bluuebunny/crossref_metadata_2025_split huggingface dataset:
TELLING THE STORY OF ADULT PROTECTIVE SERVICES: CALIFORNIA’S IDENTIFICATION, SERVICES, AND OUTCOMES MATRIX
Authors: Liu Pi-Ju ( , Hass Zachary , Conrad Kendon , Conrad Karen , Yeh Jarmin C , Iris Madelyn , Stratton Sara , Butler Andrew 
Published: November 2019

Abstract
Adult Protective Services (APS) is responsible for investigating reports of abuse, exploitation, and neglect among vulnerable adults. California’s APS program investigates approximately 15% of all abuse, neglect, and exploitation reports in the country. Once abuse or neglect is substantiated, caseworkers design and implement a service plan for clients to reduce future risk; however, APS intervention effectiveness have not been extensively investigated. In partnership with San Francisco and Napa APS, risk and harm of abuse were measured by type using standardized items from the Identification, Services, and Outcomes Matrix, which is derived from the validated Elder Abuse Decision Support Short Form during case investigation (before APS interventions) and at case closure (after APS interventions). Data from 1,472 older adults’ (on average 78 years old; 57% females) served by APS during the six-month pilot demonstration showed the reduction of risk/harm in self-neglect (p&lt;.001), neglect (p&lt;.001), emotional abuse (p&lt;.001), physical abuse (p=.002), and financial abuse (p&lt;.001) after APS interventions. Effective interventions differ by type of abuse such that caregiver support (b=-.98, p&lt;.10), emergency assistance (b=-1.14, p&lt;.05), and client engagement (b=-1.85, p&lt;.05) decreased self-neglect risk/harm; client engagement (b=-2.24, p&lt;.05) decreased neglect by others risk/harm; case management services (b=-1.17, p&lt;.05) decreased physical abuse risk/harm; and financial planning services (b=-3.99, p&lt;.05) decreased financial abuse risk/harm. No services were identified as effective for emotional abuse. Since effective services differed by type of abuse, it is important to consider the etiology of abuse before implementing the services needed by older adults to effectively decrease harm/risk.
ADVANCE CARE PLANNING COMMUNICATION: AN INTERACTIVE WORKSHOP WITH ROLE-PLAY FOR STUDENTS AND PRIMARY CLINICIANS
Authors: Blomberg Ben A , Quintana Catherine , Hua Jingwen , Hargis-Fuller Leslie , Laux Jeff , Drickamer Margaret 
Published: November 2019

Abstract
There is a need for increased clinician training on advance care planning (ACP). Common barriers to ACP include perceived lack of confidence, skills, and knowledge necessary to engage in these discussions. Furthermore, many clinicians feel inadequately trained in prognostication. There is evidence that multimodality curricula are effective in teaching ACP, and may be simultaneously targeted to trainees and practicing clinicians with success. We developed a 3-hour workshop incorporating lecture, patient-oriented decision aids, prognostication tools, small group discussion, and case-based role-play to communicate a values-based approach to ACP. Cases included discussion of care goals a patient with severe COPD and one with mild cognitive impairment. The workshop was delivered to 4th year medical students, then adapted in two primary care clinics. In the clinics, we added an interprofessional case applying ACP to management of dental pain in advanced dementia. We evaluated the workshops using pre-post surveys. 34 medical students and 14 primary care providers participated. Self-reported knowledge and comfort with ACP significantly improved; attitudes toward ACP were strongly positive both before and after. The workshop was well received. On a seven-point Likert scale, (1=Unacceptable, 7=Outstanding), the median overall rating was 6 (“Excellent”). In conclusion, we developed an ACP workshop applicable to both students and primary clinicians. We saw improvements in self-reported knowledge and comfort with ACP, though long-term effects were not studied. Participants found the role-play especially valuable. Most modifications for primary care clinics focused on duration rather than content. Future directions include expanding the interprofessional workshop content.
HEALTHCARE ENCOUNTERS AS PREDICTORS OF DEATH ANXIETY IN OLDER ADULTS
Authors: Becker Todd D 
Published: November 2019

