bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE RELATIONSHIP BETWEEN ADVANCE CARE PLANNING AND COGNITIVE FUNCTION IN A MULTICULTURAL COHORT
Authors: Camacho Simone , Tolea Magdalena , Mendez Nicole , Zambrano Joyce Jimenez , Galvin James 
Published: December 2022

Abstract
Engagement in Advance care planning (ACP) – the process of communicating preferences for future medical decisions, has been linked to increasing age, greater decision-making capacity, and higher education, and is more prevalent in White older adults. To advance knowledge of ACP in multicultural populations, we examined variations in the relationship between sociodemographics, cognitive functionality and ACP. A total of 303 older (mean-age: 69.4±10.5; 69.9% females; 29.6% Non-Hispanic White, 21.2% African American, and 49.2% Hispanic) participants in a community-based dementia screening program were included. ACP measures included life insurance, disability insurance, long-term care (LTC) insurance, power of attorney (POA), living will, and having a health care proxy (HCP). Although most participants had health insurance (92.4%, no differences by race), low rates of ACP engagement were found in racial/ethnic minorities across multiple ACP measures (all ≤40%). Black older adults had the highest use of life insurance (p&lt;.001). Higher ACP rates (i.e., LTC, HCP, living will) were associated with better global cognition (MoCA; p&lt; 0.05). Higher POA rates were associated with lower AD8 scores (30.1% in AD8&lt; 2 vs 15.4% in AD8≥2, p=0.003). Finally, ACP rates varied across racial-SES groups being highest in high SES White participants and lowest in minorities with low SES, regardless of subjective or objective cognitive performance. Findings link ACP to greater cognitive functionality and highlight racial and SES disparities in ACP engagement, particularly related to non-insurance-based planning. Understanding cultural differences in decision making can lead to targeted interventions to increase early ACP in cognitive aging and dementia for older adults.
BUILDING A PROTOCOL FOR LIVE DISCHARGE FROM HOSPICE: UNDERSTANDING THE APPROACHES, CHALLENGES, AND OPPORTUNITIES
Authors: Wladkowski Stephanie P , Schroepfer Tracy , Enguidanos Susan 
Published: December 2022

Abstract
A live discharge from hospice can occur when a patient stabilized under hospice care no longer meets the life expectancy hospice eligibility criteria. In 2019, 278,400 hospice patients across the United States were discharged alive from hospice care, with 18,096 (6.5%) discharged due to being ‘no longer terminally ill.’ For these individuals and their caregivers, the result is a disruption of care continuity and an often burdensome transition. Hospice care improves end-of-life outcomes for some patients, and a live discharge results in lost access to important supportive services and resources, while the patient remains ‘terminal.’ Further, an increased burden is placed on primary caregivers who may be unprepared for this transition. Currently, there is no explicit discharge process available within hospice to guide practitioners in transitioning patients and their caregivers out of hospice care. This study aimed to garner a deeper understanding of current approaches and accompanying challenges to inform the development of an explicit live discharge protocol. Focus group interviews with hospice social workers at four hospice agencies across the U.S. were conducted. Using thematic analysis, four key themes emerged, including the logistical (n=13) and psychosocial (n=9) approaches, the need for clear professional roles during a live discharge (n=12), and specific challenges (n=14), such as needed services and desired discharge timeline to best support the patient-caregiver dyad. Findings demonstrate the complexities of conducting a live discharge, the uniqueness of each hospice agency, and the need for more research to support a standardized and reimbursable discharge process.
UNDERSTANDING THE RELATIONSHIP BETWEEN COPING STYLES AND DEATH ANXIETY IN OLDER ADULTS
Authors: Coromac-Medrano Juliamaria , Watts Amber , Sinclair Christian , Engel Ilana 
Published: December 2022

