bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diversity and Variation in Assisted Living Care, Nationally and Over Time
Authors: Cornell Portia , Shippee Tetyana 
Published: December 2021

Abstract
Assisted living is generally understood to offer a greater degree of privacy and independence than a nursing home; most residents pay privately, with some receiving support from state subsidies and Medicaid; regulation and oversight are the purview of state agencies. Within these broad parameters, however, one assisted living community may look quite different from another across the country, or down the street, in its resident population and the regulations that govern its operating license. The purpose of this symposium is to explore that variation. The papers leverage an in-depth review of changes in assisted-living regulation from 2007 to 2019 and a methodology to identify Medicare beneficiaries in assisted living using ZIP codes. To set the stage, the first paper examines variation across assisted living licenses to identify six regulatory types and compare their populations’ characteristics and health-care use. The second paper analyzes trends over time in the clinical acuity of assisted living residents associated with changes in nursing home populations. The third paper investigates racial disparities in assisted living associated with memory-care designations and proportions of Medicaid recipients. The fourth investigates how regulation of hospice providers in assisted living affect end-of-life care and place of death. The final paper describes requirements related to care for the residents with mental illness in seven states. The symposium concludes with an expert in long-term care disparities and quality discussing the implications for policymakers, providers, and the population needing long-term care in assisted living.
Trends in Acuity of Residents in Assisted Living
Authors: Hua Cassandra 
Published: December 2021

Abstract
Assisted living serves as a substitute for nursing home residents with low care needs, especially in markets with a high proportion of dually eligible Medicare beneficiaries. This study examines trends in the acuity of residents in assisted living communities over time in comparison to nursing homes to characterize how substitution has affected the resident compositions of both settings. We also examine how trends in acuity are shaped by dual eligibility. Using Medicare claims data, we identify cross-sectional samples of beneficiaries in each setting from 2007-2017. The proportion of residents in assisted living with high care needs has increased 18% in assisted living communities compared to 8.7% in nursing homes. Acuity levels are higher among dually eligible assisted living residents compared to assisted living residents who are not dually eligible. Policy makers and administrators should examine whether assisted living is prepared to provide care for an increasingly acute population.
Place of Death Among Assisted Living Residents as a Factor of Hospice Regulations
Authors: Belanger Emmanuelle , Teno Joan , Dosa David , Zhang Wenhan , Gozalo Pedro , Thomas Kali 
Published: December 2021

Abstract
Our objective was to examine the likelihood of dying in RC/AL among a national cohort of fee-for-service Medicare beneficiaries who died in 2018 (N=31,414) as a factor regulations allowing hospice care. We estimated multivariable logistic regression models to examine the association between RC/AL as place of death and supportive hospice regulations, controlling for demographic characteristics, dual Medicare/Medicaid eligibility, years in AL, and hospital referral region (HRR) to control for hospice practice patterns. A majority of beneficiaries in our cohort died in RC/AL; more than half while receiving hospice services. In unadjusted models, the odds of remaining in RC/AL communities until death were significantly higher in the presence of regulations supportive of hospice care. This relationship was no longer significant once adjusting for covariates and an HRR fixed effect, suggesting important variation in end-of-life experiences for AL residents not explained by hospice regulations.
Measuring Dyadic Interactions and Dining Environment in Dementia Mealtime Care: A Systematic Review of Instruments
Authors: Liu Wen , Kim Sohyun 
Published: December 2021

Abstract
It is critical to use validated instruments to assess mealtime dyadic interactions and dining environment for people with dementia to evaluate the process and efficacy of mealtime interventions. However, the quantity and psychometric quality of such instruments are unknown. This systematic review aimed to synthesize the quantity and quality of instruments that assess dyadic interactions, physical environment, and/or social environment during dementia mealtime care. We searched Pubmed, CINAHL, AgeLine, PsychINFO, and Cochrane Library for records published between 1980-2020. Records were eligible if they included any instrument assessing concepts of interest (i.e., mealtime dyadic interactions, physical and/or social dining environment). From eligible records, eligible instruments originally developed or later modified to measure concepts of interest were identified, and instruments’ characteristics were extracted: 1) development process, 2) concept/construct assessed, 3) sample/setting, 4) administration method, 5) item description, 6) scoring format/interpretation, 7) reliability, and 8) validity. A newly developed tool was used to evaluate instruments’ psychometric quality. In total, 26 eligible instruments were identified. Seventeen instruments assessed dyadic interactions, 1 assessed only physical environment, and 8 assessed physical & social environment. All instruments were observational tools and scored as having low psychometric quality. Reasons for low psychometric quality included use of small sample size compared to the number of items, limited psychometric testing, and inadequate estimates. A number of instruments were developed and/or used to assess dyadic interactions, physical and/or social environment in dementia mealtime care. All instruments warrant further testing to accumulate psychometric evidence in larger diverse samples in different care settings.
Residents' Wayfinding Challenges and Environmental Interventions in a Care Home
Authors: Elkes Shelby , Chaudhury Habib 
Published: December 2021

