bluuebunny/crossref_metadata_2025_split huggingface dataset:
AGE-FRIENDLY COMMUNITIES IN THE ANDES: CONSIDERATIONS TO IMPROVE UPTAKE
Authors: Guillemot Jonathan , Warner Mildred 
Published: December 2023

Abstract
Despite the demographic aging of the Global South, the uptake of WHO’s age-friendly cities framework remains extremely low. The Andean region of Latin America is currently represented by only four cities, out of more than 1,400 globally. Causes may include the partial inadequacy of the eight WHO domains for communities in the Andean region. We argue for a broader human ecological framework to address the macro, meso and micro levels to better address the context, challenges and opportunities for age-friendly cities in the Andean region. WHO’s age-friendly city domains are focused primarily at the meso (community) scale – on built environment, services and participation. We call for more attention to the macro policy scale, in societies where robust social security systems cannot be assumed. We also call for more attention to the micro scale, to recognize the critical role of family and informal care supports. We question whether the WHO domains are the result of a design bias, with Global North settings in mind for its development. We find the domains of UNICEF’s child-friendly cities initiative, which give more attention to the realities of the Global South, helpful to broaden WHO’s age friendly framework.
BARRIERS TO HEALTH CARE ACCESS AMONG UNDOCUMENTED IMMIGRANTS: PERSPECTIVE OF PALLIATIVE CARE HEALTH CARE PROVIDERS
Authors: Cardenas Valeria , Hulsebus Lindsey , Enguidanos Susan 
Published: December 2023

Abstract
Undocumented immigrants face numerous barriers to obtaining healthcare services, largely due to fear of deportation and limited access to health care. The purpose of this study was to learn about challenges and facilitators palliative care healthcare providers experience in caring for seriously ill undocumented immigrants and the factors affecting access to care in this seriously ill population. From November 2022 to January 2023, we conducted semi-structured, individual telephone interviews with 11 palliative care healthcare providers from two inner city hospitals in California. Our interview protocol elicited providers’ experience caring for undocumented immigrants, including the patients’ stage of illness when providers encounter them, referrals made by the healthcare team, and gaps in care they have witnessed for these undocumented immigrants. Transcripts were analyzed using thematic analysis. Themes related to provider perceived patient care-seeking behaviors and challenges include complications of postponing care, financial burden, fear of deportation, transportation, health literacy, lack of family support, lack of awareness and misperceptions of palliative care. Themes related to provider care challenges include language barriers, longer care process, and cultural barriers. Facilitators and recommendations include awareness of care options and reassurance, importance of social and community resources, expanded palliative care awareness, knowledge, and access, and improved cultural competence. Our findings underscore the need for intervention studies that focus on alleviating identified barriers for undocumented immigrants. Future studies are needed to elicit the perspectives of seriously ill undocumented patients.
UNDERUTILIZATION OF HOSPICE CARE IN OLDER BLACK ADULTS
Authors: Tate Channing 
Published: December 2023

Abstract
Hospice is underutilized in Black Americans despite evidence that Black Americans benefit from hospice services. There are several potential reasons hospice is underutilized in Black Americans including lack of knowledge of hospice, poor opinions of hospice, and low self-efficacy in end-of-life decision-making. Patient decision aids are one technique used to improve patient knowledge and agency in making medical decisions. This research project endeavored to addresses potential barriers to hospice enrollment in Black adults and evaluates if a hospice specific patient decision aid could improve hospice knowledge, opinions of hospice, and decision-making self-efficacy. The study was a pilot randomized controlled trial that enrolled Black adults aged ≥ 65 years. The three primary outcomes for the study included hospice knowledge measured by the Hospice Knowledge Scale, opinions of hospice measured by the Hospice Beliefs and Attitudes Scale, and confidence in making decisions measured by the Decision Self-Efficacy Scale. Additionally acceptability and usability outcomes of the decision aid were collected. All participants completed the three baseline surveys prior to randomization. Those randomized to the intervention were provided with the hospice patient decision aid while those in the control did not receive the decision aid. Hospice knowledge, opinions of hospice, and decision self-efficacy improved from baseline to one-month follow-up in the intervention group, but between group (intervention vs control) differences were not statistically significant. Overall acceptability outcomes were favorable, and participants stated the patient decision aid would be beneficial in facilitating hospice decision making.
THE DIRECT EFFECT OF COMMUNITY-LEVEL RISK FACTORS ON LUNG CANCER INCIDENCE IN FOUR NEW ENGLAND STATES
Authors: Jansen Taylor , Song Qian , Long-Foley Kristie , Dugan Elizabeth 
Published: December 2023

