bluuebunny/crossref_metadata_2025_split huggingface dataset:
Life Course Socioeconomic Status and Late-Life Cognition and Cognitive Decline in the Rush Memory and Aging Project
Authors: Krasnova Anna , Tom Sarah , Valeri Linda , Glymour Maria , Crane Paul , Bennett David 
Published: December 2020

Abstract
The relationships among life course socioeconomic status (SES) measures with later life cognition and cognitive decline are unclear. We test the hypothesis that life-course SES is associated with late life level of cognition and rate of cognitive decline. The Rush Memory and Aging Project enrolled 1,864 dementia-free people aged ≥65 years between 1994 – 2018. Participants reported early life (parental education, number of siblings, and childhood financial need), mid-life (income at 40 years), and late life (baseline income) SES. Global cognitive function is a composite of 19 neuropsychological tests, administered annually. We utilized marginal structural models to assess the effect of SES (dichotomized at the median) at three life-course stages on late life global cognitive function and decline. We calculated inverse probability weights to adjust for socio-demographic confounders at each life-course stage. A total 1,063 participants had all relevant variables. Average follow-up was 4.4 years, and mean baseline age was 80.4 years. Most respondents were non-Hispanic white (89.7%) and female (74.1%). In the fully adjusted model, high childhood SES (coefficient 0.10; 95% CI 0.01, 0.20) and high late-life SES were associated with higher cognition intercept (coefficient 0.21; 95% CI 0.09, 0.32). High mid-life SES was associated with slower rate of cognitive decline (coefficient 0.02; 95% CI 0.001, 0.05). Childhood and late-life SES measures were not related to cognitive decline. Childhood and adult SES may reflect processes in building cognitive capacity, while midlife SES may reflect cognition maintenance. Interventions relating to SES across the life-course may benefit later life cognition.
Intention to Receive Cognitive Screening for Alzheimer’s Disease in Nondemented Older Adults
Authors: Park Juyoung , Tolea Magdalena , Besser Lilah , Galvin James 
Published: December 2020

Abstract
The study explored factors associated with intention to receive cognitive screening for Alzheimer’s disease (AD). It also examined whether self-efficacy mediates the relationship between knowledge about screening and the intention to be screened. A population-based, random-digit dialing survey was performed; 1,043 responses were collected from a sample of nondemented older adults living in urban, suburban, and rural areas. A majority were female (66.8%, n = 697) and White (82.7%, n = 863) with a mean age 62.6 years (SD = 10.2). Findings from regression analysis identified that being female (β = .080), being depressed (β = .149), and having a positive life orientation (β = .120) were significantly associated with the intention to receive cognitive screening, p &lt; .05. Results indicated that older adults with a positive life orientation reported greater intention to be screened for AD, whereas depressed participants were more likely to plan to be screened for AD. Bootstrapping results identified a mediating effect of self-efficacy (β = .2668, t = 7.3137, p &lt; .0005). Self-efficacy mediated the relationship between knowledge about screening and intention to be screened. Using self-efficacy as a mediation effect indicated that older adults with knowledge about screening understand the benefits of early screening and diagnosis and are more likely to have self-efficacy (i.e., confidence to consult with a physician), and thus are more likely to show intention to be screened. Intention to be screened for AD could increase public awareness by defining effective ways to assist older adults to seek a cognitive screen.
Disentangling and Quantifying Mechanisms of Increased Fall Risk Among Older Adults With Depression
Authors: Lohman Matthew , Resciniti Nicholas , Merchant Anwar 
Published: December 2020

