bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathways to Reduced Overnight Hospitalizations: Evaluating 62 Physical, Behavioral, and Psychosocial Factors
Authors: Oh Jean , Nakamura Julia , Kim Eric 
Published: December 2021

Abstract
As healthcare costs rise steadily and rapidly, researchers and policymakers are increasingly interested in reducing healthcare utilization costs. Growing evidence documents many factors that may influence healthcare utilization; however, less is known about how changes in candidate predictors influence subsequent healthcare utilization. Using data from 11,374 participants in the Health and Retirement Study (HRS)—a diverse, longitudinal, and nationally representative sample of older adults in the United States, we evaluated a large range of candidate predictors of overnight hospitalizations. Using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 62 predictors over four-years (between t0;2006/2008 and t1;2010/2012) were associated with subsequent hospitalizations during the two years prior to t2 (2012-2014 (Cohort A) or 2014-2016 (Cohort B)). After adjustment for a rich set of baseline covariates, changes in some health behaviors (e.g., frequent physical activity), physical health conditions (e.g., no physical functioning limitations), and psychosocial factors (e.g., higher purpose in life, lower anxiety, more volunteering) were associated with decreased hospitalizations four years later. However, there was little evidence that other factors (e.g. smoking, obesity) were associated with subsequent hospitalizations. Notably, some psychosocial factors had effect sizes as large as some physical health conditions. Several indicators of physical health, health behaviors, and psychosocial well-being may predict subsequent hospitalizations, and these factors may be novel targets for interventions and policies aiming to reduce healthcare costs in older adults.
Protection against APOE4-associated aging phenotypes with a longevity-promoting intervention
Authors: McGill Cassandra , Christensen Amy , Qian Wenjie , Finch Caleb , Benayoun Berenice , Pike Christian 
Published: December 2021

Abstract
Two of the primary risk factors for late onset Alzheimer’s Disease (AD) are aging and APOE genotype. While the causal relationship between aging and AD is not well defined, there are strong leads from shared phenotypes such as decreased metabolic function and increased inflammation. APOE genotype may be linked to AD phenotypes through the regulation of aging processes. The NIA Interventions Testing Program (ITP) recently found that 17α-estradiol (17αE2) treatment increases rodent lifespan. Since 17αE2 acts upon systemic and neural pathways associated with AD pathology, we propose that 17αE2 may be a pleiotropic intervention strategy. Further, because APOE4 is associated with a senescent phenotype, 17αE2 may have APOE genotype-specific effects. Using 10-month-old APOE3 or APOE4 targeted replacement male mice maintained on normal chow with and without 14.4 ppm 17aE2 for 20 weeks, our initial results indicate genotype differences in the efficacy of 17αE2 across multiple outcomes. APOE4 mice exhibited an aged phenotype compared to APOE3, with APOE4 mice having a higher frailty index; however, 17αE2 treatment reduced the frailty index most strongly in APOE4 mice. APOE4 mice were impaired across multiple metabolic measures including body weight, plasma leptin, and hepatic steatosis. 17αE2 significantly attenuated the APOE4 metabolic phenotype. These data confirm and extend prior findings that APOE4 is linked to progeroid effects both peripheral and neural outcomes associated with AD risk. Importantly, 17αE2 significantly improved a range of measures, but showed the strongest effects in the APOE4 genotype. This research was funded by the Cure Alzheimer's Fund.
Role of Nativity in End of Life Care Planning
Authors: Kyaw Kay Thwe , Helzner Elizabeth , Rosenberg Carl , Reinhardt Michael 
Published: December 2021

