bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOW DO UNMET NEEDS VARY BETWEEN PEOPLE WITH AND WITHOUT DEMENTIA RECEIVING HOME AND COMMUNITY-BASED SERVICES
Authors: Jutkowitz Eric , Wolf Jack , Parikh Romil , Langworthy Benjamin , Shippee Tetyana 
Published: January 2025

Abstract
The National Core Indicators Aging and Disability (NCI-AD) survey samples home and community-based service recipients to understand their unmet HCBS needs. Using 2016-2019 NCI-AD data (N=24348), we evaluated the demographic (e.g, race), health (e.g, hearing ability), environmental (e.g., living alone) and payer (e.g., Medicaid) factors associated with reporting an unmet need among HCBS users age ≥65 with and without dementia. We defined an unmet need as reporting wanting more adult day services, caregiver support, delivered meals, homemakers, personal care assistance, or transportation services. We modeled the odds of unmet needs and tested for differences in unmet needs between people with and without dementia. Personal care assistance was the most frequently used service among people living with and without dementia (59% vs. 50%) followed by delivered meals (22% vs. 37%), homemaker services (21% vs. 25%), adult day services (12% vs. 8%), transportation (9% vs. 8%) and caregiver support (9% vs. 5%). Unmet needs among people with and without dementia respectively varied between 5% and 3.2% (adult day services) to 11% and 14% (personal care assistants). Asians compared to Whites without dementia were significantly more likely to report an unmet need for personal care and homemaker support, and less likely to report an unmet need for caregiver support, but there was little association for people with dementia. Overall health and hearing ability also had different associations with unmet needs between people living with and without dementia but the relationships were not consistent in direction.
LONELINESS AMONG OLDER CAREGIVERS IN THE CALIFORNIA HEALTH INTERVIEW SURVEY
Authors: Chen Xiayu , Lydon Elizabeth , Jones Sarah , Mathias Vincent F , Rogers Wendy , Mudar Raksha , Raj Minakshi 
Published: January 2025

Abstract
In the U.S., adults aged 65 and above represent the second largest age group among familial caregivers. Navigating dual challenges in caregiving demands and their own aging process may lead to higher risk of social isolation for older caregivers. However, research regarding loneliness among older caregivers remains limited. This study aimed to (a) compare risk factors for loneliness between older caregivers and non-caregivers; (b) evaluate if sociodemographic, health, and caregiving characteristics are related to loneliness among older caregivers; and (c) compare the association between these characteristics and loneliness among older caregivers of persons with dementia versus without dementia. We conducted a secondary data analysis of the 2020 California Health Interview Survey. One-fifth of the older adults (n=7,638) served as caregivers in the past year, and 15% of older caregivers experienced loneliness. Using a series of weighted multivariable logistic regressions, we found that older caregivers were more likely to experience loneliness compared with older non-caregivers (aOR = 1.15, 95% CI: 0.89 - 1.49). Those caring for other older adults had a lower likelihood of loneliness compared with those caring for younger individuals (aOR = 0.48, 95% CI: 0.27 - 0.85). Caregivers of persons with dementia were more likely to experience loneliness compared to those caring for persons without dementia (aOR = 1.67, 95% CI: 1.05 - 2.66). Our analyses revealed that older caregivers, especially those assisting persons with dementia, face a higher risk of loneliness, underscoring the need for targeted support and inclusive caregiving policies.
FORTITUDE AND THE MORAL GOOD OF AGING
Authors: Wohns Nicolai 
Published: January 2025

Abstract
Fortitude, classically one of the four cardinal virtues, is taken to be necessary for the possession of every other virtue. In this presentation, I analyze the positive aspects of aging from a philosophical perspective and argue that fortitude is also of particular importance for the moral good of aging. Once aging is understood as a dynamic phenomenon with biological, socio-psychological, and existential dimensions, it becomes apparent that it presents myriad physical and mental challenges for which fortitude is required for one to flourish. I focus on the biological dimension in particular, suggesting that, though it is usually defined in terms of loss, biological aging brings with it the possibility for moral virtue. Using this virtue-theoretic framework, I conclude by arguing, contrary to some trans-humanist critics, that there are in fact positive aspects of aging that depend on biological aging.
THEORIZING FORTITUDE, FRIENDSHIP, AND OLD AGE IN LORE SEGAL’S SHORT STORY CYCLE “LADIES LUNCH”
Authors: Trinkaus Eva-Maria 
Published: January 2025

