bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSOCIATION OF BPSD AND CARE PARTNER OUTCOMES MEDIATED BY CARE PARTNER DISTRESS
Authors: Berish Diane 
Published: January 2025

Abstract
Behavioral and psychological symptoms of dementia (BPSD) include a range of symptoms that commonly occur during hospitalization and post-discharge. BPSD can be difficult to anticipate and can create challenges for family care partners which may lead to adverse care partner outcomes. Repeated measures data from the Fam-FFC study provides opportunity to examine the time-dependent relationship among BPSD, associated care partner distress, and care partner outcomes. Mediation models were used with Neuropsychiatric Inventory Questionnaire (NPI) scores at discharge from an acute care hospitalization, NPI scores of associated care partner distress at 2-months post discharge, and care partners outcomes at 6-months, including burden, strain, desire to institutionalize and level of preparedness for caregiving. Patient and care partner characteristics were included as covariates. Results showed that NPI severity had direct effects on desire to institutionalize (estimate=0.0754, p=0.0119) with no significant indirect effects. Care partner burden, NPI severity had statistically significant direct effects (estimate=0.3023, p=0.0038), with 53.4% (p&lt;0.0001) mediational effect of associated care partner distress. Similarly, for care partner strain, NPI severity had statistically significant direct effects (estimate=0.21, p=0.003), with 48.8% (p&lt;0.0001) mediational effect of associated care partner distress. There were no significant effects for the outcome of care partner preparedness. The repeated measures design study allows for the examination of these relationships over time and helps to build evidence for a mechanistic model. These results show the importance of assessment of BPSD presentation, particularly post-acute hospitalization, and providing support for care partners to reduce negative outcomes.
EVALUATING NURSING HOME-BASED INTERVENTIONS ON COMPETENCY LEVELS
Authors: Recker Amy , McCreedy Ellen , Baier Rosa , Smith Kate , George Regina , Geisser Sophia , Aguilar Vanessa , Snow A Lynn 
Published: January 2025

Abstract
The intervention at the heart of the 40WINKS sleep trial relies on a principle that can be applied to many other nursing home-based interventions: Progress through the intervention requires a gradual and consistent accumulation of skills that build upon one another. Without completing a fundamental level of the intervention (e.g., begin to hold staff huddles regularly), a nursing home’s team could not incorporate advanced concepts (e.g., engage in collaborative problem solving during huddles). With this in mind, the 40WINKS research team decided to evaluate the participating nursing homes based on progressive levels of competency. We evaluated levels of competency for each of the seven core elements of the intervention (leadership team functioning; huddles; problem solving; small action plans; individualized care; continuous metacognition; sleep and daytime activity information; connecting day and night staff; and spillover, spread, and integration), scoring each core element as not met, foundational, proficient, or advanced. We developed a matrix with the seven core elements and examples of the corresponding competency levels, which research team members complete weekly. We aggregate the competency matrices on a monthly basis and meet to code each nursing home into one of the four competency levels overall. This presentation will delve more in depth into this process, provide a roadmap for applying this approach to other interventions, and share preliminary results.
THE ASSOCIATION BETWEEN NEIGHBORHOOD PERCEPTIONS AND RISK OF FALLS
Authors: Le Qun , Chen Lingming , Procter-Gray Elizabeth , Zhang Meng , LoPilato Danielle , Aguirre Annabella , Li Wenjun 
Published: January 2025

