bluuebunny/crossref_metadata_2025_split huggingface dataset:
EVALUATING THE BEHAVIORAL RECOVERY OUTREACH (BRO) TEAM MODEL: TEAM MEMBERS’ PERSPECTIVES
Authors: Peeples Amanda , MacDonald Elizabeth , Matthews Kathleen 
Published: December 2023

Abstract
The VA’s Behavioral Recovery Outreach (BRO) Team model seeks to address the unmet needs of aging Veterans with complex behavioral, psychological, neurocognitive, and medical concerns. Consisting of a core team of a social worker, nurse, and psychologist, BRO teams collaborate with the broader VA Community Living Center or inpatient team on behavioral assessment and treatment planning to help stabilize the Veterans’ behaviors and ready them for discharge to the community. Then, upon discharge the BRO Team provides ongoing behaviorally focused transitional support services to help ensure the Veterans’ sustained stability in the community and prevent unnecessary rehospitalizations. While dissemination efforts have demonstrated positive clinical outcomes for the Veterans served, little was known about the factors that support or hinder successful implementation of this complex program. This paper presents results from qualitative interviews with ten members from seven BRO Teams (out of ten active teams at the time) undertaken in late 2021 as part of a larger BRO program evaluation. The BRO Team model, including the goals and core components of BRO, are defined. Determinants of successful BRO implementation and team operations, including staffing, inter-departmental relationships, model clarity, and support, are described. BRO Team members’ views of the impact on and response of BRO recipients (BRO-enrolled Veterans, family members, and VA and community care partners), such as helping family members understand dementia, assistance with navigating the VA system, and support with behavioral health care planning and modification leading up to and following transitions to community care, are also detailed.
RECRUITMENT SUCCESSES AND CHALLENGES OF EMPLOYING IN-HOME SENSOR TECHNOLOGY WITH OLDER AFRICAN AMERICAN ADULTS
Authors: Calloway Shayla , Raulston Journie , Barnes Lisa 
Published: December 2023

Abstract
Older African Americans are under-represented in clinical research studies of aging. Many previous studies have shown results of in-home monitoring technologies to collect objective data for aging in place but few studies include minoritized populations. The CART platform uses home-based sensor technology to unobtrusively assess activity in the home and was embedded in homes of participants from the Minority Aging Research Study (MARS), an ongoing longitudinal study of cognitive decline in older African Americans. This presentation will highlight efforts to engage, recruit, and retain older African American participants in Chicago, with a particular focus on challenges and lessons learned. Recruitment consisted of presentations and mailings to potentially eligible MARS participants based on pre-specified inclusion criteria. Of 153 participants who met initial eligibility criteria, 36 refused before consent, 34 were ineligible after screening, and we enrolled 76 non-Hispanic African Americans participants (80% women; mean age = 80.4 (6.3) years); mean education = 16 (2.8) years; 78% without cognitive impairment). Enrolled participants were slightly younger, more likely to be female, and had higher education. There was no difference in cognitive impairment between those who enrolled compared to those who were ineligible after screening. Since enrollment, 11 have withdrawn and 7 are no longer active. The most common challenges include privacy concerns, broadband internet issues, emerging medical conditions, or changes in residency or resident occupancy. These results demonstrate that older African Americans participating in an ongoing longitudinal study can be recruited and retained in an ancillary study that involves home-based sensor technology.
THE HIDDEN TOLL OF INCARCERATION: EXPLORING THE LINK BETWEEN IMPRISONMENT HISTORIES AND PAIN AMONG OLDER ADULTS
Authors: Yang Yulin , Lutz Gabriel , Chen Chixiang , Kheirbek Raya 
Published: December 2023

Abstract

Objective
Incarceration is linked to poor health outcomes across the life course. However, little is known whether and to what extent incarceration histories shape pain in later life. This study aims to examine the link between incarceration histories and pain outcomes among middle-aged and older adults in the United States.

Methods
We used data from a nationally representative sample of community-dwelling adults aged 50+ in the 2012-2018 biennial waves of the US Health and Retirement Study (HRS) to estimate pain trajectory in U.S. older adults with and without a history of incarceration. We fit generalized estimating equation (GEE) models adjusting for socio-demographic covariates and early life experience to estimate the risk of reporting moderate-to-severe pain and related limitation.

Results
We included 12,394 respondents aged 68.76 on average (SD= 10.34), 59% female, and 7% with incarceration histories (n= 870). Persons with incarceration histories have a greater risk of reporting moderate-to-severe pain (PR=1.38, 95% Confidence Interval [CI]: 1.24, 1.53) and pain-related limitation (PR=1.50, 95% CI: 1.34, 1.67) even after adjusting for socio-demographic covariates and early life experience.

