bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brief Video-Delivered Interventions to Reduce Anxiety in Older Veterans: A Pilot RCT
Authors: Gould Christine , Carlson Chalise , Anker Lauren , O'Hara Ruth , Wetherell Julie , Goldstein Mary , Beaudreau Sherry 
Published: December 2021

Abstract
Older Veterans with anxiety disorders encounter barriers to receiving mental health services that may be overcome by using brief technology-delivered interventions. To address this, we conducted a pilot randomized controlled trial (RCT) comparing the effects of a guided self-management intervention called BREATHE, a 4-week video-delivered (DVD/internet) intervention and a psychoeducation control (Healthy Living; HL) on anxiety symptom severity. Older Veterans with anxiety disorders (N = 48; 87.5% men; Mean age = 71.77 ± 6.2 years) were randomized to BREATHE or HL. Regarding intervention delivery modality, 67% used DVDs, 23% used the internet, 4% used both to access their assigned intervention. Both groups experienced significant declines in affective anxiety from baseline to 8 weeks followed by an increase in symptoms (i.e., quadratic pattern). HL had significant declines in somatic anxiety, whereas BREATHE did not experience such declines. The longitudinal effects and Veteran satisfaction will be further described in the presentation.
Ushering in the Silver Age of Telehealth: Addressing Telehealth Disparities for Older Adults With Disabilities
Authors: Touchett Hilary 
Published: December 2021

Abstract
One silver lining of COVID-19 has been the ushering in of ‘the golden age of telehealth’. However, this unplanned rapid conversion to telehealth left many providers and clinics unprepared to address systemic barriers that adversely affect older adults, particularly those with disabilities. Data from the VA Corporate Data Warehouse suggest that the rapid adoption of telehealth in mental health clinics during COVID-19 widened telehealth utilization disparities for older Veterans (65+) with disabilities. With 4.5 million Veterans 55+ who have at least one disability more attention to addressing this widening gap is needed. For those with hearing, vision, and complex mobility impairments, there are unique challenges to initiating telehealth services. Dr. Touchett will present preliminary findings while discussing ethical and contextual considerations when using telehealth with older Veterans who have disabilities, while discussing ways to facilitate robust clinical encounters for this population.
Profit Status and Employee Turnover in Iowa Nursing Homes
Authors: Sharma Hari , Xu Lili 
Published: December 2021

Abstract
Employee turnover is a huge concern for nursing homes that care for millions of older individuals whose physical and cognitive impairments make them vulnerable, especially in the middle of a pandemic like COVID-19. Existing research has shown that high turnover of employees can lead to poorer quality of care. Low pay is often cited as one of the key reasons for high turnover of employees in nursing homes. For-profit nursing homes may try to maximize profits by limiting wages paid to their employees. In this study, we examine whether profit-status of a facility is associated with high turnover of its employees. We obtain data on 415 nursing homes operating in Iowa between 2013-2017. We descriptively examine the turnover trends in nurse employees and all employees over time by profit status. We evaluate whether profit status is associated with high turnover using pooled linear regressions controlling for nursing home and resident characteristics. Descriptive results show that for-profit facilities had higher turnover of nurse employees (61.1% vs. 49.6%) and all employees (56.6% vs. 45.4%). Results from multivariate regressions show that, compared to non-profit facilities, for-profit facilities had 6.93 percentage points higher (p&lt;0.01) turnover of all employees, and 7.76 percentage points higher (p&lt;0.01) turnover of nurse employees after controlling for facility and resident characteristics. Given existing evidence on the adverse impact of high employee turnover on nursing home quality, we need policies aimed at lowering employee turnover, targeting for-profit nursing homes.
Family Conflict and Older Chinese Americans’ Self-Efficacy in End-of-Life Care Planning: The Role of Acculturation
Authors: Wang Kaipeng , Sun Fei , Liu Yanqin , De Fries Carson 
Published: December 2021

Abstract
Family involvement in end-of-life (EOL) care is critical to ensure older adults’ health and quality of life. Older adults’ self-efficacy in discussing EOL care plans with family members can facilitate family involvement in EOL care planning. Research shows that family relationships are associated with self-efficacy in discussing EOL care with family members among older Chinese Americans. However, the roles of family conflict and acculturation remain unknown. This study examines the association between family conflict and self-efficacy in discussing EOL care with family members and whether such an association differs by acculturation levels among older Chinese Americans. Data were collected from 207 Chinese Americans aged 65-102 in two metropolitan areas in 2017. Ordinary least squares regression was conducted to examine the association between family conflict, acculturation, and self-efficacy in discussing EOL care with family. Family conflict was negatively associated with older adults’ self-efficacy in discussing EOL care with family. More specifically, the negative association between family conflict and self-efficacy in discussing EOL care with family members was more pronounced for those with higher levels of acculturation. Findings highlighted differential effects of family conflict on self-efficacy of EOL care plan discussion for older adults with different acculturation levels. Those with higher acculturation may be more independent in their EOL care planning and aware of the possible negative effects of family conflict in their EOL care planning discussions. Acculturation needs to be considered by geriatric health providers to develop family-centered interventions in improving end-of-life care planning for this population.
The Effects of Religiosity on Depression Trajectories Before and After Widowhood
Authors: Hawes Frances , Tavares Jane , Ronneberg Corina , Miller Edward 
Published: December 2021

