bluuebunny/crossref_metadata_2025_split huggingface dataset:
FUNCTION FOCUSED CARE FOR ACUTE CARE: OVERCOMING RECRUITMENT, MEASUREMENT, AND IMPLEMENTATION POST-COVID-19
Authors: Resnick Barbara 
Published: December 2022

Abstract
To help patients spend more time engaged in physical activities and avoid the complications that occur Function Focused Care for Acute Care was developed (FFC-AC-EIT). FFC-AC-EIT includes the implementation of four steps: (1) Environment and policy assessments; (2) Education of staff; (3) Establishing patient goals; and (4) Mentoring and motivating of staff, patients, and families. A total of 600 patients from 12 hospitals will be included. Eligibility of patients is based on being 55 years of age and older, admitted for a medical reasons excluding COVID-19, and demonstrating evidence of dementia. Outcome measures are obtained at baseline, discharge, 1, 6 and 12 months post discharge and include physical function, physical activity, pain and pain management, psychological and behavioral symptoms associated with dementia, delirium and adverse events (falls, rehospitalizations, nursing home admissions). Due to COVID-19 innovative approaches were implemented to be able to initiate and continue with the study. These included: identifying potential participants that were COVID-19 free off site; transitioning some intervention activities with staff to online; completing verbal consent with proxies versus face to face; adjusting follow up MotionWatch 8 deliveries and placements to be done without face to face interaction; and adjusting recruitment time periods and intervention activities to fit with intermittently high periods of COVID-19. This symposium will describe intervention challenges, solutions and lessons learned, describe an effective process and measurement model for identification of participants with dementia; and provide optimal ways to measure pain and physical activity among older adults with dementia.
MEASUREMENT CHALLENGES AND SOLUTIONS WHEN EVALUATING PHYSICAL ACTIVITY AMONG HOSPITALIZED PATIENTS WITH DEMENTIA
Authors: Drazich Brittany 
Published: December 2022

Abstract
Obtaining subjective reports of physical activity from individuals is known to be biased. With increased creation, dissemination, and use of technology, approaches for objective measurement have improved. Although actigraphy is increasingly used, challenges include a lack of clearly established cut off levels for vigorous, moderate, and low level activity in older individuals, decreased arm movement with walking, and the impact of comorbidities (e.g., Parkinson’s Disease) on actigraphy readings. The advantages of the MotionWatch 8 over other devices will be discussed and our protocol for use shared. The findings from the first 200 participants will be described and challenges to interpretation addressed. The majority of the study participants were willing to wear the MotionWatch 8 during hospitalization. Using innovative approaches to avoid direct patient contact due to concerns related to COVID-19, follow up activity was obtained at 1 month post discharge. Lastly, recommendations for interpretation of findings will be provided.
HOME HEALTHCARE ACCESS AND UTILIZATION AMONG VULNERABLE POPULATIONS IN THE US AND PUERTO RICO
Authors: Rivera-Hernandez Maricruz 
Published: December 2022

Abstract
Home health (HH) care utilization among Medicare beneficiaries has exploded, serving over 3.3 million users (The Medicare Payment Advisory Commission, 2021). With the aging of the population and the preference for Home- and Community-Based Services and/or person-centered care delivered in the home, HH care use is expected to continue increasing. Prior research has highlighted inequitable access and use of HH rooted in structural and social determinants of health (Fashaw-Walters et al., 2022). However, more research is needed about disparities in timely access to quality of care and outcomes among racial and ethnic and rural populations. Furthermore, the literature regarding post-acute care has often excluded Puerto Rico HH beneficiaries (Rivera-Hernandez et al., 2020). Given the need to ensure equity of care post-pandemic, there is a pressing need to understand disparities in care and outcomes, specifically using representative data. This symposium will feature four presentations that provide novel insight regarding HH care utilization and outcomes among vulnerable populations. Individual presentations will describe 1) Home health care services utilization among Medicare beneficiaries in Puerto Rico; 2) Public reporting role in exacerbating disparities in access; 3) Differences in home healthcare latency following hospitalization for ADRD patients by race/ethnicity and rural and urban locations; 4) Racial disparity in the start of home healthcare in high-risk ADRD patients by the quality of home health and impact on rehospitalization. In addition, studies in this panel will discuss policy and clinical implications, as well as directions for future research regarding equitable access and health outcomes among HH users.
RACE AND RURAL-URBAN DIFFERENCES IN HOME HEALTHCARE LATENCY IN PATIENTS WITH DEMENTIA
Authors: Kumar Amit 
Published: December 2022

