bluuebunny/crossref_metadata_2025_split huggingface dataset:
UNDERSTANDING LONELINESS PATTERNS AMONG WIDOWED OLDER ADULTS OVER TIME AND THE PROTECTIVE EFFECT OF SOCIAL SUPPORT
Authors: Lee Gina , Russell Daniel 
Published: December 2023

Abstract
The present study aimed to investigate loneliness among widowed and non-widowed older adults. Additionally, the study sought to identify classes with different loneliness patterns among widowed older adults over time and to determine social resources that impact loneliness patterns after spousal loss. Data from the Health and Retirement Study were utilized to compare loneliness levels between widowed (n = 137) and non-widowed (n = 2,361). Those who were married at T1 (2008/2010), widowed at T2 (2012/2014), and remained widowed at T3 (2016/2018) were defined as widowed. T-tests were conducted to compare loneliness between the two groups, revealing that widowed individuals reported significantly higher levels of loneliness at T2 only. Using growth mixture models, three distinct loneliness patterns were identified among widowed individuals: Group 1, displaying mid-level loneliness at T1 and increasing over time (n=32); Group 2, exhibiting the lowest loneliness at T1 and leveling off (n=88); and Group 3, experiencing the highest loneliness at T1 and decreasing over time (n=17). Finally, analysis of variance tests were conducted to determine whether social support and engagement as measured at T1 differed among the three identified groups. Results indicated that social support from friends and children was significantly higher among group 2 compared to the other two groups. This study provides evidence of the protective effect of social support before widowhood on the psychological well-being of older adults after spousal loss. The findings may have implications for the development of interventions aimed at supporting widowed older adults during this difficult period of transition.
A CONCEPT ANALYSIS OF SHARED DECISION MAKING FOR OLDER PATIENTS WITH DEMENTIA IN ACUTE CARE HOSPITALS
Authors: Saito Taeko , Masaki Harue 
Published: December 2023

Abstract

Background
Dementia patients often have comorbidities like Diabetes Mellitus, kidney disease, and cardiovascular disease that require patient decision-making about care, despite the challenges in judgment that stem from dementia. The study aimed to determine what Shared Decision-making is for older patients with dementia in acute care hospitals.

Methods
The study used the Hybrid Model of concept analysis method. This comprises a theoretical phase, a fieldwork phase, and an analytical phase. In the initial phase, the concept is selected. The fieldwork phase collects qualitative data to further analyze the selected concept. The third phase analyzes the empirical observations and writes up the findings. We searched Pub-Med, CINAHL, and PsycINFO for the keywords: “shared decision-making” and “patients with dementia.”

Results
We identified 14 articles that gave rise to over 100 codes. We defined shared decision-making for older patients with dementia in acute care hospitals as “The older person with dementia can be involved in collaborative activities in the care network, including delegation of authority as active decision-making. Open-minded communication based on person-centered care can be the foundation for considering feasible options. Clarify the role of family caregivers and identify decision-making participants in the care network to view the best alternative for the patient’s subsequent life”.

Conclusions
We developed a working definition of shared decision-making for patients with dementia. We clarified critical elements of the decision-making process, like based as person-centered care, open-minded communication, and collaborative decision-making activities between the person and the care network members, including delegation of authority.
COLLABORATION IN CARING FOR OLDER ADULTS WITH DEMENTIA LIVING IN LONG-TERM CARE FACILITIES
Authors: Thaitrong Phatt , Douglas Joy , Knol Linda L , Ellis Amy , Noh Hyunjin , Sanchez Shena 
Published: December 2023

