bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE BOLD PUBLIC HEALTH CENTERS OF EXCELLENCE ON DEMENTIA: MOBILIZING PUBLIC HEALTH ACTION TO ADDRESS DEMENTIA
Authors: Baumgart Matthew , Super Nora 
Published: December 2022

Abstract
Under the BOLD Infrastructure for Alzheimer’s Act, passed by Congress in 2018, the Centers for Disease Control and Prevention (CDC) established three Public Health Centers of Excellence (PHCOEs) to address Alzheimer’s disease and related dementias. Awarded in the Fall of 2020, the three PHCOEs are: (1) Dementia Caregiving; (2) Dementia Risk Reduction; and (3) Early Detection of Dementia. Each PHCOE is charged with identifying, translating, and disseminating research findings and evidence-based public health best practices in their particular area of focus – and then working with state, local, and tribal public health agencies across the country to undertake dementia-related activities in their communities. This Symposium will feature an overview by Dr. McGuire of the BOLD Act and CDC’s efforts to address Alzheimer’s and related dementia, followed by presentations on the work and the plans of each of the PHCOEs. Dr. Gaugler will discuss the Caregiving PHCOE’s efforts to support unpaid caregivers of those living with dementia, including how best to meet the caregiving needs of diverse communities. Mr. Baumgart will present the Risk Reduction PHCOE’s findings on the state of the evidence on risk reduction and how that evidence is being translated to public health action. Dr. Chodosh/Dr. Borson will review the plans of the Early Detection PHCOE to increase awareness of the value of earlier detection and the best ways of conducting detection strategies. Finally, Ms. Super will discuss how this public health work complements the work of the aging community in addressing Alzheimer’s and related dementias.
FRAILTY INDEX AT THE BEGINNING OF ELDERHOOD AND HEALTHCARE COSTS AND UTILIZATION OVER 10 YEARS
Authors: Jang Jieun , Kim Dae 
Published: December 2022

Abstract

Background
We assessed whether the frailty index measured at the beginning of elderhood can predict healthcare costs over 10 years in a nationwide Korean population.

Methods
This retrospective cohort study included 215,887 individuals who underwent a standardized comprehensive geriatric assessment at the age of 66 years as part of the National Screening Program for Transitional Ages in 2007–2009 and participants were followed up until December 31, 2019, from the Korean National Health Insurance database. Frailty status was defined based on a 39-item frailty index: robust (&lt; 0.15), pre-frail (0.15 to &lt; 0.25), frail (≥0.25). Generalized linear model was used to examine any changes in healthcare cost among pre-frail group, frail group following 10 years from the age of 66 years, relative to changes in healthcare cost of the robust group. This study constructed an interaction term between the frail group and age.

Results
Frailty status at age 66 years was associated with an increased annual total healthcare cost per NHI beneficiary (robust * age vs frail * age: β = 89.5, SE = 4.0, P &lt; .0001), annual inpatient healthcare cost per NHI beneficiary (robust * age vs frail * age: β = 70.3, SE = 4.1, P &lt; .0001) over 10 years, but not significant in annual outpatient cost per NHI beneficiary after adjusting for frailty category, demographic factor, socioeconomic factor, and time fixed effect. Conclusions: The frailty index at the age of 66 years was associated with an accelerated increase in healthcare costs over 10 years.
A PSYCHOMETRICALLY ROBUST LONGITUDINAL RESEARCH MEASURE OF FRAILTY: FIVE DIMENSIONS ACROSS AGE AND TIME
Authors: Voll Stacey , Terrera Graciela Muniz , Hofer Scott 
Published: December 2022

Abstract
The research construct of frailty in aging requires a measure with sound psychometric properties, that is stable across longitudinal points of observation. Using Exploratory Factor Analysis and Longitudinal Mixed Methods, we developed a five-factor research measures of frailty that is robust across time. Standardized regression scores for each factor allow us to estimate the change in severity of dysfunction as individuals age. We propose a system for developing research tools for the concept of frailty in large longitudinal data sets, and present our findings of five factors of frailty for females and males from the English Longitudinal Study on Ageing.
DATA-DRIVEN IMPROVEMENTS TO DEMENTIA DISEASE DETECTION STRATEGIES IN AN FQHC SETTING
Authors: Sivers-Teixeira Theresa M , Tabon Patrick , Yuan Jessie , Thayer Erin , Matta Sonali , Olsen Bonnie 
Published: December 2022

