bluuebunny/crossref_metadata_2025_split huggingface dataset:
TRENDS AND VARIATION OF MEDICARE ADVANTAGE AMONG LONG-STAY NURSING HOME RESIDENTS
Authors: Yun Hyunkyung , Kosar Cyrus 
Published: January 2025

Abstract
Despite the large growth of the Medicare Advantage (MA) to now comprise over 50% of all Medicare beneficiaries, the role of MA in long-term care has been understudied. We examined trends in MA enrollment among long-stay nursing home (NH) residents and geographic variation in these trends (2010 to 2021). We compared the individual and NH characteristics between beneficiaries of traditional Medicare (TM), general MA, and MA plans specialized for long-term care, Institutional Special Needs Plans (I-SNPs). Among long-stay residents, MA enrollment grew from 13.0% in 2010 to 31.6% in 2021, while MA enrollment increased from 23.6% to 40.8% for all other Medicare beneficiaries. I-SNP enrollment grew substantially; in 2010, 34 I-SNPs enrolled 15.7% of MA long-stay residents. By 2021, 126 I-SNPs enrolled 30.8% of them. The individual- and facility- characteristics for TM and non-I-SNP MA enrollees were broadly comparable. I-SNP enrollees, however, were more likely to be Black (20.4% of residents vs 14.5% for TM, 13.5% for other MA) and dually enrolled in Medicaid (I-SNP 97.7%, TM 83.6%, other MA 83.1%). I-SNP enrollees were more likely to be in NH with 1-2 (low) star-ratings (I-SNP 38.7%, TM 38.4%, other MA 38.2%) and less likely to reside in facilities with 4-5 (high) star-ratings (I-SNP 38.7%, TM 42.1%, other MA 42.4%). MA enrollment has grown substantially among long-stay residents. As new models such as I-SNPs become more prevalent, future research and monitoring are needed to ensure that the care needs of this high-need population are being adequately met.
PERCEIVED AND PERFORMANCE FATIGABILITY IN UNDERSTANDING HEALTHY AGING: STUDY OF MUSCLE, MOBILITY AND AGING (SOMMA)
Authors: Glynn Nancy , Cawthon Peggy , Schrack Jennifer 
Published: January 2025

Abstract
Characterizing fatigability, the quantification of an individual’s susceptibility to fatigue in the context of standardized physical task(s), is a more sensitive approach to assess the presence and severity of fatigue, a critical prodromal trait of chronic and acute health conditions. We have validated measures of perceived physical fatigability (Pittsburgh Fatigability Scale, PFS) and performance fatigability (Performance Deterioration [PD, measured during a fast-paced 400m walk by calculating gait speed of lap2-lap9/lap2*100] and the Pittsburgh Performance Fatigability Index [PPFI, measured during a usual-paced 400m by using wrist-worn raw accelerometry data to quantify percent cadence decline). Our symposium will capitalize on the extensive phenotype data collected at baseline in SOMMA (N=879, mean age 76.3±5.0 years; walking speed 1.04±0.20 m/s; 59.2% women; 85% white), to further elucidate the correlates and consequences associated with greater perceived and/or performance fatigability in order to inform potential interventions to promote healthy aging. First, Ms. Reagan Garcia will examine whether time spent in activPAL measured sedentary behaviors are related to higher perceived physical fatigability (PFS). Next, Dr. Kyle Moored will share findings on the role of maximal treadmill cardiorespiratory fitness (VO2peak) and PFS on life-space mobility and whether these associations are moderated by perceived neighborhood factors. Dr. Caterina Rosano will explore the association between nigrostriatal dopaminergic integrity and performance fatigability (PD). Lastly, Ms. Emma Gay will be comparing skeletal muscle energetics and walking energetics profiles of those with lower PFS/lower PPFI vs. higher PFS/higher PPFI. Discussant, Dr. Jennifer Schrack will offer insights for new directions for fatigability research.
PHYSICAL FITNESS, FATIGABILITY, AND LIFE-SPACE MOBILITY: DIFFERENCES BY NEIGHBORHOOD CONTEXT
Authors: Moored Kyle , Duchowny Kate , Rosso Andrea , Cawthon Peggy , Carlson Michelle , Glynn Nancy 
Published: January 2025

