bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Serum Albumin in Patients With Coexisting Cognitive Impairment Predicts Surgical Complications
Authors: Tirambulo Coco Victoria , McFadden Caitlyn , Lieberman David , Fain Mindy 
Published: December 2020

Abstract
Cognitive impairment (CI, ~15-20%) and malnutrition (~38.7%) are common concerns among older adults ≥65 years. CI and malnutrition may be used as predictive risk factors for poor surgical outcomes. The 2012 ACS NSQIP/AGS Best Practice Guidelines for the preoperative assessment of geriatric surgical patients classify severe nutritional risk as either having a BMI &lt; 18.5 kg/m2, serum albumin (SA) &lt; 3.0 g/dL and/or unintentional weight loss &gt; 10%-15% within 6 months. Using SA as a surrogate marker for malnutrition, we evaluated the relationship between CI, malnutrition, and risk for poor surgical outcomes in a geriatric population. Electronic medical record chart reviews of patients (≥65 years old) undergoing elective intermediate or high-risk surgery (IHRS), between 2016 and 2019 in Tucson, AZ, were conducted. Pre-and-post assessment factors such as cognitive status via mini-cog, laboratory markers (SA), and hospital complications were examined. Multivariate regression analyses were performed to determine the association between cognitive status, SA levels, and hospital complications. Of the 173 patients undergoing IHRS included in this assessment (mean age: 75.5±7.4 years, [60-93 years], 54.9% male), 42.8% experienced hospital complications. Multivariate regression analysis revealed cognitive impairment and low SA levels were significantly associated with this outcome (p&lt;0.05), adjusted for age and gender. We demonstrated MCI and low SA levels are risk factors of postoperative hospital complications among older patients undergoing elective IHRS. Increased understanding of predictive factors can help enhance prevention efforts, aiding in improving patient experiences and reducing patient and hospital costs.
The Relationship Between Race and Ethnicity in Post-Surgical Discharge Disposition
Authors: McFadden Caitlyn , Tirambulo Coco Victoria , Lieberman David , Fain Mindy 
Published: December 2020

Abstract
Racial and ethnic disparities have been reported regarding outcomes of intermediate or high-risk surgical (IHRS) procedures. This study aimed to assess whether or not these disparities exist with respect to post-procedural discharge disposition (DD). EMR chart reviews of patients (≥65 years old) undergoing IHRS were conducted, 2016-2019 in Tucson, AZ. Race and ethnicity were reported as American Indian/Alaskan Native; Black or African American; More-Than-One-Race; Native Hawaiian/Pacific Islander; White/Caucasian; Unknown/Not Reported, Hispanic/Latino; Non-Hispanic/Latino; or Unknown/Not Reported. DD was reported as to home, home with home health, rehabilitation center, skilled nursing facility (SNF), death, or other. Kruskal-Wallis tests were performed to determine the association with DD. Of the 161 patients (mean age: 74.7±6.9, [60-91], 53.4% male) assessed, 15.4% were discharged to a facility other than home or home with home health. Ethnicity was significantly associated with discharge disposition (p&lt;0.005). Non-Hispanic/Latinos (66.1%) were more likely to be discharged home compared Hispanic/Latinos (14.8%), while those Unknown/Not Reported were more likely to be discharged to a SNF. Although race was not significantly associated with DD (p&lt;0.062) due to sample size, it is clinically important to consider as 59.9% of White/Caucasians were more likely to be discharged home compared to 1.6% of American Indian/Alaskan Natives; 1.6% Black or African Americans; 5.7 of More-Than-One-Races; and 12.0% Unknown/Not Reported. We demonstrated ethnic disparities affect postoperative DD. Although racial disparities were not significantly associated with DD, anticipating the impact of race and ethnicity to facilitate discharge planning that meets the goals of the older patient is crucial to care.
Cognitive Reserve, Incident Cancer, and Rate of Memory Decline in Later Life
Authors: Romero Monica Ospina , Brenowitz Willa , Hayes-Larson Eleanor , Ackley Sarah F , Mayeda Elizabeth R , Glymour M Maria , Kobayashi Lindsay 
Published: December 2020

