bluuebunny/crossref_metadata_2025 huggingface dataset:
CONTENT AND QUALITY OF CHATGPT AS A SOURCE OF DEMENTIA INFORMATION: COMPARATIVE ANALYSES
Authors: Dosso Jill , Kailley Jaya , Angus Payton , Robillard Julie
Published: January 2025

There is significant demand for easily accessible, reliable online health information from older adults and their families (Soong et al., 2020). Online information about Alzheimer’s Disease and dementia ranges in quality from misleading and predatory to supportive and evidence-based (Robillard & Feng, 2016). ChatGPT was released to the public in November 2022 and is a well-known example of a new class of online tools, Large Language Models, which are generative artificial intelligence systems that can produce fluent, coherent answers to users’ questions based on extensive training data. In this work, we use a validated evaluation tool (Robillard et al., 2018) to evaluate the quality and content of information about dementia from ChatGPT-3.5 at two time points (2023, 2024) and from two versions of the model (free GPT-3.5, paid GPT-4). Prompts were developed using questions extracted from the FAQ pages of national dementia organization websites in Canada, USA, and Mexico. We found that all versions of ChatGPT were unbiased, remind the user to speak to a physician, and took an appropriately balanced tone. GPT-4, unlike GPT-3.5, links to specific, identifiable, dated sources for its claims including scientific research. All forms of ChatGPT had a high Flesch-Kincaid Grade Level, indicating moderate readability. Results indicate that ChatGPT, particularly GPT-4, can be a relatively high-quality source of dementia information for non-expert users. However, it is limited in its ability to link users to local resources. Findings can inform older adults, care partners, and healthcare professionals in their decision-making around use of this new tool.
NURSING HOME ADMISSION FROM RESIDENTIAL CARE FACILITY: NATIONAL HEALTH AGING TRENDS STUDY (NHATS) 2011–2019
Authors: Son Jung Yoen , Marriott Deanna J , Struble Laura , Weiyun Chen , Larson Janet
Published: January 2025

Limited studies have examined risk factors for nursing home admission among residents in residential care facilities (RCF), and prior research is limited by short follow-ups, which are insufficient to observe changes in health and nursing home admission. This study aimed to (1) identify baseline factors associated with transfers to a nursing home and (2) identify time-varying factors associated with transfer to a nursing home over 8 years, using a national dataset from the National Health Aging Trends Study (NHATS) collected between 2011 and 2019. We conducted Cox proportional hazards regression to examine candidate predictors (chronic conditions, hospitalization, sleep disturbances, mental health, physical performance, difficulties in activities of daily living (ADL), self-reported health, social and physical activity, and sociodemographic) associated with nursing home admission. Employing backward elimination, we built parsimonious final models for analysis. The analytic sample included 970 participants (mean age at baseline=85.7 years, 67.2% women, 83.1% White, mean length of stay at baseline=2.3 years) and 143 had transferred to nursing homes over 8 years. Those who had better physical performance at baseline (HR=0.83,CI=0.79-0.88) and were college educated (HR=0.58,CI=0.37-0.86) demonstrated a significantly lower risk for nursing home admission over 8 years. Residents who maintained physical activity (HR=0.56,CI=0.37-0.86), better physical performance (HR=0.87,CI=0.80-0.94), and fewer ADL difficulties (HR=1.13,CI=1.02-1.26) were at lower risk for nursing home admission over 8 years. Our findings can assist in identifying older adults in RCFs at risk of nursing home admission. Strategies to promote physical function and physical activity could be helpful to avoid/delay such admission.
THE COGNITIVE DECLINE TOWARD DEMENTIA AMONG NURSING HOME RESIDENTS
Authors: Hayajneh Audai
Published: January 2025

A scarcity of studies have examined the factors associated with mild cognitive impairment (MCI) as well as moderate cognitive impairment-as considered as dementia- among nursing home residents (NHRs). The aim of this study was to recognize the nature of relationship between the health risk variables, such as comorbidities, length of stay at hospital, the quality of life, the occurrence of depression, disability, and frailty, and dementia in NHRs. The study deployed cross-sectional design, using a convenient sample of 182 nursing home residents. The settings of the study were in the middle region of Jordan. Both stages of the MCI and dementia were determined through Montreal cognitive assessment (MoCA). Bivariate and multivariate analyses were utilized to explore the relationship between the health risk variables, and each of the MCI and dementia. There were significant differences between the stages of cognitive impairment (The MCI and dementia) in terms of age, the quality of life, comorbidities, depression, frailty. The variation in mental ability scores was dependent on the marital status of the participants, the monthly income, recently hospitalized, the level of depression, and frailty among older adults residing at nursing homes. The results of this study contribute significantly to building a healthcare management protocol to deal with nursing home residents with depressive symptoms as well as the deferral of the trajectory of development of dementia among those risky residents.
A MODIFIED MULTIFACTORIAL INTERVENTION FOR OLDER ADULTS WITH DIFFERENT KNEE OSTEOARTHRITIS SEVERITY
Authors: Aree-Ue Suparb , Roopsawang Inthira , Saraboon Natthayawadee
Published: January 2025

