bluuebunny/crossref_metadata_2025_split huggingface dataset:
FINANCIAL HARDSHIP IS ASSOCIATED WITH REPEATED STRESSORS AS MEASURED BY STRESSOR DIVERSITY
Authors: Surachman Agus 
Published: January 2025

Abstract
Financial hardship supplements traditional measures of socioeconomic status (i.e., education, income) to elucidate how the insufficiency of socioeconomic resources is experienced. Financial hardship may impact health by differentiating exposure to stressors in daily life. This study examined how three domains of financial hardship (i.e., material, behavioral, and psychological) relate to daily stressor concentration (e.g., experiencing many stressors that are all arguments versus fewer stressors spread across arguments, work stress, home overloads). Higher stressor concentration has been associated with poorer health and well-being across adulthood. The present analyses used data from the Midlife in the United States study wave 3 (2016-2020), in which 1,024 participants (ages = 43-90, 57% female) completed 8-day daily diary interviews. Measures of financial hardship include material indicators of poverty, healthcare, and financial aid; psychological perceptions of financial situation; and behaviors including payments, earnings, and spending. Daily stressor concentration was calculated using 1- the Gini diversity index. In a regression model accounting for age, sex, daily stressor exposure, and education, a higher total score of financial hardship was associated with higher stressor concentration (b = 0.07, SE = 0.03, p &lt;.01). This result replicated across material (b = 0.26, SE = 0.09, p &lt;.01) and psychological domains (b = 0.11, SE = 0.04, p &lt;.01) of financial hardship, and the findings were exacerbated with older age (ps &lt;.05). Experiencing repeated stressors in specific domains may be a mechanism by which insufficient economic resources can worsen health outcomes for adults as they age.
EAST MEETS WEST : APPLICATION OF AI TO SUPPORT HEALTHY AGING AND EFFECTIVE CARE IN DIVERSE CULTURES
Authors: Sun Fei , Guo Guifang , Ding Yong 
Published: January 2025

Abstract
This East Meets West symposium showcases five studies focused on the utilization of Artificial Intelligence (AI) in fostering healthy aging and effective care for older adults in the U.S.A. and mainland China. The first study delves into older Chinese adults’ preferences for assistive robots, highlighting their need for safety, physical functioning, and emotional support, alongside concerns regarding cost and user-friendliness. The second study introduces an innovative approach by integrating assistive robots with reminiscence music therapy to aid stroke recovery, showing promising outcomes in enhancing self-efficacy, daily living activities, positive emotions, and upper limb functionality. The subsequent three studies explore the feasibility, usefulness, and efficacy of AI-based technologies in interpreting medical records, monitoring disease progression, and providing customized health information to family caregivers. The study from the U.S. reveals that lab results interpretation generated by ChatGPT-4 demonstrated higher accuracy, relevance, and helpfulness. Similarly, the research from China is pioneering modules for early detection and comprehensive monitoring of neurodegenerative disease progression. Despite encouraging evidence, the final study points out the limitations in using GPT-3.5 Turbo for health information classification (with a focus on daily care category) into three levels with the accuracy rate falling short of expectations. In summary, these studies offer promising evidence of the benefits of AI-based innovations in promoting healthy aging and supporting caregivers in the U.S.A and mainland China. They also underline the existing limitations and adopting a person-centered approach to cater to the specific needs of older adults. After individual presentations, a discussant will provide critical feedback.
USING A LARGE LANGUAGE MODEL TO CLASSIFY DEMENTIA CAREGIVERS’ HEALTH INFORMATION WANTS
Authors: Li Zhuochun , Luo Zhimeng , Zou Ning , He Daqing , Xie Bo , Hilsabeck Robin , Aguirre Alyssa 
Published: January 2025

