bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE IMPACT OF CULTURE CHANGE ON FINANCIAL PERFORMANCE OF HIGH MEDICAID NURSING HOMES
Authors: Lord Justin C , Davlyatov Ganisher K , Ghiasi Akbar , Weech-Maldonado Robert 
Published: November 2019

Abstract
This study examines the association between culture change artifacts and financial performance among under-resourced nursing homes (70% or higher Medicaid census). Culture change represents a transformational process to become person-centered, through staff and resident empowerment. Cultural artifacts represent the physical evidences that culture change is occurring. In this study, we focus on the workplace (nurse staffing consistent assignments) and leadership (residents engagement) artifacts to assess the relationship between culture change practices and performance. Survey data came from 387 nursing home directors from 2016- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the total profit margin (%), while the independent variables comprised composite scores for leadership (0-25) and workplace artifacts (0-15). Control variables included organizational-level (ownership, chain affiliation, size, occupancy rate, and Medicare and Medicaid payer mix), and county-level factors (Medicare Advantage penetration, per capita income, educational level, unemployment rate, poverty level and competition). Multivariate regression was used to model the relationship between cultural change artifacts and financial performance. Workplace artifacts in nursing homes were found to be associated with significantly higher profit margin (β = 0.30, p &lt; 0.05), while leadership artifacts were not. Culture change practices aimed at improving nursing staff consistent assignments are associated with better financial performance. Given increasing nursing home market competition and declining resources for high Medicaid nursing homes, facilities with a greater emphasis on workplace culture may be able to perform better financially among these under-resourced facilities.
SOCIAL FUNCTIONING AS AN IMPORTANT CLINICAL TARGET DURING CARE TRANSITIONS FROM SKILLED NURSING FACILITIES
Authors: Simons Kelsey , Mills Whitney L , Bower Emily S , Gillespie Suzanne , Orden Kimberly Van 
Published: November 2019

Abstract
Care transitions from skilled nursing facilities (SNF) to home signify a period of medical risk for older adults. They also present opportunities for clinical interventions to reduce these risks and to enhance or maintain patients’ quality of life. A substantial body of research has been published on improving late life care transitions (CTs), including the development of standardized CT models for acute care. However, such models typically focus on improved coordination of medical services; overlook the need to address psychosocial well-being and social connectedness; and have rarely been implemented in SNFs. This poster will present a conceptual model of social functioning in older adults that draws on constructs from the World Health Organization’s World Report on Ageing and Health (2015). We propose that social functioning is a key part of overall functioning among older adults who use SNFs and is simultaneously influenced by physical, psychological, and cognitive functioning. To illustrate our model, we will present results of a qualitative study (n= 21) that describes declines in social functioning following care transitions to the community from VA SNFs. Implications for clinical practice include the need to better integrate social functioning in clinical assessments, goal setting, discharge planning, and coordination of care activities. The need for additional research on this topic will also be addressed. Our project is highly relevant to the overall conference theme “Harnessing the Power of Networks” as it presents a conceptual model and study findings related to social connectedness and social functioning in older adults who use SNFs.
FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES
Authors: Mauldin Rebecca L , Lee Kathy , Williams Antwan 
Published: November 2019

Abstract
Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.
INTERGENERATIONAL OCCUPATIONAL THERAPY PROGRAMMING FOR COMMUNITY-DWELLING OLDER ADULTS AND SCHOOL-AGE CHILDREN
Authors: Chilton Robin L 
Published: November 2019

Abstract
Community Intergenerational Action (CIA) was a four-week pilot program designed to bring community dwelling older adults and fourth-grade students together to engage in meaningful activities within a supportive group context under the facilitation of Robin Chilton, MBA, OTR/L, and four Master of Occupational Therapy Students from Cleveland State University. A phenomenological, qualitative research design study was conducted to explore the impact and meaning of this intergenerational occupational therapy programming on the social and emotional well-being of older adults. Participant observation, journaling, and in-depth interviews were used to determine the meaning of the program to the participants. CIA was conducted using ten female elders, and fifteen children ages nine to ten years old. Each week a new theme was introduced to assist the participants in solving a mystery and included an occupation-based activity such as horticulture and crafts. The CIA program was developed in a way that would allow it to be replicated in other intergenerational settings. Students involved in this study identified helping and cooperating with the older adults throughout the program as very important to them. The students began to feel a sense of empathy and increased self-awareness after spending time with the older adults. The program allowed the older adults to reminisce about their past, and feel a sense of generativity, or contribution to the younger generation. Findings provide an opportunity for others to use similar programs to engage older adults and children in meaningful occupation that will contribute to their overall sense of social and emotional well-being.
EARLY INPATIENT REHABILITATION IN GERIATRIC PATIENTS: A SYSTEMATIC REVIEW OF OUTCOME MEASURES
Authors: Hauer Klaus , Heldmann Patrick , Werner Christian 
Published: November 2019

