bluuebunny/crossref_metadata_2025_split huggingface dataset:
STAYING ENGAGED: A TAILORED COMMUNITY PROGRAM FOR PEOPLE LIVING WITH DEMENTIA AND THEIR FAMILY CAREGIVERS
Authors: McGhan Gwen , Shapkin Kimberly , Alpaugh Whitney , Cyr Jessica Power 
Published: November 2019

Abstract
Tailored care strategies have potential to address declines in physical and cognitive functioning for people living with dementia (PLWD) while making a positive difference in their daily lives; however, these services are not commonplace. As dementia progresses, PLWD become more dependent upon caregivers, increasing caregiving strain and negatively affecting their ability to provide support. The purpose of this study is to examine the feasibility of a tailored community dementia program (TCDP) prescribed for individual abilities of PLWD and measure the impact on the caregiving dyad. A mixed method design was used for a 12-week TCDP with 8 dyads living in the community. Recreational therapy and exercise physiology specialists led the cognitive and physical components of the program. PLWD and caregivers completed assessments at baseline, 6, 12 and 18 weeks. Daily activity was measured in PLWD with no decline observed during the assessment period. Measurements for family caregivers included caregiver strain, satisfaction and assessment of the PLWD’s abilities. Although quantitative findings were not significant, caregivers praised the program in the follow-up focus group with one commenting that “it is important for the mental health of the family and for the patient to keep them active…and (for) socialization”. Another caregiver wrote in their journal “I feel he has really benefited from this program. It keeps him engaged with people and I do think he is more fit”. Overall the TCPD shows promise as a meaningful intervention. Cohort 2 begins in summer 2019 and will implement changes suggested by the caregiving dyads.
SCREENING FOR VISION AND HEARING LOSS IN OLDER ADULTS WITH DEMENTIA: A FEASIBILITY STUDY
Authors: McGilton Katherine , Höbler Fiona , Reed Marilyn , Labreche Tammy , Pichora-Fuller M Kathleen , Shoemaker Valerie , Wittich Walter 
Published: November 2019

Abstract
Sensory loss accounts for one of the most common chronic conditions among older adults, with hearing loss affecting half of adults aged over 65 years and vision loss almost one fifth of those aged 70 years and over. Together, dual sensory loss is found to be most prevalent in older adults with dementia. The highest prevalence is found in long-term care (LTC) settings. For this reason, we conducted a multi-stage study to identify the most effective vision and hearing screening tools for use with older adults living with dementia and to evaluate their feasibility of use by nurses working in LTC. We first conducted a comprehensive review of the literature, and supplemented this with an environmental scan of healthcare professionals and sensory specialists working with older adults who have dementia. Following this extensive review and consultative decision-making process, a package of vision and hearing screening tools was selected for use by nurses working in LTC. On-site training was provided by two experienced audiologists and optometrists, after which the feasibility of sensory screening by three nurses of 17 residents under their care was evaluated. We report on the six measures of hearing and seven measures of vision that were piloted for screening of older adults with dementia living in LTC, and on the findings for their feasibility of use by nurses working in this setting. Recommendations regarding the feasibility and reliability of screening for vision and hearing loss in older adults with dementia are discussed.
CONSEQUENCES OF ECONOMIC HARDSHIP AND SELF-RATED HEALTH AMONG OLDER ADULTS
Authors: Li Yang , Mutchler Jan 
Published: November 2019

