bluuebunny/crossref_metadata_2025_split huggingface dataset:
DEVELOPMENTAL ORIGINS OF EXCEPTIONAL HEALTH AND SURVIVAL: A FOUR-GENERATION COHORT STUDY
Authors: Keys Matthew , Larsen Pernille , Pedersen Dorthe , Kulminski Alexander , Feitosa Mary , Wojczynski Mary , Christensen Kaare 
Published: December 2023

Abstract
Little is known about the early life health trajectories associated with longevity, due to the length of follow-up required for such studies. In the Long Life Family Study (LLFS) we have identified 659 Danish long-lived sibships and their descendants across three generations and followed them through national civil and health registries. We have previously shown lower adult mortality and morbidity in both offspring and grandchildren generations. Here we compared perinatal, infant, and maternal health outcomes of third-generation grandchildren (n = 5637) and also fourth-generation great-grandchildren (14,908) born into these long-lived families between 1973-2018, to matched controls from the general population. Hazard ratios (HRs) and odds ratios (ORs) were estimated by Cox proportional hazards and conditional logistic regression models. A general pattern of reduced risk was observed in the grandchildren across a range of perinatal and infant health outcomes, most notably in infant mortality (HR = 0.53, 95% CI [0.36, 0.77]), preterm birth (OR = 0.82, [0.72, 0.93]), and low birth weight (OR = 0.83, [0.76, 0.90]). These associations were robust to further adjustment for parental education levels. Negligible infant survival advantage was observed in the great-grandchildren (HR = 0.90, [0.70, 1.17]). However, there were signals of benefit across some other perinatal outcomes, although much fewer and weaker in magnitude than in the grandchildren. Our findings suggest that phenotypic longevity may have developmental origins as early as the perinatal period, and that this effect persists over at least three generations.
ASSOCIATIONS OF NIGHT AND DAY SLEEP WITH COGNITIVE PERFORMANCE IN SHIFT WORKERS: PRELIMINARY RESULTS
Authors: Kim Jinyoung , Yook Soonhyun , Nam Stephanie , Kim Hosung , Alavi Mohammad Hesam , Oliver Joanna , Lim Diane 
Published: December 2023

Abstract
Emerging evidence suggests that night shift workers are at higher risk of severe cognitive impairment, mainly because of the repeated disruption of the sleep–wake schedule and the resulting poor sleep (e.g., less deep sleep or shorter sleep time). However, questions remain about how daytime and nighttime sleep characteristics correlate with cognitive performance in shift workers. The purpose of this study is to examine the association of objective sleep quality, measured on workdays and days off, with cognitive performance, determined by the psychomotor vigilance task (PVT), in shift workers compared to day workers. We included eight night shift and ten day shift workers from an ongoing pilot study in this analysis. Participants undergo multiple home sleep studies with electroencephalograms on their workdays or days off. Sleep quality measures include total sleep time (TST), percentage of deep sleep stage in TST, and wake time after sleep onset (WASO). Night shift workers showed longer TST and shorter WASO during their nighttime sleep on days off compared to day shift workers. In night shift workers, longer deep sleep on days off was significantly correlated with faster mean reaction time to a visual stimulus (better cognitive performance) on the PVT (r = -.944, p = .016), after controlling for age. However, longer deep sleep during their daytime sleep was associated with slower reaction time (r = .756, p = .049). Further studies are necessary to elucidate differential impacts of daytime and nighttime sleep on the risk of future cognitive impairment in night shift workers.
NURSING HOME STAFF UNDERSTANDING AND CONFIDENCE IMPLEMENTING MONTESSORI APPROACHES AFTER TRAINING
Authors: Hilgeman Michelle , Kennedy Katherine , Haigh Sylvia , Mochel Amy , Bishop Teddy , Curyto Kimberly , Mills Whitney 
Published: December 2023

