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Gait speed significantly affects functional status and health outcomes in older adults. This cross-sectional study evaluated cognitive and physical fitness contributors to usual and peak gait speed in persons with Alzheimer's dementia. Multiple hierarchal linear regression was used to obtain squared semipartial correlation coefficients (sr2) and effect sizes (Cohen's ƒ2). Participants (n = 90; 56% male) averaged 77.1 ± 6.6 years of age and 21.8 ± 3.4 on Mini-Mental State Examination. Demographic/clinical, physical fitness, and cognition variables explained 45% and 39% of variance in usual and peak gait speed, respectively. Muscle strength was the only significant contributor to both usual (sr2 =.175; Cohen's ƒ2 = 0.31; p <.001) and peak gait speed (sr2 =.11; Cohen's ƒ2 = 0.18; p <.001). Women who were "slow" walkers (usual gait speed <1.0 m/s) had significantly lower cardiorespiratory fitness and executive functioning compared with "fast" walkers. In conclusion, improving muscle strength may modify gait and downstream health outcomes in Alzheimer's dementia. [ABSTRACT FROM AUTHOR]

Effective disease management in older adults relies on medication adherence to prevent adverse outcomes like hospitalization, particularly among those with cognitive impairment. In this study, we examined the impact of cognitive impairment on medication management, adherence, and hospitalization risk across levels of cognitive function. Analyzing data from 28,558 community-dwelling older adults, we found that those with dementia had the most difficulty managing medications (13.12%), followed by cognitive impairment without dementia (5.80%), and intact cognition (1.96%). Only persons with dementia showed a significant association between medication management difficulty and hospitalization risk (Odds Ratio [OR] = 1.71; 95% Confidence Intervals: 1.08, 2.70; p =.02). Cost-related medication nonadherence was associated with hospitalization risk solely among those with intact cognition (OR = 1.25; 95% CI: 1.07, 1.45; p =.004). Dementia was associated with higher odds of medication management difficulty and subsequently hospitalization risk, underscoring the need for resources to support medication use for this population. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the additive and dominance genetic variance in growth and multiple‐stress tolerance traits in 7‐week‐old and 15‐week‐old Pacific white shrimp Litopenaeus vannamei. Four different animal models were studied by including all or different subsets of the following effects: additive genetic effects (A), additive genetic and common environmental effects (A + C), additive genetic and dominance effects (A + D), and additive, common environmental, and dominance effects (A + D + C). Variance components were estimated using the average information restricted maximum likelihood method. In general, estimates of additive genetic variance were inflated under the simple model (A) and decreased remarkably under the more complex models (A + C, A + D, and A + D + C). The genetic parameters of two‐stage (7‐week and 15‐week shrimp) growth and multiple‐stress tolerance traits were more suitable for estimation using the A + C model. The additive effects (0.311–0.754) of seven traits in 7‐week shrimp were greater than the dominance effects (4.950 × 10−7 to 0.201), whereas the additive effects of the same seven traits in adult shrimp ranged from 7.712 × 10−8 to 0.468 and the dominance effects ranged from 0.074 to 0.577. Except for survival time, carapace length, and carapace width, the additive effects of the other traits were smaller than the corresponding dominance effects. Thus, better genetic improvement of 7‐week and 15‐week shrimp growth and multiple‐stress tolerance can be obtained with selective breeding than with crossbreeding and better genetic improvement of 7‐week shrimp growth traits can be obtained with crossbreeding than with selective breeding. Our study further enriches the database for enhancing growth and stress resistance in Pacific white shrimp and provides reference information for growth improvement and multiple‐stress resistance breeding. [ABSTRACT FROM AUTHOR]

Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health‐care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health‐care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high‐risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health‐care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions. [ABSTRACT FROM AUTHOR]

Background: Home time is an important patient‐centric quality metric, which has been largely unexamined among assisted living (AL) residents. Our objectives were to assess variation in home time among AL residents in the year following admission and to examine the associations with state regulations for direct care workers (DCW) training and staffing and for licensed nurse staffing. Methods: Medicare beneficiaries who entered AL communities in 2018 were identified, and their home time in the year following admission was measured. Home time was calculated as the percentage of time spent at home per day being alive. Resident characteristics and state regulations in DCW staffing, DCW training, and licensed staffing were measured. We used a multivariate linear regression model with AL‐level fixed effects to estimate the relationship between person‐level characteristics and home time. Linear regression models adjusting for resident characteristics were used to estimate the association between state regulations and residents' home time. Results: The study sample included 59,831 new Medicare beneficiary residents in 12,143 ALs. In the year following AL admission, residents spent 94% (standard deviation = 14.6) of their time at home. Several resident characteristics were associated with lower home time: Medicare–Medicaid dual eligibility, having more chronic conditions, and specific chronic conditions, for example, dementia. In states with greater regulatory specificity for DCW training and staffing, and lower specificity for licensed staffing, residents had longer adjusted home time. Conclusion/Implications: Home time varied substantially among AL residents depending on resident characteristics and state‐level regulatory specificity. AL residents eligible for Medicare and Medicaid had substantially shorter home time than the Medicare‐only residents, largely due to longer time spent in nursing homes. State AL regulatory specificity for DCWs and licensed staff also impacted AL residents' home time. These findings may guide AL operators and state legislators in efforts to improve this important quality of life metric. [ABSTRACT FROM AUTHOR]

