bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rural Residents’ Hopes and Fears about Aging in Place: The Need to Improve Access to Aging Resources
Authors: Brothers Allyson , Jiao Yuquin , Schneider Sue , Wright Kaitlyn 
Published: December 2021

Abstract
To support older adults’ preferences to age in place, home and community-based aging-related resources are available, but are often under-utilized. Many barriers prevent individuals from accessing aging-related resources, especially in rural and geographically isolated locations. Therefore, we set out to better understand the perspectives of community members who plan to age in place in rural areas. We administered a survey as part of a broader university-community partnership called Senior Access Points (SAP), which addresses aging-related resource access. Participants were N = 210 individuals living in rural regions across Northern Colorado, ranging from 37 to 94 years old (mean age = 68.91, SD = 8.85). We assessed hopes and worries about growing older at home, and awareness of available resources. Two independent coders applied a pre-determined coding scheme, then achieved consensus ratings. An overwhelming majority of participants affirmed the importance of being able to remain in their current home (94.8%) or community (95.3%) as they age. Top hopes for aging in place centered around health/medical; housing/home services; and independent rural lifestyle. The top worries were related to health/medical; housing/home services, and transportation. Resource awareness was low: 43.3% of all participants were not aware of any available resources. Overwhelmingly, rural residents hope to grow older at home, but may not know how to connect to resources that support this goal. The resource needs we identified are being used to inform community-driven approaches to improve both awareness and availability of community resources in these rural communities.
An Evaluation of the Service Intensity Add-On Payment Policy Reform in the Medicare Hospice Benefit
Authors: Christian Thomas , Gozalo Pedro , Teno Joan , Plotzke Michael 
Published: December 2021

Abstract
In 2016, the Centers for Medicare & Medicaid Services (CMS) implemented the Service Intensity Add-On (SIA) payment, which incentivized skilled nurse and medical social worker (SN/MSW) visits in the last seven days of life. Little is known about the impact of this initiative. Using 100% Medicare hospice claims, we identified a 10% random sample of Medicare hospice beneficiaries utilizing routine home care service during calendar years 2012-2018. We compared the provision of SN/MSW visits on service dates before and after the SIA’s implementation relative to beneficiaries’ date of death. We also determined hospice providers’ success in providing SN/MSW visits in the last days of life and categorized all providers into quintiles according to the average rate of these visits in the period prior to the SIA’s implementation. Cumulative over the last seven days of life, we calculated an increase of 15.7 SN/MSW minutes (95% confidence internal [CI] 14.9-16.5 minutes) per beneficiary after the SIA was implemented. The per-minute increase was greatest on days nearer to death (4.0 minutes day of death, 95% CI 3.6-4.2). There was no detectable visit increase on days which were ineligible for the SIA. Additionally, those providers in the quintile providing the lowest rate of SN/MSW visits pre-SIA exhibited a 14-percentage point increase in rates of these visits, the third, fourth, and fifth quintiles exhibited little change over time. Further monitoring is needed to ensure beneficiaries receive adequate end-of-life care.
Residential Environment, Depressive Symptoms, and Anxiety Symptoms Among Community-Living Older Adults
Authors: Cheung Ethan Siu Leung , Liu Jinyu 
Published: December 2021

Abstract
Past literature has suggested significant relationships between neighborhood environment and mental health of older adults. However, the effect of residential environments is underexplored. The present study aims to study: (Q1) how residential built environments are associated with depressive and anxiety symptoms among community-living older adults, and (Q2) whether the associations of their physical and cognitive health status with mental health vary by residential environments. We analyzed data from Round 9 of National Health and Aging Trends Study. Residential environments were indicated by home despair, cluttered home, and existence of entrance ramp. Covariates included age, gender, race, living arrangement, ADL limitations, physical capacity, and cognitive status. The logistic regression results show that higher levels of clutter at home and the lack of entrance ramp were significantly associated with more depressive symptoms and that levels of clutter were positively associated with anxiety symptoms. Residential environments significantly moderated the association between physical health and mental health. With similar physical capacity, older adults with higher levels of home despair and clutter had more depressive and anxiety symptoms. Older adults who had more cluttered home reported significantly higher levels of anxiety than those who had similar ADL limitations, but lived in a less cluttered housing environment. However, we didn’t find any moderating effect of residential environments on cognitive impairment and mental health. Our findings promote the necessity for practitioners and policymakers to consider the effect of residential environments on mental health among both physically healthy and impaired older adults in the United States.
Social Roles of Family and Friends Differ in Social Networks of Older Adults Who Live Alone
Authors: Ashida Sato , Schafer Ellen , Thompson Lena 
Published: December 2021

