bluuebunny/crossref_metadata_2025_split huggingface dataset:
Motor and Pulmonary Function and Mobility Disability Among Black and White Older Adults With and Without HIV
Authors: Lange-Maia Brittney , Buchman Aron , Leurgans Sue , Lynch Elizabeth , Lamar Melissa , Erlandson Kristine , Barnes Lisa , Maia Brittney Lange 
Published: December 2020

Abstract
Black-White disparities in gait speed have been observed in studies of adults reporting HIV, consistent with work among older adults without HIV. However, it is unknown if racial differences exist among adults with HIV for other mobility-related factors. We aimed to determine if racial differences exist in mobility disability among older adults with and without HIV and assess if pulmonary and motor function contribute to mobility disability. We examined older adults age 50+ with HIV (N=177; 72% Black) and without HIV (N=191; 68% Black). Motor function summarized 10 motor performances including gait speed; pulmonary function summarized 3 measures assessed using hand-held spirometry. Mobility disability was based on self-report. In regression models adjusted for age, sex, medical conditions, and smoking, neither race nor HIV status were associated with mobility-related factors. However, in models stratified by HIV status, Blacks with HIV had worse motor (β=-4.3, p=0.04) and pulmonary function (β=-50.5, &lt;0.001) and higher odds of mobility disability (odds ratio [OR]=2.9, 95% confidence interval [CI]=1.01-8.2) compared to Whites with HIV. Racial differences were not apparent among uninfected participants in motor function, pulmonary function, or mobility disability. In subsequent models, racial differences in mobility disability were attenuated and no longer significant in HIV when adjusting for motor function (OR=0.88 per/% higher motor composite, 95% CI=0.84-0.93). Racial differences in mobility disability in HIV were unaffected when controlling for pulmonary function. Results suggest that Blacks with HIV have greater mobility disability compared to Whites with HIV, and these differences are due to differences in motor function.
Fall Prevention in Dutch Physician Practices: A Descriptive Study
Authors: Meekes Wytske , Leemrijse C J , Korevaar J C , van de Goor L A M 
Published: December 2020

Abstract
Falls are an important health threat among frail older people. Physicians are often the first to contact for health issues and can be seen as designated professionals to provide fall prevention. However, it is unknown what they exactly do and why regarding fall prevention. This study aims to describe what physicians in the Netherlands do during daily practice in regards to fall prevention. About 65 physicians (34 practices) located throughout the Netherlands were followed up for 12 months. When a physician entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the physician received a pop-up asking if the patient is frail. If so, the physician subsequently completed a questionnaire. The physicians completed 1396 questionnaires. More than half (n=726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF) and 37% of these patients received fall prevention. Physicians did not know of 20% of the patients if they had experienced a fall and of 29% of the patients if they had a FOF. The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors. The results show that physicians are not always aware of a patient’s fall history and/or FOF and that only part of these patients receives fall prevention. Hence, it might be important to develop and implement strategies for systematic fall risk screening and fall prevention provision in the primary care setting to reduce falls among frail older people.
Four Eating Behaviors That Might Prevent Metabolic Syndrome Onset in Older Adults: Cohort Study
Authors: Wada Sayori , Hamaguchi Masahide , Nakabe Nami , Ueda Miho 
Published: December 2020

