bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHURN: TRANSITIONS OUT OF HEALTH SECTOR EMPLOYMENT FOR LOW-PREPARATION WORKERS, 2017–2022
Authors: Bishop Christine , Donelan Karen 
Published: January 2025

Abstract
Shortages and turnover for front-line paid caregivers and support staff in long-term services and supports for older adults undermine quality of care. These workers are part of the health sector workforce, and also participate in a larger labor market of jobs requiring minimal formal education and brief training. The Brandeis Front-line Health Worker Survey queried a random sample of U.S. residents screened for holding patient-facing jobs in the health sector between the survey date (Summer 2022) and five years prior (2017), generating information on a retrospective longitudinal cross section of US health sector workers. Respondents reporting occupations in Bureau of Labor Statistics Job Zones 1 and 2 were identified as participating in low-preparation labor markets. About half of low-preparation health sector workers reported work in nursing homes, residential settings, or home care. We estimated annual rates of transition into and out of heath sector employment for all low-preparation health workers for years prior to and during the pandemic. Descriptive logistic regressions showed the relationship of job churn to gender, caregiver status, and previous employment pattern. Despite concerns about health workforce stability as the pandemic wound down, low-preparation workers exhibited about the same year-to-year transition rates out of (and back into) the health sector throughout the period. This suggests that the Great Resignation in healthcare is a continuing pattern rather than a pandemic phenomenon. Employers and public policy makers setting wages and working conditions should recognize that front-line workers have, and have always had, alternatives beyond the health sector.
NURSING HOME STAFFING DISPARITIES IN DISTRESSED COMMUNITIES DURING PANDEMIC
Authors: Kang Yu Jin , Nielsen Karen , Jordan Jacqueline , McGee Blake 
Published: January 2025

Abstract
This repeated measures study aims to examine the extent of US nursing home staffing disparities in distressed communities during the COVID-19 pandemic. The study used 2020-2022 Nursing Home Compare, 2021 LTCFocus, and the Distressed Community Index from the Economic Innovation Group. Mixed-effects models were used for data analysis. Outcomes were quarterly case-mix adjusted hours per resident day (HPRD) of all nursing staff in the last three quarters of 2020 and all of 2021: registered nurses (RN), licensed practical and vocational nurses (LP/VN), and certified nursing aides (CNA). Predictors included 2020 first quarter nurse staffing levels and distressed community index quintile. Covariates were nursing home size (greater or less than 100 beds), 5-star overall rating, Medicaid payer percentage, and non-profit status. Of the 13,845 nursing homes, 70% were for-profit and 50% had over 100 beds. On average, 5-star overall rating of nursing homes was 3.19 (sd=1.41) and Medicaid payer percentage was 60% (sd=23.5%). Compared to pre-pandemic nurse HPRD, average HPRD of the subsequent 7 quarters declined (differences: Total=-0.67, 17%; RN=-0.30, 43%; LP/VN=-0.13, 15%; CNA=-0.26, 11%). Pandemic HPRD were negatively associated with pre-pandemic HPRD (slopes: Total= -0.078; RN= -0.039; LP/VN= -0.010; CNA= -0.062, all p&lt; 0.001). Modeled interactions suggest that declines in HPRD were greatest in the most distressed communities. Analyses showed declines in nursing home staffing levels during the pandemic, with the lowest HPRD and greatest declines observed in the most distressed communities and RNs. Practical significance of the predictors and resident outcomes requires further examination.
ACTIVITIES OF DAILY LIVING (ADL/IADL) ASSISTANCE AND DEPRESSION AMONG COMMUNITY-DWELLING OLDER ADULTS IN THE US
Authors: Gupta Debasree Das , Kelekar Uma 
Published: January 2025

