bluuebunny/crossref_metadata_2025 huggingface dataset:
Vacuum-Assisted Excision of B3 Lesions: A District General Hospital Experience
Authors: Sandhya Anu , Tahir Qurat Ul Ain , Veerapatheran Keerthanaa
Published: January 2025

Objective The objective of this study was to evaluate the efficacy of utilizing vacuum-assisted excision (VAE) for the management of B3 lesions and to determine the rate of malignant upgrades.

Materials and Methods This observational study was conducted at Surrey and Sussex NHS Healthcare Redhill. All patients with B3 histology on core biopsy from October 2019 to October 2022 were included in the study. The upgrades in both the B3 group with atypia and the B3 group without atypia were examined in terms of ductal carcinoma in situ (DCIS), invasive status, and grade. The data obtained were analyzed using the SPSS version 21.

Results About 65% of the participants in the present study have B3 lesions in their left breast and 43% of the participants have lesions located in the upper inner area of the breast. The majority of the participants in the study had B3 lesions without atypia (75%). In 70 participants, VAE was performed. Out of 70 participants, only 15 had lesion upgrade after VAE (21.4%). Post-VAE follow-up planning was discussed in multidisciplinary team as per the National Health Service breast screening guidelines.

Conclusion The utilization of VAE is a viable alternative strategy for the treatment of B3 lesions, resulting in a decrease in the necessity for invasive surgical interventions. This observational study shows the efficacy of a less invasive procedure in replacement of a surgical procedure producing optimal long-term benefit and less side effects.
Contemporary Use of ctDNA for the Colorectal Surgeon
Authors: Heit Madilyn , Cohen Stacey A.
Published: January 2025

While advances in treatment and diagnostics have improved prognosis in colorectal cancer (CRC), room for advancement remains, highlighting the importance of improving tools for early detection and treatment guidance. Current national guidelines rely on stage-based treatment recommendations but fail to identify patients with lower stage disease who have a higher likelihood of recurrence or those for whom additional therapy may not be beneficial. Circulating tumor DNA (ctDNA) is an emerging noninvasive blood-based assay, which can inform cancer status as a single time point and/or longitudinal biomarker. ctDNA can be used for the diagnosis of cancer, detection of minimal/molecular residual disease, molecular profiling, and assessing treatment response. In patients for whom operative management is indicated, detectable ctDNA is associated with worse survival outcomes. This review highlights the expanding field of ctDNA in CRC, underlining pivotal data and areas with the need for more research that are key for colorectal surgeons to understand.
Photon science and quantum control
Authors: Bucksbaum Philip H.
Published: January 2025

Recent advances in laser technology have hastened developments in other fields—precision measurement, atomic cooling, gravitational-wave sensing, quantum computing, cryptography, and many more. Like the laser itself, those fields may transform society.
2025 is the International Year of Quantum Science and Technology
Authors: Feder Toni
Published: January 2025

Building awareness and inspiring a future workforce are two aims of the UN-designated quantum year.
Is the Moon there when nobody looks? Reality and the quantum theory
Authors: Mermin N. David
Published: January 2025

Einstein maintained that quantum metaphysics entails spooky actions at a distance; experiments have now shown that what bothered Einstein is not a debatable point but the observed behavior of the real world.
What’s under the hood of a quantum computer?
Authors: Middleton Christine
Published: January 2025

Many layers lie between everyday users and the delicate, error-prone hardware they manipulate.
Artificial intelligence–enabled histology exhibits comparable accuracy to pathologists in assessing histological remission in ulcerative colitis: a systematic review, meta-analysis, and meta-regression
Authors: Puga-Tejada Miguel , Majumder Snehali , Maeda Yasuharu , Zammarchi Irene , Ditonno Ilaria , Santacroce Giovanni , Capobianco Ivan , Robles-Medranda Carlos , Ghosh Subrata , Iacucci Marietta
Published: January 2025

Background and Aims

Achieving histological remission is a desirable emerging treatment target in ulcerative colitis (UC), yet its assessment is challenging due to high inter- and intraobserver variability, reliance on experts, and lack of standardization. Artificial intelligence (AI) holds promise in addressing these issues. This systematic review, meta-analysis, and meta-regression evaluated the AI’s performance in assessing histological remission and compared it with that of pathologists.

Methods

We searched Medline/PubMed and Scopus databases from inception to September 2024. We included studies on AI models assessing histological activity in UC, with or without comparison to pathologists. Pooled performance metrics were calculated: sensitivity, specificity, positive and negative predictive value (PPV and NPV), observed agreement, and F1 score. A pairwise meta-analysis compared AI and pathologists, while sub-meta-analysis and meta-regression evaluated heterogeneity and factors influencing AI performance.

Results

Twelve studies met the inclusion criteria. AI models exhibited strong performance with a pooled sensitivity of 0.84 (95% CI, 0.80–0.88), specificity 0.87 (0.84–0.91), PPV 0.90 (0.87–0.92), NPV 0.80 (0.71–0.88), observed agreement 0.85 (0.82–0.89), and F1 score 0.85 (0.82–0.89). AI models demonstrated no significant differences with pathologists for specificity, observed agreement, and F1 score, while they were outperformed by pathologists for sensitivity and NPV. AI models for the adult population were linked to reduced heterogeneity and enhanced AI performance at meta-regression.

