bluuebunny/crossref_metadata_2025_split huggingface dataset:
QUALITY OF CARE IN A LONG-TERM CARE COMMUNITY
Authors: Murray Laura A , Heinz Melinda 
Published: November 2019

Abstract
Older adults may need to reside in long-term care facilities for additional assistance. However, research indicates differences in the quality of care. The purpose of this study was to conduct a naturalistic observation, recording factors affecting the quality of care residents received in a long-term care community. Over a three-week period, observations took place in the nursing home, assisted living, and memory care portions of the community. We predicted that there would be more issues negatively impacting quality of care in the nursing home area due to its medical model philosophy. Open-observations were recorded, coded, and analyzed for themes. Results indicated that the most significant issue influencing quality of care in all areas of the long-term care facility was communication (N = 57 recorded instances). Approximately 66% of recorded communication issues in the nursing home were negative compared to positive (25%) or neutral (8%) instances. Elderspeak was prevalent with staff using high pitched voices or saying “hun” to residents. At times, staff spoke too loudly to residents who did not have hearing impairment or would talk about residents in front of other residents, not taking into consideration privacy. In the memory care environment, positive examples were noted. Staff was friendly and worked together as a team, creating a positive work environment. Overall, results indicated staff members may need professional development in the area of communication, particularly staff working in the nursing home. In addition, reminding staff while it is their workplace it is also the resident’s home would be beneficial.
MANAGEMENT OF NONCOGNITIVE NEUROPSYCHIATRIC SYMPTOMS OF DEMENTIA IN NURSING HOME RESIDENTS
Authors: Basnet Prasanna , Acton Gayle , Champion Jane D 
Published: November 2019

Abstract
Background: It is challenging for nursing home (NH) staff to manage non-cognitive neuropsychiatric symptoms (NPS) of dementia. There is a need for an assessment of staff knowledge regarding non-pharmacological approaches to manage NPS of dementia. This assessment will inform development of policies/procedures to assist NH staff for management of problematic behaviors in residents with dementia (RWD) using non-pharmacological approaches thereby complying with CMS directives to reduce psychotropic medication use. Methods: NH staff members were interviewed using semi-structured interview methods. Interviews continued until thematic saturation was reached. A total of 17 interviews were completed. Findings: Forgetfulness, hallucinations, anger, agitation, combativeness are the most common problematic dementia behaviors. Participants reported that these behaviors make activities of daily living (ADL) care challenging and time-consuming. Redirection, distraction, and recreational activities are the most common approaches identified by participants to manage non-cognitive NPS using non-pharmacological techniques. Participants reported rushing residents to get things done hinders cooperation and escalate problematic behavior. Some participants believed the use of a low dose PRN benzodiazepine is effective as this calms the resident with dementia and reduces NH staff time requirements for assistance with ADL care. Participants described adverse reactions such as weight loss, and general decline as an outcome of somnolence secondary to psychotropic medications use. Implications: NH staff who participated in this project had not received any formal education or instruction concerning non-pharmacological approaches for the management of non-cognitive NPS. NH protocols are indicated for non-pharmacologic behavior management techniques prior to the administration of psychotropic medications.
MEASURING CLIENT EXPERIENCE IN RESIDENTIAL AGED CARE TO INFORM AND SUPPORT CONSUMER CHOICE
Authors: Fetherstonhaugh Deirdre M , Wells Yvonne , Herd Angela 
Published: November 2019

Abstract
The Australian Government Aged Care Quality and Safety Commission (prior to January 2019 known as the Australian Aged Care Quality Agency) is responsible for accreditation of Australian aged care services which are audited against the Australian Accreditation Standards. Accreditation reports are publicly available. Prior to 2017, some clients were interviewed about their experiences, but the resulting information could not represent the client experience within a service due to low numbers, biased sampling, and an unsystematic approach to asking questions. La Trobe University was engaged to develop and pilot an interview tool to measure client experience for use in accreditation. Potential questions were identified through a literature review, mapped against the Accreditation Standards, and workshopped with an expert reference group. Twenty-four questions and a visual analogue were then piloted. Consumer groups and groups of Indigenous and culturally diverse clients in residential aged care homes were consulted. The perspective of Quality Agency surveyors was sought on the questions’ usability. Statistical analyses sought to identify questions that minimised missing data, were responded to similarly by residents and their representatives, and elicited stable responses on retest. Twelve questions were identified as optimal. The 10 quantitative questions proved to reflect a single underlying dimension (consumer experience) and, when summed and explored through regression analyses, differentiated services significantly. The consumer experience interview tool is now used in all accreditation audits in Australia. Results are then used to generate consumer experience reports, which are published online and can support consumer choice of a residential aged care home.
NURSING ASSISTANTS’ OPINIONS ON CREATING THE PERFECT DINING EXPERIENCE FOR RESIDENTS WITH DEMENTIA
Authors: Ferguson Christine , Douglas Joy W , Jung Seung Eun , Noh Hyunjin , Ellis Amy 
Published: November 2019

