bluuebunny/crossref_metadata_2025_split huggingface dataset:
Providers’ Perceptions of Telehealth Barriers Among Homebound Adults in in a Home-Based Primary Care Practice
Authors: Moody Kate , Kalicki Alex , Gliatto Peter , Franzosa Emily , Ornstein Katherine 
Published: December 2021

Abstract
The COVID-19 pandemic resulted in a dramatic shift to video-based telehealth use in home-based primary care. We conducted an online 11-item survey exploring provider perceptions of patients’ experience with and barriers to telehealth in a large HBPC program in New York City. More than one-third (35%) of patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020. The majority (82%) required assistance from a family member and/or paid caregiver. Among patients who had not used telehealth, providers deemed 27% (n=153) “unable to interact over video” for reasons including cognitive or sensory ability. Fourteen percent lacked caregivers. Physicians were not knowledgeable about patients’ internet connectivity, ability to pay for cellular plans, and video-capable device access. These findings highlight the need for novel approaches to facilitating telehealth and systematic data collection before targeted interventions to increase video-based telehealth use.
Implementation Science Translation: Program Sustainment for Managing Distress Behavior in Dementia
Authors: Curyto Kim , Kolanowski Ann 
Published: December 2021

Abstract
Distress behaviors in dementia (DBD) are common in nursing home settings, are distressing, and result in poorer outcomes for residents and staff. We present on the implementation of STAR-VA, an interdisciplinary intervention for effective management of DBD in Veterans Health Administration (VA) nursing home settings, called Community Living Centers (CLCs). A primary focus of this symposium is the use of implementation science concepts to improve and sustain evidence-based programs through tailored implementation strategies and key partnerships. Key implementation science concepts from conceptual frameworks, including the Consolidated Framework for Implementation Research (CFIR) and the use of organizational Knowledge Reservoirs (KR) for sustaining new clinical practices, formed the basis of this work. Their application in health care practice will be discussed using STAR-VA as an exemplar. Interdisciplinary CLC staff feedback during STAR-VA implementation and sustainment is presented, including feedback regarding barriers to integrating new program interventions into usual care processes. Mapping key implementation strategies onto reported barriers informed development of implementation tools and strategies designed to guide adaptions tailored to the needs of the residents and frontline staff, increasing the chances of successful sustainment. Finally, we highlight the importance of key leadership partnerships in implementation of evidence-based programs to improve care of residents with DBD and present strategies for developing these partnerships. Discussion will include the importance of using implementation science to implement evidence-based interventions for effective management of DBD and strategies for sustainment of these effective practices into usual care.
Longitudinal Analyses Indicate Bidirectional Associations Between Loneliness and Self-Rated Health in Adulthood
Authors: Finkel Deborah , Phillips Dianna , Reynolds Chandra 
Published: December 2021

Abstract
Loneliness is a potent stressor that increases in prevalence with age in late life and has been linked with numerous adverse physical health outcomes and lower scores on measures of self-rated health (SRH). The association between loneliness and SRH is likely bidirectional—for example, experiencing loneliness may result in physiological changes that alter how individuals perceive their health, and worsening perceptions of one’s own health or mobility may act in an increasingly restrictive manner with respect to social interaction. Despite this, limited longitudinal work has examined temporal dynamics between loneliness and SRH. Recently completed harmonization of 9 loneliness items across three longitudinal twin studies of aging in Sweden resulted in sample of 1939 participants aged 40 to 98 at intake (mean age = 74.64) with up to 25 years of follow-up (mean = 7.63) across up to 8 waves (mean = 3.29). Univariate analysis indicated that SRH decreased with age up to age 82 and then leveled off, whereas loneliness continued to increase across the age span. Bivariate dual change score models were used to examine lead-lag relationships across time: which variable contributes to subsequent changes in the other variable. Results indicated a bi-directional relationship: loneliness does not increase after age 82 when SRH is included in the model, and SRH does not level off after age 70 when loneliness is included in the model. Thus, declining SRH may lead to reduced participation in social activities and also feelings of loneliness may intensify perceptions of poor health.
A Pilot of a Sustainability-Extending Intervention in Canadian Nursing Homes
Authors: MacEachern Lauren , Song Yuting , Ginsburg Liane , Wagg Adrian , Hoben Matthias , Doupe Malcolm , Estabrooks Carole , Berta Whitney 
Published: December 2021

