bluuebunny/crossref_metadata_2025 huggingface dataset:
SOCIAL DETERMINANTS OF CHINESE OLDER ADULTS’ SOCIAL PARTICIPATION: A MULTIPLE-GROUP ANALYSIS
Authors: Liang Jianling , Zhuang Jia , Zhuang Jie
Published: January 2025

In China, as the nation’s aging population grows, its family structure diversifies, with more older adults living apart from their children. While social participation is widely acknowledged as a crucial channel for older adults to maintain their social and psychological well-being, its social determinants among older adults from different family structures remain obscure. This study addresses this knowledge gap with data from the Telephone Support Service in Jiangmen City, China (N = 9,871). First, one-way ANOVA results reveal that older adults living alone demonstrate a higher level of social participation than those living with spouses or those with their children (F = 23.441, p <.001). Further, multiple-group analysis (MGA) was performed to determine the group difference across these three elderly groups regarding the relationship between their social participation and health status (i.e., vision, hearing, and mobility) and demographic features (i.e., age and gender). Three group differences were identified. First, compared with those living alone, the relationship between vision and social participation is significantly stronger among older adults living with spouses (CMIN = 4.317, p =.038). Second, the relationship between mobility and social participation among older adults living alone is significantly stronger than that demonstrated among those living with children (CMIN = 5.772, p =.016). Third, the relationship between hearing and social participation is significantly stronger among older adults living alone than those living with children (CMIN = 5.741, p =.017). These findings offer fresh insight to understand the social participation of older adults with different features.
RACIAL/ETHNIC DISPARITIES IN TRAJECTORIES OF HOSPITALIZATIONS AMONG PATIENTS WITH HEART FAILURE
Authors: Dhingra Radha , Xu Hanzhang , Hammill Bradley , Lynch Scott , West Jessica , Green Michael , Dupre Matthew
Published: January 2025

Little is known about racial/ethnic differences in the long-term patterns of hospitalization following the diagnosis of heart failure (HF). We examined racial/ethnic differences in trajectories of hospital admissions following a diagnosis of HF and assessed the factors contributing to the long-term risks of hospitalization. We included 5,606 patients with newly-diagnosed HF between January 2015 and July 2018 in the Duke University Health System and followed them for up to five years. Group-based trajectory models were used to identify trajectories of all-cause admissions following the diagnosis of HF. Multinomial logistic regression models were used to identify patient characteristics associated with the trajectories of admissions. Approximately 45.6% (N=2,556) of HF patients had low risks of hospitalization, 36.6% (N=2,052) had elevated risks of admission shortly after diagnosis (early risk), 9.9% (N=553) had elevated risks at later stages of illness (late risk), and 7.9% (N=445) had consistently high risks of hospitalization. Non-Hispanic Black patients were more likely to exhibit early risks of hospitalization (odds ratio, [95% CI]: OR=1.33, [1.16-1.52]; P<.001), late risks of hospitalization (OR=1.92, [1.58-2.34]; P<.001), or consistently high risks of hospitalization (OR=1.89, [1.52-2.35]; P<.001) compared with non-Hispanic White patients. Diabetes, chronic kidney disease, and residence in a disadvantaged neighborhood significantly contributed to the excess risks of admissions among non-Hispanic Black patients. Overall, these findings have important implications for identifying the social and clinical factors associated with racial disparities in the timing and frequency of hospital admissions in HF patients.
ACTING WITH AWARENESS AND VISUOSPATIAL LEARNING IN MILD COGNITIVE IMPAIRMENT
Authors: Zammitti Melissa , Bower Emily , Tremont Geoffrey
Published: January 2025

Mindfulness practice is a potentially low-risk intervention for mild cognitive impairment (MCI), with numerous studies indicating its robustness in addressing modifiable risk factors associated with the progression of MCI. Evidence suggests a positive association between mindfulness and cognitive ability, including within the visuospatial processing domain; however, which facets of mindfulness are associated with aspects of visuospatial processing are not well understood. We aimed to assess the relationship between the five facets of mindfulness and visuospatial learning and memory (VSLM). We hypothesized that stronger endorsement of the acting with awareness facet would correlate with improved VSLM, as present-mindedness could enhance the processing of one’s physical surroundings. In this secondary analysis, we conducted a hierarchical linear regression using baseline data from a pilot intervention study involving older adults with MCI. 46 participants with amnestic MCI (65% female, mean age 71.6 years) completed the Five Facet Mindfulness Questionnaire (FFMQ) and the Brief Visuospatial Memory Test-Revised (BVMT-R). We controlled for age, race, gender, education, and depression. The analyses revealed a negative relationship between BVMT-R learning scores and FFMQ Acting with Awareness subscale scores (FFMQ-A) such that higher learning was related to lower awareness (β= -.540, p=.021. Associations between BVMT-R scores and other mindfulness facets were not significant (p’s>.05). Findings suggest that the specific domain of mindfulness, acting with awareness, may be associated with poorer visuospatial learning over repeated trials in individuals with MCI. The findings encourage further investigation of the acting with awareness facet and its role in interventions for older adults with MCI.
CO-CREATING RESOURCES TO RAISE AWARENESS OF RISKS OF GOING MISSING AMONG PERSONS WITH DEMENTIA
Authors: Daum Christine , Vahedi Vanessa , Chawrun Isabella , Neubauer Noelannah , Rutledge Emily , Adekoya Adebusola , Miguel-Cruz Antonio , Liu Lili
Published: January 2025

