bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CEREBELLUM MAY MITIGATE OBESITY-DRIVEN COGNITIVE IMPAIRMENT IN LATE LIFE
Authors: Garbarino Valentina R , Baeuerle Eric , Orr Miranda E
Published: November 2019

Mice that overexpress mutant human tau in forebrain neurons develop many features of Alzheimer’s disease (AD), including behavioral impairments and neurodegeneration by 5 months of age. While an appropriate model to study AD-like pathology, the transgene’s high neurotoxicity makes it difficult to investigate how aging impacts AD onset and progression. The removal of endogenous mouse tau decreases the transgene’s neurotoxicity in young mice, which has allowed us to age mice to 20 months of age and investigate behavior at a more AD-relevant stage of life. Interestingly, the tau transgenic mice show increased discrimination between familiar and unfamiliar objects than non-transgenic littermates (p = 0.02) suggesting tau transgenic mice have better memory. The transgenic mice also displayed increased physical activity in the Open Field Test than non-transgenic littermates (distance traveled, p = 0.0102, and gait speed, p = 0.0219). Their improved behavioral performance occurred despite significant forebrain atrophy (20% smaller, p=0.0003). Interestingly, the non-transgenic control mice lacking endogenous mouse tau developed insulin resistance and obesity, and had significantly smaller cerebellum than transgenic mice (10% smaller, p = 0.0007). These data suggest that insulin resistance and obesity contribute more profoundly to poor behavioral performance than forebrain neurodegeneration. Moreover our study suggests that the cerebellum, recognized primarily for its role in coordination and motor function, may be an important mediator of late life cognitive function, especially in the presence of insulin resistance and obesity.
PRIMING OF MICROGLIA ACTIVITY INCREASES SUSCEPTIBILITY TO DEPRESSION-LIKE BEHAVIORS
Authors: Frolinger Tal , Iqbal Umar , Pasinetti Giulio M
Published: November 2019

This study investigates the role of microglia activity in stress-induced depression and anxiety and the mechanisms associated with the role of certain microbiome derived anti-inflammatory polyphenols in attenuating stress-induced microglia immune priming and symptoms of depression. We implemented a chronic unpredictable stress (CUS) paradigm to exhibit priming of microglia innate immunity in the context of the onset of depression and anxiety phenotypes. Mechanistic studies related to prophylactic treatment using dietary microbiome derived polyphenols were also investigated in this model. Depression and anxiety phenotypes, gene expression in microglia and protein expression in the cortex of mice were measured following a primary exposure to short-term unpredictable stress (US) followed by CUS. We examined the long-term, persistent CUS induced changes at 4-weeks of post-stress rest following a secondary US exposure. We found depression phenotypes resulted from US only following exposure to CUS. This was accompanied by an increase and persistent upregulation of toll-like receptor 4 (TLR4), RAGE, and HMGB1 gene expression in isolated cortical microglia. Priming by CUS also amplified gene expression of IL-1β in microglia and protein IL-1β in the cerebral cortex following US re-exposure. Increased activity of NF-kB was also noted in the period following CUS. Furthermore, polyphenol treatment prevented stress-induced phenotypes, upregulation of HMGB1, IL-1B, and TLR4 gene expression, as well as upregulation of IL-1β and NF-kB. The study suggests that latent activity of the TLR4-NFkB-IL1β pathway contributes to immune priming and increases susceptibility to depression-like behaviors. Anti-depressant effects of polyphenols may result from their ability to attenuate microglia priming.
NEW APPROACH TO STUDYING COLLECTIVE EFFECTS OF GENETIC FACTORS ON ALZHEIMER’S DISEASE
Authors: Yashin Anatoliy , Wu Deqing , Arbeev Konstantin , Akushevich Igor , Yashkin Arseniy , Duan Matt , Stallard Eric , Ukraintseva Svetlana
Published: November 2019

Despite the wide recognition of the multifactorial nature of Alzheimer’s disease (AD), mechanisms of the collective influence of genetic and environmental factors on AD remain poorly understood. We used the Cardiovascular Health Study (CHS) and Framingham Heart Study (FHS) data to investigate the effects of genetic and gene-environment interactions on AD prevalence in the association analysis using logistic regression. Based on results of this analysis, we developed several new measures of integrated effects of SNPs, including for specific gene or group of genes, by constructing SNP-specific Interaction Polygenic Risk Scores (SIPRSs), Gene-specific Interaction Polygenic Risk Scores (GIPRS), and Trait-specific Interaction Polygenic Risk Scores (TIPRS), and tested them in the above data. We found strong interaction effects on AD among the SNPs in NRG3 gene and smoking, and among the SNPs in ATM and creatinine. In summary, we developed a new approach to measuring the collective impact of SNPs on complex traits, and discovered significant effects of the newly constructed SIPRS, GIPRS, and TIPRS on AD prevalence. The results of this study open a new opportunity of investigating the joint impacts of genetic and environmental factors on AD and other phenotypes of aging and health.
PICOLINIC ACID, A TRYPTOPHAN METABOLITE, DOESN’T AFFECT BONE MINERAL DENSITY BUT UPREGULATES LIPID STORAGE GENES
Authors: Isales Carlos , McGee-Lawrence Meghan , Hamrick Mark , Hill William D , Bollag Wendy , Ding Ke-Hong , Shi Xing-ming , Kennedy Eileen
Published: November 2019