Abstract
Feeding residents with dementia in long-term care settings can be challenging, partly related to environmental factors. Certified Nursing Assistants (CNAs) are primarily responsible for feeding residents with dementia who need assistance. Given that older adults with dementia have an increased risk of developing malnutrition, there is a need to develop standards in place for constructing an ideal dining environment to optimize residents’ dietary intake. This qualitative study was conducted to explore CNA’s perspectives of how dining areas could be enhanced to improve food intake of residents with dementia. Nine focus groups were conducted with a total of 53 CNAs who had at least one year of experience feeding residents. Focus groups were audio recorded and transcribed verbatim. Data were analyzed using directed content analysis guided by the Social Ecological Model. CNAs reported that distractions can significantly inhibit residents’ food intake; therefore, limiting distractions such as noise and crowding is important. CNAs also reported the benefit of playing music in the dining area depended on the individual resident. Additionally, CNAs emphasized the importance of offering a variety of appetizing menu choices tailored to residents’ preferences. CNAs have firsthand experience with residents with dementia and can provide valuable insights. Long-term care administration should consider interdisciplinary support to improve the mealtime experience of residents with dementia in an effort to enhance their dietary intake. In particular, providing a variety of menu choices in a well-lit, calm, spacious, and homelike dining environment can be beneficial.
IMPROVING SLEEP USING MENTORED BEHAVIORAL AND ENVIRONMENTAL RESTRUCTURING (SLUMBER)
Authors: Chodosh Joshua , Hernandez Diana , Mitchell Michael , Cadogan Mary , Brody Abraham A , Alessi Cathy , Smilowitz Jessica , Martin Jennifer 
Published: November 2019

Abstract
Sleep disturbances are common in skilled nursing facilities (SNF) affecting up to 70% of residents. Poor sleep is linked to depressed mood, cognitive impairment, increased pain, and functional disability. SNF residents depend on staff for basic day-to-day needs making it essential that staff be empowered in sleep improvement efforts. In SLUMBER, we are using a multi-site stepped-wedge design to implement a program for SNF staff to improve common sleep-disruptive factors. This three-month program includes four in-person staff meetings and three didactic webinars covering three content areas: 1) improving the nighttime sleep environment, 2) increasing daytime activities, light exposure, reducing daytime sleeping, and 3) helping individual residents having difficulty with sleep. In addition to mentoring staff on sleep improvement strategies, technology provides feedback on noise levels from decibel meters throughout the unit and weekly “sleep pearls” text messages sent to staff to reinforce teachings. We measured noise readings (in decibels) in one second increments. For sleeping hours, 10pm to 6am, we calculated the percentage of observations exceeding 60 decibels. Post intervention in the first of six study units, 78% of noise readings exceeded 60db during sleeping hours compared to three months later where 50.3% of noise readings exceeded 60db, suggesting benefits of noise-reduction efforts. SNF staff reported several instances of improving sleep among chronically poor sleepers and an improved work environment. This mentoring program can achieve important environmental improvements with perceived benefit to residents and staff. Whether this leads to objective symptom and physiological improvements awaits conclusion of this four-year trial.
EXAMINATION OF TRUST IN THE HEALTH CARE SYSTEM AMONG OLDER IMMIGRANTS RESIDING IN THE MIDWEST
Authors: Husa Robyn , Matsuo Hisako , Gallardo Jennifer Hale , Willoughby Lisa 
Published: November 2019

Abstract
Ethnic minority populations, such as immigrants, have demonstrated lower levels of trust in the health care system and their health care providers compared with non-migrant populations (Navaza et al., 2012; Renzaho, Polonsky, McQuilten, & Waters, 2013). This medical mistrust may adversely influence older adult immigrants’ use of and satisfaction with health services (Hong et al., 2018a; Jang, Kim, & Chiriboga, 2005). Thus, the current project aimed to characterize influences of medical mistrust (healthcare system and healthcare providers) in older adult immigrant populations living in the United States of America (U.S.). We interviewed 142 older adult immigrants and refugees (aged 60+ years) who identified as Bosnian, Chinese, Indian, Korean, Latino, and Vietnamese about their perceptions on living in the U.S., of the healthcare system, and healthcare utilization as a part of the Successful Aging among Immigrants in Midlife (SAIM) project. Linear regression models predicting trust in the healthcare system and trust in healthcare providers were tested with healthcare knowledge (measured with a single item about flu shots) , acculturation, length of time in the U.S. , and age as predictors. We found that older age and healthcare knowledge was predictive of higher levels of trust in healthcare providers for Chinese. Although healthcare knowledge was predictive of trust in the health care system for the Chinese participants, greater length of time and higher acculturation were associated with higher trust in the healthcare system among Indian participants. The implications of the different predictive variables in each of the hypothesized models will be discussed.
PAIRING STORIES AND EDUCATIONAL CONTENT FOR A CULTURALLY CELEBRATORY HEALTHY AGING COMMUNITY RESOURCE
Authors: Croff Raina L , Francois Edline , Lawrence Caroline , Rothberg Zoe , Towns Juell , Fuller Patrice , Pruitt Andre , Kaye Jeffrey 
Published: November 2019

