bluuebunny/crossref_metadata_2025_split huggingface dataset:
TECHNOSOCIAL INNOVATIONS IN THE HEALTHCARE SECTOR: WHAT ETHICAL ISSUES MIGHT WE FACE AS WE AGE?
Authors: Lord Marie-Michele , Drolet Marie-Josee 
Published: December 2023

Abstract
Technosocial innovations are designed to transcend current practices by linking technological development to community well-being. Their dazzling development is gradually transforming health services. Despite their recognized potential, a growing number of studies point to the ethical risks associated with their development. We are currently conducting a study to obtain a comprehensive picture of the ethical issues associated with the use of technosocial innovations for older adults and their care partners in the healthcare sector, and to identify key indicators of the presence of those ethical issues. A prospective design is use and combines a systematic literature review with a Delphi method. Of all the studies looking at the ethical issues involved in deploying technosocial innovations in the healthcare sector, a limited number have focused on those we may experience as we age. Still, six empirically-supported ethical issues have emerged : 1) exacerbation of the digital divide; 2) exclusion at multiple levels; 3) epistemic injustices; 4) infringement of dignity and confidentiality; 5) ageism; and 6) increased dependency dynamics. A number of indicators were identified in the early stages of the Delphi method, including a high rate of abandonment of the use of proposed innovations, and performance indicators with little integration of PREMs and PROMs. It is imperative to translate current knowledge into concrete resources that can be used in order to protect our rights and health as we age. This study is a first step towards identifying indicators that can be concretely used by health organizations wishing to act ethically.
THE ASSOCIATION BETWEEN APOE Ε4 AND EPISODIC MEMORY IN MIDLIFE: TESTING THE COGNITIVE PHENOTYPE HYPOTHESIS
Authors: Park Kyoung Shin , Etnier Jennifer , DuBois Samantha , Kibildis Samuel , Som-Pimpong Hadassah , Vance Jarod , Wahlheim Christopher 
Published: December 2023

Abstract
Carrying at least one ε4 allele of Apolipoprotein E (APOE ε4) is a strong genetic risk factor for Alzheimer’s disease (AD). It is contentious whether the effect of APOE ε4 on memory decline is because of cognitive phenotype or prodromal AD cases. Inconsistent findings on this topic could be due to the presence of AD pathology in older ages and the lack of sensitivity of memory measures. To exclude potential prodromal AD cases, we tested the association between APOE ε4 and episodic memory among cognitively unimpaired adults in midlife. Data from a subset of 103 participants (Mage=57±6 years; 87.4% females) from an ongoing clinical trial (NIH R01AG058919) were analyzed. APOE genotype was assessed from passive drool saliva samples, and participants completed memory assessments. Analyses of covariance compared 39 carriers of APOE ε4 versus 64 non-carriers of APOE ε4 for their performance of mnemonic discrimination, auditory-verbal and visuospatial short- and long-term memory, paired associative memory, and verbal logical memory, while controlling relevant covariates (e.g., age, education, sex, and physical activity level). After covariate adjustments, significant negative relationships between APOE ε4 and mnemonic discrimination were observed while nearly significant negative relationships were observed for auditory-verbal long-term memory. These findings imply that APOE ε4 could be associated with a cognitive phenotype of decline in mnemonic discrimination and auditory-verbal long-term memory, and the phenotype effects on memory decline could start in midlife. This suggests the importance of early lifestyle interventions for cognitive health in midlife, especially in people at genetic risk for AD.
THE ASSOCIATION OF CAREGIVER STRAIN AND NEEDS OF CAREGIVERS AND PEOPLE LIVING WITH DEMENTIA
Authors: Griswold Allison , Moore Miranda , Jungermann Joanna , Perkins Molly , Bender Alexis 
Published: December 2023

