bluuebunny/crossref_metadata_2025_split huggingface dataset:
SELF-RATED HEATH PREDICTS INCIDENT MODERATE/SEVERE DISABILITY IN AGING MEN: THE MANITOBA FOLLOW-UP STUDY
Authors: John Phil St , Nowicki Scott , Tate Robert 
Published: January 2025

Abstract

Background
There is evidence that Self-Rated Health (SRH) predicts death, but less evidence that SRH predicts new disability. Objective: To determine if SRH predicts moderate/severe disability in a prospective cohort study of aging men.

Methods
We conducted an analysis of a prospective cohort study of men who qualified for air crew training in the Royal Canadian Air Force, which began in 1948. Since 2004, an annual survey is sent out which measures age-reference SRH, functional status, and the Short-Form-36 (SF-36). In 2004, 796 men were alive, responded to the questionnaire and did not have disability. Functional status has been measured with an annual questionnaire which includes items on Basic Activities of Daily Living (BADLs) and Instrumental ADLs (IADLs). We considered impairment to be two or more BADLs impaired (of five considered) or three or more impaired IADLs (of seven). We calculated the median time to disability, and compared groups with a log rank test. We then constructed a proportional hazards model for the outcome of new disability.

Results
SRH was associated with incident disability: Compared to those with Excellent SRH, the Hazard Ratio (95% confidence interval) was 1.79 (1.19, 2.68) for those with Very Good SRH; 2.87 (1.91, 4.30) for those with Good SRH; and 2.40 (2.04, 5.65) for those with Fair/Poor/Bad SRH. This association persisted after adjusting for age, the SF-36 and chronic diseases. Conclusions: SRH predicts new disability.
TWENTY-FOUR-HOUR ACTIVITY COMPOSITION ASSOCIATIONS WITH MUSCLE POWER AND STRENGTH IN OLDER MEN AND WOMEN
Authors: Roe Lauren , Strotmeyer Elsa , Glynn Nancy , Cawthon Peggy , Ma Yan , Hetherington-Rauth Megan , Kritchevsky Stephen , Cauley Jane 
Published: January 2025

Abstract
Physical activity (PA) and sedentary (SED) behavior have opposing associations with skeletal muscle function and are often studied separately, but are codependent. We evaluated associations of 24-hr movement behaviors [moderate-to-vigorous intensity (MVPA), light intensity (LPA), SED, and sleep] with muscle power and strength in 714 community-dwelling older adults (58% women, 76±5 years) from the Study of Muscle, Mobility and Aging (SOMMA). Compositional data analysis applied to 24-hr accelerometry (wrist-worn) determined proportions of time spent in each behavior relative to the remaining behaviors. Multiple linear regression evaluated associations between 24-hr composition with peak stair climb ascend power and leg press power (W), and maximum leg press strength and grip strength (kg). Compositional isotemporal substitution methods determined theoretical changes in the outcome if 10-60 minutes of one behavior was displaced by another in 10-minute increments. Higher proportions of MVPA vs. other behaviors were associated with higher leg press power in men (β: 67.5, 95% CI: 19.9, 115.1) and women (β: 29.1, 95% CI: 8.1, 50.2), and higher stair climb power in women (β: 25.0, 95% CI: 16.5, 33.4). Higher proportions of LPA vs. remaining behaviors were associated with lower leg press power in men (β: -117.9, 95% CI: -193.7, -42.1) and women (β: -39.0, 95% CI: -73.5, -4.6), and lower stair climb power in women (β: -31.6, 95% CI: -45.5, -17.8). No significant associations were found for strength. The most effective time-use substitution to improve muscle power may be through displacing SED or LPA with MVPA in older men and women.
WHAT COMES FIRST? SENTINEL CHRONIC AND SUBSEQUENT MULTIMORBIDITY AMONG OLDER ADULTS
Authors: Zuo Dongmei , Cunningham Solveig 
Published: January 2025

