bluuebunny/crossref_metadata_2025_split huggingface dataset:
SEXUAL AND GENDER IDENTITY AND THEIR PROPERTIES IN AGING WITH PRIDE: NATIONAL HEALTH, AGING, AND SEXUALITY AND GENDER STUDY
Authors: Nelson Christi , Fredriksen-Goldsen Karen , Hoy-Ellis Charles , Romanelli Meghan , Kim Hyun-Jun 
Published: December 2023

Abstract
Increasing diversity and rapidly evolving sociopolitical context are changing how sexuality and gender identity are experienced, expressed, and measured in contemporary America. Based on longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, we examine sexual and gender identity, differentiation from other related constructs (i.e., desire, behavior, expression, relationships) as well as the associations between properties of sexual and gender identities (e.g., congruence, continua, visibility, centrality, and transformation) and the health and well-being of LGBTQ midlife and older adults (N=2,233), aged 50-102 at baseline. The findings document important differences in current as well as lifetime sexual experiences, desires, and romantic relationships by sexuality and gender identity. Measures incorporating a continuum as opposed to binary response categories better capture the experiences of bisexual, sexually diverse, and transgender older participants as compared to lesbians and gay men. When examining transformation, 7% reported changes to their sexual identity and 3% reported changes to their gender identity over 4 years. Those who changed their identity over time showed a higher level of identity stigma and poorer physical and psychological health-related quality of life. Our findings reveal that heterogeneity and intersectionality are critical to understanding sexual and gender identity. It is important to consider multiple aspects of sexuality and gender (e.g., romantic relationships) that are often overlooked in gerontological and sexuality and gender research. Scholarship on sexual and gender identity development and transformation in later life is needed to better address diversity in the aging population.
DEMOGRAPHIC CORRELATES OF AGING-RELATED GENE EXPRESSION LEVELS AMONG OLDER AMERICANS
Authors: Wu Qiao , Klopack Eric , Kim Jung Ki , Faul Jessica , Thyagarajan Bharat , Cole Steve , Crimmins Eileen 
Published: December 2023

Abstract
Measures of conserved transcriptional response to adversity (CTRA), DNA damage response (DDR), and senescence-associated secretory phenotype (SASP) gene expression can be regulated by social and environmental exposures. The resulting synthesis of proteins can affect aging. To further understand how demographic disparities get “under the skin” and link to health outcomes, we examine associations between (A) age, gender, and race/ethnicity and (B) three gene expression composite scores derived from RNA sequencing data in a nationally representative sample of 2,680 Americans aged 55 and older from the 2016 Health and Retirement Study. We also compare the associations across models using multiple approaches to controlling for blood cell composition. OLS regressions suggest that compared to those aged 55-64, being older is associated with a lower inflammatory sub-score of CTRA (Ages 75-84: β=-0.04, p=0.008; Ages 85+: β=-0.12, p&lt;0.001), lower CTRA (Ages 85+: β=-0.15, p&lt;0.001), higher DDR (Ages 85+: β=0.03, p=0.042), and lower SASP (Ages 75-84: β=-0.05, p=0.015; Ages 85+: β=-0.07, p=0.017) scores. Women have significantly higher inflammatory (β=0.06, p&lt;0.001) and antiviral (β=0.04, p=0.002) sub-scores of CTRA. Compared to non-Hispanic Whites, non-Hispanic Blacks have a higher inflammatory sub-score of CTRA (β=0.04, p=0.026) and a lower SASP score (β=-0.19, p&lt;0.001), and Hispanics have a lower SASP score (β=-0.08, p&lt;0.001). Adjusting for education, drinking, smoking, BMI, and chronic conditions does not change the results much. Overall, using expression levels of the genes that mark major leukocyte subsets to control for blood cell composition does not notably differ from approaches based on complete blood count and flow cytometry.
BIOMARKERS HELP CLARIFY HOW SYSTEMIC AGING CONTRIBUTES TO MORTALITY: UTILIZING A MACHINE-LEARNING APPROACH IN HRS
Authors: Klopack Eric , Crimmins Eileen 
Published: December 2023

