bluuebunny/crossref_metadata_2025_split huggingface dataset:
EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY
Authors: Shen Jay , Yoo Ji , Kim Pearl 
Published: December 2023

Abstract
In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Fifty eight community-dwelling adults aged 67 to 94 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and level of physical impairment was matched. Main outcomes were (A) hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. Twenty nine patients were cared by primary care providers who received the IPETC;29 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021. An average cost-saving of $22,135 per patient was observed among those treated by the healthcare providers who received the IPE/telehealth curriculum training than those treated by the providers without the training. CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.8% to 42.8% in documented advance care plans. Innovative interdisciplinary education and telehealth primary care has shown improvement of quality and efficiency of dementia care in a provider shortage area.
TECHNOLOGY-ASSISTED CARE PLANNING IN PRIMARY CARE OF A PROVIDER SHORTAGE AREA
Authors: Kang Mingon , Kim Laurie , Yoo Ji 
Published: December 2023

Abstract
We applied faireness algorithm to identify and mitigate bias in healthcare system. We also developed DeepPlan soft that can assist primary care providers, patients and caregivers with providing real-time risk prediction system, for example, discussing nursing home placement and designation of power of attorney. Our DeepPlan was built using cloud database system than can be exchangeable in secure way between patients and primary care providers. We linked DeepPlan use to workforce education and now we are ready for presenting education and patient clinical outcomes of using DeepPlan in primary care in a provider shortage area.
EPIDEMIOLOGIC GEROSCIENCE INNOVATIONS AT THE NEXUS OF REPRODUCTIVE AGING AND WOMEN’S HEALTH
Authors: Shardell Michelle 
Published: December 2023

Abstract
Signs of reproductive aging in women usually begin in women’s 30s and co-occur with declining circulating estrogen concentrations and irregular menstrual cycle onset. Menopause, defined by cessation in menstruation for ≥1 year, occurs on average at age 51 years, but about 1% experience menopause before age 40. Menopause and reproductive aging contribute to multiple health conditions such as certain cancers; however, a less studied condition is the genitourinary syndrome of menopause (GSM). GSM signs and symptoms include vulvovaginal atrophy, vaginal dryness, urinary tract infections, and more. Additionally, menopause leads to increased risk of osteoporosis, dementia, and other aging-related conditions. Given the multifactorial implications of reproductive aging in women’s health, an interdisciplinary geroscience-guided framework for epidemiology of aging is needed to identify biological contributors and consequences of reproductive aging to develop healthspan-enhancing interventions. In this symposium, we present five new developments across multiple stages of reproductive aging, consistent with meeting theme “Building Bridges. Catalyzing Research. Empowering All Ages”. Among women aged 35-60 years, we assess the role of cervical “inflamm-aging” in GSM; diabetes and vaginal dysbiosis associations with GSM; and vaginal microbial and metabolic signatures of urinary conditions/dysfunction. Among women aged ≥65 years, we examine associations of post-hip fracture sex hormones with physical recovery and links between age and type of menopause with Alzheimer’s disease. Building on the 2021 Journals of Gerontology Series A special issue on intersections of reproductive and aging biology, we discuss opportunities to advance reproductive aging and women’s health research by combining molecular assessment with rigorous epidemiology. This is a collaborative symposium between the Epidemiology of Aging, Geroscience, and Women’s Issues Interest Groups.
ASSOCIATIONS OF URINARY CONDITIONS WITH VAGINAL MICROBIOTA AND METABOLITES ACROSS REPRODUCTIVE STAGES
Authors: Shardell Michelle , Robbins Sarah , Borgogna Joanna-Lynn , Stennett Christina , Yeoman Carl , Burke Anne , Ravel Jacques , Brotman Rebecca 
Published: December 2023

