bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLUSTERING OF MULTIDIMENSIONAL NEIGHBORHOOD CHARACTERISTICS IN SHAPING HEALTHY AGING
Authors: Yu Jiao , Qin Weidi , Wang Jiuzhou , Kahana Eva 
Published: January 2025

Abstract
Neighborhoods are pivotal in shaping later life health and well-being. While previous research has primarily examined a single dimension of neighborhood risk factors (e.g., socioeconomic disadvantages), this study proposes a timely shift toward a multi-dimensional perspective of neighborhood characteristics. We aim to explore how multiple neighborhood characteristics synergistically shape various later life health outcomes, including comorbidity, disabilities (ADL), mental health, functional limitations, cognitive health, and epigenetic aging (GrimAge). Using data from the 2014 and 2016 waves of the Health and Retirement Study linked to the National Neighborhood Data Archive (n = 8,474), we first applied a machine learning algorithm -- the Partitioning Around Medoids (PAM) method to identify a neighborhood typology based on neighborhood-level socioeconomic status, facilities, services, and hazards. This analysis identified four clusters: affluent neighborhoods, mid-SES with high hazards neighborhoods, high amenity neighborhoods, and disadvantaged neighborhoods. Subsequently, we conducted multilevel regression analyses to examine the association between the identified neighborhood clusters and later life health outcomes. Regression results revealed significant health disparities across different neighborhood clusters. Compared to their counterparts living in affluent neighborhoods, older adults residing in disadvantaged neighborhoods and those in mid-SES with high hazards neighborhoods experienced greater chronic conditions, worse mental health, and more functional limitations. These findings underscore the urgent need for tailored interventions aimed at enhancing service facilities and mitigating environmental hazards in disadvantaged and high-risk communities. Addressing these neighborhood factors is essential for promoting communities that are conducive to healthy aging and supportive of successful aging in place.
TOXIC HOMES AND COMMUNITIES? EXPOSURE TO URBAN FIRES AND INCREASED LIFE COURSE DEMENTIA RISK
Authors: Finlay Jessica , Bowman Grace , Miller Matthew , Reid Colleen 
Published: January 2025

Abstract
Little is known about the health impacts of wildland urban interface (WUI) fires, which are increasingly common and mostly burn human-made materials. The Marshall Fire Community Health Research Study investigated a destructive WUI fire that affected communities of Superior and Louisville (CO) on December 30, 2021. Semi-structured seated and mobile interviews conducted July through November 2023 probed for perceived impacts on physical, mental, social, and cognitive health. Participants (n=44) were on average 52 years old (±16 years), 86% identified as Non-Hispanic White, 67% female, 86% homeowners, and 46.5% of participant homes were fully destroyed (53.5% smoke damaged). Reflexive thematic analysis identified behavioral and social pathways that may pose longer-term risk for Alzheimer’s Disease and Related Dementias across the life course. This includes early-life educational disruptions (e.g., displacement and stress/anxiety) and mid-life increased risk for hypertension, obesity, and alcohol consumption through heightened stress, lack of time and motivation for diet and exercise, maladaptive coping mechanisms, poor sleep quality, and reduced access to health-promoting services. Later life factors include increased risk for depression, social isolation, physical inactivity, diabetes, and exposure to poorer air quality. These risks varied by individual factors such as education, employment, insurance coverage, type of fire damage, and household composition. Individuals whose homes were smoke damaged may be particularly vulnerable. The study identifies novel behavioral and social pathways through which WUI fires may pose multifaceted and long-term cognitive health risks beyond the acute recovery phase.
SLEEP QUALITY IMPROVES IN DEMENTIA CAREGIVERS USING ONLINE SELF-GUIDED ACCEPTANCE AND COMMITMENT THERAPY
Authors: Fauth Elizabeth , Gossner Jacob , Juhasz Audrey , Aller Ty , Levin Michael 
Published: January 2025

