bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining the Personal Determinants of Health for Older Adults
Authors: MacLeod Stephanie , Kraemer Sandra , Fellows Annette , Albright Laurie , Ruiz Joann , McGinn Michael , Schaeffer James , Yeh Charlotte 
Published: December 2020

Abstract
Social Determinants of Health (SDOH) are defined as the broad community-scale conditions and factors shaping daily life. Meanwhile, less is known about the personal, individual-level characteristics impacting health outcomes. These have not been defined as a construct, leaving a gap in overall understanding of the resources that shape healthy and successful aging. Our primary purpose is to propose and define a new construct encompassing critical personal resources to be known as the Personal Determinants of Health (PDOH), built on resilience as a key strength later in life and supported by factors that buffer challenges and declining health. A literature search was conducted to streamline the scope of this review, with key terms determined to identify relevant publications; common databases and resources were utilized. Search strategies failed to identify a standard definition for Personal Determinants of Health as a construct, nor does this term exist regarding applied initiatives with older adults. Thus, a clear opportunity exists to establish PDOH as a unique construct. Despite evidence that individual characteristics impact late-life health outcomes, these key personal resources have not been established as a separate construct. Thus, we propose to define PDOH with a foundation of resilience supported by selected personal resources. Establishing this new construct will be critical in designing initiatives to support older adults and improve their health outcomes.
COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants
Authors: Woolford Stephen , D’Angelo Stefania , Curtis Elizabeth , Parsons Camille , Dennison Elaine , Patel Harnish , Cooper Cyrus , Harvey Nicholas 
Published: December 2020

Abstract
Frailty and multimorbidity, which are more prevalent in older people, have been suggested as risk factors for severe COVID-19 disease. We investigated whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19 in the UK Biobank. 502,640 participants aged 40-69 years at baseline (54-79 years at COVID-19 testing) were recruited across UK 2006-10. A modified assessment of frailty using Fried’s classification was generated from baseline data. COVID-19 test results (England) were available 16/03/2020-01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. 4,510 participants were tested for COVID-19 (positive=1,326, negative=3,184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR=1.4 [95%CI=1.1, 1.8]), report slow walking speed (OR=1.3 [1.1, 1.6]), report two or more falls in the past year (OR=1.3 [1.0, 1.5]) and be multimorbid (≥4 comorbidity groupings vs 0-1: OR=1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. Furthermore, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. In conclusion, frailty and multimorbidity do not appear to aid risk stratification, in terms of a positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.
Dementia Care under COVID-19 and Infectious Disease Pandemic Restrictions
Authors: Bradbury Kelly , Moody Elaine , Aubrecht Katie , Sim Meaghan , Rothfus Melissa 
Published: December 2020

Abstract
Emergency measures including social distancing and program restrictions during COVID-19 has reduced supports for people living with dementia and family/friend caregivers in the community. Consequently, these reductions in dementia services and resources have added to existing challenges and (in)equities for this stigmatized population. The objectives of this study were to identify how community-based resources and services for people with dementia and their caregivers are impacted by public health emergency measures enacted during COVID-19 and other infectious pandemics and secondly, use an intersectional health equity perspective to explore how supports for people and families living with dementia are affected by social determinants of health. A scoping review using JBI methodology was conducted. Academic databases searched included Embase, Medline, CINAHL and PAIS. Grey literature was searched using the CADTH tool. English articles published after 2000 in high-income countries were included. Data was extracted by two reviewers using an adaptation of the Health Equity Impact Assessment tool to explore factors related to health equity. Findings included articles discussing the COVID-19 pandemic (N=15). Most alterations to dementia services included switching to telehealth platforms with some advantages/disadvantages of this method discussed. Limited information on how different populations experienced service changes was identified and more research is needed to address issues of (in)equities for people living with dementia and their caregivers during public health emergencies. Information on how health emergency responses affects dementia services and their users will provide important information on resources for current and future efforts to analyze and assess their impacts.
Exploring the Impact of Age-Related COVID-19 Messaging on Internalized Ageism in Older Adulthood
Authors: Sangrar Ruheena , Chesser Stephanie , Porter Michelle 
Published: December 2020

