bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPACT OF RESPITE SERVICES ON DEMENTIA CAREGIVERS’ NEUROCOGNITIVE AND PREDEATH GRIEF OUTCOMES: A PILOT STUDY
Authors: Schneider Sydnie , Elliott Lauren , McLean Elisabeth , Neugebauer Volker , Diehl Keegan , Singer Jonathan 
Published: January 2025

Abstract
Caring for individuals with dementia presents a significant challenge, often placing caregivers under immense stress. Research has consistently highlighted that caregivers of individuals with dementia face an elevated risk of experiencing health concerns themselves due to the high stress and burden. This burden extends beyond psychological strain, with studies indicating higher rates of neurocognitive decline and pre-death grief (PDG) among family caregivers. Despite growing recognition of these health risks, there is currently a lack of interventions that target the family caregivers of persons with dementia. This study implemented 12-weeks of 3-hours of respite. We assessed overall neurocognitive functioning and PDG in caregivers at baseline and follow-up. Pilot data from 8 caregivers were analyzed. Assessments comprised of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; i.e., attention, language, visuospatial ability, and immediate/delayed recall) and the PG-12 (i.e., pre-death grief). The individual reliable change index (RCI) for each participant was calculated as the difference in overall scores on the RBANS and PG-12 scores at baseline and follow up. Average PG-12 scores decreased (RCI = -0.88) at intervention, indicating a decrease in PDG. Further, RBANS (RCI = 1.2), immediate memory index (RCI = 4.58), language index (RCI = 3.16), attention index (RCI = 1.58), and delayed memory index (RCI = 2.33) scores increased. However, average visuospatial/constructional index (RCI = -8.04) scores decreased. These preliminary results suggest that only 3 hours of respite a week has the potential to reduce PDG and improve neurocognitive functioning among family caregivers of persons with dementia.
SUPPORTING SAFE AND HEALTHY SEXUAL EXPRESSION IN LONG-TERM CARE: A REVIEW OF CANADIAN RESOURCES
Authors: Grigorovich Alisa , Brassolotto Julia , Manduca-Barone Alessandro , Colobong Romeo , Martin Lori Schindel , Iaboni Andrea , Feldman Sid , Kontos Pia 
Published: January 2025

Abstract
Little is known about what educational resources are available to practitioners in Canada for supporting the safe and healthy sexual expressions of persons living with dementia in long-term care (LTC). To address this gap, we conducted a critical review of publicly available online resources in Canada. Our objectives were to identify existing resources, describe key content areas and modalities, and assess strengths and weaknesses. To find resources, we conducted a systematic Google search, targeted websites searches, and contacted experts. Resources were included if they were in English, publicly accessible (e.g., not behind a paywall), focused on support of sexual expression of persons living with dementia in LTC, and informed action at the micro level of practice and/or meso level of organizational policy. We identified 9 resources, the majority of which were text-based and aimed at supporting staff or organizations in developing policies or practices regarding assessment and intervention in non-consensual sexual behavior. Guidance on consent was narrowly focused on bioethical principles, often neglecting fluctuating capacity, assent, and the role of substitute decision-makers. Although some acknowledged that healthy sexual expression in the context of dementia should be supported, the focus was primarily on support of non-erotic intimacy (e.g., hugging vs. stroking/kissing). We also found stigmatizing language (e.g., “demented”), and cursory attention to sexual and gender diversity, and ethnically and culturally diverse content. Although the available resources provide an important foundation, there is a pressing need to develop additional resources to better support sexual expression for persons living with dementia in LTC.
EXPLORING THE FEASIBILITY AND UTILIZATION OF CLARE: A MOBILE APPLICATION FOR CAREGIVERS AFTER HOSPITAL DISCHARGE
Authors: Wang Dingyue , Matters Doreen , Hendrix Cristina 
Published: January 2025

