bluuebunny/crossref_metadata_2025_split huggingface dataset:
PROVIDING INPATIENT CARE BEYOND HOSPITAL WALLS: GEOGRAPHIC FACTORS IN ACUTE HOSPITAL CARE AT HOME WAIVER PROGRAMS
Authors: Franzosa Emily , Gorbenko Ksenia , Baim-Lance Abigail , Schiller Gabrielle , Wurtz Heather , Masse Sybil , Ornstein Katherine , Leff Bruce 
Published: December 2022

Abstract
The Centers for Medicare and Medicaid Services’ (CMS) Acute Hospital Care at Home waiver offers hospital-level reimbursement to provide acute hospital-level care in patients’ homes for the first time. While this initiative may make acute care at home more financially viable for health systems, it also requires aligning Hospital at Home (HaH) operations with inpatient, rather than outpatient, regulatory requirements. We aimed to understand how participating HaH programs adapted to these requirements. We conducted semi-structured interviews with multiple leaders from 14 HaH waiver programs (n=18 clinical/medical, operational and program directors) varying in size, urbanicity, structure, and region, examining data through thematic analysis. Both urban and rural participants described geographic effects of waiver requirements. For instance, to ensure response to patient emergencies within 30 minutes, programs contracted with paramedic services to expand service areas, added program locations or moved primary locations to other system hubs. Programs maximized staff capacity across service areas by “leasing” staff from other home-based programs, focusing on urban hubs with more staff, balancing in-person visits with remote monitoring, and providing “hybrid” in-person/video appointments. However, travel time, length of acute care visits, staffing shortages, the need for new skills (e.g., acute care nurses, dietitians) and limited state scope of practice regulations, particularly for paramedics, limited the area and populations served. Adapting to waiver requirements required significant efforts to address staffing, logistical and regulatory challenges. Future waiver improvements should explicitly consider the unique resources needed to expand hospital-level care in geographically diverse ambulatory environments.
DIMENSIONS OF IMPLEMENTATION FOR DEMENTIA-FRIENDLY COMMUNITY INITIATIVES
Authors: Scher Clara , Greenfield Emily 
Published: December 2022

Abstract
Dementia-friendly community (DFC) initiatives are a community-level approach to support individuals living with dementia and their care partners. DFC initiatives engage in a range of activities including raising awareness about dementia, enhancing local services, and advocating for inclusive public facilities and spaces. There is significant variation in the implementation of DFC initiatives worldwide which creates challenges for both process and outcomes evaluation. We used data from qualitative interviews with DFC leaders in Massachusetts to develop a framework to assess the implementation of DFC initiatives. Qualitative descriptive analysis yielded distinct dimensions such as robustness of multisectoral action teams, diversity of strategies for outreach to older adults, and degree of focus on coordinating care. Building on the tradition of using radar charts to evaluate DFC initiatives, we visualized the shape of implementation across the various dimensions. This framework can help to advance research, practice, and policy as part of the DFC movement.
DEVELOPING A MEASURE OF COMMUNITY-LEVEL DEMENTIA FRIENDLINESS IN FAITH COMMUNITIES
Authors: Epps Fayron , Bender Alexis , Gore Janelle , Gunn Grayson , Markert Dana , Moore Miranda 
Published: December 2022

Abstract
As the prevalence of dementia rises, modifying built and social environments of persons living with dementia (PLWD) becomes increasingly essential. Although there is a call to rigorously evaluate dementia-friendly community initiatives, no known comprehensive evaluation tools exist to assess small communities (churches and community centers). Therefore, we are developing a person-centered Dementia-Friendly Community Assessment tool. This tool will consist of new and validated scales to assess the level of dementia-friendliness among churches enrolled in a dementia-friendly congregation program based in African American communities. A draft of a theory-informed survey instrument is being shared with stakeholders (church leaders, caregivers, and PLWD) during focus groups who will provide feedback on their understanding and relevance of questions on the instrument. The tool will then be modified based on feedback and the final instrument will be piloted with broad church membership. Our aim is to enable programs to quantify their dementia-friendly community initiative’s impact.
COMMUNITY CONTEXT OF OLDER ADULT CARE: A CASE STUDY DURING THE COVID-19 PANDEMIC
Authors: Skemp Lisa 
Published: December 2022

Abstract

Introduction
Expectations for older adults (OA) to live in the community and prevent costly long-term care assume OAs’ informal network members are available, able, and willing to fill this need. Yet, little is known about the processes whereby OAs construct care networks, especially during COVID-19.

