bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSOCIATION OF DIABETES WITH OLFACTION IN OLDER ADULTS: THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY
Authors: Pleasants Hanna , Chen Honglei , Mosley Tom , Chamberlin Keran , Yuan Yaqun , Shrestha Srishti , Pinto Jayant , Kucharska-Newton Anna 
Published: January 2025

Abstract
Although extant research suggests a cross-sectional association between prevalent diabetes and poor olfaction, the long-term association of diabetes with olfactory impairment remains unclear. We examined the association of diabetes in midlife and in older adulthood, with olfaction ascertained in older adulthood among 6,122 participants of the ARIC cohort who attended ARIC Visit 5 (2011-2013; 58.6% female, 22.7% Black race). Diabetes status and hemoglobin A1c (HbA1c) levels were ascertained at midlife (Visit 2; 1990-1993; mean age 55.0 (SD 5.2)) and in older adulthood (Visit 5; mean age 75.8 (SD 5.2) years). Odor identification was measured at Visit 5 using the 12-item Sniffn’ Sticks and categorized as poor (0-8) versus moderate or good (9-12). Binary logistic regression (exposure: diabetes status) and linear regression (exposure: HbA1C level) were used to model hypothesized associations. Diabetes prevalence at midlife (Visit 2) was associated with poor as compared to good olfaction in older adulthood (median follow-up time 21 years; adjusted odds ratio (AOR) (95% CI) = 1.25 (1.02, 1.53)). Similarly, greater HbA1c in midlife was associated with a lower olfaction score in older adulthood (beta coefficient: -0.101 (SE ± 0.04) per each 1 percent greater HbA1c level). Observed associations were attenuated when diabetes and HbA1c, in association with olfaction, were ascertained in older adulthood (all at Visit 5) (AOR 1.14 (95% CI: 1.00, 1.29); beta coefficient: -0.06 (SE ± 0.04), respectively). These findings support the association between midlife diabetes and impairment in olfactory function in older age.
ASSOCIATION OF PROCOLLAGEN TYPE III N-TERMINAL PEPTIDE WITH AGE AND MORTALITY: THE LONG LIFE FAMILY STUDY
Authors: Cvejkus Ryan , Wojczynski Mary , Jin Shiow , Thyagarajan Bharat , Zmuda Joseph 
Published: January 2025

Abstract
Procollagen type III N-terminal peptide (P3NP) is released into circulation during collagen biosynthesis and is a biomarker of fibrosis in several organs. Herein, we tested the association between baseline plasma P3NP concentration, measured using a sandwich enzyme-linked immunosorbent assay, and risk of all-cause mortality over 17 years in men (n=1882) and women (n=2277) aged 69.9 ± 15.5 (range, 32 – 110) years at baseline. Baseline median [IQR] P3NP level in the full cohort was 5.4 [4.5, 6.7] μg/L, and there was a significant positive linear trend across 10-year age groups. Among those aged 30-39, the median P3NP was 5.2 [4.4, 6.0] μg/L, and among centenarians, the median P3NP was 9.7 [7.9, 11.5] μg/L. Mortality risk, using 1442 observed deaths, was calculated per standard deviation (SD) of log P3NP using Cox Proportional Hazards models adjusted for baseline age, sex, height, weight, field center, alcohol use, smoking history, chronic diseases, serum creatinine, and familial relatedness. A 1 SD higher P3NP level was associated with an 18% increased risk of mortality (HR: 1.18, 95% CI: 1.10 - 1.26). The association was non-significantly stronger in women (HR: 1.25, 1.12 – 1.40) compared with men (HR: 1.11, 1.01 – 1.21). After further adjustment for physical function, the overall association remained but was attenuated (HR: 1.10, 1.02 – 1.18). In conclusion, higher P3NP was independently associated with mortality after adjustment for important covariates, especially in women, suggesting that the prevention of excess collagen deposition (fibrosis) may be particularly important for overall health and survival.
FACTORS ASSOCIATED WITH POOR SELF-RATED HEALTH BETWEEN AGES 70 AND 95: THE JERUSALEM LONGITUDINAL AGING STUDY
Authors: Stessman-Lande Irit , Rozenberg Aliza , Jacobs Jeremy , Stessman Jochanan 
Published: January 2025