Knee osteoarthritis (OA) is a common health condition affecting older adults’ health worldwide. Several modalities to mitigate disease severity have been implemented; however, whether those interventions benefit all stages of disease severity has not been explored. This quasi-experimental study aimed to compare the effect of a modified multifactorial intervention program on health outcomes between older adults with mild and moderate knee OA severity. Ninety prospective participants who met the inclusion criteria were assigned into Group 1 (mild symptoms) or Group 2 (moderate symptoms). The modified multifactorial intervention program—health education about knee OA, weight control, quadriceps exercise, and home visits—was delivered to both groups lasting 12 weeks. The health outcomes (weight, psychological well-being, muscle strength, and knee OA severity) were assessed at baseline, 8-, and 12-week after enrollment using standard self-reported questionnaires and a 30-second sit-to-stand test. Data were analyzed using descriptive, independent-t-test, MANCOVA, and repeated measure MANOVA. Results revealed that the remaining 85 participants’ age ranged from 60 to 85 years, with a mean age of 68.8 years (SD = 8.6 years); almost were females (95.2%; n = 79). Although knee OA severity and psychological well-being significantly differed between the groups at baseline, there was no interaction effect on other dependent variables. Weight and muscle strength evaluated by a 30-second sit-to-stand test has no significant difference between groups. Results can be concluded that the modified multifactorial intervention program is beneficial to promote better knee joint function and health among older people with mild and moderate knee OA.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE SELF-MANAGEMENT USING TECHNOLOGY IN DAILY LIFE: A PILOT STUDY
Authors: Woo Seoyoon , Ferrell Anastasiya , Chulak Jamy
Published: January 2025

Rationale

Self-management is crucial to preventing lung function decline and improving the quality of life but is rarely performed daily in people with chronic obstructive pulmonary disease (COPD). During the COVID-19, they were forced to use telemedicine and telerehabilitation for support. However, the extent to which such technology is used to manage COPD remains unknown. This study aimed to examine the use of technology for COPD self-management and its barriers and facilitators.

Methods

A cross-sectional study using an online survey method was conducted. People with COPD(N=102; mean age=44years) completed a set of questionnaires, including the Self-Management Assessment Scale and the Media and Technology Usage and Attitudes Scale, and open-ended questions. Descriptive statistics, multiple regressions, and the interpretative thematic approach were used to analyze the data.

Results

Compared to mobile device usage(94.2%), only 3.9% used it to self-manage COPD. However, over 60% expressed a willingness to use mobile apps for self-management. eHealth literacy significantly predicted both Media and Technology Usage(β=0.70,p=0.001) and Attitudes(β=0.20,p< 0.001). COPD self-efficacy significantly predicted all five domains of self-management needs: knowledge(β=0.33,p=0.003), goals for future(β=0.36,p=0.02), daily routines(β=03,p=0.004), emotional adjustment(β=0.53,p< 0.001), and social support(β=0.51,p=0.02). Barriers to using mobile apps included their reliability, forgetfulness, and usability, just to name a few. Mobile apps for COPD self-management can be more attractive if they feature monitoring and recording of symptoms and provide relevant resources.

Conclusion

This study identified factors influencing the use of technology for COPD self-management. The findings can be considered in designing self-management intervention tools to help better manage COPD.
OLDER AGE AND DEPRESSION AS THE RISK FACTORS FOR HYPERTENSION AMONG NORTH KOREAN DEFECTORS
Authors: Chu Sang Hui , Kim Oksim , Kim Hokon
Published: January 2025

Observations indicate a low obesity prevalence among North Korean Defectors (NKRs), who fled to South Korea, attributed to undernourishment prior to their arrival. With an aging NKR demographic, there’s growing concern over chronic disease management, including hypertension. Previous studies reported a high or comparable prevalence of elevated blood pressure among NKRs, yet the influence of mental health on hypertension has been underexplored. Given the high rates of trauma-related conditions and depression within this group, these factors could significantly elevate hypertension risk. Understanding hypertension risk factors across different age groups could inform tailored management strategies for older NKRs. This study assessed the impact of mental health on hypertension among 449 NKRs categorized into three age groups: younger (< 30 years; n=141), middle-aged (40-59 years; n=243), and older (≥ 60 years; n=65). The assessment of Post-Traumatic Stress Disorder (PTSD)/complex PTSD (CPTSD) employed the International Trauma Questionnaire (ITQ), covering six domains: re-experiencing, avoidance, sense of threat, affective dysregulation, negative self-concept, and disturbance in relationships. Hypertension and depression were identified through self-reported diagnoses. Logistic regression analysis revealed that, in addition to older age, depression was significantly associated with hypertension, but not PTSD/CPTSD, after controlling for gender, living alone, and residency period in South Korea. These findings suggest the necessity of prioritizing mental health improvement, especially depression, in hypertension management among NKRs. This work was supported by the Basic Science Research Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Education (2019R1I1A2A01058746).
OUTCOMES OF AN INTEGRATED HEALTH CARE AND COMMUNITY PROVIDER INTERPROFESSIONAL TEAM
Authors: Drost Jennifer , Hughes Michelle , Fosnight Sue , Marchiano Joseph , Hazelett Susan , Gareri Michele , Chrzanowski Brandi
Published: January 2025