Tryptophan is an essential amino-acid broken down initially to kynurenine (kyn), an immunomodulatory metabolite that we have previously shown to promote bone loss. Kyn levels increase with aging and have also been associated with neurodegenerative disorders. Additional tryptophan metabolites include picolinic acid (PA); however, in contrast to kyn, PA is neuroprotective. Thus, we hypothesized that PA might be osteoprotective. In an IACUC-approved protocol, we fed PA to aged (23-month-old) C57BL/6 mice for eight weeks. In an effort to determine potential interactions of PA with dietary protein, we added PA to both a standard (18%) and a low protein diet (8%). The mice were divided into four groups: control (18% protein), +PA (700 ppm); low protein (8%), +PA (700 ppm). There was no difference in weight among the groups [36.1±4.1, 34.6±3.8, 32.8±3.2, 32.6±3.0 gm, (Means±SD, control vs +PA vs 8% vs +PA, p=ns; n=8-10/group). Mice were sacrificed and bones and stromal cells collected for analysis. We found that addition of PA to the diet had no impact on femoral BMD or BMC (BMD: 0.069±0.008 vs 0.075±0.007 vs 0.069±0.005 vs 0.070±007, p=ns). Addition of PA to the diet had no impact of % body fat as measured by DXA; however, stromal cells isolated from the PA-fed mice showed a significant increase in the expression of the lipid storage genes, Plin1 and Cidec. Thus, although PA is downstream of kyn, the kyn-induced detrimental effects on bone mass are no longer observed with PA but instead this kyn metabolite appears to impact energy balance.
HETEROGENEITY OF SENESCENT RIBOSOME COMPLEX AFFECTS THE TRANSLATIONAL EFFICIENCY OF SENESCENCE RELATED MRNAS
Authors: Kim Joon , Kim Hag Dong , Yang Hee Woong
Published: November 2019

The ribosome, a protein factory, has a lateral stalk known as the ribosomal P complex made up of rpLP0, rpLP1, and rpLP2. It plays an important role in translation by recruiting translational factors. One of these proteins, rpLP2, was decreased in translating ribosome when cellular senescence was induced. Additionally, Y-box binding protein-1 (YB-1), a multifunctional protein that regulates the transcription and translation, was also reduced in polysomal fraction of senescent cells. We have discovered that rpLP2 depletion in heterogeneous ribosome causes the detachment of YB-1 in polysomes and link to cellular senescence. Here, we also have found that a decrement of CK2α or GRK2 on senescent cells induced an increment of unphosphorylated rpLP2, resulting in the release of YB-1 from a ribosome complex. The heterogeneous senescent ribosome has different translational efficiency for some senescence related genes such as AHR, RAB27B, FEZ1, and DDIT4. Our results revealed that the decrease of rpLP1/rpLP2 and YB-1 in translating senescent ribosomes is not specific to cell type or stress type. Furthermore, the same phenomenon was observed in aged mouse liver. Taken together, our results suggest that the senescent ribosome complex appears to have low levels of rpLP1/ rpLP2 and YB-1, resulting in the alteration of translational efficiency for senescence related genes. (Journals of Gerontology: Biological Sciences, 2019 in press)
4-PHENYLBUTYRATE: MOLECULAR MECHANISMS AND AGING INTERVENTION POTENTIAL
Authors: Bene Michael R , Thyne Kevin , Dorigatti Jonathan , Salmon Adam B
Published: November 2019

4-Phenylbutyrate (PBA) is a FDA approved drug for treating patients with urea cycle disorders. Additionally, PBA acts upon several pathways thought of as important modifiers of aging including: histone deacetylation, proteostasis as a chemical chaperone, and stress resistance by regulating expression of oxidative stress response proteins. PBA has also been shown to extend lifespan and improve markers of age-related health in Drosophila. Due to its wide range of effects PBA has been investigated for use in numerous age-related disorders including neurodegenerative and cardiovascular diseases. To better understand the effects of PBA on the molecular level, we used both in cellulo and in vivo studies. Treatment of primary mouse fibroblasts, C2C12 mouse muscle cells, and NCTC 1469 mouse liver cells with PBA demonstrated differential responses among cell lines to upregulation of oxidative stress response and histone acetylation. Specifically, upregulation of the oxidative stress response protein DJ-1 by PBA was found to have a corresponding dose response curve to histone H3 acetylation in primary fibroblasts. To study effects of PBA in vivo, four cohorts of HET3 mice were treated with PBA at different doses in drinking water for 4 weeks. PBA was well tolerated and led to different effects on body composition dependent on the sex of mice. We are currently investigating the molecular effects of PBA treatment in multiple tissues samples from these mice. The potential of PBA to alter many fundamental pathways, and specifically those related to stress responses, make it an attractive prospect for treatment of many age-related disorders.
AGING INDUCES NLRP3 INFLAMMASOME DEPENDENT ADIPOSE B CELL EXPANSION TO IMPAIR METABOLIC HOMEOSTASIS
Authors: Camell Christina , Dixit Vishwa Deep
Published: November 2019

