bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polypharmacy in the Older Adult: Medication Review in the Community
Authors: Pacetti Staci , Avallone Margaret , Perweiler Elyse 
Published: December 2020

Abstract
Polypharmacy remains a significant healthcare issue in the United States, resulting in drug interactions, adverse drug reactions, and potentially dangerous complications. Polypharmacy, often defined as the simultaneous use of five or more medications, may lead to adherence problems and an increased risk of hospitalizations and death, particularly in the older population. Medication management was incorporated into undergraduate nursing clinical experience in an affordable housing urban community as part of the New Jersey Geriatric Workforce Enhancement Program (NJGWEP), a 5-year grant supported by DHHS-HRSA. This paper will describe the first phase of this project, which involved the determination of the prevalence of polypharmacy and high-risk medications in this setting. The charts of sixty residents were reviewed and along with demographic information, the following data was collected: total number of medications (prescription, non-prescription and herbal supplements), high-risk medications using Beers criteria and identification of common themes or issues. The average age of the residents was 72 years, with cardiovascular diseases and diabetes mellitus being the most common comorbidities. Fifty-two of the sixty residents (86%) received five or more medications daily, meeting the definition of polypharmacy. The average number of medications taken on a daily basis was 8.9. Among the residents, centrally-active agents such as gabapentin, tramadol and lorazepam were the most commonly prescribed medications. The second phase of this project will include implementation of a medication reconciliation process to identify potential issues using the Beers criteria and implement appropriate interventions to ensure safe medication practices in this high-risk population.
Prescribing Trends of Anticholinergic Drugs Between 1989 and 2017: A UK Biobank Study
Authors: Mur Jure , Cox Simon , Marioni Riccardo , Russ Tom , Terrera Graciela Muniz 
Published: December 2020

Abstract
Prescription drugs with anticholinergic properties are commonly prescribed and negatively impact physical performance, cognitive function, and increase the risk of falls and dementia. The prevalence of anticholinergic drugs is high in later life, when there is an increased risk of adverse drug effects. Recent, in-depth longitudinal analyses of specifically anticholinergic prescribing in Europe is lacking. Prescriptions for the UK-Biobank participants (n=222,122) were ascertained from primary care electronic patient records. We assigned anticholinergic activity to each drug by using a composite score. We used linear regression to study the association between current anticholinergic burden and time period, explore secular trends in anticholinergic use, and various demographic factors. We further explored the results in the context of different classes of prescriptions drugs. 74 distinct drugs in the sample (1.1%) had anticholinergic effects. An individual’s overall anticholinergic burden increased nonlinearly (linear estimate=0.474, quadratic estimate = 0.094, both p&lt;2.2x10-16) between 1989 (mean=0.09, σ=0.009) and 2000 (mean=0.22, σ=0.006) and increased nonlinearly (linear estimate=0.282, quadratic estimate=0.074, both p&lt;2.2x10-16) from 2000 to 2016 (mean=0.27, σ=0.009). The proportion of patients prescribed at least one anticholinergic drug per month increased from 6.1% to 16.7% from 1989 to 2000 and increased to 18.6% by 2016. When adjusted for sex and polypharmacy, age was negatively associated with recent cross-sectional anticholinergic burden (estimate=-0.042, p&lt;2.2x10-16). Our results demonstrate an increase in prescribing of anticholinergic drugs over the past 30 years and indicate contemporary deprescribing of anticholinergic drugs in the later decades of life.
Attitudes of Graduating Medical and Nursing Students Toward Older Persons in Ghana
Authors: Karikari Grace , Lesa Huber , Lohrmann David , Adamek Margaret , Omodior Karo 
Published: December 2020

