bluuebunny/crossref_metadata_2025_split huggingface dataset:
A HOME-VISIT PILOT INTERVENTION TO PROMOTE COMMUNICATION SKILLS AND WELL-BEING FOR DEMENTIA FAMILY CAREGIVERS
Authors: Lee Jung-Ah , Kehoe Priscilla , Gibbs Lisa 
Published: November 2019

Abstract
Dementia takes a significant toll on caregivers resulting in their suffering from chronic stress and depression due to responsibility for care for persons with dementia (PWD). Behaviors of PWD could be aggravated by inappropriate responses by family caregivers such as correcting PWD’s memories. The study purpose is to examine the feasibility of a home-visit-based intervention designed to promote communication skills with PWD and well-being in family caregivers. This pilot study used a single-arm experimental pre-post design to test the feasibility of 4 weekly home visits for 13 female family caregivers in Southern California (spouse, n=7; adult children, n=6; mean age=64.3, ranging 46-82). Trained home visitors used video scenarios for behavioral education for caregivers. All caregivers completed the entire home visit program. Significantly caregiver burden was decreased from baseline (M(SD)=51.38(4.58)) to follow-up at 5 weeks (M=43.31(5.67), Wilcoxon signed rank test: p=.04). Additionally, caregiver-reported PWD’s negative behaviors were reduced from baseline to follow-up (Mbase=22.31(3.52), Mfolllowup=19.31(4.4), p=.13). There were other improvements (non-significant) in greater caregiver self-efficacy and less depressive symptoms from baseline to follow-up. Caregiver satisfaction with the intervention was high (M=4.6(0.65) of 5). Qualitatively, participants appreciated the home visits for educational sessions and welcomed the empathy provided. Caregivers expressed better communications and responsiveness to the PWDs. The results showed the home-visit-based caregiver intervention was feasible and had a potential effectiveness on reduction of caregiver burden and possibly on self-efficacy and well-being. A larger-scale study will be needed to demonstrate long term positive effects on caregiver interactive skills and their well-being.
PERCEIVED AVAILABILITY OF CARE AND SUPPORT AMONG OLDER ADULTS IN BANGLADESH
Authors: Luna Farhana Ferdous 
Published: November 2019

Abstract
Care for older adults is most precarious in developing countries where poverty and weak state support systems have put the well-being of their older populations at risk. Bangladesh is one such nation characterized by excess poverty, poor health, high mortality rates, and illiteracy among its older adults. The lack of elder-friendly infrastructure presents another problem for aging well in Bangladesh. This study examined perceptions about the adequacy of care and support received by older Bangladeshis. A cross-sectional survey collected data from 100 older people who were purposively sampled. Results revealed that older people generally are not satisfied with support services from the government and feel that old-age care has historically declined. Inadequate care and support was cited both at family and state levels. Respondents expressed concern that earlier generations of older people were better taken care of than the present generation, and that the former received more respect than the latter. Factors related to perceived support deficits included poverty, widowhood, and migration of sons. In this patrilineal culture, widowed women in particular perceived themselves as disadvantaged in terms of care availability. We conclude by recommending that policies be designed to enhance care and support services for older people in Bangladesh, particularly the most vulnerable and marginalized among them.
DECISION-MAKING AND DISPARITIES IN QUALITY OF CHOSEN PLANS AMONG RACIAL-ETHNIC GROUPS IN MEDICARE ADVANTAGE
Authors: Rivera-Hernandez Maricruz , Blackwood Kristy L 
Published: November 2019

