bluuebunny/crossref_metadata_2025_split huggingface dataset:
ALCOHOL CONSUMPTION AND ABUSIVE/NEGLECTFUL BEHAVIORS AMONG FAMILY CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA
Authors: Chilatra Jessica Hernandez , Browning Wesley , Yildiz Mustafa , Winstead Vicki , Pickering Carolyn 
Published: December 2023

Abstract
Despite its suspected role in elder abuse and neglect (EAN), little is known about alcohol use disorders (AUD) among family caregivers of people with Alzheimer’s disease and related dementia (ADRD). As part of a micro-longitudinal study in which caregivers completed 21 daily surveys about their caregiving experiences, we examined the effects of daily drinking behaviors and screening positive for hazardous drinking (based on the Alcohol Use Disorder Identification Test (AUDIT-C)) on the daily risk of EAN. A generalized linear mixed model with days (n = 9513) nested within caregivers (N=453) was used to evaluate the relationships between caregivers’ alcohol consumption patterns and the odds of using an abusive and/or neglectful behavior. Caregivers’ alcohol consumption on a given day increases the odds of using physical abuse (OR=2.19; 95% CI=1.12–4.28; p=.022), psychological abuse (OR=1.40; 95% CI=1.01–1.94; p=.041) and neglect (OR=1.48; 95% CI=1.17–1.86; p=.001) that same day. Screening positive for AUD significantly increases the odds of a caregiver’s use of neglect on a given day (OR=2.43, 95% CI=1.52–3.88, p=&lt;.001), but not physical or psychological abuse. There were no interaction effects between AUD and daily drinking, meaning AUD increases the risk of neglect independent of daily drinking behavior. Interventions to manage AUD may reduce the risk of neglect among ADRD caregivers experiencing hazardous drinking. Interventions focused on daily drinking behaviors are needed to reduce the general risk of EAN among ADRD caregivers. Findings show that subpopulations exist within ADRD caregivers who engage in EAN behaviors that would benefit from different targeted interventions.
BUILDING BRIDGES AND CATALYZING RESEARCH FOR EVIDENCE-BASED INFECTION CONTROL: PROJECT ECHO FOR NURSING HOMES
Authors: Behrens Liza , Heilbrunn Emily , Boltz Marie 
Published: December 2023

Abstract
Nursing homes were ill-equipped for the pandemic; though facilities are required to have infection control staff, only 3% have taken a basic infection control course. Significant research has focused on infection control in the acute care setting; however, little is known about the implementation of infection control practices in long-term care communities. In this symposium, we will describe findings from the Project ECHO for Nursing Homes- a national, Patient-Centered Outcomes Research Institute (PCORI) funded study. First, Dr. Kraschnewski will present over all study findings from the stratified, cluster randomized controlled trial of 136 nursing homes that participated in up to 33 weeks of best-practice training to improve COVID-19 infection control practices. Next, Dr. Calo will present on implementation outcomes at 6-months including readiness for change and the implementation climate in the NH. Next, Ms. Heilbrunn will discuss the impacts of implementing evidence-based infection control practices through COVID-19 on NH residents’ well-being. Finally, Dr. Behrens will describe NH leadership perspectives (n=14) on preparing and maintaining care quality during times of diminishing resources. Data presented in this symposium can guide NHs in strategies to implement evidence-based infection control in their homes and informs researchers who are looking to implement similar implementation studies in the NH setting.
SLEEP REGULARITY, SLEEP TIMING, AND COGNITIVE PERFORMANCE AMONG WOMEN ENTERING EARLY OLDER AGE
Authors: Derby Carol , Hood Michelle , Hall Martica , Joffe Hadine , Thurston Rebecca , Kravitz Howard , Swanson Leslie 
Published: December 2023

