bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXPERIENCES OF FAMILY CAREGIVERS OF INDIVIDUALS WITH HYPERTENSION AND DIABETES: A META-ETHNOGRAPHY
Authors: Alhabodal Ashwag , Edoziuno Confidence Francis- , Williamson Marsha , Henderson Wendy , Lucas Ruth 
Published: January 2025

Abstract
The number of older adults diagnosed with chronic diseases such as hypertension or diabetes mellitus is growing, and their home care is often managed by family caregivers. The purpose of this meta-ethnography is to synthesize qualitative evidence, published between 2014 and 2024, and identify common challenges, motivations, and coping strategies of caregivers. Ten articles were included, conducted in diverse settings across high-, middle-, and low-income countries with 261 caregivers, mostly females. Through Noblit and Hare’s approach, five overarching themes were identified: caregiving expertise and knowledge, psychosocial impact, support and coping mechanisms, financial and physical burdens, and intrinsic motivations and values. Many caregivers receive inadequate formal training and resources, which often lead to intense emotional, financial, and physical burdens. These personal burdens were balanced by their strong personal values and motivation to provide care. The voices of caregivers reveal not only the depth of their commitment but also the significant cost caregiving takes on their mental and emotional health. Caregivers speak of isolation and anxiety, as well as the resilience they draw from family bonds and religious beliefs. Their narratives highlight the universal challenges experienced by caregivers globally. However, the availability and quality of support systems may differ widely. Caregivers have a critical role in the management of chronic diseases for their older adult family members, and they require interventions and policy changes to ensure their well-being and the quality of care they provide.
EXPLORATION OF VARIABILITY IN STRESS AND SLEEP QUALITY IN OLDER PEOPLE WITH MILD COGNITIVE IMPAIRMENT
Authors: Kabaya Sonoko , Greiner Chieko , Yamaguchi Yuko , Nakamura Masahide 
Published: January 2025

Abstract
Mild cognitive impairment (MCI) is common, affecting 10%-35% of people over 65, since medical technology has advanced. Previous studies have reported that stress in older people with MCI exacerbates cognitive decline and can lead to daily depressive affect contagion between family caregivers (FCs) caring for older people with MCI. They have also indicated that stress adversely affects sleep quality and duration among older people with MCI. However, it is not clear how stress and sleep quality in older people with MCI fluctuate within a day especially throughout night. The aim of this study was to explore the characteristics of variability in stress and sleep quality in older people with MCI. We recruited dyads of older adults with MCI over the age of 65 and FCs. Data collection was performed continuously for 7 consecutive days. We adopted smart watches (GARMIN vívosmart 4) to measure Heart Rate Variability (HRV)-based stress and sleep quality. The Mann-Whitney U test was performed using Python 3.12. Results showed that stress levels were significantly higher during wakefulness compared to nighttime sleep (p=0.05e-89); however, no significant differences were observed based on the depth of sleep (p &gt;.05). This finding is beneficial for considering how to reduce their stress especially during deep sleep and how to improve sleep quality.
EXPLORING TRANSITIONAL CARE UNITS IN ONTARIO CANADA: A QUALITATIVE STUDY
Authors: McGilton Katherine , Krassikova Alexandra , Yeung Lydia , McKay Sandra , Puts Martine , Guilcher Sara , Kuluski Kerry , Bethell Jennifer 
Published: January 2025

