bluuebunny/crossref_metadata_2025_split huggingface dataset:
VALUE AND INFORMATION NEEDS FOR DEMENTIA FAMILY CAREGIVERS: CONSIDERATIONS DURING END-OF-LIFE DECISION MAKING
Authors: Schlag Karen E , Kmetz Lorie , Burrows David , Kwak Jung 
Published: November 2019

Abstract
Family caregivers often make key end-of-life care decisions for their relatives. For those caring for persons with dementia (PWDs), a third of older decedents, making end-of-life decisions as a surrogate is especially challenging. Notably, few evidence-based interventions exist to support caregivers in this capacity. Guided by the Ottawa Decision Support Framework which recognizes three determinants of informed decisions - information, value clarity, and support, the current study identifies key value considerations and information needs among family caregivers as they weigh decisions regarding hospice enrollment and artificial nutrition and hydration (AHN) for PWDs. One focus group (n=7) and four individual interviews (n=4) were conducted with dementia family caregivers. All face-to-face and telephone interviews were audio-recorded, transcribed verbatim, and verified for accuracy. Thematic analysis (Braun & Clarke, 2006) was conducted to identify and organize themes. Two main themes and subthemes emerged: 1. Caregivers expressed hospice-related values including having enough knowledge about hospice treatments for both Alzheimer’s and new symptoms, having caregiver support services, considering family needs, and weighing the extent the PWD can engage with others meaningfully and remain at home. 2. Caregivers shared AHN-related values including clearly understanding AHN treatments, services and risks for the PWD considering the patient’s functional status. Participants’ information needs reflected their priority of practical needs being met. These findings offer implications for how to design decision support tools and interventions that provide practical and specific information on the benefits and risks of hospice and AHN for PWDs and caregivers.
UNIQUE TRANSCRIPTOME OF AGE-ASSOCIATED VISCERAL FAT-RESIDENT GAMMA DELTA T CELLS
Authors: Starr Marlene E 
Published: November 2019

Abstract
Gamma delta T cells (Tγδ) are a unique group of immune cells that perform both adaptive and innate functions. We recently identified a population of Tγδ cells which show an age-dependent expansion in the visceral fat of both mice and humans. However, little is known regarding the role of these cells in the fat. The purpose of this study was to begin delineating their role by: (1) comparing the gene expression profile of visceral fat-resident Tγδ to conventional T cells (Tconv) and to circulating Tγδ, and (2) identifying age-dependent changes in gene expression within the visceral fat-resident Tγδ population. Tγδ and Tconv were magnetically purified from blood and visceral fat of young and aged mice. Using NanoString technology, we found that overall transcriptomes of Tγδ in fat and blood were strikingly different. Transcriptomes of Tγδ and Tconv within the fat were more similar, but distinct with the former having high representation of pathways related to inflammation, cytokine and chemokine signaling, and macrophage function and the latter having high representation of pathways related to T- and B-cell function and TNF superfamily. Within the Tγδ population we identified significant (&gt;1.8-fold change, p&lt;0.01) age-associated differences in expression for 8 upregulated genes (C6, Cxcl13, Prg2, Il5ra, Ctla4, Marco, Ccl8, Il10) and 10 downregulated genes (Col4a1, Xcl1, Col1a1, Cfd, Col3a1, Lbp, Thbs1, Klrd1, Il6st, Ccl17). These genes will guide further research aimed at understanding the role of these cells and how their age-associated changes contribute to chronic inflammation, an underlying component of multiple age-related diseases.
ADULT DAY HEALTH SERVICES ATTENDANCE IS LINKED TO A REDUCTION IN LONELINESS
Authors: Mak Wingyun , Burack Orah R , Reinhardt Joann P 
Published: November 2019

