bluuebunny/crossref_metadata_2025_split huggingface dataset:
DEMENTIA CARE AND BEHAVIORAL HEALTH WORKFORCE DEVELOPMENT: INNOVATIONS IN TRAINING ACROSS SETTINGS
Authors: Wyman Mary F , Cimarolli Verena R , Stone Robyn 
Published: November 2019

Abstract
It is well-established that there is a critical shortage of trained health care staff who can deliver high-quality behavioral health services to persons with dementia. The development of innovative professional training curricula, and effectively implementing and sustaining such programs, is a key element in addressing this workforce crisis. This symposium highlights cutting-edge efforts being conducted across the continuum of care, to train health care professionals to support optimal behavioral health for persons with dementia. In the outpatient setting, Wyman et al. present data from a survey of mental health clinicians on their perspectives about working with persons with dementia and caregivers, revealing critical gaps in knowledge and skills to target in continuing education programming. Wray and colleagues focus on integrated behavioral health in primary care, discussing how geriatric experts can most effectively contribute to improved assessment and treatment within this setting. Koepp presents an innovative program to transform outpatient mental health care for persons with dementia through provider training and consultation. In the residential care setting, Reinhardt and colleagues report on the implementation of a comprehensive approach to the alleviation of behavioral health problems through training direct care staff in person-directed care in nursing homes. Finally, Karel et al share how VA interprofessional nursing home teams learn and sustain an evidence-based program to address behavioral concerns among residents with dementia. The discussant will lend a deep expertise in research and policy related to the geriatric workforce to her remarks on the presentations.
BEHAVIORAL HEALTH WORKFORCE DEVELOPMENT TO IMPROVE DEMENTIA CARE IN INTEGRATED PRIMARY CARE
Authors: Wray Laura O , Vest Bonnie M , Brady Laura Levon , King Paul R 
Published: November 2019

Abstract
People with dementia (PwD) receive most of their health care in primary care, yet timely recognition and optimal management of dementia in that setting continues to be challenging. Implementation of primary care medical home models in the Veterans Health Administration (VHA) holds promise for improving quality and coordination of dementia care through interprofessional collaboration. Integrating behavioral health providers (BHPs) into primary care may help to support the care of people with dementia and their families. However, most integrated BHPs have a generalist training background and likely require professional education to address the unique needs of patients with dementia. We will describe findings from a national VHA education needs survey of integrated BHPs and an in-depth qualitative study examining primary care for PwD in two large VHA healthcare systems. We will discuss how geriatric experts can serve as trainers to address current gaps in primary care of PwD.
TRANSFORMING DEMENTIA SERVICE DELIVERY: THE MENTAL HEALTH GERO-CHAMPIONS PROGRAM
Authors: Koepp Regina M 
Published: November 2019

Abstract
In order to provide effective mental health care to older adults with major neurocognitive disorders (e.g., Alzheimer’s disease and related dementias) within outpatient mental health clinics, mental health practitioners must possess a basic understanding of these disorders, the needs of and challenges faced by people living with dementia and their families, and effective treatment approaches for this population. The Mental Health Gero-Champions Program was established in 2015 at a large Veterans Affairs medical center with the aim of providing clinical support and opportunities for training to multidisciplinary mental health providers to enhance skills in assessing and treating older adults with neurocognitive disorders. This presentation will provide an overview of the Mental Health Gero-Champions Program, describe the development and implementation of this program, and discuss challenges and successes in sustaining this transformative initiative over time.
INTEREST GROUP SESSION—SYSTEMS RESEARCH IN LONG TERM CARE: DEVELOPING AN EVIDENCE BASE FOR NURSING HOME STAFFING IN EUROPE AND BEYOND: MANY PATHS TO ONE GOAL?
Authors: Hamers Jan , Backhaus Ramona , Corazzini Kirsten 
Published: November 2019

