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Older people living with frailty emphasize autonomy and function as acute healthcare outcome goals. Existing Patient-Reported Outcome Measures (PROMs) measure function but do not comprehensively address autonomy. This initial development of a novel autonomy outcome measure used co-creation and cognitive interviews, working toward a PROM for Older People living with frailty receiving Acute Care (“PROM-OPAC”). Novel item question stems and responses considering autonomy were devised with lay research partners. Items were examined for content by lay volunteers, and then selected based on relevance, completeness, and accessibility. Retained items were cognitively tested with patient participants. Item selection considered content validity and feasibility and was undertaken collaboratively with lay research partners. The study involved 3 lay research partners and 4 further lay collaborators throughout all stages, and 14 patient participants were recruited for the cognitive interviews. Twenty-two novel items were appraised. Seven were selected for retention. This preliminary PROM-OPAC comprised 7 items to measure autonomy and was intended for administration alongside a function measure to capture meaningful acute healthcare outcomes. Development will continue with quantitative testing and validation.

Abstract Introduction The current service metrics used to evaluate quality in emergency care do not account for specific healthcare outcome goals for older people living with frailty. These have previously been classified under themes of ‘Autonomy’ and ‘Functioning’. There is no person-reported outcome measure (PROM) for older people with frailty and emergency care needs. This study aimed to identify and co-produce recommendations for instruments potentially suitable for use in this population. Methods In this systematic review, we searched six databases for PROMs used between 2010 and 2021 by older people living with frailty receiving acute hospital care. Studies were reviewed against predefined eligibility criteria and appraised for quality using the COSMIN Risk of Bias checklist. Data were extracted to map instrument constructs against an existing framework of acute healthcare outcome goals. Instrument face and content validity were assessed by lay collaborators. Recommendations for instruments with potential emergency care suitability were formed through co-production. Results Of 9392 unique citations screened, we appraised the full texts of 158 studies. Nine studies were identified, evaluating nine PROMs. Quality of included studies ranged from ‘doubtful’ to ‘very good’. Most instruments had strong evidence for measurement properties. PROMs mainly assessed ‘Functioning’ constructs, with limited coverage of ‘Autonomy’. Five instruments were considered too burdensome for the emergency care setting or too specific for older people living with frailty. Conclusions Four PROMs were recommended as potentially suitable for further validation with older people with frailty and emergency care needs: COOP/WONCA charts, EuroQol, McGill Quality of Life (Expanded), and Palliative care Outcome Scale.

Abstract Background Healthcare outcome goals are central to person-centred acute care, however evidence among older people is scarce. Older people who are living with frailty have distinct requirements for healthcare delivery and have distinct risk for adverse outcomes from healthcare. There is insufficient evidence for whether those living with frailty also have distinct healthcare outcome goals. This study explored the nature of acute care outcome goals in people living with frailty. Methods Healthcare outcome goals were explored using semi-structured patient interviews. Participants aged over 65 with Clinical Frailty Score 5-8 (mild to very severe frailty) were recruited during their first 72 hours in a UK hospital. Purposive, maximum variation sampling was guided by lay partners from a Patient and Public Involvement Forum specialising in ageing-related research. Qualitative analysis used a blended approach based on framework and constant comparative methodologies for the identification of themes. Findings were validated through triangulation with participant, lay partner, and technical expert review. Results The 22 participants were aged 71 to 98 and had mild to very severe frailty. One quarter were living with dementia. Most participants had reflected on their situation and considered their outcome goals. Theme categories (and corresponding sub-categories) were ‘Autonomy’ (information, control, and security) and ‘Functioning’ (physical, psychosocial, and relief). A novel ‘security’ theme was identified, whereby participants sought to feel safe in their usual living place and with their health problems. Those living with milder frailty were concerned to maintain ability to support loved ones, while those living with most severe frailty were concerned about burdening others. Conclusions Outcome goals for acute care among older participants living with frailty were influenced by the insecurity of their situation and fear of deterioration. Patients may be supported to feel safe and in control through appropriate information provision and functional support.

