bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Low-Intensity Daily Walking Activity on Cognitive and Brain Function in Older Adults
Authors: Eldreth Dana , Varma Vijay , Chuang Yi-Fang , Carlson Michelle 
Published: December 2021

Abstract
Physical activity is an effective intervention to prevent or delay cognitive decline and dementia in older adults; however, many have difficulty achieving recommended moderate- to vigorous-intensity guidelines. This study examined the impact of low-intensity daily walking activity on executive cognitive and brain function in 66 older adults (mean age=67.26 ; SD=6.04). Daily walking activity was measured using a step activity monitor and brain function was assessed using functional magnetic resonance imaging during the Flanker task. Analyses included whole and region of interest (ROI) in the right middle frontal gyrus (RMFG), occipital cortex (OCC) and anterior cingulate (ACC). Partial correlations were performed between step activity, behavioral performance, and ROI activation, adjusting for age and education. Most of the step activity was in the low-intensity range. No associations were observed between step activity and task performance (p&gt;.05). Task-related activation occurred in the RMFG, lateral OCC and paracingulate (p&lt;.01). Increased activation in the RMFG was associated with greater amount r(62)=.390, p=.001, duration r(62)=.309, p=.013 and frequency r(62)=.327, p=.007 of step activity. Stratification by sex revealed a positive association between amount of step activity and RMFG activation in women r(44)= .360, p=.014, but not men. Whole brain correlation revealed that amount of step activity was positively associated with precuneus activation (p&lt;.01), an area impacted early in Alzheimer’s disease. These results support the benefits of low intensity daily walking activity on prefrontal function in older adults and suggest the importance of designing attainable and sustainable physical activity interventions to promote brain health in older adults.
Capturing Change in Balance Confidence over 30 Days: Insights Gained from a Micro-Longitudinal Study
Authors: Su Tai-Te , Griffin Aileen , Washington Faith-Christina , Sosnoff Jacob , Meija Shannon 
Published: December 2021

Abstract
Balance confidence reflects one’s estimate of their ability to maintain balance and avoid falls. Extensive literature has shown the relationships between balance confidence, functional limitations, and falls in later life. However, change in balance confidence, especially within short timescale, remains largely unknown and deserves further research. In this study, we aimed to investigate how older adults’ balance confidence would change over 30 days and explore whether baseline characteristics would explain the individual differences in change. We used data from the Daily Balance Project that employed intensive-repeated measurements to examine the dynamics of subjective and objective fall risk across a month. Twenty-one participants (age=78.6±5.8, 48%female) were enrolled, and individual characteristics were measured upon recruitment. Throughout the study, participants self-reported their daily balance confidence using the Activity-Specific Balance Confidence (ABC) Scale. We performed growth modeling techniques to examine change within a multilevel framework. Our results showed that overall, ABC scores were high (79.9±17.4) at first, but the linear change was non-significant (b=0.03, SE=0.21, p=.89) on average. However, we found that balance confidence increased in individuals with higher educational attainment (b=0.37, SE=0.13, p&lt;.01) and decreased among those with greater physical fall risk (b=-0.18, SE=0.07, p&lt;.01) and accurate understanding of fall risk at baseline (b=-0.24, SE= 0.12, p=.04). Although ABC scores were stable within the period of one month, our study highlights the distinction of individual characteristics in the process of balance confidence appraisal. We suggest that these nuances should be taken into account when developing more fine-grained fall risk assessments and interventions.
Sleep and Cognition: Results From a Longitudinal Cohort of Older Puerto Rican Adults
Authors: Arevalo Sandra 
Published: December 2021