Background: Antipsychotic use is a safety concern among older patients in home health care (HHC), particularly for those with Alzheimer's disease and related dementias (ADRD). The objective of this study was to examine the prevalence and predictors of antipsychotic use among older adults with and without ADRD who received HHC, and the association of antipsychotic use with outcomes among patients living with ADRD. Methods: In this secondary analysis of adults ≥65 years receiving care from an HHC agency in New York in 2019 (N = 6684), we used data from the Outcome and Assessment Information Set, Medicare HHC claims, and home medication review results in the electronic HHC records during a 60‐day HHC episode. ADRD was identified by diagnostic codes. Functional outcome was the change in the composite activities of daily living (ADL) score from HHC admission to HHC discharge (measured in 5833 patients), where a positive score means improvement and a negative score means decline. Data were analyzed using logistic (predictors) and linear regression (association with outcome) analyses. Results: The point prevalence of antipsychotic use was 17.2% and 6.6% among patients with and without ADRD, respectively. Among patients living with ADRD, predictors of antipsychotic use included having greater ADL limitations (odds ratio [OR] = 1.30, p = 0.01), taking more medications (OR = 1.04, p = 0.02), having behavioral and psychological symptoms (OR = 5.26, p = 0.002), and living alone (OR = 0.52, p = 0.06). Among patients living with ADRD, antipsychotic use was associated with having less ADL improvement at HHC discharge (β = −0.70, p < 0.001). Conclusions: HHC patients living with ADRD were more likely to use antipsychotics and to experience worse functional outcomes when using antipsychotics. Antipsychotics should be systematically reviewed and, if contraindicated or unnecessary, deprescribed. Efforts are needed to improve HHC patients' access to nonpharmacological interventions and to provide education for caregivers regarding behavioral approaches to manage symptoms in ADRD. [ABSTRACT FROM AUTHOR]

Background: Despite the rapid growth of assisted living (AL) communities and the increasing similarity between AL and nursing home (NH) populations, little is known about the characteristics of older adults at the time of AL admission and how these characteristics compare to individuals newly admitted to NH from the community. This study examined the individual, facility, and geographic factors associated with new AL admission. Methods: This retrospective descriptive study used data from the national Medicare enrollment and claims datasets, the Minimum Data Set, and the Medicare Provider Analysis and Review. The study cohort included 158,124 Medicare beneficiaries newly admitted to ALs and 715,261 newly admitted to NHs during 10/2017–10/2019. Multinomial logistic regression analysis and logistic regression analysis were conducted to examine factors associated with new admissions. Results: Demographic, socioeconomic, and health service use characteristics were associated with new admission to long‐term care. Specifically, Medicare fee‐for‐service beneficiaries, those age 75 years and older, male, having one skilled nursing facility (SNF) stay or any hospital stay in the past 6 months are more likely to be newly admitted to AL, whereas those who are dually eligible, racial/ethnic minorities, and having two or more SNF stays in the past 6 months are more likely to be admitted to an NH. Conclusion: There are substantial differences between individuals who are newly admitted from the community to AL versus those to NH. [ABSTRACT FROM AUTHOR]

The study was designed and conducted to optimize the structure of polyculture for Penaeus vannamei, Siganus guttatus (omnivorous fish), and Selenotoca multifasciata (carnivorous fish), and to compare the changes in yield, survival, and utilization rates of nitrogen (N) and phosphorus (P). Five treatments were performed as follows: Control (C) (0.0719 kg/m3, 0, 0), PSS1(0.0719 kg/m3, 0.0018 kg/m3, 0.0008 kg/m3), PSS2 (0.0719 kg/m3, 0.0033 kg/m3, 0.0016 kg/m3), PSS3 (0.0719 kg/m3, 0.0047 kg/m3, 0.0023 kg/m3), and PSS4 (0.0719 kg/m3, 0.0064 kg/m3, 0.0031 kg/m3) (with P:Penaeus vannamei, S:Siganus guttatus, and S: Selenotoca multifasciata). The yield and survival of P. vannamei in different treatments were significantly different (P<0.05), with the highest yields being P. vannamei (718.75 kg/hm3), S. guttatus (32.97 kg/hm3), and S. multifasciata (15.63 kg/hm3) for treatment PSS2. The highest survival of P. vannamei was 89.4 ± 1.6% for treatment PSS2, while the highest N and P utilization rates were 27.7% and 37.5% for treatment PSS3. The polyculture mode when using a suitable density can improve production and survival of P. vannamei, as well as the utilization rates of N and P. [ABSTRACT FROM AUTHOR]

This paper presents a process for efficiently recovering palladium (Pd) from spent Pd/Al2O3 catalysts used for hydrogenation reactions, using ultrasound-assisted leaching (UAL). A system composed of H2SO4 and NaCl was investigated under ultrasound-enhanced conditions and compared to regular leaching methods to demonstrate the superiority of UAL. Single-factor experiments were conducted to determine the optimal conditions for leaching, which included an ultrasound power of 200 W, a liquid–solid ratio of 5:1, a leaching time of 1 h, a leaching temperature of 60 °C, H2SO4 concentration of 60%, and 0.1 mol of NaCl. The leaching rate under these conditions was found to be 99%. Additionally, kinetic analysis of the UAL process showed that the apparent activation energy of the Pd leaching reaction was 28.7 kJ/mol, and it was found that Pd leaching from spent catalysts was controlled by diffusion. The tailings were analyzed by SEM, revealing that during ultrasonic leaching, the specific surface area of the spent catalyst increased, the mass transfer rate of the solution was accelerated, the passivation film on the surface of the spent catalyst was peeled off, and a new reaction interface was formed. This improved the leaching rate of Pd and provided a new approach to efficiently leach precious metals such as Pd from spent catalysts. [ABSTRACT FROM AUTHOR]