Abstract
Current evidence calls for an interdisciplinary, team approach to caring for older adults with dementia. Registered dietitian nutritionists (RDNs) are interdisciplinary team members who play an important role in nutrition and dementia care. Our study explored how RDNs collaborate with licensed healthcare providers and direct care staff to provide nutrition care for older adults with dementia living in long-term care (LTC) facilities. RDNs who work with residents with dementia in the U.S. (n = 18) were recruited to participate in one of five focus groups, where they described the various disciplines they collaborate with. Focus groups were led by a trained moderator using a semi-structured interview guide, transcribed verbatim, and audited by the research team for accuracy. Transcripts underwent descriptive content analyses using NVivo© software. Descriptive content analyses revealed the following diverse groups who work collaboratively with RDNs: 1) nursing staff, 2) foodservice staff, 3) therapists, 4) physicians, and 5) other non-clinical staff, including activities staff and nursing home administrators. Additionally, RDNs reported they worked closely with residents’ family members and resident members of the food committee. In conclusion, in LTC settings, RDNs collaborate with various groups, encompassing clinical, non-clinical, and even residents/family to care for older adults with dementia. However, collaboration is not limited to clinical staff. To provide optimal nutrition care for older adults with dementia, it is important to recognize the value of collaborating with both clinical and non-clinical stakeholders to meet resident needs.
DIRECT AND INDIRECT CAUSAL EFFECTS OF AIR POLLUTANTS ON ALZHEIMER’S DISEASE RISK AND DISPARITIES
Authors: Akushevich Igor , Yashkin Arseniy , Bona Vito Di , Kravchenko Julia 
Published: December 2023

Abstract
Ambient air contaminants have been associated with higher risk of Alzheimer’s disease (AD), related dementia, and cognitive impairment; however, mechanisms that underlay these effects remain unclear. Pre-existing arterial hypertension, diabetes mellitus, cerebrovascular disease, and renal disease have a strong impact on AD risk and disparities. These diseases, in turn, are associated with exposure to air contaminants, including particulate matter (PM2.5). We applied causal mediation analysis in the formulation of VanderWeele which provides causal estimates of the direct and indirect (through the effects on pre-existing diseases) effects of PM2.5 exposure on the risk of AD. We used Administrative Health Insurance Claims from 5%-Medicare (N=6,042,239; 1991-2020) to identify the date of onset for AD and risk related diseases such as arterial hypertension, diabetes, cerebrovascular, and kidney diseases that were considered mediators in these analyses. Information on ambient PM2.5 at the zip code level were derived from the Socioeconomic Data and Applications Center (SEDAC) that incorporates air monitoring data, satellite aerosol optical depth, meteorological conditions, chemical transport model simulations, and land-use variables. The estimates supported the hypotheses on the linear dependence of the dose-response function with higher effects for Males vs. Females, White vs. Black subpopulations, and stroke-belt states vs. other U.S. regions. We found that the contributions of indirect effects were stronger for younger older adults and reached up to 13% for cerebrovascular disease, 10% for arterial hypertension, 5% for diabetes, and 4% for chronic kidney disease. Analysis in subpopulations demonstrated health disparities in the effects of PM2.5 on AD risk.
EARLY DETECTION IN ALZHEIMER’S DISEASE AT ADVENTHEALTH: A DAVOS ALZHEIMER’S COLLABORATIVE FLAGSHIP SITE
Authors: Smith Steven , Pratley Richard , Baldivieso Valeria , Baksh Magda , Shepherd Gayle , Lopez Janice , Selzler Katherine , Murray James 
Published: December 2023

Abstract

Background
The emergence of new therapeutics highlights the need for more efficient and equitable early identification of people at risk of developing Alzheimer’s disease. The Davos Alzheimer’s Collaborative flagship program was designed to test feasibility, acceptability, and implementation of a digital cognitive assessment (DCA) followed by a blood-based biomarker (BBM) as part of primary care workflows.

Methods
Patients ≥65 years were contacted via their AdventHealth primary care provider or through social media to complete the Cogstate Brief Battery (CBB) DCA virtually. The CBB assesses four cognitive domains: processing speed, attention, visual learning, and working memory. Patients with an abnormal or borderline composite score were offered the PrecivityAD® blood test from C2N Diagnostics, an Alzheimer’s disease screening tool.

Results
Approximately 2387 patients expressed interest to participate and 1077 e-consented: 96% social media, 4 % PCP. Of those, 742 patients completed the DCA. 28% were positive, 15% were borderline, and 56% were negative for cognitive issues. Additionally, 192 patients received the blood test results where, 17.7% had high likelihood, 67.7% low likelihood, and 14.6% could not distinguish presence or absence of amyloid plaques. Utilization of digital tools varied across race and ethnicity.