Abstract
Staff understanding and confidence delivering non-pharmacological interventions are critical for improving outcomes related to behavioral distress in dementia. We conducted a mixed methods evaluation with frontline staff (nursing, recreation therapists, etc.) at 8 VA Community Living Centers enrolled in a stepped-wedge cluster randomized trial of Montessori-based approaches. Training and data collection were conducted remotely and surveys were shortened to reduce participant burden. Normalization Process Theory (NPT, May et al., 2022) guided questions and analysis. Staff completed N=21 qualitative interviews, N=307 surveys (1-month pre-training and during baseline), and N=906 post-training evaluations. Results revealed 83%-87% passed post-training knowledge exams. NPT surveys reflected Montessori was not a normal part of staff work currently (M=5.58 and 6.35 on a 10-point scale); though they believed it would become a normal part of their work in the future (M=7.11 and 7.68). After training, Montessori was rated as more familiar (M=5.15 to M=6.55, t=-3.12, p=.002), and significantly more staff reported that their role included Montessori delivery/oversight X2=13.26(2), p=.001. Content analysis was used to examine qualitative transcripts for the NPT domain Coherence (e.g., comprehension, self-efficacy, internalization). Three themes emerged: 1) ability to describe Montessori principles, 2) familiarity with Montessori approach, and 3) willingness to try it. All participants were able to describe Montessori, though some reported conditional self-efficacy/confidence. Representative quotes reflect challenges and successes in understanding and early application of the intervention in VA CLC environments. Considerations for pragmatic trial designs amid fluctuating COVID precautions are also discussed (e.g., nursing shortages, implementation and evaluation discrepancies, and site-level variability).
USING THE LTSS STATE SCORECARD TO MEASURE PROGRESS ON THE 2022 NATIONAL STRATEGY TO SUPPORT FAMILY CAREGIVERS
Authors: Tell Eileen , Nadash Pamela 
Published: December 2023

Abstract
Through the Recognize, Assist, Include, Support, & Engage (RAISE) Family Caregivers Act of 2018, the RAISE Family Caregiver Advisory Council was created. Since 2019, the Council has directed in-depth information-gathering and research efforts to develop recommendations and an implementation plan for addressing our critical family caregiving crisis. The Council recently released the 2022 National Strategy to Support Family Caregivers, which highlights nearly 350 actions the federal government will take to support family caregivers in the coming year and more than 150 actions that can be adopted at other levels of government and across the private sector to build a system to support family caregivers. Integrating measures of improvement with regard to family caregiver support, across the domains identified in the National Strategy into the LTSS State Scorecard will provide a tool by which progress toward the RAISE goals can be measured. Currently, the Scorecard focuses on indicators specific to Supporting Working Family Caregivers. While these are critical, our research team has identified at least 10 additional indicators that could be included and that would address other caregiver support domains such as adequacy of direct care workforce, integration of family caregivers into care plans, direct pay to family caregivers, and more. In this session we will identify the indicators, explain how they relate to RAISE goals and discuss methods for including them in the Scorecard.
NO PENSION, NO HAPPINESS?—FINANCIAL SUPPORT EXPECTATION IN THE OLDEST-OLD AGE AND DEPRESSIVE SYMPTOMS
Authors: Han Chengming , Zhou Nan 
Published: December 2023

Abstract

Objective
This paper aims to explore the effect of financial support expectation on depressive symptoms among the oldest-elderly. Method. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) 2018. The analytical sample included 10641 respondents who were older than 45. Financial support expectations refer to whom they would reply on when they cannot work, which includes four categories: children, themselves (savings or commercial life insurance), pensions, and others. Linear regression models were employed after controlling for pension, health insurance and urban-rural household registration (hukou).

Results
More than half of the sample reported that they would rely on their children when they became too old to work. Those who reported that they would rely on themselves (b=-1.72, p=0.000) or pensions (b=-1.23, p=0.000) reported lower levels of depressive symptoms compared to those who would rely on their children. When pension and health insurance were controlled for, only those who would rely on themselves presented lower level of depressive symptoms. Pension and health insurance (except rural health insurance) mediated the association between the financial support expectation and depressive symptoms. However, the hukou status inhibited the mediating effect of pension and health insurance.