Abstract
This contribution addresses the question of ‘fortitude’ from a literary studies perspective. In my narrative analysis of Lore Segal’s short story cycle “Ladies Lunch” (2023) I look at the representation of fortitude in the context of friendship in old age. Fictional narratives about female friendships in old age, Chivers argues, can be part of “constructive narratives of aging” in an “imaginary world that can reflect and especially affect circulating social thought” (2003). Friendship in old age, in Segal’s fictional text, constitutes a form of care among the women who partake in their regular lunch meetings in which they contest the readers’ views on stereotypes of old age, but at the same time, also express personal vulnerabilities in opposition to a “decline narrative” (Gulette 2001). On the contrary, the kind of reciprocal care they experience comes from a vulnerability that manifests as a “radical openness towards surprising possibilities” (Hirsch 2016). In theorizing fortitude, this narrative analysis addresses the ways fortitude manifests in ways that do not necessarily address danger or pain in the literal sense of the word. Rather, it provides a perspective that juxtaposes fortitude and age in order to address courage in accepting situations and the creative adaptation to those within the story.
POLICY SERIES: WHAT IS “GOOD WORK” IN LONG-TERM SERVICES AND SUPPORTS? SETTING A RESEARCH AND POLICY AGENDA FOR DIRECT CARE WORK
Authors: Morgan Jennifer , Taylor Philip , Behrens LIza 
Published: January 2025

Abstract
This symposium considers the importance of the care-work nexus in long-term care research and policy. Person-centered care delivery is widely accepted as delivering optimal client outcomes, but this is often not practiced. Job quality is considered a crucial determinant of well-being for individuals, society and of organizational performance, yet direct care work is not generally afforded “good work” job quality. Raising standards of appropriate care and care work job quality is essential to improve the life quality of both clients and workers. Drawing from empirical research in the USA and internationally, this session considers the current state of long-term care work across key dimensions of job quality. Critically from a job quality perspective, this session foregrounds the authentic worker voice in identifying a research and policy agenda focused on addressing the care-work nexus. First, we will provide an overview of job quality across long-term care services and supports sectors highlighting the target areas for research and policy advocacy by sector. Second, we will engage workers and union leaders, using a community-engaged co-design framework, in the local SEIU 775 Washington to react to the job quality domains and provide feedback on priority-setting. Third, Washington-based SEIU leaders will collaborate to review the policy, advocacy and negotiation wins made for clients and worker in conversation with employer partners. Finally, scholars, in collaboration with workers/leaders, will summarize the areas targeted for future research and policy agendas aimed at improving job quality and person-centered approaches for both workers and clients.
DIRECT CARE WORKERS IN LTSS: RESEARCH AND POLICY AGENDA SETTING
Authors: Taylor Philip , Scales Kezia 
Published: January 2025

Abstract
At a time when the provision of long-term care is under more scrutiny than ever, and as demand for care increases, it is timely to consider what this will mean for the future organization of care work. Recent reviews have recommended changing the nature of the modern workplace, creating good work, and reducing poor-quality work. As well as positive worker outcomes, good work benefits organizational performance—and enhances care quality. The task is to develop a “conducive model” of jobs that generates positive outcomes for a care workforce that is disproportionately female and people of color who face multiple structural inequities. Drawing on international literature concerning the relationship between long-term care organization, staffing and care quality, the working environment, and worker and resident/client outcomes, this paper utilizes the multidimensional job quality concept to assess the state of knowledge. Unsurprisingly, the evidence demonstrates that poor-quality jobs result in poorer worker outcomes, and good-quality jobs support good care. However, significant gaps in understanding across dimensions of job quality are identified, particularly how it can be operationalized in day-to-day practice. It is argued that focusing on job quality will help reframe the analysis and interventions needed to improve care and adapt provision to meet future demand. In conversation with our worker and union leader guests and the panel scholars, we will collaboratively set the research and policy agenda for direct care workers in LTSS. Implications for establishing a national taskforce or an international concord on the direct care workforce will be discussed.
CO-DESIGNING SOLUTIONS WITH WORKERS: SETTING RESEARCH AND POLICY PRIORITIES
Authors: Rhodes Annie , Waters Leland 
Published: January 2025

