bluuebunny/crossref_metadata_2025_split huggingface dataset:
EMERGENCY DEPARTMENT AND INPATIENT HOSPITAL HEALTHCARE UTILIZATION IN THE YEARS PRECEDING INCIDENT DEMENTIA
Authors: Kumar Raj , Ornstein Katherine , Bollens-Lund Evan , Li Jing , Covinsky Ken , Kelley Amy 
Published: December 2022

Abstract
There is evidence health utilization increases after incident dementia, particularly toward the end of life. However, less is known about utilization in the years before dementia. Our study objectives were to compare outpatient emergency department (ED) and inpatient hospital utilization in the six years preceding incident dementia compared to a reference group without dementia. We obtained data on n=5,547 Beneficiaries from the Health and Retirement Study-Medicare linked sample, and defined dementia using a validated algorithm. Those with (n=1,241) and without (n=4,306) dementia were balanced on confounders using inverse probability weighting applied to longitudinal Generalized Estimating Equation models. We found persons with dementia had greater odds of ED (OR=1.46, 95% CI: 1.21, 1.77) and inpatient hospital (OR=1.35, 95% CI: 1.12, 1.63) usage in the years preceding dementia compared to those without dementia across a comparable timespan. This study provides evidence to suggest greater healthcare burden may exist before manifestation of dementia.
CAN VIRTUAL EXERCISE PROMOTE PHYSICAL RESILIENCE DURING THE COVID-19 PANDEMIC AMONG ACTIVE OLDER ADULTS?
Authors: Manning Kenneth , Jennings Stephen , Pearson Megan , Sloane Richard , Hall Katherine , Bourassa Kyle , Morey Miriam 
Published: December 2022

Abstract

Background
Gerofit is a facility-based exercise and health promotion program for older Veterans that transitioned to virtual delivery in March 2020. Little is known about how virtual exercise would promote resilience in the physical function of individuals previously participating in-person.

Methods
Preliminary data from 1 of 14 sites was gathered 72 Veterans returning to facility-based exercise after COVID mandated shutdowns. 39 individuals chose not to participate virtually, and 33 actively participated virtually for over 1 year. Re-entry data were then compared to the patients’ most recent test. Assessment means were compared within groups.

Results
Change scores from T1 to T2 were: -1.19 versus +2.4 repetitions for 30-second arm curls; +1.57 repetitions for 30-second chair stands; and -113.87 versus -77.3 yards for six-minute walk distance for non-virtual versus virtual groups. Implications: Participation in virtual exercise interventions may promote resilience and resistance to functional decline in previously active individuals during enforced isolation.
VIRTUAL NUTRITION EDUCATION AND PRODUCE DELIVERY INCREASES DIETARY QUALITY AMONG OLDER VETERANS
Authors: Parker Elizabeth , Cassatt Sarah , Giffuni Jamie , Katzel Leslie , Ortmeyer Heidi , Addison Odessa 
Published: December 2022

Abstract
This project assessed the impact of a 14-week virtual group nutrition education plus produce delivery on diet quality of Baltimore GEROFIT participants. RD led classes focused on healthy aging content. Participants could receive an optional bag of local produce. Dietary intake assessed via a 24-hour recall was used to calculate healthy eating index (HEI-2015; higher scores=higher diet quality). Twelve participants enrolled in the program. Two participants discontinued produce delivery due to physical/environmental limitations prohibiting preparation; seven completed recalls at pre/post and received produce (86% male; 71% Caucasian; age=73 years; BMI=33 kg/m2). There were no changes in overall diet. However, among participants who received &gt;80% of produce (n=4), HEI scores increased (+5.4 points). Daily F&V increased by 1.9 servings. Daily protein intake decreased (-25g). This study highlights areas for program improvement including a stronger emphasis on protein intake and incorporating physical/environmental adaptations that may increase participation among older Veterans with disabilities.
AFFECTIVE REACTIVITY TO DAILY STRESSORS AND IMMUNE GENE EXPRESSION IN THE MIDUS STUDY
Authors: Apsley Abner , Lee Sun Ah , Bhat Aarti , Almeida David , Shalev Idan 
Published: December 2022