Abstract
We examined cross-sectional and prospective associations of sleep duration and insomnia symptoms with measures of cognitive function among older adults aged 45-75 y from the Boston Puerto Rican Health Study, a longitudinal cohort of 1500 participants of Puerto Rican ancestry. We found, statistically significant cross-sectional associations of sleep duration (hours) and an executive function domain before (F=6.20; Prob&gt;F=0.0001) and after (F=2.33; Prob&gt;F=0.05) controlling for covariates (age, sex, education, smoking, drinking, mental and health conditions and medication use); between sleep duration and global cognition before (F=5.38; Prob&gt;F=0.0003) and a trend after controlling for covariates (F=2.20; Prob&gt;F=0.0669). In longitudinal associations, sleep duration (time2) was significantly associated with global condition at time3 (F=2.42; Prob&gt;F=0.0475) after controlling for time2 global cognition. In conclusion, we found hours of sleep and insomnia symptoms significantly associated with various cognitive factors. A public health focus on sleep hygiene may improve cognitive health outcomes in older Puerto Rican adults.
Sensory Impairment is Associated With Recurrent Falls: Study of Women’s Health Across the Nation
Authors: Karvonen-Gutierrez Carrie , Hood Michelle , Ehrlich Joshua , Neitzel Richard , Ylitalo Kelly 
Published: December 2021

Abstract
This study evaluated the relationship between individual and combined sensory impairments (vision, hearing, peripheral nerve (PN)) with recurrent falls in the past year among 1951 women (mean age 65.6 years) from the Study of Women’s Health Across the Nation. Sensory impairments were defined as self-reported vision difficulty, hearing loss, or ≥4 on the Michigan Neuropathy Screening Instrument. Recurrent falls were defined as ≥2 self-reported falls. Hearing was the most commonly reported impairment (39.2%), followed by vision (22.1%) and PN (16.0%). Among those with any impairments, 7.0% of women reported impairments in all domains. Recurrent falls were more common among women with vision (19.4%), hearing (17.3%), or PN impairments (24.7%) as compared to women without sensory impairments (7.0%). The greatest burden of recurrent falls was among women with all three sensory impairments; one-third (34.6%) of women with vision, hearing and PN impairment were recurrent fallers. In an adjusted logistic regression model, vision, hearing, and PN impairments were associated with statistically significantly higher odds of recurrent falls in the past year (odds ratio (OR) = 1.58, 1.76, 2.11, respectively; all p&lt;0.01), after adjustment for age, race/ethnicity, economic strain, and depressive symptoms. The presence of all three sensory impairments was associated with nearly 6-fold increased odds of recurrent falls (OR=5.65, 95% CI 3.25, 9.82) compared to women with no impairments. Sensory impairments often onset during mid-life and early late adulthood. This work demonstrates that these impairments are associated with falls and that women with impairments across multiple sensory domains are at greatest risk.
Program Practices Predict Intergenerational Interaction among Youth and Older Adults
Authors: Jarrott Shannon , Turner Shelbie , Naar Jill Juris , Scrivano Rachel , Weaver Raven 
Published: December 2021

Abstract
Non-familial intergenerational programs engage younger and older people in shared programming for mutual benefit, frequently involving senior centers or adult day programs and preschools. With growing interest in the potential benefits of intergenerational strategies, it is imperative to know their effects on participant interaction during intergenerational programming. To address this knowledge gap, activity leaders at five sites serving older adults and/or preschoolers received training to implement 14 evidence-based practices during intergenerational activities involving 109 older adult and 105 preschool participants over four years. We utilized multi-level modeling to test whether variations in implementation of practices were associated with variations in participants’ responses to programming on a session-by-session basis. For both preschool and older adult participants, analyses revealed that the implementation of certain practices was associated with significantly more intergenerational interaction. Specifically, when person-centered best practices (e.g., leading activities that are age- and role-appropriate for older adults) were implemented, preschoolers (estimate=5.83, SD=2.11, p=0.01 and older adults (estimate=5.11, SD=.10, p=0.02) had more intergenerational interaction. Likewise, when environmental-centered best practices were implemented, such as pairing materials between intergenerational partners, preschoolers (estimate=6.05, SD=1.57, p=0.002) and older adults (estimate=6.50, SD=1.85, p=0.001) had more intergenerational interaction. Our findings reveal session-by-session variation in intergenerational interaction that can be impacted by implementation practices, which highlights the importance of training activity leaders to implement evidence-based practices. Researchers and practitioners should consider how session-by-session variation in program implementation affects participant response.
Informal Caregivers’ Perceptions of Burdens and Benefits Predict Greater Confidence in Their Abilities
Authors: de Rosa Cristina , Lorenz Rebecca , Sullivan Suzanne 
Published: December 2021