Visceral adiposity in elderly is associated with alterations in adipose tissue immune cells leading to inflammation and metabolic dysfunction. The Nlrp3 inflammasome is a critical regulator of macrophage activation, inflammation, and immunometabolism in visceral adipose tissue during aging; however, the potential contribution of adipose tissue B cells is unexplored. Here, we show that aging expands adipose-resident B cells and fat-associated lymphoid clusters (FALCs) in visceral white adipose tissue of female mice. Adipose tissue B cells exhibit a memory-like B cell profile similar to the phenotype of aged B cells that are increased in spleen of old mice. Mechanistically, the age-induced FALC formation and adipose B cell expansion, but not B cell transcriptional program, is dependent on the Nlrp3 inflammasome. Furthermore, B cell depletion in aged mice improves insulin sensitivity and metabolic capacity of adipose tissue. These data reveal that inhibiting Nlrp3-dependent B cell accumulation can be targeted to reverse metabolic impairment in aging adipose tissue.
A STUDY ON THE COMPARISON OF STRESS INDEX OF DEMENTED OLDER ADULTS AND THE PAIN OF THE MAIN CAREGIVER
Authors: Kim Sujin , Cho Eunhee , Sinwoo Hwang , Kwon Eunji
Published: November 2019

The purpose of this study was to compare the stress and fatigue index between the demented older adults and the non-demented older adults and to identify the correlation between the behavioral psychological symptoms of the demented older adults and the pain of the main caregiver. A total of 100 participants(80 demented older adults and 20 non-demented older adults) were selected. The demented older adults, who visited hospital neurology as an outpatient, were paired up with the caregivers who provided the care for the demented older adults. The non-demented older adults who had normal cognitive function without limitation in a daily life and scored MMSE of 24 or higher were selected. The stress and fatigue index were measured by using an autonomic nervous system analyzer that measures heart rate variability(HRV), and structured questionnaires were used to examine behavioral psychological symptoms. The collected data were analyzed by using Independent t-test and Pearson’s correlations analysis. The result of the analysis showed that average score of the demented older adults had higher stress index than the control group(non-demented older adults), which was statistically significant(t=3.350, p=.001). In addition, the result indicated the statistically significant positive correlation between the behavioral psychological symptoms of demented older adults and the level of pain of main caregivers (r=0.89, p=<.001). The results of this study suggest that managing both the physical and psychological aspects of the stress in the main caregivers is necessary, as well as the development of stress management program for the demented older adults.
OPTIMISM, QUALITY OF LIFE, AND COGNITION IN RECENT NURSING HOME RESIDENTS
Authors: DiGasbarro Diana , Van Haitsma Kimberly , Meeks Suzanne , Mast Benjamin T
Published: November 2019

Dispositional optimism may be an important resource for well-being across the lifespan. However, the relationship between optimism and quality of life in recent nursing home residents with and without cognitive impairment has not been examined. The aim of this study is to fill this gap in a sample of 66 older adults with a mean age of 74.59 years old (SD=10.37) who were admitted to a nursing home within the previous 30 days. Sixty older adults completed measures of cognition, quality of life, and optimism, and thus were included in analysis for the current study. Participants were split into groups based on the presence or absence of cognitive impairment, and linear regressions were conducted to examine the relationship between optimism and quality of life. In recent nursing home residents without cognitive impairment (n=30), optimism did not predict quality of life and accounted for a very small amount of variance (R2=.042, p=.280). However, in recent nursing home residents with cognitive impairment (n=32), optimism accounted for 20.9% of the variance in quality of life (R2=.209, p=.009). Higher levels of optimism were associated with better quality of life. Future research should explore why a stable trait like dispositional optimism is a stronger predictor of quality of life in recent nursing home residents with cognitive impairment compared to those without cognitive impairment. This line of research would be synergistic with emerging research on the identification and encouragement of strengths in older adults with cognitive impairment.
PREDICTORS OF CHANGES IN WELL-BEING AMONG THE INTEGRATED MEMORY CARE CLINIC CLIENTS
Authors: Kovaleva Mariya A , Higgins Melinda , Jennings Bonnie M , Song Mi-Kyung , Clevenger Carolyn , Griffiths Patricia C , Hepburn Ken
Published: November 2019

The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses who seamlessly provide dementia care and primary care. This analysis explored predictors of significant changes in clients’ well-being and symptoms in clients’ first-year experience at the IMCC (N=42 caregivers, three assessments over nine months). The significant changes were decreases in caregivers’ distress regarding PLWDs’ delusions (Delusions-Distress) and PLWDs’ anxiety (Anxiety-Distress), and in PLWDs’ severity of delusions, depression, and total symptom severity. Mixed linear models were used to determine significant predictors among baseline sociodemographic characteristics that correlated significantly with outcomes that changed significantly over time. Caregivers not employed outside home had lower baseline Delusions-Distress (p=0.006) and slower decline in Delusions-Distress (p=0.015). The longer PLWD needed care, the lower baseline Delusions-Distress caregivers reported (p=0.023). Caregivers not living with their PLWD reported higher baseline Anxiety-Distress (p=0.016). Caregivers not employed outside home reported lower baseline Delusions-Severity for their PLWD (p=0.006). Caregivers not employed outside home reported PLWDs’ lower baseline depression severity (p=0.026). Older caregivers reported PLWDs’ lower baseline total symptom severity (p=0.002). Increase in caregiver’s age was associated with PLWDs’ higher total symptom severity (p=0.049). For PLWD with male caregivers, total baseline symptom severity was lower compared to PLWD with female caregivers (p=0.01). These findings highlight that PLWDs’ illness duration and caregivers’ employment status, living arrangement, age, and gender may determine their perception of their PLWDs’ symptoms. Clinicians may individualize caregiver education with the knowledge of such predictors.
NURSE-LED DEMENTIA MEDICAL HOME: WHAT IS IT LIKE FOR CLIENTS?
Authors: Kovaleva Mariya A , Higgins Melinda , Jennings Bonnie M , Song Mi-Kyung , Clevenger Carolyn , Griffiths Patricia C , Hepburn Ken
Published: November 2019

