33 with 1 incident of programming error. The agreement between ActivPAL and CHAMPS was fair (ICC =0.57, [95%CI]= -.08 -.85) with most participants (61.6%) over-reporting PA on CHAMPS. The ActivPAL accelerometer was acceptable and feasible to use among pre-frail AA older adults. Communication prior to applying the accelerometer is crucial to prevent non-compliance. The results confirm prior studies, which suggest that older adults may over-report PA levels. ActivPAL offers a feasible and accurate approach to assess PA among older AA.
Novel Analytic Approaches to Investigate Minute-Level Actigraphy and Associations With Physical Function
Authors: Hua Kaiyuan , Luo Sheng , Hall Katherine , Morey Miriam , Cohen Harvey 
Published: December 2020

Abstract
Background. Functional decline in conjunction with low levels of physical activity has implications for health risks in older adults. Previous studies have examined the associations between accelerometry-derived activity and physical function, but most of these studies reduced these data into average means of total daily physical activity (e.g., daily step counts). A new method of analysis “functional data analysis” provides more in-depth capability using minute-level accelerometer data. Methods. A secondary analysis of community-dwelling adults ages 30 to 90+ residing in southwest region of North Carolina from the Physical Performance across the Lifespan (PALS) study. PALS assessments were completed in-person at baseline and one-week of accelerometry. Final analysis includes 669 observations at baseline with minute-level accelerometer data from 7:00 to 23:00, after removing non-wear time. A novel scalar-on-function regression analysis was used to explore the associations between baseline physical activity features (minute-by-minute vector magnitude generated from accelerometer) and baseline physical function (gait speed, single leg stance, chair stands, and 6-minute walk test) with control for baseline age, sex, race and body mass index. Results. The functional regressions were significant for specific times of day indicating increased physical activity associated with increased physical function around 8:00, 9:30 and 15:30-17:00 for rapid gait speed; 9:00-10:30 and 15:00-16:30 for normal gait speed; 9:00-10:30 for single leg stance; 9:30-11:30 and 15:00-18:00 for chair stands; 9:00-11:30 and 15:00-18:30 for 6-minute walk. Conclusion. This method of functional data analysis provides news insights into the relationship between minute-by-minute daily activity and health.
Perceived Value of Using a Digital Tool to Screen for Elder Mistreatment in the Emergency Department
Authors: Abujarad Fuad , Gill Thomas , Pantalon Michael , Jubanyik Karen , Dziura James , D’Onofrio Gail , Choo Esther 
Published: December 2020

Abstract
A major barrier to reducing Elder Mistreatment (EM) is an inability to accurately identify victims. We conducted a qualitative study to evaluate stakeholders’ perceived value and likelihood of adopting a tablet-based digital health tool to facilitate screening and prompt self-disclosure of EM in emergency departments (ED). The interactive tool utilizes virtual coaching, interactive multimedia libraries (graphics, animations, etc.), electronic screening, and brief motivational interviewing designed to enhance identifying EM among older adults. We conducted 3 focus groups with stakeholders, including 24 adults 60+ years, 2 social workers, 2 caregivers, and 2 ED clinicians. Two focus groups included only older adults, while one included representatives of all stakeholders. The main findings include: using a female voice for the tool narrator, larger font size, more multimedia, and headphones for privacy; and making a person available during screening if assistance is needed. Stakeholders indicated that it is difficult for victims to ask for help and any type of mistreatment screening would be helpful. On a 7-point Likert scale ranging from “1=Very Comfortable” to “ 7=Very Uncomfortable”, older adults scored 2.8 on average for whether they would feel comfortable using a tablet to screen for EM. Some said digital screening would maintain privacy and anonymity. Stakeholders highlighted the need to explain community resources available to older adults once EM is disclosed, especially resources offering help to the caregiver. In summary, this qualitative study supported using tablet-based screening for EM and highlighted the need to target stigma related to EM disclosure and fear of retaliation.
Developing a Questionnaire to Assess Opinions Regarding the Importance of Bathing and Washing Without Water
Authors: Groven Fabian , Hamers Jan , Odekerken-Schröder Gaby , Zwakhalen Sandra 
Published: December 2020

