bluuebunny/crossref_metadata_2025_split huggingface dataset:
CREATIVE STORIES FROM A MEMORY CARE COMMUNITY: VALUES, NORMS, IDENTITIES, AND EXPERIENCES
Authors: Chee Kyong Hee , Gerhart Olga , Kim Seoyoun , Caldwell Sara 
Published: November 2019

Abstract
As an arts-based, creative storytelling program for persons living with Alzheimer’s Disease and related dementias (ADRD), TimeSlips involves a facilitator showing a picture to participants, who then exercise their imagination to create a story. The program has shown to benefit participants’ well-being, possibly because of the opportunity to express themselves. Although they may reflect participants’ values and identities, the content of such stories had not been the focus of investigation. The aim of this study is, therefore, to identify major themes of such stories through a qualitative content analysis. We implemented a creative storytelling program at Silverado Onion Creek Memory Care Community (currently, The Auberge) in Austin, and offered 6 weekly sessions with 4 small groups of residents. A total of 26 residents participated in the study, creating 24 collective stories in total. Three researchers first open-coded these stories and then met to reach consensus concerning the themes that emerged. Ten themes were identified: family values, generativity, religious reference, reference to love, reference to home, cultural norms, uncertainty and worries, positivity, negativity, and dissonance and disagreements. The first 6 themes represent the values, beliefs, and norms of the participants, with the remaining 4 reflecting their personal identities, personalities, and experiences. The findings suggest that they continue to value families and religion, care about others, and make judgements about people, things, and circumstances that they face. Researchers, practitioners, and care partners can benefit from “listening to” creative storytellers more closely to learn about their opinions, expectations, and preferences.
USABILITY OF AN ONLINE DISCUSSION PLATFORM: DEVELOPMENT OF A CODING SCHEME
Authors: Han Soojeong , Teng Andrew , Lin Shih-Yin , Chu Frances , Demiris George , Zaslavsky Oleg , Chen Annie T 
Published: November 2019

Abstract
Online discussion platforms have the potential to support or even improve older adults’ well-being. Nonetheless, potential health benefits are often shaped by the usability of such platforms. Improving usability is imperative to maximize these potential benefits. As a part of a qualitative analysis of a study of an online community for older adults with frailty symptoms, we developed and refined a coding scheme targeting usability. The scheme was derived by reviewing contemporary literature on user experience, usability, and health information technology in older adults. Our review revealed challenges to apply commonly used terms to summarize our qualitative data. For example, the concept of perceived usability has different meanings and definitions in existing frameworks as they pertain to user engagement and technology adoption (specifically, the Technology Acceptance Model) than usability in an online discussion context for older adults. Because none of the meanings of usability fully encompassed the breadth of this concept for older users, we developed a coding scheme that is practical and captures a broad range of older adults’ perceptions of usability. Through qualitative analysis of the online discussion content using the newly developed coding scheme, new themes emerged such as confusing layout (e.g., difficulty in locating discussion boxes), insufficient instruction or training (trouble posting discussions), unwanted results (e.g., pressed a wrong key), and memory issues and cognitive burden. This presentation describes the process of developing a coding scheme, illustrates nuances of meanings in concepts related to usability, and presents preliminary results of our qualitative analysis.
DEMENTED OLDER ADULT’S SALIVARY CORTISOL LEVELS AND PHYSICAL STRESS INDEX AS STRESS INDICATOR
Authors: Kwon Eunji , Cho Eunhee 
Published: November 2019

