bluuebunny/crossref_metadata_2025_split huggingface dataset:
DISPARITIES IN HEALTH OUTCOMES AMONG MIDDLE-AGED AND OLDER SEXUAL MINORITY CANCER SURVIVORS
Authors: Brown Maria , McElroy Jane 
Published: January 2025

Abstract
This cross-sectional, exploratory study analyzed 2021 Behavioral Risk Factor Surveillance System public-use data for a propensity-score matched sample (N=25,545), from states that collected sexual identity and cancer survivorship information, to explore health outcomes among sexual minority (SM) and non-SM cancer survivors. In bivariate analysis, SM survivors had more chronic conditions than non-SM survivors (males 45-64 years: 1.67 vs 1.03; females 45-64 years: 1.46 vs 1.16) and were more likely to report multiple chronic conditions (males 45-64 years: 44.5% vs 29.0%), depressive disorders (males 45-64 years: 42.9 vs 23.4%; males 65+ years: 20.8% vs 11.2%; females 45-64 years: 52.9% vs 36.5%; females 65+ years: 42.7% vs 41.3%), and difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition (females 45-64 years: 30.1% vs 18.9%; males 65+ years: 15.9% vs 8.5%). In logistic regression models, after controlling for demographics, health, and health behaviors, SM males and females in both age groups had similar odds of being a cancer survivor as their non-SM counterparts, and greater odds of poor health, multiple chronic conditions, depressive disorder, ADL limitations, and difficulty concentrating, remembering, or making decisions. Cancer status was not always associated with these outcomes. Further research should explore treatment experiences and factors contributing to disparities within this population and among SM cancer survivors and assess whether health outcomes of SM cancer survivors are related to stage of disease at diagnosis, time since treatment, or decisions made during treatment.
TRANSGENDER OLDER ADULTS HOSPITAL USE IN SOUTH CAROLINA
Authors: May Jennifer , Smyles Hanna , Adams Swann 
Published: January 2025

Abstract
Transgender adults in the South represent a unique population with health disparities and care inequities due to longstanding false stereotypes and discrimination surrounding their transgender status. Transgender adults report less access to health insurance, lower quality of life, and severe mental distress compared to the general U.S. population. There is a paucity of literature identifying the hospital patterns of transgender older adults (≥50 years). This study examines hospital utilization among transgender older adults (≥50 years) in South Carolina to describe their demographic characteristics and use of inpatient, outpatient surgery, and emergency department services. We conducted a secondary analysis of restricted hospital claims data from 2000 to 2022; identified transgender adults, using ICD-9 and ICD-10 codes, who used hospital services in South Carolina. Patient demographics and clinical data were analyzed using descriptive statistics. We identified 382 unique individual transgender adults with our algorithm. Most identified as White (76%); 70% were in the age range of 50-59; sex as reported on the administrative record was mostly male at 51%. 78% (n=299) of transgender adults were from urban areas. Transgender adults could have had more than one type of hospital use with 272 unique individuals using inpatient hospital services, 334 unique individuals using outpatient hospital services, and 346 unique individuals using emergency room services. Understanding the hospital use and the urban vs rural location of the transgender adult population can help identify state resource allocation, capacity building, and creating a foundation for bolstering health services and reducing health inequities.
ORAL HYGIENE AND THE INCIDENCE OF FUNCTIONAL DECLINE IN OLDER ADULTS AGED ≥75 YEARS: THE OHSAKA STUDY
Authors: Otsuki Naoko , Mameno Tomoaki , Takeuchi Satoko , Ikebe Kazunori , Kono Ayumi , Yamamoto Ryohei 
Published: January 2025

