bluuebunny/crossref_metadata_2025 huggingface dataset:
BRIDGING THE GAP IN OBESITY TREATMENT FOR OLDER PEOPLE: THE ROLE OF THE TREAT AND REDUCE OBESITY ACT (TROA)
Authors: Van Vleet Samuel C , Jang Jeein , Fields Maizonne
Published: January 2025

Obesity is a chronic disease with significant impacts on health outcomes and economic burdens throughout the life course. Obesity is prevalent and often undertreated among older people, especially those with lower socioeconomic status and those living in rural areas. Current coverage for obesity treatment is sparse and inconsistent across states, creating barriers to care for many. The Treat and Reduce Obesity Act (TROA), a public policy initiative that has been in development for over a decade, seeks to address these gaps in care among Medicare beneficiaries. TROA, which has garnered bipartisan support and is bicameral, aims to improve access to comprehensive treatment options for older people. This presentation explores the benefits of treating obesity on various comorbidities, such as heart disease, sleep apnea, and diabetes, and will emphasize the need for expanded Medicare coverage for obesity treatments. Utilizing data from the 2024 Obesity Coverage Nexus Platform, we highlight the high prevalence and associated risks of obesity among older people and examine how state-level variations in insurance coverage for obesity treatments impact access. The passage of TROA would provide a more equitable and effective approach to obesity management, helping to alleviate the economic burden of out-of-pocket costs for obesity treatments and improving health outcomes for lower-income and underserved populations.
CHINESE FAMILY CAREGIVERS’ EXPERIENCE SUPPORTING FAMILY MEMBERS WITH DEMENTIA TRANSITIONING INTO US NURSING HOMES
Authors: Yuan Yiyang , Dubé Catherine , Lim Emily , Xu Shu , Qu Shan , McPhillips Emily , Lapane Kate
Published: January 2025

Asian American family caregivers of individuals with dementia experience a greater burden compared to other racial/ethnic groups, underscoring the need for formal long-term care options including nursing homes. Transitioning a family member with dementia into a nursing home can be stressful due to cultural expectations and the lack of linguistically and culturally appropriate care. This qualitative study focused on caregivers of Chinese descent, the largest Asian community in the U.S., and explored their experiences as they support their family members with dementia through the nursing home transition. We conducted fourteen in-depth, semi-structured interviews with Mandarin- or English-speaking family caregivers. Through thematic analysis, we identified six major themes: the role of filial piety, allocation of caregiving duties, reasons for and against nursing homes, decisions about nursing home care, the impact of the COVID-19 pandemic, and advice and suggestions. Filial piety remained a significant influence across all aspects of the caregiving experience. Caregivers reported physical, emotional, and financial struggles, limited availability of culturally and linguistically appropriate nursing home care, concerns about nursing home quality, and challenges in family discussions regarding the transition to a nursing home. Caregivers noted that COVID-19-related social isolation might have worsened their family members’ dementia. Many expressed the need for the Chinese community to become more familiar with healthcare options for the aging population and called for additional nursing home staff training to enhance the quality of culturally and linguistically appropriate nursing home care. Understanding caregivers’ experiences can also help identify areas for improvement in dementia care services.
CLINICIAN AWARENESS, ATTITUDES, AND INTEREST IN BLOOD TESTS FOR ALZHEIMER’S DISEASE
Authors: Tracy Karen , Wood Julie , Tiede Ben , Scholler Emily
Published: January 2025

Clinical research demonstrates the value of early detection of dementia, including dementia caused by Alzheimer’s disease (AD) and related disorders. Yet, timely and accurate diagnosis of AD in clinical practice remains challenging. The most widely used biomarkers to aid diagnosis of AD are positron emission tomography (PET) scans and cerebrospinal fluid (CSF) biomarkers. However, the clinical community recognizes that these tests have some limitations. Blood tests, also known as blood-based biomarkers (BBMs), are emerging as an aid for detecting and diagnosing AD. These include tests that measure circulating levels of amyloid or phosphorylated tau protein. The Global CEO Initiative on Alzheimer’s Disease (CEOi) is leading a global effort to prepare for the widespread adoption of BBMs for diagnosis of AD into clinical practice. As part of this effort, CEOi commissioned the American Academy of Family Physicians and GSA to issue surveys to their members in May and June 2024 to explore current perceptions and experience with BBM testing. Members were also asked to share their thoughts on how BBMs might be used in clinical practice and what is needed to strengthen their knowledge about BBMs. Insights from compatible surveys issued by AAFP and GSA are shared along with what clinicians would need to employ BBM tests in their practices.
COGNITIVE AND PRACTICE EFFECTS OF IMMERSIVE VIRTUAL REALITY USE IN OLDER ADULTS: PRELIMINARY RESULTS
Authors: Delgado Ferdinand , Greenberg Jeremiah
Published: January 2025

