bluuebunny/crossref_metadata_2025 huggingface dataset:
VALIDATION OF MODIFIED SENSE OF CONTROL SCALE AMONG OLDER CANCER PATIENTS
Authors: Zhang Peiyuan , Clem Sarah , Guan Ting , Becker Todd , Sacco Paul
Published: January 2025

Sense of control, defined as the degree to which individuals feel able to influence their behavior and are responsible for the consequences, is a key intervention target for older cancer populations who experience high levels of distress. Despite being widely used, the 10-item Sense of Control Scale (SCS) with two subscales (i.e., Perceived Constraints and Personal Mastery) has not been validated with older cancer populations. This study aimed to examine (1) factorial and convergent validity of SCS and (2) measurement invariance between older cancer and non-cancer populations. Using data (N=2,865) from the most recent wave (2020) of the Health and Retirement Study, we examined factorial validity and measurement invariance using second-order confirmatory factor analysis and multi-group confirmatory factor analysis, respectively. We then assessed convergent validity with depression via Pearson product–moment correlation. SCS had adequate global model fit, χ2(33)=295.43, p<.001 (RMSEA=.08, SRMR=.04, CFI=.94, TLI=.92) and good local fit (rangeλ=.64–.88). Regarding measurement invariance, likelihood chi-square ratio test results showed significant differences in model fit across configural, metric, and scalar models (p<.001), but the magnitude of the change was negligible (ΔCFI<.01). Thus, we concluded that SCS is invariant between older cancer and non-cancer populations. Compared to older non-cancer populations, older cancer populations appeared to have a significantly lower personal mastery (ΔM= –0.12, p=.045) and higher perceived constraints (ΔM= –0.1, p=.047). SCS was negatively correlated with depression (r= –.36, p<.05), showing desirable convergent validity. Overall, the SCS exhibits favorable preliminary psychometric properties with older cancer patients and appears invariant to cancer status.
ASTHMA AND COPD EXACERBATIONS: ED VISITS AND HOSPITALIZATIONS AFTER WILDFIRE SMOKE EXPOSURE AMONG OLDER ADULTS
Authors: Lin Zhao Xiang , Sharon Tal , Szerszen Anita
Published: January 2025

Global temperatures are rising, leading to more intense wildfires, as seen in Quebec, Canada, on June 2023, where 13 million acres burned. The resulting particulate matter may severely degrade air quality, posing risks to older adults (OAs) with respiratory diseases. Studies indicate Black/African American communities may be disproportionately affected by air pollution compared to white communities. This study evaluated the impact of wildfires on emergency department (ED) visits and hospitalizations for COPD and asthma among adults 65 and older. The observational cohort study assessed 1321 patient records from two representative New York City hospitals. Findings revealed no significant change in the overall volume of ED visits, hospitalizations, and median length of stay during the smoke-affected months compared to the previous year. However, there was a significant increase in non-white OAs’ ED visits and hospitalizations due to COPD or asthma: 27.19% in 2022 to 35.87% in 2023 (p = 0.0007), and more non-white patients with Medicaid insurance (80% in 2023, 71.43% in 2022). Significantly, more Black/African Americans required acute care: 16.74%, from 11.06% in 2022 (p = 0.003). These results indicate that worsening air quality may disproportionally impact non-white OAs. Black/African Americans and those with Medicaid insurance may more likely experience COPD or asthma exacerbation, requiring ED evaluation and/or hospitalization due to smoke pollution. The escalation in global temperatures and resulting wildfires may particularly affect OAs of color, especially those facing socioeconomic disadvantages. The findings underscore the importance of targeted public health strategies to address these disparities.
EXAMINING THE IMPACT OF EXTREME HEAT TEMPERATURES IN FOOD INSECURITY AMONG LOW INCOME OLDER ADULTS
Authors: Crook Jennifer , Kim Dahee , Xie Rui , Emrich Christopher , Hawthorne Timothy , Zhong YunYing , Brightman James , Thiamwong Ladda
Published: January 2025

Extreme heat significantly impacts health outcomes in low-income older adults (LOAs), though a better understanding of the mediating effects in food insecurity (FI) has not been fully appreciated. Food insecurity is the lack of or inability to obtain adequate nutrition and the added burden of extreme weather overwhelms already tenuous household environments, especially in LOAs with limited resources. Through onsite interviews, our team sought to uncover the impact of extreme heat in LOAs (n=45) from low-income communities in Central Florida. We assessed FI with the U.S. Food Security Survey Module (US FSSM) 10-item questionnaire. Participants reported either food secure (FS) (n=32) or FI (n=13) status. Statistically significant impacts of extreme heat or hot weather were identified in health and day-to-day activities (x2[df=1] = 5.27, p = 0.02) with mean rank scores of FS 18.6 and FI 27.9 and sleep (x2[df=1] = 6.25, p = 0.01), with mean rank scores of FS 16.2 and FI 25.6, though none were observed for food or hydration or connection with friends. Significant barriers to community resource utilization included transportation (x2[df=1] = 9.99, p = 0.002) and distance from home to the center (x2[df=1] = 4.54, p = 0.03), but not time, health issues, or knowledge about services provided. No significant findings were detected in reduced physical activity, staying inside, visiting a cool place, or staying hydrated. Severely hot weather temperatures facilitate increased barriers in LOAs living with FI. Future efforts should consider FI when designing interventions targeted towards LOAs living in hot climate conditions.
BODY WEIGHT CHANGE IN OLDER PEOPLE DURING THE COVID-19 PANDEMIC: RESULTS FROM THE BERLIN AGING STUDY II (BASE-II)
Authors: Vetter Valentin , Drewelies Johanna , Düzel Sandra , Homann Jan , Bertram Lars , Regitz-Zagrosek Vera , Gerstorf Denis , Demuth Ilja
Published: January 2025