Abstract
Background: Older adults with depression are up to four times more likely to fall, yet the mechanisms by which depression increases fall risk are unclear. This study sought to quantify and compare the relative strength of selected mechanisms mediating the association between depression and falls. Methods: We used longitudinal linked data (2006 – 2010) from the Health and Retirement Study and Prescription Drug Study. The analytic sample included non-institutionalized adults age &gt; 65 with data on physical functioning and medication use (n=3,565). Falls and injurious falls over the past two years were self-reported outcomes. Depression was measured using the Composite International Diagnostic Interview (CIDI). We used causal mediation analysis to estimate the total and direct associations between depression and falls and compared strength of three potential mediating mechanisms – frailty, cognition, and antidepressant (AD) use. Results: Of 190 participants reporting depression in 2006, 85 (44.7%) fell and 30 (15.8%) were injured from a fall between 2008 and 2010. Depressed individuals were 92% more likely to fall compared to non-depressed (OR=1.92, p&lt;.01). We found significant indirect effects of AD use (indirect OR=1.17, p&lt;.01) and frailty (OR=1.12, p=.013) representing 19% and 13% of the total effect of depression on falls, respectively. Cognition was not a significant mediator. Results were similar for falls leading to injury. Discussion: Results suggest that AD use and frailty explain a significant portion of the elevated risk for falls among depressed individuals. Identification of these and other mechanisms may inform clinical treatment decisions for older adults with depression.
Mobility Screening for Fall Risk Assessment in a Population-Based Sample of Older Adults: An Analysis From the CLSA
Authors: Beauchamp Marla , Kuspinar Ayse , Sohel Nazmul , Mayhew Alexandra , Griffith Lauren , Raina Parminder 
Published: December 2020

Abstract
Existing guidelines for fall prevention in older adults recommend mobility screening for fall risk assessment; however, there is no consensus on which test to use and at what cut-off. This study aimed to determine the accuracy and optimal cut-off values of commonly used mobility tests for predicting falls in the Canadian Longitudinal Study on Aging (CLSA). Mobility tests at baseline included the Timed Up and Go (TUG), Single Leg Stance (SLS), chair-rise, and gait speed test. Inclusion criteria were: age ≥ 65 years and history of a fall or mobility problem at baseline. Accuracy of fall prediction at 18-months for each mobility test was measured by the area under the receiver operating curve (AUC). Of 1,121 participants that met inclusion criteria (mean age 75.2 ± 5.9 years; 66.6% women), 218 (19.4%) participants reported ≥1 fall at 18-months. None of the mobility tests achieved acceptable accuracy for identifying individuals with ≥1 fall at follow-up. Among women 65-74 and 75-85 years, the TUG identified recurrent fallers (≥2 falls) with optimal cut-off scores of 14.1 and 12.9 seconds (both AUCs 0.70), respectively. Among men 65-74 years, only the SLS showed acceptable accuracy (AUC 0.85) for identifying recurrent fallers with an optimal cut-off of 3.6 seconds. Our findings indicate that for a population-based sample of community-dwelling older adults, commonly used mobility tests do not have sufficient accuracy for identifying fallers. The TUG and SLS can identify older adults at risk for recurrent falls, however their accuracy and cut-off values vary by age and sex.
Intersection of Sex and Frailty in Humoral Immune Responses to Influenza Vaccine in Community-Dwelling Older Adults
Authors: Shapiro Janna , Kuo Helen , Morgan Rosemary , Li Huifen , Klein Sabra , Leng Sean 
Published: December 2020

Abstract
Older adults bear the highest burden of severe disease and complications associated with seasonal influenza, with annual vaccination serving as the best option for protection. Variability in vaccine efficacy exists, yet the host factors that affect immune responses to inactivated influenza vaccines (IIV) are incompletely understood. We hypothesized that sex and frailty interact to affect vaccine-induced humoral responses among older adults. To test this hypothesis, community-dwelling adults above 75 years of age were recruited yearly, assessed for frailty (as defined by the Cardiovascular Health Study criteria), and vaccinated with the high-dose trivalent IIV. Humoral immune responses were evaluated via hemagglutination inhibition titers. The study began during the 2014-2015 influenza season, with yearly cohorts ranging from 76-163 individuals. A total of 617 vaccinations were delivered from 2014-2019. In preliminary analyses, the outcome of interest was seroconversion, defined as ≥ 4-fold rise in titers. Crude odds ratios suggest that females are more likely to seroconvert to influenza A strains (H1N1: OR = 1.39, (0.98-1.96) ; H3N2: 1.17 (0.85 – 1.62)), while males are more likely to seroconvert to the B strain (OR = 0.85 (0.60 – 1.22)). Furthermore, this sex difference was modified by frailty – for example, the odds of seroconversion to H1N1 were 65% higher for females than males among those who were nonfrail, and only 30% higher among females who were frail. Together, these results suggest that sex and frailty interact to impact immune responses to influenza vaccines. These findings may be leveraged to better protect vulnerable populations.
Initial Translation of a Dementia Caregiver Intervention Into a Mobile Health Application
Authors: Maynard Taylor , Frink Travis , Mankodiya Kunal , Davis Jennifer , Ott Brian , Uebelacker Lisa , Tremont Geoffrey 
Published: December 2020

