bluuebunny/crossref_metadata_2025_split huggingface dataset:
PROMOTING PROVIDER ADHERENCE TO THE MEDICATION M OF THE AGE-FRIENDLY 4MS FRAMEWORK
Authors: Ohuabunwa Ugochi , Kantamneni Leela 
Published: December 2023

Abstract

BACKGROUND
The Age Friendly Health Systems (AFHS) initiative promotes use of the 4Ms Framework: We sought to evaluate provider adherence to protocols addressing the medication M of the framework.

METHODS
The project was conducted among patients &gt; 65years treated in the inpatient (IP), outpatient (OP) and emergency departments (ED) of Grady Memorial Hospital (GMH). We implemented 2 approaches to improve provider prescribing among older adults 1) Using a clinical decision support tool via the electronic health record Epic Systems®, a best practice advisory (BPA) offered individual provider feedback regarding potentially inappropriate medications (PIMs) ordered and offered safer alternative medications. 2)A pharmacist-led daily medication review with provider feedback on PIMs in the Acute Care for Elderly (ACE) Unit. Primary outcome: Percentage of PIMs discontinued. Secondary outcomes: Percentage of BPA vs pharmacist recommendations accepted, discharge PIMs, Length of Stay (LOS), mobility, delirium and Katz scores, 30-day readmission rate. RESULTS: 8270 BPA alerts fired for 3291 patients, mean age 73.7, with 5709 BPAs in IP, 1462 in ED & 1083 in OP settings. Providers responded to alerts by overriding BPA (10.2%), canceling BPA (60.4%), removing alerted PIM (20.6%), ordering alternative medication (3.5%).. With the pharmacist led intervention, ACE Unit providers accepted 47.2% recommendations, discontinued 17.9% PIMs . 19% of ACE and 1.1% of GMU patients were discharged without PIMs. 30-day readmission rate was 19.1% (ACE) vs 27% (GMU) (P = 0.31).

Conclusion
There was a higher provider acceptance rate with the pharmacist led intervention but no significant difference in PIM discontinuation rate
OLDER-ADULT PERSONAL SUPPORT WORKERS’ CONTRIBUTIONS DURING THE COVID-19 EMERGENCY RESPONSE
Authors: Wu Haorui 
Published: December 2023

Abstract
When COVID-19 devastated long-term care facilities across Canada, most public attention was turned to older adult residents/clients, rather than their service providers, especially the personal support workers (PSWs). Some PSWs are over 55 age and above; they featured dual roles in the COVID-19 settings: (1) they were a vulnerable group disproportionately impacted by COVID-19 and (2) they were essential workers providing support in the older-adult care facilities. Since current older-adult-driven research, practice, and policy have primarily focused on generalized assumptions of older adults as a vulnerable, passive, and dependent group rather than recognizing their diversity, expertise, assets, and experiences, this project aims to identify these older-adult PSWs’ contributions. This qualitative study invited 13 PSWs from older-adult care organizations in the Greater Toronto area of Canada to participate in in-depth interviews. This study uncovered three major contributions of older-adult PSWs within the individual-work-family triangulation. At the individual level, they bear the potentially high health risks of COVID-19, while supporting people around them. At the workplace level, they took on extra responsibilities to reduce the spread of the virus, dealing with the client’s/residents’ unfavourable behaviours and stress, and supporting their co-workers to maintain their organizations’ operations. At the family level, they worked overtime to compensate for their family members’ income loss and kept their family members at home to avoid infections. These outcomes inform the older adult research, practice, and policy by enhancing the appreciation of older adults’ diverse strengths and promoting older adults’ contributions in disaster settings.
ADDRESSING CO-OCCURRING ALCOHOL AND MENTAL HEALTH PROBLEMS IN OLDER ADULTS: CO-DESIGNED DIRECTIONS FOR PRACTICE
Authors: Bareham Bethany , John Deepti , O’Donnell Amy , Liddle Jennifer , Hanratty Barbara 
Published: December 2023

