bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Older Pedestrian Injuries and Fatalities Among Communities in Massachusetts
Authors: Wang Shuangshuang , Silverstein Nina , Lee Chae Man , Porell Frank , Dugan Beth 
Published: December 2020

Abstract
The number of pedestrian crashes in the United States has increased by 35 percent from 2008 to 2017. Among all pedestrian fatalities in 2017, 48% were pedestrians aged 50 and older, which suggests a disproportionate threat to older residents’ health and safety. Massachusetts has a large older population and is experiencing increased numbers of older pedestrian crashes. This research identified risk factors and community characteristics contributing to older pedestrian crashes and suggests leveraging the state’s age-friendly efforts to speed the implementation of countermeasures. Based on ten-year statewide crash data (2006-2015) and community indicators from the 2018 Massachusetts Healthy Aging Data Report, this study examined 4,472 crashes across Massachusetts that involved pedestrians age 55 and over. The leading reasons for crashes were driver’s inattention, driver’s failure to yield right of way, and driver’s issues with visibility. Older pedestrians were hit while walking in the road, often in crosswalks at intersections. Many factors were found to contribute to older pedestrian crashes: time of day (rush hour), time of year (winter), and community factors (higher rates of disabilities, higher percentage of racial minority residents, higher number of cultural amenities, and lack of dementia-friendly community efforts. Greater awareness of older pedestrian safety risks is needed. Communities highlighted in this research warrant priority attention from planning, health, aging services, and transportation authorities to improve older pedestrian safety.
Does Inflammation Mediate the Association Between Sleep Duration and Incident Dementia Among Older Adults?
Authors: Wu Chenkai , Xu Weihao 
Published: December 2020

Abstract
Sleep duration is a risk factor for multiple health outcomes. Growing attention has been directed to the association between sleep duration and dementia; however, results were inconsistent and the mechanisms remained largely unknown. We hypothesized that elevated levels of inflammation markers— C reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)—would mediate the association between sleep duration and dementia among older adults. Data were from the Health, Aging, and Body Composition Study; 3,010 participants free of dementia at baseline were included. Sleep duration was classified into: short (&lt;6 hours), normal (6-8 hours), and long (&gt;8 hours). Incident dementia was defined as (i) use of prescribed dementia medications, (ii) adjudicated dementia diagnosis, or (iii) a race-stratified cognitive decline &gt;1.5 SDs from the baseline mean. We used Cox models to examine the associations among sleep duration, inflammation, and dementia. The average age was 73.6 years (SD=2.9); 49% were male and 41% were black. During 10 years of follow-up, 515 participants (17.1%) developed dementia. Long sleep duration was associated with higher hazard of dementia than normal sleep duration (HR=1.50, 95%CI=1.02-2.21). This association was attenuated by approximately 10% when CRP or IL-6 was added in the model. When all three inflammation markers were included in the model, the hazard ratio of long sleep duration was reduced by nearly 30% and no longer significant (HR=1.36, 95%CI=0.89-2.08). Long sleep duration was associated with high risk of incident dementia among older adults and the association was partly explained by elevated levels of inflammation markers.
Decreasing Emergency Room Utilization in High Risk Geriatric Patients
Authors: Fani Shamsi , Munoz Lizette , Lavayen Susana , McKenzie Blair , Chun Audrey , Cao Jeff , Chow Stephanie 
Published: December 2020

Abstract
Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.
Gene Expression Profiling Suggests Downregulation of Wnt Pathway Signaling With Aging
Authors: Kuipers Allison , Nestlerode Cara , Wheeler Victor , Miljkovic Iva , Zmuda Joseph 
Published: December 2020

