bluuebunny/crossref_metadata_2025_split huggingface dataset:
WE ARE NOT CURING A LOT OF THINGS, BUT WE ARE CARING: GERIPACT PATIENT NEEDS SHAPE TEAM NEEDS
Authors: Solimeo Samantha , Steffen Melissa J , Gardner Ellen E , Adjognon Omonyele , Shin Marlena , Moye Jennifer , Sullivan Jennifer L 
Published: November 2019

Abstract
This study used a qualitative observational design to identify the team-, clinic-, and system-level resources necessary for effective geriatric medical home (i.e., GeriPACT) implementation and to differentiate the needs of GeriPACT compared to traditional PACT. Analysis of 80 interviews conducted with team members from 8 geographically dispersed GeriPACTs identified needs that may be unrecognized by primary care leadership, including: clinical space to accommodate caregivers and patients with impaired visual, mobility, cognitive, or hearing acuity; greater utilization of caregiver support programs and social workers to facilitate aging-in-place; age-sensitive clinical reminders; team member continuity and direct phone lines to reduce patient anxiety; and longer standard appointment lengths to reflect clinical complexity. In contrast to traditional primary care teams, GeriPACTs are not simply “PACTs for older adults”: GeriPACT members articulate population-specific resources that require support from facility leadership to accommodate the complex, age- clinical and social resources needed to support aging-in-place.
CLINICIAN-PERCEIVED CHALLENGES OF OSTEOPOROSIS CARE IN AN INTEGRATED HEALTHCARE DELIVERY SYSTEM
Authors: Seaman Aaron T , Steffen Melissa J , Miller Karla , Solimeo Samantha 
Published: November 2019

Abstract
The burden of osteoporosis, both on the health care system and individuals, is high. Despite this, a high percentage of patients with or at risk of osteoporosis are not identified, screened and treated appropriately. Delivering osteoporosis care to at-risk patients is complicated by a fractured health care delivery system. In this presentation, we present data from interviews with VA clinicians in order to identify challenges of osteoporosis care within the VA health care system. While clinicians reported initiating a range of bone health care delivery interventions, they identified challenges that inhibited long-term sustainability: 1) low prioritization of bone health among national and facility leadership; 2) fragmentation of clinical responsibility and care delivery; and 3) barriers endemic to the osteoporosis care delivery system. Our results indicate that, even within an integrated health care delivery system, significant coordination challenges exist.
SPREAD AND SUSTAINMENT OF QUALITY IMPROVEMENTS IN VA RURAL PRIMARY CARE CLINICS
Authors: Kramer Josea , O’Hanlon Claire , Douglas Joe , Mitchell Michael N , McClean Michael , Clarke Shawn , Callaway-Lane Carol 
Published: November 2019

Abstract
The VA has invested in developing the skills of its primary care workforce through the longitudinal Geriatric Scholars Program. Now in its 11th year, the program has increased career satisfaction and job retention, standardized provider behaviors, improved clinical decision-making and reduced dispensing of potentially inappropriate medications. The program consists of: intensive coursework in geriatrics; workshop in quality improvement (QI); and initiation of a micro QI projects in the Scholar’s clinic. Electives enable learners to tailor the program to self-identified gaps in knowledge, skills and competencies. This presentation focuses on the sustainment and spread of these QI projects based on a recent survey of Scholars. Differences between rural and urban QI projects are compared. Commonality among rural QI projects is explored based on topic, team composition, and the types of efficiencies gained in clinical and/or organizational processes to improve care for older Veterans living in rural areas.
PERCEPTIONS OF DEMENTIA
Authors: Kingston Paul , Taylor Louise , Eost-Telling Charlotte , Bailey and Jan 
Published: November 2019

Abstract
This paper considers narratives of 143 respondents (“Observers”) to a Mass Observation Project Directive exploring individuals’ perceptions of dementia. Perceptions of dementia held by “Observers” with experience of dementia and those without differed sharply. “Observers” with experience of dementia offered insight into living with and caring for a person with dementia, and the impact this had on their lives and personal relationships. Whereas, “Observers” with no direct experience of dementia focused more on common disease symptoms such as memory loss and reflected idealised views of care. “Observers” often feared being diagnosed with dementia themselves. This suggests education to facilitate care planning and ameliorate fears held by the public is required.
HOW CLINICAL SETTING AND EXPERIENCES INFLUENCE NURSING STUDENTS’ ATTITUDES TOWARD OLDER ADULTS
Authors: Hovey Susan 
Published: November 2019

