bluuebunny/crossref_metadata_2025_split huggingface dataset:
A MIXED-METHODS EVALUATION OF A 20-YEAR SENIOR MENTOR PROGRAM FOR MEDICAL STUDENTS
Authors: Kilaberia Tina R , Ratner Edward , Englund June 
Published: November 2019

Abstract
The purpose of this mixed-methods evaluation is to demonstrate the success from the past 20 class years of continuous use of senior mentors to teach geriatrics to approximately 3400 Year 1 and Year 2 medical students in a home visit model. Using a pre-test post-test design (N=131), we evaluated student satisfaction, self-confidence in various geriatrics assessments, and performance on an Objective Structured Clinical Evaluation (OSCE). We additionally conducted a formal qualitative evaluation of students’ open-ended reflections (N=97) across three years, from 2016-18, on what they learned. In addition, relying on the principles of community-based research, we collaborated with a volunteer senior on all aspects of this evaluation, and included a community of seniors at a large urban senior care high-rise to enhance our interpretive validity by asking seniors to reflect on a set of representative quotes for each qualitative theme. The senior mentor home visit model demonstrated high satisfaction, improved self-confidence in geriatric assessment, attainment of competencies, and improvement in attitude scores. With regard to the qualitative portion of the evaluation, six themes about learning were recognized: (1) how to perform an interview and exam in a home setting, (2) how life for seniors is different than students expected, (3) the value of physical infrastructure and amenities in senior housing, (4) the importance of senior’s community, including family, neighbors, spiritual community, (5) challenges with aging, and (6) strengths among seniors in coping with such challenges while maintaining individual agency.
FAMILY AND SOCIAL NETWORKS FOR AGE-RELATED PLANNING CONVERSATIONS: CHARACTERISTICS AND VARIABILITY
Authors: Chen Emily K 
Published: November 2019

Abstract
Informal advance care planning (IACP) – that is, conversations with surrogate decision-makers about wishes for health care or end-of-life preferences – have been identified as equally if not more important than legal documentation for achieving a high-quality end-of-life experience. Fairly high rates of adults report having had these conversations; this is especially true of people who are older, sicker, or who have had caregiving experience. However, relatively little is known about the content and characteristics of these conversations, such as who people are talking to, what triggers the conversation, and what is actually said. This paper reports findings from interview-based research that asked 38 middle-age and older adult respondents (ages 55 to 74) about conversations related to several areas of age-related planning, including planning for health care needs and wishes about end-of-life. The interactive interview protocol used the open-source EgoWeb software to elicit information about age-related planning conversations, family and social networks, and who within those networks served as conversation partners for the various topics. We will share results of the analysis of the networks and conversation topics. We found that some individuals more readily engage in discussions about future planning across topics than others, but that part of this is driven by the readiness of their family and friends to engage in these topics. This suggests that targeting individuals to increase rates of IACP has limitations when family and friends are resistant, and that dyadic interventions may be appropriate in some cases.
CAREGIVER BURDEN, BENEFIT, AND PERCEPTIONS OF END-OF-LIFE CARE QUALITY
Authors: Luth Elizabeth A , Pristavec Teja 
Published: November 2019

Abstract
End-of-life care quality (EOLCQ) gauges our success in providing quality care to dying individuals. EOLQC measures rely on reports from bereaved family members who provide care for dying loved ones, but analyses seldom account for how caregivers’ experiences influence their EOLCQ perceptions. Caregivers frequently experience burden, which is linked to poor health outcomes and may negatively bias EOLCQ reports. Individuals may also perceive caregiving benefits that can offset deleterious burden effects, but potentially encourage overly positive EOLCQ perceptions. This paper links National Study of Caregivers (2011) and National Health and Aging Trends Study (2011-2016) data, using regression analysis and a sample of 380 EOL caregivers to examine how caregiving burden and benefits perceptions shape and moderate EOLCQ reports. Caregiving burden is unrelated to EOLCQ in adjusted models. Benefits are associated with marginally greater odds of being informed about the dying person’s condition and reporting their personal care needs were met. Burden and benefits moderate these two measures. Despite benefits, low burden caregivers report they were informed about the dying person’s condition with 90% probability. Regardless of burden, high benefits caregivers report the same with 90% probability. Low burden and benefits caregivers report met care needs with 90% probability. High burden and benefits caregivers have 90% probability of such reports. Given these reports are used in formal hospice care evaluations by CMS, additional research should explore why caregiving burden and benefit are associated with some EOLCQ measures and why individuals reporting high burden and benefits provide more positive EOLCQ appraisals.
END-OF-LIFE CARE PREFERENCES AND WELL-BEING IN LONG-TERM CARE RESIDENTS
Authors: Shryock Kelly , Dickens Jacinta , Thomas Anisha , Meeks Suzanne 
Published: November 2019