Abstract
CLARE is the first mobile application tailored to enhance discharge education and teaching practices in hospital settings. This mixed-method study aimed to assess the feasibility of CLARE in providing caregiving training and support immediately following hospital discharge. Additionally, the study sought to apply the Unified Theory of Acceptance and Use of Technology (UTAUT) framework to identify factors that promote or hinder the intent and use of CLARE among caregivers. Caregivers included in the study were primary caregivers assisting patients post-discharge, aged at least 35 years, and caring for patients aged at least 55 years. Data from application usage was analyzed alongside caregiver interviews. CLARE areas of teaching encompassed discharge preparation (e.g., early mobility instruction), COVID-19 care protocols (e.g., isolation; quarantine; home sanitization; monitoring shortness of breath), and caregiver self-care strategies (e.g., managing anxiety and stress). Preliminary findings from the 23 enrolled caregivers (with a target enrollment of 50) revealed that 65.2% were female, and the majority (78.3%) were between 50 and 80 years old. Usage statistics indicated that 17.4% of caregivers completed all tasks, 34.8% completed over 80% of tasks, and 52.2% completed more than half of the tasks in CLARE. Survey and interview responses showed that CLARE is a user-friendly, time-efficient, and informative app that facilitates awareness of caregiver needs. Caregivers appreciated the clear and real-time information in CLARE. Our findings suggest a need for ongoing development and updates to CLARE, alongside comprehensive interventions addressing the diverse hospital discharge needs of caregivers.
AGING SINGLE PARENTS: PSYCHOSOCIAL OUTCOMES AND WELL-BEING AMONG A MARGINALIZED POPULATION
Authors: Hanes Douglas 
Published: January 2025

Abstract
Objective Over the last 50 years, single parents—in particular, single mothers—have received much popular and political attention. And yet, their aging experiences remain unresearched. This paper analyzes aging among single parents, including their sex/gender and racial/ethnic composition, as well as their psychosocial well-being, in a population-based aging study. Method Using Health and Retirement Study data (N = 38,785), we identify single parents as participants who were never married at baseline and have children (n = 680), 1.80% of participants with children. Multilevel regressions analyzed psychosocial outcomes: discrimination experiences, subjective social status, and social support. Results Odds of single parenthood increased for each subsequent birth cohort (OR = 1.89, p &lt; 0.001). Women (□2 = 85.192, p &lt; 0.001) and people of color (□2 = 802.32, p &lt; 0.001) were more likely to be single parents, who also had lower education levels and wealth. Single parents were more likely to report discrimination due to race (OR: 1.522, p = 0.047), with single mothers of color more likely to report discrimination due to financial status (OR = 1.575, p = 0.049). Single parents received less positive social support and more negative support from their children; they were also more likely to experience depression, have lower self-rated health, and smaller social networks. Discussion Aging single parents are more likely to belong to already-marginalized groups, and face further and ongoing discrimination, known risk factors for adverse later-life health and well-being. These results indicate the need for greater attention to this marginalized group.
LONG-TERM AND INTERGENERATIONAL EFFECTS OF EARLY-LIFE EXPOSURE TO THE 1959–1961 CHINESE FAMINE ON HEALTH
Authors: Cheng Mengling , Sommet Nicolas , Kerac Marko , Spini Dario 
Published: January 2025

Abstract
Undernutrition in early life is associated with increased risk of poor health and mortality in later life. Less is known if the health effects of early-life undernutrition transmit across generations. This study examined the associations between early-life famine exposure and self-rated health in the first generation (F1) and the subsequent generation (F2). We used data from the China Health and Retirement Longitudinal Study (2011-2020, 11,000 participants). We classified F1 participants by famine exposure (exposed/unexposed) and timing at famine exposure (exposed in utero, infancy, pre-school, primary school, or adolescence); we classified F2 offspring by their parents’ famine exposure status. We performed growth curve models to investigate the associations between early-life famine exposure and self-rated health in F1 and F2. The first generation (F1) exposed to famine in utero, infancy, pre-school, primary school, or adolescence had poorer self-rated health than those unexposed (IRR=1.06, 95% CI [1.04 – 1.07], p &lt;.001). The offspring generation (F2) whose parents were exposed to famine also had poorer self-rated health than those of unexposed parents (IRR=1.05, 95% CI [1.01 – 1.10], p &lt;.05). Findings of this study show the long-term and intergenerational effects of early-life famine exposure on health, indicating cumulative advantage and disadvantage over the life course and across generations. Our study highlights the need to prevent and treat child/adolescent undernutrition to improve health in the long run.
HOME HEALTH CARE ACCESS AND OUTCOMES AMONG VULNERABLE OLDER POPULATIONS: CHALLENGES AND OPPORTUNITIES
Authors: Gadbois Emily , Johnson Michael 
Published: January 2025

