bluuebunny/crossref_metadata_2025_split huggingface dataset:
EVALUATION OF AMINO ACIDS LEVELS OF HOSPITALIZED PATIENTS WITH DELIRIUM
Authors: Azhar Gohar , Sharma Shakshi , Gibson Regina , Pangle Amanda , Wolfe Robert , Wei Jeanne 
Published: December 2023

Abstract
Delirium is an acute and often fluctuating change in cognitive status characterized by disorientation, disorganized thought processes and changes in perceptual and psychomotor function. The common precipitating etiologies of delirium include any acute illnesses, infections, hospitalizations, fluid or electrolyte imbalance, or medications. Neurotransmitters are synthesized from amino acids. We hypothesized that regardless of the clinical reason for delirium, a sudden imbalance of plasma amino acids might alter the level of neurotransmitters and contribute to delirium. We measured amino acids in hospitalized patients 60 or older, both genders, with delirium secondary to any infection (n=13) for a period of 3 days and compared them with healthy control, non-delirious group (n=13). Delirium was evaluated twice daily using the Confusion Assessment Method (CAM) test. Plasma amino acids were analyzed using LC-MS. Our results showed that level of isoleucine was significantly higher in delirious patients on day 1 (64.26 %) as compared to healthy control (43.25%, p &lt; 0.01). The level of tryptophan was slightly lower on day 1 as compared to control (31.13 % vs 36.80%, p=NS). However, the tryptophan/isoleucine ratio on day 1 was significantly lower in delirious compared to healthy controls (49.96% vs 85.54 %, p &lt; 0.01). The tryptophan/isoleucine rose on day 2 of delirium but was still significantly lower compared to the healthy control (59.0% vs 85.54%, p &lt; 0.01). Our results suggest that significant alterations in the levels and ratios of amino acids, in particular, tryptophan and isoleucine might disrupt the synthesis of neurotransmitters and hence contribute to delirium.
RACE AND SEX DIFFERENCES IN RELATIONS OF DIABETES BIOMARKERS WITH PHYSICAL FUNCTIONING BEFORE DIABETES ONSET
Authors: Khambaty Tasneem , Splain Ashley , Katzel Leslie I , Evans Michele K , Zonderman Alan B , Waldestein Shari R 
Published: December 2023

Abstract
It remains unclear if declines in physical functioning linked to Type 2 diabetes (T2DM) occur even before T2DM onset. We examined the longitudinal associations of T2DM biomarkers with upper and lower extremity strength among adults without T2DM at baseline. Participants were 1,572 African American (AA) and White adults (M(SD) age at baseline = 47.3 (9.7) years, 55% female, 53% AA) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, assessed on up to 3 time points between 2004-2017. Participants provided blood samples for measurement of fasting glucose and glycosylated hemoglobin (HbA1c), and completed dominant and nondominant handgrip strength assessment, and a chair stands task to assess upper and lower extremity strength, respectively. Linear mixed effects regression models estimating relations of HbA1c on age-related change and adjusting for race, sex, literacy, and poverty status revealed significant four-way interactions of HbA1c, race, sex, and age (B = -.2.59, t(2853) = -2.0 p = 0.04), and to a lesser extent of fasting glucose, race, sex, and age (B = -.07, t(2863) = -1.84 p = 0.06) on change in the chair stands task, but not on handgrip strength (ps &gt; 0.29). Among younger AA and White men, and younger White women, increasing HbA1c was related to worse lower extremity strength. However, among AA women, and older White women, increasing HBA1c was related to better lower extremity strength. Our findings suggest differential relations of worse glucose regulation on physical functioning amongst African American and White men and women.
OLDER ADULTS’ USE OF HOME AND COMMUNITY-BASED SERVICES: INDIVIDUAL ATTRIBUTES AND LOCATION DISPARITIES
Authors: Roberto Karen , Savla Tina 
Published: December 2023