Abstract
Transitional care units (TCUs) provide short-term, low-intensity, restorative care to older adults who are medically fit to leave the hospital but cannot do so due to various factors, such as the availability of home care support or long-term care beds. TCUs are similar to skilled nursing facilities in the US, also referred to as intermediate care models, post-acute care or alternate care units depending on the country of origin. In Ontario, Canada, TCUs were introduced in the past decade, and little is known about them. The objectives of this study were to examine the processes of care of TCUs in Ontario employing an exploratory qualitative design. Semi-structured interviews were conducted with seven TCU managers. A five-step inductive thematic analysis adapted from Braun and Clarke was applied to the data to identify themes. Interviewees were on average 43 years of age; four identified as men and three as women. Years of experience as a TCU manager at the time of the interview ranged from 2 months to 5 years. Four themes were identified: a) going above and beyond; 2) managing patients’ expectations; 3) creating a team that works together; 4) navigating a constantly changing environment. Qualitative findings demonstrate the important role of TCUs in helping patients transition from acute care to other settings. TCUs are filling in a gap in the healthcare system of Ontario and need to be recognized as a core service. Qualitative findings may be used by healthcare organizations and unit managers to guide the operation of TCUs.
FEASIBILITY OF SMART AMBIENT BRIGHT LIGHT (SABL) FOR NURSING HOMES RESIDENTS WITH DEMENTIA
Authors: Liao Yo-Jen , Jao Ying-Ling , Boltz Marie 
Published: January 2025

Abstract
Ambient bright lighting interventions have shown some positive benefits on nursing home (NH) residents with dementia. A feasible implementation approach and stakeholder buy-in have not been well evaluated. This study examined NH staff’s perspectives on the feasibility of implementing the Smart Ambient Bright Light (SABL). The SABL was installed in participants’ bedrooms and common areas in two NHs to automatically deliver bright light during the day and dim light during the night. This convergent mixed methods study enrolled 22 participants, including nursing, activity, maintenance, and administrative staff. Quantitative data were collected using the Acceptability of Intervention Measure, Feasibility of Intervention Measure, and Intervention Appropriateness Measure. Qualitative data were collected via semi-structured interviews and analyzed using content analysis. Quantitative results showed good feasibility (mean=4.4, SD=0.51), acceptability (mean=4.1, SD=0.9), and appropriateness (mean=4, SD=0.7) on a 1-5 scale. Qualitative results were categorized in installation, light brightness, automatic system, and resident responses categories. Maintenance staff reported that installing the SABL was relatively easy. Brightness wise, some reported that the lights were too bright while others thought it made people more awake during the day. Most staff reported that the lighting system was easy to use while others preferred manual control to better accommodate residents’ various routine. Some reported that residents showed improved neurobehavioral symptoms, sleep, mood, and engagement. Overall, staff perspectives on SABL were positive, but some improvements to the light brightness and automatic system are needed. Limitations on the facility’s building structure and lighting fixtures should be considered in future studies.
FUNCTIONAL IMPROVEMENT AMONG NURSING HOME RESIDENTS WITH DEMENTIA AFTER SKILLED NURSING FACILITY STAY
Authors: Montoya Ana , Park Pil , Jensen Megan , Bynum Julie 
Published: January 2025

Abstract
Dementia is associated with decline in physical function that may be exacerbated during a hospitalization. Physical function is potentially modifiable through physical therapy during a short-term skilled nursing facility (SNF) stay after hospitalization. While many nursing home (NH) residents experience functional improvement after a SNF stay, some experience no improvement or even decline. It remains unclear whether long-stay NH residents with dementia benefit from a SNF stay prior to transitioning back to long-term care. This study aimed to determine if NH residents with dementia are as likely to experience functional improvement in activities of daily living (ADL) as those without dementia after a SNF admission. Using Michigan state Minimum Data Set (MDS) data from 2017-2019, we identified long-stay NH residents with Medicare-covered SNF stay in 2018 and qualifying ADL variables (n=2,127 residents with dementia; n=1,595 residents without dementia). We analyzed NH residents’ assessments within 120 days after SNF admission and calculated the Long-Form ADL Self-Performance score. We defined functional improvement as one point decrease in ADL score from the first SNF assessment. Almost two thirds of residents experienced functional improvement (61.2% with dementia vs. 63.3% without dementia; p=0.189). The median time to achieve improvement did not differ between the two groups (16 vs. 14 days, respectively; p=0.063). Cox proportional-hazards models revealed no effect of dementia on functional improvement after incorporating demographic characteristics and clinical indicators (HR=0.94, 95%CI [0.85-1.04]). These results support prior findings that NH residents with dementia achieve similar benefit from a SNF stay compared to those without dementia.
GIS ANALYSIS OF PHYSICAL ACTIVITY AND FALL RISK AMID GLOBAL WARMING: ROLES OF COMMUNITY ENVIRONMENTS
Authors: Li Yingru , Thiamwong Ladda , Kim Dahee , Emrich Christopher , Xie Rui , Crook Jennifer , Zhong YunYing 
Published: January 2025

