bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE BURDEN OF SPOUSAL CAREGIVERS IN YOUNG-ONSET DEMENTIA: INSIGHTS FROM A MIXED-METHODS STUDY
Authors: Cui Xiaoyan , Wang Junqiao , Wu Bei , Ding Ding , Zhao Qianhua , Tang Xueting , Wang Jing 
Published: January 2025

Abstract
Becoming a spousal caregiver for a person with young-onset dementia (YOD) is an unexpected event that deviates from the normal life course trajectory, creating unique and profound challenges. Understanding their burden, the primary sources of this burden, and their coping resources is essential for developing tailored support services. We employed a mixed-methods approach to gain a comprehensive understanding of the burden experienced by eleven spousal caregivers of persons with YOD living in the community. We used the Zarit Burden Interview to quantify caregiving burden and conducted semi-structured qualitative interviews to explore the caregiving experience in depth. We utilized a joint display method to integrate and present the converging findings from quantitative and qualitative data, offering a holistic perspective on the caregiving burden. All spousal caregivers in this study experienced varying degrees of burden, driven primarily by the dynamic care needs and dependency of their loved ones. The integrated data showed that they face significant challenges in maintaining their personal identity and social life, with many sacrificing career aspirations and enduring social isolation. Societal expectations compounded the burden, leading to self-imposed guilt and dissatisfaction. While caregiving reconfigures family dynamics, it often strengthens bonds with children. The lack of support resources and overwhelming responsibilities places immense psychological stress on them. Despite these challenges, caregivers remain committed to their roles. There is an urgent need to develop family-centered community support services and respite care to provide younger spousal caregivers with the time and space to manage their personal lives and alleviate their burden.
PREDICTORS OF INTENT TO USE DIGITAL MEMORY BOOK AMONG DEMENTIA CAREGIVERS
Authors: Lee Yura , Oh Chorong , Park Min Sook , Bong Ji Yae 
Published: January 2025

Abstract
A memory book is a popular reminiscence approach for people with dementia (PWD) and caregivers (CGs). Recently, it has evolved into a digital form by incorporating music, videos, or other multimedia, referred to as a digital memory book (DMB). Like conventional memory books, DMBs have been found to improve quality of life, cognition, communication, and mood for PWD and CGs, while also reducing CG burden. Despite these benefits, the usage of DMBs remains low, and there is limited research identifying factors influencing intent to use DMBs in this population. Considering that family CGs are most often the facilitators of DMBs for PWD, this study aims to examine the predictors of intent to use DMB among dementia CGs. Based on the Technology Acceptance Model, we collected data from 170 dementia CGs. Findings from linear regression analyses show that dementia type, primary caregiver status, age, race, education, caregiver health, and relationship to PWD were significantly related to intent to use DMBs. We also found a significant interaction effect between dementia type (Alzheimer’s disease [AD] vs. other dementias) and stage (mild vs. moderate to severe) (b=0.493, SE=0.217, p &lt;.05). Specifically, differences in intent to use DMBs between mild and moderate to severe stages were significantly greater among CGs for AD compared to other dementias (ΔM= 0.45 vs. 0.05). This study contributes to identifying predictors of the intent to use DMB among dementia CGs. Considering these factors will be crucial in developing and implementing DMB programs to enhance their use, thereby benefiting this population.
USING TRANSFER LEARNING TO IMPROVE ALGORITHMIC DEMENTIA CLASSIFICATION ACROSS DIFFERENT RACIAL AND ETHNIC GROUPS
Authors: Leist Anja , Glymour M Maria , Langa Kenneth , Kim Jung Hyun 
Published: January 2025

Abstract

Background
In the absence of clinical assessments, algorithmic ‘probable dementia’ estimation aids public health and epidemiological research on determinants and consequences of dementia. Algorithmic performances have differed by social and racial/ethnic groups due to heterogeneous sample sizes. In this study, we present improvements in the accuracy of group-specific ‘probable dementia’ estimation using a transfer learning approach. Transfer learning – a novel approach not previously applied in algorithmic dementia classifications – uses a large “source” dataset with imprecise (non-clinical) outcome assessments to develop an initial algorithm with a large and diverse sample, complemented by a smaller “target” dataset with high-quality (clinical) outcome assessments to develop models with refined estimation of model coefficients.

