bluuebunny/crossref_metadata_2025_split huggingface dataset:
DEVELOPMENT OF AN OPIOID EDUCATION RESOURCE FOR OLDER CANCER PATIENTS
Authors: Manna Ruth , Moryl Natalie , Gangai Natalie , Malhotra Vivek , Wang Jennifer , Korc-Grodzicki Beatriz 
Published: November 2019

Abstract
Pain is a common problem in older cancer patients, estimated to affect 70% of those with advanced disease. As older adults live longer after diagnosis, the use and misuse of opioids will continue to rise. Gaps in available age-friendly opioid resources for patients were identified at a Comprehensive Cancer Center. An interprofessional team worked to develop a resource to educate older cancer patients and their caregivers regarding safe opioid use. Expert clinical opinions from Supportive Care, Anesthesia Pain, Nursing, and Geriatrics Services as well as patient observations informed drafts of the resource. A total of 22 older patients in three geriatric clinics were approached for a short interview (8 open questions) surrounding opioid understanding and concerns. The most stated concerns were fear of addiction, concern about the opioid epidemic, and potential unwanted side effects. There was an evident lack of awareness of what an opioid was or which one of the medications in their list was an opioid. The interviews underscored the need for the education resource to include names of opioids, address concerns about the opioid epidemic and signs of addiction. Language was added to describe safe use, storage and disposal of opioids. Special considerations in the older adult were emphasized. Links to additional information were provided. Finally, patient education experts reviewed the draft to adapt the language to be patient-friendly. Opioids are often effectively used in cancer pain management and older cancer patients warrant proper education. Patient perspectives are critical in the development of relevant patient education resources.
ADVANCING PROGRAM REACH BY TAKING TRAINING ONLINE
Authors: DeMott Andrew , Hughes Susan , Spencer-Brown Lesha 
Published: November 2019

Abstract
The National Recreation and Park Association (NRPA) is one of four national organizations to receive funding from CDC to disseminate arthritis-appropriate evidence-based interventions (AAEBIs). NRPA has partnered with Fit & Strong!, a CDC-approved AAEBI and National Council on Aging falls prevention program, to disseminate through local park and recreation agencies across the country. To meet the needs of this dissemination effort, Fit & Strong! adapted its in-person instructor training into an online curriculum which became available March 2018. After initial pilot-testing, Fit & Strong! created a five-module training curriculum using Moodle teaching software. The training curriculum uses slides, graphics, videos, and interactive questions to assess mastery. After completing the training, fidelity checks are performed on all instructors by having them video record a class session and share it with the Fit & Strong! team for review. After evaluating the videos, the team meets with the instructors by phone to debrief and advise on any needed improvements. Through this partnership, Fit & Strong! trained an initial cohort of 39 instructors across 18 states within a month’s time. Training evaluation results have been positive. To date, over 900 participants have been reached. A second cohort of approximately 40 new instructors will be trained in Spring 2019. This presentation will review the processes of creating and executing the online training, potential cost and time-saving benefits to CBOs, instructor feedback, and the ease with which instructors can complete the training and offer the program anywhere across the country.
STRENGTHENING A COMMUNITY HEALTHY AGING EDUCATION PROGRAM THROUGH CBO PARTNERSHIPS AND RCQI
Authors: Graupner Jeffrey P , Molony Jason , Kelemen Leah , Ding Kedong , Thompson Katherine 
Published: November 2019

Abstract
The SHARE Network (Supporting Healthy Aging Resources & Education) is a Geriatrics Workforce Enhancement Program serving older adults in a large urban, underserved community. For 4 years, one objective of the SHARE Network has been to increase health literacy while fostering positive change in older adults through “Healthy Aging” presentations. Led by geriatrics subject experts, these presentations cover a wide range of important health topics for older adults at a variety of community-based organization (CBO) partner locations. Rapid Cycle Quality Improvement (RCQI) efforts to enhance this programming include surveying audience members after a presentation, then sharing results with CBO partners at monthly meetings to review popular topics, participant demographics, quality of presentations, suggestions for improvement, etc. These recurring RCQI meetings have proven critical to maintaining a robust healthy aging curriculum and network engagement across a variety of organizations and interests. Analysis of participant survey data demonstrates the strength of QI efforts and includes a qualitative analysis of open-ended responses. To date, 153 presentations have been held with 2,704 attendees and 1,470 respondents, 86.3% of whom planned to make a health change after attending the presentation. Qualitative analysis of these behavior change plans reveals that 82.6% are proactive behaviors versus restrictive behaviors, and that diet, exercise, and lifestyle changes are most common. This program, and its RCQI approach, serves as a successful model for aligning the educational objectives and priorities of network partners, while ensuring relevancy and cultural competency in promoting positive healthy behaviors in the older adult community.
IMPROVING THE PERSONAL CARE ASSISTANT WORKFORCE THROUGH TRAINING, DATA, AND TECHNOLOGY
Authors: Abujarad Fuad , Swierenga Sarah J , Luz Clare , Hanson Katherine , Curtin Chris , Luo Zhehui , Swanson-Aprill Lauren A 
Published: November 2019