Abstract
Demented older adults experience many internal and external stress inducers that are thought to be a source of behavioral and psychological symptoms of dementia(BPSD). The purpose of this study was to compare the stress index among older adults through salivary cortisol levels and physical stress index. This study was cross-sectional design, including 139 participants who recruited until May of this year(104 demented older adults who visited hospital outpatient neurology and 35 non-demented older adults as control group). The physical stress index was measured by heart rate variability and salivary cortisol levels(4 samples/day, 1 days). Salivary cortisol levels were measured at four times after wake up, after breakfast, before dinner and after dinner. The data were analyzed using independent t-test and generalized estimating equations. In salivary cortisol levels measured after wake up, the demented older adults reported about 1.5 times higher than non-demented older adults(p=.042). And the salivary cortisol levels measured after breakfast were about 2.3 times higher in the demented older adults than in control groups(p=.002). Accordingly, the results can be concluded that demented older adults have higher stress levels than control groups in the morning. Also the physical stress index through heart rate variability(HRV) in the demented older adults(6.30±0.65) had higher than control groups(6.00±0.55, t=2.45, p=.016). There are significant differences in salivary cortisol levels and physical stress index between demented older adults and control groups. As stress inducers affects BPSD for the demented older adults, nursing intervention should be tailored to proper way based on their stress inducers.
THE EFFICACY OF CASE-BASED INSTRUCTION ON STUDENT ATTITUDES TOWARDS PAIN AND OPIOID RISK ASSESSMENT IN OLDER ADULTS
Authors: Aggarwal Aarushi , Sanchez-Reilly Sandra , Mader Michael J , Ross Jeanette 
Published: November 2019

Abstract
A survey of US medical schools found that only 10-12 hours of the 4 year curriculum are dedicated to instruction in pain management in older adults. Since chronic pain afflicts 100 million Americans, and older adults have a higher risk of prescription medication misuse, there is urgency regarding proper education.This study evaluates the success of case-based instruction on the topics of pain management and opioid risk assessment, with a goal of increasing instructional hours in a format other than didactic. 200 fourth-year medical students were split into groups of 20, with 2 instructors in each room. A survey was administered pre/post workshop asking participants to rate 10 statements using a Likert scale. The 2 hour workshop involved case studies to work through while using a created pain instructional card.The case-based instruction format demonstrated high efficacy in shaping the beliefs and personal evaluations of medical students. Prior to the workshop, only 34% of students were positive about their pain assessment abilities. 9.5% were positive about their opioid conversion skills, and only 4% were positive about opioid risk assessment skills. After the workshop, these positive evaluations increased to 97%, 95%, and 92% respectively. The McNemar test proved these findings to be statistically significant (p&lt;.0001). Case-based instruction with small-group discussion is a reliable tool in teaching medical trainees about pain management and opioid risk assessment in adults aged 65 and older. This workshop needs to be run with geriatric/palliative care residents to evaluate clinical incorporation of session concepts through resident charting.
FACILITY AND RESIDENT LEVEL DIFFERENCES: ANTIBIOTIC USE IN NURSING HOMES FOR RESIDENTS WITH ADVANCE DEMENTIA
Authors: Hendricksen Meghan , Habtemariam Daniel , Mitchell Susan 
Published: November 2019

Abstract
Previous studies have shown that there is a high frequency of antibiotic use in NH for advance dementia patients. However, research has shown limited clinical benefit from antimicrobial use for this population, and antimicrobial exposure increases colonization with drug-resistant bacteria in nursing homes. The aim of this study was to identify NH and resident level characteristics associated with antibiotic use for patients with advance dementia. Using data from an ongoing cluster RCT in 28 Boston NHs; Trial to Reduce Antimicrobial use in Nursing home residents with Alzheimer’s disease and other Dementias (TRAIN-AD), testing a program intervention to improve management of infections in advanced dementia. These data are taken from baseline measurements 2 months prior to intervention, and individual nursing home residents with advance dementia are units of analysis (n = 425). We ran multivariable logistic regression model with antibiotic use as the outcome, adjusting for clustering at NH level, with NH (#beds, profit status, staffing, #cognitively impaired, etc.) and individual patient characteristics (age, gender, race, etc.) as independent variables. Analyses found residents were more likely to receive antibiotics if they resided in nursing homes that employed less intense infectious disease practices prior to baseline (AOR = 2.34; 95% CI 1.08, 5.05), and full-time nurse practitioners or physician assistants (AOR= 3.68; 95%CI 1.49, 9.04). Female patients also had higher odds of receiving antibiotics (AOR=2.16; 95%CI1.10, 4.67). These findings provide potential insight into the importance of education regarding stringent infectious disease practices for practitioners, particularly for patients with advanced dementia.
DISCUSSING SPIRITUAL HEALTH IN PRIMARY CARE IN ENGLAND
Authors: Whitehead Ishbel Orla 
Published: November 2019