Persons living with dementia are at risk of getting lost and going missing due to wayfinding challenges. Yet, there are few accessible resources available that raise awareness of the risks of going missing and strategies to manage these risks. The purpose of this project was to develop engaging and informative learning resources for first responders, search and rescue personnel, persons living with dementia, care partners, and health and social care providers. Co-design and co-production approaches guided the development of these resources and were informed by reviews of the academic and grey literature, dialogue with persons with lived experiences, and content analysis of missing person cases. We produced three sets of resources: 1) nine dementia-friendly first responder videos for police and search and rescue personnel to enhance their awareness of dementia and risks of going missing; 2) a toolkit of strategies and resources for persons living with dementia and care partners to reduce the risks associated with getting lost and going missing; 3) eight personas and scenarios that depict contextual factors within missing events that can be utilized by service providers and the public in their interactions with persons living with dementia and care partners. All resources were reviewed by participants through interviews, focus groups, and written feedback to identify essential content and ensure accuracy, relevance, and comprehensibility. These sets of learning resources can elevate awareness and offer practical strategies to support persons living with dementia, care partners, first responders, and service providers.
DIFFERENCES IN ADVANCED CARE PLANNING BY LEVEL OF COGNITIVE IMPAIRMENT
Authors: Arellanes Isabella , Jacobson Mireille
Published: January 2025

Advance Care Planning (ACP) allows patients to make decisions regarding their health care while they still have the ability to do so. ACP may be particularly important for individuals experiencing cognitive decline who are likely to become unable to make decisions for themselves. This study identifies differences in advance care planning based on cognitive impairment status. This sample includes 6,650 older adults between the age of 65-90 years from the 2018 wave of the Health and Retirement Study. Cognition was categorized based on the Langa-Weir cognition classifications, with normal cognition classified by scores of 12-27 (n= 5,313), “cognitive impairment, not dementia” by scores of 7-11 (n= 1,085), and dementia by scores between 0-6 (n= 252). Among respondents with a normal cognition score, 65% reported having either a living will or power of attorney. Among those categorized as having “cognitive impairment, not dementia” and dementia, the percentages of ACP completion were lower, 59% and 54%, respectively. In a regression model controlling for race/ethnicity, gender, years of education, marital status, AD or dementia diagnosis, income, and healthcare utilization, all but diagnosis were significant predictors of ACP. There was a significant difference in ACP between those with normal cognition as those classified as having “cognitive impairment, not dementia” (p< 0.05). Compared to those in the normal cognition group, those in the “cognitive impairment, not dementia” group are 1.3 times more likely to engage in ACP (p < 0.05). These findings suggest differences in significant predictors of ACP based on level of cognitive impairment.
EFFECTS OF FRAILTY AND FUNCTIONAL IMPAIRMENT ON THE ASSOCIATIONS OF COGNITIVE IMPAIRMENT AND DEMENTIA WITH HEALTHCARE COSTS
Authors: Fink Howard , Sheets Kerry , Langsetmo Lisa , Schousboe John , Kats Allyson , Ensrud Kristine
Published: January 2025

Dementia and cognitive impairment (DCI) are associated with higher total healthcare costs (THC). We sought to determine the fraction of incremental THC of DCI accounted for by frailty and/or functional impairment. We utilized a multi-cohort dataset of 8165 community-dwelling, fee-for-service Medicare beneficiaries (53% women, 79% non-Hispanic White, mean age 79 years) who had index exams in 1 of 4 prospective cohort studies linked with Medicare claims. Cohort-based DCI was defined by self-or-proxy report of a dementia diagnosis or abnormal cognitive test results. Multimorbidity was count of chronic conditions. Frailty was a claims-based deficit accumulation index (CFI) or the Cardiovascular Health Study phenotype (3+ components of shrinking, slowness, weakness, poor energy, low physical activity). Functional impairment was self-reported difficulty performing 4 ADLs (with none, 1, 2, 3 or 4 of walking, climbing steps, transferring, bathing/showering). Annualized THC were ascertained for 36 months following index exams. After adjustment for age, race, geographic region, and multimorbidity, those with cohort-based DCI vs. no DCI had higher incremental THC ($6883 in women and $7276 in men). Respectively, 40%, 31%, 33% and 63% of incremental THC in women and 28%, 29%, 40% and 58% of incremental THC in men were attributable to CFI, phenotypic frailty, functional impairments or a combination of all 3 measures. In conclusion, in both men and women, most of the incremental THC of DCI were attributable to frailty and functional impairment. Further attention should be given to assessment of these geriatric syndromes and potential mitigation of their impact among those with DCI.
A QUICK NOVEL MOBILE HEARING IMPAIRMENT ASSESSMENT FOR DIGITAL SPEECH HEARING SCREENING
Authors: Banks Russell , Greene Barry , Morrow Isaiah , Ciesla Marissa , Woolever David , Tobyne Sean , Jannati Ali , Pascual-Leone Alvaro
Published: January 2025

