bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE ROLE OF HEALTH LITERACY IN HEALTH CARE UTILIZATION AMONG TAIWANESE OLDER ADULTS
Authors: Liao Zih-Yong , Liao Pei-Chun , Kuo Fang-Lin 
Published: December 2023

Abstract
Health literacy is one of important capabilities links to health-related behaviours. The extant study provides limited information about the healthcare access of older adults. This study investigated factors determining the healthcare utilisation of 2423 community-dwelling older adults from the Taiwan Longitudinal Study on Ageing between 2011 and 2015. We used linear mixed-effects regression models and cumulative logit models to examine whether personal characteristics are associated with healthcare utilisation. A significant association was found between the level of difficulties in health literacy and healthcare utilisation after controlling for age, comorbidity, depression, mobility and accessibilities. The higher the older adults scored in the difficulty of health literacy, the lower frequencies of clinics (p = .03), inpatient (p = .02) and dentist visits (p = .02). Individuals who access health-related information more easily have a better chance to receive inpatient services when they feel unwell (p = .0004). Better perceived health is less likely to use clinics (p &lt; .0001), emergency (p &lt; .0001) and inpatient services (p = .0007) but not include visits to pharmacy and traditional medicine. People engaging in workouts are less likely to purchase in a pharmacy (p = .02) but visit traditional medicine (p = .02) more often. It echoes that health literacy is an intermediate attribute to self-efficacy in managing personal health matters and suggests a perspective that older adults consider taking traditional medicine as a self-care instead of healthcare treatment. Future intervention programmes can address health literacy promotion as an initiating step to facilitate participants’ engagement.
NETWORK ANALYSIS OF ANXIETY AND DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS WITH DIFFERENTIAL MENTAL HEALTH RISKS
Authors: Liu Tianyin , Zhang Wen , Wong Gloria Hoi-Yan , Lum Terry 
Published: December 2023

Abstract
Anxiety and depressive symptoms are common in older people, and network analysis may provide deeper characterization of symptom-symptom interactions to inform personalized care. The aim of this study was to elucidate characteristics of anxiety and depressive symptom networks of older adults with differential risks for depression and anxiety. A total of 4184 older adults (mean age = 77.3±8.8 years, 3245 women) were recruited from the community. Their anxiety and depressive symptom were measured using the Generalized Anxiety Disorder Scale 7-item (GAD-7) and Patient Health Questionnaire 9-item (PHQ-9), respectively. A cut-off score of 5 was used for both scales to differentiate people with mild or above anxiety/depressive symptoms; by this criterion, 1067 (25.5%) of the sample had no anxiety/depressive symptoms, 1690 (40.4%) had symptoms in one domain, and 1427 (34.1%) had symptoms in both domains. Central symptoms and bridge symptoms were identified via centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. Overall, Restlessness (GAD-7 item 5), Depressed mood (PHQ-9 item 2), and Fear (GAD-7 item 7) had the highest centrality values; two bridge symptoms, Restlessness and Psychomotor disturbances (PHQ-9 item 8), were also identified. Higher risks for depression and/or anxiety were positively associated with global strength; Restlessness and Depressed mood remained to be central symptoms, but in those with both depression and anxiety risks, Restlessness and Guilt/Self-blame (PHQ-9 item 6) bridged the two domains. Interventions designed to target central symptoms and bridge symptoms may be effective in alleviating co-occurring experiences of anxiety and depression.
COMPREHENSIVE MOBILITY FRAMEWORK VERIFICATION USING CANADIAN LONGITUDINAL STUDY ON AGING DATA
Authors: Webber Sandra , Liu Yixiu , Barclay Ruth , Jiang Depeng , Ripat Jacquie , Nowicki Scott , Tate Robert 
Published: December 2023

