bluuebunny/crossref_metadata_2025_split huggingface dataset:
KINLESS OLDER ADULTS WITH DEMENTIA: QUALITATIVE ANALYSIS OF DATA FROM THE ADULT CHANGES IN THOUGHT STUDY
Authors: Taylor Janelle , Gray Marlaine Figueroa , Freitag Callie , Kariya Hitomi , Crane Paul , Vig Elizabeth , Berridge Clara , Larson Eric 
Published: January 2025

Abstract

Objectives
To examine the circumstances and needs of older adults who were “kinless,” defined as having no living spouse or children, when they developed dementia.

Methods
We conducted a secondary analysis of information from the Adult Changes in Thought study. Among 848 participants diagnosed with dementia between 1994 and 2016, we identified 64 who had no living spouse or child at dementia onset. We then conducted a qualitative analysis of administrative documents pertaining to these participants: handwritten comments recorded after each study visit, and medical history documents containing clinical chart notes from participants’ medical records.

Results
In this community-dwelling cohort of older adults diagnosed with dementia, 8.4% were kinless at dementia onset. Participants in this sample had an average age of 87 years old, half lived alone, and one third lived with unrelated persons. Through inductive content analysis, we identified 4 themes that describe their circumstances and needs: (1) life trajectories, (2) caregiving resources, (3) care needs and gaps, and (4) turning points in caregiving arrangements.

Discussion
Our qualitative analysis reveals that the life trajectories that led members of the analytic cohort to be kinless at dementia onset were quite varied. This research highlights the importance of nonfamily caregivers and participants’ own roles as caregivers. Our findings suggest that clinicians and health systems may need to work with other parties to directly provide dementia caregiving support rather than rely on family, and address factors such as neighborhood affordability that particularly affect older adults who have limited family support.
LET’S GET PHYSICAL: ACTIVITY, FUNCTION, AND FITNESS AS KEY COMPONENTS OF AGING AND HEALTH
Authors: Schrack Jennifer , Wanigatunga Amal , Spira Adam 
Published: January 2025

Abstract
Physical activity, physical function, and physical fitness (“activity, function and fitness”) are established predictors of health and longevity. Yet, many aspects of how and why measures of activity, function, and fitness are so strongly linked with physical and cognitive health in older adults remain under-addressed. This is further complicated by the multidimensional aspects of activity, function, and fitness, allowing them to function as both predictors and outcomes of health. This symposium will focus on quantifying and defining measures of activity, function, and fitness and their associations with various features of physical and cognitive health across several large U.S. cohort studies. Dr. Davoudi will present the prevalence of impairments in motor function (gait speed, chair stands, standing balance, grip strength) in the National Health and Aging Trends Study (NHATS). Dr. Wanigatunga will describe new methodology to assess the combined contribution of sensory and motor functioning to cognitive health in the Baltimore Longitudinal Study of Aging (BLSA) and the Atherosclerosis Risk in Communities (ARIC) study. Dr. Dougherty will present the association of physical activity with Alzheimer’s biomarkers (amyloid, total tau, phosphorylated tau) and cognitive functioning in the Biomarkers of Cognitive Decline Among Normal Individuals (BIOCARD) study. Dr. Twardzik will describe trends in public transit use and associations with physical activity in NHATS. Finally, Dr. Yue will present the association of sleep quality and quantity with measures of fitness and energetic efficiency in the BLSA. Collectively, these presentations will highlight novel pathways through which activity, function, and fitness contribute to healthy aging.
LINKS OF SLEEP WITH CHANGES IN CARDIORESPIRATORY FITNESS AND ENERGETIC EFFICIENCY IN MIDDLE-AGED AND OLDER ADULTS
Authors: Yue Yiwei , Callow Daniel , Diallo Idiatou , Rabinowitz Jill , Wanigatunga Sarah , Simonsick Eleanor , Schrack Jennifer , Spira Adam 
Published: January 2025

