bluuebunny/crossref_metadata_2025_split huggingface dataset:
MLTSS AND AGING IN PLACE: HOW PERSONAL CARE SERVICES HELP AVOID NURSING FACILITY ADMISSIONS OF OLDER ADULTS
Authors: Neumann Lycia Tramujas Vasconcellos , Documet Patricia I 
Published: November 2019

Abstract
Older adults value community living and prefer to “age in place”, which increased the need for long-term care to be provided at home. Recently, a capitated option for Medicaid beneficiaries, managed long-term services and supports (MLTSS), has become popular. This evaluation research study investigated 1) the effectiveness of attendant care services to avoid long-term institutionalization of older adults when provided as part of an MLTSS program, and 2) the effect of the type of attendant care services on long-term institutionalization. Using enrollment and claims data of 491 community-dwelling older adults enrolled in an MLTSS program for at least six months, multivariate regression models analyzed the association between long-stay nursing facility (LSNF) admissions and the use of attendant care services. Findings confirmed the hypothesis that those receiving attendant care services are less likely to have LSNF admissions and that as the dosage increases, the odds of LSNF decreased. The type of attendant care services also influenced the results. Participants who used only self-directed AC services were 93% less likely to have an LSNF admission than those receiving no AC services, and 23.5% less likely to have this outcome than those who only received agency attendant care services. In addition, the use of other home and community-based services are also significantly associated with LSNF admissions. These findings have important research and practical implications at the program and policy level, as MLTSS programs spread across the country and aim to “rebalance” the LTSS system.
PATTERNS OF UNMET NEEDS AND STRENGTHS AMONG STROKE PATIENTS AND THEIR INFLUENCE ON OUTCOMES
Authors: Woodward Amanda , Hughes Anne K , Reeves Mat , Fritz Michele , Freddolino Paul , Coursaris Constantinos , Swierenga Sarah J 
Published: November 2019

Abstract
The transition home after a stroke is a particularly challenging time for patients and caregivers. There is extensive literature on unmet needs among stroke patients, but there are fewer studies that examine the strengths and resources of stroke patients and how these may influence their subsequent recovery. This study uses data from the Michigan Stroke Transitions Trial (MISTT), a pragmatic 3-arm clinical trial that tested the efficacy of case management against usual care. Two intervention groups (n=160) received up to 90 days of services from a social work case manager. A complete biopsychosocial assessment was conducted approximately 5 days after discharge. Latent class analysis was used to identify different classes based on six indicators of unmet needs and twelve indicators of strengths. Four homogenous classes were identified in the final model. Class 1 (n=56, 35%) included patients with few needs and strong social support, but few other strengths. Class 2 (n=46, 29%) had few needs and a high level of strengths across all indicators. Class 3 (n=39, 24%) has moderate needs related to mental health, non-stroke physical health, and finances, but few strengths. Class 4 (n=19, 12%) has moderate needs related to social support, non-stroke related physical health, and finances, but with moderate strengths related to indicators like coping, cognition, and insight. Class membership was related to short-term quality of life. Understanding the combination of needs and strengths has potential implications for services provided during care transitions as well as the policies and funding mechanisms that support those services.
ACUTE CARE UTILIZATION IN OLDER ADULTS LIVING UNDIAGNOSED OR UNAWARE OF DEMENTIA
Authors: Amjad Halima , Roth David L , Huang Jin , Wolff Jennifer L , Samus Quincy M 
Published: November 2019

