bluuebunny/crossref_metadata_2025 huggingface dataset:
DETERMINATION OF OPTIMAL VIBRATION DOSE TO TREAT PARKINSON’S DISEASE GAIT SYMPTOMS: A CLINICAL TRIAL
Authors: Pretzer-Aboff Ingrid , Elswick R K , Gouelle Arnaud , Helm Noah , Blackwell GinaMari , Cloud Leslie
Published: December 2023

Most people with Parkinson’s disease (PD) will experience gait problems. Previous studies demonstrated improved gait and balance after vibration stimulation was applied to the feet of PD patients. However, not all study participants showed improvement, perhaps due to sub-optimal vibration stimulus. Thus far, the optimal frequency and amplitude of vibration for mitigating gait dysfunction in PD have yet to be systematically explored. The PDVibe2TM (Resonate Forward LLC, DE) delivered vibration to the feet of 26 people with PD gait disturbances. We hypothesized that a global frequency, amplitude, and minimum duration of vibration therapy is required to improve gait. This was a phase Ib trial to identify optimal vibration parameters. Thirteen participants were recruited at Hoehn & Yahr (H&Y) stage II and 13 participants at stage III. Each group was randomly assigned to different frequency and amplitude settings prescribed by the central composite design methodology. Each participant received vibration for 18 minutes per walking session, for eight sessions spread over one week. Results showed an optimal dose response to treatment for frequency and amplitude of vibration based on the Functional Ambulation Performance score for stages II and III. In the H&Y stage II group, outcomes were stabilized after the 4th treatment. This stabilization was not seen in stage III participants. Global frequency and vibration amplitudes have been identified for treating PD gait disorders. Patients with more advanced Parkinson’s disease may require a longer duration of therapy.
STATIN USE REDUCES ALL-CAUSE MORTALITY IN NURSING HOME RESIDENTS WITH DEMENTIA
Authors: Gellert Paul , O’Sullivan Julie L , Kohl Raphael , Lech Sonia , Romanescu Laura , Schuster Johanna , Kuhlmey Adelheid , Yasar Sevil
Published: December 2023

Background

Statins are recommended for the prevention of primary and secondary cardio and cerebrovascular events. However, little is known about the benefits of statin therapy in older adults with dementia. Therefore, this retrospective cohort study aims to investigate the association between statin use and all-cause mortality using health insurance claims data of nursing home residents with and also without dementia.

Methods

Time-variant Cox proportional hazards models were used to evaluate the association of statin use with all-cause mortality and adjusted for potential confounders.

Results

Overall, N=326,669 individuals were included in the analysis (mean [SD] age 84.02 [8.45] years; 74% women). During a mean observation period of 2.42 years (SD=1.59), a total of 239,321 deaths occurred. The fully adjusted models showed that participants with dementia statin users compared to non-users had a 20% lower risk for all-cause mortality (HR 1.20; 95%CI: 1.19–1.22, p<.001). In a subanalysis, similar trends remained within those with history of atherosclerotic cardiovascular disease (ASCVD) (HR 1.22; 95%CI: 1.21–1.24, p<.001) and without ASCVD disease (HR 1.12; 95%CI: 1.09–1.16, p<.001); and when stratifying by dementia type, Vascular dementia (VaD) (HR 1.27; 95%CI: 1.22-1.32, p< 0.001) and Alzheimer’s disease (AD) (HR 1.19; 95%CI: 1.13-1.26, p< 0.001). Trends remained similar when stratifying by statin intensity, age, nursing home care level required, and sex.

Conclusion

Our study demonstrates the benefits of statin therapy in highly vulnerable nursing home residents with dementia. This contributes to filling the knowledge gap regarding the harms and benefits of statin therapy in older adults.
INNOVATING HOME-BASED CARE THROUGH HOME HEALTH DISCHARGE DECISION SUPPORT (HEADS-UP)
Authors: O’Connor Melissa , Brace Margaret , Bowles Kathryn
Published: December 2023

Medicare and private payers rely upon home health (HH) nurses and physicians to evaluate the needs of older adults and decide when ready for discharge. However, there are no national, empirically derived clinical decision support tools to assist clinicians in making these frequent and important discharge decisions. The purpose of this work was to begin development of a clinical decision support tool to support HH clinician decision-making grounded in the evidence and based in real time. Clinician experts, in teams of three: two nurses and one physician reviewed and judged 500 case studies via a secure, dedicated website, making the decision if the older adults should be discharged from services versus recertified for additional care. Our sample matches the national older adult HH population by gender, race and primary diagnosis. The clinician experts recommended over 44.6% of older adults be recertified for more care when in reality, HH clinicians recertified only 22% for additional care. Regardless of insurance status, Blacks were 1.75 times more likely than Whites to be discharged by HH clinicians even though experts recommended more care (p=0.031). Hispanics trended toward being more likely to be discharged by HH clinicians compared to the experts’ recommendation for more care (p=0.094). Our findings indicate that when provided with organized clinical information and ample time to accurately identify the needs of older adults, expert clinicians refer for additional care significantly more often than real-world HH clinicians and that racial disparities exist in current HH discharge decision making.
INTRODUCING EFRAILTY: SIMPLIFYING SELECTION OF FRAILTY ASSESSMENT TOOLS
Authors: Cheslock Megan , Sison Stephanie , Zhong Lily , Newmeyer Natalie , Raman Vaishnavi , Orkaby Ariela , Schwartz Andrea , Kim Dae
Published: December 2023

