bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using the Age-Friendly 4Ms Framework to Redesign a Community Clinical Experience
Authors: Avallone Margaret , Pacetti Staci 
Published: December 2020

Abstract
The Age-Friendly 4Ms Framework (IHI/Hartford Foundation) was used to redesign an existing undergraduate nursing community experience, teaching students how to evaluate what matters to the individual, medications, mentation, and mobility. As part of the NJ Geriatric Workforce Enhancement Program (NJGWEP), a 5-year grant supported by DHHS-HRSA, ten senior nursing students joined a team of bilingual social workers, APNs, and a PharmD in an affordable housing urban highrise. This paper will describe the implementation and evaluation of a redesigned clinical experience using the 4Ms framework. Students visited older residents with bilingual social workers, performed health assessments and developed person-centered plans of care. Students presented resident cases during weekly interprofessional conferences to promote team collaboration and planning. Residents who screened positive for dementia were referred to an interprofessional Memory Assessment Program. Medications were reviewed using the Beers criteria, reconciled, and referred to primary care providers if appropriate. Fall risk was assessed and managed using the STEADI toolkit (CDC). Students were evaluated on attainment of geriatric-specific competencies, including medication review, cognition and depression screening, and fall risk assessments, by direct observations and interview. Following the semester-long experience, students completed a retrospective pretest/posttest survey to evaluate achievement of objectives based on the 4Ms. Mean scores for achievement of learning objectives ranged from 4.7-4.9 on a Likert scale of 1-5. Students identified barriers that older diverse individuals face when managing chronic health problems in the community. Students also valued the partnership with the social workers, stating, “We learned from each other.”
An Alzheimer’s Curriculum to Educate the Current and Future Public Health Workforce
Authors: Kennedy Taylor , French Molly , Blais Linelle , Reed Nia 
Published: December 2020

Abstract
Alzheimer’s disease is the 6th leading cause of death among adults in the United States and the 5th leading cause for those aged 65 and older. Nearly 14 million Americans will be diagnosed with Alzheimer’s dementia by 2060, but the public health workforce is struggling to meet current demands. As the older adult population continues to grow, the public health sector will need to ensure a sizable and competent workforce is prepared to meet the needs of those living with dementia as well as their caregivers. In support of national efforts to promote and ensure a competent workforce, the Alzheimer’s Association, Centers for Disease Control and Prevention, and Emory University developed “A Public Health Approach to Alzheimer’s and Other Dementias” (ADOD) curriculum. The free, introductory curricular resource was first piloted by faculty and students at undergraduate schools of public health across the country; however, due to its broad applicability the curriculum has since been updated and expanded to educate graduate students in schools of public health, students in related disciplines, and practicing public health professionals. The curriculum provides an introduction to ADOD as a public health crisis, basics of dementia, the role of public health in addressing the epidemic, and the creation of dementia-friendly communities. The purpose of the curriculum is to educate future public health workforces about ADOD; encourage the current public health workforce to apply knowledge to practice; and seek to improve health outcomes for those living with dementia, as well as their caregivers.
Assessment of Aging and Disability Concentration in a Master’s Program
Authors: Mulhorn Kristine 
Published: December 2020

Abstract
A concentration in aging and disability is an alternative concentration in our Master of Health Administration (MHA) program. Students to take both of their electives in this area as well as completing their residency in a post-acute care setting. To ensure students meet the learning objectives, the following assessment plan. First, a curricular map of the areas”” of competency within our program are outlined and then the content and areas of assessment are considered based on whether the competencies are “Introduced”, “Reinforced,” and “Mastered.” Next, the key assignments in each course within the concentration were aligned with the Program Objectives for the MHA Program. Another assessment strategy involves the competencies of the on-campus residency. A comparison of the competencies of the residency for those students who conducted their residency in the acute care setting to those competencies of the residency for the students who completed their residency in a post-acute setting. A final method for assessment is a review of the evaluations and the final paper for the residency. The residency is a capstone project in which students conduct analysis based on the operations management factors within the facility.
Development of Synthetic Health Records to Support Urban Planning for Healthy Aging
Authors: Liu Yuezhong , Theng Yin Leng 
Published: December 2020

