Do nursing homes with a higher proportion of residents with dementia have greater or fewer complaints?

Objectives: Nursing home (NH) residents' capacity to communicate deteriorates with dementia. Consequently, NHs with high proportions of people living with dementia (PLWD) may receive fewer resident complaints, and/or investigating complaints may be challenging. We assessed NHs' proportion of PLWD in relation to total and substantiated complaints. Methods: Data were from the ASPEN Complaints/Incident Tracking System and the Certification and Survey Provider Enhanced Reports (2017). NHs (N = 15,499) were categorized based on high (top-10%), medium (middle-80%), and low (bottom-10%) dementia prevalence. Negative binomial Poisson regression assessed complaint patterns in relation to NHs' high/low (vs. medium) proportions of PLWD and other facility/resident characteristics. Results: Compared to NHs with medium-dementia prevalence, NHs with low proportions of PLWD had higher total (average marginal effect [AME] = 0.16, p < 0.001) and substantiated (AME = 0.30, p < 0.001) complaints, whereas NHs with high proportions of PLWD had fewer total (AME= -0.07; p < 0.05) and substantiated (AME= -0.11, p < 0.05) complaints. Also, NHs' profit status, chain-affiliation, size, staffing, and resident ethnicity were associated with total and substantiated complaints. Conclusion: The association between high proportions of PLWD and lower NH complaints suggests either that these NHs have higher overall quality or that complaints are underreported. Regardless, surveyors and families may need more involvement in monitoring higher dementia prevalence facilities.

The Importance of Zero-Deficiency Complaints in Nursing Homes: A Mere Consequence or Serious Concern?

Complaints represent an important metric for assessing the quality of nursing home (NH) care. Using the Automated Survey Processing Environment (ASPEN) Complaints/Incidents Tracking System dataset (2017), we examined the relationships between zero-deficiency complaints (ZDCs) and zero-deficiency substantiated complaints (ZDSCs) and the proportion of residents with dementia. NHs (N = 15,339) were separated into three groups-proportion of residents with dementia in the top, two middle, and the bottom quartiles. Negative binomial regressions assessed zero-deficiency complaint patterns in relation to NHs' proportion of residents with dementia, controlling for facility characteristics, staffing, and racial pattern. We reported average marginal effects (AMEs) and 95% confidence intervals (CIs). NHs in the top quartile yielded higher numbers of both ZDC (AME = .189, 95% CI: .102-.276, p < .001) and ZDSC (AME = .236, 95% CI: .094-.378, p = .001), than NHs in the bottom quartile. Results suggest a need for more uniform investigation processes and staff training to promote a more valid complaint process for residents with dementia.

Consumer Complaints in Nursing Homes: Analyzing Substantiated Single-Allegation Complaints to Deficiency Citations

Complaints provide important information to consumers about nursing homes (NHs), but how substantiated complaints map onto deficiency citations is unknown. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Federally collected NH complaint and inspection records were obtained to identify all single allegation, substantiated complaints for NHs across the U.S. in 2017. Overall, the 369 complaint allegations in our sample resulted in a total of 585 deficiencies at the inspection stage; however, 35.2% of the allegations led to no deficiencies. Nearly two-thirds of the 369 substantiated single allegation complaints were categorized at the intake stage as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Further, 18% of the inspection deficiencies originated with complaint allegations that were prioritized as immediate jeopardy at intake, but of these, 71.4% were determined upon inspection to constitute "no actual harm with potential for more than minimal harm." These results provide evidence that complaints have the potential to provide unique valuable information on NH quality of care and draw regulatory attention to consumers' concerns. Future studies should include qualitative research concerning complaint processes by conducting interviews/surveys of complainants, NH staff/administrators, long-term care ombudsmen, and state officials.

A Collaborative Approach to Improving Care Outcomes for Residents in Assisted Living

Purpose: Assisted Living (AL) residents are embedded in "care convoys" comprised of a dynamic network of formal and informal care partners. Using the convoys of care model-a multi-level framework connecting care convoy properties to resident outcomes-we examined healthcare management and communication between convoy members. We recommend strategies to engage primary care in supporting collaboration, communication, and consensus-building for older adults and their convoys. Methods: Data were collected from the longitudinal study, Convoys of Care: Developing Collaborative Care Partnerships in AL. Fifty residents and their care convoy members (N = 169) were followed in eight AL homes in Georgia over 2 years. Original data were analyzed using Grounded Theory Methods of qualitative data, including formal and informal interviewing, participant observation, and record review. Results: The convoys of care model provide an innovative perspective that will assist providers in supporting AL residents and their care partners to achieve better care outcomes. Findings demonstrate the utility of understanding the structure and function of social resources and implications for improving healthcare outcomes. Conclusion: This research informs the work of physicians and mid-level providers with patients in AL by providing strategies to uncover specific social determinants of health. Recommendations for use in patient encounters are enumerated.

Protective roles of meditation practice and self-esteem on cognitive functions over time: findings from the Midlife in the United States study

BACKGROUND

Cognitive function is an important component of healthy ageing. However, it is unclear whether relaxation/meditation practices provide cognitive benefits, particularly in midlife and early late life. Meditative practices are associated with higher self-esteem, and self-esteem serves as a general protective factor for many health outcomes. The current study examines associations between meditation practice, self-esteem, and change over 10 years in midlife cognitive performance.

METHODS

Data were from waves 2 (2003-2004) and 3 (2013-2014) of the Midlife in the United States (MIDUS) study. We used structural equation modelling to examine whether persistent meditation practice at both waves or episodic practice at one wave is associated with better cognitive function over 10 years, compared to no meditation practice, while controlling for prior cognitive function and covariates (baseline socio-demographics, health, and functional status). Additionally, we assessed if self-esteem mediates the above associations.