Virtual reality through head-mounted displays (VR-HMD) is emerging as a tool for cognitive training in older adults. However, little is known about the impact of commercially available VR-HMD games on cognitive function. The purpose of this study was to examine preliminary results on the practice effects of VR-HMD games and their influence on cognition. Six participants (aged 71-81 years; 5 males) played VR-HMD games twice a week for eight weeks, for 60 minutes each session. Using the Meta Quest 3, participants played First Steps, featuring three laser shooting tasks (single-laser, dual-laser, and automatic laser) on weeks 1 and 5, and Fruit Ninja (Classic and Zen modes) on weeks 2 and 6. A Tai Chi and table tennis game were also played, but game scores were not recorded. Their average game score after each week was used for analysis. NeuroTrax BrainCare Tests were used to measure executive function (EF), information processing speed (IPS), attention, and visual-spatial ability before and after the intervention. Paired sample t-tests revealed significant practice effects in the single-laser (4251.24±1114.80 to 5066.36±1553.75, p=0.02) and automatic laser (4930.24±1311.34 to 6059.54±1219.53, p=0.018) tasks in First Steps, and Fruit Ninja’s classic mode (30.46±5.80 to 43.48±12.07, p=0.017). Visual-spatial ability showed a significant improvement (124.22±11.08 to 129.5±9.23, p=0.014), but not the other cognitive domains (p≥0.05). Improvement in Fruit Ninja’s classic mode showed a correlation trend with the change in visual-spatial ability (p=0.052). In conclusion, older adults can improve game performance in VR-HMD. Further research is needed to clarify VR-HMD effects on cognitive function.
COGNITIVE ASSESSMENT OF MARSHALLESE PEOPLE USING QDRS (QUICK DEMENTIA RATING SCALE)
Authors: Azhar Gohar , Sharma Shakshi , Riklon Sheldon , Kabua Philmar M , McElfish Pearl , Wei Jeanne Y
Published: January 2025

Health disparities in Marshallese living in the US are common due to language barriers, cultural differences, lack of insurance, and inability to pay. Marshallese face strikingly high rates of heart attacks, diabetes, depression, and anxiety. As cognition in this population has been understudied, we used the Quick Dementia Rating Scale (QDRS), to determine aspects of their cognition. QDRS is a dementia staging tool of 10 items (30 points). Forty-nine subjects consented to the study, which included 34 younger adults (YA) and 15 older adults (OA). Self-reported co-morbidities of diabetes were 67% in OA vs 38% in YA; heart diseases were 67% in OA vs 9% in YA; hypertension was 33% in OA vs 18% in YA; anxiety and depression were 60% in OA vs 26% in YA. Cognitive assessment showed that 13% of OA had moderate to severe difficulty in memory and recall compared to only 2% of YA. Additionally, 7% OA had moderate to severe problems in orientation, attention, concentration, language, and decision-making abilities. Moderately severe problems were also found in behavior with personality changes and reduced personal hygiene in OA. Only 3 % of YA had problems performing tasks or activities outside the home compared to 7% in OA. Furthermore, 13 % of OA had moderate to severe problems with anxiety or depression with no issues reported by YA. Our results demonstrated that higher risks associated with cardiovascular diseases and diabetes mellitus corelated with greater cognitive, behavioral, and functional impairment in older adult Marshallese in Arkansas.
COMPARATIVE ANALYSIS OF FALL RATES AMONG COMMUNITY-OLDER ADULTS IN SIX COUNTRIES
Authors: Kooshiar Hadi
Published: January 2025

The number of older people who desire to live in their homes is rising. So, this study aimed to evaluate fall rates in community-dwelling older adults across six English-speaking countries. This cross-sectional survey was conducted with 114 older adults residing in Canada, the USA, Australia, Ireland, New Zealand, the UK, and Northern Ireland. Participants recruited online through social media and passive snowball sampling completed self-rated fall risk (FRQ) and Activities-specific Balance Confidence (ABC-6) surveys, along with sociodemographic and health-related questions. Canadian and Irish respondents comprised the highest and lowest proportions of the sample, at 37% and 9%, respectively. The mean age was 67 (SD = 7.8), with a balanced gender distribution. Chronic diseases, notably joint pain and abnormal blood pressure, were reported by 25.4% of respondents. 44.8% of respondents reported falls in the past year, with 35.1% reporting falls in the past six months. Multiple falls were reported by 25.2% of respondents, with 45.8% reporting fractures primarily in the hands, forearms, or arms. Fall rates varied significantly among the countries: Canada (54.1%), USA (44.4%), Australia (53.8%), Ireland (40%), New Zealand (41.7%), and the UK and Northern Ireland (23.5%). Geographic, demographic, and methodological factors influence these rates. Higher fall rates in Canada may be due to an aging population and adverse weather conditions. The study’s findings have direct implications for research, clinical practice, and education. Recommendations for a prospective design with a large sample size are essential for a more comprehensive understanding of falls rate and effective prevention of falls.
DEPRESSIVE SYMPTOMS AND HANDGRIP STRENGTH IN MEXICAN AMERICAN OLDER ADULTS: SEX DIFFERENCES
Authors: Okada Jamil , Patino Joshua , Martinez Ariza , Snih Soham Al
Published: January 2025

The aim of this study was to examine the role of sex in the relationship between depressive symptoms and handgrip strength decline among Mexican American older adults aged ≥65 who scored normal or high in handgrip strength (≥17 Kg in females and ≥27 Kg in males) at baseline over 23 years of follow up. Participants (N=1226) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/1994-2016). Measures included high depressive symptoms as the independent variable assessed with the Center for Epidemiological Study Depression Scale (CES-D ≥16), handgrip strength in kilograms as outcome variable, and socio-demographics, comorbidities, body mass index, cognitive function, physical function, and disability as covariates. General linear mixed models were used to estimate the population average change in handgrip strength as a function of high depressive symptoms over time. Female participants with high depressive symptoms experienced a greater [β= -1.34, Standard Error (SE)= 0.26, p-value= < 0.0001] decline in handgrip strength over time than females without high depressive symptoms after controlling for all covariates. No significant decline (β= - 0.52, SE= 0.39, p-value= 0.1812) in handgrip strength as a function of high depressive symptoms was found among male participants over time after controlling for all covariates. In conclusion, we found that the effect of high depressive symptoms was greater among female than male participants. Screening and treatment of depressive symptoms may delay decline in muscle strength to further delay disability, maintain independence, prevent institutionalization, and reduce the risk of mortality in this underserved population.
DEVICE MEASURED SLEEP QUALITY AND PHYSICAL ACTIVITY IS ASSOCIATED WITH COGNITION IN CHRONIC STROKE
Authors: Stein Ryan , Falck Ryan , Tai Daria , Davis Jennifer , Hsiung Ging-Yuek , Eng Janice , Middleton Laura , Liu-Ambrose Teresa
Published: January 2025

