bluuebunny/crossref_metadata_2025_split huggingface dataset:
HEALTH CARE ACCESS AND USE AMONG ADULTS AGING WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
Authors: Stokes Jeffrey E , Waldron Danielle A , Sauer Jacquelin , Hartford Emily 
Published: December 2023

Abstract
Adults with intellectual and developmental disabilities (IDD) are living longer than ever before, a testament to advancements in healthcare. However, adults with IDD face a number of challenges accessing healthcare, and particularly preventative healthcare targeted towards midlife and older adults, which have previously been far less utilized by adults aging with IDD. This study uses longitudinal data from the National Core Indicators In-Person Survey (NCI-IPS) to examine factors associated with adults with IDD’s utilization of two preventative healthcare measures specific to mid- and later life: mammograms and colonoscopies. Both mammogram and colonoscopy utilization exhibited curvilinear age trajectories, with usage increasing through ages 60 and 65 respectively, before decline at older ages. For both mammogram and colonoscopy utilization, living with family was associated with a 50% lower likelihood of utilization, while poor health, access to transportation, and community inclusion were associated with increased usage. For mammograms, participating in a community activity was also associated with increased utilization. Women with IDD were also about 25% less likely to receive a colonoscopy than men. Interestingly, the likelihood of receiving a mammogram dropped significantly in 2018-2019 compared to a decade prior, whereas the likelihood of receiving a colonoscopy increased over time. No racial/ethnic differences were found. Results highlight a number of factors associated with preventative healthcare use among the population of adults aging with IDD. These were similar for mammogram and colonoscopy utilization, and highlight the importance of living situation, transportation, and community engagement for adults with IDD’s access to preventive medicine.
EVALUATION OF EDUCATION INITIATIVES TO INCREASE DELIVERY OF AGE-FRIENDLY CARE IN CONVENIENT CARE CLINICS
Authors: Schiltz Nicholas , Bender Anna , Armstrong Grace , Foradori Megan , Duffy Evelyn , Pohnert Anne , Dolansky Mary 
Published: December 2023

Abstract
The Age-Friendly Health Systems model of care reliably provides four evidence-based elements of high-quality care, to all older adult patients: What Matters, Medications, Mentation, and Mobility (the 4Ms). MinuteClinic at CVS implemented the 4Ms model in all 1100+ locations nationwide in May 2020. To prepare MinuteClinic providers to deliver 4Ms care, educational modules were developed to provide an understanding of the gerontology that supports the 4Ms model of care: an orientation module with two scenarios illustrating the usual care of an older adult patient followed by the same patient receiving 4Ms care, monthly grand rounds (case studies of older adult conditions with the 4Ms), and ten video vignettes regarding integration of 4Ms care. Our goal was to evaluate the effectiveness of these education initiatives, as measured by changes in the mean number of Ms delivered per visit. Over 70% of 3,188 providers completed at least one education module. The rate of 4Ms delivery was 1.7 times higher (p&lt; 0.001) among those completing at least one education module, and 5.7 times higher (p&lt; 0.001) among those completing ten or more modules compared to those who completed none. Each course was associated with significant within subject increases between 10% and 38% in 4Ms delivery in the month following course completion. The self-directed learning environment (e.g., providers self-select into number and type of courses) reflects real-world variation in engagement; despite this variation, improvements in 4Ms delivery were observed at any educational dose, underscoring the value of prioritizing education time with quality improvement initiatives.
SOCIAL RELATIONSHIPS AND DUAL FUNCTIONALITY IN LATER LIFE
Authors: Thomas Patricia , Sauerteig-Rolston Madison , Bauldry Shawn , Nemeth Samuel , Ferraro Kenneth 
Published: December 2023