Abstract
Adequate economic resources ensure that older adults’ basic needs are met and facilitate a healthier lifestyle. Hardship signals unfulfilled needs experienced by individuals lacking adequate economic resources. Despite well-documented associations between indicators of hardship and self-rated health, little is known about whether hardship has the same impact on self-rated health across age groups. The purpose of this study was to investigate the association between hardship and self-rated health among older adults and determine whether this association differed by age. Employing data from the 2014 Survey of Income and Program Participation, we conducted logistic regression analysis to examine the association between hardship and self-rated health among adults age 55 and older in the United States, and the moderating effect of age on this relationship. Analyses were weighted using replicate weights provided by the survey. Indicators of hardship were dichotomized (1 = experienced hardship, 0 = no hardship). Analyses indicated that individuals who were unable to pay utility bills, unable to pay rent or mortgage, or who experienced food insecurity had lower odds of reporting good/very good/excellent health relative to those not experiencing these hardships. The association between hardship and self-rated health was shown to be less substantial among the oldest cohort (age 75 and older) relative to younger adults. Hardship is directly relevant to health outcomes as it represents the consequence of unfulfilled needs experienced by individuals lacking adequate economic resources. This study contributes to our understanding of the role of age in the association between hardship and self-rated health.
BEHAVIORAL DESIGN: A NOVEL APPROACH TO CREATING ADVANCE DIRECTIVE INTERVENTIONS
Authors: Tarbi Elise , Morgan Brianna , Sloan Jason 
Published: November 2019

Abstract
The 1.7 million older adults receiving long-term services often do not receive end of life care consistent with their wishes. Advance directives (ADs) can help, yet only one-third of Americans have completed ADs. The limited effectiveness of traditional interventions to increase AD completion may be because they do not address the behavioral aspects of advance care planning. Behavioral Design is an innovative approach that combines design thinking and behavioral economics to identify predictable behavioral bottlenecks and create real-time solutions. This study used Behavioral Design to address low AD completion rates of long-term care residents. Consistent with the Behavioral Design process, an interdisciplinary team compiled evidence from 10 diverse data sources to identify behavioral bottlenecks to AD completion. These barriers were analyzed using the cognitive bias codex to determine behavioral levers for intervention. Informed by these findings, the study team designed multicomponent interventions to address behavioral aspects of AD completion. Four behavioral bottlenecks incorporating ten behaviorally mediated causes for lack of AD completion were identified. For example, AD completion is affected by complexity mediated by hassle factor, choice overload, and ambiguity effect. Three interventions were designed to address these behaviorally mediated causes. For example, the intervention HeAD Start would provide a simple, easy to read AD (addressing choice overload) to residents upon admission (addressing hassle factor) with scheduled follow-up by trained staff (addressing ambiguity effect). Behavioral Design incorporates design thinking and leverages behavioral economic principles to create behaviorally mediated AD interventions. Next steps include testing behaviorally informed designs in practice.
AGING IN PLACE: EFFECTIVE INTERPROFESSIONAL COLLABORATION AND ENGAGEMENT WITH OLDER ADULTS
Authors: Fine-Smilovich Elizabeth , Morris Diana L , Rosenberg David M , O’Toole Elizabeth , Booth-Lord Cynthia , Papp Klara K , Thomas Patricia A 
Published: November 2019

Abstract
Background: An innovative educational program addresses two gaps in health professions education: lack of an emerging workforce comfortable caring for older adults and proficiency in working in an interprofessional (IP) setting. We sought to explore whether AIP provides grounding in pillars of IPE and geriatric competencies through experiential learning in IP teams with older adults in a community setting. Methods: Early health profession students n=37 (MD, MSN, PA, SW), working in teams of 3, made monthly visits to older adults’ residences over a one-year period. Workshops on core geriatric and IPE principles defined expected learning goals for client visits. Visits were followed by: 1) written field notes; 2) reflections based on pre-determined learning prompts; and 3) debriefing sessions with faculty members. Students completed pre and post program questionnaires including Attitudes Towards Social Issues in Medicine, Geriatrics Attitude Scale, ICCAS, and RIPLS. Pre-post results were analyzed using t-tests and qualitative analysis of comments. Results: 25 (68%) students completed pre-post questionnaires. Responses on the interprofessional collaboration scale significantly increased following the program (t=2.09; p = 0.047) and 94% responded that they could “well” or “very well” describe issues that impact older adults’ health, quality of life, and convey appreciation toward older adults. Discussion: Students, engaging with older adults longitudinally in a community setting learned pillars of IPE, geriatric care competencies, and gained insights into this population. An interprofessional, experiential learning program is feasible and effective way to increase interest and self-efficacy in working with older adult populations.
RESILIENCE, RESOURCEFULNESS, AND MINDFULNESS: DISTINCT BUT COMPLEMENTARY INTERVENTIONS
Authors: Musil Carol M , Jeanblanc Alexandra , Wallace McKenzie , Burant Christopher J , Zauszniewski Jaclene 
Published: November 2019

