bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTEGRATING AGE-FRIENDLY QUALITY IMPROVEMENT INTO RURAL CLINICAL ROTATION FOR MEDICAL STUDENTS
Authors: Christensen Keri , Severance Jennifer , Hadley Lesca 
Published: January 2025

Abstract
Early learning experiences in quality improvement (QI) prepare medical students for practice in complex health systems and for improving processes of care for older adult patients. We developed a curriculum using the Institute for Healthcare Improvement (IHI) Age-Friendly Health Systems 4Ms framework to train third-year medical students (n=75) in geriatrics-focused QI during a twelve-week family medicine clinical rotation in rural communities. Prior to the rotation, students completed asynchronous online training introducing QI models, Plan-Do-Study-Act (PDSA) cycles, and the Age-Friendly 4Ms framework. During the rotation, students met with their preceptor to identify a goal and conduct project activities to enhance Age-Friendly care for older adults within their practice setting. Students also collected information about the local community and patient outcome data related to CMS quality measures. Geriatrics faculty conducted weekly virtual meetings with students to discuss projects and challenges. A final written assignment summarizing their project results, clinical implications and next steps for the primary care setting in a standard abstract format that can be used for a poster presentation at a professional conference. Students (n=71) completed evaluation surveys to rate the usefulness of training and to self-assess knowledge and skills using five-point Likert-type items. Students (n=50) reported increased knowledge and skills in conducting QI activities and improved understanding of the importance of improving processes and patient care. Integrating the Age-Friendly Health Systems framework into QI training can support competency development in system-based practice while disseminating Age-Friendly practices and resources within a health care setting.
POLICY SERIES: INEQUITABLE IMPACTS OF POLICY AND PAYMENT CHANGES ON CARE USE AND OUTCOMES FOR OLDER ADULTS WITH HIGH CARE NEEDS
Authors: Falvey Jason , Kumar Amit 
Published: January 2025

Abstract
Over the past decade, the CMS has introduced numerous value-based policy initiatives. While these changes aim to reduce cost of care, they often have disparate effects on patient care and clinical outcomes particularly among minority communities and older adults with high-needs. The first presentation explores the disproportionate impacts of Medicare Advantage (MA) penetration among skilled nursing facility (SNF) users across various racial and ethnic identities, shedding light on the disparities perpetuated within the healthcare system. Another will then examine the ramifications of the Patient-Driven Groupings Model (PDGM) on older adults with dementia receiving home care, scrutinizing the changes in care and potential impacts on outcomes associated with this shift. Following this, the discussion shifts to the inequitable access to adult day services in urban areas, particularly highlighting the barriers faced by many older adults seeking non-institutional long-term care options that are growing in number around the country. Last, the symposium will discuss findings from qualitative work exploring how neighborhood disadvantage affects community mobility and successful aging in place among older adults recovering from lower extremity surgery, and the structural inequities experienced by this population with changes to home health care benefits. We will specifically highlight factors such as community cohesion and exposures to violent crime as key deterrents for recovery among older adults living with new mobility disability. Overall, this symposium will stimulate current debate on merits and demerits of various federal policies and growth of MA plans for older adults with high-needs.
GEOGRAPHIC PATTERNS IN THE LOCATIONS OF ADULT DAY CENTERS AND NURSING HOMES IN TEXAS
Authors: Downer Brian 
Published: January 2025

