bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXPLORING AI ELDERS’ CULTURAL PERCEPTIONS OF DISASTERS AND THE ROLE OF GENERATIVITY IN PREPARING FUTURE GENERATIONS
Authors: Thompson Lena , Buch Elana , Ashida Sato 
Published: December 2023

Abstract
Natural and man-made disasters have a great impact on human health, especially for AI Elders. As keepers of cultural and community knowledge, AIAN Elders also serve as guides on how to best support their communities. This study focuses on a Midwestern Tribe’s cultural perceptions of disaster management, specifically being generative, or passing down disaster management knowledge and practices to future generations. In-person semi-structured interviews were conducted with eighteen Elders from the Midwestern Tribe. Recordings were transcribed, de-identified, and coded thematically using an interpretive phenomenological analysis approach. The study received approval from the Tribe’s Department of Emergency Management and the interview guide was reviewed and approved by a Community Advisory Board of six individuals. Elders described past experiences with natural and man-made disasters, including what they did before, during, and after disasters. Elders also explained how people cared for one another, including the importance of interconnectedness with all beings, caring for grandchildren, and the role of the Tribal Government in disaster management. Elders also described how culture shaped disaster management practices, such as traditional practices to follow during a storm, and the important role of Elders in teaching communities what to do when disasters happen. Exploring the role of generativity in passing on disaster-related information is one way to learn how Elders’ knowledge is valued by the community. Findings suggest that Elders can provide important guidance to Tribal governments and public health systems to determine effective disaster management strategies for AIAN communities.
BUILDING BRIDGES TO CONNECT BETWEEN NEEDS, RESOURCES, AND RURAL RESIDENTS
Authors: Karlin Nancy , Wiese Lisa Ann , Ford Cassandra 
Published: December 2023

Abstract
The percentage of older adults living in rural areas is predicted to rise with population aging. This impacts access to resources, creates barriers to effective aging, and promotes a unique aging experience. Consequently, demands are growing for services to support healthy aging in rural regions already experiencing healthcare disparities. This symposium will focus on location variations in resource availability, and unique interventions to promote aging in place. In the first and second presentations, researchers report on differences in current service utilization, satisfaction, and perceived future service needs/use among rural versus frontier-residing older adults in Wyoming, and in Nigeria, respectively. In the third presentation, successes and failures of an interdisciplinary approach to increase Alzheimer’s disease and related dementias (ADRD) diagnosis/treatment rates are shared. The fourth group reports the impact of an intergenerational RCT intervention of training older adults in computer literacy and online chair yoga engagement, for decreasing pain levels and cognitive risk. This is a Rural Aging Interest Group Sponsored Symposium.
BUILDING BRIDGES BETWEEN RURAL PROVIDERS AND RACIALLY/ETHNICALLY DIVERSE RETIRED FLORIDA FARM WORKERS
Authors: Wiese Lisa Ann , Tolea Magdalena , Pulido Joanne 
Published: December 2023

Abstract
We report results from a consortium-led randomized controlled clinical trial to optimize rural community health through interdisciplinary detection and care (ORCHID), funded by the Florida Department of Health/Moore Alzheimer’s Disease Research Foundation. This project involving providers, nursing students, office staff, community residents and caregivers, targets a health professional shortage area with a 39% poverty rate. Both the control group (56% non-White, n=11) and intervention group ((93% non-White, n=9) received training on screening tools and updated ADRD information using the Florida Department of Health ADRD Resource Guide. The intervention group is participating in an additional four hours of evening online ADRD diagnosis/treatment training geared towards primary care clinicians, available at no-cost through Washington University. Both groups are being offered in-depth cognitive assessments by Adult Gerontological Nurse Practitioners (AGNP) during home visits. Connections to under-utilized local resources are being facilitated by local nursing students. Initial results include that although pre-post total Alzheimer’s Disease Knowledge Scores (Carpenter et al., 2009) correlated strongly (r =.93; p =.003), there was no significant difference in knowledge (p =.07) in the control group. There was also no significant increase in ADRD diagnostic rates, and AGNP visits were not requested. Instead, the control group providers report the routine practice of conducting annual cognitive screening in persons over age 65, and referring patients as needed to the nearest neurology providers 30 miles away, which residents do not visit. However, connections to local resources increased by 65%. New ADRD diagnosis/treatment rates in the intervention group will be available August, 2023.
UNDERSTANDING THE CURRENT LOCATION DISPARITIES IN ADRD AND ITS DETERMINANTS IN NIGERIA
Authors: Ogidigo Oloaigbe (Joyce) , Okpalefe Okiemute , Omeje Kingsley , Anosike Chioma 
Published: December 2023

