bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remotely Supervised Cranial Electrical Stimulation and Clinical Pain for Older Adults With Knee Osteoarthritis
Authors: Ahn Hyochol , Miao Hongyu , Ali Yumna 
Published: December 2021

Abstract
Knee osteoarthritis (KOA) is one of the most prominent causes of chronic pain, functional impairment, and disability in older adults. The current standards of care for KOA are aimed toward reducing pain and are largely comprised of analgesic medications, but existing pharmacologic approaches often produce significant adverse effects. Moreover, recent evidence suggests that KOA pain is characterized by alterations in pain-related brain mechanisms. Cranial electrical stimulation (CES), which delivers a low-amplitude alternating electric current to the brain, can facilitate the reversal of maladaptive brain function. Portable CES devices can be used at home with real-time monitoring through a secure videoconferencing platform to facilitate high adherence. Thus, the purpose of this pilot clinical study was to examine the preliminary efficacy of remotely supervised CES on clinical pain severity in older adults with KOA. Thirty participants with KOA were randomly assigned to receive 10 daily sessions of remotely supervised CES with 0.1 mA at a frequency of 0.5 Hz for 60 minutes (n=15) or sham CES (n=15). We measured clinical pain severity using the numeric rating scale (NRS; range, 0 – 100). Participants (67% female) had a mean age of 59 years. Active CES significantly reduced scores on the NRS (Cohen’s d = 1.43, P &lt; 0.01). Participants tolerated CES well without any adverse events. Our findings demonstrate the promising clinical efficacy of remotely supervised CES for older adults with KOA. Future studies with larger-scale randomized controlled trials with follow-up assessments are needed to validate and extend our findings.
Barriers to and Recommendations for Research Recruitment of Individuals Affected by Serious Illness
Authors: Cardenas Valeria , Rahman Anna , Giulioni Jenna , Kogan Alexis Coulourides , Enguidanos Susan 
Published: December 2021

Abstract
Researchers are encountering increasing challenges in recruiting participants for healthcare research. We conducted semi-structured individual interviews to identify participant barriers to research and recommendations for overcoming these challenges. We recruited 17 patients and eight caregivers who were approached to participate in a randomized control trial. We also recruited 31 primary care physicians. Using grounded theory, three researchers independently coded the transcripts and then met to compare codes and reconcile discrepancies. Themes from patient and caregiver interviews included time constraints, privacy concerns, lack of research familiarity, disconnect with research institution, self-perceived health status, and concerns with study randomization and repetitive questions. Physician-identified barriers focused on time constraints and study randomization. Patient and caregiver recommendations for study recruitment included various recruitment techniques. Physician recommendations were related to incentives. Although patients and caregivers prefer that their physicians recruit them for health-related research studies, physicians identified time constraints as a barrier to research involvement.
Premenopausal Bilateral Oophorectomy Effects on Clinical and Real-World Physical Function Measures
Authors: Fortune Emma , Jahanian Omid , Morrow Melissa , Miller Virginia , Mielke Michelle 
Published: December 2021

Abstract
Women with premenopausal bilateral oophorectomy (PBO) are at increased risk for physical function (PF) declines. This study investigated the relationships of field-based physical activity measures with clinical PF and strength parameters in post-menopausal women with and without PBO. Women with (n=21; age=64±4 years; BMI=32±8 kg.m-2) and without (n=15; age=67±6 years; BMI=28±6 kg.m-2) PBO performed PF and strength tests (walking speed, distance walked, short physical performance battery (SPBB), leg and chest strength), and wore ankle accelerometers for 7 days (daily step count and loading index [the cumulative sum of each step’s skeletal loading]). Age, BMI, step count and loading index were entered into stepwise multiple regression to identify significant predictors of PF and strength parameters. Step count was a predictor of SPBB score in both groups. In women without PBO, step count was a predictor of walking speed; loading index was a predictor of leg strength; step count and loading index were predictors of distance; and step count and age were predictors of chest strength. For PBO women, loading index and BMI were predictors of walking speed and distance; BMI was a predictor of leg strength; and there were no predictors of chest strength. These data suggest while field-based physical activity was strongly and positively associated with clinical PF and strength measures for women without PBO, BMI was a dominant negative factor for PF in women with PBO. Future work will include a larger sample size and additional confounders to further elucidate underlying factors of reduced PF and mobility after PBO.
Caring During COVID-19: Inequalities in Resource- and Information-Sharing by Race, Ethnicity, and Nativity
Authors: Park Sung 
Published: December 2021