Low body weight and especially unwanted weight loss were shown to be associated with higher mortality in older adults. Change in body weight was reported to be one of the unintended side effects of lockdown measures that were put in place to combat the COVID-19 pandemic. In this study, we first describe weight change in 472 participants (mean age: 67.5 years, 48% women) of the Berlin Aging Study-II (BASE-II) that was collected at four timepoints over an average total follow-up time of 10 years. In a second step we examine differences in weight change between groups defined by socio-economic, cognitive, and psychosocial variables as well as morbidity burden, biological aging markers (epigenetic clocks, telomere length), and frailty. During the follow-up period, which includes the first six months of the pandemic, women and men lost on average 0.87% and 0.5% of their body weight per year. A statistically significantly higher rate of weight loss was detected for men with low positive affect, accelerated epigenetic age (7-CpG clock), diagnosed metabolic syndrome as well as a more masculine gender score (all p< 0.05). Although the literature generally suggests an increase in body weight during the pandemic, older participants of the BASE-II sample lost 2.5-times (women) and 2-times (men) more weight than expected in this age group. Our explorative analysis of additional variables assessed during an examination directly before the pandemic’s onset could inform future studies that aim at a more in depth understanding of the matter.
BRIDGING THE DIGITAL DIVIDE: FACTORS INFLUENCING EHEALTH USE AMONG HOMEBOUND OLDER ADULTS DURING THE PANDEMIC
Authors: Park Joonhyeog , Kim BoRin , Cho Joonyoung , Park Sojung
Published: January 2025

The pandemic has increased the use of eHealth. However, homebound older adults may face a significant digital divide and need support in adopting eHealth. This study investigates to what extent and how access to devices for information and communication technologies (ICTs), previous online experience, and ICT training are associated with eHealth use during the pandemic. Data came from the COVID-19 survey of the National Health and Aging Trend Study. The sample was restricted to homebound older adults aged 70+ who rarely or never left home, or left home with difficulty or assistance (N=591). Hierarchical multinomial logistic regression was used to examine the influence of access to ICT devices, online experience, and ICT training with or without assistance on eHealth engagements including non-users, patient portal users, video telehealth users, and users of both services. Findings indicate that access to ICT devices was positively associated with all forms of eHealth use: patient portal (RRR=3.69, p<.05), video telehealth (RRR=2.56, p<.05), and both (RRR=3.81, p<.05). However, after adding previous online experience and ICT training into the analyses, access to ICT devices was not significant. While previous online experience was a significant predictor for the use of patient portal (RRR=11.97, p<.001), ICT training with assistance significantly increased the probability of the use of video telehealth and both forms of eHealth. This study highlights that access to ICT devices alone does not address eHealth disparities among homebound older adults. Educational interventions and strategies that encourage online engagement are crucial to bridge this gap.
CHANGES IN CARE TRAJECTORIES DURING THE COVID-19 PANDEMIC AMONG OLDER ADULTS WITH CARE NEEDS
Authors: Leggett Amanda , Truskinovsky Yulya , Freedman Vicki , Wiemers Emily , Corman Jennifer , Hoffman Geoffrey
Published: January 2025

Background and Objectives

This study examined whether the progression of care after the onset of an activity limitation changed during the COVID-19 pandemic. Because the pandemic caused widespread disruptions in care, we considered changes in care type and intensity.

Research Design and Methods

We used longitudinal data from the National Health and Aging Trends Study between 2015-2022 to examine trajectories of care after the onset of an activity limitation defined as having difficulty or getting help with any self-care or mobility activity or having probable dementia [N=4,191]. Outcomes included use of paid and unpaid help, number of paid and unpaid helpers, hours of paid and unpaid help, living in a residential care setting, living with adult children, and receiving no care. We estimated trajectories of care using mixed effects models and models with individual fixed effects and compared trajectories before and after the onset of the pandemic.

Results

We found no changes in whether individuals received any paid or unpaid care but we found a reduction in the number of paid and unpaid caregivers and mixed evidence on changes in hours of paid and unpaid care in the post-pandemic period. We did not find evidence that changes in care trajectories during the pandemic differed by years since the onset of the activity limitation.

Discussion and Implications

Reductions in the number of caregivers without a reduction in hours of care implies more intensive caregiving demands among caregivers during the pandemic with potential implications for the well-being of caregivers and care recipients.
CHANGES IN SOCIAL CONTACTS AND PSYCHOLOGICAL WELL-BEING AMONG OLDER ADULTS DURING THE PANDEMIC
Authors: Kim BoRin , Li Ke , Jeong Chung Hyeon
Published: January 2025