Abstract
Regularly engaging in physical activity (PA) may reduce fall risk among older adults. However, hot weather amid global warming and/or less walkable community environments may negatively impact their participation in PA, especially those who live in low-income or otherwise socially vulnerable areas. This study aims to visualize spatial variations of PA and fall risk among low-income older adults (LOAs) across four communities in Orlando, Florida, during the summer months and to examine the roles of community environments on fall risk and PA. This study used data from 63 LOAs collected from May to September 2023. Self-reported fall risk was measured using the CDC STEADI fall risk checklist. PA was assessed through average active and sedentary minutes recorded by FitBit over five months. Community environments were assessed using walk scores and 31 different social vulnerability index characteristics. This study employed ArcGIS pro to visualize spatial variations and SPSS Amos to examine the roles of community environments. LOAs’ PA and fall risk varied across the four communities. Higher PA and lower fall risk were observed among LOAs in communities with higher walk scores and lower social vulnerability indexes. The results of path analysis revealed recursive relationships: higher community social vulnerability was associated with lower community walkability, which led to less active and more sedentary time among LOAs, contributing to their higher fall risk. These findings highlight the impact of community environments on LOAs’ health and well-being and suggest that actions should be taken to improve community walkability, particularly in socially vulnerable communities.
GUIDING FUTURE AUTONOMY-SUPPORTIVE BEHAVIOR BASED ON HISTORICAL KNOWLEDGE OF NURSING THEORIES
Authors: Bleijlevens Michel , Gronek Melissa Botana , Vluggen Stan , Moonen Esmee , van Dijk Aileen , Hamers Jan , Meijers Judith 
Published: January 2025

Abstract
Autonomy in care provision is central to providing person-centered, ethically sound care that meets the needs and preferences of older people. By stimulating autonomy, nurses can help maintain dignity, enhance quality of life, and promote overall well-being. Nevertheless, there remains a lack of knowledge on what autonomy is and how nurses could show autonomy-supportive behavior. This review examines the concept of autonomy and how nurses can effectively foster it in their ADL practice. In this scoping review, leading nursing theories that shaped the nursing profession and mentioned autonomy or related terms were selected from nursing textbooks, internet searches, and expert consultations. Two researchers independently conducted the screening and analysis using inductive coding. Ultimately, nine theories were included that mentioned related concepts to autonomy such as self-governance. None of the theories explicitly described autonomy or autonomy-supportive behaviors. However, we did find themes related to autonomy such as: being oneself, having a sense of freedom and control, expressing and making choices, and engaging deliberately in actions. Furthermore, six actions were identified to guide nurses in enhancing autonomy: being aware of their own behavior; respecting individual uniqueness; fostering interpersonal connections; facilitating open communication; allowing patients to choose the best course of action; and providing collaborative guidance and assistance. While nursing theories may lack explicit guidelines on autonomy-supportive behaviors, the actions identified in this review offer a practical framework for enhancing autonomy in long-term care. However, further knowledge development in this area is essential in order to stimulate autonomy-supportive behavior.
HELPING AGING VETERANS PLAN AHEAD (HAVE)
Authors: Sullivan Dennis , Dawson Bonnie , McFadden Angela , Rhodes Ramona , Sawyer Linda , Crawford Christina 
Published: January 2025