Abstract
Research suggests aging is a coordinated physiological decline occurring in multiple systems and at multiple biological levels. However, it is largely unknown how general biological aging and specific systemic aging co-occur and influence one another to affect mortality. There is also emerging interest in understanding how social exposures may differentially accelerate decline in individual physiological systems. We utilize data from the Health and Retirement Study, a nationally representative sample of about 4000 US adults over age 55. We used eXtreme Gradient Boosting (xgboost) in a training subsample to create estimates of mortality risk based on sets of biomarkers representing biological systems (e.g., brain and nervous system, adaptive immune system, cardiovascular system, renal system) as well as cellular aging (using epigenetic clocks and telomere length). These models generated mortality risk scores for each system (e.g., renal functioning using BUN, creatinine, and cystatin C). Mortality was regressed on these scores in a testing subsample to assess the relative impact of each system on mortality risk. Results suggest cellular aging, cardiovascular aging, and age-related metabolic dysfunction contribute most to mortality risk. Aging of these systems also partially mediates the mortality risk associated with age, race/ethnicity, sex, and education. These results suggest aging of specific systems may be differentially affected by sociodemographic exposures and may differentially contribute to mortality risk. This research may help guide interventions focused on reducing inequalities in mortality risk by identifying health risks that would have the greatest impact on mortality at the population level.
CONTRACT NURSE UTILIZATION AND FACILITY AND COMMUNITY FACTORS
Authors: Pradhan Rohit , Davlyatov Ganisher , Dayama Neeraj , Weech-Maldonado Robert 
Published: December 2023

Abstract
While NHs have long been plagued by nursing staff shortages, the situation has further deteriorated with the COVID 19 pandemic. The NH industry has attempted to address the persistent shortage of nursing staff by increasingly relying on contract nurse staffing. Research suggests that the increased utilization of contract nurses may have negative implications for NH quality and financial performance. However, all NHs are not equally likely to utilize nurse contract staffing. For instance, potentially, NHs with poorer quality of care and financial challenges may be forced to rely more on contract nurse staffing. The primary purpose of this paper is to explore the antecedents---facility and community factors---associated with increased utilization of nurse contract staffing. Employing a pooled cross-sectional observational study design, we extracted secondary data from the PBJ nurse staffing, Nursing Home Compare, Rural-urban commuting area (RUCA) codes, and the American Community Survey (ACS) for the period 2017-2021. To test the relationship between the ratios of contract nurses and facility/community factors, we employed multivariate mixed-effects maximum likelihood regression. We ran three separate regressions for RNs, LPNs, and CNAs. Our results suggest that among facility level factors, NHs with more beds, higher occupancy rates, and higher proportion of Medicare residents were generally more likely to employ contract nurse staffing with some minor differences across the three models (RNs, LPNS, CNAs). Among community factors, location in micropolitan/small town areas, higher poverty rates, and higher education levels were positively associated with nurse contract utilization. Policy and managerial implications are discussed.
SYNTHESIS AND APPLICATION OF QUANTITATIVE METHODS FOR MODELING CHANGE IN MULTIMORBIDITY AND RELATED HEALTH DOMAINS
Authors: Bishop Nicholas , Nagel Corey , Quiñones Ana 
Published: December 2023