Social interactions are critical for health and well-being among older adults. The pandemic has significantly reduced face-to-face social contacts while promoting remote interactions. This study explored the patterns of changes in in-person and remote social contacts during the first year of the pandemic, and their impacts on psychological well-being among older adults. Also, we examined if remote social contacts could substitute for in-person contacts in terms of psychological well-being. Data came from older respondents (age65+) in the 2021 Health and Retirement Study Perspectives on the Pandemic, focusing on the first-year pandemic experiences (N=4,539). Latent class analysis identified distinct patterns of changes in in-person and remote contacts with diverse social relationships. OLS regressions examined the associations between changes in social contacts and psychological well-being. Four profiles were derived for changes in in-person and remote contacts, respectively. While “Decreased All-Types Contacts” was the largest among in-person contact profiles (36.8%), most of our sample was categorized into “Stable Contacts” among remote contact profiles (64.0%). Decreasing in-person contacts were negatively associated with well-being regardless of the types of relationships. Interestingly, older adults experiencing increased remote contact with friends and/or diverse groups were likely to have worse psychological well-being. Interaction analysis showed that remote social contacts served as an alternative to in-person contacts only for the relationship with friends. Our findings highlight the challenges that older adults faced in maintaining social connections through non-traditional channels during the pandemic and underscore the need for targeted support for older adults in the dynamic changes of social landscapes.
INTIMATE PARTNER HOMICIDE SUICIDE IPHS EVENTS AND MEDIA COVERAGE: PANDEMIC COMPARED TO PREPANDEMIC YEARS
Authors: Salari Sonia , Videla Emma , Sillito Carrie
Published: January 2025

Intimate partner homicide-suicide IPHS, involves the murder of a current or former partner, followed by the offender’s suicide. We content analyzed our news surveillance data over the modern pre-pandemic years (2018, 2019) and pandemic years (2020-2022). In 2020, U.S. domestic violence went up 8% and the FBI reported a ‘murder surge.’ Lockdown reduced COVID contagion, but also isolated people in their homes, some with abusers. FBI NICs data on background checks show a pandemic run on firearm acquisitions in U.S. households. We collected articles, TV news, police reports, and obituaries for n=725 IPHS events, representing over 1600 deaths. Age categories are young (18-44, n=256), middle (45 to 59, n=176) and elder adult cases, age 60+ (n=293). Evidence suggests gender-based violence in the form of femicide, as the vast majority (95%) were male perpetrated. Our research questions: 1) Did 2020 have more IPHS? and 2) What qualitative changes in IPHS media coverage happened during the pandemic? Our results found a dip in IPHS for the year 2020, but increasing violence in 2021 and 2022 (peak)—particularly for the young. We suggest a “crisis effect” for IPHS in 2020 and then a surge. Pandemic gun sales were greater among the young. Media coverage of IPHS varied by age. Elder adults had significantly fewer cases with names announced in news media, especially during the pandemic. This represents ageism, because the young and middle-aged had almost none who went unannounced. Domestic violence victims of all ages deserve recognition.
OLDER ADULTS’ BEHAVIOR IN SEEKING SERVICE INFORMATION DURING THE EARLY COVID-19 PANDEMIC
Authors: Zhou Leyi , Ren Cheng , Lou Christine Wei-Mien , Chow Julian Chun-Chung
Published: January 2025

This study examines the expanding digital divide affecting older adults in the context of the COVID-19 pandemic. It focuses on exploring the factors that influence how older adults access information during COVID-19, emphasizing the challenges faced by those from disadvantaged backgrounds due to limited technology experience. Utilizing survey data conducted in May 2020 from the San Francisco Human Services Agency, which includes responses from 3,255 older adults in households receiving public benefits, this research employs logistic regression analysis to examine how demographic factors—such as race/ethnicity, education level, and primary language—impact the ways in which older adults access information during the pandemic. The analysis encompasses a range of information sources, including both digital and traditional media, to uncover disparities in access. The results unveil stark disparities: Black older adults exhibited significantly lower odds of accessing information via online news and email compared to their White counterparts, indicating a pronounced digital exclusion. Conversely, Chinese older adults demonstrated a higher propensity for social media engagement, suggesting cultural and community-based differences in information dissemination preferences. Education emerged as a critical determinant, with older adults possessing less formal education showing diminished access to digital information sources. These nuanced findings highlight the critical need for targeted interventions aimed at bridging the digital divide. By tailoring educational and training initiatives to the unique needs of diverse older adult populations, the study underscores the importance of ensuring equitable access to essential information, thereby empowering all older adults to navigate public health crises more effectively.
UNMASKING THE CONSEQUENCES OF THE COVID-19 PANDEMIC ON COGNITION AND 24-HOUR BEHAVIORS: INSIGHTS FROM THE CLSA
Authors: Falck Ryan , Liu-Ambrose Teresa , O’Connell Megan , Smith Eric , Griffith Lauren , Cossett Benoit , Hogan David , Wolfson Christina
Published: January 2025

