bluuebunny/crossref_metadata_2025_split huggingface dataset:
GREATER DEMENTIA SEVERITY IS ASSOCIATED WITH INCREASED RISK OF POTENTIALLY PREVENTABLE READMISSIONS DURING HOME HEALTH CARE
Authors: Knox Sara , Downer Brian , Haas Allen , Middleton Addie , Ottenbacher Kenneth 
Published: November 2019

Abstract
Approximately 14.0% of Medicare beneficiaries are readmitted to a hospital within 30-days of home health admission. Individuals with dementia account for 30% of all home health care admissions and are at high-risk for rehospitalizations. Our primary objective was to determine the association between dementia severity at admission to home health and 30-day potentially preventable readmissions (PPR) during home health care. A secondary objective was to develop a dementia severity category from OASIS items based on the Functional Assessment Staging Tool (FAST). Retrospective cohort study of 124,119 Medicare beneficiaries receiving home health (7/2013 – 6/2015) and diagnosed with dementia (ICD-9 codes). The primary outcome was 30-day PPR during home health. The predictor variable of dementia severity was categorized into six levels (non-affected to severe). The overall rate of 30-day PPR was 7.6% (95% CI 7.4, 7.7) but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, patients classified as stage 6 and stage 7 had 1.36 (95% CI 1.28, 1.45) and 1.90 (95% CI 1.59, 2.26) times higher odds to experience a 30-day PPR compared to patients classified as stage 1-2. Dementia severity in the later stages is associated with increased risk for PPR. Development of a dementia severity category based on OASIS items and the FAST is feasible. Future research is needed to determine effective strategies for decreasing PPR during home health for individuals with severe dementia. Future research is needed to validate the proposed dementia severity categories used in this study.
PATIENT PRIORITIES CARE: GOAL-ALIGNED CARE FOR VETERANS WITH DEMENTIA AND THEIR CAREGIVERS
Authors: Freytag Jennifer , Dindo Lilian , Catic Angela , Naik Aanand 
Published: November 2019

Abstract
Patient Priorities Care (PPC) is an approach to clinical conversations that focuses on aligning care with patient priorities. This approach involves identifying and incorporating patient values, goals, and preferences into care for patients with multiple comorbid conditions. We have previously described how this clinically feasible and sustainable approach has been implemented in VA and private healthcare settings, and how this approach results in documented care aligned with patient goals. In this paper, we describe the way PPC has been adapted and implemented in a VA geriatrics clinic for Veterans with dementia and their caregivers. We discuss results from a funded pilot project in which we investigated the role of caregivers in patient goal setting; assessed patient functioning using self-reported and sensor measures; and examined clinical conversations and interviews. We use these results to discuss implementation strategies targeting: (1) caregiver activation and involvement in clinical conversation and decision-making, (2) patient and caregiver education about the disease trajectory of dementia, (3) life space function and using physical sensor data in dementia care, (4) measures of community integration for patients and caregivers, and (5) features of successful clinical conversations in this context.
INDOOR AND OUTDOOR FALLS AMONG ADULTS AGING WITH A PHYSICAL DISABILITY
Authors: Eagen Thomas J , Mroz Tracy , Chippendale Tracy , Karvonen-Gutierrez Carrie , Battalio Sam , Singsank Katie , Molton Ivan 
Published: November 2019

Abstract
Falls among community-dwelling adults are a significant public health concern. Adults aging with a physical disability report a high number of falls, recurrent falls, and injuries caused by falls. Prevention strategies are needed to reduce the incidence of falls among this population; however, the location of the fall may influence which strategies will be most effective. The purpose of this project was to examine falling indoors versus outdoors was associated with fall related psychological concerns (e.g., self-efficacy), self-reported physical activity levels, physical function and sociodemographic characteristics (e.g., sex, age, education, employment), using survey data of adults aging with four conditions: muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), and spinal cord injury (SCI). Of the 1381 participants who completed the survey in 2017, 52% (n=719) reported at least one fall in the past 6 months. When asked about their worst fall, 32% of falls (n=233) occurred outdoors and 68% (n=486) occurred indoors. Participants with MS were significantly more likely to report falling outdoors (MS=35%, MD = 21%, PPS = 21%, SCI = 24%). Factors significantly associated with outdoor falls included living in an urban environment (OR = 1.59; 95%CI:1.06, 2.39), being more physically active (OR = 1.01; 95%CI:1.001, 1.02) and having better physical function (OR = 1.05; 95%CI:1.03, 1.08). These results fill a critical gap in the falls literature on fall location and have important implications for tailoring fall prevention interventions for individuals aging with a physical disability.
ASSOCIATION OF ATTITUDES WITH ECONOMIC WELL-BEING AND HEALTH: A FOUNDATION FOR PUBLIC POLICY
Authors: Laditka Sarah B , Laditka James N , Gunn Laura 
Published: November 2019

