bluuebunny/crossref_metadata_2025 huggingface dataset:
A TYPOLOGY OF CARE-RELATED CHALLENGES THAT EMERGE FROM DEMENTIA FAMILY CAREGIVERS’ PHYSICAL PAIN
Authors: Turner Shelbie , Mindlis Irina , Reid M Carrington , Pillemer Karl
Published: January 2025

Many dementia family caregivers experience persistent physical pain. In addition to compromising quality of life, caregivers’ pain is associated with difficulty performing caregiving tasks and unmet needs in care recipients. This study developed a typology of care-related challenges that emerge as a consequence of pain among dementia family caregivers. We conducted semi-structured, in-depth interviews with 25 dementia family caregivers living with persistent pain. We inductively analyzed data via a thematic analysis approach to identify and categorize caregiving challenges stemming from caregivers’ pain. We then analyzed how challenges were related to one another and their consequences for caregiving outcomes. Analysis revealed three interrelated categories of caregiving challenges: 1) physical (e.g., inability to lift person with dementia), 2) psychological/emotional (e.g., worry about future progression of care), and 3) family/relational (e.g., resentment towards healthy family members for not helping with care). Caregivers reported that the co-occurrence of challenges compounded one another in ways that made both caregiving and pain management more difficult. For example, care recipients frequently became agitated when pain interfered with caregivers’ ability to perform care tasks (a family/relational challenge), which heightened caregivers’ negative emotions (a psychological/emotional challenge). Whether caregivers reported challenges and whether each challenge was connected to caregiving outcomes was dependent on various contextual factors, such as whether caregivers reported benefits from their own pain (e.g., greater empathy). The resulting typology offers a theoretical framework to guide future translational research on the topic of caregivers’ pain, including illuminating promising intervention targets of pain self-management programs for dementia family caregivers.
DEVELOPING THE NATIONAL STUDY OF CAREGIVING: CAREGIVING APPRAISAL MEASURE FOR CAREGIVERS OF PEOPLE WITH DEMENTIA
Authors: Wang Dingyue , Silva Susan , Hendrix Cristina
Published: January 2025

This study aimed to develop and psychometrically validate the NSOC-Caregiving Appraisal (NSOC-CA) measure using data from the National Study of Caregiving (NSOC) IV Round 12. We also aimed to compare dementia and non-dementia caregiving experiences to determine whether this measure differentiates the caregiving experiences between the two groups. We analyzed data from 1783 adult family caregivers using principal components analysis (PCA) to identify caregiver experience domains. Varimax rotation was used to derive orthogonal factors. Hierarchical mixed-effects models, controlling for nesting effects due to some patients having multiple caregivers, were conducted to test for dementia vs non-dementia caregiver experience differences. The final 25-item PCA model was a 3-factor solution that explained 96% of the total variance. Identified domains were labeled: psychological well-being, caregiving burden, and personal impact. NSOC-CA demonstrated high reliability (Cronbach’s alpha = 0.89, for the three subscales 0.89, 0.80, 0.75 respectively). Pearson correlations of the subscale scores ranged from 0.12 to 0.46. Dementia caregivers compared to non-dementia caregivers had worse psychological well-being, greater caregiving burden, and more negative overall caregiving appraisal (all p <.0013 without covariates; and all p <.0006 with covariates) but did not differ on personal impact (p >.05). NSOC-CA is a reliable tool for assessing the caregiver experiences of those caring for patients with dementia. NCOS-CA can differentiate the caregiving experiences of those who care for family members living with and without dementia. Future research will focus on further developing the scale and assessing its psychometric properties.
JAPANESE OLDER CAREGIVERS’ EXPERIENCES OF PROVIDING CARE AT HOME FOR AN OLDER SPOUSE LIVING WITH DEMENTIA
Authors: Wada Mineko , Takeda Kazuya , Hanaoka Hideaki
Published: January 2025

This qualitative research study explored older caregivers’ experiences of providing home care for an older spouse with dementia in Japan. The proportion of older adults (age 65+) in Japan reached 29% in 2022. The number of households in which one older adult cares for another has been increasing in tandem and is expected to continue to grow steadily. While a growing body of research has focused on the experiences of adult children who provide care for older relatives, little is known about how older adults experience caring for an older spouse at home. In this study, semi-structured individual interviews were conducted with eight older couples in which one partner provided care for their spouse who was living with dementia. Interviews with caregivers were designed to elicit their caregiving experiences and the meanings of caring for their partner at home in their later life. Interviews were digitally recorded, transcribed verbatim, and analyzed thematically. The analysis yielded four themes regarding caregivers’ experiences of older-to-older caregiving: 1) physical burden of caregiving was intensified by caregivers’ physical functioning decline; 2) “I’ll continue to look after my spouse as long as my body’s reached its limit”: a strong sense of love and compassion arising from a long spousal relationship; 3) negotiating the financial burden of caregiving with using formal community care support; and 4) a sense of loneliness: from no family support for caregiving to withdrawal from social networks. We discuss what it means for older caregivers to care for their spouse at home.
DEVELOPING A FRAILTY INDEX USING THE ELECTRONIC HEALTH RECORDS TO EXPLORE THE POLYPHARMACY AND FRAILTY RELATIONSHIP
Authors: Yasin Reham , Lekan Deborah , Kennedy-Malone Laurie , McCoy Thomas , Boone Anna , Bacon Cindy
Published: January 2025

