Digital Commons Network^™

High-Frequency Functional Trajectories Predict Depressive Worsening In Singapore's Community-Dwelling Older Adults, Kaung Htet Tun Salai, Yi Wen Tan, Grace Cheong, Paulin T. Straughan

ROSA Journal Articles and Publications

Background/Objectives: Functional difficulty and depression often coexist in older adults, yet local Singapore-based research often lacks detailed temporal resolution due to heterogeneity in ageing. This study employs non-parametric, data-driven longitudinal clustering to analyse functional trajectories and their association with depression, using high-frequency data to pinpoint key intervention periods. Methods: Data were drawn from 4273 community-dwelling older adults from Singapore Life Panel^® (2020–2024). Participants completed quarterly self-reported assessments of ADL, IADL and depressive symptoms (8-item CES-D). We employed k-means longitudinal clustering (kml) to identify functional trajectory groups and Cox regression to evaluate the hazard of increased depression (≥5-point increase in …

Disposition At Equipoise: A Qualitative Study Of Emergency Physicians' Decision-Making About Hospitalizing People With Dementia, Anita N Chary, Annika R Bhananker, Rebecca Franks, Jason Bowman, Adrian D Haimovich, Victoria Martell, Elizabeth M Schoenfeld, Cameron J Gettel, Shan W Liu, Kei Ouchi, Maura Kennedy, Aanand Naik, Manish N Shah

Faculty, Staff and Student Publications

Background: People with dementia are often hospitalized from the emergency department (ED) for conditions that could potentially be treated in the outpatient setting. In scenarios of clinical equipoise-where either admission or discharge may be appropriate-little is known about how emergency physicians make disposition decisions.

Methods: We conducted a qualitative study with attending emergency physicians at a single academic medical center. Interviews included open-ended questions about disposition decision-making in general as well as structured case scenarios using a think-aloud protocol. We used an inductive approach to code interview data and elucidate themes about the factors emergency physicians consider in disposition decisions …

Communicating Across Languages: Experiences Of Spanish-Speaking People With Dementia And Care Partners In The Emergency Department, Anita N Chary, Victor Lara, Sumin Yoon, Annika R Bhananker, Edgar Ordoñez, Michelle I Suh, Manish N Shah

Faculty, Staff and Students Publications

No abstract provided.

Dampak Penerapan Integrated Care For Older People Dan Ina-Frail Dalam Menurunkan Sindroma Kerapuhan Pada Lansia, Mochamad Ramadhan Arista Pesat Eka Putra, Vetty Yulianty Permanasari

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Indonesia is facing a significant increase in its elderly population, requiring effective and sustainable integrated geriatric services, one of which is through the implementation of Integrated Care for Older People (ICOPE) to assess intrinsic capacity decline combined with the Ina-FRAIL questionnaire to measure frailty in the elderly. This study aims to assess the condition of frailty in older adults through the ICOPE approach in integrated geriatric services at Humana Prima Hospital in Bandung using a quantitative design with an experimental approach. The assessment was conducted using the ICOPE and Ina-FRAIL instruments to monitor intrinsic capacity and the level of frailty …

Marital Satisfaction And Social Media Use: A Comparative Study Based On Addiction Levels, Fatma Ayhan, Elif Arık, Merve Gülsüm Saçan, Zehra Sevim, Esme Arguç

Makara Human Behavior Studies in Asia

In recent years, the widespread use of social media platforms has raised questions about their impact on marital relationships. This study examined the relationship between marital satisfaction, social media use, and certain sociodemographic characteristics. This descriptive and cross-sectional study comprised 461 individuals residing in Turkey who had been married for at least one year. Data were collected using the Bergen Social Media Addiction and Marital Satisfaction Scales. Statistical analyses included t-tests, analysis of variance, and multiple linear regression analysis. Social media addiction was high among 16.5% of the participants. Marital satisfaction was higher among males, those who married at age …

A Nurse-Led Staff Education Program To Prevent And Detect Elder Abuse By Caregivers In The Home, Nicola Violet Brown-Walters

