bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Old Age Care Services and Long-Term Care Insurance: Evidence From Korea
Authors: Kim Hoolda , Mitra Sophie 
Published: December 2020

Abstract
Along with a rapidly aging population globally, the need for homecare is on the rise. Such care can be a heavy financial burden on older people and their households. To address this issue, the Korean government initiated two programs: care services for low-income individuals and voluntary long-term care insurance for people age 65+. Although it has been a decade since the implementation of the programs, there is limited evidence on how they affect the economic lives of older people, with and without disabilities. We use the 2008-2018 Korean Longitudinal Study of Aging (KLoSa) that provides detailed information about healthcare and homecare utilization and out of pocket costs for people aged 45 or older. We investigate the economic effects of old age public assistance programs using multivariate linear regression models and a dynamic panel model. The preliminary results indicate that older people with disabilities are more likely to utilize homecare services but do not experience any significant extra costs associated with homecare, implying that old age public assistance programs mitigate the financial burden of homecare for older people.
Denials, Surprise Charges, Starting Over: How Medicare Recipients Navigate the Medicare Mental Health Coverage Gap
Authors: Fullen Matthew , Dolbin-MacNab Megan , Brossoie Nancy , Wiley Jonathan , Lawson Gerard 
Published: December 2020

Abstract
Medicare is the primary insurance provider for approximately 51 million older adults, including those who seek mental health care. Medicare provider eligibility was last updated in 1989, and approximately one-third of the graduate-level mental health workforce (i.e., Licensed Professional Counselors and Licensed Marriage and Family Therapists) is excluded from Medicare, despite these professionals participating in Medicaid, TRICARE, the Veterans Administration, and private insurance plans. This Medicare mental health coverage gap (MMHCG) raises concerns about older adults’ access to mental health care, resulting in a policy misalignment between Medicare’s provider regulations and a growing number of older adults seeking mental health care. However, little is known about the precise impact of the MMHCG. To better understand how the MMHCG impacts older adults, we interviewed 17 Medicare-insured individuals about their experiences accessing mental health services. Using a phenomenological framework to analyze our data, we found that Medicare recipients described several consequences, such as: 1) a detrimental impact on their mental health and well-being; 2) concerns about having to start over with new providers due to commencing mental health treatment only to have services interrupted once the provider is no longer Medicare-reimbursable; and 3) relying on pro bono services from Medicare-excluded providers with uncertainty about the long-term sustainability of these arrangements. The presenters will describe how these findings fit within the current Medicare mental health service context, including the direct impact on older adults’ mental health. Discussion will also focus on policy implications of the findings and possible solutions for addressing the MMHCG.
Mental Health of Homebound Older Adults in China: The Moderating Effect of Loneliness
Authors: Chen Tao , Wang Shuangshuang , Yao Nengliang (Aaron) 
Published: December 2020

Abstract
Homebound older adults are confined to their homes due to physical, mental, or social limitations, which contributes to elevated levels of depression. However, the mental health status of the homebound population in China is relatively overlooked. This study compares mental health status between homebound and non-homebound older adults, and examines the moderation effect of loneliness. The sample consists of 1,301 older adults aged 60 and over (39% homebound, 49% females, mean age = 69) from Shandong Aging and Health Survey, conducted by Shandong Provincial Government in 2019. Mental health status was measured by feelings of depression, not cheerful, bored, not calm or peaceful, and not happy. Compared to non-homebound older adults, homebound older adults tend to be older, lower educated, live in rural areas, and in worse health conditions. Results from generalized linear regression models show that controlling for demographic and physical health status, homebound population were more likely to have worse mental health status than other Chinese older adults. Feeling lonely, isolated, or lack of companionship intensifies the adverse effects of being homebound on older adults’ mental health. Findings from this study suggest that homebound older adults in China had both physical and psychological sufferings. Social programs and interventions may be designed to improve homebound older adults’ mental health. As the number of homebound older adults increases in China, medical care models may be tailored to improve the accessibility of healthcare services among people who are confined to their homes.
Statistical Estimation of Accelerated Biological Brain Aging After Mild Traumatic Brain Injury in Older Adults
Authors: Irimia Andrei , Kim Jun , Wang Shania , Lee Hyung Jun , Ngo Van , Mahoney Sean , Robles David 
Published: December 2020

