Outcomes and Treatment Costs of Skilled Nursing Facility Patients with Pressure Injuries and Malnutrition

Abstract Skilled nursing facilities (SNF) provide care for individuals requiring skilled care while transitioning to a more permanent residence post hospitalization. This analysis shows that diagnosed malnutrition and pressure injuries (PI) adversely impact SNF patients’ health and recovery. Length of SNF stay, total charges, and discharge disposition were analyzed using SNF claims from 2016-2020 Centers for Medicare & Medicaid Services (CMS) Standard Analytical File databases. An average of 4.5% SNF patients had diagnosed PIs, and 4.9% had diagnosed malnutrition. Patients with diagnosed malnutrition were more likely to have PIs than patients without diagnosed malnutrition (11.9% vs 4.1%). Patients with PIs had higher charges ($12,304 vs. $10,937), were less likely to be discharged home (11.1% vs 18.9%), and more likely to be discharged to a hospital (15.8% vs 11.0%) or deceased (2.8% vs 1.6%). Patients with diagnosed malnutrition displayed a similar pattern for charges ($11,587 vs $10,969), and discharge to home (14.5% vs 18.8%), hospital (13.5 vs 11.1%) or deceased (2.8% vs 1.6%). Length of SNF stay did not differ between patients with and without PIs (18.5 vs 18.6) and was slightly shorter for patients with diagnosed malnutrition (17.3 vs 18.9). While higher probability of rehospitalization or death could impact these results, drivers behind these differences need further investigation. Because malnourished patients were more likely to have PIs and both PI and malnutrition are associated with poorer patient discharge outcomes and higher costs, efforts to identify malnutrition and implement proper nutrition interventions should be prioritized as part of SNF quality improvement initiatives.

momentary associations between loneliness and cognitive performances remained significant after controlling for the momentary level of feeling depressed.Unlike the concurrent effect, there was no lagged effect of loneliness on daily cognitive performances.These results suggest that transient but intense feelings of loneliness can function as acute stress and thus, compromise daily cognitive functioning short-term.Results will be discussed in terms of the potential benefit of momentary real-time interventions to lessen feelings of loneliness to maintain older adults' cognitive functioning.

OLDER ADULTS' ACCEPTANCE OF TECHNOLOGY DURING THE PANDEMIC: THE COVID TECHNOLOGY ACCEPTANCE MODEL (TAM)
Megan O'Connell, 1 Kristen Haase, 2 Allison Cammer, 1 Shelley Peacock, 1 Theodore Cosco, 3 and Lorraine Holtslander, 1 1.University of Saskatchewan,Saskatoon,Saskatchewan,Canada,2. University of British Columbia,Vancouver,British Columbia,Canada,3. Simon Fraser University,Vancouver,British Columbia,Canada During the pandemic, technology-mediated communication was one of the few ways to maintain social and community connections.We explored how the pandemic impacted older adults' use and appraisal of technology.In a random sample of 407 older adults (M age = 81.1 years; range 65-105 years) almost half (n = 161) reported they changed how they used technology to virtually connect with others during the pandemic, and 78 of these reported that this was new technology for them.We adapted the technology acceptance model (TAM) for the pandemic, the COVID-TAM, and describe how physical distancing led to new acceptance of technology due to an increased perception of usefulness of technology for maintaining community and social connections.The 71 older adults who denied using technology were asked about the reasons underlying their reluctance to use technology to access social networks and community events during the pandemic.Thematic analysis revealed factors consistent with a double-digital divide; lack of physical exposure to technology creates an additional psychological barrier to adoption of new technology.Of the technology-reluctant subgroup of older adults, few reported lack of perceived usefulness of technology during the pandemic.Instead, most reported lack of self-efficacy or fear of technology underlying their lack of technology use for social and community connections during the pandemic, which we incorporate into the COVID-TAM.Findings indicate that technology training can help mitigate this fear and increase social and community connections that are technology-mediated in circumstances where physical distancing is necessary.

OUTCOMES AND TREATMENT COSTS OF SKILLED NURSING FACILITY PATIENTS WITH PRESSURE INJURIES AND MALNUTRITION
Kirk Kerr, 1 Cory Brunton, 1 and Mary Beth Arensberg, 2 1. Abbott Nutrition,Columbus,Ohio,United States,2. Abbott,Columbus,Ohio,United States Skilled nursing facilities (SNF) provide care for individuals requiring skilled care while transitioning to a more permanent residence post hospitalization.This analysis shows that diagnosed malnutrition and pressure injuries (PI) adversely impact SNF patients' health and recovery.
Length of SNF stay, total charges, and discharge disposition were analyzed using SNF claims from 2016-2020 Centers for Medicare & Medicaid Services (CMS) Standard Analytical File databases.An average of 4.5% SNF patients had diagnosed PIs, and 4.9% had diagnosed malnutrition.Patients with diagnosed malnutrition were more likely to have PIs than patients without diagnosed malnutrition (11.9% vs 4.1%).Patients with PIs had higher charges ($12,304 vs. $10,937), were less likely to be discharged home (11.1% vs 18.9%), and more likely to be discharged to a hospital (15.8% vs 11.0%) or deceased (2.8% vs 1.6%).Patients with diagnosed malnutrition displayed a similar pattern for charges ($11,587 vs $10,969), and discharge to home (14.5% vs 18.8%), hospital (13.5 vs 11.1%) or deceased (2.8% vs 1.6%).Length of SNF stay did not differ between patients with and without PIs (18.5 vs 18.6) and was slightly shorter for patients with diagnosed malnutrition (17.3 vs 18.9).While higher probability of rehospitalization or death could impact these results, drivers behind these differences need further investigation.Because malnourished patients were more likely to have PIs and both PI and malnutrition are associated with poorer patient discharge outcomes and higher costs, efforts to identify malnutrition and implement proper nutrition interventions should be prioritized as part of SNF quality improvement initiatives.

