bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolonged Mechanical Ventilation At Home Versus Long Term Care: Caregiver Characteristics And Strain
Authors: Marcus Esther-Lee , Jacobs Jeremy , Stessman Jochanan 
Published: December 2021

Abstract
Although the number of Prolonged Mechanical Ventilation (PMV) patients and their informal caregivers (CGs) is rising both at Home or Long Term Care (LTC), little is known concerning CG characteristics or strain. We enrolled 120 patients and 106 informal CGs: 34/46 and 72CGs/74 PMV patients from Home Hospital and LTC respectively. CGs were married (82%), female (60.4%), mean age 59 ±14 years; spouses (29%) or children (40%) of the PMV patient. The 13-item Modified Caregiver Strain Index (MCSI) (Maximum severity=26) was 13.6± 6.5, similar at Home vs. LTC (14.3±7.5 vs. 13.3±6.0, p=0.9). Most frequent complaints were distress concerning patient’s changes (93%) or upsetting behaviours (82%), feeling overwhelmed (82%), sleep disturbance (69%) and emotional adjustments (67%). Home CGs reported significantly more physical and financial burden, confinement, and need for work adjustment, while LTC CGs reported greater emotional disturbance and upsetting patient behaviours. Hierarchical clustering identified three clusters of CG strain: burden (physical/time/financial), emotional (upsetting adjustment/ behaviours/overwhelmed) and disturbance (work/plans/confinement). Emotional strain was most frequent, irrespective of site of care; however CGs at Home vs. LTC experienced significantly higher burden and disturbance vs. higher emotional strain respectively. In multivariate models, after adjusting for numerous patient and CG variables, increasing CG strain was consistently associated with rising patient symptomatology. This relationship was pronounced among CGs of Home PMV patients, with a significant interaction variable of Home*Patient symptomatology. Our findings identify specific patterns of strain among caregivers of PMV patients whether at home or LTC, and highlight the importance of addressing their unique needs.
Learning Needs of Dementia Family Caregivers during the Pandemic
Authors: Clevenger Carolyn , Epps Fayron , Hepburn Kenneth , Perkins Molly , Glasgow Glenna Brewster 
Published: December 2021

Abstract
The COVID-19 pandemic has dominated and transformed all caregiving contexts and situations. In a time of COVID-19, caregivers now have to learn how to take all of the complicated precautions to keep themselves and their persons from being exposed to the virus given their population’s mortality rate from COVID-19 infections exceed 40%. As part of a larger initiative to develop an asynchronous online education program for family caregivers of persons living with dementia illnesses (PLWD) to prepare them to master the new demands of their caregiving role in this extraordinary circumstance of the COVID-19 pandemic, we conducted three focus groups with 13 dementia family caregivers to inform the structure, content, and “feel” of the course. Focus groups were conducted with a lead interviewer, via Zoom, audio and video recorded and transcribed for analysis. Participants were asked two groups of questions: their lived experience over the past year and course content for caregiving during crisis. Caregivers identified 4 themes regarding their lived experience of caregiving during the pandemic: (a) mixed feeling about the stay-at-home orders; (b) positive adaptation to telemedicine, (c) vaccine risks and benefits; and (d) impact of social isolation on the PLWD. The groups also recommended specific course content based on their experiences. Participants recommended specific course content based on their experiences, such as health system navigation and the logistics of what to do following the death of a PLWD. Results from these groups have been incorporated into an asynchronous online course to be pilot tested in coming months.
A Scoping Review of Youth Caregivers: Addressing the Needs of This Growing Population
Authors: Doshi Heena , Chen Gracie , Bostarr Norma , Cherry Debra , Mittelman Mary , Satyadev Nihal 
Published: December 2021

