bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emerging Biotechnology Markers of Cognitive Impairment
Authors: Huisingh-Scheetz Megan , Schrack Jennifer 
Published: December 2021

Abstract
The early detection of cognitive impairment is among the National Institute on Aging’s (NIA) current research priorities. Sensor-based technologies have exploded in recent years allowing remote, continuous measurement of older adults’ free-living activity. This highly granular data has stimulated exciting new research exploring how change in health can be detected remotely using novel “biotechnology” markers. Yet, this area of research is in its infancy as it relates to predicting cognitive function. This symposium will provide an overview of the sensor-cognition research landscape and will feature 5 new studies exploring the relationship between biotechnology markers and cognitive function, each with unique sensors, cognitive measures and samples. The first three presentations will report associations between accelerometry-based activity measures (chest or wrist devices) and cognitive function (assessed by diagnosis, a neurocognitive assessment, or microstructural changes on DTI) in the Baltimore Longitudinal Study on Aging, a large, NIA-funded epidemiologic dataset. The fourth presentation will report the significance of free-living hip accelerometry activity measures beyond clinically-available information in a random forest prediction model of 1-year change in Montreal Cognitive Assessment scores among urban, predominantly African-American older adults without moderate-severe dementia residing in the community. The final presentation will report associations between room-to-room transitions as detected by in-home, infrared motion sensors and mild cognitive impairment using data from a community-dwelling sample of older adults residing alone. This symposium will provide a substantial expansion of current knowledge in this research space and will be relevant to clinicians or researchers with an interest in sensor technology or dementia.
Predictors of Falls in Older Adults With and Without Dementia
Authors: Okoye Safiyyah , Fabius Chanee , Wolff Jennifer 
Published: December 2021

Abstract
Persons living with dementia (PLWD) have up to twice the risk for falling and three-times the risk of serious fall-related injuries as those without dementia. Falls are a leading cause of hospitalizations among PLWD, who are more likely to incur high costs and experience negative health consequences (e.g, delirium, in-hospital falls) than persons without dementia. Few studies have examined risk factors for falls comparing Americans with and without dementia. We used data from the 2015 and 2016 rounds of the National Health and Aging Trends Study (n=5,581) to prospectively identify risk factors for a single fall and recurrent (2+) falls over a 12-month period among community-living older adults ≥65 years with and without dementia in a series of bivariate logistic regressions. Overall, we identified fewer predictors of single or recurrent falls among PLWD compared to persons without dementia. For example, socioeconomic indicators (e.g., income, financial hardship) predicted recurrent falls in persons without dementia, but not in PLWD. Among PLWD, falling in the previous year was associated with both single (odds ratio (OR): 3.38, 95% confidence interval (CI): 1.77, 6.49) and recurrent falls (OR: 6.19, 95% CI: 3.50, 10.93). PLWD who experienced recurrent falls were also more likely to be identified as having a fear of falling (OR: 2.17, 95% CI: 1.33, 3.54), physical function impairments, depression symptoms (OR: 2.23, 95% CI: 1.34, 3.71), and anxiety symptoms (OR: 1.73, 95% CI: 1.14, 2.62). Further study of fall-risk factors could inform screening, caregiver education and support, and prevention strategies for PLWD.
Transitions in Adherence Trajectories From Intervention to Maintenance of a Falls Prevention Exercise Program
Authors: Sung Pildoo , Lee May-Ling June , Tan Kok Yang , Malhotra Rahul , Chan Angelique 
Published: December 2021

Abstract
The successful implementation of a falls prevention exercise program for older adults hinges on self-maintenance after active intervention. However, little is known about the pattern of adherence from the intervention to the maintenance phase of such programs, and the factors influencing adherence. We investigate transitions in exercise adherence trajectories from the active intervention to the maintenance phase of a falls prevention exercise program in Singapore, and whether exercise self-efficacy is associated with adherence in the maintenance phase. We analyze data of 143 older adults who participated in a 12-week, group-based falls prevention exercise program, followed by a 6-month maintenance phase, in 2018-2019. Sequential process latent class growth modeling identifies the distinct exercise adherence trajectories in the active intervention and the maintenance phase separately and their transition patterns. Multivariable regression examines whether baseline and change in self-efficacy during the active intervention predict adherence during the maintenance phase. The analysis reveals three exercise adherence trajectories— adherent (40% of participants), intermittent (38%), and disengaged (22%)—in the active intervention phase, and two trajectories—adherent (33%) and disengaged (67%)—in the maintenance phase. Those adherent in the maintenance phase comprise participants who were adherent (42%) or intermittent (58%) in the active intervention phase. Baseline and increase in exercise self-efficacy during the active intervention are positively associated with adherence in the maintenance phase. The findings capture the heterogeneity in exercise adherence patterns within and across the active intervention and maintenance phases of falls prevention exercise program, and the importance of exercise self-efficacy in continued adherence to exercise.
Delivery of Home and Community Based Services During a Pandemic: Unexpected Consequences
Authors: Cherlin Emily , Ayedun Adeola , Straker Jane , Wilson Traci , Brewster Amanda , Rubeo Chris , Curry Leslie 
Published: December 2021

