bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE ETHNIC-SPECIFIC EFFECTS OF BEHAVIORS ON INCIDENT GOUT WITHIN A LARGE MULTIETHNIC COHORT OF OLDER ADULTS
Authors: Thompson Mika D , Pirkle Catherine M , Wu Yanyan , Youkhana Fadi , Cooney Robert V , Wilkens Lynne R 
Published: November 2019

Abstract
Gout, a common rheumatic disease in older adults, disproportionately affects Pacific Islander and Black populations, relative to Whites; however, the ethnic-specific incidence and determinants remain severely understudied within these groups. We examined gout incidence and the effects of behavioral factors, including diet, physical activity, and smoking, on incident gout within a large multiethnic population of older adults from the Multiethnic Cohort Study linked to approximately 20 years of Medicare gout claims. Using samples of Black (N=15,660), Native Hawaiian (N=7,600), Japanese (N=32,923), Latino (N=21,793), and White (N=29,129) participants, we conducted multiple Cox regressions, producing hazard ratios (HR) and 95% confidence intervals (CI). Native Hawaiians had the highest incidence of gout (9.97 per 1,000 person-years), followed successively by Black, Japanese, White, and Latino participants. 3+ alcoholic drinks/day was associated with an increased risk, especially among Blacks (HR:1.55, 95%CI:1.23,1.94). Current smoking was associated with increased risk among Blacks (HR:1.28, 95%CI:1.10,1.49) and Japanese (HR:1.17, 95%CI:1.03,1.32). Better dietary quality tertiles were associated with a decreased gout risk for most ethnic groups, with the largest effect observed among Whites (HR[Q1vsQ3]:0.70, 95%CI:0.63,0.78), while vitamin C was weakly associated with a decreased risk of gout only among Native Hawaiians (HR:0.85, 95%CI:0.75,0.98) and Japanese (HR:0.91, 95%CI:0.85,0.98). Overall, notable ethnic differences were observed in both gout incidence and effects of modifiable behaviors. As the first study to examine the incidence and longitudinal determinants of gout utilizing several large samples of underrepresented ethnic groups, our findings offer crucial insights that may improve precision in preventing and treating gout.
ORGANIZATIONAL AND OLDER ADULT VOLUNTEER PERSPECTIVES ON ROLE CONFLICT MANAGEMENT STRATEGIES
Authors: Crittenden Jennifer A , Butler Sandra S 
Published: November 2019

Abstract
Older adults are increasingly occupying multiple life roles, including working, caregiving, and volunteering, creating the opportunity for role conflict. Such conflict occurs when stress and strain created by the demands of multiple life roles outstrips an individual’s resources to successfully manage such demands. A two-phase research study was recently completed with 1,697 RSVP volunteers drawn from 55 RSVP program sites across the country (Phase I) with a follow-up survey of RSVP programs conducted with 17 sites (Phase II). Grounded in role theory, the Phase I volunteer survey explored role conflict in addition to self-reported strategies used to mitigate the experience of role conflict. The Phase II program survey gathered responses from volunteer managers and staff about the strategies used by their older adult volunteers to avoid and address role conflict. Based on findings from both surveys, caregivers engaged the following strategies in order to minimize role conflict: obtaining respite care, and volunteering alongside their care recipient. Worker-specific strategies focused largely on time management and included volunteering during off-work hours and completing time-limited volunteer assignments. While a high level of convergence was noted between volunteer manager and volunteer perspectives, two themes emerged from the volunteer survey that were not identified in program survey responses: seeking volunteer opportunities that leverage similar skills and experiences across roles and seeking volunteer opportunities that provide a different experience from that of other roles. Implications for future research and volunteer management strategies will be discussed.
CAREGIVER PREFERRED STRUCTURE FOR A TELEHEALTH-BASED INTERVENTION ONE-TO-ONE VERSUS GROUP
Authors: Shofner Sabrina J , McKenzie Glenise , LaFazia David , McNeill Loriann , Spoden Natasha , Mattek Nora , Teri Linda , Lindauer Allison 
Published: November 2019

