bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTERVENTIONS FOR COGNITIVE FRAILTY: DELPHI CONSENSUS WITH RESEARCHERS, CLINICIANS, AND EXPERTS BY EXPERIENCE
Authors: Holland Carol , Dravecz Nikolette , Broughton Susan , Davis Sally Fowler , Dixon Mandy 
Published: January 2025

Abstract
The conjunction of physical frailty and cognitive impairment without dementia is described as Cognitive Frailty (CF). Indications that CF is potentially reversible has led to proposals that addressing risk factors, symptoms or mechanisms of CF would be appropriate targets for interventions for prevention, delay or reversal. However, no study has brought experts together across sectors to determine targeted or structures of interventions, and most resources on interventions are from the perspective of academic or clinical researchers only. We conducted an international Delphi consensus study bringing together experts from academic and clinical research, lay people with lived experience of CF, informal carers, and professional care practitioners/clinicians. Three rounds of the Delphi study were held to discern which factors were agreed upon by the whole sample and on which did people with differing expertise have differing views. A scoping review and Round 1 was used to gather initial statements. In Round 2, 56 people responded to statements and open text boxes, with 7 lab based researchers, 27 researchers working with people, 14 people with lived experience or informal family carers, and 10 professional carers/clinicians. Analysis of quantitative data gave 74 statements on which there was at least 70% agreement and qualitative data gave 24 statements, which were then combined to give 90 statements for Round 3, to which 38 original participants responded. Consensus was found for 88 of the statements. Differences between the groups were observed at both stages. Outcomes can be used to feed into co-creation of interventions for cognitive frailty.
THE POTENTIAL OF EXTENDED REALITY SOLUTIONS TO SUPPORT OLDER ADULTS WITH AND WITHOUT COGNITIVE IMPAIRMENTS
Authors: Boot Walter , Dilanchian Andrew , Kalantari Saleh 
Published: January 2025

Abstract
We are living in an era of rapid technological innovation, which presents novel opportunities for technology to foster and enhance the independence, productivity, health, safety, social connectivity, and quality of life of older people with and without cognitive impairments. Both established and emerging technologies can play significant roles in achieving these aims, but to meet their fullest potential they must be designed with a user-centered approach that considers the needs, abilities, and preferences of diverse populations of older people, should be evaluated for usability, and rigorously assessed to determine if they are achieving their intended outcomes. This talk will focus specifically on the potential of novel Extended Reality (XR) solutions, including Virtual Reality (VR) and Augmented Reality (XR), to support activities vital to older people’s brain health, wellbeing, and independence. It will begin with an introduction to the capabilities of these technologies and how these technologies are well-suited to support aging adults, followed by the potential of these tools to support older people with and without cognitive impairments in domains such as cognitive health, social connectivity, wellness, way-finding, and leisure. Evidence for the efficacy of these interventions will be summarized, followed by a presentation of best practices and design guidelines for the use of XR among aging persons based on the latest empirical evidence. We will conclude with a discussion of the future of these technologies and outline a research agenda moving forward.
INCOME POOLING IN MIDLIFE: A COMPARISON OF REMARRIED AND COHABITING RELATIONSHIPS
Authors: Wright Matthew , Schwartz Tatum , Brown Susan , Manning Wendy 
Published: January 2025

Abstract
The share of midlife cohabitors has risen in recent decades, though little is known about their income pooling practices. Cohabitation could be attractive because partners may be able to preserve their economic autonomy and maintain assets for the next generation. Conversely, cohabitation may operate as an alternative to marriage, allowing couples to combine their resources to achieve economies of scale without the legal obligations of marriage. We used the nationally representative Families and Relationships Survey to compare income pooling among cohabiting and remarried U.S. adults aged 50-65 (N = 888). Aligning with the hypothesis that cohabitation and remarriage are distinct in middle age, the odds of income pooling were lower for cohabitors than remarrieds. However, the gap between cohabitors and remarrieds narrowed by later ages. This study provides insight into the economic organization of midlife cohabiting relationships, which may have implications for individual well-being and relationship decision-making among middle-aged couples.
FACILITATORS OF BEHAVIORAL HEALTH CARE ACCESS AND UTILIZATION FOR TRANSGENDER OLDER ADULTS
Authors: Lampe Nik , Rodill Zena , Nowakowski Alexandra 
Published: January 2025

