bluuebunny/crossref_metadata_2025_split huggingface dataset:
NURSING HOME CULTURE CHANGE AND QUALITY OF LIFE AND HEALTH DEFICIENCIES: NATIONWIDE PANEL STUDY
Authors: Lepore Michael J , Lima Julie C , Clark Melissa A , Gozalo Pedro L , Miller Susan C 
Published: November 2019

Abstract
Transforming nursing home (NH) cultures—from impersonal institutions to enriching communities where residents and employees thrive—requires multifaceted change. NHs deploy an array of culture change (CC) practices, in three core domains: resident-centered care, staff empowerment, and physical environment. This study uses novel data on CC practice from a nationally representative panel of NHs (N=1,585) surveyed in 2009/2010 and 2016/2017. To understand how changes in practice adoption may relate to quality changes we linked longitudinal data on the CC practice domain scores for resident-centered care, staff empowerment, and physical environment and on NH deficiencies relating to health and quality of life (QoL) and combined these with Certification and Survey Provider Enhanced Reporting baseline data. Multinomial logistic regressions incorporating survey weights and inverse probability of weight (to address CC selection) estimated the relative risk ratios (RRR) of increased CC practice corresponding with NHs having fewer or no change in deficiencies, versus increased deficiencies. NHs with much increase in staff empowerment scores had a higher likelihood of no change (compared to an increase) in health deficiencies (RRR 2.0; 95% CI 1.15, 3.61) and severe health deficiencies (RRR 2.03; 95% CI 1.05, 3.93). With a RRR of 1.63, NHs with any improvement in resident-centered care scores appeared to have a higher likelihood of no change (compared to an increase) in QoL deficiencies but statistical significance was not reached (p=0.11). This study provides some support for the benefits of CC practices, and in particular, supports the importance of staff empowerment practices in NHs.
CONTEMPORARY EARLY RETIREMENT FACTORS AND STRATEGIES TO ENCOURAGE AND ENABLE LONGER WORKING LIVES
Authors: WILSON Donna M 
Published: November 2019

Abstract
Accelerating population aging is raising concern in many countries now about the availability of workers for essential work roles and responsibilities. A scoping research literature review was done to identify factors currently associated with early retirement and contemporary strategies to encourage and support longer working lives. Among 53 relevant articles, seven early retirement factors were revealed: Ill health, good health, workplace issues, the work itself, ageism, social norms, and having achieved personal financial or pension requirement criteria. Six solutions, none of which had been proven effective, were identified: Occupational health programs, workplace enhancements, work adjustments, addressing ageism, changing social norms, and pension changes. The evidence base on early retirement prevention is not strong, with qualitative research studies needed to gain a more in-depth understanding of early retirement influences and also mixed-methods studies needed to test early retirement prevention solutions for their effects, and particularly in the healthcare sector as healthcare needs typically rise with advanced ageing. Until more evidence is available, every healthcare and other organization should perform an early retirement risk assessment and identify current versus needed policies and programs to encourage and to enable more middle-aged and older people to work longer in life.
SKILLED NURSING FACILITY VALUE-BASED PURCHASING PROGRAM: DISPARATE IMPACTS
Authors: Gaudet Hefele Jennifer L , Wang Joyce , Lim Emily 
Published: November 2019

