bluuebunny/crossref_metadata_2025_split huggingface dataset:
ENHANCING WELL-BEING THROUGH EXERCISE DURING OLDER AGE
Authors: Marquez David 
Published: December 2022

Abstract
Dr. Marquez’s Roybal pilot Enhancing Well-Being Through Exercise During Older Age piloted an adaptation of a group exercise evidence-based program for people with arthritis symptoms, Fit & Strong!, that included education on emotional wellbeing and mental health. The pilot used a waitlist design to test the 8-week program among Black residents reporting depressive symptoms living in a senior housing facility. A battery of physical, emotional, and cognitive outcomes were collected pre and post intervention and a subset of participants (n=11) received MRIs pre and post. The sample included 28 participants (n=13 intervention, n=15 waitlist) who had a mean age of 69.8, were 89% female, reported a mean of 3.6 chronic conditions, and an average WOMAC pain score of 5.7 (moderate pain). Though under-powered, analyses show greater improvements in key physical activity and cognitive domains among the intervention group compared to the waitlist group.
DOES FIVE-STAR QUALITY RATING MATTER FOR NURSING HOME QUALITY DURING THE COVID-19 PANDEMIC?
Authors: Yu Lei , Qiu Xiao , Sun Na 
Published: December 2022

Abstract
Objectives Nursing homes (NH) confronted tremendous difficulties considering confirmed residents Covid-19 cases and deaths in the U.S. The Centers for Medicare & Medicaid Services (CMS) applies the Five-Star Quality Rating (FSQR) to indicate the quality of care in nursing homes based on health inspection surveys, staffing as well as care process and resident outcomes during the COVID-19 pandemic. This study aims to examine whether FSQR was related to the total number of NH resident Covid-19 cases and deaths.Design This study analyzed 6,978 nursing homes across the country with data from CMS Nursing Home Compare, CMS COVID-19 Nursing Home Public File, Long-term Care Focus, Payroll Based Journal, Rural-Urban Commuting Area. Negative binomial regressions were used to investigate associations between FSQR and NH COIVD-19 outcomes controlling for state fixed effects and clustering of nursing homes within counties. The characteristics of facility, residents, payer-mix, nursing staff, and geographic location were also controlled. ResultsComparing to NH with 1-star in Health Inspection, Staffing, or Overall ratings, NH with better performance have lower risk of having increased number of COVID cases and deaths among residents. Further, nursing home Quality Measures rating is not significantly associated with residents’ COVID-19 deaths. ConclusionOverall, the FSQR is a useful measure of quality in part when investigating NH’s performance during the COVID-19 pandemic. Future policymakers should pay special attention to providers performing poorly in FSQR when improving the quality of nursing homes, particularly regarding infection control.
NORTH CAROLINA NURSING HOME AND PUBLIC HEALTH RESILIENCE DURING 2021 OF THE COVID-19 PANDEMIC
Authors: Lane Sandi , Spaulding Trent , Hege Adam , Sugg Maggie , Iyer Lakshmi 
Published: December 2022

Abstract
Since the onset of the COVID-19 pandemic many healthcare organizations have operated in a climate of uncertainty. Building resilience is one method used to survive and thrive during periods of uncertainty. Measuring an organization’s resilience (ability to prepare for, respond and adapt during time of change) allows the organization to identify its vulnerabilities and set priorities to avert negative outcomes during an untoward event. Through collaboration with four long-term care professional associations, the Benchmark Resilience Tool (BRT-13) resilience survey was disseminated to North Carolina long-term care leaders in April 2021. The BRT-13 survey was also sent to North Carolina public health officials via email during the same timeframe. The BRT-13 contains 13 resilience (RES) items divided into two factors of adaptive capacity (AC) and planning (PL) on a five-point Likert scale of strongly disagree (1) to strongly agree (5). Organizational factors surveyed included type of facility, rural-urban classification area designation, ownership type, level of debt, level of profitability, and employee satisfaction. A total of 142 completed surveys were received, 101 (71%) from long-term care leaders and 41 (28.9%) from Public Health officials. Overall average resilience scores ranged from 3.96 for public health respondents to 4.46 for continuing care retirement communities (CCRC) respondents. Analysis of Variance (ANOVA) was employed to compare the three factors (AC, PL, and RES) to the organizational factors. Resilience was significantly associated with one factor, employee satisfaction. Our findings indicate that organizations can build resilience through processes that contribute to staff satisfaction.
IDENTIFYING THE FRAILTY COMPONENTS THAT ARE MOST IMPORTANT IN PREDICTING POSTSURGICAL OUTCOMES
Authors: Mardini Mamoun , Smail Emily , Tighe Patrick , Price Catherine , Kaufmann Christopher , Manini Todd 
Published: December 2022

