bluuebunny/crossref_metadata_2025_split huggingface dataset:
SELF-RATED ORAL HEALTH SATISFACTION AMONG OLDER ADULTS RECEIVING ONE HOME AND COMMUNITY-BASED SERVICE
Authors: Chamut Steffany , Boroumand Shahdokht 
Published: December 2022

Abstract

Objective
To assess self-rated oral health (OH) satisfaction among recipients of the home and community-based services (HCBS) administered by the Administration on Aging.

Methods
This cross-sectional study is representative of the national population of the 2014 National Survey of Older Americans Act Participants (NSOAAP), and analyzed baseline OH data from community-dwelling adults (n= 3,995) age 60 and older covering case-management, congregate-meals, home-delivered-meals, homemaker-services, and transportation.

Results
Among the 3,995 participants, 35% received only one HCBS, the majority being age 75-84 (42%), females (67%), Non-Hispanic Whites (72%), and living in urban areas (53%). About 54% reported having a dental visit in the last twelve months, 30% were not satisfied with their OH, and 45% reported having 4-6 medical conditions. Congregate-meals (67%), home-delivered-meals (23%), and transportation (6%) were the most services provided (n=1,130). Being not satisfied with general health (OR=4.44, CI95=2.81-7.00) p&lt;.0001, experiencing difficulties with three or more activities of daily living (ADLs) (OR=2.06, CI95=1.15-3.70) p= 0.0149, and not having a dental visit in the last twelve months (OR=1.66, CI95=1.06-2.59) p= 0.0248 were the strongest indicators negatively associated for not being satisfied with OH among HCBS participants.

Conclusion
Oral diseases and oral microbiota are known to be precursors of dementia, Alzheimer’s, multiple systemic diseases (i.e. diabetes), and mortality. Understanding OH issues among HCBS recipients could refine policies that focus on improving functional status with person-centered services, and help identify opportunities to revamp older adults’ oral and systemic health, promote healthy aging and longevity allowing them to continue living independently at home.
SPIRITUAL RESILIENCE? THE ROLE OF RELIGIOSITY IN BUFFERING THE EFFECT OF NEIGHBORHOOD DISORDER ON COGNITIVE DECLINE
Authors: Lee Haena , Choi Yeon Jin , Jung Jong Hyun 
Published: December 2022

Abstract
Living in neighborhoods with high levels of disorder and danger can induce psychological distress and compromise cognitive function. However, not all individuals who live in difficult life circumstances have poor health outcomes. Research on resilience shows that some older adults maintain healthy profiles despite adversity, but this has not been tested with respect to cognitive aging. In this paper, we focus on religiosity–religious belief and attendance–as a source of resilience and how it can reverse or reduce cognitive risks in later life that result from long-term exposure to neighborhood disorder. We used 2006-2016 Health and Retirement Study (HRS) to investigate how religiosity moderates the relationship between neighborhood disorder and cognitive decline. We assessed trajectories of cognitive functioning using the Telephone Inventory for Cognitive Status. We measured neighborhood disorder and neighborhood unsafety using the 2006/2008 HRS interviewer observation data and Housing data. We found that individuals living with higher levels of neighborhood disorder had lower cognitive functioning at baseline. The disorder effect was mitigated by religious belief—for instance, poor neighborhood conditions were negatively associated with cognitive function only for those with lower religious belief. The protective effect of religious belief was more pronounced among older Black women. This is consistent with prior literature that spirituality serves as a protective factor in the African American community, especially among women, for triumphing over adversity and lack of secular resources over the life course.
ADVANCE DIRECTIVES: SOLO AGERS RISK OF BECOMING "UNBEFRIENDED"
Authors: Parekh Rupal , Adams Kathryn Betts , Schuman Donna 
Published: December 2022

