bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Characteristics of Subjective Cognitive Decline Among Caregivers, 2015-2019
Authors: Jeffers Eva , Patel Roshni , Bouldin Erin , Knapp Kenneth , Guglielmo Dana , Taylor Christopher , McGuire Lisa 
Published: December 2021

Abstract
Approximately 20% of U.S. adults provide unpaid care to family members and friends with a health condition or disability, and 20% of caregivers reported being in fair or poor health themselves. Much of the assistance caregivers provide have cognitive components, such as medication or financial management, yet little is known about caregivers’ cognitive functioning. Subjective cognitive decline (SCD), or self-reported worsening of memory over the past year, among caregivers could impact the quality of care they provide. This study assessed prevalence of SCD by caregiving status and, among caregivers, the distribution of sociodemographic and other characteristics by SCD status. The study included 93,851 community-dwelling adults aged ≥45 years in 22 states who completed both the Behavioral Risk Factor Surveillance System Cognitive Decline and Caregiving modules during 2015-2019. All data were weighted; comparisons are based on modified Rao-Scott chi-square tests (α=0.05). Among caregivers (n=21,238), 12.6% (95%CI:11.7-13.5) reported SCD, compared with 10.2% (95%CI:9.7-10.7) of non-caregivers (p&lt;0.0001). Caregivers with SCD had more chronic health conditions, lower educational attainment, and were less likely to be married or employed than caregivers without SCD, despite a similar age distribution. Caregivers with SCD were also more likely than caregivers without SCD to report fair or poor health, frequent mental distress, a history of depression, and frequent activity limitations. SCD may negatively impact caregivers’ health, function, and ability to provide care. With the anticipated increases in the need for caregiving, it is critical to understand the cognitive health of caregivers to better support caregivers and care recipients.
I Mind My Own Business and Expect Others to Do the Same: Conversations About Declining Financial Capacity
Authors: Zheng Mingyang , DeLiema Marguerite 
Published: December 2021

Abstract
Introduction: One of the smartest ways to prepare for declines in financial decision making capacity is to appoint an agent under power of attorney for finances and to share important financial information and preferences with trusted family or friends. Yet only 12% of older Americans with children think that they’ll need help with their finances as they age, and more than half are uncomfortable talking about their finances with children. Method: We conducted four in-depth interviews with older adults and four focus groups with Black, Latino, low income, and low-middle income adults aged 65 and older. An average of 9 participants were in each 2-hour focus group. Results: Barriers included lack of awareness, denial of future changes in capacity, lack of trustworthy surrogate decision-makers, shame about one’s financial situation, desire for privacy, fear of being a burden, and resistance to overtures by children. Barriers differed by ethnicity and socioeconomic status, with lower income older adults having less knowledge of advance planning and Powers of Attorney. Implications: Significant education is needed around Powers of Attorney and how to begin the advance planning process. Study findings informed the Thinking Ahead Roadmap, a guide to facilitate planning and communication around future money management. The Roadmap uses an empowerment framework to motivate individuals to appoint trusted financial advocates and prepare them for a smooth transition in money management, thereby reducing risk of exploitation, costly mistakes, and family conflict.
Identity Theft and Older Adults: How Minorities and the Poor Suffer the Worst Consequences
Authors: Burnes David , DeLiema Marguerite , Langton Lynn 
Published: December 2021

Abstract
Society’s growing reliance on technology to transfer and store private information has created more opportunities for identity thieves to access personal data. Prior work using data from the National Crime Victimization Survey (NCVS) Identity Theft Supplement (ITS) showed that baby boomers were significantly more likely than Millennials to be victims of identity theft and that older people and minorities experience more severe economic and psychological consequences. This study examines how socioeconomic status, demographic characteristics, and incident-specific factors relate to how much money is stolen during identity theft, the likelihood of experiencing out-of-pocket costs, and emotional distress among identity theft victims age 65 and older. Using combined data from the 2014 and 2016 NCVS-ITS, this study examines the correlates of financial and psychological consequences of identity theft among 2,307 victims age 65 and older. Older Black victims are more likely to have greater amounts of money stolen and are more likely feel distressed than older non-Latino white identity theft victims. The most disadvantaged older adults living at or below the federal poverty level are nearly five times as likely to suffer out-of-pocket costs. The length of time information is misused and the hours spent resolving identity theft are significantly associated with emotional distress. More than one-third of older victims experience moderate to severe emotional distress following identity theft, and those who can least afford it suffer out-of-pocket costs. Greater advocacy and psychological support are needed to help older adults recover, in addition to tools to protect their personal information from misuse.
Using Voice and Touchscreen Technology to Protect Vulnerable Clients in Residential Care Facilities
Authors: Brown Jocelyn , Davitt Joan , Luby Pam , Adams Dorinda 
Published: December 2021

