bluuebunny/crossref_metadata_2025_split huggingface dataset:
ENGAGING PEOPLE WITH DEMENTIA AND THEIR FAMILY IN ADVANCE CARE PLANNING: A 33 COUNTRY DELPHI STUDY
Authors: van der Steen Jenny , Korfage Ida 
Published: December 2023

Abstract
Reaching a consensus about a definitional framework of advance care planning in dementia was a main goal of an international Delphi study conducted by the European Association for Palliative Care. Four rounds with a panel of 107 experts from 33 countries were conducted between September 2021 and June 2022. The framework comprised a definition and three issues that are of particular importance in the case of dementia, which were capacity, family, and engagement and communication. Focusing on the latter, we provide recommendations that achieved a consensus in the Delphi study. We also interviewed persons with dementia and provide their recommendations for health care providers directly offered by them which the panel found eye-opening. The framework fits dementia and is unique in that it focuses on a communication process that continues independent of the level of capacity, beyond a focus on documenting specific current or end-of-life treatment preferences. It evolved in consensus with experts from western and non-western countries and it should promote inclusiveness of persons with dementia and their family caregivers. The more inclusive conceptualization of what advance care planning in dementia is, provides a much-needed basis for research and policy initiatives on advance care planning in dementia. Further, the work also highlights ambiguity such as about when family caregivers can act as proxies and when not, and the methods may be used as a template for developing frameworks on advance care planning with other specific conditions.
IMPROVING THE ENGAGEMENT OF RESIDENTS WITH DEMENTIA IN ADVANCE CARE PLANNING DISCUSSIONS IN LONG-TERM CARE
Authors: Kaasalainen Sharon , Wickson-Griffiths Abigail , Vellani Shirin , Sussman Tamara 
Published: December 2023

Abstract
As part of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC), we have designed and evaluated a number of tools and resources to promote a palliative approach in dementia, including a Canadian version of the Conversation Starter Kit (CSK) booklet. We used participatory action research to design tools for use with care providers based on survey data and interviews. Data was analyzed using thematic analysis and descriptive statistics. We found that residents reported that they engaged in asking more questions to their care provider after completing the CSK booklet. However, care providers stated that they did not feel comfortable addressing questions and concerns raised by residents and their family members. Hence, we co-designed two tools to help build capacity among care providers to support ACP discussions with residents and families, including an e-learning module about ACP discussions for people with dementia and a Conversation Guide. Pilot findings of these tools suggest that staff appreciate the information and tools to enable them to initiate ACP discussions and address difficult conversations. Clearly, residents with dementia and their families need to be supported to engage in ACP discussions early on in their disease trajectory so that residents are afforded the opportunity to voice their values and wishes for end of life care. At the same time, care providers need to have the skills (e.g., listening, probing) and comfort to engage in these discussions to support and help prepare residents and families for important decisions that need to be made later on.
COMMUNITY-BASED RESEARCH ON GRIEF SUPPORT FOR OLDER ADULTS: FROM EXPLORATION TO IMPLEMENTATION
Authors: Stone-Bury Lisa , Weiskittle Rachel 
Published: December 2023

Abstract
Community-based research has initiated a shift from research existing in an ivory tower to being collected and then implemented for the direct benefit of the public. The social sciences continue to struggle with the balance between rigorous science and feasible interventions, creating a common disconnect between research and practice. This is particularly relevant to grief and bereavement, for which services are often under-utilized among older adults. This symposium will discuss a multidisciplinary team’s application of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, describing the development, findings, and service outcomes of a community-based research initiative within a mid-sized city. First, Lisa E. Stone will describe the challenges and successful strategies in the collaborative process of questionnaire development with multidisciplinary community stakeholders. She will also present on the methodology used to attain large community and grief professional samples, including recruitment strategies for adults across the lifespan. Second, Caroline Collins-Pisano will present key age-related findings from the community study, highlighting the lifespan factors that impact grief experiences and utilization of grief resources among older adults. Lastly, Rachel E. Weiskittle will present on the team’s process of implementing data-driven grief interventions, focusing on the translation of community-based findings to multifaceted grief services for older adults. In sum, this symposium presents a community-based application of the EPIS framework that focuses on direct, tailored, and immediate implementation of grief services, a consistent need for the aging population.
PARTICIPATION IN AND EXCLUSION FROM EXTENDED LATE WORKING LIFE DURING THE DEMOGRAPHIC, DIGITAL, AND GREEN TRANSITION
Authors: Motel-Klingebiel Andreas 
Published: December 2023

