bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOES PHYSICAL FUNCTION RESPONSE TO INTENTIONAL WEIGHT LOSS IN OLDER ADULTS VARY BY RACE-ETHNICITY?
Authors: Beavers Daniel P , Neiberg Rebecca , Beavers Kristen , Kitzman Dalane , Nicklas Barbara M , Messier Stephen , Rejeski Jack , Kritchevsky Stephen 
Published: November 2019

Abstract
The purpose of this study is to explore whether the effect of weight loss on physical function in older adults varies by race/ethnicity. Individual level data from 1369 older, (67.7±5.4 years), obese (BMI: 33.9±4.4 kg/m2), adults (30% male, 21% African American) who participated in eight randomized controlled trials of weight loss were pooled. Studies were 5-6 months in duration and collected baseline demographic and pre/post gait speed (n=1296), short physical performance battery (SPPB; n=866), and grip strength (n=401) data. Treatment effects were generated by weight loss assignment [weight loss (WL; n=764) versus non-weight loss (NWL; n=605)], as well as categorical amount of weight change (high loss: &gt;-7%, moderate loss: -7 to -3%, and weight gain/stability: &lt;-3%). Analyses were adjusted for age, sex/gender, study, education, baseline BMI, and baseline value of the outcome measure of interest. Race/ethnicity stratified results were presented if the interaction term was p≤0.10. A race/ethnicity*weight loss assignment interaction was observed for gait speed (p=0.07), with African Americans experiencing greater weight loss-associated improvement (WL: 0.07±0.01 m/s versus NWL: 0.02±0.01 m/s; p=0.03) compared to Whites (WL: 0.08±0.01 m/s versus NWL: 0.07±0.01 m/s). A race/ethnicity*weight loss amount interaction was also observed for gait speed (p&lt;0.01), with greater weight loss associated with greater improvement in both African Americans and Whites; although, gains were most apparent in African Americans experiencing high loss (0.12±0.02 m/s) compared to gain/stability (0.01±0.01 m/s). The beneficial effects of weight loss on gait speed appear greater in African Americans and are augmented with greater weight loss.
VALIDITY OF COMMUNITY-BASED FRAILTY CHECK-UP BY SENIOR VOLUNTEERS FOR PREDICTING ADVERSE HEALTH OUTCOMES
Authors: Tanaka Tomoki , Takahashi Kyo , Akishita Masahiro , Iijima Katsuya 
Published: November 2019

Abstract
Aim: For achieving healthy aging for all, multi-faceted frailty is serious problem in super-aged society such as Japan. We developed community-based frailty check-up program performed by trained senior volunteers. In this study, we aimed to validate the ability of the results of check-up to predict needing long-term support or care insurance or death in community-dwelling older population. Methods: A total of 1,536 older adults (mean age, 73.0±6.1 years; 74% women; non-eligible for long-term support or care) participated in the check-ups held from April, 2015 to March, 2018 in Kashiwa City, Japan. At check-ups cite, 21 items including nutrition, oral and physical functions, and social conditions were assessed; Outcome was needing long-term support or care insurance, or death from the day of check-ups until October, 2018. Results: During follow-up {median 678 days (inter-quartile range, 199-1263)}, 116 (7.6%) were newly needing for long-term support (n=50) or care (n=49), or death (n=18). The number of positive responses among 21 items was associated with decreased risks of outcome {age-sex adjusted hazard ratio (95% confidence interval), 0.87 (0.81-0.92)}. Compared those with &gt; 18 positive responses (third tertile), individuals with &lt; 14 positive responses (first tertile) were highly increased risks of outcome {age-sex adjusted hazard ratio (95% confidence interval), 2.44 (1.22-4.49)}. Conclusions: Community-based frailty check-ups program could predict the needing long-term support or care insurance or death in community-dwelling older population. The appropriate intervention for individuals with bad results of the check-up might contribute to serving as early prevention of multi-faceted frailty.
HAS FRAILTY SCORE AND FRAILTY LETHALITY CHANGED OVER TIME? HARMONIZATION OF NHANES COHORTS FROM 1999 TO 2016
Authors: Blodgett Joanna M , Rockwood Kenneth , Theou Olga 
Published: November 2019

