bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOES PHYSICAL FUNCTION RESPONSE TO INTENTIONAL WEIGHT LOSS IN OLDER ADULTS VARY BY SEX-GENDER?
Authors: Beavers Kristen , Neiberg Rebecca , Beavers Daniel P , Dewey Eliza , Kitzman Dalane , Messier Stephen , Rejeski Jack , Kritchevsky Stephen 
Published: November 2019

Abstract
The purpose of this study is to explore whether the effect of intentional weight loss on physical function in older adults varies by sex/gender. Individual level data from 1369 older, (67.7±5.4 years), obese (BMI: 33.9±4.4 kg/m2), adults (30% male, 21% African American) who participated in eight randomized controlled trials of weight loss were pooled. All studies were 5-6 months in duration and collected baseline demographic and pre/post gait speed (n=1296), short physical performance battery (SPPB; n=866), and grip strength (n=401) data. Treatment effects were generated by weight loss assignment [weight loss (WL; n=764) versus non-weight loss (NWL; n=605)], as well as categorical amount of weight change (high loss: &gt;-7%, moderate loss: -7 to -3%, and weight gain/stability: &lt;-3%). Analyses were adjusted for age, race/ethnicity, study, education, baseline BMI, and baseline value of the outcome measure of interest. Sex/gender stratified results were presented if the interaction term was p≤0.10. A sex/gender*weight loss assignment interaction was observed for SPPB (p=0.07), with women experiencing greater weight loss-associated improvement in SPPB score (WL: 0.42±0.08 versus NWL: 0.10±0.09; p=0.02) compared to men (WL: 0.30±0.11 versus NWL: 0.30±0.13). A sex/gender*weight loss amount interaction was observed for grip strength (p=0.05), with no difference observed across categories in women; however, greatest grip strength improvement was seen in men experiencing moderate weight loss compared to high loss and weight gain/stability categories. Weight loss-associated improvement in SPPB score is greater in women than men; grip strength gains in men are greatest among those achieving moderate weight loss.
WHAT MATTERS FOR COMPLETION OF ADVANCE DIRECTIVES AMONG AMERICAN OLDER ADULTS?
Authors: Lou Yifan , Liu Jinyu 
Published: November 2019

Abstract
Background: Most previous studies consider advance directives as one single outcome, which conceals possible variations of individuals’ decisions on two different advance directives documents–living will (LW) and durable power of attorney for healthcare (PA). To advance the knowledge on advance planning among older adults in the US, this study examined how health status and education are associated with completions of LW and PA and whether such associations vary by age and race. Methods: Data are from the 2016 wave of Health and Retirement Study. Health status was indicated by chronic condition and ADL and IADL functional limitations. Logistic regression model was used to examine how the completions of LW and PA are associated with health and education variables respectively. Interaction terms were created to test the moderating effects of race and age. Results: The analysis results show that older adults with higher IADL functional limitation and more education were more likely to complete completing PA or LW. Being white and higher age will increase the probability for an older adult to complete PA, whereas the older adults with heart problem were more likely to complete LW. The association between IADL/ADL and PA was stronger in white than other racial groups, and the association between IADL and LW was stronger in young-old than the oldest-old. Conclusion: The findings highlight the importance of examining the completions of two advance directive documents respectively and indicate the necessity of developing distinct and concrete strategies to promote the completions of PA and LW.
ELDER VOICES NETWORK: PARTNERING WITH OLDER PEOPLE AND THEIR CAREGIVERS TO AVOID MEDICAL HARM
Authors: Ranahan Molly , Brennan-Taylor Mary , Richbart Michael , Clark Collin , Gadzo Ryan , Singh Ranjit , Wahler Robert 
Published: November 2019

