bluuebunny/crossref_metadata_2025_split huggingface dataset:
GERIATRIC MEASURES AS PREDICTORS OF 1-YEAR MORTALITY IN MAJOR SURGERY PATIENTS
Authors: Tang Victoria L , Covinsky Kenneth , Finlayson Emily , Jing Bocheng , Boscardin John , Ngo Sarah 
Published: November 2019

Abstract
A growing proportion of older adults are undergoing major surgery despite the higher risk of post-operative mortality. Geriatric measures (i.e. physical, cognitive, and psychosocial function) are often not included in studies evaluating post-operative outcomes in older adults. Our goal was to determine the association of geriatric measures and 1-year mortality in older adults after major surgery. We analyzed longitudinal data from the Health and Retirement Study linked to Medicare claims (N=1364 participants), age ≥ 65 and who underwent abdominal aortic aneurysm [AAA] repair, coronary artery bypass graft [CABG], or colectomy. Our outcome was mortality within 1 year of the major operation. Predictors included the following geriatric measures: dependence in activities of daily living (ADL), dependence in independent activities of daily living (IADL), mobility ability, and dementia, and depression. We analyzed using multivariate cox proportional hazard models. Mean participant age was 76±6 years, 56% were women, 11% underwent a AAA repair, 50% CABG, 40% colectomy; 18% died within 1 year of their major operation. After adjusting for age, comorbidity burden, surgical type, gender, race, wealth, income, and education, the following measures were significantly associated with 1-year mortality: depression (adjusted HR (aHR): 1.53, p=0.03), dementia (aHR: 1.90, p=0.03), &gt;1 ADL dependence (aHR: 2.35, p&lt;0.01), &gt;1 IADL dependence (aHR: 1.95, p&lt;0.01), and inability to walk several blocks (aHR: 1.69, p&lt;0.01). In this cohort, 18% of participants who underwent major surgery died within 1 year and function, cognition, and psychological well-being were significantly associated with mortality. These measures should be incorporated into pre-operative assessment.
WORKING BACK TO NORMAL FUNCTION FOLLOWING HOSPITALIZATION: A GROUNDED THEORY STUDY
Authors: Liebzeit Daniel , Bratzke Lisa , King Barbara 
Published: November 2019

Abstract
Transitions older adults experience post hospital discharge have primarily focused on the process of moving care from one setting to another (e.g. hospital to home). Older adults often experience a significant transition in terms of losing functional status after a hospital stay. Little is known about how older adults regain their functional ability, the type of work they engage in to recover, and conditions that influence their ability to work after a hospital stay. The objective of this Grounded Theory study was to understand strategies older adults use post discharge as they work to regain their functional status and what conditions facilitate or limit their ability to work toward returning to normal. A qualitative study was conducted. Adults aged 65 and older discharged from a large Midwestern teaching hospital (N = 14) were interviewed using in-depth one-on-one interviews. Data were analyzed using open, axial, and selective coding. Participants described key strategies they employed to regain their normal function following hospitalization and illness: doing exercises, expanding physical space, resuming prior activities and daily cares, and tracking improvement with benchmarks. Several conditions such as, presence of informal (family, friends) and formal (healthcare providers) support, perceived threats (relocation), and having poor physical or physiologic function, acted as barriers and facilitators to participants ability to work back to normal function. This study provides empirical data on work older adults engage in to transition back to normal function during the post discharge period. It presents opportunities for better supporting their work of regaining function.
SYMPTOM EXPERIENCES OF HOSPITALIZED OLDER ADULTS ON ADMISSION AND FUNCTIONAL OUTCOMES 1 MONTH POST-DISCHARGE
Authors: Zisberg Anna , Shulyaev Ksenya , Liberty Anat , Gur-Yash Nurit , Agmon Maayan , Pud Dorit 
Published: November 2019