The article suggests improvements for the value assessment of deprescribing interventions to reduce potentially inappropriate medications. It outlines limitations to current practice of deprescribing cost-effectiveness analyses (CEA) and recommendations for improvement including application of longer time horizon for deprescribing CEAs, tailoring deprescribing CEAs to the needs of decision makers, and adding patient-centric value elements.

Background: Existing literature on online reviews of healthcare providers generally portrays online reviews as a useful way to disseminate information on quality. However, it remains unknown whether online reviews for assisted living (AL) communities reflect AL care quality. This study examined the association between AL online review ratings and residents' home time, a patient‐centered outcome. Methods: Medicare beneficiaries who entered AL communities in 2018 were identified. The main outcome is resident home time in the year following AL admission, calculated as the percentage of time spent at home (i.e., not in institutional care setting) per day being alive. Additional outcomes are the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. AL online Google reviews for 2013–2017 were linked to 2018–2019 Medicare data. AL average rating score (ranging 1–5) and rating status (no‐rating, low‐rating, and high‐rating) were generated using Google reviews. Linear regression models and propensity score weighting were used to examine the association between online reviews and outcomes. The study sample included 59,831 residents in 12,143 ALs. Results: Residents were predominately older (average 81.2 years), non‐Hispanic White (90.4%), and female (62.9%), with 17% being dually eligible for Medicare and Medicaid. From 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one‐unit increase in the AL's average online rating was associated with an increase in residents' risk‐adjusted home time by 0.33 percentage points (p < 0.001). Compared with residents in ALs without ratings, residents in high‐rated ALs (average rating ≥4.4) had a 0.64 pp (p < 0.001) increase in home time. Conclusions: Higher online rating scores were positively associated with residents' home time, while the absence of ratings was associated with reduced home time. Our results suggest that online reviews may be a quality signal with respect to home time. See related Editorial by David et al. [ABSTRACT FROM AUTHOR]

Background: Despite the rapid growth of assisted living (AL) and frequent hospitalizations among AL residents, little is known about their patterns of post‐acute care transitions and outcomes. This study examined the post‐acute care transitions among AL residents and their association with outcomes in the first 30 and 60 days after hospital discharge. Methods: This study used data from 2018 national Medicare enrollment and claims datasets, the Minimum Data Set (MDS), and Medicare Provider Analysis and Review (MedPAR) of 104,497 unique Medicare beneficiaries residing in ALs in the U.S. Post‐acute care referrals, based on hospital discharge status, to skilled nursing facilities (SNF), home with home health care (HHC), home without HHC, and other settings. Outcomes included 30‐day and 60‐day hospital readmissions, emergency department (ED) visits, long‐stay care nursing home placement, and mortality. Multinomial logistic regression analysis and logistic regression analysis were conducted. Results: The most common post‐acute care referral was to SNF (40%), followed by home without HHC (28%), home with HHC (17%), and others (15%). Compared to discharge home without HHC, discharge to SNF was associated with a lower likelihood of ED visits (Odds Ratio = 0.597, p < 0.01) and hospital readmissions (OR = 0.856, p < 0.001), and higher likelihood of long‐stay nursing home placement (OR = 11.224, p < 0.01) and mortality (OR = 2.025, p < 0.01). Discharge home with HHC was associated with a higher likelihood of hospital readmissions (OR = 1.148, p < 0.01) and a lower likelihood of long‐stay nursing home placement (OR = 0.737, p < 0.05) than discharge home without HHC. The results were similar within the first 30 days as well as 60 days after hospital discharge. Conclusions: AL residents who are discharged to different post‐acute care settings tend to differ in 30‐day and 60‐day outcomes. At hospital discharge, clinicians and discharge planners should be provided information about the exact type and availability of services at AL to make the most appropriate discharge referrals for AL residents. [ABSTRACT FROM AUTHOR]

Objectives: Examine the relationships between dual eligibility and race/ethnicity characteristics of Medicare-Certified Home Health Agencies (CHHAs) and experience of care ratings. Methods: Analysis of 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs Results: CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings for all three domains (e.g., for care delivery, quartile 4 vs. 1: odds ratio [OR] = 0.622, p <.001); CHHAs with higher concentrations of racial/ethnic minorities generally were less likely to have high experience of care ratings in care delivery (e.g., Black: quartile 4 vs. 1: OR = 0.418, p <0.001), communication (e.g., Black: quartile 4 vs. 1: OR = 0.316, p <0.001), and specific care issues (e.g., Hispanic: quartile 4 vs. 1: OR = 0.397, p <.001). Discussion: CHHAs with greater concentrations of dual-eligible patients and racial/ethnic minorities were more likely to have poor experience of care ratings. [ABSTRACT FROM AUTHOR]

