bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and Risk Factors of Elder Mistreatment in the Community: A Longitudinal Population-Based Study
Authors: Burnes David , Hancock David , Eckenrode John , Lachs Mark , Pillemer Karl
Published: December 2021

Prior population-based elder mistreatment (EM) risk factor research has focused on problem prevalence using cross-sectional designs, which cannot make causal inferences between proposed risk factors and EM or discern existing cases from new cases entering the population. This study sought to estimate the incidence of EM and identify risk factors for new cases. It is a ten-year prospective, population-based cohort study with data collected between 2009 (Wave 1) and 2019 (Wave 2). Based on Wave 1 random, stratified sampling to recruit English/Spanish-speaking, cognitively intact, community-dwelling older adults (age ≥ 60) across New York State, this study conducted computer assisted telephone interviews (CATI) with 628 respondents participating in both Wave 1 and Wave 2 interviews (response rate=60.7%). Ten-year EM incidence was regressed on factors related to physical vulnerability, living arrangement, and socio-cultural characteristics using logistic regression. Ten-year incidence rates included overall EM (11.4%), financial abuse (8.5%), emotional abuse (4.1%), physical abuse (2.3%), and neglect (1.0%). Poor self-rated health at Wave 1 significantly predicted increased risk of new Wave 2 overall EM (odds ratio [OR]=2.8), emotional abuse (OR=3.67), physical abuse (OR=4.21), and financial abuse (OR=2.8). Black older adults were at significantly heightened risk of overall EM (OR=2.61), specifically financial abuse (OR=2.8). Change from co-residence (Wave 1) toward living alone (Wave 2) significantly predicted financial abuse (OR=2.74). Healthcare visits represent important opportunities to detect at-risk older adults. Race is highlighted as an important social determinant for EM requiring urgent attention. This study represents the first longitudinal, population-based EM incidence study.
A Meta-Analysis of the Effects of Tailor Activity Program (TAP) for People with Dementia
Authors: Jeong Jiin , Yoo Eun-Young , Kang Byoung-Ho , Ha Yae-Na
Published: December 2021

Ninety eight percent of people with dementia are accompanied by neuropsychiatric symptoms (NPS). NPS is an important predictor of the negative prognosis of dementia. It also increases the burden on caregivers and lowers the quality of life. The tailored activity program (TAP), which is occupation-based intervention, have a positive effect on reducing NPS through meaningful activities. The aim of this study was to provide an integrated effectiveness of the TAP on NPS in people with dementia and caregiver burden through meta-analysis. We searched for studies that indicated the effectiveness of TAP through Embase, ProQuest, Pubmed, and RISS. We included a total of seven TAP studies written in Korean and English. Of these seven study designs, five were randomized control trials (RCTs) and two were one group non-RCTs. The result of meta-analysis shows that the effect size of the NPS was 0.62 (95% confidence interval [CI]=0.40-0.83, p<0.001), the caregiver burden was 0.68 (95% CI=0.29-1.07, p=0.001). Both variables indicated moderate effect. These results indicate that the TAP is an effective intervention for reducing NPS of people with dementia and the burden of caregivers. Therefore, TAP is clinically useful approach, we expect TAP to be actively applied to people with dementia in the community.
Are Loneliness and Social Isolation Equal Threats to Health and Well-being? An Outcome Wide Longitudinal Approach
Authors: Henriksson Tatiana , Nakamura Julia , Kim Eric
Published: December 2021

The detrimental effects of loneliness and social isolation on health and well-being outcomes are well documented. In response, governments, corporations, and community-based organizations have begun leveraging emerging tools to create interventions and policies aimed at reducing loneliness and social isolation at-scale. However, these efforts are frequently hampered by a key knowledge gap: when attempting to alleviate specific health and well-being outcomes, decision-makers are unsure whether to target loneliness, social isolation, or both. Participants (N=13,752) were from the Health and Retirement Study- a diverse nationally representative, and longitudinal sample of U.S. adults aged > 50 years. We examined how changes in loneliness and social isolation over a 4-year follow-up period (from t0:2008/2010 to t1:2012/2014) were associated with 32 indicators of physical-, behavioral-, and psychosocial-health outcomes 4-years later (t2:2016/2018). We used, multiple logistic-, linear-, and generalized-linear regression models, and adjusted for sociodemographics, personality traits, pre-baseline levels of both exposures (loneliness and social isolation), and all outcomes (t0:2008/2010). After adjusting for a wide range of covariates, we observed that both loneliness and social isolation have similar effects on physical health outcomes and health behaviors, whereas loneliness is a stronger predictor of psychological outcomes. In particular, behavioral dimensions of the social isolation measure (i.e., participation in social/religious activities, social interaction frequency) were most strongly associated with the largest number of health and well-being outcomes, including all-cause mortality. Loneliness and social isolation have independent effects on various health and well-being outcomes, thus, should be distinct targets for interventions aimed at improving the health and well-being.
Comparisons of factors associated with suicidal ideation of older individuals by health status
Authors: Sung Hyeyeon , Na Jihun , Lee Sungkyu , Baek Sehyun
Published: December 2021