Abstract
In 2018, the federal government delivered the first round of incentive payments under the Skilled Nursing Facility (SNF) Value Based Purchasing (VBP) program. Incentive payments are based on post-acute readmissions performance. Facilities received payments that were either higher, on-par, or less-than typical. Our study sought to determine whether minority- and Medicaid-serving SNFs had the same likelihood of being among the top performers/incentive payment earners compared with SNFs serving more advantaged populations. We used publicly available data on SNF-VBP performance rankings available from CMS, linked to SNF characteristics publicly available from LTCFocus.org. Using logistic regression, our three analytic models examined the likelihood of being in the top 20% of SNF-VBP performance rankings among: SNFs in which the majority (&gt;50%) of residents are African American(AA)/Black; SNFs in which the majority of residents are Hispanic/Latino; and SNFs in which 85% or more residents are Medicaid-pay. Results show that AA/Black-serving SNFs have two-thirds the odds of being in the top 20% of rankings compared to SNFs where the majority of residents are White (OR: 0.667 p&lt;0.001). Hispanic/Latino-serving SNFs have less than half the odds (OR: 0.447 p&lt;.01). High-Medicaid SNFs have less than one-third the odds of being in the top compared to SNFs with no Medicaid-pay residents (OR: 0.271 p&lt;0.0001). Results are robust to alternate specifications of racial/ethnic and payer compositions. Lower payments to SNFs serving vulnerable populations is concerning, in that fewer resources may be available to these SNFs for patient care and quality improvement, which may result in creating or exacerbating disparities.
PREDICTORS OF LONGITUDINAL COGNITIVE DECLINE AMONG COMMUNITY-DWELLING KOREAN OLDER ADULTS
Authors: Shin Jinhee , Cho Eunhee 
Published: November 2019

Abstract
Objective This study aims to explore predictors to longitudinal decline of cognitive function in old adults in Korean. Methods The data were derived from the information system of the Korean Longitudinal Study of Aging (KLoSA) which performed nationwide aging panel survey for adults aged over 45 years between 2006 and 2016. The sample consisted of 1,262 older adults who completed K-MMSE. Of the total 1,262 participants, 752 had normal cognition, 243 had mild cognitive impairment, and the rest 267 had dementia. Variables from diverse dimensions were derived from the KLoSA. The linear mixed models were used to predict and explain predictors affecting cognitive function decline over time. Results The ADL and IADL, depression, exercise, and social activity were time-varying variables significantly related to the cognitive function of the older adults. Over time, difference in change of the K-MMSE score between three groups was significant. Conclusions This study identified predictors influencing decrease of cognitive function over time in older adults in Korea. Tailored intervention needs to be developed and implemented in order to delay the cognitive function decline. Improving physical function through regular exercise, increasing social activity, and managing depression by early detection and treatment are recommended according to the cognitive function status. Keywords: old adults, cognitive function, K-MMSE, predictor
OPTIC FLOW IMPROVES SPATIAL GAIT FUNCTIONING ESPECIALLY IN MEDIOLATERAL DIRECTION
Authors: Fallahtafti Farahnaz , Kim Hyeon Jung , Yentes Jennifer M , Venema Dawn , Boron Julie Blaskewicz 
Published: November 2019

Abstract
Instances where multiple tasks are completed simultaneously are considered high cognitive load situations (HCLS, also called dual-task), potentially affecting gait performance in older adults. Walking while talking is a common HCLS that requires additional cognitive resources. Optic flow (OF) provides visual information about speed and direction of self-motion, and thus, may ameliorate gait deficits under HCLS. This study aimed to identify the effect of HCLS, as well as OF, on gait performance in older adults. The HCLS included walking while talking on the phone, compared to walking alone. Fifteen older adults (70.86±4.7yrs) underwent four experimental conditions: walking alone with(1) and without OF(2), as well as walking while talking with(3) and without OF(4). Step width, step length, and double support time were measured and examined with 2(HCLS) x 2(OF) repeated-measures ANOVAs. There was a main effect of OF; step width was narrower with OF compared to without OF (p=0.048). For step length, there was a significant interaction between HCLS and OF (p=0.045). Without OF, there were no differences in step length; however, with OF step length was significantly longer when walking alone compared to when walking while talking (p=0.002). Double support time was not affected by HCLS or OF. Considering younger adults have longer and narrower steps compared to older adults, OF may have enhanced step width regardless of HCLS and step length when walking only. Using OF in training programs designed for older adults, could be a potential factor to improve spatial gait function, more so in the mediolateral direction.
NEIGHBORHOOD CONTEXT AND LATER-LIFE WELL-BEING: OBJECTIVE AND SUBJECTIVE INDICATORS
Authors: Webster Noah J , Mair Christine , Cutchin Malcolm 
Published: November 2019

