bluuebunny/crossref_metadata_2025_split huggingface dataset:
Passive Infrared Motion Sensors Improved the Detection Accuracy of Nocturnal Agitation
Authors: Au-Yeung Wan-Tai , Miller Lyndsey , Beattie Zachary , Kaye Jeffrey 
Published: December 2021

Abstract
Actigraphy has been used to detect agitation in persons with dementia, although this technology must be worn by participants. Another promising sensing methodology is passive infrared (PIR) motion, which provides continuous, low-cost, and unobtrusive data, and may also improve the detection of agitated periods. Using data from the MODERATE (Monitoring Dementia-Related Agitation Using Technology Evaluation) study, we compared the predictive value of detecting agitation in a male participant, who was 64 years old with Alzheimer’s disease (AD), living in a memory care unit, and monitored with actigraphy on his wrist and four PIR motion sensors within his living quarters. The participant’s medical record indicated that he experienced agitation during 17 nights over 96 consecutive days. 929,037 data points were captured for analysis. From each night, the features extracted from the actigraphy wearable included total and standard deviation of activity counts, activity counts in the most and the least active hours, and median activity counts in one hour. Features extracted from the PIR motion sensors included dwell durations in the areas around bed, sofa, front door and bathroom, and the number of transitions between these areas. Using logistic regression to predict agitated periods, comparable classification performances were achieved using these two sets of features (AUC = 0.74 for wearable and AUC = 0.71 for PIR motion sensors). When these two sets of features were combined, the classification performance showed notable improvement (AUC = 0.83). This study points to the value of utilizing PIR motion sensors for detecting dementia-related agitation.
Personal and Environmental Challenges of Aging in Place with Long-Term Mobility Disabilities
Authors: Ramadhani Widya , Rogers Wendy 
Published: December 2021

Abstract
Maintaining independence while aging in place at home requires support, especially for older adults aging with long-term mobility disabilities. As age-related changes progress, individuals with long-term mobility disabilities experience more challenges engaging with daily living activities (ADLs) and instrumental activities of daily living (IADLs). To understand the activity challenges of these older adults, we analyzed the interview data from the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study, a comprehensive user needs assessment of 60 older adults who have had mobility disabilities for at least ten years (Koon et al. 2019). We selected interview data that focused on the conduct of ten activities at home: bathing, dressing, moving around, toileting, transferring, doing hobbies, housekeeping, home maintenance, managing diet and nutrition, and caring for others. This archival study used the coding schemes from the ACCESS study that were developed using both conceptual- and data-driven approaches (Koon et al., 2019). The ecological theory of adaptation and aging (Nahemow and Lawton, 1973) was the underlying framework to identify the challenges related to older adults' functional capacity (personal) and physical environmental barriers (environmental). We identified five main challenges: physical strength, general health limitations, mobility limitations, physical access, and transferring. Older adults' responses to overcoming the challenges involved personal, environmental, and person-environment interaction strategies. This study provides insights into the relationship between the source of environmental barriers and personal coping strategies to guide the design of appropriate aging in place supports for older adults with mobility disabilities.
Predictors of Food Insecurity Before and During COVID-19 Among Middle-Aged and Older Adults
Authors: Cheng Jianjia , Nicklett Emily 
Published: December 2021

