bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing Effective, Evidence-Based Older Adult Fall Prevention
Authors: Bergen Gwen 
Published: December 2020

Abstract
Over one in four older adults (65 years and older) in the US reports falling annually with estimated medical costs of $50 billion. Evidence-based strategies exist that can reduce falls with one of the most promising being multifactorial, clinically-based initiatives such as the Centers for Disease Control and Prevention’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Initiative. STEADI includes three core components for health care providers: screen for risk factors, assess modifiable factors, and intervene to reduce falls with evidence-based strategies. Barriers to implementation include competing patient demands and limited time during patient visits. Efficient, effective implementation of clinical fall prevention is important to increase the use of multifactorial interventions. In addition, understanding older adult attitudes about the preventability of falls is needed to increase patient adherence to prescribed interventions. This symposium will cover:1. Background data on older adult falls over time,2. Description of an initial implementation of STEADI in an outpatient, Southeastern clinical practice including lessons learned,3. Attitudes of older adults toward fall prevention with implications for health promotion,4. Process evaluation of an ongoing implementation of STEADI in New York State with lessons learned. Understanding practical methods of implementing the three core components of fall prevention into practice supports wider dissemination of evidence-based fall prevention, while understanding patient attitudes toward falls informs the design of health promotion approaches to increase patient uptake of prescribed interventions. Wider dissemination and increased patient adherence in combination can reduce older adult falls and their associated medical costs.
Implications of Older Adult Attitudes Toward the Preventability of Falls for Health Promotion
Authors: Bergen Gwen , Mark Janice , Henry Ankita 
Published: December 2020

Abstract
Older adults’ behavioral stage of change for adopting fall prevention interventions, and their use of evidence-based interventions are not well understood. A survey was administered to older adults (65 years+) (n=1063) to understand their stage of change and fall prevention behaviors. Descriptive statistics were calculated and logistic regression conducted to determine factors most related to stage. The distribution of subjects by stage was precontemplation (17%), contemplation (2%), preparation (5%), action (15%), and maintenance (61%). The strongest variable related to being in an action stage (preparation, action, maintenance) was screening positively for fall risk (Risk Ratio: 8.7, 95% CI: 5.4, 14.1). The most common preventive actions for those in an action stage were taking Vitamin D (37%), and having vision tested (30%). Older adults at risk for a fall are ready to take action to prevent falls; health promotion should focus on increasing knowledge and use of different evidence-based interventions.
Changes in the Age-Adjusted Rate of Older Adults Dying From a Fall and Reporting a Fall and Fall Injury, 2012–2018
Authors: Burns Elizabeth , Kakara Ramakrishna , Moreland Briana , Henry Ankita 
Published: December 2020

Abstract
Falls are a leading cause of injury among older men and women (≥65 years) in the United States. Vital Statistics and Behavioral Risk Factor Surveillance System data were analyzed to determine the age-adjusted fall death rate, the rates of older adults reporting a fall and fall injury, and associated trends. The fall death rate increased 16% from 55.3/100,000 in 2012 to 64.4/100,000 in 2018 (p≤0.05). Like the rates in 2012, the rate of falls reported in 2018 was 713/1000 older adults and the rate of fall injuries reported was 171/1000 older adults. When assessing the rates of older adults reporting a fall or fall injury by sex, the rates among men increased from 2012 to 2016 from 637/1000 to 773/1000 (21% increase, p≤0.05) for falls and from 120/1000 to 153/1000 (28% increase, p≤0.05) for fall injuries. Understanding how these data change over time can inform targeted interventions to reduce falls.
STEADI in Primary Care: A Process Evaluation of the New York State Implementation
Authors: Johnston Yvonne , Reome-Nedlik Chelsea 
Published: December 2020

