bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPACT OF THE TEACHING NURSING HOME ON STAFF SATISFACTION AND BURNOUT
Authors: Degenholtz Howard , Dunbar-Jacob Jacqueline , Ratliff Kim , Fick Donna , Dickson Chelsea , Campbell Kenna , Kitt-Lewis Erin , Franke Emily 
Published: December 2023

Abstract
The Teaching Nursing Home (TNH) is designed to improve the long-term care workforce and improve quality of care in nursing homes (NHs). The initiative is guided by an academic-practice partnership with mutual respect and shared learning and has multiple components: enhanced clinical rotations for nursing students with partner schools of nursing, implementation of the Institute for Healthcare Improvement Age-Friendly Health System “4M” quality improvement model, and an online learning network. Following the principles of participatory research, NH staff were engaged in the selection of outcomes and in decisions regarding data collection. The University of Pittsburgh collected staff satisfaction at two nursing homes, and burnout at three NHs. Baseline surveys were conducted in the winter of 2022 using a combination of web-based and in-person paper administration, and follow-up surveys were collected in 2023, one year after implementation. Response rates ranged from 14% to 54%. A total of 190 surveys were available at baseline, and 183 at follow-up. All surveys were anonymous; cross-sectional analyses were conducted to identify trends. Baseline burnout scores varied considerably across the three participating NHs and improved at two of the three NHs (p = .0000). By contrast, job satisfaction was unchanged in one NH and declined in one NH across two dimensions (p= .0058; p = .01216). After the first year of implementation, the TNH program is showing some benefit in terms of reducing burnout, a factor associated with turnover. As the Age-Friendly NH program is disseminated, it is important to track the impact on the workforce.
IMPORTANT IMPROVEMENTS TOWARD EQUITY IN PROSTATE CANCER SURVIVAL BETWEEN WHITE AND BLACK MEN
Authors: Merrill Ray , Gibbons Ian 
Published: December 2023

Abstract
Prostate cancer survival is significantly influenced by tumor stage, age, and marital status at diagnosis. There is also evidence that cases diagnosed prior to age 40 and after age 80 years have a poorer prognosis. While Blacks have historically had lower prostate cancer survival than whites, it is not clear whether this difference still exists and if it varies across the levels of tumor stage, age, or marital status at diagnosis. These issues are addressed in this study. Analyses are based on Surveillance, Epidemiology, and End Results (SEER) data to obtain 5-year relative survival (5-YRS) estimates. Cases reflect 2000-2015 and follow-up extends through 2020. Over the study period 5-YRS decreased for Whites and increased for blacks, such that by 2015 the 5-YRS was about the same between races. Multiple regression models with race, age, and marital status simultaneously estimated showed that 5-YRS in Whites versus Blacks was not significantly different for local/regional stage or distant stage. 5-YRS in married (or living with a partner) was 3.02 higher for local/regional stage but not significant for distant stage. 5-YRS was significantly lower in the age groups &lt; 40 and ≥80 for local/regional stage but were highest in the age group &lt; 40 and significantly fell with older age for distant stage. Race did not modify the relationship between 5-YRS and tumor stage, age, or marital status at diagnosis. Thus, while tumor stage, age, and marital status at diagnosis are important predictors of 5-YRS for prostate cancer, White and Black inequality no longer exists.
INCIDENCE AND DYNAMICS OF MOBILITY DEVICE USE AMONG COMMUNITY-DWELLING OLDER ADULTS IN THE UNITED STATES
Authors: Liu Xinran , Baumann Sara , Rosso Andrea , Venditti Elizabeth M , Yao Yao , Albert Steven 
Published: December 2023

