bluuebunny/crossref_metadata_2025_split huggingface dataset:
FEASIBILITY OF USING AN E-INTERVENTION PLATFORM FOR LONGITUDINAL RESEARCH ON DEMENTIA CARE DYADS
Authors: Paul Constanca , Teles Soraia 
Published: January 2025

Abstract
Remote Measurement Technologies (RMT) are increasingly used in research, offering cost-effective and unobtrusive data collection. This study examines the feasibility of using the e-intervention “iSupport-Portugal,” adapted from WHO’s “iSupport” for longitudinal research on dementia care dyads. A prospective cohort study was designed to predict the institutionalization of persons with dementia (PwD) at 9 months using baseline data from informal caregivers (IC) registering on isupport-portugal.pt. Participation rates, loss to follow-up, and event rates were analyzed. Completers and non-completers of baseline and follow-up assessments were compared on sociodemographic and psychosocial variables. In 16 months, 253 IC registered on isupport-portugal.pt, with 82% agreeing to research. Most are women (82.6%), middle-aged (M=51.6), and children of the PwD (70.0%). The baseline protocol was completed by 52.9% of IC. Baseline participation rate was higher among spouses/children of PwD compared to other IC (46.5% vs. 27.5%; χ²(1, N=253)=4.194, p=.041). Compared to caregivers lost to follow-up, completers (65.3%) were significantly older (M 54.5 vs. M 46.7, t(174) =−4.220, p&lt; 0.001), more often male (89.7% vs. 60.3%; χ²(1, N=175)=7.950, p=.005), children/spouses of PwD (69.9% vs. 34.8% others, χ²(1, N=176)=9.413, p=.002), cohabitating with PwD (82.4% vs. 60.0%, χ²(1, N=118)=6.197, p=.013), and had cared longer (Mdn 43 vs. Mdn 18; U=847, p=.008). The institutionalization rate was 7.8% at 9 months. iSupport-Portugal is a pioneering e-program exploited as an RMT that enabled cost-effective data collection from IC across national territories. High loss to follow-up calls for innovative retention strategies, especially for younger IC, which may intersect with platform user experience. Funding:FCT (2022.07587.PTDC)
FINE TUNING OF A PRETRAINED GAIT MODEL FOR FRAILTY CLASSIFICATION PREDICTION
Authors: McDaniel Laura , Essien Ime , Guo Yuxiang , Gupta Ayush , Shenoy Vineet , Abadir Peter , Chellappa Rama 
Published: January 2025

Abstract
This study presents a multimodal gait model designed to identify the frailty status of individuals based on their gait observed in video footage. Frailty is defined as a clinically recognizable state of increased vulnerability resulting from age-related declines in reserve and function across multiple interrelated physiological systems. These risks manifest as an increased likelihood of falls, hospitalization, need for long-term care, disability, and mortality. Although deep learning has advanced in medical applications, its potential in early frailty detection through gait analysis is limited by the need for extensive data, which is currently limited. To address this issue, we leveraged the OpenGait framework, GaitBase, a pretrained gait model typically used for gait surveillance and recognition applications, by fine-tuning it with medical data for frailty classification. Data were collected using the marker-less Qualisys Motion Capture system, resulting in a dataset of 64 individuals classified by frailty status—non-frail, frail, and pre-frail—according to the Fried Frailty Phenotype. Detectron2 models were used for panoptic image segmentation and detection, generating silhouette and box predictions from video frames. By integrating both silhouette and RGB data, our model enhances robustness and generalization across the three frailty classes. To address the challenges of a small dataset, we employed data augmentation, hyperparameter tuning, and cross-validation to improve classification accuracy. This model aims to advance frailty classification using deep learning, offering a time-efficient method for clinicians to assess frailty. Future steps include incorporating metadata such as height and weight to further enhance prediction accuracy.
FRAILTY TRAJECTORIES IN BRAZILIAN COMMUNITY-DWELLING OLDER ADULTS: A 9-YEAR FOLLOW-UP STUDY
Authors: Melo Ruth , Assumpção Daniela , Cachioni Meire , Falcão Deusivania , Batistoni Samila Sathler Tavares , Borim Flávia Silva Arbex , Neri Anita Liberalesso , Yassuda Mônica Sanches 
Published: January 2025