Methods
Data came from the Health and Retirement Study (source data: N=6,630) and the Harmonized Cognitive Assessment Protocol (target data: N=2,388). Different algorithms to estimate probable dementia were evaluated through overall accuracy (Brier score), calibration (intercept, slope), and discriminative ability (area under the receiver operating characteristic curve, AUC; area under the precision-recall curve, AUPRC).

Results
Among non-Hispanic Black participants, the transfer-learned algorithm had higher accuracy than the best previously reported algorithm (Brier 0.049 vs. 0.061; AUC 0.84 vs. 0.81; AUPRC 0.52 vs. 0.39). Among Hispanic participants, the transfer-learned algorithm improved model calibration (Intercept −0.07 vs. −1.19; Slope 0.88 vs. 0.08).

Discussion
The use of transfer learning can improve algorithms to estimate probable dementia from non-clinical assessments for groups historically underrepresented in research. More accurate classification will lead to more equitable epidemiological and public health research on dementia.
FEASIBILITY AND ACCEPTABILITY OF MBCT AND BA TO REDUCE PRE-DEATH GRIEF IN FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Neugebauer Benjamin , Cummings Caroline , Sparks Sarah , Elliott Lauren , Neugebauer Volker , Chrzanowski Lauren , McLean Elisabeth , Singer Jonathan 
Published: January 2025

Abstract
Family caregivers of individuals with Alzheimer’s Disease and Alzheimer’s Disease Related Dementia (AD/ADRD) may experience pre-death grief (PDG). Behavioral activation (BA) and mindfulness-based cognitive therapy (MBCT) improve grief outcomes for bereaved individuals but neither have been investigated in the context of PDG. Notably, there are high rates of treatment attrition for family caregivers of persons with AD/ADRD underscoring the need to improve treatment options for this population. The present study is Stage I of NIH Stage Model for Behavioral Intervention Development that examines the acceptability and feasibility of two interventions. Participants in West Texas have limited to no resources due to a lack of respite, neurologists, and caregiving interventions, as they live 5 hours from a large urban setting. Family caregivers in West Texas were randomized to receive MBCT or BA following administration of neuropsychological and psychological assessments. Participants completed a shorter battery of assessments each session, and the full battery during the final session and at all follow ups. Thirty-three participants were recruited and consented, 84.8% (n=28) completed the study, 96.0% (n=27) of participants completed the final survey, and 86% (n=24) completed the 1-month follow up. When comparing the number of sessions attended by participants receiving MBCT vs. BA, there was no significant differences (p=0.73). Qualitatively, participants endorsed enjoying the interventions, and reported they were not burdensome. Results support the feasibility and acceptability of these evidence-based interventions for family members of persons with AD/ADRD in a unique West Texas sample.
IMPLEMENTING SMART AMBIENT BRIGHT LIGHT FOR NURSING HOME RESIDENTS WITH DEMENTIA: ASSESSING FIDELITY
Authors: Berish Diane , Wang Julian , Beiglary Shevvaa , Jao Ying-Ling , Liao Yo-Jen 
Published: January 2025

Abstract
Up to 90% of persons with dementia experience neurobehavioral symptoms and poor sleep which may be associated with limited daylight exposure and circadian disruptions. Lighting interventions regulate the circadian rhythm and have been shown to reduce agitation. Smart Ambient Bright Light (SABL) incorporates natural light and is an automatic lighting system that delivers bright light during the day (photopic illuminance ≥400 lux, circadian stimulus [CS]≥0.3) and dim light during the night (lux≤40, CS ≤0.1). Two methods were used to assess SABL fidelity. First, manual measurements were conducted during the daytime twice a week. Second, each participant wore a light sensor to measure individual lighting exposure for 24 hours, 7 days a week, every other week. Manual measurement results indicated that the SABL lighting conditions across different spaces generally met the targets during daytime (lux: mean=394.2, SD=49.75; CS: mean=0.302, SD=0.07). Individual sensors also showed that participants’ average daytime light exposure during the intervention met the target for lux (mean=406.9, CI=369.9-443.8) and CS (mean=0.363, CI= 0.332-0.393). Individual nighttime lighting exposure during the intervention was above target for lux (mean=94.5. CI= 82.3-106.7) and CS (mean=0.111, CI=0.098-0.124). Additionally, participants received higher daytime CS (t=-8.7, p&lt; 0.001) and daytime lux (t=-8.48, p&lt; 0.0001) while also receiving lower nighttime CS (t=4.43, p=0.0001) and nighttime lux (t=7.4, p&lt; 0.0001) during the intervention period than the control period. The results indicate the SABL achieved fidelity for daytime, but its fidelity for nighttime, especially lux, could be improved. Future studies should incorporate lessons learned to improve SABL implementation fidelity.
ACTIVITY INTENSITY AND FALL-RELATED DEATHS AMONG OLDER ADULTS: RESULTS FROM A 12-YEAR NATIONAL SURVEY
Authors: Adeyemi Oluwaseun , Chodosh Joshua 
Published: January 2025