Abstract
Positive advances in life expectancy, healthcare access and medical technology have been accompanied by an increased prevalence of chronic diseases and substantial population ageing. How this impacts changes in both frailty level and subsequent mortality in recent decades are not well understood. We aimed to investigate how these factors changed over an 18-year period. Nine waves of the National Health and Nutrition Examination Survey (1999-2016) were harmonized to create a 46-item frailty index (FI) using self-reported and laboratory-based health deficits. Individuals aged 20+ were included in analyses (n=44086). Mortality was ascertained in December 2015. Weighted multilevel models estimated the effect of cohort on FI score in 10-year age-stratified groups. Cox proportional hazard models estimated if two or four-year mortality risk of frailty changed across the 1999-2012 cohorts. Mean FI score was 0.11±0.10. In the five older age groups (&gt;40 years), later cohorts had higher frailty levels than did earlier cohorts. For example, in people aged 80+, each subsequent cohort had an estimated 0.007 (95%CI: 0.005, 0.009) higher FI score. However, in those aged 20-29, later cohorts had lower frailty [β=-0.0009 (-0.0013, -0.0005)]. Hazard ratios and cohort-frailty interactions indicated that there was no change in two or four-year lethality of FI score over time (i.e. two-year mortality: HR of 1.069 (1.055, 1.084) in 1999-2000 vs 1.061 (1.044, 1.077) in 2011-2012). Higher frailty levels in the most recent years in middle and older aged adults combined with unchanged frailty lethality suggests that the degree of frailty may continue to increase.
RACIAL AND ETHNIC DIFFERENCES BETWEEN GRIP STRENGTH AND FUNCTIONAL LIMITATIONS: RESULTS FROM NHATS 2010-2014
Authors: Vasquez Elizabeth , Quiñones Ana R , Gensburg Lenore 
Published: November 2019

Abstract
Current research regarding grip strength highlights the robustness of grip strength as a predictor of morbidity and mortality. The aim of this study was to evaluate the association of grip strength over four years with functional limitations among racially/ethnically diverse older adults. We analyzed National Health and Aging Trends Study (NHATS) data 2010-2014. Our sample included 4,413 adults &gt; 65 years old. Functional limitation was defined as a sum of difficulty performing eight ADL/IADLs (range 0-8) at each wave. Grip strength was measured using a digital hand dynamometer and readings were recorded in kilograms (kg) (maximum of 32 kg for men and &gt; 20 kg for women). We estimated stratified linear regression models by race/ethnicity and age, and adjusted for BMI, education, and gender. The majority of the sample was between 65-79 years of age (64%), 55.1% were female and the average BMI was 27.5. We found that differences in ADL/IADL limitations increased and grip strength decreased over the four year period of observation. We also found racial/ethnic differences between waves 1 and 4 with greater ADL/IADL limitations for Hispanics with lower grip strength scores compared to non-Hispanic whites. There were racial/ethnic differences in the association between grip strength and ADL/IADL over time in Non-Hispanic blacks and Hispanics when compared to Non-Hispanic whites. This is an important issue to address since loss of muscle strength in older adults may lead to several negative outcomes such as limited activities of daily living which may affect older adults differentially based on race/ethnicity.
UNDERSTANDING AGING AND FRAILTY WITH A PREDICTIVE NETWORK MODEL
Authors: Farrell Spencer , Mitnitski Arnold , Rockwood Kenneth , Rutenberg Andrew 
Published: November 2019

