bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHRONIC DISABILITIES AND POLYSUBSTANCE USE IN ADULTS AGED 50 + ACROSS 25 US STATES
Authors: Massey John , Thompson Mika , Johnston Laura , Phillips Michael 
Published: December 2023

Abstract
Given an aging demographic that reports higher substance use patterns than preceding generations, as well as variability in cannabis legality at the state level, substance use and abuse is an area of concern for older adults experiencing chronic disabilities. Examining trends for polysubstance use for three of the most used substances (nicotine, alcohol, and cannabis) allows for possible insight into use patterns exhibited by older adults, particularly those with disabilities. Using national data across 25 states from 2020-2021 BRFSS, we investigated recent substance use for adults aged 50 and over (N=200,793). We conducted multinomial regression analyses to examine polysubstance use by individual disabilities (including hearing, vision, cognition, mobility, self-care, and independent living) and any disability. Our results indicated that 36.72% reported at least one disability, while 1.46% reported recent polysubstance use of alcohol, nicotine, and cannabis. All but one (mobility) of the individual disabilities were associated with higher odds of polysubstance use. Having any disability was associated with 42% higher odds of polysubstance use (OR: 1.42, 95%CI: 1.30-1.56) compared to no use. Understanding trends associated with polysubstance use for the three most commonly used substances in the U.S. for older adults 50+ with disabilities may influence future policy discussions, public health campaigns, efforts to educate older adults on the potential harms associated with polysubstance use, and at improving health equity and population health outcomes.
CLIMATE CHANGE, AIR POLLUTION, AND MENTAL HEALTH AMONG OLDER KOREAN AMERICAN RESIDENTS IN LOW-INCOME SENIOR HOUSING
Authors: Park Juyoung , Jang Yuri 
Published: December 2023

Abstract
Given the impact of climate change and air pollution on human health, the present study examined how older individuals’ perceived disruption by extreme weather and air pollution would be linked with mental health. We focused on older Korean Americans living in low-income senior housing and selected anxiety as an indicator of mental health. Data came from surveys with Korean American residents in five low-income senior housing facilities located in the Greater Los Angeles area (n=343, Mean age = 78.4). Anxiety, measured with the GAD-7, averaged 3.38 (SD = 3.77). Perceived levels of disruption caused by extreme weather and air pollution averaged 1.71 (SD = .69) and 1.75 (SD = .72), respectively, out of a range from 1 (not at all) and 4 (very much). Individuals who reported greater disruptions by extreme weather and air pollution had a higher level of anxiety. Given the high correlation between the two types of disruption (r = .56, p &lt; .001), we tested separate regression models of anxiety. Each variable of the perceived disruption by extreme weather (β = .18, p &lt; .001) and air pollution (β = .18, p &lt; .001) was found to have a significant impact on anxiety. Although limited by the use of a small sample of convenience restricted to one ethnic group in one geographic location, our findings suggest the potential mental health impact of climate change and air pollution and call attention to intervention strategies.
CLINICAL CORRELATION OF MOCA AND TAU IMAGING
Authors: Sunil Surya , Nair Malini , Byrne Nicole , Rodriguez Adriana , Nair Anil K 
Published: December 2023

Abstract

Background
Tau-PET Scan measures brain tau deposition. Montreal Cognitive Assessment (MOCA) is used for cognitive impairment in (MCI) and Alzheimer Disease (AD). We analyzed the correlation of MOCA to tau-PET imaging in a memory clinic. Hypothesis Tau-PET positivity correlates with lower MOCA scores in memory clinic patients Objectives To assess the correlation of tau-PET positivity to MOCA test scores in memory clinic patients To evaluate an MOCA score cut-off that translates optimally to tau-PET positivity

Method
Retrospective observational chart review study of 34 patients attending a memory clinic in Boston, MA, with MOCA score and tau-PET scan included for analysis No stratification based on initial or final diagnosis, severity of cognitive impairment, or tracer used. Baseline MOCA and a binary PET scan result were analyzed with covariates age, sex and race. Analysis done on ‘R’ v. 2.4.0. Pearson correlation estimated MOCA score to tau-PET status. Kruskal Wallis/Chi square tests for relationship of age, sex, gender and education with MOCA score and tau-PET status. ROC analyses and sensitivity/specificity were obtained.