Abstract
Home and Community-Based Services (HCBS) are designed to support older adults with functional and cognitive limitations. Yet, use of services is low, gaps exist in service provision, and available services do not always meet the person’s need. This symposium focuses on idiosyncrasies surrounding HCBS use. Nah and colleagues identify individual (income, ADL limitations, informal support) and county-level (poverty and public spending on services) factors associated with HCBS use among persons living with dementia in rural Appalachia. Shippee and colleagues’ examination of services received/desired indicates that older adults who are Black/other race/ethnicity were more likely to receive ADS; individuals living with AD/ADRD consumed personal care services at the highest proportion. Cheng’s and Li’s assessment of generosity in supporting HCBS reveals that while overall state support for HCBS has increased, Medicaid and OAA programs expenditures for services varies substantially across states. Fortinsky and colleagues’ examination of risk factors for emergency department use among older adult Medicaid HCBS users shows use was associated with high school education, more severe depressive symptoms, and more chronic conditions; non-Hispanic Asian individuals had the lowest likelihood of use. Konetzka and Wang provide national evidence that use of Medicaid HCBS influences Medicare post-acute care utilization among the dually enrolled. Collectively, the symposium highlights the importance of taking into consideration individual variations in care needs, local and state support for HCBS, and disparities in healthcare and service use influencing older adults’ use of HCBS, and advances understanding of intersecting micro- and macro-level effects on service availability, use, and outcomes.
UNMET NEED AMONG A NATIONAL SAMPLE OF OLDER ADULT HCBS USERS
Authors: Shippee Tetyana , Bucy Taylor , Mulcahy John , Jutkowitz Eric 
Published: December 2023

Abstract
Long-term services and supports delivered in the home or community (home and community-based services) continue to be favored by consumers and policymakers alike. Given that HCBS is largely state-directed, there is considerable heterogeneity in program design and eligibility, and no standardized tool by which quality is measured. In the absence of the widespread use of standardized and uniform measures of HCBS quality, unmet need is poorly understood. We examined the relationship between services received and desired as a means of predicting unmet need among a national sample of older adult (65+) consumers of publicly funded HCBS (e.g., Medicaid, PACE, OAA) using data from the National Core Indicators - Aging and Disability survey. Our sample included 13,459 older community-dwelling adults, of which 60.0% were White, 23.2% were Black, and 17.0% of another race/ethnicity. Roughly 15% of older adults reported having AD/ADRD (54% White, 20% Black). Older adults with AD/ADRD were more likely to use personal care services (59.6%), followed by delivered meals (21.3%), and homemaker services (18.6%) compared to those without AD/ADRD. Adults with AD/ADRD desired more caregiver support services and transportation services vs what they were already receiving. Of 10% already receiving caregiver support services, approx. 9% desired additional support. Of 9.6% receiving transportation services, 7.3% desired additional support. We found variation in HCBS received and desired among older adults by both AD/ADRD status and race/ethnicity, suggesting gaps in unmet needs for these groups.
ESPO AND HEALTH SCIENCES SECTION SYMPOSIUM: BUILDING BRIDGES: LEVERAGING SOCIAL CONNECTIONS AND ENVIRONMENTS TO IMPROVE HEALTH IN LATER LIFE
Authors: Moored Kyle , Britt Katherine , Cudjoe Thomas 
Published: December 2023

