bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dyadic Experiences of Living With Cognitive Impairment Through a 3-Year Longitudinal Qualitative Study
Authors: Wang Jing , Wu Bei , McConnell Eleanor , Ding Ding , Corazzini Kirsten 
Published: December 2020

Abstract
The fastest growth of population living with cognitive impairment takes place in China. The estimated prevalence of cognitive impairment among older adults in China is between 13% and 20%. This study focused on persons with cognitive impairment (PWCI) and their spousal care partners to explore how spousal relationships impact dyadic experiences of living with cognitive impairment through a person-centered care lens. We conducted a longitudinal qualitative study of 10 dyads of PWCI and their care partners over three years with three data collection time points. Our findings suggest that the complexity of changing experience of living with cognitive impairment is interpreted in the dynamic nature of their spousal relationship and relationship with others, patterns of communication, daily activities and care during the extended period of cognitive decline. It is crucial to help them nurture the belief that there is a significant meaning in the journey of living with cognitive impairment.
Institutional and Cultural Barriers to ACP: Staff Perspectives
Authors: Gutman Gloria , de Vries Brian , Kwan Helen , Jang Katrina , Soheilipour Shimae 
Published: December 2020

Abstract
This study explored staff knowledge and engagement in assisting residents/families with ACP. Focus groups were conducted at two long-term care homes, one Exclusively Chinese (EC; n = 25); one Multi-Ethnic (ME; n = 41). In each, separate focus groups were held with registered staff, care aides, and support staff who also completed brief surveys providing socio-demographic data and information about their training and experience with ACP. Perceived barriers to engagement in ACP included limited knowledge and inadequate training in facilitating ACP, cognitive impairment of residents, language barriers, lack of openness to discussing ACP, family expectations and misinformation. EC staff also considered cultural and religious beliefs as one of the main barriers to engaging in ACP both for residents and families; staff at ME focused more on timing and the role of family. Support staff and care aides did not perceive ACP as within their scope of practice, deferring to nurses.
Digital Health Tool to Assist Older Adults in Self-Disclosing Elder Mistreatment
Authors: Abujarad Fuad , Choo Esther , Pantalon Michael , Jubanyik Karen , Dziura James , Edwards Chelsea , D’Onofrio Gail , Gill Thomas 
Published: December 2020

Abstract
Elder Mistreatment (EM) is a global health issue that continues to be under detected and inadequately addressed in healthcare settings. In this symposium, we will describe how we built and currently use the VOICES digital health tool to screen for EM. The tool is designed exclusively with older adults in mind and runs on iPads to be used in the emergency department. VOICES screens, educates, uses motivational interviewing to facilitate self-disclosure of EM, and refers patients for in-person screening. The tool includes multimedia components such as videos, audio and animations designed to educate and enhance screening for EM. Patients who screen positive are then guided through an automated Brief Negotiated Interview (BNI) that uses motivational interviewing to help them self-identify and self-disclose. Our tool will help identify cases of EM that otherwise may go undetected and overcomes major challenges associated with traditional methods of screening.
Regional Workshops to Widely Disseminate an Innovative Practice
Authors: Hain Debra , Suriaga Armiel 
Published: December 2020

Abstract
The second stage of the CMS Region IV project involved a series of 20 half-day workshops and five follow-up webinars to introduce Go to the Hospital or Stay Here?, the training resources available (12 videos, 5 case studies and Best Practices summary), and strategies for implementation. Altogether 1124 representatives from long-term care facilities, state agencies, ombudsman groups and hospitals attended these interactive workshops. Polled participants reported that resident and family insistence on transfer to the hospital was a major barrier to successful reduction of acute care transfers for them. Those who implemented the Guide facility-wide reported an average 28% reduction in transfers. Primary barriers to facility-wide implementation were lack of leadership, making a choice to absorb the cost of financial penalties and failure to distinguish the goal of Guide use from those of existing transfer reduction programs. The facilities found the workshops helpful preparation for effective implementation of the Guide.
Utilizing Implementation Science to Accelerate Adoption of a Program to Prevent Avoidable Transfers
Authors: Southard Karen , Kaye Suzie 
Published: December 2020

