bluuebunny/crossref_metadata_2025_split huggingface dataset:
TYPOLOGIES OF SOURCE OF CARE AMONG OLDER ADULTS: A COMPARATIVE STUDY OF CHINA AND THE UNITED STATES
Authors: Kong Dexia , Lu Peiyi 
Published: December 2023

Abstract

Background
We investigated typologies of source of care for older adults in China and the United States and applied Anderson Health Behavior model to examine associated significant determinants.

Methods
Cross-sectional data from 2014 Health and Retirement Study and 2013 China Health and Retirement Longitudinal Study were used. We included older respondents aged 65+ who had at least one limitation in activities of daily living (ADL) and instrumental ADL (IADL) (NChina=2,482, NUS=3,152). Respondents reported whether they received assistance with ADLs and IADLs from spouse, child/grandchild, relatives, other, and formal helpers, respectively. We employed latent class analysis to characterize the typologies of sources of care and multinomial logistic regression to examine the significant determinants of identified typologies.

Results
Four classes were identified in China: class 1 (59.91%) minimal care with IADL assistance from child/grandchild; class 2 (8.66%) child/grandchild-based care; class 3 (27.96%) spouse-based care; and class 4 (3.46%) spouse/child/grandchild-based care. Five classes were identified in the US: class 1 (51.97%) minimal care overall with limited spousal support; class 2 (20.88%) child/grandchild-based care; class 3 (8.44%) spouse-based care; class 4 (13.20%) formal care plus child/grandchild support; and class 5 (6.31%) various sources. In both countries, ADL and IADL were significant determinants.

Conclusion
In the US, sources of care were more diverse and included formal assistance. In contrast, older Chinese relied largely on their spouses and children/grandchildren for support. In both countries, physical circumstances are significant determinants. Policy efforts on supporting family-based care and expanding formal care are needed in both countries, particularly China.
AGING, MIGRATION, AND GRANDPARENTING IN POST–ONE CHILD POLICY CHINA
Authors: Zhang Nan 
Published: December 2023

Abstract
China’s rapid rural-urban migration and population ageing are posing significant challenges to traditional patterns of intergenerational familial support. To tackle population ageing, China’s one-child policy has been replaced by a two-child policy, subsequently a three-child policy. With limited institutional childcare facilities in place, ageing grandparents from rural areas often move to the cities where their adult migrant children settle to provide care for grandchildren. This group of older, rural people are largely marginalised and are invisible on the current research and policy agenda. This ongoing study, conducted in the Yangtze River delta urban area — one of the most developed, crowded, and the largest migrant-receiving urban regions in China — aims to uncover their experiences during the process of migration and adaptation, and establish the way in which this arrangement of grandparenting has impacted their everyday lives and well-being. Three compelling themes emerged at this stage: 1) intensified caring responsibilities imposed on older women largely owing to patriarchy; 2) intersection of old age, being women and exclusion of social welfare due to having a rural origin contribute to poor well-being; 3) the feeling of a lack of balance in terms of family exchange over the life course is not uncommon. It is possible that urbanisation will reinforce vulnerability and marginalisation of and exacerbate social exclusion of older women from rural origin. This project will form an important evidence base to tackle issues such as social exclusion of disadvantaged communities in China against the backdrop of rapid population ageing and urbanisation.
CONNECTING OLDER ADULTS AND DOCTOR OF PHYSICAL THERAPY STUDENTS THROUGH A COMMUNITY-BASED EXERCISE PROGRAM
Authors: Moriello Gabriele , Hamilton Alice , Bush Julie , Nunno-Evans Michelle , Schoellig Shannon , Hollins Nancy 
Published: December 2023