Abstract
Longer lives are often accompanied by greater risk of cognitive and physical impairments, but we investigate whether social relationships reduce the risk of those impairments. We examine dual functionality – the absence of both dementia and activities of daily living impairments – and draw upon stress process and social integration theories to examine the impact of positive and negative dimensions of relationship quality with friends and family to better understand how social factors may affect how long people maintain both their physical and cognitive functioning in later life. We use nationally representative panel data from the Health and Retirement Study (2006-2016, N=6,985) and Weibull accelerated failure-time models. Higher strain with family members and with friends was associated with a loss of dual functionality at earlier ages (Time Ratio = .97 [95% CI: .95, .99] and TR = .96 [CI: .94, .98], respectively). Greater social support from family members was beneficial, related to a longer time as dual functional (TR = 1.04, CI: 1.02, 1.06); however, more support from friends was related to loss of dual functionality at earlier ages (TR = .98, CI: .96, .99). Findings reveal the implications of social support and strain in different types of relationships for dual functionality.
CARING SELF-EFFICACY AND BEHAVIORS OF MIGRANT NURSING ASSISTANTS WORKING IN RESIDENTIAL AGED CARE FACILITIES
Authors: Shrestha Sumina , While Christine 
Published: December 2023

Abstract
Data show a significant proportion of nursing assistants from migrant backgrounds in the Australian aged care industry. However, compared to locally-born counterparts, they are more likely to be employed as casual staff and offered shorter shifts, irregular hours, and lower pay, often without employment benefits. Previous studies have shown that the working environment of an organization influences employees’ self-efficacy, affecting their performance. This study hypothesized that migrant nursing assistants from non-English-speaking countries have lower confidence in caring for older residents and, thus, execute less-satisfactory caring behaviors than their local, English-speaking colleagues. The caring self-efficacy was quantitatively measured from the perspective of nursing assistants in residential aged care facilities (N = 280), and caring behaviors were explored from older residents’ perspective (N = 13). Results showed that nursing assistants whose first language was not English had lower levels of caring self-efficacy than native English speakers. However, older residents found that they frequently met residents’ individual needs and were more competent, emotionally present, respectful, and amiable, despite communication issues. Older residents insisted that the personalities of nursing assistants have a greater impact on their job performance than their backgrounds. These findings suggest that although migrant nursing assistants from non-English-speaking countries had low self-efficacy to carry out their job, their performance was appreciated by older residents. This study supports the Australian government’s strategy of using immigration to prevent or respond to an aged care workforce crisis, but it also advocates for improved working conditions, organizational resources and benefits for those with non-English-speaking backgrounds.
FOOD INTAKE WAS TEMPORALLY ASSOCIATED WITH STAFF MEALTIME CARE APPROACHES AND BEHAVIORS OF RESIDENTS WITH DEMENTIA
Authors: Liu Wen , Perkhounkova Yelena , Hein Maria , Bakeman Roger 
Published: December 2023

Abstract
Nursing home residents with dementia commonly experience low food intake, resulting in functional and nutritional consequences. Prior work supports associative relationships of resident behaviors and staff approaches with food intake, yet research on temporal relationships is limited. This study examined temporal associations of resident behaviors and staff approaches with food intake. Videotaped mealtime observations (N=160) involving 36 staff and 27 residents (53 staff-resident dyads) in 9 nursing homes were analyzed. Sequential analysis was conducted for resident behaviors and staff approaches as antecedents of resident successful food intakes in 5-, 10-, and 15-second time windows. Increased resident-initiated food intake was associated with preceding resident positive verbal behaviors, but not other resident behaviors or staff approaches. Decreased resident-initiated food intake was associated with preceding resident functional impairments and resistive behaviors, but not other behaviors or approaches. Increased staff-initiated food intake was associated with preceding staff person-centered verbal approaches, but not resident behaviors or other staff approaches. Decreased staff-initiated food intake was associated with preceding resident positive/neutral nonverbal behaviors and functional impairments, and staff task-centered care approaches. Findings confirm the importance of certain strategies in promoting food intake, including facilitating resident positive verbal communication, supporting functional impairments, responding to resistive behaviors, maximizing the use of person-centered care, and minimizing the use of task-centered care. Resident positive/neutral nonverbal behaviors which reflect resident active engagement during mealtime, do not facilitate staff-initiated food intake and may be an indicator of resident independence and readiness to initiate food intake. Further investigation is needed using larger diverse samples.
BUILDING THE RESEARCH PRACTICE PARTNERSHIP TO PROMOTE CONTINUOUS QUALITY IMPROVEMENT IN ADULT PROTECTIVE SERVICES
Authors: Davitt Joan , Becker Todd , Brown Jocelyn , Barry-Dutro Erin , Sesek Greg , Zhang Peiyuan 
Published: December 2023

