bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMMUNITY DISCHARGE AFTER SKILLED NURSING FACILITIES BETWEEN MEDICARE FEE-FOR-SERVICE AND MEDICARE ADVANTAGE
Authors: Rivera-Hernandez Maricruz , Chou Lin-Na , Kumar Amit 
Published: January 2025

Abstract
The purpose of this study was to assess differences in rates of successful community discharge among Medicare Advantage (MA) and fee-for-service (FFS) enrollees by race/ethnicity. We linked the Master Beneficiary Summary File, Medicare Provider and Analysis Review data, and the Minimum Data Set. We identified 2,412,731 Medicare enrollees who were admitted to a skilled nursing facility in 2020. We assessed community discharge within 100 days remaining out of the skilled nursing facility for 30 days (LTC focus; Rivera-Hernandez et al., 2019). Approximately, 34.48% beneficiaries were enrolled in a MA plan at admission. A higher proportion of MA beneficiaries were discharged to the community compared to FFS beneficiaries (53.64% vs. 42.70%). Among MA beneficiaries, 54.50% of Hispanic beneficiaries and 47.51% of Black beneficiaries were discharged to the community compared to 53.31% among white enrollees. However, 45.85% of white FFS beneficiaries were discharged to the community compared to 38.71% Hispanic and 34.60% of Black FFS beneficiaries. After adjusting for clinical, demographic characteristics and facility fixed-effects, rates of discharge to the community remained approximately 4.87 percentage points (p.p.) higher (95% CI, 4.72 to 5.02) among MA compared to FFS enrollees. In addition, this difference among FFS and MA beneficiaries remained wider among Black (3.43 p.p., 95% CI, 3.05 to 3.81) enrollees when compared to the difference among white FFS and MA enrollees. The observed differences in successful discharge to the community among Medicare enrollees suggest the need to promote equity in the transition of care among the underserved adult population.
NURSING HOME STAFF PERSPECTIVES ON SUPPORTING PERSON-CENTERED CARE IN THE FACE OF RISK TO MAINTAIN QUALITY OF LIFE
Authors: Curyto Kimberly , Taylor Philip 
Published: January 2025

Abstract
Nursing home (NH) quality of care efforts emphasize person-centered care as a best practice. Evaluations of person-centered interventions report positive outcomes including improved resident psychological wellbeing, quality of life, and staff job satisfaction. However, prioritizing NH resident personal preferences and values can lead to choices that increase risk, and thus staff must act in ways that balance resident autonomy and safety. Best practices in person-centered care in the NH should honor choice and maintain safety in support of overall resident wellbeing through shared decision making among residents, families and the whole clinical team. The COVID-19 pandemic placed NH residents and staff at risk of decline and death and created barriers to implementing person-centered care. A primary focus of this symposium is to share a range of staff perspectives on supporting NH resident autonomy and safety in the face of risk, including those of NH leaders, mental health providers, and direct care team members such as nursing staff, recreation/activities staff, and social workers. Presentations will highlight the impact of a focus on safety during the increased risk from the pandemic on resident and staff wellbeing, and staff adaptation efforts to ensure person-centered care. Understanding NH staff and leadership perspectives on response to risk while supporting person-centered care will inform future care management during crises and other times of increased concern for safety in NH settings. Important perspectives of paid care workers during the pandemic will be discussed in the context of workforce development efforts.
MENTAL HEALTH PROVIDERS’ PERSPECTIVES OF BALANCING RISK AND RESPONSE AND THE PANDEMIC’S IMPACT IN VHA NURSING HOMES
Authors: Curyto Kimberly , Page Kyle , Shoji Kristy , Ryu HyeRim , Washington Tracey , Karel Michele 
Published: January 2025

