bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE AHR AS A POTENTIAL MEDIATOR OF MUSCULOSKELETAL FRAILTY WITH ANTI-RETROVIRAL THERAPY
Authors: Tripathi Alok , Sultana Shabiha , Shi Huidong , MacArthur Rodger , de Chantemele Eric Belin , Hamrick Mark , Lawrence Meghan McGee 
Published: January 2025

Abstract
Musculoskeletal frailty, often associated with aging, is frequently observed in patients living with HIV on long term anti-retroviral therapy (ART) and linked to poor health outcomes from accelerated disease progression to increased mortality. Mechanisms underlying this frailty phenotype are poorly understood but may involve disease progression as well as ARTs themselves. One possible mediator is activation of the aryl hydrocarbon receptor (AhR). NF-κB, activated by HIV infection, is an upstream regulator of AhR which induces the enzyme IDO-1 to produce the endogenous AhR ligand kynurenine. However, connections between ART, HIV, and AhR in musculoskeletal frailty had not been previously explored. In preliminary studies we tested the effects of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) ARTs in a mouse myoblast cell line (C2C12). FTC, but not TDF, increased transcriptional activity of AhR, expression of AhR and its target gene CYP1A1, and increased cellular indicators of senescence. FTC also impaired myoblast differentiation as confirmed morphologically by microscopy. Next, we tested the effects of FTC and another ART agent, tenofovir alafenamide (TAF, a prodrug of TDF) in primary human mesenchymal stem cells and myoblasts, showing increased expression of AhR, AhR target genes, and increased senescence in both cell populations. Moreover, FTC and TAF decreased expression of myoblast differentiation markers (MYOG and MYOD). While further research is needed to elucidate the underlying mechanisms of interactions between ART, HIV, and AhR signaling, these studies raise the possibility that targeting AhR may serve as a novel therapeutic approach for improving musculoskeletal function in this setting.
ASSESSMENT OF RISK OF FALL IN THE HOME ENVIRONMENT OF KOREAN OLDER ADULTS: REVISION AND VALIDATION OF THE K-HOME FAST
Authors: Park Min Kyung , Kim Gwang Suk , Kim Layoung , Lee Jae Jun , Kim Namhee , Lee Ji Yeon 
Published: January 2025

Abstract
Most older adults experience a fall inside their house. Because the home environment varies based on culture and time, the tools to assess fall risk must be regularly modified and validated. Therefore, this study aimed to develop the Revised K-HOME FAST (Korean version of the Home Falls and Accidents Screening Tool) and evaluate its validity and reliability. The Revised K-HOME FAST was developed in these phases: 1) development of the Revised K-HOME FAST, 2) feasibility test, 3) verification of content validity, and 4) data collection and verification of reliability. Internal consistency was confirmed by conducting home-visit assessments with 211 community-dwelling older adults who had experienced at least one fall in the local community. To verify inter-rater reliability, six investigators were paired and independently assessed the homes of 20 older adults. The final Revised K-HOME FAST consisted of 25 items categorized into seven home areas: bathroom/toilet, bedroom, living room, kitchen, stairs, entrance, and entire house. The item-content validity index of the preliminary version of Revised K-HOME FAST ranged from 0.8 to 1.0, except for one item. The internal consistency (Kuder–Richardson Formula 20) of the Revised K-HOME FAST was.65. The agreement percentage for each item ranged from 92% to 100%, and the intraclass correlation coefficient ranged from 0.79 to 1.00, indicating high inter-rater reliability. The Revised K-HOME FAST has satisfactory validity and reliability for assessing the risk of falls in the home environment of community-dwelling older adults in Korea.
END-OF-LIFE RESOURCE AND PLACE OF DEATH BY COMMUNITY-BASED HOUSING TYPE
Authors: Park Sojung , Kim BoRin , Shin Esther , Baek Jihye , Ryu Byeongju 
Published: January 2025