Abstract
Most individuals with dementia are undiagnosed or they/their families are unaware of the diagnosis. Implications of dementia diagnosis and awareness are poorly understood. Our objective was to determine whether undiagnosed dementia or unawareness increases risk of hospitalization or emergency department (ED) visits, outcomes with recognized risk in diagnosed dementia. We linked National Health and Aging Trends Study (NHATS) data to fee-for-service Medicare claims for 4,311 community-living participants in the nationally representative cohort. We assessed probable versus no dementia using validated NHATS dementia criteria, undiagnosed versus diagnosed using Medicare claims, and aware versus unaware using NHATS self or proxy report of diagnosis. Cox proportional hazards models evaluated hospitalization and ED visit risk by time-varying dementia diagnosis and awareness status, adjusting for sociodemographic characteristics, functional impairment, medical comorbidities, and prior hospitalization. Compared to no dementia, persons with dementia who were unaware but diagnosed had greater risk of hospitalization (HR 1.66, 95% CI 1.26-2.19) and ED visits (HR 1.63, 95% CI 1.28-2.08). Persons unaware but diagnosed also had greater risk compared to persons aware and diagnosed (hospitalization HR 1.34, 95% CI 0.98-1.82; ED HR 1.38, 95% CI 1.05-1.83). Persons with undiagnosed dementia demonstrated hospitalization risk similar to persons with no dementia (HR 1.02, 95% CI 0.79-1.31) and similar or potentially lower than persons aware and diagnosed (HR 0.82, 95% CI 0.61-1.10); ED visit findings were similar. Results suggest that being unaware of dementia diagnosis may affect healthcare utilization. Strategies to improve communication and understanding of dementia could potentially reduce hospitalizations and ED visits.
HOSPITAL CARE USE IN OLDER ADULTS: THE ROLE OF PSYCHOLOGICAL AND SOCIAL FACTORS
Authors: Straatmann Viviane , Dekhtyar Serhiy , Meinow Bettina , Fratiglioni Laura , Calderon-Larranaga Amaia 
Published: November 2019

Abstract
Although older people’s health status is the main determinant of healthcare use, there has been little research on how psychosocial factors relate to healthcare utilization. We explored the extent to which psychological and social aspects predict the use of hospital care in an older Swedish population. 2867 people ≥60 years from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed from baseline (2001-2004) for four years. We created standardized indexes of psychological well-being, and social well-being. Binomial negative mixed models were used to estimate the association of psychological and social indexes with hospital care use (i.e. unplanned hospital admissions [UHA], 30-day readmissions [30DR] and length of stay [LOS]). Individuals with a psychological well-being score above the median had less UHA (IRR 0.43, 95%CI 0.20-0.93) and lower LOS (IRR 0.18, 95% 0.06-0.58), even after full adjustment. High levels of social well-being were also protective for UHA and LOS in the minimally adjusted model, but not after adjusting by life style and personally traits. Relative to individuals with poor well-being on both indexes, those with rich psychological and poor social well-being had reduced hospital care use (IRR 0.44 95%CI 0.24-0.84; IRR 0.23, 95%CI 0.08-0.67, respectively), and even further in those with rich psychological and social well-being (IRR 0.33 95%CI 0.14-0.75; IRR 0.10, 95% 0.02-0.45, respectively). No statistically significant association was found with 30DR. Provided the importance of psychosocial aspects in predicting UHA and LOS, targeting the former could be a strategy for reducing healthcare use and, eventually, costs.
AFFECT VARIABILITY AND SLEEP: EMOTIONAL UPS AND DOWNS ARE RELATED TO A POORER NIGHT’S REST
Authors: Leger Kate A , Charles Susan , Fingerman Karen 
Published: November 2019

Abstract
Emotional experience is strongly related to physical health. Yet, fluctuations in daily emotional experience, known as affect variability, have been less examined. It is unknown how affect variability throughout the day is related to sleep, a critical health behavior. The current study examines this relationship in an ecological momentary assessment of 277 older adults. Regression models indicate that greater variability in daily positive affect is associated with fewer hours of sleep (b = -0.648, p = .04) and greater morning tiredness (b = 0.67, p = .006) even after adjusting for mean levels of affect. Although greater negative affect variability is associated with worse sleep quality (b = -0.77, p = .02) and greater morning tiredness (b = 0.91, p = .004), these relationships disappear once mean negative affect is added into the model. Findings support models describing the downside in the fragility of positive affect.
MATTERS OF THE HEART: DAILY SOCIAL INTERACTIONS AND CARDIOVASCULAR REACTIVITY IN MIDDLE AND OLD AGE
Authors: Birditt Kira S , Turkelson Angela , Mones Meaghan , Najarian Kayvan , Gonzalez Richard 
Published: November 2019

