bluuebunny/crossref_metadata_2025_split huggingface dataset:
INCREASED PHYSIOLOGICAL VARIABILITY PREDICTS DECLINING HEALTH AND CRITICAL TRANSITIONS IN HEMODIALYSIS PATIENTS
Authors: Cohen Alan A , Nakazato Yuichi , Sugiyama Tomoko , Leung Diana L , Legault Véronique , Côté Anne-Marie 
Published: November 2019

Abstract
Increased variability in levels of several individual biomarkers has been shown to predict adverse outcomes, particularly in hemodialysis patients, for whom time series data is often available. Here, we evaluate the feasibility of using multivariate approaches to quantify global physiological variability as a potential predictor of adverse outcomes. We used data on 588 deaths and 1196 hospitalisations across ~38,000 visits of 591 hemodialysis patients at a Quebec hospital, as well as data on frailty and mortality in 580 patients assessed 20+ times within a one-year period at a hospital in Saitama, Japan. We use two approaches: principal components analysis (PCA) of the coefficients of variation (CVs) of the individual biomarkers over the previous year, and Mahalanobis distance (MD) of the biomarker profile relative to the same profile at the previous time point. We show that both methods provide substantial prediction of both impending mortality and impending hospitalisation, with hazard ratios across the 95% quantile range of the indices varying between 1.5 and 3.5 (p&lt;0.0001). Each unit change on the first PCA axis (PC1) increased frailty odds by 2.34 (95% CI: 1.21-4.52). PCA performed substantially better than MD. CVs of various biomarkers were consistently positively correlated, and PC1 was a good predictor of frailty, mortality, and hospitalisation. Overall, these results confirm that complex physiological integration can break down, resulting in loss of homeostatic control and increasing variability, as predicted by complex systems theory. The resulting indices provide a predictive signal of impending critical health transitions, with both theoretical and clinical implications.
MULTIMORBIDITY PATTERNS ARE DIFFERENTLY ASSOCIATED WITH DEPRESSION IN MIDDLE-AGED AND OLDER CHINESE
Authors: Yao Shan-Shan , Cao Gui-Ying , Chen Zi-Shuo , Huang Zi-Ting , Xu Beibei 
Published: November 2019

Abstract
The associations of multiple physical conditions with depression are still unclear. This study examined the relationship between physical multimorbidity patterns and depression among middle-aged and older Chinese. Patterns of physical multimorbidity were identified using Exploratory Factor Analysis (EFA) among 21,933 participants ≥ 45 years from 2011 to 2015. Multiple logistic regressions were performed to assess the associations between multimorbidity, multimorbidity patterns (factor scores) and depression for each age group (45-60 years vs. ≥60 years). The overall prevalence of multimorbidity was 40% and it was higher among participants with depression (54%) than those without depression (33%). Middle-aged (OR: 1.45; 95%CI 1.16–1.80) and older (OR: 1.85; 95%CI 1.62–2.11) adults with multimorbidity were more likely to have depression compared with those without multimorbidity. Five multimorbidity patterns were identified: cardio-metabolic, respiratory, splanchnic, cardio-cerebrovascular, and tumor-and-degenerative. Middle-aged participants with higher respiratory pattern score had a higher odds to have depression (OR: 1.59; 95%CI 1.15–2.21). Among older adults, higher cardio-metabolic pattern score was significantly associated with lower odds of depression (OR: 0.78; 95% CI 0.63–0.97), while higher respiratory (OR: 1.32; 95%CI 1.04–1.68), splanchnic (OR: 1.22; 95%CI 1.01–1.47) and tumor-and-degenerative pattern scores (OR: 1.86; 95%CI 1.42–2.43) were all found to be significantly associated with higher risk of depression. The associations between physical multimorbidity patterns and depression differ by age. Future studies are needed to investigate the temporal nature of how physical multimorbidity patterns may induce depression and the underlying mechanisms.
RISK FACTORS FOR DISENROLLMENT AMONG HOME HOSPICE PATIENTS WITH DEMENTIA
Authors: Luth Elizabeth A , Russell David 
Published: November 2019