Abstract
Fall-related deaths among older adults are a growing public health concern, with activity intensity potentially playing a critical role in mitigating these outcomes. This study assessed the relationship between activity intensity and fall-related death among community-dwelling U.S. older adults. We pooled twelve years of survey data (2006 to 2017) from the Integrated Public Use Microdata Series of the National Health Interview Survey for this retrospective cohort study. We identified older adults (65 years and older) who sustained fall injuries (N=2,454). The outcome variable was fall-related death. We defined low activity intensity as a binary variable using the American Heart Association’s weekly 500 Metabolic Equivalent of Task (MET) as a cut-off. We controlled for sociodemographic, healthcare access, and health characteristics, performed survey-weighted logistic regression analysis, and reported the adjusted mortality odds (plus 95% confidence interval (CI)). The survey comprised 2,454 older adults with fall injuries, representing 863,845 US older adults. The population was predominantly female (68%), non-Hispanic Whites (85%), and divorced/separated (54%). During the follow-up period, 45% of the study population died. Approximately 81% of the study population had low activity levels. However, between 2006 and 2017, the proportion of the study population with low physical activity decreased from 90% to 67%. After adjusting for sociodemographic, healthcare access, and health characteristics, low activity level was associated with two-fold increased odds of death (AOR: 2.11; 95% I: 1.59 – 2.81). Promoting higher physical activity levels may significantly reduce the risk of fall-related deaths among older adults.
TRENDS IN DRUG-DRUG INTERACTIONS AMONG US OLDER ADULTS, 2015-2016 VS. 2021-2023
Authors: Qato Dima , Veetil Shyam Krishnan Ondanat , Wilder Jocelyn 
Published: January 2025

Abstract

Background
Adverse drug events due to drug-drug interactions are a leading cause of preventable mortality in older adults yet current information on the use of interacting regimens is limited. In this study, we quantify changes in the frequency and types of potential major (contraindicated and generally avoid) drug-drug interactions among older US adults.

Methods
Descriptive analyses of a longitudinal, nationally representative sample of community-dwelling older adults in the U.S. In-home interviews with medication logs were conducted in 2015-2016 and 2021-2023. We used Micromedex to identify potential major drug-drug interactions. Primary outcomes were the prevalence of the concurrent use of medications with a major drug-drug interactions overall and for specific medications.

Results
The study comprised of 4175 participants in 2015-2016 and 2819 in 2021-2023. In 2015-2016, 12.3% of older adults were at risk for a major drug-drug interaction compared with 10.8% in 2021-2023(P =.051). While declines in the use of interacting regimens involving aspirin (3.1% to 1.7%), warfarin (1.3% to 0.4%), and hydrocodone (0.9% to 0.4%) were observed during this time period, increases in the use of citalopram (0.9% to 1.4%), tizanidine (0.2% to 0.6%) and albuterol (0.3% to 0.6%) in interacting combinations was also found (all P&lt; 0.05). Conclusions: Although the use of interacting medications among older adults has modestly declined since 2015, 1 in 9 is still potentially at risk for a major drug-drug interaction. Improving patient awareness of commonly used drug-drug interactions has the potential to reduce preventable adverse drug events associated with their use among older adults.
UNDERSTANDING GOAL SETTING AND BEHAVIOR CHANGE MECHANICS IN OLDER ADULT SITTING REDUCTION
Authors: Greenwood-Hickman Mikael Anne , Arterburn David , Cooper Julie , Green Bev , Holden Erika , McClure Jennifer , Rosenberg Dori 
Published: January 2025

