bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPROVING THE VALUE OF SERIOUS ILLNESS CARE
Authors: Kaufman Brystana 
Published: December 2023

Abstract
My Health and Aging Policy Fellowship placement with CMMI provides an opportunity to learn about the current policies impacting palliative care payment and process for developing new models. Palliative and hospice care has been one of the fasting growing health services in the U.S. and the VA over the past decade. Although Medicare’s hospice benefit requires a 6-months life expectancy, palliative care may be appropriate for seriously ill individuals depending on their clinical and psychosocial needs. Palliative care is an interdisciplinary, team-based approach that focuses on improving quality of life, aligning care with patient preferences, and relieving distressing symptoms for people with serious, life-limiting illness and their families. In practice, palliative consultations, teams and services are highly tailored to each patient and family’s needs. The heterogeneity of patient needs, care settings and services creates challenges designing value-based payment strategies. I am working on a team that will assess the feasibility of a value-based strategy for supporting seriously ill beneficiaries’ palliative care needs. Current learnings include 1) understanding the CMMI priorities as identified in their strategy refresh in 2021; 2) mapping the design elements that are relevant for palliative care across Medicare Advantage and Traditional Medicare Alternative Payment Models; 3) synthesizing evidence and leveraging my research experience evaluating value-based payment models and outcomes for high cost, high need populations in Medicare and the VA. In addition to key learnings specific to my placement, I will share how the HAP fellowship experience has impacted my research career and opportunities for the future.
ADDRESSING THE NEEDS OF AFRICAN AMERICAN BEREAVED DEMENTIA CAREGIVERS
Authors: Baker Zachary , Supiano Katherine 
Published: December 2023

Abstract
Within the next 10 years there will be at least 9 million NEWLY Bereaved Dementia Caregivers, disproportionately affecting African American families due, in part, to dementia prevalence that is twice that of White counterparts. Up to 26% of Bereaved Dementia Caregivers experience pathologically prolonged or exacerbated grief, often referred to as complicated grief or prolonged grief disorder: 2.5x the rate of other chronic disease care contexts, like cancer. The present project used an asset-based approach to assess the needs and resources of African American Bereaved Dementia Caregivers. This project was conducted with community members and university members serving as Co-Principal Investigators. Community PIs lead a grassroots organization that has served Bereaved Dementia Caregivers since 2016. The University PI leads a research team devoted to understanding and improving the experience of Bereaved Dementia Caregivers. The present symposium will discuss the challenges and opportunities offered by this unique collaboration and insights gleaned by a project designed to serve doubly underrepresented groups: African American Bereaved Dementia Caregivers (who sometimes call themselves the “ultra-invisible”). Because this was a project funded through grant dollars, we will also discuss actionable insights that we hope may help others develop fruitful academic-community partnerships. Finally, we will share recruitment strategies for speaking with minoritized populations and insights from engaging gleaned through conversations with African American Bereaved Dementia Caregivers.
CANNABIS USE IN OLDER ADULTS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Authors: Bhagianadh Divya 
Published: December 2023

Abstract
Cannabis use among persons over 50 years old has tripled since 2000. Some studies have found negative outcomes associated with increasing use of cannabis use among older adults such as higher rates of injury and emergency department use. Other studies have shown improvements in pain, sleep and other outcomes such as self-reported health and labor force participation. In this study, we identify individual determinants and outcomes related to cannabis use among adults aged 50+ sourcing data from the 2018 cannabis module of the Health Retirement Survey and constructing a longitudinal panel by linking this data with the respondents’ 2016 and 2020 data. Among the 1,372 respondents, 10% reported past year use. Among these past year users, 35% were persistent, lifelong users and nearly 25% used solely for medical purposes. Multivariate logistic regression controlling for demographics, health and functional status and individual fixed effects showed that those who reported pain in the last wave had higher odds of reporting cannabis use (OR 1.70, p-value-0.03). Troubled sleep was associated with higher odds of cannabis use (significant at 10%). We did not see any effect of cannabis use on pain in later years or subsequent healthcare utilization (hospital or doctor visits). Our results reflect a nationally representative survey of cannabis use among aging Americans and affirms how motives and outcomes of cannabis use are age sensitive.
CATALYZING NOVEL METHODS OF MEASURING COGNITION BY HARNESSING TECHNOLOGY
Authors: Andersen Stacy , Boot Walter 
Published: December 2023

