bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXPLORING THE IMPACT OF NURSE WAGES ON NURSING HOME QUALITY
Authors: Pradhan Rohit , Ghiasi Akbar , Orewa Gregory , Davlyatov Ganisher , Weech-Maldonado Robert 
Published: January 2025

Abstract
Nurses are the primary caregivers in nursing homes (NHs) and providing high-quality care hinges significantly upon their adequacy and expertise. However, NHs have historically struggled with inadequate nurse staffing, partly due to nurse wages in NHs being lower than those in other healthcare settings, such as hospitals. This study aimed to explore the relationship between nurse wages and the quality of care in NHs. This study used secondary datasets such as the Payroll-Based Journals and Care Compare (2017-2022). Multivariate ordinal logistic regression with two-way (state and year-level) fixed effects was employed. The study included all U.S. NHs certified by the Centers for Medicare and Medicaid Services (CMS). Analytic data comprised 80,244 facilities, averaging 13,374 unique NHs per year. We focused on the CMS NH Five-Star Quality Rating System’s quality star rating (1-5 scale) as the dependent variable, with independent variables being the inflation-adjusted hourly wages for registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs), while controlling for facility and community characteristics that influence quality. The findings revealed that a one-dollar increase in hourly RN wages was linked to a three percentage-point increase in the odds of an NH receiving a higher star rating (p&lt;.01). Increased RN and CNA hours per resident day (PRD) were positively associated with higher quality ratings, whereas higher LPN hours PRD were correlated with lower quality ratings (p&lt;.001). These results highlight the need for targeted policy and managerial interventions to adjust nurse compensation strategies, particularly for RNs, to enhance NH quality.
NURSE WAGES AND NURSING HOME FINANCIAL PERFORMANCE
Authors: Lord Justin , Ghiasi Akbar , Gupta Shivani , Pradhan Rohit 
Published: January 2025

Abstract
Nursing home (NH) care is labor intensive, with staff compensation being the most significant expense. Balancing higher wages to attract qualified nurses against the allocation of resources to other facility areas is crucial. This study examined the impact of nurse wages on NH financial performance. This study used secondary datasets such as the Payroll Based Journals, Medicare cost reports. and Care Compare (2017-2022). It included all U.S. NHs certified by the Centers for Medicare and Medicaid Services (CMS). Analytic data comprised 80,244 facilities, averaging 13,374 unique NHs per year. We modeled the data using multivariate linear regression with two-way fixed effects (year and state). The operating margin at the facility level served as the dependent variable, with inflation-adjusted nurse wages as the main variable of interest. Separate models for registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) showed that a 10% wage increase correlated with operating margin decreases of 7.3%, 9.6%, and 11.5%, respectively (p&lt;.01). Positive operating margins were associated with for-profit status, chain affiliation, larger facilities, higher occupancy, and a greater proportion of Medicare residents, while higher uninsured rates and Medicare Advantage penetration negatively impacted margins. These findings underscore the necessity for striking a strategic balance between nurse compensation and NH financial health. Given the important role nurses play in NHs, and amidst an acute staffing shortage, our study emphasizes the need for policy measures that support both competitive nurse wages and the sustainability of NH operations, ensuring high-quality care and long-term viability.
USING THE ACT-OUT QUESTIONNAIRE TO INFORM ON COMMUNITY MOBILITY AND PARTICIPATION FOR PEOPLE LIVING WITH DEMENTIA
Authors: Margot-Cattin Isabel , Gaber Sophie 
Published: January 2025

Abstract
For people living with dementia to continue living in their current residences or “age in place”, it is essential for them to sustain their participation in daily activities and maintain mobility within their communities. Community mobility encompasses the ability to reach places where they can participate in meaningful everyday life activities. It also includes transportation modes such as walking, biking, driving, or using public transport. Thus, we developed the Participation in ACTivities and Places OUTside Home (ACT-OUT) questionnaire based on a transactional perspective and understanding of the person-environment relationship as unfolding and dynamic, embedded and situated, and enacted and emplaced. The ACT-OUT, used in a sit-down interview setting, which can be followed by mobile (walking) interviews, to enable the collection of rich data about around 25 important places that people currently visit, have abandoned, or wish to visit. A second part of the questionnaire collects information on traveling to the place (e.g., frequency, transportation, familiarity) and on activities performed there. The ACT-OUT has been used in multiple countries, including Switzerland, Sweden, the UK, and Canada, and among different populations, notably people with and without dementia. Results show that people with dementia experience a higher rate of abandonment of places and for many more places than people without dementia. It highlights the importance of addressing community mobility and how we conceptualize, design, and adapt important places to support people living with dementia to participate in places and activities that can maintain their well-being and health as they age in their communities.
RESPONSE TO THE DECADE OF HEALTHY AGING: AN EXEMPLAR ICOPE-BASED CARE MODEL
Authors: Yu Doris Sau Fung , Tang Yiting 
Published: January 2025