It is estimated that 1 in 4 people worldwide will be living with hearing impairment by 2050. We propose a digital Speech Hearing Screener (dSHS) using short nonsense word recognition to measure speech-hearing ability. We compare dSHS outcomes with standardized pure-tone averages (PTA) and speech-recognition thresholds (SRT). 50 participants aged 55 or older underwent PTA and SRT measurement. One-way ANOVA was used to compare differences between hearing impaired and hearing not-impaired groups, by the dSHS, with a clinical threshold of moderately impaired hearing at 35dB and severe hearing impairment at 50 dB. dSHS results significantly correlated with PTAs/SRTs. ANOVA results revealed the dSHS was significantly different (F(1,47)=38.1, p< 0.001) between hearing impaired and unimpaired groups. Classification analysis using a 35dB threshold, yielded accuracy of 85.7% for PTA-based impairment and 81.6% for SR-based impairment. At a 50dB threshold, dSHS classification accuracy was 79.6% for PTA-based impairment (NPV-93%) and 83.7% (NPV-100%) for SRT-based impairment. The dSHS successfully differentiates between hearing-impaired and unimpaired individuals in under 3 minutes. This hearing screener offers a time-saving, in-clinic hearing screening to streamline the triage of those with likely hearing impairment to the appropriate follow-up assessment, thereby improving the quality of services. Additionally, this tool can help to rule out hearing impairment as a cause or confounder of cognitive impairment.
RELATIONAL COLLABORATION BEYOND PROFESSIONAL TEAMS: NEGOTIATING HYBRID EXPERTISE WITH INFORMAL CAREGIVERS
Authors: Ginoux Laura , McAllum Kirstie
Published: January 2025

When conceptualizing collaboration in the context of health and social care, most definitions privilege interactions among members of the interprofessional team. To achieve joint goals and solve problems more effectively, these professionals must combine and integrate their disciplinary knowledge with that of others, including those outside the immediate healthcare team. Over the last three decades, the health communication literature has insisted on the need for patient-centered healthcare practices. Patient-centeredness includes appreciation for and inclusion of patients’ experiential knowledge (based on their daily experiences with health conditions). We note that the literature neglects the idea of experiential expertise of informal caregivers (ICG). Yet, ICGs are precious aids and mediators between the older adults they care for and healthcare workers (HW). Unfortunately, ICGs are not always included in decision-making processes, and hierarchies of knowledge remain within relationships with HWs. Following a literature review, our research highlights the need to develop a relational vision of collaboration that would enable interprofessional teams to consider ICGs as part of the team, enhance the quality of interactions, and, therefore, improve the quality of care provided to older adults. The objectives of this paper are threefold. First, we define our theoretical model of relational collaboration. Second, we explain why developing relational collaboration between ICGs and HWs benefits teams as well as older adults. Third, we contend that nurturing the relational dimensions of collaboration (respect, cultural humility, empathy, compassion, and trust) enables ICGs and HWs to negotiate a hybrid form of expertise that integrates medical and experiential knowledge.
A PARTICIPATORY STUDY TO CO-DESIGN SOCIAL NORM NUDGES FOR IMPROVING MENTAL HEALTH HELP-SEEKING IN OLDER PEOPLE
Authors: Liu Tianyin , Wang Jia
Published: January 2025

Mental health help-seeking is often delayed in older people, and different theories have hypothesized diverse mechanisms to improve help-seeking. The theory of planned behavior (TPB) and nudge theory (NT) converge on social norms as promising targets for intervention. Despite accumulating evidence of social norm nudges in promoting health behaviors, no intervention has utilized social norms to promote mental health help-seeking in older adults. This study aims to (a) co-design social norm-nudges with different stakeholders and (b) pilot their feasibility and effects in improving mental health help-seeking intention in older people. The participatory study recruited ten older people, two social workers, and two experienced researchers to co-design the social norm nudges. All participants received three-hour training on TPB and NT principles, followed by ten interactive co-design workshops over three months. A set of 14 social norm nudges was designed and piloted among 20 older people for feasibility and effects. The participants completed a self-administered baseline questionnaire, received 14 social norm nudges over smartphones in two weeks (one message per day), completed the post-intervention questionnaire and provided feedback to the nudges afterwards. The primary outcomes were changes in subjective norms and help-seeking intention assessed using a revised Chinese version of the TPB questionnaire (C-TPB); secondary outcomes included perceived behavioral control, help-seeking attitude, perceived barriers to help-seeking (C-TPB subscales), and mental health assessed by PHQ-9, GAD-7 and UCLA-3. Preliminary results suggested the feasibility of the social norms to be delivered digitally and the effects in increasing help-seeking intention and attitude.
EFFECT OF ACTIVITY-BASED INTERVENTION ON QUALITY OF LIFE AMONG OLDER ADULTS LIVING IN COMMUNITY
Authors: Seo Jisu , Song Rhayun , Li Yuelin , Oh Eunna
Published: January 2025