Abstract
Despite heterogeneity across countries, nursing homes worldwide have to ensure the delivery of high quality care. At the same time, adequately staffing the homes remains a major concern in most countries. It is a significant challenge to determine the numbers and type of staff as well as staff’s competencies that are necessary to meet the complex needs of nursing home residents. While, especially in the US, research on the relationship between staffing and quality in nursing homes has received considerable attention, the research literature is contradictory. Evidence shows that employing more staff or more registered nurses instead of nurse assistants will not automatically lead to better nursing home quality. This inconsistency of evidence might be explained by a myriad of methodological and theoretical challenges. This symposium aims to provide an international perspective on how researchers from different European countries contribute to the development of an evidence base for nursing home staffing. The first presenter will draw on findings from a realist review conducted in the UK, focusing on the mechanisms (how, why and in what circumstances) under which staff influence care home quality. The second presenter will offer insights into a Swiss study, taking a broader perspective on measuring staffing and quality in nursing homes. The third presenter will present a new instrument to identify staffing ratios in German nursing homes and provide insight into its development process. The fourth presenter will discuss the results of a critical review on the evidence base of a Dutch nursing home staffing guideline.
IMPROVING PRIMARY CARE PROVIDER EDUCATION AND SATISFACTION VIA THE CATCH-ON LEARNING COMMUNITIES
Authors: Emery-Tiburcio Erin , Bednarcyzk Magdalena , Wallace Febe , Newman Michelle 
Published: November 2019

Abstract
Nationally, there is a shortage of geriatric trained healthcare providers caring for older adults. As the population of older adults grows, health care systems and primary care providers struggle to provide high quality, cost effective care for older adults. Time for training is also limited in busy community health centers. The CATCH-ON Learning Communities (LCs) are telehealth educational interventions based on the ECHO model, modified to be less time intensive, thus decreasing cost to participating clinics. In the LC, geriatric specialists provide evidence-based, best practice training utilizing case discussions to illustrate pertinent learning points via monthly one hour video conferences. Practical, specific behavioral recommendations are offered for immediate implementation in each session. LCs are provided to interprofessional primary care teams. The first LC with a federally-qualified health center (FQHC) yielded consistently high satisfaction from participants, along with a 17% decrease in high risk medication prescriptions and 22% increase in falls screenings. Training the primary care workforce in evidence based geriatric interventions can improve the care of all older adults within each health system, improving healthcare access to help mitigate healthcare inequalities, slow adoption of best practices and rising costs of caring for complex older adults. The CATCH-ON Learning Community is an effective, low cost model of training the primary care work force without geographical or financial constraints that frequently limit access to specialized care.
PATTERNS OF WEALTH TRAJECTORY IN LATER LIFE: CRITICAL PERIOD, ACCUMULATION, AND SOCIAL MOBILITY MODELS
Authors: Chen Yu-Chih , Park Sojung , Morrow-Howell Nancy 
Published: November 2019

Abstract
Wealth, an important financial cushion for older adults to buffer economic stress, requires a longer time to accumulate and develop in one’s course of life. However, little is known about the trajectories of wealth in later life, and how the life course socioeconomic status (SES) may contribute to the development of wealth at old-age. This study investigated longitudinal patterns of wealth trajectory and whether SES across the life course affects these trajectories using critical period, accumulation, and social mobility models. Using data from 16,189 adults aged 51 and older from the 2004-2014 Health and Retirement Study, a growth mixture model was used to explore distinct wealth trajectories. Impacts of life course models were studied using multinomial logistic regression. Results showed that four heterogeneous latent classes of wealth were identified: Stable high (reference group), Low and increasing, Stable low, and High but decline. Disadvantaged adulthood SES, accumulated exposure to socioeconomic risks, and downward or persistent socioeconomic disadvantage over the life course were associated with Stable low, Low and increasing, and High but decline, supporting all three life course mechanisms on wealth development in later life. Evidence suggests that wealth development is heterogeneous across individuals, and a strong gradient effect of life-course SES on wealth trajectories are clearly observed. Programs and policies should address the effects of life course on wealth development to strengthen the economic well-being in later life.
CAREGIVER DEPRESSIVE SYMPTOM SEVERITY AMONG OLDER ADULTS WITH COGNITIVE VULNERABILITY
Authors: Fortinsky Richard H , Wakefield Dorothy 
Published: November 2019

