bluuebunny/crossref_metadata_2025_split huggingface dataset:
DISCRIMINATION AND COPING AMONG OLDER CHINESE IMMIGRANTS DURING THE COVID-19 PANDEMIC: A QUALITATIVE STUDY
Authors: Liang Jiaming , Yu Kexin , Tung Yi-Hsuan , Li Choi Ha , Wu Shinyi , Chi Iris 
Published: December 2022

Abstract
Discriminatory events against Asians, especially Chinese, became rampant during the COVID-19 pandemic. It is difficult for older Chinese immigrants to effectively protect themselves from racism-related attacks due to their personal and social disadvantages. This study explored older Chinese immigrants’ experience of discrimination and coping strategies, as well as factors that influence their perceptions, attitudes, and coping preferences. Among 27 interviewees, 11 experienced discriminatory incidents themselves or known people around had been discriminated against during the pandemic. Thematic analysis revealed negative psychological impact of discrimination risk or experience. Most participants tended to adopt disengagement coping styles, such as avoidance, rationalization, and reducing social participation. Three primary influencing factors are: (1) perceived unkindness from government and public opinions; (2) concern for own health; (3) limited acculturation. Our findings suggest needing efforts to protect the safety of older Chinese immigrants, and raise their awareness and ability to defend themselves from racism and discrimination.
WHO GETS HOSPICE VISITS AT THE END OF LIFE: A LOOK AT MEDICARE'S HOSPICE SERVICE INTENSITY ADD-ON POLICY
Authors: Plotzke Michael , Christian Thomas 
Published: December 2022

Abstract
In 2016, the Centers for Medicare & Medicaid Services (CMS) implemented the Service Intensity Add-on (SIA) payment for the Medicare Hospice Benefit. The SIA incentivizes direct patient care by registered nurses and medical social workers during the last seven days of life through additional payments to hospices. We examined 100% of Fee-for-Service Medicare hospice claims in Fiscal Year 2020 to determine whether SIA utilization varies by patient and hospice characteristics. Using hospice level fixed-effects regression, we examine the associations between SIA utilization and various beneficiary and hospice characteristics. Relative to beneficiaries with cancer as a principal diagnosis, we find that other diagnoses are associated with only a slight reduction in SIA utilization (a reduction between 0.6 and 1.1 percentage points - where the average SIA utilization overall is equal to 85.3%). Those identifying as black had a reduction in SIA of 1.3 percentage points compared to those identifying as white. Compared to a patient dying on a Sunday, a patient’s death on Tuesday through Friday was associated with a higher likelihood of SIA (between 9.7 and 11.6 percentage points more likely) and more SIA minutes (between 29.9 minutes and 36 minutes). All reported results were statistically significant at the 0.1% level. Based on these results, we find that SIA utilization varied by certain characteristics. As a result, CMS should continue to monitor rates of SIA utilization to better understand whether any patient groups appear to be underserved at the end of life.
LIVE DISCHARGE FROM HOSPICE WITH DEMENTIA: CHALLENGES TO SUPPORTING THE PATIENT-CAREGIVER DYAD
Authors: Wladkowski Stephanie P , Wallace Cara L , Washington Karla 
Published: December 2022

Abstract
A live discharge from hospice disrupts care continuity and results in burdensome transitions for individuals with a life-limiting illness and their caregivers. In 2019, hospices served more than 1.6 million people across the United States, with nearly 63% of Medicare decedents age 85 or older. Of these patients, nearly 350,000 (20.9%) had a principal diagnosis of Alzheimer’s Disease/Dementia/Parkinson’s Disease. Research demonstrates that hospice care improves end-of-life outcomes for adults with Alzheimer’s Disease and related dementias (ADRD), yet with eligibility limited to a six-month prognosis, hospice is not structured to meet longer-term needs. The result is a live discharge from hospice. In 2019, 17.4% of hospice patients were discharged alive from hospice, with 6.5% discharged due to being ‘no longer terminally ill.’ The majority of live discharges are either hospice-initiated due to patient stabilization (extended prognosis resulting in a situation in which a patient no longer meets the life expectancy hospice eligibility criteria) or are patient-initiated (revocation) where a patient or proxy chooses to leave hospice care, typically to access disease-directed therapies or inpatient hospitalization. Both present unique challenges and opportunities for hospice providers. Informed by over 10 years of practice experience and research, this presentation will discuss the impact of live discharge from hospice and the unique impact for patients and primary caregivers of individuals with ADRD, the service gaps that exist for this population, and our recommendations for policy reform.
MULTISENSORY IMPAIRMENTS AND BRAIN VOLUMES IN MID-TO-LATE LIFE
Authors: Wanigatunga Amal , Tian Chenxin , An Yang , Cai Yurun , Gross Alden , Simonsick Eleanor , Schrack Jennifer , Agrawal Yuri 
Published: December 2022