Abstract
Stress and coping theory guides our interest in three related concepts: resilience (the capacity to bounce back and cope with stress), resourcefulness (cognitive and behavioral strategies to manage stress and adversity), and mindfulness (strategies of present moment awareness to reduce stress). These are theoretically distinct but related concepts relevant to improving health and social outcomes in older adults. Our aim was to evaluate the theoretical distinctions among these concepts in 236 grandmother caregivers. Measures of resilience (Connor-Davidson Scale), mindfulness (Decentering Scale) and resourcefulness (Resourcefulness Scale) were collected from a longitudinal, online study of 236 grandmother caregivers. To evaluate construct validity, we examined criterion validity and conducted exploratory factor analysis using Principal Axis Factoring with direct oblimin rotation in SPSS. Factor Analyses were conducted on each scale separately and with all items combined. Inter-correlations ranged from r= .28 (resourcefulness and resilience) to r= .75 (resilience and mindfulness). Factor analyses and scree plots indicated unidimensional factors for resilience and for mindfulness, and three factors for resourcefulness (personal resourcefulness aimed at either emotion regulation or planful problem solving, and social resourcefulness by external help seeking). When items from all measures were analyzed together, the five distinct factors remained. Additional construct validation with the CES-D and Duke Social Support scales supported convergent and discriminant validity of resilience, resourcefulness and mindfulness. Our results confirm the theoretical distinctions among resilience, resourcefulness, and mindfulness, providing support for the use of these concepts collectively or individually in interventions to improve health outcomes.
ORAL FRAILTY IS ASSOCIATED WITH MULTIFACETED FRAILTY IN ELDERLY OUTPATIENTS AT COMMUNITY DENTAL CLINICS
Authors: Nishimoto Misa , Tanaka Tomoki , Watanabe Yutaka , Hirano Hirohiko , Kikutani Takeshi , Sato Tetsuro , Nakajo Kazuko , Iijima Katsuya 
Published: November 2019

Abstract
Aim For achieving healthy aging, frailty prevention is essential. Because it is reported that accumulated declines in multiple oral functions (i.e. oral frailty) could lead to frailty progression, detailed countermeasures for oral frailty are currently required. However, dentists of community dental clinics don’t even know a prevalence of oral frailty among outpatients. Thus, we aimed to identify the prevalence of oral frailty and to examine the association with frailty in outpatients at community dental clinics. Methods The subjects were elderly outpatients at dental clinics in Kanagawa, Japan. Frailty was assessed using the Kihon checklists (KCL); those with ≥8 KCL score were classified as frailty. Furthermore, multiple functions (physical, nutrition, and oral) were assessed using subscale of the KCL. Oral frailty was defined as ≥3 deteriorations out of 5 oral status (remaining teeth, chewing ability, articulatory oral motor skill, subjective difficulties in eating and swallowing). Results Of 1,699 outpatients (mean age, 75 ± 6.3 years old; 40% men), 12% were frailty and 21% were oral frailty. When adjusted by confounding factors such as age and sex, those with oral frailty were associated with higher prevalence of frailty (OR, 3.25; 95%CI, 2.34-4.53), decreased physical and oral functions (OR, 1.53; 95%CI, 1.07-2.16: OR, 8.14; 95%CI, 6.05-10.95, respectively). Conclusions Oral frailty was associated with multi-faceted frailty in outpatients at community dental clinics. In addition to the importance of maintenance of whole oral functions including treating teeth, our findings suggest that it is also indispensable to consider the multi-faceted frailty for elderly patients.
ADULT DAY SERVICES IN A RURAL REGION: CHALLENGES AND OPPORTUNITIES
Authors: Butler Sandra S , Crittenden Jennifer , Walsh Dyan , Kaye Lenard 
Published: November 2019