Abstract
Caring for a person with dementia is associated with negative outcomes. Few caregiver interventions have been implemented in community settings. Mobile technology is one method for reaching many caregivers. This project translated two empirically-supported interventions for dementia caregivers into a mobile health application. A team of clinical researchers and computer engineers developed an App called CARE-Well (Caregiver Assessment, Resources, and Education) over 6 months. The group worked closely to do the following: 1). translate interventional content to be compatible with a mobile platform; 2). create new materials; 3). determine App components that captured key intervention areas; 4). troubleshoot formatting, technology, and data security; and 5). educate each other about respective areas of expertise. We developed a beta version of the App that included: 1). assessment of caregiver stress and care recipient behavioral problems; 2). psychoeducation; 3). goal diary; 4). managing behavior problems; 5). online message forum; and 6). video library. Several challenges arose during the App development process, such as how to create navigation paths and goal lists based off users’ assessment responses, data storage and usage tracking, enlarging text, and how to ensure privacy and confidentiality in the online message forum. Our experience developing the CARE-Well App showed that translating behavioral interventions into mobile health applications is feasible and dependent upon regular communication among multidisciplinary team members. Next steps for the App include beta testing with dementia caregivers and conducting a pilot randomized trial to determine feasibility for a future trial and its effects on caregiver stress.
Lead It!: An App to Enable Persons With Dementia to Lead Group Activities for Their Peers
Authors: Skrajner Michael , Gorzelle Gregg 
Published: December 2020

Abstract
LEAD IT! is an app that enables persons with early and middle stage dementia to lead activities for their peers—i.e., other persons with dementia (PWD). An alpha version of the app was tested in a Phase 1 SBIR project. The alpha version included three Montessori-inspired activities. While PWD ostensibly view LEAD IT! as a set of enjoyable activities, it is actually an evidenced-based intervention aimed at reducing responsive behaviors and enabling PWD to fill meaningful social roles. A total of 24 PWD participated in the Phase 1 study: five leaders and 19 players. LEAD IT! Programming was implemented for six weeks, twice per week. LEAD IT! produced higher levels of positive engagement and affect, and lower levels of negative engagement, as compared to standard, baseline activities—i.e., non-digital activities led by staff. More specifically, when compared to baseline programming, players exhibited an 82% increase in Constructive Engagement (P=0.000), 80% increase in Passive Engagement (P=0.000), 60% reduction in Other Engagement (P=0.035), and 171% increase in Pleasure (P=0.000). One limitation of the Phase 1 study is that, at least insofar as the intervention is only implemented twice per week for six weeks, the positive outcomes seem to be limited to the period of time during which PWD are participating in the activity—i.e., changes on global measures, such as quality of life and depression were not detected. Still, the promising results of this study suggest that LEAD IT! is worthy of further development and evaluation in a planned Phase 2 study.
Psychometric Properties of the Chinese Wayfinding Effectiveness Scale
Authors: Chiu Yi-Chen , Algase Donna 
Published: December 2020

Abstract
Being unable to find one’s way is a terrifying experience accompanied by feelings of fear or frustration. Persons with cognitive impairment (PWCIs) are apt to get lost and show difficulty in wayfinding effectiveness. Therefore, it is important to develop an instrument to measure the wayfinding effectiveness in PWCIs in northern Taiwan. This was a cross-sectional design with 180 PWCIs to examine the psychometric properties of the Chinese Wayfinding Efficient Scale (CWE) developed by Algase. An exploratory Factor Analysis with varimax rotation was computed to explore the underline conceptual structure of the CWE. The results derived 6 factors: FDPFE = Finding a destination and a path in familiar environments; FDPUFE=Finding a destination and a path in unfamiliar environments; SDAS = Sense of direction and analytic strategies; SDGS = Sense of direction and global strategies; LMD = Landmark and distance in familiar/unfamiliar environments; MAP = Using a map in familiar/unfamiliar environments. This solution explained 66.50% of variance. The internal consistency values for the total and subscales were excellent. Item 25 was single loaded, therefore, deleted. One-week test-retest reliability of the CWE total scale and subscales were estimated using a subset of data (n = 15) by calculating ICC. One subscale, Finding a distance and a path in familiar environments (FDPFE), did not have significant test-retest reliability but the rest of the subscales and total scale had excellent test-retest reliability (.81-1.00). The initial psychometric properties of the CWE were acceptable. Further research should explore the possible associate factors.
Accelerated Decline in Sense of Purpose in Life Years Prior to Dementia Diagnosis
Authors: Lewis Nathan , Rush Jonathan , Hill Patrick 
Published: December 2020

