bluuebunny/crossref_metadata_2025_split huggingface dataset:
STATE VARIATION IN NURSING HOME CIVIL MONEY PENALTY ENFORCEMENT ACTIONS FOR QUALITY DEFICIENCIES
Authors: Gammonley Denise L , Wang Xiaochuan (Sharon) , Bender Felicia 
Published: November 2019

Abstract
States vary in their overall rates of nursing home deficiency citations as well as deficiencies for actual harm or jeopardy (Harrington et al., 2018). Civil Money Penalty (CMP) fines collected by the Centers for Medicare and Medicaid Services (CMS) are one enforcement action imposed to promote nursing home compliance with regulations. Collected CMP funds are redistributed to states for the sole purpose of improving nursing home resident care and quality of life through reinvestment in quality improvement projects. Using CASPER data available for US skilled nursing homes in 2015 and 2016 through the CMS QCOR database we examined the distribution of quality of care (QOC) and quality of life (QOL) deficiencies and CMP enforcement action across states. Guided by the systems framework for evaluating nursing home quality (Unruh & Wan, 2004) we further explored how contextual factors such as state spending for nursing home care, structural characteristics of facilities in states, and inadequate care processes indicated by deficiencies contribute to CMP enforcement actions and fines. Findings indicate that 27% of enforcement actions resulting in a CMP between 2015 and 2016 were imposed for a QOL deficiency while 61.7% represented QOC deficiencies. QOL deficiencies represented only 8% of the highest severity deficiency category but 81.7% of enforcement actions for QOC were for those causing immediate harm or jeopardy. QOC deficiencies are a focus of enforcement actions as they represent critical care processes influencing resident basic needs for hydration, ambulation, skin integrity and care for other special physical and behavioral needs.
DOES THE PATIENT HEALTH QUESTIONNAIRE MEASURE MOOD-RELATED QUALITY OF LIFE IN NURSING FACILITY RESIDENTS?
Authors: Ng Weiwen , Duan Yinfei , Shippee Tetyana P 
Published: November 2019

Abstract
The Patient Health Questionnaire-9 (PHQ-9) is a depressive symptom questionnaire administered to nursing facility (NF) residents in the Minimum Data Set (MDS). Does the PHQ-9 measure mood-related aspects of quality of life (QoL)? We assessed the PHQ-9’s convergent validity with negative and positive mood items from Minnesota’s QoL survey, which is administered annually to a random sample of residents. We also examined if scores on both instruments were associated with various psychiatric diagnoses on the MDS. Using item response theory (IRT) models, we estimated that depressive symptoms (PHQ-9) had a correlation of 0.546 with negative mood and -0.425 with positive mood. With explanatory IRT modeling, we estimated that diagnoses of anxiety, depression, and bipolar disorder were respectively associated with 0.261, 0.339, and 0.301 (all p &lt; 0.001) standard deviation increases in (SD) depressive symptoms, and with 0.235, 0.261, and 0.306 SD increases in negative mood (all p &lt; 0.001), thus indicating convergent validity. For positive mood, depression and bipolar disorder had associations of similar magnitude as the other two constructs. However, anxiety disorders were not associated with lower positive mood (-0.014 SD, p = 0.636). Thus, the PHQ-9 can measure mood-related aspects of QoL. However, the PHQ-9 appears to be sensitive to relatively serious depression, whereas the Minnesota items are more sensitive to lower levels of negative mood. Also, the PHQ-9 does not measure positive mood directly. Thus, the PHQ-9 is a more limited measure of mood-related QoL than the Minnesota items.
SERVICE ENVIRONMENTS AND PSYCHOLOGICAL WELL-BEING AMONG RESIDENTIAL CARE FACILITY AND NURSING HOME RESIDENTS
Authors: Choi Yeon Jin 
Published: November 2019

