bluuebunny/crossref_metadata_2025_split huggingface dataset:
Caregiving Intensity and Psychosocial Impact of COVID-19 in Dementia and Non-Dementia Caregivers
Authors: Humber Marika , Truong Angeline , Suresh Madhuvanthi , Jacobs Josephine , Thomas Sam , Lee Trevor , Risbud Rashmi , Trivedi Ranak 
Published: December 2021

Abstract
COVID-19 has adversely impacted the well-being of informal caregivers (CG) due to infection risk, changes to the home environment, and changes to resource availability. CG of persons living with dementia (PLWD) may be especially vulnerable due to the intensity of care provided. We compared CG activities and well-being among CG who did and did not care for PLWD during COVID-19. We conducted an anonymous online survey from April 2020-present. Respondents self-identified as 18+ years and CG to a child or adult with mental health or medical conditions. CG answered questions regarding hours of care provision and caregiving activities, and completed measures of CG burden (Zarit Burden Inventory-4), loneliness (UCLA Loneliness Scale), depressive symptoms (Patient Health Questionnaire), and anxiety (Generalized Anxiety Disorder-2). Of the 258 respondents within the United States, 86 cared for PLWD (33%; 88% female; 56±12 years) while 172 did not (66%; 87% female; 49±14 years). Compared to non-dementia CGs, more CGs of PLWD provided 40+ hours of caregiving/week (36% vs. 49%, p&lt;.05), performed more caregiving activities (8.5 vs. 10.5, p&lt;.01), and assisted with more activities of daily living (55% vs. 73%, p&lt;.01). Compared to non-dementia CG, more dementia CG reported CG burden (53% vs. 67%; p&lt;.05) and loneliness (7.3 vs. 9.1, p&lt;.05). No differences in depressive symptoms or anxiety were found. Results suggest that existing needs of CG of PLWD may be exacerbated by the stressors and concerns of the pandemic, necessitating higher levels of support.
Key Factors in Intervention Implementation, Fidelity, and Sustainability
Authors: Sherman Carey , Gordon Kate , Hepburn Kenneth 
Published: December 2021

Abstract
As part of an NIA-supported effort to develop an online course to train individuals to lead the evidence-based Savvy Caregiver program and to orient sponsoring organizations to the program, we conducted semi-structured interviews to assess success and sustainability “best practices”. Interviews were conducted with 17 leaders and trainers from eleven Savvy-providing organizations. Analysis of these interviews identified two main themes associated with successful program implementation: leadership commitment and trainer ownership. Paramount to success appears to be leaders’ clear understanding of and enthusiastic commitment to the value of the Savvy program to the organization’s constituents. This translated to careful selection, training, management and on-going development of Savvy program trainers. It contributed to leaders’ appreciation of Savvy as a gateway for clients to seek out other programs and services from the organization, while the gathering of meaningful evaluation data (using established outcome-assessment instruments) contributed, in several cases, to garnering more lasting support to deliver the program. Organizations’ commitment to the program was demonstrated by securing the kinds of adequate and appropriate training, typically involving both instruction and modeling, for Savvy program leaders. These efforts fostered a sense of ownership among the leaders – the sense that the program had positive value for the caregivers served. These findings should be of interest both to scholars engaged in the development of interventions and for organizations implementing them. Taken together, the themes highlight several factors for program implementation that maximize the chances of maintaining fidelity to core program principles and ensuring its sustainability.
Interdisciplinary Community-Based Support for Caregivers of Individuals Living with Dementia
Authors: Tucker-Roghi Gina , Escoubas Jamie , Tolliver Renee , Tucker Sarah 
Published: December 2021