Abstract
Home health care (HHC) provides skilled nursing (e.g., wound care, medication management), therapies (e.g., physical, occupational, speech), and aide services (e.g. bathing, grooming, dressing), which are key supports necessary to regain function, restore health, and maintain independence in the community. This panel presents five studies examining factors that challenge equitable access and high quality outcomes associated with skilled HHC among vulnerable older populations (i.e., Veterans, people living with dementia, patients needing post-acute care). The first panelist will discuss findings using national-level HHC quality data demonstrating that access to high-quality HHC varies widely across the country for people with dementia. The second panelist will share findings from a novel data linkage using Medicare Advantage (MA) and traditional Medicare claims to understand variation in use of HHC among people living with dementia. The third panelist’s presentation will focus on a particularly vulnerable population - hospitalized older Veterans - and how payer source shapes the use of post-acute HHC. The fourth panelist will discuss results from a qualitative study with MA plans about how they design and manage post-acute HHC benefits. The final presenter will share results from an analysis of national standardized HHC assessment data to identify failures in information transfer that impact care delivery and quality for HHC patients living with dementia. The discussant, a national industry leader with over two decades of experience working in the delivery of HHC, will contextualize findings and discuss how they can inform national policy discussions around improving access and quality of HHC.
ACCESS TO HIGH-QUALITY HOME HEALTH CARE FOR PERSONS WITH DEMENTIA
Authors: Mather Harriet 
Published: January 2025

Abstract
While prior research has demonstrated variation in access to high quality home health agencies among older Medicare beneficiaries, access among persons with dementia - a population with increased need of skilled care delivered in the home - has not been explored. This study examined availability of high-quality home health agencies by dementia prevalence in the US using a cross-sectional analysis of county-level data on availability and quality of home health agencies indexed to number of FFS Medicare beneficiaries with Alzheimer’s disease and related dementia (ADRD). Using multiple Medicare Public Use Files (PUF), including star ratings for home health quality of patient care (QoPC), home health care CAHPS survey (HHCAHPS), county-level ADRD prevalence, and Medicare FFS enrollment, we found that the median county-level number of home health agencies was 15 (IQR 8-29), star rating was 3.4 (IQR 3.1-3.7) for QoPC and 3.8 (IQR 3.5-4.0) for HHCAHPS. Higher prevalence of persons with ADRD was moderately correlated with total number of home health agencies in a county (Spearman’s r=0.36, p&lt;0.05), with weaker positive correlations with high-quality home health agencies via QoPC (r=.2, p&lt;0.05) and HHCAHPS quality ratings (r=.17, p&lt;0.05). There is wide variation in access to high quality home health care among persons with dementia. To meet the needs of a growing population living at home with dementia, we must address inequities in access to high quality home health care.
MISSING DEMENTIA DIAGNOSIS INFORMATION DURING HOME HEALTH: PREVALENCE AND IMPACTS
Authors: Burgdorf Julia 
Published: January 2025

