bluuebunny/crossref_metadata_2025_split huggingface dataset:
GRANDPARENTS RAISING GRANDCHILDREN IN NEW YORK STATE: UNDERSTANDING NEEDS OF A VULNERABLE POPULATION
Authors: Guastaferro Kate , Mozid Nusrat E , Kramsky Jayna , Melkonian Matilda , Young Kashyah , Spears Essence 
Published: December 2023

Abstract
Grandparents raising grandchildren are a rapidly growing population in the US – the 2020 census estimated 5.9million children &lt; 18 were living with a grandparent and in 2023 this estimate exceeded 7.1million. The older adult was likely not anticipating raising a child and is subject to the same stressors as other adults of their age and similar socioeconomic status: financial insecurity, health problems, employment issues, and family conflict. The community-based interventions that exist for ‘grandfamilies’ address a small portion of their needs and there is no universal network of services for this family unit that can sufficiently address the grandparents’ need for support, resources, and training. A total of N = 58 grandparents (56% female; 70% White; 40% urban-dwelling; 63% married) raising grandchildren in New York State participated in the GRAND Study which sought to quantify the needs of grandparents raising grandchildren using mixed methods. Survey results, corroborated by qualitative interview and focus group data, suggest areas of need include: financial needs, legal needs (e.g., acquiring custody), social support and parenting. Additional needs were observed in grandparents’ self-reported level of depressive symptoms – 46% of responses indicated major depressive disorder – and in managing relationships with their adult child (i.e., parent of grandchild). Overwhelmingly, grandparents spoke about the ‘honor’ of raising their grandchildren despite the challenges, specifically how the public health systems with whom they interact are not responsive to their needs. Results can be used to inform a multicomponent behavioral intervention to improve the general health and well-being of grandfamilies.
HOME MODIFICATION ON FAVORITE ACTIVITY AND SELF-EFFICACY AMONG OLDER ADULTS WITH DEMENTIA
Authors: Park Soobin , Kwon Eunsun , Park Sojung , Shin Oejin , Baek Sehyun 
Published: December 2023

Abstract
Globally, most older people with dementia live at home and want to remain at home as long as possible with a sense of agency, and engagement in preferred everyday activities. To remain at home, a safe and supportive home environment is crucial as dementia progresses. Yet research on environmental modification among people with dementia is focused on neighborhood or urban built environment, and less on home modification. Guided by the ecological model of aging, this study aimed to explore the impact of home modification on both affective (e.g., self-efficacy) and adaptive behavioral (e.g., favorite activities) responses as a result of person-environmental fit among people living with dementia. Using two waves (2018-2019) data from the National Health and Aging Trends Study (NHATS), we examined the extent to which home modification is associated with self-efficacy and engagement in favorite activities. Multi-group structural equation modeling was conducted on 273 older adults living with dementia in the communities, comparing 145 with functional limitations and 129 without. Although home modification did not affect one’s self-efficacy in any group, a positive impact of home modification on engaging favorite activities, especially those that require more physical effort (e.g., active leisure), was significant among older people with dementia with functional difficulties (p&lt; 0.01). Our finding points to the importance of home modification for the most vulnerable subgroup of older adults with dementia, not only ensuring physical safety at home but their continued engagement in the activities meaningful for them, thereby helping them age in place.
HOW DO EDUCATION AND SOCIAL MEDIA USE MATTER FOR ADVANCE CARE PLANNING AMONG CHINESE OLDER ADULTS?
Authors: Pei Yaolin , Qi Xiang , Zhu Zheng , Zhang Wei , Tsay Ruey-Ming , Wu Bei 
Published: December 2023

