bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood Pressure Variability and Complexity in Nursing Home Residents Before Death
Authors: Graham Laura , Lee Sei , Steinman Michael , Peralta Carmen , Rubinsky Anna , Jing Bocheng , Fung Kathy , Odden Michelle 
Published: December 2021

Abstract
Blood pressure (BP) is a complex dynamic system in the human body and an important determinant of healthy aging. Exploring BP as a dynamic data system may provide important insights into how BP patterns can provide complementary information to the static, one-time BP measurements that are more commonly used for clinical decision making. Thus, we sought to describe BP as a dynamic data system in older adults nearing death. Using a prospective cohort study design, we assessed BP measures 6 months before death in Veterans Health Administrative nursing home residents between 10/1/2006 and 9/30/2017. Variability was characterized using standard deviation and mean square error after adjusting for diurnal variations. Complexity (i.e., amount of novel information vs. redundancy) was examined using Shannon’s entropy (bits). Generalized linear models were used to examine factors associated with overall BP variability. We identified 17,953 patients (98.0% male, 82.5% White, mean age 80.2 years, and mean BP 125.7/68.6 mmHg). In the last 6 months of life, systolic BP decreased slightly (□-7.2mmHg). Variability was stable until the last month of life, at which point variability increased by as much as 30%. In contrast, complexity did not change in the 6 months before death (□0.02 bits). Factors associated with BP variability before death include hospitalizations, hospice care, and medication changes. Systolic BP decreases in the last 6 months before death, and BP variability increases in the last month of life. Further, the increase in BP variability may be driven by increasingly complex care patterns as one approaches death.
COVID-19 and Emancipatory Gerontology: Perspectives of Political Economy and the American Rescue Plan
Authors: Estes Carroll , DiCarlo Nicholas , Yeh Jarmin 
Published: December 2021

Abstract
The present historic moment – a pandemic worsened by far-right extremism – reveals how mounting individual and collective precarity across the lifecourse and in old age resides within societal institutions of colonialism, white supremacy, patriarchy, and capitalism. Contradictions between systems of democracy and capitalism construct an ageist society aligned with neoliberal ideologies attempting to dismantle and privatize Social Security, Medicare, and Medicaid. These issues confront the call for a critical inquiry that matters in the lives of those who daily experience social injustices (Denzin, 2017). This paper presents emancipatory gerontology (Estes & DiCarlo, 2019) as a critical praxis to challenge assumptions, frameworks, and delirium writ large in American society as it relates to how we conceive of age, aging, and generations. We elucidate how the $1.9 trillion 2021 American Rescue Plan represents a paradigm shift that aims to supplant austerity economics with human, public, and community benefit. This knock on the hegemonic commitment to austerity and its mantra is an opportunity to interrogate the effects of, and advance, emancipatory policies and practices. Gerontology is inadequate without a lens for examining how critical analysis and social action might inform one another. To shift from disruption to transformation in the “new normal,” scholars must bring the past and future into the present to engage realistic utopian pedagogies of hope. Emancipatory gerontology offers a theoretical framework and vocabulary for interrogating individual and social consequences of major policy and institutional forces in relation to aging and generations across the lifecourse.
How States Supported Older Adults and Persons With Disabilities During COVID-19 Through the Medicaid Program
Authors: Miller Edward , Beauregard Lisa , Nadash Pamela , Simpson Elizabeth , Wylie Molly , Gusmano Michael 
Published: December 2021