With age, older people experience reduced participation in activities. According to the Activity theory of aging, older adults can age successfully by engaged in their favorite activities. This study was conducted to systematically review RCTs that applied activity-based interventions (ABIs) to older adults living in community, and was to classify the ABIs into interaction-based social activities, exercise-based physical activities and self-directed individual activities, as well as compare and analyze the size of the effect on quality of life based on three types of activities. The analysis included 76 randomized studies from 6 Korean databases as well as 5 English databases. Cochrane’s Risk of Bias tool was used to assess the quality of the risk of bias. A CMA version 4 was used to calculate the effect size and a 95% confidence interval using a random effect model and to assess heterogeneity and publication bias. A network meta-analysis was conducted using R version 4.3.1 software’s “netmeta” package. Using GRADE, we assessed the quality of the evidence. ABIs applied to older adults living in community significantly improved their quality of life (SMD=0.56), and all three types of activity-based interventions significantly improved their quality of life. According to the result of ranking of network meta-analysis, self-directed individual activities was found to have the highest probability of being selected at 91.7%. As older people spend more time alone as aging, it is important to enhance their quality of life by encourage them to choose and participate in activities according to their own interests.
IMPROVING AWARENESS OF FOOD RESOURCES FOR OLDER ADULTS THROUGH REGIONAL COLLABORATIVE EFFORT
Authors: Ilardo Joan , Zell Angela
Published: January 2025

The Successful Nutrition Programs Across the Lifespan (SNP-AL) created a roadmap with recommendations for selecting sustainable, successful, evidence-informed nutrition programs that meet the community’s needs and foster cross-sector collaboration; implementing interventions; and gathering data to measure program outcomes. The Capital Area Coalition (CAC) addressed lack of communication around its regional food resources. The pandemic changed many community resources, so residents weren’t aware of current food resources or how to access emergency food. 2-1-1 coordinates with regional resources and provides information about local health and human services resources. CAC’s strategy included a media campaign, implemented in Spring and Summer 2023, directing residents with food insecurity to contact 2-1-1 for available resources, using local TV and radio spots and including 1400 leaflets containing information about food resources in produce boxes delivered to income-eligible residents. They provided 2-1-1 information to appropriate agencies. We used the Collaborative Effectiveness Assessment from the Prevention Institute to measure cohesiveness. Results demonstrated CAC was highly motivated with trust, strong communication, and conflict resolution skills. They perceived their mission was simultaneously overarching and comprehensive, aligning with their overall objective. CAC’s sustainability plan for 2-1-1 is helping local agencies recognize the importance of providing current information to 2-1-1. Calls to 2-1-1 was the indicator of impact of their media campaign. We compared data from 2-1-1 for 4/2022-6/2022 and 4/2023-6/2023. Food Lines referrals increased from 32 to 37. Food Stamps/SNAP decreased to 49 from 55. Food Pantries referrals increased the most, increasing 29% from 342 in 2022 to 479 in 2023.
THE CONTRIBUTION OF NIGROSTRIATAL DOPAMINERGIC TRANSMISSION ON APATHY IN OLDER ADULTS
Authors: Song Yixiao , Cawthon Peggy , Butters Meryl , Chahine Lana , Rosano Caterina
Published: January 2025

Apathy is a common and impairing symptom in neurological disorders and its connection with striatal dopamine levels has been examined in Parkinson’s and Alzheimer’s disease. Little is known about the nature of this relationship in older adults free from neurological diseases. This study explores the link between apathy and nigrostriatal dopaminergic neurotransmission in community-dwelling older adults without overt neurological symptoms. This was a cross-sectional study of community-dwelling older adults (N=230, mean age 75.3yrs; 60% female) from Monongahela-Youghiogheny Healthy Aging Team (MYHAT) and Study of Muscle, Mobility and Aging (SOMMA) studies. The nigrostriatal dopamine binding site density of VMAT2 was quantified via (+)-[11C]DTBZ PET imaging. Apathy was assessed with Apathy Evaluation Scale, an 18-item questionnaire using a 4-point Likert scale (range 18-72; higher score indicates greater apathy). Latent class analysis was used to identify latent subtypes of apathy. Multinomial logistic regression was used to investigate the relationship between dopaminergic transmission and latent classes. Three latent classes were identified, namely, low apathy (mean 20.7; SD 2.36; N=110), moderate apathy (mean 25.5; SD 2.83; N=89), and high apathy (mean 32; SD 4.82; N=31). Each SD decrement in nigrostriatal dopaminergic transmission corresponded to 39% and 42% lower odds of having high apathy compared to low apathy (OR=0.61; 95%CI: 0.39-0.95; p-value=0.028) and moderate apathy (OR=0.58; 95%CI: 0.36-0.90; p-value=0.015), respectively, after adjusting for age at the time of MRPET scan, gender, and race. Our study highlights apathy’s inverse relationship with dopaminergic neurotransmission, which underscores the importance of considering dopaminergic pathways in managing apathy in older adults.
NURSING PRACTICE AND OPTIMAL DELIRIUM CARE AMONG OLDER ADULTS IN ACUTE CARE SETTINGS
Authors: Mailhot Tanya , Bouaouina Zineb , Joannette Tania Valentine , Khetir Imene , Lavoie Patrick
Published: January 2025

Studies have emphasized the limited availability of data regarding the current practices of nurses in delirium care for patients in acute care settings. Similarly, there is a lack of information regarding the obstacles and facilitators in providing optimal care for the prevention, detection, and management of delirium.

Aim

To describe nurses’ practices about delirium care in acute care patients and their perceptions about barriers and facilitators regarding optimal care. Method: A two phase, multi method design was used. The quantitative phase utilized a self-reported survey to assess nurses’ knowledge, practice, confidence, and collaboration regarding delirium care. The qualitative phase employed focus groups to complement and explore survey data in-depth. Recruitment took place on nine acute surgical and medical units across two university-affiliated hospitals in Canada, involving nurses in direct patient care.