Aims: To review all laboratory-confirmed cases of nocardiosis at a tertiary referral hospital over an extended period (2000–2018; 216 months) with regard to microbiological and epidemiological characteristics, risk factors, clinical management, morbidity and mortality. Methods: The medical records and microbiological data of all laboratory-confirmed cases of nocardiosis, identified by culture (with reference laboratory confirmation) or identified in a reference laboratory only, were included and analysed retrospectively. Results: 18 cases of nocardiosis were identified; 72% (n = 13) were male; all were UK resident. Median age at presentation was 56 years (range 6–83 years). Most had underlying pathology or risk factors including cancer in 39% (n = 7) and immunosuppression in 33% (n = 6). Alcohol and acid fast bacilli (AAFB) microscopy performed in 8/18 cases was negative. Routine 48-hour bacterial culture of 18 isolates was positive in 15; 3 culture-negative specimens were subsequently confirmed positive in a reference laboratory. Four patterns of clinical presentation were observed: cerebral 39% (n = 7), disseminated 28% (n = 5), pulmonary 17% (n = 3), and isolated cutaneous/articular (both n = 1). In addition one case of bacteraemia was noted. Nocardia farcinica accounted for half (n = 9) of all nocardia species identified. 55% (n = 10) required surgical intervention. One co-trimoxazole resistant isolate was identified. Morbidity and mortality were high: 78% (n = 14) required critical care. More than half of patients (55%; n = 10) died from refractory infection, including all of those with disseminated disease (n = 5). Conclusions: Nocardia spp should never be regarded as a contaminant or commensal organism in clinical specimens. Correlation of clinical and radiology findings plus risk factors are imperative for nocardiosis to be considered in the differential diagnosis in order to guide appropriate laboratory processing of specimens. Although rare, recognition of nocardiosis is important because of its high mortality. Routine 48-hour bacterial culture does not always identify Nocardia spp and isolates should also be sent to a reference laboratory.

Through a gerontological lens, using grounded theory methods and both qualitative and quantitative data, we investigated the "off-time" enrollment of mid- and later-life (MLL) community college students (age 40+) to explore how their enrollment decisions and academic goals are situated in the timing and intersection of life events and transitions, such as the responsibilities of work and family. We conducted twelve focus group interviews with MLL community college students (n = 68) in Ohio and conducted a quantitative analysis of the distribution of academic goals by age group in Ohio's 23 community colleges. We conclude that the foremost characteristic of MLL students as a group is its within-group heterogeneity and argue that the greatest barrier to serving MLL students is in how we have been thinking -- or failing to think -- about them. We take a first slice at disaggregating "adult" students and turn away from deficit narratives to identify opportunities and assets among MLLs. Finally, we offer a theory to explain how especially wide within-group diversity of MLL academic goals is produced by cohort divergence of life events, transitions and trajectories; diverse enrollment precipitants; and individual point-of-time appraisals of lifetime elapsed and lifetime remaining. We suggest that community colleges, already leaders in adult education, are in a unique position to effectively serve MLL students by recognizing and accommodating their diversity. We present implications and strategies for colleges, policymakers and researchers based on our findings.

Objective: Community colleges have considerable potential to grow the number of individuals who complete STEM baccalaureate degrees and to broaden access to educational opportunities in STEM. However, efforts to tap this potential have been hampered by nagging questions about whether community colleges prepare students adequately for advanced STEM courses at universities. In this study, we draw on data from four universities in Michigan to investigate differences in the course and degree outcomes of students who completed prerequisite STEM courses in community colleges versus students who completed prerequisites at the university. Methods: We use logistic and linear regression to control for several potentially confounding variables, including prior academic achievement as measured by high school grade point average. Results: In three of the universities, we did not find evidence of consistently weaker outcomes among students who completed STEM prerequisites at community colleges or among transfer students generally. In the fourth university, students taking STEM prerequisites in a community college had weaker course outcomes than did non-transfer students. Intersecting qualitative evidence points to differences in levels of support for transfer students as a probable explanation for the differences in students' outcomes, rather than inadequate rigor of community college STEM coursework. Conclusion: Our findings generally align with prior evidence of minor or inconsistent differences in outcomes for students who previously attended a community college, but also point to the probable role of institutional factors at universities in influencing the chances of success among students who utilize community college to complete STEM coursework.