RESULTS

We included 2168 individuals (Mage  = 65 ± 11). After controlling for covariates, the findings revealed that persistent meditation practice in both waves was associated with significantly less decline in episodic memory; however, no such effects were found for executive function. Further, although participants' higher self-esteem was significantly associated with less decline in executive function and episodic memory, it did not mediate the associations between meditation practice and cognitive functions.

CONCLUSIONS

While both persistent meditation practice and self-esteem have associations with cognitive outcomes for middle-aged and older adults in MIDUS, self-esteem as a mediator was not supported. Thus, future investigations should examine mechanisms that underlie these protective factors on cognitive performances across adulthood.

Is Use of Psychedelic Drugs a Risk or Protective Factor for Late-Life Cognitive Decline?

Objectives: Common age-related health conditions can lead to poor mental health outcomes and deteriorate cognition. Additionally, commonly prescribed medications for various mental/physical health conditions may cause adverse reactions, especially among older adults. Psychedelic therapy has shown positive impacts on cognition and has been successful in treating various mental health problems without long-lasting adversities. The current study examines the association between psychedelic drug usage and cognitive functions in middle-aged and older adults. Methods: Data were from wave 3 (2013-2014) of the Midlife in the United States (MIDUS) study. We used multiple linear regression models examining associations between psychedelic usage and cognitive functions, controlling for covariates of sociodemographic and health factors. Results: We included 2,503 individuals (Mage = 64 ± 11). After controlling for covariates, the finding revealed that psychedelic usage was independently associated with more favorable changes in executive function (β = .102, SE = 0.047, p = .031) and less depressive symptoms (β = -.090, SE = 0.021, p < .001). The same effect was not found for episodic memory (β = .039, SE = 0.066, p = .553). Discussion: Addressing the mental health implications of physical health conditions in older adults are vital for preventing neurocognitive deterioration, prolonging independence, and improving the quality of life. More longitudinal research is essential utilizing psychedelics as an alternative therapy examining late-life cognitive benefits.

Impact of Optimism on Cognitive Performance of People Living in Rural Area: Findings From a 20-Year Study in US Adults

Objectives: Mid- or early-late-life cognitive function is an indicator for developing late-life dementia. However, it is still unclear whether rural/urban living contexts provide cognitive benefits across adulthood. Further, higher optimism serves as a general protective factor for many health outcomes. The present study examines associations between rurality/urbanicity, optimism, and change in mid/late-life cognitive functions over time. Methods: Data were from waves 1 to 3 (1995-2015) of the Midlife in the United States (MIDUS) study (N = 2,507). Structural equation models examine whether long-term rural living across both waves (1-2) or intermittent rural living at one wave is associated with better cognitive function over 20 years, compared to no rural living, while controlling for prior cognitive function and covariates (baseline socio-demographics, health, and functional status). Additionally, we assessed if optimism mediates the above associations. Results: After controlling for covariates, long-term rural living (waves 1-2) was indirectly (through less optimism) associated with significantly lower levels of cognitive executive function and episodic memory in wave 3. Conclusions: While long-term rural living and cognitive outcomes have no direct association for MIDUS middle-aged and older adults, mediating roles of optimism in these associations were evident. Future investigations could examine mechanisms that underlie these risk/protective factors on late-life cognition.

The Healthy Caregiver? A Positive Impact of Informal Caregiving Status on Cognitive Functions Over Time From the Midlife in the United States Study

OBJECTIVES

The current study examined whether informal caregivers performed worse, better, or similar to non-caregivers on cognitive tests of executive functioning and episodic memory over 10 years. Methods: Data were from waves 2 (2003-04) and 3 (2013-14) of the Midlife in the United States (MIDUS) study (N = 2086). Multiple linear regression models examined whether caregiving at both waves 2 and 3 predicted better cognitive functioning at wave 3, than caregiving at only one time point or no caregiving (reference) while controlling for baseline covariates (i.e., sociodemographic, health, and functional status).

RESULTS

After controlling for covariates, caregiving at both waves was independently associated with better performance in episodic memory (b = .24, SE = .10, p = .013) but not executive function (b = -.06, SE = .05, p = .246). Discussion:The findings partially supported both healthy caregiver and stress process models, indicating caregiving may be associated with better episodic memory but not executive functioning over time among the middle-aged and older adults.

Creating age-friendly nursing homes: The time is now

The current global age-friendly movement supports older adults by promoting different policies and services. However, there is a dearth of attention to nursing home (NH) residents as part of age-friendly movements. The pioneering idea of an age-friendly health system, i.e., the "4 Ms" model is significant for NHs and formative for further developments; however, it does not identify unique components of NH care. This article aims to identify specific aspects of person-centered care in the literature to advance the development of a standardized conceptual framework. Along with residents, NH staff and administrators are integral parts of NHs. Incorporating the central role of caregivers, this study proposes a new "8 Ms" framework to describe the age-friendly NH. The traditional 4 Ms model notes that everything related to care matters to residents, along with care related to medication, mobility, and mentation. The proposed age-friendly framework introduces five additional "M," i.e., meaningful care, motivation, moderation, modification, and monitoring. This framework is proposed to advance education, training, clinical practice, research, and advocacy to promote quality of care in NHs. Application of the 8 Ms framework may yield multiple benefits, assuring good quality of care to residents, caregivers' job satisfaction, and supporting NH management in providing residents optimal care.