Abstract
Limited research regarding decision-making in Medicare Advantage (MA), which now disproportionally serves racial and ethnic minorities (~45% Hispanics and 30% African-Americans), has been conducted. Without understanding the extent to which vulnerable groups select low quality plans with high out-of-pocket costs (OOPC) and what factors influence this selection, these beneficiaries could continue to be adversely affected. The objective of this study is to understand plan choice decision-making process and differences in quality and OOPC of chosen plans between racial and ethnic minorities enrolled in MA. We used 2015 national data from Medicare and conducted in-depth interviews with 25 MA enrollees. African-Americans were enrolled in plans with higher drug deductibles and lower OOPC. In addition, Hispanics and African-Americans enrollment in high quality plans were lower by 10% and 5%, respectively, regardless whether mean OOPC were 100 or 1000 (P&lt;.05). Our interviews highlighted issues regarding financial literacy, choice overload and complexity. These seniors did not use Plan Finder from Medicare and obtained information from insurance companies. Most seniors were confused about insurance terminology and expressed poor computer literacy. Among them, there was a prevailing sentiment that more expensive plans are better. Our findings could inform the Medicare program, and vulnerable populations who would benefit from plans that maximize quality of care with lower out-of-pocket spending. Finally, this information could contribute to state organizations’ future efforts such as ensuring quality of health services for older adults including. Overall, this research provides new evidence about an increasingly important part of our publicly funded health system.
PROVIDER-IDENTIFIED BARRIERS TO PALLIATIVE CARE FOR MEDICAID PATIENTS
Authors: Enguidanos Susan , Rahman Anna , Hoe Deborah , Meyers Kate 
Published: November 2019

Abstract
In January 2018, California enacted Senate Bill 1004, which requires Medicaid (or Medi-Cal in California) managed care providers to offer home-based palliative care (HBPC) to their seriously ill patients. Since then, enrollment in HBPC has been lower than projected, which means many across the state continue to suffer without the pain and symptom management and psychosocial support available from a palliative care team. This study elicited clinician-perceived barriers to access to HBPC by Medi-Cal patients. We conducted a qualitative study comprising 25 individual interviews with a range of healthcare leaders and practitioners. Interviews were audio-recorded and transcribed verbatim. Using a grounded theory approach, we analyzed transcripts to determine primary themes. Our findings identified a myriad of access barriers to HBPC for the Medi-Cal population, including lack of physician knowledge about HBPC programs and benefits, a physician office structure that hampers the provision of HBPC education (i.e., one physician per office), cultural and language barriers among both physicians and patients, physicians’ lack of time, and competing demands on physicians. Providers also identified patient-related barriers, including cultural mismatch between HBPC providers and patients, trust issues related to the health-care system, and the complex challenges facing some patients such as lack of adequate and safe housing, behavioral health problems, and limited access to services that meet basic needs. These findings underscore the need for multiple approaches to increase physician education and awareness of HBPC and HBPC Medi-Cal benefits, develop culturally appropriate HBPC services, and develop programs that improve patients’ palliative care health literacy.
EXAMINING LONGITUDINAL HEALTHCARE UTILIZATION, OUTCOMES, AND SATISFACTION IN PRE-FRAIL OLDER ADULTS
Authors: Vaughn Ivana A , Marlow Nicole M , Sonawane Kalyani , Fillingim Roger B , Beyth Rebecca J 
Published: November 2019