Abstract
The COVID-19 pandemic required AAAs to pause essential services, serving as a catalyst for innovation. We examined such innovations as part of an explanatory mixed-methods, positive deviance study of AAA partnerships with health and social service organizations. We identified 8 AAAs with many partners serving areas with lower levels of health care use, and 3 AAAs with few partners serving areas with higher levels of health care use. We interviewed AAA and partners, (total = 123). Using the constant comparative method, we identified recurrent themes: 1) AAAs adapted to increased demand for services by developing new ways to deliver services, 2) the pandemic raised awareness of unmet needs such as social connection, 3) changes in delivery of services included embracing technology, and 4) AAAs and their partners identified resources to rapidly pivot services. AAAs and partners demonstrated resiliency to not only to sustain programs, but to innovate throughout the pandemic.
Associations Between Endogenous Estrogen, Postmenopausal Hormone Therapy, and Cognitive Changes in Older Women
Authors: Espeland Mark , Hugenschmidt Christina 
Published: December 2021

Abstract
How markers of brain health are associated with endogenous estrogen and use of postmenopausal hormone therapy (HT) varies depending on women’s years from menopause and metabolic health status, ranging from potential benefit to harm. The Women’s Health Initiative (WHI) included 7,233 women age 65-80 who underwent a randomized clinical trial of various HT preparations for an average of 5.9 years. Over up to 18 years of post-trial follow-up, diabetes (DM2) increased the risk of dementia (hazard ratio [HR] 1.54 [95% CI 1.16–2.06]). Having DM2 and also treatment with unopposed conjugated equine estrogens increased the risk to HR=2.12 [1.47-3.06]. We hypothesize that the metabolic effects of estrogen in the brain drives this interaction. In support of this, the metabolic transition following menopause may alter the impact of other treatments on cognition, for example behavioral weight loss therapy to treat obesity in women with type 2 diabetes (interaction p=0.02 for executive function).
Neighborhood Environment and Social Support Received: An Examination of Race and Gender in Baltimore City
Authors: Baik Sol , Mair Christine , Lehning Amanda , Cheon Ji Hyang , Waldstein Shari , Evans Michele , Zonderman Alan 
Published: December 2021

Abstract
Social support in urban settings is likely shaped by the context of the neighborhood environment. Patterns of support may also differ by the type of support received as well as characteristics of the person receiving support. For example, women and Black residents may have stronger support networks compared to men and white individuals, and variation by gender and race in social support may have important implications for promoting well-being in disadvantaged neighborhoods. To investigate the presence of these potential patterns in a disadvantaged urban environment, we analyzed 2,553 Baltimore City residents (ages 30-64) from the baseline wave (2004-2009) of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. We tested associations between self-assessed neighborhood environment (disorder, cohesion, and control) and social support (from partners, children, and/or friends) and further explored variation by intersections of race and gender using multi-group structural equation modeling. Our results suggest that individuals are more likely to receive support when they perceive their neighborhood to have higher social control and cohesion, particularly in terms of support from friends. Although interactions by race and sex were not statistically significant, a descriptive pattern emerged wherein Black women are particularly likely to receive support from multiple sources when they report more social control in their neighborhood. On the other hand, there is almost no association between neighborhood environment and social support for Black men. We discuss these findings in light of potential neighborhood inequities in informal support access in Baltimore City and similar urban settings.
Residence in HUD Housing Associated With Greater Benefit From HCBS Services for Medicaid Enrollees in Pennsylvania
Authors: Da Costa Damian , Degenholtz Howard 
Published: December 2021

