bluuebunny/crossref_metadata_2025 huggingface dataset:
GENDER-SPECIFIC ASSOCIATION BETWEEN DEPRESSION AND MORTALITY IN KOREAN OLDER ADULTS: A LONGITUDINAL STUDY
Authors: Cho Jungwon , Lee Jae Jun , Cho Eunhee
Published: December 2023

Late-life depression has become a significant public health problem because it adversely affects physical health, social function, and quality of life. Therefore, prevention and treatment of depression are necessary. Previous studies have indicated that depression in older adults is associated with mortality. However, research on mortality according to gender differences has not been actively conducted. Thus, this study aims to investigate gender differences between depression and mortality among Korean older adults. The data were collected from the Korean Longitudinal Study of Aging (KLoSA), which performed a nationwide aging panel survey for adults aged over 45 years between 2006 and 2020. Out of 10,254 participants, this study included 3,689 participants who were aged 65 or older and assessed depression through CESD-10. The Cox proportional-hazards model was used to calculate Hazard Ratios (HR) for mortality stratified by gender. Of the 1,599 male and 2,090 female older adults, depression was significantly higher in females (16.7%) than in males (8.8%). However, the effect of depression on mortality was significant only in males (male: HR = 1.50, 95% CI = 1.19–1.89; female: HR = 1.10, 95% CI = 0.93–1.31). Depression is more common in females, whereas the effect of depression on mortality was only significant in males. This suggests that health providers need to prevent and care for depression to decrease mortality, especially in males. Further studies are needed to explore the reasons for gender differences between depression and mortality and develop interventions to manage depression in older adults.
IDENTIFYING THE PATTERNS OF CAREGIVING DEMANDS: A LATENT CLASS ANALYSIS APPROACH
Authors: Ko Sung Hyun , Lee Yeonjung , Bierman Alex
Published: December 2023

Caregiving demands comprise the care tasks being performed or assistance being provided. Previous studies have assessed the care demands as intensity and types of care provided using various measures such as the number of care tasks provided, the hours of care provided, the number of ADL/IADL they assisted with, and the number of people assisted. However, most caregiving literature has treated caregiving demands as one-dimensional rather than considering the multi-dimensional attributes of care demands. This study examines distinct patterns of caregiving demands, each formed by varied combinations of the hours spent providing care a week, how often care was provided, the location care provided, and whether care was provided as a primary caregiver. Based on the 2022 Caregiving, Aging, and Financial Experiences (CAFE) Study data, the latent class and regression analysis were conducted on a nationally representative sample of Canadian informal caregivers. We identified four distinct patterns of caregiving demands: excessive, moderate, manageable, and minor. Excessive and moderate patterns share the characteristic of providing in-home care as primary caregivers, but the excessive group has higher burden levels than the moderate pattern. Manageable and minor patterns show low levels of burden as secondary caregivers, but the minor group does not provide in-home care. These patterns differ in caregivers’ sociodemographic characteristics (caregiver age, gender, minority, education, living with a partner, working status, and relationship to a recipient). The findings provide the basis for further understanding how the multi-dimensional layers of care demand conjointly shape the patterns of caregiving demands.
AGING IN PLACE IN JAPAN: CHALLENGES AND FACILITATORS OF OLDER-TO-OLDER CAREGIVING
Authors: Wada Mineko , Hanaoka Hideaki
Published: December 2023

The proportion of older adults (age 65+) in Japan has been steadily growing, and reached almost 30% in 2022, its highest-ever level. As the benefits of aging in place have been promoted at individual, community, and policy levels, the number of households where an older adult cares for another older adult has been increasing. However, currently little is known about the challenges and facilitators of older-to-older caregiving. This study aims to review extant literature to identify challenges experienced by older-to-older caregivers and facilitators that could help them. Drawing on a review protocol informed by Arksey and O’Malley’s framework and Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR), we searched six databases (MEDLINE, CINAHL, PsycINFO, Cochrane, Scopus, Google Scholar) using combinations of search terms including “older,” “aged,” “senior,” “caregiver,” “carer,” “care provider,” and “care recipient.” To be included in the study, the literature must be written in English and based on empirical studies focusing on older caregivers (age 65+) who care for older adults (age 65+) in community settings. The reviewed literature suggests that older caregivers experience substantial distress, caregiver burden, and sleep deprivation, which increases the risk of depression and diminished well-being, particularly if they care for older adults living with dementia. Facilitators of caregiving include strategies for self-care and problem-solving to address challenges. Future research needs to investigate (1) support options that could reduce older caregivers’ burden and promote their well-being and (2) older care recipients’ experiences of being cared for by older cares.
HEALTH-SEEKING BEHAVIOR OF COMMUNITY-LIVING OLDER ADULTS RELATES TO AWARENESS OF COMMUNITY SERVICES
Authors: Connelly Denise , Gill Navjot , Beauchamp Marla , Brunton Laura
Published: December 2023

