bluuebunny/crossref_metadata_2025_split huggingface dataset:
Covid-19 Swept Nursing Homes in the United States
Authors: Yu Lei 
Published: December 2020

Abstract
Nursing Homes experienced a colossal loss impacted by the Covid-19 pandemic in the United States. This study applied Covid-19 Nursing Home Dataset (updated on 08/16/2020) released by Data.CMS.gov to explore possible factors behind the death s at nursing homes. The results indicated 2.55 residents died per week at a nursing home averagely. Besides, the absence of nursing staff, aides, clinical physicians, PPE supplies contributes to more deaths at nursing homes. Lastly, the number of positive COVID-19 cases of nursing home staff positively associate with the number of total deaths of residents（R=0.65). These findings provide more pieces of evidence for nursing home administrators and policymakers to make adjustments to help nursing home residents better cope with challenges caused by the pandemic; however, this dataset is not the final data for the pandmic is not over. Also, the dataset covers few demographic information (gender, race, ethinicty and so on) ; therefore, researchers could explore the relationship between the demographic features and COVID-19 deaths at nursing homes.
Social Activities in Community Settings: Impact of COVID-19 and Technology Solutions
Authors: Adams Anne , Beer Jenay , Wu Xian , Komsky Jane , Zamer Jason 
Published: December 2020

Abstract
COVID-19 has created challenges for staff in promoting resident activity. To better understand the pandemic-related challenges that Activity Professionals are facing, we asked COVID-19 specific questions as part of a larger survey. The overall survey focused on identifying challenges and potential technology solutions (e.g., socially assistive robots) to assist Activity Professionals in their job duties. Activity Professionals (N=19) completed the online questionnaire. Respondents (aged M=48.00, SD=12.87; 95% female, 100% native English speakers, 68% White/Caucasian, 21% Black/African American) were highly educated/experienced: 68% had a Bachelor’s degree or above, and 53% had 10-35 years of experience. Respondents worked in Independent Living (68%), Assisted Living (37%), Memory Care (26%), Skilled Nursing (21%), or Personal Care (11%). All Activity Professionals reported impact by COVID-19, as follows: 1) Cancelled activities: Group activities/gatherings; hosting outside entertainment; fewer volunteers, vendors, paid sources. 2) New restrictions: Number of people in elevators, rooms; no contact with residents. 3) Unexpected new tasks: More 1:1 meetings; video conferencing; additional phone calls with residents, staff, and families; ordering groceries online. Daily duties changed significantly with less help and limited availability of technology. 4) Effect: Fewer activities and new delivery models (online, TV). Concerns about potential negative effects on residents while trying to meet the creativity challenge: “This has caused lots of “out of the box” thinking for ways to engage residents and keep things upbeat despite the challenges.” Results illustrate the breadth of challenges that staff are facing, some of which can be addressed by technology.
Technology Adoption Among Seniors During COVID-19 Pandemic Impacts Mental Health and Feelings of Companionship
Authors: Derynda Brittany , Goodyear Mary , Kushner Jade , Cook Nicole 
Published: December 2020

Abstract
Social isolation and lack of companionship, exacerbated by COVID-19 “stay at home” orders, has been an ongoing concern among seniors in the US. Among other strategies, Lifelong Learning Institutes (LLIs) were created to support continuing education for older adults. These programs bring seniors together to encourage engagement through lectures, art and fitness classes in a common space. LLI in South Florida adapted to COVID-19 “stay at home” orders by moving all programming online in March 2020. In May 2020 LLI members, faculty and students designed a research study to understand the experience of LLI members with social isolation and companionship prior to, and during, “stay at home” orders. Responses included 127 members (mean age 75.5). Respondents reported significantly lower social isolation (p&lt;.01) and lack of companionship (p&lt;.01) as a result of “stay at home”. Interestingly, social isolation had no significant explanatory variables. However, significant results (p&lt;.05) showed that seniors who isolated alone were 6.7 times more likely to lack companionship compared to those who isolated with a friend or spouse; seniors who reported they are not tech savvy were 8.3 times more likely to lack companionship compared to those who reported they are tech savvy; and that for every additional day of poor mental health respondents had a 1.15 higher odds of lacking companionship. These results underscore the importance of technology adoption among seniors during times of social isolation and the positive impact this can have on companionship and mental health.
Virtual Funerals During COVID-19 and Beyond
Authors: Muturi Ivy , Freeman Shannon , Banner-Lukaris Davina 
Published: December 2020

