bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health and Aging Disparities Among Latin American Older Adults: Findings From Studies in Brazil, Colombia, and Mexico
Authors: Osuna Margarita 
Published: December 2021

Abstract
Aging in Latin America is occurring rapidly, in a context of high levels of poverty and inequality. This symposium is focused on population health and the heath-disparities found in some of Latin America’s largest middle-income countries, Mexico, Brazil, and Colombia. This symposium contains presentations on different health-related issues affecting older adults, which can have further implications for wellbeing, health, and disease risk. The papers in this symposium examine a variety of health-related dimensions and disparities among older Latinos that include physiological functioning, cognition, and oral health. Using the Mexican Health and Aging Study (MHAS), Sheehan investigates the associations between personal and familial educational attainment on sleep quality. Also using MHAS, Milani. Using data from the Brazilian Longitudinal Study of Aging, Farina examines the relationship between race and cognition. Garcia uses data from the Colombian Survey of Health, Well-Being, and Aging to study the relationship between Motor Cognitive Risk Syndrome (MCRS) and cognition and frailty. Using the same dataset, Osuna examines variation in oral health in Colombian older adults and the impact this has on their wellbeing. Results indicate which population subgroups in Latin American have increased risk for poorer health and which dimensions of health have gender, race and socioeconomic disparities. The findings highlight the importance of understanding the conditions under which Latin American older adults are aging and the implications this can have in the future.
National Norms for the Elixhauser and Charlson Comorbidity Indexes Among Hospitalized Adults
Authors: Loyd Christine , Boogaerts Garner , Zhang Yue , Kennedy Richard , Brown Cynthia 
Published: December 2021

Abstract
Multimorbidity has become the defining focus of in-patient geriatric clinical practice and research. Comorbidity assessment burden is often completed using the Elixhauser (ECI) and Charlson comorbidity indexes (CCI), which can predict mortality risk, hospital length of stay and readmission, and healthcare utilization. Yet, the national norms for ECI and CCI have not been reported. Therefore, this study aimed to report comorbidity score national norms of hospitalized patients based on age, race, and sex. Using the 2017 US National Inpatient Sample, ICD-10 coding data from 7,159,694 adult patient’s (≥18years) was abstracted to calculate ECI and CCI scores. Scores were stratified into 5-year age increments from age 45-89. Adults aged&lt;45 and &gt;89 were included in the analysis, however not age-stratified. Overall mean comorbidity score for the population using the ECI was 2.76 (95%CI 2.76, 2.76) and CCI was 1.22 (95% CI 1.22, 1.22). Mean scores for both indexes increased with age until age 90, and this increase was independent of race and sex (all p-values&lt;0.001). Some individual comorbidities increased with age including congestive heart failure and dementia, while others including diabetes and chronic obstructive pulmonary disease increased with age but peaked between 60-74 years and declined in older age. Importantly, a report of US national norms for comorbidity burden among hospitalized adults can provide a reference for determining if clinical and research populations have greater or lesser comorbidity than typical hospitalized adults for their age, race, and sex.
Identity, Integrity, and Religious Doubt in Later Life
Authors: Clark Phoebe , Iwasaki Michiko , Thompson Edward , Futterman Andrew 
Published: December 2021