Abstract
The aims of this study were to identify subgroups of older adults admitted to hospital based on their experience with multiple symptoms and to explore if these subgroups differed on physical and cognitive characteristics at time of admission, and on functional outcomes one-month post-discharge. The study included 331 older adults (mean age 75.5±7.1), admitted to hospital and were hospitalized in internal-medicine units. Demographic, functional, cognitive, psychological and mobility characteristics and symptoms’ disturbance were assessed within the first 24 hours of admission and one moth following discharge. Cluster analysis identified three distinct subgroups based on patients’ experiences with five highly prevalent symptoms (tiredness, dyspnea, dizziness, sleep disturbance and pain): Low or high levels of all five symptoms (70%, 14%, respectively), and moderate levels of four symptoms with high dyspnea (14%). “All high” cluster was characterized by the worst cognitive and instrumental function, and highest anxiety and depression levels. The “moderate with high dyspnea” subgroup expressed the highest comorbidity score. Multivariate Logistic regression showed that the odds of decline in instrumental ADL one month post-discharge was 3.28 (95% CI 3.21-3.25, p=.021) for “all high” and 2.35 (95% CI 2.33-2.36, p=.043) for “all low” symptom-subgroups compared to “medium with high dyspnea” subgroup adjusted for pre-morbid function, health conditions and demographic characteristics. Belonging to certain symptom-subgroups is an important risk factor in predicting negative consequences of hospitalization. These findings emphasize the importance of evaluating and subgrouping broad range of symptoms among hospitalized older adults.
WELL-BEING AND ADVANCE DIRECTIVES AMONG PROLONGED MECHANICAL VENTILATION PATIENTS AT HOME VERSUS HOSPITAL
Authors: Stessman Jochanan , Marcus Esther-Lee , Jacobs Jeremy M 
Published: November 2019

Abstract
Despite increasing numbers of older patients requiring Prolonged Mechanical Ventilation (PMV), little is known concerning their mood, well-being, distressing symptoms and attitudes towards ventilation. Furthermore differences may exist according to place of care- whether Home Hospital or Hospital Long Term Care (HLTC). These issues were addressed using the revised Edmonton Symptom Assessment System (r-ESAS)(10 items, max severity score=100), and Short Geriatric Depression Scale, in a study of the majority of PMV patients (n=120/123) aged ≥18 (range 18-96 years) all Clalit Health Service insurees, in Jerusalem. Communicative patients were interviewed (40/46 at home, 22/74 in HLTC, average age 54 vs.73 years, p&lt;0.01). The following symptoms (dichotomized to “not-a-problem”/“problematic”) were frequently reported as “not-a-problem” among patients (Home,HLTC): tiredness (59%,58%), poor appetite (95%,90%), pain (69%,84%), drowsiness (77%,90%), nausea (85%,84%), and shortness of breath (82%,90%). General well-being (categorized to good/mild/moderate/severe impairment) was reported more frequently as good or mildly impaired at Home vs. HLTC (54% vs.26%), as was lower frequency of depression (34.4% vs. 44.4%, p=0.049). The total r-ESAS score was similar irrespective of setting: Home-24.9/100 (inter quartile range {IQR} 13.5-32.5) vs. HLTC-23.7/100 (IQR 17.5-32),p=0.74. The majority (119/120) of patients were without advanced directives prior to initiation of PMV. When asked if they had to choose again, 82% and 91% of communicative patients at home vs. HLTC would opt again for ventilation, as would 75% of caregivers of uncommunicative patients. Our findings emphasize the resilience and low levels of distressing symptoms among PMV patients, and may contribute to the decision-making process concerning advanced directives.
COST-BENEFIT ANALYSIS OF HEARING CARE SERVICES AMONG MEDICARE BENEFICIARIES WITH HEARING AIDS
Authors: Willink Amber , Willink Amber , Reed Nicholas S , Lin Frank R 
Published: November 2019

Abstract
Hearing care services for older adults with hearing aids are underutilized and are not covered by the Medicare program. Little information exists to the value of hearing care services for older adults with hearing aids. Using the Medicare Current Beneficiary Survey 2013, we conducted a cross-sectional analysis of the impact of hearing care services use on Medicare spending among those with hearing aids. Older Medicare beneficiaries with hearing aids that received hearing care services in the previous 12 months were propensity score matched to those who did not receive services. Average annual Medicare spending was $8196 (CI:$6670-$9723) among Medicare beneficiaries who used hearing care services and $10,709 (CI:$8878-12541) among matched controls. Spending differences were driven by higher skilled nursing facility and home health spending among matched controls. Increasing access to hearing care services among Medicare beneficiaries with hearing aids may provide value to the health care system and Medicare program.
GENERALIZABILITY OF CLINICAL TRIALS OF DELIRIUM INTERVENTIONS
Authors: DiBlasio Christina , Fowler Mackenzie E , Martin Roy , Zhang Yue , Kennedy Richard E 
Published: November 2019

