bluuebunny/crossref_metadata_2025_split huggingface dataset:
UNDERSTANDING CHANGES IN PUBLIC TRANSIT BEHAVIOR AND ITS LINKS TO PHYSICAL ACTIVITY: FINDINGS FROM THE NHATS
Authors: Twardzik Erica , Schrack Jennifer 
Published: January 2025

Abstract
Public transit use is beneficial to human health. With a growing older adult population, a better understanding of older adult’s use of public transit and physical activity among public transit users is needed. We aim to describe public transit use among older adults from 2015 to 2022 within a nationally representative sample. Using the 2015-2022 National Health and Aging Trends Study (n = 38,970), we examined the prevalence of public transit use among adults aged 72 years and older. We found that 8.0% of older adults use public transit to get to places outside of their home. However, the prevalence of public transit use varied by gender, age group, and year of observation. Women (6.3%) used public transit less than men (8.5%), and public transit use prevalence was lower at older ages (ages 72-74, 7.8%; ages 90+, 3.6%. Public transit use was consistent across years 2015 to 2019 (8.5%), before it decreased drastically in 2020 (3.3%) and remained low in 2021 (5.2%) and 2022 (4.7%). In 2021 and 2022 public transit users averaged 48.8 more daily minutes of physical activity than non-users. These results suggest demographic and temporal trends in public transit use among older adults. Given that older adults report 7-10 non-driving years at the end-of-life, public transit could be an attractive option for this growing population. The pandemic reshaped the transportation landscape, and many public transit systems have not recovered pre-pandemic ridership. Future efforts should integrate age friendly policies to increase older adult ridership.
“WE TREAT EVERYONE THE SAME”: PROVIDER PERSPECTIVES ON LGBT+ AGING IN EAST TENNESSEE
Authors: Winberry Joseph 
Published: January 2025

Abstract
Aging Services providers in East Tennessee were asked to report barriers and solutions they saw to 5 aging-related needs raised by local Lesbian, Gay, Bisexual, and Transgender plus (LGBT+) people fifty years and older. The 5 needs included services for caregivers, social support, culturally competent care, LGBT+ Specific Services, and Planning. Fourteen providers working in settings such as offices on aging and long-term care facilities shared 248 responses via a qualitative survey. Thematic analysis of those responses revealed 6 barrier themes (ageism and elder abuse, discrimination, fewer personal resources, identity concealment, staff limitations, and stigma) and 4 solution themes (direct affirmation, creating and sharing information in partnership, inclusive written messages and images, and training participation). Review of the data also indicated a third category of response which was denial of needs raised. The findings indicate that providers have a varied understanding of barriers and potential solutions for meeting the aging services needs of LGBT+ older adults. They also demonstrate a lack of awareness among at least some providers of how LGBT+ older adults feel about their ability to access aging services in comparison to non-LGBT+ older adults. These findings are part of a larger, multidisciplinary community-engaged participatory research project that is ongoing in East Tennessee. Its purpose is to address information and social barriers that LGBT+ older adults see as obstructing their ability to age with dignity and respect in the community they call home. The findings raised from provider survey responses are useful for designing future interventions for providers.
MAKING THE MOST: UNDERSTANDING COMMUNITY IN SEXUAL- AND GENDER-DIVERSE COMMUNITIES
Authors: Guest M Aaron , Happel Christine , Burk-Leaver Erin 
Published: January 2025