Abstract
Research suggests that death anxiety stems from fear of pain, worry about loved ones, and uncertainty about what comes after death. Understanding the relationship between coping styles and attitudes towards death in older adults may help identify individuals who need support with death anxiety. This study explored the relationships between coping styles (active, disengaged, social) and death anxiety (fear, avoidance). We used the Death Attitude Profile Revised and three subscales from the Brief Coping Orientation to Problems Experienced (COPE) Inventory. We conducted linear regressions to determine which coping styles were associated with fear of death and death avoidance. In post-hoc analyses, we investigated the role of spirituality-based coping as a two-item subscale from the active coping scale. All models controlled for age, sex, marital and educational status. The sample included 87 community-dwelling older adults (Mage=72.72 (SD=5.88); 56.32% female; 86.21% White). Higher levels of disengaged coping were significantly associated with greater fear of death and death avoidance (p &lt; .05). Use of social support coping was significantly associated with less fear of death (β = -.10, p &lt; .05). Spirituality-focused coping was associated with lower death avoidance (p &lt; .05). Disengaged coping may indicate higher death anxiety, whereas spirituality and social support coping strategies may indicate lower death anxiety. Our findings have implications for identifying individuals in need of extra support during critical points in the healthcare process. They may also inform design and implementation of psychosocial interventions for communication about healthcare goals in the context of serious or terminal illness.
AGE-RELATED IMMUNE CELL PHENOTYPES IN THE FRAMINGHAM HEART STUDY PARTICIPANTS
Authors: Fang Yuan , Chen Jiachen , Lunetta Kathryn , Murabito Joanne , Doyle Margaret 
Published: December 2022

Abstract
Mounting evidence supports a role for the immune system in the pathophysiology of dementia. Alterations in the composition of circulating immune cells is one of the key changes associated with age. However, the role of age and sex on immune cell phenotypes and their contribution to disease pathogenesis remains to be unraveled. We identified a study sample of 996 participants (mean age 62 years, range 40 to 88 years, 52% female, 22% APOE-ϵ4 carriers) from the community-based Framingham Heart Study Offspring cohort who were dementia and stroke free at the seventh examination (1998-2001), the first exam with existing stored peripheral blood mononuclear cells (PBMC). We profiled 132 circulating immune cell phenotypes from cryopreserved PBMCs by flow cytometry using standardized protocols. T cells, B cells, NK cells, and monocytes were reported as percentage of gated lymphocytes or monocytes. All other subsets were reported as percentage of the appropriate parent (e.g. CD4+ and CD8+). We summarized the distributions of each phenotype with age, sex, and APOE-ϵ4 genotype. We also evaluated the differences in percentages of T-cell subtypes including CD4+, and CD8+ T cells and their naïve, effector memory, and central memory subsets across age groups and sex. We observed that for both CD4 and CD8, naïve cells decrease with age, whereas effector/memory cells increase with age with no difference by sex. Future analyses will explore the association between immune cell phenotypes with cognitive test performance and risk of dementia in the context of exposure to cytomegalovirus infection.
WHAT IS THE DIGITAL MATURITY OF LONG-TERM CARE HOMES IN ONTARIO? A SURVEY PROTOCOL
Authors: Hakimjavadi Ramtin 
Published: December 2022

Abstract
Ramtin Hakimjavadi will discuss the barriers and facilitators of implementing a health information technology (HIT) maturity survey in the Canadian context. Alongside Dr. Liddy’s team, he is supporting the adaptation of the survey into a Canadian context, followed by a pilot study to distribute the survey to select nursing homes. Drawing from this work, Mr. Hakimjavadi will highlight the barriers and facilitators associated with the process of implementing the HIT maturity survey. Expected challenges include adjusting the survey format for respondents with limited resources, identifying a central contact within each nursing home, optimizing the survey user interface to limit response burden, and developing recruitment strategies to increase response rate. These challenges and the strategies to overcome them, impressions of the current state of HIT in Ontario nursing homes, and proposed action items to trend digital maturity in these settings over time will be discussed.
SENSORY PROCESSING CORRELATES WITH DEPRESSION AND PERCEIVED STRESS IN OLDER ADULTS
Authors: Chang Megan , Liu Chiung-ju , Blanche Erna 
Published: December 2022

