bluuebunny/crossref_metadata_2025_split huggingface dataset:
ETHICAL CONSIDERATIONS UNDERLYING ACP FOR ACCOMPANIED OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: Saylor Martha Abshire , Boyd Cynthia , Dy Sydney , Hanna Valecia 
Published: December 2023

Abstract
While clinicians understand the importance of ACP, it is difficult to overcome logistical and ethical challenges in the limited time providers have in primary clinic appointments with older adults with ADRD and other complex co-morbidities. Ethical/moral dilemmas faced by patients, families, and clinicians are reflected in the four principles of biomedical ethics including autonomy, beneficence, nonmaleficence, and justice. While ethical challenges are recognized there is a lack of real-world evidence to guide clinicians or family caregivers in ACP for older adults with ADRD based on the reality of complex patient and family dynamics. Throughout the SHARE trial, facilitated ACP conversations with trained ACP facilitators, older adult patients with cognitive impairment, and their family caregiver were audio recorded and transcribed. The purpose of this presentation is to expand our understanding of best practices for facilitating ACP conversations among persons with ADRD and their family caregivers, guided by medical ethics and the Learning Health Care System Ethics Framework. We draw on the unique dataset of recorded ACP conversations involving older adults with severe cognitive impairment (N=92, average age=88 years), family caregivers, and trained ACP facilitators. We qualitatively coded transcripts for ethical considerations of ACP conversations and conducted the thematic analysis. We will present major themes related to ethical considerations in facilitating ACP conversations among persons with moderate to severe ADRD and their family caregivers. We will provide a discussion framed in balancing patient, family, and provider needs within a Learning Health Care System.
WHO’S UP NEXT? EXTENDED FAMILY CAREGIVERS OF PERSONS LIVING WITH DEMENTIA: CURRENT AND FUTURE CARE
Authors: Savla Tina , Roberto Karen 
Published: December 2023

Abstract
Various societal trends and expanded family boundaries have led to a broad array of family members involved in caring for persons living with dementia (PLwD). We examined how extended family caregivers (FCG) manage their care responsibilities and how the care arrangement impacts the provision of future care for PLwD. Mixed-method data from 48 extended FCG and 56 nuclear FCG (71% White, 68% female, 63% co-reside with PLwD) revealed that 70% of extended FCG rely on informal helpers to care for PLwD. Spouses and daughters were more often sole caregivers while most sons relied on informal helpers. If no longer able to help, sisters, granddaughters, and nieces more likely foresaw moving PLwD to a care facility, whereas brothers, grandsons, and nephews anticipated another informal helper would assume their care. Extended FCG often expressed dissatisfaction with one or more informal helpers for failing to meet care responsibilities, potentially leading to unmet needs and increased risk for early nursing home placement for the PLwD. The discussion will focus on the attributes of informal helpers of extended FCG that contribute to stable or inconsistent care arrangements for PLwD, which can ultimately affect the well-being of PLwD and FCG.
PHYSICAL ACTIVITY AND DEMENTIA PREVENTION: THE ROLE OF HEALTH COGNITIONS AMONG 50+ HEALTHY INDIVIDUALS IN ISRAEL
Authors: Edelstein Offer 
Published: December 2023

Abstract

Background
Although dementia cannot be cured, it can be prevented by adopting various health behaviors, including regular physical activity. The current study sought to i) estimate the participation of Israel-born healthy individuals aged 50 years or older in regular physical activity; ii) assess the associations linking Health Belief Model variables (Rosenstock, 1966, 1974) and engagement in regular physical activity.

Method
This cross-sectional study was conducted in 2021-2022, using online convenience sampling. The study included 328 Israel-born participants aged 50 years or older. Physical activity was assessed by asking whether participants regularly engaged in physical activity (type of activities/times per week/minutes). Cognitive perceptions were assessed using the Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction questionnaire (Kim et al., 2014).