Abstract
Past research indicates that an individual’s affective reactivity to daily stressors is associated with elevated levels of inflammatory biomarkers such as interleukin-6 and C-reactive protein. Here, we assessed individuals’ positive and negative affective reactivity to daily stressors, and their association with expression levels of genes in the conserved transcriptional response to adversity (CTRA; proinflammatory and type-1 interferon antiviral genes). We hypothesize that gene expression levels of CTRA genes are a possible explanatory mechanistic link between higher levels of affective reactivity and inflammatory markers. Our study included 199 individuals from the Midlife in the United States Refresher study (ages 26-71, 52.8% female, and 17.9% non-white) who participated in the Gene Expression and Daily Diary Projects. Individuals provided whole blood for gene expression analysis and completed an 8-day telephone interview to assess daily experiences. Positive and negative affective reactivity scores were used to indicate magnitude of an individual’s changes in daily affect on stressor-days versus non-stressor-days, and were computed using multilevel modeling. Three CTRA gene expression scores were created for each individual, representing the average expression of proinflammatory, type-1 interferon, and a combination of both. Preliminary findings suggest a negative association between the CTRA composite score and negative affective reactivity to daily stressors (β = -0.963, p = 0.034), controlling for covariates. Further analyses will use affective reactivity to predict individual CTRA genes, correcting for multiple testing. This study will be the first to examine the relationship between daily assessments of emotions and gene expression levels in a representative U.S. cohort.
DEPRESSION, INFLAMMATION, AND THE MODERATING ROLE OF METFORMIN: RESULTS FROM THE MIDUS STUDY
Authors: Syed Sumaiyah , Yang Iris , Wilson Stephanie 
Published: December 2022

Abstract
There is a well-established link between depression and aging-related inflammation, where depression can spur inflammation and affect physical health. Previous animal trials have shown compelling evidence that the use of metformin, the first line of treatment for diabetes, can offset inflammation. These findings have not yet been extended to human samples. This study examined the association between depression and inflammation, specifically the moderating role of metformin usage in middle-aged and older adults. We predicted that metformin would attenuate the link between depression and inflammation. Participants in Project 4 of the Midlife in the United States (MIDUS) Study (n=1255, Mage = 57) provided data on medication use, depressive symptoms, and inflammatory cytokines interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP). Controlling for age, sex, body mass index (BMI), and comorbidity burden, metformin use moderated the association of depressive symptoms with IL-6 and CRP, but not TNF-α. Higher levels of depressive symptoms were significantly associated with higher interleukin 6 (IL-6) (p &lt;.001) and C-reactive protein (CRP) (p = .033) among those not using metformin. However, this effect was not significant among those using metformin, suggesting that metformin usage may attenuate the relationship between depression and inflammation. These findings support the potential of metformin in mitigating the link between depression, a well-known behavioral risk factor, and inflammation, a key source of biological aging. Metformin, an accessible and commonly prescribed drug, may have a hidden anti-aging role that may protect against the inflammatory effects of depression.
STRUCTURAL INEQUITIES IN OUTCOMES FOR DUAL-ELIGIBLE RESIDENTS IN ASSISTED LIVING
Authors: Cornell Portia , Hua Cassandra , Rahman Momotazur , Gadkari Gauri , Thomas Kali 
Published: December 2022

Abstract
We examined the association of AL residents’ dual-eligibility and the concentration of dually eligible residents in AL communities with residents’ risk of hospitalization and long-term nursing home admission. The exposure was dual status interacted with AL concentration: no-duals, minority-duals [&lt;=50%] (reference group), and majority-duals [&gt;50%]. We found that duals in AL have higher risk of hospitalization and nursing home admission than non-duals. For both duals and non-duals, moving to an AL with a high concentration of duals conferred excess risk of hospitalization. Among duals, however, lower concentration of duals in ALs increases risk of long-term nursing home admission for duals, whereas it is protective for non-duals. The association of higher hospitalization with concentration of duals suggests that quality may be a concern in communities that specialize in care for duals. However, majority-duals ALs may be better equipped to provide more comprehensive care as an alternative to nursing homes.
ADULTS' VIEWS OF AGING AS AN UNDERESTIMATED RISK FACTOR FOR HEALTH, WELL-BEING, AND LONGEVITY
Authors: Diehl Manfred , Wurm Susanne , Levy Becca 
Published: December 2022