Abstract
The purpose of this qualitative study was to explore the perspectives of older adults regarding their experience participating in an intergenerational Integrated Clinical Experience (ICE) with Doctor of Physical Therapy (DPT) students. This ICE was designed as a community-based exercise program for older adults. DPT students designed individualized one-hour fitness plans for participants every week over the course of a semester. To obtain the perspectives of older adults, a descriptive phenomenological approach was chosen. A purposive sample of 16 older adults involved in the wellness program participated in 6 focus groups and one interview. Results of the thematic analysis revealed six themes; Blending of the Generations, It Motivated Me, I Can Do It Now, Mental and Social Boost, Program Tailored to Me, and Learn and Modify Habits. Participant interviews highlighted how older adults highly valued the relationships with students, and how the intergenerational environment of the program benefited their physical, social, and mental well-being. They also noted how students served as a source of motivation, leading to behavioral change and improvements in functional outcomes. These findings support existing literature on intergenerational programs, but this is one of the few studies that looked specifically at an intergenerational ICE. This ICE provided an innovative manner to meet the physical challenges faced by many older adults, and the intergenerational nature of the experience may have contributed to the well-being of all those involved. Future research using quantitative methods are needed to extend what was learned beyond the specific context of this study.
SOCIAL DETERMINANTS OF HEALTH RELATED TO GENREAL PHYSICIAN VISITS IN OLDER ADULTS LIVING WITH MULTIMORBIDITY
Authors: Benjasirisan Chitchanok , Lim Arum , Liu Xiaoyue , Ogungbe Oluwabunmi , Himmelfarb Cheryl Dennison , Davidson Patricia , Koirala Binu 
Published: December 2023

Abstract
Multimorbidity- the presence of two or more chronic conditions- is a global concern and is commonly associated with aging. Multimorbidity results in diminished physical function, higher healthcare utilization, and increased mortality rates. To understand healthcare challenges and increase prevention and continuity of care among older adults living with multimorbidity, the social determinants of health (SDoH) affecting general physician visits need to be explored. This study aimed to examine SDoH associated with general physician visits among 50 years and older adults living with multimorbidity using cross-sectional data from the 2010 to 2018 National Health Interview Survey. The SDoH, including marital status, race/ethnicity, education, poverty-income ratio, employment, health insurance, and having a usual place for medical care, were explored using logistic regression. The outcome was at least one visit to the general doctor’s office, a clinic, or elsewhere in the last 12 months. Among 25,108 participants (mean age ± SD was 68.1±10.16 years, 55.5% female, with 2.7±0.95 average number of self-reported morbidities) adjusted analysis controlling for age, sex, and categories of comorbidities found that Hispanic (OR=0.78, 95%CI=0.66-0.91), living below the poverty level (OR=0.79, 95%CI=0.68-0.92), and uninsured (OR=0.52, 95%CI=0.42-0.63) had lower odds of having one or more physician visits. Being unemployed (OR=1.26, 95%CI=1.11-1.42) and having a usual place for medical care (OR=7.94, 95%CI=6.39-9.86) had higher odds of having one or more physician visits. The result suggested that SDoH should be considered to navigate targeted health programs and policies to improve prevention and management of multimorbidity as well as to promote health equity.
A DIGITAL LIFE STORY BOOK ACTIVITY FOR OLDER ADULTS WITH MEMORY DIFFICULTIES: PROGRAM EVALUATION
Authors: Barbour Elizabeth , Lind Majse , Bluck Susan 
Published: December 2023

Abstract
Reminiscence activities are based on maintaining a core set of personal memories to aid self-continuity (Woods, 2012). Some interventions find limited effects (Charlesworth et al, 2016) but with participants reporting high satisfaction with the program. The aims of the current study were to: (i) demonstrate feasibility of intervention delivery to older individuals with memory difficulties, and (ii) provide analyses of program efficacy using a pre-posttest, control group design. Participants (N = 45; Mage = 76.12) were randomized to the Life Story Book intervention or Waitlist Control. A Life Story Book Interview was developed, using five evidence-based principles of autobiographical memory. Personalized multimedia books were created and reviewed by participants for fourteen days. To assess feasibility, participants in the intervention completed a memory quality questionnaire and feedback survey. Those who reviewed Life Story Books reported improved memory quality pre-post intervention, t(22) = -2.39, p = .026. Participants also positively rated their intervention experience at post-test, (M = 4.46/5). All participants completed self-related questionnaires (e.g., self-continuity, self-esteem) at pretest-posttest. No measure showed significant effects. Our results represent a conundrum for researchers. We provide evidence of feasibility of, and participant enthusiasm for, this reminiscence-based intervention. As seen in the literature, however, (Elfrink et al., 2021), sensitivity to detect pretest-postest change remains a challenge. The current study highlights participants positive reactions to reminiscence-based Life Story Books. Findings are discussed in terms of methods for assessing intervention efficacy in individuals with memory decline.
CONSEQUENCES OF PERCEIVED STRESS ON COGNITIVE DECLINE AND BLOOD PRESSURE AS A MODERATOR IN OLDER BLACK AMERICANS
Authors: Byrd DeAnnah , Coon David , Thorpe Roland J , Whitfield Keith 
Published: December 2023