Abstract
Erik Erikson argued that for religiously involved individuals, the resolution of two stages – Identity vs. Role Diffusion and Integrity vs. Despair – are of critical importance in adult development. Adults typically confront their parents’ religious affiliation in adolescence and young adulthood as they establish themselves as independent actors in the world, and in later life, older adults confront their own lived lives, and evaluate in light of their religious commitments whether they have lived meaningfully and with integrity. To examine Erikson’s views of religious development, we completed open-ended interviews of 278 community-dwelling older adults (55-101 years). In these interviews, participants describe the development of their religious faith, the nature and development of their religious questioning and doubt, and the relationship between their faith and doubt over their life span. Participants were from Northeast U.S., and were denominationally, racially, and ethnically diverse. More extensive religious doubts were reported during young adulthood regarding the meaningfulness of religion in their family of origin. By contrast, religious doubts are reported less during later life, and more emphasis is placed on the value of religious involvement for themselves and their families. This pattern varies between young-old (under 75 years) and old-old (over 76 years): whereas the young-old seem to be working through their religious doubts, the old-old are more focused on the value of their religious faith. These findings are discussed in terms of Erikson’s developmental theory and with respect to cohort differences in religious belief and practice.
Age and Ageism in the COVID-19 Pandemic: What Does the Data Show?
Authors: Dhakal Usha , Kunkel Suzanne 
Published: December 2021

Abstract
Gerontologists were quick to call out the resurgence of ageism that was reflected in the paternalistic, overgeneralized, and deficit views of aging that dominated discussions about age-associated risks of the disease and its consequences. One manifestation of the blunt and potentially ageism-promoting use of age in data about the virus is the failure to routinely distinguish the independent role of age alone, separate from its association with comorbidities. A related problem is the use of broad age categories, which can also mask the role of specific comorbidities. To address that gap, this study uses data from Centers for Disease Control and Prevention, as of Feb 21, 2021 to calculate age-specific COVID-19 death rates (ASDR) and compare the extent to which comorbid conditions potentially associated with COVID-19 deaths were listed on death certificates. Findings showed that the ASDR was significantly higher for those 85 years and over (2249.96 per 100,000); the rate was 802.66 for 75-84 and 312.78 per 100,000 for 65-74. Death certificate information revealed that influenza and pneumonia was the major contributing comorbidity to COVID-19 deaths across all three age groups; (listed on 49% of the death certificates for those 65-74 who died with COVID-19, 46% of those 75-84, and 38% of those 85 and over). Future studies should be more precise about the use of age/age groups, about the rationale for those designations, and about the impact of age separate from comorbidities. Broad use of an arbitrary age as a proxy for frailty and illness contributes to ageism.
Ageism and Undergraduate Attitudes towards Older Adults during COVID-19
Authors: Shea Adam , Yu Aiping , Strong Jessica 
Published: December 2021

Abstract
The COVID-19 pandemic has shed light on the far reaches of ageism in our society. The current study sought to better understand ageist beliefs in Canadian undergraduate students during the pandemic. As part of a larger survey on ageism, we conducted a thematic analysis on open-ended responses to the following questions: 1) “Has your relationship with older adults in your life changed as a result of the COVID-19 pandemic?” and 2) “Have you noticed that attitudes or opinions towards older adults in your community have changed as a result of the COVID-19 pandemic?” Students felt that older adults should be treated differently during the pandemic because they are seen as “high risk” or “vulnerable.” Furthermore, students felt that they needed to be more cautious around older adults because older adults need to be taken care of. Students expressed fear about transmitting the virus to older adults in their lives so chose to isolate from grandparents or avoid older adults in the community in an effort to keep them safe. Finally, examples of negative and positive ageism were present in responses. Negative ageism was seen in comments about how older adults were going to die anyway, the assumption that older adults need more help, and the belief that older adults should be staying home during the pandemic. Positive ageism was present where students realized the importance of their relationships with the older adults in their lives. Results are discussed using the framework of implicit and explicit ageism.
Allophilia and Experience: Predictors of Fear in Developing Dementia
Authors: Rusch Amber , Clark Michaela , Jacobs Moyosoreoluwa , Thomassy Carmen , Patrick Julie Hicks 
Published: December 2021