Abstract
Poor oral health has been identified as a risk factor for overall health. Management of oral problems is highly significant in the field of public health. This retrospective cohort study aimed to clarify the association between the oral hygiene and the incidence of functional decline in 134,957 participants aged 75 years or older, who underwent public dental checkups in Japan. The oral hygiene levels were scored by dentists as excellent, good, or poor. The outcome was the identification of functional decline based on Long-term Care Insurance certification. An association between the oral hygiene and the incidence of functional decline were assessed using the Fine and Gray model adjusted for clinically relevant factors. During the median observational period of 36 months, the incidence of functional decline was observed in 3,360 (5.3%) men and 2,693 (3.8%) women. The multivariable-adjusted model showed that poor oral hygiene was associated with functional decline in both men and women, respectively (Sub-hazard ratios [95% confidence interval] of Excellent, Good, and Poor: 1.00 [reference], 1.10 [0.99–1.24], and 1.57 [1.33–1.84], respectively for men; 1.00 [reference], 1.29 [1.14–1.46], and 1.56 [1.23–1.97], respectively for women). The findings of the present study suggest that municipal healthcare planning and home care should recommend oral hygiene in older adults aged ≥75 years.
CRITICAL ANALYSIS OF A PRAGMATIC TRIAL TO IMPROVE CHRONIC PAIN MANAGEMENT IN A WELFARE STATE
Authors: Draeger Dagmar , Koios Daniela , Wenzel Arlett , Budnick Andrea 
Published: January 2025

Abstract
High pain intensity and substantial pain interferences impact older community-dwelling adults with a certified need for care, while their pain management is not up to standard. A three-arm cluster-randomized pragmatic trial was conducted, with individualized interventions (IG1), digital staff training (IG2), and a control group (CG). The target group was home-care recipients (aged ≥65 years) with chronic pain. We recruited 190 participants from 22 home care providers (=clusters), drop-out rate was 24%. An expert panel communicated individualized nursing and medical recommendations for each IG1-participant. Nurses and physicians in IG2 were offered digital training. CG-participants received standard care. A dichotomous assessment regarding the acceptability of each participant’s pain situation is the primary outcome for this analysis (group differences assessed by χ²-tests). At baseline, 48.4% of participants described their pain situation as “not acceptable”. At follow-up, 15.9% stated an improvement of their pain situation, while the majority (70.7%) indicated stagnation or worsening (12.4%). There are no differences between the three study-arms. Staff commitment regarding intervention implementation did not meet the pre-defined requirements and varied substantially. Physicians and nursing staff cited heavy workloads, staff shortages etc. as arguments for not implementing interventions. While executives’ support is essential, commitment of those that are supposed to carry out interventions or changes is paramount. Implementing improved pain management in a pragmatic setting encountered structural obstacles in the German health system. When planning pragmatic trials, barriers to implementing interventions under real-world conditions must be critically discussed. We recommend involving required staff early in the planning process.
EVALUATION OF A COMMUNITY-BASED CURRICULUM ON WELLNESS AND SAFE PAIN MANAGEMENT: A PRELIMINARY ANALYSIS
Authors: Tanbonliong Gretchen , Vafiadis Dorothea , Plunkett Laura , Silberman Susan , Hou Erin , Hatch Maddy , Guidry John 
Published: January 2025

Abstract
The body of recent evidence-based interventions for pain self-management targeted at community-dwelling older adults is limited. The aim of this ongoing pilot study is to determine the efficacy of a six-week curriculum in promoting knowledge, attitudes, and behaviors related to wellness and safe pain management among older adults who were recruited via community-based organizations. Interim results from a sample survey analysis of 6 out of 8 cohorts (n=87) in a quasi-experimental crossover design showed that majority of the participants (91%) were White (63%) and Black (28%) women between the ages of 60 to 79. On a scale of 1 to 5 where “4” indicates that the knowledge or behavior is being implemented, 100% of the pain prevention strategies (i.e., maintaining a healthy weight or losing weight; engaging in physical activity; getting adequate sleep; and avoiding/limiting caffeine, tobacco, or alcohol) and two pain management strategies (“using topical therapies such as gels and creams” and “cleaning out old and expired medicines”) met this threshold post-curriculum. There were statistically significant differences observed in participants’ individual acceptance and commitment to cognitive behavior therapy (p=0.0015); adoption of meditation and/or mindfulness techniques to manage pain (p=0.0118); and reported more effective pain management (p=0.0109) between the post-curriculum and 6-week follow-up period. These preliminary findings suggest that the curriculum was an effective intervention for safe pain management among community-dwelling older adults. It has potential to be replicated across multiple community-based organizations and to target other underrepresented groups in the older adult population.
A NEW LOOK AT NEUROTICISM: FINDINGS FROM THE IOWA UNMARRIED SURVIVORS STUDY
Authors: Hensley Robert , Martin Peter , Bishop Alex 
Published: January 2025