Abstract
Estimating biological brain age (BA) has the potential of identifying individuals at relatively high risk for accelerated neurodegeneration. This study compares the brain’s chronological age (CA) to its BA and reveals the BA rate of change after mild traumatic brain injury (mTBI) in an aging cohort. Using T1-weighted magnetic resonance imaging (MRI) volumes and cortical thickness, volume, surface area, and Gaussian curvature obtained using FreeSurfer software; we formulated a multivariate linear regression to determine the rate of BA increase associated with mTBI. 95 TBI patients (age in years (y): μ = 41 y, σ = 17 y; range = 18 to 83) were compared to 462 healthy controls (HCs) (age: μ = 69 y, σ = 18 y; range = 25 to 95) over a 6-month time period following mTBI. Across the initial ~6 months following injury, patients’ BAs increased by ~3.0 ± 1.2 years due to their mTBIs alone, i.e., above and beyond typical brain aging. The superior temporal and parahippocampal gyri, two structures involved in memory formation and retrieval, exhibited the fastest rates of TBI-related BA. In both hemispheres, the volume of the hippocampus decreased (left: μ=0.28%, σ=4.40%; right: μ=0.12%, σ=4.84%). These findings illustrate BA estimation techniques’ potential to identify TBI patients with accelerated neurodegeneration, whose rate is strongly associated with the risk for dementia and other aging-related neurological conditions.
Reasons for Refusing Home-based Palliative Care: A Qualitative Study of Patients and Caregivers
Authors: Cardenas Valeria , Zhu YuJun , Rahman Anna , Enguidanos Susan 
Published: December 2020

Abstract
Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that coverage for palliative care may be insufficient to expanding patient access to home-based palliative care. Research has yet to explore palliative care barriers from the perspective of palliative care-eligible patients and their caregivers. To identify patients and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers, we conducted a qualitative study using semi-structured individual interviews. Participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed via telephone. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the program explanation; and suggestions for improving messaging around home-based palliative care. Researchers used grounded theory to identify the themes within the transcripts. Two researchers independently coded the transcripts and then met to compare coding and reconciled discrepancies until 100% consensus was reached. Identified themes related to home-based palliative care referral barriers included reluctance to have home visits, timing, lack of palliative care knowledge, misconceptions of palliative care, and patients’ self-perceived health condition (not sick enough for palliative care). Themes related to recommendations for overcoming these barriers included preferring a palliative care referral from healthcare providers or from insurance company and clearer presentation of palliative care service. Findings reinforce the need for additional palliative care education among patients with serious illness and the importance of delivering the information from a trusted source.
Sequential Dependencies in Solid and Fluid Intake in Nursing Home Residents with Dementia: A Multistate Model
Authors: Liu Wen , Williams Kristine , Chen Yong 
Published: December 2020

