bluuebunny/crossref_metadata_2025_split huggingface dataset:
GENERATIVITY ACROSS ADULTHOOD: THE EFFECTS OF AGE AND AFFECT
Authors: Nelson Niccole A , Bergeman Cindy 
Published: November 2019

Abstract
Generativity, or investment in the next generation, is heavily implicated in successful aging. Due to its benefits to both the individual and society, researchers have attempted to identify factors that contribute to generativity. Most studies on generativity, however, have been conducted in cross section, limiting established relations to those occurring between individuals, not within them. The identification of true within-person effects is vital, as between-person relations do not accurately describe within-person processes. One factor that may contribute to generativity within individuals is positive affect (PA), as experiencing PA seems to broaden individuals’ resources, and ultimately build human flourishing. This process may also be moderated by age or change over time. To test these ideas, the current study applied multilevel modeling to ten years of data from N = 1,117 mid-to-later life individuals. A main effects model indicated between-person effects such that younger individuals, as well as individuals with higher global PA, tended to report higher generativity, on average, than older individuals and individuals with lower global PA, respectively. Next, considering within-person effects, individuals tended to report higher generativity during years they experienced more PA. Finally, a two-way interaction effect indicated an age-related difference in a within-person process: although midlife individuals reported higher generativity during years they experienced more PA, later-life individuals did not show this effect. Theoretical implications, including age-graded goal strivings and the broaden-and-build theory, will be discussed.
IMPLEMENTATION OF PATIENT PRIORITIES CARE WITHIN A VA GERIATRICS CLINIC
Authors: Freytag Jennifer , Dindo Lilian , Catic Angela , Naik Aanand , Tinetti Mary 
Published: November 2019

Abstract
Patient Priorities Care (PPC) is an approach to decision-making for older adults with multiple chronic conditions (MCC). PPC trains facilitators to have structured conversations with patients to identify their priorities (the outcomes that matter most given what care they are willing/able to do or receive). Clinicians then align care to achieve patient priorities rather than focusing on multiple single-disease guidelines. We piloted PPC in a VA geriatrics clinic and compared it to usual care (UC) for multimorbid adults. This retrospective cohort study (n=36 PPC, 36 UC) describes changes made by clinicians after Veterans with MCC had facilitated conversations in a VA geriatric clinic. UC Veterans were matched by prognosis, same primary clinician, and timeframe. Coders used a standardized rubric to assess documented care within medical records. Changes to care examined include medications added/removed, referrals made/avoided, self-care recommendations, and recommendations for social engagement. Although PPC and UC patients were seen by the same clinicians, patients receiving PPC had fewer added medications (mean difference -.47, t(70)=-1.99, p=.05); received more recommendations for self-care aligned with priorities (mean difference .25, t(69)=2.14, p=.003); received more recommended consultations with desired care, including podiatry, transportation, and dermatology (mean difference .55, t(70)=2.06, p=.01), and more recommendations for care and services to facilitate social interactions (p&lt;.0001). PPC produced documented changes in care that better align with patient priorities within the routine care workflow of a busy geriatrics clinic. Our results provide evidence that structured priorities conversations change the way clinicians provide care for older adults with MCC.
THE SUPPORT OF AUTONOMY FOR NURSING HOME RESIDENTS WITH DEMENTIA: OBSERVATION OF MORNING CARE
Authors: Hoek Linda J , Verbeek Hilde , Vries Erica De , Van Haastregt Jolanda C , Backhaus Ramona , Hamers Jan P 
Published: November 2019

Abstract
People with dementia in nursing homes need their social environment in supporting their autonomy. This study explored how this relational autonomy is supported by staff for residents with dementia during morning care in nursing homes. Structured observations (n=1815) were carried out to assess how resident choice is supported within staff-resident interaction. Observation of morning care consisted of four main categories: ‘getting up’, ‘physical care’, ‘physical appearance’ and ‘breakfast’. In addition, qualitative field notes were taken to support observations. In total, 55 residents with dementia were included from eight nursing home wards in The Netherlands. Results indicated that resident autonomy during morning care was only limitedly supported. Individual staff members took over tasks, regardless of resident’s individual capabilities to make a choice. Staff controlled resident’s choice for almost all observed categories. The findings of this study implicate that person-centered care during morning routine can be improved by addressing individual needs
PAVING THE WAY FORWARD IN HOUSING WITH SERVICES: THE RIGHT CARE, RIGHT PLACE, RIGHT TIME PROGRAM
Authors: Miller Edward A , Nadash Pamela , Sanders Alisha 
Published: November 2019