Abstract
Given the rapidly aging population, optimal end-of-life (EOL) consistent with individual wishes is a public health priority. Advanced Care Planning (ACP) involves Advanced Directives (AD) and establishing a Power of Attorney (POA). AD describe EOL Care preferences including options to limit treatment, withhold treatment, provide comfort care, and prolong treatments. Nativity can provide meaningful guidance in decision-making at the end of life. Data from this study came from the Health and Retirement Study, nationally representative longitudinal study of U.S. residents. The sample included 4,015 older adults, 65 and above years of age who died during study follow-up. Nativity was categorized as U.S born and Foreign born. ACP variables included presence of AD and POA, and EOLC preferences included provide comfort care, limit, withhold, or prolong treatment. Covariates included age, gender, race, marital status, education, and subjective health at baseline. Cox Proportional Hazards (Cox PH) and Weibull Models were used to identify associations between nativity and end of life care. Results: Compared to U.S born, Foreign born participants were less likely to have POA (HR: 0.75; 95% CI:0.64-0.89) in Cox PH and POA (HR: 0.63; 95 % CI:0.53-0.75) Weibull models in unadjusted models, limited treatment (HR: 1.58; 95 % CI: 1.2, 2.1), and prolong treatment (HR: 0.23; 95 % CI:0.06-0.99) and Cox PH and (HR: 0.20; 95 % CI: 0.05-0.83) in Weibull modes. Conclusion: There are differences in Advanced Care Planning by nativity. Country of origin should be considered when helping individuals plan for end-of-life care.
The Mediation Effects of Perceived Healthcare Discrimination on Racial and Ethnic Disparities in End of Life Care
Authors: Han Junghee 
Published: December 2021

Abstract
Numerous studies demonstrate racial and ethnic differences in end-of-life (EOL) care, including place of death and hospice use. Experiencing discrimination in healthcare is often cited in the literature as a potent source explaining the pathways of the racial and ethnic disparities in EOL care. However, none of the studies have tested its mediating effects on racial and ethnic disparities in EOL care. The study examines if the effects of race and ethnicity on place of death and hospice use are mediated by perceived healthcare discrimination. This is a secondary analysis of 2008-2014 data from the nationally representative Health and Retirement Study, including oversampling of Blacks and Hispanics. Samples included 1,446 decedents aged 65 or older who completed an exit interview by proxy. Perceived healthcare discrimination was measured by a self-report of receiving poorer service or treatment than other people from doctors or hospitals. In multivariate analyses, Blacks were more likely to die at hospitals (OR=1.57, p &lt; .05) than Whites. Those who experienced discriminatory healthcare were more likely to die at hospitals than those who never experienced discriminatory healthcare (OR=1.44, p &lt; .05). However, the Karlson-Home-Breen (KHB) method showed no significant mediating effects of perceived healthcare discrimination on racial and ethnic disparities in place of death. Race and ethnicity did not affect hospice use. Although there is no mediating effect of healthcare discrimination on racial and ethnic disparities in EOL care, its direct impact is observed. The research contributes to evidence on the significant role of discrimination in healthcare choices.
A Virtual Companionship Intervention Reduces Loneliness During the COVID-19 Pandemic
Authors: Rudy Ellen , McNamara Kelsey , Patel Rajiv , Sturm Corey 
Published: December 2021

Abstract
Loneliness and social isolation are established risk factors for many clinical conditions yet few scalable interventions exist. Papa Inc. is a national service that pairs older adults with “Papa Pals” (empathetic, laypeople) who provide companionship and assistance with everyday tasks. Participants have free access if their Medicare Advantage plan offers it. During the COVID-19 pandemic, Papa provided virtual companionship visits via telephone or video. This study evaluated the impact of virtual companionship visits on loneliness status (UCLA 3-item Loneliness Scale) during the COVID-19 pandemic. The sample (N=894) included adults ages 65+ who identified as lonely at baseline and who completed at least one virtual visit between March 18, 2020 and December 31, 2020. Virtual visits were classified into four categories based on participants’ total number of visit minutes: Low (124 ave min), Medium Low (ML) (305 ave min), Medium High (MH) (567 ave min), and High (1360 ave min). Lonely and severely lonely participants engaged a mean of 573 and 673 minutes in the program, respectively. Improvement in loneliness status was associated with greater use of minutes for the ML and MH participants compared to Low participants (ML OR: 1.46 95CI: 1.00 - 2.11, MH OR 1.65 95CI: 1.13 - 2.40). These findings indicate that a virtual companionship intervention can be an impactful and scalable tool for older adults who want to age at home and have limited social support, especially during the uncertain COVID landscape. Further research is warranted to understand persistent loneliness.
Can a Data-Driven Measure of Neuroanatomic Dementia Risk be Considered a Measure of Brain Aging?
Authors: Casanova Ramon , Anderson Andrea , Justice Jamie , Windham Gwen , Gottesman Rebecca , Mosley Thomas , Wagenknecht Lynne , Kritchevsky Stephen 
Published: December 2021