Methods
A longitudinal case study of one OA male who participated in the ethnographic community Older Adult Care study in one urban Chicago neighborhood is described. The OA male described his network on three occasions: 2/2018, 1/2021 and 9/2021. The care networks were described by size, density, and transitivity. Data analysis was performed using the R programming language. Adjacency networks were constructed using the network package, then visualized using the sna package.

Results
The OA’s network went from 23 members pre-pandemic in time one to 13 in time two and 8 members in time three. As network size contracted, the network density increased from 25% in time two to 46% at time three, indicating a more interconnected network. Clustering varied over time and was at its lowest in time 2 (27%) and increased by time 3 (67%). Friends and church connections were 72% of his network in time one, whereas 71% of his network were family and neighbors in time three.

Conclusions
Our OA’s large, relatively disconnected social network tightened to fewer, more closely connected members during COVID-19 months. Contextual variables (environment, health guidelines, fear, pets) influenced the networks. It is essential to understand OA care networks to promote healthy aging in community.
CHARACTERIZING HOME AND COMMUNITY-BASED SERVICE ENROLLEES IN MINNESOTA’S MEDICAID WAIVER PROGRAM
Authors: Blackburn Justin , Baggett Sharon , Burton Ellen , Snyder Yonda 
Published: December 2022

Abstract
Medicaid waivers allow states’ provision of home and community-based services (HCBS), leading to variations in design and delivery. States monitor expenditures, but cannot easily anticipate growth. Understanding the needs of this population can aid in early identification and improve service delivery. We conducted a Partitioning Around Medioids cluster analysis of first-time enrollees in Minnesota’s Elderly Waiver HCBS program during 2019 to identify trajectories of entry and characterize activities of daily living (ADL) and instrumental activities of daily living (IADL) needs at enrollment. Administrative data collected via long term care consultation assessments provided enrollment, ADL/IADL needs, living arrangements, and other clinically relevant information that was linked to other sources including Minnesota health care program enrollment and utilization, Minimum Data Set skilled nursing facility (SNF) assessments, and calls to the Senior LinkAge Line (SLL)—a free long-term care counseling service. Of 5,284 first-time enrollees, most had prior engagement with state programs—nearly two-thirds had called the SLL, 36% had a SNF stay, and 56% had prior Medicaid enrollment. We identified six clusters representing three levels of living arrangements and two levels of need: 1) lived alone, low needs (32%), 2) lived with others, moderate needs (20%), 3) congregate living, moderate needs (14%), 4) congregate living, high needs (14%), 5) lived with others, high needs (11%), and 6) lived alone, high needs (9%). Lacking caregivers and prior Medicaid were possible exacerbating reasons for HCBS enrollment. The magnitude of the differences between clusters highlights the constellation of factors leading to enrollment in HCBS.
HOME HEALTH AIDE CONTINUITY AMONG HOME-BASED LONG-TERM CARE CLIENTS
Authors: Reckrey Jennifer , Russell David , Fong Mei-Chia , Ornstein Katherine 
Published: December 2022

