bluuebunny/crossref_metadata_2025_split huggingface dataset:
“BUILDING A PLANE WHILE IT’S TAKING OFF”: PERSPECTIVES OF HOSPICE PROVIDERS FROM GROUND ZERO OF THE COVID-19 CRISIS IN NYC
Authors: David Daniel , Boafo Jonelle , Kim Patricia , Moreines Laura , Franzosa Emily , Schulman-Green Dena , Brody Abraham , Aldridge Melissa 
Published: December 2023

Abstract
The provision of care to older adults with serious illness through home hospice visits was extremely challenging for interdisciplinary teams during the COVID-19 pandemic in NYC. We interviewed 20 interdisciplinary providers (nurses, managers, administrators, physicians, medical directors, social workers, and clergy) from three organizations that provided end-of-life care in-person and through telehealth to older adults and their caregivers in NYC. Qualitative content analysis was used to identify themes, categorize findings, and identify important adaptations that were required to provide hospice care during the pandemic. Findings reveal how organizations, providers, patients, and families contended with fear, communicated challenges, and adapted to an ever-changing regulatory landscape. The experience of providing care was markedly different for those who were required to deliver care in person vs. by telehealth. Difficult care choices were made impacting access and the services offered by hospice organizations. Salient themes included: organizational challenges – “building a plane while it’s taking off” (e.g., implementing institutional safety protocols with imperfect COVID-19 information to a wary staff), patient/family challenges – “you aren’t coming in my home” (e.g., inability to enroll patients into hospice without a face-to-face visit), and provider challenges – “some things you can’t do through telehealth.” (e.g., telehealth is a vastly inferior medium to teach isolated family caregivers how to provide end-of-life support to dying family members). These findings provide an opportunity to consider the unique qualities of hospice care, what care can and cannot be effectively delivered through virtual modalities, and what effective adaptations may be sustained long-term.
TRANSITIONING TO HOSPICE DURING THE COVID-19 CRISIS: LESSONS FOR CARE COORDINATION AT THE END OF LIFE
Authors: Franzosa Emily , Kim Patricia , Moreines Laura , Boafo Jonelle , David Daniel , Brody Abraham , McDonald Margaret , Aldridge Melissa 
Published: December 2023

Abstract
The COVID-19 pandemic caused widespread delays and disruption in end-of-life services. We examined the impact of these disruptions among patients in a large, NYC health system who were referred to hospice and died between March 1, 2020 and March 1, 2021. We linked the electronic health records (EHR) of 124 patients cared for by a geriatric outpatient practice to the hospice EHRs to create longitudinal trajectories of patients’ care. We conducted an in-depth qualitative thematic analysis of linked medical and hospice records to examine provider and patient experiences as reflected in the EHR. Our sample (mean age of 91 years) were enrolled in hospice for an average of 173 days, and 81% died at home. We found challenges transitioning from medical to hospice care, including referral and enrollment delays due to infection prevention protocols, communication issues, staffing and equipment shortages (e.g., oxygen, morphine). These disruptions impacted quality of care as patients experienced shortages in personal care services, medical equipment and supplies, and missed home visits due to fear or isolation protocols. Virtual visits helped maintain access to hospice, particularly social work and spiritual care, as did ongoing communication with both the primary care and hospice teams. Our findings demonstrate that while COVID-19 added care transition challenges, new flexibilities and adaptations helped manage disruptions. Retaining these practices, such as reimbursing telehealth social work and spiritual care visits and maintaining ongoing patient contact with trusted primary care providers may help extend emotional support to patients and families during the end of life.
MODIFICATION OF THE ASSOCIATION BETWEEN HEARING LOSS AND DEMENTIA PREVALENCE BY SELF-REPORTED SLEEP DISTURBANCES
Authors: Jiang Kening , Spira Adam , Reed Nicholas , Huang Alison , Lin Frank , Deal Jennifer 
Published: December 2023