Abstract
Health deficits are age-related binary health issues (typically self-reported disabilities) that accumulate with age. Acquiring a deficit makes an individual more frail and susceptible to other associated deficits. We model this process as a network of health deficits that interact with each other. Mortality depends on an individual’s current deficits and their age. The model is trained with self-reported data from the Canadian Study of Health and Aging (CSHA) or the National Health and Nutrition Examination Survey (NHANES). The model generates longitudinally data for synthetic-individuals with frailty trajectories and mortality resembling the observed data. We verify this by comparing the prevalence of individual deficits, correlations between deficits, and predicted death ages with test data. Our trained model performs well on all of these measures. Our model informs our understanding of aging by providing an interaction network representing the associations between pairs of deficits. Our model can generate the frailty trajectories of individuals starting from a set of deficits at a given age. This can extrapolate the trajectories of observed individuals to older ages and enables “inducing” or “treating” deficits to understand the effects of individual deficits or sets of deficits on health.
RELATIONSHIP OF PREOPERATIVE COMPREHENSIVE GERIATRIC ASSESSMENT TO HEALTH STATUS IN OLDER ADULTS
Authors: Lee Ji Yeon , Kim Kwang Joon , Kim Chang Oh , Lee Kyung Hee 
Published: November 2019

Abstract
Although comprehensive geriatric assessment has been widely used in surgical older adults, its relationship to health status has not been fully identified. This study aimed to examine the relationships of preoperative comprehensive geriatric assessment to frailty and length of stay. This was a descriptive study based on multi-professional health assessments found in electronic medical records. Study participants were 150 older adults in a neurosurgical department. The comprehensive geriatric assessment was comprised of nutrition, functional status, physical activity, depression, cognition, and basic items such as the Timed Up and Go test, grip strength, and self-rated health. Frailty level and length of stay were dependent variables which represented health status. The result showed that instrumental activities of daily living, physical activity, nutrition, self-rated health, and cognition were significantly associated with frailty. Specifically, comparing robustness with pre-frail and frail level, worseness in the instrumental activities of daily living, self-rated health, physical activity, and nutrition were associated with frailty. With progression of frailty level from pre-frail to frail, the worse score in the cognitive function and self-rated health were associated with frailty. In addition, more depressive symptoms, postoperative complications, and prolonged in the Timed Up and Go test were associated with lengthened hospital stay. Older adults with worsened status in physical, emotional, or cognitive function tended to be frail and stay longer in the hospital. Clinicians need to pay attention to the subcomponents of the comprehensive geriatric assessment and are encouraged to implement it to improve health status of surgical older adults.
COMPARATIVE PERFORMANCE OF FOUR CLAIMS-BASED FRAILTY MEASURES IN THE UNITED STATES MEDICARE DATA
Authors: Kim Dae H , Patorno Elisabetta , Pawar Ajinkya , Lee Hemin , Schneeweiss Sebastian , Glynn Robert 
Published: November 2019

Abstract
Background: There has been increasing effort to measure frailty in the United States Medicare data. The performance of claims-based frailty measures has not been compared. Methods: This retrospective cohort study included 2,326 community-dwelling Medicare beneficiaries who participated in the 2008 assessment of the Health and Retirement Study. The claims-based frailty measures developed by Davidoff, Faurot, Segal, and Kim were compared against clinical measures of frailty (gait speed, grip strength) using correlation coefficients and health outcomes (e.g., mortality, hospitalization, activities-of-daily-living disabilities) over 2 years using C-statistics. Results: The Davidoff, Faurot, Segal, and Kim indices were negatively correlated with gait speed (-0.19, -0.33, -0.37, and -0.37, respectively), but age and sex adjustment variably attenuated the correlation to -0.17, -0.22, -0.18, and -0.33, respectively. The corresponding correlation coefficients with grip strength were -0.17, -0.27, -0.35, and -0.24, which attenuated to -0.09, -0.14, -0.05, and -0.23 after age and sex adjustment, respectively. The models that included age, sex, and each of Davidoff, Faurot, Segal, and Kim indices showed C-statistics of 0.67, 0.71, 0.71, 0.75 for mortality (versus C-statistic for age and sex: 0.66); 0.59, 0.64, 0.63, 0.70 for hospitalization (versus C-statistic for age and sex: 0.58); and 0.64, 0.63, 0.63, 0.70 for activities-of-daily-living disabilities (versus C-statistic for age and sex: 0.61), respectively. Conclusions: The choice of a claims-based frailty measure results in a meaningful variation in the identification of frail older adults at high risk for adverse health outcomes. Claims-based frailty measures that included demographic variables offer limited risk adjustment beyond age and sex.
OPTIMAL HEALTH PROFESSIONAL STAFFING OF PRIMARY CARE AND GERIATRIC PRACTICES SERVING FRAIL OLDER ADULTS
Authors: Donelan Karen , Spetz Joanne 
Published: November 2019