Conclusions

AI shows significant potential for assessing histological remission in UC and performs comparably to pathologists. Future research should focus on standardized, large-scale studies to minimize heterogeneity and support widespread AI implementation in clinical practice.
AD BLOOD BIOMARKERS IN DIVERSE COMMUNITY SETTINGS: A LONGITUDINAL PERSPECTIVE FROM THE ARIC STUDY
Authors: Palta Priya , Sullivan Kevin , Merten Natascha
Published: January 2025

Alzheimer’s disease and related dementias (ADRD) feature a prolonged preclinical stage spanning decades, with the transition from mid- to late-life marking the critical period for onset and accumulation of pathological brain changes that may lead to physical and cognitive disability. Identifying individuals at risk for cognitive and physical decline during preclinical stages when interventions or disease modifying treatments are more likely to be effective is needed. Blood biomarkers of ADRD pathology and neurodegeneration are promising cost-effective and non-invasive options to fill this gap. To date, however, there are limited data on temporal changes in blood biomarkers and their associations with cognitive, mobility, and neuroimaging outcomes in diverse community-based cohorts. This symposium will feature 23 years of data from the well-established community-based Atherosclerosis Risk in Communities (ARIC) Study cohort which assayed blood biomarkers of amyloid-β (Aβ)42/40, phosphorylated tau at threonine 181 (p-Tau181), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) using Quanterix Simoa assays on stored specimens at up to 3 timepoints in midlife and late-life in ~1,800 participants. This session will present findings on temporal blood biomarker changes from mid- to late-life and associated risk and protective factors of biomarker changes; mid- to late-life changes in blood biomarkers and associations with late-life neuroimaging measures of neurodegeneration, cerebrovascular disease, and amyloid deposition; and the associations of late-life blood biomarkers with prevalent and incident mobility and cognitive impairment.
CHANGE IN ALZHEIMER’S DISEASE BLOOD-BASED BIOMARKERS AND ASSOCIATIONS WITH BRAIN AMYLOID DEPOSITION
Authors: Pike James , Lu Yifei , Chen Jinyu , Walker Keenan , Sullivan Kevin , Griswold Michael , Mosley Thomas , Palta Priya
Published: January 2025

Blood-based biomarkers show promise as a noninvasive, inexpensive method for measuring Alzheimer’s disease pathology throughout the lifecourse. However, the prospective associations and discriminatory accuracy of these biomarkers at different stages of the lifecourse and among diverse, community-dwelling populations requires further investigation. Between 2014 and 2015, 329 dementia-free participants from the Atherosclerosis Risk in Communities Study underwent brain MRI and PET scans. Amyloid positivity was defined as a standardized uptake value ratio greater than 1.2. Stored plasma samples collected in midlife (1993-95, mean age 58.5 years) and late-life (2011-13, mean age 76.2 years) from a subsample of 259 participants were assayed in 2022. The assay quantified amyloid-β (Aβ)42/40, phosphorylated tau (p-Tau181), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP). Logistic regression models estimated the association between plasma biomarkers from midlife and late-life and amyloid positivity in late-life. Receiver operating characteristic curves documented the discriminatory accuracy of the biomarkers. Assays from midlife were not associated with amyloid positivity in late-life. However, late-life measurements of Aβ42/40, p-Tau181, and GFAP and change per decade from midlife to late-life in p-Tau181 and GFAP were associated with greater odds of amyloid positivity. The greatest discriminatory accuracy was achieved by using all assays measured in midlife and late-life (AUC = 0.754), although the accuracy when using only late-life measures was comparable (AUC = 0.737). Additional longitudinal research is needed to determine whether changes in plasma biomarkers measured before an individual is amyloid positive can identify older adults at risk of developing Alzheimer’s disease.
SUPPORTIVE HOME FEATURES AS PROACTIVE/REACTIVE ASSOCIATES OF DAILY FUNCTIONING IN OLDER ADULTS
Authors: Barbakoff Daniel , Glennie Kristen , Steinman Bernard A
Published: January 2025

Supportive home features (SHF) include attributes of living spaces meant to help people overcome physical limitations that may be barriers to living independently. Evidence suggests that SHFs, including home modifications (HM), may help older adults to age in place at home. However, real-life implementation of HMs is not fully understood. The purpose of this study was to clarify associations between functioning in daily-living activities and the presence of SHFs. We analyzed two waves (2011 and 2015) of the National Health and Aging Trends Study (NHATS) to examine the directionality of this relationship. SHFs were operationalized using indicators of home accessibility (e.g., presence of a bedroom, kitchen, and full bathroom with a shower or tub on the same floor). HMs were operationalized based on whether bathroom fixtures were modified to accommodate disability with features such as grab bars. Daily activities were assessed using measures of activities of daily living (ADL; e.g., dressing) and instrumental ADLs (IADL; e.g., preparing a meal). Changes in ADL/IADL functioning and SHF/HM variables were assessed over the 5-year period. Regression models also included covariates for sociodemographics, chronic conditions, mobility functioning, and participation. Results show that, whereas ADL limitations statistically predict SHF/HM outcomes, the implementation of SHF/HMs does not predict any ADL/IADL outcomes. These findings suggest that in real life, older adults implement SHF/HMs reactively in response to functional needs, as opposed to planning proactively to meet needs in the future.
CALLING OUT AGEISM: HOW INTERSECTING IDENTITIES AND CONFRONTATION TONE AFFECT PERCEPTIONS OF OLDER CONFRONTERS
Authors: Gans Hannah , Chasteen Alison , Horhota Michelle
Published: January 2025

