bluuebunny/crossref_metadata_2025_split huggingface dataset:
LINKING SELF-REPORTED FATIGUE TO OBJECTIVELY MEASURED PHYSICAL ACTIVITY IN MEN WITH AND WITHOUT HIV
Authors: Wanigatunga Amal , Kwon Sohyeon , Palella Frank , Koletar Susan , Gange Stephen , Brown Todd , Margolick Joseph , Schrack Jennifer 
Published: December 2023

Abstract
Fatigue, a symptom commonly associated with reduced physical activity, is difficult to measure among people living with HIV (PLWH), a population with the potential for comorbidity. We examined the association between self-reported fatigue and objectively measured physical activity by HIV serostatus across three commonly used fatigue measures. Self-reported fatigue and accelerometry data were collected cross-sectionally from 699 men (mean age 59 years; 57% PLWH) enrolled in the Multicenter AIDS Cohort Study. Linear regression was used to estimate differences in total daily physical activity (min/day) by self-reported fatigue measured by three separate assessments: 1) “unable to get going”; 2) “felt everything was an effort”; and 3) “work/activity difficulty due to physical health”. Models adjusted for age, BMI (kg/m2), and HIV serostatus, and interactions between HIV serostatus and each fatigue assessment were tested. Fatigue prevalence, defined as “unable to get going” (43%), “felt everything was an effort” (39%), or “work/activity difficulty” (20%) and total daily physical activity (7.4 hours active/d) appeared similar by HIV status. Men reporting “unable to get going” and “work/activity difficulty” were estimated to have an adjusted average of 21 (SE=8) fewer active min/day (p=0.01) and 35 (SE=10) fewer active min/day (p=0.001) than those without not reporting either, respectively. There was an interaction between HIV+ serostatus and “work/activity difficulty” (interaction beta: -54 active minutes/day, p=0.003). No association was detected with “felt everything was an effort” (p=0.16). Among the three questions assessed, “work/activity difficulty” was identified as a potentially useful measure of physical activity limitation in men living with HIV.
A DIVERSE LIFE IS A BETTER LIFE? THE ASSOCIATION BETWEEN ACTIVITY DIVERSITY AND PSYCHOLOGICAL WELL-BEING IN HONG KONG
Authors: Lin Zhixuan , Fung Helene 
Published: December 2023

Abstract
The debate between the devotedness and evenness of activity participation has long existed. On the one hand, the theory of selective optimization with compensation (Baltes & Baltes, 1990) argues that successful aging depends on concentrating one’s participation on fewer domains of activities. On the other hand, the social integration perspective (Rosow, 1967) posits that diversity indicates extensive knowledge and a sense of purpose, which contributes to well-being. A previous study found a positive relationship between activity diversity and older adults’ psychological well-being in a U.S. sample (Lee et al., 2018). However, it might not be the case for people living in extremely hot weather as diverse activities might increase the risk of exposure to the heat. The current study examines their relationship in the hot summer months in Hong Kong, a tropical Asian city. Community-dwelling participants aged 60 years or above (N = 344, Mage = 67.15, SDage = 5.26) completed surveys 3 times each day over 10 days, reporting their activities, positive and negative affect, meaning and engagement of each activity, and loneliness. The regional heat-risk index was acquired from Hua et al. (2021). Results showed that activity diversity negatively correlated with positive affect, meaningfulness and engagement of daily activities, and positively correlated with loneliness. Heat risk did not moderate the relationship, but it correlated with less positive and more negative affect. Our findings suggest that Hong Kong older adults benefit from focused rather than broad participation in activities.
LEVERAGING NEIGHBORHOOD EXPOSURES AS MODIFIERS OF INDIVIDUAL RISK FACTORS FOR COGNITIVE DECLINE AND DEMENTIAS
Authors: Carlson Michelle , Rosso Andrea , Lovasi Gina 
Published: December 2023