Abstract
Sleep disturbances are linked to cardiovascular disease in middle-aged and older adults, but little is known about the associations of poor sleep with cardiovascular fitness and energetic measures in this population. We investigated cross-sectional and longitudinal associations of actigraphic sleep parameters with cardiorespiratory fitness, walking energetics, and resting metabolic rate among 263 participants (mean age=72.7±10.1 years, 53.6% women) in the Baltimore Longitudinal Study of Aging. Additionally, we assessed modifying roles of sex, race, and age in these associations. Primary predictors included actigraphic total sleep time (TST), sleep efficiency (SE; % of time in bed spent asleep), sleep onset latency (SOL), wake after sleep onset (WASO), and average wake bout length (WBL). Outcomes included maximal oxygen consumption (VO2max), energetic cost of walking (ECW), and resting metabolic rate (RMR). Adjusting for demographics, comorbidities, self-reported physical activity, time, and interactions of time with covariates, longer WBL was cross-sectionally associated with lower VO2max (B=-1.24, p&lt;0.01) and higher RMR (B=62.65, p&lt;0.01); lower SE with lower VO2max (B=1.18, p&lt;0.01); and shorter TST with higher RMR (B=-16.03, p&lt;0.05). Women had stronger associations between longer TST and higher VO2max and greater WBL with slower decline in VO2max than men. Middle-aged adults showed stronger connections of higher SE and lower WASO with lower RMR than older adults (interaction p-values&lt;0.05). In summary, shorter TST, longer WBL, and lower SE are linked with poorer cardiorespiratory fitness and energetic efficiency among middle-aged and older adults. Studies are needed to determine whether enhancing sleep can improve fitness and energetic efficiency, and vice-versa.
C-REACTIVE PROTEIN LEVELS AMONG LGB OLDER ADULTS: INTERSECTIONAL ASSOCIATIONS OF RACE, ETHNICITY, AND EDUCATION
Authors: Alberth Andrew , Prasad Anyah , Collins Amanda , Rataj Alison , Farmer Heather , Stokes Jeffrey 
Published: January 2025

Abstract

Objectives
This paper assesses the intersection between sexual orientation, race, and ethnicity as they relate to CRP levels among middle-aged and older adults in the Health and Retirement Study (HRS). It will also explore how educational attainment, a commonly used demographic correlate with socioeconomic status, may differently benefit racially, ethnically, and sexually diverse middle-age and older adults.

Methods
This study uses data from the 2016 Health and Retirement study. C-reactive protein levels, sexual orientation, race and ethnicity, educational attainment, and covariate variables were collected using serum samples and survey responses from 1,426 older adults enrolled in the study. Individuals were included if they had reported measures for key independent and dependent variables. Multiple imputation was used to address missing values across control variables. Associations and moderators were assessed using ordinary least squares (OLS) regression.

Results
This study found lesbian, gay, and bisexual (LGB) respondents had lower CRP levels when they had higher educational attainment compared to similarly educated straight respondents. Additionally, Black LGB respondents had less inflammation than Black and straight or White and LGB respondents.

Discussion
This study’s findings indicate educational attainment may differently benefit LGB older adults compared to straight older adults, and respondents who are Black and LGB experience greater protection from elevated CRP levels compared to only Black or LGB respondents. These findings suggest educational attainment may be differently used to protect against systemic inflammation among sexual minority populations. Furthermore, these results suggest additional nuance is necessary to understand how CRP levels impact diverse populations.
SECOND CLASS CARE: PATTERNS OF LGBTQ+ PATIENT EXPERIENCES AND RECEIPT OF PREVENTIVE CARE IN MIDLIFE AND OLDER AGE
Authors: Tran Nathaniel , McKay Tara , Gonzales Gilbert , Fry Carrie , Dusetzina Stacie 
Published: January 2025