The few studies that have examined confrontations of ageism have shown that older adults are viewed differently after challenging the behavior. What remains unclear is how older people’s intersecting identities, as well as their confrontation tone, might influence reactions to their countering ageism. To address this question, we surveyed 500 young and older adults regarding their perceptions of warmth and competence towards older adult confronters who varied by race (Black, White) and gender (man, woman). Participants evaluated the older individuals both before and after they either moderately or strongly confronted an ageist backhanded compliment (“You don’t look that old”). The older confronter’s race and their response to the ageist comment moderated how they were perceived by participants. Specifically, both young and older adult participants rated older Black confronters as warmer when they used a moderate compared to a strong confrontation tone but did not make that distinction for White confronters. However, when the tone of the confrontation was not considered, young, and older participants generally differed in their perceptions of confronters. Older adult participants rated White confronters lower on warmth and competence after confronting compared to Black confronters. This pattern was not observed among young adult participants, underscoring the significance of intersectional identities in shaping perceptions among older adult perceivers. This study shows that older adult confronters’ intersecting identities influence how they are perceived when they challenge ageist comments. This suggests that customized confrontation techniques may be needed for older adults whose gender and racial identities vary.
LIMITATIONS OF POLYGENIC RISK SCORES FOR DEMENTIA IN FAMILIAL EXCEPTIONAL AGING: IMPACT OF SAMPLING
Authors: Xicota Laura , Cheng Rong , Rodriguez Sandra Barral , Honig Lawrence , Lee Joseph
Published: January 2025

Genetic risk factors for late-onset Alzheimer’s disease (LOAD) have been extensively studied in the general population of European background. Indeed, significant genetic variants with low to moderate contributions to LOAD have been used to calculate Polygenic Risk Scores (PRS) to identify individuals with a higher genetic risk of LOAD. The Long Life Family Study (LLFS) is characterized by having exceptionally long-lived individuals at lower risk of LOAD. With this study, we will uncover whether the described genetic risk factors for LOAD impact AD risk in LLFS, limited to US sites. In LLFS, PRS based on two large GWASs in the general population did not predict clinical AD status. The LLFS population did not have lower allele frequencies of risk alleles, but rather lacked putative effects in these risk alleles, with only 6.7% of SNPs from GWAS 1 and 7.7% from GWAS 2 were associated with AD. We then examine the relations between PRS and endophenotype, namely AD biomarkers (Aβ40, Aβ42, Aβ42/Aβ40, NfL, and GFAP). Levels of AD biomarkers were not positively associated with PRS, which can be explained by the low frequencies of SNPs associated with biomarker concentrations (3.3%-6.7% for GWAS 1; 2.6%-6.5% for GWAS 2). Here, we show that genetic risk factors for AD in the general population do not necessarily explain AD risk in a cohort of long-lived individuals; therefore, genetic risk factors based on large-scale GWASs ascertained from the general population need to be examined with caution when applied to a cohort ascertained for exceptional longevity.
BEST PROGRAMS FOR CAREGIVING: NEW PUBLIC VERSION FOR FAMILY AND FRIEND CAREGIVERS
Authors: Cannon Rachel
Published: January 2025

A new public version of Best Programs for Caregiving (BPC) launched in 2024 for family and friend caregivers to find and compare evidence-based, dementia caregiving programs available to them in their communities. Over 200 organizations were verified to be delivering one or more of the 47 programs in BPC. Data collected from surveys of developers of BPC programs and the organizations delivering BPC programs were used to understand the reach and characteristics of programs being delivered to caregivers, including information on how caregivers can enroll, types of help and support provided, cost and eligibility requirements, how they are delivered, and adaptations made for diverse communities. Survey results suggest there are more BPC programs available, and these programs have wider reach, than expected, with 25 programs offered to caregivers living anywhere in the US via remote delivery. Additionally, nearly one-fourth of programs (23.2%) were adapted for diverse communities. Along with demonstrating the new version of BPC for caregivers, discussion focuses on how caregivers can use BPC to find programs available to them, challenges encountered with verifying delivery organizations, the importance of developing culturally adapted programs, and how BPC can be used by healthcare systems, medical providers, and community organizations to strengthen implementations of comprehensive dementia care required by the Center for Medicare and Medicaid Innovation’s new payment model “Guiding an Improved Dementia Experience” (GUIDE Model).
SOCIAL RESOURCES ARE ASSOCIATED WITH COGNITIVE FUNCTION ACROSS BLACK AND WHITE OLDER ADULTS AND NEIGHBORHOOD TYPES
Authors: Sol Ketlyne , Antonucci Toni , Clarke Philippa , Zahodne Laura
Published: January 2025

