bluuebunny/crossref_metadata_2025_split huggingface dataset:
RECEIPT OF CHEMOTHERAPY AND COGNITIVE DECLINE AMONG MEDICARE BENEFICIARIES IN THE US HEALTH AND RETIREMENT STUDY
Authors: Westrick Ashly , Kabeto Mohammed , Kobayashi Lindsay 
Published: December 2023

Abstract
Research on cancer and cognitive aging outcomes has been inconsistent, with clinic-based studies showing short-term cognitive declines after chemotherapy, and population-based epidemiological studies observing inverse associations between most cancers and subsequent cognitive aging. We aimed to determine the effect of chemotherapy on cognitive decline and mortality among Medicare beneficiaries in the population-based US Health and Retirement Study (HRS). Using data from HRS-Medicare linked participants ≥65, we identified 858 incident breast, prostate, and kidney cancer diagnoses from 2000 to 2016. Cognitive function was measured using the modified telephone interview for cognitive status (range 0 to 27). Cancer treatment (chemotherapy only, other treatments, and no treatment) was obtained from Medicare claims. We used joint modeling to simultaneously model the association between cancer treatment with cognition decline and mortality. Of 858 participants, 38.7% had breast cancer, 52% had prostate cancer, and 11% had kidney cancer. The mean age at diagnosis was 72.8 years (SD=7.62). 31.7% (n=272) received chemotherapy only, 39.5% (n=339) received other treatment, and 28.8% (n=247) received no treatment. In pooled analyses, receipt of chemotherapy (vs. no treatment) was not significantly associated with cognitive decline (β: 0.08; 95% CI: -0.59, 0.76) but was significantly associated with mortality (HR: 1.39; 95% CI: 1.04, 1.88). In joint modeling, the overall hazard ratio for the receipt of chemotherapy (vs. no treatment) was 1.38 (95% CI: 1.02, 1.88). We found that receipt of chemotherapy was associated with an increased hazard of mortality, but not cognitive decline, compared to those who received no treatment.
AGING AND DECISION MAKING: THE ROLES OF AFFECTIVE AND SOCIAL CONTEXT
Authors: Nolte Julia , Seaman Kendra 
Published: December 2023

Abstract
Age differences in many facets of decision making are well-established. However, a growing literature suggests that the occurrence and strength of these age effects are moderated by contextual factors. The individual talks in this symposium exemplify how age differences in decision making vary by domain, affective intensity, and social distance. First, Nolte and Löckenhoff demonstrate age-related increments in the avoidance of health-based and consumer choices, finding that perceived difficulty, but not affective responses to choice, increase avoidance. Frank and Pachur highlight that affective responses to choice differ across contexts: Younger and older adults exhibit “affect gaps” by making less beneficial, more risk-averse choices in “affect-rich” (health-based) versus “affect-poor” (consumer) contexts. Contrasting monetary and temporal outcomes, Strough, Bruine de Bruin, and Parker illustrate that the tendency to continue failing investments is more pronounced after investing money than time. Moreover, older adults’ decreased susceptibility to this “sunk cost bias” is more evident when making choices about their own investments versus others’ investments. Lu and Löckenhoff report age differences in how decision makers discount other’s financial well-being as social distance increases: Older adults’ willingness to share money with others declines more with increasing social distance than is the case for younger adults. Finally, Wild and Löckenhoff demonstrate that across domains, older versus younger decision makers are less willing to consult with distant social partners or experts and consult fewer people fewer times. To identify directions for future research, Seaman will contextualize the five presentations against the extant aging and decision-making literature.
TO CHOOSE OR NOT TO CHOOSE: CAN AFFECTIVE OR COGNITIVE MECHANISMS EXPLAIN AGE DIFFERENCES IN DECISION AVOIDANCE?
Authors: Nolte Julia , Löckenhoff Corinna 
Published: December 2023