Abstract
COVID-19 has presented challenges for older adults who receive Medicaid home and community-based services. The federal government has allowed states to seek approval for certain flexibilities to better serve this population, including increasing provider payment rates, allowing family members to be caregivers, and permitting case management entities to provide direct services. This study uses cross-sectional data to identify factors associated with states’ adopting these Medicaid flexibilities using multivariate methods. The results indicate that the factors associated with state adoption varied depending on the flexibility. The findings suggest that states increased provider payment rates in response to prevalence of COVID-19 within their state. As cases increase, states may come under pressure to increase provider rates further which may not be feasible because of budget constraints. The results also suggest that demand for and supply of services may be a factor in whether states allowed family members to be paid caregivers. States with a higher proportion of individuals aged 85 years and older were more likely to permit caregivers to be paid which may suggest that these states may not have enough providers to care for the population. Lastly, the results suggest that provider supply was associated with whether a state allowed case management entities to provide direct care services. States with fewer home health agencies were more likely to allow this flexibility. Based on these results, states may be pursuing available Medicaid flexibilities to address provider and workforce shortages which existed prior to COVID-19 but have been exacerbated by the pandemic.
COVID-19 Lockdown Measures: Impact On Older Adults With Dementia And Their Caregivers In Singapore
Authors: Yow Quin W , Lokanathan Tharshini , Chen Hui-Ching 
Published: December 2021

Abstract
Family caregivers typically rely on community-based services and social support networks to supplement their caregiving of older adults with dementia (OAwD). In April 2020, the Singapore government implemented a partial lockdown to contain the spread of COVID-19. We assessed the policy's impact on the physical and mental health of caregivers and their OAwD. As part of a larger study, 30 caregivers were interviewed and rated the stress they experienced when caring for an OAwD during the partial lockdown. Qualitative analyses found significant behavioral changes in OAwD such as irritability, aggression and hallucinations, which led some caregivers to believe their dependents’ condition had deteriorated, as well as heightened levels of caregiving stress. Overall, our preliminary results suggested that although social distancing measures may be effective in containing the spread of COVID-19, these measures could lead to negative outcomes on vulnerable populations such as OAwD and their caregivers.
Community College Gerontology Programs: Revisiting and Re-Visioning Workforce, Career Pathways, and Transfer
Authors: Sasser Jennifer (Jenny) , Anunsen Roger , Faber Michael 
Published: December 2021

Abstract
The session will focus on new and existing innovative ways that Community Colleges are effectively addressing workforce needs resulting from a rapidly aging population; the ever-expanding career pathways available to students in the field of gerontology; as well as the continuing higher education needs of students transferring to bachelor’s and graduate-level gerontology programs. A panel of Community College and University gerontology professionals, representing both the GSA Community College and Aging Workforce Interest Groups, will share the innovative ways that they are working to address the three focus areas of this symposium. We will also include opportunities for discussion with participants about their experiences with and ideas for addressing these issues.
COVID-19 Vaccine Hesitancy Among Older Adults: Evidence From the Medicare Current Beneficiary Survey
Authors: Bhagianadh Divya , Arora Kanika 
Published: December 2021

Abstract
Objective: Older adults have been the most enthusiastic cohort about the COVID-19 vaccine since its rollout. However, there is limited evidence on vaccine hesitancy, particularly among community-dwelling older adults. In this study, we examine the prevalence and predictors (especially information sources) of vaccine hesitancy in this group. Methods: We use the Medicare Current Beneficiary Survey (MCBS)- Fall 2020 supplement data and employ multivariable logistic regression models to explore this association. We study heterogeneous effects by gender, metro/non-metro residence status, race, and age. Results: Depending on healthcare providers (HCP), social media, the internet, and family/friends as the main COVID-19 information source was associated with higher odds of negative vaccine intent when compared to those who rely on regular news. We did not find any association of ‘unsure’ vaccine intent and different information sources. Discussion: Recommendation from an HCP is a strong predictor of any vaccine acceptance and higher negative intent for COVID-19 vaccine among those who depend on HCP for information is concerning. This could be due to vaccine hesitancy among HCPs themselves or due to other mechanisms like infrequent interactions with the health system.
Health Disparities in Delirium
Authors: Dicks Robert , Choi Jimmy , Waszynski Christine , Collins-Fletcher Kadesha , Taylor Beth , Martinez Catherine , O'Sullivan David 
Published: December 2021