Abstract
Culturally celebratory programming exceeds cultural relevancy, engaging participants in celebration-making and culture-creating. African Americans aged 55+ in the Sharing History through Active Reminiscence and Photo-imagery (SHARP) study celebrate their heritage in gentrifying neighborhoods through walking-reminiscence sessions; they create culture through discussing ideas, beliefs, norms, values, and shared experiences of the past while considering these aspects within presently changing cultural dynamics. The SHARP study’s narrative approach supports cognitively healthy behaviors and community priorities of cultural preservation in response to marginalization. The SHARP smartphone application houses 72 themed walking routes in Portland, Oregon’s historically Black neighborhoods. One-mile routes with GPS-triggered historical neighborhood images prompt conversational reminiscence among walking triads. Recorded narratives are organized in a process called storytabling and thematically coded. Selections referencing cognitively healthy behaviors are flagged for pairing with online brain health content tested by 12 African Americans aged 55+. Historical images and narratives anchor educational content to relatable life experiences, framing healthy aging in a culturally celebratory, neighborhood context to improve applicability. The online resource, routes, and recorded narratives are community deliverables. Currently, 254 walking narratives from 2016-2018 walkers (n=40; 8 with mild cognitive impairment) have been transcribed and 60 analyzed. Walkers found image prompts and walking within triads of similar sociocultural backgrounds as highly motivating, healthy ways of addressing change. Content testers found narratives lent depth, meaning, and a sense of cultural resilience to educational content. Narrative approaches situate cognitive health in participant-driven terms and experiences, informing brain health best practices for marginalized and minority populations.
WALKING AND TALKING ABOUT WHAT USED TO BE: THE SHARP NEIGHBORHOOD WALKING PROGRAM FOR OLDER AFRICAN AMERICANS
Authors: Towns Juell , Fuller Patrice , Francois Edline , Croff Raina L , Kaye Jeffrey 
Published: November 2019

Abstract
The Sharing History through Active Reminiscence and Photo-Imagery (SHARP) study aims to preserve African American cognitive health through neighborhood walking and social engagement in a way that celebrates Black culture. For 6 months, African Americans aged 55+ (2016 n=19; 2017 n=21) grouped in triads walked 1-mile routes accessible via the SHARP application. Routes included historical image prompts about Portland, Oregon’s historically Black neighborhoods. Participant focus groups at months 1, 3, and 6 drove program development and refinements, and provided valuable insight into the program’s meaning for participants. Discussions were thematically coded. Emergent themes included “suggested improvements,” “technology,” “mental health impact,” “cultural incongruence,” and “cultural significance.” Participants suggested improvements to the application’s navigational aspects and expressed willingness to engage technology despite initial apprehension. The triadic structure and place-based memory prompts aided reminiscence, allowing participants to make meaningful links between their own life experiences and their walking partners’. Neighborhood walking brought to the surface participant concerns about a lack of understanding between African American generations, and between long-time residents and whiter, wealthier demographics moving in. Some participants found it emotionally taxing to walk in the now gentrified historically Black neighborhoods, but still saw the program overall as useful, interesting, and necessary--to their physical and cognitive health, to their mental health as they processed neighborhood changes and community loss, and as an important contribution to preserving community history. Addressing individual health alongside pressing issues affecting older African Americans’ sense of well-being and community may make cognitive health programs more meaningful and applicable.
THE MEDIATING ROLE OF ADVANCE CARE PLANNING IN ACCULTURATION AND USE OF NURSING HOME AMONG KOREAN AMERICANS
Authors: Cho Soyeon 
Published: November 2019

