bluuebunny/crossref_metadata_2025_split huggingface dataset:
MEDICAID ADULT DAY SERVICE CENTERS STAFFING AND SERVICE DIFFERENCES BY PROFIT STATUS
Authors: Batista-Malat Eleanor , Wilber Kathleen 
Published: December 2023

Abstract
Adult day service centers (ADSC) encompass a broad range of services, yet few studies have examined staffing and service differences in for-profit and non-profit centers. Previous long-term services and supports (LTSS) research has found that for-profit nursing homes have lower levels of staffing, however, this research has not extended to ADSCs. Data from the 2018 wave of the National Post-Acute and Long-Term Care Study were used to examine differences in staff hours per patient day (HPPD) and services offered in ADSCs by profit status. Only ADSCs that accept Medicaid were included because the majority of the responding ADSCs accept Medicaid (76.8%) and Medicaid acceptance and profit status are significantly related (p&lt;.001). Using t-tests, there was a significant difference (p=.002) in total HPPD with higher HPPD in non-profit ADSCs, with a difference of about 13 minutes. Additionally, there were significant differences in the number of transportation (p&lt;.001) and medical (p&lt;.001) services offered by profit status, with for-profit ADSCs offering a higher number of services, although there was no difference in the number of social/behavioral services (p=.122). These findings suggest that ADSCs that accept Medicaid may be subject to similar incentive structures that lead to lower levels of staffing in for-profit LTSS. The higher number of transportation and medical services in for-profit ADSCs that accept Medicaid also suggests different financial models for for-profit and non-profit ADSCs. Future research should more closely examine factors associated with ADSC staffing levels and service provision, and how these measures are associated with quality of care.
EXPERIENCES OF TECHNOLOGY USE BY OLDER ADULTS DURING COVID-19
Authors: Kilaberia Tina , Hu Yuanyuan , Ratner Edward , Bell Janice 
Published: December 2023

Abstract
Computer and communications technology use expanded during the COVID-19 pandemic, but little is known about how this affected older people. Using the Unified Theory of Acceptance and Use of Technology questionnaire and qualitative interviews, we examined 18 older adults’ technology use during COVID-19 across two subgroups of nine older adults each: those scoring above (“high”) and those scoring below (“low”) the median (4.09). Overall, older adults scored fairly high (mean 4.0; SD=0.5; range 3.1-4.8 across 16 items on a scale of 1 to 5). In each group of nine older adults, four (44%) described technology as being helpful during the pandemic. Among high scoring older adults, 100% utilized technology to order either groceries or household items and six (67%) used either telehealth or online health information system (i.e., MyChart) to communicate with health services providers, compared to three (33%) and four (44%) within the low scoring group. No one in the high scoring group described a degree of cognitive difficulty whereas four 44% in the low scoring group did. All but one (94%) older adults described needing some help with technology from family members, friends, and/or paid technology services. Two themes complement these findings by reflecting strengths (“lots of ways to do everything”) and challenges (“I just get through it”) of using technology. Greater technology mastery may positively influence the ability of older adults to meet their needs, but cognitive challenges may prevent full engagement with technology.
PREDICTORS OF FUNCTIONAL ABILITY VARY BY AGE
Authors: Pullen Carly , Patrick Julie Hicks 
Published: December 2023

Abstract
Across adulthood, chronic physical and emotional conditions can interfere with wellbeing. We examined the potential moderating effect of age on the process functional ability Using data from 401,958 adults who completed the 2020 Behavioral Risk Factor Surveillance System survey, we tested the associations among age, sex, race, chronic health conditions, poor mental health, and functional ability. The initial model was a poor fit to the data, χ 2 (DF = 24) = 592039, p &gt; .001; RMSEA = .25. In order to examine whether this poor fit was related to age differences in the model, we removed age as a predictor and included it as a moderator. Thus, we tested the model among 122,005 younger adults, 140,122 midlife adults, and 139,831 older adults. The model fit improved, χ 2 (DF = 54) = 567119.79 p &gt; .001; RMSEA = .25. Variance accounted for in functional ability differed, with 22% among younger adults, 33% at midlife, and 20.5% for older adults. Additional post hoc analyses were conducted and suggest alternate pathways to functional wellbeing across the lifespan. Our results are discussed the within the context of expanding investigations of functional wellbeing to include a set of predictors which captures both common and unique pathways across age.
RESILIENCE IN JAPANESE OLDER IMMIGRANTS AND ROLES OF COMMUNITY SUPPORT DURING THE COVID-19 PANDEMIC
Authors: Wada Mineko , Canham Sarah 
Published: December 2023