Abstract
The research team combined their long-term care management experience with feedback from the 16 pilot nursing homes and several hundred workshop and webinar participants’ reports to identify the most effective strategies for implementation of the Guide and smaller Trifold. The learning framework employed to develop these Best Practices was directed to two distinct audiences 1) the licensed staff of the facility and 2) the residents of the facilities and their families. Critical elements identified included: when and how to distribute the Guide; how the Guide can be used to support difficult conversations e.g. about end of life choices; and effective and efficient ways to train staff. The framework for discussion during the symposium will be achievement of organizational readiness and the relevance of the four E’s of implementation science as it applies to long term care organizations.
Engaging Families in Function-Focused Care: Goal Attainment and Associated Outcomes
Authors: Boltz Marie , Jones Joanne Roman , Hermann Robin 
Published: December 2020

Abstract
Partnering with families to develop function-focused plans for hospitalized persons with dementia (PWD) improves both the hospital experience and patient outcomes. This secondary analysis included patients enrolled in the intervention arm of the on-going Family-centered Function-focused Care (Fam-FFC).study. This study examined the goals co-established by family caregivers, PWD, and nurses to prevent hospital-acquired complications and promote functional and cognitive recovery. The influence of goal attainment upon delirium and physical function at discharge was also examined. The majority of patients (N=162) were female (65%), black (53%) with a mean age of 82.7 (SD= 8.2). Goal attainment ranged from -2 to 2; mean = -0.24 (SD= 0.75). The goals (N=432) represent three main areas: mobility, self-care, and cognitive stimulation. Controlling for age and admission function, goal attainment was associated with less discharge delirium (F=3.2, p = .022) but not discharge function. Results support the contribution of function-focused care to improving delirium outcomes.
Pain Incidence, Treatment, and Associated Symptoms in Hospitalized Persons With Dementia
Authors: Resnick Barbara , Boltz Marie 
Published: December 2020

Abstract
A better understanding of the relationships between pain and other syndromes in hospitalized persons with dementia (PWD) will help establish pain as a critical symptom to target. Secondary analyses from the Fam- FFC study describe the incidence and pharmacologic management of pain, and its association with physical function, delirium, and behavioral and psychological symptoms of dementia (BPSD). The sample (N=299) was mostly female (62%), non-Hispanic (98%), and Black (53%), with a mean age of 81.6 (SD=8.5); 166 (56%) received pain medication, whereas 40% (n=43) of 108 individuals who demonstrated pain did not receive analgesics. Regression analyses showed that, controlling for age, gender, cognition, and comorbidities, pain was associated with function (t= -.3.2, p=.001), delirium (t =5.0, p &lt; .000), and BPSD severity (t = 2.3, p=.023). Findings suggest pain may be undertreated in hospitalized PWD but should be considered to optimize function, decrease delirium, and prevent or decrease BPSD.
Early Detection of Age-Associated Cellular Decline: Report of an Expert Consensus
Authors: Guralnik Jack , Cesari Matteo , Beresniak Ariel , Rodriguez-Manas Leocadio , Cherubini Antonio 
Published: December 2020

Abstract
Cellular processes often decline with age and cells lose their ability to function optimally, which may lead to organ-specific dysfunction and the development of systemic age-related diseases. The cellular hallmarks of aging are associated with clinical signs and symptoms and can be termed Age Associated Cellular Decline. An expert consensus study group was convened to provide an initial framework for the development of a tool for adults over 50 years old, which identifies self-reported symptoms and observable signs likely to be early and/or surrogate markers of age associated cellular decline. A total of 16 potential early signs and symptoms of age associated cellular decline were identified and need to be validated in further research.
Occupational Therapy Innovations in Home and Community Practice for People Living With Dementia
Authors: Piersol Catherine , Trudeau Scott 
Published: December 2020