Abstract
The objectives of this study were to (1) Identify latent classes of LGBTQ+ patient experiences using seven indicators of clinical and cultural competence, (2) Identify sociodemographic characteristics associated with class membership, and (3) Estimate the association between class of patient experiences and receipt of preventive care. The sample included 954 LGBTQ+ adults aged 50-76 from the Vanderbilt University Social Networks, Aging, and Policy Study. Respondents reported on seven indicators of their clinician’s LGBTQ+ clinical and cultural competency. Latent class analysis was conducted to identify patterns of LGBTQ+ patient experiences. We estimated marginal effects of class membership on preventive care using logistic regression. Three latent classes emerged: 34% assigned to the Affirming class, 60% to the Neutral class, and 6% to the Discriminatory class. Gender identity, sexual orientation, race/ethnicity, state of residency, and HIV status significantly predicted class membership (all p&lt; 0.01), but not education, income, health insurance, or chronic conditions. Compared to those the Affirming class, individuals in the Neutral class were 12.4pp less likely to have ever been tested for HIV and 17.1pp less likely to have been recently tested for HIV, both p&lt; 0.001; those in the Discriminatory class were 12.2pp less likely to have recently received an influenza vaccination and 14.8pp less likely to have recently completed a colorectal cancer screening, both p&lt; 0.05. In the absence of explicitly affirming healthcare experiences, LGBTQ+ patients are less likely to receive timely preventive services. Increasing the capacity of health systems to provide LGBTQ+ affirming healthcare may advance health equity.
RISK AND RESILIENCE RELATED TO SELF-PERCEPTIONS OF AGING AMONG LESBIAN AND GAY OLDER ADULTS
Authors: Guest M Aaron , Giasson Hannah , Koffer Rachel 
Published: January 2025

Abstract
Lesbian and gay individuals may face unique experiences and expectations associated with growing older. In part, this may result from the perception of an overemphasis on youth in the LGBTQ+ community. The present study aimed to provide a preliminary model of how lesbian and gay adults view their aging and identify psychosocial risk and resilience factors specific to this community. Data are from a pilot study of social perceptions of aging in lesbian and gay adults, in which 45 gay and 46 lesbian adult participants (ages = 55-87, 70% white) completed questionnaires on their health, perceptions of aging, community engagement, identity congruence, and stressful experiences. Self-perceptions of aging were measured with an 8-item scale ranging from 1 to 6, where higher scores indicate greater agreement with positive perceptions of aging. In a regression model accounting for age, self-rated health, subjective socioeconomic status, and race/ethnicity, lesbian women reported better self-perceptions of aging than gay men (b = 0.50, SE = 0.16, p &lt;.01). Further, greater outness was associated with better self-perceptions of aging (b = 0.04, SE = 0.01, p =.01), LGBTQ+ community engagement did not relate to self-perceptions of aging (b = -0.11, SE = 0.12, p =.38). More stressful experiences in daily life were associated with worse self-perceptions of aging (b = -0.14, SE = 0.05, p &lt;.01). Results will be discussed in the context of a model of risk and resilience for “accelerated social aging” among Lesbian and Gay populations.
POLICY SERIES: MOVING FORWARD NURSING HOME COALITION CALL TO ACTION: BUILDING A SYSTEM FOR RESIDENT GOALS, PREFERENCES, PRIORITIES
Authors: McMullen Tara , Shippee Tetyana 
Published: January 2025

Abstract
A 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report on nursing home quality called for nursing homes to provide care aligned with residents’ goals to ensure autonomy, quality of life, and to manage risks. While there are existing structures to support care planning clinical needs, most nursing homes lack tools and procedures to systematically identify and provide care that aligns with resident goals, priorities, and preferences (GPPs). GPPs are part of the care planning process that translates into actionable interventions supported by measurement to determine if care aligns and is concordant with GPPs, and health information technology to collect GPPs. Many nursing homes are working to improve the way they gather residents’ GPPs, and develop and implement unique care plans. These efforts represent an opportunity to improve outcomes and reduce disparities. Experts representing the Moving Forward Nursing Home Quality Coalition are developing an integrated approach to these challenges. This presentation will describe the Moving Forward Nursing Home Quality Coalition and a) the purpose and structure of the new Guide for Addressing Resident GPPs; b) an evaluation that explores whether a resident’s self-directed GPPs were included in their care; c) a description of the tools that assess GPPs and the feasibility of using those tools; and d) discussion about the development of technology advancements promoting HIT readiness and person-centered care. When completed, proposed work will provide evidence of successful and feasible quality improvement approaches to care planning resident GPPs that can inform future policy changes and guidance to surveyors.
THE DESIGN AND PILOTING OF A NEW GUIDE FOR ADDRESSING RESIDENT GOALS, PREFERENCES, AND PRIORITIES
Authors: Cornelison Laci , Ciolfi Mary Lou 
Published: January 2025