Abstract
The longitudinal examination of multimorbidity (≥ 2 chronic conditions) and related health outcomes (e.g., cognition, disability, mortality) has the potential to identify disparities and intervention points in the age-related progression of chronic disease. This symposium will organize discussion of methodological and applied research projects that review and demonstrate the use of longitudinal methods to address critical questions in the study of multimorbidity and related health domains. The lead presentation “Longitudinal Methods for Assessing Progression of Multimorbidity and Related Health Outcomes” will review the use and limitations of several longitudinal methods that can be used to study the progression of multimorbidity and linked health outcomes. Following presentations will demonstrate the application of specific longitudinal methods to key research questions in the study of multimorbidity. “Emerging Cohort Disparities in Multimorbidity in U.S. Adults Entering Early Older Adulthood” presents evidence of cohort disparities in multimorbidity trajectories using mixed-effects regression to estimate age, period, and cohort effects, “Personalized and Typical Concurrent Risk: Joint Models of Recurrent Outcomes and Mortality by Race/Ethnicity” applies joint models of self-rated health, disability, and mortality to examine disparities among minoritized groups, and “Sequence Analysis of Cardiometabolic Multimorbidity and Association With Subsequent Dementia” identifies common patterning of cardiometabolic conditions over a 5-year period and their relationship with prospective dementia classification. This symposium will encourage attendees to apply the presented methods to their own multimorbidity research questions and demonstrate how these methods are being applied to address key gaps in our understating of multimorbidity progression in older adulthood. This is a Measurement, Statistics, and Research Design Interest Group Sponsored Symposium.
CONTINUING CHALLENGES IN STATE EFFORTS TO IMPROVE DIRECT CARE WORKER WAGES
Authors: Tyler Denise , Hunter Melissa , Porter Kristie , Khavjou Olga , Squillace Marie , Dey Judith , Oliveira Iara 
Published: December 2023

Abstract
Direct care workers (DCWs) receive low wages and some states have tried to improve their wages through policy changes. This mixed methods study examined the effect of state wage policies on changes in DCW wages. We also conducted 38 interviews with national experts and stakeholders across six states to determine the results of these policy changes and continued barriers to improving DCW wages. Results show some states that implemented policies to improve the wages of DCWs since 2009 reduced the gap between DCW wages and the wages of other entry-level workers, yet the gap was still substantial in many states. Experts and state stakeholders repeatedly cited consistent funding of wage policies through Medicaid reimbursement rate increases as important to effectively increasing and sustaining higher wages. Interviewees recommended that funding increases be continual, rather than requiring annual reauthorization and noted it was particularly challenging when funds were inadequate to support annual wage increases. Interviewees described Medicaid reimbursement rates as a barrier when rates did not keep pace with market trends. Interviewees also recommended professionalizing the field, increasing the respect afforded these workers, and developing ways to increase the pipeline of workers as additional ways to improve direct care work. Until there is meaningful policy change, states will continue to struggle with barriers to improved wages for DCWs which results in a disproportionate number of DCWs relying on public benefits and difficulties with recruitment and retention.
HOW CARE WORKERS’ TURNOVER INTENTION IS ASSOCIATED WITH WORKPLACE VIOLENCE?: THE ROLE OF STRESS AND JOB SATISFACTION
Authors: Ko Sung Hyun , Lee Yeonjung 
Published: December 2023

Abstract
This study examines the impact of workplace violence experienced by long-term care workers from the care recipients on their turnover intention and the mediating effect of work-related stress and job satisfaction in the relationship between workplace violence and turnover intention. Compared to the unfair experiences of abuses experienced by care recipients, care workers’ experiences have been relatively under-explored. Adopting the affective events theory as a theoretical framework and using the Korean National Long-Term Care Survey in 2019, the current analysis focuses on 2,427 care workers, excluding social workers, nurses, and occupational/physical therapists. The results of structural equations modeling and effect decomposition show a mediating effect of job satisfaction, indicating that the experience of workplace violence decreased the job satisfaction of care workers, resulting in increased turnover intention. On the other hand, workplace violence did not have a statistically significant indirect effect on turnover intention through work-related stress. Findings provide several implications for developing an inclusive and supportive policy and practice for care workers as well as the long-term care system in general in South Korea. Support programs and policies can be targeted toward the care workers who have experienced workplace violence and are less satisfied with their job. These can be done not only by highlighting the importance of training and education for care workers to help prevent workplace violence but also by providing a safe work environment, an appropriate compensation system, and the fair opportunities for promotion.
URBANIZATION, FALLS, AND FEAR OF FALLING IN COMMUNITY-DWELLING OLDER ADULTS IN THAILAND
Authors: Thiamwong Ladda , Xie Rui , Tongsiri Sirinart , Ng Boon Peng , Park Joon-Hyuk , Rodniam Jaroonrat , Li Wenjun , Eckstrom Elizabeth 
Published: December 2023

