bluuebunny/crossref_metadata_2025_split huggingface dataset:
REVOLUTIONIZING DIGITAL ENGAGEMENT: EFFECTS OF AN APP ENABLING PERSONS WITH DEMENTIA TO LEAD ACTIVITIES FOR PEERS
Authors: Skrajner Michael , Gorzelle Gregg , Zeisel John , Walker Drew 
Published: December 2023

Abstract
A Cluster Randomized Trial was conducted to evaluate the effects of an app that enables long-term care (LTC) residents with early-stage dementia to lead activities for their peers—i.e., other persons living with dementia (PLWD). A total of 72 PLWD completed the study, including 35 Control Group PLWD (Standard Programming) and 37 Experimental Group PLWD (Resident-Led Programming). Resident-Leaders exhibited 99% overall adherence to the steps required to lead activities and required minimal help from staff. A series of repeated measures ANCOVAs, controlling for Mini Mental State Examination (MMSE) scores, were conducted to examine proximal (immediate) and distal (longer-term) effects of the intervention. Regarding proximal effects, there were significantly greater increases from baseline to treatment in Constructive Engagement (p&lt;.01), Passive Engagement (p&lt;.01), and Pleasure (p&lt;.01), as well as significantly greater decreases in Distracted Engagement (p&lt;.01) and Passive Engagement (p&lt;.01), for the Experimental Group, as compared to the Control Group. Regarding distal effects, there were no significant differences between trends observed by Control and Experimental Group residents from baseline to post-treatment for neuropsychiatric symptoms, agitation, depression, or quality of life. However, for a subsample of the Experimental Group (PLWD who resided in Assisted Living), there was a significant decrease in depressive symptoms (p&lt;.05) and increase in quality of life (p&lt;.01). Data suggest that this is a highly engaging intervention that enables PLWD to lead activities for their peers. The intervention has its greatest impact during the session, when positive forms of engagement/affect are increased, and negative forms of engagement are decreased.
THROUGH THEIR LENS: A PHOTOVOICE STUDY OF OLDER ADULTS’ EXPERIENCES OF ACCESSIBILITY AND AGING IN COMMUNITY
Authors: Lee Yeonjung , Migrino Lauren , Deloria Rochelle , Robertson Kurt 
Published: December 2023

Abstract
The objective of this research is to explore the lived experiences and perceptions of older adults in relation to aging in community and accessibility to social, physical, and community resources. Photovoice was used as the methodology for this study so that older adults could take pictures of people, places or things that might shed light on what is most important to them and their experiences of accessibility and aging in their respective community. Findings present qualitative themes with thirteen older adults in seven neighbourhoods in Calgary, Canada including planning for the future; convenient access to resources and services; importance of ethno-cultural supports and diversity; affordability; and importance of cultivating connection. These themes demonstrate that aging in place requires older adults to proactively anticipate and plan for the aging process. Moreover, aging in community for older adults means having access to physical resources that are convenient and in close proximity. Additionally, improving access to ethno-cultural resources and language supports enhances older adults’ sense of safety and belonging. Older adults highlight an importance of having a diverse group of community members encompassing different ages, ethno-cultural backgrounds, and ability levels. Affordable resources and supports are essential for older adults to maintain a fulfilling and independent lifestyle within their built and social environments. Lastly, older adults seek social connection and belonging, but limited access to social supports can lead to social isolation and disconnection from their community.
ACTIVITIES OF DAILY LIVING RECOVERY IN HOME HEALTH PATIENTS WITH DIABETES
Authors: Webster-Dekker Katelyn , Lu Yvonne , Perkins Susan , Ellis Jennifer , Otis Laurie , Winton Rebecca , Hacker Eileen 
Published: December 2023