Abstract
The majority of the U.S. adult population is affected by at least one chronic condition. To develop clinical practice guidelines and early prevention interventions, it is necessary to understand the progression of multimorbidity. We investigated the first chronic condition, or sentinel condition, developed by individuals using 15 waves of longitudinal data from the Health and Retirement Study, 1992-2020. Hypertension, arthritis, and heart diseases emerged as the most frequent sentinel conditions. Employing weighted multinomial logistic regression models, we assessed the association of onset age, sex, and race/ethnicity with the likelihood of these conditions relative to a combined category of cancer, diabetes, lung diseases, or stroke as the first onset disease, adjusting for education, marital status, and household income. We find that, compared to having cancer, diabetes, lung, or stroke diseases as the sole first onset condition, each additional year of age decreases the odds of having hypertension and heart disease as the first onset disease by 1.9% and 2.2%, respectively, and decreases the odds of arthritis by 1.8%. Being Hispanic and non-Hispanic Black increases the odds of hypertension as the first onset disease by 64% and 19%, respectively. Being female increases the odds of arthritis by 60%, while being Hispanic increases the odds by 16%, and being non-Hispanic Black decreases the odds by 44%. For multimorbidity, being female and non-Hispanic Black decreases the odds by 12% and 36%, respectively, while being Hispanic increases the odds by 55%, relative to cancer, diabetes, lung diseases, or stroke as the first onset disease.
LONG-DISTANCE FAMILY CAREGIVERS’ APPRAISAL OF BURDEN AND STRAIN SCALES: FINDINGS FROM THE LDCARE INTERVENTION
Authors: Chunga Richard , Cimarolli Verena , Boerner Kathrin , Czaja Sara 
Published: January 2025

Abstract
Although there is a significant and growing number of long-distance family caregivers (LDCs) of older adults with dementia, most evidence-based interventions have been designed and evaluated for caregivers living geographically close to their care recipients. Commonly used scales were designed for proximate caregivers to assess their levels of burden and strain and used to measure outcomes of caregiver interventions. However, LDCs face unique challenges that such scales may not adequately capture. As part of the feasibility testing of a new, remotely delivered, psychoeducational intervention for LDCs, called LDCare, several commonly used burden and strain scales were administered to 40 participating LDCs. During the pre-intervention assessment, the Zarit Burden Interview-12, Pearlin’s Family Conflict Scale, Job-Caregiving Conflict, and Role Captivity Scale were administered to the LDCs. After each scale, open-ended questions were included to provide an opportunity for the participants to evaluate the scales’ relevance to their experience as LDCs. Across scales, most participants stated that the questions described their thoughts and feelings well in general, however, comments regarding some questions’ irrelevance to long-distance caregiving were most common for the Zarit Burden Interview-12 and the Role Captivity Scale. Participants remarked that lower everyday caregiving engagement and geographic distance rendered some questions difficult to answer. Concerns among some LDCs regarding the scales’ relevance to their situation indicate that further research is needed to better understand how questions may be tailored to their unique experiences.
HYPERTENSION CONTROL PROGRAM IN A LARGE HEALTH CARE SYSTEM SERVING HISPANIC MEDICARE BENEFICIARIES IN SOUTH FLORIDA
Authors: Chaves Paulo , Desoria Maureen , Roque Leslye , Mas Rafael 
Published: January 2025