Abstract
Previous research suggests that perceptions of stress shape cognitive health outcomes. However, few studies have explored this association longitudinally. The aim of this study was to determine whether perceived stress is associated with cognitive changes over time and if blood pressure (BP) acts as a moderator in a sample of older Blacks 48 to 95 years of age, who were enrolled in the Baltimore Study of Black Aging—Patterns of Cognitive Aging and interviewed at two time points, approximately 3 years apart (N = 450). Cognition included 5 domains: working memory, processing speed, verbal memory, vocabulary, and inductive reasoning. Three readings of orthostatic BP were collected and mean systolic (range = 82-230.3 mmHg) and diastolic BP (range = 51-136.7 mmHg) values were calculated for each participant. Results from the linear regression model showed no direct effect of perceived stress on cognitive decline. Systolic (F(3,426)= 4.37, p= 0.0048) and diastolic (F(3,426) = 3.26 p=0.0215) BP modified the relationship between stress and inductive reasoning at follow-up but was not related to any other cognitive domains, adjusting for age, sex, education, depressive symptoms, comorbidities, and baseline cognition. These important findings demonstrate the joint effects of stress and BP on cognition, highlighting the need for more research documenting the underlying processes and risk factors for domain-specific cognitive decline. The potential benefits of this approach provide a basis for developing cognitive interventions for this population of Black Americans.
CAREGIVER IDENTITY IN EMERGING ADULTHOOD: HOW IDENTITY DISCREPANCY AND SALIENCE RELATE TO DISTRESS
Authors: Canell Anastasia , Caskie Grace 
Published: December 2023

Abstract
As the older adult (age 65+) population grows in the United States, the demographics of caregivers are expanding to include more emerging adults (ages 18-25) who are participating in caregiving tasks. Minimal research has focused on this subgroup of caregivers to older adults, especially with regards to understanding factors that may influence their levels of caregiver distress. Guided by caregiver identity theory, the current study examined 1) the relationship between caregiver identity and caregiver distress, 2) support service utilization as a mediator between caregiver identity and caregiver distress, and 3) the inclusion of ageist attitudes within caregiver identity models. A sample of 259 emerging adult caregivers were recruited through Amazon MTurk. Fit of the hypothesized structural equation model was acceptable and squared multiple correlations (R2) indicated that 73.1% of the variance in caregiver distress, 23.8% of the variance in support service utilization, and 22.7% of the variance in ageist attitudes was explained by this model. Higher caregiver identity salience was significantly related to lower caregiver distress. Support service utilization partially mediated the relationship between identity salience and distress through an inconsistent mediation. The findings of the current study support caregiver identity as a unique, multidimensional process consisting of both identity discrepancy and salience latent constructs. Results showed low-to-moderate caregiver identity discrepancy, possibly due to identity flexibility during this developmental period. High caregiver identity salience was protective against caregiver distress for emerging adults. Ageist attitudes warrant inclusion in future research on caregiving identity development. Implications for support services are discussed.
EXPERIENCES AND SUPPORTIVE CARE NEEDS OF LATINX MILLENNIAL CAREGIVERS
Authors: Welling Anna , Hebdon Megan Thomas , Dupree Galilea , Horner Sharon , Thomas Michael , Peterson Neil , Hernandez Janice , Cuevas Heather 
Published: December 2023

