bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTEGRATING PRINCIPLES OF VALUE-BASED CARE THROUGH COMMUNITY-BASED ORGANIZATION PARTNERSHIPS
Authors: Berg-Weger Marla , Taylor Catherine 
Published: November 2019

Abstract
To develop programming consistent with value-based care principles, two GWEPs share strategies and policy implications when partnering with community-based organizations (CBO). Because the aims of value-based care – better patient outcomes and population health, reduced health care costs – cannot be achieved by changing medical practice alone, RI Geriatric Education Center (RIGEC) partners with multiple CBOs to deliver evidence-based patient education programming to empower patients/caregivers to take charge of their health. RIGEC will work directly with physician practices to bring education directly to their high-risk patient census. Saint Louis University CBO partners integrated geriatric assessment into routine care to identify geriatric syndromes. Introduction of protocols for Medicare Annual Wellness Visits, Cognitive Stimulation Therapy and exercise/strengthening enables CBOs to offer interventions. Value-based care is achieved by reducing costs as geriatric syndromes are identified earlier, enabling diagnosis, treatment, and management; improving patient outcomes and satisfaction; and strengthening provider competence in geriatric care.
WHAT IS LONELINESS: INSIGHTS FROM THE BBC LONELINESS EXPERIMENT
Authors: Victor Christina , Qualter Pamela , Barreto Manuela 
Published: November 2019

Abstract
Older peoples’ views on what defines loneliness are conspicuous by their absence. The BBC Loneliness Experiment included 3 free-text questions which aimed to address this gap in our knowledge. Participants were asked to define what loneliness meant to them; their understanding of the opposite of loneliness and if loneliness could be positive and why. There were 55,000 survey responses:12,000 aged 60+. The ‘top five’ loneliness definition were: having no one to talk to; feeling disconnected from the world; feeling left out; sadness and feeling misunderstood. The most common terms used to describe the opposite of loneliness were: being connected; contentment with social relationships; happiness; friendship and availability of people. Almost 50% reported that loneliness could be positive as did 16% of those who were often/always lonely with the reasons given for this including opportunities for personal growth, the enjoyment of being alone and knowledge that the feeling would pass
TALKING ABOUT LONELINESS
Authors: Thomas Michael 
Published: November 2019

Abstract
his paper draws on insights from a mixed methods study on temporal variations in loneliness among older people (aged 50 years plus) in England. The paper highlights alternative strategies available to participants in research interviews, including engaging with personal experience of loneliness or avoidant tactics such as digression, projection onto others or claiming ignorance of the topic. The data point towards complicating factors including a reluctance to disclose loneliness as a socially undesirable phenomenon, as well as difficulties in articulating the complexities of this topic. These considerations remind researchers of the need for reflection on the use of qualitative interviews when investigating loneliness and other difficult aspects of personal experience.
THE DAY-TO-DAY EXPERIENCES OF LATER-LIFE PROSOCIAL WORK: AN EXPERIENCE SAMPLING METHOD STUDY
Authors: Nakamura Jeanne , Tse Dwight C K , Mann Ajit , Graham Laura , Boeder Jordan , Finley Kelsey 
Published: November 2019

Abstract
As one form of productive aging, many older adults undertake significant prosocial activity. Alongside its contribution to the welfare of others, prosocial activity has been linked to a variety of positive outcomes for those undertaking it (e.g., higher life satisfaction). However, little is known about the impact of this activity on older adults’ day-to-day lives. We studied a national sample of about 150 older adults who give back to their communities on a regular basis in one of two ways: either by playing leadership roles in social-purpose organizations or as more traditional volunteer workers in such organizations. We employed the experience sampling method to describe and compare the experience of prosocial activity during a typical week for these two groups of highly engaged adults. While prosocial activity carries both costs and rewards, these show differences as well as similarities for the two groups. Implications for research and practice are discussed.
INTEREST GROUP SESSION—MEASUREMENT, STATISTICS, AND RESEARCH DESIGN: ANALYSIS OF DEVELOPMENTAL AND COMPLEX SYSTEMS: UNDERSTANDING THE DYNAMICS OF AGING
Authors: Yang Xiao , Ram Nilam , Ram Nilam 
Published: November 2019

