bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUPPORTING FAMILY CAREGIVERS: HOW DO CAREGIVERS OF OLDER ADULTS COPE WITH ROLE STRAIN? A QUALITATIVE STUDY
Authors: Rath Laura , Meyer Kylie , Avent Elizabeth S , Nash Paul , Benton Donna , Gassoumis Zach , Wilber Kathleen 
Published: November 2019

Abstract
Qualitative research on positive coping approaches actually used by caregivers can inform interventions that can be feasibly implemented. Absent from previous qualitative research is how caregivers respond to strain in the relationship, specifically. Eight focus groups were conducted with a purposeful sample of racially and ethnically diverse family caregivers in Los Angeles (n=75). An additional 8 in-depth follow-up interviews were conducted. Content analysis was used to understand the mechanisms employed by caregivers to cope with strain and tension in the caregiving relationship. Preliminary results revealed twenty-two individual themes, which were subsequently grouped into four main superordinate themes: 1) Self-care; 2) Adaptation of behaviors and feelings; 3) Seeking and utilizing assistance and respite; and 4) Education and support groups. This work can help inform the design of programs to support caregivers and prevent potentially harmful behaviors, through understanding the experiences of caregivers in their own words.
NONTRADITIONAL VIEWS? HOW SIBLINGS MATTER FOR PERCEIVED PARENTAL CARE RESPONSIBILITY IN JAPAN
Authors: Hirayama Ryo , Wakui Tomoko 
Published: November 2019

Abstract
Our aim in this study was to explore whether and how siblings’ marital and work status influence Japanese adult children’s perceived responsibility for parental care. Within traditional familial institutions in Japan, married sons were expected to assume parental care responsibility. At the same time, such care arrangements built on gendered division of labor; sons served as family breadwinners, and their wives cared for their parents-in-law while out of the paid labor force. Yet, because of sociodemographic shifts such as a greater percentage of unmarried persons and a growing number of women who seek to maintain their job, it has been increasingly unclear which adult children can and should assume the role of parental caregiver. Using online survey data from 989 Japanese adult children who were all employees with no parental care experiences ever, we sought to clarify the influences of siblings’ circumstances on whether these children anticipated assuming responsibility for conducting different care tasks for their parents. In doing so, we focused on how siblings’ gender and work and marital status might combine to affect adult children’s anticipation of parental care responsibility. A series of logistic regression analyses revealed that having a married brother made it less likely for adult daughters to anticipate assuming responsibility for conducting typical care tasks (e.g., ADL assistance) whereas for adult sons, having a single sister declined such anticipation. We discuss our findings in terms of how traditional familial institutions still impinge on Japanese adult children’s views of parental care responsibility.
ASSOCIATION BETWEEN ELDER ABUSE AND TELOMERE LENGTH IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: FANG Boye , Yan Elsie , Tung Keith , Chen Gengzhen 
Published: November 2019

Abstract
Objectives: Elder abuse is a stressful event that can lead to compromised psychological and physical health consequences. This study examines the association between elder abuse and telomere length (TL), a biomarker reflecting cellular aging and disease pathogenesis. Methods: Between 2015 and 2016, 1,002 older adults (aged≥55 years) with cognitive impairment were consecutively recruited from the geriatric and neurological departments of three Grade-A hospitals in Guangdong Province of People’s Republic of China. At two-year follow-up, 958 of these participants were reassessed and 600 of them were randomly selected for this study. The outcome variable is TL (measured in blood cells using a multiplex quantitative polymerase chain reaction) and the major independent variables were current experience of overall abuse, psychological abuse, physical abuse, caregiver neglect, and previous experience of domestic abuse in the past two years. Potential confounding variables include demographic variables and increased severity of cognitive impairment, neuropsychiatric symptoms, sleep disorders, and depressive symptoms. Results: Multivariate regression models show that current experience of overall domestic abuse (t= -5.116, β= -0.376, confidence interval[CI] -20.231–-9.006), psychological abuse (t= -4.431, β= -0.231, [CI] -13.023–-5.023), physical abuse (t= -2.474, β= -0.151, CI -14.116–-1.621), and caregiver neglect were associated with shorter TL (t= -4.470, β= -0.185, CI -10.457–-4.072). Other predictors of shorter TL were previous experience of domestic abuse and increased severity of depression. Discussion: Both current and previous experiences of elder abuse are associated with shorter TL. Multidisciplinary efforts were needed to prevent and intervene elder abuse.
NURSES’ OPINIONS AND BELIEFS ABOUT MALNUTRITION IN OLDER ADULTS: A CROSS-SECTIONAL STUDY
Authors: Cate Debbie Ten , Ettema Roelof , Schuurmans Marieke J , Schoonhoven Lisette 
Published: November 2019