Having a stroke increases risk for dementia two-fold. Both moderate to vigorous physical activity (MVPA) and sleep are positively associated with cognitive function. These associations may vary by biological sex. Notably, evidence shows physical activity mitigates the negative impact of poor sleep on cognitive function. Poor sleep quality is a common consequence of stroke and may contribute to cognitive impairment and dementia poststroke. We examined if MVPA attenuates the relationship of device-measured sleep quality and cognitive function in older males and females living with chronic stroke (i.e., > 12 months since stroke). We used baseline data acquired from 97-community-dwelling older adults with chronic stroke (71±9 years; n=38 female) enrolled in a 6-month randomized controlled trial. We measured MVPA and sleep duration using wrist-worn actigraphy. Global cognitive function was measured with the 13-item Alzheimer’s Disease Assessment Scale (ADAS-Cog). We assessed whether MVPA moderated the association between sleep duration and the 13-item ADAS-Cog score in: 1) the full sample; and 2) among males and females separately. Fugl-Meyer score, Montreal Cognitive Assessment score, age, and biological sex were included as covariates. In the full sample, MVPA significantly moderated the association between sleep duration and the 13-item ADAS-Cog score (ß=0.0006±0.0003; p=0.041). Specifically, among individuals with shorter sleep duration, those with greater MVPA had better global cognitive function. This interaction was significant in males (ß=0.0013±0.0005; p=0.016) but not females (ß=0.0004±0.0004; p=0.259). We suggest that MVPA is beneficial for preserving global cognitive function among stroke survivors with shorter sleep duration, particularly among males.
EFRAILTY.ORG: ANALYSIS OF INITIAL USERS
Authors: Cheslock Megan , Sison Stephanie , Zhong Lily , Newmeyer Natalie , Wang Kuan-Yuan (Ken) , Schwartz Andrea , Orkaby Ariela , Kim Dae Hyun
Published: January 2025

In March 2024, eFrailty.org was launched to the public with the goal of making frailty assessment tools accessible to clinicians and researchers. We report the uptake and initial user experiences of eFrailty between January 1, 2024 and July 31, 2024, as measured by Google Analytics. eFrailty was viewed over 23,000 times by more than 5,400 users. More than 1000 users (18%) returned after their initial visit. There were 4 distinct spikes in usage coinciding with the airing of a GeriPal Podcast episode, two international geriatrics conferences, and publication of a NEJM review article—all of which mentioned eFrailty. Analytics data indicated the site was accessed from over 60 different countries. The highest number of users were from the United States (2,400 users), followed by China (802), and Canada (522). The most frequently visited site feature was the ‘Help Me Choose a Frailty Tool’ page, which guides the user through a series of questions to identify an assessment tool that is best aligned to their purpose and available information. Of the 15 validated frailty assessment tools featured, the three most frequently viewed were the CGA-FI (2,105 views), Clinical Frailty Scale (709), and FRAIL Scale (680). User feedback was gathered informally from local and international colleagues using the site, and via e-mails sent through the site’s ‘Contact Us’ link. In response to feedback about the CGA-FI, the authors created a dedicated instruction manual. These initial data suggest the utility of eFrailty website for clinical care, research, and education.
ELEMENTS OF DIGNITY FROM THE VIEWPOINT OF STAFF IN LONG TERM CARE FACILITIES AND THE INTERACTION DIGNITY MODEL
Authors: Hasegawa Nanako , Niimi Yukari , Sone Chikako , Otake Eriko , Jacelon Cynthia
Published: January 2025

Japan has the highest proportion of older people of any country in the world. Culturally, it is important that older adults who enter long term care (LTC) facilities maintain their dignity as they did in their previous lives. However, providing dignified is challenging. Lack of dignity in care threatens not only the dignity and health of residents, but also that of staff. To contextualize and visualize elements of dignity from the perspective of staff, and using a hermeneutic phenomenological prospective approach, we conducted individual and follow-up interviews (18 interviews total) with 9 staff members (4 nurses and 5 certified care workers; age 25–43) working in LTC. Interviews were recorded and transcribed verbatim. Codes were extracted and organized into subthemes and themes. Member checking, blind checking, and a panel of seven judges were used to reduce bias and improve the validity of the findings. Two themes emerged as the core of individual dignity: “Individual dignity not affected by others” and “The individual dignity of the staff.” Three themes were identified as representing the interactions between staff and society: “Dignified care in the narrow sense,” “Dignified care by LTC facilities and the LTC system,” and “Dignity in relation to family members, friends, society, and other residents”. Identifying the “individual dignity of the staff” was identified as a significant finding. Dignity in LTC facilities includes not only dignity of residents but also of the staff, and “Dignified care in the narrow sense” was identified in the interaction between these two.
EXPLORING FALL RISK MANAGEMENT OF OLDER ADULTS IN A SAMPLE OF RURAL HEALTH CLINICS
Authors: Venema Dawn , Yao Yao , Kennel Victoria
Published: January 2025

