bluuebunny/crossref_metadata_2025_split huggingface dataset:
STAR CAREGIVERS: IMPLEMENTATION OF AN EVIDENCE-BASED PROGRAM IN REAL-WORLD SETTINGS
Authors: McCurry Susan , Penfold Robert , Karel Michele 
Published: December 2023

Abstract
Evidence-based non-pharmacological community programs to improve care of older adults with dementia are growing. However, many programs have historically been tested in research studies that fail to reach medically underserved populations or communities with unique service needs. STAR-Caregivers (STAR-C, also known as STAR-Community Consultants) is an evidence-based psychosocial support and skill training program designed to teach family caregivers how to identify and increase pleasant events, improve communication, and use behavioral problem-solving skills to reduce the problems experienced by their family member with dementia while improving quality of life for both persons in the caregiver-care receiver dyad. Since its original randomized controlled trial in 2005, STAR-C has been translated in a variety of real-world settings, including in Area Agencies on Aging throughout Oregon and Washington state. This symposium describes three recent new translation efforts: (1) implementation of STAR-C as a virtual training program (STAR-VTF) for caregivers of persons with dementia who are part of the Kaiser Permanente Washington health care system; (2) cultural adaptation of STAR-VTF for Latino caregivers, and (3) incorporation of STAR-C into a largely rural community care setting in Illinois during the COVID-19 pandemic using Amazon Echo technology to conduct telehealth community dyad STAR-C sessions and connect clients to supplemental services. Each presenter will discuss the dementia care needs in their respective populations, the challenges encountered in translation of STAR-C to serve target caregiving dyads, and lessons learned regarding treatment effectiveness and program sustainability.
VIRTUAL TRAINING FOR MANAGING SYMPTOMS OF DEMENTIA: A CULTURAL ADAPTATION FOR LATINO CAREGIVERS
Authors: Ramirez Maggie , Penfold Robert 
Published: December 2023

Abstract
STAR-Caregivers Virtual Training and Follow-up (STAR-VTF) is an evidence-based intervention that teaches family caregivers how to manage behavioral and psychological symptoms of dementia. The study objective was to identify what adaptations to STAR-VTF are needed to improve cultural relevance for Latino caregivers. Thirty caregivers of people living with dementia who self-identify as Hispanic/Latino and 14 providers of healthcare and social services were interviewed. Interview transcripts were analyzed using thematic analysis methods. The Cultural Treatment Adaptation Framework guided data collection and analysis. Three themes were identified: (1) there was a need to increase awareness about dementia and decrease stigma; (2) semantics mattered as certain words and phrases could be stigmatizing, offensive, or culturally inappropriate; and (3) there was a need to incorporate into program materials the traditional family structure and nature of caregiving in Latino families. Adaptations were performed on STAR-VTF, including expanding content to improve understanding of dementia, revising language that was viewed as problematic, and adding cultural examples to reflect the range of family involvement in caring for people living with dementia and multigenerational living. Findings from this study advance understanding of the Latino caregiver experience and how to modify programs to better serve their needs.
RECRUITMENT AND BASELINE RESULTS FOR THE STAR CAREGIVERS VIRTUAL TRAINING AND FOLLOW-UP PRAGMATIC TRIAL
Authors: Penfold Robert , Johnson Eric , Ramirez Maggie , Ralston James , McCurry Susan , Teri Linda 
Published: December 2023

