bluuebunny/crossref_metadata_2025_split huggingface dataset:
ROLE OF INFLAMMATION AS SEX-SPECIFIC MEDIATOR BETWEEN CHRONIC STRESS AND COGNITIVE FUNCTION
Authors: Jimenez Laura Laiton , Shalev Idan , Sliwinski Martin , Veturi Yogasudha 
Published: January 2025

Abstract
Long-term stress has been associated with poorer cognitive outcomes and increased risk of dementia, especially among women. Chronic stress is also known to lead to inflammation, whose role in neurodegeneration and associated comorbidities affecting immune function is well-established. Our investigation probes the mediating role of circulating inflammatory biomarkers (IB) in the social isolation stress (SIS) to cognitive function (CF) pathway, incorporating sex and age as moderating factors. Leveraging the MIDUS Refresher 1 cohort (N=3,800), we analyzed the role of SIS (frequency of social interactions with friends) on five CF tasks (word list recall, category verbal fluency, backward digit span, 30-second counting, and task-switching) and two IBs (C-reactive protein and interleukin-6). We employed a three-step approach to model these relationships: (1) CF~SIS; (2) IB~SIS; (3) CF ~SIS+IB. Poisson and linear regressions were employed as appropriate. After Bonferroni correction, we identified SIS as a significant predictor for the last three CF measures (p-value~0.01), with a pronounced sex effect in the last two (p-value~0.001). SIS was a significant predictor for interleukin-6 (p-value=0.0238), with a significant sex effect for C-reactive protein (p-value=0. 0.0003). Importantly, in step (3), the SIS-CF association diminished with the inclusion of IL6, highlighting its role as a putative mediator in this pathway. The sex effect remained unchanged. Next, we aim to analyze additional stressors (e.g. financial stress, perceived discrimination), examine the role of immune-related gene expression as a mediator, as well as investigate the role of inflammation-related comorbidities in the stress-CF pathway from electronic health records.
STATE OF THE EVIDENCE FOR MULTIVITAMIN/MULTIMINERAL SUPPLEMENTATION AND COGNITIVE AGING
Authors: Patusco Rachael , Srivastava Ankita 
Published: January 2025

Abstract
In 2017, nearly 40% of Americans aged 60 years and over consumed a multivitamin/multimineral (MVM) product. Nutrient inadequacies, for which older adults are at greater risk, can negatively influence cognitive aging. Bringing together the converging themes of MVM popularity and cognitive aging, this review synthesized evidence on the effects a broad spectrum MVM has on cognitive aging. A literature search was conducted using ProQuest (Embase, Medline) and PubMed. Seven studies met inclusion criteria. All studies were double-blind, placebo-controlled, randomized clinical trials utilizing an MVM product (range = 10 - 26 essential nutrients). Duration of interventions ranged from 6 months to 12 years across 63 to 5,974 participants aged 60 years and older from the U.S. and European countries. There was heterogeneity in cognitive assessments utilized with some overlap of tested domains, such as episodic memory & executive function. Shorter and smaller trials (≤ 1 year, n=3), found no overall effect of MVM supplementation on cognitive performance, however some domains were sensitive to MVM intervention. Among longer duration trials (≥ 3 years, n=4), 75% reported significant improvements in episodic memory & global cognition. When measured across studies, MVM supplementation significantly improved serum vitamin levels, which is consistent with broader MVM supplementation research. Despite heterogeneity in treatment effects in shorter duration trials, in longer duration trials (&gt;1 year), MVMs can elucidate beneficial effects, suggesting dose & duration may contribute to the treatment effect. Evidence gaps exist in exposing mechanism of action.
A CROSS-CULTURAL ANALYSIS OF PREFERENCES AND ATTITUDES TOWARD ADVANCED DIRECTIVES IN TAIWAN AND THAILAND
Authors: Weng Hui-Ching , Chen Duan-Rung , Kiiti Krungkraipetch , Puangtong Inchai 
Published: January 2025

Abstract

Introduction
Advance directives (ADs) are pivotal in healthcare planning, indicating preferences for medical treatment in critical conditions. This study examines ADs attitudes and experiences between Taiwan and Thailand, highlighting cultural influences on end-of-life care.

