bluuebunny/crossref_metadata_2025_split huggingface dataset:
VARIATION IN ASSISTED LIVING REGULATION: IMPLICATIONS FOR STATE AGENCY OVERSIGHT, PROVIDER KNOWLEDGE, AND PRACTICE
Authors: Smith Lindsey , Manis Derek 
Published: December 2023

Abstract
Researchers spend significant time and effort documenting policy, particularly in assisted living, where there are no national regulatory standards, and state governments develop and enforce regulations, leading to significant variation between and within states. Our panel explores the question we often get—do these regulations matter? Do they really impact the structures, processes, and outcomes of care provision?
ASSESSING REGULATORY STRINGENCY FOR LICENSED ASSISTED LIVING: A MULTIFACETED APPROACH
Authors: Smith Lindsey , Weems Jacy , Hua Cassandra , Dys Sarah , Carder Paula , Thomas Kali 
Published: December 2023

Abstract
Regulations in long-term care settings aim to ensure quality and accessibility for residents. However, inadequate enforcement can limit their impact on the community. Simply increasing regulations does not always lead to improved care, as it may incentivize facilities to limit admissions. Regulatory stringency encompasses the scope, specificity, and enforcement of regulations. This study examines 10 dimensions of specificity related to medical care regulations in assisted living, focusing on scope and enforcement. We found that regulations related to staffing levels and resident assessments governed almost all assisted living communities, while medication review and administrator certification were the least commonly addressed. The “Residential Care Facilities” license with an “Alzheimer’s Dementia Care Unit” certification in Maine had the highest stringency score, though the “Assisted Living Program” license in the same state had one of the lowest. High regulatory specificity and scope scores were not always associated with high enforcement. For example, the “Assisted Living Center” license in South Dakota covered 100% of the scope’s dimensions and 75% of the provisions contributing to the specificity score, but had no regulatory enforcement for these rules. Findings suggest that a multifaceted approach to assessing regulatory stringency is crucial for policymakers and researchers to understand regulatory approaches across license types and states. Accounting for differences in licensure is also important for a broad view of regulatory stringency.
INEQUALITIES IN OLD AGE WELL-BEING: THE ROLE OF REGIONAL DEPOPULATION AND SOCIAL AND MATERIAL CONDITIONS
Authors: Brandt Martina , Schmitz Alina 
Published: December 2023

Abstract
Material conditions and social integration are important predictors of wellbeing in old age. It can be expected that older individuals who reside in depopulating areas experience declines in well-being, as their property loses value, their social networks are shrinking, and public infrastructure is lacking. We conduct comparative analyses of Germany and Poland, two countries that show significant differences with regard to the economic and social situation of the older population. We expect that regional depopulation is more detrimental to well-being in Poland, as older individuals rely more strongly on informal support and individual resources in old age. We apply multilevel regression models to investigate the interrelations between overall life satisfaction, social integration, material conditions and regional factors. We combine micro-data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with macro-data on regional characteristics (depopulation, public infrastructure and economic development). Our preliminary analyses suggest that a substantial part of inequalities in old age well-being can be traced back to regional differences in the level of depopulation. Social integration and material conditions are important mediators of this association. Additionally, regional differences in care and health infrastructure are important predictors of well-being – especially for older adults in need of financial and social support. Regional depopulation can be detrimental to well-being in later life due to material hardship, low social integration and lacking public infrastructure. In the next steps, we will investigate whether there are differences at the country level by comparing Germany and Poland.
COGNITIVE IMPAIRMENT AND SOCIAL CONNECTEDNESS: A DYADIC ANALYSIS OF OLDER COUPLES
Authors: Li Meiyi , Li Yiang 
Published: December 2023

Abstract
Sociological research extensively identifies social connectedness as an important predictor of cognitive health. However, few examine how social connectedness will in turn be affected by cognitive health, especially in the dyadic context. Using couple data from Waves 2 and 3 of the National Social Life, Health, and Aging Project (NSHAP), this study investigates the gendered dyadic link between cognitive impairment and social connectedness. Results from the actor–partner interdependence models show that women’s cognitive impairments negatively affect their socialization. In terms of partner effects, women’s cognitive impairments make negative impacts on men’s number of friends and neighborhood participation. However, women’s social connectedness will not be affected by men’s cognitive impairment. Given the interdependence of older couples, this study points to the importance of understanding cognitive impairment in dyadic contexts. Results also call for dyadic interventions to prevent the negative effects caused by cognitive decline in late life.
PATTERNS AND THEMES OF OLDER ADULTS’ COPING ACROSS TWO YEARS OF THE COVID-19 PANDEMIC
Authors: Fuller Heather , Huseth-Zosel Andrea , Kinkade Emily , Van Vleet Bryce , Hajdar Melisa 
Published: December 2023

