bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE LINK BETWEEN INTRAINDIVIDUAL VARIABILITY IN COGNITIVE PERFORMANCE AND MOBILITY IN CHRONIC STROKE
Authors: Dimri Vrinda , Silva Nárlon Cássio Boa Sorte , Balbim Guilherme , Liu-Ambrose Teresa 
Published: January 2025

Abstract
Intraindividual variability (IIV) is the within-person trial-to-trial variation in reaction time during cognitive tasks. Higher IIV represents reduced consistency in responses, which may be due to lapses in attention, and is associated with reduced mobility in older adults. IIV may also be a more sensitive measure of cognitive performance versus traditional summary scores. A stroke can significantly impact one’s cognitive function and mobility. Whether IIV in cognitive performance is associated with mobility among individuals who have experienced a stroke is unknown. We aimed to examine this relationship by using baseline data from a six-month single-blinded, 3-group parallel randomised controlled trial. Participants included community-dwelling adults (N= 119, 38.7% female) with a history of stroke, aged 55 years and older (mean= 70.71 years, SD= 8.59), able to walk 6 meters, and without dementia. Mobility was assessed based on timed up and go (TUG) performance. Residualised intra-individual standard deviation (rISD) was used as measure of IIV and computed using trial latencies of a computerised Stroop Task. TUG scores significantly predicted rISD of congruent (beta= 0.03, SE= 0.01, p-value = 0.001) and neutral trials (beta= 0.02, SE= 0.01, p-value = 0.04), but not incongruent trials (beta= 0.01, SE= 0.01, p-value = 0.18). However, these effects were not found when age was included as a covariate. Overall, these findings suggest that in adults with stroke, higher IIV measured from a simple reaction time task is associated with worse mobility. Further longitudinal studies are needed to determine if higher IIV is predictive of mobility decline post-stroke.
USING THE MONTREAL COGNITIVE ASSESSMENT IN MILD AGE-RELATED HEARING LOSS
Authors: Shende Shraddha , Mudar Raksha 
Published: January 2025

Abstract
Age-related hearing loss (ARHL) is a modifiable risk factor for dementia. There is a need for early detection of cognitive concerns in older adults with ARHL. The Montreal Cognitive Assessment (MoCA) is a well-validated screening tool that has been used to screen cognition in the ARHL population. However, few studies have examined the value of both MoCA total score (MoCA-TS) and MoCA-Memory Index Score (MoCA-MIS) score in ARHL and its relation to complex hearing functions, especially in those with mild hearing loss. We administered MoCA on 15 older adults with mild-to-moderate ARHL and 15 matched normal hearing controls. MoCA-TS and MoCA-MIS were calculated. Participants also completed the Quick Speech-in-Noise (QuickSiN) test and the Hearing Handicap Inventory for Adults (HHIA). Relative to controls, worse scores were obtained in the mild ARHL group on MoCA-TS (p =.031) and MoCA-MIS (p =.039). Bivariate correlations revealed a significant negative association between QuickSiN and MoCA-TS scores (p &lt;.001), with similar trends on MoCA-MIS (p =.051). When the peripheral hearing measure was controlled using partial correlations, the negative correlation between QuickSiN and MoCA-TS remained (p =.004). The correlations of MoCA-TS and MoCA-MIS with HHIA were not significant. Our findings reveal changes in global cognition beyond encoding memory in mild ARHL. Additionally, our findings suggest that complex listening functions assessed using QuickSiN in related to overall performance on MoCA.
FAMILY TIES AND HEALTH CARE DECISION-MAKING IN LATE LIFE: EXAMINING FINANCIAL DEPENDENCY IN HEALTH FOR INDIA
Authors: Pandey Atul , Sharma Isha 
Published: January 2025

