bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE TYPES AND CONSISTENCY OF PARTICIPANT-SPECIFIED PROXIES DURING THE SPRINT CLINICAL TRIAL
Authors: Coschigano Kat , Gaussoin Sarah , Jaeger Byron , Rapp Stephen , Williamson Jeff 
Published: December 2023

Abstract

Background
For clinical trials or patient care, reports from a person familiar with the trajectory of a participant’s cognition are needed to ascertain incident Mild Cognitive Impairment and dementia. Informants offer a more unbiased evaluation of cognitive status. Recent large clinical trials studies, such as SPRINT, provide information about the contributions and consistency of informants throughout extended follow-up.

Methods
SPRINT participants named proxies and relationship at study onset. Proxies provided information for the Functional Activities Questionnaire (FAQ) and Dementia Questionnaire (DQ). We collapsed proxy relationships into seven categories and evaluated the proportion of proxies in each category at baseline, how frequently the same proxy was retained to the last visit, and the frequency of successful proxy contact during the trial.

Results
Of the 9,361 randomized SPRINT participants, 7,586 participants listed a proxy relationship from which we identified 7 categories. Participants were 35.6% female, with baseline mean age of 67.9 years. The proportion of proxies in each category was spouse/partner (51.7%), child (23.6%), sibling (8.7%), other family member (6.2%), and unelated (8.8%). The overall consistency of proxy continuation between the baseline and final SPRINT visit (mean 5.1 years) was 90.11%. Proxy consistency from first visit to last visit for a child was 93.41%, spouse/partner (91.87%), other family member (80.1%), brother/sister (86.2%), non-related (84.65%), and parent (81.73%).

Conclusion
Immediate family members (spouse, child, or sibling) comprised the majority of proxies in SPRINT. Importantly, more than 90% of identified proxies at baseline continued to be available over the life of a 5-year trial.
BARRIERS AND FACILITATORS TO IMPLEMENTING MEDICARE’S CHRONIC CARE MANAGEMENT IN RURAL PRIMARY CARE
Authors: Punke Elizabeth , Dabrowski Barbara , Teply Abby , Richardson Katy , McKibbin Christine , Carrico Catherine 
Published: December 2023

Abstract
In 2015, the Centers for Medicare and Medicaid Services introduced Chronic Care Management (CCM) to provide reimbursement to practices for care coordination services necessary to manage chronic conditions among older adults. However, uptake of this program among primary care practices is low, and few Medicare beneficiaries actually receive this service. Implementation of CCM may be even more challenging in rural, low-resourced areas. The purpose of this study was to examine factors associated with more and less successful implementation of CCM within primary care practices located in a rural state. A qualitative study was conducted, which was guided by the Consolidated Framework for Implementation Research (CFIR). Employees of practices (n = 8) that have implemented CCM were approached for study participation. Members (n = 17) of various healthcare teams were included in the study. Participants completed sociodemographic, professional, and practice history measures and completed a qualitative interview. Participants (n = 17) were predominantly White (n = 16; 94%), female (n = 16; 94%), and represented care coordinators, primary care providers, allied health professionals, and administrators. CrossTX records were analyzed to categorize practices by high and low implementation success. Content analysis, guided by CFIR, identified domains associated with implementation success, including Intervention Characteristics (I.e., Relative Advantage), Outer Setting (e.g., Patient Needs and Resources), Inner Setting (e.g., Implementation Climate, Leadership Engagement), and Process (e.g., Champions). Strategies to address barriers include addressing characteristics of the Inner Setting (e.g., Available Resources). Developing training mechanisms to address staff turnover is critical to address barriers.
LEVERAGING IOT AND NATURAL LANGUAGE PROCESSING TO IMPROVE WELL-BEING OF CHRONIC PATIENTS
Authors: Mullachery Balakrishnan , Chatterjee Samir , Brahma Arindam 
Published: December 2023

