bluuebunny/crossref_metadata_2025_split huggingface dataset:
INNOVATING HOME-BASED CARE THROUGH HOME HEALTH DISCHARGE DECISION SUPPORT (HEADS-UP)
Authors: O’Connor Melissa , Brace Margaret , Bowles Kathryn 
Published: December 2023

Abstract
Medicare and private payers rely upon home health (HH) nurses and physicians to evaluate the needs of older adults and decide when ready for discharge. However, there are no national, empirically derived clinical decision support tools to assist clinicians in making these frequent and important discharge decisions. The purpose of this work was to begin development of a clinical decision support tool to support HH clinician decision-making grounded in the evidence and based in real time. Clinician experts, in teams of three: two nurses and one physician reviewed and judged 500 case studies via a secure, dedicated website, making the decision if the older adults should be discharged from services versus recertified for additional care. Our sample matches the national older adult HH population by gender, race and primary diagnosis. The clinician experts recommended over 44.6% of older adults be recertified for more care when in reality, HH clinicians recertified only 22% for additional care. Regardless of insurance status, Blacks were 1.75 times more likely than Whites to be discharged by HH clinicians even though experts recommended more care (p=0.031). Hispanics trended toward being more likely to be discharged by HH clinicians compared to the experts’ recommendation for more care (p=0.094). Our findings indicate that when provided with organized clinical information and ample time to accurately identify the needs of older adults, expert clinicians refer for additional care significantly more often than real-world HH clinicians and that racial disparities exist in current HH discharge decision making.
INTRODUCING EFRAILTY: SIMPLIFYING SELECTION OF FRAILTY ASSESSMENT TOOLS
Authors: Cheslock Megan , Sison Stephanie , Zhong Lily , Newmeyer Natalie , Raman Vaishnavi , Orkaby Ariela , Schwartz Andrea , Kim Dae 
Published: December 2023

Abstract
Health care providers recognize the importance of frailty assessment for older adults, but they may be unfamiliar with which frailty assessment tool to use. We sought to create an accessible website to assist clinicians in choosing an effective, evidence-based frailty screening tool. We selected commonly used frailty tools based on the literature and worked with a web designer to develop the eFrailty website prototype. A short description of each tool’s key features and estimated time for assessment is included for each frailty tool. An algorithm based on differences in patient characteristics, clinical scenarios, available information, and time for assessment was created to guide users. Modeled after the highly popular ePrognosis website, eFrailty is designed to guide clinicians to select the ideal frailty tool for their clinical context. The site prompts clinicians to choose between patients considering stressful treatment (e.g., major surgery), or patients with or without serious illness. Depending on available information, clinicians choose between ‘Self reports/records only,’ or ‘Performance tests available’ including cognitive screens or physical performance testing. Alternatively, Clinicians may use the eFrailty comparison table which builds on the work of several systematic reviews of frailty identification tools to easily select the best instrument for their patient. A recent addition to the site is a crosswalk to compare scores between different frailty assessment tools. Future directions for eFrailty include beta testing to gather clinician input from point of care use.
ACTIVE PARTICIPATION OF OLDER ADULTS AT POLITICAL RALLIES AS A SOURCE OF RESILIENCE: THE CASE OF THE ISRAELI PROTEST
Authors: Ben-David Boaz , Shimon-Raz Ortal , Palgi Yuval , Ring lia , Bresslet Tchelet 
Published: December 2023

