bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship Between Metabolic Health and Mortality Among Older Hispanics in the US and Mexico
Authors: Carabello Maria 
Published: December 2021

Abstract
Studies consistently show that Hispanics, especially first-generation Mexican immigrants, face lower mortality risks in mid-to-late life than US-born non-Hispanic whites. This extended lifespan defies expectations given Hispanics’ disadvantaged socioeconomic status relative to whites and thus is referred to as the Hispanic paradox. However, it remains an open question as to whether the Hispanic paradox in mortality mirrors a lower chronic disease burden. To address this gap, this study will combine and leverage two harmonized longitudinal population-based data sources of late-middle-aged and older adults in the United States and Mexico; the Health and Retirement Study and the Mexican Health and Aging Study. First, I evaluate differences in the association between metabolic syndrome (MetS) and mortality risk for older adults living in Mexico, first-generation Mexican immigrants to the US, US-born Mexican Americans, and US-born whites. Second, I explore the extent to which the proportion of deaths attributable to MetS in each of these groups can be explained by differences in socioeconomic and health/behavioral characteristics. This study uses Cox proportional hazards models to estimate the mortality risks of MetS across groups, as well as the associated population attributable fractions (PAFs) to investigate potential differences within a decomposition framework. Developing this detailed understanding of metabolic health and the associated mortality risks across multiple generations of older Mexican immigrants may help us identify modifiable lifestyle and behavioral factors to better manage these conditions and alleviate possible complications as current and future generations of Mexican immigrants age in the US.
Barriers that Contribute to the Digital Divide Among Older Community Dwelling Adults in Later Life
Authors: Wang Haowei , Yang Mai See , Choi Yong Kyung 
Published: December 2021

Abstract
Research demonstrates that race and health literacy contribute to the digital divide, which is a major public health concern for older adults in the U.S. However, we still lack information about what types of barriers older adults have through a comprehensive examination using population -based data. This study focuses specifically on barriers to technology use among older adults. We use data from the Health and Retirement study 2012 Module “Technology Use: Barriers and Benefits” (N = 1,416). About 42% of participatnts did not use any technology (e.g., emails, social media, smart phone) (n = 501). The mean age for this non-user group was 72 years old (SD 10.3). 13% were foreign born, over half were female (56%), and the majory were somewhat educated (72% with a high school education or lower). About 23% of non-users were self-reported black, 16% Hispanic, 3% other race, and 58% non-Hispanic white. Barriers for adopting the use of technology included too difficult to keep up with the changes in technology (78%), too complicated (69%), not interested (65%), too much time required to learn (53%), too hard to learn (52%), expensive (43%), not easily available (24%), and opposed to using new technologies (27%). Results suggest that barriers were significantly correlated with more depressive symptoms among older adults who did not use technology. Compared to users, non-users were also more likely to have health conditions (e.g., hypertension, diabetes, lung disease, stroke, and arthritis). Findings of this study provide directions to address digital divide among older adults.
Digital Mobility Assessment for Regulatory and Clinical Endorsement in Hip Fracture Patients
Authors: Jansen Carl-Philipp , Taraldsen Kristin , Blain Hubert , Becker Clemens 
Published: December 2021

Abstract
Hip fracture is the most frequent non-intentional injury of older persons leading to hospital admission in Europe and North America. Until recently, in regulatory submissions no attention was given to patients’ mobility after sustaining/recovering from a hip fracture. To better evaluate efficacy and effectiveness of new drugs and treatments, it is necessary to develop mobility biomarkers since failure to recover and regain pre-fracture mobility is considered the single most important disability symptom experienced by hip fracture patients, often leading to care home admission. However, regularly used measures of mobility capacity are not representative of individuals’ performance in real life, intermittent in nature, and require visiting study centers. Digital technology has the potential to revolutionize mobility assessment in a real-life setting. With this presentation we build a case for a valid solution for real-world digital mobility assessment in hip fracture patients as carried out in the “Mobilise-D” clinical validation study.
Unpacking Data From Adult Day Centers in Order to Realize Their Untapped Potential in Dementia Care
Authors: Sadarangani Tina , Parker Lauren 
Published: December 2021

