bluuebunny/crossref_metadata_2025_split huggingface dataset:
The 4Ms in a Pandemic: A Survey of Training Needs Among Healthcare Professionals, Older Adults, and Community Members
Authors: Crittenden Jennifer , Elwell Abigail , Wihry David , Kaye Lenard 
Published: December 2021

Abstract
The University of New England, in collaboration with the University of Maine, received a five-year grant from the Health Resources and Services Administration (HRSA) to improve the health and well-being of Maine’s older adults through enhanced training under HRSA’s Geriatrics Workforce Enhancement Program (GWEP). As part of these efforts, stakeholder training needs assessment data were collected via a statewide electronic survey that was distributed to community members and providers throughout Maine. The survey, which focused on the 4M’s of Age-Friendly Healthcare, received 68 responses from older adults/community members (N = 26), program administrators (N = 12), along with community leaders, and those working in the public and non-profit sector (N = 13). A significant emphasis on social isolation, mental health, and grief and loss issues was noted and dominating themes centering on two dimensions of the 4M framework: “What Matters” and “Mentation.” Findings reflect an overriding priority by providers and consumers to keep older adults socially connected (28%, N = 34) and maintaining mental health and well-being during the pandemic (21%, N = 14). Qualitative response analysis identified additional COVID-19-related training topics such as: what to do if you or a loved one contracts coronavirus, how to handle grief and loss related to COVID-19, strategies for supporting loved ones during COVID-19, and socially distanced bereavement support. Results indicate a need to focus on meeting the emotional and mental health needs of older adults, as well as the importance of encouraging connections and mitigating the effects of social isolation during COVID-19.
Geroscience approaches to obesity
Authors: Bitto Alessandro , Kaeberlein Matt 
Published: December 2021

Abstract
Besides aging, obesity is the greatest risk factor for numerous chronic pathologies, including metabolic syndrome, type 2 diabetes, cardiovascular disease, hypertension, and cancer. Preventing and treating obesity would greatly reduce healthcare costs and the impact of the aging process, with estimated savings up to $145,000,000,000. Pharmacological interventions identified by geroscience may prove effective against diet-induced obesity. To test this hypothesis, we fed a 66% kcal/fat diet to nine-month-old C57Bl6/N mice for 6 weeks and treated them with either rapamycin, acarbose, or a combination thereof. Rapamycin, and to a lesser extent acarbose, prevented weight gain and fat accumulation in these mice. We detected increased expression of the Liver Activating Protein (LAP) isoform of the transcription factor CCAT/Enhancer Binding Protein β (C/EBPβ) in the liver of mice treated with rapamycin. C/EBPβ-LAP mediates some of the effects of caloric restriction on nutrient metabolism and increases lifespan in a mouse transgenic model. We tested whether independent activation of C/EBPβ-LAP would recapitulate the effects of rapamycin by treating mice on a high-fat diet with adefovir dipivoxil, a reverse transcriptase inhibitor that can activate LAP in vitro independently of mTOR inhibition. Adefovir dipivoxil reduced weight and fat mass accumulation in mice over the course of 6 weeks. Mice treated with adefovir dipivoxil showed increased expression of genes involved in β-oxidation and lipids mobilization, and reduced activation of fatty acid biosynthesis and lipid storage pathways. Our results identify C/EBPβ-LAP as a potential new target to improve lipid homeostasis in both aging and obesity.
A Cross Sectional Survey of Factors Influencing Healthcare Access in Older Women of South India
Authors: Sudhakar Sreejith , Jose Justin , Cherayi Shanuga 
Published: December 2021

