bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE JOINT EFFECTS OF WORK AND INFORMAL CAREGIVING ON MENTAL WELL-BEING AMONG CHINESE MIDDLE- TO OLDER-AGED ADULTS
Authors: Ye Jing 
Published: January 2025

Abstract
Although the health implications of employment and caregiving are well-documented, less is known about the joint impact of work and caregiving on the well-being of older adults. This study contributes to filling this research gap by focusing on the well-being implications of combining work and informal caregiving for Chinese older adults 60 years of age and older. The study draws on two theoretical perspectives: role strain theory and role enhancement theory. While the role strain theory assumes lower life satisfaction and higher depressive symptoms due to the double burden of paid work and caregiving, the role enhancement theory predicts an increase in well-being through the accumulation of resources and role fulfillment. Using data from the China Health and Retirement Longitudinal Study (CHARLS 2011-2018), this study aims at investigating whether and how older age working caregivers experience different life satisfaction and depressive symptoms. Besides, the moderating effects of intensity, gender, residence, socioeconomic status, and social isolation level are estimated. Results from the random-effects model show that compared to those who do not work or provide informal care, low-intensity worker-caregivers report higher life satisfaction. Only female worker-caregivers experience higher depressive symptoms, particularly with long hours of work and caregiving. These results support both role enhancement and role strain theories and suggest the need for increased investment in formal care facilities to alleviate the care burdens among older adults.
EXPLORING MEALTIME EXPERIENCES OF FAMILIES LIVING WITH DEMENTIA IN LONG-TERM CARE: A GROUNDED THEORY STUDY
Authors: Alford Heather , Cammer Allison , Ward Heather , Perepelkin Jason 
Published: January 2025

Abstract
Relationship-centered mealtime interventions improve staff-resident relationships and reduce the risk of malnutrition for residents living in long-term care settings. Less is known about the nature, goals, or outcomes of family-resident relationships at mealtimes, particularly for residents living with dementia. This constructivist grounded theory study aimed to explore what is needed to support meaningful family relationships and engagement at mealtimes with residents living with dementia in long-term care homes. Individual interviews were conducted with 13 family caregivers of people living with dementia in long-term care homes in a Western Canadian province. Interviews were recorded, transcribed verbatim, and analyzed using constant-comparison method. Three themes characterized family member participants’ experiences of mealtimes: 1) Changing Ways of Connecting, 2) Nutrition as a Reflection of Dementia Progression, and 3) Adjusting Expectations. Mealtimes are important opportunities for supporting family-resident connection and can facilitate ‘acceptance’ of the illness trajectory in dementia among caregivers. By conceptualizing their mealtime involvement, this study advances understanding of the essentiality of family caregivers for enhancing relationship-centered practices in long-term care settings. By explicating the structure, function, and experience of family involvement in nutritional care, this study addresses the current gap in understanding of how families living with dementia build and preserve relationships through nutritional care and dining.
OLFACTION AND DEMENTIA RISK IN THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY
Authors: Chen Honglei , Shrestha Srishti , Zhu Xiaoqian , Kucharska-Newton Anna , Yuan Yaqun , Kamath Vidyulata , Mosley Tom 
Published: January 2025