Abstract
Fall is a leading cause of injury-related death among old adults. This study is to explore the associations between neighborhood environment perceptions and the risk of falls among old adults. The data was drawn from the Healthy Aging and Neighborhood Study in Central Massachusetts (2018-2024). Data were collected from 379 participants who aged over 65 years and live in rural, suburban, and urban communities. Neighborhood perception was measured using a self-administered questionnaire. Factor analysis was used to derive perception scores in five aspects including neighborhood utilitarian (NU) (range:0-7), sense of community (SEC) (range:0-5), safety of community (SAC) (range:0-8), friendly neighborhood (FN) (range:0-3), and aesthetics of community (AC) (range:0-5). A higher score indicates a more positive perception. The occurrences of falls were recorded using monthly falls calendars. Negative binomial regressions were used to assess the associations of neighborhood perceptions and fall rates adjusting for sociodemographic factors and follow-up time. The participants had high neighborhood perceptions (mean±SD: NU: 2.46±1.69, SEC: 3.34±0.92, SAC: 7.42±0.94, FN: 1.03±0.85, and AC: 3.55±0.86). Lower rates of indoor falls were associated with a higher score in SEC (IRR: 0.8, 95%CI: 0.6-0.9) and SAC (IRR: 0.7, 95%CI: 0.6-0.8). A one-unit higher AC score was associated with 20% lower rates of outdoor falls (IRR: 0.8, 95%CI: 0.6-1.0). Higher scores in the SEC (IRR: 0.8, 95%CI: 0.7-0.9), SAC (IRR: 0.8, 95%CI: 0.7-0.9), and AC (IRR: 0.8, 95%CI: 0.7-1.0) were significantly associated with lower rates of falls in any place. These results suggest the need of considering neighborhood perceptions in fall intervention.
A STORM IS COMING: A CLIMATE RESILIENCE FRAMEWORK FOR SENIOR HOUSING
Authors: Patskanick Taylor , Turner Grace , Coughlin Joseph 
Published: January 2025

Abstract
Older adults’ vulnerability to extreme weather events may vary especially based on geographic location and housing or residential situation. Emergency preparedness is a potentially modifiable protective factor influencing this vulnerability. Emergency preparedness, however, looks different for older adults living in senior housing communities compared to community-dwelling older adults. For example, the responsibility for emergency preparedness for extreme weather within the senior housing environment expands to include the housing operator and community-based emergency management services rather than this responsibility relying solely on the individual older adult. This paper examines a set of twenty interviews conducted with senior housing operators, owners, and community-based emergency services personnel located in five U.S. states exploring emergency preparedness for extreme weather events in senior housing. Interviews were analyzed using an inductive, team-based thematic analysis approach. Results from this study are presented in a three-phase modified Haddon Matrix (Haddon, 1968) to provide a comprehensive framework promoting age-friendly extreme weather preparedness for senior housing operators and local emergency services. The implications of this research offers a foundation for a standardized checklist of actions and processes for senior housing operators, their individual communities, and emergency services to use to build capacity for age-friendly climate resilience. Senior housing communities serving older adults must comprehensive and resilient emergency preparedness plans and programs able to respond to a changing climate in an ongoing, adaptive, and multi-phase way that accounts for all actors in the senior housing environment (e.g., staff, residents, resident families) and through every stage of an extreme weather event.
NEIGHBORHOOD ENVIRONMENT AND PHYSICAL ACTIVITY AMONG PERSONS WITH DEMENTIA
Authors: Choi Eunyoung , Choi Yeon Jin , Cha Hyungmin , Fisk Calley , Wilkie Rachel , Ailshire Jennifer 
Published: January 2025

Abstract
Physical activity plays an important role in delaying the progression of cognitive and functional decline among people with dementia (PWD). Neighborhood environments can provide key resources or function as critical barriers to promoting physical activity among PWD. However, the specific neighborhood factors that drive this relationship are yet to be determined. Our study examines how socioeconomic (i.e., area affluence and disadvantage), physical (i.e., annual average PM2.5, temperature, park area), and social (i.e., cohesion, disorder, and safety) aspects of neighborhood environment are associated with physical activity levels among PWD living in communities across the U.S. We used data from 2006 to 2018 of Health and Retirement Study for dementia status and neighborhood social environment, merged with census-tract level data from the Contextual Data Resource for socioeconomic and physical neighborhood factors. Specifically, we used the first wave of data where PWD were identified as having dementia (N=3,073). Physical activity was measured as a weighted sum of light, moderate, and vigorous activity (range: 0-31). We estimated linear regression models adjusting for individual-level sociodemographic covariates. Higher neighborhood socioeconomic affluence (B=0.45, 95% CI=0.07, 0.84) and social cohesion (B=0.70, 95% CI=0.32, 1.09) were associated with higher levels of physical activity. Conversely, any sign of neighborhood physical disorder (B=-1.23, 95%CI=-2.09, -0.38) was associated with reduced physical activity. No significant relationships were found from physical neighborhood environment factors. This study provides empirical evidence for the social-ecological model which posits the important role of broader environmental factors that influence PWD’s physical activity participation.
NOVEL AUTOMATED TOOLS TO IDENTIFY COGNITIVE DECLINE AND EMOTIONAL DISTRESS IN THE CONTEXT OF MCI AND AD/ADRDS
Authors: Bannon Sarah , Federman Alex 
Published: January 2025