Abstract
Alzheimer’s disease and related dementias (ADRD) is a growing health challenge in low- and middle-income countries, particularly in sub-Saharan Africa. Evidence of geographical variation is associated with increased ADRD incidence, and current research suggests that early-life rural living further increases ADRD risk. However, the scarcity of studies conducted in resource-poor countries limits conclusions. Consequently, the awareness and response to ADRD have been limited. In Nigeria, several rural communities still associate dementia with the normal process of aging, with many patients stigmatized and abandoned in the belief that their condition is beyond any medical intervention. Thus, many of those affected delay seeking medical care and endure poor outcomes. This is exacerbated by the lack of mental health service access in rural areas. This geographic disparity and deeply rooted structural inequalities have posed additional challenges to adequately diagnose and provide care for individuals across the lifespan living in these settings. Hence, population-based data on ADRD incidence in Nigeria is required to estimate its true burden and inform the design of ADRD prevention and management strategies. We report our analysis of the current situation of ADRD in rural Nigeria while exploring future perspectives and directions. For example, heath policies to increase the ratio of mental health professionals per number of patients, mostly in rural areas, foment proactive primary care centers. Ultimately, understanding rural-urban variation in ADRD diagnostic incidence and prevalence will inform needed policies to improve timely management and access to supportive services for older adults in Nigerian and other under-resourced regions.
HIDDEN BARRIERS TO ENGAGING HOME- AND COMMUNITY-BASED SERVICES IN DEMENTIA CARE RESEARCH
Authors: Parker Lauren , Marx Katherine , Gaugler Joseph , Gitlin Laura 
Published: December 2023

Abstract
The high prevalence of dementia in the United States has resulted in a reliance on home-and community-based services (HCBS) to assist in the provision of care for community-dwelling persons living with dementia. Partnering with HCBS organizations, like Adult Day Services (ADS), is beneficial to disseminating evidence-based dementia care interventions as it is an existing service that can be leveraged to foster relationships between research staff and clients. While benefits exist, challenges in identifying community-partner organization, ethical approval, and community-partner staffing can be unintended barriers. Using the ADS Plus Program as a case-study, this presentation will detail hidden barriers in engaging HCBS partnerships into dementia care research. Specifically, we will discuss barriers to 1) developing relationships to implement a multi-site national-trial, 2) high touch points necessary to engage sites from underrepresented populations, 3) institutional review board requirements (e.g. CiTi training, Federal Wide Assurance Forms), and 4) staff readiness to participate in research. We also offer recommendations based on lessons learned from the ADS Plus Program to enhance the pipeline from engagement with HCBS to participate in research to implementing an evidence-based interventions. Lessons learned from the ADS Plus Program demonstrates that changes are needed to improve the efficiency of the pipeline from community-based participation into dementia care research and implementation of evidence-based interventions.
THE MARGRET M. AND PAUL B. BALTES AWARD LECTURE AND PRESENTATION
Authors: Jarrott Shannon 
Published: December 2023

Abstract
The Margret M. and Paul B. Baltes Award Lecture will feature an address by the 2022 Baltes Award recipient, Eric S. Kim, PhD, of the University of British Columbia. This session will also include the presentation of the 2023 Margret M. and Paul B. Baltes Award to recipient Reuben Ng, PhD of the National University of Singapore. The Margret M. and Paul B. Baltes Foundation Award in Behavioral and Social Gerontology recognizes outstanding early-career contributions in behavioral and social gerontology. The award is generously funded by the Margret M. and Paul B. Baltes Foundation.
PSYCHOLOGICAL WELL-BEING AND PHYSICAL HEALTH IN THE CONTEXT OF OUR RAPIDLY AGING WORLD
Authors: Kim Eric 
Published: December 2023