Abstract
In general, the rate of advance care planning (ACP) engagement is low in Chinese societies globally. Few studies have compared the ACP engagement among Chinese in different regions. This study aims to examine and compare the associations between education, social media use, and advance care planning (ACP) discussion among Chinese older adults in mainland China (Wuhan), Taiwan (Taichung), and United States (Honolulu). Community-dwelling older adults ≥ 55 were recruited from 2017 to 2018. The ACP discussion rate in Wuhan, Taichung, and Honolulu were 15.2%, 19.2%, and 31.3%, respectively. Logistic regression models reveal that education was positively associated with ACP discussion in Taichung and Honolulu. Social media use was positively associated with ACP discussions in Wuhan and Honolulu, and it attenuated the association between education and ACP discussion in Honolulu. The present study contributes to previous research by comparing the association between education, social media use, and ACP discussion in different settings within the same ethnicity. Practice interventions may need use a social media as a tool to promote advance care planning among Chinese older adults where the palliative care is in the initial stage. Form a policy standpoint, it is important to develop palliative care while promoting advance care planning.
HOW IS THE NURSING HOME QUALITY OF CARE ALIGNED WITH THE QUALITY OF LIFE?
Authors: Kwon Jenny , Bowblis John 
Published: December 2023

Abstract
The CMS Five-Star Quality Rating System does not currently incorporate nursing home (NH) consumers’ opinions. This study aims to investigate the association between star ratings and resident/family satisfaction. A unique, facility-level dataset of Ohio NHs that contains star ratings, consumer satisfaction scores, and NH characteristics was constructed (N=701). The key dependent variables were the overall, health inspection, and quality star ratings, categorized into two groups: 1-3 stars and 4-5 stars. Key independent variables were overall resident and family satisfaction scores, which ranged from 0 (low) to 100 (high). Bivariate and logistic regression analyses were conducted. Bivariate results showed consumer satisfaction and star ratings were correlated, but not perfectly related. Regression results found an increase in resident satisfaction was associated with an increased probability of being a 4-5 star rated facility across all star ratings (p&lt;.05). An increase in family satisfaction was also associated with an increased probability of being a 4-5 star rated facility for the overall and health inspection ratings (p&lt;.01). Early studies found little relationship between star ratings and consumer satisfaction. Due to improvements made to the star ratings, this study found consumer satisfaction is associated, though imperfectly, with star ratings, suggesting that a consumer-driven measure of quality still needs to be publicly reported.
HUMAN FACTORS ISSUES IN THE DESIGN OF VIRTUAL REALITY TO SUPPORT OLDER ADULTS’ SOCIAL AND COGNITIVE ENGAGEMENT
Authors: Borbolla Veronica Falcon , Boot Walter , Dilanchian Andrew , Torres Ana Sophia Garces , Hernandez Mario , Xu Bill Tong , Mostafavi Armin , Kim Benjamin 
Published: December 2023

Abstract
Emerging technologies such as virtual reality (VR) hold tremendous potential to improve the lives of older adults, including the opportunity to support social and cognitive engagement. However, this potential will only be realized if VR technologies and applications (apps) are well-designed, considering the needs, preferences, and abilities of older people. To explore and understand design barriers ahead of a randomized controlled trial testing the efficacy of a psychosocial VR intervention for older adults, a team of eight evaluators who underwent standardized and comprehensive training on how to perform a heuristic analysis assessed the design of 28 commercial VR apps. Apps were chosen for their potential to support social interactions, enhance cultural opportunities, facilitate new learning, or support leisure activities. Each app was evaluated based on the Nielsen Norman Group’s ten usability heuristics. For different VR components (hardware, app menus, VR environment), this analysis highlighted specific heuristic violations, examined the general human factors of these apps, and identified positive design elements while suggesting solutions for observed heuristic violations. The heuristic analysis revealed significant usability challenges, especially in areas like “System Status Visibility,” “User Control and Freedom,” and “Help and Documentation.” The primary system components exhibiting these heuristic violations were the “User Interface” and “Virtual Environment.” It was concluded that current virtual reality systems do not adequately address human factors issues, particularly considering the needs and abilities of older adult users. Based on this extensive evaluation, training and design solutions will be presented and VR guidelines for older adults will be introduced.
IDENTIFYING BRIDGE SYMPTOMS AMONG DEPRESSIVE SYMPTOMS IN CHINESE OLDER ADULTS: THE ROLE OF EATING CULTURE
Authors: Yang Zhongfang , Yu Junwen , Hu Tiantian , Zhu Zheng 
Published: December 2023

Abstract

Introduction
Identifying bridge symptoms among Chinese older adults with depressive symptoms is crucial for enhancing the precision and individualization of interventions.

