bluuebunny/crossref_metadata_2025_split huggingface dataset:
TRAINING FOR CAREGIVER OF OLDER ADULTS IN ECUADOR: REPORT ON PRESENTIAL, DISTANCE, AND HYBRID MODALITIES
Authors: Guillemot Jonathan , Saenz Samantha , Landazuri Maria Augusta Vélez 
Published: December 2023

Abstract
Caregiving for older adults in Ecuador is provided by family members, professional caregivers as well as untrained domestic workers. All three groups lack access to theoretical and technical training. The accelerating care drain towards Europe and North America, the fast-paced aging in the region as well as increasing trends of North American older adults migration to Ecuador, increase the need for large scale, quality and affordable caregiver training. We report the methods and outcomes of three modalities of training for caregivers of older adults combining over 100 individuals trained over the course of four years: a traditional presential training, which was offered prior to the COVID-19 pandemic; an online modality via Zoom during the pandemic; and the early outcomes of a novel hybrid modality, combining presential and asynchronous video-based learning. We found that social interaction, including the sharing of personal experiences, was an essential part of the training experience, which translated into long-term social bonds and early stages of solidarity networks between participants. Online synchronous training allowed a broader geographical coverage but failed to contribute to socialization as well as generated challenges related to the learning experience and efficacy. The novel modality offered the broad geographical coverage, lowered the cost and allowed socialization. It however created technical and quality control challenges. Training of caregivers is a key component to promote aging in place and age-friendliness. Our experience and conclusion aim to contribute to the future of training in the Global South as well as in the Global North.
CARDIOVASCULAR DISEASE RISK SCORES AND INCIDENT DEMENTIA AND COGNITIVE DECLINE IN OLDER MEN AND WOMEN
Authors: Vishwanath Swarna , Hopper Ingrid , Tonkin Andrew , Murray Anne , Shah Raj , Woods Robyn , McNeil John , Ryan Joanne 
Published: December 2023

Abstract

Background
Risk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether CVD risk scores are associated with dementia risk in older adults remains unclear. The aim of this study was to determine whether CVD risk scores are associated with dementia and cognitive decline in older men and women.

Methods
19,114 participants from a prospective cohort of individuals aged 65+ years. The Atherosclerotic Cardiovascular Disease risk score (ASCVDRS), Systematic Coronary Risk Evaluation 2 – Older Persons (SCORE2-OP) and the Framingham risk score (FRS) were calculated at baseline. Risk of dementia (DSM-IV criteria) and cognitive decline (&gt;1.5 standard deviation (SD) decline from previous assessment in cognitive function) were assessed using hazard ratio.

Results
Over a median follow-up of 6.4 years, 850 individuals developed dementia and 4352 cognitive decline. Men and women in the highest ASCVDRS tertile had a 41% (95%CI 1.08,1.85) and 45% (1.11,1.89) increased risk of dementia compared to the lowest tertile respectively. Likewise, men and women in the highest SCORE2-OP tertile had a 64% (1.24,2.16) and 60% (1.22,2.11) increased risk of dementia. Findings were similar but the risk was slightly lesser when examining risk of cognitive decline for both ASCVDRS and SCORE2-OP. FRS was only associated with the risk of cognitive decline among women (highest vs. lowest tertiles: 1.13 [1.01-1.26]).

Conclusion
These findings suggest the utility of CVD risk scores in clinical practice, to not only assess future risk of CVD, but also as potential early indicators of cognitive impairment in older men and women.
CLINICIAN AND STAFF PERSPECTIVES IN TRANSITIONS OF CARE FOR DUAL-USE VETERANS LIVING WITH DEMENTIA
Authors: Ayele Roman , Albright Karen , Battaglia Catherine , Levy Cari 
Published: December 2023