Abstract
Delirium, or acute confusional state, affects up to 7 million hospitalized older adults annually, and is associated with increased risk of mortality, institutionalization, and cognitive and functional impairment. There has been a proliferation of both pharmacological and nonpharmacological clinical trials to reduce the incidence and sequelae of delirium. In other neuropsychiatric disorders, exclusion criteria prevent up to 75% of individuals with the condition under study from participating. It is unclear how well these trial samples represent the population of older adults with delirium. We selected all intervention trials registered at ClinicalTrials.gov containing the keyword “delirium” (N=131), regardless of type of intervention. We manually examined study descriptions to restrict analysis to studies with delirium as a primary or secondary outcome (N=92). Of these 92 studies, 76% enrolled only adults, with 45% enrolling only older adults. 38% of studies were restricted to surgical units, 27% to intensive care units, and 7.6% to medical units. Only 1 study examined nursing homes and 4 studies examined palliative care. 50% of studies excluded individuals with pre-existing dementia, 28% excluded individuals with psychiatric disorders, and 30% excluded individuals with neurological disorders. 34% of studies excluded individuals with alcohol or drug abuse. Overall, many intervention studies for delirium are limited to the surgical and ICU populations, and they exclude individuals with common comorbidities associated with an increased risk of delirium. Similar to other neuropsychiatric disorders, these findings raise significant concerns about the generalizability of clinical trials in delirium to the hospitalized older adult population.
ELDER SELF-NEGLECT: REPORTING AND RESPONSE WITHOUT APS OVERSIGHT
Authors: Melekis Kelly A 
Published: November 2019

Abstract
Self-neglect is generally considered a geriatric phenomenon and subsumed within the category of elder abuse and neglect. In the U.S., self-neglect is the most commonly reported form of elder abuse and neglect and has been linked to decreased physical and psychological well-being, higher mortality rate, and increase health care services utilization. While self-neglect typically falls under the purview of a state’s adult protective service (APS) system, there are several states where this is not codified and/or practiced. This study examined the state of existing laws, policies and programs that address elder self-neglect in the U.S. in an effort to better understand how self-neglect reporting and response is handled, particularly in states where APS does not have oversight. A 50-state review of existing policies and laws addressing elder self-neglect was followed by key stakeholder interviews with those who oversee self-neglect reporting and response in states where APS does not have oversight. Findings indicate that a range of rationales explain variation in responsibility for self-neglect cases, including a lack of specificity in statutes, concerns that self-neglect does not fit into legal/criminal models due to the lack of perpetrator/victim relationship, and strong sentiments that those engaging in self-neglect need human services and support rather than investigatory or legal approaches. While the inclusion of self-neglect into the broad category of elder abuse and neglect is often perceived as vital for the provision of services, findings indicate it may exacerbate the complex challenges inherent in defining and conceptualizing both the term and its response.
DEMENTIA KNOWLEDGE, ATTITUDES, AND BELIEFS: A 3-YEAR UPDATE
Authors: Santos Pedro M , Paúl Constança , Alvarez Catarina , Cavaleiro Ana Margarida , Nunes Tatiana , Paules Silvana 
Published: November 2019