Abstract
Physical capacity (e.g., objective fitness, perceived fatigability) contributes independently to life-space mobility, the extent and independence of travel within the community. This relationship may differ by neighborhood context, where higher physical capacity may be especially necessary to overcome environmental barriers to mobility. We examined baseline associations between physical capacity and life-space mobility in community-dwelling older adults, and whether these associations were moderated by perceived neighborhood factors. Participants were from the Study of Muscle, Mobility and Aging (SOMMA; N=775, Mean±Standard Deviation age=76.1±4.9). Life-space mobility was self-reported using the Life-Space Assessment (higher=greater life-space, 83.6±19.3). Physical capacity measures included maximal treadmill cardiorespiratory fitness (VO2peak, 20.3±4.8 mL/min/kg) and perceived physical fatigability (Pittsburgh Fatigability Scale (PFS) Physical score, higher=more fatigability, 15.4±8.5). Self-reported neighborhood physical disorder (e.g., trash/vandalism) and social cohesion (e.g., neighborhood trust) scores were stratified into tertiles. Linear regressions estimated associations adjusted for demographic, health, and socioeconomic confounders. Each 1-SD higher VO2peak was associated with 2.5-point higher (95% CI: 0.84,4.2) life-space score, with associations significantly greater for the highest physical disorder tertile (b=3.8, 95% CI: 1.5,6.2, p-interaction=.018) and lowest social cohesion tertile (b=5.7, 95% CI: 2.9,8.6, p-interaction=.046). Each 1-SD higher PFS Physical score was associated with 3.2-point lower (95% CI: -4.6,-1.7) life-space score, with no differences by neighborhood measures (p-interactions&gt;.15). Unlike perceived physical fatigability, the impact of objective fitness on life-space mobility may be greatest for those living in more disordered and less socially integrated neighborhoods. Findings reinforce the importance of considering individual-level contributors to life-space mobility within the environmental context (i.e., person-environment fit).
CAN DETERIORATION IN BALANCE BE EASILY DETECTED IN MIDDLE AGE?
Authors: springer Shmuel , Hayek Roee , Toledo Silvi Frenkel , Baranes Guy 
Published: January 2025

Abstract
Balance and physical performance tend to start declining in middle-age. However, most existing tests are generally not sensitive enough to detect subtle balance disorders in this population. We aimed to evaluate the utility of the Brief Balance Evaluation Systems Test (Brief-BESTest) and accelerometry data to identify middle-aged individuals with excessive balance deterioration. Young adults (YA, 25.3±2.3 years), early middle-aged (EMA, 47.7±2.6 years), and late middle-aged (LMA, 60.6±3.6 years) individuals, 25 subjects in each group, were tested using the Brief-BESTest with accelerometer (Delsys, USA) placed over their lower-back to measure the trajectory of the center-of-mass during standing tasks (95% confidence ellipse of trajectory, 95%CE). Significant differences in Brief-BESTest scores were found between the young and the two middle-aged cohorts (P &lt; 0.05) and between EMA and LMA (p &lt; 0.05). The 95%CE showed significant differences between YA and LMA in all standing conditions (P &lt; 0.05) and between EMA and LMA (p &lt; 0.05) when standing on a foam with eyes closed. Both, the Brief-BESTest scores and the 95%CE values demonstrated increased variation with age, allowing to identify subjects in the lower interquartile range (LIQR) defined as having accelerated balance deterioration. Significant moderate correlation (R2=0.44, P=0.001) was found between Brief-BESTest and 95%CE of single-leg-stance, and 46% of individuals in the LIQR were identified by both tests. These results enhance the utility of balance testing in midlife with the long-term goal of minimizing age-related functional decline. In addition, the results suggest that balance assessment using accelerometry motion data, available on any smartphone, can further facilitate early detection of balance decline.
GENDER AND RACE AS MODERATORS BETWEEN ACTIGRAPHY SLEEP AND INFLAMMATORY MARKERS
Authors: Shen Yuqi , Ji Linying , Kessler Claudette , Engeland Christopher , Buxton Orfeu , Zonderman Alan , Evans Michele , Gamaldo Alyssa 
Published: January 2025