Abstract
Frailty is a medical syndrome occurring in nearly 60% community dwelling older adults and could have insidious origins in middle-adulthood that manifest predominantly as decline and multi-morbidity. Identification of pre-frail states in adults could potentially reduce its impact in late-life. The study used data from the Health and Retirement Study (HRS) to: 1) compare long-term healthcare utilization between pre-frail and non-frail patients, 2) compare risk of pain progression, functional decline, and mortality between pre-frail and non-frail patients, and (3) compare satisfaction with healthcare, self-perceptions of aging and satisfaction with life between pre-frail and non-frail patients. The primary predictor, pre-frailty phenotype, was based on the Paulson-Lichtenberg Frailty Index (PLFI), a validated HRS-version of the Fried criteria. Additional covariates included sociodemographics, comorbidities, smoking status, sleep quality, health status, and body mass index. Statistical analyses consisted of descriptive statistics, univariate analysis, negative binomial regression with log-link function, logistic regression, generalized linear modeling and Cox regression. Pre-frailty status increased the incidence of hospitalizations (IRR: 1.23; 95%CI: 1.18-1.28) and doctor’s visits (IRR: 1.18; 95%CI: 0.15-1.22); increased the risk of pain progression (HR: 1.61, 95%CI: 1.53-1.69), functional decline (HR: 1.77, 95%CI: 1.67-1.87), and all-cause mortality (HR: 1.09, 95%CI:1.03-1.16); lowered odds of healthcare satisfaction (OR: 0.79, 95%CI: 0.62-0.99) and lowered satisfaction with aging ((β: -0.23 95%CI: -0.36- (-0.10)) and satisfaction with life (β: -0.27 95%CI: -0.44- (-0.11)). Frailty syndrome is highly prevalent and having a better understanding of its influence on health outcomes at intermediate pre-frail states could provide insight into reducing manifestations in later life.
MULTIDIMENSIONALLY HETEROGENEOUS HEALTH LATENT CLASSES AND HEALTHCARE UTILIZATION FOR OLDER CHINESE
Authors: Ye Linglong , Luo Jiecheng , Shia Ben-Chang , Fang Ya 
Published: November 2019

Abstract
Objectives: Based on a multidimensional perspective, this study aimed to assess the heterogeneous health latent classes of older Chinese, and further examined the effects of health latent classes and associated factors on healthcare utilization. Methods: Data came from the Chinese Longitudinal Healthy Longevity Survey in 2014. Latent class analysis was adopted to identify heterogeneous health latent classes by health indicators of physical, psychological, and social dimensions. Two-part models were used to evaluate the impact of health latent classes and socio-demographic factors on outpatient and inpatient utilization. Results: Among 2,981 participants aged 65 and over without missing health indictors, four health latent classes were identified and labeled as “Lacking Socialization” (10.4%), “High Comorbidity” (16.7%), “Frail Group” (7.7%), and “Relatively Healthy” (65.1%). Among 1,974 participants with complete information, compared with the Relatively Healthy group, those in the Lacking Socialization group costed more inpatient expenditure (p-value =0.02). Those in the High Comorbidity and Frail groups tended to use healthcare services and costed more outpatient expenditure (all p-value &lt;0.01). After controlling for health latent classes, the effects of age, gender, marital status, education, residence area, occupation, and health insurance on healthcare utilization were significant. Conclusions: Four heterogeneous health latent classes were identified by multidimensional health, and had significant effects on healthcare utilization. After controlling for health latent classes, different effects of socio-demographic factors on healthcare utilization were found. It enhances our understanding of heterogeneous health and complex healthcare demands in older Chinese, and is valuable for improving healthcare resource allocation targeted for healthy aging.
HOME AND COMMUNITY HEALTHCARE FOR FRAIL OLDER ADULTS: A PATIENT, CAREGIVER, AND PRACTITIONER PERSPECTIVE
Authors: McDonald Andrew , Rizzotti Rowena , Rivera Joanna , Park Grace , Garm Antonina , D’Arcy Ryan , Song Xiaowei 
Published: November 2019

Abstract
Frailty and the decline in ability to maintain independent living may be forestalled through discussions with healthcare providers and seniors about managing health at home. In addition, the use of technology in supplementing doctors’ visits to assess frailty progression may be easily adopted by some but not others. We conducted this qualitative study to elucidate the context in which seniors access care at home and current barriers to independent living, from the perspectives of both seniors and practitioners. Pre-approved discussion questions were administered to two audio-recorded focus group sessions of 14 participants. The first group were community-dwelling older adults and informal caregivers, while the second consisted of healthcare practitioners. Group members were sampled to include a range of health backgrounds and levels of technological expertise. Thematic analysis with NVivo Software was used to parse out key discussion topics from the audio transcripts. The caregiver/patient group emphasized the stigma of frailty and age-related isolation, desiring transparency and advocacy from care teams. Practitioners/researchers discussed the importance of a holistic biopsychosocial approach to frailty management and the need for standardized frailty measurement. Patients/caregivers used health-tracking devices at home and were more optimistic about telehealth/video-conferencing than practitioners. Awareness of contextual factors surrounding “aging in place” and what aspects of care are valued by patients and practitioners is key to advancing home health and paving the way for new evidence-based services in the home.
PERCEPTIONS OF EMPOWERMENT AMONG HOME CARE AIDES
Authors: Butler Sandra S , Kusmaul Nancy 
Published: November 2019