Abstract
Limitations in daily and instrumental activities of daily living (ADL/IADL) are among the strongest predictors of late-life depression, while ADL/IADL assistance has the potential to reduce depression among older adults. Prior research in this area has predominantly focused on proximate (e.g., going without food when hungry, wetting/soiling bed or clothes) or healthcare (e.g., hospitalizations, nursing home placements) outcomes of unmet ADL/IADL needs. Thus, the risk/protective association of ADL/IADL assistance with late-life depression remains unclear. To address this gap, we evaluated the longitudinal association between ADL/IADL assistance and subsequent depression using data from a nationally representative sample of community-dwelling Americans age 65 and older (n=5,176) who participated in the 2016-2018 Health and Retirement Study. We conducted bivariate and multivariable (logistic regression) analyses to estimate: 1) the proportion of older adults reporting ADL/IADL difficulties but not getting ADL/IADL help, and 2) the odds of subsequent depression among those reporting no versus one or more help with ADL/IADL (reference: those reporting no ADL/IADL difficulties). Results indicated a higher proportion of older adults did not get help with ADL (6.4%) compared to no help with IADL (1.9%). However, the adjusted odds of subsequent depression associated with no IADL assistance (adjusted odds ratio [aOR]: 3.22; 95% confidence interval [CI]: 2.19,4.78) was 1.66 times higher than that associated with no ADL assistance (aOR: 1.94; 95% CI: 1.35,2.78). Given these findings, enhancing long-term care services for older adults would be essential for meeting the current national goal of reducing mental distress among persons living with disabilities.
PATTERNS OF SEDENTARY BEHAVIORS IN OLDER ADULTS IN CHINESE CARE HOMES: A LATENT PROFILE ANALYSIS
Authors: Li Qi , Dong Sihan , Liu Xueying , Xu Mengjiao , Song Yuting 
Published: January 2025

Abstract
Sedentary behaviors remain common among older adults. Previous studies in this area are mostly focused on community settings and used variable-centered approach. In this study, we aimed to identify the pattern of sedentary behaviors among older adults in residential care homes in China. This cross-sectional analysis used data from 283 older adults who lived in 11 residential care homes in China. Eligible participant aged 65 years or older, had lived in the current care home for ≥3 months, and was able to communicate verbally or in writing. Sedentary behaviors were assessed with the Elderly Sedentary Behavior Questionnaire. Participants self-reported the average daily time spent in the past week on each of eight behaviors, such as watching TV, socializing, and doing nothing. Patterns of sedentary behaviors were identified using latent profile analysis and verified by associating with depressive symptoms using a regression model. The average daily sedentary time of older people was 11.6 hours (SD=2.6). Four patterns of sedentary behaviors emerged, which we labeled the high sedentism group (23%), the balanced group (50%), the high mentally-active group (8%), and the high mentally-passive group (19%). Compared to older adults in the balanced group, those in the high sedentism group and high mentally-passive group had higher risks of depressive symptoms and those in the high mentally-active group had lower risks of depressive symptoms. Targeted interventions are warranted for older adults of different patterns of sedentary behaviors, particularly older adults in the high sedentism group and high mentally-passive group.
TWENTY-FOUR-HOUR MOVEMENT AND BLOOD PRESSURE: SIX PART COMPOSITIONAL DATA ANALYSIS STUDY FROM THE PROPASS CONSORTIUM
Authors: Blodgett Joanna , Ahmadi Matthew , Atkin Andrew , Koster Annemarie , Stamatakis Emmanuel , Hamer Mark 
Published: January 2025

Abstract
Physical activity has widely known benefits for cardiovascular health. However, the influence of movement across the entire 24-hour behavioural spectrum (e.g. sleeping, sedentarism, activity type, etc.) on blood pressure remains underexplored. This study investigated associations between free-living activities that comprise a 24-hour day and systolic and diastolic BP (SBP; DBP). Data from six cohorts within the Prospective Physical Activity, Sitting and Sleep consortium (ProPASS) consortium (n=14,761; mean age 54.2±9.6 years) were analysed. Using thigh-worn accelerometers, all activity over a 7-day period and nurse-assessed BP were collected. Individual participant meta-analyses, employing compositional data analysis, were conducted. Reallocation plots were generated to estimate BP reductions by reallocating time from one behaviour to another, highlighting the potential benefits of minimal and optimal behavioural changes.
Results: On average, participants spent significant proportions of their day of sleeping (7.3hrs;31%), sedentary(10.9hrs;45%), standing(3.1hrs;13%), slow walking(1.5hrs;6%), fast walking(1.1hrs;5%), and exercise-like activity(10.9min;0.01%). Increased time spent in exercise or sleep, relative to other activities, correlated with lower BP. An additional 5 minutes/day of exercise-like activity was associated with estimated reductions of -0.68mmHg (-0.15,-1.21; SBP) and -0.54 mmHg (-0.19,0.89; DBP). Clinically meaningful improvements in SBP and DBP (2 & 1 mmHg) were estimated after reallocating 20-27 minutes and 10-15 minutes, respectively, from other activities to exercise.
Conclusion: This study highlight the significance of exercise in BP management, even in small doses within everyday life. It suggests that minor adjustments to daily routines, favouring exercise, could contribute to significant BP reductions in free-living contexts.
PSYCHOSOCIAL AND NEIGHBORHOOD-RELATED HEALTH FACTORS FOR BLACK AND WHITE ADULTS OF THE HANDLSLEEP PROJECT
Authors: Gamaldo Alyssa , Buxton Orfeu 
Published: January 2025