Abstract
Physical distancing measures and the restrictions on large group gatherings following the COVID-19 pandemic have left many to consider alternative approaches to commemorating the death of a loved one. Advancements in information technologies and the availability of affordable electronic devices have brought forth the ability to use virtual platforms to host funeral services for those unable to be with their loved ones. The aim of this study was to identify existing and potential online platforms for hosting a virtual funeral, explore the safety considerations of hosting a service during the pandemic and share the experiences of individuals who have previously hosted a virtual service. To conduct the research, an environmental scan was undertaken searching academic, grey literature and online websites. The results showed that there are currently several online platforms made specifically for virtual services and many free public platforms that can be used. Death services must ensure staff who are in direct contact with the deceased have proper Personal Protective Equipment and companies must adhere to regulations regarding group gatherings, screening for symptoms and physical distancing. Some individuals expressed having a positive experience, stating that the virtual service felt more intimate, while others expressed difficulty in navigating the technology, particularly the older adult attendees. Virtual funeral services may prove to be a practical and safer alternative during COVID-19 and may provide some comfort for those facing such challenging times. By examining existing platforms and their use, an opportunity exists to generate recommendations for additional supports, particularly for older adults.
Financial Well-Being Across Age Cohorts and Its Impact on Retirement Security
Authors: Skees Stephanie , Roll Stephen 
Published: December 2020

Abstract
The lack of retirement savings in the United States has been well-documented. For example, in 2013 roughly one-third of households near retirement lacked either a defined benefit or defined contribution retirement plan (U.S. Government Accountability Office, 2015), and the median retirement account balance is $0 (Oakley, Brown, & Saad-Lesler, 2018). While this lack of savings is concerning, less clear is the relationship between retirement security and a household’s sense of financial well-being. To that end, this study uses the nationally representative 2017 Survey of Household Economics and Decisionmaking to investigate the relationship between both retirement security indicators and subjective financial well-being—as measured through the Consumer Financial Protection Bureau’s financial well-being scale—across the life course. Specifically, we use multiple regression approaches to compare how financial and knowledge-based indicators of retirement security contribute to the financial well-being of young, mid-career, and pre-retirement cohorts. Preliminary results indicate that feeling “on track” for retirement savings and comfort in making retirement savings decisions were among the strongest contributes to a sense of financial well-being across age cohorts. However, these indicators were particularly important to the financial well-being of older households. Surprisingly, having a 401(k), IRA or pension had no significant impact on savings when controlling for other factors. This study speaks to the importance of both providing effective retirement savings tools, including both educational and financial resources, at multiple points across the life course. It also contributes to a small but growing literature on the intersections between subjective financial well-being and financial decisionmaking.
Neutrophil-Lymphocyte Ratio and Mortality in the Long Life Family Study
Authors: Vivek Sithara , Thygarajan Bharat , Murabito Joanne M , Schupf Nicole , Zmuda Joseph , Mengel-From Jonas , Wojczynski Mary 
Published: December 2020