This study examined the factors associated with suicidal ideation among older individuals and compared those factors by their objective and subjective health status. Data were obtained from the 13th wave of the Korean Health Panel Survey in 2018. The sample of 6,283 older individuals, who are 55 years and older, was classified into four groups by their objective and subjective health status. Objective health status was measured by the number of chronic health conditions, and subjective health status was defined by an individual’s self-reported health status. To examine the factors associated with suicidal ideation among four groups of older individuals, logistic regression analyses were conducted after controlling for socio-demographic characteristics, physical health and mental health characteristics. The results show that depression and anxiety were found as common factors associated with suicidal ideation for all four groups. As for the group of older individuals who reported bad objective health and bad subjective health, younger age, being male, and low educational attainment were found to be associated suicidal ideation. For those with bad objective health regardless of their subjective health status, the level of stress was found to be related to suicidal ideation among older individuals. Based upon those results, the present study discussed practical and policy implications for suicide prevention among older individuals by reflecting their objective health and subjective health status.
Complementary and Integrative Health Approaches and Opioid Prescriptions Among Older Veterans With Chronic Pain
Authors: Han Ling , Goulet Joseph , Skanderson Melissa , Redd Doug , Brandt Cynthia , Zeng Qing
Published: December 2021

Complementary and integrative health (CIH) approaches are recommended in national guidelines as viable options for managing chronic pain and de-prescribing opioids. We followed 1,993,455 Veterans with musculoskeletal disorders for two years who were not using opioids at study entry. CIH exposure was ascertained from primary care visits for acupuncture, massage and chiropractic care via natural language processing and structured data. Opioid prescriptions during the 2-year follow-up were abstracted from Veterans Health Administration (VHA) electronic pharmacy records. Propensity score (PS) was used to match CIH recipients with non-recipients with most comparable baseline characteristics. Overall, 140,902 (7.1%) Veterans received CIH, with a prevalence of 2.7% for Veterans aged ≥ 65y, comparing to 6.3% and 10.5% for those aged 50-64y and ≤ 49y, respectively. Among the 1:1 PS-matched sub-cohort (136,148 pairs), Cox proportional hazard model revealed that time to fill first opioid prescriptions was significantly longer for CIH recipients (mean: 587 days) than non-recipients (mean: 491 days), with adjusted Hazard Ratio of 0.48 (95% Confidence Interval (CI): 0.45-0.51) for Veterans ≥ 65y, 0.44 (95% CI: (95% CI: 0.43-0.45) for 50-64y and 0.47 (95% CI: 0.46-0.48) for age ≤ 49y group (p value for interaction, 0.003). Sensitivity analyses among full cohort or modeling total supply of first opioid prescriptions derived consistent results. These findings suggest potential benefit of CIH use in delaying and reducing opioids prescriptions for patients with chronic pain and may have implication for older Veterans ≥ 65y who have been found less likely to seek CIH therapies than their younger counterparts.
Cultural Considerations to the Life Participation Approach in Aphasia:A Filipino Case Study
Authors: Ulatowska Hanna , Santos Tricia Olea , Cuadro Carla Krishan
Published: December 2021

Stroke is among the common causes of chronic disability (Feigin, 2014). Around one-third of stroke survivors are affected by aphasia, a communication disorder affecting the ability to comprehend and express oneself (Dickey, et. al., 2010). Culture is essential to understanding aphasia and providing person-centered care. Philippine cultural identity is reflected via respect for older persons, collectivism in family and community, and devotion to religion (Pe Pua & Protacio-Marcelino, 2000). The Filipino family is a primary support system, and cultural values directly influence caregiving approaches in chronic disability. This single case study examines the life of a Filipino man who has successfully lived with aphasia for over 25 years. Having finished a doctorate from Harvard University, served as the youngest University president, and member of the Philippine government, he suddenly had a stroke and was able to communicate only via single words, gestures, and facial expressions. His life is discussed in the context of the unique, multi-modal communication system which developed through the years with his family. Music and symbolism via watercolor paintings also define his aphasia journey. The value of religion in Filipino culture (Cruz, et. al., 2019) and its role in fostering positivity in his aphasia journey is examined. This study also highlights Filipino collectivism through the support of family and community in addressing communication needs and facilitating meaningful relationships at various stages in life. Cultural values deeply rooted in Filipino caregiving, such as debt of gratitude and filial devotion to parents (Enriquez, 1992), are discussed.
Diversity, Equity and Inclusion in an Age-Friendly Health System
Authors: Eckstrom Elizabeth , Morgan Emily , De Lima Bryanna , Pleet Anna
Published: December 2021