The association between polypharmacy and frailty among hospitalized adults was explored using a secondary data analysis of the EHR in adults aged 50 years or older (N=46,645) hospitalized in medical-surgical units between 2013 and 2017. A Frailty Index (FI) was created based on the accumulation of a deficit theoretical framework (Mitnitski et al., 2001). The FI was constructed following the guidance provided by Searle et al. (2008) and Theou et al. (2023). This study’s FI was unique because it included indicators from nursing flowsheets, ICD-10 codes, laboratory blood biomarkers, as well as other frailty indicators (35 deficits in this study). The indicators were coded as “1” for present and “0” for absent. FI-35 was calculated by dividing the number of indices in an individual by the total number of indices measured, with frailty defined by a cut-off point of ≥ 0.25. In the study (25,961), 42.0% were identified as frail. A significant association was found between polypharmacy and frailty. The study showed 54.5% of individuals with polypharmacy classified as frail, compared to 31.4% in the non-polypharmacy group (χ²=1283.886; p< 0.001). The odds of frailty were 53.1 % higher for those in the polypharmacy groups relative to non-polypharmacy groups, adjusting for age and Elixhauser comorbidity index score (AOR=1.531, 95% CI=[1.437, 1.631], p< 0.001). When recognizing frailty in hospitalized patients with known polypharmacy, consideration should be made for medication reconciliation and medication deprescribing before discharge.
DEVELOPMENT OF A NOVEL PHENO FRAILTY INDEX FOR MICE
Authors: Samuelson Brady , Zhu Dantong , Kane Alice
Published: January 2025

Frailty is assessed in both model organisms and people with frailty index tools that quantify health related deficits. Here we aim to develop a new mouse frailty assessment tool (Pheno-FI) based on clinically-relevant physiological and functional measures that are easily obtainable, and can be measured longitudinally. The Pheno-FI score was developed using male and female C57BL/6 mice (N=40) at 12 months of age. We selected 17 items to include that changed with age, were health-associated, and were not correlated with each other. These included variables like HR, PLT, RBC, WBC, basophils, QRS, QT, open field, glucose, nesting and burrowing to provide a holistic view of frailty. The standard deviation (±1.5) of the baseline mice were used to determine the sex-specific cut points for our deficits, and if values were outside these cut points they were given a score = 1, and within the cut points a 0. Pheno-FI is the average of these items. Once developed in the baseline data, the Pheno-FI was calculated for male and female mice aged 12 to 36 months. Pheno-FI scores increase with age in both males and females, and are positively correlated with the previously validated mouse clinical frailty index (Females R2=0.6, p= 7.7e8 Males R2=0.62, p= 3.1e11). Additionally, Pheno-FI scores show a negative correlation with lifespan (Female R2= -0.56 p=6.7e-7 Male R2= -0.5 p=2.3e7). The Pheno-FI provides a new tool for the field to classify frailty in longitudinal aging mouse studies, to explore frailty mechanisms, biomarkers and interventions.
ECOLOGICAL MOMENTARY ASSESSMENT OF SOCIAL INTERACTION, LONELINESS, AND FRAILTY IN PREDEMENTIA
Authors: Hong Dahye , Kim Jennifer , Yoon Seolah , Kang Chaeeun , Kang Bada
Published: January 2025

The pre-dementia stage, encompassing subjective cognitive decline (SCD) and mild cognitive impairment (MCI), is recognized as being vulnerable to frailty and is associated with adverse health outcomes, such as falls or disability. Although social interaction and loneliness are considered to be associated with frailty, little is known about the relationship between social interaction, loneliness, and frailty in the pre-dementia stage. Therefore, this study examined the relationship between social interaction, loneliness, and frailty among 101 community-dwelling older adults in the pre-dementia stage (individuals with SCD = 67; individuals with MCI = 34) in Korea. To capture real-time measurements of social interaction and loneliness, we utilized an ecological momentary assessment that involved repeated sampling of individuals’ states. Participants reported their frequency of social interactions and loneliness via a mobile application four times a day for two weeks. Multivariate logistic regression analysis was used to investigate the associations between social interaction, loneliness, and frailty. We adjusted for mild behavioral impairment (MBI), which indicates dementia risk and increases vulnerability to frailty, alongside sociodemographic, health-related characteristics, and functional limitations. Our study demonstrated that social interaction has a negative association with frailty among individuals in the pre-dementia stage, regardless of the presence or severity of MBI symptoms. However, loneliness was not significantly associated with frailty. This study highlights that the assessment of social interactions using ecological assessment will help identify at-risk individuals and implement targeted interventions for the prevention and management of frailty in older adults in the pre-dementia stage.
ENHANCING MUSCLE FUNCTION IN FRAILTY: FINDINGS FROM A PILOT STUDY ON MAGNETIC MITOHORMESIS THERAPY
Authors: Sagong Hae , Tsai Pao-Feng , Wang Chih-Hsuan , Brown Lynn , Edison Jos
Published: January 2025