The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide both dementia care and primary care. In this prospective longitudinal cohort study we aimed to evaluate caregivers’ and their persons’ living with dementia (PLWD) (reported by caregivers) experiences at the IMCC. Changes in caregivers’ psychological well-being and health status and in PLWDs’ quality of life and neuropsychiatric symptoms were explored via three assessments during the clients’ first year at the IMCC. Forty-nine caregivers completed baseline assessments, including a sociodemographic questionnaire and established instruments. Mixed linear models were used to examine changes in caregiver- and PLWD-centered variables. With time as the only predictor and with full baseline sample included, significant changes were observed in caregivers’ distress regarding their PLWDs’ delusions (p=0.048) and in caregivers’ distress regarding their PLWDs’ anxiety (p=0.018). Additionally, significant changes were observed in PLWDs’ severity of delusions (p=0.032), depression (p<0.001), and total symptom severity (p=0.005). For outcomes that changed significantly over time, we explored whether time still significantly predicted changes when controlling for two variables deemed clinically important: the total number of PLWD’s chronic comorbidities besides dementia at baseline and the total number of visits the dyads made to the clinic during the study. Controlling for the total number of visits to the IMCC cancelled significant improvement in caregivers’ distress regarding PLWDs’ delusions. While most variables remained unchanged, several important symptom-related outcomes improved rapidly upon clinic enrollment, indicating potentially efficacious symptom management at the IMCC.
SYSTEMATIC REVIEW AND GAP ANALYSIS ON ALZHEIMER’S DISEASE IN ASIAN AMERICANS, NATIVE HAWAIIANS, AND PACIFIC ISLANDERS
Authors: Lim Sahnah , Roberts Timothy , Wong Jazmine , Mohaimin Sadia , Sohn Young-Jin , Sivanesathurai Ragavan , Kwon Simona C , Trinh-Shevrin Chau
Published: November 2019

Background: The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) aging population is rapidly growing and the burden of Alzheimer’s disease and its related dementias (AD/ADRD) will likely mirror this demographic growth. AANHPIs face significant barriers in obtaining timely AD/ADRD diagnosis and services; yet little is known about AD/ADRD in this population. The study objective is to conduct a systematic review on the published literature on AD/ADRD among AANHPIs to identify gaps and priorities to inform future research and action plans. Methods: The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Co-author (TR), an experienced Medical Librarian, searched PubMed, EMBASE, PsycINFO, Cochrane Central of Clinical Trials, Ageline and Web of Science for peer-reviewed articles describing AD/ADRD among AANHPIs. The search was not limited by language or publication date. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. Results: The title/abstract and full texts of 1,447 unique articles were screened for inclusion, yielding 310 articles for analysis. Major research topics included prevalence, risk factors, comorbidities, interventions and outreach, knowledge/perceptions/attitudes, caregiving, and detection tools. A limited number of studies reported on national data, on NHPI communities generally, and on efficacy of interventions targeting AANHPI communities. Conclusion: To our knowledge, this is the first systematic review on AD/ADRD among AANHPI populations. Our review provides a first step in mapping the extant literature on AD/ADRD among this underserved and under-researched population and will serve as a guide for future research, policy and intervention.
ASKING THE PEOPLE WHO MATTER THE MOST: DESIGNING A VALUE-BASED DEMENTIA SPECIALTY CLINIC
Authors: Aguirre Alyssa , Ulack Christopher , Suarez Joel , Carberry Kathleen , Rousseau Justin , Wallace Scott , Hilsabeck Robin
Published: November 2019

This presentation will highlight our research which uses a qualitative methodology to incorporate the voices and experiences of people impacted by dementia into the value-based health model. This model is characterized by a team-based approach as well as the measurement of outcomes. The aim of value-based care is to provide individuals meaningful and compassionate care that helps them achieve the health outcomes that matter most to them. Foundational to creating this person-centered model is the incorporation of the perspectives of individuals with dementia and their care partners. Experience Groups offer an opportunity for those affected by dementia to share their expertise and describe their daily challenges and successes so we are able to learn from their experiences and better understand unmet and unarticulated needs. The findings of this research—consisting of 41 patients and 11 care partners—enabled the development of outcome measurement tools implemented at the clinical level, and the design of a care delivery model that addresses unmet needs. Some of the key findings from the research that have been implemented at the Cognitive Disorders Clinic and that will be highlighted in this poster are: 1. Care partners would like more emotional support from their medical team; 2. Individuals want more information about the trajectory of the disease and an actionable “roadmap-of-care”; 3. Care partners and those with early stage memory loss desire counseling and team-based care versus strictly physician-provided care.
MULTIPLE PERSPECTIVES ON WHAT (IF ANY) IS AN OPTIMAL TIME FOR PEOPLE WITH DEMENTIA TO MOVE TO A CARE HOME
Authors: Samsi Kritika , Cole Laura , Manthorpe Jill
Published: November 2019