Abstract
Bathing is one of the most performed activities among nurses. Although care recipients experience bathing as an important activity in daily living, nurses often undervalue this care task. We developed a questionnaire to measure nurses’ opinions regarding 1) the importance of the bed bath, and 2) a bathing innovation known as Washing Without Water. Construction of the questionnaire items was based on literature and interviews with nursing home residents (n=8), their family (n=5) and nurses (n=6). After items construction, nurses and nursing students (n=124) completed the questionnaire to assess the questionnaire’s internal consistency (IC) and construct validity. Cronbach’s alpha coefficients were analyzed as an indicator for IC and items were deleted if this resulted in improved IC. To analyze the construct validity, a Principal Component Analyses (PCA) with Direct Oblimin Factor rotation was performed. The final scale consists of two subscales. The first subscale measures nurses’ opinions about the importance of the bed bath and consists of 12 items. The second subscale consists of 17 items and aims to inventory nurses’ opinions about the Washing Without Water innovation. The Cronbach’s alpha coefficients are high (.81 for the first and .89 for the second subscale). The PCA results show a one factor loading for both subscales, explaining 33,20% and 37,08% of the variance for the first and second subscale respectively. Results indicate a reliable and valid questionnaire to measure nurses’ opinions related to the bed bath, which can support health care institutions in evaluating the bed bathing process.
Caregivers’ Perspectives of Medication Management Advice for People With Dementia at Hospital Discharge
Authors: Sawan Mouna , Jeon Yun-Hee , Bond Christine , Chen Timothy , Hilmer Sarah , Gnjidic Danijela 
Published: December 2020

Abstract
People with dementia admitted to hospitals are more likely to be exposed to inappropriate polypharmacy and experience worse outcomes than people without dementia. Family and informal caregivers play an important role in managing medications across transitions of care; however, studies describing the experiences of medication guidance provided to caregivers at hospital discharge are limited. We have explored caregivers’ perceptions on the quality of and factors that influence caregiver participation in medication guidance at discharge. A qualitative approach using semi-structured interviews was conducted with 29 caregivers of people with dementia across Australia by telephone. Purposive sampling was used to ensure maximum variation of diverse perspectives. Content analysis was used to derive themes. Three themes were derived from analysis: inconsistent approaches to provision of medication information at discharge, caregiver awareness to advocate for the care recipient and managing competing priorities. Some caregivers reported inadequate information was provided because the information was communicated to the patient without the caregiver being present. Other caregivers stated a medication list, discharge summary and discussion with a healthcare profession provided useful information. Caregiver involvement in discussions on medication guidance at discharge was influenced by caregiver awareness to advocate for the care recipient to ensure medication safety and managing competing priorities at the time of discharge to manage stress. Caregivers flagged the need to establish structured caregiver education at discharge and community-based services to manage medications safely. Future studies are needed to explore development of resources to caregiver encourage participation during medication guidance at discharge.
Randomized Controlled Trial of Tailored Music Listening Intervention for Sleep in Dementia
Authors: Petrovsky Darina , Roan Shana , Gooneratne Nalaka , Bradt Joke , Gitlin Laura , Hodgson Nancy 
Published: December 2020

Abstract
Sleep disruption in older adults living with Alzheimer’s disease and related dementias (ADRD) is debilitating and contributes to increased institutionalization, reduced cognitive function, and accelerated disease progression. Given the potential harmful effects of pharmacologic treatment, non-pharmacologic approaches, such as music, may provide a safer alternative to improve sleep quality in this vulnerable population. No empirically validated music protocol exists to address sleep disruption in older adults with ADRD living at home. Therefore, the specific aims of this wait-list randomized controlled trial were to examine the 1) feasibility; 2) acceptability; and 3) preliminary efficacy of a tailored music intervention in home-dwelling older adults with ADRD with sleep disruption and their caregivers. This presentation focuses on baseline characteristics of dyads, which included persons with ADRD and their caregivers who have completed the clinical trial so far (N=28). The mean age of persons with ADRD was 71.6 (SD: 7.6). The mean age of caregivers was 58.7 (SD: 16.7). Sixty-eight percent (n=19) of persons with ADRD were female. Similarly, the majority of caregivers were female (n=20, 71.4%). Seventy-four percent of persons with ADRD scored 0.5 on the Clinical Dementia Rating instrument, indicative of very mild dementia. The majority of dyads identified themselves as non-Hispanic (&gt;92%). Seventy-nine percent of persons with ADRD identified themselves as Black or African-American (n=22, 79%), while 82.1% of caregivers identified themselves as Black or African American. Preliminary analysis of qualitative data indicates high acceptability of the intervention. Results from this research study will inform a future efficacy trial.
Visual Impairment at Age 85 Predicts Subsequent Cognitive Decline at Age 90
Authors: Jacobs Jeremy , Stessman Jochanan 
Published: December 2020