Conclusion
Financial uncertainty is a potential threat in the oldest-old age. Reducing the urban-rural inequality in pension and health insurance would help reduce the negative effects of financial uncertainty.
ASSOCIATION BETWEEN MULTIPLE FRAILTY INDICES AND CVD MORTALITY
Authors: Seligman Benjamin , Qazi Saadia , Rane Manas , Preis Sarah , Orkaby Ariela , Gaziano J Michael , Driver Jane 
Published: December 2023

Abstract
Introduction Frailty, a syndrome of physiologic vulnerability, increases cardiovascular disease (CVD) risk. Which frailty tool is ideal for risk stratification remains unclear. We calculated three frailty scores from the Million Veteran Program (MVP) and examined their association with mortality and CVD in older Veterans. Methods Participants were from MVP - a large, contemporary Veteran cohort study - and aged ≥50 years at baseline (2011-2018). The frailty scores used were: MVP-FI (36-item questionnaire deficit accumulation frailty index), VA-FI (31-item EHR index), and modified Study of Osteoporotic Fractures (mSOF; a physical frailty score). MVP-FI and VA-FI scores of ≤0.10 were robust, 0.11-0.20 pre-frail, and ≥0.21 frail; mSOF scores of 0 were robust, 1 pre-frail and ≥2 frail. Primary outcomes were all-cause and CVD mortality. Secondary outcomes were incident stroke, myocardial infarction (MI), and heart failure (HF). Cox regression was used to evaluate the association of frailty with outcomes. Results Among 190,688 participants, mean age was 69 ±9, 94% were male. By MVP-FI, 29% were robust, 42% pre-frail, and 29% frail. Hazard ratios (HR, 95% CI) for all-cause mortality were 1.66 (1.61-1.72) and 3.05 (2.95-3.16) for pre-frailty and frailty, respectively. For CVD mortality, HRs were 1.76 (1.65-1.88) and 3.65 (3.43-3.90) for pre-frailty and frailty. Hazards of stroke, MI, and HF also increased with greater frailty. VA-FI and mSOF yielded concordant results. Conclusion Irrespective of measure, frailty is associated with increased all-cause mortality and CVD event risk. Clinicians and researchers may consider the most convenient tool for available data to incorporate frailty into practice.
SATISFACTION WITH WALK ON! FROM PROGRAM CLIENTS AND LEADERS
Authors: Ajja Rahma , Kemp Elizabeth Chmelo , Hughes Jaime , Van Laethem Lauren , Welsh Kimberly , Guerrier Tami , Hirsch Mark , Nicklas Barb 
Published: December 2023

Abstract
This presentation demonstrates the high degree of satisfaction with Walk On! from qualitative survey data from both clients and program leaders. As part of the curriculum, each attendee completes a survey asking about satisfaction around location, day/time, length of program, and changes in walking abilities. The survey also includes an opportunity for open-ended responses and suggestions for improvement. Overall, surveys showed a very high degree of satisfaction with the program with 80-100% of clients indicating they are “Very Much” satisfied with the program components. All open-ended responses were positive and examples include: “Very pleased with the instruction and environment”; “Encouraged me to walk at home and neighborhood”; “This program gave me energy to walk better and has changed my life”; “Enjoyed the fellowship with others”; and “I now walk with more confidence”. Leaders also complete a satisfaction survey upon completion of their Leader Training program and after leading a Walk On! program. A majority of the leaders “Strongly Agreed” or “Agreed “that: The length of the training was appropriate (83%); Course materials were explained well (100%); Course materials were easy to use (100%); I feel prepared to lead Walk On! (67%). Leader statements include: “I loved everything about this program. It was not just a walking program to me. I had social, cognitive and physical growth” and “This program afforded me the opportunity to have a real collaborative, immersive experience with elders.” Together, these positive findings support the need to scale and spread WalkOn! into additional community settings.
REPORTING MERIT-BASED INCENTIVE PAYMENT SYSTEM LIKE DATA IN A UNIQUE AGE-FRIENDLY HEALTH CARE SETTING
Authors: Waters Leland , Slattum Patricia 
Published: December 2023