Abstract
Medicare-funded Home Health Care (HHC) delivers skilled health care services through visits to patients’ homes. Poor information transfer between HHC and other care settings is a perennial issue; HHC providers rarely have reliable and complete information regarding patients’ clinical history or needs. One-third of HHC patients have dementia, but lack of visibility into a patient’s dementia status could negatively impact HHC providers’ ability to appropriately tailor care to these individuals. We examined a national sample of 426,606 older adults (65+) who received Medicare HHC in 2018 and had diagnosed dementia, as reported in the Medicare Beneficiary Summary File. The majority (68.3%) did not have their dementia diagnosis captured in the HHC claims or assessment files. We fit multilevel logistic models clustering at the HH agency-level and adjusting for patient sociodemographic characteristics and clinical status and HHC agency characteristics. Patients whose dementia diagnosis was not captured during HHC were less likely to receive Speech-Language Pathology (aOR: 0.63; 95% CI: 0.61-0.64), social work (aOR: 0.70; 0.69-.72), or aide visits (aOR: 0.81, 95% CI: 0.80-0.82). Patients whose dementia diagnosis was not captured were also more likely to be hospitalized (aOR: 1.69; 1.65-1.73) or to visit the Emergency Department (aOR: 1.47; 95% CI: 1.44-1.50) during HHC, and less likely to have their Activities of Daily Living (ADL) limitations stabilize or improve by HHC discharge (aOR: 0.70; 95% CI: 0.68-0.72). Results suggest HHC providers often lack pertinent information regarding patients’ dementia status, contributing to reduced access to relevant services and increased risk for negative outcomes.
INNOVATING LONG-TERM CARE DURING COVID-19 ACROSS FOUR NATIONS: INNOVATIONS, BARRIERS, AND FACILITATORS
Authors: Chu Charlene , Melo Ruth , Bowers Barbara 
Published: January 2025

Abstract
The COVID-19 pandemic has starkly highlighted the vulnerabilities of older adults in residential long-Term Care Homes (LTCHs), amplifying calls to “reimagine” the LTC sector. Active engagement and inclusion of older adults, their families, and staff in the development and implementation of LTC innovations have been recommended by the United Nations and the World Health Organization, but little is known about such engagement in innovations. This symposium presents a comprehensive scoping review aimed at understanding innovations implemented in LTCHs in four countries (Brazil, Canada, Switzerland, United States) since 2020, and the practices of inclusion within innovation processes within LTCHs. The first paper outlines the scoping review methodology and summarizes national-level results, including the number of studies per country and types of studies (e.g., observational, experimental). The second paper presents an analysis of interventions deployed across different countries. The third paper focuses on the types and goals of technology-based innovations implemented in LTCHs during COVID-19 and summarizes the extent to which perspectives of residents, staff, and family caregivers were considered regarding technology-based innovations. The final paper examines the barriers and facilitators of the innovation process during COVID-19. This international symposium contributes to the reimagining and transformation of LTCHs into more resilient, inclusive, and high-quality living environments.
INNOVATIONS IN LONG-TERM CARE SECTOR DURING COVID-19: A SCOPING REVIEW
Authors: Melo Ruth , Santos Suzanne , Bhatti Sumaya , Duan Yanjun , Chu Charlene , Zuniga Franziska , Cranley Lisa , Lepore Michael 
Published: January 2025

Abstract

Different innovations were implemented in Long-Term Care (LTC) homes during COVID-19. Although designed to support stakeholders, innovations also have the potential to exacerbate disparities and inequalities in this sector. This scoping review aims to analyze innovations implemented in the residential LTC sector during the pandemic in four countries: Canada, USA, Brazil, and Switzerland. Potential studies were searched in six databases. Search strategy and eligibility criteria followed the mnemonic “PCC” (i.e., Population: residents, family members/caregivers, and other stakeholders, Concept: innovation, and Context: residential LTC sector). The studies retrieved from databases were screened by two independent reviewers. Discordances between reviewers were solved by consensus or by a third reviewer. A customized spreadsheet was used for data extraction. The search identified 4,056 registers. After excluding duplicate studies, 3,122 records were screened. From them, 98 studies fulfilled the eligibility criteria and were included. Half of the studies were conducted in the USA (51.0%), followed by Canada (39.8%). Few studies were conducted in Switzerland (n=3) and Brazil (n=1). Included studies have different design

