Digital Commons Network^™

Enhancing Dementia Classification For Diverse Demographic Groups: Using Vision Transformer-Based Continuous Scoring Of Clock Drawing Tests., Mengyao Hu, Yi Lu Murphey, Tian Qin, Edmundo R Melipillán, Laura B Zahodne, Richard Gonzalez, Vicki A Freedman

Faculty, Staff and Student Publications

Objectives: Alzheimer's disease and related dementias significantly affect older adults' quality of life. The clock-drawing test (CDT) is a widely used dementia screening tool due to its ease of administration and effectiveness. However, manual CDT-coding in large-scale studies can be time-intensive and prone to coding errors and is typically limited to ordinal responses. In this study, we developed a continuous CDT score using a deep learning neural network (DLNN) and evaluated its ability to classify participants as having dementia or not.

Methods: Using a nationally representative sample of older adults from the National Health and Aging Trends Study (NHATS), we …

Application Of Claims-Based Frailty Index To A Structured Electronic Health Record Data, Min Ji Kwak, Caroline Schaefer, Youngran Kim, Sunyang Fu, Chan Mi Park, Abhijeet Dhoble, Nahid Rianon, Holly M Holmes, Dae Hyun Kim

Faculty, Staff and Student Publications

Background: The Claims-based Frailty Index (CFI) has been developed and validated using Medicare claims data. However, whether CFI can be applied to structured electronic health record data has not been studied.

Methods: We applied the CFI to a structured electronic health record dataset (Explorys dataset) and a Medicare fee-for-service 5% sample data and compared the prevalence of frailty from each dataset, using the cohort of older adults. Then, we assessed the odds ratio and area under the curve of the frailty predicting adverse clinical outcomes, any hospital or emergency room visit, or any adverse drug events related encounter within 1 …

Does Schooling Improve Cognitive Abilities At Older Ages? Causal Evidence From Nonparametric Bounds, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Hans-Peter Kohler

Upjohn Institute Working Papers

We revisit much-investigated relationships between schooling and health, focusing on schooling impacts on cognitive abilities at older ages using the Harmonized Cognition Assessment Protocol in the Health & Retirement Study (HRS) and a bounding approach that requires relatively weak assumptions. Our estimated upper bounds on the population average effects indicate potentially large causal effects of increasing schooling from primary to secondary; yet, these upper bounds are smaller than many estimates from the literature on causal schooling impacts on cognition using compulsory-schooling laws. We also cannot rule out small and null effects at this margin. We do, however, find evidence for …

More Schooling Can Delay The Onset Of Dementia Later In Life, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Iliana Kohler, Hans-Peter Kohler, Shana D. Stites

Upjohn Institute Policy and Research Briefs

No abstract provided.

Causal Effects Of Schooling On Memory At Older Ages In Six Low-And-Middle-Income Countries: Nonparametric Evidence With Harmonized Datasets, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Iliana Kohler, Hans-Peter Kohler, Shana D. Stites

Upjohn Institute Working Papers

Higher schooling attainment is associated with better cognitive function at older ages, but it remains unclear whether the relationship is causal. We estimate causal effects of schooling on performances on the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) word-recall (memory) test at older ages in China, Ghana, India, Mexico, Russia, and South Africa. We used harmonized data (n=30,896) on older adults (≥50 years) from the World Health Organization Study on Global Ageing and Adult Health. We applied an established nonparametric partialidentification approach that bounds causal effects of increasing schooling attainment at different parts of the schooling distributions under …

Implementing Exercise Is Medicine At Byu, Destiny Rose H. Romero

Undergraduate Honors Theses

Exercise has been proven for millennia to have significant health benefits, both preventative and curative. Many modern diseases and ailments can be prevented, alleviated, or even cured with increased physical activity. Unfortunately, the United States health system has yet to effectively integrate exercise into mainstream medical models. The American College of Sports Medicine (ACSM) is working to solve this disconnect through their global health initiative Exercise is Medicine (EIM). Most relevant to BYU is their EIM-On Campus program, which incorporates principles of exercise medicine into colleges and universities. This thesis first explores the dynamics of the health system that inhibit …

Assessing Older Adult Behavioral Health Diagnoses In Oregon By Geographical Area, Physical Disability Status, And Age., N F. Parsons, Allyson Stodola, Ellis Hews, Nirmala Dhar, Sheryl Elliott, Sarah Dys, Walter D. Dawson

Institute on Aging Publications

This repeated cross-sectional study aims to assess potential differences among behavioral health (BH) diagnoses for older adults. Differences in services across urban versus rural/remote areas may contribute to deeply entrenched barriers to improved BH for this population.