Abstract
This prospective observational study analyzed the factors influencing frailty trajectories among Brazilian community-dwelling older adults over a nine-year follow-up period. Sociodemographic data, self-assessed health, multimorbidities, social support, advanced daily living activities (AADL), cognition, and frailty phenotype were selected for analysis from the Fibra (Frailty in Brazilian Elderly) study database. Incidence was calculated based on new cases (pre-frailty/frailty) at follow-up versus phenotype (robust/pre-frailty) at baseline. Pearson’s chi-square test was used for intergroup comparison (i.e., progression status). The relative risk (RR) for frailty progression and reversal was calculated using logistic regression, both in crude (c) and adjusted (a) forms. After nine years, the proportion of older adults classified as frail increased (11.9% to 18.1%), while the proportion of those classified as robust decreased (30.1% to 13.8%). The incidence of frailty and pre-frailty was 22.9% and 49.4%, respectively. Advanced age (RRa:3.41; p=0.001), cognitive impairment (RRa:2.06, p=0.002), illiteracy (RRa:1.70; p=0.012), male sex (RRa:1.68; p=0.044) and non-performance/abandonment of AADL (RRa:1.48; p=0.007) were predictors of worsening/death in follow-up. Only living alone was protective against frailty. After nine years, there was an increase in older adults living with frailty and a reduction in the ones considered robust, with an incidence of frailty of 22.9%. Different factors predicted worsening/death after nine years. Future longitudinal studies should improve the understanding of risk factors for frailty progression.
GENDER DIFFERENCES IN DEPRESSIVE SYMPTOMS’ IMPACT ON CHRONIC DISEASES, FUNCTIONAL LIMITATIONS, AND MORTALITY
Authors: Ahn Seoyeon , Visaria Abhijit , Malhotra Rahul , Chan Angelique 
Published: January 2025

Abstract
Despite extensive research on chronic diseases, functional limitations, and depressive symptoms at older ages, the patterns of change and interconnectedness among them remain unclear. We examined the trajectories of chronic diseases (cardiometabolic conditions and chronic pain) and functional limitations in individuals aged 60-69 years at baseline and explored how depressive symptoms influenced the onset of chronic diseases, functional limitations, and mortality using data from three waves of the Panel on Health and Aging of Singaporean Elderly (2009-2015; n=386 men and 471 women). We used multichannel sequence analysis to investigate gender-specific health trajectories and random-effects logistic regression to examine depressive symptoms’ role in the onset of chronic diseases, functional limitations, and mortality. Inverse probability of attrition weights were used to account for selection bias due to loss to follow-up. Our findings reveal distinct gender-specific health trajectories. Men had higher mortality rates but experienced slower progression in chronic pain and physical functional decline, despite an earlier onset and higher prevalence of cardiometabolic diseases. Women lived longer but experienced earlier onset and faster progression of chronic pain and functional decline. Depressive symptoms were linked with faster onset of cardiometabolic diseases and functional limitations in both genders, and with mortality only in men. Individuals, families, providers, and policymakers should be mindful of the gender differences in the onset and progression of health deterioration and mortality in old age. Our findings also highlight the need for gender-specific research on the complex interactions between chronic diseases, functional limitations, mortality, and depressive symptoms.
GENETIC AND SEROLOGICAL BIOMARKERS AS PREDICTORS OF PARKINSON’S DISEASE COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW
Authors: Mohammed Hajir , Yousif Mohamed Atif Mohamed , Elhassan Mohamed , Elhussein Yassein , Badawi Dina , Gabralla Sarra , Abdelrahman Nadir 
Published: January 2025

Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disorder in the elderly population. Cognitive impairment (CI) is one of the most common and important non-motor symptoms in Parkinson’s disease and the identification of predictive biomarkers for it would help in its management. Databases were searched systematically down to Jan 2019. Selection criteria focused on studies with serological and genetic biomarkers. Other radiographically or clinically related papers were excluded. Total of 9 studies with 11 different biomarkers were assessed and found to be significantly associated with cognitive decline in PD. These include APOE4 allele mentioned in 2 studies (RR= 2.98), (RR= 7.4). miR-203a-3p/miR-16-5p ratio (AUC= 0.7593), Serum high mobility group box-1 levels (RR= 1.398), ganglion cell inner plexiform layer complex in the macula thickness (RR= 0.553), B12 (RR= 0.793), CSF NfL (HR= 2.82). MIA, CRP and albumin group (HR= 4.3), Neuroexosomal EAAT-2 (P= 0.003), and P16 (P= 0.003). Biomarkers can serve as potential predictive tools. Their integration into routine assessments could enhance the stratification of patients at risk for cognitive impairment, allowing for tailored therapeutic approaches and preventive strategies aimed at mitigating cognitive decline. However, they warrant further investigation to elucidate their roles in the pathophysiology of cognitive impairment in PD. Longitudinal studies are needed to validate these biomarkers and determine their utility in predicting cognitive decline over time. Additionally, exploring the interplay between these biomarkers and other neurobiological factors may uncover novel therapeutic targets.
GEOGRAPHIC DISTRIBUTION OF THE CERTIFIED NURSING ASSISTANT WORKFORCE IN U.S. COUNTIES
Authors: Johnson Mallory 
Published: January 2025

Abstract
Although geographic disparities in LTSS access are well documented, no studies exam the spatial variation in the workforce primarily responsible for delivering direct care. This study assesses the distribution of the certified nursing assistants (CNA) and the community characteristics associated with CNA employment. A cross-sectional design is used to explore the relationship between CNA employment and health care delivery and training infrastructure, local labor market structure, and population characteristics. Data from CMS’s Payroll Based Journal, the American Community Survey, and the National Conference of State Legislatures are fitted to a negative binomial hurdle model. 2,871 counties employ 1,616,798 CNAs (“count locations”). Only 271 counties employ no CNAs (“zero locations”). Zero locations are more likely to be rural and have lower population, less hospitals, and fewer CNA training programs even though their aging population is higher. Regression results demonstrate that the number of hospitals, nursing home beds, and total population are positively associated with CNA employment in both count and zeros locations. Medicaid expansion, the foreign-born population, and the proportion of the workforce employed in hospitality or public sector jobs, and land area are negatively associated with CNA employment in both count and zero locations. Differential effects are seen for the number of CNA training programs, population with a disability, and insurance status. CNA employment is highly variable. These findings confirm the “inverse care law” by demonstrating that CNA employment is not associated primarily with population need but with other health care, labor market, and population factors.
GROUND REACTION FORCE IN SIT-TO-STAND MOVEMENT PREDICT SARCOPENIA
Authors: Ota Kazuki , Yoon Jieun , Shibuya Kyohei , Miyashita Mariko , Miyama Tomoko , Okura Tomohiro 
Published: January 2025

Abstract
New method for evaluating lower-limb muscle strength has been attempted using ground reaction force during sit-to-stand movement. The specific variables used are the vertical peak force, the rate of force development (RFD), and the stable time. These variables have also been shown to be associated with physical function and experience of falling. However, their relationship to sarcopenia, the loss of skeletal muscle mass and muscle strength, and predictors of sarcopenia have not been investigated. In this study, we aimed to investigate the relationship between ground reaction force during sit-to-stand movement and sarcopenia diagnostic factors, as well as identify predictors of sarcopenia. The subjects were 1462 people aged 46-89 years (71.0±8.9 years). The sarcopenia was determined by grip strength, waking speed, and skeletal muscle mass (SMI) index. Force variables were calculated using the Zaritz (BM-220, Tanita Corporation). The statistical methods used was the Pearson correlation coefficient test, with P &lt; 0.05. In addition, ROC curve analysis was performed, the area under the curve (AUC) and accuracy were calculated. The results showed that there were 1411 people without sarcopenia and 51 people with sarcopenia. Significant positive correlations were found between grip strength, walking speed, and SMI index and vertical peak force (r = 0.446, 0.306, 0.338), RFD (r = 0.264, 0.389, 0.159). Furthermore, the RFD had high discriminatory accuracy (AUC: 0.841, accuracy: 83.3 %). These results suggest that ground reaction force in sit-to-stand movement is a useful predictor of sarcopenia.
HOW CHILDHOOD NEGLECT AFFECTS LATER LIFE LONELINESS
Authors: Tavares Karina , Barbera Gina , Tsotsoros Cindy 
Published: January 2025

