bluuebunny/crossref_metadata_2025_split huggingface dataset:
MEDICAID FINANCING AND SEGREGATION OF DUALS IN ASSISTED LIVING
Authors: Thomas Kali , Cornell Portia , Hua Cassandra , Rahman Momotazur 
Published: December 2022

Abstract
We used 2018 Medicare enrollment data, a national directory of licensed ALs, and Medicaid state policies. We identified a cohort of 474,661 AL residents and a comparison cohort of 58,911,266 community-residing individuals. We compared the distribution of duals across ALs to the distribution of community-dwelling duals across ZIP codes by taking the ratio of AL Gini index for each state over the community Gini index for each state (the “Gini ratio” or GR). On average, states with both waivers and state plans covering services in AL had the lowest Gini ratio (less segregated than community; GR=0.87;) States with no Medicaid financing for AL had the highest Gini ratio (more segregated than community, GR=1.16). Medicaid coverage for home and community-based services in AL is associated with increased access to AL for duals.
RETENTION OF DUALLY ELIGIBLE BENEFICIARIES IN ASSISTED LIVING AT THE END OF LIFE
Authors: Hayes Susan , Rosendaal Nicole , Wang Xiao (Joyce) , Thomas Kali , Belanger Emma 
Published: December 2022

Abstract
To examine to what extent dually eligible beneficiaries (duals) residing in assisted living remain there toward the end of life, we conducted a prospective cohort study of 98,944 Medicare beneficiaries present at validated AL ZIP codes in January 2017, and who died during a two-year follow-up. The outcome was AL residence in the last 30 days of life. We compared decedents who were not duals (80,156 decedents), with those newly dually eligible in 2017-2018 (3,722 decedents), and those already dually eligible in 2016 (15,066 decedents). Only 36.7% of new dual decedents resided in AL in the last 30 days of life, compared to 66.2% among those dually eligible in 2016, and 84.5% of those without Medicaid. While 29 states retained over half of all decedents in AL until death, only 8 states retained a majority of dually eligible decedents.
LGBTQ+ AFFIRMING CARE AND UNDETECTABLE=UNTRANSMITTABLE: EVIDENCE FOR OLDER GAY AND BISEXUAL MEN IN THE US SOUTH
Authors: Akre (she/her) Ellesse-Roselee , McKay Tara , Henne Jeff , Conway Adam , Gothelf Isabel , Kari Nitya 
Published: December 2022

Abstract
One of the most significant innovations in HIV prevention is the use of HIV treatment to prevent HIV transmission. This information has been disseminated as the “Undetectable = Untransmittable” (U=U) message. Despite evidence of effectiveness, U=U awareness, belief, and understanding remain limited in some communities. In this study we examine whether having an LGBTQ affirming healthcare provider increases U=U awareness, belief, and understanding among midlife and older gay and bisexual men in the US South, an understudied and underserved population and region where new HIV infections are increasing. We use data from the Vanderbilt University Social Networks Aging and Policy Study (VUSNAPS) on sexual minority men aged 50 to 76 from four Southern US states collected in 2020-2021. We find that only one in four men report prior awareness of U=U, but awareness is higher among HIV-negative and HIV-positive men who have an LGBTQ-affirming provider. Having an affirming provider significantly increases U=U belief and understanding, improves risk perception accuracy, and increases the likelihood of having ever tested for HIV among HIV-negative men. Improving access to LGBTQ affirming healthcare may improve U=U awareness, belief, and understanding, which could help to curb HIV transmission in the US South.
PARTICIPATORY DESIGN: AN ESSENTIAL PROCESS FOR SOCIALLY ASSISTIVE ROBOTIC ACTIVITIES IN LONG-TERM CARE SETTINGS
Authors: Lorraine Mion , Latshaw Emily , Lin Yi Chun , Migovich Miroslava , Ghosh Ritam , Khan Nibraas , Sarkar Nilanjan , Tate Judith 
Published: December 2022