Abstract
The 1960s War on Poverty was based on expectations that certain attitudes could improve health and economic well-being: aspiration and ambition, propensity to plan, personal efficacy, avoidance of unnecessary risk, connectedness to information and help, and trust. If true, promoting those attitudes might improve lives. The nationally representative Panel Study of Income Dynamics (PSID) developed scales to repeatedly measure associations of those attitudes with income and well-being. After five annual measurements, researchers found few associations. Acknowledging more data might be needed, researchers concluded that changing attitudes was unlikely to help. We studied those same associations using five decades of PSID measures on income and work disability, physical or “nervous” health problems limiting work (1968-present; n=5,027; 170,583 person-years; mean baseline age 34.2), with multinomial logistic Markov models and dynamic microsimulation, modelling three levels of each outcome plus death. We also examined persistence of the attitudes (measurement reliability). Results suggested the attitudes were persistent (intraclass correlations &gt; 0.87). Controlling for age, sex, race, education, and baseline income, attitudes were strongly associated with the outcomes. For example, with above-median baseline income, 19.4% in the top baseline self-efficacy quintile had incomes below 150% of poverty at age 70, compared with 27.0% in quintile 1 (p&lt;0.001). Similarly, 5.5% in the highest quintile reported severe work disability (could not work, or limited “a lot”) at age 70 compared to 23.7% in the lowest (p&lt;0.001). Other attitudes showed similar significant patterns. Attitudes in early- to mid-adulthood may contribute importantly to economic well-being and health throughout later life.
PSYCHOLOGICAL MECHANISMS THAT UNDERLIE GOAL EXPECTANCY AMONG RETIREES
Authors: Tsotsoros Cindy , Mooney Anna , Earl Joanne , Hershey Douglas 
Published: November 2019

Abstract
The way individuals envision, formulate, and strive to meet retirement goals is poorly understood. In particular, few studies have focused on the goal setting process of individuals who have already retired. In this investigation, the authors replicate and extend Hershey and Jacobs-Lawson’s (2009) model of retirement goal expectancy across five retirement resource domains. Their (path) model posits individuals’ perceptions of the consequence of failing to achieve a goal determines the perceived importance of the goal. Perceived goal importance, in turn, determines the effort individuals allocate toward achieving the goal (goal striving). And goal striving, in turn, predicts the perceived likelihood the goal will be achieved (goal expectancy). This basic model was empirically tested across five key retirement resource domains (health, physical, social, cognitive and emotional) identified by Wang and Shi (2013). The sample of 698 American retirees (Mage=77.14 years, SD=6.00) was divided into four subgroups: males and females, aged 66-77 and 78-94. Twenty theoretically-driven path analysis models were tested using AMOS (i.e., four subgroup models across five retirement domains). Differences were observed across subgroups and domains in terms of the magnitude of path coefficients and the amount of accounted variance in goal expectancy criterion measures (R2 values ranged from .26-.67). Overall, the path model was effective at capturing variability in retirement goal expectancy. Findings not only provide a synthesis of the 2009 goal model with Wang and Shi’s Dynamic Resource Theory, but they also suggest areas in which retirement intervention specialists can intercede to increase the likelihood of goal attainment.
RETIREMENT ADJUSTMENT: COMPARISON AMONG CHINESE, JAPANESE, AND KOREAN RETIREES
Authors: Yeung Dannii , Nakagawa Takeshi , Cho Jinmyoung 
Published: November 2019

