bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFECT OF A HOME-BASED EXERCISE PROGRAM ON SUBSEQUENT FALLS IN OLDER ADULTS WITH COGNITIVE FRAILTY
Authors: Liu-Ambrose Teresa , Falck Ryan , Davis Jennifer , Khan Karim , Madden Kenneth 
Published: December 2023

Abstract
Cognitive frailty is characterized by concurrent physical frailty and mild cognitive impairment. and increases the risk for falls. Whether exercise can reduce falls in older adults with cognitive frailty is unknown. We examined the effects of a home-based exercise intervention on subsequent falls among community-dwelling older adults with cognitive frailty and a history of falls. A secondary of a 12-month randomized controlled trial among older adults aged ≥70 years with a fall in the last 12 months. Participants were randomized to either 12 months of home-based exercise (EX; n=172) or usual care (UC; n=172). For this analysis, we only included participants who were classified as cognitively frail based on a Short Physical Performance Battery (SPPB) score ≤ 9/12 and a Montreal Cognitive Assessment score &lt; 26/30. Our primary analysis examined the effect of EX on self-reported falls over 12 months. The secondary analysis examined whether higher exercise adherence, or dose, benefits physical frailty among the EX participants. At baseline, 192 participants were classified as cognitively frail (EX=93; UC=99). Falls rates were lower in EX participants vs. UC participants (IRR=0.65; p=0.042). At 12 months, in the EX group, SPPB score was significantly higher among participants with high adherence vs. those with low adherence (estimated mean difference: 1.22; p=0.004). Exercise is a promising strategy for reducing subsequent falls in older adults with cognitive frailty and a history of falls. Greater exercise adherence, or dose, may reduce physical frailty in this population at high risk for disability.
EFFECTS OF INTERPERSONAL AND INTRAPERSONAL PROMOTION STRATEGIES ON FALLS: A PHYSICAL ACTIVITY TRIAL
Authors: McMahon Siobhan , Wyman Jean , Guan Weihua , Choma Elizabeth , Hayes Shannon , Wang Qi , Rothman Alexander , Lewis Beth 
Published: December 2023

Abstract
Although fall-reducing physical activity (PA) interventions have promising effects on falls, little is known about the relative effects of different PA promotion strategies within such interventions. This trial assessed the effects of two promotion components within a PA intervention on participants’ falls 12 months post-intervention. The components included interpersonally-oriented (e.g., social support, social comparison) or intrapersonally-oriented (e.g., goal-setting, action planning) behavior change strategies informed by empirical evidence and theory. In this 2x2 factorial trial (Ready-Steady3 [RS3]),309 community-dwelling older adults (mean age 77+/-5) with &gt; 1 fall risk factor were randomized to 1 of 4 intervention conditions. Factors represented random assignment (No, Yes) to interpersonal or intrapersonal components. All intervention conditions included the Otago Exercise Program adapted for small groups and a PA monitor (Fitbit) and were delivered in community settings over 8 weekly meetings, 90 minutes each. We assessed fall rates using participants’ documentation of falls on prospective monthly calendars. The main and interaction effects of interpersonal and intrapersonal components on fall rates were examined using negative binomial regression. The estimated fall incidence rates among participants assigned vs. those not assigned to the interpersonal component or the intrapersonal components, respectively, were:1.0 (+/-1.4) and 0.9 (+/-1.3), and 1.1 (+/-1.6) and 0.9 (+/-1.1) per person-year. Neither the main nor the interaction effects of either component were statistically significant, suggesting that interpersonal and intrapersonal components in RS3 PA interventions did not affect fall rates. Further investigation is warranted to identify which promotion strategies and dosages reduce falls and injuries in community-dwelling older adults.
AGE-BASED ENTITLEMENT: AN AGEIST PRACTICE OR A TOOL FOR COMBATTING AGEISM?
Authors: Harnett Tove , Jönson Håkan 
Published: December 2023