Abstract
The indirect impact of COVID-19 on food security of middle aged and older adults is not well understood. This study examines changes in risk factors for food security from 2018-2020 in a population-based sample. Using data from the Health and Retirement Study (2018 and 2020 waves), we utilized generalized estimating equations (GEE) with repeated measures to examine factors associated with food insecurity among US adults aged 50 and older (n=3170) before COVID-19 and since COVID-19. The prevalence of food insecurity doubled from 2018 (4.83%) to 2020 (9.54%). In multivariate analyses, the population-averaged odds of experiencing food insecurity was 81% higher in 2020 compared to 2018. Other factors significantly associated with higher odds of food insecurity included being female (OR: 1.29), Black (OR: 1.46), lowest quintile for wealth (OR: 1.82), not working due to a disability (OR: 3.29), renting (OR: 2.04), greater IADL limitations (OR: 1.32), and greater number of chronic illness comorbidities (OR: 1.14). Factors significantly associated with lower odds of food insecurity included older age (65-74: OR: 0.73; 75+: OR: 0.56) and being above the median income level (OR: 0.47). Partnership status, education level, and ADL limitations were not significantly associated with the population-averaged odds of experiencing food insecurity. This study identified factors related to food insecurity among a community-dwelling sample of middle aged and older adults in the U.S. Future research should examine the impact of policies and intervention strategies to address the disproportionate impact of COVID-19 on populations at increased risk of experiencing food insecurity.
Relying on Myself: The Lived Experience of Being at Risk for Falling in the Hospital Among Older Adults
Authors: Dolan Hanne , Rishel Cindy , Rainbow Jessica , Taylor-Piliae Ruth 
Published: December 2021

Abstract
Inpatient falls are a persistent problem and despite research efforts during the last decade, inpatient fall rates have not significantly decreased. Older adults have an estimated 50% greater inpatient fall rate than younger adults. How older adults perceive their own fall risk affects their adherence to fall prevention recommendations. The aim of this phenomenological study was to gain a deeper understanding of the lived experiences of being at risk for falling in the hospital among older adults aged 65 years and older (N=9). Participants (female=55%, age range=67 – 86) were interviewed twice using video conferencing within two weeks of hospital discharge. The audio-recorded interviews were transcribed, and then analyzed using van Manen’s interpretive phenomenological method. The Health Belief Model expanded with the concepts of independence, fear of falling, embarrassment, dignity, and positivity effect served as the theoretical framework. Five major interpretive themes emerged: Relying on Myself, Managing Balance Problems in an Unfamiliar Environment, Struggling to Maintain Identity, Following the Hospital Rules, and Maintaining Dignity in the Relationships with Nursing Staff. These themes describe how the participants thoughtfully planned their mobilization to avoid falls. This process was influenced by their struggling to remain independent, following the hospital fall prevention rules out of politeness, and experiencing both positive and negative relationships with nursing staff. Hospitalized older adults employed their self-efficacy to manage balance problems in the hospital. These findings have not been previously documented in the literature. Fall prevention interventions supporting hospitalized older adults’ self-management of fall risk are needed.
Mitigating Implicit Racial Bias in the Clinical Setting: A Qualitative Study of Family Medicine Residents
Authors: Goroncy Anna 
Published: December 2021

Abstract
Implicit racial bias (IB) in physicians contributes to racial health inequities. Health profession trainees are not consistently trained to address IB. This phenomenological study explored Family Medicine (FM) residents’ experience of applying strategies to mitigate IB during home visits (HVs) to homebound older adults. FM residents completed pre-work related to IB, applied strategies to mitigate IB during HVs, then completed written reflections and commitments-to-change (CTC). A two-month survey assessed completion of targeted changes and barriers faced. Researchers completed a thematic analysis identifying five themes: Response to IAT, barriers, strategies, value of HVs and mindfulness. All residents’ stated level of CTC remained the same (9/9, 100%) and 8/9 residents (89%) had partially or fully implemented their intended change at 2 months. Residents continued applying newly-learned strategies two months after training with transference to other clinical settings and bias types. These findings can facilitate development of clinically-based IB curricula with lasting impacts.
The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia.
Authors: Gavin Nicole , Shan Mu , Johns Shelly , Judge Katherine , Fowler Nicole 
Published: December 2021