Traditional medical care accounts for 10% of health outcomes, while social determinants of health account for over 60%. To address complex interactions between medical illness, social and behavioral health issues, and medications, effective care requires collaboration between medical and community-based providers. We have developed a collaborative interprofessional model of care between a health system and the local Area Agency on Aging (AAoA) called the Care Management Interdisciplinary Team (CMIT). CMIT care managers (social workers and nurses) complete evaluations of consumers focused on concerns around recent health care utilization (ED visits/hospitalizations), falls, medications, home safety, and behavioral health concerns. Care managers (CM) then present these complex older adults to the team, including geriatric medicine and pharmacy specialists, which develops care plans that are implemented by the CM and the consumer’s primary care physician. CM presented cases between January-December 2023 and worked to follow up at 3 months. Eighty-one consumers were presented to the CMIT team over a 1-year period. A 3-month follow up is available for 44 consumers (54%). Of those with 3-month follow ups, at baseline, 10 (23%) consumers had recent health care utilization episodes, 17 (39%) had concerns about falls, 17 (39%) had concerns about medications, 21 (48%) had home safety concerns, and 10 (23%) had behavioral health concerns. At the 3-month follow up, 5 consumers had improved health care utilization, 6 fewer had falls, 5 had medication changes, 13 had improved home safety concerns, and 7 had improved behavioral health concerns.
REDUCING OR STOPPING MEDICATIONS FOR CHRONIC PAIN: VIEWS AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Noh Hyunjin , Jeong Haelim , Kan Denise , Lee Lewis
Published: January 2025

Effective pain control is vital in enhancing quality of life. As the dangers of adverse drug interactions are recognized, there is a shift towards reducing reliance on medications that could be ineffective or harmful (known as deprescribing) and a push for embracing non-drug methods in managing pain. However, limited research exists on how older adults perceive deprescribing. Therefore, this study aimed to understand the views of deprescribing among community-dwelling older adults living with multiple health conditions and chronic pain. Participants were recruited from the Alabama Area Agency on Aging offices. Eligible participants were 65+, Alabama residents living outside of nursing homes, cognitively intact, have more than one chronic illness and chronic pain, and take medications for the illnesses, including pain medicine. Individual, open-ended interviews were conducted by phone, asking about their experiences with taking multiple medications and thoughts about deprescribing. Thematic analysis of interviews with 30 participants revealed facilitators, barriers, and needs for deprescribing. Facilitators for deprescribing included interest in more holistic methods for pain management, concerns for long-term side effects, and desire for better quality of life, while barriers included fear of worsening pain, reluctance to change in medical regimen, and lack of support from healthcare providers. Needs for deprescribing included credible information from their healthcare providers about deprescribing and social support in deprescribing decision-making. These findings suggest that older adults may benefit from education and advocacy efforts designed to improve their knowledge and self-efficacy and healthcare providers’ willingness to openly communicate with older adults about deprescribing.
EFFECTIVENESS OF TARGETED WEB-BASED ADVERTISING WHEN RECRUITING OLDER ADULTS FOR A CLINICAL TRIAL
Authors: Baldyga Kathryn , Millar Courtney , Iloputaife Ike , Taffet George , Lipsitz Lewis
Published: January 2025

Recruiting older adults for clinical trials can be particularly challenging. Our objective was to determine if targeted web-based advertising is an effective recruitment strategy. The STAMINA Study (Senolytics To Alleviate Mobility Issues and Neurological Impairments in Aging) is a pilot 12-week study of the effects of intermittent Quercetin and Dasatinib on cognition and mobility in older adults with mild cognitive impairment and slow gait. Individuals were initially recruited using traditional strategies such as presentations and advertisements in clinical practices, subject registries, and community sites. After 10 months of slow recruitment rates, a web-based advertising company was used to deliver targeted online study advertisements based on an individual’s browsing history. Recruitment rates were calculated based on the total number of individuals engaged in each stage of the recruitment process, divided by the number of months the strategy was utilized. Web-based advertising reached more individuals (~40 individuals/month) compared to traditional methods (~5 individuals/month). Compared to traditional methods, web-based methods had at least twice the rate of expressed interest, telephone and in-person screening completion, eligibility, and enrollment. All individuals recruited from traditional methods completed the intervention, while 3 individuals recruited from web-based advertising dropped out. Those recruited using web-based advertisements tended to be younger compared to traditional methods, but were similar in racial distribution and education. Targeted web-based advertisements may be more effective in recruiting older adults for clinical trials than traditional recruitment methods, but need further evaluation of compatible study designs, potential population bias, and cost effectiveness.
IMPACT OF ART-BASED INTERVENTION ON BRAIN FUNCTIONAL CONNECTIVITY IN OLDER ADULTS ALONG THE ALZHEIMER’S CONTINUUM
Authors: Huang Chenshan , Yan Yuanjiao , Shi Yanhong , Lin Rong , Li Hong
Published: January 2025

Background

Combined art-based interventions (CAIs) are considered effective treatment options for older adults along the Alzheimer’s disease (AD) continuum; however, the neural mechanisms underlying associated changes in neurocognitive performance remain unclear. Thus, we aimed to investigate the impact of a CAI programme in older adults along the AD continuum and to understand its mechanism.