Abstract
Lung cancer is the most common cancer globally and 70% of diagnoses are among the 65+ population. This study identifies what town-level risk factors are contributing to geographic disparities in 65+ lung cancer in N=796 towns in Connecticut, Massachusetts, New Hampshire, and Rhode Island. Multiple spatial-based analyses (e.g., Moran’s I, Getis-Ord Gi*, mapping) were conducted before running a series of spatial regression models to determine the association between town-level risk factors (i.e., environmental exposures, respiratory conditions prevalence, education rates, smoke free legislation) and lung cancer incidence. Mapping and Moran’s I test suggested the 65+ rates of lung cancer in our sample were non-randomly distributed and clusters of high and low rates were present. A hot spot analysis was conducted in ArcMap 10.8 which identified several significant clusters of 65+ lung cancer. Spatial regression models showed that community rates of comorbid respiratory conditions (65+ asthma, COPD, and tobacco use disorder (TUD)) increased lung cancer incidence by 7%, while increasing ozone emissions were directly associated with a 10% increase in incidence. Comprehensive smoke free legislation coverage was significantly associated with lung cancer incidence, but no increasing or decreasing relationship was found. No effects were found for the percentage of 65+ with low education, or 60+ who were current or former smokers. Spatial regression models allow for results which are specific to the geographic sample used and this study suggests that comorbid respiratory conditions and ozone emissions are directly associated with increased rates of 65+ lung cancer incidence in our sample.
SOCIAL INTEGRATION, COGNITION, AND FUNCTIONAL OUTCOME IN OLDER ADULTS FOLLOWING TRAUMATIC BRAIN INJURY
Authors: Jung Wonkyung , Hoffman Jeanne , Byun Eeeseung , Thompson Hilaire 
Published: December 2023

Abstract
Persons aged 65 and older have the highest rates of traumatic brain injury (TBI), and this injury is known to be related to significant, persistent functional changes. What is not known is what factors may mediate these changes. The current study aimed 1) to examine interrelationships among social integration, functional outcome, and cognition in older adults at years 1, 2, and 5 post-traumatic brain injury (TBI) and 2) to examine if functional outcome mediates the concurrent and longitudinal relationships between social integration and cognitive function post-TBI in older adults. This is a secondary analysis of data obtained from Traumatic Brain Injury Model System National Database (TBIMS-NDB). Included subjects from the database were persons aged 65 years and older at the time of injury (N=1469). We used longitudinal mediation analysis to address study aims. We found that social integration had a direct effect on functional outcome and cognition at 1, 2, and 5-years post-TBI. Functional outcome had a positive direct effect on concurrent cognitive function. Regarding mediation, social integration and cognition were mediated by concurrent functional outcome. However, there were no significant mediating effects of concurrent functional outcome on concurrent social integration or subsequent cognitive function. Our findings suggest there are positive relationships between social integration, functional outcome, and cognition over time. With a better understanding of these interrelationships, tailored interventions that target social integration, such as activities fostering a sense of belonging in the community and cultural diversity programs may promote improved functional and cognitive outcomes.
SOCIAL ISOLATION OF OLDER ADULTS WITH AND WITHOUT PHYSICAL HEALTH CONDITIONS DURING COVID-19
Authors: Kilaberia Tina , Hu Yuanyuan , Ratner Edward , Bell Janice 
Published: December 2023

