bluuebunny/crossref_metadata_2025_split huggingface dataset:
WORKFORCE EDUCATION, TECHNOLOGY, AND EVALUATION TO REDUCE HEALTH DISPARITIES IN A PROVIDER SHORTAGE STATE
Authors: Yoo Ji , Reed Peter , Kim Laurie 
Published: December 2023

Abstract
State of Nevada has been a provider shortage area and ranks 50th state of primary care providers per capita in 2022. As a result, Medicare spends highest spending per capita and highest 30-day readmission rate of vulnerable and older adults, i.e., individuals with Alzheimer’s Disease Related Dementias. To respond these challenges, geriatric workforce education program (GWEP) was launched in 2019. Along with interdisciplinary education of healthcare providers, GWEP overarched to an innovative technology, i.e., digital health and machine learning methodology aiming at mitigating bias in healthcare and predicting events, i.e., nursing home placement and designating power of attorney timelines that are useful for planning advance care in primary care. GWEP team evaluates the impact of these education and technology implementation impact on healthcare delivery efficiency, i.e., healthcare cost. in real-world payment system. This is a collaborative symposium between the Community-Engaged Research, Geriatric Education, and Patient/Person Engagement in Research Interest Groups.
ASSOCIATION OF DIABETES AND VAGINAL MICROBIOTA WITH THE GENITOURINARY SYNDROME OF MENOPAUSE
Authors: Robbins Sarah , Shardell Michelle , Beitelshees Amber , Miller Ryan , Ravel Jacques , Taylor Simeon , Brotman Rebecca 
Published: December 2023

Abstract
The genitourinary syndrome of menopause (GSM) comprises urogenital signs and symptoms associated with estrogen deficiency during menopause. For many, decreased estrogen reduces vaginal Lactobacillus species abundance, a state associated with adverse urogenital outcomes. For these reasons, vaginal microbiota in women’s reproductive aging is an emerging topic of interest in geroscience research. The risk of diabetes also increases with menopause; however, few studies have jointly assessed diabetes and vaginal microbiota with GSM. Therefore, we assessed the relationships between diabetes, vaginal microbiota and GSM in a study of 811 participants aged 35-60 recruited to a 2-year observational cohort with follow-up every 6 months. Diabetes was defined as self-reported diabetes medications, history, or serum glycated albumin &gt;16.5%. There were 22 and 251 postmenopausal participants with and without diabetes, respectively. Mixed-effects logistic regression quantified the association of vaginal microbiota with GSM outcomes among those with and without diabetes. After adjustment for covariates, low-Lactobacillus vaginal microbiota states were associated with lower odds of vulvovaginal atrophy (VVA) (aOR=0.23, 95% CI: 0.04-1.33) among postmenopausal participants with diabetes; however, this finding was not statistically significant. In contrast, among postmenopausal participants without diabetes, low-Lactobacillus microbiota was significantly associated with higher odds of VVA (aOR=1.63, 95% CI: 1.07-2.47). Diabetes significantly modified the association between vaginal microbiota and VVA among postmenopausal individuals (p=.032). Findings were similar for clinician-assessed vaginal dryness. These results suggest that the relationship between vaginal microbiota and GSM may differ by diabetes status. Larger studies are needed to further understand the relationships between diabetes, vaginal microbiota and GSM.
SEX HORMONES ARE ASSOCIATED WITH BONE DENSITY AND PHYSICAL FUNCTION IN WOMEN RECOVERING FROM HIP FRACTURE
Authors: Cappola Anne 
Published: December 2023