Abstract
This study is significant because older healthcare consumers continue to rise with estimations that nearly 72.1 million persons in the United States will be over the age of 65 by 2030. A fundamental question remains, will the future nursing workforce possess the attitude and knowledge to competently provide age-friendly care to older adults. The aim of this study explores how clinical setting, previous experiences with older adults, and previous work experiences in long-term care settings influence the attitudes of first year prelicensure nursing students toward this population. Six baccalaureate nursing schools from a Midwest state in the United States participated in this descriptive, cross-sectional, correlational study. One hundred and nine participants who completed their first clinical experience participated in the study. An understanding of this experience may provide nurse educators with insight into how to design clinical learning activities so nursing students’ acquire interest in care of older adults.
SAFER MEDICATION MANAGEMENT FOR HOME-DWELLING OLDER ADULTS
Authors: Verloo Henk , Gunten Armin von , Wernli Boris , SANTIAGO-DELEFOSSE Marie , MARTINS Maria Manuela , Pereira Filipa 
Published: November 2019

Abstract
Taking several medications at the same time can lead to adverse effects and dangerous situations for home-dwelling older adults with chronic conditions. Accurate medication management can be a difficult challenge, especially for people living at home. However, little research has been carried out into the experience of older adults and their informal caregivers with medication management. The aim of the study is, first, to identify factors that can cause undesirable side effects and make taking multiple medications potentially dangerous for home-dwelling older adults. Second, the study will investigate the experiences of this group of patients with medication management. Third, the role of both professional and informal caregivers will be examined. Recommendations will be made on how to improve the safety of medication management for home-dwelling older adults with chronic conditions and should help to prevent the adverse effects and dangerous situations that can lead to hospitalization, institutionalization or premature death
MHEALTH PROTOTYPE AND PILOT PROTOCOL TO ENHANCE SOCIAL SUPPORT FOR PERSONS LIVING WITH DEMENTIA
Authors: Corazzini Kirsten , Bailey Donald (chip) , Wright-Freeman Kayla , McConnell Eleanor 
Published: November 2019

Abstract
An emerging component of mHealth is the use of tailored mobile applications (app) to facilitate self-management of chronic illnesses, including the mapping of social networks to assist adults living with chronic illnesses to help them be able to identify sources of social support. The purpose of this study is to describe a prototype app to support persons living with dementia (PLWD) in the community and their informal caregivers to map social networks and identify sources of emotional, instrumental, informational, and appraisal of social support. Adapting the Network Canvas open-source software and drawing upon a previously-developed mobile application for adults to self-manage chronic illnesses, we share the key specifications, including health care provider output, preliminary end user feedback, and the pilot protocol designed to test the feasibility. Findings illustrate the importance of leveraging social network data in novel ways to enhance self-management and well-being among PLWD and their caregivers
IDENTIFYING COMMUNITY PARTICIPATION CHALLENGES FOR ADULTS AGING WITH MOBILITY AND VISION DISABILITIES
Authors: Harris Maurita T , Koon Lyndsie M , Remillard Elena T , Rogers Wendy A 
Published: November 2019

Abstract
There are growing numbers of older adults with mobility and vision disabilities acquired in early to mid-life who are a part of a population described as “aging with disability”. For these individuals, the addition of normative age-related declines (e.g., vision loss, arthritis) on top of a long-term disability can create extensive barriers to community participation. We present findings on activity challenges with community participation among older adults with long-term vision and mobility disabilities (N=120) from the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) interview study. Results provide detailed insights on the specific task-based challenges experienced when engaging in one’s community (e.g., going to entertainment events, doing activities with a group or organization, and participating in religious services and activities) as well as the solutions and strategies employed to overcome those challenges. Findings provide guidance for the design of supportive technologies that promote participation and independence for this understudied population.
ELDER ABUSE AMID THE OPIOID EPIDEMIC: APS CASES IN RURAL AMERICA
Authors: Teaster Pamela B , Roberto Karen A , Savla Jyoti 
Published: November 2019

