bluuebunny/crossref_metadata_2025_split huggingface dataset:
Findings From Implementation of the EIT-4-BPSD Trial
Authors: Resnick Barbara , Boltz Marie , Kolanowski Ann 
Published: December 2021

Abstract
Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home (NH) residents with dementia. BPSD result in negative health outcomes, functional decline, high care costs, increased risk for inappropriate use of antipsychotic medications and social isolation. Behavioral approaches are endorsed as the first line of treatment for BPSD. Despite regulatory requirements, less than 2% of nursing homes consistently implement these approaches. The EIT-4-BPSD Trial was done to test a novel implementation approach to assure that staff in nursing homes use non-pharmacologic, behavioral approaches for the management of BPSD. EIT-4-BPSD is a theoretically-based four-step approach that includes: 1. Assessment of the environment and policies; 2. Education of staff; 3. Establishing person-centered care plans; and 4. Mentoring and motivating staff. Implementation of the four-step approach was guided by the Evidence Integration Triangle (EIT). The EIT brings together evidence and key stakeholders from the NH and uses a participatory implementation processes, practical evidence-based interventions, and pragmatic measures of progress toward goals. A total of 55 nursing homes from two states and 553 residents were included in this study. Nursing homes were randomized to EIT-4-BPSD or education only. This symposium will describe the utility of the EIT as an implementation framework based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance model, report detailed effectiveness outcomes of EIT-4-BPSD at the setting and resident levels, and address recruitment and measurement challenges and future solutions to these challenges.
Breathing Uneasy: Fit-Tested N95 Respirator Access in Washington State Long-Term Care Facilities
Authors: Ham Carolyn , Nakamura Mikkie 
Published: December 2021

Abstract
Long-term care facilities (LTCF) have been disproportionately impacted by illness and death from COVID-19. Shortages of respirators for staff, especially Particulate Filtering Facepiece Respirators (N95), have limited LTCFs ability to follow public health recommendations for preventing COVID-19 transmission. Use of N95 respirators was infrequent in Washington State (WA) LTCFs prior to May 2020. N95 respirators must be individually fit tested to provide intended protection; a fit test is a procedure that tests the seal between the N95 respirator and the wearer’s face. The WA Department of Health (WA DOH), collaborated with stakeholders to survey LTCFs in November 2020 regarding needs for fit tested respirators and analyzed responses (n=384). Responses by facility type: 8.3% nursing homes, 17.7% assisted living, 62.8% adult family home, 11.2% other. In WA, adult family homes (AFH) are licensed for six or fewer residents. 23.70% of LTCFs indicated they did not have any N95 respirators in stock at their facility; 96.7% of these were AFH. In August 2020 WA DOH surveyed AFH owners and received 110 responses; 9.76% reported having at least one staff member fit tested for respirators. Smaller facilities may experience increased burden in accessing N95 respirators and fit testing due to lack of established relationships with suppliers and small volumes being purchased. WA DOH used federal COVID funding to contract with mobile fit testing providers and prioritized AFHs for this service. Between December 1, 2020-February 28, 2021, staff at 290 LTCFs were fit tested. The project will continue throughout 2021.
Measuring What Matters in Long-Term Care: Common Data Elements in Brazil, China, and the United States
Authors: Lepore Michael , Corazzini Kirsten , Zimmerman Sheryl 
Published: December 2021