Abstract
Disparities in cognition and sleep have been observed in middle-aged and older Black and White adults. However, limited research has examined the association between cognition and sleep as well as the underlying psychosocial, contextual, and biomarker factors that explain this association. This symposium will include presentations using data from Healthy Aging in Neighborhood of Diversity Across the Life Span Sleep Study (HANDLSleep), which was conducted to explore psychosocial and contextual factors related to sleep and cognition in a sample of Black and White middle-aged and older adults in Baltimore, MD. The objectives of the proposed symposium are the following: (1) discuss the associations observed between sleep and cognition using cross-sectional and ambulatory data (2) discuss how psychosocial, contextual, and inflammatory markers relate to sleep and cognition. Master and colleagues explored the daily coupling associations between actigraphic sleep and working memory. Allan and colleagues explored the association between different dimensions of health (e.g., sleep and cognition) and objective and subjective measures of neighborhood quality. Linying and colleagues examined the extent that mean and variability of actigraphic sleep relate to global mental status. Lastly, Shen and colleagues explored the association between actigraphic sleep and inflammatory markers and the extent this association varies by race and sex.
ASSOCIATIONS BETWEEN MEASURES OF HEALTH AND OBJECTIVE AND SUBJECTIVE NEIGHBORHOOD QUALITY
Authors: Allan Alexa , Thorpe, Jr. Roland , Buxton Orfeu , Ross Lesley , Beydoun May , Zonderman Alan , Evans Michele , Gamaldo Alyssa 
Published: January 2025

Abstract
The current study examined the cross-sectional associations between self-reported mental/emotional (e.g., patient health questionnaire), sleep (e.g., Pittsburgh Sleep Quality Index), physical (e.g., medical conditions), and cognitive health (e.g., Montreal Cognitive Assessment) and subjective and objective measures of neighborhood quality. This preliminary analysis included 77 community-dwelling socioeconomically diverse Black and White adults (Mage = 62.17, SDage = 9.71; 70% female) from the HANDLSleep study. Neighborhood quality was assessed using self-reported measures of physical built disorder (e.g., graffiti), social cohesion (e.g., close-knit neighborhood), and social control (e.g., neighbors act if children disrespecting an adult). Area Deprivation Index (ADI) National and State values were extracted from the Neighborhood Atlas using participant addresses. Multivariable linear regression analyses were conducted using health measures as the outcome of interest. Models were adjusted for age, sex, race, education, and poverty status. In the adjusted models, participants living in neighborhoods of greater deprivation (i.e., State ADI) reported higher levels of depressive symptomology (p &lt;.05) and worse sleep quality (p &lt;.05). Likewise, higher reports of physical built disorder were associated with poorer cognition (i.e., attention, p &lt;.05). Contrastingly, reports of better social cohesion were associated with lower insomnia severity scores (p &lt;.05) and better performance on a measure of executive function (p &lt;.01). Reports of more social control was also associated with better executive function (p &lt;.05). These findings highlight the importance of examining both objective and subjective neighborhood characteristics as they pertain to different dimensions of health.
PSYCHOLOGICAL RESILIENCE MAY IMPROVE SLEEP QUALITY OF FAMILY CAREGIVERS OF OLDER ADULTS
Authors: Malhotra Rahul , Quach Ha-Linh , Lim-Soh Jeremy 
Published: January 2025