Abstract
The genitourinary syndrome of menopause describes signs/symptoms of the female genitourinary tract, including urinary symptoms/conditions, resulting from declining estrogen in menopause. Menopause is also associated with declining abundance of Lactobacillus spp. in the vagina. Vaginal and urinary microbiota are highly concordant, where low abundance of certain Lactobacillus spp. have demonstrated associations with urinary symptoms/conditions. The vaginal microenvironment also includes microbially- and host-produced metabolites that may impact genitourinary health. Thus, we aimed to identify vaginal microbial and metabolic signatures of urinary conditions. In a two-year cohort study comprising 476 participants aged 35-60 years who contributed 1,153 semiannual person-visits, 15.2% (27/178) postmenopausal and 10.4% (31/298) non-postmenopausal participants self-reported a history of urinary conditions (overactive bladder, recurrent urinary tract infection[UTI], or cystitis). Among postmenopausal participants, history of urinary conditions was associated with higher covariate-adjusted odds of L. gasseri-dominated (OR[Odds Ratio]=4.29, 95% Confidence Interval[CI]=1.31-14.88) versus L. crispatus-dominated communities. Significant metabolites were enriched for the lipids sphingomyelins and metabolites involved in glycolysis (P&lt;.05). Urinary conditions were associated with joint microbiota-metabolite profiles characterized by higher sphingomyelins, pyruvate, and genera Varibaculum and Escherichia; and lower dihydroxyacetone phosphate, nicotinamide, Gardnerella vaginalis, and genus Fusobacterium (P&lt;.001). In contrast, among non-postmenopausal participants, urinary conditions did not significantly relate to microbial community (P&gt;.10); however, sphingomyelins remained significantly enriched (P&lt;.05). Signatures among postmenopausal participants include known UTI pathogen E. coli and metabolites that may facilitate and fuel its growth. Among non-postmenopausal participants, urinary conditions more strongly related to metabolic profiles than microbiota. Investigation of these signatures in incident/recurrent urinary conditions is needed.
HEALTH BEYOND DISEASE IN OLD AGE: RELATIONSHIP OF INTRINSIC CAPACITY WITH HEALTH CARE UTILIZATION
Authors: Si Yafei 
Published: December 2023

Abstract
In contrast to the traditional disease-centered approach, intrinsic capacity (IC) is a fine-grained and comprehensive measure of overall health. It plays an essential role in the healthy aging model proposed by the World Health Organization. However, how IC contributes to healthcare utilization and medical expenditures beyond the presence of chronic conditions in old age is not well understood. Data were from the China Health and Retirement Longitudinal Study. We used a validated, multidimensional tool (locomotor, cognitive, psychological capacity, sensory capacity, and vitality) for assessing IC at baseline (Wave 2011). Outcomes include outpatient and inpatient use, and their expenditure measured in Wave 2013. We used logistic and linear regression models to identify the association of IC with healthcare utilization, adjusting for demographics, lifestyles, and multi-morbidity (the presence 2+ out of 14 chronic conditions). We included 14,887 participants, and equally categorized them into three groups (low, intermediate, and high IC). Compared with those with a low IC, older adults with an intermediate level or high level of IC had a significant reduction of outpatient use (OR=0.80, 95% CI=0.72-0.90; OR=0.61, 95% CI=0.53-0.69) and inpatient use (OR=0.69, 95% CI=0.58-0.81; OR=0.58, 95% CI=0.49-0.70), after adjusting for demographics, lifestyles, and multi-morbidity. We did not find a significant association between IC and healthcare expenditure. Assessment of IC for older adults provides valuable information for healthcare use beyond chronic conditions. Assessment of IC in routine clinics may help screen for older adults with high healthcare utilization, which could optimize the allocation of healthcare resources and improve patient-centered care.
ENHANCING CARE FOR OLDER VETERANS WITH COMPLEX PHYSICAL, COGNITIVE, AND PSYCHOLOGICAL COMORBIDITIES
Authors: Gregg Jeffrey , Gould Christine , Karel Michele 
Published: December 2023