Abstract
Understanding the factors that influence where people die is crucial, as most individuals spend their last year of life at home. This study investigates the influence of end-of-life resources on the place of death in older adults, based on where they lived. Data came from twelve waves of the National Health and Aging Trend Study (2010~2022). We analyzed the unmet needs of end-of-life resources such as end-of-life care services, functional help, and social/family support, and the type of housing (senior housing vs. traditional home) based on income status. The sample included community dwellers who died during the study period and had information about end-of-life care-related supports (N= 2701). Multinominal regression analyses were used to investigate the influence of end-of-life resources and housing type on the place of death (home, hospital, nursing home, hospice facility, or other). We found individuals living in traditional homes, both low-income and non-low-income, tend to have low levels of end-of-life care services but receive high levels of social/family support and they are more likely to die at home. In contrast, individuals living in senior housing, particularly those in low-income models, tend to have high levels of unmet needs for functional help and social/family support and are more likely to die in a nursing home or other facilities. We discussed the unequal distribution of end-of-life resources based on residential type, and the implications of this on the apparent mismatch between unmet resources and the place of death, focusing on the potential role of senior housing.
FEASIBILITY OF A SUPPORTIVE HOUSING PROGRAM FOR OLDER VETERANS WHO PREVIOUSLY EXPERIENCED HOMELESSNESS
Authors: Ritter Ashley , Hoban Luke , Brown Rebecca , Cusack Meagan , Moriarty Helene 
Published: January 2025

Abstract
The number of older adults experiencing homelessness is on the rise nationally, with earlier incidence of geriatric syndromes that jeopardize community living occurring at younger ages in this population. NewCourtland, a provider of housing and health services in Philadelphia, began a program serving older Veterans who experience homelessness with complex health and social needs in 2019. This study examined the feasibility and acceptability of program implementation among program participants and staff. We conducted focus groups with program staff (n=10) and residents (n=9) using a semi-structured interview guide. Transcripts were analyzed using inductive codes derived from the CFIR framework. Key themes regarding program feasibility and acceptability include the attainment of new space and autonomy coupled with the need for goal setting to achieve stability in a community setting. Residents and staff both reported that moving into stable housing was a critical step towards community re-integration for participants. This allowed participants to develop regular habits and boundaries in their personal lives. The program’s focus on goal setting motivated participants to work with the staff members to meet their needs. However, this was only possible if trust had been established on both sides. Clear rules and consistent interaction with staff were essential, both to achieve participant buy-in and reduce staff burnout over time. Findings provide practical insights into how to improve supportive housing programs and enhance community reintegration for older adults with experiences of homelessness and complex health and social needs.
A NEW DATA SET TO EXAMINE HOME HEALTH AGENCIES
Authors: Loomer Lacey , Patel Sweta , Belanger Emmanuelle , Gozalo Pedro 
Published: January 2025

Abstract
Using Outcome and Assessment Information Set (OASIS) data from 2015 to 2019, we developed a dataset representing home health agency Medicare patients that will be made publicly available for researchers and policymakers to compare over time and geographically. We created unique home health stays based on start of care and discharge assessments from OASIS and aggregated the data to the calendar year, agency, county, state, insurance (fee-for-service vs. Medicare Advantage), and by admission (institutional vs. community). We identified demographics for home health stays using the Medicare Beneficiary Summary File. We characterize the home health stays using OASIS variables including length of stay, activities of daily living, instrumental activity of daily living, cognitive function, common diagnoses, urinary tract infections, incontinence, history of falls, and pressure ulcers. Type of admission was determined based on Medicare claims for hospital, nursing home, or inpatient rehabilitation facility in the fourteen days prior to home health admission. Insurance was determined using the Medicare Beneficiary Summary File identified in each month of the home health stay, if a patient changed insurance through the stay, the stay’s attribution was prorated by month to each type of health insurance. There were 6,761,470 home health stays from 5,051,631 Medicare beneficiaries in 2016 compared to 6,703,521 home health stays from 4,969,010 Medicare beneficiaries in 2019. In 2019, 1994 home health agencies served fee-for-service patients only, 94 served Medicare Advantage patients only, and 8,720 served both.
A STUDY OF FACTORS RELATED TO RETENTION OF FOREIGN NURSING CARE WORKERS WHO CAME TO JAPAN UNDER THE EPA SCHEME
Authors: Tsukada Noriko , Nishimura Jun 
Published: January 2025