Abstract
Adult day centers (ADCs) in the United States represent a vital, but commonly overlooked, resource for dementia care among community-dwelling older adults. However, the severity of dementia in ADC users, their medical complexity, the supports offered to them, and health outcomes associated with adult day services among persons living with dementia is poorly understood. This is in part due to a lack of standardized data collection in this industry. In this symposium, we present the most current research on these issues, as well as strategies to improve data collection across ADCs to strengthen care. The symposium begins with analysis of data from the state of California that identifies patterns of chronic conditions in ADC users with dementia that are associated with emergency department visits and hospitalizations. We then examine data from the Centers for Disease Control, comparing dementia specialized ADCs and their participants to non-specializing ADCs. We compare the extent to which states with ADC programs require collection of patient centered reported outcomes on persons with dementia. Finally, we explore an innovative collaboration between researchers and community partners to simplify data collection in these centers. Our findings suggest that persons with dementia in ADCs are an extremely complex population and that some ADCs are better suited than others to meet their extensive needs. Additional patient-centered data collection can be supported with widely available software, and has the potential to demonstrate the effectiveness of ADCs, aid in program development, and help leverage funding opportunities.
Relationship Between Clusters of Chronic Conditions and Disability Trajectories
Authors: Klinedinst Tara , Terhorst Lauren , Rodakowski Juleen 
Published: December 2021

Abstract
Recent evidence shows that more complex clusters of chronic conditions are associated with poorer health outcomes. Less clear is the extent to which these clusters are associated with different types of disability (basic and instrumental activities of daily living (ADL, IADL) and functional mobility (FM)) over time. This was a longitudinal analysis using the National Health and Aging Trends Study (NHATS) (n = 6,179). Using latent class analysis, we determined the optimal clusters of chronic conditions, then assigned each person to a best-fit class. Next, we used mixed-effects models with repeated measures to examine the effects of group (best-fit class), time (years from baseline), and the group by time interaction on each of the outcomes in separate models over 4 years. We identified 5 chronic condition clusters: “multisystem morbidity” (13.9% of the sample), “diabetes” (39.5%), “osteoporosis” (24.9%), “cardio/stroke/cancer” (4.5%), and “minimal disease” (17.3%). Group by time interaction was not significant for any outcome. For ADL outcome, only time was significant (F3,16249 = 224.72, p &lt; .001). For IADL, both group (F4,5403 = 6.62, p &lt; .001) and time (F3,22622 = 3.87, p = .009) were significant. For FM, both group (F4,5920 = 2.96, p = .02) and time were significant (F3,16381 = 213.41, p &lt; .001). We did not find evidence that any cluster experienced greater increases in disability over time, but all clusters containing multiple chronic conditions had risk of IADL and FM disability. Increased screening for IADL and FM disability could identify early disability and prevent decline.
Utility of the Late Life Function and Disability Instrument (LLFDI) in rehabilitation services for older adults
Authors: Toto Pamela , Stankiewicz Anne 
Published: December 2021

Abstract
Introduction: The Late Life Function and Disability Instrument (LLFDI) is a valid self-report tool that quantifies disability based on activity limitations and participation restrictions in everyday life. Both the original longer tool (LLFDI) and the shorter computer adaptive version (LLFDI-CAT) offer practitioners a method for measuring function independent or in conjunction with performance-based assessment. Objectives: Examine scores of the LLFDI and LLFDI-CAT for measuring disability in older adults who are receiving rehabilitation services in community and institution settings. Method: A secondary data analysis was conducted comparing scores from occupational therapy evaluations with older adults from 3 groups: 1) older adults in primary care using the LLFDI; 2) older adults in primary care using the LLFDI-CAT; older adults in a skilled nursing facility (SNF) using the LLFDI-CAT. Results: Mean scores for Activity Limitation and Participation Restriction were lowest for older adults in a SNF indicating greater disability. A one-way Analysis of variance on ranks showed a main effect for Activity Limitation, χ2 (2) = 22.267, p &lt; 0.001, and Participation Restriction, χ2 (2) = 60.372, p &lt; 0.001. Post-hoc analyses revealed significant differences between groups based on tool (i.e. LLFDI vs. LLFDI-CAT) for Activity Limitations and setting (i.e. primary care vs. SNF) for Participation Restriction. Conclusion: The LLFDI-CAT may be the preferred instrument to measure disability in older adults across treatment settings. Additional research is warranted to understand how personal and environmental factors influence LLFDI-CAT outcomes.
Listening to Older Adults: A Qualitative Analysis of Advice Given During COVID-19
Authors: Van Vleet Bryce , Fuller Heather , Huseth-Zosel Andrea 
Published: December 2021