Abstract
Loneliness is the subjective experience of inadequate social contact, and it is linked to numerous detrimental psychological and medical outcomes like depression, cognitive decline, sleep fragmentation, metabolic syndrome, diminished immune functioning, and morbidity. Older adults with cognitive impairment and/or other comorbidities are at greater risk for loneliness due to diminishing social roles, functional status, and death of peers. They are often encouraged to attend adult day services to engage in an environment of socialization and supported activities, and in the case of adult day health services, additional medical services such as physical therapy, skilled nursing care, medical management, and nutritional counseling. In this study we examined whether attending adult day health services (ADHS) at least once a week would be associated with decreased levels of loneliness across time. Our data came from a sample of older adults attending ADHS in New York City from 2018-2019 who scored five or greater on the Nursing Facility Level of Care Index, which is a score derived from assessments of cognition, communication and vision, mood and behavior, functional status, continence, and nutritional status from the Uniform Assessment System in New York (UAS-NY). We found that attendance was linked with fewer reports of loneliness across time, ∑2(1, N=563) = 21.33, p&lt;.001. These results highlight the importance of attending adult day health services for people with a complex health status and the potential role ADHS may play in reducing loneliness in a vulnerable population.
HOUSING CONTEXT AND FUNCTIONAL HEALTH AMONG LOWER INCOME OLDER ADULTS
Authors: Webster Noah J 
Published: November 2019

Abstract
The characteristics of where older adults live have strong links with disability. Although lower income older adults experience disability at higher rates, less is known about the link between housing characteristics and functional health in this group. A within group comparison among this population is needed to understand how aspects of this vulnerable subgroup’s housing context are associated with health outcomes. The present study examines the association between housing and functional health among a U.S. nationally representative sample of independent living (i.e., not living in nursing homes or assisted living facilities) lower income adults age 65+. Using data from round one of the National Health and Aging Trends Study, a sub-sample of N=2,865 lower income (&lt;$15,000 in the past year) older adults was selected for analysis. Regression analyses indicate that lower income older adults living in multiunit buildings reported better functional health compared to those in other housing contexts (e.g., free-standing homes). This link also significantly varied by age and gender. Living in multiunit housing was associated with better functional health among those age 90+, not associated among those age 80-90, and was negatively associated among those age 65-79. In terms of gender, the link between multiunit housing and better functional health was only significant among women. Findings highlight variation in health across lower income older adults’ housing contexts. Potential explanatory mechanisms (e.g., social isolation) will be discussed. Such information can inform senior housing policy regarding best approaches to providing housing for older adults that optimizes and promotes independent living.
ELDER SEXUAL ABUSE: A REVIEW OF LEGALLY MANDATED APPROACHES TOWARD PREVENTION AND FUTURE IMPLICATIONS
Authors: Hand Michelle 
Published: November 2019

Abstract
Rape stereotypes involve the assault of young women due to sexual desire, resulting in the exclusion of older adults from sexual violence research, policies, and interventions, suggesting a need to further knowledge in this area (Bows & Westmarland, 2015). Debates also persist on the prevalence and nature of elder sexual abuse (ESA), where it occurs, and its most common perpetrators (Bows, 2018). Thus a systematic scoping review was conducted to explore the nature and prevalence of ESA as well as mandated prevention and intervention strategies to guide practice, policy, research and education on prevention. Eligible sources were research-based and focused on the nature of ESA along with legal prevention and/or intervention mandates. In total, 38 peer-reviewed articles and reports were screened in for review, obtained from AgeLine, EBSCO, Clinical Key Flex, PubMed, Google, and Google Scholar databases. Findings suggest while consensus has not been reached (Bows, 2018), ESA estimates range from 0.2% to 7% of U.S. elder abuse cases, yet actual rates are likely much higher due to underreporting (Cannell et al., 2014). Additionally, results suggest ESA most often occurs in nursing homes, predominantly perpetrated by staff or residents (Ramsey-Klawsnik et al., 2008). Still, ESA remains underreported despite several mandated approaches to prevention and intervention (Payne, 2010). Thus findings demonstrate a need for reliable estimates of prevalence, location as well as common victim-perpetrator relations and awareness of required steps toward prevention and intervention (Payne, 2010). Beyond this, transdisciplinary efforts are needed to yield effective training, education, and culturally appropriate resources.
RATINGS OF PERCEIVED EXERTION: PREDICTING MOBILITY DISABILITY AND RESPONSE TO PHYSICAL ACTIVITY IN OLDER ADULTS
Authors: Cenko Erta , Gill Thomas M , Glynn Nancy W , Pahor Marco , Qiu Peihua , Valiani Vincenzo , You Lu , Manini Todd M 
Published: November 2019

