bluuebunny/crossref_metadata_2025_split huggingface dataset:
SKELETAL MUSCLE ENERGETICS ARE ASSOCIATED WITH PERFORMANCE FATIGABILITY
Authors: Qiao Yujia (Susanna) , Santanasto Adam , Cawthon Peggy , Forman Daniel , Kritchevsky Stephen , Nicklas Barb , Newman Anne , Glynn Nancy 
Published: December 2023

Abstract
Performance fatigability manifests as insufficient energy to complete daily physical tasks and worsens with aging, exacerbating vulnerability to disability. Skeletal muscle energetics also declines with aging. Thus, we hypothesized muscle energetics may be an important contributor to performance fatigability. In the Study of Muscle, Mobility and Aging (SOMMA), participants completed a usual-paced 400m walk while wearing a wrist-worn ActiGraph, from which raw data were used to derive the Pittsburgh Performance Fatigability Index (PPFI, higher=more severe fatigability) that quantifies percent decline in the entire individual cadence-versus-time trajectory. Maximal oxidative phosphorylation (maxOXPHOS) in skeletal muscle mitochondria was quantified in vitro using high-resolution respirometry in permeabilized fiber bundles from vastus lateralis muscle biopsies. Maximal adenosine triphosphate production (ATPmax) was assessed in vivo by 31P magnetic resonance spectroscopy. We conducted separate tobit regressions to examine associations of maxOXPHOS and ATPmax with PPFI, adjusting for technician/site, age, sex, race, height, weight, and mins/day moderate-to-vigorous physical activity measured by ActiGraph in free-living, in N=795 participants with complete PPFI scores and &gt;1 energetics measure (70-94 yrs, 58% women). Median PPFI scores were 1.4% [IQR: 0-2.9%]. After adjustment, each SD (18.4 pmol/(s*mg)) lower maxOXPHOS was associated with 0.55% (95% CI: 0.26, 0.85) higher PPFI scores, while each SD (0.2 mM/sec) lower ATPmax was associated with 0.54% (95% CI: 0.27, 0.81) higher PPFI scores. Our results indicate that lower skeletal muscle energetics were associated with more severe performance fatigability. This suggests that therapeutics targeting muscle energetics may thereby potentially mitigate fatigability and lessen susceptibility to disability among older adults.
THE RELATIONSHIP BETWEEN LONG-TERM CARE OMBUDSMAN PROGRAM SPENDING AND NURSING HOME OUTCOMES
Authors: Kennedy Katherine , Kosar Cyrus , Thomas Kali 
Published: December 2023

Abstract
As part of the Older Americans Act, State Long-term Care Ombudsman Programs (LTCOP) serve older adults in nursing homes (NHs) and board and care facilities. The National Academies of Science, Engineering, and Medicine called for increased LTCOP funding to improve NH quality. We hypothesized that increases in spending on LTCOP would be associated with a lower prevalence of NH residents with low-care needs who could be cared for in the community and fewer residents taking antipsychotics. We conducted a secondary analysis using the National Ombudsman Reporting System, NH facility-level data from LTCfocUS.org for 15,592 US NHs (2011-2018), and the Area Health Resource File. Using a two-way fixed effects model with standard errors clustered at the facility-level, we examined the relationship between LTCOP spending per LTC bed at the state-level and outcomes, controlling for year, state, facility, and market characteristics. Increased LTCOP spending was associated with a lower proportion of residents in NHs with low-care needs and a lower percent of residents receiving antipsychotics (p &lt; .0001). In 2011, the average share of low-care NH residents (weighted by bed size) was 13.34%, and the share of residents on antipsychotics was 25.95%. For every $25 annual change in LTCOP funds, there was a .84 percentage point decrease in the prevalence of low-care residents for the average NH, and a .80 percentage point decrease in the share of residents receiving antipsychotics. States that have increased funding for their LTCOP observe better outcomes. This documents the need to increase funding to support LTCOP.
USING NETWORK ANALYSIS METHODS TO STUDY MULTIMORBIDITY PATTERNS
Authors: Griffith Lauren , Brini Alberto , van den Heuvel Edwin , John Philip St , Stirland Lucy , Mayhew Alexandra , Muniz-Terrera Graciela 
Published: December 2023