Abstract
The wingless (Wnt) pathway is involved in many age-related diseases and conditions, including cancer and cardiovascular disease. However, the impact of aging on Wnt pathway signaling remains largely unknown. Therefore, we surveyed peripheral blood expression of 43 Wnt pathway genes and tested for association with age in 369 Afro-Caribbean men recruited from the population of Tobago (mean age 64 years, range 51-89 years). Gene expression was measured in counts per sample, then normalized and background subtracted. All expression counts were transformed to normality after excluding any extreme outliers. Fourteen Wnt genes showed detectable expression in our sample and were examined further for association with age using linear regression both individually and using stepwise selection models to identify independent signals. A Bonferroni-corrected alpha for the 14 tested genes (α=0.0036) was used. Six of the 14 tested genes showed significant univariate correlation with greater age [r (gene): 0.169 (APC), 0.179 (AXIN1), 0.222 (CTNNB1), 0.211 (GSK3b), -0.178 (LEF1), -0.166 (TCF1)]. When combined, expression of four genes was determined to be marginally (P&lt;0.05) independently associated with age (AXIN1, CDH2, CTNNB1, TCF1). After correction for multiple testing, a 10-year greater age was independently associated with 4% greater CTNNB1 expression and 8% lower TCF1 expression respectively (both P&lt;0.0001), and this association accelerated after age ≥60 years (p-interaction 0.01 and 0.07, respectively). Greater expression of CTNNB1 and lower expression of TCF1 may indicate decreased Wnt pathway signaling. These results are the first to suggest that aging may be associated with alterations in Wnt pathway signaling.
Interactions Between Genes From Aging Pathways Significantly Influence Risk of Alzheimer’s Disease
Authors: Ukraintseva Svetlana , Arbeev Konstantin , Duan Hongzhe , Akushevich Igor , Feitosa Mary , Christensen Kaare , Stallard Eric , Yashin Anatoliy 
Published: December 2020

Abstract
Age is major risk factor for AD; however, relationships between aging and AD are not well understood. Decline in physiological resilience is universal feature of human aging that may also play role in AD. Aging-related pathways (such as IGF-I/P53/mTOR-mediated) that are involved in tissue resilience work in concert to decide outcomes of cell responses to stress/damage, such as survival, apoptosis, autophagy, etc. We hypothesized that interplay among genes in these pathways may influence AD risk as result of epistasis (GxG). We estimated effects of pairwise epistasis between SNPs in 53 genes from respective pathways on AD risk in the LLFS compared with other data (HRS, CHS, LOADFS). We found significant (fdr&lt;0.05) GxG effects on AD risk in older adults across datasets. The SNP rs11765954 in CDK6 gene was involved in top GxG effects on AD in all datasets, when paired with SNPs in BCL2 and PPARGC1A. The CDK6 role in AD could be pleiotropic, depending on its activity in neurons: CDK6 expression is needed for DNA repair and neuronal survival; however, CDK6 overexpression may lead to the cell cycle reentry in postmitotic neurons resulting in apoptosis, which may contribute to neurodegeneration. CDK6 was earlier found to interfere with BCL2 effects on apoptosis, and with PPARGC1A effects on energy metabolism, which might contribute to observed GxG between these genes. We conclude that interactions among genes from biologically connected aging pathways may significantly influence AD risk. Uncovering such GxG effects has a potential to yield new genetic targets for AD prevention/treatment.
Interventions to Enhance Resilience Among Family Caregivers: A Systematic Review
Authors: Chi Nai-Ching , Han Soojeong , Fu Ying-Kai , Nakad Lynn , Demiris George 
Published: December 2020