Magnetic Mitohormesis Therapy (MMT) employs low-amplitude pulsing electromagnetic fields (PEMF) and has demonstrated the ability to enhance muscle function and metabolism. Given that muscle weakness is a key contributor to frailty, this study employed a double-blind pilot randomized controlled crossover trial design involving prefrail/frail participants without neurodegenerative diseases, from two distinct types of long-term care facilities. Eight Participants underwent 12 weeks of twice-weekly treatment followed by 12 weeks of sham control, or vice versa, with two groups randomly assigned: Sham-Treatment (S-T group) and Treatment-Sham (T-S group). Treatment was delivered using The QuantumTx BIXEPS Fitness and Wellness device delivered PEMF at 1.5 mT flux densities. FRAIL Scale, SPPB, SF-12v2 Health Survey, SWAY Cognitive Tests, and Body Composition Measurements were assessed at every 6 weeks. Results showed that the S-T group demonstrated improved performance in the Gait Speed test. Their scores from the Gait Speed test were higher at 24 weeks compared to baseline (p=.01), and their overall SPPB scores were higher at 24 weeks compared to baseline (p=.01). Participants noted the study site’s accessibility and described the treatment as quick and straightforward. This study provided preliminary evidence of the benefits of MMT in frail older adults; however, further research with a larger sample size and shorter study duration is needed to lower the dropout rate and mitigate the development of new health issues.
FEASIBILITY OF A LIFESTYLE-INTEGRATED EXERCISE DELIVERED VIA AN MHEALTH PLATFORM IN PREFRAIL OLDER ADULTS
Authors: Li Na , Wang Nan , Lin Siyang , Yuan Yin , Huang Feng , Zhu Pengli
Published: January 2025

Background

Lifestyle-integrated Functional Exercise, which integrates exercise into daily life, may be a promising alternative to overcome traditional exercise barriers. Recent advances in mHealth technology hold the promise of preserving the benefits of supervised exercise training in group settings by remotely guiding and tracking exercise progress. Objective: To assess the feasibility and acceptability of an mHealth platform to deliver a personalized lifestyle-integrated multicomponent exercise program for pre-frail individuals.

Methods

This was a community-based, mixed-methods, prospective, single-cohort feasibility study. All participants were prescribed a lifestyle-integrated multicomponent exercise program by healthcare professionals using the PF-Life platform (web-based portal), and participants engaged in customized exercise following in-app video instructions and feedback on the PF-Life platform (smartphone application). Physical activity was registered daily through wearable devices. Result：16 participants successfully completed the study with a retention rate of 100%. Mean adherence to the number of days exercised per week was 88.8% (95% CI 75%-100%). Changes were observed from baseline to follow-up for total Handgrip strength (21.41±6.38 vs. 24.12± 6.62 kg, d =0.714), TUG (8.23±1.33 vs. 7.48± 2.01 seconds, d=1.647) and 30-second chair rise test (17.13±4.3 vs. 20.04±4.54 repetitions, d =0.94). The sedentary time decreased by a mean of 33 minutes/day and low physical activity increased by 31 minutes/day during the intervention.

Conclusion

This study provides preliminary evidence that an lifestyle-integrated exercise based on mHealth platform has good adherence, safety, reliability and usability, with initial results in reducing sedentary time and improving physical function.
FRAILTY TRAJECTORIES AND ITS ASSOCIATED FACTORS IN JAPANESE OLDER ADULTS
Authors: Taniguchi Yu , Kitamura Akihiko , Hata Toshiki , Fujita Koji , Abe Takumi , Nofuji Yu , Seino Satoshi , Yokoyama Yuri
Published: January 2025

The present study had two objectives: to identify aging trajectories in frailty status from age 65–90 years among community-dwelling older Japanese; and to identify factors associated with this trajectory among these people. The present prospective study used repeated measures data on frailty status from a 13-year longitudinal study. 1706 older adults completed an annual frailty assessment at least once during the follow-up. Frailty status was determined using an index based on the Fried frailty phenotype criteria. Potential associated factors for frailty trajectory included physical, biological, lifestyle-related, and psychological factors, as well as comorbidities. We identified five trajectory patterns in the frailty score from age of 65 to 90 years —individuals who were robust (10.5%) as well as individuals with late-onset frailty (16.1%), middle-onset frailty (25.6% and 35.2%), and early-onset frailty (12.7%). The early-onset frailty group were already pre-frail at the age of 65 years, and their frailty score gradually progressed to frail status. Compared with the robust group, the early-onset group showed a higher prevalence of cerebrovascular diseases, bone and joint diseases, poor nutrition, sarcopenia, hospitalization, low cognitive function, and smoking at the end of follow-up. Associated factors in the middle-onset group largely overlapped with those of the early-onset group. The late-onset frailty group tended to have a higher association with heart disease and bone and joint diseases compared with the robust group. Proposed effective population-based frailty prevention strategies in each age group may contribute to effective strategies to extend healthy life expectancy.
LONGITUDINAL SEX DIFFERENCES IN FRAILTY AND AGING IN UM-HET3 MICE
Authors: Wu Judy , Samuelson Brady , Betz Elizabeth , Kane Alice
Published: January 2025