Abstract
This study evaluated the role of the built environment on residents’ wayfinding behaviours at Louis Brier Home in Vancouver, British Columbia, Canada. The goal of this study was to explore baseline mobility challenges for the residents traveling between their bedrooms and social spaces. In response to this, low-cost environmental interventions were proposed and implemented to support safe and independent wayfinding for the residents. The project consisted of three phases. First phase involved a mixed methods approach using behavior mapping and spatial observations of the residents interacting with their physical environment, combined with one focus group with the staff members. In the second phase, researchers presented actionable environmental interventions for the care home administration to consider and implement. The final phase involved post-implementation behaviour mapping, spatial observations and a focus group session. The implemented environmental interventions influenced in improved resident wayfinding and orientation in the long-term care home.
Construction and Validation of a Frailty Index in Primary Care in Italy: The Health-Search Frailty Index
Authors: Vetrano Davide , Zucchelli Alberto , Onder Graziano , Bernabei Roberto , Fratiglioni Laura , Marengoni Alessandra , Lapi Francesco 
Published: December 2021

Abstract
Recognizing frailty in primary care is important to implement personalized care pathways and for prognostication. The aim of this study was to build and validate a frailty index based on routinely collected primary care data in Italy. We used clinical data from 308,280 Italian primary care patients 60+ with at least 5 years of follow-up, part of the Health Search Database. A heuristic algorithm was used to select the deficits to be included in a highly performant frailty index. The fitness of the index was assessed through the c-statistics derived by survival models. Results were externally validated using the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). After testing 3.4 million of deficits combinations, 25 deficits were selected to be included in the Health Search Frailty Index (HS-FI). After adjusting by sex, age and geographical area, the HS-FI was associated with 5-year mortality (HR per 0.1 increase 1.99; 95%CI 1.95-2.02) and hospitalization rate (HR per 0.1 increase 1.25; 95%CI 1.23-1.27). In the external validation cohort, HS-FI independently predicted mortality, hospitalization, incident disability, incident dementia, and incident falls. This is the first frailty index built following a data-driven approach, using national representative primary care data. The implementation of such tool – derived by routinely collected data – in primary care software will ease the prompt, comparable and reliable recognition of frailty at the population level.
Patient-Rated Performance of Home Health Agencies and Hospitalization Risk: A Propensity-Score Matched Analysis
Authors: Ma Chenjuan , Groom Lisa , Lin Shih-Yin , David Daniel , Brody Abraham 
Published: December 2021

Abstract
Home health care is the most commonly used home- and community-based service to older adults “Aging in Place”. Patient experience of healthcare services is a critical aspect of patient-centered care. Indeed, policymakers have linked patient-rated quality of care to payment to healthcare providers. This study aimed to examine the association between patient-rated care performance of home health agencies and risk for hospitalization among Medicare beneficiaries. This study used several national datasets from 2016 and included 491,718 individuals from 8,459 home health agencies. Home health agencies’ performance was measured using patient experience star rating from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). Propensity score matching was used to balance the differences in patient characteristics at baseline between those receiving care from high-performing home health agencies and those in lower-performing agencies. On average, patients were 80.5 years old, 65% female, 81% White, 10% Black, and 6% Hispanic, with 90% taking 5 or more medications. Patients had a mean score of 1.73 (SD=1.69) on the Charlson Index. Respectively, 10% and 16% of patients were hospitalized within 30 and 60 days of home health care initiation. Estimates of logistic regression after propensity score matching found that patients receiving care from lower-performing agencies were at similar risk for both 30-day (OR=0.99, p=0.817) and 60-day (OR=1.02, p=0.616) hospitalization following the start of home health care, compared to those in high-performing agencies. Our findings suggest discrepancies (or no relationship) between patient experience and objective outcomes of home health care.
Who Provides Care in a Crisis? Family Caregivers’ Experiences of Home Care During the COVID-19 Pandemic
Authors: Reckrey Jennifer , Perez Sasha , Ornstein Katherine 
Published: December 2021