Abstract
Understanding of intervention sustainability processes is limited. Failure to sustain evidence-based innovations means that intended improvements are short-lived, scale-up and spread are unlikely, and real losses are incurred on research investments. We explored the sustainability of a health care aide (HCA)-led quality improvement (QI) initiative, Safer Care for Older Persons (in residential) Environments (SCOPE), that was implemented in long-term care homes (LTCHs) in Manitoba, Canada. Based on our understanding of factors influencing post-implementation sustainability processes, we developed and piloted a “low-dose” and “high-dose” “Booster” intervention to extend the two-year post-implementation period over which SCOPE was naturally sustained. Both versions of the “Booster” involved the following components: a HCA-led team with management support, a workshop to review SCOPE QI approaches and tools, a binder of QI resources, and supports from an experienced Quality Advisor (QA). We collected data from various sources to depict the most accurate account of QI sustainability and conducted thematic analysis to understand each team’s experience with sustainability processes. We used a qualitative assessment rubric to evaluate the impact of the “Booster” conditions on the teams’ performance against core SCOPE components. Our results suggest that the “Booster” served to establish more relaxed expectations and generally renew interest in LTCH QI initiatives. The calibre of management support was associated with teams’ performance and management support varied with the level of QA support. These pilot results will inform the next study phase, which examines longer-term sustainability of QI initiatives in LTCHs beyond the initial 2-year post-implementation period.
Analysis of 29 Items of the Meaningful Activity Participation Assessment-Meaningful Scale Through Rasch Analysis
Authors: Nam Sanghun , Bae Suyeong , Hong Ickpyo 
Published: December 2021

Abstract
Individuals find meaning in their personal activities. Meaningful activities can improve an individual's emotional and physical health and quality of life. The Meaningful Activity Participation Assessment-Meaningful Scale (MAPA-M), which can measure these meaningful activities, is measured in 29 items. In this study, the psychometric properties of 29 items of MAPA-M were investigated through Rasch analysis. The data used in this study was the Well Elderly Study 2 data among public data provided by the Inter-university Consortium for Political and Social Research (ICPSR). We used 480 randomized samples from the Well Elderly Study 2 data. Before proceeding with the Rasch analysis, as a result of checking the unidimensionality assumption of 29 items, 19 items satisfied the unidimensionality assumption. As a result of Rasch analysis of 19 items, the Driving item was removed as misfit (infit mean-square = 2.04, infit z-standardized fit statistics = 9.90, outfit mean-square = 1.86, outfit z-standardized fit statistics = 8.99). The 18 items with the misfit items removed show a conceptual item-difficulty hierarchy, and there was no differential item functioning that worked for sex and age groups. The person strata value is 3.97, which corresponds to the confidence value of 0.88. These results indicate that the 18 items in MAPA-M show appropriate item-level psychometric properties. In other words, the modified MAPA-M 18 indicates that meaningful activities can be accurately and stably measured.
Sleep, Activity, and Well-Being In Persons With Dementia: Findings From the Healthy Patterns Trial
Authors: Hodgson Nancy , Petrovsky Darina 
Published: December 2021

Abstract
Irregular sleep-wake patterns are common in persons living with dementia (PLWD), pose a great burden to caregivers, and are the principal causes of distress and institutionalization of PLWD. A growing body of research supports the importance of activity-based interventions to reduce the frequency and intensity of sleep wake disruption, reduce neuropsychiatric symptoms, and improve quality of life. To date, there are no studies linking sleep disruption and well-being with the nature and timing of activity. This session focuses on lessons learned from the Healthy Patterns Study - a randomized trial of a home-based activity intervention in 200 dyads of PLWD and their caregivers (NCT03682185). Session 1 focuses on the main findings from the clinical trial. Session 2 focuses on the cultural adaptation of the timed activity protocol to improve quality of life (QOL), improve sleep and reduce neuropsychiatric symptoms in older Latinos Session 3 describes the community outreach efforts used over a one-year period to recruit a diverse sample of PLWD and their caregivers for the Healthy Patterns trial. Session 4 examine the relationship between caregiver mastery and neuropsychiatric symptoms in PLWD. Together these findings highlight the complex role of sleep and wake activity in promoting well-being in persons with dementia.
Virtual Interdisciplinary Collaboration in Statewide Implementation of the MIND at Home Dementia Care Program
Authors: Johnston Deirdre , Bourquin Jennifer , Spliedt Morgan , Antonsdottir Inga , Stringer Cody , Smithroat Noemi , Reuland Melissa , Samus Quincy 
Published: December 2021