Results
Tau PET positivity did not correlate significantly with MOCA score (r= -0.24, 95%CI –0.54 to -0.12, p=0.19). A cut point of 22 on the MOCA estimated tau deposition in the brain by PET scan, with an AUC of 80%, 95% CI –0.6 to –0.99, possibly indicating a ceiling effect on the MOCA.

Conclusion
Tau PET does not correlate with MOCA scores, possibly due to a ceiling effect in the mild impairment subjects.
CLINICIAN PERSPECTIVES ON PRE-VISIT AGENDA-SETTING FOR PERSONS WITH DEMENTIA AND THEIR CARE PARTNERS
Authors: Cassidy Jessica , DesRoches Catherine , Hurwitz Isabel , Wolff Jennifer , Lum Hillary 
Published: December 2023

Abstract
Family care partners often assist persons with dementia in managing their health care, including through healthcare system patient portals. Thus, gaps in communication with family care partners can lead to unmet care needs. OurNotes is an agenda setting intervention included within pre-visit questionnaires that is sent through the patient portal. The intervention aims to encourage patients to share concerns before the visit to enhance communication between patients and clinicians. The objective of this study was to understand clinician perspectives on use of OurNotes in dementia care, including engaging care partners and suggestions for improving the intervention. Semi-structured interviews were conducted with 20 clinicians from two health systems with experience using OurNotes and caring for patients with dementia. Using rapid assessment methods, a codebook was developed and used in a team-based, thematic analysis. Participants were majority White, female, between 30-39 years, worked in primary care, and physicians. Clinicians identified: 1) Benefits of pre-visit preparation that enhanced clinician knowledge of the patient and/or care partner agenda; 2) Improved delivery of family-centered dementia care through greater care partner involvement; 3) Challenges of balancing patient and care partner concerns during clinical visits; and 4) Suggestions for focused efforts on improving care partners’ accessibility and use of OurNotes (and the patient portal). We conclude that optimizing use of OurNotes by care partners may support effective agenda setting by patients, care partners, and clinicians, and ultimately improve dementia care.
CO-DESIGNING A GREEN ACTIVITY PRESCRIPTION PROGRAM WITH HISPANIC/LATINO PERSONS LIVING WITH MEMORY CHALLENGES
Authors: Lassell Rebecca , Tamayo Valeria , Pena Triana , Tejeda Carlos , Torres Anderson , Zwerling Jessica , Gitlin Laura , Brody Abraham 
Published: December 2023

Abstract
Nature activities can improve well-being and may modify risk factors for cognitive decline. There is a gap between nature activities offered within a person’s community and their ability to participate in them, including Hispanic/Latino persons living with memory challenges (MCI and mild dementia) in urban lower-resourced areas. An occupational therapist can bridge this gap by tailoring nature activities available in a person’s home, neighborhood, and community to their interests and needs. Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Prescription (GAP-H) with Hispanic/Latino individuals living with memory challenges and their care partners. Participants were recruited via convenience and snowball sampling in the Bronx, NY with outdoor activity professionals (n=7), Hispanic/Latino persons living with memory challenges and care partners (n=5), and interdisciplinary healthcare providers/dementia experts (n=7). Co-design occurred iteratively with 5 focus groups and 2 individual interviews lasting 30-90 minutes and focused on intervention and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes intervention design and research design. Participant preferences for intervention design were captured by subcodes session duration (30-90 minutes), frequency (4-8 sessions), and delivery modes (in-person and phone). Participants’ preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of well-being, social participation, decreased loneliness, and stewardship were identified. Preferred language for recruitment materials were memory challenges, Hispanic/Latino, and well-being. Referral pathways were identified including community-based organizations and primary care. Findings can inform the co-design process of other interventions for this population.
COGNITIVE DECLINE AND FALLS ARE INDEPENDENT RISK FACTORS FOR SWALLOWING DYSFUNCTION IN OLDER PEOPLE
Authors: Liu I-Ting 
Published: December 2023