Abstract
Ensuring a quality personal care aide (PCA) workforce is critical to meeting the needs of an aging population. The Integrated Model for Personal Assistant Research and Training (IMPART) program is a PCA training and advocacy model designed to increase the number of qualified PCAs. A core component is an evidence-based, comprehensive PCA training program, Building Training…Building QualityTM (BTBQTM), supported by a robust data platform. This online system was designed to register, train and certify PCAs and Trainers, maintain a qualified PCA workforce database, and enhance the capacity to track IMPART process, performance, and impact measures. This innovative system was developed using a User-Centered Design approach, which includes four main user interfaces: Administrator, PCA, Trainer, and Public. It automates central administration functions, tracking, and reporting of training events, and standardizes and consolidates all training activities on a scalable and usable web-based technology platform. User acceptance testing of the tool and a usability evaluation with representative PCAs and trainers has been completed. Over 50 PCAs have completed BTBQTM modules and 22 new trainers have completed a new BTBQTM Trainer Certificate program during the tool development phase. The PCAs are already reporting substantially higher wages. Launching the new web-based data platform in April 2019 will make it possible for these programs to scale up for wide distribution. As more PCAs and trainers graduate, the number of qualified PCAs will increase exponentially. The data collected with this technology can inform responsible fiscal and policy decisions about resource allocation to support a stronger PCA workforce.
END-OF-LIFE SERVICES IN TRIBAL COMMUNITIES
Authors: Jervis Lori L , Cox Derrell W 
Published: November 2019

Abstract
Terminally ill American Indians/Alaska Natives (AI/ANs) are less likely to receive hospice and palliative care than other racial/ethnic groups, with fewer than 1/3 receiving these services compared to over 45% of EuroAmericans (Johnson, 2013; NHPCO, 2017). While some AI/ANs believe that End of Life (EoL) services will hasten their deaths (Colclough & Brown, 2014), claims that Natives reject EoL services due to death taboos are likely overgeneralizations. Rather, extant studies point to barriers to access resulting from lack of financial resources and inadequate service infrastructure, especially in rural areas (Jervis, Jackson, & Manson, 2002; Kitzes & Berger, 2004; Kitzes & Domer, 2004; Weech-Maldonado et al., 2003). While these factors undoubtedly play a role in underutilization, our preliminary research suggests that other factors—such as a lack of tribally based EoL programs and the cultural mismatches that occur when non-Native programs attempt to deliver hospice services to Native clients—may discourage AIANs from seeking and/or retaining these services. In this presentation, we report on results from a nationwide telephone survey of the availability of EoL care across AIAN tribes. We also present findings from in-depth interviews with local service providers on the challenges and successes they experienced in providing EoL care to their AI clients in one tribal community. Together, these findings will add to our growing understanding of the factors that inhibit and facilitate EoL service utilization, and suggest possibilities for improving access.
STRENGTHENING OLDER INDIGENOUS NEW ZEALANDERS AT END OF LIFE: WHAT ROLE DO HEALTH SERVICES PLAY?
Authors: Moeke-Maxwell Tess H , Mason Kathleen R , Gott Merryn 
Published: November 2019

Abstract
Older indigenous people and their families draw on specific tribal care customs to support end-of-life care as these help to fortify and strengthen older people. New Zealand’s health and palliative care services can either help or hinder families to utilise their care customs. The aim of the Pae Herenga study was to investigate the specific traditional care customs employed by older New Zealand Māori. This involved 60 face-to-face interviews with participants who had a life limiting illness (majority aged over 65), family carers, indigenous healers, spiritual practitioners, and health and palliative care professionals across four key geographical sites. Three digital story workshops involving 16 participants were also included. The study findings show that no matter what the older person’s illness was, their cultural customs and protocols helped to fortify them and kept them spiritually safe at end-of-life. Hospitals and hospices helped families to action their customs by providing rooms large enough to host gatherings of thirty or more people; prayers, songs, speechmaking and communal sharing of food took place. However, incidences of racism, a lack of space, and a lack of support for indigenous plant medicines prevented the use of ancient traditional end-of-life care customs for older people. The findings suggest that health and palliative care services can help older indigenous people maintain their spiritual strength by providing them with culturally supportive care and environments equipped to host the dying and their families.
PREVALENCE AND CORRELATES OF SYMPTOMS OF ANXIETY AND DEPRESSION AT THE VERY END OF LIFE
Authors: Kozlov Elissa K , Phongtankuel Veerawat , Reid Cary 
Published: November 2019