Abstract
The COVID-19 pandemic forced a reconceptualization of how mental health services were offered to older adults in nursing homes, affecting residents and staff, as each experienced stringent and evolving infection control precautions. An anonymous national survey of Veterans Health Administration Community Living Center (CLC) mental health professionals in October 2022 included questions about the impact of the pandemic on CLC residents and healthcare teams. Respondents (N=107) included psychologists (82%) and psychiatric providers (18%). Sixty-six percent of respondents worked in the CLC before the pandemic and reported providing mostly in-person clinical care (97%). In comparison, across the entire sample two-years later, 72% reported providing in-person clinical care, 23% a mix of in-person and virtual care, and 5% entirely virtual care. An expert panel coded responses to the question, please describe your work with Veterans and teams in the CLC during the pandemic, in rotating groups of two to identify qualitative themes, and reviewed as a group to achieve consensus. Several themes emerged: 1) varied and changing methods/modes of work, 2) continued psychotherapy and assessment services, 3) increased education and support for the team, 4) declines in resident engagement, mental health, and cognition, and 5) negative impact on providers/the team (e.g., barriers to teamwork and person-centered care). Results underscore the impact the pandemic/precautions had on residents’ and teams’ well-being, as well as the adaptability of mental health providers, and may inform ongoing and future efforts to balance risk and support person-centered care.
LONGITUDINAL QUALITATIVE RESULTS FROM STAFF IMPLEMENTING MONTESSORI DURING THE PANDEMIC
Authors: Hilgeman Michelle , Kennedy Katherine , Mills Whitney , Snow A , Bishop Teddy , McIntosh Nathalie , Curyto Kimberly 
Published: January 2025

Abstract
Promoting autonomy, dignity, and independence are core values of Montessori approaches to person-centered care in nursing homes. Yet infection control precautions restricted staff and resident freedoms during the COVID-19 pandemic. We describe longitudinal data from a stepped-wedge, randomized clinical trial examining implementation and effectiveness of Montessori approaches in eight Department of Veterans Affairs nursing homes (2021-2023). COVID-rates were calculated from electronic health records (EHRs) and graphed over 18 months around the intervention. Staff (N=168) participated in qualitative individual or group interviews at baseline, 3-, 6-, 9-, and 12-months. Normalization Process Theory informed questions and qualitative content analysis about the effects of COVID-19 on Montessori implementation and staff experiences. Transcripts were coded by members of the study team using NVivo. There was variability in COVID rates: most NHs concentrated below 1% of resident-days with COVID and occurred after 3-months of Montessori training/implementation, while two sites experienced peaks of 5% and 15%. Qualitative themes across implementation included: 1) Staff described fluctuating waves of COVID, changes in precaution protocols, and variable policy interpretations across sites to be associated with negative impact on residents and staff (isolation, loneliness, burden, burnout, low morale). 2) Staff identified creative adaptations (e.g. walkie-talkies) to implement Montessori within precaution protocols. 3) Staff reported that Montessori principals improved morale, mitigated negative effects of the pandemic and related precautions, and created a pathway for increased advocacy for person-centered care and resident wellbeing despite risks. Findings highlight the importance of reinforcing person-centered care in the midst of safety concerns during crisis.
USE OF AND EXPERIENCES WITH TELEHEALTH VISITS AND PATIENT PORTALS IN A NATIONALLY REPRESENTATIVE SAMPLE OF OLDER ADULTS
Authors: Solway Erica , Singer Dianne , Kirch Matthias , Roberts Scott , Kullgren Jeff 
Published: January 2025

Abstract
The University of Michigan National Poll on Healthy Aging (NPHA) has explored older adults’ changing views and experiences related to telehealth and other health-related technologies over the past several years. NPHA surveys are fielded twice per year to a nationally representative sample of over 2,500 adults ages 50-80 (completion rates: 50-60%). When the poll first included questions about telehealth use and perceptions in 2019, just 4% of U.S. adults ages 50-80 reported having a telehealth visit in the past year. Telehealth expanded rapidly during the pandemic and by mid-2020, 26% of older adults reported having had a telehealth visit within the prior three months. In addition, the NPHA has explored patient portal use, documenting an increase in portal uptake over time as well as older adults’ experiences with, and barriers to, portal use. Recently, the NPHA explored older adults’ experiences related to sending portal messages to their health care providers and the out-of-pocket costs associated with this. Other recent NPHA research has demonstrated use and interest in direct-to-consumer telehealth services provided by online-only companies. As of 2023, the poll found that 7.5% of people ages 50-80 had used at least one direct-to-consumer health care service from an online-only provider, and 32% said they would be interested in these types of health care services in the future. The NPHA provides timely insights on older adults’ changing perspectives and experiences related to emerging areas of health care that can help to inform efforts to improve access, quality, and integration of health care.
A NEW NORMAL: AARP SURVEY FINDINGS ON OLDER ADULTS’ EXPERIENCES AND PERSPECTIVES ON TELEHEALTH AND AI IN HEALTH CARE
Authors: Lampkin Cheryl , Keenan Teresa 
Published: January 2025