Abstract
Social networks consisting of family and friends tend to better facilitate older adults’ emotional well-being than networks consisting of only family or only friends. This study assessed the heterogeneity of older adults’ network compositions based on the network members’ relationship (family vs. friends) and proximity (local vs. non-local) and evaluated the types of interactions between older adults and types of members. Adults 60 years and older living in a U.S. Midwestern city participated in a one-time structured survey (n=133), and reported about 1,730 social network members. Compared to participants who lived with others, those who lived alone reported more depressive symptoms and higher frequency of feeling lonely (p=0.002). Those who lived alone also had higher proportions of local friends in their networks than those who lived with others (p=0.02). Whereas the social roles of family and friends were similar in networks of older adults who lived with others, those who lived alone were less likely to identify family as who they co-engaged in social activities with (local family OR=0.55, non-local family OR=0.27) and who provided companionship (local family OR=0.33, non-local family OR=0.11) compared to their local friends. Having more members who co-engaged in activities was associated with lower depressive symptoms (p=0.05) and less frequency of feeling lonely (p&lt;0.01). Providing supportive infrastructure for community-based older adults to develop and maintain co-engaging relationships with local friends may be beneficial. Network approaches can be used to identify existing network members who may be inspired to play this role.
Addressing the Social and Medical determinants of Health for Safe Medicines Use
Authors: Simmons June , Woosley Raymond , Sefilyan Ester 
Published: December 2021

Abstract
Both social and medical factors can negatively affect health outcomes, especially in vulnerable populations. To address these two types of factors in a hospital post-discharge population, two non-profit organizations collaborated to combine their novel decision support programs to address the question: could combined programs have greater potential for improved health outcomes? HomeMeds (HM), a social health program in which trained social services staff make home visits to vulnerable clients, was combined with MedSafety Scan (MSS), a medical health, clinical decision support tool. Data captured in the home visits were entered into the HM and MSS programs to detect those patients at greatest risk of adverse health outcomes due to medications. Patients received a post-discharge home visit by trained social services staff. The number of drugs reported as being taken was on average 10.4, which was less than prescribed at discharge in 62% of patients. Both programs detected serious risk of medication-induced harm, mostly from different causes such as drug-drug interactions or for use not recommended in older adult. Combined analysis of data from two novel decision support programs yielded complementary findings that together address both medical and social determinants of health. These have the potential to reduce medication-induced harm, costly re-hospitalization and/or emergency room visits and support the further evaluation of this combined approach in other vulnerable populations such as the seriously mentally ill, frail, those confined to home, opioid-dependent or otherwise impaired.
Challenges in Implementing an Explicit Protocol for Live Discharge From Hospice
Authors: Wladkowski Stephanie , Enguidanos Susan , Schroepfer Tracy , Pabst Keegan 
Published: December 2021

Abstract
A live discharge from hospice can occur when a patient stabilized under hospice care and no longer meets the life expectancy hospice eligibility criteria. In 2018, 220,000 hospice patients across the United States were discharged alive from hospice care, with 1 in 6 discharges due to stabilization, with a life expectancy exceeding hospice’s six-month criteria. Hospice practitioners prepare patients and their caregivers upon enrollment for the possibility of a live discharge should their condition stabilize, however, there is no explicit discharge process available within hospice to guide practitioners in transitioning patients (and caregivers) out of hospice care. This transition process largely falls within the domain of hospice social workers, yet there is no research documenting the challenges and facilitators to conducting a live discharge from hospice. This study aimed to understand social workers' perspectives on the live discharge process. To better understand challenges and facilitators to the live discharge process, we conducted focus group interviews with hospice social workers at four hospice agencies across the U.S. We asked participants to discuss specific tasks associated with the live discharge process for a patient and their caregiver including identifying concrete services needed post-discharge; assessing the psychosocial and grief risk of patient and caregiver; and developing a post-discharge follow-up plan. Using constant comparison analysis we identified several themes including the need for clear professional roles during a live discharge, interprofessional education, and the need for dedicated time for live discharge follow-up. Policy implications and opportunities also will be discussed.
Strengthening Strategies to Recruit Racial/Ethnic Minority Populations for Health Research Studies
Authors: Thompson Roy , Konrad Thomas , Xu Hanzhang 
Published: December 2021

