bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFECT OF SELF-GUIDED INTERVENTIONS ON MENTAL HEALTH OF INFORMAL DEMENTIA CAREGIVERS: A SYSTEMATIC REVIEW
Authors: Ko Eunjung , Wongvibul Thanchanok , Rose Karen , Jun Jin 
Published: December 2023

Abstract
Informal caregivers of people living with dementia often experience emotional and mental distress due to the demands of caregiving. Self-guided interventions aimed at improving the mental health of these caregivers have emerged, but their effectiveness remains understudied. We systematically examined the effects of self-guided interventions on stress, burden, and mental health of informal caregivers of people living with dementia. PubMed, CINAHL, PsycINFO, Scopus, and Embase databases were searched using relevant search terms for the study aims. Included articles focused on informal caregivers of people living with dementia and self-guided interventions to improve psychological or mental health. Sixteen articles and 1,182 samples were included in this review. Self-guided interventions covered topics on caregiving skills, emotional self-care, and/or information on social or financial resources related to caregiving. Outcomes of each study included stress, burden, depressive symptoms, anxiety, distress, quality of life, self-efficacy, positive aspects of caregiving, and loneliness. Depressive symptoms and burden were the most frequently measured outcomes. Stress was generally reduced after the interventions, whereas the results of burden and mental health from each intervention were inconsistent. Interventions lasting shorter than three months were more likely to be effective compared to longer interventions. Self-guided interventions may be useful for improving mental health of informal caregivers of people living with dementia due to its low time burden, ease-to-access, and affordability. Future research is needed to determine the optimal length and components of self-guided interventions and to collaborate with clinicians for wider distribution to informal caregivers of people living with dementia.
LOCALIZATION OF Β-AMYLOID PLAQUES IN THE BRAINS OF WAR VETERANS, PARTICIPANTS OF THE DOD-ADNI STUDY
Authors: Nikitin Stanislav Kolpakov , Yashkin Arseniy , Akushevich Igor 
Published: December 2023

Abstract
We examined the allocation of β-amyloid (Aβ) plaques in the brains of Veterans, long-time survivors of traumatic brain injury (TBI), and those, who did not report brain trauma, and compared it with a spatial distribution of Aβ plaques in the brains of participants of the ADNI program as well as with the pattern of the spatial distribution of Aβ in the brains of participants of ADNI with Alzheimer’s disease. This study included 675 community-dwelling male participants from the ADNI and DoD-ADNI databases (137 veterans, 131 cases of TBI, and 123 AD cases) 62 years old or older. We performed regression analysis, using a pseudo-randomization algorithm, and propensity-score inverse-probability weighting to equalize the subsamples for fourteen outcomes, 12 standardized uptake value ratio variables, and 0.79 and 1.11 cutoffs. Race, educational level, geriatric depression score, age when florbetapir-18 (18F) PET scans were performed, APOE genotype, and Modified Hachinski Ischemic Score were used as predictors. The pattern common for AD showed the highest levels of β-amyloid in the cingulate cortex as well as in the frontal, parietal, and temporal lobes. Veterans have shown a statistically significant increase of 18F concentration in the cerebellum gray matter along with a lower concentration of it in the whole cerebrum as well as in neocortical regions than patients, who did not participate in combats. The continuous exposition to micro-TBI events, which does not necessarily suppose the loss of consciousness or severe contusion likely can explain the high concentration of 18F in cerebellum gray matter in ex-combatants.
SUPPORTING OLDER ADULTS WHO LIVE ALONE: UNDERSTANDING THEIR UNMET NEEDS USING NHATS SURVEY DATA
Authors: Bergh Marissa , Raval Aasha , Travers Jasmine 
Published: December 2023