Abstract
Policies aim to extend working lives by investing in the capacity and employability of older workers, changing the regulatory framework, promoting innovative life-course policies, and advancing lifelong learning, which gains relevance under the impact of increasingly aging populations, digitalisation, and the green transition. However, as some national, branch, and company policies are counterproductive, encouraging early exit and perpetuating ageist training and recruitment practices, working longer may not be equally achievable and beneficial for all workers. This symposium presents research on exclusion and inequality in late working life, providing evidence for policy innovation towards inclusive extended work and sustainable working conditions. It combines comparative multi-level research based on registry and survey data as well as qualitative information. Contributions address the opportunities and limitations of equal and inclusive extended work under the impact of population aging, digitalisation, and the green transition. This includes a conceptual introduction to research and policy on extended late work in Europe during the triple demographic, digital and green transition, an analysis of age discrimination in company and branch policies based on expert interview data, an examination of the perceived significance of lifelong learning for exclusion risks, an analysis of risk experiences associated with extended work, and a commentary discussing the findings in the context of gerontological debates on exclusion and precarity in later life. The (co-)authors represent a mix of early career, mid-career, and senior scholars with interdisciplinary backgrounds from Europe and North America. The audience is invited to discuss concepts, analyses, and conclusions with the presenters.
INEQUALITIES IN THE FRAILTY-FREE LIFE EXPECTANCY OF ADULTS IN ENGLAND AGED OVER 50
Authors: Sinclair David , Maharani Asri , Matthews Fiona 
Published: December 2023

Abstract
Understanding how the onset of frailty differs between socio-economic groups will help health and care providers plan for increasing demand from an ageing population and highlight population groups to target interventions to reduce frailty. We aimed to calculate the frailty-free, frail and total life expectancies of adults aged over 50 using data from the English Longitudinal Study of Ageing (ELSA), and analyse associations with socio-economic characteristics. Survey data from ELSA waves 1-9 (2002-2019) was used to follow the frailty trajectories of individuals (n=11,423 at wave 1). Individuals were categorised into non-frail and frail states using a frailty index. A multistate model assessed the risk of individuals transitioning between states or dying. Transitions were associated with the participants’ socio-economic characteristics and converted to life expectancies. Increased wealth, reduced deprivation, more education, and marriage are all associated with increased frailty-free and total life expectancies, and reduced frail life expectancies. Wealth is the most important socio-economic indicator of frailty-free life expectancy. At age 50, large inequalities in frailty-free life expectancies exist between the wealthiest, least deprived population (females: 36.1 [35.1-37.0], males: 34.6 [33.7-35.4] years) and the least wealthy, most deprived population (females: 22.1 [21.3-22.7], males: 21.3 [20.4-22.0] years). This is the first study to investigate the associations between frailty-free life expectancies and socio-economic characteristics in Europe. Large inequalities in frailty-free and frail life expectancies exist between those with different socio-economic characteristics. This highlights the people most at risk of early frailty at younger ages.
DIGITALIZATION OF HEALTH SERVICES FOR OLDER ADULTS: HEALTH INEQUALITIES AND THE COVID-19 PANDEMIC
Authors: Hall Alex , Eost-Telling Charlotte , Beyer Fiona , Aminu Abodunrin , Sinclair David , Craig Dawn , Hanratty Barbara , Todd Chris 
Published: December 2023

