bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Associated With Prescription Opioid Use Among Community-Dwelling Older Adults
Authors: D’Aiuto Carina , Vasiliadis Helen-Maria 
Published: December 2020

Abstract
Opioid use is a growing concern in North America, particularly among older adults. Despite the opioid crisis and the aging population, few studies have evaluated the factors associated with opioid use among older adults. Our sample includes 1657 people aged ≥65 years recruited in primary care clinics from 2011 to 2013 in the Montérégie region of Québec and participating in the “Étude sur la Santé des Aînés” ESA-Services study, a longitudinal study on aging and health service use. The presence of chronic diseases was identified through self-reported health survey data linked to health administrative data. Opioid prescriptions were identified using the provincial pharmaceutical drug registry for those covered under the public drug insurance plan. Logistic regression analyses were conducted to examine the factors associated with opioid use over a 4-year period. 31.9% of participants used opioids. Factors associated with opioid use included: female sex (OR=1.24, 95%CI: 1.01-1.53), annual household income of &lt;$25,000 (OR=1.25, 95%CI: 1.01-1.55), level of social support (OR=0.85, 95%CI: 0.73-0.99), and presence of pain/discomfort (OR=1.66, 95%CI: 1.34-2.04). Further, participants with ≥3 chronic physical conditions also reporting anxiety and/or depression were 3.63 (95%CI: 1.83-7.18) times more likely to use an opioid than those with 0-2 chronic physical conditions and no common mental disorder. Moreover, those with moderate, high, and very high psychological distress were more likely to use an opioid than those with a low psychological distress. Our findings suggest that, among other factors, physical and psychiatric multimorbidity is strongly associated with prescription opioid use in older adults.
Pharmacist-Led Audits for Older Adults With Cancer Yield Significant Interventions
Authors: Erdeljac Hilary , Yager Stephanie , McClain Megan , Wall Sarah , Presley Carolyn , Folefac Edmund , Rosko Ashley 
Published: December 2020

Abstract
Older adults with cancer have comorbidities that require medical management and confounders of chemotherapy and supportive medications exacerbate polypharmacy. A multidisciplinary team model was created to address these needs within the Cancer Aging and Resiliency (CARE) clinic. To reconcile medications for accuracy, compliance, side effects, and effectiveness, a pharmacist-led audit includes identification of potential therapeutic duplications, drug-drug interactions, or potential medication inappropriateness identified using Beers criteria. A pharmacist led review of patient’s prescriptions can identify drug therapy problems (DTP) and result in safer medication management. METHODS: A retrospective review of pharmacy specific interventions was conducted using CARE Clinic patient data from February 2016 to October 2019 evaluating data from n=259 patients. RESULTS: A preliminary analysis of n=137 patients who had received medication reconciliation were included. The mean number of medications per patient was 13.1 ± 5.7 and 457 DTP were identified leading to 523 medication related interventions. There was an average of 3.3 DTP per patient. The most common types of DTP included medication reconciliation (n=137, 30.0%), potentially inappropriate medication (PIM) (n=74, 16.2%), administration/technique (n=35, 7.7%), and drug-drug interaction (n=28, 6.1%). The most frequent types of interventions involved education to the patient (n=166, 31.7%), medication reconciliation (n=137, 26.2%), medication discontinuation (n=84, 16.1%), patient to discuss further with physician (n=39, 7.5%), and medication initiated (n=35, 6.7%). Updated results involving approximately 259 patients will be presented. CONCLUSION: Comprehensive medication review within a multidisciplinary setting for the management of older adults with cancer can reduce polypharmacy and inappropriate medication use.
Prevalence and Risk Factors of Postprandial Hypotension Among Japanese Older Adults in a Facility
Authors: Suzuki Noriko , Hashizume Masahiko , Shiotani Hideyuki 
Published: December 2020