Abstract
Older adults have been disproportionately affected by COVID-19. This study examined health care utilization and social isolation during the pandemic among older adults using written surveys and zoom and phone interviews. We compared two subgroups, those reporting physical health problems (N=12) and those reporting no health problems (N=6). Half of those with physical health problems reported postponing routine or elected healthcare as compared to four (66%) in the subgroup without physical health problems. Seven of 12 (58%) older adults with physical health problems reported isolation specifically from decreased participation in church even though as many lived either in a retirement community or with family, suggesting greater environmental or social supports. This compares to two (33%) in the subgroup without physical health problems reporting isolation from decreased participation in church with only one older adult living in a retirement community. Interviews identified three themes that complement these data: avoiding danger, compound stress (reported only among those with health problems (N=4)), and church as the largest event. These findings suggest that those with physical health problems were less able to delay seeking healthcare, were more likely to feel isolated when unable to attend church services, and suffered from compound stress due to the combination of public health directives and social unrest, such as the George Floyd protests. Religious, faith, or spiritual supports may be important buffers against social isolation during public health emergency, especially for older adults with physical health conditions and when there is concurrent social unrest.
THE COGNITIVE DECLINE–MORTALITY ASSOCIATION IS MODIFIED BY LIVING ALONE AND SOCIAL NETWORK: A PARADOX OF ISOLATION
Authors: Murayama Hiroshi , Sugiyama Mika , Inagaki Hiroki , Ura Chiaki , Miyamae Fumiko , Edahiro Ayako , Okamura Tsuyoshi , Awata Shuichi 
Published: December 2023

Abstract
Cognitive decline (CD) is a well-known mortality risk. To date, modifiers of this relationship have been insufficiently investigated. This study explored the factors modifying the association between CD and all-cause mortality among older Japanese people. A baseline questionnaire was completed with all 132,005 residents, aged ≥65 years, without long-term care insurance certification in Adachi Ward of the Tokyo Metropolitan area in July 2015 (valid response: 75,358). The final analytic sample was 74,872, excluding 486 who reported a history of dementia (mean age = 73.7 ± 6.0 years; 44.9% males). We assessed CD using a self-administered dementia checklist that was validated via the Clinical Dementia Rating Scale. The survival analysis (average follow-up of 1,657 days) showed that CD was associated with a higher mortality risk (hazard ratio [95% confidence interval] = 1.40 [1.28–1.53]). We examined the interaction between socio-demographics, health behaviors/conditions, and CD on mortality. Only household composition and social network (SN; frequency of contact with others) demonstrated significant associations with CD. The stratified analyses showed that the CD-mortality association was stronger among those with a small SN (1.62 [1.40–1.87]) than a large SN (1.26 [1.12–1.41]). Conversely, the association was weaker in living-alone individuals (1.11 [0.90–1.38]) than in cohabiting individuals (1.46 [1.33–1.61]). Although living alone and having a small SN represented “isolated” status, their modifying effects on the CD-mortality relationship were the exact opposite. Our findings highlight that the isolation type needs to be considered when implementing dementia prevention and support for older people with CD/dementia.
JOB AVAILABILITY FOR OLDER WORKERS IN A COMMUNITY: ANALYSIS ON JOB POSTINGS
Authors: Yeo Hyesu 
Published: December 2023

Abstract

Objectives
This study examined the current job availability in a local job market for older workers and investigated the required skills the older workers to be competitive.

Background
Most studies approached older workers’ employment transition from the supply side of the labor market, examining individual-level factors for a successful employment transition. However, there is a lack of knowledge on the demand side, such as job opportunities, regarding older workers’ employment transition.

Methods
The study uses combined data with job postings collected in the 4th quarter of 2021 from three engines and the O*NET database with occupational information to identify job opportunities and required skills. Additionally, the 2020 and 2021 American Community Survey were used to explore the characteristics of the older workforce in the community.

Results
A total of 5,160 job postings divided into 468 occupations were found in the community. The most frequently available jobs were healthcare (14%), transportation and material moving (13 %), and sales (13%) occupations, which required some work experience needed. The older labor force mostly had a college or associate degree (45.8%) and was in educational (16%), office (11%), and sales (11%) occupations. All occupations require technological skills.