Abstract
Older adults are hidden victims of the opioid crises, suffering abuse at the hands of those who seek resources to support their addiction. Using APS data from 2015-2017 provided by the Kentucky Department for Community-Based Services, we used a logistic regression model with robust standard errors to examine whether substantiated cases of elder abuse were associated with opioid misuse by perpetrators. Overall, 9% of the 462 substantiated cases over the three-year period involved perpetrators were substance users. The percentage of these cases rose from 5% in 2015 to 13% in 2016 before dropping to 7% of elder abuse cases in 2017. Opioid use was most prevalent among perpetrators of financial abuse of older adults with cognitive and/or physical care needs. The current study offers a first look at empirical linkages between opioid misuse and elder abuse and revealed consistencies across cases that call for further investigation.
EXCLUSION SPOTTER: APPLYING ADVANCES IN AI TO IDENTIFY AGEISM IN ONLINE JOB POSTING
Authors: Palmarini Nicola , Martie Lee , Wasiak Mattie F , Zhang Gaoyuan 
Published: November 2019

Abstract
The landscape in which employers and candidates interact is changing as more job adverts are pushed online. Employment platforms (e.g., Indeed and LinkedIn) are now among the primary mechanisms for job posting, job search, and initial negotiations. Through such job platforms, a single job advert can now reach millions of people around the world. This exposure of a job advert has obvious benefits for the employer, but this exposure also has the power to alienate and exclude large portions of society. In particular, the word choice of a single job advert can, perhaps unintentionally, exclude thousands of people by their personal traits (e.g., gender or race). Age is a particular trait that garners more attention as ageism is often cited in the literature as going overlooked, not understood, and generally escaping social awareness. To begin tackling this problem, with the purpose of supporting older adults and enabling their contribution to society, we applied advances in AI to create a tool, called Exclusion Spotter, that gives feedback to recruiters and employers on which words in their advert are possibly excluding people by age. We applied Exclusion Spotter to 3660 job adverts, clustered by 372 job titles. We found a significant difference (p=.02) in the number of age-related words for engineering related positions versus all other job titles. Among 47 engineering related titles we matched 47.37 age related words per title and 2.8 per advert. Among the other 325 titles we matched 24.37 age related words per title and 2.1 per advert.
ORGANIZATIONAL PRACTICES FOR THE AGING WORKFORCE: DEVELOPMENT AND VALIDATION OF THE LATER-LIFE WORK INDEX
Authors: Wilckens Max R , Wöhrmann Anne M , Deller Jürgen , Wang Mo 
Published: November 2019

Abstract
Most developed countries face an ageing workforce. Extended working lives require organizations to employ older individuals successfully. It is, however, widely untapped, which organizational practices drive successful employment of an older and age-diverse workforce, because adequate measure are missing. We hence develop the Later Life Work Index (LLWI) as a multi-faceted measure for researchers and practitioners, combining the detailed level of assessment relevant in practice with thorough conceptual coverage. We build on an empirically derived taxonomy of organizational practices developed by Wöhrmann et al. (2018). Proposed taxonomy is based on qualitative expert interviews and consists of nine dimensions covering age-inclusive organizational climate and leadership, as well as practices regarding work design, health management, individual development, knowledge management, transition to retirement, continued employment options, and health and retirement coverage. Within a first study, we developed an inventory to operationalize the intentionally broad LLWI construct. Items were iteratively developed and pretested with 30-42 German human resource managers. The final inventory consists of 100 Likert scaled, sufficiently reliable items. Within a second study among 600 managers and older workers in Germany, we confirmed the factor structure proposed by the LLWI, and ensured construct validity regarding similar scales (convergent validity) and individual level health and motivation outcomes (criterion validity). Discriminant validity is shown among the index dimensions, and regarding positive and negative affect. This paper enhances the understanding and quantitative assessment of organizational practices for later life work. We further plan to reduce the number of items to increase practicability of the measure.
OVERVIEW: THE VA GERIATRIC SCHOLARS PROGRAM FOR PRIMARY CARE WORKFORCE DEVELOPMENT
Authors: Kramer Josea , Douglas Joe , Clarke Shawn , Melendez Luis 
Published: November 2019