Health care providers recognize the importance of frailty assessment for older adults, but they may be unfamiliar with which frailty assessment tool to use. We sought to create an accessible website to assist clinicians in choosing an effective, evidence-based frailty screening tool. We selected commonly used frailty tools based on the literature and worked with a web designer to develop the eFrailty website prototype. A short description of each tool’s key features and estimated time for assessment is included for each frailty tool. An algorithm based on differences in patient characteristics, clinical scenarios, available information, and time for assessment was created to guide users. Modeled after the highly popular ePrognosis website, eFrailty is designed to guide clinicians to select the ideal frailty tool for their clinical context. The site prompts clinicians to choose between patients considering stressful treatment (e.g., major surgery), or patients with or without serious illness. Depending on available information, clinicians choose between ‘Self reports/records only,’ or ‘Performance tests available’ including cognitive screens or physical performance testing. Alternatively, Clinicians may use the eFrailty comparison table which builds on the work of several systematic reviews of frailty identification tools to easily select the best instrument for their patient. A recent addition to the site is a crosswalk to compare scores between different frailty assessment tools. Future directions for eFrailty include beta testing to gather clinician input from point of care use.
ACTIVE PARTICIPATION OF OLDER ADULTS AT POLITICAL RALLIES AS A SOURCE OF RESILIENCE: THE CASE OF THE ISRAELI PROTEST
Authors: Ben-David Boaz , Shimon-Raz Ortal , Palgi Yuval , Ring lia , Bresslet Tchelet
Published: December 2023

The governing Israeli coalition suggested on Dec 2022 a reform plan that would fundamentally alter the system of checks and balances within Israeli society. According to law experts, the plan would effectively end liberal democracy in Israel. This turn of events sparked the largest protest movement in the 75year history of Israel. The current situation is unparalleled, and the mental health costs appear to be significant. However, the toll on older adults has not been directly examined yet. The breadth of the protest movement is remarkable. A July 2023 poll conducted by the Israel Democracy Institute estimated that almost a quarter of Israeli citizens had participated at a protest action at least once. It was primarily through participation at large rallies held weekly across the country - one of the main symbols of the protest movement. Interestingly, the survey reported a 37% participation rate among older adults, the highesy participation rate among all tested age groups. Since older Israelis are members of the founding generation of the state, their participation is not surprising. They feel threatened as their way of life and heritage are at risk. In the current study, we conducted a survey that examined mental health indices among older Israelis. Specifically, we wanted to test whether active participation at the protest could serve as a source for resilience in older age. Unfortunately, political turmoil is not unique to Israel. Thus, we hope that our findings could assist practitioners globally.
ADJUSTING TECHNOLOGY FOR AN AGEING POPULATION: CO-PRODUCING TECHNOLOGICAL SOLUTIONS WITH OLDER ADULTS.
Authors: Morgan Deborah , Marston Hannah R , Maddock Carol , Williams Aelwyn , Menzfeld Gemma Wilson- , Jones Elizabeth , Gates Jessica
Published: December 2023

Since the onset of Covid 19, there has been a shift towards moving essential services online. This has the potential to further exclude sub-sections of the population from accessing essential services. This is particularly the case for older people who lack basic digital skills or who are not confident using digital technology, amplifying the risk of exclusion, and increasing the risk of social exclusion, loneliness and social isolation among digitally excluded older people. Research suggests that barriers to engagement with digital technologies include cost, lack of support, and technology being perceived as complicated or not for ‘people like me (French, Quinn & Yates, 2019). As such, there is an urgent need to develop digital solutions with older people, co-designing technology that meets their needs. The presentation will draw on data and experiences of older people involved in a seed corn project funded by the Research Wales Innovation Fund (April 2023- July 2023). The project aimed to co-design an affordable digital solution with digitally excluded older people to support the development of digital skills and confidence. The presentation will focus on the skills deficit identified by older adults with limited digital skills and explore how this knowledge is being incorporated into a co-designed prototype launcher app. The presentation will highlight the benefits and challenges of co-producing solutions for an ageing population.
THE EFFECTIVENESS OF REIMAGINE AGING: AN INTERVENTION TO REDUCE INTERNALIZED AGEISM IN OLDER ADULTS
Authors: Murphy Dallas , Porter Michelle , Mackenzie Corey , Chipperfield Judith
Published: December 2023

