bluuebunny/crossref_metadata_2025_split huggingface dataset:
Common Data Elements for Workforce and Staffing Measurements in Long-Term Care
Authors: Chu Charlene , Zúñiga Franziska , Corazzini Kirsten 
Published: December 2021

Abstract
The workforce in residential long-term care (LTC) is key in providing high-quality, person-centered care for residents. However, low staffing and adverse staffing outcomes such as turnover or job dissatisfaction hinder the provision of high-quality care. International research can add valuable insights for policy and practice by learning from different settings and cultures. The initiative “To Harmonize Research In long-term care liVing Environments (WE-THRIVE)”, is led by an international group of LTC researchers to identify common data elements (CDE) for cross-comparative research that support older adults thriving in LTC. In this symposium, we will present an overview of the WE-THRIVE initiative with a specific focus on CDEs and measurement. The first talk will provide the context for the WE-THRIVE initiative, and discuss the collaborative and iterative processes required to develop the initial CDEs in the area of workforce and staffing. In the second talk, we will discuss which staff should be “in the house” to meet the needs of residents during and after a pandemic, and what type of workforce data system should be available to ensure the best quality outcomes for residents and carers. Next, current issues in the measurement of staffing in LTC based on a review of reviews of staffing’s relationship to quality of care will be discussed. Finally, we extend the debate to consider theoretical and empirical explanations for the relationship between staffing and quality in LTC and the promotion of person-centred care outcomes.
COVID-19 Vaccine Intentions Within the Medicare Population
Authors: Swenson Tami 
Published: December 2021

Abstract
COVID-19 vaccine intentions by older adults reflect individual care seeking behavior and medical system trust and broader systemic cultural shifts related to vaccine hesitancy. The purpose of this paper is to examine the October wave of the rapid response panel survey fielded by the Centers for Medicare and Medicaid Services (CMS) to track and monitor the effects of the pandemic within the Medicare population. With a sample size of 9686 Medicare beneficiaries, the calculated statistics use replicate weights to adjust for the complex survey sample design and balanced repeated replication using Fay’s adjustment of 0.3 for variance estimation. When asked about the likelihood of getting the COVID-19 vaccine if one were available, 58 percent of the Medicare population definitely or probably intended to get the vaccine, 16 percent expressed they would probably or definitely not, and 26 percent were not sure. Black or Hispanic Medicare beneficiaries were significantly more likely to express they would probably not or definitely not get the vaccine than White, non-Hispanic Medicare beneficiaries. Distrust of what government says about the vaccine and concern about the safety or side effects were the most common reasons for not intending to get the vaccine. Those expressing intentions to not get the COVID-19 vaccine in the October 2020 survey wave were more likely to lack access to the internet, which is a potential systematic barrier if they changed their intentions following the FDA approvals of the COVID-19 vaccines and more information became available in the winter and spring of 2021.
Immigration-Related Factors and Depression Help-Seeking Among Older Chinese Americans
Authors: Kong Dexia , Guo Man , Simon Melissa , Dong XinQi 
Published: December 2021

Abstract
Asian Americans have the lowest mental health service utilization rate among all racial/ethnic groups. One important yet understudied aspect of this group’s mental health service use is its potential associations with immigration-related factors such as migration reasons, years in U.S., acculturation, and ethnic enclave residence. Using data from the Population-based Study of Chinese Elderly in Chicago (collected 2013-2015, N=3,123), this study investigates whether and how immigration-related factors shape mental health service utilization. Four categories of help-seeking behaviors for depressive symptoms were examined, including not seeking help (23.5%), seeking help from informal source(s) only (40%), seeking help from both informal and formal sources (28.7%), and seeking help from formal source(s) only (8.8%). Results of logistic regressions showed that U.S. Chinese older adults who migrated for family reasons were less likely to seek help from informal sources only than those who migrated for other reasons [Odds Ratio (OR)=0.64, 95% Confidence Interval (CI)=0.42-0.99). Less acculturated older immigrants (OR = 0.88, 95% CI = 0.79-0.97) and those who lived in Chinatown (OR = 2.34, 95% CI = 1.21-4.52) were more likely to seek help from formal sources only (relative to not seeking any help). Our findings showed that majority of the older Chinese Americans with depressive symptoms either did not seek help or sought help from informal sources only. Their help-seeking behaviors were shaped by their migration and acculturation experiences. Leveraging informal support networks and ethnicity-specific resources in Chinatown represent a culturally appropriate approach to facilitate mental health help-seeking among U.S. Chinese older adults.
Building Researchers' Capacity for Embracing the Engagement of Older Adults in Research
Authors: Berman Rebecca , Lessem Rachel , Danilovich Margaret 
Published: December 2021

