bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frailty & Depression: Mediators of Fear of Falling and Quality of Life in Older Adults
Authors: McKay Michelle , Whitehouse Christina , Mensinger Janell 
Published: December 2020

Abstract
Fear of falling is a known predictor for decreased health-related quality of life (QoL) in older adults, including among high risk frail community-dwelling older adults with multiple comorbidities including depression. The study aimed to examine the sequential explanatory roles of frailty and depressive symptoms in the relationship between fear of falling (FoF) and QoL in a program for all-inclusive care for the elderly (PACE). This was a retrospective single cohort study that included 84 older adults in a PACE program located in the Northeastern United States. Participants were cognitively intact older adults ≥55 years (M=70.33; SD=6.46). FoF was assessed with the Falls Efficacy Scale-International; frailty was measured with the Edmonton Frail Scale; QoL was measured with the Short Form 12v2 which includes both physical and mental domains. Using the Process Macro (model 6) in SPSS, path models were constructed hypothesizing frailty and depressive symptoms as serial mediators of the relationship between FoF and QoL while controlling for race, gender, age and comorbidities. Frailty and depressive symptoms serially mediated the FoF and mental QoL relationship (Indirect Effect = -0.10; 95% CI= -0.19, -0.03). Serial mediation effects of frailty and depressive symptoms were not replicated for the association between FoF and physical QoL (Indirect Effect = 0.00; 95% CI= -0.04, 0.05). Understanding the roles of frailty and depressive symptoms in explaining the association between FoF and mental health-related QoL can delineate targeted areas for intervention development not typically considered when attempting to reduce the influence of FoF on QoL in older adults.
A Geriatrics Telehealth Curriculum: A Workshop for Medical Students on “Tele-skills” using Standardized Patients
Authors: Wilson Lindsay , Powell Ross , Foster Megan , Vogel Kathleen , Kelley Casey , Henage Cristine , Roberts Ellen , Busby-Whitehead Jan 
Published: December 2020

Abstract
Background: Telemedicine allows for interprofessional care of geriatric patients and allows older adults to access healthcare from their homes. The coronavirus pandemic has prompted a rapid shift to telemedicine. In 2016-2017, only 58% of medical schools in the US offered telemedicine curricula. Thus, a large gap in medical education has emerged. There are specific skills needed to ensure students’ “webside” manner is comparable to their bedside manner.This curriculum was created to train medical students in geriatric-sensitive telemedicine using standardized patients (SP). Methods: A didactic detailing geriatric interviewing preceded the SP encounter. Students were assigned roles for the SP encounter as follows: A) Set agenda, elicit questions, triage problems, perform a history, ensure appropriate lighting and audio B) Perform a geriatric review of systems and reconcile medications C) Present an assessment and plan to the preceptor D) Relay the plan to the SP E) Provide feedback. Students were given pre- and post-surveys to assess their comfort using telemedicine and caring for SP’s &gt;65 years old. Results: Seventeen participants were surveyed (pre-survey=17, post-survey=10). Fifty-nine percent of participants reported no prior experience with telemedicine. Participants reported statistically significant increases in comfort using telemedicine (p=0.022), using telemedicine for patients &gt;65 years old (p&lt;0.001), interviewing patients &gt;65 years old over telemedicine (p=0.007), managing patients over telemedicine (p=0.040), and managing patients &gt;65 years old over telemedicine (p=0.001) after completing the curriculum. Discussion: This virtual curriculum improved medical student comfort with geriatric care and telemedicine and highlights the need for telemedicine curricula in medical schools.
Is Health Information Exchange Use by Hospitals and Home Health Agencies Associated with Lower Readmission Rates?
Authors: Jones Christine , Thomas Jacob , Roczen Marisa , Ytell Kate , Gritz Mark 
Published: December 2020

