bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and Utilization Outcomes of Matched People With and Without HIV Aged 65+
Authors: Olivieri-Mui Brianne , Shi Sandra , Oh Gahee , McCarthy Ellen , Wilson Ira , Montano Monty , Kim Dae Hyun 
Published: December 2021

Abstract
The prevalence of age-standardized comorbidities is significantly elevated for PLWH across an array of cohorts. However, healthcare needs of older people living with (PLWH) and without (PWOH) HIV may be similar if they have similar geriatric conditions. PLWH and PWOH aged 65+ and eligible for Medicare from 7/1/2014-1/1/2015 were matched 1:1 on age, sex, race, and census region (n=7654). Cox regression assessed count of prevalent geriatric conditions (dementia, depression, falls, hip fracture, sensory deficits, osteoporosis, orthostatic hypotension, urinary incontinence, frailty, and polypharmacy), and risk for clinical or utilization outcomes (cancer, kidney disease, muscle wasting, hepatitis C, liver disease, myocardial infarction, stroke; hospitalization, nursing home and home health admission) during follow-up between 1/1/2015-12/31/2016. PLWH and PWOH are similar in count of geriatric conditions. Compared to those with none, those having 2+ geriatric conditions were similar across PLWH and PWOH in their risk of ≥1 clinical outcome (PLWH: HR 1.57 95% CI [1.29-1.90]; PWOH: HR 1.31 [1.02-1.67]), hospitalization (PLWH: HR 2.35 [1.96-2.83]; PWOH: HR 2.07 [1.65-2.60]), and home health admission (PLWH: HR 2.09 [1.58-2.76]; PWOH: HR 2.20 [1.55-3.12]). Having 2+ geriatric conditions, PWOH had 4.45 times the risk (95% CI 3.16-6.26) and PLWH had 2.88 times the risk (95% CI 2.18-3.81) of NH admission compared to no geriatric conditions. In this study, PLWH use nursing homes less than PWOH despite having a similar number of geriatric conditions and clinical outcomes. Further research to understand this apparent discrepancy will be critical to achieve equity in nursing home access.
Closing the Loop: An Environmental Scan of APS-Reporter Feedback Policies and Practices
Authors: Ojelabi Olanike , Campetti Randi , Greenlee Kathy , Haggerty Kristin Lees 
Published: December 2021

Abstract
Abuse, neglect, and exploitation of older adults are prevalent and underreported in the United States. Pathways to identifying and resolving cases of abuse against older adults depend on mandated and non-mandated reporters bringing attention to these cases through reports to Adult Protective Services (APS). However, existing research points to several barriers to reporting. One significant barrier is a lack of communication from APS to reporters about reports they have made (e.g., whether the report is appropriate for APS, the investigation outcome, and services provided by APS). This lack of reciprocal communication likely serves as a disincentive for future reporting. This study aims to promote improved communication between APS and reporters by examining the legal, ethical, and practical barriers and facilitators to communication at key points in the reporting and response pathways. In this first phase of the project, we conducted an environmental scan of policies and practices related to reporting, investigation, and feedback. Early results from the environmental scan suggest most APS agencies (81%) do not currently provide feedback to reporters. Among those providing feedback, 20% provide feedback only to mandated reporters, and 50% provide only procedural feedback, which focuses on the process of receiving and screening reports for investigation and not on the outcome of the investigation. In the next phase of this study, we will supplement these findings through interviews with APS leaders across the U.S. These early results will begin to fill an important gap in the understanding of feedback loops between APS and reporters.
Structural and Individual Ageism Predicts Elder Abuse Proclivity and Perpetration
Authors: Chang E-Shien , Monin Joan , Zelterman Daniel , Levy Becca 
Published: December 2021

Abstract
Considering that elder abuse affects one in six older persons worldwide, a need exists to identify factors that predict this abuse. Previous studies have found that ageism operates at both structural (i.e., societal-level stigmatizing views toward older persons) and individual levels (i.e., negative age beliefs) to affect health. However, it was not known whether and if so, how these two levels work together to impact perpetrators committing elder abuse. Thus, examining the mechanism between ageism and elder abuse was the aim of the current study. We hypothesized that structural and individual ageism would simultaneously predict elder abuse. In addition, following Stereotype Embodiment Theory, the impact of structural ageism on elder abuse would be mediated by individual ageism. In Sample 1, participants described their proclivity to abuse older people if they could do so without punishment (n=1,580). In Sample 2, family caregivers described actual abuse of their older care recipients (n=400). Overall, elder abuse proclivity (33% in Sample 1) and perpetration (56% in Sample 2) were prevalent. As hypothesized, structural ageism and individual ageism simultaneously predicted elder abuse proclivity and perpetration. Also as predicted, individual ageism significantly mediated the association between structural ageism and elder abuse in both samples. This the first study that examined the mechanistic pathways between structural and individual levels of ageism in the context of elder abuse. Effective solutions to prevent elder abuse should incorporate upstream interventions to mitigate the adverse effects of ageism.
Oral Health for Older Adults: Policy Barriers and Opportunities
Authors: de Lazaro Stephanie Sam , Durben Anchee Nitschke , Kline Juliette 
Published: December 2021