Abstract
Workforce issues in eldercare are of growing concern with the dramatic aging of our population and the growing need for personal care assistance. Due to difficult job conditions, recruitment and retention of direct care workers have presented challenges throughout the country both in facility-based and community-based care. The empowerment of workers has been theorized as one vehicle for improving job satisfaction among healthcare workers. Models of structural and psychological empowerment have been explored as factors to reduce job strain among healthcare workers in institutional settings, but have not been well examined in the home care setting. This paper will report on an exploratory study of perceptions of empowerment among home care aides (HCAs) in two states. In-person and telephone semi-structured interviews were conducted with 12 HCAs ranging in age from 20 to 64; eight were white and U.S. born and four were black and African born. All 12 study participants reported positive aspects of empowerment in their home care work (e.g., receiving information and good support, feeling competent, having an impact on their clients’ lives, and finding the work meaningful), and most felt autonomous in their work and believed they had the resources they needed to do the job. Nonetheless, negative aspects of empowerment were also frequently described (e.g., poor support, constrained information and resources, limited autonomy due to regulations, and few opportunities for advancement). This paper will explore and interpret these seemingly contradictory findings, with a discussion of implications for recruitment and retention of this valuable workforce
REACTIVITY TO THE MEASUREMENT OF PSYCHOLOGICAL WELL-BEING IN OLDER ADULTS
Authors: Amireault Steve , Friedman Elliot M , Huffman Mary K 
Published: November 2019

Abstract
Although it is known that measurement reactivity can yield medium-sized effects (Cohen’s d = .50) on anxiety, its effects on psychological well-being (PWB) measures (e.g., purpose in life, personal growth) are unknown. The aim of this study was to evaluate reactivity to the measurement of PWB in older adults. Ninety-four adults aged 60 ≥ years (mean = 75) were recruited from a fitness center, retirement home and community center in Indiana. All participants received a questionnaire via postal mail at baseline (T1) and 2-3 weeks later (T2). Using block randomization (block size = 16), older adults were randomly allocated (1:1 ratio) to one of two conditions: PWB measures assessed at T1 and T2; and PWB measures were at T2 only. Purpose in life and personal growth were assessed using Ryff’s PWB scales. Multiple imputation analysis was conducted to account for attrition at T2 (18%), and all participants were analyzed according to the condition they were originally assigned. ANCOVA, controlling for recruitment sites, revealed that purpose in life (p = .03), but not personal growth (p = .08), T2 scores were on average lower when PWB was measured twice compared to those when PWB was measured once. The detected difference in purpose in life T2 scores was of medium size (d [95%CI] = - .50 [-.95, -.04]). This finding suggests that initial or later scores might be biased – a problematic finding because if ignored, measurement reactivity has the potential to affect conclusions drawn from gerontological research that focuses on PWB.
THE INFLUENCE OF THE UNIVERSAL TWO-CHILD POLICY ON CHINA’S FUTURE AGING AND POPULATION
Authors: Jia Can , li Handong 
Published: November 2019