Abstract
Mobility devices significantly enhance the activities and participation for individuals with mobility disability, particularly in the rapidly expanding population of older adults globally. This research reports patterns of mobility device use among community-dwelling older adults in the United States. Using the National Health and Aging Trends Study (NHATS) waves 1-9, data on basic demographics and mobility device use were collected in a nationally representative group of community-dwelling older adults (65+ years old). Mobility device use included canes, walkers, wheelchairs, and scooters. In a total of 47,722 person-years observed in community settings, 2,943 incident mobility device uses over an average of 3.8±3.0 years were identified among 2,591 participants, with an incidence rate of 61.7/1,000 person-year. Participants had an average age of 80.3±7.2 years, with 57.7% female, 70.2% White, 20.1% Black, and 5.7% Hispanic, and 34.6% living alone. The majority (51.3%) of incident mobility device use lasted no longer than one year, and only 18.6% continued for four or more years. The most popular combinations of mobility device types were cane only (44.3%), cane+walker (15.7%), walker only (15.1%), and walker+wheelchair (8.3%). 30.5% of community-dwelling older adults changed their patterns of mobility device use at least once, with the most common changes including cane only to cane+walker (16.4%), cane+walker to cane only (7.97%), walker only to walker+wheelchair (5.2%), and cane+walker to walker only (5.1%). Mobility device use among community-dwelling older adults is dynamic: use of mobility devices involves mostly short bouts and changes frequently, with a preference for a combination of mobility devices.
INHIBITION OF AUTOPHAGY RESTORES IMMUNOMODULATORY CAPACITY OF SENESCENT MSCS VIA COX-2/PGE2 PATHWAY
Authors: Ma Yang 
Published: December 2023

Abstract
Mesenchymal stem cells (MSCs) have been increasingly utilized in many therapeutic applications including autoimmune diseases and tissue repair due to their regenerative and immunomodulatory capacity. In vitro expansion will cause cell senescence and compromise their therapeutic effect. Therefore, underlying mechanisms of MSCs senescence during in vitro culture and methods of enhancing their therapeutic capacity need to be explored. Autophagy is a key regulator of biological properties of MSCs and is highly related to aging process. Whether manipulation of autophagy could restore immunomodulatory capacity of senescent MSCs after in vitro culture is still unclear. We demonstrated here that autophagy was significantly increased in aged MSCs compared with young MSCs. Inhibition of autophagy by BafA and CQ enhanced their immunomodulatory capacity of eliciting M2 polarization of macrophages. COX-2/PGE2 pathway was activated by inhibition of autophagy in this process. Inhibition of COX-2/PGE2 pathway of aged MSCs by SC-236 abandoned the enhanced immunomodulatory capacity of aged MSCs. Inhibition of autophagy by CQ of aged MSCs also increased their therapeutic capacity in cutaneous wound models of rats by increasing their capacity of eliciting M2 polarization of macrophages. Taken together, this work indicates that inhibition of autophagy of MSCs after in vitro expansion could ameliorate senescence-related changes in MSCs and enhance their immunomodulatory capacity. This may represent a potential therapeutic avenue to clinical application of MSCs.
INTEGRATING HOME HEALTH IN AN INTEGRATED CARE SYSTEM: VETERAN EXPERIENCES WITH A VA PILOT PROGRAM
Authors: Davila Heather , Good Mary , Seaman Aaron , Walkner Tammy , Roman Irene San , Benzel Heather , solimeo Samantha 
Published: December 2023

Abstract
The Veterans Health Administration (VA) serves nearly 3 million Veterans aged 65 and over, 350,000 of whom use skilled home health (e.g., nursing, rehabilitation therapy) or homemaker/home health aide services annually. Despite being the nation’s largest integrated healthcare system, VA has traditionally purchased home health services from contract agencies. Coordinating care between VA and contract agencies is an ongoing challenge, and accessing home health has become increasingly difficult, especially in rural areas. To address these challenges, the Iowa City VA launched VA’s first “VA Home Health” (VAHH) program in 2021. In 2022, the VA Midwest Health Care Network (VISN 23) expanded VAHH to three additional sites, with over 700 Veterans served to date. We interviewed Veterans receiving VAHH who had previously used contract services (n=30) to learn about their care experiences. Veterans described multiple benefits of VAHH over contract services: staff’s access to VA electronic health records, mechanisms for quickly sharing information with other care providers, understanding of Veterans’ unique care needs (e.g., PTSD), and knowledge of the breadth of services VA offers. Most Veterans said they were highly satisfied with VAHH, with many expressing a desire for VAHH to expand and serve more Veterans. Our preliminary findings suggest VAHH may improve Veterans’ experiences with care and overall quality of care. Given VA’s focus on expanding Veterans’ access to home-based services, these preliminary findings could inform national VA decisions surrounding home health delivery. Our findings are also relevant to other healthcare systems as they address similar coordination and access challenges.
KINLESSNESS, RACE, AND QUALITY OF CARE AT THE END OF LIFE: FINDINGS FROM NATIONAL HEALTH AND AGING TRENDS STUDY
Authors: Pei Yaolin , Qi Xiang , Zhu Zheng , Wu Bei 
Published: December 2023