Abstract
The COVID-19 pandemic ushered in a “new normal” as it relates to receiving health care--especially for older adults. This presentation will include insights on how new technology and attitudes about technology have impacted how older adults receive health care services. For example, findings from a recent survey of 1,700 older adults conclude that while over half say they are likely to attend a phone or video session with a mental health professional (53%) or their primary care provider (52%) for a mental health concern, most are skeptical of telehealth believing they get better quality care for both physical (82%) and mental health (69%) concerns in person. Similarly, another AARP study found older adults believe in-person visits are better than telehealth visits when it comes to providing a personal touch (73%), diagnosis accuracy (72%), and thoroughness (68%). However, many said in-person and telehealth are about the same when it comes to keeping personal information safe (60%) and private (52%). These and other insights are based on data obtained from multiple recent AARP surveys fielded among nationally representative samples of midlife and older adults. Studies also included oversamples of Black/African American and Hispanic/Latino respondents, enabling enhanced analyses. This multi-analysis presentation will provide unprecedented insights on familiarity and use of technology in receiving health care as well as opinions and attitudes on the use of artificial intelligence (AI) in health care. Additionally, a preview of new data collected in late fall 2024 will provide timely insights on current views on health care innovations.
EFFECTS OF A CANCER DIAGNOSIS ON ECONOMIC PROSPERITY IN THE LONG RUN: EVIDENCE FROM LINKED SURVEY AND CREDIT DATA
Authors: Warren John , Thomas Amanda , Grodsky Eric , Muller Chandra 
Published: January 2025

Abstract
Although 40% of Americans will experience cancer in their lifetime, little is known about the long-term impacts of cancer diagnosis on debt, wealth, and financial precarity later in life. Using data from High School and Beyond (HSB) —a large (n~25,500) nationally representative study of high school students followed from 1980 through 2022—linked to consumer credit records (2004-2023), we estimate changes in debt, credit, and other economic measures resulting from after a cancer diagnosis. We also consider how these processes vary across demographic, educational, and family background groups. Approximately 13,900 individuals from the original cohort responded to the 2021/2022 survey, with more than 1,000 indicating a lifetime diagnosis other than skin cancer; another 490 cohort members died from various forms of cancer by 2021/2022. The most common cancers reported were breast (n=350) and prostate/vaginal (n=150 each) with more than one-third diagnosed in early adulthood (≤ 45 years old). Preliminary results using cross-sectional measures of financial well-being indicate reduced annual income earnings and heightened financial precarity as compared to otherwise similar people without a cancer diagnosis. With linked consumer credit data, we are well-equipped to expand knowledge about the effects of a cancer diagnosis on financial health by analyzing fluctuations in indicators such as credit score, medical and other forms of debt, bankruptcy, and estimated wealth in the months and years after a cancer diagnosis. Our analyses will model these outcomes, inclusive of key confounders (age, education, type of cancer, etc.) both for the full sample of demographic and socioeconomic subgroups.
SOCIAL ISOLATION AMONG MARGINALIZED OLDER ADULTS: APPLYING A UNIFIED MODEL OF RESILIENCE
Authors: Wister Andrew 
Published: January 2025