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a nurse-led, evidence-based staff education initiative designed to improve the prevention and detection of elder abuse in the home by caregivers within an outpatient primary care setting. Elder abuse places older adults at risk for physical harm, neglect, medication mismanagement, and violations of autonomy and patient rights. Elder abuse remains a pervasive and underrecognized problem in nursing practice, often resulting from limited staff education, inconsistent screening practices, and uncertainty regarding mandatory reporting requirements. The practice-focused question examined whether implementing a nurse-led targeted education program guided by the ADDIE instructional design model and …

Association Between Frailty Status And Pain, Balance, And Quality Of Life In Patients With Lumbar Spinal Stenosis, Musa Güneş, Aydin Si̇nan Apaydin

Turkish Journal of Medical Sciences

Background/aim: Frailty is a clinical syndrome that affects individuals physically and psychosocially. However, the association between lumbar spinal stenosis (LSS) and frailty remains unclear. This study aimed to compare pain, balance, disability, fear of falling, and quality of life between patients with LSS with and without frailty.

Materials and methods: This cross-sectional study included 43 frail and 48 nonfrail patients with LSS according to the frailty criteria of Fried et al. Pain intensity (numeric rating scale [NRS]), static balance (single leg stance test [SLST]), dynamic balance (Timed Up and Go test [TUG]), disability (Oswestry Disability Index [ODI]), fear of falling …

Validity Of The Turkish Version Of The Oral Frailty Index-8 And Its Relationship With Frailty, Malnutrition, And Sarcopenia In Older Adults, Süleyman Emre Koçyi̇ği̇t, Bi̇lal Kati̇poğlu, Yilmaz Önal, Kübra Bahar Baykan, İlknur Şeker Kaya, Fatma Sena Dost, Özge Dokuzlar, Esra Ateş Bulut, Ali̇ Ekrem Aydin, Derya Kaya, Ahmet Turan Işik

Turkish Journal of Medical Sciences

Background/aim: The Oral Frailty Index-8 (OFI-8) is a reliable screening for oral frailty. In our study, while presenting the Turkish reliability and validity study of the OFI-8, we also aimed to establish a cut-off value for oral frailty in Turkish population.

Materials and methods: Patients who presented to the outpatient clinic between January 2024 and January 2025 were evaluated. The test’s internal consistency and test–retest reliability were assessed. Divergent validity was evaluated using frailty scores, muscle strength, and nutritional status. A receiver operating characteristic (ROC) curve was generated to determine the optimal cut-off values for identifying frailty, malnutrition, and probable …

Sarcopenia In Atrial Fibrillation: A Prospective Study, Mehmet Aki̇f Topçuoğlu, Ezgi̇ Yilmaz, Di̇nç Doğan Öge, Ali̇ Nai̇m Ceren, Ridvan Muhammed Adin, Ethem Murat Arsava

Turkish Journal of Medical Sciences

Background/aim: The link between atrial fibrillation (AF) and lean body mass is unclear. This study presents the effects of AF on sarcopenia indices, including ultrasonographic muscle architecture.

Materials and methods: In this study conducted in neurology units, 72 subjects with AF (mean age: 71 ± 11years, 49% female) were compared with 538 without AF (mean age:66±12years; 53% female) in terms of sarcopenia indices [anthropometry; Short Physical Performance Battery (SPPB); hand grip strength (HGS); bioimpedance analysis (BIA) indices; skeletal muscle mass index (SMMI) normalized to weight, height and body mass index (BMI); and phase angle (PhA)]; muscle ultrasonography [thickness, cross-section area …

Inflammation As A Harbinger Of Death: A Retrospective Cohort Study Of Preoperative Biomarker Risk Stratification In Orthopedic Trauma, Serkan Aydin, Burhan Kurtuluş

Turkish Journal of Medical Sciences

Background/aim: This study aimed to evaluate the prognostic significance of preoperative inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), C-reactive protein (CRP), and procalcitonin in predicting 30-day and 1-year mortality in patients undergoing femur fracture surgery.