Results

231 nurses reveal diverse insights into delirium care in acute settings and survey participants showed solid knowledge of delirium symptoms and outcomes, yet 23% did not identify the hypoactive form’s prevalence. While 81% reported receiving information on delirium screening, challenges included time constraints and misuse of detection tools. Qualitative themes highlighted communication’s vital role, challenges posed by delirium presentations, the significance of staff support, time constraints, the impact of experienced staff, the role of families, and the importance of additional resources for optimal delirium care.

Conclusion

Findings align with existing literature, emphasizing the multifaceted nature of delirium care and the need for tailored approaches, education, and collaborative strategies to improve overall care quality.
CHATO NATIONAL TRIAL: USING OPEN-ENDED RESPONSE TO DEVELOP VIDEO TUTORIALS TO IMPROVE NURSING HOME IMPLEMENTATION
Authors: Jaros Maria , Coleman Carissa , Yang Frances , Shaw Clarissa , Hein Maria , Perkhounkova Yelena , Williams Kristine
Published: January 2025

The Changing Talk: Online (CHATO) intervention was developed to increase staff access to person-centered dementia care communication education in a national nursing home sample. A qualitative review of the post-evaluation survey responses (N=1605) from participants in the first year of the study was performed to determine issues associated with the modules to improve implementation across nursing homes. Three open-ended questions addressed technical difficulties and what participants liked most and least about the program. Technical difficulties were reported by 21.1% of participants, including internet connection (5%), video difficulties (3.8%), non-specific technical difficulties (3.7%), website interface (3.1%), registration (1.8%), and navigating the modules (1.1%). Sixty-nine percent of participants reported what they liked the best about the course. Participants indicated real-world application (22.4%) was liked best, followed by the videos in the modules (18.8%), and the presentation of the material (5.9%). When asked what participants liked least about the course, 54.3% of participants provided input. The length of the three-hour course (21.4%) was liked least, followed by the presentation of the material (7.7%), and the interactive components of the modules (6.5%). In response to these findings, video tutorials were created addressing components most reported in the post-evaluation which included outlining navigation features within the CHATO training, registering for the course, and navigating to the modules. Tracking new users accessing the video tutorials via the CHATO website as well as annual coding will provide ongoing monitoring of implementation success and will provide input for re-design of the modules in future research.
CHARACTERIZING THE CIRCUMSTANCES OF FALLS AMONG COMMUITY-DWELLING OLDER ADULTS
Authors: Kehrer-Dunlap Abigail , Bollinger Rebecca , Keleman Audrey , Ances Beau , Stark Susan
Published: January 2025

Falls are the leading cause of injury, institutionalization, and injury-related mortality among older adults. As the older adult population is expected to grow exponentially in the next decade, the cost and consequences of falls will continue to rise. While promising fall prevention interventions exist, the death rate due to falls continues to climb. Limited population health effectiveness of these interventions may be attributable to a poor understanding of contributing factors to falls, such as the environmental and contextual circumstances in which falls occur. The objective of this study was to characterize the circumstances of falls among community-dwelling older adults. We completed monthly, prospective fall monitoring with 350 cognitively normal (Clinical Dementia Rating=0) older adults for up to four years. Standardized interviews were conducted to gather the circumstances of all reported falls, including the location, time of day, and activity at the time of the fall. We qualitatively analyzed fall interviews to determine the reason for the fall and factors of limited or divided attention preceding the fall. There were a total of 1,133 falls reported by 212 (61%) participants. The majority of falls occurred outdoors (53%), in the afternoon (45%), while walking or running (50%), and due to tripping over or catching feet on an object (37%). Additionally, 37% of falls occurred during instances of limited or divided attention. Taken together, these findings provide a greater understanding of the circumstances of older adult falls that may inform future classifications of types of falls and lead to tailored fall prevention approaches.
DEVELOPING A TAILORED STRAIN INDEX FOR LONG-DISTANCE FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Falzarano Francesca , Cimarolli Verena , Boerner Kathrin , Chunga Richard
Published: January 2025

Most research has examined the experiences and consequences of dementia family caregiving among proximate caregivers, while the unique needs of the growing number of long-distance caregivers (LDCs) remain understudied. Since the vast majority of research and evidence-based intervention efforts have specifically focused on caregivers who reside in close proximity to their care-recipients, existing measures of caregiver strain do not adequately capture the unique distance-related challenges experienced by LDCs. Thus, the current study aims to evaluate the suitability of a nine-item strain index tailored for LDCs. The scale is comprised of: 1) a three-item measure assessing level of difficulty experienced with the physical, financial, and emotional aspects of care from the National Study on Caregiving (NSOC); and 2) six novel items assessing difficulty with LDC (e.g., monitoring care, traveling to the care-recipient). Baseline data (n=40) derived from a study examining the feasibility of LDCare - a virtual, multicomponent intervention for LDCs - were used to conduct an exploratory factor analysis (EFA) with the NSOC and LDC-specific items. Initial findings suggested the exclusion of two factors that did not significantly contribute to the scale’s underlying covariance structure. Further analyses suggested that a seven-item scale comprised of two components yielded the best model fit, accounting for 57.1% of the total variance. The final scale included three items capturing distance challenges and four items assessing general caregiving challenges. Findings provide evidence for the scale’s suitability among LDCs and underscore the importance of tailored assessments to adequately measure the unique challenges associated with LDC.
GRANDMOTHER INITIATIVES IN FAMILY TRANSFORMATION: OUTCOMES OF AN INTERVENTION STUDY
Authors: Musil Carol , Jeanblanc Alexandra , Burant Christopher , Zauszniewski Jaclene
Published: January 2025

