bluuebunny/crossref_metadata_2025_split huggingface dataset:
Area Deprivation Share: A New Measure of Social Need Faced by Hospitals Serving Older Adults
Authors: Hansmann Kellia , Powell Ryan , Kind Amy 
Published: December 2021

Abstract
Medicare’s Hospital Readmissions Reduction Program (HRRP) places disproportionate penalties on hospitals serving populations with complex medical and social needs. Without measures to identify the social need intensity of populations cared for by these hospitals, the HRRP cannot account for these risk factors, leading to burdensome penalties that may inadvertently hinder the ability of such hospitals to care for vulnerable populations. The objective of this study is to characterize the social need intensity of US hospital acute care populations. Using the Area Deprivation Index (ADI), a validated measure that ranks neighborhood socioeconomic disadvantage based on income, employment, housing, and education factors, we determined an “Area Deprivation Share” (ADS) for hospitals with 25 or more discharges using 100% of national Medicare claims data from 2013-2014. Hospital ADS is the proportion of qualifying discharges residing in the most disadvantaged neighborhoods (ADI ≥ 80th percentile) out of all qualifying discharges during the study period. Of 4,603 hospitals, median ADS was 17% (Interquartile Range: 6% - 34%). Hospitals in the highest quintile of ADS (39% to 100%), were more frequently located in small towns or isolated rural areas (52.6%, comparted to 24.2% in lower quintiles) and served a higher percentage of Black patients (19.0%, comparted to 9.7% in lower quintiles). ADS is a potential tool to inform future Medicare policy decisions. Additional research will inform how hospitals target care processes to meet the needs of older adults with complex social needs. Further study can also explore overlapping disadvantage domains of socioeconomic status, race, and rurality.
Association of Home Based Primary Care Enrollment with Social Determinants of Health for Older Veterans
Authors: Montano Anna-Rae , Ge Augustus , Halladay Christopher , Edwards Samuel , Rudolph James , Cornell Portia 
Published: December 2021

Abstract
The Veterans Administration (VA) Home-based Primary Care (HBPC) program provides comprehensive primary care to older Veterans with multiple chronic conditions who may be at risk of adverse health outcomes due to their social determinants of health. Area Deprivation Index (ADI) can be used as a surrogate measure of a Veteran’s social needs. The objective of this study was to estimate the effect of neighborhood disadvantage, as measured by ADI, on HBPC enrollment for a sample of older Veterans. We estimated a linear multivariate model in which the exposure was ADI and the outcome was enrollment in HBPC. Controls included clinical and demographic characteristics. In a final sample of 12,005,453 observations (total Veteran months) on 353,485 individual Veterans, 18.4% lived in high-deprivation neighborhoods (ADI greater than or equal to 80). Mean monthly probability of new HBPC enrollment was 0.0061. Controlling for clinical characteristics, housing instability, and distance from the medical center, Veterans residing in high-deprivation neighborhoods were 1.4% to 14.8% less likely to enroll in HBPC, though the association was not statistically significant. The VA HBPC program provides beneficial comprehensive, primary care services to Veterans at risk of poor health outcomes. However, a Veteran’s social determinants of health could prevent enrollment. More research is needed to determine the relationship between Veterans’ social needs and HBPC enrollment.
COVID Pandemic Impact on Nevada Adult Protective Services
Authors: Ramsey-Klawsnik Holly 
Published: December 2021

Abstract
Empirical data regarding Covid pandemic impact on the Nevada Adult Protective Services (APS) Program clients, casework, and staff was gathered and analyzed as part of a multi-faceted program evaluation. Key findings include: 66% of the staff agreed or strongly agreed that the pandemic made their jobs more challenging. Respondents reported Covid-related challenges faced by clients, the program, and themselves as social workers serving older and vulnerable adults. Adverse client impacts observed included increased social and emotional isolation, loss of housing, exacerbation of symptoms of mental illness, necessary services being cut from clients subsequent to testing Covid positive, and fear and reluctance to allow needed visiting service providers, such as home health aides, into their homes. We will discuss the implications of the findings on APS services and clients, and on related health and human services designed to promote the wellness and independence of older and vulnerable adults.
Cross-Level Mediating Effects of Social Relationships between Religiosity and Successful Aging
Authors: Park Hayoung , Jun Hey Jung , Joo Susanna 
Published: December 2021

