bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPACT OF HOME HEALTH VALUE-BASED PURCHASE MODEL ON OWNERSHIP OF HOME HEALTH AGENCY: A LONGITUDINAL ANALYSIS
Authors: Ma Chenjuan 
Published: December 2023

Abstract
Home health care serves over 5 million Americans “aging in place”. In January 2016, home health value-based purchasing model (HHVBP) was introduced and piloted in 9 states in the US with a purpose of improving care quality and efficiency, and expanded nationwide in 2023. This study aimed to examine the impact of HHVBP on business operation of home health agencies (HHA), including ownership changes. This is a longitudinal study using 7 years (2013-2019) of data from two national data sources. A dummy variable was used to indicate whether an HHA is in a state with HHVBP or not. Ownership measures included both the type and changes of ownership between 2013-2017. A total of 14,334 HHAs (95,137 agency-years) were included in analysis. Of the 14,334 agencies, about 19% were in HHVBP states, 88% continued business in all study years, 1679 were new agencies and 49 agencies discontinued business. In HHVBP states, 363 out of 2781 (13%) were newly added, compared to 1316 out of 11,553 (11%) in non-HHVBP states. Agencies in HHVBP states were more likely to be public agencies (e.g., 6.08% vs. 4.97% in 2013; 5.62% vs. 4.60% in 2018), though it slightly decreased over time; and experience changes in ownership and particularly the years after the implementation of HHVBP (e.g.,2.44% vs. 2.38% in 2013; 7.03% vs. 4.39% in 2018). The HHVBP can have a significant impact on the operation and ownership type of home health agency, which in turn may impact availability and quality of home health care.
ISSUES OF LIFE-SUSTAINING TREATMENT DECISION ACT IN CLINICAL PRACTICE FOR INDIVIDUALS AT THE END OF LIFE
Authors: Song Eunjeong , Shin Dongsoon , Lee Jooseon , Eom Minjeong , Oh Suhee , Yun Seon Young , Lee Heejung , Song Rhayun 
Published: December 2023

Abstract
This study aimed to investigate the status and issues related to the patient’s decision-making regarding life-sustaining treatment (LST) in clinical practice and to provide strategic suggestions to improve the hospital policy. The retrospective observational study was conducted with adult patients, admitted between Jan 1 and Dec 31, 2021, who went through the end-of-life process and died in a university hospital in Korea. The electronic data included age, gender, admission date, expiration date, and Do-not-attempt-resuscitation (DNAR) and LST-related data (date to sign, who signed, and clinical state when signed). A total of 916 patients were included. Only 4.1% of the patients decided on LST by themselves, while the decision was made mainly by the family, specifically children (54.2%). The time of signing DNAR consent was before eight days from the date of death (33.7%) and the previous day of the death (27.6%). While early warning score was used to predict the critical state of the patients, the period from the date of sign to the date of death was 8.9 (SD=25.7) days for DNAR and 2.76 (SD=6.95) days for LST. Strategic suggestions were made to facilitate the timing of signing the consent form for LST based on the early warning score, and encourage patient involvement in the decision-making process. Further efforts are required to improve the awareness of patients and medical staff on the implementation of LST and to clarify the ambiguity of the timing of document preparation.
ASSOCIATIONS BETWEEN GAIT MEASURES AND QUADRICEPS MUSCLE THICKNESS AS MEASURED BY POINT-OF-CARE ULTRASOUND
Authors: Ganbat Uyanga , Feldman Boris , Arishenkoff Shane , Meneilly Graydon , Madden Kenneth 
Published: December 2023

