bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health equity impacts of COVID-19 policies on dementia-relevant community services: A SGBA+ policy scan
Authors: Aubrecht Katie , Burke Rosanne , Gahagan Jacqueline , Dowling Laura , Hande Christine Kelly Mary Jean , Hardie Susan , Keefe Janice 
Published: December 2020

Abstract
This presentation shares the methodology and early findings from a policy scan conducted to understand and assess the impact of COVID-19 policies on dementia care in the community for diverse populations in the province of Nova Scotia, Canada. The scan provided baseline information on: 1) Provincial legislative and regulatory policies related to dementia care in the community; 2) Orders and legislation enacted in response to COVID-19 that potentially impact those policies. Information was obtained from publicly accessible databases and government websites. Searches were also conducted using Google. 135 Acts were collected and reviewed. A specific aim of the scan was to generate knowledge about the impact of these layered policies in the context of a public health crisis from the perspective of local socially and geographically marginalized communities. A Sex and Gender Based Analysis Plus analytical approach was used to assess potential health equity impacts of COVID-19 policies on dementia care in the community. Information was organized using an adapted Health Equity Impact Assessment tool and Systems Health Equity Lens. Strengths and limitations of the approach and tools are discussed.
Air Travel Concerns and Complaints of Persons Living With Dementia and Their Travel Companions
Authors: Peterson Colleen , Statz Tamara , Barsel Sara , Birkeland Robyn , Gaugler Joseph , Finlay Jessica 
Published: December 2020

Abstract
Air travel is increasingly accessible and rising numbers of older adults choose to fly. The prevalence of Alzheimer’s disease and related dementias (ADRD) is also expected to increase due to advances in longevity and the aging Baby Boomer population. An ADRD diagnosis does not necessarily end the desire to travel for leisure, and air travel may be necessary for family and/or care reasons. Taken together, more persons living with ADRD are expected to use air travel. This is concerning since adverse outcomes, including confusion and delirium, can be exacerbated by unfamiliar environments, such as airports and in-flight situations. Yet there is little research on air travel with this population. The current study seeks to 1) understand air travel experiences, issues, and needs of persons living with ADRD and their travel companions; and 2) identify facilitators and barriers to safe and comfortable air travel for persons living with ADRD. Persons living with ADRD (n=49)and ADRD travel companions (n=176) provided information on their air travel experiences through a nationally distributed web-survey. They traveled for family visits (80.0%) and leisure (38.0%). Both persons living with ADRD and travel companions indicated anxiety (50% and 60.7%, respectively), difficulty understanding announcements and signage (39.1%, 55.2%) and getting lost or separated (37.5%, 53.2%) as primary travel concerns. Qualitative comments identified themes of frustration with locating family restrooms and quiet spaces. Results from this study will inform ongoing efforts to develop dementia-friendly airports and improve older adult travel experiences, independence, and quality of life.
Spatial Cluster Analysis of Fatal Road Accidents From Non-Use of Seat Belts Among Older Drivers
Authors: Adeyemi Oluwaseun , Paul Rajib , Arif Ahmed 
Published: December 2020

Abstract
Identifying county-level spatial clusters of fatal accidents due to non-use of seatbelt among drivers 65 years and older can help with injury prevention policies and targeted place-based interventions. We estimated the odds and identified hotspots of fatal accidents among drivers 65 years and older (n=57,715) based on a cross-sectional analysis of data from 2010 to 2018 from the Fatality Analysis Reporting System. The outcome variable was fatality status (fatal/non-fatal), and the main independent variable was seatbelt use (not used/used). Other covariates were drunk driving, distracted driving, and speeding while age, gender, and airbag deployment were used as confounders. Rural-urban status of accident location was used as an effect modifier. Odds ratios were calculated from logistic regression. The age-adjusted fatality rate was computed as the crude fatality rate per 100,000 population weighted by the average population composition by age-groups. Spatial autocorrelation was assessed by local Moran’s I, and cluster analysis was performed using the Moran’s I index-derived Z-scores. The median age-adjusted seatbelt-related fatality rate per county was 2.35 per 100,000 population (IQR: 5.60). Not wearing a seatbelt was associated with an 11-fold (Adjusted OR: 11.37; 95% CI: 10.18-12.70) increased odds of a fatal event in metropolitan counties and a 7-fold (Adjusted OR: 7.43; 95% CI: 6.10-9.04) increased odds in rural counties and small towns. Hot spots for seatbelt-related fatal road accidents were found in multiple counties in Texas, South Dakota, and Mississippi. Study findings can be used for county-specific interventions tailored to 65 and older for preventing fatal road accidents.
Effect of Osteoarthritis on Prefrontal Cortical Activation Patterns During Downward Reaching in Older Women
Authors: Hernandez Manuel , Hu Yang , Bishnoi Alka 
Published: December 2020