Analyzing The Intention To Volunteer Through The Integrated Model Of Behavioral Prediction, Sage Mendre

University Honors Theses

Nationwide, a significant portion of adults lack basic, functional literacy skills. To combat functional illiteracy in the United States, non-profit organizations who focus on literacy require the services of volunteers. In Portland, Oregon, the Portland Literacy Council (PLC) is responsible for training volunteer tutors to help people learning English as a second language (ESL) and native English speakers who want to improve their literacy skills. The integrated model of behavioral prediction (IMBP) is a communication theory that identifies the core factors that can lead to the intention to perform a behavior. The connection between volunteering in literacy environments and IMBP …

Dementia Care: The Role Of Experiential Learning In Nursing Education, Jeannie Simpson

Wisdom & Compassion: The LUSON Journal

The escalating global prevalence of dementia necessitates enhanced educational strategies to prepare nursing students to care effectively for individuals living with dementia. Traditional methods in nursing education predominantly focus on pharmacological treatments and basic caregiving strategies, often neglecting innovative approaches like the Music & Memory® program, Virtual Dementia Tour®, and Montessori dementia. By including these innovative approaches, future nurses will be better equipped to develop and implement person-centered care for individuals living with dementia to improve their quality of life. The integration of these approaches will also meet the growing demands of dementia care, aligning with global health mandates.

Is Ride-Hailing A Potential Solution For Older Adults After Driving Cessation? The Role Of Objective And Perceived Accessibility, Minju Kim Song

Dissertations and Theses

Due to age-related physical and cognitive changes, older drivers have a greater risk of crashes and are restricted by age-dependent regulation. Nonetheless, many older adults in the United States maintain a car-dependent lifestyle and still prefer driving. When driving cessation or reduction becomes necessary, a primary concern is finding suitable alternative transportation modes. However, the availability of alternative transportation modes does not guarantee their actual use of these options.

As a relatively new transportation mode, ride-hailing services, such as Uber and Lyft, offer on-demand, door-to-door transportation and may be a feasible transportation solution for older adults who stop driving. While …

Art, Play, And Neuroplasticity: Advancing Dementia Care Through Art-Enriched Environments, Piper Hutson, James Hutson

Faculty Scholarship

Dementia represents a global public health crisis, characterized not only by progressive memory loss but by a pervasive decline in cognitive flexibility, social functioning, and overall quality of life. Traditional therapeutic modalities, often limited to pharmacological management and cognitive training, have yielded only modest gains in symptom mitigation and patient well-being. Recent advances in neuroscience have illuminated the brain‘s capacity for neuroplasticity—its inherent ability to adapt, reorganize, and form new neural connections even in advanced age and the presence of neurodegenerative conditions. This emerging understanding invites a critical re-evaluation of dementia care strategies, highlighting the potential of non-pharmacological interventions to …

Nursing News & Views - June 2025, Brenda Rocha Rn, Cno

Nursing Newsletters

Nursing News & Views - June 2025

Variation In The Potentially Inappropriate Use Of Antipsychotic And Benzodiazepine Medications Among Individuals Receiving Residential Medication Management Reviews, Mouna J. Sawan, Alexander J. Clough, Jodie Hillen, Andrew R. Zullo, Daniela C. Moga, Natalie Soulsby, Danijela Gnjidic