Abstract
Transgender older adults in the United States (US) experience significant disparities in behavioral healthcare access and utilization. However, the specific facilitators that contribute to positive or adequate behavioral healthcare experiences among this vulnerable aging population remain uncertain. Understanding the unique facilitators that shape positive behavioral healthcare experiences for transgender (trans hereafter) older patients can assist medical practitioners in integrating these lessons into their practices, thereby promoting cultural responsiveness in care. In this qualitative study, we aim to address the question: What factors facilitate positive behavioral healthcare access and treatment among transgender older adults in the US? Between September 2021 and January 2022, the first author conducted 47 semi-structured, individual interviews with transgender adults aged 65 or older residing in the US. Analyses focused on the behavioral healthcare access and utilization experiences of interview respondents. Data analyses were conducted collaboratively by the authors using NVivo (Release 1.6) software inductively using a grounded theory approach. Findings suggest opportunities for enhancing behavioral health support and resources for transgender older communities. Four main themes emerged from the data: (1) engaging with behavioral healthcare practitioners who offer compassionate, patient-centered care; (2) utilizing culturally tailored peer-support services; (3) ensuring equitable access to gender-affirming medical interventions; and (4) addressing financial and logistical barriers to behavioral healthcare access. These insights highlight opportunities for enhancing behavioral health support and resources for transgender older communities while emphasizing the importance of incorporating these factors into behavioral healthcare research and practice to promote cultural responsiveness in care for this vulnerable aging population.
PUBLIC HEALTH RESPONSES TO DEMENTIA IN RURAL AND TRIBAL AREAS: BOLD AND BEYOND
Authors: Spears Katie , Bouldin Erin , McGuire Lisa 
Published: January 2025

Abstract
Rural and tribal communities have unique characteristics specific to their geographical location and cultures that can influence how disease prevention and health promotion programs are delivered in these areas. Public health officials may need to adapt traditional strategies to improve uptake, effectiveness, and reach in rural and tribal settings. CDC’s Healthy Brain Initiative (HBI) Road Map Series identifies priority actions public health agencies can take to promote brain health and support caregivers. The Road Map Series includes one designed for local and state agencies and another for Indian Country. CDC’s Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Public Health Program awardees carry out Road Map actions to develop and strengthen the public health infrastructure. This session will illustrate how public health entities have developed dementia resources within rural and tribal areas in their jurisdictions. Four states – Maine, Mississippi, Utah, and Washington – and a tribal board – the Northwest Portland Area Indian Health Board – will be presenters. They will characterize their population, identify the dementia programs and services they offer, describe challenges faced, and discuss the impact of rurality and tribes on their approach to service delivery and outreach. Presenters will discuss resources and collaborative approaches used to ensure success. Together, these presentations will highlight public health strategies that have been effective at supporting brain health in all communities across the lifespan.
TRANSFORMING BRAIN HEALTH IN RURAL COMMUNITIES IN WASHINGTON STATE
Authors: Fadel Meghan , Getz Marci , Ward Angela 
Published: January 2025