Abstract
Hospice delivers care to a substantial and growing number of individuals with primary and comorbid dementia diagnoses. Dementia diagnosis and racial/ethnic minority status are risk factors for hospice disenrollment. However, little research examines racial/ethnic disparities and other risk factors for hospice disenrollment among hospice patients with dementia. This paper uses multinomial logistic regression to explore sociodemographic and functional status risk factors for hospice disenrollment among 3,949 home hospice recipients with primary or comorbid dementia. Results indicate that patients with a primary dementia diagnosis, racial/ethnic minority groups, and those higher functional status have elevated risk of disenrollment due to hospitalization, disqualification, and electively leaving hospice care. Additional research is needed to understand why primary dementia diagnosis and underrepresented racial/ethnic status are associated with multiple kinds of hospice disenrollment so that hospice practice can be tailored to respond to the needs of these individuals.
PERSPECTIVES ON SETTING GOALS OF CARE AMONG HOSPICE PATIENTS WITH HEART FAILURE, THEIR FAMILIES, AND HEALTHCARE TEAM
Authors: Baik Dawon , Russell David , Jordan Lizeyka , Dooley Frances , Creber Ruth Masterson 
Published: November 2019

Abstract
Older adults with heart failure (HF) face many end-of-life care issues. Shared decision making (SDM) in hospice is an important process that allows HF patients and their family caregivers to discuss their preferences on goals of care (GOC) with their healthcare team. Yet, little research has explored how the values and preferences of HF patients and their family are integrated into their care plans through SDM process. This presentation examines facilitators and barriers to setting GOC among hospice HF patients. Qualitative interviews were conducted with HF patients/family caregivers (n=7) and providers (n=32) at a large not-for-profit hospice agency. Several facilitators emerged: building trust, active listening, helping patients and family caregivers understand hospice and prognosis. Barriers included acceptance, family conflict, language discordance between patients and providers and lack of communication about care transition. Findings confirmed the need for individually-tailored goal-setting approaches to navigating the end-of-life trajectory among HF patients.
FACETS OF CLOSE, ROMANTIC, AND INTIMATE RELATIONSHIPS IN LATER LIFE
Authors: Kolodziejczak Karolina , Gerstorf Denis , Rook Karen 
Published: November 2019

Abstract
Research on the role of close social relationships for physical health and well-being in later life has received increased attention over the past decades. Yet, we are still only beginning to understand potentially underlying mechanisms such as joint goals and affectionate touch. Likewise, we also know little about the relevance of particular social facets such as the role of friends and the nature of sexuality. In this symposium, we have compiled four empirical projects that showcase current and future endeavors to address some of these long-standing questions. Ungar et al. use dyadic data from older couples to examine how shared goals with the partners and positive illusions about these joint goals relate to goal progress and relationship satisfaction. Zhaoyang and Martire analyze long-term longitudinal dyadic data from older couples to examine if and how the frequency of affectionate touch between partners predicts physical health, well-being, and relationship satisfaction five years later. Fiori et al. make use of three-wave longitudinal data from a large and representative US sample to examine the unique roles that close social ties and weaker social ties have independently of one another for age-related changes in two central aspects of affective experience. Kolodziejczak et al. use time-lag data from two cohorts of adults in late midlife to capture historical changes in the perceived importance of sexuality and the evaluation of one’s sex life. Karen Rook will integrate the insights gained from these four papers, discuss their potential and limitations, and consider directions for future research.
AFFECTIONATE TOUCH AND RELATIONAL, MENTAL, AND PHYSICAL WELL-BEING IN OLDER COUPLES: A NATIONAL LONGITUDINAL STUDY
Authors: Zhaoyang Ruixue , Martire Lynn M 
Published: November 2019

