bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSESSING RISK FOR ENDOMETRIAL CANCER AMONG HISPANIC FEMALES AGE 50 YEARS AND OLDER
Authors: Rodriguez Ana , Kuo Yong-Fang , Hsu Enshuo 
Published: November 2019

Abstract
Endometrial cancer is the most common gynecological cancer in the US, with most women diagnosed between 55 and 64 years old. Seventy-five percent of women with endometrial cancer are postmenopausal, and the most common symptom is postmenopausal bleeding. Only a few studies have addressed the lack of knowledge and awareness of risk factors and/or health care utilization for early signs and symptoms of endometrial cancer. The objective of this study was to evaluate health care utilization among Hispanic women aged ≥50 years who are at risk for endometrial cancer. This retrospective cohort study used a combination of diagnosis and procedure codes from UTMB’s electronic health records to identify Texas Hispanic females who had a health encounter at ≥50 years of age between 2012 and 2016. Risk factors included conditions/treatments affecting hormone levels, age, body mass index, diabetes, gravidity, parity, family history of endometrial or colorectal cancer, previous diagnosis of breast or ovarian cancer or endometrial hyperplasia, smoking or alcohol use, and treatment with radiation therapy in the pelvis area. Multivariate logistic regression models evaluated for predictors of endometrial cancer. The study included 11,563 Hispanic females aged ≥50 years (median age=57). Most women were overweight. Currently, we identified 705 Hispanic females (6.1%) with possible endometrial cancer with validation underway. Females who have a history of vaginal spotting/bleeding, pelvic bleeding, and pelvic pain are at higher risk for endometrial cancer. It is important for physicians to educate patients on recognizing the signs and symptoms of endometrial cancer.
CANCER PREVALENCE AND THE ROLE OF MULTIMORBIDITY AMONG OLDER ADULTS: USING NHANES 2011-2016
Authors: Tang Fei , Vasquez Elizabeth 
Published: November 2019

Abstract
Cancer risk increases as age, understanding the potential risk factors of cancer is essential for cancer prevention. Biological and epidemiologic studies suggest relationships between individual chronic conditions and increased cancer risk. However, limited researches have analyzed the association between multimorbidity (simultaneous presentation of two or more chronic diseases) and cancer. The current study is aimed to evaluate whether having multimorbidity is associated with increased all-site and site-specific cancer prevalence among older adults. Data of 5,200 older adults aged 55 years and older who participated in the 2011-2016 National Health and Nutrition Examination Survey (NHANES) were included in the study. Single and multiple logistic regression models were used to evaluate the associations between multimorbidity and cancer. 3,623 (70%) individuals in our study were identified as having multimorbidity and 992 (19%) individuals were diagnosed with cancer. After adjusting for demographic covariates and smoking status, having multimorbidity was significantly associated with having all-site cancer (AOR: 1.57; 95% CI: 1.25 – 1.98) and lung cancer (AOR: 8.91; 95% CI: 1.51 - 52.73). Multimorbidity was associated with increased odds of having cancers among older adults. Our findings add to the evidence suggesting the potential relationships between multimorbidity and cancer. Future longitudinal studies are needed to examine the biological mechanisms and temporality of the association. If the association between multimorbidity and cancer is affirmed, it could have substantial implications in public health, as management of multiple chronic conditions could also advantage cancer prevention among older adults.
LONG-LIVED INDIVIDUALS PRESENTING WITH LARGE BREAST AND COLON TUMORS HAVE A LOWER RISK OF CONCURRENT METASTASIS
Authors: Sweigart Benjamin , Johnson Michelle R , Voisine Michael , Song Zeyuan , Bertrand Kimberly , Andersen Stacy L , Sebastiani Paola , Perls Thomas T 
Published: November 2019