Abstract
The United Nations Decade of Healthy Aging 2021-2030 calls for proactive and collaborative strategies to enable older adults to “live well” with optimized functional capacity, considering both intrinsic capacity (IC) and the environment. The Integrated Care of Older People (ICOPE) framework has been established as a comprehensive approach to guide IC assessment and care prescription for promoting healthy aging. In line with this global initiative, Hong Kong, a city with accelerated aging, has implemented the “Jockey Club Pathway to Healthy Aging” (Path-HA) program. This 12-week program incorporates the concepts of clinical critical care pathway, goal-oriented empowerment-based behavioral modification, asset-based capacity building, and health-oriented peer support. The program aims to optimize the functional status of local older adults across Hong Kong districts. The signs of accelerated aging and risk factors related to ICOPE health concerns are identified through the assessments. To date, more than 5,500 older adults are involved in this study and more than 1,800 have been recruited into the program and have received person-centered care and interventions for reducing the risks corresponding to critical pathways to healthy aging. This symposium is aligned with the ICOPE framework to address healthy aging in Hong Kong: (a) IC profiles of older adults, (b) promoting IC with a synergistic way to enhance care prescription, (c) critical pathways of the Path-HA program, and (d) the effects of critical care pathways on IC conditions. With these efforts endeavored, we will share the outcomes, insights and foresight regarding the regional contribution to optimizing functional capacity.
PROMOTING INTRINSIC CAPACITY OF OLDER ADULTS: A SYNERGISTIC APPROACH TO ENHANCE CARE PRESCRIPTION
Authors: Zhou Yu , Chen Shuangzhou , Tang Yiting , Chen Feng , Yu Doris Sau Fung 
Published: January 2025

Abstract
The United Nations has declared the Decade of Healthy Aging 2021-2030 to prioritize proactive and collaborative strategies for older adults to live well. The World Health Organization’s Integrated Care of Older People (ICOPE) framework aims to guide the assessment of intrinsic capacity (IC) and the environment to promote healthy aging. Based on a research initiative that employs the WHO-ICOPE approach to promote healthy aging, a territory-wide ICOPE-based comprehensive health assessment was conducted in Hong Kong. Those with signs of accelerated aging were referred to a 12-week Jockey Club Pathway to Healthy Aging Program. The program adopts a health-social collaborative approach, clinical critical pathway, empowerment-based behavioral modification, and health-orientated peer support to provide person-centered care to optimize the functional status of older adults. From April 2022 to May 2023, a sample of 3,073 community-dwelling older adults [mean age (SD) = 74.7(7.5)] were recruited from eight geographic districts in Hong Kong and assessed with validated instruments. Latent class analysis identified five IC functional profiles of older adults according to the ICOPE framework. These five patterns include (1) compromised psycho-cognitive functional class, (2) compromised musculo-mobility functional class, (3) compromised metabolic-mobility functional class, (4) compromised nutritional-metabolic equilibrium but preserved functional class, and (5) preserved functional class. After controlling for the demographic profile, chronic disease burden and polypharmacy, the identified IC classification significantly predicted the health-related quality of life and frailty status of the older adults. The study provide new insights on the development of an integrative assessment and care planning for healthy aging promotion.
COUPLES’ VIEWS OF THEIR JOINT AGING: DEVELOPMENT OF A NEW SCALE
Authors: Bodner Ehud , Segel-Karpas Dikla , Estlein Roi 
Published: January 2025

Abstract
The construct of subjective views of aging (VoA) constitutes a growing field of research, relating to individuals’ general cognitions about the aging process, and their individual experience of aging. VoA develop throughout the life-course and have significant implications for individuals’ health and well-being in later age. Although VoA often develop within a relational context of the married couple, suggesting the construct has an inherent interpersonal component, no theoretical framework or empirical studies have explored VoA from a dyadic perspective to consider the couple as an aging unit. We developed and tested a new scale to assess the way individuals expect to age within their current intimate relationship. Based on experts’ evaluations, we identified five domains that are meaningful to couples’ joint aging: (1) changes in health, (2) changes in family roles, (3) the transition to retirement, (4) changes in appearance and sexuality, and (5) coping with death. We then developed an initial pool of 39 items and tested these on a sample of over 300 midlife adults. Using factor analysis, we extracted a scale of 9 items relating to the 5 domains. We tested for validity against constructs of VoA and couple’s relationships. The scale showed good internal reliability and validity.
THE LONGITUDINAL PROCESSES LINKING PSYCHOSOCIAL FACTORS AND STRESS-RELATED EXPERIENCES TO HEALTH
Authors: Luo Jing , Pfund Gabrielle , Mroczek Daniel 
Published: January 2025