Abstract
The Japanese government broadened the status of residence to encompass foreign nursing care workers, due to the shortage of nursing care workers. The first step, taken in 2018, used the Economic Partnership Agreement (EPA) scheme with Indonesia, followed by the Philippines and Vietnam. This study explored factors related to the retention of EPA nursing care workers, including elements of social security programs in Japan. Structured questionnaires were sent to 722 institutions: for EPA workers, 10 questionnaires were sent to each institution. Both administrators and EPA workers were asked to respond to the survey either by mail or electronically from November 7 to December 8, 2023. A total of 396 responses from EPA workers were analyzed in this study. Despite the low response rate (5.5%), preliminary bivariate analyses revealed that although “amount of requests to the government” made by the respondents was found to be statistically significantly related to retention of EPA workers for all three countries, other factors related to perceptions toward retention varied. For example, as for Indonesian workers, job satisfaction, whether or not there are Indonesian senior certified care workers at the same institutions they work and amount of understanding of social security systems were found to be statistically significant factors, while job satisfaction, levels of understanding Japanese at work, and knowledge about social security agreement were found for Philippine’s workers. It is suggested that the government consider these differences among the three countries and develop country-specific actions to promote retention of EPA workers from each country.
DESCRIBING HOW ADAPTIVE LEADERSHIP IN LONG-TERM CARE CAN MOTIVATE AND PREPARE CARE WORKERS TO PROMOTE QUALITY
Authors: Haunch Kirsty , Devi Reena , Spilsbury Karen 
Published: January 2025

Abstract
Adaptive leadership is one approach to enhance the experience of people living and working in long-term care (LTC) residential environments. Adaptive leadership is comprised of a set of strategies aimed at enabling care teams to work together, or create organisational capacity to support culture changes, to accomplish person-centred environments. The defining feature of adaptive leadership is the separation of technical solutions (i.e., applying existing knowledge/techniques to problems) and adaptive solutions (i.e., a shift in how people work together not just what they do). Our aim is to describe and illustrate adaptive leadership behaviours in LTC and the potential benefit for the processes and outcomes of care. We conducted a documentary analysis of (publicly available) UK regulatory inspection reports. Twenty reports, judged as providing outstanding quality were purposively sampled to represent variations in ownership, size, and geographical location. Data were initially analysed using content analysis. Heitz’s adaptive leadership framework was used to frame the data. Adaptive leadership behaviours helped to engage, empower, and energise the workforce to accomplish meaningful change. These behaviours included accepting everyone’s unique perspective on how to solve problems, a willingness to learn lessons, an openness to feedback, embrace diversity, a fair and inclusive workplace, continuous growth, innovation and emotional intelligence. Key structural components enabling adaptive leadership included organisational support, ‘in house’ operational support, peer support and training. Our work highlights the benefit of recognising adaptive challenges in LTC and empowering teams to apply the most appropriate problem-solving solutions, and in particular applying adaptive solutions when merited.
EFFECT OF HOME CARE NURSES’ REMOTE CONSULTATION WITH ADVANCED NURSES ON PATIENT SYMPTOMS: A FEASIBILITY STUDY
Authors: Noguchi-Watanabe Maiko , Yamahana Reiko , Sunada Junko 
Published: January 2025

Abstract
Homecare nurses provide care for patients with a wide variety of illnesses, which requires a broad and comprehensive knowledge base. Simultaneously, symptom management requiring more specialized knowledge is required, and remote consultation with advanced nurses is expected. This study aimed to evaluate the effect of remote consultation by homecare nurses with advanced nurses on patient symptoms. Participants were homecare nurses in Japan. A remote symptom management consultation regarding specific cases was sought by ten homecare nurses. Consultations were provided thrice per case using Zoom at approximately one-month intervals by three advanced nurses: two wound, ostomy, and continence (WOC) care nurses and one cancer nurse. The research team selected the advanced nurse according to the case and coordinated the consultation schedule between advanced and homecare nurses. Before each consultation, we obtained responses from homecare nurses via a webform regarding patient who wanted to consult, their symptoms, and changes in symptoms since the previous consultation (worsening/maintenance/improvement). The study was approved by the Ethics Review Committee of the Tokyo Medical and Dental University. The WOC nurses provided consultations on six cases related to pressure ulcers, two, to stomas, and one, to nephrostomy management, while an advanced nurse specializing in cancer nursing provided consultation on one case related to decision-making support. Consultations took place three times per participant. Nine cases (90%) improved their symptoms, and 1 case (10%) remained unchanged before the consultation; It has been shown that homecare nurses who receive consultations from advanced nurses, even remotely, is effective in alleviating patients’ symptoms.
EXPLORING THE OPTIMIZATION PATH OF LONG-TERM CARE INSURANCE SYSTEM IN RURAL AREAS OF CHINA
Authors: Mi Hong , Si Wanwan 
Published: January 2025

