bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUCCESSES IN THE TRANSLATION OF CAREGIVER INTERVENTIONS IN COMMUNITY-BASED ORGANIZATIONS AND HEALTH CARE SYSTEMS
Authors: Cho Jinmyoung , Stevens Alan B 
Published: November 2019

Abstract
Family caregiving of an older adult has become an essential element of the U.S. health care system, with 83 percent of long-term care provided to older adults coming from family members or other unpaid helpers. With the amount and type of care provided by families expected to increase, caregiving demands should be coupled with community and health care systems-based supports. While scientific research has demonstrated the value of providing education, skills training and support to family caregivers, health care and social service providers do not systematically include these interventions in their services. Thus, for the vast majority of family caregivers, caregiving support services remain extremely fragmented, if not elusive. This symposium provides four examples of how health care systems that frequently see patients with dementia and community-based organizations who provide ongoing supportive services to family caregivers, have adapted evidence-based caregiver interventions into branded service programs. Dr. Jinmyoung Cho will present racial/ethnic comparisons on the impact of community-based implementation of a caregiver education program, REACH-TX. Dr. Leah Hanson will introduce the implementation of Mindfulness-Based Dementia-Care (MBDC) within a health care system. Dr. Christine Jensen will address how caregivers can benefit from evidence-driven programs in health care settings. Lastly, Dr. David Coon will present two different approaches to translation of evidence-based programs through community-based organizations, with CarePRO embedded after completion of a clinical trial and EPIC embedded from the program’s initial pilot phase. The discussant, Dr. Alan Stevens, will highlight the needs of caregivers and support services recognized by all key stakeholders.
COMMUNITY-BASED IMPLEMENTATION OF A CAREGIVER EDUCATION PROGRAM, REACH-TX: RACIAL-ETHNIC GROUP COMPARISON
Authors: Cho Jinmyoung , Smith Donald R , Stevens Alan B 
Published: November 2019

Abstract
We present the effect of racial/ethnic group difference on the impact of REACH TX on measures of quality of life as implemented by the Alzheimer’s Association North Central Texas Chapter. Five dimensions of quality of life (burden, depression, social support, self-care, and problem behaviors) were assessed at baseline and 6-month follow-up among three racial/ethnic groups of caregivers (White: 1,050; African American: 269; Hispanic: 176). Generalized estimating equations (GEEs) were used to assess racial/ethnic differences in the changes of quality of life after adjusting covariates. Significant interaction effects between racial/ethnic group and time (from baseline to follow-up) were found in burden, depression, and social support. White and Hispanic caregivers showed significant improvements, while the improvement among African American Caregivers was not statistically significant. The disparity in outcomes among diverse racial/ethnic groups in the program suggests the REACH TX intervention would benefit from tailoring interventions for African American caregivers.
HOW STATES CHANGED REGULATORY REQUIREMENTS FOR ASSISTED LIVING STAFF SINCE 2003
Authors: Carder Paula , Dys Sarah 
Published: November 2019

Abstract
In 2003, the Assisted Living Workgroup (ALW) published quality improvement recommendations for states’ regulations, including 26 regarding staffing/workforce. We reviewed states’ 2003 and current regulations to identify the presence of ALW standards. Over half of states’ regulations reflect 7 of the 26 staffing/workforce recommendations. Those most often added after 2003 concern criminal background checks, with a 58.8 percent increase in states that added federal background checks and use of criminal background checks to inform hiring. At least 40 states’ regulations reflect the ALW recommendations for administrator and direct care staff training. Very few states require staff performance evaluations (n=13), human resource policies to improve retention (n=1), or management practices to improve retention (0). The 10 ALW recommendations concerning staff who administer medications have been adopted by fewer than 23 states. These findings can inform future policy analysis and research on staffing/workforce in assisted living communities.
DIGITAL INDEPENDENCE: HEALTH-RELATED DIFFICULTY IN INTERNET USE AND HOW IT AFFECTS OLDER ADULTS’ QUALITY OF LIFE
Authors: Ang Shannon , Lim Emily , Malhotra Rahul 
Published: November 2019