Abstract
Mobility within and between life spaces (one’s room, home, local community, and further destinations) positively influences quality of life and health in older adults. Understanding factors that impact mobility is relevant in many contexts (e.g., in clinical and research environments, for city-planning and social programming). The purpose of this study was to verify a comprehensive theoretical framework for mobility (Webber et al., 2010) with structural equation modelling using data from the Canadian Longitudinal Study on Aging (CLSA). We estimated associations between latent factors consisting of physical, psychosocial, environmental, financial, and cognitive attributes, and life space mobility for participants 65-85 years of age (n=11,667, mean age 73 ± 6 years) with age, sex and education as covariates. The model demonstrated good fit (CFI = 0.90, RMSEA (90% CI) = 0.025 (0.024, 0.026)). Physical, psychosocial, and cognitive health were positively associated with life space mobility. Being less afraid to walk after dark (environmental variable) was also associated with greater mobility. Financial status influenced mobility through positive associations with psychosocial health and physical health. Higher education was related to better cognitive function and better financial status. Age was indirectly associated with life space mobility through its negative associations with financial status, cognition, and physical health. The same model can be used for males and females. The comprehensive mobility framework was verified with the large population-based CLSA dataset. Continued use of the framework is supported as it accurately portrays the complexity of factors that influence older adults’ life space mobility.
RETIREMENT AND COGNITION: EXAMINING THE MENTAL RETIREMENT CONCEPT
Authors: Veal Britney , Meng Hongdao , Andel Ross 
Published: December 2023

Abstract
The concept of “mental retirement” posits that those approaching retirement experience less incentives to continue to engage with work, which is expressed as the so called “on-the-job” retirement effect, leading to negative changes in cognition. To test this notion, we set out to examine if participants who were about to voluntarily retire would have worse cognitive performance compared to those who continued working. We used members of the Health and Retirement Study who reported voluntarily retirement (n=333) in 2008 compared to those who continued working (n=2424). Cognition was assessed at four and two years prior to 2008 and in 2008. Analyses of covariance (ANCOVAs) were conducted with sociodemographic characteristics, chronic conditions, and baseline (2002) cognition as the covariates. Those who retired in 2008 and those who continued working varied on average age, 62.1±6.1 years vs. 60.7±6.1 years, p&lt;.001, sex, 39% men vs. 45% men, p=.04, and average years of education, 13.3±2.6 years vs. 13.6±2.6, p=.04. ANCOVA results showed no significant between-group differences four years before retirement, F(1, 2669) = 0.00, p=.96, significantly worse cognitive scores among those who were planning to retire in two years compared to those who remained in the workforce, F(1, 2645) = 4.75, p=.03, and smaller, non-significant group differences in 2008, F(1, 2730) = 1.69, p=.19. These results support the existence of the “on-the-job” retirement effect, whereby the expectation of retired is accompanied by reduction in cognitive functioning, although it remains unclear whether this effect carries into retirement and/or under what circumstances.
A KNOWLEDGE-DRIVEN BIO-BEHAVIORAL NETWORK MODEL OF THE INFLAMMASOME AND CALORIC RESTRICTION
Authors: Chacko Thomas , Broderick Gordon , Moore Nadia , Parker Daniel , Kraus William , Huffman Kim 
Published: December 2023

Abstract
Healthy dynamic equilibrium between immune and endocrine function can be altered not only by illness but by changes in lifestyle including caloric intake. The Comprehensive Assessment of the Long-term Effects of Reducing Intake of Energy Study (CALERIE™) is a large multi-year longitudinal study funded by the National Institute on Aging investigating what metabolic adaptations would result from a 25% caloric restriction sustained for 2 years and how these might positively affect primary aging and inform on aging biomarkers and chronic diseases of aging. A broad range of behavioral and physiological markers were measured at different levels of biology, making comprehensive integration and interpretation of data challenging. Here we propose a knowledge-based framework for integrating data that fully applies our current understanding of biobehavioral regulatory biology. Leveraging the Elsevier Knowledge Graph and the MedScan Natural Language Processing (NLP) engine we extracted from peer-reviewed literature 816 documented regulatory relationships linking a subset of 85 data elements readily available, including ~ 15 immune inflammatory and 12 endocrine markers. With a connection density of ~11%, this network was supported by &gt; 23,000 citations or a median of 7 citations per regulatory interaction. A structural analysis of connectivity patterns identified inflammatory marker CCL2, insulin and testosterone as key mediators of large-scale coordinated response to caloric restriction. Ongoing analysis will identify immune and endocrine decisional logic that drives network dynamics, providing candidate intervention targets potentiating caloric restriction that remain explainable in the context of established pathway biology.
A SIGNAL FOR HEALTH EQUITY: DIFFERENCES IN WHOLE HEALTH AND SOCIAL NEEDS AMONG MEDICARE ADVANTAGE SUBPOPULATIONS
Authors: McNamara Kelsey , Rudy Ellen 
Published: December 2023