Abstract
Rural communities experience unique strengths and barriers as they work to address dementia, making strategic action on brain health and caregiving particularly important. Since 2005, the Healthy Brain Initiative (HBI) has been working to support public health strategies that promote brain health, address dementia, and support individuals living with dementia and their caregivers in all communities. As a part of the HBI effort, the Road Map Series has served as a basis for action in rural communities by guiding local, state, and tribal public health leaders on strategies as they prioritize actions to address brain health and caregiving. The HBI also provides resources to aid in evaluation and implementation of public health approaches. One such effort is the annual Road Map Strategists Program, which helps build the capacity of local health departments and tribal organizations to address brain health. Examples of other tools include an implementation guide, a guide for health improvement planning, and an evaluation toolkit. Washington State has taken great strides in addressing brain health. Efforts include local health department participation in the HBI Road Map Strategists Program, federally funded action through a Building Our Largest Infrastructure Dementia (BOLD) Infrastructure for Alzheimer’s grant, and several initiatives led by the Washington State Dementia Action Collaborative. Lessons learned from implementing the HBI Road Map and prioritizing strategic action in rural communities and tribal nations offer valuable models for expanding work in Washington and beyond.
PERCEIVED BURDEN ON OTHERS, LONELINESS, AND SUICIDE RISK IN CAREGIVERS
Authors: Van Orden Kimberly 
Published: January 2025

Abstract
Caregiving can foster increased purpose and mastery, but also anxiety, depression, and suicide ideation. Mechanisms whereby caregiving impacts suicide risk in dementia caregivers are not well characterized. The Interpersonal Theory of Suicide posits that stressors such as caregiving increase suicide risk by producing feelings of not belong to valued relationships/groups (low belonging, loneliness) and like one is a burden on others (perceived burden). Given that caregivers by definition are caring for others, they may be protected against perceived burden. This presentation will examine the relevance of the Interpersonal Theory of Suicide to understanding mechanisms whereby caregiving may increase suicide risk, with a particular focus on perceived burden on others. Data come from 106 caregivers who reported both significant loneliness and caregiving stress (i.e., required inclusion characteristics for studies funded by Rochester Roybal Center for Social Ties & Aging Research). Subjects completed semi-structured interviews (Columbia Suicide Severity Rating Scale) and self-report measures of social disconnection (Interpersonal Needs Questionnaire), depressive symptoms, caregiving burden, and neuropsychiatric symptoms. Results indicate that 10% reported suicide ideation (past month) and 14% reported feeling like a burden on others (past month). Caregivers who reported perceived burden were 3.5 times more likely to report suicide ideation. Findings suggest that perceived burden is as least as common as suicide ideation, supporting relevance of the Interpersonal Theory. Additional analyses will examine characteristics of those who reported perceived burden to explore potential contributors to developing perceptions of burden despite providing dementia care.
URBAN ENVIRONMENT EXPOSURES AND COGNITIVE HEALTH: AN EVIDENCE GAP MAP OF SYSTEMATIC REVIEWS
Authors: Cleland Claire , Hunter Ruth 
Published: January 2025

Abstract
With a rapidly ageing global population and continued trends in urbanisation, it is crucial we understand the influence of the urban environment on cognitive health. To address gaps in the evidence, we must first understand the current evidence base. The aim of the current study was to create an Evidence Gap Map (EGM) that identifies and presents all systematic reviews investigating urban environment exposure and its impact on cognitive health outcomes. A total of 57 reviews (with 257 outcomes) were included in the EGM. Five reviews were classified as high quality, 43 as moderate quality and nine as low quality. The EGM indicates that the evidence base is concentrated on ‘environmental by-products’ and ‘social environment’ and their impact on outcomes of dementia, Alzheimer’s disease, and cognitive impairment. Areas also saturated were air pollution within ‘environmental by-products’ and educational attainment within the ‘social environment’. Areas with limited evidence included exposure to ‘traffic-related behaviours and all cognitive outcomes, and all four exposures (‘environmental by-products’, ‘social environment’, ‘urban design’ and ‘traffic related behaviours’) and child cognitive measures. The study provides an overview of the current evidence base regarding built, natural and social environmental exposures and cognitive health outcomes. The EGM provides a live, interactive, visual representation of the evidence. We identify key evidence gaps to be addressed including environmental exposures and cognitive outcomes, traffic-related behaviours, and urban by-products such as noise pollution and light pollution.
APPLICATION OF THE CLAIM-BASED FRAILTY INDEX (CFI) TO STRUCTURED ELECTRONIC HEALTH RECORD (EHR) DATA
Authors: Kwak Min Ji , Schaefer Caroline , Kim Youngran , Fu Sunyang , Dhoble Abhjieet , Rianon Nahid , Holmes Holly , Kim Dae Hyun 
Published: January 2025