Deciding an ‘optimal’ time for a person with dementia to move to a care home may be difficult for people with dementia, family carers, and professionals who support them; but there is currently limited evidence to help make this decision. Using phenomenology, we carried out qualitative interviews with 20 family carers, 5 people with dementia, 20 care home managers and 20 social workers, about their experiences, views and attitudes regarding timing of a move to a care home. Social workers indicated that managing risks and safety of person with dementia living in their own home were paramount when considering where person with dementia should live. These concerns included mishandling gas and electrical equipment at home, wandering and getting lost outside, and breakdown of family care. They and care home managers valued wishes of the person with dementia, and minimising any emotional distress to them when a move did come about. Family carers reported feeling stressed, and guilty around decision-making and ultimate move of their relative to a care home. Many described weighing up various risks when reaching ‘tipping point’ and making trade-offs between available options or uncertain future choices. Participants with dementia recognised they had struggled to cope at home and needed more support; however, many found the move difficult as they relocated nearer to family, away from their home and friends, and resigned themselves to less independence. Most people with dementia reported that their carers initiated discussions about timing of move, and that family discussions about this were common.
SOCIAL COGNITION AND AWARENESS IN ALZHEIMER’S DISEASE
Authors: Dourado Marcia , Belfort Tatiana , Neto José Simões
Published: November 2019

Social cognition is the capacity to interpret and predict another’s behavior according to beliefs, intentions, and emotions, and the ability to decode environmental stimuli in order to be better able to adapt to new situations. A key question is the relationship between social cognition and awareness in dementia. This study aimed to investigate the relation between social and emotional functioning (SEF) and awareness in Alzheimer's disease (AD). In a cross-sectional design, a consecutive series of 50 people with mild to moderate AD and their 50 family caregivers were assessed. The study variables were awareness, SEF, neuropsychiatric symptoms, cognition, working memory, quality of life, functional activities, presence of depressive symptoms, and caregivers’ burden and cognition. We found a significant difference between self-rated SEF and informant-rated SEF. In 56% of the cases, self-rated SEF was lower than the informant-rated SEF. People with AD mostly (56%) had mildly impaired awareness of disease, 20% had moderate impaired awareness of disease, and 6% were unaware of the disease. A multivariate linear regression examined the association between informant-rated SEF score and the variables. The social functioning and relationship domain of awareness and informant-rated QoL of people with AD were significantly associated with informant-rated SEF. Conclusion: The relationship between informant-rated SEF and awareness of social functioning and relationship supports the multidimensional nature of awareness. SEF and awareness of social functioning shows that they are comprised of judgments related to perceptions about oneself and values qualitatively different from awareness of memory or functionality, which can be directly observed.
GOALS OF CARE IN END-STAGE RENAL DISEASE: THE INFLUENCE OF AGE AND MULTIMORBIDITY
Authors: Waldrop Deborah P , Denny Patricia , Lauer Sandra , Grimm Kathleen , Murawski Phyllis , Panesar Mandip
Published: November 2019

The number of people with End Stage Renal Disease (ESRD) who need dialysis treatment has increased sharply among adults age 75+. Older adults on dialysis have lower rates of advance care planning and higher treatment intensity, hospitalization and intensive care than people other chronic illnesses. Comprehensive care of older adults with ESRD includes advance care planning that addresses goals of care and not just specific medical treatments. The purpose of this study was to explore the nature of symptom burden and advance care planning in dialysis patients. The study design was exploratory, descriptive and cross-sectional. Quantitative and qualitative data were collected during in-person chairside interviews with people having dialysis treatments. Categorical questions focused on demographics and advance directives. The Dialysis Symptom Inventory was used to measure symptom burden. Open-ended questions addressed the trajectory of illness and goals of care. Thirty-five interviews were conducted. Participants’ Mage=55.8 years (range 27-84); 51 % were >60. A distinctive pattern of difference by age emerged. Participants >60 demonstrated greater multimorbidity and lower symptom burden (MDSI=30.13; Range 11-63) compared with those <60 (MDSI=36.31; Range 3-78). Goals of care also varied with age. Older adults’ goals were: (1) Functional (e.g. to walk better, drive); and (2) Existential (e.g. maintaining, surviving, enjoying). Goals of participants <60 were: (1) Transplantation; and (2) Engagement (e.g. work, school, travel). The results suggest that the illness experience and goals are influenced by age and multimorbidity. Implications: ESRD-specific advance care planning conversations with a focus on goals of care are important.
PREVALENCE AND MANAGEMENT OF HYPERTENSION AMONG MIDDLE-AGED AND OLDER ADULTS IN CHINA
Authors: Cheng Jianjia , Choi Jungtae , Li Lydia
Published: November 2019