Abstract
Social ties are essential for survival but the mechanisms accounting for this link are unclear. This study examined links between daily interpersonal experiences and cardiovascular reactivity. A total of 34 participants (aged 40 to 80) completed ecological momentary assessment surveys every three hours for 4 days and wore a device that assessed heart rate (HR) and heart rate variability (HRV). Multilevel models revealed that a greater number of social interactions and negative social interactions predicted increased HR. Links between social interactions and cardiovascular reactivity varied by gender and race. A greater number of interactions and negative interactions predicted increased HRV among men and not women. A greater number of social interactions predicted increased HR among Black individuals and White women but not White men. Thus, social interactions appear to get under the skin via the cardiovascular system but in unique ways that vary by gender and race.
USING A UNIVERSAL SATISFACTION SCORE IN LONG-TERM CARE SETTINGS
Authors: Castle Nicholas , Schwartz Lindsay , Gifford David 
Published: November 2019

Abstract
The CoreQ (not an acronym) consists of a limited number of satisfaction items (3-4 items, depending on setting) that are used to create an overall satisfaction score for long-term care facilities. This measure has been used in assisted living (AL) and skilled nursing facilities (SNFs) and has been endorsed by the National Quality Forum (NQF). Briefly, the development and psychometric testing of the CoreQ will be described, including the rationale for producing an overall satisfaction score and correlation with important quality indicators like Five-Star. Using data collected over the past 3 years, comprising more than 100,000 respondents, the use of the CoreQ measure will be described. For example, the CoreQ scores are used in MA to allow providers to benchmark their performance. The use of the scores in this way will be discussed including how providers have used the scores for quality improvement. Some states have elected to use CoreQ in pay for performance and other state initiatives. A case study of how New Jersey uses CoreQ with SNFs will be presented, including distribution of scores and addressing data collection challenges. CoreQ can be utilized as a short customer satisfaction measure to allow providers to benchmark their performance, residents and families in decision-making, and states and others to use for accountability.
USING OBSERVATIONAL DATA TO INFORM CANDIDATE PHENOTYPES FOR GEROSCIENCE TRIALS
Authors: Sanders Jason L , Arnold Alice , Boudreau Robert , Kritchevsky Stephen , Newman Anne 
Published: November 2019

Abstract
Geroscience trials will manipulate aging mechanisms which may have pleiotropic effects and alter multiple biologic processes and clinical outcomes. Determining an intervention’s efficacy and safety will require measuring several aspects of aging and intermediate endpoints with less regard to specific diseases. Picking the right measurements will significantly impact a trial’s cost-effectiveness and chance of success. Observational studies are ideal resources to test candidate phenotypes before investing in trials. We present a decade’s worth of results from the Cardiovascular Health Study as examples of using observational data to inform measurement in geroscience trials. Specifically, we illustrate the underlying theory, construction, operational characteristics, and inter-relationships of candidate phenotypes spanning circulating biomarkers, tissue and organ structure, and functional status, all of which can be used in geroscience trials depending on the intervention’s target and predicted outcome.
CHRONIC PAIN SELF-MANAGEMENT PRACTICES AND PREFERENCES AMONG URBAN AFRICAN AMERICAN OLDER ADULTS
Authors: Janevic Mary R , Janevic Mary , Robinson-Lane Sheria , Murphy Susan , Piette John 
Published: November 2019

Abstract
African American older adults experience disproportionate burden from disabling chronic pain. Pain self-management interventions for this group are most effective when they integrate culturally-relevant preferences into intervention design. In the STEPS pilot trial, we collected focus group (n=23) and survey (n=57) data from African Americans age 60+ years about pain-management practices. Participants were recruited from the community and reported pain for 3+ months, with intensity &gt;4 (0 to 10 scale). The most frequently-used pain-management strategies were exercise (75%) and prayer/Bible reading (74%). Also commonly used were healthy eating (61%), OTC medications (65%), and herbal supplements (51%). Focus group themes provided more nuanced information, including reasons for avoiding prescription pain medications, positive experiences with topical treatments, the value of movement, and the role of social support. Findings reveal strong engagement in pain self-care in this population. Interventions can build on existing practices by incorporating spirituality and appealing options for physical activity.
MOBILIZING NETWORKS TO ADDRESS DEMENTIA IN A LATINO COMMUNITY
Authors: Gelman Caroline , Giunta Nancy 
Published: November 2019