Abstract
The STAR-Caregivers program is efficacious in reducing the behavioral and psychological symptoms of dementia (BPSD). In this pragmatic trial, we are testing a 6-session, self-directed, online version of the program that leverages secure email, an online learning management system, and brief coaching telephone calls to expand access to training. This paper reports on issues related to recruitment and baseline levels of psychosocial measures collected. Caregivers and persons living with dementia (PLWD) were randomized to intervention or usual care. Baseline measures were collected via REDCap and included standardized measures for PLWD dementia severity and functioning and caregiver measures for anxiety, stress, depression, and caregiving mastery. The study recruited 67 dyads. Recruitment increased greatly when we removed the inclusion that subjects be on antipsychotic medications. Baseline clinical showed the average score on the Dementia Severity Rating Scale was 22.2 (mild) and 28.8 on the Revised Memory and Problem Behavior Checklist (mild). The average Functional Activities Questionnaire was 22/30. Caregivers reported low levels of stress (KCSS), depression (PHQ8), and anxiety (GAD2) with mean and standard deviation: KCSS = 22.8 (6.6), PHQ8 = 4.9 (4.65), and GAD2 = 1.3 (1.4). The mean Caregiver Mastery Score was moderate at 20.4 (3.28). Virtual delivery of the STAR Caregiver training program is feasible. Caregivers of PLWD with mild to moderate cognitive and functional decline seem most amenable to intervention. We are currently analyzing outcome date to determine the efficacy of this program and plan to investigate the optimal timing of caregiver outreach and support programs.
RATE OF CHANGE IN DEPRESSIVE SYMPTOMS OVER THE FINAL MENSTRUAL PERIOD
Authors: Avis Nancy , Colvin Alicia , Chen Yuqing , Joffe Hadine , Kravitz Howard 
Published: December 2023

Abstract
Studies have shown that women are more vulnerable to elevated depressive symptoms during the menopause transition (MT) then before. This study evaluates change in depressive symptoms, as measured by the Center for Epidemiological Studies-Depression (CES-D) score, over the final menstrual period (FMP), a more precise measure of menopause timing compared to MT stages. The sample consisted of 1,783 women in the SWAN cohort with an observed FMP and at least one CES-D assessment from baseline through follow-up (1996 – 2017). Piecewise linear growth curves were fit to repeated measures of CES-D scores as a function of time from FMP (+/- 10 years). Results showed two places with a change in slope. CES-D scores decreased by 0.22 annually (95% CI: -0.41, -0.04) until 36 months prior to FMP (Period 1). From -36 months until the FMP (Period 2), there was a non-statistically significant increase in CES-D, followed by a decline (-0.19 annually, 95% CI: -0.34, -0.03) after FMP (Period 3). We examined a range of predictors (sociodemographic, health-related, psychosocial, hormonal) of change in CES-D score during each period. Upsetting life events were related to CES-D change at periods 1 and 2, social support at periods 1 and 3, and smoking at periods 2 and 3. Baseline CES-D was related at period 1, and anxiety was related to CES-D change at period 2. These results provide a more nuanced picture of change in depressive symptoms over the FMP and the variables related to depressive symptoms at different time points over the FMP.
THE ASSOCIATION OF URINARY INCONTINENCE AND DISABILITY AMONG A DIVERSE SAMPLE OF MID-LIFE SWAN WOMEN
Authors: Dugan Sheila , Crawford Sybil , Wente Karla , Waetjen L , Karvonen-Gutierrez Carrie , Harlow Sioban 
Published: December 2023

Abstract
Few studies have examined the prospective association between urinary incontinence (UI) and disability in midlife women. We assessed associations between UI type, frequency and amount with reported disablity in a racially/ethnically diverse cohort of community dwelling midlife women. Data was from longitudinal analyses of questionnaires from the multi-center, prospective cohort Study of Women’s Health Across the Nation. We used multivariable ordinal logistic regression to examine if UI type, frequency and amount at the 13th follow-up were associated with the World Health Organization Disability Assessment Schedule (WHODAS) at the 15th follow-up (controlling for other factors, e.g. menopause status, body mass index, lifestyle and psychosocial factors) and disability at Follow-up 13. UI was associated with subsequent reports of disability in participants, particularly in the WHODAS domains of mobility, communication, and societal participation. Associations were strongest for mixed UI type compared to stress UI or urge UI, daily frequency of UI compared to monthly or weekly, and larger amounts of urine leakage compared to drops of leakage. UI appears had a strong association with multiple domains of disability in midlife women after two years of follow-up. It is important for clinicians to address UI earlier in symptom onset. Screening for mixed UI and UI that occurs more frequently and it larger amounts, more specifically, may yield better information regarding a patient’s future disability risk.
COGNITION ON THE GO: UNIQUE INSIGHTS INTO BRAIN HEALTH FROM HIGH-FREQUENCY COGNITIVE APPROACHES
Authors: Oravecz Zita , Germine Laura 
Published: December 2023

