bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-Hospital Care Intensity Modifies the Relationship Between Depressive Symptoms and Hospital Readmissions
Authors: Abrams Leah , Hoffman Geoff 
Published: December 2020

Abstract
The objective of this study was to examine whether more structured post-acute care reduces the deleterious impact of depressive symptoms on older adults’ post-hospital outcomes (30-day hospital readmissions, 30-day falls, 1-year falls, and 1-year mortality). The sample comprised 23,485 eligible index hospitalizations from 7,151 unique fee-for-service Medicare beneficiaries from Health and Retirement Study linked to Medicare claims from 2000 to 2014. Depressive symptoms were measured using the eight-item Center for Epidemiologic Scale - Depression. We ran multinomial probit models regressing post-hospital setting on depressive symptoms while adjusting for sociodemographic factors, socioeconomic factors, family support, and health status. Then, we ran adjusted logistic regression models of each outcome while interacting depressive symptoms with post-acute care setting. We found that 62% of hospitalizations were routine discharges home, 17% were discharged to home health, and 21% were discharged to a Skilled Nursing Facilities (SNF). When adjusting for sociodemographic and socioeconomic factors, each increasing depressive symptom was associated with a half percentage point higher probability of referral to home health and 1.6 percentage points higher probability of discharge to SNFs, driven by differences in family support and health status. Rehabilitation in SNFs, compared to routine discharges home, reduced the positive association between depressive symptoms and 30-day readmissions (OR=0.95, p=0.027). However, post-acute care settings did not modify the association of depressive symptoms with falls or mortality. Considering depressive symptoms in discharge decisions, above and beyond their associations with family support or health status, may help hospitals avoid readmissions but may not improve health and functioning.
Unplanned Re-Hospitalization Among Older Persons Results in Loss of their Independence
Authors: Qualls Brandon , Seyoum Hiwot , Walker Tammy , Carey Mary 
Published: December 2020

Abstract
The Centers for Medicare & Medicaid Services defines a hospital readmission as an inpatient stay that begins within 30 days of the discharge date of an index admission, to the same or a different hospital. The aims of the study were to analyze the recurrent readmissions of older persons admitted to a community hospital with diagnoses of: Chronic Obstructive Pulmonary Disease (COPD), Pneumonia (PNA), and Congestive Heart Failure (CHF). Based on the results, we will develop additional strategies that can be used to reduce the rate for hospital readmission for older patients. A retrospective chart review of hospitalizations was conducted. Among 30 readmissions, the mean age was 79.5±14. The index disposition was distributed among three destinations: self-care (27%), home health organization (40%), and to skilled nursing home (33%). Most of the readmissions were for CHF (27%), COPD (10%), and PNA (13%), the only other large category include respiratory failure (10%). The readmission disposition was different from the index disposition: self-care (7%), home health organization (47%), and to skilled nursing home (20%). After hospital readmission within 30 days, older persons were more likely to be discharged to home health care organization than self-care, p&lt;0.05. Actions that can be taken by hospitals to reduce 30-day readmissions to maintain older person independence include: clinical readiness of patients for discharge, proper infection prevention techniques, reconciling medications, good communication, and adequate patient education. This study reports that that older persons are at higher risk for unplanned hospital re-admissions and often lose their independence.
Older adults’ vaccine hesitancy: psychosocial predictors of influenza, pneumococcal, & shingles vaccine uptake
Authors: Nicholls Louise Brown , Gallant Allyson , Cogan Nicola , Rasmussen Susan , Young David , Williams Lynn 
Published: December 2020

Abstract
Influenza, pneumococcal disease, and shingles are more prevalent in older people, with this group having an increased risk of developing severe illnesses and complications. These illnesses are preventable via vaccination, but uptake of these vaccines is low and decreasing year-on-year. However, little research has focused on understanding the reasons behind vaccine hesitancy in older adults. We implemented a cross-sectional survey to determine the self-reported vaccination behaviours of 372 UK-based adults aged 65-92 years. We assessed previous uptake and future intention to receive the influenza, pneumococcal, and shingles vaccines. Participants also self-reported their health and socio-demographic data, and completed two scales measuring the psychological factors associated with vaccination behaviour (5C and VAX scales). Self-reported daily functioning, cognitive ability, and social support were also assessed. Considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines in this population. Greater calculation of the disease/vaccination risk and preference for natural immunity also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering predicted lack of uptake. Therefore, more understanding of vaccine benefits and disease risks may be required for these vaccines. Additional qualitative data generally supported these findings, which can contribute to future intervention development and research targeted at more diverse groups (e.g. older adults with cognitive impairments).
Early-life Stress, Depressive Symptoms, and Inflammation: The Role of Social Factors
Authors: Nakamura Julia , Kim Eric , Rentscher Kelly , Kuhlman Kate 
Published: December 2020

