bluuebunny/crossref_metadata_2025_split huggingface dataset:
END-OF-LIFE CARE DISPARITY FOR ASIAN AMERICAN PACIFIC ISLANDER AND WHITE AMERICANS WITH DEMENTIA
Authors: Kim Hyosin , Lin Haiqun , Zafar Anum , Wu Bei , Duberstein Paul , Jarrín Olga 
Published: January 2025

Abstract
Alzheimer’s disease and related dementias (ADRD) disproportionately affects Asian American and Pacific Islander (AAPI) older adults, similar to other minoritized groups. People living with ADRD have significant caregiving and end-of-life care needs. Little is known about racial disparities in end-of-life care for the AAPI Medicare beneficiaries with dementia. Using Medicare administrative, claims, and assessment from inpatient, hospice, and post-acute and long-term care settings for Medicare beneficiaries who died in 2019, differences in end-of-life care and place of death for AAPI (n= 20,301) and non-Hispanic White (n=762,443) Medicare beneficiaries with dementia and comparable levels of multimorbidity (median 6, IQR 5-8) were studied. Compared to White beneficiaries with dementia, AAPI beneficiaries with dementia were more likely to be dually enrolled in Medicare and Medicaid (60% vs. 32%), yet less likely to use home health care (52% vs. 55%) or nursing home care (54% vs. 64%) during the last 3 years of life; less likely to use hospice care during the last 6 months of life (52% vs. 65%); and more likely to die in an inpatient setting (34% vs. 26%) compared to their white counterparts. Differences were magnified among beneficiaries with high chronic disease burden (four or more comorbidities in addition to dementia). Underuse of hospice services and the high rates of Medicare-Medicaid dual enrollees among AAPI beneficiaries with dementia and multiple comorbidities warrant further attention, as the disease burden particularly increases with multiple chronic conditions.
RECONSTRUCTING CULTURAL IDENTITY: THE ORAL NARRATIVES OF CENTENARIAN DESCENDANTS OF INDIGENOUS ANCESTRY
Authors: Bishop Alex , Finchum Tonya , Heinz Melinda 
Published: January 2025

Abstract
This study examined storytelling narratives of indigenous centenarians from the Oklahoma 100 Year Life Project. Qualitative content analysis was conducted using oral history narratives of N = 16 centenarian descendants (n = 5 men; n = 11 women) of American Indian ancestry (n = 8 White/Caucasian; n = 4 African-American; n = 4 Indigenous). Of interest was identifying themes reflecting cultural influences. Analyses resulted in four thematic classifications. The first theme included “transmission of historical trauma,” and involved resettlement, slavery, and race relations. One centenarian man reflected, “That’s the reason they’re called sooners... that use to belong to the Cherokees, and they took all the land...” A second theme involved “mutual interdependence.” One centenarian woman remarked, “I never enjoyed anything if I had it and didn’t share with somebody else. That’s the way I’ve been all my life. I just love to share things with people” A third theme concerned “leisure and sporting.” One centenarian man recounted training with the varsity track team, “... everybody was blowing just like a steam engine except me...I had been running all summer long out there in the buffalo grass pastures.” The fourth theme entailed “lifelong learning.” One centenarian woman recalled, “I organized a club... we studied Indian customs... our families and traditions... we called ourselves ‘Tsa-la-gi,’ which means Indian ladies.” Results will further highlight differential influences of American Indian cultural heritage on socio-emotional well-being in human longevity.
LONG-TERM IMPACTS OF A LIFESTYLE INTERVENTION IN OLDER ADULTS WITH DIABETES AND OVERWEIGHT OR OBESITY: LOOK AHEAD
Authors: Huckfeldt Peter , Semelka Charles , Jakicic John 
Published: January 2025

