bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSESSING THE INTEGRATION OF AGE-FRIENDLY DESIGN RESEARCH INTO THE DESIGN OF HEALTH CARE ENVIRONMENTS
Authors: Calkins Margaret 
Published: January 2025

Abstract
Older adults account for roughly 2/3rds of all patient days in hospitals, and more than 90% of days in post-acute care settings. It is not just the care delivered by clinicians that determines outcomes. Different environments – organizational, social, as well as physical – also have significant impacts on a variety of health and well-being outcomes. Great strides have been made over the past two decades in the design of residential and care environments for older adults, and in the research that evaluates these designs. Research has examined these environments at many scales from overall design concepts (for example, the medical model versus residential design approaches) down to details such as the design of supportive handrails and hardware. This presentation will give a brief overview of this research and explore SAGE (Society for the Advancement of Gerontological Environments) Federation’s post-occupancy process for evaluating residential and care environments for older adults, which has been conducted annually for the past 20 years. However, much less focus has been paid to making other healthcare environments, particularly acute care hospitals, more age-friendly. The Island Health system in Vancouver, Canada, set out to change this and designed the Royal Jubilee Hospital to be age-friendly from pre-admission through discharge. The presentation will also explore the process that Island Health used for decision-making, and how this has influenced subsequent new construction.
EMPOWERING OLDER ADULTS THROUGH SMART TECHNOLOGY: A NEW ERA IN AGING-IN-PLACE AND HOME HEALTH CARE
Authors: Kim Daejin 
Published: January 2025

Abstract
Demographic aging presents unique global challenges, especially regarding the preference of many older adults to age in place. Traditional physical environments often inadequately support the complex needs of this demographic, highlighting the need for innovative approaches. This presentation focuses on the integration of smart home technologies that are powered by machine-learning algorithms to facilitate successful aging in place. Smart home technologies encompass an array of sensors, devices, and machine-learning analysis, and can significantly enhance the wellness and independence for older adults through home automation, health monitoring, and daily activity tracking through machine learning algorithms. They provide essential insights into the functional, cognitive, and social well-being of older individuals, thus supporting their independence and enriching their quality of life. Despite their immense potential, a knowledge gap persists regarding the availability and integration of smart home technologies in homes designed for older adults. This presentation addresses this gap by highlighting the practical applications of these technologies for healthcare professionals, architects, and policy makers. It discusses challenges like privacy, user-friendliness, and affordability, and explores future advancements in this field. The presentation also emphasizes the importance of adopting technological solutions to transform built environments for older adults through a comprehensive overview of the critical role of smart home technologies. It underscores how tailored, effective technological support can significantly improve living conditions for older adults, enabling them to live safely and independently in their preferred environment. The presentation is a call to action for creating more supportive and adaptable living spaces for our aging society.
MARITAL STATUS AND QUALITY OF END-OF-LIFE EXPERIENCES AMONG OLDER US ADULTS
Authors: Mahmoud Kafayat , Carr Deborah , Onge Jarron Saint 
Published: January 2025

Abstract
Understanding the quality of end-of-life experiences is a critical goal, because many older adults experience discomfort or care discordant with their preferences at the end of life. While extensive research documents the protective effects of marriage for health, we know of no studies focusing specifically on marital status differences in end-of-life well-being and care. We examine the extent to which marital status (married, remarried, divorced, widowed, never married) affects end-of-life physical and emotional well-being, quality of care, and dignified care, and whether these associations differ by gender. Using 13 waves of data from the National Health and Aging Trends Study (NHATS), we estimate multivariable multinomial and binomial logistic regression models to evaluate how marital statuses affect diverse indicators of end-of-life well-being and gender differences therein. Our analyses show that married persons do not fare uniformly better than their unmarried counterparts; rather, patterns differ across outcomes. Widowed and remarried persons have a higher likelihood of reporting excellent or very good care at the end of life, relative to married persons. Widowed older adults also are more likely to report receiving care concordant with their preferences. Divorced older adults report poorer pain management, while remarried and never married older adults report less sadness relative to married persons. Patterns do not differ significantly by gender. Unmarried or remarried persons may perceive a more urgent need to do advance care planning, which can enhance the quality of dying experiences. We discuss how marital relationships more broadly shape end-of-life experiences.
PLANS4CARE: TRANSLATING EVIDENCE FROM IN-PERSON CAREGIVER INTERVENTIONS TO A DIGITAL PLATFORM
Authors: Jutkowitz Eric , Piersol Catherine , Koeuth Sokha , Gitlin Laura 
Published: January 2025