Abstract
The Veterans Administration (VA) has partnered with non-VA hospitals to improve access to care. However, older Veterans living with dementia (VLWD) who use both VA and non-VA care may experience gaps in care, placing them at risk of adverse health outcomes during transitions. This research aims to understand the barriers and facilitators in transitions of care for VLWD following non-VA hospitalization. We conducted 23 interviews with VA and non-VA clinicians involved in transitions of care for VLWD. Snowball sampling was used to identify participants, and rapid analysis identified themes. VA Participants faced significant challenges in receiving timely discharge communication from non-VA stakeholders, relying on VLWD, who are poor historians, for information about their non-VA hospitalization. Inadequate staffing for care coordination was also a barrier to timely care, resulting in frustration for VLWD and their families when tests had to be redone due to a lack of appropriate documentation from non-VA hospitals. Both VA and non-VA stakeholders experienced similar care coordination challenges for VLWD, their families, and clinicians. Non-VA stakeholders described the VA as a “black box” due to a lack of communication and collaboration. However, stakeholders expressed a desire to provide quality care, improve care coordination, and give timely care to veterans. These findings highlight the barriers experienced by VA and non-VA stakeholders and provide opportunities for improvement in coordinating care for VLWD. Implementing care coordination programs and improving communication and collaboration between VA and non-VA stakeholders can improve the quality of care for VLWD and their families during transitions.
DEMENTIA AND MILD COGNITIVE IMPAIRMENT: PREVALENCE, CONVERSION RATES, AND LONGEVITY BETWEEN AGES 70 AND 95
Authors: Stessman Jochanan , Jacobs Jeremy 
Published: December 2023

Abstract
This study describes the prevalence and conversion rates of Mild Cognitive Impairment (MCI) and dementia between age 70-95, and the association between cognitive status and mortality. The Jerusalem Longitudinal Study (1990-2023) prospectively follows a representative community-dwelling cohort born 1920-21, assessed at home visit during 1990,1998, 2005, 2010, 2015 at ages 70, 78, 85, 90, and 95 (n=437, 806, 1170, 584, 468) respectively. Comprehensive assessment included Mini Mental State Examination (MMSE), defining normal cognition (29-30/30), MCI (24-28/30) and dementia (≤23/30). Mortality data were collected from the Ministry of Interior. Cox proportional hazards ratios (HR) were determined, adjusting for gender, education, self-rated health, physical activity, BADL status, diabetes, hypertension, ischemic heart disease. At ages 70, 78, 85, 85, 90, and 95 the prevalence of MCI was 13.5%, 21.5%, 38.7%, 37.0%, and 50%; prevalence of dementia was 3.2%, 4.2%, 24.3%, 31.3%, 35.7%. Between age 70-78, 78-85, 85-90, 90-95, conversion rates from MCI back to normal were 74.2%, 27.4%, 18.2%, 7.3%; MCI declining to dementia were 6.5%, 29.2%, 37.0%, 50.9%; MCI remaining MCI were 19.4%, 43.4%, 44.8%, 41.8%. Dementia was significantly associated with increased mortality throughout the entire study period: at age 70-78 Hazards Ratio=4.36 (CI 95%: 2.09-9.10), age 90-95 HR=1.5 (CI 95%: 1.01-2.21). In contrast, MCI was not associated with increased mortality, apart from at age 85: HR=1.38 (CI 95%: 1.04-1.82). Our findings show that conversion rates from MCI to dementia are age-dependent, with less than half of MCI subjects progressing to dementia. Unlike dementia, MCI was largely unassociated with mortality.
EMBEDDING A PHYSICIAN REFERRAL PATHWAY TO LINK PEOPLE WITH DEMENTIA TO COMMUNITY SERVICE PROGRAMS
Authors: Lepore Michael , Shivers Stephani , Curbeam Deanna 
Published: December 2023