Abstract
With the increasing number of age 60 years and above population, it is becoming important to improve healthcare and economic assurance for grandparents/parents. Family ties and culture is a way of consideration of healthcare choices and providing financial support. Family member’s financial stability assure the finance for healthcare for aged population. The dissolution of traditional extended families in India is closely related to the above-described issues, which also lead to rising economic inequality, urbanization, modernization, growing individualism, and a greater emphasis on healthcare choices. The rise in nuclear families and longer life expectancies has led to an increase in the cost of caring for the late ageing population. This study is examining the role of family ties and healthcare decision making through the lens of financial dependency. This study uses Longitudinal Ageing Study in India (LASI) i.e. secondary data source capturing 31464 respondents with the age of 60 years and above. It again classified into the male (16366) and female (15098) cohort. The data provide significant information related to the coverage of financial security. One out of every five individuals with age 60 years and above is enrolled in an organized sector’s pension plan. A sizable share (20.65%) of the population is covered by central and state pension programs. In contrast, only a small percentage of India’s retired population (2.1%) is covered by private pension, or employer-funded pension schemes. Just 7% of individuals believe their family’s financial situation is adequate, whereas 53% comes from middle class family.
GROWTH OF THE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY AND THE ROLE OF PRIVATE EQUITY
Authors: Miller Katherine , Gupta Ravi , Polsky Daniel 
Published: January 2025

Abstract
The Program of All-Inclusive Care for the Elderly (PACE) is a managed care program for adults 55+ who require nursing home level of care and are mostly dual-eligible for Medicare and Medicaid. PACE programs receive capitated payments per person for comprehensive medical and social services to enrollees, primarily in adult day health centers. In 2016, the Centers for Medicare & Medicaid began allowing for-profit ownership of PACE. Our objective is to describe the growth of PACE from 2010 to 2022 in the context of the 2016 policy change allowing for for-profit investment. We also describe the share of for-profit programs receiving private equity investments. We use Refinitiv and Medicare Advantage contract and enrollment data. Enrollment in for-profit programs from 2016 to 2022 increased by an annual average of 13% compared to 5.6% in non-profit programs. This is the context of an annual rate of increase in enrollment of 11% in the 6 years pre-policy change and 7% in the 6 years post-policy change. Among enrollees at for-profit programs in 2022, 47% received care at programs with private equity investments. Despite the growth of for-profit ownership and private equity investments, most enrollees received care from non-profit programs (78%) in 2022. Since allowing for-profit ownership, expansion has been driven by for-profit entities, ~50% of which received private equity investments. While expanding access to PACE may be important for certain adults, examining the effects of growth in for-profit and private equity ownership of PACE programs for patient outcomes is an important next step.
LIVING WITH MULTIMORBIDITY AND FINANCIAL TOXICITY: A PATIENT- AND CLINICIAN-INFORMED FRAMEWORK
Authors: McDermott Cara , Lourie Michael , Hazlewood Hudson , Sloan Caroline 
Published: January 2025

Abstract
Most older adults in the US have multimorbidity (2+ serious illnesses). Living with multimorbidity impacts patient quality of life, specifically managing the symptoms of multiple diseases and accompanying medications, emotional strain, and financial toxicity, or the financial stress of having unaffordable medical expenses. We developed an initial framework describing financial toxicity in multimorbidity to inform a financial toxicity screening tool and associated interventions for the clinical setting. We then iteratively refined the framework with patient and clinician feedback. We recruited 8 patients with multimorbidity taking 5+ medications from Duke Primary Care, along with 8 clinicians. We conducted semi-structured interviews with patients to describe their experiences living with multimorbidity and financing/prioritizing healthcare needs. In focus groups with clinicians, we explored ways to adapt existing financial toxicity screening questionnaires plus barriers/facilitators to future implementation of financial toxicity interventions in primary care clinics. Our initial framework included the dynamic nature between acute stressors (e.g., heart failure exacerbation), financial coping (e.g., borrowing money), financial reserve (e.g., insurance coverage), and patient outcomes (e.g., quality of life). We added/clarified the following domains following patient interviews and clinician focus groups: caregiver support/involvement (e.g. help with bills), health system constraints (e.g. cannot waive copays), health system-based support (e.g. charity care), community-level supports/programs (e.g. food banks), clinician moral distress (e.g. anger at not being able to provide optimal care), clinician financial coping (e.g. changing prescription based on cost). Next steps include using the framework to adapt screening questionnaires and interventions to detect and address financial toxicity in multimorbidity.
ADAPTING TO HEALTH CHANGE: STUDENT RESPONSES TO DIFFERENT DELIVERY MODALITIES
Authors: Kleszynski Keith , Jennings Lee , James Shirley 
Published: January 2025

