bluuebunny/crossref_metadata_2025 huggingface dataset:
FACTORS ASSOCIATED WITH OBJECTIVELY MEASURED LIFE-SPACE AND GREEN SPACE IN AGING ADULTS
Authors: Odden Michelle , Tan Annabel , Lai Sylvie Dobrota , Mwanda Sheila , Rhodes David , Judd Suzanne , Ravi Vishnu
Published: January 2025

Life-space is an important aging health outcome, and measurement of the life space allows for a better characterization of participants’ environments than their home address. We developed a mobile phone application to passively capture life-space in older adults and sampled Google street view images from participants’ life-space to characterize the environments where they spent their time. We recruited 82 participants aged 65 and older from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. They were followed for 2 weeks and invited to complete nightly mobile questionnaires. We measured features of the built environment that capture walkability (sidewalks, benches, streetlights), neighborhoods (houses), and green space. Among 82 participants, 76 completed all 14 days of data collection. Median daily maximum distance from home was 6.6 km (IQR: 1.3 to 15.5, range: 0 to 5074.9 km). Median distance traveled over two weeks was 477.1 km (IQR: 234.4, 817.13; range: 39.1 to 31,743.1 km). Adults younger than 70 years, women, Black participants, and those with income >$75,000 per year had larger life-space and traveled further from home. Engagement in exercise, number of chronic conditions, and depressive symptoms were not associated with life-space metrics. Participants with 2 or more chronic conditions spent less time in green space, although the effect sizes did not reach statistical significance after multivariable adjustment (standardized effect sizes -0.61 (95% CI: -1.35, 0.14) and -0.05 (95% CI:-0.11, 0.01), respectively). In summary, there was wide variation in objectively-measured life-space and we found sociodemographic patterning of life-space movement.
FACTORS IN ABDOMINAL OBESITY, SARCOPENIA, AND SARCOPENIC OBESITY AMONG KOREAN ELDERLY: KNHANES 2022
Authors: Huyen Do Thi Thu , Gao Xianqi , Park Moonkyoung
Published: January 2025

Background

Abdominal obesity, sarcopenia, and sarcopenic obesity are prevalent among the elderly, contributing to significant health risks. Understanding the nutritional, lifestyle, and biomarker profiles associated with these conditions is crucial for developing targeted interventions.

Purpose

This study explores the associations between nutritional intake, lifestyle factors, and biomarkers with abdominal obesity, sarcopenia, and sarcopenic obesity among Korean elderly individuals, using data from the 2022 Korea National Health and Nutrition Examination Survey (KNHANES).

Methods

The analysis included 845 participants (293 normal, 360 with abdominal obesity, 160 with sarcopenia, and 32 with sarcopenic obesity). Variables analyzed included hand grip strength, body composition, dietary habits (e.g., caloric intake, protein intake, supplement use), lifestyle factors (e.g., physical activity, sedentary behavior, smoking), psychological factors (e.g., depression, anxiety, stress), and biomarkers (e.g., hsCRP, cholesterol, triglycerides, blood pressure). Statistical analyses were conducted using SPSS 29.0, applying descriptive statistics and logistic regression within a complex sampling design.

Results

The prevalence of abdominal obesity, sarcopenia, and sarcopenic obesity was 34.7%, 43.6%, 18.0%, and 3.8%, respectively. Sarcopenia was more prevalent among males, those aged 75 and older, and those living alone. Abdominal obesity was more common among those with hypertension or diabetes. Sarcopenic obesity was associated with living alone, high hsCRP, stress, and low physical activity.

Conclusion

Comprehensive nutritional and lifestyle assessments are essential in managing abdominal obesity, sarcopenia, and sarcopenic obesity among the elderly. Public health strategies that improve diet quality and promote physical activity may mitigate these conditions.
FALLS PREDICT FASTER PROGRESSION OF ALZHEIMER DEMENTIA
Authors: Keleman Audrey , Li Melody , Bollinger Rebecca , Krauss Melissa , Grant Elizabeth , Morris John , Stark Susan
Published: January 2025

Preclinical Alzheimer disease (AD) is a decades-long period in which pathological changes accumulate in the brain (e.g., amyloid plaques) but individuals remain cognitively unimpaired (CU; Clinical Dementia Rating®[CDR®]=0). Motor impairments such as falls have been associated with preclinical AD and may offer early intervention opportunities. However, as aging affects cognition, motor function, and falls, differentiating between trajectories of healthy aging and preclinical AD is complex. This longitudinal cohort study investigated the impact of falls and preclinical AD on dementia symptom onset. We prospectively monitored falls for 1 year among 124 CU older adults and assessed preclinical AD status using amyloid positron emission tomography. We followed this cohort for 12 years and evaluated CDR annually. The cohort was grouped by baseline preclinical AD and faller status: 34 Preclinical AD-/Fall- (“healthy agers”), 53 Preclinical AD-/Fall+, 15 Preclinical AD+/Fall-, and 22 Preclinical AD+/Fall+. Kaplan-Meier survival analysis examined time to progression to CDR 1 (mild dementia) by group. Participants were on average 74 years old at baseline, 78% female, and 96% White with no significant demographic differences between groups. Preclinical AD+/Fall+ individuals progressed to CDR 1 most rapidly, while Preclinical AD-/Fall- (“healthy agers”) progressed least quickly. Preclinical AD+/Fall- and Preclinical AD-/Fall+ groups had similar progression rates. Each group’s proportional hazard of dementia progression differed significantly from healthy agers, unadjusted and controlling for age and gender (ps< 0.5). These findings suggest falls associate with faster progression of AD dementia, warranting further research to disentangle motor function and falls in healthy agers and those with preclinical AD.
FEASIBILITY AND ACCEPTABILITY OF A TELEHEALTH-BASED GROUP INTERVENTION FOR VETERANS WITH MCI
Authors: Luci Katherine , Pilkinton Patricia , Dragan Deanna , Jacobs M Lindsey , Apostolou Hannah , Hinton Allyshia , Tedder Jamie , Granger Teresa
Published: January 2025