Abstract
Throughout the COVID-19 pandemic, older adults developed coping strategies to adapt to the necessary social distancing precautions intended to protect from severe illness. However, over time, especially as vaccines became available, their need and ability to adapt and cope shifted. This longitudinal, mixed-methods study investigates whether older adults’ perceptions of coping changed across the first two years of the pandemic and how older adults described their experiences with coping at different points during this time. Between April 2020 and June 2022, five waves of interviews were conducted with 76 Midwestern older adults between the ages of 70 and 97. At each timepoint, participants rated their level of perceived coping, quality of life, and stress. They also answered several open-ended questions about their current daily life and experiences during the pandemic. Repeated-measures ANOVAs indicated participants’ perceived coping and quality of life significantly increased between the first and final interview. Thematic coding of interview transcripts identified four themes of coping across two years of the pandemic: 1) staying occupied, 2) seeking social support, 3) cultivating an adaptive mindset, and 4) future planning. Theme meaning shifted once vaccines were available, as participants adapted to ‘a new normal’ lifestyle, gained realistic perspectives, and appreciated their own resilience. Findings suggest older adults had nuanced and shifting coping experiences throughout the initial two years of the pandemic, but overall coped by drawing on life experiences. Our discussion will highlight variability in older adults’ coping over time and directions for future study and practice.
HEALTH PROFESSIONALS’ ATTITUDES TOWARD TECHNOLOGY AND ARTIFICIAL INTELLIGENCE: AN EXPLORATORY STUDY
Authors: Choi Moon 
Published: December 2023

Abstract
The growing number of older adults, particularly those living alone, demands innovative health and social care solutions for the aging population. Mobile apps and other technologies are emerging every year to enhance the efficiency and effectiveness of geriatric health professionals’ work management. However, limited knowledge exists regarding geriatric health professionals’ perceptions of technology. The acceptance of technology is critical because emerging technologies cannot be fully utilized in the field without a positive attitude towards accepting them. The current study aims to investigate geriatric health professionals’ perceptions and attitudes towards technology and artificial intelligence (AI). The data were collected from a national survey of health professionals specialized in home visits conducted by community health centers in South Korea (N=1,026). Technology acceptance was evaluated using the Technology Acceptance Model Questionnaire, and study participants were asked about their self-reported knowledge of AI. A series of regression models showed that younger age, higher education level, and male gender were positively associated with higher technology acceptance levels. Regarding AI knowledge, only younger age was positively associated with better AI knowledge. The findings suggest the existence of a cohort difference in perceptions and attitudes towards technology among geriatric health professionals, which warrants further investigation into the underlying mechanism.
IMPROVING HOSPITAL AND POST-ACUTE OUTCOMES AND EXPERIENCES OF DYADS LIVING WITH DEMENTIA: RESULTS OF THE FAM-FFC TRIAL
Authors: Boltz Marie , Kuzmik Ashley , Rose Karen 
Published: December 2023

Abstract
Hospitalizations of persons living with dementia are associated with protracted functional decline, delirium, and behavioral symptoms of distress as well as increased care partner stress. This symposium presents findings from the Family-centered Function -focused Care (Fam-FFC) trial. In Fam-FFC, nurses purposefully empower family care partners in the assessment, decision-making, care delivery, and evaluation of function-focused care during hospitalization and the 60-day post-acute period. The goal is to improve the functional recovery of the patient while increasing family preparedness for caregiving, bridging hospital to post-acute setting. This cluster randomized controlled trial tested the impact of Fam-FFC in 455 dyads of diverse persons living with dementia and their care partners. The first presentation will compare Fam-FFC outcomes for patients and care partners to the attention control group outcomes at discharge, two and six months. The second presentation will report the impact of Fam-FFC upon adverse patient events (falls, emergency department transfers, hospital admissions) in the two arms. Next, the presenter will utilize Fam-FFC data to describe the patient and care partner characteristics that contribute to care partner distress at the time of hospital discharge. The fourth presentation will focus on staff-patient interactions in the Fam-FFC trial, including the influence of clinical factors upon the quality of the interaction. The final paper will report on the trajectory of behavioral symptoms of distress, and associated outcomes, from hospital admission to six-month follow-up. Our discussant, Karen Rose will lead a discussion of unanswered questions, next steps, and implications of this work for policy and practice.
THE IMPACT OF FAM-FFC UPON ADVERSE OUTCOMES IN HOSPITALIZED PERSONS WITH DEMENTIA
Authors: Resnick Barbara 
Published: December 2023