Abstract
Research suggests that older adults living alone in the community are at higher risk for poor health-related outcomes due to lack of cohabitants to support their health needs. Using National Health and Aging Trends Study (NHATS) data, we identified community-residing older adults (≥65 years) with assistance needs for Instrumental Activities of Daily Living (IADLs), Activities of Daily Living (ADLs), or mobility. We used bivariate analyses to compare the unmet needs related to IADL, ADL, and mobility tasks between those living alone and those living with others. Of the 3,458 individuals identified, 28.9% (n=1001) lived alone. Those living alone were more likely to be women, unpartnered, and lacking informal caregivers. There was no difference in perceived overall health scores between the groups. Individuals living alone experienced more mobility and IADL-related unmet needs. In the month prior to survey completion, those living alone were more likely to forgo getting out of bed (p=0.031), grocery shopping (p&lt; 0.001), cooking (p&lt; 0.001), and paying bills (p=0.025) due to lack of available assistance. Our findings suggest that older adults living alone may need higher levels of formal assistance with IADLs to remain living in the community. Given the key role IADLs play in promoting quality of life and a person’s ability to remain independent and engaged in the community, it is important to consider IADLs in addition to ADLs when assessing formal care needs for those living alone. Policy makers should prioritize the specific needs of those living alone when developing national aging strategies.
“IT CAN BE A CHAMELEON”: LEWY BODY DEMENTIA PRESENTATION WITH AN ELUSIVE CLINICAL PROFILE—CASE REPORT AND DISCUSSION
Authors: Barney Javier Malcolm , Moya Mario , Martin Jessica , Dentino Andrew 
Published: December 2023

Abstract
Lewy body dementia is a progressive neurodegenerative disease and is considered to be the second most common cause of dementia in the population above 65 years of age. It remains a challenging and complicated disease process to profile clinically with an elusive diagnosis that shares similarities with Alzheimer’s, leading to patients being misdiagnosed. The decline is compounded by inappropriate coordinated care efforts, and therefore ill preparing the patient and negatively affecting their relatives and support groups. We describe the case of an 83-year-old Hispanic male who over the course of 32 months sustained multiple injuries due to falls landing him in the emergency department; receiving numerous consultations from hospitalists, surgeons, infectious disease specialists, neurologists, psychiatrists, and radiologists. A combined blend of inpatient and outpatient visits was not enough to circumvent the recurrent theme that plagues similar cases worldwide with non-reliable criteria that can identify Lewy Body Dementia early in the presentation of the disease. The first mention of DLB was almost at the 32 months mark into the patient’s journey at this particular Hospital System. A multidisciplinary approach with enhanced communications and round table discussions should be a quality of care improvement initiative to help better serve this population of patients. DLB’s rapid progression and sensitive drug therapy parameters should place this as equally scalable as other multi-specialty collaborations such as tumor board, limb salvage committee, ethics, and Trauma review.
INTEGRAL ROLE OF SOCIAL WORKERS WITHIN A COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Schwartzkopf Ashley , Myers Jennifer , Schubert Cathy , Penney Lauren , Damush Teresa , Preddie Aliana , Bravata Dawn 
Published: December 2023

Abstract
Comprehensive geriatric assessment (CGA) programs are expanding to support the wellbeing of community-dwelling older adults. Although a variety of CGA models have been described, the specific contributions of social work in CGA programs has not been rigorously evaluated. We examined the role of social work within a well-established, interdisciplinary, home-based geriatric program at one large, midwestern VA Medical Center. Semi-structured interviews were conducted with the VA-Geriatric Resources for Assessment and Care of Elders (GRACE) team to understand their perspective on social work expertise within a geriatric interdisciplinary team. Nine VA-GRACE team members were interviewed: 1 geriatrician, 1 pharmacist, 4 advanced practice nurses, and 3 social workers. VA-GRACE social workers participated in home-based CGAs by identifying psychosocial barriers that affected patients’ medical care and quality of life, and engaging in ongoing case management. VA-GRACE team members valued the social workers problem-solving skills which were critical to ensuring that: patients received needed home services; caregiver needs were met; home safety and equipment issues were addressed; and patients received appropriate cognitive services. The VA-GRACE team members valued social workers for their perceived positive work ethic, as well as their critical knowledgebase which they apply to training new staff, supporting nurses (especially during periods of staff shortage), promoting patient enrollment, and developing and implementing cohesive care plans. In conclusion, these results support the integral role of social work in an interdisciplinary team providing comprehensive geriatric assessments and highlight unique contributions that social workers make to promote the health and wellbeing of older adults.
A CALL TO ACTION FOR FALL INJURY PREVENTION: QUALITY IMPROVEMENT IN THE DEPARTMENT OF VETERANS HEALTH ADMINISTRATION
Authors: Barrett Blake , Chavez Margeaux , Bradley Sarah , Arriola Nora , Broderick Vianna , Ramrattan Anita , Bulat Tatjana , Cowan Linda 
Published: December 2023