Abstract
Poor sleep health is a modifiable behavior linked to cognitive impairment risk. While prior work has focused primarily on sleep quantity and quality, emerging evidence suggests the importance of sleep timing and regularity. We examined whether sleep timing and regularity were associated with cognitive performance within a diverse cohort of women ages 60.5-72.2 years, and tested whether associations were independent of sleep duration and quality (wake after sleep onset). The sample included 1178 SWAN women who completed 4-7 nights of actigraphy and cognitive testing at the 15th SWAN follow-up in 2015-2016, [Mean age 65.5 (± 2.63 years); 25% Black, 12% Chinese, 6% Hispanic White, 11% Japanese, 46% Non-Hispanic White]. Sleep timing was defined as the midpoint time between sleep onset and waking, averaged across nights and was dichotomized as healthy (2am – 4am) or unhealthy (outside 2am – 4am). Sleep regularity was defined as the standard deviation of the sleep midpoint across nights. Associations of sleep regularity and timing with verbal episodic memory (East Boston Memory immediate (EBMT-I) and delayed (EBMT-D)), and processing speed (Symbol Digit Modalities) were examined using linear regression. Covariates included sleep duration and quality, age, race/ethnicity, education, economic hardship, depression, comorbidities, medications, alcohol use, vasomotor symptoms and testing language. Greater sleep irregularity was associated with worse verbal memory (EBMT-I β= -0.29; p=0.02; EBMT-D β= -0.36; p=0.007). Sleep midpoint outside the healthy range was associated with slower processing speed (β= -1.48; p=0.017). Sleep timing and regularity may be important targets for interventions aimed at preserving cognitive health.
ACCESSING AND UTILIZING SWAN DATA AND BIOSPECIMENS FOR NEW RESEARCH QUESTIONS
Authors: El Khoudary Samar , Santoro Nanette , Harlow Sioban , Colvin Alicia , Avis Nancy , Karvonen-Gutierrez Carrie , Brooks Maria 
Published: December 2023

Abstract
Sharing scientific resources is a critical component of contemporary research. Data and specimens from established studies can be used for manuscripts on special topics and research projects from experienced investigators and advanced trainees. Researchers external to a study, however, may find it challenging to identify available resources and to determine the steps required to access them. This presentation will describe the SWAN datasets, specimens and documents that are housed at the NIA Aging Research Biobank. It will review the process for requesting the archived resources, provide tips for successful applications, and explain the data and/or material transfer agreements created for research projects. The SWAN longitudinal cohort study aims to understand variations in the experience of reproductive aging and its impact on midlife and early old age outcomes across multiple racial and ethnic groups. SWAN includes 3302 women aged 42-54 years from 7 sites in the United States and consists of a baseline and 17 follow-up visits. The study has repeated measures of reproductive hormones, menopausal symptoms, sleep, genitourinary and sexual function, physical and cognitive function, cardiometabolic and bone health, psychological well-being and quality of life. Serum, plasma, and urine specimens were collected at each clinic visit, and a substudy obtained daily urine for ≤50 days annually for ≤10 years. An expansive collection of SWAN biospecimens and datasets are available to external investigators and trainees. Understanding the existing resources and processes required to access them provides researchers the opportunity to use these valuable resources to advance academic research.
CONTEXTUAL FACTORS IN AGING AND LONG-TERM SERVICES AND SUPPORTS RESEARCH
Authors: Fabius Chanee , Ornstein Katherine 
Published: December 2023

Abstract
In the coming years, there will be more older Americans living in the community with extensive medical and long-term care needs increasing the need for long-term services and supports (LTSS) that assist with routine daily activities (e.g., bathing, dressing, medication management). Increasingly research studies are examining factors associated with receipt of LTSS including care preference, family availability and financial resources. Yet LTSS care experiences are likely a result of factors that extend beyond personal preference or individual factors, such as neighborhood quality. availability of home care workers, and state policy characteristics (e.g., state Medicaid generosity). Little research to date has examined how the LTSS environmental context affects the health and well-being of older adults with disabilities and their caregivers. In order to improve LTSS research we need to expand analyses to consider relevant contextual factors. This symposium will feature five presentations that provide novel insight regarding social and physical contextual factors contributing to LTSS using multiple data sources. We will describe (1) a conceptual framework of LTSS-relevant environmental domains and associations between select LTSS-relevant characteristics and older adult care experiences, (2) the relationship between neighborhood deprivation and place of death, (3) care experiences of older Medicare-Medicaid enrollees living in counties with Medicaid Managed Long-Term Services and Supports, (4) trends in paid home care employment and state public financing, and (5) associations between adverse consequences due to unmet, LTSS use, and social isolation.
ASSOCIATION BETWEEN NEIGHBORHOOD DEPRIVATION AND PLACE OF DEATH: A POPULATION STUDY
Authors: Mather Harriet 
Published: December 2023

