bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Nursing Home Preferred Networks Good for Patients' Outcomes? Evidence From the Veterans Health Administration
Authors: Cornell Portia , Corneau Emily , Magid Kate , Moyo Patience , Rudolph James , Levy Cari , Mor Vincent 
Published: December 2021

Abstract
In the Veterans’ Administration (VA), medical centers contract with community nursing homes to provide care to Veterans. As a purchaser, the VA could pursue a strategy of selecting a high-quality network; alternatively, it could focus resources on oversight by its nursing-home coordinators. The question of whether narrow networks are good for Veterans’ outcomes, conditional on quality, therefore, needs empirical investigation. We examined the effect of network concentration on hospital admissions, conditional on Veterans’ clinical acuity. We operationalized network concentration as the number of Veterans already in residence at the time of admission, and controlled for publicly reported quality measure (star rating). We identified 93,805 VA-paid admissions to nursing homes between 2013 to 2016. To address selectin bias, we estimated effects using a distance- based instrumental variable (IV) for each measure, with the log of distance to the nearest nursing home with a specified number of Veterans at the facility in the previous month (1-4, 5-9, and 10-13, and 14+ Veterans). Going to a facility with 10-13 or 14+ Veterans had a higher hospitalization probability (6.2 and 3.3 percentage points higher, respectively), than going to a facility with 1-4 Veterans. If quality rating improves outcomes, then broader networks are beneficial if consumers (Veterans) choose based on quality, given a broader choice set. Conditional on quality, concentrated networks do not seem to lead to fewer hospital admissions. Our results suggest that the VA could do more in its oversight role to work with these nursing homes to decrease hospital admissions.
Quality Improvement Efforts in VA Community Living Centers Increased Following Public Reporting of Performance
Authors: Davila Heather , Mills Whitney , Clark Valerie , Hartmann Christine , Mohr David , Berlowitz Dan , Baughman Amy , Pimentel Camilla 
Published: December 2021

Abstract
In 2018, the US Department of Veterans Affairs (VA) began publicly reporting performance ratings for its 134 Community Living Centers (CLCs; nursing homes) based on health inspections, staffing, and clinical quality measures. CLCs operate within a large, integrated healthcare system with unique financial and market incentives. Although public reporting has led to quality improvements in non-VA nursing homes, we do not know whether CLCs respond to public reporting differently than private sector nursing homes. To address this knowledge gap, we used a comparative case study approach involving 3 purposively selected CLCs with varied (low, medium, high) performance ratings. We conducted semi-structured interviews with personnel (n=12) responsible for quality measurement and improvement. Interviews focused on opinions of public reporting, actions taken to improve performance ratings, and motivations for change. Participants indicated public reporting improved transparency and provided an “outside perspective” on their performance. Strategies to improve performance ratings involved 1) data/information, 2) individual roles, and 3) teamwork/communication. All 3 CLCs made changes in these areas, yet respondents in the higher performing CLCs described implementing more strategies immediately after learning their ratings. Respondents in all 3 CLCs described being motivated to deliver good care and achieve public ratings that reflected the care they provided. This meant addressing internal weaknesses that contributed to lower scores for 2 CLCs. Our findings suggest public reporting may improve internal data collection, reporting, and quality improvement efforts in CLCs. They highlight the potential positive impact of public reporting in prompting quality improvement in nursing homes.
Moving Online: Evidence-Based Programming During COVID
Authors: Hughes Susan , DeMott Andrew , Stapleton Gerald , Huber Gail 
Published: December 2021