To address the well-documented stress and health challenges faced by grandmothers raising grandchildren, a sample of 342 grandmothers living with grandchildren participated in a national online, NIH funded randomized clinical trial testing two methods to reduce stress. We evaluated whether the 4-week Grandmother Initiatives in Family Transformation (GIFT) intervention (Resourcefulness Training © via video plus structured journaling) compared to a 4-week unstructured journal-only condition (with video instruction) improved grandmothers’ individual and family well-being: a) mental health (general mental health and depressive symptoms), b) physical health (self-rated and general health), c) family well-being (family functioning) and d) resources (resourcefulness, support, and reward) at 2, 12, and 24 weeks post-intervention. We ran RM-ANOVA for each outcome, looking at changes over time, time by arm, time by days journaling, and time by number of video views for their arm. Grandmothers in both arms showed significant improvements on general mental health and family functioning and reduced depressive symptoms and stress across time, establishing that both arms received helpful interventions; there were no changes in physical health indicators. Participants in both arms reported improved resourcefulness, support, and caregiving reward. Significant improvements over time in mental health and support were reported by participants journaling more frequently. The number of video views was significant over time only for resourcefulness, although there were between-subjects effects for video views for general mental health and depressive symptoms. Implications for online interventions to reduce stress, and the impact of active participation (journaling, practice and video support) are discussed.
EFFECTS OF A THEORY-ORIENTED SOCIAL FACILITATION INTERVENTION ON SOCIAL ISOLATION: A RANDOMIZED CONTROLLED TRIAL
Authors: Xiao Huimin , Liu Huangqin , Huang Qiyuan
Published: January 2025

Transitioning to a nursing home represents significant life changes, which often result in a significant reduction and potential dissolution of pre-existing emotional bonds with family, friends, and social networks. Social facilitation is essential to help nursing home residents adapt a new life in nursing home. Thus, this study aimed to develop and examine the effects of the social facilitation program based on the cognitive-behavioral model of social isolation (SFCBSI), on social isolation, subjective well-being, cognitive tendencies, psychological adjustment, self-efficacy, and social support of nursing home residents. A randomized, controlled, assessor-blinded, parallel-arm trial was conducted in two nursing homes Fujian, Southeast of China from September 2023 to February 2024. 180 participants were randomly assigned to the intervention group (n = 90) and the control group (n = 90). The control group received routine institutional care. The intervention group received the SFCBSI program involving cognitive reconstruction, emotional management, and behavioral change, which was implemented by group for 4 weeks. Participants were assessed using the Cognitive Appraisal Orientation Test, Nursing Home Adjustment Scale, General Selfefficacy Scale, Perceived Social Support Scale, Social Isolation Scale and the Memorial University of Newfoundland Scale of Happiness Survey. Outcomes were evaluated at baseline and immediately after the intervention. The intervention participants showed significant differences in social isolation, subjective well-being, cognitive tendencies, psychological adjustment, self-efficacy, and social support, compared to the control group (P < 0.001). It indicates that the SFCBSI could reduce social isolation and improve psychological well-being among nursing home residents.
INSIDE THE BLACK BOX OF MANAGED CARE: SERVING AT-RISK OLDER ADULTS IN MASSACHUSETTS’ SENIOR CARE OPTIONS PROGRAM
Authors: Nadash Pamela , Cohen Marc , Miller Edward , Fassi Janelle , Pallis Maryssa , Siebecker Megan , Simpson Elizabeth
Published: January 2025

People dually eligible for Medicare and Medicaid are at risk for poorly coordinated care, high-cost health service utilization, and poor outcomes. Commonwealth Care Alliance (CCA), a not-for-profit managed care organization, serves approximately 35,000 people dually eligible for Medicare and Medicaid in the Commonwealth of Massachusetts. CCA has two primary products: Senior Care Options, which has served people 65 years or older since 2003, and One Care, which has served people 18-64 years of age since 2013. Drawing from key informant interviews and other data collection, this study sought to understand the organizational experience of the CCA model. It identifies the challenges CCA faces in ensuring that its vulnerable membership has access to both appropriate clinical care and the broad range of health-related services that are critical to the health of members. It also identifies the plan’s mechanisms for addressing these challenges. The evolution of CCA’s model of care and the various mechanisms it adopted over time to adapt to the needs of its membership and comply with state and federal requirements are discussed. These changes are then placed in the context of ongoing conversations about the most effective models of integrated care. Findings highlight CCA’s focus on health-related social needs; the impact of member advocacy on program design; and the implications of non-profit status for workplace culture and resources.
PREVALENCE OF LIFESTYLE-BASED MODIFIABLE DEMENTIA RISK FACTORS AMONG CANADIAN ADULTS AGES 50+
Authors: D’Amico Danielle , Tan Brian , Binns Malcolm , Chertkow Howard , Anderson Nicole
Published: January 2025