Method
Employing pairing matching, the study selected 259 matched pairs from an initial Taiwanese pool of 1488 and a Thai sample of 268 based on gender, age, education, and medical work background. Demographics included 72.2% females, with an average age of 32.91 (range 18-72), 92.3% holding a bachelor’s degree or higher, and 95% working in health-related fields.

Results
The comparison revealed no significant differences in the perceived necessity of ADs at the current life stage or in the preference for familial decision-making during hospitalization. However, significant disparities emerged in several areas, including comfort in discussing death (Taiwan 95.8%, Thailand 84.6%) and willingness to discuss end-of-life care (Taiwan 96.1%, Thailand 91.5%). A substantial gap was found in the belief regarding peers’ consideration of ADs, with 84.6% of Taiwanese versus 49% of Thais believing their age group would consider such directives. Furthermore, all eight aspects related to the desired qualities of healthcare agents showed significant differences, with Taiwanese respondents valuing trust, communication, understanding, and support more highly than their Thai counterparts.

Conclusions
The study underscores cultural differences in attitudes towards advance directives between Taiwan and Thailand, particularly in discussions about end-of-life care and qualities desired in healthcare proxies. These findings highlight the need for culturally tailored approaches to enhance awareness and acceptance of advance directives in both regions.
JOINT ASSOCIATION OF VISIBLE AND SELF-PERCEIVED AGING WITH PREMATURE MORTALITY
Authors: Kou Minghao , Ma Hao , Wang Xuan , Qi Lu 
Published: January 2025

Abstract
This study quantifies the association of a combination of visible and self-perceived aging indicators with the risk of all-cause and cause-specific premature mortality. Utilizing data from 369,741 UK Biobank participants initially free of cardiovascular disease and cancer, with follow-up until December 31, 2022, we analyzed four aging indicators: hearing loss, teeth loss, self-perceived age, and falls. Using Cox proportional hazards models, we assessed their joint association with mortality outcomes over a median follow-up of 13.74 years, during which 22,934 cases of premature mortality were documented. Compared to participants without aging indicators, those exhibiting all indicators experienced a 81% (95% confidence interval, 59%–107%), 96% (47%–160%), 55% (26%–91%), and 114% (73%-165%) higher risk of all-cause, cardiovascular disease, cancer, and other causes of premature mortality, respectively. Notably, these associations were more pronounced in younger participants, those with unhealthy lifestyles, and lower socioeconomic status (P &lt; 0.05 for interactions). Additionally, we identified a significant additive interaction between aging indicators and frailty index, contributing an additional 16.08% (95%CI, 7.91-24.25%) risk of premature mortality. In summary, the combination of visible and self-perceived aging indicators was associated with a higher risk of all-cause and cause-specific premature mortality. These findings highlight the importance of considering both visible and self-perceived aging indicators in health risk assessments and intervention planning.
THE ROLE OF FAMILY AND SOCIAL INTERACTIONS IN THE ASSOCIATION OF FAMILY BEREAVEMENT AND PSYCHOLOGICAL WELL-BEING
Authors: Kim Nahyun , Shin Haeun , Kim Kyungmin 
Published: January 2025