Abstract
Research on end-of-life care in nursing homes comes largely from the viewpoint of staff or family members. We examined patient perspectives on end-of-life care, preferences for care, and quality of life in long-term care settings. We hypothesized that fulfillment of the Self Determination Theory (SDT) needs of autonomy, competence, and relatedness would be related to better well-being and that the degree to which end-of-life care preferences are seen as possible in the setting would be related to SDT need fulfillment and well-being. Preliminary data, collected from older individuals at the end of life (over 55, presence of significant chronic disease, in long term care setting) (n= 72), demonstrated that autonomy, competence, and relatedness measures were moderately and significantly correlated with well-being as measured by life satisfaction, higher positive affect, lower negative affect, and overall quality of life measures The degree to which residents believed that their end-of-life care preferences could be honored in the setting was also significantly correlated with autonomy, competence, relatedness, positive affect, and psychological quality of life. These results are consistent with SDT and suggest that if long term care settings can promote autonomy, connection, and competence in making end of life decisions, possibly by discovering and fulfilling preferences for end of life care, individuals who end their lives on those settings have potential for greater satisfaction and happiness. These results suggest that SDT is a useful framework for ongoing research on how to improve the end of life experiences of older adults in long term care.
FREQUENCY OF CONTACT AMONG FAMILY MEMBERS AND END-OF-LIFE CARE PLANNING
Authors: McDarby Meghan , Kozlov Elissa K , Carpenter Brian 
Published: November 2019

Abstract
The purpose of the current analysis was to examine how contact between adult children and their older parents may relate to having end-of-life care conversations. We analyzed responses from adult children (n = 66) of 36 older adults (65+) who participated in an intervention to improve family communication. Children reported the frequency of their in-person and phone contact with parents. They also completed the Conversations about Care Arrangements Scale (alpha = 0.95), 8 items that measure the extent to which adult children have discussed plans about future care with their parents (1=have not talked at all, 5=talked extensively). We calculated a composite from all 8 items (potential range 5-40). Participants reported that they had, on average, not talked extensively with their parent about plans for future care (M = 18.7, SD = 8.22). Overall, 42.4% of children reported that they visited their parent one time or less per year. Children reported speaking on the phone with their parent an average of 4.74 times per week (SD = 6.80, range = 0-30) and initiating an average of 2.59 of those calls (SD = 3.82, range = 1-20). Frequency of weekly phone conversations between child and parent was significantly associated with having talked more extensively about future care plans (r = 0.25, p &lt; 0.05), as was frequency of phone calls initiated by the adult child (r = 0.29, p &lt; 0.05). Frequency of in-person visits to parents was not significantly associated with conversations. Infrequent contact may limit opportunities for care conversations.
HUSBAND’S EMOTIONAL SUPPORT PROVISION TO ADULT CHILDREN AND WIFE’S MARITAL SATISFACTION IN LATER LIFE
Authors: Choi Heejeong , Yoo Jaeeon 
Published: November 2019

