bluuebunny/crossref_metadata_2025_split huggingface dataset:
Awareness of Hospice Care Among Rural Residents: Findings from Social Determinants of Health Framework
Authors: Luo Yan , Noh Hyunjin , Lee Lewis , Lee Hee 
Published: December 2021

Abstract
Although the demand for hospice care increases as our society ages, the awareness of hospice care among adults in the southern rural region of the US has not been documented. This study aims to assess the rate of hospice care awareness among rural residents living in the Black Belt Region and examine social determinants of health (SDH) associated with the awareness. A cross-sectional survey was conducted among a convenient sample living in rural Alabama (N=182, age=18-91). Participants’ awareness of hospice care, demographic characteristics (i.e., age, gender), and SDH (i.e., financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and awareness of hospice care among participants while controlling for demographic characteristics. The majority of participants had heard of hospice care (82.4%), and older participants (over 50 years old) were more likely to report having heard of hospice care (OR=7.35, p&lt;0.05). Participants reporting worries about stable housing (OR=0.05, p&lt;0.05) and higher social isolation were less likely to have heard of hospice care (OR=0.53, p&lt;0.05), while participants with higher health literacy had a higher likelihood to have heard of it (OR=2.60, p&lt;0.01). Our study is the first study assessing the status of hospice care awareness among residents living in the Black Belt Region. This study highlighted that factors including age and certain SDH (i.e., housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice care awareness.
Investigating Sequential and Simultaneous Changes in Trajectories of Cognitive Decline and Depressive Symptoms
Authors: Klee Matthias , Leist Anja 
Published: December 2021

Abstract
Background. The role of depression as risk factor or early symptom of cognitive decline and dementia is still debated. Exploiting longitudinal trajectories of memory recall in a large European sample, we sought to better understand the nature of simultaneous versus sequential changes in depressive symptoms alongside memory recall at older ages. Method. A total of 4,865 respondents to the SHARE survey, mean age at t1 61.5 years (SD = 7.53), completed the EURO-D depression scale and a delayed recall task across six waves spanning ~13 years. We applied k-means clustering to distinguish trajectories of depressive symptoms and delayed recall. Clusters indicating depressive and recall trajectories were included in logistic regressions to assess likelihood of parallel versus sequential change, controlling for age, gender, employment status and education. Results. Analyses revealed six distinct trajectories each for depressive symptoms and delayed recall. Visual inspections indicated that only declining recall trajectories showed increases in depressive symptoms, occurring simultaneously rather than sequentially. Using grouped declining recall trajectories as outcome, the low-increasing depressive symptoms trajectory was associated with cognitive decline (OR = 1.52 [1.11, 2.06]), whereas the stable-high depressive symptoms trajectory was associated with cognitive decline in respondents aged 60-69 years (OR = 1.78 [1.01, 3.16]). Discussion. Distinguishing trajectories in depression and recall incorporates longitudinal information able to further elucidate relationships between depression and cognition. While the findings suggest depression as a co-morbidity, attention needs to be given to a comparatively small high-stable depressive symptoms trajectory group with elevated risk of cognitive decline in their 60s.
Caregiver Task Difficulties at the End of Life: A Latent Cluster Analysis
Authors: Litzelman Kristin , Kizza Irene , Berghoff Ashley 
Published: December 2021

Abstract
Caregivers engage in myriad tasks from household help to complex medical care. However, little information is available on how caregivers experience individual tasks – particularly key end-of-life tasks such as managing breathing problems or patients' sadness and anxiety. The purpose of this study was therefore to assess task difficulty. Using data from the National Health and Aging Trends Survey and the National Survey on Caregivers (2015-2017), we assessed eleven caregiving tasks in 241 primary caregivers of care recipients in their last month of life. A latent cluster analysis revealed three key clusters: 1) pervasive difficulties, in which caregivers reported difficulty across most or all of the tasks; 2) minimal difficulties; and 3) emotional management difficulties, in which caregivers reported difficulty with managing sadness and anxiety and lower levels of difficulty on the other tasks. Weighted frequency analyses revealed that caregivers in the pervasive difficulties cluster were most likely to be filial caregivers (85% versus 63% of the full sample, p&lt;0.05) or co-residing with the care recipient (49% versus 37% of the full sample, p&lt;0.05). Caregivers identified as having pervasive difficulties were also more likely to report providing intensive care, more than 100 hours per week (54% versus 36% of the full sample, p&lt;0.05). Care recipient condition was not associated with cluster membership. The findings highlight the need to consider caregiver coping at the task-level and have implications for understanding unmet needs. Future research will assess predictors of cluster membership and how task difficulties are associated with symptoms and well-being outcomes.
Change in medical and health care decision-making patterns at the End-of-Life: A cohort of the very old people
Authors: Liu Xinran , Albert Steven 
Published: December 2021