Abstract
While recent decades have witnessed an overall trend away from deaths in hospitals and facilities and towards deaths at home, socioeconomic disparities persist. Minoritized individuals while less likely to die in a nursing facility are more likely to die in hospital and (except for dementia) less likely to die at home; more educated individuals are also less likely to die in a nursing facility but conversely less likely to die in hospital and more likely to die at home. Despite growing interest in the role of neighborhood-level factors in health disparities, no studies have examined the impact of neighborhood deprivation on place of death. Using a representative sample of Medicare beneficiaries (n = 3043) drawn from the National Health and Aging Trends Study, we examined the association between census-tract level social deprivation index (quartiles) and place of death (home vs all else, hospital vs all else, nursing facility vs all else, hospice residence vs all else) in a series of multivariable regression models, adjusting for relevant sociodemographic (age, sex, race, education, income) and clinical covariates (dementia, heart disease, lung disease, cancer). Compared with residence in the least deprived quartile, residence in a neighborhood in the most deprived quartile was associated with reduced odds of home death (aOR: 0.66 (0.45, 0.99)) and increased odds of death in a nursing facility (aOR: 1.68 (1.00, 2.80)). Future studies should confirm these findings and examine mechanisms through which neighborhood deprivation impacts place of death (including availability and quality of home-based clinical care.
CHARACTERISTICS AND CARE EXPERIENCES OF OLDER DUAL-ENROLLEES LIVING IN AREAS WITH MEDICAID MANAGED LTSS
Authors: Jopson Andrew , Fabius Chanee , Wolff Jennifer 
Published: December 2023

Abstract
Medicaid-funded long-term services and supports (LTSS) are foundational in helping older dual-enrollees with disabilities remain in the community. Over the past decade, nearly half of U.S. states have transformed LTSS delivery through managed LTSS (MLTSS) with the goal of improving care coordination and avoiding unnecessary health care utilization. Despite this rapid growth, no prior studies describe whether characteristics and care experiences of older dual-enrollees differ between counties with and without MLTSS. We draw on the nationally representative 2015 National Health and Aging Trends Study (NHATS) linked to the census tract of participants’ place of residence to examine differences in demographic characteristics, health, and care experiences of older dual-enrollees with LTSS need (n=462) by county-level presence of MLTSS. We broadly defined LTSS need as receiving assistance with one or more self-care or mobility activity or having probable dementia. More than half (56.9%) of older dual-enrollees with LTSS need lived in counties with MLTSS. Hispanic/other individuals were three times more likely to live in counties with (versus without) MLTSS presence (54.2% vs. 15.8%, p&lt;0.0001) while individuals living in rural regions less likely to live in counties with MLTSS presence (8.8% vs. 31.8%, p&lt;0.05). There were no differences in age, gender, self-reported health, dementia status, or number of chronic conditions of the sample population by MLTSS presence. Similarly, no differences were observed in experiencing adverse consequences from unmet care needs or social participation restrictions by MLTSS presence. These results are a foundational step toward building evidence and understanding who MLTSS programs are serving.
THE GROWTH OF THE HOME CARE WORKFORCE FROM 2000 TO 2019 AND THE ROLE OF PUBLIC FINANCING
Authors: Shen Karen , Ballreich Jeromie , Fabius Chanee , Ornstein Katherine , Reckrey Jennifer 
Published: December 2023