Abstract
Testosterone and estrogen have anabolic effects, and alterations could affect recovery from hip fracture. We hypothesized that differences in sex hormones during the year after a hip fracture would be associated with bone mineral density (BMD) and physical function. This analysis included 149 women aged 65 years or older enrolled in the Baltimore Hip Studies 7th cohort. Testosterone and estradiol by LC/MS/MS and sex hormone binding globulin were assayed at four time points post hip fracture (within 15 days of admission, and at 2, 6, and 12 months) on fasting morning samples. Longitudinal regression models accounting for clustering by subject were constructed to examine the relationship between each hormone and BMD and short performance physical battery (SPPB) score over time. Mean age was 81 years, BMI was 25.6 kg/m2, and 92% were white. Testosterone levels were low in women at all time points (median 10-12 ng/dL), as were estradiol levels (median 3-5 pg/mL). In adjusted models, increases in total and free estradiol during recovery were associated with improvement in BMD, whereas total testosterone, but not free testosterone, was associated with improvement in SPPB. These analyses support physiologically relevant relationships between higher estradiol levels and improvement in BMD and higher testosterone levels and improvement in physical function during the year after hip fracture, even at the low levels of sex hormones found in post-menopausal women. These findings suggest that differences in reproductive aging that affect sex hormone production may have clinical effects on recovery from a sentinel event, long after menopause.
BUILDING BRIDGES ACROSS THE GENERATIONS: RESEARCH ON DIVERSE APPROACHES FOR INTERGENERATIONAL CONNECTIONS
Authors: Eisenstein Amy , Gonzales Ernest 
Published: December 2023

Abstract
Intergenerational bonds are a unique and critically important set of social connections that have powerful impacts on families and communities, as well as the older and younger people themselves. America is increasingly age-segregated, so that naturally occurring, cross-generational contacts are not as common as they have been in previous eras. Research from the FrameWorks Institute and others suggest that ageist language can further divide the generations, create a sense of “othering,” and contribute to the isolation and minimization of older adults. Conversely, studies also show that meaningful intergenerational programming, which brings to light the strengths of both generations, may reduce social isolation and loneliness and enhance the physical and mental well-being of older adults. This symposium will bring together three research projects each exploring diverse approaches to intergenerational connections. The first paper will present lessons learned from a study of digital communication between grandparents and grandchildren during the COVID-19 pandemic, and the implications this shift in communications has on the psychological well-being of older grandparents. The second paper will present findings regarding the physical and psychosocial outcomes experienced by older adults who provide intergenerational tutoring in elementary school settings. The final session will highlight the process of integrating implementation science frameworks into a multistage study design aimed to assess the implementation of an intergenerational technology program within higher education. The session will wrap-up with a discussion on how these projects fit within the broader scope of intergenerational programs, and will highlight gaps and further opportunities for research in this field.
CAN GOOD SELF-RATED HEALTH MITIGATE THE FRAILTY-INDUCED HEALTH CARE EXPENDITURE? EVIDENCE FROM CHINA
Authors: jin Haiyu 
Published: December 2023

Abstract
As the pathophysiology of frailty remains unknown, intervention efforts have primarily focused on improving functions and alleviating symptoms instead of treating frailty-causing biology. Frail individuals are not a clinically homogeneous group; further risk stratification may identify subgroups more resilient to health risks. Self-rated health (SRH), a simple measure of an individual’s overall perception of overall health, might be a surrogate of resilience among the frail. This work aims to determine the joint association of frailty and SRH with healthcare expenditure. Data were from the China Health and Retirement Longitudinal Study. Persons were classified as non-frail, prefrail, and frail. SRH was classified as poor (including very poor) and good (fair/good/very good/excellent). Healthcare expenditure was classified into outpatient, inpatient, and self-treatment. The Cox model was used to address the study’s aims. All analyses were adjusted for age, sex, residence, education, income, insurance, smoking, and chronic conditions. Although frailty was positively correlated with poor SRH, 36.0% of the frail reported good health and 26.6% reporting poor health were deemed non-frail. Frailty and SRH were independently associated with higher odds of incurring and higher average expenditures. Among persons with poor SRH, prefrailty and frailty were associated with higher odds of incurring the cost and higher average expenditures than the non-frail, while no association was found between frailty and healthcare expenditure among those with good SRH. Frailty was associated with higher healthcare expenditure only among persons with poor SRH. Frail individuals reporting good health are resilient to frailty-induced health risks.
THE LIVED EXPERIENCE OF COPD AND EMOTIONAL DISTRESS IN US VETERANS: A MIXED-METHOD STUDY
Authors: Bamonti Patricia , Rose Grace , Park Stella , Silberbogen Amy , Moy Marilyn , Moye Jennifer 
Published: December 2023