Abstract
Generation Z, those who are born in 1997 or thereafter, account for six percent of the estimated 53 million family caregivers in the US – and this percentage is growing, especially given the health impacts of the pandemic. This review focuses on caregiving youth (ages 0-18) and young adult caregivers (ages 18-25) who assist household members who need regular assistance with ADLs and IADLs. This presentation will analyze key trends in the literature of this demographic and identify gaps in research. Our review broadens the knowledge base of how caregiving done by this population impacts brain development, and hence their long term physical, emotional, and mental health. In spite of the significant number of caregiving youth and young adults, current publications on these demographics remain sparse, with most studies being conducted on spousal and adult caregivers. Our group found that the existing literature reviewed the adverse implications on the health and education outcomes for young adult caregivers. This included increased anxiety/depression compared to non-caregivers and for those in post-secondary education, the contribution of caregiving to college incompletion. There are no known studies on this population who have entered the workforce and who also continue their caregiving role. Adequate understanding and characterization of caregiving youth and young adult caregivers will inform better interventions and future policy for them. Support for this demographic, in turn, may improve health outcomes for older adults, who are the majority of those in their care.
Innovations on Dementia Advocacy among Students of a Medical University in Taiwan
Authors: Kuo Tsuann 
Published: December 2021

Abstract
In 2017, Taiwan established Dementia Action Plans 2.0 to respond to the World Health Organization's call to increase dementia awareness and support for dementia carers. However, efforts have not yet been made to educate and increase dementia literacy on the younger generations. This paper addressed the outcomes to increase knowledge and information about dementia and caregiver resources to university students. 93 students participated in a two-day workshop on dementia literacy, followed by two months of advocacy in Taichung City, Taiwan. Students were divided into 14 advocacy groups and the outcome reports were categorized qualitatively using content analysis. The results showed that students were from nine departments and over one-quarter having a dementia loved one in the family. Four innovative categories were developed, including (1) dementia literacy for students and the public; (2) dementia friendly action plans; (3) dementia caregiver’s advocacy and (4) reducing dementia stereotypes. Highlights included students using social media to promote dementia literacy, face-to-face experiences to inform public education, dementia education on early onset dementia and using diverse bio-psycho-social angels to evaluate dementia. Students expanded advocacy to many social media, innovations and target areas, including Facebook, Instagram, Google spreadsheet, stickers, postcards, illustration of children’s books and public announcement. This paper revealed that younger generations used many advocacy methods that were thinking outside of the box. In conclusion, dementia is no longer an elder’s business but young adults can bring technological, inter-generational and cultural innovations into fulfilling the goals of Dementia Global Action Plans.
PPA Tele-Savvy: Developing an Online Intervention with Caregivers of Persons with Primary Progressive Aphasia
Authors: Morhardt Darby , Roberts Angela , Penn Alyssa , Lindauer Allison , Rogalski Emily , Weintraub Sandra , Hepburn Kenneth 
Published: December 2021

Abstract
Primary progressive aphasia (PPA) typically results from a neurodegenerative disease such as frontotemporal lobar degeneration or Alzheimer’s disease and is characterized by a progressive loss of specific language functions with relative sparing of other cognitive domains until later stages when widespread cognitive decline consistent with generalized dementia is more prevalent. PPA tends to appear earlier than most dementias, in late middle-age, and can result in a high degree of psychological and economic burden for the family. Thematic analysis of PPA caregiver studies reveal families are learning to adapt to not only declining language across communicative contexts and domains, but concomitant behavioral, social communication and personality changes over time. While there are several evidence-based dementia caregiver interventions, none are specifically designed for the PPA family caregiver. This pilot project, funded by the Emory University Roybal Center is the adaptation of an evidence-based on-line psychoeducation program (Tele-Savvy) to address the unique challenges facing informal caregivers of those living with PPA and to help these caregivers achieve mastery within this context. PPA caregivers have been engaged through focus groups to identify their most pressing caregiving challenges and how the existing Tele-Savvy curriculum should be adapted to meet their needs. Synchronous and asynchronous video modules have been designed to address: PPA education, the impact on dyadic connection and caregiving challenges and communication strategies specific to PPA. The Tele-Savvy central processes of coaching and de-briefing will also be pilot tested and refined.
Frailty and Functional Status improvement after Skilled Nursing Facility based Post-Acute Care
Authors: Shi Sandra , Olivieri-Mui Brianne , McCarthy Ellen , Kim Dae Hyun 
Published: December 2021