MInds Navigating the Diagnosis of Mild Cognitive Impairment (MiND-MCI) is a nine-session telehealth intervention developed for older Veterans experiencing stress related to MCI. MIND-MCI targets memory and thinking abilities, stress/coping, and lifestyle risk factors through peer support, education, and skills training. This DoD-funded study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of MIND-MCI to improve QoL among Veterans with MCI. At baseline, participants (n = 16) in this pilot study were ages 61-79 years old and scored in the mild cognitive impairment range (M = 22.8) on the Montreal Cognitive Assessment. Retention rates (88%) and attendance (M = 7/9 sessions) of study completers suggest feasibility and acceptability of the intervention. Eleven participants demonstrated high engagement (attended ≥ 75% of sessions). Participants reported a high level of acceptability (120/147 total score possible) on the Telehealth Usability Questionnaire, and a majority of participants indicated that they agree or completely agree with the acceptability of the intervention on two additional measures (Acceptability of Intervention Measure and the Intervention Appropriateness Measure). Preliminary feedback was obtained from study interventionists to identify barriers and facilitators for delivering this treatment over telehealth. Themes included: range of severity of MCI across participants, session interruptions and delays related to troubleshooting technological issues, strategies used to support older adults’ use of a telehealth platform, and the importance of peer support. Preliminary results support strong engagement with and acceptability of telehealth modalities in this older adult population, a population often presumed to lack telehealth capability and proficiency.
FEASIBILITY AND ACCEPTABILITY OF GAMIFIED CYCLING EXERCISE IN A LONG-TERM CARE HOME: A QUALITATIVE STUDY
Authors: Hung Lillian , Zhao Yong , Lam Michelle , lam Jamie , Fong Arwen , Wu Tiffany , Xiao Michelle , Ren Haopu (Lily)
Published: January 2025

Gamification can motivate older adults to exercise by transforming physical activities into enjoyable experiences. Incorporating gaming elements in cycling exercises can foster a sense of interest and achievement, potentially improving health outcomes. This study investigated the acceptability and feasibility of motivating residents living in long-term care homes with a gamified cycling exercise. Fourteen residents (13 living with dementia) completed a 4-week gamified cycling exercise twice a week. Safety during exercise was addressed by monitoring heart rate and symptom observation. With an interpretive description approach, we conducted interviews with residents and family members and focus groups with staff and leadership. The thematic analysis identifies three themes representing the feasibility and acceptability of gamified cycling exercise among LTC residents: ease of use and accessibility, physical and mental health benefits, fun engagement and community building. Future research should explore dementia-friendly design, culture-related game content, family orientation and engagement, group exercise and organization support. This study showed promising acceptability and feasibility of gamified cycling exercise in a long-term care home. Successful implementation relies on tailoring interventions to meet residents’ specific needs and preferences while acquiring rapport with interdisciplinary staff in the care home.
FEASIBILITY OF USING AN E-INTERVENTION PLATFORM FOR LONGITUDINAL RESEARCH ON DEMENTIA CARE DYADS
Authors: Paul Constanca , Teles Soraia
Published: January 2025

Remote Measurement Technologies (RMT) are increasingly used in research, offering cost-effective and unobtrusive data collection. This study examines the feasibility of using the e-intervention “iSupport-Portugal,” adapted from WHO’s “iSupport” for longitudinal research on dementia care dyads. A prospective cohort study was designed to predict the institutionalization of persons with dementia (PwD) at 9 months using baseline data from informal caregivers (IC) registering on isupport-portugal.pt. Participation rates, loss to follow-up, and event rates were analyzed. Completers and non-completers of baseline and follow-up assessments were compared on sociodemographic and psychosocial variables. In 16 months, 253 IC registered on isupport-portugal.pt, with 82% agreeing to research. Most are women (82.6%), middle-aged (M=51.6), and children of the PwD (70.0%). The baseline protocol was completed by 52.9% of IC. Baseline participation rate was higher among spouses/children of PwD compared to other IC (46.5% vs. 27.5%; χ²(1, N=253)=4.194, p=.041). Compared to caregivers lost to follow-up, completers (65.3%) were significantly older (M 54.5 vs. M 46.7, t(174) =−4.220, p< 0.001), more often male (89.7% vs. 60.3%; χ²(1, N=175)=7.950, p=.005), children/spouses of PwD (69.9% vs. 34.8% others, χ²(1, N=176)=9.413, p=.002), cohabitating with PwD (82.4% vs. 60.0%, χ²(1, N=118)=6.197, p=.013), and had cared longer (Mdn 43 vs. Mdn 18; U=847, p=.008). The institutionalization rate was 7.8% at 9 months. iSupport-Portugal is a pioneering e-program exploited as an RMT that enabled cost-effective data collection from IC across national territories. High loss to follow-up calls for innovative retention strategies, especially for younger IC, which may intersect with platform user experience. Funding:FCT (2022.07587.PTDC)
FINE TUNING OF A PRETRAINED GAIT MODEL FOR FRAILTY CLASSIFICATION PREDICTION
Authors: McDaniel Laura , Essien Ime , Guo Yuxiang , Gupta Ayush , Shenoy Vineet , Abadir Peter , Chellappa Rama
Published: January 2025