Abstract
Evidence indicates family caregivers of individuals living with dementia (ILwD) are at risk for diminished physical and mental health; which may decrease their quality of life and directly impact their ability to provide care. An interdisciplinary approach to self-care and skill-building for caregivers is provided in a virtual support group offered by Council on Aging in Sonoma County, CA. As part of the nonprofit’s Adult Day Program, the group is offered to client caregivers and has two goals: First, creating a community-based, long-term support system for ILwD who are aging-in-place; second, fostering a safe and supportive community for family caregivers, by providing opportunities to collaborate with peers and an interdisciplinary team that includes a Marriage and Family Therapist (MFT), an Occupational Therapist (OT), and a Recreation Therapist (the day program manager). The closed group model established through eight weekly sessions builds trusting relationships in a frame that combines: the OT client-centered and collaborative approach to problem-solving everyday challenges of caregiving, the MFT skills of creating a safe space for discussion and deeper exploration, and program staff insights regarding the ILwD’s current interests and abilities exhibited during Day Program activities. Sessions include an emotional check-in by group members; a brief overview of best-practices and common caregiving concerns related to a weekly topic; and an opportunity for caregivers to explore the integration of best-practices into daily routines, while also attending to their well-being as caregivers. Program evaluation and results related to the program’s effectiveness and implications for scalability will be discussed.
The Relationship between Burden and Financial Factors for Help-Seeking Older Adult Caregivers
Authors: Qualls Sara , Yun Stacy , Weber Kendall , Ferszt Geffen 
Published: December 2021

Abstract
Older adult caregivers often experience unique financial challenges (Schultz & Eden, 2016). The purpose of the present study was to explore the relationship between caregiver finances and caregiver burden for this sample. A sample of 131 caregivers seeking counseling services completed questionnaires assessing demographics, care recipient functioning (ADLs/IADLs), and finances (yearly income, impact of caregiving on finances). A majority, 74.8% of caregivers, indicated financial burden since caregiving. A hierarchical multiple regression was computed to predict caregiver burden. The caregiving characteristics block explained 8.1% of the total variance in caregiver burden, F(7, 123) = 1.54, n.s. Specifically, being younger was significantly associated with more caregiver burden. Adding the care recipient functioning block explained an additional 6.9% of the variance in caregiver burden, Fchange(2, 121) = 4.93, p &lt; .01. The caregiving characteristics and care recipient functioning model accounted for 15% of the total variance in caregiver burden, F(9, 121) = 1.55, p &lt; .05. Again, younger age uniquely predicted greater caregiver burden. Lastly, caregiving finance factors contributed an additional 13.5% of the variance, Fchange(4, 117) = 5.54, p &lt; .001. Thus, the final caregiver characteristics, care recipient functioning, and caregiving finances model accounted for 28.5% of the total variance in caregiving burden, F(13, 117) = 3.59, p &lt; .001. Specifically, having less income and greater monthly expenses related to caregiving predicted higher levels of caregiver burden. These findings imply that those with fewer resources may benefit from intervention for the heavier burden they perceive compared to peers with more financial resources.
A Scoping Review of the Examination of Sandwiched Caregivers’ Psychological Well-being and Physical Health
Authors: Hodgdon Barbara , Wong Jen D , Pittman Patricia S 
Published: December 2021

Abstract
As numbers of sandwiched caregivers in the United States grow, it is essential to document the literature on the impact of dual care responsibilities on aspects of psychological well-being and physical health. This scoping review examined the literature on sandwiched caregivers’ psychological well-being and physical health, identified gaps in the literature, and provided suggestions for future studies to advance the literature on sandwiched caregivers in the United States. Guided by the Arksey and O’Malley (2005) framework, this scoping review comprised of 15 peer-reviewed articles between 1980 and 2019, that examined aspects of the psychological well-being (e.g., depression, affect) and physical health (e.g., health behaviors, chronic conditions) of sandwiched caregivers in the United States. Findings showed that there was ambiguity surrounding the conceptualization of sandwiched caregivers, specifically how older and younger care recipients were defined. Also, most studies examined psychological well-being while physical health was understudied. The findings of this review also showed that, compared to non-sandwiched caregivers (e.g., spousal, filial caregivers) and non-caregivers, sandwiched caregivers exhibited greater depressive symptoms and psychological distress as well as poorer health behaviors. Furthermore, sandwiched caregivers who were female and employed were more susceptible to greater depressive symptoms than their employed male counterparts or employed non-caregivers. In considering future directions, more work is needed that examines physical health. Additionally, sandwiched caregivers of minority status merit attention as multigenerational care occurs at greater rates in these populations. Finally, caregiving during the pandemic may have a detrimental impact on sandwiched caregivers’ lives which should be investigated.
Caregivers' Medical Care Provision at Patient End-of-Life: Associations with Emotional Difficulty and Gains
Authors: Leggett Amanda , Koo Hyun Jung , Baker Elaina , Lee Hannah 
Published: December 2021

