bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adapting an Evidence-based Physical Activity Program for The REJOIN Trial for Older Breast Cancer Survivors
Authors: Bluethmann Shirley , Flores Eileen , Grotte Meghan , Heitezenrater Jared , Truica Cristina , Schmitz Kathryn 
Published: December 2021

Abstract
Purpose: Physical activity (PA) is a recommended part of breast cancer survivorship. PA promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially in reducing joint pain associated with adjuvant hormonal treatment. The purpose of this report is to describe adaptations to Fit & Strong!, an evidence-based curriculum, to meet the needs of older BCS. Methods: First, we reviewed all educational materials with scientific experts, including specialists in breast and exercise oncology. Next, we conducted semi-structured phone interviews with 3 BCS for an in-depth review of educational materials for the trial. All interviews were recorded and transcribed. Constant comparative analysis was used to identify themes and specify required technical changes. Subsequently, we recruited 3 new BCS to pre-test adapted materials and exercise sessions, complete a follow-up interview to refine our final product and rate acceptability with older BCS. Results: Overall, BCS found the materials and experience very acceptable (mean score of 9.5/10). Content changes included simplifying exercise instructions, prioritizing trial-specific content and updating photographs to be more age-appropriate. Due to COVID, the pre-test activity was conducted by Zoom and participants were given additional time and coaching to participate using this technology. BCS said they would prefer to exercise in person but reported the remote experience as very satisfactory. Conclusion: Our multi-step adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming clinical trial, which will also be conducted remotely to maximize safety and access.
Are Machine Learning Models Used to Represent Accelerometry Data Robust to Age Differences?
Authors: Manini Todd , Bai Chen , Wanigatunga Amal , Saldana Santiago , Casanova Ramon , Mardini Mamoun 
Published: December 2021

Abstract
Regular and sufficient amounts of physical activity (PA) are significant in increasing health benefits and mitigating health risks. Given the growing popularity of wrist-worn devices across all age groups, a rigorous evaluation for recognizing hallmark measures of physical activities and estimating energy expenditure is needed to compare their accuracy across the lifespan. The goal of the study was to build machine learning models to recognizing the hallmark measures of PA and estimating energy expenditure (EE), and to test the hypothesis that model performance varies across age-group: young [20-50 years], middle (50-70 years], and old (70-89 years]. Participants (n = 253, 62% women, aged 20-89 years old) performed a battery of 33 daily activities in a standardized laboratory setting while wearing a portable metabolic unit to measure EE that was used to gauge metabolic intensity. Participants also wore a Tri-axial accelerometer on the right wrist. Results from random forests algorithm were quite accurate at recognizing PA type; the F1-Score range across age groups was: sedentary [0.955 – 0.973], locomotion [0.942 – 0.964], and lifestyle [0.913 – 0.949]. Recognizing PA intensity resulted in lower performance; the F1-Score range across age groups was: sedentary [0.919 – 0.947], light [0.813 – 0.828], and moderate [0.846–0.875]. The root mean square error range was [0.835–1.009] for the estimation of EE. The F1-Score range for recognizing individual PAs was [0.263–0.784]. In conclusion, machine learning models used to represent accelerometry data are robust to age differences and a generalizable approach might be sufficient to utilize in accelerometer-based wearables.
Barriers and Facilitators Impacting Physical Activity Among Rural American Indian Older Adults
Authors: Pedersen Maja , Harris Kari , Lewis Jordan , Grant Mattea , Kleinmeyer Chelsea , Glass Ashley , Brown Blakely , King Diane 
Published: December 2021

