bluuebunny/crossref_metadata_2025_split huggingface dataset:
BECOMING DEMENTIA CAPABLE: AN INNOVATIVE EDUCATIONAL STRATEGY FOR EMS PROVIDERS
Authors: Davis Kimberly , Jensen Christy , Waters Leland 
Published: January 2025

Abstract
There is an identified need to provide Emergency Medical Services (EMS) providers with foundational knowledge and skills in care of older adults living with dementia. EMS providers are uniquely positioned to recognize, intervene, and connect older adults and caregivers to community resources. Further, they can provide invaluable information and referrals to primary care providers (PCP), including partnering for long-term management. However, focus groups revealed they receive little to no formal training in best practices for care of older adults. This ongoing HRSA-funded project incorporates a two-pronged approach to training EMS providers: (1) training on the challenges of living with dementia from both the patient and caregiver perspectives including disease progression, management, communication skills, and community resources; and (2) training in advance care planning needs including introduction of the Physician Orders for Scope of Treatment, medical-ethical conversations in end of life, and patient advocacy. Content aligns with goals in the “Dementia State Plan 2020-2024: Building a Dementia Capable Virginia” which seeks to incorporate a public health approach to mitigate the impact of dementia. Training was provided in 7 regions of Virginia and has so far reached 275 EMS providers, first responders, and “hidden responders” (i.e. SW, behavioral health, elder law, etc.). Preliminary evaluation data reveals intention to change practice as a result of the educational strategy and will be shared at the symposium. As front-line workers, EMS providers are poised to help with early identification for older adults who would benefit from referral and early treatment, thereby reducing disease and disability.
“I DON’T USE ANYTHING SPECIAL”: DIETARY SELF-MANAGEMENT AMONG BLIND AND VISION-IMPAIRED PERSONS WITH TYPE 2 DIABETES
Authors: Nicklett Emily , Crowley Julia , Perez Rene , Fears Vanessa , Hernandez Beatriz Morales , Burgos-Melendez Yesenia 
Published: January 2025

Abstract
Diabetic retinopathy, a common complication of type 2 diabetes (T2D), is a leading cause of blindness and vision impairment (BVI) among middle-aged and older adults. Diabetes self-management is critical for maintaining eyesight and reducing the risk of further diabetes-related complications; however, those with BVI likely face additional challenges in managing diabetes, including following a diabetes-friendly diet. This study explores barriers and facilitators to maintaining a diabetes-friendly diet among BVI persons with T2D and examines how these experiences may influence their dietary behaviors. In collaboration with Vibrant Works—a community-based organization in San Antonio, Texas offering employment, independent living, and well-being services to the blind and low-vision community—phone-based questionnaires were fielded in January-March 2023 (n=18, ages 42-70). The questionnaires included validated measures of dietary adherence, followed by an open-ended, semi-structured interview about challenges and strategies for diabetes self-management. Quantitative data were entered directly into a database and qualitative data were transcribed and coded with themes emerging directly from the data. Six themes emerged that characterize barriers and facilitators to dietary behaviors: (a) vision status and comorbidities; (b) prior knowledge and experience in food preparation; (c) habits and routines; (d) access/accessibility (i.e., transportation, BVI-friendly cooking tools, accessibility of food stores; (e) support (i.e., social and tangible support); and (f) neighborhood and community factors (i.e., walkability, sidewalk quality, food store availability). Findings from this study can inform more equitable strategies for dietary self-management among populations experiencing both T2D and vision loss through direct practice, future research, and policy approaches.
EVALUATION OF EQUITY IN HOSPICE CARE UTILIZATION AMONG MEDICARE-ENROLLED AUTISTIC OLDER ADULTS
Authors: Bishop Lauren , Nikahd Melica , Hyer J Madison , Hand Brittany 
Published: January 2025