Abstract
Older veterans present in healthcare settings with more diagnoses than younger veterans and non-veteran older adults. Older veterans are also more likely to present with co-occurring physical, cognitive, and psychological conditions that are difficult to assess and treat. This is further complicated by the fact that many older veterans reside in rural areas without easy access to specialty care and, even in non-rural settings, there is a dire shortage of providers with geriatric expertise both within and outside of the Veterans Health Administration (VHA) system. The current symposium highlights promising findings from a variety of VHA programs aimed at enhancing the quality and reach of care provided to older veterans with complex needs. First, Dr. Bamonti will present mixed-methods results from her work in the development of Step-Cognitive Behavioral Therapy, a novel virtual intervention for older veterans with COPD. Second, Ms. Carlson will describe program evaluation outcomes from a project aimed at expanding geriatric mental health services via telehealth to older veterans with complex needs residing in rural areas. Third, Dr. Peeples will discuss factors affecting the implementation of the VA Behavioral Recovery Outreach Team model, which is aimed at facilitating successful discharge from inpatient settings and preventing rehospitalization for older veterans. Finally, Dr. Gregg will describe qualitative findings examining a component of the Geriatric Scholars Program for Psychologists, a national post-licensure training program for psychologists treating older rural veterans with complex needs. Dr. Karel, National Director of VHA Geriatric Mental Health, will close with discussion and highlight future directions.
BUILDING COMMUNITY RELATIONSHIPS FOR MORE MEANINGFUL ENGAGEMENT WITH OLDER BLACK ADULTS
Authors: Fuller Patrice , Fennell Charles , Lindauer Allison , Croff Raina 
Published: December 2023

Abstract
Black people are grossly underrepresented in clinical trials, especially in Oregon, where only 2% of the population is Black. The Oregon Alzheimer’s Disease Research Center’s (OADRC) Outreach, Recruitment, and Engagement (ORE) Core aims to correct this disparity by promoting research participation, fostering retention, and supporting quality experiences for Black Oregonians. Essential to this goal has been having an ORE Core that is 50% Black, leaders experienced in Black-centered cognitive health research, and a team that demonstrates commitment to community partnerships. The ORE Core engages a Community Outreach Specialist (COS) whose efforts reflect our Core’s value of “service before sign-up.” The COS differs from a traditional “recruiter” in that the focus is on community relationship-building, rather than recruitment. This can only be supported by first serving the community (e.g., joining community boards, volunteering) before asking community members to sign-up for research. The OADRC promotes research participation by supporting studies that focus exclusively on older Black health. The African American Dementia and Aging Project, supported by a valuable community health partnership, aims to understand lifestyle factors affecting cognitive health. The Sharing History through Active Reminiscence and Photo-imagery Study (SHARP) aims to improve brain health through a culturally celebratory framework centering the Black experience. As a result, SHARP has sustained high retention rates and increased Black participation in Center research. We discuss the role of ORE Cores, the role, values, and reflections of our COS, and examine how Center studies foster sustained community relationships, ultimately for more meaningful engagement within the Black community.
FROM CELLS TO SYSTEMS
Authors: Kheirbek Raya , Latham-Mintus Kenzie 
Published: December 2023

Abstract
Individuals who have been incarcerated may experience chronic pain due to various reasons, such as physical injuries sustained during their time in prison, untreated chronic medical conditions, or addiction to prescription medications. The pain may persist into late life, resulting in reduced quality of life, increased healthcare costs, and limited access to end of life care and hospice services. This issue requires collaboration among experts in pain management, geriatrics, and palliative care to develop effective interventions that address the unique needs of this population. Suicide among veterans is another pressing issue that requires an interdisciplinary approach. Incarcerated veterans may face numerous challenges upon release, including limited access to healthcare and social support, economic instability, and the stigma associated with a criminal record. These factors may contribute to increased risk of suicide. Addressing this issue requires a collaborative effort among experts in mental health, social work, and criminal justice to develop comprehensive programs that provide support for veterans transitioning from incarceration to civilian life. Being imprisoned can have lasting negative health consequences that persist throughout a person’s lifetime. Incarcerated individuals may face limited access to quality end-of-life care and hospice services, resulting in increased suffering during their final days. The experience of incarceration can also lead to social isolation and stigma, exacerbating mental health issues and further decreasing the quality of life at the end of life. Effective interventions are needed to address the unique healthcare needs of incarcerated individuals, particularly as they approach the end of life
PROFILES OF OLDER INCARCERATED PERSONS WHO ATTEMPT SUICIDE FOLLOWING RELEASE
Authors: Barry Lisa , Li Yixia , Byers Amy 
Published: December 2023