Abstract
Self-rated health assessment is widely used among individuals aged over 70 to subjectively gauge health status, with poor self-rated health associated with shorter life expectancy. This study aimed to identify risk factors for poor self-rated health between ages 70-95. The Jerusalem Longitudinal Aging Study (1990-2023) prospectively follows a representative community-dwelling cohort born 1920-21, assessed during home-visit during 1990, 1998, 2005, 2010, 2015 at ages 70, 78, 85, 90, and 95 (n=604, 1024, 1222, 729, 508) respectively. Participants answered the question “Do you feel healthy?”; those answering “no” were defined as having poor self-rated health. Depression emerged as the most significant risk factor for declining self-rated health, with a 3-4.6 times higher risk compared to those without depression across different age groups (P≤0.044). Self-reported financial difficulty, physical inactivity, impairments in activities of daily living, and background comorbidity showed inconsistent correlations with declining self-rated health. There was a robust statistically significant association between self-rated health and mortality across all ages between 70-100 years old, with poor self-rated health consistently predicting shorter life expectancy. Even after adjusting for other risk factors, the association between poor self-rated health and mortality remained significant. The findings suggest that while commonly accepted risk factors for illness might not directly correlate with decline in self-rated health, nonetheless depression emerges as a significant predictor. This implies that poor self-rated health could be a symptom of underlying affective status. Overall, the study underscores the importance of considering mental health factors in assessing self-rated health and predicting longevity between ages 70-100.
PAIN BEHAVIORS AND PAIN TREATMENTS AMONG ENGLISH- AND SPANISH-SPEAKING HISPANICS IN US NURSING HOMES
Authors: Nielsen Natalia , Castañeda-Avila Maira , Lapane Kate 
Published: January 2025

Abstract
In U.S. nursing homes, racial/ethnic differences in nonverbal pain indicators and pain management have been documented among individuals with communication challenges. The role of language has yet to be explored. We evaluate the extent to which English- and Spanish-speaking Hispanics (H-E, H-S, respectively) were less likely to have nonverbal pain behaviors recorded and more likely to have no pain management relative to non-Hispanic English-speaking White residents (NHW-E). We identified newly admitted residents using national Minimum Data Set 3.0 data between 2010 and 2020 (n=1,201,724). Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI) estimated using robust Poisson models compared pain behaviors and treatments across ethnic/language groups. Vocal complaints and facial expressions were most commonly documented (Vocal: 29.1% NHW-E, 17.1% H-E, 18.5% H-S; Facial: 20.3% NHW-E, 15.0% H-E, 18.3% H-S). Documentation of pain behaviors was less frequent among Hispanic residents than NHW-E (e.g., any pain behaviors: aPR H-E: 1.17; 95% CI: 1.14-1.19; aPR H-S: 1.11; 95% CI: 1.10-1.13). Hispanic residents (H-E: 47.8%; H-S: 49.1%) were less likely to receive any type of pharmacologic pain intervention compared with NHW-E (59.4%) (aPR H-E: 0.85; 95% CI: 0.83-0.88; aPR H-S: 0.88; 95% CI: 0.86-0.90). Staff participating in the MDS assessment were less likely to document pain behaviors and its treatment among Hispanic residents relative to non-Hispanic white residents, with differences not observed based on resident’s language. Interventions to improve recognition of pain behaviors among Hispanics are warranted.
THE VAGINAL MICROBIOTA BEFORE AND AFTER HYPEROSMOLAR LUBRICANT USE IN PRE-, PERI-, AND POSTMENOPAUSAL WOMEN
Authors: Brown Sarah , He Xin , Johnston Elizabeth , Mark Katrina , Ravel Jacques , Brotman Rebecca 
Published: January 2025

