bluuebunny/crossref_metadata_2025 huggingface dataset:
AGE-SPECIFIC DETERMINANTS OF PHYSICAL ACTIVITY ENGAGEMENT IN BREAST CANCER SURVIVORS: A MULTIGROUP ANALYSIS
Authors: Jung Mi Sook , Cui Xirong , Cha Kyeongin , Lee Ahrim , Park Eunyoung , Yeom Hyun-E
Published: January 2025

Physical activity is highly beneficial for breast cancer survivors. However, many survivors often have insufficient levels of physical activity due to fatigue, psycho-social barriers, limited knowledge, and low self-efficacy. These barriers vary in type and severity due to age-related factors, potentially leading to differences in physical activity levels and health-related quality of life (HRQOL). This study drew upon the Individual and Family Self-Management Theory to explore the interrelationships between contextual and process factors and proximal outcomes (physical activity, HRQOL). Community-dwelling 450 breast cancer survivors were recruited to assess cancer stigma, health literacy, social support, exercise self-efficacy, behavioral regulation, physical activity engagement, and HRQOL. Structural equation modeling and multigroup analysis with the moderating effect of age were performed. Greater stigmatization of cancer, lower social support, and worse behavioral regulation were directly associated with lower physical activity engagement while health literacy, behavioral regulation, and physical activity engagement had direct effects on HRQOL. Behavioral regulation mediated the association between contextual factors (stigma, health literacy) and physical activity. After confirming full measurement invariance between the groups, significant differences in factor loadings were found in specific pathways from contextual (stigma) and process factors (behavioral regulation, social support) to physical activity, highlighting age-related differences in how these factors interact. The findings underscore how complex patterns of contextual and process correlates influence physical activity in older and middle-aged women with breast cancer, respectively. The age-specific uniqueness should be considered when developing targeted strategies to promote active living and achieve optimal health in later life.
AGING IN PLACE WITH A WARMING CLIMATE: HOUSING POLICY AND DESIGN FOR AGING WITH EXTREME HEAT
Authors: Kain Nichole
Published: January 2025

Aging populations—particularly in areas prone to extreme heat—are facing unique residential challenges. In the past 10 years, extreme heat has killed more people in the United States (U.S.) than all other weather hazards combined, and it is expected to get hotter, with extreme heat events predicted to happen more often in the future. People over the age of 65 are disproportionately represented as the majority of heat victims, and are likely to perish in their own homes during these events. This study reveals that age-adaptive and climate-adaptive housing designs contribute to our quality of life and ability to survive as we age in a warming world. In addition to advancing our understanding of aging in places with extreme heat, this research offers two pieces of applied materials: A residential guide/handout for the general public that combines mitigation for both extreme heat and age-friendly design, as well as a policy research brief promoting the future development of energy efficient and age-friendly housing.
AN INTERNATIONAL COMPARISON AND CHINA’S REGIONAL DEVELOPMENT: EVALUATION OF QINGDAO’S LONG-TERM CARE POLICY
Authors: Song Huiru , Mi Hong
Published: January 2025

Qingdao is the first city in China to fully implement long-term care insurance, and its system has important reference significance for the healthy and equity development of the elderly population in Shandong Province. The policy divides long-term care insurance benefits into medical services and nursing services, with the medical service fee being 3,500 yuan per year for employees and 3,000 yuan per year for residents, and the nursing service fee being 18,000 yuan per year for employees and 5,000 yuan per year for residents. According to forecasts, the GDP of Shandong Province is expected to reach 14,145.63 billion yuan in 2035. Therefore, according to the ratio of one employee to two permanent residents, under the fixed disability rate program, the province’s disabled elderly population is 1,554,800, including 513,100 employees and 1,041,700 permanent residents, and under the variable disability rate program, the province’s disabled elderly population is 1,728,700, including 570,500 employees and 1,158,200 permanent residents. At the same time, under the fixed disability rate plan, the long-term care insurance expenditure in Shandong Province in 2035 will be 8826,153,360 yuan, accounting for 6.23/10,000 of GDP. Under the variable disability rate scenario, long-term care insurance expenditure is 981,3526,560 yuan, accounting for 6.937 per 10,000 of GDP, which is much lower than that of OECD countries. In the future, Shandong Province should implement precise positioning based on Qingdao’s policies and combine the regional characteristics of each city to promote long-term care insurance from wide coverage to full coverage.
ASSESSING READINESS OF BLACK OLDER ADULTS TO DISCUSS ADVANCE CARE PLANNING WITH THEIR SURROGATES
Authors: Akabike Ekenechukwu , Howe Rebecca , Agnoli Alicia , Bidwell Julie , Amadi Grace
Published: January 2025

