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Barber B, Weeks L, Steeves-Dorey L, McVeigh W, Stevens S, Moody E, Warner G. Hospital to Home: Supporting the Transition From Hospital to Home for Older Adults. Can J Nurs Res 2021; 54:483-496. [PMID: 34704507 PMCID: PMC9597142 DOI: 10.1177/08445621211044333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background An increasing proportion of older adults experience avoidable
hospitalizations, and some are potentially entering long-term care homes
earlier and often unnecessarily. Older adults often lack adequate support to
transition from hospital to home, without access to appropriate health
services when they are needed in the community and resources to live safely
at home. Purpose This study collaborated with an existing enhanced home care program called
Home Again in Nova Scotia, to identify factors that contribute to older
adult patients being assessed as requiring long-term care when they could
potentially return home with enhanced supports. Methods Using a case study design, this study examined in-depth experiences of
multiple stakeholders, from December 2019 to February 2020, through analysis
of nine interviews for three focal patient cases including older adult
patients, their family or friend caregivers, and healthcare
professionals. Results Findings indicate home care services for older adults are being sought too
late, after hospital readmission, or a rapid decline in health status when
family caregivers are already experiencing caregiver burnout. Limitations in
home care services led to barriers preventing family caregivers from
continuing to care for older adults at home. Conclusions This study contributes knowledge about gaps within home care and transitional
care services, highlighting the importance of investing in additional home
care services for rehabilitation and prevention of rapidly deteriorating
health.
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Affiliation(s)
- Brittany Barber
- Faculty of Health, 3688Dalhousie University, Halifax, NS, Canada
| | - Lori Weeks
- School of Nursing, 3688Dalhousie University, Halifax, NS, Canada
| | - Lexie Steeves-Dorey
- Rehabilitations & Supportive Care, 432234Nova Scotia Health, Halifax, NS, Canada
| | - Wendy McVeigh
- Continuing Care Central Zone, 432234Nova Scotia Health, Halifax, NS, Canada
| | - Susan Stevens
- Continuing Care, 432234Nova Scotia Health, Halifax, NS, Canada
| | - Elaine Moody
- School of Nursing, 3688Dalhousie University, Halifax, NS, Canada
| | - Grace Warner
- School of Occupational Therapy, 3688Dalhousie University, Halifax, NS, Canada
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Choi E, Han KM, Chang J, Lee YJ, Choi KW, Han C, Ham BJ. Social participation and depressive symptoms in community-dwelling older adults: Emotional social support as a mediator. J Psychiatr Res 2021; 137:589-596. [PMID: 33168196 DOI: 10.1016/j.jpsychires.2020.10.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/25/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022]
Abstract
Previous studies have documented the protective effects of social participation on depression in older adults. In this study, we investigated the association between social participation and depressive symptoms and the associated gender difference in older adults. In addition, we explored the mediating role of emotional social support in the association between social participation and depressive symptoms. We collected data from 4751 community-dwelling adults aged 60 and above from the Korean Retirement and Income Study (KReIS) conducted in 2017 and 2018. The relationship between social participation (participation in different types of activities, frequency of participation, and the number of activities participated) and the risk for depressive symptoms was examined. Older adults who participated in social activity, volunteer work, and donation had decreased risk of depressive symptoms. More frequent and more diverse participation in activities further reduced the risk. Overall, women benefited more from social participation than men. Importantly, emotional social support significantly mediated the relationship between social participation and depressive symptoms. Social participation was associated lower odds for depression in older adults, particularly in older women. Our findings provided one of very few pieces of evidence that documents the mediating role of emotional social support in the relationship between social participation and depression among the elderly.
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Affiliation(s)
- Eunsoo Choi
- Department of Psychology, Korea University College of Liberal Arts, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Jisoon Chang
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea
| | - Youn Jung Lee
- Department of Psychiatry, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Kwan Woo Choi
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Wild K, Sharma N, Mattek N, Karlawish J, Riley T, Kaye J. Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study. J Med Internet Res 2021; 23:e18806. [PMID: 33439144 PMCID: PMC7840292 DOI: 10.2196/18806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/23/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. OBJECTIVE This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. METHODS Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. RESULTS During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. CONCLUSIONS Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.