Fall risk management (FRM) is an important component of primary care for older adults. Rural populations are aging more rapidly than urban ones, increasing the importance of FRM in rural communities. The Centers for Disease Control’s (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) toolkit supports FRM implementation, including fall risk screening, assessing, and intervening. However, factors such as gaps in knowledge, time and financial constraints, and lack of patient engagement can limit FRM implementation. Using questions based on the STEADI toolkit, we surveyed Nebraska Rural Health Clinics (RHCs) to explore current FRM practices, facilitators, and barriers; 27% responded. Eighty-two percent screened older adult patients for fall risk. The percent of responding RHCs that conducted the following assessments for over half of their patients identified at-risk were: home environment (70%), comorbidities (45%), gait/strength/balance (40%), vitamin D (34%), orthostatic hypotension (21%), medication (17%), and footwear (17%). External reporting of quality measures focused on screening, assessment, and care plan documentation. Long-term FRM impacts (fall-related emergency department visits, hospitalizations) were rarely tracked, nor required for external reporting. Facilitators of FRM were availability of rehabilitation therapists in the community, time to conduct screening and assessments, and the Medicare Wellness Visit. Barriers were time to provide interventions, reimbursement, and patient receptivity to FRM activities. We are developing a quality improvement program called Coordinated Action Toward Community Health: RedUce Risk And Limit (CATCH RURAL) Falls to facilitate implementation of the CDC’s STEADI toolkit in RHCs for older adults including possible adaptations for FRM in rural communities.
FACTORS ASSOCIATED WITH LONGITUDINAL DIGITAL SURVEY ENGAGEMENT IN THE ELECTRONIC FRAMINGHAM HEART STUDY
Authors: Zhang Yuankai , Pathiravasan Chathurangi , Rong Jian , Borrelli Belinda , Faro Jamie , Wang Xuzhi , Liu Chunyu , Murabito Joanne
Published: January 2025

Smartphone surveys are increasingly used in health research, but factors affecting long-term survey response among older adults, are not well understood. We conducted a study of 611 participants (mean age 74 years, 57% women, 86% White) from the electronic Framingham Heart Study to identify sociodemographic, health-related, and technological factors associated with survey response over 32 weeks assessed longitudinally across four 8-week periods. The same number of surveys were sent to the participants with one group receiving half of surveys every 2 weeks and the other group receiving all surveys every 4 weeks. The outcome was the proportion of surveys each participant returned during each period (up to 22 surveys of 20 unique types were sent during each period). Multivariable mixed-effects regressions with random intercepts examined associations between multiple factors and response rates, adjusting for age group (≤75 versus >75 years), sex, and time periods. Lower depressive symptom score (20-item CES-D; β=-0.04, p-value=0.028), younger age group (≤75 years; β=0.08, p-value=0.009), and use of iPhone (vs. Android; β=0.24, p-value< 0.001) were significantly associated with higher response rates. Significant effect modification by time periods (p-value< 0.05) indicated that over time, non-drinkers, iPhone users, and the 2-week survey group had less decline in response rates compared to their counterparts. Findings suggest that sociodemographic, health-related, and technological factors significantly influence digital survey engagement among older adults, with interactions between these factors and time. This highlights the need for targeted strategies to improve long-term engagement, particularly among older participants and those with higher depressive symptom scores.
FEASIBILITY OF WHEY PROTEIN SUPPLEMENTATION TO IMPROVE OLDER ADULT FUNCTION POST-HOSPITALIZATION
Authors: Yang Michelle , Gongloor Pratik , Deer Rachel , Volpi Elena , Li Shuang , Hommel Erin
Published: January 2025

Sarcopenia, the age-related involuntary loss of muscle mass and function, is frequently accelerated following hospitalization. Whey protein supplementation may reduce sarcopenia and improve functional recovery. We performed a pilot randomized-controlled trial to assess feasibility of providing whey protein to older adults during and following an acute hospitalization with the goal to improve function. Subjects ages 65+ were recruited from a single academic hospital’s medical-surgical units. Subjects were randomized into three arms: maltodextrin, whey protein, or collagen supplementation, provided twice daily during hospitalization and for 30-days post-hospitalization. Primary outcomes were recruitment, retention, adherence, and data collection feasibility rates. Secondary outcomes were preliminary efficacy on physical function and body composition. From June 2019 to February 2024, 116 subjects were enrolled, a rate of ~2 per month. Retention was 76.8%. Adherence rates were 58.5% for maltodextrin, 58.6% for whey protein, and 60.6% for collagen. Adherence was significantly higher for subjects completing the study compared to those that withdrew or were re-hospitalized. Data collection feasibility rates were moderate to high with SPPB completed on 100% of participants and DEXA collection on 61% of participants. Preliminarily, there were no statistically significant differences in physical function or body composition between groups. Overall, we demonstrated slow recruitment, low adherence, and moderate retention rates in this study of adults 65+ following an acute hospitalization. A prior trial suggested potential efficacy of whey protein on improving function of frail hospitalized older adults. However, strategies to optimize recruitment, retention, and supplement adherence are necessary before performing further assessment of efficacy.
FINANCIAL HEALTH AND WELL-BEING OF RURAL CAREGIVERS OF OLDER ADULTS WITH CHRONIC ILLNESSES
Authors: Osei Evans , Lalani Nasreen , Yang Siqi , Wagle Sampada , Katare Bhagyashree
Published: January 2025