Abstract
Internationally sharable common data elements on residential long-term care (LTC) settings, such as nursing homes and assisted living facilities, can facilitate comparisons across diverse LTC settings for valuable insights on LTC regulation and oversight, practice and operations, infrastructure development, human resources issues, and quality and safety. However, such insights are predicated on the premise that data elements capture information that matters to the full LTC community, including residents, relatives and staff, and are able to be collected across diverse care settings, including low-resource contexts. A critique of much current LTC measurement is its focus on deficits and loss, rather than thriving, person-centered care, and healthy aging, which have been established as important to LTC communities internationally. Further, measurement burden, cultural differences in perceptions of data sharing, and data infrastructure differences are key issues for international data. An international collaborative of LTC researchers—Worldwide Elements to Harmonize Research in Long-Term Care Living Environments (WE-THRIVE)—has developed a set of common data elements that are recommended for parsimoniously assessing key outcomes, workforce and staffing, person-centered care, and the contexts within which LTC settings operate. The studies in this symposium provide insights into the validation and implementation of WE-THRIVE recommended measures in diverse, low-resource LTC contexts, including LTC settings in Brazil, China, and rural Midwest US. Study findings validate WE-THRIVE measures, and provide new knowledge to inform capacity-building for the measurement of person-centered care and healthy aging outcomes in diverse, low-resource, LTC settings.
Measuring What Matters Across International Long-Term Care Settings
Authors: Lepore Michael , Corazzini Kirsten 
Published: December 2021

Abstract
Measuring what matters most to residents, relatives and staff in residential long-term care settings is critical, yet underdeveloped in our predominantly frailty and deficits-focused measurement frameworks. The Worldwide Elements to Harmonize Research in Long-Term Care Living Environments (WE-THRIVE) consortium has previously prioritized measurement concepts in the areas of care outcomes, workforce and staffing, person-centered care, and care context. These concepts include knowing the resident and what matters most to the resident, and outcomes such as quality of life, and personhood. We present findings of our currently recommended measures, including both general population and dementia-specific measures, such as the Person-Centered Care Assessment Tool (PCAT), the Personhood in Dementia Questionnaire (PDQ), and the ICEpop CAPability Measure for Older People (ICECAP-O). We also describe remaining gaps in existing measures that will need to be addressed to fully specify common data elements focused on measuring what matters most to residents, relatives and staff.
Activity Fractionation Moderates the Relationship of Gait Speed With Alzheimer’s Disease Risk
Authors: Tian Qu , An Yang , Schrack Jennifer , Kuo Pei-Lun , Wanigatunga Amal , Simonsick Eleanor , Resnick Susan , Ferrucci Luigi 
Published: December 2021

Abstract
Older adults with slow gait have a modestly elevated risk of Alzheimer’s disease (AD). Whether strategies to maintain function, such as interlacing periods of activity and rest, modify this relationship is unknown. We analyzed 577 initially cognitively normal participants aged 50+(53%women,26%Black) who had baseline data on gait speed and fractionation via ActiHeart. Diagnoses of mild cognitive impairment (MCI)/AD were adjudicated during an average 7.3years follow-up. We examined gait speed, fractionation, and their interaction with MCI/AD risk using Cox proportional-hazards models, adjusted for demographics and APOE-e4. Each 0.2m/sec faster gait speed was associated with 24% lower risk of MCI/AD(p=0.04). Fractionation was not associated with MCI/AD risk(p&gt;0.05). There was a significant gait*fractionation interaction(p=0.013). At high fractionation, gait was not predictive of MCI/AD. Slow gait speed is less predictive of future MCI/AD in individuals who fractionate their activity to maintain function, possibly indicating brain function that drives such compensatory strategy is still conserved.
Cellular Resilience as a Potential Predictor of Lifespan
Authors: Salmon Adam 
Published: December 2021

Abstract
The progressive decline of resilience during the aging process across multiple functional systems suggests basic biological mechanisms of regulation. We exploited a primary cell model to identify markers of cellular resilience or the ability of cells in culture to respond and return to homeostasis following acute challenge including metabolic, oxidative, or proteostatic stress. Using primary fibroblasts from minimally-invasive skin biopsies of genetically heterogeneous mice, we are able to determine individual cellular resilience as well as the normal lifespan and healthspan of each donor. Our studies suggest donor age and sex affect cellular resilience and that this measure of resilience can predict functional outcomes in some interventional studies. While longevity studies continue, these studies point to a potential highly important marker of healthspan and longevity as well as a model to delineate the biology of resilience in animal and translational models.
Epidemiologic Determinants of Dynamics in Heart Failure Prevalence and Mortality in Older U.S. Adults
Authors: Yu Bin , Akushevich Igor , Yashkin Arseniy , Kravchenko Julia 
Published: December 2021