Abstract
For older adults transitioning from the hospital to home health agencies (HHAs), clinical information exchange is key for optimal transitional care. Hospital and HHA participation in regional health information exchanges (HIEs) could address fragmented communication and improve patient outcomes. We examined differences in characteristics and outcomes for patients with either Medicare or Medicare Advantage (MA) insurance who transitioned from hospitals to HHAs based on HIE participation with 2014-2018 data from the Colorado All Payer Claims Database. We performed analyses including chi square and t tests to compare patient characteristics and 30-day readmission rates for high versus lower HIE use, determined by HIE participation (+) and non-participation (-) among HHAs and hospitals: High HIE use dyads (Hospital+/HHA+) were compared to lower HIE use dyads (Hospital+/HHA-, Hospital-/HHA+, Hospital-/HHA-). We identified 57,998 care transitions from 123 acute care hospitals to 71 HHAs. On average, patients were 75 years old, had a three day hospital length of stay, over half were female (58%), 82% had Medicare and 18% had MA insurance. Although most characteristics were similar between high versus lower HIE use dyads, high HIE use dyads had a higher proportion of Medicare patients compared to the lower HIE use dyads (85% vs 79%, p &lt;0.001). Thirty-day readmissions were 12.4% for care transitions that occurred among high HIE use dyads (n=27,784) compared to 12.8% among lower HIE use dyads (n=32,929, p=0.102). For adults transitioning from hospitals to HHAs among high HIE use dyads, a trend toward lower 30-day readmission rates was identified.
Mindfulness Intervention Benefits Older Adults Receiving Rehabilitation Services in Long Term Care
Authors: Felsted Katarina , Supiano Katherine , Mai Trinh , Muradas Anthony 
Published: December 2020

Abstract
Research literature includes preliminary examination of mindfulness in rehabilitation settings; however, further investigation is warranted. Some of the strongest findings to date are adaptation improvements such as self-efficacy, increased quality of life, and decreased stress. The purpose and aims of this pilot feasibility and acceptability study were to develop, administer, and evaluate a modified mindfulness program for older adults in rehabilitation in long term care, and to measure self-efficacy, quality of life, and perceived stress. Nine residents 65+ were recruited. Inclusion criteria for participants included residents receiving any type of therapy (e.g., physical, occupational, speech), an anticipated length of stay inclusive of the intervention treatment period, and cognitive capacity to participate. A mindfulness intervention was developed by the research team and administered by a CITI trained, qualified mindfulness instructor. As this is a pilot study, no control group was used. This study proved both feasible and acceptable. All eligible participants consented; both attendance and retention percentages were above the 75% standard (78% and 89%, respectively), and the Meaningful Activities Scale rating=82.4, indicating strong acceptability. Statistical results values for the Health-Related Quality of Life (V=153, p&lt; 0.001), Bandura’s Self Efficacy Questionnaire (V=153, p&lt; 0.001), and Cohen’s Perceived Stress Scale (V=152, p&lt; 0.001) were all statistically significant. These preliminary research findings will inform a larger pragmatic trial testing preliminary effectiveness of the intervention in this population in quality of life, self-efficacy and stress reduction. While this study began prior to the COVID-19 pandemic, its findings are now even more relevant to gerontology.
Explorations of Alaska Native Urban Eldership
Authors: Kim Steffi 
Published: December 2020

Abstract
Successful aging in Alaska Native people or “Eldership” is a state that is embedded within a cultural, relational, and generational context (Boyd, 2018; Lewis, 2011; Wexler, 2014). Eldership has been described as a developing and nuanced personal quality shaped by individual, relational, and contextual influences (Kim, 2020). Within the cultural and traditional understanding of Alaska Native people, the concept of Eldership is analogous to the Western concept of successful aging. With increasing numbers of outmigration from rural community members (Driscoll et al., 2010), this study investigated the impact of relocation from a rural traditional community to an urban Western community and its effect on the Elder’s perception of “Eldership.” This study considered the broader impact of the multi-systemic and socio-ecological context of minority and majority culture, dominant culture, and its implications for successful aging and identity (Grandbois & Sanders, 2009; Kirmayer et al., 2011). Gee’s discourse analysis was used for the systematic interpretative study of 25 Elder interviews regarding their use of language describing their lived experiences, including three identified discursive patterns: cultural discourse, psychological discourse, and Elder identity discourse. Based on the study findings, Elders’ experiences are impacted by socio-economical and cultural differences encountered during relocation shifting the cultural frame of Alaska Native “Eldership” according to rural or urban contexts.
Facilitating mental health service use for older Chinese immigrants: a case study of community-based organizations
Authors: Hu Yuanyuan , Xu Qingwen 
Published: December 2020