Modifiable lifestyle behaviours are key determinants of cognitive health and dementia risk. The prevalence of lifestyle-based dementia risk factors is currently unknown among the Canadian adult population. The purpose of this study was to establish age- and sex-adjusted prevalence of risk in five domains using validated scales: 1) physical activity (CHAMPS); 2) brain-healthy eating (Eating Pattern Self-Assessment); 3) cognitive engagement (Florida Cognitive Activities Scale); 4) social connections (UCLA Loneliness Scale); and 5) mental well-being including depression, anxiety, distress, and perceived stress (DASS-21 and PSS-10). Males ages 70-79 (n=120) and females ages 60-69 (n=145), 70-79 (n=217), and 80+ (n=115) completed each scale online. Depending on the age decade x sex group, the percentage of individuals who exhibited mild depression, anxiety, distress, and perceived stress were 20.0-28.7%, 14.7-22.6%, 13.0-20.0%, and 43.3-54.7%, respectively. 33.1-54.5% did not meet the physical activity recommendations of 150 minutes/week of moderate to vigorous exercise. No participants met the brain-healthy eating recommendations. High-risk cut-off scores (below the 10th percentile) ranged from 8.0-11.6 for cognitive engagement and 23.4-24.4 for social engagement. The number of domains upon which individuals were at high risk ranged from 1 to 5 (median = 4). Data are currently being collected for females ages 50-59 and males ages 50-69 and 80+. This study is part of the first-of-its-kind research-based community centre at Baycrest delivering personalized dementia risk reduction programming. These data will be used to identify domains in which participants are at-risk in order to guide personalized dementia risk reduction program strategy.
ECONOMIC IMPACT OF FRAILTY OR PREFRAILTY IN THE ELDERLY AGED 75 OR OVER IN JAPAN
Authors: Yoshida Hiroto , Matsuzaki Yuriko
Published: January 2025

This study examined the impact of frailty or pre-frailty on medical and long-term care expenditures in an older Japanese population. The subjects were those aged 75 years and over who responded to the survey (March 2018) in Bibai, Hokkaido, Japan (n=1,203) and have never received certification of long-term care insurance at the survey. We followed up 758 individuals (63.0%) who used medical services at least once during the follow-up period until the end of August 2019 (17 month-period). We defined frailty as a state in performing 4 items or more and pre-frailty 2 or 3 items of 15 items which were composed of un-intentional weight loss, history of falls, etc. Among 758 subjects, 202 subjects (26.6%) were judged to be frailty group, 210 subjects (27.7%) pre-frailty group, and 346 subjects (45.6%) non-frailty group. We compared period to the new certification of long-term care insurance (LTCI), accumulated medical and long-term care expenditures between the three groups during the follow-up period. Cox proportional hazard models were used to examine the association between baseline frailty and the new certification of LTCI. The relative hazard ratio (HR) was higher in pre-frailty group than non-frailty group (HR=3.93, 95% CI∶1.37-11.22, P=.011). The average cumulative medical and long-term care expenditures per capita during the follow-up period were significantly (P=.025) larger for those in the frailty group (1,190,000 yen). We confirmed the accessibility of pre-frailty to long-term care service use and the strong economic impact of frailty in the elderly aged 75 or over in Japan.
FACTORS AFFECTING THE IMPLEMENTATION OF THE PRITAH INTERVENTION: LESSONS LEARNED
Authors: Ponstein Klarissa , Bleijlevens Michel , Erkens Petra , Hamers Jan
Published: January 2025

The implementation of effective healthcare interventions into routine practice is challenging and influenced by various factors, including the context of implementation, individuals involved, and intervention characteristics. This study aims to explore challenges by implementing the Prevention and Reduction of Involuntary Treatment At Home (PRITAH) intervention. After a careful preparation phase, we faced serious challenges that temporarily delayed implementation. To gain insights into the reasons and factors that led to implementation delay of PRITAH, two separate focus groups were conducted with 1) two policy staff members, a district nurse, two case managers dementia, and a middle manager, and 2) two senior managers and three directors. We examined both barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR). Results show that relevant stakeholders, including members from focus group one, were not involved in a timely manner. Moreover, communication gaps between senior management and middle management, policy staff, district nurses and dementia case managers led to inconsistencies in knowledge of the implementation steps being taken and hindered the decision-making processes. Nevertheless, the members of both focus groups acknowledged the shared goal of preventing involuntary treatment at home as facilitator, emphasizing the importance of goal alignment. Furthermore, a clear implementation plan from the intervention developers ensured that implementation efforts were guided by organizational expectations. The delays in implementing PRITAH emphasize timely stakeholder engagement, effective communication, joint alignment of goals and a clear implementation plan. Based on the results an adapted implementation plan has been developed.
THE GENDERED LONG ARM OF CHILDHOOD: EARLY PARENT–CHILD RELATIONSHIP AND LATER-LIFE MENTAL HEALTH IN RURAL CHINA
Authors: Wang Jia , Ma Mingyue
Published: January 2025