Abstract
People admitted to a skilled nursing facility (SNF) for post-acute care undergo comprehensive evaluation and rehabilitation, potentially enabling prediction of future functional recovery. We identified the first SNF admission per beneficiary (n=250,159) between 07/01/2014 – 06/30/2016 in a 5% Medicare sample, using the Minimum Data Set (MDS) and the Outcome and Assessment Information Set (OASIS). Episodes were excluded for non-community discharge (n=43,397) or no OASIS admission assessment within 14 days of SNF discharge (n=77,989). A deficit accumulation Frailty Index (FI) was measured on admission MDS assessment and categorized into robust (MDS-FI&lt;0.15), pre-frailty (MDS-FI0.15-0.24), mild frailty (MDS-FI0.25-0.34), and moderate or worse frailty (MDS-FI≥0.35). Outcomes were functional decline obtained from OASIS, readmission, or death after initiation of home care. Functional status was measured by activities of daily living from OASIS assessments. A total of 135,310 SNF episodes were matched to OASIS episodes. Of these, there were 6,472 (4.8%) robust patients, 38,923 (28.8%) pre-frail, 63,727 (47.1%) mildly frail and 26,053 (19.3%) moderately frail or worse. In a logistic regression after adjustment for OASIS admission function, compared to robust status, frailty was associated with hospital readmission or death within 30 days of OASIS admission, (mild frailty OR1.33 [95%CI 1.23-1.45] and moderate or worse OR1.81 [95%CI 1.66-1.97]). Frailty was also associated with functional decline at OASIS discharge, after adjustment for OASIS admission function (mild frailty OR1.50 [95%CI 1.38-1.63] and moderate or worse OR2.30 [95%CI 2.11-2.50]). Among those discharged from SNF with home services, a SNF-based MDS-FI is associated with increased likelihood of poor community outcomes.
Physical Frailty is Correlated with Worse Quality of Life in Older Adults with Hypertension
Authors: Liu Pan , Zhang Yaxin , Li Shijie , Li Ying , Chen Yumeng , Zhao Ou , Li Yun , Ma Lina 
Published: December 2021

Abstract
Background: Hypertension is one of the commonest chronic cardiovascular diseases in older adults. Frailty and hypertension often coexist in older people, but few studies have explored frailty in older hypertensive adults. We aimed to explore the correlation of frailty with quality of life in older hypertensive adults. Method: We enrolled 291 patients with hypertension aged ≥60 years. Ambulatory blood pressure monitor was performed. Physical frailty was assessed by Fried phenotype. Quality of life was assessed by SF-36. Results: Forty-eight (16.5%) patients were frail. Compared with non-frail older hypertensive patients, frail patients were older, had lower education levels, a higher rate of living alone, and a longer duration of hypertension. Moreover, they had lower diastolic blood pressure (DBP) and mean arterial pressure (MAP), and higher pulse pressure, more chronic diseases, a higher proportion of calcium channel blockers (CCBs) usage, and worse quality of life. Frailty scores were positively correlated with pulse pressure, and negatively correlated with DBP and MAP. The SF-36 score was negatively correlated with frailty scores and positively correlated with grip strength and walking speed. After adjusting for age, the SF-36 score was negatively correlated with frailty and positively correlated with walking speed. Frailty, when adjusted for age, duration of hypertension, DBP and comorbidity, had a significant effect on the SF-36 score. Conclusion: Frailty was associated with worse quality of life of older adults with hypertension. Frailty prevention and intervention may help improve the quality of life of older hypertensive adults. Keywords: frailty, older adults, hypertension, quality of life
Skeletal Muscle Quality Of Nonagenarians And Centenarians
Authors: Miljkovic Iva , Sterczala Adam , Barinas-Mitchell Emma , Cvejkus Ryan , Feitosa Mary , Thyagarajan Bharat , Wojczynski Mary , Zmuda Joseph 
Published: December 2021