Abstract

Background
Adapting to Health Change (AHC) is a two-hour aging sensitivity simulation training designed to improve student empathy and understanding of common age- and chronic illness-related functional changes. AHC includes role-play with props and 4 activity stations: hearing loss, neuropathy and dexterity, vision loss and medication management, and mobility and transfer. Training is facilitated by interdisciplinary faculty and staff.

Methods
AHC was delivered in-person in 2 sessions to 38 speech pathology students and delivered virtually to 136 social work students in 4 sessions. The simulation was modified for online education by using common household items for props in the activity stations. Post-training evaluation results were analyzed between delivery modalities and student groups.

Results
Students strongly agreed that the simulations helped them better understand how it feels to age with health changes (79%) and potential stereotypes and biases associated with aging (80%). Students strongly agreed the simulations provided useful insight into the aging experience (82%) and that the experience will help them develop into better health care providers of patients adapting to changes associated with aging (83%). The majority of students felt that their knowledge of age-related challenges had improved (94%). There were no significant differences between student groups or between those who received virtual versus in-person delivery.

Conclusion
Aging empathy simulations improve student understanding of age-related health changes and can be effectively delivered in-person or online, making wider delivery to health professions students using virtual training platforms more feasible.
AGE-FRIENDLY ESCAPE ROOM: A POLYPHARMACY QUANDARY
Authors: Yang Betsy , Park Caroline , Davis Carter , Weith Joanne , Kang Simeon , Tee Silvia , Gould Christine , Shastri Vinita 
Published: January 2025

Abstract
Gamification, or adding elements like interactivity and puzzle-solving to teaching, has the potential to promote engagement in geriatric medical education. We organized a 60-minute escape room at a regional internal medicine conference to teach the 4Ms (What Matters, Medications, Mobility, and Mentation) Age-Friendly framework to interprofessional providers through gamification. 15 interprofessional participants received a short patient case and formed small teams to “Escape the Room” by rotating through each of the respective stations of 4Ms, moderated by interdisciplinary preceptors, to learn about salient points of geriatric care with the specific “M” in mind for the patient case. At the end of their 4 station rotations, participants received a clue to solve the final puzzle using the 4Ms framework which answers the question “Which medication will we deprescribe first to treat our patient experiencing cognitive impairment, polypharmacy, and falls?” From the retrospective post-then-pre questionnaire, we evaluated participants’ confidence and knowledge of 4Ms and workshop effectiveness. Results showed significant improvement in participants’ confidence (2.73) and knowledge (2.24) of 4Ms (on a 10-point Likert Scale, p&lt; 0.01, n=15, Wilcoxon Signed-Rank Test). Participants strongly agreed with recommending the workshop to others (μ=4.9 out of 5, SD=0.4) and applying 4Ms to their practice (μ=4.9 out of 5, SD=0.3). Qualitative feedback indicated the escape room was both “useful” and “engaging”, though some participants recommended allotting more time to the activity. With this workshop, we demonstrated that an interprofessional escape room can teach important geriatric concepts in an effective and engaging manner.
CAN NOVICE LEARNERS BE CLINICAL CHANGE AGENTS FOR DEMENTIA CARE PRACTICE?
Authors: Duthie Edmund , Denson Kathryn , Simpson Deborah , Barnes Stacy , Betley Wendy , Szymkowski Amanda , Denson Steven 
Published: January 2025

Abstract

Intro
Caregiver support is an essential component in dementia care and yet clinicians’ referrals to community-based support services are lacking. Direct Connect (DC) is a clinician-initiated referral process for dementia patients and caregivers, offered by the Alzheimer Association to make the process simple and efficient.

