bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rural and Indigenous Health Disparity in Medical Service Use for Dementia and Diabetes Mellitus in Minnesota
Authors: Rhew Sung Han , Bright Patrick , Lemieux Andrine , Warry Wayne , Jacklin Kristen 
Published: December 2020

Abstract
Minnesota has shown relatively high growth of mortality from diabetes mellitus (DM) and dementia in recent years, especially in rural areas. Analysis of medical care utilization patterns may reveal the reasons for this trend. The goal of the present study was to characterize the Minnesota dementia and diabetes care landscape by rurality and geographic region. Specifically, we compared the Metro region to five other rural-urban regions. Disease-specific 2017 hospital admission and emergency department (ED) visit data was obtained from the State Center for Health Statistics and the Healthcare Cost and Utilization Project. We used the logistic regression analysis adjusted by multiple covariates to evaluate rural-urban differences in hospital admissions and ED visits. Age-adjusted rates of ED visits for both DM and dementia were significantly higher in rural zip code areas, especially in northeast regions. Rural areas had elevated odds for dementia hospital admissions (OR=1.05, p&lt;0.0001) and ED visits (OR=1.24, p&lt;0.0001), but decreased odds for DM hospital admission (OR=0.96, p&lt;0.0001) and ED visits (OR=0.96, p&lt;0.0001). This was particularly true in the northeast region (relative to Metro regions) where ED visits were less likely due to DM (OR=0.89, p&lt;0.0001) but more likely related to dementia (ORs=1.42, p&lt;0.0001). Geographic differences for ED visits due to DM were greater than those for dementia, with higher rates for rural as compared to urban regions (northeast MN compared to a large metropolitan region). This geographical mismatch between mortality rates and ED visit rates may illustrate the relative lack of access to health services in rural MN.
A Path to Early Diagnosis of MCI and Dementia: Integrating myMemCheck Into the Primary Care Workflow
Authors: Mansbach William , Mace Ryan , Frangiosa Theresa , Biggar Virginia , Comer Meryl , Simmons Steven 
Published: December 2020

Abstract
Barriers to the early detection of mild cognitive impairment (MCI) and dementia can delay diagnosis and treatment. myMemCheck® was developed as a rapid free cognitive self-assessment tool that can be completed in the practice setting or at home to identify older adults that would benefit from a more comprehensive cognitive evaluation for MCI and dementia. Two prospective cross-sectional studies (N = 59; N = 357) were conducted to examine the psychometric properties and clinical utility of myMemCheck®. myMemCheck® evidenced adequate reliability (test-retest, r = 0.67) and strong construct validity (η2 = 0.29, discriminating normal, MCI, dementia). Receiver operating characteristic analysis evidenced an optional myMemCheck® cut score for identifying older adults with MCI or dementia (sensitivity = 0.80, specificity = 0.67, positive predictive value = 0.91, negative predictive value = 0.43). myMemCheck® explained 25% of cognitive status beyond basic patient information. We provide specific suggestions for integrating myMemCheck® into practice to optimize workflow. Study results are further interpreted in the context of two national online surveys (healthcare professionals, N = 181; consumers, N = 1740). Healthcare professionals widely agreed on the need (94%) and importance (86%) of cognitive self-assessments. Public demand for cognitive self-assessment was confirmed by consumers who trialed myMemCheck® as part of their survey participation—86% agreed on the need for a tool like myMemCheck®. Mixed methods findings suggest that myMemCheck® could fast- track the diagnostic process, facilitate appropriate referrals for cognitive and neuropsychological evaluation, reduce assessment burden in healthcare, and prevent negative outcomes associated with undetected cognitive impairment.
Frailty Modifies Effects of Chair Yoga on Chronic Pain in Older Adults With Osteoarthritis
Authors: Park Juyoung , Liu Zuyun 
Published: December 2020