Abstract
Sensory processing is defined as the ability to respond to sensory information from the environment and to act accordingly to the situational demands. Sensory processing is associated with anxiety in middle-aged adults, specifically in those with sensory over-responsiveness and under-responsiveness. It remains unclear how age-related change in sensory processing is correlated with mental health. The purpose of this study is to examine the correlations between sensory processing patterns, depression, and perceived-stress in older adults. Respondents were recruited from community networks serving older adults. They were asked to complete an electronic survey, including the Adult Sensory Processing Scale (ASPS), the Perceived Stress Scale, and the Center of Epidemiologic Depression Scale-Revised. ASPS has 11 factors related to over-responsive, under-responsive, and sensory seeking in visual, auditory, tactile, vestibular and proprioceptive input.Of 148 older adults (Mean age = 72 years) completed the survey, 30% perceived moderate to high levels of stress, and 18% had depressive symptoms. The total score of the ASPS Scale is positively correlated with perceived stress (r=0.26; p=.001) and depression (r=0.27; p=.001). Specifically, those who were over-responsive to auditory and vestibular input, and under-responsive to proprioception had higher stress levels and greater depression.Sensory decline or impairment in older adults may alter older adults’ ability to process sensory information. As sensory processing has significant impact on anxiety and perceived stress in older adults, it should be considered in evaluation and intervention, particularly on audition, vestibular and proprioception. Including sensory-based approach may help better manage their mental health.
EFFECT OF HYPERTENSION ON PREFRONTAL CORTEX ACTIVATION IN OLDER ADULTS DURING INSTRUMENTED TRAIL WALKING TASKS
Authors: Hernandez Manuel , Bishnoi Alka 
Published: December 2022

Abstract
Hypertension (HTN) can lead to non-amnestic cognitive impairment. However, it is unclear if this cognitive impairment affects dual task walking in older adults with HTN. The objective of this study was to evaluate the differences in prefrontal cortex (PFC) oxygenated hemoglobin (HbO2) levels during comfortable walking (CW) and an instrumented trail walking task (TWT) in older adults with HTN. We hypothesized that older adults with HTN would show decreased activation, or lower PFC HbO2 using functional near-infrared spectroscopy, during TWT in comparison to older adults without HTN. There were 15 adults in HOA group (11 females; 65±9 years old), and 9 adults in HTN group (3 females; 68±8 years old). The experimental paradigm consisted of three tasks (CW, TWT-A, TWT-B) in each of two blocks, with difficulty increasing from TWT-A to TWT-B through the inclusion of task-switching. A linear mixed effect model was conducted to investigate the effects of cohort, task, block and interaction between them on HbO2. We found that: 1) HTN adults exhibited lower HbO2 levels compared to HOA (p&lt; 0.001), during TWTs but not CW; and 2) increased HbO2 levels were observed in TWTs relative to CW. During TWTs, HTN adults showed decreased activation compared to HOA, which shows that their ability to focus on dual task execution is limited. The hypertensive adults face difficulty in matching the attentional demands of the dual task, similar to cognitively impaired older adults, which may be partly explained by capacity sharing theory.
ECONSULT IMPROVES ACCESS TO SPECIALIST ADVICE FOR PRIMARY CARE PROVIDERS
Authors: Fung Celeste , Liddy Clare 
Published: December 2022

Abstract
Dr. Liddy will present an overview of the Champlain BASE™ eConsult service, with a focus on its implementation in long-term care (LTC). eConsult is a secure web-based tool that enables providers to communicate electronically with specialists concerning a patient’s care. Evaluation of over 100,000 cases has consistently demonstrated positive impacts on access to care: PCPs receive responses in a median of 0.9 days, and two-thirds of cases are resolved without the patient needing a face-to-face specialist visit. A cross-sectional analysis of eConsult cases sent from LTC settings in 2018 demonstrated similar response times and referral avoidance to the larger sample (a median response time of 0.6 versus 0.9 days; proportion of cases resolved without a specialist visit 70% versus 67%). These findings, coupled with eConsult’s proven success at improving access to and equity of care, demonstrate the importance of supporting eConsults expansion.
CAREGIVER TLC: A VIRTUAL PSYCHOEDUCATIONAL PROGRAM FOR CAREGIVERS: BASELINE PRELIMINARY DATA
Authors: Montoro-Rodriguez Julian , Gallagher-Thompson Dolores , Ramsey Jennifer , Bilbrey Ann Choryan , Kajiyama Bruno , Jason Kendra , Thompson Larry W 
Published: December 2022