Abstract
Postprandial hypotension (PPH) is an unrecognized sudden drop of blood pressure (BP) after meals and a hidden problem among older people including those living in long-term care facilities (LTCFs). Though PPH causes dizziness, falls, and syncope, it has received little attention from¬¬¬ healthcare workers (HCW) including caregivers, nurses and physicians, and risk factors of PPH should be carefully assessed to improve quality of life. Therefore, we aimed to examine the prevalence and risk factors of PPH in a LTCF in Japan. Participants were 114 older adults living in a LTCF in Japan (mean age 85.9 years old; 85 female (74%)). To examine PPH, blood pressure (BP) was measured before and after lunch. BP after meal was measured four times every 30 minutes. PPH is defined as a BP drop of 20 mmHg or more and we also defined a BP drop within a range of 19 to 15 mmHg as potential-PPH. As risk factors, we compared systolic and diastolic BP at baseline, body mass index, pulse rate, disease and complications between groups with/without PPH. The prevalence of PPH was 41% (47/114) and 52% with potential-PPH; 11% (13/114) added. Among risk factors, systolic BP was significantly higher in those with PPH (142.6 vs 123.5 mmHg, p &lt;0.001). This study revealed that PPH & potential-PPH occurred in half of the subjects in a LTCF in Japan. HCW need to focus on high systolic BP to predict PPH and future research is necessary to prevent and cope with PPH for older people.
Racial, Ethnic, and Place-of-Birth Disparities in Body Types: Association to Glycated Hemoglobin in Older Adults
Authors: Chukwurah Queendaleen 
Published: December 2020

Abstract
Obesity, a public health concern for older adults, contributes to abnormal glycated hemoglobin (HbA1c). We examine place of birth disparities in the prevalence rate of body types and their association to HbA1c using the National Health Nutrition and Examination Survey (NHANES) III. Body mass index /waist circumference (WC) cut off values were used to create six body types: normal weight with normal WC, overweight with normal WC, obese with normal WC, normal weight with high WC, overweight with high WC, and obese with high WC. Abnormal HbA1c was defined as HbA1c &gt;5.7%. Weighted multivariable logistic regression adjusted for age, gender, education, and poverty-income-ratio was run. The sample population included 4,584 participants aged 50 years and older identifying as non-Hispanic whites (NHW), US-born Hispanics (USB-H), and foreign-born Hispanics (FB-H). The mean (SD) sample age was 63.9 (0.3). USB-H had the highest proportion of obese with high WC (35.6%,p&lt;0.0001) compared to NHW (26.6%) and FB-H (22.2%). USB-H (aOR 1.97 95% CI 1.45,2.68) and FB-H (aOR 1.51 95% CI 1.10,2.06) had higher odds of abnormal HbA1c compared to NHW. Overweight with high WC (aOR 1.47 95% CI 1.11-1.93) and obese with high WC (aOR 2.11, 95% CI 1.60-2.79) had a high likelihood of abnormal HbA1c compared to normal weight with normal WC. Further adjustment for co-morbid conditions yielded a significantly improved fitting model (Maximum-rescaled R-square (MRRS) =0.1997,p&lt;0.0001) compared to that further adjusted for health-related behaviors (MRRS=0.082,p&lt;0.0001). The knowledge of these associations in an at-risk sub-population is insightful for clinical assessments and preventive interventions.
Sex Differences in Bone-Active Medication Utilization Before and During the Year After Hip Fracture
Authors: Kirk Jennifer , Orwig Denise , Gruber-Baldini Ann , Hochberg Marc , Magaziner Jay , Rathbun Alan 
Published: December 2020

Abstract
Bone-active medications (BAM) [prescriptions (RxBAM) and supplements(calcium/vitamin D] increase bone mineral density and reduce osteoporotic fracture risk. However, RxBAM utilization rates are low, and it is unclear who is treated with BAMs before/after a hip fracture. This study examined sex differences in BAM use at baseline and predicted the probability of RxBAM use during follow-up(2, 6, and 12-months). The sample included frequency-matched males and females 65 years or older from the Baltimore Hip Studies’ seventh cohort. Differences in baseline characteristics between males and females with complete data(n=313) were assessed using t-tests and chi-square tests. Generalized estimating equations(GEE) predicted the probability of RxBAM use by sex among participants(n=270) with outcome data during follow-up adjusted for baseline characteristics. Prior to fracture, there were sex-differences in BAM use, with fewer men than women taking RxBAMs(9% versus 26%), calcium(18% vs. 57%) and vitamin D (55% vs. 68%). These differences remained over the year post-hip fracture. Only 12(3.5%) participants took RxBAM the entire study period. Of RxBAM users n=70(26%), there were few new-users (n=35), and many participants stopped or never started treatment. Unadjusted GEEs showed that men were less likely to use RxBAM (OR= 0.42; 95% CI:0.22,0.78, p=.007), during the hip fracture recovery period compared to females. However, after controlling for differences in baseline characteristics between males and females, particularly pre-fracture BAM medication use, the observed association (OR=0.62; 95% CI:0.29, 1.31; p= 0.23). RxBAM use was low, especially in men and may contribute to the high rates of preventable subsequent osteoporotic fractures and post-fracture mortality.
Motor and Physical Function Impairments in Middle-Aged and Older Adults in the Baltimore Longitudinal Study of Aging
Authors: Cai Yurun , Tian Qu , Agrawal Yuri , Simonsick Eleanor , Schrack Jennifer 
Published: December 2020