Advance care planning (ACP) is a tool to identify health care goals in serious situations or if anticipating end-of-life circumstances. ACP is not always utilized by those who might most benefit from it and appears underutilized by black older adults for unclear reasons. This study explores 3 aims to better understand the readiness of black older adults to complete ACP including examining patient readiness to participate in ACP using the stages of change model, types of barriers and promoting factors to patient participation in ACP, and patients and surrogates’ concordance on ACP readiness. A sub-analysis explores how readiness for ACP participation varies based on the patient-surrogate relationship. A mixed methods design used surveys and qualitative interviews to assess black older adults aged 60 – 91 and their associated surrogate selected from outpatient clinics within an academic hospital and a local community church in Sacramento, CA. Participants included 30 older adult respondents with 12 surrogates consisting of 7 adult children and 5 spouses/partners. Results suggest variation of end-of-life care discussion readiness where 63% of surrogates report already completing this discussion but only 45% of patients with surrogates report similar findings. Variation also occurs with patient readiness to discuss end-of-life care with adult children (17% of patients with children surrogates report not thinking about having these discussions yet) compared to those with a spouse/partner surrogate (100% of patients with partners/spouses have already had discussions). Additional research may help increase understanding of themes of patient and surrogate readiness and engagement in ACP.
ASSOCIATION BETWEEN NEIGHBORHOOD PHYSICAL ENVIRONMENT SATISFACTION AND AGING ATTITUDES IN OLDER CHINESE ADULTS
Authors: Xu Sophie Zhijing , Zhao Dan , Mao Weiyu , Wang Jing , Yang Zhongfang , Zheng Yaguang , Wu Bei
Published: January 2025

With the aging population and increasing prevalence of chronic diseases in China, understanding the factors influencing aging attitudes among elderly individuals is crucial. This study examines the role of neighborhood environment satisfaction in shaping aging attitudes among elderly Chinese individuals with chronic diseases. Using data from the latest China Longitudinal Aging Social Survey (CLASS, 2020), demographic characteristics including gender, marital status, education level, residence type, employment status, and age were analyzed. Regression analysis explored associations between aging attitudes and satisfaction with various neighborhood environment factors, controlling for demographic variables. The sample included 7,111 participants aged 60 years and older. Among them, 5,574 (78.38%) had chronic diseases. Higher satisfaction with road conditions (β = 0.815, P < 0.001) and accessibility facilities (β = 0.339, P = 0.003) showed significant positive associations with attitudes toward aging in this group. Conversely, none of the neighborhood environment satisfaction factors were significantly associated with aging attitudes among older adults without chronic diseases. This study underscores the importance of neighborhood environment satisfaction in shaping aging attitudes among elderly Chinese individuals with chronic diseases. Creating age-friendly environments and tailored interventions can foster positive aging experiences and well-being in this demographic. These findings have implications for policymakers, urban planners, and healthcare professionals striving to create supportive environments conducive to healthy aging in rapidly aging societies like China.
ASSOCIATION BETWEEN WAIST-BASED ANTHROPOMETRIC INDICES AND MILD COGNITIVE IMPAIRMENT FROM THE KFACS
Authors: Lee Daehyun , Shin Hyung Eun , Jung Heeeun , Jang Jae Young , Cho Hyunjin , Lim Nahyun , Won Chang Won , Kim Miji
Published: January 2025

While several studies have explored the association between obesity and cognitive function in older adults, definitive evidence linking waist-based anthropometric indices to impaired cognitive function remains lacking. Our study aimed to investigate the association between the waist-based anthropometric indices and mild cognitive impairment (MCI) in older adults according to sex. We conducted a retrospective study on 1,192 community-dwelling older adults (51.8% women; mean age 75.1±3.6 years) from the Korean Frailty and Aging Cohort Study during a 6-year follow-up. The waist-based anthropometric indices at baseline include waist circumference (WC), waist-to-height ratio (WHtR), waist-to-weight ratio (WWR), and weight-adjusted-waist index (WWI). These indices were calculated as follows: WHtR= WC (cm) / height (cm), WWR= WC (cm) / body weight (kg), and WWI= WC (cm) /√(body weight (kg)). MCI incidence was measured from Wave 2 to 4, with MCI defined as Mini-Mental State Examination< 24. Multivariate logistic regression analysis was utilized to examine the association between these waist-based anthropometric indices and MCI, and restricted cubic spline curve was used to assess the potential nonlinear relationship. The incidence of MCI was 21.1% in men and 34.1% in women during 6-year follow-up (p< 0.01). The highest WWI quintile was significantly associated with MCI only in men (odds ratio: 4.49, 95% confidence interval: 1.39–14.47) in the fully adjusted models. However, no significant associations were found in WC, WHtR, and WWR. Our findings suggest that WWI is more strongly associated with MCI compared to other waist-based anthropometric indices in men, proposing its potential as a clinical indicator for MCI.
ASSOCIATION OF ALCOHOL CONSUMPTION WITH IMMUNE CELL PHENOTYPES IN THE FRAMINGHAM HEART STUDY
Authors: Ragab Ahmed , Chen Jiachen , Cao Yumeng , Doyle Margaret , Lunetta Kathryn , Murabito Joanne
Published: January 2025