Abstract
High-frequency ambulatory cognitive assessments offer the opportunity to examine cognitive change at multiple timescales. When deployed multiple times per day via pervasive mobile technology (e.g., smartphones), ambulatory cognitive assessments allow us to conduct semi-continuous monitoring of cognitive changes while individuals go about their daily lives. Variation in performance that occurs over these short timescales may be associated with a wide range of contextual factors (e.g., our thoughts, emotions, and behaviors) including the way we respond to challenges presented by our everyday environments. Short-term change and variation may also reveal information about overall brain health and risk for cognitive decline over longer timescales. This symposium focuses on how high-frequency, ambulatory cognitive assessments can generate new insights into cognitive aging, psychological processes, and risk for neurocognitive decline by revealing detailed patterns of cognitive change and variation over short timescales (hours to weeks). The talk by Sliwinski et al. gives an overview of high-frequency cognitive assessment approaches. The talk by Harrington et al. will show how dimensions of experienced affect may influence short-term changes in multiple domains of cognition. The talk by Hakun et al. will show how short-term cognitive variation may predict how we respond to everyday stressful experiences. The talk by Oravecz et al. will show how to extract substantively meaningful predictors of long-term cognitive change from short-term processes such as retest learning.
ASSOCIATION BETWEEN PROVIDER DISCONTINUITY AND QUALITY OF CARE FOR NURSING HOME RESIDENTS
Authors: Yun Hyunkyung , Unruh Mark , Jung Hye-Young 
Published: December 2023

Abstract
Discontinuity in outpatient care has been associated with lower quality care in community settings, but little is known about discontinuity of care in nursing homes (NHs). We examined discontinuity in clinician care and care quality for NH residents using Medicare fee-for-service claims for a 20% national sample of beneficiaries (January 1, 2012 to December 31, 2019). For residents with NH stays of ≥2 years, we examined changes in attributed clinicians during the first two years of their stays. Residents were attributed to the physician or advanced practitioner with a plurality of visits provided to them in the NH in a given year. Estimates were adjusted for resident, clinician, and NH characteristics. The determinant of interest reflected whether there was a change in the attributed clinician from the first to the second year. Among 280,831 residents in our sample, 37.6% (105,551) were attributed to a different clinician in their second year. On a quarterly basis, these residents had a 0.2 percentage point [pp] (95%CI, 0.2-0.3; p-value &lt;.001) higher likelihood of an ambulatory care sensitive (ACS) hospitalization, a 0.2 pp (95% CI, 0.1-0.3; p-value &lt;.001) higher likelihood of an ACS emergency department (ED) visit, and $609 (95% CI, $548.4-$669.5; p-value &lt;.001) higher health care costs in their second year compared to residents without a clinician change. Compared to baseline rates, these represent relative increases of 14.2% in ACS hospitalizations, 11.5% in ACS ED visits, and 8% in costs. Discontinuity in care is associated with lower-quality care for NH residents.
LOWERING THE AGE FOR MEDICARE ELIGIBILITY: WHO BENEFITS?
Authors: Sneed Rodlescia 
Published: December 2023

Abstract
Advocacy groups and government officials have recommended lowering the Medicare eligibility age to increase health equity and promote utilization of preventive services. Consequently, policy analysts have begun to evaluate the impact of such a policy change. The purpose of this study was to determine who would benefit most from reducing the Medicare eligibility age. Using data from the 2018 Health and Retirement Study, we calculated the number of individuals who would become insured if the Medicare eligibility age was reduced to 60, 55, or 51. We also examined health profiles for such individuals, comparing them to their insured counterparts. Complex survey procedures were used to generate population estimates. We estimate that 1.43 million Americans would become insured if the Medicare eligibility age were reduced to 60. Lowering the age to 55 or 51 would insure 3.45 million and 4.59 million people, respectively. Evaluating data for those ages 51-64, those currently uninsured reported less preventive health screening than their insured counterparts, including lower screening for high cholesterol, cervical cancer, and prostate cancer. They also had lower vaccination rates for influenza and shingles. Of those currently uninsured, 36.5% reported having no usual place where they received care. Hypertension prevalence was similar among insured and uninsured individuals, but the uninsured were less likely to be on antihypertensive medications. Taken together, our findings suggest that lowering the Medicare eligibility age would result in new healthcare coverage for individuals who underutilize the healthcare system, which could have important implications for health.
THE ROLE OF FRAILTY ON THE IMPACT OF SOCIAL RELATIONSHIPS ON HEALTH OUTCOMES: RESULT FROM THE FRÉLE LONGITUDINAL STUDY
Authors: Mehrabi Fereshteh , Béland François 
Published: December 2023