Abstract
Most older adults want to live at home in a community setting and avoid moving to a nursing home. Adult day centers (ADCs) are a valuable resource that can help older adults live at home. However, a concern is older adults may not have access to ADCs to benefit from their services. This analysis describes geographic patterns in the locations of ADCs and nursing homes in Texas. We used data from the Texas Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) to identify all licensed ADCs and CMS certified nursing homes, respectively, in Texas. Data for county characteristics (population, % aged &gt;65) came from the US Census. Texas has 425 ADCs and 1,195 nursing homes. Among the 254 Texas counties, 48 (18.9%) have at least one ADC and 217 (85.4%) have at least one nursing home. Of the 37 counties with no nursing home, 1 county had an ADC while 170 of the 206 counties without an ADC had at least one nursing home. Approximately 6% (n=73) of nursing homes and 54.8% of ADCs (n=233) were in the thirteen counties boarding Mexico, with Hidalgo County (total population n=855,175; 11.5% aged &gt;65) having nearly one-third of all ADCs (n=132). Conversely, the five most populous counties in Texas (total population n=12,482,916; 12.0% aged &gt;65) had 26.1% of ADCs (n=111) and 30.0% of nursing homes (n=354). These findings suggest that older adults living in large metropolitan areas of Texas may have inadequate access to ADCs.
RISK PERCEPTIONS OF DIRECT CARE NURSING HOME STAFF ASSOCIATED WITH RESTRICTED SOCIAL ACTIVITIES
Authors: Akter Nahida , McClean Melissa , Kowalchik Kalei , Mogle Jacqueline , Carpenter Joan , Behrens LIza 
Published: January 2025

Abstract
Recognized globally, social activities support better quality of life in older adulthood. The COVID-19 pandemic presented unprecedented challenges for nursing homes (NHs) in balancing infection prevention control (IPC) measures with honoring resident preferences for social activities. The purpose of this study was to explore NH staff’s risk perceptions around facilitating resident preferences amidst pandemic restrictions. Guided by the Preference-Based Person-Centered Risk Engagement Model, this study used mixed methods to achieve an in-depth understanding NH staff risk perception. Quantitative data included demographics and risk perceptions using the Risk Propensity Scale. Participants (N=24) were 39 years on average (range: 18-62), mostly female (88%) and white (79%). Purposive sampling reflected a range of roles within the NH context: certified nursing assistants (29%), activities directors (25%), social workers (25%), and nurses (21%). Average risk perceptions scores were in the risk avoider range at 3.53 (SD = 1.43; range: 1.00-7.14) and most participants (58%) self-identified as risk avoiders. Those who identified as risk seekers were significantly more likely to be male (chi-sq(2)=17.14, p&lt;.01) and African American (chi-sq(4)=20.42, p&lt;.01). Qualitatively, semi-structured individual interviews collected staff perceptions of risk related to residents’ social activities. Guided content analysis revealed two main themes supported by six sub-themes: Factors of decision-making (family influence, organizational, staff and resident characteristics) and Direct care staff influencing preference-based care (cognitive skills and technical skills). Findings will be discussed considering implications for how best to support direct-care staff with varied perceptions of risk (risk seekers/risk avoiders) to encourage social activities when IPC measures are indicated.
NURSING HOME LEADER PERSPECTIVES OF DELIVERING QUALITY CARE AT TRANSITION TO ENDEMIC PHASE OF COVID-19
Authors: Behrens LIza , VanHaitsma Kimberly , Boltz Marie , Calo William , Van Scov Lauren , Kraschnewski Jennifer 
Published: January 2025

Abstract
Nursing Home (NH) leaders are challenged to deliver quality person-centered care (PCC), despite the COVID-19 transition to an endemic phase. This study aimed to describe NH leadership perspectives on preparing and maintaining quality care during the transition point between the COVID-19 pandemic and endemic to identify how best to support NHs in balancing infection risks with PCC. Fifteen (n=15) NH leaders enrolled in the Project Extension for Community Health Outcomes (ECHO) study participated in semi-structured interviews between March and April of 2022. Interviews lasted approximately 60 minutes, were recorded, transcribed verbatim, and verified for accuracy. Multiple coders used constant comparative method to code remaining transcripts (final kappa was.76). Final descriptive themes and subthemes were created via group consensus. NH Leaders reported an average of 18.2 years of experience and held various roles as leaders including Administrator (n=7), Director of Clinical/Health Services (n=3), Director of Nursing (n=2), Director of Infection Prevention and Control (n=1), and Staff Development Director/Coordinator (n=2). Leaders described their perspectives in six themes: Facilitators to operations during COVID-19, Barriers to operations during COVID-19, Resources, Infection control and vaccine uptake, Handling residents’ preferences during COVID-19, and ECHO participation. Results confirmed continued challenges in delivering quality PCC impacted by enforcement issues with vaccination processes and uptake for staff, supply gaps, and lack of knowledge in how to handle residents’ preferences for social activities. Results demonstrate the need for more resources to support staff delivery of quality PCC while balancing risks related to managing the COVID-19 endemic.
USE OF AND EXPERIENCES WITH ALTERNATIVE SITES FOR HEALTH CARE BY US ADULTS AGES 50–80
Authors: Keenan Teresa , Komisar Harriet , Dean Olivia , Solway Erica , Lampkin Cheryl 
Published: January 2025