Background Pain management is important to post‐acute functional recovery, yet older persons with Alzheimer's disease and related dementias (ADRD) are often undertreated for pain. The main objectives were (1) to examine the relationship between ADRD and analgesic use among Medicare home health care (HHC) recipients with daily interfering pain, and (2) to examine the impact of analgesic use on functional outcome in patients with and without ADRD. Methods: We analyzed longitudinal data from the Outcome and Assessment Information Set, Medicare HHC claims, and HHC electronic medical records during a 60‐day HHC episode. The sample included 6048 Medicare beneficiaries ≥65 years receiving care from an HHC agency in New York in 2019 who reported daily interfering pain. Analgesic use was assessed during HHC medication reconciliation and included any analgesic, non‐opioid analgesic, and opioid. ADRD was identified from ICD‐10 codes (HHC claims) and cognitive impairment symptoms (Outcome and Assessment Information Set [OASIS]). Functional outcome was measured as change in the composite Activity of Daily Living (ADL) limitation score in the HHC episode. Results: ADRD was related to a lower likelihood of using any analgesic (odds ratio [OR] = 0.66, 95% confidence interval [CI]: 0.49, 0.90, p = 0.008) and opioids (OR = 0.54, 95% CI: 0.47, 0.62, p < 0.001), but not related to non‐opioid analgesic use (OR = 0.94, 95% CI: 0.74, 1.18, p = 0.58). Stratified analyses showed that any analgesic use (β = −0.43, 95% CI: −0.73, −0.13, p = 0.004) and non‐opioid analgesic use (β = −0.31, 95% CI: −0.56, −0.06, p = 0.016) were associated with greater ADL improvement in patients with ADRD, but not in patients without ADRD. Opioid use was not significantly related to ADL improvement regardless of ADRD status. Conclusions: HHC patients with ADRD may be undertreated for pain, yet pain treatment is essential for functional improvement in HHC. HHC clinicians and policymakers should ensure adequate pain management for older persons with ADRD for improved functional outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Care‐partner support affects outcomes among assisted living (AL) residents. Yet, little is known about care‐partner support and its effects on hospitalization during post‐acute care transitions. This study examined the variation in care‐partner support and its impact on hospitalizations among AL residents receiving Medicare home health (HH) services. DESIGN: Analysis of national data from the Outcome and Assessment Information Set, Medicare claims, Area Health Resources File, and the Social Deprivation Index File. SETTING: AL facilities and Medicare HH agencies in the United States. PARTICIPANTS: 741,926 Medicare HH admissions of AL residents in 2017. MEASUREMENTS: Care‐partner support during the HH admission was measured based on the type and frequency of assistance from AL staff in seven domains (i.e., activities of daily living (ADL), instrumental ADLs, medication administration, treatment, medical equipment, home safety, and transportation). Care‐partner support in each domain was measured as "assistance not needed" (reference group), "Care‐partner currently provides assistance," "care‐partner need additional training/support to provide assistance" (i.e., inadequate care‐partner support), and "care‐partner unavailable/unlikely to provide assistance" (i.e., unavailable care‐partner support). Outcome was time‐to‐hospitalization during the HH admission. RESULTS: Among the 741,926 Medicare HH admissions of AL residents, inadequate care‐partner support was identified for all seven domains that ranged from 13.1% (for transportation) to 49.8% (for treatment), and care‐partner support was unavailable from 0.9% (for transportation) to 11.0% (for treatment). In Cox proportional hazard models adjusted for patient covariates and geography, compared with "assistance not needed", having inadequate and unavailable care‐partner support was related to increased risk of hospitalization by 8.9% (treatment (hazard ratio (HR) =1.089, P <.001)) to 41.3% (medication administration (HR =1.413, P <.001)). CONCLUSION: For AL residents receiving HH services, having less care‐partner support was related to increased risk of hospitalization, particularly regarding medication administration, medical equipment, and transportation/advocacy. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Home health (HH) is a major type of home‐based skilled care available to Medicare beneficiaries. We examined the association between living situation (home alone, home with others, and assisted living (AL) residence) and utilization and functional outcomes among Medicare HH recipients. DESIGN: Analysis of national data from the Outcome and Assessment Information Set, HH Compare, Medicare claims, and Area Health Resource Files. SETTING: Medicare‐certified HH agencies in the United States. PARTICIPANTS: National population of Medicare beneficiaries ≥65 years old who received HH care in CY 2017 (N = 6,637,496). MEASUREMENTS: Outcomes included time‐to‐event measures of hospitalization and emergency department (ED) visits, and improvement in activities of daily living (ADL) from the start to the end of the HH admission. RESULTS: AL residents (12%) and patients living alone at home (24%) had longer survival time without hospitalization and ED visits than patients living with others at home (64%). Adjusting for covariates and HH agency‐level random effects, and compared with patients living with others, AL residents had lower risk of hospitalization (hazard ratio (HR) = 0.85, P <.001) and ED visit (HR = 0.92, P <.001); however, less ADL improvement (β = 0.29 (29% less of total independence in one ADL)); and patients living alone had lower risk of hospitalization (HR = 0.94, P <.001) and ED visit (HR = 0.93, P <.001), yet more ADL improvement (β = −0.15 (15% more of total independence in one ADL)). CONCLUSION: In the national population of Medicare HH recipients, patients living with others at home had the highest risk of hospitalization and ED visits, whereas AL residents had the lowest risk of hospitalization and patients living alone at home had the lowest risk of ED visits, meaning that combined support from HH and AL reduces acute care admissions. Evidence‐based interventions are needed for HH patients living with others at home to avoid unnecessary acute care use. [ABSTRACT FROM AUTHOR]