Abstract
Tooth decay and gum disease are two of the most common chronic health conditions in the United States, are reversible and preventable, and impact approximately 68% of older adults nationwide (CDC, 2021; World Health Organization, 2020). While the Affordable Care Act added provisions to health prevention services, oral health prevention coverage was only included for children, leaving many adults and older adults without coverage (Nasseh & Vujicic, 2017). The research team used a rapid review process using 17 key search term combinations to identify literature in three medical databases (PubMed, CINAHL, and Consumer Health Complete) to identify system and policy level barriers and opportunities to address oral health equity issues for older adults in the United States. 40 articles met inclusion criteria for thematic analysis. Findings revealed three barrier categories: 1) poor oral health literacy of patients and health care providers, 2) reimbursement variability contributing to access and utilization barriers, 3) workforce and scope of practice variability. In addition, four opportunity categories were identified: 1) community-based oral health programming for older adults, 2) new reimbursement models, 3) medical-dental collaborations, and 4) policy and practice act updates. The COVID-19 public health crisis has impacted the implementation of some system and policy level opportunities. However, new health care initiatives specific to Medicare in discussion at the national level provide an opportunity to make some headway on the policy updates needed to address the oral health of older Americans. Findings and implications will be shared with the audience.
Racial segregation and mental health service use by older adults
Authors: Kim Kyeongmo , Burnette Denise 
Published: December 2021

Abstract
Older adults living in racially segregated neighborhoods often lack access to mental health care. This study assessed the role of racial segregation in mental health service use and examined whether the relationship between segregation and mental health service use differs by race/ethnicity. We linked residential segregation data from the National Neighborhood Change Database to the 2015 Medical Expenditure Panel Survey. The sample included 4,023 adults aged 65 and older. We measured mental health service use as visit(s) to a mental health professional and/or use of prescribed medication for mental health (1=yes, 0=no) during the past year. Residential segregation was assessed using a combined measure of isolation (level of interaction with the same racial and ethnic group members) and dissimilarity (evenness of distribution of racial groups). Indices ranged from 0 (integrated) to 1 (segregated). We adjusted for age, sex, race/ethnicity, marital status, education, income, attitude toward health care, health insurance, and mental health status. Multiple logistic regression analyses showed that older adults living in more segregated counties were less likely to use a mental health service than those living in more integrated counties (OR=0.77, p=.04). The relationship did not differ by race/ethnicity. As expected, Blacks and Hispanics underused mental health services compared to Whites. The findings highlight that racial segregation limits access to mental health care. Practitioners and policy-makers should identify mental health needs and service use patterns to target services effectively and efficiently. Future research should explore the intersection of income and mental health care resources in segregated neighborhoods.
Sedentary Behavior, Sleep Quality, and Subjective Memory Function in Middle-Aged Adults
Authors: Chen Yen , Holahan Carole , Castelli Darla 
Published: December 2021

Abstract
While there is evidence that prolonged sedentary behaviors (SB) are associated with poor memory performance, less is known about the effect of SB on subjective memory. Poor subjective memory could be an early symptom of mild cognitive impairment or dementia. Besides SB, sleep quality has been identified as an essential component of cognitive health. Yet little is known about the effects of different types of SB on sleep quality and how such effects could, in turn, affect middle-aged adults’ subjective memory. The sample included 306 adults ranging in age from 40 to 60 (M = 44.42) from Amazon MTurk. Mediation analysis with PROCESS (Hayes, 2013) was used to examine the mediational path, controlling for demographic variables. Exploratory factor analysis categorized 10 different sedentary activities into Common Engaging SB (e.g., sitting in cars), High Engaging/Leisure SB (e.g., doing hobbies when sitting), and Less Engaging/Passive SB (e.g., watching TV). Common Engaging SB included a variety of behaviors, including transportation, reading, talking on the phone, and socializing. Common Engaging SB had a significant direct effect on sleep quality (B = 0.19, p &lt; .001) and frequency of forgetting (B = -1.61, p &lt; .001), and sleep quality had a significant direct effect on frequency of forgetting (B = -1.90, p &lt; .001). Sleep quality mediated the association between Common Engaging SB and frequency of forgetting (indirect effect = -0.05, 95% bootstrap CI = -0.09, -0.02). Reducing sitting time, particularly Common Engaging SB, could be a useful strategy to improve subjective memory functioning.
Stigma of Dementia During COVID-19: First Insights From a Twitter Study
Authors: Bacsu Juanita-Dawne , O'Connell Megan , Chasteen Alison ,   Sarah Fraser on behalf of CCNA's SSI Working Group
Published: December 2021