Abstract
Objective: To characterise and analyse beliefs, knowledge, and attitudes regarding dementia three years after the first Portuguese survey (2015), in order to inform mental health research and policy-making, and establish the baseline to assess “Dementia Friends” campaign impact. Method: An advisory group, including academics and representatives of Alzheimer Portugal and Alzheimer Society UK, drafted the survey based on previous international research and the first national survey. The survey was uploaded to the Directorate-General of Health website and disseminated through relevant stakeholders and social networks. The survey was cascaded by inviting recipients to further share it. Data were collected during July 2018. Results: 1716 individuals completed the survey: median age 43y, 83.4% female, 25.1% professionals working in the field of dementia. 31.7% of respondents know someone close with dementia, and 42.5% have/had relatives with dementia. 14.7% consider people with dementia must leave/stop to attend ceremonies and social events, but this percentage increased to over one-third (37.3%) when asked about the opinion of most people living in their community. Regarding the key messages of “Dementia Friends” campaign, results reveal that 25.6% of respondents consider dementia is a natural part of ageing, 21.3% that it is not caused by diseases of the brain and 17.4% that it is just about losing memory. Conclusions: The second survey results reinforce the need for initiatives to change people’s perceptions of dementia, that build up on evidence-based decision-making and international learning and cooperation as part of “Dementia Friends” global movement.
COGNITIVE IMPAIRMENT AND SLEEP DIFFICULTIES OVER 10 YEARS IN A NATIONAL SAMPLE OF OLDER ADULTS
Authors: Robbins Rebecca , Sonnega Amanda , Turner II Robert W , Jean-Louis Girardin , Langa Kenneth 
Published: November 2019

Abstract
Prior studies suggest that sleep difficulties (e.g., trouble falling asleep) may be associated with cognitive impairment. We used a large, nationally representative longitudinal survey of adults over the age of 50 in the US to examine the relationship between sleep difficulties and cognitive functioning. Generalized estimation equation (GEE) linear regression models were used to analyze data from the 2004-2014 waves of the Health and Retirement Study. We examined sleep difficulties and cognitive functioning within participants and across time (n=17,642). Sleep difficulty was measured as trouble falling asleep, nocturnal awakenings, and waking too early scored as 1= rarely/never, 2=sometimes, and 3=most of the time. A summary score indicated cognitive functioning (range 0-27). Models controlled for age, gender, race/ethnicity, marital status, education, chronic medical conditions, depressive symptoms, and body mass index (BMI). Compared to those with no sleep difficulties, those who reported difficulty falling asleep [“sometimes” OR=0.83,95%CI:0.71-0.96 and “most of the time” OR=0.79,95%CI: 0.64-0.98] and waking too early [“most of the time” OR=0.79,95%CI: 0.63-0.98] had worse cognitive functioning. Compared to those with no sleep difficulties, those who reported nocturnal awakenings [“most of the time” OR=1.29,95%CI:1.08-1.54] had higher cognitive functioning. Over time, lower cognitive function was more likely among those reporting difficulty falling asleep (OR=0.73,95%CI:0.54-0.97), nocturnal awakenings (OR=0.77,95%CI:0.61-0.97) and waking too early (OR=0.65,95%CI: 0.47-0.88). In this nationally representative, longitudinal sample of older US adults, we found that over time lower cognitive function was more likely among those who reported difficulty falling asleep, nocturnal awakenings, and waking too early.
ACCURACY AND USABILITY OF A MOBILE ALERT SYSTEM FOR COMMUNITY CITIZENS TO LOCATE PERSONS WITH DEMENTIA WHO GET LOST
Authors: Daum Christine H , Neubauer Noelannah , Oliva Carlo , Beleno Ron , Liu Lili 
Published: November 2019

Abstract
Three out of five persons with dementia wander. While the literature supports community engagement in the location of lost older adults, publically funded Silver Alert programs are associated with jurisdictional issues and alert fatigue. In collaboration and consultation with key stakeholders (older adults living with dementia, care partners, service providers, advocates, police organizations), we developed Community ASAP, an alert system (mobile website and app) that mobilizes community citizens who volunteer to keep watch for persons with dementia reported to be lost. The purpose of this study was to evaluate usability and functionality of the Community ASAP app. Thirteen participants from six regions in Canada received a total of 130 missing person notifications. They recorded the time and content of these notifications, completed the Website Usability Questionnaire, and provided written feedback or participated in a group interview about their experiences using the app and suggestions for improvements. The Community ASAP app delivered notifications with 100% accuracy and received messages from participants with 98% accuracy. Overall, participants thought the interface was easy to navigate, graphics were pleasing, easy to use, and was clearly organized. Suggestions for improvements to increase usability included: 1) Multi-sensory alerts to make them more noticeable and increase readability; 2) Clearer navigation within the home screen and preferences; 3) User support (instructions, demo video, technical support). Evaluation results for this innovative app were favourable; suggestions will be used to further improve usability, particularly for end users who are novices at using mobile applications.
TOTAL AND POST-DISCHARGE 30-DAY EPISODE PAYMENTS FOR BENEFICIARIES WITH ALZHEIMER’S AND DEMENTIA
Authors: Kamdar Neil , Mahmoudi Elham 
Published: November 2019