This study presents a multimodal gait model designed to identify the frailty status of individuals based on their gait observed in video footage. Frailty is defined as a clinically recognizable state of increased vulnerability resulting from age-related declines in reserve and function across multiple interrelated physiological systems. These risks manifest as an increased likelihood of falls, hospitalization, need for long-term care, disability, and mortality. Although deep learning has advanced in medical applications, its potential in early frailty detection through gait analysis is limited by the need for extensive data, which is currently limited. To address this issue, we leveraged the OpenGait framework, GaitBase, a pretrained gait model typically used for gait surveillance and recognition applications, by fine-tuning it with medical data for frailty classification. Data were collected using the marker-less Qualisys Motion Capture system, resulting in a dataset of 64 individuals classified by frailty status—non-frail, frail, and pre-frail—according to the Fried Frailty Phenotype. Detectron2 models were used for panoptic image segmentation and detection, generating silhouette and box predictions from video frames. By integrating both silhouette and RGB data, our model enhances robustness and generalization across the three frailty classes. To address the challenges of a small dataset, we employed data augmentation, hyperparameter tuning, and cross-validation to improve classification accuracy. This model aims to advance frailty classification using deep learning, offering a time-efficient method for clinicians to assess frailty. Future steps include incorporating metadata such as height and weight to further enhance prediction accuracy.
FRAILTY TRAJECTORIES IN BRAZILIAN COMMUNITY-DWELLING OLDER ADULTS: A 9-YEAR FOLLOW-UP STUDY
Authors: Melo Ruth , Assumpção Daniela , Cachioni Meire , Falcão Deusivania , Batistoni Samila Sathler Tavares , Borim Flávia Silva Arbex , Neri Anita Liberalesso , Yassuda Mônica Sanches
Published: January 2025

This prospective observational study analyzed the factors influencing frailty trajectories among Brazilian community-dwelling older adults over a nine-year follow-up period. Sociodemographic data, self-assessed health, multimorbidities, social support, advanced daily living activities (AADL), cognition, and frailty phenotype were selected for analysis from the Fibra (Frailty in Brazilian Elderly) study database. Incidence was calculated based on new cases (pre-frailty/frailty) at follow-up versus phenotype (robust/pre-frailty) at baseline. Pearson’s chi-square test was used for intergroup comparison (i.e., progression status). The relative risk (RR) for frailty progression and reversal was calculated using logistic regression, both in crude (c) and adjusted (a) forms. After nine years, the proportion of older adults classified as frail increased (11.9% to 18.1%), while the proportion of those classified as robust decreased (30.1% to 13.8%). The incidence of frailty and pre-frailty was 22.9% and 49.4%, respectively. Advanced age (RRa:3.41; p=0.001), cognitive impairment (RRa:2.06, p=0.002), illiteracy (RRa:1.70; p=0.012), male sex (RRa:1.68; p=0.044) and non-performance/abandonment of AADL (RRa:1.48; p=0.007) were predictors of worsening/death in follow-up. Only living alone was protective against frailty. After nine years, there was an increase in older adults living with frailty and a reduction in the ones considered robust, with an incidence of frailty of 22.9%. Different factors predicted worsening/death after nine years. Future longitudinal studies should improve the understanding of risk factors for frailty progression.
GENDER DIFFERENCES IN DEPRESSIVE SYMPTOMS’ IMPACT ON CHRONIC DISEASES, FUNCTIONAL LIMITATIONS, AND MORTALITY
Authors: Ahn Seoyeon , Visaria Abhijit , Malhotra Rahul , Chan Angelique
Published: January 2025

Despite extensive research on chronic diseases, functional limitations, and depressive symptoms at older ages, the patterns of change and interconnectedness among them remain unclear. We examined the trajectories of chronic diseases (cardiometabolic conditions and chronic pain) and functional limitations in individuals aged 60-69 years at baseline and explored how depressive symptoms influenced the onset of chronic diseases, functional limitations, and mortality using data from three waves of the Panel on Health and Aging of Singaporean Elderly (2009-2015; n=386 men and 471 women). We used multichannel sequence analysis to investigate gender-specific health trajectories and random-effects logistic regression to examine depressive symptoms’ role in the onset of chronic diseases, functional limitations, and mortality. Inverse probability of attrition weights were used to account for selection bias due to loss to follow-up. Our findings reveal distinct gender-specific health trajectories. Men had higher mortality rates but experienced slower progression in chronic pain and physical functional decline, despite an earlier onset and higher prevalence of cardiometabolic diseases. Women lived longer but experienced earlier onset and faster progression of chronic pain and functional decline. Depressive symptoms were linked with faster onset of cardiometabolic diseases and functional limitations in both genders, and with mortality only in men. Individuals, families, providers, and policymakers should be mindful of the gender differences in the onset and progression of health deterioration and mortality in old age. Our findings also highlight the need for gender-specific research on the complex interactions between chronic diseases, functional limitations, mortality, and depressive symptoms.
GENETIC AND SEROLOGICAL BIOMARKERS AS PREDICTORS OF PARKINSON’S DISEASE COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW
Authors: Mohammed Hajir , Yousif Mohamed Atif Mohamed , Elhassan Mohamed , Elhussein Yassein , Badawi Dina , Gabralla Sarra , Abdelrahman Nadir
Published: January 2025