Abstract
Early detection of cognitive impairment is essential for enabling access to clinical assessments and treatments and facilitating participation in clinical trials for Alzheimer’s disease. By employing smartphones and digital technologies to capture cognitive behaviors with high precision we may be able to detect novel, subtle biomarkers of cognitive impairment during clinic-based assessments, in-home self-administered tasks, and daily activities. In this Collaborative Symposium from the Alzheimer’s Disease and Related Dementias and Technology and Aging Interest Groups, we will explore the development of technologies to detect cognitive impairment and discuss the feasibility of obtaining these data in non-traditional settings. The first presentation reports on the use of eye-tracking technology to detect cognitive impairment with high accuracy. The second presentation discusses acoustic features from digital voice recordings of a cognitive screener that are associated with cognitive impairment and increase the screener’s specificity. The next presentation describes linguistic features from voice recordings of a memory test that are associated with depression and distinct from those associated with cognitive impairment. The fourth presentation introduces a smartphone application that measures hand grip strength, a known correlate of dementia risk. The symposium concludes with a summary of older adults’ attitudes toward wearable technologies to detect cognitive decline and the development of a smart reminder system to promote adherence to home-based assessment. Overall, these presentations highlight ways we can harness technology to capture unique features of cognitive function that increase the accuracy of traditional testing or detect cognitive impairment in novel settings. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias and Technology and Aging Interest Groups.
COMPARISON OF LONELINESS AND SOCIAL NETWORK BETWEEN OLDER ADULT CAREGIVERS AND NONCAREGIVERS
Authors: Yong Ting , Visaria Abhijit , Malhotra Rahul 
Published: December 2023

Abstract
In ageing societies, more older adults are taking up informal caregiving roles. Caregivers, compared to non-caregivers, are found to have poorer psychosocial outcomes such as loneliness and social isolation in various studies. However, most of this research is not specific to older adult caregivers and does not account for selection bias into caregiving. We compare loneliness and social network between older adult caregivers and older adult non-caregivers in Singapore, applying inverse probability weighted regression adjustment (IPWRA), to address selection bias into caregiving, on data from a nationally representative longitudinal study of older adults. Those providing unpaid assistance to any person because of their health condition were considered as caregivers. Loneliness (score: 0-12; higher score=lonelier) and social network (0-60; higher score=greater network) were measured using validated scales. The relationship of caregiving status with loneliness and social network was estimated using IPWRA, controlling for multiple demographic and health characteristics. Of the 2639 respondents, 7.2% were caregivers. Older adult caregivers, versus non-caregivers, were more likely to experience loneliness (average treatment effect [ATE] β-coefficient for loneliness score: 0.328 (95% confidence interval: 0.011-0.645; p-value: 0.042); and odds ratio for being lonely: 1.080 (1.001-1.165); p-value: 0.047). However, they did not differ in terms of their social network (ATE β-coefficient for social network score: 1.456 (-0.405-3.316); p-value: 0.125). Our findings suggest that even with a similar extent of social network, older adult caregivers are at a higher risk of loneliness, i.e., perceived social isolation or relational deficits, compared to non-caregivers.
THE ADULT DAY CENTER: UNTAPPED TERRITORY FOR AGING RESEARCH
Authors: Sadarangani Tina , Sun Fei 
Published: December 2023

Abstract
Adult day service centers (ADCs) in the United States are a vital, but overlooked source of community-based long-term care for diverse older adults with multiple chronic conditions, including dementia. The National Institute on Aging has called for more research on ADCs. In this interdisciplinary symposium, we present challenges and opportunities in conducting research in these congregate settings. First, we look at the operating status of ADCs nationally in the aftermath of the COVID-19 pandemic and disparities in access to care using longitudinal data from the National Post-acute and Long-term Care Study. Then we examine the lack of electronic health record utilization and clinical data capture in 4,035 ADCs nationally and discuss strategies to modernize technology in these settings to facilitate data collection. We subsequently present a new database, developed vis a vis an academic/community partnership between the National Adult Day Services Association and researchers, that centralizes and makes data collection feasible in ADCs with limited resources. We will also explore factors supporting intervention research that are unique to ADCs. Finally, we present a protocol adapted for the ADC setting, to test a mobile application that facilitates data collection and enables communication between ADCs, caregivers, and healthcare providers. Our findings show that, while research in ADCs has been limited historically, academic, government, and community partners are working together to spur pragmatic innovations that modernize these settings and better resource them to elevate standards of care.
UNDERSTANDING EVERYDAY NEEDS OF OLDER ADULTS WITH MACULAR DEGENERATION OR GLAUCOMA
Authors: Mumma Kara , Remillard Elena , Umar Tooba , Bhookya Divya , Rogers Wendy 
Published: December 2023