Abstract
The Sage Resource Project aimed to broaden the pool of researchers who include the voice of older adults using long-term services and supports (LTSS) in research processes. We developed training to build researcher capacity to engage older adults through the development of Sage Model research advisory boards. Methods included training strategies for learning mode, design, duration, and emphasis of content that were informed by results of a researcher needs assessment and input from 2 older adult research advisory boards. Over 100 researchers registered for a 4-webinar series. All respondents to webinar evaluations (22) reported learning about topics that aligned with webinar objectives and had interest in engaging older adult stakeholders and/or developing an older adult research advisory board in the future. Representatives from five universities expressed interest attending online interactive workshops to build advisory boards. Lessons learned identify directions for research on best practices for developing older adult advisory groups.
Vision, Cognitive Impairment, and Dementia in the Aging, Demographics, and Memory Study
Authors: Ehrlich Joshua , Swenor Bonnielin , Zhou Yunshu , Langa Kenneth 
Published: December 2021

Abstract
Vision impairment (VI) is common in late-life and may be a modifiable risk factor for cognitive decline and dementia. In this study, using data from the population-based Aging, Demographics and Memory Study (ADAMS), we analyzed the association of VI with cognitive impairment no dementia (CIND) and dementia. We found that VI (binocular presenting acuity &lt;20/40) was significantly associated with incident CIND (OR=3.5, 95% CI=1.4-8.9, p=0.008) and dementia (OR=1.8, 95% CI=1.0-3.1, p=0.040) after adjusting for age. However, among those with CIND, VI was not associated with dementia (OR=0.9, 95% CI=0.4-1.8, p=0.733). The association between VI and CIND remained significant in models fully adjusted for demographic and health factors (OR=2.7, 95% CI=1.0-7.5, p=0.049). We conclude that VI is associated with development of CIND but not with subsequent onset of dementia. These findings suggest that the association between VI and dementia is driven by the elevated risk of dementia among those with CIND.
Retinal Vascular Density on OCT-A and Age-Related Central and Peripheral Hearing Loss in an Italian Older Population
Authors: Sardone Rodolfo , Bortone Ilaria , Panza Francesco , Sborgia Giancarlo , Giuliani Gianluigi , Pastore Valentina , Boscia Francesco , Quaranta Nicola 
Published: December 2021

Abstract
Age-related hearing loss (ARHL) and retinal vessel changes have both been associated to neurodegeneration/dementia, suggesting a possible link between these two conditions in older age. We analyzed data on 886 older participants (65 years+, age range: 65-92 years) in the cross-sectional population-based Salus in Apulia Study. OCT-A scan was used to measure SVD and DVD of the capillary plexi of the macula in different retinal quadrants. Peripheral ARHL was defined as &gt;40 dB HL of PTA (0.5,1,2, and 4KHz) in the worst ear, and age-related CAPD as &lt;50% at the SSI-ICM test in at least one ear. DVD at the whole retina and at the parafoveal quadrant were inversely associated only with age-related CAPD [OR:0.93; 95%CI: 0.88-0.96 and OR:0.94; 95 CI:0.90-0.99, respectively]. The association of retinal vascular density with age-related CAPD may bring us a further step forward in understanding the biological mechanisms underlying the links between neurodegeneration/dementia and ARHL.
Implications of Disability for Functional Trajectory, Service Use, and Expenditures
Authors: Anderson Wayne , Alkema Gretchen 
Published: December 2021