Abstract
Alzheimer’s disease and related dementias (ADRDs) are rapidly increasing public health concerns with significant impact on individuals, families, and healthcare systems. Though recent technological advances have enabled earlier and more accurate diagnosis for some, the vast majority of individuals experience delays in diagnosis and unmet early support needs. Diagnostic delays and inadequate support exacerbate psychological distress for impacted individuals, which is important to address given 1) the impact of distress on long-term outcomes and 2) the difficulty of treating distress once it becomes chronic. Novel automated technologies have the potential to more effectively and efficiently identify changes in cognition and distress, and if leveraged could provide cost-effective avenues to improve ADRD care. This symposium describes novel methods of leveraging large-scale data and technology to enhance screening and identification of early decline and distress in the context of cognitive impairment and ADRDs. Ryan Mace, PhD will describe healthcare providers’ impressions of barriers to assessing subjective cognitive decline and gaps in current practice. Sarah Bannon, PhD will present findings from a secondary data analysis of electronic medical records examining structured data elements as indicators of psychological distress among individuals with recent ADRD diagnoses. Ayushi Divecha, MPH MPT will describe the use of random forest models to identify individuals at high risk for developing dementia from a harmonized database of 5 of the largest NIH-funded studies of aging across the US.
OVERCOMING BARRIERS IN DETECTING SUBJECTIVE COGNITIVE DECLINE: A QUALITATIVE STUDY WITH HEALTH CARE PROFESSIONALS
Authors: Mace Ryan , Cohen Joshua , Ritchie Christine , Okereke Olivia , Bartels Stephen , Hoeppner Bettina , Brewer Judson , Vranceanu Ana-Maria 
Published: January 2025

Abstract
Identifying older adults with subjective cognitive decline (SCD) is imperative for early interventions targeting modifiable risk factors for Alzheimer’s Disease and Related Dementias (ADRD). However, with fewer than half of older patients with SCD engaging in discussions about their concerns with healthcare professionals, a significant gap in current practice is evident. To address this gap, we engaged healthcare professionals (physicians and medical staff) in a qualitative study that aimed to: 1) understand barriers and facilitators to identifying SCD, and 2) develop strategies to guide the implementation of screening and assessment tools into routine care. We conducted live video focus groups with 26 healthcare professionals (Mean experience = 17 ± 13.6 years) from 5 clinics that treat older patients (e.g., psychiatry, neurology, integrative medicine, memory care). We analyzed the qualitative data using a hybrid deductive–inductive approach. We proposed concrete strategies for addressing barriers to SCD identification using the Expert Recommendations for Implementing Change (ERIC) framework. Four themes on barriers to SCD identification emerged: 1) the clinical heterogeneity of SCD, 2) variability in patients’ self-identification, 3) variability in clinical assessment practices, and 4) need for additional research and standardization. ERIC-informed strategies to address barriers included: education and training for providers, standardized diagnostic protocols, incorporating caregiver reports, and promoting de-stigmatizing language. Our study contributes to the symposium theme by delineating the intricacies of identifying SCD among older adults and by proposing ERIC framework-based strategies that align with the need for novel screening and assessment tools.
DO MINIMUM STAFFING LEVELS IMPROVE NURSING HOME QUALITY? EVIDENCE FROM CALIFORNIA’S MINIMUM STAFFING REGULATIONS
Authors: Bowblis John , Brunt Christopher 
Published: January 2025