Abstract
Aging is the product of numerous dynamic processes that span multiple domains of functioning (e.g., biological, psychological, social), multiple levels of analysis, and multiple time-scales. Scientific inquiry in many fields has benefited from articulation and analysis of complex systems. This symposium brings together a collection of papers that illustrate how dynamical systems modeling is contributing to both theory and understanding of aging. Yang and colleagues apply Boolean network approach to intensive longitudinal data to identify sequences of emotion and behavior that lead to a stable equilibrium, and suggest how that information can be used to design interventions that push individuals toward a healthier equilibrium. Rector and colleagues illustrate use of dynamic indicators and multiscale entropy measures as indicators of resilience and explain how those measures may be used in prediction of physical recovery. Brick highlights how sequence mining methods can be used to identify commonalities and differences in dynamic change, and how those patterns characterize and distinguish groups with respect to aging trajectories. Moulder and colleagues demonstrate how latent maximum Lyapunov exponents can be used to study sensitivity of individuals’ developmental trajectories to initial conditions. Boker and colleagues provide a general overview of how dynamic models, including an adaptive equilibrium regulation model, distinguish resilience to acute versus chronic stressors and patterns of regulation. Together these papers highlight the value complex system thinking can add to our understanding and optimization of aging.
OPTIMIZING INDIVIDUALS’ DAILY FUNCTION: A BOOLEAN NETWORK APPROACH FOR IDENTIFYING INTERVENTION SEQUENCES
Authors: Yang Xiao , Yang Xiao , Ram Nilam , Conroy David , Pincus Aaron , Gerstorf Denis 
Published: November 2019

Abstract
Development and aging are the product of a process wherein an individuals’ functional components co-act to produce change. System dynamics can be described using a variety of methods. In this paper we illustrate how Boolean network methods may be used to describe the sequences of emotion and behavior states that lead to a stable equilibrium – e.g., healthy function; and the interventions needed to push an individual toward healthier equilibria. We applied Boolean network models to intensive longitudinal data obtained from 150 participants (age 18-89 years) to describe individuals’ on-going psychosocial dynamics and identify the specific social behaviors that may be driving them toward undesirable and/or desirable equilibria (e.g., high and low negative emotions). Results are discussed with respect to how they inform theory about developmental systems, and construction of interventions meant to guide individuals toward healthy aging.
RESILIENCE AND RECOVERY IN OLDER ADULTS: A COMPLEX SYSTEMS APPROACH
Authors: Rector Jerrald , Rector Jerrald , Rikkert Marcel G Olde , Melis René 
Published: November 2019

Abstract
In medicine, we still cannot objectively assess who will recover from health stressors imposed by disease or its treatment. If resilience, the dynamic ability to respond to and recover from health stressors, is considered as an emergent feature of a complex system, then methodology from complexity science may help us quantify the health-promoting features that support the recovery process. This presentation describes ongoing work aimed at empirically testing the concept and predictive value of resilience by examining the extent to which small-scale responses of bodily systems (i.e. heart rate, activity) to natural (micro)perturbations and indicators of loss of complexity are related to physical functioning and recovery throughout the journey of 120 geriatric inpatients. Dynamic indicators of resilience (variance, autocorrelation) and multiscale entropy measures were estimated from continuous heart rate and accelerometer data and compared to measures of patients’ physical functioning (e.g., ADLs, frailty) at admission, discharge and 3 months later.
AN ADAPTIVE EQUILIBRIUM REGULATION MODEL OF RESILIENCE
Authors: Boker Steve , Boker Steve , Bergeman Cindy 
Published: November 2019