Trends in Nursing Home Complaints: Prevalence and Variation Across Center for Medicare and Medicaid Services Regions

Resident complaints are vital to understanding nursing home (NH) quality. Using complaints as facility- and resident-level outcomes, this study replicates prior analyses (spanning 1998-2002 and 2007-2012) with 2013-2017 data, the phase prior to NH regulatory changes initiated in November, 2017. Advancing prior papers, we analyze the number of complaints, allegations, and deficiency citations separately. Between 2013-2017, 458,101 total complaints (5.9/NH/year) were identified, containing 949,466 allegations (12.2/NH/year), and resulting in the issuance of 156,135 deficiency citations (2.0/NH/year) in about 15,600 NHs across the country. Regarding the number of complaints, substantiated complaints, and deficiency citations, results show a steady increase compared to previous years. Furthermore, there are marked differences among the CMS survey regions on the prevalence of overall complaints, substantiated complaints, and deficiency citations. However, the average rate of substantiation of complaint allegations shows a decreasing trend over these years, suggesting that complaints may have increased due to higher care expectations.

Longevity is not an ingredient of successful aging as self-reported by community-dwelling older adults: a scoping review

OBJECTIVES

There has been a long-standing debate in gerontology about what constitutes successful aging (SA). This scoping review investigated older adults' perspectives on longevity as part of SA to promote developing a standardized conceptual model.

METHOD

The current review followed the JBI methodological guidelines and used Rowe & Kahn's SA framework and Baltes' selection, optimization, and compensation model as the foundational theoretical framework. Five electronic databases (PubMed, Scopus, PsycInfo, CINAHL, and Web of Science) were searched using specific inclusion criteria (participants, concept, and context) to identify original studies that evaluated SA.

RESULTS

Eighteen studies, including 9,360 individuals (aged 60 years and older), were selected. Main indicators involved six primary domains: Psychological, physical, social, environmental, spiritual, and behavioral. Physical activity, basic aspects of wellbeing, positive outlook, satisfaction with life, interpersonal relationship, participation in meaningful activities, and financial security emerged as the most important factors. The findings suggest that older adults do not consider longevity a primary component of SA.

CONCLUSION

We identified multidimensional self-reported SA components without longevity being emphasized, guiding further improvement of older adults' wellbeing. The study outlines an updated conceptual framework that can be applied to real-life scenarios to test how older adults can best adapt to the challenges of aging.

Mind-Body Practice and Family Caregivers' Subjective Well-Being: Findings From the Midlife in the United States (MIDUS) Study

Objectives: Informal caregiving has been associated with higher stress and lower levels of subjective well-being. Mind-body practices including yoga, tai chi, and Pilates also incorporate stress reducing activities. The current study aimed to examine the association between mind-body practice and subjective well-being among informal family caregivers. Methods: A sample of informal caregivers were identified in the Midlife in the United States study (N = 506, M ± SD_age = 56 ± 11, 67% women). We coded mind-body practice into three categories, including regular practice (participating in one or more of them "a lot" or "often"), irregular (participating "sometimes" and "rarely") and no practice ("never"). Subjective well-being was measured using the 5-item global life satisfaction scale and the 9-item mindfulness scale. We used multiple linear regression models to examine associations between mind-body practice and caregivers' subjective well-being, controlling for covariates of sociodemographic factors, health, functional status, and caregiving characteristics. Results: Regular practice was associated with both better mindfulness-related well-being (b = 2.26, p < .05) and better life satisfaction (b = 0.43, p < .05), after controlling for covariates. Discussion: Future research should examine whether there is a selection effect of caregivers with higher well-being being more likely to choose these activities, and/or if mind-body practices are effective non-pharmacological interventions to improve family caregivers' quality of life.

RESTRICTIONS ON RESIDENT CONTACT IN ASSISTED LIVING DURING COVID-19: A MIXED-METHODS STUDY

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

COMPLAINT PATTERNS IN US NURSING HOMES: 2013–2017

Nursing home (NH) quality of care is often short of meeting residents' and family expectations to maintain optimum quality of life. Using complaints as a facility-level outcome (i.e., complaints per NH), this study updates earlier published findings by replicating prior analyses with more recent data, and by analyzing the number of complaints, complaint allegations, and deficiency citations separately. This will allow us to determine whether any major change has taken place in the consumer complaint pattern in recent years. The result reveals, in the entire study period (2013-2017), overall, 458,101 complaints (5.9/NH/year) were identified that contain 949,466 allegations (12.2/NH/year), which resulted in the issuance of 156,135 deficiency citations (2.0/NH/year) in about 15,600 NHs across the country. Regarding the number of complaints, substantiated complaints, and deficiency citations, the results show a steady increase compared to previous years. Furthermore, there are marked differences among the ten CMS survey regions on the prevalence of overall complaints, substantiated complaints, and deficiency citations. The current study found a lower number of NHs with zero complaints and a higher number of NHs with five/more complaints in later years suggesting a steady increase in the number of complaints over the years. However, the average rate of substantiation of complaint allegations is showing a decreasing trend in recent years. This may be because people are now complaining more due to higher care expectations. Alternatively, it may be simply be because of the easier complaint lodging process developed in recent years. Other policy and practice implications will be discussed.

Mind-Body Practice, Personality Traits, and Cognitive Performance: A 10-Years Study in US Adults

It is widely established that physical activity is associated with better cognitive outcomes, and accumulating evidence suggests that mind-body practice (MBP, e.g., movement therapies such as yoga) may yield similar benefits. Personality is related to both daily activities and cognition, but its role in the association between MBP and cognition is not well understood. Using data from waves 2 and 3 (2004–2014) of the Midlife in the United States (MIDUS) study, the current study examines bidirectional temporal associations between personality traits, MBP, and cognition in healthy adults (N = 2050). We applied a cross-lagged regression analysis to examine bidirectional effects between MBP, Big Five personality traits, and two cognitive domains (episodic memory and executive function) and controlled for relevant variables (sociodemographic factors, health, and functional status) at wave 2. MBP at baseline was independently associated with more favorable change in episodic memory, but not in executive function, both before and after including control variables. Also, episodic memory and executive function at baseline were related to increase in MBP. The findings show that MBP and cognitive function predict each other over time. There is also some evidence for cognition and personality associations over time; however, personality traits are not related to subsequent MBP.