Abstract
Older adults are more likely to avoid decisions, which puts them at risk of experiencing negative consumer or health outcomes. Because the underlying reasons remain unclear, this pre-registered online study assessed the roles of (1) affect (especially regret), (2) subjective difficulty, and (3) cognitive ability in explaining age-related differences in decision avoidance. In addition, half of all participants were randomized to a writing intervention aimed at reducing avoidance tendencies. An adult lifespan sample (N = 432, Mage = 50.94, SDage = 19.53 years, 50% women, 62% Non-Hispanic White) chose between making or avoiding four consumer and health-based decisions. Affect, including regret, was assessed before (pre-decisional), during (peri-decisional), and after making decisions (post-decisional). Subjective difficulty was measured during the decision process. Finally, participants completed assessments of demographic background, socio-emotional experience, health, personality, and cognitive ability. We found that older adults were more likely to avoid decisions (p&lt;.001), but age was unrelated to peri-decisional affect and subjective difficulty. Peri-decisional and post-decisional affect were not consistently related to avoidance, but participants who reported more difficulty were more likely to avoid decisions (p=.002). Covariates and cognitive measures could not explain age-related differences, but lower growth-goal-orientation and stronger maximization tendencies predicted decision avoidance after accounting for age (ps&lt;.05). The intervention was successful at improving peri-decisional cognitive load and peri-decisional affect (ps&lt;.05) but did not reduce decision avoidance. In sum, none of the assessed mechanisms could explain age-related increases in decision avoidance. Across age groups, perceived difficulty but not actual cognitive ability predicted avoidance tendencies.
FACTORS ASSOCIATED WITH ELECTRONIC HEALTH RECORD ADOPTION AMONG ADULT DAY SERVICES IN THE US
Authors: Li Yawen , Chok Jay , Chui Geoffrey , Roosan Don , Shultz Ken 
Published: December 2023

Abstract
Successful adoption of Electronic Health Records (EHR) is becoming increasingly important for Adult Day Service Centers (ADSC) to function effectively and competently, particularly in care coordination with other healthcare providers. Therefore, in the present study, we assessed the EHR adoption among ADSC and its associated organizational characteristics using the 2018 National Study of Long-Term Care Providers (NPALS). The sample included 4,035 ADSC from a national representative sample. Directors or managers of ADSC completed the survey that included questions on organization characteristics, staffing, practice procedures, services, technology use, etc. Findings reveal that the adoption rate of EHR among ADSC was less than thirty percent and less than twenty percent of ADSC used EHR for health information exchange with either physicians or pharmacists. In addition, we found that an ADSC located near other healthcare providers, with Medicaid authorization and a higher percentage of Medicaid patients, and various computer capabilities such as recording participants’ demographic information, clinical notes, medications, service plans, and lab results were related to a higher likelihood of EHR use and EHR exchange. However, possibly due to privacy concerns, the capabilities to record participant problems and view lab results, negatively predict EHR exchange with physicians or pharmacists. The findings are discussed in terms of challenges and strategies to promote EHR adoption in ADSC.
TECHNOLOGY AS A CATALYST FOR SUPPORTING AGING WITH DISABILITY
Authors: Mitzner Tracy 
Published: December 2023

Abstract
Individuals aging with long-term disabilities may need support to perform and participate in everyday activities associated with well-being and quality of life. Technology solutions have potential to effectively promote autonomy and aging-in-place for this population. This symposium will highlight technology research and development efforts from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge). TechSAge is dedicated to understanding the needs of, and developing supportive technologies for people aging with long-term vision, hearing, and mobility disabilities. Mumma et al. will present insights from interviews of adults aging with vision loss due to glaucoma and macular degeneration regarding their challenges and response strategies for everyday activities. Lee et al. will discuss findings from interview data exploring how wisdom is manifested from the lived experiences of individuals aging with disability (i.e., hearing, vision, and mobility). Mitzner et al. will describe characteristics of the participant sample from a clinical trial examining the effect of a Tele Tai Chi intervention on physical activity and social connectedness for adults aging with long-term mobility disabilities. Sanford et al. will present the findings from three TechSAge pilot projects focused on the use of technology to support in-home rehabilitation for individuals aging with long-term upper extremity disabilities: DigiHand, KeyStroke, and 3DP for AT. Together these studies illustrate the needs and coping strategies of older adults with disabilities and the potential of technology to support those needs. This is a collaborative symposium between the Lifelong Disabilities and Technology and Aging Interest Groups.
EXPLORING WISDOM IN PERSONS AGING WITH DISABILITY
Authors: Lee Hye Soo , Dye Maya , Rogers Wendy 
Published: December 2023

