bluuebunny/crossref_metadata_2025 huggingface dataset:
PEER-BASED CHECK-IN SUPPORT AND PERSONAL AGENCY IN TANGIBLE INTERFACE DESIGN FOR REDUCING ISOLATION IN OLDER ADULTS
Authors: Bhowmick Pallabi , Huber Lesa
Published: December 2023

About one in four older adults in the US are socially isolated, an issue worsened by the COVID-19 pandemic. The aims of a 2-week diary study and field deployment of a peer-based tangible check-in system with 16 participants aged 65 to 87 were to understand how older adults check-in with others, who they check-in with, what difficulties they face, and how technology can help them stay connected. Findings show that perceived check-in behavior varies from actual check-in behavior. Although participants listed family as their strongest relationships forming the closest social circle, 75% of the participants had up to third-quarters of their communication with friends as compared to all other relationships. Secondly, passive check-in and monitoring from family members make older adults non-participatory recipients of care and takes away human agency. The check-in system allowed participants to actively check-in on their peers. Participants found the technology non-stigmatizing and bonded with each other quickly. Finally, older adults prefer tangible interfaces, such as buttons and physical controls over digital interfaces, because they do not require fine motor skills or visual acuity. Tangible systems can provide familiar, intuitive, and accessible systems by leveraging everyday physical objects as user interfaces. Study participants found the tangible check-in system easy and enjoyable to use. Such tangible peer-based systems improve social connectedness, address ageism by restoring agency, meet accessibility and aesthetic needs, thereby encouraging technology adoption. They also empower older adults to maintain their independence, instill in them a strong sense of community, and improve quality of life.
THE IMPACT OF COVID-19 ON RELATIONSHIPS BETWEEN CARE TEAMS AND FAMILY CAREGIVERS IN CONGREGATE CARE
Authors: Hoben Matthias , Dymchuk Emily , Chamberlain Stephanie , Beeber Anna
Published: December 2023

Family/friend caregivers are essential in the quality of care and life of residents living in congregate care (nursing homes and assisted living). However, the COVID-19 pandemic and related public health measures substantially changed the way family/friend caregivers could be involved in resident care. It also changed the dynamic of the relationships between care teams and family/friend caregivers. While research has explored these impacts, much of the research has focused on the family/friend caregiver perspective. Our objective was to explore the impact of COVID-19 and related public health measures on these relationships from the perspective of care teams. Using videoconferencing, we conducted 9 focus groups and 2 semi-structured interviews (total of 37 participants) with managers/administrators of 6 congregate care settings and their teams (care aides, nurses, recreation and rehabilitation staff, educators). The themes we identified reflect (1) pressures care teams experienced from family/friend caregivers, (2) conflicts between care teams and family/friend caregivers, (3) support care teams received from family/friend caregivers, and (4) how care teams supported family/friend caregivers. The COVID-19 pandemic disrupted long-standing relationships between care teams and family/friend caregivers, negatively impacting care teams, family/friend caregivers, and residents. However, care teams also reported encouraging examples of successful collaboration and support from family/friend caregivers. Involving family-friend caregivers in decision making was particularly critical. Learning from these promising practices will be critical to improving preparedness for future public health crises, as well as quality of resident care and life in general.
BRAIN HEALTH TOGETHER: DEVELOPING AND PILOT-TESTING AN ONLINE GROUP PROGRAM TO REDUCE DEMENTIA RISK
Authors: Barnes Deborah , Hoffmann Coles , Chesney Margaret , Brodaty Henry , Chao Linda , Tang Paul , Sudore Rebecca , Turo Patricia
Published: December 2023

Growing evidence suggests that multi-domain interventions can slow cognitive decline and reduce dementia risk in older adults. However, most programs have been in-person and/or had relatively long intervention periods (1 to 2-years). The primary goal of this study was to develop and pilot-test Brain Health Together, a 12-week, virtual-group program to reduce dementia risk through targeting modifiable risk factors in older adults who report cognitive decline. Initial content was developed with input from an external Science Advisory Board. 7 individuals who had been participating in online group movement classes for the previous 2 years were invited to pilot-test and provide feedback on Brain Health Together content and structure. In addition to the movement classes, the pilot program included weekly 1-hour group brain health education classes and 30-minute individual brain health coaching sessions for 12 weeks. The first 4 education classes included general content. Based on participant feedback, subsequent classes provided in-depth content on a single brain health risk factor each week, including expert videos and facilitated discussion. Before their first coaching session, participants completed a brief survey about their current lifestyle behaviors and medical conditions related to brain health. This was used to generate an individualized brain health report that summarized areas with low, moderate or high opportunity for change. Coaching sessions focused on setting SMART (Specific, Measurable, Achievable, Realistic, Timely) goals to address modifiable risk factors. After 12 weeks, participants reported more exercise, less loneliness, and longer sleep duration. We are currently enrolling for a larger clinical trial.
A WHOLE-HEALTH MODEL OF CARE TO PROMOTE SOCIAL AND RACIAL JUSTICE
Authors: Faul Anna , Cotton Sam , Yankeelov Pamela , Gordon Barbara
Published: December 2023