Abstract
Adult day services (ADS) programs provide stimulation and socialization for older adults with cognitive and physical disabilities, and much needed respite for family caregivers. Like many services for older adults, ADS programs are far less available in rural regions of the country than in more urban settings. This paper reports on a needs assessment for an ADS program in a small city, which serves as a health and human services hub for a large rural area; a particular focus of the study was to assess the feasibility and interest in intergenerational programming. Family caregivers were surveyed (n = 84) about their use and knowledge of and interest in ADS. Less than one in five respondents were using or had ever used ADS. Cost (20%) and ignorance of such programs (20%) were primary reasons for not using ADS; reduction of stress was the most frequently cited reason for using ADS (73%). Ten in-person interviews were conducted with ADS program directors and service providers who refer clients to ADS. Funding issues emerged as the key challenge given lack of private insurance coverage and poor reimbursement levels from public insurance programs. Challenges around transportation, stigma, and marketing of services also surfaced in the interviews. Nonetheless, all ten informants spoke of the positive impact of ADS for both consumers and their caregivers, and generally endorsed intergenerational activities, though with caveats. Implications will be discussed, including the need for greater financial support for this valuable aspect of our long-term supports and services system.
REDUCING ANTIPSYCHOTIC PRESCRIBING IN NURSING HOMES: FACILITATORS AND BARRIERS FOR HIGH-IMPACT STATE INITIATIVES
Authors: Crystal Stephen , Hermida Richard , Jarrín Olga F , Neese-Todd Sheree , Angell Beth , Rosenthal Marsha 
Published: November 2019

Abstract
In conjunction with the National Partnership to Improve Dementia Care in Nursing Homes initiated in 2012, states implemented initiatives to reduce antipsychotic use. All achieved substantial reductions, but improvement varied across states. By 2018, several states had achieved reductions of more than 45%, including several of the largest states. These reductions are noteworthy given the challenging nature of behavioral symptoms of dementia, and difficulties encountered historically and internationally in changing strongly-rooted clinical practices. How were these successful interventions achieved in high-performing state initiatives? What were the barriers encountered and facilitators that helped overcome these barriers? What does this experience suggest for sustainability of change? To address these questions, we draw on a mixed-methods study of antipsychotic prescribing in nursing homes incorporating analyses of prescribing data, state policy case studies, and facility case studies. Successful states integrated large-scale educational initiatives with strong regulatory action, often focusing especially on laggard facilities. Texas’ initiative was particularly noteworthy, achieving a 56.5% reduction across its far-flung network of nearly 100,000 residents and 1,200 facilities. Texas used metrics to identify facilities that achieved notable reductions in antipsychotic prescribing, and encouraged them to share their strategies with “late adopters”. The state deployed a designated Quality Monitoring Program (QMP), distinct from the survey process, to provide on-site technical assistance to laggard facilities, and provided education for all levels of staff and assistance in implementing data-driven improvement strategies. Successful state initiatives achieved considerable buy-in on the need to reduce antipsychotic use, a key factor in achieving successful system change.
POWER OF SOCIAL SUPPORT AGAINST DEPRESSIVE SYMPTOMS OF OLDER AFRICAN AMERICANS
Authors: Cho Seungjong 
Published: November 2019

Abstract
Depressive symptomatology is one of the most prevalent mental health problems. About 20% of Americans experience depressive symptoms in their lives (Gotlib & Hammen, 2014). Social support, on the other hand, was proved to be a powerful buffer against depressive symptoms of older adults (Kim & Ross, 2009; Sheiman & Meersman, 2004). Few studies have explored this association exclusively among older African Americans who had a culture of powerful social support. Therefore, the purpose of this study is to compare the effects of different sources of social support (from spouse/partner, children, relatives, and friends) against depressive symptoms among older African Americans. This study analyzed the 2014 Health and Retirement Study (HRS; N = 187). Depressive symptomatology was operationalized as a count outcome (number of having symptoms; CES-D8 scale). A negative binomial regression model of depressive symptoms showed that higher levels of spousal support were associated with lower levels of depressive symptoms (coefficient = –.179, p &lt; .001). For each additional score in spousal support, the expected log count of the number of depressive symptoms was decreased by .179. Other sources of social support were not significant predictors of depressive symptoms among older African Americans in this study. Among the covariates, self-rated health (coefficient = .358, p &lt; .001) and household income (logged; coefficient = –.275, p = .014) were significant. The current study supported the results of previous studies showing the power of positive spousal interactions against depressive symptomatology, especially among a nationally representative sample of older African Americans.
AN MHEALTH BEHAVIORAL INTERVENTION FOR PROMOTING PHYSICAL ACTIVITY AND SLEEP IN COMMUNITY-DWELLING OLDER ADULTS
Authors: Li Junxin , Szanton Sarah , Liu Minhui , Lukkahatai Nada , Li Junxin , Gooneratne Nalaka 
Published: November 2019