Abstract
Older people in the UK experience the highest rates of alcohol-related harm of all age groups, due to reduced tolerance to alcohol with age. Most older people drinking at harmful levels have co-occurring mental health problems. This population fall between services, which are ill-equipped to address their complex and multifaceted needs. This study aimed to co-design directions for integrated services to support this group in North East/North Cumbria, England. Co-design was guided by Intervention Mapping, and was informed by four workshops with older people with co-occurring alcohol/mental health problems; informal caregivers and supporting practitioners. Workshops built on evidence from i) a preceding qualitative study with these groups examining lived experience, support needs, and challenges in supporting this group and ii) a literature review of existing interventions/services for older people with alcohol or mental health problems. Findings highlight the importance of availability, accessibility and flexibility of support for older people, who often present in crisis, and can face additional barriers to accessing services such as hearing/mobility issues. Mental health practitioners should be trained in identifying and addressing harmful drinking in older people. Practitioners must be knowledgeable of relevant, local services and prepared to signpost appropriately. Care should encompass peer support, and support and advocacy to address wider issues that impact mental health and alcohol use including finances, social isolation and illness. This study informs the development of integrated community alcohol/mental health support for this patient group. Applicability of directions to other care systems is considered.
MEASURING IMPLEMENTATION FIDELITY OF THE TRANSITIONAL CARE MODEL IN THE MIRROR-TCM TRIAL
Authors: Hanlon Alexandra , Ahrens Monica , Hirschman Karen , Mccauley Kathleen , Shaid Elizabeth , Osokpo Onome , Pauly Mark , Naylor Mary 
Published: December 2023

Abstract
Examining the fidelity to the implementation of multi-component evidence-based interventions is essential but challenging. To capture the application of the Transitional Care Model (TCM) as designed, an advanced practice registered nurse (APRN)-led, team-based, care management strategy in a replication RCT conducted in three diverse health systems, an innovative method was utilized. This session describes the procedures, challenges, and decision-making processes associated with measuring the fidelity of the implementation of TCM’s core components over the trial. Standardized data collection forms were created for the APRNs to document the TCM elements addressed during each contact with and on behalf of the hospitalized older adults and their caregivers who had been randomly assigned to the TCM group (N=480). Measurable performance expectations for each element were established a priori (e.g., a minimum of 9 in-person visits). A dichotomous variable was created for each of the 38 elements making up the 10 TCM components which were provided monthly to each site to monitor their intervention implementation. Since not all elements were applicable to all older adults, the overall patient-level fidelity score required scaling to standardize the maximum fidelity score to 38. The individual components were inherently weighted according to their complexity as reflected by their respective number of elements. The average overall patient-level fidelity score was 34.2 (standard deviation: 3.5), median = 34.7. Higher fidelity scores indicated implementation of the minimum dose of the intervention elements. The findings provide critical insight into how to develop measures of implementation fidelity for complex multi-component evidence-based interventions.
DEVELOPMENTAL CHANGE IN PROBLEM DRINKING ACROSS THE LIFESPAN: BETWEEN- VERSUS WITHIN-PERSON AGE EFFECTS IN NATIONAL DATA
Authors: Lee Matthew , Yeung Ellen 
Published: December 2023