Abstract
Many caregivers of persons living with dementia use social media to express dementia care-related health information wants (HIWs), i.e., types of information caregivers seek that can help them manage challenges and concerns. Recent developments in large language models (LLMs) hold promise in automatic classification of HIWs expressed in large quantities of social media posts. As a first step, we evaluated GPT-3.5 Turbo’s performance in classifying 60 social media posts based on our previously developed HIW framework, which includes 7 first-level categories, including daily care. Under daily care, there are 7 second-level categories and a total of 32 third-level subcategories. All 60 posts were previously verified by 3 experienced clinicians as being in the daily care category; 40 posts were in the second-level category of mood and behavior management and 20 in the second-level category of safety; and 20 posts in each of the 3 third-level categories: agitation; memory loss and confusion; and driving safety. We asked GPT-3.5 Turbo to classify the posts on the first level; 14 (23%) were accurately classified to daily care. Next, we asked GPT-3.5 Turbo to classify those 14 posts into one of the second-level categories in daily care; 10 (71%) were accurately classified into mood and behavior management or safety. Finally, we asked GPT-3.5 Turbo to classify the 10 remaining posts into the third-level subcategories. Seven (70%) were accurately classified: agitation 5/5 (100%), driving safety 2/2 (100%) and memory loss and confusion 0/3 (0%). Disappointed by GPT-3.5 Turbo’s performance, we discuss plausible reasons and solutions.
GAIT SPEED MODERATES EFFICACY OF HOME-BASED EXERCISE ON FALLS IN OLDER ADULTS WITH PREVIOUS FALL
Authors: Rice Jordyn , Falck Ryan , Davis Jennifer , Dian Larry , Madden Kenneth , Cook Wendy , Miran-Khan Karim , Liu-Ambrose Teresa 
Published: January 2025

Abstract
Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. We performed a secondary analysis of a randomized controlled trial, to assess if baseline gait speed moderated the effects of an exercise program on subsequent falls among older adults. Community-dwelling adults &gt;70 years who had fallen within the previous 12 months were randomized to either 12 months of home-based exercise (EX; n=172) or standard of care (SC; n=172). For this study, we examined intervention effects on fall rates at 6 and 12 months stratified by baseline gait speed (slow &lt; 0.80m/s or normal &gt;0.80 m/s) using negative binomial regressions. We also investigated whether baseline gait speed moderated the intervention effects on mobility and cognitive function using linear mixed modeling. At baseline, 134 participants had slow (EX=70; SC=64) and 210 had normal (EX=102; SC=108) gait speed. For participants with slow gait speed, EX reduced fall rates by 44% at 6 months (IRR=0.56; 95% CI:[0.33, 0.95]; p= 0.03) compared with SC; for participants with normal gait speed, there was no significant effect of exercise on fall rates at 6 or 12 months. Gait speed moderated intervention effects; EX participants with slow gait improved: 1) Timed Up-and-Go at 6 months (estimated mean difference= -4.05; 95% CI:[-6.82, -1.27]; p= 0.00); and 2) Digit Symbol Substitution Test at 12 months (estimated mean difference= 2.51; 95% CI:[0.81, 4.21]; p=0.00). Our study suggests older adults with slow gait speed may be a target population for exercise-based falls prevention.
END-OF-LIFE PLANNING IN GERMANY AND SOUTH KOREA: PERCEIVED ENGAGEMENT AND ACTUAL BEHAVIOR
Authors: Kim-Knauss Yaeji , Shin Yumi , Ha Jung-Hwa , Lang Frieder 
Published: January 2025

Abstract
End-of-life planning could manifest differently across cultures, shaped by prevailing social norms. This study examines behaviors associated with perceived engagement in end-of-life planning and explores potential cultural variations. We focus on two distinct cultures, Germany and South Korea, drawing on data from the ‘Ageing as Future’ project’s online survey conducted in 2023 for the German sample (aged 60+, n=708) and data collected between 2023 and 2024 for the Korean sample (aged 60+, n=519). We identify two outcome behaviors of interest: advance care planning (ACP) and discussions with relatives about one’s death, commonly known as formal and informal end-of-life planning, respectively. Logistic regression models revealed that perceiving oneself as actively engaged in end-of-life planning increased the likelihood of completing ACP, a finding consistent across cultures. Additionally, being German, older, female, and having higher education levels were associated with higher odds of ACP completion. Concerning discussions with relatives, on the other hand, perceiving engagement in end-of-life planning increased the likelihood of this informal planning, with a significantly stronger effect observed in the Korean sample compared to the German sample. Being German and having at least one child were also positively associated with engaging in these discussions. These findings suggest a greater reliance on informal discussions about death with relatives in the Korean context. Given the cultural differences and the lower prevalence of end-of-life discussions in Korea compared to Germany, the normalization of such discussions in Korea is needed, but with a culturally tailored approach.
WILLINGNESS TO LIVE UNDER IMPAIRMENT: FACTORS ASSOCIATED WITH DESIRED LONGEVITY
Authors: de Couto Clara Paula , Rupprecht Fiona , Nikitin Jana , Rothermund Klaus 
Published: January 2025