Abstract
Older people living in congregate environments are obvious beneficiaries of supportive services. The potential for prevention is clear, particularly among low-income elders living in subsidized housing; it is this group that is at high risk for significant healthcare and other costs, and it is this group that suffers considerably from a fragmented healthcare system. Policymakers have long seen the advantages of reaching this population, but most existing housing with services programs have focused more on social than health-related supports. The Right Care, Right Place, Right Time initiative (R3) was launched in July 2017 to demonstrate the value of supportive services to seniors living independently in affordable housing in the Greater Boston area, while reducing health care costs. The R3 program consists of two on-site wellness teams, including a wellness nurse and wellness coordinator. Each team is responsible for about 200 participants across two housing sites. The R3 evaluation included both quantitative and qualitative components. The quantitative component entails pre/post comparison as well as a control group analysis, focusing on various health and health utilization outcomes. The qualitative component includes key informant interviews examining program development and implementation and focus groups capturing the resident experience. The purpose of this symposium is for evaluation team members to report on the experiences of program participants, administrators/staff, housing managers/staff, and community partners with the R3 program, and to assess program impact. Edward Miller and Pamela Nadash will serve as chair and co-chair, respectively; Alisha Sanders as the discussant.
COLLABORATION WITH FIRST RESPONDERS IN R3: THE CRITICAL ROLE OF COMMUNITY PARTNERS IN HOUSING WITH SERVICES
Authors: Nadash Pamela , Miller Edward , Simpson Elizabeth , Shellito Natalie 
Published: November 2019

Abstract
Because seniors represent a rising proportion of Emergency Medical Services (EMS) provider activity, there is a growing focus on determining how EMS providers can better serve the aging population. Multifamily senior housing properties benefit from reductions in resident turnover; EMS providers aim to improve community health and minimize unnecessary and low-priority callouts. Developing partnerships between the two service sectors can help both meet their individual goals while reducing health system costs. Drawing on experience with the R3 initiative, this study describes how a partnership between EMS providers and supported housing sites has led to reductions in ambulance transfers to hospitals and reinforced falls reduction programs within senior housing. The R3 program represented an effort to work closely with EMS providers and, by doing so, provides an example of how collaboration between the two sectors can work to the advantage of both parties by identifying residents who would benefit from intervention.
THE USE OF SPECIALIST HEALTH CARE IN NURSING HOMES AS AN INDICATOR FOR QUALITY OF CARE
Authors: Wolf-Ostermann Karin , Wolf-Ostermann Karin , Schmidt Annika , Gand Daniel , Gerhardus Ansgar , Rothgang Heinz 
Published: November 2019

Abstract
Needs-based medical care is essential for maintaining and promoting health and quality of life in long-term care. But still knowledge of medical needs and of needs-based medical care of nursing home (NH) residents is limited. However, individual studies, primarily based on secondary data, show that NH residents have significantly less contact with specialists than community-dwelling elderly. The aim of the study is therefore to gain knowledge about medical needs of NH residents as well as about the use of (specialist) medical care especially with respect to vision, hearing and oral health. Besides sociodemographic and care-related data we evaluated health status and utilization of medical care by means of standardized assessments for n=500 NH-residents. Results show that there are inequalities in (specialist) medical care: More experienced knowledge about unmet medical care needs will be used to generate ideas on how to improve the provision of medical care in nursing homes.
SLEEP QUALITY AS A MECHANISM LINKING PHYSICAL ACTIVITY AND COGNITIVE FUNCTIONING
Authors: Bisson Alycia N , Lachman Margie E 
Published: November 2019

