bluuebunny/crossref_metadata_2025_split huggingface dataset:
Childhood Lead Exposure and Cognitive Functioning Among Older Adults: Evidence From the Health and Retirement Study
Authors: Lee Haena , Lee Mark , Warren John Robert 
Published: December 2021

Abstract
Many children born in the early 20th century were exposed to water-borne lead, a neurotoxin that negatively impacts brain development. While lead exposure has been linked to poor cognition among children and young adults, no population-level research has examined the long-term implications of lead exposure for cognitive functioning in later life. Our study is the first to address this gap by utilizing novel data linkages between the 1940 U.S. Census and the Health and Retirement Study (HRS). Our sample includes respondents who were under age 17 (born 1924-1940) by the time of the decennial enumeration on April 1, 1940. Given that the dominant source of lead exposure was water during this period, we assessed lead exposure by using water chemistry and piping material data for each HRS respondent’s city of residence in 1940. Late-life cognitive functioning for HRS participants (observed 1998-2016) was measured using the Telephone Interview for Cognitive Status. We find that lead exposure during childhood is significantly and negatively associated with cognitive functioning in later life. HRS participants who lived in cities with lead pipes and acidic or alkaline water—the conditions required for lead to leech into municipal water—showed lower levels of cognitive functioning decades later as compared to other participants. This association persisted net of race, gender, childhood socioeconomic status and childhood health. However, the association was largely accounted for by adjusting for educational attainment. This implies that childhood lead exposure impacts later-life cognition via its effect on educational attainment.
Community Leaders’ Perspective of Strategies to Enhance Social Connectedness in Rural Communities
Authors: Oh Patricia , Kaye Len , Parham Lori 
Published: December 2021

Abstract
Age-Friendly communities are charged with fostering a social environment where social connections are available, accessible, and meaningful. Thematic content analysis of 67 interviews (representing 73 communities) conducted between 12/09/2019 and 01/24/2020) and 59 interviews (representing 71 communities) conducted between 12/14/2020 and 1/19/2021 with age-friendly leaders in rural Maine suggested the importance of expanding multi-sectoral collaborations and developing flexible strategies that allow older people to create and maintain social connections, even during COVID. Prior to the pandemic, common strategies were: (1) local partners and volunteers; (2) in-person activities; (3) accessibility; (4) reciprocity; and, (5) neighborhood-specific solutions. During the pandemic, there was an increased reliance on regional partners and funders to develop low or no-tech and tech-enabled social opportunities. Additional adaptive strategies included: (1) intergenerational ties; (2) emphasizing fun; and, (3) flexibility. The study has implications for understanding how rural age-friendly communities develop and grow multi-sectoral collaborations to enhance social connections.
Staff Perspectives on Lessons Learned From an Interdisciplinary Memory Care Coordination Program
Authors: Antonsdottir Inga , Samus Quincy , Reuland Melissa , Johnston Deirdre , Spliedt Morgan , Sloan Danetta 
Published: December 2021

Abstract
MIND at Home is a home-based care coordination program for persons living with dementia (PLWD) and their informal care partners (CP). Assessments, care planning and coordination is delivered by trained non-clinical Memory Care Coordinators (MCCs), working together on an interdisciplinary team with nurses and geriatric psychiatrists. We report qualitative results from program staff (two nurses and eight MCCs) who implemented the program in the context of two clinical trials. Care team respondents answered open-ended questions covering 5 domains pertaining to: helpful skillsets; positive and challenging factors aspects of care coordination; barriers to care coordination for clients; and improvements suggestions/resources to strengthen the program. Compassion, finding common ground, listening, organization, and time management were reported as critical skills. Staff enjoyed team collaboration, being in and learning about the community, increasing CP confidence and mastery when caring for a PLWD. Reported challenges included documentation in EHR, accessing/navigating resources, driving long distances, unsafe neighborhoods, ambiguous assessment tools, and working with low engagement clients. Common barriers faced by clients (as reported by staff) were financial struggles/poverty, and lack of insurance coverage for needed services. Staff suggested several improvements: better communication strategies, integration with LTSS services and medical providers, 24-hour program hotline, continuous education for staff, simplified data collection and care delivery tracking process. This presentation on the experience of MIND at Home trained nurses and MCCs provides deep insight on how this and similar care coordination programs might be successfully implemented or strengthened.
Teaching End-of-Life Decision Making to Undergraduate Nursing Students
Authors: Greenberg Sherry , Innella Nancy , Pilkington Bryan 
Published: December 2021

