bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges in the Measurement of Staffing: A Review of Reviews
Authors: Zúñiga Franziska , Osinska Magdalena , Blatter Catherine , Simon Michael 
Published: December 2021

Abstract
The question concerning the relationship of staffing and quality of care of residents in residential long-term care (LTC) has been explored extensively; however, no consistent evidence has been brought forth so far. Inconsistent measurement of staffing might hinder this research field to move forward. We assessed its measurement in a narrative review of reviews that explore the staff – quality of care relationship. We identified 12 systematic reviews, covering 1960 to May 2018. Most studies included had a cross-sectional design, were performed in the USA and worked with secondary, administrative data (e.g., OSCAR). Comparability of studies was limited by diverse definitions and measurement methods for staffing, including data about grade-mix, number of staff, and staff-resident ratios. We suggest performing international multi-case studies to compare and contrast LTC staffing and develop appropriate international common data elements. Logic models support the description of the expected relationship between staffing aspects and quality.
An International Perspective on the Impacts of COVID-19 on Adult Education and Training
Authors: Dikhtyar Oksana , Helsinger Abigail , Cummins Phyllis , Hicks Nytasia 
Published: December 2021

Abstract
The COVID-19 pandemic has caused one of the worst economic crises since the Great Depression and the current recession has been more detrimental to older workers compared to other age groups. Not only has it forced more older workers out of their jobs, but it has also made it much harder for jobless older workers to find a new job. Furthermore, due to increased automation and digitalization in the workplace, older workers will likely need upskilling or reskilling to improve their employment prospects in the changed labor market. This situation brings the importance of offering training and continuous education programs that target older workers to the forefront of adult education policy and practice. This qualitative study examines measures taken in response to COVID-19 in adult education and training (AET) in seven countries including Sweden, Norway, the Netherlands, Australia, Singapore, Canada, and the United States. The findings are based on key informant interviews with international policy experts and scholars in the field of AET in addition to information gathered from written materials (e.g., government and organizational reports). To expedite their economic recovery and improve labor market outcomes for their workers, some countries have increased government funding for vocational and continuing education or offered financial support for post-secondary students while others have provided funds to employers to offer training and retraining for their employees. Some of these measures have the potential to expand adult educational opportunities in the post-pandemic world. Implications for policy and practiced are discussed.
COVID-19 Vaccination in Home Health and Hospice: Barriers to Vaccination and Results From a Home Vaccination Program
Authors: Rosati Robert , Landers Steven , Videon Tami 
Published: December 2021

Abstract
Little is known about vaccination rates in home health and hospice populations. Results draw upon two separate data sources from The Visiting Nurse Association Health Group (VNAHG). Among VNAHG patients surveyed between February 2 and March 1, 202, 24% had received at least one COVID-19 vaccine. Among vaccinated patients, roughly one quarter did not travel to get the vaccine (received inpatient vaccination). They mostly traveled by car (88%), and 70% received help from a family member. Of patients who had not received a vaccine (76%), 81% were pursuing or planning to pursue obtaining a vaccine. Additionally, of those not pursuing a vaccine, 30% indicated it was because they could not get to a vaccine site. 44% of patients in the VNAHG “in home” vaccination pilot were bedbound, and 100% of patients had ambulation difficulties that make it impossible for them to leave home. All (100%) had a health care provider(s) recommended they get the vaccine. Only 38% have internet access. A quarter tried to call to schedule a vaccine, but only one was able to speak to someone. 40% of the patients attempted to get a COVID-19 vaccine prior to enrollment in the program. Most patients (81%) did not have someone available to assist with their transportation to get vaccinated, and most indicated difficulty securing an appointment. Many indicated severe traveling difficulties (requiring oxygen, needing ambulance transport). These findings highlight the high barriers for homebound patients, and the need and value of clinicians traveling to provide in-home vaccines.
Perceptions of Family Caregivers of People With Dementia Regarding Symptom Management and the COVID-19 Pandemic
Authors: Harris Melissa , Titler Marita 
Published: December 2021