Abstract
Long-term caregiving can negatively impact caregivers’ physical and psychological well-being and are associated with increased morbidity and mortality among caregivers. A more positive caregiving experience is associated with increased coping skills and resilience. Caregiver-targeted interventions designed to promote caregivers’ resilience may lead to improved caregivers’ well-being, the quality of caregiving, and care recipients’ outcome. However, a comprehensive evaluation of effective interventions that enhance resilience among caregivers is lacking. Therefore, the purpose of this study is to critically evaluate existing training programs to inform clinical practice and future program design. A literature review was conducted to search available articles published before June 2018 in databases including PubMed, CINAHL, PsycINFO, and Scopus. Search strategies used index and keyword methods. The inclusion criteria were peer-reviewed, research studies published in English that evaluated an intervention primarily aimed to improve family caregivers of adult patients’ resilience or had a primary outcome of resilience. Seven studies fit the criteria identified. Six studies used psychosocial therapy and one used pharmacological therapy to promote caregivers’ resilience. Several effective resources were identified, such as counseling, self-help manuals, psychoeducation, cognitive behavioral therapies, and the use of an antidepressant. All studies reported positive improvements in caregivers’ outcomes and six studies reported caregivers had improved resilience after receiving interventions. However, most interventions require health professionals to train patients and caregivers for multiple sessions. Future studies should develop feasible, effective, and less labor-intensive interventions, such as self-help manuals, telehealth interventions, or interventions delivered during routine visits.
Palliative Care Research: Successful Recruitment and Retention Strategies of Patient-Caregiver Dyads
Authors: Hansen Lissi , Hiatt Shirin , Lyons Karen 
Published: December 2020

Abstract
Research shows that the well-being of patients with serious illness and their family caregivers is significantly associated. Thus, to build the scientific knowledge upon which to establish high quality palliative and end-of-life care practices for these patients and their caregivers, research studies should include successful recruitment and retention strategies that focus on the patient-caregiver dyad. Aims: To review the literature focusing on successful dyadic recruitment and retention strategies and to describe successful recruitment and retention strategies, and attrition in a longitudinal study of end-stage liver disease (ESLD) patient-caregiver dyads. Methods: A five-year prospective longitudinal study of dyads included quantitative and qualitative data collected at 5 time points over 1 year: at baseline, 3, 6, 9, and 12 months. Results: Over a 32-month period 336 dyads were approached and 241 were enrolled. The refusal rate was 27 dyads (8.0%). Over the course of the study, 31 patients or caregivers withdrew for various reasons (too sick, liver transplantation). The attrition due to death of patients was 53 dyads (20.2%). Successful strategies used for recruitment and retention included tailoring to provider preference for referral, accommodating patient preference for data collection method, and having predictable and ongoing contact between a specific study staff and dyads. Conclusions: Less than 10 studies address recruitment and retention strategies most effective in dyadic research in various serious illnesses and clinical settings. Recruitment of ESLD patient-caregiver dyads is challenging. Future longitudinal dyadic studies of serious illnesses and palliative care may benefit from strategies learned from the current ESLD study.
Are Urban Home Health Agencies More Likely to Achieve Improvement in Care Quality?: A Cohort Study
Authors: Ma Chenjuan 
Published: December 2020

Abstract
Home health care (HHC) is a core source of home- and community-based services to older adults “aging in place.’ HHC quality is under increasing scrutiny. This study aimed to examine urban vs. rural disparities in HHC quality in the US. This is a cohort study using 2014-2019 national Home Health Compare data linked to Providers of Services (POS) files. Quality of HHC was measured by agency rates of 1) timely initiation of care and 2) hospitalization. We examined 6,448 home health agencies or 38,688 agency-years. At baseline, the mean rate of timely initiation of care was 91.3% (SD: 7.6; range: 28.0-100.0), with urban agencies performing worse (urban vs. rural: 91.0% vs. 92.3%); and the mean rate of hospitalization was 15.6% (SD: 3.7; range: 0.0-37.0), with urban agencies performing better (urban vs. rural: 15.3% vs. 16.4%). Estimates from multivariate hierarchical linear regressions showed that while the rates of timely initiation of care increased annually over time (β= 0.62, p=0.000), this improvement trends did not differentiate between urban and rural agencies (urban: β= 0.087, p=0.086). There was slight annual improvement in hospitalization rates over time (β= -0.07, p=0.0.003) and the trends in annual reduction in hospitalization rates were more significant in rural agencies than urban agencies (urban: β= 0.10, p=0.000). Our findings indicate urban (vs. rural) disparities in HHC quality and the trends of quality improvement.
Identifying the Role of Spatial Transitions in the Palliative Care Experiences of Unhoused Older Adults
Authors: Johnson Ian , Light Michael 
Published: December 2020