Abstract
One’s competence, or ability to cope, becomes lower as people age due to multiple factors, such as decreased physical and cognitive functioning, social isolation, and reduced income. Considering this change, providing appropriate services may help older adults to maintain their independence and improve their psychological well-being and quality of life. Therefore, this study aimed to investigate services that are positively associated with psychological well-being (i.e., mood, psychological health, self-efficacy) of older adults. For the analysis, observations were derived from the National Health and Aging Trends Study (NHATS), which includes a nationally representative sample of Medicare beneficiaries ages 65 and older. Service environments were assessed by (1) reflect availability and usage of 13 services (i.e., service unavailable, service available/ not being used, service available/ being used by residents) and (2) number of services available within three categories (i.e., help with ADL/IADL, transportation services, social and health-related services) Both having social events and activities available and participating in it were positively associated with older residents’ mood, while using housekeeping services and walking areas (e.g., outdoor walking path) were associated with better psychological health and self-efficacy. When models were estimated with service categories, having more social and/or health-related services available were associated with better psychological health and self-efficacy. Findings of this study suggests that social events and activities, housekeeping services, and areas to walk for pleasure or exercise would improve older residents’ psychological well-being. For Not only providing those services, residential facilities should encourage older residents to participation in or use the services.
WHEN LIFE DOESN'T GO AS PLANNED: UNMET EXPECTATIONS ABOUT RETIREMENT TIMING AND SUBSEQUENT DEPRESSIVE SYMPTOMS
Authors: Abrams Leah R , Mehta Neil 
Published: November 2019

Abstract
The 2008 Great Recession affected American’s retirement timing, but it remains unclear how unfulfilled expectations about retirement timing influence psychological well-being. This study examines how unmet expectations about working at age 62 relate to subsequent depressive symptoms, with special attention to sociodemographic differences in unmet expectations and their consequences. We use longitudinal data from 10,557 adults ages 51+ in the Health and Retirement Study (1994-2014). Mean expected probability of working full time at age 62 (ranging 0-100) was 40.5 (SD=54.65). We created quartiles: no chance (0 probability, 35% of sample), unlikely (1-30, 16%), unsure (33-80, 28%), and very likely (85-100, 21%). Expected probability and the association between expectations and reality were significantly lower for racial minorities compared to whites, low education compared to high, and pre-baby boomers compared to baby boomers. Those who were working at age 62 but expected to be retired did not experience elevated depressive symptoms compared to those who correctly expected to be working. In contrast, those who were unexpectedly not working experienced significantly higher depressive symptoms compared to those who correctly expected to be retired (Unsure: IRR=1.16 p=0.024, Very likely: IRR=1.19, p=0.010). This association was slightly attenuated after adjusting for declines in functioning, suggesting partial, but not complete, mediation by health status. The association was consistent by race, education, and birth cohort, but was larger in men than women. Taken together, our findings indicate that unexpected continued employment does not harm psychological well-being, but earlier than expected retirement may result in higher depressive symptoms.
OSTEOARTHRITIS AND DEPRESSION IN A MALE VA POPULATION
Authors: Burant Christopher J , Graham Gregory , Kresevic Denise M , Deimling Gary , Ibrahim Said , Kwoh Kent 
Published: November 2019

Abstract
Osteoarthritis (OA) is a leading cause of disability among older adults. By 2050, approximately 60 million will suffer from arthritis adding up to a total societal cost of $65 billion. Chronic illnesses resulting in pain, and functional decline have been associated with depression in previous studies. The primary goal of this study is to investigate whether OA severity, as measured by the Western Ontario McMasters Arthritis Composite (WOMAC), impacts reported levels of depression and to what degree clinical and sociodemographic variables play a part. A causal model was developed and tested examining the antecedents of OA disease severity and depression. Information on clinical, demographic, socioeconomic, and psychosocial variables was collected on 596 male Veterans with moderate to severe symptomatic OA of the knee\hip. A Confirmatory Factor Analysis was conducted to determine the factor structure of the WOMAC. A 2nd order three factor solution (pain, stiffness, and function) fit the data well (TLI of .94, a CFI of .94 and a RMSEA of .058). The results of the Structural Equation Model reveal a final model that fit the data well (TLI of .95, a CFI of .97 and a RMSEA of .047). Depression was predicted by higher WOMAC scores (beta=.37 , p&lt;.01); higher levels of comorbidity (beta= .11, p&lt;.05); younger age (beta= -.29, p&lt;.01); being white (beta=-.11, p&lt;.05); lower levels of income (beta= -.12, p&lt;.05); lower levels of religiosity (beta= 11, p&lt;.05). Clinicians should be aware of the impact of disease severity when treating OA patients with depression.
DIRECTIONALITY BETWEEN COGNITION AND DEPRESSIVE SYMPTOMS: A LONGITUDINAL CROSS-LAGGED PANEL ANALYSIS
Authors: Chan Randolph , Tang Jennifer Y M , Liu Tianyin , Wong Gloria H Y 
Published: November 2019