Abstract
Using the internet is increasingly a necessity. However, older adults may not do so due to either non-health reasons (e.g., lack of digital literacy or internet access) or health-related reasons. While researchers have studied internet use among older adults, most do not discriminate whether non-use is due to health reasons or otherwise. Recent studies also reveal that older adults use the internet to keep in touch with family and friends, highlighting that limitations in internet use may be detrimental for their well-being. We therefore, examine the key correlates of health-related difficulty in internet use, and how it may affect quality of life by reducing the size of their social support networks. Data were from a national survey of older Singaporeans (n=3966) conducted in 2016-17. Multinomial logistic regression and mediation analysis were used to identify older adult subgroups more likely to experience health-related difficulty in internet use, and whether such difficulty affected older adults’ quality of life through their social support networks. Results showed that males, those of Malay ethnicity, those with less education, and those with more instrumental activity of daily living (IADL) limitations were more likely to experience health-related difficulty in internet use. Social support networks mediated the relationship between health-related difficulty in internet use and quality of life. These findings suggest that other than managing the health conditions of older adults who face health-related difficulty in internet use, offline modes of keeping them socially connected may promote their quality of life.
INTERVENTION DEVELOPMENT: PARTICIPANT EXPERIENCES WITH NOVEL TECHNOLOGICAL DEPRESSION TREATMENTS
Authors: Shah Avani A , Morthland Martin , Scogin Forrest , Presnell Andrew 
Published: November 2019

Abstract
The purpose of this presentation is to discuss the development process of two novel technology-based interventions for depression in older adults while comparing older adults’ preferences for audio-based and computer-based cognitive behavioral therapy for depressive symptoms. The audio program consisted of eight compact discs and a workbook while the computer program consisted of 11 modules of similar duration provided on a tablet PC. Fifty-one older adults were recruited from medical settings and rural communities and randomly assigned to an immediate treatment group (computer or audio) with minimal contact or a four-week minimal contact delayed treatment control condition. Participants rated computer-based and audio-based cognitive behavioral therapy fairly equally, with 75% of those who received audio treatment and 85% of those who received computer-based treatment indicating benefits to their mood. Qualitative experiences will be presented by themes: challenges, benefits, recommended improvements, and technological issues. The goal of the presentation is to share information that may help clinicians and researchers develop other mental health technological interventions tailored for older adults needs.
DEVELOPING A DEMENTIA-FRIENDLY COMMUNITY GLOBAL TOOLKIT: INSIGHTS FROM STAKEHOLDERS IN WHO MEMBER COUNTRIES
Authors: Sun Fei , Chima Emmanuel , Seeher Katrin , Dua Tarun , Kestal Devora 
Published: November 2019

Abstract
Drawing on perspectives from stakeholders involved in dementia friendly initiatives (DFIs) in WHO member countries, this paper describes the characteristics of DFIs around the world and summarizes success factors and barriers to implementation. Data were collected through an online consultation survey of 129 stakeholders from 46 countries in all six regions of WHO. Most DFIs present three essential features of WHO’s definition for DFI, that is, centering on the needs of persons living with dementia (PWD), multi-sector collaboration, and physical and social environmental changes. Over 70% participants reported their DFIs targeted PWD and included PWD as important partners. High-income countries tend to focus on enhancing professional capacity and environmental adaptation, while low-middle income countries prioritize dementia awareness campaigns. This corresponds to the reported disparities in levels of inclusion of PWD in societies, support to PWD, and service access for PWD found between low-middle income countries and high-income countries.
AGE-FRIENDLY CARE AND MOBILITY IN HOSPITALIZED OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: Vickers Jasmine K , Kennedy Richard E , Biswal Shari , James David , Booth Katrina , Simmons Emily , Flood Kellie 
Published: November 2019