Abstract
Researchers in gerontology have addressed the way age-based arrangements may communicate stereotypical and devaluing images of older people, thereby linking high age to frailty and dependence. The present article considers proposed reforms to the Swedish eldercare system designed to guarantee people over 85 the right to move into a nursing home regardless of their needs. The purpose of the article is to investigate older people’s views on age-based entitlement in light of this proposal. What might the consequences of implementing the proposal be? Does it communicate devaluing images? Do the respondents consider it a case of ageism? The data consists of 11 peer group interviews with 34 older individuals. Bradshaw’s taxonomy of needs was used to code and analyze data. Four positions on the proposed guarantee were identified: care should be arranged: (1) according to needs, not age; (2) according to age as a proxy for needs; (3) according to age, as a right; and (4) according to age, to combat “fourth ageism”, meaning ageism directed towards frail older persons with care needs, i.e. persons in the fourth age . The notion that such a guarantee might constitute ageism was dismissed as irrelevant, while difficulties in getting access to care were presented as the real discrimination. It is theorized that some forms of ageism posited as theoretically relevant may not be experienced as such by older people themselves.
RETIRING TO POVERTY: VETERANS’ PROTESTS FOR NONPAYMENT OF PENSIONS IN NIGERIA
Authors: Chidebe Runcie , Agha Agha A , Ugwu Ejike , Narine Donnette , Yamashita Takashi , Cummins Phyllis 
Published: December 2023

Abstract
The lack of satisfactory retirement plans coupled with poor retirees’ well-being has led to the introduction of different pension and social security policies in Nigeria. Of all the public servants impacted by the weak pension system, Nigerian veterans are the most vulnerable. Veterans spent their youthful years serving the nation and defending its territory; however, when they retire, they retire to poverty. Since 2015, Nigerian veterans have been staging protests and blocking access roads for non-payment of pensions, gratuities, and other allowances. We adopted a qualitative research approach and used content analysis to examine 45 news articles (2015-2022) related to veterans’ protests for non-payment of pensions in Nigeria. A semi-structured interview was conducted with ten veterans. Our findings show the protests were perceived as the last resort to ‘save their lives’ from poverty and ill health. Non-payment of pensions to veterans in Nigeria has a negative socio-psychological impact on the veterans, their families, and the country. Some of the protest placards read: “We have sacrificed our youthful years fighting for Nigeria, we should be celebrated’, “When we remember the dead, we should also remember the living”. Some quotes from the interviews are: “We’re here, alongside our wives and children, and the widows of late military personnel and veterans who died in service, some of whom died fighting Boko Haram terrorists. We’ll be sleeping over at this place until they…accede to our demands.” Veterans organize themselves in diverse groups. Our findings provide evidence to support improved pensions for veterans in Nigeria.
THE SPILLOVER EFFECTS OF COMPREHENSIVE CARE FOR JOINT REPLACEMENT (CJR) MODEL: A STUDY FROM CALIFORNIA
Authors: Kim Narae , Jacobson Mireille 
Published: December 2023

Abstract
In 2016, Medicare implemented the Comprehensive Care for Joint Replacement (CJR) program to test whether paying hospitals a bundled payment for 90 days of an episode of care for lower extremity joint replacement (LEJR), the most common surgery for Medicare beneficiaries, can improve care coordination and quality in traditional Medicare (TM). Unlike most Medicare alternative payment models, CJR participation was randomly assigned across Metropolitan Statistical Areas (MSAs). Hospitals in selected MSAs were required to participate in the program, while hospitals in other MSAs were paid in the usual fee-for-service manner. Taking advantage of this random assignment, we examined CJR’s direct effects on TM patients and spillover effects on Medicare Advantage (MA) and non-Medicare patients in California. Using California’s Patient Discharge Data (PDD) from 2014 to 2017and event study and difference-in-differences models, we studied changes in adjusted length of stay and home discharge rates before and after program implementation in hospitals in treated versus control MSAs. We found that the CJR program affected not only TM patients, but also untargeted MA and non-Medicare patients. Both TM and non-Medicare patients in treated hospitals experienced shortened length of stay (-3.9% & -1.3%, p&lt;0.05) and increased likelihood of discharge home (3.4%, 2.3%, p&lt; 0.001) relative to those in untreated hospitals after program implementation. MA patients experienced an increase in not only home discharge rates (4.7%, p&lt; 0.001) but also length of stay (2.5%, p&lt; 0.01). Programs designed to affect Medicare costs have the potential to affect the care of patients not covered by the program.
DEVELOPMENT OF A CULTURALLY TAILORED COST MANAGEMENT INTERVENTION INFORMED BY CAREGIVER VOICES
Authors: Benton Donna , Mage Susanna , Wilber Kathleen , Meyer Kylie 
Published: December 2023