Discussion
In a nationally representative sample of older adults (with or without incarceration history), our study demonstrates an independent association between a history of incarceration and pain in later life. Our findings highlight the far-reaching impact of incarceration and the need for developing optimal pain management strategies to reduce the burden of disabling symptoms. Interventions should prioritize socioeconomically vulnerable groups, who may have the least access to pain treatment in later life.
A TALE OF TWO EXPERIENCES: NAVIGATING END-OF-LIFE CARE WITH A HISTORY OF INCARCERATION
Authors: Lutz Gabriel , Yang Yulin , Chen Chixiang , Kheirbek Raya 
Published: December 2023

Abstract

Objectives
The negative health effects of being imprisoned are well-documented throughout one’s lifetime, but the impact of incarceration on end-of-life experience is not fully understood. Thus, this study aims to explore the relationship between a person’s history of incarceration and their end-of-life experience

Methods
The Health and Retirement Study, a survey of Americans aged 50 and above that is nationally representative, provided the data for this study, which involved a secondary analysis of existing information. The dataset included individuals who had participated in the HRS but had deceased between 2012 and 2018.

Results
Among 1710 respondents aged 78 (SD10 years) on average at baseline, there are 53% female, and 8% with incarceration history (n=139). We found incarceration history to be positively associated with caregiving and lower risk of dying alone OR 1.84 (95% CI: 0.64-5.21) higher chance of using hospice OR 1.16 ( 95% CI: 0.72- 1.87) and dying at home, but lower levels of quality of life at the end of life OR -0.44 (95% CI: -1.88, 1.01) and utilization of palliative care services OR 0.49 ( 95% CI: 0.21, 1.12).

Conclusion
Our study, which included representative sample of older adults from across the country has revealed an association between a person’s past imprisonment and their end-of-life experience . The study highlights the pervasive effects of incarceration and underscores the importance of developing effective palliative care strategies for early identification of the needs to alleviate suffering and improve quality of life for this vulnerable population.
EVALUATING A MICROLEARNING INTERVENTION ABOUT NUTRITIONAL CARE FOR OLDER PEOPLE TARGETED AT NURSES
Authors: ten Cate Debbie , Dikken Jeroen , Ettema Roelof , Schoonhoven Lisette , Schuurmans Marieke 
Published: December 2023

Abstract
Nurses play a pivotal role in the care of older people with malnutrition or who are at risk. However, research shows that they lack the motivation to give adequate nutritional care. To change this motivation, an educational intervention targeted at nurses would be desirable. To optimize learning efficacy, we developed a microlearning intervention and conducted a first evaluation. The aim of this study was to evaluate the microlearning intervention on reaction, learning and behavioral change among nurses. The evaluation was assessed with focus groups, a questionnaire, participant observations and patient records. The data was both qualitatively and quantitatively analyzed. Two focus groups were held with a total of seven nurses. They mostly mentioned positive experiences, stated that their knowledge about nutritional care increased and that their behavior in daily practice changed. Of the 306 participants, who received the intervention, 94 filled in the questionnaire of which 66% was satisfied with the microlearning intervention and over 69% agreed that they learned something new. Five nurses were observed while giving care to a total of twelve older care recipients. No clearly detectable changes in behavior during care moments or in reporting in patient records were observed. Nurses had a mainly positive experience with the microlearning intervention. They confirmed learning and changing behavior in daily practice. However, from observations this behavioral change was not visible. The intervention may be potentially useful in education for (future) nursing professionals. With the microlearning intervention, nurses may be better equipped to provide nutritional care to older people.
EMERGENCY DEPARTMENT USE AMONG OLDER ADULTS RECEIVING MEDICAID HOME- AND COMMUNITY-BASED SERVICES
Authors: Fortinsky Richard , Robison Julie , Wakefield Dorothy , Grady James , Steffens David , Migneault Deborah , Lee Chae Man 
Published: December 2023

Abstract
Medicaid-funded home and community-based services (HCBS) for older adults aim to prolong independent living despite physical and cognitive disabilities. Medicaid-eligible HCBS populations are racially and ethnically heterogeneous, with multiple chronic conditions. Clinical threats to continued independent living among older adult HCBS recipients include acute illnesses, injuries, and exacerbations of chronic conditions, which could trigger a pathway of emergency department (ED) visits, hospitalization, and long-term nursing home admission. Despite its importance in the pathway from independent living, little is known about the rate of, or risk factors for, ED use in this target population. Accordingly, we determined predictors of ED use in a statewide cohort (N=5,651) in Connecticut’s Medicaid HCBS program for adults age &gt;65, who were clinically assessed using a uniform tool between April 2020-March 2021. ED use, (0 vs 1+ visits), was ascertained over 12 months following clinical assessment using Medicare and Medicaid claims data. Predictor variables were racial and ethnic group, primary language, age, sex, educational attainment level, dementia diagnosis or moderate-severe cognitive impairment, depressive symptom severity, and Charlson comorbidity index. Cohort members were 76% female, 30% Hispanic, 15% non-Hispanic Black, 4% non-Hispanic Asian, 33% age &gt;85. Forty-one percent had 1+ ED visits. Multivariate logistic regression analyses revealed that ED use was associated with (adjusted odds ratios p&lt;0.05): high school education, more severe depressive symptoms, and more chronic conditions. Non-Hispanic Asian individuals had lowest ED visit likelihood. ED use among older adults receiving Medicaid HCBS might be reduced if depressive symptoms and multiple chronic conditions are optimally managed.
EXPLORING SECTORAL REACH IN AGE-FRIENDLY COMMUNITIES
Authors: Black Kathy , Oh Patricia 
Published: December 2023