Abstract
Cognitive reserve (cognitive skills and abilities acquired before onset of brain pathology) helps maintain cognitive function during aging. Cognitive decline after cancer treatment, known as “chemobrain,” is a prevalent outcome among older cancer survivors. It is unknown whether cognitive reserve buffers against acute neuropathological events such as cancer-related cognitive decline. We examined acute and long-term rate of memory decline associated with incident cancer diagnosis by education levels as proxy for cognitive reserve (low: &lt;12 years; intermediate: 12 to &lt;16 years; high: ≥16 years) in 14,449 adults aged 50+ in the US Health and Retirement Study from 1998-2016. Memory (z-scored) was assessed biennially as immediate and delayed word recall combined with proxy assessments. We used adjusted linear mixed models to determine long-term rates of memory decline before and after cancer diagnosis, and acute memory decline immediately after diagnosis (3,248 incident cases), and compared them with corresponding memory trajectories in cancer-free participants. Acute memory decline immediately after diagnosis was larger in those with low (-0.098 SD units, 95% CI: -0.150, -0.045) versus high (-0.038 SD units, 95% CI: -0.084, -0.008) education. Long-term memory decline after cancer was faster in those with low (-1.16 SD units/decade, 95% CI: -1.25, -1.07) versus high (-0.89 SD units/decade, 95% CI: -0.96, -0.82) education. Consistent with previous research showing an inverse cancer-dementia relationship, individuals with cancer had more favorable memory trajectories than cancer-free individuals with similar age and education. Among those with cancer, lower cognitive reserve was associated with greater acute and long-term memory decline after diagnosis.
A Community Resource Referral Intervention for Informal Caregivers of People With Dementia
Authors: Boyd Kelly , Doyle Kate , Borson Soo , Huang Elbert , Lindau Stacy , Nathan Aviva , Thompson Katherine , Makelarski Jennifer 
Published: December 2020

Abstract
The National Alzheimer’s Project Act (PL-111-375) calls for connecting dementia caregivers to community resources, but few caregiver interventions have focused on this component of support. CRx-D is a theory-driven, scalable intervention that addresses common caregiver needs through: (1) education to normalize needs, (2) coaching on resource activation and (3) tools to promote access, including a printed list of nearby resources (“HealtheRx-D”), an online resource finder, proactive and ongoing text message support. We pretested the intervention arm of CRx-D among 10 caregivers of PWD to assess appropriateness, feasibility and fidelity. Patients presenting for care at 3 outpatient clinics were screened for eligibility, enrolled and given the intervention (12/19-01/20). Of 1,038 patients approached, 12 were caregivers of PWD; 10/12 met all eligibility criteria. All 10 eligible caregivers were enrolled in the study. Caregivers were, on average, 49 years old (range, 29-65), primarily female (n=8), Black/African American (n=9), and half were children of PWD (n=5). At baseline, several caregivers indicated unmet caregiving or health needs (caregiving education [n=7], free/affordable meals [n=5] and financial assistance [n=5]) indicating the intervention’s appropriateness. Intervention components were delivered as intended to all caregivers, although one caregiver provided a landline so could not receive texts. A scalable resource referral intervention for caregivers is appropriate. Delivery is feasible with high fidelity. Identifying caregivers at the point of their own healthcare requires high volume screening. These findings will inform a randomized controlled trial of 344 caregivers of PWD to evaluate the impact of CRx-D on caregiver self-efficacy and satisfaction with care.
I Don’t Want to See It End: A Faith Community Nurse Intervention for Older Adults and Caregivers
Authors: Sessanna Loralee , Pomeroy Sherry , Askew Yvonne 
Published: December 2020