Abstract
Nursing staff is a key component in providing high quality of care to nursing home (NH) residents, therefore, as of 2021, 39 states have minimum nursing staff regulations. In September of 2023, CMS announced a proposed rule for a first ever federal minimum nursing staff level, even though the effectiveness of these regulations at improving quality is unknown. In this paper, we utilized a difference-in-differences regression framework to understand how changes to minimum staffing regulations impact staffing and quality. In particular, we examine California’s 2018 change to staffing regulations that increased the minimum staffing level from 3.2 to 3.5 hours per resident day (HPRD) and implemented a new 2.4 HPRD minimum requirement for certified nurse aides (CNA). Comparing California to neighboring states that did not change staffing requirements, California NHs increased CNA staffing levels 0.15 HPRD (6.5% increase) and total nursing staff levels of 0.184 HPRD (4.8% increase) on average. Even with these increases, only about 70% of NHs met the new CNA requirement and 90% met the new 3.5 HPRD staffing requirements in 2019. While staffing levels increased, only 3 of the 13 quality measures examined were statistically significant at the 5% or 10% levels. At the 5% level, there was improvement in incontinence among long-stay residents. At the 10% level, there was improvement in pressure ulcers among long-stay residents and the short-stay rehospitalization rate. These results indicate that increasing staffing levels through mandated minimums had small to negligible impact on most aspect of NH quality.
ASSESSING THE INFLUENCE OF NURSING HOME SIZE AND CARE MODELS ON COVID-19: CASE AND MORTALITY RATES
Authors: Young Yuchi , Liu Yichun , Shayya Ashley , Chiu Wan-Yu , Hsu Wanhsiang , O’Grady Thomas 
Published: January 2025

Abstract
The COVID-19 pandemic disproportionately affected older adults in nursing homes, emphasizing the need for comparing various long-term care options. This study compares COVID-19 prevalence and mortality rates in traditional nursing homes, Green Houses (GHs), and nursing homes nested in Continuing Care Retirement Community (CCRC-NHs). CMS data and LTCFocus Data were utilized. COVID-19 case and mortality rates from June 1, 2020, to September 30, 2022, across traditional NHs, GHs, CCRC-NHs in 11 states were included. Poisson regression was utilized to compare risk among types of NHs while adjusting for covariates. The average age of residents of CCRC-NHs and GH was 84.4 and 83.1-years, respectively, higher than those in small (77.5-years) and large (77.6-years) traditional nursing homes (P&lt;.0001). The proportion of female and White residents was significantly higher in CCRC-NHs and GHs than in traditional NH. Compared to GH residents, those in CCRC-NHs (RR 1.50, 95% CI 1.10-2.07), large NHs (RR 1.57, 95% CI 1.14-2.15), and small NHs (RR 1.80, 95% CI 1.32-2.47) had a higher risk of COVID-19 infection, with the highest risk observed in traditional small NHs. There were no statistically significant differences in COVID-19 mortality rates across different types of NHs. This study suggests that nursing home size and care models influence COVID-19 transmission, GHs, with their smaller, person-centered care settings, experienced lower infection rates, highlighting the potential advantages of such environments in pandemic management. Conversely, traditional NHs and CCRC-NH models, with more institutional layouts, may contribute to higher transmission rates suggesting a need for care model reevaluation.
ASSESSING THE IMPACT OF THE PATIENT-DRIVEN PAYMENT MODEL ON NURSING HOME CARE QUALITY: A STAFFING PERSPECTIVE
Authors: Orewa Gregory , Weech-Maldonado Robert , Davlyatov Ganisher , Lord Justin , Becker David , Feldman Sue 
Published: January 2025