Abstract
Widowhood is associated with decreased emotional well-being, particularly increased depression. Religiosity may help improve mental health among widowed individuals. However, longitudinal studies exploring the role of religiosity on emotional well-being among widowed older adults is lacking, as are studies which examine this relationship using different dimensions of religiosity. This study analyzed data from the 2006-2016 waves of the nationally representative Health and Retirement Study (HRS). Trajectories of depression among older adults &gt;50 years (N=5,486) were examined to explore patterns of depression among those entering widowhood and the potential impact of religiosity on depressive symptoms during widowhood. Ordinary least squares (OLS) regression analysis was used to examine the association between widowhood and depression as well as the role of religiosity as a moderator of this association. Older adults experienced an increase in depressive symptomology after the onset of widowhood, and although the levels of depressive symptomology decrease post-widowhood, they do not return to their pre-widowhood levels. Additionally, high religious service attendance and higher intrinsic religiosity were both associated with lower depressive symptomology. High religious service attendance moderated the relationship between widowhood and depression. The relationship between high religious service attendance and depression was stronger among widowed older adults living alone. This study highlights the long-term effects of widowhood on depressive symptomology among older adults. The findings also suggest that higher religious service attendance can lessen the effects of widowhood on depressive symptoms, especially for those living alone. These findings may inform intervention development around increased screening and treatment for depression.
Social Isolation and Sleep Quality of Older Adults in China: Do Family and Friendship Isolation Differ?
Authors: Zhang Dan , Lin Zhiyong , Chen Feinian , Li Shuzhuo 
Published: December 2021

Abstract
This study provides one of the first population-based studies investigating associations between social isolation, especially its two sub-dimensions (family isolation and friendship isolation), and sleep quality among older adults in China. We address three major research questions: 1) Does the risk of poor sleep quality vary by social isolation status? 2) Are the associations between social isolation and sleep quality mediated by mental disorders (depressive symptoms and loneliness) and physical impairments (pain and comorbidity)? and 3) Does the isolation from family members and friends differ in explaining sleep quality? We analyzed data from the 2014 wave of the China Longitudinal Aging Social Survey (CLASS), in which 7,597 respondents (aged 60-98) had complete information on measures of sleep quality (self-rated sleep difficulty), social isolation (using the Lubben Social Network Scale), and other analytical variables. Logistic regression models were estimated to predict the risk of sleep difficulty and Karlson-Holm-Breen (KHB) decomposition method was employed to test potential mediating effects. Results showed that social isolation, both family and friendship isolation, was significantly associated with higher risks of having sleep difficulty. The adverse effect of family isolation was found to be stronger than that of friendship isolation. Although both mental disorders and physical impairments mediated significant shares of associations between social isolation and sleep quality, physical impairments explained a lesser extent of them than mental disorders. These findings will be helpful for health policymakers and practitioners to design effective intervention strategies to help older adults with sleep problems.
A Nurse-Led Conceptual Model to Inform Patient-Centered Type 2 Diabetes Management in Public Clinical Settings
Authors: Bosun-Arije Stella , Nwakasi Candidus 
Published: December 2021

Abstract
Globally, there is an increased need to provide patient-centered care for people diagnosed with Type 2 diabetes mellitus (T2DM). In Nigeria, a poorly financed health system worsens the difficulties associated with managing T2DM in clinical settings, resulting in a detrimental effect on patient-centered care. We aimed to develop a conceptual model to promote patient-centered T2DM care in clinical settings. We explored nurses' contextual perceptions of clinical practices and operations that are relevant to T2DM management across public hospitals in Lagos, Nigeria. Identifying a nurse-led intervention is critical to care optimization for people diagnosed with T2DM. Using a qualitative research, we used semi-structured questions and the Constant Comparison Method to interview 17 practice (registered) nurses with over 1-year experience working in public hospitals across Lagos, Nigeria. The Framework Method was used for data analysis. The nurses provided insight into four areas of patient-centered T2DM management in clinical settings. They are: empowering collaboration, empowering flexibility, empowering approach, and empowering practice. The nurses discussed an empowering pathway through which health settings could provide patient-centered care to individuals diagnosed with T2DM. The pathway includes the integration of macro, meso, and micro levels for patient management. Their views informed the development of a conceptual model for the optimization of patient care. The model developed from this research sits within the Patient-Centered Care model of healthcare delivery. The model has the potential to inform patient-centered care in countries with poorly financed healthcare systems, and developed countries with comparatively better healthcare.
Medication Management and the Role of the Geriatric Pharmacist in Interdisciplinary Care Teams
Authors: Jensen Christine , Burnette Lauren , Zanjani Faika 
Published: December 2021

