bluuebunny/crossref_metadata_2025_split huggingface dataset:
ABILITY OF THE PHYSIOLOGICAL PROFILE ASSESSMENT TO CLASSIFY FALLER TYPE: A PROSPECTIVE COHORT STUDY
Authors: Jehu Deborah A , Davis Jennifer C , Velsey Kristin , Cheung Winnie , Liu-Ambrose Teresa 
Published: November 2019

Abstract
Accurately identifying older adults who will experience subsequent falls is important for the provision of secondary fall prevention. The purpose of this study was to determine the accuracy of the Physiological Profile Assessment (PPA) – a valid and reliable fall-risk assessment [1] – in predicting subsequent falls over a 12-month period in older adults who sought for medical attention after an index fall. Seven hundred thirty-seven community-dwelling adults, aged 70 years and older, who were seen at the Vancouver General Hospital Fall Prevention Clinic, completed the PPA at their initial visit. Falls over the subsequent 12 months were tracked prospectively via monthly falls calendars. All individuals received geriatric care at baseline. Binary logistic regressions were performed to determine the accuracy of classifying two prospective faller types: 1) no additional falls; 2) one or more additional fall(s). Baseline PPA, age, and sex were entered as independent variables. During the 12 month observation period, 345 participants had no additional falls (Age:81.3±6.6yrs;Female=251) and 392 fell one or more times (Age:82.3±6.5yrs;Female=230). The classification accuracy was 51.3% for those who had no additional falls and 64.8% for those with one or more additional fall(s) (Overall:58.5%;χ2=29.0;PPA:β=-0.21;Age:β=-0.01;Sex:β=-60). The PPA was not able to accurately differentiate between those who did and did not subsequently fall. Fall-risk assessment sensitivity and specificity should be improved in older adults seeking medical attention following an index fall to inform secondary fall prevention. [1] Lord SR, et al., 2003. Phys Ther.
CHANGES OVER TIME IN DAYTIME SLEEPINESS AMONG OLDER ADULTS RECEIVING LONG-TERM SERVICES AND SUPPORTS
Authors: Petrovsky Darina V , Hirschman Karen B , Brewster Glenna , Hanlon Alexandra L , Huang Liming , McPhillips Miranda Varrasse , Hodgson Nancy A , Naylor Mary D 
Published: November 2019

Abstract
The purpose of this study was to examine the predictors of excessive daytime sleepiness (EDS) over the first two years of long-term services and supports (LTSS) for 470 older adults in assisted living communities (ALCs), nursing homes (NHs), or their homes. Mixed effects linear regression modeling using a backward elimination process was used to build a final multivariable model. In the final model, being female (p&lt;0.001) and fewer functional deficits (p&lt;0.001) at baseline were associated with decreases in EDS, while higher baseline measures of BMI (p=0.004) and number of symptoms (p&lt;0.001) were associated with higher EDS. Compared to older adults living in the community and receiving LTSS, those in NHs and ALCs had higher EDS (p&lt;0.001). Greater feelings of belonging and depressive symptoms at baseline were associated with slower rates of increase in EDS over time (both p&lt;0.001). Modifiable predictors of EDS and clinical implications will be discussed.
ABERRANT FUNCTIONAL CONNECTIVITY UNDERPINNING CHANGES IN LIFE-SPACE MOBILITY IN OLDER ADULTS
Authors: Hsu Chun Liang , Best John R , Crockett Rachel A , Chan Patrick , Liu-Ambrose Teresa 
Published: November 2019

Abstract
Subtle, but observable, changes in mobility often exist among older adults. Life-space mobility defines the frequency and extent of movements in the environment, and lower life-space mobility is associated with adverse health outcomes and mild cognitive impairment (MCI). Currently, the underlying mechanism of this association is not well understood. The aim of this study was to examine the functional neural correlates of reduced life-space mobility over 12 months. Thirty-five older adults over the age of 65 years with MCI were recruited and enrolled into this 12-month prospective study. Resting-state functional magnetic resonance imaging was completed at study baseline. Clinical assessment of anthropometric, behavioural measurements, and life-space mobility was conducted at study baseline and at the 12-month period. Over the 12-month study, the 35 participants demonstrated a significant reduction in LSA scores (paired sample t-test mean change=-6.53, p=0.01); greater baseline connectivity between the default mode network and the sensorimotor network was significantly associated with lower life-space mobility (R2=0.44, p=0.04). These findings suggest reduced life-space mobility in older adults may be partially due to altered inter-network connectivity in the brain such that normal neuro-cognitive motor behaviours is disrupted. Therefore, the maintenance of functional architecture of the brain may be essential in preserving the extent and frequency of older individuals’ movement in their environment.
SYSTEMATIC REVIEW OF THE EFFECTS OF NON-VR EXERGAMING ON MOBILITY OUTCOMES OF OLDER ADULTS LIVING IN LONG-TERM CARE
Authors: Chu Charlene H , Biss Renee , Sultana Afroza , Gauthier-Beaupré Amelie , Talebzadeh Arezoo 
Published: November 2019