Abstract
Maryland’s Department of Human Services, Office of Adult Services developed a multiyear plan to strengthen Adult Protective Services. This plan included the development of a partnership between OAS and the University of Maryland School of Social Work to develop, implement and sustain a Continuous Quality Improvement (CQI) review process for Adult Services Programs (APS) to improve outcomes for vulnerable, elderly, and disabled adults. This paper focuses on partnership development between state government and university researchers to engage collaboratively in continuous quality improvement and intervention efficacy evaluation. Challenges and strategies for building logic models, developing performance measurement strategies, translating existing administrative data into research ready formats, and engaging stakeholders at the state level and in local departments of social services will be discussed. Key challenges included, staffing issues, technology, access to administrative data, and inadequate system resources to engage in research. Strategies for overcoming these challenges will be discussed.
INCLUSION AND INTEGRATION OF COMMUNITY STAKEHOLDER PERSPECTIVES IN RESEARCH: INSIGHT FROM AND FOR GERONTOLOGISTS
Authors: Leach Carrie , Moss Karen 
Published: December 2023

Abstract
Engaging diverse stakeholders in research is increasingly required by funding agencies though training, skills and capacity building for engaged approaches have not kept pace. To advance the science of community engaged research (CEnR) we convene leading scholars who will provide insight on the inherent issues of engaging stakeholders in research and strategies for overcoming obstacles. The first presentation will summarize findings from a study of gerontologists and aging trainees to understand the needs and challenges of engaging patient and community stakeholders in research. The second will present strategies for engaging Certified Nursing Assistants (CNAs) in a communication program for people living with dementia in skilled nursing facility. The third will present findings from community discussions that informed adaptations to the development of remote sensing technologies and discuss the continuing role for community engagement in implementation. The fourth presentation will offer insight on integrating diverse perspectives in the development of a dementia-focused intervention in a nursing home. The final presentation will summarize the results of a tobacco exposure study to inform the development of a harm-reduction intervention among long-term renters in extended-stay hotels and the benefits of stakeholder partnerships in building trust and aiding in renter recruitment. We will conclude with an attendee inclusive discussion to envision a path that may empower people of all ages and at all career stages to engage diverse stakeholders as partners to catalyze scientific research that is responsive and relevant to those who have a stake in healthy aging and results in social change. This is a collaborative symposium between the Community-Engaged Research and Patient/Person Engagement in Research Interest Groups.
TRANSITIONING TO WIDOWHOOD: THE ROLE OF SOCIAL INTEGRATION IN MODERATING WELL-BEING OVER TIME
Authors: Kinkade Emily , Fuller Heather 
Published: December 2023