Abstract
Purpose: Differences in attitudes between graduating medical and nursing students toward older persons in Ghana were compared. Additionally, the association between the overall quality of students’ experiences with older persons and their attitudes was examined. Materials and Methods: A sample of 135 final year medical and nursing students from a public institution in Ghana participated in a cross-sectional study by completing a web-based self-administered questionnaire consisting of the 14-item University of California at Los Angeles Geriatric Attitudes (UCLA-GA) scale, and demographic questions. Data analysis involved a two-sample t-test and a one-way ANOVA. Results: Most participants (82.2%) held positive attitudes towards older persons. The mean score for the UCLA-GA scale that assessed attitudes of students towards older persons was 3.41 ± 0.41 (min: 2.29, max: 4.64); differences in attitudes between the two groups was significant (p = 0.001). Medical students had more positive attitudes toward older persons than nursing students. The association between students’ attitudes and the overall quality of their experiences with older persons was significant (p = .001). Students whose experiences with older persons were negative had the least positive attitudes. Conclusion: Considering the impact negative experiences with older persons may have on students’ attitudes, attention should be given to creating positive experiences through clinical and community-based exposures. Direct interactions with older persons who are active and living independently may challenge some common stereotypes such as older persons are infirm and senile, and foster positive attitude development.
Older Adults Aging With HIV: A Growing Population Experiencing Comorbidities and Social Isolation
Authors: Treston Carole 
Published: December 2020

Abstract
Significantly more than half of people living with HIV in the United States are over age 50 and at least half of that number are over 70 years old. Advances in antiretroviral treatments continue to extend the lifespan of people with HIV. However, people aging with HIV, particularly those diagnosed earlier in the epidemic, known as “long term survivors” are likely to face a myriad of challenges: clinical, psychosocial, financial, and logistical. Aging with HIV is a complex mix of long-term treatment effects, early onset of general aging, comorbidities and other confounding factors including mental health and psycho-social factors that affect quality of life. Older persons living with HIV have experienced tremendous loss, stigma and discrimination, including within the healthcare system. Now, renewed losses amplified by the emergence of multiple comorbidities including cardiovascular and metabolic disease, HIV associated neurocognitive disease, other neurological disability, diminished bone health and frailty and other conditions can impair quality of life significantly. A review of the common comorbidities experienced by people aging with HIV and the intersection with social isolation, stigma and loss will be presented. Strength based, holistic care that focuses on resilience, and includes advocacy, social networks and care coordination delivered by nurses and nurse practitioners as part of a collaborative inter-professional education program at the Association of Nurses in AIDS Care to address the unique challenges experienced by PLWH will be described.
Sequential Patterns of Multimorbidity in a Nationally Representative Cohort Study of Aging
Authors: Schiltz Nicholas , Hu Yicheng , Foradori Megan , Bailey Jessica Cooke 
Published: December 2020

Abstract
Multimorbidity – the presence of two or more chronic health conditions – is common among older adults. Despite this, relatively little is known about the epidemiology of specific sequences of disease onset that occurs in mid-life and older adults over time. This may be attributed to the sheer number of possible permutations, which is difficult to handle with traditional methods. This is a retrospective cohort study using the Health & Retirement Study (HRS), a nationally-representative panel survey of aging. The study population included all adults age 50 and older that had no reported chronic disease at baseline (n=5567). We use a data mining algorithm, Sequential Pattern Discovery using Equivalence classes (SPADE), to identify all possible sequences of eight self-reported age-related chronic diseases: hypertension, arthritis, diabetes, cancer, stroke, heart disease, chronic lung disease, and psychiatric disorders. There were 67 unique sequences of disease identified that occurred in at least 1% of the study population. The most common two event sequence was Arthritis=&gt;Hypertension (15.5% of all subjects), and the second most common was Hypertension=&gt;Arthritis (9.6%). The most common three-way sequence was Arthritis=&gt;Hypertension=&gt;Heart Disease (1.8%). Arthritis=&gt;Stroke occurred in 1.5% of subjects and was associated with the highest mortality rate (71.3% of subjects died). Sequential pattern mining allows for the discovery of longitudinal patterns of disease that frequently occur in older adults and advancements in our understanding of the epidemiology of multimorbidity. Future applications may include predicting a given patient's disease trajectory based on their life course and disease history.
Reciprocal Effects Between Life Satisfaction and Sleep Duration in Chinese Older Adults
Authors: Liu Qian , Pan Haimin , Pei Yaolin 
Published: December 2020