Research has shown that older adults desire to age in their homes. To age at home safely and comfortably, there are a variety and number of community support services available, however, previous studies show older adults do not utilize these services fully. There is a need for clarity about this gap between availability and use. Understanding the construct of health-seeking behaviour by community-living older adults may provide insights into this identified gap. Therefore, the objective was to determine whether health-seeking behaviour in community-living older adults is related to: dimensions of wellness; awareness of community support services; living as an older man or woman; or being younger or older than 75 years. A cross-sectional study design involving 99 community-living older adults (≥ 65 years, without impaired executive function) employed validated outcome measures of physical function, fear of falling, personal resilience, social well-being, spiritual well-being, awareness of community support services, and health-seeking behaviour. Relationships were calculated using multiple linear regression. Health-seeking behaviour was positively correlated (R= 0.40, p<.01) with awareness of community support services. Health-seeking behaviour was not correlated with dimensions of wellness (i.e., physical function, fall risk, personal resilience, spiritual wellbeing, or social wellbeing). No difference between age groups (U=986.5, n1=68, n2=31, p=0.61) nor sex (U=931.5, n1=66, n2=33, p=0.24) was found for health-seeking behaviour. The findings indicate that awareness of community support services positively influenced health-seeking behaviour. The healthcare system should ensure equitable, accessible, age-friendly, and relevant information and distribution strategies to increase awareness of older adults for local supportive services.
RELATIONSHIP BETWEEN SOCIAL ISOLATION AND EXPECTATION FOR PERMANENT LIVING IN A MARGINALIZED COMMUNITY IN JAPAN
Authors: Watanabe Yuichi
Published: December 2023

Social isolation is a predominant issue for the well-being of older adults in Japan. In marginalized communities, there is a high aging ratio of over 50%, and many older adults live alone. If they did not have connections in the community, there would be huge problems, not just loneliness but also the lack of necessities of daily life. This fact could threaten their permanent living. Therefore, This research examines the relationship between social isolation and permanent living expectation. Data were gathered by surveying a marginalized community every two years from 2015 to 2019 (N=435). Logistic regression analysis was conducted. For measuring social isolation, the questionnaire includes two items as independent valuables; “How many contacts do you have with community residents in a week?”, “How many contacts do you have with someone living out of this community in a week?.” An item measured permanent living expectation as a dependant valuable; “Would you like to be living here permanently when you live alone?” Gender, age, economic status, health status, and living alone were also included in the analysis. The results show that the number of contacts with community residents significantly predicted the permanent living expectation(P<.00, odds ratio=1.099). Health status is also significantly associated with a permanent living expectation. Findings suggest that social isolation in a community is a risk for giving up a permanent living. It could be social exclusion. Our effort to make mutual connections and contacts among the community residents could ease the risk of social exclusion.
USING INTERPERSONAL RELATIONSHIPS AND SOCIAL NETWORK TO UNDERSTAND ELDER MISTREATMENT RECURRENCE
Authors: Xue Wei- Lin , Hass Zachary , Liu Pi-Ju
Published: December 2023

The incidence of elder mistreatment are often recurrent rather than one-time. The recurrence of mistreatment contributes to severe physical and psychological problems for victims and negative social consequences. Poor interpersonal relationships and social isolation are the main factors of mistreatment occurrence in the literature. However, very few studies have considered how the quality of interpersonal relationships and the level of social networks affect the likelihood of mistreatment recurrence. We used the National Social Life, Health, and Aging Project waves 1 (2005–06) and 3 (2015–16) data for longitudinal analyses (N=1,592). The quality of interpersonal relationships (i.e., supportive relationship, strained relationship) and the level of social networks (i.e., social engagement, social isolation, and feeling safe in society) were conceptualized using factor analysis to estimate factor scores. Logistic regression models were built to predict the risk of recurrent mistreatment using interpersonal relationship quality and the level of the social networks. Controlling for demographic variables, victims in wave 1 with support from interpersonal relationships are more likely to experience reoccurring mistreatment (p< 0.05, OR=1.58). Model interaction effects indicated that older adults with strained interpersonal relationships and low social engagement are most at risk of experiencing mistreatment recurrence. The surprising finding that supportive interpersonal relationships are positively associated with mistreatment recurrence might indicate that those who support older adults are potential perpetrators. Identifying potential perpetrators and assessing the quality of interpersonal relationships and social networks are essential to preventing mistreatment recurrence.
PERCEPTIONS OF HEALTH PROFESSIONALS, PATIENTS, AND FAMILIES ON DECISION TO DISCONTINUE LIFE-SUSTAINING TREATMENT
Authors: Lee Jooseon , Song Eunjeong , Shin Dongsoon , Yun Seon Young , Eom Minjeong , Oh Suhee , Lee Heejung , Song Rhayun
Published: December 2023