Abstract
Latinx millennial caregivers are the largest ethnic minority subgroup within the millennial caregiving cohort. Due to age and life stage, members of this understudied group must often manage the competing priorities of career, family, and caregiving. Layered with these challenges are the experiences of being part of a minority group in the United States, with systemic barriers impacting access to healthcare, insurance, a safe built environment, and educational opportunities. The purpose of this qualitative descriptive study was to explore the experiences and needs of Latinx millennial caregivers. Participants were recruited locally and nationally using recruitment flyers and social media advertising. Data were collected from 29 participants using five focus group interviews and one individual interview. Data analysis using interpretive thematic analysis and inductive coding occurred. Twenty female and nine male Latinx millennial caregivers participated in the focus groups. Two meta-themes threaded throughout the analysis included the Latinx experience (immigrant background, Latinx culture, and navigating barriers as a minoritized individual) and being a super-caregiver. Main themes were identified: family well-being, occupational and financial well-being, social support dynamics, challenges and rewards of family caregiving, and coping strategies. Family and community were emphasized in all main themes. In this study, the importance of family and community relationships motivated caregiving and were areas where support was needed for Latinx millennial caregivers. Interventions and clinical support for these caregivers is needed that addresses their cultural background, the value of family and community, and the barriers they experience to accessing care and support.
PREPAREDNESS AND NEEDS AMONG YOUNG, MIDDLE-AGED, AND OLDER ADULT LATINX CAREGIVERS
Authors: Kopera-Frye Karen , Srejon Refat 
Published: December 2023

Abstract
Taking care of one’s family is a primary obligation among Latinx communities. According to CDC’s Behavioral Risk Factor Surveillance System, 22.9% of New Mexican adults reported providing care to a friend or family member in the past 30 days; 10.4 % provided care to an individual with dementia. The southern Border region of New Mexico is remote and desert, with high rates of poverty and inaccessibility to health care and services. Caregivers may feel unprepared for caregiving, lack the knowledge and skills required to provide care, but struggle through because of the importance of La Familia. Adverse physical and psychological consequences have been found; yet those who report greater preparedness exhibit lower levels of strain. Seventy-six primarily female and healthy Latinx caregivers (age range 20-76 years, 30% young, 40% middle-aged, and 30% older adults) were surveyed on caregiving they provide, administered the Preparedness for Caregiving Scale, and asked what types of services are needed in their role. Results indicated the top three provided aspects of caregiving were (in descending order): Food, emotional support, and transportation. Caregivers reported a high degree of preparedness in taking care of the recipient’s physical needs, handling emergencies, and proving overall care. Needed resources included emotional support, financial assistance, and respite. Greater caregiving provision was significantly associated with better health (r =. 53, p = .09) and greater resource needs (r = .35, p &lt;.01). Thus, level of preparedness is an important caregiving dimension to address, especially with culturally diverse communities having strong cultural caregiving norms.
A LEAP! FORWARD?: DOES PERSONALIZED EXERCISE HELP MAINTAIN COGNITIVE FUNCTION IN OLDER ADULTS?
Authors: Medina Valerie , Burns Jeffrey M , Vacek James L , Mahnken Jonathan , Clutton Jonathan , VanSciver Angela , Watts Amber 
Published: December 2023

