bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFECT OF AN INTENSIVE LIFESTYLE INTERVENTION IN ADULTS WITH TYPE 2 DIABETES ON LONG-TERM HEALTH CARE SPENDING AND USE
Authors: Davis Ian , Frenier Christopher , Huckfeldt Peter , Harada Ann , Pajewski Nicholas , Espeland Mark , Goldman Dana 
Published: December 2023

Abstract
This study investigates the impact of the Look AHEAD intensive lifestyle intervention (ILI) on long-term health care spending. We investigated self-reported health care use and spending from 2002-2012 (during the intervention) and 2013-2019 (after the intervention). Lasso regressions, trained in Medicare data, were used to predict outpatient, inpatient, prescription drug, and total healthcare spending based on self-reported health care use. Other outcomes included self-reported outpatient visits, unique prescription drugs, and inpatient hospitalizations. Regressions comparing spending and use outcomes for the ILI and diabetes support and education (DSE) control groups were adjusted for baseline demographic characteristics, clinical status, and study site. We included 3957 participants (1997 ILI, 1960 DSE) who had at least one interview during the post-intervention period. Similar to prior work, we found that the ILI group had lower inpatient, outpatient, and prescription drug spending relative to the DSE group during the intervention period, resulting in lower total spending (adjusted difference: -$715: [95% CI: -$1178 to -$252]; P&lt;0.001). However, most of the intervention’s effects on spending and use did not persist beyond the intervention period, except for prescription drug spending (adjusted difference: -$189: [95% CI: -$364 to -$14]; P=0.03) and unique prescriptions (adjusted difference: -0.3: [95% CI: -0.5 to -0.1]; P&lt;0.001). Our results imply that an intensive lifestyle intervention can reduce health care spending for adults with type 2 diabetes, but interventions may need to be continued to maintain spending reductions.
EXPLORING THE UTILIZATION OF MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) PROGRAMS IN WORKFORCE DEVELOPMENT
Authors: Cotton Sam , Faul Anna 
Published: December 2023

Abstract
Measuring patient outcomes is a critical component of the HRSA funded Geriatric Workforce Enhancement Programs (GWEPs), which aim to improve the quality of care for older adult patients. In 2019, GWEPs were tasked with aligning patient outcomes with the CMS Merit-based Incentive Payment System (MIPS) program, which incentivizes quality care and patient outcomes. Collecting and using MIPS data effectively can be a challenging task, particularly when done across multiple levels of care. To address these challenges, the National Association of Geriatric Education Centers (NAGEC) created a workgroup to develop advocacy and solutions for patient outcomes. This symposium will discuss the utilization of MIPS as performance metrics across three GWEPs, the challenges in reporting these outcomes, and implications for future policy changes. This symposium’s primary objective is to explore how GWEPs can effectively measure patient outcomes, despite the challenges involved in collecting and utilizing MIPS data. By discussing these challenges and proposing potential solutions, this symposium aims to improve the effectiveness and sustainability of GWEPs, ultimately leading to better outcomes for older adult patients. Overall, measuring patient outcomes is critical for ensuring that older adult patients receive high-quality care that is tailored to their individual needs and preferences. Despite the challenges involved in collecting and utilizing MIPS data, our symposium provides an opportunity to explore potential solutions and advocate for policies that support improved patient outcomes in geriatric care.
RURAL HEALTH, FAMILY CAREGIVING, AND DEMENTIA: CHARACTERISTICS AND NEEDS ACROSS POPULATIONS
Authors: Stephens Caroline , Goodwin Rebecca , Ornstein Katherine 
Published: December 2023