Abstract
New York City has the largest older Chinese population of any city in the United States. Older Chinese adults in New York City often meet significant stress to fulfill their needs, and mental health issues are common among this population (Mui, 1996; Dong, 2012). Despite the high prevalence, Asian Americans have the lowest rates of mental health services use compared to other ethnic groups (Abe-Kim et al., 2007). Additional to wide disparities in mental health access, older immigrants experience additional factors that affect their decision making to use mental health services. Limited knowledge exists about community-based organizations facilitating mental health services use for this population. This study aimed to fill this gap by case study approach and conducted a qualitative analysis of data collected as part of a study that investigated the resilience of the Chinese communities in New York City in the context of aging and immigration. Data from five community-based organizations serving this population were examined, through reading agency history and program introduction, visiting agency location and observing its operation, and interviewing the agency staff and program directors. Data collected were integrated, synthesized, and analyzed. Findings represent organizational staff’s perceptions of the mental health issues among older Chinese immigrants, needs and accessibility of mental health services, and facilitation of access and utilization of services by screening, education and referral. The qualitative results address individual help-seeking behavior and pattern, organizational response to and coordination of mental health needs, and capacity building on the community level.
Personal Activities, Social Participation and Functional Disability in Aged Living Alone with Fall Experience
Authors: Jung SuJung , Tak Sunghee 
Published: December 2020

Abstract
Functional disability leads to limitations in the older adults’ personal activities and social participation. The purpose of this study was to examine the International Classification of Functioning Disability and Health(so called ICF) model in which personal activities and social participation influence functional disability in older adults who live alone and have experienced falls. The study used a secondary data analysis of the 2017 National Survey of Older Koreans. A total of 501 study participants met the inclusion criteria. The results of multiple linear regression indicated that gender and the number of acquaintances were significantly related to the functional disability of social participation while overnutrition, depressed symptom and cognitive dysfunction were related to the functional disability of personal activities. Lastly, poor muscle strength, old age and economic status were predictors of the functional disabilities of both personal activities and social participation. The findings of the study revealed that it is important to comprehensively evaluate not only personal activities but also social participation of older adults who live alone and have experienced falls. In addition, the ICF model may be useful in the development of intervention programs for preventing functional disability in the population.
Social Adversity Impacts on the Rhesus Macaque Immune System Resemble Those of Aging
Authors: Sanchez-Rosado Mitchell , Snyder-Mackler Noah , Brent Lauren , Higham James , Kimock Clare , Watowich Marina , Pavez-Fox Melissa , Pantoja-Maldonado Petraleigh 
Published: December 2020