Abstract
Close family members provided the majority of end-of-life (EOL) caregiving. The number of older adults who are kinless (without close family/partnerships) are increasing. We therefore examined the association between kinlessness and quality of EOL care among older adults, and the moderating role of race in this association. Data were derived from the combined Round 2 to Round 11 of the National Health and Aging Trends Study. 3066 older adults who aged 65 and above and were living in the community or residential care at last interview were included in the working sample. Kinlessness was defined as lacking children and a spouse/partner. The primary outcome was quality of care at the end of life. Logistic regression models ware used to examine the association between kinlessness, race, and quality of care at the end of life. A total of 8.0% of decedents were kinless at the end of life. Kinless older adults were less likely to receive excellent EOL care than those with kin. Having at least one child or spouse/partner weakened race disparities in EOL care quality among older adults. These results point to a significant disadvantage for the minority kinless older adults, who had worse EOL care quality. Practice interventions may include a culture match between older adults and providers. Form a policy standpoint, guardianship is needed to enable kinless older adults to receive high-quality EOL care.
LEVERAGING CONSUMER HEALTH TECHNOLOGIES TO ENGAGE CARE PARTNERS OF OLDER ADULTS WITH DEMENTIA
Authors: Smith Jamie , Cassidy Jessica , Riffin Catherine , Wolff Jennifer , Lum Hillary 
Published: December 2023

Abstract
Care partners are critical in supporting the complex health needs of older adults with dementia; the importance of their role increases with disease progression. Despite their extensive involvement in dementia care, care partners are not systematically identified or supported in healthcare settings. Consumer health information technology (CHIT) affords a largely untapped opportunity to formalize dementia care partner identification and engagement in healthcare delivery. One example is OurNotes, a portal-based agenda-setting questionnaire that allows patients to submit concerns for discussion ahead of medical visits. In a proof-of-concept study, OurNotes was first adapted to elicit the identity of the person completing the form and clarify their relationship to the patient, and subsequently piloted at an academic geriatric practice. Semi-structured interviews were conducted with 15 care partners to elicit their perceptions of the adapted OurNotes (utility, benefits, challenges) and suggestions for refinement. Transcripts were analyzed using deductive, thematic analysis. Care partners’ perceptions of the tool were overwhelmingly positive. Major benefits included enhancing their feelings of preparedness for the visit, having a voice to express concerns, and streamlining visit communication. The most commonly endorsed challenge was the time required to complete the adapted OurNotes in addition to routine check-in items. A primary suggestion was to enable the submitted OurNotes responses to be edited/updated. Findings suggest that the adapted OurNotes is an acceptable approach to identifying care partners in the dementia context. Refinements may further facilitate visit efficacy through preparedness. Future research will examine CHIT engagement on patient and care partner outcomes.
LGBTQ+ INCLUSIVITY TRAINING AND EDUCATION FOR SKILLED NURSING FACILITIES
Authors: May Jennifer , Domeracki Alexis , Ashar Perisa , Hart Foxx , Wheeler Jason , Salgado Glaucia , Wang Melanie 
Published: December 2023

Abstract
The population of older adults is growing in the United States, leading to greater need for specialized care offered by skilled nursing and long-term care facilities. Among older adults that require specialized health care, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) older adults are more likely to experience health disparities and health care barriers due to lifelong discrimination and exclusion. Healthcare workers within skilled nursing facilities (SNF) have expressed they do not feel prepared to care for LGBTQ+ older adults. The aim of this research was to develop the LGBTQ+ Inclusivity Training and Education (LITE) toolkit to provide information to healthcare workers, staff, residents, and their families in the SNF environment. Phase 1 used a community engaged approach to develop the LITE toolkit through engagement with an LGBTQ+ Community Advisory Board. Phase 2 was the implementation and evaluation of the LITE toolkit with 25 SNFs throughout North Carolina. The majority of SNF healthcare workers and staff (N=20) who responded to the survey indicated that the LITE toolkit was “easy to use,” they were satisfied with the contents, and that it would improve the way they care for patients. Providing LGBTQ+ focused education for members of the SNF community addresses the need for healthcare worker and staff training, thereby contributing to equitable care and inclusive environments for the LGBTQ+ older adult community. Additional work focused on understanding the facilitators and barriers to using the LITE toolkit in the SNF setting is needed.
LIFE-COURSE AND CONTEXTUAL FACTORS OF ADVANCE CARE PLANNING AMONG OLDER ADULTS WITH LIMITED INCOME
Authors: Kimpel Christine , Lauderdale Jana , Schlundt David , Dietrich Mary , Ratcliff Amy , Maxwell Cathy 
Published: December 2023