Abstract
Wisdom can benefit one’s well-being and lead to a more fulfilling life. One pathway is using wisdom as a resource for coping with adversities in life. At the same time, wisdom can be fostered from experiencing adversities in life. The TechSAge ACCESS interview study explored the challenges and coping strategies of individuals aging with disability (i.e., hearing, vision, and mobility), providing us the opportunity to investigate the wisdom fostered from participants’ lived experiences. Studying wisdom in a population with disability has at least two practical implications for the intersectional field of aging, disability, and technology. First, we can gain and disseminate the knowledge regarding how to cope with aging with disability, which would benefit individuals with similar disability and their care networks. Second, we can utilize participants’ wisdom to guide our research. Focusing on their strengths and coping strategies instead of their weaknesses would offer us additional ways to support individuals aging with disability. There are specific merits to utilizing the ACCESS data for wisdom research. The sample of individuals aging with disability allows us to explore wisdom that manifested as an interaction between a person and a situation. We are exploring participants’ answer to the question regarding the advice they would give to others with similar disability as a wisdom assessment task. This is a contribution to the wisdom literature as it is rare to be able to administer assessment tasks that are relevant to participants’ lives and interests.
HYPOTHALAMIC MICROSTRUCTURE IN OLDER ADULTS IS ASSOCIATED WITH CORTICAL ATROPHY AND NEUROCOGNITION
Authors: Aleksic Sandra , Fleysher Roman , Tal Noa , Darby Timothy , Weiss Erica , Barzilai Nir , Lipton Michael , Milman Sofiya 
Published: December 2023

Abstract
The hypothalamus is emerging as an important regulator of aging. Hypothalamic inflammation in mice shortens lifespan and accelerates neurocognitive decline. However, the role of the hypothalamus in systemic and neurocognitive aging in humans is unresolved. We studied the cross-sectional relationships between hypothalamic microstructure, cortical atrophy and neurocognition in community dwelling older adults (n=124, median age 78.7 (IQR 74.3-83.4) years, 58% women). Hypothalamic microstructure was assessed using magnetic resonance imaging (MRI)-diffusion tensor imaging (DTI) parameters that included mean diffusivity (MD) and fractional anisotropy (FA), obtained using a novel automated image processing pipeline. Greater MD and lower FA were indicative of compromised microstructural integrity. Neurocognitive assessments included a battery of 11 tests that were used to quantify standardized domain-specific (executive, memory, language, attention and visuomotor) and overall neurocognitive scores. Age was positively associated with hypothalamic MD (beta=0.037 SD per year of age, p=0.005). In linear models adjusted for age, sex, education, white matter hypointensities, and total intracranial volume, hypothalamic MD was negatively associated with cortical thickness in the cingulate, frontal, and parietal lobes (betas -0.07, -0.06, -0.07 respectively, all FDR-adjusted p≤0.01). On the other hand, in a multivariable adjusted model that included cortical thickness, hypothalamic FA was positively associated with the overall and all domain-specific neurocognitive scores (betas ranged 0.14 - 0.18, FDR- adjusted p values&lt; 0.05). Hypothalamic microstructure is independently associated with cortical atrophy and neurocognition in the aging brain. Longitudinal studies can establish temporality and potential mechanisms by which hypothalamic dysfunction may accelerate systemic and neurocognitive aging in humans.
IDENTIFYING AND PREVENTING RESIDENT-TO-RESIDENT AGGRESSION IN LONG-TERM CARE: EMERGING GLOBAL PERSPECTIVES
Authors: Chang E-Shien , Mosqueda Laura 
Published: December 2023