Abstract
Modifiable health behaviors, such as physical activity and sleep quality are important for cognition throughout life. A growing body of research also suggests that engaging in enough physical activity is important to sleeping well. One recent study found that sleep efficiency mediates the relationship between physical activity and cognition. It is still unknown whether other metrics of sleep quality are mediators. The present study tested mediation in the second wave of the Midlife in the United States (MIDUS) study. Using the PROCESS macro for SPSS, we found that those who were more physically active fell asleep faster, and had better executive functioning. In addition, those who were more physically active reported waking up fewer times during the night, and had better executive functioning and self-rated memory. Discussion will focus on the moderating role of gender and distinctions between findings with different measures of sleep, physical activity, and cognition.
RACIAL DISPARITIES IN 30-DAY READMISSION RATES AMONG MEDICARE PATIENTS DISCHARGED TO SKILLED NURSING FACILITIES
Authors: Rivera-Hernandez Maricruz , Rivera-Hernandez Maricruz , Rahman Momotazur , Mor Vincent , Trivedi Amal N 
Published: November 2019

Abstract
The 30-Day All-Cause Readmission Measure is part of the Skilled Nursing Facility Value-Based Purchasing (SNFVBP) beginning 2019. The objective of the study was to characterize racial and ethnic disparities in 30-day rehospitalization rates from SNF among fee-for-service (FFS) and Medicare Advantage (MA) patients using the Minimum Data Set. The American Health Care Association risk-adjusted model was used. The primary independent variables were race/ethnicity and enrollment in FFS and MA. The sample included 1,813,963 patients from 15,412 SNFs across the US in 2015. Readmission rates were lower for whites. However, MA patients had readmission rates that were ~1 to 2 percentage points lower. In addition, we also found that African-Americans had higher readmission rates than whites, even when they received care within the same SNF. The inclusion of MA patients could change SNF penalties. Successful efforts to reduce rehospitalizations in SNF settings often require improving care coordination and care planning.
IMPACT OF AN INTENSIVE MULTIDOMAIN LIFESTYLE INTERVENTION ON DEFICIT ACCUMULATION FRAILTY INDICES
Authors: Simpson Felicia , Pajewski Nicholas M , Bertoni Alain M , Ingram Frank , Nicklas Barbara M , Kritchevsky Stephen , Ojeranti Daniel , Espeland Mark M 
Published: November 2019

Abstract
Background: Type 2 diabetes and obesity increase accumulation of health deficits over time and may accelerate biological aging. It is unknown whether multidomain lifestyle interventions can mitigate against this. Methods: Within a large, randomized controlled clinical trial of intensive lifestyle intervention (ILI) including caloric restriction, increased physical activity, dietary counseling, and risk factor monitoring compared with diabetes support and education (DSE) we examined the trajectory of frailty across 8 years. We used two complementary frailty index (FI) definitions, one modeled on work in the Systolic Blood Pressure Intervention Trial; the other including additional deficits related to aging with obesity and type 2 diabetes mellitus. Differences between intervention groups and the consistency of these across clinical subgroups were assessed with re-randomization tests. Results: Data from 4859 adults (45-76 years at baseline, 59% female) were analyzed. Random assignment to ILI was associated with lower FI scores throughout 8 years of follow-up (p&lt;0.001), over which time mean differences between intervention groups averaged 5.8% and 5.4% for the two indices. At year 8, the percentages of participants categorized as frail (FI&gt;0.21) were lower among ILI (39.8% and 54.5%) compared with DSE (42.7% and 60.9%) for the two indices (both p&lt;0.001). Intervention benefits were relatively greater for individuals who were older, not obese, and without history of cardiovascular disease at baseline. Conclusions: Eight years of multidomain lifestyle intervention slows the accumulation of health deficits over time in overweight or obese adults with type 2 diabetes.
PREDICTING ADVERSE OUTCOMES IN ED PATIENTS USING THE CLINICAL FRAILTY SCALE AND A FRAILTY INDEX
Authors: Rockwood Kenneth , Pulok Mohammad , van der Valk Alex , Theou Olga 
Published: November 2019