Parkinson’s disease (PD) is the second most common neurodegenerative disorder in the elderly population. Cognitive impairment (CI) is one of the most common and important non-motor symptoms in Parkinson’s disease and the identification of predictive biomarkers for it would help in its management. Databases were searched systematically down to Jan 2019. Selection criteria focused on studies with serological and genetic biomarkers. Other radiographically or clinically related papers were excluded. Total of 9 studies with 11 different biomarkers were assessed and found to be significantly associated with cognitive decline in PD. These include APOE4 allele mentioned in 2 studies (RR= 2.98), (RR= 7.4). miR-203a-3p/miR-16-5p ratio (AUC= 0.7593), Serum high mobility group box-1 levels (RR= 1.398), ganglion cell inner plexiform layer complex in the macula thickness (RR= 0.553), B12 (RR= 0.793), CSF NfL (HR= 2.82). MIA, CRP and albumin group (HR= 4.3), Neuroexosomal EAAT-2 (P= 0.003), and P16 (P= 0.003). Biomarkers can serve as potential predictive tools. Their integration into routine assessments could enhance the stratification of patients at risk for cognitive impairment, allowing for tailored therapeutic approaches and preventive strategies aimed at mitigating cognitive decline. However, they warrant further investigation to elucidate their roles in the pathophysiology of cognitive impairment in PD. Longitudinal studies are needed to validate these biomarkers and determine their utility in predicting cognitive decline over time. Additionally, exploring the interplay between these biomarkers and other neurobiological factors may uncover novel therapeutic targets.
GEOGRAPHIC DISTRIBUTION OF THE CERTIFIED NURSING ASSISTANT WORKFORCE IN U.S. COUNTIES
Authors: Johnson Mallory
Published: January 2025

Although geographic disparities in LTSS access are well documented, no studies exam the spatial variation in the workforce primarily responsible for delivering direct care. This study assesses the distribution of the certified nursing assistants (CNA) and the community characteristics associated with CNA employment. A cross-sectional design is used to explore the relationship between CNA employment and health care delivery and training infrastructure, local labor market structure, and population characteristics. Data from CMS’s Payroll Based Journal, the American Community Survey, and the National Conference of State Legislatures are fitted to a negative binomial hurdle model. 2,871 counties employ 1,616,798 CNAs (“count locations”). Only 271 counties employ no CNAs (“zero locations”). Zero locations are more likely to be rural and have lower population, less hospitals, and fewer CNA training programs even though their aging population is higher. Regression results demonstrate that the number of hospitals, nursing home beds, and total population are positively associated with CNA employment in both count and zeros locations. Medicaid expansion, the foreign-born population, and the proportion of the workforce employed in hospitality or public sector jobs, and land area are negatively associated with CNA employment in both count and zero locations. Differential effects are seen for the number of CNA training programs, population with a disability, and insurance status. CNA employment is highly variable. These findings confirm the “inverse care law” by demonstrating that CNA employment is not associated primarily with population need but with other health care, labor market, and population factors.
GROUND REACTION FORCE IN SIT-TO-STAND MOVEMENT PREDICT SARCOPENIA
Authors: Ota Kazuki , Yoon Jieun , Shibuya Kyohei , Miyashita Mariko , Miyama Tomoko , Okura Tomohiro
Published: January 2025

New method for evaluating lower-limb muscle strength has been attempted using ground reaction force during sit-to-stand movement. The specific variables used are the vertical peak force, the rate of force development (RFD), and the stable time. These variables have also been shown to be associated with physical function and experience of falling. However, their relationship to sarcopenia, the loss of skeletal muscle mass and muscle strength, and predictors of sarcopenia have not been investigated. In this study, we aimed to investigate the relationship between ground reaction force during sit-to-stand movement and sarcopenia diagnostic factors, as well as identify predictors of sarcopenia. The subjects were 1462 people aged 46-89 years (71.0±8.9 years). The sarcopenia was determined by grip strength, waking speed, and skeletal muscle mass (SMI) index. Force variables were calculated using the Zaritz (BM-220, Tanita Corporation). The statistical methods used was the Pearson correlation coefficient test, with P < 0.05. In addition, ROC curve analysis was performed, the area under the curve (AUC) and accuracy were calculated. The results showed that there were 1411 people without sarcopenia and 51 people with sarcopenia. Significant positive correlations were found between grip strength, walking speed, and SMI index and vertical peak force (r = 0.446, 0.306, 0.338), RFD (r = 0.264, 0.389, 0.159). Furthermore, the RFD had high discriminatory accuracy (AUC: 0.841, accuracy: 83.3 %). These results suggest that ground reaction force in sit-to-stand movement is a useful predictor of sarcopenia.
HOW CHILDHOOD NEGLECT AFFECTS LATER LIFE LONELINESS
Authors: Tavares Karina , Barbera Gina , Tsotsoros Cindy
Published: January 2025