Abstract
The organisation that regulates doctors and family physicians’ professional body in the UK both require doctors to consider patients’ spiritual health, especially towards the end of life. Discussion of spiritual health can encapsulate positive aspects of patients’ lives, and may be valuable for older people as physical and mental health decline. Tools are available for doctors to structure discussion of spiritual health in consultations but anecdotal reports suggest that this seldom happens. This study aimed to understand the barriers to GPs discussing spiritual health and their knowledge and views of current tools, particularly the HOPE tool by Anandarajah and Hight. Narrative literature review using systematic methods and mixed methods investigation into current practice, An online survey was conducted with 177 family physicians in England, investigating how doctors define spiritual health, their comfort with the topic, and their knowledge and acceptability of the HOPE tool, using patient vignettes. Definitions of spiritual health were heterogeneous, within three themes: self-actualisation and meaning; transcendence and relationships beyond self; and expressions of spirituality. Doctors felt more comfortable discussing spiritual health after a patient-led cue. Introduction of the HOPE tool increased doctors’ comfort with the topic. Discordance between doctor and patient beliefs and cultural backgrounds influenced views and practice. Concerns about regulator disapproval was a major barrier to discussions. Spiritual health does not appear to be a routine part of family practice in the UK. Tailored education, containing a structured tool such as HOPE, with regulatory approval, may help overcome barriers to discussion of spiritual health.
BARRIERS AND SOLUTIONS TO IMPROVE AGE-RELATED SERVICE ACCESS IN UTAH: A QUALITATIVE STUDY
Authors: Schiwal Alex T , Fauth Elizabeth B 
Published: November 2019

Abstract
Utah is projected to be in the top 10 states for growth in the aging population, but it is among the most rural. Local and regional contexts guide policy and practice, and these perspectives will inform solutions as more older adults require services in rural and other under-served areas in the coming decades. Guided by Bronfenbrenner’s Process-Person-Context-Time model, this study used a qualitative participatory research orientation involving stakeholders in Utah’s aging service system in order to identify local barriers and solutions to accessing rural aging services. The stakeholders included service providers, caregivers, older adults, state-administrators, and other community members. There were 3 male and 7 female participants ranging in age from 40 to 80. Thematic analysis revealed that communities faced barriers common to rural areas (local service insufficiencies, distance and time concerns, systemic issues such as healthcare and ageism, finances - both personal and programmatic were deemed a recurrent barrier, in addition to transportation issues. However, participants reported assets in rural areas, such as a strong sense of belonging in the community and creative problem solving. Solutions for improving access to age-related services included strategies for making information more available, publicized, and centralized and increasing access to telehealth or internet-delivered services and health information. These barriers and solutions were nested across the levels of context in Bronfenbrenner’s model, with both person, time, and in interactions (processes) having influence, but localized analysis of the barriers is necessary to ensure that the solutions are appropriate in a specific context.
USING SPATIAL ANALYSIS TO OPTIMIZE DISASTER PREPAREDNESS FOR FRAIL OLDER ADULTS
Authors: Bond Megan , Tice Jessica L 
Published: November 2019