Abstract
The COVID-19 pandemic has renewed focus on social connections as fundamental contributors to health across the lifespan. Social connections have been studied in numerous ways (e.g., social network size, daily social interactions, engagement in social activities) and may facilitate health via multiple, dynamic biopsychosocial mechanisms. In line with this year’s theme, we review novel insights from early-career scholars into how “building bridges” with others throughout life may promote mental and cognitive health in later life. Further, we emphasize how bridging disciplines (e.g., social and neurocognitive sciences) is vital to understanding how social environments may “get under the skin” to impact health. Presentations will span multiple social-ecological levels (community, institutional, interpersonal). Beginning at the community/institutional level, Dr. Moored will discuss how the quantity of neighborhood social destinations contributes to GPS measures of community mobility in older adults. Dr. Britt will then describe how religious participation, a specific social institutional activity, is associated with an inflammatory biomarker predictive of cognitive impairments. The remaining talks will then report on daily social experiences. Dr. Ng will highlight links between daily support exchanges and life satisfaction in older adults and how these relationships differ by marital status. Extending to the caregiving context, Dr. Puga will present on how role captivity and daily changes in social isolation contribute to mood symptoms in family caregivers of individuals living with dementia. Our Discussant, Dr. Cudjoe, will provide a critical review in the context of new directions for research on social connections and environments.
RESEARCH TO STRENGTHEN, INNOVATE, AND TRANSFORM AGE-FRIENDLY COMMUNITY PRACTICE
Authors: Black Kathy 
Published: December 2023

Abstract
There is much research being conducted to better understand and advance age-friendly community practice. This symposium presents research from leading age-friendly researchers and practitioners across the United States. Drs. Black and Oh provide an analysis of the nation’s sectoral efforts based on progress reported by the age-friendly communities. Drs. Hernandez and Coyle will describe the research and community engagement that led to the development of an aging equity conceptual framework and examples of how it is being operationalized in the City of Boston. Drs. Greenfield and doctoral student Pope will present on a scoping review of studies in the U.S. and Canada on the range of ways in which the public sector participates in age-friendly community efforts. Drs. Coyle and Oh and doctoral students Gleason and Somerville present on a study that explored factors inhibiting communities from officially joining the age-friendly network. Dr. Perry reports on efforts to elevate the voice of older adults on social justice issues pertaining to aging in place in the domain of housing. Individual abstracts provide further detail on each study’s methods and findings.
CAREGIVER WELL-BEING OUTCOMES IN A STROKE TRANSITIONS TRIAL: THE EFFECTS OF CAREGIVER BURDEN AND PREPARATION
Authors: Woodward Amanda 
Published: December 2023

Abstract
The Michigan Stroke Transitions Trial (MISTT) was an open, pragmatic randomized trial which tested the effectiveness of a 60-day in-home social work case management for patients and caregivers transitioning home after hospitalization for a stroke. This secondary analysis explores the effect of caregiver burden and preparation on caregiver outcomes. The analytic sample is the 169 caregivers who participated in MISTT. Dependent variables are the Bakas Caregiver Outcomes Scale (BCOS) and the Patient Health Questionnaire-9 (PHQ9) at 90 days after discharge home. Key predictors include the Preparedness for Caregiving Scale and the Oberst Caregiving Burden Scale which measures caregivers’ perception of burden in relation to the both the time and difficulty of caregiving tasks. Analyses that controlled for outcomes at 7 days post discharge as well as caregiver age, marital status, and education were conducted using Stata v.16. Results indicate that caregivers who perceived caregiving tasks as more difficult had worse outcomes as measured by the BCOS. In addition, there was a significant interaction between task difficulty and age such that the effect of task difficulty on BCOS declined with age. In addition, depression was associated with greater task difficulty and less preparation. This study contributes to a growing body of work related to the complexity of transitions of care and has implications for how we support caregivers as their care recipient moves from inpatient to outpatient care.
POLICY SERIES: INTERDISCIPLINARY PUBLIC POLICY DISCUSSION SESSION
Authors: Taffet George , Lindberg Brian 
Published: December 2023

Abstract
This interactive session is an interdisciplinary look at the impact of social isolation and loneliness policy issues as we age. This session, organized by the GSA Public Policy Committee, will provide both GSA section leadership and attendees an opportunity to have an open dialogue on important public policy issues of significance in the field of aging. The panelists represent the six sections of GSA: ESPO, BS, BSS, SRPP, HS, and AGHE.
STRENGTHENING CAREGIVING NETWORKS: PROMISING PRACTICES TO SUPPORT PAID AND FAMILY CARE TEAMS IN THE HOME
Authors: Franzosa Emily , Ornstein Katherine 
Published: December 2023