Abstract
Given the need to ensure equity of timely access to post-acute care among minority groups in rural areas, there is a pressing need to understand disparities in the start of home healthcare among minorities with Alzheimer's disease and Related Dementia (ADRD). This study investigates differences in the timing of initiation of home healthcare services following acute hospitalization for ADRD patients by race/ethnicity and rural and urban locations. A secondary analysis was conducted among older adults with ADRD using Medicare data, discharged to home following an episode of acute hospitalization in 2016-2017. The study outcome was a delay in the start of home healthcare after two days of hospital discharge, defined as a home health latency. Compared to non-Hispanic Whites residing in urban areas, Blacks living in urban areas and Hispanics living in rural areas have a significantly higher odd of home health latency 1.15 (95%CI;1.11-1.18) and 1.06 (95%CI;1.02-1.10), respectively.
INNOVATIONS IN REMOTE SUPPORT FOR DEMENTIA FAMILY CAREGIVERS
Authors: Meyer Kylie , Miller Lyndsey , Kaye Jeffrey 
Published: December 2022

Abstract
Remote delivery of dementia caregiver interventions can decrease delivery costs, and make it more feasible to provide evidence-based interventions to caregivers across the country. As the science behind remote delivery develops, new technologies and their applications can ensure preservation of important intervention components and principles, as well as novel forms of data collection. In this symposium, investigators will present on studies that demonstrate how technology can be used to improve delivery and assessment of remote caregiver interventions. Walter Dawson, D.Phil, will share findings from the Support via Technology: Living and Learning with Advancing Alzheimer’s disease and related dementia (STELLA) intervention. Using secondary data collected via weekly survey, he examined the association between costs of care and behavioral symptoms of dementia. Next, Allison Gibson, PhD, MSW, will present results from focus groups about caregivers’ experiences of the Harmony at HOME (H@H), a telehealth intervention to improve person-environment fit and limit behavioral symptoms of dementia. Kylie Meyer, PhD, will present results from the Learning Skills Together intervention, which uses teleconferencing to teach family caregivers how to provide complex care tasks while adhering to self-efficacy theory. Lastly, Shirin Hiatt, MPH, MS, RN, will present findings from the REmote Assessment and Dynamic Response (READyR) study, which tests the application of remote monitoring technology to assess adherence to value-based care (e.g., autonomy) among spousal family care partners. Each study was supported by the Emory University Roybal Center for Dementia Caregiving Mastery or Oregon Roybal Center for Care Support Translational Research Advantaged by Integrating Technology.
ASSOCIATION OF PLASMA LIPID METABOLITES WITH ANKLE-BRACHIAL INDEX IN THE LONG LIFE FAMILY STUDY
Authors: Kuipers Allison , Cvejkus Ryan , Thyagarajan Bharat , Patti Gary , Feitosa Mary , Mengel-From Jonas , Barinas-Mitchell Emma , Zmuda Joseph 
Published: December 2022

Abstract
We tested the association of lipid metabolites with ankle-brachial index (ABI) in the LLFS. Minimum ABI from doppler was used. Participants underwent phlebotomy after &gt;8 hours fasting. Plasma metabolites were isolated via solid phase extraction. Lipid metabolites (N=193) were measured using RPLC-MS and corrected for batch effects in 948 participants. We used linear mixed models adjusted for age, sex, site, fasting, and relatedness. Twenty metabolites were associated with ABI (FDR P&lt;0.05), of which 17/20 were triacyclglycerol (TAG) species, plus cholesterol ester (22:6), phosphatidylcholine (35:7), and phosphatidylethanolamine (38:7). After additional adjustment for traditional ABI risk factors, only two TAGs (50:1, 42:0) were significantly associated after multiple testing correction. While not significant in the base model, the metabolite lysophosphatidylcholine (18:3) demonstrated a marginally significant protective association after full adjustment (P=0.014). While triglycerides are known correlates of atherosclerotic deposition, these findings may identify novel metabolic correlates of peripheral vascular health in long-lived individuals.
REFRAME, REFORM, AND TRANSFORM: POLICY APPROACHES TO IMPROVE NURSING HOME QUALITY IN THE UNITED STATES
Authors: Perone Angela 
Published: December 2022