Abstract
Our society is rapidly aging. Thus, citizens, researchers, and policymakers alike are seeking ways to re-engineer society to achieve the dual aim of helping our aging population age well and fostering new ways for older adults to deploy the abundance of strengths that accrue with age. Most public health, biomedical, and psychological efforts have focused on reducing harmful risk factors. This approach has contributed greatly to prevention and treatment programs. However, another approach to achieving this dual aim is to expand the focus and evaluate upstream dimensions of psychosocial well-being. This approach might help inform the multidisciplinary and multi-level response efforts we need. In this talk, I will describe a theoretical model, results from a series of studies evaluating associations between a sense of purpose with reduced risk of chronic conditions, and mechanistic biobehavioral processes underlying these associations. This work aims to provide new directions for building a science of resilience and providing new targets for multi-level interventions that we can weave into our daily lives via practices and systems.
HOSPITAL-IN-HOME: IMPLEMENTATIONS IN THE VA HEALTH CARE
Authors: Sullivan Jennifer , Franzosa Emily , Cooper Dayna 
Published: December 2023

Abstract
The Department of Veterans Affairs (VA) Hospital-In-Home (HIH) program delivers patient-centered, acute-level hospital care at home within a single-payer integrated health-care system. Compared to inpatient care, HIH has demonstrated improved patient safety, effectiveness, and patient and caregiver satisfaction. As of 2022, there were eleven HIH sites across the VA, evidence of modest adoption. This symposium presents findings from the first year of a 4-year project that aims to conduct an in-depth inquiry in to the most effective ways to implement, adapt and sustain HIH across the VA. We will present an overview of the VA HIH program, describe one HIH program in-depth, present a birds-eye-view of the national program, present comparisons of sites’ implementations in terms of structure, patient characteristics and outcomes, and conclude with an implementation-science framework to examine program adoption, adaptations, successes and challenges. National leadership will provide perspectives on management, planning and policy of Hospital-In-Home.
THE BOSTON HOSPITAL-IN-HOME PROGRAM—A LOCAL PERSPECTIVE
Authors: Jindal Shivani , Pietruszka Brittany , Meears Rachel , Parris James 
Published: December 2023

Abstract
The Hospital-in-Home (HIH) model provides patient centered care, may reduce complications and costs. VA Boston Healthcare System (VABHS) planned its HIH program in 2018 and enrolled its first patient in May 2019. HIH provided care to 45 patients in 2019 which grew to 185 in 2022. The team is comprised of 2 clinicians (a hospitalist physician and a physician assistant), a nurse manager, 5 registered nurses (RN), a social worker and a pharmacist. The program practices complementary HIH (admissions from inpatient care) and substitutive care (all other admissions). At this time, majority of the recruitment comes from the inpatient services, followed by heart failure and primary care clinics. The program catchment area is about 25 miles from the West Roxbury campus of VABHS. A hybrid visit approach is taken for clinician visits - initially, the veteran is seen in person or by video by the clinician on admission to the program. Subsequent visits are done with RN assessments in the home and the clinician conducting the visit by telephone or video. In FY 2021, conditions of patients treated by HIH include congestive heart failure (50%), chronic obstructive pulmonary disease (14%), wound care (6%), diabetes (2%) and other conditions (20%). In FY 2022, the average daily census was 15.9 veterans and average visits per day 4.8. The HIH program outcomes include reduction of bed days of acute care in the hospital and reduction in the use of unnecessary medications through deprescribing which may translate to cost avoidance for the medical center.
THE DEPARTMENT OF VETERANS AFFAIRS HOSPITAL-IN-HOME PROGRAM: A BIRD’S EYE VIEW
Authors: Hung William , Intrator Orna , Sullivan Jennifer , Makineni Rajesh , Li Jiejin , Cai Shubing 
Published: December 2023