Abstract
Sleep problems are prevalent among older adults. It is evident that sleep duration, as an important indicator of sleep quality, is closely associated with life satisfaction. However, it remains unclear as to whether sleep duration influences life satisfaction, or whether lower levels of life satisfaction increase the likelihood of sleep duration decline. This study examined the directional relationship between life satisfaction and sleep duration among Chinese older adults. Data were derived from the China Health and Retirement Longitudinal Study (2011, 2013, 2015 waves; age≥60 year; n = 5689). A cross-lagged panel model (path analysis) with three time points was used to jointly examine the longitudinal reciprocal effects between life satisfaction and sleep duration. This model achieved acceptable indices of goodness of fit. The results revealed that sleep duration were positively associated with life satisfaction at all time points (2011 to 2013: B=.06,SE=.01,p&lt;.0001; 2013 to 2015: B=.05,SE=.01,p&lt;.0001), and life satisfaction also positively predicted sleep duration across timepoints (2011 to 2013: B=.07,SE=.01,p&lt;.0001; 2013 to 2015: B=.03,SE=.01,p&lt;.05).These associations remained unchanged when taking demographics, and noontime napping into account. The findings indicate that the relationship between life satisfaction and sleep duration is bidirectional. Sleep duration may present as a mechanism for the relationship between life satisfaction and health, and suggests that effective treatment of sleep duration may improve life satisfaction.
Disability and Symptom Burden Among the Very Old: Comparison of Survivors and Decedents
Authors: Liu Xinran , Albert Steven 
Published: December 2020

Abstract
How does disability and symptom burden among the very old differ between those who die and those who do not die over 12 months? We explored patterns of disability and symptom burden in the Health ABC cohort study, which involved quarterly phone interviews in 2011-14 (years 15-17). A proxy completed the interview when the proband was unable to participate. We identified a sample of 291 decedents with at least 1-year of follow-up before death and matched a 1:1 sample of survivors at the time of death by race, sex, and age (within ±3 years). 252 decedents (age 90.0±3.03, 65.1% Black, 52.4% female) and 288 survivors (age 90.1±3.03, 64.9% Black, 52.4% female) with at least 3 quarterly interviews were included for analysis. Decedents had a higher proportion of proxy-reported interviews compared to survivors (40.9%vs16.0%, P&lt;0.01). Disability prevalence among decedents was significantly higher (P&lt;0.01) compared to survivors (using an assisted walking device, 62.3%vs37.4%; difficulty getting in/out of bed, 32.0%vs19.4%; difficulty bath/shower, 28.9%vs10.0%; difficulty dressing, 19.0%vs8.7%). Decedents and survivors differed significantly (P&lt;0.05) in self-reported number of symptoms (2.35vs1.78), severity of disability due to shortness of breath (4.09vs2.04), constipation (3.97vs1.74), and difficulty concentrating (1.98vs1.25). Decedents also had a significant higher score (P&lt;0.01) on self-reported loss of appetite (2.24vs1.91) and worse global quality of life rating (3.04vs2.64), compared to survivors. The patterns were similar in proxy-reported group and in the group with a combination of self-and proxy-reported interviews. Even in very late old age, disability and symptom burden increase with the approach of death.
Mobility Matters: A Pilot Study on Increasing Health Literacy Among Fall-Risk Elders
Authors: Milidonis Mary , Keehan Jane , Deuley Rebecca , Formoso Sara , Montgomery Katherine , Kopera-Frye Karen 
Published: December 2020

Abstract
Mobility is important to sustain for older adults to live independently. The purpose of this project was to evaluate teach back and ask me 3 interventions with a health education program that included Otago strength and balance exercise and a walking program The pilot program, Mobility Matters, was completed with 16 older adults (mean age =76, range 63-87, SD = 8.6), 69% African American, 94% female. Older adults with moderate fall risk were recruited from community centers and participated in a 3-month program where they were paired with physical therapy students for pre- and post-intervention assessment. Participants were randomly assigned to a health literacy intervention group (HLG) (n=9) and received teach back and ask me 3 intervention twice a month for three months. The control group (n=7) received the same program of balance exercises/ walking program and after 3 months was given the health literacy intervention. Groups were not significantly different on age, gender and REALM scores. Assessment measures included: timed up and go, 30 second chair rise, 4 stage step test, 6 minute walk test, and activity balance confidence scale (ABC). Paired t-test analysis revealed mean significant differences on the measures of four stage balance test (p =.008), six-minute walk test (p=.026) and approached significance on ABC (p=.054). No significant differences were found for the non-health literacy group on all measures. The results suggest that health literacy intervention may improve outcomes for health education interventions with balance and aerobic exercise.
Improved Processing Speed Is a Potential Mechanism by Which Exercise Reduces Falls
Authors: Liu-Ambrose Teresa , Davis Jennifer , Falck Ryan , Khan Karim 
Published: December 2020

