bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nursing Home Staff’s Perceptions of Healthcare Decision Making for Unbefriended Residents
Authors: Kim Hyejin , Perkins Molly , Pope Thaddeus , Comer Patricia , Song Mi-Kyung 
Published: December 2020

Abstract
‘Unbefriended’ adults are those who lack decision-making capacity and have no surrogates or advance care plans. Little data exist on nursing homes (NHs)’ healthcare decision-making practices for unbefriended residents. This study aimed to describe NH staff’s perceptions of healthcare decision making on behalf of unbefriended residents. Sixty-six staff including administrators, physicians, nurses, and social workers from three NHs in one geographic area of Georgia, USA participated in a 31-item survey. Their responses were analyzed using descriptive statistics and conventional content analysis. Of 66 participants, eleven had been involved in healthcare decision-making for unbefriended residents. The most common decision was do-not-resuscitate orders. Decisions primarily were made by relying on the resident’s primary care physician and/or discussing within a facility interdisciplinary team. Key considerations in the decision-making process included “evidence that the resident would not have wanted further treatment” and the perception that “further treatment would not be in the resident’s best interest”. Compared with decision making for residents with surrogates, participants perceived decision making for unbefriended residents to be equally-more difficult. Key barriers to making decisions included uncertainty regarding what the resident would have wanted in the given situation and concerns regarding the ethically and legally right course of action. Facilitators (reported by 52 participants) included some information/knowledge about the resident, an understanding regarding decision-making-related law/policy, and facility-level support. The findings highlight the complexity and difficulty of healthcare decision making for unbefriended residents and suggest more discussions among all key stakeholders to develop practical strategies to support decision-making practices in NHs.
Predicting Change in Depressive Symptoms in the Nursing Home
Authors: Reinhardt Joann , Burack Orah , Cimarolli Verena , Weiner Audrey 
Published: December 2020

Abstract
Depressive symptoms are common among nursing home (NH) residents. Important predictors of depression to tease apart include demographic characteristics, physical status, functional ability, and chronic pain. A challenge to addressing depression is that a majority of NH residents have some level of dementia. Nonpharmacological management of depression in the NH is a recommended first line of treatment including: personalized activities, music therapy, repositioning, and attention to personal care needs (toileting, resting, and hydration). A holistic approach to the well-being of NH residents is the adoption of person directed (PDC) care models. In this study, predictors of decreased depression over time was examined in residents (N=144) living in two communities featuring PDC models, and those living in traditional care communities within the same NH. Care in the two PDC communities focused on provision of comfort care for persons with advancing dementia at-risk of not having their care needs met largely due to their inability to clearly communicate these needs. Care practices focused on knowing each elder deeply, and anticipating their needs. Care practices also included an emphasis on staff empowerment and meaningful life activities for residents. Traditional communities are those where PDC practices had not yet been incorporated. Data on demographic characteristics, cognitive status, physical and functional status, behavioral symptoms, and pain were extracted from the MDS. Results showed that being in the PDC group, less time in the nursing home, having less pain, and fewer behavioral symptoms were significant predictors of decreased depressive symptoms over a six-month period.
Profiling Nursing Home Care Specialization Groups
Authors: Wang Xiao (Joyce) , Burr Jeffrey , Hefele Jennifer , Wang Joyce 
Published: December 2020

Abstract
The nursing home (NH) industry has experienced a shift toward care specialization. This study used NH-level panel data from 2011 to 2017 to describe unique care specialization groups in urban areas using latent profile analysis (LPA) (N= 64695, with 12,143 unique NHs). We focused on urban NHs because NHs specialize in care due to competition and memetic pressure, more likely to be the case for urban NHs. To identify care specialization profiles, LPA was applied using different types of specialist staffing levels (physical therapist, occupational therapist, physicians, and dietitians) and the share of special care units aimed at chronic conditions like Alzheimer’s Disease and AIDs. Model diagnostics and information criterion guided selection of the best fitting model. Model stability over time, interpretability of results, and parsimony were also taken into consideration. The final results indicated a 4-profile model fit the underlying data best and the patterns remained comparatively stable over seven years. The 4-classes are uniquely identified as: high use of specialists of all types (3%), moderate use of specialists of all types (7%), mixed use of specialists and special care units (26%), and low specialization use (64%). From 2011 to 2017, the size of the ‘low specialization’ group became smaller, whereas the high and moderate groups grew larger. In addition to describing a clear trend towards increased care specialization, our findings indicated great heterogeneity in NHs’ care specialization patterns in urban areas. Future studies should examine market and organizational characteristics, as well as performance outcomes for different specialization groups.
Are the Self-Employed Mentally Healthier Than Salaried Workers? Evidence From Korea, Mexico, and the United States
Authors: Jun Hankyung 
Published: December 2020