Abstract
Nursing homes (NHs) are one of the most heavily regulated industries in the United States. However, concerns about quality of care remain, especially for more vulnerable residents, including those with dementia. Concerns only increased during recent natural disasters and the COVID-19 pandemic. Community and industry advocates have suggested diverse reforms that prompted new federal policies. This study poses the following research questions: (1) How do federal policies compare with proposals by community (staff and patient advocates) and industry (NH) advocates to improve quality of care in NHs before and during the pandemic; and (2) How do federal policies address micro, mezzo, and macro level issues? To address these questions, this study employs a multi-level comparison case study design. Primary data includes systematically collected and analyzed federal bills, CMS regulations, and community and industry reports, press releases, and website data from 2018 through 2022. Findings revealed that policy proposals fell into three categories: reframe, reform, and transform. Reframe approaches included minimal transformation at the micro-level. Reform approaches involved more mezzo and macro-level changes. Transform approaches proposed significant structural changes at the macro-level. Community advocates presented far more transformative changes than industry advocates and federal policymakers. Federal policies focused on reframe and reform solutions at the micro level and rarely proposed transforming macro-level structures (e.g., workforce structural inequities). This study has important implications for research, policy, and practice by exposing limitations and strengths of proposed solutions for addressing resident care and concludes with suggestions for better aligning with community advocates.
THRIVING OR SURVIVING? FACTORS ASSOCIATED WITH NURSING HOME SOCIAL SERVICE DIRECTORS REPORTING THRIVING AT WORK
Authors: Kusmaul Nancy , Bern-Klug Mercedes , Smith Kevin , Cheek Dana 
Published: December 2022

Abstract
Nursing homes (NHs) provide care to medically complex residents. Social services (SS) are primarily responsible for addressing residents’ psychosocial needs. High staff turnover in nursing homes is a significant problem. When SS staff leave, training and experience goes with them. Much research has explored nursing staff turnover, far less about SS staff turnover. Social service workers who are thriving are more focused, innovative, and engaged. This study explored characteristics contributing to NH SS directors reporting thriving at work. We surveyed 924 NH SS directors from randomly selected nursing homes. Guided by Spreitzer’s model, a hierarchical logistic regression was conducted utilizing unit contextual factors and individual agentic behaviors to examine likelihood of thriving. Unit contextual factors, i.e. being valued, feeling influence, and the NH providing quality care had the greatest influence on SS directors reporting thriving at work. These results suggest great potential for NHs to foster thriving in SS directors.
POINT-OF-CARE TESTING FOR THE FRAILTY PHENOTYPE PREDICTS POSTSURGICAL OUTCOMES
Authors: Mardini Mamoun , Kaufmann Christopher 
Published: December 2022

Abstract
Frailty is a cornerstone in geriatric medicine and is known to be strongly associated with poor postsurgical outcomes. Fried and colleagues defined frailty as a syndrome with five interlinked components, including weakness, low energy, slow walking speed, decreased physical activity, and unintentional weight loss. Consequently, frailty could serve as a useful measure for the purposes of pre-probability risk assessment for clinical outcomes after a surgery. Electronic health records (EHR) are a rich source of information, and when harnessed appropriately, could provide a valid presurgical frailty screening metric and be used towards anticipating adverse postsurgical outcomes. The growing adoption of EHR in clinical settings can help in identifying patients in need of enhanced intervention to promote recovery following a surgery. However, to date, few studies have fully characterized how individual frailty components, as assessed in the clinic, could be a predictor of postsurgical outcomes. This symposium will examine how presence of frailty and its individual components predict three postsurgical clinical outcomes: length of stay, 30-day mortality, and discharge disposition. We will present data from a unique dataset of approximately 14,000 patients who underwent frailty assessment at the University of Florida-Health (UFHealth) presurgical clinic as part of their standard clinical evaluation. Our presentations will examine each frailty syndromic components and overall frailty as predictors of the outcomes of interest. Findings will demonstrate the utility of electronic health records data for the allocation of at-risk patients for poor postsurgical outcomes. Funding: UF Claude D. Pepper Older Americans Independence Center P30AG028740 and R01 AG055337.
THE MEANING OF FAMILYHOOD FOR GRAY DIVORCE IN ISRAEL
Authors: Koren Chaya , Cohen Yafit , Demeter Naor , Egert Michal 
Published: December 2022