Abstract
This study delves into the complexities of individuals’ desires for longevity and their willingness to live with impairment. When deciding about their longevity desires, some individuals may focus on present-oriented, concrete aspects of their lives, like their current state of health, whereas others may weigh up more future-oriented, abstract aspects, such as how important it is to be healthy. We investigated what factors are associated with individuals’ willingness to live with impairment. Factors associated with willingness to live with impairment were examined in a sample of N = 790 German participants aged 39–90 years (Mage = 63.38, SD = 14.30, 51% female). To examine age-specific factors related to desired longevity under impairment conditions, chronological age was added as a moderator in the analyses. Findings indicated that for middle-aged adults, fear of becoming a burden and higher importance of health were associated with lower willingness to live with impairment. For older adults, lower willingness to live with impairment was associated with higher levels of instrumental preparation for the end of life. The obtained age differences can be understood as reflecting a shift in time perspective and personal experiences. Among middle-aged adults, willingness to live with impairment is more strongly influenced by distant events that pertain to the future (e.g., fear of becoming a burden). Older adults, however, place more importance on their current life situation (e.g., instrumental preparation), and their willingness to live with impairment seems to be more conditional on practical aspects in the present.
PREMATURE DEATH ATTRIBUTABLE TO SOCIAL DETERMINANTS OF HEALTH AMONG ASIAN AMERICANS: A POPULATION-BASED COHORT
Authors: Qi Xiang , Wang Katherine , Wu Bei 
Published: January 2025

Abstract
Asian adults are one of the fastest growing ethnic minority groups in the US and have higher levels of unfavorable social determinants of health (SDoH), including limited English fluency, unemployment, and reduced healthcare access, yet the impact of these SDoH on mortality remains understudied in this population. This study aims to examine the prospective associations of multiple SDoH with premature all-cause mortality, and to investigate their respective contribution among a nationally-representative cohort of Asian Americans, using data from 3,888 Asian adults aged 20-74 who participated in the National Health and Nutrition Examination Survey 2011-2018. Cox proportional hazards regression models were employed to examine the relationships of SDoH factors with mortality; and population attributable fractions (PAFs) were calculated to assess the contributions of each individual SDoH on premature death. We found that unemployment, limited English proficiency, social isolation, no health insurance, in poverty, housing instability, less education, and food insecurity were significantly associated with mortality (HRs range from 1.20 to 2.35). SDoH explain up to 38.6% of mortality in the Asian Americans, among them, unemployment (18.5%), limited English fluency (9.0%), and social isolation (8.3%) showed the highest relative contributions to mortality. These results challenge the “Model Minority” stereotype, often perpetuated by English-only national survey data, and highlight the unique SDoH challenges faced by Asian Americans. Future research disentangling SDOHs on health outcomes by Asian subgroup is necessary to dispel the “model minority” stereotype that remains prevalent and provide better informed preventive practices and interventions for this population.
LONGEVITY IN THE PACIFIC: FINDINGS FROM THE KUAKINI HAWAII CENTENARIAN STUDY
Authors: Willcox Bradley , Masaki Kamal , Martin Peter , Lee Gina , Obhi Hardeep , Poon Leonard 
Published: January 2025

