bluuebunny/crossref_metadata_2025_split huggingface dataset:
BETTER NP PRACTICE ENVIRONMENTS REDUCE HOSPITALIZATION DISPARITIES AMONG DUALLY ENROLLED PATIENTS
Authors: Nikpour Jacqueline , Brom Heather , Mason Aleigha , Chittams Jesse , Poghosyan Lusine , Carthon Margo Brooks 
Published: December 2022

Abstract
Adults dually-enrolled in Medicare and Medicaid experience twice as many hospitalizations and higher rates of ambulatory care-sensitive conditions (ACSCs) – such as coronary artery disease [CAD] and diabetes, compared to Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address care needs of dually-eligible patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and disparities in all-cause hospitalizations between dually-eligible and Medicare-only patients with ACSCs. Using linked secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ) and Medicare claims files, we examined 189,420 patients with CAD and/or diabetes (19.1% dually-eligible, 80.9% Medicare-only), cared for in 470 practices employing NPs across four states (PA, NJ, CA, FL) in 2015. After adjusting for patient and practice characteristics, dually-eligible patients in poor practice environments had the highest odds of being hospitalized compared to their Medicare-only counterparts (OR 1.60, CI: 1.49-1.71). In mixed practice environments, dually-eligible patients had approximately 48% higher odds of a hospitalization (OR 1.48, CI 1.31-1.68), while in the best practice environments, dually-eligible patients had approximately 37% higher odds (OR 1.37, CI 1.21-1.57, p &lt; .001). As policymakers look to improve outcomes and reduce costs among dually-eligible patients, addressing a modifiable aspect of care delivery in NPs’ clinical practice environment is a key opportunity to reduce hospitalization disparities. Yet further efforts are needed to address remaining disparities by meeting patients’ health-related social needs, such as poverty and access to care.
AGE-RELATED DIFFERENCES IN HEALTH-RELATED QUALITY OF LIFE AMONG WESTERN CANADIAN NURSING HOME RESIDENTS
Authors: Shieu Bianca , Schwartz Todd , Hoben Matthias , Toles Mark , Beeber Anna , Anderson Ruth 
Published: December 2022

Abstract
Nursing homes (NHs) typically focus on health-related quality of life (HRQoL) among residents aged 65 and over despite approximately 7% of NH residents are younger (aged 18-64). Research suggests that the needs of younger NH residents are not being met and they may have low HRQoL. However, differences in HRQoL of younger and older NH residents may not be apparent in studies that use HRQoL measures designed for research with older NH residents. We hypothesized that the younger residents would have lower HRQoL mean scores than the older (aged ≥ 65) residents using a HRQoL measure based on the HRQoL score derived from Resident Assessment Instrument – Minimum Data Set 2.0 items. The measure uses items that emphasize physical aspects of quality of life rather than social aspects. In a sample of 21,129 residents from 94 NHs in Western Canada, we performed descriptive analyses, t-test, chi-square test, and an adjusted propensity score (PS) analysis through retrospective cohort study from years 2016 to 2017. The HRQoL index score ranged from -.351 to .996 (Mean= 0.693, SD=0.265). In the PS model, the adjusted mean score for younger was higher than for older adults with a mean difference at 0.061 (95% CI 0.031, 0.091) (p&lt;.001). Other domains such as mental health condition of quality of life must be examined in younger NH residents because it is a crucial factor influencing their daily lives, thereby we can explore a more complete set of HRQoL domains of them and redesign care for their unique needs.
CHRONIC DISEASE AND LIFE EXPECTANCY DISPARITIES OF OLDER ADULTS IN SINGAPORE
Authors: Guo Xueying , Wee Hwee lin , Chen Cynthia 
Published: December 2022