Abstract
Age-related sensory impairment, such as loss in vision or hearing, have been linked to poor brain health. Yet, the relationship between co-occurring sensory impairments and brain volumes remains unclear. We used cross-sectional sensory and brain imaging data from 208 cognitively normal participants of the Baltimore Longitudinal Study of Aging (mean age 72 years; 59% women). Sensory impairments were separately identified with vision, hearing, smell, proprioception, and vestibular function testing. Brain imaging volumes were derived using an automated multi-atlas approach. Multiple linear regression models were used to estimate brain volumetric differences by number of sensory impairments (0-5) or by multisensory impairment status (MSI; ≥2 impairments). For every one additional sensory impairment, there was lower volume in the orbitofrontal gyrus (beta=0.35 cc [SE=0.17], p=0.04) but higher volumes in the caudate (0.14 cc [0.05], p=0.006) and putamen (0.13 cc [0.06], p=0.043). Participants with MSI (versus no MSI) had lower volumes in superior frontal gyrus (-1.01 cc [=0.34], p=0.003), lower orbitofrontal gyrus (-0.91 cc [0.38], p=0.018), superior parietal lobe (0.68 cc [0.27], p=0.011), and precuneus (-0.74 cc [0.35], p=0.038), but similar volumes in the caudate (p=0.12) and putamen (p=0.14). A negative relationship between MSI and brain volume across multiple regions was largely observed yet our exploratory findings raise the possibility that MSI is associated with compensatory maintenance of brain volume structures in the basal ganglia. Future directions include replication of these findings in other studies and longitudinal analyses to determine how MSI relates to brain atrophy.
EFFECTS OF ASSISTIVE TENNIS SHOES ON GROUND REACTION FORCE FOR PATIENTS WITH PERIPHERAL ARTERY DISEASE DURING WALKING
Authors: Evans Nathaniel , Rahman Hafizur , Pipinos Iraklis , Johanning Jason , Hassan Mahdi , Myers Sara 
Published: December 2022

Abstract
Peripheral artery disease (PAD) is caused due to buildup of atherosclerotic plaques, typically in the leg arteries, preventing adequate blood circulation and ultimately claudication. A previous study showed that the vertical ground reaction force (VGRF) curve is significantly flatter in claudicating patients, resulting in a lower and less fluctuant center of mass when ambulating. Patients with PAD also demonstrate significantly decreased propulsion forces in the anterior– posterior direction. Assistive tennis shoes (carbon fiber: CF, and spring-loaded: SL) can potentially assist push-off by substituting for muscle forces using energy stored in a carbon fiber plate or metal spring within the shoe. This study aims to examine how the CF and SL shoes impact walking performance in patients with PAD. A total of ten patients with PAD performed a progressive treadmill test using a pressure-instrumented treadmill for each shoe type: i) standard shoes, ii) CF shoes, and iii) SL shoes. We calculated the peak VGRF for three subjects to date as an average of ten stance phases for the beginning of the walking condition (pain free condition). Preliminary results from three subjects showed that patients with PAD generated a greater peak VGRF wearing CF and SL shoes compared to normal shoes during the heel contact (normal: 0.97±0.10BW, CF: 1.03±0.08BW, and SL: 1.09±0.10BW) and push-off (normal: 0.97±0.06BW, CF: 0.99±0.04BW, and SL: 1.03±0.05BW). In future, we will calculate the VGRF for the remaining patients in pain free and pain conditions and conduct statistical analysis to identify significant differences among shoe types.
A NATIONAL SNAPSHOT OF INFORMATION SHARING DURING CARE TRANSITIONS BETWEEN HOSPITALS AND SNFS
Authors: Adler-Milstein Julia 
Published: December 2022