Abstract
Social adversity can impact immune function and is associated with increased morbidity and mortality. Many of these immune-related changes resemble the effects of the natural aging process. To date, little is known about the effects of social adversity on the immune system change across the lifetime. Here, we investigated how aging and social adversity (measured as social status) impact immune cell proportions. We performed flow cytometry on peripheral whole blood from a population of free-ranging rhesus macaques to quantify changes on immune cell proportions across the lifespan (n=99) and across different social statuses (n=53). Overall, we found that high adversity recapitulated the effects of aging. We found significant shared decreases in CD3+/CD4+ T cell proportions and corresponding increases in CD3+/CD8+ T cell proportions between individuals of older ages and low social status. These findings suggest that social adversity has similar effects to aging on T cell proportions, possibly affecting the T cell component of the immune response. In contrast, CD3+/CD4+/CD25+ T regulatory cell proportions increased with age, which is typical of normal aging. Contrary to our expectations, these cells were less abundant in low status individuals, indicating some overall regulatory immune deficits specific to lower status individuals. CD3+/CD8+/CD25+ T regulatory cells, which contribute to self-tolerance, were higher in high status individuals, suggesting that overall primary immune regulatory cells can be affected by social adversity and impair the regulation of inflammation. We provide evidence that social adversity alters immune cell proportions, implicating it in the development of inflammatory and/or aging-related diseases.
Usability of Telemedicine in Relation to Acceptability, Psychosocial Impact, and Future Use
Authors: Prevodnik Katja , Hvalič-Touzery Simona , Dolničar Vesna , Škafar Maja , Petrovčič Andraž 
Published: December 2020

Abstract
This poster presents the results of an intervention study exploring how engagement in telemedicine at home affects chronic patients’ perceptions of usability and acceptability of the employed equipment, perceptions of its psychosocial impact, and intention of future use in the context of population aging. A purposively selected sample of 103 patients (mean age: 58 years) with chronic conditions (diabetes and/or hypertension) recruited in a community health center in Slovenia tested a home telemedicine system (TMS). After three months of utilization, an assessment of the relative importance of the usability and acceptance of TMS as factors influencing the patients’ self-reported psychosocial perception of TMS and intention of future use was performed based on a proposed structural equation model explaining these interdependencies. The results confirmed four of eight tested hypotheses. Notably, the intensity of TMS use was found to affect the evaluation of its usability, the perception of its psychosocial impact, and the intent of future use. Usability was found to be the main factor directly influencing acceptability, perception of psychosocial impact and intent for future use, whereas acceptability did not significantly affect either the perception of the psychosocial impact of TMS or the intent of future use.
“When you are working in this environment, you’re more likely to get sick”: Mapping Care Relationships in LTC
Authors: Gregor Andreina Marquez de la Plata , Aubrecht Katie , Daly Tamara , Bourgeault Ivy , Braedley Susan , Owusu Prince , Armstrong Pat , Armstrong Hugh 
Published: December 2020

Abstract
The pandemic has shone a light on problems within the long-term care (LTC) sector. As was true prior to COVID-19, many of the present issues in LTC can be traced to challenging working conditions, such as persistent understaffing of care workers. Working short-staffed means rushing through care, while only satisfying the most basic bodily needs of the resident. This presentation shares early findings from a thematic analysis of interviews conducted with seven care workers as part of the “Mapping Care Relationships” stream of the Seniors –Adding Life to Years (SALTY) project, a pan-Canadian research program that maps how promising approaches to care relationships are organized and experienced in LTC. The purpose of the analysis was to understand how short-staffing is affecting the formation and preservation of meaningful staff-resident relations, and what the impact is on quality of care. Two overarching themes emerged: 1) a relationship between time and work-place illness, injury and violence; 2) a relationship between care worker autonomy and resident quality of care. When working conditions do not support workers in voicing and/or addressing challenges they experience in the workplace, whether this results from understaffing or hierarchical power structures, care workers’ ability to deliver even basic care is jeopardized, and resident and worker health and wellness are placed at risk. Themes are discussed in the context of COVID-19 in light of responses to outbreaks in LTC that have reduced the availability of care workers, family visitors and volunteers, and emphasized top-down and even militarized approaches to care management.
Age Variations in Perceived COVID-19 Threats, Negative Impacts, and Associations with Well-Being
Authors: Gruenewald Tara , Ong Anthony , Zahn Danielle 
Published: December 2020