Methods
We created a brief educational intervention targeting medical, nursing, and pharmacy students to develop them into DC champions at clinical rotation sites in Wisconsin. Content focused on dementia detection, caregiver burden, available resources, and DC referrals. Delivery included online, in-person, and hybrid formats. Data was collected with a post-intervention survey and student interviews. At baseline (2021), 277 DC referrals were made by clinicians in Wisconsin.

Results
Following a 2-year rollout to students (N=375), the annual number of DC referrals received from clinicians increased (300 in 2022; 351 in 2023). However, review of referral data revealed the increase was primarily from licensed clinicians not at student champion sites. Follow-up interviews with students indicated they find it daunting to suggest changes in busy clinical settings where they lack experience and autonomy. Despite incorporating scripting and role playing into our educational session, students continued to lack confidence.

Discussion
Although student champions have proven effective in other clinical conditions, our results suggest different strategies are needed for dementia care. Based on these findings, we propose to refocus training efforts toward more senior learners such as medical residents who have more experience and clinical autonomy, and to embed the DC referral within the electronic health record to facilitate usage.
IMPACT OF ENVIRONMENTAL SATISFACTION ON SLEEP QUALITY AMONG SOUTH ASIAN CAREGIVERS FOR OLDER ADULTS
Authors: Chekuri Srujana , Siddiqui Aziza , Karki Dinesh , Boron Julie Blaskewicz 
Published: January 2025

Abstract
Caregivers for older adults rely heavily on good sleep quality for their general health and ability to provide care. This study investigated the impact of environmental satisfaction, both at home and in the surrounding neighborhood, on sleep quality among South Asian caregivers for older adults, specifically those not living with the care recipients. Participants completed a survey focused on South Asian caregivers’ sleep quality and satisfaction with their surroundings, such as the cleanliness of living spaces, noise levels, and the condition of neighborhood walkways and cycling lanes. A series of regression analyses were used to examine relationships. Results demonstrated a statistically significant relationship between environmental satisfaction and sleep quality. Specifically, high satisfaction with home cleanliness, and low noise levels were positively associated (p&lt; 0.05) with increased sleep duration. Similarly, the state of outdoor infrastructure, such as well-kept sidewalks, and cycling routes were also positively associated (p&lt; 0.05) with more hours of sleep among caregivers. This highlights the significant role of favorable indoor and outdoor environments in enhancing sleep quality among South Asian caregivers for older adults, pointing to the potential benefits of targeted environmental interventions. These findings further emphasize the need of a supportive environment for the well-being of South Asian caregivers, even when they are not living with their care recipient. The focus on a specific cultural group may limit generalizability. Thus, future studies should incorporate diverse caregiver samples to explore the generalizability of results across different cultural contexts and living situations (e.g., residing with or without the care recipient).
BURDEN AND BENEFITS OF INFORMAL CAREGIVING AND OLDER CAREGIVING RECIPIENTS’ SUBJECTIVE WELL-BEING
Authors: Qin Weidi , Dang Linh , Mezuk Briana 
Published: January 2025

