An upstream open reading frame (uORF) signals for cellular localization of the virulence factor implicated in pregnancy associated malaria.

Plasmodium falciparum, the causative agent of the deadliest form of human malaria, alternates expression of variable antigens, encoded by members of a multi-copy gene family named var. In var2csa, the var gene implicated in pregnancy-associated malaria, translational repression is regulated by a unique upstream open reading frame (uORF) found only in its 5' UTR. Here, we report that this translated uORF significantly alters both transcription and posttranslational protein trafficking. The parasite can alter a protein's destination without any modifications to the protein itself, but instead by an element within the 5' UTR of the transcript. This uORF-dependent localization was confirmed by single molecule STORM imaging, followed by fusion of the uORF to a reporter gene which changes its cellular localization from cytoplasmic to ER-associated. These data point towards a novel regulatory role of uORF in protein trafficking, with important implications for the pathology of pregnancy-associated malaria.

Development and implementation of online training modules on abuse, neglect, and exploitation.

Online training for care managers to identify, report, and prevent abuse, neglect, and exploitation was developed for a demonstration involving the dually eligible Medicare and Medicaid population. It was composed of three modules covering background, screening, and reporting abuse. Of 453 enrollees, 273 completed at least one module and 212 completed all three. Pre- and post-training surveys for each module were used to examine changes in the proportion of correct answers for each question, using the related-samples Cochran's Q statistic. Improvements in knowledge from pre- to post-training were evident in modules covering background on abuse and reporting abuse, but not in the module about communication principles and screening for abuse. Its content may have already been familiar to the trainees, who were primarily social workers and nurses. Lessons learned are being used to adapt the training for a wider audience to increase public awareness of abuse.

Subjective Successful Aging Predicts Probability of Mortality Over 9 Years Among Adults Aged 50-74.

BACKGROUND AND OBJECTIVES: Although the relationship between mortality and objective successful aging (health, functional ability, social engagement) is clear, the relationship between subjective successful aging (SSA) and mortality is inconclusive. Building on the broader literature regarding psychological well-being, these analyses examine the relationship between SSA and mortality, adjusting for demographic, health, and lifestyle characteristics with known mortality risks. RESEARCH DESIGN AND METHODS: We analyzed self-report data collected between 2006 and 2008 from 5,483 people. In addition to demographic, health, and lifestyle variables, we measured SSA using a valid, reliable measure. Over the course of 3,285 days, 695 people died. We computed four sequential Cox proportional-hazard models to examine the association between SSA and time to death. The first model included only SSA; Model 2 added demographic characteristics; Model 3 added health characteristics; Model 4 added lifestyle characteristics. RESULTS: We found that SSA had a significant association with mortality, accounting for known mortality risk factors. Each one-point rise in SSA decreased the risk of mortality by three percent (0.97; 95% CI= 0.95-0.99; p<0.05). The probability of death within 9 years for persons with SSA scores from 0-5 was 45%; for persons with SSA scores from 25-30, risk of mortality was less than 10%. DISCUSSION AND IMPLICATIONS: Findings provide evidence that lower SSA scores reveal greater risk for mortality beyond demographic, health, and lifestyle variables. A brief assessment of SSA can provide unique clinical information and be used to identify people who might benefit from interventions to reduce mortality risk.

Balancing Caregiving and Work: Role Conflict and Role Strain Dynamics.

Positing role conflict as a bidirectional construct in which work interferes with caregiving (WIC) and caregiving interferes with work (CIW), this study investigated its antecedents (demands and support of caregiving and work) and consequences (role strain). A national sample of 583 women between the ages of 50 and 64 years identified using random-digit-dial procedures completed a telephone survey. Structural equation modeling revealed that caregiving demands were positively associated with CIW and caregiving burden; instrumental caregiving support reduced CIW and caregiving burden. Work demands were positively associated with WIC, CIW, caregiving burden, and work burden. Emotional workplace support reduced WIC, CIW, and work burden. CIW and WIC were positively associated with caregiving burden; only WIC was positively associated with work burden. Findings suggest that demands and supports related to the caregiving role do not influence work-related role strain; work demands and supports influence role strain experienced from both caregiving and work domains.

Evaluating Nursing Home Resident and Staff Experiences With a Life Story Program.

Life story programs hold promise for improving person-centered care and relationships between nursing home residents and staff. A pilot life story intervention study in 16 nursing homes provided residents with complimentary biographical life story books and summaries, and staff with action plans to enhance care planning. Trained volunteers and program staff collected life stories, and researchers interviewed 170 residents at three points in time. Overall, residents had positive experiences with the program, but were less willing to share their books with others afterwards. They also experienced a decrease in depression (Patient Health Questionnaire-8 [PHQ-8]) over time. Surveys of 92 staff demonstrated increases over time in perceived importance of knowing residents' life stories. Administrator/admissions staff found it conditionally feasible to incorporate the program into admission processes. Practice implications of life story work include opportunities to help staff learn more about residents they care for, improve person-centered care, and honor resident preferences in care planning.