Results
The average weekly minutes of physical activity was 165.62 (S.D. 176.17), whereas only 43.6% performed 150 minutes of physical activity weekly. A multivariate linear regression indicated that among all of the model’s variables, perceived severity (β=-.204, p&lt;.001), cues to action (β=.134, p&lt;.001), feminine gender (β=-.155, p&lt;.01), and low income (β=-.113,p&lt;.05) emerged as significant predictors of weekly minutes of physical activity. The model explained 14.2% of the variance in the performance of weekly minutes of physical activity [F(7,320)=12.22, p&lt;.001].

Conclusions
The current research underlines the role of health cognitions (perceived severity, barriers, and cues for action) regarding engagement in physical activity. The results of the current study might serve as a basis for intervention programs among various target populations.
ADULT DAY SERVICES DATA COLLECTION AND OUTCOMES: A NATIONAL STRATEGY REALIZED
Authors: Zagorski William 
Published: December 2023

Abstract
The National Adult Day Services Association (NADSA), in its commitment to advance the development and recognition of adult day services across the United States, has defined a comprehensive set of data points and uniform outcome measures to be utilized throughout the Adult Day Services (ADS) industry. NADSA represents more than 500 unique Adult Day Service Centers (ADSCs) across the country. This project has culminated in the opening of a single national secure data entry portal and repository for the collection of this data free to use for adult day service providers across the country. Prior to its full release in January 2023, the beta testing phase allowed for the utilization of this platform across nearly a dozen states, more than 20 ADSCs and more than 500 ADS participants in a variety of settings. As of January 2023, the system is now available to more than 500 ADSCs serving more than 12,000 participants. This session will describe the data points and outcome measures as well as the uniform tools to be utilized for collection and introduce the data portal to the greater academic community. This longitudinal data will be available to NADSA academic partners to provide greater avenues of research into the benefits of adult day services use to participants, caregivers, payors, and the community.
EMOTION REGULATION SUCCESS IN A LABORATORY TASK IN YOUNG ADULTS AND COGNITIVELY DIVERSE OLDER ADULTS
Authors: Growney Claire , English Tammy 
Published: December 2023

Abstract
Age is associated with declines in cognitive resources viewed as important for emotion regulation, and older adults with mild cognitive impairment (MCI) are expected to experience difficulty with emotion regulation. The present study examines how providing support through emotion regulation instructions might contribute to improved emotional well-being using different indices of emotion regulation success. Young adults (age 21–34, n = 66) and older adults with MCI (age 70–84, n = 60) and cognitively normal older adults (age 70–84, n = 90) completed a laboratory task in which they viewed high-arousal negative emotional film clips under instructions to regulate prohdonically (a) using any emotion regulation strategy, and (b) using an instructed strategy based on condition: distraction or reappraisal. We examined three indices of emotion regulation success: self-perceived emotion regulation success, self-reported experience of the target emotion, and behaviorally-coded expression of the target emotion. Overall, there were no group differences in experience or expression, but older adults with MCI perceived that they regulated with less success compared with younger adults and cognitively normal older adults. Younger adults reported experiencing less of the target negative emotion on instructed versus self-selected strategy trials, whereas older adults with MCI expressed less of the target negative emotion on instructed versus self-selected strategy trials. Findings suggest that younger adults and older adults with MCI might benefit more from support with regulating emotions compared with cognitively normal adults, who are theorized to have expertise in this domain.
DID CHILDHOOD ABUSE PREDICT CARE EXPECTATION FOR FORMAL CARE: THE ROLES OF FAMILY FUNCTIONING AND CARE PREPARATION
Authors: Bai Xue , Liu Chang , Zhou Jiajia , Hu Bo 
Published: December 2023