Abstract
There is increasing interest in better understanding the sectoral reach of age-friendly community practice. Action across a wide variety of actors is central to achieving age-friendly societal change according to the World Health Organization and an explicit goal for governmental participation in its Global Network of Age-Friendly Cities and Communities. However, there is limited knowledge regarding the scope of sectoral reach by age-friendly communities. We used qualitative inquiry to assess sectoral efforts reported by American age-friendly communities that completed a five-year cycle of participation (n=40). We employed directed content analysis using a priori indicators by sectoral actors: public (i.e., government), private (i.e., business), and civil society including nonprofit organizations and volunteers. We classify sectoral actions by type (i.e., intersectoral, multisectoral) and by clustered domain community foci (i.e., built, social, service). Our study identifies the extent and types of sectoral actors and actions reported by age-friendly communities with the greatest efforts reported in the public sector, and while similarly distributed across all the domains, slightly more efforts were noted in the built environment. We also found greater intersectoral efforts (i.e., explicitly working towards shared goals) than multisectoral (i.e., not necessarily in collaboration on shared goals), particularly across government. While our study substantiates the breadth of actions towards age-friendly change, additional research is needed to examine the ways in which the public and other sectoral actions are further linked to outcomes in communities in the United States and in other countries.
ALTERNATIVE PATHS TO AN AGE-FRIENDLY COMMUNITY
Authors: Gleason Shayna , Oh Patricia , Coyle Caitlin , Somerville Ceara 
Published: December 2023

Abstract
While the age-friendly community movement has seen tremendous progress in the past decade, with over 700 U.S. member communities in the Network of Age-Friendly States and Communities (NAFSC), many more U.S. communities have not yet joined the network. Joining NAFSC can spur activity to improve local conditions for older residents, as well as allow communities access to informational resources and contacts from peer communities that have undertaken similar initiatives. A better understanding of the barriers preventing communities from joining NAFSC, the hesitancy about joining, and the age-friendly work being done outside of NAFSC is critical to extending age-friendly work nationally. The present study explored factors that inhibit communities from joining NAFSC. We conducted 12 semi-structured virtual interviews with community leaders in Maine and Massachusetts whose communities are not NAFSC members but are actively working on aging-related issues. Participants were recruited through the researchers’ professional networks. We intentionally cultivated diversity of community size during recruitment. Transcripts and interview notes were coded thematically. Resulting themes included a lack of knowledge/misconceptions about what joining NAFSC requires, a perception that there are few benefits to joining, political concerns, insufficient personnel capacity, other financial priorities (e.g., children’s programming, COVID relief), and a desire to retain local control over aging-related initiatives. Recommendations include clearer communication of NAFSC membership requirements and benefits, additional technical assistance to communities, and loosening of reporting requirements for small communities.
THE USE OF THE “TIME TRAVEL” PARADIGM OF ALZHEIMER’S DISEASE FOR FAMILY CARE PARTNER EMPOWERMENT
Authors: Johnson Christopher , Johnson Roxann , Sun Fei 
Published: December 2023

Abstract
This study describes how family carers are taught the Time Travel model of Alzheimer’s Disease (AD). As persons with AD experience cognitive, emotional, social, physical and functional time travel, families can learn to join them on their journey. Stage models (e.g., Reisberg and associates FAST and GDS) of AD clarify how changes through time occur using stage markers. Yet the disease is non-linear. Persons with AD don’t travel neatly in stages but fluctuate in recall of names, faces and events. They migrate in a non-linear downward spiral fluctuating back and forth through time, revisiting people, places, events and traumas of their distant past. Time Travel apps and other life history data are available to provide real person-centered care that’s time appropriate. Families are trained to connect in the approximate time frame in which the person has traveled. Hence, care partners are taught time appropriate communication and interventions (e.g., activities, pictures, music etc.) to respond to challenging behaviors. The Models use with family carers empowers them to validate their loved ones’ approximate time frame they are in. Family carers are inspired to become “best friends” of AD persons by understanding how this cognitive disability works. When a lady with travels to age 20 in her mind but sees an 80-year-old face in the mirror, she demands the person leave the bathroom. This behavior is puzzling to families. Time Travel model explains how this works driving care planning, redesigns (e.g., mirrors) and activities, and supports validation therapy, “Best Friends” and other pedagogy.
USING SIMULATION TO ASSESS THE FIDELITY OF ADVANCE CARE PLANNING IN THE CONTEXT OF A PRAGMATIC TRIAL
Authors: Cotter Valerie , Sloan Danetta , Scerpella Daniel , Wolff Jennifer , Smith Kelly 
Published: December 2023