Abstract
The Florida Department of Elder Affairs (DOEA) provides programs and services for over 65,300 older people and adults with disabilities. These individuals are uniquely vulnerable and may be disrupted, displaced, and disoriented during the natural disasters common to Florida. DOEA clients are homebound or dependent upon community-based services to provide supervision or direct assistance to perform basic self-care. Often, clients are unable to complete personal care independently, which makes sheltering in place a unique challenge, yet they can only evacuate with special transportation and support arrangements in the shelter. It is critical to DOEA to accurately predict clients likely to be seriously affected by storms, plan for relocation before an event, and arrange for the provision of extended care after. DOEA responded by utilizing ArcGIS mapping software to join client residence locations to evacuation zone polygons and developed a methodology to prioritize clients with personal and functional barriers to evacuation. Proven during Hurricane Michael (2018), local emergency managers were able to use this tool to complete wellness checks on survivors before outside aid arrived. This initiative is evolving with the challenges posed by each storm season. Hurricane Dorian (2019) required the addition of latitude and longitude of client locations for when traditional street navigation became unavailable. Importing and overlaying primary data on secondary emergency management resources is a strategy that could be replicated by other organizations that have similar needs to reconcile individual locations in context of local threats, making this methodology transferrable to other disaster and flood-prone communities.
THE ASSOCIATION BETWEEN D3CR MUSCLE MASS AND MORTALITY IN COMMUNITY-DWELLING OLDER MEN
Authors: Cawthon Peggy M , Blackwell Terri , Cummings Steven R , Orwoll Eric S , Duchowny Kate A , Ensrud Kristine E , Cauley Jane A , Evans William J 
Published: November 2019

Abstract
We have shown that men with low muscle mass assessed by D3Cr (deuterated creatine) dilution are more likely to have worse physical performance and incident fractures, injurious falls and disability. However, the relation between D3Cr muscle mass and mortality is unknown. With data from Year 14 Visit of the MrOS study (N=1400, mean age 84.2 yrs), proportional hazards models estimated the risk of mortality (hazard ratio and 95% CI) by quartiles of D3Cr muscle mass (standardized to body mass); we calculated p for trend across quartiles. Models were adjusted for age, race, clinical center, alcohol use, smoking status, comorbidities, activity, percent fat, exhaustion, and cognitive function. Cause of death was centrally adjudicated. Over 3.3±0.8 years of follow-up, 197 (14.1%) men died. Men in the lowest quartile of D3Cr muscle mass/wgt were 2.8-fold more likely to die than men in the highest quartile (HR: 2.8, 95% CI: 1.6, 4.9; p for trend&lt;.001). The HRs for each cause-specific mortality outcome were of similar magnitude to the HR for overall mortality: cancer death (HR, Q1 vs Q4: 2.2, 95% CI: 0.7, 7.1; p trend =0.140); CVD death (HR, Q1 vs Q4: 3.7, 95% CI: 1.3, 10.5; p trend =0.008); or non-cancer non-CVD death (HR, Q1 vs Q4: 2.4, 95% CI: 1.0, 5.6; p trend=0.019). We conclude that low muscle mass assessed by D3Cr dilution is a strong risk factor for mortality in older men, providing additional evidence that low muscle mass is an important risk factor for adverse health outcomes.
ASSOCIATION BETWEEN GAIT SPEED MEASURED USING A WEARABLE DEVICE AND SARCOPENIA
Authors: Kang Min-gu , Kim Kwang-il , Kang Joon Koo , Kang Seong-Ji , Roh Hye-Kang , Jung Hwa-Young 
Published: November 2019

Abstract
As slow gait speed is a major feature of frailty and a diagnostic criterion of sarcopenia, gait speed measurement is widely used. Nowadays, with development of wearable devices, it is possible to measure daily-life gait speed without additional effort just by wearing the device. It is meaningful to measure daily-life gait speed and to analyze the association between the speed and sarcopenia. Participants were men over 50 years of age who visited the university hospital. Daily-life gait speed was checked using a smart belt (WELT) for 4 weeks. Afterwards, a survey about past medical history, usual gait speed measurement, handgrip strength measurement, and dual energy X-ray absorptiometry were performed. A total of 217,548 daily-life gait speed measurement data were analyzed for 106 participants. The mean daily-life gait speed was 1.23 ± 0.26 m/s. The mean age was 71.1 ± 7.6, and daily-life gait speed was significantly slower as people get older. (P&lt;0.001) Additionally, weekday gait speed (1.23 ± 0.26 m/s) was significantly faster than weekend gait speed (1.22 ± 0.26 m/s). (P&lt;0.001) Participants with sarcopenia (1.15 ± 0.25 m/s) had significantly slower mean daily-life gait speed than normal subjects (1.23 ± 0.26 m/s). (P&lt;0.001) In analyzing factors related to gait speed, age and skeletal muscle mass of lower limbs were significantly associated with mean daily-life gait speed. Additional information about the gait speed can be obtained by measuring daily-life gait speed, and the daily-life gait speed has a significant association with the skeletal muscle mass of lower limbs.
COMBATTING LONELINESS: SERVICE USE AMONG RURAL FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Hoyt Emily K , Roberto Karen A , Savla Jyoti 
Published: November 2019