Abstract
Most Americans with dementia live at home and families are commonly responsible for overseeing the daily activities of the person with dementia. Families require support, education, and skill-building to manage caregiving responsibilities. Occupational therapist are ideally suited to teach care partners tailored strategies for obtaining the “just right fit” between the capacities of the person and the demands of the environment, thus reducing behavioral symptoms, optimizing function and safety and enhancing well-being. Care of Persons with Dementia in their Environments (COPE) is an evidence-based intervention designed to address these outcomes. Over three phases, the occupational therapist employs a problem-solving method to identify strategies that address caregiver-reported difficulties related to managing daily activities, behavioral challenges and other caregiver concerns. This presentation describes the development and implementation of COPE highlighting the distinct approaches of occupational therapy in delivering home- and community-based services to persons living with dementia and their care partners.
Multimodal Neuroimaging Predictors of Gait Decline
Authors: Sargent Lana , Tian Qu , Nalls Mike , Singleton Andrew , Studenski Stephanie , Resnick Susan , Ferrucci Luigi 
Published: December 2020

Abstract
Prior studies suggesting associations between cortical brain areas and gait speed has been largely cross-sectional and limited to one modality neuroimaging. Using machine learning from 506 cognitively normal BLSA participants aged 55+ who had repeated measures of brain volumes, diffusion tensor imaging (DTI), and gait speed, we examined multimodal neuroimaging predictors of gait decline, accounting for demographics, body composition, and grip strength. Significant predictors of gait decline included changes in volumes and DTI measures of gray matter in selected frontal, parietal, temporal, and subcortical areas, as well as white matter changes in both fractional anisotropy and diffusivity of tracts connecting frontal areas to subcortical motor areas. This predictive model highlights the importance of atrophy and microstructural deterioration in selected frontal and subcortical motor areas in predicting gait speed decline.
Bile Acids in Dementia: Brain Amyloid, White Matter Lesions, and Atrophy
Authors: Varma Vijay , Wang Youjin , An Yang , Varma Sudhir , Bilgel Murat , Doshi Jimit , Legido-Quigley Cristina , Thambisetty Madhav 
Published: December 2020

Abstract
While Alzheimer’s disease (AD) and vascular dementia (VaD) may be accelerated by hypercholesterolemia, the mechanisms underlying this association is unclear. Using a novel, 3-step study design we examined the role of cholesterol catabolism in dementia by testing whether 1) the synthesis of the primary cholesterol breakdown products (bile acids (BA)) were associated with neuroimaging markers of dementia; 2) pharmacological modulation of BAs alters dementia risk; and 3) brain BA concentrations and gene expression were associated with AD. We found that higher serum concentrations of BAs are associated with lower brain amyloid deposition, slower WML accumulation, and slower brain atrophy in males. Opposite effects were observed in females. Modulation of BA levels alters risk of incident VaD in males. Altered brain BA signaling at the metabolite and gene expression levels occurs in AD. Dysregulation of peripheral cholesterol catabolism and BA synthesis may impact dementia pathogenesis through signaling pathways in the brain.
Examining How African American Family Dementia Caregivers Conceptualize and Manage Crisis Events
Authors: Cotton Quinton , Block Laura , Morgan Jennifer , Gilmore-Bykovskyi Andrea 
Published: December 2020

Abstract
African American (AA) family dementia caregivers report high unmet needs, which often culminate in crisis – an unplanned stressful situation requiring immediate decision. However, perspectives from AA caregivers regarding crisis are lacking. To gain insight into caregivers’ conceptualization and experiences of crisis, we used community/coalitional-based recruitment of AA caregivers to conduct semi-structured interviews with 34 AA caregivers which were analyzed using thematic analysis (N=34, 94% female, 56% ages 65 to 74). AA caregivers largely perceived crisis as stressful events, a normal part of caregiving and viewed management of these events as routine. Crisis was characterized as ongoing, lengthy or emergent, sometimes necessitating external support (.e.g. hospitalization). Caregivers managed crisis by increasing caregiving work, de-prioritizing their own health and needs, involving family and friends, and accessing emotional support through neighborhood connections. These perspectives can inform future culturally-tailored interventions that are responsive to AA strengths, values, and help seeking preferences.
Impact of Fear of Falling on Future Falls and Changes in Physical Activity in Older Adults With Glaucoma
Authors: Ramulu Pradeep , E Jian-Yu , Mihailovic Aleksandra , Kuo Pei-Lun , West Sheila , Gitlin Laura , Li Tianjing , Schrack Jennifer 
Published: December 2020