Abstract
There is a growing role for digital technologies in society, but concerns that older adults may be disadvantaged and excluded with the growth of use of these technologies. The COVID-19 pandemic led governments across the world to mandate lockdowns and social restrictions. This was accompanied by rapid implementation of many digitalized services, including to access health and social care. This paper reports on a project to advance our understanding of how health and social care services for older adults (65+) have been digitalized during the COVID-19 pandemic, and to learn what has worked well and what has not, with a specific lens on health inequalities. We report main findings from three workstreams: (i) a mapping review, to identify (a) the types of evidence available on the digitalization of health and social care services for older adults during the COVID-19 pandemic, and (b) the extent to which factors related to health inequalities have been considered in this evidence; (ii) quantitative analysis of health care records to examine the impact of digitalization on access to primary care for older people in England during the COVID-19 pandemic, with a focus on incidence rate of consultation types (face-to-face, telephone and video) examined against age, gender, ethnicity and socioeconomic status; (iii) qualitative work to explore the experiences of UK older adults of South Asian and Black African or Caribbean descent of using digital technologies to access primary care. We consider how digitalization of health and social care services relates to health inequalities for older people.
PREFERENCES FOR NEW MODELS OF SOCIAL CARE FOR OLDER PEOPLE IN ENGLAND
Authors: Walbaum Magdalena 
Published: December 2023

Abstract
Ageing and increasing diversity of the population pose challenges for social care provision. England has implemented several initiatives to improve care quality and make it more personalised, informed, and connected. This study aimed to understand the preferences of older people, including those from diverse backgrounds, for different aspects and models of social care, and how they trade-off different features of care. The study included two workstreams with participants aged 50+: 1) A qualitative study that explored preferences across five themes: housing settings, community assets, technology use, provision of care, and control and dignity; 2) A quantitative survey that analysed variations in preferences by demographic, socioeconomic, and needs-related factors. A discrete choice experiment was also conducted to evaluate the strength of preferences for different attributes. Older people value their independence and control over their lives and prioritise access to community resources and social connections. Participants also emphasised the importance of building a positive relationship with their care provider, respecting their sexual identity and personal beliefs to receive good quality care. In this presentation, differences in preferences among demographic, socioeconomic, and ethnic groups will be highlighted, underscoring the need to ensure that care packages align with individual preferences, beliefs, and values and promote equitable access to care, and outcomes. This approach may ensure that older people from diverse backgrounds receive high-quality care that promotes their independence and dignity and produces equitable care outcomes.
INCREASING THE REPERTOIRE FOR DEPRESSION CARE: PEER SUPPORT AS DEPRESSION CARE FOR VULNERABLE OLDER ADULTS
Authors: Joo Jinhui , Davey-Rothwell Melissa , Choi Namkee , Gallo Joseph , Xie Alice 
Published: December 2023

Abstract
Despite facing greater risks for poorer health, low-income White and BIPOC older adults underutilize mental health services even when they have indicated need. Increasing the repertoire for depression care that is community-based and uses paraprofessionals has potential to increase access and engagement. We are testing the effectiveness of a peer support intervention called Peer Enhanced Depression Care (PEERS) which is an 8-week community-based intervention that uses trained peer mentors to deliver emotional, appraisal and informational support in addition to encouraging self-care skills to depressed low-income white and BIPOC older adults. Enrolled participants are randomized to either the peer support intervention (PEERS) or to the social interaction control and followed for 12 months. The primary outcome is depression and secondary outcomes include engagement, mental health service use, and social, emotional, and physical functioning. Challenges related to the onset of the COVID-19 pandemic and social isolation required a shift from recruitment initially focused on the health care system to community-based organizations serving older adults. Required contactless recruitment strategies eg. flyers and newspaper ads, led to self-referral of community-dwelling older adults to the study. Challenges to participant enrollment included barriers related to communication, stigma related to help-seeking, distrust and unfamiliarity with research. Recruitment of peer mentors was facilitated by a robust infrastructure supporting the employment of the peer support workforce. Continued PM supervision after initial training, review of skills and evaluation of performance were important in maintaining quality and fidelity to the intervention.
A STAKEHOLDER-PARTNERED APPROACH TO INEQUITIES AFFECTING HOME HEALTH CARE WORKERS, OLDER ADULTS, AND CAREGIVERS
Authors: Okereke Olivia , Eme Vivian Anable , Totten Keliane , Locascio Joseph , Simmons Alison , Carpenter Nancy , Weiner Anthony 
Published: December 2023