Abstract
Due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum for long term care facilities to restrict visitation by all nonessential personnel, including guardianship case managers. To enhance caseworker access to their guardianship clients, an eastern seaboard state agency distributed Amazon Echo Show devices to clients in long term care facilities. These touchscreen and voice-activated devices have both video and audio capabilities. This study reports the results of the first phase of a comprehensive evaluation, pilot testing the devices via a group of “superuser” case managers to understand the potential challenges and benefits of using these devices. Sixteen case managers participated in two virtual focus groups before and after the installation of an Echo device with one of their guardianship clients. Participants were asked to discuss experiences in accessing clients and client engagement before and after device installation. The focus groups were audio-recorded and transcribed verbatim and two researchers independently identified themes using open and axial coding. Major themes identified included: challenges to device installation and use, strategies to overcome challenges, benefits to using Echo devices, and ethical concerns. These findings suggest that touchscreen or voice-activated devices with video capability can assist case managers in protecting vulnerable clients and ensuring their well-being when in-person access is restricted. Additionally, the devices can be used to enable isolated residents to connect to the outside world, including family, friends, and case managers through technology. Strategies for replication of this innovative program will be discussed.
Addressing Needs of Older Adults in Low-Income Independent Living Facilities in Community Health
Authors: Dudley Nancy , Rauch Lisa , Adelman Toby , Canham Daryl 
Published: December 2021

Abstract
Access to quality care in long-term care settings including independent living facilities is needed for a diverse high-risk aging U.S. population. There is an urgent need to assess and address complex care needs of older adults living longer with chronic conditions and serious illness. However, a system to assess and identify health problems, intervene, and evaluate outcomes is lacking. This session presents learnings from a pilot study developed in collaboration with Nurse Managed Centers at low-income independent living facilities for older adults and undergraduate nursing students in community health practice. We will discuss the adaptation of the Omaha System for provision of care in independent living facilities to address complex care needs. Finally, we will discuss the impact of this project and its potential for healthcare transformation in independent living facilities and transformation of education in undergraduate nursing programs.
Hospice Care Inequities in Individuals With Alzheimer's Disease and Related Dementias
Authors: Brody Abraham , Estrada Leah , Durga Aditi , Lin Shih-Yin , Ford Ariel 
Published: December 2021

Abstract
Despite known benefits of hospice, inequities exist. Using data from a multi-site pragmatic trial in a representative groups of hospices, we examined inequities in length of stay (LOS) and general inpatient use (GIU) for 12,153 patients with dementia (primary and secondary diagnosis) using descriptive statistics and association tests. There were significant associations between race/ethnicity and GIU and LOS (p&lt; 0.001). In those with primary diagnosis of dementia, Asian (31%) and Black/AA (24%) individuals had significantly greater utilization of GIU than Hispanic (19%) and white individuals (21%). Greater inequities were found in those with a secondary diagnosis. LOS amongst Asians were shortest with 78% having an LOS ≦14 vs 50-59% in other groups. Differences in long-stay &gt;60 days (7%) vs 14-22% in other groups were found. There were similar differences examining by primary vs. secondary diagnosis. These inequities point to cultural and systems factors that require further study and intervention.
Links Between Personality and Sleep Midpoint in Older Adults in the National Social Life, Health, and Aging Project
Authors: Patel Krishna , Rojo-Wissar Darlynn , Duggan Katherine , Hisler Garrett , Hasler Brant , Spira Adam 
Published: December 2021

Abstract
Chronotype has been linked to poor cognitive outcomes and mortality among older adults. Although previous studies indicate an association between personality and sleep, little is known about associations between personality and chronotype in older adults. We examined the association between personality and objective sleep midpoint (a measure of chronotype) in 463 older adults aged 73.5 ±7.7 from the National Social Life, Health, and Aging Project who completed the Midlife Developmental Inventory Personality scale and three nights of wrist actigraphy, from which we derived participants’ average sleep midpoints. After adjusting for demographics, higher conscientiousness was associated with earlier sleep midpoint (B=-0.53, SE=0.02, p&lt;0.01). Associations for other traits were not significant. Findings link conscientiousness to chronotype and raise the possibility that earlier sleep timing may partially account for associations of conscientiousness with health outcomes. Further studies are needed investigating the role of personality in links of sleep and circadian factors with health.
Sleep and Working Memory: Short-Term Links in Daily Life and Long-Term Associations
Authors: Lücke Anna , Wrzus Cornelia , Gerstorf Denis , Kunzmann Ute , Katzorreck Martin , Schilling Oliver 
Published: December 2021