Abstract
Hearing loss and sleep disturbances are both known risk factors for dementia. High prevalence and modifiability in late life make them potential targets for dementia prevention. However, their combined contribution to dementia is unknown. The National Health and Aging Trends Study (NHATS) is a longitudinal panel survey of a nationally representative sample of Medicare beneficiaries. A validated algorithm based on self- or proxy-reported diagnosis, AD8 dementia screening, and cognitive tests was used to classify participants as having probable/possible vs. no dementia. Pure-tone audiometry was added to the 2021 round of NHATS; participants with better-ear 4-frequency (0.5, 1, 2, 4 kilohertz) pure-tone average above 25 decibels were categorized as having hearing loss. Participants reported their frequencies of taking &gt;30 minutes to fall asleep and having trouble falling back asleep and were defined as having each symptom if it was experienced ≥2 nights/week. We used Poisson regression with robust standard errors and included an interaction term between sleep disturbances and hearing loss, adjusting for demographics, smoking, body mass index and comorbidities. Among 2,383 participants aged 71+ years (46% male, 7% Black), hearing loss was cross-sectionally associated with higher dementia prevalence only among participants with sleep disturbances (&gt;30 minutes to fall asleep: prevalence ratio [PR]=1.81, 95% CI:0.99, 3.31; difficulties falling back asleep: PR=1.82, 95% CI:1.02, 3.26). Older adults with both hearing loss and sleep disturbances might represent a high-risk subgroup that needs to be prioritized. With the complex etiology of dementia, a better understanding of the co-occurrence of multiple risk factors is needed.
ASSOCIATIONS OF OBJECTIVE MULTISENSORY IMPAIRMENT WITH COGNITIVE IMPAIRMENT: THE ARIC-NCS STUDY
Authors: Smith Jason , Kamath Vidyulata , Chen Honglei , Shrestha Srishti , Abraham Alison , Gross Alden , Reed Nicholas , Deal Jennifer 
Published: December 2023

Abstract
Sensory impairments frequently co-occur among older adults. Characterizing the combined impact of a multisensory phenotype on cognitive impairment could help elucidate a potential mode of pathogenesis. We investigated associations between multisensory impairment (co-occurring, objectively-measured hearing loss [pure-tone average ≥25 dB], vision loss [presenting near or distance acuity &gt;0.3 logMAR], anosmia [Sniffin’ Sticks test score ≤6], and peripheral nerve damage [≥1 insensate site on left or right foot]) and cognitive impairment (mild cognitive impairment [MCI] or dementia). Our study sample consisted of Black and White adults aged 70+ years in the Atherosclerosis Risk in Communities (ARIC) study; a longitudinal, community-based cohort. We estimated prevalence ratios (PRs) of baseline (ARIC visit 6, 2016-2017) expert-adjudicated MCI/dementia and odds ratios (ORs) of progression to MCI/dementia through ARIC visit 7 (2019) by number of impairments (0 [reference], 1, 2, 3 or more) using Poisson and logistic regression models, respectively. Overall, among 814 participants (age range: 71-93 years, 62% female, 41% Black race), an increasing number of impairments was associated with increased prevalence of baseline MCI/dementia (1 impairment, PR=1.14 [95% CI: 0.67-2.01]; 2 impairments, PR=1.53 [95% CI: 0.87-2.79]; ≥3 impairments, PR=2.26 [95% CI: 1.18-4.38]; p-trend: .007) and increased progression to MCI/dementia (1 impairment, OR=1.47 [95% CI: 0.67-3.49]; 2 impairments, OR=1.64 [95% CI: 0.69-4.12]; ≥3 impairments, OR=5.68 [95% CI: 2.18-15.52]; p-trend: .001). These findings suggest multiple concurrent sensory impairments contribute additively to greater MCI/dementia prevalence, signaling the importance of considering multiple impairments together in studies of the contribution of sensory losses to cognitive impairment.
SENSORY AND MOTOR FUNCTIONS IMPROVE LONG-TERM PREDICTIONS OF NEURODEGENERATION AND COGNITIVE DECLINE
Authors: Merten Natascha , Paulsen Adam , Chappell Richard , Chen Yanjun , Ferrucci Luigi , Hancock Laura , Johnson Sterling , Schubert Carla 
Published: December 2023