Abstract
CMS’ 2024 Medicare Advantage (MA) Final Rule introduced the health equity index (HEI) to encourage plans to advance equity and improve outcomes for enrollees with social risk factors. Enrollees of focus include those receiving a low-income subsidy, dually eligible for Medicare and Medicaid, and/or having a disability. These populations historically have higher unmet social needs and poorer health outcomes. The purpose of this epidemiological study was to compare self-reported whole health and social needs among MA subpopulations. Analysis included 28,588 MA members who were screened for a companion care program (January–June 2023). Questionnaire included a social needs screener, UCLA-3 Loneliness Scale, and CDC’s Healthy Days Measure. To compare across metrics/domains (mental health, physical health, whole health, social support, loneliness), data was normalized 0 to 100 where higher scores represent better outcomes. Among the cohort, average age was 72, 31% male, and 37 states represented. Subpopulations included 70% traditional MA (TMA), 13% dual-eligible (DE), 17% people with disabilities (PWD), &lt; 1% veterans (V). Average outcomes reported by subpopulations were (TMA; DE; PWD; V): number of unmet social needs (1.6; 2.3; 2.6; 1.4); social support score (63; 54; 53; 70); mental health score (74; 63; 59; 73); physical health score (57; 50; 48; 52); whole health score (65; 56; 53; 65). People with disabilities reported the lowest scores and indicate an important subpopulation in need. Meeting the HEI, and ultimately improving outcomes for some of the most historically marginalized members, will require an individualized and holistic approach to health and social care.
CHANGES IN MULTIMORBIDITY AMONG HOSPITALIZED ADULTS IN THE US
Authors: Picken Lauren , Zhang Yue , Loyd Christine 
Published: December 2023

Abstract
Having multiple chronic health conditions, or multimorbidity, is common among adult inpatients and is associated with risk of death, disability, and reduced quality of life. This investigation examines prevalence trends of multimorbidity over time among inpatients based on age, sex, and race and assesses hospitalization rates for individual diseases over time. Retrospective cross-sectional analysis of 2012-2018 US National Inpatient Sample datasets was completed. Participants were hospitalized patients ≥55y from community hospitals. ICD-9 and 10 codes for admitting diagnoses were used to calculate disease burden using the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). Unweighted mean index scores and admission rates for diseases were compared. Mean age for the sample was 72y, and inpatients were mostly female (53%) and White (77%). The mean comorbidity scores increased across the sample: mean CCI increased from 1.69 to 1.97 and mean ECI increased from 3.66 to 4.14. Comorbidity scores were higher over time with increasing age until about age 80-84 (for CCI) and age 85-89 (for ECI) and increased similarly among males and females. Black and Native American inpatients had the largest increase in mean CCI and ECI scores. Comorbidities with increased hospitalization rates included congestive heart failure (+5%), dementia (+6%), complicated diabetes (+14%), complicated hypertension (+17%), renal disease/failure (+5%), and obesity (+5%). Growing disease burden among inpatients supports the continued need for programs aiming to prevent and treat chronic diseases and multimorbidity, especially among underrepresented populations including Black and Native American communities.
DIFFERENCES BETWEEN TRAINEE AND SUPERVISOR PERSPECTIVES ON THE IMPACT OF COVID-19 ON GEROPSYCHOLOGY TRAINING
Authors: Luskey Valerie , Jacobs M Lindsey , Mlinac Michelle , Bashian Hannah , Reel Candice , Boyle Julia 
Published: December 2023