Abstract
An emerging body of literature has linked the quality of care for care recipients with the quality of work experience with the professional caregiver across the spectrum of long-term services and supports. For instance, prior to the COVID-19 vaccine, nursing home workers who worked in multiple locations were significantly more likely to be infected with COVID-19 and, subsequently, more likely to infect care recipients. Despite the natural alignment with worker and recipient interests, LTSS quality improvement efforts often do not focus on aligning recipient and worker perspectives as a reform and quality improvement strategy. For instance, although current evidence supports that staffing ratios improve both recipient care and caregiver safety, there has been a backlash against a proposed staffing mandate in nursing homes by provider stakeholders. To uplift the caregiver’s voice and collaborate with SEIU 775 (Washington State), workers from home care and nursing home organizations with leadership experience will talk with panelists about COVID-19, staffing ratios, advocacy, job quality, job safety, career ladders, and advancement, and intrinsic rewards. These workers will relay their experiences and discuss why they took up these jobs, stay in these jobs, and work to improve these jobs through union strategies. Panelists will ask questions related to agenda setting and co-designing research and policy solutions that simultaneously uplift and align recipient and caregiver voices.
“HOW DOES THAT MAKE YOU FEEL?” USING NETWORK SCIENCE TO ESTIMATE AFFECT DYNAMICS ACROSS ADULTHOOD
Authors: Hamilton Lucas , Allard Eric 
Published: January 2025

Abstract
Research on affect dynamics has dramatically changed in the past two decades. With the proliferation of ecological momentary assessment and online data collection, methodological and analytical approaches have greatly expanded. One approach is the estimation of emotion networks which can be done through a few lines of R code but requires a great deal of planning and interpretation by the researcher. Network estimation models individual emotions as distinct (i.e., sad or angry) and dimensionally dependent (i.e., sad and angry). This technique can test the independent influence of each emotion and unique associations between every pair of emotions. Critically, network structures (i.e., magnitude of co-fluctuation, independence of items) can be compared both within-individuals and between groups. Our previous findings demonstrate the feasibility and utility of estimating emotional reactivity across the lifespan. Using a video clip elicitor and a sample of 531 people (178 younger, 175 middle-aged, and 178 older adults), emotion networks were used to verify mean affective reactivity before and after the clip while also testing distinct co-occurrences (i.e., mixed emotions). To further demonstrate the usefulness of this approach, we have undertaken a database project that evaluates affective blending in response to 48 video clips. Mirroring the methodology from above, a sample of younger, middle-aged, and older adults rated their emotions before and after each video clip they watched. After summarizing overall reactivity findings, we will discuss how emotion networks offer great utility for disentangling unique and co-occurring emotions and their importance in emotional aging research.
PARSIMONIOUS MODELS OF LONG-TERM COGNITIVE DECLINE AND IMPAIRMENT PREDICTION IN MIDDLE-AGED ADULTS
Authors: Merten Natascha , Pinto A Alex , Paulsen Adam , Chappell Richard , Chen Yanjun , Engelmann Corinne , Hancock Laura , Schubert Carla 
Published: January 2025