Abstract
Pathological changes in dementia often start decades before clinical symptoms making early detection important for interventions. We assessed if midlife sensory and motor functions improve prediction of long-term neurodegeneration as indicated by blood-based biomarker positivity and of cognitive decline and impairment when included in models with the CAIDE or Framingham Risk Score (FRS). This longitudinal study included 1529 (mean age 49yrs) Beaver Dam Offspring Study participants with measured serum neurofilament light chain (NfL) from baseline, 5-, and 10-yr follow-up. We assessed hearing,vision,olfaction, motor, and health history data, and calculated CAIDE and FRS at baseline. Outcomes were neurodegeneration (NfL+; value≥age-specific 97.5%ile), 10-yr cognitive decline (trail-making test B time;10% most decline), and cognitive impairment (neurocognitive case review). Logistic regressions were used to test whether adding baseline sensory and motor functions improves models of 10-yr incidence of NfL+, cognitive decline or impairment compared to models based on CAIDE or FRS alone. There were 115 incident NfL+, 139 cognitive decline, and 240 cognitive impairment cases. The area under the receiver operating characteristics curve (AUROC) for NfL+ prediction improved from 0.68[0.62,0.73] to 0.72[0.66,0.77](p&lt;0.01) after adding sensory and motor functions to CAIDE-only models. AUROCs also improved for cognitive decline from 0.72[0.68,0.76] to 0.77[0.73,0.81](p&lt;0.001) and impairment from 0.59[0.55,0.63] to 0.65[0.61,0.68](p&lt;0.001) in CAIDE-only versus CAIDE-sensory-motor models. Improvements were similar in FRS-models. Including midlife sensory and motor functions improved long-term predictions of neurodegeneration, cognitive decline and impairment. Sensory and motor assessments might become relevant for cost-effective and non-invasive screenings to identify high-risk individuals early for future prevention and interventions.
CO-MORBID DEMENTIA AND CANCER THERAPY DECISION-MAKING: A SCOPING REVIEW
Authors: Halpin Sean , Alain Gabriel , Zhao Hui , Fowler Mackenzie , Zhang Qiuyang , Cadet Tamara , Ye Minzhi , Krok-Schoen Jessica 
Published: December 2023

Abstract
Co-morbid dementia complicates cancer therapy decision-making in older adults. Our scoping review examined cancer therapy decision-making among older persons with co-morbid cancer and dementia and their caregivers. Pubmed, Embase, CINAHL, PsycINFO, Cochrane Library, Scopus, and Web of Science were searched from 2018-2022, resulting in 8,654 articles screened, with eight meeting the inclusion criteria. Most studies were conducted in the UK (89%) and reported homogeneity in race and geography. Breast (56%) and prostate (45%, with one reported stage) were the most frequent cancers reported. Five studies (56%) reported multiple types of dementia, with two (22%) indicating stages. The studies indicated that communication between patients, caregivers, and clinical teams might alleviate stress caused by worsening health prospects. Future research should consider diverse racial, geographic, cancer types, dementia types, and healthcare stages to improve understanding of these decision-making processes.
PHENOTYPES OF COGNITIVE FUNCTION IN THE CONTEXT OF COMORBIDITIES
Authors: Zheng Yaguang , Mao Weiyu , Wang Jing 
Published: December 2023

Abstract
While a growing body of evidence has shown that the prevalence of cognitive impairment varies depending on the population, limited research has explored the complex relationships among different cognitive function domains or changes in cognitive functions in the context of comorbidities (e.g., diabetes and stroke). The objective of this symposium is to address knowledge gaps by demonstrating these complex relationships in the context of comorbidities. Zheng and colleagues discuss the prevalence of mild cognitive impairment and dementia in adults with diabetes using nationally representative data from a large-scale dataset. Zhu et al. explore the inference of changes in cognitive function and relationships among cognitive function domains using a novel phenotypic network approach. Further, Li et al. use a similar phenotypic network approach to identify the dynamic associations across cognitive, physical, psychological function, and quality of life among Chinese patients with acute ischemic stroke. Nan Wang & colleagues discuss factors associated with the perceived risk of Alzheimer’s disease and related dementias (ADRD) and how the perceived risk of ADRD is related to cognitive function. Following the paper presentations, Dr. Jing Wang will lead a discussion. The novel finding from this symposium will provide a more comprehensive understanding of how cognition changes over time and how interventions could target multiple domains or be tailored to the varied medical comorbid conditions to improve overall cognitive functions.
MECHANISMS OF CHANGE IN COGNITIVE FUNCTION DOMAINS IN OLDER ADULTS
Authors: Zhu Zheng , Zwerling Jessica , Qi Xiang , Pei Yaolin , Zheng Yaguang , Wu Bei 
Published: December 2023