Abstract
Vaginal lubricants are commonly used in clinical practice and to alleviate vulvovaginal symptoms in menopause. However, most products are hyperosmolar and may disrupt beneficial vaginal bacteria like Lactobacillus spp. We sought to investigate the impact of a single exposure to lubricant among patients referred for transvaginal ultrasound (TVUS) in which lubricant was used during the exam. We recruited 104 participants who self-collected mid-vaginal swabs daily for one week between baseline and TVUS, and immediately before and 6-12 hours after TVUS. Participants attended a visit 2-5 days after TVUS, continued to sample twice weekly, and attended a final clinical visit in week 10. Microbiota composition was characterized by 16S rRNA gene amplicon sequencing and assigned to community state types (CSTs; low-Lactobacillus CST-IV vs Lactobacillus-dominated CSTs I/II/III/V). Yue-Clayton theta indices defined vaginal microbiota stability before and after TVUS. Generalized linear mixed models evaluated the within-participant relative change in the odds of having a CST-IV microbiota after TVUS versus before. Our findings suggest that vaginal microbiota stability decreased after TVUS. Despite no overall change in the odds of a CST-IV microbiota after TVUS among all participants, certain subgroups showed increased risk. Specifically, peri/postmenopausal women (N=19, aOR:3.22, 95% CI:1.16-8.98) and those with a history of bacterial vaginosis (N=58, aOR:1.73, 95% CI:1.10-2.72) were more prone to decreases in Lactobacillus-dominant microbiota after TVUS. In contrast, premenopausal women and those with no bacterial vaginosis history appeared more resilient against perturbations. Reformulation may be necessary to reduce lubricant toxicity, particularly for peri/postmenopausal women who frequently use these products.
TRANSITIONS BETWEEN MEDICARE FEE-FOR-SERVICE AND MEDICARE ADVANTAGE AMONG OLDER ADULTS WITH CANCER
Authors: Castañeda-Avila Maira , Epstein Mara , Lapane Kate 
Published: January 2025

Abstract
To date, SEER-Medicare analyses focused on Medicare Fee for Service (FFS) patients due to data availability. The rising enrollment in Medicare Advantage (MA) underscores the necessity of including these patients in cancer research. We examined transitions between FFS and MA among older adults diagnosed with cancer and explored factors associated with coverage by FFS, MA, or transitions between these types of insurance. From the time of diagnosis to end of follow-up, 62.3% were continuously enrolled in FFS, 21.3% were continuously enrolled in MA, 11.8% transitioned from MA to FFS, and 4.5% transitioned from FFS to MA. Continuous enrollment in MA was more common among women (Odds Ratio (OR) =1.25, 95% Confidence Interval (CI):1.22-1.28), Hispanic (OR=2.21, 95%CI: 2.14-2.28) and Black adults (OR=1.79, 95% CI: 1.74-1.85) and less likely among older adults ≥74 (OR=0.85, 95%CI: 0.83-0.86), unmarried people (OR=0.85, 95%CI:0.83-0.87), and people with brain, lung, and ovary cancer relative to prostate cancer (OR ranges: 0.35-0.46). Factors associated with transitioning from MA to FFS after a cancer diagnosis included age ≥74 (OR: 1.82; 95%CI: 1.77-1.86), Hispanic (OR: 1.98; 95%CI: 1.91-2.60) and Black adults (OR=1.56, 95%CI:1.91-2.06), or having a diagnosis of colorectal, leukemia, lung, lymphoma, multiple myeloma, oral cavity, ovary, and brain cancer relative to prostate cancer (OR range: 1.96-3.69). Black (OR=2.20, 95%CI:2.09-2.33) and Hispanic (OR=1.70, 95%CI:1.60-2.33) adults were more likely to transition from FFS to MA. Understanding reasons for switching types of Medicare insurance among patients with cancer may be important for interpreting studies of social determinants of health using SEER-Medicare data.
USING MIXED EFFECTS GROWTH MODEL TO EXAMINE LONG-TERM COURSE OF PHYSICAL ACTIVITIES AMONG POSTSTROKE PATIENTS
Authors: Han Ling , Luzum Geske , Allore Heather , Askim Torunn , Tan Xiangchun , Thingstad Pernille , Håberg Asta , Saltvedt Ingvild 
Published: January 2025