Frailty is a common geriatric syndrome characterized by age-associated decline and vulnerability to adverse health outcomes. Frailty can be quantified using frailty indices (FIs) which count the number of health deficits in an individual. Sex differences are observed in aging with women living longer than men, despite women being frailer. Our goal is to assess sex differences in behavioral and molecular assessments of aging, and how frailty may influence these changes. Across the lifespan of UM-HET3 male and female mice(n=37) we are longitudinally measuring FI score, behavioral assessments and blood outcomes including white blood cell counts (WBC) and glucose levels. Preliminary data from the first 3 timepoints unexpectedly suggest frailty scores decrease over time(p=9.98e-13), with no clear sex differences. For nesting, females have higher scores at all timepoints (p=7.71e-04). Males have higher WBC than females (p = 1.29e-06), with no change over time. Glucose levels increase overtime for both sexes, (p=2e16), but males have lower glucose counts than females (p=5.25e-3). Frailty is associated with lower glucose levels in both sexes (p= 4.45e-05). Heart rate is higher in females (p= 3.52e-04) and increases over time for both sexes (p=3.59e-03). Additionally, higher frailty scores are associated with lower heart rates(p=0.0236) in both sexes. Data collection is ongoing and we expect to see more significant effects of sex, age, and frailty as the mice grow older. This work will help understand the impact of frailty and sex differences on aging.
METABOLOMICS BIOMARKERS FOR FRAILTY: A LONGITUDINAL STUDY OF AGING MICE
Authors: Zhu Dantong , Wu Judy , Samuelson Brady , Kane Alice
Published: January 2025

Aging is associated with changes in dynamic biological processes which may contribute to the development of aging-related diseases. Metabolomic profiling allows us to measure a wide spectrum of metabolites as read outs of these biological processes. The temporal dynamics of metabolites can be utilized to identify age-related biomarkers and to elucidate possible aging mechanisms. We performed a longitudinal study of aging female (n = 20) and male (n = 25) C57 mice and measured frailty index and derived metabolomics from plasma samples at five time points from 13 to 30 months of age. We identify differentially abundant metabolites by differential analysis over the time course and select metabolite features by a machine learning approach both in the whole cohort and in sex-stratified subgroups. We reveal novel metabolites associated with △frailty index (difference between individual frailty index and median frailty index at a given sex and age group), and merge these metabolites with frailty index and age related metabolites to generate a union set of metabolite features associated with frailty in aging. We found frailty related metabolites are generally enriched in lipid metabolism, amino acid metabolism and metabolism of cofactors and vitamins, although there is strong sex dimorphism of the specific metabolites. Notably, we identify FAD and 4−hydroxyhippurate in females and ergothioneine and creatine in males as candidate metabolites associated with frailty. In summary, our results identify sex-specific metabolite biomarkers of frailty in aging, and shed light on potential mechanisms involved in aging and the development of frailty.
THE EFFECT OF FRAILTY ON COGNITION IN OLDER ADULTS: THE MEDIATING ROLE OF DEPRESSIVE SYMPTOMS
Authors: Yuan Yiyang , Lapane Kate
Published: January 2025

This study aims to examine the effect of physical frailty on cognitive function with depressive symptoms as a mediator in older adults in the United States. The Health and Retirement Study (HRS 2016; baseline) was linked to its sub-study Harmonized Cognitive Assessment Protocol (HCAP; follow-up), which was conducted in a randomly selected half of the 2016 HRS participants, to identify 1,503 adults aged 65 and above. The exposure physical frailty and mediator depressive symptoms were measured in HRS at baseline respectively by the Fried frailty phenotype on low weight, physical inactivity, exhaustion, weakness, slowness (total score: 0-5; dichotomized as not frail (score: 0) vs. frail (score: 1-5)) and the Center for Epidemiological Studies Depression (CES-D) Scale (total score: 0-8). The outcome overall cognitive function was measured in HCAP at follow-up by the Mini-Mental State Examination (total score: 0-30). Causal mediation analysis was used to assess the direct effect of physical frailty and its indirect effect through depressive symptoms on cognitive function, considering the interaction between the exposure and the mediator. Having physical frailty would decrease cognitive function by a total effect of -0.26 (95% CI: -0.59 to 0.07), with total natural direct effect of -0.14 (95% CI: -0.48 to 0.20) and pure natural indirect effect through depressive symptoms of -0.12 (95% CI: -0.22 to -0.01). The lack of clinically meaningful effects is likely due to the short length of follow-up. This study employs the natural temporal order in HRS and HCAP, but analysis with longer follow-up is warranted.
EPIDEMIOLOGICAL FEATURES OF URINATION AND DEFECATION DYSFUNCTION: INSIGHTS FROM THE CHARLS STUDY (2011–2020)
Authors: Zhu Haoran , Zhang Jing , Liu Guangtian , Jing Liwei , Wang Rui , Ye Yan
Published: January 2025