Abstract
Individuals who experience neglect within the first eighteen years of life are at increased risk for loneliness later in life. This study explores whether the type of neglect experienced (emotional, physical, or both), and the age at which it occurs, affects later-life loneliness. This was accomplished by using a subsample of 169 women aged 18−86 who reported experiencing at least one form of neglect. Demographic indicators, the 17-item ACEs questionnaire (Felitti et al., 1998), and the UCLA Loneliness Scale (Russell, 1996) were examined. Neglect was categorized into three groups: emotional neglect, physical neglect, and both emotional and physical neglect. Age of first experienced neglect was categorized into three groups: ages 0−5, 6−11, and 12−18 years. When comparing the three categories of neglect, an ANOVA revealed that those who experience both emotional and physical neglect experience the highest levels of later-life loneliness. A multiple linear regression model showed that age alone predicted 2.3% of the variance in loneliness. When including both age and neglect, the model accounted for 9.8% of the variance, and adding their interaction improved the prediction to 12.3%. This study underscores that experiencing both emotional and physical neglect, particularly during early childhood, significantly increases the risk of loneliness in later life.
IMMEDIATE AND SUSTAINABLE EFFECTS OF TDCS ON PAIN IN OLDER ADULTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Lee Chiyoung , Park Juyoung , Fain Mindy , Galvin James , Ahn Hyochol 
Published: January 2025

Abstract
Chronic pain management is a complex clinical process requiring thorough assessment. Especially for older adults with Alzheimer’s disease and related dementias (ADRD), behavioral pain indicators are crucial in complementing self-reports. We simultaneously assessed the impact of transcranial direct current stimulation (tDCS) on mitigating both self-reported pain and pain behaviors to more objectively and comprehensively explore its effects in older adults with ADRD. The analysis investigated 40 participants randomly (1:1) subjected to active and sham tDCS for 20 min on 5 consecutive days. The numeric rating scale (NRS) and Mobilization–Observation–Behavior–Intensity–Dementia (MOBID-2) scale were used to assess self-reported pain and pain behaviors, respectively. Multi-group latent transition analysis enabled the simultaneous evaluation of both pain domains in a single model and analysis of their changes as a function of intervention exposure by modeling the transition probabilities of latent classes and comparing these changes between groups. Two latent pain categories (“high pain” and “low pain”) were identified based on NRS and MOBID-2 scores. Active group participants with “high pain” exhibited a 47.1% probability of transitioning to “low pain” immediately after intervention completion compared with no transition in the sham group. From immediate to 1-month follow-up, both groups exhibited positive transitions (44.3% vs. 39.2%). Active group participants with “high pain” at 1-month follow-up had a 58.4% likelihood of transitioning to “low pain” by 3 months post-intervention, whereas sham group participants exhibited no change. Our findings support the immediate and enduring effects of tDCS on pain reduction in older adults with ADRD.
IMPACT OF 4MS ON OUTCOMES FOR HOSPITALIZED OLDER ADULTS IN AN AGE-FRIENDLY SYSTEM
Authors: Lam Justin , Kwiatek Susan , Carney Maria , Solomon Philip , Tursi Mark , Nouryan Christian , Burns Edith 
Published: January 2025

Abstract

Introduction
The Institute for Healthcare Improvement identifies four essential components (the 4Ms) of high-quality care for older adults within an Age-Friendly Health System (AFHS): What Matters, Medication, Mentation, and Mobility. This framework allows healthcare providers to address and act on key issues, such as goals-of-care discussions, the in-patient use of potentially harmful medications (e.g. benzodiazepines, opioids, hypnotics), delirium prevention, and mobility maintenance.