Abstract
The rural population in the US is aging faster, more likely to live alone, and has more comorbidities than the overall aging population. Despite the greater need for long-term care services, rural residents may experience the most barriers to formal services (hospital, home health) and availability of family caregivers. Unfortunately, there is a dearth of research on aging and end-of-life care in rural areas. This symposium includes 4 presentations focused on rural health, family caregiving and dementia and the characteristics and needs across these diverse populations. The first presentation examines rural disparities in use of family and formal caregiving for older adults with disabilities using data from the Health and Retirement Study. The second presentation describes the unmet services needs among people with dementia and their caregivers living in rural Appalachia, and highlights contextual factors that shape service access and utilization. The last two presentations use data from the Utah Population Caregiving Database to examine the characteristics of families of nursing home (NH) residents who die with dementia and of those who die in rural NHs. Understanding the unique characteristics and needs of these underserved populations will help inform rural health practice and policy considerations to better serve this population, especially as we continue to see changes in the hospital and NH landscape across the US. Moreover, it is critical that even as federal and state policies rebalance long-term care from institutional settings to home- and community-based settings, the unique needs of those living in more rural areas are considered.
RURAL DISPARITIES IN THE USE OF FAMILY AND FORMAL CAREGIVING FOR OLDER ADULTS WITH DISABILITIES
Authors: Miller Katherine , Ornstein Katherine , Coe Norma 
Published: December 2023

Abstract
As federal and state policies rebalance long-term care from institutional settings to home- and community-based settings, reliance on formal (paid) and family (unpaid) caregivers for support at home nationally has increased in recent years. Yet, it’s unknown if use of formal and family care varies by rurality as a disproportional share of the aging population reside in rural areas. Using the Health and Retirement Study, we describe patterns in receipt of combinations of formal and family home care by rurality among community-dwelling adults aged 65+ with functional limitations from 2004-2016. Compared to older adults in urban areas, older adults in rural areas are more likely to receive any family care than those in urban areas and less likely to receive any formal care (2.4 and -4.4 percentage points respectively, p&lt;0.05). From 2004 to 2016, a growing proportion of older adults in rural areas receive care from family caregivers exclusively while a decreasing proportion receive care from formal caregivers exclusively. When examining older adults in urban areas, we find the opposite trend — a growing proportion of urban adults rely exclusively on formal care and a decreasing proportion rely exclusively on family care. We find that national estimates of sources of caregiving and their trends mask significant heterogeneity in uptake by rurality. Understanding how older adults in rural areas are, or are not, receiving home-based care compared to their urban peers and how these patterns are changing over time is the first step to informing supports for family and formal caregivers.
UNMET SERVICE NEEDS AMONG RURAL APPALACHIAN CAREGIVERS OF PEOPLE WITH ALZHEIMER’S AND DEMENTIA
Authors: Russell David , Miyawaki Christina , Bouldin Erin 
Published: December 2023

Abstract
Risk factors for Alzheimer’s disease and related dementias (ADRD) are higher in rural areas than urban areas, and home- and community-based services (services) are less accessible. This study sought to identify unmet services needs among people with ADRD and their caregivers living in rural Appalachia, and highlight contextual factors that shape service access and utilization. We interviewed 22 caregivers and persons with ADRD living in Western North Carolina between August 2021 and April 2022 with recruitment assistance from local agencies and organizations. Themes were identified across domains of our conceptual model informed by theories of health services use, family caregiving, and sociocultural contexts. Family caregivers communicated multiple unmet needs, foremost of which included fragile and insufficient support systems or imbalances between family and paid caregiving support, a lack of clarity about their services options, and feeling behind in preparing for the future. In the presence of unmet care needs, family caregivers made decisions (or not) to use services in aiding them with caring for persons with ADRD. These decisions were shaped by illness-level (e.g. ADRD symptoms and progression), predisposing (e.g. work experiences), and enabling factors (e.g. family support). The sociocultural contexts in which family caregivers and the persons they cared for with ADRD were embedded within, including their culture, beliefs and family norms, also shaped perceptions and use of services. These contexts should be better understood and considered when developing and implementing acceptable services for people with ADRD in rural areas.
WHO DIES IN A RURAL NURSING HOME WITH AND WITHOUT FAMILY? EVIDENCE FROM THE UTAH POPULATION DATABASE
Authors: Goodwin Rebecca , Ornstein Katherine , Iacob Eli , Hollingshaus Michael , Smith Ken , Tay Djin , Utz Rebecca , Stephens Caroline 
Published: December 2023