Abstract
Nursing home (NH) residents with dementia commonly experience low food intake leading to negative consequences. While multilevel factors influence intake, evidence is lacking on how intake is sequentially associated. This study examined the temporal association between previous and current solid and fluid intake in NH residents with dementia. We analyzed 160 mealtime videos involving 27 residents and 36 staff (53 dyads) in 9 NHs. The dependent variable was the current intake state (fluid, solid, no-intake). Independent variables included the prior intake state, technique of current intake state (resident-initiated, staff-facilitated), duration between previous and current intakes. Covariates included resident and staff characteristics. Two-way interactions of duration and technique with the prior intake state, and resident comorbidity and dementia severity were examined using Multinomial Logit Models. Interactions were significant for technique by comorbidity, technique by dementia severity, technique by prior fluid and solid intake, and duration by prior fluid intake. Successful previous intake increased odds of current solid and fluid intake. Staff-facilitation (vs. resident-initiation) reduced odds of solid and fluid intake for residents with moderately severe (vs. severe) dementia. Higher morbidity decreased odds of solid intake (vs. no-intake) for staff-facilitated intake. Resident with severe dementia had smaller odds of solid and fluid intake for resident-initiated intake. Longer duration increased odds of transition from liquid to solid intake. Findings supported strong sequential dependencies in intake, indicating the promise of intervening behaviorally to modify transitions to successful intake during mealtime. Findings inform the development and implementation of innovative mealtime assistance programs to promote intake.
A Pilot Study of an Innovative Model of Care Delivery: Service Robot for Older People with Dementia in a Rural Community
Authors: Wang Kuan-Yuan , Chen Cheng-Sheng , Chen Hui-Mei , Chen I-Te 
Published: December 2020

Abstract
Background: The telehealth approach offers enhanced service delivery for older patients living in rural areas. Purpose: We conducted a pilot study to evaluate the feasibility of using the Zenbo robot to improve the quality of care of elderly individuals with dementia. Methodology: In this study, we developed a digital solution on service robots and smart devices, which can leverage the capacity of the user-friendly interactive interface and digital dialog system. A group of eleven volunteered older adults was selected for this study. To assess the likability and acceptance of the Zenbo, we conducted a one-on-one (robot vs human) pilot study in our long-term care stations. Each participant engaged in conversational interactions for five consecutive days and completed a survey of 12 questions about the experiences they had with the Zenbo, at the beginning and the end of the study respectively. Results: Subjects with lower GDS-15 scores have more positive attitudes toward the robot before the intervention. 27% of older adults had an increase in positive attitudes toward the interaction with the Zenbo robot. With the aid of teleoperated mobile robotic systems at home, the innovative service model can be achieved through telecommunication between primary health professionals or caregivers at remote locations and psychiatrists at the medical center to make the seamless care environment real. Conclusion: The IoT technologies can be used to assist physicians in switching from a hospital-centered model of care to a home-based service for older people with dementia. It merits more future clinical trials and usability tests.
Age Differences in the Consumption and Avoidance of COVID-19 Information
Authors: Deng Stephanie , Nolte Julia , Loeckenhoff Corinna 
Published: December 2020

Abstract
Staying informed about COVID-19 is crucial to maintaining public health. Although older adults are at increased risk of complications, recent data (Global Web Index, 2020) suggest that they are less likely to seek out information about COVID-19. This is consistent with prior evidence indicating that information seeking is negatively associated with age (Mata & Nunes, 2010). However, it remains unclear whether older adults merely fail to seek information or intentionally avoid information. In response, we examined whether age is associated with general information seeking and deliberate information avoidance in the wake of the COVID-19 pandemic. Based on previous work indicating age-related shifts in motivational priorities (Carstensen, 2006) we also examined whether avoidance motives differ by age. In a pre-registered online study, an adult lifespan sample (N=500, Mage=49.90, 51% female, 67% non-Hispanic White) completed self-report measures of media consumption, information avoidance, and avoidance motives with respect to the COVID-19 pandemic. In addition, we measured behavioral information avoidance by allowing participants to opt out of receiving valid COVID-19 information. As predicted, age was associated with decreased media consumption (p&lt;.001) and higher information avoidance about COVID-19 on the behavioral measure (p&lt;.01). Self-reported information avoidance, in contrast, was highest among younger adults (p&lt;.05). Further, with the exception of concerns about trustworthiness, older adults were less likely than younger adults to endorse various information avoidance motives (ps&lt;.05). Thus, although information seeking is lower and behavioral information avoidance about COVID-19 is higher in later life, this cannot be traced to explicit intentions or select motives.
Changes in Family Caregiver Roles and Interactions During the COVID-19 Pandemic
Authors: Moone Rajean , Suleiman Elizabeth Lightfoot Kamal Abdi , Kutzler Courtney , Otis Jacob , Turck Kenneth , Yun Heejung 
Published: December 2020