Abstract
To understand how Fear of falling (FoF) alters mobility, FoF was evaluated annually in 243 older adults (median age=70) with varying degrees of visual field loss from glaucoma, and Rasch-analyzed FoF scores associated with the likelihood of falling in the following year (judged by prospective calendar data) and changes in physical activity (Judged by annual accelerometer trials). At lower FoF levels, each one-unit worsening in FoF was associated with a 2.73-fold higher odds of reporting a fall in the next year (95% CI:1.55,4.81) but not with average daily steps taken (p = 0.44). At higher FoF levels, inter-year changes in FoF were not significantly associated with a fall in the next year (p = 0.78); but were associated with 407 fewer daily steps taken per one-unit change in FoF (95% CI:-743,-71). FoF is an important driver of mobility; the specific aspects of mobility affected varies by the degree of FoF.
Creating and Keeping Exercise Gains Into Your 70s, 80s and 90s
Authors: Manning Kenneth , Kopp Teresa , Oursler Kris ann , McDonald Michelle , Morey Miriam , Hall Katherine , Lee Cathy , Giffuni Jamie 
Published: December 2020

Abstract
Background: Gerofit, an exercise program for older Veterans, is undergoing national dissemination (17 sites in 6 years). Four sites have accrued 4-year functional outcomes (gait speed, 8-foot-up-and-go, 30-second chair stand, and six-minute walk). Methods: Functional assessments were administered quarterly in first year and annually thereafter. Individuals with baseline and at least two follow up measures were included for analysis (n=587). Means were gathered across each timepoint. Results: Mean values for functional assessments from baseline to 4 year were as follows: gait speed m/s- 1.04, 1.12, 1.13, 1.13, 1.09, 1.07, 1.13; 8 ft-up-and-go seconds- 7.6, 6.82, 6.69, 6.69, 7.29, 7.29, 7.51; 30 second chair stands 11.88, 14.06, 14.72, 14.89, 14.69, 14.71, 14.96; and six-minute-walk yards- 499, 532, 541, 544, 531, 530, 556. All follow up measures were significantly improved over baseline (P&lt;.01) and superior to normative age-related decline. Implications: Results indicate that exercise promotes compression of morbidity and improved functional health.
One Song, Many Voices: Dementia and The Power of Music
Authors: Sheets Debra , MacDonald Stuart , Smith Andre 
Published: December 2020

Abstract
Choral singing is a novel approach to reduce dementia stigma and social isolation while offering participants a sense of purpose, joy and social connection. The pervasiveness of stigma surrounding dementia remains one of the biggest barriers to living life with dignity following a diagnosis (Alzheimer Society of Canada, 2018). This paper examines how a social inclusion model of dementia care involving an intergenerational choir for people living with dementia, their care partners and high school students can reduce stigma and foster social connections. Multiple methodologies are used to investigate the effects of choir participation on cognition, stress levels, social connections, stigma, and quality of life. Results demonstrate the positive impact of choir participation and indicate that this socially inclusive intervention offers an effective, non-pharmacological alternative for older adults living with dementia in the community. Discussion focuses on the importance of instituting meaningful and engaging dementia-friendly activities at the community level.
Leveraging Existing Data from CMS-Linked Cohort Studies for the Advancement and Translation of Frailty Research
Authors: Xue Qian-Li , Ensrud Kristine , Lin Shari 
Published: December 2020

Abstract
As population aging is accelerating rapidly, there is growing concern on how to best provide patient-centered care for the most vulnerable. Establishing a predictable and affordable cost structure for healthcare services is key to improving quality, accessibility, and affordability. One such effort is the “frailty” adjustment model implemented by the Centers for Medicare & Medicaid Services (CMS) that adjusts payments to a Medicare managed care organization based on functional impairment of its beneficiaries. Earlier studies demonstrated added value of this frailty adjuster for prediction of Medicare expenditures independent of the diagnosis-based risk adjustment. However, we hypothesize that further improvement is possible by implementing more rigorous frailty assessment rather than relying on self-report of ADL difficulties as used for the frailty adjuster. This is supported by the consensus and clinical observations that neither multimorbidity nor disability alone is sufficient for frailty identification. This symposium consists of four talks that leverage data from three CMS-linked cohort studies to investigate the utility of assessment of the frailty phenotype for predicting healthcare utilization and costs. Talk 1 and 2 use data from the NHATS cohort to assess healthcare utilization by frailty status in the general population and the homebound subset. Talk 3 and 4 use data from the MrOS study and the SOF study to investigate the impact of frailty phenotype on healthcare costs. Taken together, their findings highlight the potential of incorporating phenotypic frailty assessment into CMS risk adjustment to improve the planning and management of care for frail older adults.
Physical Frailty, Cognitive Impairment, and Healthcare Utilization in Linked Cohort and Claims Data
Authors: Buta Brian , Sheehan Orla , Chung Shang-En , Blinka Marcela , Xue Qian-Li 
Published: December 2020