Failing to Complain: Do Nursing Homes with more Residents with Dementia have Fewer Complaints?

The majority of nursing home (NH) residents have Alzheimer’s Disease or Related Dementias (ADRD). However, the association of ADRD prevalence and NH quality is unclear. The objective of the current study is to understand the association of NH characteristics, including the proportion of ADRD residents, with the prevalence of NH complaints as an indicator of quality of care and quality of life. We merged data from the ASPEN Complaints/Incident Tracking System with national NH data from the Certification and Survey Provider Enhanced Reports, the Minimum Data Set, the Area Health Resource File, and zip-code level rural-urban codes in 2017. Three groups of NHs were created, including those whose proportion of residents with ADRD was in the top decile (i.e., high-dementia NHs (N=1,473)) and those whose proportion of ADRD residents was in the lowest decile (i.e., low-dementia NHs (N=1,524)). Bivariate results revealed high-ADRD NHs had higher percentages of Medicaid-paying residents, were less likely to be for-profit and chain-affiliated, had lower staffing hours and lower percentages of Black, Hispanic, and Asian residents. Using NHs in the middle deciles as reference, negative binomial regression models showed that having a low proportion of ADRD residents was significantly associated with higher numbers of total complaints (p<.001) and substantiated complaints (p<.001), whereas having a high proportion of ADRD residents was significantly associated with lower numbers of substantiated complaints (p=.001). The findings suggest the proportion of residents with ADRD in NHs is associated with quality, as measured by complaints. Policy implications of these findings will be discussed.

Mind-Body Practice, Personality Traits, and Cognitive Performance: A 10-Year Study in US Adults

It is widely established that physical activity is associated with better cognitive outcomes, and accumulating evidence suggests that mind-body practice (MBP) may yield similar benefits. Personality is related to both daily activities and cognition, but its role in the association between MBP and cognition is not well understood. The current study examines bidirectional temporal associations between personality traits, MBP, and cognition in healthy adults. We used data from waves 2 and 3 (2004-2014) of the Midlife in the United States (MIDUS) study from a total of 2,050 individuals (age: M=64 years, SD=11, range=42 to 92; 56% women). We applied a cross-lagged regression analysis to examine bidirectional effects between MBP, Big Five personality traits, and two cognitive domains (episodic memory and executive function) and controlled for sociodemographic factors, health, and functional status covariates in wave 2. After controlling for covariates, MBP was independently associated with a more favorable change in episodic memory, but not in executive function. Regarding cross-lagged effects of cognitive function, episodic memory was related to subsequent MBP and agreeableness, and executive function was related to subsequent MBP, openness, and conscientiousness. Agreeableness had a negative effect on subsequent executive function. The findings point toward bidirectional associations between cognitive function MBP, while there was no evidence for cross-lagged associations between personality and MBP. Future research should guide us whether MBP can counteract cognitive decline as an alternative and complementary practice and the role that personality can play in such interventions.

Person-Centered Care in Nursing Homes: Potential of Complementary and Alternative Approaches and Their Challenges

A person-centered approach to care shifts the mind-set of care partners from a traditional medical model to a social model in managing chronic conditions. Using a qualitative descriptive approach, this study examines the barriers and facilitators to the implementation of person-centered care (PCC) and how the integration of complementary and alternative approaches (CAA) has the potential to improve residents' quality of life in nursing homes (NHs). Findings indicate that NHs offer a wide range of engagement activities, but these activities are not purposefully integrated into a person-centered plan of care. Factors such as turnover, "working short," supervisor support, and rising resident care needs make it challenging to implement PCC in NHs. This knowledge of the landscape of activities will help us identify and improve strategies for supporting residents at a deeper, more meaningful level. CAA has the potential to be therapeutic for residents if integrated into collaborative approaches to care.

Movement-based mind-body practices and cognitive function in middle-aged and older adults: Findings from the Midlife in the United States (MIDUS) study

OBJECTIVES

Cognitive function is a key component of healthy aging. While conventional physical activities (walking, jogging, etc.) have been shown to support physical and cognitive health in late-life, it remains unclear whether traditional Eastern movement-based mind-body practices (MBP) have long-term cognitive benefits above and beyond conventional leisure physical activities. This study examines the relationship between movement-based MBP and cognitive function in middle-aged and older adults during a 10-year follow-up period.

METHODS

We used data from Waves 2 (2004-05) and 3 (2013-14) of the Midlife in the United States (MIDUS) study. MIDUS initially surveyed a national probability sample of community-living adults aged 24-75 years in 1995 (Wave 1). Tests of cognitive functioning measuring executive function and episodic memory were added in Wave 2 and repeated in Wave 3. We estimated multivariable linear regression models to examine the effect of MBP (Wave 2) on the episodic memory and executive function (Wave 3) while controlling for covariates (sociodemographic factors, health, and cognitive function at Wave 2).

RESULTS

A total of 2097 individuals aged 42-92 years (M = 64 ± 11, 56 % women) were included. After controlling for sociodemographic factors, health and functional status, and prior levels of cognitive function, engaging in MBP was independently associated with a smaller decline in episodic memory (b = 0.11, p = .03), but not executive function (b=0.03, p = .34).

DISCUSSION

The findings provide the first large population-based evidence supporting the cognitive benefits of MBP over a 10-year period among middle-aged and older adults. Future research should examine whether MBP are effective non-pharmacological intervention to attenuate age-related cognitive decline.

