bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOW DOES MEDICARE ELIGIBILITY AFFECT CHOICE AND UTILIZATION?: EVIDENCE FROM VETERANS
Authors: Aouad Marion , Rose Liam , Wagner Todd 
Published: January 2025

Abstract
Health insurance streamlines access to care, thereby improving well-being and health. In efforts to control costs, health insurers use selective contracting to limit the size of their provider networks. Regulators have focused on network adequacy rules, given concerns that overly restrictive networks may impede appropriate access. This raises an important question about what happens to patient behavior if a network expanded. We examine the effects of network expansions by focusing on veterans who receive care from the Veterans Health Administration (VHA). We exploit the change in their insurance network induced by Medicare eligibility at age 65 to examine changes in inpatient health care behaviors. Using regression discontinuity methods, we find that hospitalizations increase by approximately 3 percent at 65. Interestingly, there are large insurer reallocations – individuals increasingly choose the new Medicare option for hospitalizations once it is available (a 70 percent increase relative to the pre-65 share.) while the VHA and commercial insurers are used increasingly less, with an approximately 7 and 51 percent decline, compared to the pre-65 share, respectively. We also find larger reallocations toward Medicare for certain groups, particularly among individuals who live closest to a Medicare hospital and further from VHA hospitals, and among those who visit the hospital for elective medical procedures (e.g., knee replacement). The results show the link between network size and cost containment, with expansions resulting in greater use of elective inpatient care.
MEDICARE-MEDICAID DUAL ELIGIBLE SPECIAL NEEDS PLANS (D-SNPS): ENROLLMENT TRENDS (2007–2023)
Authors: Dahal Roshani 
Published: January 2025

Abstract
Dual-Eligible Special Needs Plans (D-SNPs), private Medicare Advantage plans, exclusively enroll Medicare-Medicaid dual enrollees. First operationalized in 2006 and popular among state Medicaid agencies, enrollment in integrated plans remains a challenge. CMS expects states to transition existing plans into D-SNPs by end of 2025. We used publicly available SNP monthly data (2007-2023) to examine enrollment growth. CMS began reporting on integration status (2022) of D-SNPs: Coordination-Only, Highly-Integrated (HIDE), and Fully-Integrated (FIDE). D-SNPs began with 0.67million duals (73.9% of SNP enrollment). A moratorium on SNPs (2008-2009) correlates with slight decline; however, Affordable Care Act (2010) lifted moratorium and legislation extended SNPs through 2018, resulting in higher enrollment (mean 81.7%). In February 2018, SNPs were permanently authorized and annual enrollment in D-SNPs has consistently increased (11% to 16%). As of December 2023, there were 5.69 million duals (+16.4%) in D-SNPs, representing 89.5% of SNP enrollment. Of 823 plans, 60.6% were Coordination-Only, 29.8% were HIDEs, and 8% were FIDEs. Only twelve states offered FIDE-SNPs. Percentage of integrated plans have declined in the last year, despite overall increase in all D-SNPs (Coordination-Only plans grew by 34%, FIDE 15.7%, HIDE 12.5%). D-SNP market has experienced consistent high growth rate, outpacing growth in Medicare Advantage (8%). Although designed to serve duals, focused on integrating Medicare-Medicaid benefits, less than 10% D-SNPs are fully integrated more than 15 years later. Although HIDE-SNPs (a higher level of integration) began only in 2021, almost 30% of duals are enrolled. Integration under D-SNPs is important for reducing fragmented care among duals.
UNMET NEEDS FOR MENTAL HEALTH CARE: ARE THERE RACIAL DISPARITIES AMONG OLDER AMERICANS IN NEW YORK?
Authors: Li Chien-Ching , Yen Pei-Shan , Chen Yi-Fan , Matthews Alicia 
Published: January 2025