The study aimed to examine hypertension prevalence and management in China. Data were from a national survey of a probability sample of 45+ in China (N = 17,047). Self-reported hypertension diagnosis and readings from electronic blood pressure monitors were used to create four variables: diagnosed, measured (>=140/90 as high), undiagnosed, and overall (diagnosed + undiagnosed) hypertension. Respondents with diagnosed hypertension were asked about medication use, blood pressure monitoring, and lifestyle advice from doctors; and were considered inadequate blood pressure control if having measured hypertension. Weighted descriptive statistics and multivariate logistic regression were conducted. The prevalence of diagnosed, measured, undiagnosed and overall hypertension was 27%, 37%, 14%, and 51%, respectively. Across all four, older age adults, women, and urban residents had higher rates. Among hypertensive patients, 82% took anti-hypertensive medications, 91% monitored blood pressure, 60% received lifestyle advice, and 53% had inadequate blood pressure control. Compared to the 45-54 years old, the 75+ was less likely to receive lifestyle advice (OR=0.63, 95% CI=0.43-0.95) and the 65-74 was less likely to have adequate control (OR=0.75, 95% CI=0.73-0.98). Men were less likely to use medications (OR=0.77, 95% CI=0.63-0.95) but more likely to receive lifestyle advice (OR=1.48, 95% CI=1.23-1.78) than women. More education and urban (vs. rural) were associated with better hypertension management and control. In conclusion, hypertension affects half of the middle-aged and older population in China. More than half of hypertensive patients have inadequate blood pressure control. People who are older, women, low-educated, and rural residents are disadvantaged in hypertension management.
EXERCISE EFFECTS ON WELL-BEING ON CANADIAN WOMEN OVER THE AGE OF 65
Authors: Bardutz Holly A , Corley Constance
Published: November 2019

Two groups of Canadian women, over the age of 65, were interviewed (n = 20) in a study focused on brain health. The first group (n = 12) regularly attended exercise classes and met the exercise standards of the Canadian Society of Exercise Physiologists for the age group over 65 years for at least six months. Women in the comparison group (n = 8) had been taking adult education classes twice a week or more for at least six months. Thematic coding was used to analyze the results. Both groups reported benefits from their participation in their respective groups. However, the results show that the group who exercised regularly consistently reported improved mood, increased mental alertness, a better ability to handle stress, less pain, and improved sleep. These factors were not reported by the non-exercise group, which did benefit by gaining new knowledge, making new friends and feeling good because they were learning new things. This study suggests that Canadian women over the age of 65 who have been exercising regularly report many of the effects of exercise on the brain that are beneficial to their well-being. They did not specifically mention the new brain cells being made (neurogenesis) nor did they note neuronal rewiring (neuroplasticity), however they did self-report some psychological benefits that the Comparison Group did not report, as noted above. This research has implications for both practice and research.
ASPIRIN BENEFIT IS NOT AFFECTED BY BODY WEIGHT IN HEALTHY OLDER PERSONS
Authors: Woods Robyn L , Polekhina Galina , Nelson Mark , Wolfe Rory , Ernst Michael E , Murray Anne M , McNeil John
Published: November 2019

Recent meta-analysis (Rothwell et al, Lancet 2018;392:387-99) of aspirin trials in predominantly middle-aged people suggested that aspirin’s effects on clinical outcomes vary according to dose and body weight, concluding that under dosing in heavier people may be responsible for reduced efficacy of aspirin. Data from ASPREE (ASPirin in Reducing Events in the Elderly; randomized primary prevention trial of low dose aspirin versus placebo in 19,114 healthy older participants, mainly aged 70+ years) were analyzed for interaction of body habitus on the main outcomes after 4.7 years of study treatment. Increases in body weight, BMI or waist circumference (WC) did not influence cardiovascular endpoints or incident cancers in the aspirin group compared with placebo. In ASPREE men, an increase of 10 kg body weight elevated the risk of major hemorrhage with aspirin (HR 1.20; 95% confidence interval 1.01-1.43; P=0.04) and 10 cm increase in WC elevated all-cause mortality by 23% with aspirin (HR 1.23; 95% confidence interval 105-1.44; P=0.01), driven by cancer-related deaths (HR 1.39; 95% confidence interval 1.11-1.73; P=0.004). These effects of increased abdominal girth were not seen in women. Evidence from ASPREE does not support increasing the dose of aspirin in larger older people to improve the drug’s efficacy. Our results point to a link between central adiposity, hemorrhage risk and cancer-related death in older men taking aspirin.
HEALTH INTERVIEWING IMPROVES THE MEDICAID HOME AND COMMUNITY-BASED SERVICES HOME CARE AIDE-CLIENT RELATIONSHIP
Authors: Danilovich Margaret , Johnson Rebecca E , Diaz Laura , Boyken Lara
Published: November 2019