Abstract
Transdiagnostic interventions treat multiple conditions by addressing common underlying mechanisms. Randomized controlled trials, systematic reviews, and meta-analyses support that Acceptance and Commitment Therapy (ACT) is a transdiagnostic mindfulness-based Cognitive Behavioral Therapy that improves anxiety, depression, pain, etc. in diverse populations. ACT efficacy is supported in dementia caregivers, typically studied via psychological or care-related outcomes. ACT improves sleep in cancer caregivers, and sleep is often disturbed in dementia caregivers. The current study examines if sleep quality improves in (N=80) dementia caregivers engaging with a caregiver-tailored six-session online, self-guided ACT program. Participants completed the Sleep Quality Scale and other assessments at T1 (pre-intervention), T2 (post-intervention) and T3 (6-week followup). A sleep-related item from a depression inventory assessed sleep restlessness. Items from a behavioral symptom inventory assessed the extent to which care receivers woke the caregiver or others in the night, and assessed caregivers’ stress appraisal of this experience. We did not hypothesize that care receivers’ wakefulness would be impacted, but hypothesized improvements in the other caregiver sleep indicators. Repeated measures ANOVA identified that caregivers improved average sleep quality [F(2,158)=7.907, p&lt;.001; partial eta-squared =.091] and reported less sleep restlessness [F(2,156)=10.039, p&lt;.001; partial eta-squared =.114]. Post hoc comparisons identified change occurring between T1-T2 (Intervention phase), sustained over time (T3). Care receivers’ waking behavior did not change over time (p=n.s.), but caregivers experiencing this behavior across all timepoints (N=17), reported being less bothered by it [F(2,32)=5.457, p&lt;.01; partial eta-squared =.254]. ACT interventions offer promise in improving sleep experiences for dementia caregivers.
THE COMBINED IMPACT OF MIDLIFE AND LATE-LIFE VASCULAR RISK FACTORS ON 33-YEAR INCIDENT DEMENTIA: THE ARIC STUDY
Authors: Smith Jason , Pike James , Lutsey Pamela , Sharrett Richey , Gross Alden , Deal Jennifer 
Published: January 2025

Abstract
Midlife vascular risk factors are associated with an increased risk of dementia. However, the overall contribution of modifiable vascular risk factors in midlife and late-life to dementia remains unclear. In this study, we quantified population attributable fractions, which account for risk factor prevalence and strength of relative risks, of incident dementia from vascular risk factors measured in midlife and early late-life. We used 33 years of prospective cohort data in the Atherosclerosis Risk in Communities (ARIC) Study. Incident dementia was ascertained from baseline (1987-1989) through December 31, 2020. We quantified population attributable fractions of incident dementia by age 80 from the combination of hypertension, diabetes, and self-reported current cigarette smoking (at least one risk factor versus none) measured at different ages (45-54 [n=7,731], 55-64 [n=12,273]; 65-74 [n=6,660]). Overall, the prevalence of having one or more of the vascular risk factors was 61.6% at age 45-54, increasing to 68.2% by age 55-64 and 77.5% by age 65-74. The population attributable fraction of dementia from having one or more vascular risk factors increased from 22.7% (95% CI: 15.3-30.1%) for risk factors measured at age 45-54 to 26.4% (95% CI: 19.1-33.6%) at age 55-64 and 45.4% (95% CI: 32.5-58.3%) for risk factors measured at age 65-74. Our data indicate between 23%-45% of incident dementia cases in ARIC were attributed to a combination of hypertension, diabetes, or current smoking up through age 74. Public health strategies targeting modifiable vascular risk factors could delay or prevent new dementia cases.
EXPERIENCES OF CHALLENGES AND DISCRIMINATION AMONG ASIAN AND ASIAN AMERICAN OLDER ADULTS
Authors: Vang Cindy , Lee Yeonjung , Her-Xiong Youhung 
Published: January 2025