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Affiliation(s)
- Katherine Wild
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Nicole Sharma
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Nora Mattek
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Jason Karlawish
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Thomas Riley
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Jeffrey Kaye
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
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Lopes LGDO, Santos CMD, Bulgarelli AF. Pessoas idosas institucionalizadas, transtornos depressivos e questões odontológicas: qual o estado da arte? REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.200351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Fazer um mapeamento e uma discussão sobre o conhecimento científico envolvendo o objeto de pesquisa Condições de saúde bucal e depressão em idosos institucionalizados. Método Revisão de Escopo do tipo mapeamento da literatura. O mapeamento dos dados selecionados foi feito pela técnica de sistematização de dados por meio da Análise de Conteúdo Somativa na perspectiva de Temas Manifestos nos textos. Após as exclusões foram selecionados 27 artigos. Resultados Com a análise dos artigos foi possível dividi-los em dois temas. Todos os continentes possuem publicações acerca do tema. Sobre sua metodologia, muitas pesquisas com desenho de estudos dedutivos foram realizadas e poucas pesquisas foram desenvolvidas com métodos indutivos. Conclusão O presente estudo identificou que existe uma interlocução entre algumas condições de saúde bucal (xerostomia e perda dentária) e prevalência de transtornos depressivos em idosos institucionalizados.
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Hsu YC, Wright CL. The effects of a Socially Supportive Activities Program (SSAP) on mood in long term care: A pilot study. Geriatr Nurs 2019; 40:572-578. [PMID: 31174888 DOI: 10.1016/j.gerinurse.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
This study examined the effects of a facilitated 10-week Socially Supportive Activities Program (SSAP) designed to improve mood in a geriatric institutional setting. A sample of 68 Taiwanese elders in long-term care facilities with depressive symptoms were randomly assigned to either an experimental group (N = 35) or a control group (N = 33). Outcomes were measured before the intervention, week 1, and at week 12, one-week post intervention. In the experimental group, pre-post measurement results demonstrated significant reductions in depressive symptoms, measured by Geriatric Depression Scale, and significantly higher levels of self-transcendence, measured by the Self-Transcendence Scale. An additional post-intervention measure of mood was collected with the Apparent Emotional Rating Scale. The AERS also demonstrated a significantly higher score (better mood) in the experimental group than in the control group. This study supports the use of a structured, facilitated, well-designed social activities program like the SSAP, to enhance and improve mood in elders who live in long-term care facilities.
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Affiliation(s)
- Ya-Chuan Hsu
- Department of Nursing, Chang Jung Christian University, Tainai City, Taiwan.
| | - Cheryl L Wright
- School of Nursing, Oregon Health & Sciences University, Portland, USA
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Rehabilitation Providers' Prediction of the Likely Success of the SNF-to-Home Transition Differs by Discipline. J Am Med Dir Assoc 2019; 20:492-496. [PMID: 30630726 DOI: 10.1016/j.jamda.2018.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our article's primary objective is to examine whether rehabilitation providers can predict which patients discharged from skilled nursing facility (SNF) rehabilitation will be successful in their transition to home, controlling for sociodemographic factors and physical, mental, and social health characteristics. DESIGN Longitudinal cohort study. SETTING AND PARTICIPANTS One hundred-twelve English-speaking adults aged 65 years and older admitted to 2 SNF rehabilitation units. MEASURES Our outcome is time to "failed transition to home," which identified SNF rehabilitation patients who did not successfully transition from the SNF to home during the study. Our primary independent variable consisted of the prediction of medical providers, occupational therapists, physical therapists, and social workers about the likely success of their patients' SNF-to-home transition. We also examined the association of sociodemographic factors and physical, mental, and social health with a failed transition to home. RESULTS The predictions of occupational and physical therapists were associated with whether patients successfully transitioned from the SNF to their homes in bivariate [hazard ratio (HR) = 4.96, P = .014; HR = 10.91, P = .002, respectively] and multivariate (HR = 5.07, P = .036; HR = 53.33, P = .004) analyses. The predictions of medical providers and social workers, however, were not associated with our outcome in either bivariate (HR = 1.44, P = .512; HR = 0.84, P = .794, respectively) or multivariate (HR = 0.57, P = .487; HR = 0.54, P = .665) analyses. Living alone, more medical conditions, lower physical functioning scores, and greater depression scores were also associated with time to failed transition to home. CONCLUSIONS/IMPLICATIONS These findings suggest that occupational and physical therapists may be better able to predict post-SNF discharge outcomes than are other rehabilitation providers. Why occupational and physical therapists' predictions are associated with the SNF-to-home outcome whereas the predictions of medical providers and social workers are not is uncertain. A better understanding of the factors informing the postdischarge predictions of occupational and physical therapists may help identify ways to improve the SNF-to-home discharge planning process.