Abstract
Singapore is one of the countries with longest life expectancy, also one of the most rapidly ageing societies in the world. This study investigates the future demographic transitions in Singapore, focusing on the life expectancy disparities of the older adults. We developed a dynamic Markov microsimulation model based on the Singapore Multi-Ethnic Cohort study. The model was adapted to project future trends of chronic diseases, mental illnesses as well as hospitalisation costs of Singapore older people from 2020 to 2050. The prevalences of diabetes, heart disease, hypertension, stroke, disability, dementia and depression of people aged 51 and above was projected to be increasing. Overall projected life expectancy at age 51 for male is 27.8 years, and for female is 34.5 years. Moreover, for older people with secondary or upper education, the overall projected life expectancy at age 51 is 34.1 years, active life expectancy at age 51 is 28.6 years. For older people with primary or lower education, the overall life expectancy at age 51 is projected to be 27.9 years, and active life expectancy projected to be 23.9 years. Our study has significant social and economic implications for policymakers in the way that it demonstrates disparate trends in aging and costs among different education groups in Singapore.
HOME-BASED EXERCISE PROGRAM WITH MEAL DELIVERY INCREASES DAILY STEP COUNT IN HOMEBOUND OLDER ADULTS
Authors: Kaur Harmanpreet , Lee Jessica 
Published: December 2022

Abstract
The United Nations projects adults aged 60 and older will reach 2.1 billion by 2050. With this trend, there will be an increase in older adults who are homebound, leading to more frailty with increased healthcare utilization and institutionalization. Improvements in frailty and homebound status may occur through increased physical activity, which has been shown in multiple randomized controlled trials to improve frailty. Our study aims to evaluate the effects of a home-based exercise program, administered through Meals on Wheels, on gait speed and frailty status in sixty-four homebound adults age 60 and older. All participants receive meal delivery for 12 weeks and half are randomized to receive an exercise kit with weekly exercise handouts. All participants are asked to wear an activity tracker with an additional longitudinal measure at 6 months. We now have 6 participants who have completed the study. Preliminary analysis was conducted on step count between the exercise and non-exercise group using two-sample t-tests. Average daily step count in the exercise group (n=3) was 2656 compared to 813 in the non-exercise group (n=3), p&lt; 0.00001 during the first 12 weeks. The step count in the exercise group did decrease during the weeks after the intervention stopped, however they remained more active than the non-exercise group, 1112 vs 548, p&lt; 0.0001. No adverse events were noted. As we continue to enroll participants, we are encouraged that the home-based exercise program with meal delivery appears to be a safe and effective way to increase physical activity in homebound older adults.
HEALTHY AGING TALK AROUNDS: NEAR AND FAR
Authors: Mullins Lindsay 
Published: December 2022

Abstract
BackgroundLoneliness and chronic health conditions are the two most cited ailments among older adults (OAs) that deter independent living. Community-tailored health programs increase feelings of connectivity to neighbors and link OAs to healthcare resources. MethodsDesign. The Healthy Aging Talk Around program is product of CAB formation, input, and a series of talks in-person (near) and virtually (far). Using qualitative methods, data was collected to determine significant health issues for OAs and qualitative data were collected through surveys to evaluate knowledge, access, and feelings of connectivity related to series gatherings. Setting and Population. Inner-city and rural OAs in the deep south from various communities (2 FBOs, 1 Assisted Living, 2 neighborhood groups). Series was held in community and later online. Attendance ranged between 75-130 OAs. Measures. Qualitative measures included pre and post series surveys (n=110; n = 91) with questions to determine the impact of the series. Analysis. Content analysis was conducted with the qualitative data to determine the impact of the series on 1.) knowledge of health issue(s), 2.) likelihood of accessing health resources, and 3.) feelings of connectivity and isolation. ResultsThe qualitative data analysis suggested the series as relatable because information was tailored linked to local community resources. Discussion of independent living challenges fostered connectivity with neighbors. Once virtual, knowledge and access were similar, feelings of connectivity were less prevalent. ConclusionA community-tailored health program series can increase knowledge of health issues, access to resources, and create neighborly connectivity potentially influencing ability to age in place.
PERSPECTIVES OF UNDER-RESOURCED PATIENTS ABOUT THE MEDICARE ANNUAL WELLNESS VISIT
Authors: Ferrone Christine , Goldman Roberta , Wilkinson Joanne , Borkan Jeffrey , Clark Phillip 
Published: December 2022