Inclusion of caregiver supports and services in home- and community-based service programs: recent reports from state units on aging.

Caregivers have an important role in assisting frail and/or disabled individuals to maintain their independence in the community. Support to assist caregivers in this often stressful and demanding role is critical to sustaining the caregivers' health and ability to provide care. This paper reviews federal policy changes since 2000 that have expanded and enhanced services for informal caregivers. Next, data collected from State Units on Aging and other state agencies are presented to describe the extent to which caregiver services are included in home- and community-based programs under three funding streams (Medicaid waivers, Centers for Medicare and Medicaid Services-funded programs, and state-funded programs). Program characteristics, such as eligibility and consumer-directed options, are included. Finally, the accomplishments and initiatives reported by state respondents related to supporting informal caregivers are also explained. Results indicate that services for informal caregivers are receiving greater attention and are frequently offered under home- and community-based service programs by the states that participated in this study.

A Novel Intervention to Identify and Report Suspected Abuse in Older, Primary Care Patients.

BACKGROUND: Previous research has identified several barriers faced by clinicians in detecting and reporting elder abuse, such as lack of knowledge about the process to report suspected cases of abuse and lack of access to experts to consult with. A novel intervention was designed and tested that embedded two Adult Protective Services (APS) specialists in a healthcare system operating primary care clinics serving a large Medicare population. OBJECTIVES: To examine the types of roles the APS specialists played in the healthcare system and the number and types of cases of suspected abuse among older patients that clinicians consulted them about and reported to APS. DESIGN: Cross-sectional, exploratory study. SETTING: Primary care clinics in five regions of Texas. PARTICIPANTS: Older patients of primary care clinics. INTERVENTION: APS specialists and project staff trained clinicians on how to identify and report abuse, neglect, and exploitation among older patients. The specialists were also available in person or by telephone and email to consult with clinicians about patients suspected of being abused by others or being self-neglecting. MEASUREMENTS: Data were obtained by conducting semistructured telephone interviews with APS specialists; and from APS specialists' written documentation/notes of consultations with clinicians regarding suspicion of abuse among patients and whether a report to APS was warranted. RESULTS: The APS specialists trained clinicians on abuse, consulted with clinicians, and served as a liaison between the healthcare system and APS. During the project, clinicians reported 529 older patients to APS, and 386 patients received one or more services documented by APS at case closure. These cases involved 902 allegations of various types of abuse, of which the most common was self-neglect (617 or 68%). CONCLUSION: Embedding APS specialists in a large healthcare system led to clinicians' increased awareness of the importance of identifying and reporting elder abuse, particularly self-neglect. J Am Geriatr Soc 68:1748-1754, 2020.

Improving policies for caregiver respite services.

This paper provides a template for the decade ahead regarding the delivery, supply, and funding of caregiver respite services. Policy changes are needed to address these issues as concerns about our country's ability to meet future caregiving needs are growing along with our aging population. Federal initiatives and state-level policies and programs affecting respite are reviewed and directions for policy advancement are highlighted. Much more work is needed to educate caregivers and the general public about the necessity for respite beginning early in the caregiving career to prevent burnout and other adverse effects. Because it is unlikely that there will be a sufficient number of direct-care workers to replace unpaid caregivers, improved policies are needed to ensure that their situation is sustainable through increased availability of high-quality respite and other services vital to caregiver health and well-being. Among the 2015 White House Conference on Aging's priorities in the next decade, policies on long-term services and supports will require focused attention on family caregivers and the direct-care workforce to strengthen their ability to give care now and support their own physical, emotional, and financial needs in the future.

A national survey of assisted living facilities.

PURPOSE: Throughout the 1990s, assisted living was the most rapidly growing form of senior housing. The purpose of this paper is to describe the existing supply of assisted living facilities (ALFs) and examine the extent to which they matched the philosophy of assisted living. DESIGN AND METHODS: The study involved a multistage sample design to produce nationally representative estimates for the ALF industry. Administrators of nearly 1,500 eligible ALFs were interviewed by telephone. RESULTS: As of 1998, there were an estimated 11,459 ALFs nationwide, with 611,300 beds and 521,500 residents. Nearly 60% offered a combination of low services and low or minimal privacy, whereas only 11% offered relatively high services and high privacy. Seventy-three percent of the resident rooms or apartments were private. Aging-in-place was limited by discharge policies in most ALFs for residents who needed help with transfers, had moderate to severe cognitive impairment, had any behavioral symptoms, or needed nursing care. The industry is largely private pay and unaffordable for low- or moderate-income persons aged >/=75 unless they use assets as well as income to pay. IMPLICATIONS: ALFs differed widely in ownership, size, policies, and the degree to which they manifested the philosophy of assisted living. This diversity represents a challenge for consumers in terms of selecting an appropriate facility and for policy makers in terms of deciding what role they want assisted living to play in long-term care.