An unintended side-effect of the COVID-19 pandemic has been changes in lifestyle factors which impact middle-aged and older adult cognition – including changes in 24-hour behaviours (i.e., physical activity, sedentary behaviour, and sleep). In a longitudinal analysis of the Canadian Longitudinal Study on Aging (CLSA) tracking cohort, we explored age- and sex-differences in the effects of the COVID-19 pandemic on cognition and 24-hour behaviours, and whether pandemic-related changes in 24-hour behaviours and cognition are associated. We included cognitively healthy participants at baseline (2012-2105), follow-up 1 (FU1; 2015-2018), and follow-up 2 (FU2; 2018-2021), with complete neuropsychological testing data (N=11,355). Cognition and 24-hour behaviours were indexed at each timepoint. Participants were categorized into pre-pandemic (N=6,174) and post-pandemic (N=5,181) cohorts based on whether FU2 assessments occurred before or after COVID-19 pandemic onset (March 11th, 2020). We examined time x cohort changes in cognition and 24-hour behaviours from FU1 to FU2, and if changes in 24-hour behaviours from FU1 to FU2 were associated with changes in cognition. All models were allowed to vary by age and sex. Our results indicated that post-pandemic cohort males and females aged 65+ years had significantly worse cognition and poorer 24-hour behaviours from FU1 to FU2 than their peers in the pre-pandemic cohort (p’s< 0.05). However, changes in 24-hour behaviours from FU1 to FU2 were unassociated with changes in cognition, irrespective of age or sex. Our results highlight that the pandemic negatively impacted 24-hour behaviours and cognition in older adults – although these effects may be unassociated with each other.
UTILIZATION OF THE LONG COVID DIAGNOSIS CODE IN US NURSING HOME RESIDENTS
Authors: Abul Yasin , Harris Daniel , Chachlani Preeti , Hayes Kaley , Mor Vincent , Gravenstein Stefan
Published: January 2025

The National Center for Health Statistics implemented the ICD-10 code U09.9 for “Long COVID” or “post COVID-19 condition” on October 1st, 2021. Overall utilization, trends, and variation in the use of the U09.9 ICD code in long term care (LTC) residents remains understudied. We therefore conducted a serial cross sectional study using the COVVAXAGE database, by linking CVS Health and Walgreens’ customers data to the 100% Medicare enrollment files. Monthly, from October 2021 through April 2023, we identified individuals living in LTC and enrolled continuously in Medicare FFS for 12 months. We used Medicare Part A and B claims to identify long COVID (U09.9). We estimated the monthly occurrence of a long COVID code among all LTC residents and stratified by a recent (8 weeks) and latent (52 weeks) diagnosis of COVID-19, and by region. We identified over 200,000 LTC residents each month (mean age = 82.8; 69% women; 79.4% White; 11.9% Black). The overall long COVID coding rate was lowest in April, 2023 (1 per 10,000 residents) and highest in February, 2022 (14 per 10,000 residents). Residents with recent COVID-19 diagnosis had the highest long COVID coding rate (e.g., 58 per 10,000 residents) in January 2023. Temporal trends in long COVID coding rates varied widely by geography and were cyclical, following epidemic trends in LTC residents. Long COVID U09.9 ICD code documentation rates were generally low and varied in LTC residents. Remarkable variation in coding rates by region, urbanicity, and frailty status occurred, and needs further study.
A US–CHINA COMPARISON ON THE DETERMINANTS OF RESIDENTIAL RELOCATION AND ASSOCIATED MORTALITY RISK
Authors: Kong Dexia , Lu Peiyi
Published: January 2025

Many middle-aged and older adults relocate to pursue a better living environment. However, existing studies have inconclusive evidence on the determinants of relocation and its health implications, as well as lack a cross-national perspective. This study sought to compare the US and China in examining the determinants of residential relocation and its associated mortality risk. Longitudinal data from the US Health and Retirement Study in 2010-2018 and from China Health and Retirement Longitudinal Study in 2011-2018 were used (NUS=20,292, NChina=11,694). Community-dwelling respondents (aged 50+) reported whether they had relocated and were followed up until 2018. Log-binomial regression model investigated the significant predictors of relocation. Cox survival analysis examined the relationship between relocation and all-cause mortality, adjusting for baseline covariates and accounting for selection bias. About 19% American and 17% Chinese respondents relocated between communities over the study period. The common positive predictors of relocation in both countries were younger age, higher education, urban residence, and renting (relative risk>1, P< 0.05). Relocation was associated with lower mortality risk in both countries (US: HR=0.63, 95%CI=0.57, 0.70; China: HR=0.40, 95%CI=0.32, 0.50), and this association was significantly stronger in China compared to the US. (Prelocation×country=0.0009). The determinants of relocation in the US and China showed similarities, aligning with the person-environment framework. Residential relocation was linked to increased survival advantages in both countries, probably because old adults who relocated can make informed and voluntary decisions to relocate and adjust effectively following the move. Pre- and post-relocation interventions are suggested to facilitate the process of moving.
CHOICES AND EXPECTATIONS OF END-OF-LIFE HEALTH CARE PROXY: A COMPARATIVE STUDY BETWEEN TAIWAN AND THE UNITED STATES
Authors: Chen Duan-Rung , Tseng Winston
Published: January 2025

Objective

This research compares healthcare proxy preferences and expectations in Taiwan and the United States, highlighting cultural impacts on end-of-life care planning.

Methods

From August 2022 to October 2023, the study used Survey Cake for online responses, employing snowball sampling. It compared 345 Taiwanese and 339 Californian respondents, matched by gender and age.

Results

Despite similar demographics, distinct preferences emerged. A majority (75.5%) were under 30. In the US, 89.7% had higher education versus 75.2% in Taiwan. More Americans were married (19.2%). Preferences for healthcare proxies varied: Taiwanese favored parents, while Americans chose spouses or partners. A higher percentage of Taiwanese (61.8%) were willing and believed that their family members acting as proxies could meet their expectations, significantly higher than American respondents (48.2%). More American respondents (47.2%) expressed unwillingness to have family members make end-of-life decisions for them, contrasting sharply with Taiwanese respondents (24.2%). Regarding specific end-of-life medical decisions made by family members, Taiwanese respondents significantly favored letting healthcare proxies handle all medical decisions, including discontinuing life support, authorizing or refusing necessary pain medication or surgery among six decisions. Americans (92.7%) were more amenable to legal actions for personal wishes, markedly more than Taiwanese (66.2%).