Abstract
The VA has invested in developing the skills of its primary care workforce through the longitudinal Geriatric Scholars Program. The program consists of core components --- intensive course in geriatrics, intensive workshop in quality improvement (QI) and initiation of a micro QI projects in the Scholar’s clinic; electives allow learners to tailor the program to self-identified gaps in knowledge, skills and competencies. The program has demonstrated direct impacts of continuing education through a workforce development process that enhances skills and competencies at a pace and selection that meets clinicians’ self-identified gaps in training. Now in its 11th year, the program has been shown to increase career satisfaction and job retention, standardize provider behaviors, improve clinical decision-making and reduce dispensing of potentially inappropriate medications. This symposium further explores the impact of the program on individual clinicians and on clinical teams.
DYNAMICS OF HUMAN MUCOSAL-ASSOCIATED INVARIANT T CELL REPERTOIRES ACROSS THE HUMAN LIFE SPAN
Authors: Loh Liyen , Lappas Martha , Crowe Jane , Thomas Paul G , Eckle Sidonia , Godfrey Dale I , Kedzierska Katherine , Crawford Jeremy C 
Published: November 2019

Abstract
Mucosal-associated invariant T (MAIT) cells are innate-like lymphocytes and are important for immune responses against bacterial and viral infections. While MAIT cells are known to undergo marked numerical changes with age in humans, our understanding of how these cells alter during these different phases across the human lifespan is largely unknown. Here we investigated MAIT cells from umbilical cord, children, young-adults and elderly. Functional analyses across 18-90 y/o adults showed that their MR1-dependent polyfunctionality was robust throughout old age. Strikingly, elderly MAIT cells displayed upregulated basal inflammatory cytokines, which were reduced to the level of young-adult MAIT cells in the absence of the aged environment. T cell receptor αβ analyses of MAIT cells across the human lifespan showed narrowing with age and large clonal TCRαβ expansions in elderly. These data suggest that MAIT cells in the elderly display remarkable plasticity, highlighting MAIT cells as key players in aged immune responses.
IMPLEMENTING THE 4MS IN PRIMARY CARE: BUILDING AN AGE-FRIENDLY HEALTH SYSTEM
Authors: Flaherty Ellen , Fulmer Terry 
Published: November 2019

Abstract
The Age Friendly Health Systems initiative is a culture change movement funded by the John A. Hartford Foundation in collaboration with the Institute for Health Care Improvement. Transforming clinical training environments into integrated geriatrics and primary care systems to become Age-Friendly Health Systems must incorporate the principles of value-based care and alternative-payment models. This symposium will discuss how the implementation of the Geriatric Interprofessional Team Transformation in Primary Care (GITT-PC) model and the Reducing Avoidable Facility Transfer Model (RAFT) in primary care will improve patient outcomes focused on the 4M’s of the Age Friendly Health System. The success of the GITT-PC model focuses on 4 Medicare reimbursable services including the Annual Wellness Visit, Transitional Care Management, Chronic Care Management and Advance Care Planning. The RAFT model focuses on What Matters Most to residents of long term care facilities and reduces ED visits and hospital transfers through elicitation of goals of care and 24 hour virtual support from an interprofessional geriatric team.
LESSONS LEARNED FROM NURSING HOME CIVIL MONETARY PENALTY PROJECTS
Authors: Sturdevant Diana L , Buckwalter Kathleen C 
Published: November 2019