Abstract
Caregivers play a vital part of dementia care management and are key to keeping people living with dementia at home. Providing this care can result in caregiver strain, especially among those who live in low or under resourced communities, such as rural or impoverished areas. One instrument for measuring caregiver strain among this population is the BRI caregiver strain instrument, which includes four dimensions of strain including caregiver mastery, relationship strain, health strain and social isolation. To date, little research assessing the validity of the instrument. We assessed the validity using confirmatory factor analysis in a cohort of 930 caregivers providing care to people undergoing assessment for dementia representing four diverse regions in Georgia (Atlanta, Albany, Augusta, and Macon). Then, we examined the associations of the lack of caregiver knowledge of dementia, care recipient function, and challenging behaviors using univariate and multivariate linear regression. We found that the four-factor solution showed good model fit and was appropriate for subsequent analysis with this population. In our regression models, we found that caregiver lack of understanding of dementia significantly predicted caregiver strain (β=2.09, P&lt;.001). When controlling for care recipient function, lack of knowledge decreased in strength, but remained significant (β=1.86, P&lt;.001). When adding challenging behaviors, lack of dementia knowledge lost significance and challenging behaviors became the strongest predictor of caregiver strain (β=2.03, P&lt;.001). Caregiver strain is a multifactorial process and tools to reduce challenging behaviors and increase caregiver knowledge are promising points of intervention early in the diagnostic process.
THE EFFECT OF A DRUG-BURDEN INDEX ON FALLS RISK INCREASING MEDICATIONS DEPRESCRIBING IN VETERANS AT RISK OF FALLING
Authors: Paulsen Michelle , Chen Sunny , Martinez Erica , Ritchey Katherine 
Published: December 2023

Abstract
Falls risk-increasing medications (FRIMs) have negative effects on balance and psychomotor functioning which increase the risk of falling in older adults. Thus, deprescribing of FRIMs is a recommended fall prevention intervention. The Drug Burden Index (DBI) measures total exposure to anticholinergic and sedative medications and has been associated with falling risk in older adults. We evaluated if inclusion of a DBI score would influence deprescribing of FRIMs in older veterans at risk of falling. A pharmacist conducted a medication review for FRIMs in two cohorts of older veterans participating in a fall prevention group. The primary care prescriber (PCP) was alerted to recommendations through the electronic medical record. Inclusion of the DBI was included and shared with the PCP in the second cohort only. Changes to FRIMs and reduction in DBI score was calculated for all participants three months after initial FRIM review. Nearly all (95%) participants (n=44) were prescribed a FRIM. The most common active prescriptions contributing to DBI score were for anticholinergics (37.9%), antidepressants (33.3%) or anticonvulsants (31.8%) agents. DBI improved in both cohorts, but DBI change was greatest in the second cohort (n=18) (first cohort mean DBI change= 0.168; second cohort mean DBI change= 0.189; p 0.002). Percentage of recommendations accepted and acted upon by PCP was similar between both groups (60% vs 59%). Inclusion of a DBI is a helpful measure of FRIM deprescribing and may further encourage deprescribing behaviors. Feedback from PCPs will clarify the role of DBI in fall prevention medication reviews.
THE EFFECT OF FINANCIAL STRAIN AND LANGUAGE OF INTERVIEW ON DEPRESSIVE SYMPTOMS IN MEXICAN AMERICAN OLDER ADULTS
Authors: Hernandez Veronica , Nasser Lucy , Snih Soham Al 
Published: December 2023

Abstract
We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine the relationship of financial strain and interview language to high depressive symptoms among Mexican Americans aged ≥75 years without history of depressive symptoms at baseline over a 12-year period (2004/05-2016; N=1157). Participants scored &lt; 16 in the Center for Epidemiologic Studies Depression Scale at baseline. Measures included age, marital status, years of formal education, body mass index, social isolation, church attendance, self-reported medical conditions, cognitive and physical function, pain, falls, disability, and hand grip strength. We used a generalized estimating equation model to estimate the odds ratio (OR) and 95% confidence interval (CI) of depressive symptoms as a function of financial strain and interview language over time, adjusting for all covariates. We found that participants experiencing financial strain and interviewed in Spanish had greater odds of experiencing high depressive symptoms (OR=2.48, 95% Cl=1.37-4.48) compared to those who were not experiencing financial strain and selected be interviewed in English. No significant association with depressive symptoms was found in participants with financial strain and interviewed in English or those without financial strain and interviewed in Spanish. In conclusion, Mexican American older adults were at a high risk for high depressive symptoms over time if they were experiencing financial strain and preferred be interviewed in Spanish. Early screening for depression may prevent or delay depressive symptoms for individuals in this population at high risk for depression.
THE EFFECT OF PANDEMICS ON TRUST IN DOCTOR IMPROVEMENT AMONG CHINESE OLDER ADULTS: LESSONS FROM COVID-19
Authors: Guo Chao , Hu Xiyuan , Yuan Dianqi , Tang Huameng , Yang Peisen 
Published: December 2023