Abstract
Many homebound individuals with dementia rely on both paid caregivers (e.g., home health aides, home attendants, other homecare workers) and family caregivers to live safely at home. We conducted semi-structured interviews with 15 family caregivers of individuals with severe dementia receiving home-based primary care in NYC to explore how caregiving changed during the COVID pandemic. Most individuals with long-standing paid caregivers experienced infrequent home care disruptions. In fact, paid caregivers were often the primary and sometimes only individuals to provide direct care; family caregivers themselves often stayed away and managed care from a distance. While most family caregivers described heightened attention to infection control, guidance about COVID prevention and safety rarely came from home-based primary care providers or home care agencies and instead was considered “common sense.” These findings confirm the essential role paid caregivers play in home-based dementia care teams.
Aging Into Disability: A Conceptual Challenge for Gerontology
Authors: Kahana Jeffrey , Goler Timothy , Force Lawrence 
Published: December 2021

Abstract
One of the most fraught subjects facing a fast growing aging population is the subject of aging into disability. This paper examines the processes of aging into disability as a distinct challenge for not only older persons, but also for the field of gerontology, and public policy-makers. Disability in youth and in middle age has largely defined the disability rights agenda, and elders aging into disability have not been the subject of much attention from scholars in the field of disability. Surprisingly, however, scholars and policy-makers in gerontology have also by and large avoided the subject of older persons aging into disability—a complex process that involves impairment, environmental disablement, and changes in social relationships. This process accelerates with advancing age, and disproportionately affects women. Moreover, when older adults develop mobility limitations, experience falls, become hard of hearing, or experience other such impairments of age related disability, they do not think of themselves as aging into disability, or being disabled. This lack of disability identity may protect them from stigma and from low self-esteem. At the same time, it stands in the way of seeking accommodations and from developing a bond with other older adults who are aging into disability. This paper explores the dynamics of disability avoidance as an ideal that can harm older adults and their caregivers. It aims to bring disability more fully into the normal life-course, and to suggest lines of inquiry for gerontological research, to broaden the field, and to make service communities more inclusive .
Mental and Physical Health in Swiss Older Survivors of Enforced Child Welfare Practices
Authors: Thoma Myriam , Bernays Florence , Eising Carla , Maercker Andreas , Rohner Shauna 
Published: December 2021

Abstract
It is the purpose of child welfare practices to provide a protective environment for minors. However, welfare practices for children and adolescents have also been linked to a higher risk for maltreatment, trauma, and deprivation. Due to such early-life adversity, affected individuals often report a life course depicted by further trauma, socio-economic disadvantage, mental and physical ill-health. Examination of the long-term health correlates of enforced child welfare practices, as well as potential mediators, have previously been neglected in later life. It was therefore the purpose of these studies to examine the long-term correlates of enforced child welfare practices; the associated maltreatment, trauma, and deprivation; and the physical and mental health outcomes in Swiss older survivors (n=132, MAGE=71 years) and an age-matched control group (n=125). These studies further examined the mediating role of socio-economic factors (e.g., education, income), self-esteem, and self-compassion. Mental health was assessed with a structured clinical interview; physical health, self-esteem, and self-compassion with psychometric instruments. Survivors reported significantly more types and severity of childhood maltreatment, trauma, and deprivation than the control group. They also reported significantly more lifetime and current mental health disorders and more physical illnesses. Socio-economic factors and self-esteem, but not self-compassion, acted as significant mediators. Exposure to maltreatment, trauma, and deprivation in childhood and adolescence is linked to poorer mental and physical health in later life. Potential targets for intervention and health-protective measures include socio-economic factors and self-esteem, which were found to diminish the detrimental long-term impact of early-life adversity and disadvantage into later life.
Associations of Physical Function and Physical Activity With COVID-19-Like Symptoms
Authors: Saadeh Marguerita , Calderón-Larrañaga Amaia , Vetrano Davide , Von Rosen Philip , Welmer Anna-Karin 
Published: December 2021

Abstract
Physical function and physical activity have been associated with health outcomes related to the cardiopulmonary and immune systems, but the extent to which they are related to the risk of developing COVID-19-like symptoms remains unclear. We aimed to explore these associations among Swedish older adults. We analyzed data from 904 individuals aged ≥68 years from the population-based Swedish National study on Aging and Care in Kungsholmen. COVID-19-like symptoms were assessed by phone interview (March-June 2020) and included fever, cough, sore throat and/or a cold, headache, pain in muscles, legs and joints, loss of taste and/or odour, breathing difficulties, chest pain, gastrointestinal symptoms and eye inflammation. Muscle strength, mobility, and physical activity were objectively examined in 2016-2018. Data were analyzed using logistic regression models and stratifying by age. During the first outbreak of the pandemic, 325 (36%) individuals from our sample developed COVID-19-like symptoms. Those with longer time to perform the chair stand test had an odds ratio (OR) of 1.5 (95% confidence interval [CI] 1.1-2.1) for presenting with COVID-19-like symptoms compared to those with a faster time to perform the test, after adjusting for potential confounders. The risk was even higher among people aged ≥80 years (OR: 2.6; 95% CI 1.5-4.7). No significant associations were found for walking speed or moderate-to-vigorous physical activity. A weaker muscle strength, especially among the oldest-old adults, may contribute to higher odds of developing COVID-19-like symptoms, emphasizing the need to maintain sufficient levels of muscle strength in old age.
Back to Life, Back to Reality: Participation and Function After Acute Hospitalization in Older Adults
Authors: Arieli Maya , Kizony Racheli , Gil Efrat , Agmon Maayan 
Published: December 2021