Abstract
How does medical and healthcare decision-making among the very old people change in their last year before death? We explored patterns of decision-making in the Health ABC cohort study in 2011-14 (years 15-17), which involved 12 waves of quarterly phone interviews. When the participant was unable to do the interview, a proxy completed it instead. We identified a sample of 291 decedents (aged 90.0±2.9 at death, 35.7% Black, 52.6% female) with at least 1-year follow-up before death. Percentages of decedents who have made medical or healthcare decisions in the last four quarters before death were 32.0%, 31.2%, 32.6%, 41.9%, respectively. Decedents made more healthcare decisions in the last quarter before death (P&lt;0.01), compared to the baseline. Across all quarters, decision-making is most in need for medications (17.6%), hospital admission (13.2%), and ER/urgent care visit (13.2%). We matched a 1:1 sample of survivors at the time of death by race, sex, and age (within ±3 years). In random effects models with multiple imputations of missing data, we found that decedents were more likely to make healthcare decisions than survivors across all four quarters before death or censor (Odds ratio=1.99, 95%CI: 1.49-2.65, P&lt;0.01). The significance still held after adjusting for age, female, race, education, and interview methods. Overall, compared to matched survivors, the frequency of making medical and healthcare decisions among the very old decedents has already been high in the last year before death. This frequency rose sharply in the last quarter before death.
Length of Stay in Hospice Care across Racial/Ethnic Minorities over 65 Years of Age: A Descriptive Analysis
Authors: Yu Heshuo , Brown J Scott 
Published: December 2021

Abstract
Purpose: This study aims to explore the relationship between race/ethnicity and length of stay in hospice care among adults over 65 years of age in the United States. This topic is understudied within a population-representative sample, particularly among non-White decedents. Methods: Secondary analysis of data from the 2007 NHHCS (n=3,918). Race/ethnicity included Hispanics/Latinos, Non-Hispanic Whites, African Americans, and other races. Length of hospice stay was measured by the number of days that patients received hospice care from hospice agencies. Results: The study found that African Americans have a longer length of stay in hospice agencies than Whites, even after controlling for all other factors in the model. Female gender, older age, and several diseases are covariates that significantly impact length of hospice stay. Discussion: Compared to other races/ethnicities, the long length of stay in hospice among African Americans may negatively impact the quality of end-of-life care and quantity of skilled staff visits. Future research is recommended to further explore potential consequences of longer hospice stays, especially within African American communities. Studies with larger samples of minorities that integrate socioeconomic factors need to be done to better study the relationship between length of hospice stay and race/ethnicity.
Role of Home-Modification Training for Care Managers
Authors: Nishino Akiko , Harazono Yoritaka , Tanaka Moeko , Yoshida Kazunori , Funaki Toko , Takada Ryosuke , NASU Takenori , TOBIMATSU Taketo 
Published: December 2021

Abstract
With the aging of society, the long-term care insurance system -which includes home modifications to continue living at home- was established in 2000. However, the quality of home modifications has been persistent issue, and effective training is expected to conclusively solve this problem. To this end, the purpose of this study is to clarify the rational for training care managers who plan home modifications. A survey comprising two sets of questionnaires was conducted; one set encompassed is all 62municipalities in Tokyo, whereas the other involved care manager who participated in training program. The results of the first questionnaire showed that, out of 62 municipalities, 9 (14.5%) provided training on home modification, of which 8 (88.9%) provided training on administrative procedures. In one municipality that provided training on practical aspects of home modification, we provide questionnaires to 59 care managers participating in the training. -Lectures on administrative procedures, physical conditions of invalids, and reading drawings were conducted by administrative staff, occupational therapists, and architects, respectively. Afterwards, the participants attended a planning workshop. According to the questionnaire conducted after the workshop, 80.4% of the participants could understand home modifications in the system, 85.5% understood how to modify homes based on the occupants’ symptoms and physical conditions, 81.6% could interpret drawings, 90.2% could plan modifications, and 81.6% found the training useful. These findings indicate that the training of care managers has indeed been effective in actual practice. Improving the quality of home modifications through multidisciplinary cooperation is significant in maintaining home life.
Cardio-Dance Exercise to Improve Cognition and Mood in Older African Americans: A Propensity-Matched Cohort Study
Authors: Fausto Bernadette 
Published: December 2021