Conclusion

The study reveals significant cultural divergences between the US and Taiwan in choosing end-of-life decision-makers, reflecting deeper values and trust in the family. It underscores the importance of acknowledging cultural diversity in healthcare preferences and decisions, advocating for broader research perspectives.
EXPLORING THE OUTCOME OF DEMENTIA EDUCATION AMONG UNIVERSITY STUDENTS IN TAIWAN
Authors: Wang Jouchieh , Kuo Tsuann
Published: January 2025

Training students to become familiar with dementia is crucial at medical universities as they will most likely to serve people with dementia in the future. This study employed a dementia literacy test and a semi-structured interview to university students to investigate whether a multi-purpose dementia program enhanced students’ sensitivity and attitudes toward dementia-related issues. A total of 415 students participated in pre-arranged dementia lectures, courses, extracurricular activities and service learning. Nine university students were invited to participate in in-depth interviews. The results showed that students had more positive attitudes and knowledge towards dementia. Students were exposed to knowledge-based learning by multi-disciplinary lectures, hands-on skill training and various types of alternative therapies such as arts, music or horticulture. Students felt that they gained empathy, communication skills, and dispelled stereotypes about dementia. After attending various activities within half a year, students not only became familiar with dementia issues but also reflected on what the medical profession can do for people with dementia. Students started to join contests to design dementia activities and to test different programs using design thinking on dementia patients and their caregivers. It was obvious that when students were exposed to various types of dementia activities on campus, the dynamics to learn among peers and to care for dementia family became a culture f on campus. In conclusion, this paper will showcase the multi-purpose training model on dementia which is to be implemented as Taiwan prepares to set its national dementia policy for the next 8 years.
UNDERSTANDING THE IMPACT OF BPSD ON CAREGIVER HEALTH OUTCOMES FROM THE PARADIGM OF SOCIAL INTERACTION
Authors: Yang Ziying , Yu Doris Sau Fung , Li Polly Wai Chi
Published: January 2025

Behavioral and Psychological Symptoms of Dementia (BPSD) in persons with dementia (PwD) is a crucial determinant of caregiver health outcomes. With increasing evidence on factors associating with BPSD, it is imperative to develop a theoretical model to elucidate the mechanisms behind this association. This study aimed to develop and test an integrative model based on an integrative stress and coping, stress-vulnerability, and the social interactional paradigm to explain the impact of BPSD on caregiver health outcomes. A total of 200 family caregivers of PwD were recruited from three tertiary hospitals in China. Validated questionnaires were used to measure the BPSD, caregivers’ expressed emotion (EE), their attribution about patients’ BPSD and neurotic personality. Dyadic relationship strain was measured. The caregivers’ health outcomes were captured by their health-related quality of life (HRQL) and depression. By using path analysis (AMOS 26.0), our findings indicated that BPSD independently predicted a higher level of depression and poorer mental HRQL of family caregivers. The explanatory pathways highlighted the roles of caregivers’ EE and relationship strain in mediating the impact of patients’ BPSD on caregiver depression (β=0.049, p<0.001) and mental HRQL (β=-0.037, p<0.001). Caregivers of higher neuroticism was even more susceptible to depression (β=0.033, p<0.001) and poorer mental HRQL (β=-0.025, p<0.001) and their maladaptive attribution, poorer emotional regulation and relationship quality aggravate the negative response to BPSD. These findings inform interventions would provide highly specific insights to increase the caregivers’ adaption to the BPSD in a dementia caregiving context.
AFTER THE STORM: ASSOCIATIONS AMONG HOPE AND POSTTRAUMATIC GROWTH IN YOUNGER AND OLDER ADULTS
Authors: Bordes Piper , Belalcazar Kimberly , Cherry Katie
Published: January 2025

Hurricane Ida devastated south Louisiana on August 29, 2021 having psychosocial consequences for those directly and indirectly impacted by this environmental event. The present research is part of a larger study on positive factors that enhance long-term disaster recovery. In this study, we factorially crossed age (younger, older) and disaster exposure (indirect, direct) in order to examine their influence on post-traumatic growth with greater precision than previous work in a disaster context. Participants were sampled from three parishes (counties) where Ida damage was more severe and two parishes which were farther inland with less damage. All were tested in person or virtually via Zoom platform in a single session where they responded to several individual difference measures, a structured storm questionnaire and survey measures of state hope and post traumatic growth. Results indicated that state hope scores were comparable across the age and exposure groups. Older adults had greater post-traumatic growth than did their younger counterparts, although the two exposure groups did not differ. Correlation analyses revealed that hurricane stressors were negatively associated with hope and positively associated with fear during heavy storms and worry about damage to home since Hurricane Ida. These findings support the hypothesis that older age may be a protective factor for well-being after exposure to a devastating hurricane. Implications of these data for understanding the beneficial role of positive psychological factors in long-term hurricane recovery are discussed.
LIFE PROBLEMS, DAILY ACTIVITIES, AND ALERTNESS IN LATE LIFE
Authors: Gao Sibo , Zhou Zexi , Fingerman Karen
Published: January 2025