Abstract
Fear of developing dementia is common and has been linked to delays in seeking medical attention (Arlt et al., 2008). We used data from 320 adults (M age = 39.7, SD = 12.3, range 20 – 70) to examine the ways in which objective knowledge and subjective experience with dementia influence positive attitudes toward persons with dementia. We further examined how these constructs related to fear of developing dementia. A path analysis showed the model fit the data well, X2 (DF = 1) = 0.74, p = .39; RMSEA &lt; .001. Objective knowledge and subjective experience were significantly associated with higher allophilia. Allophilia and subjective experiences were associated with personal fear. However, allophilia decreased fear, whereas subjective experiences were associated with increased fear of developing dementia. To clarify these findings, we conducted a moderated regression in which age was examined as a moderator of the relation between allophilia and fear as well as the relation between subjective experience and fear. Significant results were obtained [F (5, 294) = 10.41, p &lt; .001; R2 = .15]. Age moderated the effect of personal experience on fear. Stronger effects emerged for adults in their 20s compared to those in their 40s; similarly, age exerted a stronger effect for those in their 40s than for those in their 50s. Regarding age effects on the relation between allophilia and fear of dementia, for adults in their 20s and 40s, allophilia reduced fear of dementia. For adults in their 50s, allophilia was associated with higher fear.
The Impact of Mental Health Stigma and Ageism on Students’ Intention to Work with Older Adults: A Mixed Methods Design
Authors: Woolverton Cindy , Biccum Katelind , Yu Aiping , Xin Lanlan , Strong Jessica 
Published: December 2021

Abstract
Approximately 20% of older adults have a mental or neurological disorder which can cause significant disability. With a growing older adult population, there is a need for providers receiving specialized training in aging to provide quality care. However, there continues to be shortages of students seeking careers in geriatrics and especially in working with older individuals with mental health (MH) concerns. The present study explored the relationship between MH stigma, ageism and intention to work with older adults among undergraduate students. Undergraduate students (N=188) completed a battery of questionnaires including intention to work with older adults, positive and negative attitude towards older adults, and open-ended questions exploring MH stigma views. Regression results indicated that MH stigma, positive, and negative attitudes significantly predicted intention to work with older adults, (F(3, 182) = 8.51, p = .000). Examination of the coefficients revealed that positive attitudes significantly predicted intention to work with older adults (t=4.38, p=.000), and MH stigma demonstrated a trend towards significance (t=1.90, p=.059). Open-ended responses were analyzed using qualitative description methods which revealed themes consistent with negative and positive stereotypes, MH problems going undetected, and need for additional support in recognizing and treating MH conditions among older adults. Positive attitudes are an important predictor in students’ intention to work with older adults, and MH stigma may be an important factor to explore further. Qualitative themes also describe how MH concerns are an important area to focus on among older adults, although there continues to be evidence of aging stereotypes.
The Role of Aging Anxiety, Ageism, and Health Locus of Control on Middle-Aged Adults Health Outcomes and Behaviors
Authors: Bashian Hannah , Caskie Grace 
Published: December 2021

Abstract
Older adults with more ageist attitudes and aging anxiety and who endorse an external health locus of control (HLOC) have poorer mental and physical health and less engagement in healthy behaviors than those who report less ageist attitudes, aging anxiety, and endorse an internal HLOC. However, middle-aged adults have not been examined in this literature. Using Terror Management Theory as a framework, this study examined the relationship of middle-aged adults’ aging anxiety, ageist attitudes, and HLOC with health behaviors and mental and physical health outcomes. 391 middle-aged participants (40-55 years) completed measures of ageist attitudes, aging anxiety, HLOC (Internal, External, and Powerful Other), engagement in health behaviors, mental health, and physical health. The path analysis model demonstrated acceptable fit, χ2(2)=7.794, p=.02, CFI=.99, TLI=.92, RMSEA=.09). For health behaviors, eight of the 10 paths were significant; higher aging anxiety, higher ageist attitudes, and less endorsement of internal HLOC were related to less engagement in healthy behaviors. For mental health and physical health, five of the 10 paths were significant; in general, higher aging anxiety, higher ageist attitudes, and less endorsement of internal HLOC were related to poorer mental and physical health. This study demonstrated that middle-aged adults’ aging anxiety, ageist attitudes, and health locus of control are related to their health behaviors and mental and physical health. Furthermore, higher endorsement of specific forms of ageist attitudes and aging anxiety were related to worse reported mental and physical health and to less engagement in health behaviors. Implications of these findings will be discussed.
Bone-Active Medication Utilization from 2013-2017 Amid Beneficiaries Aged 65+ with Medicare Part D by Provider Type
Authors: Kirk Jennifer , Fleming Sean , Orwig Denise 
Published: December 2021