Abstract
Caregivers spend an average of 20% of their annual household income on out-of-pocket caregiving costs. Yet, no evidence-based interventions help family caregivers manage these expenses and financial stressors. Responses to financial strain must be culturally tailored to Latino family caregivers, whose out-of-pocket care costs comprise nearly half their annual household income. This presentation describes the development of the CONFIDENCE Financial Education Intervention, a 5-week psychoeducational intervention informed by the Resourcefulness and Quality of Life Theory and made to address the needs of Latino family caregivers. To ensure CONFIDENCE was responsive to the needs of Latino caregivers, the investigators 1) conducted 11 qualitative in-depth interviews with caregivers to learn about their experiences managing care costs and 2) convened a community advisory council of Latino family caregivers to guide intervention components, content, and delivery. Council recommendations guided multiple intervention modifications. For example, based on these recommendations from the council, the investigator team expanded the intervention’s target audience from focusing on women to including caregivers of all genders so families could participate together (familialism). Findings from the interviews and the council overlapped. During interviews, caregivers reported feeling worried about the growth of future caregiving costs increasing; similarly, the council described the importance of helping caregivers understand how costs would change throughout the disease trajectory. Caregiver interviews and the advisory council also emphasized the importance of addressing the needs of middle-income caregivers to prevent future financial adversity. By integrating the caregiver voices, we developed an intervention tailored to meet the needs of Latino families.
PRELIMINARY RESULTS OF THE CONFIDENCE FINANCIAL INTERVENTION FOR CAREGIVERS TO PERSONS LIVING WITH DEMENTIA
Authors: Meyer Kylie , Zauszniewski Jaclene , Song Lixin , Benton Donna 
Published: December 2023

Abstract
Family caregivers to persons living with dementia experience high out-of-pocket costs of care that contribute to material and psychological hardship and can undermine current and future financial security. Latino/Hispanic family caregivers pay nearly double the out-of-pocket costs relative to non-Latino/Hispanic caregivers. CONFIDENCE is a 5-week psychoeducational intervention designed to help caregivers manage out-of-pocket caregiving costs and psychological strain by equipping caregivers with resourcefulness skills and building their self-efficacy in managing care costs. The intervention is culturally tailored to meet the needs of Latino/Hispanic family caregivers. The investigators are conducting a single-arm pre-and post-test trial to determine the preliminary efficacy of the CONFIDENCE intervention among Latino/Hispanic family caregivers to persons living with dementia (NCT05292248). Preliminary results from the first ten study participants, completed as a part of planned interim analyses, indicate a positive change in the hypothesized direction for each study outcome from baseline survey to follow-up surveys, completed within two weeks of program completion. Caregivers who participated in CONFIDENCE reported increased levels of resourcefulness (M=85.1[SD=7.0] vs. M=97.5[SD=5.6], p-value=0.02). We also observed higher levels of caregiver self-efficacy post-intervention (M=40.4[SD=6.0] vs. M=57.2[SD=6.6], p-value&lt;0.001). Lastly, preliminary analyses suggest reduced levels of psychological financial strain following intervention (M=18.3[SD=4.2] vs. M=8.6[SD=2.7], p-value=0.04). Initial results suggest that psychoeducational intervention may prepare caregivers to manage high out-of-pocket care costs. After completing data collection, the study team will examine how intervention participation may affect out-of-pocket caregiving costs. In future studies, we will consider the potential mediating roles of resourcefulness and self-efficacy on study outcomes.
ASSOCIATION BETWEEN PET OWNERS’ AND PETS’ PHYSICAL ACTIVITY LEVELS: A SYSTEMATIC REVIEW
Authors: Notthoff Nanna 
Published: December 2023