Abstract
The governing Israeli coalition suggested on Dec 2022 a reform plan that would fundamentally alter the system of checks and balances within Israeli society. According to law experts, the plan would effectively end liberal democracy in Israel. This turn of events sparked the largest protest movement in the 75year history of Israel. The current situation is unparalleled, and the mental health costs appear to be significant. However, the toll on older adults has not been directly examined yet. The breadth of the protest movement is remarkable. A July 2023 poll conducted by the Israel Democracy Institute estimated that almost a quarter of Israeli citizens had participated at a protest action at least once. It was primarily through participation at large rallies held weekly across the country - one of the main symbols of the protest movement. Interestingly, the survey reported a 37% participation rate among older adults, the highesy participation rate among all tested age groups. Since older Israelis are members of the founding generation of the state, their participation is not surprising. They feel threatened as their way of life and heritage are at risk. In the current study, we conducted a survey that examined mental health indices among older Israelis. Specifically, we wanted to test whether active participation at the protest could serve as a source for resilience in older age. Unfortunately, political turmoil is not unique to Israel. Thus, we hope that our findings could assist practitioners globally.
ADJUSTING TECHNOLOGY FOR AN AGEING POPULATION: CO-PRODUCING TECHNOLOGICAL SOLUTIONS WITH OLDER ADULTS.
Authors: Morgan Deborah , Marston Hannah R , Maddock Carol , Williams Aelwyn , Menzfeld Gemma Wilson- , Jones Elizabeth , Gates Jessica 
Published: December 2023

Abstract
Since the onset of Covid 19, there has been a shift towards moving essential services online. This has the potential to further exclude sub-sections of the population from accessing essential services. This is particularly the case for older people who lack basic digital skills or who are not confident using digital technology, amplifying the risk of exclusion, and increasing the risk of social exclusion, loneliness and social isolation among digitally excluded older people. Research suggests that barriers to engagement with digital technologies include cost, lack of support, and technology being perceived as complicated or not for ‘people like me (French, Quinn & Yates, 2019). As such, there is an urgent need to develop digital solutions with older people, co-designing technology that meets their needs. The presentation will draw on data and experiences of older people involved in a seed corn project funded by the Research Wales Innovation Fund (April 2023- July 2023). The project aimed to co-design an affordable digital solution with digitally excluded older people to support the development of digital skills and confidence. The presentation will focus on the skills deficit identified by older adults with limited digital skills and explore how this knowledge is being incorporated into a co-designed prototype launcher app. The presentation will highlight the benefits and challenges of co-producing solutions for an ageing population.
THE EFFECTIVENESS OF REIMAGINE AGING: AN INTERVENTION TO REDUCE INTERNALIZED AGEISM IN OLDER ADULTS
Authors: Murphy Dallas , Porter Michelle , Mackenzie Corey , Chipperfield Judith 
Published: December 2023

Abstract
A life time of exposure to ageist messaging and beliefs may lead older adults to internalize this messaging and direct it inwards, or towards their peers. This internalized ageism can have severe multi-faceted consequences on the well-being of older adults. However, little research has addressed reducing internalized ageism. Thus, Reimagine Aging, a six-week process-based intervention to reduce internalized ageism was designed and implemented, using tools of education, acceptance and commitment therapy, and attributional retraining to target theoretically based mechanisms of change. The data from 72 community-dwelling older adults (M = 70.4 years, SD = 6.4 years) were analyzed for changes in perceptions of aging and mechanisms of change. Participants completed questionnaires prior to the intervention, immediately following the intervention, and at a two-month follow-up. Results demonstrated that participants’ self-perceptions of aging (partial eta squared = 0.37, p &lt; .001) and perceptions of older adults (partial eta squared = 0.27, p &lt; .001) became significantly more positive and maintained these gains at follow-up, associated with large effect sizes. Furthermore, the increases in self-perceptions of aging were mediated by increases in the theory-related mechanisms of psychological flexibility, mindfulness, and perceived control. Positive gains in perceptions of older adults were mediated by these process-based factors to a lesser degree. This study provides initial support for the effectiveness of this process-based intervention targeting a reduction of internalized ageism. This has the potential to reduce the harmful consequences of internalized ageism impacting older adults globally.
UNDERSTANDING HEALTHCARE UTILIZATION, FRAILTY, AND DELAYS AMONG OLDER SEXUAL AND GENDER MINORITY ADULTS
Authors: Wong Chelsea , Smith Louisa , Cavanaugh Robert , Olivieri-Mui Brianne 
Published: December 2023