Abstract
We conducted participatory design research for long term care (LTC) socially assistive robotic activities comprised of social, cognitive and physical components and enhanced human-robot (HRI) and human-human interactions (HHI). Repeated sessions were conducted with 10 geriatric experts (physicians, activity directors, nurses, occupational therapist) and 12 LTC residents (ages 70–92). Two robots, animal and humanoid, were used in combination with virtual reality. Four collaborative activities for paired older adults were designed and evaluated: playing drums to music, completing paintings, a fishing game, and training a dog with simple commands. Within each activity, three levels of difficulty were designed. Stakeholder feedback was obtained through observations and interviews. Numerous modifications were made following each session that addressed hardware, software and activity issues. Modifications were necessary both for the HRI and HHI aspects of the activity. Our experience demonstrates the necessity for participatory design in the deployment of technology for LTC settings.
GENETIC AND PHARMACOLOGIC PROTEASOME AUGMENTATION AMELIORATES ALZHEIMER’S-LIKE PATHOLOGY IN MICE AND FLIES
Authors: Pickering Andrew 
Published: December 2022

Abstract
The proteasome has key roles in neuronal proteostasis, including removal of misfolded and oxidized proteins, presynaptic protein turnover, as well as synaptic efficacy and plasticity. Proteasome dysfunction is a prominent feature of Alzheimer’s disease (AD) (1–3). Artificial impairment of proteasome function can mimic many neurodegenerative phenotypes (4, 5). We report impaired proteasome function to represent an early-stage marker of AD preceding many other markers of the disease. Significantly, we show that prevention of proteasome dysfunction by genetic manipulation in fly and cell culture models of AD delays mortality, cell death, and cognitive deficits. We developed a transgenic mouse with neuronal-specific proteasome overexpression which, when crossed with a mouse model of AD showed reduced mortality and cognitive deficits. To establish translational relevance, we developed a set of novel TAT-based proteasome-activating peptidomimetics. These agonists stably penetrate the blood-brain-barrier and enhance 20S as well as 26S proteasome activity. We show that treatment with these agonists protects against cell death in a cell culture model of AD as well as both cognitive decline and mortality in fly and mouse models of AD. The protective effects observed from proteasome overexpression in our models appear to be driven at least in part by increased turnover of the amyloid precursor protein (APP) by the proteasome. We conclude that the proteasome plays an important role in AD progression. Furthermore, augmentation of proteasome function is protective against AD-like pathogenesis in diverse models of the disease, representing a new therapeutic target for treatment of AD.
A DIGITAL ELDER ABUSE INTERVENTION FOR THE EMERGENCY DEPARTMENT
Authors: Abujarad Fuad , Choo Esther , Dziura James , Edwards Chelsea , Pantalon Michael , Jubanyik Karen , D'Onofrio Gail , Gill Thomas 
Published: December 2022

Abstract
Elder abuse continues to grow as a national issue with significant gaps in standards for identifying victims. The emergency department provides an opportune setting for affected older adults to report abuse privately, but traditional screening methods may miss certain types of elder abuse when there are no visible signs of abuse. Community resources and reporting methods may not be known or can be stigmatized, therefore creating a challenging scenario for victims of abuse to navigate without fear. The VOICES Elder Abuse Intervention (EAI) is a unique self-administrated tablet-based tool with an automated digital coach that combines major components of screening, educational content, and brief psychoeducational interviewing to empower the older adults and encourage self-identification and self-reporting of abuse. The digital format of the tool allows this EAI to be integrated within an existing elder abuse workflow protocol in the emergency department, rather than replacing it entirely. We will discuss our completed study that included (N=1,002) participants over the age of 60, which suggests that patients find the EAI user-friendly and easy to use. For example, 93% of participants agreed that VOICES was appropriate for learning about abuse, and 94% agreed that using VOICES was very easy to use. Informed by these findings, we plan to adapt and evaluate VOICES EAI for use in other older adult populations and healthcare settings.
MENTAL HEALTH RESILIENCE IN SWISS OLDER ADULT SURVIVORS OF CHILD WELFARE–RELATED MALTREATMENT
Authors: Thoma Myriam , Bernays Florence , Maercker Andreas , Rohner Shauna L 
Published: December 2022