Abstract
Caring for a person with Alzheimer’s disease and related dementias (ADRD) can be stressful. Support programs are available for caregivers, but distance and cost present barriers to participation. Our mixed-methods study explored consumer acceptability and preliminary efficacy of a telehealth-based caregiver intervention, Tele-STAR. Caregivers in Tele-STAR met one-to-one with a consultant over eight weeks, via video conferencing, to address behavioral symptoms of dementia. We measured the effect of the intervention on caregiver reactivity to behavioral symptoms. Focus groups were used to assess acceptability. The literature suggests that stressed caregivers drop out of support programs. Thus, in the focus groups we asked about preference for intervention mode (one-to-one versus group). We hypothesized that more stressed caregivers would prefer the one-to-one mode. Data were analyzed using paired t-tests for the quantitative data, and a phenomenological lens for the qualitative data. Of the thirteen enrolled caregivers, twelve completed the study. Significant improvement was found in caregiver reactivity (p=0.001). Twelve caregivers participated in focus groups, in which they reported that the intervention helpful and they valued the therapeutic relationships with the consultants. Few had difficulty with the technological interface. Most liked the one-to-one mode of the intervention, but were open to a hypothetical group-based option. However, more stressed caregivers preferred a one-to-one intervention over a group intervention (p=0.06). While one-to-one interventions tend to be preferred by caregivers, they are expensive. Our findings suggest that one-to-one telehealth-based interventions should be reserved for more stressed caregivers who need intensive support with managing behavioral symptoms of dementia.
INEQUALITY IN COMMUNITY HEALTH SERVICES USE IN ISRAEL: A COMPARISON BETWEEN ELDER JEWS AND ARABS
Authors: Lowenstein Ariela , Naim Sigal Pearl 
Published: November 2019

Abstract
Population aging is an important social and public health issue globally. However, increase in longevity causes physical frailty and disability for many elders, which might lead to independence loss and impact quality of life. This increases health services usage and leads to higher costs of medical treatments. Data show that higher socio-economic status and accessibility to health services might reduce inequality in service use and impact mortality rates and quality of life. Also, that improved socio-economic status and population accessibility to Health services may stem from inner health system factors, as well as those related to the patients. Among minorities lower usage of formal professional services, including health services, are often related to cultural differences and many times to lower technological level, which are not considered by service providing organizations. Thus, lack of attention to service using minorities’ needs may cause a gap between potential consumers to services use. Israel is a multi-cultural society with mixed population of Jews and Arabs. Currently, Arabs comprise 20.9% and Jews 74.3%. However, the rate of disabled Jews is 16% compared to 31% among older Arabs.
SERUM 25(OH)D SIGNIFICANTLY IMPACTS ALZHEIMER’S DISEASE IN OLDER ADULTS LIVING IN LONG-TERM CARE COMMUNITIES.
Authors: Churchill Robert A , Robbins Ronna , Ranjit Nalini , Sweitzer Sara , Briley Margaret 
Published: November 2019

Abstract
6.08 million Americans suffer from Alzheimer’s Disease (AD), with some estimating diagnoses will reach 15.0 million by 2060. Age is the strongest risk factor for AD, and the prevalence of AD among older adults necessitates investigation into preventable risk factors. 25-hydroxyvitamin D [25(OH)D] deficiency is more prevalent in older adults than other age demographics. Research shows a strong correlation between deficient 25(OH)D serum levels (≤20ng/ml) and AD diagnosis. The association with insufficient (≤30 ng/ml) levels remains unclear. Older adults (age &gt; 65 yo) of five LTC communities in Texas participated in the cross-sectional study. One-year medical history and demographics were abstracted from medical records using double-blinded data abstraction and entry. Blood draws measured 25(OH)D serum levels. Adjusted logistic regression models examined if insufficient 25(OH)D serum levels (≤30 ng/ml) are associated with AD diagnosis. Confounders were total daily vitamin D supplementation, BMI, race, gender, age, years in community, and diagnosis of liver and renal disease. Participants (n=174, mean age: 83 yo) consisted of 63% female and 89% Caucasian. Fifty five percent had insufficient serum 25(OH)D levels (mean level: 32.6 ng/ml; mean supplementation rate: 1,138 IU per/d), and 20% had diagnosis of AD. 25% had both insufficient serum levels and AD, while 12.6% had adequate serum levels and AD. Those with insufficient 25(OH)D serum levels had elevated odds (OR=2.8; CL: 1.14, 7.02; p=0.024) of having AD after adjusting for confounders. Insufficient serum 25(OH)D levels (≤30 ng/ml) are associated with increased diagnoses of AD, indicating the importance of adequate levels among LTC residents.
COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL: POST-ACUTE CARE AND PREFERRED PROVIDER NETWORKS
Authors: Gruman Cynthia A , Cowell Amy , Palmisano Kathryn , Rogers Shannon , Dummit Laura 
Published: November 2019