Abstract
Dementia care quality and value can be enhanced by lateral integration between health systems (HS) and community-based organizations (CBOs), however clinical providers are often unaware of CBO programs. HS could heighten access to CBO programs among people living with dementia (PLWD) by recognizing CBOs as extended care teams, streamlining referrals, and facilitating information exchange through electronic health records (EHRs). Catalyzing CBO and HS integration, we piloted physician referral to a CBO for virtual delivery of Cognitive Stimulation Therapy (CST) in an embedded pragmatic trial. CST, a 14-session group intervention for PLWD, has been shown to benefit participant cognition and other outcomes, yet CST access is limited partially due to the risks and costs of in-person gathering. To enhance access, we trialed a version of virtual CST (vCST) and assessed patient follow-through on physician vCST referrals. Participating sites–one primary care clinic and one neurological specialty clinic—identified eligible PLWD via EHR (e.g., cognitive score indicating mild cognitive impairment to moderate dementia) and clinicians verified eligible PLWD appropriateness for vCST. Clinician-verified PLWD were randomized to intervention (referral, n=56) and control (no referral) groups, and clinicians provided vCST referrals. Results show the percentage of PLWD who followed through on (‘accepted’) the vCST referral. Similarities and differences—across demographics, cognitive scores, and referral sources—between PLWD who accepted versus declined referral are described. Future research will assess conversion rates from vCST referral to program completion, the completeness of outcome measures captured from EHRs, and the impact of vCST on cognitive scores.
MOTIVATIONS AND ROLE CAPTIVITY AMONG INFORMAL CAREGIVERS TO COMMUNITY-DWELLING PERSONS WITH DEMENTIA
Authors: Bloom Rachel , Osso Francesco , McCarthy Megan , Falzarano Francesca 
Published: December 2023

Abstract
There are 11 million informal (unpaid) caregivers currently assisting a person with dementia in the United States. Motivations for taking on this challenging role vary, with many citing their responsibility to family or a shared interpersonal history. Many caregivers do not feel as if they have a choice in taking on care responsibilities for relational and/or financial reasons and are held “captive” in this role. Prior research indicates role captivity as a key mediating force in the development of depression among dementia caregivers, but limited work has directly linked quantitative measures of role captivity with qualitative data surrounding motivations for providing care. The current mixed-methods study uses quantitative and qualitative data to explore this connection in a sample of 46 participants providing care to a community-dwelling person with dementia. Study findings show that role captivity was significantly associated with greater costs of care, feelings of grief, and depressive symptoms, as well as lower levels of self-efficacy and mutuality. These relationships were assessed alongside thematic analyses of interview data centered on motivations for providing care, familial and cultural expectations, and financial necessity. This research paints a detailed picture of the way in which dementia caregivers understand and relate to their role and can inform the design of effective psychological supports for this population.
NEUROPSYCHIATRIC SYMPTOMS OF DEMENTIA AND CAREGIVERS’ BURDEN
Authors: Paul Constanca , Sousa Susana , Teixeira Laetitia 
Published: December 2023

Abstract
Informal caregiving (IC) is a major health and social asset although simultaneously a potential burden and depression risk factor for those who care. Neuropsychiatric symptoms of dementia are disturbing and may contribute to a negative experience of care. To understand the neuropsychiatric symptoms of dementia in caregiving we have two objectives: to know the prevalence of neuropsychiatric symptoms perceived by ICs and if there is an association of neuropsychiatric symptoms and burden and depression of caregiver. We study a community-based sample (N=101) of primary care users with mental health concerns, referred by GPs. Instruments include sociodemographic information; Neuropsychiatric Inventory (NPI-Q), Caregiver Burden Scale (CBS) and Geriatric Depression Scale (ABCDS). The sample mean age was 79.4 (sd=7.7) years, 54 (53.5%) were female and 34 (33.7%) had no formal education. Half of the sample were married and 41 (41.90%) were widowed. The NPI-Q total score and the Distress dimension score were 10.1 (sd=5.6) and 11.9 (sd=9.1), respectively. The more reported symptoms were agitation/aggression (69.3%), and apathy/indifference (65.3%). We found a significant positive association between NPI-Q and caregivers’ burden (0.296) and depression (0.227) and between Distress and caregivers’ burden (0.417) and depression, 0.416. Conclusion: Neuropsychiatric symptoms of dementia appear associated with the burden and depression of informal caregivers. Training ICs to cope with care receiver symptoms is a priority to increase the quality of care and reduce burden and depression of caregivers.
NURSING HOME WORKFORCE EDUCATION: DOES ONE SIZE FIT ALL? EVIDENCE FROM THE CHATO NATIONAL TRIAL
Authors: Williams Kristine , Perkhounkova Yelena , Coleman Carissa , Hein Maria , Yang Frances , Shaw Clarissa 
Published: December 2023