Abstract
MIND at Home, a well-researched holistic, family-centered dementia care coordination program, provides collaborative support to community-dwelling persons living with dementia (PLWD) and their informal care partners (CP). Through comprehensive home-based assessment of 13 memory-care domains covering PLWD and CPs, individualized care plans are created, implemented, monitored, and revised over the course of the illness. Non-clinical Memory Care Coordinators (MCCs) working with an interdisciplinary team provide education and coaching to PLWD and their identified CP, and serve as a critical liaison and resource and between families, medical professional, and formal and informal community resources. This paper will describe a statewide pilot implementation of the program within a health plan across diverse sites in Texas and will present qualitative and quantitative descriptions of a key component of the program's effective translation to practice, the virtual collaborative case-based learning sessions. Health plan teams completed online interactive training modules and an intensive in-person case-based training with the Johns Hopkins team prior to program launch, and then engaged in weekly, hour-long virtual collaborative sessions that included health plan teams (site-based field teams, health plan clinical supervisory and specialty personnel [RNs, pharmacists, a geriatric psychiatrist, behavioral health specialists] and Johns Hopkins MIND program experts and geriatric psychiatrists. To date, the program has enrolled 350 health plan members, conducted 65 virtual collaborative sessions, and provided 423 CME/CEU units to team members. We will provide an overview of virtual collaborative session structure, participant contributions and discussion topics, case complexity, as well as didactic learning topics covered.
The Impacts of the COVID-19 Pandemic on Family Caregivers' Care Work, Anxiety, and Loneliness
Authors: Parmar Jasneet , Anderson Sharon 
Published: December 2021

Abstract
Our study examined the effects of COVID-19 pandemic and public health measures on family caregivers (FCGs) of frail older adults; specifically, their care work, anxiety, and loneliness all of which are associated with decreased wellbeing. Approximately 604 FCGs completed the survey and findings evidenced COVID-19 creating two solitudes. First, 73% of FCGs for individuals living with them were providing significantly more care during COVID-19. Second, those caring for residents in congregate settings were unable to care. Both situations, community-dwelling and congregate care, increased FCG distress and decreased wellbeing. Anxiety significantly increased from 36% pre COVID-19 to 54% during COVID-19. Loneliness increased from 46% to 85%. FCGs report their mental (58%) and physical (48%) health deteriorated. The detrimental impact of the pandemic and public health measures on FCGs caring at home and in congregate care, and their related needs, need immediate attention from both the health and social systems of care.
Beyond the Lockdown Binary: Family Caregiver Needs for Creative Solutions During a Global Pandemic
Authors: McGhan Gwen , Flemons Kristin , McCaughey Deirdre , Hindmarch Whitney 
Published: December 2021

Abstract
As COVID-19 lockdowns began in Canada last spring, family caregivers (FCGs) of people living with dementia (PLWD) found themselves facing a catch-22: they and their family members were often most at risk of severe outcomes should they contract the virus, yet the public health measures put in place also detrimentally affected their ability to continue providing care. To understand the nuances of caregiver experiences during the pandemic, we conducted 9 focus groups with 19 FCGs of PLWD in the Calgary region in summer 2020. Caregivers reported negative outcomes resulting from decreased services for both themselves and the PLWD, including increased isolation, poor mental health, and accelerated dementia progression. Caregivers also emphasized the importance thinking beyond the binary of either locking down or opening up; rather, we must find creative solutions to safely continue providing supports to caregivers. This presentation explores FCG suggestions for balancing COVID-19 risk against caregiver needs.
Control Beliefs, Age, and Objectification Experiences in Younger and Older Women
Authors: Sherman Aurora 
Published: December 2021

Abstract
Control beliefs show age-related patterns; mastery decreases in adulthood, while constraints beliefs often increase. However, there is a great deal of individual variation. This paper addresses antecedents of control beliefs, with attention to experiences and beliefs related to sexual objectification, which have particular impact for women. In this study, younger women (N = 132, M = 20.93) and older women (N = 86, M = 67.83) were surveyed regarding their experiences with sexual objectification and constraints beliefs. Multiple regression analyses revealed higher self-objectification was associated with higher constraints (R2 = .09**) and lower mastery (R2 = .11**) but reports of body evaluation and sexual advances were not associated with control beliefs. Further, there were no interactions of either objectification scale with age. These results suggest that objectification may be an important part of the aging experience across the life course, not just in young adulthood.
Older Adults’ Perceptions of Smart City Initiatives to Age in Community
Authors: Kim Jongwoong 
Published: December 2021

Abstract
This project explores older American adults’ perceptions of smart city initiatives for them to “age in community” particularly in the northeast region. As the U.S. population is aging, it is imperative that the American cities can support their citizens to live in their preferred community environments for as long as they want. While there are many definitions of a smart city, some exemplary smarty city initiatives can be characterized as actively utilizing information and sensor technologies to promote efficiency and sustainability of city-wide systems, ultimately enhancing the quality of citizens' life. This project examines, in particular, seven smart city initiatives that are implemented globally: smart streetlights, health and fall monitoring system, community ridesharing, enhanced CCTVs, "age-friendly map," contact tracing app, and smart traffic system. By surveying those age 55 and older, with a representative sampling from the nine states in the northeast region, this project found that the vast majority of older Americans in this region would prefer to age in rural and suburban communities, and depending on where they prefer to age in (rural-exurban-suburban communities vs. urban-urban center communities) and gender (female vs. male), they perceive particular sets of smart city initiatives as more important for them to age in community. Furthermore, regardless of the community/location preference and demographic (gender, income level, and age) differences, 40% of the respondents expressed no concern of data or information privacy issues from these initiatives, opening some doors for the municipalities that plan to adopt some of these initiatives in the near future.
Age-Related Neuroprotection by Dietary Restriction Requires OXR1-Mediated Retromer Function
Authors: Wilson Kenneth , Bar Sudipta , Brownridge George , Beck Jennifer , Brem Rachel , Bellen Hugo , Ellerby Lisa , Kapahi Pankaj 
Published: December 2021