Abstract
Self-employed workers are often reported to have better health than salaried workers. Whether this is because self-employment has health benefits or healthier workers are self-employed is not clear. Self-employed workers may have higher job satisfaction due to higher levels of self-efficacy and autonomy, but may also experience higher job stress, uncertainty, and lack of health insurance leading to mental health problems. Self-employed workers in the U.S. may have different characteristics than those in Mexico and Korea given different working and living environments as well as different institutional arrangements. This study will examine the association between self-employment and mental and cognitive health for older adults in the U.S., Mexico, and South Korea. It uses harmonized panel data from the Health and Retirement Study, the Korean Longitudinal Study of Aging, and the Mexican Health and Aging Study. We compare the health and selection effect of self-employment using a pooled logistic model, fixed-effects model, and a bivariate probit model. In addition to comparing self-employed and salaried workers, we analyze differences between self-employed with and without employees. By using rich data and various models, we address reverse causality and estimate the relationship between self-employment and health. We show that the positive health effects of self-employed workers in the U.S. disappear once controlled for unobserved heterogeneity, indicating the possibility of healthier workers selecting into self-employment. Interestingly, for Korea and Mexico, healthier individuals seem to select into wage work which reflects the difference in working conditions across countries. Further analysis will show effects by business size.
Factors Influencing Practitioner Choice in Nonparticipation in Medical Assistance in Dying
Authors: Brown Janine , Goodridge Donna , Thorpe Lilian 
Published: December 2020

Abstract
Canadians aged 65 and older compromised 79% of the individuals who chose a medically assisted death between January 1 – October 31, 2018. Despite public approval for MAID, and positive professional reception, few practitioners are participating in MAID care and the underlying factors influencing this require exploration. What are the factors considered by practitioners when contemplating MAID participation? Interpretive Description guided a qualitative, exploratory project. Data included semi-structured interviews with 35 practitioners who currently did not participate in MAID, interviewer field notes and reflective content. Data was analyzed through open coding, a constant comparative approach and thematic analysis. Participants are contemplating numerous endogenous and exogenous factors in determining care participation. The endogenous factors included philosophy of care, MAID/faith/spirituality congruence, the conceptualization of duty, comfort with death and previous life experiences. Within these factors, participants described knowing if MAID participation was, or was not, possible through a process of self-reconciliation. Those who thought MAID care participation may be possible, but yet were not participating, intentionally contemplated numerous exogenous factors including risk, time and practice factors, patient, family and community considerations, system structures, and visibility. Non-participation in MAID care is important to understand to support the self-determination of older adults who may consider MAID. Contemplating involvement in MAID care is complex with both numerous factors influencing practitioner choice. Practitioners require care options, safe passage, respect, model of care clarity, removal of practice barriers, open conversations, enhanced education opportunities and time to facilitate safe, supportive work environments and client care.
Meaning Making as a Central Mechanism of Dignity Therapy for Older Adults With Cancer
Authors: Mroz Emily , Bylund-Lincoln Carma , Wisolmerski Rachel , Wilkie Diana , Fitchett George , Handzo George , Chochinov Harvey , Bluck Susan 
Published: December 2020

Abstract
Nearly 500,000 older Americans die a cancer-related death each year (National Vital Statistics Report, 2018). Following a diagnosis of a serious illness like cancer, maintaining a sense of dignity is central to a patient’s wellbeing. Dignity Therapy (DT) was recently introduced as an intervention to enhance dignity for terminally ill patients (Chochinov et al., 2005). This therapy provides patients opportunities to foster a sense of dignity though making meaning of their lives (Hack et al., 2010). To date, whether meaning-making actually occurs as a central mechanism of effective DT has not been tested. The current study investigates (i) how often and in what forms meaning-making occurs during DT, and (ii) how patients’ baseline feelings of dignity relate to meaning-making during DT. Participants were 25 male and female cancer outpatients (M age = 63.08; SD = 5.72). They completed the Patient Dignity Inventory (Chochinov et al., 2008) and then participated in Dignity Therapy with a trained provider. Sessions were audio recorded, transcribed, and reliably content-analyzed for meaning-making using an established coding scheme (Park & Folkman, 1997). Content-analysis revealed that all patients made meaning of past life events at least once (range: 1-12 occurrences). Multiple forms of meaning-making emerged, with Finding Benefit and Personal Growth most common. Patients reporting more dignity-related distress prior to DT showed greater meaning-making during the DT session (r = .46, p &lt; 0.05). This study provides foundational evidence that meaning-making is a key mechanism of Dignity Therapy, helping older adults with cancer enhance dignity at end-of-life.
Association Between Frailty and Development of Alzheimer's Disease–Related Dementias
Authors: Li Chih-Ying Cynthia , Downer Brian , Chou Lin-Na , Ottenbacher Kenneth , Markides Kyriakos S , Snih Soham Al 
Published: December 2020