Withholding and withdrawing treatment is debated among health professionals who care for individuals at the end of life. This study aimed to compare the perception of life-sustaining treatment decisions by health professionals, patients, and families by providing data to guide medical professionals to support patients in making self-directed decisions about when to limit or continue their life-sustaining treatment. A descriptive survey was conducted with health professionals (220 from general tertiary hospitals) and 110 patients and their families. The majority of participants (85-95%) agreed with the suspension of meaningless life-sustaining treatment. In a clinical situation, the decision was made mainly by the family (84%), followed by the patient (10%) or the primary doctor (6%). However, the patients and their families reported that patients should make decisions (74%). The appropriate timing to discuss the suspension of the life-sustaining treatment was when the patients were still conscious but expecting severe deterioration” consistently reported by participants (45-58%). The most important factor during their decision-making would be “possibility of the patient’s recovery” by health professionals (43-55%), but “pain of the patients (58%)” was reported by the patients and their families. In conclusion, there is still a significant discrepancy in the perception of life-sustaining treatment decisions among health professionals, patients, and their families. The ambiguity of the timing for the decision to terminate life-sustaining treatment and the discrepancy between patients and their families’ opinions remain obstacles to implementing the Act to respect the patient’s right to self-determination and achieve the goal of a dignified end-of-life.
IMPACT OF BODY POSITION AND ARM USE ON EYE DROP INSTILLATION IN OLDER ADULTS
Authors: Trenary Tanner , Droste Andrew , Cook Rachel Logue , Cain Stephen , Sample Alanson , Burke David , Newman-Casey Paula Anne , Brown Susan
Published: December 2023

Visual impairments in older adults are associated with declines in physical, cognitive and social functioning, often leading to a loss of independence and quality of life. Increased age is a major risk factor, with conditions such as glaucoma having a 7-fold increase in prevalence from the 50s to the 80s (Klein & Klein, 2013). Treatment in the form of eye drops is commonly prescribed yet suboptimal adherence can significantly impact outcomes (Newman-Casey et al., 2015). The purpose of this preliminary study was to determine the effects of body posture and hand use on eye drop instillation success in a sample of 20 healthy, non-eye drop users (mean age: 70.0 +/- 3.7 y). Participants administered eyes drops without instruction while seated, standing and in a supine position. Video analysis was used to determine the number of attempts before successful instillation occurred (failed attempts) as well as whether participants used one or two hands. Despite published recommendations to use both hands (Davis et al, 2018), only 65% adopted a bimanual approach. The percentage of failed attempts was lowest in the supine (11.6%) compared to the seated (25.7%) or standing (21.2%) positions. Pinch strength was not correlated with successful instillation as has been previously reported (Naito et al., 2021), possibly due to participants’ overall level of physical functioning. Based on these results, a supine position is recommended for eye drop instillation where the head and neck are stabilized.
ADVERSE EVENTS IN OLDER ADULTS AT RISK FOR DEMENTIA DURING VIRTUAL EXERCISE AND COGNITIVE TRAINING
Authors: Faig Karla , Gallibois Molly , Bohnsack Alanna , McGibbon Chris , Sexton Andrew , Haché Josée , Knill Samantha , Jarrett Pamela
Published: December 2023

Synchronizing Exercises, Remedies in Gait and Cognition at Home (SYNERGIC@Home/SYNERGIE~Chez soi) is a home-based, double-blind, randomized controlled trial (NCT04997681) targeting community-dwelling older adults at risk for dementia. Anglophone and Francophone participants living in an Atlantic Canadian province (New Brunswick) underwent 16 weeks (three sessions/week) of interventions which consisted of virtual cognitive and physical exercise designed to delay or prevent the onset of dementia. This research aims to determine the frequency, severity, and relationship of the adverse events (AEs) that occurred during the intervention phase. All reported AEs were reviewed and managed by members of the research team, including a geriatrician. Participant’s (n=60) mean age was 68.9 years (SD 6.58), and the majority (76.7%) were female. Forty percent were living in rural communities, and 60% were urban. Of these participants, there was a total of 88 AEs reported by 42 individuals; 70% having at least one AE. The most common AE (39.8%) was musculoskeletal in nature. The majority (71.6%) of all AEs were unrelated to the intervention, and 69.3% of all AEs were classified as mild. There was only one serious AE, and it was unrelated to the intervention. The intervention had to be discontinued in two individuals, and modifications were required in 59 cases for participants to continue in the study. When delivered virtually with videoconference supervision, physical and cognitive interventions resulted in no serious related AEs and few related, mostly mild AEs, that were safely managed through modifications to the physical interventions.
COGNITIVE IMPAIRMENT IS ASSOCIATED WITH INFERIOR POSTURAL BALANCE AND REDUCED GAIT SPEED
Authors: Schmidt Laura Katharina , Stuckenschneider Tim , Koschate Jessica , Zieschang Tania
Published: December 2023