Abstract
Rates of psychological symptoms for patients with serious illness is high, but there has been limited research investigating psychological symptoms at the very end of life. The aim of this study was to better understand the prevalence, intensity and correlates of psychological distress at the very end of life. This cross-sectional study utilized caregiver proxy interviews. Caregivers were contacted after their loved one recently died after being on home hospice and invited to participate in a brief interview with a trained research assistant. Patient, caregiver and hospice utilization data were also abstracted from electronic medical records. N = 351 caregivers were included in the study. According to caregivers, 46.4% of patients had moderate to severe anxiety, as assessed with a score of ≥4 on the Edmonton Symptom Assessment Scale (ESAS) and 43% had moderate to severe symptoms of depression in the last week of life. Symptoms of anxiety and depression were significantly associated with caregiver burden scores and inversely associated with the age of the patient. Psychological symptom management at the very end of life is essential to providing comprehensive hospice care. Our study revealed that nearly half of patients die with moderate to severe symptoms of anxiety and/or depression. Future research is needed to improve psychological symptom management at the very end of life in order to improve the quality of life for both patients and their families.
THE PERSISTENCE OF TRADITIONAL VALUES: GRANDPARENTS REARING GRANDCHILDREN
Authors: Edwards Anne B , Henderson Tammy L , Niemeyer Crystal , Stanley Jessica L 
Published: November 2019

Abstract
The goal of this study is to examine how cultural values are preserved and transmitted by grandparents rearing grandchildren in one community in the southeast region of the Yukon-Koyukuk Census Area in Alaska. The eight participants (six females and two males) lived in a community in the Kusilvak Census Area, with ages ranging from 47 to 73 years old. Participants’ took part in a semi-structured interview, which were then transcribed and coded into larger themes of 1) loss of traditional values, 2) continuing traditional values, 3) practicing traditional values, and 4) transmitting traditional values. The participants provided examples of how the cultural values that were strong at one point in their lives, were no longer exemplified in their community, and, in fact, behaviors that went against accepted values were seen. Participants spoke most often of how community members were cared for, how the community was valued over the individual, and the connections within families. The GRGs practiced those traditional values by caring, supporting, and loving the people in their families and communities, and by practicing humor and sharing with others. While this community has been influenced by modern ways of living currently found in the United States and Canada, it still remains relatively isolated from the technological and social influences that dominate what is considered “typical, modern” family life. The findings from this study illustrate the important roles that GRGs play in the persistence of cultural values, and the importance of incorporating these values in programs to assist this community.
CARE DEPENDENCY IN OLD AGE IN MEXICO: SITUATIONAL ANALYSIS, IMPLICATIONS, AND RECOMMENDATIONS
Authors: López-Ortega Mariana , Gutiérrez Robledo Luis Miguel F 
Published: November 2019

Abstract
The demographic transition, population aging, and the epidemiological transition in Mexico have modified the burden of the disease profile, and impose important economic, social, and health care challenges, particularly old-age and disability-related care dependency. We describe old age health and dependency conditions, and analyze the supply of services to dependent population, including aging and disability norms and policies, the role of the government and the private sector (profit & non-profit) in the provision of related services. Based on the analysis, it is clear that public strategies for care dependency are practically non-existent and that policies aimed at these populations focus on guaranteeing access to basic health services, an economic income, and social integration. Also, there are no support strategies for family caregivers who currently carry most of the care work. Care dependency strategies to support those who need them as well as those who currently provide them are urgently needed.
PATIENTS’ PAIN AND THEIR SPOUSAL CAREGIVERS’ NEGATIVE AFFECT: THE MODERATING ROLE OF SELF-EFFICACY
Authors: Nah Suyoung , Martire Lynn , Marini Christina 
Published: November 2019

Abstract
Spousal caregivers of chronic pain patients may experience high levels of negative affect, perhaps in part because they regularly witness patients’ suffering. Yet, few studies have examined the relation between patients’ chronic pain and spousal caregivers’ negative affect. According to social cognitive theory, individuals’ self-efficacy may modulate how much negative affect they experience in response to stressful situations. The purpose of this study was to test the hypothesis that spousal caregivers would report higher levels of negative affect on days when patients experienced higher levels of knee pain. We also tested the hypothesis that patients’ and spouses’ self-efficacy for managing pain would each buffer this positive association. A total of 144 knee osteoarthritis (OA) patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel models indicated that patients’ self-efficacy, but not spouses’ self-efficacy, moderated the positive association between patients’ pain and their spouses’ negative affect, even after controlling for spouses’ gender, age, and depressive symptoms. That is, spouses reported higher levels of negative affect on days when patients experienced more pain, but only among patients whose self-efficacy for managing pain was low. These findings suggest that patients’ self-efficacy for managing pain may serve as a protective factor for their spousal caregivers’ daily negative affect. Interventions targeting patients’ self-efficacy for managing pain may be beneficial for couples coping with knee OA.
LONG-TERM OUTCOMES OF THE BENEFIT-FINDING GROUP INTERVENTION FOR ALZHEIMER’S FAMILY CAREGIVERS: A DOUBLE-BLIND RCT
Authors: Cheng Sheung-Tak 
Published: November 2019