Abstract
According to the Centers for Disease Control and Prevention, in the United States, about 80% of older adults - individuals aged 65 years and older, have at least one chronic health condition. Chronic diseases require ongoing medical attention or limit activities of daily living, which in turn, affects quality of life. Heart diseases, cancer, and diabetes are the leading chronic diseases. Literature shows that timely and frequent follow-ups by providers significantly reduce readmissions of chronic patients and contribute to their well-being. However, health care provides do not have adequate bandwidth for regular patient follow-ups, which is vital for chronic patients. One solution for this growing problem, is to leverage smart home monitoring technologies facilitating self-care, which in turn can contribute to patients’ well-being. The goal of this research is to build and leverage an IoT-based smart home monitoring platform and assess its impact on the well-being of chronic patients. The platform included an mHealth mobile app with daily journaling capability, which allowed patients to blog about their symptoms, daily activities, and feelings. Analyzing patients’ daily blog data with Natural Language Processing (NLP) methods, this research revealed a strong correlation between a patients’ blog entries and their well-being score. The results also demonstrated that patients’ well-being scores can be predicted from such journal entries analyzed at real time, collected remotely from their home environment, leading to timely diagnosis and intervention opportunities. A field trial was conducted involving five heart disease and eight cancer patients for 180 days to validate the conclusions.
WHOLE HEALTH(Y) AGING WITH GEROFIT: THE DEVELOPMENT OF A PILOT WELLNESS PROGRAM FOR OLDER VETERANS
Authors: Parker Elizabeth , Ortmeyer Heidi , Giffuni Jamie , Addison Odessa , Hall Katherine 
Published: December 2023

Abstract
The Veterans Health Administration (VHA) services over 9 million Veterans; approximately half are older than 65 years of age. Veterans are at a higher risk of comorbidities, including obesity and related chronic diseases, which contributes to higher health care costs, mobility disability, poor quality of life and even death. Gerofit is a VA Best Practice and Whole Health clinical exercise program for Veterans &gt;65yrs that has positively impacted physical functioning, mental health symptoms, medication burden and 10-year mortality. This project describes the development of a comprehensive wellness and health promotion program incorporated into Gerofit, called Whole Healthy Aging Gerofit (WHAG). This novel program implemented wellness components to supplement the Gerofit in-person or virtual exercise options, including health education seminars, mindfulness classes, yoga classes, nutrition education classes, produce pick up service, and the Companion Dog Fostering program. WHAG deliverables included class attendance, individual Personal Health Inventories, observed physical function, self-reported physical activity levels, diet quality, perceived mental health, and Veteran satisfaction. The average Gerofit participant is approximately 73 years old, with obesity and multiple comorbid conditions (n=16), takes 10 medications, and is functionally impaired as assessed by gait speed (1.04 m/s). Programs that target healthy aging are needed to ensure the health of the population as it ages. This pilot program, WHAG, is one example of a comprehensive, patient centered wellness program that supports participants in setting their own goals and definitions of wellness to promote healthy aging.
“I’M INDEPENDENT. SO FAR...”: INVESTIGATING INFORMAL CAREGIVING PATTERNS OF OLDER ADULTS WITH PRIMARY LIVER CANCER
Authors: Watman Deborah , Perez Sasha , Chen Yingtong , Lubetsky Sara , Woodrell Christopher 
Published: December 2023

Abstract
Older adults with advanced stage hepatocellular carcinoma (HCC) are living longer given improved treatment effectiveness. Little is known about their unmet supportive care needs and their caregivers’ needs, some of which may be addressed by palliative care. Previous studies of palliative care in populations facing liver disease have cited difficulty with recruitment. This is a cross-sectional study at a single academic medical center in NYC that uses validated survey instruments and qualitative interviews to explore caregiver support for those receiving treatments for HCC. We recruited patients with liver disease, and caregivers of patients 60 years or older. Validated survey instruments were used to collect data and a qualitative interview is conducted that focuses on the experience of supporting a loved one with HCC. 65% (13/20) participants were over the age of 60. PDSA framework was used to improve recruitment to four caregivers thus far. Results showed that language matters. Recruitment materials were updated from “palliative” to “supportive” care, to reduce stigma and fear of worsening health status and the perception of burden. Older adults value their independence and are not likely to identify a “caregiver”. They may be more willing to identify a loved one who is there to help. 90% of older adults identified a caregiver using the Duke Social Support Index. Thoughtfulness and adaptability are necessary when recruiting amongst this vulnerable yet increasingly independent population. Furthermore, older adults facing liver disease may be solo agers with no caregiver, increasing the need for supportive care as their disease progresses.
BUILDING RESILIENCE USING PHOTOVOICE AMONG FAMILY CAREGIVERS
Authors: Ramos Mary Dioise 
Published: December 2023