Abstract
This study aimed to analyze the cross-level mediating effects of social relationships on the association between religiosity and successful aging. The data was the 7th Korean Longitudinal Study of Ageing and the sample was 1,191 couples aged 65 and above. Independent variables were the level of participation in religious activities at the individual level and religious similarity between couples at the couple level. The dependent variable was successful aging at the individual level, which consisted of physical, cognitive, social, and psychological dimensions. Mediating variables were two social relationships: frequency of social interaction at the individual level and marital satisfaction at the couple level. We applied Full Information Maximum Likelihood estimation to include 8% of the sample with missing values in data. According to the multi-level mediation path analysis, both frequency of social interaction and marital satisfaction had mediating effects on the association between the level of participation in religious activities and successful aging; the more they participate in religious activities, the higher the frequency of social interaction and marital satisfaction, and this had positive effects on successful aging. Also, marital satisfaction had a mediating effect on the association between religious similarity and successful aging; when married couples have the same religion, marital satisfaction was higher than when they do not, and this had a positive effect on successful aging. This study is meaningful in presenting multi-dimensional discussions on religiosity and social relationships in later life and a new empirical model to promote successful aging at both individual and couple levels.
Transformations and Transmission – A Contextual Look at Religious Biographies of Older Adults
Authors: Spannari Jenni , Tervo-Niemela Kati , Kallatsa Laura 
Published: December 2021

Abstract
Examination of religious biographies tend to show increase of religiosity towards old age, most often in the context of a previously familiar religious community. These changes in individuals do not happen in a vacuum. Religious landscapes are also in transformation, characterized by a steady decline of institutional religiosity and religious practice in most European countries and more recently in the US and Canada, too. However, there is a dire lack of detailed knowledge on how these changes in individuals and societies are intertwined. This paper presents findings of the Finnish sub-project of the five-country research project “Transmission of religion across generations.” The paper utilizes both three-generation interviews, and the contextual information gathered in the families about the past and present generations. The narratives about religious biographies of the oldest (gen.1) interviewees are discussed, and set in the context of the changes in the surrounding social sphere and the interviewees’ role in the family. Key findings include a general trend of increased flexibility, openness and communication over time – both in the religious views of the individuals, the roles different generations take in the family, and the cultural atmosphere in the society. Also, the results suggest that this flexibility is an essential factor in successful transmission of religion or other convictions across generations. The findings illustrate the complexity and contextuality of building and researching narratives of religious biographies. Thus, the results contribute to future examinations on how changes in societies and families affect the religious styles and convictions of older adults.
Association between anticholinergic burden and dementia in UK Biobank
Authors: Mur Jure , Cox Simon , Marioni Riccardo , Russ Tom , Muniz-Terrera Graciela 
Published: December 2021

Abstract
Previous studies on the association between the long-term use of anticholinergic drugs and dementia report heterogenous results. This variability could be due to, among other factors, different anticholinergic scales used, and differential effects of distinct classes of anticholinergic drugs. Here, we use 171,775 participants of UK Biobank with linked GP prescription records to calculate the cumulative annual anticholinergic burden (ACB) and ascertain dementia diagnoses through GP- and inpatient records. We then use Cox proportional hazards models to compare 13 anticholinergic scales and anticholinergic burden (ACB) due to different classes of drugs in their association with dementia. We find dementia to be more strongly predicted by ACB than by polypharmacy across most anticholinergic scales (standardised ORs range: 1.027-1.125). Furthermore, not only the baseline ACB, but the slope of the longitudinal trajectory of ACB (HR=1.094; 95% CI: 1.068-1.119) is predictive of dementia. However, the association between ACB and dementia holds only for some classes of drugs – especially antidepressants, antiepileptics, and high-ceiling antidiuretics. Moreover, we do not find a clear relationship between reported anticholinergic potency and dementia risk. The heterogeneity in findings on the association between ACB and dementia may in part be due to different effects for different classes of drugs. Future studies should establish such differences in more detail and further examine the practicality of using a general measure of anticholinergic potency as it relates to the risk of dementia.
Caregiving and COVID-19: Perspectives from a Care Coach
Authors: Marnfeldt Kelly , Estenson Lilly , Rowan Julia , Wilber Kathleen 
Published: December 2021

Abstract
Family caregivers of community-dwelling older adults have faced unprecedented caregiving challenges during the COVID-19 pandemic. Examining the accumulated impact on family caregivers can help health and aging service providers design resources and supports that are resilient to emergency situations, and reduce negative psychological and physical consequences and risk of abuse within caregiving dyads. Data was collected as part of a pilot intervention in which “Care Coaches” provided telephonic coaching sessions to family caregivers of older adults. We examined Care Coach observations documented after coaching sessions with 24 family caregivers between March 2020 and February 2021. Two coders employed thematic analysis to generate codes and themes. The sample was 70% female, 80% were the spouse or significant other of their care receiver, the mean age was 61, and 53% were Non-Hispanic White. Themes and sub-themes included: (1) increased caregiver burden and diminished care networks due to fear of exposure to or contraction of COVID-19, (2) barriers to accessing in-home personal assistance services and home-delivered meals despite intervention efforts, and (3) the exacerbation of caregiver social isolation due to COVID-19 lockdown policies. Findings highlight the ways in which COVID-19 has amplified caregiver burden through the breakdown of formal and informal support systems. Potential adaptations of community-based services for older adults and their caregivers include remote service liaisons and need assessment of caregiver dyads to assure access to home-based personal assistance services and nutrition support for those at greatest risk of negative consequences during emergency service lapses.
Comparison of Older Adult and Healthcare Provider Beliefs About Fall Prevention Strategies
Authors: Bergen Gwen , Henry Ankita , Haddad Yara 
Published: December 2021

