bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXPLORING THE EFFICACY OF MOCA SCORE CORRECTIONS IN REDUCING THE INFLUENCE OF RACE/ETHNICITY
Authors: McCray Rachel , Bubu Omonigho , Blanc Judite , Seixas Azizi , Jean-Louis Girardin , Turner Arlener 
Published: December 2022

Abstract
As studies have highlighted significant differences in test score distributions between ethnicities, we chose to examine if the MoCA corrections for education curb racial differences. Therefore, we use data from the NIA Alzheimer's Disease Research Center (ADRC) program to explore the efficacy of score corrections in reducing the influence of race/ethnicity. This study utilized the NACC dataset to analyze data covering UDS visits from September 2005 to February 2021. Participants included in the analyses (n= 11987, 64.9% women, 12.3 % Black/African American, mean age 73□9.460; 16□4.98 years of education) were all cognitively normal. The analyses uses the Montreal Cognitive Assessment (MoCA) with and without correction for education (addition of one point for less than 12 years of education), via cut off score derived cognitive status categories. A 2x3 contingency table revealed a statistically significant association between participants’ race (black vs white) and performance on the uncorrected MoCA, X22,n=5291=188.971, p&lt;.001, and the corrected MoCA X22,n=5282=167.073, p&lt;.001. Additionally, a One-way ANCOVA analysis comparing the correlation of education and uncorrected MoCA score for Black/African American (r=.425, p&lt;.001) and White participants (r=.198, p&lt;.001) shows a significant difference between the two groups F1,5288=167.992, p&lt;.001. Specifically, in Black/African American participants, the correlation is much stronger suggesting that years of education is a greater determinant of cognitive status. These results demonstrate that regardless of controlling for education via adding buffer points significant racial disparities in global cognition scores were still present. Alternative corrections for race and education should be considered for future test adaptations.
EXPERIENTIAL ASSESSMENT OF AN INNOVATIVE DEMENTIA CARE TRAINING SEQUENCE FOR HEALTH AND HUMAN SERVICES WORKERS
Authors: Wehry Susan , Wihry David 
Published: December 2022

Abstract
This poster presents results of an assessment of an interdisciplinary dementia care training titled Dementia Reconsidered (DR). In contrast to disease and deficit-focused training curricula, DR incorporates and emphasizes the strengths and humanity of people living with dementia and focuses on person-directed support for, and care of, persons living with dementia. For example, DR makes the case for an approach to shared and supported decision-making that optimizes the individual’s— and significant others’—abilities. The on-line lectures were chunked to accommodate cognitive load and active learning; 20-30 second stretch breaks were interspersed to facilitate attention. This may account for the higher retention and utilization rates of DR than are often found in one-off trainings. A retrospective pre-post survey administered at the conclusion of DR sessions measured participant learning outcomes. Participants in DR sessions were representative of the fields of social work (42%), nursing (21%), and a significant “other” category (28%), mostly long-term care administrators. Among post-training survey respondents (N=36), 77% improved their knowledge of the key principles of person-directed dementia care; 73% (N=37) showed improved comfort in supporting residents with dementia during the CoVID-19 pandemic; 83% (N=24) showed improvement in ability to distinguish capacity and competency; and 83% (N=23) reported increased comfort in supporting people with dementia in making decisions in the face of diminished capacity. At six month follow-up, 63% (N=33) had used a skill gained from their training (17% no, 20% not sure). Implications for training in dementia care practices will be discussed.
DIRECT CARE WORKFORCE IN THE US BEFORE AND DURING COVID-19
Authors: Kelly Christopher , Deichert Jerome , Holley Lyn 
Published: December 2022

Abstract

Purpose
This study describes the changes in the direct care workforce between 2019 and 2020. Design and

Methods
Data were from the 1% Public Use Microdata Sample (PUMS) of the 2019 and 2020 American Community Survey (ACS). Logistic regression was used to compare demographic and employment characteristics of direct care workers (DCWs) in 2019 and 2020.