Abstract
We examined the association of olfaction with incident dementia and characterized this relationship by key demographic subgroups and APOE-ε4 genotype in the ARIC study. We further examined how change in olfaction was associated with dementia incidence. Olfaction was evaluated using the 12-item Sniffin’ Sticks test in 4470 ARIC participants in 2011-2013 (visit 5) and in 2658 participants in 2016-2017 (visit 6). We defined olfaction as good (score 11-12), moderate (9-10), hyposmia (7-8), and anosmia (0-6). Dementia status was ascertained from 2011-2013 through 2020. Of the 4470 participants at baseline (age:75±5 years, 21% Black race, 60% women), 17% developed dementia over 10 years. In multivariable Cox models, moderate olfaction (hazard ratio (HR):1.5, 95%CI:1.3-1.9), hyposmia (HR:2.2, 95%CI:1.8-2.8), and anosmia (HR:3.5, 95%CI:2.8-4.3) were associated with higher dementia rate in a linear, monotonic manner relative to good olfaction. Findings were similar across subgroups of age, sex, race, and APOE-ε4 genotype. We also used logistic regression to estimate marginal dementia probability. We found that, on the risk difference scale, the absolute risk difference between anosmia and good olfaction was higher in APOE-ε4 carriers (0.29, 95%CI:0.20-0.37) compared to that in non-carriers (0.16, 95%CI:0.11-0.21); jointly, APOE-ε4 carriers with anosmia had the greatest cumulative dementia probability. Further, compared to participants who maintained good olfaction from visit 5 to visit 6, those with stable anosmia (HR:5.6, 95%CI:2.7-11.6) and a decline from good to anosmia (HR:4.5, 95%CI:2.2-9.4)) showed comparable associations with dementia incidence. Our study provides important data about how simple noninvasive olfaction tests may inform future dementia risk.
PROSOCIALITY AND SUBSEQUENT COGNITIVE HEALTH: A PROSPECTIVE COHORT STUDY
Authors: Farmer Justin , Macchia Lucía , Gong Jessica , Steptoe Andrew , Bu Feifei , Kubzansky Laura 
Published: January 2025

Abstract
Specific prosocial behaviors, including volunteering and caregiving, have been linked to better maintenance of cognitive health in older adults. However, limited epidemiologic work has examined the relationship between one’s cognitive-emotional orientation toward prosociality generally and these same health outcomes. This study uses data on 7844 participants from the English Longitudinal Study of Ageing (ELSA) to test the hypothesis that higher versus lower prosociality is associated with higher maintenance of cognitive health in adults 50 years or older. We derived a 9-item prosociality scale using items from well-validated measures of self-reported altruism and collectivism assessed in ELSA. Linear mixed-effects models were used to examine the relationship between this measure and changes in executive function and verbal memory over an 11-year period. Cox proportional hazards models were then used to compare time to dementia based on level of prosociality. Results from both longitudinal and survival analyses suggest that higher prosociality is associated with maintaining better cognitive health even after controlling for sociodemographics (e.g., age, education, wealth) and baseline health characteristics such as depression and cardiovascular disease. Comparing across tertiles, participants with high versus low prosociality had 24% slower decline in verbal memory and 55% slower decline in executive function. This aligned with a 35% reduced hazard of dementia during this same period for those with high vs. low prosociality. These results suggests that prosociality, beyond formal volunteering, is an important modifiable risk factor for improving later life cognitive function on an individual and population level and should therefore be further examined.
PALLIATIVE CARE FOR PEOPLE WITH MODERATE-SEVERE DEMENTIA IN THE COMMUNITY: RESULTS OF THE IN-PEACE TRIAL
Authors: Sachs Greg , Johnson Nina , Gao Sujuan , Pan Minmin , Torke Alexia , Hickman Susan , Kroenke Kurt 
Published: January 2025

Abstract
Dementia care management programs in the community demonstrate some benefits. Study limitations include limited numbers of people living with dementia (PLWD) with advanced disease or from minoritized populations; lack of palliative care components; and limited success reducing health care utilization. IN-PEACE tested dementia care management integrated with palliative care for PLWD with moderate-severe disease in the community and their caregivers. 201 PLWD-caregiver dyads were randomized to either a dementia care coordinator (99) or usual care (102) and followed for 24 months. Outcomes were neuropsychiatric symptoms (NPI-Q severity) and symptom management (SM-EOLD) in PLWD; distress (NPI-Q distress) and depression symptoms (PHQ-8) in caregivers; and the combined measure of ED visits/hospitalizations. Outcomes were assessed quarterly. Separate mixed effects models were run for each symptom/distress measure and a zero-inflated Poisson model compared the mean number of ED/hospitalization events. Subgroup analyses were conducted based on baseline NPI-Q severity, sex, race, income, and health system. There were no statistically significant differences between groups in any symptoms or distress measures in PLWD or caregivers. PLWD receiving the intervention, however, had substantially fewer ED/hospitalization events (means 1.06 events versus 2.37, p &lt; 0.007). The intervention reduced the proportion of PLWD who had one or more ED/hospitalization events (78.4% of controls vs. 50.5% of intervention, p &lt; 0.001). The relative risk reduction was 35.6% for an event, absolute risk reduction 27.9%, and number needed to treat (NNT) of 3.6. PLWD with higher NPI-Q at baseline and Black PLWD experienced greater reductions in ED visit hospitalization events.
EQUITABLE AND SOCIALLY JUST AGE-FRIENDLY COMMUNITIES FOR OLDER LGBTQ+ ADULTS OF COLOR
Authors: Oswald Austin , Cooper Lujira 
Published: January 2025