Abstract
Filipino Americans remain one of the most underrepresented groups in research. It is challenging to identify the healthcare needs related to palliative and end-of-life care, especially among family caregivers. Palliative care is not yet well known in general, including among Filipino immigrants. Most people seem to adjust to the caregiver role and recover from Trauma/Emotional strain. However, some experience a long-lasting decline in their mental and physical health. This study will fill the gap in our understanding of the experiences of bereaved Filipino American family caregivers who have provided palliative and end-of-life care to their loved ones. This study aimed to explore the opportunities and challenges faced by Filipino American family caregivers who provided palliative and end-of-life care to their loved ones in the United States. The study also examined the impact of Photovoice as an intervention to build resilience, social support, and health-related quality of life among caregivers. The findings revealed that caregivers engaged in self-care activities, sought support from their social networks and healthcare providers, used coping strategies to manage emotional stress, found meaning in their caregiving experiences, and faced physical and emotional demands associated with caregiving. The Photovoice intervention was found to improve caregivers’ resilience and HRQOL significantly, but not their social support. Caregivers need assistance to manage the demands of providing care, including preparing for the future, securing help, and navigating agencies and relationships. Healthcare providers need to provide adequate support and resources to help caregivers manage the physical and emotional demands associated with caregiving.
PERSPECTIVES TOWARD ADVANCE CARE PLANNING IN FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA: Q METHODOLOGY STUDY
Authors: Cho KyungAh , Shin Myoung Hwan , Lee Jung-Ah , Heo Seongkum , Baek Sang Yi , Yang Jisun , Park SeongHu , Kim JinShil 
Published: December 2023

Abstract

Background
Family caregivers’ perspectives toward advance care planning (ACP) is critically important to reflect end-of-life wishes of people with dementia (PWD). Purpose: To explore the ACP perspectives among family caregivers of PWD using a Q methodology. Methodology: Q sample with statements regarding the characteristics of caregivers’ perspectives toward ACP was constructed. P sample of 25 caregivers completed each grid with a statement for Q sorting table. Data analysis was done using the PQ Method program (Ver. 2.35).

Results
Three factors emerged through a Varimax rotation and explained 53% of the total variance. Factor 1 (n = 12) (General cases: Planned preparation of pre-care planning (PPP) and understanding and thoughtfulness of the behaviors of PWD) consisted of caregivers who knew the importance of PPP and willingly tried to understand and manage dementia. Factor 2 (n = 7) (Severe cases: Unplanned preparation of PPP and feeling of responsibility and burden for management of PWD) consisted of caregivers who did not have PPP and had concerns and anxiety about management of PWD. Factor 3 (n = 5) (Mild cases: Optimistic preparation of PPP and proudness for caring PWD) consisted of caregivers who were optimistic about dementia care, were proud of their duty of caring PWD, and thought meeting patients’ needs and caring them as valuable.

Conclusions
Caregivers of PWD had different ACP perspectives based on the severity of cognitive impairment in patients. Clinicians should consider the levels of patients’ cognitive impairment to provide effective ACP education to caregivers of PWD.
RURAL CAREGIVER PERSPECTIVES OF SUPPORTING PATIENT ENGAGEMENT IN VIDEO VISITS
Authors: Gately Megan , Waller Dylan , Maynard Matthew , Moo Lauren 
Published: December 2023