Abstract
This study examines the long-term effects of benefit-finding on caregivers’ depressive symptoms (primary outcome), and global burden, role overload, and psychological well-being (secondary outcomes). 96 Hong Kong Chinese caregivers of relatives with Alzheimer’s disease were randomly assigned to receive the benefit-finding intervention (BFT) or one of two control conditions, namely, simplified psychoeducation (lectures only; SIM-PE) or standard psychoeducation (STD-PE). Caregivers received four biweekly one-to-one interventions of three hours each at their own homes. Participants and raters were blind to experimental assignment. We focused on outcomes measured at 4- and 10-month follow-ups. The trajectories of intervention effects were modeled by BFT x time and BFT x time2 interaction terms. Mixed-effects regression showed significant BFT x time2 interaction effects on depressive symptoms against both control conditions, suggesting diminishing BFT effects over time. Z tests showed that, compared with controls, BFT participants reported substantial reductions in depressive symptoms at 4-month follow-up (d = -0.85 and -0.75 vs. SIM-PE and STD-PE respectively). At 10-month follow-up, BFT was indistinguishable from STD-PE whereas a moderate effect was observed in the comparison with SIM-PE (d = -0.52). In addition, some inconsistent effects on role overload were observed but no effect was found for the other outcome variables. It is concluded that benefit-finding is an efficacious intervention for depressive symptoms in Alzheimer caregivers, with strong effects in the medium-term post-intervention and possible moderate effects in the long-term.
THE MODERATING EFFECT OF RAISING ONE’S GRANDCHILDREN ON THE RELATION BETWEEN SLEEP AND DEPRESSION
Authors: Stearns Melanie , Nadorff Danielle K 
Published: November 2019

Abstract
Recent evidence has shown that poor quality sleep is associated with depression, particularly among older individuals (Bao et al., 2017; Nadorff, Fiske, Sperry, & Petts, 2012). Moreover, given the high prevalence of depressive symptoms among older adults, it is important to identify possible risk factors of poor sleep quality. One possible risk factor is being a custodial grandparent (raising one’s grandchildren), as increased caregiving responsivities are associated with increased depressive symptoms (Brand-Winterstein, Edelstein, & Bachner, 2018). Based upon these previous findings, the current study examines the effect of custodial status on the relation between sleep quality and depressive symptoms. The sample (N = 466) was a subset of individuals recruited in the second wave of the MIDUS biomarkers project completed in 2009 who answered the sleep, caregiving, and depressive symptoms variables of interest. Measures included the Center for Epidemiological Studies Depression Scale (CESD), the Pittsburgh Sleep Quality Index (PSQI), and a question regarding custodial grandparent status. The current study aimed to examine whether poor sleep quality might serve as a risk factor for experiencing depressive symptoms and how custodial grandparents might differ from other older adults. Moderation analyses were conducted using SPSS’ Process macro on the sample. The interaction between global sleep quality and custodial grandparent status was significant in predicting depressive symptoms, t (1, 465) = 3.90, p = .04, such that custodial grandparents reported a stronger positive correlation between greater global sleep problems and depressive symptoms than non-custodial grandparents. Implications, future directions, and limitations are discussed.
IMPROVING SUPPORT FOR CAREGIVERS OF SERIOUSLY ILL OLDER VETERANS: STEPS TOWARD LAY NAVIGATION
Authors: Boucher Nathan A 
Published: November 2019

Abstract
This session will discuss mid-stage findings from a five-year, federally-funded study to develop lay navigation supporting informal caregivers, often family/friends, of older Veterans with advanced stage illness. Caregivers of Veterans report numerous burdens in their caregiver role related to food, clothing, shelter, utilities, and transportation. Current programs focus on Veterans’ needs rather than caregivers’ needs. Few programs focus on practical needs that can be met with VA and community-based supports. Lay navigator programs may be used to support caregivers’ social/practical needs. Lay navigation is used with patient populations, but models focused on caregivers do not readily exist. Dr. Boucher will discuss establishment of and input from the study’s Stakeholder Advisory Board and data from sample of caregiver and Veteran interviews informing a lay navigation training curriculum and pilot intervention. Feedback from audience members will be encouraged in this session exploring quality improvements in caregiver support applicable to multiple health systems.