Abstract
Asian Americans are one of the fastest-growing racial and ethnic minority older adult populations, with projections of up to 7.8 million in 2060. Despite the expected increase in this population, Asian Americans are often sidelined in discourses focused on discrimination and health disparities. The disparate discrimination and challenges for Asian and Asian American (AAA) older adults are not new; however, COVID-19 has exacerbated existing and emerging vulnerabilities and difficulties. The purpose of this study was to explore AAA older adults’ understanding and experiences of overcoming challenges and discrimination during the COVID-19 pandemic using a grounded theory methodology. Participants (N=30) identified as 50 years and older, resided in the United States, and had origins from Asia were recruited through convenience and snowball sampling methods. These older adults participated in a one-time open-ended interview about their experiences and how they overcame challenges and discrimination during the pandemic. The results of our study describe the process of overcoming COVID-19 challenges and discrimination through causal conditions, contextual factors, and intervening conditions, which influenced the central phenomenon of maintaining vigilance for COVID-19 and discrimination, participants’ resilience, and mental, emotional, and social consequences. Results imply further research to deepen knowledge of AAA older adults’ experiences with discrimination and resilience and policies to support interventions to enhance these older adults’ well-being.
AD/ADRD AND SOCIAL SUPPORT ADVOCACY FOR BLACK NURSING HOME RESIDENTS
Authors: Bailey Dionne , Bucy Taylor , Skarphol Tricia , Shippee Tetyana 
Published: January 2025

Abstract
Black older adults represent 24% of all nursing home (NH) residents in the U.S., 20.2% of whom have Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). Despite consuming a disproportionate share of NH services, when compared to their white counterparts, Black older adults experience worse health outcomes and are more likely to reside in lower-quality facilities, a direct byproduct of systemic racism. To cope with the stress of inadequate care delivery, many Black residents rely on external social support networks. Little research to date has explored how external social support is or can be, leveraged by Black residents for improved care delivery. Drawing on the Minority Stress Model, we applied thematic analysis to three focus group transcripts (n=22) conducted with AD/ADRD caregivers in Minnesota. We found that resident social support networks overwhelmingly adopted a “support through advocacy” mentality. Although these efforts are grounded in the care of their friends or family, advocacy behaviors often had to be extended to additional residents because they identified themselves as lacking social support. Given the disproportionate share of Black residents with AD/ADRD living in institutional-based settings, understanding both formal and informal care delivery practices, especially the role of Black resilience, is essential to creating high-quality care settings.
WHAT FACTORS ARE ASSOCIATED WITH SELF-PERCEPTION OF INTENSE FAMILY CAREGIVING?
Authors: Hassell Susan , Campione Joanne 
Published: January 2025

Abstract
The stress and anxiety associated with family caregiving can contribute to the caregiver’s own health and well-being and can also be linked to less effective caregiving. As part of the 2023 National Survey of Older Americans Act (OAA) Participants, the following item was asked among 1,187 clients of the National Family Caregiver Support Program (NFCSP): “On a scale of 1 to 5, where 5 is very intense, how intense is the care you provide?” Fifty-one percent responded that the care is intense or very intense. Of the remaining caregivers, 15% responded that the care was not intense and 34% felt neutral. We first tested 62 survey variables for bivariate significant differences between “intense care” vs. “not intense care” and then used stepwise multivariable logistic regression. Variables included caregiver demographics, caregiving situational factors, caregiver nutrition, caregiver well-being, care receiver (CR) demographics and health conditions, and the number of activities of daily living (ADL) difficulties experienced by the CR. From the final logistic regression model (c-statistic = 0.74), the factors associated with a significant increase (p &lt; 0.01) in the likelihood of self-reported intense care were: 1) CR’s number of ADL difficulties, 2) caregiver food insecurity score, 3) CR has Alzheimer’s or other memory-related disease, 4) caregiver provides all or almost all the care, and 5) the caregiver has no time for self. These findings provide a deeper understanding of the type of caregivers that may need more support from the NFCSP and from the OAA’s case management and home-delivered meals programs.
THE ROLE OF CARDIOVASCULAR MORTALITY IN LIFE EXPECTANCY GAPS AFTER AGE 50 BETWEEN US AND OTHER HIGH-INCOME COUNTRIES
Authors: Bramajo Octavio , Mehta Neil 
Published: January 2025