Abstract
Mid-life weight loss and maintenance is often recommended as a means to improve health later in life, however its long-term benefits have not been rigorously established. The Action for Health in Diabetes (Look AHEAD) randomized controlled trial compared an intensive lifestyle intervention (ILI) designed to induce and maintain a 7% weight loss through caloric restriction and increased physical activity with a control condition of diabetes support and education (DSE) in 5,145 individuals aged 45-76 years with type 2 diabetes and overweight/obesity over up to 11 years of follow-up beginning in 2001. Although the ILI group had greater initial improvements in cardiovascular disease risk factors compared to DSE, there were no overall differences in the incidence of the trial’s primary and secondary cardiovascular outcomes between the ILI and DSE groups. However, ILI did have a positive impact on diabetes control and complications, depression, physical health–related quality of life, and health care use and costs. Subsequently, the Look AHEAD trial transitioned to an in-person observational study in 2012 to assess the long-term benefits and potential harms of an ILI, which continued for 10 years before transitioning to phone-only observational period in 2022 – the Look AHEAD Aging study. This symposium will describe the long-term impact of the lifestyle intervention and the effect of diabetes-related risk factors on self-reported vision and hearing (Espeland and colleagues), nutritional risk (Houston and colleagues), self-reported disability in basic activities of daily living, instrumental activities of daily living, and mobility (Semelka and colleagues), and multi-morbidity (Davis and colleagues).
LATE-LIFE DISABILITY FOLLOWING THE ACTION FOR HEALTH IN DIABETES (LOOK AHEAD) TRIAL
Authors: Semelka Charles , Neiberg Rebecca , Huckfeldt Peter , Hayden Kathleen , Chen Haiying , Wagenknecht Lynne , Espeland Mark , Houston Denise 
Published: January 2025

Abstract
The Look AHEAD trial intensive lifestyle intervention (ILI) was associated with better mobility in adults with type 2 diabetes and overweight/obesity. The objective of this study is to describe the post-intervention impact on disability in older adults. Disability was assessed using the Pepper Assessment Tool for Disability (PAT-D) at the first post-trial visit and three subsequent study visits during the observational phase. Disability was defined by self-reported responses ‘of a lot of difficulty’ or ‘unable to do’ on any item within the PAT-D subscales for Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), and mobility. Regression models using generalized estimating equations were used to examine the association between intervention assignment and BMI across post-trial visits with disability prevalence, adjusting for age, sex, race/ethnicity, CVD history, and repeated measures. The mean±SD age and BMI of participants (n=1299) at the first post-trial visit was 68.7±5.6 years and 34.4±6.1 kg/m2, 61% were female, 69% were White, 8% had CVD history at baseline, and 51% were assigned to ILI. Over a median 9 years of post-trial follow-up, disability increased in BADLs from 3.1% to 12.6%, IADLs from 3.5% to 22.7%, and mobility from 21.9% to 46.7%. Participants with a higher BMI (35+ vs. &lt;30 kg/m2) had increased odds of disability in IADLs (OR [95% CI]: 2.0 [1.5-2.8]) and mobility (2.2 [1.7-2.9]). There was no association between prior assignment to ILI and disability (p≥0.78). In conclusion, we found clinically relevant differences in late-life disability by post-trial BMI status.
LONG-TERM ASSOCIATION OF DIABETES CONTROL WITH SELF-REPORTED VISION AND HEARING
Authors: Espeland Mark , Walkup Michael , Wagenknecht Lynne , Hayden Kathleen , Semelka Charles , Wing Rena , Beckner Tara , Houston Denise 
Published: January 2025

Abstract
Older adults with type 2 diabetes are at increased risk for vision and hearing loss. We examined whether better control of glycosylated hemoglobin (HbA1c), blood pressure, and weight was associated with better self-reported vision and hearing acuity among older adults with type 2 diabetes and overweight or obesity. The Look AHEAD Aging study administered a standardized questionnaire to N=1,008 individuals, mean (SD) age 77.8 (5.7) years, who had been enrolled in the Look AHEAD trial of intensive lifestyle intervention (ILI). We examined how mean levels of HbA1c, systolic blood pressure (SBP), and body mass index (BMI) over the prior 10 years were associated with markers of vision and hearing acuity, controlling for age, gender, and diabetes duration. Hearing and vision deficits were assessed by self-report of fair, poor, or worse abilities. Multisensory deficits were defined as reported deficits for both vision and hearing. Relatively better 10-year control of HbA1c was associated with less prevalent vision deficits (OR=0.72 per IQR lower HbA1c, p=0.002) and with less prevalent multisensory deficits (OR=0.65 per IQR lower HbA1c, p=0.002). Better 10-year SBP control was also associated with less prevalent vision deficits (OR=0.72 per IQR lower SBP, p=0.005). Prior random assignment to ILI and 10-year BMI levels were not associated with self-reported vision. HbA1c, SBP, BMI, and intervention assignment were not significantly associated with hearing acuity. Long-term control of HbA1c and SBP are important to maintaining vision in older individuals with type 2 diabetes. HbA1c control may also reduce the prevalence of multisensory deficits.
LONG-TERM EFFECTS OF AN INTENSIVE LIFESTYLE INTERVENTION ON NUTRITIONAL RISK IN OLDER ADULTS WITH DIABETES
Authors: Houston Denise , Anderson Andrea , Semelka Charles , Hayden Kathleen , Huckfeldt Peter , Chen Haiying , Wagenknecht Lynne , Espeland Mark 
Published: January 2025

