bluuebunny/crossref_metadata_2025_split huggingface dataset:
ROLE MODEL OF AGING AND ATTITUDES TOWARD AGING IN ASIAN AMERICANS
Authors: Jung Seojung , Jopp Daniela 
Published: November 2019

Abstract
While having a role model for successful aging may have a beneficial influence and promote successful aging throughout the course of one’s life, very little empirical research has examined role models for successful aging, particularly among Asian Americans. The current study examined Asian Americans’ role models for successful aging and their link with attitudes toward own aging with a sample of 135 individuals aged 18 to 74 years (Mage = 36.76, SD = 14.73; female, 71.9%). Participants were asked whether they had a specific role model for successful aging and, if they had, the reasons why the role models were chosen. Participants’ open-ended answers were then analyzed using qualitative content analysis using a coding scheme drawn from a prior study on role models for successful aging (Jopp et al., 2016). The categories most often mentioned were public figures, followed by parents, other relatives, non-specific persons, grandparents, non-family acquaintances, and self. Participants with at least one family role model were more likely to have positive attitudes toward aging, and this effect was strong even after controlling for ethnic identity, filial obligation, self-rated health, and other demographic variables. The present study suggests that Asian Americans identify role models for successful aging both within their immediate families and among public figures, while family role models are more likely to promote the development of positive attitudes toward own aging. The implications for understanding Asian Americans’ role models on motivating, promoting, and facilitating positive aging processes will be discussed.
MEDICATION DISCREPANCIES AND COMMUNICATION ERRORS DURING NURSING HOME INTAKE: A MIXED-METHODS ANALYSIS
Authors: Patterson Mark E , Bollinger Sandra , Foust Janice 
Published: November 2019

Abstract
Older adults experience high medication discrepancy rates during transitions from inpatient to nursing home settings. Dosage changes and multiple prescribers increases the risk of inaccurate handoffs and creates challenges for medication reconciliation at nursing home intake. Our objectives were to 1) Characterize medication discrepancies occurring at nursing home intake and 2) Identify resident and medication related factors associated with medication discrepancies. Demographics, comorbidities, medications, discrepancy types and location were prospectively collected over 9-months. Chi-square tests were used to determine factors associated with discrepancies. A focus group of nurse practitioners, pharmacists, and administrators from four long-term care facilities was convened to discuss medication reconciliation challenges at resident intake. Thematic analysis was used to determine key themes. 22%, 12%, and 3% of residents experienced one, 2 to 5, or six or more discrepancies, respectively. The most prevalent discrepancies were omission (34%), frequency (20%), and therapeutic duplication (13%) occurring in analgesics, respiratory and genitourinary medications. 44% of discrepancies occurred between nursing homes and hospitals and 39% involved the community pharmacy. The most significant risk factors for discrepancies included age over 70, Charlson comorbidity indices over 7, readmission to nursing homes, or the prescribing of at least 17 medications. Staff faced challenges of delayed and/or inaccurate data, incompatible documentation forms and inefficient workflows for resolving discrepancies. Residents at greatest risk for medication discrepancies require additional attention during admission medication reconciliation to prevent errors. Nursing home intake and medication reconciliation workflow needs to be improved with data sharing technology to increase accuracy and efficiency.
THE IMPACT OF MUSIC AND MEMORYSM ON RESIDENT MOOD, BEHAVIORS, AND USE OF MEDICATIONS IN NURSING HOMES
Authors: Bakerjian Debra , Bettega Kristen , Marin-Cachu Ana , Azzis Leslie , Taylor Sandra 
Published: November 2019