Few studies examine neighborhood resources in healthy cognitive aging despite evidence that living in neighborhoods with lower socioeconomic status (NSES) is associated with increased risk for Alzheimer’s Disease and Related Diseases (ADRD) with persistent race disparities in ADRD and NSES. Fewer studies examine which social resources buffer against the detrimental effects of living in lower-resourced neighborhoods. In this cross-sectional study, multiple linear regressions examined associations between structural and functional social resources and cognition stratified by intersectional groups of participant self-reported race and neighborhood type. Participants were drawn from the Michigan Cognitive Aging Project, a longitudinal epidemiological study of cognitive aging in southeastern Michigan (Mage=64). Global cognition was a composite of five comprehensively-assessed cognitive domains. Participant addresses were linked to year 2017 measures of neighborhood resources from the National Neighborhood Data Archive. Latent class analysis of 2,813 Michigan census tracts identified that most participants lived in tracts characterized as low-resourced (Bn=162=Wn=128) or moderately-resourced (Wn=80>Bn=64). Only among White residents of low-resourced neighborhoods, a larger social network (β=.257, p=.001) was associated with better cognition. Among Black residents of low-resourced neighborhoods, more support in their closest relationship (β=.150, p=.044) was associated with better cognition. Among Black residents of moderately-resourced neighborhoods, more strain from friends (β=-.255, p=.087) was associated with worse cognition. Support from relatives of Black, but not White, residents in both neighborhood types was associated with better cognition. Nuanced, culturally-sensitive interventions may support racially diverse older adults to foster and broaden desired relationships to buffer against adverse cognitive outcomes of neighborhood stressors.
HEALTH CARE COST DIFFERENCES BY GEOGRAPHIC CONTEXT AND DEMENTIA STATUS FOR MEXICANS AND MEXICAN AMERICANS
Authors: Anuarbe Mónika López , Gutierrez Angela
Published: January 2025

Research documents geographic differences in healthcare costs among Latinés living in the U.S. Yet healthcare costs by geographic context and dementia status for Latiné subpopulations residing in different countries, such as Mexicans in the U.S. and in México, have been overlooked. Utilizing pooled cross-sectional and weighted data of Mexicans ages 50+ from the 2012-2015 Mexican Health and Aging Study (n=15,723) and the 2012-2016 Health and Retirement Study (n=5,136), we investigated: 1) Associations between geographic context and healthcare costs; 2) Whether dementia status moderates the geographic context-healthcare costs relationship. We hypothesized that persons with dementia incurred higher healthcare costs in both countries, and that residents in less populated areas had higher healthcare costs. Preliminary findings from our two-part model (logit; GLM), which accounted for personal and healthcare characteristics, propose that persons with dementia in México had 60.3% higher average healthcare costs than individuals without dementia. Respondents with dementia also had higher odds (b=0.12; p=0.04) of incurring any healthcare costs in less densely populated areas (under 15,000 persons). However, their U.S. counterparts with dementia had lower, but insignificant, odds of incurring healthcare costs, with the dementia-rural interaction suggesting that individuals with dementia in areas with at 250,000-1 million persons were less likely to incur healthcare costs compared to areas with at least 1 million inhabitants (p<0.001), and that their healthcare costs were lower (p=0.05).These results underscore how geographical context varies across countries and how dementia status leaves some individuals more financially vulnerable than others, affecting healthcare access and overall health.
STUDY DESIGN OF THE AGING AND COGNITIVE HEALTH EVALUATION IN ELDERS (ACHIEVE) AND ACHIEVE-MRI STUDY
Authors: Huang Alison
Published: January 2025

This presentation describes the study design of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study and the ACHIEVE-MRI sub-study. The ACHIEVE study (n=977) is a multicenter, randomized controlled trial testing the effect of a best-practice hearing intervention vs. health education control on the primary outcome of cognitive decline over 3 years. Participants in the ACHIEVE study were 977 community-dwelling adults aged 70-84 years with untreated hearing loss and without substantial cognitive impairment. The ACHIEVE study was partially nested within the Atherosclerosis Risk in Communities [ARIC] study; participants were recruited from the ARIC study (n=238) and de novo (n=739) from the surrounding communities of four U.S. sites. Participants were randomized 1:1 to hearing intervention or health education control and followed for 3 years. ACHIEVE study participants (n=977) were median age 76.4 years, 53.5% female, 87.8% White, and 53.3% held a Bachelor’s degree or higher. The ACHIEVE-MRI study is a sub-study testing the effects of hearing intervention on 3-year change in brain MRI characteristics and cognitive function with speech-in-noise performance. The ACHIEVE-MRI study included a subset of ACHIEVE study participants (n=445) who received three-dimensional magnetic resonance imaging at baseline and at 3-year follow-up. Participants were slightly younger and had higher income and greater memory function compared to ACHIEVE study participants. The ACHIEVE-MRI study also had a larger proportion of participants recruited de novo (83%). This presentation provides important background for contextualization of ACHIEVE study and ACHIEVE-MRI study findings on brain structure and function and speech-in-noise performance presented in this symposium.
EFFECT OF A HEARING INTERVENTION ON THREE-YEAR CHANGE IN BRAIN MORPHOLOGY: ACHIEVE RANDOMIZED TRIAL
Authors: Pike James
Published: January 2025