Abstract
Despite higher prevalence of dementing illnesses in Latina/o populations, detection is lower compared to white populations, compounding racial/ethnic and economic disparities. Undetected illness compromises effective delivery of primary care and impedes linkages to much needed services. Development of robust detection and culturally sensitive management of cognitive impairment is critical for adequate care of this population. The Geriatric Workforce Enhancement Program at the University of Southern California (USC) partnered with Eisner Health, a Federally Qualified Health Center, serving a primarily immigrant, Spanish-speaking, uneducated, urban older adult population, to help achieve their goal of becoming an Age-Friendly Health System to prioritize identification and management of cognitive impairment. Over 14 months, a sustainable clinic workflow was developed and implemented to detect, evaluate, diagnose, and develop care plans for patients and their care partners. Staff and provider education was delivered through didactics, workshops, case reviews, and at-elbow training. Additional efforts focused on EHR optimization and alignment of existing clinical resources. Frequency data was extracted using i2iTracks software reflecting pre and post-implementation. Results show a higher percentage of patients diagnosed with cognitive impairment in the post-implementation period (7.35%) compared to pre-implementation (4.05%). Detailed data tracking the volume of patients engaged at each step of the workflow supports meaningful analysis of barriers and opportunities for optimization, such as how and where additional resources and efforts will yield the greatest effects. Data-driven strategies such as these, strengthen efficiency and effectiveness of the collaborative process and result in sustainable outcomes for this underserved population.
PUTTING IT TOGETHER: THE COMPLEMENTARY EFFORTS OF PUBLIC HEALTH AND AGING TO ADDRESS DEMENTIA
Authors: Super Nora 
Published: December 2022

Abstract
The Public Health Centers of Excellence are part of a larger effort by the Centers for Disease Control and Prevention (CDC), through the BOLD Infrastructure for Alzheimer’s Act and the Healthy Brain Initiative, to advance cognitive health and dementia as public health issues – and to expand the public health response to the Alzheimer’s crisis. These efforts are designed to complement, not supplant, the long-standing work of the aging community to help people with dementia and their families. This presentation will discuss how the new and expanded public health work corresponds with the efforts of the aging community and will illustrate the unique roles of the public health and aging communities in the fight against Alzheimer’s. In addition, the presentation will review initiatives – such as the Milken Institute’s Alliance to Improve Dementia Care – that seek to bring both communities together on a common dementia agenda.
TRENDS IN OSTEOPOROSIS DRUG USE AMONG MEDICARE BENEFICIARIES WITH & WITHOUT ALZHEIMER’S DISEASE/RELATED DEMENTIAS
Authors: Armstrong Peyton , Kuo Yong-Fang , Westra Jordan , Raji Mukaila 
Published: December 2022

Abstract

Background
Osteoporotic fractures are a leading cause of disability and premature death in the elderly. Patients with Alzheimer’s and related dementia (ADRD) have high rates of osteoporosis (OP) and substantial risk of osteoporotic fractures. Yet research is sparse on trends and predictors of OP medication use in ADRD.

Methods
Medicare beneficiaries with OP aged ≥67 years with Medicare parts A/B/D without HMO from 2016–2018. Outcome was receipt of OP medications in 2018. A multivariable logistic regression assessed association between ADRD and OP drug prescribing, adjusted for age, sex, race, region, Medicare entitlement, dual Medicaid eligibility, chronic conditions, number of provider visits/hospitalizations, and nursing home (NH) resident status. Age/ADRD and NH residency/ADRD interactions were tested.