Abstract
Malnutrition in older adults is a frequent and major problem. Despite the fact that nurses have an essential role in nutritional care, they fail to ensure appropriate delivery in preventing and treating malnutrition. For improvement, it is necessary to understand the perspective of nurses about malnutrition. The aim of this study was to gain insight into nurses’ opinions and beliefs about malnutrition in older adults. A cross-sectional study was conducted where nurses working in different health care settings were asked to fill in a survey with twelve questions regarding different aspects of malnutrition. Nurses (n = 557) frequently observe malnutrition in older care recipients, and they consider this as a serious health problem. They believe that prevention and treatment of malnutrition is important and they see screening of malnutrition as a relevant nursing activity. They also consider nutritional care as multidisciplinary. Nurses state their need for education to give adequate nutritional care. Nurses’ opinions and beliefs about malnutrition in older adults is positive, which enhances nurses’ behavior to give sufficient nutritional care to older adults. To gain more benefit in improving nursing activities within nutritional care for older adults, more education is needed targeting nurse professionals and nurse students.
THE SAFEST REVIEW: THE SHOCK-ABSORBING FLOORING EFFECTIVENESS SYSTEMATIC REVIEW IN CARE SETTINGS
Authors: Drahota Amy K , Keenan Bethany E , Lachance Chantelle , Felix Lambert , Raftery James P , Farrell-Savage Kirsten R , Mackey Dawn 
Published: November 2019

Abstract
Falls in hospitals and care homes are a major issue of international concern. Falls cost the US $34 billion a year, with injurious falls being particularly life-limiting and costly. Shock-absorbing flooring decreases the stiffness of the ground surface to reduce the impact of a fall. There is a growing body of evidence on flooring for fall-related injury prevention, however no systematic review exists to inform practice. We systematically reviewed the evidence on the clinical and cost-effectiveness of shock-absorbing flooring use for fall-related injury prevention in care settings. We searched six databases, clinical trial registries, conference proceedings, theses/dissertations, websites, reference lists, conducted forward citation searches, and liaised with experts in the field. We conducted study selection, data collection, and critical appraisal independently in duplicate. We evaluated the influence of shock-absorbing flooring on fall-related injuries, falls, and staff work-related injuries. We adopted a mixed methods approach considering evidence from randomised, non-randomised, economic, qualitative, and implementation studies. We assessed and reported the quality of outcomes using the GRADE approach and Summary of Findings Tables. This review, conducted over the course of 2019, summarises the certainty of the evidence on whether and which shock-absorbing floors influence injuries from falls, the chance of someone falling over, and work-related injuries in staff (e.g. from manoeuvring equipment across softer floors). Our findings are applicable to health and social care professionals, buildings and facilities managers, carers, older adults, architects, and designers. Funded by National Institute for Health Research, Health Technology Assessment (ref 17/148/11); registered in PROSPERO (CRD42019118834).
ASSISTED LIVING IMMUNIZATION PROJECT
Authors: Beck Maureen S 
Published: November 2019