Abstract
Family caregivers provide the majority of support for older adults and people with disabilities in the U.S. The onset of the COVID-19 pandemic forced radical changes in duties and relationships between family caregivers and care recipients. These changes can be attributed to fears of virus transmission as well as federal, state and local government mitigation strategies resulting in social distancing and quarantining limiting caregiving interactions. This qualitative investigation conducted 55 Zoom interviews over summer 2020 with family caregivers to explore their changing roles and duties during the pandemic. Researchers utilized a semi-structured interview guide to explore caregiver experiences with COVID-19. The average age of the caregiver participants was 59 and the average age of the care recipients for whom they provided care was 74. All participants provided unpaid care for family members. Interviews were conducted in English (n=40), Spanish (n=5), Somali (n=5) and Korean (n=5). Care recipients resided in a facility (nursing home, memory care, ICF-DD, or other assisted living) (70%) with the caregiver (20%), and in a separate independent setting (10%). Data from each interview were coded into themes by two researchers. Themes that emerged from the analyses included concerns about care recipient mental and physical health deterioration, lack of communication from formal providers, change in relationships with other family members, and future concerns. Implications for additional research and practice are included.
Dual Caregivers of Relatives with Dementia in Rural Virginia: The Added Stress of COVID-19
Authors: Hoyt Emily , Savla Jyoti , Roberto Karen , Knight Aubrey L , Blieszner Rosemary , McCann Brandy R 
Published: December 2020

Abstract
Family caregivers often find themselves “sandwiched” between caring for an older relative with dementia (PWD) and another person. Serving in a dual caregiving role presents unique challenges and has consequences for caregivers’ physical and mental health. Seven daily diary interviews with 46 dual dementia caregivers assessed their daily stressors and informal and formal supports. Results showed that dementia caregivers who also cared for another older relative reported poorer physical health and used more community-based services to care for the PwD. Conversely, dementia caregivers who also cared for younger relatives reported greater secondary stressors, lower family support, and use of fewer community-based services to care for the PwD. Since the COVID-19 pandemic began, two telephone interviews were conducted with 15 dual dementia caregivers. Caregivers were asked in-depth questions about how the pandemic had impacted their caregiving responsibilities, mental health, and use of community-based services. Guided by stress process and behavior models, a thematic analysis of dual caregivers’ interviews revealed that caregivers had less time for themselves, engaged in self-care activities less often, and felt their social life had suffered. Many of the caregivers reported feeling exhausted, stressed, and had more things to do than they could handle. Of the eight caregivers that used services before COVID-19, six experienced a change in services including loss of services, different workers, or self-selected cancellation of services. Discussion focuses on challenges dual dementia caregivers face and the added stressors they experienced during the COVID-19 pandemic.
Frailty and COVID 19 Infection in Hospitalized Veterans: A Case Series
Authors: Fernandez Marlena , Hart Valerie , Diaz Alma , Burton Lorena , Cevallos Victor , Ruiz Jorge 
Published: December 2020

Abstract
Frailty, a clinical syndrome characterized by vulnerability to stressors resulting from loss of physiological reserve across multiple systems. In patients with COVID 19 infection, the presence of frailty may place older adults at higher risk for poor clinical outcomes including hospitalizations and mortality. The aim of this case-series study was to describe the characteristics of patients with frailty and COVID-19 who were hospitalized at a VA Medical Center. A VA Frailty Index (VA-FI) was generated at baseline as a proportion of variables from electronic health records. The VA-FI categorized Veterans into non-frail (FI&lt;.21) and frail (FI≥.21). We calculated the VA-FI for Veterans admitted at the time of COVID-19 admission date. We compared the characteristics of frail and non-frail Veterans. A total of 137 veterans were admitted, 96.3% (n=132) were male, mean age 66.81 (SD=13.87) years, and 65.7% (n=90) were frail. When comparing Veterans who were frail versus non-frail, there were no differences in age, race, ethnicity, BMI, rates of cardiopulmonary resuscitation, ICU admissions, use of vasopressors or length of stay. There were significant differences in rates of intubation (frail n=10, vs. non-frail n=0), p = 0.018 and non-invasive respiratory support (frail n=9 vs non-frail n=0), p=.025. There were 13 and 7 readmissions in the frail and non-frail groups respectively. Eleven Veterans died during hospitalization, all of whom were frail. Frailty is associated with poor clinical outcomes in hospitalized Veterans with COVID 19 infection. Recognition of frailty may help to optimize the management of COVID 19 related complications.
Mental Health Impact of the Confinement Measures During the COVID-19 Pandemic
Authors: Pauly Claire , Schröder Valerie , Pauly Laure , Krüger Rejko , Leist Anja 
Published: December 2020