Alcohol consumption, prevalent among 2.3 billion people worldwide, accounts for 4.7% of global mortality. While excessive drinking is harmful, moderate intake may have nuanced effects on immune function, though this relationship is not well-studied. We analyzed the relationship between average daily alcohol consumption and immune cell phenotypes among Framingham Heart Study Offspring participants. Consumption was examined in multiple ways: categorized and ordinalized (nondrinkers, moderate, at-risk, heavy), using average grams per day, and dichotomized as light vs heavy drinkers, with and without non-drinkers omitted. We profiled immune cell phenotypes using flow cytometry, including T, B, and NK cells, and T subtypes: CD4+, CD8+, CD4+CD28-CD27-, CD8+CD28-CD27-, CD4+ TEMRA, CD8+ TEMRA, CD4+/CD8+ ratio, CD4+(TN/TM), CD8+ (TN/TM), CD8+ Tc17/Treg ratio, CD4+ Th17/Treg ratio and GranzymeB CD8+/CD4+ratio. We used linear mixed effects models adjusting for age, sex, and cytomegalovirus status to test for associations, and FDR≤0.05 within an analysis set (defined by consumption definition) to declare significance. Among 928 participants (mean age 62 years, range 40-88, 52% female), 64% consumed alcohol. Compared to abstainers, CD4+(TN/TM) ratio was significantly increased in the moderate and at-risk daily consumption categories (β=0.26 for both, FDR=0.03). There were no significant linear associations between consumption and any of the immune cell phenotypes. However, among drinkers, we observed a significant negative association between average daily alcohol consumption and CD8+(TN/ TM) ratio (β= -0.14 for each higher category of consumption, FDR=0.03). The effects of consumption appeared stronger in males than females. Our findings suggest alcohol consumption may impact immune cell phenotypes.
ASSOCIATION OF CARDIOMETABOLIC RISK FACTORS AND TRANSITION OF DISABILITY STATUS AMONG CHINESE ADULTS
Authors: Pei Heming , Chen Gong , Li Jiajia , Liang Bo
Published: January 2025

Background

Chronic diseases significantly increase the risk of functional disability. Understanding the relationship between cardiometabolic risk factor (CMRF) comorbidities and transitions in disability status is crucial for devising early intervention strategies at the population level.

Method

This study utilized a prospective cohort design, drawing data from the China Health and Retirement Longitudinal Study (CHARLS) spanning from 2011 to 2018. A total of 6,397 Chinese middle-aged and older adults were followed for a total of 44,779 person-years. A Multi-state Markov model was employed to simulate longitudinal disability status transitions and to estimate the effect sizes of CMRFs, along with demographic, socioeconomic, and behavioral factors.

Results

Over the 7-year follow-up, CHARLS participants experienced an increased likelihood of transitioning from normal physical function to IADL (Instrumental Activities of Daily Living) impairment, rising from 7.6% to 11.0%. Moreover, the transition intensity from intact ADL (Activities of Daily Living) to IADL impairment was 2.5 times higher than that from intact ADL to ADL impairment. Unlike other chronic conditions, CMRFs particularly influenced ADL by significantly reducing the probability of recovery from ADL impairment to a better physical function state. Specifically, the probability of shifting from IADL impairment to intact ADL decreased by 30% (HR=0.70, 95% CI [0.53-0.92]) among individuals with two CMRF components.

Conclusion

The findings suggest that CMRFs act as risk factors by impeding the recovery process of ADL impairment. Early intervention targeting obesity, hypertension, hyperlipidemia, and diabetes could help reduce or delay the incidence of functional disability.
ASSOCIATION OF CREATININE- AND CYSTATIN-C–BASED INDICES WITH INCIDENT SARCOPENIA: A LONGITUDINAL STUDY
Authors: Jang Jae Young , Shin Hyung Eun , Lee Daehyun , Jung Heeeun , Cho Hyunjin , Lim Nahyun , Won Chang Won , Kim Miji
Published: January 2025

Creatinine and cystatin-C–based indices have been reported to be associated with sarcopenia; however, the long-term relationship between these indices and sarcopenia remains unclear. This study examined the longitudinal relationship between baseline serum creatinine and cystatin-C–based indices and incidence of sarcopenia during a 6-year follow-up to compare which indicator well predicts sarcopenia in community-dwelling older adults. This study included 698 participants (mean age=75.1±3.7years; women=54.4%) from the Korean Frailty and Aging Cohort Study (KFACS). Baseline Creatinine-to-cystatin-C ratio estimated glomerular filtration rate (eGFR) ratio (eGFRcystatin-C[mL/min/1.73m2]/eGFRcreatinine[mL/min/1.73m2]), sarcopenia-index (serum creatinine[mg/dL]×eGFRcystatin-C[mL/min/1.73m2]), predicted skeletal muscle mass index (pSMI), and total-body muscle mass index (TBMM) were measured. Sarcopenia was defined by following the guidance of the Asian Working Group for Sarcopenia 2019. The incidence of sarcopenia during 6-year follow-up was 22.5% in men and 16.7% in women. The pSMI and TBMM showed higher area under the receiver operating characteristic curves for predicting the incidence of sarcopenia in men (pSMI==0.634; TBMM=0.635) and women (pSMI=0.727; TBMM=0.724) than other indices. Higher pSMI and TBMM were associated with the incidence of sarcopenia in both men (pSMI, odds ratio [OR]=0.370, 95% confidence interval [CI]=0.223–0.614; TBMM, OR=0.928, CI=0.896–0.962) and women (pSMI, OR=0.149, CI=0.072–0.307; TBMM, OR=0.896, CI=0.857–0.936), after adjusting confounders. pSMI and TBMM showed higher predictive capabilities for the incidence of sarcopenia compared to other indices. Also, higher pSMI was strongly associated with a lower risk of incident sarcopenia. These findings suggest that monitoring pSMI could help predict the onset of sarcopenia in community-dwelling older adults.
ASSOCIATIONS BETWEEN 10-YEAR PHYSICAL FUNCTION TRAJECTORIES AND 24-HOUR ACTIVITY CYCLE BEHAVIORS IN OLDER ADULTS
Authors: Greenwood-Hickman Mikael Anne , Zhu Weiwei , Idu Abisola , Harrington Laura , McCurry Susan , LaCroix Andrea , Shaw Pamela , Rosenberg Dori
Published: January 2025