Abstract
Recent declines in heart failure (HF) prevalence and increases in mortality among older adults in the US suggest the need for research to investigate the relative contribution of the epidemiological determinants of these two processes to their historical and current trends. Study data were derived from a 5% sample of Medicare beneficiaries, 1991-2017. Partitioning analysis was used to decompose age-adjusted prevalence and incidence-based mortality (IBM) into their constituent components. HF prevalence trend decomposition demonstrated three phases: (a) Decelerated Increasing Prevalence (1994-2006) mainly driven by decreasing incidence, overpowering increasing survival, (b) Accelerated Declining Prevalence (2007-2014) and (c) Decelerated Declining Prevalence (2015-2017), mainly driven by declining incidence, overpowering declining survival. For HF IBM four phases were identified: (a) Decelerated Increasing Mortality (1994-2001) with declining incidence and increasing survival driving deceleration, (b) Accelerated Declining Mortality (2002-2012), (c) Decelerated Declining Mortality (2013-2016), mainly driven by declining incidence, overpowering declining survival, and (d) Accelerated Increasing Mortality (2017) mainly driven by declining survival, overpowering declining incidence. Study findings suggest that the recent decade-long decline in HF prevalence and 15-year decline in HF mortality mainly reflected decreasing incidence, while the most recent increase in mortality was due to declining survival, which may be associated with the Hospital Readmission Reduction Program. If current trends of incidence and survival persist, HF prevalence and mortality are forecasted to grow, suggesting that actions to reduce HF risk factors and improve treatment and management of HF after diagnosis are warranted.
Reluctance to Accept Palliative Care and Recommendations for Improvement
Authors: Cardenas Valeria , Rahman Anna , Zhu Yujun , Enguidanos Susan 
Published: December 2021

Abstract
Although insurance companies are increasingly paying for home-based palliative care (HBPC), enrollment remains low. To identify patient and caregiver perceived barriers to HBPC and their recommendations for overcoming these barriers, we conducted semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on HBPC services; positive and negative aspects of the palliative program explanation; and suggestions for improving HBPC messaging. Seventeen patients and eight caregivers who were eligible for a randomized controlled trial of HBPC were interviewed. Themes related to HBPC referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that HBPC referrals come from healthcare providers or insurance companies and presenting HBPC more clearly. Findings reinforce the need for palliative care education among seriously ill patients and the importance of delivering palliative care information and referrals from trusted sources.
Interventions for QoL and Other Outcomes Among Caregivers of Older Adults With Visual Impairments
Authors: Hazzan Afeez , Haibach-Beach Pamela , Lieberman Lauren , Williams Jamia 
Published: December 2021

Abstract
Unpaid family caregivers play a critical role in the care of older adults with visual impairments (VI). Caring for older adults with VI requires much time and energy, often resulting in psychological stress and reduced quality of life (QoL). However, there is a paucity of data on the impact of caregiving on QoL and related outcomes among these caregivers. The purpose of this study was to conduct a scoping review examining issues of QoL, health, stress, burden, and barriers among unpaid caregivers of older adults (i.e. aged 60 years or more) with VI. The study aimed to summarize interventions for addressing these issues. This study followed the Arksey and O’Malley (2005) five stage approach for scoping reviews. We performed a search of published peer-reviewed articles available in PubMed, CINAHL Complete, and PsycINFO to identify relevant studies. Two reviewers conducted the screening of titles, abstracts, and full-texts. Of the 452 records identified, 24 were eligible for full-text screening and five articles met the final inclusion criteria. The following four themes were identified: (1) prevalence of QoL-related barriers among unpaid caregivers of older adults with VI; (2) adverse events among unpaid caregivers of older adults with VI; (3) interventions for unpaid caregivers of older adults with VI; and (4) potential impacts of intervention on unpaid caregivers of older adults with VI. These findings reveal a lack of interventions for unpaid caregivers of older adults with VI, despite the prevalence of QoL-related barriers and adverse events. Research addressing these issues are urgently needed.
Adaptation of the Care Ecosystem Intervention for Individuals with Dementia in a High-Risk, Care Management Program
Authors: Forester Brent , Donelan Karen , Vogeli Christine , Ritchie Christine 
Published: December 2021