Abstract
Presurgical frailty among patients is strongly associated with poor postsurgical outcomes. In the prior presentations of this symposium, we assessed the associations between each individual frailty syndromic component and three postsurgical outcomes. However, it remains unclear whether individual relationships remain after accounting for presence of the other components. In regression models that included all frailty components, demographic information, and medical history, results showed that weight loss and slow walking speed were significantly associated with length of stay and 30-day mortality, respectively. Of note, the odds of mortality in patients with slow walking speed was over three times higher than patients with normal walking speed. Lastly, weaker grip strength was strongly associated with discharge to more intensive care (vs. to home). These findings suggest that frailty screening should be universally applied before surgical procedures for better risk stratification.
PRESURGICAL GRIP STRENGTH PREDICTS POSTSURGICAL OUTCOMES IN OLDER ADULTS
Authors: Manini Todd , Mardini Mamoun , Smail Emily , Tighe Patrick , Price Catherine , Kaufmann Christopher 
Published: December 2022

Abstract
Muscle weakness is a strong predictor of a myriad of health outcomes among older adults. However, measures of muscle strength are not incorporated in healthcare settings which is partly due to a lack of established clinical applicability. Maximal grip strength was measured in 11,668 older patients (73.2+/-6.0 yrs, 50.3% female) during a standard presurgical consultation. Each kilogram of maximal grip strength was associated with approximately 1-hour shorter length of stay. Patients categorized as having weak muscle strength according to sex-based norms had a higher 30-day post-surgery mortality than their non-weak counterparts (Odds Ratio: 2.5, p=0.002 after statistical adjustment of age, sex, race and disease history). Additionally, patients with weak muscle strength were less likely to be discharged home than patients without weakness (68.8% vs. 83.9% returning home, p&lt;0.01). Grip strength is a consistent predictor of post-surgical outcomes that might be used to improve care management.
PRECLINICAL DEMENTIA CARE AND PREVENTION IN CONTEXT: FROM INSIGHTS TO ACTION
Authors: Gan Daniel Rong Yao , Heyn Patricia , Greenfield Emily 
Published: December 2022

Abstract
Dementia affects people with lower socioeconomic statuses disproportionately. People with undiagnosed Alzheimer’s disease may or may not express dementia symptoms depending on their brain reserve, cognitive reserve, and their ability to compensate for brain pathology. Much of these depend on their childhood education, but late-life social engagement may also play a role. As lifespan increases globally, preclinical dementia care and prevention in community settings will be increasingly important. The characteristics of everyday environments that are kind to various changes amid declining cognition may enhance the quality of life of older adults with and without dementia. Such environments may be available or unavailable in diverse communities of varying socioeconomic statuses. This collaborative symposium between the ADRD and CEnR interest groups brings together multidisciplinary scholars to imagine psychosocial interventions that could mitigate place-based disparities in cognitive health. The first presentation frames the importance of relational perspectives in a biopsychosocial-ecological model of care amid cognitive decline. The second presentation shows the cognitive impact of networks among kinless older adults across Europe. The third presentation explores community perspectives on preventive brain health programs in various neighborhoods. The fourth presentation centers the voice and action of people with dementia to improve their neighborhood social environments. The final presentation identifies policy implications for community-based care and prevention from network perspectives. Discussions will distil the significance of community for persons living with and without dementia diagnosis to generate place-based interventions that may better support care and prevention in diverse settings, and identify structural barriers to these efforts.
SOCIAL NETWORKS AND COGNITIVE FUNCTION: POLICY IMPLICATIONS FROM RECENT RESEARCH
Authors: McConnell William , Haggar Katherine , Manchella Mohit , Roth Adam , Perry Brea 
Published: December 2022