Abstract
State Medicaid programs seek to shift the delivery of long-term care services away from institutional settings and toward community-based settings by expanding access to home-and-community-based services (HCBS). HCBS are hypothesized to prevent or delay the need for protracted nursing home stays. This study explores the question of which types of community residence maximize this protective effect of HCBS. We used a probabilistic matching technique to identify whether waiver-eligible Medicaid enrollees were likely to reside in project-based HUD housing in 2013. We applied multinomial logistic regression to observe the risk of long-stay nursing home admission (&gt;100 days) relative to persistent community residence in the subsequent four years. Our model controlled for age, race, gender, urban status, and receipt of home-and-community based services. Our predictor of interest was the interaction between receipt of home and community based services (HCBS) and residence in HUD housing. The eligible baseline population included 152,632 community-residing Pennsylvania Medicaid enrollees in 2013. The analytic sample excluded individuals who died during 2013 or who were no longer waiver-eligible after 2013. Residence in HUD project-based housing while receiving HCBS is independently associated with a 27% percent reduction in risk of long-stay nursing home admission (p = .01) when controlling for individual-level demographics. No significant association was observed between the predictor of interest and risk of death during the follow-up period, suggesting that this finding is not likely confounded by individual health status. Further research should test whether this association is causal and specify possible mechanisms.
Developing a Shared Language to Describe the Age-Friendly Ecosystem
Authors: Dash Kim , Shue Jody , Driver Tim , Bonner Alice , Pelton Leslie , Snyder Rani , Fulmer Terry 
Published: December 2021

Abstract
While multiple sectors—cities and communities, education, employment, health, and public health—have identified and implemented strategies to promote age-friendly systems, their efforts have mainly advanced in siloes. Each sector has met goals specific to its constituents, however, the major transformations required to realize systemic inclusivity and well-being among diverse groups of older adults remains indefinable. To begin to address this gap, we have engaged age-friendly sectors in a process of coordinated planning to define and operationalize an age-friendly ecosystem (AFE) that advances cross-sector and age-friendly solutions to meet the needs of all older adults. Our process borrows from Kania and Kramer (2011) who describe conditions to achieve substantial collective impact when coordinating efforts across sectors: a common agenda, shared measurement systems, mutually reinforcing activities, and continuous communication. In this presentation, we describe our stepwise process to set a common agenda, by engaging older adults and working with experts across sectors, to agree on a series of characteristics that define an AFE. Specifically, we surveyed older adults about their perceptions of an age-friendly ecosystem as well as conducted a review and analysis of relevant activities (i.e., policies, programs, and practices) associated with five age-friendly sectors. Next, activities were organized by common and defining characteristics. We then convened more than 40 international experts representing diverse age-friendly sectors to review and revise the AFE characteristics. Through structured and facilitated group processes, we worked with experts to identify and define six critical AFE characteristics as well as examples of corresponding activities.
Leveraging Partnerships for a Nursing Home COVID Learning Community
Authors: Ross Sarah , Severance Jennifer , Knebl Janice , Luk-Jones Susanna 
Published: December 2021

Abstract
The rapid and uncertain trajectory of community spread in nursing homes statewide spurred action by the University of North Texas Health Science Center to create a nursing home (NH) COVID learning community. As an existing ECHO hub, we assembled an interdisciplinary team leveraging local NH partnerships, a regional Quality Improvement Organization (QIO), and a regional emergency response task force to rapidly scale up delivery. Specialist teams include a geriatrician and NH medical director, administrator, nursing administration, infection control expert, and a QIO specialist. With the IHI curriculum as a road map for essential training elements, we adapt each week’s agenda based on the interests and concerns of the participating nursing facilities and the incidence rate in our community. At this time, we have two more sessions before completion of phase 1. The three cohorts are engaging 151 participants from 68 nursing facilities with a total attendance of 747.
Intensity of Grandparent Caregiving and Well-Being in a Cultural Context: A Systematic Review
Authors: Chan Athena Chung Yin , Lee Sun-Kyung , Zhang Jingchen , Banegas Jasmine , Marsalis Scott , Gewirtz Abigail 
Published: December 2021

Abstract
With improved longevity and changes in family structure, grandparents are key resources in providing care for grandchildren. However, mixed findings indicate that multiple role engagement may enhance well-being or bring demands on grandparents raising grandchildren. Little is known about how the intensity of grandparent caregiving is associated with their well-being in different family contexts (i.e., structures, cultures/regions, and reasons of care). This systematic review examines the association between the intensity of grandparent caregiving and their well-being. Peer-reviewed articles published after 1990 were identified in five electronic databases. A keyword search was performed for keywords associated with: (a) grandparent caregivers raising grandchildren, and (2) well-being (i.e., physical, mental, cognitive, and life satisfaction). Only quantitative studies were included. Fifty-six articles from 28 countries/regions were included. Findings suggested that the well-being of grandparents is optimal when they provide caregiving of moderate intensity, with optimal amounts varying across sociocultural contexts. In Europe and Australia, providing supplementary care seems beneficial for grandparents’ well-being, especially supporting dual-earner families. In Asia, economic resources buffer the adverse effect of primary care on grandparents’ well-being. In the U.S., findings vary across ethnicity/race. White grandparents enjoy health benefits providing supplementary care with support from adult children. However, Hispanic grandparent caregivers in multigenerational households have better well-being than those in skipped-generation households, whereas Black custodial caregivers have better well-being than supplemental caregivers. Collectively, the intensity of grandparent caregiving and well-being is complicated by their roles in the family and cultural differences. This systematic review calls for culturally-tailored family interventions.
Successes and Lessons Learned From Age-Friendly Community Collaborations: Baystate Health GWEP
Authors: Brennan Maura , Dobert Rebecca 
Published: December 2021