Abstract
Many Latino older adults delay seeking help for symptoms of Alzheimer’s Disease or Related Dementia (ADRD) due to substantial barriers to services. Community-based Natural helpers (NHs) can increase health-related knowledge and can serve as full partners in health education and promotion. This paper presents the process and product of the first phase of a community-based participatory research study to develop a culturally-tailored intervention increasing knowledge about ADRD and services in East Harlem, NY. We describe the results of the initial survey and development of El Barrio SHARE, an intervention that recruits and trains community residents to provide information and referrals about dementia, tapping into natural community networks of people (hairdressers, bodega clerks, mail carriers) who interact with and have longstanding relationships with older adults in the course of their work. NHs are well-positioned to observe and detect problems, and can link elders to relevant, culturally-sensitive resources, accessible support, and treatment.
THE RELATIONSHIP BETWEEN PAIN AND STRESS IN OLDER BLACKS
Authors: Taylor Janiece L , Taylor Janiece L , Parker Lauren , Thorpe Jr. Roland J , Whitfield Keith E 
Published: November 2019

Abstract
Older Blacks have higher rates of undermanaged and undertreated pain than other racial/ethnic groups. Pain can lead to disability and poor quality of life. It is essential that we identify modifiable factors related to pain in this population. This study examined if stress was associated with pain among older Blacks. Data were taken from the Baltimore Study on Black Aging, (N=602, mean age 69 [SD= 9.76]). A total of 78% of participants reported bodily pain in the past month. Women had an increased odds of reporting bodily pain (OR 1.89, 95% CI 1.17, 3.07) compared to men. Using logistic regression controlling for age, self-rated health, sex, depressive symptoms, and chronic conditions, higher levels of stress were associated with increased odds of bodily pain (OR 1.04, 95% CI 1.00, 1.07). Identification of effective coping mechanisms to combat stress may lead to pain relief among older Blacks, particularly Black women.
COMMON PURPOSE: NETWORKING INITIATIVES TO FOSTER DEMENTIA-CAPABLE CARE FOR LIFELONG DISABILITIES
Authors: Taylor Catherine , Gadbois Christine , Fournier Sandra L , Clark Phillip G , Helm Faith 
Published: November 2019

Abstract
As individuals with I/DD live longer, Alzheimer’s disease is on the rise, particularly in individuals with Down syndrome. Practitioners have recognized that the I/DD system does not possess the expertise to provide appropriate care for this population as it ages. A series of federally funded initiatives in Rhode Island – supported by the Centers for Medicare and Medicaid Services (CMS), the Administration for Community Living (ACL), and the Health Resources and Services Administration (HRSA) -- have begun to equip health care and direct care professionals to meet the needs of individuals with I/DD and AD. Using a “connector” model, the GWEP at RIGEC has woven together these efforts, aligned program goals from disparate funders, built connections between the Aging Network and the disability system, and worked with the National Task Group on Intellectual Disabilities and Dementia Practices (NTG) to create sustainable resources for the health care and direct care workforces.
THE MAGIC OF MUSIC FOR IMPROVING PSYCHOLOGICAL HEALTH FOR THOSE WITH DEMENTIA AND THEIR CAREGIVERS
Authors: MacDonald Stuart , Sheets Debra J , Smith Andre P , Kennedy Mary , Hundza Sandra 
Published: November 2019

Abstract
Arts-based interventions for person’s with dementia and their caregivers represent an inexpensive, non-invasive, and non-pharmacological intervention with the potential to improve psychological function as well as reduce healthcare costs. The paper presents an overview of Voices in Motion (ViM), and the impact of this social-cognitive intervention on changes in psychological function for those with dementia and their caregivers (current n=26 dyads). Choir rehearsals were held on a weekly basis, and included a social discussion component. A range of outcomes (neuropsychological and physiological function, neural activation) were assessed using an intensive repeated measures design that facilitates both between- and within-person analyses, including nuanced evaluation of whether psychological function improves post intervention relative to an individual’s personal average, yielding a conservative within-person test of the benefits of intervention. Discussion focuses on the promise of such interventions for mitigating dementia symptoms and facilitating the psychological health of caregivers.
SYSTEMATIC CHANGES IN GAIT PURSUANT TO CHOIR PARTICIPATION FOR CAREGIVERS AND PERSONS WITH DEMENTIA
Authors: Hundza Sandra , MacDonald Stuart W , Sheets Debra J , Smith Andre P 
Published: November 2019