Abstract
Neighborhoods are known to shape well-being across the life course, particularly in later life. Yet, neighborhoods remain an underutilized focus in public health interventions due to lack of measurement specificity and understanding of mechanisms across well-being outcomes. This symposium brings together four complementary papers from social work, sociology, and psychology that incorporate multiple (objective and/or subjective) indicators of neighborhood context from national to locally-based samples to predict diverse forms of well-being. Lehning and colleagues use objective (Census) indicators of neighborhoods from the National Neighborhood Change Database, combined with data from the National Health and Aging Trends Study (N=7,197), to explore links between changing neighborhood age composition and older adults’ self-rated health.. Sharifian and colleagues examine the associations between perceived neighborhood characteristics (social cohesion, physical disorder) and cognition directly and indirectly through mental health pathways (depressive symptoms, anxiety) using the Health and Retirement Study. Webster and colleagues examine links between objective (Census) and subjective (perceived safety) neighborhood indicators and social well-being using data from the Detroit-based Social Relations Study (N=259). Mair et al. combine objective neighborhood-level data with individual-level data from the Healthy Aging in Neighborhoods of Diversity across the Life Span dataset to examine direct and indirect effects of neighborhood context on obesity risk among N=2,707 middle-age and older Baltimore City residents. These papers will be discussed by Malcolm Cutchin, a health geographer and social gerontologist, who will provide an interdisciplinary reflection of neighborhood measurement and use neighborhoods as a platform to promote diverse forms of well-being in later life.
REAL-WORLD REPRESENTATIVENESS OF CANADIAN RESEARCH SUBJECTS WITH MILD COGNITIVE IMPAIRMENT
Authors: Huang Vivian , Hogan David B , Ismail Zahinoor , Maxwell Colleen J , Smith Eric E , Callahan Brandy L 
Published: November 2019

Abstract
Studies of mild cognitive impairment (MCI) utilize stringent inclusion/exclusion criteria which may impact the generalizability of findings to the broader clinical population. We compared characteristics of MCI patients in a Canadian memory clinic in Calgary to MCI research participants in published Canadian studies to assess the representativeness of research samples. Clinic participants included 555 MCI patients from the Prospective Study for Persons with Memory Symptoms registry. Research participants included 4,981 individuals with MCI retained from a systematic literature review of 112 peer-reviewed empirical Canadian studies. Clinic patients and research participants were diagnosed with MCI using similar diagnostic criteria (i.e., from the NIA-AA, or Petersen criteria). Both samples were compared on baseline demographic variables, medical and psychiatric comorbidities, and global cognitive performance using chi-square tests and t-tests with weighted means. Diverse presumed causes were noted among clinic patients. Clinic patients were younger, more likely to be male, and more educated than research participants (ds: 0.22-0.98). Psychiatric disorders, traumatic brain injury, and sensory impairments were common in clinic patients (up to 83%), but participants with these conditions were excluded from approximately 80% of studies in the systematic review. Clinic patients performed significantly worse on two global cognitive assessments (ds: 0.53 – 1.27). Stringent eligibility criteria such as used in Canadian MCI research studies would exclude a considerable subset of MCI patients seen in our referral clinic. This may have contributed to the disparities between the clinical and research cohorts in the cognitive measures examined. The implications of these findings will be discussed.
FACTORS PROMOTING CONTINUED LIFELONG LEARNING: FOCUS ON THE PERSON-ENVIRONMENT FIT IN JAPAN
Authors: Yasuzato Chiharu , Katagiri Keiko 
Published: November 2019