Abstract
Selecting appropriate outcome measures for multimorbid, acutely hospitalized geriatric patients poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation. The objective of this review was to describe primary outcome measures used in randomized controlled trials (RCTs) on early rehabilitation in older hospital patients, to analyze their matching to intervention programs, and to evaluate the effects of matching on the main findings of these RCTs. A systematic literature search was conducted in PubMed, Cochrane CENTRAL, CINAHL, and PEDro databases. Inclusion criteria were: RCT, patients aged ≥ 65 years, admission to hospital, physical exercise intervention, and primary outcome measure during hospitalization. Two independent reviewers extracted the data, assessed the methodological quality, and analyzed the matching of primary outcome measures to the intervention, study sample, and setting. Main study findings were related to the results of the matching procedure. In 28 included articles, 33 different primary outcome measures were identified, which we grouped into six categories: functional status, mobility status, hospital outcomes, adverse clinical events, psychological status, and cognitive functioning. Outcome measures differed considerably within each category showing a large heterogeneity in their matching to the intervention, study sample, and setting. Outcome measures that specifically matched the intervention contents were more likely to document intervention-induced benefits. Mobility instruments seemed to be the most sensitive outcome measures to reveal such benefits. High specificity (optimized match) of outcome measures and intervention contents is a key factor to reveal benefits of early rehabilitation in acutely hospitalized geriatric patients.
THE INTERPLAY OF FUNCTIONAL PERFORMANCE AND COGNITION ON WALKING SPEED RESERVE
Authors: Dawson Nicole T , Trapuzzano Ashleigh 
Published: November 2019

Abstract
Domains of functional performance (strength, balance) and cognition (executive function, processing speed) have been shown to independently predict both comfortable and gait speed. Walking speed reserve (WSR) reflects an individual’s ability to increase their walking speed when needed to adjust to environmental demands. Increasing speed requires a higher demand of neuromuscular control and cognitive resources. Few studies have investigated WSR; however, poorer cognitive status has been shown to be associated with a smaller WSR. Understanding mechanisms in WSR could help with intervention development. The purpose of this study was to investigate the interplay of functional performance and cognition on WSR. Sixty-seven community-dwelling older adults (mean age 80.57; 71% female) completed assessments including: global cognition (Mini Mental State Examination), leg strength (30 Second Chair Stand), balance (Functional Reach), executive function (Trail Making Test Part-B, clock-drawing test, Flanker Task), simple reaction time, processing speed (Digit Symbol Substitution Test), and gait speed (comfortable and fast) using the GAITRite® system. WSR (fast-comfortable gait speed) was the dependent variable. Independent variables in the regression model were selected using Pearson correlation values &lt;0.05 (strength (r=.332, p=.006) and processing speed (r=.361, p=.003)). Linear regression revealed that the strength and processing speed explained 16.3% of the variance (adjusted r2) of WSR and were both unique predictors of WSR indicating individuals with greater strength (B=.79, p=0.036) and faster processing speed (B=.44, p=0.015) have a greater capacity to alter their gait speed. Further, the interdependence between cognition and physical performance emphasizes the importance of interprofessional care for older adults.
SOCIAL SUPPORT AND SOCIAL RESOURCES PREDICTING LIFE SATISFACTION AMONG CENTENARIANS AND OCTOGENARIANS
Authors: Arieli Rotem , Martin Peter , Poon Leonard 
Published: November 2019

