bluuebunny/crossref_metadata_2025_split huggingface dataset:
CAPABLE IMPLEMENTATION: PROGRESS AND BARRIERS
Authors: Paone Deborah , Szanton Sarah 
Published: December 2022

Abstract
CAPABLE is an evidence-based 4-to-6-month program that improves daily function and the home environment based on the older adult’s goals. Study aims were to: (1) understand context and readiness factors in implementation, (2) identify barriers and facilitators, and (3) examine the utility of two frameworks. The unit of analysis was the organization. We employed the CFIR and RE-AIM frameworks for this qualitative study, using multiple data sources and traced the implementation of 40 organizations over 3 years. Leadership support, perceived value of the program, initial funding, strategic importance, and program champion were common supportive factors. Common challenges included difficulty with recruitment, staffing and infrastructure readiness and sustainability of funding. This study indicates readiness, technical support, and resources needed for implementation and sustainability of CAPABLE and suggests external environmental supports needed. It offers a practical way to monitor, evaluate, and report on ongoing implementation of evidence-based programs.
DRIVERS AND RESTRAINERS OF CAPABLE DISSEMINATION
Authors: Szanton Sarah , Paone Deborah 
Published: December 2022

Abstract
Using the technique of Force Field Analysis, the co-developer of CAPABLE examined drivers and restrainers of dissemination for the CAPABLE program. This generated 19 distinct drivers including robust research findings, demonstrated clinical and economic utility, and high value to older adults. The environmental shift toward value-based approaches in Medicare and Medicaid also increased the perceived value of CAPABLE. In addition, there were 8 restrainers, including component complexity, siloed health and housing sectors, and the operational lift needed to build the program. Lessons are offered from this case study to move from research to embedded practice.
TRANSLATION OF A MEDICARE CLAIMS-BASED FRAILTY ALGORITHM FROM ICD-9-CM TO ICD-10-CM
Authors: Faurot Keturah , Duchesneau Emilie , Shmuel Shahar , Park Jihye , Stürmer Til , Jonsson-Funk Michele L , Lund Jennifer L 
Published: December 2022

Abstract
Clinical trials often have insufficient power to estimate drug effects in older adult populations. Medicare claims data are a valuable resource for studying healthcare delivery for older adults. The Faurot frailty index (FFI) is a validated algorithm that uses demographic, enrollment, and ICD-9-CM-based claims information to predict ADL dependency as a proxy for frailty. The original FFI consists of 20 constructs, including those related to geriatric syndromes, of which 16 are based on ICD-9-CM diagnosis codes (e.g., arthritis, dementia). In October 2015, the US healthcare system transitioned to ICD-10-CM. In this study, we updated and validated the FFI for the ICD-10-CM era . We used General Equivalence Mapping (GEM) to translate the ICD-9-CM codes to ICD-10-CM. For each construct, we manually reviewed the ICD-10-CM codes after GEM, assessed the suitability, and plotted the monthly prevalence before and after the transition (2013-2017). Code lists for all but 1 construct required editing after translation using GEM (adding and/or removing codes). We observed increasing monthly prevalence for several constructs, although trend lines were consistent across the ICD-9-CM and ICD-10-CM eras: bladder dysfunction (1.8-2.5%), weakness (2.7-3.9%), and psychiatric illnesses (6.9-9.1%). Rehabilitation services did not translate well using diagnosis codes, however, adding CPT codes improved capture. The updated FFI was strongly associated with frailty-related geriatric outcomes (1-year mortality, hospitalization, SNF admission). Studies of drug effects in older adults should use validated indices, such as the FFI, to reduce bias. Thorough evaluation of claims-based algorithms is essential to support healthcare services research using these measures.
STATE USE OF VALUE-BASED PAYMENT IN NURSING FACILITIES
Authors: Tyler Denise , Porter Kristie , Hunter Melissa , Oliveira Iara , Squillace Marie , Dey Judith 
Published: December 2022