Whole health models of care aim to coordinate care across sectors, address the needs of older adults with multiple chronic conditions, and promote health equity. The FlourishCare team will present data on the effectiveness of a whole health model, the FlourishCare Model (FCM), serving 159 older adults with multiple chronic conditions, using a two-level longitudinal design and hierarchical linear modeling to test a multilevel growth model. The results showed significant growth in total FlourishCare Index (FCI) scores over time for individual health behaviors, healthcare access, and social determinants. Biological determinants showed significant growth only for rural patients. The FCM was able to support patients with lower education attainment to improve at a higher rate than those with higher education attainment, both for the total score on the FCI and for healthcare access. The FCM was also able to support rural patients at a higher rate than urban patients to gain access to healthcare, and it supported Hispanic patients the most in improving their social determinants of health. The study demonstrates the importance of a whole health approach to care, which focuses on what matters most to patients, particularly older adults who place importance on quality-of-life outcomes. The study also shows how a whole health approach can address health equity by accelerating the flourishing of rural, Hispanic patients with lower educational attainment, promoting social and racial justice.
PET OWNERSHIP AND LONGITUDINAL CHANGE IN PSYCHOLOGICAL ADAPTATION – EVIDENCE FROM THE BLSA
Authors: Friedmann Erika , Gee Nancy , Simonsick Eleanor , Resnick Barbara , Gurlu Merve , Adesanya Ikmat , Shim Soyeon
Published: December 2023

Successful aging depends in part on maintaining psychological adaptation. Research examining the relationship of pet ownership (PO) or human-animal interaction (HAI) to human health supports contributions to psychological status, mostly in populations with diseases or disabilities. We examine the contributions of PO to maintaining psychological adaptation among generally healthy community-dwelling older participants in the Baltimore Longitudinal Study of Aging (BLSA). Participants (N=637, age M=68.3, SD=9.6 years, pet owners N=149) completed assessments of anxiety (Perceived Stress Scale-10), depression (Center for Epidemiological Studies Depression), happiness (1-10 rating) and psychological wellbeing (SF-12 Mental Component Score) every 1-4 years and a 10-year PO history. Linear mixed models with random intercepts were used to examine changes in psychological adaptation outcomes over up to 13 years (M=7.5, SD=3.6) according to time-varying PO. Overall anxiety decreased (b=-0.0360,se=0.0104,p=0.001) and depression increased (b=.099141, se=0.015837, p< 0.001) with aging. Psychological wellbeing (b=0.00055, se=0.00119, p=0.644) and happiness (b=-.00405,se=0.0206,p=0.844) did not change. PO moderated changes in anxiety (b=0.058452,se=0.024376,p=0.017), happiness (b=-0.101373,se=0.04779,p=0.034), and psychological wellbeing (b=-0.005541,se=0.002764,p=0.045), but not depression (b=-0.01134, se=.037065,p=0.769). Anxiety and happiness improved in pet owners and deteriorated in non-owners. Psychological wellbeing deteriorated faster for pet owners than non-owners. This study provides important longitudinal evidence that PO may promote some aspects of psychological adaptation among generally healthy community-dwelling older adults by moderating age-related declines in psychological adaptation later in life. It also highlights differences in psychological responses to animal assisted interventions in residents of care facilities from changes during the life-courses of generally healthy community-residing older adults.
NEIGHBORHOOD SEGREGATION AND CHARACTERISTICS OF OLDER CHINESE IMMIGRANTS LIVING IN GREATER CHICAGO
Authors: Jiang Yanping , Tang Fengyan , Mendhe Dinesh
Published: December 2023

Neighborhoods profoundly influence health of older adults, with those living in more affluent neighborhoods tending to be happier and healthier. However, which neighborhoods to live, is shaped by pull and push factors, particularly among racial/ethnic minorities that disproportionally live in segregated neighborhoods characterized by social and economic deprivation. Residential segregation, however, is not well-examined among older Asian Americans. This study aimed to close this gap by investigating neighborhood, sociodemographic, and health behavior characteristics among older Chinese immigrants living in segregated neighborhoods. Data were drawn from 3,097 participants from Population Study of Chinese Elderly (PINE). Residential segregation was operationalized using Index of Concentrations at the Extremes (ICE), and the tertiles of ICE scores were used to categorize neighborhoods into four groups, ranging from neighborhoods extremely segregated toward Chinese speakers to segregated toward English-only speakers. Results showed that, compared to neighborhoods segregated toward English-only speakers, neighborhoods extremely segregated toward Chinese speakers had lower neighborhood socioeconomic status and cohesion but higher neighborhood disorder. Also, participants in neighborhoods segregated toward Chinese speakers were more likely to be unmarried but less likely to live alone, receive less education, and live in the U.S. longer. These participants also reported lower acculturation and racial discrimination, were more likely to smoke, and had lower adoption of preventive health practices than those living in neighborhoods segregated with English-only speakers. Findings highlight challenges and opportunities among older Chinese immigrants living in segregated neighborhoods and provide insights into existing mixed findings on health impacts of residential segregation among this understudied population.
NEIGHBORHOOD AND DEPRESSION AMONG US CHINESE OLDER IMMIGRANTS: THE MEDIATION EFFECTS OF COPING
Authors: Wang Yi , Guo Man , Liu Jinyu , Lou Yifan , Carter Kara
Published: December 2023