Abstract
Our aim was to use the Comprehensive Geriatric Assessment (CGA) database to investigate whether the Clinical Frailty Scale (CFS) measuring the baseline state, and a Frailty Index (FI) based on a CGA (current state, with acute illness) can predict adverse outcomes in acutely ill Emergency Department (ED) patients. It contains CFS and FI scores on 1028 ED patients referred to internal medicine at the Halifax Infirmary between 2009-2019 (Mage 80.69 ± SD 8.28, range 57-103; 54.9% female). The mean scores were 0.44±0.14 (FI) and 5.58±1.66 (CFS). Most patients (72%) arrived via ambulance. The average length of stay was 27.0±20.5 hours. Overall, 22% were discharged home, and 63.5% had died by December 2017 with a mean survival time of 1.98±2.01 years. Controlling for age, sex, and Canadian Triage Acuity Score, the odds ratio (95% Confidence Interval) of being discharged home and the hazard ratio (95% Confidence Interval) for mortality was 0.94 (0.92-0.95) and 1.02 (1.02-1.03), respectively per 0.01-point increase in FI. For the CFS, using score ≤4 as the reference, the odds ratio and the hazard ratio were 0.70 (0.42-1.16) and 2.02 (1.51-2.69), respectively for the CFS 5 group, 0.47 (0.27-0.81) and 2.72 (2.05-3.61), respectively for the CFS 6 group, and 0.38 (0.21-0.70) and 4.67 (3.51-6.20), respectively for the CFS 7-9 group. Even controlling for acuity, both the CFS and the FI independently predict adverse outcomes in ED patients. These add prognostic information to the routinely collected ED assessments, and establish targets for care plan based on recovery to baseline.
GEOGRAPHIC DISPARITIES IN COUNTY-LEVEL PREVALENCE OF ALZHEIMER’S DISEASE ACROSS THE UNITED STATES
Authors: Fowler Mackenzie E , DiBlasio Christina , Crowe Michael , Kennedy Richard E 
Published: November 2019

Abstract
Small-area geographic disparities in health care delivery have been observed across multiple disorders, but remain poorly studied for Alzheimer’s disease (AD) and other dementias. While national and state estimates of the prevalence and incidence of AD are available, estimates across finer geographic regions offer an opportunity to tailor programs to the needs of the local population. We estimated prevalence of AD at the county level across the continental United States. We used prevalence rates of AD by age category and race among Medicare fee-for-service beneficiaries published by the Centers for Disease Control (CDC). These prevalence rates were projected onto bridged-race county-level population data for 2017 from the National Center for Health Statistics, with empirical Bayes spatial smoothing to reduce variability in rates due to small population sizes. Estimated prevalence of AD varied more than threefold across counties, from a low of 51.8 per 1,000 persons in Loving County, Texas to a high of 169.6 per 1,000 persons in Kalawao County, Hawaii. Higher prevalence of AD was seen in the Southeastern and Midwestern United States. However, we observed specific counties with low prevalence of AD within regions with high prevalence of AD, and vice versa. These small-area geographic variations may provide vital information about social and environmental influences on dementia care, yet little data have been available to date. Understanding geographic disparities in prevalence will be critical for addressing practice variation in the prevention and diagnosis of dementia.
MISCLASSIFICATION IN DEMENTIA DATA IN THE CARDIOVASCULAR HEALTH STUDY: A PROBABILISTIC BIAS ANALYSIS
Authors: Odden Michelle , Arnold Alice , Newman Anne B , Hazzouri Adina Zeki Al , Miller Lindsay , Lopez Oscar , Mukamal Kenneth , Rawlings Andreea 
Published: November 2019