Abstract
As the United States’ population increasingly consists of older adults aged 65+, an increase is expected in the prevalence of osteoporosis and the number of osteoporotic fractures. Bone-active medications (BAM) delay osteoporosis progression and prevent fragility fractures, but historically low treatment persistence rates and drug utilization for BAM exist among at-risk older adults. This research assessed for differences in the BAM utilization rates over five-years in Medicare Part D by provider type: geriatric specialists (GERO), generalists, specialists, nurse practitioners (NP), and physicians’ assistants (PA). This longitudinal retrospective analysis included providers with at least one BAM prescription among beneficiaries aged 65+. An analysis of response profiles was used to model the mean BAM utilization rates overall and by provider group. Of the 50,249 providers included in this analysis, 88.15% were generalists, 5.76% specialists, 1.48% GERO, 2.73% NP, and 1.87% PA. From 2013-2017, the prevalence of BAM utilization was 6%. Over the five years, BAM utilization rates did not change significantly, but provider-specific rates were significantly different (F=12.53, p&lt;.001). Provider-specific utilization rates were inconsistent with the highest utilization rates and most considerable variation observed among specialists (14.95%). PAs and NPs’ BAM utilization rates were stable at around 9.02% and 9.20%, but GERO and generalists exhibited the lowest utilization rates, 4.86% and 5.79%, respectively. While specialists had the higher-than-expected utilization rates, the overall and provider-specific BAM utilization rates were low and did not increase over time. Further research is needed to identify how provider-related factors, like geographic region and clinical training, influence underutilization.
Using Health-Related Quality of Life to Identify the Incident Cardiovascular Disease Risk
Authors: Phyo Aung Zaw Zaw , Ryan Joanne , Gonzalez-Chica David A , Stocks Nigel P , Reid Christopher M , Tonkin Andrew M , Woods Robyn , Freak-Poli Rosanne 
Published: December 2021

Abstract
Previous studies have revealed that poor health-related quality of life (HRQoL) is associated with a higher risk of hospital readmission and mortality in patients with cardiovascular disease (CVD). The association between HRQoL and incident CVD is still limited for general older people. This study explored the associations between baseline HRQoL and incident and fatal CVD in community-dwelling Australian and the United States older people enrolled in ASPREE clinical trial. A cohort of 19,106 individuals aged 65 to 98 years, who were initially free of CVD, dementia, or disability, were followed between March 2010 and June 2017. The SF-12 questionnaire was used to assess HRQoL, and the physical (PCS) and mental component scores (MCS) of SF-12 were derived using norm-based methods. Incident major adverse CVD events included fatal CVD (death due to atherothrombotic CVD), hospitalizations for heart failure, myocardial infarction or stroke. Analyses were performed using Cox proportional-hazard regression. Over a median 4.7 follow-up years, there were 922 incident CVD events, 203 fatal CVD events, 171 hospitalizations for heart failure, 355 fatal or nonfatal myocardial infarction and 403 fatal or nonfatal strokes. A 10-unit higher PCS, but not MCS, was associated with a lower risk of incident CVD (HR=0.86, 95%CI 0.79-0.92), hospitalization for heart failure (HR=0.72, 95%CI 0.60-0.85), and myocardial infarction (HR=0.85, 95%CI 0.75-0.96). Neither PCS nor MCS was associated with fatal CVD events or stroke. Physical HRQoL can be used in combination with clinical data to identify the incident CVD risk among community-dwelling older people.
Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014)
Authors: Quiñones Ana , Markwardt Sheila , Allore Heather , Newsom Jason , Nagel Corey , Dorr David , Botoseneanu Anda 
Published: December 2021