Abstract
Introduction: Institutionalized older adults have high-rates of mobility decline resulting in reduced quality of life and increased dependency. Given the ageing population, there has been a proliferation of exergaming technology targeting older adults to maintain their physical activity (PA) levels and prevent decline. However, it is unclear if exergaming is effective to maintain or improve the PA of institutionalized older adults. Method: Four databases (MEDLINE/CINAHL/PsycINFO/Compendex) were systematically searched (key terms like “nursing homes”, exergaming”). Quantitative manuscripts examining the effects of exergaming on PA measures of institutionalized older adults published in English between 2006-present were eligible. Virtual reality was excluded from the search. No meta-analysis was conducted due to hetereogeneity of the results. Results: 11 studies were included from a search that yielded 208 results. The exergaming platforms that were used the most were the Kinect and Wii. The most commonly used PA measures were the Berg Balance Scale and the Timed-up-and-Go (n=4 studies) with no other measures being used in more than one study. Interventions ranged in exercise (e.g. cognitive-motor training, strength training, balance, etc), frequency, duration, and modality. Study designs were also heterogeneous. Articles were of very poor to poor quality. There was minimal reporting on adverse events. Older adults with cognitive impairment were commonly excluded. Challenges in current technology and studying this group are highlighted. Conclusion: Exergaming may be promising to maintain PA but more robust research is needed. More exergaming technology designed for long-term care to meet the specific complex needs of this population is warranted.
CHARACTERISTICS OF THE GAIT INITIATION PHASE IN OLDER ADULTS WITH DIABETIC PERIPHERAL NEUROPATHY
Authors: Kang Gu Eon , Nguyen Hung , Zahiri Mohsen , Zhou He , Wang Changhong , Goel Rahul , Najafi Bijan 
Published: November 2019

Abstract
Impairment in steady-state gait in older adults with diabetic peripheral neuropathy (OADPN) is well-known, however little attention has been paid to the gait initiation phase in which postural transitions occur from upright standing to steady-state gait. Given the risk of falls in the gait initiation phase in older adults, knowing its characteristics may be as important as steady-state gait. The aim of this study was to investigate kinematic characteristics of the gait initiation phase in OADPN compared to healthy older adults (HOA). Thirteen OADPN (72.9±6.1 years; 33.0±4.8 kg/m2), and 11 HOA (71.8±2.7 years; 26.5±4.3 kg/m2; no cardiovascular, neurological or orthopedic condition, no history of falling) performed gait on level ground for minimum 10 meters at self-selected comfortable speed. We collected kinematic data using five wearable sensors (LEGSysTM, BioSensics LLC, Watertown, MA) attached on the shanks, thighs and lower back. We used previously validated algorithm to analyze kinematic parameters for the gait initiation phase. Our statistical model showed that the number of steps, stride velocity, gait cycle time, double limb support and mediolateral center-of-mass sway during the gait initiation phase is significantly different between HOA (2.4±0.7 steps; 1.16±0.15 m/s; 1.12±0.10 seconds; 20.3±4.8%; 4.0±1.5°, respectively) and OADPN (4.0±2.1 steps; 0.92±0.29 m/s; 1.23±0.12 seconds; 29.2±10.3%; 7.0±2.9°, respectively) (all p&lt;0.05). The results suggest that OADPN take more, slower and more unstable steps to reach steady-state gait from upright standing compared to HOA. The results also provide implications for needs to develop new interventions targeting the gait initiation phase in OADPN.
ACADEMIC PARTNERING IN A COMMUNITY-BASED FALL PREVENTION PROGRAM
Authors: Klima Dennis W , Wehlandl Emily , Holmes Aspen , Weimert Jessica , Rhoten Nicholas , Wolfe Jestine , Avila Katherine , Austin Nate 
Published: November 2019