Abstract
While caregivers of older adults with dementia often report considerable levels of depressive symptoms, much less is known about depressive symptoms among family members of older adults with depression or recent delirium. As part of an ongoing randomized clinical trial testing an in-home multidisciplinary team intervention for older adults with cognitive vulnerability due to dementia, depression, and/or delirium (care recipients, or CR) and their caregivers, in this presentation we report baseline data from the first 211 dyads enrolled in the trial to determine how caregiver depressive symptom severity is related to: CR diagnoses; CR cognitive impairment severity; and CR depressive symptom severity. CR diagnostic groups: Depression Only (n=49); Dementia Only (n=61); Depression and Dementia Only (n=47); Delirium Plus (n=54). Depressive symptom severity was measured using the Center for Epidemiologic Studies Depression Scale; CR cognitive symptom severity was measured using the Telephone Interview for Cognitive Status. Among CR, 57% were female, mean/sd age=77/6.9, 93% White; among caregivers, 64% were female, mean/sd age=66/13.7, 91% White, 55% spouses, 25% daughters, 9% sons. In multivariate linear regression models, which included covariates caregiver gender, relationship to CR, and number of hours/week providing care, we found that caregiver depressive symptom severity was less severe among caregivers of CR with Dementia Only compared to CR with Depression Only (b=-3.32; p=0.06); not associated with CR cognitive symptom severity; and significantly associated with CR depressive symptom severity (b=0.14; p&lt;0.01). We conclude that family members of older adults with depression deserve greater attention to address their own depressive symptoms.
FACTORS ASSOCIATED WITH UNMET NEED AMONG FAMILY CAREGIVERS
Authors: Campione Joanne R , Zebrak Katarzyna 
Published: November 2019

Abstract
This study investigates the relationship between caregiver demographics, caregiving intensity, caregiver support use, and aspects of the caregiving situation with perceived unmet need. The data source was survey response data from 1,558 informal caregivers caring for older adults (age 60+) or caring for any adult with Alzheimer’s disease or related dementia (ADRD). Participants were randomly recruited through U.S. Area Agencies on Aging client lists of any service and interviewed in December 2016. Caregivers were asked, “Are you receiving all the help you need?” Twenty-two percent (n=345) said “Definitely No” and were classified as having unmet need. We placed caregivers in tertiles based on their Zarit burden score; unmet need was 14% among low burden, 20% among medium, and 34% among high. The mean age of the care recipient (CR) was 81 years. Caregivers were 70% non-Hispanic White, 52% caring for CR with ADRD, and 43% spouse of CR. A multivariable logistic regression found two predictive factors (odds ratio p-value &lt; 0.01) that increased the likelihood of reporting unmet need: daily intensity of caregiving and not feeling appreciated by CR. Usage of caregiver education, counseling or support group services in the past 6 months decreased the likelihood of reporting unmet need. In the high burden subgroup, Black caregivers were more likely to report unmet need than White caregivers. Understanding the relationship between caregiver demographics, self-reported burden level, service use, and the caregiver’s need for more help can assist caregiver support programs in assessing, measuring, and addressing the ongoing needs of caregivers.
WHOM DO WE SERVE? DIVERSITY OF OLDER COMMUNITY CARE RECIPIENTS’ FUNCTIONING ACROSS EUROPE
Authors: Stoop Annerieke , Lette Manon , de Bruin Simone , Nijpels Giel , van Hout Hein 
Published: November 2019

Abstract
Across Europe, an increasing number of older people with multiple health and social care needs stay in their own homes until old age. Community care aims to support them to live at home for as long as possible. Comparative studies showed that population characteristics of older community care recipients differ between European countries. This is due to differences in financing, delivery and governance of community care. However, little is known about differences in health, including physical, cognitive, mental and social functioning, of older community care recipients served across European countries. The aim of this study was to provide insight into these differences. We used data of the IBenC study, which was collected using the interRAI HC-Assessment among 2884 older community care recipients from six European countries: Belgium, Finland, Germany, Iceland, Italy and the Netherlands. We found that prevalences of impairments in different health domains were highest among Italian community care recipients followed by the Belgian population, and lowest among community care recipients from the Netherlands. Feelings of loneliness were lowest among the Italian and highest among the Dutch population. This variation between European countries may be explained by differences in eligibility for and access to formal community services and informal care provision as well as cultural diversity. Insight in these differences supports understanding of community care across Europe among European and national policy-makers and researchers.
FROM BIG DATA TO COMMUNITY SETTINGS: HOW CAN EXERCISE IMPROVE HEALTH OUTCOMES IN OLDER CANCER SURVIVORS?
Authors: Bluethmann Shirley M , Leach Corinne 
Published: November 2019