Abstract
Healthcare systems play a key role in hypertension control and health equity promotion in large populations. This study assessed the impact of a multifaceted hypertension control program in a large healthcare system serving Medicare and dual eligible (DE) Beneficiaries primarily of Hispanic origin in South Florida, an understudied population. Leon Medical Centers, a major integrated healthcare services provider to Medicare and DE patients in Miami-Dade, FL, implemented a hypertension control program in 2011. Electronic health records (2008-2018) from patients aged 65-89 years with hypertension were analyzed. Controlled BP definition was annual average systolic BP&lt; 140 mmHg and diastolic BP&lt; 90 mmHg. Age- and diabetes-standardized annual BP control rates were calculated. Random effects modeling compared BP control levels after vs. before program implementation. From 2008 (n=4,710) to 2018 (n=21,540), mean age±SD increased (73.4±5.3 to 77.1±6.1). Proportion of Hispanics remained constant (&gt;98%). Overall age-adjusted odds of BP control were 5.8 (95% confidence interval [CI]: 5.6-6.1) times higher after program implementation. BP control rates increased similarly in both sexes. In women, standardized control rates increased from 68.9-73.3% (2008-2010) to 88.8-92.3% (2013-2018). Standardized control rates tended to be lower in DE than in Medicare patients at baseline – e.g., 2008: 67.2% (65.9-69.3%) vs. 72.2% (70.4-73.8%), but similar after program implementation – e.g., 2018: 89.9% (89.3-90.5%) vs. 90.2% (89.4-91.0%). Implementation of a primary care-based, multicomponent, culturally congruent hypertension control program was associated with meaningful increases in BP control levels in both men and women, and Medicare and DE patients in a large healthcare system in South Florida.
IMPACTS OF PAYMENT REFORM AND COVID-19 ON POSTACUTE CARE ACCESS FOR OLDER ADULTS WITH DISABILITIES
Authors: Prusynski Rachel , Leland Natalie , Humbert Andrew , Dahal Arati , Brown Cait , Amaravadi Harsha , Mroz Tracy 
Published: January 2025

Abstract
Recent Medicare payment reforms, the Patient-Driven Payment Model (PDPM) for skilled nursing facilities (SNFs) and the Patient-Driven Groupings Model (PDGM) for home health agencies (HHAs), aim to improve access to post-acute care for patients with complex care needs by focusing reimbursement on diagnosis and medical complexity. Caring for complex patients, such as those with disabilities, under previous systems may have been less profitable for providers, discouraging admissions. We examined whether these policies improved access to SNF and HHAs for beneficiaries with disabilities. We conducted an interrupted time series analysis of Medicare hospitalizations from 2018-2021 to identify changes in access to SNFs or HHAs. This period included reform implementation and the COVID-19 pandemic, which emerged shortly after reforms. We identified 7,734,908 hospitalizations for beneficiaries with a disability as the original reason for Medicare entitlement. Before reforms, 11.1% of beneficiaries with disabilities were discharged to SNFs and 13.1% to HHAs. PDPM was associated with no difference in HHA discharges but a 0.43-percentage point (pp) decline for SNF. PDGM was associated with increases in HHA (1.91pp) and SNF (0.37pp) discharges until the COVID-19 pandemic, when HHA discharges again increased, remaining high at an average of 18.4% after vaccination efforts. SNF discharges declined at the onset of the pandemic but increased to 14.3% of all hospital discharges after vaccination efforts. Results suggest PDPM worsened access to SNF for beneficiaries with disabilities, but SNF access rebounded after COVID-19 vaccinations. Alternatively, PDGM improved access to HHAs for beneficiaries with disabilities, which remained high during the pandemic.
APPLYING THE TDF FRAMEWORK TO VACCINATION DECISION-MAKING AMONG DIVERSE OLDER ADULTS
Authors: Patskanick Taylor , Ashebir Sophia , Balmuth Alexa , D’Ambrosio Lisa , Coughlin Joseph 
Published: January 2025

Abstract
Annual immunization rates among U.S. adults remain low relative to younger age groups and vary further by vaccine target. Gaps in research understanding the factors influencing older adults’ uptake of vaccines typically indicated for those aged 50+ such as pneumococcal, flu, tetanus, diphtheria and pertussis, shingles, and coronavirus 2019 as persist. Older adults represent a spectrum in the degree to which they may be up-to-date on these recommended vaccines and the facilitators or barriers to this uptake may further vary across vaccine targets. This paper presents findings from the qualitative portion of a cross-sectional study conducted from 2021 to 2022 in which 25 virtual focus groups and interviews of adults aged 65+ (N=112) and who identified as Black or African-American, Latine, Asian or Asian-American, or White were convened to discuss vaccination decision-making. Groups were stratified by racial/ethnic identity and degree to which participants were up to date on the aforementioned vaccinations. In this paper, data were analyzed in MAXQDA2024 using the Theoretical Domains Framework to identify and map the framework’s constructs across vaccine targets among the partially or fully vaccinated. Findings compare and contrast the prevalence of domains (e.g., social influence, emotion, knowledge) across targets among the vaccinated in our sample. Implications of this work for healthcare professionals who seek to influence health behavior change and future research focused on the implementation of interventions to improve vaccination uptake among older adults will be discussed.
INFLUENZA VACCINATION AND OLFACTION IN OLDER ADULTS: FINDINGS FROM HEALTH ABC
Authors: Yuan Yaqun , Chamberlin Keran , Li Chenxi , Luo Zhehui , Tian Teresa , Simonsick Eleanor , Chen Honglei 
Published: January 2025