To examine the added effect of having both cognitive deficit and physical frailty, compared to having either one only, on hospitalization and emergency department (ED) visits. Data from a population-based study of 3,157 community-dwelling older (≥60 years) Chinese adults in the U.S. were used. Cognitive deficit was measured by the Mini-Mental State Examination (i.e. education-adjusted score: 16 [illiterate], 19 [primary school], and 23 [≥middle school]). Physical frailty was identified using the Short Performance Physical Battery (0–6 out of 15). The numbers of hospitalizations and ED visits in the previous two years were self-reported. In this sample, 12.63% had cognitive deficit alone, 5.95% had physical frailty alone, and 4.26% had both. Compared with participants having neither cognitive deficit nor physical frailty, those having physical frailty alone were 1.5 times as likely to have hospitalizations (Rate Ratio [RR] = 1.52 [1.07, 2.16], p = 0.02) and ED visits (RR = 1.52 [1.07, 2.15], p = 0.02). Having cognitive deficit alone was not significantly related to either outcome. However, having cognitive deficit with existing physical frailty increased the likelihood of both hospitalization (RR = 2.00 [1.36, 2.96], p < 0.001) and ED visits (RR = 2.04 [1.37, 3.03], p < 0.001) to a greater extent than having physical frailty alone. Having cognitive deficit alone was not significantly related to the likelihood of hospitalizations or ED visits, however having cognitive deficit with existing physical frailty increased the likelihood of both outcomes to a greater degree than having physical frailty alone. This suggests cognitive deficit and physical frailty have synergistic effects on hospitalizations and ED visits. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine the effects of dementia and Medicare–Medicaid dual eligibility on unplanned facility admission among older Medicare home health (HH) recipients. Method: This study involves a secondary analysis of data from the Outcome and Assessment Information Set (OASIS) and billing records (i.e., International Classification of Diseases, 10th Revision [ICD-10] codes) of 6,153 adults ≥ 65 years receiving HH from a nonprofit HH agency in CY 2017. Results: Among dual eligible patients with dementia, 39.3% had an unplanned facility admission of any type, including the hospital, nursing home, or rehabilitation facility. In the multivariable Cox proportional hazard model of time-to-facility admission, dual eligible patients with dementia were more than twice as likely as Medicare-only patients without dementia to have an unplanned facility admission (hazard ratio = 2.35; 95% confidence interval: 1.28, 4.33; p =.006). Discussion: Low income and dementia have interactive effects on facility admissions. Among Medicare HH recipients, dual eligible patients with dementia are the most vulnerable group for unplanned facility admission. [ABSTRACT FROM AUTHOR]

Patients in home health care (HHC), a rapidly growing healthcare sector, are at high risk for infections. This study aimed to identify risk factors for infections among HHC patients using the Outcome and Assessment Information Set (OASIS) data. We used a 5% random sample of the 2013 national OASIS data. Infections were identified if records indicated that patients were hospitalized or received emergency care for one of three types of infections (respiratory, wound site, and urinary tract infection). Multivariate logistic regression models were used to identify risk factors for each individual infection type. The final analysis included 128,163 patients from 8,255 HHC agencies nationwide. Approximately 3.2% of the patients developed infections during their HHC stay that led to hospitalization or emergency care treatment. We found that associations between demographics and infection risk are specific to the type of infection. In general, a history of multiple hospitalizations in past 6 months, comorbidity, having a severe condition at HHC admission, and impaired physical functioning increased HHC patients' risk of infections. We also identified that HHC patients with caregivers who needed training in providing medical procedure or treatment are at higher risk for wound‐site infections. Our findings suggest that patients with underlying medical conditions and limited physical function status are more likely to develop infection. The caregiver's lack of training in providing needed care at home also places HHC patients at high risk for infection. Education for patients and caregivers should be tailored based on their health literacy level to ensure complete understanding. [ABSTRACT FROM AUTHOR]