Abstract
Background. American Indian (AI) older adults experience pronounced health disparities and demonstrate among the lowest levels of physical activity (PA) of racial and ethnic groups. Nearly half of AI older adults live in rural areas, indicating distinct challenges to participation in PA. Research to identify factors influencing PA among this population is missing from the literature, yet is critical to inform culturally relevant PA intervention development and implementation. Purpose. To identify barriers and facilitators to PA among rural AI older adults using the ecological model and qualitative methods. Methods. A community-based approach was used to conduct semi-structured interviews with rural AI older adults. Interview questions were based on a multi-level ecological model. Content analysis was performed, using an iterative coding process to identify findings. Results. Participants’ (n=21) mean age was 66 years. Barriers and facilitators to PA were identified across ecological model levels. Barriers included factors such as caregiving and community responsibilities, lack of acceptable areas for walking, and overall lack of community-level support for older adult health. Facilitators included a personal connection to the land and ancestors through PA, multigenerational participation, and supportive tribal policies. Conclusion. This study addressed a critical gap in the literature by identifying barriers and facilitators among rural AI older adults, which can inform PA intervention development. In this way, their voices are uplifted to shape efforts addressing longstanding health disparities through relevant public health interventions.
Factors Associated With Latent Classes of Exercise Motivation Among Physically Active Older Adults
Authors: Bomi Choi , Joo Susanna , Lee Changmin , Kim Kwang Joon , Kim DaeEun , Kim YoonMyung , Jun Hey Jung 
Published: December 2021

Abstract
The objective of this study was to estimate the latent classes of exercise motivation and to find relevant factors in older adults. The sample comprises 179 people who reported practicing physical exercise regularly. We performed Latent Class Analysis (LCA) and multinomial logistic regression. Exercise motivation was observed with six indicators: medical advice, fun, weight loss, leisure, fitness, and socializing. Independent variables of regression analysis included sociodemographic characteristics (age, gender, marital status, education, and household income), health and well-being (subjective health, and life satisfaction), and satisfaction on neighborhood environment (physical, service, and sociocultural aspects respectively). Results of LCA indicated that the three-class model yielded optimal fit indices. Class 1 (7.5%) was labeled as ‘mainly for medical advice and socializing’. Class 2 (46.5%) was labeled as ‘mainly for fun’, while class 3 (46.0%) was labeled as ‘only fitness’. Results of multinomial logistic regression showed that males, people with lower education, and higher satisfaction with their sociocultural neighborhood were more likely to be categorized as ‘mainly for fun’ group compared to the reference group (‘only for fitness’). Subjective health was marginally significant (p&lt;.10): People with positive subjective health tend to be categorized as ‘mainly for fun’ than ‘only for fitness’ group. Satisfaction with their sociocultural neighborhood was marginally significant (p&lt;.10) in distinguishing ‘only for fitness’ and ‘mainly for medical advice and socializing’ group. The results of this study emphasized the heterogeneity in exercise motivation. Significant factors of exercise motivation in this study implied the importance of individualized interventions to promote exercise participation.
Get Moving! Your Brain Will Thank You.
Authors: Nunez Christina , Nuccio Alexandria , Golden Charles 
Published: December 2021

Abstract
Exercise and cardiovascular fitness are important for physical health and well-being. Recent studies show that exercise is associated with cognitive performance across multiple domains including memory, a common complaint for older adults. Data included a ten-word list of delayed recall, a clock drawing activity, and a three-meter walking course derived from the National Health & Aging Trends Study Database (NHATS Round 9). A total of 4977 participants were included in the analysis which was predominantly white (69.7%), non-Hispanic (94.5%), female (59.2%), and between the ages of 70-84 (62.7%). A hierarchical linear regression revealed that performance on the three-meter walking course positively predicted performance on delayed recall, F(4,3999)=300.257, p&lt;.001, and on the clock drawing activity, which is a common screening task for cognitive decline, F(4,3978)=156.433, p&lt;.001; accounting for 23.1% and 13.6% of the variability, respectively, over and above known demographic variables. Findings suggest that fitness may be one of many factors that is associated with memory and overall cognitive decline. These findings are timely as many individuals slowed down as a result of the COVID-19 pandemic, resulting in decreases in exercise and physical activity. Not being physically active or exercising may be related to poorer physical and cognitive health, with specific concerns regarding memory. Taking into consideration the fear and anxiety associated with declining memory in late life, it is crucial to explore this area further along with other factors that may contribute to the association and develop new ways for older adults to exercise safely during the COVID-19 pandemic.
The Association between Leisure and Physical Activity Level with Depressive Symptoms after 5-years of follow-up
Authors: Chang Milan , Eymundsdottir Hrafnhildur , Ramel Alfons , Sigurdardottir Sigurveig , Gudnasson Vilmundur , Launer Lenore , Jonsson Palmi 
Published: December 2021

