bluuebunny/crossref_metadata_2025 huggingface dataset:
INDIVIDUAL FACTORS AFFECTING GLYCATED HEMOGLOBIN LEVELS AMONG OLDER ADULTS WITH DIABETES: A CROSS-SECTIONAL STUDY
Authors: Min Jungkyung , Harvey Idethia
Published: December 2022

Introduction

Many older adults fail to maintain glycemic control even though reasonable glucose control can prevent the onset of macro- and microvascular complications. This present study aimed to determine the independent association of demographic characteristics, clinical factors, treatment modalities, and lifestyle behaviors with glycated hemoglobin levels (HbA1c) among Korean older adults, a group at a very high risk of diabetes.

Methods

We analyzed data from a representative sample of participants (N = 707) aged > 65 years in the Korea National Health and Nutrition Examination Survey (KNHANES), 2016-2018. Participants were classified into two groups according to their age [group 1 (ages 65 to 74) and group 2 (age ≥75)]. Data were analyzed using t-test, analysis of variance, Pearson’s correlation, and hierarchical multiple regression.

Results

Age (p=0.003), place of residence (p=0.01), treatment modality (p< 0.001), sedentary behavior (p=0.04), and moderate activity (p=0.002) significantly affected HbA1c levels. In comparison to the factors in two age groups, duration of diabetes was the variable more strongly associated with HbA1c levels (p< 0.001, β=0.283) in group 1, whereas treatment modality was the one strongly associated with HbA1c levels (p< 0.001, β=0.249) in group 2.

Conclusion

It is essential to consider the age duration of diabetes, and biochemical factors to manage HbA1c levels in older adults. Furthermore, our findings suggest including physical activity in the educational program to provide information for diabetes management. In the clinical setting, more close attention should be taken among healthcare providers to control the glucose level for older adults with diabetes.
CHRONIC CONDITION SELF-MANAGEMENT FOR OLDER AFRICAN AMERICANS: THE CHALLENGE OF COMPLEXITY
Authors: Fritz Heather , Cutchin Malcolm
Published: December 2022

Older African Americans have higher rates of comorbidity and face substantive challenges with chronic condition self-management (CCSM), including less effective and supportive CCSM care than their white counterparts. Such disparities in care stem, in part, from physicians’ lack of understanding about challenges older African Americans face as they engage in CCSM. Yet little is known about the CCSM experiences of older African Americans with comorbidity. In this study, we aimed to determine the central dynamics of those experiences. As part of a larger study on African American CCSM and physician empathy, we conducted in-depth qualitative interviews with 30 older African Americans living in Detroit aged 65 years and older with comorbidity. We used grounded theory analysis to distill findings into a core conceptual category as well as component domains and dimensions. “Complexity” emerged as the core category to describe CCSM in our sample. Complexity resides often at the intersection of race, age, and social position making the older African American CCSM experience inherently difficult for those of different races, ages, and social positions to understand. Data illustrate that domains of complexity include "care time", "care roles", "social context", "logistics", "learning", and "pain management". Each domain is composed of 2 to 4 dimensions, further fleshing out the nature of CCSM complexity for older African Americans with comorbidity. Findings provide a basis to enhance understanding and empathy for older African Americans with comorbidity. We discuss how the model will be used to test understanding of older African American CCSM by medical students.
PHYSICAL FUNCTIONING AND BODY SIZE IN MID-LIFE WOMEN: THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION
Authors: Oh Minsuk , Ylitalo Kelly , Leis Aleda , Lange-Maia Brittney , Strotmeyer Elsa , Cauley Jane , Karvonen-Gutierriez Carrie
Published: December 2022

To evaluate patterns of age-related changes in physical functioning (PF) and associations with body size, we utilized data from the longitudinal Study of Women’s Health Across the Nation (SWAN). Participants (n=1,793) with self-reported SF-36 PF data at visit 4 (2000-01; mean age:50.0 years ±2.7), visit 15 (2016-17), plus one additional visit were included. Body weight and waist circumference were measured at each visit; change from visits 4 to 15 was calculated. Five PF trajectories were identified using latent class growth modeling (% of women): (1) persistently low (4.1%); (2) start moderate and improve slightly (5.4%); (3) start high and decline slightly (24.0%); (4) persistently high (59.5%); and (5) start high and decline substantially (7.0%). Participants with persistently low PF (Group 1) lost weight during follow-up (mean change: -3.2% body weight) whereas there was little change in all other groups (ANOVA p< 0.0001). Women with persistently low PF (Group 1) had < 2% increase in waist circumference over follow-up; all other groups had more than double that increase (range: 4.1%-6.1%; ANOVA p=0.002). No statistically significant differences in anthropometry changes across the PF groups were observed after adjustment for sociodemographic and time-variant health characteristics. PF trajectories may be associated with changes in body weight or waist circumference during midlife and transition to older adulthood; however, these associations may be explained by other major health-related variables. Future research is needed to understand the complex interplay between PF and body size, particularly for women at-risk for late-life disability that may benefit from preventive efforts in mid-life.
THE FIT OF THE HAPA MODEL TO THE EXPERIENCE OF EXERCISING AFTER STROKE: A DEDUCTIVE CONTENT ANALYSIS
Authors: Silva-Smith Amy
Published: December 2022