Abstract
Older adults experience motor function decline early in the disablement process, impacting daily activities and contributing to adverse health outcomes. Few studies have comprehensively examined the interrelationships among motor and functional impairments and investigated whether their contributions to mobility difficulty vary in well-functioning older adults. We examined direct and indirect associations of motor and physical function impairments with slow gait speed (&lt;1.0m/s) and mobility difficulty using structural equation modeling (SEM) among 858 participants aged ≥50 years in the BLSA (mean age=74.1±10.6, 55% women). Motor and physical function tests included grip strength, knee extension strength, proprioception, finger tapping, standing balance (semi-, full-tandem, single-leg), repeated chair stands, and usual gait speed. Mobility difficulty was defined as self-reported difficulty in walking ¼ mile or climbing stairs. Motor and physical function impairments increased linearly with age, with 27.6% of participants having slow gait speed and 10.4% having mobility difficulty. Age-adjusted SEMs identified chair stands pace as the strongest predictor of slow gait speed, followed by latent factors of upper and lower extremity muscle strength and standing balance. Chair stands pace was the strongest predictor of mobility difficulty, followed by gait speed. Latent factors of muscle strength, proprioception, finger tapping, and standing balance were indirectly associated with mobility difficulty via gait speed. All models showed good model fit (RMSEA&lt;0.05, CFI&gt;0.95). These findings suggest components of strength and balance are among the most important contributors to poorer functional performance in mid-to-late life. Future longitudinal studies gauging the effect of change in these factors are warranted.
Effects of Dance Therapy on Balance and Risk of Falls in Older Persons
Authors: Chakravarty Esha , Chakravarty Indrani , Chakravarty Ipsito , Bhattacharjee Prasenjit 
Published: December 2020

Abstract
Loss of balance and risk of falls is a major problem in older persons. Literature shows increasing use of yoga practices and dance therapy across Indian oldage homes and day care centres to improve balance and reduce risk of falls in older persons. Aim of this study is to evaluate the effects of dance therapy with focus on therapeutic movements derived from Indian classical dances on balance and risk of falls in older adults of Day Care Centres in Calcutta Metropolitan Institute of Gerontology, under Ministry of Social Justice and Empowerment, Govt. of India. Total of 24 older adults across 2 day care centres participated in the study attending dance therapy sessions for 3 months. All of them self reported problems of balance and repeated falls alongwith difficulties in performing Activities of Daily Living. Twenty one of them were females and 3 males. The mean age of the participants was 75.5 years. Limits of Stabililty (LOS) was used to measure balance and pre tests and post tests were performed. Results showed that the Limits of Stability were significantly higher (17.5%) in older persons after participating in the dance therapy sessions. This study supports that dance therapy using movements derived from Indian classical dance forms can support older persons to function with reduced risk of falls, improved balance, safely carry out mobility tasks and perform better Activities of Daily Living . Further studies can show how dance therapy can facilitate healthy ageing and influence State policies on healthy ageing.
Measuring Fear of Falling and Appraisals of Harm
Authors: Lach Helen , Noimontree Wanida 
Published: December 2020