Studies have shown that neighborhood environment shapes older Americans’ aging experience and health. However, it remains largely unknown whether and how neighborhood environment influences the well-being of older Asian Immigrants. Guided by the neighborhood stress process model, this study aims to investigate (a) the associations between neighborhood environmental stressors and depression among Chinese older immigrants and (b) the potential mediation effects of intrapersonal (sense of mastery and sense of hopefulness) and interpersonal coping (social engagement) resources in such associations. This study analyzed data collected from 2,801 Chinese older immigrants in the greater Chicago area. Structural equation modeling with bootstrap resampling was used to fit path models on neighborhood environmental stressor, intra- and interpersonal coping resources, and depression. Findings showed that neighborhood social disintegration and physical disorder were associated with more depressive symptoms directly and indirectly via lower intra- and interpersonal coping resources. Specifically, older immigrants living in neighborhoods with greater social disintegration reported lower sense of mastery and social engagement, which in turn were associated with more depressive symptoms (partial mediation). Older immigrants living in neighborhoods with greater physical disorder reported lower sense of hopefulness and mastery, which subsequently were associated with more depressive symptoms (full mediation). The findings showed that neighborhood environmental stressors are risk factors for mental health of Chinese older immigrants, and coping resources may serve as pathways of the associations. The findings have implications for practice as they are helpful to inform the development of tailored psychosocial interventions to enhance coping resources in older immigrants.
MARITAL STATUS TRANSITIONS AND INFLAMMATION DURING MID AND LATER LIFE: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Authors: Stokes Jeffrey E , Farmer Heather , Patterson Sarah
Published: December 2023

Research has increasingly utilized inflammatory markers to understand how social factors influence health, yet little research to date has examined marital status, or–crucially–later-life changes to marital status in relation to inflammation. Further, few studies have examined variation in such associations by gender, race/ethnicity, or age. We used data from the 2016 Health and Retirement Study (HRS) Venous Blood Study (n=9,933), which captures five inflammatory markers: C-reactive protein (CRP), Interleukin-6 (IL-6), Interleukin IL-10 (IL-10), Interleukin-1 receptor antagonist (IL-1Ra), and tumor necrosis factor alpha (TNF). Information concerning marital status came from the 2014 and 2016 waves of HRS, to ascertain stability of and changes to marital status over 2 years. Interactions were examined between marital status/transition groups and participants’ gender, age, and race/ethnicity. Overall, results were consistent across outcomes. Across 4 of 5 outcomes, the Newly Widowed and Never Married exhibited higher inflammation than the Continuously Married. Further, relationships between Continuously Widowed status and higher CRP and IL-6, and between Newly Widowed status and higher IL-1Ra, were present only for men. The association of Continuously Widowed status with higher CRP and IL-6 weakened with age, as did the effect of Newly Married status on IL-6. No clear patterns were identified concerning interactions with race/ethnicity. Findings indicate that marital transitions may have potential to harm physiological health. Negative consequences of widowhood for inflammation were also greater for men than for women, yet these harms may be attenuated at older ages when widowhood is an “on-time” rather than an “off-time” event.
IS LONELINESS CONTAGIOUS? AN ECOLOGICAL MOMENTARY ASSESSMENT WITHIN ROMANTIC COUPLES
Authors: Luchetti Martina , Rupprecht Fiona , Nikitin Jana , Gamaldo Alyssa , Mogle Jacqueline , Ledermann Thomas , Sliwinski Martin , Sutin Angelina
Published: December 2023

Although marriage has been found to be protective against feeling lonely, loneliness might also be ‘contagious’ and spread from one individual to another, particularly within close relationships. Feelings of loneliness tend to correlate within spouses and are associated with relationship strain and lower perceived support from the partner. Despite interest in loneliness among married couples, little is known about how loneliness might affect romantic partners, especially in everyday life. In this study, we examined momentary states of loneliness within middle-aged and older couples, and how these states affect each partner over the course of days. Data were from 137 opposite-sex couples (274 participants), between 40 and 70 years old, who completed phone-based assessments of loneliness on a scale from 0to 100, three times a day, for eight consecutive days. Data were modeled using a combination of dynamic structural equation modeling and actor partner interdependence modeling. For both couple members, auto-regressive associations indicated that loneliness states carried over from moment to moment for both partners. In addition, loneliness of the female partner at time t was associated with loneliness of the male partner at the previous assessment (time t - 1), but not vice versa. Partner effects were in part moderated by relationship quality (strain, perceived support). The results provide insight into how loneliness functions within couples in everyday life contexts and suggest that loneliness might have dyadic implications for the health and well-being of aging couples.
COMPARATIVE TRANSCRIPTOMIC OF LONGEVITY
Authors: Gorbunova Vera
Published: December 2023

