bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Social Connection/engagement Predicts Changes in Depressive Symptoms and IADL in Stroke
Authors: Elayoubi Joanne , Nelson Monica 
Published: December 2021

Abstract
Social connections/engagement have been found to be potentially protective against depression and declines in physical functioning. We examined whether social connection/engagement was protective against depression and functional decline after stroke. Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998-2012. Multilevel modeling was used to examine how social connection/engagement were associated with trajectories of depressive symptoms and limitations with instrumental activities of daily living (IADLs). Models controlled for age, gender, education, and race. In addition, analyses with depressive symptoms as outcome controlled for functional limitations with ADLs. Participants who were lonely and did not have friends in their neighborhood pre-stroke had more depressive symptoms at the time of stroke. Participants with close children pre-stroke showed less increase in depressive symptoms over time. Within-person increase in loneliness and within-person decline in providing help were related to more depressive symptoms post-stroke. Participants who felt lonely and did not provide help pre-stroke had more IADL limitations at the time of stroke. Smaller pre-stroke household size and pre-stroke volunteering were associated with less increase in IADL limitations with stroke. Within-person increase in having friends and providing help after stroke were associated with fewer IADL limitations post-stroke. Taken together, these findings suggest that social connection/engagement may buffer the negative psychological and physical outcomes of a stressful event such as stroke.
Loneliness, Social Isolation and All-Cause Mortality in Older Adults
Authors: Barnes Timothy , Tkatch Rifky , Ahuja Manik , Albright Laurie , Schaeffer James , Yeh Charlotte 
Published: December 2021

Abstract
As distinct constructs, loneliness and social isolation have both been associated with mortality in older adults. Many studies have examined each construct separately; however, few have examined their impact together, especially within the U.S. Using data from a large sample of U.S. adults age 65+ (N=7,982), the effect of loneliness and social isolation on all-cause mortality was examined considering their separate and joint effects. Measures were based on the UCLA-3 Loneliness Scale and the Social Network Index (SNI). Loneliness was categorized as: Severe, moderate, or no loneliness. Social isolation (defined by the SNI) was categorized as: Limited, medium, or diverse social networks (SN). Cox proportional hazards regression models were performed. Among participants, there were 328 deaths after data collection (4.1%). In separate, adjusted models, loneliness (severe, HR=1.86, 95% CI: 1.43-2.41 and moderate, HR=1.51, 95% CI: 1.16-1.98) and social isolation (limited SN, HR=2.37, 95% CI: 1.72-3.27 and moderate SN, HR=1.55, 95% CI: 1.12-2.14) were both associated with mortality. Modeled together, loneliness (severe, HR=1.55, 95% CI: 1.18-2.04 and moderate, HR=1.40, 95% CI: 1.07-1.83) and social isolation (limited SN, HR=2.08, 95% CI: 1.49-2.89 and moderate SN, HR=1.46, 95% CI: 1.05-2.02) both remained significantly associated with all-cause mortality with limited SN as the stronger indicator. Results demonstrate that both loneliness and social isolation contribute to greater risk of mortality among older adults. Furthermore, individuals with limited SN are at greatest risk. As the COVID-19 pandemic continues, loneliness and social isolation should be targeted safely in efforts to reduce mortality risk among older adults.
Social Support Moderates the Impact of Marital Transitions on Depression for Older Adult Women
Authors: Tucker Julia , Bishop Nicholas , Wang Kaipeng , Phillips Farya 
Published: December 2021