Abstract
Engaging nursing home residents and their designated representatives in meaningful conversation about their needs and preferences for care, services, and environments is essential to high quality long-term care, as confirmed in the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report. The Moving Forward Coalition’s Goal One Committee has created a quality improvement Guide for Addressing Resident Goals, Preferences, and Priorities (GPPs) to support nursing home care planning staff in improving and deepening care planning conversations with residents. The Guide includes key suggestions, tools, resources, and training material that will help homes lay a foundation for resident and family inclusion and empowerment in disclosing goals, preferences, and priorities (GPPs) and also in implementing those GPPs at the outset of a resident’s admission to care and as needs and preferences change over time. Goal Committee One leads will present the Guide purpose and design along with a review of included resources; review the feedback and suggestions from myriad nursing home stakeholders, including current nursing home residents, nursing home providers, and nursing home quality improvement organizations; outline the results of the Guide pilot in several nursing homes, and the upcoming planned Guide evaluation and wider dissemination.
MOVING FORWARD TOWARD A NURSING HOME MEASURE FOR GOAL CONCORDANCE AND EVALUATION OF RESIDENT GOALS
Authors: McMullen Tara 
Published: January 2025

Abstract
Longstanding evidence suggests that the goals, preferences, and priorities (GPP) of nursing facility residents may not be adequately addressed during episodes of care. Aligning care with residents’ GPP represents an opportunity to improve outcomes and reduce disparities in the resident population. The 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report recommended improvement in quality measures under the domain of resident and family experience, along with reporting of these measures on Care Compare to improve shared decision-making and transparency. The subcommittee on quality improvement and measurement is focused primarily on measures of GPP as a useful addition to CMS’ plans to expand the Quality Reporting Program (QRP) measure set. To develop a reliable measure of concordance, this committee explored and assessed the alignment between the individual goals set by residents and the care interventions provided by the staff in routine care delivery. In an evaluation that employed in-depth interviews and reviews of the resident care plan and portions of the medical record, this group of subject matter experts attempted to gain a better understanding of the concordance between resident goals and care provision with the intent to identify areas for improvement in care delivery and enhanced person-centered care practices. In this presentation, committee members will discuss the development and outcomes of this evaluation along with an update on the development of a care concordant measure for nursing home settings.
IDENTIFYING TOOLS TO MEASURE NURSING HOME RESIDENT GOALS, PRIORITIES, AND PREFERENCES FOR PERSON-CENTERED CARE
Authors: Roberts Tonya , Parikh Romil , Li Jingxi , Nizza Megan , Smith Amelia , Levy Sorah , Shippee Tetyana 
Published: January 2025

Abstract
Identifying nursing home (NH) residents’ goals, priorities, and preferences is a critical step in the delivery of person-centered care. While numerous instruments and tools exist to measure resident preferences, it remains unclear how psychometrically validated instruments used in research may be feasibly applied in practice. In this review, we aimed to identify instruments for assessing residents’ goals, priorities, and preferences and develop recommendations for application in practice. We searched MEDLINE, CINAHL, and PsycINFO databases to identify instruments that assessed quality of life, satisfaction, person-centered care, psychosocial needs and goals, and preferences and were validated in US NHs. We also surveyed experts in the field to identify assessment tools from grey literature. We identified a total of 28 validated tools from 23 peer-reviewed articles and 12 additional tools from 35 grey literature sources. These tools varied in structure (e.g. open vs closed questions), content (e.g. domains covered), and length (e.g. few to many items). Tools could be grouped into two major types: generative and evaluative. Generative tools assessed specific resident goals, priorities, and preferences that could inform care planning particularly upon admission, but also throughout the resident’s stay. Evaluative tools required residents to evaluate aspects of care and may be most appropriate beyond admission. NH staff may find different benefits to various assessment approaches and may need to make local decisions about which to use and which will integrate into existing workflows effectively.
GENDER AND EDUCATIONAL DIFFERENCES IN TRAJECTORIES OF PHYSIOLOGICAL AGEING
Authors: Bloomberg Mikaela , Steptoe Andrew 
Published: January 2025