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Park MJ, Park NS, Chiriboga DA. A latent class analysis of social activities and health among community-dwelling older adults in Korea. Aging Ment Health 2018; 22:625-630. [PMID: 28282727 DOI: 10.1080/13607863.2017.1288198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study presents an empirical typology of social activity and its association with the depressive symptoms and self-rated health of community-dwelling older adults (n = 464) in South Korea. METHOD Latent class analysis (LCA) was used to classify the types of social activities. Data analyses were conducted using Mplus 7.2 program for LCA and SPSS 22.0 for multiple regression analyses. RESULTS LCA identified people who fell into one of the four activity groups: Diverse, Community Center/Disengaged, Religion Plus, and Friendship/Leisure. Membership in these four groups predicted differences in depressive symptoms and self-rated health. CONCLUSIONS Results indicate that typologies of social activity could enhance practitioners' understanding of activity patterns and their associations with health and well-being.
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Affiliation(s)
- Mi Jin Park
- a Department of Aging and Social Work , Catholic University of Pusan , Busan , South Korea
| | - Nan Sook Park
- b School of Social Work , University of South Florida , Tampa , FL , USA
| | - David A Chiriboga
- c Department of Child and Family Studies, University of South Florida , Tampa , FL , USA
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Yohannes AM. Living with a Spouse or Others: Beneficial or Harmful in the Presence of Depressive Symptoms? J Am Geriatr Soc 2017; 66:632-633. [PMID: 29155455 DOI: 10.1111/jgs.15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Abebaw Mengistu Yohannes
- Department of Physical Therapy, School of Behavioral and Applied Sciences, Azusa Pacific University, Azusa, CA
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Graham CL, Scharlach AE, Stark B. Impact of the Village Model: Results of a National Survey. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:335-354. [PMID: 28509628 DOI: 10.1080/01634372.2017.1330299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Villages are a relatively new, consumer-directed model that brings together older adults in a community who have a mutual interest in aging in place. These membership organizations provide social and civic engagement opportunities, volunteer provided support services, and referral to vetted community providers to achieve their primary goals of promoting independence and preventing undesired relocations. This cross sectional survey of 1,753 active Village members from 28 Villages across the US measured members' perceived impacts in the areas of social connection, civic engagement, service access, health and well-being, and ability to age in place. Results showed that involvement in the Village was a key factor associated with greater perceived impacts. Over half of members perceive that the Village has improved their sense of connection to others and their feeling that they have someone to count on. Though younger members in better health were more likely to perceive impacts in social connections, results suggest older women, living alone with some disability may be the most likely to experience improved health, quality of life, and mobility. The implications for social work practice are discussed.
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Affiliation(s)
- Carrie L Graham
- a Center for the Advanced Study of Aging Services, School of Social Welfare , University of California Berkeley , Berkeley , California , USA
| | - Andrew E Scharlach
- a Center for the Advanced Study of Aging Services, School of Social Welfare , University of California Berkeley , Berkeley , California , USA
| | - Bradford Stark
- a Center for the Advanced Study of Aging Services, School of Social Welfare , University of California Berkeley , Berkeley , California , USA
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Graham C, Scharlach AE, Kurtovich E. Do Villages Promote Aging in Place? Results of a Longitudinal Study. J Appl Gerontol 2016; 37:310-331. [PMID: 27708072 DOI: 10.1177/0733464816672046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Villages are a new, grassroots, consumer-directed model that aims to promote aging in place and prevent unwanted relocations for older adults. In exchange for a yearly membership fee, Villages provide seniors with opportunities for social engagement (social events and classes), civic engagement (member-to-member volunteer opportunities), and an array of support services. In total, 222 Village members were surveyed at intake and 12-month follow-up to examine changes in their confidence aging in place, social connectedness, and health. The strongest positive results were in the domain of confidence, including significantly greater confidence aging in place, perceived social support, and less intention to relocate after 1 year in the Village. As most seniors were in good health and well connected at the time they joined the Village, there were not improvements in health or social connectedness. Authors discuss the importance of longer term, longitudinal studies to examine the effectiveness of Villages in preventing institutionalization over time.