Abstract
Worldwide population aging has greatly increased the diversity of the “aging enterprise.” Research has established a solid portfolio of evidence showing that positive and negative views of aging represent independent resilience or risk factors for health, well-being, and longevity. Indeed, the effects of views of aging remain significant beyond the effects of other risk factors for health and mortality. This raises the following questions: What do we currently know about the effect of self-perceptions of aging (SPA) and subjective age (SA) on health, well-being, and longevity? What are recent advancements and perspectives? Which research questions should be addressed to stimulate further, sustainable developments in research and practice? This symposium addresses these questions with a diverse set of presentations and from different perspectives. Wahl and colleagues will discuss the role of SPA in the clinical context, namely in a sample of older adults with terminal cancer comparing them to older adults without a terminal illness. Based on a population-based sample, Wurm and Schaefer will report findings on the impact of different gain- and loss-related SPA and SA on mortality over a 23-year period. Building on an earlier meta-analysis, Westerberg and colleagues evaluated data from over 100 studies and will present the findings of a systematic review on the role of SPA and SA for health and longevity. Finally, Nehrkorn-Bailey et al. will present findings from a clinical trial that addressed views of aging as a mechanism to promote physical activity. Dr. Becca Levy will serve as the discussant.
ASSESSING DEMENTIA CLASSIFICATION IN THE NATIONAL CORE INDICATORS AGING AND DISABILITY SURVEY
Authors: Mulcahy John , Bucy Taylor , Shippee Tetyana , Jutkowitz Eric 
Published: December 2022

Abstract
Improving the quality of long-term care services for older adults is a national priority. The National Core Indicators Aging and Disability (NCI-AD) collects data from multiple states to evaluate long-term care recipients’ service satisfaction and needs. Many analysts are interested in exploring the service environments of people living with dementia. However, dementia measurement and reporting varies in NCI-AD between states. Dementia status may be obtained from administrative records or self-reported during the survey. We explored the measurement of dementia in NCI-AD and the implications of relying on administrative or self-reported dementia status. We analyzed NCI-AD data from 2015-2018 representing 24,569 respondents age 65+, of which 5,502 (22.4%) were identified as having dementia. 42.9% of respondents had dementia status determined administratively and 57.1% had it determined during the survey. To assess dementia accuracy by data source, we fit separate LASSO models for both the administrative and survey subpopulations predicting dementia status using demographic and functional predictors. We then used each model to predict dementia status in the subpopulation with discordant dementia data source. Using the administrative model to predict survey reported status resulted in a higher sensitivity than using the survey model to predict administrative status (44.6% vs 32.2%). The diminished predictive accuracy of the survey model suggests administrative records may capture cases of dementia diagnosis that would be missed by self-report. These findings highlight analytical caveats for researchers interested study long-term care quality for people with dementia using NCI-AD, and emphasize the importance of moving towards more standardized dementia reporting.
FINDING THE MINDS OF OUR ELDERS: TESTING THE MINORITY STRESS AND COGNITION MODEL WITH INDIGENOUS OLDER ADULTS
Authors: Whetung Cliff 
Published: December 2022

