bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coping Styles and Stroke Knowledge Mediate the Effect of Social Support and Uncertainty Among Stroke Patients
Authors: Zhang Humin , Gao Jie , Sun Yuyan , Han Ziting 
Published: December 2020

Abstract
Objectives:This study aimed to investigate the mediating roles of coping styles and stroke knowledge between social support and uncertainty in illness among patients with primary stroke in China. Methods:The total of 204 Chinese primary stroke patients recruited using convenience sampling were asked to answer Mishel Uncertainty in Illness Scale for Adult(MUIS-A), Stroke Knowledge Questionnaire(SKQ), Social Support Rating Scale(SSRS), and Medical Coping Modes Questionnaires (MCMQ). Demographics characteristics of the patients were presented using descriptive statistics. We reported the relationship between the study variables using Pearson’s Correlation Coefficients. We performed structural equation modeling to estimate the mediator effect of coping styles and stroke knowledge between social support and uncertainty in illness.Results: The results showed that 92% of patients with primary stroke had moderate above level of uncertainty in illness, with a mean score 75.04 (SD=9.61).Uncertainty was positively associated with coping styles (r=0.232, P＜0.01), and negatively associated with social support(r=-0.237, P＜0.01) and stroke knowledge (r=-0.386, P＜0.01).The structural equation model indicated that the coping styles(19.8% of total effect) and stroke knowledge (38.5% of total effect)respectively acted as mediator role between social support and uncertainty in illness.Conclusions:Most patients with primary stroke present moderate above level of uncertainty in illness. stroke knowledge and coping styles were important mediating factors in the pathway between coping styles and uncertainty in illness. Our findings suggest the provision of stroke knowledge and training of coping styles for patients with primary stroke could alleviate their uncertainty in illness.
Emotional Health and Mortality of Older Parents of Children With Serious Developmental Disabilities
Authors: Hoyle Jessica , Laditka Sarah , Laditka James 
Published: December 2020

Abstract
Caring for a child with serious developmental disability (SDD) involves stress as parents age and anticipate the child’s future welfare. There are few studies of older parents of children with SDD. We followed parents for 18 years using the Panel Study of Income Dynamics (PSID). We defined SDD as: (1) autism, intellectual disability, learning disorder, epilepsy with seizures, attention deficit disorder/attention deficit hyperactivity disorder, or cerebral palsy; requiring (2) qualification for services and serious lasting impairment evidence. We used the PSID and its Child Development Supplement (1997-2007, 2014), linking children’s and parents’ data, with 5,780 parent-child dyads and 45,534 analytic observations. Parent outcomes included physician-diagnosed anxiety or depression, psychological distress (Kessler K6), and death. Discrete-time hazard analysis controlled for child and parent characteristics, and survey design. We identified parents of: Group 1, children without SDD or challenging behaviors; Group 2, SDD without challenging behaviors; Group 3, challenging behaviors without SDD; Group 4, SDD with challenging behaviors. Among parents ages 60+ and compared to Group 1, Group 2 through 4 odds ratios for anxiety/depression were, respectively, 1.28 (95% confidence interval, 0.63-1.92), 1.79 (1.35-2.24), and 2.62 (2.25-2.99), p-trend &lt;.0001. Group 4 mental health risks were particularly high when children lived with the older parent: for anxiety/depression OR 6.75 (3.00-15.21), and distress OR 8.83 (3.58-21.77). At ages 60+ mortality was higher for parents of children with SDD (relative risk, RR 2.38, 1.21-4.67), especially Group 4 (RR 4.64, 1.39-15.47). Parents of children with developmental disabilities need emotional support, respite, and interventions addressing challenging behaviors.
Comparing Elder and Child Abuse Prevention Approaches in Japan: Strategies for Reducing Elder Abuse
Authors: Katsumata Asako , Tsukada Noriko 
Published: December 2020