Abstract
Literature suggests 10–15% of Americans experience death anxiety (DA). While DA is a response to heightened death awareness, research has not fully explored the link between DA and healthcare utilization. 2012 Health and Retirement Study data were used. Three binary logistic regressions analyzed hospitalization, ER admission, nursing facility placement, and outpatient visits’ abilities to predict DA (0 = “none,” 1 = “at least some”) over the past week. Model 1 included demographics and all four types of healthcare encounters. One item from the Beck Anxiety Inventory assessed DA. Most subjects in the sample (N = 7,185) were married (n = 4,302), and White (n = 5,479). Fifteen percent reported ER admissions, 24.6% reported hospitalizations, 1.1% reported nursing facility placements, and 91.5% reported outpatient visits. Regression results from each model showed nursing facility placement and outpatient visits to be statistically significant predictors of DA across all models (OR ranges = 2.23–2.38 and 1.23–1.25 respectively, p &lt; .05 in all models). Hospitalization predicted DA in Models 1 (OR = 1.30, p = .004) and 2 (OR = 1.46, p &lt; .001). Model 3 showed ER admission (OR = 1.52, p &lt; .001) predicted DA. Results from each model indicated individuals who experienced nursing facility placements exhibited double the odds of experiencing DA, compared to those who did not. Outpatient visits were the weakest predictor of DA in each model. DA’s association with healthcare utilization provides implications for providers. Future research should explore the relation between DA and health outcomes.
NEUROTICISM PREDICTS INFORMANT-REPORTED COGNITIVE DECLINE THROUGH HEALTH BEHAVIORS
Authors: Best Rachel D , Cruitt Patrick J , Hill Patrick L 
Published: November 2019

Abstract
Our current study attempts to better understand the relationship between personality and cognitive decline. In this study, we analyzed whether health behaviors act as mediating variables for the relationship between personality and cognitive decline. Additionally, we were interested to see how personality influences different health behaviors, and which health behaviors in particular are predictive of cognitive decline. In addition to analyzing the composite score of health behaviors in relation to personality and cognitive decline, we analyzed each of its four components (wellness maintenance, accident control, traffic risk, and substance abuse; Vickers, Conway & Hervig, 1990). To measure cognitive decline, we used the Ascertain Dementia Eight Item Scale, an informant-report screening measure. Personality has consistently been linked to cognitive decline (Curtis, Windsor & Soubelet, 2015; Chapman, Duberstein, Tindle, Sink, Robbins, Tancredi & Franks, 2013; Low, Harrison & Lackersteen, 2013), but has not yet been analyzed with an informant report measure. Informant-report may be more reliable than self-report when measuring cognitive decline because participants who exhibit cognitive impairment may not be equipped or willing to report about their own cognitive ability. We found that neuroticism significantly predicted informant-reported cognitive decline and that this relationship was mediated by health behaviors, specifically, wellness maintenance. Wellness maintenance was the only category of health behavior that predicted informant-reported cognitive decline. Surprisingly, conscientiousness was unrelated to informant-reported cognitive decline as were extraversion, agreeableness, and openness to experience.
A COHORT LONGITUDINAL STUDY OF SOCIAL CAPITAL AND DEPRESSIVE SYMPTOMS IN THE WISCONSIN LONGITUDINAL STUDY
Authors: Carr Kyle A 
Published: November 2019

Abstract
This study examined the association between the two dimensions of social capital, structural and cognitive, and depression, as well as investigating their within- and between-effects. Using the Wisconsin Longitudinal Study, I applied a multi-level 2-wave longitudinal analysis, over a 7-year period, to examine these two dimensions of social capital influence on individual’s depressive symptoms at both the between- and within person levels. Results suggest both dimensions of social capital are negatively related with levels of depressive symptoms for individuals. The within-person changes for both self-efficacy and sense of belonging were larger than the estimates of between-effects, while trust and structural social capital effects were equal. These findings add to the growing body of literature examining depressive symptoms in late life, while also providing evidence for policymakers to hone in on key areas that can address depressive symptoms with social capital interventions.
KNOWLEDGE OF AGING, NEGATIVE AGE BIAS, AND POSITIVE AGE BIAS: AGE GROUP DIFFERENCES
Authors: Caskie Grace , Canell Anastasia E , Bashian Hannah M 
Published: November 2019