Abstract
Americans experienced significant challenges as a result of the pandemic, further magnifying the weak U.S. social safety net. With few institutional supports available, individuals turned to each other for assistance. Relying on multiple nationally representative surveys, this study examines resource-sharing by race, ethnicity, and nativity over a one-year period during COVID-19. Furthermore, this study examines knowledge-related behaviors, such as information-seeking and information-sharing, which were also important tools utilized during the pandemic. Differences in both resource- and information-sharing contributed to disparities in the perceptions of risk, the reported levels of need, and concomitant behaviors linked to well-being. This research emphasizes the importance of personal relationships during times of crisis, and the role of social connections in shaping health and economic inequalities between minority- and non-minority populations.
Using a Theoretical Framework in a Qualitative Metasummary About Fatigue Adaptation After Stroke
Authors: Teng Chiao-Hsin , Anderson Ruth , Davis Leslie 
Published: December 2021

Abstract
We describe how we used a theoretical framework, Adaptive Leadership Framework for Chronic Illness (ALFCI), to complete a qualitative metasummary in a scoping review of 26 articles. We abstracted and grouped qualitative findings relevant to fatigue adaptation in stroke survivors using constructs of the ALFCI as 4 main themes: 1) adaptive challenges, 2) adaptive work, 3) adaptive leadership and collaborative work, and 4) technical challenges and technical work. We found that stroke survivors encountered different aspects of challenges (e.g., physical dysfunction vs. mental distress) and utilized various adaptive work (e.g., conserving energy vs. restructuring normality) as well as what stroke survivors needed from healthcare professionals (e.g., basic knowledge about fatigue). The ALFCI provides a useful lens to synthesize qualitative findings regarding fatigue adaptation and therefore researchers can target different problems that need to be tackled for stroke survivors, care partners, or healthcare professionals, respectively.
Loneliness, Sleep Quality, and Cognitive Function in Community-Dwelling Older Adults
Authors: Yu Kexin , Fausto Bernadette 
Published: December 2021

Abstract
Loneliness is a risk factor for cognitive decline in older adults, however, the underlying mechanisms are less understood. Individuals who experience frequent loneliness tend to have poorer sleep quality. Empirical evidence supports the influence of sleep on cognitive health. This study examined the possible mediating effect of sleep characteristics on the relationship between loneliness and cognition. The study sample included 557 participants from wave 2 of the National Social Life, Health, and Aging Project who had actigraphy sleep measures (mean age = 73.17, 52.6% female). Loneliness was assessed with the 3-item UCLA Loneliness Scale. Cognitive function was measured with the Montreal Cognitive Assessment. Five sleep quality indicators were objectively recorded with wearable devices: assumed sleep time; actigraphy sleep time; time spent awake after sleep onset (WASO); sleep fragmentation; and sleep percentage (actigraphy sleep/(assumed sleep + WASO)). Path analysis model results show that WASO, fragmentation, and sleep percentage mediate the link between loneliness and cognitive function. Loneliness was positively related to WASO, and WASO was negatively associated with cognition. Loneliness correlated with increased sleep fragmentation which was associated with worse cognitive function. Individuals who had more frequent loneliness had a lower sleep percentage, and sleep percentage was positively associated with cognitive function. Nonetheless, the path from loneliness to these three sleep characteristics became insignificant after controlling for depressive symposiums. Depressive symptoms and fragmentation were found to double mediate the association between loneliness and cognitive function. Sleep and depression could be underlying pathways for the association between loneliness and cognition.
The Longitudinal Relationships Between Social Isolation, Frailty, and Health Outcomes Among Canadian Older Adults
Authors: Mehrabi Fereshteh , Béland François 
Published: December 2021

Abstract
Social isolation and frailty are global public health issues that may lead to poor health outcomes. We tested the two following hypotheses: 1) changes in social isolation and frailty are associated with adverse health outcomes over two years, 2) the associations between social isolation and health vary across different levels of frailty. We estimated a series of latent growth models to test our hypotheses using data from the FRéLE longitudinal study among 1643 Canadian community-dwelling older adults aged 65 years and over. Missing data were handled by pattern mixture models with the assumption of missing not at random. We measured social isolation through social participation, social networks, and social support from different social ties. We assessed frailty using Fried’s criteria. Our results revealed that higher frailty at baseline was associated with a higher rate of comorbidity, depression, and cognitive decline over two years. Less social participation at baseline was associated with comorbidity, depression, and changes in cognitive decline. Less social support from friends, children, partner, and family at baseline was associated with comorbidity, cognitive decline, and changes in depression. Fewer contacts with grandchildren were related to cognitive decline over time. The associations of receiving less support from partner with depression and participating less in social activities with comorbidity, depression, and cognitive decline were higher among frail or prefrail than robust older adults over time. This longitudinal study suggests that intimate connectedness and social participation may ameliorate health status in frail older populations, highlighting the importance of age-friendly city policies.
Aging LGBT Adults’ Access to Social Resources According to LGBT Identity and Sociodemographics
Authors: Kittle Krystal , Boerner Kathrin , Kim Kyungmin 
Published: December 2021