OBJECTIVES To investigate the association of the utilization of Medicare‐certified home health agency (CHHA) services with post‐acute skilled nursing facility (SNF) discharge outcomes that included home time, rehospitalization, SNF readmission, and mortality. DESIGN Retrospective cohort study. SETTING New York State fee‐for‐service Medicare beneficiaries aged 65 years and older admitted to SNFs for post‐acute care and discharged to the community in 2014. PARTICIPANTS A total of 25,357 older adults. MEASUREMENTS The outcomes included days spent alive in the community ("home time"), rehospitalization, SNF readmission, and mortality within 30‐ and 90‐day post‐SNF discharge periods. The primary independent variables were SNF five‐star overall quality rating and receipt of CHHA services within 7 days of SNF discharge. Zero‐inflated negative binomial regression and logistic regression models characterized the association of CHHA linkage with home time and other outcomes, respectively. RESULTS: Following SNF discharge, 17,657 (69.6%) patients received CHHA services. In analyses that adjusted for patient‐, market‐, and other SNF‐level factors, older adults discharged from higher quality SNFs were more likely to receive CHHA services. In analyses that adjusted for patient‐ and market‐level factors, receipt of post‐SNF CHHA services was associated with 2.03 and 4.17 (P <.001) more days in the community over 30‐ and 90‐day periods. Receiving CHHA services was also associated with decreased odds for rehospitalization (odds ratio [OR] =.68; P <.001; OR =.91; P =.008), SNF readmission (OR =.36; P <.001; OR =.62; P <.001), and death (OR =.34; P <.001; OR =.63; P <.001) over 30‐ and 90‐day periods, respectively. CONCLUSION: Among older adults discharged from a post‐acute SNF stay, those who received CHHA services had better discharge outcomes. They were less likely to experience admissions to institutional care settings and had a lower mortality risk. Future efforts that examine how the type and intensity of CHHA services affect outcomes would build on this work. J Am Geriatr Soc 68:1573‐1578, 2020. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the independent and interactive effects of dementia and racial/ethnic minority status on functional outcomes during a home health (HH) admission among Medicare beneficiaries. Methods: Secondary analysis of data from the Outcome and Assessment Information Set [OASIS] and billing records in a non-profit HH agency in New York. Participants were adults ≥ 65 years old who received HH in CY 2017 with OASIS records at HH admission and HH discharge. Dementia was identified by diagnosis (ICD-10 codes) and cognitive impairment (OASIS: M1700, M1710, M1740). We used OASIS records to assess race/ethnicity (M0140) and functional status (M1800-M1870 on activities of daily living [ADL]). Functional outcome was measured as change in the composite ADL score from HH admission to HH discharge, where a negative score means improvement and a positive score means decline. Results: The sample included 4,783 patients, among whom 93.9% improved in ADLs at HH discharge. In multivariable linear regression that adjusted for HH service use and covariates (R2 = 0.23), being African American (β = 0.21, 95% confidence interval [CI]: 0.06, 0.35, p = 0.005) and having dementia (β = 0.51, 95% CI: 0.41, 0.62, p<0.001) were independently related to less ADL improvement at HH discharge, with significant interaction related to further decrease in ADL improvement. Relative to white patients without dementia, African American patients with dementia (β = 1.08, 95% CI: 0.81, 1.35, p<0.001), Hispanics with dementia (β = 0.92, 95% CI: 0.38, 1.47, p = 0.001) and Asian Americans with dementia (β = 1.47, 95% CI: 0.81, 2.13, p<0.001) showed the least ADL improvement at HH discharge. Conclusion: Racial/ethnic minority status and dementia were associated with less ADL improvement in HH with independent and interactive effects. Policies should ensure that these patients have equitable access to appropriate, adequate community-based services to meet their needs in ADLs and disease management for improved outcomes. [ABSTRACT FROM AUTHOR]

In this study, we aimed to examine the relationship of social support with hospitalizations and emergency department (ED) visits among older Chinese adults in the United States and its possible mechanism. This was a secondary analysis of data from the Population Study of Chinese Elderly (July 2011-June 2013; N = 3,157). After adjusting for demographic, clinical, and functional covariates in logistic regression analyses, significant interaction between social support from spouse and the number of functional limitations in (instrumental) activities of daily living was related to lower odds of hospitalization (odds ratio [OR] = 0.97 [0.95-0.99]) and ED visits (OR = 0.98 [0.96-0.99]). This finding suggests that among older Chinese American adults with functional limitations, more spousal support was related to lower odds of hospitalizations and ED visits. Future studies should comprehensively measure social support (e.g., content, amount) from other sources and investigate how unnecessary acute health service utilization in this population may be reduced by social support interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives Depressive symptomatology is a significant predictor of increased health services utilization and health care cost in the general older adult population. However, there is scant information on the relationship between depressive symptoms and health service utilization among U.S. Chinese older adults. The objective of this study was to examine the relationship between depressive symptoms and physician visits, emergency department (ED) visits, and hospitalization. Research Design and Methods Cross-sectional data were derived from the Population Study of Chinese Elderly in Chicago (PINE) collected between July 2011 and June 2013 (N = 3,159). Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between depressive symptoms and physician visits, ED visits, and hospitalization. Results U.S. Chinese older adults with depressive symptoms were more likely to have at least one ED visit (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.44–2.28) and hospitalization (OR = 1.9, 95% CI = 1.47–2.33) in the past 2 years than those without depressive symptoms, while adjusting for sociodemographic and health-related covariates. Other significant factors associated with health services utilization in this population included number of people in household, health insurance coverage, and acculturation. Discussion and Implications Depressive symptoms are positively associated with hospitalization and ED visits among U.S. Chinese older adults. Routine screenings of depressive symptoms should be part of the clinical encounter in these care settings so that appropriate treatment or timely mental health service referrals could be provided to this population to ultimately optimize their utilization of health services. [ABSTRACT FROM AUTHOR]