Abstract
Olfactory impairment is common in older adults and is likely associated with multiple adverse health outcomes. However, few risk or protective factors for olfactory impairment in older adults have been identified. We examined the cross-sectional association between flu vaccination and olfaction among 2507 participants of the Health, Aging and Body Composition study (aged 71-82 years, 51.7% women, and 37.4% Blacks). Olfaction was tested at the clinic visit Year 3 in 1999-2000, using the Brief Smell Identification Test. Olfaction was defined as good (test score 11-12), moderate (9-10), or poor (0-8). Participants were asked about receiving flu vaccines in the past year at each clinic visit from Years 1 to 3. We used multinomial logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CI) of flu vaccine reported at each clinic visit and olfaction tested at Year 3, adjusting for demographics, lifestyle, general health status, and flu occurrence within the past three months. At Year 3, compared with those not vaccinated, participants with flu vaccination were less likely to have moderate olfaction (OR=0.66, 95%CI, 0.51-0.85) and potentially fewer poor olfaction (OR=0.79, 95%CI, 0.60-1.02). The association appeared more evident in men and white participants. Similar findings, albeit slightly attenuated, were found in analyzing flu vaccination data reported at Year-1 and Year-2 clinical visits. Our study provides preliminary evidence that flu vaccination may be protective against olfactory loss in older adults, especially for men and the white race.
METHODOLOGICAL CHALLENGES WITH VOLATILE OLDER PARTICIPANTS: LESSONS FROM A VACCINE HESITANCY SURVEY
Authors: Van Vleet Bryce , Fuller Heather , Huseth-Zosel Andrea 
Published: January 2025

Abstract
Vaccine hesitancy is a critical health risk to older adults who may refuse vaccination for common, preventable, and life-threatening diseases like shingles, pneumonia, COVID-19, and influenza. Despite the importance of understanding vaccine hesitancy among older adults, mistrust in science and hostility towards researchers has been previously documented but it is unclear how these processes impact the research process. Thus, we sought to examine the characteristics and response patterns of volatile survey participants. Data were drawn from a mixed-methods survey about vaccination perceptions and behaviors conducted with 901 community dwelling older adults (65+). Volatile participants (n=59) were identified through their expression of excessive anger (e.g., explicit language, criticism, etc.) or mistrust (e.g., paranoia, accusations, etc.) in open-ended responses. First, linear regression was conducted to identify possible demographic predictors of volatile responses (R2=.063, p&lt;.001). Volatile respondents were significantly more likely to be younger, highly religious, and conservative. Next, chi-square and post-hoc analyses were used to examine differential missingness in volatile participant responses. Volatile participants were more likely to answer questions they likely considered controversial, such as questions about COVID-19 and influenza vaccines. Volatile participants were also less likely to fully complete certain items of vaccine hesitancy and vaccine barrier scales. However, intra-individual response variability analysis did not detect outright deception from volatile participants. Overall, this study highlights methodological challenges in researching vaccine hesitancy among older adults and suggests recommendations to future researchers on conducting studies on politicized topics with skeptical, or even hostile, participants.
ORAL CARE IS A NECESSITY NOT A LUXURY: POLICIES THAT HELP OR HINDER ORAL CARE FOR OLDER ADULTS
Authors: Gallant Kayla , Reid Katrina , Ilardo Joan , Zell Angela 
Published: January 2025