Abstract
We hypothesized large tumors (stage T3 or T4) are less likely to metastasize in centenarians compared to younger patients. We analyzed 2004 to 2015 Surveillance, Epidemiology, and End Results (SEER) data for the most common cancer types (breast, colon, lung, and prostate) among patients with T3 or T4 tumors and compared rates of M1 (presence of metastases) at time of diagnosis according to ages 30-110 years. Among 44,066 breast cancer patients, metastasis rates fell after age 80 for T3 and after age 74 for T4 tumors. The relative risk of metastasis [RR] for T3 patients ages 90-110 years compared to ages 50-89 years was 0.73, 95% CI 0.57;0.94, and the RR for T4 patients was 0.48, 95% CI 0.42;0.55. Among 296,041 colon cancer patients, metastasis rates for T3 and T4 tumors steadily declined after age 60; RR for T3 patients was 0.66, 95% CI 0.62;0.71 and for T4 was 0.73, 95% CI 0.69;0.78 for the older and younger age groups. No difference in metastasis rates at diagnosis was observed for ages 90-110 with small cell and non-small cell lung cancers. Among 52,738 men presenting with stage T3 prostate cancer, the rate of metastasis steadily increased after age 70 (RR = 6.00, 95% CI 4.72;7.63) while there was no substantial difference in metastasis rate according to age for T4 patients. More work is needed to determine whether these findings are related to differences in screening and detection among those at older ages or whether they have a greater resilience to metastasis.
CHARACTERIZING CONCURRENT ALZHEIMER’S DISEASE AND CANCER IN U.S. ADULTS OVER 65
Authors: Schiaffino Melody K , Murphy James 
Published: November 2019

Abstract
Cancer (CA) care delivery fragmentation persists for patients across the cancer continuum. Racial and ethnic disparities are one of the primary factors attributable for variation in treatment outcomes, in addition to language and patient-provider communication barriers. Latino and African-American communities also bear a greater burden of Alzheimer’s Disease (AD) risk than White making patients experiencing AD+CA at risk for poor quality and treatment disparities. This study aims to characterize AD+CA in a population-based sample. Using 2004-2013 SEER-Medicare data we identified multiple cancers and the prevalence of concurrent AD+CA in the database (N=273,349). Patients selected for a first primary, histologically confirmed, any stage, not diagnosed in death certificate or autopsy and had at least 24 months of data prior to diagnosis to calculate a comorbidity index. All analyses were conducted in SAS 9.4 (Cary, N.C.). Across lung (LC), colorectal, head and neck (HNC), prostate (PC), and cervical cancer (CC) we found 5890 cases of AD+CA or 2.15%. While lung represented the largest sample, colorectal (CRC) cancer was responsible for the largest proportion of concurrent AD+CA cases at 3.52% of all CRC. Black and Latino CRC, HNC patients had higher than overall prevalence of AD+CC. Black CRC patients had 6.13% AD+CA vs White 3.27 and Latino HNC patients reported 5.06% vs 3.25 White. Earlier stage patients had higher AD+CA vs later stages for CRC, HNC, and CC. The opposite was true for LC. Finally, women had slightly higher prevalence of AD+LC but significantly higher AD+CRC and AD+HNC compared to men.
GREATER HYPOGLYCEMIA UNAWARENESS IN OLDER COMPARED TO YOUNGER RURAL VETERANS WITH TYPE 2 DIABETES
Authors: Valencia Willy Marcos , Wang Kaicheng , Muralidhar Kiranmayee , Dang Stuti 
Published: November 2019

Abstract
Hypoglycemia is of great concern in older patients, especially when complicated with multimorbidity and geriatric syndromes. We implemented a telemedicine model to address hypoglycemia knowledge, risk factors, incidence and comanagement with their primary care teams (PCT). We identified 166 consecutive rural veterans with high hypoglycemia risk, based on a local medication database (sulfonylureas and insulin), age, and recent glycated hemoglobin A1c (HbA1c). We conducted a telephone medication reconciliation and survey assessing glucose self-monitoring (GSM), hypoglycemia knowledge and symptoms. Variables were tested using chi-square, Fisher’s, and one-way ANOVA. Multivariable logistic regression model was built to assess the association of hypoglycemia and age group, adjusted with treatment, HbA1c%, self-monitoring, and knowledge. There were 54 veterans aged &lt;65 (younger), and 112 veterans aged ≥65 years (older). Average HbA1c was higher in younger than older (8.20±1.96 vs 7.43±1.34%, p=.003). There was no difference in treatment regimens, but the older had greater GSM (p=.028) and lower hypoglycemia symptom knowledge (p=.026). Symptomatic hypoglycemia was greater in younger versus older (50.0% vs 30.4%, p=0.014). Recent (past-2-weeks) hypoglycemic events were more frequent in younger than older (24.1 vs 1.79%, p&lt;.001). Regression analyses showed that younger veterans were more likely to have hypoglycemia (OD=2.37, 95% CI 1.11-5.04). Our results indicate a great need to evaluate older adults with high hypoglycemia risk, in whom we observed less reports of hypoglycemia albeit with similar regimens and lower HbA1c. We suspect greater hypoglycemia unawareness, thus we are implementing a project using continuous glucose monitoring in this high-risk population.
DESIGN AND EVALUATION OF AN ECOLOGICAL MOMENTARY ASSESSMENT TOOL FOR ASSESSING DEPRESSION IN DEMENTIA
Authors: Niculescu Iulia , Iaboni Andrea 
Published: November 2019