Abstract
The national population of unhoused older adults is predicted to nearly triple by 2030. Unhoused older adults have a mortality rate four to nine times higher than housed populations, and face structural barriers during illness trajectory that likely influence both where care takes place and processes around attaining psychosocial later-life goals. This study aimed to (1) document patterns in the healthcare trajectories of unhoused older adults and (2) examine the role of care transitions in psychosocial goal attainment. Retrospective chart review was completed in partnership with a mobile homeless palliative care team; additional data was gathered from provider focus group. Through a content analysis of this data, it was discovered that older unhoused palliative care patients experienced more transitions, and that numerous care transitions were associated with disruptions to goals. The type of care transitions patients experienced also did not reflect their later-life goals. Patients’ movements impacted the role of formal and informal care networks in care and highlighted the implications of place in common psychosocial goals, such as family reconciliation. Unconventional neighborhood supports were found to help facilitate treatment adherence. These findings offer translational opportunities for further research, including “rapid respite” models and other innovations in mobile palliative care for unhoused and precariously-housed people with life-limiting illness.
Concomitant Cholinesterase Inhibitor and Anticholinergic Drug Use Among Older Adults With Dementia
Authors: Carter Elizabeth , Tan Erwin 
Published: December 2020

Abstract
Anticholinergic medications (ACh) are frequently prescribed to older adults despite being associated with impaired physical functioning. Moreover, the concomitant use of ACh and cholinesterase inhibitors (ChEI) reduces the body’s response to both drugs, thereby diminishing the modest effectiveness of ChEI at slowing the progression of dementia symptoms. The objective of this study was to assess the risk of concomitant ACH/ChEI use on functional outcomes, including fall, fracture, and traumatic brain injury (TBI). We conducted a retrospective review of data from the OptumLabs® Data Warehouse, a de-identified administrative claims database for commercially insured and Medicare Advantage (MA) enrollees, representing a diverse mixture of ages, ethnicities, and geographical regions across the U.S. Our cohort included adults 65 and older enrolled in MA between 1998 and 2017. Subjects were required to have dementia (by a diagnosis and/or prescription for a dementia drug (memantine or ChEI)) and at least one claim for ChEI during 12 months of follow-up. Subjects had to be enrolled in MA 6 months prior to the dementia index date. We defined concomitant ACh/ChEI use as an overlap of 30 days or more. Nearly one-third (29%) were concomitantly prescribed ACh and ChEI. Half (51%) of concomitant users were prescribed ChEI first, 46% were prescribed ACh first, and 3% received prescriptions on the same day. Results from multiple logistic regression analyses show that older adults with dementia who had concomitant ACh/ChEI use were 18%, 16%, and 25% more likely to experience a fall, fracture, or TBI, respectively, than those taking ChEI alone.
A Short, Valid, and Flexible Web-Based Screener for Mild Cognitive Impairment
Authors: Schmidt Nicole , Germine Laura , Grodsky Eric , Muller Chandra , Warren John Robert , Manly Jennifer 
Published: December 2020