A life time of exposure to ageist messaging and beliefs may lead older adults to internalize this messaging and direct it inwards, or towards their peers. This internalized ageism can have severe multi-faceted consequences on the well-being of older adults. However, little research has addressed reducing internalized ageism. Thus, Reimagine Aging, a six-week process-based intervention to reduce internalized ageism was designed and implemented, using tools of education, acceptance and commitment therapy, and attributional retraining to target theoretically based mechanisms of change. The data from 72 community-dwelling older adults (M = 70.4 years, SD = 6.4 years) were analyzed for changes in perceptions of aging and mechanisms of change. Participants completed questionnaires prior to the intervention, immediately following the intervention, and at a two-month follow-up. Results demonstrated that participants’ self-perceptions of aging (partial eta squared = 0.37, p < .001) and perceptions of older adults (partial eta squared = 0.27, p < .001) became significantly more positive and maintained these gains at follow-up, associated with large effect sizes. Furthermore, the increases in self-perceptions of aging were mediated by increases in the theory-related mechanisms of psychological flexibility, mindfulness, and perceived control. Positive gains in perceptions of older adults were mediated by these process-based factors to a lesser degree. This study provides initial support for the effectiveness of this process-based intervention targeting a reduction of internalized ageism. This has the potential to reduce the harmful consequences of internalized ageism impacting older adults globally.
UNDERSTANDING HEALTHCARE UTILIZATION, FRAILTY, AND DELAYS AMONG OLDER SEXUAL AND GENDER MINORITY ADULTS
Authors: Wong Chelsea , Smith Louisa , Cavanaugh Robert , Olivieri-Mui Brianne
Published: December 2023

Older sexual and gender minority adults (OSGM) have a higher burden of frailty, mental health conditions, and healthcare delays compared to non-SGM older adults (non-OSGM). The study aimed to evaluate the impact of health disparities related to frailty and delays on the relationship between OSGM and healthcare utilization, we hypothesized that improving frailty and delays would reduce healthcare utilization. We used marginal structural models in the All of Us version 6 Controlled Tier Dataset to study the mediating role of frailty and delays on healthcare utilization (self-reported general doctor (PCP) and mental health (MH) visits) by SGM status. OSGM (n=4,763) compared to non-OSGM (n=68,146) were younger (mean [SD], 63 [8] vs 66 [8]), had higher frailty (26% vs 19%), reported more delays (30% vs 24%), less excellent mental health (23.2% vs 30.2%), and majority were insured (96% vs 97%). Minimal differences between the total effect and controlled direct effect between SGM status and visits for frailty (PCP -0.01, MH 0.15) and delays (PCP 0, MH 0.16), suggests visits would remain similar if all OSGM were not frail or reported no delays. Contrary to our hypothesis, improving frailty and delays did not impact healthcare utilization among OSGM. Factors other than frailty and healthcare delays may be influencing healthcare utilization among OSGM in All of Us. Further, bias due to self-report/volunteer bias may affect the ability to examine the association of interest. Future work should examine the consensus between survey and EHR reported healthcare utilization within All of Us.
GENDER DIFFERENCES IN COGNITIVE IMPAIRMENT OF AFRICAN AMERICAN AND HISPANIC SEXUAL AND GENDER MINORITY OLDER ADULTS
Authors: Oswald Austin , Fredriksen-Goldsen Karen
Published: December 2023

Cognitive health of sexual and gender minority (SGM) older adults with intersecting racial/ethnic minority identities is an under-researched topic. This research utilizes data from Aging with Pride: National Health Sexuality/Gender study to examine differences in health-promoting and risk factors for cognitive impairment among African American and Hispanic SGM older adults. Informed by the Health Equity Promotion Model, bivariate statistics and linear regression models were applied to better understand subgroup differences in cognitive impairment and risk and protective factors. Daily discrimination and identity stigma were positively associated with cognitive impairment for African American and Hispanic groups. Outdoor leisure was negatively associated with cognitive impairment for African Americans whereas social support was negatively associated with cognitive impairment for Hispanics. Analysis of gender differences revealed that African American men experienced significantly higher rates of identity stigma than African American women; however, the effect of identity stigma on cognitive impairment was stronger for African American women. Among Hispanics, women compared to men were significantly more vulnerable to the effects of daily discrimination and identity stigma on cognitive impairment. Regarding cognitive impairment, engaging in physical activity and outdoor leisure were significantly protective for African American men but not for women, whereas social support was significantly protective for both Hispanic men and women. These findings address a void in SGM aging research by examining racial/ethnic and gender differences in cognitive health. They highlight the need for intersectionality and subgroup differences in research to develop tailored interventions to improve cognitive health among racially/ethnically diverse SGM older adults.
LIVING ALONE WITH DEMENTIA AND NAVIGATING ESSENTIAL TRANSPORTATION NEEDS
Authors: Nemec Mary , Girling Laura
Published: December 2023