Abstract
Israel is a society that values familyhood alongside self-determination. Gray divorce rates in Israel are low, yet they have nearly doubled since 1996 from 2% to 3.65%. Little is known about grey divorce in modern societies and even less in societies located between tradition and modernity such as Israel. Deriving from data analysis, our aim is to present the meaning of familyhood for gray divorce in Israel from the experiences of individuals and couples who divorced at age 60+ and their adult children, using a life course perspective. 72 in-depth qualitative interviews were audio recorded and transcribed verbatim with divorced men, women, and their adult children, analyzed as individuals, dyads, and family units based on principles of dyadic interview analysis. Findings include three themes: (a) The value of familyhood as a divorce delay. (b) Between couplehood dissolution and familyhood preservation. (c) Gray divorce shaping a new familyhood. Implications are discussed.
A BIOPSYCHOSOCIAL-ECOLOGICAL, FAMILY-FRAMED APPROACH TO DEMENTIA CARE
Authors: Podgorski Carol 
Published: December 2022

Abstract
An individual’s experience of cognitive impairment is shaped by biopsychosocial factors, including their own perceptions of illness as well as interactions with family members, healthcare providers, and the communities in which they live. With advancing illness an individual’s dementia care requires the involvement and commitment of others, usually family. Hence, the quality of a person’s illness experience is shaped largely by relationships with family members and others throughout their respective communities. Current models of dementia care recognize family members as an important part of the care team, but fail to consider a patient’s family system and relationships as social determinants that affect care outcomes. This presentation will introduce a biopsychosocial-ecological, family-framed approach to dementia care that addresses factors that influence care considerations at both the individual and relational levels of the social ecological networks that the patient and their family members occupy.
USE OF TECHNOLOGY TO DELIVER AND MONITOR NONPHARMACOLOGICAL INTERVENTION FOR ADRD WITH BEHAVIORAL SYMPTOMS
Authors: Rhodus Elizabeth , George Rosmy , Kryscio Richard , Barber Justin , Gibson Allison , Wilcock Donna , Jicha Gregory 
Published: December 2022

Abstract
Onset of the COVID-19 pandemic created numerous barriers to providing care supports and clinical research for persons living with Alzheimer’s disease and related dementias (ADRD). Technology offered one avenue for continued care support and clinical data collection. This study reports on the use of technology to deliver a 6-week, non-pharmacological care intervention directed toward caregivers of persons with ADRD and remote data collection including cognitive assessment, biometric data, and survey data for community-residing persons with ADRD and behavioral symptoms (N=28). Benefits and challenges of such technology use for intervention delivery and data collection will be discussed. Benefits include increased geographical outreach, no travel time, and greater scheduling flexibility. Challenges include access to technology (equipment and/or internet), internet connection quality, ease of use, and equipment return at study completion. These findings offer specific aspects to consider while designing and implementing remote care programming and clinical research for community-residing persons with ADRD.
APS PERSPECTIVES ON CHALLENGES AND STRATEGIES SERVING CLIENTS DURING THE COVID-19 PANDEMIC SURGE
Authors: Elman Alyssa , Gottesman Elaine , Makaroun Lena , Chang E-Shien , Clark Sunday , Rosen Tony 
Published: December 2022