Abstract
There are numerous ways in which neighborhood environmental factors have been shown to contribute to adverse health. More remains to be done to link long-term neighborhood exposures, such as social and physical activities, to modifiable individual risk factors for cognitive decline and dementia. Individual interventions are usually small in scale and conducted in those with higher socioeconomic status (SES). Additionally, increases in healthy behaviors, such as walking, have been difficult to promote and sustain. Each of these risk factors is known to be influenced by environmental features. This symposium will explore the roles of neighborhood-level social (nSES, affluence, cohesion, discrimination) and physical (air pollution) factors as drivers of cognitive aging and dementia across multiple longitudinal studies of community-based aging. Studies span urban and rural communities, including the Health ABC Study, the Cardiovascular Health Study, and the Think Phresh study. These studies are important to evaluating the role of neighborhood features on cognitive aging by expanding beyond cross-sectional data and by studying residentially stable older adults most likely to be affected by their local context. Those neighborhood factors that impact individual activity, cognitive aging, and Alzheimer’s disease risk will be further discussed for differences by race/ethnicity.
NEIGHBORHOOD SOCIOECONOMIC STATUS AND CHANGES IN COGNITIVE FUNCTION IN OLDER ADULTS: FINDINGS FROM HEALTH ABC STUDY
Authors: Cheng Greta Jianjia , Godina Sara , Fan Erica , Rosso Andrea 
Published: December 2023

Abstract
Neighborhood socioeconomic status (NSES), an overall marker of neighborhood condition, may influence multiple aspects of health and well-being in older adulthood, including cognitive function, though results regarding neighborhood and cognition have been largely cross-sectional. We examined the association between NSES and changes in cognitive function using 610 participants from the Pittsburgh site of the Health, Aging, and Body Composition (Health ABC) Study, a longitudinal cohort of community-dwelling, Black and white adults aged 70 and older. Changes in cognitive function were measured annually over a 6-year follow-up (2006-2012) using the Modified Mini-Mental State Examination (range: 0-100, 3 visits on average per person). Using baseline home address, NSES was calculated for census tracts by summing z-scores of six 2010 census variables representing wealth/income, education, and occupation, and divided into tertiles. Multivariate mixed-effect linear regression models assessed associations, adjusting for individual-level sociodemographic and health-related covariates. In the fully adjusted model, the lowest NSES tertile (vs. the highest) was not associated with baseline cognitive function (β: -0.99, 95% CI: -3.86, 1.87) but was associated with a faster rate of decline in cognitive function (β: -1.54, 95% CI: -2.67, -0.41). No significant differences in baseline cognitive function or rates of change were observed in the middle (vs. the highest) NSES tertile. There was no evidence of effect modification by race. The results indicate that exposure to adverse neighborhood socioeconomic environments may accelerate cognitive decline in late life. The findings add to existing literature concerning the role of environments in the context of aging.
“AN INHUMANE LACK OF RESOURCES”: PERSPECTIVES ON PALLIATIVE AND HOSPICE CARE FOR UNHOUSED OLDER ADULTS
Authors: Ingle M Pilar , Cutforth Asia , Matatall Elise 
Published: December 2023

Abstract
Palliative and end-of-life (PEOL) care offer many benefits to those with life-limiting illness; however, older unhoused individuals face barriers in accessing these types of care. The purpose of this study was to explore healthcare and social service providers’ perspectives on approaches and challenges to addressing PEOL needs among unhoused individuals in Colorado. A descriptive, convergent mixed-methods design was used, including an online survey and semi-structured interviews. Participants were eligible if they worked in healthcare or social services in Colorado and provided direct care/services to adults. Guided by the Behavioral Model for Vulnerable Populations, the survey assessed satisfaction with care provided and identification of challenges in providing care along predisposing, enabling, and need contexts. Interviews focused on deeper accounts of provider experiences. Thematic analysis was used to evaluate qualitative data. Sixty-seven providers completed the survey, and 17 participated in interviews. Only 30% were satisfied with care provided to unhoused individuals with life-limiting illness within their organization. Lack of informal care support, mental illness, substance use, complex care needs, and lack of community resources were most frequently identified in the survey as challenges in providing care. Interviews highlighted person-centered and holistic approaches to care, as well as challenges of providing complex care in the context of an inhumane lack of resources. Tailored PEOL interventions, including street-based palliative care and social model hospice homes, were discussed as possible solutions. This study highlights humanizing approaches within structural challenges to providing PEOL care for unhoused individuals, and highlights potential opportunities to improve access to care.
INTERROGATING THE SKILLED NURSING STAYS OF HOMELESS AND SERIOUSLY ILL OLDER ADULTS
Authors: Mukherjee Namrata , Johnson Ian , Light Michael 
Published: December 2023