Abstract
Aging, oropharyngeal lesion, neuromuscular and progressive neurological disease such as dementia are well-known risk factors of dysphagia. The aim of this study is to evaluate the significant risk factors of swallowing dysfunction in clinical practice. 100 subjects aged 65 or older who received Comprehensive Geriatric Assessment (CGA) were enrolled at EDA Hospital, Taiwan, form January 2022 to February 2023 (IRB: EMRP-110-108). Exclusion criteria: unable to communicate 、advanced disease or totally dependent. CGA was performed by well-trained nurses and geriatrician. Swallowing dysfunction was identified by abnormal swallow exam or related complaints. Cognitive impairment was defined as Short Portable Mental State Questionnaire (SPMSQ) &lt; 8 (SPMSQ &lt; 6 in those without education) or with diagnosed dementia. Binary logistic regression was constructed to assess the independent associated factors of dysphagia. Basic demographic analysis showed that patients with dysphagia were older, had poor ADL, higher number of geriatric syndromes and chronic comorbidities. Multivariate analysis revealed that cognitive decline (OR: 82.74, p=0.035) and falls (OR: 45.17, p=0.011) are still independent associated factors of swallow dysfunction after adjustment for age, sex, BMI, socioeconomics, other geriatric syndromes, chronic comorbidities including stoke and Parkinson disease. Dementia was known as one of the risk factors of dysphagia. Another small follow-up study demonstrated that falls risk is predictive of dysphagia in Parkinson’s disease. Through this study, participants will be able to identify the high-risk group of dysphagia. Prevention such as pneumococcus vaccination, oral hygiene, and speech therapy can be applied on those who have a fall history and clinical cognitive impairment.
COGNITIVE DISPERSION IS ASSOCIATED WITH PROTECTIVE COGNITIVE AND SOCIODEMOGRAPHIC FACTORS IN MIDUS
Authors: Klepacz Laura , Hamm Jeremy , Cerino Eric 
Published: December 2023

Abstract
Research examining the relationship between an individual’s levels of variability across a range of cognitive domains (dispersion) suggests that higher dispersion may be an early indicator of future cognitive impairment. However, this literature is still in its infancy and more research is needed to systematically examine the correlates of dispersion in large-scale, national samples that include individuals across the adult lifespan. Our study thus examined the relationship between cognitive dispersion across 6 tasks, mean cognitive performance, and sociodemographic characteristics in a national sample of adults from the Midlife in the United States (MIDUS) study (n=4,198; age 55±12.45). Dispersion was calculated by generating an intraindividual standard deviation across 6 unique cognitive tasks spanning several neuropsychological domains. In contrast to past research, bivariate correlations indicated that higher levels of cognitive dispersion were associated with higher levels of mean performance across cognitive tasks (r=0.28), higher education (r=0.08), higher income (r=0.04), and younger age (r=-0.07) (all ps&lt;.05). The positive association between cognitive dispersion and mean performance was strongest for the episodic memory and working memory tasks. These results were consistent in both wave 2 and 3 of MIDUS and replicated in regression analyses that also revealed an increase in dispersion across waves 2 and 3 of MIDUS was associated with an increase in mean performance across the two waves (b=0.05, p&lt;.001). Results of our study point to the possibility that, in certain unimpaired adult lifespan populations, dispersion may be associated with protective cognitive and sociodemographic factors linked to healthy cognitive aging.
COMPARING ILLNESS PERCEPTIONS OF MULTIMORBIDITY AMONG OLDER ADULT UTILIZERS AND NON-UTILIZERS OF HOME-BASED CARE
Authors: Bankole Ayomide 
Published: December 2023