Abstract
This presentation highlights the development, implementation, and results of an educational session with undergraduate nursing students about end-of-life decision making. The purpose of this qualitative thematic analysis study was to explore student perspectives of end-of-life decision making following an education session. The aims were to 1) develop themes from student feedback on end-of-life decision making and 2) refine educational strategies to teach end-of-life decision making to nursing students. The study was conducted with 72 junior level baccalaureate nursing students enrolled in an undergraduate gerontological nursing course. An interactive lecture was developed, following short philosophical ethics readings, which brought the students up to date on the history of end-of-life discussions, key cases, and different frameworks to approach a cluster of ethical issues associated with end-of-life care. A debate pedagogical model was employed as an engaging activity in which students directly applied recently learned concepts. In the debate activity, students were divided into two teams. Each team was assigned a position, which was a specific response to the case question: Should practitioners assist in their patient’s committing suicide? Should practitioners offer medical aid in dying? Each team conferred, presented their position, responded to the arguments or reasons from the opposing position. The session ended with a debrief by the course instructors. In the first semester, 31 nursing students completed four open-ended questions following the class. Results included increased student confidence discussing end-of-life issues and identification of two concepts commonly referred to in end-of-life care discussions and in bioethics, autonomy and dignity.
Visual Impairment and Objectively Measured Physical Activity in Middle-Aged and Older Adults
Authors: Cai Yurun , Schrack Jennifer , E Jian-Yu , Wanigatunga Amal , Urbanek Jacek , Simonsick Eleanor , Swenor Bonnielin 
Published: December 2021

Abstract
Vision loss is associated with restricted physical activity (PA), yet the relationship between multiple domains of vision measures and objectively measured PA, especially activity patterns, in mid-to-late life remains unclear. In 603 BLSA participants (mean age=73.5±11 years; 56% women; 69% white), best-corrected and presenting visual acuity (VA), contrast sensitivity, visual fields (VF), stereo acuity were assessed from 2015 to 2019. Free-living PA was assessed using a wrist-worn ActiGraph accelerometer for 7 days. Linear regression models showed that participants with vs. without best-corrected VA impairment had 29.3 fewer active minutes/day (p=0.03) and trended towards fewer activity counts (p=0.05), adjusting for sociodemographic and health characteristics. VF impairment was associated with 268,636 fewer activity counts (p=0.02), 46.2 fewer active minutes/day (p=0.02), and a 3% greater activity fragmentation (p=0.009). Older adults with visual impairment have restricted and more fragmented activity patterns. Longitudinal studies are warranted to examine causality between visual impairment and PA decline.
Free-Living Gait Cadence Measured by Wearable Accelerometers for Assessing Fall Risk
Authors: Urbanek Jacek , Roth David , Karas Marta , Wanigatunga Amal , Juraschek Stephen , Appel Lawrence , Schrack Jennifer 
Published: December 2021