Abstract
Lifelong learning of older people is categorized as social participation. Most studies on social participation have examined the motivation to start; however, those on continuing participation are few. This study aimed to identify the factors promoting continued lifelong learning among older adults, focusing on both personal and socio-relational factors. To do this, in-depth semi-structured interviews were conducted with 20 Japanese citizens, aged 60-75, with a learning experience of more than 3 years. Results showed that both personal and socio-relational factors matter. First, personal factors include older adults’ past learning experience, access to learning in the present, and work status. Past learning experience relates to their perception as students and their memories of learning during school age. Regarding accessibility, classes within walking distance, for example, would help in continuation of learning, especially for people with health problems. People may choose to become involved in learning activities after retiring from the workforce and they have time to spend. Second, the importance of socio-relational factors was evident in how family supported older people by accepting how important learning was for them and offering them rides to the classes. Within the class, they can share information about the happenings and activities in their community, become mentors, and stimulate each other. The instructor enhances their enthusiasm to learn and provides a comfortable learning space. Therefore, the findings of this study suggest that while there is no single condition, a person-environment fit promotes older adults continued learning.
NEIGHBORHOOD ENVIRONMENTS AND OBESITY: EXPLORING PATHWAYS TO RISK OF CARDIOVASCULAR DISEASE
Authors: Mair Christine , Lehning Amanda , Mattocks Nicole , Kim Kyeongmo , Millar Roberto , Evans Michele K , Zonderman Alan B , Waldstein Shari 
Published: November 2019

Abstract
Modifying neighborhood environments to target well-established risk factors for cardiovascular disease may reduce health disparities by complementing clinical services. Prior research, however, includes limited measures of neighborhoods and does not adequately account for individual-level processes known to mediate health outcomes. We combine baseline data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) dataset with neighborhood-level data to yield a diverse sample of Black and white middle-aged and older residents of Baltimore City (N=2707). We use structural equation modeling to examine associations between neighborhood environments and obesity (BMI&gt;=30), focusing on individual-level mediators. Initial direct associations between neighborhoods and obesity (e.g., presence of businesses, β=-0.062) are mediated by healthcare access and health behaviors. Additional indirect pathways exist through health behaviors (e.g., neighborhood disorder, access to parks). These findings highlight the importance of considering indirect pathways to cardiovascular health promotion among aging adults in different neighborhood contexts.
ANXIETY AND DEPRESSIVE SYMPTOMS MEDIATE THE LINK BETWEEN PERCEIVED NEIGHBORHOOD CHARACTERISTICS AND COGNITION
Authors: Sharifian Neika , Sharifian Neika , Zaheed Afsara B , Spivey Briana N , Zahodne Laura B 
Published: November 2019

Abstract
Although prior research has linked perceived neighborhood characteristics to cognition, scant research has investigated underlying mechanisms regarding how neighborhood characteristics impact cognition. One pathway, in particular, may be through mental health outcomes. Poorer neighborhood characteristics have been independently linked to greater depressive and anxiety symptoms, which may, in turn, be risk factors for cognitive decline in later life. The current study examined direct and indirect effects of perceived neighborhood characteristics (social cohesion, physical disorder) on cognitive functioning (episodic memory, executive functioning) through anxiety and depressive symptoms using longitudinal data from the Health and Retirement Study (2010–2014). Results revealed that higher social cohesion was associated with better memory and executive functioning through lower anxiety and depressive symptoms. Physical disorder was associated with worse episodic memory and executive functioning through greater anxiety symptoms. These findings highlight the importance of neighborhood context for promoting both mental and cognitive health outcomes in older adulthood.
ARE FAMILY RELATIONSHIPS A PROTECTIVE RESOURCE AMONG ADULTS WITH FUNCTIONAL IMPAIRMENT?
Authors: Chunga Richard E , Wang Haowei , Carr Deborah 
Published: November 2019