The objectives of this literature review were to (1) synthesize biological processes linked to frailty and their corresponding biomarkers and (2) identify potential associations among these processes and biomarkers. In September 2016, PubMed, Cumulative Index to Nursing and Allied Health, Cochrane Library, and Embase were searched. Studies examining biological processes related to frailty in older adults (≥60 years) were included. Studies were excluded if they did not employ specific measures of frailty, did not report the association between biomarkers and frailty, or focused on nonelderly samples (average age < 60). Review articles, commentaries, editorials, and non-English articles were also excluded. Fifty-two articles were reviewed, reporting six biological processes related to frailty and multiple associated biomarkers. The processes (biomarkers) include brain changes (neurotrophic factor, gray matter volume), endocrine dysregulation (growth hormones [insulin-like growth factor-1 and binding proteins], hormones related to glucose and insulin, the vitamin D axis, thyroid function, reproductive axis, and hypothalamic–pituitary–adrenal axis), enhanced inflammation (C-reactive protein, interleukin-6), immune dysfunction (neutrophils, monocytes, neopterin, CD8+CD28−T cells, albumin), metabolic imbalance (micronutrients, metabolites, enzyme-activity indices, metabolic end products), and oxidative stress (antioxidants, telomere length, glutathione/oxidized glutathione ratio). Bidirectional interrelationships exist within and between these processes. Biomarkers were associated with frailty in varied strengths, and the causality remains unclear. In conclusion, frailty is related to multisystem physiological changes. Future research should examine the dynamic interactions among these processes to inform causality of frailty. Given the multifactorial nature of frailty, a composite index of multisystem biomarkers would likely be more informative than single biomarkers in early detection of frailty. [ABSTRACT FROM AUTHOR]

Background: Alcohol use and its associated problems are on the rise in China. In this study, we examined the associations between alcohol use and cognitive functioning in a representative sample of adults aged 45 years and older in China. Methods: Baseline data for 16,328 participants of the China Health and Retirement Longitudinal Study were analyzed. Alcohol use was measured by drinking status (never, former, moderate, and at‐risk drinkers), number of standard drinks per week, and years of drinking. Cognitive functioning was assessed for visuospatial ability, episodic memory, orientation/attention, and overall cognitive functioning. Multivariate linear and logistic regressions were used to examine the independent association between alcohol use and cognitive functioning controlling for age, gender, education, domestic partner status, and depressive symptoms. Results: The study participants were, on average, 66 years old (median 59, range 45 to 102). The prevalence of ever drinking during lifetime and current at‐risk drinking (>14 drinks per week) in this population was 34.6 and 6.7%, respectively. Drinking was more common among men with 48.8% being ever drinkers and 14.4% current at‐risk drinkers, respectively. At‐risk drinkers, compared to people who never drank alcohol, had worse episodic memory (β = −0.11, p = 0.048). Moreover, number of standard drinks per week was associated with worse episodic memory (β = −0.001, p = 0.02). None of the other measures of alcohol use was associated with the overall or domain‐specific cognitive functioning. Conclusions: At‐risk drinking status was associated with worse episodic memory. Clinicians should incorporate alcohol use assessment into routine care for middle‐aged and older adults in China and provide them with resources and strategies to effectively manage their alcohol use. This may help preserve episodic memory in this population. [ABSTRACT FROM AUTHOR]

Objectives: To examine pain interference in verbally communicative older adults with mild to moderate Alzheimer's disease (AD) and to examine the association of pain interference with cognitive function and depressive symptoms. Method: For this pilot study, we used a cross-sectional design to examine pain interference (Brief Pain Inventory-Short Form), cognitive function (Mini-Mental State Exam), and depressive symptoms (15-item Geriatric Depression Scale) in 52 older (≥65) communicative adults with AD who reported being free from chronic pain requiring daily analgesics. Results: Pain was reported to interfere with general activity (13.5%), mood (13.5%), walking ability (13.5%), normal work (11.5%), enjoyment of life (11.5%), relationships with other people (9.6%), and sleep (9.6%). Pain interference was significantly positively correlated with both cognitive function (rs = 0.46, p = 0.001) and depressive symptomology (rs = 0.45, p = 0.001), indicating that greater reported pain interference was associated with better cognitive function and more depressive symptoms. Conclusion: Among older people with AD who report being free from chronic pain requiring daily analgesics, 2 in 10 are at risk of pain interference and depressive symptoms. Those with better cognitive function reported more pain interference and depressive symptoms, meaning pain is likely to be under-reported as AD progresses. Clinicians should regularly assess pain interference and depressive symptoms in older persons with AD to identify pain that might be otherwise overlooked.. [ABSTRACT FROM AUTHOR]