Abstract
As a secondary analysis, this study used data from our previous 8-week chair yoga (CY) intervention trial with two-arm, access-blinded randomized controlled trial to examine modifying effect of baseline frailty on intervention effects of CY on pain and pain interference (i.e., consequences of pain on relevant aspects of life). Using the cumulative frailty index (FI) approach, we constructed the FI using 82 comprehensive deficits, including physical function, balance, fatigue, emotional well-being, and social activity. We calculated FI at baseline, 4 weeks, and 8 weeks. A linear mixed-effects model with random intercept was used, adjusting for research sites, cohort effect, and time. To test for potential modifying effects of baseline FI on the intervention effect by CY, we added a three-way interaction term: intervention (CY vs. Health Education Program), time, and baseline FI. A total of 112 participants (M = 75.3[7.5] years; 76% female, 40% White, 46% Hispanic) completed the study. Each 0.01 increment in baseline FI was associated with higher pain (β = 0.28, p &lt; .001) and pain interference (β = 0.51, p &lt; .001). There was a significant interaction effect among intervention, time, and baseline FI (p = .02 for pain, p = .01 for pain interference), indicating that participants with higher levels of baseline FI had greater declines in pain and pain interference. Frailty modified the intervention effect of CY on pain in older adults with lower extremity osteoarthritis, underscoring the importance of assessing frailty to improve management of pain in the population.
Best Practices for Including Individuals With Dementia as Research Participants
Authors: Judge Katherine , Minyo Morgan , MacNeil Amanda , Grant Claire , Lucas Kaitlyn 
Published: December 2020

Abstract
Including individuals with dementia as participants in research studies can be a challenge given the cognitive symptoms experienced, including difficulties with attention, memory, language, and executive functioning and behavioral symptoms, such as agitation and frustration. Researchers, however, have begun to include individuals with dementia as more active participants in the research process. Specifically, individuals with dementia have provided self-report information about their illness experience, including how they cope and manage with their illness and how illness-related strains are related to psychosocial outcomes. Researchers also have starting using self-report data collection protocols instead of proxy-report measures to assess the impact of non-pharmacological interventions developed for individuals with dementia on well-being outcomes such as depressive symptoms, unmet needs, and relationship strain. To date, however, there are no clear guidelines or ‘best practices’ to assist researchers in developing study protocols that facilitate the inclusion and participation of individuals with dementia. This poster will present findings from a systematic literature review of studies that have successfully included individuals with dementia as research participants. Key areas examined include: 1) the focus and type of research question studied; 2) the use and type of cognitive screening tools for determining study eligibility; 3) implementation of qualitative versus quantitative research designs; 4) objective versus subjective measures; 5) data collection tools; 6) psychometric evidence of data obtained; and 7) how data have been analyzed. Findings highlight the importance of collecting data directly from individuals with dementia to further understand the illness experience and assess the impact of non-pharmacological interventions.
Social Engagement and Cognitive Health: The Mediating Role of Cognitive and Physical Activity
Authors: Amano Takashi , Morrow-Howell Nancy , Park Sojung , Carpenter Brian 
Published: December 2020

Abstract
This study aimed to assess the association between social engagement and conversion from Cognitive Impairment No Dementia (CIND) to dementia and to investigate the mediating role of cognitive and physical engagements on that relationship. Data from two waves (2010 and 2014) of the psychosocial and core modules of the Health and Retirement Study (HRS) were used. The sample consisted of 929 people who had CIND in 2010 and participated in the survey in 2014. Latent Class Analysis (LCA) with eight indicators of social engagement (activities with children, volunteering with youth/others, attending educational course/organization, meeting up, speaking on the phone, writing or emailing) found three groups: formal and informal social engagement (20.7%), informal social engagement only (48.9%), and low social engagement (30.5%). Binary logistic regression analysis showed sub groups with higher levels and greater variety of social engagements were associated with lower probability of conversion to dementia in four years. Path analysis with structural equation modeling (SEM) framework showed the relationship between patterns of social engagement and lower conversion to dementia was mediated by having higher engagement in cognitive activities (e.g. home maintenance, playing sports), but not by engagement in physical activities (e.g. playing games, using computer). Results from this study implied (1) promoting active social engagement may be a promising intervention to prevent or delay conversion from CIND to dementia, and (2) promoting social engagement may be a particularly effective and efficient strategy since it promotes other activity engagements that may itself prevent or delay conversion from CIND to dementia.
Cognitive Performance in Older Adults With Subjective Cognitive Decline
Authors: Taler Vanessa , Morrison Cassandra , Sheppard Christine 
Published: December 2020