Abstract
Moving into retirement is a stressful life event. However, recent research findings suggest that not every retiree experiences maladjustment. This paper investigated longitudinal changes in depressive symptoms during the retirement transition utilizing harmonized data of CHARLS, JSTAR, and KLoSA. Participants were selected for examination if meeting the following criteria: They were working in Wave 1 and had retired in Wave 2 (China=1053; Japan=184; Korea=706). These participants were categorized into two subgroups based on their status in Wave 3, either remained retired or reemployed. The proportion of retirees who were reemployed in Wave 3 is significantly higher in Korea (49.3%) and China (41.1%) than in Japan (17.4%). In each wave, the level of depressive symptoms was measured by the 10-item CES-D scale. Results of the repeated measures analyses show that, even after controlling for gender, mean level of depression increased over time among Korean retirees [F(2,702)=3.65,p=.026,η2=.010], whereas Japanese retirees’ depressive symptoms only increased in Wave 2 (Mean Difference =.83,SE=.39,p=.034) but not in Wave 3. Among Chinese, depressive symptoms did not significantly worsen after retirement, but the changes varied between retired persons and those who were reemployed in Wave 3 [F(1,1030)=4.25, p=.040, η2=.004]. Specifically, individuals who were reemployed after retirement experienced a reduction in depressive symptoms between Wave 1 and 3, whereas a reverse pattern is shown among retirees. This suggests that reemployment is beneficial to the well-being of Chinese retirees. The effects of socioeconomic factors (e.g., private and public health insurance and pension support) on depressive symptoms will be discussed.
EVALUATING THE FEASIBILITY AND EFFICACY OF A PILOT INTERVENTION TARGETING UNEMPLOYED OLDER WORKERS
Authors: Yang Jie 
Published: November 2019

Abstract
The great recession of 2007–2009 has led to historically high unemployment rates, and almost half of the unemployed population was long-term unemployed in 2010. Both discriminations against the long-term unemployed and ageism hinders older unemployed workers reentering the workforce, and they risk severe mental health deterioration. However, traditional job training programs are shown to be ineffective in protecting their participants’ mental health. Hence, adopting Jahoda’s Latent Deprivation Theory, the author worked with a non-profit in the Greater Boston area on developing an innovative intervention targeting older unemployed older workers’ mental health and income generation outcomes. The pilot intervention (lasting three months) created a quasi-office environment where participants can have a time structure, engage with peers, work on projects, and receive training. The current study evaluates the effect of this pilot program on multiple mental health outcomes. Pre-and-post comparisons were conducted using quantitative analysis (N=13). Participants’ depressive symptoms dropped significantly, and they reported having a better time structure of the day as well as higher scores in extraversion in terms of personality change. Qualitative analyses were conducted to analyze the pre-and-post interviews. Participants reported overwhelming approval of the intervention in helping them better cope with unemployment and being productive in seeking jobs or generating incomes. One example of quotes is “…compared to three months ago, I’m in a very different place. Before the Collaboratory, I had become extremely depressed and withdrawn…The Collaboratory has helped make a massive difference in my sense of well being right now.”
PRECARIOUS PATHWAYS INTO RETIREMENT AND NEW RISKS FOR GENDERED ECONOMIC EXCLUSION IN SWEDEN, 1990-2015
Authors: Motel-Klingebiel Andreas , Kelfve Susanne 
Published: November 2019

Abstract
The ability and disposition of ageing people to maintain their labour market activity and/or to retire from work structurally depend on pension systems, activation policies, ageism, changing for labor demand and economic shifts. Structural conditions are changing, but social change does not mature homogeneously and neither do the institutional shifts induced by it. Gains in opportunities and resources do not benefit all people, groups and even societies in the same way. Changes increase insecurities and life course inhomogeneity, create unequally distributed challenges and show asynchrony in shifts and outcomes. They generate new precarity in ageing and socially structured risks for exclusion in work and retirement and refer to existing later life inequalities by cohort, gender, region, education, class and ethnicity. From this perspective of ageing and social change, the paper deals with shifts in late work and retirement patterns and later-life outcomes under changing institutional conditions, focusing on gendered risks for economic exclusion and later life precarity in Sweden. Swedish registry data comprising individual work and health histories as well as employer, regional and neighborhood information on the total population 50+ ever living in Sweden 1990-2015 is used in a cohort sequential perspective. Analyses focus on gender inequalities and concentrate on occupational activities, retirement transitions and pension revenues under changing social conditions. Models find increasingly heterogeneous preretirement and transition patterns, new gender gaps and increasing risks of economic exclusion in retirement with disadvantaged groups as forerunners in overall relative declines in later-life economic positions.
DOES CAREGIVING MATTER? THE RELATIONSHIPS BETWEEN CAREGIVING EXPERIENCE AND ADVANCE CARE PLANNING IN OLD AGE
Authors: Shen Huei-wern 
Published: November 2019