Abstract
Adaptive equilibrium regulation (AER) models distinguish between the effects of acute versus chronic stressors as a system responds to changes in the environment. Acute stressors have a short time interval during which the stressor is present. Chronic stressors have an onset and may also have an offset, but the stress persists over a period of weeks, months or years. Resilience to an acute stressors may involve rapid self-regulation back to equilibrium without affecting the regulation process itself. Resilience to a chronic stressor may require the system to readapt itself so that regulation of the chronic stressor becomes more effective over time. We present a differential equation model that allows for adaptation of regulation in response to chronic stress and illustrate its use in intensive longitudinal burst data from the Notre Dame Study of Health and Wellbeing.
SEQUENCE MINING FOR COMPLEX PATTERN FINDING
Authors: Brick Tim 
Published: November 2019

Abstract
The processes of aging play out across multiple variables and multiple timescales, with patterns of daily, and weekly behavior that may be influenced by each other and by changes across the aging process. Further, many of these patterns do not fit neatly into the linear modeling approaches common in the field. Sequence mining, an approach from the data mining literature, provides a means of identifying commonalities and differences in these sequences in ways that can begin to handle the multivariate and multi-timescale nature of behaviors in aging. In this talk, I present an example of sequence mining to illustrate its ability to find arbitrarily complex patterns of behavior that characterize and distinguish groups and individuals.
ASSOCIATION BETWEEN FAMILY TYPOLOGY AND COGNITIVE FUNCTION AMONG OLDER ADULTS IN THE US? FINDINGS FROM THE PINE STUDY
Authors: Li Mengting , Guo Man , Stensland Meredith , Dong XinQi 
Published: November 2019

Abstract
A broad literature has explored racial and ethnic disadvantages in cognitive aging. Migration and acculturation created additional challenges on cognitive aging of minority older immigrants. Asian Americans are the fastest growing minority group in the United States. Chinese Americans constitute the largest segment of Asian Americans. Family is a core social value in Chinese culture. Less is known regarding the impact of family relationship on cognitive function for US Chinese older immigrants. Data were derived from the Population Study of Chinese Elderly (PINE), a community-engaged, population-based epidemiological study of 3,157 US Chinese older adults aged 60 and above in the greater Chicago area from 2011-2013. A typology approach is a useful tool to operationalize multifaceted family relationships. Our prior study used Latent Class Analysis to cluster family typologies, evaluating structural, associational, affectual, functional and normative aspects of family relationship. Cognitive function was evaluated by global cognition, episodic memory, executive function, working memory, and Chinese Mini-Mental State Examination (C-MMSE). Linear regression and quantile regression were used. The findings showed detached and commanding conflicted typologies were associated with lower global cognitive function compared with unobligated ambivalent typology. Wish respect to cognitive domains, detached, commanding conflicted, and tight-knit typologies were associated with lower episodic memory, working memory, and C-MMSE than unobligated ambivalent typology, respectively. Commanding conflicted typology, featured by high intergenerational conflicts, was associated with lowest cognitive function among all typologies. Health care professionals and social service providers should focus on older adults with commanding conflicted typology and prevent them from cognitive impairment.
LONELINESS, MARITAL STATUS, AND COGNITIVE IMPAIRMENT AMONG OLDER AMERICANS
Authors: Lam Jack , Bardo Anthony R , Yamashita Takashi 
Published: November 2019