Abstract
It is estimated that up to 60% of older Veterans (OVs) do not have an Advance Directive (AD). The HAVE clinical program initiative was developed to address this problem by helping OVs understand the importance of having an ACP. Initially, OVs at high risk for institutionalization (per Office of GEC PLI List) were invited (by letter and phone call) to participate in HAVE. At the first visit (conducted in-person or by VVC), the OV (and Caregiver) met with a HAVE lay health advisor (HLHA) who conducted a baseline assessment including administration of Brief Health Literacy, Knowledge of Care options, and Quality of Life rating questionnaires. Education focused on incorrect responses was provided and AD materials were provided for home review. The HLHA then used motivational interviewing techniques to help the OV articulate his/her desires for ACP and to indicate what he/she thought was important that he/she could do to ensure these wishes were honored and to then create SMART goals for doing this. Up to three follow-up phone visits were conducted. In the first four months of the program, 218 eligible OVs were identified. Of these, 17 refused or could not be contacted, 40 already had an AD, and 55 were scheduled for a first visit. To date, 16 of the 17 OVs completing the HAVE program created a new AD and 6 OVs updated their older AD. Given the early success of HAVE, the program is being expanded to Veterans over age 60.
IDENTIFYING UNKNOWN STAGED CANCER IN THE UNITED STATES BY SELECTED VARIABLES DEPENDS ON THE TYPE OF REPORTING SOURCE
Authors: Merrill Ray 
Published: January 2025

Abstract
Appropriate site-specific cancer treatment depends on the stage of disease at diagnosis. However, some cancer is unstaged, especially in older age. This study examines the level of unstaged cancer incidence for 24 cancer sites in the US according to type of reporting source and, for each source, the rate of unstaged cancer by sex, age, race, ethnicity, and household income. The rate of unstaged cancer according to cancer lethality is also investigated. Analyses were based on 2,719,800 male and 2,727,223 female malignant cancer cases diagnosed during 2015–2021. Data was collected by 22 population-based cancer registries in the National Cancer Institute’s SEER Program. Poisson regression estimated rate ratios adjusted for sex, age, race, ethnicity, and household income. Approximately 9.4% of males and 7.2% of females had unstaged cancer. The adjusted rate of unstaged cancer was 60% (95% CI 59%-61%) higher in males than females, significantly increased with age, decreased with household income, and was 11% (95% CI 10%-12%) higher in Blacks (vs. Whites) and 11 (95% CI 10%-12%) higher in Hispanics (vs. non-Hispanics). Several adjusted rate differences were identified according to the type of reporting source. Finally, there was a significant negative association between site-specific percentages of unstaged cancer and 5-year relative survival rates for males and females. Thus, the level of unstaged cancer is negatively associated with cancer lethality and depends on the type of reporting source. The type of reporting source should be considered when identifying the level of unstaged cancer according to selected variables.
IMPACTS OF HANDGRIP ON REVERSING FRAILTY PROGRESSION IN OLDER ADULTS: A TWO-YEAR FOLLOW-UP STUDY
Authors: Chou Wan Yun , Hou Su-I 
Published: January 2025