Abstract
Multimorbidity is a risk factor for patient-important outcomes including quality of life and functional decline. Multimorbidity research has focused mainly on disease counts, with less attention to patterns among chronic conditions. Network analysis has been increasingly used to examine multimorbidity clusters, but there are no guidelines for its conduct. In 12 recent studies using network analysis, we found heterogeneity in association measures (10 different measures) and clustering algorithms (5 different methods) used to identify multimorbidity clusters. Using self-reported data on 24 diseases in community-living adults aged 45-85 from the Canadian Longitudinal Study on Aging, we conducted network analyses using the 10 association measures and 5 clustering algorithms to better understand how these choices impact the number and types of clusters identified. We compared the similarity among clusters using the adjusted Rand index (ARI); an ARI of 0 is equivalent to the diseases being randomly assigned to clusters and 1 indicates perfect agreement. Two clinicians independently identified potential disease clusters which we compared to network analyses results. We found results differed greatly across combinations of association measures and cluster algorithms. The number of clusters identified ranged from 1 to 12 and their similarity was generally very low. Compared to clinician-derived clusters, the ARIs ranged from 0 to 0.23 indicating little similarity. These analyses demonstrate the need for a systematic evaluation of the performance of network analysis methods on binary clustered data like diseases. Moreover, diseases may not cluster, and a personalized approach to the care of older adults may be needed.
BIOLOGICAL AGE AND COGNITIVE PERFORMANCE AMONG LATE MID-LIFE WOMEN
Authors: Thurston Rebecca , Kusters Cynthia , Chang Yuefang , Maki Pauline , Carroll Judith 
Published: December 2023

Abstract
Older biologic age, indicated by accelerated epigenetic aging, may place women at risk for poorer cognitive performance as they age. However, findings are inconsistent and based upon limited neuropsychological batteries. Studies of midlife women are few, yet women comprise two thirds of those with Alzheimer’s disease, and midlife is a critical transition and potential window for early intervention. We tested whether greater epigenetic age would be associated with poorer cognitive performance among late midlife women. 224 MsBrain study participants (average age=59 years, 82% White, 14% Black, 4% other ethnicities) underwent phlebotomy, including epigenetic aging clock estimates (GrimAge, DunedinPACE, PCPhenoAGE), and a neuropsychological battery assessing global cognitive function (Montreal Cognitive Assessment), verbal learning and memory (California Verbal Learning Test), working memory and attention (Letter Number Sequencing), letter fluency (P, R, W); semantic fluency (animal task), spatial ability (Card Rotations), processing speed (Symbol Digit Modalities Test), and perceptual speed (Finding A’s). In linear regression models controlling for age, race, and education, older PCPhenoAge was associated with poorer global cognitive performance [B(SE)=-.07(.03), p=.01], verbal memory [B(SE)=-.09(.03), p=.006], working memory [B(SE)=-.12(.03), p=.0001], attention [B(SE)=-.10(.04), p=.02], spatial ability [B(SE)=-.77(.34), p=.02], processing speed [B(SE)=-.24(.09), p=.007], and somewhat lower letter fluency [B(SE)=-.23(.13), p=.07]. GrimAge and DunedinPACE showed similar yet less consistent patterns. Interactions by race (p’s&lt;.05) indicate that associations between older biologic age and poorer cognitive performance (verbal learning, verbal memory, processing speed) was particularly pronounced among Black women in the sample. Older biologic age is associated with poorer cognitive performance across multiple domains among late midlife women, particularly for Black women. Biologic age may serve as an early indicator of risk that could help identify women warranting early intervention to help maintain cognitive function. Supported by NIH RF1AG053504, R01AG053504, K24HL123565
EFFECTS OF GAMIFIED COGNITIVE TRAINING TO DETER THE PROGRESSION OF MILD COGNITIVE IMPAIRMENT
Authors: Yu Doris S F , Li Polly , Two Wung Wai , Waye Mary 
Published: December 2023