Abstract
The culture change movement has fostered an intentional move away from restrictive ethos of care in hospitals, post-acute rehabilitation, and skilled nursing. However, for the millions in the United States who are uninsured, Medicaid-insured, or dual-eligible are less likely to access ‘deinstitutionalized’ healthcare environments. This presentation presents findings from a constructivist grounded theory study, Research and Supportive Care at Later-life for Unhoused People (RASCAL-UP), on the role of skilled nursing in the experiences of palliative care patients with histories of homelessness. Through provider interviews (n=30), field observations (n=12), and longitudinal chart documentation of a subset of homeless palliative care patients with stays in skilled nursing (n=13), this presentation will reflect on major findings: (1) barriers to skilled nursing entry; (2) successes and challenges in transitioning into skilled nursing residence; (3) acts of resistance to (re)institutionalization; and (4) discharge options and outcomes. Results showcase a need to fill the residential service gap between supportive housing and skilled nursing care and policy change that incentivizes consumer-directed practices for all.
USING PHOTOVOICE TO UNDERSTAND SOCIAL MODEL HOSPICE FROM RESIDENTS’ PERSPECTIVES
Authors: Jensen Francine 
Published: December 2023

Abstract
Individuals who experience homelessness and are diagnosed with six months or less to live are disadvantaged at a critical time of life. Many people choose to die at home using hospice services supported by family or close friends, but those without stable housing are unable to access hospice, demonstrating inequitable access at the end of life. For some, social model hospice (SMH) care is being provided free of charge by communities to increase access to hospice services for these individuals. The literature about SMH is growing, but currently missing are the voices of those receiving this care and its impacts on their end-of-life experiences. Using photovoice, a community-based participatory method, three residents shared their first-person perspectives using disposable cameras to document meaningful aspects of care, both positive and negative, and helped researchers analyze themes. Until this study, photovoice had not been used with people experiencing homelessness at the end of life. We found participants eager to take part in all aspects of photovoice as their health permitted. Their perspectives documented and informed the humanistic side of SMH care, illuminating the value of respect, care, autonomy, meeting physical needs, and forming supportive relationships; few criticisms were offered. Consistent with photovoice aims, this method is a powerful research tool involving a disadvantaged group who provided visual commentary on what is working and what could improve at one SMH location. Findings can inform policy decisions for communities interested in starting SMHs and help functioning SMHs make programmatic decisions to support vulnerable residents.
THE ROLE OF DEMENTIA AND SERIOUS ILLNESS IN RECEIPT OF PAID CARE
Authors: Reckrey Jennifer , Kleijwegt Hannah , Kelley Amy , Ornstein Katherine 
Published: December 2023

Abstract
Little is known about receipt of paid care for individuals living at home with dementia and other non-dementia serious illnesses. This retrospective cohort study sought to characterize receipt of paid care among individuals with impairment in self-care activities and/or other manifestations of serious illness in the context of family caregiving and socioeconomic status. Data from participants ≥65 years enrolled in the Health and Retirement Study between 1998-2018 with new-onset need for help in ≥1 self-care task was linked to fee-for-service Medicare claims (sample n=2,521). We found that those who received paid care experienced higher healthcare utilization than those without paid care. Receipt of paid care was highest among those with multiple manifestations of serious illness: 41.7% of those with self-care impairment, dementia, and non-dementia serious illness received ≥40 hours of paid care per week. When present, paid care accounted for 54% of total caregiving hours. In multivariable models, those with Medicaid were more likely to receive paid care (p&lt;0.001), but those in the highest income quartile received more hours of paid care (p=0.05.) Those with non-dementia serious illness were more likely to receive paid care (p&lt;0.001), but those with dementia received more hours of paid care (p&lt;0.001). The role of paid caregivers grows as people experience multiple manifestations of serious illness and high care hours are common among those with dementia. Future work should explore how paid caregivers can collaborate with families and healthcare teams to improve the health and well-being of the seriously ill living at home.
PAID CAREGIVERS PROVIDE SOCIAL SUPPORT TO FAMILY CAREGIVERS OF OLDER ADULTS WITH DEMENTIA
Authors: Quach Emma , Franzosa Emily , Moo Lauren , Hartmann Christine 
Published: December 2023