Self-Reported Satisfaction of Older Adult Residents in Nursing Homes: Development of a Conceptual Framework

BACKGROUND AND OBJECTIVES

Resident satisfaction is an integral part of nursing home (NH) quality of care. However, there is no uniform categorization framework to classify self-reported satisfaction of older adult residents in NHs. This scoping review systematically investigated the studies reporting data on older residents' satisfaction to evaluate the quality of NH service and to create a conceptual model for older residents' satisfaction.

RESEARCH DESIGN AND METHODS

We used Donabedian's structure-process-outcome model as a theoretical framework. In three electronic databases (PubMed, Scopus, and CINAHL), potential studies were searched using specific inclusion criteria identifying original studies that investigated older adult residents' satisfaction in NHs.

RESULTS

Fifteen studies, including 264,133 residents and 15,577 NHs, were selected for this review. Although a wide variety of resident satisfaction measures were used in the included studies, all these indicators reflect five primary domains: Psychological, Clinical, Social, Environmental, and Spiritual, with the common focus of improving the quality of life of residents. Though technical competence is a fundamental aspect of healthcare service, we found autonomy, environment, meaningful activities, and interpersonal quality of professionals as the most important predictors for the resident's satisfaction.

DISCUSSION AND IMPLICATIONS

The current review has synthesized a broad range of satisfaction measures, which will help future researchers and policymakers provide guidance for further improvement of NH care services and as a heuristic device to spur research. Future research is needed to apply this conceptual framework for comparisons of self-reported resident satisfaction in other institutional settings across countries.

Analyzing Nursing Home Complaints: From Substantiated Allegation to Deficiency Citations

Complaints provide important information to consumers about nursing homes (NHs). Complaints that are substantiated often lead to an investigation and potentially a deficiency citation. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Because a complaint may contain multiple allegations, and the data do not identify which allegation(s) lead to a complaint’s substantiation, we identified all substantiated single allegation complaints for NHs in 2017. Our data were drawn from federally collected NH complaint and inspection records. Among the 369 substantiated single-allegation complaints, we found most were categorized as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Of the deficiency citations resulting from complaints in our sample, 27.9% were categorized as quality of care and 19.5% were in the category of resident behavior and facility practices, which includes abuse and neglect. While two-thirds (N=239) of the substantiated complaints generated from 1 to 19 deficiency citations, nearly one third had no citations. Surprisingly, 28% of substantiated abuse and neglect allegations resulted in no deficiency citations. More surprisingly, a fifth of complaints that were categorized as “immediate jeopardy” at intake did not result in any deficiency citations. We also found a number of asymmetries in the allegation categories suggesting different processes by Centers for Medicare and Medicaid Services (CMS) region. These results suggest that the compliant investigation process warrants further investigation. Other policy and practice implications, including the need for better and more uniform investigation processes and staff training, will be discussed.

Movement Therapy and Cognitive Function in Middle-Aged and Older Adults: A 10-Year Study

Cognitive function is an important component of healthy aging and physical activities have been shown to support late life cognitive function. However, it is unclear whether non-traditional physical activities provide additional benefits for cognitive function above and beyond traditional leisure physical activities. This study examines the associations between movement therapy and cognitive function in the US population. We used data from the waves 1, 2 and 3 (1995-2014) of the Midlife in the United States (MIDUS) study. MIDUS included a national probability sample of community-living adults aged 25-75 years old in 1995 (wave 1) and added the wave 2 cognitive functioning tests of executive function and episodic memory. We applied multivariate linear regression models to estimate the effect of movement therapy (wave 2) on the cognitive episodic memory and executive function (wave 3) while controlling the covariates (wave 2 sociodemographic factors, health, and cognitive function). A total of 2097 individuals aged 42-92 years (mean 64.4, sd 10.9, 55.6% women) were included in the analysis. Movement therapy was independently associated with better episodic memory (beta=0.117, p=0.02), but not with executive function (beta=0.039, p=0.14), after including control variables. The results suggest that movement therapy may be an effective non-pharmacological intervention to attenuate age-related cognitive decline in middle-aged and older adults. Future research should test whether these findings can be replicated in similar populations and if confirmed, interventions should incorporate a wider range of physical activities in community-living older adults with the goal of maintaining and improving physical and cognitive health.

Effects of yoga-related mind-body therapies on cognitive function in older adults: A systematic review with meta-analysis

OBJECTIVES

Considering dementia has no definite curative intervention available through modern medical management, alternative therapeutic symptomatic interventions are needed urgently. This systematic review with meta-analysis evaluated whether yoga-related practices, as a preventive mind-body therapy, is effective for the management of cognitive decline in older adults.

METHODS

Seven electronic databases (Abstracts in Social Gerontology, Age Line, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science) were searched using specified inclusion criteria to identify original studies that investigated the effects of yoga-related mind-body therapies on cognitive function, in the context of aging. A meta-analysis was also carried out calculating the overall effect sizes, expressed as standardized mean differences (i.e., d).

RESULTS

Twelve studies, including 912 participants (73.9% female; 239 with and 673 without cognitive impairment) were selected for this review; eleven were randomized controlled trials. One study had a high risk of bias and was excluded from the meta-analysis. Studies involved a wide variety of yoga practices with a common focus on meditative postural exercises. Results revealed significant beneficial effects on memory (Cohen's d = 0.38), executive function (Cohen's d = 0.40), and attention and processing speed (Cohen's d = 0.33). No adverse effects were reported.

DISCUSSION

Yoga-related mind-body interventions for older adults appear to be safe, feasible, and effective alternative practice for maintenance of cognitive functions both in age- and disease-related cognitive decline. Practicing yoga can be a useful part of daily routine to maintain cognitive function in older adulthood. Suggestions for further research were discussed.

Experience of hepatitis C virus seroprevalence and its genomic diversity among transfusion-dependent thalassemia patients in a transfusion center

INTRODUCTION:

One of the most common blood-borne transfusion-transmitted diseases is hepatitis C. Patients with a history of multiple blood transfusions are significantly at a greater risk of infection by contaminated blood and blood products. Beta thalassemia major is one such condition where repeated blood transfusions are required for patient management.