Materials and methods: This retrospective, multicenter cohort study included patients who underwent surgical treatment for femur fractures between January 2018 and December 2024. Patients were stratified into survivor and nonsurvivor groups based on 30-day and 1-year outcomes. Demographic characteristics, comorbidities, laboratory parameters, and inflammatory indices were recorded and analyzed. Linear and multivariate logistic regression analyses were performed to identify …

Primary Care Providers' Perspectives On Telehealth Medicare Annual Wellness Visits For Older Adults In A Midwestern Health System, Vaibhavi Mone, Paul Estabrooks, Jane Potter, Hongmei Wang, Jungyoon Kim

Health Services and Informatics Research

Background

Medicare annual wellness visits (AWVs) are vital for older adults' preventive care, which was transitioned to telehealth modalities during COVID-19. This study examined primary care providers' perceptions of telehealth-delivered AWVs and explored the factors influencing telehealth implementation using the Practical Robust Implementation and Sustainability Model (PRISM).

Participants and Setting

Twenty-five primary care providers from eight clinics within an integrated health system in the Midwestern United States were interviewed. Eligibility required having conducted at least one telehealth AWV for patients aged 65 or older between March 2023 and October 2023.

Methods

Semi-structured interviews lasting 30–45 min were conducted using purposeful …

Staff Education To Reduce The Incidence Of Bias In Managing Patients With Opioid Use Disorder In A Rehabilitation Center, Almarie Alison Mclaren

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project addressed stigma and implicit bias toward individuals with opioid use disorder (OUD) within a rehabilitation subacute care setting. OUD remains a significant public health concern and at the project site, inconsistent staff education was identified as a practice gap requiring intervention. The purpose of this practice-focused DNP project was to evaluate the impact of a structured staff education intervention on healthcare staff knowledge, attitudes, and confidence in caring for patients with OUD. The project was guided by a thorough evidence search. The project was implemented using brief, unit-based educational sessions delivered to interdisciplinary …

Pain Prevalence And Pain Management At The End Of Life: Regional And Urban-Rural Differences From A National-Representative Survey Of Chinese Older Adults, Yaolin Pei, Xiang Qi, Zexi Zhou, Yifan Lou, Jing Wang, Yang Li, Bei Wu

Faculty, Staff and Student Publications

Background: Effective pain management is essential for improving quality of life at the end of life. However, challenges persist globally, particularly in China, where palliative care remains underdeveloped. This study investigates pain prevalence and the associations between pain severity, place of death, and the quality of pain management among older adults in China, with a focus on regional and urban-rural disparities.

Methods: We used data from the 2014, 2016, 2018, and 2020 waves of the China Longitudinal Aging Social Survey. The final sample included 1,525 older adults who died during the study period. We conducted OLS regression analyses to examine …

Older Adults And Suicide: Protective Pathways To Apply Shores In Counseling, Anna A. Ellenson, Jenny L. Cureton

Adultspan Journal

Older adult suicide (OAS) is a growing concern as the U.S. population continues to age and access to counseling expands. Despite legal and ethical requirements, counselors are often underprepared to address suicide in later life, especially through the lens of suicide protective factors (SPFs). This conceptual article introduces SHORES, a research-informed mnemonic (Skills and strategies for coping, Hope, Objections to suicide, Reasons for living/Restriction of means, Engaged care, and Support), to help counselors assess, intervene, and plan treatment with older adults. We review literature on OAS, highlight gaps in counselor training, and provide an application guide for using SHORES with …

The Scope And Impact Of Walking The Talk For Dementia 2024, Sherril B. Gelmon, Kate Irving, Walter Dawson, Jonathan Adrián Zegarra-Valdivia, Lingani Mbakile-Mahlanza, Fernando Aguzzoli-Peres

Institute on Aging Publications

Walking the Talk for Dementia (WTD) is a global educational initiative integrating a walk along the Camino de Santiago with a symposium to combat dementia stigma, raise awareness, and foster inclusion.