Abstract
Frailty is characterized by a significant decline in the functional reserves of multiple organ systems, which increases vulnerability to stressors and elevates the risk of adverse health outcomes. Addressing frailty is becoming crucial for both intervention and policymaking. This prospective cohort study, conducted between 2018 and 2020 at a medical center in Taiwan, aimed to assess the needs of individuals at risk of frailty within the community. The study involved 318 participants aged 65 and older who attended annual health examinations. Frailty was measured using Fried’s frailty scale, cumulative deficits, and physical risk variables, assessed through self-reported questionnaires and objective measures at admission, 6, 12, and 24 months. Based on frailty scores, participants were categorized into low-risk and high-risk groups, with 0 indicating low risk and 1 or higher indicating high risk. The study analyzed differences between these groups concerning the five criteria of Fried’s frailty scale: weight loss, low handgrip strength, exhaustion, slow walking speed, and physical inactivity. Wilcoxon signed-rank tests and Generalized Estimating Equation (GEE) models were employed for analysis. 60% (n=193) of participants were considered high-risk. Notably, the decline in grip strength was significantly greater in the high-to-low-risk group compared to the low-to-high-risk group at 12 and 24 months (p=0.036 and 0.016). GEE models revealed a borderline significant reduction in frailty risk associated with improvements in cognitive function (aOR=0.69, 95% CI=0.46-1.04). These findings suggest that enhancing grip strength and cognitive function can contribute to reversing frailty, highlighting the benefits of targeted interventions for older adults.
IMPLEMENTING THE LOOK AHEAD LIFESTYLE INTERVENTION IN PRACTICE AND COMMUNITIES: A SCOPING REVIEW
Authors: Du Yan , Ubaque Lina Paola Buitrago , Medrano Valeria , Finley Erin , Hazuda Helen , Espinoza Sara , Song Lixin , Volpi Elena 
Published: January 2025

Abstract
Diabetes is a public health concern as the population aging rapidly. The Look AHEAD study demonstrated that a lifestyle intervention could improve glucose and lipid control, mental health, physical function, quality of life, and the need for diabetes medications. We conducted a scoping review to explore the implementation of the Look AHEAD intervention in other populations and settings. We searched PubMed, Scopus and CINAHL in December 2023. Two researchers screened each article independently. The data extracted from the included studies were systematically tabulated and analyzed to identify study characteristics, key themes, trends, and gaps. The review included 21 articles from 8 study projects. Twelve articles reported on study methods or qualitative findings. Seven projects focused on adults (RCT), and one in older adults aged 65 and over (one arm, pre-and post- test). Interventions were delivered in clinical (4 projects), community (3 projects), and academic (1 project) settings, with sample sizes ranging from 20 to 331 participants. The number of educational sessions ranged from 10 to 60. Most studies incorporated self-monitoring, goal setting, psychological strategies, and social support for physical activity and diet. Three projects used meal replacements. Weight improved significantly in all intervention groups except one pilot trial. HbA1c improved across all groups, with only one study reporting significant results. Two studies assessed reduced diabetes medication use. The studies varied in sample size, intervention sessions, and settings. Overall, adapting Look AHEAD to other settings is feasible, but the effectiveness, adoption, and sustainability of implementing the adapted interventions warrant further investigation.
IMPROVE TECHNOLOGY AND EHEALTH LITERACY IN A RETIREMENT COMMUNITY VIA THE USE OF LLM-POWERED CHATBOT
Authors: Chung Ray-Yuan , Chen Feng , Jeon Yein , Zaslavsky Oleg 
Published: January 2025

Abstract
The low levels of technology and eHealth literacy of retirement community residents are a barrier to technology use and information retrieval. In response, we proposed the development of an LLM-powered chatbot to improve the technology and eHealth literacy of the residents. We adopted a human-centered design approach and aimed to complement the existing technological infrastructure of the community app by providing straightforward, conversational assistance. To enhance user accessibility, we emphasize the interface’s features including large text, white and black interface for vision support, voice interaction capabilities, and simplified navigation, catering to the varied technological proficiency levels within the community. The chatbot’s functionalities are divided into two primary goals: facilitating information navigation within the retirement community and enhancing technology and eHealth literacy among its residents. For information navigation, the chatbot allows users to easily access essential information such as dining menus and contact details. To improve technology literacy, the chatbot delivers simple, up-to-date guides and information on specific questions posed by the users, providing them with easy-to-follow instructions. To evaluate our chatbot, residents were asked to complete tasks during the trial session and complete a survey. The survey collected demographics, digital literacy scores, user satisfaction, and feasibility. Residents successfully utilized our chatbot to complete the tasks. Furthermore, they reported high levels of satisfaction and a strong likelihood of recommending it to peers. Therefore, we suggest that our chatbot may serve as a valuable tool for older adults with low technology and eHealth literacy.