Abstract
Older adults and people with disabilities often rely on both family and paid caregivers to live independently in the community. But while paid and family caregivers work closely together in the home, these groups are often siloed in research and policy. Research describing the structure and work of caregiving teams is limited, as are efforts to better support them in providing person-centered care. In this symposium, we present innovative interdisciplinary research that highlights the vital relationship between paid and family caregivers and how this influences the care they provide. We begin with two studies focusing on the structure and function of older adults’ formal and informal care networks. First, Franzosa et al present results from a care mapping project which found care networks were often far more expansive than what is captured in medical records. Reckrey et al describe the need to provide family-centered home care that reflects the nuanced and individualized care that these teams provide, based on a study of interviews with families and paid aides. Next, we describe results of two promising interventions to support family and paid care in the home. Weidenbacher et al describe a community health worker-led navigation program connecting family caregivers of seriously ill veterans to supportive resources, and Scales and King describe a training for home care workers and family members to facilitate collaborative problem solving and person-centered care. Taken together, these studies broaden our understanding of care teams in the home and highlight promising opportunities to support team-based home care. This is a collaborative symposium between the Family Caregiving and Paid Caregiving Interest Groups.
VISUALIZING VETERANS’ CARE: UNDERSTANDING THE BREADTH OF OLDER VETERANS’ PAID AND FAMILY SUPPORT NETWORKS
Authors: Franzosa Emily , Ali Imran 
Published: December 2023

Abstract
Many older veterans rely on a complex network of paid and unpaid caregivers to age safely at home. Medical records often only capture a primary family caregiver, giving medical teams a limited picture of veterans’ supports at home as well as plans for contingency care. We tested a novel visual tool, care mapping, to better understand the scope of veterans’ formal and informal support. We created collaborative care maps with 10 dyads/triads of veterans age 65+ eligible for VA-paid home care and their primary paid and family caregivers. We compared the maps to veterans’ electronic medical records (EMRs) to explore care network structure, function and adequacy. Care maps identified substantially more care partners than EMRs, including functional, medical, socioemotional and spiritual supports such as family, paid aides, neighbors, Veterans’ groups, faith communities, local businesses (pharmacies, food delivery), and social media. Veterans, family and paid caregivers described working together closely, with aides serving as a “third arm” to fill care gaps. Care was often mutual, as veterans described financial and emotional support they provided to family members, aides and their families, and friends. Participants also described these networks as dynamic and fluid, changing based on care needs and care partners’ availability and skills. Identifying the range of support Veterans receive from family, paid aides, and their community may better help medical teams understand often overlooked community supports and relationships, identify care gaps and tailor home and community-based services where they are most effective and needed.
FEASIBILITY OF A COMMUNITY-BASED NAVIGATOR SUPPORT PROGRAM FOR CARE PARTNERS OF SERIOUSLY ILL VETERANS
Authors: Boucher Nathan , Weidenbacher Hollis , Eldridge Madeleine , Johnson Kimberly , Van Houtven Courtney , Steinhauser Karen , Allen Kelli 
Published: December 2023