Abstract
Given the increasing focus on the importance of sleep for health and well-being, we assessed the (a) association of caregiving status (family caregiver/non-caregiver) with sleep quality and its moderation by psychological resilience and (b) factors influencing sleep quality among caregivers. Cross-sectional data on subjective sleep quality (Pittsburgh Sleep Quality Index (PSQI); higher global or component scores represent worse sleep quality) and psychological resilience (Connor-Davidson resilience scale) from Singapore on 167 family caregivers of older adults and 135 non-caregivers was analyzed. Multivariable linear regression models assessed the association of caregiving status with global PSQI score and it’s moderation by psychological resilience and identified caregiver and care-recipient characteristics associated with global PSQI score among caregivers. Mean global PSQI score (6.0 versus 4.5), proportion with poor sleep quality (global PSQI score&gt;5; 46.1% versus 28.1%) and mean component scores (for sleep latency, sleep quality, sleep duration, and daytime dysfunction) were higher for caregivers, versus non-caregivers, reflecting their worse sleep quality. In multivariable analysis, caregivers had higher global PSQI score than non-caregivers (beta-coefficient: 1.04, p&lt;0.05). However, this association was moderated by psychological resilience (beta-coefficient: -0.70, p&lt;0.05) – the deficit in sleep quality for caregivers versus non-caregivers reduced with higher psychological resilience. Finally, among caregivers, those with higher education, fewer chronic conditions, fewer functional limitations, and higher psychological resilience had lower global PSQI score, i.e., better sleep quality. Our findings reveal the detrimental effect of being a family caregiver (versus not) on sleep quality and identify psychological resilience as a potential modifiable factor for mitigating it.
HEALTH CONDITIONS AND CONTINUOUS POSITIVE AIRWAY PRESSURE DISCONTINUATION IN US MIDDLE-AGED AND OLDER ADULTS
Authors: Sekhon Vishaldeep , Roth David , Albrecht Jennifer , Wickwire Emerson , Spira Adam , Amjad Halima , Tseng Chien-Yu , Kaufmann Christopher 
Published: January 2025

Abstract
Although continuous positive airway pressure (CPAP) is an efficacious treatment for obstructive sleep apnea (OSA), suboptimal adherence is common, reducing its effectiveness. OSA co-occurs with chronic health conditions that may impact adherence to CPAP. This study evaluated health conditions as predictors of CPAP discontinuation over 2 years. Data came from the 2016 and 2018 Health and Retirement Study, a longitudinal cohort study of a nationally representative sample of 20,000 older adults in the U.S. In both years, participants were asked if “a doctor had ever told them they have a sleep disorder,” and if so, which disorder and any treatments received (including CPAP). In 2016, participants also reported whether a doctor ever told them they had several health conditions (high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, psychiatric problems, and arthritis). We identified CPAP users in 2016 with available data in 2018. Participants not listing CPAP in 2018 were considered to have discontinued CPAP. We used logistic regression to determine which health conditions predicted CPAP discontinuation after controlling for age, sex, race/ethnicity, education, BMI, and marital status. Of N=902 CPAP users in 2016, 38% did not indicate CPAP use in 2018. Participants diagnosed with diabetes in 2016 had 36% increased odds of CPAP discontinuation (AOR=1.36, 95% CI=1.02-1.80) compared to those without diabetes after accounting for other covariates. CPAP discontinuation did not differ across other health conditions. Overall, CPAP users with diabetes were at increased likelihood of CPAP discontinuation, necessitating efforts to encourage CPAP adherence in this vulnerable group.
PUBLIC HEALTH APPROACHES FOR SUSTAINABILITY OF DEMENTIA EVIDENCE-BASED PROGRAMS
Authors: Waugh Kellie , Leavitt Talyah Sands 
Published: January 2025