Abstract
There is an increasing interest in identifying aging-related factors which may be permissive of Alzheimer’s Disease (AD) emergence. We previously used machine learning to derive an index of neuroanatomic risk of dementia called AD pattern similarity (AD-PS) score using MRIs obtained in the Atherosclerosis Risk in Communities (ARIC) study. Here, we investigate the potential of the AD-PS scores as a brain-focused measure of biologic age. Among 1970 ARIC participants with MRI collected at ARIC Visit 5, we related AD-PS scores to three measures of aging: mortality (n=356) over 8 years of follow-up; an a priori panel of 32 proteins related to aging (N=1647); and a deficit accumulation index (DAI) based on 38 health-related measures. We found lower AD-PS scores associated with significantly lower mortality (HR=0.58, CI-95%, [0.45 - 0.75], p &lt; 0.001) after adjusting for age, race, smoking and hypertension. Among the 32 proteins, nine were significantly associated to AD-PS scores (p &lt; 0.05) with 4 remaining significant adjusting for multiple comparisons (Growth/differentiation factor 15, Tumor necrosis factor receptor superfamily member 1A and 1B and Collagen alpha-1(XVIII) chain). Finally, in a linear regression model after adjusting for age, race, sex, hypertension and smoking, AD-PS scores were associated with the DAI (p &lt; 0.001). The consistent patterns of associations suggest that a data-driven measure of AD neuroanatomic risk may be capturing aspects of biologic age in older adults.
Combating Social Isolation among Older Immigrant Adults: A Qualitative Interpretive Meta-Synthesis
Authors: Miller Vivian , Tonui Betty , Adeniji Dolapo 
Published: December 2021

Abstract
Older immigrants totaled 7.3 million in 2018, representing 13.9 percent of the population of seniors in the U.S. While this population is found to contribute significantly to society, along with new opportunities comes circumstantial challenges. Of these, one of the most salient issues for foreign-born older adults is social isolation. Additionally, this population may be at an increased risk for social isolation with poor mental health because migrating to a new country might results in resettlement challenges. Despite these concerns, less is known about the consequences of social isolation among older immigrant adults. Guided by the Population Interest Context (PICO) framework and the Qualitative Interpretive Meta-Synthesis (QIMS) guidelines, this study seeks to explore consequences of social isolation among older immigrant, as well as interventions to combat isolation. The final sample of six full text articles were published between 2011 and 2021, totaling 180 participants with ages ranging from 61 to 93 years old. Findings from the study indicated that older immigrants are at risk of social isolation and loneliness because they have fewer social connections due to leaving behind their familiar social group in the home country, encounter linguistic challenges that negatively contribute to greater social isolation and poor mental health. Despite these difficulties older immigrants reported various social interventions, i.e., access to senior centers, community programs and services to be of greater importance in building social networks. Authors discuss opportunities for future research, such as exploring evidence-based studies on interventions for social isolation and loneliness of older immigrant populations.
Designing a Genetic Screen to Identify Factors Required for Meiotic Nuclear Rejuvenation
Authors: Jones Chelsey 
Published: December 2021