Abstract
Rapid integration of telehealth in response to the COVID pandemic highlighted digital divide issues, specifically for video, which is a live, synchronous encounter. Older patients may have difficulty navigating a video session due to age, health-related impairment, or low technical competence. Further, specialty services which involve hands-on care, such as occupational therapy (OT), are more complex to translate to video, potentially necessitating a second person to assist with set-up or delivery of clinical care. Caregivers may aid in bridging the digital divide between patient and clinicians in a video session. However, little is known about caregiver willingness and capacity to assume a support role in video, particularly caregivers of rural patients, who have more complex care needs and face more issues accessing needed technology than urban patients. To understand the caregiver role supporting older rural patient engagement in video sessions, we conducted interviews with caregivers (N=25) of older rural veterans with an OT video visit. Interview topics included caregivers’ prior use of and general attitudes toward technology, and experiences of the video visit, including set-up and operation of technology and experience participating and supporting patient engagement. Findings revealed a range of rural caregiver perspectives about the role of technology to facilitate patient access to care, including enabling factors which highlighted caregivers’ education and training support needs. This study deepens our understanding of the importance of caregivers to support rural patient access of video sessions, informing development of strategies to optimize caregiver participation.
DO OLDER ADULTS APPRAISE ELDERSPEAK COMMUNICATION AS PATRONIZING OR RESPECTFUL IN HOSPITAL DEMENTIA CARE?
Authors: Shaw Clarissa , Ward Caitlin , Weimar Lisa 
Published: December 2023

Abstract
Elderspeak communication is speech that sounds like babytalk to older adults. The Iowa Coding Scheme for Elderspeak (ICodE) contains 11 elderspeak attributes: diminutives, childish terms, collectives, short words, directives, reflectives, minimizers, exaggerated praise, laughter, tag questions, and exaggerated prosody. Thirty-one older adults (aged 74.5±7.8 years) listened to 41 clips of nursing staff providing care to hospitalized patients with dementia and rated each clip using the 5-point Emotional Tone Rating Scale for patronizing and respectful (5=very, 1=not at all). Each clip was classified using the ICodE as either neutral (no elderspeak), containing a single attribute, or containing an attribute with exaggerated prosody. Linear mixed modeling was used to evaluate the differences in patronizing and respectful ratings between neutral clips and each attribute, and clips with each attribute and exaggerated prosody, while controlling for within-subjects correlation and adjusting for multiple comparisons. Mean ratings for neutral clips were 4.0±1.1 for respectful and 1.7±1.0 for patronizing. Ratings for elderspeak attributes ranged from 2.1 to 2.9 for patronizing and 2.8 to 3.8 for respectful. Ten of the 11 attributes, excluding exaggerated praise, were rated as significantly more patronizing and less respectful than neutral. The addition of exaggerated prosody was significant in comparison with the elderspeak attribute alone for exaggerated praise (more patronizing and less respectful), laughter (more patronizing), short words (less patronizing, more respectful), and diminutives (less respectful). This analysis validates that the attributes of the ICodE are considered more patronizing and less respectful by older adults compared to neutral communication in hospital dementia care.
EARLY WARNING SYSTEM SCORE FOR URGENT ET TUBE OR UNPLANNED ICU ADMISSION FOR ELDERLY PATIENTS IN GENERAL WARDS
Authors: Suwanpasu Sunee , Poonsap Sukanya , Praparpak Werapattra 
Published: December 2023

Abstract
Early warning system scores are tools used to identify the early signs of physiologic deterioration in order to initiate early intervention and management. This study aims to investigate the efficacy of the National Early Warning Score (NEWS) score and Search out Severity Score (SOS) in predicting urgent ET tube or unplanned ICU admission. A Prospective analytical study of 85 patients aged 60 years and over in general medical wards, was conducted to assess the ability of SOS and NEWS. Prediction ability was assessed using sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC). The NEWS and SOS systems at 4 hours before the event were the most effective, with the cut-off values of NEWS&gt; 7 and SOS&gt; 4 giving the best accuracy (sensitivity 71.4%, 64.3% specificity 98.2%, 98.2%. Respectively). The area under the ROC curve [AUC]) was 0.90 (95% CI 0.81-0.99) and 0.86 (95% CI 0.75-0.97), respectively. The prediction efficiency decreased over time before the event. However, at 8, 12, and 24 hours before the incident, it was still accurate at a good-fair level (AUC 0.82, 0.82, 0.74, and 0.77, 0.79, 0.72, respectively) The NEWS system provides excellent accuracy, while the SOS system gives a good accuracy level. Therefore, the NEWS system should be used for the early detection of abnormalities and as a guideline for the rapid response to changes in the vulnerable elderly. It keeps patients out of the crisis and is safe and able to predict worsening patients.
INVESTIGATING ADVERSE OUTCOMES OF LONG-TERM STEROID IMMUNOSUPPRESSION IN ELDERLY RENAL TRANSPLANT RECIPIENTS
Authors: Johnson John , Stevenson Heather , Mujtaba Muhammad , Kueht Michael 
Published: December 2023