Abstract
Anticipatory grief is the process of experiencing normal bereavement before the physical death of a significant person. To date, anticipatory grief has been related to higher levels of caregiver depression, anxiety, subjective burden, and poorer problem solving. Additionally, higher levels anticipatory grief are observed in caregivers of those with Alzheimer’s Disease and Related Dementias (ADRD) compared to caregivers of those with mild cognitive impairment, implying a relationship between disease severity and caregiver anticipatory grief. Analyses were performed on data for ADRD caregivers (n=56) enrolled in the IU Telephone Acceptance and Commitment Therapy for Caregiver (TACTICs) trial; an RCT evaluating an ACT intervention for ADRD caregivers with anxiety. Inclusion criteria included identifying as the primary caregiver of an ADRD patient, and clinically significant anxiety (GAD7 score &gt;10). The average age of caregivers was 61.9 years, 41.1% were spouses, 83.9% were white and 14.3% were black. Mean anticipatory grief scores were notably higher (84.6) compared to the previously reported means across the literature (74.9). Using multiple regression models, we determined a caregivers’ anticipatory grief, as measured by the anticipatory grief scale, is not significantly associated with the patients’ dementia severity, as measured by the Dementia Severity Rating Scale (DSRS) (p=0.66), Results revealed that higher levels of caregiver burden, as measured by the Zarit Burden Index, are significantly associated with more anticipatory grief (p&lt; 0.01). Understanding these relationships contributes to a better understanding of ADRD caregivers, identifying “high-risk” caregivers, and informing future interventions and care.
A Student-Led Community Outreach Telehealth Program for COVID Education and Health Promotion (COACH)
Authors: Yang Michelle , Clayton Cam , Harris Devin , Pelletier Chelsea , Schmidt Julia , Zwicker Jill , Sakakibara Brodie 
Published: December 2021

Abstract
While public health measures of quarantining, socially isolating, and physical distancing are important to minimize the spread of coronavirus (COVID-19), these actions may also compromise the ability to manage one’s own health, thereby increasing the risk of adverse health events. The purpose of this study was to evaluate a student-delivered Community Outreach teleheAlth program for Covid education and Health promotion (COACH) to community-living adults (age ≥65 years). We hypothesized that COACH would improve health promoting behaviour as measured by the Health Directed Behaviour subscale of the Health Education Impact Questionnaire. We also anticipated COACH would improve secondary outcomes of perceived stress, depressive and anxiety (Depression, Anxiety, and Stress Scale-21), social support (Medical Outcomes Study Social Support Survey), health-related quality of life (Short Form-36), and health promotion self-efficacy (Self-Rated Abilities for Health Practices Scale). In this single-group pre-post study, we recruited 75 community-living adults with access to telephone/video-conferencing technology to participate in six 30-45 minute sessions with trained medical students over a two-month period. The mean age of participants was 72.4 years (58.7% female), with 80% reporting two or more chronic conditions. No participants were diagnosed with COVID-19 during participation. Paired sample t-tests showed significant improvement in health directed behaviour (p &lt; .001, d = 0.45) and self-efficacy (p &lt;.001, d = 0.44), but significant decrease in mental health-related quality of life (p &lt; .001, d = -1.69). Overall, COACH may help improve health directed behaviour and health promotion self-efficacy, despite decreases in mental health possibly associated with COVID-19 restrictions.
Association of Dual Sensory Impairment with Long-term Depressive and Anxiety Symptoms
Authors: Armstrong Nicole , Teixeira Camila Vieira Ligo , Brenowitz Willa , Swenor Bonnielin , Powell Danielle , Simonsick Eleanor , Jones Richard , Gendron Colby 
Published: December 2021