Abstract
Baystate is the largest health system in Western Massachusetts with 4 hospitals, 3 Community Health Centers (CHCs) and a large primary care network. Baystate Medical Center (BMC) is in Springfield, Massachusetts. BMC and the CHCs were the first health care sites nationally to be recognized by the Institute for Healthcare Improvement as “Committed to Care Excellence” in the age friendly movement. Collaboration with a city-wide coalition of community-based organizations led to simultaneous recognition of Baystate as “age friendly” and recognition of the city as both dementia and age friendly. The 3 awards were presented at a Springfield senior center with media coverage and the participation of the mayor and other political leaders. This collaboration persists and the GWEP and coalition partners continue to participate in multiple joint educational and community outreach projects. As a result, the city coalition has added health care to its initial focus on housing and transportation.
Household Structure and Older Persons
Authors: Zhang Sainan , Simelane Sandile , Jhamba Tapiwa , Snow Rachel 
Published: December 2021

Abstract
This research explores the life circumstances of older persons (aged 60 years and above), focusing on the sociodemographic and socioeconomic conditions of those who live alone. We situate the living arrangements of older persons within the global context of changing household structures in 76 countries from all regions of the world. Older persons who live alone are among those most likely to need governmental and other forms of social support. The analysis presented here is crucial for supporting policy responses to the needs of older persons, including the special attention they require during the current COVID-19 crisis. It also supports the operationalization of the Madrid International Plan of Action on Ageing (MIPAA)(United Nations, 2002), the realization of United Nations Principles for Older Persons (United Nations, 1991), and the broader framework of the Programme of Action of the International Conference on Population and Development(ICPA-POA).
Community Options to Fund Aging Services: A National Study to Track Local Initiatives
Authors: Koumoutzis Athena , Heston-Mullins Jennifer , Mayberry Pamela , Applebaum Robert 
Published: December 2021

Abstract
The majority of federal support for older people needing in-home services and supports comes from the Medicaid program. However, less than 10% of older people are eligible for Medicaid and to receive long-term services, a person must have a severe disability. Many older people with moderate levels of disability or those who are not impoverished are not eligible. In response to these system limitations, some counties across the nation have developed alternative funding strategies, such as property tax levies, to better serve older members of their communities. After identifying 15 states with such initiatives, a survey was distributed to 414 contacts within these states, with a response rate of 55%. Respondents included organizations such as area agencies on aging, councils on aging, and county departments on aging. Local funding varied within and across states, with annual funding ranging from $8,000-$47 million. Most commonly provided services with local funds include home-delivered (81%) and congregate (73%) meals, transportation (61%), and homemaker services (49%). A majority of programs (63%) indicated that local funds are used to provide at least one family or friend caregiver service. This study is the first compilation and description of locally-funded elder service initiatives in the U.S. Locally-funded initiatives can help older people with long-term services needs continue to live in their own homes and communities. On the other hand, some have raised questions about whether this is a good approach to funding aging services, raising concerns that this will lead to further inequities across states and communities.
Use of Community-Based Participatory Research in Mental Health Studies With Older Adults: A Systematic Review
Authors: Yau Jessie Ho-Yin , Au Walker Siu Hong , Liu Tianyin , Zhang Anna Y , Wong Gloria H Y , Lum Terry Y S 
Published: December 2021

Abstract
Community-based participatory research (CBPR), a bottom-up approach that community stakeholders and academics are involved equitably, is an effective approach for enhancing relevance and value in public health research and has gained popularity in recent decades. However, little is known about how CBPR can be used in mental health studies with older adults. This systematic review examined the current state of knowledge about how CBPR approach has been adopted in mental health research among older adults in different societies. According to the PRISMA guidelines, we searched five major databases and screened the literature using these criteria: 1) journal articles reporting use of CBPR in mental health research among older adults, 2) articles published in English language, 3) studies conducted in any settings with any mental health research. Initial search found 3,227 articles and preliminary screening identified 23 eligible articles. We found that around 90% of studies were conducted in the West. Most studies adopted CBPR to develop community-based mental health interventions or to revise current interventions or models while addressing the cultural needs of their studied population. Few studies adopted CBPR to evaluate existing mental health workshops or programmes. The extent of involvement of older adults in the CBPR approach varied across studies, from questionnaire design to programme evaluation. Our review uncovered ways of CBPR implementation across different societies and elements of successful implementation in CBPR practices in mental health research among older adults.