Abstract
Gait parameters and sarcopenia predict falls risk which is one of the major causes of both mortality and morbidity among older adults. Our objective was to evaluate whether anterior thigh muscle measured by point-of-care ultrasound is significantly associated with standard gait measures. All subjects were referred from ambulatory geriatric medicine clinics at an academic center. Quadriceps muscle thickness was measured by a portable ultrasound device. Gait variables were measured by the patient walking for 6 minutes. The primary response variables were gait variables, and the predictor variables were age, biological sex, body mass index, and MT. Univariate and multivariate regression analyses were performed. A total of 150 participants were recruited from geriatric medicine clinics. Muscle thickness was measured in 149 participants and the mean (SD) was 1.91 (0.52) (median 1.82 cm, 0.96 to 3.68 cm). Among all the gait variables, average swing time (P = 0.010) and average stance time (P = 0.010) were correlated significantly with muscle thickness. Muscle thickness also showed a negative association with step time variability percent (P = 0.005). Muscle thickness (P = 0.046), age (P = 0.025), and gender (P = 0.047) had a statistically significant association with present step time variability. PoCUS showed a significant association with average swing time, average stance time, and step time variability all of which are predictive of future falls risk. Although more work needs to be done, PoCUS is a reliable and feasible muscle measurement method, which could lead to faster clinical decision-making and falls risk assessment.
GERIATRIC RENAL TRANSPLANT CO-MANAGEMENT: EVALUATION OF FRAIL OLDER ADULTS FOR TRANSPLANT ELIGIBILITY
Authors: Doan Jared , Chow Stephanie , Baim-Lance Abigail , Blum Moritz , Lerner Susan , Rosen Greta , Hung William , Ko Fred 
Published: December 2023

Abstract
Older transplant patients have higher rates of adverse post-transplant outcomes. The Renal Transplant Co-Management (RCOM) program is a collaboration of surgeons, geriatricians, and social workers to medically and psychosocially optimize older renal transplant candidates by providing comprehensive geriatric-centered vulnerability assessments with corresponding medical and psychosocial interventions. The RCOM assessment aids the surgical team in deciding patient transplant eligibility, and greater clarity on its role may be clinically valuable. Fifty-five patients from a single metropolitan hospital were evaluated during the study period (1/1/22 to 6/16/22). Assessments included frailty (Clinical Frailty Scale/CFS), functional status (Karnofsky Score, Katz Index, Lawton-Brody Scale) and cognition (Montreal Cognitive Assessment/MoCA) – factors that the renal transplant team considers in listing a patient for surgery (i.e., listed/transplanted) or not (i.e., ineligible/removed from the list). Twenty patients (36.4%) were female. Mean age of ineligible/removed (n=10) and listed/transplanted (n=45) patients was 74.7 (4.8) and 72.5 (3.8), respectively, with no differences in age, gender, race, education, or health insurance between groups. Patients who were listed/transplanted had a higher Lawton-Brody instrumental activities of daily living (IADL) score than those not listed (p=0.025, t-test). CFS (p=0.118), Karnofsky (p=0.09), Katz (p=0.074), and MoCA (p=0.094) were similar but approached statistical significance despite a small sample size. Functional status as measured by IADL may be a significant factor considered in determining the transplant eligibility of older adults. Ongoing study and a larger sample size may provide greater clarity on the physical and cognitive functions that impact eligibility for transplant listing in frail older adults.
RELATIONSHIPS BETWEEN PAIN AND OPTIMISM AMONG COMMUNITY DWELLING OLDER ADULTS
Authors: Rivera Lucia , Mancilla Isabel , Bergstrom Jaclyn , Molina Anthony 
Published: December 2023

Abstract
Measures of life outlook in older adults have been investigated in connection to pain, as both pain management and outlook are important factors of successful aging. Positive outlook helps promote healthy aging while depression is associated with higher pain levels and interference, which negatively contribute to the aging process. Thus, we hypothesized that higher pain levels are associated with lower optimism among community-dwelling older adults. We utilized data from the UC San Diego Successful Aging Evaluation (SAGE), a prospective longitudinal cohort study initiated in 2010, to evaluate the relationship between pain and optimism in 378 community-dwelling adults aged ≥50 years. We used the revised Life Orientation Test (LOT-R) to measure optimism and three pain subscales, PROMIS Pain Interference, PROMIS Pain Intensity, and MOS 36-Item Short-Form Health Survey (SF-36), as pain measures. Regression analyses reveal negative relationships between pain and optimism for all three pain scales, with regression coefficients of -0.277 (p&lt; 0.0001), -0.246 (p&lt; 0.0001), and 0.269 (p&lt; 0.0001) respectively. The correlations were strongest among men, Caucasians, and college graduates. The correlations remained significant when adjusting for gender, age, completion of college, marriage status, and household income, but not for race/ethnicity. This study was limited by the underrepresentation of non-Caucasian participants (N=87) and by the self-reported nature of the SAGE data. These findings indicate value in considering physical and psychological elements together when encouraging healthy aging. Future research can investigate whether interventions that increase optimism can decrease pain in older adults or whether pain management interventions can increase optimism in this population.
THE IMPACT OF HEALTH-RELATED QUALITY OF LIFE ON CLINICAL OUTCOMES IN ATRIAL FIBRILLATION POPULATIONS
Authors: Pierre-Louis Isabelle , Bamgbade Benita , Lopez-Pintado Sara , Forrester Sarah , Wang Weijia , McManus David , Saczynski Jane 
Published: December 2023