Abstract
The objective of this community-based study was to explore how Japanese older immigrants cultivated resilience in overcoming challenges during the COVID-19 pandemic and how Tonari Gumi, a community service agency, supported the process. As Japanese people make up a small proportion of the population in Canada, there are limited resources to meet their distinct needs. Thus, Japanese older adults were particularly affected by disrupted support and service systems when COVID-19 public health orders were implemented. In this qualitative study, seven community-dwelling Japanese older immigrants and five staff from Tonari Gumi participated in semi-structured interviews. The interviews were analyzed thematically using a conceptual lens of resilience, which refers to the ability to survive and thrive in the face of adverse life experiences. Our analysis yielded three themes: Challenges and concerns; Staying active: physically, mentally, and socially; and Creating needs-based services and programs to survive, connect, and enjoy. The initial challenge experienced by Japanese older immigrants was “a feeling of emptiness,” followed by hardships associated with digital literacy, English literacy, fear of COVID, and concerns about the future. In response to the challenges, Japanese older immigrants stayed active by rebuilding and sustaining regular exercise habits, nurturing and sustaining positive mindsets, and sustaining and expanding social connections. Tonari Gumi developed and delivered a variety of new services and programs to meet the needs of survival, social connection, and fun. We will discuss key actions that older individuals and service providers took on to facilitate resilience and implications for research, policy, and practice.
A MENDELIAN RANDOMIZATION STUDY SUPPORTS CAUSAL EFFECT OF OVERWEIGHT ON LONGEVITY
Authors: Duan Hongzhe , Holmes Rachel , Arbeev Konstantin , Bagley Olivia , Wu Deqing , Yashin Anatoliy , Ukraintseva Svetlana 
Published: December 2023

Abstract
Overweight was associated with better survival in some studies. This was termed “obesity paradox”; however, its mechanism is unclear. Mendelian Randomization (MR) is a common approach to uncovering causality in observational data using SNPs as instrumental variables (IVar). However, only few SNPs usually pass all the required assumptions. Here we use a new strategy of selecting IVar for the MR study of causal relationships between overweight and longevity in the Health and Retirement Study (HRS) data. We paired all SNPs in eight candidate obesity-related genes (ADIPOQ, FTO, LEP, LEPR, INSIG2, MC4R, PCSK1, PPARG) available in HRS, and used such ‘composite SNPs’ as IVar, which resulted in significantly more IVar candidates compared to single SNPs. The following variables were used in MR analysis as “exposure”: (1) ‘overweight’ BMI 25-30 vs. (0) ‘normal’ BMI 18.5-25, at ages 75-85; and “outcome”: (1) survived 85+ vs. (0) died before age 85. Inverse-Variance Weighted (IVW), and maximum likelihood (ML) from R-package MendelianRandomization were used to test causality. We found that being overweight at ages 75-85 had significant protective effect on survival at ages 85+ in both sexes, white males, and black males and females. In conclusion, pairing SNPs is a convenient simple approach to increasing numbers of IVar candidates for MR. Results of our MR study suggest that being overweight in late life causally contributes to longevity. One potential mechanism may involve larger energy reserves contributing to a better resilience of overweight people in face of an adverse health event, such as, e.g., major surgery.
OPIOID PRESCRIBING AND OPIOID USE IN OLDER ADULTS: BUILDING AND REFINING A CHANGE PACKAGE FOR PRIMARY CARE
Authors: Childs Ellen , Noel Megan , Hsu Clarissa , Parchman Michael , Hall Kendall , Shoemaker-Hunt Sarah , Keane Nicole 
Published: December 2023