Abstract
Release from incarceration is a strong risk factor for suicide. Yet little is known regarding factors associated with suicide attempt among older adults who reentered the community following incarceration. Leveraging a national cohort of U.S. veterans age ≥50 released from incarceration between FY2007 and FY2018 (N=30,584), we conducted a 1:3 matched case-control study and compared demographic and comorbidity factors between those who attempted suicide (cases, N=643) and those with no suicide attempt (controls, N=1,929) up to 13 years post-release. Comorbidity profiles were determined using latent class analysis. As compared with controls, cases had higher proportions of chronic illnesses (e.g., chronic lung disease [35.2% vs. 19.6%], diabetes [32.2% vs. 19.4%], Hepatitis C [24.9% vs. 9.6%]); depression (75% vs. 28.7%); substance use disorders (SUDS) (83.0% vs. 39.4%); and other serious mental illnesses (SMI) (e.g., schizophrenia [34.2% vs. 13.2%], psychotic illness [39.5% vs. 12.5%]). We found four distinct latent clusters among cases (entropy statistic = 0.80): (1) “Minimal Comorbidity” (18%); (2) “PTSD/SUD” (35%); (3) “High Psychiatric/SMI” (32%); and (4) “High Medical/Psychiatric Comorbidity” (15%), and four clusters among controls (entropy statistic = 0.84): (1) “Minimal Comorbidity” (50%); (2) “SMI” (8%); (3) “Tobacco dependence/SUD” (33%); and (4) “High Medical/Psychiatric Comorbidity” (9%). Compared with controls, fewer cases were likely to have the “Minimal Comorbidity” profile (18% vs. 50%), whereas more were likely to have profiles with SMI (32% vs. 8%). Establishing comorbidity profiles of older persons reentering the community after incarceration may help determine who is more likely to die by suicide, thus informing prevention efforts.
BIOLOGICAL MARKERS OF FALLS IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT
Authors: Pieruccini-Faria Frederico , Okuyan Canan , Sarquis-Adamson Yanina , Son Surim , Sultana Munira , Montero-Odasso Manuel 
Published: December 2023

Abstract
Mild Cognitive Impairment (MCI) nearly doubles the risk of falls in older adults. While the association between cognition and falls risk is relatively well understood, no study has explored how biological markers of organic integrity contribute to falls risk in MCI. This study aimed to identify biological markers that could be associated with an increased rate of incidental falls in MCI. A total of 142 participants with MCI (aged 74.3 ± 6.1 years;75% women) with blood tests performed at baseline in Gait and Brain Cohort Study were analyzed. Participants were followed up to 7 years (mean of 28 ± 22.1 months), and falls were reported during the follow-up period(70% fell). Eighteen biological markers extracted from blood serum were dichotomized into low and moderate-to-high levels based on tertile cut-offs. Negative binomial regression model was used to estimate the incident rate ratio (IRR) of falls for biological markers, adjusted for age, sex, global cognition, gait speed, total follow-up duration, and history of falls in the past 12 months at baseline. Results showed that low Parathyroid Hormone (PTH) level (IRR=1.73; 95%CI=1.07, 2.79; p=0.02) and moderate-to-high Interleukine-8 (IL-8) level (IRR= 1.81; 95%CI 1.05-3.14; p=0.03) were associated with an increased rate of falls during the follow-up. Moderate-to-high IL-8 level was also associated with an increased rate of falls with injuries (IRR=2.07; 95%CI=1.05, 4.08; p=0.03). This suggests that in addition to cognitive deficits, impaired calcium metabolism caused by low PTH level and inflammatory processes affecting internal organs may increase falls risk in older adults with MCI.
RETINAL AGING IN COMPANION DOGS
Authors: Mowat Freya , Salzman Michele , Merten Natascha , Rogers Callie 
Published: December 2023