Abstract
Though gender and education are key characteristics that contribute to heterogeneity in ageing-related outcomes, how physiological age (PA) differs by gender and education level is not yet clear. Furthermore, previous studies examining PA are cross-sectional; understanding how PA changes with increasing chronological age is a necessary next step. We examined how gender and education interacted to inform longitudinal PA trajectories using three waves of data (2004/05-2012/13) from 8,891 ELSA participants. PA was derived in a healthy subsample then validated in the full analytic sample by confirming associations between PA and incident ageing-related chronic conditions, memory impairment, and functional limitations. We then used joint models adjusted for birth cohort to produce trajectories of PA between chronological ages 50 and 80 in men and women at three levels of education (less than high school, high school, and above high school). Gender differences in PA were minor at age 50, but PA increased faster in women than in men (p &lt; 0.001); by age 70, women had PA 1.6 years (95% confidence interval=1.0-2.1) older than men. Examination of interactions between gender and education revealed that these gender differences occurred among less educated women only (p interaction=0.03); women educated above high school level maintained PA younger than men at age 70. These results suggest that higher education may be important to reduce gender disparities in physiological ageing. Policies to promote gender equity in higher education may contribute to reducing gender inequalities in a wide range of health outcomes in old age.
SPOTLIGHTING THE EXPERIENCES OF THE HOME CARE WORKFORCE CARING FOR OLDER ADULTS LIVING WITH DEMENTIA
Authors: Fabius Chanee , Spetz Joanne 
Published: January 2025

Abstract
Medicaid Home and community-based services (HCBS) and home-based clinical care (i.e., Medicare home health care) aim to support independence and well-being in the community, especially for older adults living with disability and complex health conditions, such as dementia. Many older adults receive both Medicaid HBCS and home-based clinical care, often concurrently, with services coordinated and delivered by paid and unpaid care partners including care managers, home care workers, and family caregivers. Amid concerns related to workforce shortages, shifting payment policies, and the rising complexity of those aging in place, there have been recent calls to better support the workforce providing care in the home. Responding to these calls will require additional knowledge and understanding of the experiences of workforce members as well as the older adults they serve. This symposium presents four unique studies that describe: 1) experiences of care managers (“supports planners” in Maryland) serving older adults with and without dementia in Medicaid HCBS in Maryland; 2) unmet caregiving needs in a national sample of Medicare home health patients living with dementia; 3) Medicare home health clinician perspectives on supporting dementia caregivers through health information technology, and 4) home care worker attitudes about delivering person-centered care for persons living with dementia. The findings presented reveal current areas of challenge and inform the development of innovative strategies to better support the range of paid and unpaid caregivers caring for older adults living with dementia in the community.
HOME CARE WORKER PERSPECTIVES ON PERSON-CENTERED CARE FOR PEOPLE WITH DEMENTIA
Authors: Reckrey Jennifer , Xu Emily , Watman Deborah , Perez Sasha , Franzosa Emily 
Published: January 2025

Abstract
Person-centered care for people living with dementia has been associated with improved functional ability and quality of life, yet little is known about person-centered care in the home setting. This study explored home care worker perspectives on providing person-centered care for people living with dementia. Using secondary qualitative analysis of 22 semi-structured interviews with home care workers, we identified themes related to the Dementia Initiative’s person-centered dementia care framework. We found that home care workers frequently acknowledged their client’s personhood and developed meaningful relationships with their clients, implementing individualized strategies to meet client needs. However, barriers to person-centered care included limitations of home care worker scope of practice and challenging dynamics with other home care workers and family caregivers. In addition, home care agencies’ formal care plans sometimes served as a barrier to person-centered care, but home care workers advocated within and around their task-based duties to ensure client needs were met. This analysis highlights the importance of integrating home care workers in person-centered healthcare teams and sustaining the meaningful relationships between home care workers and their clients, family caregivers, and other home care workers. Standardized training of home care workers in the principles and goals of person-centered dementia care could enhance existing person-centered care practices and promote alternatives to disease-centered practices. Recognizing home care workers’ unique role in providing person-centered care is essential to identify and meet the needs of people living with dementia in the community and their family caregivers.