Rural caregivers experience various financial stressors and challenges in providing care to their ill family members. Rural health disparities such as limited access to care, economic opportunities, resources, and support pose increased financial threats and insecurity resulting in poor patient and caregiver outcomes. Our study aimed to explore perceived financial stressors/challenges and their impacts on the self-care and well-being of rural caregivers of older family members with serious chronic illness. Using a purposive sampling approach, we did qualitative interviews among N=20 rural female caregivers caring for their older family member with any serious chronic illness. Interviews were done in-person and online, interview duration was about 30-45 minutes. Data was transcribed and analyzed deductively and inductively using thematic content analysis. Major financial impacts of caregiving included: leaving job or reducing work hours, time constraints on caregivers’ self-care, inability to balance family relations and caregiving roles, and difficulty navigating financial processes in the existing healthcare system. These challenges led to cutting down on groceries, reliance on retirement savings, and lack of personal time. Participants faced sleep and diet disruptions, shouldered financial decisions alone with limited or no support, and felt guilty over unfulfilled care recipient wishes due to financial constraints. Adequate self-care, coping, and well-being are associated with improved financial well-being and reduced financial threat. Caregiver support programs should focus on strategies and interventions to improve the financial well-being and overall quality of life of caregivers in the rural communities.
FRAILTY, FALL RISK, AND FEAR OF FALLING POSITIVELY ASSOCIATED IN COMMUNITY-DWELLING OLDER ADULTS
Authors: Tice Abigail , Conner Norma , Zhang Wei , Huo Qun , Li Yingru , Emrich Christopher , Xie Rui , Thiamwong Ladda
Published: January 2025

More than one in four older adults fall annually, resulting in 3 million emergency department visits. Frailty, a biological syndrome resulting from declining physiological systems, increases vulnerability to adverse outcomes in older adults. Frailty has been identified as a risk factor for fall occurrence in older adults. Many community-dwelling older adults report heightened fear of falling (FOF), and FOF is recognized as a risk factor for fall occurrence. While frailty is significantly, positively correlated with fall risk and FOF, the relationship between all three measures is less understood. The current objective was to examine relationships between frailty, fall risk, and FOF using the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL), Stopping Elderly Accidents, Death, and Injuries (STEADI), and short Fall-Efficacy International (short FES-I) questionnaires, respectively, in 178 older adults 65 years or older in Orlando, Florida. Spearman correlation analysis revealed significant associations between FRAIL and STEADI scores (p< 0.0001, r=0.6291), FRAIL and short FES-I scores (p< 0.0001, r=0.5294), and STEADI and short FES-I scores (p< 0.0001, r=0.7230). Linear regression analysis supports the significant associations between FRAIL and STEADI scores (p< 0.0001, r2=0.4407), FRAIL and short FES-I scores (p< 0.0001, r2=0.3293), and STEADI and short FES-I scores (p< 0.0001, r2=0.4636). The significant positive relationships suggest that as frailty increases, fall risk and FOF increase and that as FOF increases, fall risk increases. This work implicates the importance of screening in older adults to prevent the progression of frailty to reduce fall risk and FOF. Addressing FOF is important to reduce fall risk in older adults.
HEALTH SEEKING BEHAVIOR FOR YOUNG ONSET DEMENTIA IN WESTERN COUNTRIES AND EAST ASIA: A SCOPING REVIEW
Authors: Chen Ko-Xin , Chang Han-Yun , Cotter Valerie
Published: January 2025

Aim

We aimed to investigate the impact of culture in Western countries and East Asia on the health-seeking behavior in young onset dementia.

Background

While previous research has largely focused on the impact of culture on health-seeking behaviors in late onset dementia, a gap exists in understanding these influences in young onset dementia since they present unique challenges and needs.

Design and Methods

A scoping review was conducted using Arksey and O’Malley’s framework. Databases searched included Embase, Ovid MEDLINE, Cochrane Trials, CINAHL, PsycINFO, Scopus, Airiti Library, and Taiwan’s National Digital Library of Theses and Dissertations, with coverage up to July 22, 2024. The PRISMA-ScR checklist was employed to ensure the rigor of this scoping review.

Results

From 1,611 retrieved articles 27 studies were included. The synthesized results were analyzed using the Health Belief Model. Two main themes emerged from the analysis: (i) perceived susceptibility, severity, and barriers, with subthemes including stigma, financial impact of working, psychological and emotional effects, diagnostic challenges, and access to healthcare; and (ii) perceived benefits, self-efficacy, and cues to action, with subthemes including welfare, individualistic or collective values, meaningful activities, and environmental support.