Abstract
With the current spotlight on systemic racism and the need to address health inequities, it is critical to develop culturally appropriate strategies for recruiting research study participants from racial/ethnic minority groups. Empirical studies have highlighted that people from racial/ethnic minority groups have poorer health outcomes compared to non-Hispanic Caucasians. However, racial/ethnic minority groups remain underrepresented in healthcare research. Several factors may contribute to the lower participation of racial/ethnic minority groups. Sequelae of atrocities in healthcare research on African American/Black people in the US during slavery and Jim Crow eras were widespread and persistent. Discrimination against people of Hispanic descent and increased anti-Asian discrimination have also been documented. Fear and mistrust of the health system and researchers have been identified as critical barriers to participation in clinical research for these populations. Further, health research teams rarely reflect the racial/ethnic diversity of the US population, hindering diversity in recruiting study participants. Inadequate ethnic/racial minority groups participation in study populations not only weakens external validity of empirical studies, but research interventions and policies being implemented may not be culturally appropriate to all populations. Therefore, systemic strategies to improve recruitment of racial/ethnic minority groups should: 1) increase preferential funding to incentivize research teams becoming more racially/ethnically diverse; 2) increase recruitment of racial/ethnically diverse healthcare researchers; 3) use community-based participatory research designs to build trust among racial/ethnic minority populations; 4) provide training on culturally appropriate research study recruitment strategies to the academic communities; 5) apply a prism of intersectionality for representation throughout the research cycle.
Supportive Homes as Mediator between Rural Status and Disability of Older Adults
Authors: Steinman Bernard , Whitlock Bremen , Mittlieder Casandra , Overton Julie , Pynoos Jon 
Published: December 2021

Abstract
By definition, older adults living in rural communities have fewer formal resources available to address aging-related functional needs. Supportive environments are frequently relied on in rural settings to help address this discrepancy. The purpose of this study was to assess the role of supportive housing features and home modifications in mediating the association between rurality and disability. We hypothesized that environmental supports would be more crucial in rural settings than non-rural settings. We analyzed data from the National Health and Aging Trends Study (NHATS). Variable selection was guided by the International Classification of Functioning, Disability and Health (ICF), including covariates for sociodemographics, chronic conditions, mobility functioning, and participation. A series of regression models tested mediation by environmental variables of the association between rurality (as determined by the metro/nonmetro file indicator) and ADL/IADL disability. Supportive home environments were operationalized using indicators of whether participants had access to homes from the outside without having to use stairs; presence of a bedroom, kitchen, and full bathroom with a shower or tub on the same floor; and whether bathroom fixtures had been modified with features such as grab bars. Results suggest a statistical relationship between rurality and disability that is explained in part by the presence or lack of supportive home features, and these effects were greater in rural settings. Implications are that older adults who live in rural settings can benefit greatly by supportive environments and modifications in areas of the home that are known to cause difficulty.
Technology for Healthy Aging: Use of Electronic Communication among Older Adults
Authors: Yang Rumei , Du Yan , Wang Haocen , Nie Zuoting , Ji Chumin , Jiang Yun 
Published: December 2021

Abstract
In the digital era, many electronic platforms have been established to facilitate patient-provider communication, such as e-mail, text messaging, and patient portal. The use of these electronic platforms is termed as electronic-communication (e-communication). E-communication has a variety of personalized healthcare functions, such as exchanging information, reviewing lab results, and facilitating patient engagement. However, little is known about the actual use of e-communication among older adults who are potentially major users of e-communication considering their high-level health care needs. Understanding their use of e-communication is critical in improving the application of e-communication in older adults. Using data from American Health Information National Trends Survey (HINTS2019-Cycle3; n=1,961; meanage =74.10, range=65-98), we explored: 1) the prevalence of e-communication use among older adults, and 2) factors affecting their use of e-communication. Variables were measured by self-reports. Weighted logistic regression with replicate weights provided by the HINTS was performed for data analysis. We found that 50% older adults reported the use of e-communication in the last year. Factors associated with higher likelihood of older adults’ e-communication use included younger age (OR=09.96, 95%CI=0.93-0.98, p&lt;0.001), higher education (OR=4.82, 95%CI=2.32-10.02, p&lt;0.001 for college graduate or higher), higher income (OR=1.58, 95%CI=1.05-2.38, p=0.030), comorbid conditions (OR=1.64, 95%CI=1.02-2.64, p&lt;0.001), and having a regular provider (OR=2.06, 95%CI=1.31-3.22, p=0.002). This study provided nationally representative results demonstrating a great potential use of e-communication in older adults. Special attention is needed to focus on socially vulnerable older adults (e.g., those with older age, lower education and income, and having comorbidity).
Obese Body Mass Index in late-life as a protective factor for Mild Cognitive Impairment, Dementia and Death
Authors: Natale Ginny , Zhang Yun , Hanes Douglas , Clouston Sean 
Published: December 2021