Abstract
The current study examined the association between intergenerational support exchange and marital satisfaction among older Korean couples. Prior work has not paid due attention to the fact that older parents and adult children often exchange various types of support in the context of marital relationships, and that provision or receipt of support could influence their marital relationships (see Lee, Zarit, Rovine, Biritt, & Fingerman, 2010; Polenick, Birditt, & Zarit, 2018, for exceptions). Using the 2008 Actual Living Condition of the Elderly and Welfare Need Survey (ALCEWNS), a nationally representative survey of community-dwelling adults 60 years and older, we evaluated the links between marital satisfaction and each spouse’s reports of emotional and instrumental support provided to or received from adult children. For analyses, a series of actor-partner interdependence models were estimated. Findings revealed that wives’ marital satisfaction was associated with their husband’s exchange of emotional support with adult children. By contrast, husbands’ marital satisfaction was unaffected by their wife’s emotional support exchange with adult children. More specifically, wives were more satisfied with their marriage when their husband reported providing greater emotional support to adult children than receiving it from adult children. In addition, wives indicated higher marital satisfaction when the couple provided similar levels of emotional support to their children. Provision or receipt of instrumental support had no bearings on marital satisfaction of either spouse. Taken together, our findings highlight how older couples may evaluate their relationship quality in the Korean cultural context.
THE INTERSECTION OF RELIGION AND SES IN MANAGING CHRONIC CONDITIONS AMONG OLDER PERSONS IN NIGERIA
Authors: Mahmoud Kafayat O 
Published: November 2019

Abstract
Increased life expectancy in Nigeria has corresponded with higher rates of chronic diseases among older persons. Consequently, this is a new experience that older persons progressively have to deal with. In this study, I explored how religion and social support helped older persons cope with their chronic disease conditions, in light of the prevailing socio-cultural and economic circumstances in Nigeria. The research was conducted in two state-owned medical institutions, in a city in the North-Central part of Nigeria. In-depth, qualitative interviews were conducted among 19 purposively selected chronically ill persons aged between 50 years and over, during clinic days. The study revealed that religion is central to peoples’ management of feelings of despair, and acceptance of chronic disease conditions, as well as their adherence to prescriptions. This is explained by the theme “God as the Bestower and Reliever.” Also, some respondents perceived their coreligionists to be financially supportive. Although, some participants expressed that they depended on their families for their upkeep and emotional well-being, dire socio-economic conditions and lack of governmental support in chronic care meant that financial support was limited. This is explained by the theme “Times are Hard.” Subsequently, most respondents bore a dual burden of coping with chronic conditions even as they were financially responsible for themselves and their families. This was particularly stressful because it meant that most respondents were constantly worried about being able to meet basic daily needs, as well as manage the financial costs of their treatments, which proved expensive to manage.
PRESCRIPTION DRUG USE FOR PAIN AND FOR SLEEP AND INCIDENT FRAILTY IN OLDER ADULTS
Authors: Cil Gulcan , Park Juyoung , Bergen Andrew W 
Published: November 2019

Abstract
There is emerging evidence for association of polypharmacy with incident frailty. We performed a longitudinal study within the Health and Retirement Study (HRS) to address whether self-reported prescription drug use for pain and/or sleep (co-use or single use for pain or for sleep) influences incident frailty. We utilized data from the 2006–2014 waves of core and family member exit files in HRS to assign self-reported prescription drug use and sociodemographic and other drug use behavior variables as covariates and construct a Burden Model of frailty (≥ 0.2 ratio of positive/total indicators). We performed unadjusted and adjusted competing risk hazard model analysis with death as a competing risk. In a sample of 7,201 unique non-frail (at baseline) individuals (mean[SD] age 72[6.5] years, 54% female, 85% White, 12% African American, 7.3% Hispanic), prevalences of co-use and single-drug use for pain or for sleep were 2.2%, 14.9%, and 5.6%, respectively. Of 7,201 respondents, 2,723 (37.8%) became frail over the follow-up period and 713 (9.9%) died in non-frail state. The adjusted competing risk hazard model suggest that co-use and single use for pain or for sleep were associated with an increase in the risk of frailty by 92%, 58%, and 31%, respectively (p &lt; .001), with statistically significant differences between all risk strata. Adjustment for baseline frailty score and selected chronic disease resulted in modest reductions in effect size with retention of significance. Validation of these initial findings should be undertaken with provider and pharmacy data to identify drug-, dosage-, and duration-specific risks.
HYPERGLYCEMIA AND INCIDENCE OF FRAILTY IN OLDER MEXICAN ADULTS LIVING IN RURAL AREAS
Authors: Espinoza Betty Manrique , Almaraz Ana Rivera , Rodriguez Aaron Salinas 
Published: November 2019