Abstract
Background. Assessing depression in people with dementia is challenging due to limitations of retrospectivity. Mobile Ecological Momentary Assessment (EMA) provides a novel approach in assessing depressive symptoms by collecting informant measures in intervals throughout the day, decreasing recall bias and increasing representativeness. Objective. The objective of this study is to design an EMA application for assessing depression in individuals with dementia. Methods. A literature review was conducted to determine commonly used and validated assessments for depression in dementia. Assessments were analyzed for common items, where items less commonly used (&lt;50% of assessments sharing the item) or not relevant to be collected using EMA were excluded. Wording of items were also analyzed to develop the specific structure of questions for the EMA assessment. Results: Six assessments were found and demonstrated adequate performance outcomes. Items fell into either mood-related, dementia-related, vegetative, psychotic or positive mood symptom groups. The mood-related group was analyzed separately for prominent items, which were sadness, anxiety, pessimism, loss of interest and irritability. Wording of items were modified to be consistent with being collected throughout the day, rather than retrospectively. These items were incorporated as core observational domains in the application to be tested. Sadness and anxiety were additionally included as self-report items as studies have shown these to be most discordant between individuals with dementia and informants. Conclusions: This research is a first step towards an innovative approach to assessing depression in dementia. Next steps involve evaluation of the application’s feasibility and reliability for assessing depression in dementia.
DECIDE, DISCOVER, AND DO: AN INTERVENTION FOR COMMUNITY-DWELLING INDIVIDUALS WITH DEMENTIA
Authors: Gorzelle Gregg , Skrajner Michael , Zeisel John , Best Cassie , Walker Drew 
Published: November 2019

Abstract
Decide, Discover, and Do!TM (D3) is a mobile application being developed and evaluated in an NIA-funded Phase 1 SBIR project. The goal of D3 is to enhance the quality of life and care for community-dwelling individuals with dementia (IWD) whose primary care partners (CPs) are their family members. D3 consists of (1) video-based, interactive training for family CPs on best practices in dementia care and (2) evidence-based activities for CPs to facilitate with their loved ones. The study examines the impact of D3 training modules on knowledge transfer and the effects of D3 activities on engagement/affect. The activities are unique in that they create an overarching narrative for daily activities that creates a consistent routine, thereby capitalizing on procedural memory. The activities build upon one another, starting with the IWD choosing a topic (e.g., nature) early in the day, followed by the dyad engaging in a tablet-based activity related to the topic (e.g., reading an article about rainforests), and culminating in an experiential activity (e.g., tasting various foods found in rainforests ). In pilot work, when training was implemented with homecare workers, there was a significant increase in knowledge from pre- to post-test (+21.0, p&lt;.01). In addition, similar activities were shown to be highly engaging, with IWD exhibiting significantly higher levels of constructive engagement (+0.40, p&lt;.01), and significant lower levels of other engagement (-0.13, p&lt;.05), when compared to standard programming. This Phase 1 study will be complete by the conference; outcome data will be presented.
OLDER ADULTS’ PERSPECTIVES OF COGNITIVE HEALTH PROMOTION AND ACTIVITIES TO AMELIORATE COGNITIVE DECLINE
Authors: Bacsu Juanita R , Johnson Shanthi , Viger Marc 
Published: November 2019