Abstract
The Fam-FCC education and coaching of care partners emphasizes optimizing physical and cognitive function and detection of changes in condition to prevent falls, avoidable transfers to the emergency department and hospital readmissions. Thus, the aim of this study was to examine the impact of Fam-FFC upon the desired outcomes of less transfers to the emergency department, hospital readmissions, and falls. The majority of patients identified as female, with an average age of 81.5 (± 8.4); approximately 64% were White patients and 36% were Black or African American patients. The sample indicated, on average, moderate impairment in cognition (MMoCA=11.7±7.0) and baseline (pre-admission) some impairment in physical function (MBI=78.1±22.6), mild pain (MPAINAD=0.79±1.5) and depression (MCESD=9.1±6.2). There were no group differences in transfers to the emergency department; however intervention participants were approximately 10% less likely to be hospitalized (p&lt;.04) over the study intervention. The total number of falls or transfers to the emergency department did not differ between groups. The findings of this study suggest that Fam-FFC may be implemented without increasing the risk of falls, while possibly decreasing hospitalizations.
RELATIONSHIP DISSOLUTION AND BIOLOGICAL AGING IN MID LIFE
Authors: Bourassa Kyle , Brennan Grace , Caspi Avshalom , Moffitt Terrie 
Published: December 2023

Abstract
Several decades of empirical research has shown that people who experience relationship dissolution—such as romantic breakups, divorce, and bereavement—have increased risk for poor health across a range of disease outcomes. However, it remains less clear which physiological pathways might best explain links between relationship dissolution and later health. One candidate mechanism that might help explain this wide range of observed health outcomes is accelerated biological aging, which is theorized to represent a common cause of age-related chronic diseases, disability, and early mortality. The current study examined whether relationship dissolution, measured across a 20-year period of adulthood, was associated with biological age in midlife using participants (n = 910) from the Dunedin Study, a birth cohort assessed over four decades of life. Relationship dissolution was assessed using a count of romantic breakups from age 26 until age 44 from life history calendars. Biological aging was assessed using a midlife aging factor derived from four validated measures of aging—the Pace of Aging, gait speed, BrainAGE, and facial age—assessed at age 45. We found that people with more breakups in adulthood had more advanced biological age in midlife, β = 0.10, 95% CI [0.04, 0.16], p = .003. This association remained when controlling for adversity and poor health in childhood, as well as disadvantaged socioeconomic origins and time spent in romantic relationships, β = 0.09, 95% CI [0.03, 0.15], p = .007. The results suggest accelerated aging may be one physiological mechanism linking relationship dissolution to poor health.
PRAGMATIC, SUSTAINABLE, AND COST-FEASIBLE TECHNOLOGIES TO ENABLE REMOTE CARE COORDINATION SERVICES
Authors: Lee Knoo , Bacon Suzette , Conrow Elizabeth , Curtis Elizabeth , Roberts Ashley , Reeder Blaine 
Published: December 2023

Abstract
The aim of this presentation is to communicate the approach and lessons learned in successfully deploying open source smart home and consumer-grade technologies to enable novel remote care coordination services for older adults as part of the CMS-funded ASSETs for Aging in Place demonstration project. Major barriers to use of technologies that enable service reach to rural or home-bound at-risk populations are technology availability, internet connectivity, cost, configuration, installation, ease of management, and usability and usefulness of clinically relevant data displays for decision-making to support personalized care coordination, coaching, and self-management goals. We have pioneered a reusable, innovative approach and infrastructure through partnership with the State of Missouri Department of Social Services and a non-profit hosting partner that facilitates testing and deployment of such remote services with broad goals of scalability and translation as starting principles. The specific focus of this presentation will describe technology selection, configuration, proof-of-concept testing, use of mobile hot spots to overcome broadband availability in rural areas, team composition and skills, introduction and training of the OT/Nurse/Social Worker teams to technology, resources required to stand up the team and transition to independent technology expertise in the field with mobile, video, and remote messaging tools, and user-centered design engagement of the care coordination and informatics teams to drive dashboard features and visual display developments for new work flows. An overview of the approach, technologies, and practical considerations to support research and development of new technology-enabled services for older adults will be presented.
CIRCULATING SASP FACTORS ARE ELEVATED IN PATIENTS WITH POSTOPERATIVE DELIRIUM
Authors: Palmer Allyson K , White Thomas , Atkinson Elizabeth , LeBrasseur Nathan 
Published: December 2023