Abstract
Data routinely collected in observational studies from phone calls, medical records, and death certificates can be used to categorize dementia, though there may be misclassification. We applied probabilistic bias analyses to assess the magnitude, direction, and uncertainty of the error due to misclassification of dementia data in the Cardiovascular Health Study (CHS). We categorized dementia among all participants (73,284 person-years) using medications, ICD-9 codes, use of proxy, and death certificates, and compared to the gold standard adjudicated dementia in the CHS Memory Studies (28,250 person-years). Using the gold standard, positive (PPV) and negative predictive values (NPV) of dementia categorization were estimated within strata defined by age and sex. In probabilistic bias analyses, we reclassified participants from the full study using estimated PPVs and NPVs in 5,000 replicates. We estimated the hazard ratio (HR) of dementia associated with age, race, sex, hypertension, diabetes, and APOE4 genotype in this bias analysis and compared these results to those using original data. ICD-9 codes had low specificity and were excluded in further analyses. The NPV was differential by sex (66% for females and 79% for males) and race (51% for blacks, 60% for whites). In bias analysis, the HR for black race was attenuated from 2.81 (95%CI:1.36-5.80) to 1.23 (95%CI:1.14-1.33). The estimate for hypertension was statistically significant only in bias analysis. Estimates and inferences for the other covariates were modestly different. Differential misclassification may lead to important biases of risk factors, but can be recognized and addressed using probabilistic bias analyses.
PROMIS COGNITIVE FUNCTION AND CONCERN SCALES: LINGUISTIC VALIDATION IN AMERICAN SIGN LANGUAGE FOR DEAF OLDER ADULTS
Authors: Kushalnagar Poorna 
Published: November 2019

Abstract
Objective: To culturally and linguistically validate PROMIS Cognitive Functions and Concerns Scales in American Sign Language (PROMIS-ASL) for use with deaf older adults over 50. Methods: We used the standard procedures developed at the U.S. National Center for Health Statistics Cognitive Survey Laboratory to culturally adapt and translate items from the cognitive scales of the Patient Reported Outcomes Measurement Information System (PROMIS). We describe cultural adaptation and linguistic translation procedures led by a team of primarily deaf investigators. Using multidimensional exploratory or confirmatory factor analyses, we identify or confirm the items most likely to comprise each subset. Once the PROMIS-ASL version is finalized, we will compute test-retest reliability using ICC (intraclass correlation coefficient) from two-way random effects ANOVA models. Results: We produced an accessible patient reported outcomes cognitive measure in American Sign Language and a culturally appropriate set of items that are relevant to the experiences of deaf older adult over 50 users of accessible technology and services. Conclusions: The final PROMIS-ASL product with cognitive domain will be distributed for public use.
MORAL GAIN OR DECAY? EXAMINING AGE-RELATED CHANGES IN MORAL JUDGMENT
Authors: Lu Minjie , Fung Helene H 
Published: November 2019

Abstract
The present study investigates age-related changes in moral judgment. In particular, we examined both cognitive and affective dimensions of morality in contributing to moral punishment. One hundred and twenty participants (aged from 22 to 75) recruited from Mturk were presented with 10 moral transgression stories (e.g. lying, harming), and reported their wrongness judgment, moral conviction, emotional experience, and moral punishment. Results revealed divergent patterns on the relationships between age and the evaluations on cognition and emotion. In terms of cognitive evaluation, compared to younger adults, older adults perceived immoral acts as more wrong and considered their stands as more connected to their moral conviction. However, older adults reported less intense negative emotions (anger, disgust, contempt), suggesting they were less aroused by immoral acts. In terms of moral punishment, age was negatively correlated with punishment, and this correlation was mediated by the age-related decrease in negative emotions.
THE ASSESSMENT OF VIEWS ON AGING: A REVIEW OF SELF-REPORT MEASURES AND INNOVATIVE EXTENSIONS
Authors: Notthoff Nanna , Beyer Ann-Kristin , Blawert Anne , Gabrian Martina , Klusmann Verena 
Published: November 2019

Abstract
Individual views on aging refer to either older people in general or to a person’s own age and aging. Classical approaches seem to hardly map the multidimensional, multidirectional, and highly individual nature of experiences as well as the malleability of perceptions of aging. For this paper, we reviewed existing measures of views of aging. These were categorized based on eight dimensions which were defined by an expert panel and based on current characterizations of views on aging in the literature. Results on 96 instruments call for a strengthening of the affective and the behavioral components in contrast to the apparently cognitive focus of the measures and argue for a stronger emphasis on the developmental nature of views on aging (time references, changes). This is particularly important when aiming to study the lifelong dynamics of views on aging. The suitability of innovative extensions will be discussed.