Abstract
Advanced care planning (ACP) is encouraged as the completion of ACP increases the likelihood for patients to receive their preferable end-of-life care and for caregivers to be less stressed. Common approaches to increase the engagement of ACP target on intervention or information provision to patients in the very late stage of life. Arguing that caregiving experience may influence how people plan their own end-of-life care, the present study focuses on caregiving roles. Using seven waves of data (2002, 2004, 2006, 2008, 2010, 2012, and 2014) from the Health and Retirement Study (HRS), 863 older people who were 65+ and alive in 2012 but passed away prior to 2014 were included in this study to examine the relationships between an individual’s caregiving experience (2002-2012) and his/her completion of ACP (2014). Findings from logistic regression showed that caregiving experience did not influence older adults’ (65+) ACP completion in 2014. When considering different types of caregiving experience (none, spousal, parental) among older cohort (75+), the odds of completing ACP for those with spousal caregiving experience were 2.47 times more likely than those without any caregiving experience. However, no relationship was detected among those with parental caregiving experience. Other factors relating to ACP completion were poorer health, death being expected, death due to cancer, older age and being racial minorities. Practitioners and policymakers could consider encouraging older adults (65+) who provide spousal care to engage in ACP. Future research taking longitudinal approaches to identify reasons behind the existence of the relationship is urged.
A COMMUNITY HEALTH EDUCATION PROGRAM TO ENCOURAGE EXERCISE AND PROPER NUTRITION IN LATINOS
Authors: Kopera-Frye Karen , Graboski-Bauer Ashley , Gonzalez-Marquez Ana Luisa 
Published: November 2019

Abstract
New Mexico now has the 32nd highest adult obesity rate (28.8% for 2015). Thirty one percent of this obesity rate encompasses Latinos; rates are the highest among the 26-44 years age group. Obesity rates in NM for children aged 2-11 range from 11 – 14%. Healthy Kids New Mexico adopted the 5-2-1-0 challenge. (American Academy of Pediatrics) which refers to eating 5+ vegetables, reducing screen time to 2 hours, 1 hour+ daily activity, and daily water intake (H20). Therefore, project I’M HIP2’s main goal was to educate parents and children, within an intergenerational context, on improving diet and activity levels to reduce obesity. The Intergenerational Mentoring on Health Information Pathways 2 (I’M HIP2) program involved 74 Hispanic families including one target child, one parent, and one other relative, e.g., aunt or grandparent. Monthly educational sessions focused on physical activity and adapting meals to be healthy. Project outcomes included exercise frequency, Body Mass Index (BMI), and a knowledge quiz assessing healthy meal facts, exercise knowledge via a 10-item quiz; all assessments pre- and post-program. Paired t-test analyses revealed significant changes in knowledge quiz total scores (t 70 = 5.03, p &lt; .0001), increased exercise frequency (t 72 = 2.106, p &lt; .05); no significant change in BMI from pre- to post-assessments. The families reported overwhelmingly positive responses to how the program had changed their eating styles and activity levels. This study has implications for how we can harness this invaluable resource of the generations to affect health impacts on Hispanic families.
AN ACADEMIC-COMMUNITY PARTNERSHIP FOR IMPROVING ORAL HEALTH OF ADULTS 75-PLUS YEARS IN RURAL SOUTHEASTERN OREGON
Authors: rose tamara , mize darcy 
Published: November 2019