Aim
The aim of this study was to identify the bridge symptoms and to explore the intercorrelation between depressive symptoms clusters in Chinese older adults.

Methods
Depressive symptoms were measured in 2014, 2016, and 2018 using the nine-item version of Center for Epidemiological Studies Depression Scale, and analyzed with cross-lagged panel dynamic network and centrality examination.

Results
Total of 3,438 participants were included. “D5: Had poor appetite” and “D9: Enjoy life” reported the highest value of outstrength (rnegative=0.063; rpositive=0.048) and the highest value of bridge strength (rnegative=0.029; rpositive=0.024) in negative and positive affects cluster. The strongest path is from D5 to D9 (β=-0.02).

Discussion
To explore the potential mechanism of depressive symptoms in Chinese older adults, identifying the bridging symptoms between the positive affect clusters and negative symptoms clusters of depressive symptoms may be needed.

Implications for Practice
More insights into the relationship between eating culture and the potential mechanisms could be provided to aid in the development of culturally sensitive interventions for Chinese older adults with depressive symptoms.
IDENTIFYING FACTORS THAT CONTRIBUTE TO THE FINANCIAL STRAIN OF HISPANIC CAREGIVERS OF OLDER ADULTS
Authors: Howard Margret , Mak Wingyun , Burack Orah 
Published: December 2023

Abstract
Informal caregiving has been shown to have negative effects on the caregiver’s physical, mental, and financial health. To date, studies have mainly focused on the physical and mental health of caregivers; however, finances too are an area of caregiver vulnerability. In this study we examined which types of financial hardships are the greatest predictors of financial strain in Hispanic caregivers (N=184) for persons 50 or older. Data were obtained from the American Association of Retired Persons (AARP) Caregiving in 2020 survey, which oversampled for Hispanic caregivers. A hierarchical regression analysis was conducted to predict caregiver financial strain. Independent variables were entered in three steps: (1) age and gender, (2) emotional strain, physical strain, length of expected caregiving, and attitude towards caregiving (3) taking on more debt, borrowing money, unable to afford basic expenses, late/unpaid bills, using short-term savings, using long-term savings, being unable to save, and moving to a less expensive home. Age and gender were not significant (ΔR2=.007, p=.531). Emotional (β=.309, t=3.512, p&lt;.001), and physical strain (β=.229, t=2.627, p=.009) were both predictors of financial strain (ΔR2=.312, p&lt;.001). Additionally, the specific financial hardships related to financial stress above and beyond steps one and two (ΔR2=.137, p&lt;.001) were being unable to afford basic expenses (β=.356, t=4.161, p&lt;.001), and using long term savings (β=-.308, t=-4.372, p&lt;.001). These results have implications for education and interventions concerning financial hardships and options for Hispanic caregivers of older adults.
IDENTIFYING SOLUTIONS TO ADDRESS THE BEHAVIORAL HEALTH OF OLDER ADULTS: A QUALITATIVE ANALYSIS
Authors: Stodola Allyson , Elliott Sheryl , Parsons Nathan , Dys Sarah , Sotka Susan , Dawson Walter 
Published: December 2023