Abstract
Nearly half of the Thai population lives in urban areas without retirement pensions. Urbanization may increase physical inactivity, falls, and other non-communicable diseases. Little is known about the urban-rural differences in falls and fear of falling among community-dwelling older in Thailand. We surveyed a random sample of 433 persons who were: i) aged 60 years and older; and ii) had no cognitive impairment (Chula Mental Test ≥ 16/36). The participants had the mean age was 70.40 (± 7.53) years, included 62.9 % female, 22% having poor balance, 85% having limits in doing vigorous physical activity, 71% having limits in performing moderate physical activity, and 63.5% having pain interfere with normal activities. About half had financial problems sometimes, and 68 % reported living with a spouse and children. 30% had hypertension and took antihypertensive medication. 16% felt tired most of the time, and 11% felt nervous all the time. We found that urban older adults had a higher fall rate than rural older adults (52.8% vs. 40.4%, p =.034). Urban older adults also had a higher level of fear of falling than rural older adults (43.9% vs. 28.4%, p = .000016). Additionally, urban older adults had significantly worse general health than rural older adults (p =.0046). There were no significant differences in balance performance and fall self-efficacy scores. It is important to recognize and identify fall risk factors among urban older adults and provide access to systematic community-based fall prevention programs incorporating screening and tailored interventions based on those risk factors.
MUSIC AND QUALITY OF LIFE IN OLDER ADULTS
Authors: Lehmberg Lisa , Fung Victor 
Published: December 2023

Abstract
Research studies have indicated that music is an important contributor to older adults’ quality of life. In this segment, the presenter will share overarching observations from their original research and the literature regarding music making, listening, creating, and activities involving movement to music in relation to facets of quality of life, such as identity, social connections, enjoyment, and self-understanding and expression. These studies were done in a range of contexts (e.g., retirement communities and senior centers), formats (small and large groups, participatory and presentational), and groups that engage in different musical styles (e.g., classical and vernacular). Music has been shown to be critical to the quality of life of those who participate. However, additional research is needed with diverse populations, including those who are homebound, homeless, in supervised care (e.g., assisted living, nursing homes, or hospice care), as well as older adults of varying ages and national origin.
RAPID DIGITAL TRANSFORMATION EXPERIENCES FOR SOCIAL CONNECTEDNESS AMONG LOW-INCOME OLDER ADULTS
Authors: Chung Jane , Gendron Tracey , Winship Jodi , Wood Rachel , Mansion Natalie , Parsons Pamela 
Published: December 2023

Abstract
Digital technology has become critical for making social connections and providing social support during COVID-19. However, social isolation challenges disproportionately affected older adults living alone in low-income communities due to a lack of internet access, digital technology ownership, and limited capital. We conducted a mixed-methods study to examine the role of digital technology in this population to keep socially connected during the national lockdown (N=25; 76% African American). Of the participants, 36% reported social isolation, and 36% reported loneliness. Both quantitative and qualitative data illustrate differential experiences of technology use for remaining socially connected. The qualitative data from focus group interviews show that participants were forced to adapt to the isolated situation quickly by learning about new ways of connecting with others through technology. This enabled a long-overdue adoption of digital technologies among individuals who had experienced digital exclusion before the pandemic. Despite the high interest in digital technology-enabled social connections, concerns about its surveilling nature, the possibility of over-dependence on technology, and negative technology experiences due to unreliable functions or lack of tech support made them hesitant to adopt new technology. Future research should highlight the need to include older adults in all stages of technological solution development that recognize the sociocultural context of use with a focus on growth-oriented opportunities for older people.
IS THERE A WORRY ADVANTAGE? THE ROLE OF FEAR OF LONELINESS IN OLD AGE IN LONELINESS PREVENTIVE ACTIVITIES
Authors: Degen Nora , Kim-Knauss Yaeji , Lang Frieder 
Published: December 2023