We investigated the feasibility of a Medicaid Home and Community-based Services home care aide (HCA) led health interview with clients (n=21) during usual care services provided by a single provider. We provided interview training in English and Spanish and HCAs (n=21) conducted five interviews using a card sort methodology to elicit client care preferences. The interviews consisted of five topics relative to care: 1) food and drink, 2) physical activity and mobility, 3) self-care, 4) home environment, and 5) how I spend my time. HCAs audio-recorded interviews and photographed card sorts for analysis. We conducted semi-structured interviews by telephone with clients and focus groups with HCAs, to evaluate the health interviewing experience. We transcribed interview recordings and evaluated fidelity to the health interview script. We administered the Your Health Orientation, Willingness to Communicate, and PROMIS-global health to clients and the Active Empathetic Listening Scale to HCAs. We used t-tests to investigate changes in survey outcomes pre and post interviews. Results show it is feasible to train English and Spanish speaking HCAs in a simple, health interviewing technique to elicit care preferences from clients. Doing so contributes new knowledge on client preferences. Clients desire HCAs who provide empathy, compassion, and motivation, and HCAs observed that interviewing clients helped them to better understand their care recipient’s needs. Future work should determine how embedding health communications training as part of orientation to client care, would influence HCA retention rates, as well as modify client health outcomes.
SURROGATES’ DECISION-MAKING CONFIDENCE AND COLLABORATIVE WILLINGNESS ON THE POST: THE ROLE OF SOCIAL NORMS
Authors: Spalding Rachael , Wilson Jenna , Edelstein Barry
Published: November 2019

When patients become incapacitated due to illness or frailty, “surrogates” work with patients’ providers to make medical decisions on their behalf. In surrogate decision-making situations, surrogates’ decision-making confidence predicts collaborative willingness, or the extent to which they are willing to work with the patient’s providers when making decisions (Spalding & Edelstein, under review). In an attempt to explain this finding, the current study examined whether perceived social norms for patient-physician collaboration and another psychological variable, consideration of future consequences, mediated the relation between decision-making confidence and collaborative willingness. Participants (n= 172) from Amazon’s Mechanical Turk completed self-report measures and a hypothetical surrogate decision-making task. A parallel multiple mediation analysis using 5000 bootstrapped samples with the PROCESS macro (Hayes, 2013) was conducted. The overall model explained 43.4% of the variance in collaborative willingness, F(4, 166) = 9.59, p< .001. There was a significant indirect effect of decision-making confidence on collaborative willingness through perceived social norms (b= .068, SE= .034, 95% CI [.014, .154]). There was not a significant indirect effect through consideration of future consequences. After including the significant indirect path through perceived social norms, the direct effect (b= .348, p< .001) of decision-making confidence on collaborative willingness was reduced (b= .243, p= .003). Thus, perceptions of social norms partially accounted for the relation between decision-making confidence and collaborative willingness. This finding illustrates how social perceptions of patient-provider collaboration can facilitate desirable medical decision-making behaviors, such as collaboration.
DOES THE ASSOCIATION BETWEEN AGE AND MAJOR ILLNESS VARY BY NATIONAL HEALTHCARE QUALITY?
Authors: Andersson Matthew A , Wilkinson Lindsay R , Schafer Markus H
Published: November 2019

Though the risk of chronic disease and disability accelerates once adults are in their 60s, 70s, and 80s, researchers have long suspected that economic, social, and institutional variation — even among high-income Western nations — may powerfully influence the likelihood that people remain healthy at advanced ages. This study builds on comparative research into global aging, by offering a multiple-indicator test of whether national healthcare quality modifies the association between age and major illness. Recent individual-level data on morbidity among respondents aged 50 or older (16 countries; 2014 European Social Survey) are merged with nation-level healthcare indicators. Healthcare quality is assessed using a subjective, evaluation-based approach (based on the 2011 International Social Survey Programme) and an objective, attributable-mortality approach (2010 Healthcare Access and Quality, based on the Global Burden of Disease Study). Lagged nation-level economic and health indicators are controlled to help isolate healthcare effects. Multilevel logistic and linear regression models of any major health condition and morbidity reveal that while older individuals showed approximately a 10% reduction in probability of major illness when residing in countries with higher healthcare quality, associations between age and morbidity indices combining number and severity of illness showed greater modification by healthcare quality, with reductions around 18%. Results across subjective and objective approaches to healthcare quality are strikingly consistent. Taken together, results are suggestive of healthcare’s protective role in reducing age-related illness and disability. Future research should illuminate pathways by which healthcare quality may lead to differences in healthy aging among advanced nations.
THE EFFECT OF SENSE OF COHERENCE ENHANCEMENT PROGRAM BASED ON SALUTOGENESIS FOR ELDERLY WITH METABOLIC SYNDROME
Authors: Yun Jungmi , Park Hyoung Sook
Published: November 2019

This study aimed to develop and verify a sense of coherence (SOC) enhancement program based on salutogenesis for elderly with metabolic syndrome. This study was a quasi-experimental study. The inclusion criteria were patients with metabolic syndrome aged 60 or over who visited the outpatient department of a university hospital and a public health center located in an urban area. The intervention group (n=24) attended the SOC enhancement program. The health promotion theoretical framework, salutogenesis, provided the program structure and conceptual framework of this study. This program included comprehensibility, manageability, and meaningfulness which were core concepts of salutogenesis and consisted of multiple tailored behavior interventions composed of education, Tai-Chi exercises, individual activities, self-monitoring, self-help groups, and individual counseling. This program was provided once a week over 10 weeks, but Tai-Chi exercise was conducted twice a week. The control group (n=25) was provided with general health information once. The interactions between groups and measurement time showed significant differences in self-efficacy (p=.001), perceived social support (p<.001), SOC (p<.001), health behavior (p=.010), and the physical health-related quality of life (p=.001). The metabolic-related physiological indicators showed significant improvement in total cholesterol (p=.004) and LDL-cholesterol (p=.009). This study showed that the SOC enhancement program strengthened the self-efficacy, social support, and SOC in the elderly with metabolic syndrome, improved the health behavior, and was effective in improving some metabolic-related physiological indicators. Based on the results of this study, I suggest to expand the scope of the sense of coherence program and conduct the intervention longer.
PARTICIPANTS’ PERCEPTIONS OF A COMMUNITY-BASED DANCE PROGRAM
Authors: Bewernitz Megan R , Freiberger Cari
Published: November 2019

