bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hearing Loss and Healthcare Satisfaction
Authors: Jilla Anna , Reed Nicholas 
Published: December 2020

Abstract
Patient satisfaction with care has become increasingly important since Medicare’s shift to value-based reimbursement models using the Hospital Care Quality Information from the Consumer Perspective survey. Effective communication plays an underappreciated role in satisfaction with care. Hearing loss impacts two-thirds of adults over 70 years and is a barrier to communication. Previous research has found that adults with hearing loss have poorer health outcomes and incur higher medical expenditures. The present study aims to explore the association of hearing loss on satisfaction with care. Nationally representative data from the 2015 Medicare Current Beneficiary Survey (MCBS) collected information on self-reported hearing with a hearing aid (no trouble, a little trouble, or a lot of trouble) and satisfaction with quality of health care (very satisfied/satisfied and dissatisfied/very dissatisfied) for all adult Medicare beneficiaries. A weighted sample of 48.6 million Medicare Beneficiaries was analyzed using logistic regression, adjusted for sex, race, educational attainment, income, general health, and functional limitations in instrumental activities of daily living. The adjusted model found that compared to adults with no hearing trouble, those with a little trouble hearing and a lot of trouble hearing had 1.47 times (95% CI: 1.06, 2.03) and 1.74 times higher odds (95% CI: 1.15, 2.62) higher odds of reporting dissatisfaction with care, respectively. Hearing loss, possibly mediated by its impact on communication, is associated with satisfaction with care. Given the emphasis placed on patient-reported satisfaction value-based reimbursement programs, hearing loss may represent a potential, low-risk/high-reward area of intervention to improve satisfaction.
The Association of Vision, Hearing, and Dual Sensory Impairments With Walking Speed and Incident Slow Walking
Authors: Shakarchi Ahmed , Varadaraj Varshini , Assi Lama , Reed Nicholas , Swenor Bonnielin 
Published: December 2020

Abstract
Vision (VI), hearing (HI) and dual sensory (DSI, concurrent VI and HI) impairments are increasing in prevalence as populations age. Walking speed is an established health indicator associated with adverse outcomes, including mortality. Using the population-based Health and Retirement Study, we analyzed the longitudinal relationship between sensory impairment and walking speed. In multivariable mixed-effects linear models, we found differences in baseline walking speed (m/s) by sensory impairment: Beta=-0.05 (95%CI=-0.07, -0.04), Beta=-0.02 (95%CI=--0.03, -0.003), and Beta=-0.07 (95%CI=--0.08, -0.05) for VI, HI and DSI, respectively, as compared to those without sensory impairment. However, similar annual declines (0.014 m/s) in walking speeds occurred in all groups. In time-to-event analyses, events were defined as “slow walking” (speed &lt;0.60m/s) and “very slow walking” (&lt;0.40m/s). Incident “slow walking” was 43% (95%CI=25%, 65%), 29% (95%CI=13%, 48%) and 35% (95%CI=13%, 61%) greater in VI, HI and DSI, respectively, than the no sensory impairment group, while incident “very slow walking” was 21% (95%CI=-4%, 54%), 30% (95%CI=3%, 63%) and 89% (95%CI=47%, 143%) greater; the increase was significantly greater in DSI than VI and HI. These results suggest that older adults with vision and hearing impairments walk slower and are at increased risk of slow walking than older adults without these sensory impairments. Additionally, older adults with DSI are at greatest risk of very slow walking.
Use of the New ICD-10 Vision Codes Among Medicare Beneficiaries With Stroke
Authors: Hreha Kimberly , Ottenbacher Kenneth , Ehrlich Joshua , Whitson Heather 
Published: December 2020