Abstract
Some states use value-based payment (VBP) programs as part of their nursing facility Medicaid payment systems. The purpose of this study was to determine which states use these programs, their goals, the measures used and other elements of these programs. An environmental scan was conducted to identify states that have VBP programs for nursing facilities, the key design elements of those programs, and the goals that states are aiming to achieve. Interviews with seven stakeholders were also conducted. We found that 20 states and the District of Columbia use VBP for nursing facilities with the goals of improving quality and increasing efficiency. However, due to lack of evaluation, it is not known if these programs are achieving their goals. Additional research is needed to determine which state programs are most successful. The results of such research would help in the development of future VBP programs.
THE COVID-19 PANDEMIC MAY HAVE EXACERBATED NURSE STAFFING DISPARITIES IN NURSING FACILITIES
Authors: Porter Kristie , Gasdaska Angela , Squillace Marie , Dey Judith , Oliviera Iara , Feng Zhanlian , Segelman Micah 
Published: December 2022

Abstract
Nursing facilities (NFs) have historically struggled to maintain adequate nurse staffing. We used PBJ data linked with other publicly available sources and conducted stakeholder interviews to understand nurse staffing between 2019 and 2020. We found large declines in the population of NF residents and in staffing hours. Measured in hours per resident day (HPRD) to account for the size of the NF resident population, there were slight increases in staffing. Staffing was nonetheless a major challenge for NFs because they required increased staffing due to the impact of the pandemic. NFs in higher quartiles of percentage of minority residents lost nurse staffing HPRD relative to NFs in the lowest quartile of minority residents. Stakeholders explained that NFs with more minority residents were likely to employ staff who live in more vulnerable communities with a greater concentration of minorities, who were more impacted by COVID.
GERIATRIC PRACTICE LEADERSHIP INSTITUTE—AN INTERPROFESSIONAL TEAM APPROACH USING THE IHI AGE-FRIENDLY MODEL
Authors: Knebl Janice , Severance Jennifer , Murphy Sara , Camp Kathlene , Roach James , Fairchild Thomas 
Published: December 2022

Abstract
According to the Institute of Medicine, immediate steps must be taken to educate and train both the current and future health care workforce to work collaboratively in addressing the diverse needs of the growing older adult population.1 Most healthcare professionals had very little education or clinical training in the care of older adults nor the most effective ways to work as a clinical team. The Geriatric Practice Leadership Institute (GPLI) is a collaboration between two universities providing inter-professional teams of early and mid-career professionals the skills and knowledge needed to leverage leadership skills to effectively work within interdisciplinary teams to provide age-friendly care to older adults. The GPLI incorporates the Institute for Healthcare Improvement (IHI) Age-Friendly Health Systems 4Ms’ Framework into the training. The GPLI is an on-line, team-based program which engages 5-7 teams each session. Module topics include Age-Friendly Health Systems, organizational culture, leading self, leading inter-professional teams, and quality improvement. Additionally, teams select and completes a quality improvement project based on the Age-Friendly Health Systems 4Ms and submits a final report and presentation. The teams are also assigned a coach for support. Continuing education credits and a micro-credential are available to participants. The GPLI has trained over 175 health care professionals during the past 7 years with teams representing ambulatory to emergency responder organizations. The GPLI has been funded by the Health Resources and Services Administration (HRSA) Geriatrics Workforce Enhancement Program grant (numberU1QHP2873), which currently covers all costs for participants.
MENTAL HEALTH IMPACT OF DISCRIMINATION: THE PROTECTIVE FUNCTION OF SOCIAL CAPITAL IN DIVERSE GROUPS OF OLDER ADULTS
Authors: Yan Mengzhao , Jang Yuri , Wilber Kathleen 
Published: December 2022