Individuals who experience neglect within the first eighteen years of life are at increased risk for loneliness later in life. This study explores whether the type of neglect experienced (emotional, physical, or both), and the age at which it occurs, affects later-life loneliness. This was accomplished by using a subsample of 169 women aged 18−86 who reported experiencing at least one form of neglect. Demographic indicators, the 17-item ACEs questionnaire (Felitti et al., 1998), and the UCLA Loneliness Scale (Russell, 1996) were examined. Neglect was categorized into three groups: emotional neglect, physical neglect, and both emotional and physical neglect. Age of first experienced neglect was categorized into three groups: ages 0−5, 6−11, and 12−18 years. When comparing the three categories of neglect, an ANOVA revealed that those who experience both emotional and physical neglect experience the highest levels of later-life loneliness. A multiple linear regression model showed that age alone predicted 2.3% of the variance in loneliness. When including both age and neglect, the model accounted for 9.8% of the variance, and adding their interaction improved the prediction to 12.3%. This study underscores that experiencing both emotional and physical neglect, particularly during early childhood, significantly increases the risk of loneliness in later life.
IMMEDIATE AND SUSTAINABLE EFFECTS OF TDCS ON PAIN IN OLDER ADULTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Lee Chiyoung , Park Juyoung , Fain Mindy , Galvin James , Ahn Hyochol
Published: January 2025

Chronic pain management is a complex clinical process requiring thorough assessment. Especially for older adults with Alzheimer’s disease and related dementias (ADRD), behavioral pain indicators are crucial in complementing self-reports. We simultaneously assessed the impact of transcranial direct current stimulation (tDCS) on mitigating both self-reported pain and pain behaviors to more objectively and comprehensively explore its effects in older adults with ADRD. The analysis investigated 40 participants randomly (1:1) subjected to active and sham tDCS for 20 min on 5 consecutive days. The numeric rating scale (NRS) and Mobilization–Observation–Behavior–Intensity–Dementia (MOBID-2) scale were used to assess self-reported pain and pain behaviors, respectively. Multi-group latent transition analysis enabled the simultaneous evaluation of both pain domains in a single model and analysis of their changes as a function of intervention exposure by modeling the transition probabilities of latent classes and comparing these changes between groups. Two latent pain categories (“high pain” and “low pain”) were identified based on NRS and MOBID-2 scores. Active group participants with “high pain” exhibited a 47.1% probability of transitioning to “low pain” immediately after intervention completion compared with no transition in the sham group. From immediate to 1-month follow-up, both groups exhibited positive transitions (44.3% vs. 39.2%). Active group participants with “high pain” at 1-month follow-up had a 58.4% likelihood of transitioning to “low pain” by 3 months post-intervention, whereas sham group participants exhibited no change. Our findings support the immediate and enduring effects of tDCS on pain reduction in older adults with ADRD.
IMPACT OF 4MS ON OUTCOMES FOR HOSPITALIZED OLDER ADULTS IN AN AGE-FRIENDLY SYSTEM
Authors: Lam Justin , Kwiatek Susan , Carney Maria , Solomon Philip , Tursi Mark , Nouryan Christian , Burns Edith
Published: January 2025

Introduction

The Institute for Healthcare Improvement identifies four essential components (the 4Ms) of high-quality care for older adults within an Age-Friendly Health System (AFHS): What Matters, Medication, Mentation, and Mobility. This framework allows healthcare providers to address and act on key issues, such as goals-of-care discussions, the in-patient use of potentially harmful medications (e.g. benzodiazepines, opioids, hypnotics), delirium prevention, and mobility maintenance.

Methods

EMR data pulled manually and through aggregated dashboards. Population/Setting: patients ≥65 admitted June-July 2024 to eight hospitals (5 community, 2 tertiary, 1 quaternary) within a large integrated health system, all committed to care excellence. Patients grouped into categories based on the number of assessed M’s. Positive screens were reviewed for “act-ons.” Patient outcomes: LOS, disposition, 30-day readmissions and ED visits.

Results

Of 2,337 adults aged ≥65, 0.3% had no assessments, 10.6% had one assessment, 39.6% two assessments, 40.3% three assessments, and 9.2% had all four assessments. Of the 118 patients who had all 4Ms assessed, chart review showed 42% had an ‘act-on’ for What Matters, 43% act-on for Medication, 22% act-on for Mentation, 83% act-on for Mobility. Mean LOS 11.8 days (range: 3-72); June 30-day readmissions: 10.2%. Conclusions: A minority of patients had all 4Ms assessed. Act-ons were documented most frequently for Mobility, less for other M’s. Data on outcomes for ≤3M assessments is being analyzed and compared to those with 4Ms. This data will contribute to the growing evidence base for all 4Ms in AFHS transformation.
IMPACT OF IMMIGRATION TIMING ON MEDICATION NON-ADHERENCE AND COGNITIVE FUNCTION IN OLDER ADULTS
Authors: Fang Yuan , Han Jayoung
Published: January 2025