Abstract
Fear of falling (FOF) causes premature disability in older adults who limit their physical activities, making FOF an important area for aging research. Measures of falls self-efficacy have been widely used, but less attention has been paid to measuring the construct of fear. We re-assessed an older measure of fear and appraisals of harm to determine the factor structure and potential for a shorter version. Data was collected from 329 older adults from a variety of community setting (mean age 76.3, 84% female, 81% White); 63.8% reported FOF. Factor analysis resulted in four factors with eigenvalues greater than 1.0. Two factors achieved adequate Cronbach’s alpha: appraisals of harm outcomes (0.924) and social stigma (0.815). Further analysis was used to identify a short form, resulting in a 6 item measure of appraisal of harm outcomes (Cronbach’s alpha 0.86). The original and short versions were moderately correlated with falls self-efficacy as measured by the short form, and level of fear of falling using a 10-point rating scale (.327 - .492). Research is needed to further clarify psychological targets to help older adults remain physically active to improve quality of life.
Integrated Multidisciplinary Approach to Advance Care Planning for Vulnerable Older Adults
Authors: Gabbard Jennifer , Pajewski Nicholas , Callahan Kathryn , Dharod Ajay , Foley Kristie , Williamson Jeff 
Published: December 2020

Abstract
Advance Care Planning (ACP) is increasingly recognized as a crucial step to ensure patients receive medical care that consistent with their overall goals and values; however it remains suboptimal among vulnerable older adults. The objective was to determine whether a nurse navigator led ACP pathway plus a provider-facing EMR documentation program called ACPSmart improves ACP documentation within the EMR within an Accountable Care Organization (ACO) for vulnerable older adults. This was a randomized, pragmatic, effectiveness clinical trial was conducted from November 1, 2018 to November 1, 2019, at 8 primary care practices. Patients 65 years or older within an affiliated ACO with multimorbidity plus physical impairments, cognitive impairments, and/or frailty were included. Participants were randomized to either a nurse navigator led ACP pathway (NN) or usual care (UC). The primary outcome was documentation of new ACP discussion within the EMR at 12 months along with the quality of ACP discussions. Among 759 randomized patients (379 NN / 380 UC, mean age 77.7 years), compared to usual care, the NN led ACP pathway resulted in a higher rate of ACP documentation (42.2% vs 3.7%, p&lt;0.001). There was also higher completion rates of ACP legal forms (24.3% vs 10.0%, p&lt;0.001), MOST forms (10.3% vs 1.1%, p&lt;0.001), along with documentation of medical decision maker (64% vs 35%, p&lt;0.001). The nurse navigator led ACP pathway plus ACPSmart documentation program increased documentation of ACP within the EMR. This may mitigate prior barriers to ACP and could substantially improve ACP documentation within the EMR.
Frailty as a Moderator of the Relationship Between Social Isolation and Health Outcomes
Authors: Mehrabi Fereshteh , Béland François 
Published: December 2020

Abstract
Previous studies have reported that social isolation is a predictor of adverse outcomes, which is also closely associated with frailty. Very little is known about the moderating role of frailty on the impact of social isolation on health. We performed a cross-sectional analysis of the first wave of the FRéLE longitudinal study, consisting of 1643 Canadian community-dwelling older adults aged 65 years and over. Multivariate regression analysis was performed to examine the interaction between social isolation and frailty on health, controlling for socioeconomic characteristics and life habits. Social isolation was measured through social participation, social networks and support for different social ties namely, friends, children, extended family, and partner. In contrast to Berkman’s theory on the impact of social isolation on health, we found that frailty had no modifying role on the effects of social isolation on health. Frailty was significantly associated with all adverse outcomes. Less social participation was associated with ADLs, IADLs, depression and cognitive decline. The absence of friends was associated with depression and cognitive decline. Less support from children and having no children were associated with ADLs, comorbidity and depression. Fewer contact with extended family and having no family members were notably associated with ADLs and IADLs. Those who received less support from a partner or had no partner were more depressed and had more difficulties in performing IADLs. This study suggests that older adults who participate in social activities and have social ties, feel better with respect to physical health than those who feel isolated.
How Well Do Videos on YouTube Meet Information Needs of ADRD Family Caregivers? A Qualitative Analysis
Authors: Wu Shinyi , Foster Katherine , Ramirez Magaly , Jin Haomiao , Joe Elizabeth 
Published: December 2020