Abstract
Objectives: The influence of childhood abuse could be lasting and extensive. This study aims to examine the associations between childhood abusive experiences (i.e., physical abuse, emotional abuse, and bully victimization) and ageing adults’ care expectation for formal care in later life, as well as the potential mechanism of the associations. Methods: This study used data from the Panel Study of Ageing and Society (PAAS) in Hong Kong, with 5,007 participants aged 50 and over included in the study. Path analyses were performed to examine the direct effects of abusive experiences in childhood on future care expectation and formal care, and the indirect effects through serial mediators of family functioning and care preparation. Results: Ageing adults experiencing more childhood abuse were less likely to report care expectations in the future ( = -0.051, p &lt; 0.01), and the direct effects ( = -0.042, p &lt; 0.05) and indirect effects ( = -0.009, p &lt; 0.05) from the serial mediation were significant. Among those people who reported clear care expectations, they were more likely to choose formal care if they had more abusive experiences in childhood (= 0.049, p &lt; 0.05), from which the association was largely explained by decreased family functioning and more care preparation ( = 0.042, p &lt; 0.001). Discussion: This study is the first to connect childhood abuse and late-life care expectation. From a life course perspective, it encourages more considerations regarding care preparation and formal care among people with a history of childhood abuse.
FINANCIAL EXPLOITATION AND MENTAL HEALTH OF HOLOCAUST SURVIVORS: THE MODERATING ROLE OF POSTTRAUMATIC SYMPTOMS
Authors: Weissberger Gali , Bensimon Moshe , Shrira Amit 
Published: December 2023

Abstract
Financial exploitation (FE) is associated with devastating emotional, health, and economic consequences. We examined whether anxiety and depressive symptoms associated with self-reported history of financial exploitation (FE) are more pronounced amongst Holocaust survivors, especially those with high-level posttraumatic stress disorder (PTSD) symptoms. A community-based cohort of 137 Israeli older adults born prior to 1945 were included in the study sample. Holocaust survivors (n = 61) were participants who reported living in a European country occupied or dominated by Nazi or pro-Nazi regimes between 1939-1945. Groups were further subdivided into survivors with low or high levels of PTSD symptoms (≥31 on the PTSD Checklist; PCL-5). Questionnaires assessed FE history, posttraumatic symptoms (PCL-5), depressive symptoms (PHQ-9), and anxiety (GAD-7). Age, education, self-rated health, and non-Holocaust lifetime adversity were also measured and included as covariates. Hierarchical linear regression models revealed that relationships between FE and depressive and anxiety symptoms were significant only among survivors (p = 0.005 and p = 0.008, respectively). The interaction between PTSD symptom level group and FE was also significant for both depressive (p = 0.007) and anxiety (p = 0.012) symptoms, such that survivors with PTSD who reported FE had significantly greater symptoms of depression and anxiety compared to all other groups. Findings suggest that the experience of FE may be particularly impactful amongst survivors who continue to struggle with posttraumatic symptoms related to the Holocaust. Future studies may consider examining whether findings are relevant to other groups with PTSD.
USING RE-AIM TO GUIDE INTERVENTION DEVELOPMENT AND PILOT TESTING: CASE STUDY OF THE TLC INTERVENTION
Authors: Utz Rebecca , Thompson Amber , Sparks Cathi , Wong Bob , Iacob Eli , Terril Alexandra , Caserta Mike 
Published: December 2023

Abstract
Research-based interventions are often not fully translated or implemented into health or community settings, even after assessing and establishing feasibility and efficacy during pilot tests and randomized trials. The Time for Living and Caring (TLC) study, an intervention designed to improve respite care for dementia caregivers funded by NIA R01-AG061946, employed the principles of the RE-AIM framework to guide stage-1 research activities related to intervention (re)development and pilot testing, with the hope that implementation could be achieved more quickly and efficiently. RE-AIM is a framework used to guide dissemination and implementation activities by evaluating an intervention in terms of its: Reach to target populations; Effectiveness or efficacy; Adoption by target staff, settings, systems and communities; Implementation consistency, costs and adaptions made during delivery; and Maintenance/sustainment of intervention effects in individuals and settings over time. This presentation will describe the types of data used to evaluate each component of RE-AIM during the study’s stage-1 activities. Data include feedback from a community advisory board (n=12), a randomized waitlist-control sample evaluating feasibility and initial efficacy of intervention of the TLC intervention (n=163), and feedback from stakeholders and providers who would be partners in the implementation of the TLC intervention (n=59). Based on stakeholder feedback, our findings support recommending adopting and designing interventions with an eye toward the principles of RE-AIM as best practices to increase the likelihood that interventions developed in the research context can be translated and implemented to those who will benefit from them.
ACCESS TO NEIGHBORHOOD AMENITIES AND RISK OF INSTITUTIONALIZATION AMONG PERSONS WITH DEMENTIA
Authors: Choi Yeon Jin , Fennell Gillian , Ailshire Jennifer 
Published: December 2023