Abstract
The age-friendly movement has been critiqued for inadequately addressing the needs of historically disadvantaged populations, like older LGBTQ+ adults of color. This presentation describes a multi-year participatory action research project with five older Black lesbian women aged between 65 and 75. We hosted five focus groups where participants shared their daily experiences living in an age-friendly city and proposed ideas to more inclusively meet the needs of older LGBTQ+ adults of color within age-friendly activities. Focus group data were analyzed thematically, and four themes were identified which expand existing age-friendly frameworks, promoting greater equity and justice: 1) attending to the interaction between identities and structures throughout the life course, 2) understanding the impact of historical and contemporary experiences of violence and discrimination on health and aging, 3) addressing the evolving sociopolitical landscape regarding the human rights and freedoms of diverse older adults, and 4) developing interventions that create safe and affirming spaces for older LGBTQ+ adults of color. While mainstream age-friendly frameworks are widely acknowledged for enhancing the health, independence, and social connectivity of older adults, addressing the unique challenges associated with aging while navigating multiple intersecting marginalized identities requires a critical perspective. The findings of this research underscore the necessity of culturally tailored age-friendly frameworks and interventions to address the distinct needs and experiences of older LGBTQ+ adults of color. We argue that gerontology must seriously consider the impact of privilege and oppression on the health and aging experiences of vulnerable and underserved populations within age-friendly communities.
VOLUNTEERING AMONG OLDER ADULTS AND EFFECTS OF ETHNIC MINORITY IDENTITY BEFORE AND DURING COVID-19
Authors: O’Dea Eireann , Wister Andrew , Li Lun , Canham Sarah , Mitchell Barbara 
Published: January 2025

Abstract
The ongoing COVID-19 pandemic has presented numerous challenges to older adults in Canada, including the ability to engage in volunteer work. This situation has created a new volunteer landscape in which common predictors of volunteering may have shifted. The purpose of this study is to improve understanding of the current social context surrounding volunteering in Canada, by a) determining changes in the associations between human, social, and cultural capital variables and volunteering among older adults and b) examining the potential relationship between ethnic minority background and volunteering among older adults, using data from the Canadian Longitudinal Study on Aging (CLSA), collected prior to and during the pandemic. This study utilized data from 24,306 participants (aged 55+) who participated in the CLSA Baseline, Follow-up 1 and the COVID-19 Study Baseline surveys. Results confirm a decrease in volunteering among CLSA participants during the early stages of the pandemic. When compared to pre-pandemic associations, volunteers during the early stages of the pandemic were more likely to be young-old (55-64), male, employed, and not involved in religious activities. Findings provide evidence of pandemic effects on volunteering among older adults in Canada.
WHO ENJOYS THE GOLDEN YEARS? RACIAL AND SOCIOECONOMIC DISPARITIES IN YEARS OF HEALTHY RETIREMENT
Authors: Abrams Leah , Zhang Yuan 
Published: January 2025