Abstract
Family caregivers need access to information, education, and support for taking care of individuals with Alzheimer’s disease and other dementia (ADRD). As YouTube is increasingly being used for sharing health information, videos regarding the disease and caregiving are becoming an important source of information to support family ADRD caregivers. This study aimed to assess the types and quality of information available on YouTube videos related to ADRD caregiving. A framework categorizing information needs of family ADRD caregivers was developed through a qualitative study with caregivers (N=21) and with healthcare and community stakeholders (N=6). The framework was used to conduct content analysis of YouTube videos. Nineteen categories of information needs were identified, including information about ADRD, healthcare services and treatment, available community resources, caregiving skills, and short- and long-term care. YouTube videos that met the keywords, language, and view selection criteria were evaluated by two coders on a developed rating scale to measure their relevance and helpfulness. A neurologist verified the ratings in 10% of the coded videos for quality assurance. There were 48 English and 23 Spanish videos met the selection criteria. More English (89.6%) than Spanish (56.5%) videos provided tips on handling specific ADRD symptoms. The majority categories of information needs (15 of the 19) were absent in most videos (87.0%, 89.6%). Many of the most watched videos were not rated as helpful. Community-based providers and healthcare organizations are encouraged to make high quality needed information in commonly accessed videos sharing service to support ADRD family caregivers.
Does Anxiety Affect the Clock-Drawing Task in Patients in a Memory Clinic? A Clinical Correlation Study
Authors: Khachan Hamed , Kanjolia Mahak , Nair Anil 
Published: December 2020

Abstract
Background: It is unknown if anxiety levels affect performance on clock drawing test (CDT) in memory clinic patients. Method: We performed a retrospective analysis of memory clinic patients in the south shore of Boston from 2010 to 2019. We correlated anxiety screen data (GAD7) to CDT scores, based on contour, numbers, and hands placement. Univariate analyses used Spearman correlation. A multivariate regression model analzed GAD7 to covariates of CDT, age, sex, and race. Hypothesis : We hypothesized a positive correlation between anxiety levels scored by the GAD7 and CDT. Results: 994 patients in the memory clinic between 2010-2020 had analyzable data. Patients were 58.6% female, 84.6 % White. Mean age was 70.1±14.4, CDT 1.84±1.04. CDT score correlated significantly to race (⍴=-0.16, p&lt; 0.001), age (⍴=-0.28, p&lt;0.001), gender (⍴=0.05, p=0.16), but not GAD7 (⍴=0.05, p=0.27). Multivariate model confirmed the lack of association of anxiety scores to CDT (□= 0.08, p=0.78). GAD7 scores correlated to female gender (□= -1.16, p=0.04). Conclusions: CDT scores were not affected by anxiety as measured on GAD7 scores. However, a positive correlation was shown on anxiety scores in females to CDT completion.
Depression and Cognitive Functioning Among Adults Age 60 and Over: United States, 2011-2014
Authors: Kramarow Ellen , Brody Debra 
Published: December 2020

Abstract
Previous studies have noted an inverse association between depression and cognitive functioning. The objective of this research is to explore this relationship with data from a nationally representative survey containing validated measures of cognition, depression, and other health conditions. The study population was respondents aged 60 and over who completed the examination component of the 2011-2014 National Health and Nutrition Examination Survey (NHANES) (N=3,472). Cognitive tests included the CERAD word list learning trials, measuring immediate and delayed memory, and the Digit Symbol Substitution test (DSST), measuring attention and processing speed. The presence of depressive symptoms was based on a score of 10 or higher out of 27 from the Patient Health Questionnaire (PHQ-9). Statistical analyses included regression models with low cognitive performance (scoring in the lowest 25th percentile) as the dependent variable. Results from regression models showed that having depressive symptoms significantly increased the odds of scoring in the lowest 25th percentile of both the DSST (OR = 3.4) and the CERAD test (OR = 1.7), controlling for age, sex, and race and Hispanic origin. Adding in a measure of heart disease showed an independent effect of heart disease on low cognitive performance (OR = 1.7 for DSST and OR = 1.3 for CERAD test), while the effect of depression was lessened but still statistically significant. In this study, depression is associated with cognitive functioning, but its effect may be attenuated by the presence of other chronic health conditions.