Abstract
The Richmond Health and Wellness Program (RHWP) offers screening, education, care coordination, and resources as an enhancement to primary care for older adults in five low-income apartment buildings and in a community center. Participants may receive primary care through multiple healthcare systems in the region that do not have a common electronic medical record (EMR). To track age-friendly workflows to the Health Resources Services Administration (HRSA) in the domains of advance care planning, falls prevention, and high-risk medication use, case note documentation in a REDCap database is used to generate Merit-based Incentive Payment System (MIPS)-like data. We report on advance care plans developed, fall risk screenings and risk reduction interventions implemented, high-risk medications screened, and referrals to primary care for high-risk medication deprescribing, including risk reduction with opioid use. When reporting MIPS data to HRSA, we include a disclaimer for RHWP data defining the numerator and denominator used for the MIPS-like measure calculation. For example, when reporting advance care plan completion, we include “RHWP is a care coordination site and care is not provided at the site. The population includes adults aged 55+ or people (of any age) with disabilities in low-income congregate living facilities and all adults participating in RHWP at the Virginia Commonwealth University Health Hub.” The numerator indicates the number of clients with advanced care plans created, and the denominator indicates the total number of clients seen during the reporting period. This presentation will provide strategies to meet reporting requirements when EMR records are not available.
LINKING MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) MEASURES TO AGE-FRIENDLY HEALTH SYSTEMS
Authors: Murphy Sara , Severance Jennifer , Ross Sarah , Taylor Kate , Knebl Janice 
Published: December 2023

Abstract
IHI’s Age-Friendly Health Systems initiative provides a framework for older adult primary care focused on the 4Ms: Mentation, Mobility, Medications, and What Matters which addresses the need for an integrated system of care. Additionally, the Centers for Medicare & Medicaid Services have implemented merit-based incentivized payment system (MIPS) measures to promote provider practices that improve healthcare quality. MIPS measures and age-friendly care practices may be improved through training, which may lead to better patient outcomes. To integrate the 4Ms to improve care and patient safety, the Center for Older Adults at the University of North Texas Health Science Center standardize workflows and increase the number of annual wellness visits (AWV). A standardized template in the electronic medical record was created, questions in the patient registration software were added to identify eligible patients, and three different types of AWVs were standardized. Training courses were developed and completed by providers. The percentage of patients who receive an AWV is measured on an annual basis. Learnings have been integrated into training courses. Between July 2020 to June 2021, 297 healthcare professionals completed online training modules, with post-survey ratings showing helpful content with learning objectives being met. Provider support through training and incorporating MIPS measures and the Age-Friendly 4Ms framework into the AWV can support consistent outcome measurement and improve quality care for older adults.
SEXUAL MOTIVES, MARITAL QUALITY, AND DEPRESSIVE SYMPTOMS OF MID-LIFE SAME- AND DIFFERENT-SEX COUPLES
Authors: Chai Hye Won , Joo Susanna , Lee Jihye , Umberson Debra 
Published: December 2023

Abstract
Self-determined sexual motives, or self-endorsed reasons for having sex, is a significant determinant of psychological health with notable gendered patterns. However, previous studies mostly focused on young adult different-sex couples and fell short of exploring the mechanisms through which self-determined sexual motives are associated with psychological health. Using dyadic data from the Health and Relationships Project (HARP) on 124 gay, 171 lesbian, and 124 straight midlife married couples, this study examined the mediating role of marital quality in the association between self-determined sexual motives and depressive symptoms. Actor-partner interdependence mediation model (APIMeM) was used for analyses. Results showed significant mediating effects of individual’s own marital quality for all couple types (i.e., gay, lesbian, straight couples), such that individuals with higher levels of self-determined sexual motives reported better marital quality, which in turn was associated with their lower levels of depressive symptoms. For partner effects, same patterns emerged for lesbian and gay couples wherein individuals’ own marital quality mediated the association between their spouse’s sexual motives and their own depressive symptoms. However, there were gendered patterns within straight couples. For women, their own marital quality mediated the association between their partner’s sexual motives and their own depressive symptoms. For men, their spouse’s marital quality mediated the association between their partner’s sexual motives and their own depressive symptoms. These findings suggest marital quality as a useful intervention point to enhance the psychological health of midlife couples in same-sex and different-sex marriages and also highlight the salience of gendered dynamics within straight couples.
EFFECTS OF MENOPAUSE AND MARITAL TRANSITIONS ON SUBJECTIVE SEXUAL SELF-EFFICACY AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: Ferguson Melissa , Liu Yin 
Published: December 2023