Abstract
We interviewed fifteen stakeholders including state-level policy officials, medical practitioners, dental advocacy organizations, and educators to identify factors influencing oral care provision for older adults in residential settings. The interviews were conducted by two second-year medical students under the supervision of a Ph.D. social worker and a Doctor of Public Health. Analysis of interview transcripts followed grounded theory methodology. Our findings revealed several key themes limiting the provision of dental care to older adults in residential settings. These themes included financial constraints (e.g., Medicare and Medicaid coverage and reimbursement could be unpredictable state by state and year by year), inadequate training (e.g., few specialized dental training programs addressing geriatric oral care needs), limited resources for care provision within nursing facilities, and a systemic insufficient awareness of the dental needs of older adults in residential settings. This study’s results illustrate the means of overcoming the limitations plaguing oral care for older adults in residential settings and ultimately advancing geriatric oral health outcomes in skilled nursing facility (SNF) settings. Next steps are to introduce a “train-the-trainer” model at a SNF. Registered and student dental hygienists will train certified nursing assistants to provide basic oral care for older residents in the SNF to improve geriatric oral health, ensure access to basic oral care, and strengthen the SNF’s ability to provide dental services.
EARLY PALLIATIVE CARE UTILIZATION AMONG OLDER ADULTS WITH METASTATIC CANCER IN A MEDICARE COHORT
Authors: Nowels Molly , Kozlov Elissa , Crystal Stephen , Duberstein Paul 
Published: January 2025

Abstract
Meta-analytic data have found early palliative care (EPC) to be associated with better outcomes among older adults with cancers. EPC is now recommended for all people with advanced cancers. Ideally, the resources required to appropriately treat referred patients would reflect the needs of the patient population. We are aware of no prior attempts to characterize patients receiving EPC. To address this gap, we used a 20% random sample of fee-for-service Medicare enrollees from 2008-2016 to identify predictors of EPC use within 8 weeks of a new diagnosis of metastatic cancer. Logistic regression modeling adjusted for demographics, cancer site, indicators for a variety of physical and behavioral health diagnoses, the Elixhauser comorbidity index, and several indicators for past-year health service use. 525,936 individuals were included, with 4.9% (25,982) receiving EPC. Several behavioral health diagnoses were associated with increased odds of EPC, including both active and remitted alcohol use disorder; active drug use disorder; major depression; and schizophrenia. These findings suggest that the caseloads of palliative care clinicians may disproportionately include persons with histories of significant psychiatric disorders and behavioral health disorders. Though palliative care clinicians may effectively manage some psychological symptoms, such interventions fail to consistently do so. Moreover, few palliative care teams include psychologists or psychiatrists, potentially leading to significant gaps in clinical expertise. Models of palliative care should integrate specialty mental health clinicians to meet the demand for EPC services and manage the spectrum of needs among older adults with advanced cancers.
EXPLORING THE RELATIONSHIP BETWEEN HOME TIME AND SERIOUS ILLNESS AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Butler Rachel , Degenholtz Howard 
Published: January 2025

Abstract
Population-based measures like Healthy Days at Home (HDAH) are increasingly used as quality of life or health system performance metrics. These measures are just beginning to be studied in the context of older adults living with serious illness (SI). We explored factors associated with the duration of home time among community-dwelling Medicare beneficiaries with SI. Using 2016 data from the National Health and Aging Trends Study (NHATS) linked to Medicare claims, we calculated home time for sampled community-dwelling older adults using the HDAH measure. We operationally defined SI as having a diagnosis code in Medicare claims for at least one of nine severe chronic conditions identified by the Dartmouth Atlas. We conducted multivariate analyses to explore how a SI diagnosis (independent variable) is associated with home time (dependent variable). Covariates included gender, age, household composition, census division, and health and well-being (including self-reported health, number of chronic conditions, psychological symptoms, and subjective well-being). In unadjusted analyses, we found the overall community-dwelling sample population had a mean of 361.9 HDAH, while those with SI had a mean of 353.6 HDAH. A Poisson regression showed that community-dwelling older adults with SI had statistically significant fewer HDAH compared to those without SI (β=-0.03 fewer HDAH; CI:-0.03, -0.02). None of the covariate effects were statistically significant. This work furthers our understanding of opportunities to enhance service delivery systems for community-dwelling older adults with SI, a population not necessarily at the end-of-life but one that is vulnerable to frequent, intensive, high-cost health system encounters.