bluuebunny/crossref_metadata_2025_split huggingface dataset:
A STEPPED WEDGE CLUSTER RANDOMIZED TRIAL OF THE STRIDE SUPERVISED WALKING PROGRAM IN VA HOSPITALS
Authors: Hastings Susan , Stechuchak Karen , Coffman Cynthia , Choate Ashley , Van Houtven Courtney , Wang Virginia , Meyer Cassie , Kappler Caitlin 
Published: December 2022

Abstract
In trials, hospital walking programs improved functional ability after discharge, but little evidence exists on their effectiveness under routine practice conditions or their implementation across health systems. We conducted a Type III hybrid implementation-effectiveness, stepped-wedge cluster randomized trial (SW-CRT) in 8 Veterans Affairs hospitals examining a hospital-based walking program known as STRIDE. Based on the SW-CRT design, hospitals were randomized to a sequence (timeline) for STRIDE, and additionally randomized 1:1 to receive implementation support according to the Replicating Effective Programs (REP) framework only or REP plus additional team-based communication training known as CONNECT. The study was powered to examine impact of STRIDE on discharge destination to home vs other (primary outcome); hospital length of stay (LOS) was a secondary outcome. Patient-hospitalizations in pre-STRIDE time periods (n=8167) were similar to post-STRIDE time periods (n=9070) (e.g., mean age 73, 97% male, 28–30% Black race). In adjusted models, odds of discharge to home were higher among eligible patients hospitalized in post-STRIDE time periods (OR 1.6; 95% CI 1.3–2) compared to pre-STRIDE. Findings were robust to 3 sets of sensitivity analyses. There was no difference in LOS (IRR 1.01; 95% CI 0.94,1.09). Hospitals randomized to CONNECT had higher program reach (mean 13% vs 3%) but lower daily fidelity (mean 25.7% vs 37.5%). Despite limited direct program reach, implementation of a hospital walking program was associated with higher odds of discharge to home. Implementation strategies like CONNECT that enhance teamwork and communication may improve patient access to clinical programs being implemented in new settings.
SURVIVAL OF THE FITTEST OR FRAILEST? COMPARING THE HEALTH OF CENTENARIANS OVER A 10-YEAR PERIOD
Authors: Pat Lian Ying Chun , Lau Bobo Hi Po , Cheung Karen Siu Lan , Chan Grace Man Yee , Kwan Joseph Shiu Kwong , Luk James Ka Hay , Martin Peter , Chan Cecilia Lai Wan 
Published: December 2022

Abstract
The first centenarian study in Hong Kong was conducted in 2011 and examined the multidimensional health of adults aged 95 or older. The 2011 study found that, among a population of about 3,000 centenarians, a significant proportion enjoyed a high degree of autonomy in their daily functions in relatively good health. The study has been repeated in 2021/22 (i.e., born in 1926 or before) when the city had more than 11,000 centenarians. Comparison of the two samples (2011: Nf77; 2021/22: Nf120) who lived with their family shows a significant difference in functional health, but not as much for physical health, favouring the 2011 cohort. More than 75% of the 2011 cohort demonstrated autonomy in activities of daily living (Bathing: 77.9%, dressing: 85.7%, toileting: 90.9%, indoor transfer: 89.6%; continence:75.3% and feeding: 94.8%). Only about half of the 2021/22 cohort were autonomous in these areas (40.0%, 44.3%, 54.7%, 42.5%, 63.2%, 46.7%, respectively). The number of chronic illnesses between the two cohorts were comparable (Mean(SD): 2011: 2.7 (1.6); 2021: 3.26 (1.60), yet dementia and frailty were more prevalent in the 2021 cohort (dementia: 44%; frailty: 9.1%) then the 2011 cohort (41.0%; 23.4%). Our findings alert metropolitans worldwide to the fast-increasing population of adults of advanced age with significant personal care and health needs in the community. Existing care for older adults has to be reframed and overhauled to provide comprehensive home- and personal-care support which will be essential for realizing ageing-in-place for adults in advanced age, especially after social distancing policies in COVID-19.
DEVELOPING A NOVEL FRAILTY INDEX TO STUDY FRAILTY OF SEXUAL AND GENDER MINORITY OLDER ADULTS IN THE ALL OF US DATABASE
Authors: Wong Chelsea , Wilczek Michael , Bosse Jordon , Smith Louisa , Manjourides Justin , Orkaby Ariela , Olivieri-Mui Brianne 
Published: December 2022