Abstract
Recent theories suggest that non-sexual physical contact with close others plays a key role in promoting health and well-being in adulthood. However, the impact of non-sexual physical contact in later life, especially the affectionate touch between romantic partners, has been largely unexplored. Using two waves of dyadic data (N=953 couples, Mage=71 years) from National Social Life, Health, and Aging Project (NSHAP), we examined whether shared affectionate touch between spouses prospectively predicted both partners’ relational, mental and physical well-being five years later, independent of sex activity. Dyadic analyses results indicated that frequency of shared affectionate touch with the partner predicted increases in spouses’ own relationship satisfaction, life satisfaction and mental health, but not in physical health, over five years. No interpersonal (i.e., partner) effect of shared affectionate touch was found. Findings underscore the unique role of non-sexual physical contact between spouses in promoting relational and mental well-being for older couples.
DISSEMINATION STRATEGIES: ALIGNMENT WITH GERI-ED
Authors: Platts-Mills Tim , Rosen Tony , Stoeckle Rebecca Jackson , Dash Kim , Lees-Haggerty Kristin 
Published: November 2019

Abstract
The National Collaboratory to Address Elder Mistreatment’s model provides hospital emergency departments with training and tools to help recognize and respond to elder mistreatment. The Geriatric Emergency Department (GERI-ED) initiative, supported by The John A. Hartford Foundation and West Health, encourages hospitals to integrate best practices for older adults into their emergency departments by providing guidelines and options for accreditation (GED-A). Recognizing the importance of coordinating efforts to develop tools that can be shared and implemented widely, the Collaboratory has intentionally and strategically aligned itself with the GERI-ED by inviting members of the GED-A team to join the Collaboratory. In this presentation we will describe how aligning these two initiatives has the potential to achieve greater impact than either initiative alone. We will provide a case example of how the elder mistreatment care model is implemented in GERI-EDs, highlighting factors that facilitate and hinder model implementation in such settings.
PERSPECTIVES OF OLDER ADULT STAKEHOLDERS ON THE IMPACT OF COMMUNITY-BASED EXERCISE
Authors: Elhajjmoussa Lekaa , Mays Allison M , Rosales Katrina B , Rosen Sonja L 
Published: November 2019

Abstract
This focus-group study aims to identify the perceptions of older adults (&gt;50 years) who participated in community-based exercise classes as part of the Leveraging Exercise to Age in Place (LEAP) Study. LEAP enrollees participate in community-based classes that include Tai Chi, EnhanceFitness, Arthritis Exercise, and the Healthier Living Workshops. Nine LEAP participants attended a focus group at Cedars-Sinai Medical Group. The focus group included quantitative and qualitative questions in both a verbal discussion format and a written questionnaire that examined the effects of liaisons, social connections, and incurred changes as a result of participating in LEAP classes. Participants endorsed liaisons within the healthcare system, including physician referrals and communication with a community health coach, as aiding in their decision to participate in health classes. Participants cited positive changes in their physical states, such as increases mobility and decreases in pain, and positive psychological changes, such as increases in energy and socialization, post LEAP completion. Among the ideas and critiques noted by the focus group attendees was the desire to have LEAP classes become part of communities permanently, and to have longer exercise class session duration. These findings suggest that direct merging of liaisons within the healthcare system and community-based exercise programs for older individuals, such as those offered by LEAP, is an effective way to positively influence older patient outcomes both physiologically and psychologically. These results call for future research that focuses on how healthcare systems and community programs can work together to maximize positive patient outcomes for older individuals.
RACIAL DIFFERENCES IN THE DAILY EXPERIENCES OF AFRICAN AMERICANS AND EUROPEAN AMERICANS PROVIDING CARE
Authors: Cichy Kelly E , Koumoutzis Athena 
Published: November 2019