Abstract
Influenza immunization rates in the United States hover around 60% for people 65 years of age and older. Healthy People 2020 set a target rate of 90% for flu immunization. The influenza vaccine can reduce disease and expense with approximately 7 million flu related diseases, 109,000 hospital admissions, and 8,000 deaths prevented. A local assisted living had an unusually low influenza immunization rate last year of 40%. The goal of the quality improvement project was to increase the rate of influenza immunizations in this facility. The rational was that by providing education, promoting the event, and increasing direct communication with families and residents through phone call and emails the rate would improve. A collaborative project was begun in the summer of 2018. Approval was received by IRB and the facility administrators. Plans were made for two presentations to family and residents, promotional advertisement, family communication, and a scheduled flu day with the pharmacy. The presentation provided flu history and facts and myths about the immunization. Correct answers were rewarded with bookmarks with flu information. The assisted living director provided follow-up immunization data. Compared to the previous year, the immunization rate increased to 90%, counting immunizations on flu shot day and records of outside immunizations. Data concerning flu incidence from the 2017-2018 and 2018-2019 seasons will be requested to determine project impact. A partnership between primary care providers and long term care facilities focused on improving standards or meeting metrics can enhance care for your patient and the community.
EXPLORING THE IMPACT OF RACE-ETHNICITY ON RESPONSE TO WEIGHT-LOSS TREATMENT: RESULTS FROM THE POWR-UP STUDY
Authors: Miller Marshall G , Germain Cassandra M , Starr Kathryn N Porter , Payne Martha E , Sloane Richard , Bales Connie W 
Published: November 2019

Abstract
Racial/ethnic differences in obesity prevalence and in responses to weight-loss treatment between Black and White women are well documented. Whether these differences influence responses to weight-loss treatment among older women is unknown. Therefore, we evaluated racial/ethnic differences among participants in a 6-month weight-loss study with traditional versus higher protein intake. Participants were obese (BMI ≥ 30 kg/m2) community-dwelling women, age 45 years or older, who self-identified as either Black or White. Change in body-weight, 6 minute walk test (6MWT), general health (SF-36), and satisfaction with life (SWL) were evaluated at 0, 4 and 6 months. Both racial groups reduced (ps &lt; 0.01) body weight at 4 and 6 months, with a trend toward more weight loss among White women (p = 0.07), relative to Black women. Other racial/ethnic differences included greater improvements in general health (p = 0.05) and 6MWT (p &lt; 0.05) for White versus Black women at 6 months; these differences persisted after adjusting for treatment group, age/education, and comorbidity. Although racial/ethnic differences in SWL were not observed, significant improvement was observed only among White women (p &lt; 0.01). Interestingly, weight loss was associated with improved 6MWT only among Black women (r = -0.66, p &lt; 0.05) and with general health only among White women (r = -0.44, p &lt; 0.05). Overall, White women experienced greater improvements in health and physical function as a result of weight-loss than did Black women. Further research is needed to identify equitable intervention strategies for the treatment of sarcopenic obesity.
WHAT CAN COUNTY-LEVEL EMERGENCY MEDICAL SERVICES DATA TEACH PUBLIC HEALTH ABOUT OLDER ADULT FALLS
Authors: Ham Carolyn R , deGrauw Xinyao , Dorsey Scott 
Published: November 2019

Abstract
Fall-related injuries in older adults contribute to an increasing number of deaths, hospitalizations and Emergency Medical Services (EMS) responses. In Snohomish County, the third largest county in Washington State, EMS agencies with electronic health records cover 96% of the county’s population. This EMS data contains unique information on falls, which can estimate costs and clarify intervention priorities. We analyzed 2018 data from EMS in Snohomish County. Fall incidents were summarized by count, frequency, and rate per 1,000 population. Costs for transferring patients to emergency departments (ED) were estimated using 2015 Snohomish Community Paramedic Analysis, and direct medical costs averted by implementing a single intervention were estimated based on prior research by Stevens and Lee (2018). There were total 38,910 incidents in older adults, of those 4,777 incidents were caused by falls (1606 in males and 2906 in females). The mean age (SD) was 81.0 (±8.9). The incidence rate was 45.6 per 1000 (55.8 in females and 30.6 in males). There were 573 repeated falls (12%). Most of the falls happened at home (54.85%), followed by assisted living and nursing homes (27.84%). 85.53% of the falls were transferred to ED, at an estimated cost of 3.15 million dollars. We calculated that one million dollars in medical cost could be averted by implementing home modifications delivered by an occupational therapist (OT). This research demonstrates the utility of EMS data for describing fall injury and determining interventions. Fall prevention programs should focus on preventing repeated falls and addressing home safety risks.
IMPLEMENTATION CHALLENGES AND OPPORTUNITIES IN A COMMUNITY-BASED TRANSITIONAL CARE SERVICES PROGRAM
Authors: Weaver Raven H , Bolkan Cory 
Published: November 2019