Abstract
Team Alice, named after an older adult in our community who died as a result of medication harm, is an interdisciplinary team of prescribers, pharmacists, educators, advocates, and researchers with a mission to protect older people from medication-related harm across the continuum of care. In 2019, Team Alice partnered with the Erie County Department of Senior Services, older people, and caregivers to form the Elder Voices Network (EVN) as a vehicle for patient-driven deprescribing in the Western New York region. The objective of this presentation is to detail the planning and implementation of critical components of EVN’s formation, including outreach and engagement, funding development, community partnerships, roles and communication, and decision-making. Case study results demonstrate the capacity of community-based participatory research (CBPR) to empower older people and caregivers with knowledge, skills, and tools to promote self-advocacy across the system. Presenters will also discuss recommendations useful for future patient engagement initiatives.
THE USE OF SELF-MANAGEMENT TECHNOLOGY AND HEALTH CARE UTILIZATION IN LATER LIFE
Authors: Liu Darren , Yamashita Takashi , Burston Betty , Keene Jennifer 
Published: November 2019

Abstract
Health-related websites and applications are useful tools for self-management in health care settings. However, the limited accessibility due to the lack of technology-related skills can be a “digital divide” issue that particularly affects older adults. To better understand the role of such tools in later life, this study examined the use of internet-based technology in relation to health care service utilization. A nationally representative samples of adults age 55 years and older (n = 1,157) were obtained from the health behaviors module of the 2014 Health and Retirement Study (HRS) in the U.S. We analyzed the use of health management websites and apps and its association with health care service utilization measured by the number of doctor visits during the last two years before the interviews. Negative binomial regression was used to model the number of doctor visits as a function of the health management technology use and other covariates. Results revealed that the level of technology use (b = 0.41, p &lt; 0.05) was significantly associated with a 50% greater number of doctor visits. Such technology use was significantly more common among adults with good health than those with poorer health outcomes (17.32% & 9.60%, respectively, p &lt; 0.05). The findings suggest that healthy adults take advantage of available internet-based self-management tools and proactively utilize health care services more often than individuals who can be categorized as “unhealthy”. There is a continuing need for research on introducing strategies that can ultimately reduce health disparities by decreasing the digital divide.
THE SHARED MEANING OF COMPASSION FATIGUE AMONG REGISTERED NURSES WORKING IN SKILLED NURSING FACILITIES
Authors: Steinheiser Marlene 
Published: November 2019

Abstract
The purpose of this hermeneutic interpretive phenomenology study was to describe the shared meaning of compassion fatigue (CF) among registered nurses (RNs) who work in skilled nursing facilities (SNFs). The specific aims were to describe: 1) contributors (triggers, situation, or patient characteristics) that cause symptoms of compassion fatigue, 2) associated physical and emotional symptoms, and 3) the short-term outcomes of unresolved compassion fatigue impacting nurses and patient care. CF can negatively impact patient outcomes, is associated with decreased quality of patient care, and can be a reason why nurses leave the profession. Eight participants were interviewed three times each, while concurrent data analysis helped to formulate mutual understanding of the phenomenon and informed subsequent interviews. Self-reflection, journaling, record keeping, and use of direct quotes enhanced trustworthiness. Four shared meanings were abstracted:1) I feel conflicted and that causes my CF; 2) physical and emotional manifestations of CF; 3) CF is infused in every aspect of my life; 4) we are trying to cope with CF. The participants shared their central desire to make a difference in the lives of their patients, which was of paramount importance. When participants felt they were unable to make the desired difference, they began to develop symptoms of CF. Symptoms were compounded when they experienced frequent patient deaths. A resiliency program specifically addressing the needs of SNF nurses, incorporating individuals and their organizations, could positively impact the nurses’ professional quality of life. Future research is needed to better understand CF and interventions specific to SNF nurses.
CHALLENGES AND IMPERFECT SOLUTIONS FOR COGNITIVE SCREENING WITH OLDER IMMIGRANTS
Authors: Willoughby Lisa , Pusopa Chuleeporn , Prakobchai Sattha , Meekanon Paweena , Goswami Spondita , Matsuo Hisako , Malmstrom Theodore K 
Published: November 2019