Abstract
The Medicare Annual Wellness Visit (AWV) involves a personalized risk assessment and prevention plan to help prevent disease and disability among older adults. Though studies have shown that AWV uptake is suboptimal, little is known about the perspectives and experiences of patients completing it. Family medicine physicians are conducting AWVs at a Rhode Island pilot teaching clinic participating in the GWEP's Age-Friendly Health Systems Initiative. To evaluate perspectives of the clinic's under-resourced patients, 20 qualitative telephone interviews were conducted following their AWV. Interview recordings were analyzed for content and themes. Few patients recognized the term ‘Annual Wellness Visit’ or recognized it was significantly different from other visits: “I noticed it was a bit different, but not that different. I’m usually not covered for a visit like that by Medicare.” Mental health, mobility and medications were discussed at most of the AWVs. Some patients noticed that a physician did the medication review instead of the nurse. Patients had varying experiences of how advance directives were discussed, and some thought it unnecessary since a family member knows their preferences. A few patients were dissatisfied that their physician did not focus on their chronic or acute health problems. However, most patients “trusted” their physicians to do “whatever is necessary” for them, and were glad to have had the AWV because “instead of talking about being sick all the time, talking about how to stay well”. Recommendations for patient education to improve understanding and the experience of the AWV will be offered.
HEALTH PROFILES OF OLDER NURSING HOME RESIDENTS BY SUICIDAL IDEATION: A LATENT CLASS ANALYSIS
Authors: Yuan Yiyang , Barooah Adrita , Mack Deborah , Lapane Kate , Ulbricht Christine 
Published: December 2022

Abstract
In US nursing homes, 2% of residents have documentation of suicidal ideation (SI). Whether older residents’ health profiles differ by SI is unknown. Using the 9th Patient Health Questionnaire-9 (PHQ-9) item on Minimum Data Set 3.0, we identified 15,277 older residents with and 562,184 without SI. Latent class analysis using frailty, cognitive impairment, palliative care index, pain, and remaining PHQ-9 items as indicators identified health profiles by at-admission SI and estimated the association between profiles and SI at 90 days. In residents with at-admission SI, four profiles emerged: (1) frail, intact/moderate cognitive impairment, all depressive symptoms (prevalence: 22.8%); (2) frail, moderate/severe pain, depressed mood, sleep problems, fatigue (32.2%); (3) frail, severe cognitive impairment, depressed mood, fatigue, feelings of worthlessness (22.9%); (4) pre-frail, moderate/severe cognitive impairment, depressed mood (22.0%). Compared to the residents in profile 4, those in profile 1 [adjusted OR (aOR): 1.24; 95% Confidence Interval (CI):1.11-1.37] and those in profile 2 [aOR: 1.11; 95% CI: 1.01-1.22] were more likely to continue reporting SI at 90 days. In residents without at-admission SI, three profiles emerged: (1) frail, depressed mood, fatigue (33.9%); (2) frail, severe cognitive impairment (38.1%); (3) prefrail/frail (28.0%). Residents in profile 1 were more [aOR: 2.80; 95% CI: 2.60-3.00] while those in profile 2 were less [aOR: 0.79; 95% CI: 0.71-0.86] likely profile 1 residents to report SI at 90 days. Findings indicate substantial heterogeneity in the health profiles between and within older residents with and without self-reported SI.
“I EAT TO NOT DIE”: DIET AND EXERCISE EXPERIENCES OF OLDER ADULTS LIVING ALONE
Authors: Choi MoonKi , Bae Juyeon 
Published: December 2022

Abstract
Living alone is a critical health risk factor among older adults. Regular exercise and a balanced diet are important for maintaining an independent and healthy life. However, it can be more difficult for older adults living alone to maintain healthy exercise and dietary habits due to the lack of social support. This was a qualitative descriptive study to explore the life changes that accompany living alone, focusing on exercise and diet and the need to improve the nutrition and physical activity of older adults living alone. Thematic analyses were applied to analyze the qualitative data collected from semistructured in-depth interviews. Fifteen subjects, including 5 men and 10 women, participated in the interviews. The mean age was 77.73 ± 7.37 years, and the mean duration of living alone was 17.73 ± 12.89 years. Six main themes were developed: unavoidable difficulties of living alone (lack of someone to depend on and loneliness), just eating “to not die”, exercise that is good for health but hard to do alone, conflict between maintaining independence and dependence on others, coping with available resources, and resources needed for regular exercise and a balanced diet. Living alone led to poor dietary habits, such as skipping meals or insufficient food intake. Food security should be ensured through the reinforcement of social support, financial assistance, and the operation of public cafeterias. In addition, a tailored group exercise program that can meet the need for social interaction and improve self-efficacy would help older adults living alone maintain regular exercise habits.
CURRENT PRACTICE PATTERNS IN HOME HEALTH OCCUPATIONAL THERAPY
Authors: Liu Chiung-ju , Burch Hannah , Glover Sabrina , Donofrio Abigail , Oliveros Gianna , Demeo Gianna 
Published: December 2022