Abstract
The numbers of Americans with dementia are projected to increase by 44.8% by 2025. Many of these patients are cared for in nursing homes (NH), 70% of NH residents with dementia have been reported to have significant behavioral or psychiatric symptoms (BPSD) that are often challenging to manage. Historically, the first lines of treatment for BPSD has been antipsychotic medications; however, serious adverse effects have been associated with these drugs. Our main aim was to study the effects of Music and MemorySM (M&M), a personalized music program, on improving behaviors and reducing antipsychotics and other medications in residents with dementia in participating NHs. This 3-year, quasi-experimental, mixed methods study used a cluster, randomized design in three phases. We used the Qualtrics Research Suite to create and disseminate a baseline survey and a 4-part quarterly survey thereafter. The quarterly survey collected select resident MDS data including diagnoses, medication use, pain, falls, mood and behaviors; how M&M was being implemented; resident use of M&M; organization level information. We also downloaded NH 5-Star quality rating quarterly. A total of 265 NH and 4,109 residents participated in the study. We found the odds of antipsychotic use declined by 11%, antianxiety medications by 17%, and antidepressants by 9% per quarter. The odds of residents exhibiting aggressive behaviors declined by 20% per quarter, depressive symptoms by 16% and residents reporting pain by 17%. Our findings indicate that M&M provides substantial benefit to NH residents, particularly in reduction of psychoactive medications and improving mood and behaviors.
TRANSITIONAL CARE OUTCOMES IN VETERANS RECEIVING POST-ACUTE CARE IN A SKILLED NURSING FACILITY
Authors: Burke Robert , Canamucio Anne , Glorioso Thomas , Baron Anna , Ryskina Kira 
Published: November 2019

Abstract
More than 200,000 Veterans transition between hospital and skilled nursing facility (SNF) annually. Capturing outcomes of these transitions has been challenging because older adult Veterans receive care at VA and non-VA hospitals, and four different kinds of SNFs: VA-owned and -operated Community Living Centers (CLCs), VA-contracted community nursing homes (CNHs), State Veterans Homes (SVHs), and non-VA community SNFs. We used a novel data source which concatenates VA, Medicare, and Medicaid data into longitudinal episodes of care for Veterans, to calculate the rate of adverse outcomes associated with the transition from hospital to SNF in all enrolled Veterans age 65 and older undergoing this transition 2012-2014. The composite primary outcome included Emergency Department (ED) visits, rehospitalizations, and mortality (not in the context of hospice) within 7 days of hospital discharge to SNF. We used multivariable logistic regression to adjust for Veteran and hospital characteristics and hospital random effects. In the 388,339 Veterans discharged from 1502 hospitals in our sample, we found more than 4 in 5 Veteran transitions (81.7%) occurred entirely outside the VA system. The overall 7-day outcome rate was 10.7%. After adjustment, VA hospitals had lower adverse outcome rates than non-VA hospitals (OR 0.80, 95% CI 0.74-0.86). VA hospital-CLC transitions had the lowest adverse outcome rates; in comparison, non-VA hospital-CNH (OR 2.51, 95% CI 2.09-3.02) and non-VA hospital-CLC (OR 2.25, 95% CI 1.81-2.79) had the highest rates. These findings raise important questions about the VA’s role as a major provider and payer of post-acute care in SNF.
INCREMENTAL COST AND READMISSIONS ASSOCIATED WITH COLECTOMY PATIENTS UNDERGOING HOME HEALTH SERVICES
Authors: Kamdar Neil , Mahmoudi Elham 
Published: November 2019

Abstract
Home health services has been considered a recommended form of post-discharge management of older patients undergoing surgery. In this study, we examined total 30-day episode payments and 30-day readmission rates for those who were and were not utilizers of home health services following colectomies. We utilized administrative claims data (2012-2017) from the Michigan Value Collaborative across 77 hospitals in Michigan. Post-acute care includes skilled nursing facility, inpatient/outpatient rehabilitation, emergency department visits, home health services, and other outpatient visits. All payments were risk adjusted using generalized linear models using Hierarchical Condition Categories, age, sex, insurance type, and prior 6-month payments. Controlling for selection bias for those utilizing home health services, we performed propensity score matching at a caliper of 0.001 without replacement. We identified 15,531 colectomies with 4,397 (28.3%) utilizing home health services within 30 days. There were 4,197 home health users and non-users with home health users having significantly higher adjusted 30-day episode payments ($33,254 vs. $30,463, 95% CI Diff: ($2,097, $3,486)). While there were only slight differences in adjusted index surgical base payments between home health users ($21,531, 95% CI: ($21,279, $21,783) and non-users ($20,703, 95% CI: ($20,409, $20,998)), there were substantially larger post-discharge payments for home health users ($3,617 vs, $1,839, 95% CI Diff: ($1,597, $1,959)). Colectomy patients utilizing home health services had a higher readmission rate (21.5% vs. 15.6%, p &lt;0.0001). Colectomy patients utilizing home health services are more resource intensive in the post-discharge period. Recommendation for home health services increases costs and readmission.
UNDERSTANDING NON-MEDICAL COSTS FOR HEALTH CARE: EVIDENCE FROM INPATIENT CARE FOR OLDER PEOPLE IN CHINA
Authors: Yang Wei 
Published: November 2019