Abstract
Solo agers are an at-risk population of almost 14 million older U.S. adults currently living alone (Administration for Community Living, 2018). Having been independent for most of their lives they often enter older age unprepared for declining health. Even though the numbers of solo agers are rapidly increasing with the aging of the Baby Boomer generation, research remains scant on this population (Colby & Ortman, 2014). A mounting concern facing solo agers is finding themselves “unbefriended” (i.e., having no one to act as health care proxy in the event of incapacitation due to a medical crisis). The risk of unbefriended status emphasizes the critical importance of advance care planning; however, many solo agers have no advance directives and factors influencing advance care planning in this group are unclear. In this mixed-methods study, we examined factors influencing advance care planning among solo agers. Survey data were collected from 467 members of a Facebook group for self-identified “elder orphans,” six of whom subsequently participated in qualitative interviews. Among these solo agers, 55% indicated they had advance directives. Hierarchical logistic regression results indicated financial and overall wellbeing predicted having advance directives; however, perceived health risk did not. An interpretive phenomenological analysis of data from six in-depth interviews revealed emergent themes of fears of the future and reluctance to plan for end of life despite acknowledging health risks. Findings can inform policies to meet the growing needs of solo agers who may be at elevated risk of becoming unbefriended.
PATTERNS OF HEAVY ALCOHOL USE AMONG OLDER MARRIED AND COHABITING COUPLES
Authors: Curl Angela , Bulanda Jennifer , Roberts Amy 
Published: December 2022

Abstract
Heavy drinking has increased among older adults in recent years. Research suggests romantic partners influence each other’s alcohol use, but this influence may vary by partnership type and relationship quality. Heavy drinkers are more likely to form cohabiting versus marital unions and, relative to marriage, cohabitation is linked with a higher risk of heavy episodic drinking. Although some studies have explored older married couples’ alcohol consumption, we lack research on older cohabitors despite the substantial growth in this form of partnership during later life. We use data from the 2014-2018 waves of the Health and Retirement Study to examine drinking behavior among a sample of older married and cohabiting couples (n=1,876) using Actor-Partner Interdependence Models (APIM). Heavy drinking is measured as consuming more than 3 drinks on a given day or 7 drinks per week for women, or 4 drinks on a given day or 14 per week for men (NIAAA, 2021). Compared to first marriages, being in a cohabiting union is associated with significantly higher odds of one (OR=5.22) or both (OR=3.82) partners becoming heavy drinkers over the observation period, but there are no significant differences between those in first marriages and remarriages. Relationship quality is also a significant correlate of heavy drinking risk, with male partners’ negative relationship quality and female partners’ positive relationship quality associated with a higher risk of heavy drinking over time. Results suggest the importance of accounting for partnership type and relationship quality in understanding partners’ drinking behavior.
DEVELOPMENT OF A BEHAVIORAL FRAMEWORK FOR DEMENTIA CARE PARTNERS’ FALL RISK MANAGEMENT
Authors: Zhou Yuanjin , Berridge Clara , Hooyman Nancy , Sadak Tatiana , Mroz Tracy , Phelan Elizabeth 
Published: December 2022

Abstract
Although older adults living with dementia (OLWD) are at high risk for falls, few strategies that effectively reduce falls among OLWD have been identified. Dementia care partners may have a critical role in fall risk management (FRM). However, little is known in what ways care partners behave that may be relevant to FRM and how to effectively engage them in FRM. Semi-structured, in-depth interviews were conducted with 14 primary care partners (Age: 48-87; 79% women; 50% spouses/partners; 64% college-educated; 21% people of color) of community-dwelling OLWD to ascertain their own behaviors and those of care partners who were secondary in the caring role. The analysis of interview data suggested a novel behavioral framework consisting of eight domains of FRM behaviors adopted across four stages. The domains were 1. functional mobility assistance, 2. assessing and addressing health conditions, 3. health promotion support, 4. safety supervision, 5. modification of the physical environment, 6. receiving, seeking, and coordinating care, 7. learning, and 8. self-adjustment. Four stages of FRM included 1. supporting before dementia onset, 2. preventing falls, 3. preparing to respond to falls, and 4. responding to falls. FRM behaviors varied by the care partners’ caring role. Primary care partners engaged in behaviors from all eight domains. Secondary care partners were reported to assist in health promotion support, safety supervision, modification of the physical environment, and receiving, seeking, and coordinating care. This multi-domain and multi-stage framework will inform intervention development to engage care partners in managing fall risk for community-dwelling OLWD.
SIGNIFICANCE OF SECOND YEAR MEDICAL STUDENTS PARTICIPATING IN THE 48-HOUR HOSPICE HOME IMMERSION PROJECT, 2017–2018
Authors: Hanlon Samuel , Packard Benjamin , Gugliucci Marilyn 
Published: December 2022