Abstract
The COVID-19 pandemic has had a major impact on the physician-patient relationship. For older adults, trust in doctors during the pandemic affects their lives and health. This study aimed to estimate the effect of the first wave of COVID-19 transmissibility in China on older adults’ trust in doctors. We obtained individual data from the Chinese Family Panel Studies (CFPS). A total of 2,225 participants aged 65 and older were included in this study. The COVID-19 pandemic was used as a natural experiment. We obtained difference-in-differences (DID) estimates of the pandemic’s effects by exploiting temporal variation in the timing of COVID-19 exposure across participants interviewed from 2018 to 2020 together with the geographical variation in COVID-19 severity at the provincial district level. Overall, the DID estimates showed that the COVID-19 pandemic could significantly increase trust in doctors after controlling for multiple covariates (adjusted β: 0.053, 95% CI: 0.028–0.078). Stratified analyses showed that the effect was only in females and the more educated ones but not in their counterparts. In addition, the COVID-19 pandemic showed a positive effect on trust in doctors among 65-79-year-olds (0.082, 0.056–0.109), but older adults over the age of 80 showed significantly reduced trust in doctors (-0.236, -0.418–-0.055). Our findings confirm the association between the COVID-19 pandemic and trust in doctors among older Chinese people. Hospitals and other medical organizations should pay more attention to improving older adults’ trust in doctors and building a better physician-patient relationship to face the future pandemic.
THE EFFECTIVENESS OF NON-PHARMACOLOGICAL INTERVENTIONS ON SLEEP QUALITY IN RA AND FMS: A SYSTEMATIC REVIEW
Authors: Chin Ching-I 
Published: December 2023

Abstract

Objective
Sleep disturbances can significantly impact the well-being of individuals with Rheumatoid Arthritis (RA) and Fibromyalgia (FMS), leading to daytime sleepiness, fatigue, and increased pain. This systematic review aims to assess the available evidence on the effectiveness of non-pharmacological interventions in improving sleep quality for individuals with RA and FMS.

Method
A comprehensive search was conducted in English electronic databases (CINAHL plus, SPORTDiscus, EMBASE, Medline, PubMed, Web of Science, and Google Scholar) to identify relevant articles. The review includes 15 studies, consisting of 13 randomized controlled trials (RCTs) and 2 non-randomized controlled trials (non-RCTs), published between 2012 and 2022. Primary and secondary outcome measures related to sleep quality were assessed using subjective and objective measures.

Results
Interventions in the studies were diverse, involving physical and mind-body approaches, lasting 6 to 16 weeks with session durations of at least 30 minutes. The total intervention hours ranged from 6 to 32 hours across all studies. Follow-up evaluations were conducted in four studies up to 6 months after the last treatment. While the Arthritis Foundation Exercise Program and Yoga did not report statistically significant improvements in sleep quality for RA, non-pharmacological interventions showed a positive impact on sleep outcomes for RA and FMS populations.

Conclusion
Non-pharmacological interventions show promise as a potential alternative method to improve sleep quality for individuals with RA and FMS. However, there is no evidence to support the superiority of one intervention over another. Keywords: Rheumatoid Arthritis. Fibromyalgia Syndrome. Sleep quality. Sleep disturbance. Exercise. Non-pharmacological intervention.
THE EFFECTS OF EARLY-LIFE ADVERSITY ON WOMEN’S COGNITIVE HEALTH AFTER AGE 50
Authors: Johnson Kimson 
Published: December 2023