Abstract
Opioid use is associated with increased risk of harms in older adults (≥65) due to physiologic changes, drug interactions, and comorbidities. The AHRQ Opioids in Older Adults project developed a change package based on an evidence review and expert recommendations that included nine high-leverage changes (HLCs) and related key activities to address safe opioid use in this population. We used the change package to support fourteen primary care practices participating in two fifteen-month learning collaboratives convened to implement innovations in safer opioid use in older adults. Given the nascent understanding of how practices address opioid safety among older adults, this presentation will describe the HLCs implemented by practices compared to the original change package offered to them as a way to validate and improve the change package for broad use and uptake. Of the original nine HLCs, practices implemented seven, including staff education, risk assessment, opioid use disorder assessment and treatment, processes and workflows, non-pharmacologic pain management, medication management, and using data to inform practice. All activities fit into an original HLC, however the activities that practices implemented varied from the original key activities identified by the literature review and expert panel. For example, under the using data to inform practice HLC, most practices struggled to complete chart reviews, and were unable to “review data regularly” as offered in the original change package. This presentation will describe strategies used to improve opioid safety for older adults in primary care.
DECLINE IN OBJECTIVELY MEASURED STATIC BALANCE WITH AGING
Authors: Banarjee Chitra , Choudhury Renoa , Park Joon-Hyuk , Xie Rui , Stout Jeffrey , Thiamwong Ladda 
Published: December 2023

Abstract
Balance performance is a key predictor of falls, contributing to an increased risk of chronic disease and future falls in older adults. In this study, we aimed to characterize the effects of age, gender, and body mass index (BMI) on changes in balance over time. BTrackS, a portable and inexpensive technology system, was utilized to objectively measure the changes in static balance with eyes closed. We assessed 70 community-dwelling older adults (Mage=74.8 years, 77% female, MBMI=26.95 kg/m2) over 2-4 longitudinal observations, with an average of 174 days between baseline and follow-up assessments to characterize the balance performance over time. The balance performance measure was computed as the average center of pressure (COP) path length (cm) across three testing trials. The balance performance measure at baseline significantly positively correlated with age (Pearson’s r=0.417, p&lt; 0.001) and with BMI (r=0.264, p=0.029), but did not differ by gender (p=0.480). Change in balance (difference in static balance over time, cm) was correlated (r=0.393, p&lt; 0.001) with age, such that older adults experienced a greater decline in static balance over time, however, gender (p=0.620) and BMI (p=0.709) did not show a significant correlation. Older adults with increased BMI were found to be more likely to have limitations in balance. These results suggest that clinicians and researchers need to account for the age-related effects on changes in balance performance over time. Rapid deterioration of balance with increased age also has implications for increased monitoring of balance function and further intervention in older adults as they age.
“BEYOND JUST A SINGING GROUP”: PERCEPTIONS OF PARTICIPANTS, CAREGIVERS, AND LEADERS OF PARKINSON’S SINGING GROUPS
Authors: Brown Jessy , Logue Cailie , Bartel Maya , Jordan Tera , Stegemoller Elizabeth 
Published: December 2023

Abstract
Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease after Alzheimer’s disease, and its prevalence is increasing. There is no cure, so symptom treatment is currently the only method to decrease the disease burden for individuals diagnosed with PD. A common treatment modality option that has been shown to improve both motor and non-motor symptoms in PD is therapeutic singing, often in a group setting. Previous literature has explored perceptions of singing groups for persons with PD (PwPD) and their caregivers (CGs) and has found overall positive experiences and outcomes. No study has sought to understand the perspectives of the leaders of the singing groups. The purpose of this study was to understand the perceptions and experiences of participants in singing groups (n=31), their caregivers (n=8), and those leading the groups (n=10) across several different singing groups in the United States. A qualitative phenomenological methodological framework was used with principles of grounded theory to make meaning from the transcripts. Three main themes emerged from the data: peer support, proactive PD management, and the effects of the pandemic. These findings indicate that even during a global pandemic, all three participant groups experienced positive outcomes resulting from peer support and either experiencing or witnessing effective management of PD symptoms. All three participant groups reported similar perceptions and experiences about their involvement which reinforces the rationale to use singing as a treatment modality for PD.
INFLAMMATORY BIOMARKERS ASSOCIATED WITH BRAIN MRI MEASURES: FRAMINGHAM HEART STUDY OFFSPRING COHORT
Authors: Chen Jiachen , Doyle Margaret , Fang Yuan , Ragab Ahmed A Y , Murabito Joanne , Lunetta Kathryn 
Published: December 2023