Abstract
The link between social relationships and health is well-established as per Berkman and Krishna’s theory. However, the biological mechanisms by which social relationships impact health, such as frailty, remain unknown. This study aimed to examine whether the effects of changes in social relationships on changes in physical, mental, and cognitive health outcomes varied among frail older adults compared to robust peers. Data were from three waves of the FRéLE study among 1643 Canadian community-dwelling older adults aged 65 years and over. We performed latent growth curve models (LGMs) to test our objectives with the assumption of missing not at random. We measured social isolation through social participation, social networks, and support from different social ties (e.g., children, friends). We assessed frailty using the phenotype of frailty. Health outcomes include disability, chronic diseases, depression, and cognitive decline. The results revealed that increasing changes in social participation, social contact with friends, and social support from different social ties were associated with greater changes in cognitive and mental health, but not physical health, among frailer older adults compared to those who were more robust. This longitudinal study suggests that social support has a protective and compensatory role in enhancing mental health among frail older adults, but not among robust peers. Public health policies and interventions should focus on ameliorating social connectedness among physically frail older adults to enhance mental health outcomes. Future research studies could explore other risk factors that impact the relationships between social connectedness and health among older populations.
DENTAL-RELATED DECISION-MAKING CAPACITY IN OLDER ADULTS WITH VARIED COGNITIVE FUNCTIONS
Authors: Chen Xi , Madiloggovit-Lower Jirakate , Comnick Carissa 
Published: December 2023

Abstract

Background
Decision-making is often impaired in individuals with cognitive impairments. However, how cognitive impairment affects dental treatment decision-making remains unclear. We sought to describe dental-related decision-making capacity in older adults with varied cognitive functions.

Methods
Sixty-five participants, including 14 healthy controls and 51 with documented cognitive impairment, were categorized into healthy controls, mild cognitive impairment (MCI), mild dementia, moderate dementia and severe dementia. A hyperthetical dental problem along with three treatment options were presented. Participants were first asked to identify the problem, related treatment options and the pros and cons of each option. They were then asked to choose a treatment using the given funds. Visual and verbal cues were provided if participants failed to complete the task independently. Participants were scored based on their performances. Data was analyzed using the Kruskal- Wallis test and Holm method for multiple comparisons and a linear regression model for the multivariate analysis.

Results
Ninety-six percent of the participants with cognitive impairment showed some sorts of deficits in treatment decision-making. Sixty percent of those with MCI and 70% of participants with mild dementia could not explain pros and cons of the treatment choices, significantly higher than that in the healthy controls (10%). The decision-making capacity significantly differed across groups (p&lt; 000.1). Compared to the health controls, decision-making capacity decreased 18%, 33%, 71% and 86% in the MCI, mild dementia, moderate dementia and severe dementia groups, respectively.

Conclusion
Dental-related decision-making deficits was highly prevalent in older adults with cognitive impairment and occurred as early as MCI.
CONTRAST SENSITIVITY AND BRAIN NETWORK COMMUNITY STRUCTURE IN THE BRAIN NETWORKS AND MOBILITY STUDY
Authors: Thompson Atalie , Tanase Alexis , Miller Michael , Williamson Jeff , Hugenschmidt Christina , Chen Haiying , Kritchevsky Stephen , Laurienti Paul 
Published: December 2023