Abstract
The Oregon Older Adult Behavioral Health Initiative (OABHI), a program of the Oregon Health Authority, seeks to improve behavioral health (BH) services for older adults and people living with physical disabilities. Twenty-four OABHI Specialists work with BH and Aging services agencies, community-based organizations, and other key partners to strengthen the BH workforce, educate communities, provide complex care consultations, improve intra-agency collaborations, and foster timely access to coordinated, culturally-responsive services. Semi-structured, in-depth interviews with Aging and BH service agency managers and direct service providers (n=29) across Oregon were conducted over 12 weeks in 2023 to evaluate impacts of their involvement with the OABHI and improvements needed to better address the BH needs of these populations. Direct service staff and managers shared suggestions on programs, policies and inter-agency agreements that should be implemented to address the top BH-related challenges in their area. The first-hand experiences of direct service staff and managers who work with these populations provide unique insight into not only the most prevalent systemic issues, but what they perceive to be the key resources needed to help address these issues. Qualitative data were analyzed to develop systems-level recommendations to address gaps in BH resources for older adults, and were presented to policymakers and other decision makers in Oregon. Results indicate key resources and policy changes needed to support OABHI-delivered interventions, promote intra-agency collaboration, increase investment in BH services, and provide resources for an increasing population of older adults and people living with physical disabilities who have BH needs.
IMPACT OF DEPRESSIVE SYMPTOMS ON ORAL HEALTH OF OLDER ADULTS WITH CHRONIC CONDITIONS BY GENDER
Authors: Hong Dahye , Kim Jennifer (Jeehyun) , Kang Bada 
Published: December 2023

Abstract
Oral health is crucial for the nutrition and well-being of older adults, especially those with chronic conditions. Although recent studies have demonstrated an association between depressive symptoms and oral health, little is known regarding the gender-specific association between symptoms of depression and oral health among older Korean adults with chronic conditions. Therefore, this study examined the gender-specific relationship between depressive symptoms and oral health, using data from the Korean Longitudinal Study of Aging (2018–2020). Study participants aged 65 or older with one or more chronic conditions were analyzed (N = 1,185 women and 1,919 men). The comprehensive aspects of oral health, including functional limitations, pain, discomfort, and psychological and behavioral impacts, were measured. Generalized Estimation Equation analyses were applied to two models presenting depressive symptoms dichotomously and the severity of depression, respectively. When considering depressive symptoms in dichotomous manner, such as present or absent, having three or more chronic conditions and experiencing cognitive decline were both significantly related to deteriorated oral health for both genders. Moreover, the association between depressive symptoms and deteriorated oral health was more robust in men. While categorizing the severity of depressive symptoms, the worse the depressive symptoms, the poorer the oral health in women. Therefore, this study suggests that interventions to alleviate depressive symptoms could benefit the oral health of both men and women with multiple chronic conditions. For women, targeted interventions based on the severity of depressive symptoms could effectively improve oral health.
IMPLEMENTATION OF VIRTUAL REALITY TO IMPROVE QUALITY OF LIFE FOR VETERANS IN HOSPICE AND PALLIATIVE CARE
Authors: Laffer Alexandra , Corle Melanie , Canell Anastasia , Moo Lauren , Gately Megan , Dillon Kristen 
Published: December 2023

Abstract
Virtual Reality (VR) is a safe and effective adjunctive care option with multiple clinical applications. An interdisciplinary VR program aimed at improving quality of life for veterans receiving inpatient hospice and palliative care was implemented at the VA Bedford Health Care System. Principles from the 4Ms of Geriatrics (Mentation, Mobility, Medications, and Matters Most) guided evaluation and outcomes. Implementation involved decision-making around hardware and software, learning about processes at other facilities, financing, and creating policies and procedures. Project development began in 2021 and data collection began in March 2023. Veteran residents enrolled in inpatient hospice and palliative care were invited to participate. As of August 2023, 22 VR visits were conducted with 13 veterans. Preliminary data suggests VR can be used with a wide range of individuals receiving hospice and palliative care. Analysis of pre-post measures indicate improvement in mood (62%) and overall day (81%), and reduced pain. Barriers to engagement include staffing (e.g., availability), technology (e.g., VR technical issues), hospital procedures/policies (e.g., infection control, COVID-19), and patient factors (e.g., interest, symptoms). Facilitators include hospital support, interdisciplinary collaboration, and understanding of the setting and patient preferences/ needs. Although conception to implementation took two years, a VR program to improve quality of life for veterans enrolled in hospice and palliative care appears to be feasible and clinically beneficial. Experience has shown that flexibility, adaptability, and an individualized approach facilitate engagement. Best practices in the application of VR within the hospice and palliative care setting will continue to be evaluated and honed.
IMPLEMENTING AN AREA AGENCY ON AGING COMMUNITY CARE TRANSITION INITIATIVE: FACILITATORS AND BARRIERS
Authors: Coe Antoinette , Chiang Hao-Ping , Rowell Brigid , Bergman Nathaniel 
Published: December 2023