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Affiliation(s)
- Carrie Graham
- 1 Center for the Advanced Study of Aging Services, School of Social Welfare, University of California, Berkeley, USA.,2 Health Research for Action, School of Public Health, University of California, Berkeley, USA
| | - Andrew E Scharlach
- 1 Center for the Advanced Study of Aging Services, School of Social Welfare, University of California, Berkeley, USA
| | - Elaine Kurtovich
- 1 Center for the Advanced Study of Aging Services, School of Social Welfare, University of California, Berkeley, USA.,2 Health Research for Action, School of Public Health, University of California, Berkeley, USA
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Lyons BE, Austin D, Seelye A, Petersen J, Yeargers J, Riley T, Sharma N, Mattek N, Wild K, Dodge H, Kaye JA. Pervasive Computing Technologies to Continuously Assess Alzheimer's Disease Progression and Intervention Efficacy. Front Aging Neurosci 2015; 7:102. [PMID: 26113819 PMCID: PMC4462097 DOI: 10.3389/fnagi.2015.00102] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/13/2015] [Indexed: 11/24/2022] Open
Abstract
Traditionally, assessment of functional and cognitive status of individuals with dementia occurs in brief clinic visits during which time clinicians extract a snapshot of recent changes in individuals’ health. Conventionally, this is done using various clinical assessment tools applied at the point of care and relies on patients’ and caregivers’ ability to accurately recall daily activity and trends in personal health. These practices suffer from the infrequency and generally short durations of visits. Since 2004, researchers at the Oregon Center for Aging and Technology (ORCATECH) at the Oregon Health and Science University have been working on developing technologies to transform this model. ORCATECH researchers have developed a system of continuous in-home monitoring using pervasive computing technologies that make it possible to more accurately track activities and behaviors and measure relevant intra-individual changes. We have installed a system of strategically placed sensors in over 480 homes and have been collecting data for up to 8 years. Using this continuous in-home monitoring system, ORCATECH researchers have collected data on multiple behaviors such as gait and mobility, sleep and activity patterns, medication adherence, and computer use. Patterns of intra-individual variation detected in each of these areas are used to predict outcomes such as low mood, loneliness, and cognitive function. These methods have the potential to improve the quality of patient health data and in turn patient care especially related to cognitive decline. Furthermore, the continuous real-world nature of the data may improve the efficiency and ecological validity of clinical intervention studies.
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Affiliation(s)
- Bayard E Lyons
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA ; Department of Neurology, Oregon Health and Science University , Portland, OR , USA
| | - Daniel Austin
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA ; Department of Biomedical Engineering, Oregon Health and Science University , Portland, OR , USA
| | - Adriana Seelye
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA ; Department of Neurology, Oregon Health and Science University , Portland, OR , USA
| | - Johanna Petersen
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA ; Department of Biomedical Engineering, Oregon Health and Science University , Portland, OR , USA
| | - Jonathan Yeargers
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA
| | - Thomas Riley
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA
| | - Nicole Sharma
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA
| | - Nora Mattek
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA ; Department of Neurology, Oregon Health and Science University , Portland, OR , USA
| | - Katherine Wild
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA ; Department of Neurology, Oregon Health and Science University , Portland, OR , USA
| | - Hiroko Dodge
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA ; Department of Neurology, Oregon Health and Science University , Portland, OR , USA
| | - Jeffrey A Kaye
- Oregon Center for Aging and Technology, Oregon Health and Science University , Portland, OR , USA ; Department of Neurology, Oregon Health and Science University , Portland, OR , USA ; Department of Biomedical Engineering, Oregon Health and Science University , Portland, OR , USA ; Neurology Service, Portland Veteran Affairs Medical Center , Portland, OR , USA
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