Abstract
Behavioral interventions targeting low physical activity (PA) and comorbid emotional distress are critically needed to address gaps in the management of chronic obstructive pulmonary disease (COPD). A mixed-methods study was conducted to guide the development of Step-Cognitive Behavioral Therapy (Step-CBT), a virtual behavioral intervention under study integrating PA promotion with CBT for those with COPD. Semi-structured interviews with U.S. Veterans with COPD at the VA Boston Healthcare System explored the lived experience of COPD and emotional distress. Participants completed the Patient Health Questionnaire-9 [PHQ-9], Beck Anxiety Inventory [BAI]), and wore an accelerometer (ActiGraph wGT3X-BT) for 14 days to measure objective PA. Thematic analysis was used to code responses and identify themes. Participants (n=22; 90.9% male, age 68.0±6.0 years; 96% White) were assessed. PHQ-9 indicated moderate depression severity (M=11.3± 5.3) and BAI scores indicated moderate anxiety severity (M=26.5±9.4). Average daily step count was (M=6,611±4,799). In response to questions eliciting participants’ experience of emotional distress, participants described Emotions, Behaviors, and Cognitions associated with distress that interacted with COPD and PA (e.g., “I’ve gotta catch my breath where before I could just do up the yard with no problem… so that gets me depressed”). When asked about engaging in daily PA in the context of emotional distress, three themes emerged: Emotion Regulation and Coping (e.g., healthy behavioral coping, maladaptive coping, etc.), Factors that Motivate (i.e., routine/schedule, etc.), and Social Context. Findings illuminate linkages between emotional distress and PA that will guide the creation of vignette-based treatment modules in the development of Step-CBT.
CONECTAR: A MINDSET TO INCREASE HISPANIC ENGAGEMENT IN DIGITAL TECHNOLOGY RESEARCH
Authors: Young Vanessa , Serrano-Rubio Luis , Gaona Carlos , Jones Floyd , Seshadri Sudra , Kaye Jeffrey , Beattie Zach , Gonzales Mitzi 
Published: December 2023

Abstract
In-home digital technology affords the opportunity for more precise and ecologically valid assessments of daily activity engagement. However, concerns about loss of privacy can hinder recruitment, especially within communities already underrepresented in research. Literature on effective, culturally tailored recruitment strategies is limited. Herein, we describe strategies employed for an in-home digital technology study with 100% Mexican American representation. Hispanic participants were recruited from the greater San Antonio area. Direct recruitment strategies conducted in both English and Spanish included community outreach events, a participant repository, cross-enrollment with other research studies, and by word of mouth. Mass recruitment strategies included flyer dissemination, newsletters, and digital announcements through community organizations (i.e., Salud America!) and national (i.e., Research Match) and institutional websites. Between September 2022 and February 2023, 31 participants were enrolled out of 154 individuals who were contacted. Of these, 29% were recruited from community events, 22.6% from word of mouth, 19.4% from cross-enrollment, 12.9% from the research repositories, and 16.1% from mass recruitment strategies. The most common reasons for non-enrollment included lack of interest (n=49), screen failure (n=29), and privacy concerns (n=12).Direct recruitment efforts achieved higher rates of enrollment, while mass media campaigns yielded lower responses and resulted in more unsuccessful contact attempts. Understanding the relationship between social networks and research beliefs may be particularly relevant given the Hispanic culture’s collectivist and family-oriented nature. Hence, social network theories, combined with a diffusion of innovation framework, may be advantageous for increasing trust and may consequently improve representation of diverse groups in research.
IDENTIFYING AND PREDICTING PLACE OF CARE TRAJECTORIES DURING THE LAST THREE YEARS OF LIFE
Authors: Lin Haiqun , Zafar Anum , Setoguchi Soko , Jarrín Olga 
Published: December 2023