Abstract
Older adults may experience the death of family members more frequently than ones in earlier stages of life, and such family losses can affect psychological well-being in late life. After experiencing family losses, social interactions with remaining family members and acquaintances can be important resources for psychological adjustment. Bereaved individuals may interact more frequently with remaining family members following family deaths. Some people may be more socially engaged to cope with the negative effects of family losses, while others may reduce their social activities. This study examined the mediating role of intergenerational contact and social participation in the association between the total number of family deaths (occurred in the past 10 years) and psychological well-being (i.e., life satisfaction and depressive symptoms). We analyzed a sample of 2,279 respondents (aged 65–80) from the 2020 Korean Longitudinal Study of Ageing. The results indicated that there was no direct association of the number of family deaths with life satisfaction and depressive symptoms. However, we found one significant indirect path; experiencing more family deaths was linked to more frequent physical contact with non-coresident children, which in turn, led to higher levels of life satisfaction. Yet, the frequency of participation in social meetings was not significant as a mediator in the link between the number of family deaths and psychological well-being. Our findings suggest the importance of considering multiple family losses in late life and investigating underlying mechanisms linking accumulative life stressors to psychological adjustment among older adults.
INTERGENERATIONAL BENEFITS OF DISASTER PREPAREDNESS CAREGIVER INTERVENTION
Authors: Donohoe Maria , Adeagbo Morolake , Anderson Brittany , Seaman Aaron , Ashida Sato 
Published: January 2025

Abstract
The evaluation of interventions focuses on understanding how intervention contents and components impact participant outcomes through specified mechanisms of influence. Social network literature highlights the importance of quality interactions; however, little attention has been paid to how the characteristics of interpersonal interactions may influence intervention processes and impacts. Implementation of a disaster preparedness intervention with caregivers of persons living with dementia (PLWD) began as part of a randomized controlled trial. The Disaster PrepWise-Caregiving (DPW-CG) program helps caregivers develop a household disaster and emergency management plan considering the unique family caregiving needs. Currently, DPW-CG is being delivered by trained AmeriCorps members who are college students. As part of a larger trial, a team of implementation scientists are concurrently conducting observational evaluations of the intervention delivery. The preliminary data reveals key characteristics of intergenerational interactions between the caregivers and the AmeriCorps members that influence the quality of intervention delivery. Our initial findings show that caregivers of PLWD, especially spousal caregivers who are older, looked forward to the company of AmeriCorps members and shared their life experiences and values throughout the visit. Before the commencement of intervention delivery, older caregivers strategically welcomed and eased AmeriCorps members into the process through small talk, offering food/drinks, and confidence-building compliments. This often resulted in better engagement during the intervention and positive learning experiences for the AmeriCorps members. Future intervention trials may seek to understand how characteristics of interpersonal interactions benefit program deliverers and recipients and impacts intervention effectiveness and outcomes.
AGING SCIENCE EDUCATION: OLLI COLLABORATION BENEFITS UNDERREPRESENTED STUDENTS
Authors: Laflamme Maeva , Mallers Melanie Horn , Zettel-Watson Laura , Piazza Jennifer 
Published: January 2025

Abstract
The aging population is growing and diversifying, generating a need for workforce specialists (e.g., scientists, physicians) prepared to integrate knowledge about aging into their respective fields. Unfortunately, the fields that bring innovative change to improve the lives of older adults are the fields that continue to lack diversity due to a “leaky pipeline,” whereby underrepresented students are often lost or pushed out academically from MSTEM fields. To increase diversity in the aging-science workforce, a critical goal is to implement training programs that advance the study of aging within MSTEM. With the support of NIH funding, we designed an empirically derived, multi-pronged program to purposefully intersect the study of aging with science and research. To increase student involvement with older adults, we partnered with our campus-based Osher Lifelong Learning Institute (OLLI) members, many of whom are scientists themselves, regularly serve as panelists, interview participants, proofread students’ works, and act as audience members for our students. They also informally interact with students through community-based service learning opportunities, outreach, and volunteer activities. After collaborating with OLLI for one year, students report greater empathy and joy when interacting with older adults, increased interest and motivation to work in aging sciences, and decreased ageism. The MSTEM-OLLI collaboration has served as a critical component of advancing our goal of recruiting, retaining, and preparing underrepresented undergraduates for a future in MSTEM aging research. Our findings indicate that strengthening and expanding meaningful partnerships between older adults and students is a key priority to enhancing aging science programs.
DEVELOPING A TYPOLOGY OF SENIOR CENTERS: CONCEPTUAL AND METHODOLOGICAL CONSIDERATIONS
Authors: Somerville Ceara , Mutchler Jan 
Published: January 2025