Abstract
The Care Ecosystem (CareEco) model is a telephone-based dementia care program providing standardized, personalized and scalable support and education for caregivers and persons living with dementia (PLWD), medication guidance, and promotion of proactive decision-making. It has demonstrated improvement in quality of life for PLWD and reduced unnecessary healthcare expenditures. We initiated a pragmatic, embedded randomized pilot trial of an adapted CareEco model for nurses who provide high-risk care management and are embedded in primary care practices within a large healthcare system. Outcomes include feasibility of collecting emergency department visits, usability and acceptability of the intervention by nurse care managers, caregiver strain, behavioral symptoms of dementia and healthcare expenditures. Challenges of implementation include engaging key care management leaders, adaptation of the CareEco training modules for nurses, identification of primary caregivers, training and reinforcing knowledge and skills of the nurses, embedding clinical assessments into care manager workflows and integration with the EMR.
Policy Series: Update on Polling and Policy Efforts on Loneliness, Telehealth, Caregiving, and Advance Care Planning
Authors: Solway Erica , Lindberg Brian 
Published: December 2021

Abstract
Older adults and their caregivers experienced dramatic changes in many aspects of their lives during the COVID-19 pandemic which resulted in important shifts in organizational and federal priorities and policies. To explore older adults’ changing experiences and perspectives amidst the pandemic, the University of Michigan National Poll on Healthy Aging (NPHA), a recurring, nationally representative household survey, polled over 2,000 adults age 50-80 at multiple timepoints through January 2021 about their feelings of loneliness and use of telehealth. In June 2020, the NPHA also surveyed adults age 50-80 about advance care planning before and during the COVID-19 pandemic and asked family caregivers about their care challenges in the three months since the pandemic. This session will start with a presentation of results from these polls, first exploring change over time in loneliness and telehealth use and then focusing on experiences related to advance care planning and caregiving challenges. Next, presenters from diverse national coalitions and organizations, including the Coalition to End Social Isolation and Loneliness, the National Academy for State Health Policy, the National Alliance for Caregiving, and the Coalition to Transform Advanced Care will describe their organizations’ efforts, including their work with research and advocacy partners, state and federal agencies, and the Biden administration to facilitate dialogue and advance activities and policies related to these timely topics.
Dementia Family Caregivers’ Ambivalent Feelings and Cardiovascular Risk: Longitudinal Correlates
Authors: Romero-Moreno Rosa , Vara-García Carlos , Barrera-Caballero Samara , olazarán Javier , Mausbach Brent , von Känel Roland , Olmos Ricardo , Losada-Baltar Andrés 
Published: December 2021

Abstract
Cross-sectional data show that caregivers’ ambivalent feelings are associated with psychological distress. The association of ambivalent feelings with caregivers’ cardiovascular risk has not been studied. For this purpose we analyzed preliminary data from the Spanish Longitudinal Caregiving Spanish Longitudinal Study (CUIDA-LONG). One-year follow-up data were available for 96 dementia family caregivers. The following variables were assessed: sociodemographics, body mass index (BMI), disruptive behaviors, ambivalence, depressive symptomatology and cardiovascular risk with the inflammatory biomarker C-reactive protein (CRP). A hierarchical regression model was tested. Sociodemographic variables and change over time in stressors, ambivalence and depression were entered as predictors of change in CRP. 27% of the variance in CRP was explained through the model. More time since being a caregiver, higher BMI and greater increase in ambivalence contributed significantly to an increase in CRP. Ambivalent feelings contribute significantly to the cardiovascular risk of those who care for a relative with dementia.
An Intensive Longitudinal Study of the Association of Stress With Hyperglycemia Using Real-Time Data Collection
Authors: Mausbach Brent 
Published: December 2021