Abstract
The claim-based frailty index (CFI) was initially developed to identify frailty in Medicare claims. However, the application of CFI to structured data from an Electronic Health Record (EHR) has not been thoroughly studied. We aimed to apply CFI to structured EHR data, The Merative™ Explorys® Therapeutic Dataset Delivered, and estimate the validity of CFI compared to the 5% random sample of Medicare fee-for-service claims (2017-2018). We identified older adults (≥65 years old) with heart failure (HF) in Explorys data (n=52,295) and in Medicare claims (n=33,217). The CFI was calculated from each dataset separately. The CFI from Medicare claims showed a right-skewed distribution (mode of the CFI = 0.210) with a wider shape, whereas the CFI from Explorys data was also right-skewed but with a longer tail and had a narrower distribution (mode of the CFI = 0.186). When we assessed the prevalence of the 93 components of CFI, the components based on procedure codes were more prevalent in Medicare claims than in Explorys data. When frailty was defined as CFI ≥0.25, Explorys data identified fewer cases of frailty (18.1% vs 42.4% in Medicare claims). However, CFI from Explorys data had better discrimination (C-statistic: 0.636 vs 0.608 in Medicare claims) in predicting hospital admission or emergency room visits 1 year after the index visit. These results suggest that CFI may be implemented in EHR data and used for predicting adverse clinical events in HF patients.
FINANCIAL IMPLICATIONS OF DEMENTIA: AN EIGHT-YEAR FOLLOW-UP OF MATCHED SAMPLES
Authors: Choi HwaJung , Langa Kenneth , Norton Edward , Cho Tsai-Chin , Connell Cathleen 
Published: January 2025

Abstract
Financial consequences of dementia could be devastating because of the extensive care needs and high care costs associated with dementia. This study is to determine the financial status of older adults before and after the onset of dementia and assess the potential implications for individuals, families, and socieity. This population-based cohort study compared two matched samples of U.S. adults aged 55 years or older from national, longitudinal data. To create matched samples (dementia vs. control), the study included extensive baseline variables of sociodemographic characteristics, economic status, family availability, health conditions, disability status, and outpatient care use. In total, 2387 adults experienced the onset of dementia during the 2-year follow-up (dementia group) and 2387 adults did not (control group). Participants were followed up for 8 years from the baseline. Over the 8-year follow-up in the dementia group, the 2-year out-of-pocket medical costs increased from $4005 to $ 10,006, median wealth was reduced from $79,339 to $30,490, and those enrolling in Medicaid increased from 16.1% to 29.7%. No statistically significant changes in financial outcomes were found in the control group. The study found that in-home medical care, hospital stay, and nursing home facility stay increased dramatically, especially within two years after the onset of dementia. Greater family care availability is significantly associated with a lower level of transition to a nursing home, which is the most expensive care setting. The potential mitigating effect of family care availability should be accounted for in developing an intervention to reduce the financial effects of dementia.
FRAILTY THERAPEUTICS: CLOSING THE PHYSICAL ACTIVITY GAP FOR FRAIL ADULTS
Authors: Huisingh-Scheetz Megan , Bryant Brittni , Foster Brandon , Taylor Corliss , Parkhideh Arianna , Mendez Benjamin , Brown Sylvia , Thomas Nikita 
Published: January 2025