Abstract
Racial and ethnic differences in mental health problems have been widely discussed in the existing literature. However, limited research examines the disparities in mental health care among older Americans, who have been found to face access barriers to care. This study aimed to examine the racial and ethnic disparities in unmet needs for mental health care among older Americans in New York. We analyzed data from the New York City Community Health Survey (NYC CHS; 2012-2020). Our study sample included participants aged 50 years and older from the NYC CHS. The dependent variable of interest was the unmet need for mental health care (yes, no), which was assessed through the question, “Did you need treatment for mental health but did not receive it?”. The independent variable was race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian/Pacific Islander, other non-Hispanic). Covariates measured at a multi-level, including demographics, access to care, and neighborhood factors, were included. Regression results indicated racial/ethnic disparities in unmet needs for mental health care. Individuals in other non-Hispanic group were more likely to report having unmet needs for mental health care. However, non-Hispanic Blacks and Asian/Pacific Islanders exhibited a higher likelihood of having unmet mental health care needs compared to Whites. More importantly, older individuals without a personal doctor and those residing in underprivileged neighborhoods were associated with a higher likelihood of having unmet mental health care needs. Further development of community-based interventions is needed to mitigate access barriers to mental health care among older Americans.
FEASIBILITY AND ACCEPTABILITY PILOT OF THE ENHANCING ACTIVE CAREGIVER TRAINING (ENACT) INTERVENTION
Authors: Eaton Jacqueline , Neller Sarah , Cajavilca Moroni Fernandez , Dayley Amber , Johnson Julene , Ellington Lee 
Published: January 2025

Abstract
The process of actively engaging dementia caregivers in interventions has been insufficiently studied. This limits our understanding on how best to improve interventions. Enhancing Active Caregiver Training (EnACT) was developed to facilitate active engagement using participant-informed vignettes that portray caregiving experiences. We conducted a randomized waitlist-controlled pilot study to test the feasibility and acceptability of EnACT with a group of 30 caregivers of persons living with dementia. Participants were randomly assigned to intervention (n=15) or control (n=15) groups. The intervention group received three EnACT sessions during the first 7 weeks, which was then repeated for the control. Sessions used the vignettes to facilitate small-group dialogue, exploration, and reflection. These were delivered by trained interventionists via Zoom and each session lasted 60 minutes. Feasibility and acceptability data were collected to assess 1) interventionist training and delivery, 2) acceptability of treatment conditions, 3) participant adherence, and 4) recruitment, randomization, and assessment protocols. Preliminary results suggest that EnACT is feasible and acceptable to caregivers and interventionists. Retention rates were high (97%) and twenty-nine participants (97%) completed all six outcome surveys. Levels of satisfaction improved across the intervention, with the highest satisfaction focused on interventionists, engagement, topics, length, and accessibility. Data from this pilot is being used to prepare and plan for a fully powered randomized controlled trial.
PERSONALIZED MUSIC PLAYLISTS FOR HOSPITALIZED OLDER ADULTS: CREATING AND REVISING VOLUNTEER WORKFLOW
Authors: Nguyen Victor , Morka Angela , Wong Kayla , Nandigam Maanasa , Kiwak Eliza , Li Judy , Sharninghausen Jody , Marottoli Richard 
Published: January 2025

Abstract
Personalized music has been shown to decrease the incidence of neuropsychiatric symptoms among hospitalized older adults. As part of the “Creativity in Aging” project at Yale Geriatrics, this quality improvement study aims to evaluate the process and feasibility of a personalized music program in an inpatient geriatrics unit. We collaborated with the hospital volunteer department to credential and train five undergraduate volunteers in building personalized music playlists for hospitalized older adults to listen to during their stay. From October 2023 to February 2024, 88 patients were referred to the program by hospital staff, and 57 patients participated. Here we describe the process of developing and revising the pilot. Following “test” sessions led by a medical student and resident physician familiar with the unit, an initial protocol was developed. Volunteers used REDCap and paper spreadsheets to organize HIPAA-secure patient data including referrals, linkage to personalized playlists stored on iPads, and brief pre- and post-listening surveys. Volunteers filled out feedback forms after each weekly shift to identify workflow issues and suggest improvements. Challenges included 1) identification of appropriate patients and 2) hand-off of patient referrals, notes, and next steps between shifts. Consultation with multiple stakeholders including volunteers, nursing managers, and attending physicians, led to solutions: 1) recruitment of nursing staff and creation of resident physician training module, after which nurses and resident physicians became key patient referral sources, and 2) remodeling of REDCap to manage volunteer “hand-off” communication, replacing the physical note-keeping system. We aim to make this a sustainable volunteer program.
A CROSS-NATIONAL COMPARISON OF THE EFFECT OF SMOKING AND DRINKING BEHAVIOR ON COGNITIVE HEALTH IN TAIWAN AND THE US
Authors: Su Yan-Jhu , Shih Yao-Chi 
Published: January 2025