Abstract
Older sexual and gender minority adults (OSGM) have a higher burden of frailty, mental health conditions, and healthcare delays compared to non-SGM older adults (non-OSGM). The study aimed to evaluate the impact of health disparities related to frailty and delays on the relationship between OSGM and healthcare utilization, we hypothesized that improving frailty and delays would reduce healthcare utilization. We used marginal structural models in the All of Us version 6 Controlled Tier Dataset to study the mediating role of frailty and delays on healthcare utilization (self-reported general doctor (PCP) and mental health (MH) visits) by SGM status. OSGM (n=4,763) compared to non-OSGM (n=68,146) were younger (mean [SD], 63 [8] vs 66 [8]), had higher frailty (26% vs 19%), reported more delays (30% vs 24%), less excellent mental health (23.2% vs 30.2%), and majority were insured (96% vs 97%). Minimal differences between the total effect and controlled direct effect between SGM status and visits for frailty (PCP -0.01, MH 0.15) and delays (PCP 0, MH 0.16), suggests visits would remain similar if all OSGM were not frail or reported no delays. Contrary to our hypothesis, improving frailty and delays did not impact healthcare utilization among OSGM. Factors other than frailty and healthcare delays may be influencing healthcare utilization among OSGM in All of Us. Further, bias due to self-report/volunteer bias may affect the ability to examine the association of interest. Future work should examine the consensus between survey and EHR reported healthcare utilization within All of Us.
GENDER DIFFERENCES IN COGNITIVE IMPAIRMENT OF AFRICAN AMERICAN AND HISPANIC SEXUAL AND GENDER MINORITY OLDER ADULTS
Authors: Oswald Austin , Fredriksen-Goldsen Karen 
Published: December 2023

Abstract
Cognitive health of sexual and gender minority (SGM) older adults with intersecting racial/ethnic minority identities is an under-researched topic. This research utilizes data from Aging with Pride: National Health Sexuality/Gender study to examine differences in health-promoting and risk factors for cognitive impairment among African American and Hispanic SGM older adults. Informed by the Health Equity Promotion Model, bivariate statistics and linear regression models were applied to better understand subgroup differences in cognitive impairment and risk and protective factors. Daily discrimination and identity stigma were positively associated with cognitive impairment for African American and Hispanic groups. Outdoor leisure was negatively associated with cognitive impairment for African Americans whereas social support was negatively associated with cognitive impairment for Hispanics. Analysis of gender differences revealed that African American men experienced significantly higher rates of identity stigma than African American women; however, the effect of identity stigma on cognitive impairment was stronger for African American women. Among Hispanics, women compared to men were significantly more vulnerable to the effects of daily discrimination and identity stigma on cognitive impairment. Regarding cognitive impairment, engaging in physical activity and outdoor leisure were significantly protective for African American men but not for women, whereas social support was significantly protective for both Hispanic men and women. These findings address a void in SGM aging research by examining racial/ethnic and gender differences in cognitive health. They highlight the need for intersectionality and subgroup differences in research to develop tailored interventions to improve cognitive health among racially/ethnically diverse SGM older adults.
LIVING ALONE WITH DEMENTIA AND NAVIGATING ESSENTIAL TRANSPORTATION NEEDS
Authors: Nemec Mary , Girling Laura 
Published: December 2023