Abstract
Racial and ethnic minority populations in the US experience greater cumulative disease burden, as well as social and economic barriers, stressors, and limited advocacy/access to culturally informed healthcare. This increased risk burden is expected to be associated with an increased risk for delirium during acute care encounters. Previous studies on health disparity and delirium are limited and report equivocal findings regarding delirium incidence, possibly related to sample bias or non-validated measures. Risk for delirium during acute care in health disparity populations (HDP) that include Black African Americans (BAA) and Hispanic-Latinx (HL) has not been systematically studied using validated measures. We conducted a retrospective analysis utilizing our delirium program (ADAPT) registry that systematically assessed all hospitalized patients through their entire hospital stay for the years 2018-2019 (36K patients, 80% NHW, 11% HL, 9% BAA). The Confusion Assessment Method (CAM and CAM-ICU) and Richmond Agitation Sedation Scale (RASS) were used as screening assessments to identify delirium. We know from previous studies that negative CAM results in our environment have high specificity. The incidence of delirium between populations was compared using a chi-square test. Delirium incidence was higher in HDP (BAA combined with HL) compared to NHW in 71-80yo (16.0% vs 12.6%, p=0.003). Delirium incidence was not different in all other age groups compared; &lt;65yo (p=0.191), 61-70yo (p=0.223), 81-90yo (p=0.644). Understanding the association, or lack thereof, between health disparities, ethnic and race-based risks for delirium is expected to provide important insights into more focused delirium assessment, prevention and mitigation strategies in these populations.
Caregiving Intensity and Depressive Symptoms Among Older Adults After Partners’ Onset of Dementia
Authors: Harris Melissa , Ha Jinkyung , Hoffman Geoffrey 
Published: December 2021

Abstract
Caring for a partner with Alzheimer’s disease or related dementia (ADRD) can create tremendous care burdens. However, the extent to which onset of ADRD in a partner impacts caregiving intensity and emotional health, the relationship of increased care intensity to emotional health, and whether relationships vary across the older adult population, are less clear. We used 9 waves (years 2000-2016) of the nationally representative Health and Retirement Study dataset to examine the number of weekly caregiving hours provided and depressive symptoms for older (ages ≥51) individuals after partners' ADRD onset (measured with the Telephone Cognitive Interview Survey). We compared changes in outcomes from before to after partners' ADRD onset using zero-inflated negative binomial regression models, overall and among sub-populations with potential vulnerability to excess care burdens – women and racial/ethnic minorities. In our sample of 2,186 older Americans with 10,120 unique observations, we observed a 215% increase (p&lt;0.001) in weekly caregiving hours provided and 21% increase (p&lt;0.001) in depressive symptoms reported by older respondents after partners' ADRD onset. Even larger impacts were observed for women and for non-Hispanic whites. Increased amounts of caregiving were associated with increases in depressive symptoms after a partner's ADRD onset. In all, ADRD has substantial impacts on family. Improved support mechanisms, including enriched community resources, clinician focus on dyadic needs, respite care, and policy efforts such as tax credits for caregivers, will be needed to meet the needs of couples increasingly affected by ADRD.
Worse Self-Reported Hearing Ability Is Associated With Greater Perceived Physical and Mental Fatigability
Authors: Gmelin Theresa , Moored Kyle , Lin Frank , Golub Justin , Wojczynski Mary , Boudreau Robert , Galvin Angeline , Glynn Nancy W 
Published: December 2021