Abstract
This cross-sectional study investigated gender and race differences in the association between actigraphic sleep (mean levels and variability) and inflammatory markers (circulating interleukin [IL]-6, IL-10, tumor necrosis factor [TNF]-𝛼 and C-reactive protein [CRP]). The study included participants from the HANDLSleep study (n=99; 74% female, 54% Black adults; age range: 46-82). Within-person mean and standard deviation (iSD) of sleep were estimated using one week of wrist actigraphy (mean ± SD = 6.8 ± 0.5 day), including nighttime sleep time, 24-hr sleep time, wake after sleep onset, nighttime sleep midpoint (Timing), and sleep maintenance efficiency. Linear regression models were conducted including interaction terms (race*sleep; or sex*sleep) and covariates (age, WRAT3 literacy scores, poverty status). Results indicated that race significantly moderated the association between variability in sleep maintenance efficiency and circulating IL-6 (interaction term p =.002). Race-stratified analyses revealed that among White adults, greater variability in sleep maintenance efficiency was significantly associated with higher circulating IL-6 (b = 0.10, p =.003). No significant association was found among Black adults. Results also indicated that gender significantly moderated the relationship between mean level 24-hr total sleep time and circulating IL-6 (interaction term p =.001). Stratification analyses revealed that longer mean 24-hr total sleep time was associated with higher levels of IL-6 among men (b = 0.003, p =.008). No significant association was found among women. Consistent with prior studies, the current study observed associations between actigraphic sleep and inflammation primarily among White adults and among men.
POORER SLEEP HEALTH MAY INCREASE THE RISK OF DEVELOPING PHYSICAL FRAILTY, PARTICULARLY AMONG WOMEN
Authors: Thalil Muhammad , Lee Soomi , Almeida David 
Published: January 2025

Abstract
Longitudinal evidence on the association between sleep and physical frailty is limited, especially using a multidimensional measure of sleep health. In this study, we examined the prospective association between sleep health and physical frailty among U.S. older adults. We also examined how this association differs by age, sex and race. We used data from the National Health and Aging Trends Study (NHATS), with a sample of 929 older adults (65+) who completed a sleep module during 2013 and 2014. Self-reported items on the SATED model (i.e., satisfaction, daytime alertness, timing, efficiency, and duration) were used to create a sleep health composite and Fried’s frailty phenotype was used to assess frailty. Multiple multinomial logistic regression models adjusted for baseline frailty status, socio-demographics, and health correlates revealed that having poorer sleep health increased the risk of onset of frailty at follow-up (RR = 1.30, 95% CI: 1.02–1.64). Among specific sleep health dimensions, lack of daytime alertness and short (&lt; 6 hours) or long (≥ 9 hours) sleep duration were significantly associated with frailty, however, poor sleep satisfaction, timing and efficiency were not significantly associated with frailty. Stratified analyses revealed that the association between sleep health and frailty was significant among women, those aged &lt;80 years, and non-Hispanic Whites after adjusting for socio-demographics, but only significant among women (RR = 1.44, 95% CI: 1.04–1.98) after adding health correlates. Findings suggest that having poorer sleep health across multiple dimensions is associated with increased risk of frailty among older adults, especially among women.
EFFECTS AND DIRECTIONALITY OF A HANDICRAFT INTERVENTION ON HAND FUNCTION AND HIGH-LEVEL COGNITION IN OLDER ADULTS
Authors: Kobayashi-Cuya Kimi , Ogawa Susumu , Iizuka Ai , Takahashi Tomoya , Suzuki Hiroyuki 
Published: January 2025