Abstract
Informal caregivers experience both burdens and benefits from caregiving. This analysis aimed to determine whether caregiver perceptions of burdens and benefits predicted feelings of confidence in their abilities. In the National Study of Caregiving (NSOC) Round II (2015), we identified 1,390 caregivers as “primary” for providing the greatest number of care hours in the past month to individuals age 65 and over. Logistic regression was performed to assess the influence of primary caregivers’ gender, age, relationship to their care recipients, and self-reported indications of burdens and benefits on the odds that they would report confidence in their abilities. Caregivers were more likely to report confidence in their abilities when caregiving taught them to deal with difficult situations (OR=5.93, 95% CI [4.67, 7.54]), gave them satisfaction that their care recipient was well cared for (OR=1.97, 95% CI [1.26, 3.04]), and when caregiving brought them closer to their care recipient (OR=2.61, 95% CI [2.02, 3.36]). Caregivers were less likely to feel confident if they reported frequent changes in routine (OR=.78, 95% CI [.64, .96]). The final model predicted confidence (chi-square = 525.383 [4] p &lt; .001) and correctly classified 78.7% of cases. All other variables were non-significant. These findings suggest that confidence in abilities is influenced by caregivers’ perception of learning to handle difficult situations, satisfaction, closeness to the recipient, and burdens associated with changes in routine. Future research should further explore burdens and benefits of caregiving. Health care providers should routinely assess caregivers and provide referrals for additional resources.
The association between caregiver education on adult T2DM and patient’s outcomes in community: A systematic review
Authors: Tark Aluem , Song Jiyoun , Kim Jeong-Yeon , Park So Yeon , Woo Kyungmi 
Published: December 2021

Abstract
Introduction Adult type 2 diabetes (T2DM) threatens public health and most patients manage their diabetic condition while in the community. As it is challenging for patients to properly manage diabetes alone, caregiver involvement in T2DM patient care is encouraged. This study aimed to examine the association between caregiver involvement in T2DM education within a community and the patients’ diabetes care outcomes (e.g., glycated hemoglobin (HbA1c) level, behavior, or hospitalization). Methods The available scientific literature in PubMed, Cochrane, EMBASE, and CINAHL was searched. The methodological quality of bias was assessed using the Cochrane risk of bias tool. Results A total of 13 out of 741 published studies were synthesized in this review. There is evidence that caregiver involvement in T2DM education is effective in the reduction of HbA1C and BMI, but not necessarily effective in reducing lipids. Study results indicate that caregiver related interventions can significantly improve patient diabetes knowledge, physical activity, and self-efficacy, but results were more mixed regarding medication adherence. Risk of bias analysis classified the majority of studies (77%) to be moderate or high quality. Conclusion This review aimed to explore the association between caregiver involvement in adult T2DM education in the community and patients’ diabetes care outcomes. The findings show an improvement in biological and behavioral self-management outcomes with caregivers involved in T2DM education, though no studies examined the direct association between complications or hospital readmission. Future research focused on tailored interventions and longer follow-up of patient outcomes are recommended.
“We’ve all Lost so Much”: The Experiences of Essential Family Caregivers’ Long Term Care Visitations During COVID-19
Authors: Chu Charlene , Yee Amanda , Stamatopoulos Vivian 
Published: December 2021