Abstract
When considering problem drinking from a lifespan developmental perspective, an often-stated underlying premise is that problem drinking peaks around early young adulthood and then declines throughout the remainder of the lifespan. However, relative to adolescence and young adulthood, the supposed later declines in midlife and older adulthood are less firmly established and based primarily on cross-sectional data. Thus, this study contrasted cross-sectional versus longitudinal age effects on problem-drinking changes across the adult lifespan. Analyses used two waves of longitudinal data from a U.S.-representative sample. We generated descriptive “porcupine figures” graphically depicting both cross-sectional and longitudinal age effects simultaneously. In addition, we used multilevel models to partition, test, and contrast cross-sectional versus longitudinal age effects on problem drinking in different age periods of the adult lifespan. While age effects were consistent in young adulthood across the cross-sectional and longitudinal tests, key discrepancies were shown in midlife and older adulthood. Specifically, the supposed continuation of problem-drinking reductions throughout midlife and older adulthood was observed cross-sectionally but not longitudinally. These findings call into question the notion of normative drinking-related declines that continue beyond young adulthood and throughout the remainder of the adult lifespan. We will discuss plausible alternative explanation for how cross-sectional data can lead to spurious conclusion about developmental change (e.g., age-confounded cohort effects). If replicated in future research, our evidence for relative stability or even increases in problem drinking in midlife and older adulthood can contribute to a more lifespan-developmentally-informed understanding of risky behaviors and thereby guide lifespan-developmental tailoring of interventions.
EXPLORING CONGRUENCY OF DEATH LOCATION PREFERENCES VERSUS EXPECTATIONS: FINDINGS FROM BRAZIL, ITALY, JAPAN, AND THE US
Authors: Clem Sarah , Zhang Peiyuan , Cagle John 
Published: December 2023

Abstract
Dying in one’s preferred death location is a common indicator of a good death. Previous studies exploring the congruency between individuals’ death location wishes and their actual death locations relied on samples of patients with terminal diagnoses. Data for this study came from the Four-Country Survey on Aging and End-of-Life Medical Care 2017 from which nationally representative samples of the general public were collected in the U.S., Italy, Japan, and Brazil. Bivariate analyses of the total sample (n=4,239) identified that 45% of participants reported expected death locations that differed from their preferred place of death. Among the majority of participants reporting a preference for a home death, 61% of these individuals in Japan (p&lt;.001) and 43% from Brazil (p&lt;.001) reported they were more likely to die in a hospital. Whereas, in both Italy and the U.S., the majority of participants within each death location category reported the same location for their preferred and most likely death location. Logistic regression models identified unique predictors of congruency for each country. Noteworthy, in the Italy model, females were 43% lower odds of having congruent death location perceptions compared to men (OR=0.57, p=0.02). In the U.S. model, racial differences were also notable, as Black participants had over 2 times greater odds of congruent death location perceptions compared to White participants (OR=2.18, p=0.02). By further understanding the congruency of death location perceptions among the general public, we can gain insight into the perception of whether individuals feel that a quality death experience is attainable.
FACTORS ASSOCIATED WITH WANDERING AMONG PERSONS WITH DEMENTIA: A RETROSPECTIVE STUDY
Authors: Miguel-Cruz Antonio , Perez Hector , Rutledge Emily , Daum Christine , Liu Lili 
Published: December 2023

Abstract
Persons living with dementia are at increased risk of getting lost and going missing due to critical wandering. Risk factors associated with critical wandering within this population are underexplored, thus prompting this study. In this retrospective observational study, we examined anonymized data from 25,785 MedicAlert® subscribers. We used a logistic regression model with a self-reported critical wandering incident as the outcome variable (p&lt; 0.05). The average age of our sample was 75.42 (SD 14.34). Fifty-one percent (13,064/25,785) of cases had dementia and almost 22% (5,561/25,785) were involved in a critical wandering incident at least once. People living with dementia were two and a half times more likely to be involved in a missing incident compared to people without dementia (OR=2.56, 95% CI [2.39, 2.73], p&lt; 0.001). The likelihood of being involved in a lost incident increased with advancing age; people 95-104 years old were seven times more likely to wander than those under age 65 (OR=7.11, 95% CI [5.96, 8.47], p&lt; 0.001). Sex at birth, official Canadian languages spoken, ethnic background, population density, living arrangement, and medication were associated with increased dementia-related missing incidents. Numerous risk factors for missing incidents were identified. Our study paves the way for implementing preventative strategies to ultimately decrease the risk of going missing for person living with dementia.
THE PROMISE AND CHALLENGES OF GERONTOLOGISTS WHO ADVANCE THE SCIENCE OF COMMUNITY-ENGAGED RESEARCH
Authors: Leach Carrie , Gan Daniel , Brothers Allyson , Sargent Lana , Dys Sarah 
Published: December 2023