Abstract
This symposium will include 3 papers that provide critical interprofessional and interdisciplinary perspectives on our work to understand and measure staffing in health care teams caring for older adults, and frail older adults. The Health Teams for Frail Elders project was funded by the Gordon and Betty Moore Foundation from August 2016 to October 2018. Dr. Karen Donelan, project Principal Investigator, will chair the session, providing a brief project overview of project aims and activities. A survey and health services researcher, Dr. Donelan will set the context for this large scale project. Dr. Barbara Roberge, a geriatric nurse practitioner who established one of the first senior health programs in the nation along with Dr. Kenneth Minaker at Mass General Hospital, was our primary care and nursing lead on our site visits. She will talk about the care settings we visited, her development of a site assessment tool that covered a range of frail elder needs, and will summarize professional roles and staffing observed within different site types. Dr. Julie Berrett-Abebe, a junior investigator on our team (PhD 2017), will present a paper on the competencies and roles of social workers and community health workers in primary and geriatric practices, as well as the roles of community health workers. Dr. David Auerbach, a national expert in health policy and workforce analysis, will present 4 models of staffing of practices, demonstrating efficiencies in optimizing services for frail elders while minimizing costs.Dr. Joanne Spetz will be the discussant of cross-cutting themes.
INFLUENCING FACTORS OF SUBJECTIVE AGE: FINDINGS FROM THE KUSATSU LONGITUDINAL STUDY ON AGING AND HEALTH
Authors: Ikeuchi Tomoko , Seino Satoshi , Taniguchi Yu , Narita Miki , Abe Takumi , Amano Hidenori , Kitamura Akihiko , Shinkai Shoji 
Published: November 2019

Abstract
Background: Subjective age (SA) has been found to be a biopsychosocial marker of aging, yet little is known about factors that influence SA development. This study examined factors influencing SA using longitudinal data of community-dwelling older Japanese. Methods: Data drawn from the Kusatsu Longitudinal Study were collected during annual health check-ups in 2017 and 2018 from participants (aged 65-95) who completed all the measurement items used for this analysis (N=981). SA was indexed by asking participants to specify in years how old they felt. Proportional discrepancy scores ((subjective age - chronological age)/chronological age ×100) were calculated to indicate younger or older SAs and used as a dependent variable. As influencing factors of SA, chronological age, sex, years of schooling, history of smoking, cognitive function (using MMSE scores, range 14-30 at baseline), depressive symptoms, physical function (gait speed), and social function (employment status) were examined. Analyses were performed with random-effects GLS regression models. Results: Significant partial regression coefficients were found for cognitive function (0.48%, CI: 0.18, 0.79), years of schooling (-0.42%, CI: -0.69, -0.15), depressive symptoms (0.32%, CI: 0.11, 0.53), and chronological age (-0.18%, CI: -0.30, -0.68). Implications: This study found that older age and longer years of schooling were associated with younger SA, while better cognition and depressive symptoms were linked to older SA. Better cognition being associated with older SA was inconsistent with existing studies. This may be due in part to the association of better cognition and the level of satisfaction influenced by awareness of age-related physical/social changes.
EVACUATING OR SHELTERING IN PLACE DURING A DISASTER: HOW ASSISTED LIVING ADMINISTRATORS MAKE THE DECISION
Authors: Peterson Lindsay J , Hyer Kathryn , Dosa David , June Joseph , Dobbs Debra J , Thomas Kali S 
Published: November 2019