Transportation serves a basic human need for older adults and is firmly linked to independence, quality of life, and access to essential services (e.g., medical, nutritional, social). The matter of transportation and driving reduction/cessation is especially challenging in regard to people with Alzheimer’s and related dementias (ADRD). Many individuals with ADRD rely on cohabitating caregiver(s) (e.g., spouse, partner, adult children) to arrange and execute essential transportation needs. However, little is known about how individuals with ADRD who reside alone in the community navigate required transportation. In order to address this gap in the literature, this paper combines narrative data from two ongoing National Institutes of Health (NIH)-funded interview-based protocols that focus on understanding the needs of community-dwelling older adults with ADRD and a collateral informant (N=84). Interview data underwent thematic analyses. Findings indicate four overarching themes: 1. Nuances of ridesharing apps, 2. Family/fictive kin transportation network(s), 3. Unpredictable public transportation, 4. Unmet needs exacerbated by inadequate transportation, and 5. Balancing driving autonomy and risk of harm to self/others. These thematic illations have implications to assist development of strategies for continued mobility and appropriate access to required services for those who reside alone with ADRD, despite changing needs and capabilities. Historically, the focus on transportation among those with ADRD has centered on those with a cohabitating caregiver, however, our findings provide insights into the nuances of how this understudied subpopulation with ADRD experience and navigate their mobility needs.
NEIGHBORHOOD DISADVANTAGE, IMAGING BIOMARKERS OF ALZHEIMER’S DISEASE, AND COGNITION IN DIVERSE OLDER ADULTS
Authors: Fan Erica , Royse Sarah , Snitz Beth , Pascoal Tharick , Shaaban C , Lopresti Brian , Villemagne Victor , Cohen Ann
Published: December 2023

Neuroimaging biomarkers of Alzheimer’s disease (AD) are well-validated in White populations. However, it remains unclear how these biomarkers are associated with cognition in non-White populations disproportionately affected by systemic socioeconomic discrimination. We investigated whether neighborhood disadvantage modifies associations of neuroimaging biomarkers with cognition in a diverse cohort of 198 adults ≥50 years, 50% of whom are Black. Outcomes included cognitive impairment and neuropsychological test scores. Predictors were indices of neurodegeneration, vascular damage, and brain amyloid burden, quantified using MR-based measures of cortical thickness and white matter hyperintensities (WMH) and [11C]PiB PET, respectively. We measured neighborhood disadvantage using area deprivation index (ADI), a composite measurement of socioeconomic conditions in a census tract. In linear models, higher ADI, neurodegeneration, and WMH were separately associated with worse cognition. We found an ADI*neurodegeneration interaction on delayed recall memory (p=0.08). Neurodegeneration-positive participants had worse story delayed recall compared to neurodegeneration-negative regardless of ADI (β=-1.57, p=0.01). In neurodegeneration-negative participants, higher ADI is associated with worse delayed recall (β=-0.04, p=0.004): those with a high ADI exhibited low delayed recall, comparable to neurodegeneration-positive participants. ADI was not associated with cognition in neurodegeneration-positive participants. WMH and ADI interacted in models of impairment, visual memory, and visual copy (interaction p’s< 0.10). In those with high ADI, greater WMH was associated with worse cognition (β=-0.30, p=0.02) while participants with low ADI scored well regardless of WMH volume. Taken together, the relationship between neuroimaging biomarkers and cognition differs by neighborhood socioeconomic conditions, highlighting the need for clinical strategies that acknowledge structural disadvantage.
A DEPRESCRIBING CURRICULAR FRAMEWORK USING AN INTER-PROFESSIONAL APPROACH: IMPLICATIONS FOR NURSING EDUCATION
Authors: Sun Winnie , Sadowski Cheryl , Raman-Wilms Lalitha , Gagnon Camille
Published: December 2023

Background Deprescribing is an important component of managing polypharmacy and reducing harm from potentially inappropriate medications. Current undergraduate nursing education does not consistently incorporate components of deprescribing into curricula. It is essential to bridge the gap in promoting deprescribing competencies, teach related knowledge and skills and assess learning outcomes. The purpose of this presentation is to engage nursing educators who teach geriatrics to identify and implement a curriculum framework for deprescribing. Methodology The Canadian Medication Appropriateness and Deprescribing Network (CaDeN) Healthcare Professional Committee undertook a consensus approach to developing competencies for deprescribing, along with literature review and analysis of prescribing competencies. The authors outlined the required knowledge and skills related to the competencies, with recommended teaching and assessment strategies. Results The seven deprescribing competencies include: gathering and interpreting patients’ medication history and clinical information within their context, using tools that help identify potentially inappropriate medications, weighing potential benefit and harm of continuing or deprescribing medications, using shared decision-making about deprescribing, communicating deprescribing and monitoring plans, and monitoring progress and outcomes. Integrating deprescribing competencies in nursing curricula requires an intentional and structured approach across all years of the program, focusing on interprofessional collaboration. Learning activities should be active and practical, progressing from early to advanced learner skills and include integration of deprescribing through experiential education. Conclusion This presentation provides implications for the nursing profession to apply deprescribing competencies at different learner levels, using appropriate learning and assessment outcomes, and strategies in which deprescribing competencies could be achieved in an interprofessional setting.
AGE-ASSOCIATED CHALLENGES AMONG HIV POPULATION IN VIETNAM: PERSPECTIVES FROM MULTIPLE STAKEHOLDERS
Authors: Xia Qing , Xiong Yuan , Sun Fei , Le Giang , Van Hoang  , Nguyen Khanh , Dang Huong , Liu Ethan
Published: December 2023