Abstract
In recent years, “alternative” sites for health care – such as urgent care and retail health clinics – have expanded to meet the growing demand for more convenient and accessible care. In August 2023, the University of Michigan National Poll on Healthy Aging asked a national sample of 2,687 adults ages 50-80 (completion rate: 50%) about their use of and opinions about alternative sites of care. In all, 60% of adults ages 50-80 reported using an alternative site in the past two years: urgent care clinic (47%), retail clinic (28%), worksite clinic (9%), and mobile health clinic (5%). Use of these alternative sites was more common among those ages 50-64, women, and those with higher incomes. Among older adults who visited an alternative care site in the past two years, 91% reported having a primary care provider (PCP). Of those with a PCP, 71% contacted their PCP about their visit to an alternative site. The most common reasons reported for visiting an alternative site were to avoid the hospital emergency department (44%) or to get a vaccine, specific test or to get a health exam (35%). The majority (62%) said they were likely (11% very likely, 51% somewhat likely) to use an alternative site for health care in the future, including 43% who had not used in alternative site in the past two years. Poll findings suggest that these sites will continue to play a significant role in the delivery of health care in the future.
MEDIATION OF THE NUTRITIONAL STATUS BETWEEN THE NUMBER OF TEETH AND DEPRESSION AMONG OLDER ADULTS IN WESTERN CHINA
Authors: Tian Xin , Hu Yuexia , Xie Yuqing , Xia Xin , Wang Yanyan 
Published: January 2025

Abstract
Depression is a common mental disorder. Studies have shown that depression is associated with the number of teeth, but underlying mechanisms deserve further research. Our study aimed to explore the mediating effect of nutritional status between the number of teeth and depression. We analyzed cross-sectional baseline data from the 2018 West China Health and Aging Trend study (WCHAT), including 6632 multi-ethnic adults aged 50-95. The survey tool for depressive symptoms is 15-item Geriatric Depression Scale (DGS-15), and nutritional status was evaluated through Mini Nutritional Assessment-Short Form (MNA-SF). We conducted a multiple linear regression to estimate relationships between the number of teeth, nutritional status, and depression. Mediation models and pathway analysis were constructed to figure out the mediating role of nutritional status. Of 6632 participants, the depressive symptoms proportion was 17.3%. Multiple linear regression proved a total association between the number of teeth and depression (β = -0.148; 95% confidence interval: -0.218 to -0.078), the associations remained significant after adjusting MNA-SF scores. Mediation analysis verified nutritional status partially mediates the associations between the number of teeth and depression (indirect effect estimate = -0.059, 95% CI: -0.076 to -0.044; direct effect estimate = -0.088, 95% CI: -0.155 to -0.017). Structural equation model framework pathway analysis confirmed the association between the number of teeth, nutritional status, and depression. Our data suggested that nutritional status partially mediated the relationship between the number of teeth and depression, early identification of nutritional status and emphasis on oral hygiene are necessary to mitigate the risk of depression.
THE ASSOCIATION BETWEEN ORAL HEALTH/HYGIENE AND COGNITIVE IMPAIRMENT AMONG MULTIETHNIC OLDER ADULTS IN WEST CHINA
Authors: Xie Yuqing , Xia Xin , Li Yun , Wang Yanyan , Tian Xin , Hu Yuexia 
Published: January 2025