The aging U.S. immigrant population exhibits higher rates of both diagnosed and undiagnosed Alzheimer’s Disease and related dementia compared to U.S.-born residents. Traditional diagnostic methods often fail to detect cognitive decline in immigrants due to cultural and linguistic barriers. Immigration is a multifaceted risk factor affecting cognitive health through acculturation, language proficiency, and healthcare access. This study examines the moderating role of immigration timing in the relationship between medication non-adherence and cognitive function. We analyzed data from the Health and Retirement Study (HRS), focusing on adults >65 years who participated in interviews between 2012-2016 (n=10,869). Cognitive function was assessed using recently developed standardized latent cognitive scores. The relationship between medication non-adherence and cognitive scores was modeled using a moderated moderation model, examining interactions between age at immigration, education, and medication non-adherence, controlling other confounders. Non-immigrants were assigned a high placeholder value for age at immigration, and this variable was rank-normalized for analysis. A sensitivity analysis using the raw age at immigration variable was also conducted. Medication non-adherence, immigrant, and older age at immigration were associated with lower cognitive scores, while higher education was positively associated. Significant negative two-way interactions indicated that immigration status (β=-0.38±0.14, p=0.0006), timing (β=-0.13±0.03, p< 0.0001), and education (β=-0.91±0.03, p=0.0003) moderated the impact of medication non-adherence on cognitive decline. In conclusion, our study showed that medication non-adherence is a significant predictor of cognitive decline, with later immigration worsening cognitive vulnerability, highlighting the moderating effect of immigration age on the relationship between medication non-adherence and cognitive decline.
JOURNEY TO GUIDE: ONE PRACTICE’S ROAD TO IMPLEMENTATION
Authors: Clevenger Carolyn , Medders Laura
Published: January 2025

In July 2023, Guiding and Improved Dementia Experience (GUIDE) was announced by the Center for Medicare and Medicaid Innovation Center. GUIDE was proposed to test the efficacy of an alternate payment methodology for participating dementia care models committed to providing an enhanced quality of care. The program is hoping to improve quality of life, reduce total cost of care, reduce inappropriate prescribing and healthcare utilization, and delay nursing home placement. GUIDE will pay for comprehensive clinical services as well as caregiver support services. Emory’s Integrated Memory Care has been providing comprehensive dementia care services in our unique model since 2015. However, the IMC has had to adapt our current practice to meet the new requirements of GUIDE. The IMC will discuss implementing the necessary requirements for the GUIDE program and how we adapted our current clinic model to meet the GUIDE requirements. The IMC has had to establish additional processes for intake—including a home visit, utilize different required assessments and measures, continue providing caregiver support, and respite care.
KEY INSTRUMENTAL ACTIVITIES OF DAILY LIVING AND COGNITIVE DOMAINS IN NON-DEMENTED OLDER ADULTS: A NETWORK ANALYSIS
Authors: Li Jiaying , He Rendong , Hsu Erh-Chi , Li Junxin
Published: January 2025

Background

Interconnected relationships within and between instrumental activities of daily living (IADL) and cognitive domains indicate central IADLs, cognitive domains, and bridge IADLs, which we aim to identify as modifying them can effectively enhance holistic cognitive and IADL functions.

Methods

A cross-sectional analysis of adults aged 65 and older in United States on five IADL and six cognitive domains. Network analysis identified central and bridge variables. Non-parametric and case-dropping bootstrap methods checked network stability. Network comparison tests assessed sex differences with Benjamini-Hochberg adjustments.

Results

Of the 2,239 participants, 56.4% were female. We computed and tested three networks: IADL, cognition, and bridge. The Correlation Stability Coefficients for these were 0.67, 0.75, and 0.44 respectively, all exceeding the threshold of 0.25. Meal preparation (centrality: 3.87), visual attention (0.86), and shopping (0.41) were identified as central IADL, central cognition, and bridge IADL respectively, as they had the highest centrality indices and were significantly higher than others in their networks (p < 0.05). Notably, gender differences emerged in the IADL network, with stronger associations between laundry and meal preparation in females (1.69 vs. males: 0.74, p = 0.001) and higher centrality in meal preparation among females (difference = 1.99, p = 0.007).

Conclusion

While broad enhancements in all IADL and cognitive domains are beneficial, targeting meal preparation, visual attention, and shopping optimizes cost-effectiveness in improving holistic IADL, holistic cognition, and holistic cognition function via IADL interventions among older adults. Notably, meal preparation interventions may be less effective in males, requiring tailored approaches.
LIVING WITH YOUNG ONSET DEMENTIA IN RESIDENTIAL CARE: A SCOPING REVIEW
Authors: Johansson Linda , Bielsten Therése
Published: January 2025