Abstract
Companion dogs cohabit with humans in approximately 45% of US households. They experience similar environmental exposures and lifestyles to their human companions, and have shown sensory, cognitive, and neurological decline with aging. The relationship between age and retinal neurologic function in dogs has not been described. The aim of this study was to determine associations between age and retinal full-field electroretinographic measures in companion dogs, an important translational model species for human neurologic aging. Healthy adult companion dogs with no ophthalmic abnormalities were included (n=54, 18 male, 36 female, median weight 25.7kg, median age 89 months). Unilateral full-field light-adapted and dark-adapted electroretinography (ERG) was performed using a handheld device, with mydriasis and topical anesthesia. Standard least squares effect leverage models were used with log transformed data to determine the cross-sectional effect of age, sex, and bodyweight on ERG amplitudes and peak times. Age and sex were significantly associated with ERG outcome variables, more consistently with ERG amplitude than peak time; age had the largest and most significant effect leverage on outcomes (significantly affecting 3/9 peak time and 8/10 amplitude outcome variables). Younger and female dogs had higher ERG amplitudes. Body weight had no significant effect on any outcome. Our finding that aged companion dogs have reduced ERG amplitudes and prolonged peak times mirror ERG findings in aging humans. Because dogs have a shorter lifespan compared with humans, they may act as a sentinel species to monitor for emerging risk factors for age-related neurologic decline.
TRAJECTORIES OF C-REACTIVE PROTEIN OVER THE MENOPAUSE TRANSITION: THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION
Authors: El Khoudary Samar , Qi Meiyuzhen , Chen Xirun , Greendale Gail , Karlamangla Arun , Matthews Karen 
Published: December 2023

Abstract
Inflammation is a mechanistic pillar of aging contributing to the pathogenesis of several common medical conditions. Numerous in-vitro and animal experiments support a link between estrogen decline over the menopause transition (MT) and inflammation. Whether the MT per-se is associated with increased inflammatory load is not obvious. Using longitudinal data from 1,459 (11,373 observations) women (at baseline: 42-52 years old; underweight/normal 39.6%, overweight 28%, obese 32.4%; White 44.5%, Black 27.8%, Chinese 10.7%, Japanese 12.1%, Hispanic 4.9%) with a known final-menstrual-period (FMP) date and at least 3-measures of high sensitivity C-reactive protein (hs-CRP) spanning between 10 years before to 14 years after FMP, we characterized trajectories of hs-CRP and their associations with premenopausal obesity and race/ethnicity. Observations indicating acute inflammation were deleted and data were censored at first use of hormone therapy. Group-based trajectory modeling adjusted for time-varying smoking-status and steroids/statin use was utilized to identify trajectories. LOESS plots and piecewise linear mixed-effects models were used to determine if trajectories were linear or had inflection points around FMP. Three distinct hs-CRP trajectories were identified: low-rise (low-level significantly increased 2.5Yrs after FMP; 26.6%), medium-stable (remained stable across MT; 41.7%), and high-decline (high-level significantly declined at FMP; 31.7%). White women were more likely to show the medium-stable trajectory, Black and Hispanic the high-decline, and Chinese and Japanese the low-rise trajectory. Premenopausal obesity predicted the high-decline trajectory, underweight/normal predicted the low-rise, while overweight predicted the medium-stable trajectory. Heterogeneous patterns of hs-CRP over the MT exist and are related to women’s race/ethnicity and premenopausal obesity.