Abstract
African Americans often report lower caregiver burden, however, few studies consider the broader daily context of African American caregivers’ lives. This study examines racial differences in the associations between providing care for a spouse or parent and daily health and well-being among African Americans and European Americans, including how other daily stressors moderate these associations. During eight days of interviews, respondents aged 34 to 84 years (N = 1,931) from the National Study of Daily Experiences (NSDE II) reported on their daily stressors, negative affect (NA), physical symptoms, and whether or not they provided support to a spouse or parent with a disability. Controlling for demographics, on caregiving days, NA was higher than on non-caregiving days (p &lt; .05) for all respondents. On caregiving days with no work stressors, African Americans only reported more physical symptoms than on caregiving days with work stressors (p &lt; .05). Implications will be discussed.
EXPOSURE AND EMOTIONAL REACTIVITY TO DAILY STRESS IN SAME-SEX AND DIFFERENT-SEX MARRIAGES
Authors: Garcia Michael , Donnelly Rachel , Umberson Debra 
Published: November 2019

Abstract
Recent work exploring links between stress processes and well-being within marriage suggest that women may be at an increased risk for exposure and emotional reactivity to daily stress. However, studies have focused primarily on heterosexual couples, raising questions concerning whether and how these gendered patterns might unfold differently for men and women in same-sex marriages. In the present study, we analyze 10 days of dyadic diary data from 756 midlife men and women in 378 gay, lesbian, and heterosexual marriages to consider how exposure and emotional reactivity to daily stress may differ across union types. We find that women are exposed to more daily stressors than men and that this exposure is especially detrimental to the well-being of women in different-sex marriages. These findings highlight the need to include same-sex couples when exploring gendered linkages between daily stress processes and well-being within marriage.
CONSISTENT ASSIGNMENT: AN UPDATE ON THE QUALITY IMPACT
Authors: Castle Nicholas , Harris John A 
Published: November 2019

Abstract
The association of consistent assignment of Nurse Aides (NAs) with nursing home quality indicators is examined. Consistent assignment is defined as the same caregivers consistently caring for the same residents almost (80% of their shifts) every time they are on duty. Data used came from a survey of nursing home administrators, Nursing Home Compare, the Certification and Survey Provider Enhanced Reporting (CASPER) data, and the Area Resource File. All of the data was from 2015, and included 3,550 facilities. Several multivariate logistic regression models (using GEE) were used, including staffing variables (turnover, agency use, staffing levels), facility factors (size, ownership, occupancy rate), and market characteristics (competition, Medicaid rates). An average of 77% of nursing homes reported using at least some level of consistent assignment; although some were at low levels. In the multivariate analyses, accepted levels of consistent assignment were used. Turnover and family satisfaction quality were significantly (p&lt;.01) better in facilities with the highest levels of consistent NA assignment. 7 of the 9 Quality Measures and 3 of the 5 Five-Star measures examined were significantly (p&lt;.01) better in facilities with the highest levels of consistent NA assignment. Consistent assignment has developed as a preferred practice in nursing homes based on little empirical evidence. The findings presented here provide substantial justification for the use of this staffing practice for NAs.
THE STUDY OF AGING A SEARCH FOR MEANINGFUL PATIENT AND PUBLIC INVOLVEMENT IN GERONTOLOGICAL QUALITATIVE DATA ANALYSIS
Authors: Hanratty Barbara , Stocker Rachel , Brittain Katie 
Published: November 2019

Abstract
Patients and the public are involved in health and social care research more than ever before. Much effort has been put into developing patient and public involvement (PPI), and promoting co-production of research with patients and the public. Yet there is little guidance for researchers on how to involve PPI partners in the research process, or how involvement can be judged as meaningful. This presentation has its origins in the attempts of one research team to question and navigate a way of involving PPI in long term care research. In this presentation, we describe our model of collaborative qualitative data analysis with PPI partners, in a study exploring primary care services for older adults living in long-term care facilities in England. Anonymised interview transcript excerpts were presented in written, audio, and role-play format to our PPI partners. PPI partners derived meaning from interview data, identifying, confirming and critiquing emerging themes. Their input at this critical stage of the study deepened our initial analysis and prompted the research team to new and different interpretations of the data. This talk addresses ways of engaging PPI partners in innovative ways during data analysis, and offers other researchers some questions, challenges and potential principles for effective practice. We conclude that in areas such as long term care, with multiple stakeholders and a dynamic environment, effective PPI may be flexible, messy and difficult to define.
SURVIVING THE COMPLEXITY: USING GROUNDED THEORY TO UNDERSTAND KINSHIP CAREGIVING
Authors: Tompkins Catherine J 
Published: November 2019