Abstract
Nearly 98% of older adults with Alzheimer’s disease and related dementias (ADRD) experience behavioral and psychological symptoms of dementia (BPSD). Although BPSD are linked to caregiver burden, perceptions of family caregivers on the impact of BPSD and their experiences addressing them in the home are unclear, and little is known about the impact of the pandemic on these experiences. Study aims were to explore: 1) the experiences of family caregivers of community dwelling older adults with ADRD regarding BPSD and how they manage BPSD in the home, and 2) how the pandemic impacted family caregivers’ experiences, BPSD of their relatives, and BPSD management. A qualitative, exploratory approach was used; 21 family caregivers were interviewed virtually. Content analysis and constant comparative methods were used. Ten major themes emerged: 1) Emotional and psychological responses of caregiver, 2) Loss, 3) Anticipation, 4) Reliance, 5) Learning to caregive, 6) Rewarding, 7) Emotional and psychological responses of care recipient 8) Cognition of care recipient, 9) Care strategies, 10) Caregiver perspectives. Caregivers did not use terms “behaviors” or “symptoms”, instead they described their relatives’ and their own experiences interdependently. Caregiving challenges presented before the pandemic (e.g. equivocal effects of medications, increasing care demands), many of which were compounded by the pandemic. Future research should explore the experiences of caregivers from a range of backgrounds. Findings illustrate communication barriers exist between clinicians, community services, people with ADRD and their families which may be addressed through clinician education, family-centered care planning, and policies to expand support service access.
Facilitators and Barriers to Implementation of the EIT-4-BPSD Intervention
Authors: Behrens Liza , Riley Kiernan , Boltz Marie , Kolanowski Ann , Van Haitsma Kimberly 
Published: December 2021

Abstract
This study aimed to explore the perceptions of stakeholders (site champions, administrators, and front-line, social service, and activity staff) regarding the EIT-4-BPSD implementation strategy, including its utility, and the barriers and facilitators to implementation in real-world settings. A process evaluation included qualitative data from focus groups conducted with 93 stakeholders of 21 nursing homes (NHs) that implemented the EIT-4-BPSD strategy. Data were analyzed using a conventional content analysis. Emerging codes were sorted into categories then organized in meaningful clusters based on the domains of the RE-AIM framework. Challenges, facilitators, and contextual factors explain variability in implementation of EIT-4-BPSD strategy among NHs in six key categories: multi-stakeholder engagement, multi-level outcomes, process adaptations, uptake and utility of EIT resources, adoption barriers and facilitators, and future planning. Overall, stakeholders reported that the EIT-4-BPSD strategy can be successfully implemented in NHs and is helpful in improving staffs’ approach to BPSD.
Hearing and Vision Impairment in Older Adults: Implications for Cognitive, Mental, and Brain Health
Authors: Deal Jennifer , Lin Frank , Swenor Bonnielin 
Published: December 2021

Abstract
Sensory impairment impacts over 55% of Americans aged 60 years or older and may have important downstream consequences for the cognitive health of older adults. This session will present evidence for a relationship between sensory impairment and accelerated cognitive decline, increased risk of incident dementia, and increased mental and physical fatigability from two observational cohort studies. Additionally, this session will investigate the possible nature of these relationships. It may be that sensory impairment is a marker of dementia-related pathological changes in the brain, with potential ramifications for risk prediction and stratification. Alternatively, sensory impairment may have a direct impact on the aging brain, a potential causal mechanism liking sensory impairment and brain health, with implications for disease prevention. As part of this session, we will present evidence for associations between central auditory processing, a potential risk marker, and brain volumes measured with structural magnetic resonance imaging (MRI), and retinal vasculature density, as measured with optical coherence tomography. We will conclude by describing associations between age-related macular degeneration, a leading cause of blindness, and neurocognitive test performance and regional changes in brain atrophy and connectivity.
State-Level Health Care Expenditures Associated With Disability
Authors: Anderson Wayne , Khavjou Olga , Honeycutt Amanda , Bates Laurel , Hollis NaTasha , Grosse Scott , Razzaghi Hilda 
Published: December 2021