Conclusion
The study found a mismatch between the available jobs and the actual older labor force, and those who are in employment transition, even downward movement, would be required some related experience. These suggest that a pre-employment transition program providing job training and age-friendly employment support services would be helpful for older workers in all occupational classes.
CO-PRODUCTION TO TAILOR A DIGITAL TOOL FOR MONITORING SYMPTOMS OF DEMENTIA IN NURSING HOME CARE IN SWEDEN
Authors: Malm Johannes , Bielsten Therése , Odzakovic Elzana , Finkel Deborah , Nilsen Charlotta , Kåreholt Ingemar 
Published: December 2023

Abstract
Symptoms of dementia change over time, resulting in complex situations that can negatively impact the person with dementia, as well as their relatives, and create challenges for staff members. Behavioral and Psychological Symptoms of Dementia (BPSD), such as delusions, hallucinations, agitation, depression, anxiety, apathy, irritability, aberrant motor behavior, and sleep disturbances, occur in approximately 90% of older people with dementia. The purpose of the study was to identify potential barriers and facilitators prior to introducing a web-based digital tool, the Daily-BPSD. Daily-BPSD is going to be used by staff members for daily registrations of severity levels of BPSD for persons with dementia in nursing home care in Sweden. Qualitative data collection was conducted in co-production with previous users of a similar digital tool in disability care (n = 11) and future users in dementia care (n = 32). The participants were assistant nurses, care managers, nurses, occupational therapists, and relatives. The responses highlight the importance of an accessible and time-effective registration procedure, a manageable number of variables and registrations occasions per day, and ensuring that the same information does not need to be documented in different systems. The findings will be used to tailor Daily-BPSD and adequately prepare staff members for large-scale data collection in the next step of the research project. Daily-BPSD could provide an extended foundation of knowledge of the person with BPSD, which could be used to provide more person-centered and appropriate care.
EARLY DETECTION OF DEMENTIA AND MILD COGNITIVE IMPAIRMENT WITH BRAINCHECK
Authors: Huang Bin , Huynh Duong , Ghomi Reza Hosseini 
Published: December 2023

Abstract
Dementia is projected to affect 14 million people in the United States and 152 million people globally in the coming decades. Early detection of dementia, which involves diagnosis of mild cognitive impairment (MCI), a possible prestage of dementia, is critical for intervention and care planning but remains a challenge with current clinical protocols. While brief screening tools are narrow in scope, comprehensive neuropsychological tests are time-consuming and require specialized training and expertise to conduct and interpret results. BrainCheck, a computerized cognitive assessment tool, provides an accessible and promising solution to address these current challenges. The aim of this study was to evaluate BrainCheck for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. A total of 99 participants clinically diagnosed with dementia (DEM; n=42), MCI (n=22), or normal cognition (NC; n=35) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group. BrainCheck battery performance showed significant differences between the three groups, achieving 88% or higher sensitivity and specificity for separating DEM from NC, and 77% or higher sensitivity and specificity in separating the MCI group from the NC and DEM groups. Three-group classification found true positive rates of 80% or higher for the NC and dementia groups and true positive rates of 64% or higher for the MCI group. These results show that BrainCheck was able to distinguish between diagnoses of DEM, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment.
THE MEDIATING ROLE OF PAIN SEVERITY IN THE ASSOCIATION BETWEEN DEPRESSIVE SYMPTOMS AND GAIT SPEED
Authors: Mehta Rhea , Shardell Michelle , Ryan Alice , Dong Yu , Beamer Brock , Hochberg Marc , Rathbun Alan 
Published: December 2023