Methods
EMR data pulled manually and through aggregated dashboards. Population/Setting: patients ≥65 admitted June-July 2024 to eight hospitals (5 community, 2 tertiary, 1 quaternary) within a large integrated health system, all committed to care excellence. Patients grouped into categories based on the number of assessed M’s. Positive screens were reviewed for “act-ons.” Patient outcomes: LOS, disposition, 30-day readmissions and ED visits.

Results
Of 2,337 adults aged ≥65, 0.3% had no assessments, 10.6% had one assessment, 39.6% two assessments, 40.3% three assessments, and 9.2% had all four assessments. Of the 118 patients who had all 4Ms assessed, chart review showed 42% had an ‘act-on’ for What Matters, 43% act-on for Medication, 22% act-on for Mentation, 83% act-on for Mobility. Mean LOS 11.8 days (range: 3-72); June 30-day readmissions: 10.2%. Conclusions: A minority of patients had all 4Ms assessed. Act-ons were documented most frequently for Mobility, less for other M’s. Data on outcomes for ≤3M assessments is being analyzed and compared to those with 4Ms. This data will contribute to the growing evidence base for all 4Ms in AFHS transformation.
IMPACT OF IMMIGRATION TIMING ON MEDICATION NON-ADHERENCE AND COGNITIVE FUNCTION IN OLDER ADULTS
Authors: Fang Yuan , Han Jayoung 
Published: January 2025

Abstract
The aging U.S. immigrant population exhibits higher rates of both diagnosed and undiagnosed Alzheimer’s Disease and related dementia compared to U.S.-born residents. Traditional diagnostic methods often fail to detect cognitive decline in immigrants due to cultural and linguistic barriers. Immigration is a multifaceted risk factor affecting cognitive health through acculturation, language proficiency, and healthcare access. This study examines the moderating role of immigration timing in the relationship between medication non-adherence and cognitive function. We analyzed data from the Health and Retirement Study (HRS), focusing on adults &gt;65 years who participated in interviews between 2012-2016 (n=10,869). Cognitive function was assessed using recently developed standardized latent cognitive scores. The relationship between medication non-adherence and cognitive scores was modeled using a moderated moderation model, examining interactions between age at immigration, education, and medication non-adherence, controlling other confounders. Non-immigrants were assigned a high placeholder value for age at immigration, and this variable was rank-normalized for analysis. A sensitivity analysis using the raw age at immigration variable was also conducted. Medication non-adherence, immigrant, and older age at immigration were associated with lower cognitive scores, while higher education was positively associated. Significant negative two-way interactions indicated that immigration status (β=-0.38±0.14, p=0.0006), timing (β=-0.13±0.03, p&lt; 0.0001), and education (β=-0.91±0.03, p=0.0003) moderated the impact of medication non-adherence on cognitive decline. In conclusion, our study showed that medication non-adherence is a significant predictor of cognitive decline, with later immigration worsening cognitive vulnerability, highlighting the moderating effect of immigration age on the relationship between medication non-adherence and cognitive decline.
JOURNEY TO GUIDE: ONE PRACTICE’S ROAD TO IMPLEMENTATION
Authors: Clevenger Carolyn , Medders Laura 
Published: January 2025

Abstract
In July 2023, Guiding and Improved Dementia Experience (GUIDE) was announced by the Center for Medicare and Medicaid Innovation Center. GUIDE was proposed to test the efficacy of an alternate payment methodology for participating dementia care models committed to providing an enhanced quality of care. The program is hoping to improve quality of life, reduce total cost of care, reduce inappropriate prescribing and healthcare utilization, and delay nursing home placement. GUIDE will pay for comprehensive clinical services as well as caregiver support services. Emory’s Integrated Memory Care has been providing comprehensive dementia care services in our unique model since 2015. However, the IMC has had to adapt our current practice to meet the new requirements of GUIDE. The IMC will discuss implementing the necessary requirements for the GUIDE program and how we adapted our current clinic model to meet the GUIDE requirements. The IMC has had to establish additional processes for intake—including a home visit, utilize different required assessments and measures, continue providing caregiver support, and respite care.