Abstract
Older adults with diabetes are at high risk for impairments in their ability to perform activities of daily living (ADLs). Home health (HH) services help patients regain their ability to perform ADLs after being hospitalized, but there may be disparities in degree of ADL improvement based on characteristics such as race/ethnicity. We aimed to identify factors associated with improvements in ADLs from the start of HH care to discharge in older adult (age ≥65) patients with diabetes receiving HH. This secondary analysis used Outcome and Assessment Information Set-D data collected between October 1, 2021, and March 31, 2022 in the Southern U.S by a HH agency. We used multiple linear regression to examine factors associated with improvement in ADL performance. The sample (n=1350) was 55% female and 76% White, with a mean age of 76.3 (SD 7.3). Ninety-seven percent of patients improved their ADL score from start of HH care to discharge. Black/African American race (b= -0.33) and having bowel incontinence or an ostomy (b= -0.51) were associated with less ADL improvement. Having a caregiver who needed training/support (b= 0.44) or was unlikely to provide assistance (b= 0.78), the presence of a surgical wound (b= 0.52), pain that interfered with activity (b= 0.46), confusion (b= 0.30), and better scores in prior functioning (b= 0.13) at the start of HH were associated with greater improvement in ADLs upon discharge from HH. These findings require further investigation, but indicate Black patients experienced disparities in ADL improvement which should be addressed.
RACIAL/ETHNIC DISPARITIES IN MARITAL STATUS AND LIVING ARRANGEMENT TRANSITIONS AMONG US OLDER ADULTS
Authors: Wang Xueqing , Zhang Xuezhixing , Zang Emma 
Published: December 2023

Abstract
US older adults’ family life, including marital status and living arrangement, has become increasingly complex and diverse in recent decades. However, there is limited understanding of the average duration each racial/ethnic group typically spends in different marital statuses and living arrangements during older ages. Using data from the Health and Retirement Study 1992-2018, this research note investigates the racial/ethnic differences in the expected years to be spent at age 50 in each of the marital statuses (i.e., married, divorced, widowed, and never married) and living arrangements (i.e., living alone, living with spouse, living with non-spouses only, and nursing home. At age 50, Whites spend significantly more time married compared to Blacks and Hispanics, primarily due to the latter spending longer years divorced or never-married. Regarding living arrangements, Whites also spend notably more time living with spouse than Blacks and Hispanics, with the latter spending more time living only with non-spouses. These findings suggest that Whites have a distinct advantage in maintaining a stable, two-person family structure in late adulthood, while Blacks and Hispanics are more likely to spend their later years without their spouses. These patterns have broad implications for understanding persistent social inequality in late adulthood.
THE ASSOCIATION BETWEEN FINANCIAL HARDSHIP AND MARKERS OF INFLAMMATION AMONG CANCER SURVIVORS
Authors: Surachman Agus , Yao Jingxin , DiMaria-Ghalili Rose Ann , Juon Hee-Soon 
Published: December 2023

Abstract
This study examined the cross-sectional association between financial hardship and inflammation markers among cancer survivors. Furthermore, we tested if financial hardship mediated the link between education and inflammation. We used data from 304 cancer survivors (Ages = 32-90, 51% female, 81% non-Hispanic white) in the Midlife in the United States (MIDUS) wave 3 and Refresher Biomarker studies. Financial hardship was based on three domains: material (e.g., lower income to poverty line ratio), psychosocial (e.g., difficult paying bills), and behavioral (e.g., cut back on spending). We included interleukin-6 (IL-6) and c-reactive protein (CRP) as inflammation markers. Analyses were adjusted for confounders, including age, race/ethnicity, sex, marital status, body mass index (BMI), and smoking status. Analysis was conducted using the structural equation model framework. The second-order measurement model of financial hardship with three domains (material, psychosocial, and behavioral) in the first order showed a satisfactory model fit. Higher financial hardship was significantly associated with elevated CRP (Est = 0.14, SE = 0.06, p &lt; .01) but not IL-6 (Est = -0.07, SE = 0.05, p = .13). Furthermore, financial hardship partially mediated the association between education and CRP (indirect effect: Est = -0.03, SE = 0.02, p &lt; .05). Inflammation is a major biological pathway associated with socioeconomic disparities in long-term chronic health conditions among cancer survivors. Explicating socioeconomic conditions contributing to this disease process beyond traditional socioeconomic indicators are critical to identifying potential intervention areas to narrow the disparities.
THE DIFFERENCE BETWEEN CYSTATIN C- AND CREATININE-BASED EGFR AND ASSOCIATIONS WITH COGNITION IN THE CHS
Authors: Miller Lindsay , Potok O , Rifkin Dena , Longstreth William , Lopez Oscar , Ix Joachim 
Published: December 2023