Results
Sample consisted of 47,871 people with OP and ADRD and 201,840 with OP without ADRD. OP drug use was 38.6% in ADRD patients vs. 52.7% in non-ADRD. After adjustment for demographics, chronic conditions, previous hospitalizations/physician visits, the OR for OP drug in ADRD vs. Non-ADRD was 0.85 (95% CI: 0.83–0.87). NH residents had lower odds for OP medication (OR: 0.61, 95% CI: 0.58–0.64). There were significant interactions between ADRD/age and between ADRD/NH residency. The OR for OP drug use associated with ADRD was 0.88 (95% CI: 0.86–0.90) among community-dwelling elders and 0.66 (95% CI: 0.64–0.69) among NH residents. Conclusions: ADRD patients received OP drugs at lower rates than non-ADRD counterparts. More research is needed on prescribing or deprescribing OP drugs in context of ADRD severity, patient preferences, remaining life expectancy and time-to-benefit from OP drugs.
THE ROLE OF SLEEP DISTURBANCE IN COGNITIVE OUTCOMES AMONG LONELY ADULTS IN THE HEALTH AND RETIREMENT STUDY
Authors: Grudzien Adrienne 
Published: December 2022

Abstract
Both sleep disturbance and loneliness have been linked to poorer cognitive performance and increased risk of dementia in older adults. Loneliness is believed to influence cognitive functioning directly and indirectly through the HPA axis dysfunction, which increases systemic inflammation through endocrine, immune system, and genetic pathways which produce a range of negative effects on brain tissue. Higher levels of HPA axis activity associated with lonely feelings may lead to poorer sleep quality, which decreases beta-amyloid and tau clearance, as well as memory consolidation, which may further disrupt sleep through alterations in brain tissue. Despite the growing body of research, little is known about how sleep disturbance and loneliness, both modifiable risk factors, interact to effect cognition and dementia risk over time. Secondary analysis of the 2006, 2010, 2014, and 2018 waves of the Health and Retirement Study was completed using data from 1,092 participants (mean age: 66.24; SE: .1366). Mixed effects regression modeling was used to evaluate the role of sleep disturbance in the relation between loneliness (R-UCLA loneliness scale, 11 item) and four cognitive performance measures: Immediate and Delayed Word Recall, Serial 7s, and Backward Count, and cognitive status category (cognitively normal, cognitively impaired, and dementia) across a 12-year period. Sleep disturbance moderated the relation between loneliness and Immediate Word Recall (p=.048) and Serial 7s (p=.032) outcomes even after controlling for demographic covariates and depression. Findings suggest that sleep disturbance may exacerbate the negative physiological effects of loneliness on episodic memory and executive functioning in older adults.
POSITIVE EMOTION EXPRESSION AND ADAPTIVE COPING BEHAVIORS FOR ADULT CHILDREN OF PARENTS WITH MEMORY LOSS
Authors: Gad Dustin , Piechota Amanda , Monin Joan 
Published: December 2022

Abstract
The broaden-and-build theory suggests that experiences of positive emotion may lead to enhanced utilization of adaptive coping strategies, and a decrease in maladaptive coping strategies (Gloria & Steinhardt, 2016). This relationship between positive emotion and adaptive coping has yet to be studied directly in a sample of adult child caregivers of a parent with memory loss. As part of a larger study investigating relationship dynamics between adult children and their parents with memory loss, adult children 18 years of age and older (n= 67) responded to self-report surveys and engaged in a 6 minute, video recorded, positive interaction session, playing “name that tune” with each other. The session was observationally coded by two coders for “enjoyment/enthusiasm/fun” (k= .516), “laughter” (k= .631), and “positive affect displayed towards partner” (k=.464), using a reliable and valid support-seeking and caregiving behavior coding system (Collins & Feeney, 2000). Spearman’s rank correlations between these behavior codes and the self-reported Brief COPE Inventory (BCI) scores suggested positive correlations between “laughter” and the emotional support subscale of the BCI (rs=.259, p= .034), and between “positive affect displayed towards partner” and the venting subscale of the BCI (rs= .256, p= .036). These findings suggest that the expression of positive emotions in the caregiving process might yield important psychological benefits to the caregiver, through increased utilization of specific coping mechanisms. More research in this area is needed to determine whether positive emotion expression is associated with the use of adaptive coping more so than maladaptive coping mechanisms in this population.
LIFE-COURSE MULTI-DISCIPLINARY PREDICTORS OF DEMENTIA AMONG OLDER ADULTS
Authors: Kuwayama Sayaka , González Kevin , Márquez Freddie , González Hector , Tarraf Wassim 
Published: December 2022