Abstract
Better identification and increased life expectancy of autistic people has given rise to a need to better understand their end-of-life care. The purpose of this study was to compare hospice utilization of autistic older adults to non-autistic older adults using hospice claims from Medicare and examine if known inequities in hospice utilization among the general population are exacerbated among autistic older adults. Our sample included 5,468 autistic older adults and 10,934 matched population comparison older adults who died between 2013-2021. We used multivariable logistic regression to compare these groups on the odds of any, early (at least 28 days before death), intermediate (4-27 days before death), and late (within 3 days of death) hospice utilization. Interaction terms were used to assess whether effects were modified by beneficiary’s sex, race, or rurality. In a sensitivity analysis, we repeated our analyses in unmatched samples. The autistic older adult and matched population comparison groups had similar odds of any hospice utilization (OR: 1.05; 95% CI: 0.98-1.13), early (OR: 1.01; 95% CI: 0.91-1.11), intermediate (OR: 1.03; 95% CI: 0.95-1.13), and late hospice (OR: 1.07; 95% CI: 0.96-1.19). In our models evaluating the impact of other known inequities, we did not find significant interactions between autism diagnostic status and sex, race, or rurality. Results were similar in the unmatched samples. Our findings suggest that autistic older adults experience similar receipt and timing of hospice as non-autistic peers, highlighting the potential power of zero cost, universal health policies in reducing healthcare utilization disparities among autistic people.
DISABILITY: INDEPENDENT OR DEPENDENT VARIABLE IN GERONTOLOGICAL RESEARCH?
Authors: Putnam Michelle , Stark Susan 
Published: January 2025

Abstract
A critical issue for bridging aging and disability research is developing a shared understanding of when disability should be employed as an independent or a dependent variable. To date, this discussion has rarely been had across researchers. Is disability a dependent variable, an outcome? Or does it contribute to outcomes as an independent variable? Or both? How disability is conceptualized, measured, analyzed, and interpreted matters for how we understand the role disability plays over the life course. Disability status is used as both an independent and a dependent variable in gerontological and disability/rehabilitation research. Research in both fields often focuses on reducing likelihood, duration, and severity of disability. A key distinction between fields is how each conceptualize disability – what it is and what it means – particularly given age of onset and type of disability. For example, in gerontological research, often positions disability as an individual trait that mediates the ability to live independently (typically reducing independence). However, disability/rehabilitation research commonly positions disability as a situational trait, or moderating variable associated with difficulty of living independently, but not causing inability to live independently. NIH’s recent inclusion of disability as a social determinant of health provides an opportunity for gerontologists to more deeply consider how disability is employed in research designs and why. We discuss how more consistent use of disability as an independent and/or dependent variable can help bridge aging and disability research and provide greater understanding of the role disability plays over the life course.
MANAGING MULTIPLE CHRONIC CONDITIONS: FINDINGS BY NATIONAL CLAUDE D. PEPPER OLDER AMERICANS INDEPENDENCE CENTERS
Authors: Graham Eileen , O’Conor Rachel , Wolf Michael 
Published: January 2025

Abstract
Multimorbidity is an increasing concern among clinicians, as older adults accumulate chronic conditions that require complex coordination of care. There is an increasing interest among research and clinical communities to understand the impacts of multimorbidity on individuals and how quality of care can be optimized to improve quality of life in the aging population. The primary objective of the Claude D. Pepper Older Americans Independence Centers national network is to advance scientific knowledge that will help older adults maintain function, independence, and quality of life. The current symposium highlights recent work put forth by three of the 15 National ‘Pepper’ Centers (Northwestern, Mt. Sinai, UCSF). Graham will present recent findings on how multimorbidity is longitudinally related to physical and mental health-related quality of life, and their cognitive, psychological, social, and health-related determinants. The next three presentations explore the role of caregivers in supporting the health and quality of life of older adults with multimorbidity. O’Conor will discuss complexity of family care dyads management of MCC, by reviewing patient and caregiver perspectives on challenges of successful management at home. Allison will discuss the interplay of care support structures and dementia care needs in the home. Reckrey will discuss results from a qualitative analysis exploring perspectives of geriatricians on the importance of paid caregivers of older adults with MCC. In sum, this symposium will present novel evidence showing the importance of understanding of how multimorbidity and dementia impact caregiving considerations, primary care decisions, and health related quality of life for older adults.
CASCADING BURDEN OF UNCONTROLLED CHRONIC CONDITIONS AMONG PERSONS LIVING WITH DEMENTIA
Authors: O’Conor Rachel , Pack Allison , Russell Andrea , Oladejo Dianne , Morhardt Darby , Lindquist Lee , Wolf Michael 
Published: January 2025