Abstract
The COVID pandemic disrupted the way evidence-based health promotion programs (EBPs) are delivered to older adults who were the most at-risk group in terms of mortality and faced unprecedented threats to their independence and physical and mental health. Many organizations stopped in-person EBPS causing older adults to lose access to key social networks and health resources. It is a top public health priority to find new ways to keep older adults connected to their EBPs. Fit & Strong! (F&S!) is a group exercise/health education EBP for older adults with arthritis offered by CBOs in 32 states. CBOs stopped offering F&S! in-person in March 2020. Since the lockdown, we have worked closely with our provider network to develop and pilot a version that is remote/online and live, titled “F&S! @Home”. Instructors deliver F&S! @Home to older adults with minimal technological resources. We created a staging website for both providers/instructors and participants that is used to initiate the classes, enable providers to manage participants, collect data, and share support materials. The pilot began September 2020; since that time 15 classes have been offered to 147 participants. Administration on Community Living falls and arthritis outcomes data are being collected. Preliminary analyses of 45 participants and 8 instructors demonstrate a high rating of the program (mean score of 90.2 out of 100) with no adverse outcomes to date. This presentation will review the process of creating the online adaptation, lessons learned, and will review pre/post outcomes and participant and instructor evaluation feedback.
The Effects of the COVID-19 Pandemic on the Work and Financial Outcomes of Older Black and Hispanic Adults
Authors: Jason Kendra , Carr Dawn , Chen Zhao 
Published: December 2021

Abstract
This study investigates how older Black and Hispanic adults’ work engagement is impacted by the effects of COVID-19. Using intersectionality and cumulative (dis)advantage as complementing theoretical frameworks, data from the Health and Retirement Study, and series of logistic regression models, we measure work engagement changes pre- and post- COVID-19. Preliminary findings suggest that net of other controls, there were no substantial or significant reductions in resilience as the result of COVID-19 itself for any racial/ethnic group. White older adults, and to some degree Hispanics older adults, experienced erosion in resilience related to financial hardships, but the resilience of Black older adults remained stable in the face of increased hardship. Future work in this area will improve our limited understanding of older Black and Hispanic adults’ experiences of managing and coping with COVID-19- related work and financial risks– information that will be critical for planning intervention and support services.
Physical and Cognitive Correlates of GPS-Derived Life-Space Characteristics in Older Adults
Authors: Moored Kyle , Crane Breanna , Carlson Michelle , Rosso Andrea 
Published: December 2021

Abstract
Life-space mobility, movement within one’s living environment, is important for functional independence in later life. It is unclear which life-space characteristics (i.e., space, duration, shape) are most affected by physical and cognitive limitations. GPS-derived measures mitigate recall bias and offer novel ways to characterize life-space. We examined associations between physical and cognitive performance and GPS-derived life-space characteristics. Participants were 164 community-dwelling adults (Age: M=77.3±6.5) from baseline data of a clinical trial to improve walking in older adults. Participants carried a portable GPS for 7 days, which passively collected real-time location. Standard deviational ellipses (SDEs) and minimum convex polygons (MCPs) were derived for each day. Area and compactness of these measures quantified activity space and shape, respectively. For each measure, 7-day medians and median absolute deviations (MAD) were computed to capture both central tendency and variability of weekly activity. Activity duration was quantified as percentage of time outside home. Adjusting for age and sex, percent time outside home was associated with lower mobility performance (i.e., 6-minute walk (6MWT), figure 8 walk, ρ’s=.17-.18, p’s&lt;.05) and executive functioning (i.e., Trail Making Test, Part A: ρ=.16, p=.04, Part B: ρ=.19, p=.01). Median MCP and SDE areas, but not compactness, were associated with 6MWT performance (ρ’s=.18-.20, p’s&lt;.05). MCP area MAD was associated with greater global cognition (3MSE, ρ=.15, p=.05). Life-space characteristics were differentially associated with performance measures, suggesting physical and cognitive limitations may constrain life-space mobility via different mechanisms. Variation in these associations by neighborhood walkability and active versus passive travel will also be examined.
Social Activity and All-Cause Mortality in Older Black Adults of the Minority Aging Research Study
Authors: Lamar Melissa , James Bryan , Capuano Ana , Wilson Robert , Barnes Lisa 
Published: December 2021