Background: Underrecognized and untreated pain in people with Alzheimer's disease (AD) is a public health concern1 and is associated with sleep disturbances, loss of appetite, and depressive symptoms2. As cognition worsens, people with AD may be unable to reliably report their pain3; 4. While previous studies have examined self‐reported pain intensity in persons with AD5; 6, there has been limited investigation into how this pain interferes with daily living (i.e. pain interference). Wang et al (2017) reported that cognition has a positive association with pain interference and depression7 in AD. However, the relationship of the specific aspects of pain interference with cognitive function and depression has not been explored. Here we investigate the association of specific pain interference subscores with cognitive function and depressive symptoms in verbally communicative older adults with mild to moderate AD. We hypothesized that (1) AD individuals with better cognitive function will report more pain interference in all categories; and (2) all elements of pain interference will be positively associated with depressive symptoms. Method: For this secondary analysis, we investigated the relationship between pain interference (Brief Pain Inventory‐ Short Form), cognitive function (Mini‐Mental Status Exam), and depressive symptoms (15‐item Geriatric Depression Scale) in 52 older communicative adults (ages ≥ 65) with AD. Data analyses were conducted in R using Spearman correlation coefficients to assess the univariate associations between study measures. Result: We found significant positive correlations between cognitive function (median MMSE = 17.00) and pain interference subscores of general activity, mood, walking ability, normal work, sleep, and enjoyment of life (r =.30‐.37, p < 0.05), but not "relations with other people." Further, the relationship between depressive symptomatology (median GDS‐15 = 2.00) with pain interference was significant in all measures except "general activity" (r =.26 ‐.38, p < 0.05). Conclusion: Among adults with AD, nearly all aspects of pain interference were positively associated with cognitive function and depressive symptoms. Regular assessment of specific pain interference measures and screening for depressive symptomology can be used as another tool to help identify unreported and underrecognized pain. Moreover, distinguishing individual elements of pain interference may allow for more individualized management of pain and depressive symptoms in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: People with Alzheimer's disease (AD) report pain less frequently and receive less pain medication than people without AD. Recent studies have begun to elucidate how pain may be altered in those with AD. However, potential sex differences in pain responsiveness have never been explored in these patients. It is unclear whether sex differences found in prior studies of healthy young and older individuals extend to people with AD.Objective: The purpose of this study was to examine sex differences in the psychophysical response to experimental thermal pain in people with AD.Methods: Cross-sectional analysis of 14 male and 14 female age-matched (≥65 years of age, median = 74) and AD severity-matched (Mini-Mental State Exam score <24, median = 16) communicative people who completed thermal psychophysics.Results: There was a statistically significant main effect of sex for both temperature and unpleasantness ratings that persisted after controlling for average and current pain (mixed-effects general liner model: temperature: p = 0.004, unpleasantness: p < 0.001). Females reported sensing mild pain and moderate pain percepts at markedly lower temperatures than did males (mild: Cohen's d = 0.72, p = 0.051, moderate: Cohen's d = 0.80, p = 0.036). By contrast, males rated mild and moderate thermal pain stimuli as more unpleasant than did females (mild: Cohen's d = 0.80, p = 0.072, moderate: Cohen's d = 1.32, p = 0.006). There were no statistically significant correlations of temperature with perceived unpleasantness for mild or moderate pain (rs = 0.29 and rs = 0.20 respectively, p > 0.05).Conclusions: Results suggest experimental pain-related sex differences persist in older adults with AD in a different manner than those previously demonstrated in cognitively intact older adults. These findings could potentially aid in developing targeted pain management approaches in this vulnerable population. Further studies are warranted to replicate the findings from this pilot work. [ABSTRACT FROM AUTHOR]

Our study examined the proportion of skilled nursing facility (SNF) post-acute care residents who did not receive timely primary care provider (PCP) services following discharge, factors associated with lack of timely PCP services, and factors associated with perfect 30-day home time among those who did not receive timely PCP services. Longitudinal cohort study; data sources included Medicare claims and other administrative databases. 25,357 fee-for-service New York State Medicare beneficiaries aged 65 years and older admitted to SNFs for post-acute care in 2014 and then discharged to the community. Our outcomes were a timely PCP visit (within 7 days of SNF discharge) and perfect 30-day home time, and we examined their association with patient, SNF, and county factors. Among SNF discharges, 60.6% had a timely PCP visit. In multivariate regression analyses, female sex, nonwhite race, Medicare only status, less functional impairment and medical comorbidity, a surgical hospitalization, fewer hospital days, more SNF days, absence of home health services, for-profit SNF status, higher SNF star rating, lower ratio of registered nurse/total nursing hours, and rural counties were associated with lower odds of a timely PCP visit following SNF discharge. Among those without a timely PCP visit, female sex, less cognitive and functional impairment, less medical comorbidity, a surgical hospitalization, fewer hospital days, receipt of home health services, and higher SNF star rating were associated with increased odds of perfect 30-day home time following SNF discharge. That 4 in 10 post-acute care SNF patients did not have a timely PCP visit post-SNF discharge, with racial minority and rural county status associated with decreased odds of a timely PCP visit, is concerning. Examination of whether the timing and type of outpatient visit may have varying effects on different post-acute care subpopulations would build on this work. [ABSTRACT FROM AUTHOR]

Background and Objectives: Depressive symptomatology is a significant predictor of increased health services utilization and health care cost in the general older adult population. However, there is scant information on the relationship between depressive symptoms and health service utilization among U.S. Chinese older adults. The objective of this study was to examine the relationship between depressive symptoms and physician visits, emergency department (ED) visits, and hospitalization., Research Design and Methods: Cross-sectional data were derived from the Population Study of Chinese Elderly in Chicago (PINE) collected between July 2011 and June 2013 (N = 3,159). Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between depressive symptoms and physician visits, ED visits, and hospitalization., Results: U.S. Chinese older adults with depressive symptoms were more likely to have at least one ED visit (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.44-2.28) and hospitalization (OR = 1.9, 95% CI = 1.47-2.33) in the past 2 years than those without depressive symptoms, while adjusting for sociodemographic and health-related covariates. Other significant factors associated with health services utilization in this population included number of people in household, health insurance coverage, and acculturation., Discussion and Implications: Depressive symptoms are positively associated with hospitalization and ED visits among U.S. Chinese older adults. Routine screenings of depressive symptoms should be part of the clinical encounter in these care settings so that appropriate treatment or timely mental health service referrals could be provided to this population to ultimately optimize their utilization of health services., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)