Abstract
Family caregivers are integral to the care of long-term care (LTC) residents. COVID-19 public health policies initially restricted all essential caregivers from visiting LTC homes. In lieu of in-person visitations, caregivers were allowed technology-based visits then restrictive outdoor visits, followed by indoor visitations. This study aims to illuminate the experiences of essential caregivers’ as they visited their loved ones in LTC during COVID-19’s restrictive policies. We conducted seven caregiver focus groups (N=30) from Ontario and British Columbia, Canada. Thematic analysis and line-by-line coding were completed using NVivo. We found six themes that were common to all the visitation types: 1) “LTC Home disorganization” to facilitate visits and poor communication; 2) “Lack of staffing and resources”; 3) “Mistreatment from staff and management” as caregivers were seen as inconveniences; 4) “Shock and disbelief” when family members first saw their loved ones; 5) “Significant lack of person-centered or family-centered ethos” for example the residents’ needs were ignored such that their cognitive and physical impairments sometimes made visitations impossible, as well as the burden of multiple weekly COVID-19 tests; and, 6) “Collateral damage” in the form of trauma and irreparable harm to the relationships between residents and families. These results emphasized caregivers who ultimately felt betrayed and ignored by the broader healthcare system. Our findings provide an in-depth understanding of how COVID-19 public health policies have impacted the essential caregivers and the long-lasting impacts on residents and caregivers alike. Understanding caregiver’s experiences can inform future pandemic response policies and encourage more person-centered protocols.
Differences in subjective age by filial caregiving status among US adults in mid and later life
Authors: Choi Hyojin , Litzelman Kristin 
Published: December 2021

Abstract
Subjective age is an important indicator of age identity and is associated with both psychological and physical well-being. Previous studies have revealed that older adults who feel younger than their chronological age show better health status, better life satisfaction, and less risk of mortality. Considerable evidence shows that stress contributes to feeling older than one’s chronological age. Given the fact that taking a caregiving role involves stress, it is expected that caregiving might accelerate subjective aging. This study examined the association between the stressor of caregiving and subjective age in mid and later life. Data were drawn from the Health and Retirement Study in 2014 and 2016. Participants aged 50 years and over (n=1,087) were identified according to adult-child caregiver status at across the two waves: those who provided care consecutively (long-term caregivers), those who became caregivers in 2016 (new caregivers), those who were no longer providing care in 2016 (recent caregivers), or those who did not report providing care in both 2014 and 2016 (non-caregivers). Linear regression analysis showed that new caregivers reported feeling older than their chronological age compared to non-caregivers. However, long-term or recent caregivers did not show significant differences in subjective age compared to non-caregivers. The finding is consistent with the stress process theory and adaptation hypothesis. Although the onset of caregiving stress may accelerate subjective aging, this deleterious effect may decrease over time due to family caregivers’ adaptability. Future research will examine the role of support, resilience and mastery in this pathway.
A Randomized Placebo-Controlled Trial of Metformin for Frailty Prevention in Older Adults
Authors: Tavabi Amir , Wang Chen-pin , Michalek Joel , Cortes Tiffany , Leonard Ethan , Powers Becky , Musi Nicolas , Espinoza Sara 
Published: December 2021

Abstract
Frailty is a progressive physical decline leading to higher morbidity and mortality in older adults. Previous studies have demonstrated shared mechanisms between insulin resistance, inflammation, and frailty. The purpose of this trial is to determine whether metformin prevents frailty in non-frail, community-dwelling older adults (≥65 years) with pre-diabetes, determined by 2-hour oral glucose tolerance test (OGTT). Frail individuals (Fried criteria) and those with renal impairment (glomerular filtration rate &lt;45 mL/min) are excluded. Eligible participants are randomized to metformin or placebo and followed for two years. The primary outcome is frailty; secondary outcomes include physical function (short physical performance battery), systemic and skeletal muscle inflammation (plasma and muscle inflammatory markers), muscle insulin signaling (muscle biopsy), insulin sensitivity (insulin clamp), glucose tolerance (OGTT), and body composition (dual-energy x-ray absorptiometry) measurements. Participants are followed every 3 months for safety assessments, every 6 months for frailty assessment and OGTT, and every 12 months for muscle biopsy. Currently, 99 participants, including 53 (53.5%) male and 91 (91.9%) white, are active (54) or have completed the study (35). At baseline, mean age was 72.3 ± 5.5 years, body mass index was 30.7 ± 5.9 kg/m2, and Hemoglobin A1c was 5.73 ± 0.37%. Mean frailty score was 0.5 ± 0.6 and the proportion of non-frail and pre-frail participants were 58.6% (n = 58) and 41.5% (n = 41), respectively. Findings of this clinical trial may have future implications for the use of metformin in older adults with pre-diabetes in order to prevent the onset of frailty.
Frailty and Dementia: Differences in Health Care Utilization and Costs
Authors: Sison Stephanie Denise , Oh Gahee , Shi Sandra , Olivieri-Mui Brianne , McCarthy Ellen , Kim Dae 
Published: December 2021