Abstract
Previous studies have shown that smoking tobacco and alcohol consumption impact individuals’ cognitive health. However, less studies have focused on cross-national comparisons of the effects of smoking and alcohol consumption on cognitive health and their differential effects across gender. This cross-sectional study used the Health and Retirement Study (HRS) 2018 (N= 7,467) and the Taiwan Longitudinal Study in Aging (TLSA) 2019 (N=2,776) for comparison. The cognitive function scores of the HRS are from the Telephone Interview of Cognitive Status-Modified (TICS-M; range: 0-35). For the TLSA, the Montreal Cognitive Assessment (MoCA; range: 0-30) is used. Our results show that both smoking and drinking negatively affect one’s cognitive health among the US and Taiwanese populations, yet important gender differences were found. Taiwanese women aged 60 and older were found to have lower cognitive scores relative to otherwise similar men; however, in the United States, middle-aged and older women were found to perform better in their cognitive tests than their male counterparts. No moderating effects of gender on smoking were found among older persons from both countries. Some drinking was found to be protective for Taiwanese women, while binge drinking among US women further negatively impacted their cognitive health. Findings suggest that both smoking and drinking may impose negative influence on one’s cognitive health and these impacts differ by gender. These differences may be the result of differences in the social context and cultural meaning of health behaviors. Further research is needed to address gender disparities in health behaviors.
PREVENTING SOCIAL ISOLATION AND LONELINESS AMONG OLDER ADULTS WITH DEMENTIA: FINDINGS AND INSIGHTS FROM JAPAN
Authors: Chen Limei , Inoue Megumi 
Published: January 2025

Abstract
This study examines the implementation and impact of social capital interventions to mitigate the interplay between social isolation, loneliness, and dementia within Japan’s aging population. With an emphasis on advancing knowledge through a socio-ecological approach, our research focuses on social capital interventions, leveraging “chiiki-ryoku” (community power) at the community level for individuals with dementia and their caregivers. These interventions include Community (Dementia) Cafes, Dementia Supporter Caravan Training Programs, Community Social Workers, and Dementia Friendly-Communities, which are evaluated for their effectiveness in fostering social engagement and support networks. Our findings highlight the critical role of social capital in enhancing community resilience and well-being, demonstrating that interventions that cultivate active social participation and strong social networks in defined physical spaces such as junior high school area or municipal area can serve as protective factors against social isolation and loneliness. The research contributes to the broader discourse on social capital and dementia care by revealing the nuanced challenges and potential for meaningful impact through context-sensitive, integrative strategies. It posits that fostering a sense of belonging and meaningful relationships within communities can significantly alleviate the adverse effects of loneliness and social isolation among those affected by dementia. Through a detailed examination of Japan’s response to dementia-related social isolation, this study provides insights into the development of effective, sustainable interventions that promote social health and well-being in aging societies.
SOCIAL NETWORKING SITE USE AND MENTAL HEALTH IN OLDER LGB CANADIANS IN THE CLSA
Authors: Grady Alexandra , Stinchcombe Arne 
Published: January 2025