Physical activity (PA), sedentary behavior (SB), and sleep comprise an individual’s 24-hour activity cycle, which is likely bidirectionally associated with physical function over the life course. To explore how function predicts activity, we examined whether self-reported (activities of daily living [ADLs]) and objective (short Performance-based Physical Function [sPPF]) measures of physical function predicted PA, SB, and sleep in the Adult Changes in Thought (ACT) cohort. We fit linear mixed effects models to define trajectory slopes for each functional measure over the prior 10 years. We used multivariable linear regression to investigate the relationship between trajectories and device-measured PA and SB and self-reported sleep. Participants (N=905) were 77.6 (SD=6.9) years old, 55% female, 91% White, and reported impairment on a median of 1 ADL (IQR=[0,2]) with a median score of 9 (IQR=[8,11], higher=better functioning) on the sPPF at activity measurement. A steeper increasing slope of ADL impairment was associated with more sitting time (35.0 mins/day [4.3,65.0] per 0.4-unit increase in slope), longer mean sitting bout duration (3.5 min/bout [0.8,6.2]), fewer steps (-1372 [-2223,-638]), less MVPA (-13 min/day [-22.6,-5.0]), and more time in bed (25.5 min/day [6.5,43.5]). More steeply decreasing sPPF slope was associated only with steps and MVPA (-1180 steps [-2853,-185] and -15.7 min/day [-35.6,-2.3] per 0.3-unit decrease in slope). Standing time, Light-intensity PA, and self-reported sleep quality were not associated with either measure. Combined with prior literature suggesting associations with future function, these findings support the bidirectional nature of the relationship between the late-life 24-hour activity cycle and physical function.
ASSOCIATIONS BETWEEN PULMONARY FUNCTION AND PHYSICAL REHABILITATION OUTCOMES AMONG OLDER ADULTS
Authors: Mathis Lindsey , Sun Na , Ho Simon , White Lane , Addison Odessa , Savin Douglas , Falvey Jason
Published: January 2025

Physical rehabilitation is crucial for older adults with functional impairments, as persistent impairments are linked to increased risks of hospitalization, mobility disability, and mortality. Impaired pulmonary function and associated symptoms of dyspnea may limit participation in rehabilitation programs, but it is unclear whether these impairments negatively impact outcomes. To answer this question, our analysis included 819 community-dwelling rehabilitation users (63% female; weighted n=3,882,191) from Round 5 (2015) of the National Health and Aging Trends Study (NHATS). Peak expiratory flow (PEF) categorized participants into “normal,” “moderately impaired,” or “severely impaired” lung function. Participants reported whether they met rehabilitation goals during their latest episode of care (yes/no). Multivariable survey-weighted logistic regression, adjusting for demographics and medical complexity, was used to estimate these relationships. In our sample, 71% had normal PEF, 22% had moderate PEF impairment, and 7% had severe PEF impairment. Severe impairment had 57% lower odds (aOR=0.4, 95% CI 0.2-0.9) and moderate impairment had 35% lower odds (aOR=0.6, 95% CI 0.4-1.0) of meeting rehabilitation goals compared to normal PEF. Similar trends were observed when limiting rehab users to only musculoskeletal condition (e.g., joint replacement). This study found that nearly 4 million older adults in the U.S. use rehabilitation annually, with 29% having impaired lung function. Our data suggest impairments in PEF may limit progress with rehabilitation, even for those with musculoskeletal indications, and thus suggests care pathways to more optimally manage older adults with limited lung function in rehabilitation settings may be needed to help them achieve their goals.
ASSOCIATIONS OF MEAN COGNITIVE PERFORMANCE AND INTRAINDIVIDUAL VARIABILITY WITH WHITE MATTER LESIONS
Authors: Urias Uriel , Thomas Kelsey , Garcia Mary Ellen , Gonzalez Amanda , Luu Britney , Gutierrez Victoria , Bangen Katherine
Published: January 2025

White matter lesions (WMLs) are magnetic resonance imaging markers of small vessel cerebrovascular disease and have been associated with Alzheimer’s disease and related dementias. Intraindividual variability (IIV), often measured as variability in performance across neuropsychological tests at a single time point, has emerged as a sensitive marker of early cognitive difficulties that may have utility beyond measures of mean neuropsychological performance (MP). However, the associations of IIV with neuroimaging variables remains understudied. This study included 70 older adults without dementia (mean age=68.57) who completed a comprehensive neuropsychological battery and underwent MRI brain scans. WMLs were adjusted for estimated total intracranial volume and transformed to reduce skew. Linear regression models examined the associations of IIV, MP, and WMLs both across and within the cognitive domains of memory, attention/processing speed, and executive function. Covariates included age, sex, and education. IIV showed no significant association with WMLs, neither within nor across the domains examined (all p’s>.05). In the domains of memory (B=-.035, p=.025), executive function (B=-.039, p=.018), and in global cognition (B=-.065, p=.003) lower MP was associated with more WMLs. In the attention/processing speed domain, MP was not significantly associated with WMLs (all p’s >.05). The present study only examined cross-sectional data, so future studies should re-evaluate the associations with IIV, MP, and WMLs longitudinally. While the small sample size may limit the generalizability of this study, these findings suggest that measures of MP may better reflect WMLs relative to measures of IIV.
BEREAVED DEMENTIA CAREGIVERS MAKE MEANING THROUGH RELIGION IN A PHOTO-ELICITATION INTERVENTION
Authors: Yang Annabelle , Bogdewiecz Taryn , Benson Jacquelyn , Washington Karla , Rolbiecki Abigail
Published: January 2025