Abstract
The rates of inpatient falls in the Department of Veterans Health Administration (VHA) have been declining steadily over the last 10 years, but the rates of major fall-related injuries have remained stagnant. This poster describes quality improvement (QI) efforts in the VHA to evaluate and improve implementation of fall injury prevention practices. It also describes the importance of focusing on fall injury prevention, in addition to fall prevention. QI efforts were led by an interdisciplinary team using mixed methods. Objectives included: 1) determine best practices in fall injury prevention in VHA inpatient units, 2) determine the utility of current methods for evaluating implementation of fall injury prevention practices, and 3) improve fall injury prevention practice implementation by co-designing an evaluation tool with VHA staff who are its intended users. Findings suggest the need to raise awareness of and use of fall injury prevention practices, that is distinct from fall prevention practices. Staff do not typically separate fall injury prevention practices from general fall prevention, making it challenging to implement tailored prevention practices (e.g., hip protectors or helmets directed at fall injury prevention vs. fall prevention). Furthermore, staff reported difficulty implementing and evaluating fall injury prevention practices. Staff preferred tools using a formal evaluation process with interdisciplinary teams to outline standards and document barriers and facilitators to reducing fall injuries. Our findings support need for a validated tool to evaluate and improve implementation of fall injury prevention practices (above and beyond fall prevention) to improve care and reduce Veteran fall-related injuries.
ASSESSING BALANCE INTERVENTION OUTCOMES IN OLDER ADULTS WITH HEARING LOSS
Authors: Price Caitlin , Hardison Holland , Spradley Laura 
Published: December 2023

Abstract
Previous studies reveal individuals with hearing loss are more likely to experience falls and fall-related injury. Fall risk exponentially increases with more severe degrees of hearing loss. Because both the risk of falls and the incidence of hearing loss increase with age, investigating the efficacy of balance intervention programs in older adults with hearing loss is vital to enhancing clinical outcomes and reducing heightened risk of falls in these individuals. Various balance intervention and physical exercise programs have been shown to reduce fall rates. However, which individuals achieve the greatest benefit from these programs remains unclear. Do those at greater risk of falls demonstrate more or less benefit from balance intervention? The current study aimed to (1) assess the impact of the A Matter of Balance (AMOB) program on older adults’ fall risk and balance measures and (2) evaluate which measures (e.g., postural stability, balance confidence, fall risk, physical activity, degree of hearing loss) best predict balance intervention outcomes. Pre- and post-intervention balance and fall risk in older adult participants (60-90 years) with hearing loss were assessed via measures of postural sway and subjective questionnaires. Results revealed balance-related benefits following the completion of the AMOB program. Older adults initially identified as having higher fall risk demonstrated the most significant benefits as observed in fall risk reduction. Our results inform clinical practice by clarifying which individuals may benefit most from balance intervention programs and thus improve targeted intervention approaches for older adults at greater risk for falls and fall-related injury.
ANTIHYPERTENSIVE DEPRESCRIBING AND DISABILITY IN VA NURSING HOME RESIDENTS WITH AND WITHOUT DEMENTIA
Authors: Liu Xiaojuan , Graham Laura , Jing Bocheng , Dave Chintan , Li Yongmei , Fung Kathy , Odden Michelle 
Published: December 2023