Abstract
Malnutrition is common in older adults and is associated with morbidity, mortality and decreased quality of life. We examined the post-intervention impact of the Look AHEAD intensive lifestyle intervention (ILI) on nutritional risk – the presence of risk factors such as food insecurity, poor appetite, and low food intake which can lead to malnutrition – in older adults with type 2 diabetes and overweight/obesity in the Look AHEAD Aging study (~9 years after the intervention was terminated). Nutritional risk scores (range 0-21) were calculated from the DETERMINE checklist, a 10-item questionnaire of factors linked to poor nutrition in older age, and categorized as low (0-2), moderate (3-5) and high (6+). Multinomial logistic regression was used to examine the association between intervention assignment, post-intervention weight change, unintentional weight loss, and current BMI with nutritional risk adjusted for current age, sex, race/ethnicity, and education in 1032 participants. Forty percent of participants were at high nutritional risk and 48% at moderate nutritional risk. There was no association between prior assignment to ILI (p=0.65) or post-intervention weight loss or gain of ≥5% (p=0.09) and nutritional risk. However, unintentional weight loss of ≥10 lbs over the past year was associated with high nutritional risk (OR [95% CI]: 2.18 [1.16-4.09]) and current BMI of ≥30 kg/m2 was similarly associated with both moderate (1.62 [1.01-2.60]) and high (1.68 [1.03-2.74]) nutritional risk. In conclusion, current BMI and recent unintentional weight loss, but not past assignment to ILI or post-intervention weight loss/gain, were associated with nutritional risk.
THE EFFECT OF SECONDARY JOBHOLDING ON INCOME MOBILITY OF DIRECT CARE WORKERS
Authors: Kim Jiyeon 
Published: January 2025

Abstract
Recent studies show that many direct care workers acquire secondary jobs because their primary employment does not offer sufficient wages or work hours. While prior research has emphasized how secondary jobs protect direct care workers from poverty, it is unclear how these jobs affect these workers’ subsequent employment outcomes. This paper analyzes longitudinal data to investigate whether secondary jobs can serve as a pathway for direct care workers to obtain a primary job that provides income above the poverty-line and test if some secondary occupations are more beneficial than others. I find that whereas a secondary job in a non-direct care occupation helps direct care workers later attain a primary job that pays above poverty-level, working in two direct care jobs restrains them from doing so. In addition, these effects vary by race and gender such that the benefits to holding a non-direct care secondary job are greater among men and whites, compared to their women and racial minority counterparts. These findings raise concerns about unequal opportunities for wage mobility among direct care workers and the implications this has for the retention of this workforce.
CHALLENGES AND FACILITATORS TO IMPLEMENTING A PILOT HOME HEALTH PROGRAM IN THE VETERANS HEALTH ADMINISTRATION
Authors: Walkner Tammy , Seaman Aaron , Good Mary , Benzel Heather , Roman Irene San , Davila Heather 
Published: January 2025