Abstract
Senior centers are important resources for older adults and their families, intended to serve their communities by tailoring programs and services to meet the needs and interests of those in their local environment. The network of senior centers across the nation and within states is heterogenous, but there is limited research focused on senior centers’ organizational capacity. This project uses a novel dataset from a comprehensive database of all senior centers in Massachusetts (n=342) to explore the commonalities and differences in models of senior center operations. A factor-cluster approach was applied to a subsample of 278 senior centers. Nearly 40 indicators of organizational goals, structure, people, resources, and policies were included in a nonlinear principal components analysis, resulting in 11 standardized scales representing components of organizational capacity (e.g., leadership, governance, core programs and services). These scores were then entered into a two-step cluster algorithm to determine the optimal grouping of senior centers into distinct types of operational models. Three clusters emerged; the most notable differences between them occurred on measures of wellness programs, core programs and services, staff capacity, space capacity, and social and financial resources. Differences between clusters on several demographic characteristics of the community (e.g., population size and density, racial and ethnic composition) were observed, providing empirical support of senior centers operating in response to their local populations. Senior centers are locally focused, but identifying common operational types and their relation to the wider community can inform research, policy, and practice to better support the network.
GENDER DIFFERENCES IN DISEASE BURDEN AND QUALITY-OF-LIFE TRAJECTORIES AMONG OLDER ADULTS LIVING WITH MULTIMORBIDITY
Authors: Lim Arum , Benjasirisan Chitchanok , Tebay Jordan , Himmelfarb Cheryl Dennison , Davidson Patricia , Koirala Binu 
Published: January 2025

Abstract
Heart failure (HF) is a leading cause of hospitalization and is associated with higher multimorbidity. Despite gender disparities and differences in HF research participation and health outcomes, differences in the trajectories of their lives have not been studied enough. This study aimed to examine the 1-year trajectories of disease burden and quality of life (QoL) for older adults with multimorbidity. Multimorbidity was defined as the presence of HF and one or more conditions among common chronic conditions in older adults. The study prospectively collected socio-demographic, clinical, and outcome data at baseline, 30-day, and 1-year follow-up using an electronic patient portal among adults aged 50 years and older living with multimorbidity. Disease burden and QoL data were collected using a modified disease burden impact scale and the EuroQoL (EQ)-5D-5L. Linear mixed-effect models were used for statistical analyses. A total of 200 patients (102 women and 98 men) completed surveys at the three time points. Participants’ mean±SD age was 71±9.5 years; men were older than women. The disease burden decreased at the 30-day follow-up (23.7±14.9) and the 1-year follow-up (24.6±15.7) compared to baseline (26.3±16.3). In an unadjusted analysis, disease burden was higher in women than men (beta=2.516; p=0.017). QoL was not significantly different by gender and time. After adjusting for age and social support, there were no significant gender differences in disease burden and QoL trajectories and no time and gender interaction. There is a need for gender-based research on multimorbidity to promote health equity.
CONTINUOUS USERS OF LONG-TERM CARE 2.0 IN TAIWAN: PATTERNS AND HEALTH COSTS OVER TIME
Authors: Chen Ya-Mei , Wu Shih-Cyuan , Chao Shiau-Fang , Lin Ming-Jen , Chu Chien-Fang 
Published: January 2025