Abstract
Research has pointed to sense of purpose in life as an important individual difference that promotes successful aging, predicting greater psychological wellbeing, physical functioning, and cognitive health in older adulthood. Despite such benefits, it is unclear how major life challenges such as the onset of cognitive impairment may impact the sense of purpose of older adults. Building on this, the present study examined long-term change in sense of purpose in a longitudinal sample of older adults who would later develop dementia. Data were from 341 participants without dementia at study intake who were subsequently diagnosed with dementia during the follow-up period (Mage = 81.92 years at intake, Mage = 89.19 years at diagnosis, 72.72% female). Participants completed annual assessments of purpose in life up to 17 years prior to dementia diagnosis (M = 6.99 assessments prior to diagnosis). Piecewise growth modeling examined change in sense of purpose in life with time structured as years to diagnosis. Results suggested a period of accelerated decline distinct from normative age-related change beginning around 5.60 years prior to dementia onset. Discussion will focus on two potential explanations: that perceiving declines in cognition may lead to diminished sense of purpose in life or that underlying changes in the brain may impact both cognition and sense of purpose resulting in concurrent decline over time.
Trajectories of Walking Speed and Cause-Specific Mortality: Evidence From England
Authors: Gessa Giorgio Di , Zaninotto Paola 
Published: December 2020

Abstract
Decreased walking speed can predict adverse health-related outcomes such as falls and admissions to hospital. Experiencing fast decline in walking speed has also been associated with increased risk of ‘all-cause’ mortality. In this study, we investigate the links between walking speed trajectories and specific causes of death. We used data from the English Longitudinal Study of Ageing, a large nationally representative survey which collects information biennially on people aged 50 and over in England since 2002. The sample consisted of 4,112 respondents eligible for a walking speed test at baseline who had not died before 2006. Rate of change in walking speed was derived from growth curve models and categorised in three trajectories (slow, moderate, and fast decline). We used competing risk analysis to explore the relationships between these trajectories and mortality, and their interactions with baseline wealth. During a mean of 9.5 years of follow-up, 1543 participants (37%) died (639 from cardiovascula disease -CVD, 311 from respiratory disease -RD, and 593 from cancer). Results suggest a significant difference in mortality across walking speed trajectories (with increased risk of death among those with fast declines) for CVD and RD deaths (P&lt;0.001), even after controlling for baseline characteristics. There was no significant difference for cancer deaths (p=0.44). Further stratified analyses suggested that fast decline was associated with higher CVD and RD mortality even among those with an initial fast walking speed (&gt;1.22 m/s). Strategies to maintain motor performances in later life have the potential to preserve life.
Adaptive Causal Thinking About Mobility Challenges: Implications for Quality of Life
Authors: Chipperfield Judith , Hamm Jeremy , Parker Patricia , Krylova Maria , Chuchmach Loring , Perry Raymond , Krause Cheliza , Hoppmann Christiane 
Published: December 2020