MATERIALS AND METHODS:

The present study was conducted to investigate the serological prevalence of hepatitis C virus (HCV), its viremia, and genotype distribution with clinical parameters among multitransfused thalassemic individuals. In this study, a total of 300 patients were screened to detect anti-HCV antibody in serum, along with liver function parameters and genotyping.

RESULTS:

Seventy-five (25%) patients were found to be HCV positive by enzyme-linked immunosorbent assay (ELISA). Among them, 49 (65%) were HCV RNA positive having a significant viral load in their blood and rest 26 (35%) were below detection level, which signify auto clearance of the virus in those patients. According to our study, HCV genotype 3 was the major circulating strain (92.59%) followed by genotype 1. Liver enzymes, such as alanine aminotransferase, aspartate aminotransferase, and total bilirubin, were significantly elevated among HCV seroreactive individuals.

CONCLUSIONS:

This study clearly indicates that the incidence of transfusion-transmitted hepatitis C is high in thalassemia patients, but actual scenario of HCV viremia can only be found by HCV RNA qualitative and quantitative detection method and not by ELISA, is a major concern for this high-risk group of population.

A comprehensive screening program for β-thalassemia and other hemoglobinopathies in the Hooghly District of West Bengal, India, dealing with 21 137 cases

We here present a report of population screening programs (January 2012-December 2015) conducted by the Thalassemia Control Unit, Imambara Sadar Hospital, Chinsurah, Hooghly in the Hooghly District of West Bengal, India for prevention of thalassemia. We screened β-thalassemia (β-thal) heterozygotes and homozygotes, and Hb E (HBB: c.79G > A)-β-thal compound heterozygotes. Among 21 137 cases, we found 1968 heterozygotes and 192 homozygotes or compound heterozygotes. Results were evaluated with standard hematological analyses including red cell indices, hemoglobin (Hb) typing and quantification. The participants of the screening program were divided into six groups (children, pre-marriage cases, post-marital cases, family members of affected individuals, family members of carriers and pregnant women). While considering the average frequency of carriers, many reports recorded both related individuals (family members of trait and affected individuals) as well as unrelated individuals such as school children and pregnant women. These would have to be considered separately and only the unrelated individuals taken to estimate carrier frequencies in this article that would give more realistic data on carrier frequency of unrelated individuals.

Snake venom hemorrhagins

Viperine and crotaline snake venoms contain one or more hemorrhagic principles called hemorrhagins. These are zinc-containing metalloproteases characterized by the presence of a protease domain, with additional domains in some of them. They act essentially by degrading the component proteins of basement membrane underlying capillary endothelial cells. The toxins also act on these cells causing lysis or drifting apart, resulting in hemorrhage per rhexis or per diapedesis. Some of these toxins have been found to exert additional effects such as fibrinogenolysis and platelet aggregation that facilitate hemorrhage. The structural and functional features of this class of toxins have been discussed in this review in an attempt to get a better understanding of their toxicity. This can be of immense therapeutic value in the management of snake venom poisoning, as hemorrhagins are among the major lethal factors in snake venom.

Characterization of the rat Star gene that encodes the predominant 3.5-kilobase pair mRNA. ACTH stimulation of adrenal steroids in vivo precedes elevation of Star mRNA and protein

The steroidogenic acute regulatory protein (STAR) participates in steroidogenesis through the mitochondrial transfer of cholesterol to cytochrome P450scc. The rat adrenal Star gene is transcribed as a 3. 5-kilobase pair (kb) and 1.6-kb mRNA with the larger mRNA predominating ( approximately 85% of total) in vivo. Hypophysectomy (HPX) produced a 3-5-fold decrease in Star mRNA along with a loss of adrenal steroids, whereas P450scc mRNA decreased by less than 2-fold. Adrenocorticotropic hormone (ACTH) treatment of HPX rats maximally stimulated steroidogenesis rates within 5 min with over 10-fold elevation of steady state blood levels occurring within 10 min. For intact rats there was a 5-10-fold larger increase, paralleling previously observed elevations of cholesterol-cytochrome P450scc association and metabolism in subsequently isolated adrenal mitochondria. ACTH did not increase either total STAR protein or a group of modified forms until at least 30 min after completion of acute stimulation, indicating that elevated translation of STAR protein cannot alone mediate this acute stimulation. Parallel slow changes in STAR protein and corticosterone formation after ACTH treatment are consistent with participation of STAR forms as co-regulators of these hormonal responses. ACTH stimulation of HPX rats increased Star mRNA by 2.5-fold within 20 min and by 4.5-fold after 1 h, thus preceding the rise in the STAR protein. A 3.5-kb Star cDNA clone isolated from a rat adrenal cDNA library exhibited a 0.9-kb open reading frame and a 2.5-kb 3'-untranslated region (3'-UTR). The open reading frame sequence differed at only 12 amino acids from that of the mouse Star. The rat Star gene seven exons with exon 7 encoding the entire 2.5 kb of 3'-UTR of the 3.5-kb mRNA. The 3'-UTR sequence suggests that 1.6- and 3.5-kb mRNA are formed by an alternative usage of different polyadenylation signals. Multiple UUAUUUA(U/A)(U/A) motifs also suggest additional regulation through this extended 3'-UTR. Although elevation of STAR protein by ACTH does not cause the acute increase in adrenal cholesterol metabolism, changes in the turnover or distribution of an active STAR subfraction cannot be excluded.