With the population aging, China has over 42 million older adults with disabilities, experiencing Urination and Defecation Dysfunction (UDD). The study aims to understand the epidemiological characteristics of UDD from 2011 to 2020, utilizing the China Health and Retirement Longitudinal Study (CHARLS) database. CHARLS is a longitudinal study, involved adults aged 45 and older, with having a cross-sectional survey at each two years. All participants in the CHARLS database who had UDD were included in the study. Chi-square tests and a logistic regression analysis were conducted. A total of 17,156, 17,897, 17,715, 19,097 and 19,129 eligible participants were recruited in each wave of survey, respectively, while associated prevalence were 4.4%, 4.0%, 4.7%, 4.7%, and 5.0%. The prevalence remained stable without significant changes across the ten years. In the univariable analysis, a higher prevalence was observed among older adults over 76 years (P< 0.05), compared to younger adults. Urban residents had a higher prevalence in Northern, Central and Southern China (P< 0.05) than other regions. Furthermore, through the multivariable analysis with the logistic model, higher UDD prevalence was identified among urban older female in Northern, Central, Southern, and Southwest China. Therefore, health educational campaigns and medical intervention programs should be provided for these high-risk population in China. The findings emphasize the potential burden of UDD in older populations, and underscore the importance of integrating urinary and fecal incontinence into geriatric health education.
INTEGRATED DEMENTIA CARE CENTER IN TAIWAN: A SIX-YEAR JOURNEY TO DEVELOP A HOLISTIC CARE MODEL
Authors: Kuo Tsuann , Huang Yi-Jia , Chen Yu-Chun , Lu Yu-Lan , Lin Yi-Hsiu
Published: January 2025

Taiwan launched its 8-year Dementia Action Plan 2.0 in 2017 and has developed over 114 Dementia Integrated Care Centers (DICC). Using the Chronic Disease Management Model, a multi-disciplinary and holistic care center was established by Chung Shan Medical University Hospital to care for more than 400 people with dementia and their family members each year. The DICC was consisted of medical, care, and support divisions so patients can be cared for by medical specialties, nurses, nutritionists, pharmacists, physical therapies, occupational therapies, social workers, psychologists and legal representatives. This study also analyzed over 2000 patients’ records retrospectively and found out that with the help of care managers at DICC, people with dementia were less likely to be hospitalized, entering emergency room, reduced caregiver burdens, and maintained cognitive level longer. The center also outreached to the community and established a network where people with dementia can attend physical, arts, leisure, and learning programs. The caregivers who were interviewed and attended these programs indicated that they were able to accept their family’s conditions faster and more at ease with their family dynamics. The DICC also served as an important site for University students to be trained to become future dementia specialists. In conclusion, a center with multi-disciplinary professionals took years to integrate and build collaborations so people with dementia and their families could get the best coordinated care. This paper will reveal how the Dementia Integrated Care Center will be implemented in Taiwan.
LIFE SATISFACTION OF OLDER ADULTS: IMPACT OF LEISURE PARTICIPATION AND REGIONAL CHARACTERISTICS
Authors: Lee Rokbit , Heo Jinmoo , Lee Inheok , Kim May , Im Sua
Published: January 2025

As Korea is transitioning into an aged-society, improving well-being of older adults has become important, and literature has demonstrated various individual and societal factors that impact their well-being. The purpose of this study is to explore the role of individual and regional factors that are associated with older adults’life satisfaction. Specifically, we used leisure participation as individual factor and regional characteristics include perceived stress and volunteer participation rate. Data were drawn from the 2020 National Survey of Korean Elderly and Statistics Korea. As the individual data were nested in regions (cities and provinces), we used hierarchical linear modeling to analyze the data. Findings show that volunteering, traveling, and participating in club activities were positively related to life satisfaction of older adults. The relationship observed between older adults’ participation in travel, club activities, volunteering, and life satisfaction suggests that engaging in productive leisure activities is a crucial aspect of daily life of older adults. At regional level, perceived stress level was negatively associated with life satisfaction whereas volunteer participation rate was positively related to life satisfaction. The negative correlation between older adults’ perceived local stress and life satisfaction, and the positive correlation between local social volunteer participation rate and life satisfaction suggest that stress perceived by individuals due to their residential area or surrounding environment has a negative impact on their lives. A statistically significant cross-level interaction was observed indicating that the impact of volunteer participation rate on life satisfaction was stronger in regions with higher levels of perceived stress rate.
INTRAINDIVIDUAL VARIABILITY MODIFIES COGNITIVE TRAINING IN COGNITIVELY VULNERABLE OLDER ADULTS WITH HIV
Authors: Vance David , Azuero Andres , Schexnayder Julie , Puga Frank , Byun Jun , Xiao Chunhong , James Dara , Wheeler Pariya
Published: January 2025

Cognitive Intra-Individual Variability (IIV), the fluctuation in cognitive performance within an individual, often stems from compromised cognitive control due to brain pathology. In cognitive aging studies, cognitive IIV has been shown to predict cognitive decline 3 years later, dementia, and mortality. Those with HIV-Associated Neurocognitive Disorder (HAND) frequently exhibit heightened cognitive IIV; this is concerning as the HIV population has become an aging epidemic (i.e., by 2030 70% of people with HIV will be 50 and over). This study investigated whether computerized Speed of Processing (SOP) training could mitigate cognitive IIV and whether baseline cognitive IIV influenced the impact of SOP training on individuals with HAND or borderline HAND. In a 3-group experimental design, 216 middle-aged and older individuals living with HIV (PLWH) and HAND were randomly assigned to: 1) 10 hours of SOP training (n=70); 2) 20 hours of SOP training (n=73); or 3) 10 hours of Internet Navigation Control Training (n=73). Participants underwent a seven-domain cognitive battery at baseline, posttest after training, and at 1 and 2-year follow-ups, with the coefficient of variation (CoV) representing cognitive IIV dispersion. Linear mixed-effect models did not reveal an obvious pattern of SOP training effects on cognitive IIV. Albeit, a three-way interaction tests between group, time, and baseline IIV CoV [F(6, 453.96)=1.74, P= 0.11], and group, time, and baseline IIV CoV median split indicator [F(6, 467.84)=2.024, P= 0.061] posited potential moderation effects. While SOP training did not directly enhance cognitive IIV, its effects may be influenced by individual baseline cognitive IIV.
THE AHR AS A POTENTIAL MEDIATOR OF MUSCULOSKELETAL FRAILTY WITH ANTI-RETROVIRAL THERAPY
Authors: Tripathi Alok , Sultana Shabiha , Shi Huidong , MacArthur Rodger , de Chantemele Eric Belin , Hamrick Mark , Lawrence Meghan McGee
Published: January 2025