Abstract
Hospitalization of older adults with cognitive impairment (CI) has been associated with higher risk for adverse outcomes. Acute Care for Elders (ACE) Units were developed to meet the unique hospital care needs of older adults and have been associated with reductions in functional decline and readmissions. The Virtual ACE intervention was developed to disseminate ACE principles across hospital units. Virtual ACE included training interprofessional providers to utilize screens and care protocols to optimize care for older adults on eight units at a large academic medical center. We conducted a preliminary analysis of mobility and patient outcomes before and after Virtual ACE among 192 older adults with CI on hospital admission. Chi-Square tests were used to examine the associations between Virtual ACE and patient outcomes. There were statistically significant pre vs. post improvements in patients’ mobility from bed to chair (30% vs. 51%, p=0.011) and on the unit hallway (12% vs. 27%, p=0.046). Although not statistically significant, there were also improvements in hospital room mobility (39% vs. 50%, p=0.214) and documentation of activities of daily living (ADL) screens (70% vs. 80%, p=0.196). There were non-significant reductions in pressure ulcer prevalence (26% vs. 22%) and restraint use (5% vs. 0%) during the hospital stay. Pain was similar before and after Virtual ACE. Virtual ACE was associated with increased mobility and slight reductions in adverse outcomes. As increased hospital mobility improves patient functioning post-discharge, Virtual ACE has the potential to maintain function and enhance outcomes in hospitalized older adults with CI.
MULTISENSORY STIMULATION FOR HOSPITALIZED PATIENTS WITH DEMENTIA: A PILOT STUDY
Authors: Molony Sheila L , Waszynski Christine 
Published: November 2019

Abstract
Introduction: Delirium occurs in up to 50% of hospitalized patients and the risk is higher in persons with dementia. Multi-sensory stimulation environments (MSSE), including trademarked “Snoezelen” rooms, have been effective in achieving positive outcomes in persons with dementia, but there have been no studies in the acute-care setting. Purpose: This pilot study tested the effect of a therapeutic Multi-sensory Stimulation Environment known as “the Hub” in an acute-care hospital. Methods: A sample of 56 patients were randomized to receive usual care or the Therapeutic Hub intervention during hospital days 2-4. Hub activities were multi-sensory and tailored based on preferences and abilities. We will describe techniques to address methodological challenges in the study with acutely ill, cognitively vulnerable participants. We will also present qualitative data describing the experience of participants receiving the Hub intervention, and will present preliminary findings regarding between group-differences in function (Functional Independence Measure), mobility, falls, wellbeing (Warwick-Edinburgh Mental Wellbeing Scale)– and person-environment relationship conceptualized as situational at-homeness (S-EOH). Conclusion: The results of this study will inform future trials on the effects of unique therapeutic environments for hospitalized persons at highest risk for delirium.
VISIBILITY OF PROGRAMS AND SERVICES ON HOSPITAL WEBSITES: GERIATRICS COMPARED WITH OBSTETRICS
Authors: Johnson Brenda P , Kim MyoungJin , McMahon Emily E , Mojadam Ali 
Published: November 2019

Abstract
Hospitals increasingly use a digital platform to market their services as well as reflect the values and mission of the organization. As payment incentives and national initiatives grow for making hospitals more “age friendly” in both the quality and extent of specialized services for older adults, the visibility of these services on a digital platform is of interest. This exploratory, descriptive analysis of hospital websites was to illuminate the ease with which a consumer could identify that a hospital has specialized services in geriatrics as compared with obstetrics. A proportionate stratified random sampling based on the five geographical regions of the country was used to select 220 hospitals with 5% margin of error, 95% confidence interval and 50% sample proportion with no prior information from a population of over 600 hospitals known to have implemented at least one quality initiative specific to older adults (NICHE). A binary matrix was developed for collecting data related to the visibility of services in three main areas of hospital websites: 1) images and terms on the homepage 2) identification of programs in the “Services” function and 3) availability of the specialty in the “Search for Doctor” function. Data show that the frequency of all key words used to identify obstetrical services was greater than those used to describe geriatric services across all functional areas explored in this study. Implications are that hospital websites may be an underutilized resource for marketing services as well as accurately reflecting specialized services for the older adult population.
PROLONGED MECHANICAL VENTILATION: CHARACTERISTICS OF PATIENTS TREATED AT HOME COMPARED TO HOSPITAL LONG-TERM CARE
Authors: Jacobs Jeremy M , Marcus Esther-Lee , Stessman Jochanan 
Published: November 2019