Abstract
Older adults with long-term vision loss may experience challenges in their everyday activities. Different types of vision loss may cause different problems. For example, macular degeneration leads to a loss of foveal vision whereas glaucoma leads to peripheral vision loss. As part of the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study, we are using a mixed-methods approach to explore the unmet needs of older adults with these two conditions to provide guidance for interventions. We will present insights from 51 older adults (mean age = 69, SD = 5.5) who have had serious difficulty seeing for an average of 42 years (SD = 24.3) due to either glaucoma (n = 28), macular degeneration (n= 19), or both conditions (n = 4). We will present participants’ difficulty ratings for a wide range of everyday activities as well as initial themes and illustrative quotes from interview data on challenges and response strategies for their most difficult activities (e.g., shopping, traveling for leisure, dressing). For example, it can be difficult to navigate through a crowded store and read details on labels when shopping. Additionally, flying was described as frustrating and stressful because airports can be unfamiliar and require arrangements (e.g., transportation to/from, guidance to the gate). Moreover, when getting dressed, participants said that they rely on touch to differentiate between clothes; however, color coordination and matching can be very difficult. Data provide insights on unmet needs among people aging with vision loss and illuminate opportunities for technology innovation.
LIFETIME REVICTIMIZATION: EVIDENCE FROM THE WISCONSIN LONGITUDINAL STUDY
Authors: Kong Jooyoung , Easton Scott , Fletcher Jason 
Published: December 2023

Abstract
Research has documented the increasing prevalence of elder abuse victimization and its devastating impact on the health and well-being of older adults. However, a life-course view of the victimization experiences of older adults has rarely been adopted in the elder abuse literature. The current study examined lifetime links between victimization experiences that span childhood, adulthood, and older adulthood. Specifically, we examined: a) the mediating effect of adverse childhood experiences (ACE) on elder abuse victimization via intimate partner violence (IPV) victimization in middle adulthood, and b) whether this indirect association differs by gender. Data were obtained from the Wisconsin Longitudinal Study (WLS). We analyzed the previous and current victimization experiences of a total of 5,391 older adults in their early 70s and estimated the mediational and moderated mediation models. The key results indicated that a higher ACE score was associated with exposure to IPV victimization in middle adulthood, which was in turn associated with exposure to elder abuse victimization. This indirect association was stronger for women than for men. Regarding specific types of childhood victimization, parental physical abuse, sexual abuse, and witnessing domestic violence significantly predicted elder abuse victimization via IPV. Our results support the phenomenon of lifetime victimization, whereby an individual experiences reoccurring forms of victimization across the life span from childhood to late adulthood. Findings highlight the compelling need for the assessment of cumulative victimization experiences and their impact on elder abuse victims. A life course-based, trauma-informed approach would greatly enhance prevention and intervention services for elder abuse.
AN INTERGENERATIONAL TRAINING PROGRAM TO SUPPORT LATINE ELDERS: LESSONS LEARNED
Authors: Cotton Quinton , Kissell Paul , Johnson Elma , Chambers Yolima , Nkimbeng Manka , Gaugler Joseph 
Published: December 2023

Abstract
Cultural adaptation and tailoring of caregiving interventions has garnered greater attention in part due to high levels of unmet need and poor intervention outcomes among dementia caregivers from racial and cultural groups. Additionally, there is a growing interest in understanding intervention mechanisms. We conducted a formative analysis of the process employed in the design of an intergenerational training program to support elders within the Latine community. A content analysis of memos and stakeholder listening sessions and document review guided this analysis. Framed within a discussion on the continuum of cultural adaptation, we report on lessons learned. Lessons include: 1) embracing community-led design, 2) demonstration of partnership commitment to facilitate trust-building, 3) consistent appreciative inquiry, and 4) demonstration of cultural centeredness within the partnership.
TRAJECTORIES OF FORMAL SOCIAL PARTICIPATION, GENDER, AND END-OF-LIFE CARE QUALITY AMONG OLDER AMERICANS
Authors: Mahmoud Kafayat , Onge Jarron Saint , Ekerdt David 
Published: December 2023

Abstract
Limited research has examined the association between formal social participation trajectories and end-of-life care quality. The end of life could be characterized by experiences of heightened feelings of physical and psychological distress, breathlessness, constant hospitalization, and intrusive interventions. Formal social participation may improve the end-of-life care of older adults because they serve as sources of useful information, receipt of emotional support, and improve self-efficacy. This research examines the associations between formal social participation trajectories and proxy ratings of overall end-of-life care quality, and the moderating role of gender. Growth-based trajectory models were used to identify distinct developmental trajectories of formal social participation among older adults in the United States. Findings revealed four social participation trajectory classes among older adults towards the end of life, all with a general tendency to decline across time. Multinomial logistic regression analyses showed that although older adults with higher levels of formal social participation have more positive overall end-of-life care ratings, there are gender differences in these care ratings. Women are less likely than men to chart, by proxy report, positive care ratings at the end of life even though they have higher levels of formal social participation, and these gender differences in end-of-life care rating are explained more by healthcare factors than formal social participation trajectories. These results suggest that both formal social participation and positive interactions with health care at the end of life are more beneficial for older men than women.
STRESS AND DEATH: GLUCOCORTICOIDS AND SURVIVAL IN A WILD PRIMATE MODEL OF AGING
Authors: Campos Fernando 
Published: December 2023