HIV remains a significant global public health concern. The growing population of aging individuals living with HIV in Vietnam presents a multifaceted pressing issue, calling for research, policy, and practice interventions. This study aims to identify the aging-associated healthcare needs among the HIV population from three stakeholder groups: healthcare professionals, family caregivers, and persons living with HIV-AIDs. Qualitative data was collected through five focus group interviews involving 10 people living with HIV (PLWH), 9 caregivers, and 8 healthcare providers in Hanoi, Vietnam, in March 2023. Data analysis followed thematic analysis techniques, uncovering recurring patterns and themes across the three participant groups.PLWH reflected diverse experiences, showing mental health struggles, aging-related concerns, and a lack of preparation due to health challenges or unexpected longevity. Resilience and optimism are also manifested in PLWH. Caregivers demonstrated crucial roles, including bridging care, medication adherence, and financial and emotional support. They highlighted the necessity of training programs to enhance their care capabilities. Both PLWH and caregivers expressed a desire for formalized training programs on HIV and aging. Furthermore, healthcare providers reported mental and physical health changes among aging PLWH, such as insomnia, forgetfulness, and memory deterioration. They noted a lack of resources and called for comprehensive training across medical staff to enhance the well-being of the aging PLWH.This study demonstrated the complicated age-associated needs among PLWH in Vietnam. The findings underscore the need for policy and practice innovations to address aging-related cognitive, mental health, and long-term care concerns.
BUILDING LONG-TERM HIV SURVIVOR RESEARCH CHAMPIONS FOR PERSON-CENTERED CARE VIA COMMUNITY DISSEMINATION
Authors: Danilovich Margaret , Rapoport Andy , Nicholson Meredith
Published: December 2023

As HIV becomes a chronic condition, it is critical for research to include the perspectives of long-term HIV survivors who face the challenges of managing both HIV and aging. We created SHARE (Survivors of HIV Advocating for Research Engagement), a nationwide research advisory board for long-term survivors. SHARE’s goal is to incorporate long-term HIV survivor voices into research to influence person-centered care for long-term survivors. Through SHARE, board members have built research capacity through research methods training culminating in the board conducting a community needs assessment to learn community-directed priorities for HIV and aging. Following the needs assessment, each board member worked to identify and conduct research dissemination activities within their own communities to engage others in conversations about aging and HIV and educate on opportunities for greater research involvement. In this paper presentation, the speakers describe the process of building capacity among SHARE members so that they could serve as research champions through community dissemination efforts. The presenters will describe the methods of community dissemination including lunch and learns, webinars, infographics, podcasts, photovoice, and advocacy. Mixed-methods analysis of the impact of research dissemination will be presented including changes in community member knowledge about research, willingness to participate in research studies, and understanding of tools to find and use research. The presenters will also share data from SHARE board member self-reflection on the challenges and opportunities for researchers to engage community member in dissemination activities that are tailored to the community and can influence adoption of research among end users.
SELF-MANAGEMENT SUPPORT STRATEGIES BASED ON THE RNAO GUIDELINES IN AECOPD PATIENTS: A RANDOMISED CONTROLLED TRIAL
Authors: Peng Weisi , Luo Weixiang , Yang Xiufen , Qu Chaoran , Huang Di , Liu Yan , Fan Yi , Zhang Weiwei
Published: December 2023

Abstract Chronic disease management is a key intervention for the management of AECOPD patients. We conducted a Chinese-based trial according to RNAO’s chronic disease management guidelines.The aim of this study was topply an evidence-based guideline practice protocol for self-management in patients with chronic disease to improve the clinical outcomes, as well as reduce the economic costs for patients discharged with AECOPD.In this study, the “Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients”, published by RNAO, was used as a practice guideline to be applied in the follow-up of patients discharged from COPD to understand patients’ post-discharge self-management ability, pulmonary function, and readmission within one year, and to compare the cost-effectiveness for patients after discharge. The follow-up of both groups was conducted over time, and the patients’ self-management ability and pulmonary function in the observation group were effectively improved at month 6 and month 12 and was significantly different in comparison with the control group (P< 0.05). The observation group showed significant differences in readmission rates and economic costs at month 12 as compared to the control group (P< 0.05).Application of the guideline’s chronic disease self-management support strategies could stabilize patients’ blood oxygenation levels, better maintain pulmonary function, significantly improve patients’ self-management ability, and reduce patients’ medication costs. Keywords: COPD;Chronic disease self-management; RCT; economic analysis
DEMENTIA CAREGIVERS’ ETHICAL CONSIDERATIONS OF HOME-MONITORING ASSISTIVE ROBOTS IN DEMENTIA CARE
Authors: Wang Jing , LaRoche Dain , Begum Momotaz , Tang Xueting , Arthanat Sajay
Published: December 2023