Abstract
Ratings of perceived exertion (RPE) during exercise are linked to several physiological indices and are often elevated in older adults. This study evaluated the association between RPE of walking and incident major mobility disability (MMD) as well as response to a physical activity (PA) program. Older adults (n=1633) at-risk for mobility impairment were randomized to a structured PA or health education (HE) program. During a 400m walk, participants rated exertion as “none”, “light”, “somewhat hard” or “hard”. An MMD event was defined as the inability to complete the 400m walk. Transitions between RPE states and an MMD event—when RPE was not collected— were assessed over the follow-up (every 6 months for an average of 2.6 years). Participants rating their exertion as “hard” at baseline 400m walk had nearly 3-fold higher risk of MMD compared with those rating as “light” (HR: 2.61, 95%CI: 2.19-3.11). During follow-up, the PA group was 25% more likely to transition from “light” to “hard” RPE (1.25, 1.05-1.49), but was 27% (0.73, 0.55 – 0.97) less likely to transition from a “hard” RPE to MMD than the HE group. Additionally, the PA group was more likely to transition from an MMD event to a “hard” RPE (2.09, 1.38-3.17) than the HE group (i.e. recovery). Older adults rating “hard” effort during a standardized walk test were at increased risk of MMD. A structured PA program increased transition from light to hard effort, which may reflect greater capacity to perform the test and increased recovery from an MMD event.
STARTING THE CONVERSATION: RESULTS FROM AN INTERPROFESSIONAL WORKSHOP ABOUT ADVANCE CARE PLANNING
Authors: Barnes Stacy L , Breakwell Susan , Cannon Jordan 
Published: November 2019

Abstract
Advance care planning is more than documenting end of life medical decisions; it should be the beginning of an important and ongoing conversation about personal values, goals, and preferences. Health profession students must be prepared to have these conversations and overcome any existing barriers to effective patient-provider communication. To this end, a multidisciplinary planning team from Marquette University and the Medical College of Wisconsin developed a 2-hour workshop directed at students in the health professions. It was designed to be highly interactive, including guided self-reflection, drawing, writing, videos, small group work, case presentations, and large group discussion. The workshop was scheduled to coincide with National Healthcare Decisions Day (April 16th). A total of 149 students participated, representing the disciplines of medicine, nursing, physician assistants, counseling psychology, speech pathology, and biomedical sciences. Feedback from both students and faculty was overwhelmingly positive, indicating interest and need for this type of program. A post-event questionnaire, which included a retrospective pre/post-test, assessed learners’ gains in knowledge and self-efficacy. Significant (&lt; 0.001) gains were found on all measured items. Data from an electronic follow-up survey suggested the majority of participants took additional actions steps related to advance care planning in the month following the workshop. In conclusion, this is a low-cost, replicable workshop that aligns with current recommendations for advanced care planning (IOM, 2015), is well received by students and faculty in the health professions, and may serve as a springboard for increasing the number of advance care planning conversations.
“THEY SHOULD PUT ALZHEIMER’S GROUPS IN THE CHURCHES”: A SYNTHESIS OF AFRICAN AMERICAN CAREGIVERS’ LIVED EXPERIENCES
Authors: Murphy Erin R , Brooks Destony , Bryant Julie , Fields Noelle L , Xu Ling 
Published: November 2019