Results
While the total number of DCWs increased by 0.08% and the number employed in home care increased by 3.45%, the number of DCWs employed in hospitals decreased by 3.73% and the number employed in residential care facilities decreased by 4.01% from 2019 to 2020. Compared to 2019, DCWs in 2020 were more likely to be nonmedical aides, under 25, over 65, non-white, to purchase health insurance directly, and to receive health insurance from Medicaid. DCWs in 2020 were less likely to be widowed, to be recently married, to be non-English speaking, to work year-round and full-time, to have moved in the last year, and to be below poverty than they were in the previous year. Implications: By the end of 2020, the early effects of the COVID-19 pandemic on the direct care workforce could be seen. While the total number of DCWs increased slightly, this was due to the accelerated growth of DCWs in home care, as the decline in the number of DCWs in hospitals and residential care facilities also accelerated. The direct care workforce in 2020 was more nonmedical, part-time, entry-level or exit-level and non-white than in the previous year.
OLDER ADULTS LEAVING THE WORKFORCE: SENSORY LOSS, RETIREMENT, AND DISABILITY
Authors: Morales Emmanuel Garcia , Assi Lama , Reed Nicholas 
Published: December 2022

Abstract
Hearing loss (HL), vision loss (VL), and their combination (dual sensory loss, DSL) are common among older adults. Sensory loss impacts labor productivity which might result in departures from the workforce. Whether older adults leave due to retirement or a disability, and how these responses are associated with sensory loss remains unexplored. Using the 2004-2018 rounds of the Health and Retirement Study, self-reported sensory loss (No Impairment/HL/VL/DSL) at baseline, and reason for leaving the workforce (retirement or disability) were observed. Competing risk models models for departures from the workforce treating retirement or disability as a competing risk were estimated. Among 5,201 adults employed at baseline, ages 50-94, 3,436 reported retirement, and 4254 reported a disability as a reason for not working. In Fine-Gray models, treating retirement as a competing risk and adjusting for sociodemographic and clinical characteristics, we found that compared to older adults without impairments, DSL was associated with a 50% increase in the rate of departures from the labor force due to disability among adults in the in the risk group (SHR=1.51; 95% CI=1.09,2.11). In contrast, when treating disability as the competing risk, HL was associated with a 22% increase in the rate of departures labor force due to retirement (SHR=1.22; 95% CI=1.10,1.36) among adults in the risk group when compared to those without impairments. In sample of older adults, we provide evidence that the presence of sensory impairments is associated with departures from the workforce. Our results highlight differences in the type of departures by sensory loss.
URBANIZATION, FINANCIAL SOURCE, AND PLACE OF DEATH AMONG CHINESE LONGEVITY OLDER ADULTS
Authors: Zhou Rui , Wang Shuangshuang , Yao Nengliang 
Published: December 2022

Abstract
The research on place of death among Chinese oldest adults is scare. This study explored the associations of urbanization and financial source on the places of death among Chinese longevity older adults. The sample consists of 21,920 decedents (female=60%, died at home=89%, mean age at death=95) from 2000-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), conducted by Peking University. Places of death were divided into two categories: home and other sites (including hospitals, institutions and others). Urbanization was measured by residential areas: rural or city. Financial source consisted of family financial support and retirement wage. Chi-square test showed that older adults living in rural areas and getting family finance support were more likely to die at home. Results from binary regression models show that controlling for covariates, decedents living in cities were 6.2 times more likely to die in other places than at home and those received retirement wage were 3.1 times respectively. Notably, older adults who lived in cities and also had retirement wage were 17.7 times more likely to die in other places comparing to those living in rural areas with only family finance support. Findings suggest that more older adults will choose to die at hospitals or institutions as the process of urbanization and the development of social pension system in China, which will put enormous pressure to the hospital-centered healthcare system. Improving the quality of healthcare in grassroots areas might be a feasible attempt to relive the pressure of hospital-centered healthcare system in cities.
PALLIATIVE AND END-OF-LIFE CARE INTERVENTIONS FOR INDIVIDUALS EXPERIENCING HOMELESSNESS: A SCOPING REVIEW
Authors: Ingle Pilar 
Published: December 2022