Abstract
Mild cognitive impairment (MCI) is highly prevalent condition among older adults, and has a greater risk of progression to dementia. Even cognitive training has great efficacy to delay the onset of dementia, its time-limited offer by professional members reduces its availability. Whereas ‘gamification’ evolves as important concept to enhance treatment engagement, we developed an innovative Sudoku solving algorithm titled ‘T-code’ to assimilates the key domains of cognitive training on attention, logical and deductive reasoning. A single-blinded RCT randomized 288 older adults with MCI to receive the 24-week Sudoku Mind Activation and Revitalizing Training (SMART) Program (n=157) or the usual care (n = 131). A battery of cognitive assessments, the Memory Inventory for Chinese, the Short Form-36 were evaluated at baseline, immediately after the 12-week Sudoku training and after the 12-week home-based self-practice. Focus group interview was conducted to explore subjects’ experience and reasons for its therapeutic effects if any. The results indicated that participants in the SMART Program had greater improvements in global cognitive function, working memory, language, short- and long-term delay recalls, recognition memory, CTT 1 and subjective memory complaints immediately after the 12-week training than the control. These effects, together with executive function, were sustained till the end of the programme. The qualitative findings converged with the outcome evaluation, and improved self-confidence, more active life engagement, and enhanced mood status might sustain the cognitive benefits. This game-based cognitive training is a treatment option of high accessibility, availability and acceptance to prevent MCI from progressing to dementia.
IN-VEHICLE SENSORS TO DETECT CHANGES IN DRIVING BEHAVIORS WITH EMERGENCE OF MCI
Authors: Tappen Ruth , Jang Jinwoo , Moshfeghi Sonia , Yang KwangSoo , Rosselli Monica , Coniff Joshua , Furht Borko , Newman David 
Published: December 2023

Abstract
Driving is a complex behavior requiring attention, judgment, orientation, memory, processing speed, visual acuity, adequate limb strength, and other functional abilities. It has been suggested that a change in driving behavior may be an early indicator of cognitive decline in the aging brain. The literature suggests that older drivers will drive less and more slowly as their cognitive skills begin to decline. In the “In-Vehicle Sensors to Detect Cognitive Change in Older Drivers” study, sensors are installed in participant vehicles and data is downloaded every three months at which time a carefully curated battery of cognitive tests is also administered. Records of those suggesting mild cognitive impairment (MCI) are reviewed by a Consensus Diagnostic Panel for confirmation. In the first 100 participants who have been followed over a year, nine participants evidenced existing or emerging MCI. Of these, six have experienced a decline in cognition in the last year. A comparison of driving behaviors over the year evidenced the previously reported slower, less frequent driving but also a previously unreported increase in hard braking and hard turns. The uniqueness of our longitudinal study is the continuous tracking of vehicle acceleration patterns over time, revealing significant relationships between g-force acceleration and cognition.
ANTIHYPERTENSIVE DEPRESCRIBING AND COGNITIVE FUNCTION IN VA NURSING HOME RESIDENTS: A TARGET TRIAL EMULATION
Authors: Jing Bocheng , Liu Xiaojuan , Odden Michelle , Dave Chintan , Graham Laura , Li Yongmei , Fung Kathy , Steinman Michael 
Published: December 2023

Abstract
Deprescribing is the practice of discontinuing or reducing medication that no longer provides benefits or causes harm. While deprescribing antihypertensives for frail elderly patients has gained interest, its impact on patient-centered outcomes such as cognitive function remains unknown. We emulated a target trial involving 45,183 Veteran Affairs nursing home residents aged ≥65 with stays ≥12 weeks between 2006-2019. Eligible residents must have a 4-week stable medication use period; they were allocated to the deprescribing/control arms, and censored at death, discharge, or two-year follow-up for intention-to-treat analysis. We used the Cognitive Function Scale (CFS) to assess cognitive outcomes, categorizing residents into cognitively intact, mild-, moderate-, and severely-impaired groups. We used an ordinal generalized linear-mixed model to analyze the effect of deprescribing on CFS, adjusting for confounders with 47 baseline covariates using inverse probability of the treatment weights. 1,290 and 11,354 patients were in deprescribing/control arms. At baseline, deprescribing was associated with an increased risk of worse cognitive function (OR=1.168 for being in a higher CFS category [95% CI:1.115-1.224]). Overall, cognition worsened in both arms over time (OR=1.007 per week for progression to higher CFS category, 95% CI:1.006-1.008). However, deprescribing mitigated the time trend, and the residents in the deprescribing arm had significantly decreased odds (improved CFS) at 0.996/week (95% CI: 0.995-0.997), 0.900 (95%CI: 0.881-0.919) over 26-weeks, and 0.811 (95% CI: 0.777-0.845) over 52-weeks. Our findings suggest that deprescribing is associated with a slower decline in cognitive function and can help inform future deprescribing interventions for BP management in nursing home residents.
NUTRITION THERAPY IN DISCHARGED OLDER ADULTS REDUCES HOSPITAL READMISSIONS AND LENGTH OF STAY
Authors: Ramel Alfons 
Published: December 2023