Abstract
Home health aides (HHAs) provide on-site support for homebound older adults with cognitive impairments, while lessening strain on familial caregivers. However, HHAs face structural challenges in work-related transportation. Massachusetts General Hospital (MGH) researchers partnered with community and corporate stakeholders to inform a study evaluating whether on-demand transportation for HHAs via Uber rides will: 1) Improve metrics among HHAs (total visits, total unique patients, hours/week and days/week worked, missed visit/no-show rates, work satisfaction); 2) Increase racial, ethnic, socioeconomic and geographic diversity of older adults with cognitive impairments receiving homecare. Community partner CCHERS (Center for Community Health Education Research Services) helps residents of public/publicly-assisted housing in high-need areas of Greater Boston gain training and entry-level employment in healthcare as HHAs. Through its collaborations with other groups (e.g., Mothers for Justice & Equality, HomeCare Aide Council, Mass HomeCare Alliance), CCHERS identified that lack of affordable, accessible, reliable transportation was among the most-cited barriers affecting HHAs and equitable homecare delivery. Corporate partner Uber Health, through work in preliminary social-impact case studies, identified the platform’s central ride-coordination approach as preferred by Black and Hispanic women in the 18-45y age group (~80% of the local HHA workforce). MGH researchers’ study goals and metrics were informed by input of partners. With its community-engaged approach, innovative partnerships, and focus on achieving equity objectives to benefit patients and homecare workers alike, this project has potential for strong local impacts and future implications for state and/or national policies to provide high-quality, equitable homecare by directly addressing employment transportation-related barriers.
ESPO and Biological Sciences Section Symposium: Highlighting the Future Leaders of Geroscience
Authors: Yousefzadeh Matt , Ghosh Bhaswati 
Published: December 2023

Abstract
The Emerging Scholars Symposium (ESPO) is organized by post-docs and PhD students from GSA’s BS ESPO Committee. The goal of this symposium is to foster the next generation of aging researchers by recruiting trainees and early career investigators as speakers from contributed abstracts.
INTRAINDIVIDUAL VARIABILITY IN SLEEP DURATION IS ASSOCIATED WITH HIPPOCAMPAL VOLUME IN MID LIFE
Authors: Diaz Jose , Almeida David 
Published: December 2023

Abstract
Sleep is associated with global cognition, consolidation of memories, and structural & functional integrity of areas of the brain that support healthy cognition. While there has been research on sleep in older adults that indicates associations between poor sleep, cognitive decline, memory performance, and changes in the brain, there has been comparatively little work assessing the impact of sleep on the structure of the brain during middle adulthood. Changes in the brain begin much earlier than older adulthood, with midlife seeing cortical thinning and a decrease in brain volume in areas that support healthy cognitive functioning and memory, such as the hippocampus. Understanding how sleep may contribute to hippocampal volume in midlife may help inform how changing poor sleep is important for supporting successful aging. The current study examines the associations between 7 days of actigraphy measured sleep and hippocampal volume (MRI) in 82 midlife adults (Mage = 49.13 years, SD = 11.74; 28-76 years old) who completed the Biomarker and Neuroscience projects in the Midlife in the United States Refresher study. Results indicated that bi-lateral hippocampal volume was negatively associated with high (vs low) intraindividual total sleep time variability (&gt;= 60 min; mean average deviation), with a 280 and 252 mm3 (p’s = .006 & .035) volume reduction for left and right hemispheres respectively. This relationship was not seen for other measures of sleep quality and the analysis additionally controlled for age, sex, BMI, race, depression status, education, and subjective physical & mental/emotional health.
LATENT VARIABLE MODELING FOR BIOLOGICALLY INFORMED PROGNOSIS IN STUDIES OF PHYSICAL RESILIENCE
Authors: Bandeen-Roche Karen , Xue Qianli , Varadhan Ravi 
Published: December 2023