Conclusion

Health-seeking behavior for young onset dementia is influenced by cultural differences between Western countries and East Asia. Specifically, Western cultures emphasize individualistic values, while East Asian cultures prioritize collective decision-making. Clinical implication: It is crucial to develop informed and culturally appropriate care for persons with young onset dementia that is tailored to the distinct needs of Western and East Asian populations.
INADEQUATE SLEEP ASSOCIATED WITH FRAILTY DEVELOPMENT AND FALL RISK IN LOW-INCOME OLDER ADULTS
Authors: Tice Abigail , Chen Chen , Gurupur Varadraj , Ng Boon Peng , Fukuda David , Lopez Janet , Choi Hwan , Thiamwong Ladda
Published: January 2025

Sleep, which is important for improving brain performance and overall health, declines with aging, and older adults from disadvantaged socioeconomic groups are more likely to have poorer sleep. Frailty, the decline of physiological systems, is associated with poor sleep parameters (e.g., less deep sleep and sleep duration) in older adults. As frailty progresses, fall risk and fear of falling (FOF) increase, increasing the likelihood of a fall that can result in serious injury, hospitalization, and even death. The relationship between sleep duration and frailty, fall risk, and FOF is not well understood, therefore, the objective of this study was to investigate the relationships between them. The Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL), Stopping Elderly Accidents, Death, and Injuries (STEADI), short Fall-Efficacy International (FES-I), and Pittsburgh Sleep Quality Index (PSQI) questionnaires were administered to 124 community-dwelling, low-income older adults aged 60 years or more in Orlando, Florida. Spearman correlation analysis revealed associations between sleep duration and FRAIL (p=0.0258, r=-0.1741), STEADI (p=0.0010, r=-0.2537), and short FES-I (p=0.0083, r=-0.2056). While unpaired t-test analysis revealed no difference in short FES-I between low sleep (< 7 hours; n=83) and healthy sleep (7-8 hours; n=72), FRAIL (p=0.0248) and STEADI scores (p=0.0338) significantly increased with low sleep duration. In conclusion, inadequate sleep duration appears to increase the development of frailty and fall risk in community-dwelling older adults. Screening older adults for sleep problems and interventions to improve sleep duration have the potential to reduce frailty and fall risk in low-income older adults.
KNOWLEDGE GAPS REGARDING NALOXONE USE AMONG OLDER ADULTS IN HIGH OPIOID PRESCRIBING REGIONS IN SOUTHERN USA
Authors: Azhar Gohar , Armstrong Naomi , Camp Lauren , Coker Karen , Savary Patricia E , Sharma Shakshi , Gibson Regina , Wei Jeanne Y
Published: January 2025

Arkansas has one of the highest opioid prescribing rates in the country. Nevertheless, there is a dearth of knowledge regarding opioid use and naloxone among older adults. We surveyed community dwelling older adults about opioid risks and naloxone use in rural Arkansas. Total number of respondents was n=461, and the age ranged from 50-59 (22%), 60-69 (34%), 70-79 (30%), or 80+ (14%) with 77% females and 52% black or African Americans. The percentage correct answers received from survey respondents decreased as age increased. Older adults underestimated their risk for opioid overdose (older vs younger; 35% vs 16%, P=0.020). In addition, more older adults believed that only heroin or fentanyl users were likely to overdose on opioids (older vs younger; 85%,vs 68% P=0.029). The use of naloxone as an overdose antidote was much less recognized by older adults (older vs younger; 66% vs 87%, P=0.016), as well as the requirement to administer as second dose of naloxone if the initial dose was unsuccessful (older vs younger; 40% vs 63%, P=0.033). Most older adults were unaware that naloxone could be obtained from the pharmacy without a prescription (older vs younger; 47% vs 71%, P=0.018). In summary, knowledge gaps regarding opioids and naloxone use were significantly higher in older adults. Since older adults are frequently prescribed opioids for pain, it is imperative that greater educational efforts are directed towards ameliorating the knowledge deficits about opioids and correct use of naloxone to prevent adverse effects and deaths due to opioid overdose.
LIGHT EXPOSURE IN NURSING HOME RESIDENTS WITH DEMENTIA: IMPACT ON AFFECT AND NEUROBEHAVIORAL SYMPTOMS
Authors: Jao Ying-Ling , Liao Yo-Jen , Berish Diane , Wang Julian , Calkins Margaret , Chiu Ching-Ju , Kuan Yun-Han , Boltz Marie
Published: January 2025

Persons with dementia are at a higher risk for circadian disturbances and need more bright light to regulate circadian rhythm due to age-related vision deficiencies and reduced activity in suprachiasmatic nuclei. However, the impact of light exposure on nursing home (NH) residents with dementia has not been well evaluated. This secondary analysis examined the associations of daytime light exposure with affect and neurobehavioral symptoms in this population. Circadian stimulus (CS) was included as a lighting measure. Data of 13-week repeated measures were from a clinical trial with 27 residents with dementia. Participants wore light sensors to measure individual light exposure (lux, CCT, and CS) and Philadelphia Affect Rating Scale and Neuropsychiatric Inventory were used to assess affect and neurobehavioral symptoms every other week. Correlation and multilevel modeling (MLM) analyses were performed. Participants’ average age was 87 and 74% were female. Results showed that higher lux levels were significantly correlated with more contentment (r=0.162, p=0.0399) and less sadness (r=-0.185, p=0.0183), less depression (r=-0.157, p=0.0459), and less anxiety (r=-0.207, p=0.0081). Higher CCT levels were significantly correlated with less delusion (r=-0.182, p=0.0205) and appetite changes (r=-0.159, p=0.0434). Higher CS levels were significantly correlated with aberrant motor behavior (r=-0.171, p=0.0293) and anxiety (r=-0.210, p=0.0072). MLM showed that CS significantly predicted decreased aberrant motor behavior (β=-5.04, p< 0.05), nighttime behavior (β=-4.85, p< 0.05), and anxiety (β=-6.08, p< 0.05). The results revealed the importance of light exposure in this population. The findings can guide environmental design to improve affect and neurobehavioral symptoms for NH residents with dementia.
LONGITUDINAL AUTOREGRESSIVE AND CROSS-LAGGED EFFECTS BETWEEN FRAILTY AND COGNITIVE FUNCTION OVER 14 YEARS
Authors: Kim Min Jung , Park Chang Gi
Published: January 2025