Abstract
Minors affected by child welfare practices in Switzerland during the last century had a high risk for exposure to childhood trauma and maltreatment. Several studies with this cohort demonstrated substantially higher levels of clinically-relevant psychopathology in older adult survivors in comparison to non-affected control individuals. However, these studies also revealed that not all affected individuals developed mental health disorders over their lifespan. To date, this mental health resilience in survivors of an advanced age is still insufficiently understood. Therefore, this study aimed to assess and compare the resilience profiles of older adults who were formerly affected by child welfare-related trauma and maltreatment (risk group, RG; n = 132; Mage = 71 years) and non-affected, age-matched controls (control group, CG; n = 125). Within the RG, approximately one-third of the individuals had no current or lifetime DSM-5 mental health disorders. In comparison to the survivors with a history of mental ill-health, these individuals were older, had a higher income, and expressed a higher subjective satisfaction with their socio-economic status. Furthermore, they reported less early-life physical abuse, and had lower levels of neuroticism, as well as empathy-related characteristics. In addition, they showed higher levels of self-esteem and trait resilience. Group differences between the RG and CG highlight the importance of considering past adversity in the understanding of mental health resilience in later life.
GENETIC RISK FOR ADHD ON LATER LIFE EMOTIONAL AND COGNITIVE HEALTH: TESTING MECHANISMS OF EFFECT
Authors: Arpawong Thalida , Huh Jimi 
Published: December 2022

Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is associated with emotional regulation and cognitive processing challenges throughout life. Not well-understood is how ADHD genetic risk (ADHD-GR) affects depressive symptoms (DepSx) and cognitive functioning in older age. Furthermore, less is known about the mechanisms through which some individuals show better outcomes despite higher ADHD-GR. We evaluated potential mechanisms using the Health and Retirement Study with data from 7,871 European Americans (EAs) and 1,226 African Americans (AAs), ages 50-93, and ADHD-GR calculated from a mixed ancestry genomewide scan. Mediators included closeness of parental relationships during childhood, sense of purpose in life in adulthood, and educational attainment. Outcomes included validated scales for DepSx and cognitive functioning. Structural equation models were stratified by race/ethnicity due to potential differences in genetic effects, adjusted for age, gender, ancestry, and health conditions with DepSx and genetic risk for dementia with cognitive functioning. Among EAs, ADHD-GR significantly predicted lower sense of purpose (p&lt;.05) and worse parental relationships (p&lt;.001), with higher levels of both, in turn, predicting less DepSx (p's&lt; 0.01). ADHD-GR also showed significant direct effects on DepSx (p&lt;.01), controlling for mediators. Additionally, ADHD-GR predicted less education (p&lt;.001), but more education predicted better cognitive functioning (p&lt; 0.001). No relationships with ADHD-GR were significant among AAs. Findings imply that among EAs, mediators could be targets to mitigate negative effects on psychological and cognitive health, two hallmark challenges for individuals with ADHD. More work is needed to characterize ADHD-GR on outcomes among older AAs.
POST-TRAUMATIC STRESS AND LONELINESS AMONG OLDER PUERTO RICANS: HOW DOES DISCRIMINATION MATTER?
Authors: Wang Kaipeng , Ortiz Daniel Vélez , Colón Lisa , Sun Fei 
Published: December 2022