Older adults facing life problems often report worse psychological and physical well-being compared to their counterparts without such issues. Daily activities may play an important role in these links. This study examined the association between life problems, daily activities, and alertness (i.e., being energetic and feeling less tired) in late life. We used the data from the Daily Experiences and Well-being Study. Participants aged 65+ (Mage=74.15, N=258) indicated whether they had experienced life problems (e.g., health, financial, legal) in the past year. Every 3 hours for 5–6 days, participants completed ecological momentary assessments where they reported engagement in various daily activities (e.g., eating, driving, doing chores) and level of alertness. They also wore Actical accelerometers to record their physical activities across the study period. Multilevel models revealed that participants with more life problems reported a similar amount of physical activities (i.e., sedentary time, energy expenditure), but lower levels of alertness (i.e., feeling less energetic and more tired) throughout the day, compared to those with fewer problems. Participants with more life problems reported feeling more energetic in assessments when they engaged in more leisure activities (e.g., reading, watching TV) compared to assessments when they engaged in less. In contrast, for participants with fewer life problems, leisure activities were not associated with the feeling of being energetic. Findings suggest that older adults with more life problems may be more vulnerable in everyday alertness, and emphasize the need to consider the salubrious effect of leisure activities amid problems in late life.
ADVANCING HOSPICE CARE: A SCOPING REVIEW OF DECISION-SUPPORT TOOLS IN END-OF-LIFE
Authors: Beltran Susanny , Harvey Shanelle
Published: January 2025

Hospice, known for improving end-of-life (EOL) care outcomes and reducing hospitalizations and medical expenses, faces challenges with eligibility and referral processes. This often leads to late referrals and short lengths of stays which undermine patients’ ability to fully benefit from the service. In the era of electronic medical records, decision-support tools (DST) offer a promising solution for enhancing decision-making in healthcare. This scoping review, guided by Arksey and O’Malley’s framework and the Joanna Briggs Institute guidelines, maps the use of DSTs in EOL care, and reports their application (i.e., diagnoses, interventions, facilitators and barriers, and efficacy). Our search in EBSCOhost databases like MEDLINE, PsycInfo, and CINAHL, from June to September 2022 (updated July 6, 2023), used terms related to EOL care and DSTs. From 624 identified studies, 76 were considered, and 30 met the inclusion criteria upon full review. DSTs for EOL care have evolved into two primary categories: Prognostic Tools (PT), focusing on conditions like heart failure, dementia, and COPD, using clinical indicators; and Clinical Decision Support tools (CDS), aiding assessment, and referral in palliative care with techniques like structured interviews and natural language processing. The 30 studies revealed broad application across various illnesses. Barriers commonly reported included limited generalizability of the research, and late referrals. Facilitators include collaborative initiatives, user-friendly interfaces, integration into clinical workflows, and training for healthcare providers. This diverse array of tools and their varied applications highlight the complexities and potential in EOL care, emphasizing the need for improving their integration to enhance care outcomes.
ASSOCIATION OF DIABETES WITH OLFACTION IN OLDER ADULTS: THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY
Authors: Pleasants Hanna , Chen Honglei , Mosley Tom , Chamberlin Keran , Yuan Yaqun , Shrestha Srishti , Pinto Jayant , Kucharska-Newton Anna
Published: January 2025

Although extant research suggests a cross-sectional association between prevalent diabetes and poor olfaction, the long-term association of diabetes with olfactory impairment remains unclear. We examined the association of diabetes in midlife and in older adulthood, with olfaction ascertained in older adulthood among 6,122 participants of the ARIC cohort who attended ARIC Visit 5 (2011-2013; 58.6% female, 22.7% Black race). Diabetes status and hemoglobin A1c (HbA1c) levels were ascertained at midlife (Visit 2; 1990-1993; mean age 55.0 (SD 5.2)) and in older adulthood (Visit 5; mean age 75.8 (SD 5.2) years). Odor identification was measured at Visit 5 using the 12-item Sniffn’ Sticks and categorized as poor (0-8) versus moderate or good (9-12). Binary logistic regression (exposure: diabetes status) and linear regression (exposure: HbA1C level) were used to model hypothesized associations. Diabetes prevalence at midlife (Visit 2) was associated with poor as compared to good olfaction in older adulthood (median follow-up time 21 years; adjusted odds ratio (AOR) (95% CI) = 1.25 (1.02, 1.53)). Similarly, greater HbA1c in midlife was associated with a lower olfaction score in older adulthood (beta coefficient: -0.101 (SE ± 0.04) per each 1 percent greater HbA1c level). Observed associations were attenuated when diabetes and HbA1c, in association with olfaction, were ascertained in older adulthood (all at Visit 5) (AOR 1.14 (95% CI: 1.00, 1.29); beta coefficient: -0.06 (SE ± 0.04), respectively). These findings support the association between midlife diabetes and impairment in olfactory function in older age.
ASSOCIATION OF PROCOLLAGEN TYPE III N-TERMINAL PEPTIDE WITH AGE AND MORTALITY: THE LONG LIFE FAMILY STUDY
Authors: Cvejkus Ryan , Wojczynski Mary , Jin Shiow , Thyagarajan Bharat , Zmuda Joseph
Published: January 2025