Abstract
Many older adults with functional impairment rely on paid caregivers (e.g., home health aides) to remain living at home. Continuity in the provider of healthcare services is known to impact care-recipient outcomes in settings like primary care; however, limited quantitative research has explored variability in provider continuity among home-based long-term care services. We conducted a retrospective pooled cross-sectional study using a secondary analysis of managed long-term care and home care agency records in order to: 1) describe home health aide continuity among a population of older adults receiving Medicaid-funded home-based long-term care using the Bice-Boxerman index, and 2) identify factors associated with greater home health aide continuity using multivariate regression. Among 3,864 older adults who received claim-paid home health aides services between January 1, 2018 and March 10, 2020, average home health aide continuity scores were lower (i.e., worse continuity) as care hours increased: 0.71 among those receiving &lt; 3 service hours/day (n=1221), 0.62 among those receiving 3-7 service hours/day (n=1622), and 0.41 among those receiving &gt;7 service hours /day. Among those with the highest care hours (&gt;7 hours /day), increases in the level of ADL impairment and cognitive impairment were significantly associated with decreases in continuity scores. While clients with the highest care needs are the most dependent on their home health aides and may benefit most from stable paid caregivers, home health aide continuity scores are the lowest among this group. Future work will explore the impact of home health aide continuity on long-term care-recipient health outcomes.
ACCOUNTING FOR DIVERSITY IN COGNITIVE STATUS IN THE DESIGN AND EVALUATION OF INCLUSIVE PROSPECTIVE MEMORY SOLUTIONS
Authors: Sanders Edie , Boot Walter , Stuart Robin 
Published: December 2022

Abstract
Technology holds tremendous promise for supporting older adults' performance of important everyday activities. However, truly inclusive design of technology-based solutions must account for diversity with respect to cognitive status. This talk will focus on empirical studies conducted under the umbrella of the Enhancing Neurocognitive Health, Abilities, Networks, & Community Engagement (ENHANCE) Center with an emphasis on designing inclusive prospective memory solutions for older adults with cognitive impairments. Initial usability studies will be discussed examining the usability and efficacy of novel technology solutions, including the use of smartwatches and digital assistants, to support prospective memory, the ability to remember and carry out an intention in the future, which is crucial for maintaining health, independence, and social connections.
DEMENTIA CARE IN NURSE PRACTITIONER-LED CARE MANAGEMENT FOR COGNITIVELY VULNERABLE OLDER ADULTS
Authors: Fortinsky Richard , Ladda Shawn 
Published: December 2022

Abstract
Care management approaches are being widely tested in the Medicare-eligible population to manage chronic conditions, but few have focused on cognitive vulnerability as the pathway to optimizing independence in the community-dwelling older population. Cognitive vulnerability refers to living with dementia, depression, and/or a history of delirium. This presentation features a nurse practitioner-led team care management model (3D Team) to address cognitive vulnerability, tested in an ongoing clinical trial with older adults in a Medicare Advantage population. For older adults with dementia and their families served by the 3D Team, the nurse practitioner works closely with occupational therapists (OTs) delivering a nonpharmacological dementia care intervention. Preliminary results presented will include: characteristics of dyads that have received the dementia care intervention (N=70 dyads to date), how the nurse practitioner and OTs communicate, how the nurse practitioner reinforces dementia care skill-building strategies introduced by OTs, and process evaluation results to date.
DAILY EVENING ELECTRONIC MEDIA USE, SEDENTARY BEHAVIORS, AND SLEEP IN LATER LIFE
Authors: Kim Yijung , Richards Nicole , Fingerman Karen 
Published: December 2022

Abstract
Sleep complaints and disorders are two of the most common disturbances to health and well-being in later life. This study examined how evening electronic media use and daytime sedentary behaviors affect subsequent sleep hours and perceived sleep quality, and whether consistent sleep hours (i.e., sleep regularity) moderate these associations. Data were drawn from 241 older adults (Mage = 74.02) from the Daily Experiences and Well-being Study who completed ecological momentary assessments and wore an accelerometer for four days on average. A series of conditional fixed-effects models indicated that older adults reported more sleep disturbances on nights following the evening computer use. Sedentary behaviors and evening television viewing were not associated with sleep quantity and quality. Older adults with more consistent hours of bedtime reported better sleep quality regardless of their evening electronic media use and daytime sedentary behaviors, thereby highlighting the importance of sleep regularity in later life.
NONLINEAR ASSOCIATIONS OF DAILY STRESS REACTIVITY WITH HEALTH AND WELL-BEING
Authors: Rush Jonathan , Ong Anthony , Piazza Jennifer , Charles Susan , Almeida David 
Published: December 2022