Abstract
Physical activity has been described as the ‘ideal’ intervention for frailty. In fact, exercise is the most effective frailty mitigation intervention studied to date. Yet, frail older adults face great challenges to physical activity over time. These challenges include decreased physiologic capability, greater barriers, fewer resources, narrower availability, reduced self-efficacy, poorer outcome expectations and restricted payor coverage for long-term activity programming. In this presentation, we will review the challenges frail adults face to participating in the most promising frailty intervention. To do this, we will summarize barriers noted in prior frailty exercise trials and will also report findings from our local survey study assessing physical activity behavior change factors among non-frail, pre-frail and frail older adults (n=101, 93% African-American). We will also review the current restricted payment structure for community-based long-term care services like exercise programs. We will then describe a novel exercise intervention designed to address several of these unique challenges, currently undergoing efficacy testing in a randomized controlled trial. The EngAGE trial is a multisite randomized controlled trial designed to compare an exercise intervention delivered over a voice-activated device in the home (EngAGE) versus paper-based exercises in n=124 frail, homebound, African-American older adults. We will share the EngAGE trial design, methods, measures and preliminary study fundings. We will close by summarizing key remaining issues that need to be addressed to close the physical activity gap for frail adults and will offer ideas for future research directions. Trial registration: ClinicalTrials.gov NCT05337514
AGING IN PLACE IN BRAZIL: SOME NEW EMPIRICAL EVIDENCE AND REMARKS ON THE ROLE OF ENVIRONMENTS FOR EDUCATION
Authors: Oswald Frank , Doll Johannes , Neumann Lycia Tramujas Vasconcellos 
Published: January 2025

Abstract
Aging in Place and the changing role of place for aging in modern societies has become an increasingly important topic both from an empirical and applied perspective. Studies have demonstrated effects of improving the environment, however, research on complex interactions of place, aging and education is scarce, although particularly a tradition of educational theory exists in Brazil. This symposium aims to address links between place, aging, and education in later life in Brazil for health and well-being. The first contribution by Frank Oswald aims to rethink place and aging relationships and to focus on enduring and novel challenges in this regard to provide an overview over selected theories in environmental gerontology and beyond. Second, Mariana Alves da Silva do Nascimento presents qualitative data from a study conducted in São Paulo with community residents on perceptions, preferences, and expectations of aging in place from an Architecture and Urban Planning perspective. The third contribution by Sérgio Luiz Valente Tomasini uses a participatory approach to shed light on planning of outdoor spaces (gardens) within Long-Term Care Facilities in Brazil, emphasizing that participatory methods can positively impact adaptive outcomes of older adults in institutional settings. Fourth, Johannes Doll and Estela Kohlrausch emphasize the significance of educational aspects for environmental gerontological perspectives on place and aging in societies that face globalization, urbanization, digitalization and climate change, which can help to better understand environment in a broader context by “reading the world” (Paulo Freire) differently. Finally, Lycia Tramujas Vasconcellos Neumann will serve as the session’s discussant.
RETHINKING THE PLACE OF PLACE FOR AGING: ENDURING AND NEW CHALLENGES FOR ENVIRONMENTAL GERONTOLOGY
Authors: Oswald Frank 
Published: January 2025

Abstract
Environmental gerontology emphasizes the relationship between place and aging from a conceptual perspective while also aiming to empirically analyze person-environment (P-E) relationships to improve quality of life and health in later life. After decades of empirical research, a critical discussion of theorizing place and aging is needed to better address not only enduring but also new challenges of P-E processes in rapidly changing societies worldwide, including challenges of housing, mobility, accessibility and participation for older adults in the “third” and “fourth” age. This contribution aims to (1) rethink the place of place for aging in modern societies from different disciplines, (2) identify a set of enduring and novel issues of P-E relationships. This is underpinned by specific references to empirical findings from selected studies, often over-representing ageing in Western societies. An example of an enduring issue would be the essential understanding of how an aging individual interacts with the home environment. An example of a novel issue would be technology use in later life in an increasingly digitalized world. Moreover, the contribution aims to (3) provide an overview over selected theories addressing place and aging interrelations, and emphasizing fundamental concepts such as interaction, transaction, co-construction and co-constitution to understand P-E interrelations, and finally to (4) offer a synthesis of how theories can address enduring and novel challenges and identify open questions that remain.