Abstract
Background. Mid-March 2020, with exponentially increasing COVID-19 infections, Luxembourg closed schools and businesses, and declared a crisis (état de crise) to implement confinement measures, including orders to not leave the home unless to fulfill essential needs. The psychological consequences of these policy responses to the pandemic on older people, considered a high-risk group, were unknown at the time. The aim of this study was to use the nationally representative CON-VINCE study that assessed mental health at the height of the confinement measures mid-April 2020, to assess the psychological impact of quarantine on older adults. Method. A total of 451 participants aged 60+ years (55.0% male) filled in the CES-D, the GAD-7 and the 3-item loneliness scale that measured depressive symptoms, level of anxiety, and feelings of social isolation. Results. Mean age was 67.7 years (SD 5.5), average number of school years were 13.1 (SD 3.6). The participants were mainly of Luxembourgish nationality (87.8%), and a majority (69.8%) was married. Clinically relevant depression scores were present in 13.1%, generalized anxiety in 1.8%, and self-perceived isolation in 16.9% of participants. Number of depressive symptoms was associated with perceived isolation (p&lt;0.001) and current exercise levels (p=0.02). Discussion. The rate of older adults with clinically relevant impaired mental health was similar to pre-pandemic levels in Luxembourg, suggesting that negative mental health consequences of the confinement measures were largely absent. Possible explanations are that confinement was considered a universal experience, and that the healthcare system remained functional, unlike in other countries at the time.
Nimble Gerontological Interprofessional Education During a Pandemic
Authors: Hebdon Megan Thomas , Wilson Christina , Carney Katherine Bernier , Telonidis Jacqueline , Chase-Cantarini Sue 
Published: December 2020

Abstract
To improve communication and collaboration among health professionals, interprofessional education (IPE) experiences have been offered to students through the Utah Geriatric Education Consortium (UGEC) with the support of long-term care (LTC) partners since 2017. The COVID-19 pandemic presented a unique challenge in delivering in-person IPE training. Here we describe adaptations and student outcomes with our Spring/Summer 2020 training sessions. Students (n=46) from health profession programs were recruited and enrolled in the sessions. A LTC partner helped plan two-hour remote training sessions to introduce students to current issues and health care team member roles in LTC. Moderated small group discussions regarding the 4 Ms Framework and a patient case were completed using virtual breakout rooms. A shared virtual document was used to guide discussions and record insights. Student participants (n=46) were primarily White (85%), female (70%), and enrolled in physical therapy (28%), nutrition (33%), and medicine (15%) programs. Thirty-one students completed post-course satisfaction surveys with Likert-scale and open-ended questions. Most students who completed the survey agreed or strongly agreed that the course was effective (85%) and engaging (81%), and will improve care (88%). Positive course aspects included: comprehensive information with speaker experiences and use of 4 Ms; course structure with moderated small groups; and interprofessional collaboration with common goals and multiple perspectives. Despite the challenges of COVID-19, an IPE experience was effectively delivered using video conferencing technology, community collaboration, and moderated small group discussions. The successes of this IPE delivery model will enhance engagement and accessibility of future gerontological workforce training.