Abstract
Our research group has developed and/or evaluated numerous evidence-based non-drug dementia caregiver interventions (e.g., Tailored Activity Program and Skills2Care). For these interventions, healthcare professionals conduct in-home assessments to evaluate cognitive function of the person living with dementia, determine the caregiver’s care challenges (e.g., behaviors), and provide tailored strategies. In randomized trials, these interventions improved caregiver outcomes (e.g., less time caregiving), person with dementia outcomes (e.g., reduced behavioral symptoms), and health system outcomes (e.g., cost savings). Informed by this evidence, our team engaged in an iterative process to create a digital platform that caregivers can use on-demand. First, we mined the clinical trial data and identified 80 caregiver challenges that we grouped into 8 domains: for persons with dementia, behaviors, self-care mobility, household tasks, leisure participation, and healthcare; caregiver-centered challenges (need for respite), and general dementia care practices. Second, we reviewed unique strategies documented and published, which we grouped into 6 categories: communication, cueing, simplifying activity, enhancing, engagement, modifying environment, and taking care of self. Third, two healthcare providers on our team independently mapped care challenges to evidence-based strategies based on the level of cognitive function. Our approach generated a database of 80 care challenges linked to &gt;1500 evidence-based strategies classified by six levels of cognitive functioning (high to low), and a simple user interface for caregivers to generate personalized care plans. Translating in-person sessions to digital platforms and maintaining tailoring and clinical relevance requires an iterative developmental process that is data-driven and informed by caregiver input.
FOSTERING ENGAGEMENT: AN EXPLORATION OF INNOVATIVE DEMENTIA ENVIRONMENTS FROM FOUR COUNTRIES
Authors: Verbeek Hilde 
Published: January 2025

Abstract
Dementia is one of the major age-related diseases and challenges those affected, societies, as well as health care systems worldwide. In an effort to better meet the needs of people living with dementia (PlwD), innovative care concepts for community-dwelling PlwD, as well as those in need for long-term care are being developed worldwide. Aiming to strengthen independence and slow down the cognitive decline, efforts concentrate on continuously engaging PlwD in activities of daily life, despite a progression of the disease. This international symposium will provide five presentations on different innovative care environments in the community, which stimulate and support an active daily life of PlwD. The first presentation dissects the care environment of Green Care Farms in the Netherlands and its effects on the engagement of residents. The second presentation discusses activity programming and self-directed behavior in Canadian long-term care. The third presentation presents social participation of PlwD in shared housing arrangements in Germany. The fourth presentation describes how the neighborhood-built environment can contribute to social health aspects for PlwD in German municipalities and the fifth presentation considers the feasibility and effectiveness of a virtual care farm activity in the United States.
SOCIAL PARTICIPATION OF PEOPLE LIVING WITH DEMENTIA IN GERMAN SHARED-HOUSING ARRANGEMENTS
Authors: Wolf-Ostermann Karin , Misonow Julia , Altona Janissa 
Published: January 2025