Abstract
Urban planning for healthy ageing is about planning for ageing population, which considers the needs of older adults and communities during the planning process and the implications of decisions for human health and well-being. However, access to real electronic health record (EHR) data is hindered by legal, privacy, security, and intellectual property restrictions. The lack of freely distributable health records become one important issue for healthy ageing urban planning. This research develops a source of synthetic health records based on reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle chronic diseases for urban planning. Type 2 Diabetes Mellitus (T2DM) is used as a case study for proof of concept. This research methodology includes three steps: 1) Review and meta-analyse of the individual and built environmental variables related to the prevalence of T2DM. 2) Develop agent-based modelling and simulation for synthetic health records. 3) Evaluate the simulation result with standard healthcare file format in Geographic Information System (GIS) application. The pilot validation compares the annual prevalence of T2DM by age group and ethnicity with the public available health data. The simulation results roughly approximate age, gender and racial group at diagnosis curves (R2 = 0.876), it correctly generated more than 90% of patients for the all age group in Singapore. As a summary, these pilot validated synthetic records could be used as a risk-free (no privacy & security issues) data for supporting urban planning for healthy ageing.
Supporting Caregivers of Older Adults Through Education in Mindful Gratitude Practice
Authors: Lee Sungsim 
Published: December 2020

Abstract
This presentation describes a supportive mindfulness practice for caregivers of older adults based on the principles of Won Buddhism (an integrative, a modernized Buddhism). As the aging population grows, there is a significant increase in recognition of the negative impact of caregiver stress on older adults’ quality of life. The ability for caregivers to deal compassionately with stress is essential, as caring for older adults can awaken feelings about one’s own vulnerability and mortality. The ‘Mindful Gratitude Practice’ offers a way to cope with stress, cultivate self-care, and improve the care of others. Relevant research will be summarized, which shows mindfulness and gratitude practice respectively benefit positive influence in both physical and emotional well-being. Mindful Gratitude Practice as a spiritual approach that fosters caregivers' emotional stability, reduces their stress and improves the relationship between older adults and their caregivers. In this presentation, three processes of Mindful Gratitude Practice will be described: 1. Understanding a mindfulness practice by establishing intention, attention, and attitude, 2. Learning the principles of a gratitude practice and implementation, and 3. Incorporating mindfulness into a gratitude practice. Research results have demonstrated that through this learning process, caregivers have acquired the concept of interconnectedness, experience grateful moments, and a deep feeling of appreciation in their caregiving relationships. The presenter will guide participants in a short experience of Mindfulness Gratitude Practice. Further readings and resources will be provided for those who are interested.
Development and Evaluation of the Caring Ahead: Preparing for End of Life in a Dementia Questionnaire
Authors: Durepos Pamela , Kaasalainen Sharon , Ploeg Jenny , Sussman Tamara , Akhtar-Danesh Noori 
Published: December 2020

Abstract
A palliative approach is recommended in long-term care to support persons with dementia and help families prepare for end-of-life. Despite this, 50% of family caregivers of persons with dementia report feeling unprepared for death. A questionnaire is needed to assess caregiver death preparedness as an outcome measure for strategies within palliative care. A mixed methods design with qualitative and quantitative phases was used to develop and evaluate the ‘Caring Ahead: Preparing for End-of-Life in Dementia’ questionnaire. The questionnaire has 30 items organized into Medical, Relationship/Personal, Spiritual and Practical subscales with a 7-pt Likert response scale. To date, the questionnaire has been tested with 117 participants who are 61 years old on average, female (86%), adult children (77%) caring for a person with dementia in long-term care. The mean item score is 5.61 (SD 0.71). Participants report limitations in preparedness related to: 1) communication with healthcare providers about traditions and preferences for end-of-life care; 2) knowledge of the dying process and; 3) life purpose after death. A test-retest with 32 participants demonstrates a high degree of reliability; Intraclass Correlation Coefficient 0.91 (CI95%: 0.31-0.97). A moderate positive correlation between participant total scores and a single global preparedness item suggests concurrent validity, r=.66 (CI95%: 0.51-0.80). These findings will be used to refine the questionnaire and contribute a valuable measurement tool for clinicians, researchers and policy-makers working in palliative care.
COVID-19 Infections in Long-Term Care Facilities in Wuhan, China: Challenges and Lessons
Authors: Cai Yi , Wang Jing , Wu Bei 
Published: December 2020

Abstract
The impact of the COVID-19 infection on older residents and the direct frontline workers in long-term care (LTC) facilities in Wuhan, China deserves close attention. The fatality rate for older residents infected by the COVID-19 is among the highest in China Viral outbreaks are likely to occur in LTC facilities due to group-living arrangements, lack of precautionary measures, and older residents’ vulnerability to diseases. In this study, we aimed to explore different stakeholders’ experiences and challenges in the midst of the spread of the virus in LTC facilities. We conducted telephone interviews with four groups from two LTC facilities and two hospitals: twelve older residents (Four suspected cases and two infected), ten family members, four direct frontline workers (two infected), two nursing home managers, and four health care professionals working in the two hospitals that infected older residents were transferred to. We found that the gap in the transition of care quality between LTC facilities and local hospitals was widened during the COVID-19 outbreak. LTC facilities were slow to take precautionary measures and underprepared to handle the crisis after the infections occurred. The wellbeing of older residents was significantly impacted during the transition, particularly for those with dementia. Health care professionals in local hospitals were under tremendous stress providing treatments for older residents while ensuring their safety. There is an urgent need to improve transitional care and the capacity in preventing and handling this type of crisis for older residents in LTC.
Post-Acute Care for Medicare Beneficiaries in Accountable Care Organizations
Authors: Colligan Erin , Branand Brittany 
Published: December 2020