Abstract
For several decades, until around 2010, Americans enjoyed increases in life expectancy, and for some, extended disability-free life expectancy. However, mortality progress has since stagnated, Americans with low education have not benefited from delayed disability, and there remain substantial racial disparities in morbidity and mortality. We aim to determine who in American society retains health and functioning to enjoy retirement years by simultaneously examining healthy life expectancy and time spent in retirement. We use data on physical functioning and work status from the Health and Retirement study in two periods (1998 and 2016) to run Markov models that calculate the number of years and percent of remaining life in healthy work, unhealthy work, healthy retirement, and unhealthy retirement by race and socioeconomic status. Results to date reveal that, in 2016 compared to 1998, adults over age 51 spent a smaller portion of their life in healthy retirement, with a shift toward healthy work. In 2016, Black and white men and women all spent between 17-20% of remaining life years after 51 in healthy retirement, but they arrived there differently. Men spent about 42% of life years healthy and working, compared to about 30% for women. Women spent more time not working with functional limitations. Looking to race, white men spent a greater portion of time working with functional limitations, whereas Black men were not working with functional limitations. Black women spent more time working with functional limitations and less time not working, with and without functioning.
ASSESSING AND STRENGTHENING THE INFRASTRUCTURE FOR CAREGIVING SUPPORTS: A STATE PERSPECTIVE
Authors: Rabalais Jennifer , Rataj Alison 
Published: January 2025

Abstract
Objective. While progress has been made in policies that recognize and support caregivers, there is a need for a unified framework for caregiver supports. The New Hampshire Alliance for Healthy Aging (NHAHA), a statewide coalition focused on building meaningful partnerships to support and promote healthy aging in communities, has a focal area of ensuring that informal family caregivers have adequate supports. Through NHAHA, we examined current state data, policies, and practices that could be leveraged to develop a recommended plan of actions for caregiving supports that aligns with national caregiving strategies. Methods. Using a mixed-methods design, this study used qualitative data from a focus group (n = 14) to assess barriers to accessing caregiving services. A statewide survey (2024) is underway to understand existing services and supports in NH and will be used in further analysis. Data from NH’s State Plan on Aging (2023), which conducted a survey (n = 955) asking several questions about caregiving supports and hosted 10 public listening sessions (n = 185) was also used. Data was catalogued and inventoried across themes in this applied research approach. Results. Three major themes emerged. Caregivers often do not self-identify. Caregiving has negative effects on caregivers financial standing and career. Caregiving supports are siloed, difficult to navigate, and often dissolve without warning. Future Directions. Increased education for caregivers that provides information and resources. Create a system of care for caregivers including respite and financial relief. Advance caregiver friendly work environments.
SPOUSAL EDUCATION AND COGNITIVE FUNCTION: EVIDENCE FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING
Authors: Liu Hui , Wang Juwen , Zhang Wencheng , Zaborenko Callie 
Published: January 2025

Abstract
Education is one of the strongest social factors influencing cognitive outcomes. Previous studies have predominantly focused on the impact of one’s own education, with less attention given to the education of one’s spouse. Guided by the “linked lives” perspective, this study examines the association between spousal education and cognitive function among older couples in England. We analyzed data from the English Longitudinal Study of Ageing (ELSA) Waves 7-9, 2014-2019. The sample comprised 7,131 married and cohabiting couples. Cognitive function was assessed using the modified version of the Telephone Interview for Cognitive Status (TICS). Results from the Actor-Partner Interdependence Model (APIM) showed a significant correlation in cognitive trajectories between spouses within dyads. Cross-sectional APIM analysis revealed that higher educational attainment of both spouses was associated with better cognitive function in both themselves and their partners. Longitudinal APIM growth curve analysis suggested that the association between spousal education and cognitive function was mainly driven by correlations at the initial levels, with no significant association observed with the slope of cognitive trajectories over time. We discuss these findings in the context of England and compare them to recent studies conducted in the U.S. and Mexico. Potential explanations for both similarities and differences in findings across studies are explored, shedding light on the nuanced interplay between spousal education and cognitive function.
GENDER DISPARITIES IN VISUAL DIFFICULTY AMONG OLDER ADULTS: A CROSS-NATIONAL ANALYSIS
Authors: Burns Shane , Saenz Joseph , Ehrlich Joshua 
Published: January 2025

Abstract

Background
Rapid global aging will lead to an increase of older adults with visual difficulty, especially women. However, little is known what contextual factors drive this gendered distinction across the world.

Methods
Using data from the Health & Retirement Study (HRS) international family of studies, we investigate gender disparities in visual difficulty among respondents ages 55-89 in the United States (n=14,452), England (n=5,708), Mexico (n=10,972), and Korea (n=6,649) while adjusting for demographic, socioeconomic, and health characteristics.