Abstract
Among adults 65 and older, 30% are taking at least five medications to treat acute and chronic health conditions (Gavin, 2020). As the number of medications increases, the more complex the regimen tends to be, which increases risks with proper management and unwanted side effects. Our interdisciplinary geriatric assessment team has been conducting medication reviews for individuals living with dementia, where geriatric pharmacists meet with these individuals and their family caregiver. These sessions build a trusting relationship, where older adults are able to receive education about their prescription and over-the-counter medications, address any concerns and reach shared goals. Pharmacists routinely recommend deprescribing, and all recommendations are sent to the older adults’ primary care provider. After the initial appointment, a follow-up takes place six months later to re-examine adherence to recommendations and assess outcomes. Since April 2019, our pharmacists have served over 300 individuals, where nearly 90% would recommend this review to others. Pharmacists have recommended over 250 medication changes, averaging 2.53 per person. A statistically significant decrease in prescription medications (from 12.48 to 12.16) has been identified, in addition to a trending decline for over-the-counter medications (3.91 to 3.79). Medication reviews have successfully reduced the overall number of medications, as 36% of recommendations have been accepted by the patient and their healthcare provider. Comprehensive medication review programs, where pharmacists are integrated into an interdisciplinary care team, offer high quality, best practice healthcare, where safety and quality of life is improved for older adults.
Predictors of Care Management Utilization
Authors: Danilovich Margaret , Prabhu Sharmila 
Published: December 2021

Abstract
Care management is the process of planning and coordinating care to assist individuals or families in managing their health. This may involve managing inpatient or outpatient medical care or helping with other household, legal, or financial needs. Care management service providers are challenged in knowing how best to allocate limited resources (i.e. care manager time) to best meet client needs. Research shows predictors for increased care management needs include advanced age, multiple comorbidities, frequent care transitions, and private insurance coverage, but the association of objectively measured functional assessments and care management hour utilization is unknown. This secondary data analysis aimed to identify factors that predict the amount of care management service among low-income older adults enrolled in a care management program. We used de-identified care management data from the electronic health record at 1 social service agency. We used multivariate regression to predict the number of hours of care management utilization from demographics, comorbidities, intake ADLs/IADLs, physical health, and self-reported quality of life. We found moderate to strong correlations between physical health and quality of life (r=0.58) and activities of daily living and instrumental activities of daily living (r=0.81). Baseline self-reported quality of life predicted the number of hours of care management utilization (p=.03; beta = 6.75). Quality of life can be useful in predicting the number of service hours that a particular client may require from a care management program and should be considered as an intake question to assist social service providers in allocating hours adequately to clients.
Comparing Loneliness Among Individuals in Long-Term Care Settings and the Community
Authors: Hua Cassandra 
Published: December 2021

Abstract
We used the NHATS COVID-19 module to examine whether individuals in long-term care communities were lonelier than individuals in the community during the pandemic. Additionally, we examined whether individuals in long-term care communities with more restrictive policies concerning visitors and communal activities were more likely to experience loneliness than individuals in communities with less restrictive policies. Approximately 45% of individuals in long-term care communities (n=134) felt at least a moderate amount of loneliness during COVID-19 when compared to 34% of individuals in the community (n= 2,666) (p&lt;.05). However, the association was no longer statistically significant after adjusting for age, race, and sex. Among individuals in long-term care communities with the most restrictive policies, 48% experienced loneliness compared to 44% individuals in less restrictive communities. However, this finding was not statistically significant. Discussion will focus on similarities and differences within these populations that could have led to these results.
Learning Humanities and Ethics of Aging Through the Lens of an Avatar Creation
Authors: Hanna Gay , Kim Yoon Chung 
Published: December 2021