Abstract
Dietary restriction (DR) is the most robust method to delay aging and the onset of neurogenerative disorders across multiple species, though the mechanisms behind this phenomenon remain unknown. To elucidate how DR mediates lifespan extension, we analyzed natural genetic variants that associate with increased longevity under DR conditions in the Drosophila Genetic Reference Panel. We found that neuronal expression of the fly homolog of human Oxidation Resistance 1 (OXR1) is necessary for DR-mediated lifespan extension. Neuronal knockdown of OXR1 also accelerated visual decline but not physical decline, arguing for a specific role of OXR1 in neuronal signaling. Further, we find that overexpression of the TLDc domain from human OXR1 is sufficient for lifespan extension in a diet-dependent manner. Studies from the Accelerating Medicines Partnership - Alzheimer's Disease network show that patients with reduced OXR1 protein levels are more prone to Alzheimer's disease diagnosis, and we find that overexpression of human OXR1 is protective in animal and cell Alzheimer's models. In seeking the mechanism by which OXR1 protects against age-related neuronal decline, we discovered that it provides a necessary function in regulating the neuronal retromer complex, which is essential for the recycling of transmembrane receptors and for maintenance of autophagy. We further discovered that OXR1 deficiency can be rescued by genetic or pharmacological enhancement of retromer function, and that this enhancement extends lifespan and healthspan. Understanding how OXR1 operates could help uncover novel mechanisms to slow neurodegeneration including Alzheimer's disease.
Cultural Consistency in Late-Life Declines in Positive Personality Traits
Authors: Chopik William 
Published: December 2021

Abstract
Personality has elements of both stability and change across the adult lifespan. There has also been evidence for terminal decline—late-life decreases in positive psychological characteristics. However, many of these studies have examined these patterns in primarily Western populations. The current study examined the consistency of age differences in positive personality traits (i.e., character strengths) across cultures. I examined 2,895,051 participants ranging in age from 13 to 100 (Mage = 34.31; 65.3% women) from 90 different countries. I reproduced patterns of terminal decline across cultures. In addition to mean differences between cultures (e.g., focusing on the present is associated with more positive traits [Mr = .45]), cultural characteristics often moderated the effects of age on positive personality traits. For example, terminal decline was more dramatic among people from collectivistic cultures and flatter among people from individualistic cultures. Results will be discussed in the context of cultural variation developmental processes.
Association of Frailty and Suicide in Adults 65 Years and Older
Authors: Kuffel Randall , Morin Ruth , Covinsky Kenneth , Boscardin John , Li Yixia , Byers Amy 
Published: December 2021

Abstract
Nearly 10,000 adults aged 65 years and older die by suicide in US annually. Although prior studies have linked individual diagnostic factors to late-life suicide risk, to our knowledge none have examined how accumulated health burden affects suicide risk. Such a metric could be studied utilizing a frailty index (FI). Our primary study objective was to determine the relationship of FI to risk of suicide. We examined a longitudinal cohort of 2,858,876 veterans 65 years and older from fiscal year 2012-2013 (baseline) through 12/31/2017, linking the VA’s suicide and mortality databases with medical record data. FI was defined by 31 variables, including morbidity, function, cognition, mood, sensory loss, chronic pain, and failure to thrive. We used Fine-Gray proportional hazards regression to examine time to suicide attempt (fatal and non-fatal). Our sample’s average age was 75 (SD 8), 88% White, 9% Black, and 98% male. Thirty-seven percent of veterans were non-frail, 30% were pre-frail, 17% mildly frail, 9% moderately frail, and 7% severely frail. Over the course of the study, 9,043 veterans had a documented suicide attempt with &gt;60% fatal. After adjusting for race, gender, region, substance use disorder, and PTSD, risk of suicide attempt increased across frailty categories: Hazard ratios increased from 1.37 (95%CI: 1.30-1.45) for pre-frail individuals to 1.57 (1.43-1.72) for severely frail individuals. We found similar results after further adjustment for the Charlson Comorbidity Index, suggesting cumulative deficit FI may be a strong prognostic marker for risk of suicide in adults over 65; informing late-life suicide prevention efforts.