Abstract
ASTHO, with support from CDC, has gathered strategies, examples, and resources to inform the development of sustainability focused capacity-buildings materials for public health departments, including an actionable resource for integrating sustainability into Healthy Brain Initiative (HBI) implementation. Attendees will be provided with a guided look through this tool, developed to elevate the importance of sustainability and support health departments in sustaining their programmatic dementia work. The public health-driven strategies included provide a unique guide for embedding sustainability into dementia initiatives and evidence-based programs from initial planning to implementation. Subsequently, the guidance is extended to ensure health equity is operationalized throughout the entirety of this process. Attendees will enhance their ability to ensure positive outcomes and provide long-term program benefits by thoughtfully considering complex factors that determine the sustainability of evidence-based programs, such as duration of funding, partnership, and organizational support. To encourage practical application, the presentation will showcase two state public health department examples of evidence-based programs that have effectively prioritized sustainability. The presenter will offer reflective insights on what sustainability means for public health practitioners involved with dementia and older adult health programs and shed light on how these efforts sustain positive outcomes across the life span and advance health equity.
MITOFIT: A FORMATIVE/SUMMATIVE EVALUATION OF A NOVEL INTERVENTION ON MITOCHONDRIAL FITNESS
Authors: Maxwell Cathy , Grubbs Brandon , Boon Jeffrey , Dunavan John , Knickerbocker Kelly , Patel Maulik 
Published: January 2025

Abstract

A key driver that leads to age-associated decline and chronic disease is mitochondrial dysfunction. Our prior work revealed strong community interest in the concept of mitochondrial fitness that led to development of a video-based intervention to prompt behavior change in adults aged 50+.

Aim
To conduct formative and summative evaluations of MitoFit, an instructional, biologically-based communication intervention aimed at improving physical activity (PA) in older adults, aged 50+.

Methods
Phase 1 formative evaluation- Community-dwelling older adults (N=101), rated the acceptability, appropriateness and helpfulness of our MitoFit video series, titled, “How to Slow Down Aging Through Mitochondrial Fitness.” (4 out of five on a Likert-scale survey). Phase II summative evaluation- A subgroup of phase I participants (N=19) participated in a 1-month MitoFit intervention prototype to evaluate intervention and data collection feasibility (70% completion).

Results
Phase I: Participants (mean age: 67.8 [SD 8.9]; 75% female) rated the MitoFit videos as acceptable (agree: 97%-100%), appropriate (agree: 100%) and helpful (agree: 95%-100%) to support adaptation and continued work on our novel approach. Phase II: Participants (mean age: 71.4; 72% female) demonstrated MitoFit competencies (obtaining pulse, calculating maximum and zone 2 heart rate, demonstration of exercises). At one-month post-instruction, 13 participants (68.4%) had completed a self-initiated daily walking/exercise plan and submitted a daily activity log. Feasibility scores ranged from 89.4% to 94.7%. Fifteen participants (78.9%) stated an intention to continue the MitoFit intervention.

Conclusion
MitoFit was enthusiastically embraced, and is a cost-effective, scalable, and efficacious intervention to advance with community-dwelling adults.
DEVELOPING AND TESTING A PROTOCOL FOR TELEPHONE REASSURANCE CALLS: A RANDOMIZED PILOT STUDY
Authors: Minyo Morgan , Bass David , Judge Katherine , McCarthy Kate , Terry Christine , Willis Crysta , Beach Douglas , Perkins Fatima 
Published: January 2025

Abstract
Telephone reassurance call programs that provide conversation and check-ins to isolated older adults have increased since the COVID-19 pandemic. The goals of these programs are to give older adults opportunities to express unmet needs, receive service referrals, and increase their use of home-and community-based services. Few empirical studies have examined the efficacy of these programs, including whether different approaches to telephone reassurance calls lead to different outcomes. This 24-month randomized controlled pilot study recruited older adults from an Area Agency on Aging to compared two approaches to telephone reassurance calls: 1) usual care, unstructured friendly check-in calls from a social worker (n=20) and 2) a newly developed protocol of semi-structured calls from a social worker (n=23), which was adapted from an evidence-based program. Multivariate results found significant differences in multiple outcomes. Compared to usual care (M=0.7, SD=1.0), participants who received the new semi-structured calls (M=2.1, SD=2.8) identified 1.75 more unmet service needs (t=2.69, p=.01). Participants who received the new semi-structured calls (M=1.1, SD=1.3) also received 1.23 more service referrals (t=4.07, p&lt;.01) than usual care participants (M=0.3, SD=0.6). Additionally, participants who received the new semi-structured calls (M=3.7, SD=2.6) started or continued using 1.39 more services (t=2.02, p=.05) than usual care participants (M=2.4, SD=1.7). Findings suggest that the semi-structured protocol led to more beneficial outcomes while requiring only a seven-minute increase in the length of each telephone reassurance call. Discussion will focus on next steps for expanding the semi-structured protocol and sample in a multisite randomized trial.