Abstract
Prevalence of frailty among older sexual and gender minority adults (OSGM) is unknown despite disparities in mental health, medical comorbidities, and physical function. The NIH-funded All of Us Program was launched May 2018 aiming to enroll 1 million US participants focusing on those underrepresented in biomedical research, including OSGM. Using validated methods, we developed an All of Us deficit accumulation frailty index (AoU-FI) consisting of 33-items using baseline survey responses of adults aged 50+. Deficit domains include comorbidities, physical functioning, mental health, cognition, and sensory impairment. AoU-FI was valid if ≤20% of items were missing and ≤70% were comorbidities. OSGM self-identified or had discordance between gender and sex responses. OSGM (n=5,678) and non-OSGM (n=66,325), were similar in age (mean (IQR) = 66.7 (60–73) vs 66.9 (60–74)) but were more diverse (White 78% vs 82%, Black 7.5% vs. 6.5%, Hispanic/Latino 6.9% vs. 5.9%). AoU-FI had an expected gamma distribution across groups. OSGM frailty had a narrower range (0–0.67 vs. 0–0.75) and higher mean of 0.19 (sd=0.11) vs 0.17 (sd=0.1) compared to non-OSGM. To our knowledge, this is the first study of frailty among OSGM. Findings suggest OSGM experience worse frailty, highlighting the need to understand disparities in frailty, identify interventions, and develop policies to support OSGM. Additionally, our novel AoU-FI creates opportunities to apply frailty to diverse participants and types of data from digital health to genomics within the All of Us database.
THE IMPACT OF A DIGITAL CANCER SURVIVORSHIP PATIENT ENGAGEMENT TOOLKIT ON OLDER CANCER SURVIVORS’ HEALTH OUTCOMES
Authors: Nahm Eun-Shim , McQuaige Mary , Steacy Katarina , Corbit Nancy , Zhu Shijun , Seong Hohyun 
Published: December 2022

Abstract
Cancer is a disease that predominantly affects older adults. The median age at diagnosis is 66 years and 62% of the 15.5 million American cancer survivors are age ≥65 years. Provision of supportive care after treatment is critical to this group due to their complex care needs; however, limited resources are available to them. As increasing numbers of older survivors adopt technology, digital health programs have significant potential to help them improve their health and communicate with their providers. Previously, we developed/tested a digital Cancer Survivorship Patient Engagement Toolkit program for older adults, CaS-PET Silver. The aim was to examine the preliminary impact of CaS-PET Silver on older survivors’ health outcomes. This was a 2-armed RCT with two observations (baseline, 8 weeks) on a sample of 60 survivors age ≥65 years (mean age, 70.1±3.8), who were treated with curative intent within 12 months from enrollment (02/2020-01/2022, COVID-19 pandemic). Outcomes included health-related quality of life (HRQoL), self-efficacy for coping with cancer, symptom burden, health behaviors, and patient-provider communication. Data were analyzed using descriptive statistics, linear mixed models, and content analysis. The majority of participants were black (68.3%, n=41) and female (56.6%, n=34). At 8 weeks, CaS-PET Silver group showed significantly improved physical HRQoL (p &lt; .001, ES=0.64) and symptom burden (p=.053, ES= -0.41). Self-efficacy (ES=0.56), mental HRQoL (ES=0.26), and communication (ES=0.40) showed a tendency to improve. Most participants reported benefits from the program on health management (mean, 19.41±2.6 [3–21]). Further research is needed with larger, diverse older cancer populations.
DIABETES MELLITUS AND HARD BRAKING EVENTS IN OLDER DRIVERS
Authors: Liu Difei , Chihuri Stanford , Mielenz Thelma , Hill Linda , DiGuiseppi Carolyn , Strogatz David , Li Guohua 
Published: December 2022