Abstract
The Patient-Driven Payment Model (PDPM) launched on October 1, 2019, restructured Medicare payments to reflect resident needs over service quantity, aiming to improve quality and efficiency in nursing homes (NH). PDPM’s shift towards resident needs (rather than therapy minutes) may lead to greater nurse utilization, which may potentially improve the quality of care. This study draws on the resource-based view (RBV) theory to understand the association between the PDPM and NH quality of care mediated by nurse staffing intensity. Utilizing a longitudinal design (2017-2021), seven different datasets were merged (Cost reports, Payroll Base Journal (PBJ), Care Compare, Area Health Resource File (AHRF), HHS Provider Relief Fund, CDC NH COVID-19 public files, and CDC COVID-19 Data Tracker). Structural equation modeling (SEM) was used to assess the direct and indirect effects of PDPM on care quality, with nursing staffing intensity serving as a mediator. NH quality of care was operationalized using quality-measure five-star rating and staffing intensity by RN, LPN, and CNA hours per resident. We examined the direct effect of PDPM on quality of care and the indirect effect of PDPM on quality through nurse staffing. Control variables included organizational and market-level factors, and COVID-19-related variables. The result suggests an increase in RN staffing post-PDPM but a decrease in CNA hours (p&lt; 0.001). PDPM had an indirect positive effect on quality through RNs while negative through CNAs. PDPM also showed a positive direct effect on quality. Policy implication highlights the complex interplay between different staffing roles and the impact on quality.
POLICY SERIES: ELECTION YEAR RESULTS: IMPLICATIONS FOR OUR FUTURE
Authors: Lindberg Brian , D’Antonio Patricia 
Published: January 2025

Abstract
Will Social Security be targeted? Will Obamacare be gutted? How will Medicare drug prices be affected? These and many other programs and policies will be influenced by who sits in the White House and the Congress starting in 2025. Join your colleagues and GSA’s own pundits for a discussion on what went down on November 5th and what will be coming up in aging policy.
PROVIDING STUDENTS WITH INSIGHTS ABOUT AGING AND TECHNOLOGY USING A COLLABORATIVE TEACHING APPROACH
Authors: Schoenfeld Elinor , Bruckenthal Patricia , Horwitz Shelley , Zadok Erez , Trimboli Tracy , Ye Fan 
Published: January 2025

Abstract
Novel and innovative methods are needed to introduce our youth to what roles they can play in supporting our aging population, whether it be in a professional or personal role. To engage college lowerclassmen in discussions about aging, a multidisciplinary team of faculty from the College of Engineering and Applied Sciences and the Schools of Medicine, Nursing, and Social Welfare developed a 10-week seminar entitled “Smart Aging – at the Intersection of Technology and Healthcare.” Students were introduced to community engagement, modern sensing, and analytics technologies for physiologic and physical data, concerns about data security and privacy issues related to technology use, and issues faced by older adults aging at home, including social isolation and social determinants of health. Students learned the process of developing vignettes/personas related to aging in place and how technology may help overcome an identified aging-in-place challenge. To learn about aging-in-place outside of class, students were asked to speak with family members or neighbors about aging. Each week students were asked to share and discuss what they have learned about aging in place from their explorations. At the end of the course, students presented their own vignettes/personas and graded the other students’ work. We are currently taking lessons learned to develop a similar multidisciplinary graduate-level course. During this presentation, we will share our experiences with teaching a cohort of freshman and sophomores about aging and share some of their vignettes/personas to highlight their perceptions about and insights into aging.
STUDENTS CONNECTING THE DOTS BETWEEN POLICY THROUGH SERVICE, RESEARCH, AND TEACHING
Authors: Jarrott Shannon 
Published: January 2025

Abstract
Students pursuing social sciences degrees because of a desire to improve individual, family, and community circumstances should learn how policy impacts their efforts. I offer examples of teaching, research, and service that orient students to gerontological policy at the organizational, state, and national levels. Examples illustrate fortitude of students, older adults, and organizations in the face of emergent need and opportunity. At the organizational level, students engaged in service at an intergenerational day program for children and older adults developed a satellite food pantry in response to intergenerational need for healthy food access. At the state level, the Ohio the Scholars in Aging program convenes annual cohorts of undergraduate and graduate students from across the state in study of policy making via a partnership between the Ohio Association for Gerontology Education (OAGE) and the Ohio Department of Aging. At the federal level, research students facilitated older adults’ access to the federally funded Senior Farmers’ Market Nutrition Program during COVID. Students’ goals to support the well being of older adults and their families and communities are facilitated through engaged learning, service, and research that connects theory, skills, evidence, and policy. Students may learn about policies that are responsive to emergent need and can harness resources across agencies. They may also identify policies that isolate organizations and prevent collaboration, even when addressing similar goals for different populations. Awareness of the different shapes policies take in their objectives, implementation, and impact enhances students’ ability to navigate and utilize policy to positive effect.