Abstract
Psychosocial factors, including individual factors (e.g., personality, sense of purpose), contextual factors (e.g., employment status), and stress-related experiences, have been demonstrated as important protective/risk factors of health. However, little is known about the processes and mechanisms linking these factors to health and aging. The current symposium tackles the longitudinal associations between psychosocial factors and health with five presentations investigating the interindividual and intraindividual processes linking these factors to various health outcomes (physical, cognitive, physiological health and well-being) as people age. In the first study, from a life-course perspective, Brown and colleagues examined the effects of low SES and perceived stress in childhood on two physiological health indicators in midlife and the underlying mediators. Zooming into late adulthood, the second study by Choi and Mejía examined the joint effects of spousal combinations of employment status and socioeconomic resources on older couples’ individual and shared manifestations of cumulative health risk. The third study by Chopik examined the prospective effects of subjective well-being on stress reactivity decline and their dynamic reciprocal relations over time at the intraindividual level. The fourth study by Luo and colleagues examined the how the dynamic interplays between personality and people’s stress experiences and health behavior engagement contribute to individual differences in health change. In the fifth study, Pfund and colleagues investigated the dynamic intraindividual associations among sense of purpose, social stress-related perception (loneliness), and cognitive decline over time. Collectively, this set of studies improves our understanding of how psychosocial factors shape people’s health and healthy aging.
THE RECIPROCAL RELATIONSHIPS AMONG SENSE OF PURPOSE, LONELINESS, AND COGNITIVE DECLINE
Authors: Pfund Gabrielle , Ong Anthony , Mroczek Daniel , James Bryan , Jackson Kathryn , Graham Eileen 
Published: January 2025

Abstract
Dementia is the leading cause of disability in older adults worldwide. As of yet, there are no easily accessible cures. Thus, a wide range of research has focused on modifiable intra- and interpersonal factors that may contribute to lower risk for dementia and generally slow down cognitive decline. A promising protective intrapersonal factor from the well-being literature is sense of purpose, as higher levels of sense of purpose are tied to a swath of healthy cognitive aging outcomes. Meanwhile, greater experiences of loneliness are typically a risk factor for poorer cognitive aging. The current study calls upon data from the ongoing Memory and Aging Project from the Rush Alzheimer’s Disease Center (N = 1,736; waves: up to 18; age: M = 81.07, SD = 8.04, 65-101). Every year, participants complete an extensive cognitive battery and report on their sense of purpose and loneliness. Given the likely reciprocal relationship between these three constructs, the current project uses random intercept cross-lagged panel models to better establish the between- versus within-person and concurrent versus longitudinal processes behind these relationships. Findings highlight the bidirectional relationship of these variables across time metrics and levels. For example, lower levels than one’s average of sense of purpose predicts decreases in cognitive functioning a year later, and decreases in cognitive functioning also precede decreases in sense of purpose. Future research would benefit from exploring combined efforts to bolster sense of purpose and reduce loneliness, while continuing to mind the potential influence of cognitive decline on these constructs.
PSYCHOSOCIAL DISADVANTAGE DURING CHILDHOOD AND MIDLIFE HEALTH
Authors: Brown Ryan 
Published: January 2025

Abstract
Psychosocial disadvantage in childhood contributes to health disparities in aging-related health outcomes through biological and behavioral pathways. We leveraged the 30-year longitudinal NHLBI Growth and Health Study to examine associations between (a) low childhood SES (age 10) and (b) perceived stress in childhood (age 11) with midlife insulin resistance and epigenetic aging (age 40) in a sample of 433 Black and white women. We also explored whether late adolescent (age 19) waist circumference would mediate the relationships between SES and perceived stress and aging-related outcomes. Epigenetic aging was assessed in saliva and quantified through the GrimAge2 and DunedinPACE clocks. Insulin resistance was represented by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). For each aim, multivariable linear regression models were estimated. Covariates included age, race, diabetes status, smoking status for all outcomes, and analysis cluster and estimated cell type composition variables for epigenetic clocks only. Higher parental education was associated with lower insulin resistance (b=-0.22, SE=0.10, p=.03), lower midlife GrimAge (b=-1.76 years, SE=0.56, p=.002), and slower midlife DunedinPACE (b=-0.03, SE=0.2, p=.04). Childhood perceived stress was significantly indirectly associated with midlife insulin resistance, b=0.01, 95% CI [0.001,0.01], p=.02, and midlife GrimAge, b=0.016 years, 95% CI [0.003,0.04], p=.01, through late adolescent adiposity. This highlights preliminary evidence for this life-course perspective on psychosocial stress, adiposity, and aging-related health. Future work may examine these individual factors in the context of broader structural systems (e.g., schools) and other facets of SES to better understand area-level effects (e.g., familial, neighborhood, region) for tailoring social interventions.
THE NEW MAP OF LIFE: TRANSFORMING THE COURSE OF LONG LIVES THROUGH IMPACT-DRIVEN RESEARCH
Authors: Shavit Yochai , Carstensen Laura 
Published: January 2025