Abstract
Between 2000 and 2019, employment in home care industries grew from under one million workers to more than 3.5 million workers in 2019. However, there is significant variation across states in this growth, with some states experiencing over 300% growth in the share of the population employed in home care, and some states experiencing growth of less than 30%. This study uses state-level data from a variety of sources to explain this variation in growth across states and to quantify the contribution of different demand- and supply-side factors to the growth in the home care workforce. On the demand side, we consider changes in public financing (Medicaid HCBS spending, Medicare home health and hospice reimbursements), population aging and chronic disease burden, and nursing home capacity. On the supply side, we examine changes in the share of the non-elderly population in a state that is foreign-born, and the share without a college education, as these populations are significantly more likely than average to work in the home care industry. We find that demand-side factors can explain almost all of the variation in growth across states. In particular, the growth of public financing in Medicaid and Medicare–which nationally increased by 222% and 140%, respectively, over this period–can explain the majority of the variation in growth across states. These results have implications for understanding differences in the size of the workforce across states, which may impact older adults and persons with disabilities’ access to paid home care.
FEATURES OF LEARNING FROM HIGH-FREQUENCY COGNITIVE ASSESSMENTS AS DIGITAL BIOMARKERS OF COGNITIVE CHANGE
Authors: Oravecz Zita , Vandekerckhove Joachim , Wang Cuiling , Katz Mindy , Hakun Jonathan , Sliwinski Martin 
Published: December 2023

Abstract
In measurement burst designs, participants’ cognitive performance is measured multiple times per day, for several days, forming a measurement burst. Ideally, these are repeated once or twice a year as people age. Such rich longitudinal data are generated by multiple processes (e.g., aging and learning) that operate on multiple timescales. We propose a Bayesian process model that can extract person-specific, substantively meaningful features of learning and change from such data. We show how to model retest gains across measurement bursts, as well as warm-up effects within a burst, while quantifying change across bursts in peak performance and accounting for short-term within-person variability. Individual differences in these features are also linked with psychosocial variables and biomarkers of cognitive decline in a one-step analysis. We also highlight how this approach allows for drawing intuitive inferences on cognitive decline with Bayesian posterior probabilities.
ASSISTED LIVING ADMINISTRATORS’ PERSPECTIVES OF HOW COVID-19 AFFECTED DIRECT CARE STAFF
Authors: Vogel Carlyn , Dobbs Debra , Peterson Lindsay , Molinari Victor , Meng Hongdao 
Published: December 2023

Abstract

Background
Coronavirus disease 2019 (COVID-19) presented many new challenges within assisted living communities (ALCs) and exacerbated preexisting challenges. With high quality of care in ALCs as the continuous goal to achieve, it is important to recognize challenges faced in these communities, especially those related to staffing and COVID-19. Objective: The objective was to investigate issues related to staffing and the effect of COVID-19 in ALCs, including staff absence, leadership, impacts on staff, and impacts on staff retention.

Methods
Participants were ALC administrators (N=129) from the parent study of the Strategic Approach to Facilitating Evacuation by Health Assessment of Vulnerable Elderly in Nursing Homes II (SAFEHAVEN II) funded by the National Institute on Aging. Quantitative analysis was used to determine structure and process characteristics of ALCs during COVID-19 that impacted a process outcome. Qualitative analyses were used to gain perspectives of administrators about the impact of COVID-19 within their ALCs.

Results
Provision of memory care services (structure characteristic), challenge with staff sent home to comply with COVID-19 precautions, challenge paying staff for time off due to COVID-19, and staff anxiety (process characteristics) were significant predictors of staff absence from work (process outcome). Three key themes interpreted from administrators’ interviews were Leadership Shown Toward Staff, Impact of COVID-19 on Staff, and Impact of COVID-19 on Staff Retention. Implications: This dissertation discusses implications for research, policy, and practice to inform continual efforts to improve aspects of staffing and the quality of resident care in ALCs.
DEVELOPMENT AND VALIDATION OF THE MINNESOTA AL REPORT CARD FOR RESIDENT QUALITY OF LIFE DOMAINS
Authors: Bucy Taylor , Shippee Tetyana , Kohli Nidhi 
Published: December 2023