Abstract
Attitudes towards aging include both positive and negative beliefs about older adults (Iverson et al., 2017; Palmore, 1999). Palmore’s (1998) Facts on Aging Quiz, a widely used assessment of knowledge about aging, also identifies common societal misconceptions about aging. Findings regarding age group differences in attitudes toward aging are mixed (Bodner et al., 2012; Cherry & Palmore, 2008; Rupp et al., 2005). The current study compared knowledge of aging, negative age bias, and positive age bias between young adults (18-35 years, n=268) and middle-aged adults (40-55 years; n=277). Middle-aged adults reported significantly greater average knowledge of aging than young adults (p=.019), although both groups had relatively low knowledge (MA: M=13.0, YA: M=12.2). Middle-aged adults also showed significantly less negative age bias (p&lt;.001) and significantly more positive age bias than young adults (p=.026). Although the total sample was significantly more likely to be incorrect than correct on 23 of the 25 facts (p&lt;.001), young adults were significantly more likely than middle-aged adults (p&lt;.001) to respond incorrectly for only 2 of 25 facts. Both facts reflected greater negative age bias among young adults than middle-aged adults. These facts concerned older adults’ ability to work as effectively as young adults (fact 9) and frequency of depression in older adults (fact 13). Results demonstrate that age bias is not limited to young adults and may continue through midlife, though negative age bias in particular may be lower for individuals approaching older adulthood, which could have implications for their psychological and physical well-being.
A RANDOMISED FEASIBILITY STUDY TO REDUCE SITTING IN OLDER ADULTS UNDERGOING ORTHOPAEDIC SURGERY
Authors: Aunger Justin A , Greaves Colin T , Asamane Evans A , Davis Edward T , Whittaker Anna C , Greig Carolyn A 
Published: November 2019

Abstract
Osteoarthritis is a prevalent condition in older adults that causes many patients to require a hip or knee replacement in order to improve quality of life and reduce pain. Reducing sedentariness prior to surgery may aid in improving physical function and post-operative outcomes. Thus, we performed a pragmatic randomised controlled feasibility study with 2:1 allocation into intervention or usual care in Birmingham, UK. The intervention involved multiple techniques to reduce sedentary behaviour, including motivational interviewing and action planning. The primary outcome was feasibility, assessed using mixed methods. We included exploratory measures to inform a future definitive trial, such as ActivPal3 objective measurement of physical activity and sedentariness, Short Physical Performance Battery (SPPB), Basic Psychological Needs questionnaire, and serum cardiometabolic biomarkers. Assessments were at baseline, one-week pre-surgery, and six-weeks post-surgery. We recruited 35 participants aged 64-87 years eight weeks before hip or knee arthroplasty. The study was found to be feasible with some modifications. Within-group comparisons showed that the intervention group significantly improved their physical function (SPPB) score by 0.71 points (95% CI 0.07 to 1.36, p=0.032), a clinically significant increase. Additionally, those in the intervention group retained to post-surgery trended towards a mean sedentary time reduction of 66 min.d-1 (p=0.497). In this older mobility-limited surgical population it is feasible to use behavioural techniques to displace sedentary time to activity. Future trials should further assess the effect of reducing sedentariness on health in larger samples of older adults with osteoarthritis undergoing orthopaedic surgery.
THE RELATIONSHIP BETWEEN PERSONAL AGING ANXIETY AND ATTITUDES TO OLDER PATIENTS AMONG HEALTHCARE PROFESSIONALS
Authors: Inker Jenny 
Published: November 2019

Abstract
Nearly 20% of adults age 50 and older report experiencing age discrimination by a healthcare professional. Numerous harmful health consequences flow from ageism in healthcare encounters, including failure to accurately diagnose and respond to treatable conditions such as pain and depression. Despite this, little is known about ageism among healthcare professionals, including whether job role and work setting influences attitudes to older patients. This study aims to use relational ageism theory to explore the relationship between personal aging anxiety among healthcare professionals and their attitudes to older patients, including potential moderating factors of job role and work setting. A convenience sample of healthcare professionals working for a small regional health system in the US (N = 145) completed an online survey using the Aging Anxiety Scale to measure personal aging anxiety and the Geriatric Attitudes Scale to measure negative attitudes to older patients. Regression analyses demonstrated that personal aging anxiety significantly predicted attitudes to older patients, with greater anxiety associated with more negative attitudes. Job role significantly predicted attitudes to older patients with physicians’ attitudes being more negative compared to other disciplines, while work setting was not predictive of attitudes toward older patients. This research confirms the need to provide ageism awareness training for healthcare professionals and to include in this training an exploration of internalized attitudes to aging. Further research with a larger, more representative sample is indicated to test replication and to better understand how to overcome job role risks of ageism among healthcare professionals.
EFFECTS OF FUNCTIONAL BRAIN NETWORKS AND WHITE MATTER DISEASE ON MOBILITY OF OLDER ADULTS IN AN EXERCISE INTERVENTION
Authors: Neyland Blake R , Kraft Robert , Lyles Mary , Kritchevsky Stephen , Laurienti Paul J , Nicklas Barbara M , Hugenschmidt Christina 
Published: November 2019