Abstract
This session presents findings from a STEADI process evaluation that was conducted within a primary care setting in New York State. This process evaluation used mixed methods including quantitative analysis of surveys with clinic staff as well as qualitative methods such as intercept interviews with healthcare providers and clinic staff, and structured interviews with key stakeholders. The RE-AIM framework guided development of the process evaluation tools. The process evaluation was conducted over a 2-month period approximately 18 months post-implementation. Facilitators included: (a) Adoption - physician champion and administrative support; (b) Implementation - wellness coordinators, preparation and training, and organizational quality measures; (c) Maintenance - feedback from patients, local and national recognition, and impact on fall-related outcomes. Barriers included: (a) Adoption – organizational priorities and complexity of electronic health records; (b) Implementation – resistance to change and competing patient care demands; (c) Maintenance - staff turnover and follow through of referrals.
Artificial Intelligence for ADRD Caregivers: A Systematic Literature Review
Authors: Xie Bo , Tao Cui , Li Juan , Hilsabeck Robin , Aguirre Alyssa 
Published: December 2020

Abstract
Artificial intelligence (AI) may improve the care for persons with Alzheimer’s disease and related dementias (ADRD) and caregivers’ quality of life. To examine existing research on this topic, we searched 5 publication databases using keywords related to Alzheimer’s, dementia, caregiver, and artificial intelligence, and found 113 relevant results. We then screened the titles, abstracts, and full texts, and excluded studies not including family caregivers, not involving providing information to users, screening/diagnosis of dementia, caregiver anxiety/burnout, or lacking empirical data. Thirty results remained. These studies included technologies such as robots to facilitate social engagement and assist with daily activities. Most were qualitative or cross-sectional with small samples. These studies generally reported positive outcomes in favor of AI tools but levels of evidence were low. These findings suggest the need for systematic designs that can generate high levels of evidence for the feasibility and efficacy of AI-based interventions for ADRD caregivers.
A Delphi Study on Dementia Care Technology Use and How to Mitigate Risks: Design to Implementation
Authors: Berridge Clara , Demiris George 
Published: December 2020

Abstract
What information is needed to navigate person-centered technology use in dementia care? The threefold aim of this Delphi study was to learn which technologies will be most prevalent in dementia care in 5 years, understand benefits and risks, and identify specific options to mitigate risks. Twenty-one interdisciplinary domain experts from academia and industry in aging and technology in the U.S. and Canada participated, an 84% response rate. Technologies rated most likely to cause value tensions were also predicted to be most prevalent and will be described, along with the identified risks. Suggestions to mitigate the risks are categorized as follows: intervene during design; make specific technical choices; build in choice and control; require data transparency; place restrictions on data use and ensure security; enable informed consent; and proactively educate users. The specific recommendations that are relevant to designers, clinicians, researchers, ethicists, and policy makers will be presented and discussed.
Measurement Opportunities and Challenges With Long-Term Care Residents With Dementia
Authors: Holmes Sarah , Galik Elizabeth , Resnick Barbara 
Published: December 2020

Abstract
Measuring clinical outcomes among older adults with moderate to severe dementia present practical and psychometric challenges. Proxy report surveys, direct observations, chart abstraction, and objective measures, such as actigraphy are frequently used with this population. The purpose of this paper is to describe issues related to measurement in the FBFC trial. Challenges to actigraphy included the resistance of residents and removal of devices, inability to detect limited movement and/or the type of activity performed. The combined use of the three measures to optimize understanding of physical activity will be addressed. Behavioral outcome measures included the Cornell Scale for Depression in Dementia, the Cohen Mansfield Agitation Inventory, and the Resistiveness to Care Scale. Despite the use of these multiple measures, limited behaviors were identified due to timing of assessments and items included within the measures. Optimal ways in which to capture behavioral symptoms will be reviewed.
Implementation of Function and Behavior Focused Care
Authors: Resnick Barbara , Galik Elizabeth 
Published: December 2020