Abstract
The immigration of Japanese citizens to Hawaii more than one hundred years ago profoundly changed the culture of these islands. Their diet, exercise, and spirituality may have influenced the longevity of Hawaii residents. This presentation highlights longevity predictors among Hawaiian men of Japanese descent. A sample of 3,734 participants (Mage = 77.82 years at baseline) from the Kuakini Hawaii Centenarian Study was included in this research. With follow-up longitudinal data, we compared participants who survived into their 70s, their 80s, their 90s, or to 100 years of age. Results indicated that cognitive function, F(3,3,733) = 52.59, p &lt;.001, and self-reported health, F(3,3,733) = 18.72, p &lt;.001, at baseline distinguished those who survived to centenarian status compared to those who died in their 70s, 80s, or 90s. Centenarians were more likely to carry the protective FOXO3 allele, χ2 (N=3,352) = 8.94, p &lt;.05, and less likely to be diagnosed with diabetes, χ2 (N=3,560) = 12.43, p &lt;.01. Regression analyses suggested that father’s age death (β =.04, p &lt;.05), fluid intelligence (β =.12, p &lt;.001), ADL impairment (β = -.23 p &lt;.001), health behaviors, (i.e., BMI, smoking and drinking, β =.55, p &lt;.01, β = -.10, p &lt;.001, and β = -.08, p &lt;.01, respectively), and diabetes (β = -.06, p &lt;.01), were significantly associated with age at death. The results support policymakers and practitioners in promoting healthy longevity among a culturally distinct group.
WHY CULTURAL CONTEXT IS VITAL TO STUDY LONGEVITY IN JAPAN
Authors: Gondo Yasuyuki 
Published: January 2025

Abstract
Due to the worldwide expansion of the aging population, the number of centenarians has been increasing over the last decade. However, the centenarian population ratio is highly diverse among countries. The cause of diversity tends to be attributed to differences in the country’s economic situation. However, cultural differences in attitudes toward aging and deference to older people are potentially influential factors. In the case of Japan, regardless of its higher centenarian ratio in the world, there is a larger bed-bound population of centenarians. This unique situation is caused by combining a universal insurance system supported by a strong economy, a traditional healthy diet, and motivation to maintain good health. However, rather than those, a conventional attitude of deference to older people would be an essential cause of longevity in Japan. In Japan, Respect for the Aged Day is a national holiday. It was enacted in 1963 based on the Act on Social Welfare for the Elderly. With this timing, many local governments start presenting cash to older people. Currently, these cultural-based policies seem to have reached a turning point. A multi-country survey reported that only 25% of Japanese people wish to live to 100, the lowest among countries. At the same time, the main reason not to wish for a long life was “dislike to be a burden to people around” by observing a more significant number of bed-bound older people daily. This negative motivation might accelerate healthy behavior and cause further longer life, ironically.
THE IMPACT OF AN INTENSIVE LIFESTYLE INTERVENTION IN TYPE 2 DIABETES ON LONG-TERM MULTIMORBIDITY
Authors: Davis Ian , Huckfeldt Peter , Woodhouse Mark , Espeland Mark , Wagenknecht Lynne , Goldman Dana , Salive Marcel , Harada Ann 
Published: January 2025

Abstract
Multimorbidity, or the accumulation of multiple chronic diseases, is an important clinical issue in aging and is associated with geriatric syndromes, physical and cognitive function declines, increased health care costs, and poorer health-related quality of life. This study aims to better understand multimorbidity occurrence and accumulation over the postintervention period (2013-2019) of Look AHEAD, which randomized 5145 individuals aged 45-76 in 2001-2004 with type 2 diabetes and overweight/obesity to an intensive lifestyle intervention (ILI) or a control arm receiving diabetes support and education (DSE). The ILI was previously found to reduce weight, improve diabetes control, and reduce diabetes complications. The ILI was also associated with relative improvements in self-reported multimorbidity during the intervention period. We included 2940 participants consenting to linkage of their trial data with Medicare data, focusing on participant years with Medicare fee-for-service coverage during the postintervention period. We identified conditions from the list developed by the “Department of Health and Human Services Initiative on 21 Multiple Chronic Conditions (MCC)”. We estimated ILI versus control differences in numbers of conditions using linear models that control for baseline demographic and clinical characteristics and study site. We found similar levels of multimorbidity for the ILI and DSE groups (4.21 versus 4.31, p=0.41). This result suggests that the positive impacts of the ILI on diabetes control did not translate to long-term reductions in multimorbidity.
DIRECT CARE WORKER RETENTION DURING THE COVID-19 PANDEMIC AND THE IMPACT OF STATE POLICIES
Authors: Miller Katherine , Yang Yang , Shen Karen 
Published: January 2025