Abstract
Weiner’s attribution theory posits that it is adaptive to ascribe challenges to controllable causes (e.g., insufficient effort, bad strategies) and maladaptive to ascribe them to uncontrollable causes (e.g., old age). This is supported by our prior research that showed a heightened risk of mortality when mobility challenges were attributed to old age. The present pilot study randomly assigned older adults (N=36) in a day hospital to either an attributional retraining (AR) intervention group that viewed a video intended to shift causal thinking regarding mobility challenges (uncontrollable→controllable causes), or to a comparison group (No-AR). Participants completed a Time1 survey, the AR intervention (one week later), and a Time2 follow-up survey two weeks later. A manipulation-check revealed that AR was effective in shifting causal thinking away from maladaptive causes; a decline in the endorsement of the old age attribution was observed in the AR group (Ms=2.61 vs. 2.06; p=.02), but not in the No-AR group (Ms=2.45 vs. 2.35, p=.30). The AR and No-AR groups were equivalent at Time 1 on two quality-of-life outcomes: helplessness and perceived control (PC) over health. However, helplessness declined (Time1-Time2) in the AR group (Ms=1.13 vs. 0.73, p=.03), whereas it was relatively stable in the No-AR group (Ms=1.42 vs. 1.26, p&gt;.20). Moreover, PC increased marginally in the AR group (Ms=6.50 vs. 6.69; p=.06), but declined in the No-AR group (Ms=6.20 vs 5.45, p=.05). Together, these findings suggest that attributions can be shifted away from uncontrollable causes and that this shift can have a protective effect that benefits quality-of-life.
Changes in Leisure Self-Efficacy and Fall Risk: One-Year Results of N’Balance, a Fall Prevention Intervention Program
Authors: Payne Laura , Headley Cathy , Katzenmeyer Christine , Lee Chungsup 
Published: December 2020

Abstract
Fear of falling can prevent people from engaging in valued leisure activities. Yet few studies have examined the role of leisure self-efficacy in fall prevention (Datillo, Martire, Proctor, 2012). The purpose of this study was to assess how participation in a fall prevention program affected worrying about falls, self-reported falls, and leisure self-efficacy in older adults over a 1-year fall prevention intervention. N ’Balance is an 8-week community-based multi-modal fall prevention program. This community intervention study included a treatment (N=50) and control group (N=42). Data were collected in four waves: 1) pre-program physical assessment and survey, 2) post-program physical assessment and survey, 3) six month follow-up survey, and 4) 12 month follow-up survey. Measures included the Activities-Specific Balance Confidence Scale (Powell, Myers 1995), self-reported worry about falling and the leisure self-efficacy scale. Analysis of covariance was used to assess the group x time effects of N ‘Balance on worry about falling, leisure self-efficacy and the number of falls in the last 12 months, while controlling for age and subjective health. From baseline to six months post intervention, fall worry decreased significantly for the treatment group and increased for the control group (p&lt; .05). However, there was no significant change over time in the number of self-reported falls by either group. Leisure self-efficacy was higher at baseline for the treatment group and decreased significantly from 6 to 12-months post N Balance participation, whereas the control group had lower leisure self-efficacy at baseline and increased significantly over the 1-year study period (p&lt;.05).
Patient-Reported Outcome Measures in Older Veterans Initiating a New Episode of Mental Health Care
Authors: Jedele Jenefer , Austin Karen , Resnick Sandra 
Published: December 2020

Abstract
The VA Measurement Based Care (MBC) in Mental Health (MH) Initiative supports implementing patient reported outcome measures (PROMs) for MH treatment planning and shared decision-making as a routine aspect of care. Using VHA administrative data, we identified Veterans initiating a new MH treatment episode (index encounter), i.e. prior 6-months without VHA MH encounters. We compare MH diagnoses, medications, and encounters during the 6-months from and including the index encounter by age (50-64; 65-79; 80+) between Veterans receiving 1 or more measures (PROM) to those receiving none (noPROM). The percentage of PROM Veterans decreased with age: 26.7% (50-64); 18.5% (65-79); 12.5% (80+). Consistent across age, PROM Veterans had more encounters than noPROM Veterans. In the year before treatment initiation, a smaller percentage of PROM Veterans had multiple MH diagnoses (21.0% v. 29.1%). At treatment initiation, both groups were equally likely to have multiple diagnoses (20.7% v. 20.1%); a higher percentage of the noPROM group were diagnosed with schizophrenia (3.8% v. 1.0%), bipolar (4.5% v. 2.2%), or PTSD (29.2% v. 21.8%). Substance use disorder and major depression were more prevalent in the PROM group. These patterns held across age categories. A smaller percentage of PROM Veterans had been prescribed psychotropic medication during the index encounter (32.8% v. 42.8%). For PROM Veterans, an average of 3 measures were received 1.5 months apart. The number of measures declined and the interval between measures increased with age. Potential barriers and possible efforts to target the use of PROMs with older Veteran patients are discussed.