Abstract
Non-medical costs can constitute a substantial part of total health care costs, especially for older people. Costs associated with carers, travel, food and accommodation for family members accompanying and caring for older people during their medical visits can be hefty. This study seeks to examine the effects of non-medical costs on catastrophic health payments and health payment-induced poverty among older people in rural and urban China. Using data from the China Health and Retirement Longitudinal Survey 2015, this study finds that inpatient costs account for a significant proportion of household expenditure, and non-medical costs can account for approximately 18% of total costs. That share is highest for those who belong to the lowest wealth groups. Non-medical costs increase the chances of older people incurring catastrophic health payments and suffering from health payment-induced poverty. Such effects are more concentrated among the poor than the rich. The results also show that the rural population are more likely to incur catastrophic health payments and suffer from health payment induced poverty compared to the urban population. This paper urges policy makers to consider reimbursing the non-medical costs of patient care, improving health care systems in general and for the rural populations specifically.
EPIGENETICS OF STRESS AND ADAPTATION ACROSS HEALTHSPAN AND LIFESPAN
Authors: Ferrucci Luigi , Salimi Shabnam , Ferrucci Luigi 
Published: November 2019

Abstract
Any stimulus that endangers body integrity (stressor) results in an adaptive response to resolve stressful state and determine adaptive or and maladaptive responses. Both chronic extrinsic and intrinsic stressors can produce long-lasting, epigenetic changes in various organs that can eventually result in accelerated changes in bio-physio-pathology. There is initial evidence that stress response involves mechanisms of the epigenetic basis of adaptation and stress response to biological aging and chronic diseases. With aging, homeostasis stability declines causing augmented vulnerability to the external and internal stress. Individuals in whom vulnerability trespass a certain threshold experience accelerated aging and deterioration of health and/ or “secondary aging” phenomena such as premature mortality. Because of substantial heterogeneity of the rate of decline in homeostatic stability, there is inter-individual variability in the age of appearance of chronic diseases and the increased risk of disability and mortality. Thus, tools for the quantification of a stress response would be clinically valuable. Therefore, this symposium suggests approaches to study the epigenetic basis of molecular adaptations across various age, organs’ health-span, and life-span.
EPIGENETICS MARKERS OF AGING AND EXPOSURES
Authors: Murabito Joanne 
Published: November 2019

Abstract
Widespread changes to the epigenome occur with aging. DNA methylation is one of the most commonly studied epigenetic mechanisms, reflects lifetime exposures that impact aging, and is associated with age-related disease risk. Many longitudinal cohort studies have existing cross-sectional or longitudinal DNA methylation data along with genotype and expression data permitting investigation of relationships between DNA methylation markers, exposures, and disease. The data can be leveraged to conduct large epigenome-wide association studies (EWAS) of aging and age-related disease to identify DNA methylation biomarkers and lead to insights into novel biologic pathways for development of interventions to delay aging. DNA methylation age measures robustly predict chronologic age and associate with both healthspan and lifespan. During the workshop, examples from cohort studies and the CHARGE consortium will be presented.
GENERAL AND GENDER-SPECIFIC DYNAMICS DETERMINING THE HEALTH STATUS OF WORKING INFORMAL CAREGIVERS
Authors: Schwartz Abby , Clark-Shirley Leanne J , Rainville G 
Published: November 2019