Abstract
Health behavior interventions targeting illness perceptions improve outcomes for those with chronic illness. Research investigating illness perception in the context of multimorbidity suggests illness-perception of multimorbidity (IP-MM) predicts short-term health status among individuals with multimorbidity. However, less is known about IP-MM among home-based care (HBC) utilizers who receive in-home support for multimorbidity management. This study aimed to compare IP-MM among older adults HBC-utilizers and non-utilizers. Secondary analysis of a cross-sectional study exploring IP-MM in 116 community-dwelling older adults with ≥2 chronic conditions. IP-MM was assessed via MULTIPleS summary and subscale scores (0-78), including causal-links (0-9), prioritization (0-12), treatment-burden (0-18), activity-restrictions (0-9), and emotional-representations (0-30), where higher scores indicate stronger perceptions. HBC-utilizers self-reported receiving nursing, rehabilitative, or medical services at home. One sample t-tests was performed to compare MULTIPLeS subscales between HBC-utilizers and non-utilizers. HBC utilizers comprised of 18% with 82% as non-utilizers. Mean number of chronic conditions was 4.5 (2); Mean age was 73.3 (6.72), 71% female, 35% Hispanic, 33% Black, 27% White, and 5% Asian. Mean (SD) MULTIPleS summary score was 39.39 (21.1). Subscales scores:[activity restriction: 5.19 (2.88); causal relationships: 4.81 (3.07); prioritization:8 .24 (3.52); treatment burden: 7.84 (5.57). HBC utilizers had significantly higher mean treatment-burden subscale scores (10.38 ± 5.51), than non-utilizers (7.28 ± 4.45), p=0.027. No significant differences in other subscales or summary scores. Older adult HBC-utilizers and non-utilizers experienced comparable IP-MM, differing only in treatment burden perceptions. Additional research on IP-MM is needed to develop interventions that improve multimorbidity management and treatment-burden among HBC utilizers.
COMPARISON OF SELF-RATED HEALTH, FRAILTY-INDEX, AND MULTIMORBIDITY AS HEALTH INDICATORS
Authors: Halonen Pauliina , Enroth Linda , Jääskeläinen Tuija , Koskinen Seppo , Jylhä Marja , Kananen Laura 
Published: December 2023

Abstract
Self-rated health (SRH) predicts mortality and other adverse events (e.g. hospitalizations, intensive care), and reflects clinical biomarker levels even in individuals without diseases. We hypothesize SRH captures information relevant to clinical decision-making, with minimal effort, and might be used prior to more intensive and focused health assessments. To explore the clinical utility of SRH, we 1) analysed its overlap with clinical health assessments, multimorbidity, and Rockwood frailty-index (FI), and 2) compared their performances in mortality prediction. Our data came from two population-based cohort studies in Finland: Health 2000 Survey (H2000: n=6,329, aged 30-97 years) and National FinHealth 2017 Study (FH17: n=4,105, aged 30-98 years). Cox regression adjusted for age and sex, and Harrel’s C-index were used to assess the performances of continuous SRH, FI, and multimorbidity in 4-years-all-cause mortality prediction. Of those with fair/poor SRH, 85% in H2000 and 91% in FH2017 were also frail (FI≥0.25), and 91% and 81% had at least two diseases, respectively. Baseline SRH (H2000: HR[95CI]=3.14[2.10-4.69], FH17: HR[95CI]=4.57[2.37-8.83]), FI (H2000: HR[95CI]=1.40[1.28-1.53], FH17: HR[95CI]=1.54[1.32-1.80]) and number of diseases (H2000: HR[95CI]=1.18[1.10-1.27], FH17: HR[95CI]=1.18[1.03-1.35]) predicted death, and their C-indices were 0.879, 0.884, 0.877 in H2000 and 0.797, 0.800, 0.779 in FH17, respectively. SRH is concordant with clinical health indicators, such as multimorbidity and FI, and predicts mortality equally well in community-dwelling adults. The analyses are ongoing and we will further assess the utility of SRH in other cohorts, using other outcomes, and clinical indicators from registers, and perform age-, sex- and disease-stratified analyses.
COMPARISONS BETWEEN COGNITIVELY-IMPAIRED AND HEALTHY OLDER ADULTS ON NAVIGATION METRICS
Authors: Pervratil Michael , Kossowska-Kuhn Dorota , Charness Neil 
Published: December 2023