Abstract
Family caregivers play crucial roles in patient care and medical decision making, especially at end-of-life (EOL). Yet, most research focuses on caregivers’ burden, with little attention to rewards that make for a fulfilling EOL care experience. We consider caregiver involvement at EOL and associations with caregiver stress and gains. Data are drawn from the 2017 National Study of Caregiving’s last month of life and core interviews which includes caregivers (n=283) for a nationally representative sample of Medicare eligible older adults, and questions caregivers about their care provision and EOL experience. We consider indicators of caregivers’ involvement in medical decision making and support received from providers as predictors of caregivers’ emotional difficulty and gains at EOL utilizing linear regressions controlling for demographic characteristics. Caregivers were 60.7 years of age on average, 72.5% female, 21.3% non-white, and 11% were spousal partners. Making medical decisions was associated with increased emotional difficulty at EOL (B=0.93, SE=0.24, p&lt;.001). In contrast, more caregiving gains were associated with having care decisions align with the CG’s wishes (B=-0.64, SE=0.30, p&lt;.05), being more informed by providers (B=0.41, SE=0.16, p&lt;.05), helping the care recipient with anxiety or sadness (B=0.69, SE=0.28, p&lt;. 05), and surprisingly, feeling that care decisions were made without their input (B=0.82, SE=0.29, p&lt;.01). Being more involved and informed in care was associated with both positive and negative caregiver outcomes at EOL. Understanding caregiver emotional difficulty and gains at EOL are critical for identifying how clinicians can better support caregivers at EOL and improving the caregiving experience.
Prevalence of Binge Drinking by Caregivers of Persons with Alzheimer’s Disease or Related Dementia
Authors: Kunicki Zachary , Jones Richard 
Published: December 2021

Abstract
Some caregivers of persons with Alzheimer’s Disease and related dementias (ADRD) are known to be under high levels of burden, which is associated with higher levels of anxiety, depression, and stress. Previous research has established anxiety, depression, and stress are associated with binge drinking, but little research has examined binge drinking rates among ADRD caregivers. Binge drinking could influence the ability of ADRD caregivers to provide care. The purpose of this study was to explore the prevalence and prevalence correlates of binge drinking among ADRD caregivers using the 2019 Behavior Risk Factor Surveillance Survey (BRFSS). We identified N = 1,642 persons who were the primary informal caregivers of a person with ADRD. Among them, the prevalence of binge drinking was 14 per 100 persons. Bivariable analyses suggested male caregivers and caregivers with 14 or more days of poor mental health in the past 30 days had the highest prevalence of binge drinking at 18 per 100 persons. Caregivers who were 65 or older or had the lowest prevalence at 3 per 100 persons. Caregiving characteristics revealed providing 20 to 39 hours of care per week had the highest prevalence of binge drinking (17 per 100) whereas spousal caregivers (9 per 100) had the lowest prevalence. Smoking status and hours per week providing care were associated with higher odds of binge drinking in multivariable analyses. Future research should examine if binge drinking by ADRD caregivers is related caregiver burden and the quality of care provided to the persons with ADRD.
A Novel Electronic Frailty Index as a Predictor of Clinical Outcomes After Transcatheter Aortic Valve Implantation
Authors: Rangel Maria , Annabathula Rahul , Pajewski Nicholas , Williamson Jeff , Zhao David , Callahan Kathryn 
Published: December 2021

Abstract
Transcatheter aortic valve implantation (TAVI) is becoming the preferred therapeutic approach for older adults with severe aortic valve disease. Frailty portends increase mortality and adverse outcomes after TAVI. We sought to evaluate an electronic Frailty Index (eFI) as a predictor for increased healthcare utilization, adverse clinical and functional outcomes. We retrospective studied 302 adults older than 65 years that underwent TAVI at our institution between October 2017 and September 2020. The mean age of the cohort was 79 ±6.94 years old; 43% were female. Frail individuals (eFI &gt;0.20), as compared to Fit (eFI &lt;0.10) and Prefrail (0.10&gt;eFI&lt;0.20), were more likely to have a higher society of thoracic surgeons score and a greater burden of comorbidities. Subjects classified as Prefrail/Frail had longer intensive care unit stay post-TAVI than fit individuals (&gt;24 hours: 17% vs 4%, respectively, p 0.02); and trended toward longer hospitalization time and discharge to a setting different than home. The Prefrail/Frail group also had a higher proportion of subjects with persistent New York Heart Association Class III heart failure symptoms 30 days post-TAVI as compared to Fit (14% vs 2%, p 0.04), however both groups demonstrated significant symptomatic improvement post-procedure. No significant differences in 30 day mortality, major adverse cardiovascular events or readmissions were found. TAVI is an effective treatment with a low incidence of early adverse clinical outcomes in older adults regardless of frailty status; eFI could help in identifying and targeting susceptible adults that may require additional resources to recover post-TAVI.
Outcomes of a Telephone-Based Frailty and Functional Assessment
Authors: Sison Stephanie Denise , Arias Karla Tejada , Newmeyer Natalie , Schoenburg Racheli , Valencia Carolina Fonseca , Kim Dae 
Published: December 2021