Abstract
Research suggests that social resources positively influence the health and well-being of lesbian, gay, bisexual, and transgender (LGBT) aging adults, but their access to social resources may vary according to LGBT identity. Using data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N=2,536), multivariate models tested how access to social resources varied by LGBT identity and whether the effect of LGBT identity showed additional variations by sociodemographic characteristics (i.e., age and education) among aging LGBT adults. Lesbian respondents had larger social networks than gay respondents, while gay respondents had smaller networks than transgender respondents. Lesbian respondents had more social support and community belonging than other identity groups. Bisexual male respondents and transgender respondents had less support than gay respondents and bisexual male respondents reported less community belonging than gay respondents. Education and age moderated the association between LGBT identity and social support. Findings highlight the importance of considering social support separately from social network size with the understanding that large social networks do not necessarily provide ample social support and this distinction was particularly relevant for transgender respondents who had larger social networks, but less social support than gay respondents. Results also suggest that feelings of LGBT community belonging vary among LGBT identity groups. Health and human service professionals should not only consider the sexual and gender identity of their aging LGBT clients, but also consider the clients’ additional sociodemographic characteristics when assessing their access to social resources.
The Role of Minority Stress and Social Resources in the Healthcare Utilization of Aging LGBT Adults
Authors: Kittle Krystal , Boerner Kathrin , Kim Kyungmin 
Published: December 2021

Abstract
Research suggests that minority stress can influence the healthcare utilization of aging LGBT adults, and that social resources can buffer the effect of stress on healthcare utilization. Using data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N = 2,560), multiple logistic regression assessed the associations between minority stress (i.e., internalized stigma and LGBT identity disclosure) and healthcare utilization (i.e., health screenings, emergency room use, routine checkups, and regular provider). We also examined the moderating effect of social resources, including social network size, social support, and LGBT community belonging, in these associations. Internalized stigma was negatively associated with having a routine checkup in the previous year (OR = 0.82, p = .038). Disclosure was positively associated with having a health screening within the past 3 years (OR = 1.52, p = .000) and having a regular provider (OR = 1.33, p = .021). Further, we found that social support moderated the association between disclosure and health screenings (OR = 1.52, p &lt; .001); thus, having higher levels of social support and disclosure in tandem increased the likelihood of getting a health screening in the last three years. Health and human service professionals should provide information about internalized stigma and LGBT identity disclosure to educate their clients about the ways in which these minority stressors can impact their healthcare experiences. Providers should assess the social support of their aging LGBT clients and inform them about the added benefit that social support can have in their healthcare experiences.
Transforming Dementia Care: Implementation Challenges Moving Evidence-Based Programs to Health Care
Authors: Gitlin Laura , Hepburn Kenneth , Czaja Sara 
Published: December 2021

Abstract
Although evidence for dementia care programs continues to grow, families and health providers do not have ready access to programs, nor have they been widely disseminated and routinized in healthcare. Understanding implementation considerations when embedding evidence-based programs in healthcare systems can inform ways to effectively transform dementia care. This symposium will examine similarities and differences in implementation challenges encountered and strategies used when implementing four evidence-based programs being tested in different healthcare environments using distinct study designs. Dr. Gaugler et al., will discuss implementation challenges encountered with a staff-delivered intervention (ADS Plus) to support caregivers in adult day services that is being tested using a mixed methods hybrid trial design in &gt;50 sites nationally. Dr. Hodgson et al., will discuss adaptions and their measurement to COPE, a home-based dyadic support program being embedded in 10 PACEs of a large healthcare system using a noninferiority trial testing staff training strategies. Dr. Forester et al., will examine implementation of the Care Ecosystem for dementia patients in a high-risk, integrated care management program using a pilot embedded pragmatic trial. Dr. Hepburn et al., will explore tactical challenges of implementing Tele-Savvy, an online caregiver psychoeducation program, within the context of a pilot pragmatic clinical trial. Drawing upon implementation science, themes discussed include balancing adaptations and fidelity, measurement of implementation outcomes and organizational readiness, and staff training implications. Also highlighted are research design considerations. Dr. Czaja, an expert in the design and implementation of dementia care interventions from in-person to technology-based will be the discussant.
Addressing Tactical Challenges in Embedding Tele-Savvy in a Pilot Pragmatic Trial
Authors: Hepburn Kenneth , Clevenger Carolyn , Berg Karina , Fortinsky Richard 
Published: December 2021