Abstract
Loneliness has been linked to increased risk of mortality and morbidity, and emergent research has identified a negative association between loneliness and cognitive functioning. While the determinants of loneliness are wide in scope, loneliness is closely tied to marital status in later life. At the same time, research has shown that those who are married have lower risk of cognitive impairment. The aim of this study was to determine the association between loneliness and cognitive impairment, and examine whether it is moderated by marital status. Data come from 9 waves of the RAND version of the HRS (1998 - 2014). Consistent with previous research, results from random effects logit models showed that loneliness is associated with greater risk of cognitive impairment [Odds-ratio (OR) = 1.41, p &lt; 0.01]. Additionally, those who are widowed (OR = 1.29, p &lt; 0.01), separated/divorced (OR = 1.33, p &lt; 0.01), or never married (OR = 1.70, p &lt; 0.01) are also more likely to have a cognitive impairment, compared to those who are married. However, the association between loneliness and cognitive function was found to only differ among those who are widowed. Contrary to expectations, widows who report feeling lonely are 29% (p &lt; 0.01) less likely to have a cognitive impairment. In sum, while loneliness and marital status are closely linked with one another, they are both independent determinants of cognitive impairment. The distinct theoretical mechanisms linking loneliness and marital status to cognitive function in later life are discussed.
DEVELOPING DEMENTIA-SPECIFIC PROVIDER TRAINING IN MENTAL HEALTH: WHAT IS THE TARGET?
Authors: Wyman Mary F , Voils Corrine I , Trivedi Ranak B , Gleason Carey E 
Published: November 2019

Abstract
Most persons with dementia (PwD) live in the community and receive mental health care in the outpatient setting, making these providers an important target for education to improve dementia care. To inform the development of training curricula, we surveyed 65 mental health providers in a Veterans Affairs outpatient clinic on perceived barriers and training needs related to service delivery to PwD and caregivers. We used an adapted version of the Sense of Competence in Dementia Care Staff scale to assess domain-specific competencies. Respondents rated this work as highly important and wanted dementia-related training. They reported low competency in person-centered care approaches and challenging clinical situations, e.g., managing risk of harm. System-level barriers affecting services for PwD were noted. Findings suggest that outpatient mental health professionals are an underutilized resource in dementia care. This work can inform the development of provider training and identification of system-level barriers in this setting.
THE RELATIONSHIP BETWEEN STAFFING AND QUALITY FOR CARE HOME RESIDENTS: A REALIST REVIEW
Authors: Spilsbury Karen , Haunch Kirsty 
Published: November 2019

Abstract
In recent years, quality of care in the sector has come under increasing scrutiny, and practice and policy concerns have been raised about staffing levels, recruitment and retention. Beyond broad recognition that ‘staff influence quality’, little is known about the care home workforce and its relationship to quality. We are undertaking the first study in the UK to address this important question, considering quality from a range of perspectives. One work package comprises a realist review to develop theoretical explanations of how, why and in what circumstances staffing promotes quality for residents and relatives. We will present three mechanisms that promote quality - individual commitment to resident focused care, reciprocity in the team, and a mandate to be creative and flexible to meet residents’ needs. We will consider the contexts required to trigger these mechanisms – staffing numbers, stability of the team, size of the team, and clear leadership.
A NEW INSTRUMENT TO DETERMINE ADEQUATE STAFFING RATIOS IN GERMAN NURSING HOMES
Authors: Wolf-Ostermann Karin , Rothgang Heinz , Darmann-Fink Ingrid , Kalwitzki Thomas , Fünfstück Mathias 
Published: November 2019

Abstract
Ever since mandatory long-term care insurance was introduced in Germany there has been concern about staffing of nursing homes. As attempts to introduce the Canadian PLAISIR system failed today staffing ratios between federal states differ by more than 20 % and perceived understaffing is a major reason for the lack of nurses. Against this background the reform act from December 2015 commissioned the development of a new instrument to identify necessary staffing ratios. The University of Bremen was mandated to develop this instrument, and will present the final product in August 2019 to the Commissioner. The contribution will describe the methods applied in developing the instrument and the resulting instrument itself which translates the number and characteristics of any given nursing home into staffing requirements according to certain degrees of qualification, thus replacing general quotas of registered nurses to auxiliary staff by individual ratios for each nursing home.
CAREGIVING AND PREPARATION FOR RETIREMENT
Authors: Porterfield Shirley L , Kwon Eunsun 
Published: November 2019