Abstract
The COVID-19 pandemic majorly impacted geriatric specialty training. To better understand this impact, a survey study was conducted to examine the pandemic’s unique impact on geropsychology training. Participants (N=62) included psychology trainees specializing in geropsychology and psychologists providing geropsychology training. The majority of participants identified as white (90.3%), female (87.1%), and 30-39 years old. Using a 5-point Likert scale ranging from “not at all impactful” to “extremely impactful”, participants rated their subjective experience on how the pandemic positively and negatively affected geropsychology training in three functional competency areas (assessment, intervention, and consultation) consistent with the Pikes Peak Model for Geropsychology Training. A 2x3 mixed design repeated measures ANOVA was conducted to examine similarities and differences in trainees’ and supervisors’ perceptions of the pandemic’s impact on the competency domains. Results indicate that supervisors’ and trainees’ perception of the pandemic’s negative impacts aligned, F(1,43)=.01, p=.931. Results were consistent across all competency domains, F(2,86)=1.39, p=.26; however, perceptions of the positive impacts significantly differed, F(2,84)=6.459, p=.002. Overall, both trainees and supervisors perceived more positive impacts on intervention and consultation compared to assessment, t(43)=3.54, p≤.001. However, trainees (M=1.8, SD=.112) reported more positive impacts overall compared to supervisors (M=1.3, SD=.09), F(1,42)=9.08, p=.004. These findings have significant implications for the level of competence in emerging geropsychologists’, particularly in the areas of cognitive and capacity assessments. Recommendations for additional assessment training and supervision will be provided.
EARLY LIFE LEARNING DISABILITY, PREMATURE PARENTAL DEATH PREDICTS LATE LIFE COGNITIVE IMPAIRMENT
Authors: Nkwata Allan , Smith Jacqui 
Published: December 2023

Abstract
Recent studies have increasingly identified links between early learning difficulties and later life cognitive impairment. Additionally, the death of a parent adversely affects various outcomes across the life course, particularly when the death occurs earlier than expected. This study evaluated the impact of early learning problems and death of a parent on change in cognitive function over 10 years among older Americans enrolled in the Health and Retirement Study. Data were from respondents’ early educational experiences collected in the 2015 and 2017 Life History Mail Survey and childhood stress measures were from the aggregated childhood histories (N = 10,775). Cognitive impairment was assessed per Langa-Weir’s classification, which includes normal, cognitively impaired but not demented (CIND) and demented groups. Generalized Estimating Equations (GEE) regressions estimated odds ratios (ORs) and 95% confidence intervals (CI) with adjustment for socio-demographic and lifestyle factors. Having at least one early learning problem, and death of a parent before the age of 16 were each associated with increased risk of later life cognitive impairment over time (OR 1.60, 95% CI 1.45-1.76 and OR 2.02, 95%CI 1.83-2.24 respectively). However, learning problem-related differences in risk of cognitive impairment varied by parental death status over time (learning problems x death x time, p=0.05). The risk was highest, amongst those that reported both experiencing early learning problems and parental death relative to those without learning problems. Policies and interventions that enhance diagnosis of early learning problems and improve childhood social contexts are needed to promote healthy cognitive aging amongst older Americans.
FAITH-BASED COMMUNITY OUTREACH TO INCREASE ALZHEIMER’S CLINICAL RESEARCH PARTICIPATION IN THE BLACK COMMUNITY
Authors: Gibson Ethlyn , Niknejad Bahar , Okhravi Hamid , Andrews Ebony , Brown-Hughes Travonia 
Published: December 2023