Abstract
The study examined attitudes towards Advance Care Planning (ACP) as a potential mediator in the association between acculturation and willingness to use nursing home in Korean American older adults (aged 60 and older). Data were driven from a cross-sectional study of 235 community-dwelling Korean American older adults (aged 60 and older) in 2013. Multivariate regression models of willingness to use nursing home were entered in the following order: (1) demographics, (2) health, (3) acculturation, and (4) attitudes towards advance care planning. The mediation effect of attitudes towards ACP in the relationship between acculturation and willingness to use nursing home was separately examined using the bootstrapping method. Higher acculturation was associated with positive attitudes towards ACP and more likelihood of using nursing home. The proposed mediation model was fully supported: positive attitudes towards ACP served as an intervening step between acculturation and willingness to use nursing home. The mediating role of attitudes towards ACP yields implications for developing culturally sensitive advance care planning education program targeting older individuals.
FEELING AUTHENTIC DURING PLAYING PICKLEBALL IN LATER LIFE: PREDICTING POSITIVE PSYCHOLOGICAL FUNCTIONING
Authors: Ryu Jungsu , Heo Jinmoo , Lee Chungsup , Kim Amy Chan Hyung , Kim Kyung Min , Yang Hyunmin 
Published: November 2019

Abstract
Authenticity, being trustful with oneself, is regarded as a principle predictor of healthy functioning. However, the association between authenticity and psychological functioning has not been examined, even though leisure is an ideal context within which to experience authenticity. Therefore, this study examined the association between authenticity and psychological functioning in older adults playing pickleball. A convenience sample of 112 males and 96 females (64.11±6.56, 50 to 82yrs) was recruited from the 2017 U.S. Open Pickleball Championship which is an annual international pickleball tournament. The participants were asked to fill out a questionnaire primarily asking about their levels of authenticity (4-items) and psychological functioning measured by both perceived stress (4-items) and happiness (single item). The pearson correlation tests found higher levels of authenticity were significantly correlated with being less stressed (r = -.373, p &lt; .01) and happier (r = .203, p &lt; .01). A two-step hierarchical regression was used to determine the unique contribution of authenticity to either perceived stress or happiness, and found that authenticity uniquely contributed to 10% of the variance in perceived stress (F= 4.678, p &lt;.001) and 2.3% of the variance in happiness (F= 3.046, p &lt;.01). These results suggest that feeling authentic in older adults playing pickleball may play an important role in positive psychological functioning.
PREDICTING FUNCTIONAL DECLINE IN OLDER ADULTS: MORE ACTIVITY NOW EQUALS LESS DECLINE LATER
Authors: Whitehead Brenda 
Published: November 2019

Abstract
According to the Function Spiral Model (Whitehead, 2017), aging attitudes influence activity engagement, which impacts functional ability via physical conditioning (or deconditioning). This study tests the activity ♢ conditioning ♢ function segment of the model using 59 older adults aged 61-92 (Mage = 76 at Time 1) who participated in 2 in-person assessments of physical health, gait, and function, spaced 3 years apart. Participants also completed mail-in questionnaires, reporting engagement in activities (walking, gardening, household chores, social clubs, etc.) at each time point. Hypotheses were 1) a lower activity level at Time 1 would predict greater decline in physical function across the 3-year span, and 2) that this effect would be mediated by changes in physical conditioning. Dependent t-tests revealed that both physical function—as indicated by the timed Get Up and Go test—and physical conditioning—as indicated by peak respiratory flow—declined during the period. The regression model testing the effect of activity engagement at Time 1 on decline in physical function (controlling for age, baseline function, and activity change) supported hypothesis 1 (-0.43, p = .003): more activity at Time 1 predicted less decline in physical function over time. Instead of supporting the mediation hypothesis, the model including both activity and conditioning demonstrated the strength of the activity at Time 1 effect, which actually increased in magnitude (-0.48, p = .001). Although the hypothesized mediation was not supported, the findings highlight current activity engagement as an important mechanism for slowing the progression of future age-related functional decline.
FACTORS ASSOCIATED WITH LIFE-SPACE CONSTRICTION IN LATER LIFE: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Authors: Choi Moon , Mezuk Briana 
Published: November 2019

Abstract
This study aimed to examine factors associated with life-space constriction, using the data from the Health and Retirement Study, a nationally representative sample. We limited our analysis to those who were 65 years and older and answered to the 2012 experimental module on life-space (N=895; mean age=75.3; 59.4% women). Life-space was assessed with the modified version of the UAB Study of Aging Life-Space Assessment, ranging nine zones: room, home, own property, immediate neighborhood, town, community, county, state, and region. A series of logistic regression models were used to estimate odds ratios for life-space constriction by sociodemographic and health characteristics. The results showed that 3.0% and 6.7% of older adults reported that they had never been to places beyond their home and own property/apartment building for the past four weeks, i.e. the critical boundaries in terms of social isolation. The significant factor associated with the life-space constriction within home, immediate neighborhood, and town was physical mobility limitation (OR: 1.18, 1.09, 1.11, respectively), while the constriction within county was associated with education level (OR: 0.91). Driving a car was negatively associated with the life-space constriction within own property/apartment building and home (OR: 0.48 and 0.22, respectively). Policy makers need to pay more attention to social and environmental factors influencing social isolation among older adults such as transportation options and social class disparity.