Age And Sex Impact The Role Of Thrombospondin-2 And Thrombospondin-5 In Response To Hindlimb Ischemia, Irene Helenowski, Ashley Peters, Melissa Rangel, Corinne Bunn Md, Xuerong Wang, Kristopher Maier, Vivian Gahtan

Biostatistics Collaborative Core: Faculty Publications and Other Works

Peripheral arterial disease progression to critical limb ischemia remains a significant burden in the aged, necessitating revascularization. Therapies to enhance neovascularization, such as angiogenesis or arteriogenesis, may provide an option for patients not suitable for surgery. The thrombospondins (TSPs) are secreted matricellular glycoproteins, with TSP-1, TSP-2, and TSP-5 implicated in neovascularization. Currently, there is little data regarding the effects of TSP-2, TSP-5, sex, and aging on angiogenesis and arteriogenesis. In vitro, the effect of TSP-2 or TSP-5 on early or late passage endothelial cell (EC) tubule formation or disruption was assessed. In vivo, angiogenesis, and arteriogenesis in male and female, …

Stimulated Cytokine Production, Attachment, And Emotional Well-Being In Dementia Spousal Caregivers, Daniel L Argueta, Sarah Roberts, Kelly N Brice, E Lydia Wu-Chung, Vincent D Lai, Jensine Paoletti-Hatcher, Bryan T Denny, Charles Green, Samantha Henry, Luis D Medina, Paul E Schulz, Jennifer Stinson, Cobi Heijnen, Christopher P Fagundes

Faculty, Staff and Student Publications

Background: Proinflammatory cytokine production may be related to poor emotional adjustment in dementia spousal caregivers. People who display attachment insecurity may be at increased risk for adverse caregiving experiences and poor psychosocial outcomes.

Objective: This study aimed to understand whether proinflammatory cytokine production was associated with anticipatory grief, caregiver burden, and depressive symptoms and whether those relationships were stronger for caregivers higher on attachment anxiety or avoidance.

Method: A sample of 103 dementia spousal caregivers provided self-report data on demographics, health information, and psychosocial outcomes. We also determined lipopolysaccharide-induced whole-blood interleukin-6, interleukin-1β, tumor necrosis factor-α, and interleukin-10 production and combined …

Comment On ‘Muscle-Specific Strength Better Predicts Physical Performance Decline Than Conventional Metrics: The I-Lan Longitudinal Aging Study’ By Chien Et Al., Ricardo M. Lima, Anthony J. Blazevich

Research outputs 2022 to 2026

No abstract provided.

Recommended Best Practices For Construct-Centered Adaptation Of The Harmonized Cognitive Assessment Protocol, Emily M. Briceño, Darina T. Bassil, Pranali Khobragade, Anthony Ngugi, Martine El Bejjani, Eric Ochieng, Silvia Mejia-Arango, Salima Douhou, Kazione Kulisewa

School of Medicine Publications

Objectives: The Harmonized Cognitive Assessment Protocol (HCAP) neuropsychological assessment approach aims to support the collection of harmonizable data on cognitive function for cross-national cognitive aging and dementia research. As the measurement of cognition is sensitive to differences in contextual, cultural, educational, linguistic, social, and other factors that may influence cognitive test performance, HCAP requires adaptation to be appropriate for the contexts in which it is administered. We aim to provide methodological recommendations for the adaptation and implementation of the HCAP and other cognitive data collection tools in novel settings.

Methods: We drew from existing guidelines on cross-cultural psychological test adaptation …

Prediabetes Associates With Musculoskeletal Alterations Independent Of Total Body Adiposity, Alan Fappi, Clifton J Holmes, Chao Cao, Vasavi Shabrish, Aman P Aher, Karen Shen, Paul K Commean, Dwight A Towler, Dominic N Reeds, Gretchen A Meyer, Bettina Mittendorfer

2020-Current year OA Pubs

BACKGROUND: Excess adiposity is a major risk factor for insulin resistance, prediabetes, and Type 2 diabetes and increases the risk for sarcopenia and osteosarcopenia later in life. It has been proposed that altered metabolic function and musculoskeletal status in people with obesity are directly linked, presumably because they share common pathophysiological mechanisms. However, the effect of metabolic dysfunction, independent of adiposity, on musculoskeletal status is unknown.