Abstract
Background and Objectives: The relationship between objective and subjective cognitive function and depressive symptoms is complex and potentially multidirectional. This longitudinal prospective study examined the directionality of their relationship among a community sample of older people with no known diagnosis or treatment for dementia or depression. Research Design and Methods: We examined the temporal relationship between objective cognitive functioning, subjective cognitive complaints, and depressive symptoms in 1,814 community-dwelling older people at baseline and one-year follow-up using regression and two-wave cross-lagged panel analyses, after controlling for demographic and health confounders. Results: Cross-lagged analysis showed that depressive symptoms at follow-up were directly predicted by baseline subjective cognitive complaints, but not baseline objective cognitive functioning. The effect differed across objective cognitive functioning levels. In people with clinically significant cognitive impairment at baseline, objective cognitive decline but not baseline subjective cognitive complaints predicted depressive symptoms. In people with mild objective cognitive impairment at baseline, baseline subjective complaints but not objective cognitive decline predicted depressive symptoms. Discussion and Implications: The effects of objective and subjective cognitive decline on depressive symptoms varied across older people with different levels of cognitive impairment. Awareness and insight of one’s cognitive status may contribute to the development/progression in depressive symptom in people with mild cognitive impairment. Mechanisms unrelated to appraisal may be involved in increased depressive symptoms among older persons with significant objective cognitive impairment.
DEPRESSION SEVERITY AND OBSTRUCTIVE SLEEP APNEA IN OLDER ADULTS
Authors: Boston Nicholas C , Bennett Ryan , Cirillo Nikolas , Solow Andrew , Fornalski Nicole , Stripling Ashely M 
Published: November 2019

Abstract
Objective: The connection between obstructive sleep apnea and depression in older adults is well documented; however, to date the relationship between severity of these depressive symptoms in this population remains under-explored. As such, the current analysis examined a potential relationship between varying levels of depression severity among older adults with sleep apnea. Participants and Methods: Data was derived from a de-identified database of older adults (age&gt;=65) from the National Alzheimer’s Coordinating Center (NACC). The sample (N=90; 50% female; 97.8% Caucasian; Mage=77 years; SDage=10.4 years) was sorted into three groups using the Neuropsychiatric Inventory Questionnaire (NPI-Q): 1) Mild Depression [n=56], 2) Moderate Depression [n=29], and 3) Severe Depression [n=5]. Results: A univariate analysis revealed an overall significant omnibus effect between sleep apnea and depression severity (F[2,4041])=16.231, p&lt;.001), while controlling for age, race, and sex. Post-hoc comparison found that those with severe depression had significantly higher levels of sleep apnea compared to those with mild (Mdif =-.499, p = .029) and moderate (Mdif =-.597, p = .009). Conclusions: These data support the possible association between depression severity and obstructive sleep apnea. Results may be attributable to two different theories: that low serotonin levels may simultaneously influence depression, respiratory muscle-tone, and sleep disturbance, and that intermittent hypoxia may create a cascade effect of neurovascular pathology resulting in depressive symptoms. Implications of the current findings suggest it may prove beneficial to keep in mind the risks associated with sleep apnea, and more severe depression, should an individual present with either.
CLINICAL FACTORS ASSOCIATED WITH INCREASED SEDENTARY TIME IN VERY ACTIVE OLDER ADULTS
Authors: Madden Kenneth , Chase Jocelyn 
Published: November 2019