Abstract
The Internet has historically been an important avenue for social connection between lesbian, gay, and bisexual (LGB) people. Social networking sites (SNS) may have positive mental health impacts for LGB people. Limited research has explored SNS use in older LGB adults. The purpose of this study was to examine SNS use by sexual orientation in a sample of heterosexual and LGB Canadians using data collected from Follow-up 1 of the Canadian Longitudinal Study on Aging (n=21,836; 583 LGB). Participants completed self-report measures of SNS use, depression symptoms (CESD-10), and loneliness (UCLA 3-item Loneliness Scale). After adjusting for age, gender, income, and education, a significant difference remained in the odds of LGB participants using SNS to make new friends (OR = 1.82, p&lt;.001) and promote themselves or their work (OR = 1.34, p=.005) in comparison to heterosexual participants. In terms of mental health, the linear regression treating depression as the outcome variable showed an interaction between being LGB and using SNS to stay in touch with friends (B=-1.23, p=.012), such that using SNS to stay in touch with friends as an LGB person was associated with fewer depression symptoms. The linear regression treating loneliness as the outcome variable showed an interaction between being LGB and using SNS to make new friends (B=.44, p=.013), indicating that LGB people who use SNS to make new friends report more loneliness than heterosexual people who use SNS to make new friends. This study adds to the growing literature on how older LGB adults use SNS.
AN ANALYSIS OF PALLIATIVE CARE PROVIDER NURSING HOME CONSULTATIONS FOR PATIENTS WITH COGNITIVE IMPAIRMENT
Authors: Nesvet Matthew , Floyd Alex , Cagle John , Elftmann Hanley , Unroe Kathleen 
Published: January 2025

Abstract
Nursing homes (NH) are important sites of care for people with serious illnesses in need of end-of-life care. Extant studies have shown NH residents with dementia struggle to receive high quality care. There is some evidence that palliative care (PC) interventions may improve quality of life (QOL) and care. There is little prior description of PC consults conducted in the nursing home setting. We examined notes PC providers wrote after initial consults with 197 residents of 8 nursing homes enrolled in UPLIFT, an NIH-funded clinical trial evaluating implementation of a PC model of care. Residents enrolled in UPLIFT who screened positive for PC needs were referred for consultations. We analyzed initial consult notes to learn about the residents referred and content of the consultative visits, including recommendations made. Mean age of the residents was 75 years. 70% were White, 19% Black/African American, and 52% female. Goals of care were discussed in 83% of the PC consults, the most commonly observed intervention. The most frequent types of recommendations by PC providers were: 1) medication-related (n=207); 2) referrals to other clinical services (n=103); 3) non-pharmacologic symptom relief (n=53); and 4) specific recommendations for NH staff-based activities (n=40). In total, PC providers averaged three recommendations when at least one family member, friend, or guardian was present during the clinical encounter in person (n=127) or by phone (n=38), and two when only the resident participated in the encounter (n=33).
PREVALENCE AND LONGITUDINAL PERSISTENCE OF PAIN IN DEPARTMENT OF VETERANS AFFAIRS (VA) NURSING HOMES
Authors: Am Linda , Jacques Wildjena Jean , Zhao Shibei , Quach Emma , Hartmann Christine , Pimentel Camilla 
Published: January 2025

Abstract
Pain is highly prevalent in U.S. nursing homes, with estimates of 22%-85% of residents experiencing any pain (Cole et al., 2022). Current studies about pain in Department of Veterans Affairs (VA) nursing homes offer information about a single point in time. Identifying whether pain improves or worsens is critical but difficult. We evaluated prevalence and longitudinal patterns of pain among residents of VA’s 134 nursing homes. We used individual-level VA data from the Minimum Data Set 3.0 from October 1, 2018 to September 30, 2019 (N=40,954). We limited analyses to residents with long length of stay (&gt;100 days); admission, quarterly, or annual clinical assessments (A0310=1,2,3); not comatose (J0200=1); and recent self-reported/observed pain (J0300=1). We randomly selected an “index” assessment for each resident and evaluated pain in ≥2 subsequent, consecutive assessments. We defined “persistent pain” as pain consistent across assessments and “intermittent pain” as pain documented in only one assessment. Our analytic sample was 1,824 long-stay VA nursing home residents. Pain was documented among 900 (49.3%) residents, among whom 509 (56.6%) had persistent pain. Among residents with intermittent pain (N=391; 21.4%), 298 (76.2%) reported worsening pain, and 93 (23.8%) reported improvement in pain. This study demonstrates high prevalence of any pain and persistent pain in VA nursing homes, with experiences of pain potentially worsening over the course of a nursing home stay. Results are consistent with studies in non-VA nursing home settings, underscoring the need to address pain more effectively in all long-term care settings.
PERSONALITY TRAITS AS PREDICTORS OF BURNOUT IN SANDWICH GENERATION CAREGIVERS
Authors: Ju Catherine , Lohmar Sabine , Fenstermacher Erika , Owsiany Montgomery , Edelstein Barry 
Published: January 2025