Abstract
Neutrophil to Lymphocyte Ratio (NLR) reflects the balance between the innate (neutrophils) and adaptive (lymphocytes) immunity. Though NLR is a strong predictor of mortality in the general population, the distribution of NLR and its association with mortality has not been evaluated in families with exceptional longevity. Hence, we evaluated this question in the Long Life Family Study, a family based study of exceptional longevity. We used data from offspring of long lived (n=2065) family members and spousal controls (n=673). We used multivariate linear regression models adjusted for age, family relatedness, sex, field center, BMI and comorbidities (diabetes, CVD, cancer) to evaluate differences in NLR between long lived family members and spousal controls. Cox proportional hazard models were used to examine the association between NLR and mortality. 157 (7.6%) offspring in long lived families and 68 (10.1%) spousal controls were deceased during 12 years of follow up. NLR was similar among offspring in long lived families and spousal controls (1.96±1.06 vs.1.98±1.28; p=0.64). There was a significant positive association between NLR and overall mortality [HR: 1.3, 95% CI (1.01, 1.67)), p:0.04]. There was no statistically significant difference in this association among offspring in long lived families and spousal controls (p for interaction =0.16). The association between NLR and overall mortality was no longer significant [HR: 1.24; p:0.36] after adjustment for IL-6 and hsCRP. These results suggest that NLR may be a predictor of mortality in families with exceptional longevity though this association may not be independent of other inflammatory biomarkers.
Tailored Strategies and Shared Decision-Making for Caregivers Managing Patients’ Pain: A Web App
Authors: Chi Nai-Ching , Nakad Lynn , Fu Ying-Kai , Demir Ibrahim , Gilbertson-White Stephanie , Herr Keela , Demiris George , Burnside Lee 
Published: December 2020

Abstract
Family caregivers (FCs) are essential in helping manage pain for patients who receive hospice care at home, but an accessible resource to prepare FCs in pain management is lacking. This study aims to develop an accessible resource that aids FCs in pain management. First, we conducted two literature reviews and two secondary data analyses to investigate the challenges that FCs face when managing pain for patients. Based on the results, we identified 20 common challenges that prevent FCs from providing effective pain management. Second, we developed evidence-based content to address each identified challenge, and a library to provide FCs with pain education. Third, experts and clinicians (n=10) in hospice care validated the content, and FCs (n=10) gave feedback on how to improve the understandability of the content. Currently, we are converting the content to a web app prototype. The web app will consist of: (1) an assessment tool with questions to assess the FCs’ challenges when managing patients’ pain, (2) computer-generated strategies tailored to address the identified challenges, (3) discussion questions for FCs to use with their care team to prioritize goals of pain management, and (4) a library to enhance access to educational materials. This study presented the process of developing an evidence-based and user-centered web app. This study will advance the field of pain management in hospice care by providing accessible and evidence-based tools to support and engage FCs in pain management. Also, this web app will allow best practices to be quickly translated from research into practice.
Student-Led Fall Prevention Care Management Reduced Fall Risks at Assisted Living Facilities
Authors: Kiyoshi-Teo Hiroko , McKinley-Yoder Claire , Lemon Erin , Ochoa Olivia 
Published: December 2020

Abstract
Older adults in residential care settings are four times more likely than those not living in care facilities to experience falls. Yet, fall prevention efforts at long-term care settings are under-resourced, under-regulated, and under-studied. To address this gap, we developed and studied the impact of a specialty clinical, Fall Prevention Care Management (FPCM), for nursing students to decrease older adults’ fall risks. We enrolled assisted living residents that facility liaison identified as being high fall risk (fall rates or fall risk were not tracked at the study sites) and MOCA ≥15, in 2 assisted living facilities in Northwest USA. Participants received weekly, 1-hour, individual, semi-structured, Motivational Interviewing-based care management visits by same students over 6 visits. Changes in fall risks were measured by the CDC STEADI assessment (unsteadiness & worry), Falls Self-Efficacy Scale International-Short (FESI-S), and Falls Behavioral Scale (FAB). Twenty-five residents completed the study. Students addressed the following (multiple responses possible): emotional needs (n=23), improved motivation to prevent falls (n=21), and individualized education/coaching (i.e., exercise, mobility aids) (n=10-17). FESI-S score improved from 16.0 to 14.4 (p=.001; decreased fear. FAB score improved from 2.94 to 3.10 (p=.05; more frequent fall prevention behaviors). Frequency of those who felt steady while standing or walking increased (24% to 40%, p=.07) and those who did not worry about falling increased (20% to 36%, p=.08). FPCM clinical offered valuable opportunity to address unmet care needs of older adults to reduce fall risks.
Priorities for End-of-Life Care Reporting in Nursing Homes: Results From a Mixed-Methods Study
Authors: Gruneir Andrea , Hoben Matthias , Jensen Charlotte , Buencamino Monica , Easterbrook Adam , Marshall Sheila , Keefe Janice , Estabrooks Carole 
Published: December 2020