Abstract
People with disabilities face a diverse array of health care and support needs. These needs can vary by disability type, degree, and timing of the advent of functional limitations. These differences have implications for needed health care service use and related expenditures. The symposium will open with a Centers for Disease Control and Prevention-sponsored analysis of adult disability-associated health care expenditures, both nationally and by U.S. state, in total, by per adult, by per adult with disability, and by payer, to illustrate the contribution and variation of these expenditures to individual states and the health care system. We will next present a U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation effort to identify onset and patterns of reduced functional ability at end of life for older adults with and without dementia as related to other comorbidities. The last paper will present a Commonwealth Foundation study on older adults with functional disabilities and multiple chronic conditions, comparing those with high health care needs versus the subset of those people who are also high cost. Patterns of utilization differed between these two groups, and by state. These findings have implications for the development of care models that might best meet people’s needs. Our discussant will respond to the studies’ findings and discuss the important role that efforts to understand the nature of disability and functional status and the scale and scope of service use and costs have for people with disabilities.
Association Between Dual-Task Gait and Cognitive Function in Older Adults
Authors: Suri Anisha , VanSwearingen Jessie , Redfern Mark , Sejdic Ervin , Rosso Andrea 
Published: December 2021

Abstract
Community mobility involves walking with physical and cognitive challenges. In older adults (N=116; results here from initial analyses: N=29, Age=75±5 years, 51% females), we assessed gait speed and smoothness (harmonic-ratio) while walking on even and uneven surfaces, with or without an alternate alphabeting dual-task (ABC). ANOVA assessed surface and dual-task effects; Pearson correlations compared gait with global cognition and executive function composite z-scores. The four conditions (even, uneven, even-ABC and uneven-ABC) affected speed(m/s) (0.97±0.14 vs 0.90±0.15 vs 0.83±0.17 vs 0.79±0.16). Smoothness (2.19±0.48 vs 1.89±0.38 vs 1.92±0.53 vs 1.7±0.43) was affected by only surface (controlled for speed). Greater speed was associated with better global cognition(ρ=0.47 to 0.49, p&lt;0.05) for all conditions and with better executive function for even-ABC(ρ=0.39, p=0.04) and uneven-ABC(ρ=0.40, p=0.03). Executive function was associated with smoothness during even(ρp=-0.42, p=0.03) and uneven(ρp=-0.39, p=0.04) walking. Type of walking challenge differentially affects gait quality and associations with cognitive function.
Pain Assessment in Impaired Cognition (PAIC15) Instrument: Cutoffs Against Three Standards
Authors: van der Steen Jenny , de Waal Margot , Achterberg Wilco 
Published: December 2021

Abstract
Observational pain scales can help identify pain in persons with impaired cognition including dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) observational pain scale covers 15 important items that are indicative of pain, but it is unclear how likely pain is for persons with each summed score (theoretical range 0-45). The goal of our study was to determine sensitivity and specificity of cut offs for probable pain on the PAIC15 against three possible standards. We determined cut offs against (1) self report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with 137 residents assessed twice. The area under the ROC curve was excellent against the PAINAD cut off (□0.8) at both assessments, but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, cut offs at the PAIC15 could be 3 or 4. Guided by self report we recommend PAIC15 scores of 3 and higher to represent probable pain with sensitivity and specificity in the 0.5 to 0.7 range.
Relationships of Pain Treatment With Dementia and Functional Outcome in Medicare Home Health Care
Authors: Wang Jinjiao , Cato Kenrick , Conwell Yeates , Heffner Kathi , Yu Fang , Caprio Thomas , Li Yue 
Published: December 2021