Abstract
This presentation describes a series of research projects undertaken by a school of nursing to develop and test a model for interprofessional (IPE) practice and education. A pilot study and two funded projects have been completed and one funded project is currently underway. A goal has been to build an academic-community partnership to address health disparities for people 75 years and older living in rural areas of the state. This population is growing and more apt to be living in poverty. Low oral health literacy and limited dental health services in rural areas contribute to the likelihood of oral health problems impacting overall health. IPE supports the development of teamwork to improve health outcomes for patients by raising awareness about the relationship of oral health to overall health. This evolving IPE model has joined baccalaureate nursing and dental hygiene students in shared learning and practice. After classroom and simulation-based learning, student teams provided screening and education in primary care settings. The current study has expanded team membership by adding medical, dental and/or nutrition students. They are training and practicing together to be a “mobile oral health team” for older adults living in a rural community 100 miles from campus. Community stakeholders are helping to organize a day-long oral health screening clinic. Looking forward, this IPE model supported by an academic-community partnership will routinely visit chronically underserved areas with a mobile oral health team. Funding for a fully-equipped mobile unit are being sought to sustain this effort.
GAINING INTERPROFESSIONAL COMPETENCE THROUGH A GERIATRICS CASE CONFERENCE
Authors: McIlwain Amber S , Backus Danielle , Marcus Kristine , Fortner Jeff 
Published: November 2019

Abstract
There is increased demand to provide health professions students with interprofessional education and practice experience. Interprofessional Case Conferences (ICC) allow students to work in teams to learn about different professions while exploring a topic through the lens of an interprofessional core competency. The goal of this particular ICC was to provide students an experience to witness and discuss team-based, person-centered care for a common geriatric disorder. The case was designed to develop the interprofessional competency of teams and teamwork. Students were divided into teams and observed live vignettes of a care conference involving an 80-year old female admitted to a rehabilitation facility following a hip fracture and replacement. Students witnessed how patients, families, and healthcare providers work together during a stressful time. After each vignette, students discussed questions related to miscommunications, motivations of the different actors involved, and how the healthcare team should respond. In the first offering, 93 students participated, increasing to 150 in the next year. Students completed a post-survey to determine if the session delivered a positive interprofessional experience. The average positive response rate was 92.5% (92-94%, n = 53) in year-1 and 93.5% (90-97%, n = 71) in year-2. By allowing students to witness a simulated live care conference, they had a tangible event to dissect instead of discussing hypotheticals. By discussing a geriatrics case in a rehabilitation setting, students witnessed how numerous healthcare professions coordinate care for a patient and her family, thereby demonstrating competence in teamwork.
IMPACT OF GERIATRIC INTERPROFESSIONAL TRAINING ON ADVANCE CARE PLANNING IN GERIATRIC PRIMARY CARE
Authors: Barrientos Maureen E , Chodos Anna , Neumann Alicia , Troya Yvonne , Chen Pei 
Published: November 2019

Abstract
Currently, an important measure of Advance Care Planning (ACP), Advance Health Care Directives (AHCD) documentation rate, is at 33% for older adults in the United States. To address this disparity, geriatric faculty in an academic geriatric primary care practice aimed to train geriatrics fellows and other interprofessional (IP) learners to engage patients in ACP. As part of a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, geriatrics faculty and the Medical Legal Partnership for Seniors based at University of California Hastings College of Law provided ACP training to fellows and IP learners, including social work interns. In practice, the fellows and social work interns collaborated to incorporate ACP into patient visits and follow-up telephone calls. To monitor ACP progress, research staff reviewed patients’ electronic health records and performed descriptive analysis of the data. In 21 months, 4 geriatrics fellows built a panel of 59 patients who on average had 3 office visits and 7 telephone calls per person. Prior to clinic enrollment, 12 (20.3%) patients had preexisting AHCD, and 47 lacked AHCD documentation. After ACP intervention, 42 of 47 patients without AHCD documentation engaged in ACP discussion. Of those who engaged in ACP discussion, 24 completed AHCD, raising AHCD completion rate to 61%, or 36 patients in the panel of 59. ACP is a complex process that benefits from skilled communication among interprofessional providers and patients. Findings underscore the potential advantages of IP training and engaging patients in ACP discussion in an academic primary care setting.