Abstract
The aim was to investigate effects of six-month nutrition therapy on hospital readmissions, LOS, mortality and need for long-term care residence up to 18-months post-discharge in older Icelandic adults. Participants (&gt;65 years) were randomised into intervention (n=53) and control (n=53) before discharge from a geriatric unit. The intervention group received nutrition therapy based on the Nutrition Care Process, including home visits, phone calls, freely delivered energy- and protein-rich foods and supplements for six months after hospital discharge. The Icelandic electronic hospital registry was accessed to gain information on emergency room visits (ER), hospital readmissions, LOS, mortality and need for long-term care residence. One subject from each arm dropped out during the intervention period. The intervention increased body weight (+5.2kg, 95%CI: 3.9-6.5kg) and energy intake (1696kcal, 95%CI: 1557-1834kcal) compared to control. The intervention group had a lower proportion of participants with at least one readmission compared to control (1 month: 1.9% vs 15.8%, P=0.033; 6 months: 25.0% vs 46.2%, P=0.021; 12 months: 38.5% vs 55.8%, P=0.051; and 18 months: 51.9% vs 65.4%, P=0.107). There was also a lower total number of readmissions (significant at 1, 6 and 12 months) and a shorter LOS (significant at all time points) in the intervention group. However, there were no differences between groups in ER visits, mortality and need for long-term care residence. It is of great clinical relevance that a six-month nutrition therapy in older Icelandic adults discharged from hospital reduced hospital readmissions and shortens LOS at the hospital up to 18-months post-discharge.
WEB-BASED COGNITIVE BEHAVIORAL THERAPY FOR DEPRESSION AMONG OLDER ADULTS: DEVELOPMENT AND USABILITY STUDY
Authors: Kayser Jay , Ash Samson , Zheng Chuxuan , Turner Skyla , Xiang Xiaoling 
Published: December 2023

Abstract
Digital Mental Health Interventions (DMHIs) can potentially improve treatment access for older adults experiencing depression, but few tailored web-based interventions exist. This paper describes the design and development process of a web-based cognitive-behavioral therapy program called Empower@Home and reports outcomes from a usability evaluation. The program was developed in collaboration with community agencies, stakeholders, and older adults. Development was guided by user-centered design principles and informed by multiple data sources. A comparative usability evaluation with ten older adults was conducted to assess the usability of Empower@Home. Paired t-tests were used to compare scores on the System Usability Scale (SUS) between three interventions. In addition, field testing was conducted with 4 end-users to detect any further usability issues. The content and design of the intervention was heavily influenced by feedback and recommendations provided by our community partners. Empower@Home involves nine sessions, completed over ten weeks, and a printed workbook. The sessions involve psychoeducation, short video clips, interactive content, an animated storyline, and weekly out-of-session home practices. In the comparative usability evaluation, Empower@Home received statistically significantly higher usability scores than both comparison interventions, and 80% of users preferred Empower@Home over other interventions. In field testing, all participants “agreed” or “strongly agreed” that they liked the procedures used in Empower@Home and felt confident in performing program-related tasks. Empower@Home is highly responsive to end user needs and the implementation setting’s characteristics. Interventions that work with community stakeholders and thoughtfully consider implementation barriers in the design process will likely produce more usable and effective DMHIs.
GERONTOLOGY AND GERIATRICS EDUCATION AND TRAINING
Authors: Liou Chih-ling , Kalaw Karel 
Published: December 2023