Abstract
Older adults can experience vision impairment following stroke in combination with pre-existing ophthalmologic disease. The new ICD-10 coding system for identifying vision related health conditions provides a much higher level of detail for coding these complex scenarios than the previous ICD-9 system. While this new coding system has advantages for clinical care and billing, the degree to which providers are utilizing the expanded code structure is unknown. The study objective was to describe the use of ICD-10 vision codes in a large cohort of stroke survivors. We used a retrospective cohort design to study national 100% Medicare claims files from 2015 through 2017. Data were analyzed using all available ICD-10 vision codes for beneficiaries who had an acute care stay because of a stroke and who also had an ICD-10 visual code recorded at least once in their claims chart. The cohort (n= 269,314) was mostly female (57.1%) with ischemic stroke (87.8%). Approximately 15% were coded as having one or more vision impairments. Unspecified glaucoma was the most frequently used code among men (2.83%), beneficiaries over 85+ (4.80%) and non-Hispanic blacks (4.12%). But multiple vision codes were used in few patients, overall (0.6%). Less than 3% of those in the oldest group (85+ years) had two vision codes noted in their claims. Despite more available codes, the coding used to describe the vision impairments in this population of stroke survivors was not specific or diverse. Hospital providers should pay attention to specificity in order to improve coding practices.
Design and Preliminary Evaluation of a Community-Based Brain Health Promotion and Wellness Program
Authors: Block Laura , Peck Megan , Gilmore-Bykovskyi Andrea 
Published: December 2020

Abstract
Recommendations for risk reduction of dementia and cognitive decline emphasize addressing modifiable risk factors including physical activity, cognitive stimulation, and socialization. However, existing resources and programs to promote brain health through multifaceted risk factor reduction are often costly, challenging to individualize, and limited in their delivery format, narrowing their accessibility among older adults. To address community identified needs for brain health promotion resources, we applied a user-centered design approach to develop, implement, and evaluate feasibility/acceptability of a community-based brain health promotion program: Strength & Resilience Brain Health and Wellness Program. Design requirements were specified through ongoing end-user feedback via structured and open-ended surveys, group dialogue, and facilitator memoing which informed needed iterative refinements of program components. The resultant program incorporates information about brain health/dementia prevention, physical exercise, and cognitively-stimulating activities targeting attention, focus, problem solving, and communication. Integrated across components are deliberate adaptations for physical/cognitive abilities and activities to facilitate group cohesion and reduce stigma. Across two 10-week offerings, we found the program to be feasible as demonstrated through high enrollment (N=44) and retention (75%). A quarter of participants self-disclosed a dementia diagnosis in baseline surveys. Participants rated program components as acceptable, and perceived positive influences on target risk factors particularly social isolation, sense of self-worth, and cognitive stimulation. The current study provides a platform for a feasible and scalable group, community-based brain health promotion program, and suggests participant-centered outcomes extend beyond cognitive domains. More rigorous evaluation of the program is needed to evaluate fidelity across components and standardized outcomes.
Gendered Association Between Employment Status and Unmet Health Care Needs Among Middle-Aged Koreans
Authors: Song Si Young , Jun Hey Jung , Joo Susanna , Lee Sun Ah 
Published: December 2020

Abstract
Previous studies show that working people are less likely to experience unmet health care needs than non-workers. Also, employment and health are located in gendered social contexts. The present study aims to examine the moderating effect of gender on the association between employment status and unmet health care needs among middle-aged Koreans. We conducted logistic regression using the Korean Health Panel data (in 2016 and 2017; N=2,573, age range=45-64). Having experiences unmet health care needs in 2017 was the binary dependent variable. Employment status in 2016 was the binary independent variable and gender was the moderating variable. Age, education level, marital status, annual income, household type, type of medical security, disability, self-rated health, the number of chronic diseases, and stress level in 2016 were also in the analytic model based on the Andersen’s health behavioral model. The percentages of middle-aged people experiencing unmet health care needs were 18% for working men, 11% for non-working men, 13% for working women, and 16% for non-working women. The result showed there was significant moderating effect of gender (B= .72, p&lt; .05). Specifically, working men were less likely to experience unmet health care needs than non-working men. On the contrary, there was not the significant difference in experiencing unmet health care needs between working and non-working women. It indicates that it is necessary to supplement medical services for especially for middle-aged men who are not employed because they might experience considerable amounts of unmet health care needs.
Impact of Oral Health on Quality of Life and Subjective Well-Being in Community-Dwelling Older Adults in Mexico
Authors: Díaz Irma , Mendoza- Ruvalcaba Neyda Ma , Arias Elva Dolores , Diaz Julio 
Published: December 2020