Abstract
Adequate pain management is important to post-acute care functional recovery, yet persons with Alzheimer’s disease and related dementias (ADRD) are often under-treated for pain. The objectives of this study were to examine in Medicare post-acute home health (HH) recipients with daily interfering pain 1) if analgesic use at home is related to functional outcome, and 2) if ADRD is related to the likelihood of analgesic use at home. We analyzed data from the Outcome and Assessment Information Set, Medicare claims, and electronic medical records of 6,039 Medicare beneficiaries ≥ 65 years who received care from a large HH agency in New York in 2019 and reported daily interfering pain. Analgesic use was identified in medication reconciliation of HH visits and categorized into any analgesics or opioid(s). ADRD was identified from ICD-10 codes and significant cognitive impairment. Functional outcome was measured as change in the composite score of Activity of Daily Living (ADL) limitations from HH admission to HH discharge. Use of any analgesics at home was associated with greater ADL improvement from HH admission to HH discharge (β= -0.20 [greater improvement by 0.2 ADLs], 95% Confidence Interval [CI]: -0.37, -0.04; p=0.017). Compared with patients without ADRD, those with ADRD were less likely to use any analgesics (Odds Ratio [OR] = 0.66, 95% CI: 0.49, 0.90, p=0.008) or opioids (OR=0.53, 95% CI: 0.47, 0.62, p&lt;0.001) at home. Adequate pain management is essential to functional improvement in post-acute HH care. Patients with ADRD may be under-treated for pain in post-acute HH care.
The Relationship Between Knee Pain and Heart Failure in Older Black and Latino Women
Authors: Kheirbek Raya , Siaton Bernadette , Beamer Brock , Blumenthal Jacob , Katzel Les , Sorkin John , Hogans Beth 
Published: December 2021

Abstract
Background: Knee pain is the second-most prevalent and disabling common pain condition globally, having deleterious effects on daily function including mobility and exercise capacity; chronic knee pain is especially prevalent in older adults. There is substantial evidence to indicate that physically inactive individuals have higher rates of cardiovascular disease. Nonetheless, studies investigating cardiovascular risks with osteoarthritis have had mixed results. Objective: This study explores the relationship between knee pain and heart failure especially examining the factors of age, gender, race in U.S. older adults. Methods: Retrospective secondary analysis of Medicare claims data for 1.478 million adults over age 65. The standard analytical file for 2017 was segmented according to the presence of any of several ICD-10 codes for heart failure (HF). Medicare beneficiaries with and without HF diagnoses were evaluated for knee pain and other common pain-associated conditions; pain condition data was stratified by age, gender and race codes. Results: Knee pain was markedly increased in women with HF in the 65-70- and 70–75-year-old age-cohorts and relatively less increased in older age-cohorts and males. Knee pain in women was especially elevated in those with Medicare race codes indicating Black and Hispanic status. Conclusion: in a large cohort of Medicare beneficiaries, knee pain was noted to be markedly increased in younger cohorts of older women with HF, and more prevalent in Black and Hispanic women. Further studies should evaluate lifestyle, biomechanics, and inflammatory factors that may be contributing to this relationship.
Hearing Loss and Preventable Hospitalizations
Authors: Reed Nicholas , Morales Emmanuel Garcia 
Published: December 2021