Epidemiology and Environmental Health Faculty Publications

Objectives To describe the variation in the use of potentially inappropriate antipsychotic and benzodiazepine medications in residents who have received a medication review and to evaluate the extent to which this variation is associated with aged care home (ACH) and resident characteristics. Methods This cross-sectional, retrospective study used pharmacist-extracted data from 15,442 residents across 342 Australian ACHs who had a medication review during 2019. The proportion of residents receiving ≥1 potentially inappropriate antipsychotic and benzodiazepine medication according to Beers criteria were classified into quintiles by facility usage (Q1-Q5). Quintile characteristics were compared using descriptive analysis of facility and resident data. …

Aging In Harwich: A Community Needs Assessment, Claire E. Wickersham, Caitlin E. Coyle

Center for Social and Demographic Research on Aging Publications

At a time of such significant population aging, the Harwich Council on Aging commissioned a community-wide needs assessment with support from the Friends of the Harwich Council on Aging. The specific goal of this report is to support the strategic planning of the Harwich Council on Aging. An additional goal is to present information useful to other Harwich departments and organizations interacting with older residents planning for the future of Harwich. This report presents the results of a comprehensive examination of issues relating to aging in Harwich. Results presented here focus on the characteristics and needs of Harwich residents aged …

Trends In The Demographic And Well-Being Indicators Of The Singapore Life Panel Over The Past 9 Years, From 2016-2024, Rachel Wen Yi Ngu, Yi Wen Tan, Yue Qing Chew, Hanif Mohamed Yacob, Yan Er Tan

ROSA Research Briefs

The Singapore Life Panel® (SLP) has been tracking demographic and well-being indicators among older adults in Singapore for nearly a decade. This research brief presents the longitudinal trends observed in the SLP over a nine-year period (2016-2024), with the aim of identifying key shifts in these indicators and drawing attention to salient issues facing Singapore’s ageing population. The findings reveal notable demographic and well-being developments with significant implications for policy domains such as ageing-in-place, employment, and health. We highlight the following prominent trends: (i) a growing proportion of older adults living alone, accompanied by a steady decline in average household …

Blood And Mettle: The Effects Of Civil Unrest On Economic Mobility, Nathan D. Parks

Honors Projects

Civil unrest is a global phenomenon that often emerges through a combination of grievances and opportunity sparking change. Civil unrest is often used as a tool by the populace to initiate political, societal, or economic transformation. Economic mobility or the belief in it is a key contributor to mitigating individuals’ level of grievances. This paper uses lagged panel analysis to investigate the question of how civil unrest affects economic mobility beyond the time of unrest. Civil unrest is associated with changes in economic mobility, varying between positive and negative associations based on the type of unrest. Analysis was conducted using …

The Association Of Vision And Hearing Impairment On Cognitive Function And Loneliness: Evidence From The Mexican Health And Aging Study, Kimberly Hreha, Rafael Samper-Ternent, Heather E Whitson, L P Downer, Jessica S West, Brian Downer

Faculty, Staff and Student Publications

Objectives: We investigated whether self-reported vision and hearing were associated with cognitive function and loneliness among Mexican adults aged 50 and older.

Methods: Mexican Health and Aging Study data. Vision/hearing status was self-reported (excellent-very good, good, fair-poor). Cognition was measured using nine tasks. Loneliness was measured using the UCLA Loneliness Scale. Analyses controlled for demographic and health characteristics.

Results: Among 12,353 participants (mean age = 67, 58% female), poor vision, but not hearing, was associated with lower global cognition (β = -0.03, p < .05). Poor vision (OR = 1.57, 95% CI = 1.30-1.91) and hearing (OR = 1.35, 95% CI = 1.14-1.61) were associated with higher odds of being lonely after adjusting for demographics and comorbidities, but not when adjusting for limitations in daily activities and depressive symptoms.

Discussion: Poor vision is a potentially modifiable risk factor for lower cognition and loneliness among Mexican adults. …

Factors Associated With Perceived Medication Safety During Transitions Of Care In Patients With Cancer: A Secondary Data Analysis Of A Cross-Sectional Survey, Youmin Cho, Misun Hwang, Yang Gong, Yun Jiang

Faculty, Staff and Student Publications

Purpose: This study aimed to investigate perceived medication safety in patients with cancer during transitions of care and identify factors associated with their safety perceptions.