Abstract
Given the rapid growth of older Americans and the increased incidence of divorce among this population, it is paramount to identify negative health outcomes following marital transition and investigate the potential protective role of social support. Our study aims to identify relationships between change in depression and marital transitions, test whether social support moderates this association, and to examine variation by gender. The sample included 3,705 participants from the Health and Retirement Study, who reported being married or partnered in 2012. Changes in marital status were measured between 2012 and 2014 (remained married/partnered (reference), divorced/separated, and widowed). Depression was measured using the Center for Epidemiological Studies Depression short form (CESD-8). Three types of social support from family, friends, and children were assessed: social support, social strain, and social contact. Autoregressive multiple regression was used to examine the relationship between change in depression, marital transitions, social support, and gender. Widowhood and social strain were independently associated with an increase in CESD-8 scores between 2012 and 2014. Significant interactions between social support and social strain, and separation/divorce were identified, and the relationship between social support, depression, and divorce varied by gender. Change in depression was positively associated with social support for separated/divorced females, but not separated/divorced males. These results indicate that social support may modify the influence of divorce on changes in depression among recently divorced older females. These findings can help mental health service providers more effectively target older adults at the greatest risk of depression after experiencing a marital transition.
Understanding Technology Anxiety by the Interaction between Social Support and Educational Context
Authors: Joo Susanna , Lee Changmin , Kim YoonMyung , Kim Chang Oh , Lim Yun Mook , Jun Hey Jung 
Published: December 2021

Abstract
The purpose of this study was to examine the interaction effects of social support from family and educational contexts on technology anxiety among Korean older adults. We collected data by online recruiting in February 2021, and the sample was Korean older adults without dementia (N=310; 65-89 years old). The dependent variable was technology anxiety, which meant the expected degree of worry under the assumption that a wearable robot for exercise was used. Independent variables were four types of social support (emotional, instrumental, physical, and financial support) provided by family members, such as spouse, children, or siblings. The moderating variable was the binary educational context (high school and under=0; college level and over=1). Interaction effects were estimated by bootstrapping and PROCESS macro with four regression models about each type of social support. Results showed the interaction effect between physical support and educational context was significant on technology anxiety. Concretely, getting more physical support was significantly associated with a lower level of technology anxiety for highly educated older adults, while it was not significant for less-educated older adults. There was no additional type of social support which had not only significant interaction effects with educational context but also main effects on technology anxiety. It suggested that providing direct physical help, including daily care or assistance, could decrease feeling technology anxiety, especially not for less-educated seniors but for highly educated Korean older adults.
Action Planning Checklist for Social Determinants of Health: Older Adults with Chronic Conditions
Authors: Ilardo Joan , Zell Angela 
Published: December 2021

Abstract
Medical residents need training to assess social determinants of health (SDOH) related to chronic conditions. We created a checklist to identify SDOH affecting residency clinic patients’ ability to manage chronic conditions. The tool: 1) involves resident training; 2) provides decision support checklist; 3) influences patient activation; and 4) increases provider and patient communication through shared decision making. Action Planning Guide checklist (APG) includes questions pertaining to SDOH preventing patients from managing their chronic conditions and actions patients will take. Areas identified are discussed between patient and resident, increasing patient activation. The clinic’s nurse care facilitator guides referrals to community-based resources. Fifty-two patients were enrolled, with 75% of patients responding they would like to be better managers of their chronic conditions. This information is used to develop patient’s goals of care. Over 90% of patients said their conditions affect their lives and discussed ways better to care for themselves. Over 80% discussed medication management, health goals to improve their quality of life, and made a plan that maps out ways to reach their goals. All of these are essential for achieving positive health outcomes for older patients with chronic conditions. These attributes promote effective patient/provider partnerships. Seventy referrals were made; food through 2-1-1 (47%); monthly commodity food program (30%); utility payments (11%), and transportation (9%). Twenty-seven referrals were made to agencies serving older adults; 25 to the local AAA information and assistance services, and 2 to Senior Project Fresh Voucher Program.
Association of Shoulder Dysfunction with Mobility Limitation in Older Adults of the BLSA
Authors: Davis Derik , Sun Kai , Magder Laurence , Simonsick Eleanor 
Published: December 2021

