bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep Quality Among Older Women and Men in the United States by Sexual Orientation
Authors: Galinsky Adena , Goldsen Karen Fredriksen , Dahlhamer James , Norris Tina 
Published: December 2020

Abstract
Sleep problems may increase the risk for, and result from, other health problems and negatively impact quality of life. Lesbian, gay, and bisexual older adults report more sleep problems compared to their straight counterparts when such problems are measured in the aggregate (e.g. “one or more of four specific sleep problems”). However, scant national research has examined if specific types of sleep problems vary by sexual orientation among older adults. Using 2015-2018 National Health Interview Survey (NHIS) data, we used logistic regression to separately model five sleep problems among women 50+ and men 50+ (lesbian/gay women: n=377, bisexual women: n=142, straight women: n=33,216; gay men: n=508, bisexual men: n=115, straight men: n=25,998) as functions of sexual orientation, controlling for age, race, education, and income. Sexual minority older adults were more likely than their straight counterparts to have taken sleep medication in the past week (women AOR=2.04, 95% CI:1.55, 2.67; men AOR=1.81, 95% CI:1.36, 2.40). The only other difference by sexual orientation found for men was bisexual older men’s greater likelihood, compared to straight men, of having difficulty falling asleep (AOR=2.02, 95% CI: 1.08, 3.79). Older women did not differ by sexual orientation in difficulty falling asleep, difficulty staying asleep, or waking up not feeling rested for four or more days in the past week, or meeting National Sleep Foundation recommendations for hours of sleep per night, whether lesbian/gay and bisexual women were examined together or disaggregated. Future research may examine why sleep quality only sometimes varies by sexual orientation.
Empty Beds in Nursing Homes Filled by Younger Individuals Following ACA Medicaid Eligibility Expansion
Authors: Ritter Ashley , Coe Norma , Freed Salama 
Published: December 2020

Abstract
National decline in nursing home occupancy rates coupled with expansion of Medicaid insurance eligibility under the Affordable Care Act (ACA) potentially create an opportunity for younger, low-income individuals to enter nursing homes following a hospitalization. Changes in the population of individuals using nursing homes could result in downstream consequences on facility payor mix, case severity index, and ultimately patient outcomes. This study measures the effect of ACA Medicaid eligibility expansion on the patient population using nursing homes, accounting for the nursing homes’ occupancy rate. Data were obtained from the publicly available national dataset, LTCfocus (2009-2016). Difference in differences estimation with time and state fixed effects was utilized to examine the effect of ACA Medicaid eligibility expansion on two outcomes, 1) average age in years of residents as of April 1 and 2) the proportion of individuals covered by Medicaid insurance at the facility level. Results show facilities with pre-ACA occupancy rates between 40% and 50% demonstrated the largest decrease in average age by year three, 1.32 years [95% CI: -2.257, -0.385]. Facilities with a pre-ACA occupancy rate of 60-70% demonstrated the largest increase in the proportion of individuals covered by Medicaid in year one, a 5.5 percentage point increase [95% CI: 0.009, 0.102]. In summary, Medicaid expansion under the ACA resulted in an increase in younger individuals and individuals covered by Medicaid using nursing homes, varying across pre-ACA occupancy rates. It remains to be studied if increased utilization of this high cost setting provides superior patient outcomes for these populations.
Barriers to Development of an App for Improving Staff-Family Communication at Israeli Geriatric Facilities
Authors: Cohen Rinat , Maydan Gal , Brill Shai , Cohen-Mansfield Jiska 
Published: December 2020