Abstract
A longitudinal bidirectional association of hand dexterity with executive function and processing speed in high-functioning older adults has been reported, suggesting that community-level intervention programs using activities that demand dexterous abilities may help prevent the decline in these cognitive functions. Therefore, the present single-blind crossover randomized controlled trial examined the intervention effects of a 12-week manual dexterity program in community-dwelling older adults on hand sensorimotor and high-level cognitive functions, and assessed the direction of their associations. Fifty-three participants (mean age±SD, 75.2±5.6, 83% female) were randomly assigned to the intervention (handicrafts and creative cooking) or active control period (lectures on health maintenance). The primary outcome was hand dexterity, and the secondary outcomes were handgrip strength and hand sensation for hand function, and for high-level cognition, executive function, which was assessed with the trail making test (TMT)B, ∆TMT (TMTA-B) and the letter and category fluency tests (LFT and CFT, respectively), and processing speed, evaluated with TMTA and digit symbol. Linear mixed-effects models, testing for carry-over effects, showed intervention effects in hand dexterity (p&lt; 0.05) and executive function (TMTB, ∆TMT and LFT, p&lt; 0.05), whereas no effects were found for handgrip, hand sensation, nor processing speed. Also, cross-lagged panel models, adjusting for potential confounders, further revealed moderate and significant associations between baseline hand dexterity and subsequent increase in TMTB, LFT (p&lt; 0.001) and ∆TMT (p&lt; 0.05). Our results indicate that the implementation of a short-term manual dexterity program may contribute to the prevention of decline in executive function in community-dwelling older adults.
GUARDING AGAINST HARM: UNDERSTANDING AND ADDRESSING ELDER MISTREATMENT RISKS IN THE PARKINSON’S POPULATION
Authors: Smiley Adrianne 
Published: January 2025

Abstract
Parkinson’s disease (PD), particularly in moderate-to-advanced stages, poses significant challenges, including cognitive and physiological decline, leading to reduced independence in daily activities. Functional dependence—to any degree—is a primary predictor of mistreatment. Despite the recognized predictors of elder mistreatment risks associated with functional impairment, the understanding of its impact within the PD community remains limited. PD research often focuses on physiological changes and pharmacological and rehabilitative interventions; however, the risks for mistreatment are often unaddressed. As such, this project centers on advancing and disseminating knowledge about abuse and mistreatment within the PD population. An evidence-based, community-engaged, participatory action research approach with collaborative analysis methodology was employed with a primary focus on PD-specific organizational partnership, intra-organizational structural and procedural analysis, interdisciplinary collaboration, and relationship-building for reflection on themes, patterns, gaps, and needs for improving patient safety resources as a primary prevention method for reducing risks for mistreatment in the PD community. Outcomes: This action-based approach resulted in 1) the development of a survey instrument to gauge knowledge gaps about mistreatment in the PD community and inform the development of educational offerings for healthcare recipients, caregivers, and licensed medical providers, 2) the development of a patient safety research staffer responsible for analyzing reports submitted to the organization’s helpline to assess the prevalence of mistreatment risks according to self or caregiver reported data, and 3) establishment of a research agenda and population-centered plan for advancing knowledge about PD and elder mistreatment risks for harm prevention.
THE STEP-HI STUDY: IMPACT OF TESTOSTERONE AND RESISTANCE EXERCISE ON SPPB, LEG STRENGTH, AND APPENDICULAR LEAN MASS
Authors: Volpi Elena , Kiel Douglas , Paluch Rocco , Dore Peter , Fortinsky Richard , Kuchel George , Orwig Denise , Binder Ellen 
Published: January 2025

Abstract
The STEP-HI Study tested if testosterone replacement therapy in combination with resistance exercise training for 6 months could improve functional recovery from hip fracture in older women more than resistance exercise alone or standard of care. Here we present the results of the intention to treat analyses (N=122) of the effect of testosterone replacement plus exercise (EX+T, n=53) vs. exercise plus placebo (EX+P, n=51) vs. enhanced usual care (EUC, n=18) on the Short Physical Performance Battery (SPPB) scores, maximal leg press strength, and appendicular lean mass. Group differences were analyzed with contrasts using a mixed model repeated analysis of variance that included the following covariates for each outcome: clinical site, age, days since hip surgery, BMI, hip fracture type, general depression score, lung disease, comorbidity index and baseline level. EX+T had a greater improvement in SPPB score than EX+P (p&lt;0.009). Maximal leg press strength increased in all groups by the end of the intervention period with no differences between groups (p&gt;0.05). Appendicular lean mass increased to the same extent in the EX+T and EX+P groups, but slightly decreased in the EUC group as compared to EX+T (p=0.020) and EX+P (p=0.029). These findings suggest that testosterone may independently impact a composite measure of physical performance, while exercise significantly improves appendicular lean mass independent of testosterone replacement. The implications of these findings will be discussed.
DELIVERING HIGH-INTENSITY STRENGTH TRAINING AND MAINTAINING INTERVENTION FIDELITY: THE STEP-HI STUDY
Authors: Rauzi Michelle , Tran Melissa , Monroe Kelly , Stevens-Lapsley Jennifer 
Published: January 2025