Abstract
The difference (eGFRDiff) between cystatin C-based estimated glomerular filtration rate (eGFRcys) and creatinine based eGFR (eGFRcr) has been shown to be associated with frailty and mortality, but its association with cognition is unclear. Among 4,764 adults aged ≥ 65 from the Cardiovascular Health Study, we analyzed eGFRDiff per 1-SD lower (18.6 mL/min/1.73m2). Cognitive function was evaluated annually using the Modified Mini Mental State Exam (3MS; range 0-100), and the Digit Symbol Substitution Test (DSST; range 0-90); higher scores mean better performance. We used linear regression for cross-sectional analyses, and mixed models for longitudinal analyses adjusted for demographic and clinical variables. The mean age was 72.2 ±, the mean eGFRDiff was 0.64, and mean follow-up was 4.4 ± years. eGFRDiff was not associated with 3MS at baseline. Each SD lower eGFRDiff at baseline was associated with a 0.82 [95% CI: -1.22, -0.42] lower DSST score. In longitudinal analyses each SD lower eGFRDiff was associated with a significant 0.06 [95% CI: -0.11, -0.01] faster decline in 3MS scores and a 0.04 [95% CI: -0.08, -0.01] faster decline in DSST scores over time. In older adults, we found that lower eGFRDiff was associated with lower cognitive scores at baseline, and associated with more rapid decline over time. This suggests that eGFRDiff could be used clinically as a laboratory-based screen to identify older adults in need for cognitive assessment.
PREDICTORS OF PHYSICAL FUNCTION DECLINE AMONG OLDER ADULTS RECEIVING HOME CARE NURSING: PROSPECTIVE COHORT STUDY
Authors: Yasaka Taisuke , Igarashi Ayumi , Fukui Chie , Inagaki Asa , Sumikawa Yuka , Takaoka Manami , Eltaybani Sameh , Yamamoto-Mitani Noriko 
Published: December 2023

Abstract
Older adults receiving home care nursing have certain health conditions and face continuous risk of declining physical functions. Identifying those at risk of functional decline based on these factors is essential for developing appropriate strategies for maintaining their conditions. This prospective cohort study in home care nursing agencies across Japan examined ADL decline incidence and its factors among clients aged ≥75. Data were collected from nurses in charge of clients using online questionnaires. Functional status was evaluated using the ADL Hierarchy (ADLH) score, ranging from 0 (independent) to 6 (dependent). A binary logistic regression examined the relationships between clients’ characteristics at baseline and ADLH score deterioration after 6 months, controlling for ADLH score at the baseline. Of the 715 clients analyzed, 31% had deteriorated ADLH scores between baseline and 6 months later. Older age (Adjusted odds ratio 1.04 [95% confidence interval 1.01–1.07]), having neurology diseases (2.23 [1.06–4.69]), use of home visiting physicians (1.54 [1.04–2.27]), falls with/without trauma in the previous 6 months (2.77 [1.41–5.44], 1.90 [1.11–3.25]), higher ADLH score at baseline (1.35 [1.18–1.56]), higher severity of dementia (1.23 [1.02–1.47]), occurring dyspnea in the previous 30 days (1.69 [1.05–2.71]), and having BMI lower than 18.5 (between 25 and 30 as a reference) (2.58 [1.12–5.94]) were associated with ADLH score deteriorations. The results suggest that inhibiting functional decline among older adults receiving home care nursing might be possible by optimizing the management of modifiable predictors such as frequent falls, dyspnea, and weight loss.
EPIDEMIOLOGY OF FALLS AMONG OLDER ADULTS IN THE COMMUNITY FROM THE HEALTH AND RETIREMENT STUDY
Authors: Quach Lien , Dugan Elizabeth , Nguyen Uyen-Sa , Burr Jeffrey 
Published: December 2023