Abstract
Educating the nursing home workforce to provide quality dementia care is a national priority. Staff education is usually provided to all staff in communities that vary in size, location, ownership, and resources with little consideration for diversity. To evaluate suitability for diverse staff, we compared learning outcomes for White, non-Hispanic staff and staff of diverse races and ethnicities who completed CHATO in year one. White non-Hispanic staff (N=402) scored higher on knowledge assessments than staff self-reporting other races and ethnicities (N=201) at baseline (mean=57.1% vs. 49.1%, p&lt;.001). Both groups improved on post-assessment (by 19.0 and 23.1 percentage points, respectively, p&lt;.001), Communication ratings indicated that at baseline White, non-Hispanic staff were more knowledgeable about effective (p&lt;.001), appropriate (p=.008), and person-centered communication (p&lt;.001) than diverse staff; while the latter recognized elderspeak better (p=.002). Both groups improved their communication ratings post-CHATO (p from .001 to &lt;.001). While confidence in providing dementia care was similar between groups at baseline (p=.754), it improved only for White, non-Hispanic staff (p&lt;.001). Intention to use learned skills in practice was higher for staff in the diverse group (p&lt;.001). Diverse staff rated their satisfaction with the intervention lower (p &lt;.001), suggesting that it was not tailored to their needs. These findings support the value of CHATO in increasing communication knowledge among diverse NH staff. However, lower satisfaction suggests the need to adapt CHATO to be more inclusive and culturally appropriate. Tailoring education may increase impact on outcomes and overcome disparities in dementia care common in NHs serving diverse populations.
PROTOCOLS FOR COLLECTING CONVERSATIONAL LANGUAGE IN PERSONS WITH DEMENTIA
Authors: Zaslavsky Oleg , Cohen Trevor , Wu Kuan-Ching , Jin Jessica , Chien Shao-Yun , Pakhomov Serguei 
Published: December 2023

Abstract
We describe first-of-its-kind protocols for collecting spontaneous conversations in persons with dementia living in a community through conversation elicitation tools twice a month over six months. We also describe the preliminary feasibility of the protocol deployment in the first enrolled participants over the first month of data collection. Participants were recruited from the University of Washington ADRC registry. The audio was captured using RODE wireless microphone system. Four conversational elicitation techniques were used: 1) reminiscence using personal photographs; 2) reminiscence using generic historical images; 3) picture description test from neurocognitive batteries; 4) open-ended questions about daily activities. Health measures included Cornell Scale for Depression in Dementia (CSDD), Clinical Dementia Rating (CDR), and Clinical Frailty Scale (CFS). Four male and two female participants (average age 75) were recruited. Average health measures at baseline were CDR = 2, suggesting moderate dementia; CSDD=7, suggesting depressive symptoms, CFS=5, suggesting mild frailty. At baseline, the tasks’ average conversation time in seconds was as follows: daily activities =528; personal reminiscence=443; historical reminiscence =227; picture description =192. The corresponding average times for the subsequent home visits were 917; 518; 474, and 280 at visit 1 and 525; 767; 629, and 311 at visit 2. We established the feasibility of collecting conversational speech in this population. Participants seemed more interested in conversations focused on daily activities and personal pictures than general topics. There was an increase in the duration of conversations over time, which might be related to participants’ greater familiarity with the study protocol and data collectors.
THE ASSOCIATION BETWEEN PSYCHOTROPIC DRUGS AND PHYSICAL FUNCTION IN HOSPITALIZED OLDER ADULTS WITH DEMENTIA
Authors: Kim Nayeon , Resnick Barbara 
Published: December 2023