Abstract
Although much research has assessed the relationship between social support and life satisfaction for older adults, there is little information on how social support predicts life satisfaction over and above social resources among very old people. The purpose of this research was to determine pathways from demographic variables, social resources, and social support to life satisfaction. Data from 208 cognitively-intact centenarians and octogenarians of the Georgia Centenarian Study (GCS) were analyzed using multiple regression analyses to evaluate pathways from social resources via social support to life satisfaction. Three different models were analyzed in the GCS sample: one with a combined group of octogenarians and centenarians, one with only octogenarians, and one with only centenarians. Path models included: demographic variables (gender, ethnicity, residential type, and age in years) to social resources to social provisions to life satisfaction. Results in the combined older adult group showed that residence type significantly predicted social resources, β = -.26, p &lt; .01, social resources significantly predicted social provisions, β =.15, p &lt; .05, and social provisions significantly predicted life satisfaction, β =.15, p &lt; .05. Results in the centenarian sample showed that both residence type and age significantly predicted social resources, β =-.19, p &lt; .05, and β = -.17, p = .05, respectively, and social resources significantly predicted social provisions, β = .18, p = .05. Overall, results indicate the uniqueness of the centenarian population and their paths to high life satisfaction through social resources and support.
DO OLDER ADULTS WITH HIV HAVE A SOCIAL NETWORK DEFICIT? EVIDENCE FROM AGINCOURT, SOUTH AFRICA
Authors: Schafer Markus H , Upenieks Laura , DeMaria Julia 
Published: November 2019

Abstract
HIV/AIDS has had a substantial social and economic impact on Sub-Saharan Africa, and research is only beginning to examine the prevalence and consequences of HIV infection among older adults in this region. Though informal social networks provide crucial resources for older people managing health problems, little is known about how the form and function of such networks differs by HIV status. Drawing from theories of health stigma and network mobilization, we use egocentric network data from HAALSI, the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (N=5,059). HAALSI is a community-based study centered in Agincourt, South Africa, and focuses on adults ≥40 years of age. Approximately 12% of this sample is HIV positive. Results of multivariable logistic and Poisson regression reveal three main findings. First, relative to those without HIV, infected older adults have larger personal networks—including more kin and more non-kin network members. Second, HIV status has no discernible impact on whether people receive regular emotional support from those in their networks. Third, older adults who have disclosed their HIV status have a relatively high proportion of kin members in the close networks relative to those not infected with HIV and to those with HIV who have not disclosed their disease. Our findings point to the need for further research on the implications of social networks for outcomes such as well-being and health care delivery among older AIDS patients in the Global South.
A COMPARATIVE ANALYSIS OF THE SOCIAL SUPPORT IN SOLITARY SENIORS WHO ATTEND CLUB ACTIVITY OR GO OUT TO SEE FRIENDS
Authors: Takase Mai , Ogino Ryogo , Goto Jun , Okata Junichiro 
Published: November 2019

Abstract
The Toyoshiki-dai housing complex, constructed in 1960s, is located in one of the commuter towns in a metropolitan area of Japan. Those who moved to this area as youngsters are now aged over 75 and many live a solitary life; making social support vital to prevent social frailty. The municipalities and universities have been hosting interventions, e.g. club activities, to make social connection but the effects remain unclear. In this study, the relationship between activity participation and the size of social support was explored to develop an effective method to increase social connections. A cross-sectional study was conducted in October 2018 and 200 questionnaires were distributed at a lunch event at the housing complex. The participants were solitary and independent seniors over the age of 70 (M:F=14.4:67.5). The frequency of going out to participate in club activity, see friends, and the geriatric social support scale were used for analysis. As a result, compared to seniors who went out to see their friends, the size of social support was smaller in groups that remained isolated (N = 161, odds ratio = 0.26, 95% CI=0.11-0.60). On the contrary, seniors who joined club activities had similar size of social support despite the frequency of participation. Clubs in Japan are often closed groups with limited membership, which may have restricted the addition of new social connection. Future intervention researches should focus on modifying the membership system of clubs and opening of a public space where seniors can casually access and talk to acquaintances.
DEVELOPING AGE-FRIENDLY COMMUNITIES: EVIDENCE FROM MULTIPLE CASE STUDIES
Authors: Oh Patricia A 
Published: November 2019