Abstract
There are many challenges to engaging long term care residents with dementia in physical and functional activities. Resident factors include age, comorbidities, cognitive impairment, motivation, sedation and polypharmacy. Facility factors include the environment, policies and culture within the setting such as a focus on safety versus function. Commonly used non-evidence based interventions include discouraging residents from walking by repeatedly telling them to sit down, and limiting recreational activities to seated positions. De-implementation to remove inaccurate care practices and implementation approaches are needed to facilitate implementation of Function and Behavior Focused Care. This paper will describe the use of the Synthesis Model for the Process of De-Adoption and the Evidence Integration Triangle implementation strategy in the development of the Function and Behavior Focused Care intervention to alter behavior among staff and cognitively impaired residents and optimize function and physical activity in long term care.
Frailty Phenotype and Healthcare Costs in Older Community-Dwelling Men: The MrOS study
Authors: Ensrud Kristine , Kats Allyson , Langsetmo Lisa Lisa , Vo Tien , Schousboe John 
Published: December 2020

Abstract
To determine the association of the frailty phenotype with subsequent healthcare costs, we studied 1514 men (mean age 79.3 years) participating in the 2007-2009 exam linked with their Medicare claims data. The frailty phenotype (5 components) was categorized as robust, pre-frail or frail. Multimorbidity and a frailty indicator (approximating the deficit accumulation index) were derived from claims data. Functional limitations were assessed by asking about difficulty performing 5 IADL. Total direct healthcare costs were ascertained during 36 months following the exam. Mean annualized costs (2018 dollars) was $5707 among robust, $8964 among pre-frail and $20,027 among frail men. Compared with robust, pre-frailty and frailty were each associated with higher costs after accounting for demographics, multimorbidity, functional limitations and the frailty indicator (cost ratio 1.18 [1.02-1.36] among pre-frail and 1.87 [1.47-2.39] among frail). Findings suggest that assessment of the phenotype may improve identification of individuals at increased risk of costly care.
Older Adults’ Subjective Age as a Potential Psychological Resource in Clinical Management of Chronic Illnesses
Authors: Prasad Anyah , Roldan Nidya Velasco , Hendricksen Meghan , Shellito Natalie 
Published: December 2020

Abstract
Subject age is predictive of future morbidity and mortality and can be potentially viewed as a psychological resource. However, there seems to be a reciprocal relationship between subjective age and health. In a series of analyses, we demonstrated that various measures of health status such as number of chronic illnesses, self-rated health and sensory impairment have an adverse association with older adults’ subjective age. Specifically, chronic illnesses seem to have a period effect and age effect. Living with chronic illness over a period of time seems to attenuate its association with subjective age. Similarly, the association between chronic illnesses and subjective age gets weaker with increase in older adults’ chronological age. Therefore, asking those living with chronic health conditions and specifically younger older adults about their subjective age and providing appropriate resources, counseling and reassurance about chronic illness management may prevent the downstream negative health effects of increased subjective age.
Association of Psychological Resilience and Depressive Symptoms in Adults With Cardiac Disease
Authors: Ketcham Amy , Matus Austin , Riegel Barbara 
Published: December 2020

Abstract
Depressive symptoms predict hospitalization and mortality in adults with cardiac disease. Psychological resilience may protect against depressive symptoms, but benefits are not yet conclusive. We conducted a systematic review to examine the association between resilience and depressive symptoms in adults with cardiac disease. Seven databases were searched from inception to December 2019 using the search terms “cardiac disease,” “depressive symptoms,” “depression,” and “resilience.” The 623 articles identified were narrowed through title, abstract and full-text review leaving 13 studies for final analysis. Resilience and depressive symptoms were inversely related in 10 of 13 studies. The three studies with poor quality sampling techniques or significant loss to follow-up found null results. The major gap identified in the literature was poor understanding of the longitudinal pattern between resilience and depressive symptoms. If the direction of causality functions as expected in longitudinal research, optimizing resilience could help attenuate depressive symptoms.
Lifelong Engagement: The Role of Cognitive Reserve and Physical Health in Very Late Life
Authors: Martin Peter , Willcox Bradley , Willcox D Craig 
Published: December 2020