Abstract
The aim of this study was to test if the use of psychotropic medications (antipsychotics, sedatives, antiseizure, antidepressants, and anxiolytics) was associated with physical function in hospitalized older adults living with dementia. This study was a secondary data analysis using baseline data from the Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT) study. FFC-AC-EIT is an ongoing randomized controlled trial and this study included the first 290 participants. A path analysis was conducted to test the relationship between psychotropic drugs and physical function while controlling for age, gender, race, comorbidities, cognitive function, neuropsychiatric symptoms of dementia, and pain. Overall, 63.4% of participants took one or more psychotropic drugs, with the most used psychotropic drugs being antidepressants (39%), followed by antiseizure drugs (23.4%), antipsychotics (16.6%), anxiolytics (13.8%), and sedatives (4.1%). No significant association was found between the use of psychotropic medications and physical function. Cognitive function (β=1.489, SE 0.265, p&lt; 0.001), comorbidities (β=-2.680, SE 1.093, p=0.014), and pain (β=-2.837, SE 0.865, p=0.001) were directly associated with physical function. Cognitive function was also indirectly associated with function through pain. The findings support prior research showing a lack of association between the use of psychotropic medications and physical function. Additional research may be needed to investigate the mediating effects of pain between cognition and physical function in older adults with dementia.
UNDERSTANDING CHALLENGES IN DEMENTIA CARE AMONG AFRICAN AMERICAN AND LATINX POPULATIONS
Authors: Alam Rifat , Sirdich Brianna , Schwingel Andiara 
Published: December 2023

Abstract
Addressing disparities in dementia care among minoritized populations in the US is obligatory. This qualitative study explores perspectives of healthcare providers and administrators about challenges in delivering dementia care among African American and Latinx populations. 12 healthcare providers and administrators from 5 organizations in Illinois and Indiana were interviewed virtually between October 4, 2022, and March 7, 2023, and transcribed verbatim. Interviews were coded and three emerging themes were identified inductively describing participants’ perspectives. Delays in treatment-seeking: Includes challenges of the communities to understand normal aging and dementia and trust healthcare system, lack of knowledge of available resources and perceived cost, tradition of informal caregiving and diminished insights of patients. Lack of a comprehensive support system: Describes areas hindering providers and administrators becoming a support for the patients, includes- communication barriers to understand language and vernaculars, lack of access to healthcare, insurance, and resources by the minoritized communities and needs for an efficient primary healthcare team. Difficulties in patient evaluation: Time constraints of the primary care providers and shortage of specialists affect proper evaluation of patients. Engaging patients from low-income groups and immigrants in the system is complex. Non-compliance due to unavailability of transportation and telemedicine and comorbidities of older patients leads to a failure of complete evaluation of patients’ cognitive function that needs multiple visits. Our study highlights prevailing challenges and areas of advancement of dementia care among African American and Latinx populations. Developing a roadmap for a policy-level change and cross-culturally valid interventions will help address dementia inequities.
COMPETENCY-BASED UNDERGRADUATE PALLIATIVE NURSING EDUCATION USING AN INTERPROFESSIONAL TEACHING APPROACH
Authors: Felderhoff Brandi , Mbango Catherine 
Published: December 2023

Abstract
The nursing workforce is expected to be “work ready” to address healthcare needs in diverse communities. Health inequities continue to persist, and access to healthcare services that promote well-being and improve quality of life is imperative. Nursing curricula that integrate competencies in palliative supportive care for patients with chronic complex illnesses are needed to improve health equity and promote global citizenship (AACN, 2021). The shift to competency-based learning is both an accreditation requirement, and essential to prepare nursing students for the NextGen NCLEX (Wolf, 2022). Through review of the AACN’s (2021) The Essentials: Core Competencies for Professional Nursing Education core competency of palliative and supportive care in the domain of population health for entry-level professional nurses, and framework from The Interprofessional Education Collaborative (IPEC) for team-based competencies to improve population health (IPEC, 2016), a nursing-social work education partnership is well-suited to address AACN’s Essentials utilizing IPEC’s four core competencies. This approach to teaching allows students to develop knowledge and competence in caring for patients with palliative or supportive care needs, effectively bridging the competency gap (Jones & West, 2017) with curricula developed through interprofessional collaboration (Gravina, 2017). Primary palliative nursing care is an interdisciplinary patient-centered approach that focuses on the management of physical, psychological, social, and spiritual care of patients and their families. The opportunity to learn through an interdisciplinary teaching approach better prepares students to examine their place within the team, and fully understand the related roles of their allied colleagues.