bluuebunny/crossref_metadata_2025_split huggingface dataset:
Back Pain and Heart Failure in Older Adults: Findings From the Health ABC Study
Authors: Chen Jie , Zhang Yiming , Simonsick Eleanor , Starkweather Angela , Chen Ming-Hui , McCauley Paula , Maas Kendra , Cong Xiaomei 
Published: December 2020

Abstract
Both back pain and heart failure (HF) have negative influence on all aspects of life. Little is known about the impact of back pain on older adults with HF. We include 1295 older adults who had data collected in the 11th year (2007-2008) of the Health, Aging and Body Composition (Health ABC) study to evaluate the effect of back pain on health status among older adults with and without HF. The participants aged 79-91, 54.8% were female and 34.8% were African American. Among 94 participants with HF, 63 (67.0%) had back pain; among 1201 participants without HF, 649 (54.0%) had back pain. Females reporting back pain had 4.76 (95% CI: 1.83, 12.37) times the odds of having HF compared to those without back pain. Male with back pain, compared to those without back pain, had 1.14 times (95% CI: 0.65, 2.02) the odds of having HF. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CES-D) scale. Performance and functions were measured by the Established Populations for Epidemiologic Studies in the Elderly (EPESE) performance score, the Health ABC performance battery score and self-reported difficulty with functional tasks. These symptom and performance measures were significantly associated with both back pain and HF, but not the interaction terms of back pain and HF after adjusting demographic variables including gender, race, smoking status and BMI category. The high incidence and negative impact of back pain highlighted the needs of developing strategies in pain management among older adults with and without HF.
A Wasteful and Harmful Practice: Sliding Scale Insulin Use Among Nursing Home Veterans
Authors: Lam Kenneth , Gan Siqi , Jing Bocheng , Nguyen Brian , Lee Sei 
Published: December 2020

Abstract
The American Medical Directors Association and the American Diabetes Association discourage the use of sliding scale insulin (SSI) in nursing home residents with diabetes due to its association with hypoglycemia, hyperglycemia, nursing burden, and patient discomfort. However, prevalence of SSI use is unclear. We used Veterans Affairs (VA) data from October 2013 to September 2016 to determine the weekly prevalence of SSI among 22,847 veterans with diabetes admitted to VA nursing homes (NHs). Average age was 75.3 (SD 8.3) years, mean A1c was 7.3% (SD 1.6%) and 57% were admitted from hospital. We first identified residents receiving any short-acting insulin. We then classified short-acting insulin use into three mutually exclusive regimens: (1) fixed scheduled doses, (2) SSI, defined as a variable dose of short-acting insulin without a concurrent fixed dose or (3) bolus with correction (BWC), defined as a variable dose given concurrently with a fixed dose that day. During the first week of NH admission, 64.7% of residents with diabetes received no short-acting insulin, 7.4% received fixed scheduled doses, 6.3% received BWC and 21.4% were on SSI. At week 12, the prevalence of fixed dose and BWC regimens was unchanged from baseline (fixed dose = 8.4%; BWC = 7.0%). In contrast, the prevalence of SSI decreased weekly to 15.8% (p for linear trend &lt; 0.0001). Although SSI prevalence decreased from week 1 to week 12, 51% of residents on short-acting insulin were still using SSI in their 12th week of their NH stay.
Nurse Practitioners’ Experiences of Polypharmacy in Community-Dwelling Older Adults
Authors: Pariseault Christine , Sharts-Hopko Nancy , Blunt Elizabeth 
Published: December 2020