Abstract
Rising numbers of patients receiving Prolonged Mechanical Ventilation (PMV) pose a challenge, and advancing technology supports ventilators appropriate for either Home or Hospital Long Term Care (HLTC).Data guiding decisions concerning place of care are lacking. This study describes the characteristics of the majority (120/123) of all PMV patients aged ≥18 (and their caregivers) in Jerusalem, covered by the Clalit Health Service, treated either with Home Hospital or HLTC. Patients were more alert and communicative at Home vs. HLTC (40/46 vs. 22/74), younger (54 vs.73 years, p12 years (36% vs.21%, p=0.1), and without legal guardian (59% vs. 12%, p&lt;0.01). Primary reason for PMV at home was degenerative neuromuscular disease (59% vs. 28%), compared to post resuscitation/sepsis/CVA in HLTC patients (17% vs. 62%), who suffered more comorbidity, functional decline post-PMV, and pressure sores (0% vs. 42%). Ventilation was more likely to be planned at home vs HLTC (33% vs. 8%), and yet 119/120 were without Advanced Directives prior to PMV. Caregivers at home tended to be spouses (48% vs. 31%) and offspring at HLTC (17% vs. 47%), with reduced Modified Caregiver Strain Index at home (10.5 vs. 12.9, p=0.12). Mortality during follow-up was lower at home (15.2% vs. 27%). Costs to the health fund for home versus HLTC were approximately 1:3. Our findings suggest that with appropriate targeting of eligible PMV patients, Home Hospital may be the preferred model of care for patients, caregivers and healthcare providers.
INNOVATIONS IN EMERGENCY MEDICAL CARE: EARLY ADOPTERS OF GERIATRIC EMERGENCY DEPARTMENTS
Authors: Schumacher John G 
Published: November 2019

Abstract
Hospital emergency departments (EDs) treat more than 20 million older adults each year making it a remarkably significant site of healthcare delivery. To date, the nation’s nearly 5,000 EDs have been slow to modify their staffing, ED training, procedures, or physical environment to better serve the unique needs our heterogeneous older adult population. Nonetheless, nationwide a small set of innovative EDs have redesigned their care and now promote themselves as Geriatric Emergency Departments (GEDs) which specifically tailor care to older adults and their families. Using a systematic, nationwide search process of U.S. hospitals, this research identified n=83 EDs which clearly self-identified as GEDs. All eligible GEDs were contacted with n=54 (65%) responding to our self-administered survey regarding their organization, delivery of care, and adherence to national guidelines on the emergency medical care of older adults. Results document a wide variety of care models, staffing patterns, screening procedures, clinical care modifications, quality improvement efforts, physical environment enhancements, referral patterns, and tracking of older patient outcomes. Analysis of open-ended responses demonstrated widely divergent interpretations of the national guidelines on emergency care for older adults including the definition of a GED. Based on the findings, research recommendations are made to researchers regarding the conceptualization and specific wording of future survey items in order to increase the reliability and validity of research into GEDs.
PREDICTORS OF PRESSURE ULCER DEVELOPMENT AMONG SENIORS DURING EMERGENCY TRANSFERS TO HOSPITAL EMERGENCY DEPARTMENT
Authors: Reid Colin , Jiwani Hannah , Tate Kaitlyn C , Cummings Greta G 
Published: November 2019

