bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adapting to Health Change: Aging Bias, Sensitivity, and Interprofessionalism in an Aging Sensitivity Training
Authors: Kleszynski Keith , Jennings Lee , Teasdale Thomas , Ciro Carrie , Rogers Carol , Peterson Tina , Swanson Keith , Kay Beavers 
Published: December 2020

Abstract
Adapting to Health Change, a 2-hour aging sensitivity simulation to increase student sensitivity to age-related changes, was delivered to 148 health professions students in March 2020. Five small group stations (hearing loss, neuropathy and dexterity, vision loss and medication management, language and cognitive impairment, and mobility and balance) were facilitated by older adult volunteers and interdisciplinary faculty. Students completed (pre-post) Aging IQ Quiz, Aging Attitudes Assessment, Inter-professional Attitudes Scale (IPAS) Teamwork, Roles, and Responsibilities and Interprofessional Biases subscales, and an overall satisfaction rating. There was a statistically significant but small change in perceived knowledge of aging (mean Aging IQ score changed -0.025 points, p = 0.03). We also found a post-training increase in negative bias (mean Aging Attitudes Assessment score changed +2.68 points, p = 0.0001). While there was no change in attitudes about interprofessional education, this wasattributed to high baseline scores, suggesting students already valued interprofessional interactions. Multiple high satisfaction scores were encouraging. Ninety-four percent agreed that the simulation increased their understanding of age-related changes, while 97% indicated facilitators provided useful insights into the experiences of aging. A high majority (89%) felt they would be better health care providers for older patients than they would have been without the experience. This exercise to increase student empathy about age-related disabilities was well received, but did not achieve the usual intended aims. Simulation content should “re-aim” beyond empathy to teach new knowledge, highlight positive aspects of aging and professional care provision, and reinforce interprofessional roles toward wellness for older adults.
The Age-Dependent Relationship Between Vascular Risk Factors and Trajectories of Depressed Mood
Authors: Blöchl Maria , Schaare Lina , Kunzmann Ute , Nestler Steffen 
Published: December 2020

Abstract
Cardiovascular risk factors (CVRFs) have been linked to depression, but it is still unclear whether this association becomes stronger or weaker from mid- to later life. Thus, our main aim was to investigate the influence of age on the associations between CRVFs and trajectories of depressed mood. Our sample included 6835 individuals (aged 52–89 years) from the English Longitudinal Study of Ageing (ELSA), who were free of manifest vascular disease at baseline and had bi-yearly measurements of depressed mood over ten years. A composite score incorporated the presence of five CVRFs: hypertension, diabetes, smoking, obesity, and hypercholesterolemia. We used second-order latent growth models to examine the effect of CVRFs, age, and their interaction on levels and changes in depressed mood over time. Our results revealed that baseline CVRFs were associated with higher levels of depressed mood. This association decreased with age and was stronger in midlife compared to later life. CVRFs were not related to changes in depressed mood, indicating that these differences remained stable over time. These findings suggest that CVRFs in midlife, but less so in older age, predict stable differences in depressed mood. They are consistent with reports on the importance of CVRFs in midlife and may support the idea that prevention of vascular burden in this age period may be critical to maintain mental health.
The Use of Tag Questions in Person-centered Communication
Authors: Basque Shalane , Savundranayagam Marie , Kimura Maren , Williams Kristine 
Published: December 2020

Abstract
Tag questions are imperative, declarative, exclamative or interrogative statements that have been modified to include a question (e.g.., It is hot out, isn’t it?). Tag questions have been characterized as elderspeak because it suggests an expected response from the person with dementia, thus limiting his/her ability to make a decision independently. However, tag questions serve multiple functions in conversation. There is limited research on the multidimensional nature of tag questions in conversations between formal caregivers and their clients with dementia. Accordingly, the purpose of this study was to investigate the functions of tag questions used by formal caregivers in utterances coded as person-centered. Conversations (N= 87) between formal caregivers and a simulated person with dementia were video-recorded during a 5-minute care interaction involving morning care. Caregivers’ utterances were coded for the use of the following types of person-centered communication: recognition, negotiation, facilitation, and validation. During secondary data analysis, the person-centered utterances were analyzed for the use and function of tag questions. Conversational analyses revealed two broad functions of tag questions: gather information and facilitate a desired action. Tag questions used to gather information included the following specific functions: acknowledge response, establish common ground, state fact or opinion, initiate topic, conversational joking, state what is being done and questions. Tag questions that facilitated a desired reaction included the following specific functions: offers, advice and suggestions and requests and commands. Findings from the current study reveal that tag questions are not exclusively elderspeak and can be used to illicit conversation.
Inpatient Diagnosis of Delirium and Encephalopathy: Coding Trends in 2011-2018
Authors: Franks Jeffrey , Anderson Jami , Kennedy Richard , Yun Huifeng 
Published: December 2020