Abstract
Numerous studies exist that define polypharmacy and its impact on health. Additionally, the literature is rich in studies documenting the benefits of care provided by nurse practitioners. A gap in research exists at the intersection of the value of nurse practitioners in caring for older adults and their management of polypharmacy. Coinciding with a growth of America’s older adult population and the need for adequate care, the purpose of this study was to explore the experiences of nurse practitioners caring for older adults experiencing polypharmacy. A qualitative descriptive study was conducted using a purposive sampling of nurse practitioners who care for older adults. Interviews were conducted and data was analyzed for themes. Four themes emerged: defining polypharmacy, communicating and collaborating, clinical judgement of nurse practitioners in relation to polypharmacy, and medication issues of older adults. Major themes emerged that depict the complexity of medication management in older adults as well as the important role of NPs in providing care to older adults. The significance of the study findings to future practice includes improving communication and collaboration of prescribing health care providers, better identification and management of polypharmacy, and improving the health care delivered to older adults. Safe and effective prescribing for older adults requires NPs consider the unique needs of each older adult while utilizing technology to support collaboration and decision making.
Nurse Staffing and Nursing Home Deficiency of Care for Inappropriate Psychotropics Use in Residents With Dementia
Authors: Yoon Jung Min , Trinkoff Alison , Storr Carla , Galik Elizabeth 
Published: December 2020

Abstract
Psychotropics use to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs) has been the focus of policy attention due to their adverse effects. We hypothesized that NHs with lower nursing staffing would have greater reliance on psychotropics use to control BPSD. A NH deficiency of care can be cited for inappropriate psychotropics use (F-tag 758). The association between the occurrence of F-758 tags and nurse staffing in residents with dementia was examined using the 2017-18 Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs). Staffing measures included nursing hours per resident day (HPRD) and registered nurse (RN) skill-mix. Generalized linear mixed models that included covariates (NH location, bed size, ownership, proportion of residents with dementia/depression/psychiatric disorders and with Medicare/Medicaid) estimated the magnitude of the associations. There were 1,872 NHs with F-758 tags indicating inappropriate psychotropics use for NH residents with dementia. NHs with greater RN and certified nurse assistant (CNA) HPRD had significantly lower odds of F-758 tags (OR=0.59 54, 95% CI=0.47 44-0.73 66; OR=0.87, 95% CI=0.77-0.99, respectively) and similar findings were found in NHs with greater RN skill-mix (OR=0.14 10, 95% CI=0.05 04-0.37 25). There were no significant associations between the occurrence of F-758 tags and licensed practice nurse and unlicensed nurse aide HPRD. This study found that RN and CNA staffing had inverse associations with inappropriate psychotropic use citations among residents with dementia. NHs with higher RN staffing ratios may be better able to implement alternatives to pharmacological approaches for BPSD. It is suggested that NHs be equipped with adequate nurse staffing levels to reduce unnecessary psychotropics use.
The Invisible Epidemic: A Spotlight on the Opioid Crisis Among Older Adults
Authors: Hsieh Jessica , McDonald Lynn , Shnall Adriana , Mirza Raza , Sinha Samir , Austen Andrea , Watts Laura Tamblyn , Klinger Christopher 
Published: December 2020

Abstract
Canada is facing an opioid crisis, with more than 3,900 related deaths occurring in 2017. Almost 30% of those deaths were among seniors; older adults also have the highest rates of opioid hospitalization and poisoning. Despite these statistics, little is known about the specifics. A comprehensive scoping review following Arksey and O’Malley’s (2005) framework was conducted to establish the magnitude of the problem, describe treatment approaches alongside prevention, and identify implications for practice, policy and research. Eight major electronic databases in medicine and the social sciences were searched alongside the grey literature, and a stakeholder consultation convened to validate results. A total of 6,814 articles, reports and thesis were identified. Forty-five sources met inclusion criteria, the majority stemming from the United States. Most were literature reviews, cohort and cross-sectional studies, with almost half also taking a gendered approach. Four predominant themes emerged from the thematic content analysis: 1) Medical Applications of Opioids; 2) Problematic Opioid Use; 3) Treatment and Prevention Strategies; and 4) Recommendations. Data highlighted ‘the invisible epidemic’, with treatment strategies to be specifically tailored to this population in light of metabolic differences and drug interactions as part of aging. Seniors are part of the current epidemic, with tailored approaches needed to ensure adequate, evidence-based counteraction – including seniors’ voices alongside further research in this regard. Education and training for prescribers needs to be enhanced alongside cross-jurisdictional drug monitoring programs to avoid drug interactions and misuse/fraud.
Long Life Family Study Shows Reduced Coronary Artery Disease Despite High Polygenic Hazard Scores
Authors: Feitosa Mary , Kuipers Allison , Wojczynski Mary , Wang Lihua , Perls Thomas , Christensen Kaare , Zmuda Joseph , Province Michael 
Published: December 2020