Abstract
The decision to evacuate or shelter in place during a natural disaster such as a hurricane is complicated and poses risks to long-term care residents. While research has documented the difficulty of the evacuation decision for nursing home administrators, little is known about how assisted living residence (ALR) administrators make this decision. This is a concern given the physical and cognitive impairment level of many ALR residents, the increasing number of ALRs in the U.S., and the frequency of natural disasters. The purpose of this paper was to explore the factors that influenced whether assisted living administrators evacuated their ALRs for Hurricane Irma, a large hurricane that made landfall on Florida’s Southwest coast in September, 2017. This qualitative study used semi-structured interviews and focus groups with ALR owners or administrative staff (N=60) with questions including how they prepared for Hurricane Irma, their experiences during the hurricane, including whether they evacuated or sheltered in place, and lessons learned. The sample includes small (&lt; 25 beds) and large ALRs in the multiple Florida counties affected by the hurricane. A content analysis approach was used. Atlas.ti version 7 was used for initial and axial coding. Prevalent themes included “emergency management planning”, “logistics”, “pressure”, “storm characteristics,” and “staffing”. The results of this study have implications for long-term care policy and training, potentially leading to changes in how ALR leaders prepare for and respond to disasters to improve the safety of residents.
A QUALITATIVE STUDY OF NURSING HOME STAFF CONCEPTUALIZATION OF EVERYDAY DECISION-MAKING CAPACITY
Authors: Mills Whitney L , Kunik Mark E , Kiefer Lea , Curren-Vo Hannah , Mochel Amy , Naik Aanand 
Published: November 2019

Abstract
Because nursing homes are both a residence and a treatment setting, care providers are faced with the challenge of balancing resident autonomy and safety on a daily basis. While there are standardized approaches for determining a capacity to make larger decisions such as providing consent for medical procedures, there are virtually no methods for assessing capacity to make everyday decisions (e.g., food choices, smoking, navigating outside the nursing home). While it is easier for staff to prevent residents from making decisions they deem risky, to truly offer person-centered care, it is important to support a resident’s right to make decisions if they have the capacity to do so. Currently, little is known about how nursing home staff conceptualize and determine everyday decision-making capacity and how that information is used in care planning. To understand the current processes and language nursing home staff use when considering a resident’s decision-making capacity, we conducted interviews with 37 staff at two Veterans Affairs (VA) Community Living Centers (VA-operated nursing homes; CLCs). Using qualitative content analysis, we coded the transcribed interviews and identified several overarching themes: autonomy vs. safety, communication (e.g., pathways, with caregivers, with residents), determining capacity (e.g., information gathering, assessment, assumptions, indicators, interdisciplinary team member roles, referrals), interventions (e.g., legal and staff-led), and terminology used. We will describe how the findings from this study can be used to tailor development and adaptation of tools to help nursing home staff assess resident everyday decision-making capacity and to incorporate the results into person-centered care approaches.
ORGANIZATIONAL CHARACTERISTICS OF HIGHLY PERSON-CENTERED UNITS IN SWEDISH NURSING HOME
Authors: Sköldunger Anders B , Backman Annica 
Published: November 2019

Abstract
The movement from an institutional model of care towards a person-centred care as the gold standard of practice is now guiding the provision of care services in nursing homes around the world. The organizational context of care has been described as a determining factor for the extent to which staff can offer person-centred care. However, few studies have empirically investigated which factors that defines nursing home units as being person-centred. Providing information about organizational characteristics would therefor provide insight into an organizational context with capacity to enhance a person-centred care. Thus, the aim was to explore factors of nursing homes with high vs. low person-centred care with focus on organizational variables. The study was based on a cross-sectional national survey, and data on 4831 residents, 3605 staff, and facility variables were collected in 2014. Descriptive statistics and regression modelling were used to analyze the data. The preliminary results showed that characteristics of highly person-centred units were; dementia specific units and units with fewer number of beds. No significant differences were seen between private and public nursing homes in terms of degree of person-centred care. Person-centred units was characterized by managers supporting staff to provide individualized care based on the resident’s needs, as well as staff receiving supervision of a reg. nurse in the direct care. These findings can be seen as facilitators ’ for person-centred care, suggesting several contextual and organizational elements of significance for enhancing person-centred practice.