Prior studies among older adults have documented associations between hearing loss and changes in brain morphology. Whether interventions involving hearing aids can reduce age-related atrophy is unknown. A substudy within the Aging and Cognitive Health Evaluation in Elders (ACHIEVE, Clinicaltrials.gov Identifier: NCT03243422) randomized controlled trial tested the effect of a best-practices hearing intervention versus health education control on three-year change in cortical thickness among older adults with hearing loss. The study enrolled 977 community-dwelling adults aged 70-84 years at baseline (2018-2019) with untreated hearing loss (better ear pure tone average [0.5-4 kHz] ≥30 and <70 dB HL) and without substantial cognitive impairment. Participants were randomized to a hearing intervention (provision of hearing aids and related technologies, counseling, and education) or a health education control (individual sessions with an educator covering health-related topics). Three-dimensional magnetic resonance imaging was performed on 3 Tesla Siemens scanners in a subsample of 445 participants (50.3% women, 11.7% Black) at the baseline and three-year follow-up. Mixed effects models were used in intention-to-treat analyses to estimate three-year change in cortical thickness. Compared to the health education control, the hearing intervention exhibited a nominally protective effect on three-year change in average cortical thickness. The greatest effect size was observed in the occipital lobe, while the smallest effect size was detected in the temporal lobe. Statistically significant effects were detected in the pars orbitalis, rostral anterior cingulate, posterior cingulate, and isthmus cingulate. The results suggest that a hearing intervention may reduce cortical thinning among older adults.
HEARING AID USE, COGNITIVE MEASURES, AND SPEECH-IN-NOISE PERFORMANCE: FINDINGS FROM THE ACHIEVE STUDY
Authors: Reed Nicholas , Jiang Kening , Huang Alison , Morales Emmanuel Garcia
Published: January 2025

There is a paucity of information on how measures of cognition, brain structure, audition, and sociodemographic (e.g., education) affect changes in speech-in-noise performance, a priority for communication, with hearing aids over time. The ACHIEVE study is a randomized control trial of older adults with hearing loss enrolled to a hearing intervention or health education control over 3-years. Self-report demographic and health measures, social participation, hearing (pure-tone audiometry, Hearing Handicap Inventory for The Elderly[HHIE]), and a cognitive test battery (global and domain-specific [language; memory; executive function]) were collected at baseline. In addition, a subsample completed Magnetic Resonance Imaging (MRI) as part of an ancillary. Speech-in-noise performance (Quick Speech-in-Noise test; scores range 0-30 with higher being better) was measured at baseline without hearing aids and at 2-months and 3-years with hearing aids. Among 220 participants (median age=75.5; 50.9% Female) in the intervention arm, median unaided speech-in-noise scores were 19.0 (IQR=16.0-22.5) at baseline. At ~2-months and 3-years, aided scores were 21.3 (18.0-23.5) and 20.0 (16.0-22.5), respectively. Using linear mixed-effects models, age, education, martial status, social network, depressive symptoms, hypertension, hearing loss, HHIE, global, language domain and executive cognitive domains, temporal lobe volume, white matter hyperintensities, white matter integrity (fractional anisotropy, and mean diffusivity) were associated with baseline speech-in-noise performance. However, 2-month change was only associated with baseline hearing loss (B=0.28;95%CI=0.19-0.36), HHIE (B=0.12;95%CI=0.05-0.18), temporal lobe volume (B=0.93;95%CI=0.40-1.45), white matter hyperintensities (B=1.09;95%CI=0.43-1.76), fractional anisotrophy (B=-0.72;95%CI=-1.40--0.05), and mean diffusivity (B=0.70;95%CI=0.03-1.37) while 3-year change was only associated with baseline hearing (B=0.15;95%CI=0.04-0.26), HHIE (B=0.09;95%CI=0.01-0.19), and fractional anisotrophy (B=-1.14;95%CI=-2.08--0.20).
ENGAGING DEMENTIA CARE PARTNERS IN FALL RISK MANAGEMENT: HEALTH PROFESSIONALS’ PERSPECTIVES
Authors: Zhou Yuanjin , Kilcrease Amanda , Phelan Elizabeth
Published: January 2025

Older people with dementia are at higher risk of falls than those without dementia. Informal care partners are well-positioned to assist them in reducing their fall risk. However, little is known about what support care partners may need to accomplish this. Health professionals with experience working with older people with dementia and their care partners may have important insights. This study thus aimed to characterize barriers for care partners to engage in fall risk management (FRM) from health professionals’ perspectives and identify strategies to overcome these barriers. Using snowball sampling, we conducted semi-structured, qualitative interviews via Zoom with 22 health professionals from six disciplines (geriatric medicine, nursing, occupational therapy, physical therapy, social work, and pharmacy). These health professionals had an average of 22 (range: 5-44) years of clinical experience in dementia care. Thematic analysis identified the following themes related to barriers: care partners’ care burden, a low perceived need for FRM, a tendency to prioritize the preferences of older people, resistance to making changes, disagreement about care arrangement, and challenges accessing needed resources (e.g., food, home safety evaluation, mobility devices). Suggested strategies included addressing care partners’ primary concerns first (e.g., behavioral issues of older people with dementia), assessing care partners’ motivation, existing strategies, and potential support for FRM, linking recommendations to priorities and goals of the dyads, and connecting them with appropriate resources. This study offers new perspectives on challenges dementia care partners may face in managing fall risk. These perspectives warrant further exploration with dementia care partners.
EVIDENCE-BASED FALL PREVENTION TRAINING FOR OLDER ADULTS IN RURAL COMMUNITIES
Authors: Murphy Sara , Crocker Andrew , Luk-Jones Susanna , Lemack Bergen
Published: January 2025