Abstract
During the natural cycle of life, most eukaryotic organisms grow old, age, and die. A common natural mechanism by which organisms “reset” their lifespan is through sexual reproduction; however, how this rejuvenation takes place remains unknown. My lab has found that meiosis in budding yeast, the developmental program that forms sex cells, eliminates age-induced damage. This involves the formation of a novel nuclear compartment, the Gametogenesis Uninherited Nuclear Compartment (GUNC), which acts as a trash can for accumulated age-induced damage. To understand the molecular details of this process, I worked on designing a screen for genes involved in GUNC formation. My mentor and I fused three different proteins targeted to the GUNC and a protein that is able to bind to a drug-resistance plasmid, in order to couple the inheritance of a selectable DNA marker with the elimination of age-induced damage. Initial testing of these three fusion proteins suggested that they were unable to successfully target the plasmid to the GUNC; as such, testing of additional candidate proteins is necessary. We plan to eventually use this system to identify mutations that disrupt GUNC formation and cause inheritance of the drug-resistance plasmid. By identifying and perturbing proteins involved in GUNC formation, we are hoping to be able to drive the inheritance of specific types of age-induced damage, allowing for the determination of what a symptom versus a cause of aging is.
Factors Associated with Older Peoples′ Perceptions of Dignity and Well-being at Residential Care Facilities.
Authors: Roos Charlotte , Alam Moudud , Swall Anna , Boström Anne-Marie , Hammar Lena 
Published: December 2021

Abstract
Dignity and well-being should be promoted in care of older people living at residential care facilities (RCFs). In addition, care should be person-centred. Dignity and well-being can be interpreted as person-centred outcomes. Older people living at RCFs experience a lack of dignity and well-being. To promote this, it is important to understand the associated factors to target. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to attitudes of staff, the care environment and individual issues (age, gender, self-rated health and dementia) among older people living at RCFs. A national cross-sectional study was conducted retrospectively. All older people 65 years and older (n=71,696) living at RCFs in 2018 were invited to respond to the survey. The survey included the areas: self-rated health, indoor-outdoor-mealtime environment, performance of care, treatment from staff, safety, social activities, availability of staff and care in its entirety. Age, gender and diagnosed dementia were collected from two national databases. Data was analysed using ordinal logistic regression models. The result indicated that respondents who had experienced disrespectful treatment, who did not thrive in the indoor-outdoor-mealtime environment, who rated their health as poor and respondents with dementia had higher odds of being dissatisfied with dignity and well-being. There is a need to improve the prerequisites of staff regarding respectful attitudes and to improve the care environment. The Person-centred Practice framework, targeting the prerequisites of staff and the care environment, can be used as a theoretical framework for designing future improvements.
Tolerability of Lithium: A Naturalistic Discontinuation Study in Older Adults (≥60 Years)
Authors: Flapper Marinke , van Melick Els , van Campen Jos , Schutter Natasja , Kok Rob 
Published: December 2021

Abstract
Lithium is one of the most effective treatment options in both bipolar disorder and treatment-resistant depression. The use of lithium in older adults declined during the last decades, probably resulting in undertreatment of older adults. To investigate how well lithium is tolerated in old age, we aimed to determine the frequency, reasons and possible predictors of discontinuation due to adverse effects in a cohort of hospitalized adults aged 60 years or older who had started with lithium.
We performed a retrospective cohort study based on chart reviews. Participants were in treatment at Parnassia Group at The Hague, the Netherlands. After inclusion (between January 2010 and December 2016), participants were followed until April 2017, when we performed data extraction and analysis.
In our sample of 135 patients (median age 69 years, median follow-up duration 18 months), 49 (36.3%) participants discontinued lithium. Only a minority (11 (8.1%)) of the participants discontinued solely due to adverse effects. The majority discontinued lithium due to psychiatric (18,5%) reasons, (most commonly mentioned within this subgroup: lack of effectiveness and non-compliance) or a combination of reasons (7.4%). None of the factors we studied (age, gender, Charlson Comorbidity Index (CCI), polypharmacy, renal function and neurological history) were significantly associated with discontinuation due to adverse effects.
The frequency of lithium discontinuation in our cohort was in range with frequencies reported in younger patients. Older age itself should not be a reason to withhold lithium treatment.
Formative Examination of a Multi-Focus Educational Exergame Designed for Older Adults
Authors: Ruggiero Laurie , Orsega-Smith Elizabeth , Barmaki Roghayeh 
Published: December 2021