Abstract
Cultural diversity among older adults is increasing and with this comes challenges in health care needs, including the detection of cognitive impairment. Cognitive impairments manifests in many ways, with early symptoms often difficult to detect. Detecting cognitive dysfunction is typically facilitated with brief, portable screening tools. Scores on screening tools may be influenced by culture, education, and verbal abilities; in particular, these are acute issues for screening older immigrants from linguistically and culturally diverse backgrounds. The consequences of improper screening are high and, as such, finding practical, cost-effective solutions is of critical importance. In this project, we qualitatively examined the usability of different cognitive screening tools with the ultimate goal of improving the detection and classification of cognitive dysfunction among older adult immigrants. We extended our previous work by piloting adaptation guidelines for the Saint Louis University Mental Status (SLUMS) exam for use with linguistically and culturally diverse persons. We recruited 23 older immigrants (6 non-English speaking) and 14 U.S. born participants to explore the usability and test-retest reliability of the SLUMS exam administered with and without the adaptation guidelines. Our attempts to improve the flexibility of the SLUMS exam did not achieve the level of success as anticipated. Although this pilot work had low power, when coupled with our past work on developing adaptation guidelines, sheds critical light on the layered complexity that arises at the intersections of education, culture, race, gender, socioeconomic status, and intercultural interactions and the resulting potential directions for future work will be discussed.
YOU’LL SEE: YOUNGER RESEARCHERS INTERVIEWING OLDER PARTICIPANTS
Authors: Jen Sarah , Zhou Yuanjin , Jeong Mijin 
Published: November 2019

Abstract
In qualitative research, similarities and differences between the participant and researcher influence the research process and dynamics. Specifically, the age difference between older participants and relatively younger qualitative researchers is a common, but under-examined dynamic requiring nuanced, reflexive analysis. Using a life course conceptual framing, this study explored age-related participant-researcher dynamics in interviews from two qualitative studies of older women’s sexual experiences in later life. Participants included 25 women whose ages ranged from 55 to 93 and both studies were completed by the same researcher, a relatively younger woman (age 23 and 28 at times of data collection). A thematic analysis revealed three primary themes: 1) taking care - participants took care of the researcher by offering advice, asking about the researcher’s life, and expressing hopes for a positive future, 2) expertise – varied expertise was demonstrated by the researcher (e.g. substantive and scholarly) and participants (e.g. life experience), and 3) researcher growth - the researcher’s interviewing tactics shifted between the two studies (e.g. use of validation rather than consolation in response to aging-related concerns), indicating a shift in perceptions of aging and later life. Findings indicate that older women participants and younger women researchers are bound together through the life course, by shared gendered experiences, the fact that one will eventually become the other, and the mutual sharing of expertise and caring. Gerontology researchers must actively reflect on the impact of their own identities and aging perceptions on the interviewing process in order to enhance rigor in qualitative research.
A MULTIDIMENSIONAL MODEL FOR POLYPHARMACY MEASUREMENT IN OLDER ADULTS: EVIDENCE FROM THE HEALTH RETIREMENT STUDY
Authors: Bendayan Rebecca , Carr Ewan , Federman Alex D , Dobson Richard J 
Published: November 2019