Abstract
With the deepening of population aging and changes in family structure, the care needs of the disabled and mentally retarded older people have increased, and the problem of rural aging population has become more serious. In the face of the increasingly serious problem of rural aging, the improvement of the long-term care insurance system is the key to solving the problem of older people care in China. This paper focuses on the optimization path of the long-term care insurance system in rural areas of China, and researches from the aspects of the scope of coverage, assessment of incapacitation and payment of benefits, the management of the care model, and the content of the service. By analyzing the cost and expenditure situation of long-term care insurance in rural areas and the sustainability of its pilot program, combined with the data on the actual operation of long-term care insurance, this paper establishes a population-fund prediction model for the long-term care system, discusses the balance of inputs between medical care and daily life care, and provides targeted theoretical references and practical guidance for improving and perfecting the long-term care insurance system in rural areas of China.
STAFFING LEVELS IN OHIO’S NURSING HOMES, ASSISTED LIVINGS, AND MEMORY CARE UNITS: SHIFT VARIATION
Authors: Nelson Matt , Bowblis John , Menne Heather , Elliot Amy 
Published: January 2025

Abstract
In a nursing home (NH) or assisted living (AL), residents require assistance with activities of daily living and many of these residents also have cognitive impairments associated with dementia. As a result, many NHs and ALs have created dedicated memory care units (MCUs). This paper contributes to the literature on staffing in NHs and ALs by examining staffing levels for licensed nurses and other direct care staff for the overall facility and the 1 in 4 facilities that have MCUs on different shifts: day, evening, night. Data for this study come from the 2021 Ohio Biennial Survey of Long-Term Care Facilities. Staffing levels by shift were calculated as resident to staff ratios, which is the number of residents compared to number of staff by shift. Findings show that both NHs and ALs have their lowest resident-to-staff ratios, and hence most staff on the day shift (16.0 and 24.2 for licensed nurses and 10.4 and 14.2 for direct care staff, respectively). In both settings, the night shift staffing had the highest staffing ratios. Comparing the overall NH staffing to AL staffing, NHs have more staff per resident. However, on the MCU, NHs and ALs had more similar staffing levels. This suggests that NHs and ALs staff MCUs in a similar manner, but outside of the MCU, nursing homes staff better than ALs. The evidence can be used for decision making about future staffing policies.
AGE-SPECIFIC TRENDS IN LIMITATIONS TO DAILY ACTIVITIES IN AMERICANS AGED 50 AND OVER BY RACE AND ETHNICITY, 2000–2018
Authors: Bramajo Octavio , Mehta Neil , O’Grady Brandon 
Published: January 2025

Abstract
During the first decade of the 2000s the overall prevalence of limitations to daily activities (but not instrumental limitations) has increased in the US. It is not clear if the stagnation in mortality in the last decade, after decades of improvements in life expectancy, was accompanied by stagnation in disability as well or if the pace of increases of disabilities increased. However, it is not clear if specific age-groups drive these trends, and how those differences have manifested by sex, race, and ethnicity since the turn of the century. We used data from the National Interview Health Survey (NHIS), from years 2000 to 2018, and we ran a set of logistic regression models to establish age-specific trends by race for both types of limitations to activities in daily living (stratified by sex, decade and by the age-groups between 50-64,65-74-75-84) to disentangle the effect of time on how those trends developed, controlling by age, education and nativity. From 2000 to 2018 average prevalence of limitations to daily activities and instrumental limitations for adults aged 50 and above has not changed significantly, hovering on similar levels during the whole period. However, we identified an increase of limitations to daily activities and instrumental limitations for the 50-64 age group, with a steep increase during the first decade of the century and a stagnation afterward, mostly driven by Non-Hispanic Blacks and Hispanics, both for males and females. For other age groups, the trend was uneven, and we were unable to distinguish a clear direction.
BACKWARD GAIT CHARACTERISTICS: A NOVEL PERSPECTIVE ON PHYSICAL FUNCTIONING
Authors: Popelsky Braden , Ylitalo Kelly 
Published: January 2025