Sustained physical activity is recommended for secondary stroke prevention. Persons with stroke leave rehabilitation having learned exercises to reduce disability. However, once discharged, people may be on their own to navigate psychological, emotional, social, and physical challenges of maintaining those activities and starting new ones. The Health Action Process Approach (HAPA) provides a framework for understanding how self-efficacy differs depending on where a person is in the process of engaging in physical activity. The purpose of this study was to assess the qualitative fit of the HAPA model to the experience of exercise after discharge from formal stroke rehabilitation using a deductive (directed) content analysis approach. Interviews with 12 stroke survivors were analyzed deductively using the HAPA model concepts task self-efficacy, coping self-efficacy, and recovery self-efficacy to create the analysis matrix. In this sample, a period of psychological adjustment interfered with maintaining exercise and included anxiety, depression, embarrassment, and fear of falling that affected motivation and intention to exercise. Experiences with physical activity and exercise as a child and routines prior to the stroke were factors influencing task, coping, and recovery self-efficacy and ease of dealing with interruptions in exercise, including the discharge from formal rehabilitation. The findings support the qualitative fit of the HAPA model with the experience of exercise after having a stroke. A HAPA model framed intervention is being developed to support the transition from formal rehabilitation support to living in the community.
COMPARING OLDER ADULTS’ EXPOSURE TO AND SHARING OF HEALTH-RELATED MESSAGES ON FACEBOOK BY CHRONIC CONDITION STATUS
Authors: Schroeder Matthew , Miller Carrie , Pagoto Sherry
Published: December 2022

We compared older adult Facebook users with and without a chronic health condition on their frequency of exposure to and posting health-related messages. Demographics, social media use, and chronic condition status were collected via survey. Regular Facebook users aged 50+ years were recruited via Qualtrics. Participants reported if they had seen, posted, or shared: health-related information; about others’/their own health behaviors (e.g., exercise); and about others’/their own chronic condition. Responses were dichotomized as “Rarely” or “At least once a month”. Six logistic regression models, controlling for demographics and Facebook login frequency, assessed whether viewing and/or posting health-related messages differed by chronic condition status. Respondents (N=697; 77.9% female; 87.9% non-Hispanic White) were on average 61.2 years old (SD=7.9). One-half reported a chronic condition (n=351; 50.4%). In adjusted models, those with a chronic condition had a higher likelihood of seeing posts from others with health information (OR=1.37; 95% CI: 1.01, 1.86) and about others’ health conditions (OR=1.64; 95% CI: 1.20, 2.23) ≥ monthly (vs no chronic conditions). Similarly, those with a chronic condition had a higher likelihood of posting or sharing health information (OR=1.52; 95% CI: 1.03, 2.24) and about their chronic condition (OR=1.93; 95% CI: 1.16, 3.21) ≥ monthly. People with and without chronic conditions did not differ in how often they saw or posted about health behaviors. Older adults with chronic conditions were more likely than those without chronic conditions to regularly see and share health information on Facebook. The content and accuracy of this health information should be explored.
THE ROLE OF EDUCATION AND LITERACY SKILLS ON MIDDLE-AGED AND OLDER VOLUNTEERS BY RACE AND ETHNICITY IN THE US
Authors: Narine Donnette , Yamashita Takashi , Punksungka Wonmai , Helsinger Abigail , Kramer Jenna , Karam Rita , Cummins Phyllis
Published: December 2022

Volunteer participation is a form of civic engagement that benefits both the individual and society over the life course. Although education, basic skills (e.g., literacy), and race/ethnicity are individually associated with volunteering, detailed interrelations are yet to be explored. Guided by the integrated theory of volunteer work and the notion of productive aging, the goal of this study was to examine the roles of education and adult literacy in the context of volunteering in later life across racial and ethnic groups (Whites, Blacks, Hispanics) in the U.S. Using the nationally representative sample of middle-aged and older adults (age 45+; n = 3,770) from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC), structural equation modeling was constructed to evaluate mediation relationships among education, literacy, and volunteering by racial and ethnic groups. Results show no statistically significant mediation (a.k.a., indirect) effect of education on volunteering through literacy, nor was there statistically significant difference in the mediation effect across racial and ethnic groups. However, there were statistically significant differences in the direct effect of education on volunteering between Black adults and White adults [b(Black) = 0.44 versus b(White = 0.24), p < 0.05], as well as Black adults and Hispanic adults [b(Black) = 0.44 versus b(Hispanic) = 0.08, p < 0.05]. These findings indicate that higher education was more strongly associated with volunteering among older Black adults, compared to White and Hispanic counterparts. Suggested policy implications include support for the promotion of volunteer participation through culturally and socioeconomically sensitive approaches.
COGNITIVE DECLINE PUBLIC HEALTH SURVEILLANCE: EXPERT-GUIDED COLLABORATION FOR BRFSS MODULE REVISION
Authors: Shean John , Olivari Benjamin
Published: December 2022