Abstract
In program service and delivery, community significantly impacts the health and well-being of older adults, providing essential social support, fostering belonging, and ensuring access to vital resources and services. Beyond mere geographic proximity, communities embody shared traits, interests, values, and goals, aiding members in accessing various services and activities crucial for healthy aging. This includes fostering engagement, inclusivity, and support. Importantly, individuals often belong to multiple communities, enhancing their resource access as they age. A notable example is the sexual and gender-diverse community, comprising individuals identifying as gay, lesbian, bisexual, and transgender, among other identities. These individuals, especially older ones, face considerable barriers in accessing care, support, and resources, often lacking the opportunities available to their heterosexual counterparts. This symposium delves into how older individuals from these diverse backgrounds form and participate in communities. Happel et al.‘s work explores the unique experiences of loneliness, isolation, and service use among older LGBTQ adults. Guest et al. identify how community connection can affect self-perceptions of aging, resulting in accelerated social aging and adverse health outcomes. Mccoyy et al. then share a community-based participatory action approach to identifying and addressing the needs of sexual and gender-diverse older adults through alliance building. The shared theme of community and how SGD individuals create and use community will be highlighted through exemplars leading to a discussion of how we can create health-promoting communities for SGD individuals as they age.
IN THEIR OWN WORDS: EXPERIENCES OF LONELINESS, ISOLATION, AND SERVICE UTILIZATION AMONG LGBTQ+ OLDER ADULTS
Authors: Happel Christine , Dabelko-Schoeny Holly , Sheldon Marisa , Cho Al 
Published: January 2025

Abstract
Research has dismantled the stereotype of older LGBT people as lonely, depressed, and unattached to significant relationships. Yet, social isolation and loneliness are increasingly common experiences, especially when compounded by health and economic disparities. These experiences have substantial implications for our health and longevity. This study aimed to gain a better understanding of LGBTQ+ older adults’ experiences of loneliness and isolation and where and how they are connecting to community and social services to inform strategies rooted in community strengths. Through community partnerships in one Midwestern US city, semi-structured interviews were completed with 12 LGBTQ+ older adults and three service providers supporting LGBTQ+ populations. 58% of older adult participants were between 65-69. 16% were trans, and 16% were gender non-conforming. 41% were Black / African American. 92% were gay or lesbian, and 8% were bisexual. 83% had college degrees. 41% were married or living with a significant other. Interviews were analyzed using the team-based flexible coding method. Results indicated that being partnered does not necessarily relieve experiences of loneliness, and coming out later in life was associated with smaller, less satisfying support networks. Health challenges acted as both a source of positive and negative impact, as participants discussed connection to others experiencing similar challenges through support groups and social networks but also recognized limitations created by chronic conditions. Limited access to inclusive gathering spaces beyond bars, as well as the evolving queer community, were identified barriers to social connection. Intergenerational relationships were referenced as supportive and protective factors.
A COMMUNITY-BASED PARTICIPATORY APPROACH TO BUILDING ALLIANCE WITH LGBTQ2S+ OLDER ADULTS
Authors: McCoy Megan 
Published: January 2025

Abstract
The intersection of homophobia, transphobia, and heterosexism with ageism perpetuates health equity challenges for LGBTQ+ older adults. Many LGBTQ+ older adults fear having to “go back into the closet” to access healthcare, housing, and social support in later life and intentionally seek out identity-affirming settings. Yet, the availability of inclusive community spaces and services varies geographically. Understanding the experiences of LGBTQ+ older adults can inform research, advocacy, and programmatic efforts locally and regionally. Community-based participatory research (CBPR) is one framework for engaging historically silenced communities to drive research questions generated by and with the community. CBPR involves equitable community-academic partnerships, from development through dissemination. The first phase of successful CBPR involves forming a partnership and assessing community strengths, challenges, and dynamics— before we can even think about implementing a research project. This presentation will highlight how a CBPR model is used to engage key stakeholders to support LGBTQ2S+ older adults in Arizona better. Initially conceived as an advisory committee to inform research to build inclusion within one residential living community, the AZALEA Project (Arizona Alliance for LGBTQ2S+ Equity in Aging) continues to evolve as a broader statewide LGBTQ2S+ aging equity alliance. We will share emerging successes and lessons learned from an inaugural LGBTQ2S+ Aging Equity Forum and how these are informing future research development and design.
EFFECT OF COCHLEAR IMPLANT ON GAIT AMONG ADULTS WITH AGE-RELATED HEARING LOSS: A SYSTEMATIC REVIEW
Authors: Rafoul Bahaa , Agmon Maayan , Karawani Hanin 
Published: January 2025