Many persons living with dementia (PLWD) rely on informal caregivers, who undergo extensive personal upheaval approaching and after end-of-life for their PLWD. To promote successful adaptation in bereavement, caregivers can engage in a process of meaning making as they make sense of their loss, find “silver linings” in their experiences, or undergo shifts in identity. Religious and spiritual coping can facilitate this meaning making. Prior evidence has found that successful meaning making improves bereavement outcomes, reducing risk for grief complications. Caregiver Speaks is an intervention designed to facilitate such meaning making in caregivers of PLWD through photo-elicitation, whereby hospice family caregivers share stories and images narrating their experiences within a private Facebook group during active caregiving and bereavement. The purpose of the current study was to explore how caregivers from the bereavement arm of the Caregiver Speaks project made meaning of their experiences. Participants were recruited from hospices across the Midwest and Northeast US. A deductive and inductive qualitative analysis of Facebook posts was performed by two independent coders. They engaged in consensus coding to refine and categorize codes into themes. Religious and spiritual coping was a primary theme, as caregivers expressed feelings of peace knowing their loved ones were in Heaven, hope for the future because God has a plan, and comfort in scripture. Others described inner peace found in nature or meditative practices that provided comfort. These findings hold promise for meaning making interventions designed to facilitate religious and spiritual coping to improve bereavement outcomes.
BLOOD BIOMARKERS ASSOCIATED WITH POSTOPERATIVE DELIRIUM INCIDENCE, SEVERITY, DURATION AND SUBTYPE
Authors: Lee Hyangkyu , Cho Hyeonmi , Choi Jeongeun , Park Hyunki
Published: January 2025

To evaluate the associations of neurological biomarkers —specifically tau, phosphorylated tau, amyloid β40, amyloid β42, amyloid β42/40 ratio, glial fibrillary acid protein (GFAP), neurofilament light (NfL), and brain-derived neurotrophic factor (BDNF) —with the incidence, severity, duration, and subtype of postoperative delirium. In a group of patients over 70 years old who had spine surgery, delirium patients (n=95) and non-delirium patients (n=95) were matched 1:1 with propensity score matching using demographic, lifestyle, and clinical characteristics. Neurological biomarkers were measured after collecting peripheral blood samples immediately after the surgical procedure in the recovery unit. Delirium was observed twice a day from the first to the third postoperative day, and once a day thereafter. Although there were no significant associations between biomarkers and the incidence of postoperative delirium, patients who developed postoperative delirium, each 1 standard deviation increase in NfL was associated with a 1.51 increase in the peak DRS-R-98 severity score (95% confidence interval: 0.07 to 2.95). Each 1 standard deviation rise in GFAP and NfL was associated with an odds ratio of 2.08 (95% confidence interval: 1.15 to 3.74) and 2.35 (95% confidence interval: 1.13 to 4.92), respectively, for delirium duration of 4 days or more. The odds ratio for the hypoactive subtype of delirium increased by 1 standard deviation in A□42 (95% CI: 1.28 to 6.66). Our study demonstrated that blood biomarkers could be useful in predicting the severity, duration, and subtype of postoperative delirium among older adults.
BRIDGING GAPS IN GERIATRIC EXPERTISE: OREGON ECHO NETWORK’S IMPACT ON INTERPROFESSIONAL EDUCATION AND CARE
Authors: Brandis Leah , Herreid-O’Neill Anders , Abbott Maryan Carbuccia , Byerly Laura , Slingerland Kerri Smith
Published: January 2025

The United States faces a critical shortage of healthcare professionals trained in geriatric care, exacerbated by a rapidly aging population. In response to this pressing need, the Oregon ECHO Network (OEN) has forged partnerships with local and statewide organizations to pioneer a series of ECHO programs aimed at disseminating geriatric care principles across diverse care settings. Over six years, the network’s reach has expanded from primary care to encompass post-acute and long-term care communities, culminating in a portfolio of geriatric care ECHO courses. This presentation will share results from an Older Adult ECHO Impact Report covering 28 cohorts of 11 different older adult-related ECHO programs since 2018. OEN has engaged more than 50 faculty and guest speakers and 881 registrants for older adult health care education alone. Faculty panels are interdisciplinary and have included prescribing clinicians, such as physicians and nurse practitioners, along with occupational therapists, pharmacists, registered nurses, behavioral health professionals, physical therapists, peer support specialists and others. Emergent themes, ongoing gaps, lessons learned and program impacts will be shared from participant surveys and interviews. Highlighted are new collaborations with the Oregon Center of Excellence for Behavioral Health & Aging and the Geriatric Workforce Enhancement Program, underscoring efforts to address gaps in geriatric expertise through innovative educational models.
CANDIDACY 2.0-UNRAVELING HEALTH INEQUITIES IN CHRONIC CONDITION CARE ACCESS
Authors: Koehn Sharon , Jones C Allyson , Barber Claire , Jasper Lisa , Pham Anh , Lindeman Cliff , Drummond Neil
Published: January 2025