Abstract
Loneliness is associated with worse mental health conditions, more functional limitations, and higher mortality among older adults. Almost one third older Puerto Ricans have experienced loneliness. Research has shown that post-traumatic stress has been associated with higher risk of loneliness among older adults; however, such an association has not been examined among Puerto Ricans despite their high prevalence of post-traumatic stress disorder. In addition, perceived discrimination, a critical risk factor of social isolation, is likely to reduce help-seeking behaviors and aggregate loneliness among individuals who have experienced trauma. Nonetheless, few studies have focused on the moderating role of perceived discrimination on the association between post-traumatic stress and loneliness. This study examines the association between post-traumatic stress and loneliness and whether that association differs by everyday perceived discrimination among older Puerto Ricans. Data were collected from 304 Puerto Ricans aged 60 and above living in the Greater Boston area who responded to questionnaires. We used ordinary least squares regression to examine the association between post-traumatic stress, perceived everyday discrimination, and loneliness. We found that post-traumatic stress was significantly associated with higher levels of loneliness; however, the association differed by perceived everyday discrimination. The association between post-traumatic stress and loneliness was stronger for those that perceived a higher level of everyday discrimination. Findings underscored the role that perceived discrimination plays in exacerbating loneliness among older Puerto Ricans experiencing post-traumatic stress and have clinical and public health implications for service delivery and mental health promotion among older Puerto Ricans.
SOCIAL HEALTH AND IMMUNE SYSTEM IMBALANCE: SEX-SPECIFIC ASSOCIATIONS AND CAUSAL LINKS TO BRAIN AGING
Authors: van der Velpen Isabelle , Yaqub Amber , Vernooij Meike , Perry Marieke , Vernooij-Dassen Myrra , Ghanbari Mohsen , Ikram Arfan , Melis Rene 
Published: December 2022

Abstract

Background
We explored whether the balance between innate and adaptive immune system links social health to cognitive brain aging in community-dwelling older adults.

Methods
Social health markers (social support, marital status, loneliness) were measured in the Rotterdam Study in 2002-2008. Balance of the immune system was assessed using white blood-cell-based indices (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII)) during the same visit. Cognitive function and total brain volume were measured at the 2009-2014 follow-up visit.

Results
In 8375 adults (mean age 65.7, 57% female), never married participants had higher NLR, PLR and SII compared to married peers, indicating imbalance towards innate immunity. Widowed/divorced males, but not females, had higher NLR, PLR and SII. Immune system balance did not mediate associations between social health and cognitive brain aging. Discussion: Social health is sex-differentially associated with immune system balance, but does not link to cognitive brain aging through mediation.
AN OPTIMIZED MOUSE PARABIOSIS PROTOCOL FOR INVESTIGATION OF AGING AND REJUVENATIVE MECHANISMS
Authors: Rodriguez Sonia , Carver Chase , Ayasoufi Katayoun , Boynton Felicia Duke , Schafer Marissa 
Published: December 2022

Abstract
Surgical parabiosis is widely used to study the mechanistic influence of the circulating milieu on aging and regeneration. This powerful model presents diverse complications based on age, strain, sex, and other experimental parameters. In young (Y) and old (O) male and female C57BL6 mice, we optimized heterochronic (n=12) and isochronic (n=10 Y-Y, n=7 O-O) parabiosis. Throughout protocol development, we identified several complications including variable responses to anesthesia, external and internal dehiscence, dehydration, and weight loss. We identified and implemented solutions during surgical and post-surgical periods, including titrated anesthesia, reinforced internal sutures, topical agents to promote wound healing, and increased supplementation. By consistently adopting protocol changes we were able to significantly increase survival. Separately, we confirmed the time course of chimerism in heterochronic pairs of C57BL6 and Tg(act-EGFP)Y01Osb (eGFP) mice. Baseline and longitudinal blood samples were collected via tail vein. Flow cytometry was used to visualize GFP-positive cells from the parabiont blood sample. Through blood analysis we found that chimerism occurs as early as 2 days post-operatively. Exploitation of our optimized protocol may enable others to efficiently adopt the surgical parabiosis model to dynamically study mechanisms of aging and regeneration.
CELLULAR RESPIRATION AND RESILIENCE AS A POTENTIAL BIOLOGICAL MECHANISM DRIVING SEX DIFFERENCES IN AGING
Authors: Salmon Adam , Adekunbi Daniel 
Published: December 2022