Abstract
Family caregivers are at increased risk for negative impacts on their psychological and physical health compared to non-caregivers. Virtual caregiving programs are beneficial as caregivers may not have time to devote to face-to-face programs and especially important to caregivers in the context of the COVID-19 pandemic. Our team at the University of North Carolina at Charlotte is testing the efficacy of the Caregiver Thrive, Learn & Connect Virtual Program adapted from the Coping with Caregiving evidence-based multicomponent intervention (Gallagher-Thompson et al., 2003). The program offers to registered caregivers six weekly sessions over Zoom teleconferencing in small groups led by trained professionals from community partners serving socio-demographically diverse caregivers. Sessions address stress management, mood management, resilience, self-care, coping strategies, and isolation. Preliminary baseline data on 42 participants indicates that caregivers are primarily female (87%), on average 64 years old, and from diverse racial backgrounds: white (69%), African American (29%) and Asian American (2%). Participants provide care to persons with memory troubles or dementia (66%) and chronic health conditions (34%). Baseline data on initial levels of caregivers’ psychosocial outcomes indicated salient levels of mental health outcomes for burden (high = 49%; mild = 35%); anxiety (moderate = 16%; severe = 20%) and depression (mild levels = 35%; moderately and severe level of depression = 33%). Caregivers for chronic health conditions reported significantly higher anxiety compared to dementia caregivers. The Caregiver TLC program offers support to the targeted caregiver population seeking to improve their level of competence, mental health and social isolation.
STATE HOME AND COMMUNITY-BASED SERVICES AND RESIDENTIAL CARE TRANSITIONS AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Chyr Linda , Fabius Chanee , Drabo Emmanuel 
Published: December 2022

Abstract
Medicaid home and community-based services (HCBS) provide integral health-related and personal care to support community-dwelling older adults. Growing literature suggests that states with more generous HCBS expenditures may delay or substitute costly nursing home care, but evidence is limited on the impact of HCBS spending on transitions to residential care settings like assisted living. This study determines the association of state Medicaid HCBS generosity—HCBS spending as a percent of total long-term services and supports expenditure—on the probability of incident transitions to residential care settings or nursing homes. Publicly available HCBS expenditure data was linked to a nationally representative sample of 7,197 community-dwelling older adults participating in the National Health and Aging Trends Study from 2011-2018. A discrete-time, competing risk regression model estimated the association between HCBS generosity and transitions from community to residential care settings or nursing homes, adjusting for sociodemographic, socioeconomic, and health factors. Most older adults remained in the community (93.7%). Incident transitions into residential care settings were twice as likely to occur compared to transitions to nursing homes (4.0% vs 2.3%, respectively). Older adults residing in states with higher HCBS generosity (one percentage point increase) are less likely to transition to nursing homes (relative risk ratio [RRR], 0.24; 95% Cl, 0.05-1.10; p&lt; 0.1). Greater HCBS generosity was not associated with transitions to residential care setting. Assessing HCBS generosity on transitions elucidates important contextual factors affecting the movement of older adults across the care continuum.
PEEKING UNDER THE COVERS: EXAMINING ETHICAL ISSUES IN ASSISTED LIVING
Authors: Turner Kelly , Agans Gretchen , Donohue Erin , Madison Barqueisha , Lesandrini Jason , Morgan Jennifer , Kemp Candace 
Published: December 2022