Abstract
Compared to only 2% of the total population between ages 65 and 84, 15% of persons with dementia (PWD) transition to nursing homes. This may be due to caregiving challenges associated with the behavioral symptoms PWD exhibit and their reduced capacities to perform daily tasks. Access to neighborhood amenities (e.g., parks, food access, libraries, service providers) may reduce the risk of institutionalization by helping PWD maintain their health and independence through the provision of opportunities for physical exercise, nutritious diets, social interaction, and cognitive stimulation while providing their caregivers with supportive services. Using data from the2006-2016 waves of the Health and Retirement Study (HRS), the HRS Contextual Data Resource, and the National Neighborhood Data Archive, this study aimed to identify neighborhood factors that are associated with transition into a nursing home among PWD who lived in the community (N=3,366). A series of logistic regression models were estimated adjusting for sociodemographic characteristics, health status, and neighborhood characteristics. Findings suggest that access to more park areas, healthy food outlets (i.e., grocery stores, supermarkets, supercenters), social amenities (e.g., museums, libraries), and social services for older adults and those with disabilities (e.g., senior centers, adult day care centers, disability support groups) were significantly associated with a lower risk of 2-year institutionalization. Retail stores and home health services were not significantly associated with the risk of institutionalization. These findings emphasize the importance of neighborhood amenities, such as parks and healthy food outlets, in enabling PWD to age in place.
CASE SCENARIOS OF CANADIAN MEDIC-ALERT SUBSCRIBERS WITH DEMENTIA WHO GO MISSING
Authors: Daum Christine , Vahedi Vanessa , Rutledge Emily , Adekoya Adebusola , Miguel-Cruz Antonio , Liu Lili 
Published: December 2023

Abstract
With the increasing prevalence of dementia worldwide, it is expected that incidences of getting lost and going missing among persons living with dementia due to wayfinding challenges will also increase. Despite this, there is currently a gap in accessible education materials specific to risk factors and incidents of getting lost and going missing, aimed at first responders and family care partners. Case scenarios can effectively convey the circumstances of recurring events while also accounting for lived experiences. The purpose of this project was to develop case scenarios informed by real-life missing incidents that involve persons living with dementia in Canada. Qualitative description and conventional content analysis were used to analyze summary notes of missing incidents (n=515) obtained from Medic-Alert Foundation Canada hotline database. Summary notes contained: demographics of the missing person, their living situation and circle of support, events leading up to incident, by whom and where they were found, their health condition, and how they were re-united with their care partners. Case scenarios were developed that reflected the common (e.g., going missing while on foot, being found on the street) as well as less common (e.g., going missing while driving, being found seriously injured). Five experts (person living with dementia, care partner, health care professional, support providers) reviewed these scenarios to ensure relevance. Case scenarios can raise awareness of the circumstances encountered during missing incidents. The scenarios can be used by first responders and care partners to learn how to respond to missing incidents and receive support.
FUNCTIONAL LIMITATION: DIFFERENCES BY EPIGENETIC AGING, ETHNICITY, AND EXPERIENCES OF DISCRIMINATION
Authors: Brown Maria , Mutambudzi Miriam 
Published: December 2023