Abstract
Frailty is associated with an increased risk for Alzheimer’s disease and related dementias (ADRD). However, this association has not been investigated in older Mexican Americans; a population that is high-risk for frailty and ADRD. This study investigated the association between frailty and the development of ADRD over 9-year period. We analyzed 860 Mexican Americans ≥76 years old of the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) who have been linked with Medicare claims data. Survey data from Wave 6 (2007/08) was used to categorize participants as frail (either pre-frail or frail) or non-frail according to the Fried phenotype. The main outcome was ADRD diagnosis after Wave 6 interview. ADRD status was determined using the Chronic Conditions Segment of the Master Beneficiary Summary File. We estimated ADRD disease-free probability during 2007-2016 using midpoint of interval data method stratified by frailty status. Mean age of the study sample was 83.2 years (SD=4.4) and 59.3% were female. We found individuals who were frail had less ADRD-free months (46.5; SD= 36.5-52) compared to those who were non-frail (66.0; SD= 47.5-120). Individuals with a score of less than 21 points on the Mini Mental Status Exam had greater risks of ADRD development (Odds Ratio=1.35, 95% CI= 1.05-1.74) compared to their counterpart, after controlling mortality as a competing risk. Our results suggest being pre-frail, frail or cognitively impaired are risk factors for ADRD in community-dwelling older Mexican Americans.
Retirement Without God: Activism and Community Among Secular People Over 60
Authors: Blankholm Joseph 
Published: December 2020

Abstract
There are more than 1,400 nonbeliever communities in the United States and well over a dozen organizations that advocate for secular people on the national level. Together, these local and national groups comprise a social movement that includes atheists, agnostics, humanists, freethinkers, and other kinds of nonbelievers. Despite the fact that retired people over 60 dedicate most of the money and energy needed to run these groups, the increasingly vast literature on secular people and secularism has paid them almost no attention. Relying on more than one hundred interviews (including dozens with people over 60), several years of ethnographic research, and a survey of organized nonbelievers, this paper demonstrates the crucial role that people over 60 play in the American secular movement today. It also considers the reasons older adults are so important to these groups, the challenges they face in trying to recruit younger members and combat stereotypes about aging leadership, and generational differences that structure how various types of nonbeliever groups look and feel. This paper reframes scholarly understandings of very secular Americans by focusing on people over 60 and charts a new path in secular studies.
Effects of Personality and Emotion Regulation in Depressed Older Adult Inpatients
Authors: Mak Wing Jin , Yenko Ira , Aronov Avner , Park Hyunyoung , Geramian Helene , Ho Jennifer , Francois Dimitry , Zweig Richard 
Published: December 2020

Abstract
Personality pathology and emotion dysregulation are associated with impaired psychological and functional outcomes in adults. However, much less is known about their relationship with depression, social functioning, and suicidal behaviors among older clinical samples. The aim of this study was to examine how the two impact depression, social adjustment, and suicidal behavior in an inpatient sample of depressed adults 55 to 89 years of age (N=52). Personality (agreeableness and neuroticism) and suppression strategies (expressive and thought suppression) were first investigated individually and then jointly as a combined predictive model. Results found lower agreeableness predicted poorer social adjustment (β = -2.871, p &lt; .01), while higher neuroticism (β = 0.426, p&lt;.01) and greater use expressive suppression (β =.253, p &lt;.05) each predicted more severe depressive symptoms. Individuals high in neuroticism also evidenced greater use of both thought suppression and expressive suppression, while those who were more depressed endorsed poorer social functioning. Although not reaching the point of statistical significance, lower agreeableness, higher use of suppression strategies, and poor social functioning were found to be moderately associated with experience of recent suicidal ideation. Our findings demonstrated personality pathology and ineffective emotion regulation are promising potential pathways in the detection and intervention of psychological and functional impairments in depressed older adults. Our study also highlighted the need for more research examining the effects of personality pathology and emotional dysregulation from a functional perspective, which could enhance the focus of target problem areas in interventions for severely depressed older adults.
Turning 75: Why Age Matters for Victims of Assaultive Violence Reported to Police
Authors: Addington Lynn 
Published: December 2020