Abstract
Occupational therapy practitioners are essential members of the home health rehabilitation team to support patients transitioning from acute care to home. However, home health occupational therapy services have been underutilized, in part, due to limited understanding of services that the profession provides. Improving this understanding is necessary to help patients receive timely services. The purpose of the study was to describe the current practice patterns in home health occupational therapy. Fifty home health occupational therapy practitioners from 27 states completed an electronic survey between May and June 2021. The survey consisted of questions about assessment and treatment, communication with physical therapy colleagues, and the impact of the Patient-Driven Grouping Model and the coronavirus disease 2019 pandemic on service delivery. Results showed that occupational therapy assessments focused on personal care activities, mobility and balance, and cognition. The treatment content usually included training in activities of daily living, functional mobility, the application of compensatory strategies (e.g., home adaptations), and fall prevention strategies. Most respondents communicated with their physical therapy colleagues at least once a week on topics related to scheduling, changes in a patient’s condition, and falls and safety concerns. Seventy percent of respondents experienced a reduction of home visits during the recent Medicare payment reform and the pandemic. These practitioners felt that some patients might be discharged prematurely because of this reduction. The survey results highlight the pertinence of occupational therapy services to support patients’ independence and safety at home and the need to increase these services for home health patients.
FREQUENT USERS OF EMERGENCY MEDICAL SERVICES IN A METROPOLITAN CITY: INDIVIDUAL- AND SYSTEM-LEVEL CONSIDERATIONS
Authors: Martinez Beatrice , Aranda Maria , Aguilar Iris , Sanko Stephen , Vega William 
Published: December 2022

Abstract
Frequent 911 calls from older adults place a significant burden on emergency response systems. Drawing from key informant interviews, we explore factors implicated in repeated Emergency Medical Services (EMS) among older people in the City of Los Angeles and provide system and policy recommendations to mitigate overuse of EMS 911 calls. Los Angeles Fire Department (LAFD) dispatch call records documented 370,016 EMS encounters from 202,471 unique individuals over 50 from 2012 to 2016. Frequent 911 callers over the age of 50 (n=8), family members (n=6), Los Angeles Fire Department (LAFD) personnel (n=10), and community service providers (n=3) participated in in-depth, qualitative interviews to understand individual- and system-level factors that increase the likelihood of repeated calls. All interviews were audio recorded, transcribed, and analyzed thematically. Guided by Grounded Theory, two themes emerged across all interviewee groups pointing to factors that contributed to 911 calls: 1) The Nature of 911 Calls; 2) Barriers to Access. Patients and family members were aligned on a third theme: 3) Previous Encounters: Interactions with emergency care providers, while LAFD and service providers were in agreement on a fourth theme: 4) The Role of EMS Responders and Community Providers. All groups provided recommendations for the theme, 5) Change the System so that 911 calls do not serve as the default choice. Findings demonstrate the need to improve coordination between LAFD, medical and human service providers. Care coordination can support individual- and system-level supports for patients and families to address their needs and reduce repeated EMS use.
SKELETAL MUSCLE HEALTH AND LOWER URINARY TRACT SYMPTOMS IN OLDER ADULTS
Authors: Cawthon Peggy , Bauer Scott , Parker-Autry Candace , Lu Kaiwei , Cummings Steven , Hepple Russell T , Scherzer Rebecca , Covinsky Kenneth 
Published: December 2022