Abstract
Choir interventions confer psychological benefits for persons with dementia (PwD) and their caregivers. However, less is known about whether physiological function also exhibits improvements pursuant to such social-cognitive interventions. The present study, based upon a subsample of the Voices in Motion (ViM) project, explored whether participation in an intergenerational choir results in systematic improvements in gait velocity (indexed using a GAITRite computerized walkway) for both informal caregivers (n=14; 71.4% female) and PwD (n=14; 64.3% female). Longitudinal burst data from the first of three cohorts spanning 4 assessments over 3.5 months was analysed using multilevel modeling. Whereas caregivers exhibited significant improvements (p&lt;.05) in gait velocity, PwD showed no improvement. Ongoing analyses are exploring additional cohorts, and whether improvements in gait dynamically covary with reductions in comorbidities (e.g., neuropsychological function, caregiver burden, depressive affect). These results underscore the potential of choir for facilitating both psychosocial and physiological function for caregivers and PwD.
CHURCH RELATIONSHIPS, DISCRIMINATION, AND GENERALIZED ANXIETY DISORDER AMONG OLDER AFRICAN AMERICANS
Authors: Nguyen Ann W 
Published: November 2019

Abstract
The African American church has played a major role in African American communities, and church relationships represent an important stress-coping resource for older African Americans. This study examined 1) the association between everyday discrimination and generalized anxiety disorder (GAD) and 2) whether church-based relationships buffer the negative effects of everyday discrimination on GAD among older African Americans. Logistic regression analyses were conducted using data from 670 African American respondents age 55 and older from the National Survey of American Life: Coping with Stress in the 21st Century. More frequent experiences of everyday discrimination was associated with higher odds of meeting criteria for GAD. Significant interactions indicated that frequent contact with church members and high levels of subjective closeness to church members buffered against the negative effects of discrimination on GAD. Interventions that focus on the use of church members for support capitalize on a major strength among older African Americans.
Comparison of aortic remodelling after conservative treatment or thoracic endovascular repair in type B dissections
Authors: Mustafi Migdat , Andic Mateja , Bartos Oana , Grözinger Gerd , Schlensak Christian , Lescan Mario 
Published: November 2019

Abstract

OBJECTIVES
Our aim was to compare aortic remodelling in type B dissections after thoracic endovascular aortic repair (TEVAR) or conservative treatment.

METHODS
We conducted a retrospective analysis of computed tomography (CT) data sets at dissection onset and at the last follow-up in a group with conservative (group A) and TEVAR treatment (group B). An additional analysis of the preoperative CT images was performed in patients from group A, who were converted to TEVAR during follow-up. Diameters and lengths of all aortic segments were measured and growth rates were calculated.

RESULTS
We included 74 patients: 50 patients in group A (follow-up time: 1625 ± 209 days) and 24 patients in group B (follow-up time: 554 ± 129 days). The mean aortic diameter growth rate was significantly higher in group A than in group B in the mid-descending aorta (A: +7 mm/year; B: −4 mm/year; P = 0.003). Length growth difference was only present in the abdominal aortic segment and was more pronounced in group A (+2 vs ±0 mm/year; P = 0.009). The conversion rate from conservative treatment to TEVAR was 36% (n = 18). A false lumen diameter of &gt;22 mm at baseline was associated with a higher rate of conversion (P = 0.036). After conversion, the mean growth rate in the proximal descending and mid-descending aorta decreased from preoperative +11 and +18 mm/year to postoperative −9 and −14 mm/year, respectively (P &lt; 0.001).

CONCLUSIONS
In acute type B dissections, TEVAR stops aortic enlargement in the thoracic aorta, but promotes distal dilatation compared to the conservative treatment group. After conversion to TEVAR in conservatively pretreated chronic type B dissections, a more pronounced diameter decrease in the descending aorta was observed than in patients treated in the acute phase.