Abstract
The initial surge of the COVID-19 pandemic and public health measures in response dramatically impacted Adult Protective Services’ (APS) ability to conduct investigations and provide services, requiring agencies to quickly adapt. Our goal was to describe challenges for APS and strategies they developed to respond. We conducted 6 focus groups and 7 interviews during March-April 2021 used a semi-structured topic guide, with 31 participants from APS leadership, supervisors, and case workers in New York City, a community hard hit by the initial COVID surge. Focus groups and interviews were recorded and transcribed, with data analyzed to identify themes. Participants identified 9 major challenges, including: clients using concern about COVID-19 to refuse APS workers’ access to their home, necessity to perform home visits/wellness checks on behalf of other agencies who had suspended home visits, and dependence on in-office activities including receiving paper mail. Participants reported 30 formal and informal strategies adopted to address challenges. These included 13 focusing on maximizing client engagement while maintaining client and APS worker safety, such as: adding a pre-investigation before a home visit to assess COVID-19 risk/exposure, offering clients masks and hand sanitizer to build trust, and close collaboration with other agencies/programs including joint visits. Also, 17 strategies were reported to allow for remote work and support staff, including: modifying processes to replace paper mail with electronic communication/processing, offering counseling services, formally recognizing excellent performance, and leadership reaching out personally to check on staff members. These findings may inform APS planning for future large-scale societal disruptions.
SELF-NEGLECT OF OLDER ADULTS: HOW CAN ADULT PROTECTIVE SERVICES HELP?
Authors: Liu Pi-Ju , Hass Zach , Stratton Sara , Conrad Karen , Conrad Ken 
Published: December 2022

Abstract
Adult Protective Services (APS) is the only government agency dedicated to investigating elder mistreatment. This frontline agency also provides and coordinates needed services to its clients, but their service effectiveness has not been extensively investigated. Over half of all APS cases investigated are self-neglect. Although no universal definition of self-neglect exists in the literature, self-neglecting older adults fail to perform self-care tasks, such as getting adequate nutrition, maintaining personal hygiene, obtaining medical care, protecting oneself from danger, managing one’s finances– all of which may threaten their health or safety. In partnership with San Francisco and Napa APS, levels of self-neglect were measured using the Elder Self-Neglect Assessment Short-Form during case investigation (before APS interventions) and at case closure (after APS interventions). Services accepted and received by clients at case closure were also documented. A total of 634 older adults’ (on average 77 years old; 50% females) were found to be self-neglecting during the six-month pilot demonstration. Overall, levels of self-neglect decreased after APS interventions (t=-16.97, p&lt;.001). Most common services included care/case management (7%) and mental health services (12%). Services associated with decreased levels of self-neglect included in-home assistance services (b=-1.14, p&lt;.05) and care/case management (b=-0.79, p&lt;.10). Using standardized measures before and after implementing the services needed by older adults allows identification of services that decrease mistreatment. In this study, standardized assessment by APS impacted both practice and research to help advance the understanding of this elder mistreatment type.
AGE GROUP DIFFERENCES IN VIEWS ON ONE’S OWN OLDER ADULTHOOD
Authors: Turner Shelbie , Jarrott Shannon , Hooker Karen 
Published: December 2022

Abstract
Most of the current scholarship on views on one’s aging focuses on middle and older adulthood, prompting lifespan theorists to call for studies about views on one’s aging throughout the entire lifespan (Kornadt et al., 2020). In this study, we established a factor structure to Kornadt et al.’s (2020) Domain Specific Future Selves Scale, which prompted respondents to rate their thoughts on their self in old age across 9 different items. We then utilized measurement invariance testing to analyze how the factor structure differed between 433 young (18-39), 485 middle-aged (40-64), and 286 older adults (65 and older). Via Exploratory and Confirmatory Factor Analyses, three latent factors emerged, constituting future older selves in the domain of social lives (a=0.78), work and finances (a=0.62), and physical health (a=0.76). The model maintained configural (RMSEA = 0.06, CFI = .96; TLI = .95), metric (RMSEA = 0.06, CFI = .97; TLI = .96), and scalar (RMSEA = 0.06; CFI = .96; TLI = .95) invariance across all three age groups. Latent mean testing revealed that older adults thought more positively about their future social lives (p=0.005), work and finances (p=0.05), and health (p=0.02) than did younger adults, and more positively about their social lives (p=0.001) and health (p=0.05) than middle-aged adults. Results from this study offer additional psychometric validation of a measure of future selves that researchers can use across the lifespan, and deeper theoretical understanding of how domain-specific views on one’s own older adulthood might differ between age groups.