Abstract
Hearing (HI) and vision impairment (VI) are each independently associated with long-term depressive and anxiety symptoms, but the joint effects of both (DSI) may be associated with a greater risk of belonging to long-term chronically high depressive and anxiety trajectory classes. Multinomial logistic regression models adjusted by demographics and depressive symptoms were used to examine the associations of dual hearing (pure-tone average &gt;25 dB) and vision impairment (impaired visual acuity and/or contrast sensitivity) with long-term depressive and anxiety symptom trajectory classes among 2,102 participants of the Health, Aging and Body Composition Study, a cohort of older adults without mobility difficulty aged 70-79 years. An additional model evaluated the two-way interaction between DSI and social contact. Elevated depressive symptoms were defined as ≥8 on the 10-item Center for Epidemiologic Studies-Depression Scale, and anxiety symptoms were defined as present on the Hopkins Symptom Checklist. DSI was associated with increased risk of being chronically depressed (Risk Ratio, RR=1.86, 95% Confidence Interval, CI: 1.19, 2.92), not periodically depressed (RR=1.24, 95% CI: 0.91, 1.69). Those with DSI were at an increased risk of belonging to the periodically anxious (RR=1.56, 95% CI: 1.14, 2.13) and chronically anxious (RR=1.79, 95% CI: 1.02, 3.12) groups, as compared to the other groups. Single sensory impairments were not associated with increased risk of being periodically or chronically anxious. Social contact did not modify any associations. Synergistic effects between HI and VI were present. Those with DSI may be at greater risk for mood disorders, so sensory evaluations may mitigate these.
Diabetes, Obesity, and Osteoporosis in an Ethnically Diverse Population of Women Receiving Osteoporosis Screening
Authors: Kahsay Feven , Yang Wendy , Chandra Malini , Lee Catherine , Thompson Nailah , Lo Joan 
Published: December 2021

Abstract
Osteoporosis screening by bone density (BMD) testing is recommended for women aged 65-75 years. However, patients with diabetes, a risk factor for fracture, often have higher body mass index (BMI) which contributes to higher BMD. These factors may vary by race/ethnicity. The relationship of diabetes (≥2 diagnoses and treatment), obesity (BMI ≥30), and BMD-defined osteoporosis (femoral neck BMD T-score ≤ -2.5) was examined in a diverse primary care population of 44,313 non-Hispanic White, 6,103 Black, 7,777 Hispanic, and 12,634 Asian women aged 65-75 years who underwent BMD screening. Those with recent fracture, osteoporosis treatment, bone disorders, and metastatic cancer were excluded. Modified log-Poisson regression was used to examine the association of diabetes and BMD-osteoporosis. Among 70,827 women, 18% had diabetes. The prevalence of diabetes was 2-fold higher in Black, Hispanic and Asian women compared to White women. Overall, women with diabetes (versus no diabetes) were more likely to be obese and, except for Hispanic women, less likely to have BMD-osteoporosis. In unadjusted analyses, diabetes was associated with lower risk of BMD-defined osteoporosis in White, Black, and Asian women, but not Hispanic women. However, the association was attenuated or no longer evident after adjusting for BMI, suggesting that the lower burden of BMD-osteoporosis in women with diabetes is mediated in part by higher BMI. These findings support consideration of diabetes when assessing fracture risk in women undergoing osteoporosis screening. However, more studies in non-White populations with a high burden of diabetes are important since these relationships appear to differ by race/ethnicity.
Impact of APOE Genotype on Diet-induced Mitochondrial Adaptations in Mouse Skeletal Muscle
Authors: James Niaya , Shonde Oyinkansola , Jones Nahdia , Mulgrave Verona E , Rebeck G William , Allard Joanne 
Published: December 2021

Abstract
Apolipoprotein E (APOE), a component of lipoproteins that facilitates cholesterol transportation, has three variants in the human genome: APOE2, E3, and E4. Prior research found that carriers of APOE4 are more susceptible to developing Alzheimer's disease (AD) and other brain disorders than those who possess other APOE alleles, and that these carriers are also predisposed to mitochondrial impairment– an early characteristic of neuronal dysfunction. Peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1ɑ) is a major biomarker for mitochondrial biogenesis and function and cytochrome c oxidase subunit IV (COX4) is the terminal enzyme of the mitochondrial respiratory chain. Decreased measures of these proteins indicate reduced mitochondrial function. Aside from genetic inheritance, lifestyle factors such as diet and exercise significantly impact one’s risk for mitochondrial dysfunction and AD. In these studies, we examined the impact of APOE variance on physiological adaptations induced by either exercise or a high-fat diet, with a focus on biomarkers of mitochondrial function. Western blots were used to measure COX4 and PGC-1ɑ levels in skeletal muscle tissue from female APOE3 and APOE4 knock-in transgenic mice. Based on performance on a motorized rotating rod and voluntary wheel-running, we deduced that female APOE4 mice exhibit reduced motor coordination and activity relative to APOE3 mice. APOE4 mice also had reduced COX4 levels that were increased by the high-fat diet. In contrast, COX4 levels in APOE3 mice were reduced in the high-fat diet group. Our data show that diet and APOE genotype interact to produce adaptations in mitochondrial proteins in skeletal muscle.
Impact of Neighborhood Socioeconomic Disadvantage on Staffing Hours in US Nursing Homes
Authors: Falvey Jason , Hade Erinn , Friedman Steven , Deng Rebecca , Travers Jasmine 
Published: December 2021