Abstract
The incidence of dementia is rapidly increasing. Identifying risk factors for dementia may help improve risk assessment, increase awareness for risk reduction, and identify potential targets for interventions. We use a life-course multi-disciplinary modeling framework to examine leading predictors of incident dementia (ID). We use the Health and Retirement Study (HRS) to measure 57 exposures across 7 different domains: (1) demographic, (2) adverse childhood socioeconomic and psychosocial, (3) adverse adulthood experiences, (4) adult socioeconomic status, (5) health behaviors, (6) social connections, and (7) adult psychological conditions. Our outcome is ID (over 8-years) operationalized using Langa-Weir classification for adults aged 65+ years who meet criteria for cognitively normal at the baseline when all exposures are measured (Nf 1,622 in testing set and Nf1,460 in validation set). We compare standard methods (Logistic regression) with machine learning (ML) approaches (Lasso, Random Forest) in identifying highly predictive exposures across the risk domains of interest. Standard methods identified lower education, childhood financial duress, and pessimism as among the leading factors associated with ID. Psychological factors explained the highest variance for ID, followed by adult socioeconomic and adverse childhood factors. However, ML techniques differed in their identification of (1) predictors and (2) factors predictive importance. The findings emphasize the importance of upstream risk factors and the long-reach of childhood experiences on cognitive health. The ML approaches highlight the importance of life-course multi-disciplinary frameworks for improving dementia risk assessment. Further investigations are needed to identify how complex interactions of life-course risk factors can be addressed through interventions.
CO-DESIGNED PERSON-CENTERED NARRATIVES FOR PEOPLE WITH ALZHEIMER’S AND RELATED DEMENTIAS
Authors: Flessa Sarah , Harrison James , Willard Tajalei , Chandler Michael , Rogers Stephanie 
Published: December 2022

Abstract
MemoryWell’s professional writers capture and share patient life stories with care teams and families in healthcare settings, with the goal of improving person-centered care. This mixed methods study employs participatory-design methods to assess the feasibility and acceptability of adapting this existing life story service to an acute care setting and implementing stories into the electronic health record (EHR) for older adults with Alzheimer’s and Related Dementias (ADRD). Through in-depth interviews and surveys, we engage patients, family caregivers and care providers to co-design the life story process adaptation and development of EHR wireframes to iterate and pilot in the acute care setting. We will present the co-designed EHR wireframes and data analyzed using qualitative content analysis. Results describe life story utility and potential impacts on outcomes for people with ADRD. Findings from in-depth interviews with 11 providers indicated high feasibility and acceptability, e.g. describing a high likelihood of daily use. Providers shared barriers and facilitators, e.g. time and accessibility, and potential impacts on person-centered care and patient outcomes, e.g. trust, cultural competency, and delirium. Patient and caregiver data collection is underway; one patient and one caregiver have been interviewed out of ten for each respective group. Interviews with all groups have suggested that life stories would be useful for helping patients in unfamiliar and disorienting environments and learning information such as hobbies and interests would be helpful for providers to better understand and engage with patients.
ARTISTIC ENGAGEMENT AT A MEMORY CARE FACILITY, VIA A TELEPRESENCE ROBOT
Authors: Carney Amy Knepple , Hillman Vanessa , Lehman Chloe , Holland Elizabeth , Gowin Lizzie 
Published: December 2022