Abstract
Falls are a major cause of disability nationally are and linked to both fractures and fear of falling. The purpose of this study was to assess the effectiveness of a rural community-based fall prevention program using an academic partnership model with seven physical therapy students rotating through six senior centers. One hundred and fifty-four older adults (Mean age: 76.1+/- 8.5) completed Stepping On at six locations. A mixed-methods design was utilized. Physical therapy students partnered with older adult participants to teach exercises, strategize floor recovery techniques, and identify community safety barriers. A descriptive survey tool assessed demographic profiles, falls efficacy, and program effectiveness among participants. Students participated in a follow-up focus group to discuss perspectives on their role in the fall prevention program. Most participants were female (86.4%), lived alone (50.0%) and taking four or more medications (74%). Thirty-eight participants (24.7%) had fallen over the past year. Eighty-eight (57.1%) subjects noted they had less fear of falling following the community-based intervention; moreover, most subjects (74.7%) reported having an improved plan for floor rise after a fall. Major focus group themes underscored students’ enhanced ability to teach exercise and mobility activities with an increased awareness of interdisciplinary fall prevention. Following a collaborative community-based fall prevention program, seniors have a better understanding of fall causes and plan to seek floor recovery assistance. In turn, student teaching and communication skills are reinforced. Student partnering with seniors promotes fall prevention strategies and affords benefits to both students and participants.
RISING FROM THE FLOOR IN PERSONS WITH PARKINSON’S DISEASE
Authors: Klima Dennis W , Stewart Jeremy , Freijomil Frank , DiBartolo Mary 
Published: November 2019

Abstract
While considerable research has targeted gait, balance and preventing falls in individuals with Parkinson’s disease (PD), less in known about the ability to rise from the floor in this population. The aims of this study were to 1) Examine the relationship between locomotion and physical performance tests and the timed supine to stand performance measure and to 2) Identify both the time required and predominant motor patterns utilized by persons with PD to complete to floor rise transition. A cross-sectional design was utilized. Twenty community-dwelling older adults with PD (mean age 74.8+/-9.5 years; 13 men) performed a standardized floor rise test and locomotion tests in a structured task circuit. Subject demographic and anthropometric data were also collected. Statistical analyses included descriptive statistics and Pearson Product Moment correlations. Fifteen subjects (75%) demonstrated the crouch kneel pattern and fourteen (70%) used an all-4’s strategy to rise to stand. The mean time to rise from the floor was 14.9 (+/- 7.6) seconds and slower than published norms for persons without PD. Nine subjects required the use of a chair to perform floor recovery. Supine to stand performance time was significantly correlated with the: Dynamic Gait Index (r= - 0.66; p&lt;0.002), Five Times Sit to Stand Test (r=0.78; p&lt;0.001), Timed Up and Go Test (r=0.74; p&lt;0.001), and gait velocity (r= -0.77; p&lt;0.001). Rising from the floor demonstrates concurrent validity with locomotion and physical performance tests. Floor recovery techniques can be incorporated in fall prevention initiatives in conjunction with PD symptom management.
NOVEL INSIGHTS ON THE RELATIVE IMPORTANCE OF CLINICAL AND GAIT MEASURES FOR DETECTING FALL RISK IN OLDER ADULTS
Authors: Hundza Sandra , MacDonald Stuart , Commandeur Drew T , Klimstra Mark 
Published: November 2019

Abstract
We sought to extend recent research that explored model-based approaches for combining clinical and gait measures to determine the most sensitive grouping for retrospectively classifying fallers from non-fallers which resulted in a model with 92% sensitivity and 66% specificity and an overall model of 83%. In the present study, the clinical assessment battery was augmented by incorporating more challenging balance items while removing clinical measures characterized by ceiling effects and restricted range. Thirty-two community-dwelling older adults (&gt;70yrs, 16 fallers, 16 non-fallers) completed a battery comprising 76 measures of more challenging clinical measures of mobility and balance, and retained gait (GaitRITE), postural sway and physiological measures. Within each domain, highly collinear and theoretically-redundant measures were removed. Next, a Principal Component Analysis (PCA) identified those clinical and gait variables that accounted for the most unique variance. Finally, a backward stepwise logistic regression was performed on the reduced set of variables from the PCA to develop predictive equations. The current analysis yielded improved specificity of 75%, but slightly lower sensitivity 81%. Interestingly, when the results for the PCA from the previous study were used with the current data, the model classified fallers with 87% sensitivity and 86% specificity and an overall model of 86%. Notably, in all analyses, gait variables were central in identifying fall risk, with single- vs. dual-task difference scores of particular predictive importance. The differences observed between the best-fitting models across the two cohorts implies that modelling methods should accommodate and harness individual differences (e.g., machine learning techniques).
CHALLENGES AND BARRIERS FOR SERVICE PROVIDERS IN RURAL SETTINGS: AN ELDER-ABUSE NEEDS ASSESSMENT
Authors: Peitz Louise , Lee Jeong Eun , Gilligan Megan , Meinertz Naomi R 
Published: November 2019