Abstract
Severe socioeconomic disadvantage in neighborhoods where nursing homes (NH) are located may be an important contributor to disparities in resident quality of care. Disadvantaged neighborhoods may have undesirable attributes (e.g., poor public transit) that make it challenging to recruit and retain qualified staff. Lower NH staffing could subsequently leave residents vulnerable to adverse events. Thus, the purpose of this study was to evaluate whether NHs located in socioeconomically disadvantaged neighborhoods had lower healthcare provider staffing levels. We linked publicly available NH data geocoded at the Census block-group level with the Area Deprivation Index, a measure of neighborhood socioeconomic factors including poverty, employment, and housing quality (percentiles: 1-100). Consistent with prior literature on threshold effects of neighborhood poverty on outcomes, we characterized NHs as being located in a disadvantaged neighborhood if the census-block group ADI score was ≥85/100. We used generalized estimating equations clustered at the county level with fixed effects for state and rural location to evaluate relationships between ADI score and staffing. NHs located in socioeconomically disadvantaged neighborhoods had 12.1% lower levels of staffing for registered nurses (mean: 5.8 fewer hours/100 resident-days, 95% CI: 4.4-7.1 hours), 1.2% lower for certified nursing assistants (2.9 fewer hours/100 resident days; 95% CI 0.6-5.1 hours), 20% lower for physical therapists (1.4 fewer hours/100 resident-days; 95% CI 1.1-1.8 hours), and 19% lower for occupational therapists (1.3 fewer hours/100 resident-days; 95% CI 1.0-1.6 hours). These findings highlight disparities that could be targeted with policy interventions focused on recruiting and retaining staff in socioeconomically disadvantaged neighborhoods.
Low Cognitive Performance Increases The Risk Of Hospital-Associated Complications In Older Adults
Authors: Souza-Talarico Juliana , Yamaguti Siomara , Dutra Adriana , Apolinario Daniel 
Published: December 2021

Abstract
Considering the limited evidence regarding the factors that contribute to long-term consequences after hospitalization of older people, we analysed the relationship between cognitive performance and hospital-associated complications (HAC). One thousand, three hundred Individuals aged 60 and older (mean age 82.3, 53.3% female), not assigned to palliative care and admitted in medical and surgical wards from a private hospital, were followed up from admission to 30 days after discharge. HAS was evaluated using a multicomponent measure that combines 12 hospital-associated complications (delirium, functional decline, falls, pressure injuries, bronchoaspiration, non-planned ICU transfer, physical restraints, hospital stay &gt; 30 days, death, long-term care transfer, and readmission). Cognitive performance was assessed using the "10-point cognitive screener (10-CS)", which combines temporal orientation, category fluency, and word recall evaluation. Results: Overall, 464 (35.7%) participants had one or more HAC during their admission. Patients with HAC showed lower 10-CS scores than those with in HAC (p &lt;0.001). Adjusting for sociodemographic data, medication, chronic diseases, delirium screening, functional performance, each 10-CS point decreased the HAC changes by 19.2% (odds ratio = 0.808; 95% CI = 0.660 – 0.990). Conclusion: These findings show that low cognitive performance was significantly associated with the risk of developing HAC during hospitalization and within 30 days after discharge. That evidence forms the critical foundation for the next steps towards validating the accuracy of these models in predicting vulnerability to HAC and developing screening tools to be used at the point of care.