Frailty and cognitive impairment are common geriatric conditions with a strong association, though it remains unclear whether frailty leads to cognitive impairment or vice versa. Both conditions are typically irreversible and follow worsening trajectories that vary among individuals. This study examined the longitudinal autoregressive and reciprocal causal relationships between frailty and cognitive impairment, accounting for within-person processes, using a nationally representative sample, Korean Longitudinal Study of Aging 2006 to 2020. Frailty Index (FI) scores were derived from 33 items, while cognitive impairment was assessed using the Korean Mini-Mental Status Examination (K-MMSE). The sample included 3,853 adults aged 45 years or older at baseline with complete FI and K-MMSE data. A random-intercept cross-lagged panel model with robust maximum likelihood estimation was employed to address non-normality in the outcomes. The analysis revealed significant reciprocal causal relationships between FI and K-MMSE scores, with the strength of these relationships gradually increasing over time. The magnitudes of these relationships were comparable at each time point. Both FI and K-MMSE exhibited significant autoregressive effects, with FI showing consistently higher autoregressive coefficients than K-MMSE over the 14-year period. These findings suggest that frailty and cognitive function may serve as therapeutic targets for each other, with frailty being more persistent over time and cognitive impairment potentially influenced by other factors, including changes in frailty. Early interventions targeting either condition may yield synergistic preventive effects on both frailty and cognitive impairment, offering a valuable approach to managing these debilitating conditions.
LONGITUDINAL STUDIES OF COGNITIVE AGING: STUDY DESIGNS TO OPTIMIZE STATISTICAL POWER TO DETECT COGNITIVE DECLINE
Authors: Duehring Jasmin , Ong Lawrence , Edland Steven
Published: January 2025

Practice effects in longitudinal studies of cognitive function in aging and Alzheimer’s disease refer to the observation that performance on cognitive measures may improve on repeated assessments, because of increased familiarity with testing procedures and content of the tests. We have previously shown that a clinical trial run-in period intended to wash out practice effects can dramatically improve the efficiency of clinical trials. We now show that a run-in period can dramatically improve the efficiency and statistical power of longitudinal cohort studies of cognitive aging as well. Data are 1,094 participants with a baseline diagnosis of amnestic mild cognitive impairment (aMCI) enrolled in the National Alzheimer Coordinating Center (NACC) cohort (mean age 74.8, range 60 – 97, 44.1% female). In these data, the signal-to-noise in annual change after a run-period was approximately twice (2.4-fold) that observed without a run-in period. This increased signal translates to an 80% reduction in sample size required to detect a given effect of exposure, or, conversely, to an increase in statistical power given available sample size. For example, in the NACC cohort, p-values for detection of a one year change were p=0.086 without run-in, and p=8e-5 with a run-in period. Incorporating an early run-in period to longitudinal cohort studies of aging and Alzheimer’s disease can dramatically improve the statistical power of these studies to detect predictors of cognitive decline.
MULTILEVEL ANALYSIS OF AARC GAINS AND LOSSES IN OLDER ADULTS
Authors: Shiraishi Natsue , Yamamoto Yasuhiro , Nakagawa Takeshi , Horiuchi Takashi
Published: January 2025

This study investigates the factors associated with Awareness of Age-Related Change (AARC) gains and losses in older adults. Numerous educational institutions offer programs tailored to older adults, fostering continuous learning. Therefore, in the case of older people, lifelong learning, and not just educational history, should be investigated. Thus, this study examined whether lifelong learning as social participation is associated with AARC. We conducted a comprehensive analysis using an 12-month 3-wave survey collected between 2023 and 2024 (N=878, ages 70 and above at baseline). The independent variables were those measured at Time 1. AARC was analyzed in association with initial values. As a result, initial AARC-gain values were higher for those with more lifetime learning at Time 1. Our multilevel model results indicate that age (b = 0.02, p < 0.001) and lifelong learning (b = 0.11, p < 0.001) significantly are associated with levels of AARC-gains, while physical activity (b = -0.0002, p < 0.001) and IADL (b = -1.49, p < 0.001) are associated with levels of AARC-losses. No individual differences in slope were observed. These findings underscore the importance of continuous education and physical activity in mitigating age-related losses and enhancing gains, providing valuable insights for interventions aimed at improving the well-being of older adults.
NURSE STAFFING LEVELS AND OTHER FACTORS ASSOCIATED WITH NURSING HOME QUALITY
Authors: shin Juh Hyun , Harrington Charlene , Lee Soo-Kyoung , Ahn Jinhyun , Lee Yeonwoo , Ali Sanna
Published: January 2025