Abstract
Established risk scores for dementia prediction (e.g., the CAIDE and Framingham Risk Score) often focused on cardiovascular factors and have not been updated in more recent generations. We aimed to construct a parsimonious risk prediction model of 10-year cognitive decline and impairment using factors measured in midlife in a current cohort. This longitudinal study is based on N=1529(54% women, mean age 49years) Beaver Dam Offspring Study participants with data from baseline, 5-year and 10-year follow-up. We assessed hearing, vision, olfactory, motor, lifestyle, cardiovascular and general health factors, and blood-based neurodegenerative markers, and amyloid. We determined 10-year cognitive decline (trail-making test B time;10% most decline) and cognitive impairment (neurocognitive case review). We constructed least absolute shrinkage and selection operator logistic regression models with 10-fold cross-validation and evaluated predictive ability via receiver operating characteristic curves (AUCs). There were N=121 cognitive decline and N=217 cognitive impairment cases. The six top predictors for cognitive decline (age, income, motor function, olfactory function, peripheral artery disease, neurofilament light chain protein (NfL)) and for cognitive impairment (sex, motor function, olfactory function, self-rated vision, alcohol consumption, NfL) yielded AUCs of 0.80(95% confidence interval:[0.76-0.83]) and 0.73[0.69-0.77], respectively. In midlife, sensory and motor measures and NfL were among the best predictors of 10-year onset of cognitive decline and impairment. Only 6 factors were needed for acceptable to excellent AUCs. Other cohort studies should cross-validate these predictors. Risk scores for asymptomatic middle-aged people based on practical test batteries will be useful for population screenings to target early prevention and intervention strategies.
INSIGHTS ON OLDER ADULTS WITH COGNITIVE IMPAIRMENT AND HEARING LOSS: END-USER AND CARE PARTNER PERSPECTIVES
Authors: Hope Peter , Nieman Carrie , Blinka Marcela , Lee Paul , Tu Xueting , Wang Natalie , Yasar Sevil , Oh Esther 
Published: January 2025

Abstract
Hearing loss is prevalent among persons aging with cognitive impairment and can have significant repercussions for individuals and their care partners. However, hearing aid usage is low among older adults, particularly among individuals with cognitive impairment. To understand the barriers and facilitators to hearing care among persons living with cognitive impairment and their care partner and to inform the development of a hearing care intervention, we conducted 20 semi-structured interviews with 10 participants with cognitive impairment and their care partners. Participants were recruited from the Johns Hopkins Memory and Alzheimer’s Treatment Center. We used heterogeneous purposive sampling to recruit participants from diverse race, ethnicities, education, and income levels. Qualitative content analysis was used to identify themes. Among end-users and care partners, 30% self-identified as African American, 45% as male, and 40% reported less than a college degree. Participants with cognitive impairment had a mean score of 16.8 (SD8.2) on the Montreal Cognitive Assessment and mean speech frequency pure tone average of 44.9 dB HL (SD12.7). End-users and care partners identified barriers to accessing care, including stigma, cost of hearing aids, lack of availability of hearing care, and participants’ denial of hearing difficulties. Suggested facilitators for improving access to hearing care include affordable hearing aids and incorporating hearing screenings into routine care. The participants’ desire to improve communication and care partner support motivate accessing hearing care. Our findings suggest that addressing barriers, promoting affordability, and enhancing accessibility to hearing care are critical in extending care to individuals aging with cognitive impairment.
NEW TOOL ENHANCES DETECTION OF LIFE-EXTENDING INTERVENTIONS BY DELINEATING THEIR TEMPORAL EFFICACY
Authors: Jiang Nisi , Liu Qianqian , Cheng Catherine , Strong Randy , Gelfond Jonathan , Nelson James 
Published: January 2025