Abstract
Aging in place is a goal for most older adults, however in presence of advanced illness and/or Alzheimer’s disease and related dementia (ADRD) institutional placement may be needed. The number of days in each care setting in each quarter of the last three years of life was determined through linkage of several Medicare datasets. Using group-based modeling we examined place of care trajectories during the last three years of life among a 10% sample of Medicare beneficiaries who died in 2018 (n=199,828), providing a pre-COVID19 baseline for future studies, to identify dual trajectories of inpatient/institutional care, and skilled home healthcare/home hospice. Nine distinct trajectory classes and their associated sociodemographic and clinical characteristics were identified. The first three classes were characterized by healthcare use concentrated in the last three months of life (comprising 29.1%, 20.5%, and 9.1% of the sample); the next three classes were characterized by low use of inpatient/institutional care with long-term use of skilled home healthcare/hospice (14.2%, 8.2%, and 4.8%); and the remaining inpatient/institutional classes characterized by low use of skilled home healthcare/hospice with long-term use of inpatient/institutional care (4.8%, 4.9%, and 4.6%). The beneficiaries in the remaining sample are assigned to a place of care trajectory class using the parameter estimates derived from the 10% sample without further model fitting. We investigate the prediction utility of risk factors in multiple domains of demographic, clinical, and social determinants of health. Our findings may help to inform care preference during last period of life understanding the associated factors.
APPLYING THE CARE SETTING TRAJECTORY DATABASE TO STUDY END-OF-LIFE OUTCOMES IN PERSONS WITH DEMENTIA
Authors: Kim Hyosin , Jarrín Olga , Duberstein Paul , Wu Bei , Lin Haiqun , Zafar Anum , Harvey S Marie , Lopez Maria 
Published: December 2023

Abstract
This study highlights an application of the care setting trajectory database and our new, harmonized, self-reported race/ethnicity variable to evaluate the impact of home health care on later use of hospice and place of death in a large cohort of Medicare decedents. This study evaluated home health care use during the last 3 years of life as a predictor of death in the care of hospice for a cohort of 895,526 Medicare beneficiaries with dementia who died in 2019. The cohort was limited to beneficiaries continuously enrolled for at least 5 years, who were age 40 and older, and who lived in the U.S. fifty states, District of Columbia, or Puerto Rico at death. Co-variates included number of acute hospitalizations during the last 3 years of life, age at death, sex, race/ethnicity, comorbidities, insurance, rural/urban area, and state of residence. 54.5% of the cohort used home health care at any point during the last 3 years of life. Compared to beneficiaries who did not use home health care, those who received home health care were more likely to die at home (64.5% vs. 60%, OR 1.08) or in the care of hospice (65% vs. 58%, OR 1.05). Among beneficiaries who died with hospice, use of home hospice was more prevalent for those who had previously used home health care (53% vs. 49%). This study provides compelling evidence of the value of home health care as a strategy to improve end-of-life care quality among Medicare beneficiaries living with dementia.
KNOWLEDGE, ATTITUDES, AND BELIEFS ABOUT HEARING HEALTH CARE OF OLDER BLACK WOMEN SEEKING HEARING HELP IN ENT SETTINGS
Authors: Toman Julia , Lewis Charity , Sanchez Victora , Arnold Michelle 
Published: December 2023