Abstract
Objective: Associate the impact of oral health with quality of life and subjective well-being in the community-dwelling older adults in Mexico. Methods: Non-random sample; 326 subjects: age collected (60-69 / ≥ 70); gender (male / female); marital status (couple / no partner); schooling (0-6 years / ≥7); income for basic needs (yes / no); no depression (GDS-15), no cognitive impairment (MMSE) and comorbidity (no disease / ≥ 1 disease) to control biases. Oral conditions; Caries index (ICPOD) WHO criteria: Very low-Low; Moderate and High. Need for dental prostheses (WHO Manual): No prostheses needed (27-28 natural teeth or fixed / removable / total combination; Need prosthesis: 2-28 tooth without replacement. Xerostomia (Thomson Inventory); moderate to severe xerostomia &gt; 17 points. Dependent variables: Quality of Life Related to Oral Health (GOHAI); 57-60 points: High perception. Subjective well-being: Moral Scale of the Geriatric Center of Philadelphia (PGCMS): Low score (0-11). Results: Age: 71.84 ± 7,278; female / male (70.9 / 29.1%). Controlling confounding factors, multiple logistic regression showed that the need for multi-unit or total prostheses; high CPOD index; severe xerostomia; and low perception of well-being subjective, were associated with low GOHAI scores: P = 0.000; P = 0.004; P = 0.003; P = 0.02 respectively. Subjective well-being only was associated with severe xerostomia and low CVRSO perception: P = 0.0 1; P = 0.02 respectively. Conclusion: Taking into account various confounding factors, the Quality of Life related to Oral Health was the most affected by the deterioration of oral health.
Dietary Quality Among Older Overweight or Obese Veterans With Dysmobility
Authors: Parker Elizabeth , Bergamo Lauren , Perez Will , Katzel Leslie , Ryan Alice , Prior Steven , Serra Monica , Addison Odessa 
Published: December 2020

Abstract
Older adults have unique dietary challenges due to a myriad of factors including age-related taste and smell changes and lack of nutrition knowledge that increase the risk for poor dietary quality. Healthier dietary quality is associated with higher muscle mass, strength and physical performance which may reduce the development of frailty and disability later in life; however, few studies have examined dietary quality among older Veterans with limited physical functioning. The purpose of this study was to examine overall dietary quality among older, overweight/obese veterans with dysmobility. Habitual dietary intake was assessed at baseline using three, nonconsecutive 24-hour recalls and used to calculate healthy eating index (HEI-2015; higher scores indicate higher diet quality). Twenty-eight participants were included in analysis: 93% male; 54% black; aged=69.5±7.0 years; BMI=35.5±5.4 kg/m2. Means and standard deviations were calculated for average intake of total daily energy (2184±645 kcals) and protein (0.89±0.3g/kg), daily servings of fruits (0.84±0.94) and vegetables (1.3±0.87), and HEI-2015 (52.8±13.4). Overall, 96% consumed fewer than the recommended 5 daily servings of fruits and vegetables and 68% consumed &lt;1.0g/kg/d of protein (1.0-1.3g/kg/d recommended for older adults). Mean HEI-2015 was below the US national average for adults &gt;65 years (2015-2016 NHANES 65+ years: 64.0), suggesting poor dietary quality among our sample. This pilot study suggests that dietary intake quality is suboptimal in older, obese Veterans with disability and highlights the need to identify strategies that improve dietary intake quality of older Veterans who may benefit from obesity and disability management.
Bidirectional Relationship Between Subjective Age and Fear of Falling: Findings From the NHATS
Authors: Li Yuxiao , Liu Minhui , Miyawaki Christina E , Hou Tianxue , Sun Xiaocao , Tang Siyuan , Szanton Sarah 
Published: December 2020