Abstract
The purpose of this study was to analyze the association between personality traits and other variables relative to Neuroticism reported by N = 227 (M = 78.2, SD = 8.1) participants from the Iowa Unmarried Survivors Study. Using the development adaptation model as a conceptual framework (and Neuroticism as the dependent variable), a series of blocked multiple regression analyses were conducted. In the first block, age, gender, ethnicity, total years of education, and current marital status were included. The second block contained selected childhood variables, whereas the third block contained the personality variables, and the fourth block included the Venting subscale of the Brief COPE, social support, depression, stress, and loneliness. Recalled childhood abuse emerged as a significant predictor of Neuroticism, β =.118, p &lt;.05. If one was abused in childhood, one would show higher levels of Neuroticism. In addition, both venting and loneliness were significant predictors of Neuroticism, β =.120, p &lt;.05, β =.191, p &lt;.05 respectively. Moreover, stress and depression served as significant predictors of Neuroticism, β =.208, p &lt;.01, β =.432, p &lt;.01 respectively. This model explained 64% of the variance in Neuroticism scores. Although a causal relationship cannot be established via this model, the mulitdirectional nature of Neuroticism is noteworhy. Results from this study have implications relative to how geriatric social workers and aging service providers develop interventions and programming to improve mental health and quality of life for persons who remain unmarried throughout later life.
TRANSITIONS OF ASSET POVERTY AND DEPRESSIVE SYMPTOMS: A COMPARISON BETWEEN URBAN AND RURAL CHINESE OLDER ADULTS
Authors: Hu Ting , Chen Yu-Chih 
Published: January 2025

Abstract
Urban-rural disparities and asset poverty are being examined individually as critical socioeconomic factors influencing depression among older adults. However, while asset poverty, a dynamic condition evolving over the life span, is significantly influenced by urban-rural residency and household registration (hukou) status in China, the extent of their contribution to the relationship between asset poverty transitions and depressive symptoms in later life remains largely unexplored. Using four waves of the China Health and Retirement Longitudinal Study, we examined how asset poverty affects depressive symptoms among 7,982 adults aged 60 and older and the interaction effects by rural/urban areas. The fixed effect regression models revealed that older adults who transitioned from a non-asset-poor status to an asset-poor status reported elevated levels of depression compared to those who maintained a non-asset-poor status. Furthermore, significant interaction effects were found in the relationship between asset poverty and depressive symptoms. The simple slope analyses revealed that the effect of transitioning to asset poverty on depression was only significant for older adults living in rural areas or with rural hukou. The findings highlight the necessity of prioritizing policies to build a financial support system for older adults and promoting asset building to mitigate the negative impacts of asset poverty on mental well-being in later life, particularly for those in rural areas or with rural hukou. Additionally, efforts at reducing urban-rural disparities in social and family support and within the social welfare system should be advocated.
TARGETED SCREENING FOR LIVER FIBROSIS: IDENTIFYING HIGH-RISK ADULTS FOR TRANSIENT ELASTOGRAPHY EVALUATION
Authors: Namrouti Amina , Chaves Paulo 
Published: January 2025

Abstract
Non-alcoholic fatty liver disease (NAFLD) poses a significant clinical concern, impacting over 30% of the general population and leading to potentially reversible liver fibrosis, cirrhosis, and physical frailty. Transient elastography (TE) offers a non-invasive screening tool, measuring liver stiffness as an indicator of hepatic fibrosis, guiding subsequent biopsy decisions. However, TE’s availability and cost hinders its widespread use. Clinical practice relies on individual indicators like obesity for TE testing referrals. We aim to assess the accuracy of traditional indicators and explore whether combining readily available indicators in primary care settings could enhance screening accuracy. We conducted a cross-sectional analysis using National Health and Nutrition Examination Survey (NHANES) 2017-2020 data, involving adults aged ≥ 40 years without excessive alcohol consumption, cirrhosis, or hepatitis B/C. We evaluated liver stiffness measurements (LSM) &gt;7pKa by TE as the outcome. Various predictors, including systemic diseases, examination findings, and laboratory tests, were assessed using stepwise logistic regression with sampling weights. Area under the receiver operating curve (AUC-ROC) was utilized to compare predictive accuracy across models. Results showed modest accuracy of individual indicators with AUC-ROC of 52%. The final model, incorporating diabetes, BMI&gt;30 kg/m2, HR, A1c, FIB-4&gt;3.25, APRI&gt;0.5, and AST&gt;40 IU/l, yielded an improved AUC-ROC of 74%. Combining primary care indicators enhanced identification of at-risk adults for abnormal LSM, compared to relying solely on individual indicators. Further research is necessary to determine the optimal combination of indicators for identifying individuals at risk of liver fibrosis who may benefit from TE screening.
RESOLUTION OR WORK STRESS? WHY DOES RETIREMENT CHANGE HEALTH BEHAVIOR?
Authors: McKenzie Colin , Kajitani Shinya , Sakata Kei 
Published: January 2025