Abstract
Negative social stressors (e.g., perceived loneliness and/or social isolation) predict mortality in older adults; less is known about the role of positive social activities. What research does exist focuses on White adults, leaving gaps in knowledge regarding specific activities that may decrease mortality risk in Black adults. We investigated whether self-reported late-life social activity, generally and by type, predicted mortality risk in 768 Black adults (age~73yrs; non-demented at baseline) participating in MARS. Over ~6.5 follow-up years, 25% of participants died (n=192; age-at-death~83yrs). In fully-adjusted Cox models including demographic, health, and relevant psychosocial covariates, mortality risk decreased by 32% (HR=0.68,95%CI=0.49,0.93) in those with higher compared to lower social activity generally, and with higher volunteer-, church- and group-related activities specifically. Engaging in social activity, especially altruistic or faith-based activities, reduces mortality risk in older Blacks regardless of overall health or social stressors pointing toward community-based approaches to increase longevity in this population.
Grandmothers Raising Grandchildren: Predictors of Healthcare Access and Financial Security During COVID-19
Authors: Musil Carol , Jeanblanc Alexandra , Burant Chris 
Published: December 2021

Abstract
Grandmothers living with or raising grandchildren who had just completed the final data point of an NIH-funded, national, behavioral RCT were asked to complete an additional data collection point to capture the effects of the Covid-19 pandemic on their families’ access to healthcare and financial security. In Spring 2020, 258 grandmothers completed measures of access to healthcare and financial security (3 and 4 item composite scales), family strain, family functioning, and psychosocial and demographic variables. Financial security (Adj. R2=.52) was explained by knowing other grandfamilies; better family functioning; and fewer financial worries, unmet service needs, and depressive symptoms. Access to healthcare (Adj. R2=.24) was explained by being married, employed and having fewer financial worries and unmet service needs. Findings that family functioning, knowing other grandfamilies and depressive symptoms contributed to financial security, and that marital and employment status affect access to healthcare show the importance of support.
Implementing an Intervention Program During the COVID-19 Pandemic: Challenges and Successes
Authors: Mendoza Nancy , Park Cherrie 
Published: December 2021

Abstract
During the COVID-19 pandemic, the implementation of intervention programs for grandfamilies are facing multiple challenges. In this paper, we will present some of the challenges and successes of introducing the GRANDcares Plus Project (GRANDc+) during the COVID-19 pandemic. As an intervention program, GRANDc+ has demonstrated positive outcomes for grandfamilies, such as increased satisfaction with life, knowledge of services, self-care practices, and supportive social networks. Due to the pandemic, the implementation of GRANDc+ has been met with many challenges including, training of facilitators, following CDC’s COVID-19 guidelines/recommendations, and considering grandfamilies needs, concerns and safety. The pandemic has and continues to have detrimental effects on grandfamilies; this makes it more vital than ever to support grandfamilies through interventions like GRANDc+, despite what challenges we may face. Our presentation will provide insights into identifying, managing, and overcoming the challenges of implementing interventions during the COVID-19 pandemic.
The Need for Person-Centered Measures for Dementia Research and Care
Authors: Fazio Sam , Zimmerman Sheryl , Gitlin Laura 
Published: December 2021