Abstract
The prevalence of cognitive impairment increases with age. Meanwhile, older adults with cognitive impairment typically have deteriorating oral health and poor oral hygiene. However, the distribution of oral health and cognitive impairment varies among different ethnic groups. The aim of this cross-sectional, multi-center study was to investigate the association between oral health and hygiene and cognitive impairment in a sample of multi-ethnic older adults aged 50 years and older from four provinces in western China (N=6529, mean age 62.4 ±8.3 years). Oral health and hygiene were assessed by specialized oral tests and a self-made questionnaire. Cognitive status was assessed using the Chinese version of the Short Portable Mental Status Questionnaire (SPMSQ). Three multiple regression models were used to examine the association between oral health and hygiene and cognitive impairment, adjusting for relevant variables. Statistical analysis showed that the prevalence of cognitive impairment was 15.4%, with the Yi group having the highest prevalence (28.9%), followed by Tibetans and others. Poorer self-rated oral health, fewer residual teeth, less frequency of using toothbrush and toothpaste, and rare dental visits increased the risk of cognitive impairment. The SPMSQ scores and correlations between oral health and hygiene and cognitive impairment were heterogeneous across the multi-ethnic groups. These findings highlight that declining oral health and inadequate oral hygiene may increase the risk of cognitive impairment. The potential value of this study is to illustrate that implementing and promoting oral health and hygiene is essential to prevent cognitive impairment in multi-ethnic older populations.
STAYING GOLDEN: PERSPECTIVES FROM THE AGE 85+ ON THE REALITIES OF AGEISM
Authors: Patskanick Taylor , Ashebir Sophia , D’Ambrosio Lisa , Coughlin Joseph 
Published: January 2025

Abstract
The conceptualization, prevalence, and consequences of ageism are increasingly well-documented in research, but our understanding of how older people may personally experience this phenomenon during specific age periods in their older adulthood is less understood (e.g., Chasteen et al., 2021). The 85+ age cohort may experience unique forms of ageism and age-based discrimination relative to other older age groups and can comment on how they experience these biases relative to other ages in their own lifespan. This paper shares findings from a qualitative, cross-sectional study with the MIT AgeLab 85+ Lifestyle Leaders panel, a longitudinal panel of U.S. octogenarians and nonagenarians. Utilizing four virtual focus groups (N=17) conducted in January 2024, findings were analyzed in MAXQDA2024 using a team-based, inductive, thematic analysis approach. Results characterize Lifestyle Leaders’ experiences with felt forms of ageism (e.g., covert vs overt, positive vs negative, etc). The Lifestyle Leaders articulated experiences with ageism in specific domains such as product design, healthcare, and in the community-based built environment. Benevolent or compassionate ageism may be particularly amplified at age 85+. Lifestyle Leaders noted an inextricable intersectionality between their chronological age and social identities like physical ability, digital nativity, and gender. A plurality described having a longitudinal lens on the shifting institutional context for age-based discrimination over their life courses (e.g., ADEA). These findings and their implications for gerontological professionals and future research on ageism, including planned follow up to this study examining this topic via participatory action research methods, will be discussed.
VICTIMIZATION EXPERIENCES AND COGNITIVE HEALTH: VARIATION BY SEXUAL MINORITY STATUS
Authors: Barbee Harry 
Published: January 2025