Abstract
Evidence suggests physical activity (PA) improves sleep in older adults. This study examined the preliminary effect of a personalized mHealth behavioral intervention on PA and sleep in older adults. We conducted a randomized controlled pilot trial in 21 community-dwelling older adults with sleep complaints. The 24-week mHealth behavioral intervention included a 2-hour in person training session, personalized exercise prescription, real time PA self-monitoring, interactive prompts, phone consultation, and weekly financial incentives. PA and sleep were measured objectively using Actiwatch 2.0 and subjectively using questionnaires. Peripheral blood was drawn for measuring Plasma inflammatory biomarkers [interleukin 1β, 6, 8, Tumor Necrosis Factor- alpha (TNF-α), and c-reactive protein (CRP)]. Data were collected at baseline, 8-week, 16-week, and post intervention. Repeated measures ANOVA (time*group) was used to examine differences of PA and sleep across times between the two groups. Majority of participants are women (71.4%) with mean age of 73.7 (SD = 6.9). Repeated measure ANOVA showed significant (p &lt;0.05) improvement of objective and subjective PA, objective nocturnal sleep duration, self-report sleep quality (measured by Pittsburg Sleep Quality Index and Insomnia Severity Index) and decreasing of sedentary time over times in the intervention group (n=11), compared to the control group. The intervention group showed significant reduction of plasma TNF-α and CRP levels at 16-week and post intervention. Interventions combining personalized PA and mHealth strategies may positively affect physical activity and sleep in older adults. A larger study is needed to test the efficacy of this intervention and the mechanisms associated with it.
MISMATCH BETWEEN PERCEIVED AND OBJECTIVE MOTOR IMPROVEMENTS WITH ADAPTED TANGO INTERVENTION IN OLDER ADULTS
Authors: Bennett Crystal , Angel Nathalie , Hackney Madeleine 
Published: November 2019

Abstract
The purpose of this secondary analysis was to assess the relationship between objective and subjective perceptions of motor function measures in older adults following a 12 week adapted tango or health education intervention. A quasi-experimental, two-group, repeated-measures design was used. The study took place in diverse senior independent living communities in an urban metropolitan area. 74 older adults participated (Tango: n= 62, age: 82.3 (8.81) years; Education: n=12, age: 84.1 (7.86) years). Participants were assigned to 20 sessions of 90-minute tango (n = 62) or health education (n = 12) classes over 12 weeks. Motor function, depression, mental and physical quality of life were measured before and after intervention. At post-test, participants indicated their level of agreement with statements that they improved in the objectively measured domains of motor function. Correlations were performed between subjectively rated agreement, and changes in motor function and depression/quality of life. Tango subjective ratings were negatively correlated with empirically observed improvements in balance (r= -.423) and endurance (r= -.241); although their ratings moderately correlated positively with coordination (r=.319) and minimally correlated positively with lower body strength (r=.188). In Tango, decreased depression was positively correlated with self-perceived improved lower body strength (r=.271) and endurance (r= .254). Improved mental function was moderately (r=.423) positively correlated with self-perceived improved balance and coordination (r=.306). After rehabilitation, even in the presence of improved depression and quality of life, older adults may not perceive empirically observed motor function improvements, particularly in balance and lower body strength.