Abstract
Polypharmacy is associated with increased health care costs and adverse health outcomes. Traditional research on polypharmacy uses dichotomous measures which overlook its multidimensional nature. We propose a new approach to grouping older adults based on the number and type of medications taken as well as other indicators of polypharmacy. Data was extracted from 1328 respondents of the 2007 Prescription Drug Survey (a sub-study of the Health Retirement Study) who were between 50 and 70 years old and taking ≥1 medication each month. Latent class analysis was carried out with the optimal number of classes assessed based on relative model fit (AIC, adjusted BIC) and interpretability. Latent classes were formed based on the number of medications, drug types, duration of medication intake, side effects, and presence of chronic health conditions. A four-class model was selected based on model fit and interpretability of the solutions. Although there was some overlap when we compared our model with standard cut-offs for polypharmacy (i.e., ‘high polypharmacy’ classes were more likely to take 5+ and 9+ medications), chi-square tests showed significant differences between our latent classes and cut-offs based on 5+ [X2 = 894; p&lt;0.001] and 9+ medications [X2 = 398; p&lt;0.001]. Among individuals taking &lt;5 medications, our model differentiated two distinct types of ‘low polypharmacy’ based on the types of drugs reported. Our proposal to incorporate a multidimensional assessment of polypharmacy considers the wider context of medication use and chronic health in older age, moving beyond crude medication counts.
A CRITICAL REVIEW OF PAIN MANAGEMENT TRAINING PROGRAMS FOR FAMILY CAREGIVERS
Authors: Chi Nai-Ching , Barani Emelia , Fu Ying-Kai 
Published: November 2019

Abstract
Many American family caregivers (FCs) manage hospice and palliative patients’ pain at home. However, FCs encounter many barriers to pain management due to inadequate training. Although some studies have designed pain management training programs for caregivers, the content and durations vary greatly. Thus, there is a lack of consistent recommendation on how to educate caregivers on pain management. The purpose of this study is to critically evaluate existing training programs to inform clinical practice and future program design. A literature review was conducted to search available articles published before June 2018 in databases including PubMed, CINAHL, PsycINFO, and Scopus. Search strategies used index and keyword methods. The inclusion criteria were peer-reviewed, research studies published in English that evaluated a pain management education or training for family caregivers. Twenty-seven studied were included. All studies improved either patients’ outcomes (e.g. pain intensity, hospital visits) or caregivers’ outcomes (e.g. knowledge, quality of life). Most studies (85%) had research teams provide caregivers with pain management education via multiple face-to-face training sessions and written booklet, while some studies (15%) had practicing nurses used videophones, web-based platforms, and telehealth to enhance the collaboration of care and pain management with caregivers. Providing adequate pain management training can improve patients’ and caregivers’ outcomes. However, in-person training programs are not practical for busy and overwhelmed caregivers. Researcher-delivered training sessions are not clinically adoptable. Future studies should develop pain management interventions that allow nurses to coach caregivers during routine visits and enhance their communication and collaboration with caregivers.
I GOT THIS! SUCCESSFUL AGING THROUGH THE MAINTENANCE OF AUTONOMY
Authors: Nuccio Alexandria G , Stripling Ashely M 
Published: November 2019

Abstract
As America ages, an increased interest has been placed on understanding the development and maintenance of autonomy in later life. This is of particular importance given the impact of autonomy on vitality, well-being, and mood within older adults (Warner et al., 2011). However, the research examining which aspects of autonomy directly impact successful aging remains underexplored. As such, the current study utilizes the Functional Autonomy Measurement System (SMAF) to better understand which facets of autonomy promote life satisfaction in older adults. Data included assessments of the Functional Autonomy Measurement System and data was derived from the Survey of Midlife in the US Database (MIDUS 3). Participants were primarily White/Caucasian (88.7%) and female (54.0%); with a mean age of 63.64 years (SD=11.35). A series of hierarchical multiple linear regressions revealed that higher levels of Mental Functions predicted increased life satisfaction scores in models adjusted for age, sex, race, marital status, and education (F=54.152,p&lt;0.001) and that higher levels of Communication (F=37.553,p&lt;0.001), Activities of Daily Living (F=33.495,p&lt;0.001), Mobility (F=37.311,p&lt;0.001), and Instrumental Activities of Daily Living (F=8.630,p&lt;0.001) also predicted increases in life satisfaction scores but to a lesser extent. The present findings suggest that higher levels of autonomy, both physically and mentally, result in higher satisfaction with life; with perceptions of cognitive independence producing the highest levels. Implications of the current findings include increased understanding of the multifaceted nature of autonomy, and provision of recommendations which could increase autonomous behavior in later life, thus increase life satisfaction and promote successful aging.
MEANING IN LIFE AMONG THE OLD-OLD
Authors: Ermoshkina Polina , Kahana Eva , Kahana Boaz 
Published: November 2019