Abstract
Research shows a link between hearing loss, gait impairment, and an increased fall risk. A number of reviews on the effect of hearing interventions on balance have been published; however, whether Cochlear Implant (CI) can improve gait impairment and reduce fall risk remains unclear. This systematic review evaluates the impact of CIs on the walking abilities of adults with hearing loss. It contributes to the theoretical understanding of the link between hearing loss and gait, as well as to the clinical understanding of the combined effect of treatment on gain improvement. Utilizing PRISMA guidelines, we extracted seven relevant studies from PubMed, Web of Science, and Scopus. Five studies included CI users, while two included CI and hearing aid users. Inconsistency in measurement methodologies and follow-up durations were noted, contributing to incongruent findings. We found that a short follow-up (up to two months) after the activation of the CI was associated with non-improved and even worsening gait, and a longer follow-up (at least three months) was associated with a partially improved gait. However, due to various methodological inconsistencies in the seven articles available, it remains challenging to fully understand the effects of hearing treatment by the CI on gait. We suggest that future research should consider underlying mechanisms such as cognition and function in dual-task walking with longer follow-up to better understand the link between hearing and gait, especially after hearing intervention.
DISEASE-SPECIFIC CONTRIBUTIONS TO GEOGRAPHICAL DISPARITIES IN MORTALITY AMONG MEDICARE BENEFICIARIES
Authors: Ouyang Meishuo , Akushevich Igor , Kravchenko Julia 
Published: January 2025

Abstract
Improving Life expectancy (LE) in the LE-lagging states could significantly improve overall LE and eliminate health inequalities in the United States. We analyzed the disparity in mortality rates between eight states with high and low LE at 65 using individual morbidity trajectories in Medicare administrative claims data from 2000-2020. Disease-specific contributions were identified using the Powers-Yun decomposition technique for hazard functions (the Blinder-Oaxaca algorithm extended for time-to-event data). This approach identifies two effects per disease: exposure (the disparity is generated because of the difference in the prevalence of a disease in two compared populations) and vulnerability (the disparity is generated because of the difference in mortality in the subpopulation with the disease). Two population groups (80-) and (80+) separated by age 80 were analyzed. Disease-specific contributions explained 44% and 63% of the disparities in all-cause mortality in the 80- and 80+ age groups, respectively. Exposure effects dominated in the 80- group (47.8% vs. 3.5% of vulnerability effect), while vulnerability was the main contributor (40.1% vs. 23.3% of exposure effect) in the 80+ group. Heart failure, influenza, and pneumonia explained 21.3% of the disparity in the 80- group, while the other circulatory system diseases, especially the vulnerability of cardiac dysrhythmias (5%), dominated the 80+ group. Additionally, cerebrovascular diseases (10.7%) and blood diseases (14.1%) are the other two major contributors to vulnerability in 80+. Reducing disparities in LE demands multiple fronts, such as tobacco control, heightened preventive measures against influenza and pneumonia, and enhanced access to arrhythmia treatments.
MOVING FORWARD TOWARD DEPLOYING HEALTH INFORMATION TECHNOLOGY IN ALL US NURSING HOMES
Authors: Alexander Gregory , Caraballo Christina , Moen Maria , Morton Cynthia , O’Malley Terrance 
Published: January 2025