Abstract
While sedentary behavior (SB) is highly prevalent in older adults, scant evidence documents how participants actionably change this behavior. We explored intervention fidelity, participant satisfaction, and the types of goals participants set based on their preferences within a 6-month randomized controlled trial of a SB intervention for adults aged ≥60 years that successfully reduced participant sitting. Coaches tracked goals for all participants, and 8% of visits were randomly reviewed and coded for fidelity using a structured template. At study completion, participants completed a brief satisfaction questionnaire. Goals data were qualitatively coded and grouped by reminder strategy and topic. Fidelity and satisfaction data were summarized using frequencies and mean (standard deviation). Intervention participants (N=140, mean age 69 [6.0], 62% women, 66% Non-Hispanic White) had high satisfaction (95% Satisfied or Very Satisfied), and 83% reported perceived improvements to health and/or daily functioning. Fidelity to intervention content and techniques was also high across coded intervention sessions (SMART goals set in 98% of sessions, 93% active problem solving with coach, 95% discussed specific sitting break reminder strategies). Participants primarily set sitting reduction goals leveraging outward (e.g., fitness band prompts, using a standing desk for certain tasks) and habit (e.g., adding standing to a meal, standing during daily chores) reminder strategies tailored to individual preferences and lifestyle. Using inner cues such as awareness of pain or stiffness were less common. Specific goals to reduce SB varied widely, suggesting tailored SB reduction intervention approaches are likely important, particularly for older adults with chronic conditions.
ADVANCING AGE-FRIENDLY CARE IN THE VA: MIXED-METHODS IMPLEMENTATION RESULTS OF 39 IMPLEMENTATION INSTANCES
Authors: Peeples Amanda , Ashcraft LauraEllen , Goodman Octavia , Whiteside Phoebe , Brown Rebecca , Burke Robert , Warren Connor , Pelcher Lindsay 
Published: January 2025

Abstract
Age-friendly care integrates the 4Ms (what Matters, Medication, Mentation, Mobility) to promote evidence-based care for older adults. The Safer Aging through Geriatrics-Informed Evidence-Based Practices Quality Enhancement Research Initiative (SAGE QUERI) is a hybrid type-III implementation-effectiveness trial comparing an implementation strategy bundle to dissemination as usual. We implemented four evidence-based practices (EBPs) aligned with the 4Ms across 9 VA Medical Centers. We used descriptive statistics and qualitative interviews with 30 implementing clinicians to report mixed-methods outcomes for reach, adoption, implementation, and maintenance across 39 implementation instances. Reach to Veterans varied widely across EBPs: Mobility n=30; Mentation n=37; Medication n=184; what Matters n=8000+. Eligibility criteria impacted reach; clinicians reported the ease of enrolling Veterans in an EBP with wide eligibility (e.g., every Veteran who is a candidate for surgery) versus an EBP with strict eligibility (e.g., “all the moons have to be aligned” to identify/enroll Veterans). Across 39 implementation instances, 77% (n=31) initially adopted the EBP, with a total of 169 clinicians trained (what Matters n=21; Mobility n=29; Medication n=30; Mentation n=89). Clinicians described training requirements, alignment of EBPs with current practices, and organizational support as key factors influencing adoption. Implementation fidelity varied by EBP: 34% what Matters; 80% Mobility; 100% Mentation and Medication. Clinicians noted the wider impact of EBP-related practice changes, including using new skills with Veterans ineligible for the full EBPs. Across 39 implementation instances, 51% (n=20) reached full maintenance; an additional 23% (n=9) achieved implementation. Sites that had successfully integrated EBPs into practice expressed intentions to sustain EBPs.
DESCRIBING ADVANCED PRACTICE REGISTERED NURSES’ INFLUENCE ON IMPROVED NURSING HOME OUTCOMES
Authors: Johnson Alisha , Vogelsmeier Amy , Thompson Veronica 
Published: January 2025