Abstract
Brain MRI volumes measuring brain atrophy have been associated with risks for Alzheimer’s Disease (AD) and related dementia. Inflammatory biomarkers associated with brain MRI volumes may provide insight into the neuroinflammation associated with these diseases. The study aim is to identify circulating inflammatory biomarkers associated with total and regional brain MRI volumes in the Framingham Heart Study Offspring cohort. Participants (N=662, 52% female, mean age 62 years) free of dementia and stroke at the time of blood draw and who had MRI measures within five years were profiled using the OLINK Proteomics inflammation panel. Pairwise cross-sectional associations between 68 biomarkers and eight brain MRI volumes were investigated using linear mixed-effect models accommodating familial correlations and adjusting for covariates (age, age2, sex, time between blood draw and MRI measurement, age-sex interaction, and number of APOE ε2 and ε4 alleles), using FDR≤0.1 to declare significance. APOE genotype-stratified analyses were performed to explore effect modification. Higher levels of 8 proteins were significantly associated with smaller total brain volumes (TCBV), including CDCP1, HGF, IL6, IL8, MMP10, OPG, VEGFA, and 4E-BP1. Higher levels of SCF and TWEAK were significantly associated with larger TCBV, and higher levels of SCF were also associated with larger parietal gray matter volume. In APOE ε4 carriers, higher levels of IFNγ were associated with greater white matter hyperintensity volumes. Consistent with our findings, SCF has been shown to have neuroprotective effects in animal models. Further studies are needed to confirm these potential risk and protective factors and to elucidate mechanisms.
IMPLEMENTING AGE-FRIENDLY HEALTH SYSTEMS: SCALING 4MS CARE ACROSS VA
Authors: Solberg Laurence , Jindal Shivani , Church Kimberly , Schwartz Andrea 
Published: December 2023

Abstract
The U.S. Department of Veterans Affairs (VA) provides health care to 9 million enrolled Veterans across a variety of settings. Nearly 50% of enrolled Veterans are age 65 and older, compared to 16% of the U.S. population. The VA has set out to become the largest integrated Age-Friendly Health System (AFHS), using the 4Ms as a framework to improve care for older adults: what Matters, Medication, Mentation and Mobility. When implemented together, the 4Ms allow interprofessional teams and health systems to provide care consistent with what Matters to each older adult. Since joining AFHS movement in 2020, over 190 care settings at 100 VA facilities have earned recognition from the Institute for Healthcare Improvement (IHI). VA has identified key drivers to scale-up and spread 4Ms care at the national, local, and team level. Drivers include active and visible national leadership, building a coalition of local champions, and regular commmunication with teams. VA has accelerated adoption of the 4Ms by following IHI’s Action Community (AC) model. At close of registration, 145 teams from 69 VA facilities enrolled in the VA AC. The VA AC offered a series of monthly webinars and coaching calls to empower teams to create a 4Ms plan building on exisiting best practices. In addition to using evidence-based tools identified by IHI, teams may also leverage VA clinical innovations to support their 4Ms plan. Implementation of AFHS provides a framework for interdisciplinary teams to continuously improve Veteran-centered care and ultimately, fulfill VA’s mission to honor America’s aging Veterans.
IDENTIFYING SENOLYTIC TARGETS OF DIETARY FLAVONOIDS IN RENAL CELLS BY THERMAL PROTEOME PROFILING
Authors: Strassheim Quinn , Banarjee Reema , Rutherford Delaney , Dey Amit , Tsitsipatis Dimitrios , Moaddel Ruin , Gorospe Myriam , Basisty Nathan 
Published: December 2023