Fall-related sequelae including balance as well as gait impairments are more pronounced in older adults with cognitive impairment (CIOA) compared to cognitively healthy older adults (CHOA). Evidence is scarce about differences in postural balance and gait in CHOA and CIOA after a fall, even though these are major risks for recurrent falls. Especially, there is a dearth of data based on validated sensor technologies. Thus, it is our aim to use sensor-based data to investigate differences between these two groups. Postural balance and gait were measured using three wirelessly synchronized IMU’s (APDM, Inc., Portland, USA) in n=50 CHOA, mean age 73.82±8.25 years and n= 56 CIOA, mean age 78.27±8.0 years. Data were collected at participants’ homes as part of a comprehensive geriatric assessment in the “SeFallED” study within four weeks after presentation to the emergency department (ED) after a sentinel fall (German Clinical Trials Register ID: 00025949). Differences in postural balance and gait between two groups were analyzed by using a Mann-Whitney-U-Test. Statistical analysis revealed a significantly poorer postural balance in CIOA compared to CHOA for the parameters Jerk (m2/s5; p=0.039) and mean velocity (m/s; p=0.036). Further, CIOA had a significantly lower gait speed (m/s; p=0.035) and stride length (m/s; p=0.028) compared to CHOA. Even though both groups had shortly experienced a fall with presentation to the ED, impairments in gait and balance parameters were more prominent in CIOA. Based on these results, physical exercise interventions should focus on the improvement of impaired gait speed and balance particularly in CIOA.
IMPLEMENTATION OF BRAINCHECK FOR COGNITIVE ASSESSMENT AND CARE PLANNING IN THE CLINICAL SETTING
Authors: Huang Bin , Zavala Patrick , Mann Christine , Harlock Sarah , Dekle Kori , Knighton Amy , Ajtai Bela , Hemphill John
Published: December 2023

With the growth of the older adult population (age ≥ 65 years), age-associated neurocognitive disorders, such as Alzheimer’s disease and related dementias (ADRD), are becoming more common in America and worldwide. The increasing number of patients has surpassed the capacity of healthcare systems. Thus, there is a need for time-efficient, cost-effective solutions for better allocation of limited clinical resources that can benefit clinicians and patients. Here, we conducted a quality improvement study in collaboration with Savannah Neurology Specialists and Dent Neurologic Institute. We evaluated users’ perspectives on the usability and feasibility of implementing BrainCheck, a computerized tool for cognitive assessment and care planning. One neurologist and their team from each institute received 45 minutes of training on BrainCheck and used it on an iPad from mid-November to the end of December 2022. In total, 49 patients have completed BrainCheck Cognitive Assessment, and 7 of them also completed BrainCheck Cognitive Care Planning during the study period. On average, it took 13-18 minutes to administer BrainCheck Cognitive Assessment, interpret the result, and document it in EHR. The majority of patients (96%) reported satisfaction with the testing experience and found the instructions easy to understand. Both providers reported high usability of BrainCheck (6.2/7.0) as measured by the Post-Study System Usability Questionnaire. These results demonstrate the great potential of BrainCheck for clinical use, as it can support providers in assessing the cognitive function of their patients in a timely and efficient manner.
RISK FACTORS OF OSTEOARTHRITIS AMONG OLDER ADULTS WITH COGNITIVE DECLINE IN SOUTH KOREA
Authors: Kim Jennifer (Jeehyun) , Kang Bada
Published: December 2023

Individuals with cognitive decline are vulnerable to developing osteoarthritis owing to reduced physical activity and impaired communicational ability. While the cross-sectional relationship between cognitive decline and chronic diseases has been previously studied, longitudinal studies are needed to identify determinants associated with the onset of osteoarthritis among older adults with cognitive decline. This study was aimed at elucidating the risk factors of osteoarthritis based on cognitive status. 1,142 older adults, including 334 cognitive decline and 808 normal cognition individuals, were selected from the Korean Longitudinal Study of Aging. Kaplan-Meier curves were plotted to estimate the probability of osteoarthritis based on the participants’ sex and cognitive status. Cox proportional hazard regression analysis was performed to determine factors associated with the risk of osteoarthritis after the participants were stratified by cognitive status. Female sex and advanced age were associated with a greater risk of osteoarthritis in both the participants with and without cognitive decline. Furthermore, the risk of osteoarthritis was significant among older adults with cognitive decline if they lived alone, were depressed, had social engagement fewer than once per week, or had a high dependency on others for completing activities of daily living. However, there was an increased risk of osteoarthritis among older adults with normal cognition who had a high body mass index and a chronic medical condition. Therefore, comprehensive coping strategies focusing on the socio-environmental characteristics and clinical symptoms of older adults with cognitive decline should be considered to prevent a further increase in the healthcare burden associated with osteoarthritis.
CARDIOVASCULAR DISEASE AND FRAILTY IN OLDER ADULTS FROM COLOMBIA
Authors: Sosa-Sarmiento Paola , Ocampo-Chaparro Jose , Reyes-Ortiz Carlos
Published: December 2023

Cardiovascular disease (CV) is a leading cause of death worldwide. Frailty is a growing geriatric syndrome. Limited research has explored the relationship between cardiovascular disease and frailty. This study assesses the association between a cardiovascular disease history and older adults’ frailty. We used data from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study, a cross-sectional nationwide population-based survey (2015) including community-dwelling adults ≥60 years. A secondary dataset of 5,242 participant responses was analyzed. Frailty was assessed according to the Fried Frailty Phenotype (weakness, low speed, low physical activity, exhaustion, and weight loss) and categorized as frail (3 or more components) vs. not frail or pre-frail. We performed logistic regression analysis to assess the association between a history of cardiovascular disease (hypertension, stroke, heart disease) and frailty, adjusting for socio-demographics, other comorbidities, and functional status. The prevalence of cardiovascular disease was 59.4%, and frailty was 20.0%. Compared to those who do not have CV disease, those having 1 CV disease (OR=1.23, 95% CI 1.04-1.46) or ≥2 CV diseases (OR=1.55, 95% CI 1.24-1.94) were associated with higher odds for frailty. A higher number of CV diseases were independently associated with frailty among older Colombian adults. In future studies, preventing CV disease might help to decrease frailty in older adults.
CHANGE IN USE OF REMOTE HEALTH TECHNOLOGIES AMONG OLDER AFRICAN AMERICAN MEN DURING THE COVID-19 PANDEMIC
Authors: Sherman Ledric , Alexander-Bady Janae
Published: December 2023