Abstract
Half of all potentially avoidable hospitalizations among persons living with dementia (PLWD) are due to poorly controlled chronic conditions. Yet little is known about how PLWD and their caregivers manage the multiple chronic conditions (MCC) and polypharmacy they often contend with, or how these health management behaviors impact PLWD and caregiver well-being. We conducted qualitative interviews with patient-caregiver dyads exploring capacity to manage MCC. PLWD were eligible if they had mild or moderate dementia, ≥3 chronic conditions, ≥5 medicines, and a caregiver. Three coders applied a priori and emergent codes to transcripts. We interviewed 68 participants (PLWD: mean age 78 years, 65% female, 53% white, 32% Black; Caregivers: mean age 65 years, 73% female, 56% spouse, 38% adult child). PLWD were managing 5 chronic conditions and took 9 medicines on average. PLWD recalled instances of difficulty managing MCC and subsequent hospitalization, while emphasizing they had recovered. Following errors in health management behaviors, they expressed gratitude for additional caregiver support. In contrast, caregivers described a cascading burden of uncontrolled chronic conditions among PLWD. Many reported feeling overwhelmed managing the complexity of MCC, including multi-drug regimens, for the PLWD. Caregivers cited difficulties achieving adequate control for numerous chronic conditions (e.g. hypertension, diabetes, heart disease). Consequences included hospitalizations and increased regimen complexity; in turn, these increased caregiver responsibilities, emotional strain, and financial costs. Findings suggest management of MCC compounds caregiving responsibilities and contributes to caregiving burden. Supporting caregivers’ practical skills for managing MCC may promote PLWD and caregiver well-being.
WHEN DO PAID CAREGIVERS SUPPORT THE HEALTH OF OLDER ADULTS? GERIATRICIAN PERSPECTIVES
Authors: Reckrey Jennifer , Estrada Leah , Watman Deborah , Franzosa Emily 
Published: January 2025

Abstract
Paid caregivers (e.g., home health aides, personal care attendants, other home care workers) may support not only the function but also the health of the older adults they care for in the home, but little is known about how medical providers view paid caregiver role in healthcare. This secondary qualitative analysis of interview data from geriatricians (n=9 geriatricians, n=27 interviews) used thematic analysis to identify geriatrician perspectives on when paid caregivers do the most to support the health of their older adult clients. Geriatricians perceived that paid caregiver contributions were greatest in the care of high-needs older adults including those with multimorbidity, dementia, and significant functional impairment. They described that paid caregivers stepped up to fill healthcare gaps when families could not provide all needed support (e.g., long distance family caregivers). They also described how the personal qualities and internal motivation of paid caregivers affected their role in care, but rarely acknowledged the systemic barriers to greater paid caregiver participation in health-related care. As the locus of long-term care continues to shift from institutions to the community, a greater number of older adults with multimorbidity and dementia will rely on paid caregiver to live at home despite growing functional impairment. Future work should consider how to best integrate paid caregivers who are already providing health-related support into the care team and explore barriers to paid caregiver participation in health-related care more generally, especially for older adults with the highest care needs.
IDENTIFICATION AND MACHINE LEARNING PREDICTION OF MEDICARE BENEFICIARIES’ COGNITIVE FUNCTION TRAJECTORIES
Authors: Lin Haiqun , Xia Weiyi , Zafar Anum , Kim Hyosin , Setoguchi Soko , Kobylarz Fred , Roy Jason , Jarrín Olga 
Published: January 2025