Procollagen type III N-terminal peptide (P3NP) is released into circulation during collagen biosynthesis and is a biomarker of fibrosis in several organs. Herein, we tested the association between baseline plasma P3NP concentration, measured using a sandwich enzyme-linked immunosorbent assay, and risk of all-cause mortality over 17 years in men (n=1882) and women (n=2277) aged 69.9 ± 15.5 (range, 32 – 110) years at baseline. Baseline median [IQR] P3NP level in the full cohort was 5.4 [4.5, 6.7] μg/L, and there was a significant positive linear trend across 10-year age groups. Among those aged 30-39, the median P3NP was 5.2 [4.4, 6.0] μg/L, and among centenarians, the median P3NP was 9.7 [7.9, 11.5] μg/L. Mortality risk, using 1442 observed deaths, was calculated per standard deviation (SD) of log P3NP using Cox Proportional Hazards models adjusted for baseline age, sex, height, weight, field center, alcohol use, smoking history, chronic diseases, serum creatinine, and familial relatedness. A 1 SD higher P3NP level was associated with an 18% increased risk of mortality (HR: 1.18, 95% CI: 1.10 - 1.26). The association was non-significantly stronger in women (HR: 1.25, 1.12 – 1.40) compared with men (HR: 1.11, 1.01 – 1.21). After further adjustment for physical function, the overall association remained but was attenuated (HR: 1.10, 1.02 – 1.18). In conclusion, higher P3NP was independently associated with mortality after adjustment for important covariates, especially in women, suggesting that the prevention of excess collagen deposition (fibrosis) may be particularly important for overall health and survival.
FACTORS ASSOCIATED WITH POOR SELF-RATED HEALTH BETWEEN AGES 70 AND 95: THE JERUSALEM LONGITUDINAL AGING STUDY
Authors: Stessman-Lande Irit , Rozenberg Aliza , Jacobs Jeremy , Stessman Jochanan
Published: January 2025

Self-rated health assessment is widely used among individuals aged over 70 to subjectively gauge health status, with poor self-rated health associated with shorter life expectancy. This study aimed to identify risk factors for poor self-rated health between ages 70-95. The Jerusalem Longitudinal Aging Study (1990-2023) prospectively follows a representative community-dwelling cohort born 1920-21, assessed during home-visit during 1990, 1998, 2005, 2010, 2015 at ages 70, 78, 85, 90, and 95 (n=604, 1024, 1222, 729, 508) respectively. Participants answered the question “Do you feel healthy?”; those answering “no” were defined as having poor self-rated health. Depression emerged as the most significant risk factor for declining self-rated health, with a 3-4.6 times higher risk compared to those without depression across different age groups (P≤0.044). Self-reported financial difficulty, physical inactivity, impairments in activities of daily living, and background comorbidity showed inconsistent correlations with declining self-rated health. There was a robust statistically significant association between self-rated health and mortality across all ages between 70-100 years old, with poor self-rated health consistently predicting shorter life expectancy. Even after adjusting for other risk factors, the association between poor self-rated health and mortality remained significant. The findings suggest that while commonly accepted risk factors for illness might not directly correlate with decline in self-rated health, nonetheless depression emerges as a significant predictor. This implies that poor self-rated health could be a symptom of underlying affective status. Overall, the study underscores the importance of considering mental health factors in assessing self-rated health and predicting longevity between ages 70-100.
PAIN BEHAVIORS AND PAIN TREATMENTS AMONG ENGLISH- AND SPANISH-SPEAKING HISPANICS IN US NURSING HOMES
Authors: Nielsen Natalia , Castañeda-Avila Maira , Lapane Kate
Published: January 2025

In U.S. nursing homes, racial/ethnic differences in nonverbal pain indicators and pain management have been documented among individuals with communication challenges. The role of language has yet to be explored. We evaluate the extent to which English- and Spanish-speaking Hispanics (H-E, H-S, respectively) were less likely to have nonverbal pain behaviors recorded and more likely to have no pain management relative to non-Hispanic English-speaking White residents (NHW-E). We identified newly admitted residents using national Minimum Data Set 3.0 data between 2010 and 2020 (n=1,201,724). Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI) estimated using robust Poisson models compared pain behaviors and treatments across ethnic/language groups. Vocal complaints and facial expressions were most commonly documented (Vocal: 29.1% NHW-E, 17.1% H-E, 18.5% H-S; Facial: 20.3% NHW-E, 15.0% H-E, 18.3% H-S). Documentation of pain behaviors was less frequent among Hispanic residents than NHW-E (e.g., any pain behaviors: aPR H-E: 1.17; 95% CI: 1.14-1.19; aPR H-S: 1.11; 95% CI: 1.10-1.13). Hispanic residents (H-E: 47.8%; H-S: 49.1%) were less likely to receive any type of pharmacologic pain intervention compared with NHW-E (59.4%) (aPR H-E: 0.85; 95% CI: 0.83-0.88; aPR H-S: 0.88; 95% CI: 0.86-0.90). Staff participating in the MDS assessment were less likely to document pain behaviors and its treatment among Hispanic residents relative to non-Hispanic white residents, with differences not observed based on resident’s language. Interventions to improve recognition of pain behaviors among Hispanics are warranted.
THE VAGINAL MICROBIOTA BEFORE AND AFTER HYPEROSMOLAR LUBRICANT USE IN PRE-, PERI-, AND POSTMENOPAUSAL WOMEN
Authors: Brown Sarah , He Xin , Johnston Elizabeth , Mark Katrina , Ravel Jacques , Brotman Rebecca
Published: January 2025