Abstract
Our aging population demands more responsive policies and services and calls for a shift from involving older adults as individual participants toward collaborating with or empowering their communities as research partners. Knowing how to build capacity for community-engaged research (CEnR) among gerontologists requires understanding the challenges of such endeavors. A survey was distributed to gerontologists in March 2021 to December 2022, and was supplemented by a brainstorming focus group. We received responses from academic faculty, staff, students, and trainees (n=98) representing multiple academic disciplines from community health and implementation science to behavioral and social sciences. Many identified as a minoritized person (57.7%) and used mixed methods (55.1%). Focus group findings revealed challenges around community and participant recruitment, sustaining relationships, low-resource contexts and recognition. These reflected concerns around time, work, and funding – three most commonly-occurring words in survey responses. Barriers articulated include, “the time it takes to cultivate real relationships with community partners to design and carry out research together,” “confusion among academic colleagues on how this work is scholarship,” and a “lack of understanding and recognition from universities and funding agencies.” To more effectively mobilize knowledge and remain relevant, institutions would do well to heed calls for training on involving community members as co-researchers (78.6%), learning about rapidly developing CEnR methodologies (75.3%), and sustaining successful intervention programs after grant funding has ended (70.4%) among other priorities. This study provides critical insight into the landscape of CEnR among gerontologists and may be used to develop more supportive programs and structures.
TOBACCO IN HOTELS: A STUDY OF NICOTINE EXPOSURE AND RESIDENT RISK
Authors: Lewinson Terri , Dasgupta Abhirupta , Murphey James 
Published: December 2023

Abstract
Secondhand smoke (SHS) exposure exacts considerable health and financial impact on thousands of Americans yearly. One in four nonsmokers (about 58 million people) is routinely exposed to SHS, primarily at home. There is wide variability in smoke-free home policy adoption, leading to sociodemographic disparities in tobacco exposure and adverse health effects among low-income renters. Although there is no safe level of tobacco smoke exposure, varying perceptions about exposure effects and risks contribute to inconsistent use of harm-reduction strategies such as smoke-free home policies in private dwellings. Therefore, we surveyed and interviewed low-income extended-stay hotel renters (n=77) to learn about their perceptions of tobacco exposure. We also measured participants’ willingness to self-monitor these risks and adopt at-home smoke-free interventions. Most survey participants identified as nonsmokers (56.8%) exposed to tobacco smoke regularly. However, both nonsmokers and smokers preferred smoke-free rooms and indicated they would likely participate in personal health research by sharing air and biosamples to measure their exposure. We will present survey results of tobacco exposure knowledge and attitudes among long-term renters in Metropolitan Atlanta extended-stay hotels, perceptions of exposure risk, and self-efficacy beliefs. From our interview findings, we share renter and hotel manager readiness perceptions for implementing at-home smoke-free interventions. Lastly, we will share the results of integrating community-engaged partnerships with local organizations and respondent-driven sampling methods to build trust and aid renter recruitment.
ACCESS TO LOCAL ESTABLISHMENTS AND NEIGHBORHOOD PERCEPTIONS: A FOCUS ON THE ROLE OF LOCAL BANKING
Authors: Goldman Alyssa , Bea Megan Doherty 
Published: December 2023