Abstract
Family caregivers (FCs) of institutionalized noncommunicative older persons reported multiple unmet communication needs focusing on the need to receive reliable and regular updates on the patient’s condition. We have developed a mobile app for improving communication between FCs and healthcare professionals (HPs), based on 152 interviews with FCs and 13 discussion groups with HPs from four Israeli geriatric facilities. Both parties participated in app planning, tailoring it to their needs and abilities. App use implementation encountered major obstacles including the bureaucratic process concerning signing contracts between the university and software development firms, which hindered the process for a full year; data security department required disproportionate security levels that interfered with user experience and delayed the development process; the study’s definition varied across different ethics/Helsinki committees (Institutional Review Boards; IRBs), which led to different demands, e.g., insurance for medical clinical trials although no drugs or medical device were involved; lack of cooperation by mid-level staff members despite the institutional adoption of the app project; low utilization by HPs resulted in FCs not receiving timely responses. Despite these and other obstacles, we tested app use for 15 months in one facility in a pre-post-design with intervention and control groups, and we have since begun testing it in another facility. FCs who had used the app had positive feedback and wished to continue using it. App use optimization requires implementation planning, assimilating changes in each facility’s work procedures and HP’s engagement and motivation and thus depends on institutional procedures and politics.
Usable and Privacy-Enhanced Telepresence Robots for Older Adults Aging in Place
Authors: Wu Xian , Beer Jenay 
Published: December 2020

Abstract
Aging population is growing rapidly in the United States and people are living longer. Maintaining health and wellness while aging-in-place is crucial for older adults. Telepresence technology is beneficial for this target population to stay socially connected, as well as utilize telehealth and telemedicine services. However, such technology was not specifically designed for older adults. For older users to adopt telepresence, it is important to ensure that they do not experience adoption barriers, such as issues with usability and privacy. This research used a user-centered evaluation to design, develop, and test telepresence user interfaces (UI). Thirty older adults (aged 60+) participated in a within-subjects evaluation of two telepresence UIs: 1) the controlled condition - a generic UI, called Presence, based on currently available telepresence systems; and 2) the experiment condition - an enhanced custom telepresence UI that was designed follow human factors and design principles for older adults, named InTouch. Participants tested both UIs in a virtual home environment developed in Unity. Qualitative and quantitative results suggest that older adults perceived the experiment condition – InTouch, to be more usable and private – and our older users provided insight on which usability and privacy features were critical for them. By investigating the design of telepresence for older users, and applying those findings to design recommendations, we aim to improve the ease of use and privacy level of telepresence– not only for our target users but for all users who wish to enhance social connectedness and utilize telehealth.
Use of GPS Tracking Technology to Measure Mobility in Older Adults: A Systematic Review
Authors: Chung Jane , Sargent Lana , Brown Roy 
Published: December 2020

Abstract
Global positioning system (GPS) tracking technology is increasingly used in aging research to objectively measure the spatial and temporal aspects of mobility in older adults. The review aims to systematically synthesize the literature to identify GPS-driven mobility measures and potential determinants of mobility limitation for community-dwelling older adults. A systematic search of six electronic databases was conducted. A total of 4897 articles were found with 2578 left to review after deduplication. Twenty-five studies met inclusion criteria: 24 cross-sectional studies and one follow-up study that measured mobility changes over time. Various types of GPS devices were used, including smartphones, GPS watches, or portable data logging kits. The GPS tracking period ranged from 1 to 30 days. The daily device wear time varied from 10 to 24 hours. Commonly reported GPS-based mobility measures included time out of home, distance moved, the number of out-of-home trips or walking tracts, the number of visited places, life-space area, and walking speed. Twenty-one studies reported some aspects of demographic, physical, psychosocial, or environmental factors related to the levels of GPS-based mobility. GPS tracking technology can continuously record individuals’ activities and functional abilities within their life space. We found that there was heterogeneity in ways of applying GPS technology and defining and measuring mobility in community-dwelling older adults. Given the lack of consistency in GPS-based mobility assessment, a clear definition of mobility and standardization of GPS data collection and analysis are required for comparison across studies and better understanding determinants of mobility limitation in community-dwelling older adults.
Reframing Aging: Penn’s Village Members Thrive While Aging in Place
Authors: Evans Lois , Eleey Jane , Saperstein Avalie 
Published: December 2020