Abstract
Public health messages during the COVID-19 pandemic have indicated a higher risk for older people and/or those who have multiple health conditions. Subsequent societal discourse, however, has at times arguably protested the full protection and treatment of older people from COVID-19, potentially contributing to internalized ageism. To date, how older people interpret age-related pandemic messaging and discourse has not been explored. This study examined older adults’ perspectives of age-related COVID-19 messaging and societal discourse, as well as their perceptions of vulnerability, using a social constructionism framework. Adults age 65 to 89 years participated in semi-structured interviews about their thoughts and experiences with ongoing pandemic-related public messaging. Preliminary analysis suggests that participant perspectives of COVID-19 messaging are situated along a continuum of concern associated with contracting the virus. While some, for example, describe minimal concern, others express being fearful. Individual perceptions of safety appear to be informed, in part, by the presence or absence of an underlying health condition. Individual approaches to media criticism and consumption, personal risk-taking thresholds, financial stability, and social connectedness also appear to influence how the participants perceive pandemic-related messaging. Findings suggest the framing of COVID-19 and pandemic protocols, as well as the media’s sensationalization of age-related issues, can impact older peoples’ perceived vulnerability of contracting the virus. Future research is needed to understand the long-term implications of ongoing pandemic-related messaging on older adults’ experiences of aging, as well as the consequences such messaging could pose to for their health and social behaviors.
Facility Characteristics and Quality Deficiencies of Florida Nursing Homes With COVID-19 Cases and Deaths
Authors: Wang Xiaochuan , Wilson Courtney 
Published: December 2020

Abstract
The Coronavirus disease 2019 (COVID-19) has been disproportionately affecting nursing homes throughout the United States, resulting elevated risk for COVID-19 morbidity and mortality to nursing home residents. Given the high percentage of aging population, large number of nursing homes, and staggering surge of COVID-19 cases in Florida, it’s critical to understand factors that may affect Florida nursing homes’ vulnerability to the COVID-19 pandemic. Using Nursing Home COVID-19 Dataset as of July 26, 2020 obtained through Centers for Medicare and Medicaid Services (CMS), and Provider Info Dataset and Health Deficiencies Dataset available through CMS Nursing Home Compare data, we constructed a database of Florida nursing facilities with confirmed COVID-19 cases and deaths, with corresponding facility characteristics and quality deficiencies. We examined the facility characteristics (e.g. facility size, ownership state, chain affiliation, staffing level) and quality deficiencies (e.g. infection control deficiencies) of Florida nursing homes with and without publicly reported COVID-19 cases and deaths. Results indicated that, as of July 26, 2020, 73.3% and 40.8% of Florida nursing homes had resident COVID-19 cases and death, respectively (N=701). Findings also suggested that Florida nursing homes of large facility size, chain affiliated, and for profit, were significantly more likely to have documented resident COVID-19 cases (p&lt;.05). Larger facility size (120 beds or more), staff shortage, and having prior infection control deficiency citation, were significantly related to the odds of having resident COVID-19 deaths (p&lt;.05). Policy and practice implications and future research directions will be addressed to better protect the at-risk nursing home residents.
Factors Associated With Loneliness During the COVID-19 Pandemic Among Older Adults With Chronic Conditions
Authors: Polenick Courtney , Perbix Emily , Salwi Shreya , Maust Donovan , Birditt Kira , Brooks Jessica 
Published: December 2020

Abstract
Social distancing related to the COVID-19 pandemic may heighten loneliness among older adults, especially those with chronic conditions that increase risk for severe illness from the coronavirus. Little is known, however, about potential risk and protective factors linked to loneliness during the pandemic. In the present study, we examined factors associated with loneliness in a U.S. sample of adults aged 50 and older with at least one chronic condition. Participants included 701 adults aged 50 to 94 (M = 64.57 years, SD = 8.84) who were recruited over 8 consecutive weeks between May 14 and July 9, 2020 to complete an anonymous online survey. We estimated a series of multiple linear regressions to determine how sociodemographic characteristics, health characteristics, stress related to COVID-19, and social resources were independently associated with loneliness during the pandemic. Two-thirds of participants reported moderate to severe loneliness. The fully adjusted regression model showed that being a person of color, having a spouse or cohabiting partner, and reporting more emotional support were linked to lower levels of loneliness. Higher anxiety symptoms, more worry about being infected with COVID-19, and greater perceived financial strain because of COVID-19 were associated with higher levels of loneliness. These findings pinpoint potential targets for interventions to improve and maintain the well-being of a particularly vulnerable subgroup of older adults during the COVID-19 pandemic and in future public health crises.
Unsung Heroes: Caregiver Experiences During COVID 19
Authors: Mata Aaron , Mickens Melody , Dassel Kara , Utz Rebecca 
Published: December 2020