Abstract
Medical education on palliative medicine and end-of-life care is generally lacking in the medical curricula. The University of New England College of Osteopathic Medicine (UNECOM) Learning by Living: 48 Hour Hospice Home Immersion Project is an immersion-based learning model whereby UNECOM 2nd year students live in an18-bed acute care hospice house to care for dying patients, provide family support, and conduct post-mortem care. This project determined if and in what ways immersion experiences were valuable in augmenting student medical end-of-life care education during AY 2017-2018.Retrospective ethnographic/autobiographic data were analyzed from the eight randomly selected student hospice immersion journals (approx. 200 pages) who participated during academic year 2017-18. Pre-fieldwork, fieldwork, post-fieldwork journals were reviewed and analyzed using manual content analysis followed by NVivo 12+ analysis. Thematic coding resulted in representative quotes, key words, and native concepts. Inter-rater reliability was established with the use of a codebook and agreed upon thematic definitions. Four key themes included: Subversion of End of life (EOL) Expectations; Character Development/Introspection; Exposure to Diverse Cultural/Spiritual Perspectives; and Skills to Bring into Future Practice. Proximity to death/dying resulted in reflections on values and priorities, and a renewed sense for compassionate patient care. Students developed skills for future practice, including competency in EOL and post-mortem care, navigating difficult, emotionally laden family dynamics, and contributing to an interprofessional staff team even in uncomfortable situations. This immersion positively affected student perspectives about death and end-of-life care; creating life-altering experiences in patient-centered-care. Students stated significant impacts to employ as a physician.
CONSIDERATIONS OF AGE-FRIENDLY 4M PRINCIPLES IN DEPRESCRIBING INTERVENTIONS: A SCOPING REVIEW
Authors: Wang Jinjiao , Shen Jenny , Conwell Yeates , Nathan Kobi , Yu Fang , Ramsdale Erika , Fick Donna , Simmons Sandra 
Published: December 2022

Abstract
The 4Ms – Medication, Mentation, Mobility, and What Matters - represent the key components in the Age-Friendly Health Systems initiative and provide a conceptual framework for research in the older adult population. Over 40% of older adults experience polypharmacy, which can be addressed by deprescribing unnecessary medications. This review aimed to assess the degree to which the 4Ms were considered in intervention design, sample selection, and outcome assessment in deprescribing trials by keyword search in six databases and snowballing. Thirty-seven of the 564 trials identified met the review eligibility criteria. Imbalanced consideration of 4Ms in the deprescribing trials was observed. Intervention design: “Medication” was considered in all trials; “Mentation” was considered in 8 trials; “Mobility” (n=2) and “What Matters” (n=6) was less often considered. By targeting providers, most of the trials lacked consideration of patient-centeredness - aligning what matters most to older adults and their families with deprescribing decision making and implementation. Sample selection: “Medication” was considered in 15 trials (e.g., samples including patients taking ≥ 5 medications or specific types of medications), whereas “Mentation” (n=6), “Mobility” (n=6) and “What Matters” (n=0) were less often considered. Outcome assessment: “Medication” was the most commonly assessed outcomes (n=33), followed by “Mobility” (n=13) and “Mentation” (n=10) outcomes, with no study examining “What Matters” outcomes. 4Ms were not purposefully considered in the intervention design, sample selection, and outcome measurement of existing deprescribing trials. Future deprescribing trials need a more balanced and complete consideration of the 4Ms in the trial design and implementation.
TRAJECTORIES OF K-12 SCHOOLS IN THE 1930S-1960S AND COGNITIVE AGING: VARIATION BY RACIAL COMPOSITION
Authors: Yu Wenshan , Smith Jacqui 
Published: December 2022