Abstract
Health-related declines that affect physical functioning are a common stressor among older adults. Functional impairment can take a toll on older adults’ psychological well-being as it limits one’s capacities to independently carry out meaningful daily activities. The extent to which impairment affects mental health may vary based on the levels of support and strain in one’s personal relationships. Stress buffering perspectives suggest that support mitigates the detrimental psychological consequences of impairment, whereas stress amplification perspectives predict that strain will amplify these consequences. We use data from 2012 and 2016 waves of the Health and Retirement Study (N=3800) to explore: (a) the direct effects of functional limitation on depressive symptoms (CES-D); (b) the extent to which these associations are moderated by spouse, child, other relative, and friend support/strain; and (c) gender and marital status differences therein. Using lagged endogenous regression models, we find that impairment significantly increases depressive symptoms among men and women, and these effects are intensified by marital strain for both married men and women. However, buffering effects are found for women only, such that marital support mitigates against depressive symptoms in the face of current impairment. These results may reflect the gendered nature of marriage, where men with impairment uniformly benefit from marriage although women may experience protective effects of only in highly supportive unions. Results for other strain and support moderators also reveal gender differences, reflecting the distinctive ways that men and women interact with kin and friends over the life course.
GRANDPARENTS’ PERSPECTIVES ON A MULTIGENERATIONAL DIGITAL HEALTH PHYSICAL ACTIVITY INTERVENTION
Authors: Kobayashi Marissa , Leite Rafael O , Lugo Isabella , Wetstone Rachel , Vanegas Dario , George Sara M St , Czaja Sara J 
Published: November 2019

Abstract
Studies examining associations among grandparents’ involvement and grandchildren’s lifestyle behaviors have been largely mixed or negative highlighting the need for interventions that help grandparents promote grandchildren’s healthy behaviors. The current study explored older adults’ interest in participating in a digital intervention with their grandchildren. As part of the intervention, grandparents and grandchildren would engage in weekly walks and use a mobile application to track their steps, photos and conversations. Twelve grandparents (63±6.5yrs; 75% female; 50% Hispanic) participated in qualitative interviews. Researchers asked open-ended questions to assess grandparents’ relationships with their grandchildren, motivation to participate, and feedback on prototypes. A 10-item systems usability questionnaire was also administered. Three researchers independently analyzed interview transcripts using a rapid assessment approach and reached consensus on key themes. Grandparents described having positive relationships with their grandchildren and used texts to schedule time with them; family dynamics (conflicts, divorce) influenced the amount of time they spent together. Grandparents’ motivation for participating in the intervention included the opportunity to enhance their relationship with their grandchild and improve their own health. Grandparents noted weekly walks would feasibly occur on the weekends given their grandchildren’s competing activities. They were receptive to proposed weekly session topics (e.g., sports/hobbies, ancestry, humor) and suggested other topics to discuss during weekly walks, such as faith/religion, morality, safety, and nutrition. They strongly agreed or agreed that they would use the prototypes frequently and found them easy to use (83% and 92%, respectively). Results from this study will inform the next iteration of intervention prototypes.
OLD AND FORGOTTEN? CARE FOR ELDERS IN MEXICO AND THE U.S.
Authors: Aguila Emma , Angel Jaqueline L , Markides Kyriakos 
Published: November 2019

Abstract
The United States and Mexico differ greatly in the organization and financing of their old-age welfare states. They also differ politically and organizationally in government response at all levels to the needs of low-income and frail citizens. While both countries are aging rapidly, Mexico faces more serious challenges in old-age support that arise from a less developed old-age welfare state and economy. For Mexico, financial support and medical care for older low-income citizens are universal rights, however, limited fiscal resources for a large low-income population create inevitable competition among the old and the young alike. Although the United States has a more developed economy and well-developed Social Security and health care financing systems for the elderly, older Mexican-origin individuals in the U.S. do not necessarily benefit fully from these programs. These institutional and financial problems to aging are compounded in both countries by longer life spans, smaller families, as well as changing gender roles and cultural norms. In this interdisciplinary panel, the authors of five papers deal with the following topics: (1) an analysis of old age health and dependency conditions, the supply of aging and disability services, and related norms and policies, including the role of the government and the private sector; (2) a binational comparison of federal safety net programs for low-income elderly in U.S. and Mexico; (3) when strangers become family: the role of civil society in addressing the needs of aging populations; and (4) unmet needs for dementia care for Latinos in the Hispanic-EPESE.