Abstract
The age-friendly community movement is gaining momentum in the United States. More than 325 communities have joined the AARP Network of Age-Friendly States and Communities or the WHO Global Network of Age-Friendly States and Communities. The purpose of this multiple case study was to explore what influences municipal decision-making about joining a network and how communities mobilize the resources at their disposal to make age-friendly changes after joining. The conceptual model that guided this exploratory study incorporated Kingdon’s policy change model to explore municipal decision-making about joining a formal age-friendly network and resource mobilization theory to explore factors that influence implementation of age-friendly changes after a community joins an age-friendly network. Data was gathered in three in-depth case studies of age-friendly communities in New England-- Brookline, Massachusetts; Newport, Vermont; and Ellsworth Maine. In these three cases, the policy entrepreneur was key to municipal decision-making. Kingdon posits that a single problem definition increases the likelihood that a policy is adopted. However, in these cases, the policy entrepreneur used selective framing to advocate with local organizations and municipal government, a departure from Kingdon’s model. Implications for age-friendly policy adoption will be discussed. Resource mobilization theory posits that implementation of change is dependent on resources and collaborations. Each case had access to different resources, but partnerships were key to moving the work forward (with or without collaborations). The primary resources utilized were relational and ideological. Material resources were less likely to move the work forward. Implications will be discussed.
USING PHOTOVOICE TO EXPLORE THE SALIENCY OF NEIGHBORHOOD LANDMARKS FOR PERSONS LIVING WITH DEMENTIA
Authors: Seetharaman Kishore , Shepley Mardelle 
Published: November 2019

Abstract
This study demonstrates the potential of Photovoice, a participatory action research method involving participant-generated photo-elicitation, to explore how persons living with dementia (PLWDs) perceive neighborhood landmarks. Previous research has highlighted the role of well-designed, stable geographical landmarks in improving the navigability of neighborhoods for PLWDs. However, the specific attributes that render landmarks salient have not yet been sufficiently explored, resulting in inadequate evidence-based environmental design guidelines for dementia-friendly communities (DFCs). To address this gap, a Photovoice study was conducted with five community-dwelling PLWDs and their care partners, as part of a dementia-friendly neighborhood walking program in the city of Seattle, USA. Photovoice facilitated the exploration of saliency of neighborhood landmarks from an emic perspective by empowering PLWDs to identify and take photos of salient landmarks during the group walk and interpret and reflect on attributes that contributed to saliency using the photos as visual aids in a focus group discussion and survey questionnaire. PLWDs associated the saliency of landmarks not only with objective physical attributes, e.g., size, shape, color, texture, but also with subjective factors linked to their past, passions, hobbies, and emotions related to having dementia. Findings suggest that the design of outdoor landmarks should satisfy universal design principles, as well as aspects of familiarity, recognizability, and memorability, to ensure that the neighborhood physical environment provides navigational support to PLWDs. The study proposes using Photovoice to facilitate community engagement in the planning and design of DFCs and mobilize people’s lived experience to generate more robust dementia-friendly environmental design guidelines.
CAREGIVING AND SERVICE USE: CULTURAL INFLUENCES, REGIONAL BARRIERS, AND FAMILY RELATIONS
Authors: Savla Jyoti , Roberto Karen A , Blieszner Rosemary 
Published: November 2019

Abstract
Elder care in rural Appalachia is challenging due to poor socioeconomic conditions, geographical isolation, and lack of services and transportation. Certain aspects of Appalachian culture, namely self-reliance, traditionalism, and strong family ties, also create unique barriers for using services to help care for persons with dementia (PwD). Quantitative and qualitative data from 85 caregivers of PWD with moderate to high care needs were explored to examine caregivers’ use of personal care services, identification with their community, attitudes towards service use, and geographical distance from the nearest service location. Results suggest that although services such as adult day centers, food banks, meal delivery, and support groups are widely dispersed throughout rural Appalachian counties, use or nonuse of services was driven by lack of economic resources, care preferences of the PwD, and dissatisfaction with previous service use. Discussion focuses on suggestions for uptake of services by caregivers of PwD in rural Appalachia.
EXPANDING RELATIONAL BOUNDARIES OF DEMENTIA CARE
Authors: Roberto Karen A , Savla J Tina 
Published: November 2019

Abstract
Rapid changes in family structures have expanded caregiving boundaries beyond the level of lineal kin to include extended and fictive kin. Guided by stress process and health behavior models, we analyzed semi-structured interviews with 120 family caregivers of persons with dementia (PWD) in rural Appalachia to explore personal/family circumstances that influence the responsibilities nonlineal kin assumed to meet the needs of PwD. Compared to spouse and adult children caregivers, nonlineal caregivers reported that PWD had similar behavioral problems, but greater ADL limitations. They also expressed greater burden, overload and role captivity; yet, they reported higher personal mastery, and perseverance. Although sisters and nieces did not report using any paid services to care for PwD, grandchildren and fictive kin used paid services such as meal delivery, personal care, and respite services. Findings provide new insights into a more elaborated conception of caregiving that considers the transformations occurring in family life today.