Abstract
Although there is a large body of literature linking atrial fibrillation (AF) to adverse clinical outcomes, little is known with regards to the potential links between health-related quality of life (HRQoL) and AF related clinical events. To address this gap, individuals with AF aged ≥ 65 years were recruited from clinics in Massachusetts and Georgia between 2016-18 and followed until 2020. HRQoL was assessed via the Atrial Fibrillation Effect on Quality of Life (AFEQT). The AFEQT is a validated HRQoL measure that quantifies the effect of AF on patients’ daily life on a scale of 0 to 100. AFEQT scores &lt; 80 indicated poor HRQoL and ≥ 80 indicated good HRQoL. The clinical events included major bleeding, stroke, and death. Of the 1,244 participants, the mean age was 75.5 (SD: 7.1), 49% identified as female, 13% were non-White, and 57% were married. After 2 years, 105 major bleeding events (49% poor HRQoL), 19 strokes (42% poor HRQoL) and 108 deaths (59% poor HRQoL) occurred. Our composite outcome included 200 participants (53% poor HRQoL). After adjusting for key covariates, poor HRQoL was associated with an increased risk of our composite outcome (adjusted hazard ratio [AHR]= 1.34, 95% CI: 1.00, 1.80) and death (AHR= 1.58, 95% CI: 1.05, 2.38). We found no significant differences between poor and good HRQoL in major bleeding and strokes. HRQoL is important when assessing health of AF patients. Health providers who treat patients with AF should consider HRQoL when evaluating the risk of death and other adverse outcomes.
EFFECTS OF MARITAL STATUS AND ETHNICITY ON NEUROCOGNITIVE FUNCTIONING IN A RURAL OLDER POPULATION
Authors: Elliott Lauren , Singer Jonathan , Rerick Peter , Fadalla Carol , McLean Elisabeth , Jump Alayna , Molinar-Lopez Veronica , Neugebauer Volker 
Published: December 2023

Abstract
Research indicates being married is related to better physical and psychological health. Yet, little is known regarding the relationship between marital status and neurocognitive functioning and whether it differs based on ethnicity (Hispanic vs. non-Hispanic). Data from 1864 participants (Mage=59.68, SD=12.21), who were mostly Hispanic (n=1053), women (n=1295), and married (n=1,125) from Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education, & Research) were analyzed. Neuropsychological testing comprised RBANS, Trails Making Test, and Clock Drawing. Participants were dichotomized into married and unmarried (i.e., widowed, divorced, separated, never married). There was a significant interaction between Hispanic identity and marital status on overall neurocognitive functioning (F(1,1480) =4.79, p &lt; .05, ηp2=.003). For non-Hispanic individuals, married individuals had higher overall neurocognitive functioning compared to the unmarried individuals, whereas neurocognitive functioning for Hispanic individuals did not significantly differ between married and unmarried individuals. There were significant main effects as married individuals (M=84.95, SD=15.56) had greater overall neurocognitive functioning than unmarried individuals (M=83.47, SD=15.86; F(1,1480) = 14.67, p &lt; .001, ηp2=.01), and Hispanic individuals (M=78.02, SD=14.25) had lower overall neurocognitive functioning than non-Hispanic individuals (M=91.43, SD=15.07; F(1,1480) = 284.99, p &lt; .001, ηp2=.16). Hispanics living in rural areas experience additional stressors that could lead to worse neurocognitive functioning, which is supported by the Lifespan Biopsychosocial Model of Cumulative Vulnerability and Minority Health, which postulates that race/ethnicity/SES-related stressors exacerbate the impact of other life stressors. Reduction of stress on rural Hispanics should be a priority as it could positively affect their neurocognitive functioning.
INFLUENCE OF CHANGES IN MEMORY AND THINKING ON PREFERENCES AND SATISFACTION OF HEALTH CARE COMMUNICATIONS
Authors: Sillner Andrea , Boltz Marie , Berish Diane , Hill Nikki 
Published: December 2023