Transcriptome analysis provides a nuanced view into the changes that occur in cells and tissues. Transcriptome changes rapidly and reproducibly in response to physiological influences and environmental insults. Recent years have seen an exponential increase in transcriptome data at bulk, single cell and spatial resolution that allows insights into the mechanisms and regulatory pathways of aging and longevity. In this session Drs. Gorbunova (University of Rochester) and Gladyshev (Harvard Medical School) will discuss comparative transcriptomics of longevity across species with diverse lifespans that revealed unique signatures of longevity and the integration of transcriptome and proteome data. Dr. Gladyshev will discuss development of transcriptomic clocks of measuring biological aging. Dr. Artyomov will discuss single-cell resolution approaches to reveal aspects of immune aging in humans, and Dr. Palovics will present the use of transcriptomics to understand rejuvenating effects of heterochronic parabiosis.
LIVING WELL? A MATCHED ANALYSIS OF MINORITY ETHNIC AND WHITE BRITISH PEOPLE WITH DEMENTIA AND THEIR CARERS
Authors: Victor Christina , Quinn Catherine , Matthews Fiona , Pentecost Claire , Gamble Laura
Published: December 2023

The increasing heterogeneity of the older population is reflected in the UK in an increasing number of those with dementia and carers drawn from minority ethnic groups. Data from the IDEAL dementia study is used to compare ‘living well’ among people with dementia and carers from ethnic minority groups with matched white British peers. We used a cross-sectional case-control design. Outcomes for both groups were quality of life, life satisfaction, wellbeing, loneliness and social isolation and, for carers, measures of stress, relationship quality, role captivity and caring competence. Our sample consisted of 20 people with dementia and 15 carers who self-identified as being of Indian, Pakistan, Bangladeshi, Black African, Black Caribbean or mixed ethnicity who were matched with 60 white British participants with dementia and 45 white British carers. People with dementia from minority ethnic groups had poorer quality of life (-4.74, 95% CI: -7.98 to -1.50) and higher loneliness (1.72, 95% CI: 0.78 to 2.66) scores whilst minority ethnic carers had higher stress (8.17, 95% CI: 1.72 to 14.63) and role captivity (2.00, 95% CI: 0.43 to 3.57) and lower relationship quality (-9.86, 95% CI: -14.24 to -5.48) than their white British peers. People with dementia from minority ethnic groups experience lower quality of life and caregivers higher stress and role captivity and lower relationship quality. Confirmatory research with larger samples is required to facilitate analysis of the experiences of specific minority ethnic groups and examine the factors contributing to these disadvantages.
WORKFORCE EDUCATION, TECHNOLOGY, AND EVALUATION TO REDUCE HEALTH DISPARITIES IN A PROVIDER SHORTAGE STATE
Authors: Yoo Ji , Reed Peter , Kim Laurie
Published: December 2023

State of Nevada has been a provider shortage area and ranks 50th state of primary care providers per capita in 2022. As a result, Medicare spends highest spending per capita and highest 30-day readmission rate of vulnerable and older adults, i.e., individuals with Alzheimer’s Disease Related Dementias. To respond these challenges, geriatric workforce education program (GWEP) was launched in 2019. Along with interdisciplinary education of healthcare providers, GWEP overarched to an innovative technology, i.e., digital health and machine learning methodology aiming at mitigating bias in healthcare and predicting events, i.e., nursing home placement and designating power of attorney timelines that are useful for planning advance care in primary care. GWEP team evaluates the impact of these education and technology implementation impact on healthcare delivery efficiency, i.e., healthcare cost. in real-world payment system. This is a collaborative symposium between the Community-Engaged Research, Geriatric Education, and Patient/Person Engagement in Research Interest Groups.
ASSOCIATION OF DIABETES AND VAGINAL MICROBIOTA WITH THE GENITOURINARY SYNDROME OF MENOPAUSE
Authors: Robbins Sarah , Shardell Michelle , Beitelshees Amber , Miller Ryan , Ravel Jacques , Taylor Simeon , Brotman Rebecca
Published: December 2023

The genitourinary syndrome of menopause (GSM) comprises urogenital signs and symptoms associated with estrogen deficiency during menopause. For many, decreased estrogen reduces vaginal Lactobacillus species abundance, a state associated with adverse urogenital outcomes. For these reasons, vaginal microbiota in women’s reproductive aging is an emerging topic of interest in geroscience research. The risk of diabetes also increases with menopause; however, few studies have jointly assessed diabetes and vaginal microbiota with GSM. Therefore, we assessed the relationships between diabetes, vaginal microbiota and GSM in a study of 811 participants aged 35-60 recruited to a 2-year observational cohort with follow-up every 6 months. Diabetes was defined as self-reported diabetes medications, history, or serum glycated albumin >16.5%. There were 22 and 251 postmenopausal participants with and without diabetes, respectively. Mixed-effects logistic regression quantified the association of vaginal microbiota with GSM outcomes among those with and without diabetes. After adjustment for covariates, low-Lactobacillus vaginal microbiota states were associated with lower odds of vulvovaginal atrophy (VVA) (aOR=0.23, 95% CI: 0.04-1.33) among postmenopausal participants with diabetes; however, this finding was not statistically significant. In contrast, among postmenopausal participants without diabetes, low-Lactobacillus microbiota was significantly associated with higher odds of VVA (aOR=1.63, 95% CI: 1.07-2.47). Diabetes significantly modified the association between vaginal microbiota and VVA among postmenopausal individuals (p=.032). Findings were similar for clinician-assessed vaginal dryness. These results suggest that the relationship between vaginal microbiota and GSM may differ by diabetes status. Larger studies are needed to further understand the relationships between diabetes, vaginal microbiota and GSM.
SEX HORMONES ARE ASSOCIATED WITH BONE DENSITY AND PHYSICAL FUNCTION IN WOMEN RECOVERING FROM HIP FRACTURE
Authors: Cappola Anne
Published: December 2023