It is well known that minority communities are disproportionately affected by disparities present within the US health care system. With the onset of COVID-19, these gaps in health quality continue to be exacerbated. Understanding health technology use differences pre-COVID and post-COVID among African American men is a necessary first step towards improving health outcomes that may be targeted via health technology interventions. The purpose of this study was to explicate and contextualize post-COVID health technology use among African American men in the United States for self-management of health. Of the 54 participants, all between the ages of 65-85, who completed a 30-item technology use questionnaire, a majority reported having type 1 diabetes and high blood pressure and that their current health was good or very good. For technology devices used pre-COVID, the highest reported devices owned were smartphones, desktop computer, laptop, and fitness tracker. Post-COVID, participants purchased fitness tracker CGM, glucose meter, and scale to check weight. As researchers and providers work towards addressing the prevalent health disparities disproportionately affecting members of our communities, these results provide an informative description of pre- and post-COVID.
HEALTH PRIORITIES ALIGNED DECISION MAKING FOR DISCRETE DECISIONS
Authors: Banks Jack , Soni Suha , Madrid Vanessa , Samper-Ternent Rafael , Arain Salman , Tinetti Mary , Naik Aanand
Published: December 2023

The outcomes that establish the evidence-base and frame expectations for discrete interventions, primarily survival and disease-specific markers, may not be the outcomes older adults with multiple chronic conditions (MCCs) prioritize. An advisor group consisting of 6 health professionals with expertise in geriatrics, cardiology, vascular surgery and decision-making plus a panel of patient stakeholders created a decision-making framework titled ‘health priorities identification – discrete intervention decision’ (HPI-DID) process. This study aimed to refine the HPI-DID process using revascularization for peripheral arterial disease (PAD) as an exemplar procedure through eliciting feedback on the HPI-DID process from patients and caregivers. Seven older adults who recently underwent a revascularization procedure for PAD or their caregivers took part in one-to-one interviews with JB and SS. During interviews, participants were asked to verbalize or ‘think-aloud’ their thoughts while reviewing and performing each component of the health priorities process and probed what could be added or cut to improve the procedure-related communication and decision-making process. Participant feedback resulted in structural changes to the process. Font size was increased and specific words were bolded. Three additional tables detailing expected benefits, tradeoffs and complications from the procedure and their expected durations were added. The mean percentage of patients who experience these outcomes is now also listed. We will conduct a pilot trial to evaluate the feasibility and acceptability of our refined HPI-DID process with clinical interventionalists and older patients with MCCs considering revascularization for PAD.
PERCEIVED COGNITIVE FUNCTION: RELATIONSHIPS WITH DIABETES COMPLICATIONS AND SELF-EFFICACY IN LATINX OLDER ADULTS
Authors: Wood Shenell , Cuevas Heather
Published: December 2023

Cognitive dysfunction is a concern for individuals with type 2 diabetes (T2DM) and can affect diabetes self-management. However, it is often overlooked clinically and remains relatively understudied in Latinx older adults as a complication of T2DM. This project sought to explore the relationships between perceived cognitive dysfunction and its effects on self-efficacy and complications of T2DM in older Latinx adults. This was part of an analysis of baseline data from a larger randomized controlled trial investigating an cognitive rehabilitation intervention for older adults with T2DM. A total of 87 participants (mean age 67.3 +/- 5.4) completed a survey consisting of the Diabetes Empowerment Scale - short form (self-efficacy); PROMIS Bank v.2 - Cognitive Function (perceived cognitive function); and a self-report of number and type of diabetes complications. Participants had lower perceived cognitive dysfunction than the general population (Mean total score: 36.6 +/- 7.9); low self-efficacy (mean total score: 2.3 +/- 0.7) and reported at least 2 complications related to T2DM. Greater perceived cognitive dysfunction was related to lower self-efficacy (p = 0.04). Diabetes duration was positively associated with self-efficacy (p = 0.03), but not perceived cognitive dysfunction (p = 0.22). Self-efficacy was positively associated with number of diabetes complications (p = 0.03). Irrespective of diabetes duration, patients with more severe perceived cognitive dysfunction reported lower self-efficacy (p = 0.03) than those with lower levels of cognitive dysfunction. Assessment of cognitive function may help inform patient education interventions for Latinx older adults to improve the self-efficacy and potentially reduce complications.
THEORETICALLY BASED FACTORS ASSOCIATED WITH STROKE FAMILY CAREGIVER HEALTH
Authors: Kum Cleopatra , Jones Holly , Miller Elaine , Kreitzer Natalie , Bakas Tamilyn
Published: December 2023

Background

Most stroke survivors are cared for at home by family members, many of whom experience depressive symptoms and life changes as a result of providing care. While many studies have explored the factors associated with depressive symptoms and quality of life in family caregivers, few have focused on caregiver health. Purpose: To determine theoretically based factors associated with unhealthy days in stroke family caregivers.