Abstract
Studies have revealed how experiences of victimization generate stress and harm cognitive health outcomes. For minority populations, such as sexual minorities, victimization experiences may occur more frequently, thus posing a greater risk to their cognitive health outcomes in later life stages. This project explores this possibility by analyzing how different types of victimization experiences, including being treated with less respect, receiving poorer services, and being threatened or harassed influence cognitive health outcomes among older adults in the United States. To achieve this goal, I examined data from the Health and Retirement Study, a nationally representative survey of middle-age and older adults in the United States. Specifically, I employed adjusted logistic regression models and adjusted Poisson regression models to test the extent to which experiencing different forms of victimization influenced subjective cognitive health, via self-rated memory, as well as a variety of objective markers of cognitive health. All models controlled for key sociodemographic variables. Preliminary results indicate that respondents who experienced different types of victimization also reported significantly worse cognitive health outcomes. Additionally, sexual minorities who reported victimization experiences had worse cognitive health outcomes than the heterosexual respondents who also reported victimization experiences. Together, these results demonstrate how perceived experiences of victimization can harm cognitive health, and also reveals potential explanations for why older sexual minorities face greater risk of cognitive impairment than their heterosexual counterparts.
VULNERABILITY, LIFE SATISFACTION, AND SOCIAL SUPPORT AMONG OLDER ADULTS: RESULTS FROM THE CLSA
Authors: Levasseur Melanie , Naud Daniel , Cihlar Volker , Micheel Frank , Mergenthaler Andreas , Trottier Lise 
Published: January 2025

Abstract
When experiencing, at a specific moment, multidimensional difficulties (physiological, psychological, socioeconomic or social) increasing the probability of being harmed or having coping challenges that negatively impact their lives, individuals in situations of vulnerability are at risk of reduced life satisfaction. Although not demonstrated yet, social support may mitigate this impact in older adults. This study aimed to examine the associations between situations of vulnerability, life satisfaction and social support, as well as the moderating effect of social support on the association between situations of vulnerability and life satisfaction among older women and men. Secondary analyses of the cross-sectional data on 21,491 respondents aged ≥65 from the Canadian Longitudinal Study on Aging were conducted, stratified by sex. Confirmatory factor analysis was used for identifying a latent vulnerability variable using physiological, psychological, socioeconomic and social indicators. Linear regression estimated the association between vulnerability and life satisfaction, and the moderating effect of social support. Respondents were aged between 65 and 89 (mean=73.4; standard deviation=5.8). For both sexes, reporting more depressive symptoms, chronic conditions and insufficient income best explained vulnerability, followed by dependence in basic activities of daily living, less social participation and living with fewer people. Vulnerability was associated with lower life satisfaction (p&lt;0.001) for both sexes, and social support acted as a buffer against vulnerability (p&lt;0.001) for women. Results confirm the multidimensionality of vulnerability. The buffering effect of social support in women reinforces recommendations concerning policies and interventions designed to increase opportunities of social connections, and further research is warranted for men.
SOCIAL PARTICIPATION OF TRANSGENDER BABY BOOMERS IN QUÉBEC: RESULTS FROM A CASE STUDY OF ACTIVISTS
Authors: Valpuesta Dolores Majón 
Published: January 2025

Abstract
The systematic discrimination linked to the intersection of gender identity and advanced age in transgender older adults results in further social participation restrictions and higher risk of disability (65% of transgender adults report poor mental health). Despite the importance of participation for health, little is known about the social participation of transgender older adults, especially among the new generation, the baby boomers. This study thus aimed to explore the social participation for transgender older adults. Based on the Iridescent Life Course theory, a case study was carried out with 2 transgender baby boomer community-dwelling from Quebec (Canada). Two French-speaking transgender women, 60 and 67 years old, with more than 5 years of activism. According to the experience of these activists, participation was positive and, with the gender transition in old age, a form of liberation, overcoming fears and denunciation, having a favourable impact on the community (e.g., sharing life experience for empowering other generations). Despite their positive experience, gender transition also involved a networks restriction, and, in some situations, they considered their rights were not respect. Presenting themselves with pride allows them to overcome the stigmatization of others as a barrier to participate. Boomers are perceived as a prejudiced generation and, consequently, activists were more comfortable interacting with younger generations (more naturalization, less judgmental). When trying to be included in heteronormative and cisgender contexts that did not consider the specificity of their life trajectories as they age, transgender older adults perceived the invisibility of their realities conditioned their social participation.