Abstract
Alzheimer’s disease and related dementias (ADRD) are challenging chronic health conditions that disproportionately impact African Americans. Caring for a family member with ADRD can be a taxing experience that impacts the mental, social, and physical realms of the caregiver’s life. Chronic fatigue and high levels of anxiety, depression, and agitation have all been associated with caregiving. The extant literature on caregivers is limited by being conducted primarily in settings with White participants, excluding the cultural attitudes and values that may impact caregiver experience. As part of a larger, mixed-methods team studying the impact of an innovative psychoeducational intervention, the researchers conducted a qualitative interpretive meta-synthesis (QIMS) to better understand the experiences and perceptions of African Americans who care for family members with ADRD. A QIMS was chosen as the methodology for this study because of its ability to create a more holistic understanding of the phenomenon, while maintaining the integrity of the original studies. An exhaustive literature search yielded 1,285 potentially relevant studies. Studies were compared across a priori inclusion criteria. Findings of this study indicate that overall knowledge of ADRD is relatively low among caregivers and participants are unsure of how to access educational materials. Synthesis of these studies also indicate a need for incorporating spiritual well-being into caregiving services. Results of this study may help social workers and other health care professionals to better understand cultural perceptions of the disease and how to better provide psychoeducational interventions related to the specific needs of African American caregivers.
PHYSICAL THERAPY STUDENTS' ATTITUDES TOWARDS WORKING WITH PEOPLE WITH DEMENTIA AFTER VARIOUS LEARNING EXPERIENCES
Authors: Vincenzo Jennifer L , Bennett Holly 
Published: November 2019

Abstract
Working with people with dementia (PWD) can be challenging even for the most seasoned health professionals. Hence, teaching health professional students how to effectively work with this patient population is of importance. Two cohorts (n=43; aged 23-36 years) of Graduate Physical Therapy students participated in multi-modal learning experiences geared towards working with PWD within a geriatrics course. Modules included: 1) online lectures and readings followed by a team based learning activity, 2) 3 hours of ‘positive approaches to care’ along with a simulated experience of performing Activities of Daily living and Instrumental Activities of Daily Living of PWD, and 3) one-on-one interactions during both lunch and dinnertime with at least three PWD residing in a state veteran’s home. The Dementia Attitudes Scale (DAS) was used to measure attitudes of students at baseline and following each activity. Repeated measures analysis of variance revealed a significant increase in positive attitudes of students working with PWD across each activity (98.2 +/- 10.5 baseline) with the most positive attitudes noted after interactions with PWD in a state veteran’s home (111.2 +/- 15.0), [F (2.0, 83.8) = 19.4, p &lt; .01, partial eta^2 = .32]. However, this difference was not significant when controlling for students who had previous experience interacting with PWD . In conclusion, Doctor of Physical Therapy students’ attitudes towards PWD improve with different learning experiences, with the greatest improvements after one on one interactions with PWD if the student did not have prior experience interacting with PWD.
NOVEL GAMMA-SECRETASE MODULATOR REGULATES APP PROCESSING AND INFLAMMATORY RESPONSES IN NPM-EXPOSED MICE
Authors: D'Agostino Carla , Cacciottolo Mafalda , Sioutas Constantinos , Wagner Steven L , Tanzi Rudolph E , Morgan Todd E , Finch Caleb E 
Published: November 2019