Abstract
Post-acute care (PAC) is a component of health-care utilization and spending that is subject to the discretion of providers. Prior research has demonstrated that Accountable Care Organizations (ACOs) recognize PAC as a logical target for increased efficiency and cost savings. As part of the evaluation of the Centers for Medicare & Medicaid Services (CMS) Next Generation ACO (NGACO) Model, we investigated NGACOs’ approaches to PAC services and the impact of these efforts on utilization and cost using a mixed-methods study design. We conducted interviews and surveys with NGACO leadership and providers and performed a difference-in-differences analysis of utilization and spending based on Medicare claims data. We found that NGACOs focused specifically on establishing partnerships with skilled nursing facilities (SNF) to facilitate transitions in care by establishing new channels of communication, sharing performance data, embedding staff in SNFs, and (in some cases) sharing financial risk. We observed a statistically significant decrease in SNF spending, a trend toward fewer SNF days, and statistically significantly lower expenditures for other PAC settings (e.g., inpatient rehabilitation and long-term acute care facilities). These findings suggest that NGACOs have contributed to improving transitions in care and diverting beneficiaries from intensive PAC settings. Nonetheless, the reduction in PAC spending alone did not translate to a decline in total cost of care. Future ACOs may need to expand their focus to the inpatient utilization and spending that precedes PAC in order to impact total cost of care.
Geographic Distance and Social Isolation Among Family Caregivers Providing Care to Older Adults
Authors: Li Lun , Wister Andrew 
Published: December 2020

Abstract
Family caregiving is associated with social isolation, but the role of geographic distance between caregiver and receiver in caregiving experience is unclear with mixed research findings. This study examined the relationship between geographic distance and caregiver social isolation (CSI), and explored the interaction between geographic distance and caregiving intensity in association with CSI. Based on the Ecological Model of Caregiver Isolation, hierarchical linear regression and ANCOVA analyses were applied to conduct data analysis with the 2012 Canadian General Social Survey (N=2,881). Caregivers living a short distance from receivers reported the lowest CSI than coresident, moderate and long distance caregivers. Being involved in higher intensity caregiving as the primary caregiver, undertaking more caregiving tasks, and providing care more frequently resulted in higher CSI scores. Additionally, long and moderate distance caregivers reported greater CSI than coresident and short distance caregivers only when providing higher intensity caregiving. Geographic distance is a salient contextual factor affecting CSI, and longer distance creates environmental barriers for caregiving provision. Employing a granulated measure of geographic distance positioned within an ecological framework facilitates an understanding of the nuanced association between geographic proximity and CSI. Furthermore, the identified interactive effects between geographic distance and caregiving intensity on CSI further reveal the complexity of caregiving experience. The findings are relevant for programs supporting caregivers in different contexts, especially physical distance.
Measuring Childlessness Among Middle-Aged and Older Americans
Authors: Xu Xiao , Liang Jersey , Kim BoRin , Raymo James , Ofstedal Mary Beth 
Published: December 2020

Abstract
Existing literature on childlessness among middle-aged and older Americans is sparse, and measuring childlessness is not straightforward for those with complex family histories. To address this knowledge gap, we examined data on 19,929 respondents age ≥50 from the 2016 Health and Retirement Study. All analyses accounted for complex sample design to generate nationally representative estimates. The proportion of respondents without children differed significantly depending on how “childless” was defined: 1) 14.9% (95% confidence interval [CI]: 13.9-15.9%) having no biological children, versus 2) 10.4% (95% CI: 9.5-11.3%) having no children/step-children that were living and in-contact. When measured based on absence of biological children, the prevalence of childlessness was higher in younger cohorts (17.7%, 13.2%, and 9.0% for age 50-64, 65-74, and ≥75 years, respectively, p&lt;0.001) and among more educated individuals (17.4%, 12.3%, and 9.6% for more than high school, high school, and less than high school education, respectively, p&lt;0.001). The prevalence of childlessness was also higher among men (16.7%) than women (13.2%) (p&lt;0.001) and among non-Hispanic whites (16.0%) than Hispanics (9.8%) (p&lt;0.001). Similar patterns, but lower prevalence, were observed when measuring childlessness based on absence of children/step-children that were living and in-contact. Although non-Hispanic whites (16.0%) were more likely than non-Hispanic blacks (13.0%) to have no biological children (p=0.007), a similar proportion of them had no children/step-children that were living and in-contact (10.8% versus 10.6%, p=0.06). Given fertility decline and growing family complexity, these findings help inform the structure of social support and long-term care needs of middle-aged and older Americans.
Who Masturbates? It Depends: Predictors of Masturbation by Gender and Partnership of Older Adults
Authors: Barrett Patricia , Burgess Elisabeth 
Published: December 2020