Musculoskeletal frailty, often associated with aging, is frequently observed in patients living with HIV on long term anti-retroviral therapy (ART) and linked to poor health outcomes from accelerated disease progression to increased mortality. Mechanisms underlying this frailty phenotype are poorly understood but may involve disease progression as well as ARTs themselves. One possible mediator is activation of the aryl hydrocarbon receptor (AhR). NF-κB, activated by HIV infection, is an upstream regulator of AhR which induces the enzyme IDO-1 to produce the endogenous AhR ligand kynurenine. However, connections between ART, HIV, and AhR in musculoskeletal frailty had not been previously explored. In preliminary studies we tested the effects of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) ARTs in a mouse myoblast cell line (C2C12). FTC, but not TDF, increased transcriptional activity of AhR, expression of AhR and its target gene CYP1A1, and increased cellular indicators of senescence. FTC also impaired myoblast differentiation as confirmed morphologically by microscopy. Next, we tested the effects of FTC and another ART agent, tenofovir alafenamide (TAF, a prodrug of TDF) in primary human mesenchymal stem cells and myoblasts, showing increased expression of AhR, AhR target genes, and increased senescence in both cell populations. Moreover, FTC and TAF decreased expression of myoblast differentiation markers (MYOG and MYOD). While further research is needed to elucidate the underlying mechanisms of interactions between ART, HIV, and AhR signaling, these studies raise the possibility that targeting AhR may serve as a novel therapeutic approach for improving musculoskeletal function in this setting.
ASSESSMENT OF RISK OF FALL IN THE HOME ENVIRONMENT OF KOREAN OLDER ADULTS: REVISION AND VALIDATION OF THE K-HOME FAST
Authors: Park Min Kyung , Kim Gwang Suk , Kim Layoung , Lee Jae Jun , Kim Namhee , Lee Ji Yeon
Published: January 2025

Most older adults experience a fall inside their house. Because the home environment varies based on culture and time, the tools to assess fall risk must be regularly modified and validated. Therefore, this study aimed to develop the Revised K-HOME FAST (Korean version of the Home Falls and Accidents Screening Tool) and evaluate its validity and reliability. The Revised K-HOME FAST was developed in these phases: 1) development of the Revised K-HOME FAST, 2) feasibility test, 3) verification of content validity, and 4) data collection and verification of reliability. Internal consistency was confirmed by conducting home-visit assessments with 211 community-dwelling older adults who had experienced at least one fall in the local community. To verify inter-rater reliability, six investigators were paired and independently assessed the homes of 20 older adults. The final Revised K-HOME FAST consisted of 25 items categorized into seven home areas: bathroom/toilet, bedroom, living room, kitchen, stairs, entrance, and entire house. The item-content validity index of the preliminary version of Revised K-HOME FAST ranged from 0.8 to 1.0, except for one item. The internal consistency (Kuder–Richardson Formula 20) of the Revised K-HOME FAST was.65. The agreement percentage for each item ranged from 92% to 100%, and the intraclass correlation coefficient ranged from 0.79 to 1.00, indicating high inter-rater reliability. The Revised K-HOME FAST has satisfactory validity and reliability for assessing the risk of falls in the home environment of community-dwelling older adults in Korea.
END-OF-LIFE RESOURCE AND PLACE OF DEATH BY COMMUNITY-BASED HOUSING TYPE
Authors: Park Sojung , Kim BoRin , Shin Esther , Baek Jihye , Ryu Byeongju
Published: January 2025

Understanding the factors that influence where people die is crucial, as most individuals spend their last year of life at home. This study investigates the influence of end-of-life resources on the place of death in older adults, based on where they lived. Data came from twelve waves of the National Health and Aging Trend Study (2010~2022). We analyzed the unmet needs of end-of-life resources such as end-of-life care services, functional help, and social/family support, and the type of housing (senior housing vs. traditional home) based on income status. The sample included community dwellers who died during the study period and had information about end-of-life care-related supports (N= 2701). Multinominal regression analyses were used to investigate the influence of end-of-life resources and housing type on the place of death (home, hospital, nursing home, hospice facility, or other). We found individuals living in traditional homes, both low-income and non-low-income, tend to have low levels of end-of-life care services but receive high levels of social/family support and they are more likely to die at home. In contrast, individuals living in senior housing, particularly those in low-income models, tend to have high levels of unmet needs for functional help and social/family support and are more likely to die in a nursing home or other facilities. We discussed the unequal distribution of end-of-life resources based on residential type, and the implications of this on the apparent mismatch between unmet resources and the place of death, focusing on the potential role of senior housing.
FEASIBILITY OF A SUPPORTIVE HOUSING PROGRAM FOR OLDER VETERANS WHO PREVIOUSLY EXPERIENCED HOMELESSNESS
Authors: Ritter Ashley , Hoban Luke , Brown Rebecca , Cusack Meagan , Moriarty Helene
Published: January 2025