Abstract
The Michigan Region VII Area Agency on Aging (AAA) implemented a Community Care Transition Initiative (CCTI) for rural hospitalized older adults at high risk for readmission. After discharge home, AAA CCTI participants received a home visit by an AAA-trained pharmacy technician community health worker (CHW), a telehealth AAA pharmacist medication review, assessments by the CHW and pharmacist, education, primary care follow-up coaching, and referrals. As part of a program evaluation, we conducted six interviews with AAA key informants (e.g., pharmacist, director, CHWs). A semi-structured interview guide was piloted and revised to assess implementation, processes, impact, and future directions. Interviews were conducted via Zoom, recorded, transcribed, and checked for accuracy. Thematic analysis was used to identify implementation facilitators, barriers, and areas for program refinement. Three researchers coded the transcripts, developed a codebook, and resolved discrepancies by consensus. NVivo 14® was used for data management and analysis. Barriers to AAA CCTI implementation included unknowns at project start and need for procedures, anxiety about entering a client’s house, client’s lack of familiarity with technology, lack of perceived pharmacist benefit, limited personnel, and billing or financial reimbursement. Facilitators identified were the AAA’s reputation and backing, relationships built between healthcare providers, referral processes (e.g., community mental health), and pharmacist telehealth visit efficiency. Program refinements included shortened follow-up time and tailored visits to different client situations and needs. The results provide insights into the design of implementation strategies to disseminate the AAA CCTI to meet rural older adults’ health and social needs after hospitalization.
IMPLEMENTING CARE COORDINATION WITH HOME DELIVERED MEALS AND HEALTHCARE: CHALLENGES AND LESSONS LEARNED
Authors: Orsega-Smith Elizabeth , O’Hanlon Julia , Karpyn Allison 
Published: December 2023

Abstract
Increasing lifespans are resulting in frail, isolated and food insecure older adults. Home Delivered meals (HDMs) are gateways into the homes of frail and vulnerable older adult, and this program will explore how HDMs can provide a natural opportunity to identify health issues potentially preventing unnecessary emergency rooms visits and hospitalizations. A daily wellness check and care coordination involved the use of a program coordinator, a nurse advocate, a local and predominately rural senior center (HDM provider and its HDM volunteers), and university evaluation team designed to support innovative health services provided to vulnerable older adults. The purpose was to examine the evaluation results 12 months after program. At baseline, clients reported high physical dependence (91.6%), hypertension (72.13% ), risk for falls (100%), and risk of food insecurity (48%). During the 12 month period, the nurse advocate team made 6,096 phone calls to participants with most phone calls (79.5%) categorized as a general client check-ins. Calls directly impacting quality of life included transportation support (6.1%), housing support (4.3%), and access to medical equipment (6.7%). Approximately 650 calls were service-related calls to outside agencies, organizations, and medical providers. This model exemplifies the increasing importance of clinicians and public health professionals, working collaboratively with community-based resources. The role of the nurse advocate team is critical in connecting resources to individuals based on specific circumstances and conditions, including geographic location and ability to access medical and social services. These efforts helped to avoid expensive treatments, manage living challenges, and facilitate medical care.