Abstract
As an increasing number of older adults are aging-in-place, individuals’ perceptions of their neighborhood environments have emerged as significant social-contextual issues for healthy aging. Prior studies have focused on how neighborhood characteristics shape perceptions of residential neighborhoods. Far less research has focused on the role of local banking, despite the intersections between local banking establishments and a host of key community social and economic resources, particularly for the older adult population. We use nationally representative data from older adults interviewed at Rounds 2 and 3 of the National Social Life, Health, and Aging Project (N=4,589) linked with the National Establishment Time Series database to examine neighborhood perceptions as a function of local banking establishment density. We find that older adults who live in areas with higher rates of banking establishments report significantly higher levels of neighborhood safety, even when adjusting for a host of individual and neighborhood characteristics. Importantly, other types of establishments also shape perceived neighborhood safety, however, the significance of certain associations only emerges when we adjust for the presence of local banking. We suggest that local banks may be a lynchpin in catalyzing the broader socioeconomic vitality of a place, supporting older residents’ favorable perceptions of neighborhood safety. We discuss the implications of our findings for inequality in aging in light of unequal access to local banking across social groups, potentially increasing the vulnerability of older adults who are less likely to adopt mobile banking solutions and who are more likely to be susceptible to financial exploitation.
NURSING HOME EXPECTATIONS AND MENTAL HEALTH AMONG OLDER ADULTS IN THE HEALTH AND RETIREMENT STUDY
Authors: Lane Annalise , Dang Linh , Mezuk Briana 
Published: December 2023

Abstract
Three million older adults live in long-term care facilities. Transitioning into a nursing home is a major life event that can worsen mental health. Expectedness of nursing home transitions may have implications for mental health; however, this area is understudied. This study examined the relationship between expectations of transitioning into a nursing home in the next five years and depressive symptoms and passive suicidal ideation, and how social integration modified these relationships. Sample included respondents aged 65+ from the 2018 Health and Retirement Study (n=7,944, mean age=73.9, 55.4% female, 80.5% Non-Hispanic White). Nursing home transition expectations were modeled continuously (range: 0-100%). Mental health outcomes were assessed by the Composite International Diagnostic Interview-Short Form. Social integration measured composition, frequency of contact, and closeness with spouses/partners, children, other family members, and friends. Multivariate logistic regressions were fit for depressive symptoms and passive suicidal ideation separately, adjusting for demographic, health characteristics, and health-related reasons for moving. Additional models simultaneously adjusted for all social integration measures. Higher nursing home expectations were associated with elevated depressive symptoms (OR: 1.06, 95% CI: 1.01-1.11), major depressive episode (OR: 1.08, 95% CI: 1.02-1.15), and suicidal ideation (OR: 1.10, 95% CI: 1.03-1.16). These relationships persisted even after accounting for social integration. Future research can explore modifiable factors salient to these relationships, such as perceived social support and family care, to inform mental health-targeted interventions as older adults transition into long-term care.
THE IMPACT OF LIVING IN MULTIGENERATIONAL NEIGHBOURHOODS ON LONELINESS IN LATER LIFE
Authors: Hyde Martin , Evans Elizabeth 
Published: December 2023

Abstract
Intergenerational solidarity has been identified as a key factor for effective social functioning. However, evidence suggests that divisions between younger and older generations within Great Britain (GB) have never been greater. Growing residential age segregation is thought to be driving intergenerational division. This, in turn, is assumed to lead to an increased risk of loneliness among older adults. However, to date, this has not been empirically tested. To examine this issue, we created a new measure of multigenerational neighbourhoods, for all lower super output areas in England and Wales. These were linked to individuals aged 50 and over living in England and Wales in 2018/2019 in the UK Household Longitudinal Survey (N = 14,196). Loneliness was measured using the UCLA-3 scale. Multilevel regression analyses were performed. Covariates included, area level deprivation, urban/rural, residential tax band, home ownership, individual age, sex, marital status and financial situation. The results show that the mix of generations within a neighbourhood has a weak (r = 0.33) and non-significant (p=.493) association with loneliness among older adults. To the best of our knowledge this is the first study to directly examine the impact of neighbourhood age diversity on loneliness in later life. Our findings suggest that the mere presence of different generations within a neighbourhood is not a sufficient condition to combat loneliness in later life