Methods

This parallel-arm randomised controlled trial was conducted between April 2021 and January 2023. Participants were randomised in a 1:1 ratio to either intervention group (IG) or waitlist control group (WG). The IG underwent a 16-week CAI programme. Neuropsychological assessments and magnetic resonance imaging were conducted before and after the intervention.

Results

After the intervention, the IG showed greater improvement in general cognitive function, language, and memory than the WG. Significant differences were observed in the functional connectivity (FC) values in the temporal and cerebellar anterior lobes, fusiform, inferior occipital, and lingual gyri, and perirhinal and visual cortices between the groups. Further analyses showed that FC values reduced in these regions in the IG. In addition, changes in FC values were positively correlated with those in neuropsychological test scores in the IG.

Conclusions

Our study suggests that the CAI programme can effectively improve general cognitive function, language, and memory in older adults along the AD continuum. These improvements may be changed due to decreases in FC in key brain regions, deepening the understanding of the neurocentral mechanisms that act as a tool for improving cognitive function.
TESTING THE IMPLEMENTATION FRAMEWORK FOR BEHAVIORAL AND LIFESTYLE INTERVENTIONS IN ALZHEIMER’S DISEASE (MOBILIZE)
Authors: Salisbury Dereck , Lin Vankee , Yu Fang
Published: January 2025

Introduction

Implementing multi-site behavioral intervention trials in Alzheimer’s disease (AD) has many unique challenges, leading to substantial variations in delivered intervention doses and cognitive findings. These issues can be addressed by the IMplementation Framework fOr Behavioral and LIfestyLe Interventions In AlZheimer’s DiseasE (MOBILIZE) that was developed to guide the design and implementation of behavioral interventions in AD.

Methods

This study systematically evaluated the implementation outcomes of the multi-site aerobic exercise and cognitive training (ACT) trial that employed MOBILIZE. Building on the person-centered care principle, MOBILIZE includes three implementation outcomes (screening, intervention adherence, and safety) with corresponding team processes to guide trial implementation. Screening was operationalized as the duration (days) between each screening visit, last screening visit to enrollment, and enrollment to first intervention session. Intervention adherence outcomes included: adherence (attendance), session dose adherence (calculated by dividing the number of sessions that achieved >=70% of the prescribed session dose / total number of sessions completed), and days required to complete the prescribed 72 sessions. Safety was operationalized as the type, number, and severity of study-related adverse events (AEs). RESULTS. The sample (n=146) was 73.8±5.7 years in age and 23.4±2.1 on Montreal Cognitive Assessment score, with 48.0% female, and 91.8% white. Screening-to-enrollment averaged 117.4±71.7 days. Intervention adherence was 77.4%±28.3%. There was 9-study related adverse events. Screening-to-enrollment and intervention adherence differed across sites, mainly due to COVID-19 influence. CONCLUSIONS. MOBILIZE helped the ACT Trial achieve high intervention adherence and safety and may be particularly important for early-stage and multi-site trials in AD.
THE LINK BETWEEN INTRAINDIVIDUAL VARIABILITY IN COGNITIVE PERFORMANCE AND MOBILITY IN CHRONIC STROKE
Authors: Dimri Vrinda , Silva Nárlon Cássio Boa Sorte , Balbim Guilherme , Liu-Ambrose Teresa
Published: January 2025

Intraindividual variability (IIV) is the within-person trial-to-trial variation in reaction time during cognitive tasks. Higher IIV represents reduced consistency in responses, which may be due to lapses in attention, and is associated with reduced mobility in older adults. IIV may also be a more sensitive measure of cognitive performance versus traditional summary scores. A stroke can significantly impact one’s cognitive function and mobility. Whether IIV in cognitive performance is associated with mobility among individuals who have experienced a stroke is unknown. We aimed to examine this relationship by using baseline data from a six-month single-blinded, 3-group parallel randomised controlled trial. Participants included community-dwelling adults (N= 119, 38.7% female) with a history of stroke, aged 55 years and older (mean= 70.71 years, SD= 8.59), able to walk 6 meters, and without dementia. Mobility was assessed based on timed up and go (TUG) performance. Residualised intra-individual standard deviation (rISD) was used as measure of IIV and computed using trial latencies of a computerised Stroop Task. TUG scores significantly predicted rISD of congruent (beta= 0.03, SE= 0.01, p-value = 0.001) and neutral trials (beta= 0.02, SE= 0.01, p-value = 0.04), but not incongruent trials (beta= 0.01, SE= 0.01, p-value = 0.18). However, these effects were not found when age was included as a covariate. Overall, these findings suggest that in adults with stroke, higher IIV measured from a simple reaction time task is associated with worse mobility. Further longitudinal studies are needed to determine if higher IIV is predictive of mobility decline post-stroke.
USING THE MONTREAL COGNITIVE ASSESSMENT IN MILD AGE-RELATED HEARING LOSS
Authors: Shende Shraddha , Mudar Raksha
Published: January 2025