Abstract
Downward reaching may lead to falls in older adults, but the underlying mechanisms are poorly understood, particularly in older women with osteoarthritis. Given the importance of attentional resources when maintaining balance in balance-demanding conditions, functional near-infrared spectroscopy may provide a lens to the attentional resource allocation needed to maintain balance while reaching down to the ground with or without full contact with the floor. We examined the changes in the executive control of downward reaching movements in older women with osteoarthritis. We hypothesized that prefrontal cortical activation would be higher in older women with osteoarthritis, compared to age-matched controls, particularly as the balance demands increased. Older women with osteoarthritis (n=7, mean±SD age: 66±3 years) and age-matched controls (n=10, mean±SD age: 67±6 years) were recruited from the local community. The effect of the base of support and target position (toe or maximal forward distance along ground) on attentional resources in older women with osteoarthritis were evaluated using the average oxygenated hemoglobin levels as a measure of prefrontal cortical (PFC) activation. Significant base of support by cohort and target by cohort interactions were observed on average PFC activation levels (P&lt;0.005). As expected, PFC activation levels increased as the contact with the floor decreased and as the target distance increased, but older women with osteoarthritis were unable to increase their PFC activation levels as much as age-matched controls. In conclusion, these data suggest that older women with osteoarthritis may not be adequately modulating attentional resources to meet high-balance demanding tasks.
A Prospective Study of Frailty and 30-Day Functional Outcomes of Hospitalized Older Adults With Pneumonia
Authors: Park Chan Mi , Kim Wonsock , Kim Jong Hun , Kim Dae 
Published: December 2020

Abstract
Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. A prospective cohort study was conducted to investigate the clinical and functional outcomes of pneumonia in older adults with different levels of frailty. Between November 2019 and March 2020, we enrolled 92 adults who were 65 years or older and hospitalized for pneumonia at an academic medical center in Seoul, Korea. A deficit-accumulation frailty index (FI) was calculated using 50 items from comprehensive geriatric assessment (range: 0-1; higher values indicate greater frailty). The ability to perform 21 daily activities and physical tasks prior to the illness and after 30 days was self-reported. Primary outcome was death or functional decline from prior level at 30 days. The study cohort had a mean age of 79.4 (standard deviation [SD], 7.11) years, 38 (41.3%) women, and 20 (21.7%) nursing home residents. The mean FI was 0.29 (SD, 0.19), with 27 (29.4%) robust (FI&lt;0.15), 21 (22.8%) pre-frail (FI, 0.15-0.24), 19 (20.7%) mild-to-moderately frail (FI, 0.25-0.44), and 25 (27.2%) severely frail (FI≥0.45) categories. Among 71 patients without maximum disability at baseline, 8 (11.3%) died and 39 (54.9%) experienced functional decline. The 30-day risk of primary outcome for increasing frailty categories were 47.8%, 57.9%, 77.8%, and 81.8%, respectively (p-for-trend=0.022). Our results indicate that pneumonia is a major disabling illness in older adults with frailty. A proactive geriatric evaluation and multidisciplinary intervention are needed to improve functional recovery in these patients.
Delayed Hospital Discharge–The Effect of Dementia and GP Contacts Prior to Hospitalization
Authors: Aaltonen Mari , El Adam Shiraz , Sakamoto Mariko , Martin-Matthews Anne , McGrail Kimberlyn 
Published: December 2020