Abstract
Skeletal muscle adipose tissue infiltration is hypothesized to lead to poorer muscle quality and function with aging. Indeed, skeletal muscle adiposity has emerged as a consistent, independent predictor of skeletal muscle strength, mobility, metabolic disorders, and survival among older adults. However, phenotypic features of skeletal muscle among the oldest-old remain poorly characterized. Herein, we evaluated the skeletal muscle characteristics of 54 nonagenarians and centenarians (mean age 98 years, range 90-110 years; 63% women) and 25 middle-aged individuals (mean age 54 years, range 40-59 years; 36% women) belonging to the Long Life Family Study (LLFS), an international, multicenter cohort of families with a clustering of longevity. Ultrasonography was used to measure echo intensity of the sternocleidomastoid muscle, which has a similar fiber type distribution to the rectus femoris. Greater echo intensity is indicative of lower muscle quality (greater adipose and fibrotic tissue). Current smoking, alcohol intake, and BMI were similar between the age groups. Nonagenarians and centenarians had lower grip strength (16.3 vs. 39 kg) and were less physically active (22.2% vs 66.7% exercised 1+ times per week) compared to younger individuals (P&lt;0.001 for all). Mean±SE echo intensity, adjusted for gender, field center, BMI and physical activity was 52.1±1.7 among nonagenarians and centenarians compared to 44.2±2.4 among younger individuals (P=0.0098). Our preliminary findings suggest that nonagenarians and centenarians may have substantially lower skeletal muscle quality and strength compared to their younger aged counterparts. Additional research is needed to better understand the mechanisms leading to poorer muscle characteristics of the oldest-old.
Appendicular Lean Mass Loss Does Not Impact Physical Performance Change During Caloric Restriction in Older Adults
Authors: Beavers Daniel , Miller Ryan , Beavers Kristen , Nicklas Barbara 
Published: December 2021

Abstract
Data from 11 six-month randomized controlled trials were pooled, with 902 participants randomized to caloric restriction (CR; n=762) or Non-CR (n=140) to determine if CR-induced appendicular lean mass (ALM) loss was associated with change in physical performance among older adults. After adjusting for age, sex, race, body mass index, exercise assignment and baseline value of the outcome, CR had significant ALM loss [-0.77 kg (95% CI: -0.89, -0.65)], while Non-CR had ALM gain [+0.28 kg (0.08, 0.49)]; p&lt;0.001. Both groups experienced similar improvements in the Short Physical Performance Battery (SPPB) score [CR: +0.45 (0.35, 0.55) vs Non-CR: +0.50 (0.30, 0.69); p=0.63] and sit-to-stand time [CR: -1.42 s (-1.81, -1.03) vs Non-CR: -1.85 s (-2.49, -1.21); p=0.19]. Change in SPPB score and sit-to-stand time was not associated with change in ALM (both p&gt;0.15). In spite of significant ALM loss, CR resulted in overall improvements in physical performance in older adults.
Geriatric Knowledge Gaps of Community-Based Providers: A National Study of Asked Questions
Authors: Lindquist Lee , Madore Aylin , Miller Stephanie , Kerr Alice , Bradley Sara 
Published: December 2021

Abstract
Primary care providers (PCP) - internists, family practitioners, nurse practitioners, physician assistants - play an integral role in the care of older adults, although many receive limited geriatrics education. We sought to examine what questions community-based PCPs had about geriatrics and clinical care of older adults. As part of large clinical continuing medical education (CME) conferences across 12 states (FL,GA,CA,IL,NY,MA,DC, PA,AZ,TX,TN,WA), PCPs attended a live in-person 60-minute geriatrics-focused lecture and entered questions into a mobile application. Questions were then qualitatively analyzed using constant-comparison and tie-break methodology. At all sites, 103 questions were asked with 158 upticks (PCPs could check off that they had similar question) with a range of 3-18 questions per lecture. PCPs asked questions on the following common themes: 1.) Medication-related (e.g. discontinuing medicines in asymptomatic patients, optimizing pain relief), 2.) Dementia (e.g. prevention, nutraceuticals, agitation) 3.) Medicare Coding 4.) Falls 5.) Weight loss, and 6.) Insomnia. There were a number of questions referencing incorrect practices (e.g. prescribing inappropriate medications such as benzodiazepines for sleep, placement of gastric tubes in late-stage dementia, antibiotics to treat asymptomatic bacteria). In conclusion, community-based PCPs nationally experience gaps in geriatric knowledge and several utilize practices that could jeopardize older adult health. While attending CME-based lectures is one means of overcoming these gaps, some PCPs may not find time or realize geriatrics as an educational need. PCPs need to be better supported with opportunities to ask geriatric care-related questions in order to improve the care of older adults.
Using the 4 M of the Age Friendly Health System to improve MIPS documentation in Primary care: A Feasibility study
Authors: Tewary Sweta , Kruszynski Denise , Pandya Naushira , Cook Nicole , Damier Sashah , Twahir Assma 
Published: December 2021