Abstract
Transportation serves a basic human need for older adults and is firmly linked to independence, quality of life, and access to essential services (e.g., medical, nutritional, social). The matter of transportation and driving reduction/cessation is especially challenging in regard to people with Alzheimer’s and related dementias (ADRD). Many individuals with ADRD rely on cohabitating caregiver(s) (e.g., spouse, partner, adult children) to arrange and execute essential transportation needs. However, little is known about how individuals with ADRD who reside alone in the community navigate required transportation. In order to address this gap in the literature, this paper combines narrative data from two ongoing National Institutes of Health (NIH)-funded interview-based protocols that focus on understanding the needs of community-dwelling older adults with ADRD and a collateral informant (N=84). Interview data underwent thematic analyses. Findings indicate four overarching themes: 1. Nuances of ridesharing apps, 2. Family/fictive kin transportation network(s), 3. Unpredictable public transportation, 4. Unmet needs exacerbated by inadequate transportation, and 5. Balancing driving autonomy and risk of harm to self/others. These thematic illations have implications to assist development of strategies for continued mobility and appropriate access to required services for those who reside alone with ADRD, despite changing needs and capabilities. Historically, the focus on transportation among those with ADRD has centered on those with a cohabitating caregiver, however, our findings provide insights into the nuances of how this understudied subpopulation with ADRD experience and navigate their mobility needs.
NEIGHBORHOOD DISADVANTAGE, IMAGING BIOMARKERS OF ALZHEIMER’S DISEASE, AND COGNITION IN DIVERSE OLDER ADULTS
Authors: Fan Erica , Royse Sarah , Snitz Beth , Pascoal Tharick , Shaaban C , Lopresti Brian , Villemagne Victor , Cohen Ann 
Published: December 2023

Abstract
Neuroimaging biomarkers of Alzheimer’s disease (AD) are well-validated in White populations. However, it remains unclear how these biomarkers are associated with cognition in non-White populations disproportionately affected by systemic socioeconomic discrimination. We investigated whether neighborhood disadvantage modifies associations of neuroimaging biomarkers with cognition in a diverse cohort of 198 adults ≥50 years, 50% of whom are Black. Outcomes included cognitive impairment and neuropsychological test scores. Predictors were indices of neurodegeneration, vascular damage, and brain amyloid burden, quantified using MR-based measures of cortical thickness and white matter hyperintensities (WMH) and [11C]PiB PET, respectively. We measured neighborhood disadvantage using area deprivation index (ADI), a composite measurement of socioeconomic conditions in a census tract. In linear models, higher ADI, neurodegeneration, and WMH were separately associated with worse cognition. We found an ADI*neurodegeneration interaction on delayed recall memory (p=0.08). Neurodegeneration-positive participants had worse story delayed recall compared to neurodegeneration-negative regardless of ADI (β=-1.57, p=0.01). In neurodegeneration-negative participants, higher ADI is associated with worse delayed recall (β=-0.04, p=0.004): those with a high ADI exhibited low delayed recall, comparable to neurodegeneration-positive participants. ADI was not associated with cognition in neurodegeneration-positive participants. WMH and ADI interacted in models of impairment, visual memory, and visual copy (interaction p’s&lt; 0.10). In those with high ADI, greater WMH was associated with worse cognition (β=-0.30, p=0.02) while participants with low ADI scored well regardless of WMH volume. Taken together, the relationship between neuroimaging biomarkers and cognition differs by neighborhood socioeconomic conditions, highlighting the need for clinical strategies that acknowledge structural disadvantage.
A DEPRESCRIBING CURRICULAR FRAMEWORK USING AN INTER-PROFESSIONAL APPROACH: IMPLICATIONS FOR NURSING EDUCATION
Authors: Sun Winnie , Sadowski Cheryl , Raman-Wilms Lalitha , Gagnon Camille 
Published: December 2023