Abstract
Mobility limitation affects one-third of older adults; yet, the impact of shoulder dysfunction which effects roughly 20%, is inadequately documented. As arm swing is a fundamental component of ambulation, we investigated the cross-sectional association between shoulder range of motion (ROM) and walking endurance using time to walk 400m as quickly as possible and lower extremity performance using the expanded Short Physical Performance Battery (e-SPPB). Data are from 614 men (50.5%) and women aged ≥ 60 years (mean 71.8 ±8 years) in the Baltimore Longitudinal Study of Aging (BLSA) who performed bilateral shoulder elevation and/or bilateral shoulder external rotation (ER) during nurse-administered physical examination. We examined odds of poor 400m-walk and e-SPPB performance defined as the worst quartile associated with abnormal shoulder elevation (≤9%) relative to bilateral normal shoulder elevation and abnormal shoulder external rotation (≤5%) relative to bilateral normal shoulder external rotation (ER) in separate analyses. Analyses were adjusted for age, sex, weight and height. Adjusted odds (95% confidence interval) of poor 400m-walk performance associated with abnormal shoulder elevation (N=254) were 4.7 (1.1-19.5;p=0.035) and with abnormal shoulder ER (n=401) were 4.8 (1.4-16.7;p=0.010). Adjusted odds of poor e-SPPB performance associated with abnormal shoulder elevation (N=462) were 3.5 (1.6-7.7;p=0.002) and with abnormal shoulder ER (n=457) were 2.9 (1.1-7.4;p=0.030). Results suggest abnormal shoulder ROM is associated with poorer walking endurance capacity and lower-extremity functional performance in the relatively healthy older adults. Future research is warranted to develop novel screening paradigms that mitigate mobility limitation and functional decline in older adults with shoulder dysfunction.
CBOs’ Capacity and Resilience on Serving Older AA and NHPI Adults During the Pandemic
Authors: Lee Eun Jeong , Hara-Hubbard KeliAnne , Bishop Sonia , Lim Jae , Ko Linda 
Published: December 2021

Abstract
Community-based organizations (CBOs) are essential settings for older Asian American (AA) and Native Hawaiian Pacific Islander (NHPI) adults for accessing culturally and linguistically appropriate services and connecting with and support each other. This study examined the impact of the COVID-19 pandemic on CBOs’ ability to serve older AA & NHPI adults. This mixed methods study (survey and semi-structured interviews) used a sequential exploratory design. We recruited 65 leaders and staff members from 40 CBOs serving older AA & NHPI adults nationally. Descriptive analysis was conducted with the survey data followed by thematic analysis of the interview data. Many CBOs were impacted by the increased demands for services (80%) and created new services (75%) while experiencing programming disruption (69%), decreased staffing (55%), and loss of revenue (38%). Some CBOs temporarily closed their organizations (38%), while others closed permanently (3%). To remain in operation, many CBOs (65%) increased their online presence, hired staff (52%), and recurred to financial reserves (20%). The semi-structured interviews identified four themes: 1) CBOs resourcefulness to acquire and share resources, 2) technology as a connector for CBOs and an isolator for older adults, 3) heightened racial discrimination against Asians, and 4) emergence of multi-level resilience (personal/ community/organizational). CBOs experienced disruption in their operation, and heightened racial discrimination during the pandemic. Yet, CBO’s ability to remain resilient was critical to continue to provide key programs for older adults. Future studies may want to examine evolving needs of CBOs as they adjust to new public health challenges during the pandemic.
Effects of a Web-based Intervention on Cardiovascular and Physical Health of Korean Older Adults During the Pandemic
Authors: Kwon Soonhyung , Shin Oejin 
Published: December 2021