Abstract
According to a 2018 AARP study, 42% of unpaid caregivers experience loneliness. While findings across multiple studies suggest that caregivers experience loneliness either because they lack intimacy in close relationships (i.e., emotional loneliness) or they feel disconnected from their social network (i.e., social loneliness), little is known about how aspects of dementia caregiving influence loneliness, particularly among rural caregivers. The purpose of this study was to examine the association between in-home service use and caregivers experience with both types of loneliness. Eighty-eight co-residing dementia caregivers in rural Appalachia (Mean Age = 68 years; 91% White; 58% Spouses) completed telephone interviews that included questions about their use of formal services and perceptions of emotional and social loneliness. More than half (58%) of the caregivers accessed 1 to 4 formal services. Regression models revealed that caregivers who experienced greater social loneliness were more likely to access personal care services (p=0.013) and respite services (p=0.004) compared to caregivers who experienced less social loneliness. Further, caregivers who experienced greater emotional loneliness were also more likely to access personal care (p=0.028) and respite (p=0.039) services compared to caregivers who experienced lower emotional loneliness. These associations remained robust even after controlling for relationship to the PwD (spouse vs. non-spouse). Findings suggest that beyond assisting with the care of the PwD, the use of formal services may help family caregivers manage loneliness and relieve social isolation. Discussion will focus on the importance of service accessibility and use for the health and psychological well-being of rural family caregivers.
COGNITIVE AND SUBJECTIVE EFFECTS OF OXYCODONE IN OLDER ADULTS WITH HEALTHY AND UNHEALTHY ALCOHOL PATTERNS
Authors: Cherrier Monique , Terman Gregory , Shen Danny , Shireman Laura , Saxon Andrew , Simpson Tracy , Kooner Preetma , Wicklander Katie 
Published: November 2019

Abstract
Chronic unhealthy levels of alcohol use, may predispose adults to use illicit substances and/or modify their response to prescribed medications, such as pain medications. We examined the cognitive and side effect response of older adults who met criteria for healthy and unhealthy alcohol drinking patterns after exposure to 10mg of oxycodone. Using a human laboratory model, eligible participants were characterized on cognitive, side effect measures and cold-pressor pain test (CPT) at baseline and repeated 90 minutes, 3 and 5 hours post dosing (10mg oxycodone). Blood samples were taken at regular intervals to measure drug levels. One-hundred twenty-five adults completed the study day, eighty participants with heavy alcohol consumption and 45 with healthy. Middle age (MA) group had a mean age of 51 (11.2) years, older adults (OA) 72 (4.2) years. Between group (unhealthy vs healthy drinkers, middle age vs older adult) comparisons for cognitive performance indicate a significant decline at 90 min. However, MA and OA heavy alcohol consumers evidenced less decline on sustained attention (D2) and working memory, but more decline on a measure of balance (berg). Anti-nocioceptive effects were greatest in healthy (MA,OA) in comparison to heavy, however there were no differences on pupil miosis. Subjective rating of side effects were rated more severe in the OA unhealthy group compared to MA and healthy. These findings indicate unhealthy alcohol consumption attenuates the impact of opioid medication. Results indicate that alcohol consumption patterns should be considered when using opioids in older and middle age adults.