Abstract
With the goal of increasing the clinical use of frailty, we piloted a quality improvement project to determine the feasibility and utility of a telephone-based frailty and functional assessment. We identified 122 established patients with serious medical illness from an academic geriatrics clinic. A geriatric fellow assessed the functional status and conducted the Mini Nutritional Assessment, telephone-MoCA, and Geriatric Depression Scale to generate a deficit-accumulation frailty index (FI) score which was automatically calculated through the electronic medical record. A note was then generated to inform the providers of the details of the assessment and to provide recommendations based on the findings. From November 2020 to March 2021, 104 out of 122 (85.2%) established patients (mean [SD]: 83.4 [7.1], 66% female, 81% White, and mean [SD] FI: 0.32 [0.17]) agreed and proceeded with the assessment. One month after the call, we found that the assessment was included in the clinical decision-making of 55 out of 100 patients seen by their primary care provider. The top 3 incorporated recommendations were chronic disease management based on frailty status (n=56), lifestyle change and counseling to prevent frailty progression (n=44), and management of cognition and mood (n=18). Management of physical status including referral to PT and OT were incorporated in 15 encounters. Our results suggest that a telephone-based frailty and functional assessment is feasible and has value-added contributions in improving the care of older adults through providing a holistic view of their health status.
End of Life Virtual Reality Training: Medical Student Increased Empathic Ability
Authors: Gugliucci Marilyn , Manukhin Daniel , Dyer Elizabeth , Swartzlander Barbara 
Published: December 2021

Abstract
Introduction: It is unclear if medical student empathy declines by third year of clinical rotation trainings. Desensitization throughout the first two years may lead to decreases in empathy as a coping mechanism to avoid burnout in the clinical years. This study determined if self-assessed empathy increased after conducting an Embodied Labs, Inc. end of life virtual reality (VR) experience. Methods: Mixed methods, quantitative/qualitative, research were applied for University of New England (UNE) College of Osteopathic Medicine (COM) 2nd year medical students (N=174). They completed the 3-part 30 minute Clay Lab VR experience. UNE IRB approved pre/post-tests focused on empathy. Data were collected using RedCap. Closed questions were analyzed applying frequency analysis and paired-sample t-test through excel. Open-ended questions were analyzed through N-VIVO 12+. Results: The data included pre/post-tests from 146 students volunteers. Results indicated statistical significance (P=.01) in all closed questions except for question 7 (What is your view of conducting a full code on a patient with a DNR? (P=.14). The greatest difference seen between pre (23.97% agree or strongly agree) and post-test (64.38% agree or strongly agree) data was for question 3 (I gained knowledge about what hospice is by embodying Clay in this virtual reality lab); P= .00. Three qualitative themes included: Impact, Empathy, EOL Knowledge. Conclusion: This VR Lab experience increased self-assessed empathy at the time of Clay Lab completion; however, enduring empathy and learning about hospice/EOL has not been measured. Further research is suggested to determine the longitudinal impact of virtual reality education.
Effect of Baseline BMI and IL-6 on Gait Speed Response to Caloric Restriction in Older Adults
Authors: Hsieh Katherine , Neiberg Rebecca , Beavers Kristen , Beavers Daniel 
Published: December 2021