Abstract
Objective The goal of the current study was to estimate the hazards of conversion from unimpaired to mild cognitive impairment (MCI) to probable dementia and death for underweight, normal, overweight and obese older adults in an aging cohort where the timing of examinations may be associated with the severity of dementia. Methods We analyzed six waves of the National Health and Aging Trends Study (NHATS); a longitudinal aging cohort. Participants were classified into mutually exclusive cognitive statuses: cognitively unimpaired, MCI, probable dementia and death. Time-to-event ratios and cognitive transitions were examined with multistate survival models accounting for misclassification. BMI was computed from height and weight measurements and expressed in kg/m2 and categorized into underweight, normal, overweight and obese. Results Participants (n=6,078) were 77 years old, on average, and the majority were white, females and high school graduates. About one third (32.68%) of the sample has normal BMI, one third is overweight (35.59%), the rests are obese (26.41%) or underweight (5.33%). After adjusting for the effects of diabetes, CVD, vigorous physical activity, age and race/ethnicity, the protective effect of obesity in late-life against developing dementia (HR=0.44; 95%CI[0.29-0.67]) and dying from dementia (HR=0.63; 95%CI[0.42-0.95). Discussion Prior research shows the risk of dementia associated with obesity at older ages is either attenuated or reversed. Our findings support a protective factor of obesity in late-life against conversion to dementia and death.
The Effects of Multi-Component Interventions on Cognition: A Systematic Review
Authors: Ahn Sangwoo , Anderson Joel 
Published: December 2021

Abstract
Given the lack of a cure for Alzheimer’s disease (AD), the number of people with AD is expected to surge unless the onset is delayed. Although there have been efforts to examine the effects of single-domain neuroprotective interventions on cognition, no conclusive results have been found so far. Due to the multifactorial causes of AD, interventions combining multiple neuroprotective components may induce more beneficial effects. However, there are few comprehensive reviews evaluating the effects of multi-domain programs on cognition. Thus, the purpose of this systematic review was to evaluate the effects of currently available multi-component interventions on cognition such as global cognition, episodic memory, and/or executive function affected early in AD. The literature search was conducted using PubMed, CINAHL, Web of Science, Scopus, and PsycINFO up to September 2020. Of the 1,445 articles located, 17 met eligibility criteria (n = 10,056, mean age = 72.8 years). According to the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies, 8 and 9 studies had strong and moderate overall quality, respectively. The effect sizes of each included study were calculated using Cohen’s d. Multi-component interventions comprising physical activity, cognitive exercise, cardioprotective nutrition, and/or cardiovascular health consultation/education exerted beneficial effects on cognition (very small to moderate effect sizes; Cohen’s d = 0.16 to 0.77). Clinically, health care providers are recommended to consider those elements to potentially stave off AD. There is a pressing need for researchers to identify optimally effective doses of neuroprotective multi-component interventions.
Comparison of methods to classify ADRD in claims and cancer registry data
Authors: Nalawade Vinit , Murphy James , Schempp Tim , Yakuta Melissa , Moore Alison , Gilbert Paul , Schiaffino Melody 
Published: December 2021

Abstract
Alzheimer’s disease and related dementias(ADRD) affects 10.3% of older Americans (65+), among these 15-30% go on to be diagnosed with cancer. The highest burden of ADRD is experienced by Latino/a (12.2%) and African-American (13.8%) older adults. Older patients with pre-existing ADRD are less likely to receive guideline-concordant cancer care due to lack of consideration of cognitive status, and underestimation of ADRD diagnosis is an issue in secondary data. Our study compares two validated algorithms for classifying ADRD in a sample of cancer patients, the NCI-Charlson and CMS-Chronic Conditions Warehouse (CCW) index. We used existing claims from NCI’s SEER-Medicare linked database (2004-2013, N=37,932). Patients were selected based on cancer diagnosis at any stage with at least 36 months of data prior to diagnosis to identify ADRD. We analyzed breast, lung, prostate, cervix, head & neck(HNC), and colorectal(CRC) cancers(CA). We found a prevalence of 2.8% (9549 cases of ADRD+CA) using the NCI-index compared with a prevalence of 5.6% (18989 cases) with the CCW-index. ADRD+CA numbers differed significantly in all cancers for all races, however, we observed the greatest magnitude of difference among Latino/a and African-American patients. The NCI index significantly underestimated prevalence compared with the CCW: 1.21% vs 3.28% Breast; 2.29% vs 4.60% CRC; 2.88% vs 6.44% Lung; 1.36% vs 8.62% Prostate, and 4.21% vs 11.61% HNC. Our findings suggest a need to develop validated algorithms for classification, using an evidence-base generated by incorporating information and decision-making theories from the expertise of clinicians currently diagnosing ADRD using clinical assessments in diverse populations.