Abstract
Early-life stress (ELS) is associated with elevated risk of adverse psychological (e.g., depression) and physical health outcomes (chronic diseases driven by inflammation) in older adulthood. We evaluated whether four social factors buffered the ELS-depressive symptoms and ELS-inflammation associations. Data were from 3,416 adults (58.28% female; Mage=68.41; SDage=10.24) who participated in the 2006 wave of the Health and Retirement Study, a nationally representative sample of older adults in the United States. We used hierarchical regression analyses to first test the main effects of ELS on depressive symptoms and inflammation (high-sensitivity C-reactive protein). We then assessed whether four social factors (perceived support, frequency of social contact, network size, and volunteer activity) moderated the ELS-depressive symptoms and ELS-inflammation relationships. We found a small positive association between ELS and depressive symptoms (B=0.17, SE=0.05, p=.002), which was moderated by social contact and perceived support. Specifically, ELS was only associated with elevated depressive symptoms for participants with limited social contact (B=0.24, SE=0.07, p&lt;.001) and low perceived support (B=0.24, SE=0.07, p&lt;.001). These associations remained after accounting for potential confounders (age, body-mass index, adulthood stress, and marital status). ELS was not associated with inflammation, and no social factors moderated the ELS-inflammation link. Increased social contact and perceived support may be protective for individuals at an elevated risk of developing depressive symptoms as a result of ELS. Future interventions may benefit from leveraging these social factors to improve quality of life in adults with ELS.
The Frailty Index, Missing Data, and Imputation
Authors: Pridham Glen , Rutenberg Andrew 
Published: December 2020

Abstract
The frailty index (FI) is a summary measure of health during aging that is defined by the average number of ‘things wrong’, i.e. health deficits, across a sundry of lab, clinical, and questionnaire measurements. Missing data are ubiquitous in aging studies. Although the FI appears to have robust predictive power—even when ignoring missing data, there has not been a systematic study of the consequences of imputation when used in the principle investigation. We investigated the standard imputation methodology, multiple imputation using chained equations (MICE), and other missing data methods, in terms of prediction of mortality and statistical power using the 2003/04 and 2005/06 NHANES datasets. When we masked known data completely at random, we observed that available case analysis incorrectly estimated the true variance of the FI leading to potential problems in hypothesis testing, whereas imputation helped mitigate this effect. We also observed that the default imputation methods from MICE showed a significant increase in FI relative to the ground truth together with a decrease in predictive power, hence we suggest other options when performing imputation with NHANES. The underlying missing mechanism in NHANES is not random and appears to be important, for example survival curve analysis showed that the top half of patients with the most missing data died significantly younger than the bottom half.
The Role of Communities of Residence on Older Mexican Adults’ Likelihood of High Depressive Symptoms
Authors: Downer Paige , Wong Rebeca 
Published: December 2020

Abstract
Exposure to population- and individual-level poverty, poor health, and negative life-events contributes to overall life adversity that may increase older adults risk of depression. We hypothesize that increased neighborhood-level multidimensional poverty and decreased proportions of within-neighborhood health promoting socio-demographic characteristics will be positively associated with depression among older Mexican adults. This study uses data from Wave 1 (2001) and Wave 3 (2012) of the Mexican Health and Aging Study (MHAS). Wave 1 will be used for information for socio-demographic characteristics, including gender, female-headed households, rural settings, and employment status. Wave 3 will be used for information on self-reported depressive symptoms. Information for neighborhood characteristics will come from the 2000 Mexican Census that has been linked with the 2001 MHAS wave. Older Mexican adult’s exposure to multidimensional poverty at the locality (city/town) level will be measured by the proportion of the population aged 15 and older with low education; the proportion of the population with low access to health care services; the percentage of homes with inferior construction materials; and the proportion of the population without sewage and running water. A multivariable logistic regression will be used to model the association between older Mexican adult’s neighborhood and community characteristics in 2001 on depression in 2012. The expected findings will inform government policies to increase access to affordable housing, the availability of health care services, educational and employment opportunities, and public infrastructures such as transportation, water, and sanitation services, and energy services to reduce mental health burden.
Simulating the Effects of Construction in NYC’s Chinatown on Fruit and Vegetable Consumption in Local Residents
Authors: Yi Stella , Li Yan , Imbruce Valerie , Tan Yi-Ling , Foster Victoria , Wang Vivian , Kwon Simona 
Published: December 2020