Abstract
This study used data from the Health and Retirement Study (HRS) data to investigate how an understudied group of Indigenous Older Adults (IOAs) in the United States fared over a 14-year period (2006-2020) in the domain of global cognitive function. The number of IOAs, defined here as Native American and Alaska Natives, will more than double in the next 30 years. Concurrently, the number of IOAs living with cognitive impairments will also increase. Guided by the Minority Stress and Cognition Model, we tested the hypothesis that discriminatory stress increases the risk of cognitive impairment in later life. Using a robust set of psychosocial (e.g. educational quality, perceived everyday discrimination experiences), behavioral (e.g. substance use, exercise), and physiological (e.g. diabetes, hypertension, obesity) risk factors, we modeled the cognition trajectories 186 IOAs using mixed growth curves. We found that one third of these IOAs reported experiencing everyday discrimination at least once per month, the highest of any ethnic group. They also reported high rates of other risk factors for cognitive impairment like low education, SES, and physical activity, and high rates of depression and chronic health conditions. Our analysis found that everyday discrimination was negatively associated with total cognition among IOAs but that this relationship was mediated by allostatic loads. On average, the total cognition scores of IOAs declined significantly faster than those of Whites. This study has important implications for the integration of stress as a mechanism for cognitive decline and the health equity of Indigenous older adults.
RACIAL/ETHNIC DISPARITIES IN THE EFFECTS OF RECEIVING A DIAGNOSIS OF DEMENTIA ON SOCIAL RELATIONSHIPS
Authors: Amano Takashi , Reynolds Addam , Scher Clara , Jia Yuane 
Published: December 2022

Abstract
Although early diagnosis has been recognized as a key strategy to improve outcomes for those with dementia, receiving a diagnosis may negatively influence social relationships. Absent from the literature are considerations of how race/ethnicity may alter these associations. This study examines racial/ethnic variation in the effects of receiving a diagnosis of dementia on social relationships of older adults. Data from the three waves of the Health and Retirement Study were utilized as part of this study. This study examined whether receiving a new diagnosis of dementia changed subsequent social relationships (social networks, social engagement, social support). Regression analyses with inverse probability weighting were performed to estimate the impact of receiving a dementia diagnosis on changes in social relationships. Receiving a new diagnosis of dementia reduced both informal (b = -0.476, p = 0.011, 95% CI = [-0.842, -0.110]) and formal (IRR = 0.688, p = 0.034, 95% CI = [0.487, 0.971]) social engagements. The negative impact of receiving a diagnosis on formal social engagement was stronger among non-Hispanic Blacks (IRR = 0.047, p = 0.007, 95% CI = [0.005, 0.432]). We found no statistically significant impacts of receiving a diagnosis of dementia on social networks and social support. Results suggest that receiving a new diagnosis of dementia may have unintended negative consequences on social engagement and may be more salient for racial/ethnic minorities, such as non-Hispanic Blacks. Practitioners and policymakers should be aware of these consequences and should identify strategies to alleviate the negative implications of receiving a diagnosis.
PROMOTING HEALTHY AGING THROUGH LGBTQ+ AFFIRMING CARE
Authors: Barbee Harry , McKay Tara , Tran Nathaniel , Min Judy 
Published: December 2022

Abstract
This study examines variation in health service utilization and aging outcomes among older LGBTQ+ adults by access to an LGBTQ+ affirming health care provider. Primary survey data (n=1128) come from the Vanderbilt University Social Networks, Aging, and Policy Study, a panel study of older LGBTQ+ adults residing Alabama, Georgia, North Carolina, and Tennessee. Respondents with an LGBTQ+ affirming health care provider were more likely to seek preventative care, including routine checkups, colorectal screenings, flu shots, and HIV tests. Respondents with an LGBTQ+ affirming health care provider also reported higher control over their mental health and lower levels of cognitive decline. Overall, this study suggests that increasing access to LGBTQ+ affirming care could reduce health disparities among aging LGBTQ+ populations.
LONG-TERM GENDERED PATHWAYS OF RELIGIOUS INVOLVEMENT POST WIDOWHOOD
Authors: Hawes Frances , Tavares Jane 
Published: December 2022