Abstract
As the gender divide among family caregivers closes, it is important to understand whether and how men and women differently experience caregiving. For example, literature suggests that employed family caregivers experience burden and health outcomes differently than unemployed caregivers, but less is known about how these factors affect men and women differently. Using data from Caregiving in the U.S., 2015 (source: AARP and NAC), this study reliably modelled the effect of multiple threats to good health within the caregiving role (e.g. physical, financial, and emotional strain). In the analysis, several moderated relationships were observed using data from 816 working caregivers. In the full sample, the relationship between objective caregiving burden (hours of care and counts of ADLs/IADLs) and self-reported health status was altered by financial strain. In the high burden condition, relatively poor health was progressively related to increasing levels of financial strain controlling for traditional covariates. In separate analyses for males and females, this moderated relationship was discovered to be limited to female caregivers. Physical and emotional strain did not moderate the relationship between burden and health. Several covariates related to employment conditions (e.g., caregiver-friendly workplace policies) behaved differently across models and are presented and discussed in relation to financial strain as a determinant of caregiver health. These findings shed light on gender-based differences in caregiver outcomes, and suggest that interventions aimed at assessing and improving caregiver health should account for the financial strain experienced particularly by women.
THE CENTRALITY OF GENDER EXPRESSION FOR TRANSGENDER ELDERS AND CONCEPTUALIZATIONS OF SUCCESSFUL AGING
Authors: Sloan Steffany , Benson Jacquelyn 
Published: November 2019

Abstract
Successful aging is a construct regularly addressed in the gerontological literature, most typically referred to as living in the best physical and cognitive health possible, experiencing the least amount of disease, and engaging actively within one’s social environment. There are, however, conceptually distinct aspects of aging for older adults who identify as transgender, particularly given lifelong experiences of marginalization and stigma. In order to identify factors transgender older adults consider most relevant to successful aging, a Theory-Generating Qualitative Meta-synthesis was conducted. The study utilized systematic methods and thematic analysis with qualitative data from empirical studies focusing on transgender aging experiences, particularly drawing upon data that amplified the transgender older adult point of view. Findings of this study indicate that although trans older adults do not minimize unique challenges inherent to aging as a gender minority, successful aging rests on the relief and resilience offered by authentic gender expression. As such, data from this study informed the development of a model of successful aging that centralizes the importance of gender expression. Understanding the central role of gender expression in later life can be especially impactful for social and health service providers, as it emphasizes gender affirming experiences as highly salient to one’s own assessment of quality aging. Furthermore, conceptualizing aging for transgender elders in a way that prioritizes the importance of identity can aid in preventing an unnecessarily deficits-based perspective for service providers, and supports the necessity of amplifying a culturally specific understanding of successful aging.
KNOWLEDGE OF LGBT CULTURAL SENSITIVITY AMONG AGING SERVICE PROVIDER NETWORKS
Authors: Oswald Austin , Gardner Daniel S , Johnston Tim R , Alford Sabretta G , Giunta Nancy 
Published: November 2019

Abstract
The population of lesbian, gay, bisexual, and transgender (LGBT) adults aged 50 or above is rapidly aging, posing distinct challenges to aging service providers who work to meet their complex health and social needs. In 2011, Services and Advocacy for GLBT Elders (SAGE), home of the National Resource Center on LGBT Aging (NRC), developed and implemented a suite of trainings designed to sensitize aging service providers to the needs and experiences of LGBT elders. This descriptive study examines baseline (pre-test) survey data from individuals trained between 2013 and 2018 (N=10,500). Training participants represent all states throughout the U.S. and vary widely in race/ethnicity, age, and job title. Preliminary results indicate that knowledge measured prior to trainings shows substantial variation across geographic regions, suggesting the need for more geographically targeted approaches to training delivery. Implications for practice, research, and policy with LGBT adults in later life will be discussed.
THE ECONOMIC VALUE OF FAMILY CAREGIVING: NEW NATIONAL ESTIMATES AND STATE VARIATION
Authors: Houser Ari , Houser Ari 
Published: November 2019