Abstract
Steroids are widely used in renal transplantation to prevent allograft rejection; however, long-term steroid use is associated with adverse side-effects such as hyperglycemia and osteoporosis, which elderly patients are especially susceptible to. Our study analyzed the adverse effects of long-term steroid immunosuppression in elderly renal transplant recipients using the TriNetX database. TriNetX was used to perform a propensity-score matched case-control study of 5-year outcomes in elderly renal transplant recipients (≥ 65 yrs) who either underwent an early-steroid withdrawal (ESW) or steroid-continuous (SCI) maintenance immunosuppression regimen. ESW patients were maintained long-term (5 yr) on tacrolimus and mycophenolate and discontinued prednisone 7 days post-transplant. The SCI cohort was maintained on 5yr tacrolimus + mycophenolate + prednisone. Cohorts were matched on age, sex, race/ethnicity, BMI, diabetes, cardiovascular disease, and bone disorders. Primary outcomes included rejection, drug-induced diabetes, bone fractures, and malignancy 5 years post-transplant. There were 197 patients in each cohort after matching (ESW, SCI). SCI patients had significantly higher incidences of 5-year drug-induced diabetes (4.53% vs 15.73%, p &lt; 0.01) when compared to ESW. There was no significant difference found for incidences of rejection (33.02% vs 33.91%, p = 0.86), bone fractures (12.27% vs 16.29%, p = 0.19), or malignancy (11.57% vs 15.78%, p = 0.26). Our study found that elderly SCI patients had significantly higher incidences of drug-induced diabetes when compared to ESW. More insight is needed into differences in average glucose, blood pressure, and cholesterol throughout the duration of the study and dosage differences within the SCI cohort.
PARO ROBOT INTERACTION DECREASES PAIN AND AGITATION SCORES IN HOSPITALIZED OLDER ADULTS WITH ADRD AND/OR DELIRIUM
Authors: Cacchione Pamela , Munsterman Ellen , Walke Lisa , Triantos Lisa , Johnson Michelle , Cheeks Jodi 
Published: December 2023

Abstract
Hospitals are stressful for persons with Alzheimer’s Disease and Related Disorders (ADRD) and/or delirium. Therapeutic robotic animals, used in long-term care, are gaining traction in hospitals to decrease agitation. The purpose of this RCT was to 1) test the effectiveness of the PARO Robot in decreasing agitation (CMAI-OT) and pain, (PAINAD); 2) quantify the interactions (SIT) with PARO over 2 visits in persons with ADRD and/or delirium. We enrolled 45 intervention and 42 attention control (2 one-hour PARO interactions vs. research assistant interactions) participants. The CMAI-OT and PAINAD were completed at baseline and every 20 minutes X 3 in both groups. No differences between groups on age (M=83.7), gender (63% female), race (77 % Black) number of antipsychotics prescribed [M=1.2 vs M1.5, p=0.14], or baseline CMAI-OT scores PARO vs control [M=9.3 vs M=9.4, p=0.94]. CMAI-OT decreased at 20 minutes in the PARO group [M=3.9 vs. M=7.0, p= .004] and remained lower for the hour but not significantly. PAINAD scores were similar at baseline [M=2.0 vs M=2.2, p=0.65]. PAINAD scores decreased for PARO vs. control [M= 1.64 vs. M= 2.28, p=0.02; M=0.9 vs. M= 1.8, p=0.03] at 20 & 60 minutes day one without differences day two. Participants held PARO; engaged physically; talked to; smiled; and agreed to have PARO return. We demonstrated improved agitation for first 20 minutes of PARO interaction as well as lower pain over the first 60 minutes day one. Findings did not persist through day two. Next steps are to measure emotional responses to PARO.