Abstract
While worries are generally known to be aversive, behavioral theories have also addressed potential advantages of worrying throughout life. Drawing on this notion, the present study focused on the fear of loneliness in old age and its beneficial effects on individuals’ engagement in loneliness preventive activities. Data were collected from 702 German adults (aged 22-96) who had participated in at least two out of five measurement occasions with a time interval of two years. Fear of loneliness in old age was measured using a single item (i.e., how much do you fear being lonely in old age?) and loneliness preventive activities were measured as a mean score of five social activities specifying the very intention to prevent loneliness in old age (e.g., I actively pursued contacts with friends and acquaintances in order not to be lonely in old age). Based on longitudinal multilevel regression models, we found that at the between-person level old age, female gender, and better health were independently associated with higher average loneliness preventive activities. At the within-person level, participants reported more preventive activities on occasions when they were more feared for the loneliness in old age. Such benefits of fear were particularly reported on occasions when individuals reported less state loneliness at that time. Findings indicate that aging-related worry serves as a motivator for loneliness preventive activities, particularly in situations in which individuals felt socially well connected.
LEISURE ACTIVITIES, MARITAL STATUS, AND COGNITIVE FUNCTIONING IN LATER LIFE IN MEXICO
Authors: Monserud Maria 
Published: December 2023

Abstract
Prior research indicates that leisure activities can shape cognition in later life. However, little is known about whether the implications of specific group and individual leisure activities for older adults’ cognitive functioning can be contingent on marital status and gender and whether physical and mental health can make a difference in the associations between leisure participation and cognition. Moreover, research on the role of these factors in older adults’ cognitive functioning in Mexico has been scarce. Using data from the most recent wave (2018) of the Mexican Health and Aging Study, a nationally representative sample of Mexicans aged 50+, this study examines the implications of group and individual leisure activities for cognition among married and unmarried older men and women in Mexico while considering their physical health (i.e., vision, hearing, chronic conditions, and ADL and IADL limitations) and depressive symptoms. The results suggest that not only group-based but also individual activities can be predictive of cognitive functioning among older Mexicans. The findings also reveal some marital status and gender differences and similarities in the effect of certain leisure activities on cognition. Additionally, the results demonstrate that experiencing physical health challenges and depressive symptoms can prevent older Mexicans from deriving cognitive benefits from some leisure activities. Yet, despite poorer physical and mental health, certain leisure activities can still lead to better cognitive functioning in this population group. The insights from this study can be useful for the development of preventive strategies and intervention programs to improve cognitive health in later life.
UNDERSTANDING THE LONG-TERM EFFECTS OF PUBLIC OPEN SPACE ON OLDER ADULTS’ FUNCTIONAL ABILITY AND MENTAL HEALTH
Authors: Lum Terry , Liu Yuqi , Guo Yingqqi , Lu Shiyu , Chan On Fung , Chui Cheryl , Ho Hung Chak , Song Yimeng 
Published: December 2023

Abstract
Little is known about how public open space (POS) environment quality and vitality influence older adults’ functional ability and mental health over time. POS vitality refers to the capacity of POS to accommodate a variety of users and activities. We undertook a four-year longitudinal survey of 2081 older adults in Hong Kong to investigate longitudinal relationships between POS environment quality, POS vitality, functional ability and mental health. We applied environment quality evaluation and space use behavior observation to collect data on the environment quality and vitality of POSs within the 200-m buffer area of participants’ residences. POS environment quality attributes included the number of leisure facility types, accessibility, shade, and bench quality. POS vitality attributes comprised the diversity of users and activities. We used the Chinese Lawton Instrumental Activities of Daily Living Scale to measure older adults’ functional ability and the Geriatric Depression Scale (15-item) to evaluate mental health. We applied latent growth curve models to analyze the longitudinal associations. Accessibility to POS and social interactions among users in POS were related to better functional ability and mental health among older adults at baseline. The number of leisure facility types, and social interactions among users in POS led to a slower decline in functional ability over time. However, there were no significant associations between POS and mental health over time. These findings have theoretical implications for the healthy aging research framework and practical insights for planning policies using POS as an intervention tool to facilitate older adults’ healthy aging.