Abstract
Being able to navigate one’s environment is a critical skill that contributes to daily living in a variety of circumstances. Navigation is also a complex skill, composed of multiple subskills that play a part in overall performance. Along with other facets of cognition, navigation ability is expected to decline as a part of normal aging processes. What is of additional interest is how cognitive impairment (CI) relates to navigation in older adults. Throughout the literature, differences in navigation have been demonstrated between CI populations and healthy older adults. The current study sought to probe these components of navigation by comparing CI and healthy older adults on several measures of navigation ability. A sample of CI older adults were collected across three sites in the eastern United States. As a part of a larger project, participants completed objective and subjective measures of navigation, and their results were compared with a large sample of community-dwelling older adults (ages 60-90). The goal of these analyses was to determine where CI and healthy older adults differed in navigation. The CI sample performed significantly worse on the spatial orientation test (SOT) and reported significantly worse outcomes on a general wayfinding scale. However, there was no significant difference in self-assessed need for help when navigating or frequency of feeling lost. This divergence in outcomes is highlighted and deliberated further. Utilization of subjective and objective measures is discussed along with limitations of the data.
CORRELATES OF PHYSICIAN TRUST: DEMOGRAPHIC FACTORS AND EXPERIENCES OF MEDICAL CARE DISCRIMINATION
Authors: Mundy Lindsey , Judd Suzanne , Clay Olivio , Howard Virginia , Durant Raegan , Crowe Michael 
Published: December 2023

Abstract
Lack of trust between older adults and their physicians may decrease adherence to medication or limit disclosure of information to healthcare providers. Trust may be shaped in part by demographic factors as well as previous experiences of discrimination in healthcare. We hypothesized that more experiences of discrimination in a medical care setting would be negatively associated with general physician trust. We used cross-sectional data from a follow-up visit (2013-2016) of the national REasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study. Our sample included participants who completed an 11-item general physician trust measure (score range=11-55) and a four-point item about discrimination in medical care settings (n=8,235, age 52-98, 31% Black, 45% men). We examined two sequential linear regression models with trust as the outcome, with the first model including demographic factors and the second adding discrimination in a medical setting. Female gender (β=-0.09, p&lt;.05), Black race (β=-0.03, p&lt;.05), and higher level of education (β=-0.8, p&lt;.05) were each related to lower trust. Higher income (β=0.04, p&lt;.05) and older age (β=0.12, p&lt;.05) were associated with higher trust. Perceived discrimination had a negative association with physician trust (β=-0.14, p&lt;.05) and the relationship between Black race and trust reversed direction and was no longer statistically significant (β=0.20, p=.298) with discrimination in the model. The potential impact of previous discrimination experiences in a medical care setting on physician trust should be considered when providing healthcare services to diverse populations of older adults.
COVID-19 IMPACT ON HEALTH JOURNEYS FOR VETERANS WITH CHRONIC CONDITIONS
Authors: Hossain Sheikh , Judon Kimberly , Augustine Matthew , Brown Sheldon , Boockvar Kenneth , Dolamore Michael , Villalba Madeline , Baim-Lance Abigail 
Published: December 2023

Abstract
The majority of Veterans receiving care in the Veterans Administration (VA) are over 65 years, and many have multiple chronic conditions and functional limitations. In this mixed methods pilot study, we sought to understand how these Veterans experienced the pandemic and associated VA health system changes across two contrasting (rural/urban) VA New York medical settings. From December 2021-January 2023, we conducted semi-structured interviews including co-created journey maps and extracted participants’ demographic and clinical characteristics and outpatient encounters. Journey maps visualized health and related episodes and associated pain and bright spots calibrated by intensity. 40 Veterans participated. An intense COVID-19 reaction emerged in 25% (10/39) of participant journeys. A majority (80%; 8/10) had a mental health (MH) diagnosis, compared to 55% (21/39) overall. A journey typically began with feeling shocked, afraid, or in extreme distress; subsequently there was divergence with some expressing feeling better and others describing lingering negative effects on daily routines, views of a changed world, and persistent VA service impacts. Some reported new perceptions of vulnerability due to age and decreased well-being. Participants in this group used on average more outpatient care before and during the pandemic than other participants and transitioned to greater consumption of virtual care, reflecting utilization trends across participants with mental health diagnoses. The group had mixed feelings about the benefits of virtual care. Ongoing challenges with COVID-19 may indicate the potential need for additional well-designed supportive services and environments particularly sensitive to the long-term impact of COVID-19.