Abstract
Issues: Despite the fact that African Americans are twice more likely to develop Alzheimer’s disease (AD) compared to non-Hispanic whites, they are under-represented in AD clinical research. Lower representation exists in the AHEAD Study as well, which is an AD prevention clinical trial evaluating the efficacy and safety of Lecanemab in 1400 study participants. We sought to raise awareness about AD and increase clinical research participation of African Americans in the AHEAD Study, through a community-based education and recruitment program (CERP). Description: Our diverse team from Eastern Virginia Medical School and Hampton University, a Historically Black College University (HBCU), established a Community Advisory Board and Ministerial Alliance with representation from faith-based, long-standing civic and fraternal organizations within the Greater Hampton Roads Black community. The alliance guided us to identify prioritization areas for addressing sociocultural barriers and increasing clinical research awareness and participation in traditional African American events, key historic community sites, and non-traditional community centers (i.e., YMCA, independent-living, assisted-living centers, Annual Juneteenth Celebration, Black fraternity, and sorority events.) Community health workers, embedded within the community, of the same cultural background and ethnicity, drove our CERP. Lessons Learned: As of July 2023, we offered our program at 45 community events, including community health fairs, civics events, and Purple Sunday luncheons and talks at Black churches in urban and localities in Hampton Roads, in partnership with fraternal and civic community organizations. Out of over 1700 participants, 177 community members have been prescreened for the AHEAD Study.
HEAVY DRINKING, MENTAL HEALTH PROBLEMS AND RECOVERY IN OLDER ADULTS: EXPLORING SUPPORT NEEDS
Authors: John Deepti , Bareham Bethany , O’Donnell Amy , Liddle Jennifer , Chew-Graham Carolyn , Kaner Eileen , Hanratty Barbara 
Published: December 2023

Abstract
Many older adults who consume alcohol at harmful levels experience mental health problems. Common life events such as retirement, bereavement, and declining health, can contribute to anxiety and depression, with alcohol consumption being used as a coping mechanism. Tailored support is crucial to address the unique needs of older adults facing both alcohol misuse and mental health problems. These patients often fall into gaps between services (family practice/alcohol/mental health), which are unable to meet their complex support needs. This qualitative study aimed to understand the lived experiences of older adults with co-occurring heavy drinking and mental health problems, support received and unmet needs. We conducted semi-structured interviews with 14 older adults living in the North of England (completed Summer 2023). Thematic analysis and constant comparison were employed in data analysis. Findings highlighted the importance of age-tailored initiatives such as access to mental health support while actively drinking, supervised detoxification, increased peer support and services that are age inclusive and friendly. Risk factors such as grief, loneliness, financial problems and undiagnosed trauma in older adults contributed to development of these conditions. Older adults need services to work together, integrated around patient needs and addressing heavy drinking and mental health concerns at the same time. Future research should focus on improving mental health literacy and, developing holistic and preventive interventions to address risk factors for co-occurring alcohol and mental health problems in older adults.
MALNUTRITION IN COVID-19 SURVIVORS: PREVALENCE AND RISK FACTORS
Authors: Tosato Matteo , Calvani Riccardo , Landi Francesco 
Published: December 2023

Abstract
Nutritional status is a critical factor throughout COVID-19 disease course. Malnutrition is associated with poor outcomes in hospitalized COVID-19 patients. The aim of our study is to assess the prevalence of malnutrition and identify its risk factors in COVID-19 survivors. Study cohort included 1230 COVID-19 survivors aged 18-86 attending a post-COVID-19 outpatient service. Data on clinical parameters, anthropometry, acute COVID-19 symptoms, lifestyle habits were collected through a comprehensive medical assessment. Malnutrition was assessed according to Global Leadership Initiative on Malnutrition (GLIM) criteria. Our results showed that the prevalence of malnutrition was 22% at 4-5 months after acute disease. Participants who were not hospitalized during acute COVID-19 showed a higher rate of malnutrition compared to those who needed hospitalization (26% versus 19%, p&lt; 0.01). Malnutrition was diagnosed in 25% COVID-19 survivors over 65 years of age compared to 21% younger participants (p&lt; 0.01). After multivariable adjustment, the likelihood of being malnourished increased progressively and independently with advancing age (Odds ratio [OR] 1.02; 95% CI 1.01–1.03) and in male participants (OR 5.56; 95% CI 3.53–8.74). Malnutrition was associated with loss of appetite (OR 2.50; 95% CI 1.73–3.62), and dysgeusia (OR 4.05; 95% CI 2.30–7.21) during acute COVID-19. In the present investigation we showed that malnutrition was highly prevalent in a large cohort of COVID-19 survivors at 4-5 months from acute illness. Our findings highlight the need to implement comprehensive nutritional assessment and therapy as an integral part of care for COVID-19 patients