Abstract
There are documented barriers to access and use of healthcare services faced by older Black adults in the US. Black women are more likely to report negative past experiences with the healthcare system and as a result have inherent mistrust of providers. Black women are also less likely to receive referrals for specialty and allied health care, but it is unknown if this trend is apparent for hearing healthcare. The purpose of the current study was to investigate the experiences of older Black women seeking help for hearing loss in an otolaryngology (ENT) clinic setting. Our interdisciplinary team consisting of experts in gerontology and Black women’s health, public health, audiology, and otolaryngology conducted a mixed methods study which included (1) semi-structured interviews (n=15) and (2) online administration of a validated hearing beliefs questionnaire (n=86). Interview themes uncovered included experiences with racism in healthcare, the role of religion in help-seeking, and the importance of seeking treatment for hearing loss. Triangulation of findings revealed consistency between themes and questionnaire results, including little to no expressed stigma surrounding hearing aid use and little resistance to hearing healthcare or hearing loss treatment. Our results suggest that primary care and ENT should feel confident in referring older Black women who are seeking help for hearing loss to audiology for treatment options. We will also discuss other known facilitators and barriers to serving this population in an ENT setting.
AGE-RELATED HEARING LOSS IN COMMUNITY PHARMACY: BARRIERS AND FACILITATORS TO COMMUNICATION
Authors: Lewis Penny , Thomas Shanice , Griffiths Jane , Phipps Denham , Saunders Gabrielle , Todd Christopher 
Published: December 2023

Abstract
Pharmacists have an important role in primary care, communicating with people and ensuring safe and appropriate medication use. However, inadequate communication is a barrier to the delivery of effective care for people with hearing loss. This study sought to explore factors that facilitate and impede communication with people with age-related hearing loss (presbycusis) in the community pharmacy, in order to identify solutions to improve these interactions. Online semi-structured interviews with people with age-related hearing loss (presbycusis), older people (&gt;50 years old) without hearing loss, and online focus groups and interviews with community pharmacists were conducted. Data were analysed using the framework method. Sixteen people with age-related hearing loss, three older people without hearing loss and eight community pharmacists took part. Participants described a multitude of environmental barriers to communication and person-centred pharmaceutical care such as heavy workload, lack of privacy, noise levels and Covid-19 safety measures. There was a perception among participants that their hearing loss is not relevant to the community pharmacy setting and that more could be done to signify that a pharmacy recognises the needs of those with hearing loss, furthermore, participants discussed their limited interaction with pharmacy personnel. There were varying perceptions about communication and levels of awareness among pharmacists about the key facilitators to communication. Greater interdisciplinary collaboration to develop and implement strategies/adaptations tailored to the needs of people with hearing loss would support the engenderment of hearing-friendly community pharmacies and the safe use of medicines.
INDIVIDUAL AND COUNTY-LEVEL FACTORS OF SERVICE USE BY DEMENTIA FAMILY CAREGIVERS IN RURAL APPALACHIA
Authors: Nah Suyoung , Savla Tina , Roberto Karen 
Published: December 2023

Abstract
Formal services have been shown to provide health benefits for care recipients and family caregivers. Despite prior efforts, it is still unclear which factors play a role in the decisions to use formal services by family caregivers living in under-resourced rural regions. Drawing upon the Andersen model of health service use, this study examined individual and county-level factors’ associations with the utilization of support services (e.g., homemaker, respite) and personal services (e.g., home health nurse, personal care aide) by dementia family caregivers residing in rural Appalachia (N = 163). Results of multilevel models revealed that caregivers with higher income and care recipients with more limitations in activities of daily living tended to use more support and personal services. Greater informal support from family or friends was associated with less utilization of support services, but not personal services. Caregivers residing in counties with higher poverty and lower public spending on support services for older adults were more likely to use support services. Conversely, caregivers living in counties with more home health agencies were more likely to utilize personal services. These findings suggest that caregivers living in rural regions may depend more on informal support for meeting basic care needs of their relative living with dementia. However, if the care recipient requires more specialized care, living in resource-rich counties increases their chances of receiving appropriate care. Discussion will focus on strategies to allocate funds and resources to expand care coverage to vulnerable individuals such as people living with dementia in rural regions.