Conclusion
Both PCP referrals and social media approaches demonstrated opportunities and challenges for early detection of Alzheimer’s. Implementation of both the CBB cognitive assessment and PrecivityAD® blood test was successful. Both DCAs and BBMs have value in early detection for cognitive impairment and a first step in identifying patients who could benefit from disease-modifying treatments.
INFLAMMATORY CYTOKINE, SOCIAL SUPPORT, AND HEALTH DISPARITIES IN PERSONS WITH COGNITIVE IMPAIRMENT AND DEMENTIA
Authors: Malatyali Ayse , Cidav Tom , Xie Rui , Thiamwong Ladda 
Published: December 2023

Abstract
The protective role of social support on cognitive functioning is extensively documented. A pro-inflammatory cytokine, Tumor necrosis factor-alpha (Tnf-alpha), might have a role in the connection between social support and dementia as a marker of systemic inflammation. This study describes the influence of lack of friends’ support and Tnf-alpha on cognitive functioning. We conducted a cross-sectional study on Health and Retirement Study participants aged 65 and above, using datasets from the 2016 interviews. Of the 9,262 participants, 72.4% had normal cognition. 21.3% had cognitive impairment, and 6.3% had dementia. Our regression model controlled with depression scores revealed that participants with a lack of friends’ support were 51% more likely to have cognitive impairment and 54% more likely to have dementia. The effect of Tnf-alpha was comparably higher on participants with dementia and cognitive impairment than on participants with normal cognition. Compared to quartile-1 (lowest Tnf-alpha levels), Quartile-4 (highest Tnf-alpha levels) was significantly associated with cognitive impairment (OR=1.60) and dementia (OR=2.37). Quartile-3 was only a significant predictor of dementia (OR=2.08). The effect of Tnf-alpha was insignificant in quartile-2 for both groups. Hispanics were 65% more, and African Americans were 67% more likely to have cognitive impairment than non-Hispanic whites. The likelihood of having dementia was even higher in racial/ethnic minorities: Hispanics were 3.3 times more, and African Americans were 2.3 times more likely to have dementia than non-Hispanic whites. Future research can focus on racial and ethnic variations in pro-inflammatory cytokines and social support among people with dementia.
ONLINE COGNITIVE MONITORING IN A SIMULATED ANTI-AMYLOID TRIAL: ADHERENCE AND COGNITIVE CHANGE
Authors: Kaye Jeffrey , Mattek Nora , Marcoe Jennifer , Mar Amanda , Shang Yanan , Pierce Aimee , Duff Kevin , Hughes Adriana 
Published: December 2023

Abstract
Remote assessment of cognitive function is increasingly of interest for monitoring cognitive decline. Additional advantages of remote monitoring are more frequent assessments and the examination of change over time, which may yield more sensitive indicators of cognitive status. This concept was tested in DETECT-AD (Digital Evaluations and Technologies Enabling Clinical Translation for Alzheimer’s Disease), an ongoing simulated anti-amyloid trial using digital biomarkers as outcome measures. Adherence to testing, relationships to age, global cognition, and SUVR, and trajectories of change were analyzed in the SMART (Survey for Memory, Attention and Reaction Time) test, a brief measure of visual-grid memory and executive function (Trails A/B, Stroop Color-Word), self-administered online every four weeks. To date (02/28/2023), 46/100 have been enrolled with mean(SD): follow-up=31.0(7.9) weeks (no dropout); age=78(6.6); 63% women; MoCABaseline=25.5(2.3); PET SUVR=1.09 (0.20; range=0.850-2.07). SMART surveys (n=184) completed online used a desktop (26%), laptop (48%), tablet (20%), or smartphone (7%). A mean of 4(2.0; range=1-8) SMART surveys/participant were completed with 96% completed tests. Older age significantly correlated with longer overall completion times (p=0.02), Trails-B (p&lt; 0.01) and Stroop (p=0.02) times, and more click counts on Trails-B (p=0.03). MoCA total score significantly correlated with shorter completion times on overall SMART (p=0.02), Trails-A (p&lt; 0.01), and Trails-B (p=0.03). There were no relationships between SUVR and SMART. Total SMART completion time decreased over multiple administrations (p=0.03), driven by shorter Trails-B time (p=0.01). Monthly online screening of cognitive function in a clinical trial setting is well maintained yielding novel information over time.
PROMOTING PARTICIPATION IN OCCUPATIONS AMONG OLDER ADULTS LIVING WITH NEUROCOGNITIVE DISORDERS AND CAREGIVERS
Authors: Belchior Patricia , Levasseur Melanie , Filiatrault Johanne , Ramachandran Meena , Bier Nathalie 
Published: December 2023