Abstract
Besides information about the highest degree, little information about early-life education is available in population surveys. We identified K-12 education trajectories among older adults in the Health and Retirement Study and examined their association with cognitive function. Drawing on 2017 Life History Mail Survey (n = 4,325), we used sequence analysis to determine and classify trajectories of school majority race. We identified five clusters: 1) mostly White schools (n = 3,027), 2) mostly Black schools (n = 673), 3) mostly Hispanic schools (n = 499), 4) partly missing on majority race (n = 267), and 5) mostly Mixed-race schools (n =113). Adding the cluster variable significantly improved the model regressing cognitive function on race, gender, number of years in schools, birth cohort, number of years since starting schools, and school locations (F=12.066, p&lt;0.001). Future research should study heterogeneity of K-12 education using information other than the highest degree.
A DEDICATED APPROACH TO PALLIATIVE DEMENTIA CARE
Authors: Meijers Judith , Bolt Sascha , Zwakhalen Sandra , Khemai Chandni , Schols Jos , Janssen Daisy , van der Steen Jenny , Biesmans Jesper 
Published: December 2022

Abstract
Nursing staff play a central role in the palliative care for people with dementia. Development of their palliative care competences may support timely recognition and addressing of individual needs of persons with dementia and their family caregivers in long term care. In the DEDICATED (Desired Dementia Care Towards End of Life) project, we aim to develop materials to support nursing staff in providing palliative dementia care. The first step of the project concerned a needs assessment, mapping the perspectives of nursing staff, family caregivers and people with dementia (scoping review, surveys and semi-structured interviews). Using these studies’ results as a starting point, an intervention (the DEDICATED approach) was built, using an iterative co-creation approach involving nursing staff and educators (N=12). These ‘ambassadors’ were also trained to disseminate the approach within their care teams and nursing curricula. First reactions from the pilot study regarding the DEDICATED-materials are positive and nurses and nurse educators are eager to use the materials (www.dedicatedwerkwijze.nl). Currently the DEDICATED-approach is being evaluated using a mixed methods pretest-posttest controlled design comparing three groups: a design group (12 wards), a test group (28 wards, 28 new-trained ambassadors) and a control group (12 wards). The main outcomes of study are e.g. self-efficacy, empowerment and engagement in providing palliative care for people with dementia. A secondary outcome involves longitudinal trends of the quality of dying of persons with dementia within the group.
ASSESSING INTERPROFESSIONAL ORAL HEALTH EDUCATION AND PRACTICE FACILITATION OUTCOMES WITHIN LONG-TERM CARE
Authors: Crittenden Jennifer , Coleman Rachel , Wihry David , Nelligan Labrini , O'Connell Denise 
Published: December 2022

Abstract
Older adults residing in long-term care (LTC) settings are at an increased risk of poor oral health due to comorbidities and limited ability to provide self-care. Routine oral care is essential for maintaining overall health. Coupled with resident vulnerability is a traditional lack of training and focus on oral health care in LTC. MOTIVATE (Maine’s Oral Team-Based Initiative: Vital Access to Education) is a pilot (N = 8 sites) interprofessional education program focused on daily oral health care within LTC, providing education and technical assistance to advance staff knowledge, skills, and attitudes about oral health. An evaluation was carried out using a pre/post survey design with instruments administered immediately before and after learning module completion along with a survey administered one month after implementation. Knowledge, attitudes, and oral health practices were assessed. A statistical comparison between baseline (N = 491) and post-launch (N = 215) scores revealed a statistically significant improvement (p &lt; 0.001) across all knowledge and attitudes measures including the perceived importance of oral health, understanding of interprofessional roles among the care team, the role of oral health in supporting resident dignity and quality of life, and confidence in providing oral health care. Factors facilitating the transfer of knowledge to practice (N = 478) included personal interest in the topic (46.4%), knowing where to obtain information when needed (47.6%), and knowing how to apply learning to LTC daily care responsibilities (62.4%). Findings underscore the importance of oral health training and implications for practice transformation in an interprofessional context.
STATE-LEVEL DESEGREGATION EFFORTS IN THE U.S. SOUTH POST-BROWN AND DEMENTIA RISK AMONG BLACK AND WHITE OLDER ADULTS
Authors: Walsemann Katrina , Farina Mateo , Ailshire Jennifer 
Published: December 2022