Abstract
There are substantial differences in the progression of aging between males and females including in progression and prevalence of disease and longevity. Not all can be explained solely by sex-specific endocrine regulation and growing evidence suggests there are basic biological and genetic differences in sex that drive disparity in physiological function. In this study, we describe metabolic differences at the cellular level that both define some of these biological differences as well as provide a potential mechanism for delineating relevant molecular mechanisms of aging. Using HET3 mice, a genetically heterogeneous model with a consistent female advantage in longevity, we show that primary fibroblast lines retain functional metabolic characteristics, including mitochondrial response and stress resilience, which are representative of the sex of the donor animal. These differences persist even after several rounds of passage using standard culturing techniques suggesting these differences are not driven by direct impact of circulating sex hormones. Moreover, we find that differences in these cellular responses have some predictive power to determine both sex- and individual-specific responses to physiological challenge including obesity and longevity. In addition, we are able to use this model to delineate how donor sex affects cellular responses within defined pillars of aging including proteostasis, metabolic function, and adaption to stress. Overall, our model then provides valuable in defining the cellular responses that contribute to the mammalian aging process.
QUALITY CARE AND CONFLICTING RIGHTS AMONG RESIDENTS WITH DEMENTIA, FAMILIES, AND STAFF IN LONG-TERM CARE FACILITIES
Authors: Perone Angela 
Published: December 2022

Abstract
Conflicting rights between residents with dementia and staff pose unique problems for quality of care in long-term care (LTC) facilities. Residents relying on staff for care may be afraid to express concerns. A disproportionate female (and often women of color) staff may be exposed to discrimination that stems from a resident’s loss of executive functioning and inability to control emotions. Family often find themselves somewhere in the middle. This study, thus, poses two research questions: (1) How do residents, families, and LTC staff understand their rights when conflicts arise between residents with dementia and staff?; (2) How can we leverage collective expertise of residents, families, and LTC staff to deliver a more holistic approach for addressing these conflicts? To answer these questions, I employed a multi-method qualitative design using semi-structured interviews (n=90) and participant observation (n=8 months). Building on legal consciousness theory—which explains how individuals invoke (or do not invoke) legal principles to define everyday experiences—findings revealed that staff rarely invoked legal framings to describe interactions whereas residents readily invoked rights rhetoric. Families mostly avoided rights rhetoric and instead focused on storytelling. All groups (residents, staff, and families) employed an array of emotional literacy and life experiences to navigate conflicts that coalesced around empathy. This paper concludes with research, policy, and practice suggestions for invoking principles of empathy to advance quality of care for residents with dementia by improving interactions among residents, staff, and family and workforce conditions for staff that flow from these interactions.
RESULTS FROM A PLATFORM-BASED CLINICAL TRIAL FOR PERSONS DIAGNOSED WITH MILD COGNITIVE IMPAIRMENT
Authors: Gibson Allison , Pope Caitlin , Parsons Kelly , Rhodus Elizabeth , Huffmyer Mark , Johnston Julia , Jicha Gregory 
Published: December 2022

Abstract
The process of receiving a diagnosis of mild cognitive impairment (MCI) is overwhelming. Individuals may experience adaptive or maladaptive responses to the diagnosis. Five specific areas of maladaptive response were previously identified, including 1) failure to plan for future decline, 2) decreased compliance and interaction with medical care providers, 3) decreased confidence and reduced social engagement, 4) increased physical limitations and mobility, and 5) decreased medication compliance. This pilot study reports on the delivery of the platform-based trial for persons diagnosed with MCI with survey data and qualitative focus groups data (n=38). The study consisted of a single-site platform trial examining the intervention group. Using this approach allowed the participants to explore different biopsychosocial arms of the intervention. Second, the platform design allowed researchers to determine the effects of the interventions on patient help-seeking and adherence behavior in real-world care. Feasibility, opportunities, and challenges will be discussed. Opportunities include the group’s cohesion with the group-based intervention, which increased engagement for study group participation. Additionally, participants were most susceptive to intervention components that were novel (i.e., mindfulness) and administered by a professional (i.e., pharmacist, physical therapist) as opposed to self-facilitated activities. Challenges include frequency of study visits, the study partner requirement, and the in-person delivery of the intervention. These challenges were further compounded by the COVID-19 pandemic. Findings from this study offer considerations in implementing support programming and clinical research for persons diagnosed with MCI. The presentation will also include discussion on COVID-19 pandemic-related protocol modifications of this intervention study.