Abstract
Subjective age refers to how young or old people experience themselves to be. It is associated with health status, physical function, and mental processes that influence the occurrence of fear of falling, which is a severe problem in older adults. The present study aims to contribute to existing knowledge by examining the relationships between subjective age and fear of falling. Participants were community-dwelling adults aged 65 years and older drawn from the 2011 (T1) - 2015 (T5) waves of the National Health and Aging Trends Study. Subjective age was measured by asking, “What age do you feel most of the time?” Fear of falling was measured with the question: “In the last month, did you worry about falling down?” The analyses included 1,984 participants without fear of falling at baseline, on average, 74.9±6.6 years old, female (53%), and non-Hispanic whites (76%). Eighty percent of the participants felt younger, and 4% felt older than their chronological age, but 21% of them had a fear of falling. Participants who experienced fear of falling at T5 tended to be female, non-Hispanic whites, and live alone. Generalized estimating equations revealed that an “older” subjective age independently predicted fear of falling (OR, 95%CI= 1.02, 1.01-1.02) controlling for demographics and health conditions. Fear of falling predicted an “older” subjective age (OR, 95%CI= 3.38, 1.72-6.66) after adjustment. These findings indicated bidirectional relationships between subjective age and fear of falling. Subjective age may help identify individuals who are at risk for fear of falling in older adults.
Medication Prescribed Within 1 Year Preceding Fall-Related Injuries in Older Adults in Ontario, Canada
Authors: Ming Yu , Zecevic Aleksandra , Booth Richard , Hunter Susan , Johnson Andrew , Tirona Rommel 
Published: December 2020

Abstract
Background: The consequences of fall-related injuries are becoming more significant due to ageing societies worldwide. This study aims to provide information on medications prescribed to older adults within one year before they experienced fall-related injury in Ontario, Canada. Methods: A population-based descriptive study of older adults (66 years and older) who experienced fall-related injury was conducted using administrative secondary health care data of Ontario. The percentages of patients prescribed each Anatomical Therapeutic Chemical 4th level medication class and fall-risk increasing drugs one year before their fall-related injuries was summarized. Results: From 2010 to 2014, 288,251 older adults (63.2% females) were admitted to Emergency Department due to fall-related injury, 39.9% were fall-related fractures, 12.6% were head injuries. One year prior to their injury, 48.46% of older adults were prescribed with statins; 35.23% were prescribed with diuretics; 26.84% were prescribed with antidepressants; 25.90% were prescribed with opioids and 16.61% were prescribed with anxiolytics. A higher percentage of females were prescribed with diuretics, antidepressants, and anxiolytics than males. 85 years and older people had higher percentage of prescription of diuretics, antidepressants and antipsychotics than other age group. Discussion: In general, older adults diagnosed with fall-related injuries were prescribed with more opioids, benzodiazepines and antidepressants than other general older adults. There were distinct patterns of prescription medication within each sex and age group (66-74 group, 75-84 group and 85 years and older group). Further association between medications and fall-related injuries need to be established using well-defined cohort studies.
Food Insecurity Is Associated With Depressive Symptoms Among Brazilian Community Older Adults
Authors: Freiria Carolina , Silva Graziele , Hara Larissa , Fattori André , Borim Flavia , Brito Tábatta , Corona Ligiana 
Published: December 2020