Abstract
High-risk older adults (i.e., low-income, chronically ill) often have complex, costly healthcare needs and are at risk of re-hospitalization. Hospitals traditionally lead efforts to reduce readmissions, while community-based aging services organizations (e.g., Area Agency on Aging AAA) offer older adults in-home health, social support, and information/referral to community resources. Thus, creating, sustaining, and scaling up hospital-community partnerships can better meet older adults’ comprehensive needs. We evaluated efforts of a hospital-AAA project to develop and implement a local transitional care services program (TCSP) that provided in-home/phone support post-discharge for high-needs older adults. Over a four-year period, 1,921 individuals (mean= 75 years; 57% women) were referred from hospital as eligible for TCSP. After referral, however, only 22.8% were successfully connected to community-based services and men were more likely than women to complete TCSP (Χ2= 6.92; p= .009). Of those referred, only 4% were re-hospitalized, indicating potential success of TCSP. Data revealed most were unable to be contacted (27.9%), refused the program (21.6%) or utilized alternative services, including SNFs (20.3%); inconsistent data collection and procedures yielded problematic missing data and inability to assess reasons for low engagement. We also surveyed and interviewed AAA staff (n=16) and found most staff exhibited high readiness for evidence-informed practices, supported proactive data use to improve planning, advocating, and serving clients, and identified significance of multidisciplinary community partnerships. Our findings generated recommendations to enhance staff engagement in TCSP, improve data collection for transforming data utility beyond enrollment purposes, and consider programmatic modifications to reach vulnerable elders.
ELDER CARE COMPLEXITIES AND OUTCOMES: A MANDATE FOR INTERDISCIPLINARY GERIATRIC CLINICAL ASSESSMENT
Authors: Reed Peter S , Gibb Zebbedia 
Published: November 2019

Abstract
Interdisciplinary geriatric assessment has long been considered best practice to identify the full range of elder care needs. In 2015, the Sanford Center for Aging launched an interdisciplinary comprehensive geriatric assessment clinic. This team-based assessment includes a geriatrician, social worker and pharmacist meeting together with each client to review all aspects of their health and well-being, resulting in a comprehensive care plan to coordinate care with the client’s primary care provider. To assess this approach, a survey was conducted with 415 randomly-selected clients prior to the clinical visit, with a 6-month follow-up survey completed for 170 clients (41%), gathering data on hospitalizations, long-term care utilization and quality of life. Combining these data with clinical assessment data provides a picture of clinical complexities of elder clients and offers a mandate for comprehensive interdisciplinary care. Baseline data showed 44% hospitalized in the prior year; an average of 4 chronic conditions and 10 medications; 44% with dementia or MCI and 29% with frailty. At 6-months post-assessment, 29% reported being hospitalized, 3.5% reported moving into long-term care, and there was a slight, non-significant decrease in quality of life. These data demonstrate the profound complexities that can be identified and addressed through comprehensive assessment and care, as well as the potential to reduce hospitalizations, enable people to age-in-place and maintain quality of life. Despite the well-documented value of these approaches, Medicare and other payers have not fully embraced the opportunity to achieve these positive outcomes and remain hesitant to adequately fund comprehensive approaches to care.
A LOGIC MODEL TO DESCRIBE ADULT PROTECTIVE SERVICES IN THE U.S
Authors: Gassoumis Zach , Urban Karl , Shusterman Gila , Eliason Stephanie Whittier 
Published: November 2019