The Behavioral Risk Factor Surveillance System (BRFSS) Cognitive Decline Module collects population level data on subjective cognitive decline (SCD) — self-reported difficulties in thinking or memory — which can be one of the earliest warning signs of dementia. Originally devised in 2009, the module undergoes periodic revision to ensure it remains current, the data collected are actionable, and to encourage uptake of the module by state health agencies. In 2021, the Alzheimer’s Association and the Centers for Disease Control and Prevention’s Alzheimer’s Disease Program formed an expert workgroup to examine the ongoing value and relevance of the module and propose any improvements. Workgroup members included researchers, chronic disease directors, epidemiologists, survey methodologists, policy analysts, and BRFSS coordinators. Using a consensus-building process, the workgroup utilized pre-meeting worksheets to identify areas of agreement and disagreement which informed key debates during subsequent meetings. Among many factors, the workgroup assessed the existing module for accuracy and utility. Discussion centered on aligning language and concepts contained within the module’s questions with current scientific research on SCD and how to accurately and adequately assess the associated burden SCD imposes. People living with cognitive impairment were consulted during the revision process to ensure phrasing reflected their lived experience. The result was a consensus set of suggested revisions to the Cognitive Decline Module, submitted to CDC for review and approval. The robust process, involving a variety of stakeholders and perspectives, can serve as an efficient and effective model for ensuring the longevity and usefulness of population health surveillance.
FOLLOWING PHYSICIAN’S ADVICE IN LATE LIFE: THE ROLES OF LOCUS OF CONTROL AND HEALTH STATUS
Authors: Dahal Poshan , Kahana Eva
Published: December 2022

Adherence to physicians’ recommendations plays an important role in health maintenance in old age (Kravitz, Hays, Sherbourne & DiMatteo,1993). However insufficient attention has been paid to the influence of patients’ mental and physical health and locus of control on adherence to physician’s recommendations. This paper studied subjective health appraisals, chronic illnesses, functional limitations, and cognitive impairment along with internal or external locus of control as influences on adherence to physicians’ recommendations. We explored these associations among 684 older adults (mean age = 80.71 years) living in a retirement community in Florida. Respondents participated in the Elderly Care Research Center successful aging study (Kahana, Kelley-Moore & Kahana 2012). Older patients and those with more functional limitations reported greater adherence to physicians’ recommendations (b=.15, p< 0.05). Those respondents with greater cognitive impairment were less adherent (b=-.1, p< 0.05). Internal locus of control, reflected in beliefs that patients play a major role in health outcomes was associated with less adherence (b=-0.1, p< 0.05). The belief that health professionals influence health outcomes was associated with greater adherence (b=.1, < 0.05). Lower adherence was also associated with the stronger belief that health is a matter of good fortune (b=-.06, p< 0.05). Our findings offer useful insights about the role of internal vs. external influences on health outcome expectations in late life and health behaviors of compliance with medical regimens.
WHAT MOTIVATES PHYSICIANS TO ADDRESS CAREGIVER NEEDS? THE ROLE OF EXPERIENTIAL SIMILARITY
Authors: Park Taeyoung , Pillemer Karl , Löckenhoff Corinna , Riffin Catherine
Published: December 2022

Despite the negative emotional and physical consequences of caregiving, caregivers’ needs and risks are often overlooked in health care settings. This study used survey data from a national random sample of primary care physicians (N=106) to examine the factors associated with physicians’ perceived responsibility to identify caregiver needs and risks, focusing on three theoretically implicated variables: 1) experiential similarity (i.e., physicians having personal experience with caregiving), 2) structural similarity (i.e., physicians being older and female), and 3) secondary exposure to caregivers (i.e., more time seeing older patients and a higher percentage of older adults in their patient panel). Physicians in our sample consisted of 42.5% women; most of whom were white (73.6%). The majority (76.5%) agreed or strongly agreed that they were responsible for identifying caregivers’ needs and risks. Multivariable models controlling for physicians’ age and gender revealed that physicians who had personal experience with caregiving were four times more likely than those without caregiving experience to feel responsible to identify caregivers’ needs and risks (adjusted odds ratio [aOR] 3.90; 95% confidence interval [CI] 1.34-11.41) and to assess caregivers’ mental health concerns (aOR 3.58; 95% CI 1.29-9.94). Structural similarity and secondary exposure did not play significant roles in motivating physicians. Findings highlight the role of experiential similarity in physicians’ motivation to assess caregivers’ needs and risks. Future work may benefit from designing intervention programs for physicians that incorporate experiential learning activities (e.g., conversations in which caregivers share their experiences) and evaluating whether such programs enhance physicians’ sensitivity toward family caregivers.
ORGANIZATIONAL PRACTICES FOR THE AGING WORKFORCE: A CROSS-CULTURAL VALIDATION OF THE LATER-LIFE WORKPLACE INDEX
Authors: Deller Juergen , Finsel Julia , Wöhrmann Anne , Wilckens Max , Gu Xiuzhu , Oliveira Eduardo
Published: December 2022