Abstract
Air pollution is associated with accelerated cognitive decline and increased risk of dementia in older populations (Cacciottolo et al 2017; Chen et al 2017). Rodent models of air pollution exposure also show Alzheimer-like changes including glial inflammatory responses and increased levels of endogenous amyloid beta (Aβ) peptides (Cacciottolo et al 2017 Levesque et al 2011). We hypothesized that pharmacological inhibition of Aβ production during nPM exposure would attenuate the amyloidogenic processing of APP and glial inflammatory responses. This hypothesis was tested using the γ-secretase modulator (GSM) (BPN-15606) which decreases Aβ42 levels in wild-type rodents (Wagner et al 2017; Kounnas et al. 2010). After nPM exposure of C57BL/6J male mice for 8 weeks, GSM-feeding attenuated pro-amyloidogenic and microglial inflammatory responses. Cerebral cortex levels of Aβ40 and 42 peptides were decreased by 35% and 45% respectively in mice exposed to filtered air and fed with GSM. Hippocampal levels of microglial Iba1 remained at control levels, a decrement of 50% below GSM treated mice. We suggest the Alzheimer candidate drug BPN-15606 has potential benefits to reducing the possible impact of urban air pollution in cognitive aging and Alzheimer risk. The attenuation of pro-amyloidogenic and microglial inflammatory responses is consistent with a role of endogenous Aβ levels in glial inflammatory responses and cognitive impairments from air pollution. Cacciottolo et al 2017, PMID 28140404; Chen H et al. 2017, PMID: 28917207; Levesque et al 2011, PMID 21864400; Wagner et al 2017, PMID 28416568; Kounnas 2010, PMID 20826309 Funding: P01 AG055367, R21AG050201, Cure Alzheimer’s Fund
PROGRESSIVE CARE OF AN AGING WOMAN: INTERACTIVE VIDEO SIMULATION CASES SPANNING 15 YEARS
Authors: Kennedy-Malone Laurie M , Amirehsani Karen , Zimmer Rachel , Borders Joshua 
Published: November 2019

Abstract
As a means of enhancing experiential educational opportunities for adult-gerontology nurse practitioner students who are prepared to manage the complex care of older adults, interactive simulation videos were developed using the eLearning authoring tool H5P to create learning experiences for students that can be used either in face to face classroom experiences or embedded in learning management systems. H5P is a web-based authoring tool that helps faculty build interactive course content. H5P activities provide instant feedback to students, allowing them to self-assess their understanding of the dynamic video simulation case. With funding through the Health Resources and Service Administration Advanced Nursing Education Workforce grant, four video simulation cases were developed that address emerging chronic care conditions in an older women who aged 15 years presenting initially with signs of hypothyroidism, progressed to early frailty, through moderate dementia and eventually along with her daughter face end of life health care issues. Partnering with the university instructional design experts, nurse practitioner faculty created questions that were inserted throughout the video as a means of keeping students engaged in problem-solving and decision making. A faculty handbook that described the case scenario with the interactive questions with suggested discussion questions was developed for each video simulation. The adult-gerontology primary care nurse practitioner competencies addressed in each case are identified in the handbook. Recommendations for the interactive question format will be presented and QR codes with access to direct viewing of the videos will be presented on the poster.
MAKING OLD BONES: QUALITY IMPROVEMENT IN OSTEOPOROSIS MANAGEMENT IN A GERIATRIC PRIMARY CARE CLINIC
Authors: Gilliam Meredith , Vereen Sabrina 
Published: November 2019

Abstract
Osteoporotic fractures and their sequelae are a leading cause of morbidity and mortality in older adults. In the United States, nearly 50% of white women and 20% of black women and white men will suffer a fragility fracture in his or her lifetime. Osteoporosis medications reduce the risk of major fragility fracture by 31-62%, but numerous care gaps exist, including screening rates as low as 1-47% and treatment rates as low as 16-30% even after a fracture has already occurred. From January to August 2019, we conducted a multi-faceted quality improvement project at a university hospital-based geriatric primary care clinic, with a goal of improving our rates of osteoporosis screening and treatment. We designed and tested electronic health record-based registries of eligible patients, and developed patient outreach workflows and physician “inreach” workflows. We piloted a bone health clinic. While we did not meaningfully affect the rate of osteoporosis screening, our efforts resulted in an increase in treatment of osteoporosis from 49% to 53%. Documentation of osteoporosis decision making among eligible patients improved from 66% to 80%. In our clinic, ongoing barriers to evidence-based osteoporosis management include competition for time with other medical issues, patient mistrust of medications, and the complexity of decision making around osteoporosis in older adults with polypharmacy and limited life expectancy. Future work must balance the broad application of treatment guidelines via population health tools with the need to individualize treatment decisions for each patient’s overall health and goals of care.