METHODS: We performed a comprehensive assessment of musculoskeletal status in people with overweight/obesity and prediabetes (n = 12; 72% women; age: 67 ± 6 years; weight: 81 ± 11 kg; mean ± SD) and …

Clinical Practice Guidelines For Suicide Risk Assessment, Jelitta Cleatus

Walden Dissertations and Doctoral Studies

In this doctoral project, I developed a clinical practice guideline (CPG) to address the lack of a standardized suicide risk assessment protocol at a Texas mental health clinic. At project initiation, suicide risk assessment at the facility was inconsistent due to the absence of a CPG. The guideline incorporated the Columbia-Suicide Severity Rating Scale (C-SSRS), a validated instrument that improved early detection of suicidal ideation and behaviors, which were often under recognized in older adults. This inconsistency led to the following clinical question, Does the evidence support the development of a CPG for assessing suicide risk among high-risk patients using …

Structural Empowerment And The Work Environment Of Nursing Home Care Workers In China, Yawen Ou

Lingnan Theses (MPhil & PhD)

China is experiencing a profound demographic transformation as its population ages rapidly, driven by declining fertility, increased longevity, and long-term effects of the One- Child policy. Traditional family-based elderly care has become increasingly unsustainable due to the pressures of the “4-2-1” family structure and the rising prevalence of empty-nest households. In this context, there is an increasing trend in institutionalized elderly care, accompanied by a growing demand for Nursing Home Care Workers (NHCWs). In spite of their vital importance, NHCWs often face heavy workloads, poor compensation, low recognition, and limited professional autonomy. This study explores the work environment and structural …

An Application-Based Ontological Knowledge Base Of Medications To Support Health Literacy And Adherence For The Consumer Population: An Aging Population Use Case, Clifford Chen, Muhammad Amith, Kirk Roberts, Rebecca Mauldin, Renata Komalasari, Cui Tao

Faculty, Staff and Student Publications

No abstract provided.

Nature-Based Approaches To Dementia, Cognitive Impairment, And Caregiver Well-Being: A Scoping Review Of Gardening And Therapeutic Strategies, Mary Dioise Ramos, Marcy Purnell, Jolie Harris, Gloria Giarratano

School of Nursing Faculty Publications

Background: Dementia is a growing global health concern, with behavioral and psychological symptoms (BPSD) contributing significantly to diminished quality of life and caregiver burden. Non-pharmacological interventions, such as gardening and nature-based therapies, are increasingly recognized for their therapeutic potential. Objectives: This scoping review aimed to: (1) map existing evidence on gardening and garden-based interventions for individuals with dementia; (2) assess impacts on caregivers; (3) identify mechanisms of benefit; and (4) summarize effective design and implementation strategies. Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a comprehensive search was conducted across five databases. Studies were screened using Covidence. Inclusion criteria …

Investigating The Efficacy Of An Online Multigenerational Awareness Course For Occupational Therapy Students – A Pilot Study, Susan Blair, Barbara M. Doucet, Jerilyn Callen, Kirsten Davin, Shelby Hutchinson

The Open Journal of Occupational Therapy

In today’s multigenerational society, particularly in health care settings, thriving can be challenging because of generational differences. Occupational therapy educational programs (OTEPs) prepare students for work environments where three to four different generations may be present. This study examines the effectiveness of an online multigenerational awareness (MGA) course. The secondary objectives include increasing students’ knowledge of enhanced multigenerational collaboration and communication strategies in preparation for future clinical practice. A pilot group of eight participants from various university departments reviewed the course content and completed preenrollment and postenrollment surveys, providing feedback regarding the applicability and perceived usefulness of the multigenerational awareness …

The Impacts Of Age-Related Peripheral Hearing Loss, Central Auditory Processing, And Cognition On Quality Of Life In Older Adults: A Scoping Review, Brian M. Kreisman, Samantha E. Vasquez, Anna J. Bierma