Successful employment of experienced employees becomes more important for both, individuals and organizations. To identify organizational practices that foster the motivation, health, and performance of experienced employees in particular, a holistic assessment of relevant organizational factors is needed. The Later Life Workplace Index (LLWI) provides such a measure for organizational practices for older employees by differentiating nine domains, namely organizational climate, leadership, work design, health management, individual development, knowledge management, transition to retirement, continued employment after retirement, and health and retirement coverage. So far, a German-language and an English-language version of the LLWI have been validated in Germany and the U.S in a multi-study procedure. The psychometric properties and measurement invariance of the English-language version of the LLWI will be presented. Preliminary findings from Japan and Portugal show promising results regarding reliability and validity of the LLWI in the respective country. The findings suggest that the multidimensional measurement model developed in Germany and the U.S. could be applicable to other regulatory and cultural contexts as well. A focus group consisting of the original authors of the LLWI and international scholars, whose research expertise lies in the field of employment and older employees, is currently developing a short version of the LLWI. We aim to provide researchers and practitioners from different countries with a validated measurement to holistically assess organizational practices. Researchers can utilize the LLWI to gain a comprehensive understanding of organizational influences on later life work, while practitioners are able to assess their organizational readiness for an aging workforce.
PREPARING OLDER ADULTS FOR REMOTE EMPLOYMENT: OPPORTUNITIES AND CHALLENGES
Authors: Massihzadegan Setarreh , Gleason Shayna , Mutchler Jan , Coyle Caitlin
Published: December 2022

As Americans live longer, many are finding they need or want to remain longer in the workforce. When the COVID-19 pandemic transitioned much of the U.S. workforce into temporary or permanent remote employment, many older job seekers were left behind, wanting to compete in the ever-more technology-based job market but often without the requisite skills to do so. The present study evaluated a workforce training program (funded by a Department of Labor demonstration grant) that trained low-income workers over the age of 55 for remote employment. Approximately 60 older adults were trained across three 20-week cohorts. Our data sources included biweekly participant surveys, typing speed and Microsoft Office skill assessments, exit interviews with program “drop-outs,” focus groups, training observations, data from participant applications, and instructor assessments of each participant’s level of “job readiness” at the end of the program. Results revealed that participants had acute financial need for employment, a keen interest in working remotely, and a wide range of employment experiences and past job stability. Many of their career trajectories and workplace needs were affected by COVID-19. Results also showed promising improvements in participants’ technology skills and confidence in their ability to conduct a job search over the course of the program. The need for greater connectivity between participants and employers was identified as an area for improvement for the program. The results of this study contribute to the literature on workforce development by exploring how training programs might better prepare older adults for an increasingly remote job market.
INTERNATIONALLY EDUCATED NURSES CARING FOR OLDER ADULTS: A SCOPING REVIEW
Authors: Olanrewaju Sherif , Loeb Susan , Rosaldo Manuel
Published: December 2022

Internationally Educated Nurses (IENs) are nurses who are born and obtained their licenses in their home country and relocate to work in a different country. IENs are increasing being recruited to work in Western countries to address nursing shortages. Estimates indicate that IENs account for 5-8 percent of registered nurses in the United States (US). The purpose of this scoping review was to identify and synthesize research evidence on IENs' experiences caring for older adults. A 5-step process for Scoping Reviews was applied, which includes: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the results. A search was conducted in Web of Science, PubMed, CINAHL, PsycINFO, and Google Scholar. Keywords included but were not limited to IENs, older adults, and long-term care setting. Inclusion criteria were (1) empirical studies examining IENs providing direct care for older adults in any healthcare settings and (2) original research published in English. A total of 13 articles were selected for inclusion (nine quantitative and four qualitative studies). The studies were conducted in the US (n=10), the Netherlands (n=1), Australia (n=1), and New Zealand (n=1). Results revealed three primary themes: transitional challenges, IENs' experiences working with older adults, and factors affecting IEN capacity to deliver services. Study findings are relevant to nursing leaders and policymakers in developing culturally relevant programs to help IENs transition successfully into the nursing workforce. Additional qualitative research is required to explore lived experiences of IENs caring for older adults.
THE EFFECT OF EMPLOYMENT SUPPORT PROGRAM PARTICIPATION ON MID-LIFE AND OLDER ADULTS IN A STATE
Authors: Yeo Hyesu , Wilson Steven
Published: December 2022

BackgroundQuestions have been raised about the effectiveness of these government’s efforts as older people aged 50 or older are affected by restrictions to participate in the labor market. This study examined the impact of the total programs under the Workforce Innovation and Opportunity Act in a state on older participants. MethodsThe study used the Technical College System of Georgia data between 2016 and 2020, with 11,390 participants aged 50 or over. The outcome of the program participation was employment status. The participants’ characteristics consist of gender, race, age, earnings, and types of training they received. Bivariate analyses were performed to examine the relationship between the program’s outcome and individuals’ characteristics. ResultsIn 2016-2020, most older participants were female (60%), and they were African American (64%) and White (24%). Among the total participants (N=11,390), about 60% of older people received job training, and about 70 % of them completed their training. Many older participants received training in 1) health professions and related clinical sciences and 2) business, management, marketing, and related support services. A total of 3,143 older people succeeded in finding their jobs. As age increases, the probability of getting a job and wage increase in re-employed jobs decreases. Conclusion The study found that most older people participated in service profession-related training. Also, racial minorities were the majority of the participants, while the state’s racial majority was White. This suggests considering program development to enhance racial minorities’ job skills for increasing wages through the state’s job training programs.
PRIMARY OCCUPATION AND PAIN AMONG ADULTS AGED 50 AND OLDER IN MEXICO
Authors: Milani Sadaf , Wong Rebeca
Published: December 2022