Abstract
Discrimination occurs in complex social contexts leading to various levels and types of outcomes. Although the negative health impact of discrimination is well-documented, there is a need to investigate patterns among discrimination, social factors, and health outcomes in diverse racial/ethnic groups of older adults to inform interventions. For example, social capital, such as social cohesion, social ties, and safety, is anticipated to be directly associated with mental health and also to modify the impact of discrimination. In the present study, we examined (1) racial/ethnic differences in perceived discrimination, social capital, and depressive symptoms and (2) the direct effect of perceived discrimination and social capital, as well as their interactions, on depressive symptoms among different racial/ethnic groups. Data were drawn from the National Social Life, Health, and Aging Project (NSHAP) Round 3 (2,988 non-Hispanic Whites, 719 non-Hispanic Blacks, and 499 Hispanics; 68 mean age). Compared to non-Hispanic Whites, non-Hispanic Blacks had a significantly higher level of perceived discrimination, lower social capital, and more depressive symptoms. Findings from multivariate linear regression models demonstrated that, in all racial/ethnic groups, frequent experiences of discrimination and low levels of social capital were associated with increased symptoms of depression. A significant interaction between discrimination and social cohesion was observed in non-Hispanic Whites and Hispanics. In both groups, the negative impact of discrimination was lower among those with higher levels of social cohesion. Our findings support efforts such as improving well-being for older adults by promoting age-friendly communities to build greater social cohesion.
UNMET NEEDS AMONG ADULTS AND OLDER ADULTS IN BRAZIL, ELSI-2019
Authors: Andrade Flavia , Chen Xiayu 
Published: December 2022

Abstract
Many older adults in Brazil struggle to receive adequate assistance in later life. To better understand this issue, this study examines the prevalence and characteristics of unmet needs of adults ages 50 and older with difficulties performing activities of daily living (ADL), instrumental activities of daily living (IADL), the caregiving patterns, and the consequences of unmet needs in Brazil. We use data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) study conducted in 2019-2021 (N=9,949). Results indicate that the prevalence rate of ADL was 8.9% (95% CI 7.6 – 10.5), and the prevalence of IADL was 15.6% (95% CI 13.1 – 18.5). Among those with ADL difficulties, 11.5% (95% CI 8.2 – 16.0) reported having unmet needs. Among those with IADL difficulties, 8.8% (95% CI 6.1 – 12.4) reported having at least one activity with unmet needs. Unmet needs were higher among younger adults, those living alone, Black or mixed race, or the Northeast region. Most of the care (87%) was provided by family members, primarily daughters, and wives. About 20% of caregivers had to stop working or studying to provide the needed care. Those with ADL unmet needs were less likely to visit friends or family, whereas IADL unmet needs were associated with lower odds of visiting a doctor. Our study provides the first glimpse of the characteristics of those with currently unmet needs among adults in Brazil and of caregivers. Unmet needs are associated with social isolation and worse healthcare use.
THE IMPLEMENTATION OF GERIATRIC EMERGENCY DEPARTMENT ACCREDITATION (GEDA) IN RURAL CRITICAL ACCESS HOSPITALS
Authors: Flaherty Ellen , Biese Kevin 
Published: December 2022

Abstract
The largely rural setting of Northern New England offers unique challenges to implementing improved acute care for the growing geriatric population. Northern New England is one of the United States’ most rapidly aging regions, with Vermont and New Hampshire being the second and third oldest US states respectively by median age (U.S. Census 2017). There is a need to expand innovations in geriatric emergency medicine to reach older adults in rural areas such as Northern New England. Dartmouth-Hitchcock Medical Center and the West Health are collaborating on a project leveraging telehealth to extend the reach of a GED to rural hospitals, as well as investigate the opportunities for scaling and sustaining this concept to other rural facilities across Northern New England and throughout the country. This symposium will focus on our experience implementing a hub and spoke model to achieve our goal of improving the care of older adults in rural emergency departments.
ENHANCING FEDERAL REVENUE FOR HOME AND COMMUNITY-BASED SERVICES UNDER THE AMERICAN RESCUE PLAN ACT
Authors: Miller Edward , Beauregard Lisa 
Published: December 2022