Abstract
Assisted living (AL) describes long-term residential care settings that emphasize person-centered services and choice in a “home-like” environment. There is considerable variability in how AL is defined, what services are provided, and how quality is measured. Minnesota serves as a unique policy environment in which to study AL. In May 2019, Minnesota funded the development of an AL Report Card to measure and report on the quality of AL from resident and family perspectives, created in partnership with the University of Minnesota. Literature review, stakeholder feedback, and pilot testing were completed in 2020-21 and the survey was implemented statewide in 2021-22. Using 2021 AL resident quality of life (QoL) survey pilot data (N=1,392), the goal of this work was to assess the reliability and psychometric properties of the survey in measuring 7 QoL domains: food, staffing, environment, engagement, autonomy, culture, and security. The 7 domains were measured using 6, 10, 3, 6, 5, 3, and 6 items, respectively. We found acceptable internal consistency for four QoL domains: food, staff, security, and engagement (McDonald’s omega and Cronbach’s alpha ≥0.6). Confirmatory factor analysis was performed for each individual factor using diagonally weighted least squares for ordinal data. We found high interfactor correlations between the three domains with poor internal consistency (environment, culture, and autonomy). We collapsed these three domains into one overarching domain – climate – and found satisfactory data-model fit. Findings of stability and validity of QoL report card domains have important implications for adoption outside of Minnesota.
POSTTRAUMATIC GROWTH DURING COVID PANDEMIC AMONG OLDER ADULTS: A MIXED METHODS STUDY
Authors: Chiang-Hanisko Lenny , Liehr Patricia 
Published: December 2023

Abstract
COVID has impacted life for the older adult population living in residential settings affecting psycho-social well-being. Risk for COVID is associated with increasing age and pre-existing health conditions. The purpose of the study was to investigate the post-traumatic growth (PTG) experience among older adults, and the impact of COVID and associated regulatory precautions, on well-being for older adults living in a continue care community (CCC). A parallel mixed-methods approach was used to explore the experience of older adults with PTG. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis to identify emergent themes most frequently reported from open-ended responses. Older adults (N=98) living in a single CCC completed the survey. Age ranged from 67-99 years (mean = 86) with over 90% identifying as non-Hispanic White; and female (75%). Over half (51%) reported social-psychological issues, including anxiety (32%) and depression (31%); 41% reported knowing residents who died during COVID, attributed to will to live (35%), social isolation (30%) and coexisting health conditions (75%). Qualitative analysis revealed 13 subthemes related to 5 major PTG concepts: New possibilities, relating to others, personal strength, spiritual growth and appreciation for life. This study provides a deeper understanding of how older adults residing in a CCC coped with COVID and their experiences. Results indicated that older adults experienced positive changes and PTG despite challenges. Healthcare providers should recognize these potential positive changes and growth and use them as a source for improving older adult well-being when facing pandemic challenges.
UNMET CARE NEEDS DURING THE COVID-19 PANDEMIC
Authors: Curl Angela , Roberts Amy 
Published: December 2023

Abstract

Background
Few studies have examined the characteristics of individuals who experienced unmet care needs during the COVID-19 pandemic (a time when more needs may have gone unmet).

Methods
Using 2020 data from the Health and Retirement Study, this study selected a sample of respondents over the age of 50 who reported difficulty with completing activities of daily living (ADL; eating, bathing, dressing, toileting, toileting; N=685). Unmet ADL need (outcome) was defined as having difficulty performing one or more ADLs but not receiving help performing that ADL. A logistic regression analyzed predictors of unmet ADL need, using the predictors of cognitive ability (range 0-27; Crimmins et al., 2011), self-rated eyesight, self-rated hearing, education, age, gender, race, marital status, and having a child living within 10 miles. Findings: Females were less likely to report an unmet ADL need (OR=0.66, p=.03), as were married/partnered respondents (OR=.52, p&lt;.01). In contrast, respondents with higher cognitive ability were more likely to report unmet ADL needs (OR=1.04, p=.02). The remaining predictors were not statistically significant.

Discussion
Having difficulty with basic ADLs and lacking assistance through formal or informal caregiving can increase the risk for a serious adverse event or nursing home placement. While those with higher cognitive ability could make use of creative workarounds (e.g., assistive devices); they may also have been perceived as having less need of assistance from others. By identifying groups who are more likely to have unmet ADL needs, outreach, assessment, and intervention outreach efforts can be targeted to those at greatest risk.