Abstract
Age Friendly Health Systems (AFHS) commit to evidence-based, low-risk, coordinated care that is centered on what matters most to older adults, their families and caregivers. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) has partnered with multiple primary care clinics to provide dedicated AFHS training and support to increase AFHS transformation in Broward and Miami-Dade Counties. As part of the initiative, SFGWEP provide didactic training, clinic on-site brief demonstration, and infographic guidance for EHR documentation. NSU SFGWEP activities are conducted through training surveys, provider feedback, and e-clinical measures that align with CMS MIPS measures. Three participating health systems report annually on seven e-clinical measures that, collectively, provide indicators of the 4Ms of AFHS (what matters, medication management, mentation and mobility.) From baseline to Year 1, NSU SFGWEP saw improvement in controlled hypertension (54% to 94%), opioid screening (&lt;1% to 11%), advance care planning (21% to 35%) and falls risk assessment (45% to 59%). Results demonstrate the need to continue and expand AFHS interventions for sustainability. In Year 2, SFGWEP will continue to expand awareness of best practices and benefits of the AFHS through education and training at NSU and at the various primary care sites. As mutual collaboration and implementation methods are shared among participating members, the expectation is that quality healthcare of our elder community adults will measurably improve.
Age, Sex, and Cerebral Microbleeds Affect White Matter Integrity Across Adulthood After Mild Traumatic Brain Injury
Authors: Robles David , Dharani Ammar , Chaudhari Nikhil , Rostowsky Kenneth , Wehbe Layal , Ha Michelle , Ngo Van , Irimia Andrei 
Published: December 2021

Abstract
The contributions of age, sex, and cerebral microbleeds (CMBs) to WM changes after mild traumatic brain injury (mTBI) have not been studied. We used diffusion tensor imaging (DTI) to map WM fractional anisotropy (FA) changes across the first ~6 months post-mTBI in 109 subjects aged 18-77 (46 females; age µ: 40 y, σ: 17 y) imaged within ~1 week post-injury and ~6 months later. After partialing out age, sex, and CMB counts, significant mean FA decreases were found in the anterior body, posterior body, and splenium of the corpus callosum (CC; p = 0.003, 0.009 and 0.015, respectively), left superficial frontal fasciculus (p = 0.008), and left branch of the corticospinal tract (CST; p = 0.007). Age contributed to mean FAs measured acutely in the CC body (p = 0.04), and chronically in the CC genu (p &lt; 0.001), CC body (p = 0.01), and middle longitudinal fasciculi (p = 0.04), older adults exhibiting larger decreases. CMB counts were positively associated with mean FA decreases in the CC body (p = 0.04) and middle longitudinal fasciculi (p = 0.04). Significant age-by-sex and CMB count-by-age interactions mediated FA decreases in the CC genu (p = 0.02 and p = 0.03, respectively), older males exhibiting larger decreases. Thus, the CC, longitudinal fasciculi, superficial frontal WM and CST are particularly vulnerable to post-traumatic neurodegeneration moderated by age, sex and CMB count, men and older adults being at highest risk for adverse effects. Future research should investigate our findings relative to cognitive function.
Centenarians in the Global South: A View from Ethiopia
Authors: Chane Samson , Adamek Margaret 
Published: December 2021

Abstract
As global aging advances, the number of centenarians worldwide is greatly increasing. Most of what is known about centenarians comes the Global North. It is not clear what factors contribute to longevity of centenarians in impoverished, mostly rural areas of Global South nations that still lack basic amenities. Cultural differences in the profile, lifestyles, and needs of centenarians in Africa have yet to be documented. Using a case study design, this descriptive inquiry investigated the profiles of centenarians in Ethiopia including religion, marriage, education, occupation, income, and living arrangement. Data were generated through in-depth interviews with nine centenarians (1 woman, 8 men) and were analyzed using descriptive narrative analysis. Respondents were between 100 and 108 years old. All nine were adherents of Orthodox Christianity, had been married, and were great-grandparents. Their adult lives were marked by both residential and marital stability. The Ethiopian centenarians persevered through many losses and hardships with the help of strong community-based social networks. Unlike studies of centenarians in the Global North, most respondents were male and had strict religious upbringings. Understanding the unique profiles of centenarians in the Global South will help to inform research and practice with this growing population of the oldest-old.