Abstract
The purpose of this paper is to examine the impact of retirement on actual health outcomes and intentions relating to these outcomes for Japanese men. The health outcomes investigated relate to alcohol and tobacco consumption, physical exercise, and psychological distress. This paper uses data from the first 15 waves of the Longitudinal Survey of Middle-aged and Elderly Persons (LSMEP) to estimate regression models explaining these health outcomes. An instrumental variable estimator using instruments constructed from the eligibility ages for various aspects of the Japanese pension is used to account for the endogeneity of retirement and income. Individual heterogeneity is dealt with by using a fixed effects estimator. It is found that there is no significant impact of retirement on the extent to which individuals report that they will take care not to drink too much, nor smoke too much, and to engage in a sufficient amount of exercise. Retirement leads to psychological distress declining, the proportion of men drinking alcohol to fall and the proportion who are smoking falls after retirement. The proportion of respondents engaging in moderate amounts of exercise increases following their retirement. Taken together, the results suggest that reductions in stress following retirement are driving the results. Falls in income associated with retirement explain little of the behaviour observed.
DISPARITIES IN HEARING LOSS AMONG OLDER ADULTS: HEALTH AND RETIREMENT STUDY, 2016–2018
Authors: Tan Nasya , Pike James , Kobayashi Lindsay , Clarke Philippa 
Published: January 2025

Abstract
As hearing loss becomes more prevalent in middle and older ages, more research is needed to identify factors associated with hearing loss among this population using nationally representative data. This study aimed to examine associations between sociodemographic factors and hearing loss using 2016-18 data from the Health and Retirement Study, a population-based cohort of US adults aged 51+ (n=17,468). Respondents self-reported hearing loss, age at assessment, gender, race/ethnicity, and education. We ran weighted logistic regression models that accounted for the complex survey design, stratified by gender and race/ethnicity. Covariates included year of assessment and birth cohort. Results showed that for every 5-year increase in age, the odds of hearing loss increased by 40% (95%CI=1.26, 1.55). Compared to White males, Black males were 42% less likely to have hearing loss (95%CI=0.44, 0.77). Compared to White females, Black females were 46% less likely to have hearing loss (95%CI=0.42, 0.70). Among men, those with less than a high school education were 23% less likely to have hearing loss (95%CI=0.63, 0.94)than college graduates. However, men with an associate’s degree or some college education were 34% more likely to have hearing loss (95%CI=1.14, 1.58). Education was not associated with hearing loss among women. This study highlights disparities in hearing loss in later life by race/ethnicity, gender, and education. It adds to the current literature by identifying disparities in hearing loss, and is the first study to examine hearing loss disparities using nationally representative data on middle-aged and older adults in the Health and Retirement Study.
EFFECT OF AWARENESS OF HEARING LOSS AMONG CARE RECIPIENTS ON ATTRIBUTES OF CARE PROVIDED: A NATIONAL STUDY
Authors: Powell Danielle , Zhang Wuyang , Reed Nicholas 
Published: January 2025