Abstract
Many older adults experience falls that lead to adverse health consequences. The primary objective of this study is to estimate the associations between risk factors of falls and actual falls. The second objective is to identify whether race modifies these relationships. Panel data from the Health and Retirement Study from 2006-2012 were analyzed. The total sample size of community-dwelling adults age 65+ was 22,153, and respondents were observed at different time points. Independent variables included physiological characteristics and health, lifestyle indicators, social environment, and socio-economic status. At each time point, the outcome was the number of falls reported in the two years prior to the interview. Generalized Estimating Equations for negative binomial regression models adjusted for repeated measures were performed. The mean age of participants in 2006 was 74, and 38% experienced at least one fall every two years. For each additional chronic health condition, the fall risk increased by 13%. Vision impairment increased fall risk by 21%. Conversely, higher cognitive function was correlated with a 3% reduction in fall risk. Every unit increase in ADL limitations escalated fall risk by 17%. Loneliness increased fall risk by 12%. Both vigorous (12%) and moderate (13%) physical activities were linked to a decrease in fall risk. Notably, minority racial group status modified the interplay between loneliness and falls and also bolstered the relationship between vision impairment and fall frequency. Tailoring fall prevention programs to racial and ethnic minority older adults is essential to reduce health disparities at the population level.
USING COLLECTIVE IMPACT TO ASSESS HOME AND COMMUNITY-BASED SERVICES WORKER TRAINING AND CREDENTIALING
Authors: Lane Sandi , Basrai Zavera , Yoon Caroline , Farnham Trish , Scales Kezia , Carson Erin , Boucher Nathan 
Published: December 2023

Abstract
Older adults and people living with disabilities receive home- and community-based services (HCBS) from approximately 120,000 often poorly paid and inadequately supported direct care workers in North Carolina (NC). The demand for these workers is increasing rapidly, with NC projected to add almost 23,000 new direct care jobs from 2020 to 2030. With the goal of optimizing the workforce pipeline to prepare for the high need for HCBS across NC, we conducted a Medicaid-funded landscape analysis of direct care training/credentialing using Collective Impact (CI). CI is used for diverse collaborations through forming a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and “backbone” support (dedicated coordination team). Engaging with lived experiences is crucial in CI as it leads to sustainable decision-making informed by those affected by policy change. With input from long-term services and support agencies, licensing bodies, advocates, and those with lived experience, we characterized NC HCBS training/credentialing landscape, generating a first-of-its-kind comprehensive crosswalk resource for the state. Findings reveal the complexity of training/requirements, limited portability, lack of flexibility, and a need for more person-centered and relational core competencies. In addition, funding and incentives for additional training are lacking, which limits opportunities for professional development and career advancement. CI is an effective method to analyze direct care worker training/credentialing, it allowing researchers to harness the wisdom of community partners and incorporate lived experiences of the people most impacted by potential policy changes - workers, HCBS recipients, and families.
A TECHNOLOGY SUPPORTED FALL PREVENTION INTERVENTION FOR OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT
Authors: Demiris George , Hodgson Nancy , Richmond Therese , Skubic Marjorie , Sefcik Justine , Harrison Sean 
Published: December 2023