Testosterone and estrogen have anabolic effects, and alterations could affect recovery from hip fracture. We hypothesized that differences in sex hormones during the year after a hip fracture would be associated with bone mineral density (BMD) and physical function. This analysis included 149 women aged 65 years or older enrolled in the Baltimore Hip Studies 7th cohort. Testosterone and estradiol by LC/MS/MS and sex hormone binding globulin were assayed at four time points post hip fracture (within 15 days of admission, and at 2, 6, and 12 months) on fasting morning samples. Longitudinal regression models accounting for clustering by subject were constructed to examine the relationship between each hormone and BMD and short performance physical battery (SPPB) score over time. Mean age was 81 years, BMI was 25.6 kg/m2, and 92% were white. Testosterone levels were low in women at all time points (median 10-12 ng/dL), as were estradiol levels (median 3-5 pg/mL). In adjusted models, increases in total and free estradiol during recovery were associated with improvement in BMD, whereas total testosterone, but not free testosterone, was associated with improvement in SPPB. These analyses support physiologically relevant relationships between higher estradiol levels and improvement in BMD and higher testosterone levels and improvement in physical function during the year after hip fracture, even at the low levels of sex hormones found in post-menopausal women. These findings suggest that differences in reproductive aging that affect sex hormone production may have clinical effects on recovery from a sentinel event, long after menopause.
BUILDING BRIDGES ACROSS THE GENERATIONS: RESEARCH ON DIVERSE APPROACHES FOR INTERGENERATIONAL CONNECTIONS
Authors: Eisenstein Amy , Gonzales Ernest
Published: December 2023

Intergenerational bonds are a unique and critically important set of social connections that have powerful impacts on families and communities, as well as the older and younger people themselves. America is increasingly age-segregated, so that naturally occurring, cross-generational contacts are not as common as they have been in previous eras. Research from the FrameWorks Institute and others suggest that ageist language can further divide the generations, create a sense of “othering,” and contribute to the isolation and minimization of older adults. Conversely, studies also show that meaningful intergenerational programming, which brings to light the strengths of both generations, may reduce social isolation and loneliness and enhance the physical and mental well-being of older adults. This symposium will bring together three research projects each exploring diverse approaches to intergenerational connections. The first paper will present lessons learned from a study of digital communication between grandparents and grandchildren during the COVID-19 pandemic, and the implications this shift in communications has on the psychological well-being of older grandparents. The second paper will present findings regarding the physical and psychosocial outcomes experienced by older adults who provide intergenerational tutoring in elementary school settings. The final session will highlight the process of integrating implementation science frameworks into a multistage study design aimed to assess the implementation of an intergenerational technology program within higher education. The session will wrap-up with a discussion on how these projects fit within the broader scope of intergenerational programs, and will highlight gaps and further opportunities for research in this field.
CAN GOOD SELF-RATED HEALTH MITIGATE THE FRAILTY-INDUCED HEALTH CARE EXPENDITURE? EVIDENCE FROM CHINA
Authors: jin Haiyu
Published: December 2023

As the pathophysiology of frailty remains unknown, intervention efforts have primarily focused on improving functions and alleviating symptoms instead of treating frailty-causing biology. Frail individuals are not a clinically homogeneous group; further risk stratification may identify subgroups more resilient to health risks. Self-rated health (SRH), a simple measure of an individual’s overall perception of overall health, might be a surrogate of resilience among the frail. This work aims to determine the joint association of frailty and SRH with healthcare expenditure. Data were from the China Health and Retirement Longitudinal Study. Persons were classified as non-frail, prefrail, and frail. SRH was classified as poor (including very poor) and good (fair/good/very good/excellent). Healthcare expenditure was classified into outpatient, inpatient, and self-treatment. The Cox model was used to address the study’s aims. All analyses were adjusted for age, sex, residence, education, income, insurance, smoking, and chronic conditions. Although frailty was positively correlated with poor SRH, 36.0% of the frail reported good health and 26.6% reporting poor health were deemed non-frail. Frailty and SRH were independently associated with higher odds of incurring and higher average expenditures. Among persons with poor SRH, prefrailty and frailty were associated with higher odds of incurring the cost and higher average expenditures than the non-frail, while no association was found between frailty and healthcare expenditure among those with good SRH. Frailty was associated with higher healthcare expenditure only among persons with poor SRH. Frail individuals reporting good health are resilient to frailty-induced health risks.
THE LIVED EXPERIENCE OF COPD AND EMOTIONAL DISTRESS IN US VETERANS: A MIXED-METHOD STUDY
Authors: Bamonti Patricia , Rose Grace , Park Stella , Silberbogen Amy , Moy Marilyn , Moye Jennifer
Published: December 2023