Abstract
Sedentary behavior (such as sitting) has been shown to be an independent risk factor for increased frailty and less successive aging, even in active individuals. Our study examined the clinical factors most associated with higher sedentary times (ST) in very active older adults. We recruited 54 adults from a Master’s ski team (Whistler, British Columbia; mean age 71.5±0.6 years, 55% female). Activity levels were measured using an accelerometer (SenseWear) worn continuously for 7 days. ST was defined as a lack of activity when not in the supine position, in order to exclude time spent sleeping. Potential predictor variables consisted of metabolic syndrome criteria (blood pressure, high density lipoprotein, waist circumference, triglyceride levels, fasting blood glucose), age, biological sex and heart rate. Predictors associated with ST (p&lt;0.10) were entered into a stepwise multivariate regression model. Our subjects were extremely active, engaging in moderate to vigorous physical activity for 2.6±0.2 hours per day, greatly exceeding current activity guidelines. Despite these high activity levels, they were also sedentary for an average of 9.4±0.2 hours per day. Our final minimum effective model showed that waist circumference had a significant association with ST (Standardized β = 0.36±0.13, p=0.007), explaining 18% of the variation in ST. People are often subjectively unaware of how long they spend sedentary. Our study suggests, that in addition to promoting leisure time physical activity, physicians should also objectively measure ST in highly active older patients with high waist circumferences.
POOR PHYSICAL FUNCTION EXPLAINS INCREASED WRIST FRACTURE RISK IN COMMUNITY DWELLING OBESE ICELANDIC ADULTS
Authors: Ramel Alfons 
Published: November 2019

Abstract
Background: The associations between obesity, physical function, falls and fractures are unclear. Aim: The aim was to investigate whether obese adults have poorer sensory function, physical function as well as higher fracture risk than normal weight peers; and whether confounders explain potential differences between body mass index (BMI) categories. Methods: A case-control study was conducted using 98 wrist fracture cases (50-75 years) and 48 matched controls. Measurements included among others: anthropometrics, sensory function (Semmes-Weinstein-Monofilaments), physical function (Five-times-sit-to-stand test (FTSTS), questionnaires on previous fractures and fall history, the Activities-Specific-Balance-Confidence (ABC) and the Dizziness-Handicap-Inventory (DHI) scales. Results: Obese participants had lower physical function (FTSTS: +2.8sec,P&lt;0.001), lower tactile sensitivity (monofilaments:+3.4 g,P=0.013), poorer ABC score (14.0,P&lt;0.001), higher DHI score (11.6,P&lt;0.001) and experienced more falls the previous 12 months (+0.8,P=0.006) compared to normal weight subjects. According to crude logistic regression analysis, the hazard ratios for wrist fracture in overweight and obese subjects were 2.7 (P=0.012) and 5.6 (P=0.002), respectively. When FTSTS was included in the statistical model (HR:1.7,P=0.004), it reduced the hazard ratios of overweight and obesity close to 1. Lifetime fractures (HR:5.5,P&lt;0.001) and fall history (HR:4.3,P&lt;0.001) were associated with an increased fracture risk independently from the BMI categories. Conclusion: Obese individuals have poorer physical function, higher risk of falls and increased wrist fracture risk compared to normal weight peers. Lower physical function is the main driver for the increased risk in obese subjects. Lifetime fractures and fall history are associated with an fracture independently from obesity.
INERTIAL LOAD SPRINT TRAINING IMPROVES NEUROMUSCULAR POWER IN OLDER ADULTS
Authors: Allen Jakob R , Satiroglu Remzi , Vardarli Emre , Laico Anthony , Wolfe Anthony , Coyle Edward 
Published: November 2019