Abstract
Delayed hospital discharge, also known as alternate level of care (ALC) in Canada, refers to a stay in hospital when acute services are no longer needed but the patient occupies a hospital bed while waiting to be discharged to an appropriate care setting. ALC has negative consequences for both the service system (high costs, inappropriate use of hospital resources) and individuals (feelings of uncertainty, functional loss). Extensive administrative health care data from British Columbia, Canada, were employed to study differences in ALC between people with and without dementia in 2001/02, 2005/06, 2010/11 and 2015/16, and whether continuity in physician–patient relationships prior to hospitalization is associated with ALC. We analyzed designation of ALC and length of stay in ALC, using generalized estimating equations logistic regression and negative binomial regression analysis. Of all individual, residential area and health care related factors, dementia was the single most important factor increasing the odds of designation of ALC (OR 4.76, 95%CI 4.59, 4.93). Dementia also added to the length of stay in ALC. Proportion of patients designated to ALC increased over the study years. Higher number of visits to the same general practitioner (GP) prior to hospitalization decreased the odds of ALC, especially in people with dementia. As populations age, the number of people with dementia is increasing. Efforts to control ALC have resulted in greater concentration of ALC among people with dementia. Higher continuity GP care may be a way to help understand and control these trends.
Electronic Health Record Data Can be Used at the Bedside to Identify Older Hospitalized Patients With Delirium
Authors: Khan Ariba , Heslin Kayla , Simpson Michelle , Malone Michael 
Published: December 2020

Abstract
Delirium is a serious condition that is often underrecognized. Several delirium predictive rules can assist in early detection. The coupling of prediction rules with features of the EHR are in their infancy but hold potential. This study aimed to determine variables within the EHR that can be used to identify older hospitalized patients with delirium. This is a prospective study among patients &gt;=65 years admitted to the hospital. Researchers screened daily for delirium using the 3-D CAM. Predictive variables were extracted from the EHR. Basic descriptive statistics were conducted. Chi-squared and Fischer’s exact tests were used to compare differences among those diagnosed with or without delirium as appropriate; binary logistic regression was used for multivariate modeling. Among 408 participants, mean age was 75 years, 61% were female, and 83% were black. The overall rate of delirium was 16.7% (prevalent delirium 10.5%; incident delirium 6.1%). There was no statistical difference in 30-day mortality (2.9% vs. 2.7%) or 30-day readmission (13.2% vs. 14.7%) rates between those with and without delirium (both P&gt;0.05). Even so, patients with delirium were older, more likely to have a diagnosis of infection and/or cognitive impairment, as well as increased severity of illness (all P’s &lt;0.05). Moreover, patients with delirium had a lower Braden score and higher Morse fall score (both P’s &lt;0.01). In multivariate analysis, cognitive impairment (OR 5.49; 95% CI 2.77-10.87) and lower Braden scores (OR 1.29; 95% CI 1.18-1.41) remained significant predictors of delirium. Further research is needed to develop an automated EHR prediction model.
Genome-Wide Linkage Analysis Identifies a Novel Locus for Grip Strength: The Long Life Family Study
Authors: Santanasto Adam , Wojczynski Mary , Cvejkus Ryan , Thygarajan Bharat , Christensen Kaare , Zmuda Joseph 
Published: December 2020

Abstract
Grip strength declines with aging, is an indicator of overall health, and predicts mortality among older adults. Herein, we quantified the genetic contributions to grip strength among 4534 individuals, belonging to 574 families in the Long Life Family Study (age 70.3 ± 15.7, range 24–110 years; 56% women). Grip strength was measured using a handheld dynamometer, and the maximum value of two trials in the stronger hand was used. Quantitative trait linkage analysis was completed using pedigree-based maximum-likelihood methods with logarithm of the odds (LOD) scores &gt;3.0 indicating genome-wide significance. Linkage analysis in the top 10% of families contributing to LOD scores was also performed to allow for heterogeneity among families (HLOD). All analyses were adjusted for age, sex, height and field center. Grip strength was lower per one year of older age (β: -0.34 ± 0.01kg, p &lt;0.01), and overall: 24.3% of men and 19.3% of women had “low” grip strength according to European Working Group on Sarcopenia definitions. Grip strength was highly heritable (h2 = 0.37, p&lt;0.05). We identified a potentially novel locus for grip strength on chromosome 18p (LOD 3.18) with 26 families contributing to this linkage peak (HLOD = 10.94). Deep sequencing of the chromosome 18 region may yield fundamental insight on the biology of muscle weakness with aging, and may help identify novel therapeutic targets for treatment and prevention of this common condition.
Family Caregivers’ Self-Efficacy and Its Relations to Well-Being: Gender and Age Differences
Authors: Chang Yu-Ping , Seo Young , Von Visger Tania 
Published: December 2020