Abstract
Older adults reported about 36 million falls in 2018. Although effective strategies are available to minimize fall risk, little is known about older adults’ and healthcare providers’ awareness of these strategies. This study describes and compares older adults’ and healthcare providers’ beliefs about fall prevention strategies. Demographic and fall-related data for older adults were obtained from the 2019 fall cohort of Porter Novelli ConsumerStyles. Similar data from primary care practitioners, nurse practitioners, and physician assistants, were gathered from the 2019 cohort of DocStyles. Percentages and 95% confidence intervals were calculated to compare older adults and providers. Most providers (91.3%) and older adults (85.1%) believed falls can be prevented. High percentages of providers and older adults identified strength and balance exercises (90.7% and 82.8% respectively) and making homes safer (90.5% and 79.9% respectively) as strategies that help prevent falls. More providers reported that Tai Chi (45.7%) and managing medications (84.2%) can prevent falls compared to older adults (21.7% and 24.0% respectively; p&lt;0.0001). Sizable percentages of providers and older adults endorsed less evidence-based strategies including aerobic exercise (70.7% and 58.4% respectively) and being more careful (69.3% and 81.6% respectively). Among older adults, lower endorsement of evidence-based strategies (e.g., Tai Chi, medication management) coupled with higher endorsement of limited evidence-based strategies (e.g., being careful, aerobic exercise) suggest some older adults lack awareness of effective fall prevention interventions. Increased patient and provider communication can increase awareness about the benefits of evidence-based strategies for fall prevention.
Policy Series: Building Momentum for Diversity, Equity, and Inclusion in Geriatrics and Gerontology Education
Authors: Severance Jennifer , Gordon Barbara , Lindberg Brian 
Published: December 2021

Abstract
With an increasingly multicultural and diverse older adult population, health care professionals must be prepared to serve older adults from varied backgrounds and marginalized communities; address health determinants and disparities; and promote diversity, equity, inclusion, and empathy within systems of care. The National Association for Geriatrics Education (NAGE) is a non-profit organization representing geriatric and gerontology education and training programs, including Health Services and Resource Administration (HRSA) funded Geriatric Workforce Enhancement Programs (GWEPs), and Geriatric Academic Career Awardees (GACAs). The 44 GWEPs focus on improving health outcomes for older adults by enhancing geriatrics and primary care training of the healthcare workforce. The 26 GACA awards support leaders in Age-Friendly health care transformation and interprofessional clinical geriatrics training. This symposium examines the role both programs have in reducing racial health disparities in older adults by promoting increased diversity of the geriatrics/gerontology workforce and advancing public policies for racial equity and inclusion. First, presenters will introduce the NAGE Diversity and Racial Equity Workgroup that supports a broader and unified effort across GWEPs and GACAs for equity and inclusion in geriatrics and gerontology education. Presenters will then share strategies to mobilize system-level changes within their institutions. Finally, examples of progress showcase individual GWEP and GACA projects and partnerships aimed at reducing racial health disparities within a multidimensional and local context. Presenters discuss strategies and opportunities to disrupt and transform health professions education at multiple levels and implications for policies supporting optimal aging for all older adults.
Factors Influencing Brain Healthy Diets Among Older Midwestern African Americans
Authors: Shaw Ashley , Fikru Samantha , Berkley-Patton Jannette , Goode Chris , Perales Jaime , Vidoni Eric 
Published: December 2021

Abstract
Emerging evidence suggests that up to half of Alzheimer’s disease (AD) cases are a result of modifiable risk factors related to poor diet such as blood pressure and diabetes, disproportionately affecting African Americans. Adherence to brain healthy diets remains low among African Americans. Therefore, it is important to understand needs, preferences, and barriers to inform intervention designs aimed to reduce AD risk among African Americans. Using a qualitative community-based research approach, we conducted six semi-structured focus group discussions (n= 30) to explore older African American experiences with brain healthy diets, preferences, and barriers to eating healthy. Secondly, we assessed the feasibility and acceptability of collecting biomarkers of health status and dietary behaviors among African Americans. A thematic analysis was conducted to identify emerging themes and biomarkers of health status were analyzed using descriptive statistics. We identified four themes: “Knowledge and Beliefs about Brain Healthy Diets,” “Eating Practices,” “Ways to Improve Dietary Practices,” and “Preferences for Enhancing Awareness about Brain Healthy Diets.” Themes indicated that older African Americans are receptive to healthy dietary consumption but perceived lack of education, cost, access, and perception of losing one’s culture as barriers to adherence. A total of 87.5% of participants completed biomarker assessments and 82% tested positive for 1 or more cardiovascular risk factor. Our study identified ways to enhance brain healthy dietary practices to reduce dementia risk. Also, our study demonstrated feasibility and acceptability in collecting AD related biomarkers in the African American community.
Feasibility of an Innovative Rehabilitation Program Adapted for the Post-acute Nursing Home Setting
Authors: Middleton Addie , Driver Jane , Ruopp Marcus , Lefers Lindsay , Rawlins Jessica , Harris Rebekah , Bean Jonathan 
Published: December 2021