Abstract
Current guidelines recommend that survivors achieve regular physical activity and reduced inactivity to attenuate cancer and mortality risk and to promote quality of life. Optimal ways of obtaining physical activity or measuring how much exercise has been achieved continues to be a challenge, especially among older adults and cancer survivors. Our symposium will provide insights using big data to understand population level patterns of activity and potential benefits for survivors, examining implications for survival and key health outcomes, including multimorbidity and functional limitations. We will also discuss social and environmental determinants that may be important for older survivors in designing community interventions, especially in rural communities. These include considerations related to the built environment and social support to promote leisure-time physical activity in older survivors.
GAPS AND OPPORTUNITIES TO IMPROVE ACCESS TO HEALTHCARE FOR OLDER RURAL VETERANS
Authors: Hicken Bret , Seaman Aaron T , Moo Lauren 
Published: November 2019

Abstract
Almost 25% of US military veterans live in rural areas and over 70% of these are age 55 years or older. The physical, cognitive, and functional declines common to aging coupled with accumulated physical and psychological traumas often incurred through military service make caring for older Veterans an especially difficult challenge. Furthermore, the geographic distances associated with rural living pose a significant barrier to timely access to care for aging Veterans and caregivers living in remote communities. Significant gaps remain in VA’s understanding of the needs of this population, which is essential for developing adequate models of care. This symposium highlights various aspects of the rural older Veteran experience and will suggest opportunities for improving access to care for this population. The first presentation estimates the differential impact of rural status on mortality rates among older Veterans using mortality data from the General Social Survey (Wilmoth et al). A second study is an analysis of urban/rural differences in PTSD symptoms as function of multiple co-factors and accounting for geographic location (Kurth et al). Seaman et al present qualitative data regarding the experience of Veterans with head and neck cancer to understand how rurality impacts cancer survival (Seaman et al). The final presentation will highlight a model to address mental health problems in older Veterans in primary care (Geri-PACT [Kube et al]) and will specifically highlight how this VA program may be adapted to address such needs the needs of older Veterans in rural areas.
PTSD SYMPTOMS AMONG VIETNAM, PERSIAN GULF, AND OEF/OIF/OND VETERANS: A RURAL/URBAN COMPARISON
Authors: Kurth Maria , Choun Soyoung , Lee Dylan , Rothwell David , aldwin Carolyn 
Published: November 2019

Abstract
There are mixed results in studies examining rural/urban differences in PTSD symptoms among veterans; however, many of these studies failed to consider possible confounds with geographic location. This study examined rural/urban differences in PTSD symptoms by combat exposure, war cohort, and gender. The VALOR (Veterans Aging: Longitudinal studies in Oregon) pilot study sampled Vietnam, Persian Gulf, and OEF/OIF/OND war cohorts using an online survey. The sample (N=237, Mage=57.84, SD=12.68) was mainly male (65%), White (85%), and urban (75.95%); most reported combat exposure (71%). Participants completed measures of PTSD, combat exposure, and demographics. Results indicate no effect of cohort or rural/urban status on PTSD symptoms. There was a significant effect of combat exposure, F(1,224)=4.58, p=.03, and gender, F(1,224)=4.13, p =.04, with males reporting higher levels of PTSD symptoms and combat exposure. Contrary to our expectations, there were no effects of cohort or geographic location on PTSD symptoms.
THE ROLE OF COMMUNITY ENGAGEMENT IN HURRICANE PREPAREDNESS AS PERCEIVED BY ASSISTED LIVING ADMINISTRATORS
Authors: Dobbs Debra J , June Joseph , Peterson Lindsay J , Dosa David , Jester Dylan , Hyer Kathyrn 
Published: November 2019