Abstract
China’s aging situation is becoming more and more prominent, and both the people and the government are facing unprecedented pressure of providing for the aged. For this reason, the Chinese government began implementing a new family planning policy for couples to have two children since 2016 (referred to as “universal two-child policy”). In order to explore the impact of the newly released policy, our research is based on the sixth census of China. And first, we use the cohort-component method and a Leslie matrix to construct the population prediction model. Considering some certain unique factors in China, such as the significant urban-rural dual structure and the household registration system and so on, we divide the total fertility rate into urban and rural areas which fully reflects the characteristics of China’s family planning policy. Then we predict and analyze the number and structure of China population between 2011 and 2050 based on the three scenarios of high, medium and low. And the results show that the Chinese population will present an inverted pyramid structure, and the population structure will continue to deteriorate. Besides, we adapt three indicators to analyze the aging trend in China, namely, the old-age coefficient, the population aging index, and the social dependency ratio. And the three indicators of China will continue to grow under the universal two-child policy with different changing rate, which means, the newly released policy will not change China’s aging population growth trend and the severity of China’s aging.
THE TRUTH ABOUT AGE DIFFERENCES IN PERFORMANCE ON VARYING LENGTHS OF LIKERT-TYPE TEST ITEMS
Authors: Lutz Julie , Metzger Aaron , Turiano Nicholas A , Spalding Rachael , Katz Emma , Edelstein Barry 
Published: November 2019

Abstract
Guidelines for self-report assessment with older adults emphasize the use of shorter Likert-type or agree/disagree response formats to reduce cognitive load (e.g., Yesavage et al., 1983). However, these suggestions are not founded on empirical studies directly comparing younger and older adults’ responses on different scales. Thus, the current study tested differential responding on varying Likert-type response scale lengths between younger, middle-aged, and older adults. Participants completed three versions of the International Personality Item Pool (IPIP) Neuroticism scale with 3, 5, and 7 Likert-type response scale lengths in counterbalanced orders with other questionnaires between versions. Six multi-group confirmatory factor analyses (CFAs) assessed measurement invariance across scale lengths and age groups. Invariance of convergent validity networks was also assessed with multi-group CFAs of the associations between the IPIP and measures of depression, anxiety, anger, worry, and affect. The final sample consisted of 835 adults (327 18-44; 279 45-64; and 229 65 or older) via Amazon Mechanical Turk. Measurement invariance was supported in analyses by age within each scale length and by scale length within each age group, indicating that response patterns across all scale lengths and age groups did not significantly differ. Analyses of convergent validity also supported invariance, suggesting that responses across all scale lengths and age groups reflect the same underlying construct. This study indicates that, among community-dwelling adults, shortened response scale lengths do not yield significantly different or more valid responses for older adults compared to younger adults.
CHRONIC PAIN AND ASSOCIATED RISK OF COGNITIVE IMPAIRMENT AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: Hu Yi-Han , Lin Hsien-Chang 
Published: November 2019

Abstract
Chronic non-cancer pain (CNCP) is an emerging health issue among the older population. Not only did the CNCP prevalence increase gradually in past decades, but also it may cause difficulties in cognitive processing and social and emotional functioning. However, evidence for the associations between CNCP and incident mild cognitive impairment (MCI) and Alzheimer’s disease and related dementias (ADRDs) is inconsistent and insufficient. Using the administrative claims data from health insurance companies from January 2007 to December 2017, this prospective cohort study investigated the impact of CNCP on the risks of developing MCI and ADRDs among adults aged 50 and older. To reduce potential selection bias, the propensity-score matched cohort design was applied for selecting comparable CNCP and non-CNCP patients at the beginning of the follow-up. Time-dependent Cox proportional-hazards regression models were conducted to estimate the hazard ratios (HRs) of incident MCI/ADRDs, adjusting for baseline sociodemographics and time-dependent medical conditions. Of 236,782 patients with/without CNCP, 342 individuals (0.14%) developed MCI and 1,183 patients (5.0%) had been diagnosed with one type of ADRDs during the follow-up. After adjusting confounders, CNCP patients had a 42% increased MCI risk (HR=1.42; 95% CI=1.14-1.76) and a 20% increased ADRDs risk (HR=1.20; 95% CI=1.07-1.34) relative to non-CNCP patients. Our findings indicate that CNCP is associated with incidences of MCI and ADRDs. Early diagnosis of CNCP and CNCP management may prevent cognitive impairment among middle-aged and older adults. Future studies are warranted to explore the potential effects of pain treatments on restoring cognitive function of CNCP patients.