Abstract
This presentation will describe a series of research projects using Social Network Analysis (SNA) to measure the personal social networks of community-dwelling older adults at-risk for or currently experiencing dementia. The first part of the presentation will provide a brief overview of SNA methods, including advantages of SNA compared to more traditional social activity scales. The second part of the presentation will present evidence from multiple studies to identify distinct pathways linking upstream social network characteristics to downstream pathophysiological processes in the aging brain. In particular, we will distinguish between cognitive stimulation experienced in expansive social networks and neuroendocrine benefits derived from cohesive social networks. The third part of the presentation will present implications for psychosocial interventions to reduce health disparities in dementia care and prevention. We recommend leveraging the multidimensional functionality of social networks across the lifecourse to influence multiple cognitive health pathways simultaneously.
MICROLEVEL COMMUNICATION BETWEEN FAMILY CAREGIVERS AND PERSONS LIVING WITH DEMENTIA
Authors: Kim Sohyun , Liu Wen 
Published: December 2022

Abstract
Little is known about the relationship between family caregivers and persons living with dementia communication at micro-level (smallest verbal and nonverbal behavior unit). Micro-level communication was assessed second-by-second using 75 in-home video recordings from 19 caregiver-care recipient dyads. Each care recipient (N = 38) and caregiver (N = 42) behavior unit was paired and compared using Spearman’s partial correlation. Two-hundred twenty care recipient-caregiver behavior unit pairs were correlated (n = 148 verbal, n = 72 nonverbal pairs, rs range = .456 - .990, all p &lt; .05). Ninety-one caregiver facilitative-care recipient engaging behavior unit pairs (e.g., comfort/empathetic touch, using humor) were positively correlated (rs range = .460 - .990, all p &lt; .05). Eighteen caregiver disabling-care recipient challenging behavior unit pairs (e.g., withdrawing) were positively correlated (rs range = .456 - .697, all p &lt; .05). Individualized caregiver education for matching and adjusting communication is needed to facilitate meaningful interaction.
IMPLICATION OF PAIN ON MOBILITY, FALLS, AND PSYCHOLOGICAL OUTCOMES FOR PEOPLE LIVING WITH DEMENTIA
Authors: Na Annalisa , McClure Leslie , DiMaria-Ghalili Rose Ann , Gitlin Laura 
Published: December 2022

Abstract
Dementia and pain can challenge mobility, increase fall risk, and result in psychological consequences; however, the extent of these relationships among community-dwelling people living with dementia (PLWD) is unclear. Using the National Health and Aging Trends Study, we examined 9,974 community-dwelling older adults (female=57%, age&gt;85yrs=18%) for pain prevalence, mobility (i.e., Short Physical Performance Battery [SPPB]), falls, and psychological outcomes (i.e., depression and anxiety) using four groups with and without dementia (+PLWD/-PLWD) and pain (+Pain/-Pain). Groups were compared at baseline with ANOVA and chi-square and over time with repeated-measures ANOVA models. Pain (+PLWD= 56.8%; -PLWD=49.8%) most commonly affected the low-back and knee. Group differences were significant for baseline mobility, falls, and psychosocial outcomes, p&lt;0.01, but not SPPB over time. Therefore, pain is common, especially at low back and knee, and associated with health and function among PLWD, indicating a need for early and effective interventions that can preserve quality of life.
A NATIONWIDE EXAMINATION OF MEDICARE PART B UTILIZATION DURING HOSPICE ELECTION
Authors: Christian Thomas , Plotzke Michael 
Published: December 2022