Methods

A conceptual model derived from Lazarus’ theory of stress and coping was used to guide analysis. Secondary data analysis was conducted using baseline data from a large randomized controlled clinical trial testing the Telephone Assessment and Skill-building Kit (TASK II) program with 254 family caregivers of stroke survivors within 2 weeks of discharge from acute care and rehabilitation settings in participating Midwestern facilities. Data were analyzed using multiple regression with unhealthy days as the dependent variable, and theoretically based factors (i.e., caregiver task difficulty, level of optimism, threat appraisal, depressive symptoms, and life changes) as independent variables. All scales demonstrated evidence of internal consistency reliability with Cronbach alpha scores above .70.

Results

Caregivers were mostly female (78%), white (71%), spouses (47%) or adult children (30%). Caregivers reported 9 unhealthy days on average within the past month. Unhealthy days were significantly correlated with caregiver task difficulty (r=.32), level of optimism (r=-.29), threat appraisal (r=.44), depressive symptoms (r=.60), and life changes (r=-.40) (p<.05). 37.8% variance in unhealthy days was explained, with depressive symptoms being the only significant individual predictor due to shared variance.
GERIATRICS TRAUMA CO-MANAGEMENT: PRELIMINARY DESCRIPTIVE DATA FROM A SINGLE ACADEMIC INSTITUTION
Authors: Yamada Yuji , Harada Ko , Ko Fred , Chai Emily , Suarez-Rodriguez Luis , Wedderburn Raymond , Amir Omar
Published: December 2023

Background

Traumatic injuries cause higher mortality and complications in older patients than in younger individuals. Orthogeriatric co-management programs improve outcomes and quality of care and may be a model for trauma management. We theorized that geriatricians could improve trauma care in older adults with the early identification of geriatric syndromes.

Methods

A retrospective chart review was conducted for patients aged > 65 years admitted to the trauma surgery service at a Level 2 trauma center between October 2022 and January 2023, who were co-managed by geriatricians as part of a pilot program.

Results

67 patients were included in this study. The mean age was 81 (65-99), and 38% were male. The most common injuries were rib fractures (39%), subdural hematomas (32%), and spinal fractures (10%). Geriatric syndromes identified and managed by a geriatrician included frailty (47%), major or minor cognitive impairment (48%), delirium (19%), malnutrition (13%), and polypharmacy (65%), with a mean number of 6.7 home medications. As per Beers criteria, 63% of patients were taking inappropriate medications. Geriatrician-led interventions in advance care planning included identification and documentation of healthcare proxies (i.e., increased to 87% from 11% on admission) and goals of care conversations (54%).

Conclusions

Given the high prevalence of geriatric syndromes and complex medical and social needs in older patients with trauma, geriatric co-management may enable timely diagnosis and treatment of conditions that cause poor outcomes. Further research is warranted to assess the impact of geriatric co-management models on the long-term clinical outcomes in older individuals after injury.
A NEW ROLE FOR KYNURENINE METABOLISM IN THE AGE-ASSOCIATED DECLINE OF THE BACTERIAL IMMUNE RESPONSE
Authors: Sutphin George , Espejo Luis
Published: December 2023

Tryptophan metabolism through the kynurenine pathway becomes dysregulated during normal aging and is implicated in age-associate disease, including chronic inflammation, atherosclerosis, neurodegeneration, and cancer. Kynurenine pathway enzymes and metabolites influence a range of molecular processes critical to healthy aging, including regulation of inflammatory and immune responses. Kynurenine metabolism is active in immune cells and activated in response to proinflammatory cytokine signaling. We previously determined that elevating physiological levels of the kynurenine pathway metabolite 3-hydroxyanthranilic acid (3HAA) via either direct supplementation or inhibition of the enzyme that degrades 3HAA, 3HAA dioxygenase (HAAO), extends lifespan and delays age-associated health decline in Caenorhabditis elegans. Published work suggests that 3HAA is anti-inflammatory in mammals, for example by reducing the ratio of activated to regulatory T cells and inhibiting pathological activation of macrophages. In recent work, we find that elevating physiological 3HAA can beneficially enhance the immune response of C. elegans to bacterial pathogens during aging. 3HAA is sufficient to kill bacterial and inhibit bacterial growth in culture. When HAAO is inhibited in C. elegans, 3HAA accumulates in lysosome related organelles (LROs) in the intestinal cells, the same subcellular compartment that contains engulfed bacteria. LROs are a cellular repository for both iron and zinc, and we further find that iron chelation or zinc supplementation dramatically enhances the bactericidal properties of 3HAA. Here we present a mechanistic model in which age-dependent accumulation of 3HAA in intestinal LROs combines with zinc to enhance bacterial resistance with age in C. elegans.
EAAS AND WHEY PROTEIN MAY IMPROVE PHYSICAL FUNCTION OF OLDER ADULTS INDEPENDENTLY OF GUT MICROBIOME
Authors: Azhar Gohar , Verma Ambika , Nookaew Intawat , Patyal Pankaj , Sharma Shakshi , Wolfe Robert , Wei Jeanne
Published: December 2023