Abstract
The COVID-19 pandemic represents an unprecedented threat to individual and public health, psychosocial, and economic well-being, although COVID-19 threats and impacts may vary by age and other demographic characteristics. Although greater age is a risk factor for greater COVID-19 disease severity, we know little about the association between age and perceived and experienced COVID-19 threats and their association to well-being. These associations were examined in an ongoing 3-wave investigation of over 1,700 U.S. adults (age 18-89; 53.1% female). Wave 1 analyses indicate no significant age variation in perceived threat of COVID-19 infection, with older and younger individuals reporting similar levels of COVID-19 infection threat. However, greater age was associated with lower perceived negative impact on financial and needed resources (r=-.10**), lower perceptions of COVID-19 induced harm to mental well-being (r=-.17**), and more favorable well-being profiles. Greater perceived COVID-19 threat and negative impact on resources and well-being were linked to greater feelings of stress (β’s=.45 to .68***), loneliness (β’s=.24 to .49***), social well-being (β’s=-.19 to -.36***), and poor sleep quality (β’s=.34 to .51***). These associations did not vary with age with the exception that older individuals showed stronger links between COVID-19 threat and impacts and poorer sleep quality. Ongoing analyses are examining whether these associations persist over time. Despite older adults’ greater risk of COVID-19 disease severity and mortality, older age did not appear to be linked to greater perceived COVID-19 threat or impacts, nor linkages to ill-being, with the possible exception of potential greater vulnerability to poor sleep quality.
Dementia care providers’ delivery of family caregiver support during COVID-19
Authors: Quach Emma , Franzosa Emily , Scali Rachael , Moo Lauren , Hartmann Christine 
Published: December 2020

Abstract
Family caregiver support is a cornerstone of dementia care. Yet the transition to virtual care during COVID raised questions about the ability of dementia care teams to maintain caregiver support services. We surveyed Veterans Affairs clinicians about dementia caregiver support delivery following the COVID surge in the six New England states. 38 out of 68 (55%) clinicians from 6 states responded in June and July 2020. We found: 1) Clinicians continued providing the same types of support services for family caregivers before and after COVID, with over 50% of providers interacting with caregivers daily or multiple times per week. The most prevalent services were caregiver needs assessments, information and referrals, and assistance with accessing services. Two-thirds reported continuing to offer caregiver skills training and counseling, including peer support groups. 2) Caregiver support modality changed, most frequently through the combined use of phone and video, followed by only phone, and rarely, by only video. 3) Providers indicated that phone, more than video, increased to replace in-person interactions, because of multiple factors: caregivers (who continued to call for support on an as-needed basis but declined video encounters), providers (who began to provide group support via phone), and service factors (ad hoc versus scheduled encounters). Results suggest clinicians continued providing caregiver support despite suspension of in-person interactions, but future research is needed to assess the impacts of caregiver support delivery mostly by phone and factors underlying the limited use of video in delivering caregiver support.
The Longitudinal Impact of Private Health Insurance on the Usage of Outpatient Services Among Aging Koreans
Authors: Kim Narae 
Published: December 2020

Abstract
South Korea has a universal national health insurance system; however, its coverage is only about 65%. Consequently, many Koreans have supplemental private health insurance. This study aims to examine 1) how utilization of health care services and out-of-pocket expenditure of outpatient services varies by private health insurance status and 2) whether this relationship changes for these individuals over time. We analyze six waves of the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2016. Our primary outcomes of interest are the total number of outpatient visits and total out-of-pocket spending on outpatient services per year. Our independent variable of interest is private health insurance holding status. We use simple OLS regressions for each year to test if differences exist and change over time, controlling for age, sex, education, income, and various indicators of health conditions. The difference between those who never had private health insurance and those who always or sometimes had private health insurance becomes larger over time. When comparing total out-of-pocket expenditure, those who always had private health insurance have the lowest spending at the beginning of the study period (2006); however, their spending increases sharply by 2010 and remains higher than the other groups for the rest of the study period. Findings suggest that those who always had supplemental insurance use outpatient services more frequently and spend more out-of-pocket for services as a result. In addition, discrepancies become larger over time. As private health insurance holders age, the risk of higher utilization of outpatient services grows.