Abstract
This research characterizes trends in two hospice-specific modifiers: (1) “GV” indicating services for the terminal/related conditions by an attending physician not an employee of the hospice and (2) “GW” indicating physician services unrelated to terminal/related conditions. We identified Part B (carrier/physician supplier) claims during hospice elections in Federal Fiscal Year (FY)2020, and replicated an Office of Inspector General (OIG) approach calculating potentially “questionable” Part B claims, where the physician and diagnosis codes match between the hospice and Part B claims (without a GW modifier listed). Using logistic regression, we calculated adjusted odds ratio (AOR) and 95% confidence intervals (CI) to characterize this billing. Overall, $372.8 million in physician services occurred during hospice elections in FY2020. Of this, two-thirds ($247.8 million) included a GW modifier, one-quarter ($86.5 million) a GV modifier, $2.2 million both modifiers, and $40.8 million neither modifier. Replicating the OIG methodology, we calculated $19.4 million (5.2%) as “questionable”. Beneficiaries electing hospice for 180+ days were three times more likely (95% CI 2.99-3.12) to have questionable billing as a beneficiary electing hospice 14-29 days, and facility residents were more likely to have questionable billing, relative to beneficiaries in their own homes. Questionable billing rates were also highest in the northeastern quadrant of the country. Lastly, we found ten percent of physicians accounted for almost three-quarters of all questionable billing. CMS should further monitor physician services during hospice to maintain the integrity of the benefit and ensure beneficiaries receive adequate care.
PERSPECTIVES OF THE EM-SART: INTERVIEWS WITH ADULT PROTECTIVE SERVICES CLIENTS
Authors: Burnett Jason , Haggerty Kristin Lees , Campetti Randi , Stoeckle Rebecca 
Published: December 2022

Abstract
Older adults who experience mistreatment are more likely to visit emergency departments (ED), yet screening and response protocols in these health care settings are sorely lacking. Protocols designed with the mistreated older adult’s perspective in mind are needed to maximize efficacy and effectiveness. In this study, 18 mistreated older adults completed semi-structured perspective interviews regarding the ED Elder Mistreatment Screening and Response Tool (EM-SART). The findings highlight the importance of training healthcare staff to ask elder mistreatment (EM) questions in a preset context and to ask EM questions with empathy, concern, privacy, and clarity. Participants also stressed the desire to be reported to Adult Protective Services, but to also be included in the safety planning. These findings have direct implications for training health care workers to screen and respond to EM in the ED.
A POLICY ANALYSIS OF ELDER ABUSE PREVENTION LEGISLATION: TRANSLATION OF NATIONAL INITIATIVES TO THE STATE LEVEL
Authors: Decker Autumn , Bruzios Kathryn , Weaver Raven , Bolkan Cory 
Published: December 2022

Abstract
Elder abuse (EA) is an under-recognized global public health threat in need of enhanced research and policy attention, with 1 in 6 older adults experiencing at least one form of abuse/neglect. Public policy changes, such as the federal 2017 Elder Abuse Prevention and Prosecution Act (EAPPA), aim to address EA, but little is known regarding translation and implementation of the initiatives to state-levels. Applying a thematic analytic approach, we identified four major themes from the EAPPA: criminal investigation support; abuse reporting; financial exploitation; and training/technical assistance. Then, we conducted a comparative policy analysis to evaluate each state’s EA statutes enacted since 2017 to determine whether statutes were updated to reflect the EAPPA’s goals. Preliminary findings from 10 states (i.e., states with the greatest proportion of older adults in each Health & Human Services region) showed that eight states had updated statutes relevant to an identified theme(s). Eight states updated statutes related to financial exploitation, highlighting the growing concern over this specific type of abuse. Four states updated statutes related to reporting, reflecting problems with identifying and detecting elder abuse. Two states updated statutes regarding investigation, demonstrating minimal emphasis on elder abuse investigation. No states updated statutes relevant to training/technical assistance. These findings indicate significant state-level variability in translation and implementation of recent legislation. More recognition, research, and policy attention to EA, in the U.S. and globally, is needed. We conclude with recommendations for innovation and prevention policy efforts coupled with multidisciplinary collaborations to strengthen implementation against EA at the state-level.
NEIGHBORHOOD ADVERSITY AND COGNITIVE HEALTH: THE MODIFYING ROLE OF SELF-PERCEPTIONS OF AGING
Authors: Choi Eunyoung , Zelinski Elizabeth , Ailshire Jennifer , Jang Yuri 
Published: December 2022