Abstract
The aim of the “Trajectories” project is to compile measures of nursing home (NH) quality to better characterize the final year of life for residents. In the first phase, we worked with various stakeholder groups to identify their priorities to focus the selection of possible outcomes relevant to end-of-life needs. Policy- and decision-makers from 5 Canadian health regions participated in an on-line, modified Delphi process to reach consensus on 3-4 measures of each burdensome symptoms and potentially inappropriate care practices. NH residents and families or care aides participated in an interview process using the Action Project Method. To date, all participants identified pain, mental health care, polypharmacy, and dyspnea as priorities. Policy- and decision-makers additionally identified infections and acute care transfers as priorities, while residents and families additionally identified mobility, cognition, and pressure ulcer care as priorities. There was general consistency across groups in terms of priorities but additional measures seemed to reflect either a system-wide or more personal perspective, depending on the source. Data collection with frontline staff and managers is on-going. Moving forward, we will use this list of prioritized outcomes to quantitatively assess the trajectories of these outcomes and associated factors, and to create a profile that allows for monitoring of end-of-life care in NHs.
Reversals in Decisions About Life-Sustaining Treatment Among Terminally Ill Older Korean Patients
Authors: Kim Suhyun , Choi Jung-Ja 
Published: December 2020

Abstract
Purpose: The purpose of this study was to investigate the patterns and factors of reversals in decisions about life –sustaining treatment (LST) among older patients with terminal stage of chronic cardiopulmonary diseases. Methods: In a retrospective correlational descriptive study, data were collected using medical chart review from 124 deceased older patients with terminal stage of cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment. Results: Primary decision makers were offspring (72.6%), spouse (13.7%), acquaintance (8.9%), and patients (4.8%), in order. While 31.5% of the reversed decisions were made toward higher intensity of LST, 21.9% were made toward lower intensity of LST, and 46.6% were made for each treatment without change of overall code status. The use of inotropic was the most frequently reversed LST treatment (47.5%), followed by CPR (30.6%), intubation (27.4%), ventilator therapy (24.2%), and hemodialysis (17.8%). Patients who had lung diseases (vs. heart diseases), were single, divorced or bereaved (vs. married), and had acquaintance as a primary decision maker (vs. patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment. Conclusion: This study demonstrate the complex and turmoil situation of the LST decision making process among older patients with terminal stage of cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision making process.
Predictors of Caregiver Burden in Delirium: Patient and Caregiver Factors
Authors: Tabloski Patricia , Arias Franchesca , Flanagan Nina , Fong Tamara , Schmitt Eva , Jones Richard , Travison Thomas , Inouye Sharon 
Published: December 2020