Abstract
Widowhood is associated with decreased emotional well-being, particularly increased depression. Prior research suggests that religiosity may help improve mental health among widowed individuals. However, longitudinal studies exploring the role of religiosity on emotional well-being among widowed older adults is lacking, as are studies which examine different dimensions of religiosity. This longitudinal study analyzed data from the 2006-2018 waves of the nationally representative Health and Retirement Study (HRS). Ordinary least squares (OLS) regression analysis was used to examine the relationship between widowhood and depression as well as the role of religiosity as a moderator of this association. Analysis was stratified by gender to further explore these interactions. Results show that men and women show similar levels of depression at widowhood, but men are far less likely to be depressed prior to widowhood. Women also show a better recovery pattern over time post-widowhood. Furthermore, religiosity (particularly attending church) is an effective way of coping with widowhood and mitigating depression for both genders. However, men are significantly less religious than women. This study highlights the long-term effects of widowhood on depressive symptomology among older adults. Practical implications of this study include intervention development around increased screening and treatment for depression for widowed older adults (in particular, for widowers) as well as connecting this vulnerable population with resources. These findings may also inform program outreach (such as hospice bereavement services) that aim to facilitate healthy grieving among widowed older adults.
LONELINESS IN COMMUNITY-DWELLING US OLDER LATINX ADULTS
Authors: Camacho David , Pacheco Kelly , Becker Todd , Reid Cary , Wethington Elaine 
Published: December 2022

Abstract
Loneliness is a critical public health problem yet little is known about older Latinx’s experiences with loneliness. We conducted narrative interviews (Cultural Formulation Interview), with 17 Spanish-speaking Latinx (60 years+) living with loneliness (based on 3-item Loneliness scale) in New York or Los Angeles. Interviewers were bilingual (English/Spanish) gerontological social workers with training in qualitative methods, culturally-sensitive clinical research and elicitation of “sensitive data”. Our thematic analysis was informed by Biopsychosocial and Minority Stress Models, and our gerontological clinical experience with Latinx groups. Most participants immigrated from Mexico, Dominican Republic, Ecuador or Uruguay and lived in the US for more than 20 years. Interviews ranged from 60 to 120 minutes. Most participants described comorbid depression or pain. A substantial majority (82%) had never discussed feelings of loneliness with family or friends. No participant reported seeking professional help to address loneliness. Other identified themes demonstrated how cultural and contextual factors shape loneliness: 1) Descriptions and interpretations rooted in familism and views of aging (“it seems I no longer matter to my children”); 2) perceived causes e.g. discrimination, family conflict, bereavements, immigrant stress, violence; 3) religious and cognitive coping to mitigate loneliness (“I pray that God gives me strength, “I befriend loneliness”); and 4) psychosocial functioning impact ( “there is no reason to live”). Our findings support development of culturally congruent loneliness prevention and treatment practices for older Latinx adults. Future quantitative research should explore the association of cultural and minority stress factors related to loneliness in diverse samples of older Latinx.
UNMET NEEDS AND PERCEIVED BARRIERS TO ACCESSING HCBS AMONG CAREGIVERS OF VETERANS OF ALL ERAS
Authors: Trivedi Ranak , Ngo Victoria , Lee Trevor , Humber Marika , Risbud Rashmi , Desai Shreya , Jacobs Josephine , Gallagher-Thompson Dolores 
Published: December 2022

Abstract
VA has several HCBS to offset caregiver burden, facilitate caregiving, and enhance Veterans’ home-based care, but they remain underutilized. We aimed to describe: the unmet psychosocial and HCBS needs of caregivers, barriers to accessing services, and gaps in available programs. Twenty-three caregivers participated in a 1-hr semi-structured interview (62.9□13.5y; 74.0% women; 47.8% White; 17.4% Hispanic; 65.2% spouses). Caregivers provided 7.3 hrs of daily care (SD=5.5 hrs, Range=1-24); most had provided care for 1+ year. Barriers to accessing HCBS included: a) disagreement with Veterans regarding service preferences and needs; b) lack of awareness of VA and non-VA programs; c) delays in obtaining services; and d) emotional toll of caregiving on personal health and relationship with the Veteran. The VA may need to invest in advertising existing services, develop strategies to match caregivers with available services when needed, and enhancing mental health and relationship quality for Veterans and caregivers.