Behavioral interventions targeting low physical activity (PA) and comorbid emotional distress are critically needed to address gaps in the management of chronic obstructive pulmonary disease (COPD). A mixed-methods study was conducted to guide the development of Step-Cognitive Behavioral Therapy (Step-CBT), a virtual behavioral intervention under study integrating PA promotion with CBT for those with COPD. Semi-structured interviews with U.S. Veterans with COPD at the VA Boston Healthcare System explored the lived experience of COPD and emotional distress. Participants completed the Patient Health Questionnaire-9 [PHQ-9], Beck Anxiety Inventory [BAI]), and wore an accelerometer (ActiGraph wGT3X-BT) for 14 days to measure objective PA. Thematic analysis was used to code responses and identify themes. Participants (n=22; 90.9% male, age 68.0±6.0 years; 96% White) were assessed. PHQ-9 indicated moderate depression severity (M=11.3± 5.3) and BAI scores indicated moderate anxiety severity (M=26.5±9.4). Average daily step count was (M=6,611±4,799). In response to questions eliciting participants’ experience of emotional distress, participants described Emotions, Behaviors, and Cognitions associated with distress that interacted with COPD and PA (e.g., “I’ve gotta catch my breath where before I could just do up the yard with no problem… so that gets me depressed”). When asked about engaging in daily PA in the context of emotional distress, three themes emerged: Emotion Regulation and Coping (e.g., healthy behavioral coping, maladaptive coping, etc.), Factors that Motivate (i.e., routine/schedule, etc.), and Social Context. Findings illuminate linkages between emotional distress and PA that will guide the creation of vignette-based treatment modules in the development of Step-CBT.
CONECTAR: A MINDSET TO INCREASE HISPANIC ENGAGEMENT IN DIGITAL TECHNOLOGY RESEARCH
Authors: Young Vanessa , Serrano-Rubio Luis , Gaona Carlos , Jones Floyd , Seshadri Sudra , Kaye Jeffrey , Beattie Zach , Gonzales Mitzi
Published: December 2023

In-home digital technology affords the opportunity for more precise and ecologically valid assessments of daily activity engagement. However, concerns about loss of privacy can hinder recruitment, especially within communities already underrepresented in research. Literature on effective, culturally tailored recruitment strategies is limited. Herein, we describe strategies employed for an in-home digital technology study with 100% Mexican American representation. Hispanic participants were recruited from the greater San Antonio area. Direct recruitment strategies conducted in both English and Spanish included community outreach events, a participant repository, cross-enrollment with other research studies, and by word of mouth. Mass recruitment strategies included flyer dissemination, newsletters, and digital announcements through community organizations (i.e., Salud America!) and national (i.e., Research Match) and institutional websites. Between September 2022 and February 2023, 31 participants were enrolled out of 154 individuals who were contacted. Of these, 29% were recruited from community events, 22.6% from word of mouth, 19.4% from cross-enrollment, 12.9% from the research repositories, and 16.1% from mass recruitment strategies. The most common reasons for non-enrollment included lack of interest (n=49), screen failure (n=29), and privacy concerns (n=12).Direct recruitment efforts achieved higher rates of enrollment, while mass media campaigns yielded lower responses and resulted in more unsuccessful contact attempts. Understanding the relationship between social networks and research beliefs may be particularly relevant given the Hispanic culture’s collectivist and family-oriented nature. Hence, social network theories, combined with a diffusion of innovation framework, may be advantageous for increasing trust and may consequently improve representation of diverse groups in research.
IDENTIFYING AND PREDICTING PLACE OF CARE TRAJECTORIES DURING THE LAST THREE YEARS OF LIFE
Authors: Lin Haiqun , Zafar Anum , Setoguchi Soko , Jarrín Olga
Published: December 2023

Aging in place is a goal for most older adults, however in presence of advanced illness and/or Alzheimer’s disease and related dementia (ADRD) institutional placement may be needed. The number of days in each care setting in each quarter of the last three years of life was determined through linkage of several Medicare datasets. Using group-based modeling we examined place of care trajectories during the last three years of life among a 10% sample of Medicare beneficiaries who died in 2018 (n=199,828), providing a pre-COVID19 baseline for future studies, to identify dual trajectories of inpatient/institutional care, and skilled home healthcare/home hospice. Nine distinct trajectory classes and their associated sociodemographic and clinical characteristics were identified. The first three classes were characterized by healthcare use concentrated in the last three months of life (comprising 29.1%, 20.5%, and 9.1% of the sample); the next three classes were characterized by low use of inpatient/institutional care with long-term use of skilled home healthcare/hospice (14.2%, 8.2%, and 4.8%); and the remaining inpatient/institutional classes characterized by low use of skilled home healthcare/hospice with long-term use of inpatient/institutional care (4.8%, 4.9%, and 4.6%). The beneficiaries in the remaining sample are assigned to a place of care trajectory class using the parameter estimates derived from the 10% sample without further model fitting. We investigate the prediction utility of risk factors in multiple domains of demographic, clinical, and social determinants of health. Our findings may help to inform care preference during last period of life understanding the associated factors.
APPLYING THE CARE SETTING TRAJECTORY DATABASE TO STUDY END-OF-LIFE OUTCOMES IN PERSONS WITH DEMENTIA
Authors: Kim Hyosin , Jarrín Olga , Duberstein Paul , Wu Bei , Lin Haiqun , Zafar Anum , Harvey S Marie , Lopez Maria
Published: December 2023