Abstract
Circumstances in aging including menopause, physical decline, widowhood, divorce and remarriage may influence sexual experiences and well-being in later life. While marital transition can affect both men and women in middle and older life, menopausal transition is especially salient for aging women. This study aims to examine how subjective sexual self-efficacy changes over time and whether marital transitions and menopausal transitions moderate the trajectories. Participants completed two waves of the Midlife in the United States (MIDUS) surveys (N = 1002), ranging from 40 to 84 years of age at baseline (M = 57.44; SD = 10.17) with over half being female (54%, n = 538). Factor analysis confirmed a one-factor model with a five-item subjective sexual self-efficacy construct. Over 10 years, 12% of participants experienced marital transitions, and 29% of women reporting menstrual status experienced menopause transition. Growth curve analysis was used the examine the research questions.
DYADIC EFFECTS OF PERSONALITY AND SEXUAL BEHAVIOR IN OLDER ADULTHOOD
Authors: Chopik William 
Published: December 2023

Abstract
Personality traits are associated with important life, work, and relational outcomes across the lifespan. Although personality has been implicated in models of relationship functioning, there has been relatively little research matching individual and partner personality characteristics to the frequency, quality, and variety of sexual experiences, particularly in older adulthood. The current study examined individual and spousal effects of the Big Five personality traits on sexual outcomes among 953 older opposite-sex couples followed from 2010/2011 to 2015/2016 as part of the National Social Life, Heath, and Aging Project (NSHAP; Mage = 70.60, SD = 7.92; 74.2% White, 12.2% Hispanic, 11.1% Black, and 2.5% other). Individual and spousal conscientiousness was associated with more frequent dyadic and solitary sexual activity and being part of a physically pleasurable and emotionally satisfying relationship. Those with higher levels of neuroticism and those married to spouses high in neuroticism expressed a lower preference for physical/sexual touch and cuddling, were less likely to report having a physically pleasurable and emotionally satisfying relationship, and were more likely to avoid having sex because of physical problems (and report more pain during sex). Longitudinal analyses suggested that most of these associations wavered in strength over time. The findings are discussed in the context of how relationship processes might mediate the link between personality characteristics and sexual outcomes or whether sexual outcomes promote relationship-enhancing characteristics depending on people’s personalities.
COMPARING THE ASSOCIATION BETWEEN DIABETES AND MORTALITY IN TWO INDEPENDENT BIRTH COHORT OF OLDER ADULTS IN MEXICO
Authors: Downer Brian , Castro Jose Cabrero 
Published: December 2023

Abstract
The prevalence of diabetes among middle-aged and older adults in Mexico has nearly doubled since the year 2000. This increase is primarily due to healthcare reforms that promoted diabetes screening. Insulin use and other treatments have also increased during the same period. Early diagnosis and treatment can reduce diabetes mortality risk. However, it is unclear if the increased diagnosis and treatment of diabetes in Mexico have reduced the mortality risk associated with diabetes in older adults. We used the Mexican Health and Aging Study to compare the association between diabetes and 5-year mortality in two independent cohorts of adults aged 60-69 in 2001 (1932-1941) and 2012 (1943-1952). The final sample included 3,694 participants in 2001 and 4,769 in 2012. Demographic variables included age, gender, education, living in an urban community, and having health insurance coverage. Self-reported health conditions included diabetes, hypertension, stroke, and respiratory disease. We used cox-proportional hazard regression models that included an interaction term for diabetes by cohort and adjusted for demographic and self-reported health characteristics. Overall, diabetes was associated with 2.56 times higher mortality (95% CI=2.18-3.00). The 2012 cohort did not have significantly different mortality risk compared to the 2001 cohort (HR=0.91, 95% CI=0.77-1.07). The association between diabetes and mortality for participants in the 2001 cohort (HR=2.52, 95% CI=1.95-3.26) was not significantly different from the 2012 cohort (HR=2.58, 95% CI=2.09-3.17). Our results indicate that diabetes continues to be a major risk factor for mortality in Mexico despite the increase in screening and treatment.