This study evaluated the quality of nursing homes (NHs) by analyzing deficiency citations reported by the Centers for Medicare and Medicaid Services (CMS). Key factors examined included CMS nurse staffing standards, ownership types, demographic characteristics, facility size, occupancy rates, geographic location, and Medicaid funding. Data from all U.S. NHs for Fiscal Year 2019 were sourced from CMS and LTCFocus, encompassing 13,086 facilities. Using ordinary least squares (OLS) regression, the study found that NHs with a total hours per resident day (HPRD) of 4.1 and registered nurse (RN) HPRD of 0.75 experienced fewer deficiency citations (1.18 and 0.8, respectively). In contrast, the CMS 2024 standards predict 3.48 total HPRD and RN HPRD of 0.5, with deficiencies of 0.82 and 0.6. The analysis showed that higher RN, licensed nurse, and certified nursing assistant HPRD correlated with reduced deficiency scores, indicating better quality. Conversely, higher bed occupancy rates were associated with fewer deficiencies, while increased proportions of non-White residents and urban locations correlated with more deficiencies. Additionally, larger facilities and those with higher Medicaid coverage had more deficiencies. Not-for-profit NHs generally had lower deficiency scores. These results emphasize the crucial role of adequate nurse staffing in maintaining NH quality and illustrate how various provider characteristics influence deficiency levels.
ORAL FRAILTY ASSESSMENT TOOL: INSTRUMENT DEVELOPMENT AND CROSS-SECTIONAL VALIDATION STUDY
Authors: Wan Qiaoqin , Yang Yue , Yang Chengfengyi
Published: January 2025

Oral frailty is widespread in older adults, which will gradually contribute to multiple adverse health outcomes. The current assessment tools may not comprehensively assess oral frailty, thus a practical and feasible oral frailty scale is needed. The study aimed to develop an oral frailty assessment tool and evaluate its psychometric properties. The scale was developed in two stages. First, based on the Gilbert Multidimensional Conceptual Model of Oral Health, the items were generated through a literature review and Delphi expert correspondence. For psychometric analysis, content validity, structure validity, concurrent validity, convergent and discriminant validity, and internal consistency reliability of the scale were assessed. Data were collected from a convenient sample of 372 Chinese older adults, and exploratory and confirmatory factor analyses were used. The diagnostic accuracy was further conducted through receiver operating characteristic curve analysis. The newly developed scale consisted of five dimensions and 16 items. The content validity of the scale was 0.974, with 0.649 for concurrent validity, and the aggregation and differentiation validity were ideal as well. Besides, the samples were cross-validated by exploratory factor and confirmatory factor analyses. The internal consistency reached 0.865, and the retest reliability was 0.940. Meanwhile, by comparing the diagnostic accuracy with Oral Frailty Instrument-6 (OFI-6), it was found that the cutoff value was 9.5. Findings demonstrate that the Oral Frailty Assessment Tool has acceptable content validity, structure validity and reliability in measuring oral frailty. A wider range of cultures and samples are needed to refine the scale.
PHYSIO-FEEDBACK EXERCISE PROGRAM (PEER) ON ACCELEROMETER-BASED DATA: A SMOOTHING SPLINE ANOVA MODEL
Authors: Liu Chang , Liu Yi , Thiamwong Ladda , Nguyen Tho , Zhang Wei , Xie Rui
Published: January 2025

Exercise is crucial for reducing falls in older adults. Physio-fEedback Exercise pRogram (PEER) consists of physio-feedback, cognitive reframing, and peer-led exercises that can reduce fall risk. However, there is a lack of data on the outcome of PEER on physical activity (PA) that may provide valuable insights for immediate and long-term improvements. We examined the effectiveness of PEER intervention on the daily PA level from 64 low-income older adults (mean age = 73.1 ± 6.26 years, female 87.5%), randomized into either PEER or control groups. The PEER group participated in weekly exercise sessions led by a trained peer for 8 weeks, followed by 13 weeks of follow-up, while the control group data was collected over a similar 21-week period without intervention. Physical activity was measured using a commercial accelerometer (Fitbit device). Data were categorized into sedentary, lightly active, moderately active, and very active minutes. We evaluated the peer-led group exercise days on four daily activity levels using a Smoothing Spline ANOVA (SSANOVA) model with partial splines and incorporated parameter covariates into the classic SSANVOA model. The results indicated a significant increase in moderately active and very active minutes in the PEER group during the 8-week intervention period, highlighting the short-term effectiveness of the program. We also observed the attenuation of the intervention’s effects over the 13-week follow-up across all four activity levels. PEER intervention significantly boosts daily activity levels among older adults in the short term, and sustained efforts may be necessary to maintain these benefits over the long term.
PRESENTING VISION IMPAIRMENT AND RESIDENTIAL CARE USE AMONG OLDER ADULTS
Authors: Brault Matthew
Published: January 2025

Nursing home and assisted-living facility use is common among older adults but is financially burdensome. Identifying risk factors for residential care use may focus attention on interventions that reduce or delay need for these services. Using data from the National Health and Aging Trends Study (NHATS) from 2021 (Round 11) and 2022 (Round 12), we measured the association of presenting visual acuity and contrast sensitivity on residential care use. Survey participants were assessed for presenting distance and near visual acuity and contrast sensitivity using a tablet-base examination tool. Residential care status, determined by the location of the Round 12 interview, was modeled as a function of vision impairment and relevant confounders using logistic regression. Of 2,727 participants, 2.1% were in residential care in 2022. Presenting near (19%) and distance acuity impairment (9%) were not associated with residential care, with adjusted odds ratios (aOR) of 1.48 (95% CI: 0.68 – 3.22) and 0.55 (0.17 – 1.81) respectively. Presenting contrast sensitivity impairment (24%) was associated with higher odds of residential care (aOR: 2.16 [95% CI 1.20 – 3.88]). This association was mediated by covariates for gait speed and recurrent falls. Results suggest that contrast sensitivity impairment may represent a separate risk factor for residential care use, apart from physical frailty or cognitive decline. Interventions to address or prevent eye diseases associated with impaired contrast sensitivity could reduce or delay residential care placement, a possibility that requires further investigation.