Abstract
The Comprehensive Care for Joint Replacement (CJR) model, implemented by the Centers for Medicare & Medicaid Services in 2016, is a randomized, controlled trial that tests the effect of holding a hospital accountable for payments and quality of all services provided to lower extremity joint replacement (LEJR) patients during an episode of care. The newly released results include 147,923 LEJR episodes that were initiated by 733 hospitals in 67 randomly selected metropolitan statistical areas. The objective of this presentation is to explore changes to the care pathway using results from a mixed-methods analytic approach including triangulation of findings from analysis of Medicare claims, hospital survey and hospital and associated provider interview data. Hospitals reported implementing notable changes over the past two years including hiring navigators, changes to therapy protocols, and direct discharge home. Hospital interviewees described efforts to strengthen relationships with PAC providers including the investment of resources into the development of preferred PAC provider networks. As a result of these changes, the average number of SNF days decreased by 2.3 days more for CJR episodes than for control group episodes from the baseline to the intervention period (p&lt;0.01). Changes in two of nine complexity measures indicated a statistically significant relative decrease in CJR patients’ functional status at SNF admission. The relative increases in CJR patients’ average early-loss activities of daily living (ADLs) scores (p&lt;0.05) and motion scores (p&lt;0.10) suggest an increase in patients with greater needs were discharged to a SNF relative to the control group.
ASSOCIATION BETWEEN WALKING ENERGETICS AND FRAGMENTED PHYSICAL ACTIVITY IN MID-TO-LATE LIFE
Authors: Liu Fangyu , Wanigatunga Amal A , Kuo Pei-Lun , Zipunnikov Vadim , Simonsick Eleanor M , Schrack Jennifer A 
Published: November 2019

Abstract
Physical activity becomes increasingly fragmented with age, and may be an early marker of functional decline. Energy regulation has been linked with functional decline, yet whether the energy needed for walking, a common type of physical activity, is related to fragmentation of physical activity remains unknown. The study population included 493 participants aged 50-93 years from the Baltimore Longitudinal Study of Aging. Energetic measures included the energetic cost of usual-paced overground walking (ml/kg/m), the average energy expended (ml/kg/min) during a rapid-paced 400-m walk, and a cost-to-capacity ratio between the energy expended during 5-min treadmill walk (0.67 m/s, 0% grade) and the energy expended during the 400-m walk. Activity fragmentation was extracted from accelerometer data collected over ≥3 valid days and quantified via an active-to-sedentary transition probability (ASTP). Associations between the energetic measures and ASTP were assessed using multivariate linear regression models. Interactions between energetics and total daily physical activity, quantified as total log-transformed activity counts (TLAC), were also assessed. After adjusting for TLAC, demographics, body composition and comorbidity, higher cost-to-capacity ratio was associated with 3.51% greater fragmented physical activity (p=0.005). Energetics by TLAC interactions revealed that lower rapid-paced walking energy expenditure and higher cost-to-capacity ratio were only significantly associated with greater fragmentation in the most sedentary participants (p&lt;0.01 for both). Our results suggest that deterioration of walking efficiency may manifest as a more fragmented physical activity profile, especially among sedentary adults. Future longitudinal studies to understand whether declining walking efficiency predicts the onset and progression of activity fragmentation are warranted.
MAILED SURVEYS WITH NONAGENARIANS - CHALLENGES AND LESSONS FROM THE VITALITY 90+ STUDY
Authors: Jylha Marja , Raitanen Jani , Tiainen Kristina , Halonen Pauliina , Enroth Linda 
Published: November 2019