Working in physically demanding jobs may be associated with pain in middle and old age. This has not been widely studied in Mexico, which has a rapidly aging population. We evaluated the association between primary occupation and pain over 17 years of follow-up among Mexicans aged 50 and older using data from the Mexican Health and Aging Study (2001-2018). Primary occupation was categorized as professional, agriculture, domestic/service, production/industrial, or no main job. We examined frequent pain (yes vs. no) and pain interference (none/non-interfering vs. interfering), defined as pain that limits daily activities. Mixed effects logistic regression was used to model the association between primary occupation and pain. In 2001, participants (n=11,339) were 62.1 years old on average (standard deviation: 9.3) and 55.7% female. About 25.1% of participants worked as professionals, 17.2% worked in agriculture, 16.9% in domestic/service, 22.4% in production/industry and 18.4% had no main job. Almost all of those reporting no main job were women (98.7%). Compared to professionals, those in production/industry had higher odds of frequent pain at baseline [odds ratio (OR): 2.42; 95% confidence interval (CI): 1.25, 4.67]. Those in agriculture had higher odds of frequent (OR: 2.09, 95% CI: 1.03, 4.25) and interfering pain (OR: 2.50, 95% CI: 1.10, 5.70) at baseline. Pain did not change over time by lifetime occupation. The final analysis will include an estimation of gender differences. Health care providers should consider lifetime occupational risks, which may help address pain and minimize pain interference in old age.
CORRELATES OF JOB SATISFACTION AMONG FULL-TIME EMPLOYED OLDER ADULTS WITH CHRONIC CONDITIONS
Authors: Smith Matthew , Kew Chung Lin , Bergeron Caroline , Parker Martha , Oloruntoba Oluyomi , Aguilar Kaysey , Benden Mark , Merianos Ashley
Published: December 2022

With a rapidly aging workforce and the rising prevalence of chronic conditions, efforts are needed to better understand the needs of older adult workers and how to create supportive working environments for them. This study examines factors associated with job satisfaction among full-time employed adults ages 60+ years with 1+ chronic conditions. Data were collected with an internet-delivered survey in January 2022. Analyses included 337 older adult workers with chronic conditions. An ordinal regression model was fitted to assess factors associated with higher levels of job satisfaction. The model adjusted for sociodemographics, disease characteristics, social engagement, work logistics, and perceptions about the workplace. On average, participants were age 65.14(±4.56) years and self-reported 3.05(±2.09) chronic conditions. Twenty-eight percent reported being very satisfied with their current job and 48.4% worked remotely 1+ days per work week. Higher job satisfaction levels were positively associated with being Hispanic (β=0.68, P=0.030), exhibiting stronger organizational citizenship behavior (β=0.16, P< 0.001), and working more days remotely (β=0.12, P=0.026). Higher job satisfaction levels were negatively associated with job-related stress (β=-0.26, P< 0.001), feelings of social disconnectedness (β=-0.12, P=0.010), and greater intentions of leaving current jobs within the next three months (β=-0.70, P< 0.001). Findings suggest that job satisfaction among older adult workers is rooted in their compatibility with their organizations’ work environment, management of job-related stressors, and opportunity to engage in meaningful and fulfilling interactions with others. Strategies such as remote working are encouraged to give older adults flexibility to promote work-life balance and self-manage their chronic conditions.
MEMBER CHECKING GERONTOLOGY: THE CASE OF RETIREMENT
Authors: Ekerdt David
Published: December 2022

Gerontology has long been a public-facing field with an applied focus. As such, the credibility of gerontology’s conclusions and guidance about aging are crucial, our advice having relevance and impact in proportion to its popular resonance. In 2021 I authored an article for a large-circulation newspaper that generated over 500 reader replies, creating an opportunity for member checking of a kind. The article reported my personal experience of having retired—what I expected and what was a surprise. All of my observations about emotions and lifestyle, while my own, were nonetheless grounded in the research literature. Public comments on the article came from a readership that skews male and highly educated, i.e., people like myself. Many comments affirmed my observations (e.g., about time use, awareness of finitude) as experiences we had in common. Some comments disputed my authority, as an academic, to say anything valid about the “real world.” Opinion split on the value of continued work: it gives life meaning, it invites corrosive stress. Likewise, some retirees endorsed surrender to leisure while others urged engagement. One research takeaway: with no standard way to be retired or regard it, the quality of retired life remains a measurement challenge. Another takeaway: Retirees with partners commonly describe experience in the first-personal plural (we, us), suggesting that dyads are often apt units of analysis for retirement studies. This is but one case study, but it indicates that we must continually assess whether gerontology’s knowledge is valid and whether the public is grateful for it.
THE RELATIONSHIP BETWEEN ADVANCE CARE PLANNING AND COGNITIVE FUNCTION IN A MULTICULTURAL COHORT
Authors: Camacho Simone , Tolea Magdalena , Mendez Nicole , Zambrano Joyce Jimenez , Galvin James
Published: December 2022