Abstract
Family caregivers support older adults with dementia to age in place but often experience caregiver strain, though sharing the care with paid caregivers could reduce such strain. We investigated the potential synergy between family caregivers and paid caregivers. In summer 2021, we conducted 14 interviews with family caregivers (6), home care workers (3), and social workers who work with family caregivers and home care agencies (5). We audio-recorded, transcribed, and thematically analyzed our interviews. Our analysis revealed 4 types of support family caregivers received from paid caregivers: 2 centering on the family caregiver as an individual (“person-centered”) and 2 on the relational role the individual holds as a family caregiver (“relationship-centered”). (1) Family caregivers felt positive, emotional bonding with paid caregivers, describing them as “part of the family”. (2) Family caregivers valued instrumental aid from paid caregivers, paradoxically for tasks that are beyond their formal responsibilities, e.g., feeding pets. (3) Family caregivers recognized and valued expert personal care provided to their loved ones by highly experienced paid caregivers. (4) Family caregivers valued paid caregivers’ sharing information about their loved ones and their living situations, especially when family caregivers lived separately from their loved ones. Paid caregivers may reduce or prevent family caregiver strain by providing person- and relationship-centered to family caregivers. Home care agencies should foster the relationship between paid caregivers and family caregivers.
DYADIC PROFILES OF COUPLES’ SELF-PERCEPTIONS OF AGING: IMPLICATIONS FOR MENTAL HEALTH
Authors: Huo Meng , Kim Kyungmin 
Published: December 2023

Abstract
The way older adults perceive their own aging processes influences their mental health, but we know little about how this occurs in a dyadic context, where spouses’ perceptions and health are often intertwined. The current study aims to identify dyadic profiles of self-perceptions of aging (SPA) in couples and examine how certain dyadic profiles are associated with each partner’s mental health over time. A pooled sample of 3,850 heterosexual couples aged 50+ in the Health and Retirement Study (2012/2014–2016/2018) rated positive and negative SPA and provided data on demographic characteristics, couple relationships, and health. Latent profile analysis revealed four profiles of couples’ SPA: similarly positive (32%), similarly negative (10%), wife positive–husband negative (38%), and wife negative–husband positive (20%). Physical health and marital quality differentiated couples and predicted profile membership. Couples with similarly positive SPA reported fewer depressive symptoms over time than did couples in other profiles; couples with similarly negative SPA fared worse mental health. We observed a gender difference when comparing the two opposite profiles, such that wives in the wife positive–husband negative profile reported increasingly fewer depressive symptoms than wives in the wife negative–husband positive profile. Husbands in those two profiles did not differ in mental health. This study adds to the emerging literature that advocates for an interpersonal approach to SPA. Findings revealed risk and resilience in couples as they experience and perceive aging and inform dyadic interventions that aim to protect older adults’ mental health in the long run.
NEGATIVE AGING STEREOTYPES: FEAR OF DEPENDENCY EFFECTS ON ANXIETY AND DEPRESSION IN MIDDLE AND OLDER ADULTS
Authors: Mackenstadt Darby , Adams-Price Carolyn 
Published: December 2023