PAVING THE WAY FOR AGEIST ATTITUDES THROUGH CHILDREN'S BOOKS
Lena-Emilia Schenker, and Jennifer Bellingtier, Friedrich Schiller University Jena, Jena, Thuringen, Germany Older adults are underrepresented and rarely appear in major roles in children's literature.According to developmental intergroup theory, numerically smaller groups are likely to become targets of stereotypes and prejudice.Because parental ageist attitudes are related to those of their children, and parents typically choose their children's literature, we investigated parental preferences for books featuring older and younger adults and what factors might predict this preference.In an online survey, 176 parents of children aged 12 or younger rated children's book covers featuring a child and a prominent younger or older adult.There were two identical versions of each book cover on which only the age of the adult varied.Each respondent viewed covers featuring older and younger adults, but only saw one version of each cover (i.e., counterbalanced design).Parents indicated their preference for the books by stating how much they and their children would like the book and how likely they would be to buy it.Stereotypical expectations regarding the books' storylines were rated on a semantic differential scale (e.g., modern vs. old-fashioned).Results revealed that there were no significant differences in preferences for books featuring younger, compared to older adults.However, a stronger difference in preference for books featuring younger, over older adults was predicted by the extent of stereotypical expectations regarding the storylines.In particular, this preference was stronger in parents who expected stories with older adults to conform to prevailing ageist stereotypes, suggesting that ageist expectations may deter some parents from books featuring older adults.

PHYSICAL INDICATORS OF AGING ARE RELATED TO CELLULAR SENESCENCE SIGNAL P16INK4A IN MIDLIFE ADULTS
Kelly Rentscher, Teresa Seeman, Steve Cole, and Judith Carroll, University of California, Los Angeles, Los Angeles, California, United States Cellular senescence signal p16INK4a has been identified as a biomarker of aging that accumulates with chronological age across several tissues in mice and humans and may be potentially modifiable by interventions.This study examined whether physical indicators of aging were associated with p16INK4a and other markers of the aging process in midlife adults.Participants were 543 adults aged 26-78 years (Mage=54.0;50.5% female) in the Midlife in the United States Refresher cohort.Interviews, questionnaires, and performance tests measured physical indicators of aging, including the Fried frailty index, limitations in daily activities, and age-related comorbidities.RNA sequencing of whole blood assessed biomarkers of aging: p16INK4a (CDKN2A), the DNA damage response (DDR), and the senescence-associated secretory phenotype (SASP).Older age was associated with enhanced p16INK4a (r=.11, p=.01), DDR (r=.34,p<.001),and SASP (r=.38,p<.001)expression.Multiple regression models that adjusted for age, sex, race/ ethnicity, BMI, comorbidities, and time between assessments revealed that frailty (pre-frail/frail vs. non-frail) was associated with greater p16INK4a (B=0.13,p=.048) and marginally greater DDR (B=0.06,p=.06) expression.Limitations in daily activities were also associated with p16INK4a (B=0.12,p=.045).History of heart disease, stroke, arthritis, and cancer were associated with DDR and SASP expression in unadjusted models only (ps<.05).In summary, senescence indicator p16INK4a was elevated in whole blood samples from middle-aged adults who showed signs of frailty and limitations in daily activities.Findings suggest that whole blood p16INK4a expression might potentially be used to detect early signs of aging and target interventions to reduce biological aging and frailty.

POOR PERFORMANCE IN SNF-VBP PROGRAM IS ASSOCIATED WITH WORSE COVID-19 OUTCOMES IN NURSING HOMES
Jennifer Gaudet Hefele, 1 Matt Aldag, 2 Riad Elmor, 2 Charanya Kaushik, 2 and Jessica Simpson Ballard, 2 1. Booz Allen Hamilton, Hollis, New Hampshire, United States,2. Booz Allen Hamilton,Bethesda,Maryland,United States Skilled Nursing Facility Value-Based Purchasing (SNF-VBP) was a new Medicare payment program when COVID-19 began.SNF-VBP aims to improve care through payment bonuses and penalties.However, studies have shown that minority-serving nursing homes (NHs) tend to fare worse under SNF-VBP (more likely to receive penalties, less likely to receive bonuses).This study sought to examine whether SNF-VBP performance prior to the pandemic was associated with COVID-19 outcomes and whether associations varied in NHs where the majority of residents are Black/African American (majority-Black/AA).Using publicly available data on COVID-19 outcomes and vaccinations, SNF-VBP performance, and NH characteristics, we found that majority-Black/AA NHs were less likely to have zero infections; had higher case fatality rates; and had lower resident and staff