Abstract
Prof. Adler-Milstein will present national survey results about skilled nursing facilities (SNFs) information sharing with referring hospitals. The survey, which garnered a 53% response rate, found significant gaps in information sharing. Of 471 hospital-SNF pairs, 64 (13.5%) reported excellent performance on 3 dimensions of information sharing (completeness, timeliness, and usability), whereas 141 (30.0%) were at or below the mean performance. Having a hospital clinician on site at the SNF was associated with more complete (odds ratio, 1.72; P = .03), timely (odds ratio, 1.76; P = .02), and usable (odds ratio, 1.64; P = .04) information sharing. Hospital accountable care organization participation was associated with more timely information sharing (odds ratio, 1.88; P = .02). Despite significant federal investment in hospital health IT infrastructure, we conclude that hospitals are not tailoring information sharing processes to ensure that SNFs receive timely, complete, and usable information.
MULTIMORBIDITY PROGRESSION AMONG MEDICARE BENEFICIARIES IN THE HEALTH AND RETIREMENT STUDY (1991–2015)
Authors: Quiñones Ana , Markwardt Sheila , Bobo Michelle , Allore Heather , Newsom Jason , Nagel Corey , Botoseneanu Anda , Dorr David 
Published: December 2022

Abstract
Older adults are at greater risk for developing and accumulating multimorbidity (2+ chronic conditions). This study describes the characteristics of older adults with multimorbidity using Medicare claims over a 24-year period. The HRS-Medicare data (1991-2015, N=17,199, age 67+ years) were used in descriptive analyses. We identified 8,800 (51%) beneficiaries who did not have multimorbidity at first observation (no multimorbidity), 6,270 (36%) with 2-4 conditions at the first observation (low multimorbidity), and 2,129 (12%) with 5+ conditions at the first observation (high multimorbidity). Older respondents (80+ years) had lower levels of multimorbidity at baseline compared with younger respondents (&lt; 70 years); this appeared to be related to differences by birth cohort. Higher proportions of minoritized groups had high multimorbidity (15% non-Hispanic Black; 20% Hispanic; 11% non-Hispanic White). Despite only being 22% of the entire sample, persons with obese body mass index (&gt;30) represented 41% of the high multimorbidity group. Higher incidence rates of disease accumulation were noted for Black (89/1,000 person years [py]) and Hispanic (94/1,000 py) compared with White respondents (82/1,000 py) in the high multimorbidity group. Hospitalization and ED rates increased linearly between the low and high multimorbidity groups. Functional loss was more prevalent in the high multimorbidity group compared with the no multimorbidity group; no difference was observed between no and low multimorbidity. Results highlight sociodemographic differences between Medicare fee-for-service beneficiaries with differing levels of multimorbidity, allowing new insights to guide interventions that address burdensome changes in late life.
LONG-TERM CARE STAFF DECISION-MAKING PROCESSES IN DETERMINING DAILY WELL-BEING OF RESIDENTS
Authors: Bowen Mary (Libbey) , Shin Ju Young , Rowe Meredeth 
Published: December 2022

Abstract
Much of the care provided to residents in long term care (LTC) comes from staff with minimal training, particularly in the area of the assessment of complex clinical presentations. This study utilized semi-structured focus group techniques with 25 clinical staff to understand how they determine whether a resident is functioning within or outside their daily “norm” and how they follow-up on these determinations. The overall finding was that each staff member develops an internally stored phenotype of each resident’s norm. Three primary themes emerged: 1) the staff’s phenotype becomes the ‘gold standard’ to determine whether there is a change and/or a cause for concern; 2) staff include sleep routines, fatigue, participation in usual activities, physical and mental status, and social interactions with others in their phenotypes. Staff reflect in what seems like a random manner through these comparisons, and, from this process, 3) a judgement emerges that helps inform clinical decision-making and potential action of the staff member. In most scenarios, staff decided there was no cause for concern. The identified weakness in this strategy was that staff rarely mentioned or used complementary and confirmatory formal assessment or referral mechanisms to ensure their judgment was correct. Thus, staff utilize complex multidimensional thinking and memory in decision-making but lack the skills or institutional structure to augment this with more formal and reliable techniques. This represents an interesting opportunity to build on existing assessment skills with additional types of assessment, technology-based information and formal referral mechanisms.
STAFFS’ PSYCHOSOCIAL WORK ENVIRONMENT IN RELATION TO RECIPIENT SATISFACTION IN HOME CARE SERVICES
Authors: Kåreholt Ingemar , Lundgren Dan , Kabir Zarina Nasar , Boström Anne-Marie 
Published: December 2022