Abstract
This paper examines trends in elder abuse cases (types of abuse, traits of abusers, victims and their relationships, levels of disabilities and dementia of victims, etc.) by using longitudinal data (2012-2018) collected by Japan’s Ministry of Health, Labour and Welfare since its enforcement. Considering these trends, this paper then compares the Elder Abuse Prevention Law to the Child Abuse Prevention Law to assess differences in policy and program provisions and how those relate to successful prevention outcomes. For example, while reports for both elder abuse and child abuse cases have been increasing, governmental actions taken in response have varied. The Child Abuse Prevention Law has been modified 6 times since its enactment based on abuse cases, but no amendments have been made for Elder Abuse Prevention Law based on case or evaluation data. Moreover, there have been many public awareness campaigns for child abuse prevention, but none for elder abuse prevention. These efforts appear to have positive outcomes including increased reporting of child abuse to police. This analysis aims to compare abuse data, abuse laws and public health efforts for children and older adults in Japan. Findings seek to identify disparities and areas where the public approach to child abuse can inform and strengthen elder abuse policies and programs.
Childhood Trauma and Adult Psychological Adjustment: Resilience in Older Adult Survivors of Institutional Abuse
Authors: Gee Shauna Mc , Maercker Andreas , Carr Alan , Thoma Myriam 
Published: December 2020

Abstract
Several international cohorts of older adults share past experiences of welfare-related adversity. In Ireland, reports of childhood maltreatment, neglect, and abuse within institutional welfare settings included a harsh regime, childhood labour, and physical and sexual assault. Preliminary research with these Irish survivors revealed a high prevalence of psychological disorders in adulthood. A pathological perspective of aging is often applied to such older adults, due to the long-term health consequences associated with childhood trauma. However, little is known about later life resilience or resilience mechanisms in this population. Therefore, using conceptual models of resilience, this qualitative study aimed to investigate factors associated with resilience in older adult survivors of childhood institutional abuse. Participants were 17 Irish older adults, 50-77 years of age, with experiences of childhood abuse in institutional care settings. Semi-structured interviews were conducted, lasting 60-120 minutes. Transcribed interviews were analysed using the Framework Analysis method. Nine themes were derived from the data, including core, internal, and external resilience factors: Individual characteristics, personality characteristics, support systems, goal attainment, adaptive belief systems, processing, influential events and experiences, recognition and collective identity, and access to services. Results suggest that resilience can be understood not only as an inherent trait, but also as a learnable set of behaviours, thoughts, and attitudes, which can be supported by external resources in an older adults’ environment. The identification of personal and contextual factors underpinning resilience in older adults with trauma experiences may help foster a more positive, strengths-based approach to aging in psychological research and practice.
Assistive Relaxation Therapy for Older Adults With Insomnia and Mild Cognitive Impairment: A Pilot Study
Authors: McPhillips Miranda , Li Junxin , Ward III E John , Gooneratne Nalaka 
Published: December 2020

Abstract
Insomnia symptoms are prevalent in older adults with mild cognitive impairment (MCI) and can pose treatment challenges. Our objective was to test the preliminary efficacy of tablet-based assistive relaxation therapy (ART) to improve insomnia symptoms in community-dwelling older adults with MCI. ART involves breath-based relaxation techniques coupled with a physical anchoring task to redirect thoughts and disengage from pre-sleep anxiety-provoking cognitions. Using a pilot randomized controlled non-crossover design, 20 participants recruited from one urban adult day center were allocated in a 1:1 ratio to intervention or education only control group for a treatment period of two weeks. Our final sample (n=20) was balanced on all demographic and clinical variables and consisted of Black (100%), female (75%), older adults (mean age 68.85 ± 7.29) with mean Montreal Cognitive Assessment scores of 21.2 ± 2.48. All participants at baseline had insomnia symptoms (mean Insomnia Severity Index (ISI) score 15.8 ± 3.78) and poor sleep quality (mean Pittsburgh Sleep Quality Index (PSQI) score 12.95 ± 0.70); half had daytime sleepiness (Epworth Sleepiness Scale (ESS) score 10.15 ± 1.07). Compared to baseline, participants improved on ISI (9.83 ± 1.32; p=0.0002), PSQI (9.11 ± 1.02; p=0.0016) and ESS (8.17 ± 0.86; p=0.08). The intervention group had statistically significant mean change scores on ISI compared to the control (-7.5 ± 1.37 vs. -3.88 ± 1.48; p=.0461). There were no statistically significant between group differences on PSQI or ESS. Our preliminary results suggest ART therapy is an effective treatment for insomnia symptoms in older adults with MCI.
Decreasing Social Support Associated With Risk of MCI and Dementia Is Partially Mediated by Hippocampal Volume
Authors: Gruenewald Tara , Petkus Andrew , Wang Xinhui , Youan Diana , Gatz Margaret , Espeland Mark , Chen Jiu-Chiuan 
Published: December 2020