Methods: A secondary data analysis was performed on a cross-sectional survey data of from patients with four types of cancer (i.e., colorectal, lung, prostate, and breast). Perceived medication safety was measured by the sum score of four survey items that assessed patients' feelings about medication safety during transitions of care. Potential associated factors included sociodemographic and clinical factors (i.e., cancer types, taking oral anticancer agents), self-rated health, perceived safety in communicating with clinicians, beliefs about …

Hardiness, Optimism And Hope: Longitudinal Study Of How Individuals May Build Resilience Through Experiential Undergraduate University Courses, Paul Lim, Chin Heng Low, Kevin Koh

Research Collection Lee Kong Chian School Of Business

This study explores the antecedents of students’ resilience in a management education setting, by looking at the role of state hope and dispositional optimism in cultivating their psychological hardiness. While resilience is recognized as integral to personal growth, extant research has predominantly focused on its correlations with psychological capital (PsyCap) elements such as hope and optimism; or examined the outcomes of hardiness as a proxy of resilience. Little has been done to explicate the directional causal relationships among the PsyCap elements and hardiness in view of resilience-building. Using a longitudinal mixed methods design, this study delves into how state hope, …

The Specialist Dementia Care Program In Australia: Evidence To Date On A Home-Like Model Of Care For People With Very Severe Behaviours And Psychological Symptoms Of Dementia, Mustafa Atee, Srivalli Vilapakkam Nagarajan, Rebecca Lloyd, Stephen Macfarlane, Angela Raguz, Thomas Morris

Research outputs 2022 to 2026

Objectives: Behaviours and psychological symptoms of dementia (BPSD) have a serious impact on care and health outcomes, such as inappropriate pharmacotherapy and impaired quality of life. These symptoms are common across care settings but are more prevalent in residential aged care homes (RACHs). BPSD such as aggression and psychosis may pose a high risk of harm to residents, co-residents, caregivers and families, and the severe forms of these BPSD are linked to RACH premature admission. When people with very severe BPSD in Australia cannot be cared for in mainstream RACHs, the Specialist Dementia Care Program (SDCP) is offered. This article …

Understanding Parents’ Beliefs About The Etiology Of Youth Mental Health Problems: Differences Across Race/Ethnicity, Madeline Buchanan, Lindsay E. Holly

Psychology Faculty Research and Publications

Parents’ etiological explanations for youth mental health problems are relatively understudied; most studies focus on adult beliefs about the causes of mental disorders experienced by adults. This is concerning given research demonstrating that parents’ causal beliefs may influence several aspects of youth mental health service utilization including whether parents seek help for their youth and how they engage in treatment. The current study used a novel methodology to examine causal beliefs about youth mental health problems among a diverse group of parents (N = 417; 36.9% non-Hispanic White; 33.3% Black/African American; 29.8% Hispanic/Latino) who completed a series of questionnaires …

Awareness, Knowledge, And Motivations About Lifespan, Healthspan, And Healthy Longevity Medicine In The General Population: The Healthy Longevity (Helo) Conceptual Framework, Belinda Wang, Anna Szucs, Elena Sandalova, E. J. Horberg, Paul A. O'Keefe, Louis Island, Hans J. Meij, Sonny Rosenthal, Andrea B. Maier

Research Collection College of Integrative Studies

The global population is ageing and the gap between lifespan (total years lived) and healthspan (years lived free of diseases) is increasing. Healthy Longevity Medicine (HLM) is an approach to optimise health and healthspan, and it has substantial public health implications. Despite those implications, the understanding of public perspectives on this field is lacking. The HEalthy LOngevity (HELO) framework was developed through a literature review guided by expert discussions across disciplines to include evidence-based concepts of health-related decision-making, ageing, and HLM. The framework organises concepts into three components. The first two components, awareness and knowledge, explore public perception and understanding …

Human-Computer Interaction And Artificial Intelligence For Ageing Population, Keng Siau, Hailiang Wang, Fiona Fui-Hoon Nah, Runyu Wang, Ruitong Che, Can Liu