Abstract
Metabolic syndrome (MetS) is associated with cardiovascular disease and cancer, the leading causes of mortality and morbidity. Although eating behaviors may have an impact on the risk of MetS, exactly which behaviors can prevent MetS is not fully elucidated. We evaluated the onset of MetS in relation to eating behaviors among Japanese older adults aged 65 to 93. We enrolled individuals who underwent health check-ups between April 2008 and March 2019, and performed a nine-year follow-up in this cohort study. Cox regression models were used to compare hazard ratios for MetS onset. Among the 2,661 older adults included, the mean age was 70.21 ± 0.089 years and 46% were women. During a mean follow-up of 1567.3 ± 19.3 months, 499 candidates (18%) developed MetS. The risk of MetS was significantly low in subjects in the “often eat vegetables” and “eat more than 30 items daily” groups (hazard ratio (HR) (95% confidence interval (CI)): 0.721 (0.595–0.872), p = 0.001; and 0.690 (0.545–0.874), p = 0.002, vs without the behavior, respectively). On the contrary, the risk of MetS was significantly higher in subjects in the “eat quickly” and “eat out more than twice a day” groups (HR (95% CI): 1.442 (1.208–1.721), p &lt; 0.001; and 1.534 (1.245–1.890), p &lt; 0.001, vs without the behavior, respectively). Four eating behaviors—regular vegetable consumption, eating more than 30 items daily, eating slowly, and refraining from eating out too often—might be beneficial with regard to preventing the onset of MetS.
Clinician Distress: A Concept Clarification
Authors: Foxwell Anessa 
Published: December 2020

Abstract
In 2017, The National Academy of Medicine created the Action Collaborative on Clinician Well-Being and Resilience given the staggering statistics around distress and burnout, which is particularly high while caring for seriously ill older adults. This distress may be physical, emotional, spiritual, moral, ethical, existential or in degrees and combinations of multiple forms. Many crossover concepts are present in the literature, including moral distress, role stress, compassion fatigue, empathy, emotional labor, post-traumatic stress disorder, vicarious traumatization, and second victim. Because of the number of crossover concepts, we employed the Norris concept clarification method examining similar concepts to create an operational definition, construct a model, and develop possible research hypotheses of clinician distress. Articles were identified through PubMed, CINAHL, PsyhINFO, and SCOPUS with the expert assistance of a nurse librarian. Similar concepts in the literature were compared and contrasted with an emphasis on what encompasses clinician distress. Based on synthesis of the literature and existing concepts, clinician distress is defined as experiencing one or more negative emotions before, during, or after a clinical encounter that impacts the quality of care the clinician is able to provide to the patient. The result of this analysis provides some clarity around clinician distress and its surrogate terms, which presents opportunities for further investigation.
A Virtual Health Library for Dementia Patients and Caregivers to Improve Quality of Information and Communication
Authors: Mengell Kirsten , Indelicato Alyssa , Lawler Sarah , Smith Nancy , Brangman Sharon , Stewart Telisa 
Published: December 2020

Abstract
Access to accurate health information is critical for patient decision making and health communication. Unfortunately, there is limited quality health information for dementia patients and their caregivers. A Virtual Health Library (VHL) provided access to credible health information through the electronic medical record (EMR) to reach the dementia patients and their caregivers. A VHL was created and brought together clinicians, caregivers, technology support personnel, public health professionals, and the health sciences library. The team identified areas of interest and met monthly to create VHL materials. Materials included voice-over slides and 1-page educational content that was uploaded to the EMR for patient and caregiver access. A baseline and final questionnaire assessed demographics, empowerment, and shared decision making for both the patient and the caregivers and a pre/post was created for each module to asses knowledge and stratification. Initially, 1331 patients with dementia were recruited for the project from a university geriatrics department. The population had a 28.3% enrollment in the EMR and only 3.8% used the EMR in the past six months. Of this pool, during the initial launch 32 patients and or caregivers completed the baseline within the first week. 98% of respondents were caregivers with an average age of 58.7. With the youngest caregiver 42 and the oldest 88. Of the caregiver’s relationships to the patients is 43.3% their child, 40% their spouse, 10% other family, and 6.7% friends. During the project, participants improved access to health information and became empowered to engage with their healthcare provider.
Circulating Procollagen Type III N-Terminal Peptide and Physical Function in the Long Life Family Study
Authors: Santanasto Adam , Cvejkus Ryan , Wojczynski Mary , Schupf Nicole , Marron Megan , Christensen Kaare , Thyagarajan Bharat , Zmuda Joseph 
Published: December 2020