Abstract
Older adults, who view their lives as meaningful demonstrate better physical and mental health (Krause, 2007). However, the voices and the experiences of the old-old about what gives meaning to their lives have rarely been explored. This descriptive study examined key components of having meaning in life among independently living old-old migrants to the sunbelt. The sample consisted of 27 women and 18 men (N=45), with the mean age of 88.5 (SD=3.75) and the median annual income of $22,400, who participated in the Florida Retirement Study (Kahana et al., 2002). In response to the question “What gives the greatest meaning to your life at present?” family was reported as the primary source of meaning for the vast majority (40) of the participants. This is consistent with Tornstam’s (1997) theory of gerotranscendence reflected in a decreased sense of self-centeredness and greater connection to other generations. Men were more likely to list spouse as the primary source of meaning in life, followed by family, while women referred more generally to family. Health was equally important for men and women, followed by close friendships reported by 22 participants. This finding is consistent with Carstensen’s (2003) socioemotional selectivity theory suggesting that with age, the meaning of relationships changes and superficial relationships fade away. For those, who reported being very religious (7) Christian faith and attending church comprised key determinants. A transcendent, rather than materialistic view of life was illuminated by the fact that only one participant reported money as the greatest meaning in life.
SOCIAL VALUE OF THE ELDER PUMI MINORITY IN CHINA
Authors: Gao Meng ran 
Published: November 2019

Abstract
Social status of the elderly nowadays declines rapidly in China. As anthropologist Margaret Mead considered, post-figurative culture leading in contemporary society and the source of knowledge are from youth. The value of the elderly has been overlooked. However, in Pumi, one of the smallest ethnic minority groups in northwestern Yunnan Province of China, it is common that senior residents have high social status. This study examines the social values the Pumi elderly have by systematic analysis and participation observation methods. Based on data collected in a Pumi village during a 6-month fieldtrip, we conclude that Pumi elderly enjoy a high status in the community. They occupy core positions in all important ceremonies, such as religious activities and other daily activities including hospice. Factors behind the special old-age care phenomenon are Pumi’s history and its culture. The special culture has united the group members together and enhanced individual development with community social capital. It is clear that respecting elderly does not only contribute the transformation of ethnical knowledge but also enhance community cohesiveness. Evaluating the role of the elderly should not only from economic perspective, but also from the holistic perspective of social culture, so as to reconsider the importance of the elderly to our society.
WEALTH PROFILES AND VARIATIONS BY GENDER AND RACE: A GROWTH-MIXTURE MULTIGROUP COMPARISON
Authors: Chen Yu-Chih , Morrow-Howell Nancy 
Published: November 2019

Abstract
Wealth is fundamentally affected by various life course characteristics. However, little is known about the role of life course factors in shaping wealth trajectories in later life. This study explored how the longitudinal profiles of wealth varied by gender and race (white and non-white populations). Data came from the 2004-2014 Health and Retirement Study with 16,189 older adults aged 51 and older. With corrections for clustered effect within household, this study used growth mixture modeling (GMM) to identify the longitudinal patterns of wealth, and how these profiles varied by these two important life course attributes. The model began with a separate GMM model for race and gender to investigate the optimal latent class model. These results were combined using multi-group approach to incrementally examine the gender and race invariance using configural (same form), structural (same trajectory mean), dispersion (same trajectory variance), and distributional (same latent class size) test. Results identified four distinct wealth profiles—Stable high, Low and increasing, Stable low, and High but decline—for each race and gender category. The multigroup GMM analyses revealed that the wealth profiles varied by gender and race, but the degrees of variation differed a great deal, with results supporting a dispersion model for gender but a configural model for race. Results indicate that race has a stronger effect in shaping wealth development compared to gender. The findings suggest that understanding wealth disparities in later life could be facilitated by examining how wealth varies by gender and race.