Abstract
A 12-month trial demonstrated the Otago Exercise Program (OEP), a home-based exercise program of strength and balance retraining exercises, significantly reduced the rate of subsequent falls among 344 older adults receiving care after a fall (JAMA, 2019). A significant improvement in processing speed, as measured by the Digit Symbol Substitute Test (DSST), was also observed. Given the DSST is a predictor of falls, we conducted mediation analyses to determine whether improved DSST mediated the effects of OEP on rate of: 1) total falls; 2) non-injurious falls; 3) mild injurious falls; and 4) severe injurious falls over the 12-month trial. Our causal mediation analyses were conducted using the mediation package in R, using quasi-Bayesian estimates and 95% confidence intervals. Compared with usual care, OEP significantly reduced the rate of total falls (IRR= 0.64; 95% CI: 0.44, 0.91; p= 0.013) and mild injurious falls (IRR= 0.49; 95% CI: 0.31, 0.77; p= 0.002). Improved DSST score was also associated with lower mild injurious fall rates (IRR= 0.95; 95% CI: [0.91, 0.99]; p= 0.014). Formal mediation analyses showed that improved DSST was a significant mediator of the effect of OEP on the rate of mild injurious falls (95% CI: -0.15, 0.00; p= 0.036). Improved processing speed may be a mechanism by which exercise reduces mild injurious falls.
Vitamin D Supplementation and Mortality in Older Adults: A Systematic Review and Meta-Analysis
Authors: Zhao Yunli , Jia Shuli , Ge Meiling , Dong Birong 
Published: December 2020

Abstract
Web of Science, Embase, Medline and Cochrane Central Register of Controlled Trails from their inception to 14 January 2020 were searched in this review. We included randomized controlled trials (RCTs), which compared vitamin D supplementation versus placebo or no intervention and reported mortality as one of outcomes in older adults. Two review authors extracted data independently. Fifty-one articles were included in the analysis, which generated a total pooled sample of 89,977 people and 9813 deaths. These trials were pooled in a meta-analysis, and the outcomes were expressed as risk ratios (RRs) and 95% confidence Intervals (CIs). Across all studies, vitamin D supplementation was not associated with all-cause mortality (RR 0.98, 95%CI 0.92 to 1.04, P=0.48, I2=14%; 89,977 participants; data from 51 trails). Vitamin D supplementation was significantly decreased cancer mortality ( RR 0.85, 95% CI 0.74 to 0.97, P= 0.02, I2=0%; 34364 participants; data from 6 trails). A subgroup analysis showed the associations between the length of vitamin D supplementation more than 3 years and all-cause mortality were statistically significance (RR 0.93, 95%CI 0.88 to 0.98, p = 0.01, I2=0%; 49336 participants; data from 17 trails). Subgroup analyses by vitamin D status, forms of vitamin D (vitamin D3, vitamin D2, alfacalcidol or calcitriol), dose showed no association with all-cause mortality. The evidence from pooled analysis of 51 RCTs undertaken in older adults shows vitamin D supplementation was not associated with all-cause mortality. More long-term trails are need to know weather vitamin D supplementation can decrease all-cause mortality in older adults.
Evaluating an Advance Care Planning Skills Training for Medical, Nursing, and Social Work Students
Authors: Becker Todd , Cagle John 
Published: December 2020