Understanding dementia caregivers’ perspectives on the ethical dimensions of socially assistive robot technology is essential for its responsible and sustainable implementation. This study provides comprehensive insights into the ethical considerations of using home-monitoring assistive robots in dementia care, as seen through the perspectives of caregivers. A focus group and a follow-up interview were conducted with seven participant caregivers following their exploration of a home-monitoring assistive robot sharing their insights and experiences related to its use in dementia care. The data were subjected to thematic analysis, identifying recurring patterns and themes within the participants’ accounts. Key findings included Responsibility and Safety: Need for safety outweighed privacy concerns of caregivers. They highlighted features such as reminders, danger alerts, and integration with security systems; Autonomy and Informed Consent: our findings emphasized promoting robot technology while respecting the autonomy of individuals with dementia in deciding technology use for their own care, acknowledging the variability in their responses; Technology Maturity and Expectation Management: Caregivers expressed expectations regarding robot functionalities, highlighting the importance of technological reliability, setup processes, and technical support. Dilemma in Monitoring and Privacy: Striking a balance between monitoring and privacy emerged as a crucial concern, sparking discussions on camera usage, sensor placement, and maintaining a suitable equilibrium; Affordability Challenges: Caregivers recognized the affordability challenges associated with robot technology as a significant hurdle. The themes highlight the complexity of integrating Socially assistive robots for dementia care responsibly, thereby informing future development and implementation strategies to ensure its beneficial and ethical use.
UNDERSTANDING THE RELATIONSHIP BETWEEN AIR QUALITY AND FIVE-YEAR SURVIVAL OF PATIENTS IN THE AMERICAN FAMILY COHORT
Authors: Periyakoil Divya , Prata Ndola , Diener-West Marie
Published: December 2023

Air pollution is an important social determinant of health and associated with cardiopulmonary disease, cancer, diabetes, and cognitive impairment. This study examined the impact of air pollution on the mortality of patients in the American Family Cohort (AFC), a national dataset of 6.6 million Americans, derived from the American Board of Family Medicine PRIME Registry electronic health record data. The AFC data were merged with the Environmental Protection Agency’s Air Quality Index (AQI) measures for the study period (2016-2022). Two Cox-Regression-Models were performed to determine how (1) baseline air quality and (2) air quality measures over time would affect patients’ five-year survival. Fixed covariates of interest--gender, race, age, location, and year of entry into the study--were studied as well. The adjusted hazard of death in the group with baseline AQI greater than 50 was 4.02 times higher than that of the group with AQI less than or equal to 50 (95% CI: 3.36, 4.82, p < 0.05). Compared to younger patients, the hazard of death was 6.73 times higher in persons older than 80 years of age (95% CI: 5.47, 8.28; p < 0.05). Black/African American patients had a 4.27 times higher hazard of death (95%CI: 3.47, 5.26; p < 0.05) compared to other races. Our study shows that vulnerable populations (older adults and persons from minority communities) are disproportionately burdened by poor air quality. Public health initiatives that focus on improving air quality for minority communities will improve their longevity.
ADDRESSING UNMET MENTAL HEALTH NEEDS OF OLDER ADULTS IN TURBO, COLOMBIA: A PILOT INTERVENTION
Authors: Giebel Clarissa , Saldarriaga Gabriel , Montoya Erika , Gabbay Mark , Zuluaga Maria Isabel
Published: December 2023

Mental health is often stigmatised in lower- and middle-income countries, with little resources to provide care. Having lived through extreme and stressful live events in Colombia, including armed conflict, and older adults found to lack adequate mental health support, the aim of this pilot intervention is to improve their mental health. Based on a meta-analysis of community-based mental health interventions for older adults in LMICs, qualitative interviews with older adults and local stakeholders, and a mental health needs assessment survey of the older population in Turbo, Colombia, we consulted older adults in the region to co-produce a community-based intervention. The pilot intervention is running for 12 weeks from May to August 2023, with two sessions provided per week in a community centre. The intervention involves four components - social engagement, educational interventions, physical activities (singing, dancing, cooking), and peer support. We will use a mixed-methods approach to evaluate the effects of the intervention on older adults’ well-being, social support, and loneliness, involving pre- and post-questionnaires and semi-structured interviews. Thirty-five older adults are actively participating in the intervention. Full results will be available in October. This co-produced and evidence-based intervention for older Colombians has the potential to circumvent heavy healthcare resource costs for providing mental health support, and instead involve the community in providing care and support, with trained facilitation. In light of limited mental health support across LMICs, this intervention, if effective, could provide mental health support for older adults in other countries via cultural adaptation.
DEFENSIVENESS AGAINST INTERGROUP BIASES ACROSS ADULTHOOD
Authors: Beatty Jennifer , Hill Patrick
Published: December 2023

Research has demonstrated the pernicious role of discrimination against marginalized groups. Less work has considered the perspective of the transgressor and how defensive they may be when told they were biased. Such work is critical for understanding which individuals may be more willing to acknowledge and integrate feedback about their personal biases, allowing them to avoid future discriminatory and biased actions. Moreover, older adults may be more defensive in the face of feedback if they are less willing to change well-entrenched personal attitudes. The current study developed a new measure of feedback defensiveness and investigated whether defensiveness levels increase or decrease with age. In a sample of U.S. White adults (n = 303; age range: 19 to 85), we found that individuals reported being more defensive in the face of negative feedback about intergroup biases relative to feedback about other aspects of the self. Correlational analyses found that these biases were weaker among individuals who reported a stronger sense of personal identity. Critically, defensiveness against intergroup biases was initially unassociated with age, but when we consider individuals who avoid identity information, there is a modest age effect. This data challenges the assumption that all older adults would be defensive to feedback about their bias and considers the role of one’s sense of identity. These findings have clear implications for how clinicians, practitioners, and researchers should focus their efforts to reduce discriminatory events by alerting them to which individuals may be more willing to accept feedback about their biases.
DOES RURAL LIVING INCREASE RISK FOR MORTALITY? FINDINGS FROM TWO LONGITUDINAL STUDIES
Authors: Atherton Olivia
Published: December 2023