Age-related hearing loss (ARHL) is a modifiable risk factor for dementia. There is a need for early detection of cognitive concerns in older adults with ARHL. The Montreal Cognitive Assessment (MoCA) is a well-validated screening tool that has been used to screen cognition in the ARHL population. However, few studies have examined the value of both MoCA total score (MoCA-TS) and MoCA-Memory Index Score (MoCA-MIS) score in ARHL and its relation to complex hearing functions, especially in those with mild hearing loss. We administered MoCA on 15 older adults with mild-to-moderate ARHL and 15 matched normal hearing controls. MoCA-TS and MoCA-MIS were calculated. Participants also completed the Quick Speech-in-Noise (QuickSiN) test and the Hearing Handicap Inventory for Adults (HHIA). Relative to controls, worse scores were obtained in the mild ARHL group on MoCA-TS (p =.031) and MoCA-MIS (p =.039). Bivariate correlations revealed a significant negative association between QuickSiN and MoCA-TS scores (p <.001), with similar trends on MoCA-MIS (p =.051). When the peripheral hearing measure was controlled using partial correlations, the negative correlation between QuickSiN and MoCA-TS remained (p =.004). The correlations of MoCA-TS and MoCA-MIS with HHIA were not significant. Our findings reveal changes in global cognition beyond encoding memory in mild ARHL. Additionally, our findings suggest that complex listening functions assessed using QuickSiN in related to overall performance on MoCA.
FAMILY TIES AND HEALTH CARE DECISION-MAKING IN LATE LIFE: EXAMINING FINANCIAL DEPENDENCY IN HEALTH FOR INDIA
Authors: Pandey Atul , Sharma Isha
Published: January 2025

With the increasing number of age 60 years and above population, it is becoming important to improve healthcare and economic assurance for grandparents/parents. Family ties and culture is a way of consideration of healthcare choices and providing financial support. Family member’s financial stability assure the finance for healthcare for aged population. The dissolution of traditional extended families in India is closely related to the above-described issues, which also lead to rising economic inequality, urbanization, modernization, growing individualism, and a greater emphasis on healthcare choices. The rise in nuclear families and longer life expectancies has led to an increase in the cost of caring for the late ageing population. This study is examining the role of family ties and healthcare decision making through the lens of financial dependency. This study uses Longitudinal Ageing Study in India (LASI) i.e. secondary data source capturing 31464 respondents with the age of 60 years and above. It again classified into the male (16366) and female (15098) cohort. The data provide significant information related to the coverage of financial security. One out of every five individuals with age 60 years and above is enrolled in an organized sector’s pension plan. A sizable share (20.65%) of the population is covered by central and state pension programs. In contrast, only a small percentage of India’s retired population (2.1%) is covered by private pension, or employer-funded pension schemes. Just 7% of individuals believe their family’s financial situation is adequate, whereas 53% comes from middle class family.
GROWTH OF THE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY AND THE ROLE OF PRIVATE EQUITY
Authors: Miller Katherine , Gupta Ravi , Polsky Daniel
Published: January 2025

The Program of All-Inclusive Care for the Elderly (PACE) is a managed care program for adults 55+ who require nursing home level of care and are mostly dual-eligible for Medicare and Medicaid. PACE programs receive capitated payments per person for comprehensive medical and social services to enrollees, primarily in adult day health centers. In 2016, the Centers for Medicare & Medicaid began allowing for-profit ownership of PACE. Our objective is to describe the growth of PACE from 2010 to 2022 in the context of the 2016 policy change allowing for for-profit investment. We also describe the share of for-profit programs receiving private equity investments. We use Refinitiv and Medicare Advantage contract and enrollment data. Enrollment in for-profit programs from 2016 to 2022 increased by an annual average of 13% compared to 5.6% in non-profit programs. This is the context of an annual rate of increase in enrollment of 11% in the 6 years pre-policy change and 7% in the 6 years post-policy change. Among enrollees at for-profit programs in 2022, 47% received care at programs with private equity investments. Despite the growth of for-profit ownership and private equity investments, most enrollees received care from non-profit programs (78%) in 2022. Since allowing for-profit ownership, expansion has been driven by for-profit entities, ~50% of which received private equity investments. While expanding access to PACE may be important for certain adults, examining the effects of growth in for-profit and private equity ownership of PACE programs for patient outcomes is an important next step.
LIVING WITH MULTIMORBIDITY AND FINANCIAL TOXICITY: A PATIENT- AND CLINICIAN-INFORMED FRAMEWORK
Authors: McDermott Cara , Lourie Michael , Hazlewood Hudson , Sloan Caroline
Published: January 2025