Abstract
Accurate prediction of healthcare utilization is an important issue for Medicare managed care organizations. We hypothesized that physical frailty and cognitive impairment increase the risk of healthcare utilization in older adults receiving Medicare coverage, independent of age and multimorbidity. We used the marginal means/rates model to investigate the association between baseline cognitive impairment with/without frailty (using the physical frailty phenotype), vs. frailty alone, in NHATS and the number of incident non-ER-related hospitalizations and emergency room (ER) visits within 12 months in linked Medicare claims data (N=3,915). After covariate adjustment, physical frailty alone was predictive of both non-ER-related hospitalizations (HR=1.77; p=0.012) and ER visits (HR=1.75; p&lt;0.001). Cognitive impairment with or without frailty was only associated with ER visits (HR=1.53, p=0.002; HR=1.30, p=0.001). Our findings support the value of physical frailty and cognitive impairment assessment above and beyond multimorbidity to improve the prediction of care utilization for vulnerable subgroups of Medicare beneficiaries.
Occupational Complexity and Late-Life Global Cognition: The SONIC Study
Authors: Ishioka Yoshiko , Gondo Yasuyuki , Masui Yukie , Nakagawa Takeshi , Inagaki Hiroki , Ogawa Madoka , Yasumoto Saori , Ishizaki Tatsuro 
Published: December 2020

Abstract
Studies have reported that work exposure to cognitively demanding environments predicted the level of late-life cognitive abilities. To date, whether or not such a relationship between work complexity and cognitive function is maintained in very old adults remains unknown. In the present study, we examined how the associations between lifetime work’s complexity and global cognition vary by age groups (70s, 80s, and 90s). To this end, we used data from 2754 Japanese community-dwelling participants in the SONIC Project. Specifically, we tested multiple group path models comparing the models based on differences in age and gender. The effects of work complexities on global cognition were found for male septuagenarians and octogenarians, having controlled for the variables related to education. The relationships between them were marginally significant for male nonagenarians. Based on the analysis, we discuss the maintenance of cognitive reserve and implications for cognitive and physical health in very old ages.
Greater Perceived Physical Fatigability Is Associated with Lower Cognition: The Long Life Family Study
Authors: Gmelin Theresa , Rosso Andrea , Andersen Stacy , Cosentino Stephanie , Wojczynski Mary , Christensen Kaare , Boudreau Robert , Glynn Nancy 
Published: December 2020

Abstract
Greater perceived physical fatigability is associated with physical functional decline, but few studies have examined its relation with cognition. Adults ≥60 (mean±SD age 73.7±10.5, 54.7% female, 99.6% white) from the Long Life Family Study (n=2355) completed the Pittsburgh Fatigability Scale (PFS, 0-50, higher=greater fatigability) and a neurocognitive examination. Generalized estimating equations were used to account for family structure. Covariates included age, sex, field center, depressive symptoms (Center for Epidemiological Studies-Depression), education, and self-reported health. Each 1-point greater PFS was associated with lower: (1) global cognition (Mini-Mental Status Exam; β=-0.36,p&lt;.0001), (2) verbal fluency (phonemic: β=-0.09,p=.029 and semantic: β=-0.14,p&lt;.0001), (3) memory (Hopkins Verbal Learning Test-Revised: β=-0.06,p=.037), and (4) psychomotor speed (Digit Symbol Substitution Test: β=-0.10,p&lt;.0001), after covariate adjustment. Greater perceived physical fatigability was significantly associated with lower memory and cognitive function in older adults, and may represent a promising new biomarker of biological aging reflecting declining brain reserve, resilience, and neurodegeneration.