Abstract
The Department of Veterans Affairs (VA) Hospital-In-Home (HIH) program offers Veterans the option to receive intensive, institutional-level acute services in their homes. This study presents characteristics of Veterans across 11 HIH programs operating between fiscal years 2021 and 2022. VHA administrative data and Medicare claims were linked to identify HIH stays from HIH visits, extending a stay over time as long as visits were no more than 7 days apart, allowing for intervening ED visits. Two types of HIH stays were identified: complementary HIH (admissions from an acute inpatient stay) and substitutive HIH (admissions from all other locations). HIH patients’ sociodemographic characteristics, health conditions, and risk factors are described as well as length of HIH stay (LOS) and discharge destination. We identified 2536 veterans (1,110 complementary and 1,426 substitutive) who had 3,599 HIH stays with 73.9% of Veterans having one stay. Compared to Veterans with complementary HIH, Veterans with substitutive stays were generally younger (67 vs. 72), more likely to be Black (20% vs. 12%), and less sick (probability of 1-year mortality 14% vs 24%). Heart failure, Chronic Obstructive Pulmonary Disease, and COVID were the most frequent admission conditions for both HIH types. Average HIH LOS was 17.3 and 25.8 days for substitutive and complementary models, respectively. About 4% of substitutive and 18% of complementary stays ended in inpatient admission. In the unique VA single-payer, integrated-care system implementations may vary and comparisons of patient characteristics and outcomes can provide the basis for future implementations.
VARIATIONS ACROSS 11 DEPARTMENT OF VETERANS AFFAIRS HOSPITAL-IN-HOME PROGRAMS IN 2021–2022
Authors: Intrator Orna , Cai Shubing , Li Jiejin , Makineni Rajesh , Hung William 
Published: December 2023

Abstract
The Department of Veterans Affairs’ (VA) Hospital-In-Home (HIH) program provides Veterans with the option to receive acute level services in the comforts of their own homes. A total of 11 HIH programs operated between fiscal years 2021 and 2022. We examined the volume of the programs and average risk of one-year mortality (using the Care Assessment of Needs measure) among each program’s participants and characteristics of HIH stays (length-of-stay [LOS] and discharge destination) across program sites and program types (complementary- admissions from hospital and substitutive- other admissions) using VA administrative data linked with Medicare claims. The number of patients served in a year varied between 36 and 680 with 6 programs having &lt;200 patients. Substitutive HIH was the dominant HIH type in 8 programs (&gt;50% of patients) while only one program had clearly more complementary HIH (87%) and only 9 programs had complementary HIH. Average length-of-stay (los) in HIH was 20.5 days (SD=24.4 days, median=13 days), with averages across programs ranging between 3 - 36 days, 6 programs with average los&lt;13 days and 5 programs with average los &gt;19 days. Predicted risk of death within one-year varied: among substitutive HIH, 7 programs’ average risk was &gt; 20% and 4 programs’ average risk was &lt;15%. Among complementary HIH only one program’s risk was &lt;15% and the rest was &gt;20%. Substitutive HIH programs discharged 2-10% of Veterans to hospital, while complementary programs discharged 11-23% to hospital. Interviews with program staff will help elucidate reasons for differences and inform expected outcomes.
FEATURES OF THE SOCIAL AND PHYSICAL ENVIRONMENT AND ACCELEROMETRY-BASED PHYSICAL ACTIVITY AMONG OLDER ADULTS
Authors: Twardzik Erica , Freedman Vicki , Martinez-Amezcua Pablo , Schrack Jennifer 
Published: December 2023