Abstract
Physical resilience – rebound in relevant functioning and biomarkers following a health stressor – is hypothesized to be rooted in the level of fitness of stress-response physiology defining one’s “physiological resilience capacity” (PRC). This physiology forms a dynamical system comprising specific modules (the individual stress response systems and their underlying components) and their dynamic interactions with each other via feedback and other protocols. Such a system can be modeled using differential equations whose parameters may then define the PRC. We do not yet know how to measure these parameters directly, however. Rather, they are conceptually defined “constructs” which must be inferred using indirect measures—ideally, stimulus response data probing multiple aspects of the relevant physiology. Latent variable models are ideally suited to this setting. Two challenges for their application in studies of resilience are presented: (1) Integrating specific scientific knowledge on the dynamical systems in modeling the co-distribution of the indirect measures. (2) Synergizing such models’ advantages for construct measurement with advantages of machine learning approaches to optimize accuracy for predicting resilient outcomes by inferred PRC. Challenges and their proposed solutions are illustrated using multifaceted stimulus response data being collected in an ongoing investigation on the physiological basis of resilience to clinical stressors in older adults, the Study of Physical Resilience in agING. The work aims to produce physiologically rooted measures providing effective risk predictors for older adults facing impending stressors as well as intervention candidates by which to promote PRC in the longer term.
INTERACTIVE ROLE OF SLEEP AND AROUSAL ON COGNITION AND BRAIN STRUCTURE IN CHRONIC PAIN PATIENTS
Authors: Curtis Ashley , Nair Neetu , Craggs Jason , McGovney Kevin , McCrae Christina 
Published: December 2023

Abstract
Chronic widespread pain (CWP) patients experience heightened arousal, insomnia complaints, poor cognition, and diffuse brain structure alterations, but interactive relationships among symptoms remain unexplored. We assessed whether physiological arousal [assessed via heart rate variability (HRV)] moderated associations between sleep and cognition/brain structure. Adults (N=42, Mage=46.2±13.7) with CWP and insomnia (difficulty falling/staying asleep) completed 14 daily sleep diaries, 5-minute Holter monitoring [HRV root mean square of successive normal heartbeats (RMSSD), low frequency/high frequency (lf/hf) computed], cognitive tasks [Stroop (processing speed/attention/inhibition), Sternberg (working memory)], and magnetic resonance imaging. Moderation analyses examined interactive associations between sleep [total sleep time (TST), wake after sleep onset, sleep onset latency (SOL)] and HRV with cognition/gray matter volume of frontal/temporal regions. SOL and lf/hf interacted in associations with working memory and attention/processing speed. Longer SOL was associated with worse Sternberg/Stroop at lowest sympathetic predominance levels. Conversely, longer SOL was associated with better Stroop at highest lf/hf. SOL and RMSSD interacted in associations with anterior cingulate, showing longer SOL associated with lower volumes at lowest arousal levels. TST and RMSSD interacted in associations with right hippocampus, with shorter TST associated with lower volume at highest/average arousal levels. Shared dynamic physiological arousal and sleep onset hyperarousal mechanisms impact cognition and neural structure in CWP. Longer SOL may only negatively impact cognition/anterior cingulate structure up to a certain arousal threshold, with shared mechanisms potentially benefitting cognition at highest arousal levels. At higher arousal, longer TST may protect against hippocampal volume reduction. Future prospective studies are needed to inform temporal characteristics.