Abstract
It is crucial to gain a better understanding of these relationships in order to have a more comprehensive understanding of cognitive abilities over time and how interventions can target multiple domains to improve overall cognitive function. This study aimed to investigate the mechanism of changes in cognitive function domains in phenotypic networks. This study used data from the Aging, Demographics, and Memory Study (ADAMS) in Wave A and Wave B. We assessed 12 cognitive function domains. Latent profile transition analysis (LPTA) and cross-lagged panel network model were employed to the dynamic interactions of the 12 cognitive function domains over time in both the deterioration and improvement groups. A total of 252 participants were included in the final analysis. LPTA identified five subgroups and categorized all samples into three main categories: improvement group (n=61), deterioration group (n=54), and no change group (n=137). “D9: psychomotor processing” showed the largest value of out-strength in the deterioration group (r=0.941) and improvement group (r=0.969). The strongest direct positive effect in the deterioration group was “C9: psychomotor processing” -&gt; “C8: attention” (β=0.39). In the improvement group, the strongest direct positive effect was “C9=psychomotor processing” -&gt; “C7=visual memory” (β=0.69). Psychomotor processing can affect other cognitive domains, and it plays a crucial role in changes of cognitive function. The paths of psychomotor processing to attention and visual memory were found to be major factors in cognitive deterioration and improvement. Targeting psychomotor processing may lead to the development of more effective and precise interventions.
PERCEIVED RISK OF ALZHEIMER’S DISEASE/DEMENTIAS AND COGNITIVE FUNCTION AMONG US OLDER ADULTS
Authors: Wang Nan , Xu Hanzhang , West Jessica , Østbye Truls , Wu Bei , Xian Ying , Dupre Matthew 
Published: December 2023

Abstract
To assess factors associated with the perceived risk of Alzheimer’s disease and related dementias (ADRD) and how the perceived risk of ADRD was related to cognitive function. We conducted a retrospective cohort study using 5 waves of data from the Health and Retirement Study (2012-2022) that included adults aged 65 years or older with no previous diagnosis of ADRD at baseline. Cognitive function was measured at baseline and over time using a summary score that included immediate/delayed word recall, serial 7’s test, objective naming test, backwards counting, recall of the current date, and naming the president/vice-president (range=0-35). Perceived risk of developing ADRD was categorized at baseline as “definitely not” (0% probability), “unlikely” (1-49%), “uncertain” (50%), and “more than likely” (&gt;50-100%). Additional baseline measures included participants’ sociodemographic background, psychosocial resources, health behaviors, physiological status, and healthcare utilization. Of 1,457 participants (median age 74 [IQR=63-85] and 59.8% women), individuals who perceived that they would “definitely not” develop ADRD were more likely to be non-Hispanic Black, less educated, and have lower household income than individuals who indicated it was “unlikely” they would develop ADRD. Participants who reported their risks of developing ADRD as “definitely not,” “uncertain,” and “more than likely” had lower cognitive function than participants who perceived their risk of developing ADRD as “unlikely.” Perceived risk of developing ADRD is associated with cognitive function. The (dis)concordance between individuals’ perceived risk of ADRD and their cognitive function has implications for increasing public awareness and developing interventions to prevent ADRD.
SOCIAL DISPARITIES IN SLEEP PATTERNS AMONG US ADULTS IN MID AND OLDER ADULTHOOD
Authors: Sheehan Connor 
Published: December 2023

Abstract
As the U.S. population ages, understanding social disparities in sleep among older adults is paramount. Even as humans physiologically require sleep, sleep duration decreases, and insomnia increases throughout older adulthood. Further, the implications of sleep related conditions (e.g., heart disease) are elevated in older adulthood. Importantly, these changes in sleep patterns throughout older adulthood are distributed in a manner that reflects broader social inequities, as quality sleep is contingent upon resources that are distributed unequally across society (e.g., time, stress, quiet, comfort, access to quality medical care). The inequities in sleep have profound implications for intergenerational social inequality, well-being, and longevity. Novel results regarding social based sleep disparities by gender, race/ethnicity, and educational attainment among older adults from the Health and Retirement Study and the National Health Interview Survey will be presented. The profound implications of sleep disparities and potential interventions will also be discussed.
SLEEP DISPARITIES AMONG ASIAN AMERICANS: IMPACTS OF DISCRIMINATION AND ACCULTURATIVE STRESS
Authors: Sunmin Lee 
Published: December 2023