Abstract

Compared to other high-income countries, the United States underperforms in life expectancy. One key driver of this differential is cardiovascular disease (CVD) mortality, a cause of which the US has had worse trends since around 2008. The differential in CVD mortality has been previously described, however, its contribution to the widening of the US life expectancy lag relative to other high-income countries is unknown. We measured the contribution of CVD mortality to the post-2010 life expectancy divergence between the US and other ten high-income countries. Data and

methods
Using life table methods and WHO cause-specific mortality data, we computed life expectancy at age 50 (LE50) by sex and by two counterfactual scenarios to establish the contribution of CVD mortality in the growth LE50 gap between 2008 and 2019: first in a cause-deleted approach, removing CVD deaths, and by replacing the age-specific CVD mortality rates of the high-income countries in 2019 with the corresponding US CVD mortality improvement rate. The US had a lower LE50 compared to the average of other high-income countries in 2008), and the LE50 gap with those countries increased in 2019 by 0.4 years for females and 0.8 years for males. Either removing or replacing CVD mortality resulted in narrowing the overall LE50 gap between the US and the high-income countries in 2008 and 2019, and in most cases doing so was able to close it entirely by themselves, especially for females, with CVD explaining entirely the growth of the gap
CHARACTERIZING MEDICARE ADVANTAGE APPROACHES TO PROVIDING POSTACUTE HOME HEALTH
Authors: Gadbois Emily , Daus Marguerite , Jones Christine , Smith Jamie , Thomas Kali 
Published: January 2025

Abstract
Medicare Advantage (MA) is a major payer of post-acute home health care, but little is known about how MA approaches home health benefit design and provision. In-depth, semi-structured interviews were conducted with 18 leaders from MA plans and care management companies and transcribed; content analysis was used to characterize underlying themes. Across interviews, participants agreed that as long as clinically appropriate, home was the preferred setting for post-acute care. Participants described the role of MA plans and care management companies in the provision of home health care, with most taking a hands-off approach to selecting the setting of post-acute care, instead deferring to patients’ choices and citing CMS regulations restricting involvement. Other organizations had more involvement in the selection of post-acute setting, with participants saying that while they don’t “steer” or “direct” setting of care, hospital discharge planners often engaged with their staff for help with difficult to place patients. In the initiation of post-acute home health, participants reported a variety of strategies for service authorization and utilization management. Plans described various approaches to care management to complement post-acute home health services, which in some cases included engaging with care management companies to deliver this aspect of care. In discussing MA approaches to post-acute home health, participants also highlighted substantial challenges facing the home health industry, particularly staffing concerns, and especially in rural areas. Insights from this work can help policymakers understand how MA plans cover home health services and coordinate with providers.
THE 4MS OF BEHAVIORAL HEALTH IN AN AGE-FRIENDLY HEALTH SYSTEM: TESTING AN EDUCATIONAL FRAMEWORK
Authors: Emery-Tiburcio Erin , Porter Laura , Wang Siqi 
Published: January 2025

Abstract
The 4Ms framework of an Age-Friendly Health System (What Matters, Medication, Mentation, Mobility) was originally developed for hospital and ambulatory care settings. As many behavioral health providers did not clearly see a role for themselves in all 4Ms, the framework was adapted for use by behavioral health providers in order to improve the quality of care provided to older adults. The 4Ms-Behavioral Health (4Ms-BH) training program was designed and implemented to assess the impact of training on knowledge and clinical behavior change among mental health clinicians with little to no geriatric training. A secondary goal was to fine-tune the pilot training program for widespread implementation. Fifteen mental health clinicians from Community Mental Health Centers in three states completed eight hours of live webinar training over six months: one three-hour introduction followed by five monthly one-hour application webinars. Clinicians completed knowledge and clinical behavior measures before, during, and after training, along with an assessment of follow-up sustainability needs. The 4Ms-Behavioral Health framework was very well received by participants, who demonstrated significant knowledge gains and clinical behavior change. Participant knowledge increased for each of the 4Ms, with Medication and Mobility showing greatest improvement at 17% and 15%, respectively. Effect sizes for practice behavior change from pre-training to post-training were large (Cohen’s d range =.82 – 1.66, p≤.01) in each of the 4Ms assessment and action activities. Implications of the pilot training program for teaching students and licensed professionals will be discussed.
UTILIZATION OF 4MS TRAINING MODEL IN PRIMARY CARE SETTINGS WITH SOCIAL WORK LEARNERS
Authors: Faul Anna , Cotton Samantha , Yankeelov Pamela 
Published: January 2025