Abstract
Less supportive social relationships are linked to greater risk of cognitive decline in older adulthood. Few studies have examined if declines in social support predict risk of developing Mild Cognitive Impairment (MCI) or dementia and the neurobiological factors that may contribute to these associations. We analyzed data from 926 women in the Women’s Health Initiative Memory Study-MRI (WHIMS-MRI) to examine whether low social support at baseline and declines over an 8-year period predicted subsequent risk of developing MCI/dementia. Social support (Medical Outcomes Study Social Support Scale) was self-reported at the baseline (1994-1998) and closeout (2004-2005) of the parent WHI hormone therapy clinical trial. Annual neuropsychological assessments were conducted in WHIMS (through 2018) to ascertain incident MCI/dementia; structural brain scans were performed in 2005-2006. Structural equation models assessed the association between level and change in social support and risk of incident MCI/dementia and putative mediation of these associations by structural brain variables in women free of MCI/dementia as of the trial closeout, adjusting for demographic, lifestyle, depression, and biomedical covariates. Both low baseline social support (HR=1.24 per 1-SD; p&lt;.05) and declines in support (HR=1.18 per 1-SD; p&lt;.05) predicted incident MCI/dementia risk. Women reporting decreasing social support had significantly lower hippocampal volumes (β=-.070; p&lt;.05) which accounted for ~14% of the total effect of declining support on MCI/dementia risk. We will highlight the implications of these findings for understanding how changes in social support may be linked to risk of MCI/dementia, including potential bidirectional associations of changes in social support and neurobiological health.
Age-Friendly Environment, Social Support, Sense of Community, and Loneliness of Korean Adults
Authors: Kim Miri , Chung Soondool 
Published: December 2020

Abstract
Abrupt industrialization, urbanization, and the emergence of the nuclear family have contributed to the increase of single-person households, placing an emphasis on individualization in society. Because of such changes, more people are living alone and feeling lonely, alienated from society and family. This research examined the association between loneliness and age-friendly environment, a community equipped with policies, settings, services, and structures that promote active ageing and aging-in-place, with the mediating roles of social support and sense of community. The study analyzed a total of 590 respondents aged 45 and above using data from the age integration survey conducted by the OO Research Institute of South Korea. Structural equation modelling and the bootstrapping method were applied. Age-friendly environment was positively associated with social support (β=0.310,p=0.000) and sense of community (β=0.486,p=0.000). Social support was negatively associated with loneliness (β=-0.195,p=0.000). The full mediation effect of social support was observed in the pathway from age-friendly environment to loneliness (95% CI = [̶ 0.112, −0.028]). Social support was fundamental in lowering loneliness, and age-friendly environment could only reduce loneliness by following a pathway that enhances social support. In other words, despite how well an age-friendly environment is established, it would not decrease an individual’s loneliness unless it also enhances social support level. This finding sheds importance in maintaining satisfactory relationships that enable sharing of feelings, and fulfilling emotional and social needs in lowering loneliness. Measures to increase social support level within community are suggested.
Development of a Novel Measure of Informal Caregiver Burnout
Authors: James Nicholas , Paulson Daniel 
Published: December 2020