Abstract
Stigma is a critical issue that reduces the quality of life for people living with dementia and their care partners. Despite this knowledge, little research examines stigma of dementia, especially within the context of the COVID-19 pandemic. This presentation aims to: 1) identify the contributing factors of stigma against dementia during the COVID-19 pandemic; and 2) describe actions to challenge stigma of dementia. Using Twitter data, tweets were compiled with Python’s GetOldTweets application from February to September 2020. Search terms included keywords for dementia (e.g., Alzheimer’s) and COVID-19 (e.g., coronavirus). From the 20,800 tweets, filters were used to exclude irrelevant tweets. The remaining 5,063 tweets were analyzed by a group of coders with 1,743 tweets identified for further stigma-related coding. The 1,743 tweets were exported to Excel for thematic analysis and divided among 13 coders. Each tweet was coded independently by two reviewers to ensure intercoder reliability (e.g., 86%). Contributing factors of stigma of dementia included: ageism and devaluing the lives of people with dementia (e.g., ‘old and dying anyways’); misinformation and false beliefs (e.g., ‘COVID-19 vaccine causes dementia’); political dementia-related slander and ridicule (e.g., ‘dementia Joe’); and stigma within healthcare and long-term care organizations (e.g., pushing DNR orders). Globally, there is an urgent need for more dementia education and awareness targeted towards the general public, healthcare workers, and policymakers to reduce stigma against people living with dementia. Further research is necessary to explore the contributing factors and interventions to reduce stigma of dementia during the COVID-19 pandemic and beyond.
Adult Day Service Use among Ethnic Minority Older Adults: An Updated Integrative Review
Authors: Li Yawen , Xu Ling , Liu Jinyu , Sun Fei 
Published: December 2021

Abstract
Adult day services (ADS) are a preferred care option for racial and ethnic minorities compared to other types of long-term care services in the United States. However, there is limited knowledge on minority ADS users. Focusing on minority older adults, this study aims to (a) identify facilitator and barriers of ADS use, and (b) examine ADS’s effect on health and wellbeing. Using Whittemore and Knafl’s methodology of integrative reviews, we searched relevant studies published between 2010 to 2020 in Ageline, PubMed, PsycINFO, CINAHL, Web of Science and Google Scholar and included 8 articles in this review after extensive screening and critical appraisal. Crowe Critical Appraisal Tool (CCAT) was used to assess methodological rigor of the studies included in this review. This review showed that individual factors of ADS use among minority older adult included functional impairment, diabetes, race, gender, and degree of loneliness. Organizational characteristics, such as availability of transportation services, bilingual nurses, peer support, and cultural activities, and structural factors including for-profit status and source of payment were also related to ADS use among minority older adults. Positive outcomes associated with ADS use were improved quality of life and sense of fulfillment. Better understanding of minority older adults’ experience with ADS will help tailor the services to better fit their cultural preferences and needs. Future research should move beyond individual-level factors to identify and address organizational and structural factors such as institutional structure, organization culture and practice impact on disparities and discrimination in services access and quality.
Coresidence Increases Risk of Testing Positive for COVID-19 Among Older Brazilians
Authors: Andrade Flavia , Quashie Nekehia , Schwartzman Luisa 
Published: December 2021

Abstract
Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact. Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey, collected from July to November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians 60+. Our multivariate analyses utilize multilevel mixed-effects Poisson regression to examine the association between living arrangements and the COVID-19 outcome measures. Results show that those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational (PR=1.532, 95% CI 1.15, 2.04, p&lt;0.001) and skipped generation households (PR=1.607, 95% CI 1.04, 2.48, p&lt;0.001) were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households. Overall, our findings suggest that coresidence with younger family members is a risk factor for older adults’ health due to the higher COVID-19 positivity. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.
Mentorship Program Content Ratings: Advancing Diversity in Aging and Alzheimer’s Disease Research and Careers
Authors: Thompson Sheri , Pineda Lauren 
Published: December 2021