Abstract
PURPOSE: Maximal strength and neuromuscular power decline after the fourth decade of life. The physiological cause of this progression is partly a selective atrophy of Type II or “Fast-twitch” muscle fibers. The aim of this study was to determine the efficacy of a novel, time-efficient form of exercise training involving repeated sprints lasting 4 s on an inertial load cycle ergometer, to promote increased neuromuscular power in males and females aged 50-70y. METHODS: Three days a week, forty older adults performed 15, 20, and 30 sprints per day over weeks 1, 2-4 and 5-8 of the study respectively. Rest intervals were progressively reduced from 56s, 41s, and 26s over the same time periods. Subjects began each sprint while stationary and then were instructed to pedal as hard and as fast as possible for 4 s. Maximal power was reached after 1-4 s of sprinting and measured after a familiarization day (PRE), and then post-training (POST). RESULTS: The average increase in maximal power was 10.5±1.4% from PRE to POST (616±41 to 684±48 watts) (p&lt;0.01). CONCLUSION: Only ~2 min of cycle sprinting per training session was able to increase maximal neuromuscular power, an important physiological component of tasks of daily living throughout the lifespan.
LIFESTYLE PHYSICAL ACTIVITY IN OLDER WOMEN: ASSOCIATIONS OF CHANGE, SELF-EFFICACY, AND WELL-BEING
Authors: Lefler Leanne L , Lensing Shelly Y , Garner Kimberly K 
Published: November 2019

Abstract
Reduction of cardiovascular disease risk in undeserved populations, such as older women, is a top priority of the U.S. Our innovative trial tested a new approach to PA promotion for older women—motivational interviewing (MI), shifting the paradigm from structured exercise to self-selected activities. We present data comparing stage of change (SOC), self-efficacy for exercise (SEE), and well-being: 8 dimensions (physical, social, role limitations, emotional, general mental health, vitality, health perceptions and pain) and associations with physical activity outcomes in the Lifestyle Physical Activity for Women (LPAW) clinical trial. Methods: 106 women, &gt; 60 years old, who did not engage in regular PA, and were not frail, participated in a clinical trial of a tailored MI intervention to increase PA. We report baseline, 3 and 6 month repeated measures and PA associations with SOC, SEE, and well-being (SF36). Results: Of 106 women, 36% were Black and 63% White, with a mean age of 69. Significant improvement in SOC in both arms noted but the proportion in action/maintenance was significantly higher in the PA arm at 3 mos (78% vs. 55%, P=0.045) and 6 mos (79% vs. 50%, P= 0.019). A decrease in SEE for control (p=.001), but not for PA arm (p=.45); at 6 months, The PA arm had greater SEE compared to control. There were significant arm difference for physical component scores of SF36 (p=.02), but not for mental scores. Associations with PA will be tabulated. Conclusions: Preliminary results support the PA intervention, more data to be presented.
THE ROLE OF S100B IN AEROBIC TRAINING EFFICACY IN OLDER ADULTS WITH MILD VASCULAR COGNITIVE IMPAIRMENT
Authors: Crockett Rachel A , Barha Cindy , Hsiung Ging-Yuek Robin , Liu-Ambrose Teresa 
Published: November 2019

Abstract
Aerobic training improves cognitive and brain outcomes across different populations and neurocognitive disorders of aging, including mild subcortical ischemic vascular cognitive impairment (SIVCI). However, little is known of the underlying mechanisms through which aerobic training exerts its beneficial effects on the brain. Recently, S100 calcium-binding protein B (S100B) has been proposed as a possible mediator of aerobic training. At low levels, S100B is neurotrophic but at higher levels it is neurotoxic. Elevated levels of S100B have been associated with decreased performance on measures of global cognitive function. Thus, we conducted a secondary analysis of data collected from the proof-of-concept single-blind randomized controlled trial (NCT01027858) in older adults with mild SIVCI to determine whether the beneficial effects of 6-months, thrice weekly, moderate intensity aerobic training on cognitive performance is related to changes in S100B levels. In a subsample of 45 participants, blood samples were collected both before and after trial completion. Global cognitive function was assessed using Mini Mental State Examination (MMSE). At trial completion, aerobic training decreased circulating levels of S100B compared with usual care plus education (F(1,41) = 6.673, p = 0.013, ηp2 = 0.140; Figure 1). Furthermore, reduced S100B levels were associated with improved global cognitive function in those who received the aerobic exercise intervention (partial r = -0.519, p = 0.023). Together these findings suggest that S100B is a promising target mediating the beneficial effects of moderate-intensity aerobic training on brain health in older adults with mild SIVCI.