Falls among older adults is a public health issue affecting one-fourth of adults aged 65 and older annually and is a leading cause of unintentional injury death. Nearly 22% of older Texans live in one of the 199 rural counties, many without easy healthcare access. Texas has 71 counties with no hospital access, and only 83 rural counties have hospitals that provide 24/7 emergency care services. In response to these challenges, the University of North Texas Health Science Center Geriatric Workforce Enhancement Program (GWEP) partnered with Texas A&M Agrilife Extension Services (AgriLife) to expand A Matter of Balance (AMOB) fall prevention program for older adults in rural communities throughout Texas. Delivered as eight sessions, AMOB is designed to improve participant confidence, physical activity, and awareness through group activities in exercise, safety, assertiveness training, and problem-solving. Pre and post-surveys were administered to rate participant knowledge and confidence in managing fall-related situations on a scale from 1 (not sure at all) to 4 (absolutely sure). In 2023, AMOB sessions were held in 11 rural communities. Participants (n=182) were predominantly female (90.1%) aged 35 to 96 (average age: 75.88). A paired t-test comparing pre- and post-intervention scores revealed significant enhancements in knowledge about fall prevention strategies, improved ability to protect themselves during falls, enhanced physical strength, steadier balance, and better fall recovery skills. Evidence-based programs, like AMOB can be broadly disseminated to address challenges of falls among older adults at the individual and community level.
COMMUNITY MOBILITY IN OLDER ADULTS RECOVERING FROM DISABILITY IN DISINVESTED NEIGHBORHOODS: A QUALITATIVE STUDY
Authors: Falvey Jason , Mathis Lindsey , Cooper-Williams Jasmine
Published: January 2025

In socioeconomically disadvantaged areas, crumbling infrastructure and perceptions of limited safety can reduce opportunities for older adults to safely get around outside and engage meaningfully in social activities. This study seeks to understand how older adults in disinvested communities meaningfully recover community mobility after disabling injuries, and evaluates how recent payment reforms have challenged individualized rehabilitation delivery in home and outpatient settings. We recruited 13 adults over the age of 55, residing in neighborhoods with an Area Deprivation Index (ADI) of ≥9/10. Participants engaged in one-hour semi-structured interviews, coded by two independent researchers. The reliability between coders was verified using a kappa statistic. Five critical themes describe these mobility experiences: 1) exacerbating impact of chronic diseases and physical limitations on community mobility 2) environmental and infrastructural barriers restricting access to community resources; 3) influence of perceived safety and violent crime on participation in outdoor activities; 4) essential role of social support networks in enhancing mobility and 5) power of individual and community resilience in mitigating mobility challenges. One participant noted: “I never know when they going to start shooting and stuff. So when it start getting dark, I get up pretty early and get out early, try to get my stuff done [before dark].” –a vivid illustration of modifications in mobility forced by the fear of gun violence, complicating the recovery process Our study suggests new care pathways are needed to enhance the support for older adults navigating the challenges of recovery within socioeconomically disadvantaged neighborhoods.
PAYMENT POLICY IMPACT ON HOME HEALTH ACCESS FOR PEOPLE LIVING WITH DEMENTIA
Authors: Knox Sara , Brinton Daniel , Johnson Jada , Simpson Kit
Published: January 2025

Home health has been recommended as a strategy to prevent institutionalizations and promote aging in place for people living with dementia (PLWD). Longer home health episodes have been shown to optimize home health outcomes for PLWD. Recent payment policy reforms threaten the viability of this approach. The Patient-Driven Grouping Model (PDGM) uses patient characteristics to determine payment. Concerns have been raised that this model disincentivizes home health agencies from admitting patients, such as PLWD, who are admitted from the community and require longer episodes of care. We applied the PDGM to 100% home health files from 2019 to examine differences in PDGM components for PLWD and their peers before PDGM implementation. Two propensity score-matched groups of 153,957 individuals with and without dementia were created based on patient demographics, caregiver support, cognitive status, prior functional status, prior health care utilization, and Charlson comorbidity scores. Multivariate regression was used to examine the relationship between dementia and admission source/episode timing, functional limitations, and comorbidity level controlling for age, sex, and race. PLWD had greater odds of early community admissions (1.2 p<.0001), high functional limitation (1.09 p<.001), and of having a high comorbidity adjustment (1.49, p<.001). The primary clinical grouping for both groups was cardiac and circulatory. However, people with ADRD had twice as many Behavioral Health clinical group records. These findings indicate that people living with dementia did access and use home health differently before the implementation of the PDGM and may be experiencing negative repercussions of the new payment model.
COMMUNITY DISCHARGE AFTER SKILLED NURSING FACILITIES BETWEEN MEDICARE FEE-FOR-SERVICE AND MEDICARE ADVANTAGE
Authors: Rivera-Hernandez Maricruz , Chou Lin-Na , Kumar Amit
Published: January 2025