The Age-Friendly Health Systems (AFHS) initiative uses a 4Ms framework to encourage patient-centered care for older adults. Many health systems have implemented the core elements of AFHS – What Matters, Mentation (Cognition and Depression), Medications, and Mobility – with the goal to uniformly apply these elements to all patients 65 years and older. However, equity in AFHS delivery has not yet been examined. Five diversity, equity, and inclusion (DEI) factors, including gender, race, ethnicity, preferred language and MyChart activation, were cross-sectionally analyzed against the 4Ms framework for patients seen (in person or virtual visit) in an academic internal medicine clinic between April 2020 and April 2021 (N= 3370) using two-way contingency tables. Preferred language, gender, and MyChart activation yielded significant pairings with the 4M metrics. For the AFHS What Matters metric, females were 1.10 times more likely than males and English-speaking patients were 1.67 times more likely than non-English speaking patients to receive advance care planning (p <0.01). Females and patients with MyChart activation were about 2.0 times more likely to have a high-risk medication on their medication list compared to males and patients without MyChart activation (p <0.01). MyChart activation was also significantly associated with cognitive screening. Patients with MyChart activation were 1.09 times more likely than patients without MyChart activation to get cognitive screening (p <0.001). This study, the first to incorporate demographic data, into AFHS quality measures, suggest a need to develop best practices for equitable Age-Friendly care at the clinical team and the institutional policy level.
End-of-Life Care Factors Predict Affective Sequences in Older Adults’ Final Memories of Spousal Loss
Authors: Mroz Emily , Anaya-Dominguez Nerea , Bluck Susan
Published: December 2021

Memories from the dying days of a deceased spouse are vividly recalled and can guide grief adjustment in older adulthood (Mroz & Bluck, 2018). End-of-life factors (e.g., place of death, quality of death) likely impact the nature of recall of such memories over time. Intersecting psychology and palliative care perspectives, the current study employs mixed-methods to examine relations between end-of-life care factors and affective sequences in older adults’ final memories of spousal loss. Fifty-three participants (Mage = 81.59; M = 6.81 years since loss) completed a Final Memory Interview, provided place of spousal death (in hospital, outside of hospital), and completed the Good Death Inventory (GDI; Miyashita et al., 2008). GDI responses were organized into four quality of death categories. Final memories were reliably content analyzed for affective sequences (i.e., positive and negative affect themes; interrater agreements > .70): redemption (bad mitigated by good, McAdams 1999), contamination (good spoiled by bad; McAdams, 1998), positive stability, and negative stability. Loss of a spouse in hospital, compared to outside of hospital, related to narrating final memories with contamination, F = 4.05, p < .05. Quality of death predicted narration of final memories with positive affective sequences: lower reported comforting environment related to redemption (t = -3.05; p < .01) and higher reported appropriate medical care related to positive stability (t = 2.60; p < .05) in memories. As healthcare provision continues to adjust to improve end-of-life circumstances across care environments, the impact of circumstances on close others should factor into initiative development.
Evaluating the Conversation Starter Kit in Long Term Care: A Canadian Perspective
Authors: Kaasalainen Sharon , Sussman Tamara
Published: December 2021

This study evaluated an advance care planning intervention, the Conversation Starter Kit (CSK) booklet, for use in long term care (LTC) homes. This study used a quasi-experimental, one group pre/post design. Quantitative surveys were administered before and after a 3-month advance care planning intervention (CSK booklet). Data were collected at three LTC homes in southern Ontario. We collected data from 55 resident who were able to make decisions on their own paired with 11 family members of these residents. We also collected data from 24 family members of residents who were not able to make decisions on their own. Quantitative surveys were administered before and after the intervention. An additional structured interview was completed at the end of the intervention period, which included both closed and open-ended questions to assess perceptions about the CSK booklet’s use or non-use. Residents reported higher engagement in advance care planning after having completed the CSK booklet than before, particularly related to asking questions to health care providers about health care decisions. Family members reported feeling very certain that they would be able to make decisions on behalf of the resident but they felt less certain after completing the CSK booklet, implying that the CSK booklet raised their awareness of the types of decisions that they might need to make, hopefully triggering them to become more prepared for these decisions in the future. The CSK appears acceptable, easy to use for residents and family members/friends in LTC, and can improve resident engagement in ACP.
Food access, diet quality, and nutritional status of older adults during COVID-19: A scoping review
Authors: Johnson Kimson , Nicklett Emily , Troy Lisa M , Vartak Maitreyi , Reiter Ann
Published: December 2021