Abstract
Frailty and dementia are associated with poor health outcomes and increased health care utilization. A more nuanced understanding of this dynamic may be useful in improving care and developing policies. This retrospective cohort study was conducted using 5% random sample of Medicare fee-for-service beneficiaries (n=1,132,367; mean age 76.2 years; 57.9% female) in 2014-2016. We compared average 1-year home time (number of days alive outside of the hospital and SNF), mean total cost per beneficiary, and number of incident ICU stays per 100 person-years (PY) across four groups: frailty and dementia, dementia alone, frailty alone or neither. Frailty and dementia were identified using validated claims-based algorithms. We also determined differences in costs per group across different regions within the United States. Beneficiaries with both frailty and dementia had a high 1-year mortality rate of 21.9% (vs. dementia alone [9.7%], frailty alone [9.4%] or neither [2.1%]), while having less home time (306 days; difference of 36 days, 31 days, and 53 days, respectively), and more incident ICU stays per 100 PY (29.9 vs 9.5, 25.8, and 5.6, respectively). Mean total costs for beneficiaries with both was $26,030 compared to other groups ($12,096, $24,693, and $9,029, respectively). Across the United States, range of costs varied the most for beneficiaries with both frailty and dementia ($13,244-31,987 vs $4,621-15,364, $20,090-30,965, and $7,672-10,450, respectively). Increase in health care utilization and wide geographic variation in costs associated with patients with frailty and dementia suggests room for improvement in health care delivery to improve outcomes of this group.
Functional Trajectories and Quality of Life in Post-Acute Skilled Nursing Facility care after hospitalization
Authors: Shi Sandra , Olivieri-Mui Brianne , McCarthy Ellen , Kim Dae Hyun 
Published: December 2021

Abstract
Frailty predicts readmissions and mortality after acute hospitalizations. Understanding whether frailty predicts functional recovery after acute hospitalizations may help guide post-acute care and rehabilitation. This feasibility study enrolled 24 adults aged ≥65 years from a skilled nursing facility (SNF) after acute hospitalization. We calculated a deficit-accumulation frailty index (FI range: 0-1; non-frail [≤0.25], mild frailty [0.26-0.35], moderate [0.36-0.45], and severe [&gt;0.45]) via in-person assessment on SNF admission. We measured weekly functional improvement with modified Barthel Index, as well as quality of life. Modified Barthel Index and quality of life were measured weekly by Patient-Reported Outcome Measurement Information System (PROMIS) (standardized score with mean 50 and SD 10, higher is better). The mean age was 83.3 years [SD 8.0], and 17 (71.8%) were female. Length of stay for those with severe frailty (FI&gt;0.45) was 26.8 days [10.7] compared to those who were not frail, mildly frail, or moderately frail (13.3 [7.3], 9.4 [4.4], and 15.2 [4.9] respectively). Those with severe frailty also had delayed functional improvement (mean Barthel Index 48.6, 53.4, and 56.6 on admission, week 1, and week 2 of SNF admission respectively), compared to those with moderate frailty (mean Barthel Index 47.5, 69, 73) or mild frailty (68.3, 86, 90.5). Self-reported mental and physical health-related quality of life was relatively unchanged across SNF episode for all frailty categories. These findings suggest that older adults with moderate or severe frailty may experience a typical course of delayed functional recovery and that further monitoring may be necessary for prognostication.