The purpose of this study was to assess differences in rates of successful community discharge among Medicare Advantage (MA) and fee-for-service (FFS) enrollees by race/ethnicity. We linked the Master Beneficiary Summary File, Medicare Provider and Analysis Review data, and the Minimum Data Set. We identified 2,412,731 Medicare enrollees who were admitted to a skilled nursing facility in 2020. We assessed community discharge within 100 days remaining out of the skilled nursing facility for 30 days (LTC focus; Rivera-Hernandez et al., 2019). Approximately, 34.48% beneficiaries were enrolled in a MA plan at admission. A higher proportion of MA beneficiaries were discharged to the community compared to FFS beneficiaries (53.64% vs. 42.70%). Among MA beneficiaries, 54.50% of Hispanic beneficiaries and 47.51% of Black beneficiaries were discharged to the community compared to 53.31% among white enrollees. However, 45.85% of white FFS beneficiaries were discharged to the community compared to 38.71% Hispanic and 34.60% of Black FFS beneficiaries. After adjusting for clinical, demographic characteristics and facility fixed-effects, rates of discharge to the community remained approximately 4.87 percentage points (p.p.) higher (95% CI, 4.72 to 5.02) among MA compared to FFS enrollees. In addition, this difference among FFS and MA beneficiaries remained wider among Black (3.43 p.p., 95% CI, 3.05 to 3.81) enrollees when compared to the difference among white FFS and MA enrollees. The observed differences in successful discharge to the community among Medicare enrollees suggest the need to promote equity in the transition of care among the underserved adult population.
NURSING HOME STAFF PERSPECTIVES ON SUPPORTING PERSON-CENTERED CARE IN THE FACE OF RISK TO MAINTAIN QUALITY OF LIFE
Authors: Curyto Kimberly , Taylor Philip
Published: January 2025

Nursing home (NH) quality of care efforts emphasize person-centered care as a best practice. Evaluations of person-centered interventions report positive outcomes including improved resident psychological wellbeing, quality of life, and staff job satisfaction. However, prioritizing NH resident personal preferences and values can lead to choices that increase risk, and thus staff must act in ways that balance resident autonomy and safety. Best practices in person-centered care in the NH should honor choice and maintain safety in support of overall resident wellbeing through shared decision making among residents, families and the whole clinical team. The COVID-19 pandemic placed NH residents and staff at risk of decline and death and created barriers to implementing person-centered care. A primary focus of this symposium is to share a range of staff perspectives on supporting NH resident autonomy and safety in the face of risk, including those of NH leaders, mental health providers, and direct care team members such as nursing staff, recreation/activities staff, and social workers. Presentations will highlight the impact of a focus on safety during the increased risk from the pandemic on resident and staff wellbeing, and staff adaptation efforts to ensure person-centered care. Understanding NH staff and leadership perspectives on response to risk while supporting person-centered care will inform future care management during crises and other times of increased concern for safety in NH settings. Important perspectives of paid care workers during the pandemic will be discussed in the context of workforce development efforts.
MENTAL HEALTH PROVIDERS’ PERSPECTIVES OF BALANCING RISK AND RESPONSE AND THE PANDEMIC’S IMPACT IN VHA NURSING HOMES
Authors: Curyto Kimberly , Page Kyle , Shoji Kristy , Ryu HyeRim , Washington Tracey , Karel Michele
Published: January 2025

The COVID-19 pandemic forced a reconceptualization of how mental health services were offered to older adults in nursing homes, affecting residents and staff, as each experienced stringent and evolving infection control precautions. An anonymous national survey of Veterans Health Administration Community Living Center (CLC) mental health professionals in October 2022 included questions about the impact of the pandemic on CLC residents and healthcare teams. Respondents (N=107) included psychologists (82%) and psychiatric providers (18%). Sixty-six percent of respondents worked in the CLC before the pandemic and reported providing mostly in-person clinical care (97%). In comparison, across the entire sample two-years later, 72% reported providing in-person clinical care, 23% a mix of in-person and virtual care, and 5% entirely virtual care. An expert panel coded responses to the question, please describe your work with Veterans and teams in the CLC during the pandemic, in rotating groups of two to identify qualitative themes, and reviewed as a group to achieve consensus. Several themes emerged: 1) varied and changing methods/modes of work, 2) continued psychotherapy and assessment services, 3) increased education and support for the team, 4) declines in resident engagement, mental health, and cognition, and 5) negative impact on providers/the team (e.g., barriers to teamwork and person-centered care). Results underscore the impact the pandemic/precautions had on residents’ and teams’ well-being, as well as the adaptability of mental health providers, and may inform ongoing and future efforts to balance risk and support person-centered care.
LONGITUDINAL QUALITATIVE RESULTS FROM STAFF IMPLEMENTING MONTESSORI DURING THE PANDEMIC
Authors: Hilgeman Michelle , Kennedy Katherine , Mills Whitney , Snow A , Bishop Teddy , McIntosh Nathalie , Curyto Kimberly
Published: January 2025

Promoting autonomy, dignity, and independence are core values of Montessori approaches to person-centered care in nursing homes. Yet infection control precautions restricted staff and resident freedoms during the COVID-19 pandemic. We describe longitudinal data from a stepped-wedge, randomized clinical trial examining implementation and effectiveness of Montessori approaches in eight Department of Veterans Affairs nursing homes (2021-2023). COVID-rates were calculated from electronic health records (EHRs) and graphed over 18 months around the intervention. Staff (N=168) participated in qualitative individual or group interviews at baseline, 3-, 6-, 9-, and 12-months. Normalization Process Theory informed questions and qualitative content analysis about the effects of COVID-19 on Montessori implementation and staff experiences. Transcripts were coded by members of the study team using NVivo. There was variability in COVID rates: most NHs concentrated below 1% of resident-days with COVID and occurred after 3-months of Montessori training/implementation, while two sites experienced peaks of 5% and 15%. Qualitative themes across implementation included: 1) Staff described fluctuating waves of COVID, changes in precaution protocols, and variable policy interpretations across sites to be associated with negative impact on residents and staff (isolation, loneliness, burden, burnout, low morale). 2) Staff identified creative adaptations (e.g. walkie-talkies) to implement Montessori within precaution protocols. 3) Staff reported that Montessori principals improved morale, mitigated negative effects of the pandemic and related precautions, and created a pathway for increased advocacy for person-centered care and resident wellbeing despite risks. Findings highlight the importance of reinforcing person-centered care in the midst of safety concerns during crisis.
USE OF AND EXPERIENCES WITH TELEHEALTH VISITS AND PATIENT PORTALS IN A NATIONALLY REPRESENTATIVE SAMPLE OF OLDER ADULTS
Authors: Solway Erica , Singer Dianne , Kirch Matthias , Roberts Scott , Kullgren Jeff
Published: January 2025