Abstract
There is growing recognition of the importance of and challenges to maintaining fidelity in pragmatic randomized clinical trials. Simulations using standardized patients are a high-fidelity, low-stake, non-threatening opportunity to evaluate knowledge, skills, and competencies associated with high-quality healthcare delivery. We created standardized patient scenarios grounded in the Respecting Choices First Steps™ Advance Care Planning (ACP) curriculum to assess embedded trial ACP facilitators. Scenarios included simulations representing one-on-one encounters with a patient, and with a patient-family dyad. A standardized encounter observation checklist was used to assess and score relevant skills and behaviors including encounter set-up, ACP topics, and general communication. Each item was scored on a scale from not-done (0) to effective (2) with lower scores indicating lower fidelity. Six facilitators with varied backgrounds (social work, nursing, lay persons) each completed the two simulation scenarios. Group average domain scores across all six facilitators were moderately high. ACP Setup scoring averaged 75.5%; ACP Topics were 72.0%; and Communication were 77.4%. The lowest group scoring was observed in the coverage of ACP Topics (72%). The highest group average was observed in Communication skills at 84.9%. Lower individual scores were observed across all domains for staff who were newly hired at the time of the simulation exercise. Simulation using standardized patients and caregivers allowed investigators to monitor the fidelity of ACP communication to the trial design and provided targeted opportunities for improvement that were not readily available through usual care.
PRAGMATIC IMPLEMENTATION OF AN ADVANCE CARE PLANNING INITIATIVE: MOVING KNOWLEDGE INTO ACTION
Authors: Smith Kelly , Colburn Jessica , Scerpella Daniel , McGuire Maura , Walker Kathryn , Wolff Jennifer 
Published: December 2023

Abstract
Primary care is an important setting for patient and family-centered communication with older adults given the high frequency of interactions, longitudinal trusted relationships, and patient preferences for advance care planning (ACP). Increasing ACP conversations and documentation of advance directives in primary care is a focus of quality-of-care initiatives and is particularly relevant for older adults, including those with dementia. The SHARING Choices ACP program evaluation was designed to examine the fidelity of implementation with the two partner health systems. SHARING Choices includes a mailing (introductory letter, an agenda-setting checklist, a blank advance directive, and information about shared-portal access for family) sent two weeks prior to scheduled primary care visits for patients aged 65 and above along with access to an ACP facilitator in each practice. Embedding SHARING Choices within primary care practices involved a multi-step process, including onboarding of health system partners, facilitator identification and training, tailored onboarding, practice champion engagement, and practice orientation and ongoing support. Of 23,220 candidate patients, 17,931 outreach attempts by phone (77.9%) and the patient portal (22.1%) were made by ACP facilitators and 645 conversations occurred. Most conversations (94.8%) were less than 45 minutes in duration. Study findings reinforce the value of adaptable study design; co-designing workflow adaptations with frontline staff; adapting implementation processes to fit the operational and organizational priorities of the health system.
MULTILEVEL PERCEPTIONS OF IMPLEMENTING SHARING CHOICES: A QUALITATIVE STUDY
Authors: Saylor Martha Abshire , Hanna Valecia , Dy Sydney , Sloan Danetta 
Published: December 2023

Abstract
Reviews have found that ACP interventions alone, including those in primary care, improve advance directive documentation but have not shown effectiveness for person-centered or end-of-life outcomes. One potential reason is that these interventions may not be sufficiently comprehensive and do not address the wide scope of population, communication and systems issues needed to improve outcomes. We conducted semi-structured interviews to explore experiences with the SHARING Choices intervention through the perspectives of key stakeholders involved in the trial. We recruited all embedded ACP facilitators; the clinicians and practice managers from primary care practices from both participating health systems; and patients (and/or family) who participated in the intervention. Tailored interview guides addressed how implementation occurred and evolved, acceptability and key enablers/barriers/adjustments in implementation, and the use and perceived impact of different elements of the intervention. A multidisciplinary team generated a coding scheme based on these topics of interest and used thematic analysis to identify, analyze, describe, and report emergent themes from responses across interview groups. We interviewed 40 participants (all 9 facilitators, 11 patients and families, and 20 clinicians and administrators). We will present major themes and differences across interview groups, and how this informs the quantitative results of the pragmatic trial.