Abstract
Circulating levels of procollagen type III N-terminal peptide (P3NP) may reflect increased fibrosis of skeletal muscle and other tissues with aging. In the current study, we tested if P3NP levels were associated with baseline and 7-year change in physical function among adults aged 39-104. Participants (n=400) were from the Long Life Family Study, a study of exceptional familial longevity. Plasma P3NP concentration was measured using a sandwich enzyme-linked immunosorbent assay (inter-assay CVs &lt;3%). At baseline and 7-year follow-up visits, physical function was measured using the Short Physical Performance Battery (score 0-12), which consists of gait speed, balance, and chair-rise tests. Grip strength was measured using a handheld dynamometer. The association between log-transformed P3NP and physical function was examined using Generalized Estimating Equations adjusted for familial relatedness, age, sex, height, weight, lifestyle characteristics, chronic disease prevalence and inflammatory cytokines. Participants were aged 73.1 ± 15.2 years, 54% female, had a BMI of 26.6 ± 4.3 kg/m2, and a gait speed of 1.0 ± 0.3 m/s. One standard deviation higher P3NP concentration was related to worse baseline SPPB score (β=-0.9points), gait speed (β=-0.05m/s), chair-rise time (β=8.34seconds), and grip strength (β=-2.0kg; all p&lt;0.001). Higher P3NP concentration was also associated with greater declines in gait speed (β=-1.41, p&lt;.001) and chair-rise performance (β=0.41, p&lt;.001). Plasma P3NP concentration may be a strong, novel biomarker of current and physical function changes with aging. Future research is needed to extend our findings to a larger population, and determine the mechanisms underlying these associations.
Doing the Right Thing: Caregivers and Medical or Nursing Tasks in the Post-Acute Home Care Setting
Authors: Chase Jo-Ana , Russell David , Kaplan Daniel , Bueno Michael , Khiewchaum Rungnapha , Feldman Penny 
Published: December 2020

Abstract
Family caregivers often manage complex medical/nursing tasks (MNTs) for older adults returning home after a hospitalization. The purpose of this qualitative study was to describe caregivers’ experiences leveraging diverse resources to manage MNTs for older adults receiving post-acute home health care services (HHC). In-depth telephone interviews were conducted with 20 caregivers of older adults who received HHC following hospitalization. Interviews were digitally audio-recorded, transcribed, and analyzed using directed content analysis. The Theory of Dependent-Care informed the analytical framework. We organized codes using three theoretical constructs related to managing older adults’ MNT care needs (“tasks related to the other”), accessing existing social/environmental resources (“tasks related to the situation of care”), and working with the healthcare system (“tasks related to the system of care”). Caregivers’ descriptions of MNTs included the complexity and socioemotional impact of assisting in these tasks (e.g., dependency, trust). When needed, caregivers’ accessed social (e.g., family, friends) and environmental (e.g., neighborhood, housing) resources to help address the older adults’ care needs. Caregivers also identified challenges and strategies for navigating and coordinating care and services within HHC and the larger healthcare system. Caregivers assisting with complex MNTs in the post-acute HHC setting need additional training and support. HHC providers can actively engage caregivers by tailoring training and support strategies, assessing social and environmental contexts and resources, and facilitating caregivers’ navigation of the healthcare system. Future research could elucidate social and environmental factors associated with successful collaborative relationships among providers, older adults and their caregivers in the post-acute HHC setting.
Rural-Urban Differences in Informal Caregiving, Caregiving Intensity, and Health-Related Quality of Life
Authors: Cohen Steven , McIlmail Julia , Greaney Mary 
Published: December 2020