Abstract
Hearing loss (HL) is prevalent among older adults and may result in caregiving challenges due to communication barriers. This study aims to investigate whether care recipients’ awareness of HL is associated with attributes of care. Using data from Round 12 (2022) of the linked National Health and Aging Trends Study (NHATS) and National Study on Caregiving (NSOC), a sample of 1,133 (Mean age: 62±15 years; Female: 68%) caregivers assisting 713 older adults (Mean age: 83±8 years; Female: 63%; White: 63%) with audiometric HL was derived. From care recipients’ self-reported hearing difficulty and hearing aid use, HL awareness was defined as (1) unrecognized HL (no hearing difficulty or hearing aid use reported), (2) recognized HL (only hearing difficulty reported), and (3) managed HL (hearing aid use reported). Caregiving outcomes, including ADL/IADL-related care needs and past month hours of caregiving, were measured through self-report. Of all caregivers, 628 (55%) assisted older adults with unrecognized HL, while 162 (15%) and 343 (30%) assisted older adults with recognized and managed HL, respectively. Relative to unrecognized or managed HL, care recipients with recognized HL reported greater needs on ADL/IADL-related activities (≥3 ADL needs: 65.4% vs. 47.8%/45.0%; IADL needs: 55.1% vs 48.3%/40.0%). Results from models adjusted for multiple caregiver-recipient characteristics suggest time spent on care activities by caregivers of those with recognized HL and managed HL were 0.66 (95%CI:0.43-1.03) and 0.84 (95%CI:0.56-1.27) times lower than those with unrecognized HL. Supporting HL awareness and management as aligned with care needs may contribute to effective provision of care.
HOW HEARING DIFFICULTIES AND SOCIAL ACTIVITIES SHAPE TRAJECTORIES OF COGNITIVE FUNCTION AMONG OLDER MEXICANS
Authors: Han Chengming , Wong Rebeca 
Published: January 2025

Abstract
Objective. This paper aims to explore the role of social activities in the pathway between hearing difficulties and cognitive function among Mexicans □ 50 years over a longitudinal period. Method. Data were drawn from the Mexican Health and Aging Study (MHAS) 2015 to 2021. MHAS is a national longitudinal study of adults □ 50 years in Mexico, with baseline in 2001, and six waves completed by 2021. The analytical sample includes 8,049 Mexicans at wave 4 (2015). Cognition was operationalized as verbal memory and visual scanning scores. Multilevel ordinary least squares regression models were used to estimate the mediating effects of social activities on the association between hearing difficulties and cognition over 2015 to 2021. Results. There are 2766 (34.36%) respondents who reported having a poor or fair hearing in 2015, among whom only 9% used hearing aids. Poor or fair hearing was associated with reduced social activities, which in turn related to decreased visual scanning scores in 2021. Poor/fair hearing showed both indirect and direct effects on visual scanning scores. Reporting more social activities was associated with better cognition independently. Using a hearing aid was associated with lower verbal memory scores. Conclusion. There are few studies on sensory limitations and cognitive function that include populations in middle-income countries like Mexico. Although the results displayed on the similar mechanism on hearing difficulties and cognition in MHAS, the lower percentage of using a hearing aid suggested that Mexico has experienced rapid population aging with inadequate institutional social support for health care.
TRENDS IN PREVALENCE OF HEARING LOSS AMONG OLDER ADULTS AND UNPAID FAMILY CAREGIVERS IN THE UNITED STATES: 2011–2022
Authors: Zhang Wuyang , Powell Danielle , Reed Nicholas 
Published: January 2025

Abstract
Hearing loss (HL) prevalence rises with age and is a potential barrier to communication, a key component of caregiving relationships. With a rapidly aging population, the United States faces a surge in age-related HL prevalence in tandem with demand for disability-related care needs. We aim to estimate the trends in national prevalence of HL among (1) older adults receiving unpaid family care and (2) their caregivers. The National Health and Aging Trends Study (NHATS) and linked National Study of Caregiving (NSOC) provide nationally representative samples of Medicare beneficiaries and their family caregivers between 2011-2022. HL was measured through self-reported functional hearing ability (subjective) in both NHATS and NSOC until 2021, when NHATS introduced objective measures of hearing. In 2011, the prevalence of self-report HL was 31.7% (95% CI: 28.3%-35.4%) among care recipients and 7.9% (95% CI: 6.7%-9.3%) among caregivers. By 2022, the prevalence reached 34.9% (95% CI: 31.5%-38.4%) and 9.7% (95% CI: 8.1%-11.6%), respectively. Notably, prevalence of objective HL among care recipients more than doubled its subjective counterpart (73.5%; 95% CI: 69.2%-77.3%). Among caregiving dyads, 3.6% (95% CI: 3.5%-5.0%) had both parties reporting subjective HL and 5.7% (95% CI: 4.4%-7.3%) had caregivers with subjective HL assisting older adults with objective HL. Stratified analyses by sociodemographic characteristics suggested the prevalence of HL was higher among male, non-Hispanic White, or Hispanic care recipients along with spousal caregivers. Our findings suggest that HL is highly prevalent among both older care recipients and caregivers, and further investigation is needed to understand its caregiving consequences.