Community colleges serve nearly half of all undergraduates, including a disproportionate share of African American and Hispanic students, and are a key point of access to higher education for students who face socioeconomic disadvantages or other obstacles to participation in higher education. Community colleges stand to play a pivotal role in strengthening the nation's workforce and increasing opportunity in science, technology, engineering, and math (STEM) fields. However, a troublingly large fraction of community college students who complete advanced STEM courses ultimately leave college without postsecondary credentials. Utilizing data from the California Community College system, we investigated four hypothesized explanations for why students who have demonstrated potential to succeed in STEM fields by completing an advanced course in math, chemistry, or physics did not complete college. We found that students who left college tended to enter the STEM curriculum at lower levels of skills, struggled in non-STEM coursework, and did not take or were unable to pass STEM courses in other fields. They also were more likely to be White and more likely to be male. We conclude with recommendations for institutional policy and practice and for future research.

This study investigates community college skills builders--students who enroll for a short time, take courses concentrated in career and technical education (CTE), are highly successful in their coursework, but typically leave college without a postsecondary credential. Drawing on administrative data from Colorado, Ohio, Michigan, and California, we use k-means cluster analysis to identify a distinct group of skills builders in each state. We analyze their prevalence, characteristics, course-taking, and educational and labor market outcomes. We then develop criteria that state systems or individual institutions can use to identify skills builders in their student populations. Skills builders comprised similar proportions of students in each state, between 11 and 14 percent, and were qualitatively similar across states. Their average earnings were flat or trending downward prior to college but reversed after college, rising at a statistically significant rate. Fields of study and certificate completion rates among skills builders varied across states. Identifying skills builders will strengthen state and institutional efforts to communicate student successes that cannot be measured with credential completions, while also equipping institutions with the information needed to better serve skills builders.

Students 25 years of age and older comprise one-third of the population in public two-year institutions, and these students face significant disadvantages in first-year retention and eventual graduation. Successfully passing college math and college English are important steps for adult students in building momentum toward a degree. Classroom context and classroom experiences play important roles in students' likelihood of passing college math and English. However, little is known about how the contextual features and experiences that are associated with the likelihood of passing differ depending on students' age. Using multilevel models and statewide administrative data, we examine variation by age in relationships between students' likelihood of passing a college math or English course and the characteristics of the course itself, peers in the course, the instructor teaching the course, and student behaviors that may bear on course outcomes.

Research points to an age disparity in college completion, with adult community college students (ages 25 years and older) being less likely to complete postsecondary credentials than their younger peers. However, research also demonstrates that adult community college students are more likely to report educational goals that do not culminate in a postsecondary credential, especially goals related to updating job skills or changing careers. Hence, it is unclear whether the age gap in college completion is a result of differences in goals or a result of obstacles to persisting in college for adult students. Here, we use multilevel models to analyze longitudinal data from the Ohio community college system on over 300,000 first-time students in order to measure the age gaps in the completion of three types of postsecondary credentials--certificates, associate degrees, and baccalaureate degrees--after accounting for differences in the distribution of students' goals and other potentially relevant characteristics. We find that older students--both male and female--are more likely to complete certificates than their younger peers. Older women are more likely to complete associate degrees than younger women, while older men do not differ significantly from younger men in the likelihood of completing an associate degree. Conversely, older students are markedly less likely to complete baccalaureate degrees than younger students. Our results point to the potential value of increasing flexible access to baccalaureate degrees. Expanding community college baccalaureate offerings is a promising avenue for helping baccalaureate-seeking adult students achieve their goals.