Engagement in Advance care planning (ACP) – the process of communicating preferences for future medical decisions, has been linked to increasing age, greater decision-making capacity, and higher education, and is more prevalent in White older adults. To advance knowledge of ACP in multicultural populations, we examined variations in the relationship between sociodemographics, cognitive functionality and ACP. A total of 303 older (mean-age: 69.4±10.5; 69.9% females; 29.6% Non-Hispanic White, 21.2% African American, and 49.2% Hispanic) participants in a community-based dementia screening program were included. ACP measures included life insurance, disability insurance, long-term care (LTC) insurance, power of attorney (POA), living will, and having a health care proxy (HCP). Although most participants had health insurance (92.4%, no differences by race), low rates of ACP engagement were found in racial/ethnic minorities across multiple ACP measures (all ≤40%). Black older adults had the highest use of life insurance (p<.001). Higher ACP rates (i.e., LTC, HCP, living will) were associated with better global cognition (MoCA; p< 0.05). Higher POA rates were associated with lower AD8 scores (30.1% in AD8< 2 vs 15.4% in AD8≥2, p=0.003). Finally, ACP rates varied across racial-SES groups being highest in high SES White participants and lowest in minorities with low SES, regardless of subjective or objective cognitive performance. Findings link ACP to greater cognitive functionality and highlight racial and SES disparities in ACP engagement, particularly related to non-insurance-based planning. Understanding cultural differences in decision making can lead to targeted interventions to increase early ACP in cognitive aging and dementia for older adults.
BUILDING A PROTOCOL FOR LIVE DISCHARGE FROM HOSPICE: UNDERSTANDING THE APPROACHES, CHALLENGES, AND OPPORTUNITIES
Authors: Wladkowski Stephanie P , Schroepfer Tracy , Enguidanos Susan
Published: December 2022

A live discharge from hospice can occur when a patient stabilized under hospice care no longer meets the life expectancy hospice eligibility criteria. In 2019, 278,400 hospice patients across the United States were discharged alive from hospice care, with 18,096 (6.5%) discharged due to being ‘no longer terminally ill.’ For these individuals and their caregivers, the result is a disruption of care continuity and an often burdensome transition. Hospice care improves end-of-life outcomes for some patients, and a live discharge results in lost access to important supportive services and resources, while the patient remains ‘terminal.’ Further, an increased burden is placed on primary caregivers who may be unprepared for this transition. Currently, there is no explicit discharge process available within hospice to guide practitioners in transitioning patients and their caregivers out of hospice care. This study aimed to garner a deeper understanding of current approaches and accompanying challenges to inform the development of an explicit live discharge protocol. Focus group interviews with hospice social workers at four hospice agencies across the U.S. were conducted. Using thematic analysis, four key themes emerged, including the logistical (n=13) and psychosocial (n=9) approaches, the need for clear professional roles during a live discharge (n=12), and specific challenges (n=14), such as needed services and desired discharge timeline to best support the patient-caregiver dyad. Findings demonstrate the complexities of conducting a live discharge, the uniqueness of each hospice agency, and the need for more research to support a standardized and reimbursable discharge process.
UNDERSTANDING THE RELATIONSHIP BETWEEN COPING STYLES AND DEATH ANXIETY IN OLDER ADULTS
Authors: Coromac-Medrano Juliamaria , Watts Amber , Sinclair Christian , Engel Ilana
Published: December 2022

Research suggests that death anxiety stems from fear of pain, worry about loved ones, and uncertainty about what comes after death. Understanding the relationship between coping styles and attitudes towards death in older adults may help identify individuals who need support with death anxiety. This study explored the relationships between coping styles (active, disengaged, social) and death anxiety (fear, avoidance). We used the Death Attitude Profile Revised and three subscales from the Brief Coping Orientation to Problems Experienced (COPE) Inventory. We conducted linear regressions to determine which coping styles were associated with fear of death and death avoidance. In post-hoc analyses, we investigated the role of spirituality-based coping as a two-item subscale from the active coping scale. All models controlled for age, sex, marital and educational status. The sample included 87 community-dwelling older adults (Mage=72.72 (SD=5.88); 56.32% female; 86.21% White). Higher levels of disengaged coping were significantly associated with greater fear of death and death avoidance (p < .05). Use of social support coping was significantly associated with less fear of death (β = -.10, p < .05). Spirituality-focused coping was associated with lower death avoidance (p < .05). Disengaged coping may indicate higher death anxiety, whereas spirituality and social support coping strategies may indicate lower death anxiety. Our findings have implications for identifying individuals in need of extra support during critical points in the healthcare process. They may also inform design and implementation of psychosocial interventions for communication about healthcare goals in the context of serious or terminal illness.
AGE-RELATED IMMUNE CELL PHENOTYPES IN THE FRAMINGHAM HEART STUDY PARTICIPANTS
Authors: Fang Yuan , Chen Jiachen , Lunetta Kathryn , Murabito Joanne , Doyle Margaret
Published: December 2022