Abstract
Social isolation is associated with reduced psychological well-being; increased anxiety and depression; compromised physical health; and higher mortality among older adults. Moreover, those who experience various forms of vulnerability and marginalization in society are particularly at risk. We apply the Unified Model of Resilience and Aging (UMRA), an interdisciplinary model that integrates psychological, physiological, and social dimensions of resilience, the latter of which embodies social participation, social isolation, and community belonging. Resilience models, like the UMRA, seek to understand why some individuals, families, and communities recover from adversity better than others, in this case, social isolation and loneliness. The UMRA integrates individual and system-level processes that occur over the life course. According to the UMRA, resilience depends on the activation of internal resources (positive attitude), and activation of external resources (e.g., support from family, friends or organization) which also vary with age and other factors. The UMRA thus includes four domains of environmental resilience situated across the socio-ecological spectrum from individual to global. It also includes four system-level (organizational) functions used by the National Academy of Sciences Resilience Model: 1) Planning for adverse events requires reductions in risk in response to an identified threat. 2) Absorption of stressors and outcomes associated with an adversity is necessary to initiate resilience through recovery and adaptation. 3) Recovery occurs through various forms of short and long-term strength-based resilience. 4) Adaptation relates to changes in the system to promote future resilience. We apply the UMRA to frame causes and consequences of social isolation.
SOCIAL ISOLATION AND SOCIAL ENGAGEMENT IN OLDER ADULTS: DETERMINANTS AND INTERVENTIONS
Authors: Liu Jinyu 
Published: January 2025

Abstract
This symposium brings together five studies to examine determinants of social isolation and social engagement and to explore ways to enhance social engagement and well-being among older Americans. Focusing on marital status, the first study finds that the risk of social isolation, from low to high, is coupled, widowed, divorced, and never married. Further, divorced and never-married men are at particularly high risk of social isolation. The second study is concerned with the co-evolution of loneliness and companionship among residents in assisted living communities. It finds that increased loneliness is associated with decreased companionship ties subsequently, but not vice versa. Using a community-based participatory research approach, the third study identifies issues related to transportation, health, and family support, that influence social re-engagement among older black Americans after the COVID-19 pandemic. The fourth and fifth studies are randomized controlled trials. The fourth study reports that older adults with cognitive impairment perceive decreased feelings of loneliness after participating in an intergenerational engagement program with trained young adults. The fifth study finds that an intervention that trains former dementia caregivers to provide volunteering support to current caregivers is feasible in the Chinese American community. Further, the intervention is effective in reducing the stress of current caregivers and increasing the sense of purpose of former caregivers. Together, the five studies show that the individual, familial, and community contexts shape social isolation and social engagement in later life and suggest that group- and context-specific interventions have promise to improve social well-being of older adults.
THE CO-EVOLUTION OF LONELINESS AND COMPANIONSHIPS IN AN ASSISTED LIVING COMMUNITY: A SOCIAL NETWORK ANALYSIS
Authors: Mauldin Rebecca , Kirsh Jaclyn , Fujimoto Kayo 
Published: January 2025

Abstract
Loneliness and social isolation are distinct constructs that tend to be moderately correlated. The Evolutionary Theory of Loneliness posits that loneliness can motivate people to increase or improve their social ties. However, interrelated factors including loneliness, desired relationship quality/quantity, actual relationships, and appraisals of existing social networks may affect whether loneliness leads to increased social ties. In assisted living communities (ALCs) most opportunities for socializing with non-family members occur within the community, restricting residents’ pool of potential friends and companions. This study investigates the co-evolution of loneliness and companionship ties among older residents in an ALC using three waves of secondary data from the Social Experiences in Assisted Living (SEAL) study. We estimated a stochastic actor-oriented network-behavioral co-evolution model for companionship and loneliness dynamics in a network of 38 ALC residents to understand the reciprocal effects of loneliness and companionships. We found that increased levels of loneliness were significantly associated with a decreased likelihood of subsequently maintaining or adding companionship ties among other residents (ϴ = -.131, p &lt;.01). Changes in companionship ties were not significantly associated with changes in levels of loneliness. Greater frequency of contact with family members was significantly negatively associated with the likelihood of companionship ties with other residents (ϴ = -.113, p &lt;.05), but was not significantly associated with levels of loneliness. These findings do not support the hypothesis that increased levels of loneliness lead to maintaining or adding companions in the ALC and have implication for both theory and practice.
STUDYING LGBT OLDER ADULTS
Authors: Waite Linda , Liu Hui 
Published: January 2025