Abstract
Research has repeatedly demonstrated that greater affective reactivity to daily stressors is associated with detrimental health outcomes (e.g. inflammation, mortality). However, most research has only considered linear effects, which precludes an examination of whether moderate levels of stress reactivity may be beneficial. Using daily diary data from the National Study of Daily Experiences (N=2,018) we fit multilevel SEMs to simultaneously model daily within-person associations between stress and negative affect (i.e., stress reactivity), and individual differences in the linear and quadratic associations between stress reactivity and life satisfaction, psychological distress, and chronic conditions. Significant quadratic effects were found for each of the three outcomes (estimates=-20.23; 11.49; 20.81, ps&lt;.001, respectively), indicating a U-shaped pattern where both low and high levels of stress reactivity were associated with poorer health, whereas moderate levels of daily stress reactivity predicted better health outcomes. The results suggest that some affective response to daily stressors can be beneficial.
EMBRACING THE DIVERSITY OF GRANDFAMILIES: UNDERSTANDING THE INFLUENCE OF CULTURE AND RACISM
Authors: Mendoza Nancy , Yancura Loriena 
Published: December 2022

Abstract
In line with this year’s conference theme, we examine diversity in different forms, such as racial, cultural, and familial diversity. We discuss the importance of diversity’s influence on the experiences of grandfamilies and the impact it has on their members. Findings from a study with Latinx grandparent caregivers suggest that those raising grandchildren often do not view themselves as “raising,” but instead “helping.” Such findings highlight the importance of understanding cultural norms to appropriately tailor services and resources. In an exploration of the experiences of Korean custodial grandparents, findings demonstrated the influence of patrilineality and stigma surrounding divorce for Korean grandparent-headed families, indicating the importance of considering a grandparents’ position in the family when providing services. In a study with custodial grandparents during the COVID-19 pandemic, researchers examined the role of racial discrimination on grandparents' depressive symptoms and access to health services. Results indicated a higher level of perceived racial discrimination was associated with more depressive symptoms. These results imply the need to address racial/ethnic disparities experienced by these caregivers. Similarly, in a study of emerging adults raised by grandparents, race moderated the influence of attachment on symptoms of racial discrimination. Findings support the use of interventions addressing attachment and ethnic identity to decrease symptoms of racial trauma in grandfamilies. Together these four studies reiterate the diversity of grandfamilies, enrich our understanding of these families, and encourage us to reimagine how to best serve them.
ESPO AND HEALTH SCIENCES SECTION SYMPOSIUM: INCLUDING DIVERSE STAKEHOLDERS IN HEALTH INTERVENTION DESIGN: LESSONS LEARNED FOR ADVANCING HEALTH EQUITY
Authors: Nguyen An , Moored Kyle , Moored Kyle 
Published: December 2022

Abstract
The COVID-19 pandemic exposed persistent disparities in the effectiveness of healthcare services and long-term care among the older adult population. For example, significant gaps disproportionately affected older adults living in rural areas, racial and ethnic minorities, individuals with cognitive impairments, and those from low socioeconomic backgrounds. To improve health equity, research is needed to design, implement, and disseminate health interventions that address the heterogeneity of older adults and caregivers. Reflecting on lessons learned from including underrepresented key stakeholder groups in intervention research may reveal strategies to design health interventions that are more accessible and effective for diverse populations of older adults and their caregivers. This symposium highlights five studies that included diverse populations of older adults and/or caregivers in the design of health interventions. Dr. Schiaffino will share how disparities in co-morbid cancer and dementia across racial, ethnic, and age groups will inform improvements to care delivery processes for this population. Ms. Crane will discuss barriers to designing exergame interventions that are accessible to older adults with multiple chronic conditions and functional limitations. Dr. Díaz-Santos will describe results of piloting and refining a social connection intervention to reduce loneliness among Latinx older adults at risk for dementia. Dr. del Pino will highlight strategies to improve implementation of a screening intervention for at-risk drinking among African American older adults living with HIV. Mr. Cotton will present results of tailoring a crisis intervention to improve cultural fit for African American caregivers of people with dementia.
DETERMINING FEASIBILITY FOR USE OF GERIATRIC COGNITIVE SCREENINGS BY MEDICAL CASE MANAGERS SERVING OLDER (50+) PLWH
Authors: Maly Monica , Burk-Leaver Erin 
Published: December 2022