Abstract
Informal caregiving increases the risk for burnout (i.e., emotional exhaustion, detachedness in caregiving relationships, reduced sense of accomplishment through helping). Sandwich generation caregivers, individuals who provide care for their children and older parents, face unique challenges and experience greater burnout than individuals caring for children alone. However, little research has examined what factors are associated with outcomes such as burnout in sandwich generation caregivers. Furthermore, studies on sandwich generation caregivers rarely utilize a resiliency-based approach. This study aimed to examine whether Big Five personality traits (i.e., openness, conscientiousness, extraversion, agreeableness, neuroticism) predicted burnout in sandwich generation caregivers (N = 102). A hierarchical regression model controlling for demographics, R² =.007, F(3, 98) =.222, p =.881, indicated that openness, conscientiousness, agreeableness, and neuroticism explained an additional 32.9% of the variance. This change in R² was significant, F(4, 94) = 11.628, p &lt;.001, with openness (β = -.215), conscientiousness (β = -.265), and neuroticism (β =.257) the only significant independent predictors, R² =.336, F(7, 94) = 6.781, p &lt;.001. In a different regression model, which controlled for depression, neuroticism was no longer a significant independent predictor. These results suggest that sandwich generation caregivers with higher levels of openness and conscientiousness and lower levels of neuroticism may experience lower levels of burnout. Findings from this study enhance our understanding of sandwich generation caregivers and what personality traits may serve as resiliency factors towards decreasing burnout. Further research can examine modifiable elements of these traits to increase resiliency.
EXPLORING THE ACTUAL SITUATION OF FAMILY CAREGIVING IN GER-DISTRICT IN THE SUBURBS OF ULAANBAATAR, MONGOLIA
Authors: Hashizume Yumi 
Published: January 2025

Abstract
Supporting family caregivers is going to be an increasing concern globally including developing countries. Mongolia, a developing country has challenges in caregiving due to lack of formal services and infrastructure development that family caregiving relies on mutual assistance by close relatives. This study aimed to explore the actual situation of family caregiving in District A in the suburbs of Ulaanbaatar. A questionnaire included caregiver education, nomadic living experience, financial status, support from relatives, CAGE (alcohol dependence), GDS5, coping behaviors, and JZBI8 (caregiving burden) distributed to 562 family-caregivers selected by district personnel. Of the 537 collected, 75 individuals involved in caregiving were divided, and statistically compared in to the three groups named as economically stable (ES: n1=29), partially in need (PIN: n2=35) and totally in need (TIN: n3=11). Mean values were below the cutoff point in all groups, and comparisons showed no differences except JZBI8. ES’ JZBI8 was significantly lower than PIN’s if the relative assisted purchasing medications and watching over care-recipients [F(2, 66）=3.93, p=.024, η2=.11]. ES with a higher education had more problem-focused-coping behaviors than TIN[F(2, 30）=3.64, p=.038, η2=.02]; however, ES did not receive laundry assistance if the relative had nomadic life. PIN engaged all-day caregiving had more avoidance-escape-coping-behaviors than non-all-day [t(27）=2.22, p=.035, d=0.92, 95%CI[0.07,1.77]]. PIN with nomadic experiences could not provide financial support to care-recipients [χ2(1，n1=31)=5.490, p=0.019, φ=0.421]. Although the burden of caregiving was generally low, family caregivers’ mutual support and coping behaviors vary by economic, educational, and nomadic background, which may develope into a caregiving burden for Mongolians.