Abstract
Social and physical environments shape physical activity (PA) opportunities among older adults. Whether environmental factors are associated with patterning of PA among older adults is less understood. We examined associations of the social and physical environment with accelerometry-based daily PA metrics among older adults. Cross-sectional data from 2021 National Health and Aging Trends Study respondents with non-missing data were included. Using linear regression models with analytic survey weights and adjusted for potential confounders we investigated the associations between four environmental features: social cohesion, neighborhood disorder, broken step into the home, and continuous sidewalks with PA patterns. Three accelerometry-based PA metrics were examined: total activity counts, PA fragmentation, and number of PA bouts. 633 older adults (45% female) were included in our analytic sample. Respondents with a broken step into their home, compared with those without, had lower total activity counts (♌=-170024.3, SE=81530.6, p&lt;.05). Compared to those living in a neighborhood with no disorder, those living in a neighborhood with any disorder had more PA bouts per day (♌=10.5, SE=3.9, p&lt;.01). All other contextual factors examined were not associated with activity counts, fragmentation, or bouts of PA. Greater physical barriers to access the neighborhood may explain why broken steps were associated with less total PA (volume and intensity). Neighborhood disorder was associated with number of PA bouts per day, which may be due to greater reliance on walking for transportation in disordered neighborhoods. Future work should investigate how the neighborhood environment is structured (e.g., walkability) to elucidate these findings.
INCREASED TEMPORAL GAIT VARIABILITY OVER TIME IS RELATED TO FUTURE DEMENTIA
Authors: Tian Qu , Resnick Susan , Simonsick Eleanor , Ferrucci Luigi 
Published: December 2023

Abstract
Age-related brain changes affect the timing and coordination of gait. High gait variability may stem from impaired brain motor control and has been associated with compromised cognition and cognitive impairment. Whether increased gait variability over time is associated with future MCI or dementia is unknown. In the Baltimore Longitudinal Study of Aging, we used age-, sex-, and race-adjusted linear mixed-effects models to examine whether changes in gait variability were associated with future MCI or dementia in participants aged 65+. Gait characteristics were quantified by 3D motion analysis. Independent of baseline gait speed and compared to cognitively normal participants (n=387), those who developed dementia (n=24) had greater rates of increase in gait cycle time variability, stance time variability, and swing time variability (but not mean performance) before the symptom onset (all p&lt;0.05). Further adjustment for concurrent assessment of visuospatial ability or manual dexterity attenuated these associations. Adjustments for verbal memory, psychomotor speed, attention, or executive function did not attenuate these associations. Rates of changes in these gait variability measures were not statistically different between cognitively normal participants (n=387) and those who developed MCI (n=41). Baseline gait variability measures were not different across groups. These findings suggest that longitudinal trajectories of gait variability, not one-time assessment, provide the additional predictive value of future dementia over and beyond gait speed. Mechanisms may include compromised visuospatial ability or manual dexterity. Future neuroimaging studies are warranted to understand neural substrates connecting increased gait variability and dementia risk.
A NOVEL POSTDISCHARGE TELEHEALTH INTERVENTION FOR STROKE CAREGIVERS: IMPLICATIONS FOR IMPLEMENTATION
Authors: LeLaurin Jennifer , Eliazar-Macke Nathaniel , Freytes I Magaly , Uphold Constance 
Published: December 2023

Abstract
This study investigated the potential for implementation of the RESCUE stroke caregiver telehealth intervention by assessing acceptability, feasibility, and cost. Family caregivers (n=174) of Veteran stroke survivors from eight medical centers were randomized to usual care or intervention. The RN-led intervention involved discharge plan review, problem-solving training, education, and support delivered via one telephone session and eight asynchronous online messaging center sessions. Acceptability was assessed using an adapted Acceptability and Enactment Survey (n=42) and qualitative interviews with a subsample of caregivers (n=16). We used retention data to assess feasibility and calculated cost per participant. Findings indicate the intervention was acceptable to caregivers. Most intervention completers found the intervention very/extremely helpful (90.5%), very/extremely easy to use (78.4%), and resolved most/all caregiving problems (64.3%). Qualitative interviews showed caregivers valued the asynchronous delivery method, personalized nature of the intervention, and ability of the RN to answer medical questions and provide education. More intervention caregivers dropped out compared to usual care (50.0% vs.19.3%, p&lt; 0.001). Intervention dropout was predicted by lower education (p=0.03) and less positive views of caregiving (p=0.01). Cost was $309.98 per intervention completer. Findings support intervention acceptability and highlight the value of RN-led interventions. The relatively low cost and fully remote nature of the intervention support its suitability for widespread implementation. Multiple delivery options and flexible intervention schedules may enhance engagement. The RESCUE intervention provides a model of a low-cost post-discharge telehealth intervention for stroke caregivers that can be adapted for other conditions. Future work should test methods to augment retention.