Abstract
Sufficient sleep is relevant for both momentary cognitive functioning and long-term cognitive developments. However, which factors make people particularly vulnerable to the cognitive consequences of sleep loss remains an open question. Here, we obtained data from 122 young-old (66-69 years) and 35 very old (85-89 years) adults who provided six daily ambulatory assessments of working memory performance and daily sleep over one week, and long-term trajectories in processing speed and working memory performance. Our results add to current knowledge in three ways: First, results from multilevel structural equation models showed both too little and too much daily sleep was associated with poorer working memory in everyday life. Secondly, this association was independent of cognitive aging over the preceding four years. Thirdly, average sleep duration did not predict cognitive changes over the next year. Participants’ age and health as well as emotional functioning are discussed as further influences on the associations.
Genetic and Phenotypic Evidence for the Causal Relationship Between Aging and COVID-19
Authors: Ying Kejun , Zhai Ranran , Pyrkov Timothy , Shindyapina Anastasia , Mariotti Marco , Fedichev Peter , Shen Xia , Gladyshev Vadim 
Published: December 2021

Abstract
Epidemiological studies revealed that the elderly and those with comorbidities are most susceptible to COVID-19. To understand how genetics affects the risk of COVID-19, we conducted a multi-instrument Mendelian Randomization (MR) analysis and found that the genetic variation that supports a longer life is significantly associated with the lower risk of COVID-19 infection, as well as being hospitalized after infected. The odds ratio is 0.31 (P = 9.7e-6) and 0.46 (P = 3.3e-4), respectively, per additional 10 years of life. We further applied aging clock models and detected an association between biological age acceleration and future incidence and severity of COVID-19 infection for all subjects and individuals free of chronic disease. Biological age acceleration was also significantly associated with the risk of death in COVID-19 patients. A bivariate genomic scan for age-related COVID-19 infection identified a key contribution of the Notch signaling pathway and immune system. Finally, we performed MR using 389 immune cell traits as exposure and observed a significant negative correlation between their effect on lifespan and COVID-19 risk, especially for B cell-related traits. More specifically, we discovered the lower CD19 level on B cells indicates an increased risk of COVID-19 and potentially decreases the lifespan expectancy, which is further validated in clinical data from COVID-19 patients. Our analysis suggests that the factors that accelerate aging and limit lifespan cause an increased COVID-19 risk. Thus, the interventions target these factors (e.g., reduce biological age), after further validation, may have the opportunity to reduce the risk of COVID-19.
Maxwell A. Pollack Award Lecture
Authors: Harootyan Bob 
Published: December 2021

Abstract
The lecture will feature an address by the 2020 Pollack Award recipient, Karl Pillmer, PhD, FGSA of Cornell University. The 2021 Pollack Award recipient is Namkee G. Choi, PhD, FGSA, of the University of Texas at Austin. The Maxwell A. Pollack Award for Contributions to Healthy Aging Award recognizes instances of practice informed by research and analysis, research that has directly improved policy or practice, and distinction in bridging the worlds of research and practice.
Opioid Use Among Rural Medicare Beneficiaries
Authors: Jonk Yvonne Catharina , O'Connor Heidi , Pearson Karen , Croll Zachariah , Gale John 
Published: December 2021

Abstract
This study examines differences in opioid prescribing rates among a nationally representative sample of Medicare beneficiaries across rural and urban areas, as well as among beneficiaries with chronic overlapping pain conditions (COPCs). We assess whether prescribing patterns exceed the Centers for Disease Control and Prevention guidelines for dose and duration, and identify socioeconomic and health risk factors associated with opioid prescribing using logistic regression analyses. Data were from the 2010-2017 Medicare Current Beneficiary Survey files. Rural-Urban Commuting Area codes were used to identify patients’ residential location. The Area Health Resource Files were used to identify market characteristics such as primary care and mental health shortage areas. With the exception of 2010, over years 2011-2017, higher percentages of community-dwelling rural beneficiaries received opioid prescriptions (21.8-25.4%) compared to their urban counterparts (19.1-23.7%). During the same time period, facility-dwelling rural beneficiaries were more likely to receive opioid prescriptions (39.8-47.2%) compared to their urban counterparts (28.8-35.0%). Higher percentages (18.8%) of the community dwelling population in rural had COPCs compared to urban (15.2%), and a higher percentage of rural beneficiaries with COPCs (31.4%) received an opioid prescription than their urban counterparts (22.2%). Previous research points to other factors contributing to a lack of alternatives to opioids for pain management in rural areas, including greater reliance on primary care providers, lack of access to chronic pain specialists and alternative therapies, and travel barriers. Improving the capacity of rural primary care to deal with COPCs and expanding access to specialists via telehealth warrants further attention from policymakers.
Accelerometer-Derived Patterns of Physical Activity and Incident Frailty
Authors: Wanigatunga Amal , Cai Yurun , Urbanek Jacek , Roth David , Walston Jeremy , Bandeen-Roche Karen , Appel Lawrence , Schrack Jennifer 
Published: December 2021