Abstract
There exists lack of evidence regarding incremental post-discharge cost and utilization of healthcare services for older adults with Alzheimer’s and dementia (AD). We quantified episode payments associated with AD vs. non-AD 30 days after medical or surgical procedures. We utilized administrative claims between January 2012 and June 2017 from the Michigan Value Collaborative (MVC) across 31 different medical and surgical services. We identified all patients with any AD diagnosis code throughout their enrollment using ICD-9-CM, ICD-10-CM codes. We price standardized 30-day episode payments and split them based on patient setting. Payments were risk adjusted and winsorized at the 99th /1st percentile. Propensity score matching using calipers without replacement adjusted for clinically relevant surgical and medical procedures, HCCs, insurance type, and age to control for selection bias. We identified 66,676 AD episodes and 656,235 non-AD episodes. After propensity score matching, there were 58,485 AD and non-AD episodes with significant differences in total episode payments of ($22,378 vs. $19,595, 95% CI Diff: ($2,658, $2,910)). Post-acute care and readmission payments were significant ($4,561 vs. $3,272, 95% CI Diff: ($1,235, $1,342)) and ($1,807 vs. $1,165, 95% CI Diff: ($595, $691)), respectively. AD episodes had a higher readmission rate (21.6% vs. 14.8%, p&lt;0.0001). County variation in payments for AD episodes was substantial (Median: $4,370, Range: $3,881). AD patients are at higher risk of readmission and more resource intensive to hospitals and health systems. Examining drivers of post-discharge cost variation can influence practice pattern changes in management of AD patients.
ASSOCIATION OF SENSORY AND COGNITIVE IMPAIRMENT WITH HEALTHCARE UTILIZATION AND COST IN MEDICARE BENEFICIARIES
Authors: Deardorff William , liu Phillip , Sloane Richard , Van Houtven Courtney , Hastings Susan N , Cohen Harvey J , Whitson Heather E 
Published: November 2019

Abstract
The combination of sensory and cognitive impairment is increasingly prevalent among older adults and may be an important driver of healthcare cost due to functional disability and reduced self-care. This presentation focuses on the relationship between hearing and/or vision impairment and cognitive impairment with hospital admissions and healthcare cost using data from the Medicare Current Beneficiary Survey, a nationally representative sample of community-dwelling adults. We show that the presence of sensory impairment is associated with increased risk of hospitalization regardless of dementia status. In adjusted models, annual total healthcare costs were generally higher among those with sensory impairments compared to those without sensory impairments. We will also discuss work related to the development of a prognostic model that provides estimates of hospitalization risk among older adults with self-reported hearing and/or vision impairment. This model may help inform allocation of health care resources to those at highest risk for adverse outcomes.
CHANGES IN PERSONAL RESOURCES AND SUBJECTIVE AGE ACROSS 8 YEARS
Authors: Lothary Allura F , Hess Thomas M 
Published: November 2019

Abstract
Subjective age has been extensively researched as a predictor of physical and mental health outcomes in older adulthood. However, the mechanisms behind subjective age have not yet been established and reasons for longitudinal changes are unclear. Selective engagement theory (SET; Hess, 2014) proposes a connection between increases in objective and subjective cognitive costs and motivation to engage future resources. Costs are influenced by personal resources, mainly physical and mental health. These changes in costs may also influence subjective experiences of the aging process. For example, aging attitudes have been shown to partially mediate the associations between resources and both motivation and activity engagement (Hess et al., 2018). Using the Health and Retirement Study (HRS) data, changes in resources (physical and mental health) were hypothesized to predict changes in subjective age across 8 years. More specifically, reductions in resources were predicted to be associated with older subjective ages over time. This relationship was expected to be mediated through aging attitudes. Results indicate an association between changes in resources and changes in subjective age over time in the expected direction. Changes in resources were partially mediated by aging attitudes. However, resources function differently in predicting changes in subjective age based on the resource (physical and mental health) and chronological age of the participant. These findings provide more guidance as to the mechanisms behind subjective age and may offer theoretical guidance for future work looking at understanding changes in subjective age.