Most older adults in the US have multimorbidity (2+ serious illnesses). Living with multimorbidity impacts patient quality of life, specifically managing the symptoms of multiple diseases and accompanying medications, emotional strain, and financial toxicity, or the financial stress of having unaffordable medical expenses. We developed an initial framework describing financial toxicity in multimorbidity to inform a financial toxicity screening tool and associated interventions for the clinical setting. We then iteratively refined the framework with patient and clinician feedback. We recruited 8 patients with multimorbidity taking 5+ medications from Duke Primary Care, along with 8 clinicians. We conducted semi-structured interviews with patients to describe their experiences living with multimorbidity and financing/prioritizing healthcare needs. In focus groups with clinicians, we explored ways to adapt existing financial toxicity screening questionnaires plus barriers/facilitators to future implementation of financial toxicity interventions in primary care clinics. Our initial framework included the dynamic nature between acute stressors (e.g., heart failure exacerbation), financial coping (e.g., borrowing money), financial reserve (e.g., insurance coverage), and patient outcomes (e.g., quality of life). We added/clarified the following domains following patient interviews and clinician focus groups: caregiver support/involvement (e.g. help with bills), health system constraints (e.g. cannot waive copays), health system-based support (e.g. charity care), community-level supports/programs (e.g. food banks), clinician moral distress (e.g. anger at not being able to provide optimal care), clinician financial coping (e.g. changing prescription based on cost). Next steps include using the framework to adapt screening questionnaires and interventions to detect and address financial toxicity in multimorbidity.
ADAPTING TO HEALTH CHANGE: STUDENT RESPONSES TO DIFFERENT DELIVERY MODALITIES
Authors: Kleszynski Keith , Jennings Lee , James Shirley
Published: January 2025

Background

Adapting to Health Change (AHC) is a two-hour aging sensitivity simulation training designed to improve student empathy and understanding of common age- and chronic illness-related functional changes. AHC includes role-play with props and 4 activity stations: hearing loss, neuropathy and dexterity, vision loss and medication management, and mobility and transfer. Training is facilitated by interdisciplinary faculty and staff.

Methods

AHC was delivered in-person in 2 sessions to 38 speech pathology students and delivered virtually to 136 social work students in 4 sessions. The simulation was modified for online education by using common household items for props in the activity stations. Post-training evaluation results were analyzed between delivery modalities and student groups.

Results

Students strongly agreed that the simulations helped them better understand how it feels to age with health changes (79%) and potential stereotypes and biases associated with aging (80%). Students strongly agreed the simulations provided useful insight into the aging experience (82%) and that the experience will help them develop into better health care providers of patients adapting to changes associated with aging (83%). The majority of students felt that their knowledge of age-related challenges had improved (94%). There were no significant differences between student groups or between those who received virtual versus in-person delivery.

Conclusion

Aging empathy simulations improve student understanding of age-related health changes and can be effectively delivered in-person or online, making wider delivery to health professions students using virtual training platforms more feasible.
CAN NOVICE LEARNERS BE CLINICAL CHANGE AGENTS FOR DEMENTIA CARE PRACTICE?
Authors: Duthie Edmund , Denson Kathryn , Simpson Deborah , Barnes Stacy , Betley Wendy , Szymkowski Amanda , Denson Steven
Published: January 2025

Intro

Caregiver support is an essential component in dementia care and yet clinicians’ referrals to community-based support services are lacking. Direct Connect (DC) is a clinician-initiated referral process for dementia patients and caregivers, offered by the Alzheimer Association to make the process simple and efficient.

Methods

We created a brief educational intervention targeting medical, nursing, and pharmacy students to develop them into DC champions at clinical rotation sites in Wisconsin. Content focused on dementia detection, caregiver burden, available resources, and DC referrals. Delivery included online, in-person, and hybrid formats. Data was collected with a post-intervention survey and student interviews. At baseline (2021), 277 DC referrals were made by clinicians in Wisconsin.

Results

Following a 2-year rollout to students (N=375), the annual number of DC referrals received from clinicians increased (300 in 2022; 351 in 2023). However, review of referral data revealed the increase was primarily from licensed clinicians not at student champion sites. Follow-up interviews with students indicated they find it daunting to suggest changes in busy clinical settings where they lack experience and autonomy. Despite incorporating scripting and role playing into our educational session, students continued to lack confidence.

Discussion

Although student champions have proven effective in other clinical conditions, our results suggest different strategies are needed for dementia care. Based on these findings, we propose to refocus training efforts toward more senior learners such as medical residents who have more experience and clinical autonomy, and to embed the DC referral within the electronic health record to facilitate usage.
IMPACT OF ENVIRONMENTAL SATISFACTION ON SLEEP QUALITY AMONG SOUTH ASIAN CAREGIVERS FOR OLDER ADULTS
Authors: Chekuri Srujana , Siddiqui Aziza , Karki Dinesh , Boron Julie Blaskewicz
Published: January 2025

Caregivers for older adults rely heavily on good sleep quality for their general health and ability to provide care. This study investigated the impact of environmental satisfaction, both at home and in the surrounding neighborhood, on sleep quality among South Asian caregivers for older adults, specifically those not living with the care recipients. Participants completed a survey focused on South Asian caregivers’ sleep quality and satisfaction with their surroundings, such as the cleanliness of living spaces, noise levels, and the condition of neighborhood walkways and cycling lanes. A series of regression analyses were used to examine relationships. Results demonstrated a statistically significant relationship between environmental satisfaction and sleep quality. Specifically, high satisfaction with home cleanliness, and low noise levels were positively associated (p< 0.05) with increased sleep duration. Similarly, the state of outdoor infrastructure, such as well-kept sidewalks, and cycling routes were also positively associated (p< 0.05) with more hours of sleep among caregivers. This highlights the significant role of favorable indoor and outdoor environments in enhancing sleep quality among South Asian caregivers for older adults, pointing to the potential benefits of targeted environmental interventions. These findings further emphasize the need of a supportive environment for the well-being of South Asian caregivers, even when they are not living with their care recipient. The focus on a specific cultural group may limit generalizability. Thus, future studies should incorporate diverse caregiver samples to explore the generalizability of results across different cultural contexts and living situations (e.g., residing with or without the care recipient).
BURDEN AND BENEFITS OF INFORMAL CAREGIVING AND OLDER CAREGIVING RECIPIENTS’ SUBJECTIVE WELL-BEING
Authors: Qin Weidi , Dang Linh , Mezuk Briana
Published: January 2025