The Inverse Care Law, positing that those most in need of healthcare are least likely to receive it, continues to describe persistent health inequities among older adults with chronic conditions. This study introduces Candidacy 2.0 (Chronic Condition (CC)), an innovative framework designed to unravel the complex mechanisms of these inequities in healthcare access for diverse older adult populations. Using Critical Interpretive Synthesis, we analyzed qualitative and mixed methods literature on rheumatoid arthritis experiences across various populations, including racial and ethnic minorities, LGBTQI+ individuals, and those with disabilities. Our key finding was the identification of a crucial eighth dimension: the “embodied relational self,” which transforms the framework into a powerful tool for understanding intersectional experiences of health inequity. Candidacy 2.0 (CC) offers a comprehensive understanding of how patients’ and care providers’ experiences are shaped by systemic injustices and social determinants of health. By integrating approaches like intersectionality, concordance, and recursivity, this model provides a new lens to conceptualize and address health disparities in chronic condition management for older adults. The framework’s significance lies in its potential to guide the development of culturally relevant health promotion and intervention efforts, offering concrete explanations for access challenges rooted in socially patterned influences. Our findings have substantial implications for enhancing health equity in geriatric healthcare delivery, informing policy, and driving further research. By implementing Candidacy 2.0 (CC), stakeholders can develop targeted interventions that address the unique healthcare needs of diverse older adults, working towards eliminating disparities across the life course.
CARDIOVASCULAR DISEASE RISK AND FALLS IN MEN AND WOMEN LIVING WITH AND WITHOUT HIV: MACS/WIHS COMBINED COHORT STUDY
Authors: Vasquez Elizabeth , Kuniholm Mark , Appleton Allison , Sharma Anjali , Yin Michael , Brown Todd , Tien Phyllis , Gustafson Deborah
Published: January 2025

Falls risk assessment tools underestimate the risk among People Living with HIV (PLWH). The aim of this cross-sectional analysis was to measure associations between American College of Cardiology/American Heart Association (ACC/AHA) 10-year cardiovascular disease (CVD) risk scores and history of falls in a multi-center United States cohort of PLWH and similar people living without HIV (PLWOH). CVD risk was categorized as low, borderline, intermediate and high (< 5%, 5-7.4%, 7.5-19.9% and ≥20%, respectively) and history of falls was ascertained using a standardized protocol across study sites. Among n=2728 participants (Men, n=939, 578 MLWH/361 MLWOH; (Women, n= 1789, 1274 WLWH/515 WLWOH), median ages were 58 (IQR:51-65) and 55 (IQR:49-60) years for men and women, respectively. Median CVD risk within 10 years was 11% (IQR:6%-18%) and 5% (2%-11%) for men and women, respectively. All analyses were adjusted for age and stratified by sex and HIV status. Higher CVD risk was associated with increased history of falls (high vs low CVD risk: OR=2.31; 95%CI:1.16,4.62; intermediate vs low CVD risk OR=2.13; 95%CI:1.11,4.07) among MLWOH. Findings were similar in MLWH after adjustment for CD4+ T cell count and HIV-1 RNA detectability (<=200). In WLWH, only high CVD risk was associated with falls (OR:1.76; 95%CI:1.13,2.7), while among WLWOH, no association of CVD risk with falls was observed when compared with a low-risk score (< 5%). Results suggest CVD risk scores may be beneficial to guide providers’ lifestyle or clinical management recommendations to decrease risk of falls and preserve and/or improve quality of life among MLWOH, MLWH, and WLWH.
CARE TRANSITION EXPERIENCES OF HISPANIC PATIENTS WITH DEMENTIA FOLLOWING EMERGENCY DEPARTMENT DISCHARGE
Authors: Sandoval Jacqueline , Brook Juliette , Lien Zoe , Monin Joan , Gettel Cameron , Hagaman Ashley , Hwang Ula
Published: January 2025

Older patients report fragmented emergency department (ED) care, including insufficient communication with clinicians and inadequate referrals to outpatient care and social services. These challenges are likely even greater for those with cognitive impairment (CI) and their care partners (CPs) and especially for non-English speaking populations, where language differences bring additional challenges. This study seeks to fill a gap in the literature by exploring ED discharge care transition experiences for Hispanic patients with dementia. Ten dyads - consisting of a patient with CI or dementia diagnosis and their CP - were enrolled in the ED and completed semi-structured interviews (via video or telephone) 1 week later addressing their ED and post-discharge experiences. Interviews investigated participants’ experiences in the ED and subsequent care transitions back to the community. Interviews were recorded, transcribed and coded by three research team members for thematic content, adopting a combined deductive-inductive approach until thematic saturation was reach across all dyads. Prespecified codes were adapted using the National Quality Forum’s Quality Measurement Framework on ED Transitions of Care and included eight outcomes for ED transitions of care: accessibility of services, shared decision-making, connection and alignment, care coordination, information sharing/communication, safety, healthcare utilization/costs, and experience of care. Key study findings emphasize patient and care partner priorities of shared decision-making with the ED treating team, how patients and care partners manage language barriers and cognitive impairment challenges and identifying factors that either support or hinder the quality and safety of ED discharge care and transitions back home.
CARE TRANSITIONS FROM HOSPITAL TO HOME: PERSPECTIVES FROM OLDER ADULTS, CAREGIVERS, AND HEALTHCARE PROFESSIONALS
Authors: Alotaibi Taghreed , Sixsmith Judith , cetnarskyj roseanne , Fang mei
Published: January 2025