Abstract
Villages help older neighbors age-in-place as they manage their environments, take advantage of opportunities for social and civic engagement, and improve or maintain health and well-being. National surveys repeatedly indicate that older adults prefer community living as long as possible. But communities change, and post-retirement living may require rebuilding social connections with old and new neighbors. Fortunately, today’s retirees bring a wealth of knowledge and skills to later life which they are happy to share. Drawing on the talents and career experiences of older adults in Center City, Philadelphia, Penn’s Village (PV) was created in 2007 to address the needs and wishes of neighbors wanting to stay in their own homes as they aged. A member of the Village-to-Village Network, PV (a 501c3) has itself matured through board development, strategic planning, and member engagement. In reframing aging in Center City, PV currently offers its over 300 members and volunteers an array of educational and recreational programs (e.g., talks, affinity groups, social events and outings); services (including transportation, home repairs, IT support, companionship, accompaniment to medical appointments), and opportunities to use their personal knowledge and skills to help their neighbors-- as drivers, companions, volunteer staff and co-chairs/members of committees (e.g., Board of Directors, Program, Welcoming, Marketing & Communications, Finance, Fundraising). In FY2019, volunteers provided nearly 1200 services to PV members. Our most recent survey responses indicate that 82% of volunteers found their work highly meaningful and 79% of those who received services believed their quality of life was greatly improved.
Patient-Reported Factors Alleviating Pain Among Persons With Cancer
Authors: Fullwood Dottington , Fillingim Roger , Wilkie Diana 
Published: December 2020

Abstract
Pain impacts wellbeing and is among the most common symptoms of cancer. Factors that decrease pain severity have been understudied despite their importance for high-quality cancer care. The study purpose was to describe pain alleviating factors and their association with type of cancer. This secondary comparative analysis included 579 participants from studies of inpatients and outpatients with cancer (mean age=58.7±12.3; 27.3% female; 85.5% White, 5.7% Black, 7.6% Other). They completed the McGill Pain Questionnaire on paper or a tablet computer. To determine factors that alleviated pain, we focused on the open-ended question: 1) What kinds of things relieve your pain? We coded text responses into six outcome categories: 1) Activity level, 2) Cognitive, 3) Environmental, 4) Medical, 5) Physical, and 6) Sedentary behavior. We counted the number of activities/factors in each category and conducted multivariable regression analysis adjusting for sociodemographic constructs. Adjusted models revealed that activity (ρ=0.02), cognition (ρ&lt;0.001) and medication (ρ&lt;0.001) were more often endorsed as alleviating factors among individuals living with lung cancer compared to head and neck cancer participants. Those diagnosed with lung cancer (ρ=0.02) and males (ρ=0.02) utilized significantly less physical alleviating factors than head and neck cancer individuals and females. This is the first study to examine pain-alleviating factors among individuals living with cancer. These findings contribute new information regarding activities that alleviate pain among cancer survivors. These findings could inform interventions to promote safe, personalized care designed to alleviate cancer-pain.
Evaluation of a Collaborative Care Management Program for Community-Dwelling Older Adults on High-Dose Opiates
Authors: Mavandadi Shahrzad , Foust-Montague Kristin , Grecco Elizabeth , Oslin David , Streim Joel 
Published: December 2020

Abstract
Treating pain in later life is complex, and there are significant safety risks associated with the use of analgesics, particularly opioids. This study examined preliminary results from a pilot study of a telephone-delivered collaborative care service designed for community-dwelling older adults with chronic pain receiving prescriptions for high doses of opioids (i.e., &gt;120 mg morphine-equivalent dose). Eighty-two older adults referred by the Pennsylvania Department of Aging’s pharmaceutical assistance program for low-income seniors (PACE/PACENET) were eligible and enrolled in the program (i.e., the University of Pennsylvania/PACE Behavioral Health Laboratory). Patients were on average 73.5 (+/-6.1) years old, and the majority were white (91%) and female (70%). Patients completed a comprehensive baseline clinical assessment capturing their mental health, cognition, pain and functional status, as well as self-reported daily opioid dose and biopsychosocial needs. Patients were considered engaged in the program if they completed 2+ additional follow-up contacts with a care manager. During these contacts, care managers offered individualized treatment planning, with the goal of opioid dose reduction to safer levels. Of the 82 patients completing the baseline, 53 (65%) engaged in the program. At their last clinical contact, 91% of engaged patients achieved dose reductions (with 66% achieving dose reductions of &gt;20% and 30% reporting doses &lt;120 mg morphine-equivalent dose). Engaged patients also reported significant reductions in pain severity (p=0.05) and depressive symptoms (p=0.003) at the last contact relative to baseline. Findings support the feasibility of a community-based, collaborative care model for pain management and suggest the potential for positive treatment outcomes.
Polypharmacy and Potentially Inappropriate Medications in Patients With Dementia
Authors: Nonaka Ryo , Kanno Atsuhiro , Ohara Takahiro , Sumitomo Kazuhiro , Sato Shigeru , Miyazawa Isabelle , Koinuma Nobuo , Furukawa Katsutoshi 
Published: December 2020