Abstract
Assisted living (AL) communities comprise complex social environments composed of residents, staff, and other care partners, including external workers and residents’ family and friends. Interactions among these stakeholders, especially pertaining to decisions related to resident care, frequently are fraught with value conflicts and uncertainties. Although much attention has been devoted to the ethics of aging and end-of-life in acute care settings, there is very little research on ethical issues in AL. To address this critical knowledge gap, our interdisciplinary team of gerontologists and bioethicists developed a typology of ethics issues in AL, adapting existing categorizations designed for acute care. We applied this typology to qualitative data gathered over a one-year period as part of an NIA-funded longitudinal study focused on residents with dementia living in four diverse AL communities (R01AG062310). The team coded 465 fieldnotes and interviews, analyzing data for the frequency and context of ethical issues. We found ubiquitous conflicts between residents’ autonomy and care partners’ obligations to maintain resident safety, as well as a high prevalence of organizational issues related to staffing and expertise. Comparing code frequency and type across the four communities, we discovered manifold ways in which facility size, organizational structure, and care practices affect the profile of value conflicts in resident care. During data analysis, we also developed new codes for ethics issues arising in AL, including, ‘cognitive decline stigma’ and ‘uncertainty regarding professional obligations,’ creating new avenues of study. We conclude our presentation by discussing implications for best practices and policy formation in AL.
SUCCESSFUL TRANSITIONS TO LONG-TERM CARE COMMUNITIES
Authors: Koltz Daniel , Koltz Rebecca 
Published: December 2022

Abstract
Older adults who transition to independent and assisted-living communities perceive their transition experience differently. This research focused on understanding what factors were predominant for a successful transition from a long-time home to a dependent living community. A constructivist grounded theory method was used to explore the experiences of 18 older adults who had relocated within the past year. The participants of this study were aged 65-95 years and are equally represented by gender. Equal numbers of respondents transitioned into independent and assisted-living accommodations. Five factors related to a central concept of behavioral attitude were found to be key for a successful transition. When an older adult reported a successful transition, their behavioral attitude was positive about their new living environment. The five factors that contributed to their positive attitude are creating a new place, increased community integration, sense of safety and security, independence while dependent, and accepting a new life stage. The theory that emerged from the research emphasizes that when an older adult has increased awareness about the five factors associated with adapting to a dependent living community, this awareness will promote a positive behavioral attitude and increase the opportunity for success during and after a transition. Family members, LTC community administrators and social workers could all benefit from understanding these factors for a successful transition. Enhancing a positive experience for an older adult and improving their behavioral attitude toward the new transition.
ORGANIZATIONAL SUPPORTS ASSOCIATED WITH NURSING ASSISTANTS’ JOB SATISFACTION DURING COVID-19
Authors: Bryant Natasha , Cimarolli Verena , Falzarano Francesca , Stone Robyn 
Published: December 2022

Abstract
The COVID-19 pandemic has disproportionately affected nursing home residents and staff, including the nursing assistants who provide critical supports for older adults and people with disabilities. The pandemic has added significant strain to an already vulnerable nursing home workforce, which has historically experienced high levels of turnover, chronic staffing shortages, and high burnout. At the same time, it has generated awareness of the value of the direct care workforce to provide care in places for those most at risk from the disease. Job satisfaction of nursing assistants is as major driver of turnover and intent to leave the job. Research has demonstrated organizational supports and job stresses that are associated with job satisfaction and turnover. However, limited research has investigated the factors associated with job satisfaction in nursing homes during the COVID-19 pandemic. Using data from an employee engagement and management system, we examined organizational supports (e.g., supervision, appreciation, safety) and work-related stresses associated with job satisfaction among nursing assistants in nursing homes (n=402). Higher quality of supervision, feeling appreciated for the job, and feeling safe and comfortable at work were associated with higher levels of job satisfaction. Work-related job stressors –increased workload demands and understaffing – were associated with lower job satisfaction. Our findings provide insights into the importance of employer supports and reducing work-related stressors in nursing assistants’ job satisfaction and practical implications for nursing home leadership regarding how to support workers