Most prior work on rural-urban health disparities has been conducted with population-level data, which is limited in its capacity for causal inferences about individuals and lifespan health. The present study leverages individual-level longitudinal data, spanning up to 29 years, to understand how rurality-urbanicity predicts individuals’ risk for all-cause mortality; whether these effects hold above and beyond socioeconomic status; and whether the association between rurality-urbanicity and mortality risk varies by sex, socioeconomic status, race, and partner status. The present pre-registered study uses data from two large longitudinal studies of U.S. Americans (HRS and MIDUS; total N = ~55,000), who reported on their socio-demographic characteristics, had their addresses linked to geographical indicators (i.e., rural-urban continuum codes), and have data from the National Death Index regarding vital status and survival time. Using a series of cox proportional hazards regression models, findings showed that suburban and rural residents were at a 12% and 18% greater risk for earlier all-cause mortality compared to urban residents in HRS, but the effects of rurality-urbanicity on mortality risk were non-significant in MIDUS. The longitudinal effects of rurality-urbanicity on mortality risk were largely independent of the effects of socioeconomic status. Finally, the three statistically significant interaction effects suggest that the strength and direction of the association between rurality-urbanicity and mortality risk differed by race (HRS, MIDUS) and partner status (HRS). The discussion elaborates on the theoretical implications for our understanding of social determinants of health, as well as practical implications for health equity in rural areas.
Goal Setting for Aging Adults and Care Partners: A Scoping Review
Authors: Perepezko Kate , Toto Pamela , Hitchcock Mary , Fields Beth
Published: December 2023

Background and Objectives

Evidence demonstrates that goal-setting and care partner support help aging adults improve their health. Less is known about how aging adults and care partners collaboratively participate in goal setting, revealing a potential gap in care delivery processes. The current review describes the scope of the literature on this topic.

Research Design and Methods

A search was conducted in several relevant databases and 1,231 articles were screened for the following inclusion criteria: (a) participants included aging adults (50+ years) and care partners, (b) goal setting was conducted, and (c) articles were in English.

Results

Common goals reported by aging adults were independence, improving or maintaining functioning, addressing symptoms, and remaining socially active. Care partners listed similar goals but also identified accessing services and supports as important. The level of care partner involvement varied across articles, with some care partners serving in a supportive role, some setting goals concurrently with the aging adult, and others setting goals on behalf of the aging adult.

Discussion and Implications

This review revealed concordant and discordant prioritization of goals within dyads. These findings illustrate the importance and potential complexity of including care partners in the goal-setting process. We also found that collaborative goal-setting and care partner-directed goals are scarce, indicating the need for additional work in this area. Collaborative goal setting aligns with person and family-centered care approaches and can contribute to better care plans that meet the needs of aging adults and their care partners.
Safety and Immunogenicity of Respiratory Syncytial Virus Prefusion Maternal Vaccine Coadministered With Diphtheria-Tetanus-Pertussis Vaccine: A Phase 2 Study
Authors: Hermida Nerea , Ferguson Murdo , Leroux-Roels Isabel , Pagnussat Sandra , Yaplee Deborah , Hua Nancy , van den Steen Peter , Anspach Bruno , Dieussaert Ilse , Kim Joon Hyung
Published: December 2023

Background

Respiratory syncytial virus (RSV) fusion protein stabilized in the prefusion conformation (RSVPreF3) was under investigation as a maternal vaccine.

Methods

This phase 2, randomized, placebo-controlled, single-dose, multicenter study enrolled healthy, nonpregnant women, randomized 1:1:1:1:1 to 5 parallel groups studying RSVPreF3 (60 or 120 µg) coadministered with diphtheria, tetanus, and acellular pertussis vaccine (dTpa) or placebo, and dTpa coadministered with placebo. Safety and humoral immune responses were assessed. An extension phase also assessed a RSVPreF3 120 μg vaccination 12–18 months after first vaccination.

Results

The safety profile of RSVPreF3 was unaffected by dose or dTpa coadministration. Solicited and unsolicited adverse events (AEs) were evenly distributed across study groups. Injection-site pain was higher following the second vaccination versus the first vaccination. Medically attended AEs were rare (<5% overall). Both RSVPreF3 dose levels (alone and with dTpa) were immunogenic, increasing levels of RSV-A neutralizing antibody ≥8-fold and anti-RSVPreF3 IgG antibody ≥11-fold at 1 month postvaccination, which persisted at 12–18 months postvaccination; modest 2-fold increases were observed with a second RSVPreF3 vaccination.

Conclusions

This study indicates RSVPreF3 coadministration with dTpa induces robust immune responses and is well tolerated, regardless of the RSVPreF3 dose level used.