Abstract
The American Rescue Plan Act (ARPA) includes a one year 10 percentage point increase in the Federal Medical Assistance Percentage for Medicaid-funded home and community-based services (HCBS). The goal is to strengthen state efforts to help older adults and people with disabilities live safely in their homes and communities rather than in institutional settings during the COVID-19 pandemic. This presentation provides a detailed description and analysis of this provision, including issues state governments need to consider when expending the additional federal revenue provided. It also draws lessons from the Affordable Care Act’s Balancing Incentive Program to suggest insights for the potential of ARPA to promote further growth in Medicaid HCBS programs. The presentation concludes by highlighting the importance of instituting strategies and processes for maximizing enhanced federal matching funds under ARPA in preparation for subsequent availability of substantial additional federal resources targeting Medicaid HCBS under other proposed initiatives.
CHARACTERISTICS OF LEADERS OF AGING CENTERS
Authors: Charness Neil 
Published: December 2022

Abstract
In December of 2021 and January of 2022, current leaders of Centers on Aging belonging to the GSA Age Directors interest group were invited to fill out a survey inquiring about their backgrounds, training for leadership, and perceived needs for training via an online Qualtrics survey. Thirty-one responses were received though a few responses were missing for most questions. The sample mostly resided in the USA (86%), and identified mainly as female (63% female, 37% male). Most were married (90%). The average age of a respondent was 58 years (SD=9; range 37-74). Respondents were not diverse: 97% White. Most had doctoral level education (1 Master’s level). The results indicate that there is a need to enhance and develop leadership skills in diverse mid-career gerontologists in order to provide replacements for an aging cohort of directors. Results are also consistent with prior National Academies’ recommendations for training the gerontological workforce.
WHAT LEADERSHIP SKILLS ARE NEEDED TO DIRECT GERONTOLOGY PROGRAM: SURVEY RESULTS FROM LEADERS ACROSS THE COUNTRY
Authors: Lichtenberg Peter 
Published: December 2022

Abstract
Gerontology programs across the country, including Centers, Institutes and Departments play a key role in promoting the field and the careers of the scientists they connect with. A recent survey of 30 Gerontology leaders from the GSA interest group found that 60% of them received no leadership training before becoming a Director or Chair in their program. Only 50% of those who received some generic leadership training found that it prepared them for their current role. This presentation will highlight some of the potential areas of focus for leadership training more specific to Gerontology programs. Among the topics most highly valued by the Gerontology Program leaders include budgets, managing people, negotiating difficult situations, understanding different leadership styles, teamwork, ethics and diversity, equity and inclusion. This session will frame some of the key aspects of leadership training including a deeper understanding of universities as organizations; and negotiating for resources.
MID- AND LATER-LIFE COMMUNITY COLLEGE STUDENTS: OFF-TIME EDUCATION AND THE SIGNIFICANCE OF INTRACOHORT DIVERSITY
Authors: McGrew Kathryn , Cummins Phyllis , Dikhtyar Oksana 
Published: December 2022

Abstract
Workers ages 45 and older make up about 45% of the U.S. labor force. To meet labor market demands in the U.S., employers will need to rely on mid- and later-life (MLL) (age 40 and older) workers. Through a gerontological lens, using both qualitative and quantitative data, we investigated the “off-time” enrollment of MLL community college students to explore how their enrollment decisions and academic goals are situated in the timing and intersection of life events and transitions, such as the responsibilities of work and family. We conducted 12 focus group interviews with MLL community college students (n=68) in Ohio and conducted a quantitative analysis of the distribution of academic goals by age group. We conclude that the foremost characteristic of MLL students as a group is its within-group heterogeneity and the greatest barrier to serving MLL students is in how we have been thinking—or failing to think—about them. We take a first slice at disaggregating “adult” students and turn away from deficit narratives to identify opportunities and assets among MLLs. Finally, we offer a theory to explain how especially wide within-group diversity of MLL academic goals is produced by cohort divergence of life events, transitions and trajectories; diverse enrollment precipitants; and individual point-of-time appraisals of lifetime elapsed and lifetime remaining. We suggest that community colleges, already leaders in adult education, are in a unique position to effectively serve MLL students by recognizing and accommodating their diversity. We present implications and strategies for colleges, policymakers and researchers.
THE ESTABLISHMENT OF A COMMUNITY NETWORK TO SUPPORT FAMILY CAREGIVERS
Authors: Kuo Tsuann 
Published: December 2022