Abstract

Background
Cumulative disadvantage across the lifespan can lead to income, health, and advance care planning (ACP) disparities, resulting in increased caregiver decisional distress and reduced healthcare equity during times of cognitive incapacity. ACP is the process of patient and familial learning, communication, and documentation of life-sustaining care and quality of life preferences after personal reflection, but ACP rates remain lower among older adults with limited income. To better understand how life-course factors influence these low ACP rates, we aimed to explore participant perceptions of healthcare and ACP barriers and facilitators through different life stages.

Methods
We sampled older adults (aged 50+) with limited income from six community-based sites (N=20). Qualitative descriptive design was utilized to perform semi-structured, in-person interviews.

Results
Themes emerged from the inductive inclusion of in-vivo codes and the deductive application of the Cumulative Disadvantage Theory. Mean age: 64.8 years old (SD: 6.8); 11 participants identified as female (55.0%); 16 identified as Black/African American (80.0%). Four themes emerged: 1) structural, life-stage, 2) social stressors and resources, 3) individual stress responses and 4) ACP readiness. Participants’ perceptions denoted that proactive planning inequities among older adults with limited income result from the dynamic interplay of multi-dimensional stressors, protective factors, and personal stress responses. Implications: Identified themes serve as a conceptual basis for future intervention development that is responsive to traumatic life-course experiences and supportive of building ACP resilience (i.e., adapting to ACP stress and actively planning for times of cognitive incapacity), as well as policy and practice implications.
LONELINESS, ANXIETY AND DEPRESSION AMONG CAREGIVERS OF PERSONS WITH DEMENTIA: MEDIATING EFFECT OF SELF-EFFICACY
Authors: Thompson Alisha , Lemieux Catherine , Kim Youn Kyoung (Lily) , Ainsworth Laura , Bardales Rhonda , Trahan Julia , Wilks Scott 
Published: December 2023

Abstract
A geriatrics enhancement program in southern United States piloted an interdisciplinary telehealth program to improve the health of caregivers of persons with dementia (PWD). Literature indicates that social isolation, loneliness, anxiety, and depression are common among PWD caregivers. When caregivers struggle to manage their own health, they may lose confidence in their health care abilities, i.e., caregiver self-efficacy. Using loneliness as the primary factor, the current study tested the mediating effect of caregiver self-efficacy on distinct outcomes of anxiety and depression. In a hospital setting in southern United States, the team in medicine, nursing, and social work collected data from 95 PWD caregivers on measures of loneliness, anxiety, depression, and caregiver self-efficacy. SEM with bootstrapping tested the two hypothesized mediation models, controlling for age, gender, and relationship to care recipient. The typical respondent was a 62-year-old Caucasian female providing care to a parent. Mediation model 1 direct effects were significant for loneliness on self-efficacy (β=-.4.24, p&lt;.01); for self-efficacy on depression (β=-.02, p&lt;.05); and for loneliness on depression (β=.67, p&lt;.001). Indirect mediation effect of loneliness on depression through self-efficacy was significant (β=.09, bootstrapping 95% CI[.01, 21]). Model 2 direct effects were significant for loneliness on self-efficacy (β=-.4.19, p&lt;.01), and for self-efficacy on anxiety (β=-.02, p&lt;.05); direct effect of loneliness on anxiety was not significant (β=.04, p=.706). Indirect mediation effect of loneliness on anxiety was significant (β=.09, bootstrapping 95% CI[.02, 23]). Results underscore the importance of emphasizing social engagement, and including self-efficacy as a mediating factor, when treating caregivers’ anxiety and depression.
LOVOT ROBOT AS COMPANIONS FOR OLDER ADULTS IN LONG-TERM CARE
Authors: Hung Lillian , Ito Hiro , Wong Joey 
Published: December 2023