Abstract
At the end of a very long life, older adults often experience a significant decline in cognitive function. However, there are older adults who have maintained high levels of cognition and physical health. The purpose of this symposium is to illuminate interdisciplinary findings of cognitive engagement with late-life benefits of cognitive functioning and physical health. Components of cognitive reserve include sociodemographic variables (e.g., education, occupational complexity and responsibility), psychosocial variables (e.g., engaged life style and activity) and physical and genetic reserve (e.g., strength, APOE4). Based on three major research studies (the Japanese SONIC study; the Honolulu Asia Aging Study, HAAS; and the Georgia Centenarian Study, GCS), we highlight important aspects of building cognitive reserve and the implications for cognitive and physical health. The first presentation evaluates the importance of work complexity as a predictor of cognitive and physical health among participants of the SONIC study. Multiple group analyses yielded strong associations of occupational complexity with cognitive functioning for men. The second presentation reports logistic regression findings from the HAAS including education, strength and genetic markers, as well as mental health and their relatedness to cognitive abilities and physical health. The final presentation evaluates a structural equation model from the GCS, highlighting the interrelationship of cognitive reserve components (i.e., education, occupational responsibility, engaged lifestyle, social support, and activity) with cognitive and physical health in very late life. We will summarize and integrate the findings for their theoretical and practical implications and provide future directions.
Does Race or Ethnicity Modify the Impact of Age on Cognition in Middle- and Older-Aged Adults?
Authors: Turney Indira , Rentería Miguel Arce , Lao Patrick , Brickman Adam , Manly Jennifer 
Published: December 2020

Abstract
We compared verbal list learning, verbal memory, animal fluency, and letter fluency in 1407 education-matched participants from two community-based, intergenerational studies of cognitive aging and dementia. WHICAP participants are sampled from Medicare-eligible people aged 65+ and the Offspring cohort includes their middle-aged children. WHICAP participants (n=1218) were 72.1±6.5 years old and Offspring participants (n=189) were 53.7±8.4 years old at baseline. WHICAP participants had lower scores on most cognitive measures than Offspring participants; however, these differences were not uniform across race/ethnicity. Compared to non-Hispanic Whites, non-Hispanic Blacks in WHICAP had disproportionately lower scores on letter fluency compared to their offspring. On delayed verbal memory, non-Hispanic White and Hispanic offspring obtained higher scores than the parent generation – but among Blacks, memory scores were relatively low regardless of cohort. Racial disparities in cognition are apparent in both mid- and late-life and may be amplified in older age, particularly in Blacks.
Racial and Ethnic Disparities in Structural Measures of Brain Aging: A Systematic Review
Authors: Godina Sara , Turney Indira , Zahodne Laura , Moody Danielle Beatty , Deters Kacie , Manly Jennifer , Rosso Andrea 
Published: December 2020

Abstract
Examining the neural correlates underlying racial differences in cognitive functioning is necessary to help clarify mechanisms and to improve the generalizability of findings related to brain-behavior relationships. This systematic review aimed to determine whether there are racial differences in structural markers of brain aging among community-dwelling, neurologically healthy adults aged 18 and older. We identified studies (n=5,399) from searches in Ovid Medline, Ovid PsychINFO, and Elsevier EMBASE published until February 13, 2020. We included original articles that examined structural markers of brain aging and neuropathology across individuals from more than one race or ethnicity. These measures included magnetic resonance imaging, positron emission tomography amyloid and tau, cerebrospinal fluid amyloid, tau, and neurofilament light chain and computed tomography. Two reviewers independently screened full-text articles. We will present ongoing results and discuss the current state of knowledge, quality of existing studies, and gaps in the literature and highlight potentially key next steps.
Relationship of Indicators of Cardiovascular Health With Change in Cognition in Older Blacks
Authors: Lamar Melissa , Fleischman Debra , Leurgans Sue , Arfanakis Konstantinos , Barnes Lisa 
Published: December 2020