methods
qualitative (18.4%), observational (17.3%), experimental (17.3%) and mixed methods (10.2%). Other types of design methods (opinion, commentary, experience reports, editorial, etc.) and literature reviews accounted for 28.6% and 8.2%, respectively. The innovations presented in the studies were classified according to type, level, and setting. Stakeholder engagement with innovation was categorized as active, passive, and co-designed. results of studies that involved stakeholders are presented in the following papers.
TECHNOLOGY-BASED INNOVATIONS IN LONG-TERM CARE HOMES DURING COVID-19 AND RELATED INCLUSION PRACTICES
Authors: Chu Charlene , Bhatti Sumaya , Duan Yanjun , Santos Suzanne , Lepore Michael , Melo Ruth , Zuniga Franziska , Cranley Lisa 
Published: January 2025

Abstract
The COVID-19 pandemic has magnified challenges in Long-Term Care Homes (LTCHs), driving the adoption of technology-based solutions. The scoping review to explore technology-based innovations into a LTCH during COVID-19 in Canada, the US, Brazil and Switzerland produced 60 studies. The most reported technologies were use of telemedicine/virtual medical care tools that allowed for remote delivery of health care (n=16) within LTCHs, and robotics for clinical tasks and social interaction (n=14). Less frequently reported technologies were: wearables for health monitoring (n=2), mobile apps to improve residents’ mental well-being (n=2), and call light systems (n=1) between residents and staff. Most technologies were introduced by researchers (n=38) which primarily engaged with staff (n=30) and residents (n=24). Studies with telemedicine and robotics (n=30) focused on exploring the feasibility and acceptability of technology with the aim to improve optimal resident care and increase social connectedness. Notably, the most common goals of the technology-based innovations were to provide virtual medical care and to engage residents socially. The majority of the papers had active engagement (n=24) which relies on stakeholder’s actions (i.e. video calls). We also examined the level of inclusion and engagement of residents, their families, and staff and found varying levels of engagement. the term “co-design” was explicitly used (n=7) where the innovation was designed together with the stakeholders (for example, stakeholder opinions were considered during the process). This paper describes the engagement of stakeholders of these technological innovations, and points to the need for future research in this area.
PROJECT ECHO-GERIATRICS EXPANDS CAPACITY FOR STUDENT INTERPROFESSIONAL EDUCATION
Authors: Bennett Katherine , Brazg Tracy , McPeak Ashley , Willgerodt Mayumi , Cochrane Barbara , Mike Leigh Ann , Phelan Elizabeth 
Published: January 2025

Abstract
Interprofessional collaborative practice training is important for all health professions trainees, particularly for those who will care for older adults. However, clinical interprofessional training opportunities are limited. The Extension for Community Healthcare Outcomes (ECHO) model trains health professionals in specialty care via case-based sessions with a virtual learning community. We sought to determine whether integration of health professions students into an existing Project ECHO-Geriatrics would be a feasible and effective way to deliver training on age-friendly and interprofessional care. Our novel Age-Friendly Healthcare Interprofessional Training Program used Project ECHO as the platform for longitudinal, interprofessional health professions student education. Students were recruited from health professions schools across the University of Washington. After a brief introduction to age-friendly care and Project ECHO, participants attended at least 3 ECHO sessions and post-session debriefs. In its first two years, the program trained 44 students from 9 health professions programs (e.g. nursing, medicine, pharmacy, physical therapy, social work, dentistry). One hundred percent of participants reported the program was meaningful and worth their time. All competency items (5-point scale, 5 high, 1 low) improved, with the greatest improvements in understanding roles on an interprofessional team (3.1 pre, 4.0 post, p&lt;.001) and confidence for providing age-friendly care (2.2 pre, 4.0 post, p&lt;.001). Participants reported an increased likelihood of focusing on geriatrics in their careers. Open-ended feedback highlighted increased geriatrics knowledge as well as the importance of interprofessional teamwork. Project ECHO is a feasible and effective approach to rapidly expand age-friendly, interprofessional training for health professions students.