Abstract
We examined the determinants of healthcare access barriers, treatment-seeking, and self-medication in older women aged 60 years and more, using a cross-sectional survey design. Using a structured interview format, we interviewed 1005 older women from 7 out of 14 districts in the state through a stratified random sampling procedure. Multiple linear regression analysis results reveal that older women's healthcare access barriers significantly increased when they experienced a long duration of multimorbidity alongside poor recognition of autonomy and basic amenities available at health facilities. However, confidentiality, the ability to pay for healthcare expenditure, and the type of health care significantly improved healthcare access. In factors influencing older women's delay in treatment-seeking, optimal instrumental functionality in daily living, optimal quality of life and access to healthcare services significantly reduced delay in treatment initiation. Whereas poor health-seeking behaviors, long duration of multimorbidity, and the quality of basic amenities at hospitals significantly increased treatment initiation delay and explained 13.6% of the variance. In factors influencing older women's use of self-medication, advancing age, living in rural areas, optimal functionality, perception of providers' respect for confidentiality were associated with increased self-medication frequency. Whereas, better wealth status, prompt attention to older women's health needs, and basic amenities at hospitals significantly reduced their self-medication practice. Therefore, the optimal functional abilities, fewer morbidities, and optimal health system responsiveness significantly reduce healthcare access barriers and self-medication while improving older women's treatment-seeking behaviors.
Patterns of Healthcare Costs Among Older Adults: Demographics, Health Personality, and Resilience
Authors: Arieli Rotem , Martin Peter 
Published: December 2021

Abstract
The purpose of this study was to examine healthcare costs of older adults in relation to demographic characteristics, individual health personality traits, and resilience. Data included 3,907 participants, 65 and older, collected by a large provider of Medicare Supplemental Health Insurance. The Health Personality Assessment*, Brief Resilience Scale, total healthcare cost, and demographic information were used. In our sample, the average healthcare cost was $13,283.69 (SD=30,784.87), ranging from $0–$989,084, and higher healthcare costs were found among older, male, and less health-neurotic (i.e., lower health-related anxiety) adults. Configural frequency analyses were conducted to identify “types” and patterns of healthcare costs by age and gender. The following significant patterns emerged: Women in the oldest group with high healthcare costs and women in the young-old age group who had low healthcare costs occurred significantly more than expected by chance, p&lt;.01. Next, we hypothesized configuration patterns for resilience, health personality, and healthcare costs. Results confirmed the following “types” or patterns occurring more often than expected by chance: less-resilient individuals with high health neuroticism and high healthcare costs, p&lt;.001, and less-resilient, less-health-conscientious adults with high healthcare costs, p&lt;.001. The results suggest higher healthcare costs for individuals who are less resilient, more neurotic about their health, and less disciplined in their health practices. Future intervention programs may benefit from promoting resilience, reducing health neuroticism, and increasing health conscientiousness. *The Health Personality Assessment (HPA) is © 2021 United HealthCare Services, Inc. All rights reserved.
Insufficient Sleep and Health Care Utilization: A Scoping Review
Authors: Olatunde Kolade , Patton Susan 
Published: December 2021

Abstract
Insufficient sleep is a common problem among older adults with 26% over the age of 65 reporting less than seven hours sleep in a 24 hour time period. Evidence indicates that untreated sleep disorders are associated with osteoarthritis, heart disease, hypertension, diabetes, obesity, falls, decreased cognitive performance, and decreased health related quality of life in older adults. A scoping review was undertaken to determine what is known about the association between insufficient sleep or insomnia and health care utilization. The Joanna Briggs Institute, Methodology for JBI Scoping Reviews was used to guide the review. Searches were conducted in PubMed, HINARI, Google Scholar and Cochrane databases. Twenty nine studies were included. Overall, the review indicates that reduced sleep is associated with a greater odds of difficulties in daily activities, higher rates of health care utilization and costs, and poly pharmacy. Findings also reveal sociodemographic and geographic variations in prevalence of healthy sleep duration. Although the majority of studies focused on the causes and consequences of insomnia and recommended clinical and behavioral health promotion interventions, there is a gap in studies related to the public health or economic impact of insufficient sleep. Research in this area will provide perspectives on the need to raise awareness of the importance of sleep and to incorporate the awareness into policies that improve sleep health.
Dependency, Mortality, Invisibility: Linking Childhood Disability with Life Course Health Outcomes
Authors: Hoyle Jessica , Laditka James , Laditka Sarah 
Published: December 2021