Abstract
During the lockdown, 97.5% of Korean senior centers in South Korea were closed to prevent the spread of the coronavirus disease 2019 (COVID-19). The threat of the COVID-19 presented the need for alternative interventions for Korean older adults to maintain cardiovascular and physical health. Korean senior centers implemented web-based interventions to provide physical health services, but their effectiveness was not yet assessed. Thus, our study aimed to identify the effects of a web-based intervention using a smartwatch and mobile app in older adults when compared to center-based intervention during the pandemic. This study collected 117 Korean older adults (≥ 60) who participated in the 12-week web-based and center-based physical interventions using a smartwatch and mobile app. This quasi-experimental study was conducted between August and December in 2020. We analyzed the pre-posttest of cardiovascular and physical health across two intervention types. Our regression results indicated that participants in the 12-week web-based intervention reported better cardiovascular (systolic blood pressure: b = -13.77, p &lt; .001; cholesterol: b = -11.71, p &lt; .05) and physical health (muscular function: b = 2.99, p &lt; .001; body balance: b = -1.31, p &lt; .001; cardiopulmonary endurance: b = 33.33, p &lt; .001) than those in center-based intervention at posttest. The findings imply a web-based intervention is likely to become an innovative therapeutic strategy for older adults' health to respond to the rapidly changing social service systems amid the pandemic.
Generational Multimorbidity Disease Clusters for British Cohorts Born 1921 – 1960
Authors: Voll Stacey , Muniz-Terrera Graciela , Hofer Scott 
Published: December 2021

Abstract
The aim of this study is the first step in our understanding of the uniqueness and stability of multmorbdity disease patterns for different generations. The unique historical context that each generation has been exposed to is thought to have systemic health impacts and differences in epidemiological make-up (Clouston et al. 2021). Literature suggests that multimorbidity disease patterns, are similar across countries (Hernandez et al, 2021 – in press) and observational points, and that migration into complex disease clusters is more common as people age (Cassell et al, 2018, Kingston et al. 2018). Most commonly reported are Cardiovascular and Metabolic disease clusters which lead to lower quality of life, mortality and morbidity (Kudesia, 2021). We asked: Do multimorbidity disease patterns differ for unique generations? Using the ELSA, the disease clusters of three cohorts were examined; an older cohort, born 1921-1930, a middle cohort born 1931-1940 a younger cohort born 1941-1950 and the ”newest” cohort, born 1951-1960. Self-reported dementia and memory problems lead a specific cluster for the middle cohort, those born in 1931-1940, but not for the other cohorts. While disease patterns were different between sex for other clusters, the disease cluster of dementia and memory problems held similar disease patterns for males and females, with a prevalence of 3%. The dementia/memory problem cluster loaded with cardio/metabolic diseases. This suggests that complex multimorbidity for the British 1931-1940 cohort has had an impact related to dementia and memory problem diagnoses for this specific generation, for males and females alike.
How Lonely are Older Americans Act National Family Caregiver Support Program Participants?
Authors: Pendergrast Claire , Menne Heather 
Published: December 2021

Abstract
Older Americans Act (OAA) family caregiver services connect family members caring for older adults with a diversity of community-based resources and supports. Social isolation and loneliness are known public health threats, and family caregivers may face greater vulnerability to loneliness given the often-intensive time demands of care provision. Policy stakeholders and aging services providers are increasingly focused on combating loneliness among older adults and family caregivers. To inform efforts to reduce loneliness, we conducted descriptive analyses to identify characteristics of the participants in the OAA National Family Caregiver Support Program associated with higher rates of loneliness, measured with the 3-item UCLA Loneliness Scale. Using data from the 2019 National Survey of Older Americans Act Participants, we examined how caregiver loneliness varied based on caregiver age, gender, income, race and ethnicity, living alone, rurality, and self-reported health, as well as care recipients’ health status and difficulties with ADLs. Among our sample of 1,824 family caregivers, rates of loneliness were high overall (70%). Loneliness was significantly higher for caregivers with poor health (71.4%), incomes less than $20,000 (75.3%), living alone (75.4%), aged 65 or older (73.2%), Hispanic caregivers (82.2%) and caregivers for care recipients with 3 or more ADLs (76.0%). Findings underscore the importance of increasing social engagement opportunities for family caregivers. Policies and programs focused on reducing caregiver loneliness should be accessible to all family caregivers but should prioritize outreach and engagement for groups at higher risk of loneliness.
Racial disparities in hospitalization expenditures of older adults in Singapore
Authors: Chen Cynthia , Guo Xueying , Wee Hwee Lin , Tan Kelvin Bryan 
Published: December 2021