Abstract
Americans are able to age in more active and engaged ways than previous generations. These changes bring many positive opportunities, but also might affect the risk of criminal victimization for older adults. In considering these risks, an initial question is how best to identify older adults. One common default is to use age 65 and older, which suggests older individuals are part of a homogenous group. The Census Bureau’s multiple category approach illustrates another option, which captures variations as Americans age. This study explores the risk and characteristics of non-fatal assaultive violence using a multiple-category age definition and uses police data from the Federal Bureau of Investigation’s 2016 National Incident-Based Reporting System (NIBRS). These data were collected from 34 states and cover a range of crimes including aggravated and simple assaults. NIBRS data are well suited for this study as they collect details about the crime including victim and offender demographics and incident details such as victim-offender relationship, weapons, location and arrest. Preliminary results indicate that 34,689 assault victims were adults over the age of 65. Using a generic measure of older adult (age 65 and above) masks important variations in these assaults. Distinct patterns are observed between those aged 65 to 74, 75 to 84 and 85 and above. Within these age categories, differences also occur across racial and sex groups. The patterns observed can provide more nuanced guidance to challenge traditional assumptions about older adult crime victims and inform policies tailored to support these victims.
A Qualitative Study of Healthcare Experience Among Chinese Homebound Adults Receiving Home-Based Medical Care
Authors: Zhou Rui , Cheng Joyce , Wang Shuangshuang , Yao Nengliang (Aaron) 
Published: December 2020

Abstract
Home-based medical care (HBMC) is emerging in China, but research understanding the efficiency and effectiveness of this new care model is rare. In this study, researchers interviewed 17 Chinese homebound adults aged 45 and older (53% females, mean age=76) who have received HBMC, and collected detailed information regarding their experiences and attitudes toward HBMC. Participants were recruited from healthcare institutions in Shanghai, Jinan, and Zhangqiu of China. The evaluation of patients’ experiences with HBMC yielded both positive and negative aspects. Positive experiences included 1) the delivery method was convenient for homebound patients; 2) health problems could be detected timely because doctors visited patients regularly; 3) home care providers had better bedside manners and professional skills than hospital-based providers; 4) the medical insurance covered the cost of home care services. Negative experiences related to the supply and quality of care, including 1) the scope of current HBMC services was too limited to meet the needs of homebound patients; 2) the visit time was too short; 3) healthcare providers’ professional skills varied greatly. Findings from this study suggest that the HBMC model benefited Chinese older adults, primarily homebound adults, in terms of convenience and affordability. There are opportunities to expand the scope of home care services and improve the quality of care. Policymakers may consider providing more resources and incentives to enhance HBMC in China. Educational programs may be created to train more HBMC providers and improve their professional skills.
Older Adults and Opioid Education: Lessons Learned From Experiences in Rural Arkansas
Authors: McAtee Robin , Tobey Leah , Hayes Corey , Spradley Laura , Kumpuris Sajni 
Published: December 2020

Abstract
Nearly one-third of all Medicare participants were prescribed an opioid by their physician in 2015 (AARP, 2017) and in 2017, Arkansas had the 2nd highest opioid prescribing rate in the nation (CDC, 2019). Approaching older adults (OA) about opioids and pain management can be a sensitive topic. Educating and altering long-term treatment with opioids is especially challenging in rural areas where literacy, especially health literacy, is suboptimal. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve health outcomes including an emphasis to decrease the misuse and abuse of opioids among older Arkansans. To address this crisis, the AGEC partnered with local leaders such as the AR Drug Director, academia, Department of Health and Human Services, and multiple community based organizations to create age-tailored educational programs. Unique aspects of approaching and educating rural OA about opioids and pain management will be reviewed. Outcomes will be discussed such as their lack of knowledge about: what is an opioid, why they were prescribed, and what are viable alternatives. Also discussed will be lessons learned that resulted in more effective methods of reaching and teaching rural OA. Partnering with the AR Farm Bureau helped the AGEC reach 100’s of farmers in the extremely rural and mostly agricultural areas. Learning to not use the word opioid resulted in more participants and in a more positive attitude and outlook on attempts to change the culture of opioid use, misuse and abuse among older Arkansans.
Innovations in Gerontology Education: A Multifaceted Approach
Authors: O’Connor Melissa , O’Connor Melissa 
Published: December 2020

Abstract
By 2030, older adults are projected to outnumber children. This growth among older adults presents both opportunities and challenges on how to care for this unprecedented older adult population. In 2010, there were 7.2 family caregivers for every person 80 and older; this is expected to fall to 3 by 2050. Many older adults are at risk of becoming an elder orphan - someone aging alone with no family available to address their caregiving needs. This underscores the urgent need for the education of nurses who are prepared to care for older adults with complex social and health needs, many of whom are suffering from three to five chronic conditions. This symposium highlights cutting-edge research designed to transform nursing education to better prepare students to advance the health of older adults. Our first presentation describes ageism among undergraduate students and innovative curricula to positively influence their preference for working with older adults. Next, the groundbreaking tool-kit that encourages self-reflection on beliefs about aging and reframes how students view older adults. Third, the qualitative results of a collaborative learning experience designed to introduce students earlier and more often to older adults. Finally, findings from a student-led study investigating the unique needs of caregivers of older adults with diabetes highlights the importance of funding students to conduct research related to older adults. Our symposium ends with a discussion of how these approaches are transforming nursing education to adequately prepare nurses to improve the health and health care of older adults.