Abstract
According to the Alzheimer’s Association, 6 million people age 65 and older are living with Alzheimer’s Disease in the United States, and nearly 4 million are women. Few research studies have examined the impact of adverse childhood events (ACEs) on cognitive health among women over 50. Evaluating gender-specific differences in predictors of cognitive health can help clarify mechanisms that hinder or magnify gender-based health differences and provide information on ways to narrow gender disparities in dementia. The study examined the relationship between ACEs, cognitive impairment, and incident dementia using data from the Health and Retirement Study Cross-wave 2015-2017 Life History Mail Survey (N = 4,980; Mage = 67.6). Cognitive status was measured using the 2016 Langa-Weir three category indicator: Normal, Cognitive Impairment but No Dementia (CIND), and Dementia. Compared to women exposed to 0 ACEs, women exposed to 1 ACE had a higher relative risk for CIND and dementia (RRR=1.71, p&lt;.05; RRR=2.44, p&lt;.05). Women exposed to 3 ACEs had a higher relative risk for dementia (RRR=3.43, p&lt;.05). Non-Hispanic Black women exposed to 3 ACEs had a lower relative risk for dementia (RRR=0.18, p&lt;.05) than white women. Women with 12 years of education have a higher relative risk for CIND and dementia (RRR=2.27, p&lt;.05; RRR=3.45, p&lt;.05) than women with &gt;13 years of education. Although women’s life expectancy has increased over the past few decades, women remain at risk for delayed identification of cognitive decline. Future research should examine how other critical social determinants of health influence women’s cognitive health after 50.
THE EVOLUTION OF NURSING HOME COMMUNICATION WITH RESIDENT FAMILIES DURING THE COVID-19 PANDEMIC
Authors: Hawes Courtney , Brazier Joan , Meehan Amy , Gabois Emily 
Published: December 2023

Abstract
Nursing homes experienced numerous challenges resulting from the COVID-19 pandemic. Among these challenges was ensuring appropriate and effective communication with friends and family members of residents, particularly in light of visitation restrictions. Using qualitative data from 156 in-depth, semi-structured interviews with administrators of 40 nursing homes across the US from July 2020 through December 2021, challenges and solutions to communicating effectively with resident families are characterized. Findings include three themes: 1. Administrators identified best practices regarding the frequency of communicating with families. Particularly early in the pandemic and when visitation was restricted, families expressed a desire for very frequent updates regarding resident well-being and COVID-19. Administrators reported the challenges of balancing family expectations regarding information with their capacity to meet those expectations. 2. Administrators discussed different modes of communication used with families. Existing systems of mass-communication were expanded and new processes were developed. 3. Administrators described challenges in determining the appropriate content to communicate and navigating changing policies. While nursing home staff were required to share data on COVID-19 outbreaks, administrators shared lessons learned regarding specificity of information to be shared, and how they balanced required infection control information with pleasant updates regarding residents and their activities. Strategies identified by administrators may be informative for efforts to promote effective communication for both general day-to-day updates and for future emergency or pandemic crises.
THE FINANCIAL AND EMOTIONAL IMPACT OF COVID-19 FOR DEMENTIA CAREGIVERS: A COMPARISON OF THE NHATS AND HISPANIC EPESE
Authors: Rote Sunshine , Angel Jacqueline , Cantu Phillip , Antequera Felipe 
Published: December 2023

Abstract
During the COVID-19 pandemic, older adults and their caregivers/care partners (hereafter referred to as “caregivers”) experienced social isolation, reduced autonomy, disruptions in medical care and barriers to community-based services such as adult day centers. We compare the extent to which these disruptions affected white, Black, and Hispanic caregivers. We utilize newly released data on adult children caregivers from the Caregiver Supplement to the Hispanic Establish Population for the Epidemiologic Study of the Elderly (HEPESE CG, 2021) and the National Health and Aging Trends COVID-19 Family Members and Friends Dataset (NHATS FF, 2020/2021) to compare caregiver emotional well-being and financial strain among non-Hispanic White (NH White, n=327), non-Hispanic Black (NH Black, n=57), and Mexican American (n=57) adult children caregivers. Results reveal that a larger fraction of NH Black and Mexican American caregivers reported financial strain than NH White caregivers, and that more Mexican American caregivers reported loneliness and depression than other groups of caregivers. For Mexican American caregivers, those reporting lower financial well-being tended to be younger. For NH Black caregivers, there were no significant predictors of financial strain or wellbeing. Finally, NH White caregivers were younger, and more likely to be female and NH White dementia caregivers reported more financial strain and loneliness than NH White non-dementia caregivers. Taken together, this work provides valuable insight into the role of the COVID-19 pandemic in exacerbating caregiver health disparities among caregivers and provides valuable insight as well as to the high-impact intervention points for caregivers from minoritized populations.
THE HIGH PREVALENCE OF OVER-THE-COUNTER MEDICATION MISUSE IN OLDER ADULTS: RESPONSE TO THE CHPA-GSA NATIONAL SUMMIT
Authors: Chladek Jason , Gilson Aaron , Stone Jamie , Lehnbom Elin , Hoffins Emily , Berbakov Maria , Moon Jukrin , Chui Michelle 
Published: December 2023