Parkinson’s disease (PD) is a progressive disease that targets many aspects of the nervous system, both motor and non-motor functions. Dance as an intervention provides a creative outlet that can be more motivating than other interventions by allowing people an opportunity for not only increased movement and activity, but also socialization. Creative expression through dance also has the potential to improve not only motor capabilities like balance, but also non-motor aspects like self-efficacy, cognition, and quality of life. For the community program described in this presentation, dance faculty led the dance and choreography components of the program while an occupational therapist (OT) served to maximize options for adaptations, safety, and accessibility. OT faculty also led efforts in gathering and analyzing data regarding community participation and program design utilizing a qualitative approach by conducting semi-structured interviews with five participants (four with PD, one with hydrocephalus, all over age 65) in the program. Content analysis of the data suggests some emerging themes which include: 1) forming common bonds and making friendships within the class due to PD diagnosis and similar enjoyment of the class, 2) increased appreciation and enjoyment of music, 3) appreciation of dance instruction, and 4) how transportation options, or lack thereof, impact participation in the class. These themes will assist in informing future program delivery with the hopes of reaching a larger contingent of the community who may also be interested in dance.
MAINTAINING HEALTHY LIFESTYLE: RACIAL AND GENDER DIFFERENCES IN PHYSICIANS’ ADVICE TO OLDER ADULTS
Authors: Iqbal Asif , Oladimeji Abolade , Kahana Eva , Kahana Boaz
Published: November 2019

Older adults are often excluded from physicians’ preventive health promotion recommendations. The influence of patient race and gender on the physician-patient relationship in maintaining good health has been extensively researched, but little is known about the influence of patient race and gender on physicians’ health promotion advice to the elderly. This study explored whether patient race and gender influence primary care physicians’ health promotion advice to older adults. The sample of 536 respondents (µage = 75.51, 75.2% female) was obtained from a NCI funded study of “Health Care Partnerships in Cancer Prevention and Care of Aged. Respondents were randomly selected community dwelling older adults who attend Senior Center programs, sponsored by Area Agencies on Aging (AAA) (Kahana, Lee, Kahana, Langendoerfer, & Marshall, 2015). Multivariate logistic regression analyses were used to control for sociodemographic and health factors while accounting for a complex sampling design. African American patients had greater odds than whites for receiving recommendations to eat a healthy diet (OR = 1.62) and exercise more (OR = 1.83). Elderly women reported fewer recommendations to eat a healthy diet (OR = .81) & exercise more (OR = .45) than did men. Notably, respondents of both races and genders believed that maintaining a healthy lifestyle is very effective. These findings demonstrate that African American and female older adults receive differential health promotional advice from physician and suggest the need for raising physician awareness about the value of prevention advice for all patients.
ACCEPTABLE CHARACTERISTICS OF INTERVENTIONS FOR MIDDLE-AGED HISPANIC MEN: RESULTS FROM KEY INFORMANT INTERVIEWS
Authors: DerAnanian Cheryl , Vega-Lopez Sonia , Valdez Hector , Vega-Soto Shandel , Delgado Ferdinand , Hooker Steven
Published: November 2019

Hispanics are the fastest growing segment of the aging population. Little is known about acceptable intervention approaches for Hispanic men. Purpose: To explore perceptions of acceptable intervention characteristics for middle-aged Hispanic men. Methods: Eighteen key informants (KIs) with expertise in delivering programs to the Hispanic community participated in semi-structured interviews. All interviews were audio-recorded and transcribed verbatim. Themes were identified using a grounded theory approach. Results: “Cultural sensitivity/competency” or “biculturalism” were fundamental characteristics of an acceptable intervention (n=17 KIs). KIs indicated program facilitators need to understand and relate to the culture, and to establish the trust of the community by demonstrating mutual understanding, respect and dignity. Facilitators must be bilingual and use the same level of language as the participants. KIs highlighted the importance of the literacy level of the materials and indicated intervention content should tap into the participants’ unique cultural experiences. Including the family in the intervention, especially the spouse or partner, was considered essential for engaging the men (n=18 KIs). The KIs consistently indicated an intervention should be in-person, in either a group (n=7 KIs), one-on-one (n=5 KIs) or hybrid (group and individual; n=6) format. Only text messaging (n=10 KIs), phone calls (n=5 KIs), and Fitbits (n= 7KIs) were perceived as acceptable forms of technology for an intervention. Finally, the intervention needs to be appealing (N=5KIs), interactive (n=8KIs), and safe, fun and supportive. Conclusion: The KIs identified several important culturally relevant considerations when developing interventions for Hispanic men. Funded by the National Institute on Aging (R21 AG050084-01A1).