Abstract
Knee osteoarthritis (OA) and comorbid depression adversely impact gait speed over time. Depression can alter pain tolerance and perception; therefore, self-reported knee pain severity may mediate the relationship between depressive symptoms and gait speed, but this has not been evaluated longitudinally using repeated measures data. Thus, we assessed whether knee pain severity mediates the association between depressive symptoms and gait speed over time. Participants (n=2,222) from the Osteoarthritis Initiative with radiographic knee OA (Kellgren-Lawrence grade ≥ 2) in at least one knee were included. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D; range 0-60) at baseline and first two annual follow-up visits. The twenty-meter gait speed (meters per second) outcome was assessed at the second through fourth annual follow-up visits. Knee pain severity was assessed as a mediator and measured using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale at the first through third annual follow-up visits. Linear regression mediation using a version of the Sobel-Goodman approach was the primary method of analysis. Indirect and direct effects of depressive symptoms on gait speed for each one-unit CES-D score were -0.001 (p &lt; 0.001) and -0.003 (p = 0.020) standard deviations, respectively. Thus, approximately 24% of the association between depressive symptoms and gait speed was mediated by knee pain severity across time. The current results support the need for simultaneous, multidisciplinary interventions for both depressive symptoms and knee OA pain to prevent future decline in physical performance.
USE OF PSYCHIATRIC RISK FACTORS IN PREDICTING 10 YEAR CARDIOVASCULAR RISK FOR CHINESE PATIENTS WITH SCHIZOPHRENIA
Authors: Tang Jennifer Yee-man , Luo Hao , Lau Gary K K , Lee Edwin H M , Wang Pengcheng , Wong Ian C K , Lum Terry , Wong Gloria Hoi-Yan 
Published: December 2023

Abstract
Patients with schizophrenia are known to have excessive cardiovascular morbidity. Traditional Framingham risk prediction models do not consider additional risk attributable to factors related to psychiatric illness and treatment. The Framingham risk scores also tend to over-estimate cardiovascular risk in Chinese cohorts. This study aimed to develop a 10-year cardiovascular risk prediction model using routine clinical data from an electronic health database in Hong Kong. We identified a cohort of 39,449 patients who were diagnosed with schizophrenia between Year 2005 and 2015 and had no history of cardiovascular disease (CVD). Cox proportional hazards regression models were employed to determine psychiatric and clinical risk factors influencing the timing of incident CVD over 10 years. Psychiatric variables of interest included comorbid psychiatric disorders, duration of schizophrenia, use of antidepressant, use of first- or second-generation antipsychotics (FGA & SGA) at baseline and duration of exposure to FGA and SGA. The main analysis showed that comorbid substance use-related disorders (HR = 1.52; 95% CI 1.22 – 1.90; P &lt; 0.001) increased CVD risk and each year of cumulative exposure to FGA increased CVD risk by 2% (HR = 1.02; 95% CI 1.01 – 1.04; P = 0.001). The use of antidepressant predicted a higher CVD risk in female patients (HR 1.19; 95% CI 1.02 – 1.38; P = 0.028). Our risk model predicted that 20.6% of patients had a CVD risk ≥ 20% over 10 years. Our risk models may offer an accessible clinical tool to help monitor cardiovascular risk in patients with schizophrenia.
MEASUREMENTS OF SKIN CAROTENOID STATUS BY VEGGIE METER® IN URBAN ADULTS
Authors: Schweitzer Amy , Brown Ricardo , Monroe-Lord Lillie 
Published: December 2023

Abstract
Recent advances in technology related to objective measures of dietary intake have led to tools such as the Veggie Meter®. The Veggie Meter uses pressure-mediated reflection spectroscopy to determine skin carotenoid status as an objective proxy of fruit and vegetable intake. This project is part of a larger study to determine seasonal changes in skin carotenoids of residents in an urban setting. The purpose of this project is to report baseline measures of skin carotenoids in a subset of older urban adults. Adults frequenting community events (senior center, food pantries, health fairs) consented to triplicate Veggie Meter readings. Adults (n=54) ages &gt;60 years old who provided consent completed a survey and a baseline Veggie Meter reading. Participants were 68% female with a mean ± standard deviation age of 68 ± 7.2 years. Mean BMI was 29.9 ± 7.47 kg/m² . Most were non-smokers (75%). Participants identified as African American (78%), Caucasian (7%), two or more races (7%), or other race (6%). Mean Veggie Meter score was 275.6 ± 98.88. Smokers had a significantly lower Veggie Meter® score (216±73.4) than non-smokers (295 ± 98.7) p=0.006. Conclusion: For this sample of older adults in the DC area, differences in skin carotenoid status was seen by smoking status. Additional data is pending for Winter, Spring and Summer readings to determine whether seasonal variations exist in skin carotenoid status as measured by the Veggie Meter.