Abstract
Although the impact of visual impairment (VI) upon functional status and mortality among older people is recognized, its relationship to cognitive function is unclear. We examined the association between VI and subsequent cognitive decline from age 85-90 among subjects from the Jerusalem Longitudinal Study (1990-2020), which follows a representative study sample born 1920-21. Assessment at age 85 (2005) and age 90 (2010) included Snellen visual testing and Mini Mental State Examination (MMSE) for 488 subjects. VI was defined as corrected best eye vision ≤ 40/60. Dementia was defined as MMSE ≤24/30, after visually-dependent items (drawing, writing, reading) were excluded from the MMSE, and the score (maximum=27) was corrected to a maximum of 30 by multiplying by a factor of 1.111. At age 85 frequency of VI was 40.1% (198/488) and 86.9% (424/488) of subjects were non-demented (MMSE ≥24/30). Between ages 85-90 the mean decline in MMSE among all subjects with VI vs. non-VI was 5.2±7.7 vs. 3.9±6.7 (p=0.053), among non-demented subjects was 5.2±7.8 vs. 3.5±6.3 (p=0.002), and the transition to dementia was 34% vs. 20% (p=0.004) respectively. In logistic regression analysis among non-demented subjects at age 85, the unadjusted odds ratio (OR) for transition to dementia by age 90 associated with VI at age 85 was OR 1.95, 95%CI 1.24-3.06, p&lt;0.01, and after adjusting for gender, years of education, depression and diabetes, the adjusted OR was 1.74, 95%CI 1.09-2.76, p&lt;0.05. In conclusion, visual impairment at age 85 is independently associated with subsequent cognitive decline and the development of dementia.
Weight Loss Motivation in Older Pre-Diabetics: Preliminary Evidence by Race in the Eggspdite Study
Authors: Miller Marshall , Borack Michael , Rincker Jamie , McDonald Shelley , Starr Kathyrn , Bales Connie 
Published: December 2020

Abstract
Obesity hastens functional decline and intensifies chronic health conditions among older adults. Late-life obesity is of particular concern for older African Americans, who are at increased risk for obesity and type 2 diabetes and for whom weight loss interventions can be less effective. However, obesity interventions have been under-studied in this population; little is known about potential differences in motivation for change by race. The ongoing Eggs PreDiabetes Intervention Trial (EGGSPDITe) is a randomized controlled trial of expedited weight loss in older (60+ years) Black and White adults with prediabetes. Participants completed both the Stages- and Processes of Change questionnaires in Weight Management (S-Weight and P-Weight) at baseline and end of 4-month intervention. Preliminary combined-group analysis indicates that, while White participants reported a higher average stage of change at baseline, there was no difference by race (ps &lt; 0.05) in changes for body weight, fat mass, and hemoglobin A1c at endpoint. Reductions in weight consequences evaluation (WCE) and increases in weight management actions (WMA) subscales were observed in both races (ps &lt; 0.05), with a trend toward decreased emotional re-evaluation (EmR; p = 0.06). Of the processes of change subscales, only WCE differed by race (p &lt; 0.05), with White participants showing ≈13.5% higher utilization, relative to Black participants, at both time points. These preliminary findings suggest that weight loss interventions can be equally effective among black and white older adults, although motivations for weight loss may differ by race.
Identifying Medication Therapy Problems Related to Cognition Among Older Adults Followed by a Home-Based Care Team
Authors: Levine Allison , Emonds Erin , Smith Marie , Rickles Nathaniel , Fortinsky Richard , Ohlheiser Alis 
Published: December 2020

Abstract
Complications from dementia, depression, delirium (3Ds) and polypharmacy may accelerate patient decline. Cognitive vulnerabilities may be under-recognized and medication therapy problems (MTPs) overlooked, hindering optimal care. Clinical pharmacists on a multidisciplinary home-based care team (HBCT) being tested in a clinical trial were essential in identifying MTPs related to cognition. Medicare Advantage members &gt;65 years old, living at home in Connecticut, with ICD-10 codes related to 3Ds were eligible. APRNs conducted in-home medication reconciliation along with medical and cognitive assessments. HBCT pharmacists assessed medication lists for MTPs related to indication, effectiveness, and safety (adverse events, interactions). After review by the HBCT APRN, geriatrician, and psychiatrist, salient pharmacist recommendations were forwarded to PCPs for consideration. Using retrospective analysis, MTPs and recommendations were classified based upon the Pharmacy Quality Alliance framework. MTP analysis included 105 patients enrolled from 2017-2019. We found 166 MTPs related to cognition, with a mean (SD) of 1.58 (1.35) (range 0-6) MTPs per patient. MTPs related to indication accounted for 34% (57/166) of total MTPs, of which 79% (45/57) were underuse and 21% (12/57) overuse; effectiveness represented 13% (22/166) of MTPs; safety represented over half (52%; 87/166) of total MTPs with benzodiazepines and anticholinergics commonly implicated. Common HBCT pharmacists’ recommendations included discontinuation (23%; 38/166) and dose reduction (19%; 32/166). MTPs related to cognition were found among the overwhelming majority (79%) of patients. This work is significant because it supports the value of pharmacists on multidisciplinary teams to address cognitively harmful medications, dementia treatment side effects, and untreated cognitive conditions.