Abstract
The importance of person-centered medical and psychosocial care has become widely recognized, but there is abundant evidence that care is not always person-centered. In 2018, the Alzheimer’s Association published their evidence-informed Dementia Care Practice Recommendations, which address nine domains all grounded in a person-centered perspective. Following that work, the Association launched LINC-AD -- Leveraging an Interdisciplinary Consortium to Improve Care and Outcomes for Persons Living with Alzheimer's and Dementia. An early effort of LINC-AD, and the focus of this symposium, examined what measures are available to guide care and assess outcomes, and the extent to which they embrace person-centeredness. The results have been disappointing. This session will highlight the importance of person-centered measures in five domains of the Dementia Care Practice Recommendations, based on comprehensive reviews of literature. Each paper, presented by LINC-AD research advisors, will examine available measures and raise questions about gaps using a person-centered lens. Katie Maslow will describe frequently used measures and identify person-centered measures that could be added to studies of alternate procedures intended to increase detection and diagnosis. Drs. Mast and Molony will discuss a person-centered approach to item development and testing for assessment. Emilee Ertle will discuss the need to measure interpersonal and contextual factors associated with behavioral expressions. Drs. Prizer and Zimmerman will compare measures of dressing ability and their person-centered components. Dr. Calkins will examine the strengths and limitations of environmental assessment tools. As Discussant, Dr. Gitlin will integrate the findings from all five presentations, suggesting directions for the future.
Person-Centered Assessment of Behavior Changes in People With Dementia
Authors: Ertle Emilee , Mast Benjamin , Mountain Gail , Kolanowski Ann , Moniz-Cook Esme , Halek Margareta 
Published: December 2021

Abstract
Behavioral and psychological symptoms of dementia are increasingly being reconceptualized as expressions of distress and unmet needs. Measures that evaluate context are needed to increase our understanding of factors that influence these expressions. This review evaluated measures for two common behavioral states that are experienced as challenging for caregivers: apathy and resistance to care. A systematic literature search identified measures of apathy or resistance to care for people living with dementia. Eight measures of apathy and three measures of resistance to care were identified. Reliability and validity of these measures were evaluated using the COSMIN framework, as well as reported contextual factors within which the behavior occurs. The identified measures had fair to good reliability and validity in people living with dementia. However, available measures need to move beyond symptomatic constructs for this complex paradigm, and toward the varied interpersonal and contextual factors associated with behavioral expression.
Privacy Concerns Among Older Adults Using Voice Assistant Systems
Authors: Spangler Hillary , Driesse Tiffany , Roth Robert , Liang Xiaohui , Kotz David , Batsis John 
Published: December 2021

Abstract
Voice Assistant Systems (VAS) are software platforms that complete various tasks using voice commands (e.g., Amazon Alexa), with increasing usage by older adults. It is unknown whether older adults have significant privacy concerns with VAS. 55 participants were evaluated from ambulatory practice sites for a study on VAS detection of early cognitive decline. The mean age was 73.3±5.6 years, 58% female, 93% white, and 53% had mild cognitive impairment. Privacy concerns were assessed via Likert-based surveys. Participants believed data was used with consent (71%) and stored properly (67%); however, 71% wanted new privacy regulations, 43% were comfortable with daily activity monitoring, and 85% thought the data needs to be highly protected. Qualitative themes included “listening-in”, “tracking”, and unwanted sharing of information. Findings suggest that older adults do not have significant privacy concerns for VAS use, but requested additional regulations. Future research can compare VAS privacy concerns between age groups.
Older Adult User Feedback on Design and Functionality of EngAGE, a Voice-Activated Exercise Program
Authors: Nicholson Roscoe , Montoya Yadira , Shervani Saira , Smith Chelsea , Hawkley Louise , Huisingh-Scheetz Megan 
Published: December 2021

Abstract
The EngAGE Alexa app is a socially motivated exercise program targeting older adult-caregiver dyads to promote mobility independence. EngAGE provides exercise routines that older adults can perform in the home in conjunction with a messaging component to facilitate motivation from caregivers and a tracking component to monitor progress. This presentation will describe the qualitative results that have informed the app’s design and evaluation of its feasibility and functionality following a 14-week feasibility study in 10 dyads of older adult exercisers and their caregivers. The presentation will cover the perceived benefits of EngAGE’s older adult users (including “real world” clinically relevant improvements, the comprehensiveness of the exercises, and exercise knowledge gained), as well as likes and dislikes that contributed to our assessment of the app’s functionality. Finally, we will discuss how the feedback contributes to future directions in the development of the app’s features, supporting materials, design and content.
Comfort and Data Sharing With Artificial Companion Robots Among an Online Cohort
Authors: Berridge Clara , Zhou Yuanjin , Robillard Julie , Mattek Nora , Gothard Sarah , Kaye Jeffrey 
Published: December 2021