Cell mediated immune status in malignancy--pretherapy and post-therapy assessment

Twenty-eight cases of malignancies of different kinds were studied to assess T-cell activity and population before and after institution of therapy. Fifteen cases were diagnosed as non-metastasising squamous cell carcinoma of larynx, pharynx, laryngopharynx, hypopharynx and tonsils. Seven cases were non-metastasising infiltrating duct carcinoma of breast and 6 cases were non-Hodgkin's lymphoma (NHL). It was observed that 3 out of 15 cases (20%) of squamous cell carcinoma cases were Mantoux test (MT) negative with a T-cell population of less than 40%, 2 out of 7 cases (28.6%) of infiltrating duct carcinoma of breast were MT negative with a T-cell population of less than 40% and 3 out of 6 cases (50%) of NHL were MT negative with a T-cell population of less than 40%. The normal controls, consisting of apparently normal healthy adults, had a T-cell population of more than 40% and were all MT positive. The patients who showed a negative skin test and a T-cell population less than 40% were further subjected to assessment of T-cell population and activity after appropriate therapy, and clinical cure of the disease. It was observed that 2 out of 3 cases (66.66%) of squamous cell carcinomas, 2 out of 2 cases (100%) of adenocarcinomas and one out of 3 cases (33.33%) of NHL showed positive conversion with a T-cell population of more than 40%.

Control of cholesterol access to cytochrome P450scc in rat adrenal cells mediated by regulation of the steroidogenic acute regulatory protein

Cholesterol conversion to pregnenolone by cytochrome P450scc in steroidogenic cells, including those of the adrenal cortex, is determined by hormonal control of cholesterol availability. Intramitochondrial cholesterol movement to P450scc, which retains hormonal activation in isolated mitochondria, is apparently dependent on peripheral benzodiazepine receptor and the recently cloned steroidogenic acute regulatory (StAR) protein. In rat adrenal cells, StAR is formed as a 37-kDa precursor that is transferred to the mitochondrial inner membrane following phosphorylation by hormonally activated protein kinase A, and processed to multiple forms, some of which turn over very rapidly. In bovine cells, StAR undergoes three modifications forming a set of eight proteins seen in both glomerulosa and fasciculata cells. In the former, cyclic AMP and angiotensin II each decrease two forms and elevate six forms. Significantly, the major change seen after activation may not involve phosphorylation of StAR. Cholesterol transfer across mitochondrial membranes is also activated in isolated mitochondria by GTP and low concentrations of Ca2+, apparently prior to activation by StAR. Depletion of StAR by cycloheximide inhibits cholesterol transfer but is overcome by uptake of Ca2+ into the matrix. This activation of cellular cholesterol transport is sustained in adrenal cells permeabilized by Streptolysin O. In rat adrenal cells cAMP elevates 3.5- and 1.6-kb mRNA, hybridized by a 1.0-kb StAR cDNA. A 3.5-kb rat adrenal cDNA that encodes all except the 5' end of the longest StAR mRNA has been characterized. The corresponding gene sequence is distributed across seven exons. The shorter mRNA may arise from polyadenylation signals early in exon 7. However, the 3.5-kb mRNA comprises 80-90% of untreated rat adrenal StAR mRNA and may therefore provide the prime source for in vivo translation of StAR protein.

Identification of a rat adrenal cytochrome P450 active in polycyclic hydrocarbon metabolism as rat CYP1B1. Demonstration of a unique tissue-specific pattern of hormonal and aryl hydrocarbon receptor-linked regulation

Antibodies against a novel adrenocorticotropic hormone-inducible cytochrome P450 (P450RAP), responsible for polycyclic aromatic hydrocarbon metabolism in rat adrenal microsomes (Otto, S., Bhattacharyya, K.K., and Jefcoate, C.R. (1992) Endocrinology 131, 3067-3076), identified a cDNA clone encoding a partial cytochrome P450 sequence from a rat adrenal cDNA library. Rescreening a second cDNA library yielded several clones up to 5.0 kilobases (kb) encoding a 1629-base pair open reading frame. The deduced amino acid sequence (543 residues) matched completely with five peptides cleaved from P450RAP. The amino acid sequence of P450RAP is 92% identical to a 2,3,7,8-tetrachlorodibenzo-p-dioxin-inducible CYP1B1, cloned from mouse C3H10T1/2 (10T1/2) embryo fibroblast cells (Savas, U., Bhattacharyya, K. K., Christou, M., Alexander, D.L., and Jefcoate, C. R. (1994) J. Biol. Chem. 269, 14905-14911), which shows nearly the same characteristics in polycyclic aromatic hydrocarbon metabolism. The available 5'- and 3'-noncoding regions show, respectively, 93 and 83% sequence identity. We conclude that P450RAP protein is encoded by a rat CYP1B1 gene orthologous to the mouse CYP1B1 gene. Alignment of rat CYP1B1 amino acid sequences with rat CYP1A1 (39% identical) indicated eight regions of high identity for each (60-78%), interspersed by extensive regions of less than 30% similarity. The CYP1B1 cDNAs hybridize a 5.2-kb mRNA in rat adrenals, consistent with the length of the longest clones and the mRNA recognized in 10T1/2 cells. CYP1B1 mRNA was elevated by a 2-day adrenocorticotropic hormone treatment but much less than CYP11A1 (cytochrome P450 side chain cleavage) mRNA (2-fold versus 4-fold). The lower levels of the 5.2-kb mRNA in other steroidogenic cells (ovary) was consistent with the amount of immunodetectable CYP1B1 protein and, unlike the adrenal, expression in the ovary was stimulated 5-fold by beta-naphthoflavone, an aryl hydrocarbon receptor agonist, in parallel with CYP1A1 induction. In several other tissues (liver > lung > uterus >> kidney), CYP1B1 mRNA and protein were constitutively undetectable but highly induced by beta-naphthoflavone, although at much lower levels than CYP1A1. Rat CYP1B1, therefore, exhibits regulation through hormonal signaling and the aryl hydrocarbon receptor in a cell-specific manner.