Abstract
The main goal of teaching the humanities and ethics of aging is to understand the perspectives of older individuals as they address the challenges and opportunities presented across the aging spectrum. To encourage understanding of this humanistic and ethical process, students were given an assignment to select a profile of an older person with pre-selected characteristics that they then develop into their avatar, a virtual companion, to accompany them through the course. This assignment included three iterations of the avatar narrative related to what is studied in class around major life transition points related to work, housing, and end of life. These assignments included the creation of Mind Maps which illustrate their avatar’s ongoing concerns related to their environment including their social determinants of health. The avatar’s formative development throughout the course brought forward discussions around identity, safety, autonomy, and person-centeredness in terms of gerontological practice and policy.
COVID-19, Policy, and Nursing Homes: A Health and Aging Policy Fellows Symposium
Authors: Kusmaul Nancy , Miles Toni , Frank Lori 
Published: December 2021

Abstract
COVID-19 significantly impacted older adults, particularly those in long term care. This symposium focuses on policy, and how policies drove many of the outcomes older adults in care experienced during 2020. We begin with a case study of one nursing home describing their operations, how those were impacted by policies at the local, state and federal levels, and operational factors that proved uncontrollable. From there we look more broadly at a national effort as implemented in one state which leveraged clinical and regulatory experts to partner with nursing homes and disseminate emerging and evidence based practice cohorts to address the realities of the COVID-19 pandemic over an extended period. Then we move from the federal to two state level projects. One looks at the experience of embedding advanced practice nurses (APRNs) into long term care facilities in one state over a five year period including during COVID-19. The final presentation describes hands on support provided by one state government to nursing homes and assisted livings during COVID-19, including the coordination of staff testing and the implementation of the use of the antigen testing machines issued through federal policy. We conclude with a discussion of the interplay of federal, state, and local policy on nursing home experiences in COVID-19 and recommendations for more effective policy interventions.
Metabolomic Profile Differences Between Demented and Non-Demented APOE4 Carriers in the Long Life Family Study
Authors: Yao Yujing , Jain Mohit , Murabito Joanne , Zmuda Joseph , Christensen Kaare , Province Michael , Jin Zhezhen , Lee Joseph 
Published: December 2021

Abstract
The apolipoprotein ε4 (APOE4) is the most prevalent genetic risk factor for late-onset Alzheimer’s Disease (AD). Here we assessed the metabolomic profile differences between APOE4 carriers who develop AD vs. who do not in a sample of 142 participants, aged 65-99 years in the Long Life Family Study (LLFS). Of 7,321 metabolites, we applied a generalized estimating equation model and identified 137 metabolites significantly associated with AD. Subsequent multivariate analyses were performed for prediction and clustering recognition. Among annotated metabolites, 8 metabolites in the eicosanoids and docosanoids group, 3 metabolites in the fatty acids group, and arabitol were associated with elevated risks of AD (OR: 1.6-2.3). On the other hand, a different set of metabolites were associated with reduced risks of AD (OR: 0.34-0.64). These metabolomic profile differences can be used to help with early diagnosis in the population of older APOE4 carriers in the pre-clinical stage.
Emergency Department Admissions Among Older Adults Living Alone With Multimorbidity
Authors: Barrenetxea Jon , Chen Cynthia , Koh Woon-Puay , Qiushi Feng , Tan Kelvin Bryan , Chua Kevin , Tong Rachel 
Published: December 2021

Abstract
Older adults living alone are at higher risk of mortality, morbidity and healthcare utilization. As more older adults live alone, Emergency Department (ED) admissions could rapidly increase, particularly among those with multimorbidity. We studied the association of living alone on ED admissions among older adults with multimorbidity. We used data from 16,785 older adults of the population-based Singapore Chinese Health Study (mean age: 73 years, range: 61-96 years) who were interviewed in 2014-2016 for living arrangements and medical history. Participants were followed-up for one year on ED admission outcomes (number of admissions, inpatient days and hospitalization costs). We used multivariable logistic regression to study the association between living alone and ED admission, and ran two-part models (probit & generalised linear model) to estimate the association of living alone on inpatient days and hospitalization cost. We found that compared to living with others, living alone was associated with a higher odds of ED admissions [Odds Ratio (OR) 1.28, 95% Confidence Interval (CI) 1.08-1.51)], longer inpatient days (+0.61, 95% CI 0.25-0.97) and higher hospitalization costs (+322 USD, 95% CI 54-591). Compared to those living with others without multimorbidity, living alone with multimorbidity was associated with higher odds of ED admission (OR 1.64 95% CI 1.33-2.03), longer inpatient days (+0.73, 95% CI 0.29-1.17) and higher hospitalization costs (+567 USD, 95% CI 230-906). In conclusion, living alone is associated with higher odds of ED admission, longer inpatient days and higher hospitalization costs among older adults, particularly among those with multimorbidity.