Abstract
Polygenic hazard scores (PHS) for coronary artery disease (CAD) quantify individuals with age-specific genetic risk for CAD. We evaluated how well the PHS predict age at onset of CAD in the Long Life Family Study (LLFS; families selected for exceptional longevity), compared to the Family Heart Study (FamHS; random families and high CAD-risk families). LLFS contains 4572 European ancestry (EA) individuals from 581 families (age: 74.0 ± 14.3, range: 22-110 years). FamHS Random has 1806 EA individuals from 454 families (age: 56.2 ± 13.5, range: 22-91 years), while FamHS High CAD-risk has 2301 EA individuals from 553 families (age: 53.2 ± 12.8, range: 21-93 years). We generated the PHS from 176 published SNPs from GWAS for CAD (p&lt; 5.0 x 10-8, r2&lt; 0.2). In each of the extremes of the CAD PHS distributions (75%), Kaplan-Meier method showed that the LLFS presented significant delayed age at onset of CAD compared to FamHS (random and High CAD-risk: P&lt;0.0001). A Cox proportional hazards regression model accounting for CAD age at onset, using family bootstrap (N= 1000) to correct for family relatedness, replicated these results. For example, in the top-25% CAD-PHS when comparing to FamHS high-risk, the LLFS CAD hazards ratio was 0.127 (95% CI: 0.099, 0.164). Our findings suggest that, while PHS captured some of the risk of CAD in LLFS, part of the predisposition remains to be determined. Other relevant factors, including additional genetic discoveries and lifestyle-environment influences are needed to fully determine CAD risk in extreme samples.
The Decreased Complexity of Blood Pressure Dynamics Is Associated With Higher White Matter Lesions in Older Adults
Authors: Jiang Xin , Gao Xia , Zhang Hui , Deng Wuhong , Fu Wen , Manor Brad , Lipsitz Lewis , Zhou Junhong 
Published: December 2020

Abstract
White matter lesions (WML) are highly prevalent in older adults and thought to represent cerebral microvascular disease, contributing to slow gait and dementia. Hypertension is associated with WML. However, the underlying mechanism of this association is unclear. The complex beat-to-beat BP fluctuations represent the influence of BP regulatory mechanisms over multiple time scales. The association between WML and abnormalities in BP regulation may be manifest as a loss of complexity in BP dynamics. The aim of this study is thus to explore the relationships between hypertension, BP complexity, and WML in older adults. Twenty-two older adults with hypertension (SBP&gt;140 mmHg) and 19 age-matched older adults without hypertension (i.e., control) completed this study. Their whole-brain WML were assessed by two neurologists using the Fazekas Scale. Greater score reflects higher WML grade. Each participant completed a 10-minute BP assessment when sitting quietly following the MRI. The continuous SBP and DBP series were recorded, and the complexity of them was quantified using multiscale entropy (MSE). Lower MSE reflects lower complexity. Compared to the controls, hypertensives had significantly greater Fazekas scores (i.e., higher WML grade) (F=4.8, p=0.02) and lower complexity of SBP and DBP (F&gt;3.7, p&lt;0.01), after adjusting for age. Across two cohorts, those with lower SBP and DBP complexity had higher Fazekas score (r&lt;-0.51, p&lt;0.01), and this association was independent of age and group. These results suggest that WML are associated with a loss of complexity in BP dynamics. Future longitudinal studies are needed to examine the causal relationship between WML and BP.
A Conceptual Framework for Engaged Communication at Adult Day Services: A Mixed-Methods Study
Authors: Mamo Sara , Wheeler Kara , Perry Olivia 
Published: December 2020