Abstract
Nursing homes must comply with numerous federal/state regulations to receive Medicare and Medicaid funding. Failure to comply with these regulations can result in deficiency citations, and depending on the severity of the deficiency, a resulting Civil Monetary Penalty (CMP). Through the Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty Reinvestment Program, CMP funds are reinvested to support activities that benefit nursing home residents and that protect or improve their quality of life or quality of care. This symposium presents some of the unique challenges, successes, failures, and surprise findings from CMP-funded nursing home quality improvement projects in two, predominantly rural Midwestern states: Oklahoma and Kansas. Dr. Williams presents findings of a pilot-study testing an adaptation of a successful family caregiver telehealth support intervention in the nursing home setting and implications for future research. Dr. Sturdevant shares successes, challenges, and unanticipated results from the “It’s Not OK to Fall” project, a comprehensive, 3 year fall prevention project implemented in Oklahoma nursing homes. Lastly, Ms. Round’s paper describes the implementation and findings of a Long-term Care Leadership Academy aimed at improving leadership and team building skills of three levels of nursing home staff, including Administrators/Directors’ of Nursing, RN/LPN charge nurses and certified nursing assistants. Discussant, Dr. Kathleen Buckwalter Ph.D., FAAN, RN, will discuss how principles of nursing home culture change provides a common framework for these projects and conclude by offering suggestions on how promotion of these principles might improve the quality of care provided by nursing homes.
BARRIERS AND FACILITATORS TO IMPLEMENTING COMMUNITY FIRST CHOICE
Authors: Beauregard Lisa , Miller Edward A 
Published: November 2019

Abstract
Community First Choice is a program within the Affordable Care Act that encourages states to expand Medicaid home and community-based services (HCBS). Specifically, this Medicaid state plan benefit provides states with an additional 6% federal match to promote greater rebalancing of long-term services and supports. Through Community First Choice, states can offer services that assist with activities of daily living, instrumental activities of daily living, and health-related tasks. The program is optional for states, and, to date, eight states have pursued Community First Choice. The purpose of this study is to understand the barriers and facilitators to implementing Community First Choice in two states. Data was collected through semi-structured interviews with individuals involved in HCBS policy nationally and in Maryland and Texas, including government bureaucrats, consumer advocates, and provider representatives. The results suggest that communication with the Centers for Medicare and Medicaid Services, the enhanced federal match, and leveraging existing HCBS infrastructure facilitated implementation. Maryland and Texas encountered challenges implementing Community First Choice because of constraints posed by existing HCBS programs, ambitious timelines, limited staff resources, and insufficient engagement with external stakeholders. The findings suggest that implementing Community First Choice is a large undertaking, and states should ensure they have enough time and sufficient staffing for the implementation process. States should also understand how implementing Community First Choice will impact existing HCBS offerings and how leveraging HCBS infrastructure can facilitate implementation. The lessons from implementing Community First Choice can be informative to other states pursuing or contemplating this program.
PUBLIC REPORTING OF NH ANTIPSYCHOTIC USE: CHANGES IN THE REPORTING OF EXCLUSIONARY DIAGNOSES?
Authors: Lucas Judith A , Bowblis John R , Davis-Ajami Mary Lynn , Simon Kosali , Song Miyeon 
Published: November 2019

Abstract
Antipsychotics (APMs) are commonly used off-label to control behavioral symptoms of dementia in nursing home (NH) residents despite FDA warnings. As part of the Centers for Medicare and Medicaid Services’ (CMS) partnership to reduce the use of APMs in long-stay NH residents with dementia, CMS began publicly reporting an APM quality measure on the NH Compare website in July of 2012. This measure proxies for potentially “inappropriate” use by excluding residents with diagnoses in which APMs may be appropriate. While APM use as declined, some question if the quality measure creates an incentive to change documentation of exclusionary diagnoses to show improvements in the publicly reported APM quality measure. These exclusionary diagnoses include: Huntington’s disease, Tourette syndrome, and schizophrenia. Using Minimum Data Set (MDS) assessments from long-stay NH residents in freestanding NHs (2011-2015), we utilized a difference-in-differences framework to compared the proportion of assessments with exclusionary diagnoses in NHs that were required to report the APM quality measure (treatment) to NHs that were exempt from reporting the measure (control). We also stratified the results by grouping residents under and over 65 year of age. We find no change in exclusionary diagnoses immediately following the implementation of public reporting. However, starting in 2014, the use of exclusionary diagnoses increased in the treatment group, especially among residents aged 65+. While APM use declined for all groups over the study period, our results indicate that the reduction in APM use may not be as large as expected, especially after 2014.