The number of older adults experiencing homelessness is on the rise nationally, with earlier incidence of geriatric syndromes that jeopardize community living occurring at younger ages in this population. NewCourtland, a provider of housing and health services in Philadelphia, began a program serving older Veterans who experience homelessness with complex health and social needs in 2019. This study examined the feasibility and acceptability of program implementation among program participants and staff. We conducted focus groups with program staff (n=10) and residents (n=9) using a semi-structured interview guide. Transcripts were analyzed using inductive codes derived from the CFIR framework. Key themes regarding program feasibility and acceptability include the attainment of new space and autonomy coupled with the need for goal setting to achieve stability in a community setting. Residents and staff both reported that moving into stable housing was a critical step towards community re-integration for participants. This allowed participants to develop regular habits and boundaries in their personal lives. The program’s focus on goal setting motivated participants to work with the staff members to meet their needs. However, this was only possible if trust had been established on both sides. Clear rules and consistent interaction with staff were essential, both to achieve participant buy-in and reduce staff burnout over time. Findings provide practical insights into how to improve supportive housing programs and enhance community reintegration for older adults with experiences of homelessness and complex health and social needs.
A NEW DATA SET TO EXAMINE HOME HEALTH AGENCIES
Authors: Loomer Lacey , Patel Sweta , Belanger Emmanuelle , Gozalo Pedro
Published: January 2025

Using Outcome and Assessment Information Set (OASIS) data from 2015 to 2019, we developed a dataset representing home health agency Medicare patients that will be made publicly available for researchers and policymakers to compare over time and geographically. We created unique home health stays based on start of care and discharge assessments from OASIS and aggregated the data to the calendar year, agency, county, state, insurance (fee-for-service vs. Medicare Advantage), and by admission (institutional vs. community). We identified demographics for home health stays using the Medicare Beneficiary Summary File. We characterize the home health stays using OASIS variables including length of stay, activities of daily living, instrumental activity of daily living, cognitive function, common diagnoses, urinary tract infections, incontinence, history of falls, and pressure ulcers. Type of admission was determined based on Medicare claims for hospital, nursing home, or inpatient rehabilitation facility in the fourteen days prior to home health admission. Insurance was determined using the Medicare Beneficiary Summary File identified in each month of the home health stay, if a patient changed insurance through the stay, the stay’s attribution was prorated by month to each type of health insurance. There were 6,761,470 home health stays from 5,051,631 Medicare beneficiaries in 2016 compared to 6,703,521 home health stays from 4,969,010 Medicare beneficiaries in 2019. In 2019, 1994 home health agencies served fee-for-service patients only, 94 served Medicare Advantage patients only, and 8,720 served both.
A STUDY OF FACTORS RELATED TO RETENTION OF FOREIGN NURSING CARE WORKERS WHO CAME TO JAPAN UNDER THE EPA SCHEME
Authors: Tsukada Noriko , Nishimura Jun
Published: January 2025

The Japanese government broadened the status of residence to encompass foreign nursing care workers, due to the shortage of nursing care workers. The first step, taken in 2018, used the Economic Partnership Agreement (EPA) scheme with Indonesia, followed by the Philippines and Vietnam. This study explored factors related to the retention of EPA nursing care workers, including elements of social security programs in Japan. Structured questionnaires were sent to 722 institutions: for EPA workers, 10 questionnaires were sent to each institution. Both administrators and EPA workers were asked to respond to the survey either by mail or electronically from November 7 to December 8, 2023. A total of 396 responses from EPA workers were analyzed in this study. Despite the low response rate (5.5%), preliminary bivariate analyses revealed that although “amount of requests to the government” made by the respondents was found to be statistically significantly related to retention of EPA workers for all three countries, other factors related to perceptions toward retention varied. For example, as for Indonesian workers, job satisfaction, whether or not there are Indonesian senior certified care workers at the same institutions they work and amount of understanding of social security systems were found to be statistically significant factors, while job satisfaction, levels of understanding Japanese at work, and knowledge about social security agreement were found for Philippine’s workers. It is suggested that the government consider these differences among the three countries and develop country-specific actions to promote retention of EPA workers from each country.
DESCRIBING HOW ADAPTIVE LEADERSHIP IN LONG-TERM CARE CAN MOTIVATE AND PREPARE CARE WORKERS TO PROMOTE QUALITY
Authors: Haunch Kirsty , Devi Reena , Spilsbury Karen
Published: January 2025