About 3.9 million people live with Young Onset Dementia (YOD) worldwide. As dementia progresses, there may be a need for transition to residential care. It can be challenging for persons with YOD to access age-appropriate services, even though they might have different needs compared to persons with late-onset dementia. This scoping review aimed to present the experiences of people with YOD living in residential care facilities. Peer-reviewed research articles focusing on either the perspective of people with dementia onset before the age of 65 living in residential care or their family members were included. A literature search in MEDLINE, CINAHL, PsycINFO, Scopus, ProQuest, and Web of Science conducted in December 2023 yielded 13 qualitative studies from Europe, North America, and Australasia. Four studies included experiences of persons with YOD, three included experiences of family members, and six had a mix of participant experiences. In total, 90 (Md = 9) persons with dementia and 292 (Md = 17) family members participated. A synthesis of findings indicates that a home-like environment and age-adjusted activities based on the interests of the individual were highly valued. This review provides a first step towards understanding what person-centered care means for people with YOD in residential care. However, even though people with YOD can communicate their experiences and needs, there were few studies focusing on their perspectives. To improve care, further research needs to focus on the voices of individuals with dementia.
LIVING WITH YOUNG ONSET DEMENTIA IN RESIDENTIAL CARE: ANALYSIS OF DATA FROM THE SWEDISH DEMENTIA REGISTER
Authors: Johansson Linda , Bielsten Therése , Lindberg Jimmy , Finkel Deborah
Published: January 2025

Approximately 10,000 people in Sweden have Young Onset Dementia (YOD), i.e., dementia onset before the age of 65. As a result of disease progression, relocation to a residential care facility might be necessary. In Sweden, age-adapted residential facilities are only available in larger cities, and the specific needs of persons living with YOD might not be adequately addressed. The study aimed to describe characteristics of residents with YOD living in residential care and the quality of care. National quality registry data from the Swedish Dementia Register (SveDem) between 2012 and 2022 were used. In total, 124 people with YOD living in residential care units designed for persons with dementia (n=109) or in residential care facilities for older persons (n=15) were identified. The average age of admittance was 61.3±3.9 years, with no significant differences found between women and men. On average, six medications were used, and a medication review had been conducted within the past 12 months for 84% of the participants. Care received in accordance with one’s life story (71%) and individual environmental adaptations (64%) were common. However, few participants (22%) had advanced care plans, and restraints were present in 44% of the persons with YOD. While it is not possible to draw general conclusions from this small study, it indicates that person-centered care is central in residential care for persons with YOD in Sweden. Future research should focus on increasing the understanding of why staff use restraints to such a high extent and how this practice can be prevented.
LONGITUDINAL ASSOCIATIONS BETWEEN HAND GRIP STRENGTH AND DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS USING KLOSA
Authors: Kwon Sooyoung , Kim Gwang Suk
Published: January 2025

Many studies have reported an inverse association of hand grip strength (HGS) and depressive symptoms. However, the longitudinal directionality between these two factors remains unclear. This study was performed using a random intercept cross-lagged panel model to investigate the longitudinal reciprocal associations and autoregressive relationships between HGS and depressive symptoms in older Korean adults. We conducted secondary data analysis using the data of 3,353 older adults (mean age=74.38±6.484 [range:65~101] years; 1,480 [44.1%] were men at baseline) from the Korean Longitudinal Study of Aging (KLoSA) across 2016, 2018, 2020, and 2022 (four waves). Measures included general characteristics, mean values of HGS, and the Center for Epidemiologic Studies Depression scale-10. Result showed that no significant cross-lagged path was observed between HGS and depressive symptoms, however, across individuals, HGS was inversely correlated with depressive symptoms (β=-9.041, p<.001), and the concurrent negative relationship between these two conditions was significant only at baseline (β=-1.578, p=.004), indicating that individuals with lower HGS had higher depressive symptoms. All autoregressive paths were significant except from 2020 to 2022, suggesting the severities in one’s level of HGS and depressive symptoms carried over to the next time point. When considering gender differences, the same pattern of HGS and depressive symptoms was observed in men, while women showed a partially inverse association between them. Our findings suggest that HGS and depressive symptoms have a negative cross-sectional relationship, and gender has a different effect on the longitudinal correlation between HGS and depressive symptoms.
MEDIAL-LATERAL POSTURAL SWAY INCREASE AMONG COMMUNITY-DWELLING OLDER ADULTS WITH SELF-REPORTED ANXIETY
Authors: Suarez Jethro Raphael , Blount Amber , Lafontant Kworweinski , Lighthall Nichole , Huang Helen , Park Joon-Hyuk , Thiamwong Ladda
Published: January 2025

Anxiety is a prevalent and concerning issue for older adults. Previous research has shown that anxiety negatively affects overall balance, but the effect of self-reported anxiety on postural sway direction for older adults is unclear. This study aimed to compare sway direction between community-dwelling older adults that were categorized as having moderate-to-high anxiety and those that had low-to-no anxiety. The BTrackS Balance System (BBS), a stationary and simple balance assessment instrument, was used for measuring ranges of sway in the medial-lateral and anterior-posterior directions during a non-visual static balance test. The Geriatric Anxiety Inventory Short Form (GAI-SF) is a self-reported assessment of anxiety and was used for categorization. We cross-sectionally compared sway direction from 170 community-dwelling older adults aged 61 to 91 (152 women, mean age = 74.3 ± 7.1 years) who completed a BBS assessment and completed the GAI-SF using Mann-Whitney U tests. A total of 133 older adults were categorized as having low-to-no anxiety (GAI-SF ≤ 2), while 37 were categorized as having moderate-to-high anxiety (GAI-SF ≥ 3). The groups significantly differed in the medial-lateral direction (p = 0.03), but not the anterior-posterior direction (p = 0.14). These results show that older adults with increased self-reported anxiety may move in the medial-lateral direction more than those with less self-reported anxiety. However, these results may be limited by other factors (e.g., past injuries, depression). Future research should consider such factors among older adults that show symptoms of anxiety.
MULTISENSORY LOSS AND DEPRESSION IN THE ATHEROSCLEROSIS RISK IN COMMUNITIES NEUROCOGNITIVE STUDY (ARIC-NCS)
Authors: Shen Joseph , Huang Alison , Deal Jennifer , Chen Honglei , Kucharska-Newton Anna
Published: January 2025