Abstract
Communication about changes in symptoms or healthcare management strategies is common between older adults and their healthcare providers, such as physicians and registered nurses. Healthcare communication can occur in the context of an in-person visit or using technology through telehealth or a healthcare portal. Understanding factors that influence preferences for healthcare communication and satisfaction are important for patients and providers. For example, changes in memory and thinking may impact older adults’ ability to communicate healthcare needs or to understand what is being told to them about their health conditions. The aim of this study was to understand the influence of cognitive changes on preferences and satisfaction with communications in a sample of adults over the age of 50, living in the community, who reported on changes in memory and thinking over the last 5 years (N=289). Results showed that older adults who reported a decline in their memory and thinking over the last 5 years were significantly more likely to report that their healthcare communication needs were not met. They were also significantly less likely to be satisfied with their healthcare communications. These important findings demonstrate the need to further explore relationships between self-reported cognitive changes and communication with healthcare providers. This can inform psycho-social intervention development, ultimately enhancing healthcare communication to meet older patient preferences and improve satisfaction with the overall goal of impacting healthcare outcomes.
LONGITUDINAL PATTERNS OF COGNITION CHANGES AMONG KOREAN OLDER ADULTS WITH NO PARTNERS: A LATENT PROFILE ANALYSIS
Authors: Kim Yeoju , Kim Giyeon 
Published: December 2023

Abstract
Cognitive function decline among older adults becomes a hot topic in South Korea, as the population of the older adults has been increasing dramatically. The purpose of this study was to explore the longitudinal patterns of the cognitive function and identify factors influencing these changes among Korean older adults without their partner, using latent profile analysis. The samples included 612 adults aged 60 and older without partner from the Korean Longitudinal Study of Aging (KLoSA) in 2016, 2018, and 2020. The logistical regression was used to identify factors influencing group classification. Result revealed four types of the latent profiles were derived based on the cognitive function: the mid-level group, the high-level maintenance group, the low-level maintenance group, and low-level decline group. Factors such as depressive symptoms, social activity participation, and age were significantly associated with cognitive function decline in the high-level maintenance group, and the age was associated with the cognitive function changes. The findings highlight the importance of interventions to prevent cognitive function changes among older adults, considering depressive symptoms, social activity participation, and age.
RATES OF VISION AND HEARING IMPAIRMENT RELATED TO COGNITIVE DIFFICULTIES AMONG OLDER ADULTS IN MISSISSIPPI COUNTIES
Authors: Su Yan-Jhu , Jansen Taylor , Lee Chae Man , Silverstein Nina , Dugan Elizabeth , Xu Shu , White Kina 
Published: December 2023