Abstract
There are an estimated 37 million people with diabetes mellitus (DM) in the United States, including 16 million older adults. DM can impair patients’ driving safety due to diabetic peripheral neuropathy, hypoglycemia, or hyperglycemia, and eye diseases. However, few studies have examined the association between DM and driving safety based on naturalistic driving data. Data for this study came from the Longitudinal Research on Aging Drivers (LongROAD) project, a multisite naturalistic driving study of 2990 drivers aged 65–79 years at baseline. Driving data for the study participants were recorded by in-vehicle recording devices for up to 44 months. We used multivariable negative binomial modeling to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of hard braking events (i.e., proxies for unsafe driving behavior defined as maneuvers with deceleration rates ≥ 0.4 g) associated with DM. Of the 2856 study participants eligible for this study, 482 (16.9%) reported having DM at baseline. The overall incidence rate of hard braking events was 1.16 per 1000 miles. Adjusted for age, race/ethnicity, marital status, education level, annual household income, urbanicity, history of stroke, and number of medications, drivers with DM had a 10% increased rate of hard braking events compared to drivers without DM (adjusted IRR 1.10; 95% CI: 1.08, 1.12). Results of this study indicates that DM is associated with a significantly increased rate of hard braking events in older drivers, suggesting less safe driving. Driving safety should be incorporated into DM management and care programs.
DEVELOPMENT OF OPEN EDUCATIONAL RESOURCES FOR AN AGING AND MENTAL HEALTH COURSE
Authors: Ambrose Madison , McGee Jocelyn , Wood Sinai , Zakrzewski Chris 
Published: December 2022

Abstract
The financial pressures associated with a gerontological education are significant given the rising costs associated with education. This fact is particularly relevant for economically vulnerable university students. One source of stress is the cost of textbooks and other required course materials. Indeed textbook prices have increased at a rate faster than other educational expenses. Additionally, the perspectives of diverse and underrepresented scholars are often not as readily available in some textbooks. In this presentation, our process of adapting an undergraduate Aging and Mental Health course to reduce cost and also showcase diverse perspectives is described in detail. The goals of this project were to: 1) adapt a preexisting course to include low- and no-cost content through the integration of open educational resources (OER); 2) provide the most up-to-date evidence based information for content and skills development in the area of aging and mental health; and 3) highlight the perspectives of diverse or traditionally underrepresented scholars in this field of study. We will also share the process of developing an interactive Pressbooks webbook from a strengths-based perspective wholistic perspective.
HOPE PARTIALLY MEDIATES STRESS AND PERCEIVED BURDEN IN FAMILY CAREGIVERS OF PERSONS LIVING WITH A DEMENTIA
Authors: McGee Jocelyn , Myers Dennis , Meraz Rebecca , Polson Clay , Ke Weiming , McClellan Angela 
Published: December 2022

Abstract
Recent research suggests that hope may positively impact perceived burden in family caregivers of persons living with a dementia. However, there are few studies that have examined hope, as a multidimensional construct, on perceived burden. The purpose of this study was to investigate the relationship between objective and subjective stressors, hope and perceived burden in a sample of caregivers using taking into consideration multiple hope dimensions—specifically hope-agency and hope-pathway. Hierarchical multiple regression and mediation analyses were utilized in a sample of one-hundred and fifty-five family caregivers. Multiple regression analysis revealed that low hope-agency predicted high levels of perceived burden after controlling for known burden correlates. Hope-pathway did not impact perceive burden. Objective stress on perceived burden was partially mediated by hope-agency. The multi-dimensional aspects of hope should be taken into consideration when assessing this population. Hope-related psychosocial interventions aimed at bolstering multiple aspects of hope among family caregivers of persons with a dementia should be further developed and assessed in clinical intervention research.
65 &THRIVE: TRANSFORMING OLDER ADULT CARE IN THE EMERGENCY DEPARTMENT
Authors: Vien Tracey , Bobroff Stella 
Published: December 2022