Abstract
Informal caregiving plays an important role in and has implications for the subjective well-being (SWB) of older caregiving recipients. Using data from the 2021 National Study of Caregiving (N = 991) linked to the National Health and Aging Trend Study (N = 3,321), this study addressed three questions: 1) Is having an informal caregiver associated with better SWB among older adults? 2) Are informal caregivers’ perceptions of caregiving burden and benefits associated with older caregiving recipients’ SWB? 3) Does the relationship between perceived caregiving burden/benefits and caregiving recipients’ SWB differ by gender and relationship types (close family members vs. non-close family)? SWB was measured with a 7-item scale. Caregiving burden was measured with 9 items regarding difficulties in providing caregiving (i.e., emotional difficulty). Caregiving benefit was measured with 4 items indexing beneficial experiences (i.e., closeness to caregiving recipients). Weighted multivariable OLS regressions were used to examine the relationships between caregiving burden, benefit, and SWB. Older adults with a caregiver reported lower levels of SWB compared to those without (B = −0.73, p = 0.001). Expectedly, caregiving burden was associated with lower levels of subjective well-being in caregiving recipients (B = −1.22, p &lt; 0.001). The relationship between caregivers’ perceived benefits and caregiving recipients’ SWB differ by caregiving recipients’ gender (B = 2.01, p = 0.044) and relationship types (B = -2.25, p = 0.032). The findings highlight the importance of considering caregiving recipients’ gender and family relationships in developing interventions to improve informal caregiving experiences.
HEALTH CARE USE AMONG SPOUSE CAREGIVERS OF OLDER ADULTS LIVING WITH DEMENTIA
Authors: Lei Lianlian , Langa Kenneth , Norton Edward , Levy Helen , Kim Hyungjin Myra , Blow Frederic , Maust Donovan 
Published: January 2025

Abstract
Little is known about how caregiving is associated with caregivers’ health care use, particularly where the care recipient is a person living with dementia [PLWD]. This study aims to characterize health care use of spouses of PLWD. Using the 2000–2018 Health and Retirement Study linked with Medicare claims data, we identified community-dwelling dyads where one member had dementia, both members were aged ≥65 years, and enrolled in fee-for-service Medicare; for dyads included in multiple waves, we randomly selected one wave (N=924 unique dyads). We examined the association of spouse care intensity with spousal health care use, adjusted for spousal socio-demographic, health, and functional characteristics. Forty-three percent of spouses did not provide care; and among those providing care, the average monthly hours were 27, 150, and 430 for the first, second, and third tertiles, respectively. Adjusted for spousal characteristics, spouses not providing help had higher total annual Medicare costs ($5,728 and $5,776 higher than those in the second and third tertiles, respectively, p&lt;.05 for both), acute hospitalization (8.2% and 10.4% higher than those in the second and third tertiles, respectively, p&lt;.05 for both), and sub-acute care (7.2% higher than those in the second tertile, p&lt;.01). The spouses who did not provide caregiving hours had the highest health care costs and use. It is unclear whether PLWD spouses do not need care or whether these spouses, by virtue of their own health problems, do not have the capacity to provide caregiving.
THE FEASIBILITY OF A PEER-DELIVERED PSYCHOSOCIAL INTERVENTION FOR FAMILY CARE PARTNERS OF HOSPICE CANCER PATIENTS
Authors: Benson Jacquelyn , Pitzer Kyle , Lindsay Ryan , Washington Karla , Oliver Debra Parker 
Published: January 2025

Abstract
Providing care and support to a hospice patient with cancer can exact an enormous psychological toll on families. Approximately 50% of advanced cancer family care partners report moderate to severe depression and anxiety. Many studies indicate that the psychological suffering of family care partners can be alleviated by enhancing their coping skills. However, mechanistically informed psychosocial interventions that are better tailored to the unique needs of cancer caregivers are needed. Study objectives were to: (1) evaluate the feasibility and acceptability of a 1:1 peer-delivered psychosocial support intervention for hospice family care partners of cancer patients, and (2) determine a range of potential effects of the intervention on mechanisms of change and care partners’ psychological distress symptoms to guide variable inclusion for a future trial. The study was carried out using a convergent parallel mixed methods design. Qualitative data were analyzed using deductive thematic analysis. Descriptive statistics were performed for demographic characteristics, and rates of recruitment, attrition, and survey completion. Parametric and non-parametric t-tests were conducted to examine mean differences of study outcomes between baseline and midpoint, and endpoint. Mean differences above 0, in the expected direction, and confidence intervals with a 10% or greater change in the total outcome were used to guide decision-making about future trial inclusion. Results demonstrated that the intervention is acceptable, appropriate, and feasible to deliver to hospice family caregivers of cancer patients. Depressive symptoms, anxiety symptoms, benefit finding, and self-efficacy were also determined to be appropriate measures for future use in a larger trial.