Abstract
The World Population Prospects 2019 reports that the proportion of people who aged 65 and above takes up 9 per cent globally in 2019, reaching up to 16 per cent by 2050. Asia has the fastest rise: from 1 in 9 people aged 65 and above to 1 in 4 in 2050. Rapid growth in older adults has strong implications for diseases and healthcare expenditure. For Singapore, the transition from ‘ageing society’ (7% seniors) in 1999 to ‘super-aged society’ (20% seniors) in 2026 is projected to take 27 years, much faster than Japan’s 36 years. We used the Singapore Multi-Ethnic Cohort (MEC) of 14,465 subjects aged 21 to 94, and the Future Elderly Model (FEM) microsimulation model to project disease burden and hospitalization expenditures to 2050. We found that Chinese females had the highest life expectancy of 86.0 years, followed by Indian and Malay females with 80.4 and 75.6 years respectively. In all racial groups, women lived longer than men by 5-7 years. Cumulative hospitalization expenditures of older adults aged 51+ was US$69,500 for Chinese, US$67,600 for Malays and US$86,100 for Indians; US$71,200 for males and US$70,700 for females. The increased hospitalization spending for all three ethnic groups was due to the underlying manifestation of chronic diseases, including diabetes, hypertension, heart disease and stroke. Variations in environmental risk factors such as diet, cigarette smoking and physical activity across ethnic groups may contribute to racial differences in chronic diseases and disability. Therefore, targeted interventions are needed to reduce racial disparities.
Relationship Quality Predicts Advance Care Planning Engagement In Families Experiencing Cognitive Decline
Authors: Bloom Rachel , Fisher Celia 
Published: December 2021

Abstract
Although clinical guidelines recommend that people showing signs of cognitive decline engage in Advance Care Planning (ACP) while they still have decision-making capacity, too often this opportunity to clarify values and treatment preferences is missed among patients and their families. In reflection of the paucity of empirical data on factors influencing how this planning process begins for families experiencing cognitive decline, this study explored facilitators and barriers to ACP among adult children of parents showing signs of early- to mid-stage dementia, with a particular focus on relationship quality. Among this sample (N = 315), relationship quality positively and significantly predicted advance care planning engagement (r = .349, p &lt; .001). Financial burden weakly and positively predicted ACP engagement (r = .123, p &lt;.05), while both psychological burden (-.614, p &lt; .001) and financial burden (-.290, p &lt; .001) negatively and significantly predicted relationship quality. This study validates the use of the ACP Engagement Survey (ACPES) adapted for surrogates among adult children of people experiencing cognitive decline and contributes to a scarce literature on the impact of relationship quality on ACP engagement.
How Can Providers Better Address Recovery Needs for Geriatric TBI Survivors?
Authors: Vogel Mia , Jung Wonkyung , Thompson Hilaire 
Published: December 2021

Abstract
Older adults are at increased risk for poorer recovery from traumatic brain injury (TBI), incidence of pre-injury frailty, and comorbidity compared to younger adults. In this study, a longitudinal multiple case study approach was taken to describe gaps in health service delivery identified by older adults following mild-moderate TBI. Participants were interviewed at 1 week, and 1, 3, 6, and 12 months post injury (5 times). In total, 57 interviews were conducted with 13 participants and transcribed verbatim. Codes were identified inductively to develop a codebook for guiding thematic analysis in NVIVO. Two independent investigators double coded 16 transcripts (28%) and reached consensus; remaining transcripts were allocated to the two investigators for independent coding and verified and reconciled with the other coder until consensus was reached. Many participants were happy with the care they received. However, ongoing health issues and TBI symptoms sometimes remained unaddressed. Follow-up and care planning would have been helpful for most patients as well as ways to address common balance and dizziness issues. Among some, the unwillingness to go to a provider for follow-up or adhere to medication and physical therapy exercises were issues. In some cases, providers were unable to help or understand the reason for patients’ symptoms (e.g., smell/taste changes, ear issues, etc.). Sometimes, providers did not address the issues that were of most concern to patients, or they would prescribe treatments that were not acceptable to patients. Empathetic, tailored, and patient-centered approaches are needed to improve care delivery and outcomes.