Abstract
Kaiser Permanente Los Angeles Medical Center’s (LAMC) Utilization Management Department expanded our geriatric initiative throughout the hospital with emphasis in the Emergency Department (ED). The ED is the first point of patient contact in the hospital, early identification and initiation of interventions needed for potential discharge barriers will assist in timely discharges. LAMC obtained Geriatric ED Accreditation (GEDA) Level 2 this year, the first in the Los Angeles County to achieve this title. This was done by implementing ten new policies with quality improvement (QI) metrics, conducting age sensitivity trainings for our staff, and enhancing our ED rooms to be geriatric friendly. Two of the ten interventions in our ED include 1) volunteers to provide support to our geriatric patients prevent functional decline, prevent delirium and readmission rates, and 2) palliative care consults initiated in the ED prevent suffering and promote the best possible quality of life for patients who are facing a serious illness. Between 2020 and 2021, there has been a 15% increase for the census of 65+ patients. 21% increase of number of older adults with ED readmissions, and a 13% increase in number of older adults staying in the ED for more than 8 hours. With the increasing older adult population, we see a rise in our admission and readmissions of older adults in our ED. This indicates a need for geriatric specialized care and Kaiser plans to obtain GEDA for all Southern California Hospitals.
EXPLORING FRONTLINE PERSONNELS’ PERCEPTIONS OF SUPPORT, KNOWLEDGE, AND RESOURCES FOR ELDER ABUSE
Authors: Marrs Sarah , O’Hara Courtney , MacDonald Catherine , Yelvington Miranda , Gendron Tracey 
Published: December 2022

Abstract
In Virginia, the number of both reported and substantiated cases of abuse in later life have grown steadily over the last several years (DARS, 2021; O’Connor, 2019). Unfortunately, the resources provided to combat elder abuse have not maintained the same steady increase; in many cases, funding to agencies that work to prevent abuse in later life has even been reduced (DARS, 2021). To better understand the gap that exists between need and available resources in Virginia, we conducted an exploratory sequential mixed methods study [QUAL → quan] (Creswell & Plano Clark, 2018). In the qualitative strand, we conducted a series of interviews and focus groups with professionals who often are called upon to respond/intervene when elder abuse is suspected: aging and victim services (n = 9), healthcare providers (n = 7), law enforcement (n = 8). Three themes emerged from the qualitative data: increasing capacity, prevention/coordination, and ageism. Findings from the qualitative strand were then used to guide implementation of the quantitative strand. These participants (N = 2,891) worked in a variety of frontline settings with older adults or in aging services, mostly in health care, law enforcement, social services. Project findings point to a need for increased resources for and training on elder abuse, a shift from reaction to prevention of abuse, improved care coordination and case management, and a need to reduce harmful ageist beliefs. Moreover, our findings highlight the effect structural and societal ageism at the policy level perpetuates the prevalence of abuse in later life.
ENGAGING IN CQI TO ENHANCE ADULT PROTECTIVE SERVICES INTAKE AND SCREENING: A QUALITATIVE ANALYSIS
Authors: Davitt Joan , Brown Jocelyn , Zhang Peiyuan , Barry-Dutro Erin , Sesek Greg 
Published: December 2022

Abstract
This qualitative evaluation study was part of a larger Continuous Quality Improvement initiative implemented by the Maryland Department of Human Services Office of Adult Services to improve the Adult Protective Services (APS) screening and intake process statewide. Researchers conducted two 90-minute focus groups via Zoom with 21 intake and screening staff from 14 counties in Maryland in the summer of 2022. Focus group participants were mostly White and African American women with an average of 6.5 years working in adult services. Interviews focused on understanding challenges in APS intake/screening and strategies to overcome those challenges. Each interview was recorded and transcribed verbatim and three researchers used open and axial coding to identify themes. The key challenge expressed by all participants was the difficulty obtaining adequate information from referral sources, in order to discern whether the adult was vulnerable and if the alleged abuse/neglect/exploitation was being committed by a trusted caregiver or fiduciary as defined by state law. Inadequate referral information results in supervisors/screeners making time-consuming follow-up calls to obtain additional information or cases inappropriately screened in for investigation. This challenge was exacerbated by intake workers inexperienced in APS, understaffing, unclear policies and screening tools for APS, and community partners’ and the public’s unfamiliarity with APS services and policy. Strategies to overcome these challenges included additional staff training, public education, additional resources for APS, clearer policies, and improving the APS screening tool. Quality improvement strategies developed from this study that are relevant to APS systems nationwide will be discussed.
ELDER ABUSE SCREENING PRACTICES IN THE VETERANS HEALTH ADMINISTRATION: RESULTS FROM A NATIONWIDE EVALUATION
Authors: Makaroun Lena , Halaszynski Jaime , Smith Kathrine , Dichter Melissa , Rosland Ann-Marie , Thorpe Carolyn , Rosen Tony 
Published: December 2022