Abstract
The role of a caregiver often goes beyond the task of caring for someone who is dependent in managing activities of daily living. Children are dependent on others to care for them due solely to their age and maturity; others are dependent due to chronic ailments or short-term disabilities. Regardless of why someone is dependent, the caregiving relationship is complex. This paper focuses on a grounded theory, developed and applied to understand the complexities of kinship caregiving. The literature continues to support the identified needs of kinship caregivers (Tompkins, 2015; Lee, Clarkson-Hendrix, & Lee, 2016). To understand the unique needs of kinship families, the following grand tour question was asked: What is it like for you to live within a kinship caregiving household? The theory was developed over several years based on observational data and 15 interviews with grandparent caregivers and at least one of the grandchildren they were raising. The theory, Surviving the Complexity, is a survival process of taking on the caregiving role and doing one’s best in spite of multiple obstacles. Surviving the complexity consists of three stages: rescuing, taking-on and role reversal. The theory identifies and explains emotional, relationship and situational complexity within kinship families. Hope and denial are factors of emotional complexity: “It’s not that she (my daughter) does not love him (the child), she is just unable to right now. She will get better.” Theory development and further application of the theory will be discussed.
MOVING BEYOND INDIVIDUAL COPING TO DEVELOPING SYSTEMS-LEVEL INTERVENTIONS FOR COMMUNITY-DWELLING ADULTS
Authors: Lewinson Terri , Bowland Sharon 
Published: November 2019

Abstract
According to AARP, the number of Americans aged 65 and older will grow to 90.5 million, which is double the count in 2010. Along with the growth of the aging population, we can also anticipate more diverse older adult communities due to increased immigration and evolving, complex family constellations. Two major concerns for aging adults is managing increasing geriatric conditions that affect mobility/function and chronic morbidities, while also trying to afford quality housing, the environmental context within which older adults spend most of their time. Urban planners and human service providers must remain abreast of the housing-health needs of this aging population and prepare aging-friendly communities that foster resident resilience and address “environmental, economic, and social factors that influence the health and wellbeing of older people” (AARP, 2017). In this symposium, panelists one present findings from a qualitative study to explore collective trauma and resilience narratives among residents in Flint, Michigan. Panelists two share findings from a community-based participatory study that explores the intricate network of relationships among residents as a core indicator of livability in senior housing. Panelists three share strategies for strengthening networks to reducing resident isolation and loneliness. Lastly, the fourth set of panelists discuss policy implications and trauma-informed approaches needed for residents with a history of interpersonal trauma.
THE DIFFERENTIAL INFLUENCE OF REGIONAL CONTEXT ON LATER-LIFE HEALTH AND MORTALITY
Authors: Riley Alicia 
Published: November 2019

Abstract
This study examines regional disparities in later life health from a life course perspective. To sort out when and how region influences health over the life course, I focus on the sharp contrast between the South and the rest of the U.S. in health and mortality. I draw on data from the National Life Health and Aging Project (NSHAP), a nationally representative sample of community-dwelling older adults in the U.S., to estimate the differential risk of multiple health outcomes and mortality by regional trajectory. I find that older adults who leave the South are worse off in multiple outcomes than those who stay. I also find evidence of a protective health effect of community cohesion and dense social networks for the Southerners who stay in the South. My results suggest that regional trajectory influences health in later life through its associations with socioeconomic status, access to healthcare, and social rootedness.