Abstract
Accelerometers are widespread in research applications, yet whether they are superior to structured clinic-based assessments is unknown. Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-meter gait speed) with free-living gait cadence from wrist accelerometers (Actigraph GT9X) in predicting fall rates in 432 older adults (age 77.29±5.46 yrs, 59.1% men, 80.2% White) participating in the Study to Understand Fall Reduction and Vitamin D in You (STURDY). Accelerometry-based gait cadence was estimated with the Adaptive Empirical Pattern Transformation algorithm. Across all participants, every 10 steps/min higher cadence was associated with a 13.2% lower fall rate (p=0.036). Mobility measures were not related to falls (p&gt;0.05). Among higher-functioning participants (cadence ≥100 steps/min), every 10 steps/min higher free-living cadence (p=0.01) was associated with a 27.7% lower fall rate. Data collected from accelerometers may provide a more sensitive indicator of fall risk than in-clinic tests.
Multidimensional Sleep Health: Concepts, Advances, and Implications for Research and Intervention
Authors: Chung Joon , Goodman Matthew , Huang Tianyi , Bertisch Suzanne , Redline Susan 
Published: December 2021

Abstract
Sleep is a complex process, sensitive to aging, with theoretical and evidentiary basis for influence on multiple health outcomes. Recent scholarship has argued for a ‘multi-dimensional’ approach to sleep health, that is, a recognition that healthy sleep consists of more than its quantity (duration) and is more than the absence of sleep disorders. This new conception of sleep health acknowledges sleep’s complexity yet presents challenges for methodological treatment. How do we operationalize/analyze multiple dimensions of sleep, some of which are correlated due to physiological reasons, common measurement tools, or sensitivity to common stressors? Is it sensible to talk about ‘sleep health’ as a single, composite entity with multiple components, akin to a dietary pattern rather than a collection of individual nutrients? Exemplar data from a racial-ethnic disparities project in aging adults suggest the utility of a composite approach, and the value of considering inter-correlations among sleep metrics.
Comparison of Recruitment Strategies for Engaging Older Minority Adults: Results From Take Heart
Authors: Ramsay Jessica , Hogan Cainnear , Janevic Mary , Courser Rebecca , Allgood Kristi , Connell Cathleen 
Published: December 2021

Abstract
Few studies report best practices for recruiting older adults from minority, low SES communities for behavioral interventions. In this presentation, we describe recruitment processes and numbers for Take Heart, a randomized controlled trial testing the effectiveness of an adapted heart disease self-management program for primarily African American, low SES adults 50 years or older in Detroit. Community-based (CB), electronic medical record (EMR), and in-person hospital clinic (HC) recruitment methods were implemented. Within 22 months, 453 participants were enrolled, with an overall recruitment yield of 37%. The CB method had the highest yield (49%), followed by HC (36%) and EMR (16%). The average cost of recruiting and enrolling one participant was $142. Face-to-face interactions and employing a community health worker were particularly useful in engaging this population. Further research is needed to confirm these findings in other minority and low SES populations and share lessons learned about recruitment challenges and successes.
Response Efficacy and Action to Prepare for Disasters With Different Lead Time: Age Differences
Authors: Chen Zhirui , Cong Zhen 
Published: December 2021

Abstract
This study investigated how disaster types, namely those with short and longer warning lead time, contextualized individuals’ preparatory action, especially as associated with their response efficacy and age. The working sample included 1,467 respondents from the 2017 U.S. National Household Survey. Logistic regressions showed that individuals with higher levels of response efficacy were more likely to prepare after learning information about how to prepare. Respondents in areas prone to short lead-time disasters were less likely to prepare than those in longer lead-time disasters areas. Response efficacy was more important for action taking for short lead-time disasters, which was observed only among older adults when older and younger adults were examined separately. These findings revealed the impacts of disaster types and response efficacy on disaster preparedness and older adults’ unique vulnerability and resilience, which could guide policymaking and interventions to promote national disaster preparedness tailored to regional peculiarities.
Integrating Assessment for Social Disconnectedness Into Aging Services: Charting a Path Forward
Authors: Prendergast Alice , Fuller Kristi 
Published: December 2021