Abstract
Delirium — an acute disorder of attention and cognition — is a common, life-threatening and costly syndrome occurring frequently in older hospitalized persons. The unexpected, rapid, and volatile nature of delirium can be difficult for family caregivers to experience and may contribute to subjective feelings of distress (i.e. “delirium burden”). The aim of this study was to examine whether pre-admission patient characteristics or patient-caregiver relationship and living arrangements were associated with caregiver burden as measured by the delirium burden scale for caregivers (DEL-B-C; score 0-40, higher score is more burden). Our sample consisted of 208 older adults and their caregivers from the Better Assessment of Illness (BASIL) study, an ongoing prospective, observational study of surgical and medical patients ≥70 years old; 22% of patients experienced delirium by the Confusion Assessment Method (CAM) and the average DEL-B-C score was 7.9, 95% CI(6.95-8.88). Results indicated that neither patient-caregiver relationship and living arrangement or patient factors including pre-admission pain, sleep disturbance, or new onset incontinence were significantly correlated with delirium-related caregiver burden. However, DEL-B-C scores were significantly higher in caregivers of patients with any ADL impairment (mean 8.5 vs. 5.2, p = .016) during hospitalization although none of the individual functional deficits alone were statistically significant. This finding suggests that the association of ADL impairment and DEL-B-C scores is not driven by a single functional domain. Future studies are needed to further understand how caregiver characteristics and patient factors occurring before and during hospitalization contribute to caregiver burden after the occurrence of delirium.
Proposed Features for a Digital Nutrition Intervention for Managing Parkinson’s Disease
Authors: LoBuono Dara , Dobiszewski Sarah , Tovar Alison , Leedahl Skye , Xu Furong , Delmonico Matthew , Mahler Leslie , Lofgren Ingrid 
Published: December 2020

Abstract
Digital health technologies can enhance quality of care for people with Parkinson’s disease (PwPD) and their informal caregivers (ICG), but research in this area is lacking. Developing digital health nutrition services incorporating end-user preferences is essential. This cross-sectional, mixed-method study assessed 20 PwPD and their ICG. Participants reported sources they first search for when seeking health information, the amount of effort it takes to find the information, their confidence level in finding reliable health information, and their level of trust of information obtained. Semi-structured dyadic interviews obtained information about technology, digital health, and nutrition. Transcripts were double coded by two researchers to identify nutrition service features and a &gt;80% agreement was achieved. The mean age was 68.1±11.2 years and 65% of PwPD were male, while 80% of ICG were female. Most PwPD and ICG (82.5%) went to the internet the last time they looked up health information, and about 1/3 reported it took a lot of effort to get this information. Nearly half were concerned about the quality of the information, and approximately 70% had issues trusting health information from government agencies or diet programs. Six themes around key features for a digital nutrition intervention emerged: tailored and specific, inclusion of caregivers, promote self-efficacy, from a nutrition expert, contain a social element, and include a follow-up session. The results suggest that digital health interventions will need to be tailored to meet the needs of PwPD and their ICG.
Effectiveness of a Care Delivery Model for High-Need Community-Dwelling Older Adults
Authors: Chen Kuei-Min , Hsu Hui-Fen 
Published: December 2020

Abstract
The effectiveness of sufficient care coordination for high-need community-dwelling older adults has not been discussed. This study aimed to examine the effectiveness of a newly-developed care delivery model for high-need community-dwelling older adults. A cluster randomized controlled trial with repeated measures design was employed. A total of 145 high-need older adults participated in the study and were randomly assigned to either the intervention group or comparison group. A categorized list of care services based on the types of high-need older adults as the intervention allowed care coordinators to make adequate care service linkages. The intervention period ranged over 6 months with regulated home visits and assesssments. Functional ability, quality of life, depressive symptoms, and healthcare and social service utilizations were measured at baseline, and at 3 and 6 months into the intervention. The participants’ satisfaction with care delivery was measured at the end of 6-month intervention. Results showed that the intervention group had a better functional ability, a higher quality of life, reduced depressive symptoms, and more efficient healthcare and social service utilizations than the comparison group at both the 3-month and 6-month intervals (all p &lt; .05). By the end of the 6-month study, the intervention group were more satisfied with the care service linkages than the comparison group (p &lt; .05). The positive effects of providing a categorized list of care services for care coordinators to make service linkages have been evidenced by the outcomes. The promising findings supported a further longer-term implementation of the care delivery model.