Abstract
There has been concern about the increasing prevalence of elder abuse in the rural settings. This trend has called for more coordinated efforts to address elder abuse in the rural community. The current literature regarding elder abuse suggest there is more to learn about systematic obstacles service providers face. The framework applied in this study include elements of Bronfenbrenner’s Bioecological model, showing a multilevel application to the obstacles agencies encounter when supporting else abuse victims. Little research has been conducted on the providers who work with elders in the rural context. In this study, based on the needs assessment of Iowa, we have examined the perceived barriers service providers face. Our sample included 222 providers across Iowa who took an online survey. The survey was initially sent to members of the Coordinated Community Response team of Iowa. Our findings indicated that service providers revealed multilevel challenges (i.e., individual vs. organization level) in working with elder abuse cases. Service providers’ perceived effectiveness training was negatively associated with the quality of training they evaluated (β=.24, p&lt;.05). The data also showed us that a large portion of agencies offered no training and education on elder abuse. Common themes described by the providers as barriers to addressing abuse was lack of education, social isolation, low awareness and ageism. These results highlight that training for elder abuse in the rural setting needs multilevel systematic efforts.
FINANCIAL DECISION MAKING SELF-EFFICACY IN COGNITIVELY AND FINANCIALLY VULNERABLE OLDER ADULTS
Authors: Gross Evan Z , Campbell Rebecca J , Hall LaToya , Lichtenberg Peter 
Published: November 2019

Abstract
Financial decision making self-efficacy (FDMSE) is a novel construct that may influence how older adults make financial decisions. Our previous research with a community sample of older adults demonstrated that cognitive functioning and suspected history of financial exploitation were both associated with low FDMSE. We sought to replicate these findings in two clinical samples of older adults: people with mild cognitive impairment (MCI) or probable Alzheimer’s disease (PAD) and current victims of scams or exploitation as determined by a financial coach. Samples were obtained from the Michigan Alzheimer’s Disease Center and a financial coaching intervention study. All participants completed a 4-item FDMSE measure. One-way ANOVAs, t-tests and chi-square tests were conducted to test for group differences with controls on demographics. There was a main effect of cognitive status on FDMSE, F(2,138) = 8.10, p &lt; .001, which was driven by higher FDMSE in the healthy group (N = 63) than the MCI (N = 76) or PAD (N = 28) groups. Similarly, scam victims (N = 25) had significantly lower FDMSE than non-exploited (N = 25) peers, t(48)=2.33, p &lt; 05. Cognitive impairment and current financial scams are both associated with low FDMSE levels. Low FDMSE may exacerbate cognitive and psychosocial vulnerabilities that contribute to risk for poor financial decisions among older adults. Future interventions to enhance FDMSE may help older adults make better decisions despite changes in thinking abilities or previous negative financial experiences.
TRENDS IN GERIATRIC PHYSICAL ASSAULT INJURIES TREATED IN U.S. EMERGENCY DEPARTMENTS, 2006-2015
Authors: Rosen Tony , Clark Sunday , Gassoumis Zach , Yonashiro-Cho Jeanine , Elman Alyssa , Lachs David , Bloemen Elizabeth , Hall Jeffrey 
Published: November 2019