Abstract
Resident-to-resident aggression (RRA) is a widespread form of mistreatment in long-term care facilities, affecting 1 in 5 residents every month. Despite its high frequency and adverse consequences for residents, staff, and family members, RRA remains under-recognized and insufficiently studied. Several reasons exist for this, including challenges in obtaining high-quality data to inform evidence-based prevention and intervention strategies. Improved understanding of RRA aligns with recent national policy imperatives to increase nursing home safety and quality of care. To accelerate knowledge-to-practice translation, this symposium highlights expertise from North America and Asia to review the latest evidence and experiences that characterize and improve RRA. Dr. E-Shien Chang will identify the role of racial and ethnic conflicts in RRA using data from the largest RRA prevalence cohort study of U.S. nursing home residents. Dr. Elsie Yan will examine resident and environment risk factors of RRA in Hong Kong, illustrating the needs for improved dementia care training among direct care workers. Dr. David Burnes will discuss barriers, successes, and lessons learned in replicating and adapting a gold standard U.S. based RRA prevalence study in the unique context of Canada. Dr. Karl Pillemer will describe a novel dissemination model to expand program reach of Improving Resident Relationships in Long Term Care (IRRL), an evidence-based RRA intervention program. Finally, Dr. Laura Mosqueda, as policy expert of long-term care services and discussant, will moderate a discussion on translating RRA research to practice and policy changes within the global contexts of long-term care. This is a collaborative symposium between the Abuse, Neglect and Exploitation of Older Persons and Research in Quality of Care Interest Groups.
A COMMUNITY-BASED APPROACH TO REFINING THE ENHANCING ACTIVE CAREGIVER TRAINING (ENACT) INTERVENTION
Authors: Eaton Jacqueline , Neller Sarah , Cajavilca Moroni Fernandez , Johnson Julene , Ellington Lee 
Published: December 2023

Abstract
Several interventions for dementia caregivers target the negative effects of behavioral symptoms. Evidence suggests that actively engaging caregivers in training and preparation improves outcomes, such as reduced caregiver burden, depression, and improved subjective well-being. However, there is little information on the best approaches to optimize active engagement. Enhancing Active Caregiver Training (EnACT) is an arts-based intervention that facilitates active engagement using participant-informed vignettes that portray caregiving experiences. This presentation will describe the process of partnering with dementia caregivers to iteratively develop the EnACT intervention in preparation for a randomized controlled trial (RCT). We conducted three iterative focus groups in partnership with dementia caregivers (n=9). Feedback was incorporated into intervention design and materials following each meeting. During focus group one we reviewed and identified video vignettes for inclusion. In focus group two, we tested intervention activities. In focus group three, participants provided feedback on the facilitator guide developed during this process. Focus groups were audio-recorded, transcribed, and analyzed in three cycles using structural, descriptive, and pattern coding. Across all focus groups, we coded 679 items as what went well and 358 items as needing to change. Intervention revisions focused on narrowing vignette topics, removing confusing components (such as engagement activities that were too burdensome), enhancing accessibility, simplifying instructions, and adding facilitator training. A facilitator guide was developed with four main components: Letter to facilitator, Introduction, Preparation to Begin, and Instructions. Partnering with caregivers improved our ability to enhance acceptability and fidelity in preparation for future testing in a wait-list RCT.
LATER-LIFE EXPERIENCES OF VETERANS AND THEIR CAREGIVERS
Authors: Wilmoth Janet 
Published: December 2023