Research Collection School Of Computing and Information Systems

As the global population ages rapidly, the field of human-computer interaction (HCI) is in urgent need of innovation, redesign, and reengineering to meet the evolving needs of older adults. The older demographic faces a range of challenges—including physical limitations, cognitive decline, reduced social in-tegration, and varying levels of technological literacy—that can hinder effective engagement with digital technologies. In response to these challenges, research-ers and designers are using inclusive and adaptive approaches to enhance acces-sibility, usability, and emotional well-being. This paper reviews key design prin-ciples in HCI for the ageing population and discusses how artificial intelligence (AI) tools, such as voice …

Comparing The Performance Of 3 Sarcopenia Definitions For Predicting Adverse Events Prior To Liver Transplant, Heidi E Johnston, Hannah L Mayr, Melita Andelkovic, Tahnie G Takefala, Yanyan Chen, Aaron P Thrift, Graeme A Macdonald, Ingrid J Hickman

Faculty, Staff and Students Publications

Background: Sarcopenia is a syndrome of severe muscle wasting, associated with adverse outcomes related to liver transplantation (LT). There are several approaches used to identify sarcopenia. We aimed to investigate the prevalence of sarcopenia using 3 different criteria and determine how these performed in relation to clinical outcomes.

Methods: The cohort study included 237 adults with cirrhosis referred for LT. Sarcopenia was identified using (1) CT-defined; and the (2) original and (3) updated European Working Group on Sarcopenia in Older People criteria (EWGSOP1 and 2). Logistic regression was used to estimate OR and 95% CI for the relationships between sarcopenia …

Linking Symptom Inventories Using Semantic Textual Similarity, Eamonn Kennedy, Shashank Vadlamani, Hannah M Lindsey, Kelly S Peterson, Kristen Dams O'Connor, Ronak Agarwal, Houshang H Amiri, Raeda K Andersen, Talin Babikian, David A Baron, Erin D Bigler, Karen Caeyenberghs, Lisa Delano-Wood, Seth G Disner, Ekaterina Dobryakova, Blessen C Eapen, Rachel M Edelstein, Carrie Esopenko, Helen M Genova, Elbert Geuze, Naomi J Goodrich-Hunsaker, Jordan Grafman, Asta K Håberg, Cooper B Hodges, Kristen R Hoskinson, Elizabeth S Hovenden, Andrei Irimia, Neda Jahanshad, Ruchira M Jha, Finian Keleher, Kimbra Kenney, Inga K Koerte, Spencer W Liebel, Abigail Livny, Marianne Løvstad, Sarah L Martindale, Jeffrey E Max, Andrew R Mayer, Timothy B Meier, Deleene S Menefee, Abdalla Z Mohamed, Stefania Mondello, Martin M Monti, Rajendra A Morey, Virginia Newcombe, Mary R Newsome, Alexander Olsen, Nicholas J Pastorek, Mary Jo Pugh, Adeel Razi, Jacob E Resch, Jared A Rowland, Kelly Russell, Nicholas P Ryan, Randall S Scheibel, Adam T Schmidt, Gershon Spitz, Jaclyn A Stephens, Assaf Tal, Leah D Talbert, Maria Carmela Tartaglia, Brian A Taylor, Sophia I Thomopoulos, Maya Troyanskaya, Eve M Valera, Harm Jan Van Der Horn, John D Van Horn, Ragini Verma, Benjamin S C Wade, Willian C Walker, Ashley L Ware, J Kent Werner, Keith Owen Yeates, Ross D Zafonte, Michael M Zeineh, Brandon Zielinski, Paul M Thompson, Frank G Hillary, David F Tate, Elisabeth A Wilde, Emily L Dennis

Faculty, Staff and Students Publications

An extensive library of symptom inventories has been developed over time to measure clinical symptoms of traumatic brain injury (TBI), but this variety has led to several long-standing issues. Most notably, results drawn from different settings and studies are not comparable. This creates a fundamental problem in TBI diagnostics and outcome prediction, namely that it is not possible to equate results drawn from distinct tools and symptom inventories. Here, we present an approach using semantic textual similarity (STS) to link symptoms and scores across previously incongruous symptom inventories by ranking item text similarities according to their conceptual likeness. We tested …