Abstract
The current study sought to determine the influence of initial sleep quality and body mass index on the cognitive and mood outcomes of a community-based cardio-dance exercise program. Thirty-two older African Americans who participated in a five-month cardio-dance exercise program were propensity-matched to 32 no-contact controls (ages 60 to 88). Participants completed neuropsychological tests of attention, executive function, and memory and a self-reported depression measure at baseline and post-test. Among exercise participants, we observed significant improvements in depression (ηp2=.12, p=.009) and attention (ηp2=.12, p=.009) relative to controls. Improvements in executive function and attention were most pronounced among exercise participants with poor sleep quality (ηp2=.41, p=.04) and with obesity (ηp2 = .30, p=.001), respectively. This study provides novel evidence that cardio-dance exercise has the potential to improve depression in older African Americans. For those with poor sleep quality or obesity, exercise can also improve some cognitive outcomes.
Comparing the short and original versions of the Activities-specific Balance Confidence (ABC) scale in older adults
Authors: Tiernan Chad , Goldberg Allon 
Published: December 2021

Abstract
Balance confidence assessment in older adults has implications for falls and quality of life. It remains unclear whether the original Activities-specific Balance Confidence (ABC-16) scale or the shortened 6-item (ABC-6) scale is recommended. To further inform the decision-making process of balance confidence tool selection, a secondary analysis of an existing dataset consisting of 77 community-dwelling older adults was performed. ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) were assessed. Participants were primarily female (80.5%) between the ages of 60 and 87 years. Results indicated a strong association between the scales [r = .97, p&lt;.001); ICC(2,1) = .80] but limited agreement (95% Limits of Agreement range = 22.1; mean difference of 7.2 points in the direction of the ABC-16). Cronbach’s alphas were .95 (ABC-16) and .89 (ABC-6), suggesting high internal consistency for both scales but possible item redundancy with the ABC-16. Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2=.36) in SRH compared to model 2 (ABC-16 = primary predictor; R2=.29). Hotelling’s t-test [t(74)=2.4, p=.008] indicated that the correlation coefficient (Multiple R) from the ABC-6 model was significantly higher than the correlation coefficient from the ABC-16 model. In conclusion, despite a high correlation, the two scales did not agree strongly and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 should be considered for balance confidence assessment in older adults.
Caregiving Between Spouse and Adult Child Caregivers of Older Adults with Cognitive Impairment
Authors: Garcia Nicole , Papazyan Anna , Choi Sarah , Song Yeonsu 
Published: December 2021

Abstract
Prior studies of caregiving characteristics by type of caregivers are inconsistent, particularly those who are spouses and adult children. This study examined caregiving characteristics between spouses and adult children of cognitively impaired older adults. We analyzed phone-screening data from an ongoing trial of a dyadic sleep intervention program for persons with dementia and their caregivers. Data included spouse caregivers (n=52) and adult child caregivers (n=24). Nearly all participants (95%) lived with their care recipients (91% with dementia). Types of caregiving activities were measured by activities of daily living [ADLs] and instrumental ADLs [IADLs] with their levels of intensity (0 [total independent] to 3 [total dependent]). Care recipients’ sleep was measured by the Neuropsychiatric Inventory-Nighttime Behavioral Subscale (8 items). Analyses included Pearson correlations and t-tests. Adult child caregivers helped their care recipients at significantly higher levels as indicated by their measure of dependence in dressing (1.46±1.22 vs. 0.87±1.16, p=0.044), continence (1.22±1.38 vs. 0.54±1.04, p=0.021), laundry (2.87±0.46 vs. 2.13±1.24, p=0.007), and transportation (3.00±0.00 vs. 2.63±0.79, respectively; p=0.031) than spouse caregivers. Adult child caregivers also reported their care recipients having more difficulty falling asleep (56% vs. 19%, respectively; p=0.004) and having more numbers of sleep problems than spouse caregivers (3.54±2.08 vs. 2.48±1.51, respectively; p=0.014). The findings suggest that adult child caregivers may involve higher levels of caregiving responsibilities during daytime and nighttime, compared to spouse caregivers. Further research needs to explore complimentary ways to involve spouse and adult child caregivers in the care of this vulnerable population.
Examining Subjective Aging through the Lens of the Caregiver Experience
Authors: Hardin-Sigler Kristen , Grelle Kaitlin , Deason Rebecca 
Published: December 2021

Abstract
Caregivers of individuals with Alzheimer’s disease and related dementia (ADRD) often experience burden that has been associated with poor physical and psychological health outcomes (Andren & Elmstahl, 2007; Zimmerman et al., 2018). However, very little research investigates how the caregiving experience may impact an individual’s subjective aging experience. Various aspects of subjective aging have been implicated in health outcomes and memory function (Brothers et al., 2017; Stephan, Sutin, Caudroit, & Terracciano, 2016). The purpose of this study was to investigate the differences in perceptions of subjective aging between caregivers and non-caregivers. Participants (N = 185) completed a survey assessing several aspects of subjective aging, including subjective age, or how old an individual feels, memory function, well-being, attitudes towards aging, and aging stereotypes. A series of independent t-tests indicated that there were significant differences between groups on subjective age (p = .013), and subjective memory function (p = .013). Caregivers (n = 93) reported feeling significantly older than their chronological age, reported significantly more subjective memory complaints, and also reported poorer subjective memory function when compared to the non-caregiver (n = 92) control group. Previous literature does suggest that older subjective age ratings are associated with poor subjective memory function, so these results are not necessarily surprising. However, these results suggest that caregiving for individuals with ADRD may negatively impact caregivers’ perceptions of their own aging experience, but not necessarily their perceptions about aging in general.
How Frequently are Caregivers Included in Patient Education for Oncology Patients?
Authors: Fields Beth , Mueller Anne 
Published: December 2021