Informal caregiving plays an important role in and has implications for the subjective well-being (SWB) of older caregiving recipients. Using data from the 2021 National Study of Caregiving (N = 991) linked to the National Health and Aging Trend Study (N = 3,321), this study addressed three questions: 1) Is having an informal caregiver associated with better SWB among older adults? 2) Are informal caregivers’ perceptions of caregiving burden and benefits associated with older caregiving recipients’ SWB? 3) Does the relationship between perceived caregiving burden/benefits and caregiving recipients’ SWB differ by gender and relationship types (close family members vs. non-close family)? SWB was measured with a 7-item scale. Caregiving burden was measured with 9 items regarding difficulties in providing caregiving (i.e., emotional difficulty). Caregiving benefit was measured with 4 items indexing beneficial experiences (i.e., closeness to caregiving recipients). Weighted multivariable OLS regressions were used to examine the relationships between caregiving burden, benefit, and SWB. Older adults with a caregiver reported lower levels of SWB compared to those without (B = −0.73, p = 0.001). Expectedly, caregiving burden was associated with lower levels of subjective well-being in caregiving recipients (B = −1.22, p < 0.001). The relationship between caregivers’ perceived benefits and caregiving recipients’ SWB differ by caregiving recipients’ gender (B = 2.01, p = 0.044) and relationship types (B = -2.25, p = 0.032). The findings highlight the importance of considering caregiving recipients’ gender and family relationships in developing interventions to improve informal caregiving experiences.
HEALTH CARE USE AMONG SPOUSE CAREGIVERS OF OLDER ADULTS LIVING WITH DEMENTIA
Authors: Lei Lianlian , Langa Kenneth , Norton Edward , Levy Helen , Kim Hyungjin Myra , Blow Frederic , Maust Donovan
Published: January 2025

Little is known about how caregiving is associated with caregivers’ health care use, particularly where the care recipient is a person living with dementia [PLWD]. This study aims to characterize health care use of spouses of PLWD. Using the 2000–2018 Health and Retirement Study linked with Medicare claims data, we identified community-dwelling dyads where one member had dementia, both members were aged ≥65 years, and enrolled in fee-for-service Medicare; for dyads included in multiple waves, we randomly selected one wave (N=924 unique dyads). We examined the association of spouse care intensity with spousal health care use, adjusted for spousal socio-demographic, health, and functional characteristics. Forty-three percent of spouses did not provide care; and among those providing care, the average monthly hours were 27, 150, and 430 for the first, second, and third tertiles, respectively. Adjusted for spousal characteristics, spouses not providing help had higher total annual Medicare costs ($5,728 and $5,776 higher than those in the second and third tertiles, respectively, p<.05 for both), acute hospitalization (8.2% and 10.4% higher than those in the second and third tertiles, respectively, p<.05 for both), and sub-acute care (7.2% higher than those in the second tertile, p<.01). The spouses who did not provide caregiving hours had the highest health care costs and use. It is unclear whether PLWD spouses do not need care or whether these spouses, by virtue of their own health problems, do not have the capacity to provide caregiving.
THE FEASIBILITY OF A PEER-DELIVERED PSYCHOSOCIAL INTERVENTION FOR FAMILY CARE PARTNERS OF HOSPICE CANCER PATIENTS
Authors: Benson Jacquelyn , Pitzer Kyle , Lindsay Ryan , Washington Karla , Oliver Debra Parker
Published: January 2025

Providing care and support to a hospice patient with cancer can exact an enormous psychological toll on families. Approximately 50% of advanced cancer family care partners report moderate to severe depression and anxiety. Many studies indicate that the psychological suffering of family care partners can be alleviated by enhancing their coping skills. However, mechanistically informed psychosocial interventions that are better tailored to the unique needs of cancer caregivers are needed. Study objectives were to: (1) evaluate the feasibility and acceptability of a 1:1 peer-delivered psychosocial support intervention for hospice family care partners of cancer patients, and (2) determine a range of potential effects of the intervention on mechanisms of change and care partners’ psychological distress symptoms to guide variable inclusion for a future trial. The study was carried out using a convergent parallel mixed methods design. Qualitative data were analyzed using deductive thematic analysis. Descriptive statistics were performed for demographic characteristics, and rates of recruitment, attrition, and survey completion. Parametric and non-parametric t-tests were conducted to examine mean differences of study outcomes between baseline and midpoint, and endpoint. Mean differences above 0, in the expected direction, and confidence intervals with a 10% or greater change in the total outcome were used to guide decision-making about future trial inclusion. Results demonstrated that the intervention is acceptable, appropriate, and feasible to deliver to hospice family caregivers of cancer patients. Depressive symptoms, anxiety symptoms, benefit finding, and self-efficacy were also determined to be appropriate measures for future use in a larger trial.
THE IMPACT OF TRAUMA AND POSTTRAUMATIC STRESS SYMPTOMS ON CAREGIVER WELL-BEING
Authors: Hugenschmidt Christina , Collier Natasha , Brenes Gretchen
Published: January 2025