Abstract
Social disconnectedness poses a serious threat to the health and well-being of older adults. Although research demonstrates that social disconnectedness was prevalent among older adults long before the COVID-19 pandemic, the crisis has brought significant attention to this issue, as well as resources to address it. The crisis also shed light on the current gap in evidence and guidance on how best to assess for and address social disconnectedness, especially in practice settings. Researchers from the Georgia Health Policy Center conducted a review of existing assessment tools and processes for social disconnectedness and formulated recommendations for the Georgia Division of Aging Services (DAS) in November 2020. These recommendations involve the use of evidence-based assessments paired with person-centered counseling to address social disconnectedness among at-risk individuals. In this session, researchers from Georgia State University will define social disconnectedness, explain how it differs from related constructs, and discuss the necessity of a holistic approach to assessment; summarize the review and recommendations made to DAS; and present preliminary data from DAS’s initial implementation of the assessment process.
The Journal of Applied Gerontology: An International Forum for Information
Authors: Robison Julie 
Published: December 2021

Abstract
The mission of applied gerontology is to bridge science and practice to benefit the health and well-being of older persons, their families, their communities, and other contexts. This presentation will provide insights from the Journal of Applied Gerontology and its attempts to publish and disseminate scholarship that has international application. Following an overview of the growing internationalization of peer-reviewed submissions to the Journal of Applied Gerontology on a variety of topics and from a range of perspectives, the presentation will highlight key achievements as well as ongoing concerns and opportunities to better achieve the goals of applying gerontological scholarship to aging contexts worldwide. Concluding comments will examine how outlets for dissemination and authors themselves can better position their work to enhance their influence on aging in an international context.
Families as Valued Contributors to LTC Residents' Quality of Life: Policy Perspectives
Authors: Keefe Janice 
Published: December 2021

Abstract
Family members are essential contributors to Q0L of LTC residents. This paper analyzes how the system views family’s role in residents’ QoL and enables or inhibits family involvement. Our analysis of 21 policies that regulate LTC in four Canadian Provinces reveal differences in their portrayal of residents’ families. In many policies, family roles are characterized procedurally (task-oriented) or relationally (interactive) by policy type. Operational standards (regulatory policies) linked to licensing employ more formal terminology, while LTC program guidelines use facilitative language to engage families and build relationships through voluntary means. Specific examples of orientation and admission procedures, care protocols including use of restraints, right to live at risk, and end-of-life care are presented to reveal inter-provincial variations. We argue there are opportunities to further engage families within the current regulatory framework.
Tracing the Expression of Resident Quality of Life Policies in Canadian Long-Term Care Settings
Authors: Keefe Janice , Irwin Pamela 
Published: December 2021

Abstract
Policies favouring safety, security, and order are expressed in preference to those oriented towards person-centred resident quality of life in Canadian long-term care settings. Factors impacting the expression of these latent (under-utilised) rules were uncovered through an analysis of long-term care related policies in four provinces. 84 policies relating to resident quality of life in long-term care were analysed in three sequences, incorporating jurisdictions, policy types, and quality of life domains, over time. The analysis revealed three policy levers: situations–providing explicit and implicit examples of resident oriented quality of life policy suppression in each jurisdiction; structures–identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories–confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. Although these policies exist, their potentiality remains dormant in the dominant policy discourse, thereby signaling a positive post-pandemic possibility.
Energy and Fatigue Predict Gait Speed and Mood Decline: Results From the Health, Aging and Body Composition Study
Authors: Ehrenkranz Rebecca , Zhu Xiaonan , Glynn Nancy W , Rosano Caterina 
Published: December 2021