Abstract
This study updated prior (2003) state-level estimates of disability-associated health care expenditures (DAHE). We combined 2013-2015 data from three national data sets to estimate using multivariate regression all state-level DAHE for US adults in total, by payer, and per adult and per (adult) person with disability (PWD). In 2015, DAHE were $868 billion nationally (State range, $1.4 billion to $102.8 billion) accounting for 36% of total health care expenditures (range, 29%-41%). From over a decade ago, total DAHE increased by 65% (range, 35%-125%). DAHE per PWD was $17,431 (range $12,603 to $27,839). From over a decade ago, per-PWD DAHE increased by 13% (range, –20% to 61%). In 2015, Medicare DAHE per PWD ranged from $10,067 to $18,768. Medicaid DAHE per PWD ranged from $9,825 to $43,365. DAHE are substantial and vary by state and payer. Stakeholders can use these results to develop public health programs to support people with disabilities.
Motor Skill Training Effect on Real-Time Prefrontal Cortex Activation During Walking
Authors: Rosso Andrea , Chen Nemin , Perera Subashan , Huppert Theodore , VanSwearingen Jessie , Brach Jennifer , Rosano Caterina 
Published: December 2021

Abstract
We aimed to test the effects of motor skill training (MST) on gait automaticity measured by changes in prefrontal cortex (PFC) activation during actual walking. We used data from a 12-week trial of older adults (mean age=75.5, 60.5% women) randomized to standard physical therapy and standard+MST in a 1:1 ratio. Functional near infrared spectroscopy (fNIRS) measured PFC activation during simple and dual task walking. We will apply linear mixed models to assess effects of task, time, and MST on PFC activation. We will compare the PFC activation 1) during dual task walking compared to simple walking; 2) across visits after intervention; and 3) between participants receiving MST compared to standard physical therapy. These results will demonstrate whether gait automaticity, as evidenced by PFC activation during walking, is affected by MST.
Molecular Resiliency and Aging
Authors: Salmon Adam 
Published: December 2021

Abstract
Resilience is described as the ability to respond to acute forms of stress and recover to normal homeostasis. There is growing evidence that biology of resilience is entwined with the biology of aging. With increasing age, resilience decreases and is a likely contributor to increased morbidity, frailty and susceptibility to death with age. Conversely, increased resilience across numerous physiological markers of function is associated with longevity and healthy aging. The variation in resilience in populations suggests biological and molecular regulatory mechanisms that might provide insight into interventions to improve resilience, healthy aging and longevity. In this session, speakers will provide insight regarding short-term assays of resilience in animal models that prove useful both in delineating these biological mechanisms as well as inform on potential translational models to better understand biological resilience in human populations. The sessions focus is on defining these assays and discussion of the biological relevance each resilience assay in terms of the regulation of aging. The goals of these studies range from identifying potential predictors of individual lifespan within markers of functional resilience to leveraging geroscience to define whether markers of resilience can be modified through interventions to the aging process. Moreover, better understanding of the biology of resilience could assist in defining novel interventions that improve resilience and thereby enhance longevity.
Providing Care for Older Residents With Dementia in Nursing Homes in China: Through the Lens of Adaptive Leadership
Authors: Wang Jing , Bian Xueli , Anderson Ruth , Beeber Anna , Wang Junqiao 
Published: December 2021

Abstract
This study aims to understand staff’s experiences of providing direct care for older residents with advanced dementia in long-term care facilities through the lens of Adaptive Leadership Framework for Chronic Illness (ALFCI). Semi-structured interviews were conducted with health care aides (N=35) from 2 government-owned and 2 private long-term care facilities in urban China. Directed and conventional content analysis were used, drawing upon core constructs of ALFCI. We found that health care aides are confronted with multiple challenges such as high intensity of work, stress from managing older residents’ behavioral and psychological symptoms of dementia (BPSD), a lack of access to on-the-job dementia-specific training, and a lack of support from nurses and managing team. Some of the health care aides demonstrated use of their strengths and doing adaptive work to improve work life and care for older residents by using communication cues, enhancing person-centeredness in their care, and facilitate peer interactions.
Sexual Expression, Policy, and Practices in Skilled Nursing Facilities: An Updated Assessment in the State of Kansas
Authors: Jen Sarah , Jeong Mijin 
Published: December 2021