Abstract
Despite the benefits of palliative and end-of-life (PEOL) care for individuals with life-limiting illness, barriers to accessing this care persist among older adults experiencing homelessness. A number of studies have identified barriers to PEOL care from the perspectives of unhoused individuals and other relevant stakeholders; however, few empirically studied interventions exist to support evidence-based guidelines for PEOL care for this population. This scoping review aimed to identify PEOL interventions for adults experiencing homelessness. The search was conducted in May 2021 and yielded 480 results, from which 50 full-text articles were closely reviewed for inclusion. Sources were included if they reported findings of original, empirical research or quality improvement projects evaluating PEOL services tailored for individuals experiencing homelessness. A total of 13 articles representing 12 studies published between 2006-2021 were included in the review. Over half (n = 7) of the studies described interventions to promote advance care planning documentation, five described interventions embedding PEOL services within homeless shelters, and one described a community outreach program to increase access to PEOL services. Nearly all studies reported positive outcomes on participant perspectives, advanced directive completion rates, or cost analysis. None of the studies included clinical palliative care outcomes. Although most studies reported promising results, service and healthcare providers expressed concerns about continuing challenges and longevity of the programs. The body of literature encompassing PEOL interventions for people experiencing homelessness is limited but growing. Future research may benefit from the inclusion of clinical outcomes and efforts to reduce structural barriers to providing care.
RECRUITING PATIENT-CAREGIVER DYADS IN A PANDEMIC: CHALLENGES AND OPPORTUNITIES IN HOSPICE AND PALLIATIVE RESEARCH
Authors: Wallace Cara L , Washington Karla , Coccia Kathryn , Ferguson Verna , Wingo Anna , Hinyard Leslie , Berg-Weger Marla , Wladkowski Stephanie P 
Published: December 2022

Abstract
Hospice and palliative care (HAPC) research has shown participation in research benefits both patients and caregivers. However, recruiting participants for HAPC research can be difficult and requires flexible, adaptive, and creative strategies. This presentation will review ongoing efforts for recruitment and subsequent alterations for an active NIH study of patients and their caregivers who have been discharged alive from hospice. A live discharge occurs when a hospice patient medically stabilizes, no longer meeting policy’s prognosis eligibility criteria. In 2019, hospices in the United States served more than 1.6 million people, and 17.4% were discharged alive from hospice care, with 6.5% due to being ‘no longer terminally ill’ (NHPCO, 2021). Currently, there is not an explicit discharge process available to guide practitioners in transitioning patients and caregivers out of hospice care, creating challenges and opportunities for collaborative research.Despite existing relationships with hospice networks, our initial recruitment strategy of recruiting patients and caregivers through direct referrals has been insufficient. Incorporating creative solutions to boost recruitment efforts appears to be effective. First, we developed partnerships with hospital/health systems for identification of eligible partnerships using existing information available in Electronic Medical Records (EMRs), yielding an initial 80% increase in referrals. Additional recruitment efforts include using brief informational videos on social media platforms, such as YouTube, Twitter, and TikTok. Promising recruitment strategies for hard-to-reach populations such as HAPC patients and their caregivers, including identification and outreach using existing EMRs, expanding eligibility to include retrospective data, and integrating efforts across social media platforms.
AWARENESS OF PARTNER PREFERENCES FOR END-OF-LIFE ASPECTS AND TREATMENTS IN OLDER ADULT COUPLES
Authors: Vilpert Sarah , Meier Clément , Jox Ralf J , Borasio Gian Domenico , Maurer Jürgen 
Published: December 2022