Managing Hypercholesterolemia In Adults Older Than 75 Years Without A History Of Atherosclerotic Cardiovascular Disease: An Expert Clinical Consensus From The National Lipid Association And The American Geriatrics Society, Vera Bittner, Sunny A Linnebur, Dave L Dixon, Daniel E Forman, Ariel R Green, Terry A Jacobson, Ariela R Orkaby, Joseph J Saseen, Salim S Virani

Faculty, Staff and Students Publications

The risk of atherosclerotic cardiovascular disease increases with advancing age. Elevated LDL-cholesterol and non-HDL-cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75 years. Risk prediction among older individuals is less certain because most current risk calculators lack specificity in those older than 75 years and do not adjust for co-morbidities, functional status, frailty, and cognition which significantly impact prognosis in this age group. Data on the benefits and risks of lowering LDL-cholesterol with statins in older patients without atherosclerotic cardiovascular disease are also limited since most primary prevention trials have included mostly younger patients. Available …

Mindfulness As A Buffer Against Death Anxiety: Implications For End-Of-Life Care, Chad Alexander

University Honors Theses

Death anxiety, defined as the distress associated with the awareness of mortality, has profound psychological and cultural impacts. Western societies often respond to death salience through avoidance and medicalization, reinforcing defensive strategies described by Terror Management Theory. This project aimed to investigate whether mindfulness can serve as a buffer against death anxiety. A structured literature review was conducted using PsycINFO, PubMed, the Portland State University Library, and Google Scholar between January 2025 and April 2025. One study found that mindfulness moderated the effects of death anxiety on health-related quality of life in people living with HIV. Two experiments linked mindfulness …

From Industrial Building To Affordable Senior Housing: An Idea Book Beyond Code, Weiyi Ma

Masters Theses

This thesis envisions a proposal to adaptively re-purpose Rhode Island’s extant industrial building stock into affordable housing tailored to the needs of its older and more vulnerable citizens. Architectural dignity, in terms of older citizens amidst this housing crisis, is the creation of living environments that honor their autonomy, comfort, and identity through design interventions that provide accessible, luminous, breathable, and socially enriching spaces, reaffirming their rightful place within the community. With humanistic care and logical rigor, it establishes a mathematical framework for assessment and execution, anchored in five criteria: light, air, space, accessibility, and livability, and presents itself in …

Investigating The Associations Of Cognitive Health, Health Behaviors, And Personality In Older Community-Dwelling Adults, Yan-Jhu Su

Graduate Doctoral Dissertations

Cognitive decline poses a significant public health challenge, with profound implications for aging populations. This dissertation investigates the associations between health behaviors, leisure activities, personality traits, and cognitive function in older U.S. adults, using data from the Health and Retirement Study (HRS) and the Consumption and Activities Mail Survey (CAMS). This work comprises three studies that explore both cross-sectional and longitudinal perspectives on cognitive aging.

Study 1 examines the complex interactions between personality traits, education, health behaviors, and cognitive function. The study is divided into two parts: Study 1a explores the role of health behaviors—smoking, alcohol use, and physical activity—as …

Factors Associated With Caregivers' Concern In Maintaining The Oral Function Of Elderly Living In Long-Term Care Facilities, Susiana Nugraha, Tri Budi Wahyuni Rahardjo, Misako Higashijima, Yuko Hirano

Kesmas

This study investigated the attentiveness of elderly caregivers in long-term care facilities in maintaining oral function. A cross-sectional approach was used to achieve the study's purpose. The sample size formula accounted for 213 caregivers randomly selected from 18 long-term care facilities in 4 provinces. A self-reported questionnaire of sociodemographic characteristics and an adapted Leopold’s oral care checklist was distributed. The average age of study participants was 35.24 (±11.2 SD; aged 18–70 years), dominated by females (62.9%), and only 39% had experienced long-term care training. Multiple linear regression analysis indicated that younger caregivers likely pay more attention in the swallowing periods …