Results
Reports of visual difficulty across age groups were generally highest in Mexico, followed by Korea, the United States, and England. In the United States, women had a visual difficulty disadvantage that was fully explained by education and socioeconomic indicators. In England, women had a visual difficulty disadvantage that was partially explained by education and socioeconomic indicators. In Mexico, men had a visual difficulty disadvantage that was explained by comorbidities. In Korea, women had a visual difficulty disadvantage that was explained by comorbidities and health behaviors. Conclusions: Our results highlight the heterogeneity of gender disparities in visual difficulty among older adults across the world.
WHO PAYS FOR VETERANS’ POSTACUTE SKILLED HOME HEALTH CARE? A COMPARISON AMONG VA, MEDICARE, AND MEDICARE ADVANTAGE
Authors: Daus Marguerite , Devone Frank , Corneau Emily , Magid Kate , Kennedy Katherine , Gozalo Pedro , Thomas Kali , Jones Christine 
Published: January 2025

Abstract
Although costs to the Veteran Health Administration associated with post-acute home health care (HHC) have grown, limited evidence is available about the use and financing of HHC among older Veterans. The objective of this study is to identify Veteran, VA Medical Center (VAMC), and market characteristics that are associated with VHA versus Medicare-funded post-acute skilled HHC for Veterans who are discharged from a VAMC hospital with skilled HHC. We assembled and merged data from several sources for FY 2017-2019 including the VHA’s Residential History File, VHA Corporate Data Warehouse, and Centers for Medicare and Medicaid Services. Our cohort (n=64,347 Veterans, VAMCs=114) included all VHA and Medicare enrolled Veterans, aged 66 years or older, admitted to a VAMC for an acute care hospitalization and who received post-acute home health care within 14 days of discharge. We found that being MA-enrolled increased the probability of the VHA paying for HHC by 28.05% (95% Confidence Interval (CI): 27.12%, 28.96). Other important predictors that increased the probability of VHA-paid HHC include previous VHA-paid HHC episodes, previous VHA inpatient admission in the past 12 months, and an admitting diagnosis of sepsis. The most notable finding was that Veterans who are enrolled in MA have a significantly higher probability of having their post-acute HHC paid for by VHA. We will discuss how differences in HHC cost-sharing between MA and TM for members, prior authorization requirements, and denials of care used by MA plans could explain the lower rates of MA-paid HHC.
HOME HEALTH USE BY OLDER ADULTS WITH DEMENTIA: COMPARING MEDICARE ADVANTAGE AND TRADITIONAL MEDICARE
Authors: Smith Jamie , Xu Jianhui (Frank) , Brown Teneil , Burgdorf Julia , Polsky Daniel , Ornstein Katherine 
Published: January 2025

Abstract
Skilled home health care (HHC) is a critical service for community-dwelling older adults with dementia, but the majority of evidence about its use and quality is based on Traditional Medicare (TM) beneficiaries. Medicare Advantage (MA) plans - which now enroll over half of Medicare beneficiaries - have flexibility in financing and managing HHC, potentially affecting access and utilization. Given the growth in MA, increasing dementia prevalence, and delivery shifts to community settings, understanding how HHC use differs between MA and TM among persons with dementia is needed. This study compared HHC utilization in a nationally representative sample of persons with dementia in MA and TM. We used Medicare enrollment files linked to FY 2018-2019 MA encounter and TM claims data to identify persons 65+ years with dementia and at least one HHC visit in 2019. Our study sample included 316,407 persons with dementia (66% TM vs 34% MA). MA enrollees were more likely to identify as non-Hispanic, Black (13% vs. 10%), or Hispanic (12% vs. 6%) than TM. Greater proportion of TM beneficiaries were dual eligible (37% vs. 32%). The groups were similar in age, and 34% were male. Overall, MA enrollees were less likely to use HHC services than TM beneficiaries (26.2% vs 29.8%). This presentation will discuss variation in home health visit type/intensity and findings stratified by MA plan type, carriers, and geographic distribution. We will share novel approaches and best practices for measuring HHC utilization among people with dementia using newly available MA encounter data.