The large body of literature examining adverse childhood experiences (ACE) on late-life health has paid relatively little attention to gender variation. We contend that a gender perspective is crucial for understanding if women’s disadvantages in health have an early origin from childhood. In particular, we suggest that non-material aspects of ACE, such as poor parent-child relationships, are more likely to exhibit gendered patterns in their influences on health, particularly in developing countries with traditional gender norms and higher gender inequality. Using five waves of data from the China Health and Retirement Longitudinal Study (CHARLES), we examine the associations between parent-child relationships in childhood and later-life mental health among Chinese men and women aged 45 and above in rural areas. Our analyses yield three important findings: 1) Compared to rural men, rural women tend to exhibit worse mental health in terms of both the baseline level and the developmental trajectory of mental health over time; 2) From a snapshot perspective, poorer parent-child relationship during early life is related to worse baseline level of mental health among both rural men and women, and this association is more pronounced among rural women; 3) From a temporal perspective, poorer parent-child relationship in early life is associated with higher likelihoods of experiencing depression throughout the whole survey period, particularly among rural women. Our study sheds new light on the significance of a gender lens when examining the early-life origins of health inequality.
ADVERSE CHILDHOOD EXPERIENCES AND MENTAL HEALTH IN MIDDLE AGE AND OLDER ADULTS: THE MEDIATIONAL EFFECT OF RESILIENCE
Authors: Griffith Christopher , Broen Tiana , Scott Julia , Feliciano Leilani
Published: January 2025

Adverse childhood experiences (ACEs), physical health problems, and poor health perception are known predictors of subsequent poor mental health later in life. To support aging adults in their mental wellbeing, it is crucial to understand how they may recruit internal resources, such as resilience, to cope with past adverse experiences and current health difficulties. The current study used structural equation modeling (SEM) to examine the mediational effect of resilience on the pathways between adverse childhood experiences, sociodemographic variables, and health-related variables to mental wellbeing (a latent factor represented by depression, anxiety, and stress scores, higher score = lower mental wellbeing). Survey data were analyzed from a sample of adults aged 40 to 94 years (N = 334; Mage = 60.46; 48.8% women; 86.2% white). Number of ACEs were significantly correlated with age (β = -8.86, p <.001), number of physical health conditions (β = 0.44, p <.05) and mental health conditions (β = 1.11, p <.001), and poorer subjective health perception (β = 0.47, p <.001). Resilience mediated the pathways from subjective health perception to poor mental wellbeing (β =.05, p <.01), number of mental health conditions to poor mental wellbeing (β =.11, p <.01), and number of ACEs to poor mental wellbeing (β = 0.03, p <.05). Overall, these results highlight the significance of ACEs on mental wellbeing outcomes, and the importance of enhancing resilience in older clients with a history of ACEs.
COMMUNITY PREVALENCE OF POSTTRAUMATIC STRESS DISORDER, VETERAN STATUS, AND FALLS IN MA, CT, AND RI
Authors: Boateng Josephine , Fleet Alexa , Siebecker Megan , Jansen Taylor , Dugan Elizabeth
Published: January 2025

Post-traumatic stress disorder (PTSD) is a debilitating condition that is not well-understood in older people and often undetected. PTSD may arise from military service, falls, or other traumatic events. Understanding the prevalence of PTSD is important to identify service gaps. This study uses data from the Healthy Aging Data Report (healthyagingdatareports.org). Indicator data sources included: Medicare Beneficiary Summary Files (2014-2015 MA, 2016-2017 CT and RI), the American Community Survey (2012-2016 MA, CT, RI) and BRFSS (2012 and 2014 MA, 2012-2018 CT, 2012-2017 RI). Small area estimation techniques were used to calculate rates using Stata and ArcGIS was used for mapping and geographic analyses. Results showed that community rates for PTSD were: CT 1.2% (0.41-3.10%), RI 1.7% (0.91-4.59%), MA 1.8% (0.58%-5.71%). Massachusetts had both the widest range in PTSD community rates and the highest state rate. Military service: MA 18.8% (3.24-42.58%), CT 17.4%, (6.70-33.7%), and RI 19.0% (9.51-31.70%). Falls: MA 10.6% (6.47-18.18%), CT 26.3% (19.31-32.39%), and RI 26.3% (21.51-31.17%). Disparities in access to care or clinicians who could diagnose PTSD may contribute to some of the differences observed. Understanding these regional disparities would inform collaborative efforts from researchers, policymakers and stakeholders. Further research is warranted on this unexplored topic.
HEARING LOSS AND SPOUSE’S MENTAL HEALTH WITH GENDER DIFFERENCES
Authors: Jeon Jaemin , Lee Kyuho
Published: January 2025

This research investigated the influence of individuals’ auditory acuity on the occurrence of depressive symptoms in their spouses, mediated by the provision of support within marital relationships among elderly couples. Data from a sample of 1,069 older adult couples participating in the Health and Retirement Study (HRS) were analyzed. Utilizing three-wave dyadic data collected in 2010, 2014, and 2018, we conducted path analyses employing Mplus 7.0 to estimate the mediating effects of spousal support while controlling for autoregressive effects. Our findings indicate that husbands’ superior auditory acuity at the initial assessment (T1) was associated with a reduction in depressive symptoms among their wives at the third assessment point (T3). Spousal support served as a mediator in this relationship. However, wives’ auditory acuity did not exhibit a longitudinal impact on their husbands’ depressive symptoms. This study provides empirical evidence supporting the significant role of older adults’ auditory abilities within the context of marital relationships and the mental well-being of spouses. Keywords: hearing, spousal support, depressive symptoms