Abstract
Older adults with hearing loss often report higher fatigue due to effortful listening. We evaluated whether self-reported hearing ability is associated with perceived physical and mental fatigability (a more sensitive measure than fatigue) using the Pittsburgh Fatigability Scale (PFS). Older adults (N=2,558) from the Long Life Family Study Visit 2 (71.5±11.4 years; 54.8% women) completed PFS and self-reported hearing ability (worse=[fair,poor,very poor,deaf] or better=[good, excellent]). Age-adjusted PFS Physical and Mental scores were 2.3 and 2.5 lower, respectively, for worse vs. better hearing (p&lt;.0001). Generalized estimating equations adjusted for family-relatedness, site, age, sex, cognitive function (Mini-Mental State Examination), education, and self-reported health. Compared to individuals with better hearing, those with worse hearing had a 42% and 44% greater odds of physical (≥15) (CI:1.12-1.80,p=0.0042) and mental(≥13) (CI:1.13-1.84,p=0.0034) fatigability, respectively. These observed associations may potentially be explained via complex psychosocial and cognitive aging pathways (e.g. effortful listening) to be examined in future work.
Age-Related Macular Degeneration and the Aging Brain
Authors: Whitson Heather , Badea Alexandra , Stout Jacques , Davis Simon , Zhuang Jie , Madden David 
Published: December 2021

Abstract
Age-related macular degeneration (AMD), a leading cause of vision loss in older Americans, is associated with cognitive decline and, particularly, worse performance on verbal fluency tasks. To determine whether AMD is associated with changes in brain structure that may underlie decline in cognition, we conducted a longitudinal, observational study of 39 visually impaired AMD patients and 33 age-matched peers with healthy eyes. Participants (mean age 74.3) underwent cognitive assessments and 3T magnetic resonance imaging (MRI) at baseline and two years. At baseline, AMD patients exhibited lower cortical volume and worse white matter tract integrity, especially in inter-hemispheric connections (FDR &lt;0.05). Principal components analyses revealed faster white matter decline in the AMD group, especially in visual cortex and left hemisphere, which is implicated in language tasks. Understanding patterns of regional brain atrophy in AMD sheds light on mechanisms for the AMD-cognition link and opens windows of opportunity for intervention.
Utilization and Expenditures of High-Need, High-Cost Older Adults With Disabilities
Authors: Karon Sarita , Kordomenos Cleanthe , Knowles Molly , Segelman Micah 
Published: December 2021

Abstract
The factors that lead people to have high needs for care can vary greatly, with implications for the best approaches to serving their needs. One high need group of interest is older adults with disabilities and multiple comorbidities. There is variation in need within this group. Of particular interest is the subset that is both high need and high cost (HNHC). We present work describing Medicare and Medicaid utilization and expenditures for this high need group and the HNHC subset. Over 7.6 million people were identified as high need; 13.6% of them also were defined as HNHC. Patterns of utilization differed between these groups, with the HNHC group more likely to use inpatient care and nursing home care, but less likely to use community-based long-term services and supports. These findings have implications for the development of care models that might best meet the needs of this population.
Functional Trajectories for People With Dementia and Other Comorbidities in the Last Years of Life
Authors: Broyles Ila , Palmer Lauren , Graf Emily , Li Qinghua , Feng Zhanlian , Lamont Helen , Dey Judith , Oliveira Iara 
Published: December 2021

Abstract
A hallmark of end-of-life (EOL) is reduced functional ability. However, the impact of dementia and other comorbidities on EOL decline for older adults is less well understood. We estimated the effect of having dementia and comorbidities on activity of daily living (ADL) scores using the 2000-2012 Health and Retirement Study. We identified 5,853 people over age 65 who died and predicted monthly ADL impairments in the last 4 years of life controlling for dementia and other characteristics. Stroke and obesity were associated with significantly higher ADL scores, regardless of dementia status. However, if both dementia and either stroke or obesity were present, dementia was associated with significantly higher ADL scores approximately 1-4 years before death. Functional decline occurred closer to death if they had these conditions and no dementia. Differences in function when patients have dementia and comorbidities may affect understanding of survival time and access to appropriate care.
Staying in Touch During COVID-19: Long-Term Care Facility Communication Strategies and Family Perceptions
Authors: Straker Jane , Choi Mi Sun 
Published: December 2021