Abstract
This study aims to describe and compare functional trajectories (i.e., participation versus basic daily function) from pre-hospitalization period to one and three-months post-discharge, among older adults hospitalized for acute medical illness, of two age groups: ages 65-75, n=39, &gt;75, n=38. A Prospective longitudinal study was conducted, starting during hospitalization in internal ward and followed by home visits (1 month) and telephone interviews (3 months). Participation was measured by the Activity Card Sort (ACS) that queries about instrumental (e.g. shopping), leisure (e.g. physical activity), and social activities. Basic daily function was measured by the Modified Barthel Index (mBI). Wilcoxon test was used to compare between the ACS and mBI total retained scores within age groups. A mixed model repeated measures ANCOVA was used to compare time by group effects in ACS total scores. The results showed that basic function in both age groups was preserved, and both groups experienced a significantly greater decrease in participation level compared with basic function at one month (z=-4.1, p=.001, z=-4.5, p=.001) and at three months (z=-4.1, p=.001, z=-4.1, p=.001) in the "younger" and "older" groups, respectively. Participation trajectories were similar among age groups, however, the "older" group experienced a significantly greater decrease in participation (F(1)=(4.3), p=.042, η2= .056). Findings indicate that the traditional measure of basic function does not capture the broad spectrum of older adults’ full life and overshadows the reduced participation in meaningful activities. Health care professionals should adopt a comprehensive approach toward functional assessment to encompass participation beyond basic daily function.
Comparisons of Different Multimorbidity Measures to Predict Physical Function Among Middle-Aged and Older Chinese
Authors: Xu Hui-wen , Luo Yan , Huang Zi-Ting , Chen zi-shuo , Su He-Xuan , Xu Beibei 
Published: December 2021

Abstract
Multimorbidity has been associated with declined physical function. Several methods have been used to measure multimorbidity. However, few studies have compared the associations between different multimorbidity measures and physical function. We aimed to examine and compare the associations between different multimorbidity measures and physical function. We included 16,117 participants aged ≥45 from China Health and Retirement Longitudinal Survey (CHARLS) 2011-2018. Multimorbidity was defined as the co-existence of two or more of fifteen chronic conditions in an individual and measured by condition count at penultimate, multimorbidity patterns at penultimate (examined by exploratory factor analysis) and multimorbidity trajectories from baseline to penultimate living interview (examined by the group-based trajectory model). Physical function was assessed by activities of daily living or instrumental activities of daily living at the last follow-up. Logistic regression models were conducted for establishing prediction models in the training set. We used c-statistic, Integrated Discrimination Improvements (IDI) and Net Reclassification Index (NRI) to compare the performance of different models in the testing set. After adjusting for age and gender, compared with those without any conditions, participants with multimorbidity measured by three methods all had higher risks of poor physical function in the training set. Compared with the model using condition count (c-statistic=0.749), models using multimorbidity trajectory (c-statistic=0.712, IDI=-0.03, NRI=-0.31) and the multimorbidity pattern (c-statistic=0.739, IDI=-0.01, NRI=-0.16) showed poor predictive power (all p&lt;.05). In our study, condition count has the best predictive performance for poor physical function over short time period. It is a simple and useful tool to assess multimorbidity.
Changes in Momentary Experience Were Associated With the Onset of the COVID Pandemic
Authors: Stone Arthur , Mak Hio 
Published: December 2021

Abstract
We explored the COVID-19 pandemic’s effects on daily experience using momentary recordings of affect, activities, locations, and social interactions, documenting changes in the pandemic’s early stages. 123 individuals 50 years or older from an ongoing panel study completed 1-week bursts of Ecological Momentary Assessment (6/day) in March, May, and July. A pronounced spike in negative affect and decrease in positive affect was observed in late March compared with early March, which in May and June returned to early March levels. Levels of fatigue, however, did not follow this pattern. Being with one’s spouse/significant other and family also increased, then decreased. Working and interacting with others dropped from early to late March and then remained steady; doing chores had the opposite pattern. Regarding location, being at the workplace dropped from early to late March and remained steady, and being at home had the opposite pattern. Additional analyses explored these patterns.