Abstract
BACKGROUND: Depressive symptoms in older adults are associated with socioeconomic status (SES), medical care, and physical activity. However, there is little evidence on the longitudinal association between level of leisure activity (LA) and physical activity (PA) with depressive symptoms among community-dwelling older adults in Iceland. The study examined an association of LA and PA at baseline with high depressive symptoms (HGDS) assessed after 5 years of follow-up among community-dwelling older adults. METHODS: A large community-based population residing in Reykjavik, Iceland participated in a longitudinal study with 5 years of follow-up (n=2957, 58% women, 74.9±4.8 yrs). Those with HGDS or dementia at baseline were excluded from the analysis. The reported activity was categorized into 2 groups as no-activity versus any-activity. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS) on average 5 years later. RESULTS: After adjusting for demographic and health-related risk factors, those who reported having any LA had significantly fewer HGDS after the follow-up of 5 years (6 or higher GDS scores, Odds Ratio (OR) = 0.46, 95% Confidence Interval (CI): 0.27 ~ 0.76, P = 0.003). However, reporting any PA at baseline was not significantly associated with HGDS (OR = 0.71, 95% CI: 0.51 ~ 1.00, P = 0.053). CONCLUSION: Our study shows that any LA among older adults is associated with having less depressive symptoms 5 years later among community-dwelling older adults while having any PA was not associated with depressive symptoms after 5 years of follow-up.
Fall-Related Injury in Older Adult Home Care Recipients: A Descriptive Population Study
Authors: Xing Danilla , Zecevic Aleksandra , Lappan Nicolette , Ming Yu 
Published: December 2021

Abstract
Canada is experiencing a growing aging population leading to an increase in the number of individuals receiving home care. More needs to be known about home care clients who experience fall-related injuries. The purpose of this study was to describe the characteristics of Ontario home care recipients (65 and older) who experienced fall-related injury, and the characteristics of those injuries. We conducted a population-based descriptive study using secondary data from the IC/ES data repository for the period of 2010-2014. Person-level characteristics were extracted from the Resident Assessment Instrument - Home Care and injury characteristics from ICD-10 CA codes for falls (W00-W19) in combination with injuries (S00-S99 or T00-T14), available from the NACRS database. Descriptive statistics and rates were calculated using R. Results show the population (N= 88,731) was primarily female (67.0%), the largest age group was 85-89 years old (25.5%) and hypertension was the most prevalent (83.0%) chronic condition. Clinical Assessment Protocols (CAPs) indicated need for support in management of IADLs (75.4%), falls (72.3%) and pain (70.3%). Most patients (55.8%) used nine or more medications. In 90 days prior to home care assessment, 39.6% experienced no falls, 32.4% fell once, and 26.1% fell two or more times. Injuries primarily took place within the home (38.2%). Factures were the predominant injury type (40.8%), followed by superficial injuries (19.7%). These findings create a foundation for fall-related injury prevention in home care and further research on risk identification, the efficacy of CAPs, and home environment adjustments.
Ambivalence Among Intergenerational Relationships In Old Age
Authors: von Humboldt Sofia , Costa Andrea , Silva Sara , Leal Isabel 
Published: December 2021