Abstract
In 2017, the mayor of New York City (NYC) unveiled a 10-year plan to close the city’s largest jail complex and to build four satellite detention centers – including one in Manhattan’s Chinatown. Chinatown is a destination for affordable produce and its retail produce sector is comprised of street vendors and small stores, a style of fresh fruit and vegetable (FV) marketing the city promotes to achieve its goal of equitable access to healthy foods. The objective of this study was to project the impact of the proposed construction activity on FV consumption among residents in Chinatown. We developed an agent-based model that accounts for individual and neighborhood-level factors (e.g., age, gender, education, food environment) to predict FV consumption at the neighborhood level in NYC. We assumed that long-term construction will lead to the closure/migration of fresh produce vendors and therefore a reduction of FV access. We simulated three scenarios in which the number of fresh produce vendors is reduced by 5%, 10%, and 15% due to construction. Results suggest that planned construction could decrease the consumption of FV by 2.1%, 4.4%, and 6.8% among residents in Chinatown if the construction would reduce the number of fresh produce vendors by 5%, 10%, and 15%, respectively. Preliminary sensitivity analyses demonstrate the negative impact of the construction on FV consumption could be greater among older (65+ years) vs. young adults. The planned construction of a detention center in Chinatown may decrease the consumption of FV among its residents, particularly older adults.
COVID-19 pandemic lockdown responses from an emotional perspective: Family function as a differential pattern
Authors: Lopez Javier , Perez-Rojo Gema , Noriega Cristina , Velasco Cristina , Carretero Isabel , López-Frutos Patricia , Galarraga Leyre 
Published: December 2020

Abstract
Family can be an essential resource at times of loss or vital crisis. Loneliness and isolation in older adults might have serious negative consequences for their mental health. For this reason, this research aims to analyze the role of family function in the anxiety and depression experienced by older adults during the COVID-19 crisis. Participants were 882 Spanish community-dwelling adults over 60 years of age. Sociodemographic characteristics, characteristics related to the coronavirus, self-perceived health, family function, avoidance, depression and anxiety were analyzed. Data suggest a buffering effect of family function on anxiety and depression during the pandemic. Furthermore, being unmarried or a female, greater fear of COVID-19, worse self-perceived health, greater avoidance, and worse family function were associated with higher levels of anxiety. Likewise, greater fear of COVID-19, poorer self-perceived health, greater avoidance, and poorer family function, were associated with greater depression. These results point out that family dysfunction is a predisposing factor for the development of the emotional problems of anxiety and depression in older people in potentially stressful and loss situations.
COVID-19 Social Distancing Measures and Loneliness among Older Adults
Authors: Choi Eun Young , Farina Matthew , Wu Qiao , Ailshire Jennifer 
Published: December 2020

Abstract
In response to the COVID-19 pandemic, older adults are advised to follow social distancing measures to prevent infection. However, such measures may increase the risk of loneliness. The current study aimed to investigate (1) whether social distancing measures, particularly limiting close social interactions, are associated with loneliness among older adults, and (2) whether the association between social distancing measures and loneliness is moderated by sociodemographic characteristics. Data were from the fourth wave (April 29 to May 26, 2020) of the nationally representative Understanding America Study (UAS) COVID-19 Survey. We used data on adults 50 years or older (N = 3,283). Multivariate logistic regression models of loneliness were examined to test the independent effects of social distancing measures and their interaction with sociodemographic characteristics on loneliness. Four indicators of social distancing measures were considered: (a) avoiding public spaces, gatherings, or crowds, (b) canceling or postponing social activities, (c) social visits, (d) close contact (within 6 feet) with others. Cancelling or postponing social activities and avoiding close contact with other people were associated with 36% and 41% greater odds of loneliness, respectively. Furthermore, males and non-Hispanic Whites who had no close contact with others had a significantly greater probability of reporting loneliness than those who had contact. Our findings emphasize the heterogeneous nature of COVID-19 related experiences across subpopulations of older adults and call special attention to vulnerable groups that may be more impacted by the challenge of COVID-19 social distancing.
The Family and Medical Leave Act: A Policy Analysis and Recommendations to Address Employed Caregiver Burden
Authors: Park Geunhye , Robinson Erin 
Published: December 2020