Abstract
During the COVID-19 pandemic, family concerns regarding residents in long-term care facilities (LTCFs) increased dramatically due to the higher proportion of deaths in LTCFs and an inability to visit, observe care, or easily communicate with residents. However, little is known about how these facilities communicated with families and how communications were related to family perceptions about the facility. To address these knowledge gaps, we implemented an online survey of family members or friends of residents in LTCFs from April 28 to June 19, 2020. A total of 174 responses nationwide reported the types of communications used, frequency of communication and alternative visits, and whether the families had peace of mind, would recommend the facility and whether they were considering removing the resident from the facility. We performed chi-square and t-tests to identify differences in perception among families. Results showed that respondents had more negative perspectives of a facility when they were not informed about confirmed COVID cases. There were no differences in family members’ perceptions of a facility based on the frequency of alternative visits. When respondents could communicate with their family members in an LTCF by telephone, email, mail, and window visits, they had more peace of mind. Respondents were more likely to recommend the facility to others when they were able to communicate via mail with the facility. Our findings suggest multiple communications and transparency about COVID status were most effective in keeping positive family perceptions about the facility. Our results can inform future facility communication protocols.
Perspectives Toward Person-Centered Long-Term Care in China
Authors: Wang Jing , Corazzini Kirsten , Wu Bei 
Published: December 2021

Abstract
Health care aides provide direct care for older residents with advanced dementia in long-term care facilities. This study aims to understand care aides’ perceptions of what is ‘good’ care, what is person-centered care, and how to provide person-centered care for older residents with advanced dementia, as preparatory work of the WE-THRIVE consortium’s efforts to develop internationally-relevant common data elements of person-centered dementia care and launch comparative research in LMICs. Semi-structured interviews were conducted with health care aides (N=35) from 2 government-owned and 2 private long-term care facilities in urban China. Directed and conventional content analysis were used, drawing upon core constructs of person-centered dementia care and Nolan’s (2006) senses framework. We found that although care aides were not trained in person-centered care, they did incorporate person-centeredness in their work by tailoring their care to the needs of older residents and facilitating interactions with residents and their peers through communication cues.
Cognition Moderates the Relationship Between Hearing and Mobility in Cognitively Normal Older Adults
Authors: Pupo Daniel , Small Brent , Deal Jennifer , Armstrong Nicole , Resnick Susan , Lin Frank , Ferrucci Luigi , Tian Qu 
Published: December 2021

Abstract
Recent data has shown a consistent but modest association between hearing impairment and poor mobility; both are strongly associated with cognition. Cognitive function may moderate the relationship between hearing and mobility. We analyzed 601 cognitively normal older participants from the Baltimore Longitudinal Study of Aging who had concurrent data on cognition (attention, executive function, sensorimotor function), hearing (pure-tone average, PTA), and mobility (6-meter gait speed, 400-meter time). We performed multivariable-adjusted linear regression to test two-way interactions between each cognitive measure and PTA. There were significant PTA interactions with all cognitive measures on 400-meter time. There was a significant interaction between PTA and sensorimotor function on 6-meter gait speed. Among cognitively normal older adults, poorer hearing is more strongly associated with poor mobility in those with low cognition, especially sensorimotor function. Future studies are needed to understand how cognition may moderate the relationship of hearing impairment with mobility decline over time.
Resilience as a Determinant of Healthspan and Lifespan in Mice
Authors: LeBrasseur Nathan 
Published: December 2021

Abstract
Dynamic measures of physical resilience—the ability to resist and recover from a challenge—may be informative of biological age far prior to overt manifestations such as age-related diseases and geriatric syndromes (i.e., frailty). If true, physical resilience at younger or middle ages may be predictive of future healthspan and lifespan, and provide a unique paradigm in which interventions targeting the fundamental biology of aging can be tested. This seminar will discuss research on the development of clinically relevant measures of physical resilience in mice, including anesthesia, surgery, and cytotoxic drugs. It will further highlight how these measures compare between young, middle-aged, and older mice, and how mid-life resilience relates to later-life healthspan and even lifespan. Finally, it will provide insight into whether interventions targeting the biology of aging can modify physical resilience in mice.