Abstract
Contrast sensitivity (CS) is the ability to perceive differences in shades of light and dark, which is important for pattern recognition and depth perception. We have previously shown that impaired CS is associated with poor performance on the expanded short physical performance battery (eSPPB), and that performance on the eSPPB is associated with sensory motor cortex (SMC) connectivity at rest. We hypothesized that brain networks are important to the relationship of CS with eSPPB. Participants (n=192) were cognitively unimpaired older adults (mean age=76.5±4.7 years; 56.5% female, 9.4% black) with good visual acuity who completed CS testing. We applied graph theory to characterize the cross-sectional relationship of binocular CS to functional brain networks generated from fMRI both at rest and during a motor imagery (MI) task and determined the spatial patterns of SMC, visual (VIS) and default mode (DMN) network connectivity. Regression analyses were used to assess associations of CS with brain network connectivity without and with adjustment for sex and eSPPB. Lower CS (p=0.009) was significantly associated with degraded SMC connectivity at rest even in models adjusted for eSPPB and sex. Similarly, lower CS was significantly associated with degraded VIS and DMN connectivity during the MI task (all p&lt; 0.005) when controlling for eSPPB and sex. These results indicate that low CS and poor eSPPB are both associated with connectivity in the SMC at rest and with VIS and DMN during MI in older adults. These findings may be important for understanding the relationship between age-related visual and mobility dysfunction.
ADDRESSING CURRICULUM DESIGN CHALLENGES: THREE DELIVERY DESIGN OPTIONS FOR UNDERGRADUATE AGING AND HEALTH COURSE
Authors: Pagan Mary Theresa , Seo Minjung 
Published: December 2023

Abstract
Providing a comprehensive gerontology course to diverse academic majors is a curriculum design challenge. Current research indicates students seek out the delivery option best suited to their needs, requiring educators to design or modify courses to provide face-to-face, hybrid, and online opportunities. Further, gerontologists are challenged with initial student knowledge and views on aging, aging processes, and health disparities shaped primarily by personal/life experiences with older adults and media representations of aging. Significant design and quality assurance were minimized by utilizing the recognized work of established gerontologists providing the overall framework for a comprehensive aging course Segmenting the course into two sections, social determinants of health utilizing Deborah Carr’s Golden Years? Social Inequalities in Later Life and target population research, Grandmothers at Work, Juggling Families and Jobs by Madonna Harrington Meyer. As a research design, a mixed method design (questionnaire and interview was used on seventy-eight students (Male: 27, Female: 51) enrolled in face-to-face, hybrid, and online delivery options. As a result of attending the three-credit course, significant knowledge-base increases were found in four key content areas: 1) social determinants of health (83%), 2) theories (sociological and biological)-(90%), 3) socioeconomic (SES) variations (80), and 4) mixed methods research design (62%). A curated library of online resources (youtube, Ted Talks, documentaries, news reports) supplemented the course textbooks for each learning module, resulting in a ninety-six percent resource satisfaction evaluation average for the three delivery methods.
NURSING STUDENTS’ RESPONSE TO THE AGE-FRIENDLY HEALTH SYSTEMS 4MS FRAMEWORK CURRICULUM
Authors: O’Connor Timothy , Pandya Naushira , Tewary Sweta , Shnayder Oksana 
Published: December 2023

Abstract

Problem
There is a shortage of registered nurses, especially those choosing to work in long-term care. Providing interdisciplinary education on age-friendly health care to nursing students offers long-term care as a career option post-graduation. To evaluate the effectiveness of teaching nursing students about age-friendly health care, the students must provide adequate feedback on the educational content they receive. Purpose: This project is part of the Age-Friendly Health Systems 4Ms project and identified why nursing students did not complete a comprehensive survey after receiving an interdisciplinary educational session based on the Age-Friendly Health Systems 4Ms Framework. Research design: A focus group design was used, and subjects were recruited from nursing students who received the educational session but did not complete the comprehensive survey. Questions for the focus group discussion were derived from the content received during the academic session and from the comprehensive survey. The focus group interview was audio-recorded, and the recordings were transcribed verbatim. Data analysis: Focus group transcripts were analyzed using descriptive content analysis to determine themes.

Results
The outcome of this study provided researchers with insight into why nursing students did not complete the comprehensive survey. The results of this study will help improve future comprehensive survey response rates for the remainder of the Age-Friendly Health Systems 4Ms project. Significance: The findings of this study enhances the validity and reliability of the comprehensive survey results and informs researchers across disciplines on how to avoid low survey response rates.