The University of Michigan National Poll on Healthy Aging (NPHA) has explored older adults’ changing views and experiences related to telehealth and other health-related technologies over the past several years. NPHA surveys are fielded twice per year to a nationally representative sample of over 2,500 adults ages 50-80 (completion rates: 50-60%). When the poll first included questions about telehealth use and perceptions in 2019, just 4% of U.S. adults ages 50-80 reported having a telehealth visit in the past year. Telehealth expanded rapidly during the pandemic and by mid-2020, 26% of older adults reported having had a telehealth visit within the prior three months. In addition, the NPHA has explored patient portal use, documenting an increase in portal uptake over time as well as older adults’ experiences with, and barriers to, portal use. Recently, the NPHA explored older adults’ experiences related to sending portal messages to their health care providers and the out-of-pocket costs associated with this. Other recent NPHA research has demonstrated use and interest in direct-to-consumer telehealth services provided by online-only companies. As of 2023, the poll found that 7.5% of people ages 50-80 had used at least one direct-to-consumer health care service from an online-only provider, and 32% said they would be interested in these types of health care services in the future. The NPHA provides timely insights on older adults’ changing perspectives and experiences related to emerging areas of health care that can help to inform efforts to improve access, quality, and integration of health care.
A NEW NORMAL: AARP SURVEY FINDINGS ON OLDER ADULTS’ EXPERIENCES AND PERSPECTIVES ON TELEHEALTH AND AI IN HEALTH CARE
Authors: Lampkin Cheryl , Keenan Teresa
Published: January 2025

The COVID-19 pandemic ushered in a “new normal” as it relates to receiving health care--especially for older adults. This presentation will include insights on how new technology and attitudes about technology have impacted how older adults receive health care services. For example, findings from a recent survey of 1,700 older adults conclude that while over half say they are likely to attend a phone or video session with a mental health professional (53%) or their primary care provider (52%) for a mental health concern, most are skeptical of telehealth believing they get better quality care for both physical (82%) and mental health (69%) concerns in person. Similarly, another AARP study found older adults believe in-person visits are better than telehealth visits when it comes to providing a personal touch (73%), diagnosis accuracy (72%), and thoroughness (68%). However, many said in-person and telehealth are about the same when it comes to keeping personal information safe (60%) and private (52%). These and other insights are based on data obtained from multiple recent AARP surveys fielded among nationally representative samples of midlife and older adults. Studies also included oversamples of Black/African American and Hispanic/Latino respondents, enabling enhanced analyses. This multi-analysis presentation will provide unprecedented insights on familiarity and use of technology in receiving health care as well as opinions and attitudes on the use of artificial intelligence (AI) in health care. Additionally, a preview of new data collected in late fall 2024 will provide timely insights on current views on health care innovations.
EFFECTS OF A CANCER DIAGNOSIS ON ECONOMIC PROSPERITY IN THE LONG RUN: EVIDENCE FROM LINKED SURVEY AND CREDIT DATA
Authors: Warren John , Thomas Amanda , Grodsky Eric , Muller Chandra
Published: January 2025

Although 40% of Americans will experience cancer in their lifetime, little is known about the long-term impacts of cancer diagnosis on debt, wealth, and financial precarity later in life. Using data from High School and Beyond (HSB) —a large (n~25,500) nationally representative study of high school students followed from 1980 through 2022—linked to consumer credit records (2004-2023), we estimate changes in debt, credit, and other economic measures resulting from after a cancer diagnosis. We also consider how these processes vary across demographic, educational, and family background groups. Approximately 13,900 individuals from the original cohort responded to the 2021/2022 survey, with more than 1,000 indicating a lifetime diagnosis other than skin cancer; another 490 cohort members died from various forms of cancer by 2021/2022. The most common cancers reported were breast (n=350) and prostate/vaginal (n=150 each) with more than one-third diagnosed in early adulthood (≤ 45 years old). Preliminary results using cross-sectional measures of financial well-being indicate reduced annual income earnings and heightened financial precarity as compared to otherwise similar people without a cancer diagnosis. With linked consumer credit data, we are well-equipped to expand knowledge about the effects of a cancer diagnosis on financial health by analyzing fluctuations in indicators such as credit score, medical and other forms of debt, bankruptcy, and estimated wealth in the months and years after a cancer diagnosis. Our analyses will model these outcomes, inclusive of key confounders (age, education, type of cancer, etc.) both for the full sample of demographic and socioeconomic subgroups.