Abstract
Subjective cognitive decline (SCD) refers to a perceived decline in cognitive function in the absence of neuropsychological deficits. Older adults with SCD are at increased of subsequent development of mild cognitive impairment or dementia. We had 224 adults aged 65+ complete questionnaires assessing their subjective appraisal of their cognitive function, including questions about word-finding difficulty, memory, and attention/concentration. Participants also completed the Montreal Cognitive Assessment (MoCA). All participants exhibited cognitive performance that was within normal limits for age and education. In total, 29.5% of participants reported word-finding difficulties, 16.5% reported difficulties with remembering things, and 8.5% reported difficulties with attention/concentration. We found that (1) self-reported word-finding difficulties were associated with lower performance on delayed word recall, and (2) self-reported difficulties in concentration/attention or memory were associated with lower performance on the abstraction subtask in the MoCA. No other MoCA subtasks were associated with self-reported cognitive function. A subset of the participants (n=69) also completed a battery of tasks assessing semantic function, including picture naming, associative matching tasks, identification of semantic features, and semantic questions. Again, self-reported word-finding difficulty predicted lower performance on semantic tasks. These results suggest that older adults may be aware of changes in their cognitive performance prior to objective neuropsychological impairment. Moreover, their awareness appears to be domain-specific: self-reported language difficulty is associated with lower performance on language-based tasks, while self-reported difficulty in memory, attention, or concentration is associated with lower performance on an abstraction task.
Exploring the Benefits of Assistive Devices Use in Older Adults With Impaired Lower Limb Function
Authors: Su Tai-Te , Mejia Shannon 
Published: December 2020

Abstract
Assistive technologies are an essential component of meeting the needs of an aging population. With advancing age, chronic conditions and physiological changes can result in impaired lower limb function among older adults, which may in turn limit their ability to perform daily activities or even walking. Informed by the continuity theory, we conceptualize assistive devices (ADs) as a resource that older adults with mobility limitations can leverage to remain active and mobile in late life. However, evidence remains scarce to determine the extent to which using ADs could create a measurable change in older people’s experienced well-being. Using data from the 2012 wave of the Health and Retirement Study, our study aimed to examine the potential psychological benefits that accompany ADs use in a sample of older adults with at least some limited lower limb mobility (n = 505, 59% female, 85.6% white, age = 75.8 ± 6.7). Results from multiple linear regression showed that although AD use was not directly associated with global well-being, those who used ADs reported more positive experience while walking (b = 0.65, SE = 0.23, p&lt;.01) and traveling (b = 0.92, SE = 0.43, p&lt;.05). Additionally, our results indicated that AD users had higher self-efficacy compared with nonusers (b = 0.40, SE = 0.20, p&lt;.05) after controlling for age, gender, socioeconomic status, as well as physical function level. We suggest that AD provision should be considered in intervention strategies to increase well-being and quality of life in older adults with impaired lower limb function.
Gender Differences in Mortality Risk After Driving Cessation Among Older Men and Women: a Mediation Analysis
Authors: Yu Jiao , Kahana Eva , Kahana Boaz , Zhang Yuhan 
Published: December 2020

Abstract
Driving is the most important personal transportation mode in the US for maintaining mobility. Previous studies of older adults who stop driving have identified several health risks associated with driving cessation, including less access to health care, increased dependency, social isolation, and elevated risk of mortality. The purpose of this analysis was to examine driving status as a predictor of mortality among community-dwelling older men and older women. Data were drawn from a prospective panel study of successful aging project of 1000 older adults (mean age = 80). Participants’ driving status was measured at baseline and mortality rates were observed across the subsequent 10 years. Extended Cox proportional hazard model indicated a 76% (p&lt;0.001) significantly higher mortality risk for non-drivers versus drivers. This relationship was mediated by health conditions and functional status for both older men and older women. Among older men, health status fully mediates the association between driving cessation and mortality risk. A partial mediation effect of health status on the association between driving cessation and mortality risk was found among older women. Older women who stopped driving faced 56% (p&gt;0.01) higher relative mortality risk than their driver counterparts. Social and cultural issues such as gender stereotype, autonomy, and social connection with their implication for driving may explain existing gender differences among older adults.
Older Adults’ Perceptions of Falls and Falls Prevention: An Interview-Based Study
Authors: Catona Danielle 
Published: December 2020