Abstract
The life experience of older adults offers a unique perspective of coping through historical crises. Specific advice offered by older adults is generally underrepresented in the literature. This qualitative study explores advice offered by older adults to others on how to cope through the COVID-19 pandemic as well as advice for the community about the needs of older adults. A Midwestern sample of 67 older adults aged 70-97 completed one phone interview in June of 2020 as part of a larger study about their experiences with social distancing and isolation. Participants were asked what advice they would give to others during the pandemic and what advice they would give to communities and families about the needs of older adults during the pandemic. Transcripts of these conversations were coded using in vivo and holistic coding as first-cycle methods. These codes were then analyzed using pattern coding as a second-cycle method. Results indicated older adults offered advice along three domains: fostering physical and mental wellbeing, promoting positive life perspectives, and maintaining connections. Advice to communities regarding the needs of older adults included having a selfless attitude and taking intentional actions like grocery shopping and writing letters. However, older adults also recommended avoiding extremes to allow them to maintain their independence and preserve physical distance for safety. Older adults utilized their life perspective and their own coping strategies when offering advice. Future research should evaluate the effectiveness of the advice given and how likely that the advice will be utilized by others.
Native American Elders’ Experiences during the COVID-19 Pandemic: Case Studies
Authors: Xie Bo , Shiroma Kristina , Lowe John , De Main Atami , Davis Nathan 
Published: December 2021

Abstract
The COVID-19 pandemic has affected community-dwelling elder adults’ experiences during the COVID-19 pandemic. We report 4 case studies of Native American elders’ pandemic experience. Participants were recruited from community-dwelling older adults in Central Texas. Data collection took place via in-depth, semi-structured telephone interviews during June-August 2020. Four of the participants self-identified as Native American. Three of them were male; between the ages of 74 and 75; had at least some college education. The fourth Native American elder was a 68 year-old female with some college education. All four participants were coping well with everyday life during the pandemic. Connectedness emerged as the overarching theme among the 4 cases. Regular communication with their families was expressed as most important. A variety of communication technology was used to maintain contact with family members such as phone calls, texting, email, and video chat services particularly Zoom, FaceTime, and Facebook Video Chat. Challenges with using these technologies were also frequently reported. The participants expressed they did not feel a sense of increased loneliness or loss of being connected. Another theme emerged related to surviving the impact of the pandemic. Having the vaccine accessible along with financial resources necessary to sustain essential needs were most frequently expressed by the participants. These findings have implications for community interventions and policies that support the provision of mechanisms for Native American elders to maintain a sense of connectedness, including the adoption and use of communication technology, during times of crises such as pandemics and natural disasters.
Medical Complexity, Mortality Among High-Cost Medicare Advantage Enrollees: Palliative, Hospice Implications
Authors: Amodeo Samuel , Kowalkowski Henrik , Bangerter Lauren , Brantley Halley , Cook David , Jones Nicholas 
Published: December 2021

Abstract
Older adults with high medical spend require tailored interventions and care delivery to meet their complex needs. Palliative is a high-value solution for high-cost patients because it provides relief from the symptoms, pain, and stress associated with multiple conditions. Likewise, other high-cost patients may be closer to end-of-life and therefore benefit from hospice care. For Accountable Care Organizations (ACOs) and hospitals to implement palliative care, these programs must identify and target the high-need patient populations. This study explored patterns of spending and mortality across 4 years (2016-2019) using claims from 1,701,647 patients continuously enrolled in UnitedHealth Group Medicare Advantage (mean age=73.7; S.E.=0.01). Patients with healthcare spend in the top decile were segmented into three subgroups based on health conditions and spend patterns. Analyses identified a subgroup of patients (mean age=76.6; S.E.=0.04), with the highest rate of mortality, and significantly more chronic conditions and frailty, indicating their cost and mortality was driven by medical complexity. Odds ratios from a multinomial logistic model tie blood formulation drugs (OR XX), medicative procedures (OR XX), and nonhospital-based care (OR XX) to members of this subgroup may be connected to short-term mortality. There is a critical need to identify patients who stand to benefit from palliative and end of life care, this is particularly true for high-cost high-need patients. Our study suggests that patterns of medical complexity and morality within high-cost patient subpopulations can be used to identify high-cost patients who would benefit from palliative or hospice care.
Documenting the Need for Patient-Centered Relevant Outcomes in Adult Day Services
Authors: Boafo Jonelle , Anderson Keith , Brody Abraham , Sadarangani Tina 
Published: December 2021

Abstract
ADCs are not uniformly regulated at the federal or state level, resulting in the absence of uniform data collection. The lack of large-scale data has resulted in a dearth of evidence on the role ADC services play in the health and well-being of their clients, particularly persons living with dementia (PLWD). The purpose of this study was to compare data being collected across states and evaluate the degree to which patient centered relevant outcomes (PCROs) are being collected. A review of ADC regulations in 50 states found that &lt;10 states, required standardized reporting on ADC participants. Regulatory forms relied on clinical judgment as opposed to validated tools, and focused on eligibility for services as opposed to independence, engagement, or clinical interventions in the ADC. Emphasizing collection of PCROs in ADCs, beginning at the state level, is an essential step in documenting the value and effectiveness of ADCs, particularly for PLWD.
Qualitative Document Analysis of Patient’s Healthcare Trajectory With and Without Palliative Care
Authors: Steffen Melissa , Steffensmeier Kenda Stewart , Alexander Bruce , Berry-Stoelzle Maresi 
Published: December 2021