Abstract
We examined the feasibility and satisfaction of a short-term Veterans Health Administration (VHA)-based care partner support intervention delivered by trained navigators during COVID-19 through a single-arm interventional cohort feasibility study of a telephone-based care partner navigation intervention. Navigators (n=9) received the standard state curriculum online from a local community health worker training program plus an additional eight weeks of online role-specific training by the study team. Subsequently, navigators contacted care partners (n=30) of seriously ill veterans weekly via telephone over a 12-week period to assess social and practical needs, and connect care partners to appropriate community-based or VHA resources. All navigators (9 female; 1 male) and 17% of care partners were African-American (83% were Caucasian or other). Care partners were 90% female and 10% male; age range 41 to 80. In this telephone-based support program delivered to care partners by standard-trained navigators across 12 counties, care partners were overall very satisfied (x̄=4.69 out of 5, sd =.77) with their navigator’s responsiveness and social support throughout the 12-week course of the study. Navigators’ confidence increased over time (x̄=8.2 out of 10 (sd=1.14) to x̄=8.78 (sd=.97)), while their self-assessed effectiveness ratings lowered over time as they encountered real-life scenarios (x̄=8.5 (sd=1.43) to x̄=7.89 (sd=.93)). Navigators documented successful connections to services in the VHA and in care partners’ communities. Using remote navigators with minimal but standard training is a feasible and acceptable model of care partner support.
PRELIMINARY FINDINGS OF THE SHARING CHOICES INTERVENTION ON PRIMARY OUTCOME MEASURES
Authors: Wolff Jennifer , Zhang Talan , Giovannetti Erin , Rebala Sri , Roth David 
Published: December 2023

Abstract
A cluster randomization approach was applied to 55 primary care practices across two health systems. A 1:2 randomization design resulted in 19 practices being randomized to the SHARING Choices intervention condition and 36 practices randomized to a usual care control condition. The primary outcome variables include documentation of an advance directive (AD) or medical orders for life-sustaining treatment in the electronic health record (EHR) within 12 months of exposure to the intervention for all patients and receipt of potentially burdensome care within 6 months of death for patients who die with a serious illness diagnosis. At the time of this abstract submission, preliminary data on AD documentation in the EHR have been analyzed for one of the two health systems. In that health system, among 8,350 patients in intervention practices, AD documentation in the EHR increased from 19.2% to 25.1% one year later, compared to increases from 15.7% to 17.9% among 19,179 patients in control practices. This markedly greater increase for patients in intervention practices was highly significant statistically in a multilevel logistic regression model that took patient clustering within practices into account (adjusted odds ratio = 2.25; 95% confidence interval = 2.01, 2.51; p &lt; 0.001). The SHARING Choices intervention, therefore, more than doubled the odds of having an AD added to the EHR within one year. Preliminary findings on this outcome from the other health system and other outcomes from both health systems will be analyzed in the months ahead and presented at the GSA meeting in November.
UNDERSTANDING RESOURCE PROFILES OF OLDER LEARNERS TO PROMOTE RECURRING ENGAGEMENT IN LEARNING
Authors: Sung Pildoo , Maulod Ad , Chan Angelique , Malhotra Rahul 
Published: December 2023

Abstract
Understanding characteristics of recurring learners among older adults is important for designing targeted strategies to promote lifelong learning. Studies have shown that older adults with human, social, and psychological resources are more likely to engage in learning. However, less is known about the interplay of these resources in motivating older learners to remain engaged in learning. Using longitudinal data from 515 older learners, aged 50 years and above, collected in Singapore in 2017-2018, we examined distinct resource profiles among older learners and their impact on recurring engagement in learning. Latent profile analysis explored (1) clusters of individuals with distinct resource profiles at baseline, comprising varying levels of human (education), social (civic attitudes, civic behaviors, and loneliness), and psychological resources (motivation to learn and control/autonomy/self-realization/pleasure), and (2) whether the resource profiles were associated with recurring engagement in learning (defined as attending another course within six months from baseline). Empirical analyses identified four resource profiles: (1) educated, resourceful (42.2% of older learners), (2) less educated, less resourceful (24.5%), (3) less educated, resourceful (20.0%), and (4) educated, less resourceful (17.0%). ‘Educated, less resourceful’ learners had a lower likelihood of recurring engagement in learning than ‘educated, resourceful’ learners. In summary, older adult learners are likely to possess varying levels of human, social, and psychological resources, which predict their recurring engagement in learning. Interventions helping older learners enrich their civic and psychological resources may facilitate their continued engagement in learning.