Abstract
Although Asian Americans have shorter sleep duration and more sleep difficulty compared to Whites or Hispanics, research on Asians remains scarce. 60% of Asians are foreign-born and have high levels of limited English proficiency, which is positively associated with a range of immigrant stressors, such as discrimination and acculturative stress. Importantly, COVID-19 has exacerbated discrimination towards Asian Americans giving rise to ‘Asian hate’. In a study using data from the National Epidemiology Study of Alcohol and Related Conditions III (n=1,765), we found that individuals with high discrimination were sleeping 14.4 minutes less (SE: 6.0, p &lt; .05) and had a higher prevalence of sleep difficulty (prevalence ratio (PR): 1.73, 95% Confidence Interval (CI): 1.33-2.24) compared to those with low discrimination. An interaction effect was observed in sleep difficulty by nativity. The association between discrimination and sleep difficulty was stronger among the U.S.-born than the foreign-born. In another study of Chinese and Korean Americans (n=400), Poisson models revealed that greater acculturative stress was associated with a higher prevalence of sleep disturbance (PR: 1.18, 95% CI: 1.06% to 1.31%). Interaction tests indicated that only women had a significant association between acculturative stress and sleep disturbance (PR: 1.30; 95% CI: 1.13 to 1.49), while the association was significant for individuals identifying as “very Asian” (PR: 1.21; 95% CI: 1.08 to 1.35), but not for those identifying as “mostly Asian” or “bicultural/western”. Future sleep health research in Asian Americans should consider the critical role of discrimination and acculturative stress.
OPTIMISM MITIGATED THE DETRIMENTAL ROLE OF DEPRESSION AND ANXIETY IN SUBJECTIVE WELL-BEING AFTER CARDIAC SURGERY
Authors: Ai Amy , Nash Veronika 
Published: December 2023

Abstract
Cardiac diseases, the primary cause of death among older adults of any races, is comorbid with mental health problems such as depression and anxeity. A recent review article found that cardiovascular health was more consistently associated with optimism and hedonic/subjective well-being than with meaning-laden eudaimonic/psychological well-being. Extensive research has shown the health benefit of dispositional optimism, a personality trait. Few studies, however, have explored the protective effect of optimism the on subjective wellbeing (SWB) one months after cardiac surgery, a life altering procedure in late life. This study estimated the mediating effect of dispositional optimism between preoperative mental health and postoperative SWB. Using a prospective design, we followed 300 patients undergoing cardiac surgery. Mental health was indicated by anxiety and depression, while SWB was indicated by low symptom levels of general distress, based on its definition, one month postoperavely. A confirmatory factor analyses were performed to validate SWB with three subscales. The final solution of a structural equation model (SEM) indicated good fit (Chi-square = 47.55, df = 18, p = 0.000; CFI = 0.95; TLI = 0.92, RMSEA = 0.07, with 90 percent CI from 0.05 to 0.10). Both the CFI (0.96) and TLI (0.93) exceeded the benchmark criterion of .90. The lower CI of RMSEA is under 0.05. Optimism, indicted by two subscales, mediated preoperative mental health and postoperative symptom levels. The finding supports its mitigating role against the damage of depression and anxiety in the SWB of cardiac patients during the critical recovery time – postoperative month.
GENDER DIFFERENCES IN SLEEP QUALITY, FATIGUE, AND DEPRESSIVE SYMPTOMS AMONG ADULTS OVER 50 WITH TOTAL BLINDNESS
Authors: Choi Soyoung , Harrison Tracie 
Published: December 2023

Abstract
Visual limitations and blindness have been associated with poor sleep quality, increased fatigue, and a higher risk of depressive symptoms in the aging population. In this study, we aimed to investigate sleep quality, fatigue, and depressive symptoms in US adults over the age of 50 with total blindness, and to examine potential gender differences. The study included 88 participants (59 females, mean age 61.34±8.04; 19 males, mean age 62.32±8.17) who completed an online survey providing data on socioeconomic status, comorbidities, sleep quality, fatigue, and depressive symptoms. Descriptive and bivariate analyses were performed using R software and its required packages. While females slept less than males (t = -2.98, p &lt;.05), there was no significant difference in sleep quality (t = 1.82, p = .08) or depressive symptoms (t = 0.51, p = 0.62). Fatigue levels were significantly higher in females than males (t = 2.53, p &lt;.05). Poorer sleep quality was associated with increased fatigue and severe depressive symptoms in both subgroups. The findings indicate potential gender effects, however, given the small sample size and limitations of the cross-sectional design, further longitudinal research is needed to fully understand gender differences in sleep quality, fatigue, and depressive symptoms among adults over 50 with visual limitations.