Abstract
Older adults (65+) are the largest consumer of over-the-counter (OTC) medications and disproportionately prone to adverse drug events (ADEs). Despite perceptions that OTCs are generally safe, OTC misuse can lead to ADEs. However, as identified through the Consumer Health Products Association (CHPA) and Gerontological Society of America (GSA) National Summit, little is known about OTC misuse in older adults. This is the first muti-site study to prospectively quantify how older adults select OTCs in community pharmacies where products are typically purchased. Older adults (n=144) were recruited from 10 community pharmacies. Participants were given hypothetical symptoms and asked to select one or more OTCs. After selection, they were asked to report how they would use the product, their home medications, and their health conditions. OTC selections were evaluated for the following misuse categories: 1) drug-age (Beers Criteria), 2) drug-drug (interactions with home medications), 3) drug-disease (health conditions), and 4) drug-label (product’s indications and directions). At least one type of misuse was identified in 114 (79%) older adults, with 57 (40%) demonstrating misuse in &gt;1 category. Overall, 363 total instances of misuse were identified (x̄=3.18 per participant). There was high prevalence of drug-drug and drug-label misuse, as 107 (74%) demonstrated misuse in one or both categories. The results highlight OTC misuse frequency and complexity in older adults. Knowing older adults’ OTC misuse prevalence is critical for understanding medication-associated risks and developing effective interventions. Importantly, these results are a first step toward addressing the research gaps identified by CHPA and GSA.
THE IMPORTANCE OF ADEQUATE RESOURCES AND EQUIPMENT TO STAFF ENGAGEMENT IN A HEALTHCARE SYSTEM
Authors: Burack Orah , Mak Wingyun , Howard Margret , Isaacs Tanya , Reinhardt Joann 
Published: December 2023

Abstract
During this time of unprecedented staffing challenges, identifying factors impacting staff engagement may be one step towards rebuilding the healthcare workforce. This study was designed to identify work factors differentiating positively engaged employees from others. In May 2023, 350 employees (response rate=30%) from across a healthcare system (including skilled nursing facilities, adult day centers, community services, and assisted living) serving older adults in New York City and Westchester County, completed surveys examining employee engagement and satisfaction with five work factors. Engagement was measured using the employee net promoter scale (eNPS) in which employees rate from 1 (Not At All) to 10 (Very) “How likely is it that you would recommend the organization as a workplace.” Those answering 9-10 are classified as “Promoters” (engaged/positive concerning the workplace), 7-8 “Neutrals”, and 1-6 are “Detractors” (unengaged/negative). Participants also responded 1 “very unsatisfied” to 5 “very satisfied” on work factors: general work satisfaction, having enough resources/equipment, receiving timely information, supervisor support, and coworker respect. Based on eNPS responses, 160 (45.7%) employees were “Promoters”, 65 (18.6%) “Neutrals”, and 125 (35.7%) “Detractors.” A series of one-way analysis of variance and post-hoc Bonferonni analyses then examined work factor satisfaction by staff engagement level. As expected, “Promoters” and “Neutrals” were significantly more satisfied than “Detractors” on all five work factors however, only having enough resources/equipment separated “Promoters” (M=3.63, SD=1.24) from “Neutrals” (M=4.06, SD=89, p &lt;.05). These findings indicate that providing staff with sufficient resources/equipment should be prioritized in the effort to establish a healthcare workforce of “Promoters.”