Abstract
The Moving Forward Coalition Health Information Technology (HIT) Committee has refined two action plans designed to promote HIT adoption in all U.S. nursing homes (NH). In this work, Moving Forward is responding to two recommendations in the (National Academies of Sciences, Engineering, Medicine Report of 2022 (The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff) to deploy HIT in all NHs and to ensure that care is consistent with the individual’s goals, preferences, and priorities (GPPS). The first plan includes a HIT Readiness Guide to inform the adoption of the essential HIT capabilities required for survival in Value Based Payment models (VBP) mandated by the Centers for Medicare & Medicaid Services (CMS) to begin in 2030. The second provides an HIT enabled tool to facilitate the collection of an individual’s GPPs to facilitate goal concordant care consistent with an individual’s GPPs and to enable measurement of the degree to which the care provided is concordant with those GPPS. In this presentation, members of the HIT Committee will discuss the “what, why, and how” of these plans and the progress to date. Additionally, panel members will discuss plans for testing and evaluating tools developed from our initial work. Included will be a discussion of the challenges of sustainability and feasibility in the face of little federal support for these efforts. Although the Moving Forward Coalition and the NASEM report focus on NHs, the HIT tools being developed here will benefit all sites of care.
BIOMARKERS HELP US UNDERSTAND HOW CELLULAR AND SYSTEMIC AGING CONTRIBUTE TO MORTALITY
Authors: Klopack Eric , Crimmins Eileen 
Published: January 2025

Abstract
Research suggests aging is a coordinated decline occurring in multiple systems and at multiple biological levels. However, it is largely unknown how general biological aging and specific systemic aging co-occur and influence one another to affect health outcomes like mortality, multimorbidity, and functional limitations. There is also emerging interest in understanding how social exposures may differentially accelerate decline in individual physiological systems. We utilize data from the Health and Retirement Study, a nationally representative sample of about 4000 US adults over age 55. We used eXtreme Gradient Boosting (xgboost) in a training subsample to create estimates of health risk based on mortality, multimorbidity, and functional limitations using sets of biomarkers representing biological systems (e.g., nervous, immune, cardiovascular, and renal systems) as well as cellular aging (e.g., epigenetic clocks). These models generated risk scores for each outcome based on each system (e.g., renal functioning using BUN, creatinine, and cystatin C). Outcomes were regressed on these scores in a testing subsample to assess the relative impact of each system on health. Results suggest cellular aging, respiratory aging, and metabolic dysfunction contribute most to these health outcomes. Aging of these systems also partially mediates the risk associated with age, race/ethnicity, sex, and education. These results suggest aging of specific systems may be differentially affected by sociodemographic exposures and may differentially contribute to health risks. This research may help guide interventions focused on reducing inequalities in mortality risk by identifying health risks that would have the greatest impact on health at the population level.
USING BIOLOGICAL AGING TO BETTER UNDERSTAND THE DIFFERENTIAL RETURNS TO EDUCATION AMONG BLACK AND WHITE OLDER ADULTS
Authors: Farina Mateo 
Published: January 2025

Abstract
Numerous studies have documented “differential health returns” for education among older Black and White adults in the United States. Despite being a more select group, Black older adults with higher levels of education see a smaller return in health risk declines than White older adults. This pattern has been observed for cardiovascular and metabolic conditions, disability, and mortality. Underlying several of these age-related health conditions may be accelerated biological aging, which may provide further insight into why education returns differ across many health outcomes. In this study, we use the Health and Retirement 2016 Venous Blood Study to examine the differences in the education gradient for Black and White older adults for accelerated aging as defined by the newly developed Expanded Biological Age measure. We use a series of linear regression models to examine the association of education with accelerated biological aging and we examine whether the differences can be partly explained by health behaviors, experiences of discrimination, or psychosocial stress. Preliminary findings show that, compared to Black older adults White older adults have a larger gradient (greater returns) to education when evaluating accelerated biological aging: 3.2-year difference between those without a high school diploma and a bachelor’s degree for Blacks, and a 5.3-year difference for Whites. Health behaviors had no impact on the differences across groups, but we find some indication that stress and discrimination may have a role in mitigating the health benefits for well-educated older black adults.
MAINE REACHING FOR THE SUMMIT: ADDRESSING ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Holland John , May, Jr Alfred , Frohmberg Eric , Gordon Dawn 
Published: January 2025