Abstract
Declining mobility is associated with increased accumulation of white matter hyperintensities (WMH). However, a high WMH burden is not always accompanied by impaired mobility. Our previous work demonstrates that some variance in mobility may be explained by brain network connectivity. Here, we extended this work by measuring WMHs and brain networks in older adults participating in a lifestyle intervention. The Short Physical Performance Battery (SPPB) and resting state functional magnetic resonance imaging (fMRI) were collected before and after a 5-month caloric restriction plus aerobic exercise intervention in 57 obese, sedentary adults aged 65-78. Participants were categorized based on median splits of baseline SPPB scores and WMH burden: Expected Healthy (EH: low WMH, SPPB≥11, n=16), Expected Impaired (EI: high WMH, SPPB≤10, n=17), Unexpected Healthy (UH: high WMH, SPPB≥11, n=12), and Unexpected Impaired (UI: low WMH, SPPB≤10, n=12). Graph theory-based methods were used to characterize brain networks and compare the four groups. At baseline, the somatomotor cortex community structure (SMC-CS) was less consistent in EI (p=0.05) and UI (p=0.23) compared to EH. The EI (mean=1.25, p=0.003) and UI (mean=1.57, p=0.001) significantly improved their SPPB scores following the intervention. Although both groups had equivalent SPPB scores, SMC-CS was less consistent in the UH than EH (p=0.16). However, UH displayed a significant (p=0.004) increase in second-order connections to the precuneus compared to EH. These data suggest that studying brain networks could improve the understanding of the development of mobility disability and the CNS contributions to mobility independent of white matter disease.
IMPROV FOR CARE: TEACHING CAREGIVERS IMPROVISATION IMPROVES MOOD AND SENSE OF BURDEN
Authors: Almen Ruth , Caldwell Jessica Z Kirkland 
Published: November 2019

Abstract
There is a growing need for novel intervention for caregivers of family members with dementia. Improv for Care is a six-week program designed to teach improvisation (“improv”) skills to caregivers to practice flexible communication, build social support, and process the demands of caregiving through humor and play. This study aimed to examine changes in caregiver depression (Beck Depression Inventory-II), perception of burden (Zarit Burden Interview), qualitative experiences related to caregiving, and their cared-for person’s neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire). Fifteen caregivers completed questionnaires before and after the Improv for Care program. Wilcoxon signed rank tests for related samples revealed significant declines in both caregivers’ depressive symptoms, Z = -2.64, p = .008, and sense of burden, Z = -2.16, p = .031, after completing the program. Caregivers reported that their loved ones’ neuropsychiatric symptoms increased during the course of the intervention, Z = -2.10, p = .036, though associated distress did not also increase, Z = -1.12, p = .265. Of the 15 caregivers, 12 completed follow up questionnaires three months after course completion, which showed that their post-intervention reduction in depressive symptoms remained stable, Z = -1.02, p = .306. The Improv for Care program shows promise as an intervention for caregivers to improve stress, mood, and coping skills.
CAREGIVERS OF OLDER ADULTS: AN ANALYSIS OF THE PCORI FUNDED RESEARCH PORTFOLIO
Authors: Rurka Marissa , Khan Carly P , Witsaman Rachel , Susana-Castillo Steven , Gummi Sindhura , Moscou-Jackson Gyasi , Clauser Steven B , Arora Neeraj K 
Published: November 2019