Abstract
Prior studies indicate that widowhood may bring declines in both physical and mental health, but that social support may buffer against these declines. Social integration has also been found to alleviate widows’ depressive symptoms over time. However, less is known about whether social integration moderates the trajectory of well-being declines over longer periods of time post-widowhood. This study investigates whether social integration moderates the relationship between the transition to widowhood and changes in physical and mental well-being over time. A series of longitudinal multilevel models were run with data from participants (n=244-246) from five waves of the Social Integration and Aging study, collected every two years between 2013 and 2021. Depressive symptoms and subjective happiness were indicators of mental well-being, whereas basic and instrumental activities of daily living and total number of diseases were indicators of physical well-being. Social integration was assessed with the Social Integration in Later Life Scale (SILLS). Social integration moderated the relationship between widowhood and depressive symptoms such that increases in social integration resulted in greater reductions of depression scores over time among widows as compared to non-widows. Social integration similarly buffered against declines in physical functioning (i.e., increased basic activities of daily living) over time after widowhood occurred. No interaction effects of social integration on the relationship between widowhood and happiness or other physical well-being outcomes were found. These findings suggest social integration may be important for maintaining mental well-being and some aspects of physical health as older adults adjust to widowhood.
BUILDING AN ECONOMY THAT SUPPORTS WORKING WOMEN TO THRIVE
Authors: McCulloch Heather 
Published: December 2023

Abstract
Building on previous research about working women’s financial wellbeing, a provocative question arises: “What would the economy look like if were designed to work for women?” To answer this question, Heather McCulloch, entrepreneur in residence with the Aspen Institute Financial Security Program, conducted a translational research initiative called Women in the Economy. Intended to take a deep dive into the economic lives of working women across the U.S. who face one or more barriers, in addition to gender, to building their economic security, the project included in-depth interviews with 127 women across urban, suburban, and rural communities in 30 states and D.C. Participants were asked about the economic challenges they face, what they see as the most promising solutions, and their vision for a gender-equitable economy that enables women to strive, thrive, and reach their full potential. Findings revealed that working woman are struggling to make ends meet; they face a financial penalty - a loss of income and savings - due to caregiving; and they are not receiving the education they need to successfully navigate economic and financial systems. Building on qualitative results, a national survey (n=1224) was deployed to understand the scope of emergent topics. Among key findings are that four out of five respondents reported feeling economically insecure and only one in five reported feeling confident they would live comfortably in retirement. Together, findings based on the wisdom, voices, and experiences of working women point to policy, program, and market-based solutions that can build a gender-equitable society.
OLDER WOMEN ENTREPRENEURS ARE DRIVEN BY WANT RATHER THAN NEED
Authors: Choi-Allum Lona 
Published: December 2023

Abstract
During the COVID-19 pandemic, women ages 50+ pursued their dream of starting a business. This study contacted 278 women ages 50-plus by phone and online, examining the drivers and barriers of women entrepreneurs. Over a quarter (27%) of women said they always wanted to start a business, and 19% said they did it to follow their passion; another 17% were pursuing additional income, and 11% wanted flexible work options. Age, and perhaps the value of experience, has been an advantage in business ownership. Women entrepreneurs age 50-plus were less likely to have faced financial challenges since starting their business, with over two in five (45%) avoiding such challenges, compared to 29% of women entrepreneurs in their 40s. Nearly seven in 10 women (69%) surveyed poured their personal savings into their start-up. In addition, two in three agree that they face unique challenges in trying to access capital for their business that are different from men. Despite these challenges, most women were optimistic about their entrepreneurial path. The majority of women (97%) agreed that they made the right decision in starting their business – with about two in five (39%) saying their business is doing better than expected compared to when they first started. Respondents say they need resources on marketing, recruiting and hiring staff, and financing. And over two in five say they have not taken any type of training. Increasing awareness of business supports, funding sources, and training opportunities will help women as they grow their business.
DYNAMIC INTERPLAY BETWEEN STRESS AND POOR SLEEP AND THEIR CONSEQUENCES ON DAILY WELL-BEING
Authors: Lee Soomi , Almeida David 
Published: December 2023