Abstract
Objectives: COVID-19 has spared no age group but is proving to be most dangerous to the elderly and individuals with more vulnerable immune systems. COVID-19 represents a unique challenge to caregivers above and beyond the ordinary stresses they experience and many informal caregivers currently providing care have not planned for the pandemic and its effect on access to health care services, respite resources, and support groups, etc. The purpose of our study is to assess COVID-19’s impact on the mental health and wellness of informal caregivers. Method: An interdisciplinary collaborative of caregiving scholars created a 47-item web-based anonymous survey with quantitative and qualitative questions to assess caregiving experiences during COVID-19. Participants were recruited through convenience sampling using social media and flyers distributed by local/national organizations. Results: Participants (N=96) reported an average age of 50 years old and were predominately adult children caring for parents (45%) with neurological (40%) and chronic medical conditions (25%). Only 4% cared for individuals diagnosed with COVID 19. Nearly all reported significant changes in caregiving that included increased time spent caregiving for care recipients and other family members, greater stress and worry, fewer breaks for self-care, increased isolation, and decreased access to social/emotional supports and respite services. Discussion: Unplanned changes to caregiving during COVID 19 have created an acute need for research, clinical care guidelines, and policy promoting virtual respite care, social support for caregivers, and more readily available community based resources that promote caregivers’ physical and emotional wellbeing without requiring them to leave their homes.
Virtual connection between older people with dementia and families during COVID-19 pandemic
Authors: Hung Lillian 
Published: December 2020

Abstract
People staying in hospitals need more support to cope with the lockdown and visitor restriction during the COVID-19 pandemic, especially for older people with cognitive or physical impairment. Everyday technology such as a touchscreen tablet has great potential to support person-centred care. We aimed to support the adoption of tablets for hospitalized people with dementia to connect with families and friends. A patient-oriented research approach was employed to co-produce the toolkit. We are a transdisciplinary team, including a medical student, physicians, nurses, patients, and family partners. We facilitated staff focus groups (n=3), and conducted stakeholders’ interviews (n=4) to gain a more comprehensive understanding of users’ needs. The sample included ten patients, ten family members, 40 staff members, nurses, care workers, physicians, and unit clerks (n=40). The Consolidated Framework for Implementation Research (CFIR) guided the research design and qualitative analysis. A toolkit was developed based on participants’ perspectives on what needs to be in place to support successful adoption. We developed a mobile tablet with one mechanical arm and one leg on wheels. Participants reported impacts: (a) it puts a smile on the patient’s face, (b) it alleviates anxiety and worries on both sides, and (c) it reduces responsive behaviors. The conceptual framework CFIR provides helpful guidance in identifying barriers to implementation. Working with users including patient and family partners to explore possible solutions was key to our success. Future research should engage patient and family partners to seek proactive strategies to address obstacles to advance the science of technology implementation.
Determining the Role of ApoE4 in Age-Related Cerebrovascular Decline
Authors: Foley Kate , Borchian Peter , Garceau Dylan , Kotredes Kevin , Territo Paul , Sasner Michael , Howell Gareth , Diemler Cory 
Published: December 2020

Abstract
Cerebrovascular decline occurs during aging and may be critical during prodromal phases of Alzheimer’s disease (AD). The E4 allele of apolipoprotein E (APOE4) is the greatest genetic risk factor for AD and decreased longevity and studies suggest APOE4 increases risk for age-dependent cerebrovascular damage. To study the relationship between APOE4 and age-related cerebrovascular decline, male and female C57BL/6J (B6) mice carrying combinations of APOE alleles including APOE4 (risk) and APOE3 (neutral), as well as B6 controls were assessed at a variety of ages from 4 to 24 mos for cognitive ability, biometrics and cerebrovascular health including i) PET/MRI using 64Cu-PTSM (perfusion) and 18F-FDG (metabolism), ii) transcriptional profiling and iii) immunofluorescence. Despite no cognitive decline, male APOE4 mice showed hypo-perfusion and hypo-metabolism by 12 mos, while female APOE4 mice showed an uncoupled hyper-perfusion and hypo-metabolism phenotype. Transcriptional profiling showed differential expression of genes involved in regulation of cerebral perfusion, glucose transportation and metabolism in APOE4 mice. An age-dependent blood brain barrier compromise was also apparent in the brains of female APOE4 mice. Physical activity reduces risk for human AD and our data shows exercise improves cerebrovascular health in mice. However, the effects to cerebrovascular health in individuals carrying genetic risk factors such as APOE4 are not known. To determine whether exercise can overcome APOE4-dependent cerebrovascular damage, APOE mice are being exercised from 2-4 and to 2-12 mos. Transcriptional profiling and immunofluorescence will determine whether the benefits of exercise to the cerebrovasculature are modulated by genetic risk factors such as APOE4.
Effects of CNS Demyelination and Myelin Recovery on Urinary Physiology
Authors: Ramasamy Ramalakshmi , Rosenberg Dawn , Hardy Cara , Crocker Stephen , Smith Phillip 
Published: December 2020

Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). Of note, over 80% of MS patients have urinary symptoms as one of their earliest symptoms. Since MS patients often live into older age, urinary incontinence and retention are significant problems for which few if any effective preventive or therapeutic options are available. The mechanisms by which MS contributes to urinary dysfunction are not well understood. We propose to elucidate the impact of demyelination on urinary performance using the cuprizone model, a model used to study the effects of CNS demyelination and spontaneous remyelination. We hypothesize that CNS demyelination in the cuprizone model will result in aberrant changes in urinary function, and that after remyelination occurs this dysfunction will be alleviated. C57Bl/6 mice were treated with cuprizone (0.2% w/w) for four weeks to induce demyelination. One group was allowed four additional weeks to recover from demyelination, while the other continued cuprizone treatment. Following this eight-week treatment, pressure/flow cystometry, electromyography, and molecular studies were performed to assess demyelination-induced differences in urinary performance. Cuprizone-recovery mice displayed improvements in cystometric function compared to their demyelinated littermates, as seen through improved volume sensitivity and voiding efficiency. Pharmacologic studies showed no significant changes in contractile responsiveness. Thus, we conclude that CNS demyelination results in aging-like phenotype and urinary dysfunction consistent with that observed in clinical disease. Therapeutics aimed at increasing the remyelination potential of the CNS neurons offer the possibility of alleviating urinary dysfunction associated with MS.
NMN Rescues Endothelial Function and Neurovascular Coupling, Improving Cognitive Function in Aged Mice
Authors: Tarantini Stefano , Yabluchanskiy Andriy , Ballabh Praveen , Farkas Eszter , Baur Joseph , Sinclair David , Csiszar Anna , Ungvari Zoltan 
Published: December 2020

Abstract
Adjustment of cerebral blood flow (CBF) to neuronal activity via neurovascular coupling (NVC) has an essential role in maintenance of healthy cognitive function. In aging increased oxidative stress and cerebromicrovascular endothelial dysfunction impair NVC, contributing to cognitive decline. There is increasing evidence showing that a decrease in NAD+ availability with age plays a critical role in a range of age-related cellular impairments but its role in impaired NVC responses remains unexplored. The present study was designed to test the hypothesis that restoring NAD+ concentration may exert beneficial effects on NVC responses in aging. To test this hypothesis 24-month-old C57BL/6 mice were treated with nicotinamide mononucleotide (NMN), a key NAD+ intermediate, for 2 weeks. NVC was assessed by measuring CBF responses (laser Doppler flowmetry) evoked by contralateral whisker stimulation. We found that NVC responses were significantly impaired in aged mice. NMN supplementation rescued NVC responses by increasing endothelial NO-mediated vasodilation, which was associated with significantly improved spatial working memory and gait coordination. These findings are paralleled by the sirtuin-dependent protective effects of NMN on mitochondrial production of reactive oxygen species and mitochondrial bioenergetics in cultured cerebromicrovascular endothelial cells derived from aged animals. Thus, a decrease in NAD+ availability contributes to age-related cerebromicrovascular dysfunction, exacerbating cognitive decline. The cerebromicrovascular protective effects of NMN highlight the preventive and therapeutic potential of NAD+ intermediates as effective interventions in patients at risk for vascular cognitive impairment (VCI).
Home Health Care Practices to Reduce Acute-Care Hospitalizations
Authors: Albright Bonnie , Pelenur Yael 
Published: December 2020

Abstract
Avoidable acute-care admissions are linked to negative health outcomes for patients and are costly to insurers. Home health care agencies (HHAs) are important players in preventing these admissions. Research on best practices to prevent acute-care admissions in the home health care context is limited. The purposes of this study were both to discover what practices HHAs are implementing in Medicare-certified home health care episodes to prevent acute-care admissions, and to learn what barriers HHAs face in implementing these practices. This study used mixed methods including qualitative and quantitative elements. Seven key informant interviews were used to develop a web survey that was emailed to all Medicare-certified HHAs in Massachusetts (response rate 12.43%, n=23). Using qualitative methods including thematic review, open-coding, and member-checking this study developed a four-categorization method. The categories are assessment, interventions, communication, and global practices. The study also developed a taxonomy for describing barriers to implementing practices. The distribution of responses for the new taxonomic categories were: patient-related (32.35%), staffing-related (29.41%), software-related (17.65%), physician/hospital-related (14.29%), and reimbursement/regulation-related (5.88%). This study fills a gap in research by describing the realities of home health care practice in the context of avoidable acute-care admissions. The categorization of best practices and the taxonomy of barriers developed in this study provide frameworks for understanding HHA practice. Further research is needed to effectively reduce avoidable acute-care admissions during and after Medicare-certified home health care episodes.