Abstract
Epigenetic aging provides an opportunity to rethink processes of aging and policy and health interventions to address health disparities across the life course. Previous research has shown that social factors can result in accelerated epigenetic aging, with subsequent unfavorable health outcomes. This cross-sectional study aimed to evaluate the relationship between epigenetic aging and functional and instrumental limitations in White and Hispanic older adults and to explore how recent experiences of perceived discrimination may differentially impact this association. We used 2014 and 2016 Health and Retirement Study (HRS) data for White (n=1072) and Hispanic (n=139) adults aged 50 and older and epigenetic clock data from the 2016 HRS Venous Blood Study. We hypothesized that accelerated epigenetic aging (PhenoAge epigenetic clock regressed on chronological age) would be associated with greater limitations in activities of daily living (ADLs) and instrumental activities of daily living (iADLs), and this impact would differ by ethnicity and perceived discrimination. On average, Hispanics reported significantly more limitations in ADLs (1.10 vs .47, p&lt;.0001) and iADLs (1.22 vs .72, p&lt;.0001), and more experiences of being treated differently in service situations (44.6% vs 33.3%, p=.0084) and of people acting as if they were afraid of them (28.78% vs 22.01%, p=.0738). Epigenetic age was associated with discrimination (b=-1.98, p=.0078), with ADLs in Hispanics (b=-0.04, p=.0812), and with iADLs in Whites (b=.0069, p=.0443). Further studies of the impact of epigenetic aging on functional and instrumental limitations should be longitudinal, utilize larger samples of older adults, and oversample racial and ethnic minorities.
ROLE OF PLACE AS A DETERMINANT OF PARENT–ADULT CHILD GEOGRAPHIC PROXIMITY AND CAREGIVING
Authors: Mudrazija Stipica , Peters Elizabeth , Lepe Fernando Hernandez 
Published: December 2023

Abstract
While research has shown that the need for care impacts how close parents and adult children live, the relative importance of various factors shaping parent-child geographic proximity remains unclear, especially as it relates to characteristics of their geographic locations and communities. We explore variation in and determinants of the geographic proximity of older parents and adult children, conditional on parents needing care. Using pooled 2004-2014 data from the Health and Retirement Study on respondents age 65 years or older and their children, alongside detailed county-level contextual information from various sources, we analyze the importance of various determinants of parent-child geographic proximity, including parental health, age, and other personal characteristics, children’s personal characteristics, parent-child dyad characteristics, and place-specific characteristics that relate with availability of different health and aging services, housing affordability, and labor market opportunities. Preliminary regression results show that coresidence is substantially less likely in areas with higher availability of nursing care and continuing care options. Among non-coresidents, living in close proximity (distances under 10 miles) is less likely if parent’s area has more nursing care options, but more likely if health services that support living in place are available. Additionally, local economic and housing conditions play a role, with higher median household income associated with children living closer to parents and higher cost of rent with living further. Place-specific characteristics are important determinants of parent-child coresidence and proximity, and policymakers and care providers should consider them when determining the most effective ways to support older adults who need care.
PRECARIOUS HOUSING BEFORE, DURING, AND AFTER AN EPISODE OF LATE-LIFE HOMELESSNESS
Authors: Traver Anthony , Dabelko-Schoeny Holly 
Published: December 2023

Abstract
This qualitative study aims to understand how the living environments occupied by older adults before, during, and after an episode of homelessness inform their access to a healthy, stable, and dignified life. Indicators of accommodation, quality, and service integration are explored using the Aging in the Right Place conceptual framework. Through partnerships with a homeless shelter, a meal site, and a mental health outreach team in Columbus, OH, demographic questionnaires and semi-structured interviews were completed with 22 older adults with an episode of late-life homelessness. Nine direct service providers were also interviewed. Interviews were analyzed using the team-based flexible coding method in Nvivo 1.6.1. Results indicated that low or no income in late life forced older adults to occupy a continuum of precarious and low-quality living environments that include shared housing, doubling up, emergency shelters, institutional settings, and living on the land. AIRP indicators are discussed for each. Conflict, death of a support person, mental and behavioral challenges, unit deterioration, rental price increases, and social isolation forced OA down the housing continuum and into homelessness. Sub-optimal conditions interacted with age to exacerbate health conditions, create social isolation, and expose OA to harm. Informal and formal relationships, emergency shelter services, vouchers, and specific behaviors and attitudes were identified as critical for securing affordable and accommodating housing in which to age. Understanding the experiences of OPEH who are striving to occupy their subjective right place to age can help service providers and policymakers meet the unique needs of precariously housed OA.