Abstract
Lower urinary tract symptoms (LUTS) are associated with increased risk of mobility limitations among older adults. Our objective was to evaluate the association of muscle (D3Cr muscle mass, MRI total thigh muscle volume, Keiser extensor power, grip strength) and physical performance (400m walk, SPPB) measures with LUTS severity and bother among adults age &gt;70 years in the Study of Muscle, Mobility and Aging (SOMMA). We used data from the first 132 women and 103 men to complete their baseline visit where LUTS were assessed using the LURN Symptom Index-10 (SI-10) plus a global urinary bother question. We calculated Spearman correlation coefficients and chi-square tests as appropriate, stratified by sex. Among women, LURN SI-10 scores were inversely correlated with D3Cr muscle mass/body weight (ρ=-0.217, P=0.01), peak leg power/body weight (ρ=-0.179,P=0.04), and SPPB (ρ=-0.173,P=0.047), but not 400m walk, MRI thigh muscle volume, or grip strength (P&gt;0.1 for all). 46% of women in the lowest tertile of % muscle mass versus 38% in the highest tertile reported they were at least “somewhat bothered” by urinary symptoms (P=0.04). Among men, no muscle or physical performance measures were significantly associated with LURN SI-10 or urinary bother (P&gt;0.2 for all). In conclusion, older women with greater muscle mass, leg power, and SPPB scores had reduced LUTS severity whereas LURN SI-10 was not significantly correlated with muscle and physical performance measures in older men. Older women with higher D3Cr muscle mass were also less bothered by urinary symptoms, supporting muscle health as a novel female LUTS mechanism.
ASSOCIATIONS BETWEEN POSTURAL SWAY AND GAIT DOMAINS DURING WALKING WHILE TALKING
Authors: Jayakody Oshadi , Blumen Helena , Ayers Emmeline , Wang Cuiling , Verghese Joe 
Published: December 2022

Abstract
Poor gait performance during walking-while-talking (WWT) is associated with an increased falls risk. Whether this association between WWT and falls is moderated by balance is not known. To address this, we examined 1) cross-sectional associations between postural sway and gait domains during WWT and, 2) whether postural sway moderated the effects of gait domains on falls. Gait (using a computerized walkway) and postural sway in anteroposterior (AP) and mediolateral (ML) directions (using the SwayStar™ system) during WWT were assessed in 357 community-dwelling older adults (M Age 77.9 years; 55.5% female). Principal component analysis was used to derive distinct gait domains: pace (speed, step length), rhythm (swing, stance, step time) and variability (step length variability, double support time variability). Falls incidence over 12 months were ascertained using bi-monthly calls. Multiple linear regression (adjusted for age, sex, and education) was used to examine the associations between postural sway and gait domains. Poisson regression was used to examine the associations of number of falls with gait domains and postural sway. Greater AP- and ML-sway were associated with slower pace, greater rhythm, and greater variability (p&lt; 0.005). Slower pace (not rhythm or variability) was associated with falls incidence (n=95) and the effect of pace on falls (although p&gt;0.005) was reduced by the ML-sway (β for interaction between pace and sway -0.001 95%CI -0.002, 0.0001). These findings suggest that greater sway during WWT is associated with poorer gait performance. Interventions to maintain ML-sway during WWT may assist with reducing the effects of pace on falls risk.
EFFECTS OF RESISTANCE EXERCISE ON MOBILITY AND LIFE SATISFACTION AMONG OLDER CHINESE AMERICANS
Authors: Chen Mei-Lan , Gardenhire Douglas , Wu Ying-Jung , Lee Mi-Jung 
Published: December 2022

Abstract
Physical activity interventions have shown to be potentially effective for preventing mobility impairment and improving life satisfaction in older adults. However, few studies investigated the effect of resistance exercise training on mobility and life satisfaction in older Chinese Americans. The purpose of this study was to test the effect of a 12-week resistance exercise intervention (two times weekly) on mobility (balance, gait speed, and chair stand performance) and life satisfaction in a sample of community-dwelling older Chinese Americans aged 60-89 years (N = 30; mean age 77.9 ± 5.0 years). The study was a two-group randomized controlled trial (RCT). All participants were randomly assigned into either the resistance exercise group or the wait-list control group (15 participants in each group). Participants’ balance, gait speed, chair stand performance, and life satisfaction were assessed at baseline and 12 weeks. Descriptive statistics and t tests were used for data analysis. The results indicated that older adults participated in the resistance exercise program had significant improvements in balance, gait speed, chair stand performance, and life satisfaction at the end of the trial. Compared to the control group, the resistance exercise group had significantly greater improvements in balance, gait speed, chair stand performance, and life satisfaction at 12 weeks follow-up. The findings suggest that resistance exercise has beneficial effects in improving mobility and life satisfaction for older adults. This resistance exercise program provides a basis for developing larger RCTs for further determining the efficacy of resistance exercise among older Chinese Americans.