Abstract
In accordance with ‘aging in place’ policy, older persons in Sweden are increasingly encouraged to continue living at home and if necessary be supported by home care service (HCS). Studies have examined whether the work environment of staff has an impact on the experiences and the wellbeing of the older persons in nursing homes, but few have examined such associations in HCS. The setting was 16 HCS work units. Two surveys were sent, one to staff on psychosocial working conditions, one to care recipients on care satisfaction. For each work unit, data on individual recipient satisfaction was matched to average values on psychosocial work conditions. Outcomes analyzed with linear regressions were overall recipient satisfaction, based on one question, and indexes on: assessment of implementation of services, contact with staff, and sense of security. Index on treatment by staff was analyzed with ordered logistic regressions due to skewed distribution. We used cluster correlated standard errors (clustering on work units). Results showed that good working conditions are important for recipient satisfaction, specifically overall recipient satisfaction, treatment by staff, and sense of security. Psychosocial work factors most important were work group climate, overall job strain, sense of mastery, job control, frustrated empathy, balancing competing needs, balancing emotional involvement, and lack of recognition. Having more home help hours was associated to stronger relation between working conditions and recipient satisfaction, especially with overall recipient satisfaction and treatment by staff as outcomes.
CARE WORKERS’ ADMINISTRATIVE BURDEN IN SWISS NURSING HOMES: A MULTICENTER CROSS-SECTIONAL STUDY
Authors: Ausserhofer Dietmar , Tappeiner Waltraud , Wieser Heike , Favez Lauriane , Zúñiga Franziska 
Published: December 2022

Abstract
Apart from ‘direct’ resident care, care workers in nursing homes also perform tasks that are related to organizational or management activities. ‘Indirect’ care activities, such as administrative tasks, are often considered as burdensome, as they increase overall workload and keep care workers away from caring for their residents. So far, there is little investigation on care workers’ administrative burden. The multicenter cross-sectional Swiss Nursing Homes Human Resources Project (2018) study included a convenience sample of 118 Swiss nursing homes and 2207 care workers (i.e., registered nurses and licensed practical nurses). Care workers completed questionnaires assessing the administrative burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied 2-level binomial generalized linear mixed models. Overall, 73.91% (n=1561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n=787) reporting to spend 2h or more during a "normal" day performing administrative tasks. Ratings ranged from 42.6% (n=884; ordering supplies and managing stocks) to 75.3% (n=1621; filling out the patient’s medical record). One out of four care workers (25.5%, n=561) intended to leave the profession, whereby care workers reporting higher administrative burden (OR=1.24; 95%CI: 1.02-1.50) were more likely to leave the profession. This study provides first insights on care workers’ administrative burden in nursing homes, which can inform the development of interventions to reduce the workload related to ‘indirect care activities’ and to improve care workers’ job satisfaction and retention in the profession.
CAN THE PUBLIC LONG-TERM CARE INSURANCE SERVICES IN JAPAN PREVENT THE DETERIORATION OF CARE LEVELS?
Authors: Sugiura Aki , Kanaya Reiko , Takeya Yasushi , Toki Hiroshi , Yamamoto Ryohei , Yamakawa Miyae 
Published: December 2022