Abstract
Objective: This study aims to analyze the perspectives of intergenerational relationships between older adults and adult children. For this purpose, a qualitative research was carried out, which analyzes these relations at a cross-national level. Methods: Four hundred and twenty four older participants aged 65-97 years, were interviewed. Participants were of three different nationalities and lived in the community. All the interviews went through the process of verbatim transcription and subsequent content analysis. Results: Two dimensions of generational ambivalence were revealed from the study; support and the conflict dimensions. Findings of content analysis produced six themes, which represent intergenerational relations between older adults and adult children: older adults-adult children interaction quality; family integration; care and support; definition of limits; distance and alienation; and communication difficulties. Conclusions: This study highlighted the diversity of experiences in old age, in relation to intergenerational relationships and underlined the conflicting expectations from older adults in relation to their adult children. Keywords: Adult children, ambivalence; conflict; intergenerational relationships; older adults; support.
Different Experiences of Adult Child and Spousal Caregivers with Family Conflict
Authors: Yun Stacy , Weber Kendall , Ferszt Geffen , Dieker JoAnna , Qualls Sara 
Published: December 2021

Abstract
Previous research indicates that different types of caregivers report distinct levels of family conflict (Dieker et al., 2019). However, as half (52%) of the participants in the previous study did not report family conflict, the purpose of this study was to examine the relationships among types of caregivers, family conflict, and caregiver burden in those who experience family conflict. Participants (N = 277; aged 19 to 87; M = 52.96) comprised of 197 adult child and 80 spousal caregivers. They completed the Caregiver Reaction Scale (O’Malley & Qualls, 2017) to assess different aspects of the caregiving experience. Hierarchical regressions (block 1: demographics, block 2: family conflict) were computed to predict caregiving burden. For spousal caregivers, the final model explained 2.2% of the variance in caregiving burden, F(7, 69) = 0.22, p = .98. None of the variables were significant. Additionally, family conflict did not uniquely influence caregiving burden beyond demographics, Fchange(2, 69) = 0.03, p = .97. For adult child caregivers, the set of predictors accounted for 20.5% of the variance in caregiving burden, F(7, 183) = 6.75, p &lt; .001. Having more family beliefs and support conflict predicted greater caregiving burden (ps &lt; .01). Family conflict scores also significantly explicated caregiver burden beyond demographics, Fchange(2, 183) = 17.60, p &lt; .001. Results suggest that family conflict is a stronger driver of caregiver burden for adult child than spousal caregivers. Findings imply the need for clinicians to target appropriate interventions for adult child caregivers to reduce caregiver burden.
The Shape of Care: Patterns of Family Caregiving Among Chinese Adults in the Middle to Later Stage of Life
Authors: Duan Haoshu 
Published: December 2021

Abstract
Due to the lack of institutional support, families have long been the primary caregivers in China. Most studies to date only focused on one single care activity during a particular life course stage. Nonetheless, older adults today are more likely to care for multiple family members concurrently or sequentially (serial caregivers). The studies on discrete snapshots of care activities failed to capture the patterns of family caregiving overtime. Utilizing four waves of longitudinal data from CHARLS (2011-2018, N=17,039), this study particularly focuses on care activities to grandchildren, parents, and spouse, and maps out the family caregiving patterns overtime. Using latent profile analysis, this study identifies five family caregiving patterns: 1). Light grandchild caregivers (27%), who on average provided 4.3 years’ grandchild care mostly; 2). Heavy grandchild caregivers (11%), who on average on provided 7 years’ grandchild care mostly; 3). Light caregivers for grandchildren and parents (7%), who sequentially provided 1-year care to grandchildren and parents; 4). Heavy serial caregiver (6%), who mostly provided care to spouse and grandchildren with higher overlapping years; 5). Overall light caregivers (49%), who on average provided less than one year of care to any recipient. The preliminary results suggest that heavy serial caregivers (6%) far worst in terms of depressive symptoms and more likely to report worsened self-rated health; and overall light caregivers (49%) have the lowest depressive symptoms and more likely to report good self-rated health.
Gender Differences in the Link Between Informal Caregiving and Subjective Well-Being
Authors: Kim Aeri , Woo Kyungmi 
Published: December 2021