Abstract
People who experienced disability in childhood are living longer. It is not clear if longer lives indicate better health and less dependency, or if longer life is accompanied by increased dependency. We addressed that question by studying the joint dynamics of mortality and dependency. This population is “invisible” in most national surveys, which do not ask about childhood disability. We evaluated special education history as an indicator of childhood disability, and used that indicator to estimate dependency and life expectancy throughout adult life. Data: Panel Study of Income Dynamics and the Health and Retirement Study (n=20,563). Activities of daily living (ADLs), instrumental ADLs, and cognition defined five functioning levels including dependency and death. Multinomial logistic Markov models estimated probabilities for transitioning among the levels, with or without a history of childhood disability, adjusted for demographics. We used the probabilities in microsimulations, creating large populations of completed lives, identifying dependency at each age for each individual. Analysis showed special education history was a valid indicator of childhood disability; 13% had such history. With parent education less than high school, remaining life at age 20 was 46.0 years for people with that history, 58.3 for others; corresponding results with parent’s bachelor’s degree: 48.3 and 60.7 (p &lt; 0.05). Corresponding population percentages dependent 5+ years were: 15.2% and 3.8%, 13.1% and 3.8% (all p&lt;0.05). Special education history can indicate childhood disability. People with that history had significantly more dependency than others, and shorter lives. Accommodations and interventions can improve their health and functioning.
Health Behaviors in the LGB+ Population: Variation Across Adulthood
Authors: Noblitt Jessica , Barrett Anne 
Published: December 2021

Abstract
Health behaviors, which predict physical and mental health, are patterned by social factors, with some groups engaging in more health-enhancing behaviors than others. LGB+ people face more economic and social barriers to participation in healthy behaviors, along with the stress of discrimination that could lead to unhealthy behaviors to cope. Although some studies have examined variation in health behaviors by sexual identity, they focus almost exclusively on adolescents and young adults. However, such differences may decline across adulthood, as stress related to sexual identity declines with age among LGB+ individuals. Addressing this issue, we use data from the National Health Interview Survey (2016-2018) to examine differences by sexual identity in substance use, weight-related behaviors, healthcare utilization, and sleep. We compare the patterns across three age groups – young, middle-aged, and older adults. Results for each health behavior reveal that differences by sexual identity are indeed greatest among young adults. The magnitude is smaller in middle age, and no significant differences by sexual minority status are observed at older ages.
Failing to Complain: Do Nursing Homes with more Residents with Dementia have Fewer Complaints?
Authors: Bhattacharyya Kallol Kumar , Peterson Lindsay , Bowblis John , Hyer Kathryn 
Published: December 2021

Abstract
The majority of nursing home (NH) residents have Alzheimer’s Disease or Related Dementias (ADRD). However, the association of ADRD prevalence and NH quality is unclear. The objective of the current study is to understand the association of NH characteristics, including the proportion of ADRD residents, with the prevalence of NH complaints as an indicator of quality of care and quality of life. We merged data from the ASPEN Complaints/Incident Tracking System with national NH data from the Certification and Survey Provider Enhanced Reports, the Minimum Data Set, the Area Health Resource File, and zip-code level rural-urban codes in 2017. Three groups of NHs were created, including those whose proportion of residents with ADRD was in the top decile (i.e., high-dementia NHs (N=1,473)) and those whose proportion of ADRD residents was in the lowest decile (i.e., low-dementia NHs (N=1,524)). Bivariate results revealed high-ADRD NHs had higher percentages of Medicaid-paying residents, were less likely to be for-profit and chain-affiliated, had lower staffing hours and lower percentages of Black, Hispanic, and Asian residents. Using NHs in the middle deciles as reference, negative binomial regression models showed that having a low proportion of ADRD residents was significantly associated with higher numbers of total complaints (p&lt;.001) and substantiated complaints (p&lt;.001), whereas having a high proportion of ADRD residents was significantly associated with lower numbers of substantiated complaints (p=.001). The findings suggest the proportion of residents with ADRD in NHs is associated with quality, as measured by complaints. Policy implications of these findings will be discussed.
Who is Coming to Japan Under The New Status of Residence “Specified Skilled Care Workers”?
Authors: Tsukada Noriko 
Published: December 2021