Abstract
The Faith Community Nurse (FCN) provides population-based and other nonclinical services in community settings that are not commonly available to the older adult population. The purpose of the FCN Connections (FCNC) study was to test the impact of the FCNC intervention on the health and well-being of clients (C) age 60 and older with chronic diseases and caregiver (CG) dyads (CCGD) by embedding a FCN in a primary care practice (PCP). A mixed method design was used with two cohorts over 18 months (N = 13 CCGD). Experienced FCNs led the components of the intervention in the CCGD home, including client health assessment, education and support while identifying their caregiver’s perceived needs, providing education and spiritual/emotional support, linking to resources, and connecting the CCGD with the PCP. The CCGD completed measurements at baseline, 6 and 12 weeks. CG knowledge, preparedness, self-efficacy with caregiving activities, and spirituality were measured with statistically significant CG improvement for handling emergencies, making caregiving activities pleasant, and taking care of emotional needs of the client. Spirituality, self-esteem, function, depression, and healthy living domains were measured for clients. At 12 weeks, semi-structured interviews with the CCGD were conducted and transcribed. An experiential/phenomenological framework and Reflexive Thematic Analysis were used to analyze data which generated one overarching theme, ‘I don’t want to see it [study] end’ and key themes, Theme 1 [client]: ‘She was always there to help’ and Theme 2 [caregiver]: ‘It’s like you took the pressure off me for a while’ describing the CCGD’s FCNC experience.
Use of Homecare Nursing and Sense of Security Among Family Caregivers of Older Adults
Authors: Igarashi Ayumi , Katayama Madoka , Sakka Mariko , Noguchi-Watanabe Maiko , Fukui Chie , Inagaki Asa , Kitamura Satomi , Yamamoto-Mitani Noriko 
Published: December 2020

Abstract
Having a sense of security for living at home is essential to continue living at home and it is important to develop a community care system that enables high sense of security. Because frail to dependent older adults often accompany various conditions that require medical attention, receiving homecare nursing might allow the family caregiver to feel safe in living at home. Therefore we examined whether receiving homecare nursing service contributes to a higher family caregiver sense of security. We conducted a questionnaire survey regarding older adults who were 75 years and older with at least some sort of community care services, and their family caregivers (n=776). Family sense of security was measured using 5 items (e.g., “I feel secure about my relative living at home with help of available services”), rated on 5-point Likert scales. Characteristics of older adults were obtained from their nurses or care managers. The mean age of the older adults was 85.8 years, 58% female, and 8 % living alone. The mean total family sense of security was 20.6 (standard deviation = 3.7) out of 25. In multiple regression analysis, the family sense of security was positively associated with the use of homecare nursing (β= 0.09, p=0.020), adjusting for participants’ age, stability of their medical conditions, level of activities of daily living, use of medical procedures, living arrangements, and house call physician services. Homecare provided by nurses could contribute to longer staying at home among older adults by way of the higher family sense of security.
Impact of Cognitive Functioning and Age on Patient-Reported Outcomes in Parkinson’s Disease
Authors: Gruber-Baldini Ann , Kim Haesung , Unick Jay , Shulman Lisa 
Published: December 2020

Abstract
Cognitive impairment is prevalent in Parkinson Disease (PD) and increasing age is a PD risk factor. Age and cognition may impact patient-reported outcome measures (PROMs) level, reliability, or validity of responses. This study investigated the relative impact of cognitive function and age on PROMs in PD. Cross-sectional data (n=676) included assessments of age, cognition (Montreal Cognitive Assessment; MoCA) and PROMIS-29 Profile (physical functioning, anxiety, depression, fatigue, sleep disturbance, social functioning, pain). Analyses examined differences by age and MoCA in: 1)Level—correlations, multivariable regressions controlling for disease severity (UPDRSmotor, PD duration), comorbidity (CIRS-G), demographics; 2)Reliability--Cronbach’s alpha, and 3)Validity--correlations of PROMIS physical function with physician assessments. Sample was age M=68.0(SD=9.1); range=36-93 years, 64% male, 87% white, 37% college educated, PD duration M=8.2(SD=6.1) years, and MoCA M=24.3(SD=4.9; range 2-30). Greater cognitive impairment was consistently associated with greater physical/mental impairment (r=.14-.45; p&lt;.05), except for sleep disturbance (r=-.07, p=.08) Multivariable regressions found cognition remained a significant predictor of physical functioning, anxiety, and depression older age predicted anxiety and social functioning. Comorbidity was the greatest predictor across all the PROMs (r=.22-.45). Reliability for PROMIS measures was excellent (alpha&gt;.8) across cognitive and age groups, except for Fatigue at MoCA.36) across cognition and age groups. Cognitive impairment in PD is associated with lower physical function and mental health levels. Reliability and validity of most PROMs in PD are neither impacted by cognition nor age.
Incident Cognitive Impairment During Aging in Rural South Africa: Evidence From the HAALSI Cohort, 2014 to 2019
Authors: Kobayashi Lindsay , Farrell Meagan , Langa Kenneth , Mahlahela Nomsa , Wagner Ryan , Berkman Lisa 
Published: December 2020