Abstract
There is a growing body of research that shows participation in arts interventions (e.g., poetry, storytelling, music, and dance) can be beneficial for those living with dementia. The current study examines social interactions when the artist is not physically present, but in the room via a telepresence robot. Through the telepresence robot, dementia care residents were connected to a network of arts presenters. Using a checklist examining social behaviors (verbal and non-verbal), we assessed residents’ social engagement with the artist, other residents, and staff during these creative visits. Typical activities within the care facility were also observed. The observations were conducted on 10 individuals living within the memory care facility. Although the typical facility activities elicited social verbal behaviors, they tended to be more physical in nature and had a larger number of social nonverbal behaviors. When the behavior was verbal it tended to be more noises of excitement, such as “wooo” and “oh yeah.” Although the artist engagement activities elicited social nonverbal behaviors, they tended to be more verbally engaging and there were a larger number of social verbal behaviors during these activities. With the artist engagement we observed residents spontaneously singing songs, and helping to create poetry. The facility was already using activities that allowed the residents to become physically engaged and with the addition of artist visits there was an increase in verbal engagement. By having greater options for residents to create engagement we may see people who don’t typically engage become more involved.
A POLICY- AND PRACTICE-ALIGNED RESEARCH AGENDA FOR ENGAGING AND SUPPORTING DEMENTIA CAREGIVERS IN CARE DELIVERY
Authors: Riffin Catherine , Falzarano Francesca , Czaja Sara 
Published: December 2022

Abstract
The Cornell Institute for Translational Research on Aging (CITRA) Research-to-Practice Consensus Workshop Model is an evidence-based method for generating practice- and policy-informed research agendas on aging-related topics. The model aims to bridge the gap between research-based knowledge and practice-based insight by involving multidisciplinary stakeholders in all aspects of the agenda-setting process. Using the CITRA model as a guiding framework, we convened an NIA-funded Conference on Engaging Family Caregivers of Persons with Dementia in Healthcare Delivery, with the goal of generating actionable research priorities that will lead to improvements in dementia caregiver identification, assessment, and support in health and long-term care settings. Conference attendees were multidisciplinary thought leaders representing five stakeholder groups: family caregivers of persons with dementia, healthcare providers, researchers, payers, and policy advocates. This symposium will describe the CITRA model, using our caregiver conference as an example, and provide practical guidance on how to use the model to promote cross-disciplinary dialogue and integrate research, policy, and practice perspectives. The first presentation will provide an overview of the CITRA model and its 5-step method (Pillemer). Subsequent presentations will describe the model’s application to the topic of improving caregiver identification and support in care delivery (Griffin) and discuss how novel technology-based adaptations to the model helped to facilitate hybrid participation of virtual and in-person attendees (Falzarano). The final presentation will delineate the major priorities that resulted from the conference, discuss ongoing and future dissemination activities, and offer practical suggestions for leveraging the CITRA model in future consensus efforts (Riffin).
RACIAL AND ETHNIC DIFFERENCES IN LUNG CANCER SCREENING ELIGIBILITY AND HEALTH CARE UTILIZATION AMONG OLDER SMOKERS
Authors: Avila Jaqueline , Nwanaji-Enwerem Ugoji , Williams Randi , Robbins Hilary , Ahluwalia Jasjit 
Published: December 2022

Abstract
The United States Preventive Task Force (USPSTF) expanded the lung cancer screening guidelines with low-dose CT scan (LDCT) to narrow racial and ethnic screening disparities. However, there is a need to examine if eligible individuals can access and use health care. The objective was to examine racial and ethnic differences in LDCT eligibility and health services access and utilization among LDCT-eligible individuals. Data comes from adults 50 to 80 years old in the 2018 Health and Retirement Study (HRS), with at least a 20 pack-year smoking history who currently smoke, or have quit &lt; 15 years ago (n=7,624). The outcomes were LDCT eligibility, access to health care (health insurance and usual place of care), and health care use (visits to the doctor). White individuals were more likely to be LDCT eligible than Black and Hispanic individuals. Among those LDCT eligible, Hispanic individuals were less likely to have insurance (OR:0.43, [95%CI: 0.21; 0.86]) and to visit the doctor than White individuals (OR: 0.38 [0.19; 0.76]). Compared to White individuals, Black individuals were more likely to say their usual place of care was the ER or “other” place (OR: 2.65 [1.63; 3.32] and Hispanic individuals were more likely to say they do not have a usual place of care (OR: 1.94 [1.10; 3.41]). Expanding the criteria for lung cancer screening may not be enough to reduce racial and ethnic disparities. More efforts should address racial and ethnic disparities in the implementation of lung cancer screening, including access and use of health care.