Abstract
Drug discovery of anti-aging interventions relies on survival data, which is time-consuming and costly to generate, yet the analysis of such data often fails to capitalize on its full potential. The predominant method for assessing intervention effects on lifespan, the log-rank test, lacks the power to identify when and for how long an intervention is effective. Moreover, it has decreased sensitivity for interventions that are only effective during part of the life course. Statistical tools are needed to address these limitations. They should be capable of identifying when, for how long, and to what extent an intervention reduces (or increases) mortality risk. Here we introduce a Temporal Efficacy Profiler (TEP), which meets these needs, and apply it to survival data from 42 compounds tested in the NIA Interventions Testing Program (ITP) using UM-HET3 mice. Compared to the log-rank test, this tool identified over twice as many compounds that increased (or decreased) survival, largely because of its sensitivity to variable efficacy of the interventions across the life course. Sex differences were prevalent. The TEP revealed agents that either reduced (22 compounds) or increased (15 compounds) mortality hazards, with some (2 compounds) showing dual effects depending on sex. Notably, the efficacy of these interventions varied significantly in both duration and magnitude. Moreover, the TEP uncovered adverse effects that were missed by the log-rank test. Of note, only 8 compounds significantly reduced mortality hazards beyond the 90th percentile of mortality, a period when the burden of senescence is highest.
PREDICTING TIME TO COGNITIVE IMPAIRMENT USING BRAIN AGE
Authors: Imms Phoebe , Chen Siyu , Wang Haoqing , Li Ruixi , Irimia Andrei 
Published: January 2025

Abstract
The neurological changes that occur during the asymptomatic pre-clinical phase of cognitive impairment (CI) can be quantified using brain age (BA) measures and leveraged to identify those at risk of clinical manifestation. We employ a machine learning survival model to predict future CI among healthy older adults using cognitive, demographic, genetic, and neuroimaging data including regional brain volume and anatomically specific measures of BA. Participants were 2,718 adults from NACC (1,795 females, mean age=69.14±10.91). Converters (N=343) were diagnosed with CI during the study, and non-converters (N=2,375) were CN across all visits. We predicted time to conversion (days) from baseline MRIs (185 brain volumes and regional BA measures) and 69 clinical variables. The model was trained on 1,846 converters and 252 non-converters, validated on 32 converters and 238 non-converters, and tested on 150 converters and 200 non-converters with 5-fold cross-validation. The model’s predictive accuracy (c-index) was 0.82 for training, 0.83 for validation, and 0.78 in the test set. Important features for prediction included age, neurocognitive test scores, education, history of hypertension and stroke, BA, and volumes of the right hippocampus, right precentral gyrus, bilateral white matter, and left inferior temporal gyrus. Products of this model allow us to compare a) the risk, and b) the BA biomarkers across population subgroups with heightened CI risk such as racial minorities and people with fewer years of education. The ability to accurately predict future cognitive impairment (CI) benefits those most in need of therapeutic interventions and reduces the burden of CI on healthcare systems.
MARKERS OF PHYSICAL HEALTH AND HEALTH BEHAVIORS CONTRIBUTE TO LATER COGNITIVE FUNCTIONING AMONG ADULTS AGED 55–65
Authors: Katz Ben , Sands Laura , Khan Maham 
Published: January 2025

Abstract
Life’s Essential 8 (LE8) represents a summary score consisting of a set of physical health (BMI, blood pressure, cholesterol, A1C) and health behaviors (sleep, diet, smoking status, physical exercise) that are closely associated with risk of cardiovascular disease. LE8 is designed to be simple for physicians to calculate, using regularly collected self-report and biomarkers, and easily interpretable for patients. While no equivalent score exists for Alzheimer’s disease and related dementias (ADRD), given close links between cardiovascular risk factors and cognitive outcomes, recent studies have identified links between LE8 and cognition and dementia. However, longitudinal work in this space is limited; additionally, many prior studies do not examine links from midlife to changes in later life cognitive functioning. The present study draws from 761 midlife adults aged 55-65 without cognitive impairment at baseline who were recruited to participate in the Health and Retirement Study. Data informing LE8-style indicators (including health behaviors and bloodspot biomarker data) were recorded in 2006. Performance on the Telephone Interview for Cognitive Status (TICS) assessment was measured 14 years later. Utilizing linear regression techniques that incorporated the HRS sample weights and age, gender, education, and baseline cognitive functioning, we found that both the aggregated health behaviors (p &lt;.01) and aggregated physical health biomarker indicators (p &lt;.001) accounted for unique variance in the TICS scores 14 years later. These findings have implications both for basic research to investigate the mechanisms connecting lifestyle and physical biomarkers to later cognition, but also for clinical practice and patient communication.