Abstract
INTRODUCTION: The use of polypharmacy and potentially inappropriate medication (PIM) is a critical issue in geriatrics. Furthermore, the number of patients with dementia is dramatically increasing worldwide. In this study, we investigated: (1) if the states of polypharmacy and PIM differed in patients with and without dementia; (2) the types of medicine that were commonly prescribed; (3) the types of dementia that resulted in the prescription of multiple medicines; (4) if there was a correlation between the number of medicines and the number of medical institutions (hospitals and clinics) that the patients attended. METHODS: In total, 216 patients who were 65 years of age and older were analyzed. The number of medicines prescribed and the medical institutions they attended were counted through the electronic medical charts of Tohoku Medical and Pharmaceutical University Hospital. We employed the Beers 2019 criteria for the definition of PIM. RESULTS: (1) The number of prescribed medicines was not significantly different between patients with dementia and those without dementia. (2) Anti-hypertensives and gastro-intestinal medicines were the most commonly prescribed medicines in patients with and without dementia. (3) Patients with “dementia with Lewy bodies” and “mixed dementia” were prescribed the highest number of medicines. (4) The number of medicines and PIM use were significantly and positively correlated with the number of medical institutions. CONCLUSIONS: The number of medical institutions strongly affected the number of medicines prescribed and PIM use. Efforts should be made to organize and reduce the number of medical institutions that a patient attends.
Examining Ankle Foot Orthosis Wear Time in Patients With Peripheral Artery Disease
Authors: Myers Sara , Dinkel Danae , Hassan Mahdi , Despiegelaere Holly , Johanning Jason , Pipinos Iraklis 
Published: December 2020

Abstract
Peripheral artery disease (PAD) impacts over 8.5 million Americans and the prevalence of PAD increases with age. PAD restricts blood flow to the leg and its most common manifestation is claudication, a severe impairment of walking produced by ischemia-related, leg pain during exercise. An ankle foot orthosis (AFO) could improve these symptoms. To understand the potential impact of AFO usage, it is critical to determine wearability of the device in patients with PAD. The purpose of this study was to monitor wear time of an AFO and explore perceptions of the device. Participants (n=14) with PAD and claudication wore an AFO for three months. An accelerometer was placed directly on the AFO for 7 days and participants completed semi-structured interviews at midpoint (1.5 months) and post intervention (3 months). Based on accelerometer data at midpoint participants wore the AFO for an average of 4.9±2.3 out of 7 days and for an average of 7.5±4.2 hours each day. At post, participants wore the AFO for an average of 4.8±2.2 days for an average of 7.4±4.6 hours per day. In the interviews, almost all participants noted multiple barriers to wearing the AFO such as difficulty putting the AFO on and off, using stairs, walking on uneven ground, and driving. Our study found that participants wore the AFO ~7 hours/day but experienced barriers which may have limited their wear outside of these monitoring periods suggesting patients would wear an assistive device if design could be improved to address barriers.
Investigation of Roll-Over Characteristics in Healthy Old Individuals and Patients With Peripheral Artery Disease
Authors: Myers Sara , Bapat Ganesh , Johanning Jason , Pipinos Iraklis 
Published: December 2020