Abstract
We estimated the incidence of cognitive impairment and its key sociodemographic, social, and health-related predictors at the first longitudinal follow-up of the population-representative “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) cohort of adults aged ≥40 in rural Agincourt, South Africa. Cognitive impairment was defined as scoring ≥1.5 SD below the baseline mean composite time orientation and episodic memory score, or requiring a proxy interview with “fair” or “poor” proxy-reported memory. Activity of daily living (ADL) limitations were compared according to incident cognitive impairment status. Incidence rates (IRs) and rate ratios (IRRs) for cognitive impairment according to sociodemographic, social, and health-related predictors were estimated using Poisson regression with robust standard errors, and weighted to account for mortality. Over a 3.7-year mean follow-up, 309/3,861 at-risk participants newly developed cognitive impairment (IR=24.0/1000 person-years (PY); 95% CI: 21.6-26.8). Incidence increased from IR=9.1/1000 PY (95% CI: 5.5-16.1) among those aged 40-44 at baseline to IR=76.5/1000 PY (95% CI: 63.2-93.4) among those aged 80+. At least one ADL limitation was prevalent in 39% of those with incident cognitive impairment, compared to 7% of non-impaired participants. Incident cognitive impairment did not vary by sex/gender, HIV status, or cardiovascular factors, but was strongly graded according to education, literacy, household assets, employment, marital status, and frequency of alcohol consumption. This study presents one of the first incidence rate estimates for cognitive impairment in sub-Saharan Africa. Social disparities in cognitive impairment were apparent in patterns similar to many high-income countries.
Association of Loneliness and Social Isolation With Healthspan and Lifespan in the U.S. Health and Retirement Study
Authors: Crowe Christopher , Kwon Dayoon , Belsky Daniel 
Published: December 2020

Abstract
Loneliness and social isolation present emerging public health challenges for aging populations. To inform efforts against loneliness and social isolation, research is needed to evaluate impacts of these conditions on patterns of adverse aging outcomes. We used longitudinal, repeated measures data to isolate effects of loneliness and social isolation from effects of socioeconomic circumstances and psychological vulnerabilities, rule out reverse-causation, and test dose-response in associations with morbidity, disability, and mortality. We also explored the biological basis of relationships by testing associations with biological aging. We analyzed data from more than 12,000 adults aged 50-95 in the US Health and Retirement Study (HRS) who reported on symptoms of loneliness and social isolation at 2-3 time points during 2006-2014. We measured loneliness using the 3-item Revised UCLA Loneliness Scale and social isolation using a 6-item scale. We tested associations with chronic disease, disability, and biological aging in 2016 and with mortality through 2018. We found (1) associations of loneliness and social isolation with adverse aging outcomes are not fully explained by socioeconomic circumstances and psychological vulnerabilities; (2) the direction of relationships with disability indicates temporal precedence of loneliness and social isolation; (3) there is a dose-response in associations with loneliness; and (4) there is evidence of a biological mechanism explaining associations with loneliness and social isolation. Findings add to the emerging literature on health sequelae of loneliness and social isolation. Assessment of loneliness and social isolation in surveillance and intervention with older adults can enhance risk assessment for adverse aging outcomes.
Depressive Symptoms Among Older, Sexual Minority Adults and the Influence of Marital Status
Authors: Mezuk Briana , Bergmans Rachel , Schoebel Victoria 
Published: December 2020