Abstract
The global rise in life expectancy and the emergence of societies that are more age-diverse than ever before in human history call for a re-design of the life course.The Stanford Center on Longevity released the New Map of Life- a report detailing principles to guide research, policies, and interventions aimed at improving long lives and age-diverse societies, taking advantage of the opportunities these demographic changes entail. These have already influenced recommendations by key organizations, including the National Academy of Medicine and the World Economic Forum. This symposium offers the first look into research findings guided by the New Map of Life and their translation into actionable recommendations. First, Weiss presents an innovative approach to model long life trajectories based on Artificial Intelligence that outperforms current life expectancy and morbidity calculators. On the population level, Ashwin presents macroeconomic challenges and advantages of longevity, highlighting differences between aging societies and long-living societies. Growney describes a pilot program leveraging older adults’ strengths in early childhood education classrooms. Rangan presents findings from a study of graduating medical students highlighting the need to revamp medical education to address a severe lack of training in older adult medical care. Finally, Chu presents focus-group findings exploring older adults’ technological needs and challenges in daily life, which can alter aging experiences. All presenters detail specific ways in which their findings can inform stakeholders’ actions. Prof. Carstensen will conclude by discussing the broad picture emerging from these studies and their importance for further development of the framework.
GRADUATING MEDICAL STUDENTS’ PERFORMANCE ON A GERIATRICS KNOWLEDGE TEST IS ASSOCIATED WITH ATTITUDES
Authors: Rangan Apoorva , Shavit Yochai , Kado Deborah 
Published: January 2025

Abstract
Older adults are overrepresented among patients, with half of outpatient visits and 40% of hospitalizations for adults over 65. Training physicians in age-friendly care is imperative. Yet, medical school graduates’ knowledge of core geriatrics competencies is unknown, as are factors associated with students’ knowledge base. 30 of the 82 graduating students at the Stanford School of Medicine completed a three-part survey. Geriatrics knowledge was assessed using a validated 18-item UCLA Geriatrics Knowledge Test (GKT) and ten questions from the Geriatrics Review Syllabus (GRS). Attitudes towards older patients were assessed using the validated 14-item UCLA Geriatrics Attitudes Assessment. Finally, students reported their curricular exposure to geriatrics and career interests. The Stanford Institutional Review Board waived institutional review. Two researchers independently analyzed results in R. Geriatrics exposure was limited; 1 student took a preclinical elective and 2 took clinical electives. Most students incorrectly completed at least half of the knowledge assessment. All students missed at least 7/28 questions overall (M = 8.0, SD = 6.7), with students performing better on the GKT (M = 8.4, SD = 5.1) than the GRS portion (M = -0.4, SD = 3.0). Most students had neutral or slightly positive attitudes towards older adults (M = 3.58, SD = 0.87). Attitude scores were moderately associated with improved performance on the knowledge assessment (r = 0.55, p &lt; 0.0001). In conclusion, graduating students did not meet minimum geriatrics competencies measured by a knowledge assessment. Attitudes towards older adults were associated with performance, supporting future intersectional interventions in ageism.
PERSPECTIVES ON MEASURING QUALITY DEMENTIA CARE: FINDINGS FROM A STUDY IN LOW-RESOURCE LONG-TERM CARE
Authors: Kusmaul Nancy , Rataj Alison , Lepore Michael , Corazzini Kirsten , Kim Yoon Chung , Wang Jing , Holmes Sarah , Davie Laura 
Published: January 2025

Abstract
The quality of long-term care for persons living with dementia includes elements of both quality of life and quality of care. However, which elements are most important for measuring quality is less clear and may vary based on different stakeholder perspectives. According to the National Academies of Science, Engineering, and Medicine (NASEM), quality measurement is important because it supports work towards improving quality of care, specifically making care more safe, timely, equitable, efficient, effective, and patient-centered (2022). This presentation will discuss perspectives on quality measurement among residents living with dementia, their families, staff, and administrators in low-resource long-term care settings in two states. Using a priori team coding of interviews with 59 participants, three themes emerged: (1) Quality care includes getting to know residents and communicating with them, (2) Measures of relational aspects of quality are difficult to implement, and (3) Good quality care results in better outcomes on existing clinical quality measures. During study interviews, participants readily discussed elements of quality in individual provision of care but had difficulty describing quality measurement at an organizational or systematic scale, supporting previous findings that direct observation may be an accurate indicator of quality of care, but is challenging to implement at scale. Additionally, participants conceptualized care provision from their unique perspective (i.e. staff, resident, family) suggesting that each may have different factors that constitute quality care. This study underscores the importance of quality measurement and the challenges of operationalizing quality, particularly for persons living with dementia.