Abstract
Surrogate medical decision-making at the end of life is common and the patient’s partner is often the person who must make these critical decisions. The challenge of surrogate medical decision-making is to make decisions that best fit the patient's wishes. This study investigates how accurately older adult couples assess each other’s preferences for eleven end-of-life aspects and three medical treatments in a nationally representative sample of adults aged 58 and over living in Switzerland (N=573). The contribution of factors including end-of-life (EOL) discussion and care planning, self-rated knowledge of partner preferences, and EOL preferences homogamy in scoring higher in accurately assessing partner’s preferences for the end of life is examined. Weighted proportions, assessment accuracy scores and ordinary least squares regressions controlled for individuals’ characteristics are calculated. Results show that 44% of respondents accurately assessed their partners’ preferences for aspects related to medical, psychosocial, anticipatory and burden concerns at end of life, and 62% correctly predicted the preferences for cardiopulmonary resuscitation, life-prolonging measures, and palliative sedation. Respondents whose partner discussed their EOL preferences with them, completed an advance directive, designated them as their healthcare proxy, as well as respondents reporting very/rather good knowledge of their partners’ EOL preferences were more likely to have a higher accuracy score for their partners’ EOL preferences. Being a couple is not enough to assess one’s partner’s EOL preferences correctly. Communication about EOL wishes among the couple and individual EOL care planning should be encouraged, as both improve the assessment accuracy of partners’ EOL preferences.
UCHINANCHU AMERICAN OLDER ADULTS’ INFORMATION PREFERENCES AND BEHAVIORS IN END-OF-LIFE DECISION-MAKING
Authors: Shiroma Kristina , Xie Bo 
Published: December 2022

Abstract
End-of-life (EOL) decisions are unique and sensitive, requiring nuanced health information. Careful examination of ethnic minority older adults’ information preferences and behaviors in EOL decision making from a cultural perspective is increasingly necessary as the national and global population grows older and more diverse. Little is known about the information preferences and behaviors of Asian American older adults in EOL decision-making, especially for underrepresented ethnic minorities such as Uchinanchu American older adults. This pilot study examined Uchinanchu American older adult’s information preferences and behaviors in EOL decision making. In November 2019, I interviewed 4 Uchinanchu American older adults (age range: 67-85 years; Mean: 76 years; SD: 8.04) recruited from personal contacts and through Uchinanchu cultural groups in Texas and Hawaii. The interviews took place in-person and via phone. Each interview lasted approximately 90 minutes. Interviews were transcribed verbatim and analyzed using inductive thematic analysis. I identified three themes from the data: (1) EOL decision-making information not coming from healthcare professionals; (2) Funeral planning easier to talk about than advance EOL medical decision making; and (3) Cultural traditions may exclude people (women; non-first born children) from EOL decision making. My findings suggest possible misalignments of EOL communication between medical professionals and Asian ethnic minority older adults. These findings may inform the development of culturally competent interventions to enhance EOL decision making.
INFLUENCE OF TOTAL KNEE REPLACEMENT ON LEAN MASS MEASUREMENTS USING DUAL-ENERGY X-RAY ABSORPTIOMETRY
Authors: Jang Jae Young , Kim Miji , Lee Daehyun , Shin Hyung Eun , Won Chang Won 
Published: December 2022