Abstract
Rural nursing homes (NHs) are an increasingly important focus for policy makers given the lack of available post-acute and long-term care services in these areas. Families often play a critical role in filling this void in services and supporting NH residents at the end of life (EOL). No population-based studies to date, however, have documented the characteristics of families of persons who die in rural NHs. This study aimed to describe the size and composition of first-degree families (FDF) of Utah NH residents who died in rural/frontier NHs 1998-2016 (n=10,567). Using the Utah Population Caregiving Database, we linked rural/frontier NH decedents to their FDF (n=31,118; children=53.7%; siblings=33.8%; spouses=11.3%; parents=1.1%) and compared characteristics of those with and without FDF. Compared to rural/frontier NH decedents with FDF (77.5%), those without (22.5%) were more likely to be older (median 85.7 vs 84.8), female (61.3% vs 56.8%), Hispanic or Non-White Non-Hispanic (6.8% vs 3.7%), and less educated (&lt;9th grade; 45.9% vs 37.4%), all p&lt;0.001. There were no differences in diagnosis of dementia, Charlson Comorbidity Index, or hospitalizations in the last 6 months of life. Persons who live and die in rural NHs without FDF may be in double jeopardy, if you will, given the lack of family support and few to no options for care. Understanding the impact of family, or lack thereof, on rural NH resident EOL care trajectories is an important next step.
CLINICAL NOTES AND CARE COORDINATION CALLS AS IMPORTANT PREDICTORS OF EMERGENCY CARE UTILIZATION IN HOME HEALTH CARE
Authors: Evans Lauren 
Published: December 2023

Abstract
Home care patients experience a high illness burden and a heightened risk of negative health outcomes. There is a need to understand how clinician behaviors, including notetaking and care coordination activities, can be better integrated into risk modelling in home care settings. This study predicted hospitalization/ED visits using data from 86,866 home care episodes from an agency in the Northeastern United States. We began our analysis with nearly 200 variables, including patient-related factors (e.g., comorbidities, types of medications taken, functional status), and factors relating to clinician behavior, such as problems documented in clinical notes, and calling patterns to the patient or medical care providers. We used least absolute shrinkage and selection operator (LASSO) to aid in the selection of the best subset of variables. In our preliminary analysis, we found that two clinician behavior-related factors were the strongest risk factors for experiencing hospitalization/ED visits, specifically the proportion of concerning notes generated during the care episode (OR 8.97, 95% CI 7.64, 10.52), and a measure reflecting frequent calls to the patient’s family (OR 4.51, 95% CI 3.80, 5.37). Clinician documentation of specific problems, and the clinician’s decision to conduct a medication review were also risk factors. Patient risk factors included prior hospitalization, health conditions such as cancer and renal disease), functional limitations, certain medication classes (e.g., anticoagulants, diuretics), the use of oxygen, and the use of a urinary catheter. This study demonstrates that clinician behaviors and documentation patterns can be incorporated in risk models to yield important insights.
ENGAGEMENT OF FAMILY IN ASSISTED LIVING: SECONDARY QUALITATIVE ANALYSIS USING THE ADAPTIVE LEADERSHIP FRAMEWORK
Authors: Cho Youngmin , Crowder Victoria , Bankole Ayomide , Song Lixin , Wu Bei , Anderson Ruth , Beeber Anna 
Published: December 2023