Abstract
Physicians have long debated the diagnosis of acute confusional states as delirium or encephalopathy, often based on specialty. Recently, CMS assigned a lower severity to the nonspecific behavioral diagnosis of delirium than for the pathophysiological diagnosis of encephalopathy, potentially exacerbating these disagreements. Therefore, we sought to evaluate trends in these two diagnoses among hospitalized adults. Using 2011-2018 IBM MarketScan datasets, we identified delirium/encephalopathy patients who were ≥ 18 years and enrolled with medical and pharmacy coverage for each calendar year. Delirium/encephalopathy were defined using validated ICD-9/10 codes among hospitalized patients. We identified the physician specialties associated with the hospitalization and comorbidities using ICD9/10 inpatient/outpatient diagnosis codes within one year prior to the diagnosis of delirium or encephalopathy. Log-binomial models were used to evaluate the trends adjusting for age, gender, insurance and comorbidities. We identified 10,418 delirium and 87,393 encephalopathy hospitalized patients in 2011-2018. Of these patients, the total number of patients with either diagnosis increased, but the proportion of patients with delirium for each year decreased from 20% in 2011 to 9% in 2018. During the 8 years, neurologists and internists increased their use of both diagnoses, whereas psychiatrists only increased for delirium. Patients with encephalopathy are more likely to be older, female, and have more comorbidities. These shifts in diagnosis complicate the study of delirium and encephalopathy, and can lead to erroneous conclusions about trends in the incidence and prevalence of these disorders unless properly understood.
Local Initiatives to Fund Services for Elders: Increased Community Recognition of the Importance of Social Care
Authors: Koumoutzis Athena , Stemen Sara , Maharjan Renusha , Heston-Mullins Jennifer , Mayberry Pamela , Applebaum Robert 
Published: December 2020

Abstract
Despite the growing number of older adults in the U.S., federal and state funding for non-medical supportive services remains limited. Recent work reports that states with a more generous supply of supportive services, including home delivered meals and personal care, have fewer low care residents in nursing homes. To boost this supply, some local communities across the nation are exploring alternative funding sources. Our review found 400 local communities across 15 states using voter-approved local revenue streams to fund aging services, such as property tax levies and payroll and sales taxes, and that this strategy has been politically popular. In this paper we provide results from the first national survey of these local communities. Study results found considerable variation by state in number and scope of local initiatives, with Ohio and Michigan each reporting about 70 communities with local property tax levies, while California and Washington had only one community each using this approach. Local programs ranged in size from generating less than $25,000 in annual revenue to more than $35 million. The organizational structure for these programs, and the administrative approaches, such as the use of care managers, varied by state and community. Programs provided an array of services, but typically included traditional social care services such as home delivered meals, homemaker/personal care, transportation, and home emergency response systems. Criteria for program participation also varied, but most were targeted to serve older adults with disability who did not meet Medicaid financial or functional eligibility criteria.
Social Assistive Robots for Assisting Activity Professionals
Authors: Zamer Jason , Adams Anne , Beer Jenay , Wu Xian , Komsky Jane 
Published: December 2020

Abstract
Activity Professionals have high expectations for creating engaging and active resident social programming. A socially assistive robot (SAR) specifically designed for community-based settings has the potential to improve social programming. A SAR is suitable for engagement during times with social contact is restricted, such as COVID-19, other infectious outbreaks, weak immune system, or inability to move. We conducted an online survey to determine how a SAR can best support the responsibilities of Activity Professionals. Activity Professionals (N=19) completed the online questionnaire. Respondents (aged M=48.00, SD=12.87; 95% female, 100% native English speakers, 68% White/Caucasian, 21% Black/African American) were highly educated/experienced: 68% had a Bachelor’s degree or above, and 53% had 10-35 years of experience. Respondents worked in Independent Living (68%), Assisted Living (37%), Memory Care (26%), Skilled Nursing (21%), or Personal Care (11%). Respondents rated their job as very demanding (8 out of 10). Differences existed in terms of physical and temporal demands. Job satisfaction was high (average 8 out of 10; SD= 2). Respondents reported enjoyment in preparing, personalizing, and running activities. Least preferred was gathering residents for activities. Respondents wanted more help, but it depended on the task. Qualitative data analysis showed that help was desired for motivating residents to join activities, group communication, and resident devices. A SAR, equipped with the ability to reach every resident’s living quarter, has the potential to provide group communication, deliver engagement programs, and motivate residents to join events, providing Activity Professionals more time to engage with residents for more personal interaction.
A Novel Survey Platform in the Age of COVID-19 to Increase Accuracy and Adoptability While Reducing Selection Bias
Authors: Mendhe Dinesh , Bergren Stephanie , Dong XinQi 
Published: December 2020