Abstract
Military service is a defining life-course event that is consequential for the well-being of older adults and their caregivers. Although there has been increased attention to veteran status differences in later-life experiences, critical gaps in knowledge persist. This symposium features four presentations that address existing gaps from various perspectives. Kurth and colleagues use data from an online survey of community-dwelling combat veterans. They find that Vietnam Veterans exhibit more PTSD symptoms than veterans in two younger cohorts, and observed cohort differences are explained by military and post-service experiences. Spiro and colleagues examine later-adult trauma re-engagement (LATR) across multiple samples of Vietnam-era veterans and find that there is variation in LATR by gender and warzone experience. London and colleagues analyze data from adults aged 50+ in the 2021 National Health Interview Survey and find that: non-combat and combat veterans have more difficulty remembering/concentrating than nonveterans; hearing difficulty mediates some of the association between military service experiences and remembering/concentrating; and combat experiences moderate the relationship between hearing difficulty and difficulty remembering/concentrating. Haverhals and colleagues assess the Redefining Elder Care in America Program (RECAP) piloted recently in two VA health care centers and find that combat veterans and their caregivers reported shortcomings and challenges associated with program participation even though they were satisfied overall. Collectively, these papers underscore the enduring influence of combat exposure on older adults and the importance of innovative health care service models that are designed to provide support to caregivers. This is an Aging Veterans: Effects of Military Service across the Life Course Interest Group Sponsored Symposium.
DIGITAL TWIN NEIGHBORHOODS FOR PRECISION POPULATION HEALTH: INITIAL RESULTS OF COMMUNITY CONVERSATIONS
Authors: Perzynski Adam , Berg Kristen , Dalton Jarrod 
Published: December 2023

Abstract
Neighborhood socioeconomic inequality leads to lower use of preventive services, increased incidence and severity of disease, reduced quality of life, and higher mortality across multiple age groups. To accelerate discovery and prioritize population health strategies, we introduced Digital Twin Neighborhoods (DTNs): digital replicas of real communities that include biological, social, and geographic data and algorithms. We implemented a series of community engagement studio sessions (CES) that aim to elicit and clarify community members’ preferences and concerns about DTNs in order to most inclusively and ethically align DTN investigators’ research with community priorities. More than 30 participants have attended quarterly sessions. At CES sessions, researchers summarize the DTN framework and then engage with questions from (i) community experts and (ii) scientific experts, and (iii) open dialogue to guide project decision-making. To date, salient community experts’ concerns include: potential harms of DTNs for real-life communities; data privacy; selection of spatial indicators; and consequences for vulnerable populations. Suggestions for making DTN work more community-resonant have included: data transparency directly with residents; reconciling data definitions with local meanings of health; recognizing biases in electronic health records; and conducting shared activities within neighborhoods. CES sessions revealed foci for future DTN analyses including: how social isolation and togetherness influence health; identification of spatially defined targets for remediating structural racism; analysis of health-promoting assets’ (e.g., green space, churches) differential benefits; and examining how resilience creates practical advantages amidst difficult socioenvironmental circumstances. Conversing with community members, we are now developing implementation plans for each of these areas.
TRENDS IN SUPPORTS FOR FAMILY CAREGIVERS OF OLDER ADULTS THROUGH MEDICAID HOME AND COMMUNITY-BASED SERVICES IN THE US
Authors: Miller Katherine , Parrish Elise , Thunell Johanna 
Published: December 2023

Abstract
The aging population in the United States, combined with the dominant preference of older adults to remain in the home and community, has increased the demand for unpaid (family) caregivers - a role often undertaken by spouses. Despite known adverse effects of caregiving on health and economic well-being, few systematic policies financially supporting caregivers exist. Medicaid Home- and Community-Based Services (HCBS) 1915(c) waivers are a primary mechanism for paying family caregivers. Our objective is to systematically document and describe supports for family caregivers through Medicaid HCBS 1915(c) waivers. To accomplish our objective, we scrape data directly from approved waivers (2010-2019) serving adults aged 65+ including, but not limited to: approval date, services provided, limitations of services, allowed payments to relatives and legally authorized representatives, and the unique number of enrollees to be served by each waiver. We then describe training/education and payments available to family caregivers. Approximately 62 waivers across 15 states provide training and education to family caregivers. Waivers across 41 states (n=241) allow for payments to legally authorized representatives through 1915(c) waivers. However, upon examining the restrictions of these waivers, 67.6% of these waivers effectively exclude spouses from receiving payments. Despite growing reliance on family caregivers, supports are not widespread and existing supports reach a limited group of family caregivers. This research further contributes to Medicaid research by creating a database of waiver services; thereby contributing to our understanding to the depth and generosity of HCBS, which can be systematically updated as new waivers are approved.