Abstract
Clinical assessments for identifying mild cognitive impairment (MCI) can be costly and time-consuming. Few screeners for MCI exist that can be implemented quickly and outside of the clinic using flexible, cost-effective methods, such as web-based, mobile device-friendly assessments. Using data from middle-aged, racially and ethnically diverse Offspring Study participants (N=34 with MCI, N=54 without MCI; mean age: 53.9±3.4), we analyzed the sensitivity and specificity of several web- and telephone-based measures to identify MCI, after accounting for age and education. Web assessments included the Verbal Paired Associates (PA) and Visual PA tests. Phone assessments included the Number Series, Letter and Category Fluency, Number Span Forward & Backward, the AD8, and self-reported memory complaints. The discriminant ability of the web-based Visual PA test for MCI (ROC Area = .69) was comparable to phone-based measures, including the Category Fluency (ROC Area = .69), Number Span Forward (ROC Area = .61) and Backward (ROC Area = .67), and Letter Fluency (ROC Area = .68). Visual PA strongly predicted MCI, with a 98% reduction in the odds of MCI for every additional correct answer (OR=0.02), but our results are imprecise (95%CI: .000 to .76). A web-based Visual PA measure appears comparable to phone assessments in detection of MCI, although substantial uncertainty in its diagnostic precision remains. However, it is short, easily administered on a large-scale, and our evidence suggests that it can provide a sensitive and specific test to refer racially and ethnically diverse individuals for more thorough clinical assessment.
An Innovative Model of Dementia Programming for Community-Dwelling Older Adults With Family Caregivers
Authors: Gorzelle Gregg , Skrajner Michael , Best Cassie , Walker Drew 
Published: December 2020

Abstract
Decide, Discover, and Do!TM (D3) is an alpha-version iPad application developed and evaluated in a National Institute on Aging-funded Phase 1 SBIR project. The goal of D3 is to enhance the quality of life and care for community-dwelling persons living with dementia whose primary care partners are family members. D3 consists of (1) evidence-based activities for care partners to facilitate with their loved ones and (2) video-based interactive training on best practices in dementia care, for care partners. The activities are unique in that they create an overarching narrative for daily activities that creates a consistent routine capitalizing on procedural memory. The activities build upon one another, starting with the persons living with dementia 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 forests), and culminating in an experiential activity (e.g., tasting various foods found in nature, e.g. wild raspberries). A total of 18 participants took part in the this feasibility study. The study examined the impact of D3 training modules on knowledge transfer (16% mean increase in care partner knowledge across three courses); satisfaction with the training modules (96% satisfaction across three courses); and satisfaction with the activities programming (91% satisfaction across all items for persons living with dementia and 99% for care partners). No distal changes related to care partner stigma nor caregiver burden were seen in this short study.
Study Protocol: Partners at Meals Telehealth Intervention for Caregivers of Persons With Dementia
Authors: Qanungo Suparna , Krug Elaine Amella , Martin Kelly , Mueller Martina , Madisetti Mohan , Kelechi Teresa 
Published: December 2020

Abstract
Background: As the aging population continues to increase, it is estimated that persons with dementias (PWDs) will reach 13 million by 2050. Lack of caregiver skills related to mealtime planning and the ability to cope with dysfunctional behaviors are well-documented factors that influence nutritional outcomes for PWDs, leading to social isolation, and negatively impacting their home stay. The aim of this study protocol is to test the effectiveness of a train-the-trainer program in which non-paid volunteers in respite care centers deliver a telehealth mealtime intervention for caregivers of PWDs, Partners at Meals. The program is based on the C3P Model of Changing the Place, People and Person. Methods: A cluster-randomized controlled trial with parallel mixed methods evaluation processes is being conducted. Caregivers and PWD dyads, receiving respite services are randomized to receive Partners at Meals or enhanced-usual-care for six months. Within the intervention group, dyads are partnered with a C3P-trained volunteer who works with caregivers to devise monthly mealtime plans. Under enhanced-usual-care, dyads receive standardized educational materials modified from The Savvy Caregiver Program for Alzheimer’s caregiving. Primary outcomes include weight, calorie, protein and fluid intake of the PWDs and quality of life of the caregiver. Respite center administrators, program directors, volunteers and caregivers are evaluated for intervention fidelity, acceptability and sustainability. Implications: In this trial, we lay the groundwork to examine effectiveness and sustainability of a train-the-trainer telehealth program that could be widely disseminated for managing mealtimes in-the-home, while promoting quality of life of both the caregiver and PWDs.