Abstract
Reliable population-based data on health, functioning and quality of life among very old people are scarce because only during the last decades this age group has grown to be an important segment of population, and because data collection among the oldest old is challenging. Due to poor health, problems in hearing and vision, cognitive decline, and institutionalization, very old individuals may not be able to participate in research studies, or, the information they give may not be reliable. In the Vitality 90+ Study, the whole population aged 90+ in the Tampere area, Finland, has been investigated six times since 2001. Mailed surveys have been conducted in years 1995, 1996, 1998, 2001, 2003, 2007, 2010, 2014, and 2018. In each data collection, the response rate has been ca 80%. The questionnaires and the wording of the questions have been identical in each survey round, which provides data for investigating time trends in health, functioning, and quality of life. Linkages with national population and care registers are used for studying mortality and care use. In this poster, we analyze the impact of 1) exhaustive base data, 2) the questionnaire, 3) including institutionalized individuals and proxy answers, on the findings and on the quality and reliability of the data. We conclude that mailed surveys can be a feasible method of data collection among very old people, but only in favorable local circumstances and with great efforts from the research group.
ATTACHMENT SECURITY AND VIEWS TOWARD AGING IN OLDER COUPLES: A DYADIC PERSPECTIVE
Authors: Chang E-Shien , Goktas Seline O , Monin Joan K 
Published: November 2019

Abstract
Research has shown that attachment security–feelings of emotional safety from interpersonal closeness and responsiveness– is associated with better appraisal of stressful situations. Individuals’ views toward aging could be one avenue such appraisals are expressed that in turn contribute to better health in late life. However, no studies to our knowledge have examined the dyadic associations between attachment security and views towards aging in the context of close relationships. We hypothesized that attachment insecurity would be associated with individuals’ own and partners’ negative views toward aging in older married couples. The study sample was comprised of 77 older persons with a self-reported musculoskeletal condition and their caregiving spouses. The Experiences in Close Relationships Scale and the open-ended Image of Aging questions were used to measure attachment security and views toward aging. Data were analyzed with SPPS mixed models using the Actor Partner Interdependence Model. Mean age of care-recipients were 65.9 and 64.8 for their spouses. Contrary to our hypothesis, results showed no significant associations between each individual’s attachment security and their own views toward aging. However, care-recipients reported particularly positive views toward aging when caregivers had low attachment anxiety (p=.03), and caregivers reported more negative views toward aging when care-recipients had low attachment avoidance (p=.02). Findings suggest that having a close partner who is securely attached may be protective of one’s own views of aging, which may in turn have positive effects on health.
TRANSCRIPTOME ALTERATIONS ASSOCIATED WITH AGE-RELATED DECLINE IN PHYSICAL FUNCTION.
Authors: Graber Ted G , Marota Rosario , Thompson Jill , Widen Steve , Rasmussen Blake 
Published: November 2019

Abstract
One inevitable consequence of the effect of age on our bodies is the graduated deterioration of physical function and exercise capacity, driven, in part by the adverse effect of age on muscle tissue. Our primary purpose was to determine the relationship between patterns of gene expression in skeletal muscle and loss of physical function. We hypothesized that some genes that change expression with age would correlate with functional decline, or conversely with preservation of function. Male C57Bl/6 mice [adults (6-7 months old, n=9), older (24-25 months old, n=9), and elderly (28+ months of age, n=9) were tested for physical ability using a comprehensive functional assessment battery [CFAB, a composite scoring system: comprised of the rotarod (overall motor function), grip strength (fore-limb strength), inverted cling (4-limb strength/endurance), voluntary wheel running (activity rate/volitional exercise), and treadmill tests (endurance)]. We extracted RNA from the tibialis anterior muscles, ran RNAseq to examine the transcriptome using an Illumina NextSeq 550, comparing adults (n=7) to older (n=7) and elderly mice (n=9). Age resulted in gene expression differences of 1.5 log2 fold change or greater (p&lt;0.01) in 46 genes in the older mice and in 252 genes in the elderly (both compared to adults). Current ongoing work is examining the physiological relevance of these genes to age-related loss of physical function. We are in the process of using linear regression to determine which of the genes with age-related changes in expression are associated (R&gt;0.5 and p&lt;0.05) with functional status as measured by CFAB.
SOCIABILITY AMONG PERSONS LIVING WITH DEMENTIA IN A CREATIVE GROUP STORYTELLING CONTEXT
Authors: Chee Kyong Hee , Kim Seoyoun , Gerhart Olga , Caldwell Sara 
Published: November 2019