Abstract
Social support can promote physical activity (PA) participation. According to socioemotional selectivity theory, engaging in PA with or for important social partners may be particularly motivating for older adults. Recently, pets have been recognized as important social partners. Although studies and literature syntheses have compared PA levels of people with vs. without pets, less is known about whether humans and pets are actually active together, i.e., whether their activity levels are associated. We examined this question in a systematic literature review. Through searches in Web of Science and PubMed with a priori specified inclusion and exclusion criteria, we identified 17,565 potential records. A two-step screening process yielded 9 studies for inclusion in the systematic review. Using a modified version of the STROBE checklist, we rated their quality as M = 21.89 (SD = 2.93) out of 30 possible points. Of the 9 included studies, only 5 explicitly calculated the association between human and pet PA; 4 found a positive association and 1 found no association. Of the 9 included studies, 4 studies explicitly included older adults 60+ years. However, variations in the association between human and pet PA by age were not examined. It seems that humans and their pets are active together. A more thorough examination of this question could provide a basis for an intervention aimed at increasing human PA by incorporating pets. Such an intervention may be particularly suitable for older adults who have lost important human social partners or who have difficulty accessing PA group programs.
MULTILEVEL SOCIAL FACTORS OF HEALTH AND AGING AMONG DIVERSE POPULATIONS
Authors: Surachman Agus , Lawrence Jourdyn , DiMaria-Ghalili Rose Ann 
Published: December 2023

Abstract
While a large body of evidence increasingly documents how individual-level modifiable risk factors shape where and how people age, the aspects of the social environment in which people grow older deserve more focus. Here, we aim to identify examples of multilevel social factors that shape health and aging among samples from diverse populations and datasets. The overarching goal of this work is to yield evidence of the impact of social factors on healthy aging, specifically focusing on cognitive functioning, physical activity, unmet needs, and psychological distress for middle-aged and older adults. Our panel includes four studies focusing on distinct aspects of the social environment and outcomes that affect healthy aging. Specifically, the first presentation uses instrumental variable analysis to estimate a causal association between racial discrimination within institutional settings (e.g., housing, employment) and cognitive function measures. The second study considers neighborhood deprivation (measured using the area deprivation index and personal belief in the neighborhood) as a structural context that may strongly limit adults’ engagement in daily physical health. The third presentation identifies an association between the home environment (i.e., home disorder and disrepair) and unmet care needs (e.g., going without needed assistance with everyday activities such as eating or bathing). Our last presentation shows relationships between measures of economic status (e.g., food insecurity), social support impact, and psychological distress. We close by integrating critical findings from each study and consider the implications of each study on future research and interventions.
INSTITUTIONAL EXPERIENCES OF RACIAL DISCRIMINATION AND COGNITIVE FUNCTION: INSTRUMENTAL VARIABLE ANALYSIS
Authors: Lawrence Jourdyn , Kawachi Ichiro 
Published: December 2023

Abstract
In addition to enduring the ongoing and persistent legacy of structural racism in the United States, Black adults often encounter sources of social stress, like racial discrimination, that have documented associations with health outcomes. As inequities in cognitive aging persist for Black adults, research has worked to examine modifiable factors, like racial discrimination, that may serve as the basis for intervention development. The dysregulation of inflammatory biomarkers has been proposed as one pathway through which racial discrimination becomes embodied to contribute to racial inequities in cognitive function. We assessed how racial discrimination occurring in institutional settings affects cognitive function among a sample of Black and white adults from the Coronary Artery Risk Development in Young Adults (CARDIA) study. To mitigate the influences of measurement error and unmeasured or residual confounding on our findings, we used an instrumental variable analysis to estimate the unbiased, causal association between racial discrimination in institutional settings and a battery of standardized cognitive function measures. We found that increased experiences of racial discrimination had adverse impacts on cognitive function. Understanding how racial discrimination in these settings influences cognitive outcomes supplies insight into points of potential intervention at institutional and policy levels.
SOCIOECONOMIC STATUS, SOCIAL SUPPORT, AND PSYCHOLOGICAL DISTRESS IN AGING KENYANS
Authors: Muruthi James 
Published: December 2023