Abstract
Atherosclerotic blockages in the leg arteries, cause leg pain with ambulation (called claudication), impair gait and substantially reduce the walking ability of patients with peripheral artery disease (PAD). Ankle-foot orthoses are being developed and applied so patients can walk more and with less pain. Roll-over shape (ROS) is a potential design objective for such assistive devices. In the proposed work, we study roll-over characteristics in patients with PAD and healthy older subjects. Gait data of ten healthy older individuals (Age: 72.8 ± 5.5 years) and twenty patients with PAD (Age: 64.1 ± 6.6 years) were collected at self-selected walking speed. In patients with PAD, gait data were collected before the onset of pain and after claudication pain was induced. To generate ROS, the center of pressure data was transformed to the shank-based coordinate system and circular arcs were fit using an optimization program in MATLAB. Independent t-tests with Bonferroni corrections were used to separately compare roll-over radius differences (p&lt;0.05) between healthy older to both walking conditions in patients with PAD. The mean roll-over radius was not significantly different between healthy older vs PAD pain-free (p=0.468) or PAD pain-induced (p=0.289) walking conditions. Our results indicate invariance of ROS radius in patients with PAD, which is consistent with previous literature showing general invariance of ROS in healthy young individuals. Previous biomechanical studies show gait kinematics and kinetics are more affected by PAD than by age. Future studies should focus on the potential adaptive mechanisms in patients with PAD achieving invariant ROS.
Variation in the Association of Body Types to Decreased High-Density Lipoprotein in Older Adults (NHANES 2005-2014)
Authors: Chukwurah Queendaleen 
Published: December 2020

Abstract
General obesity and central obesity represent cardiovascular disease risk factors and are known to be related to dyslipidemia. I examine the variation in the association of combined body mass index/waist circumference classification to decreased high-density lipoprotein cholesterol (HDL-C). Body mass index /waist circumference (WC) cut off values were used to create six body types: normal weight with normal WC (NWT-NWC), overweight with normal WC (OWT-NWC), obese with normal WC (O-NWC), normal weight with high WC (NWT-HWC), overweight with high WC (OWT-HWC), and obese with high WC (O-HWC). HDL-C was defined as decreased if &lt; 40 mg/dl for men or &lt; 50 mg/dl for women and normal if ≥ 40 mg/dL for men or ≥ 50 mg/dL for women. Sample population included 5,772 participants of the National Health and Nutrition Examination Survey (NHANES 2005-2014) aged 50 years and older. The mean (SD) age was 61.8 (0.2), and 50.5% were females, while 10% were minority. The prevalence of decreased HDL-C was 29.1%. Analysis involved weighted multivariable logistic regression adjusted for age, race-ethnicity, gender, education, poverty-income-ratio, smoking, and alcohol intake. Regression reveals a higher likelihood of decreased HDL-C for OWT-NWC (aOR 2.12 95% CI 1.43,3.15 ), NWT-HWC (aOR 2.57 95% CI 1.59,4.16 ), OWT-HWC(aOR 3.09 95% CI 2.29,4.15 ), and O-HWC (aOR 5.30 95% CI 4.01,6.86 ) when compared to NWT-NWC. These associations are important to public health practice and policies as it demonstrates the implications of the parallel use of anthropometric measures for all body weights in health-risk assessments of older adults.
Geriatric Fast Facts: Four Years of Growth and Reach
Authors: Duthie Edmund , Denson Kathryn , Simpson Deborah , Denson Steven , Malone Michael 
Published: December 2020

Abstract
Clinical teachers are increasingly challenged to find the time to provide point of care education for learners. To meet this challenge, an interprofessional team from competing health care systems created and sustained Geriatric Fast Facts (GFF): easily accessible, concise 1-2 page topic summaries for clinical teachers to use (in lieu of the mini-lecture) with learners at the point of care. Designed by geriatrics educators in consultation with IT experts, we launched a mobile enabled website that is indexed and searchable by free text or topic, organ system, ACGME competency, disease, and the “underlying science” for the disease/illness. GFF topics are authored by subject matter experts with peer review by senior geriatricians. Brief quizzes test learners’ knowledge with score reports. Our 4-year results reveal that: 1) “Geriatric Fast Facts” appear in the top Google 10 listing; 2) Search engines account for 39% of site traffic; 3) 60% of unique users (N=29,000) are via direct link; 4) 19% via referral from another site. Our “bounce rate” (55%) is ideal as users quickly gain the information sought - affirmed by our session duration which averages &lt; 2 minutes. Our Google Analytics results reflect steady growth and international reach: 73% of sessions are from the U.S., 5% from Canada, 22% international and growing! In summary with our population continuing to age and time for teaching being limited, GFFs are quick, accessible, evidence-based resources for point of care teaching.