This study highlights an application of the care setting trajectory database and our new, harmonized, self-reported race/ethnicity variable to evaluate the impact of home health care on later use of hospice and place of death in a large cohort of Medicare decedents. This study evaluated home health care use during the last 3 years of life as a predictor of death in the care of hospice for a cohort of 895,526 Medicare beneficiaries with dementia who died in 2019. The cohort was limited to beneficiaries continuously enrolled for at least 5 years, who were age 40 and older, and who lived in the U.S. fifty states, District of Columbia, or Puerto Rico at death. Co-variates included number of acute hospitalizations during the last 3 years of life, age at death, sex, race/ethnicity, comorbidities, insurance, rural/urban area, and state of residence. 54.5% of the cohort used home health care at any point during the last 3 years of life. Compared to beneficiaries who did not use home health care, those who received home health care were more likely to die at home (64.5% vs. 60%, OR 1.08) or in the care of hospice (65% vs. 58%, OR 1.05). Among beneficiaries who died with hospice, use of home hospice was more prevalent for those who had previously used home health care (53% vs. 49%). This study provides compelling evidence of the value of home health care as a strategy to improve end-of-life care quality among Medicare beneficiaries living with dementia.
KNOWLEDGE, ATTITUDES, AND BELIEFS ABOUT HEARING HEALTH CARE OF OLDER BLACK WOMEN SEEKING HEARING HELP IN ENT SETTINGS
Authors: Toman Julia , Lewis Charity , Sanchez Victora , Arnold Michelle
Published: December 2023

There are documented barriers to access and use of healthcare services faced by older Black adults in the US. Black women are more likely to report negative past experiences with the healthcare system and as a result have inherent mistrust of providers. Black women are also less likely to receive referrals for specialty and allied health care, but it is unknown if this trend is apparent for hearing healthcare. The purpose of the current study was to investigate the experiences of older Black women seeking help for hearing loss in an otolaryngology (ENT) clinic setting. Our interdisciplinary team consisting of experts in gerontology and Black women’s health, public health, audiology, and otolaryngology conducted a mixed methods study which included (1) semi-structured interviews (n=15) and (2) online administration of a validated hearing beliefs questionnaire (n=86). Interview themes uncovered included experiences with racism in healthcare, the role of religion in help-seeking, and the importance of seeking treatment for hearing loss. Triangulation of findings revealed consistency between themes and questionnaire results, including little to no expressed stigma surrounding hearing aid use and little resistance to hearing healthcare or hearing loss treatment. Our results suggest that primary care and ENT should feel confident in referring older Black women who are seeking help for hearing loss to audiology for treatment options. We will also discuss other known facilitators and barriers to serving this population in an ENT setting.
AGE-RELATED HEARING LOSS IN COMMUNITY PHARMACY: BARRIERS AND FACILITATORS TO COMMUNICATION
Authors: Lewis Penny , Thomas Shanice , Griffiths Jane , Phipps Denham , Saunders Gabrielle , Todd Christopher
Published: December 2023

Pharmacists have an important role in primary care, communicating with people and ensuring safe and appropriate medication use. However, inadequate communication is a barrier to the delivery of effective care for people with hearing loss. This study sought to explore factors that facilitate and impede communication with people with age-related hearing loss (presbycusis) in the community pharmacy, in order to identify solutions to improve these interactions. Online semi-structured interviews with people with age-related hearing loss (presbycusis), older people (>50 years old) without hearing loss, and online focus groups and interviews with community pharmacists were conducted. Data were analysed using the framework method. Sixteen people with age-related hearing loss, three older people without hearing loss and eight community pharmacists took part. Participants described a multitude of environmental barriers to communication and person-centred pharmaceutical care such as heavy workload, lack of privacy, noise levels and Covid-19 safety measures. There was a perception among participants that their hearing loss is not relevant to the community pharmacy setting and that more could be done to signify that a pharmacy recognises the needs of those with hearing loss, furthermore, participants discussed their limited interaction with pharmacy personnel. There were varying perceptions about communication and levels of awareness among pharmacists about the key facilitators to communication. Greater interdisciplinary collaboration to develop and implement strategies/adaptations tailored to the needs of people with hearing loss would support the engenderment of hearing-friendly community pharmacies and the safe use of medicines.
INDIVIDUAL AND COUNTY-LEVEL FACTORS OF SERVICE USE BY DEMENTIA FAMILY CAREGIVERS IN RURAL APPALACHIA
Authors: Nah Suyoung , Savla Tina , Roberto Karen
Published: December 2023