Abstract
Nearly half of all adults over the age of 60 years have hearing loss. Recent research suggests adults with hearing loss experience increased health care expenditures and hospitalization. However, little is known about whether these are preventable hospitalizations which may indicate poorer healthcare system engagement. In this cross-sectional analysis, we examined data from combined 2016-2018 Medicare Current Beneficiary Survey (MCBS) datasets. Participants are asked to describe their self-perceived trouble hearing. Preventable hospitalizations were defined and generated from administrative claims files based on the Agency for Healthcare Research and Quality identified conditions that should be manageable in ambulatory care settings. Multivariate regression models adjusted for demographic/socioeconomic characteristics and general health determinants were used to explore the association between trouble hearing and outcomes. The combined 2016-2018 MCBS administrative claims files included 18,814 participant-years, 49.8% reported no trouble hearing, 43.4% reported a little trouble and 6.8% a lot of trouble hearing, respectively. A higher proportion of those with a lot of trouble hearing (6.8%) experienced at least one preventable hospitalization compared to those with a little trouble hearing (3.4%) and no trouble hearing (2.5%). In a fully adjusted logistic regression model, hearing loss was associated with 1.35 times the odds of experiencing at least one preventable hospitalization per year (OR=1.35; 95% CI=1.03-1.77). Medicare beneficiaries with hearing loss experience higher rates of preventable hospitalizations. This may be due to avoidance of care due to communication barriers. Further work is needed to understand underlying reasons and whether addressing hearing loss modifies the observed association.
Trends in Antiretroviral Regimen Complexity Among Medicare Beneficiaries With HIV, 2014-2018
Authors: Fleming Sean , Wastila Linda 
Published: December 2021

Abstract
Little is known about antiretroviral therapy (ART) patterns among Medicare beneficiaries with Human Immunodeficiency Virus (HIV). ART has significant implications for spending in Medicare Part D as use of single-tablet regimens (STR) grows, generic availability remains low, and price increases for branded therapies consistently exceed inflation. The objective of this study is to detail patterns of STR utilization among Medicare beneficiaries with HIV. We conducted a retrospective trend analysis using a 5% sample of Medicare Chronic Conditions Data Warehouse, 2014-2018. We included each person-month that fee-for-service beneficiaries with HIV had Parts A, B, and D coverage. Trends in annual prevalence of STR overall, by ART class, and by age, sex, and race subgroups were estimated. The study included 9,509 beneficiaries who contributed 345,708 person-months to the analysis. The prevalence of STR increased from 21.8% (95%CI, 21.5-22.1) in 2014 to 44.6% (95%CI, 44.3-45.0) in 2018 (p &lt;0.0001), an increase of 104.6%. Integrase strand transfer inhibitors (INSTI) saw the largest increase in utilization between 2014 (4.4% [95%CI 4.2-4.5]) and 2018 (35.1% [95%CI 34.8-35.4]) (p&lt;0.0001), a 701.8% increase. All sociodemographic subgroups experienced similar growth in STR use between 2014 and 2018. STR and INSTI utilization increased significantly over the study period, suggesting increased ART spending under Part D. Although increasing availability of generic multi-tablet ART regimens (MTR) may offer cost-savings, further research is needed comparing generic MTR to branded STR with regards to patient preferences, adherence, healthcare resource utilization, and total costs in the growing population of Medicare beneficiaries with HIV.
Older People With Dementia Running a Pop-Up Restaurant: How to Use Reality Shows to Reduce the Stigma of Dementia
Authors: Xu Wenqian 
Published: December 2021

Abstract
The present study focused on a Chinese reality show, Forget Me Not Café, which brought together five older people (aged 65 and older) living with dementia to run a pop-up restaurant and intended to reduce the stigma of dementia. The study aims to explore how the reality-show participants describe dementia in older people and how their views relate to the macrosocial context of dementia and older people. This study performed a thematic discourse analysis on the written and spoken content about dementia in older people (or later life) presented in the reality show. Four discursive themes were identified including: (1) age is a risk factor for dementia; (2) early signs and symptoms of dementia in older people deserve attention; (3) putting pressure on family caregivers of people with dementia; (4) expectations to maintain social engagement and slow down the development of dementia. This study also found that the views of the reality-show participants highlight the capability of older people with dementia to communicate effectively and live with the condition, their personal goals of sustaining a happy, meaningful and sociable life, as well as their actions to positively influence personal circumstances. The results of this study indicate that this reality show might help reduce the stigma of dementia and empower older people living with dementia, while it also tends to stress the responsibility for care on family carers and shift the responsibility of managing the dementia-related challenges to older people living with dementia.