Abstract
Hip fractures in women can result in significant functional decline. The STEP-HI study evaluated the effect of testosterone therapy versus placebo combined with supervised exercise training on functional recovery following hip fracture. Maximizing internal validity was essential to maintain rigor of this study. Further, knowledge of both the intervention protocol and the fidelity process are essential to understand threats to internal validity, identify barriers to the protocol, and implement appropriate solutions. Our purpose is to provide an overview of the supervised exercise training intervention and discuss the advantages of and barriers to a remote intervention fidelity monitoring process. Twenty-eight exercise interventionists (EI) across 8 sites delivered the supervised exercise training protocol. EI training was included during the initial step of a 3-step fidelity process: Step 1 Training Certification, Step 2 Initial Fidelity, and Step 3 Ongoing Fidelity. The fidelity process was managed from one site that assessed intervention fidelity through videos submitted approximately every 6 months by each site. Supervising physical therapists oversaw fidelity at their respective site and completed in-person fidelity assessments once per month. The primary advantage of this process was cost savings that occurred because there were no site visits with associated travel costs. A significant barrier was technological challenges related to recording and uploading videos to a secure file-sharing website. Across all sites, 140 fidelity assessments were completed; the mean (SD) score was 96.3% (3.4%) indicating excellent intervention fidelity. Our procedures and lessons learned will guide planning for future clinical trials of complex interventions.
HIGH SCHOOL CURRICULUM AND COGNITIVE FUNCTION IN THE EIGHTH DECADE OF LIFE
Authors: Moorman Sara , Khani Saber 
Published: January 2025

Abstract
Formal educational attainment, or years of schooling, has a well-established positive effect on cognitive health across the life course. If educators and policymakers could imbue education with even more of the vital ingredients for sustained cognitive health, then rates of cognitive impairment might continue to decline in the population as cohorts age. We hypothesized that the content and difficulty of the curriculum in high school lead to higher levels of socioeconomic attainment in adulthood and, in turn, to better cognitive outcomes in older adulthood. We estimated multilevel structural equation models (MSEMs) in data from 2,405 individuals who attended one of 1,312 U.S. high schools in 1960 and participated in the Project Talent Aging Study in 2018. Curricular difficulty (i.e., college preparatory track) and content (i.e., a greater number of semesters of math and science) in high school were positively related to cognitive function (i.e., word recall and verbal fluency) at average age 75. Effects were robust to controlling for adolescent cognitive ability, academic performance, socioeconomic background, and school characteristics. Overall educational attainment significantly mediated the association: High school curricular content and difficulty were associated with higher degree attainment, which was associated with better cognitive function in later life. We discuss implications of these findings for educational policy, where the results suggest that interventions into the content and difficulty of the high school curriculum could potentially reap cognitive benefits decades later.
UNDERSTANDING THE ROLE OF EDUCATION IN COGNITIVE FUNCTIONING AMONG OLDER BRAZILIANS
Authors: Farina Mateo 
Published: January 2025

Abstract
Education has been linked to cognitive functioning in older adulthood across time and place. However, how education is linked to later life cognitive functioning may differ across country contexts. The role of education has been widely debated with evidence for both direct and indirect pathways (i.e. occupation, health behaviors, etc.). However, much of the research has been limited in low- and middle-income countries that, in general, have lower levels of education and greater levels of social inequity. As one of the fastest-aging countries that has seen substantial improvements in education levels over the last 60 years but with significant social inequality, Brazil provides a prime example to understand how education as an exposure or the sequelae of pathways from education may impact cognitive health in older adulthood. This study uses nationally representative data from the ELSI-Brazil Study (50+) to examine the association of education with older adult cognitive functioning (global and domain-specific). I used a series of linear regression models to assess the sensitivity of the association of education with cognitive functioning after adjustments for health behaviors, health conditions, and wealth. I found that education was positively associated with cognitive functioning; for the total population, it remained relatively unchanged with downstream adulthood factors. Nevertheless, among those with more than 8 years of education, differences were attenuated by downstream factors. This suggests that education as an exposure may drive future trends in cognitive health in countries with low levels of overall education.