Abstract
Emergency transfers of seniors in long-term care facilities (LTCF) aged &gt;65 to hospital emergency departments (ED) are common and carry with them risks that can lead to less-than-optimal quality of care and quality of life. Pressure ulcers are one such risk. We used data from the Older Persons Transitions in Care (OPTIC; N=637) study, conducted in two Canadian provinces in 2011 and 2012, to assess potential predictors of pressure ulcer development between the time that a resident is transported to the ED until the time they return to their original nursing home. Step-wise binary logistic regression was employed to identify predictors of pressure ulcer development during the transition. Potential predictors included length of transition, inpatient status, demographic, health variables (including incontinence). Among the 335 residents for whom we were able to gather new pressure ulcer data, 56 (16.7%) were identified as having developed new skin wounds upon return to the LTCF. Transitions from ED admission to return to LTCF averaged 106.7 hours (sd=143.6) with a median of 50.0 hours. Length of transition and whether the resident spent time as an inpatient emerged as the only predictors: longer transition times and spending time as an inpatient predict development of bed sores. These results speak to the need for improved monitoring and treatment of skin wounds during emergency transitions of older adults from LTCF.
IMPROVEMENTS NEEDED FOR JAPANESE ELDER ABUSE PREVENTION LAW: COMPARISONS WITH OTHER ABUSE PREVENTION LAWS
Authors: Katsumata Asako , Tsukada Noriko 
Published: November 2019

Abstract
Japan has four stand alone abuse prevention laws, including child abuse (enforced in 2000), domestic abuse (2001), elder abuse (2006) and abuse for people with disabilities (2011). These laws are distinctive in that they aim to prevent abuse, not merely to address abuse after it occurs. This paper compares components of these four abuse prevention laws, delineating major strengths and weaknesses of the elder abuse prevention law in comparison to the other three. The analysis considers both institutional and domestic settings and suggests possible improvements of elder abuse prevention law that need to be made. Evidence for this analysis is supplied through examination of trends abuse using longitudinal data (2012-2017) collected by Japan’s Ministry of Health, Labour and Welfare. The analysis shows commonalities in trends in the four abuse categories. For example, the number of abuse cases has risen over time despite the dissemination and implementation of abuse prevention training, program implementation, and public outreach. Differences include reporting – police more often report abuse cases of children and people with disabilities, while elder abuse cases are more often reported by professional staff members responsible for dealing with elder abuse cases. Although some amendments have been made to the child abuse and domestic abuse prevention laws, no amendments have been made to the elder abuse prevention law despite the requirement to review its success. Needed revisions include provisions of protection orders and temporary shelters to protect elder victims from abusers as soon as possible.
ELDER ABUSE BY FAMILY CAREGIVER: DOES COGNITIVE IMPAIRMENT REALLY MATTER?
Authors: Yan Elsie 
Published: November 2019

Abstract
Previous research suggested that cognitive impairment is a risk factor for elder abuse. Persons with dementia experience elevated risk of abuse as compared to the general aging population. The present study compared rates of abuse reported by family caregivers of older persons with and without dementia. A total of 693 family caregivers participated, among which 592 were providing care older persons with dementia and 101 were providing care to older persons without. Participants provided information on their demographic characteristics, care recipient physical functioning (Instrumental Activities of Daily Living), behavioral problems (Cohen Mansfield Agitation Inventory), caregiver stress (Zarit Burden Interview), emotional and instrumental social support, and abusive behaviors directed at the care recipients (Conflict Tactics Scale and Potentially Harmful Behaviors). Abuse is common in this sample: 46.8% reported potentially harmful behaviors, 52.7% reported psychological aggression, 11% physical assault, and 1.3% injury. No significant difference was observed between caregivers providing care to older persons with or without dementia (p&gt;.05). A series of logistic regression was conducted to determine factors associated with abuse. Care recipient behavioral problems and caregiver burden were two prominent factors associated with potentially harmful behaviors and all forms of abuse. Behavioral problems are common in persons with cognitive impairment and many caregivers feel stressful managing them. It is plausible that cognitive impairments per sec do not increases risk of abuse, but the associated characteristics do. Helping family caregivers manage the caregiving situation and their expectation, positive appraisal and cognitive restructuring may help prevent elder abuse.