Abstract
Prior studies have reported barriers to meeting the sexual needs of older adults within skilled-nursing facilities, such as a lack of privacy, lack of supportive practices and policies, and judgement or discomfort on the part of the staff (Doll, 2013; Hajjar & Kamel, 2003). In 2008, Doll and colleagues assessed the scope of sexual behaviors, staff perceptions of and responses to such behaviors, and whether facilities had a sexual policy in place in SNFs in the state of Kansas (Doll, 2013). In the present study, an online survey was distributed to the same population to provide an updated assessment of sexual behaviors, policies, and practices. Of 60 survey respondents, 62.7% reported knowledge of individual sexual acts (e.g., masturbation) within the past year and 34.5% reported interactional (between two or more residents) sexual acts. When encountering a sexual event, staff were most likely to report the incident to an administrator (76.7%) and treat residents with respect (70.0%), while 35.0% and 41.7% were expected to respond with embarrassment and discomfort, respectively. Only 40% of administrators reported having a policy related to sexual expression. Findings indicate that staff are likely to respond differently to LGBTQ residents due to discomfort and those living with cognitive impairment due to concerns related to consent. The proportion of facilities in Kansas with policies related to sexual expression has increased from 26% to 40% in the past 12 years, but there remains a need for greater specificity of sexuality-related policies and trainings.
Recruiting Older Adults in a Medicare Supplement Population for Wellness Intervention Pilot Studies
Authors: Ungar Rachel , Zaidel Catherine , Tkatch Rifky , Wu Lizi , Albright Laurie , McGinn Michael , Yeh Charlotte 
Published: December 2021

Abstract
Older adults are often underrepresented in the health promotion literature, in part due to challenges in recruiting older adults for such studies. Aging Strong 2020 was specifically designed to address the health needs of older adults. A subset of adults aged 65 and older with an AARP Medicare Supplement plan insured by UnitedHealthcare were recruited for participation in one of eight interventions. Recruitment lists for each program were drawn from a pool previously screened for loneliness, purpose in life, optimism, and resilience, administered by an interactive voice response (IVR) telephone survey. Recruitment efforts were multifaceted and included emails, direct mailers, and phone calls. Incentives ranging from $25-$100 for completing surveys did not correspond with higher recruitment rates. Overall, recruitment phone calls reached 28,058(32%) individuals on the recruitment lists; a total of 1,766 participated, demonstrating that targeted efforts to recruit older adults for research opportunities can be successful.
Improving Resilience, Optimism, Purpose, and Loneliness Among Older Adults
Authors: Tkatch Rifky , Wu Lizi , Albright Laurie , Ungar Rachel , Zaidel Catherine , Cheng Yan , Schaeffer James , Yeh Charlotte 
Published: December 2021

Abstract
Aging Strong 2020 was developed to promote health and well-being and increase resilience by focusing on the pillars of enhanced purpose in life, social connectedness, and optimism. A series of eight interventions over three years tested the feasibility of enhancing these pillars. Interventions included: 1) An expressive writing program, 2) Animatronic pets, 3) A telephonic reminiscent program, 4) An online self-compassion mindfulness program, 5) A technology-based behavior change tool, 6) An online and workbook tool for purpose, 7) An online happiness program, and 8) A peer-to-peer support program. Each program demonstrated efficacy dependent on the pillar targeted and the population sampled. Overall, some improvement was found among participants in resilience (47%), purpose (49%), optimism (44%), and loneliness (48%). Further, participant satisfaction improved in each program with Net Promoter Scores increasing between 7-19 points. Results demonstrate that Aging Strong 2020 was successful, contributing to a holistic model of healthy aging.
Improving Usefulness of Cognitive Decline Population Measures in Predicting Future Dementia Burden
Authors: Olivari Benjamin , Taylor Christopher , McGuire Lisa 
Published: December 2021