Abstract
Adverse health outcomes, including poor mental health and depression, tend to be more common among those who are lesbian, gay, or bisexual (LGB). Minority stress theory posits that chronic minoritization contributes to disparities in depression. Factors like social support and income can improve mental health outcomes, and these resilience-promoting factors can be gained through marriage. However, whether marriage improves mental health outcomes in old age regardless of sexual orientation is not well established. This study aims to determine if depressive symptoms differ by sexual orientation in old age, and to test whether the association between depression and sexual orientation was moderated by marital status. The 2016 Health and Retirement Study, a nationally representative sample of U.S. adults older than 50 years (n=4,253), was the first wave to include respondent sexual orientation. Depressive symptoms were measured on the 8-item Center for Epidemiologic Studies Depression Scale (CES-D). Those with a score greater than or equal to 3 were considered to have elevated depressive symptoms. When testing main effects in the adjusted model, depression was not more common among LGB persons than heterosexual persons (OR=0.95; 95% CI=0.46-2.00). Yet, marital status significantly moderated the relationship between sexual orientation and depression (p=0.034). Among heterosexual adults, being married was protective against depression (OR=0.48; 95% CI=0.32-0.71) when compared to being never married, whereas marriage was not protective among LGB adults (OR=0.95; 95% CI=0.26-3.45). Findings indicate that LGB adults do not experience the same mental health benefits of marriage as heterosexual individuals.
Geographic Regional Variation in Patterns of Racial and Ethnic Disparities in Late-Life Depression
Authors: Vyas Chirag , Reynolds Charles , Mischoulon David , Chang Grace , Okereke Olivia 
Published: December 2020

Abstract
There is evidence of racial/ethnic disparities in late-life depression (LLD) burden and treatment in the US. Geographic region may be a novel social determinant; yet, limited data exist regarding the interplay of geographic region with racial/ethnic differences in LLD severity, item-level symptom burden and treatment. We conducted a cross-sectional study among 25,503 men aged 50+ years and women aged 55+ years in VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary study to the VITAL trial. Racial/ethnic groups included Non-Hispanic White, Black, Hispanic, Asian, and other groups (Native American/Alaskan Native and other/multiple/unspecified-race/ethnicity). We assessed depression status using: the Patient Health Questionnaire-8 (PHQ-8); self-reported clinician/physician diagnosis of depression; medication and/or counseling treatment for depression. In the full sample, Midwest region was significantly associated with 12% lower severity of LLD, compared to Northeast region (rate ratio (RR) (95% confidence interval (CI)): 0.88 (0.83-0.93)). However, racial/ethnic differences in LLD varied by region. For example, in the Midwest, Blacks and Hispanics had significantly higher depression severity compared to non-Hispanic Whites (RR (95% CI): for Black, 1.16 (1.02-1.31); for Hispanic, 2.03 (1.38-3.00)). Furthermore, in multivariable-adjusted logistic regression models, minority vs. non-Hispanic White adults had 2- to 3-fold significantly higher odds of several item-level symptoms across all regions, especially in the Midwest and Southwest. Finally, among those endorsing PHQ-8≥10, Blacks had 60-80% significantly lower odds of depression treatment, compared to non-Hispanic Whites, in all regions. In summary, we observed significant geographic variation in patterns of racial/ethnic disparities in LLD outcomes. This requires further longitudinal investigation.
The Absence of Close Social Network Connections: A Case Study Investigation in Social Isolation
Authors: LeBlanc Raeann , Walker Rachel 
Published: December 2020

Abstract
Social isolation is an emerging phenomenon known to significantly influence health outcomes and carries specific risk in older age. As part of a larger study exploring the social network effects on health among persons age 65 and above, it was found that four cases from a larger sample (n=89) could not name any one from their social relationships supportive to them in managing their health while living with complex chronic health needs. In addressing these findings, these cases, bounded spatially by individual social networks and temporally by the time of the study interview, served the basis for intensive analysis using multiple data points from in-depth interviews and survey measures. Measures included descriptive data (social networks, demographics) and measures of health (SF-12), and social support (MOS-SSS). Each participant case identified as female gender and single, three lived alone, had a high burden of chronic conditions and poor health. All had recent hospitalizations (1 or more within the past year). The structures of their social networks varied in type of relationship roles and size. Social support was perceived overall as low. This study offers a specific contribution to research on social connection/isolation. This phenomenon is relative to specific contexts. Findings emphasize that social isolation can be specific to certain aspects of identity and poorer health in older age. Additional research on the functions and qualities of social networks, in addition to the structure, are important to specify in future research and knowledge development for practice assessment to determine social connection and isolation.