Abstract
Adult Day Services provide an opportunity for social engagement for older adults who might otherwise become isolated. Communication environments at many Adult Day Centers can be difficult for participants due to the high prevalence of hearing loss and poor acoustics in large activity rooms. The purpose of this study is to understand the hearing and social health status of participants across multiple group care settings as well as participants’ challenges and motivations to engage in social communication. A mixed methods approach was undertaken. Seventy-two participants from two Programs for All-inclusive Care for the Elderly (PACE®) completed quantitative measures: hearing test, cognitive screener (MOST™), IOM Social and Behavioral Determinants of Health, UCLA Loneliness Scale, and Instrumental Activities of Daily Living. Using maximum variation sampling based on hearing status and UCLA loneliness scores, ten participants were invited to complete one-on-one semi-structure interviews. Interviews aimed to learn more about how and why participants did and/or did not engage in social communication with other PACE participants. Transcripts were coded and thematic analysis was used to identify common barriers and motivations to communication. A conceptual framework was developed by integrating quantitative and qualitative findings to recognize what contributes to meaningful interactions or engaged communication. The findings from this study will contribute to the development of an intervention to address hearing loss and support communication for older adults in group care settings. In order to maximize the potential benefit of attending group-based day services, the communication barriers and motivations of older adults need to be addressed.
Hearing Loss Health Literacy Discrepancy Between Younger and Older Adults
Authors: Squires Erika , Ou Hua 
Published: December 2020

Abstract
Increasing the accessibility and affordability of hearing healthcare is a public health concern. Because low health literacy is a significant barrier to the use of existing effective healthcare services, it is critical to assess and understand health literacy deficits specific to hearing loss before implementing interventions. The purpose of this cross-sectional study was to identify differences in hearing loss health literacy among older and young adults, which is warranted because older adults are at-risk for lower levels of health literacy compared to their younger counterparts. Adults across the lifespan (n = 170) completed the Hearing Loss Health Literacy Assessment Tool, which includes self-rated ability to access/obtain, understand, and appraise hearing health information, as well as apply information to manage life with hearing loss. Results from an independent samples t-test indicated that older adults (M = 6.3, SD = 1.45, n = 54) self-reported significantly higher overall hearing health literacy than younger adults (M = 5.37, SD = 1.27, n = 116), t(168) = 4.22, p &lt; 0.0001. Participants rated their ability to access/obtain information significantly lower than the other subscales. Age-differences in self-rated hearing health literacy exist. Findings from this study receive support from evidence indicating that the readability and suitability of the majority of patient education materials on hearing loss are not appropriate for the average U.S. adult. This investigation provides further evidence that the availability and accessibility of patient education materials on hearing loss is an important barrier that contributes to the limited use of hearing health care.
Understanding Medical Students’ Knowledge of Opioid Use Disorder: A Preliminary Study
Authors: Tewary Sweta , Kidron Ariel , Pandya Naushira , Howell Jim , Florent-Caree Marie , Ishmael Annisah , Cherner Rebecca 
Published: December 2020

Abstract
The rise of the opioid epidemic over the last two decades has increased the mortality rate, healthcare cost, and drug overdose deaths across the country. Practicing physicians are lacking in education regarding non-opioid alternatives to pain management, prevention, diagnosis, and treatment of opioid use disorder (OUD). Existing literature suggest a link between knowledge discrepancy and opioid use among clinicians resulting in patient’s abuse of opioids. Therefore, it is important to educate medical students at the start of their career. This preliminary study assesses the current knowledge and perceived skills of medical students regarding (OUD)/opioid misuse and related content in order to identify gaps and provide necessary education. The study used a pre-post survey method to understand the demographics, medical, and clinical knowledge about opioid use, abuse, and clinical knowledge regarding patient opioid overdose. The self-administered survey was administered to all students 18 years or older, M1- M4 enrolled in NSU-KPCOM. A total of 1164 students met these criteria. However, only 137 students participated in the Pre-survey collected from August 2019 to September 2019. Approximately 12% of the eligible students participated in the pre-survey. Data was analyzed using frequencies and percentages. Results of the pre-survey suggest a progressive increase in opioid knowledge from M1 to M4 years. Results of the study suggest investigating a relationship between medical education and knowledge of opioid usage, with a specific lens aimed at assessing the efficacy of opioid education during second and third years of medical school
Evidence for the Effectiveness of Health and Social Services Partnerships
Authors: Wilson Traci , Kunkel Suzanne , Brewster Amanda , Straker Jane , Blair Elizabeth , Scala-Foley Marisa 
Published: December 2020