Abstract
We draw from our personal insights as foreign-born female faculty in the U.S. to explore how our minority status in the U.S. has affected our experiences/identities in the field of aging. We practiced intersectionality by considering how our understandings of “foreignness” in academia and the aging field are intertwined with other markers of difference, including race, national origin, language, and academic programs. We also draw from tenets of collaborative autoethnography to engage two autoethnographies from two countries in Asia to pool their lived experiences and collaboratively analyze and interpret them for commonalities and differences. We begin by sharing stories about graduate study pursuits and becoming faculty in the U.S. We note how our foreignness shapes our lives as aging scholars in the U.S. academy and our personal views on aging. After exchanging our first set of writings, we identified key experiences to focus on in the subsequent writing periods. Our minority backgrounds, teaching aging subjects, and using qualitative methodology are shared identification. Moreover, the themes that deal directly with identity development and the perception of aging of non-white women can be added to promote a deep understanding of aging among the non-native-born population. This study highlights the value of collaborative autoethnography as a method of inquiry and reflection. Findings demonstrate that non-native-born female faculty members in the field of aging faced multi-faceted challenges in both professional and personal realms. Implications for supporting foreign-born female aging scholars are discussed.
CONTRIBUTIONS TO AGING RESEARCH BY DOCTORATES IN GERONTOLOGY AND GERIATRICS: A PORTUGUESE CASE STUDY
Authors: Ribeiro Oscar , Teles Soraia , Paul Constanca 
Published: December 2023

Abstract
Portugal is home to one of the world’s oldest populations, ranking in the top five OECD countries with the highest share of people aged 65 and over. The PhD in Gerontology and Geriatrics (PDGG) is the first and one-of-its-kind response in Portugal to the need of advanced training in the field. This work describes the contributions of PDGG doctorates from 2009 to 2022. Electronic/paper-based academic records were retrieved to characterize the doctorates’ entry profiles. Documentary analysis of dissertations was performed to describe their research. Related publications and its impact were identified from searches on academic databases/engines. Doctorates (N=36; 88.9% female) were aged between 23 and 54 (M 33.0). The background is in health and social sciences, with more representation from nurses (30.6%) and psychologists (22.2%). Approximately thirty percent (n=10) had a Masters in Gerontology, and all were professionally experienced with older adults (1-29 years). Doctoral research topics included cognitive impairment and mental health, healthcare/social services/interventions; intergenerationally/family relations/informal care; frailty; nutrition and physical activity, minority populations, elder abuse and spirituality. The research of the 36 doctorates involved 12374 participants (9499 older persons). Outputs comprised 153 publications in scientific journals, receiving 1640 citations, 87782 usages (e.g., views, downloads), 9538 captures (e.g., exports) and 541 in social media or news articles (PlumX metrics). Other contributes included 8 original intervention programs, 3 new and 11 translated/culturally-adapted assessment scales. This case study shows the intergenerational and lifelong learning environment of the PDGG, and its many contributions to the the aging field.
DEVELOPMENT OF TWO GERIATRIC CASES TO PREPARE STUDENTS FOR THE NEXT-GENERATION RN LICENSING EXAM
Authors: DiBartolo Mary 
Published: December 2023

Abstract
With the implementation of the Next Generation NCLEX-RN (NGN) national licensing examination in April of 2023, faculty in state of Maryland nursing schools were solicited for participation in a Maryland Nursing Workforce Center grant initiative to develop a repository of NGN case studies. A major change in the exam was the integration of a six-step clinical judgment model using a case-based format with client information presented in an electronic medical record using new question types designated for each of the steps presented sequentially. Twenty faculty “champions” from 13 Maryland schools attended several training sessions and were to develop two peer-reviewed cases for inclusion in the Qualtrics database. Once approved, these cases could then be accessed online via a secure link or QR code by Maryland-based nursing faculty and shared with students for instructional and practice purposes. Two gero-focused cases were developed. The first case focused on an older adult in a long-term care facility admitted to the hospital for a urinary tract infection with potential complication of urosepsis. Another featured a hospitalized older adult client with Alzheimer’s disease admitted from home with dehydration with potential for delirium superimposed on dementia. While a major objective of this innovative and proactive state-wide initiative is to optimize success on the modified NCLEX-RN, it is also hoped that these case examples, when appropriately integrated into the nursing curriculum, will enhance understanding of common geriatric scenarios and better prepare graduates for safe, effective nursing care of older adults.