Abstract
Sarcopenia and osteoarthritis often occur together. Many sarcopenic patients with osteoarthritis are managed by total knee replacement (TKR). The prevalence of TKR is increasing in older adults; however, metal implants can lead to the overestimation of lean mass (LM) in dual-energy X-ray absorptiometry (DXA). However, studies considering metal implants in DXA measurement of LM are scarce. Comparisons without and with automatic metal detection (AMD) are important for accurately measuring LM. Therefore, this study examined the effects of TKR on LM. Twenty-four subjects (mean age: 76.4±4.0 years) who underwent TKR were selected from the Korean Frailty and Aging Cohort Study. A GE Lunar iDXA (GE Healthcare Lunar, Madison, WI, USA) system was applied twice (with and without AMD). Leg LM was significantly overestimated in the right and left legs with TKR. The LMs with and without AMD were 6017.1±199.3 g and 5493.7±171.3 g, respectively (p&lt; 0.001), in the right leg, and 5657.1±220.1 g vs. 5173.7±201.8 g, respectively (p&lt; 0.001) in the left leg. The appendicular lean mass index (ALMI) without and with AMD was 6.5±0.6 kg/m2, 6.1±0.6 kg/m2 (p&lt; 0.001). In addition, only one subject was classified as having low muscle mass without AMD, which increased to four based on AMD according to the Asian Working Group of Sarcopenia 2019 guidelines. The overestimated leg LM in subjects after TKR decreased with AMD. Furthermore, LM with AMD increased the prevalence of low appendicular LM in the diagnosis of sarcopenia. Therefore, metal implants should be considered to accurately measure LM using DXA.
CARING FOR PARENTS AND IN-LAWS IN CHINA: IMPLICATIONS FOR COGNITIVE FUNCTIONING OF ADULT CHILD CAREGIVERS
Authors: Lin Zhiyong , Duan Haoshu 
Published: December 2022

Abstract
Considerable research and public discourse on family caregiving portrays it as a stressful and burdensome experience with serious negative health consequences. Yet, there is also recent evidence indicating better health status in caregivers compared to non-caregivers. Especially for cognitive health, caring for others involves cognitively stimulating activities that can help prevent cognitive decline. Although the negative consequences of eldercare on the mental and physical health of caregivers are well-documented, how it would affect their cognitive functioning is underexplored. Using three waves of nationally representative data in China, the China Health and Retirement Longitudinal Study (CHARLS, 2011, 2013, 2018), this study investigated the longitudinal association between parental caregiving and cognitive functioning among adult child caregivers, and further examined how this association was conditioned on the relationship type (parent versus in-law), caregiving frequency, and gender of adult children. Descriptive analysis indicated that women are more likely to be occasional caregivers for their own parents and regular caregivers for parents-in-law compared to men. Results from multilevel mixed-effects models showed that caring for own parents was beneficial for adult children’s cognitive functioning whereas caring for parents-in-law was not significantly associated with their cognitive functioning. Both sons and daughters benefited from caring for their own parents although the beneficial effect was stronger for sons. Thus, we recommend to consider relationship types between caregivers and care-recipients when investigating informal caregiving and various health outcomes. Furthermore, we suggest more policies and programs that aim to help children-in-law who look after their parents-in-law.
INTERSECTIONS OF SEXUAL ORIENTATION AND GENDER IN SPOUSAL CAREGIVING: A FOCUS ON COGNITIVE LABOR
Authors: Giles Sadie , Calasanti Toni , Geng Jing , de Vries Brian 
Published: December 2022

Abstract
Our presentation adopts a lens of intersecting inequalities based on gender and sexual orientation in exploring caregiving for a spouse or partner with dementia. How the division of labor shapes caregiving approaches is sometimes examined, but how this might differ by sexual orientation has not been explored. Previous research has often examined physical tasks and, to a lesser degree, emotion work. Here, we focus on cognitive labor (Daminger, 2019): the mental labor involved in managing the household and social relationships, including anticipating needs, identifying ways to address these, making decisions, and monitoring outcomes. This theoretical backdrop informs our analysis of data garnered from in-depth interviews conducted among gay/lesbian and heterosexual older adults (N=57) who care for their spouses with dementia. However couples may have divided these cognitive steps previously, caregivers must perform them all alone, given care receivers’ cognitive losses. Our analyses reveal that caregivers find being responsible for everything exhausting, but this manifests differently based on gender and sexual orientation. Heterosexual women, for instance, found making all the decisions problematic, whereas heterosexual men reported difficulty in anticipating needs. For the most part, the challenging issues for gay and lesbian caregivers were more varied, as their previous division of labor had been negotiated differently, without a reliance on traditional gender roles. Finally, we uncover a novel domain for cognitive labor: being the “memory keeper.” Predominantly undertaken by women, this work involved maintaining important memories and markers of the care receiver’s (and couple’s) past.