Abstract
The size of the lesbian, gay, bisexual and transgender (LGBT) population in the U.S. is estimated to be at 9 to 11 million people (about 3.5–4.5%) and is expected to grow in the future. LGBT populations persistently experience health disparities across multiple physical and mental, which widen over the life course. The study of the older LGBT population would benefit from a nationally-representative, longitudinal study with information on health outcomes but also on the social mechanisms at work that may exacerbate or ameliorate these disparities. The National Academy of Medicine (NAM) has recently called for more targeted research aimed at understanding the sources and consequences of these health disparities, particularly among older LGBT adults. The papers in this session focus on strategies to carry out such as study. O’Muircheartaigh and Schumm describe a novel strategy for recruiting such a sample; Lauderdale and Meyer present recent data mental and physical health in a small pilot study using this strategy; Johns et al. study differences in social characteristics and health for LGBT versus other older adults in two nationally-representative samples; and Azar et al. present international comparisons of these differences in the UK and the US. Together these papers add to our understanding of health and health disparities in older sexual minorities and how we might learn more about them.
DIFFERENCES IN SOCIAL CHARACTERISTICS AND HEALTH STATUS BY SEXUAL IDENTITY AMONG OLDER ADULTS: COMPARISON OF TWO COHORTS
Authors: Iveniuk James , Johns Michelle , Zhong Selena , Schilt Kristen 
Published: January 2025

Abstract
Sexual minority women experience poorer social, mental, and physical health than their heterosexual counterparts; yet limited work has been done to describe the scope of these health differences. Challenges to such analyses include a dearth of large-scale national surveys that collect sexual orientation data and small numbers of cases among those studies that do ask. To advance our understanding of the health and wellbeing of sexual minority women, we compare key indicators of health and wellbeing (e.g., diabetes, high blood pressure, asthma, depression, loneliness) by sexual identity in the National Social Life, Health, and Aging Project, a nationally representative study of older adults, and in SAMLAP, a nationally representative sample of older LGBT adults. We employ OLS and logistic regressions to assess how health outcomes differ between sexual minority women and heterosexual women in NSHAP as well as health differences among sexual minority women in SAMLAP. We controlled for age, marital status, race, education, and network size in our models. In NSHAP, we found that sexual minority women had higher depressive symptoms than heterosexual women but there were no other health differences between these two groups. In SAMLAP, bisexual women had higher odds of developing diabetes and more depressive symptoms compared to lesbian women. We will discuss our results within the context of the minority stress model which details the impact of social stigma on the health of sexual minority populations.
UNDERSTANDING OLDER ADULTS’ DIGITAL EXPERIENCES DURING AND AFTER THE PANDEMIC: A MIXED-METHODS STUDY
Authors: Yu Zhan , Chen Xiayu , Xu Qingwen , Huang Chenxi 
Published: January 2025

Abstract
During the COVID-19 pandemic, China adopted the zero-case policy and made full use of digital technology, such as mandatory QR code using; consequently, older adults were forced into the experiences of digital technology. This study aims to explore the psychological and behavioral effects of policy actions on older Chinese, particularly to address the long-term effects on their technology use. We employed a sequential mixed-methods approach. Using data from the CHRLS, generalized estimating equations was performed and the study found a significant increase in internet use among older adults in 2020 compared to 2015 (OR = 12.04, p &lt;.001). Then three focus group interviews were conducted with older adults in Shanghai. Content analysis reveals three themes: the feeling of being “compelled” to use digital technologies during the pandemic to meet daily basic needs and maintain social connections; a perception of “digital invasion” in the post-pandemic era; and an increased consciousness of the importance of self-efficacy for continued technology use. Further codes network analysis and cross-group comparisons show that both positive and negative experiences of digital use during the pandemic related to the increased use after the pandemic; prior community technology education programs and support received resulted in varied experiences and perceptions of digital use. This study offers insights into older adults’ adaptations to technology, which would help inform policies and practices for addressing the challenges of aging and technology use. It also highlights the need for tailored strategies that recognize the diverse needs of older adults in the digital age.