University Faculty Publications and Creative Works

This scoping review aims to synthesize peer-reviewed literature exploring quality of life (QoL) for individuals with age-related hearing loss (ARHL), age-related central auditory processing (ARCAP) deficits, and age-related cognitive decline. A growing body of research has identified ARHL as a risk factor for the development of dementia, highlighting the connection between the sensory and cognitive systems. As the aging population continues to grow, examining comorbid age-related hearing and cognitive decline is especially relevant. These conditions may have potential negative consequences on the daily functioning, social participation, mental health, and overall wellbeing of older adults. A systematic search of peer-reviewed literature …

Fear Of Falling: A Collaborative Approach To Treatment, Alexandra Uhren, Celeste Delap, Kate Jansen

Journal of Interprofessional Practice and Collaboration

Purpose: Physical Therapy (PT) and Behavioral Health (BH) often overlap in patient care; however, collaborative treatment is always not utilized by providers. This case study details the interdisciplinary treatment of a 69-year-old female with a fear of falling; emphasizing the importance of interprofessional collaborative care in treating Fear of Falling (FOF) in individuals at risk for fall-related injury with Cognitive Behavioral Therapy (CBT) and PT interventions.

Problem: FOF is common among older adults and can result in physical, psychological, and social consequences (Lee & Tak, 2023; MacKay et al., 2021). Patients at risk of fall-related injury experience decreased self-confidence in …

Impact Of Dialysis On Medication Pharmacokinetics, Rachel Marie Bounds

Walden Dissertations and Doctoral Studies

This doctoral project was a staff education initiative to improve nurses’ knowledge and comfort with dialysis-specific medication management. The project addressed a practice gap in which nurses at the clinical site had limited knowledge of medication administration for patients with end-stage renal disease. These patients have altered pharmacokinetics and high medication burden, which increases the risk of adverse drug events. Inappropriate management of medications during dialysis can lead to hypotension, ineffective treatment, and glucose instability, making this a critical nursing practice issue. The project answered the practice-focused question of whether a structured educational intervention would improve nurses’ knowledge and comfort …

Self-Efficacy Change Among Diverse Family Caregivers In Dementia Care, Deborah M Oyeyemi, Erich J Greene, Yunshan Xu, David R Lee, Rafael Samper-Ternent, Maya L Lichtenstein, Alan Stevens, Jeff D Williamson, Arun S Karlamangla, Debra Saliba, David B Reuben

Faculty, Staff and Student Publications

Objectives: To determine whether changes in caregiver self-efficacy (beliefs about one's ability to manage dementia-related problems and access help) differed by caregiver race and ethnicity across all participants enrolled in a large pragmatic trial of comprehensive dementia care.

Methods: In the Dementia Care Study (D-CARE), community-dwelling older adults with dementia and their unpaid family caregivers were randomized to receive usual care, community-based, or health system-based comprehensive dementia care. Caregiver self-efficacy was assessed at baseline, 6 months, and 18 months using a 4-item scale (range 4-20, higher scores indicate greater self-efficacy). Among all caregivers, we compared least squares means for overall …

High-Sensitivity Cardiac Troponin I And Frailty: Associations With The Frailty Index And Fried Phenotype In Older Women, Jedd Pratt, Abadi K. Gebre, Carlos J. Toro-Huamanchumo, Elsa Dent, Trent Bozanich, Wai E. Lim, Elizabeth Byrnes, Julee Mcdonagh, Caleb Ferguson, Craig Sale, Kun Zhu, Carl Schultz, Richard L. Prince, Joshua R. Lewis, Marc Sim

Research outputs 2022 to 2026

Despite the nexus between cardiovascular health and frailty, the relevance of high-sensitivity cardiac troponin I (hs-cTnI), a biomarker of myocardial injury, to frailty is poorly understood. We examined whether hs-cTnI concentrations were associated with frailty in a well-characterized cohort of older women. A total of 1151 community-dwelling women from the Perth Longitudinal Study of Aging Women (mean age ± SD = 75.2 ± 2.7 years) were included. Frailty was operationalized using a validated frailty index (FI) of cumulative deficits and a modified Fried phenotype. Plasma hs-cTnI were categorized into quartiles. Cross-sectional associations between hs-cTnI quartiles and frailty were assessed using …