Abstract
Participation in meaningful occupations promotes self-confidence, self-esteem, overall health, and healthier life transitions. Due to significant life changes brought by neurocognitive disorders older adults living with neurocognitive disorders as well as caregivers may undergo some disruption in their occupational participation. Few interventions have focused on their ability to engage in meaningful occupations independently and together to successfully orchestrate their life to meet their own occupational needs. The goal of this study was to document the priority needs of older adults living with neurocognitive disorders and caregivers to promote occupational participation, to guide us in the development of an intervention. To this end, a rapid literature review was conducted. Three databases (Medline, PsycInfo and CINAHL) were searched. Studies were included if they used qualitative methods, included community-based individuals and were available in English or French. A total of 20 studies met the inclusion criteria. Two needs were prioritized in the literature by both older adults living with neurocognitive disorders and caregivers: 1) to continue participating in daily activities and social roles (e.g., maintain the connection with the community, use everyday technology), 2) to educate the public about the disease (e.g., bring awareness, knowledge, and understanding of dementia among the community at large). In the presentation we will discuss how the results will inform the development of an occupational-based intervention to promote meaningful occupations.
QUALITY OF LIFE ASSOCIATED WITH HOSPITAL DEATH AMONG PERSONS LIVING WITH DEMENTIA
Authors: Sullivan Suzanne , Li Chin-Shang , Chang Yu-Ping 
Published: December 2023

Abstract
Dementia is a progressive, terminal health condition impacting quality-of-life. Hospice programs supporting family caregivers in managing end-of-life care for persons living with dementia (PLWD) and preventing non-beneficial hospitalizations are underutilized. This univariable logistic regression of the National Health and Aging Trends Study rounds 1-9 (n=719) aimed to identify associations between quality-of-life of PLWD and hospital death (yes/no). Results indicate that PLWD going outside most days (OR=3.34, p=0.0004) were more likely to die in a hospital compared to those never going outside. Those whose health did not prevent them from enjoying life (OR=2.5, p&lt; 0.0001) were more likely to die in a hospital. PLWD needing &gt;30 minutes to fall asleep (OR=2.43, p=0.002) compared to those never needing &gt;30 minutes to fall asleep, PLWD without problems speaking (OR=1.69, p=0.007), not needing help to eat (OR=1.82, p=0.001), without problems chewing or swallowing (OR=1.54, p=0.039), and having possible dementia (OR=2.35, p&lt; 0.0001) were more likely to die in the hospital. African Americans (OR=1.80, p=0.003) were more likely to die in the hospital compared to Whites, PLWD who received gas energy assistance (OR=1.95, p=0.048), and those living in the Pacific West compared to the Midwest or Northeast (OR=2.57, p=0.004) were more likely to die in the hospital. These findings suggest that quality-of-life, availability of support, financial and psychosocial well-being, and social disparities were associated with higher risk of hospital death among PLWD. Quality-of-life and psycho-social demographic features may serve as mechanistic targets for interventions supporting hospice transitions and prevention of non-beneficial end-of-life hospitalizations.
USABILITY TESTING OF THE PACE APP TO SUPPORT FAMILY CAREGIVERS IN MANAGING PAIN FOR PEOPLE WITH DEMENTIA
Authors: Chi Nai-Ching , Shanahan Angela , Nguyen Kristy , Demir Ibrahim , Fu Ying-Kai , Herr Keela 
Published: December 2023