Mounting evidence supports a role for the immune system in the pathophysiology of dementia. Alterations in the composition of circulating immune cells is one of the key changes associated with age. However, the role of age and sex on immune cell phenotypes and their contribution to disease pathogenesis remains to be unraveled. We identified a study sample of 996 participants (mean age 62 years, range 40 to 88 years, 52% female, 22% APOE-ϵ4 carriers) from the community-based Framingham Heart Study Offspring cohort who were dementia and stroke free at the seventh examination (1998-2001), the first exam with existing stored peripheral blood mononuclear cells (PBMC). We profiled 132 circulating immune cell phenotypes from cryopreserved PBMCs by flow cytometry using standardized protocols. T cells, B cells, NK cells, and monocytes were reported as percentage of gated lymphocytes or monocytes. All other subsets were reported as percentage of the appropriate parent (e.g. CD4+ and CD8+). We summarized the distributions of each phenotype with age, sex, and APOE-ϵ4 genotype. We also evaluated the differences in percentages of T-cell subtypes including CD4+, and CD8+ T cells and their naïve, effector memory, and central memory subsets across age groups and sex. We observed that for both CD4 and CD8, naïve cells decrease with age, whereas effector/memory cells increase with age with no difference by sex. Future analyses will explore the association between immune cell phenotypes with cognitive test performance and risk of dementia in the context of exposure to cytomegalovirus infection.
WHAT IS THE DIGITAL MATURITY OF LONG-TERM CARE HOMES IN ONTARIO? A SURVEY PROTOCOL
Authors: Hakimjavadi Ramtin
Published: December 2022

Ramtin Hakimjavadi will discuss the barriers and facilitators of implementing a health information technology (HIT) maturity survey in the Canadian context. Alongside Dr. Liddy’s team, he is supporting the adaptation of the survey into a Canadian context, followed by a pilot study to distribute the survey to select nursing homes. Drawing from this work, Mr. Hakimjavadi will highlight the barriers and facilitators associated with the process of implementing the HIT maturity survey. Expected challenges include adjusting the survey format for respondents with limited resources, identifying a central contact within each nursing home, optimizing the survey user interface to limit response burden, and developing recruitment strategies to increase response rate. These challenges and the strategies to overcome them, impressions of the current state of HIT in Ontario nursing homes, and proposed action items to trend digital maturity in these settings over time will be discussed.
SENSORY PROCESSING CORRELATES WITH DEPRESSION AND PERCEIVED STRESS IN OLDER ADULTS
Authors: Chang Megan , Liu Chiung-ju , Blanche Erna
Published: December 2022

Sensory processing is defined as the ability to respond to sensory information from the environment and to act accordingly to the situational demands. Sensory processing is associated with anxiety in middle-aged adults, specifically in those with sensory over-responsiveness and under-responsiveness. It remains unclear how age-related change in sensory processing is correlated with mental health. The purpose of this study is to examine the correlations between sensory processing patterns, depression, and perceived-stress in older adults. Respondents were recruited from community networks serving older adults. They were asked to complete an electronic survey, including the Adult Sensory Processing Scale (ASPS), the Perceived Stress Scale, and the Center of Epidemiologic Depression Scale-Revised. ASPS has 11 factors related to over-responsive, under-responsive, and sensory seeking in visual, auditory, tactile, vestibular and proprioceptive input.Of 148 older adults (Mean age = 72 years) completed the survey, 30% perceived moderate to high levels of stress, and 18% had depressive symptoms. The total score of the ASPS Scale is positively correlated with perceived stress (r=0.26; p=.001) and depression (r=0.27; p=.001). Specifically, those who were over-responsive to auditory and vestibular input, and under-responsive to proprioception had higher stress levels and greater depression.Sensory decline or impairment in older adults may alter older adults’ ability to process sensory information. As sensory processing has significant impact on anxiety and perceived stress in older adults, it should be considered in evaluation and intervention, particularly on audition, vestibular and proprioception. Including sensory-based approach may help better manage their mental health.
EFFECT OF HYPERTENSION ON PREFRONTAL CORTEX ACTIVATION IN OLDER ADULTS DURING INSTRUMENTED TRAIL WALKING TASKS
Authors: Hernandez Manuel , Bishnoi Alka
Published: December 2022