Abstract
Hyperglycemia is the main characteristic of diabetes and is the result of an absolute or partial deficit in the production or action of insulin. Recent evidence suggests that hyperglycemia increases the risk of frailty. This issue is of great importance for the Mexican population given the high prevalence of diabetes, particularly in older adults. Our objective was to analyze the association between hyperglycemia and the incidence of frailty in a cohort of rural older adults in Mexico. Prospective cohort study with 600 rural older adults, with measurements made in 2009, 2013 and 2018. Fragility was defined using the proposal of Fried and colleagues. The determination of glycosylated hemoglobin was performed through the A1CNow® device, with capillary blood; hyperglycemia was defined considering the recommendation of the American Diabetes Association; where values greater than 6.5% (140 mg / dL) of glycosylated hemoglobin were considered hyperglycemia. We used an ordinal logistic regression model to analyze the relationship between hyperglycemia and incidence of frailty. In the baseline measurement (2009), 8.6% of older adults presented frailty. The incidence of frailty was 6.9%. After adjusting for health and sociodemographic characteristics, hyperglycemia was significantly associated with the incidence of frailty (RR = 2.24 P = 0.018). These findings allow us to determine that hyperglycemia is a prognostic factor of the incidence of frailty. Because frailty is preventable, future interventions for the prevention of frailty should consider the presence of hyperglycemia.
EUROPEAN OLDER ADULTS FRAIL: FINDINGS FROM THE SURVEY OF HEALTH, AGEING AND RETIREMENT IN EUROPE (SHARE)
Authors: Manfredi Giulia , Midão Luís , Paúl Constança , Cena Clara , Duarte Mafalda , Costa Elísio 
Published: November 2019

Abstract
Frailty is a geriatric multidimensional syndrome whose signs and symptoms are predictors of increased vulnerability to minor stress events and risk of adverse outcomes such as falls, fractures, hospitalisation, disability and death. In this work, we aimed to update the data of frailty status in European community dwelling population, based on the latest data released (wave 6) of SHARE database, and to study the impact of each criterion on frailty assessment. Frailty status was assessed applying a version of the Fried Phenotype operationalised for SHARE. We included all participants who answered all the questions used in a frailty assessment and who disclosed their gender and, further, whose age was 50 or more. Our final sample was 60816 individuals. Of these, the mean age was 67.45 ± 9.71 years; 38497 (56.4%) were female. The overall prevalence of pre-frailty was 42.9% (ranging from 34.0% in Austria to 52.8% in Estonia) and frailty was 7.7% (ranging from 3.0% in Switzerland to 15.6% in Portugal). Pre-frailty and frailty prevalence increased along age and were more frequent among women. Regarding the five criteria considered on frailty assessment, exhaustion seems to be the criterion that contributes most to frailty status, followed by low activity, weakness, loss of appetite and slowness. With this work, we demonstrated that more than 50% of the 50+ European population are pre-frail/frail, which must be considered when designing interventions to reduce/postpone/mitigate the progression of this condition, reducing the burden associated with it.
ASSOCIATION BETWEEN FRAILTY AND DEVELOPMENT OF COGNITIVE IMPAIRMENT: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Authors: Resciniti Nicholas V , McNiel Jaleel , Lohman Matthew 
Published: November 2019

Abstract
Research has shown there is currently an increasing prevalence of cognitive impairment and dementia in older adults. To date, there remains a paucity of research to explain this increase and research on early markers and risk factors are warranted. This study aims to assess the association of cognitively normal older adults who are frail and the development of cognitive impairment four years later. Data from the Health and Retirement Study – a nationally representative sample of older US adults – was used from 2004-2008 for individuals 65 and older (n=8,377). Frailty was categorized by using Fried’s phenotype model: individuals were grouped into frail, pre-frail, and robust. Cognitive impairment – a composite score that assessed memory recall and global mental status – was classified as scoring eight or less on a 35-point scale. After restricting to cognitively healthy individuals, logistic regression with weights was used to assess the association between frailty status and the development of cognitive impairment four years later. The model was adjusted for baseline age, gender, race, education years, smoking status, and chronic health issues (high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, psychiatric problems, and arthritis). Frail individuals, compared to those who were robust, had increased odds of cognitive impairment (OR=1.74; 95% CI: 1.48-2.16), after fully adjusting. Evidence from this study suggest that frail individuals are more likely to become cognitively impaired over time. This provides a potential pathway of intervention to help delay or prevent the development of cognitive impairment in older US adults.
AN INNOVATIVE PLATFORM BASED ON WEARABLE SENSOR TO QUANTIFY FRAILTY PHENOTYPES
Authors: Zhou He , Najafi Bijan 
Published: November 2019