Background

Saudi Arabia switched from hospital-focused to home-based care for older persons with long-term care needs due to a 25% increase in acute hospital bed occupancy for non-acute older adults. Healthcare professionals, older adults, and families are affected by the change in the care transition. Improvement in health outcomes depends on understanding all three groups.

Aim

This study aims to investigate the hospital-to-home transition of older adults with chronic conditions. The objective is to identify factors that facilitate or hinder the transition, with the aim of improving care during this critical phase.

Methods

The research employed a descriptive case study analysed with thematic analysis and an institutional ethnography. Pre- and post-discharge data were obtained from older adults, carers, and healthcare workers at King Saud Medical City using semi-structured interviews, focus groups, participatory observation, and documentary analysis.

Findings

The findings indicate that culture, family, and national healthcare policies play a crucial role. Older adults and their caregivers encounter obstacles during the transition process, including gender segregation causing difficulties with care coordination. The lack of standardised post-discharge follow-up and fragmented care provision further contribute to these hurdles.

Conclusion

The research recommends creating a unified administration system as a necessary foundation for solving the largest problems in the transition. This may help Saudi Arabia’s care policymakers and planners create a family-centred healthcare system. Future research should focus on targeted strategies to improve the care transition experiences of older adults and their caregivers.
CELEBRATING THE 100TH DAY OF SCHOOL: PILOTING AN AGEISM-REDUCING TOOLKIT FOR PREK TO SECOND GRADERS
Authors: Newsham Tina , Hancock Cynthia , Alston Daniel , Borrero Lisa , Nikzad-Terhune Katherina , Tesar Sarah , Fugate-Whitlock Elizabeth
Published: January 2025

Upon learning that some celebrations of the 100th day of school involve young children dressing up “like a 100-year-old,” our team questioned the ageist ideas this activity could reinforce. Children adopt beliefs about various social groups at an early age. They are inundated with ageist messages through books, TV, and other sources and internalize those ideas without questioning them. Those who hold negative views of aging live, on average, 7.5 fewer years than those who hold positive views. To prevent negative outcomes, children must be taught accurate and positive information about aging and older adulthood from an early age. The purpose of our research project is to provide teachers with evidence-based educational materials related to aging (centenarians in particular). We created a toolkit about aging and ageism to give PreK and elementary teachers options for celebrating the 100th day of school in a way that reinforces academic content while supporting age-inclusivity. The toolkit includes lesson plans celebrating centenarians. We used a mixed-method approach to pilot test the toolkit with 40 teachers and obtained a complete data set from 25 of them. Quantitative data were collected pre- and post-pilot using the 12-item Expectations Regarding Aging Survey. Qualitative data were collected through online pre-and post-pilot survey questions and post-pilot semi-structured interviews. We provide details on the toolkit and findings from the pilot study, which revealed a statistically significant improvement in expectations about aging (p< 0.05) and strong qualitative support for the value of the toolkit.
COMBATING AGEISM: EVALUATING THE IMPACT OF AN AGE-POSITIVE TRAINING IN HEALTHCARE
Authors: Lester Barbara
Published: January 2025

Ageism among health and social service providers can have a negative impact on the services and outcomes for older adults navigating these systems. The U.S. population aged 65 and older is expected to nearly double by 2060, underscoring the need to address ageism in healthcare. To address this issue, this study explored the impact of “Building Momentum with Age Positive Teams,” an evidence-informed one-hour employee assistance training program designed to reduce ageism and foster an age-positive culture among healthcare employees. The program, adapted from the “Ending Ageism Together” workshop, was implemented from December 2023 to June 2024 at Intermountain Health, a health system with almost 70,000 employees. A total of 76 participants participated in the training and completed both the pre-test and immediate post-test, showing a significant improvement in the total score on the Expectations Regarding Ageing Scale (ERA-12) (p < 0.0001). Furthermore, 38 participants also completed a third follow-up post-test administered 30 days after completing the program. Findings indicated that there were sustained significant improvements from pre-test to both immediate post-test and 30-day post-test (p < 0.0001). The study’s findings highlight the potential effectiveness of targeted educational and workforce development interventions in reducing ageism, promoting more inclusive healthcare practices, and aligning with broader goals of reframing aging narratives. Additionally, findings demonstrated that although knowledge about aging improved, retention of this knowledge varied over time across participants. These results support the ongoing need for educational strategies that combat ageism and promote positive attitudes towards aging in healthcare.
COMMUNITY ENGAGEMENT, SOCIAL SUPPORT, AND RELATIONSHIP DYNAMICS AMONG OLDER ADULTS POST-COVID-19
Authors: Chen Limei , Yan Mengzhao , Rozario Philip
Published: January 2025