Abstract
Saving for retirement should begin with the first job, but preparation with respect to determining a specific retirement age and plans for post-retirement life, generally occurs closer to the retirement date. However, among those who provide care for family or close friends who are elderly and/or have disabilities, retirement preparation may take a back seat to more pressing current concerns. While we know quite a lot about patterns of saving for retirement and the factors that influence those patterns, we know little about retirement expectations and patterns of thinking about and planning for the broader retirement experience, particularly among caregivers. This paper uses data from the 2008-2016 rounds of the nationally-representative 1979 National Longitudinal Survey of Youth to examine retirement expectations and five areas of retirement preparation (reading, using a computer app, consulting a financial planner, calculating income, or attending meetings) among employed adults (ages 51-59 in 2016) who are or are not providing care for someone in or out of their household. Longitudinal analysis finds significantly lower retirement preparation among adults caring for someone inside versus outside the household, as well as significantly lower preparation activities among female versus male caregivers. Caregiving influences employment and, in turn, the types of retirement accounts held by men and women. Although caregiving is associated with decreased retirement savings among both men and women who have pension accounts, retirement preparation activities in 2008 and 2012 are associated with higher retirement savings in 2016.
LONG-TERM POVERTY, SPATIAL DISADVANTAGE, AND MULTIPLE EXCLUSIONS IN LATER LIFE: A CASE IN SHANGHAI
Authors: Tong Hongmei , Lai Daniel, W L , Li Lun 
Published: November 2019

Abstract
Objectives: This study aimed to examine the associations among three types of cumulative disadvantages: long term poverty, spatial disadvantage, and multiple exclusions using a Cumulative dis/advantage (CDA) and life course perspective. Method: A sample of 419 Chinese adults aged 60 and older from three communities in Shanghai completed a structured questionnaire. Multiple exclusions were measured by variables related to material resources, housing conditions, social relations, civic activities, basic services, and neighbourhood factors. Hierarchical regression was implemented by SPSS 25 and moderation analysis was performed with the SPSS macro PROCESS from Hayes (2013). Results: 39% of respondents reported that they experienced multiple exclusions and one in five respondents report often or most time living in poverty. Regression analysis indicated that experience long-term poverty and length of living in the same neighbourhood is positively associated with multiple exclusions in later life and these associations are not attenuated by demographics, and health factors. But, moderation analysis showed the length of living in the same neighbourhood has significant moderating effect on the relationship between long term poverty and multiple exclusions, particularly for older adults living in the same neighbourhood for more than 30 years. Discussion: The study findings illustrate the need to consider not only life course risks such as long-term poverty but also spatial disadvantages in addressing multiple social exclusions among older Chinese adults.
THE ROLE OF SECURED AND UNSECURED DEBT IN RETIREMENT PLANNING AMONG PRE-RETIREES
Authors: Chen Zibei , Zurlo Karen 
Published: November 2019

Abstract
The retirement landscape is transformed by the shifting of risk and responsibility to individuals, who are increasingly responsible for their retirement security. Many factors lead to indebted and overleveraged American households. Specifically, nearly 40% of Americans approaching retirement are heavily indebted. Understanding the role of secured and unsecured debt in retirement planning becomes an urgent concern because debt is highly related to well-being in retirement among a growing number of older Americans. We focus on pre-retirees because these individuals have time to earn an income and plan ahead before they commit to a fully retired lifestyle. Utilizing data from the 2015 National Financial Capability Study, we identified the secured and unsecured debt that influences retirement planning among a national sample of pre-retirees, aged 51 to 61 years. Regression and mediation analyses were used to examine the relationship between debt and retirement planning and to identify the mediating effect of having a retirement account on the relationship between unsecured and secured debt and retirement planning. Our results indicated that mortgage debt and credit card debt were negatively associated with retirement planning. Having a retirement account is positively associated with retirement planning and it also mediates the relationship between credit card debt, specifically, and retirement planning. In conclusion, we urge individuals and financial planning executives to take time during the pre-retirement years to assess various forms of debt and determine how it is affecting their retirement planning objectives. And policy-makers should address the challenges faced by indebted pre-retirees.