Abstract
The UofL GWEP used our FlourishCare curriculum (FCC) to train 52 social work (SW) learners on the 4Ms of age-friendly care. The FCC provides a variety of learning experiences, eg. online modules, workshops, interprofessional case management experiences, case conceptualization meetings, and Project ECHO’s. The FCC was delivered during the two-semester SW internship. The experiential part of the FCC allowed learners to work with small caseloads of patients incorporating the 4Ms in assessment, engagement and care navigation. Learners received weekly supervision from clinical SWers trained in the 4M model. The Kirkpatrick model of evaluation was used to evaluate the FCC, focusing on learner satisfaction, knowledge gain, self-efficacy to practice the 4M model, and patient outcomes. Evaluation data shows 95% of learners were satisfied/very satisfied with the learning experience. Learners showed a significant gain in knowledge related to the 4Ms of age-friendly care (Pre-M=65, SD=7.2; Post-M=76, SD=8.1). Learners significantly improved in in their self-efficacy to perform 4M age-friendly care (Pre-M=5.2, SD=1.3; Post-M=8.3,SD=1.9). Patient outcomes data, as measured by our biopsychosocial FlourishCare Index assessment showed that patients served by these learners significantly improved in their overall Index scores (Pre-M=50,SD=7.9; Post-M=59,SD=6.2), their psychological health (Pre-M=52,SD=5.4;Post-M=67,SD=6.1), and their health behaviors (Pre-M=49,SD=7.6; Post-M=58,SD=6.5). These results show the effectiveness of the FCC to develop a future SW workforce who has the ability to provide 4M age-friendly care.
AGE-FRIENDLY HEALTH SYSTEM “4MS STOP-AND-WATCH” PROGRAM: A CNA EDUCATION INITIATIVE IN LONG-TERM CARE
Authors: Elliott Susan 
Published: January 2025

Abstract
The valuable contributions of Certified Nursing Assistants (CNAs) working in the longterm care setting are often overlooked, particularly in the implementation of Age-Friendly Health System (AFHS) practices. The “4Ms Stop-and-Watch” initiative was developed to integrate CNAs into the AFHS transformation of a post-acute longterm care facility. With support of the facility administration, our team created didactic and experiential learning opportunities in which all facility CNA staff were invited to participate. CNAs first attended a presentation on the AFHS concepts and the 4Ms framework with a description of the “Stop-and-Watch” program provided. Participants were directed to use a paper form to identify and address at least one 4M during each shift. The information was then entered into an online questionnaire before the end of their shift. The CNA identified which of the 4Ms was addressed and the action taken (e.g., inform nursing supervisor). Survey results were compiled and analyzed to determine effectiveness of education, grasp of 4Ms assessment and intervention, and trends in resident encounters. Feedback was provided to CNAs and facility administration. The presentation will provide detailed information to enable facilities to develop a “4Ms Stop-and-Watch” program to optimize the competency and contributions of the direct care staff.
A NOVEL APPLICATION OF BOLCK-CROON-HAGENAARS METHOD WITH MIXED-EFFECT LATENT CLASS ANALYSIS OF AGING TRAJECTORIES
Authors: Xia Weiyi , Zafar Anum , Jarrín Olga , Setoguchi Soko , Roy Jason , Lin Haiqun 
Published: January 2025

Abstract
This work assesses the association between longitudinal trajectory classes and risk factors. The longitudinal trajectory classes are derived from the latent class analysis of longitudinal variables of interest such as repeated cognitive status and days in a quarter in a care setting during last years of life. This work aims to apply the Bolck–Croon–Hagenaars (BCH) method to the mixed effect group-based trajectory model to account for the individual heterogeneous effects. First, we fit a group-based trajectory model with random intercepts. The inclusion of the random effects poses a computational challenge that we address in this work. Next, each individual would be assigned a class membership with the highest posterior probability (modal assignment). Proportional assignments can be used as well. BCH weights are obtained based on the product of assigned class membership probabilities and the inverse of the matrix for misclassification errors. Finally, we reweight the data to assess the relationship between latent class memberships and risk factors. We test the performance of the bias-corrected BCH approach with simulated data. The simulation results reveal much smaller bias with BCH and larger bias with the naive three-step approach. We then apply the BCH method to assess the association between the aging trajectories, such as cognitive function trajectories or care setting trajectories in last years of life, and socio-demographic and clinical factors among Medicare beneficiary decedents. The application of the BCH method on the mixed-effect group-based trajectory modeling provides a rigorous assessment of the association between aging trajectories and risk factors.