Abstract
Food security can be defined as when the individual has access to food consumption in adequate quality and quantity, respecting aspects such as age, physiological condition and cultural habits. While international studies showed the association of Food Insecurity (FI) and many negative health outcomes, like depressive symptoms, less is known about food insecurity among older people in Brazil, especially about its association with health. The aim of this study is to analyze the relationship between FI and Depressive Symptoms (DS) among community older Brazilian adults. Were included in this study 493 community older people with 60+. Geriatric Depression Scale were used to measure DS and for assessment of FI was used the short version of the Brazilian Food Insecurity Scale, added with one question involving functional limitations to buy food. Logistic regression was used to estimate the odds ratio (OR) adjusted for covariates (e.g., sex, education, age and familiar income). The prevalence of FI were 42.4% and the prevalence of DS were 71.5% of population. The prevalence of DS was higher in the group with FI than among those without F (78.9% vs 65.8% respectively; p=0.001). In the adjusted regression analysis, the chance of presenting positive symptomatology for depression was 1.87 times higher among the older people with FI (CI 1.18 –2.91; p=0.007). The findings demonstrate high prevalence of FI and DS indicating the importance of FI screening among community-based older people in order to avoid possible negative health outcomes in this population, such as the development of depressive symptoms.
Training Medical Residents to Address Social Determinants of Health for Better Health Outcomes
Authors: Zell Angela , Ilardo Joan , Olomu Adesuwa , Meghea Cristian , Rayamajhi Supratik 
Published: December 2020

Abstract
Gaps exist in training medical residents to assess social determinants of health (SDOH) related to chronic conditions. To address the need for better screening, we partnered with two Internal Medicine (IM) residency programs based in Lansing and Flint (Michigan) to pilot the Caring for Patients with Chronic Conditions (CPCC) project. IM residencies train internists with expertise in diagnosis, treating chronic conditions, promoting health through wellness education, and preventing and managing diseases. CPCC incorporated information during didactic sessions that residents could apply during their clinical activities that can influence their current and future clinical practice patterns. Presentations and panels from local community organizations on specific topics were incorporated into the curriculum that address needs of patients age 50 and older. To build on this education, the residents adapted the Office- Guidelines Applied in Practice (Office-GAP) checklist to identify SDOH affecting a patient’s ability to managed chronic conditions. Using this tool: 1) involves resident training; 2) provides a decision support checklist; 3) influences patient activation; and 4) increases provider and patient communication through shared decision making. The checklist includes questions for patient response pertaining to SDOH that prevents them from managing their chronic conditions in addition to the level of action the patient is willing to do. Areas identified are discussed between patient and resident increasing patient activation. Referrals to community-based resources to identified SDOH needs are guided by the clinic’s care manager. The Office-GAP tool is administered during three subsequent visits to ensure that patients actually accessed the community resources.
The Impact of Cognitive Impairment on Resource Utilization During Medicare Home Health Care
Authors: Burgdorf Julia , Wolff Jennifer 
Published: December 2020

Abstract
Older adults with cognitive impairment have unique care needs that often lead to greater levels of health care utilization. Prior work suggests that older adults with cognitive impairment access home health care at higher rates; yet, recent Medicare home health payment system revisions exclude patient cognitive status when determining risk adjustment. This research examines the relationship between patient cognitive status and resource utilization during Medicare home health care. We examine 1,217 (weighted n=2,134,620) community-dwelling older adults who received Medicare-funded home health between 2011-2016, using linked nationally representative survey data from the National Health and Aging Trends Study (NHATS), home health patient assessment data, Medicare claims data, and Medicare Provider of Services files. We use weighted, multivariable negative binomial regressions to model the relationship between patient dementia status and the expected number of total visits and number of each visit type (nursing, therapy, and aide) during home health. Models adjusted for patient sociodemographic characteristics and health and functional status during home health, as well as home health provider characteristics. Among Medicare home health patients, the presence of cognitive impairment during home health is associated with 2.87 additional total visits (p&lt;0.001), 1.27 additional nursing visits (p&lt;0.01), and 1.23 additional therapy visits (p=0.04) during the home health episode. Findings suggest that recent revisions to the Medicare home health payment system may disincentivize home health care for older adults with dementia and/or financially penalize home health providers whose patient populations have a greater dementia burden.