Abstract
Assisted living (AL) residents are at high risk for safety issues (e.g., falls) and poor quality of life (QoL) because they can lose their personal preferences and autonomy in personal care or social activities once they enter AL. Family engagement (FE) plays a significant role in addressing these challenges while considering residents’ needs and preferences. The purpose of this study was to explore family caregivers’ perspectives about FE strategies in AL and contextual factors influencing FE. This study used a secondary analysis of the interview data from a larger study investigating 34 family caregivers’ opinions on AL safety and strategies to increase FE. The Adaptive Leadership Framework guided our directed content analyses to identify how family caregivers address the challenges with AL residents and staff. Family caregivers described adaptive leadership strategies pertaining to getting the residents to recognize the seriousness of their health status, finding available resources to support them, and planning for potential challenges. Family caregivers also described adaptive and collaborative work (with AL residents or staff) strategies such as advocating for resident needs, involvement in direct care or social activities, shared understanding of care plan, and making decisions together. We also found that contextual factors such as fear of speaking up and retaliation, previous experiences in FE, influenced family caregivers’ engagement in AL safety. These findings highlight the important role of family caregivers in addressing AL resident safety challenges. Also, our study provides the rationale for developing practical FE strategies to enhance residents’ safety and QoL.
PERCEIVED FEASIBILITY TO IMPLEMENT A TASK-ORIENTED EXERCISE PROGRAM BY FITNESS STAFF AT SENIOR LIVING COMMUNITIES
Authors: Liu Chiung-ju , Mansuy Lauren 
Published: December 2023

Abstract
Older adults who relocate to senior living communities have a desire to maintain their independence. The fitness infrastructure within these communities is a great platform to deliver evidence-based exercise programs to support residents’ independence, especially for those who have experienced activity limitations. Task-oriented exercise incorporates daily activities into exercise strategies and has been recommended as an approach to reduce late-life disability. The current study used an interview research design to determine the feasibility of implementing 3-Step Workout for Life, a task-oriented program, in senior living communities. The 3-Step Workout for Life program consists of gym-based group resistance exercise and home-based one-on-one activity exercise. Fourteen fitness instructors from different communities, with independent living units, in the state of Florida completed the study. Interviews were transcribed, coded, and underwent thematic analysis. Instructors perceived the screening procedure to select and enroll residents in this program could help match residents to the right fitness program. The gym-based group resistance exercise is compatible with existing instructor-led fitness programs. Although instructors perceived the home-based one-on-one activity exercise positively, such as the potential benefits for frail residents who do not attend the gym, they acknowledged several barriers to implementing this exercise. Major barriers include their job responsibility restricting them from working in the resident’s home, their belief that activity exercise should be better delivered by a rehabilitation professional, and limited staff to support the one-on-one format. The next step is to collaborate with community stakeholders to address these barriers and build capacity to implement task-oriented exercise programs.
UNCOVERING THE HIDDEN WORKFORCE: A STUDY OF DIRECT CARE WORKERS IN ASSISTED LIVING HOMES
Authors: Wyles Christina , Shea Kimberly 
Published: December 2023

Abstract
A growing number of 4.5 million U.S. direct care workers (DCWs) provide hands-on care to older adult residents in assisted living homes (ALHs) -- the smallest type of assisted living residences that require employment of DCWs. These homes typically have capacity for 8-10 residents, and they no longer resemble the original non-medical, home-like environment. With an aging population, increasing complexity of residents’ medical and functional needs, and increasing closure of nursing homes, demand for DCWs in ALHs continues to grow. Better information on this growing workforce segment, federal oversight, and consistent licensure are needed. The few available studies indicate high resident acuity and quality of care issues. To address this knowledge gap, a study explored and described the learning interests and needs and technology use of ALH DCWs. Guided by a human factors framework and an interpersonal perspective, DCWs (N = 14/ median age 41) were interviewed one-on-one using semi-structured questions. Data analysis involved qualitative content analysis of transcribed taped interviews. Findings revealed DCWs are interested in work-related topics and acknowledge the complexity of their residents. They use various health-related technologies in the care they provide, but need more access to educational opportunities that accommodate their long work hours and low salaries. The study also noted the expanded scope of practice, high risk of injury, and underrepresentation of DCWs in the literature. This study highlights learning and technology needs of DCWs in ALHs, emphasizing the need for more recognition and support for this vital segment of the long-term care workforce.
INTERGENERATIONAL FINANCIAL TRANSFER AND FAMILY STRUCTURE IN INDIA: EVIDENCE FROM LASI, 2017–2018
Authors: Nagargoje Varsha , R Dilip T , James K S 
Published: December 2023