Hypertension (HTN) can lead to non-amnestic cognitive impairment. However, it is unclear if this cognitive impairment affects dual task walking in older adults with HTN. The objective of this study was to evaluate the differences in prefrontal cortex (PFC) oxygenated hemoglobin (HbO2) levels during comfortable walking (CW) and an instrumented trail walking task (TWT) in older adults with HTN. We hypothesized that older adults with HTN would show decreased activation, or lower PFC HbO2 using functional near-infrared spectroscopy, during TWT in comparison to older adults without HTN. There were 15 adults in HOA group (11 females; 65±9 years old), and 9 adults in HTN group (3 females; 68±8 years old). The experimental paradigm consisted of three tasks (CW, TWT-A, TWT-B) in each of two blocks, with difficulty increasing from TWT-A to TWT-B through the inclusion of task-switching. A linear mixed effect model was conducted to investigate the effects of cohort, task, block and interaction between them on HbO2. We found that: 1) HTN adults exhibited lower HbO2 levels compared to HOA (p< 0.001), during TWTs but not CW; and 2) increased HbO2 levels were observed in TWTs relative to CW. During TWTs, HTN adults showed decreased activation compared to HOA, which shows that their ability to focus on dual task execution is limited. The hypertensive adults face difficulty in matching the attentional demands of the dual task, similar to cognitively impaired older adults, which may be partly explained by capacity sharing theory.
ECONSULT IMPROVES ACCESS TO SPECIALIST ADVICE FOR PRIMARY CARE PROVIDERS
Authors: Fung Celeste , Liddy Clare
Published: December 2022

Dr. Liddy will present an overview of the Champlain BASE™ eConsult service, with a focus on its implementation in long-term care (LTC). eConsult is a secure web-based tool that enables providers to communicate electronically with specialists concerning a patient’s care. Evaluation of over 100,000 cases has consistently demonstrated positive impacts on access to care: PCPs receive responses in a median of 0.9 days, and two-thirds of cases are resolved without the patient needing a face-to-face specialist visit. A cross-sectional analysis of eConsult cases sent from LTC settings in 2018 demonstrated similar response times and referral avoidance to the larger sample (a median response time of 0.6 versus 0.9 days; proportion of cases resolved without a specialist visit 70% versus 67%). These findings, coupled with eConsult’s proven success at improving access to and equity of care, demonstrate the importance of supporting eConsults expansion.
CAREGIVER TLC: A VIRTUAL PSYCHOEDUCATIONAL PROGRAM FOR CAREGIVERS: BASELINE PRELIMINARY DATA
Authors: Montoro-Rodriguez Julian , Gallagher-Thompson Dolores , Ramsey Jennifer , Bilbrey Ann Choryan , Kajiyama Bruno , Jason Kendra , Thompson Larry W
Published: December 2022

Family caregivers are at increased risk for negative impacts on their psychological and physical health compared to non-caregivers. Virtual caregiving programs are beneficial as caregivers may not have time to devote to face-to-face programs and especially important to caregivers in the context of the COVID-19 pandemic. Our team at the University of North Carolina at Charlotte is testing the efficacy of the Caregiver Thrive, Learn & Connect Virtual Program adapted from the Coping with Caregiving evidence-based multicomponent intervention (Gallagher-Thompson et al., 2003). The program offers to registered caregivers six weekly sessions over Zoom teleconferencing in small groups led by trained professionals from community partners serving socio-demographically diverse caregivers. Sessions address stress management, mood management, resilience, self-care, coping strategies, and isolation. Preliminary baseline data on 42 participants indicates that caregivers are primarily female (87%), on average 64 years old, and from diverse racial backgrounds: white (69%), African American (29%) and Asian American (2%). Participants provide care to persons with memory troubles or dementia (66%) and chronic health conditions (34%). Baseline data on initial levels of caregivers’ psychosocial outcomes indicated salient levels of mental health outcomes for burden (high = 49%; mild = 35%); anxiety (moderate = 16%; severe = 20%) and depression (mild levels = 35%; moderately and severe level of depression = 33%). Caregivers for chronic health conditions reported significantly higher anxiety compared to dementia caregivers. The Caregiver TLC program offers support to the targeted caregiver population seeking to improve their level of competence, mental health and social isolation.
STATE HOME AND COMMUNITY-BASED SERVICES AND RESIDENTIAL CARE TRANSITIONS AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Chyr Linda , Fabius Chanee , Drabo Emmanuel
Published: December 2022

Medicaid home and community-based services (HCBS) provide integral health-related and personal care to support community-dwelling older adults. Growing literature suggests that states with more generous HCBS expenditures may delay or substitute costly nursing home care, but evidence is limited on the impact of HCBS spending on transitions to residential care settings like assisted living. This study determines the association of state Medicaid HCBS generosity—HCBS spending as a percent of total long-term services and supports expenditure—on the probability of incident transitions to residential care settings or nursing homes. Publicly available HCBS expenditure data was linked to a nationally representative sample of 7,197 community-dwelling older adults participating in the National Health and Aging Trends Study from 2011-2018. A discrete-time, competing risk regression model estimated the association between HCBS generosity and transitions from community to residential care settings or nursing homes, adjusting for sociodemographic, socioeconomic, and health factors. Most older adults remained in the community (93.7%). Incident transitions into residential care settings were twice as likely to occur compared to transitions to nursing homes (4.0% vs 2.3%, respectively). Older adults residing in states with higher HCBS generosity (one percentage point increase) are less likely to transition to nursing homes (relative risk ratio [RRR], 0.24; 95% Cl, 0.05-1.10; p< 0.1). Greater HCBS generosity was not associated with transitions to residential care setting. Assessing HCBS generosity on transitions elucidates important contextual factors affecting the movement of older adults across the care continuum.