Abstract
The aim of this study was to gain an understanding of older Americans’ perceptions of falls and strength and balance exercise (SBE) as a means of falls prevention. Face-to-face, semi-structured interviews were conducted with 72 community-dwelling adults aged 65 to 89 years recruited from a variety of settings. Data were coded inductively to identify themes present within participants’ responses. This process included open coding and creating categories. Data revealed four themes related to falls: (1) others are at risk of falling, but not me, (2) people who fall experience bodily harm, (3) people who fall are a burden to others, and (4) people who fall end up in nursing homes. Four themes emerged related to benefits/facilitators of SBE: (1) SBE enables older adults to remain active and independent, (2) SBE provides an opportunity for older adults to socialize, (3) SBE has positive physical and mental health effects for older adults, and (4) healthcare providers advise older adults to perform SBE. There were three barriers associated with SBE: (1) having limited/no prior SBE experience, (2) having a pre-existing condition, and (3) disliking group-based, SBE classes. Study findings suggest older adults underestimate their risk of falling compared to their peers. As a result, SBE interventions may be promoted more effectively by highlighting personal and social benefits associated with SBE rather than physical risks associated with falls. Additionally, personal recommendations from healthcare providers as well as identification of modified and home-based programs may increase participation in SBE interventions.
Effects of the JC JoyAge Stepped-Care Model Are Differentially Associated With Older Adults’ Baseline Profiles
Authors: Liu Tianyin , Wong Gloria Hoi Yan , Lu Shiyu , Lum Terry 
Published: December 2020

Abstract
Depression is a multidimensional construct consists of different symptom clusters. This paper aims to investigate if the impact of a stepped-care model, JC JoyAge, differs for older adults with different baseline depressive symptom clusters. Data came from 702 older people aged 65 and over who completed the JoyAge program. Their depression (measured by Patient Health Questionnaire-9 [PHQ-9]), anxiety, loneliness, and cognition were assessed by social workers at baseline and 12-months follow-up. Among them 609 were at risk or with mild symptoms and received group-based preventive care (prevention group), and 93 had moderate or above symptoms and received intensive intervention (intervention group). Their responses to PHQ-9 were coded to indicate affective, cognitive, behavioral, and somatic symptom clusters. It was found that somatic complaints had the highest prevalence (91%), followed by affective (83%), behavioral (60%), and cognitive symptoms (41%). Logistic regressions were used to estimate the effects of the program. For the prevention group, the JoyAge preventive care is more effective among those who reported behavioral symptoms (b=0.44, p&lt;0.05, OR=1.55, 95% CI: 1.01, 2.40), but less so in those who had cognitive appraisal issues (b=-0.42, p&lt;0.05, OR=0.66, 95% CI: 0.46, 0.96). For the intervention group, the JoyAge intervention was more effective in treatment among those who reported more affective symptoms (b=0.46, p&lt;0.05, OR=1.59, 95% CI: 1.05, 2.42). The benefits of JC JoyAge stepped-care are differentially associated with participants’ baseline profile. Participants’ overall depressive symptom severity and the presentation of symptom clusters need to be taken into consideration when delivering the services.
Health Characteristics and Treatment Patterns of VHA Veterans Diagnosed With PTSD in Later Life
Authors: Dang Linh , Jedele Jenefer 
Published: December 2020