Abstract
Falls and fall-related injuries are significant public health issues for adults 65 years of age and older. Over a third of older adults (OA) fall each year and 10-20% of falls result in serious injuries. Cognitive impairment has been identified as a leading risk factor with over 60% of OA living with mild cognitive impairment (MCI) falling annually. Housing conditions are also a risk factor for falls. We have developed Sense4Safety, a technology-enhanced intervention that includes multiple components: 1) in-home assessment and action; 2) education and regular communication with a coach; 3) passive monitoring facilitated by depth sensors in the home; and 4) alerts. The goal of this study was to access the feasibility of Sense4Safety and its acceptability. We recruited 10 low-income OA with MCI; each participant received the intervention for 3 months. All participants completed all study procedures. The Short Physical Performance Battery (SPPB) scores which provide an objective assessment of lower extremity functioning based on clinical experts’ observation showed high correlation to the sensor system assessment (r=0.94, p&lt; 0.01). Two fall alerts were generated during the study period that triggered a timely response. Participants and their family members found the intervention to provide peace of mind and empower OA to proactively address changes in fall risk through exercise and home modifications. The combination of passive sensing and personalized coaching offers an innovative ecological approach to continuously assess functional mobility and gait in the home and captures changes that provide an early warning for fall risk.
ADVANCING TECHNOLOGY OF A GROUP MUSIC INTERVENTION FOR PERSONS WITH DEMENTIA: FINDINGS FORM A FOCUS GROUP STUDY
Authors: Orsulic-Jeras Silvia , Gorzelle Gregg , Skrajner Michael , Powers Sara , Nicolay Sarah 
Published: December 2023

Abstract
The benefits of using music to engage persons living with dementia (PLWD) are widely reported in the literature Music can elicit memories and positive feelings as well as decrease anxiety and agitation in PLWD. Moreover, conducting music interventions in a group setting has been shown to increase social interaction, produce positive mood, and promote feelings of belonging. This paper discusses the adaptation and technological development of a group music intervention for persons living in the mild to moderate stages of dementia, Making Connections through Music (MCTM). Originally, MCTM was comprised of 6 individually themed sessions containing songs and corresponding discussion prompts; materials such as handheld instruments, photos, and props were used to elicit engagement and increase socialization among group members. Session leaders, older adult volunteers, were trained to provide the experience by offering the necessary structure and support PLWD need for successful participation. This paper will focus on the technological adaptation of the original MCTM intervention. Prototypes of a tablet application and online training course for volunteers were evaluated across seven focus groups with LTC staff (n=25) and older adult volunteers (n=25). Results from focus groups demonstrated 95% of volunteers and 100% of staff were satisfied with both the tablet app and training course. Acceptability and feasibility findings will be presented. Discussion also will highlight the implementation of this program within senior centers, adult day, and residential care as well as next steps in technological advancement of this intervention and associated training.
NATURAL ENVIRONMENTS’ INFLUENCE ON RESPONSIVE BEHAVIOUR, WORK-RELATED STRESS, BURNOUT, AND TURNOVER INTENTION
Authors: Chi Peggy , Wagg Adrian , Verderber Stephen , Falenchuk Olesya , Berta Whitney 
Published: December 2023

Abstract
Natural environments in healthcare design are thought to promote health. However, its empirical research in long-term care (LTC) has been limited; the degree of rigor is mixed, focusing on older adults with little research on professional caregivers. This study examined the relationships between the natural environment and the mental health and well-being of older adults 65+ living with Alzheimer’s disease and related dementias (residents) and of their professional caregivers in LTC homes using a rigorously developed survey to standardize an approach to the evaluation of natural environments for these population groups. A cross-sectional, multiphase mixed method study was conducted that included a scoping review (n=137), a Delphi panel (n=24 experts), cognitive debriefing interviews (n=33), psychometric evaluations (n=83 LTC home areas), and multilevel modeling and regression analyses (n=1599 residents; n=563 professional caregivers). A conceptual framework on the natural environment in healthcare was developed, which informed the development of the Natural Environment Survey for Long-Term Care. This survey evaluates 1) the design of natural environments, 2) residents’ usage of and exposure to natural environments, and 3) professional caregivers’ usage of, exposure to, and perception of natural environments. Unlocked doors to outdoor spaces, outdoor activities, and indoor activities were significantly associated with residents’ responsive behavior in secure home areas (i.e., locked access and egress). Usage of and exposure to the natural environment during breaks and leisure were associated with their professional caregivers’ work-related stress, burnout, and turnover intention in secure and non-secure home areas. These findings have potential utility for decision-makers transforming LTC.