Abstract
Alzheimer’s disease and related dementias begin with mild early symptoms of memory loss, progressing to more severe cognitive and functional impairment. Reports of worsening memory and subjective cognitive decline (SCD) are often the earliest possible signs of dementia onset. The trajectory of certain types of dementia may require early detection of worsening memory in the disease progression for successful interventions. However, the predictive value of subjective measures of cognitive decline is limited; the majority of those who report subjective symptoms do not progress to diagnosed cognitive impairment or dementia. These two realities create a significant challenge in confronting the growing dementia crisis. Population-level data can be beneficial in tracking trends in SCD. Data from the Behavioral Risk Factor Surveillance System (BRFSS) core questions related to chronic diseases and from the SCD optional module from survey years 2015-2019 were aggregated across the participating 50 states, D.C., and Puerto Rico for this analysis. Among 181,097 U.S. respondents aged ≥45 years, 11.3% (95% CI=10.9-11.6) reported SCD; among 20,424 with SCD symptoms, 39.4% (37.6-40.6) reported functional difficulties associated with SCD symptoms and 33.9% (32.4-35.5) needed assistance with day-to-day activities resulting from symptoms. Studies suggest persons experiencing SCD symptoms and associated functional difficulties are at increased risk for dementia compared with those with SCD without functional difficulties. Combining responses about SCD with associated functional difficulties, anxiety, and other measures might help to better inform the future burden of more severe cognitive impairment than SCD status alone.
Lessons on Learning in Later Life With the MIT AgeLab 85+ Lifestyle Leaders
Authors: Patskanick Taylor , Miller Julie , Yoquinto Lucas , D'Ambrosio Lisa , Coughlin Joseph 
Published: December 2021

Abstract
Previous research has established the role of lifelong learning in promoting psychological wellbeing and active aging. Population aging necessitates an understanding of the unique opportunities and challenges around formal and informal learning in later life. This paper will share findings from a mixed methods study with the MIT AgeLab 85+ Lifestyle Leaders, a panel comprised of octogenarians and nonagenarians from across the United States. Drawing on an online survey and virtual focus groups with 29 Lifestyle Leaders from January 2021, findings suggest the Lifestyle Leaders most often learned new things from talking with others (46%) and reading print (54%) or online (54%) sources. The majority were familiar with attending in-person lectures or classes (89.7%) and were now using videoconferencing to do these (78.6%). A majority (56.7%) had or are currently participating in a lifelong learning program. Most consider themselves lifelong learners and described this around remaining curious and engaged with life, choices around what one learns, and greater enjoyment of learning. In the survey, a plurality of Lifestyle Leaders indicated the top two challenges affecting their ability to learn were sensory burdens (e.g., hearing loss, declining eyesight) (35%) and their energy level (32.4%); focus group data revealed that recall also is a barrier. Focus group data further highlighted generational experiences around early life learning and career paths, specifically how gender roles, diagnoses of learning disabilities, and evolving digital technology have affected these and changed over the course of their lifetimes.
Country Differences in Financial Preparation: What Do People Expect From the State?
Authors: Nikitin Jana , de Couto Maria Clara P Paula , Graf Sylvie , Rothermund Klaus 
Published: December 2021

Abstract
A considerable gap between one’s pension and living expenses in old age exists in almost all developed countries, making savings and financial preparation for old age inevitable. Nevertheless, financial preparation for old age substantially differs across countries. Using the data from the AAF project, we investigated what motivates people in different countries (USA, Germany, Czech Republic, Hong Kong, and Taiwan) to financially prepare for old age. Financial preparation was the highest in the USA, followed by Germany and the Czech Republic. The lowest levels of financial preparation were found in Hong Kong and Taiwan. These differences were explained by age-related expectations on a “paternalistic” role of the state: Greater endorsement of the idea that the state should provide financial support to older citizens led to less preparation. These findings are in line with the idea that individuals’ beliefs and expectations regarding the role of institutions shape personal actions.