Abstract
Older Blacks perform more poorly on cognitive testing than older Whites. Increased prevalence of cardiovascular disease risk factors (CVD-RFs) among Blacks compared to Whites contribute to these disparities. We investigated whether white matter hyperintensities (WMHs) in late-life, a consequence of mid-life CVD-RFs, modify the association between late-life CVD-RFs and cognition in 167 Blacks (age~75yrs; non-demented at baseline). Participants were evaluated for blood pressure (BP) markers of cardiovascular health (systolic/diastolic BP, pulse pressure, mean arterial pressure (MAP) hypertension), WMH volumes adjusted for intracranial volume, and cognition (global and domain-specific at baseline and annually, ~8yrs). Adjusted models revealed differential associations between BP markers and baseline cognition; diastolic BP and MAP predicted faster decline in episodic memory. Hypertension was not significant in any model; however, when adding WMH, the hypertension*WMH interaction was significant for baseline cognition. Cognition among older Blacks is a complex function of BP markers of cardiovascular health and WMH.
The Relationship Between Personality and Perceived Mental Fatigability
Authors: Allen Hannah , Gmelin Theresa , Smagula Stephen , Boudreau Robert , Cauley Jane , Glynn Nancy 
Published: December 2020

Abstract
Several personality traits are known to be protective against global fatigue, however perceived mental fatigability (PMF, Pittsburgh Fatigability Scale 0-50) specifically measures an individual’s susceptibility to cognitive tiredness and is associated with mobility decline. We assessed whether optimism, conscientiousness, goal reengagement and goal disengagement contributed to greater PMF in 1,812 men (mean±SD age 84.4±4.2 years, 90.4% white) in the Osteoporotic Fractures in Men Study 4th visit (2014-2016). Covariates included demographic, psychological/behavioral factors, health conditions, physical activity and function. Prevalence of higher PMF (score ≥13) was 25% (n=448). In a covariate-adjusted regression model, each SD lower conscientiousness and lower optimism were associated with 0.93 and 0.61 SDs greater PMF, each p&lt;0.01. Goal disengagement and goal reengagement were not associated with PMF. These findings warrant further investigation into how personality traits may help clinicians design targeted and effective interventions to reduce fatigability, and consequently lower the risk of adverse aging-related health outcomes.
Changes in Self-reported Energy and Brain Volumes
Authors: Tian Qu , Rosso Andrea , Glynn Nancy , Zhu Xiaonan , Rosano Caterina 
Published: December 2020

Abstract
The brain demands and consumes more energy than any other organ. Lower perceived energy may indicate compromised brain health. Little empirical data exists on the association between perceived energy and brain structure. Neuroimaging was obtained in 300 participants (mean age=83±3 y/o, 40% blacks, 57%women) with repeated self-reported energy measures(scale0-10) in the past decade. Energy decline was computed as rate of change by linear mixed models(-0.06/year). Associations of energy decline with volumes of cognitive (dorsolateral prefrontal cortex, hippocampus) and motor (precentral gyrus, putamen, caudate) areas were examined using linear regression, adjusted for demographics and total gray matter atrophy. A steeper decline in energy was associated with smaller volumes of right putamen (p=0.013) and caudate (p=0.043), a trend in right precentral gyrus (p=0.085), but not in prefrontal cortex or hippocampus. Declining energy by self-report may indicate atrophy localized in subcortical motor areas. Studies to identify the mechanisms underlying these associations are warranted.
Uncovering the Influence of Psychosocial Factors on Pain-Related Brain Responses in Older Adults With Chronic Pain
Authors: Terry Ellen , Booker Staja , Roach Keesha , Cobb Sharon , Robinson-Lane Sheria 
Published: December 2020

Abstract
Psychosocial factors such as experiences of discrimination, pain catastrophizing and perceived stress are associated with poor osteoarthritis-related pain and disability outcomes across sex and ethnic/race groups. However, the mechanisms that mediate these psychosocial factors and knee osteoarthritis outcomes across race and sex are unclear. A cross-sectional correlational design identified the associations between everyday discrimination and clinical pain, disability and functional performance among 188 non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with knee osteoarthritis. In a serial mediated model, perceived stress and pain catastrophizing mediated the relationship between discrimination and osteoarthritis-related outcome variables in female participants. Using magnetic resonance imaging, findings suggest that experiences of discrimination differentially affect structural brain regions based on both race/ethnicity and sex in older adults with knee osteoarthritis. Given this, we are also currently investigating the extent to which pain catastrophizing on pain-related brain structure differs across race/ethnic groups in older adults with knee osteoarthritis.