Abstract
Advanced practice registered nurses (APRN) embedded full-time within nursing homes (NH) improve key resident outcomes such as reducing hospitalizations, increasing advance directive use, and improving resident/family satisfaction. Despite positive evidence, this care model is not widely adopted, and there has been minimal research on how APRN practice impacts outcomes. Informed by Donabedian’s Structure-Process-Outcome framework, we conducted a cross-case analysis to understand how APRNs influenced patient (direct) and facility-level (indirect) outcomes through nursing home structures and processes. We used eight years of data generated from The Missouri Quality Initiative, a CMS-funded demonstration project aimed to reduce avoidable hospitalizations through embedded APRN care in 16 midwestern nursing homes. Cases consisted of two higher-performing homes and two lower-performing NHs. Each case was analyzed using deductive coding of four databases to create a cross-database table. First and second level thematic coding was applied to the cross-database tables to create the high and low performing cases for cross-case comparison. Stark differences arose between the higher and the lower performing cases around themes including proactive/reactive processes, individual vs. group-oriented processes, and administrative supports (present/absent/lip-service). APRNs applied proactive processes at the patient (direct) and facility (indirect) level when NH structure (i.e. adequate administrative support) was present. More successful homes, even with higher turnover, demonstrated proactive mentoring processes, initiated and supported by the APRN, instead of passive, reactive processes and deference to administration. APRNs are effective caregivers if structural supports allow for proactive processes maximizing APRN expertise, supporting the inclusion of APRNs within NH care delivery models.
PROSPECTIVE ASSOCIATIONS BETWEEN THE STATE MINIMUM WAGE AND COGNITIVE FUNCTION IN OLDER AMERICANS
Authors: Lee Boram , Petito Lucia , Kim Daniel 
Published: January 2025

Abstract
Limited research has explored how social policies influence cognitive health in older age. This study aimed to examine the associations between the state-level minimum wage and cognitive function in older US adults. We used data from the Health and Retirement Study (1998-2020) on non-self-employed workers who were age 50-75 and free of dementia at baseline, with cognitive function measured during the study period (N=7490). For cognitive function, we used data based on the Telephone Interview for Cognitive Score (TICS; 0-27, with higher values indicating better cognitive function). We explored the state-level minimum wage, adjusted to 2021 US dollars, lagged by 2, 6, and 10 years. We employed individual fixed-effects linear models and examined for differences in associations by wage, working hours, race/ethnicity, and sex. Among all workers, the state minimum wage was not associated with cognitive function. However, for low-wage workers and part-time workers, a $1 increase in the 6-year lagged state minimum wage was associated with a 0.40 (95% CI=0.17 to 0.64, p=.001) and 0.17 (95% CI=0.03 to 0.32, p=.01) point increase in the TICS, respectively, controlling for time-invariant individual factors and time-varying individual-level and state-level covariates. Among low-wage workers, stronger associations between the state minimum wage and increases in cognitive function were observed in non-Hispanic Whites (β= 0.43, p&lt;.001) but not Black Americans (β=0.04, p=0.91) and Hispanic Americans (β=0.30, p=0.21). There were no differences by sex. Overall, our findings support that increasing the state minimum wage could benefit the cognitive health of older adults, particularly among low-wage workers.
LOCAL USE OF POLLUTING COOKING FUELS AND ADULT COGNITIVE HEALTH
Authors: Mani Sneha , Gupta Aashish , Elo Irma 
Published: January 2025

Abstract
Scientific understanding of the relationship between environmental hazards and cognitive health at older ages in low- and middle-income countries (LMICs) is poor. Using data from the Longitudinal Aging Study of India and the World Health Organization’s Survey on Global AGEing and adult health for four LMICs, we examine the association of direct and local exposure to polluting cooking fuels with cognitive health at older ages. We document the negative influence of both: cognitive health is poorer among household members who use polluting fuels and among residents of neighborhoods where the use of polluting fuels is more common. We find that women living in households that use polluting fuels and where the local use of polluting fuels is the highest have the lowest predicted cognitive scores. Conversely, men living in households that do not use polluting fuels and in areas with no local use of polluting fuels have the highest predicted cognitive scores. These associations cannot be explained by accounting for individual or local differences in socioeconomic status. Our findings reveal the substantial direct and indirect influence of polluting fuel use in LMICs and help understand why overall cognitive health may be poor in these settings, especially for women. Additionally, the presence of negative externalities of solid fuel use for cognitive health implies a greater justification for efforts to reduce the use of such fuels.