Abstract
Advance care planning (ACP) helps to ensure future healthcare is congruent with individual preferences. Curricula for health-focused professions rarely include ACP content. This is a repeated measures evaluation of an innovative, interprofessional student training to enhance the ability to lead ACP discussions. Outcomes were measured via self-report surveys at two timepoints (baseline = T1 [n = 35]; posttraining follow-up = T2 [n = 20]) and included validated measures of communication self-efficacy, ACP self-efficacy, and interprofessional teamwork. Data collection from a third timepoint (T3), following randomized group assignment is currently underway. The matched T1–T2 sample (N = 17) included students from medicine (64.7%), nursing (17.6%), and social work (17.6%). Participants were largely young (M=26 years), non-Hispanic (94.0%), White (59.0%), and female (71.0%). Paired t tests examined change from T1 to T2 for all outcomes. Despite worse communication self-efficacy (Mdiff=1.6, p&lt;.001) and ACP self-efficacy (Mdiff=.92, p&lt;.001), perceptions of interprofessional teamwork improved (Mdiff=3.0, p=.008). These T1–T2 findings mirror results from similar, prior research, which subsequently discovered that both self-efficacy outcomes and their effect sizes for change worsened at T2, but ultimately and substantially improved at T3. These fluctuations suggest participants initially overestimated their self-efficacy related to ACP at T1 and corrected their appraisals at T2. Other studies should account for this self-correction. Further replication is needed to understand the dip that appears to occur before anticipated improvements occur.
Hospice Family Caregivers’ Use of Audio Diaries
Authors: Cloyes Kristin , Porter Eliabeth , Reblin Maija , Mooney Kathi , Tay Djin , Ellington Lee 
Published: December 2020

Abstract
Previous work has shown that emotional processing as part of diary writing improves well-being during and after stress. The purpose of this study was to determine the feasibility of verbal/audio diaries for home hospice family caregivers (HFCGs). We also describe diary content. As part of an ongoing multi-site, prospective longitudinal study, HFCGs of cancer patients report daily fluctuations in patients’ and their own symptoms via an automated telephone system, including a recorded diary entry. HFCGs are randomly assigned instructions to either discuss additional symptoms or discuss their thoughts and feelings. Thirty-six (85.7%) participants to date have completed at least one audio diary. For this preliminary analysis, we selected the 14 longest diary recordings from each condition (n=28) to content analyze using Linguistic Inquiry and Word Count (LIWC) and NVivo 12. Participants are 78.6% female, 53 years of age on average, and most are spouse/partner (46.4%) or adult child (35.7%) caregivers. There was no difference in the overall positivity (23%) or negativity (77%) of words in either condition, but participants asked to express thoughts/feelings used significantly more anger-related terms (p=0.04) while those asked to describe symptoms used significantly more anxiety-related terms (p = 0.003). Time was the most common theme in both conditions but arose more frequently in the symptom condition (p=.08). Our findings suggest that most audio diaries are feasible for HFCGs, but varied prompts may facilitate different types of emotional expression. Future research should assess potential impact on emotional well-being and bereavement adjustment.
How Many People Need Palliative Care and How Many Miss Out?
Authors: Davis Esther , Westley-Wise Victoria , Moules Stephen , Masso Malcolm , Barclay Greg , Nangati Zivai , Davis Joanne , Eagar Kathy 
Published: December 2020

Abstract
With an ageing population and growing burden of chronic disease, the number of people requiring palliative or end-of-life care (P&EOLC) is set to rise. It is imperative to develop a comprehensive understanding of the quality and equity of P&EOLC provision to promote sustainable health systems. The aim of this presentation is to report an observational study of N=3,171 decedents across a Local Health Network to: 1) estimate the proportion who need, access and miss out on P&EOLC in the last 12 months of life, and 2) identify differences by clinical and sociodemographic characteristics. Analysis was performed on multiple integrated datasets containing routinely collected health and mortality data. Estimation methods based on underlying cause of death were applied to determine those decedents who could potentially benefit from P&EOLC. Results identified potential benefit to 75% of decedents, of which 62% received P&EOLC and 13% missed out. Decedents aged 85 years or more and from a residential aged care facility showed the lowest proportion of access. Decedents with diagnosis of liver or kidney failure and dementia received more P&EOLC than were expected to benefit. Multivariate logistic regression identified that diagnosis and no other clinical or sociodemographic factor was significantly associated with likelihood of accessing specialist palliative care, with cancer showing highest likelihood and heart failure lowest likelihood. This research highlights the value of population-based estimates to provide a ‘whole of system view’ of quality and equity of P&EOLC, with ready translation for service planners around resource allocation for need and likely benefit.