Essential amino acids (EAAs) and dietary proteins are major nutritional supplements that support the growth and activity of gut microbes, contributing to the wellbeing of their host. We hypothesized that daily ingestion of EAAs or whey proteins for twelve weeks would improve the gut microbiome of older adults and thereby have a positive impact on their physical functioning. The stool samples were collected from the 40 subjects before and after consuming EAAs or whey proteins for twelve weeks and subjected to Illumina based 16S rRNA gene sequencing. In both groups, the most abundant families in order of relative abundance included: Bacteroidaceae, Ruminococcaceae, Lachnospiraceae, Rikenellaceae, and Prevotellaceae, which indicated that these subjects were able to maintain a dominant consortium of microbes in their guts that have been associated with healthy aging. Individual gut microbiome samples analysis with nonmetric multidimensional space (NMDS) showed that each individual was associated with its unique microbiome. The key finding of this study was a significant reduction of plasma Interleukin-18 binding protein (IL-18) in EAAs vs whey group (p < 0.003). It is plausible that the reduced level of inflammatory IL-18 contributed to improved intestinal immunity. Moreover, the reduced inflammation might have resulted in better muscle performance in the EAAs group vs whey as evidenced by six-minute walking distance (EAAs 92.55 ± 4.16 ft vs whey 47.46 ± 4.99 ft, p< 0.0001) at the completion of study. Future studies will need to explore the role of EAAs on gut microbiome mediated reduction of immune inflammation on physical function and aging.
BLACK/WHITE DIFFERENCES IN LENGTH OF STAY IN HOSPICE AMONG MIDDLE-AGED AND OLDER ADULTS IN THE UNITED STATES
Authors: Yu Heshuo , Brown J Scott
Published: December 2023

Objectives

Hospice length of stay (LOS) is a crucial measure of hospice care. This topic is understudied within a nationally-representative sample across different races/ethnicities, especially among non-White decedents.

Methods

The study used negative binomial regression to analyze three waves (2014, 2016, and 2018) from HRS (n=1,991).

Results

African Americans were found to stay longer in hospice than their White counterparts when controlling for all other variables in the model. Not married, having Medicare insurance, cancer, chronic lung disease, and dementia significantly influence length of hospice stay when holding all other variables constant in the model.

Discussion

The significant Black/White differences in hospice length of stay demonstrate the potential decrease in cumulative inequality in the delivery of appropriate and needed hospice services across the two racial groups. Future research is recommended to explore the potential consequences of longer hospice stays as well as the health and health care mechanisms related to the different disease profiles that lead individuals to hospice care, especially among African Americans.
INTOLERANCE FOR UNCERTAINTY MEDIATES DEATH ANXIETY AND HYPOCHONDRIASIS IN OLDER ADULTS
Authors: Killingsworth Derek , Muraira Joseph , Fontanese Matthew , Cornwell Hannah , Barela Lance , Kapoor Karina , Coldiron Allyson , Barnett Michael
Published: December 2023

Hypochondriasis – or illness anxiety disorder – is the preoccupation of having an illness, which has been linked with and theorized to be caused by fear of death. While death anxiety tends to decrease with age because of increased exposure to death, the association between illness anxiety and fear of death strengthens with age. Many anxiety disorders, including illness anxiety disorder, have often been explained by an intolerance for uncertainty. The current study therefore investigated whether intolerance of uncertainty mediated the effect of fear of death on hypochondriasis among older adults. Older adults (N = 260), ages 65 to 94 years (M = 75.8, SD = 7.39), responded to an online survey, which included the Death Attitude Profile-Revised questionnaire, the Intolerance of Uncertainty Scale, and the Illness Attitudes Scale. Results showed that fear of death was directly related to hypochondriasis as well as indirectly related through intolerance of uncertainty. Fear of death and intolerance of uncertainty were both positively associated with hypochondriasis. Older adults with more fear about death are more likely to experience illness anxiety and have a higher intolerance for uncertainty. It may be that older adults with higher levels of intolerance to uncertainty are more at risk for anxiety, which then may result in increased fear of death and illness anxiety with the increased exposure to death that is associated with older age. Hypochondriasis in older adulthood may therefore be best addressed by interventions that explore the uncertainty of death and focus on increasing tolerance for uncertainty.
EXPLORING PREDICTORS OF LONGEVITY USING RETROSPECTIVELY CODED AUTOBIOGRAPHICAL DATA
Authors: Barnett Brianna , Bishop Alexander
Published: December 2023