Abstract
Given the ongoing COVID-19 pandemic, secure and distanced data collection platforms are critical for reaching vulnerable populations. Commonly used electronic data collection systems lack a myriad of critical features, including a modern technology stack, new data encryption and security standards, study workflows, and reporting algorithms. Moreover, these systems do not have multilingual mapping functionalities of survey and consent forms. All of these components ultimately increase selection bias while simultaneously reducing the security and quality of the response data. In order to directly address the aforementioned issues, we have developed a multilingual and highly secure data management platform. Our application is built using stable, tested, and modular programming frameworks and design patterns targeted at accommodating intricately complex structures of polyglot mapping, large volume of data, encryption and granular user authorization. The statistical accuracy along with the multilingual mapping are the core highlights of this system. The multilingual function of this platform has the ability to eliminate selection biases while creating a well-balanced cross-section of society. Modern survey design workflows and validation checks ultimately prevent data loss and help reduce data collection errors. The platform design was initiated in April 1, 2020 and has been pilot tested for use in multilingual populations. The currently active application version of the system is capable of supporting in-person and telephone interviews, emailing survey links to every registered participant, building family tree architecture, and online consent management. This platform also has built-in report functionality. Additional features are being explored to improve study coordination and monitoring.
A Survey of Older Adults’ Perspectives of In-Person and Virtual Parkinson’s-Specific Exercise Classes
Authors: Bennett Holly , Vincenzo Jennifer , Oholendt Chris 
Published: December 2020

Abstract
Due to COVD-19, many health/wellness programs transitioned from in-person to virtual. This mixed methods study aims to explore older adults with Parkinson’s disease (PD) perceptions of in-person versus virtual Parkinson’s-specific exercise classes. Attitudes, perceptions, and experiences were determined through focus groups (n=9; Male=4; aged 75 years) among older adults with PD and an online survey (n=23; Male=14; aged 74 years). Eighteen respondents attended both in-person and virtually (n=18; Male=9). Four respondents only attended in-person, citing reasons such as difficulty with computer access to virtual classes, limited internet, easier accessibility to in-person classes, and physical injury preventing attendance to any classes. Respondents who participated in both delivery methods preferred virtual classes. Time, convenience, comfort at home, and not having to navigate transportation barriers supported participants’ preference for virtual classes. The majority of respondents indicated their fatigue and mental health were either unchanged or improved. Eighty-nine percent reported improved mobility since attending either class; specifically, in balance (n=8), flexibility (n=7), and coordination (n=3). Older adults with PD who attended both classes had minimal difficulty with computer usage and accessing the virtual program with only one participant reporting difficulty transitioning from in-person to virtual classes. Seventy percent stated they would enjoy a combination of on-site and virtual programming. Eighty-nine percent and seventy-seven perfect felt the virtual-based program was safe and beneficial, respectively. Participants who transitioned from an in-person to a virtual exercise program for people with Parkinson’s disease felt the program was safe, effective, and improved or prevented declines in their mobility.
COVID-19, Social Isolation, and Loneliness in Older Adults: Leveraging Exercise to Age in Place Study
Authors: Reddy Meghan , Shirazipour Celina , Mays Allison 
Published: December 2020

Abstract
Social isolation and loneliness are associated with morbidity and mortality and highly prevalent in older adults. Older adults, a high-risk group for developing serious complications from COVID-19, are asked to shelter-in-place limiting physical interactions. We aimed to determine the effect of the COVID-19 pandemic on social isolation and loneliness among community-dwelling older adults previously enrolled in in-person exercise classes in the Leveraging Exercise to Age in Place (LEAP) study before March 19th, 2020 when California started shelter-in-place. We conducted a pre-post analysis of cognitively intact participants (n=59) &gt;50 years, who had social connectedness, loneliness, and demographic data collected pre- and post-COVID shelter-in-place. Participants’ social connectedness was measured via the 11-question Duke Social Support Index (DSSI) and loneliness via the 3-question UCLA Loneliness Scale (UCLA 3). Participants had an average (±SD) baseline DSSI of 27.2 (± 3.5) and UCLA 3 of 4.8 (± 1.7) and were an average of 76.6 ± 9.2 years, 81% female, 63% white, 29% widowed, 42% living alone, 27% acting as caregivers, and 44% were diagnosed with 3 or more chronic health conditions. We completed post-assessments on average 61 ± 29 days after the start of shelter-in-place. Results of the paired t-tests indicated no statistically significant difference in social connectedness and loneliness pre- and post-shelter-in-place. Reasons for lack of observed change include: limitations of a small sample size, possible protective factors from enrollment in the LEAP program, or insufficient time at post-assessment to develop changes in loneliness and social isolation. Repeated assessments are needed throughout the pandemic.
Evaluation of the VA Medical Foster Home Program: Factors Important for Expansion and Sustainability During COVID19
Authors: Solorzano Nelly , Manheim Chelsea , Haverhals Leah , Levy Cari 
Published: December 2020