Abstract
Understanding patterns of intergenerational support is critical within the context of demographic change, such as changing family structures and population aging. Existing research has analyzed the proportion of direct financial transfers between older parents and adult children and vice-versa. This study also examined the association between family structure and the direction of financial transfer in India. From the first wave of the Longitudinal Ageing Study in India, samples of 30,147 older adults aged 60+ years whose children alive were included. Bivariate analysis and logistic regression methods opted to fulfill the study objectives. Findings showed that the proportion of children-to-parent transfers (13.1%) was triple that of parents-to-children transfers (4.4%). No rural-urban disparity existed in the overall proportion of parents-to-children financial transfers. Conversely, children-to-parent financial transfers have shown marked variation among rural and urban parts of India. Older adults living alone received the most financial support from their children. While controlling sociodemographic and economic characteristics, family characteristics like having children up to eight were significantly associated with higher parents-to-children financial transfers. However, having more than eight children did not show significant effect. Having more children significantly increases the likelihood of financial transfer from children to older parents. Older adults living alone were more likely to receive financial support from children but were less likely to provide it. Filial piety is deeply rooted in India and is reflected through the bond of reciprocity among younger generations to provide financial support to their older parents, which helps older people to maintain better economic well-being.
ETHNIC DIFFERENCES IN DIET QUALITY AND COGNITION AMONG OLDER ADULTS
Authors: Arellanes Isabella , Crimmins Eileen , Ailshire Jennifer , Kim Jung Ki 
Published: December 2023

Abstract
Research indicates an association between diet quality and cognitive outcomes. However, the association across ethnicities is not well understood. This study identifies differences in diet quality using the Healthy Eating Index (HEI-2015) score by ethnicity and its relationship to cognitive outcomes within ethnic groups. The sample includes 6,845 older adults from the 2014 wave of the Health and Retirement Study and nutrition data from the 2013 supplemental Health Care and Nutrition Survey. Cognitive functioning was measured based on a scale ranging from 0-27. Overall, 11% of respondents had a good quality diet, indicated by a HEI-2015 score of 81-100. Diet quality was significantly better among Hispanics than either non-Hispanic Blacks or Whites (p&lt; 0.001 in both comparisons). Diet quality was not significantly different between Whites and Blacks (p=0.82). In a regression model controlling for age, gender, and marital status, the association between diet quality and better cognition was significant among Whites (p&lt; 0.001) and Blacks (p&lt; 0.05), but not significant among Hispanics (p=0.11). A one unit increase in the Healthy Eating Index is associated with a 0.05 increase in cognitive score among Whites and a 0.03 increase among Blacks. These findings suggest significant differences in diet quality across ethnicities that may impact cognition among older adults; however, the impact may differ by ethnicity.
INCONSISTENT ESTIMATES OF POOR HEALTH BETWEEN EUROPEAN SURVEYS—A MATTER OF SURVEY DESIGN?
Authors: Kelfve Susanne , Enroth Linda 
Published: December 2023

Abstract
Several studies have reported about inconsistencies in survey estimates on health, both within and between countries. One potential source of inconsistency in results from population surveys is survey quality. In particular, the prevalence of poor health among older people is sensitive for survey design factors and the inclusion of older people with poor health. We aimed to explore the association between survey design factors and within-country differences (between EU-SILC and SHARE) in estimated prevalence of poor health (long-term illness and global activity limitation (GALI)) among older people. The analyses include people 65 years and older from 25 European countries with data collections both in SHARE and EU-SILC 2017. Results show substantial differences in sociodemographic factors and estimates of poor health, both between and within countries. The within-country differences in the prevalence of long-term illness ranged from -18 percentage points for men in Denmark (lower in EU-SILC compared with SHARE) to 42 percentage points for women in Cyprus (higher in EU-SILC compared with SHARE). The prevalence of GALI showed similar patterns. We conclude that estimates of poor health, measured by long-term illness and GALI, have great variation between surveys within the same country. Survey design factors, such as response rate and the type and number of survey mode seems to explain part of these inconsistencies. Population surveys are widely used for monitoring health and the results from these surveys are utilized in health policy planning. Thus, it is crucial to understand the possible impact of survey design on health estimates.