Abstract
Stress impairs sleep. Poor sleep also increases the likelihood of stressful experiences. Importantly, there is the vicious cycle between stress and poor sleep, such that having either one increases the odds of the other. This is problematic in the context of aging, because midlife and older adults may have physiological vulnerability to stressors and age-related deterioration in sleep. This stalemate wherein aging individuals are exposed to daily stressors and degraded sleep but need to lower stress and improve sleep for long-term health calls for further research describing how stress and poor sleep co-occur in daily life and contribute to daily health and well-being. To respond to this call, this symposium brings together four rigorous studies. Paper 1 examines how recession hardships (financial, job, housing-related) are associated with daily sleep quality in midlife and older adults. Paper 2 focuses on exposure and reactivity to daily interpersonal stressors and reports their associations with daily sleep quality and physical activity in older adults. Paper 3 investigates daily links between worry and rumination and their implications for sleep in older adults. Paper 4 examines how consecutive poor sleep is associated with day-to-day trajectories of rumination and memory lapses in midlife and older adults. These papers use relevant theories and advanced analytic techniques to describe the nature, causes, and consequences of stress and poor sleep in the second half of life. The discussant, Dr. David Almeida will integrate key findings from these studies, discuss their theoretical and methodological contributions, and consider opportunities for future research.
DAILY STRESS PROCESSES, PHYSICAL ACTIVITY, AND SLEEP IN OLDER ADULTHOOD
Authors: Leger Kate , Charles Susan , Brown Colette , Fingerman Karen 
Published: December 2023

Abstract
Older adults who engage in healthy behaviors such as being physically active and sleeping well report lower levels of stress. Less is known about the links between exposure and reactivity to stressful events in daily life and their relationship with physical activity and sleep. The current study examined within-person associations between daily physical activity, sleep, and exposure and affective reactivity to naturally occurring interpersonal stressors. Older adults (N = 180) from the Daily Experiences and Well-being Study completed ecological momentary assessments (EMAs) every 3 hours for 5-6 days where they reported negative affect throughout the day and interpersonal tensions at the end of the day. They also reported their nightly sleep quality and wore Actical accelerometers to capture physical activity. Older adults reported greater numbers of stressors on days when they spent less time being sedentary and engaged in more light physical activity. On days when older adults experienced more stressors, they reported higher levels of negative affect, but this association was attenuated when they were more physically active that day. Additionally, older adults reported lower sleep quality the night after they reported higher numbers of stressors. These findings underscore the importance of assessing physical activity, sleep and stressful events in daily life and have implications for both physical and psychological well-being.
HISTORICAL REDLINING AND COGNITIVE FUNCTIONING AMONG US OLDER ADULTS
Authors: Fisk Calley , Ailshire Jennifer , Walsemann Katrina 
Published: December 2023

Abstract
Historical redlining disproportionately harmed Black and disadvantaged communities by designating them as less desirable for mortgage lending. Residence in neighborhoods historically designated as less desirable is associated with worse health outcomes, though little research exists on older adults. Redlined neighborhoods often have characteristics that increase risk for poor cognitive function among older adults (e.g., greater air pollution and less greenspace). We examine differences in cognitive function trajectories by redlining status over 18 years (1998-2016) using data on 5,527 respondents ages 50 and older from the nationally representative Health and Retirement Study that have been linked to National Community Reinvestment Coalition Historic Redlining Scores Data. Results from multilevel linear regression models - adjusted for individual sociodemographic characteristics - show that baseline level of cognitive function is lower in neighborhoods historically designated as “Declining” (b=-0.61, p&lt;.001) or “Hazardous” (b=-0.95, p&lt;.001) compared with “Best or Desirable”. We do not find any association with cognitive change over time. Baseline differences were explained by educational attainment and income for residents of “Declining” neighborhoods, and tract-level affluence and disadvantage for residents of “Hazardous” neighborhoods. Race-stratified analyses showed that the impact of historical redlining on cognitive function was generally similar for Black and White adults, though we found no association between historical redlining and cognitive function for Black residents of “Declining” neighborhoods. Our findings suggest that redlining, as both an historical practice and process affecting the socioeconomic trajectories of individuals and neighborhoods, can shape cognitive health in older adults.