Mouse cytochrome P-450EF, representative of a new 1B subfamily of cytochrome P-450s. Cloning, sequence determination, and tissue expression

A novel benz[a]anthracene and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-inducible cytochrome P-450 (P450EF), which is very active in polycyclic aromatic hydrocarbon metabolism, has been purified from C3H10T1/2 mouse embryo fibroblasts (Pottenger, L. H., Christou, M., and Jefcoate, C. R. (1991) Arch. Biochem. Biophys. 286, 488-497). P450EF was shown to be immunologically unrelated to the major known P-450 families. A 4.9-kilobase (kb) cDNA encoding P450EF has been isolated from a lambda ZAP cDNA expression library generated from mRNA of TCDD-induced C3H10T1/2 cells. This cDNA comprises 175-base pair (bp) 5'-noncoding, 1629-bp open reading, and about 3100-bp 3'-noncoding sequence. A SmaI fragment of the 4.9-kb cDNA hybridized to a 5.2-kb mRNA species equally induced by benz[a]anthracene (10 microM) and TCDD (10 nM) in C3H10T1/2 cells, consistent with the involvement of the Ah receptor in this induction process. The deduced amino acid sequence (543 amino acids), the longest of any known cytochrome P-450, exhibits 41 and 38% identity to mouse CYP1A1 and CYP1A2, respectively, and less but substantial similarity (30-33% identity) to many members of the CYP2 family. There are five extended regions of > or = 50% identity to CYP1A1 as follows: (a) 51-118; (b) 199-222; (c) 326-343 (I-helix, O2-binding threonine); (d) 357-430; and (e) 460-487 (heme-binding cysteine). These sequence relationships suggest that P450EF is a member of a new CYP1B subfamily (mouse CYP1B1). Hybridization of mRNA and immunoblot analyses of microsomes both demonstrated beta-naphthoflavone (beta-NF) inducibility of Cyp1b-1 expression in C3H mouse lung, liver, and uterus although at lower levels relative to Cyp1a-1. The mobility of the beta-NF-inducible immunoreactive liver protein was significantly higher than that of the CYP1B1 protein detected in mouse lung, uterus, and C3H10T1/2 cells. Compared with the beta-NF-induced uterus, polycyclic aromatic hydrocarbon-induced uterine fibroblasts exhibited 10-20-fold higher levels of CYP1B1, suggesting that stromal fibroblasts are a major source of the protein.

Polycyclic aromatic hydrocarbon metabolism in rat adrenal, ovary, and testis microsomes is catalyzed by the same novel cytochrome P450 (P450RAP)

A novel ACTH-inducible P450, cytochrome P450RAP, is responsible for polycyclic aromatic hydrocarbon (PAH) metabolism in male rat adrenal microsomes. P450RAP is present at similar levels in male and female adrenal microsomes and is immunochemically distinct from P450IA1. Anti-P450RAP immunoblots a protein present in ovarian and testicular microsomes that is the same size as P450RAP and which coelutes with the P450 fraction during chromatography on an immobilized artificial membrane column made with phosphatidylcholine. Rat adrenal, ovarian, and testicular microsomes exhibit similar regioselectivities in the metabolism of two polycyclic aromatic hydrocarbons, dimethylbenz(a)anthracene (DMBA) and benzo(a)pyrene (BP). Unlike P450IA1, these microsomes form little or no 7-OH-DMBA and BP-4,5-diol but do catalyze the formation of a high proportion of the presumptive procarcinogen, DMBA-3,4-diol. The relative activities of PAH metabolism by untreated adrenal, testicular, and ovarian microsomes are approximately 60, 20, and 6 pmol/mg microsomal protein/min, respectively. PMSG induced PAH metabolism 2- to 5-fold in ovarian microsomes and also increased the P450RAP immunoblot. Hypophysectomy reduced PAH metabolism 3-fold in testicular microsomes while also decreasing the P450RAP immunoblot. This close correlation between PAH metabolism and expression of P450RAP indicates the involvement of the cytochrome in this activity. DMBA and BP metabolism by PMSG-treated rat ovarian microsomes and untreated testicular microsomes are each completely inhibited by anti-P450RAP but are not inhibited by anti-P450IA1. Essentially all of the PAH metabolism in rat adrenal, testis, and ovary is, therefore, catalyzed by P450RAP, which is hormonally elevated in each tissue by a variety of possible mechanisms, including induction and selective proliferation of cells that express this protein.

Molecular cloning of the beta-subunit of the Na,K-ATPase in the brine shrimp, Artemia. The cDNA-derived amino acid sequence shows low homology with the beta-subunits of vertebrates except in the single transmembrane and the carboxy-terminal domains

A cDNA encoding the beta-subunit of the Na,K-ATPase of brine shrimp (Artemia) has been cloned. Its nucleotide sequence and predicted amino acid sequence have been determined. The amino acid sequence shows considerable divergence from that of chicken, dog, human, pig, rat, sheep, Torpedo, and Xenopus. This is not entirely unexpected since brine shrimp is a 'fast clock' organism which diverged from the precursor of the vertebrates 0.5-1.0 billion years ago. However, a highly hydrophobic putative transmembrane domain and the carboxy-terminal domain show considerable conservation. The relatively small degree of conservation in the beta-subunit of Artemia should provide information about the functional significance of this protein.

Reactivation of affinity-purified estrogen receptors by peptides derived from histone H2B

Purification of estrogen receptors by affinity chromatography over diethylstilbestrol-agarose is associated with a major loss of estradiol binding activity. Histone H2B can restore a significant fraction of the binding activity. Cleavage of the H2B molecule into two halves by cyanogen bromide reveals that the carboxyl terminus is responsible for the major reactivating effects.