Abstract
Introduction Rural areas in the US have a disproportionately high population of older adults and have reduced access to services. Older adults in rural areas are more reliant on family and friends for care. However, little is known about rural-urban disparities among the 40+ million caregivers nationwide. As rural-urban health disparities are pervasive among older adults, there is a need to understand how rural-urban disparities impact caregiving experiences and health-related quality of life (HRQoL). The objectives of this study were to examine rural-urban differences caregiving, caregiving intensity (caregiving hours/week and types of care provided), and caregiver HRQoL. Methods Data were abstracted from the 2009 Behavioral Risk Factor Surveillance System (latest dataset to include county of residence and caregiver module). The primary measure of rural-urban status was Index of Relative Rurality (IRR) decile. Associations between rural-urban status and caregiving and rural-urban differences in caregiving intensity and HRQoL were examined using generalized linear models, controlling for confounding and accounting for complex sampling. Results Rural respondents were more likely to be caregivers than urban respondents (IRR decile OR=1.015, 95%CI 1.014-1.016). Rural caregivers, on average, provided 2.43 hours/week more caregiving for each one-decile increase in IRR decile (95%CI 2.34-2.52) and had worse overall HRQoL (OR=1.34, 95%CI 1.33-1.35). Conclusion Rural informal caregivers offer higher levels of care than urban counterparts, and increased caregiving in rural areas is associated with reduced HRQoL. These results can inform policies designed to improve caregiver health, and facilitate the translation of existing programs and interventions to address rural caregivers’ needs.
The Half Life of Stress: Caregiver Stress Increases Next-Day Severity of Behavioral Symptoms of Dementia
Authors: Pickering Carolyn , Puga Frank , Wang Danny , Yefimova Maria 
Published: December 2020

Abstract
The progressively lowered stress threshold theory posits that behavioral symptoms of dementia (BSD) are reactions to environmental and care related stressors. In line with this theory, this study tests whether the stress experienced the caregiver impacts BSD expression. Caregivers to persons with dementia recruited online completed daily diary surveys for 21 days reporting on daily contextual and environmental factors of caregiving life. Using multi-level modeling of diaries (n=911) nested within participants (N=51), two daily caregiver stressors (conflict with someone other than the person with dementia, stress about own personal health) were examined as predictors of BSD. The outcome of BSD was measured as severity (a rating on a Likert scale of 1-5 that was then person-centered to represent deviations from average severity). Covariates in the model included relationship type, caregiver age, as well as stressors to the care recipient known to increase BSD. On days when a caregiver had a conflict with others the severity of the care recipient’s BSD increased by 1.44 points from average (p&lt;.001, CI 1.05-1.75). In a time-lagged model, we observe that a caregiver having a conflict yesterday impacts today’s BSD severity by an increase of 0.43 points from average (p = 0.027, CI 0.05-0.81). Caregivers’ stress about their own health did not have a significant impact on the same day or next day BSD severity rating. These findings demonstrate that the well-being of the caregiver has measurable immediate impacts on the well-being of the person living with dementia, and suggests not all stress is equal.
Certified Nursing Assistants’ Experiences of Workplace Violence Caring for Persons With Dementia
Authors: Xiao Chunhong , Winstead Vicki , Townsend Corteza , Jablonski Rita 
Published: December 2020

Abstract
Problem: Certified nursing assistants (CNAs) are the primary providers of direct care to persons residing in long term care facilities (LTCFs), many of whom have dementia. The need to deliver direct and intimate care increases CNAs’ exposure to verbal and physical workplace violence. Purpose: To describe CNAs’ experiences of physical and verbal workplace violence experienced during direct care activities in LTCFs. Design: Qualitative. Sample & Procedure: Ten African-American CNAs (9 female, 1 male) were recruited using snowball sampling from multiple LTCFs. Interviews were recorded and transcribed. NVivo12 software was used to manage the thematic analyses. Results: The identified themes were: 1) CNAs’ perception that verbal and physical abuse was “part of the job” and unavoidable; 2) CNAs’ feelings of minimization of the abuse by administration; and 3) inadequate CNA training to recognize and de-escalate triggers of verbal and physical violence, notably care-resistant behavior. Conclusion: The combination of institutional tolerance of workplace violence, coupled with CNAs’ insufficient training in de-escalating volatile interactions with cognitively-impaired residents, is creating an unfavorable, possibly dangerous, workplace environment for CNAs. Implications: As more states elevate assaults on healthcare workers to felony crimes, there is an emerging risk of criminalizing dementia-related behavior in an attempt to address workplace violence. Interventions focused on helping CNAs recognize and de-escalate care-resistant behavior are necessary for violence prevention programs in LTCFs. Limitations: CNAs may have self-censored and under-described the severity of their experiences during face-to-face interviews, even with confidentiality protocols and the practice of off-site interviews.
Caring for Older Adults with Vision Impairment and Dementia: Data from the National Study of Caregiving
Authors: Varadaraj Varshini , Swenor Bonnielin , Chyng Shang-En , Sheehan Orla , Deemer Ashley , Ehrlich Joshua , Wolff Jennifer , Roth David 
Published: December 2020