Abstract
Low physical activity (PA) is a common phenotype of frailty, but whether disengagement of daily lifestyle PA signals impending frailty remains unexplored. Using STURDY (Study to Understand Fall Reduction and Vitamin D in You) data from 499 robust/prefrail adults (mean age=76 + 5 years; 42% women), we examined whether accelerometer patterns (activity counts/day, active minutes/day, and activity fragmentation) were prospectively associated with incident frailty over 2 years of follow-up; 48 (10%) participants developed frailty. In Discrete-Cox hazard models adjusted for demographics, medical conditions, and device wear days, every 30 min/day higher baseline active time, 100,000 more activity counts/day, and 1% lower activity fragmentation was associated with a 13% (p=0.003), 10% (p=0.001), and 8% (p&lt;0.001) lower risk of frailty, respectively. Our results show that both reduced amounts and fragmented patterns of daily PA captured from accelerometry are associated with phenotypic frailty and might signal frailty onset.
Presidential Symposium: From Global to Local: An Age-Inclusive and Rights-Based Approach to Gerontological Education
Authors: Bradley Dana , Howe Judith 
Published: December 2021

Abstract
In June 2020, the Gerontological Society of America (GSA) joined in solidarity in the movement to condemn the entrenched racism undermining American society and build upon a gero-rich international historical base of supporting human rights. However, as gerontological educators, we need to expand on the conversation of racism to the broader global discussion of inclusivity and elimination of discrimination. A global focus on human rights of older persons, which began in 1982 at the World Assembly on Aging and has led to the current discussion of the proposed UN Convention on the Rights of Older Persons. The Academy of Gerontology in Higher Education (AGHE) is GSA's education group of colleges and universities that offers education, training, curricular innovations, and research programs in the field of aging. The work of this group is grounded in an age-inclusive and rights-based perspective, and members are committed to an international view demonstrated through AGHE’s tagline Global Leaders in Advancing Education on Aging; This symposium explores the role of age-inclusivity and a rights-based perspective in gerontology and geriatrics education and offers both challenges and best practices for moving forward. The first presentation explores the meaning of age-inclusivity in aging education in a global context and asks how do we build upon our international roots? Our second presenter shares a proposed framework for a rights-based approach to gerontology education. The third presentation explores an example of a rights-based training program. We conclude with a lively discussion focusing on how to take action through education.
A Proposed Framework for Implementing a Rights-Based Approach to Gerontological Education and Training
Authors: Bradley Dana , Allen Laura 
Published: December 2021

Abstract
This paper uses the nine general principles that underpin human rights (Non-discrimination, Respect, Dignity, Autonomy, Equality, Self-fulfillment and Personal development, Full and effective participation, Intergenerational solidarity, and Recognition of intrinsic value and worth as a human being) to frame a right’s based approach. This framework looks beyond the older person and the issues they are facing to the structure and culture of the society itself and the ways in which it is contributing to challenges. Using this lens, we will discuss how to develop definitions and standards of right’s- based education that are culturally and contextually appropriate, define right’s based competencies and recognize, that despite the universal rights of older persons, the implementation may need to be adjusted for unique sociocultural environments. . Lastly we will outline a strategy to identify and train multidisciplinary teaching and research teams using this proposed framework.
Bringing Rights of Older Persons to the Real World: Lessons Learned From a Rights-Based Training
Authors: Stoeckel Kimberly , Fitzgerald Kelly 
Published: December 2021

Abstract
When gerontological education and training are grounded in a rights-based approach, this framing provides a tool to ensure the rights of older people are advocated for and experienced. A “train the trainer” program was given to non-governmental organizations (NGOs) providing services to refugees in Jordan. The goal of the training was to educate NGOs on how to use a rights-based approach when responding to and supporting older refugees. The training covered a range of topics in ensuring the rights of older people in the provision of care, protection, and inclusion. Training outcomes revealed an increased awareness of the rights of older people. Skills and knowledge gained as a result of this training empowered participants to further develop their own work, within their cultural context, to reflect a rights-based approach to services and programs.
The Value of the Evidence Integration Triangle
Authors: Resnick Barbara 
Published: December 2021

Abstract
The Evidence Integration Triangle involved engaging stakeholders in the 12 month FFC-AL-EIT activities including identifying community specific goals, supporting the staff implementing the intervention, and intervening when champions or staff were not engaged in intervention activities. Ongoing participation of the stakeholder team occurred through monthly meetings. Evaluation of implementation was based on the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) Model. Reach was based on 85 of 90 communities participating and 794 residents recruited. Effectiveness was supported based on less functional decline and more function focused care performed by residents. Adoption was based on evidence that monthly meetings were held, 77% of settings engaged as, or more than expected, and caregivers increased the amount of function focused care provided. The intervention was implemented as intended, knowledge was received, and environments and policies supporting function focused care were maintained. The Evidence Integration Triangle is an effective implementation approach for assisted living.