Abstract
Trends in Geriatric Physical Assault Injuries Treated in US Emergency Departments, 2006-2015 Older adults are common victims of assault, many of which may result in severe injuries. Our objective was to understand temporal and demographic trends in geriatric assault injuries treated at U.S. Emergency Departments (EDs) and to compare these trends to assault injuries in younger adults. We conducted an analysis of assault injuries in patients aged ≥60 compared to patients aged 18-59 treated in EDs during 2006-2015 using the National Electronic Injury Surveillance System-All Injury Program Special Study of Assaults, which collects data from a nationally representative stratified probability sample of U.S. hospitals. Total geriatric assaults seen in EDs increased from 35,135 in 2006 to 69,657 in 2015, a 98% increase. These injuries increased as a percentage of all geriatric injuries treated from 0.9% to 1.1%. Assaults in older men increased 119%, while assaults in older women increased 68%. Among age groups, the biggest percentage increases were among adults aged 60-64 (138%) and aged 65-74 (89%). ED visits for injuries associated with physical elder abuse increased from 13,241 in 2006 to 27,406 in 2015, a 107% increase. During this period, number of younger adults treated for assault did not significantly change. We concluded that geriatric assault injuries, particularly in older men in younger age groups, are dramatically increasing. Further research is needed to better understand these assaults to develop prevention strategies.
USE OF EXPOSURE CROSSOVER DESIGN TO CONTROL FOR UNMEASURED BASELINE CONFOUNDING IN OBSERVATIONAL STUDIES
Authors: Han Ling , Kerns Robert D , Skanderson Melissa , Goulet Joseph L , Luther Stephen , Brandt Cynthia 
Published: November 2019

Abstract
Observational comparative effectiveness studies face the challenge of selection bias. Due to lack of randomization, an alleged treatment effect may reflect inherent differences in baseline characteristics between comparison groups, rather than the outcome of treatment. Propensity score methods were devised to “resample” a most comparable comparison group, under a strong yet untestable assumption of no unmeasured confounding. We present an “exposure crossover” study evaluating complementary and integrative health approaches (CIH) among 6,379 US veterans who received acupuncture, massage or chiropractic therapies between 10/1/2011-9/30/2013. Their average pain intensity ratings (PIRs) during the 12-months after CIH initiation (effect period, EP) were compared with the 12-months before (baseline period, BP). Through this built-in self-matching, veterans’ characteristics and other stable baseline confounding, measured and unmeasured, were presumably eliminated. After accounting for time-varying opioid use and within-subject correlations using a generalized estimating equation, we found that in comparison to the BP, the adjusted mean PIR during the EP was -0.40 (95% Confidence Interval (CI): -0.51, -0.29) points lower; while the adjusted rate ratio of moderate to severe pain (PIRs ≥ 4) was 34% lower [0.66 (95% CI: 0.62, 0.70)]. The effect sizes were greater among veterans older than 65 years, yet diminished to null after 6-9 months. Assuming a 3-month induction period, using alternative random-intercept model, and examining post-CIH opioid use as an alternative outcome, derived similar results. These observations echo some randomized trials suggesting a modest, short-term CIH benefit, and highlight the merits and usefulness of exposure-crossover design to observational studies of medical interventions.
MEDICAL COMPLICATIONS AND INJURY LEADING TO EMERGENCY DEPARTMENT USE AMONG OLDER ADULTS
Authors: Carter Mary W , Yang Bo Kyum , Engineer Cyrus Y 
Published: November 2019

Abstract
Medical injury consistently ranks among the most expensive hospital stay diagnoses and represents a frequent cause of hospital readmission. Although older adults are at greater risk of medical injury, in part, because of greater incidence of comorbidity and increased medical complexity, little is known about the burden of medical injury leading to ED use or the costs and outcomes associated with these events among older adults. In response, this study used nationally representative data from the 2014 Nationwide Emergency Department Survey to examine the epidemiology of older adult ED-visits for medical injury. Principal diagnosis codes were grouped using AHRQ’s Clinical Classification Software to identify medical injury-related visits. Results indicated that in 2014, 506,466 ED-visits for medical injuries occurred, comprising 2% of all older adult ED-visits. Leading causes of medical injury included malfunction of device, implant and grafts (24%); infection and inflammation of internal prosthetic device, implant, and graft (16%), and other complications of surgical and medical procedures (15%). Risk factors for medical injury included being male, Medicaid as primary payor, and number of chronic conditions. Multinominal logistic regression and multivariate regression results indicate that Medical injury-related ED visits were associated with higher hospitalization risk (RRR=2.08, p&lt;0.000), 27% longer hospital stays, and 24% higher total charges relative to non-medical injury related visits. However, medical injury was not associated with risk of death after adjustment. Study findings suggest that ED-visits for medical injury occur frequently among older adults and are associated with significant burden and cost.