Clinical Trials Registration

NCT04138056.
The CO-to-H2 conversion factor of Galactic giant molecular clouds using CO isotopologues: high-resolution XCO maps
Authors: Kohno Mikito , Sofue Yoshiaki
Published: December 2023

We investigated the correlation between intensities of the 12CO and 13CO (J = 1–0) lines towards the Galactic giant molecular clouds (GMCs) W51A, W33, N35–N36 complex, W49A, M17SW, G12.02–00.03, W43, and M16 using the FUGIN (FOREST Unbiased Galactic plane Imaging survey with the Nobeyama 45-m telescope) CO line data. All the GMCs show intensity saturation in the 12CO line when the brightness temperature of 13CO is higher than a threshold temperature of about ∼5 K. We obtained high-resolution (∼20 arcsec) distribution maps of the XCO factor (XCO,iso) in individual GMCs using correlation diagrams of the CO isotopologues. It is shown that XCO,iso is variable in each GMC within the range of XCO,iso ∼ (0.9–5) × 1020 cm−2 (K km s−1)−1. Despite the variability in the GMCs, the average value among the GMCs is found to be nearly constant at XCO,iso = (2.17 ± 0.27) × 1020 cm−2 (K km s−1)−1, which is consistent with that from previous studies in the Milky Way.
Thermal pulses with mesa: resolving the third dredge-up
Authors: Rees Natalie R , Izzard Robert G , Karakas Amanda I
Published: December 2023

The Thermally Pulsing- (Super) Asymptotic Giant Branch is a late stage in the evolution of low- and intermediate-mass stars. These stars undergo strong wind mass-loss and diverse nucleosynthesis. Third dredge-up events, that occur following thermal pulses, are responsible for enriching the surfaces of Asymptotic Giant Branch stars, hence an understanding of this process is crucial for constraining galactic chemical evolution. Using a custom numerical scheme, we investigate the temporal and spatial resolution required to resolve the third dredge-up in the 1D stellar evolution code mesa. With mesa’s default controls, the third dredge-up efficiency is underestimated by as much as $\approx 76~{{\ \rm per\ cent}}$. In stars that undergo hot third dredge-up (M ≳ 6 M⊙), the third dredge-up efficiency is overestimated by $\approx 55~{{\ \rm per\ cent}}$. The Thermally Pulsing- (Super) Asymptotic Giant Branch (TP-(S)AGB) evolution is computed for models with initial masses 1 ≤ Mi/M⊙ ≤ 8 at Solar metallicity (Z = 0.014). The minimum initial mass for carbon stars falls in the range 1.5–1.75 M⊙, compatible with observations. The use of mesa for TP-(S)AGB evolution is validated by comparison to the widely used monash models which show good agreement in the maximum third dredge-up efficiency at initial masses Mi > 2 M⊙. We also compare the third dredge-up efficiency in models produced using two independent stellar evolution codes, fruity and aton, which were computed with various differences in input physics including mass-loss, and which exhibit weaker third dredge-up episodes.
Tidally offset neutral gas in Lyman continuum emitting galaxy Haro 11
Authors: Le Reste Alexandra , Cannon John M , Hayes Matthew J , Inoue John L , Kepley Amanda A , Melinder Jens , Menacho Veronica , Adamo Angela , Bik Arjan , Ejdetjärn Timmy , Józsa Gyula I G , Östlin Göran , Taft Sarah H
Published: December 2023

Around 400 Myr after the big bang, the ultraviolet emission from star-forming galaxies reionized the Universe. Ionizing radiation (Lyman continuum, LyC) is absorbed by cold neutral hydrogen gas (H i) within galaxies, hindering the escape of LyC photons. Since the H i reservoir of LyC emitters has never been mapped, major uncertainties remain on how LyC photons escape galaxies and ionize the intergalactic medium. We have directly imaged the neutral gas in the nearby reionization-era analogue galaxy Haro 11 with the 21 cm line to identify the mechanism enabling ionizing radiation escape. We find that merger-driven interactions have caused a bulk offset of the neutral gas by about $6\,$ kpc from the centre of the galaxy, where LyC emission production sites are located. This could facilitate the escape of ionizing radiation into our line of sight. Galaxy interactions can cause both elevated LyC production and large-scale displacement of H i from the regions where these photons are produced. They could contribute to the anisotropic escape of LyC radiation from galaxies and the reionization of the Universe. We argue for a systematic assessment of the effect of environment on LyC production and escape.
Measuring the cosmological 21-cm dipole with 21-cm global experiments
Authors: Ignatov Yordan D , Pritchard Jonathan R , Wu Yuqing
Published: December 2023

A measurement of the 21-cm global signal would be a revealing probe of the Dark Ages, the era of first star formation, and the Epoch of Reionization. It has remained elusive owing to bright galactic and extra-galactic foreground contaminants, coupled with instrumental noise, ionospheric effects, and beam chromaticity. The simultaneous detection of a consistent 21-cm dipole signal alongside the 21-cm global signal would provide confidence in a claimed detection. We use simulated data to investigate the possibility of using drift-scan dipole antenna experiments to achieve a detection of both monopole and dipole. We find that at least two antennae located at different latitudes are required to localize the dipole. In the absence of foregrounds, a total integration time of ∼104 h is required to detect the dipole. With contamination by simple foregrounds, we find that the integration time required increases to ∼105 h. We show that the extraction of the 21-cm dipole from more realistic foregrounds requires a more sophisticated foreground modelling approach. Finally, we motivate a global network of dipole antennae that could reasonably detect the dipole in ∼103 h of integration time.