Abstract
Maintaining cognitive function is important to health in older adulthood. Physical activity can decrease the risk of cognitive decline in older individuals. We tested whether LEAP! Rx, a personalized exercise, and lifestyle education program would improve cognition in older adults. We randomized 220 participants (Mean age (SD) = 72 (4.83)), into the program or a control group. We used the NIH Toolbox Cognitive Battery to assess cognition. We analyzed change in cognitive performance from baseline to week 12 using repeated measures ANCOVA to compare the intervention and control groups, adjusting for age, gender, and education. Referral source (self- vs. physician-referred), treatment group (intervention vs. control), and measurement time (baseline vs. week 12) had a significant three-way interaction F(8, 212) = 4.57, p&lt; 0.05. That is, clinician-referred participants in the intervention group improved more (vs. the clinician-referred control group), whereas self-referred control group participants improved more (vs. the self-referred intervention group). Older age, male gender, and lower education predicted poorer verbal learning F(1,218 = 18.79, p&lt; 0.05; F(1, 218) = 28.67, p&lt; 0.05; F(1, 219) = 4.13. Overall, cognitive scores improved more over 12 weeks in the intervention group compared to the control group. Thus, we conclude that personalized exercise programs may enhance or maintain cognitive function in older adults. The differences we observed in physician-referred versus self-referred participants has implications for implementation and scalability of health behavior change interventions, as well as implications for recruitment methods and representation in clinical trials research broadly.
IMPACT OF CAREGIVING HOURS ON COGNITIVE OUTCOMES ACROSS ADULTHOOD
Authors: Bhattacharyya Kallol Kumar , Molinari Victor , Liu Yin , Fauth Elizabeth 
Published: December 2023

Abstract
Being a caregiver has been associated with poorer physical health and well-being. The current study expands prior work by comparing cognitive functioning among individuals who were caregivers versus non-caregivers, and further examined varying caregiving hours and cognitive functioning among caregivers. Data were from waves 2 (2003-04) and 3 (2013-14) of the Midlife in the United States (MIDUS) study. A total of 2,075 individuals aged 35-86 years (Mage=55±11) were included from wave 2. We identified individuals who served as a caregiver in the past 12 months (N=264) at wave 2. Cognitive functioning was assessed by composite scores for both executive function (inductive reasoning, category verbal fluency, working memory span, processing speed, and attention switching and inhibitory control) and episodic memory (immediate and delayed free recall of 15 words). We used multiple linear regression models to examine associations between wave 2 caregiving versus non-caregiving status on wave 3 cognitive functioning (Model 1); and, among caregivers at wave 2, varying caregiving hours and wave 3 cognitive functioning (Model 2). After controlling for covariates on sociodemographic factors, and health and functional status at baseline in Model 1, caregiving was associated with better performance in episodic memory (b=.13, p&lt;.05), but not executive function (b=-.06, p=.09). Model 2 revealed no significant association for either episodic memory or executive function. The findings supported the healthy caregiver rather than the stress process hypothesis, and that former caregiving may be associated with better memory functioning over time among middle-aged and older adults.
SEDENTARY BEHAVIORS AND COGNITION: DOES THE TYPE OF BEHAVIOR MATTER?
Authors: Wingood Mariana , Bouldin Erin , Gell Nancy 
Published: December 2023

Abstract
Older adults spend 80% of their waking hours performing sedentary behaviors (SBs) that are either mentally active (e.g., using computers, socializing, and completing hobbies) or passive (e.g., television viewing and resting). Cross-sectional studies report an association between passive SB participation and cognitive impairments. However, longitudinal impact of baseline SB participation on cognition is unclear. We addressed this gap by using the National Health and Aging Trends Study (NHATS) dataset to run competing risks proportional hazards models. In our models, participants were identified as having an event (i.e., outcome) if their cognition scores dropped ≤ 1.5 standard deviations (SD) below the mean during follow-up (rounds 7-11, years 2017-2021). Competing risks included moving to long-term care facilities or dying. Our analyses included 1,574 community-dwelling older adults (mean age 84, SD = 7.1) who completed the sedentary module included in round 6 (year 2016) and had intact orientation, recall, and executive function at baseline. The majority of participants were female (55%) and non-Hispanic white (78%), and reported good or excellent health (80%). We identified that participating in active SBs had a protective effect on orientation, recall, and executive function (subdistribution hazard ratios [SHR]= 0.28-0.46, p&lt; 0.001-0.02). Activities that had significant protective effects across all models included using computers (SHR =0.15-0.46, p=&lt; 0.001-0.001) and socializing (SHR=0.27-0.52, p= &lt; 0.001-0.05). Passive SBs did not have significant SHRs. Our identified protective effects highlight the potential of preventing cognitive impairments through active SB programs. Intervention studies are needed to develop program protocols and identify effectiveness of active SB programs.