The aim of this study was to identify predictors of longevity using retrospectively coded autobiographical stories written and recorded from N = 1,858 deceased centenarians (M = 102.79 years; SD = 2.25 years) from the state of Oklahoma. Using the Developmental Adaptation Model as a conceptual framework, total number of years lived, the developmental outcome was regressed on socio-demographic characteristics including sex, race, and education, as well as retrospectively coded variables reflecting parental occupation, total years married, age at retirement, engagement in international travel, and self-attributions of longevity. Results confirmed three key predictors of living to 100 years and beyond. First, race was confirmed as a strong predictor of longevity (β = −.65, p < .001). Fatherhood agricultural occupation emerged as second key predictor of living 100 years and longer (β = .42, p < .10). Finally, total years spent in a marriage represented a third predictor of longevity (β = .47, p < .01). Results suggest being a person of color, being raised by a father who made a livelihood working in the agricultural industry, and remaining within a long-term marital union are contributing variables linked to living 100 years and longer. Further detail regarding descriptive and methodological evaluation of retrospectively coded centenarian biographies will be highlighted. Results have implications relative to how gerontological researchers and aging service professionals may evaluate and link autobiographical information of long-lived adults to developmental outcomes such as longevity.
EXTREME WEATHER PREPAREDNESS AND CLIMATE ACTIVISM AT AGE 85+
Authors: Patskanick Taylor , Ashebir Sophia , D’Ambrosio Lisa , Coughlin Joseph
Published: December 2023

Current projected shifts in climate suggest extreme weather events and disasters will become increasingly common and severe. Older adults are a population vulnerable to the impact of extreme weather due to complex mobility, health, and financial situations in later life, affecting their ability to prepare for and respond to extreme weather emergencies. These compound vulnerabilities demonstrate the importance of adequate emergency preparedness among older adults, particularly among the oldest of older adults or the age 85+ demographic. This paper shares findings from a mixed methods study with the MIT AgeLab 85+ Lifestyle Leaders panel, a research panel of U.S. octogenarians and nonagenarians, on climate change, including their perceptions of generational contributions to climate change, extreme weather preparedness, and engagement in climate justice. Utilizing a survey (n=23) and five virtual focus groups (n=19) conducted in July 2022, findings underscore differences in themes related to weather-event-related emergency preparedness among Lifestyle Leaders living in senior housing versus those community-dwelling. Additional themes note a perceived lack of individual agency and control around impacting climate change locally (including a potential life stage effect) and the urgency of climate change as a societal-level and voting issue. The implications of these findings for effective engagement with the over-85 age demographic in conversations about climate change and emergency preparedness will be highlighted.
FINANCIAL DECISION MAKING AND WEALTH LOSS IN OLDER ADULTS WITH EARLY MEMORY LOSS: THE WALLET STUDY
Authors: Lichtenberg Peter , Flores Emily , Rorai Vanessa
Published: December 2023

Angisani and Lee (2019) used the HRS to determine that wealth loss was related to early memory loss. Using methods described elsewhere (Lichtenberg et al., 2022), we investigated personal finance behaviors and wealth loss. using 12 months of checking account statements and follow up interviews with 114 older adults; 67 of whom had self-reported cognitive impairment (CI), and two-thirds of who were African American. Participants were largely recruited from research registries with the Michigan ADRC and the Michigan Center for Urban African American Aging Research. Mean age was 72 years mean education was 15 years, and 70% of the sample were women. There were no differences between the group on demographic variables, financial literacy (3-item Lusardi and Mitchell scale) or annual income. Bivariate analyses (t tests) indicated that those with CI were significantly more likely to suffer wealth loss across the 12 month period. Those with CI had significantly poorer scores on a person-centered financial decision making scale, and reported significantly lower IADL skills. In addition, those with CI were more likely to financially helping others on a regular basis, and reported a higher rate of financial exploitation. Correlations between wealth loss and CI (r=.22; p<.05), decision-making (r=.54; p<.05) and helping others on a regular basis (r=.51; p<.05). A logistic regression predicting wealth loss resulted in two measures significantly predicting wealth loss; financial decision-making and helping someone else financially on a regular basis.

Conclusions: (1) early CI is related to wealth loss and (2) decision-making intersects with wealth loss.
A STUDY ON JOB STRESS AS A MEDIATOR BETWEEN DEMOGRAPHIC VARIABLES AND SELF-REPORTED HEALTH AMONG OLDER ADULTS
Authors: Deshmukh Madhyami , Martin Peter
Published: December 2023

Job stress among older adults has not been sufficiently researched, and findings balance between work and personal life has become imperative. The aim of this research is to examine a path model that includes demographic variables (age, gender, and education), job stress, and self-reported health. Two recent waves (waves 13 and 14) of the Health and Retirement Study (HRS) were included in this analysis. A total of 8535 participants (3971 males and 4564 females) were part of this study. Bivariate correlations and multiple regression analyses were computed. The process macro in SPSS was used to assess mediation. Results indicated that job stress was associated with age, gender, and education such that women and more highly educated participants had higher job stress levels, whereas older adults had lower job stress levels. The multiple regression analysis showed that only age was significantly associated with stress, whereas gender and education were not. Furthermore, education was positively associated with better health, but health did not correlate with age or gender. As expected, job stress was associated with self-reported health at a later time point, such that more job stress was related to lower self-reported health levels. Finally, job stress mediated between demographic variables and health at a later time point. As the data were collected before the pandemic, it would be important to see if these results would have changed over the course of the pandemic. Future interventions should develop appropriate work-life balance to promote better health in later life.