Abstract
MADURA is an R25 Advancing Diversity in Aging Research (ADAR) undergraduate training program funded by the National Institute on Aging and based at the University of California San Diego. Its objectives are to improve retention and academic success of underrepresented minority (URM) trainees, and to increase graduate/medical school applications and/or entry into Aging/ADRD careers. This multi-component program includes paid research lab experience, research and academic skills training, peer support, faculty-led small groups, guest seminars, and additional professional development opportunities. The Year 1 Cohort of 32 students consisted of Hispanic/Latinx and other students under-represented in collegiate MSTEM studies. Almost ¾ of the mentees also came from disadvantaged backgrounds, per current NIH criteria. Evaluation data have been collected through brief, weekly, anonymous online student surveys, plus more comprehensive quarterly mentee and mentor surveys. This poster will describe the Program structure and 20+ group activities, trainings, seminars, and modalities, and report student ratings of satisfaction and utility. 92% of trainees rated the overall program value as Excellent, and 92% also rated effectiveness in promoting Aging/ADRD careers among underrepresented students as Excellent. Quality ratings of components such as pay, research placements, group training and group mentorship were rated as Excellent or Good by 96%. Relative student component rankings, specific suggestions for improvements, plus Mentee and Mentor perspectives on research-specific training needs, will also be presented. Based upon these experiences and data, the authors will make specific suggestions for future URM research training, mentorship program content, and expanded delivery modalities.
What Happens When the Patient Doesn’t Die? Understanding Live Discharge from Hospice Care
Authors: Wladkowski Stephanie , Coccia Kathryn , Wingo Anna , Al-Juboori Ruaa , Wallace Cara 
Published: December 2021

Abstract
Hospice has been shown to improve end-of-life outcomes, yet with eligibility limited to a six-month prognosis, the hospice system is not structured to meet longer-term needs. Though hospice is strongly associated with death, some enrolled patients do not decline as predicted leading to what is referred to as a ‘live discharge.’ In 2018, 6.3% of all hospice discharges were patients discharged alive due to decertification, or no longer meeting eligibility requirements. The aim of this presentation is to review current literature surrounding live discharge, discuss policy and practice challenges within current discharge practices, and present new research directions from two current NIH-funded studies. Studies of live discharge often do not differentiate between revocation and decertification, yet these are very different phenomena, particularly regarding decision making. Patients discharged from hospice are often referred to as “not dying fast enough,” or “failure to die on time,” yet, they are still dying from chronic illness, just outside the prescribed six-month framework. Affected patients lose access to important supportive services and resources, still require substantial care, and can struggle to process feelings of abandonment and uncertainty. Further, an increased burden is placed on primary caregivers who may be unprepared for this transition. Clinicians across agencies report great variability in managing live discharges with no standardized protocols. These findings demonstrate the complexities of live discharge, the need for more research to support a standardized and reimbursable discharge process and to define unmet needs for both patients and caregivers affected by live discharge.
A remote Tai Chi program for diverse older adults with multisite pain during the COVID-19 pandemic
Authors: Koren Yael , Leveille Suzanne , Moraes Catarina Ambrizzi , Butts William , Wayne Peter , Yeh Gloria , You Tongjian 
Published: December 2021

Abstract
The goal of this study was to evaluate feasibility and acceptability of a remote Tai Chi program in diverse older adults with multisite pain and risk for falls during the COVID-19 pandemic. Adults aged ≥65y living in diverse Boston neighborhoods were invited through mailed letters to participate in a recruitment and screening survey. Eligible adults were re-contacted to join a 4-week Tai Chi or light exercise program offered online twice weekly. We conducted pre- and post-interviews to assess pain characteristics, fall risk, computer use, and satisfaction with the program. Primary outcomes were class attendance, experience, and program safety. Among 335 survey respondents, 105 (31%) were eligible based on multisite pain and fall history or cane/walker use. Of the eligible respondents, average age was 74y, 75% were women, 62% were Black, and 31% had high school education or less. We assigned 32 participants to 4 Tai Chi (Yang-style Tai Chi tailored to older adults with pain) or 2 light exercise (stretching and strength exercise) groups conducted via zoom; of these, 24 (75%) completed the program. Overall, 79% attended ≥6 of 8 classes. There were no adverse events reported. Regarding experiences with remote exercise, 67% reported it was very easy to join, 88%, very easy to see the instructor and 83%, very easy to participate. For future planning, 29% prefer remote classes, 33% prefer in-person classes, and 38% could do either. In conclusion, remote exercise programming is safe and feasible for diverse older adults who have multisite pain and risk of falls.