Abstract
The Veterans Health Administration (VA) provides access to skilled home health (e.g. rehabilitation therapy, nursing) and home health aide services to &gt;200,000 Veterans annually to support aging in place. Historically, these services have been provided by community-based agencies contracted with VA. In 2021, the Iowa City VA implemented the VA’s first “VA Home Health” (VAHH) program. The goals were to increase Veterans’ access to home health and improve care coordination. Given early evidence of the program’s success, VAHH expanded in 2022 to three additional sites in Iowa and South Dakota. Our team conducted semi-structured interviews with VAHH leaders (n=13) and frontline staff (interviews in progress) at the 4 program sites about their implementation experiences. Implementation barriers include: a steep learning curve; the need to define roles and create operating procedures; recruiting and hiring sufficient staff to administer and deliver the program; and challenges obtaining space and vehicles for staff. Facilitators include: staff commitment to the program; existing relationships within and outside VA; and flexibility to tailor VAHH to meet site needs. Despite similarities across sites, there were also implementation differences, primarily related to recruiting staff, hiring processes, and needs of Veterans targeted for the program (e.g. social/medical complexity). Continued evaluation is part of the implementation process, and our team will be interviewing primary care staff next to gain their perspectives. Our findings provide insights into developing and implementing a promising home health program with lessons for VA sites that may also serve as a guide for other large healthcare organizations.
PHYSICAL AND MENTAL HEALTH NEEDS OF OLDER ADULTS EXPERIENCING HOMELESSNESS: CHALLENGES AND INNOVATIONS IN CARE
Authors: Souza Anita , Tsai Jenny 
Published: January 2025

Abstract
Adults over the age of 50 are the largest growing demographic of individuals experiencing homelessness. They enter a continuum of housing services with a myriad of chronic and acute health conditions that have often been unaddressed due to sporadic and episodic care utilization primarily within emergency services. The compounding health impacts of chronic homelessness accelerate aging within this demographic. Housing services offer an opportunity to address unmitigated health issues. Housing services are seeking research and programmatic interventions to meet this need. This symposium will explore the physical and mental health needs of older adults experiencing homelessness across the continuum of housing services from shelter entry to permanent supportive housing though a variety of research methodologies. The first presenter (Souza) will present results of a study applying latent class analysis to administrative shelter services data to identify unobservable subgroups within the population of older adults living in shelter. The second presenter (Berg) will discuss the implementation of shelter-based care services to older adults with complex medical needs in a low barrier, harm reduction focused hotel shelter. The third presenter (Robinson) will describe a qualitative investigation examining barriers to mental health care for older adults in permanent supportive housing. The discussant (Tsai) will lead symposium attendees in a discussion of future considerations for research, policy, and practice to meet the needs of this growing demographic of older adults.
PAIN AND MEMORY LANE: SEX-SPECIFIC INSIGHTS INTO STRESS REACTIVITY, PAIN, AND COGNITION IN MID- TO LATE LIFE
Authors: Curtis Ashley , Costa Amy , Stearns Melanie , McGovney Kevin , Miller Mary Beth , McCrae Christina 
Published: January 2025

Abstract
Pain and cognition are bidirectionally associated. Perceived stress reactivity is linked to pain and cognitive perception, but interactive relationships are unclear. Sex differences are established in all factors (pain/stress reactivity/cognition), but studies in aging and chronic pain populations are limited. This study examined sex differences in interactive associations of pain and stress reactivity on memory in middle-aged/older adults with chronic pain. Cognitively healthy aging adults (N=678; 52%-women; Mage=62.4±11.3) experiencing frequent pain in past 3 months completed assessments of pain intensity (average past week), stress reactivity (Perceived Stress Reactivity Scale), and memory (Everyday Memory Questionnaire). Multiple regressions evaluated interactions between sex, pain, and stress reactivity on memory, controlling for age, education, #medical conditions, sleep/pain medication, and depression. Sex interacted with pain in associations between stress reactivity and memory (R-squared=.005, p=.04). Greater stress reactivity was associated with worse memory for women with lowest pain (~22/100; B=.59±.24, p=.01), both women (B=.63±.18, p&lt;.001) and men (B=.76±.20, p&lt;.001) with intermediate pain (~48/100), and both women (B=.67±.23, p=.003) and men (B=1.30±.28, p&lt;.001) with highest pain (~73/100). Findings suggest relatively consistent associations between stress reactivity and memory across pain levels in aging women. In aging men, stress reactivity impacts memory at moderate pain levels, but this is exacerbated (two-fold) as pain increases. Sex-specific tailoring of behavioral pain treatments is encouraged. Techniques to reduce stress reactivity (cognitive control, mindfulness) may benefit memory. Prospective studies and objective assessments of stress reactivity, pain, cognition, and circulating sex hormones are needed to understand sex-specific modifiable risk factors of cognitive decline.
THE IMPACT OF CHILDHOOD READING ENVIRONMENTS ON COGNITIVE HEALTH IN LATER LIFE AMONG OLDER EUROPEANS
Authors: Sun Haosen , Xi Yueming 
Published: January 2025