Abstract
Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1% in youngest age category [67-69] vs. 50.3% for incident and 66.7% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6% CIND/dementia vs. 15.4% for incident and 16.8% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4%) than in the incident (11.8%) and no multimorbidity groups (13.4%). Non-Hispanic White beneficiaries were more represented in the incident (83.5%) than the prevalent (77.2%) and the no multimorbidity (77.7%). Hispanic beneficiaries were more represented in the no (8.9%) than the prevalent (7.4%) and incident multimorbidity groups (4.7%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status.
The Association Between Medicare Annual Wellness Visits and Detection and Management of Diabetes Among Older Adults
Authors: Dassel Kara , Alsulami Abdulrahman , He Yao , Allen Nancy 
Published: December 2021

Abstract
The rising prevalence of diabetes mellitus (DM) among older adults is an increasing concern in the U.S. and is expected to nearly triple within the next 40 years. The purpose of this study is to investigate the effectiveness of Medicare Annual Wellness Visits (AWV) utilization on the management of DM among Medicare beneficiaries using data from 26,703 Medicare beneficiaries seen at 13 primary care community clinics (clinic visits between 2017 and 2019). A total of 34% of Medicare beneficiaries participated in an AWV. The total sample was, on average, 72.6 years old (SD=7.0), 57% female, 84% White, and 91% non-Hispanic and had between zero and three co-morbid conditions. The AWV group was significantly younger (mean difference 2.0 years; p&lt;.001) and had fewer comorbid conditions (mean difference 0.1; p&lt;.001) than the non-AWV group at their initial visits. Comparing AWV and non-AWV groups at the first patient visit and last patient visit, there were significantly fewer patients with DM in the AWV group compared to the non-AWV groups (19.2% vs. 24.7%; p&lt;.001 and 53.5% vs. 59.2%; p&lt;.001). DM management was better in the AWV group compared to the non-AWV group at both the first and last patient visits, as exhibited by lower A1C levels (M= 5.9(SD=0.8) vs. M=6.2(SD=1.1); p&lt;.001 and M= 6.6(SD=0.8) vs. M=6.9(SD=1.4); p=.013), lower glucose levels (M=114.0(SD=34.0) vs. M=123.0(SD=51.0); p&lt;.001), and fewer DM medications (M=0.1(SD=.4) vs. M=0.2(SD=0.5); p&lt;.001 and M=0.2(SD=0.6) vs. M=0.3(SD=0.6); p&lt;.001). These results suggest that AWV are effective managing diabetes in older adults Medicare beneficiaries.
Life-Space Constriction in Aging Adults
Authors: Arms Tamatha 
Published: December 2021

Abstract
Community-dwelling aging adults desire to maintain independence and prevent or delay a sequela of declining function and ultimate frailty. Early indicators of potential declines in function and frailty, such as life-space constriction (LSC), are important to identifying early. The purpose of this study was to examine factors associated with LSC and the influence of these factors and LSC on function and frailty. A cross-sectional study using a convenience sample of community dwelling persons 55 and older living in the South was conducted. Results indicated most participants (N = 72) were female (69%; n = 50) and half were White (53.5%; n = 38). LSC explained 34% variance in function (F = 3.805 (8, 59); p = .001) when environmental supports (social network), challenges (driving time it took the participant to get to the nearest full-service grocery store) and individual factors were controlled for. There was a significant difference between Black and White participants with environmental challenges (p = .001) and function (p = .001). Individual factors included challenges (age-related physiological changes, disease burden, and mental health limitations) and buoy (assistive devices), these explained 22% variance in self-reported frailty (F= 3.099 (6, 65); p = .01). Number of assistive devices was the only significant predictor of self-reported frailty.