Abstract
Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. Veterans are at high risk for EA, and the Veterans Health Administration (VHA) has experience screening for complex psychosocial phenomena including intimate partner violence. While the VHA has national policy regarding mandatory reporting of EA cases, little is known about the extent to which VHA sites currently screen for EA in a standardized fashion and what approaches are used. To address this knowledge gap, we conducted a national survey of all 170 parent station VHA medical centers from January to August of 2021. Surveys were distributed electronically to the Social Work Chief at each site, as social work is responsible for interpersonal violence response in VHA. The survey assessed the presence and characteristics of EA-specific screening practices as well as general abuse/neglect screening conducted with patients of all ages, including older adults. Follow up emails were sent to sites who reported conducting screening requesting additional details not included in the initial survey. Overall, 138 sites (81%) responded to the survey. Among respondents, 3% reported screening older adults for EA using a previously published tool, while 2% reported screening for EA with an unstudied or locally-developed tool. Forty-three percent reported doing general abuse/neglect screening using unstudied questions/tools for patients of all ages, and 41% reported no EA screening at their site. The wide variability in current EA screening practices in VHA presents an important opportunity to standardize and improve EA detection practices.
‘IT RESTORED A BIT OF THEIR HUMANITY”: BRIDGING THE GAP THROUGH HANDS-ON INTERGENERATIONAL LEARNING
Authors: Meszaros Katherine , Beard Renee 
Published: December 2022

Abstract
The Covid-19 pandemic laid bare many of the social inequities and vulnerabilities within the American nursing home industry. Intergenerational learning is thought to be an effective approach to debunking ageism and addressing social isolation, especially in institutional care settings. This study used a mixed method approach to explore the benefits of intergenerational learning, here between college-aged students and nursing home residents. We analyzed qualitative observational data, including 56 hours of participant observation during TimeSlips™ sessions with 32 students and 30 residents at a nursing home in Worcester, Massachusetts. A content analysis of 68 student reflections on the classroom community-based learning (CBL) experience was also performed. This poster reports on the findings from the students who participated in the intergenerational learning project in 2020–2022. A series of common themes emerged. Many students began their experience as skeptics, but retrospectively reported that it was transformative. Personal interactions with elders revealed to students the shared humanity that had with older generations, which then forced them to confront their own ageism and ableism. Intergenerational learning also encouraged students to reflect on their lives, ask what type of person they want to be, what world they would like to live in, and gain new life lessons and perspectives on now to age meaningfully. The value of intergenerational learning far exceeds providing nursing home residents with social stimulation. It can be just as formative to the personal philosophies and outlooks of college-aged students. Intergenerational learning provides tangible and intangible “in-the-moment” benefits to those who participate.
THE RELATIONSHIP BETWEEN AGE DISCRIMINATION AND QUALITY OF LIFE OF DEPENDENT COMMUNITY DWELLING OLDER PERSONS
Authors: Garrido Felipe Sandoval 
Published: December 2022

Abstract
The objective of this study is to examine the age discrimination suffered by dependent older adults and its effects on their quality of life, using a large representative cohort study. Dependency is defined as having difficulties with activities of daily living, both basic (ADL) and instrumental (IADL). To identify perceived ageism, we used data collected by the English Longitudinal Study of Ageing (ELSA) in 2010–2011 (wave 5) that asked respondents about being discriminated because of their age. Quality of life was measured using the CASP-19 scale. We performed both cross-sectional and longitudinal analyses using the subsequent 2012–2013 (wave 6) and 2018–2019 (wave 9) follow-ups. Multivariable logistic regression analysis was used to estimate the odds ratios of experiencing perceived age discrimination. The results show that a quarter (22%) of all respondents experienced age discrimination. Those suffering from dependency and age discrimination had independently significant lower quality of life scores. Perceived age discrimination was cross-sectionally associated with being male, white, in poor physical and mental health, highly educated, with lower wealth. Longitudinally, with being male (odds ratio -OR-: 1.5), highly educated (OR: 1.3), and poor mental health (OR: 1.7). However, quality of life change was not statistically significant among dependent older persons in subsequent waves. Understanding ageism is important to create policies for future interventions. The present results reinforce the idea of previously documented groups at risk of age discrimination in order to protect them, but also the complex panorama of bio-psychosocial determinants involved in tackling it.