Abstract
There is a paucity of research on cognitive health promotion from the perspective of older adults, especially within a rural context. However, dementia and cognitive impairment are more prevalent among rural older adults than urban older adults. This presentation has two objectives: to examine cognitive health promotion from the perspective of rural older adults; and 2) to identify key activities associated with ameliorating cognitive decline in rural communities. Drawing on a community-based participatory research approach, data was collected through two waves of semi-structured interviews with the same group of 42 older adults in rural Saskatchewan, Canada. Guided by lay theory and cultural schema theory, data was coded using thematic analysis. In describing cognitive health promotion, four key areas emerged including emotional health, intellectual health, social health, and functional health. In discussing activities to support cognitive health promotion, participants emphasized the importance of thinking positively, keeping your brain active, mingling with others, and managing your daily affairs. Focusing on older adults’ perceptions of cognitive health promotion provides valuable information to advance knowledge of key strategies and activities to support cognitive health. In developing effective strategies to promote cognitive health, it is essential to engage in collaborative research and partnerships with older adults.
PREDICTORS OF ATTRITION IN THE MULTI-ETHNIC 1FLORIDA ADRC CLINICAL CORE
Authors: Burke Shanna L , Barker Warren , Rosselli Monica , Rodriguez Miriam , Robayo Carolina , Chirinos Cesar L , Behar Raquel , Greig-Custo Maria T 
Published: November 2019

Abstract
Understanding predictors of attrition can position researchers to increase retention efforts and focus on preventing attrition. Attrition, or dropout of participants during a study prior to completion, can threaten the internal and external validity of a study’s findings. Data from the 1FloridaADRC Clinical Core was analyzed, and included 271 participants within a two-year follow-up window, of which 216 (79.7%) were retained. T-tests and chi-square analyses were used to determine if a number of demographic, clinical, acculturation, and neuroimaging predictors were associated with attrition. The participant cohort included: 85% with cognitive impairment; 60% Hispanic; 42% over the age of 75; and 62% female. Predictors of greater attrition included: age over 75 years (p&lt; .003); cognitive diagnosis of MCI or dementia (p&lt; .01); and lower scores on the Mini-Mental Status Exam (p&lt;.04), the Hopkins Verbal Learning Test (HVLT) immediate (p&lt; .02), and delayed (p&lt;.002) Higher total score on the Neuropsychiatric Inventory Questionnaire (p&lt;.06), endorsement of night time behaviors (p&lt;.05) and greater hippocampal atrophy (p&lt;.02) were also predictive of attrition. Hispanic ethnicity was not a predictor of attrition, as retention was 81% for Hispanics versus 79% for non-Hispanics. However, among Hispanic participants, English acculturation measured by the Bidimensional Acculturation Scale for Hispanics was lower for those who dropped out (t=2.8; p=.006).
PREDICTORS OF DEMENTIA IN OLDER ADULTS: VARIATION BY NATIVITY STATUS AND RACE-ETHNICITY
Authors: Moon Heehyul , Badana Adrian , Hwang So-Yeon , Sears Jeanelle , Haley William E 
Published: November 2019

Abstract
Among many possible factors that are associated with increased risk for dementia, one important topic is the role of race and ethnicity. However, previous studies did not examine rates separately by racial/ethnic groups and by nativity status, and little of this research comes from nationally representative data. The current study investigated different predictors of dementia by race/ethnicity and nativity status using Round 1 of the National Health and Aging Trends Study (NHATS, N=7,473). Our stratified log-binominal regression analyses by race/ethnicity (Non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and Other) show that the relationship of nativity status to dementia (Probable dementia vs Possible and no dementia) is likely determined by multiple factors (e.g., education, # of cardiovascular conditions/risk factors, # in household) that may vary across race and ethnicity. The relative risks of Probable dementia were higher among immigrants in the Hispanic, and other groups, but lower among immigrants in NHBs, although the relative risk of dementia among NHBs was marginally significant. Gender was not a significant factor of Probable dementia across the four groups after adjustment for other variables including nativity status. Older age was significantly associated with the higher prevalence of Probable dementia across the four groups. However, other risk factors for dementia varied considerably between the four racial/ethnic groups after controlling for nativity status. Healthcare providers systems must be prepared to deliver culturally competent supports and services to diverse groups of older Americans and their family members.
THE EARLY BIRD GETS THE WORM, NOT ANXIETY OR DEPRESSION: HOW INSOMNIA SYMPTOMS PREDICT ANXIETY AND DEPRESSION
Authors: Bolstad Courtney J , Thomas Anisha L , Nadorff Michael R 
Published: November 2019