Abstract
Palliative care is important to the care of seriously ill patients to support the patient and family. Palliative care is often timely in the inpatient setting, but delayed in outpatient care, leading to missed opportunities. Identifying when to engage patients with palliative care in outpatient settings has been challenging. As part of a larger quality improvement project to increase access to palliative care, a qualitative sub-study was completed to identify missed palliative care engagement opportunities in patient’s healthcare trajectories. A document analysis of patients notes from a convenience sample of 20 recently deceased patients who received care within the Veteran Affairs healthcare system (VAHCS) was completed. Patients were sorted into four categories that emerged from initial analysis: cancer/palliative, non-cancer/palliative, cancer/non-palliative, and non-cancer/non-palliative. Two qualitative analysts reviewed the notes, paying particular attention to notes preceding or following seminal healthcare events. Patients in the cancer/non-palliative category were more likely to decline preventive care, engage less with the VAHCS health care or only interacted with the VAHCS for specific needs (e.g., determine VA health benefits). Similarly, non-cancer/non-palliative care patients were more likely to use a mix of VAHCS and outside healthcare, with inpatient care occurring outside of the VAHCS. For non-palliative care patients, seminal healthcare events were less likely to occur in the VAHCS. Thus, identifying opportunities to engage patients with palliative outside of seminal healthcare events may be important to increasing patient access within the VAHCS.
Improving Quality of Care via Effective Pain Management
Authors: Rose Jennifer 
Published: December 2021

Abstract
Pain is neither a vital sign nor a normal part of aging. Yet, older adults frequently experience pain chronically or from an acute event. Pain was identified as a gap per the Centers for Medicare & Medicaid Services Quality Measures report (2019). The purpose of this quality improvement project was to improve the assessment of pain at a skilled nursing facility (SNF) by using a standardized tool. The Comprehensive Pain Assessment Tool for the Cognitively Intact evaluates the complex sensation and emotional reaction of the pain experience. Nurse managers (N=7) received 1:1 education on pain, pain assessment, use of the pain assessment tool, and took a post-test. Chart audits were conducted to identify tool use and evaluate the patient response. Additional data were collected from nurse managers via a questionnaire. All nurse managers received education and completed the post-test. Pain assessments and care plans were completed for 100% of the SNF residents in the cohort (N=22). Follow-up assessments were completed on only 75% of the cohort. Of the cohort, 95% demonstrated improved physical ability and functioning in activities of daily living as their pain experience improved. Only 4.5% of the cohort participated in the anticipated level of minutes of therapy as a result of facility infection control limitations due to the COVID-19 pandemic. This project demonstrated improved pain management through use of a tool to comprehensively assess pain. An organizational policy to comprehensively assess pain at this SNF could promote a higher level of independence and functioning for older adults.
Loneliness Predicts Development of Pain, Fatigue, and Depression in Older Adults
Authors: Powell Victoria , Kumar Navasuja , Kabeto Mohammed , Galecki Andrzej , Clauw Daniel , Silveira Maria 
Published: December 2021

Abstract
Pain, fatigue, and depression form a well-recognized symptom cluster that is posited to have a shared mechanism. It is possible that chronic psychosocial stressors such as loneliness may impact the central nervous system and immune system, potentially leading to symptom cluster development. Loneliness is an increasingly recognized type of psychosocial stress, especially among older American adults. Thus, we investigated whether loneliness increased risk of developing the symptom cluster of pain, fatigue, and depression over time. Using Health and Retirement Study data from 2006 – 2016, we examined self-respondents ≥50 years-old for the presence of co-occurring pain, fatigue, and depressive symptoms surpassing threshold levels (ie., the symptom cluster). Loneliness (measured by the 3-item UCLA Loneliness Scale) at baseline was used as the predictor of interest. Of the total sample (n=11,766), n=5,956 (50.6%) had up to two complete sets of follow-up symptom cluster measurements. Logistic regression models for longitudinal data were fitted using a generalized estimating equation (GEE). After adjusting for demographic and clinical variables, loneliness strongly predicted the development of the symptom cluster (adjusted OR=3.16 (95% CI 2.77, 3.61)) as well as each component symptom (pain adjusted OR=1.54 (95% CI 1.42, 1.67); fatigue adjusted OR=1.88 (95% CI 1.74, 2.03); depression adjusted OR = 3.87 (95% CI 3.55, 4.21). Further research should investigate whether interventions targeting loneliness or other psychosocial stressors may have a role in prevention of this symptom cluster.