Adaptive leadership is one approach to enhance the experience of people living and working in long-term care (LTC) residential environments. Adaptive leadership is comprised of a set of strategies aimed at enabling care teams to work together, or create organisational capacity to support culture changes, to accomplish person-centred environments. The defining feature of adaptive leadership is the separation of technical solutions (i.e., applying existing knowledge/techniques to problems) and adaptive solutions (i.e., a shift in how people work together not just what they do). Our aim is to describe and illustrate adaptive leadership behaviours in LTC and the potential benefit for the processes and outcomes of care. We conducted a documentary analysis of (publicly available) UK regulatory inspection reports. Twenty reports, judged as providing outstanding quality were purposively sampled to represent variations in ownership, size, and geographical location. Data were initially analysed using content analysis. Heitz’s adaptive leadership framework was used to frame the data. Adaptive leadership behaviours helped to engage, empower, and energise the workforce to accomplish meaningful change. These behaviours included accepting everyone’s unique perspective on how to solve problems, a willingness to learn lessons, an openness to feedback, embrace diversity, a fair and inclusive workplace, continuous growth, innovation and emotional intelligence. Key structural components enabling adaptive leadership included organisational support, ‘in house’ operational support, peer support and training. Our work highlights the benefit of recognising adaptive challenges in LTC and empowering teams to apply the most appropriate problem-solving solutions, and in particular applying adaptive solutions when merited.
EFFECT OF HOME CARE NURSES’ REMOTE CONSULTATION WITH ADVANCED NURSES ON PATIENT SYMPTOMS: A FEASIBILITY STUDY
Authors: Noguchi-Watanabe Maiko , Yamahana Reiko , Sunada Junko
Published: January 2025

Homecare nurses provide care for patients with a wide variety of illnesses, which requires a broad and comprehensive knowledge base. Simultaneously, symptom management requiring more specialized knowledge is required, and remote consultation with advanced nurses is expected. This study aimed to evaluate the effect of remote consultation by homecare nurses with advanced nurses on patient symptoms. Participants were homecare nurses in Japan. A remote symptom management consultation regarding specific cases was sought by ten homecare nurses. Consultations were provided thrice per case using Zoom at approximately one-month intervals by three advanced nurses: two wound, ostomy, and continence (WOC) care nurses and one cancer nurse. The research team selected the advanced nurse according to the case and coordinated the consultation schedule between advanced and homecare nurses. Before each consultation, we obtained responses from homecare nurses via a webform regarding patient who wanted to consult, their symptoms, and changes in symptoms since the previous consultation (worsening/maintenance/improvement). The study was approved by the Ethics Review Committee of the Tokyo Medical and Dental University. The WOC nurses provided consultations on six cases related to pressure ulcers, two, to stomas, and one, to nephrostomy management, while an advanced nurse specializing in cancer nursing provided consultation on one case related to decision-making support. Consultations took place three times per participant. Nine cases (90%) improved their symptoms, and 1 case (10%) remained unchanged before the consultation; It has been shown that homecare nurses who receive consultations from advanced nurses, even remotely, is effective in alleviating patients’ symptoms.
EXPLORING THE OPTIMIZATION PATH OF LONG-TERM CARE INSURANCE SYSTEM IN RURAL AREAS OF CHINA
Authors: Mi Hong , Si Wanwan
Published: January 2025

With the deepening of population aging and changes in family structure, the care needs of the disabled and mentally retarded older people have increased, and the problem of rural aging population has become more serious. In the face of the increasingly serious problem of rural aging, the improvement of the long-term care insurance system is the key to solving the problem of older people care in China. This paper focuses on the optimization path of the long-term care insurance system in rural areas of China, and researches from the aspects of the scope of coverage, assessment of incapacitation and payment of benefits, the management of the care model, and the content of the service. By analyzing the cost and expenditure situation of long-term care insurance in rural areas and the sustainability of its pilot program, combined with the data on the actual operation of long-term care insurance, this paper establishes a population-fund prediction model for the long-term care system, discusses the balance of inputs between medical care and daily life care, and provides targeted theoretical references and practical guidance for improving and perfecting the long-term care insurance system in rural areas of China.
STAFFING LEVELS IN OHIO’S NURSING HOMES, ASSISTED LIVINGS, AND MEMORY CARE UNITS: SHIFT VARIATION
Authors: Nelson Matt , Bowblis John , Menne Heather , Elliot Amy
Published: January 2025

In a nursing home (NH) or assisted living (AL), residents require assistance with activities of daily living and many of these residents also have cognitive impairments associated with dementia. As a result, many NHs and ALs have created dedicated memory care units (MCUs). This paper contributes to the literature on staffing in NHs and ALs by examining staffing levels for licensed nurses and other direct care staff for the overall facility and the 1 in 4 facilities that have MCUs on different shifts: day, evening, night. Data for this study come from the 2021 Ohio Biennial Survey of Long-Term Care Facilities. Staffing levels by shift were calculated as resident to staff ratios, which is the number of residents compared to number of staff by shift. Findings show that both NHs and ALs have their lowest resident-to-staff ratios, and hence most staff on the day shift (16.0 and 24.2 for licensed nurses and 10.4 and 14.2 for direct care staff, respectively). In both settings, the night shift staffing had the highest staffing ratios. Comparing the overall NH staffing to AL staffing, NHs have more staff per resident. However, on the MCU, NHs and ALs had more similar staffing levels. This suggests that NHs and ALs staff MCUs in a similar manner, but outside of the MCU, nursing homes staff better than ALs. The evidence can be used for decision making about future staffing policies.