Social integration theory and social capital theory suggest the positive effect of community participation and the benefits of social connections gained in the community on health and wellbeing in later life. However, it is unclear whether these positive effects persist under the social restrictions imposed by the COVID-19 pandemic. To understand if the benefits of community participation can withstand such unprecedented disruptions, this study explores how community participation influences spousal/partner relationships, physical health, and mental health among older adults before and after COVID-19. Using linked data of the National Social Life, Health, and Aging Project (NSHAP) Round 3 and Covid-19 Study, we assess the impacts of volunteering, attending meetings, and religious activities using multinomial regrenssion models. Findings reveal that community participation, particularly volunteering and attending meetings, is strongly associated with improved relationship outcomes, even under stress from events related to the COVID-19 pandemic. Religious activities also support better relationships, especially when stressful events are present. While social support further enhances these positive effects, it can diminish the independent benefits of volunteering. For physical and mental health, community engagement serves as a protective factor, mitigating the adverse effects of stressful events. These results underscore the crucial role of active community involvement in promoting well-being and maintaining positive spousal/ partner relationship dynamics among older adults, highlighting its importance as a buffer against stressful events.
COPING WITH PERSISTENT NURSING HOME CHALLENGES: TEAM FUNCTIONING STRATEGIES TO EMPOWER DIRECT CARE WORKERS
Authors: Boakye Alfred , Morgan Jennifer
Published: January 2025

Nursing homes continue to experience staffing shortages, heavy workloads, poor quality indicators, and infection control challenges. Increasing levels of acuity and numbers of residents with challenging behaviors requires high-functioning teams in order for nursing homes to deliver high-quality person-centered care. Extant literature has described the benefits of developing and building teams to reduce staff conflict, reduce staff turnover and absenteeism, improve financial outcomes, and increase quality of care, motivation, and job satisfaction. Team functioning and improved communication can play a crucial role in delivering positive resident care outcomes. The aim of this study was to identify strategies that nursing homes can use to improve team functioning and communication in service of improved resident outcomes. Using a phenomenological qualitative approach with semi-structured interviews, twenty-five (25) nursing assistants were recruited from two high-quality nursing centers to understand team-related coping strategies adopted in order to combat persistent stressors. Interviews lasted 30-45 minutes. Interviewees were predominately Black (23), women (23), and had modal age range of 41-50 years old. Results of the analysis suggest that strategies such as formalizing team structures, dismantling cliques, encouraging the use of collaboration strategies, and tailoring check-in options for individual workers within teams (e.g., emails, phone calls and daily huddles) are critical to maximizing team functioning. These themes support our recommendation that nursing home leaders could profitably implement trauma-informed approaches to build more resilient teams. Trauma-informed principles such as safety, choice, collaboration, trustworthiness and empowerment offer values that can be infused into positive work cultures and support high-functioning teams.
DIFFERENCES IN HOME HEALTH SERVICES AND OUTCOMES FOR MEDICARE ADVANTAGE PLANS WITH EPISODIC VS. PER-VISIT PAYMENTS
Authors: Prusynski Rachel , D’Alonzo Anthony , Johnson Michael
Published: January 2025

For millions of older adults receiving home health (HH) services annually, those with Medicare Advantage (MA) plans receive fewer visits and have worse functional outcomes compared to similar patients with Traditional Medicare (MA) plans. However, the thousands of MA plans available to beneficiaries are not created equal. MA plans with episodic payments have fewer administrative restrictions for HH providers than MA plans that pay per visit. This study of 285,297 HH episodes from 2019-2022 used robust inverse probability of treatment weighting to detect differences in HH service provision and patient outcomes between TM, episodic MA, and per-visit MA plans. Patients with both MA plans had shorter HH episodes and fewer visits from nurses, physical, occupational, and speech therapists, and home health aides than TM. Compared to TM, patients with episodic MA were less likely to improve in mobility and self-care function (Odds ratio [OR] 0.92 and 0.94, respectively) but had lower rates of inpatient admissions during HH (OR=0.95). Patients with per-visit MA had higher rates of community discharge (OR=1.06) and inpatient admissions (OR=1.06) than TM. Per-visit MA plans had higher rates (OR=1.12) of inpatient admissions than episodic MA. While both MA plans provide fewer HH services than TM, outcomes for MA plans versus TM are mixed depending on the MA plan payment structure. However, when comparing MA plans, per-visit plans have higher rates of inpatient admissions than episodic plans, a negative patient outcome. HH providers negotiating with MA plans should prioritize episodic payments to maximize outcomes and reduce administrative burden.
EFFECTS OF DISCRIMINATION ACROSS THE LIFE COURSE: A CASE STUDY OF NARRATIVE METHOD ON TAIWANESE MOVIE BANANA PARADISE
Authors: HSU Sheng-Chin
Published: January 2025

The effects of discrimination across the life course are one of the products from the cumulations of diverse individuals and groups. This paper aims to present the results of effects of discrimination across the life course on Taiwan movie “Banana Paradise” through a narrative theory. “Banana Paradise” expressed the changes of main character in his life course, and showed diversity of his identity and discrimination via these changes during 1949 to 1989. The main objective is to offer an alternative to understand what effects of discrimination are constructed by the shifting across the life course and at the same time to show how effects of discrimination were embodied by interactions with others across one’s life course.