Abstract
In 2020, the Center of Innovation for Veteran Centered and Value Driven Care (COIN) continued its monitoring and evaluation of the Veterans Administration (VA) Medical Foster Home (MFH) programs expansion into rural areas. Veterans in MFHs are provided 24/7 care by VA trained and supervised community caregivers and primary care by VA Home Based Primary Care (HBPC) teams. One year after the three-year (2017-2019) expansion funds stopped, COIN continued monitoring remaining programs. Objectives were to understand factors critical for program expansion and sustainability and the impact of COVID-19. Phone interviews were conducted with sixteen coordinators from seventeen programs. A thematic analysis approach was used to address the evaluation objectives using transcript data. Findings showed factors important to program sustainability were: 1) Program fit (finding caregivers in the community); and 2) Local VA facility support (staffing, adaptation, and local leadership support). COVID prompted losing some caregivers and prevented others from joining. Program staffing was not impacted as many program activities ceased. Recreational therapists (RTs) were significant to maintaining Veterans well-being and reducing social isolation through virtual activities. COVID required coordinators transition their supervision of MFHs to new virtual environments and HBPC to increase telehealth to new levels. Local leadership became important to monitoring local conditions and providing support to programs. The evaluation: 1) Found factors important to program sustainability were also critical to keeping programs operational during the pandemic; and 2) Stimulated future research on the suitability of MFH programs to meet challenges to resurgences of COVID or other national emergencies.
Exploration of COVID-19-Based Changes to Caregiver Burden and Caregiving Intensity among Informal Caregivers
Authors: Cohen Steven , Kunicki Zachary , Drohan Megan , Greaney Mary 
Published: December 2020

Abstract
Individuals providing unpaid care of assistance to family members and friends (e.g. informal caregivers), may have been uniquely impacted by the COVID-19 pandemic. Research is needed to examine the pandemic’s effect on informal caregivers’ caregiving intensity and burden. Therefore, this cross-sectional study was conducted to explore self-reported changes in caregiver intensity (CI) and caregiver burden (CB) due to the pandemic to identify factors associated with changes in responsibilities and burdens. In June 2020, informal caregivers providing care to someone aged 50+ (n=835) reported their current and pre-pandemic caregiving intensity and burden. Data were collected via Amazon’s Mechanical Turk. Chi-square tests were used to examine bivariate associations between pandemic time (pre vs. post) differences in CI and CB. Multinomial regression was used to assess multivariate predictors of changes to CI and CB due to COVID-19. Results showed a significant U-shaped association between initial CB and CB change due to COVID-19. Higher levels of initial CB were associated with both a significant decrease in CB during COVID-19 (OR 1.33, 95%CI 1.06-1.67), and a significant increase in CB during COVID-19 (OR 1.22, 95%CI 1.05-1.43). There were no significant associations between initial CB and changes in CI due to COVID-19, although older caregivers were more likely to experience a decrease in CB due to caregiving (OR 1.02, 95%CI 1.00-1.05). These mixed results suggest that caregivers with high initial CB experienced the most extreme changes to CB due to COVID-19. Future planned analyses will focus on understanding the potential drivers behind these unexpected results.
Using Implementation Science to Support a Research and Public Policy Sector Older Adult Social Housing Partnership
Authors: Hitzig Sander , Sheppard Christine , Austen Andrea 
Published: December 2020

Abstract
One quarter of the residents in the City of Toronto is comprised of older adults, and this number is expected to continue to grow dramatically over the next few decades. The development of evidence-based interventions to meet the health and social care needs of Toronto’s aging population can be hampered by failing to account for broader implementation considerations that can adversely affect successful uptake. The present initiative provides a case-example of a research and public policy sector partnership that used an implementation approach to co-design an older adult social housing model for low-income older adult groups. Implementation science is the study of the uptake of research evidence into practice. Our team used the Consolidated Framework for Implementation Research (CFIR) to support the planning, implementation and evaluation process of a new social housing model for older adults by: 1) identifying all relevant stakeholders; 2) generating evidence via qualitative interviews/focus groups, a scoping review, secondary data analysis, and an environmental scan; 3) facilitating large scale stakeholder consultation events with older adults, front-line practitioners and other community agencies; 4) supporting the development of an evaluation framework; and 5) providing opportunities for knowledge exchange and transfer across each phase of the initiative. An implementation science approach has augmented the ability of the City of Toronto to optimize the co-creation of housing strategies aimed at improving the overall wellness of vulnerable older adults living in social housing. Further, a number of valuable lessons were learned on how to foster successful research and public policy relationships.