This qualitative study of students in mid- and later-life (MLL; age 40 and older) sought to address the role faculty play in facilitating student success and how institutions support faculty, especially adjunct faculty. Adjunct faculty teach a majority of classes at community colleges but are not provided the same professional development opportunities as tenure track faculty and are often not well integrated into the college system. Data were collected in focus groups with faculty (both adjunct and tenured) and students, supplemented by key informant interviews, at multiple community colleges in a Midwestern state. MLL students are a heterogeneous group and often have more demands on their time than do younger students. Our findings on the critical role faculty members play in helping MLL students succeed suggest that providing additional support for faculty is a valuable investment for community colleges. [For the corresponding grantee submission, see ED616465.]

This study estimates the short- and long-term effects of undergraduate educational debt on students' decisions to apply and to enroll in graduate school after completing requirements for a baccalaureate degree, using marginal mean weighting through stratification method (MMW-S) to analyze data from the National Center for Education Statistics Baccalaureate and Beyond 2008-2012 (B&B 08-12) survey. Although we find that historically and socioeconomically disadvantaged groups tend to accumulate higher levels of educational debt, our results indicate minimal effects of undergraduate debt on graduation school application and enrollment. We find no differences by race/ethnicity, family income, or status as a first-generation baccalaureate recipient in the effects of educational debt on graduate school application or enrollment.

To remain competitive in the labor market, many middle-aged and older adults need to upgrade existing or learn new skills through occupational training and education. Furthermore, as compared with the past, employers now are more willing to hire older workers after completing a credential due to a low unemployment rate. Moreover, employers often collaborate with community colleges to provide workforce training for their employees. Community colleges are the preferred choice for older students due to affordability, open-access admission, a greater number of credential options including short-term credentials, and convenient locations. However, little is known about challenges and opportunities for improving labor market outcomes at community colleges for adults ages 40 and older. Based on thematic analysis of student and faculty focus groups and individual interviews with staff and administrators at 23 Ohio community colleges, this paper identifies strategies community colleges employ to improve labor market outcomes for middle-aged and older adults (age 40 and older) and to meet the needs of employers. Additionally, challenges faced by older community college students during training, retraining, and finding employment are discussed. [For the corresponding grantee submission, see ED607641.]

This paper provides the first evidence on the earnings, employment and college enrollment effects of computers and acquired skills from a randomized controlled trial providing computers to entering college students. We matched confidential administrative data from California Employment Development Department (EDD)/Unemployment Insurance (UI) system earnings records, the California Community College system, and the National Student Clearinghouse to all study participants for seven years after the random provision of computers. The experiment does not provide evidence that computer skills have short- or medium-run effects on earnings. These null effects are found along both the extensive and intensive margins of earnings (although the estimates are not precise). We also do not find evidence of positive or negative effects on college enrollment. A non-experimental analysis of CPS data reveals large, positive and statistically significant relationships between home computers, and earnings, employment and college enrollment, raising concerns about selection bias in non-experimental studies.

Community college students often are unaware of the stakes involved in their performance on placement exams, used to sort the students into their first math and English courses. In our randomized experiment of approximately 13,000 newly admitted community college students, we test whether informing students, via a supplemental notification letter, about the implications of placement exam scores influences their placement exam participation, preparation, and performance. We also test whether message framing (loss-framed vs. gain-framed) alters the effect of the information on study outcomes. We find that neither type of message has an effect on placement exam preparation or performance. We find limited evidence to suggest that the loss-framed message may have a small effect on the avoidance of placement exams by increasing the likelihood of students' submitting alternative evidence of academic preparation. Overall, our evidence suggests that students' prior knowledge about the ramifications of placement exams is not enough to improve performance. Colleges should consider alternative means of assessing college readiness, such as measures of high school achievement, and should provide students who still have to take placement exams with detailed information about test content and study materials before testing.