Abstract
Mobility is fundamental to healthy aging. Mobility measures such as gait velocity, double support phase, step length, and asymmetry can quantify ambulation and identify gait patterns that signify compensation for unsteadiness, poor balance, and physical functioning limitations. Forward walking is well-established as a measure of physical functioning, but fewer studies have assessed backward direction. Independently ambulatory young adults (n=20; age: 22.9 years ±1.6) and community-dwelling older adults (n=19; age: 70.2 years ±6.2) completed repeated forward and backward walking tests on a 3.9-m instrumented pressure mat. Paper surveys assessed sociodemographic characteristics, physical activity, fall history, and self-reported physical functioning (Physical Component Score (PCS) from the Short-Form Health-Survey 12). Forward and backward gait measures were evaluated using principal component analysis (PCA), and receiver-operating curves were used to model the diagnostic efficacy of gait measures on poor physical functioning. Four principal components explained 87.6% of the variance in gait. Principal component 1 accounted for 49.1% of the variance in gait with average backward step length (0.424) and backward walking speed (0.422) exhibiting the greatest loadings, indicating stronger influence. Principal component 1 was in moderate agreement (r=0.43, p=0.012) with PCS scores. Among older adults, backward gait velocity was a better predictor of poor physical functioning (PCS ≤ 50) than forward gait velocity (p=0.044; AUC=0.682 vs. 0.546). Backward gait characteristics may be novel indicators of physical functioning. Prospective studies should establish cut points for backward gait measures that classify poor physical functioning in diverse older adult populations.
FEAR OF FALLING INTERACTS WITH ACTN3 GENOTYPE TO PREDICT FAST GAIT SPEED IN OLDER ADULTS
Authors: Goldberg Allon , Burkhardt Summer , Norris Hayden , Garber Johnathon , Little Natalie , Kendall Jaiden , Sucic Joseph 
Published: January 2025

Abstract
Deficits in walking speed are associated with poor health outcomes in older adults. The alpha-actinin-3 gene (ACTN3) harbors the R577X polymorphism, which influences muscle function and physical performance in older adults. Fear of falling (FOF) is associated with gait, mobility and physical performance deficits in older adults. Our objective was to determine if effects of FOF on fast gait speed (FGS) are associated with ACTN3 genotype, to identify individuals based on ACTN3 genotype at risk for greatest declines in FGS with onset of FOF. Older adults (N=168, female=61.3%, mean age 72.8 years, range 65-85 years) attended a study visit at which demographic, self-rated health (SRH) and FOF information was collected, and 10-meter FGS was tested. Saliva was obtained for ACTN3 genotyping. Multiple regression evaluated variance in FGS explained by FOF, RR genotype (present/absent), and interaction of FOF with RR genotype, controlling for age, sex and SRH. The final regression model explained 36.9% of FGS variance (p&lt;.001). FOF was a significant predictor (β=-.163; p=.026) of FGS. RR genotype did not independently predict FGS (β=.103; p=.161), but was interactively with FOF a significant predictor (β=-.181; p=.024) of FGS. The effect of FOF on FGS was greater in individuals with RR genotype than in the RX/XX genotype subgroup (partial eta squared 0.083 and 0.030 respectively). The significant FOF x RR genotype interaction suggests that effects of FOF on FGS vary based on ACTN3 genotype. Individuals with RR genotype (compared to the RX/XX subgroup) may experience greater FGS declines with onset of FOF.