Abstract
Due to persistently low wages and poor working conditions, direct care worker shortages and high turnover existed in long-term care (LTC) industries prior to COVID-19, but became more visible during the pandemic. Some states responded to the threat of a large exodus of workers through wage-support policies (e.g., hazard pay). However, little research has examined whether these state policies were effective in mitigating the effects of the pandemic on direct care worker exits. We use the Annual Social and Economic Supplement of the Current Population Survey 2016-2022 to decompose direct care worker exits based on where they exited to: (1) unemployment or exiting the labor force, (2) a different healthcare job or industry, and (3) non-healthcare job (e.g., retail). We compare the rates of these components for direct care workers pre-pandemic (2016-2019) and during the pandemic (examining 2020 and 2021-2022 separately), and the association of these rates with state wage-support policies. Direct care worker exits were highest in 2020, with workers primarily becoming unemployed or leaving the labor force. Yet, in 2021-2022, exits decreased relative to pre-pandemic periods, primarily because fewer people switched jobs. Among those who did switch jobs, we find that workers are more likely to stay in a healthcare industry in 2021 relative to 2016-2019. We find no evidence wage support policies were associated with direct care worker retention/exits during or post-pandemic. Together, our findings suggest that broader economic trends of a shrinking workforce may be the primary driver of direct care worker exits during the pandemic.
NAVIGATING PAID CAREGIVING IN HOSPICE DURING COVID-19: AN INTEGRATED MULTIPLE METHODS ANALYSIS
Authors: Kim Patricia , Franzosa Emily , Boafo Jonelle , McDonald Margaret , Moreines Laura , David Daniel , Aldridge Melissa 
Published: January 2025

Abstract
Paid caregivers are integral members of the end-of-life care team, but navigating paid care services is complex. Families must often work across multiple providers including hospice, home health, private pay, and government to coordinate the care they need to help patients die at home. We examined experiences with end-of-life paid caregiving among 61 patients in a large, New York City health system during the first year of the COVID-19 pandemic. We analyzed care trajectories of patients who enrolled in hospice and died between March 1, 2020-March 31, 2021, integrating data from real-time linked medical and hospice electronic health records with reflective interviews with 30 interdisciplinary team members at 3 organizations providing end-of-life care during the pandemic. We found: 1) Paid caregivers were the “eyes and ears” of the hospice team and paid caregivers’ work helped families keep patients at home; 2) Patients’ increasing end-of-life needs required additional paid caregivers, heightening patients’ infection risk; 3) Conflicting organizational policies across providers and payers, such as screening, vaccination, and visitation restrictions, disrupted aide care; and 4) Scope of practice restrictions for some types of paid caregivers reduced their ability to help. Our findings highlight both the essential support role of paid caregiving in end-of-life care, and regulatory/policy burdens that may reduce the benefit of paid caregiving at this critical juncture. Supporting stability and continuity in caregiving teams and building more flexibility into paid caregivers’ scope of practice and patients’ care plans may assist aides and families in managing end-of-life care.
A LATENT CLASS APPROACH TO UNDERSTANDING HOMELESSNESS AMONG OLDER ADULTS
Authors: Souza Anita , Tsai Jenny , Pike Kenneth 
Published: January 2025

Abstract
The complex characteristics that differentiate adults over 50 experiencing homelessness are understudied. Latent class analysis (LCA) is a novel approach to identifying unobservable subgroups within populations. Housing providers have little information to adopt tailored service approaches. Capitalizing on the strength of LCA, this paper identifies the heterogeneity within older adults utilizing housing. Using a retrospective cohort study design, we extracted data from the Homeless Management Information System to describe the health conditions of adults utilizing services of a leading housing provider in Washington. These data captured developmental disability, physical health, disabling conditions, chronic conditions, mental health problems, and substance use. Among 1,971 homeless individuals, 76% were male, 49% white, and 70% homeless 6 months or more. Forty percent were 50 years or older; 17% were veterans. Probability calculated by LCA found that a 4-class solution best represented the data (fit indices: AIC=11,688, BIC=11839, entropy=0.85). Class 1 (n=519) reported higher than average proportions of mental health problems and substance abuse along with average proportions of members with a chronic health condition and slightly higher than average proportion of members with a disabling condition. Class 2 (n=254) was dominated by individuals with a disabling condition and physical disability. Class 3 (n=827) reported the lowest proportion of members with all conditions. Class 4 (n=371) was higher than average on all conditions. This knowledge builds a foundation for further research and policy endeavors to support older adults experiencing homelessness.