Abstract
Restoring function and regaining physical activity (PA) is a fundamental goal of post-stroke rehabilitation programs, yet empirical evidence is lacking for long-term PA. Using data from the Nor-COAST study, we followed 277 individuals (mean age at baseline: 70.1, SD 10.9). Using a thigh-worn accelerometer, PA was measured for total upright time (UPT) in minutes over each 24-hr period for 6 consecutive days at 3-, 18-, and 36-months post-stroke. A mixed effects linear growth model examined post-stroke PA course, with a patient-specific random intercept to account for nesting effects of repeated UPT measurements. On average the UPT times declined by 0.61 min (95% Confidence Interval (CI): 0.84-0.62) per month after adjusting for ten a priori selected confounding factors. The adjusted average UPT is 42.5 min (95% CI: 67.2-18.1) shorter in men than in women; while one-yr aging reduced UPT time by 22.9 min (95% CI: 35.3-10.5). As expected, the day-1 NIH Stroke Scale (mean 2.8, SD 4.3) was associated with shorter UPT time (Mean difference: 7.3 min (95% CI: 3.2-11.3)). The final adjusted model revealed substantial between-patient UPT variations (intercorrelation coefficient, 0.55). These findings suggest that the PA of post-stroke patients appear to follow a modest, yet declining course over the 3 years, with substantial variation across individuals with different demographic and clinical profiles, calling for extending professional follow-up and individually tailored PA rehabilitation programs. Future studies may need to consider broader contexts of enabling PA of patients and their families, such as “walkable” neighborhoods and socioeconomic environments of communities.
COMMUNITY RATES OF CAREGIVING IN RI AND CT: FINDINGS FROM THE HEALTHY AGING DATA REPORTS
Authors: Qu Shan , Jansen Taylor , Lee Chae Man , Silverstein Nina , Dugan Elizabeth 
Published: January 2025

Abstract
Informal caregivers are a significant but often overlooked part of the US healthcare system. Grandparents may provide and receive care and may be important members of the informal support network for many families. The demands and stresses of caregiving may negatively impact caregivers’ health. Understanding the prevalence of caregiving at the community level can guide resource allocation, policy decisions, and advocacy efforts to support caregivers and improve all residents’ well-being. The present study examines disparities in community rates in Rhode Island (RI) and Connecticut (CT) for three caregiving indicators: older adults aged 60+ who provided caregiving in the last month, grandparents raising grandchildren, and grandparents who live with grandchildren. For this study, rates were calculated from the following data sources: the Behavioral Risk Factor Surveillance System (2015-2017) and the American Community Survey (2016-2018). Small area estimation techniques were used to calculate age-sex adjusted community rates (https://healthyagingdatareports.org/). Results showed that while RI had a slightly higher statewide rate of caregiving (22.5% vs 21.7% in CT) the range in community rates (14.84%-27.43%) was much larger in CT compared to RI (19.17%-27.30%). RI (0.8%) also had a slightly higher rate of grandparents raising grandchildren than CT (0.7%), but Hartford CT had the highest community rate in the two states (2.93%). RI (2.8%) also had a higher rate of grandparents who live with grandchildren than CT (2.5%). This study found that older adults providing caregiving is prevalent, and older adults play a significant role in raising grandchildren in CT and RI.
ENHANCING POSITIVE AFFECT AND CAREGIVER EFFICACY (ENHANCE): INTERVENTION DEVELOPMENT FEEDBACK
Authors: Mason Hannah , Torres Ana Sophia Garces , Chang E-Shien , Czaja Sara 
Published: January 2025

Abstract
Currently about 11.5 million informal caregivers are providing care for older adults with Alzheimer’s Disease and Related Dementias (ADRD). The overburdening of these caregivers fosters an urgency for assistive programs and services. Two important determinants of caregivers’ use of available services are accessibility and relevance, both having potential to be a facilitator or barrier to service use. To address the need for accessible and efficacious caregiver interventions, the Enhancing Positive Affect and Caregiver Efficacy (ENHANCE) intervention program is being developed. ENHANCE is a multicomponent, technology-based and personalized intervention that offers self-guided opportunities and one-on-one sessions to deliver caregiving skills, access to resources, and intrapersonal support. As part of the development process, two focus groups (n=11) were conducted with ADRD caregivers to identify caregiving challenges and obtain feedback on the ENHANCE intervention prototype. This presentation will discuss findings from the focus groups. Thematic analysis revealed three common challenges among the caregivers: (1) identity loss and emotional repression, (2) communication difficulties particularly with family and healthcare providers, and (3) unreliable formal support services. Caregivers were enthusiastic about the topics included in the ENHANCE program, particularly legal/financial planning and communication. Several participants wanted to meet again, highlighting the value of open discussion among caregivers and the importance of having their voices at the table when developing caregiving services. Incorporating caregivers’ perspectives to aid the development of caregiving interventions like the ENHANCE program can improve their design, utility, and accessibility.
FAMILY CAREGIVING COMPETENCIES FOR NURSING EDUCATION: COURSE AND CURRICULAR INTEGRATION
Authors: Hart Sara , Davis Andra , Sexson Kathryn , Zhao Hui , Seward Tanya , Perkins Connie , Cowen Nannette , Mongoven Jennifer 
Published: January 2025