Abstract
Negative stereotypes of aging tend to depict older adults as frail or a burden on society. According to Stereotype Embodiment Theory, adults who believe negative aging stereotypes tend to internalize these thoughts, and have been found to experience negative physical and mental outcomes, in later life. One aspect of these internalized stereotypes is the fear of being dependent on other people, which highlights the older adults’ worry of being seen as incompetent or child-like. Participants were aged 50 to 82-years-old (M=58.5), and primarily White (87%) women (62%). This study explored the relationship between Fear of Dependency Scale (FoD) and anxiety and depression, evaluating gender, age, and physical health as moderators. FoD was related to higher ratings of depression and anxiety in women, with age and physical health acting as moderators. When reporting a high fear of dependency, middle-aged women and women reporting poor physical health had the highest reported anxiety and depression. The early impact of FoD on women is intriguing. FoD was positively associated with higher ratings of depression for men but not anxiety, with only physical health acting as a moderator. Men with high FoD scores and poor physical health reported the highest levels of depression. It appears the negative views of aging can affect individuals, even before they reach older adulthood, and especially if they have poor perceptions of their physical health. Having negative perceptions of aging can negatively impact individuals as they age, and some groups may be more at risk for these outcomes than others.
FEELING ALONE TOGETHER: LONELINESS IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT AND THEIR CAREGIVERS WITH LOW MASTERY
Authors: Sung Pildoo , Lim-Soh Jeremy , Chan Angelique 
Published: December 2023

Abstract
Loneliness can be contagious because lonely people tend to share their loneliness with others. According to this perspective, loneliness in older persons with cognitive impairment (PCI) may beget loneliness in their family caregivers. However, not all caregivers of lonely PCI experience loneliness. This may be because caregivers have buffering resources that mitigate the contagion of loneliness. Nevertheless, empirical evidence on whether and how PCI and caregiver loneliness are related is lacking. Therefore, we examined the association between PCI loneliness and caregiver loneliness, and the moderation role of caregiver mastery on this association. We used dyadic data from 135 PCI and their family caregivers in Singapore. Descriptive statistics and bivariate correlation showed that PCI reported higher levels of loneliness than their caregivers, and PCI and caregiver loneliness were weakly related. Multivariable regression showed that PCI loneliness was not associated with caregiver loneliness, taking other covariates into account. Nevertheless, we found that the interaction between PCI loneliness and caregiver sense of mastery was significant, such that PCI loneliness was significantly associated with caregiver loneliness when caregivers had low mastery. In conclusion, lonely PCI may share their loneliness with their caregivers, and this may lead to caregiver loneliness if caregivers have low mastery. Tailored interventions should be designed to reduce loneliness among PCI and their caregivers and improve caregiver mastery as a protective factor against the spread of loneliness between PCI and caregivers.
RACIAL DIFFERENCES IN THE ASSOCIATION BETWEEN SENSE OF CONTROL AND SOCIAL SUPPORT: A CROSS-LAGGED PANEL ANALYSIS
Authors: Kim Eunbea , Lee Gina , Lee Jeong Eun 
Published: December 2023

Abstract
While it is widely acknowledged that having a sense of control and social support are crucial elements in promoting both physical and mental health among older adults, the relationship between these two factors and how they operate in diverse racial/ethnic settings is still unclear. To address this gap, we examined the bidirectional relationship between sense of control (constraints and mastery) and support received from three different resources (spouses, children, and friends) using cross-lagged panel regression analyses. Participants are White and Black Americans from four waves of Health and Retirement Study (N = 7,846 White; 944 Black). We found racial differences in the cross-over effects between social support and sense of control. In terms of constraints, while White Americans showed negative bidirectional associations between constraints and support from all resources across four waves, such associations were not observed in Black Americans. Additionally, positive bidirectional associations between mastery and support from all resources were found among White participants, whereas Black Americans showed only spill-over effects for mastery and support received from spouse and children across four waves. Notably, Black Americans’ support received from friends positively predicted their mastery across four waves. These findings underline the importance of considering racial/ethnic differences in understanding the complex interplay between social support and sense of control. Future studies should illuminate the causal relation and examine differential mechanisms in White and Black American older adults.