Abstract
Burnout is a concept which has permutated most settings over recent decades. However, due to its roots in occupational research there exists both theoretical and practical gaps to consider when measuring burnout within non-occupational settings, such as informal caregiving. This study developed and validated a measure of burnout for informal caregivers of individuals with Alzheimer’s disease and dementia, the Informal Caregiver Burnout Inventory (ICBI). Theoretical and methodological implications are discussed. Development included a 10-step method for scale development proposed by Boateng and colleagues (2018). Expert feedback on item appropriateness and clarity was collected from 33 caregivers or related professional experts and used to modify the original item-bank. Following this, a national sample of 255 current caregivers was gathered. This survey included the ICBI, two gold-standard measures of burnout, and measures of depression and caregiver burden. Item reduction analysis was used to remove items with poor item-total and inter-domain correlations. The ICBI shows good item-agreement (Cronbach’s alpha= .88) and principles of Item Response Theory were used to measure item- and scale-wide information captured. Convergent validity was then compared against other measures of burnout using Bland-Altman Plots. Divergent validity was similarly assessed by comparing the ICBI to a depression questionnaire. Finally, the predictive validity of each burnout measure was compared to their association with burden and depression. This study suggests that the ICBI may perform adequately as an index of caregiver burnout, and thus is address a methodological and clinical gap in current efforts to understand the dynamics of caregiving.
Utilization of an Integrated Medicare Advantage Model Is Positively Associated With Medication Adherence
Authors: Smith-Ray Renae , Singh Tanya , Robson Chester 
Published: December 2020

Abstract
An estimated 30% of U.S. healthcare costs are due to waste, inefficiencies, and excessive pricing. Research shows that integrated primary care models (IPC) improve health outcomes and reduce costs. Nearly all IPCs embed ancillary clinicians, including pharmacists, within the clinic. IPCs that embed a primary care clinic within a pharmacy are novel. This study describes the first known IPC for older adults that is based in a pharmacy and examines its impact on medication adherence. In January 2018, Walgreens launched an IPC focused on Medicare Advantage patients at select Kansas City Walgreens locations. Each morning the entire IPC team meets to review needs of patients who will be seen that day. Upon arrival, the patient is first seen by a pharmacist who completes medication and immunization reviews and fall risk screening. If a new medication is prescribed during the physician visit, the pharmacist returns to consult the patient. The IPC team works together to ensure that the Medicare Annual Wellness Exam is completed in entirety. We examined the impact of IPC utilization on adherence to the top seven chronic condition drug groups. IPC patients age 50+ with sub-optimal adherence (&lt;80% proportion of days covered) during the year prior to the clinic opening were included (n=64). A Student’s t-test revealed an 11% improvement in optimal adherence year-over-year between the pre- and post- periods (p&lt;0.001). The pharmacy-based IPC is associated with improved medication adherence. Future research should examine the impact of this model on patient satisfaction and additional health outcomes.
Older Adults’ Adoption of Mobility Devices: Interplay of Predisposing Factors and Precipitating Health Events
Authors: Sharmin Farhanaz , Sands Laura 
Published: December 2020