Abstract
Older adults may exhibit symptoms of Post-Traumatic Stress Disorder (PTSD) after a traumatic event, even if they do not meet the criteria for a full diagnosis. This sub-clinical PTSD affects 7-15% of older adults and is associated with elevated depressive symptoms, suicidal ideation, and poorer physical health. Individuals with sub-clinical PTSD often experience worsening symptoms, resulting in a full diagnosis of PTSD, albeit late onset. This evaluation informs the Veterans Health Administration (VHA)’s understanding of the developmental course of PTSD in older Veterans. VHA administrative data were used to examine health characteristics and service utilization in the five years before and five years after the initial VHA documentation of PTSD. We identified a cohort of Veterans (n=27,610), alive and with at least 1 encounter in all evaluation years, with a first PTSD diagnosis documented between ages 50-59, a cohort outside of the average age of diagnosis, but before Medicare eligibility. We compared periods before and after diagnosis across different ages of first diagnosis (50-54, 55-59). Veterans diagnosed at later ages (55-59) had a greater number of mental and physical health conditions. Increasing VHA use preceded a PTSD diagnosis in both groups, but the increase was steeper among those diagnosed at 55-59. Future analyses will compare these patterns to those of Veterans diagnosed at younger ages. Findings from this work may provide a profile of persons at risk for late-life PTSD for use in targeting interventions earlier to reduce the risk of developing worsening PTSD symptoms in late life.
Suicide Risk in Older Adulthood: Differential Pathways Based on Race
Authors: Fullen Matthew , Mize Mary , Hong Jihee , Shannonhouse Laura , Westcott Jordan 
Published: December 2020

Abstract
Late-life suicide is a complex public health issue, and older adults have a higher risk threshold than the national average (Drapeau & McIntosh, 2020). Most late-life suicide research focuses on elevated risk of older white males, and less is known about risk factors among Black older adults (Joe et al., 2014). Although fewer Black older adults die by suicide than White older adults, forms of suicidality do not differ between Black and White older adults (Cohen et al., 2008). Suicide risk factors, such as psychological distress (Watkins & Johnson, 2018) and chronic pain (Bazargan et al., 2016), are prevalent among Black older adults. According to the Interpersonal Theory of Suicide (IPTS; Van Orden et al., 2016), thwarted belongingness and perceived burdensomeness inform the development of suicidal desire. These findings have been corroborated among older adult samples, though lacking racial diversity. To better understand how the IPTS functions for older adults, and probe whether suicide risk pathways operate differently depending on race, we used data from over 400 homebound older adults residing in a U.S. metropolitan area to clarify if this suicide risk pathway is similar for Black and White older adults. Race moderated the relationship between physical and psychological pain and thwarted belongingness and perceived burdensomeness, with pain among Black older adults having a greater impact on their sense of belonging and burdensomeness. Findings illuminate the need for culturally nuanced understandings of suicidality in older adulthood. The presenters will demonstrate these results and discuss implications for cross-cultural suicide prevention frameworks.
Influenza Vaccine Failure Associated With Age and Immunosuppression
Authors: Kimball Joanna , Zhu Yuwei , Wyatt Dayna , Trabue Christopher H , Talbot H Keipp 
Published: December 2020

Abstract

Background
The influenza vaccine is one of the best ways to prevent influenza infection, but little is known about influenza vaccine failure.

Methods
This study evaluated patients admitted for acute respiratory illness during 2015–2019 influenza seasons to compare vaccinated influenza-negative to vaccinated influenza-positive patients. Statistical analyses were performed with STATA and R using Pearson χ 2, Kruskal-Wallis, Wilcoxon rank-sum tests, and multivariate logistic regression.

Results
Of 1236 enrolled patients vaccinated for influenza, 235 (19%) tested positive for influenza. Demographics, vaccines, and comorbidities were similar between groups except for morbid obesity (13% influenza negative vs 8%, P = .04), and immunosuppression (63% influenza positive vs 54%, P = .01). Logistic regression analysis demonstrated older patients (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.03–2.10) and immunosuppressed patients (OR, 1.56; 95% CI, 1.15–2.12) were at increased risk for influenza despite immunization. When evaluated by influenza subtype, immunosuppression increased the risk for influenza A/H3N2 (OR, 1.86; 95% CI, 1.25–2.75).

Conclusions
Our study demonstrated increased risk of influenza vaccine failure in older patients and immunosuppressed patients. These groups are also at increased risk for influenza complications. To improve protection of patients against influenza illnesses, more effective vaccines and strategies are needed.