Abstract
Deprescribing antihypertensives is of growing interest in geriatric medicine, yet clinical trial evidence is lacking. We leveraged the Veterans Affairs (VA) electronic health data and emulated a target trial of antihypertensive deprescribing on longitudinal change in disability, measured by activities of daily living (ADL), ranging 0-28. Residents included were ≥65 years with long-term stays ≥12 weeks from 2006-2019 (n=42537). We excluded those not on antihypertensives and with very high blood pressure or heart failure. The eligible residents (n=13041) were divided into newly deprescribed (reduced number of antihypertensives or dose of ≥30% after a 4-week washout) and stable users and followed up for 2 years or censored at death, discharge, or non-adherence. We used linear mixed-effects regressions to estimate per-protocol effects, with inverse probability of treatment weighting (IPTW) to adjust for confounders and additional inverse probability of censoring weighting to account for informative censoring. Analysis was stratified by dementia (yes/no) to examine the potential modification. In non-dementia subgroup (n=5954), newly deprescribed residents (n=561) had a worse ADL score (βtreat [95% CI] = 1.36 [0.82, 1.91]) compared to stable users (n=5393). Over time, ADL scores increased (worsened) 0.13 per 3 months (βtime = 0.13 [0.09, 0.17]) while antihypertensive deprescribing statistically significantly attenuated this increase by 0.25 per 3 months (βtime × treat = -0.25 [-0.48, -0.03]). The dementia subgroup showed imprecise effect (βtime × treat = -0.0003 [-0.13, 0.12]). More evidence is needed on the benefits and harms of deprescribing in long-term care populations and the importance of dementia in these relationships.
NURSE STAFFING AND VETERAN OUTCOMES IN THE VETERANS HEALTH ADMINISTRATION’S COMMUNITY LIVING CENTERS
Authors: Brown Lana , Gauss C Heath , Billings Pamela , Moore Jade , Sawyer Linda , Sparks Diane , Sullivan Sheila Cox 
Published: December 2023

Abstract
Higher nurse staffing levels have been associated with better outcomes for patients in the acute care setting and for residents in the long-term care setting. There are several publications available linking nurse staffing to improved quality measures. Conversely, minimal research has occurred examining associations between nurse staffing and Veteran outcomes. The purpose of this research study was to assess for associations between nursing hours per patient day (NHPPD) and Veteran outcome measures in the Veterans Health Administration Community Living Centers. A retrospective data review was completed for NHPPD and quality measures for 134 Community Living Centers. Descriptive statistics were used to analyze the average total NHPPD for each of six Minimum Data Set, version 3.0, quality measures. Linear regression was utilized to assess for a linear association between average total NHPPD and the defined quality measures. This study found no linear association between average total NHPPD and the following Veteran outcome measures: improvement in function (p=0.15), ability to move independently worsened (p=0.13), catheter in bladder (p=0.48), and UTI (p=0.48). However, a statistically significant linear association was found between average total NHPPD and the following Veteran outcome measures: falls with major injury (p=0.02) and help with ADLs (p=0.01). As the average total NHPPD increased, the mean for falls with major injury and the mean for help with ADLs decreased. This study adds to the body of literature regarding the impact of nurse staffing on quality measures in the long-term care setting.
RELATED FACTORS ON HOSPITALIZATION OF NURSING HOME RESIDENTS IN KOREA USING QUASI-POISSON REGRESSION
Authors: Shin Juh , Jung Sun Ok , Min Eun Jeong , Kim Jung Eun 
Published: December 2023