Abstract
Results from a June 2020 survey on comfort with two forms of artificial companion (AC) robots in normal compared with pandemic times will be presented. 1,082 adults age 21-92 (mean 64) completed the online survey for a response rate of 45%. Significantly greater comfort is reported with small AC robots relative to larger human-shaped robots in both normal and pandemic times. In bivariate and adjusted models, younger age and male gender were most commonly associated with greater comfort with AC robots. Most participants (68.7%) did not think an AC robot would make them feel less lonely. About half (52.8 %) of the participants reported that they probably or definitely would want their facial expressions to be read, while a minority (15.0%) were at least somewhat comfortable with AC robots recording their conversations. The most common person participants wanted these data types shared with is themselves, a spouse/partner, and medical provider.
CATCH-ON Connect: A Program to Increase Technology Access Among Older Adults During COVID-19
Authors: Emery-Tiburcio Erin , Sayer Janis , Golden Robyn , Castaneda Salvador , Newman Michelle 
Published: December 2021

Abstract
During the COVID-19 pandemic, technology became an essential tool to maintain connections to social support, health professionals, and services. However, many older adults do not have access to technology or do not feel comfortable using it. CATCH-ON Connect provides cellular-enabled tablets and individual, personalized technical assistance to older adults. Adults age 65+ in project partner primary care clinics who do not have an internet-ready device or who lack digital literacy are eligible to participate. Older adults learn how to access their electronic health record portal, use pre-installed apps (e.g., Lyft, Zoom), and receive education about COVID-19 and the 4Ms. Of the 40 participants enrolled to date, 46% have never accessed the internet with a tablet or smartphone. Initial qualitative outcomes indicate high satisfaction and increased electronic socialization. Quantitative results of participant technology challenges, loneliness, and utilization of telehealth services will be discussed.
Diagnosis of Behavioral Symptoms of Dementia and CNS-Active Drug Use Among Diverse Persons Living With Dementia
Authors: Thunell Johanna , Joyce Geoffrey , Qato Dima , Guadamuz Jenny , Zissimopoulos Julie 
Published: December 2021

Abstract
Approximately 90% of persons living with dementia (PLWD) experience behavioral and psychological symptoms of dementia (BPSD). Studies demonstrated high use of central nervous system (CNS) active drugs in nursing homes; one recent study documented high use among community-dwelling PLWD. Racial/ethnic disparities in BPSD diagnosis and CNS-active drug use, however, are unknown. We quantified disparities in BPSD diagnoses and CNS-active drug use using 100% Medicare Part A and B claims, 2017-2019, and Part D, 2018-2019. Beneficiaries were ages 65 and older in 2017, community-dwelling, and had a dementia diagnosis (n=801,597). We estimated models of CNS-active drug use to quantify racial/ethnic differences adjusting for confounders. Among PLWD, 66% had a BPSD diagnosis and 65% were taking a CNS-acting drug. Asians/Pacific Islanders were less likely to have a BPSD diagnosis (55%) than other groups, particularly affective diagnoses (40%). Whites were most likely to have any diagnosis (67%). Blacks were most likely to have hyperactivity diagnoses (7%). Antidepressants were most commonly used drug class (44%). Thirteen percent used an antipsychotic. Models adjusted for age, sex, comorbid conditions, dual-eligibility and BPSD diagnoses, showed non-Whites were less likely to use any CNS-active drug than Whites, but Blacks and Hispanics were slightly more likely to use antipsychotics. We found racial/ethnic differences in BPSD diagnoses and CNS-active drug use. Whether these disparities are due to differences in BPSD symptoms, health-care access or care-seeking remains an important question. Further study of disparity in outcomes associated with use will inform risk and benefit of CNS-active drugs use among PLWD.