Abstract
Live Long Walk Strong is a rehabilitation program that produces large clinically meaningful improvements in mobility when implemented as an outpatient program for older adults. We adapted Live Long Walk Strong for the post-acute nursing home setting within the Veterans Health Administration as a clinical demonstration project. The adapted version includes novel elements and bridges the inpatient stay and three months post-discharge. The inpatient phase focuses on maximizing functional recovery and includes activities focused on timing and coordination of gait, leg strength and power, and trunk muscle endurance. The care transition and virtual (telehealth) post-discharge phase focuses on case management and engagement in physical activity programs. Coaching and behavior change are a consistent focus throughout the program. To date, 13 Veterans (mean age 67.9, SD 11.7 years) have completed the inpatient phase, and of those Veterans, six have completed the entire program, five are still active, one was lost to follow-up, and one was rehospitalized. The program demonstrates feasibility, 91% of all inpatient sessions and 81% of all post-discharge sessions were completed. Regarding preliminary efficacy, 83% of Veterans who completed the program exceeded the minimal detectable change score (4 points) on the Activity Measure for Post-Acute Care (AM-PAC) Mobility scale from program enrollment to completion (mean change 6.5, SD 6.9 points). Based on findings from this clinical demonstration project, the program is feasible. However, future research is needed to further examine the program’s impact on mobility and other outcomes important to older Veterans receiving post-acute nursing home care.
Feasibility trial of an integrated treatment "Activate for Life" for physical and mental well-being in older adults
Authors: Hernandez-Tejada Melba , Nagel Alexis , Madisetti Mohan , Balasubramanian Sundaravadivel , Kelechi Teresa 
Published: December 2021

Abstract
This study describes the feasibility and patient satisfaction for an integrated treatment to address multiple health outcomes in a sample of older adults living in a low-income independent residence facility and their own homes in the community. Specifically, 30 older adults were offered the opportunity to participate in a feasibility study of different components of Activate for Life treatment targeting balance and physical strength (Otago Exercise Program), breathing retraining (Gentle Yoga and Yogic Breathing), and mental health (Behavioral Activation for Depression). Three treatment combinations were compared in a randomized repeated measures design to determine if adding components to the existing Otago program were feasible and if this affected patient satisfaction. Arm1: the Otago strength and balance program alone (n = 10); Arm 2: Otago + Gentle Yoga and Yogic Breathing (n = 10); and Arm 3: Otago + Gentle Yoga and Yogic Breathing + Behavioral Activation (we named this combination ‘Activate for Life’ n = 10). Dependent measures included recruitment rate, session completion characteristics, and satisfaction with the program. Overall, study and treatment components proved feasible, and participants reported high satisfaction with all 3 Arms.
GWEP TAG-TEAM Response: COVID-19 Health Disparities in Orange County, California
Authors: Lee Jung-Ah , Rousseau Julie , Saville Neika , Sehgal Sonia , Gibbs Lisa 
Published: December 2021

Abstract
Health disparities follow zip codes, and in Orange County, CA, both COVID-19 cases and deaths are highly concentrated in our diverse geriatric populations in Santa Ana (44,075) and Anaheim (40,984) where our two UCI Federally Qualified Health Centers (FQHCs) are located, and Garden Grove (16,174) and Buena Park (7,581), where University of California Irvine (UCI) TAG-TEAM GWEP community partner FQHCs are located. Collectively, our FQHCs serve diverse populations, with 83-88% of patients identifying as Hispanic/Latino or Asian. As we support these clinics in becoming Age-Friendly Health Systems, UCI’s GWEP pivoted to provide COVID-19 education in the form of multi-lingual materials and videos available in Spanish, Vietnamese, Korean, Mandarin, and Farsi. Additionally, through our Age-Friendly Geriatrics Tele-ECHO Series we are working to build Mental Health care competencies among these FQHC providers since the pandemic morbidity and mortality disparities have resulted in a profound mental health crisis in our communities.