Abstract
In Japan, the public long-term care insurance system supports a super-aged society. The long-term care service (LTCS) system is designed to prevent deterioration of care levels. We conducted a retrospective cohort study to clarify whether using LTCS prevents the deterioration of care levels. We use anonymized data of the Osaka National Health Insurance Database. We analyzed 16,469 subjects who were 65–74 years of age and certified at the mild care level from 2012 to 2015 at the time of initial certification. A baseline measurement was conducted 1 year after initial certification, and observation was continued until the subject’s care level deteriorated. Statistical analysis was performed using the Kaplan-Meier method and the Cox proportional hazards model. The results revealed that the period until the deterioration of care level (which occurred in 25% of subjects) was 6 months in the service use group and 22 months in the service non-use group. Although we included sex, care level, dementia, and Parkinson’s disease as variables in the statistical analysis, service users were more likely to deteriorate than non-service users (Hazard Risks: 1.89; 95% confidence interval: 1.79–2.00). It is likely that other factors, such as heart disease, may also be involved, and there may be a bias related to family caregiver factors. In conclusion, the current findings suggest that using LTCS cannot prevent the deterioration of care levels. Future studies should verify the effectiveness of LTCS by adding further variables and data regarding family caregivers and changes in outcomes.
RELATIONSHIPS OF CEREBRAL PERFUSION WITH GAIT SPEED ACROSS AGE AND SYSTOLIC BLOOD PRESSURE LEVELS
Authors: Windham Beverly Gwen , Griswold Michael , Sullivan Kevin , Mosley Thomas , Mielke Michelle , Knopman David , Petersen Ron , Vemuri Prashanthi 
Published: December 2022

Abstract
We hypothesized that poorer cerebral perfusion could impair mobility, particularly at lower systolic blood pressure (SBP). Cerebral perfusion was measured via arterial spin-labelled (ASL)-MRI in community-dwelling adults of the Mayo Clinic Study of Aging. Usual-pace gait speed was assessed over 5.6 meters on an electronic mat. Linear regression models estimated cross-sectional gait speed associations with ASL and modifying effects of age and SBP, adjusting for sex and body mass index. Results report differences in gait speed (meter/second) per standard deviation (SD) lower ASL or SBP (mean=139.1 mmHg, SD=19.7 mmHg). Among 479 participants (aged 31-94 years; mean age 67.6 years; 44% women; mean gait speed 1.17m/s), relationships of ASL with gait speed varied by age and SBP (ASL-x-age interaction: p&lt;.007; ASL-x-SBP interaction: p&lt;.007). At age 65, 75 or 85 years and a SBP of 120mmHg, each SD lower ASL was associated with a 0.04 m/s (0.01,0.07), 0.07 m/s (0.04,0.10), and 0.09 m/s (0.05,0.13) slower gait speed at respective ages. At age 65, 75 or 85 years with low ASL (1 SD below the mean), each SD lower SBP was associated with 0.06 (0.02,0.09) m/s, 0.03 (0.01,0.06) m/s or .01 (-0.02,0.04) m/s slower gait speed, respectively. With high ASL (mean ASL+1SD), lower SBP trended towards faster gait at older age, e.g. estimated gait speed was 0.04 m/s (0.00,0.09) faster for each SD lower SBP at age 85years. Poorer cerebral perfusion may contribute to slower gait, particularly with lower SBP. The interrelations of cerebral perfusion, SBP, and age with mobility merit further study.
LONELINESS AND DEPRESSION: EXAMINING THE MODERATING EFFECTS OF RESILIENCE RESOURCES
Authors: Zhang Xiaoyan , Silverstein Merril 
Published: December 2022

Abstract
Loneliness is highly prevalent among older adults and can negatively influence their mental health. However, less is known about the factors that might mitigate the effects of loneliness on mental health outcomes such as depression. We propose that resilience resources may serve as potential protective factors that buffer the impact of loneliness on depressive symptoms. This study aimed to (a) test the effects of loneliness, as well as resilience factors of perceived family support and optimism, on depressive symptoms, and (b) examine resilience factors as moderators of the relationship between loneliness and depressive symptoms. Participants derived from the Health and Retirement Study (HRS), a nationally representative sample of the population aged 50 years and older. The analytic sample was selected with baseline measurements in either 2006 or 2008 and two follow-ups across four-year intervals (N= 7,336). Structural equation modeling with latent variables and interaction terms was used to investigate study aims. Results revealed that (a) loneliness was significantly related to an increase in depressive symptoms; both perceived family support and optimism significantly reduced depressive symptoms, and (b) the link between loneliness and depressive symptoms was weaker when older adults reported higher levels of perceived family support and greater optimism. This study highlights the important protective roles played by perceived family support and optimism in reducing the adverse impact of loneliness on depression. Results suggest that strengthening family support and fostering optimism might be promising avenues for improving mental health in older adults particularly among those experiencing loneliness.