Abstract
Symptoms of insomnia are associated with symptoms of depression and anxiety in older adults, yet less is known about the impact of specific forms of insomnia (i.e. onset, maintenance, and terminal insomnia). We explored how insomnia type predicted symptoms of anxiety and depression in older adults (n = 133; mean age 69, range 65-89). We hypothesized that onset and maintenance insomnia would have stronger relations to depression and anxiety than terminal insomnia. Regression analyses indicated that onset insomnia was the only significant predictor of anxiety symptoms, and maintenance was the only significant predictor of depressive symptoms. Thus, our findings suggest that despite overlap between depression and anxiety, insomnia may have different mechanisms of affecting each disorder. Implications for the treatment of anxiety and depressive symptoms by addressing insomnia problems will be discussed.
DEVELOPMENT, RELIABILITY, AND VALIDITY OF THE CAREGIVER MEALTIME ENGAGEMENT SCALE IN NURSING HOMES
Authors: Liu Wen , Bachelar-Murphy Melissa , Williams Kristine N 
Published: November 2019

Abstract
Persons with dementia commonly experience mealtime challenging behaviors resulting in negative outcomes. Appropriate caregiver engagement is critical in engaging residents in eating. Current caregiver behavior measures are neither validated nor specific for mealtime care. A feasible and reliable measure to evaluate caregiver engagement during mealtimes is needed. Our team developed the Caregiver Mealtime Engagement Scale (CMES), a 29-item observational measure with good content validity (Content Validity Index = 1.00). The CMES includes 24 positive behaviors (e.g., position resident upright) and 5 negative behaviors (e.g., interrupt resident). Each item is scored by frequency on a 0 (never) – 3 (always) scale. Total score ranges from 0-87; higher score indicates better engagement. This study aimed to test the CMES’ reliability and validity through a secondary analysis of 87 mealtime video-recorded observations from a hand feeding trial (P30). The sample included 7 residents and 25 staff from 2 nursing homes. The CMES has good internal consistency (Cronbach’s α =.775). Inter-rater reliability was good (r = .861, p&lt;.001) based on ratings of 20 videos by two independent trained coders. Intra-rater reliability was excellent (r = .905, p&lt;.001) based on ratings of 20 videos by one trained coder at two times (2-3 weeks apart). The CMES demonstrated good convergent validity based on association with the Relational Behavior Scale (r = .822, p&lt;.001) and Mealtime Relational Care Checklist (r = .324, p=.002). Findings support the CMES’ reliability and validity. Future research is needed to test CMES among a larger diverse sample of caregivers in different settings.
FOSTERING COMPASSIONATE CARE FOR PERSONS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Cotton Samantha G , Faul Anna , D’Ambrosio Joe , Yankeelov and Pamela 
Published: November 2019

Abstract
The aim of this study was to examine the impact of the implementation of a new Compassionate Care (CC) curriculum, designed by social workers, on the quality of care provided by Certified Nursing Assistants (CNAs) to residents with Alzheimer’s disease (AD). Additionally, the purpose was to create a collaborative network of CNAs that supported each other. The sample included residents and CNAs from an experimental nursing facility and a control nursing facility. At baseline and 12-weeks, data were collected on AD knowledge, self-efficacy, caregiving satisfaction, and affiliate stigma. CNA changes in terms of their knowledge of AD, self-efficacy, caregiving satisfaction and affiliate stigma were analyzed using a two-way mixed method MANOVA. The stress levels of the residents, specifically agitation and salivary cortisol levels, was examined by testing a hybrid multilevel growth model. The final models were able to show how the changes in the CNAs specifically affected these positive outcomes. CNA knowledge and self-efficacy had the most impact on changing agitation levels, and CNA knowledge and agitation levels had the most impact on salivary cortisol levels. The results of this study showed that integrating a compassionate care curriculum into the work that CNAs perform can lead to positive outcomes on knowledge, self-efficacy, caregiving satisfaction, affiliate stigma and a reduction of agitation and cortisol levels in persons with AD.