Abstract
The economic value of family caregiving, by any measure, dwarfs actual expenditures on formal long-term services and supports (LTSS). This presentation discusses new estimates of the number of caregivers, intensity of caregiving, and the total economic value of family caregiving in 2017 in the United States, and in every state, the District of Columbia, Puerto Rico, and the Virgin Islands, based on a meta-analysis of recent nationally representative surveys of family caregivers. Previous analyses of this type have found that the total economic value of family caregiving has increased steadily from $350 billion in 2005 to $470 billion in 2013. State variation in the incidence, intensity, and economic value of caregiving will be discussed, and key predictors of this variation will be identified.
WORKSHOP PANEL REPORT ON EVIDENCE GAPS AND RESEARCH OPPORTUNITIES
Authors: Allore Heather 
Published: November 2019

Abstract
Although varied in treatment regimens and outcomes assessment, trials show safe and effective osteoporosis drug therapies up to 5 years in reducing the incidence of vertebral fractures. Trials provide evidence mainly for white postmenopausal women, while other populations (e.g., men, spectrum of race and ethnicities, residents in facilities, and people with advanced and multiple comorbid conditions) were absent or underrepresented. Evidence for osteoporosis drug therapies is lacking for people who meet neither bone mineral density nor fracture criteria for osteoporosis but are at elevated risk due to other health, genetic, or medication use factors. Fewer studies have shown that some osteoporosis drug therapies reduce the incidence of non-vertebral, including hip fractures. Notably, the workshop participants emphasized the importance of fracture on patient morbidity and survival; however, the trial results presented no data on non-fracture patient outcomes or sequelae of fractures, such as functional status, mobility, hospitalizations, and nursing home placement.
INVESTIGATING SOCIAL NETWORKS OF OLDER SINGAPOREAN LEARNERS: THE MIXED-METHODS SOCIAL NETWORK APPROACH
Authors: Ko Pei-Chun 
Published: November 2019

Abstract
Lifelong learning has been regarded as an important factor of promoting active engagement in later life for researchers and policy makers. Most of the studies tend to illustrate old learners as a homogeneous and self-resilient group of people to engage in lifelong learning. Few studies address older learners’ social capital in affecting their decision of engagement and in sustaining their motivation. The study documented the existing social networks of older Singaporeans in lifelong learning programs and illustrated how social networks contributed their participation in learning. The mixed methods consist of in-depth interviews and two network instruments (Name Generator and Position Generator) based on 30 older Singaporeans (between 50 and 79 years old) who attended lifelong learning courses between 2016 and 2018. Interviews are transcribed and analyzed. The network instruments of are quantified and visualized. The findings show that older learners’ networks included a mixture of social ties from family and friends. Learners’ closeness with network members and their living arrangement with them influenced learners’ involvement in learning and future planning. Single respondents who had more non-kin members in the networks reported to be more active due to their weak ties. Overlapping networks among couple learners increase the spousal support for learning. Learners who had wider ranges of social resources are associated with their interest in learning activities. The study suggests that advocating lifelong learning needs to take older adults’ networks into considerations as networks represent the social forces that influence their decisions and motivations.
OLDER VETERANS’ PERSPECTIVES ON MEASURING FUNCTIONAL STATUS IN VA PRIMARY CARE CLINICS
Authors: Nicosia Francesca , Spar Malena J , Neumann Alicia , Silvestrini Molly C , Barrientos Maureen , Brown Rebecca T 
Published: November 2019

Abstract
Little is known about older adults’ perspectives on measuring functional status (i.e., ability to perform basic and instrumental activities of daily living). This study used a qualitative design to understand older Veterans’ perspectives on measuring function in primary care settings. Thematic analysis of interviews conducted with 28 Veterans ≥65 years and 5 caregivers from one VA Medical Center identified several themes including: 1) importance and relevance of discussing function; 2) preferences for assessment method (e.g., provider- or self-assessment;) and 3) wording of questions (i.e., needing help vs. having difficultly). These findings suggest that effective approaches to measuring function must consider patient preferences on content and format and ensure that measurement is used to inform care. We applied these findings to develop an interprofessional intervention to improve functional status measurement for older Veterans in primary care.