Abstract
Research has documented the increased risk of cognitive impairment among older adults living in socioeconomically disadvantaged neighborhoods. Much less is known about the factors that moderate this risk. We conceptualized self-perception of aging (SPA) as a potential moderator because it reflects core beliefs about the self at older ages but is also closely linked to late-life health. Guided by the diathesis-stress model that postulates the interactive roles of cognitive styles and stressors in shaping health outcomes, we hypothesized that more positive SPA would buffer the effects of neighborhood adversity on cognitive function. Using data from the Health and Retirement Study (2008–2016), the analytic sample consisted of adults aged 54 and older (N=5,902). Cognitive function was assessed by the Telephone Interview for Cognitive Status. The neighborhood indicators included 1) poverty rates at the census tract level, 2) perceived neighborhood social cohesion, and 3) perceived neighborhood disorder. Three-level growth curve models were separately estimated for each neighborhood indicator’s effect as well as its interaction with SPA on the 8-year cognitive function trajectories. Findings showed that higher poverty rates, more disorder, and less cohesion were associated with lower initial levels of cognitive function but slower rates of cognitive decline. SPA partially moderated the linkage between neighborhood adversity and the level of cognitive function. More positive SPA was associated with reduced negative effects of living in neighborhoods with higher poverty rates and more physical disorder. These findings highlight the intersection of an individual-level psychological factor and a contextual-level factor in shaping late-life cognition.
AGING-RELATED VEGF IMPAIRS MUSCLE REGENERATION
Authors: Endo Yori , Hwang Charles , Zhang Yuteng , Neppl Ronald , Argawal Shailesh , Sinah Indranil 
Published: December 2022

Abstract

Purpose
Aging is associated with frailty, a parameter that correlates with mortality and loss of muscle mass. The molecular mechanisms behind aging-associated impairment of muscle regeneration remain incompletely understood. We hypothesized VEGF-A with known role in angiogenesis and muscle progenitor differentiation to regulate regeneration in aged skeletal muscle.

Methods
Young C57BL/6 (10 weeks old) and old C57BL/6 mice (24 months old) were subjected to muscle cryoinjury to induce regeneration. Quantifications of cross-sectional area (CSA) of regenerating myofibers were performed. Tibialis anterior muscle lysates was used for quantifying VEGF-A. To evaluate the role of VEGF in muscle regeneration, a similar experiment was performed on VEGFlo mice with a 75% decrease in VEGF-A activity and littermate controls. ML228, a hypoxia signaling activator that increases VEGF-A levels, was injected into young and old mice as well as VEGFlo and littermate controls.

Results
Old mice exhibited marked reduction in the VEGF-A protein levels and regenerating myofiber CSA on DPI 10 (1250 vs. 833μm2, p&lt;.001). Similarly, VEGFlo mice exhibited significantly smaller regenerating fiber CSA as compared to littermate controls on DPI 10 (541 vs. 238μm2, p=.0011). Pharmacological augmentation of VEGFA using ML228 increased muscle VEGF levels by 2 folds and skeletal muscle regeneration in both old mice (25% increase in regenerating fiber CSA, p&lt;.01) and VEGFlo (20% increase in regenerating fiber CSA, p&lt;.01) mice, but not young or littermate controls.

Conclusions
Muscle regeneration declines with aging in correlation with loss of VEGFA levels within skeletal muscle. Supplementation of VEGFA represents a therapeutic target for sarcopenia.
UNNECESSARY AND HARMFUL MEDICATION USE IN COMMUNITY DWELLING PERSONS WITH DEMENTIA
Authors: Deardorff W James , Jing Bocheng , Growdon Matthew , Yaffe Kristine , Boockvar Kenneth , Steinman Michael 
Published: December 2022

Abstract
Persons with dementia (PWD) often have multiple comorbidities which results in extensive medication use despite potentially limited benefit and increased risk of adverse events. Compared to the nursing home, little is known about medication overuse and misuse among the ~70% of PWD in the community. Therefore, we examined medication use from Medicare Part D prescriptions among 1,289 community-dwelling PWD aged ≥66 from the Health and Retirement Study. We classified medication overuse as over-aggressive treatment of chronic conditions (e.g., insulin/sulfonylurea use with hemoglobin A1c&lt;7.5%) and medications inappropriate near the end of life. We classified medication misuse as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics) and problematic medications (using Beers and STOPP criteria). We describe the prevalence and patterns of different types of medication overuse/misuse. Frequently problematic medications included antipsychotics (9%), benzodiazepines (12%), and gabapentinoids (13%). Our findings highlight the burden of unnecessary/harmful medications among PWD and inform future deprescribing interventions.