Abstract
In 2021, 114 Caregiver Resource Sites were established in Taiwan to provide case management and services for family caregivers who may experience caregiving burnout due to long-term care. Each Caregiver Resource Site is responsible for serving 60-100 caregivers. An effort was made to recruit volunteers and gather resources so caregivers can be surrounded in the care-friendly community network, including care counseling, support groups, caregiving skill classes, relaxation activities, caregiver café, and in-home coaching for hard-to-care moments. By forming this community network to support caregivers, it has reduced caregiver burnout and avoided possibly negative tragedies due to caregiving.
THE IMPLICATIONS OF THE BUILD BACK BETTER BILL FOR AGING HEALTH POLICY
Authors: Nadash Pamela 
Published: December 2022

Abstract
The Build Back Better Bill passed by the U.S. House of Representatives (HR 5376) included ambitious healthcare and long-term care provisions that would have greatly benefited older people, although the Bill itself represents a considerable scaling down of the Biden Administration’s original proposals. This presentation reviews key provisions of the Bill that would impact older people: paid family and medical leave, efforts to strengthen the direct care workforce, and investments in home and community-based services. In addition, the Bill expanded Medicare coverage to include hearing, dental, and vision coverage, and expanded tax credits for the medical expenses associated with family caregiving. Although the House bill failed to make it through the Senate intact, some of the provisions are likely to have staying power. This presentation reviews the Bill’s progress and assesses implications for future efforts to expand access to these benefits.
WE DID MORE DAMAGE: HOW COVID-19 COLLAPSED THE CONVOYS OF CARE FOR RESIDENTS LIVING WITH DEMENTIA
Authors: Hackett Sara , Peterson Lindsay , Vogel Carlyn , Dobbs Debra 
Published: December 2022

Abstract
COVID-19 has posed a multitude of challenges for nursing homes (NHs) and assisted living communities (ALCs). However, little information is known about how the pandemic impacted residents living with dementia. Using the convoys of care framework, we conducted a qualitative descriptive study to gain insight regarding administrators’ perceptions of how care for residents living with dementia was altered. Forty-two participants, representing 16 NHs and 43 ALCs in Florida, participated in one 60-minute semi-structured interview. Thematic analysis revealed that the convoys of care for those living with dementia were strained by the competing demands associated with maintaining residents’ social and medical care. Explicitly, participants emphasized how diminished family involvement, the increasing responsibilities of staff, and the climate of the industry, contributed to disrupted convoys of care. Consequently, this study may help inform policy and practice as it details which care strategies worked, which did not, and considerations for moving forward.
RESTRICTIONS ON RESIDENT CONTACT IN ASSISTED LIVING DURING COVID-19: A MIXED-METHODS STUDY
Authors: Peterson Lindsay , Hackett Sara , Bhattacharyya Kallol Kumar , Dobbs Debra 
Published: December 2022

Abstract
Efforts to protect assisted living residents from COVID-19 by limiting contact warrant attention. Assisted living was developed as a social model where care is provided in a home-like environment. Given the social dimensions of assisted living, we sought to better understand the effects of COVID-19-based restrictions in assisted living. We surveyed (online) assisted living community (ALC) administrators (N=130) between October 2020 and March 2021 as part of a larger project on COVID-19 in Florida. We then interviewed a subset of participants (N=26). Administrators of chain-affiliated ALCs (compared to non-chain) were 2.7 times more likely to report resident-contact limitations had disrupted care (p=0.02). Larger ALCs (25 or more beds) were marginally more likely to report care disruptions (p&lt;0.10). Three main themes emerged from our qualitative interviews – varying interpretation of COVID-19 guidelines, effect of precautions on residents, assisted living as a home. Policy implications of these findings will be discussed.