Abstract
Senescent cell accumulation is a known driver of aging and age-related pathologies. Clearance of senescent cells is a promising approach to increase longevity and reduce multiple age-related diseases in humans. Flavonoid compounds are present in fruits and vegetables, of which certain flavonoids (e.g., quercetin and fisetin) have demonstrated senolytic, or ‘senescent-cell-killing’, activity in culture and in mice. However, the cellular mechanism of senolysis and the efficacy of these compounds are not known in renal epithelial cells. Here, we combine flavonoid drug screening, targeted metabolomics, and thermal proteome profiling (TPP) with analysis by mass spectrometry (MS) to explore protein targets of senolytic drugs in senescent human renal cortical epithelial cells and human renal proximal tubular epithelial cells. Senescence was induced by exposure to ionizing radiation and the senescence phenotype was validated through a rigorous panel of senescence and viability markers. Proliferating and senescent renal epithelial cells were screened with a panel of 8 flavonoids to identify senolytic drugs and their concentrations for selectively killing senescent cells. Targeted MS assays were developed to assess intracellular drug uptake, a potential mechanism of senescent-specific killing. To identify protein targets of the senolytic flavonoids in senescent cells, we performed a variation of TPP in combination with liquid chromatography (LC)-MS/MS proteomics analysis, carefully controlling for non-senolytic interactions by excluding proteins bound by a non-senolytic flavonoid. The results of this study pave the way for the development of a more specific generation of senolytic compounds and identify novel candidate senolytic pathways engaged by dietary flavonoids.
INCONSISTENT AND UNPREPARED: HOW FAMILY CAREGIVERS AND OLDER ADULTS EXPERIENCE HOSPITAL DISCHARGE
Authors: Gale Kathy , Ruffalo Leslie , Kavanaugh Melinda 
Published: December 2023

Abstract
Family caregivers and older adult patients report confusion, inconsistency, and a lack of preparation for post-discharge activities after a hospital stay, leading to hospital readmissions. This multi-disciplinary research project investigated how family caregivers, older adult patients, and hospital clinical and administrative staff experienced the hospital discharge process at a midwestern hospital system. The research team brought together expertise in community-engaged research and bridged multiple specializations, including personal family caregiver experience, community service expertise, community engaged research leadership, and instruction of medical students and social work students. Together, we conducted semi-structured interviews with family caregiver, older adult patients, and hospital personnel via video conference and telephone. We analyzed the data using open coding strategies and principles of thematic analysis. Themes included the importance of the timing of discharge planning, communication between all systems and individuals included in the discharge process, a lack of clarity regarding the roles in the process, inconsistent identification of the family caregiver, conflicting priorities, and the impact of medication errors. Implications are (1) each organization within the older adult/family caregiver system must determine their role in the post discharge process including the type of services and resources that support older adults and family caregivers and (2) the current system of healthcare, public sector, and community must determine how to adapt and change to support older adults and their family caregivers during the post-discharge period.
TRENDS IN FRAILTY INCIDENCE AND THE IMPACT OF LIFESTYLE AMONG US ADULTS AGED ≥50 YEARS FROM 2004 TO 2020
Authors: Xu Hui-wen , Chen Yu-Ming , Yang Zhou , Xu Bei-bei 
Published: December 2023

Abstract
Few studies have estimated frailty incidence. The contribution of lifestyle to the incidence of frailty may change over time. It is necessary to quantify the impact of lifestyle on frailty incidence over time. A total of 25,639 subjects aged ≥50 years from the Health and Retirement Study (HRS) 2004-2020 were divided into seven consecutive and overlapping cohorts. Frailty was measured using the Paulson–Lichtenberg Frailty Index. Lifestyle included smoking status, alcohol consumption, physical activity, and sleep problems. The trend of frailty incidence rates was estimated by generalized estimating equation (GEE) models with a natural cubic spline. Population attributable fractions (PAFs) were calculated using hazard ratios from Cox models. Lifestyle-attributable frailty incidence rates were estimated by multiplying PAFs by the overall incidence rate of frailty. The incidence (per 1,000 person-years) of frailty showed a general trend of first decreasing and then increasing, with a peak occurrence of 22.7 (95% CI: 21.0, 24.5) in 2010–2014. Almost 20% of frailty incidence rates were attributed to current smoking, physical inactivity, or sleep problems. The incidence of frailty showed a fluctuating but decreasing trend among middle-aged and older adults in the United States from 2004 to 2020, with a peak occurrence after the Great Recession of 2007–2009. Smoking, physical inactivity, and sleep problems may have contributed importantly to the incidence of frailty. Effective and early frailty prevention strategies should be developed to reduce smoking, physical inactivity, and sleep problems, especially in the context of the global economic crisis caused by the COVID-19 epidemic.