Abstract
Studies on masturbation often exclude older adults. While the frequency of masturbation is known to decline over the life course, research has neglected masturbation in older adulthood. In the adult population, the connection between partnered sex and masturbation has been well established; this relationship is mediated by individual’s contentment with their sex life. Furthermore, the sex/masturbation relationship is distinct by gender. This study seeks to understand how these relationships exist and influence masturbation among older adults. Using data from the third wave of the National Social Life, Health and Aging Project (NSHAP) (N=2,006), we completed logistic regressions to examine how sexual thoughts, frequency and contentment with partnered sex predict older adult’s likelihood of masturbating. Preliminary analyses, controlling for partnership status, gender, age, race, mental and physical health, indicate that frequent sexual thoughts (OR 4.52) and discontentment with sex frequency (OR 1.46), rather than frequent partnered sex, are significantly associated with an increased likelihood of masturbating in the year prior. Employing separate regressions for gender, bothersome sexual dysfunctions and higher depression scores were significantly associated with increased odds of masturbating for women, but not men. For partnered older adults, only those who reported relationships that were both physically and emotionally satisfying were less likely to masturbate (OR 0.54). To our knowledge, this is the first study that considers masturbation as a sexual behavior with distinct predictors by gender and partnership status. We conclude by discussing the implications of nuanced and varying sexual desires and behaviors among the older adult population.
Does Ageism Widen the Digital Divide? And Does It Vary by Gender?
Authors: Choi Eun Young , Kim Youngsun , Chipalo Edson , Lee Hee Yun 
Published: December 2020

Abstract
Existing literature informed that ageism might affect Internet use among older adults, further widening the digital divide among age groups. However, little empirical studies have been conducted on this topic. Our study aims to investigate (1) the current use of the Internet by gender, (2) the association between ageism and Internet use, and (3) potential gender differences. A cross-sectional data drawn from the 2016 Health and Retirement Study (HRS) was analyzed. Separate multiple regression analyses were conducted by gender to determine the varying impact of ageism on Internet use. We used two types of ageism (1) internal ageism (ingroup discrimination) and (2) external ageism (discrimination from external entities) to observe each type’s contribution to Internet use. About half of the sample (52% male and 54% female) reported using the Internet “daily,” while a quarter (26% male and 25% female) responded, “never/not relevant.” No significant differences between gender were found in levels of Internet use, the rates of external ageism, or the degree of internal ageism. A higher level of ageism was associated with a lower level of Internet use. Interaction effects between age groups and ageism varied across gender: external ageism had interaction effects on men’s Internet use whereas internal ageism showed significant results for women. Our findings suggest that ageism may influence Internet use and its impact differs by gender. Gender-tailored intervention strategies should be developed to help older individuals to diminish the adverse effects of ageism on Internet use.
Education and Literacy in the Digital Divide: Cross-National Comparison of East Asia and the USA
Authors: Yamashita Taka , Kim Giyeon , Liou Chih-ling , Ando Takatoshi , Liu Darren , Bardo Anthony 
Published: December 2020

Abstract
The disproportionate access to, and utilization of, modern information, communication and computer technologies in later life (or Digital divide) is widely recognized as a major problem in economically developed nations. Extant research has established that the digital divide is largely contingent on advanced age and socioeconomic status (e.g., educational attainment). Yet, most studies have exclusively focused on Western populations. Thus, the objective of this study was to examine patterns in the digital divide by educational attainment, and identify the role that basic skills (i.e., literacy) play in shaping cross-national differences. Internationally representative data of adults aged 45 years and older from Japan, South Korea, and the US were obtained from the Program for International Assessment of Adult Competencies (PIAAC). The PIAAC data include information on everyday digital technology use (e.g., computer device, email, online information and transactions), sociodemographic characteristics, and systematic literacy assessments (score 1-500). Based on results from weighted binary logistic regression models that used the moderator function, the effects of education on email use were significantly weaker (odds-ratio = 0.78, p &lt; 0.05) in Japan vs. US, but equivalent in Japan vs. South Korea (p &gt; 0.05). Additionally, education (odds-ratio = 1.22, p &lt; 0.05) and literacy (odds-ratio = 1.01, p &lt; 0.05) were consistent predictors a digital divide, and the effects of literacy were similar across all three nations (p &gt; 0.05). Theoretical explanations of findings and other results are discussed in cultural contexts.