Abstract
The incidence of psychological distress is on the rise among aging Africans. Studies have indicated that in the absence of public support, relying on informal social networks might benefit the psychological health of aging Africans. However, the associations between social support, economic status, and psychological distress remain unclear in this population. This study investigated the prevalence of psychological distress among aging Kenyans and examined its relationships with economic status (indicated by standard measures for low- and mid-income populations) and perceived social support (multidimensional and provided by family, neighbors, and religious communities). Participants from rural and urban areas of Kenya completed computer-assisted personal interviews in May 2022 (N = 376). Overall, 61% reported high psychological distress. Structural equation modeling results indicated that food insecurity (β = .236, SE = .074, p &lt; .001), sex (β = .146, SE = .056, p &lt; .05) and self-reported physical health (β = .386, SE = .051, p &lt; .001) positively predicted psychological distress while educational status (β = .146, SE = .058, p &lt; .05), and flooring material (β = .107, SE = .056, p &lt; .05) were negative predictors. The dimensions of social support were not significantly associated with the outcome variable. The findings illuminate that psychological distress is a critical health concern for the sample and needs targeted health interventions. They also underline the critical role of economic status on the psychological distress of aging Kenyans. Future studies should further explore these relationships, especially using longitudinal and representative data.
IDENTIFYING NEW INTERVENTION TARGETS TO REDUCE RISK OF ELDER ABUSE AND NEGLECT IN DEMENTIA FAMILY CAREGIVING
Authors: Pickering Carolyn , Winstead Vicki , Hernandez-Tejada Melba 
Published: December 2023

Abstract
Persons living with dementia experience higher rates of abuse and neglect than their cognitively intact peers. Caregiver burden, including stress related to management of behavioral symptoms, has been repeatedly shown as a risk factor for family caregivers’ use of abusive and neglectful behavior. However, interventions intended to reduce caregiver burden and stress and improve management of behavioral symptoms often produce only small effect sizes and are not successful in translation. Therefore, it is important to identify other modifiable risk factors to serve as intervention targets to reduce and prevent elder abuse and neglect in dementia family caregivers. The purpose of this symposium is to understand the role of three potential targets for which there are efficacious interventions available: alcohol consumption, family conflict and self-compassion. The first paper presents the differential impact of screening positive for alcohol use disorder and daily drinking patterns on risk of neglect, physical and psychological abuse. The second paper examines the role of family conflict on a caregiver’s use of abusive and neglectful behaviors, including how risk varies by the relationship type (e.g., adult child caregiver vs spouse). The third paper discusses the protective effect of self-compassion on daily risk of abuse and neglect, including the buffering effect it has on daily stress appraisal. The discussant will highlight implications and future directions for intervention research, including how the field may shift to a personalized approach to intervention delivery to match the right intervention to the right person.
DYNAMIC IMPACTS OF FAMILY CONFLICT ON ELDER ABUSE AND NEGLECT AMONG ADRD CAREGIVERS
Authors: Browning Wesley , Chilatra Jessica Hernandez , Yildiz Mustafa , Winstead Vicki , Pickering Carolyn 
Published: December 2023

Abstract
Conflict with other family members impacts dementia caregivers’ well-being and stress-appraisals and may also influence their use of elder abuse and neglect (EAN). To test this, we utilized latent class analysis to classify spouse, adult child, grandchild, and nontraditional (step- and in-laws) caregivers (N = 453) based on family conflict levels at baseline. Caregivers were classified into four groups: “low,” “moderate,” “high,” and “EAN accusations.” Spouses were significantly more likely to be in the “low” class compared to other classes. Nontraditional caregivers were more likely to be in the “EAN accusations” class versus the “moderate” class (β = 1.73, SE = .70, p &lt; .05). Belonging to the EAN accusations class predicted EAN at baseline (t = 3.728, p &lt; .001). Next, dynamic structural equation modeling was used to test whether stress from family conflict on a given day predicts use of EAN behaviors. Family conflict stress predicted EAN on the same day (β = 0.05, 95% CI = 0.03-0.07), but not the subsequent day (CL= -0.01, 95% CI = 0.03-0.02). Similar models were conducted for each relationship type. The effect of family conflict stress on EAN was not significant for spouse and grandchildren but remained significant for adult child and non-traditional caregivers. Findings suggest interventions related to conflict management and communication among caregiving families may be beneficial new intervention targets for reducing EAN in ADRD. Addressing family conflict may be most important when the caregiver is an adult child or nontraditional relationship.