Abstract
This exploratory, mixed-methods study explores how older adults living in Canadian Long-Term Care (LTC) homes experience and perceive LOVOT, an AI-driven social robot from Japan. It is an extended arm of a mixed-methods, three-country study conducted in Singapore, Hong Kong, and Canada. Our Canadian sample consists of 20 older adults and 40 interdisciplinary staff, and 10 leadership team members. The participants join four weekly sessions of interaction with LOVOT. In the quantitative portion of the study, questionnaires are administered before and after interaction with LOVOT to assess participants’ experiences of the LOVOT robot. The qualitative portion consists of individual conversational interviews with older adults and focus groups with the LTC staff and leadership. We use thematic analysis to guide our initial conceptual framework, and later use both Chi-square tests and content analysis for our quantitative and qualitative data. This study demonstrates (1) the experiences and perceptions of older adults and their family members regarding their interactions with the LOVOT robot, and (2) the LTC staff and leadership perceptions on having the LOVOT robot in LTC. The study offers insights into the potential role of social robots in LTC homes across eastern and western countries.
MALE AND FEMALE PERSPECTIVES: EXPLORING THE USE OF PASSIVE BRAIN HEALTH TECHNOLOGY TO MEASURE GLYMPHATIC FUNCTION
Authors: Carey Cyriah , Sappington Erica , Roberts Mitchell , Dagum Paul , Iliff Jeffrey , Levendovszky Swati Rane , Jaffee Michael , VandeWeerd Carla 
Published: December 2023

Abstract
Older adults’ (OA) research participation is essential to gain insights into the causes, progression, and potential treatments of Alzheimer’s Disease (AD). Brain health technology, such as the Glymphatic Function (GF) Monitor, has the potential to measure the progression of AD. The GF Monitor is a multimodal in-ear dynamic impedance spectroscopy and electroencephalogram (EEG) system worn during sleep and records physiological signals: photoplethysmogram (PPG), bioimpedance (BioZ), and acceleration. This study aims to understand OA perceptions and perceived benefits of passive brain health technology such as the GF Monitor. Six focus groups (3 female, 3 male) were conducted with OA (N=48) between June-August 2022 in The Villages, Florida. Domains assessed included concerns for developing AD, health technology perceptions, and preferences for data/outcomes visualization. Focus groups were transcribed verbatim, and content analysis identified salient themes. Across genders, motivation to participate in brain health technology research was influenced by concerns of family history of AD. Females expressed that using the GF monitor “is a small sacrifice to pay” for data-driven interventions and “preventative measures.” Males value “receiving easily digestible results” that allow them to monitor their cognitive health. Overall participants desire passive brain health monitoring to “stay active” and “remain independent” while aging in place. Passive technology has the potential to engage OA in research. Participants value prevention, maintaining independence, and receiving comprehensive results. The GF monitor has the potential to harness these wishes to monitor and receive translational brain health findings.
MAPPING SEDENTARY BEHAVIOUR USING WEARABLE DEVICES AND DIARIES IN OLDER ADULTS WITH FRAILTY: A FEASIBILITY STUDY
Authors: Rodrigues Isabel , Adachi Jonathan , Bray Steven , Fang Qiyin , Kobsar Dylan , Rabinovich Alexander , Zheng Rong , Papaioannou Alexandra 
Published: December 2023

Abstract
Older adults with frailty are sedentary. Prior interventions to reduce sedentary time in older adults have not been successful as there is little research about context (posture, location, purpose, social environment). There is limited evidence on feasible measures to assess context of sedentary behaviour in older adults. Our aim was to determine feasibility of measuring context of sedentary behaviour in older adults with frailty using objective and self-report measures. We defined “feasibility process” using recruitment (20 participants within two-months), retention (85%), and refusal (20%) rates and “feasibility resource” if the measures capture context and can be linked (e.g., sitting-kitchen-eating-alone), and are all participants willing to use the measures. Context was assessed using a wearable sensor for posture, indoor positioning system [IPS] for location, and electronic or hard-copy diary for purpose and social-context over three days in winter and spring. We approached 80 individuals, and 58 expressed interest; of the 58, 37 did not enroll due to lack of interest or medical mistrust (64% refusal). We recruited 21 older adults (72±7.3 years, 13 females, 13 frail) within two months and experienced two dropouts (90% retention). The measures captured one domain of context, but the hard copy was not completed with detail making it challenging to link with the other devices. Not all participants were willing to use the wearable devices or electronic diary; but we linked the measures of those who did. Future studies will need to determine the most feasible and valid method to assess the context of sedentary behaviour.