Abstract
This presentation describes how we plan to address the challenges of testing an evidence-based caregiver program in a real-world setting without the infrastructure and personal contact of a typical RCT. Instead of screening participants for eligibility, clinic staff will pre-identify participants whom clinicians then confirm. Each clinic will include Tele-Savvy as standard of care; we will thus be able to obtain IRB approval for a waiver of consent. By securing agreement from each clinic to incorporate a small set of standard instruments (e.g., Pearlin Caregiver Competence scale) into their standard operating procedure of routinely collecting caregiver data gathering, we will be able to eliminate the need for a central research staff to conduct baseline and follow-up interviews and will, instead, collect key outcome data through the electronic health record. Instead of in person training of Tele-Savvy facilitators, we will rely on an online training program and facilitator manuals.
Tracking Adaptation and Fidelity When Embedding COPE, Evidence-Based Dementia Care, in PACE Sites
Authors: Hodgson Nancy , Gitlin Laura 
Published: December 2021

Abstract
One essential question in moving dementia care interventions to practice is, “What is the optimal balance between fidelity to, and adaptation of, a proven program in “real world” settings?" We present a protocol for measuring the adaptation/fidelity and implementation of an evidence-based dementia care program (Care of Persons in their Environment, COPE) in PACE settings. During pre-implementation, science-based elements of COPE were documented including the theory of change, logic model and core components. Possible adaptations to COPE in its delivery were identified and included program structure (sequence of sessions), content (assessments), and delivery methods (online). During implementation, documentation of implementation strategies is captured using an evidence-informed checklist derived from the Expert Recommendations for Implementing Change (ERIC) workgroup. Ongoing documentation of fidelity/adaptation aspects of program implementation is conducted using the FRAME framework. Understanding methods and measures deployed in adaptation and implementation of evidence-based dementia programs can help guide future translation efforts.
Causal Mediation of Stress Reduction in Family Dementia Caregivers: A Focus on Mindfulness
Authors: Gomez Liliana Ramirez , Jain Felipe 
Published: December 2021

Abstract
Although mindfulness therapies have demonstrated benefits for reducing stress and improving psychological symptoms in family dementia caregivers, the mechanisms underlying these salutary effects are unknown. We report a causal mediation pathway to improvement of stress symptoms in family dementia caregivers with Mentalizing Imagery Therapy (MIT), which employs mindfulness and guided imagery tools to reduce stress and improve understanding of self and others. In a randomized controlled trial of short-term 4-week MIT (N=24) versus a psychosocial support group (N=22), MIT demonstrated superior benefit for reducing perceived stress (p=.006). Increased trait mindfulness was a causal mediator of this effect (p=.02). Neuroimaging pre and post intervention found that increased mindfulness was associated with strengthened connectivity of the dorsolateral prefrontal cortex with an emotion regulation network (p&lt;.001). The results are discussed in light of theories of cognitive control and may inform the design of future studies aimed at reducing family caregiver stress.
The Social Effects of an Intergenerational E-Mail Pal Program
Authors: Lise Kristi , Zucchetto Jillian Minahan , Siedlecki Karen 
Published: December 2021

Abstract
Ageist attitudes and loneliness negatively impact both younger and older adults (e.g., Sun et al., 2019). This study utilized a randomized waitlist-control design to investigate the effects of a six-week intergenerational e-mail pen pal program on loneliness in younger and older adults and ageism in younger adults. Thirty-three younger adults (18-30 years) and 28 older adults (over age 65) completed an online survey assessing ageist attitudes, loneliness, well-being, and other individual differences. One week after completing a baseline survey, 17 email pen pal pairs began the six-week e-mail intervention. Participants repeated the survey one week after the completion of the intervention (which was eight weeks after the baseline for the control participants). Analyses showed that at baseline, younger adults (M=2.41, SD=.76) reported higher levels of loneliness compared to older adults (M=1.65, SD=.77), t(59) = 3.85, p &lt; .001. Repeated measures ANOVAs showed that the intervention did not have a significant effect on ageism or loneliness in either younger or older adults. However, the effect size of the intervention for loneliness among older adults was moderate to large (η2= .07). Descriptive statistics indicated that older adults in both the intervention and control groups experienced an increase of loneliness during the post-test. However, the older adults in the intervention group experienced less of an increase compared to older adults in the control group. This suggests that the intervention may have buffered the increase in loneliness that older adults may experience during the winter months and during the onset of the COVID-19 pandemic.