Formal services have been shown to provide health benefits for care recipients and family caregivers. Despite prior efforts, it is still unclear which factors play a role in the decisions to use formal services by family caregivers living in under-resourced rural regions. Drawing upon the Andersen model of health service use, this study examined individual and county-level factors’ associations with the utilization of support services (e.g., homemaker, respite) and personal services (e.g., home health nurse, personal care aide) by dementia family caregivers residing in rural Appalachia (N = 163). Results of multilevel models revealed that caregivers with higher income and care recipients with more limitations in activities of daily living tended to use more support and personal services. Greater informal support from family or friends was associated with less utilization of support services, but not personal services. Caregivers residing in counties with higher poverty and lower public spending on support services for older adults were more likely to use support services. Conversely, caregivers living in counties with more home health agencies were more likely to utilize personal services. These findings suggest that caregivers living in rural regions may depend more on informal support for meeting basic care needs of their relative living with dementia. However, if the care recipient requires more specialized care, living in resource-rich counties increases their chances of receiving appropriate care. Discussion will focus on strategies to allocate funds and resources to expand care coverage to vulnerable individuals such as people living with dementia in rural regions.
ASSOCIATION OF RELIGIOUS ATTENDANCE, RELIGIOSITY/SPIRITUALITY, AND C-REACTIVE PROTEIN IN MIDDLE TO OLDER ADULTS IN THE U.S
Authors: Britt Katherine , Boateng Augustine , Sebu Joshua , Oh Hayoung , Lekwauwa Ruby , Massimo Lauren , Doolittle Benjamin
Published: December 2023

Elevated levels of C-reactive Protein (CRP), a biomarker of systemic inflammation, are associated with a higher risk of cognitive decline and dementia. Religious attendance and religiosity/spirituality are associated with better cognitive health, yet the underlying physiological mechanisms are not well understood. We examined the association between religious service attendance, religiosity/spirituality, and CRP levels in a nationally representative sample of U.S. adults aged 50 years and older (n=6,652) from the Health and Retirement Study from 2006 to 2014. The mean age was 70.7(9.32) years, 84.4% were White, 58.4% were female, and mean CRP levels were 3.98 (8.50) ug/mL. Utilizing the generalized estimating equation (GEE), a significant negative association was found between religious service attendance and religiosity/spirituality with average CRP levels, even after controlling for age, sex, education, marital status, race/ethnicity, income, body mass index (BMI), and health conditions (diabetes, cancer, hypertension) [B: -0.39, 95% CI:-0.76,-0.03, p<0.034 and B: -0.04, 95% CI:-0.07,-0.01, p<0.01]. Age, income, and education were negatively associated with CRP levels, while being female, Black/African American, having diabetes, cancer, hypertension, and BMI were positively associated with CRP levels. Findings contribute to our understanding of a possible mechanism by which religious service attendance and religiosity/spirituality influence cognitive health through reduced systemic inflammation. Interventions are needed to sustain religious attendance supporting religiosity/spirituality for adults who find religion/spirituality important, with the potential to reduce the risk of cognitive decline and dementia.
DAILY SUPPORT EXCHANGES WITH FRIENDS AND PSYCHOLOGICAL WELL-BEING IN LATE LIFE
Authors: Ng Yee To , Chopik William , Fingerman Karen
Published: December 2023

Support exchanges are crucial to older adults’ well-being. Functionalist and identity theories suggest that individuals engage in support exchanges with social ties that are consistent with their identities/roles to maximize their well-being. This study examined support exchanges with friends in daily life and tested the link between support exchanges with friends and daily well-being, particularly how this link varied between married and unmarried older adults. Adults aged 65+ (N = 292, Mean age = 73.72, 60% married) provided information about their demographics and social partners. Across five days, they completed surveys about support exchanges with friends (i.e., receiving or giving advice, practical support, and emotional support, respectively) and daily life satisfaction at the end of each day. Multilevel logistic models revealed that unmarried older adults were more likely to receive all types of support from friends and also more likely to provide advice and emotional support (non-tangible support) to friends than married older adults. Support provision was unrelated to life satisfaction. On days when older adults received advice from friends, they reported increased life satisfaction than on days that they did not (within-person association). This within-person association was stronger among unmarried than married older adults. Patterns of findings remained unchanged after adjusting for support exchanges with other social ties. Findings highlight the role of marital status in older adults’ daily support exchanges. Unmarried older adults may compensate for the lack of a spouse with friends and are more reactive to daily support exchanges than married older adults.
THE NEED FOR FAMILY-CENTERED HOME CARE IN HOME-BASED DEMENTIA CARE
Authors: Reckrey Jennifer , Watman Deborah , Tsui Emma
Published: December 2023

Family caregivers, paid caregivers, and geriatricians frequently work together to care for people with dementia living at home, yet little is known about the paid caregiver role in home-based dementia care. We conducted repeated, one-on-one, semi-structured interviews with the care team (i.e., family caregiver, paid caregiver, geriatrician) of 9 people living at home with dementia over 6 months to explore multiple perspectives on paid caregivers’ role in care over time. In all, 29 unique respondents participated in 75 interviews that were analyzed using the framework method of analysis. Results revealed nuanced and highly individual care arrangements where paid caregiver roles in care varied significantly, though changes to this role over time were minimal. Families were the key players in defining the paid caregivers’ role regardless of home care agency involvement or source of paid caregiver payment (i.e., Medicaid-funded vs. privately paid) and geriatricians frequently deferred to family caregivers to determine how they should engage with paid caregivers. While paid caregivers often described their emotional connection to their clients, family caregivers and geriatricians rarely described this as an important aspect of paid care. To meet the nuanced care needs of people with dementia, home care needs to be centered around the unique needs of both people with dementia and their family caregivers. Rather than provide prescriptive standards for home care, family-centered home care should facilitate improved communication and clear expectation setting to be sure that care best meets the unique care needs of people with dementia living at home.