Abstract
Taiwan has implemented the Long-Term Care 2.0 (LTC 2.0) Plan since 2017, but only about one third of users continuous to remain in the system after 6 months. The current study examined the patterns of the continuous user and their associations to older adults’ health costs overtime. This study utilized Taiwan’s LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 155,220 clients who continuously utilized any LTC Plan 2.0 services for six months between 2017 and 2019. These users’ health costs were examined in the 12 months after 6 months of HCBS continuous use. Latent class analysis and generalized estimating equations were used to investigate the associations between different service use patterns and the changes in health costs. Five subgroups of LTC use patterns were identified, including home-based personal care (PC) group (n= 99,163, 63.9%), home-based medical care (MC) group (n= 13,304, 8.5%), home-based personal care and medical care (PC/MC) group (n = 9,269, 6.0%), Reablement (RA) group (n= 20,132, 13.0%), and community care (CC) group (n= 13,352, 8.6%). When compared to care recipients in PC/MC group, those in the PC group ($5.84/month, p&lt; 0.001), MC group ($8.21/month, p&lt; 0.001), and CC group ($6.79/month, p&lt; 0.001) had increased more health costs overtime. Such trends are more prominent among those with moderate and severe disability, except those in RA group. The integrated services (PC/MC group) and reablement (RA group) demonstrate slower growth in health costs, particularly among those with moderate and severe disabilities.
CURRENT TRENDS IN THE DIRECT CARE WORKFORCE
Authors: Kelly Christopher , Deichert Jerome 
Published: January 2025

Abstract
We used data from the 2020-2022 American Community Survey to examine trends among direct care workers (DCWs) in both occupation and industry. We found the number of nursing assistants, psychiatric aides, and home health aides decreased 5.8%, to nearly 1.9 million, while the number of personal and home care aides decreased 0.8%, to more than 1.3 million. Nursing assistants, psychiatric aides, and home health aides were more likely than personal and home care aides to be female, under age 25, African American, recently divorced, and to receive health insurance from their employer. They were less likely to be age 65 and over, to receive health insurance from Medicare or Medicaid, and to have a disability. Nearly 1.9 million DCWs were employed in home and community-based services, as compared to under 900,000 in residential care facilities and under 500,000 in hospitals. There were increases in the number of DCWs employed by outpatient care centers (10.7%), hospitals (7.2%) and individual and family services (3.7%). The largest decreases were in the number of DCWs employed by skilled nursing facilities (17.4%), assisted living facilities (12.3%), and private households (6.1%). DCWs employed by residential care facilities were more likely to be nursing assistants, psychiatric aides, or home health aides and they were more likely to work year-round and full-time. These findings suggest that changes already underway in the direct care workforce accelerated during/after the COVID-19 pandemic. DCWs are shifting towards jobs requiring less training and/or licensure and away from jobs in residential care facilities.
THE EFFECT OF MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORT ON PARTICIPANT QUALITY OF LIFE AND UNMET NEED
Authors: Degenholtz Howard , Treat Anny , Kastner Keri , Yauch John 
Published: January 2025

Abstract
In 2018 the Commonwealth of Pennsylvania began a three year transition of Medicaid Aging and Disabled Waiver programs to Managed Long-Term Services and Supports (MLTSS). The new program, Community HealthChoices, serves adults with disabilities who receive home and community based services (HCBS), live in a nursing facility, and people dually eligible for both Medicaid and Medicare who do not use long-term services and supports (“duals”). Three managed care organizations operate the program through state-wide contracts. The program was implemented statewide over a three year period in three regional phases, creating a unique natural experiment. In other analyses, we have demonstrated significant changes to care management and slowing in the rate of growth of HCBS spending. This is the first study of HCBS participants’ subjective experience. A total of 14,706 prospective telephone interviews were conducted with random samples of participants before the transition to CHC and 18 and 30 months post-transition. We found that psychological well-being was unchanged, but depressive symptoms decreased over time. There was no change in the consequences of unmet need (e.g., having a hot meal or a bath). In general, when compared duals, HCBS users report lower access to primary care and lower self-reported health status. After the implementation, duals users reported higher health status and HCBS users were more likely to report having a medical care coordinator. The transition to MLTSS brought substantial changes to the way Medicaid LTSS is financed and delivered in Pennsylvania. However, the experience of the average participant has been relatively stable.