Abstract
Despite existing evidence on the negative association between informal caregiving and caregiver’s well-being, three important knowledge gaps remain. First, the link warrants further scrutiny due to the possibility of individual heterogeneity. Second, less is known about how informal caregiving is related to caregiver’s well-being. Third, there is little consensus in the literature regarding whether caregiver’s gender matters. This study fills these gaps in the literature. Using seven waves of a large-scale, nationally representative longitudinal study of older adults in Korea between 2006 and 2018, this study employed generalized estimating equations models with a lagged dependent variable as well as fixed effects models. Findings from both models revealed that informal caregiving is negatively associated with subjective well-being, and this association is largely driven by female caregivers. To explore potential mechanisms undergirding this association, we examined the mediating roles of a number of health behaviors. We found that engaging in informal caregiving is associated with a reduction in regular exercise. Results from mediation analyses, however, suggested that regular exercise explains only a moderate amount of the observed association (12% for health-related life satisfaction and 8% for self-rated health). While informal caregiving is obviously a rewarding role, it poses a serious threat to caregiver’s well-being. Findings of this study on gender differences in the well-being consequences of informal caregiving lend support to taking a gender-conscious approach in programs aiming to improve the well-being of informal caregivers.
Dynamics of unmet need for social care in England
Authors: Vlachantoni Athina , Falkingham Jane , Evandrou Maria , Qin Min 
Published: December 2021

Abstract
Meeting individuals’ social care needs is a core element of UK social policy. However, the conceptualisation and operationalisation of ‘unmet need’ remain a challenge. This paper advances our understanding by incorporating a temporal dimension in the conceptual framework on unmet need to investigate the dynamics of met and unmet need for social care over time. Using data from Waves 6,7 and 8 of the English Longitudinal Study of Ageing, this paper examines five possible trajectories among individuals with a social care need at baseline: 1) no longer having such a need; 2) having continued needs met; 3) delayed needs met; 4) newly arisen unmet needs; and 5) persistent unmet needs. The results indicate that amongst those with need at baseline unmet need has decreased over time, indicating that some needs may be fulfilled with a delay. However, a significant proportion of older people experienced persistent unmet needs, particularly those who were younger, living alone, with educational qualifications, and with fewer difficulties with Activities of Daily Living at baseline. Understanding the dynamics of unmet need can support policymakers in ensuring that those facing an elevated risk of persistent unmet need over time do not fall through the social care safety net.
Family Caregivers and Support: Implications for Work Strain and Formal Service Use
Authors: Svec Joseph , Lee Jeongeun 
Published: December 2021

Abstract
In the US, many employed caregivers make professional adjustments, exacerbating already tenuous balances between work and life. Using the framework of the Stress Process Model (SPM), current research examines the sources of support (both formal and informal) and the contextual factors that facilitate or impede caregiver support. In this research, we examine whether and to what extent caregiver work strain is ameliorated by the presence of additional family caregivers and formal service use. This study utilizes data provided by the National Study of Caregiving (NSOC) data. Using panel methods for the pooled waves, we analyze the associations between work-strain and the number of additional caregivers with utilization of formal support (such as paid service support). Preliminary analyses align with the Stress Process Model as additional caregivers for each respective care-recipient is associated with lower levels of work strain. On the other hand, utilization of formal services (paid help and Medicaid funding) is positively associated with work strain. These findings suggest that the number of additional caregivers can reduce the negative impact of caregiving on work related strain among employed caregivers. That is, multiple caregivers may be more reflective of cooperative arrangements which offset work disruptions that occur with the onset of caregiving. In addition, formal sources may more frequently be used as a last resort to address caregiver burnout. Ongoing analyses are examining changes in the number of caregivers and its impact on disruptive work event, which could lead to financial outcomes for caregivers.