There is a high level of variability in caregiver experiences and outcomes, and up to 50% of variance in caregiver well-being remains unexplained. We propose that exposure to traumatic events and experience of post-traumatic stress symptoms (PTSS) may be a previously unrecognized dimension of caregiver burden. We surveyed 25 caregivers of persons with dementia (PWD) to assess 1) lifetime exposure to traumatic events, 2) post-traumatic stress symptoms (PTSS) related to the caregiving experience, and 3) associations between trauma exposures and PTSS and caregiver burden, depression, and grief. Caregivers averaged 66.4 years old (range: 36-81) and had been caring for their loved one an average of 5.5 years (range: 1-23 years). Caregivers had different relationships with the care recipients (daughter: n=9, spouse/partner: n=9, son: n=4, sister: n=2, friend: n=1) and n=11 (44%) lived with the care recipient. Forty percent of the sample had experienced at least one adverse childhood experience (ACE) and 96% reported at least one trauma as an adult. Four participants (16%) stated that caregiving for their PWD or a caregiving-related event was the most stressful event of their life, and 35% had elevated PTSS related to caregiving. ACEs and PTSS in response to caregiving were highly predictive of important outcomes for caregiver well-being, including depression (ps ≤ 0.03), prolonged grief (ps ≤ 0.03), and caregiver strain (ps ≤ 0.02). These findings suggest that trauma experienced before and during caregiving and PTSS are significantly associated with caregiver well-being.
SOCIAL NETWORK SIZE, SOCIAL FULFILLMENT, AND FINANCIAL EXPLOITATION VULNERABILITY IN OLDER ADULTS
Authors: Noriega-Makarskyy Daisy , Upal Shaneen , Erdman Elizabeth , Fenton Laura , Lim Aaron , Weissberger Gali , Mosqueda Laura , Han Duke
Published: January 2025

This study tested whether aspects of social functioning, including breadth of current social roles (e.g., being a family member, co-worker, neighbor, etc.), and fulfillment in various social supports (i.e., relationship depth), are associated with perceived financial exploitation vulnerability (FEV) among older adults. Adults aged 50 or older (N=115; 69% of sample >65 years) completed a laboratory visit consisting of questionnaires assessing relationship breadth, depth, and perceived FEV. The relationship depth measure included a total score as well as subscales for: 1) Appraisal, or availability of interpersonal advice or guidance; 2) Belonging, or availability of interpersonal empathy and acceptance; and 3) Tangible, or material/financial support resources. Hierarchical linear regressions separately tested associations between relationship depth or breadth and FEV. After covarying for demographics, depression/anxiety symptoms, and general cognition, FEV was not significantly associated with relationship breadth, or the Appraisal and Tangible subscales (p’s=.13-.93). FEV was negatively associated with Relationship Depth Total Score (B(SE) = -.08(.03), p<.01) and Belonging subscale (B(SE) = -.28(.06), p<.001). In summary, among a sample of older adults, perceived financial exploitation vulnerability was not associated with the number of different regular social roles a person had, or the availability of social resources for material/financial assistance, or interpersonal advice/guidance. Rather, financial exploitation vulnerability was greatest among individuals with a weaker sense of social belonging, marked by instances such as not having someone to go with on a spontaneous day trip. Such results corroborate the benefits of close interpersonal relationships that may reduce vulnerability to financial exploitation in older age.
THE IMPLEMENTATION OF A STATEWIDE INTERDISCIPLINARY OLDER ADULT FINANCIAL JUSTICE COALITION
Authors: Kohlbrenner Briana , Catlow Jodi , Chess Eric , De Fries Carson
Published: January 2025

Financial fraud and exploitation have devastating impacts that are felt acutely among older adults. To address this issue in Colorado, a coalition was formed in March of 2023 to bring together the state’s strong but historically disconnected contingent of experts across disciplines. This coalition includes 60 individuals representing 30 agencies including law enforcement, financial institutions, adult protective services, government, and non-profit agencies. The goals of the coalition are to 1) convene and grow this network to include all key stakeholders and leaders in financial fraud and exploitation across the state, 2) provide support, training, actionable tools, and resources for front-line workers and 3) streamline resources and create a collaborative state-wide hub for resources around financial abuse. Through this initiative we have identified barriers to collaborative efforts in this area including sharing data across agencies, building trust between industries, and an overall lack of shared language. Lessons learned from the implementation of this coalition include how to communicate across disciplines, elevating the expertise of those in the field without replicating work or operating in silos, and utilizing an academic institution to facilitate these collaborative efforts. To provide an overview of the innovative and interdisciplinary coalition, we will showcase the process of developing, maintaining, and expanding this coalition with the purpose of providing a framework for other states to replicate.