Abstract
Considering healthcare costs related to Alzheimer’s Disease and related dementias, shifting attention to the relatively malleable abilities of persons living with dementia holds promise for improving their well-being while reducing care burden. Defined as the ability to successfully interact with others, social intelligence is found to benefit well-being. Nevertheless, no known prior study has examined social intelligence among persons living with dementia. The purpose of this study is, therefore, to fill this gap by identifying the themes of social intelligence in this group. We used video-recorded data from an arts-based, creative group storytelling program (TimeSlips) that we implemented at Silverado Onion Creek Memory Care Community (currently, The Auberge) in Austin. The program is designed for persons living with dementia and involves a facilitator encouraging participants to use their imagination to collectively create a story from a staged picture. We offered 6 weekly sessions with 4 small groups of their residents (N = 26) in fall 2018 and spring 2019, and videotaped the sessions. Three researchers open-coded how participants interacted during storytelling sessions, and then met to reach consensus concerning verbal and non-verbal indicators of social intelligence. Major themes that emerged from our analysis are social awareness, initiating social interactions, and social diplomacy. Our findings suggest that those with lower cognitive function scores do not necessarily lack sociability. These findings add to social intelligence and dementia literatures, with potential implications for future research that can investigate the relationship between sociability and well-being among persons living with dementia.
THE ASSOCIATION OF MORTALITY WITH DEMENTIA IN VETERANS ENROLLED IN A MEMORY DISORDERS CLINIC: THE EFFECT OF FRAILTY
Authors: Shah Aakashi , Apracio-Ugarriza Raquel , Morani Amar , Rodriguez-Suarez Mercedes , Ruiz Jorge G 
Published: November 2019

Abstract
Dementia is a syndrome of deterioration in cognition and ability to perform everyday activities. Frailty, a state of vulnerability to stressors leading to increased morbidity, mortality and utilization is a determinant of dementia. The aim was to determine if dementia leads to increased mortality in Veterans and whether frailty affects this association. We conducted a retrospective cohort study of 308 Veterans enrolled in VA memory disorders clinic during 2016-2019. Dementia was diagnosed based on complete clinical assessments, brain imaging and neuropsychological testing. A 44–item frailty index (FI) was constructed using demographics, comorbidities, medications, laboratory tests, and activities of daily living. Patients were divided into non-Frail (FI&lt;0.21) and Frail (FI≥0.21). After adjusting for age, race, ethnicity, income, education, substance abuse, BMI, comorbidities, hospitalizations, medication use, the association of dementia with mortality was assessed using Cox proportional hazards regression. Patients were 55.2% White, 74% non-Hispanic, and the mean age was 74.4 ± 8.3 years. 113 patients were diagnosed with dementia out of which 27 died. Over a median follow-up period of 526 days (Interquartile Range: 431.5 days), there were 27 deaths. There was a significant and positive association of dementia with mortality significant even after all adjustments, HR=2.65 (95% CI: 1.02-6.92), p: 0.045. After subgroup analysis, there was no significant association between mortality and dementia according to frailty status. Our study results suggest that dementia is associated with a higher risk for mortality in Veterans at a Memory Disorders clinic. Frailty did not modify the effect.
COST-EFFECTIVENESS ANALYSIS OF THE COLLABORATIVE STEPPED CARE INTERVENTION FOR LATE-LIFE DEPRESSION
Authors: Lu Shiyu , Wong Gloria H Y , Lum Terry , Liu Tianyin 
Published: November 2019

Abstract
Late-life depression is a burden on society because it is costly and have a significant adverse effect on the quality of life. The aim of this study is to evaluate the cost-effectiveness of the collaborative stepped care intervention for depression among community-dwelling older adults compared to care as usual from a societal perspective. The intervention was piloted from 2016-2019 in Hong Kong. The study used a two-armed quasi-experimental design. Eventually, 412 older people were included (314 collaborative stepped care, 98 care as usual). Baseline measures and 12-month follow-up measures were assessed using questionnaires. We applied the 5-level EQ-5D version (EQ-5D-5L) and the Client Service Receipt Inventory (CSRI) respectively measuring quality-adjusted life-year (QALY) and health care utilization. The average annual direct medical cost in the intervention group was USD 6,589 (95% C.I., 4,979 to 8,199) compared to US$ 6,167 (95% C.I., 3,702 to 8,631) in the care as usual group. The average QALYs gained was 0.036 higher in the collaborative stepped care group, leading to an incremental cost-effectiveness ratio (ICER) of US$ 11,722 per QALY, lower than the cost-effectiveness threshold suggested by The National Institute for Health and Clinical Excellence. The study showed that collaborative stepped care was a cost-effective intervention for late-life depression over service as usual.