Abstract
Family caregivers of older adults perceive their roles as beneficial as well as burdensome. They also report physical and psychological symptoms affecting their well-being. Research indicates that caregiver self-efficacy leads to positive outcomes such as decreased caregiver burden and stress. However, it is unclear how self-efficacy is related to their well-being, and how this association might differ by age and gender. We aim to explore the relationships between family caregiver self-efficacy and well-being, and determine if age or gender moderates these relationships. We analyzed responses of 2,652 family caregivers (68% female and 32% male; mean age= 61.2) from the National Study of Caregiving (NSOC) III (2017) cross-sectional survey. We used three composite variables measuring self-efficacy: feeling confident, adjusting changes, and recovering quickly. We used five composite variables measuring well-being: pain, sleep problems, positive and negative affects, and depression/anxiety. We conducted a design-based weighted logistic regression analysis to examine the relationships among variables of interest. Results indicated that low self-efficacy was associated with increased pain, sleep problems, positive and negative affects, controlling for caregivers’ age, sex, and race/ethnicity. Examination of interactions indicated that the relationship between self-efficacy and pain and the relationship between self-efficacy and depression/anxiety were stronger in female caregivers, whereas age did not serve as a moderator in the relationship between self-efficacy and well-being. Our findings provide insight that can guide intervention development to improve family caregiver self-efficacy and well-being. Furthermore, future research may involve interventions with the consideration of family caregivers’ gender.
Rural Residence, Nutrition Risk, and Falls In Community-Dwelling Older Adults
Authors: Gell Nancy , Eckert Caitlin , Schollmeyer Jennifer , Wingood Mariana , Tarleton Emily 
Published: December 2020

Abstract
Decreasing fall risk and maintaining independence is vital for community dwelling older adults. Nutritional status and rural residence may be independent predictors of falls. The aim of this study was to evaluate if nutritional status and rurality are positively associated with fall risk and predictive of future falls in community-dwelling older adults. We used data from a health risk assessment conducted by the Support and Services at Home organization serving Medicare beneficiaries in Vermont in 2017-2019 (N=3109; 79.6 years ±8.4, 75% female). Measures included the Fall Risk Questionnaire, Determine Nutrition Risk questionnaire, and fall history. Descriptive statistics from baseline measures and logistic regression analyses were used to identify predictors of a new fall with respect to rurality, fall risk, and nutritional status. At baseline, 67% of participants lived in rural communities, 37% had high nutrition risk, and 60% had elevated fall risk. Independently, rurality and high nutrition risk were significantly associated with fall risk (p&lt;0.001) and high nutrition risk was associated with rurality (p&lt;0.001). In the adjusted model, rural residence was not significantly associated with a fall within one year from baseline, whereas participants at high nutrition risk had a 50% higher odds of falling (p= 0.001). These findings suggest that falls may be associated with nutrition risk, but not living in a rural setting. Community-based initiatives should consider including nutrition screens as part of fall risk assessments. Further research is needed to understand the relationship between nutrition status and falls risk.
Self-Reported Fears by Hospice Patients at the End of Life
Authors: Kates Jeannette 
Published: December 2020