Abstract
Exergames and digital health games have shown promising outcomes in older adults. Most games have had one focus (e.g., physical activity, cognitive functioning). We developed a demonstration version of a multi-focus educational exergame (i.e., healthy eating, physical activity, cognition) that builds on healthy aging theory. Community-engaged and mixed methods (e.g., surveys, focus groups) research approaches were used to examine preliminary game acceptability and usability. The game was demonstrated with 20 senior center members (95% female; 48% African American; 52% White; average age 64 years) and participants were able to play the game. The post-gameplay survey results support acceptability/usability of the game. For example, 87% of participants “agreed” or “strongly agreed” that they felt comfortable playing; the game instructions were clear; the text was readable; and gameplay was enjoyable. The majority also “agreed”/“strongly agreed” that the audio was appealing/helpful in playing the game (86%); sound quality was appropriate (78%); hand tracking was precise (57%), feedback on correct/incorrect responses was motivating (73%); they felt excited to get the correct answers (80%); they would play the game again (87%); and they would recommend it to a friend/family member (80%). When asked how often they would play it, the responses were: 33% five or more times/week; 27% three-four times/week; 20% one-two times/week; and 20% never. Observations and focus groups further clarified acceptability and identified areas for improvement (e.g., game instructions). Preliminary results support acceptability of this multi-component educational exergame with older adults and suggest the potential for future tailoring of this game.
Infection Control in Small Residential Care Settings: Insights From a National Survey and Washington State Data
Authors: Ham Carolyn , Unutzer Anna 
Published: December 2021

Abstract
Infection control is a vital issue in long-term care, and the increasing popularity of small residential care facilities (SRCF) raises questions about the effectiveness of this model for preventing facility-acquired infections. In SRCF, care is provided in a residential home to a small number of residents. The setting lacks common terminology, and states license SRCF under various titles including Adult Family Homes, Adult Foster Homes and Family Care Homes. To better inform infection control efforts in this unique setting type, DOH staff conducted a comprehensive search to locate states that license SRCF. A total of 24 states were identified and approached to participate in a qualitative research study; 21 responded, three declined and nine were unable to participate due to staff time constraints. Between March 12th and April 15th, 2021, ten public health and regulatory staff from nine states completed semi-structured telephonic interviews on infection control in SRCF. Infection control licensing requirements and public health oversight for SRCF varied significantly across participating states. Data from these interviews was analyzed and compared with two Washington State Adult Family Home (AFH) sources: 1) online survey of AFH providers 2) Infection Control Assessment and Response evaluations conducted by public health staff. Four themes were identified in all three data sets: access to personal protective equipment, environmental safety, staffing issues and knowledge deficits. SRCF are valued by states that license them. Despite the challenges of implementing infection control in the home-like environment, extraordinary opportunities exist for improving care and preventing infections in this setting.
A Case for Trauma-Informed Dementia Care: The Emancipatory Power of Psychological Resilience and Trauma From COVID-19
Authors: Ione Adrienne 
Published: December 2021

Abstract
The dominant nonpharmacological therapeutic approach in dementia care is “person-centered.” The racial disparities in disease and diagnosis affliction, represents an urge to incorporate trauma sensitivity. Antipsychotic use rates among this population being substantially higher than two years ago, as well as increasing evidence of ACE scores being a significant risk factor in dementia development, we need to consider the emancipatory power of trauma-informed dementia care. Data were collected from 103 peer-reviewed journal articles. Person-centered care practices were analyzed for adherence to SAMHSA’s principles that guide a trauma-informed approach. Studies were rated on a Likert-scale in six areas: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment and choice; and cultural, historical & gender issues. It was observed that of the 103 search returns, 38 met study criteria. Within these data, it was observed that the majority of studies scored low on incorporation and adherence to SAMSHA’s trauma-informed approach. While a few studies mentioned the magnifying effects of a current traumatic event on preexisting vulnerabilities, no study highlighted the growth or flourishing potential in triggering past trauma and the current traumatic event offering an opportunity of mind-somatic integration. This paper proposes trauma-informed dementia practices consider: 1) intake and assessment to include a screening of ACE score; 2) evaluation of (re)integrating current losses into current developmental and lifespan phase; and 3) offering therapeutic support of current traumatic event (COVID-19) to metabolize past traumatic events in the context of current developmental and lifespan phase.