Abstract
Aspects of social health are increasingly gaining more interest regarding research for people living with dementia (PlwD). Having a range of meaningful social relationships has been identified as crucial for healthy aging, defined by lower mortality rate, and better physical and mental health outcomes. Recent studies show that social connections and participation in social activities are important dimensions of social health and have the potential to act as a buffer in the process of cognitive decline by delaying dementia or even protecting against its development. Shared-housing arrangements (SHA) in Germany are based on the concept of enabling PlwD to lead an everyday life as normal as possible – including especially social activities as well as exercise-related, sensory, cognitive and creative approaches and out-of-home activities. We analyzed data from different studies on SHA in Germany from 2009-2022 (including the period of the COVID-19 pandemic) to evaluate to which extent social activities are actually performed by PlwD in SHA. The most frequently offered and used activities in SHA are entertainment and joint social activities (2009: 67.0%, 2011: 96.6%, 2021: 80,0%, 2022: 87,9%). This is followed by exercise-related activities (2009: 26.2%, 2011: 79.3%, 2021: 73,2%, 2022: 77,8%) and sensory-related activities (2009: 21.9%, 2011: 77.6%, 2021: 47,9%, 2022: 47,0%). The results show that participation in social activities is a lived fact in SHA - despite some reduction during the pandemic - and should be taken into account when discussing care arrangements for PlwD and conditions for living well with dementia.
GERIATRIC URINARY INCONTINENCE AND LOWER URINARY TRACT SYMPTOMS: NEW DATA, TRIALS, AND CLINICAL APPROACHES
Authors: Bauer Scott , Kuchel George 
Published: January 2025

Abstract
Lower urinary tract symptoms (LUTS) is a syndrome of commonly overlapping symptoms that occur when urine is being generated and stored in the bladder, called storage LUTS (e.g., overactive bladder and urinary incontinence), or during the initiation and process of urination, called voiding LUTS (e.g., weak stream). More than 1 out of 3 of older adults report clinically significant LUTS, contributing to poor quality of life and increased risk of falls and fractures, functional and mobility impairment, and death. Although urinary incontinence is a well-established geriatric syndrome, the remaining LUTS share many risk factors and downstream consequences. In this symposium, each session will review the pre-clinical, epidemiologic, and clinical evidence supporting the entire umbrella of male and female LUTS to be considered a geriatric syndrome. Dr. Parker-Autry will describe the rationale and proposed approach for a multi-modal clinical care pathway to treat female geriatric incontinence syndrome that she has begun to implement in her academic geriatric urogynecology clinic. Dr. Al-Naggar then will review how biological hallmarks of aging contribute to LUTS and key considerations for pilot studies of gerotherapeutic interventions targeting urologic conditions based on a randomized, placebo-controlled clinical trial testing MitoQ for overactive bladder in older women with metabolic syndrome. Lastly, Dr. Bauer will review the evidence of male LUTS as a geriatric syndrome and will describe how this novel framework led to a R01-funded clinical trial comparing a remote exercise coaching intervention versus health education control for physically inactive older men with LUTS.
DEVELOPING A RISK ASSESSMENT AND BRIEF INTERVENTION FOR ELDER MISTREATMENT: A MIXED-METHODS STUDY
Authors: Pappadis Monique , Wood Leila , Schlag Karen 
Published: January 2025

Abstract
Elder mistreatment (EM) is public health and safety concern for older adults, especially those with mild cognitive impairment and Alzheimer’s Disease and Related Dementias (MCI/ADRD); however, few tools exist to assess risk or address risks, especially those that may come from caregivers or the social environment. To address these gaps, we used Medicare outpatient data (2015-2018) and semi-structured interviews with providers, older people with MCI/ADRD, and family caregivers to: 1) Identify risk and protective factors for EM, 2) Understand education and training gaps that may contribute to risk, and 3) Develop a screening, brief intervention, and referral to treatment (SBIRT) model for caregivers and older adults with MCI/ADRD to address risks for EM. Our preliminary findings indicate that social determinants of health, such as housing, financial instability, and social isolation, along with frailty, contribute to EM risk. Caregiver stress, often from financial instability, can increase risk conditions for EM. The lack of caregiver and provider education on EM contributes to a lack of identification of risk factors. Thus, the developed SBIRT model centers on risk assessment, universal education, and referral to support based on the results of the risk assessment. Preliminary feasibility and acceptability of the SBIRT intervention will be reviewed, along with a review of risk assessment protocols. The session will end with describing the next steps to expanding the SBIRT intervention to a greater number of primary care clinics across a large academic health science center’s system.
DEVELOPMENT OF A RISK SCREEN OF ELDER ABUSE IN CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA
Authors: Olsen Bonnie , Mosqueda Laura 
Published: January 2025