Abstract
A family-centered approach to care is vital, and caregivers play an important role in patient-centered care for older adults. This analysis of the Patient-Centered Outcomes Research Institute’s (PCORI) portfolio of clinical comparative effectiveness research (CER) trials explores the extent to which caregiving for older adults is a focus within our funded studies and examines how these studies incorporate interventions and outcomes related to caregivers. Of 116 studies in the portfolio with a caregiving component, only 35 studies focus on caregivers of older adults. Approximately half of these studies (16) were not focused on a specific disease, but rather included older adults with a variety of diseases. Caregivers were the target of a delivered intervention in 18 studies. Among these studies, all but one included caregivers as part of a multicomponent intervention. The most common intervention components were caregiver training (14 studies) and inclusion of caregivers in the delivery of health services, notably coordination of care (17), home visits (9), integrated care (9), multidisciplinary care teams (9), and clinical decision tools (8). Caregiver-focused outcomes were assessed in 26 studies. The most frequently assessed domains include measures of health and well-being (most commonly psychosocial status; n=20), evaluation of care (most commonly satisfaction; n=8), and health behavior (most commonly attitudes; n=6). In general, given stakeholder interest in family-centered research on older adults, future CER research should include caregivers and/or compare interventions focused solely on the unique needs of caregivers of older adults. Inclusion of caregiver-related outcomes should also be promoted.
DIABETES AS A RISK FACTOR FOR MILD COGNITIVE IMPAIRMENT IN OLDER RESIDENTS OF RURAL WEST TEXAS
Authors: Arandia Gabriela , Boles Annette , Lopez Veronica , Neugebauer Volker 
Published: November 2019

Abstract
While a growing body of evidence suggests a link between diabetes and Alzheimer’s disease, few studies have examined the impact of diabetes on mild cognitive impairment, the precursor to Alzheimer’s disease, especially among older, rural, and ethnically diverse populations. Using data from Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education, & Research), a longitudinal cohort aging study in rural West Texas, the aim of this study was to compare the risk for mild cognitive impairment among participants who, according to blood sugar levels, were pre-diabetic/diabetic versus normal. This study uses baseline and 3-year follow-up data from a subsample (recruited from Cochran County) of the larger, four-county sample of Project FRONTIER. The study sample (n=206) ranged from 40 to 87 years old (mean age: 58.3 + 11.7 years old), was predominantly female (73.3%), White (88.4%), with slightly over half self-reporting as Hispanic (51.0%). Logistic regression results revealed that those who had prediabetes/diabetes had 1.81 times the risk for developing mild cognitive impairment compared to those who had normal blood sugar levels. These findings indicate the need for earlier intervention for improved diabetes prevention, self-management, and control (diet, physical activity, treatments) to help offset the development of mild cognitive impairment, which could progress to Alzheimer’s disease later in life. More research is needed to confirm the link between pre-diabetes/diabetes and mild cognitive impairment in other populations and settings.
PREVALENCE AND PREDICTORS OF STATIN USE IN LONG-STAY NURSING HOME RESIDENTS WITH LIFE-LIMITING ILLNESSES
Authors: Mack Deborah S , Lapane Kate L 
Published: November 2019

Abstract
Statins are one of the most commonly prescribed medications in the United States. While statin use has been studied extensively in the general population, national data on statin use in US nursing homes do not exist. This study estimated the point prevalence of statin use on September 1, 2016 and identified predictors of statin use in nursing home residents with life limiting illness. We conducted a cross-sectional analysis using national MDS 3.0 data linked to Medicare claims. We identified 424,312 long-stay residents with life limiting illnesses defined as a palliative care consultation (ICD-10 Z51.5), prognosis &lt;6 months on MDS, the Veterans Health Administration palliative care index (PCI), or a diagnosis of a serious illness (e.g., cancer, stroke, heart failure, etc.). Poisson models accounted for clustering of residents within facilities. Overall, 34% were on statins which varied by age (65-75 years: 44.1%; &gt;75 years: 31.5%). The strongest positive predictor of statin use was hyperlipidemia, while coronary artery disease and stroke were only marginally predictive across age. The strongest negative predictors were a palliative care consultation or a prognosis &lt;6 months, while PCI was not strongly associated with use. A substantial proportion of long stay nursing home residents with life limiting illnesses continue statin therapy despite evidence of net harm. Efforts to deprescribe statins in the nursing home setting may be warranted. These findings can be used to help identify and target missed opportunities to reduce the therapeutic burden and improve end-of-life care for the US nursing home population.