Multisensory loss is a potentially modifiable risk factor for depression, but population-level evidence is lacking. This study quantified the association between multisensory loss across four senses (hearing, vision, smell, touch) and depressive symptoms in older US adults. Data (N=812) were from the ARIC-NCS and the Eye Determinants of Cognition study joint cohort (2016-2017), an observational study of older adults from Washington County, MD and Jackson, MS. 812 participants with complete data on hearing, vision, olfaction, peripheral neuropathy, depression, and demographic and health covariates were included. Sensory loss was measured using objective tests (pure tone audiometry [hearing], Early Treatment of Diabetic Retinopathy Study chart [vision], Sniffin’ Sticks tests [olfaction], and monofilament tests [peripheral neuropathy]). Multisensory loss was analyzed as a count (0-4). Depressive symptoms were measured by the 11-item Center for Epidemiologic Studies Depression (CES-D-11) scale. Scores were modeled continuously. The incidence rate ratio of depressive symptoms associated with number of sensory losses was assessed using covariate adjusted negative binomial regression. Of 812 participants (aged 71-93 years, 62.7% female, 58.6% White, 43.3% with higher than a high school education) 30.3% had one sensory loss, 31.4% had two, 17.6% had three, and 5.3% had four. Each additional sensory loss was associated with a 10% (Incidence rate ratio of CES-D-11 Score: 1.10; 95% CI: 1.02-1.20) increase in CES-D-11 score in the fully adjusted model. Multisensory loss is associated with depression in older adults. Clinical awareness of this association is valuable for the promotion of mental well-being among patients with sensory loss.
NAVIGATING POST-ACUTE CARE: LIVED EXPERIENCES OF MINORITIZED OLDER ADULTS
Authors: Como Dominique
Published: January 2025

Annually, over 40% of Medicare beneficiaries use post-acute care (PAC) after hospitalization to aid functional and medical recovery. Disparities in PAC access, care quality, and patient outcomes are evident across social identities (e.g., gender, ethnicity) and social determinants of health indicators (e.g., housing, food access). However, limited research has delved into the lived experiences of older adults using PAC services. Understanding barriers and facilitators from the patient perspective is crucial for addressing health disparities. This study explored the lived experiences of older adults in PAC settings. As part of a mixed-methods study, older adults (aged 55 or older) who self-identified as Black/African American or Hispanic/Latino/Spanish origin and were actively receiving care in a PAC facility in Southern California were invited to participate in interviews. A semi-structured interview guide was developed based on information obtained from a literature review and revised following content review from community member expert. Eight participants were interviewed between May and July 2024. Thematic analysis revealed four key themes, highlighting salient areas, influencing post-acute experiences: Patient Involvement in Healthcare Experiences (e.g., active participation, patient autonomy, and self-advocacy in healthcare decisions); Provider Competence & Attitude (e.g., provider communication, knowledge, and disposition); Care Delivery Considerations (e.g., staffing levels, time constraints, physical handling practices); and Support Networks & Resources (e.g., familial support, facility resources). These findings offer valuable insights for enhancing PAC patient health and satisfaction, by providing comprehensive high-quality care, improving the effectiveness of care delivery, and strengthening patient-provider interactions to better serve minoritized older adults.
NAVIGATING THE HOME CARE LANDSCAPE FOR MEDICARE BENEFICIARIES: FINDINGS FROM A SECRET SHOPPER STUDY
Authors: Shilvock Abigail , Leung Peggy , Sterling Madeline
Published: January 2025

An estimated 2.9 million patients access home health care annually through Medicare, primarily provided by certified home health care agencies (CHHAs). Despite Medicare covering 60-day episodes of home health care, patients often experience difficulty obtaining adequate and timely care. We investigated the real-world experience of Medicare beneficiaries and their caregivers seeking care through CHHAs by conducting a cross-sectional Secret Shopper study of CHHAs in New York State between February and March 2024. A trained investigator, posing as a family caregiver seeking home care for an older adult, contacted CHHAs using a standardized script informed by the Levesque conceptual framework of access to healthcare. Out of 110 identified CHHAs, 86 were eligible for analysis. 72% of CHHAs reported availability to provide skilled home health nursing services, while 66% reported availability to provide unskilled services (i.e., home health aide). Only 5% offered private pay skilled services with nursing visits costing $115-$300 and physical therapy $145-$230 per visit. One in five CHHAs provided an hourly rate for aide services, with a mean rate of $35.60 per hour. Nearly 80% of CHHAs could obtain insurance approval and over 75% could perform an in-home nursing evaluation within a week of referral placement. However, only 50% reported the patient would start receiving services within a week of evaluation. Qualitative analysis of field notes collected by the caller revealed three main themes: 1) numerous barriers to accessing home health care, 2) variability in access and timeliness of services across agencies, and 3) inconsistent customer service.