Abstract
This work aims to characterize the functional decline in cognition during the last five years of life. A 10% random sample consisting of 195,240 Medicare beneficiaries who died in 2019, aged fifty or older and continuously enrolled in Medicare during their last five years of life, was analyzed. Cognitive function status, characterized by no impairment, memory loss, mild cognitive impairment, and dementia, was obtained from the assessment and the claim file for each beneficiary whenever it was available. Changes in cognitive function over the last five years were examined using the group-based trajectory model for ordered categorical outcomes: Ten trajectory groups of cognitive function were identified and had a better value of Bayesian Information Criterion than either the 9-class or the 11-class solution. The 10 trajectory groups were categorized into four clusters: the cognitively intact cluster (38% of beneficiaries) which contains one trajectory group with beneficiaries maintaining their cognitive function throughout the last five years, the mild cognitive impairment (MCI) cluster (27%) which contains four trajectory groups with beneficiaries experiencing slow decline in cognitive function and died with MCI, the steady decline cluster to dementia (25%) which contains four trajectory groups with beneficiaries experiencing steady decline in cognitive function and died with dementia, and the early-decline dementia cluster (10%) which contains only one trajectory group with beneficiaries whose cognitive decline started more than five years before death. Sociodemographic and clinical factors were assessed for their association with the trajectories and used to predict trajectory clusters with machine learning algorithms.
RACIAL/ETHNIC AND SEX DIFFERENCES IN LATE-LIFE COGNITIVE TRAJECTORIES
Authors: Jarrín Olga , Thorpe Roland , Kobylarz Fred , Xia Weiyi , Kim Hyosin , Zafar Anum , Lopez Maria , Lin Haiqun 
Published: January 2025

Abstract
Prior research on racial/ethnic and sex difference in late life cognitive trajectories has been limited by small sample sizes in clinical and survey cohorts. We overcome these challenges through leveraging real-world data for the U.S. Medicare beneficiary population to examine within-group differences in cognitive function trajectories and their predictors. Specifically, we found Black, Hispanic, and Asian American men and women have a higher risk of severe cognitive impairment and spend more months and years of their lives with significant cognitive impairment. These differences are largely driven by differences in the risk of cognitive impairment associated with older age, consistent with prior research on life course stress and the ‘weathering’ hypothesis that early health deterioration is a consequence of the cumulative impacts of social or economic adversity and political marginalization. Our findings replicate, and in some cases refute, findings from prior studies from smaller longitudinal cohorts, including the Health and Retirement Study. Results will be discussed from a life course perspective with attention to variation in environmental, sociocultural, political, and historical factors that create and sustain health disparities for racial/ethnic minority older adults in the United States.
NAVIGATING HEALTH AND IDENTITY TO PROMOTE FORTITUDE AMONG SGM PEOPLE: INSIGHTS FROM AGING WITH PRIDE
Authors: Hoy-Ellis Charles , Fredriksen-Goldsen Karen 
Published: January 2025

Abstract
This symposium showcases groundbreaking research illustrating the multifaceted nature of fortitude among sexual and gender minority (SGM) older adults, focusing on health, digital health access, generativity, and intersectionality. The collection of studies in this symposium leverages cross-sectional and longitudinal data from Aging with Pride: National, Health, Aging and Sexuality/Gender Study (NHAS) to address critical gaps in our understanding of the unique strengths in this population despite the adversity they face. The first presentation illuminates the disproportionate experiences of violence and abuse among older transgender adults, revealing significant links between intimate partner violence (IPV), victimization, internalized stigma, and adverse mental health outcomes. It spotlights the need for interventions that target these risk factors and promote fortitude. The second presentation examines the digital divide, exploring how older SGM adults utilize health information technologies. By comparing usage patterns and identifying barriers and facilitators, this research emphasizes the importance of improving health care access. The third presentation will examine the predictors of generativity among SGM older adults, highlighting how psychological and social resources can mitigate stigma. This study offers valuable perspectives on fostering intergenerational support and community engagement within SGM communities. Lastly, the symposium will feature research examining the intersectionality of identity among SGM older adults, showcasing heterogeneity among this population by identifying patterns based on identity centrality and discrimination experiences. Highlighting the impacts of recent policy shifts targeting SGM communities, these studies collectively underscore the crucial need for resilience-enhancing strategies that incorporate intersectional approaches for promoting health equity among vulnerable, at-risk populations.
CROSS-NATIONAL STUDIES OF RISK FACTORS FOR COGNITIVE DECLINE AND DEMENTIA
Authors: Steptoe Andrew , Brocklebank Laura 
Published: January 2025