Abstract
Older adults may report high energy alongside tiredness or vice versa; little is known about whether discordant self-reported energy (SEL) and tiredness predict trajectories of mood, cognition, or gait speed. SEL (0-10 scale dichotomized at median) and tiredness (present/absent) were obtained in 2,613 older adults (aged 74.6± 2.87 years) and used to create four groups (energized/not tired, low energy/tired, energized/tired, low energy/not tired). Center for Epidemiologic Studies Depression Scale (CES-D) and gait speed were measured over 10 years; mixed effect models compared trajectories in these domains across each group with low energy/tired group as referent. Each group was significantly associated with CES-D and gait. Adjusting for demographics, the high SEL/not tired group showed the least decline in mood (ß = -0.17, p&lt;0.01); the high SEL/tired group showed the least decline in rapid gait (ß = 0.008, p = 0.02). High SEL may indicate resilience for mood and gait speed decline.
Deep Learning Methods Capture Non-Linear Brain Aging Patterns Underlying Alzheimer’s Disease and Resilience
Authors: Thrush Kyra , Higgins-Chen Albert , Markov Yaroslav , Sehgal Raghav , Levine Morgan 
Published: December 2021

Abstract
The current era of multi-omics data collection has enabled researchers to obtain exceptionally comprehensive profiling of disease subjects. However, exceptionally high dimensionality can ultimately be an obstacle to biological insight. Previously, we presented a method in which penalized regression of methylation principal components reduces noise and improves prediction of age, disease, and Alzheimer’s Disease (AD) pathophysiology. However, strictly linear methods may overly simplify the complex epigenetic aging landscape. We hypothesized that non-linear deep learning methods could identify molecular signatures that better reflect individual resilience to AD. Through the use of an autoencoder to represent high dimensional methylation array data, and supplemental machine learning methods, we connect latent nonlinear representations of the brain to aging, resilience, and indications of AD. In particular, resultant age-predicting representations of methylation were correlated with enrichment of methylation regions and biological pathways. Contextualized within AD pathology, this work provides valuable, ongoing insight into resilience in AD.
The Relationship Between Leadership Styles, Job Satisfaction, and Tenure Among Nursing Home Administrators
Authors: Peerman Carey 
Published: December 2021

Abstract
Long-term care is considered a subset of health care administration as the characteristics and leadership skills needed differ from other areas of health care. Leadership style directly relates to organizational development, success, and effectiveness. For study purposes, specific focus was placed upon determining the degree to which nursing home administrators (NHAs) perceived styles of leadership determined job satisfaction with tenure as an NHA. Perceptions of leadership style and levels of job satisfaction were determined using a non-experimental, quantitative design, specifically employing a survey research approach. The research instrument in this study, the MLQ, provided the data essential to addressing the research questions and accompanying hypotheses. The effect of study participant response to items on the MLQ associated with the research questions was assessed using univariate analysis of descriptive factors and inferential statistical techniques for statistical significance testing purposes. A total of 87% of study participants indicated that they perceived their leadership style as Nursing Home Administrators (NHA’s) was reflective of Transformational Leadership. However, findings indicated that participants who had a Transactional Leadership style were more likely than other types of leadership styles to select an NHA as a career path if given the opportunity to choose this line of work in the future.
East Meets West: Home and Community Based Care to Enhance Aging in Place
Authors: Amano Takashi , Inoue Megumi 
Published: December 2021

Abstract
Although the magnitude and rate of aging in Japan and the United States differ, the drastic change in population structure has resulted in common challenges in both countries. One challenge is assisting older people in staying in the community. Enhancement of home- and community-based care allows older people to remain in their homes or spaces of their choice without moving into an institution to receive necessary care. This symposium includes four presentations (two from Japan and two from the U.S.) examining various efforts surrounding home- and community-based care designed to strengthen older people’s abilities to stay in the community. The presenters will cover a wide range of strategies that have been implemented in both countries. The first presenter will describe the development and delivery of a project to expand Arizona’s dementia capable system. The second presenter will describe initiatives of a professional association of geriatrics to promote the concept of aging in place. The third presenter will discuss the Home Hazard Removal Program (HARP), a new home hazard removal and fall risk self-management program delivered in the home by occupational therapists. The fourth presenter will discuss Japan’s national policy priority of promoting the use of home health care within the community-based integrated care system. The symposium will conclude with a review of similarities and differences of various efforts, summarize common goals and challenges, and identify best practices.