Abstract
The Japanese government created a new status of residence called “Specified Skilled Workers” encompassing 14 job categories that have laborer shortages, including long-term care (LTC) workers on April 1, 2019. A survey of students (N=79) at a language institute in Manila, Philippines was conducted in February, 2020 to explore characteristics of future foreign LTC workers in Japan under this new status of residence and identify factors that may help facilitate worker retention. At the time of data collected, these students were studying both Japanese and LTC practices in order to pass skill evaluation tests to enter Japan. Students were asked their perceptions of long-term care, planned lengths of stay, concerns about staying in Japan, and future career plans. Preliminary analyses revealed that 67 (88%) were single, 74(93.7%) had graduated from universities, and a half of them had a nursing background. Most students (93.7%) showed interest in an extended stay in Japan, with some interested in taking the national certified care worker examination which permits extended work in Japan. The most cited concern about being in Japan was “weather, climate and typhoons” (28.1%), followed by “language proficiency” and “living expenses” (21.9%) respectively. As Japan has limited immigration policies but a large need for LTC workers, it is imperative to understand how to attract and retain foreigners who obtain the Specified Skilled Worker status. This includes addressing both work-related and living-related concerns and needs.
The Influence of Staff-Resident Interactions on Resistiveness to Care Behavior in Assisted Living
Authors: McPherson Rachel , Resnick Barbara , Galik Elizabeth 
Published: December 2021

Abstract
Resistiveness to care (RTC) is a behavioral and psychological symptom of dementia that is common among dementia residents in assisted living facilities. RTC encompasses verbal and nonverbal behaviors that oppose care, such as crying, grabbing, hitting, or yelling, among many other resistive behaviors. The quality of care interactions which can be positive, neutral or negative, have been associated with increased RTC. The purpose of this study was to test the association between quality of care and RTC. This was a secondary data analysis using baseline data from the Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) implementation study. Controlling for cognition, age, gender, medication use, and comorbidities, it was hypothesized that quality of care interactions would be associated with resistiveness to care. A linear regression analysis was conducted to test the hypothesis. The sample included 794 participants the majority of whom were white women with a mean age of 89.48 (SD=7.61). The mean RTC was .09 (SD=.41, range 0-13) and the mean quality of care interactions were 5.96 (SD=1.44, range 0-7). Based on the regression analysis there was no significant association between quality of care and RTC. These findings may be due to the high quality of care provided and limited RTC in this sample. Ongoing research is needed, however, to continue to explore these relationships and assure that all RTC is being reported among staff and that there is no evidence of negative quality of care interactions in these settings.
Age, Emotion Regulation, and Well-Being after the 2016 Flood
Authors: Cherry Katie , Bordes Piper , Calamia Matthew , Elliott Emily 
Published: December 2021