Abstract
While educational achievement helps to accumulate cognitive reserve and promote cognitive function in later life, the influence of the early living environment before completing formal education remains unclear. This study aims to investigate how childhood reading environments, alongside educational achievements, jointly contribute to cognitive health in older adulthood. Analyzing life history data from 123,199 older Europeans aged 50 and above, sourced from the Survey of Health, Ageing and Retirement in Europe, this research examines the interplay between childhood reading environments and educational achievement and their joint effect on cognitive health at older ages. Having more books in the household at age 10 is positively associated with higher cognitive functioning in later life, independent of educational achievements and other childhood socioeconomic status (SES) factors like household size and number of rooms. Additionally, access to books in childhood partially alleviates the cognitive disparities associated with educational achievement. These findings indicate that a rich reading environment at home in childhood offers enduring benefits for cognitive health, which is particularly valuable for individuals who ended up with lower educational achievements. This underscores the potential of interventions focused on enhancing early reading environments to promote long-term cognitive resilience.
CONFLICT MONITORING AND INHIBITORY CONTROL IN OLDER ADULTS WITH AGE-RELATED HEARING LOSS
Authors: Shende Shraddha , Mudar Raksha 
Published: January 2025

Abstract
Various processes of cognitive control, including conflict monitoring and inhibitory control, are critical for listening in complex environments (e.g., speech-in-noise [SiN] recognition). However, few have examined both conflict monitoring and inhibitory control in individuals with age-related hearing loss (ARHL) despite their known challenges in SiN recognition. In 16 individuals with mild ARHL and 23 normal-hearing controls, we examined conflict monitoring using two picture-word interference tasks, “Animals” and “Objects” tasks; inhibitory control in two Go/NoGo tasks, “Single-Car” and “Object-Animal” task; and SiN using QuickSiN test. The picture-word interference tasks consisted of pictures of animals/objects that were superimposed with labels that either matched (matched condition) or did not match the pictures (unmatched condition). Participants responded by pushing the “matched” or “unmatched” button. Reaction time and accuracy were recorded. The Go/NoGo tasks consisted of pictures of cars/dogs in the Single-Car task and objects/animals in the Object-Animal task. Participants responded by pushing a button to some trials, the Go trials (cars/objects), and withholding button push to others, NoGo trials (dog/animals). Reaction time for Go trials and accuracy for Go/NoGo trials were recorded. Relative to controls, ARHL group had worse accuracy on unmatched condition of “Objects” task (p =.006) and Go trials of “Object-Animal” task (p =.018). Partial correlations revealed that worse SiN recognition was associated with worse accuracy on Go trials of the “Object-Animal” task, and no other correlations were significant. Our findings reveal alterations in both conflict monitoring and inhibitory control in mild ARHL, with inhibitory control linked to SiN recognition.
RECRUITMENT OF OLDER ADULTS FOR CLINICAL RESEARCH: STRATEGIES, COSTS, AND REPRESENTATION
Authors: Nicklas Barbara , Coen Paul , Magaziner Jay 
Published: January 2025

Abstract
Clinical research is crucial for identifying new preventative strategies and treatments to address the diverse health care needs of older adults. A necessary component of conducting ethical and unbiased research is to successfully enroll enough study participants who represent the population being studied in a cost-effective and timely manner. Despite the NIH policy mandating that investigators include participants of all ages or specify an acceptable reason for excluding participants based on age, many studies still lack appropriate representation of older adults. Furthermore, an important objective of the NIA’s Strategic Directions for Research for 2020-2025 is to “Develop and implement strategies to increase inclusion of underrepresented populations in aging research”. To implement appropriate strategies for enhancing participation of historically excluded subpopulations, additional data are needed regarding the degree of underrepresentation of these individuals in the research being conducted and reasons for lack of inclusion. This symposium includes three presentations regarding recruitment of older adults for clinical research. These include a compiled analyses of studies conducted over the past 20 years at the Wake Forest OAIC, and data on recruiting older adults for the national Molecular Transducers of Physical Activity Consortium and the two-site observational Study of Muscle, Mobility and Aging. The data presented in the first two talks provide objective observations of the most effective strategies, and the costs, for recruiting older adults. The third presentation compares basic demographics of those enrolled to those who show interest and are screened for participation, and compared to the characteristics of the local population.