Abstract
Fear is a common emotion that involves the intense anticipation of threat to a person. At end of life, this fear is often conceptualized as existential distress, which suggests a connection to spirituality. Processing impending death is essential to end-of-life closure and acceptance. Existing evidence suggests that spirituality is associated with greater coping, better psychosocial well-being, and dignified dying; however, the relationship between fear and spirituality at end of life, as well as the specific fears experienced, are not known. The purpose of this study was to explore the relationship between fear and spirituality in patients upon hospice admission. In this retrospective study, admission records from 154 hospice patients were reviewed. Hospice admission data from the psychosocial and spiritual assessments were analyzed using descriptive statistics, inferential statistics, and logistic regression. The average patient age was 81 years of age. A slight majority (51.3%) of patients admitted to fears upon hospice admission. Patients reported a range of one to six fears, with the most common fear being “pain and/or suffering.” Forty-seven percent of the patients identified as being “spiritually active.” Correlation analysis revealed no statistically significant relationship between fear and spiritually. Logistic regression analysis revealed some significant relationships between age and certain fears. Fear is a common symptom at the end of life, and appropriate emotional and psychological support should be provided to mitigate the fears. This study suggests that fears may be different for older adults.
Using the Conversation Starter Kit in Canada to Promote Resident Care Planning Discussions in Long-Term Care
Authors: Kaasalainen Sharon , Sussman Tamara 
Published: December 2020

Abstract
Advance care planning (ACP) is still rare in Canadian long-term care (LTC) homes. Residents and their families view ACP as uncomfortable and difficult to implement, leading them to avoid these discussions. The purpose of this study was to explore the perceptions of LTC residents and their families about using an ACP tool called The Conversation Starter Kit. This study utilized a mixed methods approach. Data was collected in four LTC homes in Ontario, Canada from 78 residents and family members. Data was analyzed using thematic analysis and descriptive statistics. All participants read all sections but only 73% completed all sections of the toolkit. Participants spent an average of 52.3 minutes completing the toolkit and 36.4 minutes discussing it with their family members and/or LTC staff. Participants reported: a better understanding of ACP after using the tool (80%), that the tool helped clarify the available resources and/or choices (53%), and that they felt less apprehensive about ACP after using the tool (60%). Qualitative findings revealed many strengths (e.g., usefulness, ability to start difficult conversations, content and clarification), and weaknesses of the tool (e.g., redundant information, difficulty understanding the content and lack of information regarding medically assisted dying). Family members noted that the toolkit would have been helpful to receive earlier on in their family members’ disease trajectory, perhaps before being admitted into LTC. These study findings support the feasibility and acceptability of the tool to engage residents and family members in/; ACP discussions in LTC.
Helping Fill That Gap: Aging in Place After Disaster Through the Lens of Home-Based Care
Authors: Bell Sue Anne , Krienke Lydia , DeVries Raymond , Iwashyna Theodore J 
Published: December 2020

Abstract
During a disaster, home-based care is intended to continue to function using existing care delivery models. Home-based care providers (HBCP) are often the closest contact with their clients—even during a disaster, seeing them in non-traditional care settings including shelters and hotels. This closeness and commitment to clients, gives HBCP unique insights into strategies to promote aging in place. The purpose of this study was to identify the individual and community-level support needs of older adults after a disaster through the lens of home-based care. Five focus groups were conducted with HBCP (n=27) in two disaster-affected settings: 2017’s Hurricane Irma in Florida and Hurricane Harvey in Texas. Participants were identified by contacting home health agencies listed in an open-source database of agencies receiving Centers for Medicare and Medicaid Services funding. Data was manually coded using an inductive approach and themes were iteratively identified. Forty-nine codes were identified in the preliminary analysis, which were distilled into ten themes describing factors that influence care provision during and after disasters: patient autonomy/dependence, disaster-induced trauma, reluctance to evacuate, chronic disease exacerbation, unpreparedness, systemic inequality, provider preparedness actions, strong sense of community, mistrust of governmental authority, and the uniqueness of the patient and home-based care provider relationship. The perspective offered by HBCP illustrates the complexities of community-level preparedness and informal community support for chronically ill older adults surrounding disasters. Diverse groups involved in aging and disaster response can learn from strategies employed by HBCP during disasters to improve aging in place.