Effects of facility characteristics on departures from assisted living: results from a national study.

PURPOSE: Assisted living is an increasingly important residential setting for the frail elderly person. How often and why residents leave such facilities are important issues for consumers, for clinicians advising frail patients on their options for living arrangements, and for policymakers. This research investigated the impact of facility and individual characteristics on residents' departures from assisted living. DESIGN AND METHODS: This research is based on data on 1,483 residents in a nationally representative sample of 278 assisted living facilities (ALFs). Analyses of these data from 1998 and 1999 especially focused on those residents who left a study ALF between baseline and follow-up data collection. Multinomial logit models were estimated to investigate the impact of facility and individual factors on residents' status at follow-up. RESULTS: Over three quarters of those leaving their baseline ALF did so because they needed more care. The multivariate analyses indicated that poorer functional status and being married affected residents' relative odds of death before follow-up. Moving to another setting, other than a nursing home, was more likely for residents in for-profit ALFs. Functional status, cognitive status, and the presence of a full-time RN affected residents' odds of moving from an ALF to a nursing home. IMPLICATIONS: Both facility-level and individual-level factors affected residents' relative odds of leaving an ALF. The findings with the most potentially interesting policy implications are those concerning the factors that affected residents' relative likelihoods of entering a nursing home.

A comparison of training strategies to enhance use of external aids by persons with dementia.

UNLABELLED: The purpose of this study was to compare the effectiveness of two training approaches, Spaced Retrieval (SR) and a modified Cueing Hierarchy (CH), for teaching persons with dementia a strategy goal involving an external memory aid. Twenty-five persons with dementia living in either community or nursing home settings received training on two individual-specific strategy goals, one with each training approach. Results revealed that significantly more goals were attained using SR procedures than CH, but that a majority of participants learned to use external aids using both strategies. There were no significant differences in the number of sessions required to master goals in either condition; however, significantly more SR goals were maintained at both 1-week and 4-months post-training compared to CH goals. Mental status was not significantly correlated with goal mastery, suggesting the potential benefits of strategy training beyond the early stages of dementia. LEARNING OUTCOMES: As a result of this activity, the reader will be able to (1) identify ways to enable persons with dementia to make effective use of external memory aids; (2) describe a method, Spaced Retrieval, by which persons with dementia can learn and retain information; and (3) describe two approaches to working with persons with dementia to train a strategy learning goal.

Successful aging: early influences and contemporary characteristics.

PURPOSE: positing that successful aging has independent, yet related, dimensions that are both objective and subjective, we examine how early influences and contemporary characteristics define 4 groups of people. DESIGN AND METHODS: data were gathered from 5,688 persons aged 50-74 years living in New Jersey who participated in telephone interviews. Latent profile analysis defined people who age successfully according to both objective and subjective criteria, neither criteria, and one, but not the other, criteria. Multinomial logistic regression was used to examine the extent to which early influences and contemporary characteristics predict group membership. RESULTS: although characteristics observable early in life predict group membership, their influence is modified by current health behaviors and social support. The roles of education and incarceration feature prominently. Marital, work, and volunteer statuses, as well as moderate alcohol consumption, distinguish those aging successfully according to both criteria from the other 3 groups. IMPLICATIONS: results help to define successful aging as a multidimensional construct having both objective and subjective dimensions, provide greater clarity regarding its correlates, and increase understanding of its modifiable aspects.

Convenience samples and caregiving research: how generalizable are the findings?

PURPOSE: We contrast characteristics of respondents recruited using convenience strategies with those of respondents recruited by random digit dial (RDD) methods. We compare sample variances, means, and interrelationships among variables generated from the convenience and RDD samples. DESIGN AND METHODS: Women aged 50 to 64 who work full time and provide care to a community-dwelling older person were recruited using either RDD (N = 55) or convenience methods (N = 87). Telephone interviews were conducted using reliable, valid measures of demographics, characteristics of the care recipient, help provided to the care recipient, evaluations of caregiver-care recipient relationship, and outcomes common to caregiving research. RESULTS: Convenience and RDD samples had similar variances on 68.4% of the examined variables. We found significant mean differences for 63% of the variables examined. Bivariate correlations suggest that one would reach different conclusions using the convenience and RDD sample data sets. IMPLICATIONS: Researchers should use convenience samples cautiously, as they may have limited generalizability.