Vaginal lubricants are commonly used in clinical practice and to alleviate vulvovaginal symptoms in menopause. However, most products are hyperosmolar and may disrupt beneficial vaginal bacteria like Lactobacillus spp. We sought to investigate the impact of a single exposure to lubricant among patients referred for transvaginal ultrasound (TVUS) in which lubricant was used during the exam. We recruited 104 participants who self-collected mid-vaginal swabs daily for one week between baseline and TVUS, and immediately before and 6-12 hours after TVUS. Participants attended a visit 2-5 days after TVUS, continued to sample twice weekly, and attended a final clinical visit in week 10. Microbiota composition was characterized by 16S rRNA gene amplicon sequencing and assigned to community state types (CSTs; low-Lactobacillus CST-IV vs Lactobacillus-dominated CSTs I/II/III/V). Yue-Clayton theta indices defined vaginal microbiota stability before and after TVUS. Generalized linear mixed models evaluated the within-participant relative change in the odds of having a CST-IV microbiota after TVUS versus before. Our findings suggest that vaginal microbiota stability decreased after TVUS. Despite no overall change in the odds of a CST-IV microbiota after TVUS among all participants, certain subgroups showed increased risk. Specifically, peri/postmenopausal women (N=19, aOR:3.22, 95% CI:1.16-8.98) and those with a history of bacterial vaginosis (N=58, aOR:1.73, 95% CI:1.10-2.72) were more prone to decreases in Lactobacillus-dominant microbiota after TVUS. In contrast, premenopausal women and those with no bacterial vaginosis history appeared more resilient against perturbations. Reformulation may be necessary to reduce lubricant toxicity, particularly for peri/postmenopausal women who frequently use these products.
TRANSITIONS BETWEEN MEDICARE FEE-FOR-SERVICE AND MEDICARE ADVANTAGE AMONG OLDER ADULTS WITH CANCER
Authors: Castañeda-Avila Maira , Epstein Mara , Lapane Kate
Published: January 2025

To date, SEER-Medicare analyses focused on Medicare Fee for Service (FFS) patients due to data availability. The rising enrollment in Medicare Advantage (MA) underscores the necessity of including these patients in cancer research. We examined transitions between FFS and MA among older adults diagnosed with cancer and explored factors associated with coverage by FFS, MA, or transitions between these types of insurance. From the time of diagnosis to end of follow-up, 62.3% were continuously enrolled in FFS, 21.3% were continuously enrolled in MA, 11.8% transitioned from MA to FFS, and 4.5% transitioned from FFS to MA. Continuous enrollment in MA was more common among women (Odds Ratio (OR) =1.25, 95% Confidence Interval (CI):1.22-1.28), Hispanic (OR=2.21, 95%CI: 2.14-2.28) and Black adults (OR=1.79, 95% CI: 1.74-1.85) and less likely among older adults ≥74 (OR=0.85, 95%CI: 0.83-0.86), unmarried people (OR=0.85, 95%CI:0.83-0.87), and people with brain, lung, and ovary cancer relative to prostate cancer (OR ranges: 0.35-0.46). Factors associated with transitioning from MA to FFS after a cancer diagnosis included age ≥74 (OR: 1.82; 95%CI: 1.77-1.86), Hispanic (OR: 1.98; 95%CI: 1.91-2.60) and Black adults (OR=1.56, 95%CI:1.91-2.06), or having a diagnosis of colorectal, leukemia, lung, lymphoma, multiple myeloma, oral cavity, ovary, and brain cancer relative to prostate cancer (OR range: 1.96-3.69). Black (OR=2.20, 95%CI:2.09-2.33) and Hispanic (OR=1.70, 95%CI:1.60-2.33) adults were more likely to transition from FFS to MA. Understanding reasons for switching types of Medicare insurance among patients with cancer may be important for interpreting studies of social determinants of health using SEER-Medicare data.
USING MIXED EFFECTS GROWTH MODEL TO EXAMINE LONG-TERM COURSE OF PHYSICAL ACTIVITIES AMONG POSTSTROKE PATIENTS
Authors: Han Ling , Luzum Geske , Allore Heather , Askim Torunn , Tan Xiangchun , Thingstad Pernille , Håberg Asta , Saltvedt Ingvild
Published: January 2025

Restoring function and regaining physical activity (PA) is a fundamental goal of post-stroke rehabilitation programs, yet empirical evidence is lacking for long-term PA. Using data from the Nor-COAST study, we followed 277 individuals (mean age at baseline: 70.1, SD 10.9). Using a thigh-worn accelerometer, PA was measured for total upright time (UPT) in minutes over each 24-hr period for 6 consecutive days at 3-, 18-, and 36-months post-stroke. A mixed effects linear growth model examined post-stroke PA course, with a patient-specific random intercept to account for nesting effects of repeated UPT measurements. On average the UPT times declined by 0.61 min (95% Confidence Interval (CI): 0.84-0.62) per month after adjusting for ten a priori selected confounding factors. The adjusted average UPT is 42.5 min (95% CI: 67.2-18.1) shorter in men than in women; while one-yr aging reduced UPT time by 22.9 min (95% CI: 35.3-10.5). As expected, the day-1 NIH Stroke Scale (mean 2.8, SD 4.3) was associated with shorter UPT time (Mean difference: 7.3 min (95% CI: 3.2-11.3)). The final adjusted model revealed substantial between-patient UPT variations (intercorrelation coefficient, 0.55). These findings suggest that the PA of post-stroke patients appear to follow a modest, yet declining course over the 3 years, with substantial variation across individuals with different demographic and clinical profiles, calling for extending professional follow-up and individually tailored PA rehabilitation programs. Future studies may need to consider broader contexts of enabling PA of patients and their families, such as “walkable” neighborhoods and socioeconomic environments of communities.