Abstract
Existing mobility limitations and chronic conditions increase likelihood of adopting mobility-related devices such as canes and walkers. Prior research has not considered how recent acute events such as falls and hospitalizations contribute to the adoption of mobility devices. We studied 4,592 older adults who responded to the 2015 and 2016 National Health and Aging Trends Study surveys, and classified adoption of mobility devices as: (i) Never users (did not use mobility devices either year) and (ii) New users (started using mobility devices in 2016). We determined through chi-square tests, that predisposing characteristics from 2015 that were significantly associated with being a New User in 2016 were: being female, aged 80+, minority race, having a high-school education or lower, living alone, being obese, and having a history of dementia, arthritis, stroke, mobility difficulties, falls, and hospitalization (all P’s&lt;0.05). We used logistic regression to determine the contribution of recent precipitating events on the adoption of mobility devices among older adults after controlling for 2015 characteristics that were significantly associated with being a New user. Precipitating events were significantly associated with being a New user of mobility equipment. Specifically, older adults who, between the 2015 and 2016 interviews, experienced a fall (OR=1.7; 95% CI=1.1-2.9), hospitalization (OR=3.7; 95% CI=2.3-5.9) or increase in mobility difficulties (OR=3.7; 95% CI=2.3-5.9) were more likely to be New users. Study findings reveal the importance precipitating events on the adoption of mobility devices, signaling the importance of assessing for need for mobility devices after these events.
Influence Factors and Life Satisfaction of Types of Older Adults’ Daily Time Use Using Latent Profile Analysis
Authors: Chae Joosuk , Nam Seok In , Won Haesol , Lee Juyoung 
Published: December 2020

Abstract
The purpose of this study is to divide the daily time use of older adults into types, examine the influence factors of each type, and verify the difference in life satisfaction between types. We used a total of six variables, three variables (essential, compulsory, and leisure time use) for weekdays and the same three variables for weekends. We used data from the sixth wave of the Korea Retirement and Income Study (n=3,993). Latent Profile Analysis was used to classify the older adults’ (aged 65 and over) types of daily time use, resulting in a division into three types: essential activity-centered (16%), leisure-centered (26%), and balanced (58%). The weekend and weekday activities of each group did not differ. Compared with the balanced type, the significant factors of the essential activity-centered type were age (p&lt;.01), work status (p&lt;.001), and chronic disease (p&lt;.001). In addition, the significant factors of the leisure-centered type were age (p&lt;.05), gender (p&lt;.05), subjective health (p&lt;.001), work status (p&lt;.001), and chronic disease (p&lt;.001). Life satisfaction was lowest in the essential activity-centered type and highest in the balanced type; differences between the groups were identified (p&lt;.000). Based on the results, we discuss practical interventions and the development of psychosocial programs for older adults. For the essential activity-centered type, living support is required because they spend more time sleeping and eating. In addition, we proposed the preparation of leisure programs applicable to the needs of older adults’ of the leisure-centered type, since their life satisfaction was lower than the balanced type.
Psychosocial Mechanisms of Successful Aging Among Older Women Living With HIV: A Structural Equation Model
Authors: Rubtsova Anna , Wingood Gina , Ofotokun Igho , Gustafson Deborah , Vance David , Sharma Anjali , Adimora Adaora , Holstad Marcia 
Published: December 2020

Abstract
Although older women living with HIV (OWLH) face challenges related to the intersection of HIV and aging, our published research found significant prevalence of self-rated successful aging (SRSA) in a sample of OWLH enrolled in the Women’s Interagency HIV Study (WIHS). Studies in other populations link SRSA to positive psychosocial factors but little is known about SRSA mechanisms among OWLH. The purpose of this study is to test a conceptual psychosocial model of SRSA. Our sample (N=356) included OWLH enrolled in WIHS who participated in the “From Surviving to Thriving” (FROST) substudy and completed psychosocial and cognitive assessments: average age 56.5 years, 73% Black, 55% with annual income ≤ $12,000, 74% having 3 or more comorbidities, median CD4=673 cells/ml (Q1=486; Q3=880). SRSA was assessed using a research-based 10-point scale (higher scores=better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables -- protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and negative affect (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ2(65)=72.3, p=0.25; RMSE=0.02; CFI=0.99) and explained 21% of variance in SRSA. Increased protective attributes were associated with improved SRSA both directly (p&lt;0.01) and indirectly, via improved coping with stress (p&lt;0.001). While negative affect did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes (p&lt;0.001). Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors to promote SRSA among OWLH.