Abstract
The U.S. health care system is increasingly dependent on family caregivers who play an essential role in addressing the needs of loved ones who are aging, managing chronic or disabling conditions, or facing life-limiting illnesses. The National Consortium for Family Caregiving in Nursing Education has developed twenty entry-level nursing education competencies for identifying, integrating, and supporting family caregivers in person-centered and family-centered healthcare teams. These competencies fall within four domains: the Nature of Family Caregiving, Family Caregiving Identification and Assessment, Providing Family-centered Care, and the Context of Family Caregiving. Given the time and content limitations of nursing education and the dynamic nature of healthcare, new educational competencies often encounter resistance. Here we present the competencies, along side course and curricular resources and exemplars created by the Consortium. These resources are designed to support nursing educators in identifying and integrating content and teaching methods that advance the inclusion of family caregivers in patient and family-centered care teams and that promote nursing student development of family caregiving competencies.
HEALTH INSURANCE AND FAMILY CAREGIVERS: CAREGIVERS’ PERCEPTIONS OF COMMUNICATION BY SERVICE PROVIDERS
Authors: Balmuth Alexa , Felts Adam , Ashebir Sophia , Brady Samantha , Lee Chaiwoo , D’Ambrosio Lisa , Coughlin Joseph 
Published: January 2025

Abstract
Health insurers not only play a key role in older adults’ access to medical care and services, but also interact with and, in some cases, provide benefits for caregivers of older family members. Additionally, family caregivers interact with their care recipient’s insurer to manage healthcare-related payments and when seeking information and support for their caregiving role. The relationship between health insurers and family caregivers can be just as important as their relationship with the plan member. Understanding how caregivers perceive and interact with their care recipient’s insurer is important to ensuring continuity of communication and care for older adults, as well as support for caregivers themselves. Paired with qualitative interviews, results from a survey of 244 current family caregivers in fall 2023, found that despite high levels of reported health insurance coverage among care recipients, many caregivers reported that their loved one’s health plans did not provide caregiving benefits, and many reported that they did not know if their care recipient’s health insurance offered any caregiving benefits. Results highlight caregivers’ perceptions and trust in health insurers – and how these vary across insurance types and providers. This session will provide implications for health service providers to improve communications with caregivers, including communications around their full range of offerings to caregivers and identifying caregivers’ preferred frequencies and modes of communication with insurers. Ultimately, this research aims to contribute to better health outcomes and quality of life for older adults and improved support for family caregivers.
HOURS CAREGIVING, ADLS, ROLE OVERLOAD, AND DEPRESSION SYMPTOMS: AN EXAMINATION AMONG FAMILY DEMENTIA CAREGIVERS
Authors: McDonald Claire , Bravo Adrian 
Published: January 2025

Abstract
The present study examined the associations between hours spent caregiving, Activity of Daily Living (ADL) dependency, role overload as a stressor, and depression symptoms among caregivers of adults aged 65 and older living with probable dementia. Specifically, we hypothesized that more time spent caregiving and greater ADL dependency would both be associated with more depression symptoms via greater role overload. To test study aims, we analyzed data from round 11 of the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC). To replicate findings from NHATS and NSOC, a second sample of data was collected using Academic Prolific. In the NHATS sample, there were 283 caregivers and the majority of caregivers were female (70%), white (63%) and reported an average age of 65. For the Prolific sample, there were 150 caregivers and the majority were female (51%), white (68%), and reported an average age of 40. Mediation models were tested using the PROCESS Macro (Hayes, 2013) in SPSS. In both NHATs and Prolific samples, role overload significantly mediated the associations between hours caregiving and depression symptoms (NHATs indirect β =.119, CI [.07,.18]) (Prolific indirect β =.118, CI [.02,.21]). In both NHATs and Prolific samples, role overload significantly mediated the associations between ADL dependency and depression symptoms (NHATs indirect β =.07, CI [.01,.13]) (Prolific indirect β =.111, CI [.02,.20]). These findings highlight the impact of burden among family dementia caregivers and should be investigated in more diverse populations.