Abstract
Family caregiving plays a pivotal role in the long-term care system in the U.S, as there are over 40.4 million people providing unpaid care to individuals aged 65+ (U.S. Bureau of Labor Statistics, 2019). The majority are women providing supports to a parent/grandparent and provide an average of three hours of care each day. This places greater demands on family caregivers in balancing their dual caregiver/employment roles. The Family and Medical Leave Act (FMLA) of 1993 enables family caregivers to take unpaid leave to provide supports to immediate family. While FMLA was intended to provide flexibility to employed caregivers, many struggle with family-work conflicts and caregiver burden is high. Therefore, this conceptual paper offers a critical examination of FMLA and how family caregivers of older adults are impacted. Results of this analysis revealed three themes. First, FMLA is largely inadequate for employed caregivers, as only 60% of the workforce are eligible and unpaid leave restrictions create considerable financial hardship. Second, employer discrimination is high and family caregiving discrimination claims have dramatically increased since FMLA was enacted. And third, many employed caregivers are unaware of FMLA policies and eligibility requirements, which results in underutilization of benefits. Based upon these results, several policy and employer recommendations can be made, such as expanding FMLA coverage to include paid leave and non-immediate family caregivers. Additional recommendations will also be addressed. As it has been nearly 30 years since FMLA was enacted, updated policy is vital to continue supporting employed caregivers in their roles.
Nursing Home Social Workers Perceptions of Preparedness and Coping for COVID-19
Authors: Miller Vivian , Fields Noelle , Kusmaul Nancy , Anderson Keith , Maxwell Christy 
Published: December 2020

Abstract
Social work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes, however it is unclear how social workers perceive their preparedness during this time. This study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction (RADaR) technique. Data are based on a sample of 63 (N=63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19. These findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.
Increased Blue Mood and Loneliness during COVID-19 Pandemic in a Veteran Cohort
Authors: Mattek Nora , Wall Rachel , Beattie Zachary , Wu Chao-Yi , Kaye Jeffrey , Dodge Hiroko , Silbert Lisa 
Published: December 2020

Abstract
Older Veterans are at especially high risk of depression and social isolation due to COVID-19 stay-at-home orders and necessary safety precautions. We aimed to objectively measure differences in mood reports before and after COVID-19 stay-at-home orders in rural older Veterans. Participants age &gt; 62 were enrolled in the Collaborative Aging Research using Technology (CART) initiative, a NIH and VA HSRD funded multi-site study examining the feasibility of unobtrusive remote sensing and monitoring of physical, cognitive, and health-related activities. The VA CART site consists of Pacific Northwest Veteran volunteers and their cohabitants. Weekly online health forms including questions about blue mood and loneliness were collected January – July 2020. A COVID stay-at-home order was instituted March 13 2020. Generalized estimating equations (GEE) with logit link was used to investigate differences in mood reports pre- and post- stay-at-home orders. 100 older volunteers completed 2441 health reports (mean age 71.2 years, 41% female, 19% single). Thirty-five percent were urban, 34% large rural, and 31% small rural using rural-urban commuting area (RUCA) scores urban: 1-3; large rural 4-6; small rural 7-10. After adjusting for covariates, incidence of blue mood and loneliness reports were significantly higher after stay-at-home orders (OR=4.4, p&lt;0.0001 and OR=7.2, p&lt;0.0001 respectively). Results varied by rurality with large rural volunteers showing the largest increases. Real-world monitoring of weekly health reports may identify those at greatest risk for depression and social isolation in older Veterans and their cohabitants and is of particular relevance in rural settings, where access to specialty care is limited.