Abstract
Chronic exposure to stressors has been linked with a wide range of detrimental effects on health in humans, laboratory animals, and a few wild animal populations. Glucocorticoids (GCs) mediate stress responses, and consequently GC levels are regularly measured in humans and other animals as biological markers of stress. However, no tests in humans or in natural populations of animals have yet established clear connections between environmental stressors, chronically elevated GCs, and shortened lifespan. To fill this gap, we used longitudinal data on wild female baboons to investigate the relationship between GC levels and survival—the single greatest determinant of variation in evolutionary fitness among female baboons. Using 14,173 GC measurements from 242 wild adult female baboons over 1634 female years, we document a powerful link between GCs and survival: females with relatively high current GCs or high lifelong cumulative GCs face an elevated risk of death. A hypothetical female who maintained GCs in the top 90% for her age across adulthood would be expected to lose 5.4 years of life relative to a female who maintained GCs in the bottom 10% for her age. Hence, differences among individuals in HPA axis activity provide valuable prognostic information about disparities in lifespan. Together, our results both support the value of GCs as a window into health, fitness, and aging and suggest that they may mechanistically contribute to the established link between sociality and lifespan.
AGEISM EXPERIENCED AND EXPRESSED: MANIFESTATIONS ACROSS CONTEXTS AND TRANSGRESSORS
Authors: Chasteen Alison 
Published: December 2023

Abstract
Ageism was first defined more than fifty years ago, yet its expressions and effects on society continue today. In this symposium, we examine manifestations of ageism across contexts and transgressors in order to determine the effects of ageism in light of a pandemic as well as a post-pandemic world. Important social contexts in which ageism plays a part are examined, such as the workplace and COVID-19 vaccination. As well, efforts to reduce ageism through confrontation are investigated, particularly with respect to reactions to ageist behavior. Providing a window into ageist communication during the pandemic, Bascu and colleagues detail how ageism was expressed in social media regarding policies for COVID-19 vaccination. Delving into the factors that drive older workers’ decisions to remain or to leave an organization, both Lagacé et al and Swift investigate the role that perceived ageism plays. Lagacé and colleagues assess how older workers’ perceptions of being the target of ageism impacts their well-being, their psychological disengagement, and their intentions to leave their organization. Swift considers how experiences of ageism in the workplace predict older workers’ retirement intentions through reduced job satisfaction and lowered intrinsic motivation to work. Chasteen et al. test the impact of confronting ageism on perceptions of transgressors as well as how perceivers use characteristics of an older adult target as a normative cue for determining their reactions to ageist behavior. Taken together, these presentations illustrate the influence of ageism on vital life domains such as healthcare and the labor force.
ADMISSIONS AND DISCHARGE PRACTICES IN ASSISTED LIVING: THE ROLE OF REGULATORY AND ORGANIZATIONAL CHARACTERISTICS
Authors: Hua Cassandra , Smith Lindsey , Zimmerman Sheryl , Gadkari Gauri , Slolane Philip , Carder Paula , Wretman Christopher , Thomas Kali 
Published: December 2023

Abstract
This study examined how state regulations and AL organizational characteristics relate to admissions and discharge practices. Using data from a representative sample of 250 AL communities in 7 states and a database of AL regulations, we employed bivariate analysis and multilevel linear probability models to examine regulatory and organizational correlates of AL community admissions and discharge practices for three activities of daily living (ADLs [bathing, getting out of bed, and eating]). There was a pattern between admissions regulation and admissions practices in AL; for example, 38% of communities with license types that had the most flexible admissions regulations allowed residents with feeding limitations to be admitted; conversely, 18% with the least flexible regulations allowed them to be admitted. However, the relationships were not statistically significant in bivariate or multivariate analysis. A higher percent of residents with Medicaid as a primary payer source was associated with a decrease in the probability of admitting (𝛽 = -0.01, p&lt;.001, 95% confidence intervals [CI]: -0.01, 0.00) and discharging (𝛽 = 0.01, p=.013, 95% CI: 0.00, 0.01) residents with bathing limitations. Being operated in association with a continuing care retirement community or nursing home was associated with a higher probability of discharging residents who needed assistance with bathing (𝛽 = 0.14, p=.013, 95% CI: 0.03, 0.26) and more so with feeding (𝛽 = 0.26, p &lt;.001, 95% CI: 0.15, 0.36). Findings suggest a need to consider whether models of AL and AL practices could better align with the residents’ needs.