Abstract
Maine is one of the most rural states in the country with 61.4% of its population living in rural areas and thirteen of sixteen counties categorized as rural. Maine is also the oldest state in the country based on a median age of 44.8 years. Maine’s BOLD Program strategized to treat the whole state as rural and determine various means to build the infrastructure for dementia education and services. One of these strategies is to develop a working relationship with primary care through our federally qualified health centers, who serve our target low-income population and are located in our most rural areas of the state. Because federally qualified health centers are established to provide primary care services as well as oral and behavioral health, they are open to partnerships with the Area Agencies on Aging for providing specialized umbrella services to patients with Alzheimer’s disease and related dementias (ADRD) and respite services to families and caregivers of patients with ADRD. This approach builds on the Healthy Brain Initiative Road Map strategies as well as working toward clinical to community best practices in preventing ADRD. A key resource for our work with the lead federally qualified health center has been the New York University Medical School, one of the Public Health Centers of Excellence. This collaboration has resulted in the creation of a dialogue type webinar that utilizes research to practice for early detection, diagnosis, and care planning.
MISSISSIPPI’S BOLD PUBLIC HEALTH RESPONSE TO DEMENTIA IN RURAL AND TRIBAL AREAS
Authors: White Kina , Edwards-Childs Paulita 
Published: January 2025

Abstract
Individuals living in rural communities are at an increased risk for Alzheimer’s disease and related dementias (ADRD), which aligns with other complex place-based health disparities. ADRD represents a significant public health issue in Mississippi, with the state having the highest age-adjusted mortality rates due to ADRD in the nation. The burden of ADRD in Mississippi falls disproportionately on rural and minority populations, with the state having the highest percentage of Blacks/African Americans in the nation and all 82 counties being considered medically underserved due to a lack of physicians and healthcare facilities. Given that Alzheimer’s disease and related dementias are more common with advanced age, this may increasingly affect Indian Country with a higher health burden. Mississippi’s BOLD public health response to addressing ADRD includes a collective impact of key stakeholders and prevention strategies to emphasize a life course approach for improved health outcomes. The response encompasses strategies such as community education, caregiver support programs, early detection initiatives, and access to dementia-friendly services. Moreover, it emphasizes the importance of collaboration with tribal nations, leveraging local resources, and integrating traditional and healing practices into dementia care. Key examples of these strategies include establishing dementia-friendly congregations and communities, as well as training older adult volunteers as healthy aging champions to advocate for improved local policies that allow them to age in their places and communities.
“STANDING IN THE GAP”: EXPERIENCES OF MEDICAID HOME AND COMMUNITY-BASED SERVICE SUPPORTS PLANNERS IN MARYLAND
Authors: Fabius Chanee , Rathakrishnan Sharmini 
Published: January 2025

Abstract
Medicaid Home and Community-Based Service (HCBS) care managers (called “supports planners” in Maryland) are responsible for coordinating care delivery and play a crucial role in bridging the gap between older adults, families, and home care and state agencies. This assistance is particularly relevant for older adults living with dementia and their families, as they represent nearly one-third of Medicaid HCBS participants, nationally. Despite their pivotal role in home care delivery and care quality, there is a paucity of research describing the contributions and experiences of supports planners. This study aims to improve the understanding of the role of supports planners, with implications for enhancing care coordination for older adults with dementia within Maryland’s Medicaid HCBS. We conducted seven semi-structured interviews with supports planners in Maryland from December 2023 to February 2024. Interviews were recorded, transcribed, and coded by the research team. Supports planners ranged in age from 26 to 54, were mostly female (n=5). Four supports planners were white, and three were black. Thematic analysis revealed four key themes highlighted by supports planners: 1) collaborations with paid and unpaid caregivers; 2) dementia-related care coordination; 3) the electronic management system as an information hub; and 4) supports planners’ role as liaisons in HCBS. The present study further emphasizes that supports planners are involved in numerous aspects of home care delivery. Our findings illuminate the role of supports planners in Medicaid HCBS and have implications for improving care coordination for older adults living with disabilities, especially those living with dementia.