Abstract
A growing body of literature shows that family and unpaid caregivers of older adults with cancer are assuming more care responsibilities, especially after discharge from an inpatient admission, and frequently report feeling unprepared to do so. Interprofessional collaborative practice can rectify this gap to help ensure caregivers are included in the care team and patient education in the hospital. This retrospective data analysis of electronic health record data examines the prevalence of caregiver involvement in education activities conducted by health care practitioners for older adult cancer inpatients at an academic medical hospital in the midwestern United States. Our dataset includes a total of 676 admissions of older adult cancer inpatients (565 unique patients) between 9/1/2018 and 10/1/2019. Descriptive statistical analyses were conducted to determine the prevalence of caregiver involvement in patient educational activities. The average patient was 75 years old (range: 66-89), white(95%) and male (57%). Approximately 5,720 educational topics were discussed with patients, and 88% of admissions included some patient education. Caregivers were included in 29.6% of educational topics discussed and at least one education session for 42.9% of all admissions. Caregivers are important collaborators in supporting the health and well-being of older adults with cancer, but they are often not included in patient educational activities prior to discharge. Practioners may need to evaluate barriers to including caregivers in patient education activities. A better understanding of this gap in education can help inform future interprofessional collaborative practice initiatives.
Self-efficacy in Thought Control , not Positive Gains, Mediates Effect of Benefit-Finding Intervention for Carers
Authors: Cheng Sheung-Tak 
Published: December 2021

Abstract
This study examines the therapeutic mechanism of the benefit-finding therapeutic (BFT) intervention that used cognitive reappraisal and alternative thinking to construct positive aspects of caregiving (PAC), in a cluster-randomized controlled trial for Alzheimer caregivers. 42 caregivers received BFT whereas 87 received psychoeducation as control. Both interventions were held in groups. Depressive symptoms and global burden were outcomes measured at baseline, postintervention, and 4- and 10-month follow-up. Mediators considered included PAC and three self-efficacies—controlling upsetting thoughts (SE-CUT), responding to disruptive behaviors, and obtaining respite. Using mixed-effects regression, we demonstrated that benefit-finding increased caregivers’ PAC and SE-CUT, but that only SE-CUT uniquely predicted depressive symptoms and global burden longitudinally. Path analyses with bootstrapped confidence intervals showed that SE-CUT change from baseline to postintervention mediated intervention effects on depressive symptoms, but not global burden, at both follow-ups. No mediation effects were found for PAC and the other self-efficacies. As a conclusion, The BFT effect on depressive symptoms was partly accounted for by improvement in SE-CUT. The therapeutic mechanism for the effect on burden remained unknown. The study sheds light on the importance of actively promoting positive caregiver functioning.
Daily Sleep, Well-Being, and Adult Day Services Use Among Dementia Care Dyads
Authors: Liu Yin , Leggett Amanda , Kim Kyungmin , Polenick Courtney , McCurry Susan , Zarit Steven 
Published: December 2021

Abstract
Sleep is critical for health and well-being among both persons with dementia (PwD) and their family caregivers (CG). This study described sleep characteristics for dementia family care dyads, then examined the associations with sleep quality, daytime functioning, and mood in the context of Adult Day Services (ADS) use. Caregivers (n = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons with dementia across 8 consecutive days (N = 1,359), where PwD attended ADS at least 2 days of the week. They also reported their own fatigue and affect and PwD’s daytime and nighttime sleep and behavior problems on each day. Findings from multilevel models suggested that bedtime was earlier and total time in bed was shorter before an ADS day for the dyad, and also on an ADS day for PwD; wake time was earlier for the dyad on and following an ADS day. Using ADS related to better prior night sleep quality for PwD; it also weakened the association between nighttime sleep problems and higher daytime negative affect for CG. Yesterday’s ADS use buffered the negative impact of shorter total time in bed on CG daytime fatigue; it also buffered the association between nighttime sleep problems and lowered CG daytime positive affect. Regular ADS use may protect against the adverse impact of sleep disturbances on daytime functioning and well-being for dementia care dyads.