Abstract
We examined whether the effect of caloric restriction (CR) on gait speed change in older adults (67.3±5.27 years) varied by BMI and interleukin 6 (IL-6). Data from eight six-month randomized controlled trials were pooled, with 1268 participants randomized to CR (n=710) and non-CR (n=558) conditions. Baseline BMI/IL-6 subgroups were constructed using BMI≥35 kg/m2 and IL-6&gt;2.5 pg/dL, and participants were jointly classified as high/high (n=395), high/low (n=208), low/high (n=271), or low/low (n=344). Overall treatment effects showed significant improvements in gait speed in CR versus non-CR [mean difference: 0.02 m/s (95% CI: 0.01, 0.04)]; however, CR assignment significantly interacted with BMI/IL-6 subgroup (p=0.03). Greatest gait speed improvement was observed in the high/high CR subgroup [+0.06 m/s (0.03, 0.09)] and appeared to be driven by no gait speed change among the high/high non-CR subgroup. Gait speed response to CR was greatest in older adults with elevated baseline BMI and IL-6.
Continue or not to continue? Attitudes towards deprescription among community-dwelling older adults in China
Authors: Tan Jie , Zhang Li , Wang Ying , Chen Lihui , Wu Chenkai 
Published: December 2021

Abstract
Inappropriate prescribing of medications and polypharmacy among older adults could lead to avoidable harms. It is hence vital to stop potentially inappropriate medications in this vulnerable group. An approach coined 'deprescribing' has been used to describe a patient-centerd process of optimizing medication regimens. But patient resistance to discontinuing medication use is a significant barrier to deprescribing. The present study aims to describe attitudes towards deprescribing and to examine individual-based characteristics that might be associated with these attitudes among community-dwelling older adults in China. We conducted a cross-sectional study through in-person interviews using the validated Patients’ Attitudes Towards Deprescribing questionnaire in two communities through the community-based physical examination platform. Participants were 65 years and older and had at least one chronic disease and one regular prescription medication. Of the 1,897 participants in the study, the average age was 74 years and 1,023 (53.9%) were women. The majority had one chronic disease (n=1,364 [71.9%]) and took 1-2 medications (n=1,483 [78.2%]). A total of 947 (50.0%) older adults reported being willing to stop taking one or more of their medicines if their physician said it was possible, and 1204 (63.5%) older adults wanted to stop a medicine been taking for a long time. Chronological age, marital status, number of chronic diseases, and self-rated health status were associated with the attitudes towards deprescribing. This study showed that half of the participants were willing to cease a medication that their physician though was no longer required. Individual-level factors were associated with attitudes towards deprescribing.
The Impact Of A Whole Health Model Of Care On Patient Outcomes
Authors: Faul Anna , Yankeelov Pamela , D'Ambrosio Joseph , Cotton Sam , Gordon Barbara , Hall-Faul Maria 
Published: December 2021

Abstract
The FlourishCare Model (FCM) transforms primary care sites by addressing all determinants of health and focusing on helping patients to flourish. The FlourishCare Index (FCI) is a clinical measure to assess the effectiveness of the FCM to address all determinants of health. We will present data on the effectiveness of the FCM serving 159 older adults with MCCs. The sample was mostly female (77%), White (64%), retired (54%), married (30%) or widowed (20%) and living in urban areas (64%). The mean age was 69 (SD=15), with 13 years education (SD=3). Patients changed significantly over time on total FCI scores (57%-72%;□=3.80,SE=0.63). Results show significant growth over time for individual health behaviors (58%-67%;□=2.14,SE=0.84), health care access (71%-89%;□=4.43,SE=1.00) and social determinants (62%-85%;□=5.54,SE=1.02) with psychological determinants (54%-61%;□=1.74,SE=0.95) and environmental determinants (70%-81%;□=2.81,SE=1.62) showing a trend to significance. Interaction effects with time show that the FCM supported patients with lower education attainment to improve at a higher rate than those with higher education attainment, for the total FCI score (□=-0.59,SE=0.24) and health care access (□=-0.94,SE=0.38). Receiving mental health counseling resulted in more improvement in psychological determinants than those who did not receive counseling (□=3.43,SE=2.04). The FCM was able to support rural patients at a higher rate than urban patients to gain access to health care (□=4.13,SE=2.02). The FCM supported Hispanic patients the most in improving social determinants of health (□=8.40,SE=3.93). This study showed the importance of a systems approach to care using measures that focus on what matters most to older adults who value quality-of-life outcomes.