Abstract
Cross-national studies of cognitive decline can provide insights into the relevance of risk factors in different cultural settings. They help determine whether relationships are universal or depend on the lifestyles and social context prevailing in different countries. However, cross-national studies present challenges. One important issue is harmonization of self-report and cognitive measures, and this has been greatly facilitated by the Gateway to Global Aging initiative. But there are other factors related to consistency in data collection that require careful consideration. These will be illustrated by a study relating physical activity and sleep patterns to cognitive decline and dementia risk in England using ELSA (the English Longitudinal Study of Ageing) and in China using CHARLS (The China Health and Retirement Longitudinal Study). Absolute levels of physical activity and sleep vary greatly among older people living in urban and rural settings, and with histories of predominantly non-manual work (ELSA) and more mixed occupations (CHARLS). These factors color self-report measures, making comparison difficult. In this study, we have been carrying out 8-day wrist-worn accelerometry in ELSA and CHARLS to provide objective data on movement behaviours (physical activity, sedentary behaviour, and sleep) in more than 20,000 individuals. This presentation highlights challenges related to consistency of data collection, variations in instrumentation, differences in response and adherence rates, and the suitability of machine-learning behavior classification models developed in one cohort but applied in very different people and/or contexts. We will describe our approaches to resolving these issues in order to carry out robust cross-national comparisons.
TWENTY YEARS OF FOLLOW-UP OF THE MEXICAN HEALTH AND AGING STUDY (MHAS): ITS POTENTIAL FOR CROSS-NATIONAL COMPARISONS
Authors: Wong Rebeca 
Published: January 2025

Abstract
The availability of population-based, national representative, longitudinal data for aging research has been building up for the last twenty years. As a result, the ability to make cross-national research has been enhanced greatly. Almost 20 percent of the publications that use the MHAS data are making cross-national comparisons, but the cross-national work is still in infancy. Most research focuses on documenting health and functionality trajectories and the individual determinants of these trajectories. I will present an overview of what has been done, illustrate with a couple of examples, and conclude with gaps in knowledge that could be supported by cross-national data. The lack of comparable data for many low-middle income countries may be the challenge we can help meet in the next 20 years to advance research on global aging.
BIOLOGICAL AGING PATHWAYS THAT UNDERLIE LIFE COURSE SOCIOECONOMIC DISPARITIES IN PHYSICAL FUNCTION AND LONGEVITY
Authors: Gruenewald Tara , Podber Naomi 
Published: January 2025

Abstract
The poorer functioning and greater morbidity and mortality risk in those with greater life course socioeconomic disadvantage has led to the search for the biological processes that underlie these associations, including accelerated cellular and system aging. Our study examines whether a DNA methylation profile of the pace of biological aging (DunedinPACE) and a multi-system index of physiological dysregulation (allostatic load (AL)) mediate associations between life course socioeconomic disadvantage (SESDIS) and both physical function (gait speed, chair stand time) and survival. Data are from the Midlife in the U.S. Study (N=1,295, age 26–86, 55.4% female, 69.0% white). Measures included a multi-indicator composite of childhood and adult socioeconomic indicators (SESDIS), DunedinPACE as described in Belsky et al. (2022), AL as described in Gruenewald et al. (2012), gait speed (time to complete a 50-foot walk), and chair stand time (5 consecutive rises from a seated position). Analytic models included z-scored predictors, age, race, and gender covariates and accounted for family clustering. Greater SESDIS was associated with increased mortality hazard (HR=1.42***), higher gait speed (b=0.70***) and chair stand time (b=0.85***), and higher DunedinPACE (b=0.27***) and AL (b=0.19***). Greater DunedinPACE and AL were associated with slower gait and chair stand time and lower survival. Multi-mediation analyses indicated significant bootstrapped (1,000 replications) indirect effects for DunedinPACE and AL as mediating pathways of the slower gait and chair stand time and lower survival in those with greater SESDIS. Findings highlight biological aging pathways that may contribute to life course socioeconomic disparities in physical function and longevity.