Abstract
Integration of health and social services is touted as a key method to address social needs and improve population health. We will share the latest evidence on how Area Agency on Aging (AAA) partnerships with health care entities and other organizations improve health outcomes for older adults, while reducing health care costs. AAAs are community leaders in cross-sectoral partnerships that effectively address social determinants of health for older adults, who account for a substantial share of overall health care spending. Results of a longitudinal study (2008 – 2016) which links data from four waves of the National Surveys of AAAs to data on county-level health outcomes show that AAA–health care partnerships and programs reduced health care utilization and costs. AAA partnerships with hospitals reduced Medicare spending by $136 per beneficiary. AAA involvement in evidence-based health promotion programs decreased potentially avoidable nursing home use by nearly one percentage point (representing a change of 6.5%). Finally, we will describe the prevalence and nature of contracting relationships between community-based organizations and health care entities, based on data from the 2020 CBOs and Health Care Contracting Request for Information, the third national RFI of AAAs, Centers for Independent Living, and other aging and disability community-based organizations.
What Accounts for Physical and Emotional Health? Influence of Health, Personality, and Health Activation
Authors: Kim Joseph , Cone Nicholas , Arieli Rotem , Martin Peter 
Published: December 2020

Abstract
The purpose of this study was to identify associations among health personality, health activation, and emotional and physical health, and to identify direct and indirect effects. Participants in the study consisted of 3907 older adults, 65 years of age and older. Measures used in the analyses were the Health Personality Assessment, the Consumer Health Activation Index, and The Veterans RAND 12-Item Health Survey. Structural equation modeling with bootstrap sampling estimation was conducted to examine direct and indirect effects. The measurement model, X2(307)=2142.34, CFI=0.96, RMSEA=0.04, and structural model, X2(313)=2167.36, CFI=0.96, RMSEA=0.04 yielded an acceptable fit. Significant direct paths were observed between health personality factors and health activation, and in turn health activation to emotional and physical health. The results indicate that older adults with lower levels of Health Neuroticism, lower Health Openness, higher Health Agreeableness, and higher Health Conscientiousness had higher levels of health activation. In addition, older adults with higher levels of health activation had higher emotional and physical health. Also, direct paths from health personality to emotional and physical health were observed. Lastly, significant indirect effects were health activation had a significant positive indirect effect on physical health through Health Agreeableness. Health activation had a significant negative indirect effect on emotional health through Health Neuroticism and Health Openness. The implication of this study is that health activation has a significant role in the emotional and physical health of older adults through health personality dispositions. In addition, health personality factors directly influence the emotional and physical health of older adults.
Disability During the Last Years of Life Among Nonagenarians: The Vitality 90+ Study 2001-2014
Authors: Enroth Linda , Soo Pheck Hwa , Nosraty Lily , Tiainen Kristina , Raitanen Jani , Jylhä Marja , Aaltonen Mari 
Published: December 2020

Abstract
Increasing life expectancy has postponed the last years of life to older ages. Previous studies have demonstrated that disability is determined by age, age at death and closeness to death but only few have focused on oldest old population. We examined disability during the last years of life among people aged 90 years and older between 2001 and 2014 and assessed whether it varied by age at death, sex and study year. We used population-based survey data from the Vitality 90+ Study years 2001, 2003, 2007, 2010 and 2014 (N=5711, response rate 77-86%) linked with dates of death from Statistics Finland. Disability was defined as dependency in daily activities (dressing, getting in and out of bed) and mobility (moving indoors, walking 400m, using stairs). We analyzed disability stratified by closeness to death and age at death for men and women in each study year with logistic regression method. Disability in daily activities and mobility increased systematically with closeness to death (&gt;4, 3-3.99, 2-2.99, 1-1.99 and 1&gt; years to death) for both sexes in each study year. Also higher age at death (90-91 vs. 94+ years) was associated with disability. These associations remained consistent throughout the study period. This study shows that in the oldest old population both closeness to death and age at death determine the level of disability. We suggest that the complex and resource-draining care needs at the end of life will increase with growing number of people living their last years of life in very old age.