Abstract
Cognitive impairment (CI) is a significant age-related risk exacerbated by HIV. However, AIDS Service Organizations (ASO) have not implemented effective screening tools for detection of CI in older adults living w/HIV (OALH). This study examined feasibility for use of those tools by medical case managers (MCM) serving OALH. MCMs from nine Colorado ASOs self-administered a questionnaire measuring baseline knowledge of warning signs and risk factors (WS/RF) of CI in OALH, evaluating familiarity with screening of/response to WS/RF of CI within this population. Data from 24 MCMs showed OALH comprised 47% of all clients, and 68% of respondents reported no related training. Similarly, 67% reported not feeling confident identifying WS/RF. 100% of respondents reported not screening for CI, and many endorsed limited awareness/availability of screening tools (87%), referral resources (87%), and training (83%). This identified a need and desire for use/implementation of cognitive screening tools to improve ASO care for OALH.
DISABILITY STATUS, FINANCIAL STRAIN, AND SUBJECTIVE HEALTH AND WELL-BEING FOR PEOPLE WITH LTSS NEEDS IN CALIFORNIA
Authors: Chen Lei , Kietzman Kathryn , Torres-Gil Fernando 
Published: December 2022

Abstract
Many people with needs for Long-Term Services and Supports (LTSS) are vulnerable to financial strain, a chronic economic stressor that may negatively affect a person’s well-being. This study examines the extent to which financial strain mediates the relationship between people’s disability status and subjective health and well-being, controlling for select demographic characteristics. Disability status refers to the intensity of disabilities that people report, including cognitive impairments, and/or difficulties performing activities of daily living and/or instrumental activities of daily living. Financial strain measures the number of challenges that participants incurred during the last year in acquiring food, housing, health care, and other basic needs. We use the first cycle of data (2019-2020) from the California Long-Term Services and Supports (LTSS) survey, merged with select data from the California Health Interview Survey (CHIS) (N = 2,030). Drawing from Pearlin’s Stress Process Model, we use Conditional Process Analysis (CPA) to examine the hypothesized mediation relationships. Findings show that the intensity of disability status has a direct association with self-rated health (c’ = -.2054, p &lt; .0001) and psychological distress (c’ = .7247, p &lt; .0001). Furthermore, financial strain experienced by people with LTSS needs mediates the relationship between their disability status and 1) self-rated health (ab = -.0178, BootCI= -.0285 to -.0082) and 2) psychological distress (ab = 0.19, BootCI= .1323 to .2648). These results have policy and practice implications for national and state programs, such as Medicaid, the Universal Basic Income (UBI) program, and the Master Plan for Aging in California.
EVALUATING IMPLEMENTATION OF AN ONLINE INTERGENERATIONAL TECHNOLOGY PROGRAM
Authors: Juris Jill , Scrivano Rachel , Bouldin Erin , Uva Katherine 
Published: December 2022

Abstract
Social isolation and loneliness contributed to poor health outcomes among rural older adults prior to COVID-19. Physical distancing protocols during COVID-19 exacerbated social disconnect of rural older adults and paused in-person intergenerational programs. Pilot data from a Cyber-Seniors program that was adapted for virtual delivery and participation during the pandemic (2020-2021) indicates positive health outcomes for older adults (improved social isolation and loneliness). This presentation will address a gap between outcomes and the implementation process of the intergenerational technology program. Multi-method data on student experiences as technology mentors working at a distance suggest a need for an evaluation of program implementation. The type 1 effectiveness-implementation hybrid design includes quantitative measures of student outcomes (ageism, social isolation, and loneliness) and qualitative analysis of students’ program implementation experiences. Students identified challenges accessing and working with the online platforms, scheduling meetings with older adults, and providing support with online systems by phone.