Abstract
Pain is a common symptom in older adults with Alzheimer’s Disease and Related Dementias (ADRD). It is difficult to assess and is often undertreated in people with ADRD. The PACE-app (Pain Control Enhancement application, was developed to enhance self-efficacy of family caregivers when controlling the pain of their care partner. The objective of this study was to test the usability of the PACE-app with family caregivers and clinicians. We evaluated the usability of the PACE-app. Participants (17 family caregivers, 6 clinicians) took part in a mixed-methods study that included a one-time recorded zoom meeting with standardized semi-structured guided review, interview, and a survey specific to their role. The Post-Study System Usability Questionnaire (PSSUQ) was used to measure usability. The overall PSSUQ score we found was 1.9. The range of scores can be between 1 and 7 with the lower numbers meaning favorable usability. The qualitative interviews showed a favorable user experience with 75% of all participants feeling the overall design was effective; 48% felt the tailored pain management strategies were useful; 24% suggested improving the app by having direct coaching information for the family caregiver. This study demonstrated favorable usability with those who tested the PACE-app. Suggestions for improvement were given and using the interview results in conjunction with the PSSUQ scores, we are able to make changes to the app interface to impact the overall design to enhance user experience.
A COMPREHENSIVE COMPOSITE FOR ALLOSTATIC LOAD SCORING AND RISK CATEGORIZATION FOR PREDICTIVE COMPARISONS
Authors: Buller-Peralta Ingrid , Gregory Sarah , Wells Katie , Ntailianis Georgios , O’Brien John , Ritchie Craig , Muniz-Terrera Graciela 
Published: December 2023

Abstract
Introduced three decades ago, the concept of Allostatic Load (AL) describes the wear and tear of the physiological response to chronic stress, and how sustained demand overloads the systems involved, deplete their resources, and leads them to fail. Current evidence shows positive relationship between AL and risk of developing conditions such as depression, fibromyalgia, cardiovascular disease, diabetes, cancer, early cognitive decline, and dementia. However, there is only partial consensus regarding which biomarkers can compose an AL index or how to accurately score them. Current proposals debate between purely statistical cut-off points, inclusion of gender and ethnicity differences, use of clinical reference values, and scoring ongoing medication. The result is a considerable heterogeneity of methods for AL calculation and a lack of universally agreed values, leaving researchers to subjectively choose which framework suits better to their aims. Using data from the PREVENT-Dementia study (cognitively normal mid-life participants, n=700), we developed a comprehensive composite for AL scoring to generate a more accurate and biologically relevant index, that considers both previous and recent clinical evidence. By including gender and age differences, high quartile approach, and up-to-date clinical reference values, individuals were categorized as no-risk, at-risk and high-risk of AL, which will be associated with MRI brain volume measurements. Comparison to serum Thyroid-stimulating hormone (TSH) levels will serve as proxy of the neuroendocrine biomarkers originally proposed as AL primary mediators, due to its association to increased cortisol. Additional stress-related biomarkers, such as sleep quality and the neutrophil-to-lymphocyte ratio will also be assessed for associations.
EPIGENETIC DIFFERENCE BETWEEN INSOMNIA GROUP AND NONINSOMNIA GROUP IN PARTICIPANTS WITH KNEE PAIN
Authors: Goicolea Soamy Montesino , Meng Lingsong , Huo Zhiguang , Foster Thomas C , Goodin Burel R , III Joseph L Riley , Fillingim Roger , Cruz-Almeida Yenisel 
Published: December 2023

Abstract
Chronic knee pain is a common condition that often co-occurs with insomnia. Epigenetic modifications, such as DNA methylation, may play a role in the sleep-pain relationship. In this study, we aimed to identify differentially methylated CpGs/regions and enriched genomic pathways associated with insomnia in participants with knee pain (KP). We recruited 140 cognitively healthy middle to older-aged adults with self-reported KP and extracted DNA from peripheral blood. MethylationEPIC arrays were used for methylation data quantification, R package minfi was used for data preprocessing and quality control, and Ingenuity Pathway Analysis (IPA) was used to explore functional implications of differential methylation in pathways related to insomnia. Annotated genes within ±5kb of the putative differentially methylated regions (DMRs, p&lt; 0.05) were subjected to the IPA analysis. There were no significant differences in sex or race between the two groups (p&gt;0.05). We observed an over-representation of younger participants in the insomnia group (p=0.005) and also from the University of Florida (p=0.008). At raw p &lt; 0.05 cutoff, we identified a total of 20,006 CpG probes, including 12,674 hypermethylated, and 7,332 hypomethylated CpG probes. Pathway analysis using IPA identified multiple immune-related pathways enriched with insomnia-related differentially methylated regions (DMRs), including the antigen presentation pathway (p=3.39E-08). Verapamil was identified as the most significant upstream regulator (p=8.8E-07). Our findings suggest the importance of epigenetic regulation of the immune system in the sleep-pain relationship and highlight the need for further research to understand the epigenetic contributions to sleep disorders in individuals with chronic pain.