Abstract
Aging, a major risk factor for delirium, is associated with accumulation of senescent cells in many tissues of the body. Senescent cells produce a host of proinflammatory and tissue remodeling factors collectively termed the senescence-associated secretory phenotype (SASP), which are secreted into circulation. The relationship between increased senescent cell burden and risk of delirium is not known. This study aimed to determine whether changes in circulating SASP proteins are associated with increased risk of postoperative delirium in cognitively intact older adults. Participants were recruited among patients scheduled for surgical or transcatheter aortic valve replacement, and blood was obtained at the presurgical visit. SASP factors were measured using commercially available multiplex magnetic bead immunoassays based on Luminex xMAP multianalyte profiling platform and analyzed on a MAGPIX system. Activin A concentration was determined by a Quantikine ELISA kit. Delirium cases were identified by manual chart abstraction, utilizing the problem list, ICD-10 codes, clinical notes, and nursing flowsheets. Eight of 62 (12.9%) of patients within the cohort developed postoperative delirium. Length of stay was significantly longer for patients who developed delirium (10.6 days) versus patients without delirium (6 days). Concentrations of SASP factors Activin A and PAPP-A were significantly higher in plasma of patients with delirium vs. those who did not develop delirium. IL-1 alpha concentration was significantly lower in patients with delirium vs without delirium. Other SASP factors measured were not statistically different between groups. More study is needed to determine whether these changes are directly related to increased senescent cell burden.
MAXIMIZING COLLECTIVE IMPACT ACROSS THE AGE-FRIENDLY ECOSYSTEM
Authors: Dabelko-Schoeny Holly , Kennedy Teri 
Published: December 2023

Abstract
Age-friendly initiatives have the potential to transform communities through inclusive policies and practices that meet the needs of people, families, and communities across ages and abilities. The ecosystem of age-friendly initiatives (communities, universities, public health systems, and health systems) has grown exponentially over the last decade. Despite shared values and principles, each age-friendly initiative largely operates independently with limited opportunities to share knowledge to maximize collective impact and social change. This theoretically-driven symposium provides an overview of each age-friendly initiative, challenges faced, and ideas for innovation within and across each initiative. Dabelko-Schoeny and Sheldon will utilize a macro application of the KAP (knowledge, attitude, practice) theory of behavior change to identify the vast opportunity for synergies and grand challenges across the age-friendly ecosystem. Greenfield will provide an overview of the development of the Age-Friendly Cities and Community Movement, and present ideas regarding challenges and opportunities for the future based on insights from an ongoing, community-engaged study in New Jersey. Montepare will describe the Age-Friendly University initiative and how age-inclusive practices in higher education can extend and enhance ecosystem efforts. Phillips and Wolfe will provide examples of Age-Friendly Public Health Systems including a description of a collective impact approach for state-wide age-friendly policy and practice adoption. Finally, Kennedy will offer approaches and models to advance the adoption and sustainability of age-friendly principles, programs, and policies by leveraging synergies and implementation science. This is an Age-Inclusivity in Higher Education Interest Group Sponsored Symposium.
AGE-FRIENDLY PUBLIC HEALTH SYSTEMS IN ACTION
Authors: Phillips Karon , Wolfe Megan 
Published: December 2023

Abstract
Trust for America’s Health (TFAH) leads the national Age-Friendly Public Health Systems movement, the goal of which is to elevate healthy aging as a core function of state and local departments of health. The nation’s public health system has contributed to the increased longevity of the population and there are numerous opportunities for public health to advance healthy aging in collaboration with the health care system, the aging services sector and others. TFAH has worked directly with state and local health departments to test the Age-Friendly Public Health Systems framework and seen first-hand the policy and systems changes that are possible through collective impact. During this symposium, participants will learn about the changes that are occurring in Mississippi and Washington state, where Age-Friendly Public Health practices are being adopted and implemented in collaboration with key partners, including expanding data collection on older adult health, ensuring older adults and caregivers are considered in emergency planning, and working directly with older adults in Tribal communities.
FAMILY CAREGIVING DURING THE COVID-19 PANDEMIC FOR OLDER ADULTS WITH DEMENTIA
Authors: Wiemers Emily , Lin I-Fen 
Published: December 2023

Abstract
Family caregiving plays a crucial role in meeting the care needs of older adults, especially those living with Alzheimer’s disease and related dementias (ADRD). The COVID-19 disrupted an already fragile care landscape by reducing the desirability of nursing home care and the availability of paid caregivers in the home and by destabilizing family caregiving arrangements. Older adult living with ADRD may be at higher risk for destabilized care and more vulnerable to adverse effects from the COVID-19 pandemic’s disruption to the long-term care landscape. This symposium draws on five papers providing qualitative and quantitative evidence of how care arrangements shifted during the COVID-19 pandemic among older adults with ADRD. Patterson and colleagues set the stage for understanding the impacts of the pandemic on family caregiving for older adults with dementia by providing estimates of how many families and households include someone with dementia. Choi and colleagues use a mixed-methods approach to show that family members provided more care during than before the pandemic, especially coresident family members. Lin and colleagues use quantitative evidence to examine how pandemic-specific needs and help from nonresident adult children varied by older adults’ cognitive functioning. Leggett and Tsuker examine the consequences of the pandemic for caregiver stress across different ADRD caregiver relationship types. Finally, Wiemers and colleagues extend the focus on unpaid family caregivers to include paid care and show how tradeoffs between paid and unpaid care for older adults with ADRD were affected by pandemic severity.