Abstract
The appropriateness of hospitalization for nursing home (NH) residents is still debated, with factors such as timeliness, available treatment, healthcare staff, medication options in hospitals, and safety issues determining appropriateness. Although factors impacting hospitalization have been studied expansively, research has been limited to nurse staffing. This study aims to investigate how organizational factors, nurse staffing, and government incentives impact hospitalization due to infection among NH residents in Korea. A cross-sectional design was used, and data were collected via survey from a total of 51 NHs from August 27, 2021 to March 25, 2022 using quota sampling. A total of 35 explanatory variables were included, and the response variable was the count of hospitalized residents due to infection. We analyzed data using quasi-Poisson regression. The average number of residents of hospital transfers due to infection was 5.22 (SD 7.99) per nursing home. The number of residents with Alzheimer’s or dementia increased by 1 person, and the number of hospitalized residents due to infection increased by 1.01. Moreover, we found that in NHs that did not receive top-grade incentives due to good performance, the number of residents admitted to the hospital due to infection decreased by Exp (b) 0.5133. More stable, specialized advanced nursing staff and leaders specializing in high-quality care for residents with Alzheimer’s or dementia were more effective in decreasing hospitalization. The measure of hospitalization in the future should focus on quality improvement, as hospitalization is universal use for many countries by extricating necessary versus avoidable hospitalization.
THE PREVALENCE AND PREDICTORS OF APATHY AMONG CANADIAN LONG-TERM CARE RESIDENTS: A SECONDARY DATA ANALYSIS
Authors: Agboji Aderonke , Freeman Shannon 
Published: December 2023

Abstract
Apathy, defined as a reduction in interest or motivation to engage in goal directed activities, is a frequent and persistent health concern among persons residing in long term care facilities. Research showed that apathy is associated with rapid cognitive decline, impaired functional ability, and increased mortality risk. To prevent or mitigate the negative impacts of apathy on persons living in long term care facilities, there is need for better understanding of the risk factors associated with it. Therefore, the aim of this study was to determine the prevalence of apathy and its risk factors in a large sample of Canadian long-term care residents (N=332,454). We performed cross-sectional analysis of data from MDS 2.0 assessments completed between 2015 and 2019 fiscal year. Results from descriptive and inferential analyses showed that apathy was more prevalent among persons aged 65 or younger and speak English. The strongest predictors of apathy were province of residence (OR 4.09 (CI 2.99-5.59) followed by resistance to care (OR 2.43 CI 2.38-2.49), conflict with family (OR 2.30 CI 2.2-2.4), and insomnia (OR 2.16 CI 2.11-2.2). These findings highlight the important role of environmental contextual factors including the physical and social environment as well as personal factors in the development of or recovery from apathy. Strategies for combating apathy in long term care facilities should take into account the individual, institutional and provincial variances.
USING PROCESS EVALUATION TO IMPROVE DOCUMENTATION OF LIFE-SUSTAINING TREATMENTS FOR VETERANS
Authors: Haverhals Leah , Magid Kate , Kononowech Jennifer , Beltran Jazmin , Lane Amber , Levy Cari 
Published: December 2023

Abstract
The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) intervention began in 2021 to support United States Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) clinicians in completing life-sustaining treatment (LST) templates for Veterans. In PERSIVED, HBPC clinicians partner with the PERSIVED team for 15 months, with clinicians routinely receiving coaching from the PERSIVED team. To assess participation in PERSIVED and to inform coaching sessions, the PERSIVED team conducted process evaluation interviews from August-November 2022 with N=24 clinicians across the country from seven HBPC sites. Interviews were conducted between months six-seven of PERSIVED implementation. Two PERSIVED team members conducted interviews, one acting as interviewer and the other as notetaker. Following interviews, the notetaker cleaned up the notes and the interviewer reviewed them, with the two reaching consensus on summaries on individual interviews and ultimately summarizing interview data by site. Two PERSIVED coaches then reviewed the summaries to brainstorm how to adapt coaching based on process evaluation findings. Coaches noted site-specific barriers and facilitators to improving LST template completion rates; positives of PERSIVED coaching; suggestions to improve PERSIVED; and goals for the remaining nine months of the PERSIVED intervention. Strategies suggested based on the process evaluation analyses included how to integrate checking for the LST template into existing processes, adapting note templates, discussing LST templates during team meetings, and improving education around LST template completion. The rapid integration of process evaluation findings into PERSIVED coaching sessions proved beneficial for participating HBPC teams.