Abstract
We examined caregiving relationships for individuals with vision impairment (VI) and dementia, using 2011 National Health and Aging Trends Study (NHATS) data, a survey of Medicare beneficiaries, linked to the National Study of Caregiving, a survey of family/unpaid helpers to NHATS participants. VI was defined as self-reported blindness or difficulty recognizing someone across the street, watching television or reading newspaper print. Dementia was defined as probable dementia based on survey-report or AD8 criteria. Caregiving outcomes included: (1) hours of care provided in the last month and (2) number of valued activities affected by caregiving. Among 1,196 caregivers, 617 assisted older adults without dementia or VI (D-/VI-), 298 with dementia but without VI (D+/VI-), 143 without dementia but with VI (D-/VI+), and 138 with dementia and VI (D+/VI+). In fully-adjusted regression models, caregivers of older adults D+/VI+ spent twice as many hours (IRR=2.0; 95%CI: 1.5-2.7) providing care than caregivers of older adults D-/VI-; however, caregivers of adults D+/VI- and those providing to older adults D-/VI+ spent 1.5-times more hours (95% CI=1.2-1.7; 95% CI=1.1-2.0, respectively). Additionally, caregivers of older adults D+/VI+ reported 4 times as many valued activities were affected (95%CI=2.8-5.6) then caregivers of those D-/VI-, while caregivers of those D+/VI- reported 1.9-times (95% CI=1.3-2.8) and D-/VI+ 1.6-times (95% CI=1.1-2.3) more activities were affected. Our results suggest that caring for older adults with VI has similar demands as caring for older adults with dementia, but that these implications may be magnified when caring for older adults with both dementia and VI.
Whole-Person, Whole-Team Approach to Quality Improvement: Why Person-Centered Care Matters
Authors: Engle Ryann , Snow A Lynn , Clark Valerie , Zhao Shibei , Gillespie Christopher , Hartmann Christine 
Published: December 2020

Abstract
The Department of Veterans Affairs (VA) began its culture transformation journey in 2006, supporting its nursing homes in providing high-quality, person-centered care in person-centered environments. We implemented a quality improvement intervention to support frontline staff from low-performing VA nursing homes in providing high-quality care using a whole-person, whole-team approach. The intervention consisted of a bundle with four components: 1) specialized frontline staff huddles that encouraged high-quality frontline staff communication and collaboration, 2) micro-root cause analyses and targeted interventions to promote resident sleep and reduce resident falls through individualized care, 3) in-depth frontline conversations regarding residents’ distress behaviors and mobility, and 4) targeted, team-based, person-centered performance improvement projects. The intervention was implemented at 8 low-performing VA nursing homes (August 2018 - April 2019) via in-person and virtual sessions and facilitated through CLC-based champions and intervention team-based coaches. We monitored the intervention’s impact using pre-post Centers for Medicare and Medicaid Services quality star ratings. We also conducted 17 post-intervention interviews with key informants at 7 participating nursing homes and conducted a content analysis of the data. Pre intervention, all 8 nursing homes had a history of being 1 or 2 stars in overall quality. Post intervention, 3 homes increased 1 star; 1 home increased 2 stars; 2 homes increased 3 stars; 2 homes increased 4 stars. Post intervention, participants perceived improved delivery of person-centered care (e.g., providing individualized sleep hygiene, de-implementing alarms). Our findings suggest a whole-person, whole-team intervention can effectively and efficiently improve both person-centered care and care quality.