Abstract
Caregivers of persons with dementia (PWD) are at significantly elevated risk for cardiovascular disease (CVD)s. A higher risk for diabetes is one potential mechanism of morbidity in caregivers. Diabetes has been associated with dyslipidemia, hypertension, oxidative stress, increased low-grade inflammation, and endothelial dysfunction, which all place individuals at risk for CVD. Elevated blood glucose, even in the nondiabetic range, is a significant risk marker for the development of CVD. The current study examined the semi-continuous association between stress and glucose. Participants wore a continuous glucose monitor that measured blood glucose every 5 minutes for a period of 10 days (n = 2,880/participant). Ecological Momentary Assessment (EMA) was used to measure stress, positive affect, negative affect, and dietary intake 3x/day over the 10-day period. Hierarchical linear models indicated significant within-person associations between stress and blood glucose levels (t = 3.88, df = 3.92, p = .018; R2 = 26.2%).
Age Discrimination During the COVID-19 Pandemic: Associations With Daily Well-Being
Authors: Ong Lydia , Klaiber Patrick , DeLongis Anita , Sin Nancy 
Published: December 2021

Abstract
During the COVID-19 pandemic, ageist attitudes have been pervasive in public discourse, interpersonal relationships, and medical decision-making. For example, older adults have been portrayed as vulnerable while younger adults have been portrayed as reckless. The current study examined age discrimination during COVID-19 and associations with daily affect and physical symptoms. Positive events and age were examined as moderators. From March to August 2020, 1493 participants aged 18-91 (mean=40) in the U.S. and Canada completed surveys for seven consecutive evenings about discrimination, positive events, affect, and physical symptoms. Multilevel models controlled for age, race, income, education, sample (university students vs. community), and country of residence. Results indicated that individuals who reported more age discrimination had higher negative affect (b=36.44, SE=3.97), lower positive affect (b=-19.07, SE=4.10), and increased physical symptoms (b=3.85, SE=0.49; p&lt;0.001 for all), compared to those with fewer reports of age discrimination. Within-persons, days with age discrimination were associated with higher negative affect (b=3.66, SE=1.36, p=0.008), lower positive affect (b=-2.60, SE=1.23, p=0.037), and increased physical symptoms (b=0.26, SE=0.11, p=0.02), compared to days on which age discrimination was not reported. Positive events moderated the between-person association of age discrimination with physical symptoms such that individuals with more age discrimination and more frequent positive events reported fewer daily physical symptoms than those with more age discrimination and less frequent positive events. Age did not moderate the associations. Age discrimination was associated with poorer daily well-being during the COVID-19 pandemic and may have long-term impacts on intergenerational solidarity and attitudes toward aging.
Older Adults’ Experiences Participating in Aging Strong 2020 Programs
Authors: Hudson Janella , Ungar Rachel , Albright Laurie , Schaeffer James , Wicker Ellen 
Published: December 2021

Abstract
User satisfaction assessments are integral to demonstrating intervention efficacy. Towards that end, older participants across the Aging Strong 2020 suite of offerings participated in semi-structured interviews (n = 248) to provide feedback about their experiences in the program and resulting satisfaction. Overall, most participants were satisfied with the Aging Strong 2020 interventions and reported gaining new skills, tools, or coping strategies. Participants endorsed program features that facilitated social interaction, community building, and social support. Program content specifically adapted for older adults and appropriate life stage concerns and/or areas of interest were considered especially helpful. Results demonstrate that the current test and learn model offers an opportunity for participant feedback to refine and improve future iterations of project offerings. Participant feedback led to key improvements in subsequent versions of the Aging Strong 2020 programs and their contributions to successful aging among older adults.