Abstract
In 2016, catastrophic flooding in south Louisiana claimed 13 lives with billions of dollars in damage to homes and communities in the decade after Hurricanes Katrina and Rita devastated the US Gulf Coast. In this study, we tested the inoculation hypothesis which predicts that older adults will be less distressed than younger adults due to their prior experience with severe weather events. Participants were 218 predominately middle-aged and older adults who varied in current and prior flood experience: less than half (40%) did not flood in 2016, 31% had flood damage, and 29% had relocated permanently inland after catastrophic losses in the 2005 Hurricanes Katrina and Rita and they flooded again in 2016. Depression symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9). Emotion regulation strategies were measured using the Cognitive Emotion Regulation Questionnaire-Short Form. Results indicated that the older adults had fewer symptoms of depression and were less likely to report self blame for flood-related adversities compared to younger adults. The two age groups did not differ significantly on the emotion regulation strategies of acceptance, reappraisal, positive refocusing, other blame, and perseveration. Age was inversely associated with symptoms of depression and the maladaptive strategies of self blame for flood-related misfortune and perseveration over losses. These data support the inoculation hypothesis and suggest that prior severe weather experiences, which are likely for older adults living in hurricane prone areas, are important for post-flood resilience. Implications of these findings for disaster planning and age-sensitive interventions to mitigate adversity are considered.
Comparing Cognitive and Physical Limitations as Predictors of Depression Among Older Adults
Authors: Scher Clara , Nepomnyaschy Lenna , Amano Takashi 
Published: December 2021

Abstract
Depression in older adults is associated with loss of functioning and increased mortality. While many factors contribute to depression among this population, activities of daily living (ADL) limitations and cognitive impairment have been identified as key risk factors. However, no study, to our knowledge, has examined the extent to which physical and cognitive limitations independently and jointly contribute to the risk of depression. The current study describes the prevalence and compares the independent and joint associations of these limitations with depression in a nationally representative sample of adults aged 51 and older in the US. Analyses are based on a sample of 17,044 repeated observations on 6,636 unique primary respondents from three waves of pooled data from the Health and Retirement Study. We estimate linear and logistic multivariate regression models investigating the association between ADL limitations (any limitation on Katz ADL scale), cognitive impairment (&lt;12 on the TICS-27 scale), and depressive symptoms (8-item CES-D), controlling for a standard set of socioeconomic and health factors. First, we find that 66% of respondents report no limitations, 16% report only cognitive impairment, 11% report only ADL limitations, and 7% report both types of limitations. Multivariate analyses suggest that ADL limitations have a much stronger association with depression compared to cognitive impairment, and this association is robust across alternative specifications. In next steps, we will take advantage of the longitudinal nature of these data to estimate changes in these characteristics over time and within individuals and explore heterogeneity in associations across relevant groups.
Depressive Symptoms Mediate the Influence of Fibromyalgia Status on Physical Performance and BMI in Aging Adults
Authors: Serpas Dylan , Zettel-Watson Laura , Cherry Barbara 
Published: December 2021

Abstract
Fibromyalgia is a chronic pain condition that is frequently accompanied by comorbid conditions, including depression. Depression is associated with reduced physical functioning and health disproportionately affecting middle-aged and older adults with fibromyalgia. This study examined depressive symptoms as a mechanism through which FM status is associated with BMI and physical performance among adults in mid-to-late-life. Participants included 250 community-dwelling middle-aged and older adults (82% female) with (59%) or without (41%) fibromyalgia (M age = 64.44, SD = 9.16). Depressive symptoms were measured using the Beck Depression Inventory-II, BMI was objectively assessed, and physical performance was measured using the Fullerton Advanced Balance scale, 6-Minute Walk Test, 30-Second Chair Stand, and 8-Foot Up and Go Test. Physical performance measure analyses were adjusted for age. Asymptotic mediation analyses revealed that fibromyalgia status was indirectly associated with higher BMI (95% CI [.18, 16.74]), and poorer performance in the Fullerton Advanced Balance (CI [-2.93, -1.24]), 6-Minute Walk Test (CI [-73.75, -35.35]), 30-Second Chair Stand (CI [-2.45, -1.16]), and 8-Foot Up and Go test (CI [.35, .92]) via depressive symptoms. Participants with fibromyalgia reported greater depressive symptoms which was subsequently associated with greater BMI and reduced physical performance. Findings support depressive symptoms as one factor through which fibromyalgia status is associated with higher obesity risk and reduced physical function in middle-aged and older adults with fibromyalgia. This study supports fibromyalgia status as a critical consideration when evaluating the health and disability risk of aging adults.