Objective: Standardized placement tests remain the primary means by which new community college students are assessed and placed in the hierarchy of math and English coursework. A growing body of evidence indicates that placement tests tend to underestimate students' likelihood of achieving passing grades in college-level courses, leading to students being misplaced in developmental coursework, slowing their academic progress, and increasing their likelihood of dropping out of college. This article discusses the results of a statewide research effort to improve the accuracy of student placement in math and English in the California Community College system. Method: Decision tree methods were applied to high school and college transcript data to identify key measures of high school achievement that predict performance in nine levels of community college math courses (three developmental and six college level) and four levels of community college English courses (three developmental and one college level). Results: Cumulative high school grade point average (GPA) is the most consistently useful predictor of performance across levels of math and English coursework, and a higher GPA is necessary to signal readiness for college-level coursework in math than is necessary to signal readiness for college-level coursework in English. In addition, cumulative GPA combined with specific indications of progress in the high school curriculum is frequently useful for predicting performance in math among direct matriculants and for predicting performance in both math and English among nondirect matriculants. Conclusion: Drawing on the findings, placement rules that colleges can apply directly in their placement processes are developed and validated.

Our understanding of community college pathways to baccalaureate degrees in science, technology, engineering, and math (STEM) is remarkably incomplete, despite growing recognition of the sizeable role that community colleges stand to play in increasing the number of students who enter STEM baccalaureate programs, particularly underrepresented students. Here, we drew from data on nearly 3 million students to analyze participation in and navigation of the STEM transfer curriculum in community colleges, while focusing primarily on the fields of math, chemistry, and physics. We found that a large number of students enrolled in college-level STEM coursework, and many of these students were of demographic groups that are underrepresented in STEM fields. Yet, comparatively few students progressed into advanced STEM coursework. Moreover, the contribution of community colleges to resolving longstanding demographic inequities in STEM is constrained by pronounced gender and racial/ethnic differences in points of entry into the STEM curriculum, pathways through STEM, and manner of exit from STEM. As a result, much of the considerable potential of community colleges to improve STEM baccalaureate production and equity of opportunity in STEM remains largely unrealized at this point. We conclude with practical recommendations and a detailed research agenda to guide future inquiry on this subject.

Across the United States, community colleges are facing severe funding reductions and surging enrollment, resulting in a condition of impaction in which demand for coursework exceeds financial or physical capacity. In turn, impaction is necessitating changes in enrollment management policies, including rapid evolution in registration priority policies, which ration access to coursework by granting preferential course enrollment timing to students who meet specified criteria. During times of impaction, such policies effectively preclude some groups of students from making progress toward their goals or, under the worst circumstances, from attending college at all. Given the importance of community colleges for providing access to postsecondary education, these policies have significant, long-term implications. Here, we situate the discourse on registration priority policies in a larger context and body of literature, document the variation in policies across the colleges in one state, and develop a set of recommendations for policy and future research.

Community colleges serve nearly half of all undergraduates, including a disproportionate share of African American and Hispanic students, and are a key point of access to higher education for students who face socioeconomic disadvantages or other obstacles to participation in higher education. Community colleges stand to play a pivotal role in strengthening the nation's workforce and increasing opportunity in science, technology, engineering, and math (STEM) fields. However, a troublingly large fraction of community college students who complete advanced STEM courses ultimately leave college without postsecondary credentials. Utilizing data from the California Community College system, we investigated four hypothesized explanations for why students who have demonstrated potential to succeed in STEM fields by completing an advanced course in math, chemistry, or physics did not complete college. We found that students who left college tended to enter the STEM curriculum at lower levels of skills, struggled in non-STEM coursework, and did not take or were unable to pass STEM courses in other fields. They also were more likely to be White and more likely to be male. We conclude with recommendations for institutional policy and practice and for future research. [ABSTRACT FROM AUTHOR]