Abstract
The adult protective services (APS) system in the U.S. serves as an investigative and service delivery system, targeting cases of reported abuse, neglect, and exploitation of older adults and adults with disabilities. APS developed from a piecemeal investigatory system, driven by state and local processes. This system has persisted, with little federal oversight or uniformity. In turn, little systematic information exists about the structure and process of the APS system nationwide. This poster presents an effort to construct a logic model for APS in the U.S., compiled jointly by researchers and practitioners under the auspices of the National APS Technical Assistance Resource Center. The process included initial drafting by six experts from various backgrounds and was reviewed by diverse stakeholders in three iterative rounds of review. Because of the unique nature of APS, the product has a partially non-traditional structure for a logic model, plotting context, inputs/resources, activities, activity metrics, and results. Inputs/resources are plotted across various sources: APS staff, consultative experts, community partners, operational supports, funding for services, and legal and ethical processes. Activities, activity metrics, and results are mapped across three stages of service provision—intake, investigation, and post-investigation services—and at the quality assurance level. The resultant logic model can be used at the national level to drive system change and evaluation; alternatively, it can be customized to specific state/local contexts to enable quality improvement and evaluation efforts. The pursuit of these efforts, coupled with existing national strategies, can contribute to continued system change and evolution within APS.
EXPLORING RELATIONSHIPS BETWEEN RELIGIOUS COPING AND GENERAL COPING STRATEGIES IN OLDER LONG-TERM CARE RESIDENTS
Authors: Andrew Nathaniel , Meeks Suzanne 
Published: November 2019

Abstract
Aging long-term care residents utilize a variety of coping strategies to manage stressors. While many older adults report religious faith is important in the coping process, it is unclear how religious coping appraisals and religious coping styles fit within a broader coping framework. This poster explores relationships between religious coping and general coping strategies in a convenience sample of older nursing home and assisted living residents (median age = 71.5). In this cross-sectional study, we interviewed residents (N = 102) from long-term care facilities (N = 11) in the Louisville metropolitan area and southern Indiana. Participants responded to questions about religious practices, religious coping, general coping, stress, life satisfaction, psychological distress, and health. The present analyses examined correlations between religious coping appraisals/styles and general coping strategies. We found: 1) small to moderate associations between theoretically adaptive religious coping appraisals/styles (e.g., positive appraisals, collaborative/deferring styles) and theoretically adaptive general coping strategies (e.g., positive reframing, instrumental support), and 2) small to moderate associations between theoretically maladaptive religious coping appraisals/styles (e.g., negative appraisals, self-directing styles) and theoretically maladaptive general coping strategies (e.g., denial, behavioral disengagement). Our results identify interesting conceptual relationships suggesting residents who report positive religious coping appraisals and less independent religious coping styles use adaptive coping strategies more frequently. These constructs may be explored in future research through examining their theoretical uniqueness and whether they independently account for variance in clinically-relevant outcomes. Further study of religious coping in these settings may help promote resilience and optimal aging for long-term care residents.
TECHNOLOGY REDUCES DISTRESS IN A GERIATRIC COHORT WITH DEPRESSION AND NEUROCOGNITIVE IMPAIRMENTS
Authors: Mazzone James A , Sills Jonathan , Ma Flora , Louras Peter , Alexander Erickson 
Published: November 2019

Abstract
Many older adult Veterans with Depression and superimposed Neurocognitive Impairments may demonstrate behavioral agitation. To buffer patient agitation seen within a Veteran’s Affairs residential extended care facility, psychological services were expanded to include the use of mobile technologies. To evaluate the effectiveness of adding technology supported psychological services, outcomes were gathered as part of continuous process improvement efforts. 28 Veterans with Depression and NCI who received technology enhanced services were rated by staff on observed agitation behaviors prior and following clinical encounters. In addition, a subset of 17 Veterans also provided subjective unit of distress (SUD’s) ratings based on the Brief Interview for Mental Status inclusion criteria. Paired sample T-Tests were completed to assess if technology-enhanced interventions resulted in average reductions of clinician rated observations of Veteran agitation behaviors. Significant differences were found in observations of Veteran facial tension (t(27)=3.722, p=.001), agitated body movement (t(14)=2.020, p=.053), and threatening posture (t(27)=2.243, p=.044). Evaluation of a subset of those residents who also provided SUD’s ratings show a significant change in self-reported distress after intervention (t(16)=4.3, p=.001). Effect size for this difference was large (d=1.042). These results suggest that mobile technologies can help reduce agitation and Veteran self-reported distress among older Veterans with Depression and superimposed Neurocognitive Impairments.