Abstract
Background Deprescribing is an important component of managing polypharmacy and reducing harm from potentially inappropriate medications. Current undergraduate nursing education does not consistently incorporate components of deprescribing into curricula. It is essential to bridge the gap in promoting deprescribing competencies, teach related knowledge and skills and assess learning outcomes. The purpose of this presentation is to engage nursing educators who teach geriatrics to identify and implement a curriculum framework for deprescribing. Methodology The Canadian Medication Appropriateness and Deprescribing Network (CaDeN) Healthcare Professional Committee undertook a consensus approach to developing competencies for deprescribing, along with literature review and analysis of prescribing competencies. The authors outlined the required knowledge and skills related to the competencies, with recommended teaching and assessment strategies. Results The seven deprescribing competencies include: gathering and interpreting patients’ medication history and clinical information within their context, using tools that help identify potentially inappropriate medications, weighing potential benefit and harm of continuing or deprescribing medications, using shared decision-making about deprescribing, communicating deprescribing and monitoring plans, and monitoring progress and outcomes. Integrating deprescribing competencies in nursing curricula requires an intentional and structured approach across all years of the program, focusing on interprofessional collaboration. Learning activities should be active and practical, progressing from early to advanced learner skills and include integration of deprescribing through experiential education. Conclusion This presentation provides implications for the nursing profession to apply deprescribing competencies at different learner levels, using appropriate learning and assessment outcomes, and strategies in which deprescribing competencies could be achieved in an interprofessional setting.
AGE-ASSOCIATED CHALLENGES AMONG HIV POPULATION IN VIETNAM: PERSPECTIVES FROM MULTIPLE STAKEHOLDERS
Authors: Xia Qing , Xiong Yuan , Sun Fei , Le Giang , Van Hoang  , Nguyen Khanh , Dang Huong , Liu Ethan 
Published: December 2023

Abstract
HIV remains a significant global public health concern. The growing population of aging individuals living with HIV in Vietnam presents a multifaceted pressing issue, calling for research, policy, and practice interventions. This study aims to identify the aging-associated healthcare needs among the HIV population from three stakeholder groups: healthcare professionals, family caregivers, and persons living with HIV-AIDs. Qualitative data was collected through five focus group interviews involving 10 people living with HIV (PLWH), 9 caregivers, and 8 healthcare providers in Hanoi, Vietnam, in March 2023. Data analysis followed thematic analysis techniques, uncovering recurring patterns and themes across the three participant groups.PLWH reflected diverse experiences, showing mental health struggles, aging-related concerns, and a lack of preparation due to health challenges or unexpected longevity. Resilience and optimism are also manifested in PLWH. Caregivers demonstrated crucial roles, including bridging care, medication adherence, and financial and emotional support. They highlighted the necessity of training programs to enhance their care capabilities. Both PLWH and caregivers expressed a desire for formalized training programs on HIV and aging. Furthermore, healthcare providers reported mental and physical health changes among aging PLWH, such as insomnia, forgetfulness, and memory deterioration. They noted a lack of resources and called for comprehensive training across medical staff to enhance the well-being of the aging PLWH.This study demonstrated the complicated age-associated needs among PLWH in Vietnam. The findings underscore the need for policy and practice innovations to address aging-related cognitive, mental health, and long-term care concerns.
BUILDING LONG-TERM HIV SURVIVOR RESEARCH CHAMPIONS FOR PERSON-CENTERED CARE VIA COMMUNITY DISSEMINATION
Authors: Danilovich Margaret , Rapoport Andy , Nicholson Meredith 
Published: December 2023

Abstract
As HIV becomes a chronic condition, it is critical for research to include the perspectives of long-term HIV survivors who face the challenges of managing both HIV and aging. We created SHARE (Survivors of HIV Advocating for Research Engagement), a nationwide research advisory board for long-term survivors. SHARE’s goal is to incorporate long-term HIV survivor voices into research to influence person-centered care for long-term survivors. Through SHARE, board members have built research capacity through research methods training culminating in the board conducting a community needs assessment to learn community-directed priorities for HIV and aging. Following the needs assessment, each board member worked to identify and conduct research dissemination activities within their own communities to engage others in conversations about aging and HIV and educate on opportunities for greater research involvement. In this paper presentation, the speakers describe the process of building capacity among SHARE members so that they could serve as research champions through community dissemination efforts. The presenters will describe the methods of community dissemination including lunch and learns, webinars, infographics, podcasts, photovoice, and advocacy. Mixed-methods analysis of the impact of research dissemination will be presented including changes in community member knowledge about research, willingness to participate in research studies, and understanding of tools to find and use research. The presenters will also share data from SHARE board member self-reflection on the challenges and opportunities for researchers to engage community member in dissemination activities that are tailored to the community and can influence adoption of research among end users.