Abstract
The importance of communities in disasters has been well established since Hurricane Katrina. Smit and Wandel’s bottom-up approach to assess risks during a disaster involves community stakeholders. Administrators of assisted living (AL) environments increasingly have to assess the risks of hurricane evacuation for vulnerable older adults. The current study examines intersections between social networks, communication and preparedness during a hurricane for AL administrators. We conducted focus groups and interviews with AL administrators (N=60) in Florida about communication patterns with community associations, emergency management officials, AL staff, residents and their families during Hurricane Irma (2017) and about their perceptions of preparedness. A content analysis approach was used. Atlas.ti v7 was used for initial and axial coding. Co-occurrences were found among communication and preparedness themes. Some prevalent themes included “social capital”, “high versus low tech strategies” and “leadership effectiveness”. Themes intersected with individual administrator and AL organizational characteristics.
CONTROVERSIES AND CHALLENGES IN DEFINING SARCOPENIC OBESITY
Authors: Batsis John A 
Published: November 2019

Abstract
Sarcopenia is defined as the loss of muscle mass, strength and physical function with aging and in conjunction with obesity, leads to incrementally adverse outcomes. There is no current consensus for defining this disease entity, making an accurate evaluation challenging in both the research and clinical settings. We will review the definitions put forth by the Sarcopenia Definition and Outcomes Consortium and the European Working Group for the Study of Sarcopenia. We will present data highlighting the different diagnostic criteria of sarcopenic obesity and the diagnostic accuracy of common anthropometric measures in measuring adiposity using data from the National Health and Nutrition Examination surveys. The advantages and disadvantages of the different modalities of assessing body composition will be discussed, including body impedance analysis, dual energy x-ray absorptiometry, computer tomography and magnetic resonance imaging in addition to simple, novel clinical screening tools for obesity sarcopenia will be presented.
DETERMINANTS OF GENERAL WELL-BEING IN BLACK MALES WITH CHRONIC ILLNESS
Authors: Atakere Darlingtina 
Published: November 2019

Abstract
Over the last decades, considerable attention has been directed towards examining the well-being of people living with chronic illness. The presence of one or more chronic illnesses challenges their quality of life and general well-being, thus, impacting their abilities to function physically, psychologically, and socially. I investigated reports of general well-being in Black males with chronic illness(es) in a sample of N=242 participants. The males were aged 35–63 and identified as Black/African American males. The participants responded to items assessing general well-being; ethnic identity; self-esteem; active coping; the presence of chronic illness(es); and additional demographic, social and ecological characteristics. Analyses of responses indicated that marital status, ethnic identity, self-esteem are significant determinants of general well-being in Black males with chronic illness(es). Data further showed active coping to be negatively correlated with well-being. I discuss the implications of results for the understanding of health outcomes among this marginalized population.
AGING AND MITOCHONDRIAL DISEASE: SHARED MECHANISMS AND THERAPIES?
Authors: Bitto Alessandro , Tung Herman , Ying Kejun , Smith Daniel L , Kayser Ernst-Bernhard , Morgan Philip G , Sedensky Margaret M , Kaeberlein Matt 
Published: November 2019

Abstract
Mitochondrial disease describes multiple pathologies characterized by a wide array of disease symptoms and severity, caused by mitochondrial dysfunction in one or multiple organs. Aging organisms display a similar variety of disease phenotypes, which are often characterized by mitochondrial impairment. Despite the heterogeneity of aging phenotypes, several interventions have been identified which can increase lifespan and delay the onset of age-related diseases in multiple organisms. Two age-delaying interventions, rapamycin and acarbose, dramatically suppress pathology in a mouse model of mitochondrial disease caused by depletion of the NADH-Ubiquinone Oxidoreductase Complex (Ndufs4-/-). This model recapitulates human Leigh syndrome, a childhood mitochondrial disease. Upon treatment with either drug, disease suppression is accompanied by a remodeling of nutrient metabolism and restoration of the NAD+/NADH ratio in the brain without affecting the electron transport chain. Thus, we propose that metabolic derangements induced by mitochondrial dysfunction may be a shared mechanism of aging and mitochondrial disease.