Abstract
Significant advances have been made in understanding risk factors of abuse of persons living with dementia (PLWD) by their caregivers. Intervention focused on the modifiable caregiver risk factors provides a possible avenue to primary prevention. This project developed a caregiver risk assessment screen, linked to an abuse prevention intervention. To develop the tool, we administered surveys of validated measures of risk factors to caregivers of PLWD (N=95), had an expert panel rank responses according to risk, and used these risk levels to identify items that are most predictive of risk. The sample had a mean age of 49.5 years (SD=14.4), mostly female (68.1%), mostly Latine (52.1%), predominantly family members (14.7% spouse, 43.1% child, 20.0% other). The PLWD had a mean age of 78.6 years (SD=10.8), mostly female (62.4%). Expert panel-assigned risk levels were evenly distributed, with 35.8% high, 30.5% medium, and 33.7% low risk. Using a 2:1 train/test split, the training sample demonstrated strong single-item prediction, with maximum single-item AUC (area under the curve) of 0.861 (39 items had AUC≥0.7, of which 5 had AUC≥0.8). The top performing items included: caregiver’s satisfaction with their life; acting in an emotionally aggressive manner; feeling angry when around the PLWD; being bothered by feeling nervous, anxious, or on edge; and finding looking after the PLWD to be a burden. This presentation will discuss the process of creating an abuse screening tool for caregivers of PLWD. In the next phase, we will assess the effectiveness of our intervention in reducing risk for abuse.
ADAPTING THE DETECT TOOL FOR HOME-BASED PRIMARY CARE: INSIGHTS ON POLICIES, PROVIDER PERSPECTIVES, AND TOOL DESIGN
Authors: Haggerty Kristin Lees , Cannell Brad , Ojelabi Olanike , Campetti Randi , Burnett Jason , Pickering Carolyn , Livingston Melvin 
Published: January 2025

Abstract
Elder mistreatment (EM) is difficult to detect and often goes unrecognized. Home-based primary care (HBPC) providers have enduring relationships with patients who are vulnerable to EM and the ability to see patients’ homes first-hand. Effective and efficient screening tools are urgently needed to support these providers in consistently assessing patients for signs of EM. This project includes a two-stage approach to adapting and rigorously evaluating an evidence-based EM screening tool, Detection of Elder mistreatment Through Emergency Care Technicians (DETECT), for use in home-based primary care (HBPC). In this presentation, we share results from a qualitative study conducted to inform tool adaptation and implementation strategy for DETECT revised for primary care (DETECT-RPC). This study addressed three research questions: 1) what are the implications of state- and site-specific policies on DETECT-RPC implementation, 2) what are the perceived barriers and facilitators to recognizing and reporting EM among HBPC providers, and 3) What adaptations need to be made to make DETECT-RPC feasible and effective in HBPC? Data collection included review of publicly available information and interviews and focus groups with HBPC staff from seven sites (N=16). Interview and focus group data were transcribed and coded using a thematic analysis approach. We will present key themes from the qualitative study including implications for the DETECT-RPC tool design and workflow, and key considerations for developing reporting guidelines structure.
IMPACT OF VALUE-BASED PURCHASE MODEL ON RACIAL DISPARITIES IN ACCESSING HIGH-QUALITY HOME HEALTH CARE
Authors: Ma Chenjuan , Wu Shaohui , Fletcher Jason 
Published: January 2025