Abstract
Although education is a key protective factor against dementia, older U.S. adults experienced vastly different educational contexts. One of the most consequential legal decisions impacting educational contexts was Brown v. Board of Education, which declared ‘separate but equal’ schools unconstitutional. School desegregation in the U.S. South was inconsistent, however, and many states delayed implementation for years. State resistance to school desegregation created school environments for Black children that were stressful and discriminatory. Thus, state variation in exposure to school desegregation may serve to differentiate individuals in their risk for dementia. Our project links historical data on state-level school desegregation efforts to the Health and Retirement Study, a nationally representative sample of U.S. adults over 50. We determine if state-level variation in the timing and completeness of school desegregation explains Black-White disparities in transition to cognitive impairment and dementia among older adults who attended school in the US South post-Brown.
PERCEIVED NEEDS, FELT CONCERNS, AND QUALITY OF LIFE OF OLDER ADULTS IN MISSISSIPPI: AN INTERGENERATIONAL APPROACH
Authors: Riaz Muhammad , Downey Laura , Adams-Price Carolyn , Peterson Donna , Staton Lori , Hardman Alisha 
Published: December 2022

Abstract
The purpose of the study was to identify felt needs and concerns of older adults living in their own homes in Mississippi using intergenerational perspectives. This mixed-methods study used snowball sampling to collect data through semi-structured interviews and structured questionnaires that asked about the quality of life and current and future problems among aging adults. Three generations of Mississippians participated in the study, including grandparents (N = 22), adult children (N = 23), and grandchildren (N = 19). Quantitative data were analyzed using SPSS, while qualitative data were managed with MaxQDA. Respondents identified concerns with physical health, difficulty living independently, and mental health problems affecting life satisfaction and quality of life. Incongruently with the intergenerational stake hypothesis, adult children were more invested in their children than their parents. Older adults who live closer to significant others and family were more resilient despite having physical and mental issues. Physical issues related to mobility, access to daily need services, and help with basic tasks like food preparation and mowing lawns, and issues related to mental health seemed less pronounced. Consistent with other research studies, older adults showed a positive sense of self. Similarly, parents showed resilience without being intrusive and overbearing while considering themselves as support for their children. Results could inform the development of programs or initiatives for grandparents, adult children, grandchildren, and others involved in caregiving activities and planning for older adults in Mississippi.
ASSOCIATION BETWEEN INCREASED CAREGIVER BURDEN AND MENTAL HEALTH DURING THE COVID-19 PANDEMIC IN JAPAN
Authors: Nakamoto Isuzu , Murayama Hiroshi , Takase Mai , Muto Yoko , Saito Tami , Tabuchi Takahiro 
Published: December 2022

Abstract
During the COVID-19 pandemic, informal caregivers’ mental health was more deteriorated than non-caregivers. The objective of this study was to examine the association between increased caregiver burden and severe psychological distress (SPD) during the pandemic. We used cross-sectional data from a nationwide internet survey conducted between August and September 2020 in Japan. Of 25,482 participants aged 15–79 years, 1,920 informal caregivers were analyzed (mean age, 52.3 ± 15.9 years; men, 48.8%). SPD was defined as the Kessler 6 Scale (K6) ≥ 13. The self-rated change in caregiver burden was measured with the single question item. A binary logistic regression analysis was used to examine the association between SPD and increased caregiver burden, adjusted for demographic, socioeconomic, health, and caregiving variables. To examine the differential association between increased caregiver burden and SPD, interaction terms were added and binary logistic regression was separately conducted in all variables. Of total caregivers, 56.7% reported the increased caregiver burden and 19.3% were SPD. Increased caregiver burden was significantly associated with SPD, with an adjusted odds ratio 1.90 (95% confidence interval 1.37–2.66). The association between increased caregiver burden and SPD was stronger among married caregivers, with disease treatment, and with their care-receiver’s care need level 1–2 (Japanese long term care service levels). This study demonstrated that increased caregiver burden was associated with SPD during the pandemic. Therefore, measures against mental health for the caregivers with increased caregiver burden need to be implemented immediately.