Abstract
This study evaluated an innovative wearable sensor based platform (instrumented trail-making task, iTMT) to quickly quantify frailty phenotypes, without the need of walking test. 61 older adults (age=72.8 ± 9.9years, BMI=27.4±4.9kg/m2) were recruited and assessed by Fried Frailty Criteria to determine frailty phenotypes. All subjects participated the iTMT test by standing in front of a computer, wearing a wearable sensor on the front lower shin. The sensor tracked the subject’s ankle movement and projected it on a computer-screen as a moving cursor at real-time. The subject rotated the ankle joint to navigate the cursor to reach 5 indexed circles (including numbers 1-to-3 and letters A&B placed in random orders) in the alternative order of numbers and letters. The iTMT required coordination of brain and body movement, testing subject’s cognitive-motor function. The sensor quantified ankle-rotation biomechanics during the test. All subjects completed the iTMT with average time less than 3 minutes. The ankle-rotation velocity generated during the test distinguished between the presence and absence of Slowness phenotype (Cohen’s effect size d=1.40, p&lt;0.001). The decline of ankle-rotation velocity determined the presence of Exhaustion phenotype (d=0.98, p=0.003). The ankle-rotation power generated during the test determined the presence of Weakness phenotype (d=1.38, p&lt;0.001). The ankle-velocity variability determined the presence of Inactivity phenotype (d=0.90, p&lt;0.001). This study demonstrated the feasibility and validity of the iTMT to quantify frailty phenotypes. This new platform is time-efficient and doesn’t require walking test. It’s more practical for routine assessment in small and busy clinics among patients with mobility limitation.
MULTIDIMENSIONAL FRAILTY SCORE IS SUPERIOR TO PREDICT COMPLICATIONS AFTER SURGERY THAN CONVENTIONAL RISK FACTORS
Authors: Choi Jung-Yeon , Kim Kwang-il , Jung Hee-won , Kim Cheol-Ho , Kang Sung-Bum , Han Ho-Seong , Kim HyungHo 
Published: November 2019

Abstract
Frail older adults are at increased risk for postoperative morbidity compared with their robust counterparts. We compared predictive utility of multidimensional frailty score (MFS) with physical performance parameters or conventional risk stratification indicators to identify postoperative complication in older surgical patients. From January 2016 to June 2017, 648 older surgical patients (age≥ 65) were included for analysis. The MFS was calculated through comprehensive geriatric assessment (CGA). Grip strength and gait speed were measured preoperatively. The primary outcome was postoperative complication (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned ICU admission). Secondary outcome was 6-months all-cause mortality. Sixty-six (10.2%) patients experienced postoperative complications and 6-months mortality was 3.9% (n=25). Grip strength, gait speed, MFS and ASA classification could predict postoperative complication but only MFS (Hazard Ratio = 1.564, 95% CI, 1.283-1.905, p &lt; 0.001) could predict 6-months mortality after full adjustment. MFS (C index = 0.747) had superior prognostic utility than age (0.638, p value = 0.008), grip strength (0.566, p value &lt; 0.001) and ASA classification (0.649, p value = 0.004). MFS only had additive predictive value on both age (C-index of 0.638 (age) vs 0.754 (age +MFS), p = 0.001) and ASA classification (C index of 0.649 (ASA) to 0.762 (ASA + MFS), p &lt; 0.001) for postoperative complication, but gait speed or grip strength had no statistical additive prognostic value on both age and ASA classification.