Abstract
Home healthcare (HHC) plays a pivotal role in serving Americans who “Age in Place”, particularly persons living with dementia (PLWD). Along with its rapid growth, there are increasing concerns of care disparities under the current HHC system and policies. This study aimed to examine racial/ethnic disparities in accessing high quality HHC among PLWD and identify the impact of home health value-based purchasing model (HHVBP), a policy designed for improving overall care quality, on such disparities. This study used two years of CMS HHC assessment data (i.e., OASIS) and HHC Compare Data. High quality HHC was identified based on agency care quality star rating (&gt;=4.5 stars). HHVBP status was indicated by a dummy variable. A total of 743,860 PLWD from 6,410 agencies were studied, including 80.9% White, 11.9% Black, 5.6% Hispanic, and 1.6% Asian. Nearly one-third (32.6%) of agencies were with high quality care. Our risk-adjusted model shows that Blacks were 2% more likely to access high quality care while Hispanics and Asians were both about 20% less likely to access high quality care, compared to Whites. HHVBP increased the odds of accessing high quality HHC for all racial/ethnic groups (significant interaction terms all ORs&gt;1) with most substantial among Hispanics (OR=1.60), followed by Asians (OR=1.28) and Blacks (OR=1.11). Stratification analysis indicated while the racial/ethnic disparities continue to exist in non-HHVBP states, such disparities disappeared in HHVBP states. Our study demonstrated the existence of racial/ethnic disparities in accessing high quality HHC and the effect of HHVBP in reducing such disparities.
HOME HEALTH CARE USE AND OUTCOMES AMONG PERSONS WITH DEMENTIA: A SCOPING REVIEW
Authors: Smith Jamie , Burgdorf Julia , Riser Tiffany , Ryvicker Miriam 
Published: January 2025

Abstract
One-third of home healthcare (HHC) recipients are persons living with dementia (PLWD). HHC provides skilled nursing and therapy delivered in the patient’s home. Amid population aging and a shift towards home- and community-based care, there is a growing need for HHC services for PLWD. However, dementia care research has historically focused on institutional care settings, and HHC has been understudied. We conducted a scoping review to summarize the current research landscape regarding HHC utilization and clinical outcomes for PLWD and recommend future research directions. We applied Arksey & O’Malley’s methodology and identified 32 articles that met inclusion criteria. Of these, 22 studies examined utilization, finding that PLWD used HHC differently than persons without dementia, having a higher likelihood of community referral, longer episode length, greater use of nursing and aide services, and increased costs. Sixteen papers reported on clinical outcomes: function, hospitalization, skilled nursing facility admission, and mortality. Analyses varied widely in their approach to defining dementia and measuring key outcomes. However, literature suggests an increased risk for negative outcomes, including hospitalization and institutionalization among PLWD. Findings highlight several areas for future research, most saliently, the need for analyses that consider contextual factors (e.g., market factors, racial/ethnic disparities, rurality) when examining HHC for PLWD. Future work should assess the impacts of payment model revisions and expanding Medicare Advantage coverage on utilization and care delivery for this population. A rigorous examination of care delivery and outcomes is needed to inform practice models to adapt to the unique care needs of PLWD.
BARRIERS AND FACILITATORS TO HELP-SEEKING FOR ELDER ABUSE: A QUALITATIVE STUDY FROM THE PERSPECTIVE OF VICTIMS
Authors: MacNeil Andie , Hsieh Jessica , Rollandi Isabel , Sirey Jo Anne , Lachs Mark , Burnes David 
Published: January 2025

Abstract
Understanding help-seeking among victims of elder abuse (EA) is a major challenge and significant knowledge gap in the field. The vast majority of EA victims are not connected with formal response systems, such as Adult Protective Services, law enforcement, and other agencies responsible for addressing this issue in the community. The current study sought to understand barriers and facilitators to help-seeking from the perspective of EA victims. Using a descriptive phenomenological approach, this study conducted in-depth, individual, qualitative interviews with a diverse sample (n = 32) of EA victims living in New York City and Los Angeles, United States. Analysis followed a constant comparison process involving two independent coders of verbatim transcripts. Major themes that emerged as barriers to help-seeking included: embarrassment or shame, self-blame or guilt, fear of perpetrator retaliation, fear of what could happen to perpetrator, concern for family preservation, and lack of awareness of services. Facilitators in the process of help-seeking included: reaching a “tipping point”, concern for self-preservation, accessibility and convenience of services, and having knowledge about where and how to seek support. These findings emphasize that barriers and facilitators to help-seeking span various levels of ecological influence, including the individual victim, the individual perpetrator, the victim-perpetrator relationship, and the family system. To promote greater help-seeking among EA victims, there must be accessible interventions that help address the complex and interrelated psychological, emotional, relational, and familial factors that impact help-seeking behavior among EA victims.