Abstract
Measures of population health can be a tool to advance healthy equity, because they identify disparities that may otherwise go undetected. In this study, we examined if community rates of sensory impairments (vision and/or hearing difficulty) had any association with self-reported cognitive difficulties among older adults. Understanding the distribution of multiple conditions that impact function and independent living may identify geographic hotspots in need of supportive interventions. We describe the prevalence of visual difficulty and hearing difficulty among Mississippi adults age 65 years and older and examine the association of visual difficulty and hearing difficulty with cognitive difficulty in older adults at the community level in 82 counties in Mississippi. Small area estimation techniques were used to calculate age and gender adjusted community rates using three data sources: the American Community Survey (2016-2020), the Behavioral Risk Factor Surveillance System (2017-2020), and CMS Medicare Beneficiary Summary Files (2018). Results show there are 8.7% of older adults 65+ with self-reported vision difficulty and 15.5% with self-reported hearing difficulty. The multiple linear regression models after adjusting for age, gender, race, marital status, education, income, and chronic diseases, counties with higher rates of vision difficulty and hearing difficulty were significantly associated with higher rates of cognitive difficulty compared to those with lower prevalence (vision difficulty: β=0.36, p&lt; 0.001, hearing difficulty: β=0.32, p&lt; 0.001). Implications suggest the need for practitioners and policymakers to establish cognitive difficulty-related interventions targeted to service areas with a high prevalence of sensory difficulties.
THE COGNITION IN PRIMARY CARE PROGRAM: A STEP-BY-STEP CLINIC WORKFLOW PUTTING THE GSA KAER TOOLKIT INTO ACTION
Authors: Raetz Jaqueline , Fitzpatrick Annette , Belza Basia , McKiddy Sarah , Hsu Amy , Liao Joshua , Park Christina , Gaster Barak 
Published: December 2023

Abstract
In 2020 University of Washington (UW) Medicine began developing Cognition in Primary Care (CPC), a quality improvement program adapting the GSA KAER Toolkit to help primary care providers (PCPs) detect patients with cognitive impairment in their 16-clinic primary care network. The CPC consists of a 3-part training program to help PCPs diagnose, manage and counsel patients; a set of tools embedded into the electronic health record to facilitate cognitive evaluation; and an in-clinic workflow providing on-site support for providers within their own clinic setting. During this process we interviewed providers and developed a hybrid remote and in-person orientation for clinics to initiate a workflow to support improved cognitive evaluations. Utilizing pre-implementation input, the CPC in-clinic workflow was pilot-tested at two UW primary care clinics in 2021/2022. This presentation will describe content of the clinic orientation and implementation of CPC to include 1) the typical timeframe and content of orientation; 2) meetings with clinic leadership; 3) overview of provider/staff meetings; 4) in-person walk-through for placement of materials; 5) invitation to training; 6) a 12-page handbook outlining steps in the workflow; 7) other printed CPC materials, e.g., dementia warning signs, MoCA and AD8 forms, Alzheimer Association referral cards; and 8) follow-up focus group feedback. Evaluation of the pilot clinics following implementation found significant use of all tools by PCPs and an increase in diagnoses of mild cognitive impairment. This clinic workflow may be useful as a model for other health care systems to initiate cognitive evaluation programs in primary care.
THE RELATIONSHIP BETWEEN ORAL HEALTH AND COGNITIVE FUNCTION: EVIDENCE FROM THE LASI
Authors: Pan Xi , Kelekar Uma , Muhammad T 
Published: December 2023

Abstract
The present study aimed to examine the association between oral health and cognitive function among older adults in India. Data for the study were selected from the Longitudinal Aging Survey of India (LASI, 2017-2019) and the LASI Diagnostic Assessment of Dementia (LASI-DAD) and 4,096 respondents aged 60 and above were included. Oral health was measured by self-reported physician-diagnosed oral health problems including presence of painful teeth, ulcers for more than two weeks, bleeding gums, swelling gums, loose teeth, dental cavities or caries, soreness or cracks in the corners of the mouth, or other problems as well as edentulism (i.e., losing all natural teeth, some natural teeth, or no teeth). A higher number of these problems indicated a more complex oral health condition. Cognitive function was measured by the standardized total score of all cognitive tests in the Harmonized Cognitive Assessment Protocol (HCAP). Binomial logistic regression models were used to analyze the relationship between the diagnosis of oral health problems and cognitive function. Results showed that having one or more oral health problems was associated with lower scores on cognitive function (β=-0.16, p=0.04), after controlling for sociodemographic characteristics and health status. There was no significant association between edentulism and cognitive function. Findings of the study suggest that oral health is integral to long-term overall health, specifically cognitive function. Our findings highlight the importance of educating older individuals about the connection between oral health and cognitive function along with the need for broadening their access to oral health care in India.