COVID-19 has imposed challenges for older adults to access food, particularly in minority, lower income, and rural communities. However, the impact of COVID-19 on food access, diet quality, and nutrition of diverse older adult populations has not been systematically assessed. The objective of this study is to examine changes in food access, diet quality, and nutritional status among older adults during the COVID-19 pandemic and the potential differential impacts of the COVID-19 pandemic on these nutrition-related outcomes using the framework of the socio-ecological model. An electronic search was conducted using three databases (PubMed, CINAHL, and Web of Science) on March 7, 2021. Original, peer-reviewed English-language studies published 10/1/2019-3/1/2021 were considered for which the age of participants was 50 years and older (average age range 50-98). In order to be considered, studies must have examined food access, food security, or nutrition constructs as an outcome. The initial search yielded 13,628 results, of which 9,145 were duplicates. Of the remaining 4,483 articles, 13 articles were in scope and therefore selected in the final analysis, which can be characterized as descriptive (n=5), analytical (n=6), and correlational (n=2). Studies were conducted among community-dwelling older adult populations (n=7) as well as those temporarily residing in hospital settings (n=6) in 10 countries. More research is needed to examine the impact of COVID-19 on food access/security and the differential barriers experienced by older adult populations.
Nutritional Risk and Health-Related Quality of Life in Older Adults Aging With HIV
Authors: Viviano Nicole , Gruber-Baldini Ann , Schmalzle Sarah , Stafford Kristen , Chard Sarah , Mohanty Kareshma , Parker Elizabeth , Eke Uzoamaka
Published: December 2021

Due to antiretroviral treatment success, individuals with HIV are living longer. People aging with HIV (PAWH, 50+) may be more likely to experience nutritional risk compared to their HIV-negative counterparts due to biopsychosocial factors. The DETERMINE checklist measure accounts for social and economic factors as well as aspects of the aging process that are not typically considered when examining nutritional risk and are important for PAWH. The current study examined nutritional risk and health-related quality of life (HRQoL) in PAWH using the DETERMINE checklist and PROMIS t-scores (mental and physical HRQoL) through secondary analyses of 158 participants in the Strengthening Therapeutic Resources in Older patients agiNG with HIV (STRONG) study. DETERMINE nutritional risk scores (0-21) were separated into 4 groups (low-risk [0-2, n=13], moderate-risk [3-5, n=28], high-risk [6-12, n=78], very high-risk [13-21, n=39]). The sample was 55% male, 94% Black/African American and had a mean age=59 (SD=5.5). Most of the sample (74%) were at high or very high nutritional risk and low HRQoL t-score: physical M=43.7 (SD=9.5), and mental M=45.7 (SD=10.1). Mental and physical HRQoL were significantly (p<.001) associated with nutritional risk group as tested through linear regressions. Means were as follows: physical HRQoL low-risk M=53.4 (SD=10.6), moderate-risk M=47.4 (SD=8.9), high-risk M=43.5 (SD=8.1), very high-risk M=38.4 (SD=8.9); mental HRQoL low-risk M=54.0 (SD=8.9), moderate-risk M=49.1(SD=7.9), high-risk M=46.1(SD=9.5), and very high-risk M=39.5 (SD=9.7). These associations remained significant after controlling for age and sex. Higher nutritional risk as measured by the DETERMINE checklist in PAWH was associated with poorer physical and mental HRQoL.
The Daily Challenges of Caring for Grandchildren: A Daily Analysis of Emotional and Physical Reactivity to Stressors
Authors: Rickenbach Elizabeth Hahn , Fassi Janelle
Published: December 2021

Grandparents are increasingly providing extensive and custodial care for their grandchildren. Many factors have contributed to a societal rise in caregiving among grandparents, including addiction, incarceration, dual-income families, and the cost of childcare. Past work has highlighted positive effects of grandparenting (e.g. reduced dementia risk); however, research is limited that examines the day to day challenges grandparent caregivers experience. The goal of this research was to examine daily experiences of stressors, positive events, physical symptoms, and daily mood of grandparent caregivers. Participants (n=18 grandparent caregivers) filled out a diary survey for five consecutive days that measured daily stressors and positive events. A total of 90 diaries were completed. Stressors were reported on 97.6% of days. Multilevel analysis examining emotional and physical reactivity to daily events showed that, controlling for age and gender, on days when participants reported more stressors than average, they reported higher negative affect (p=.019), lower positive affect (p=.003) and more physical symptoms (p=.002). Positive events were not significantly associated with daily mood or daily physical symptoms. Overall, the findings supported the hypothesis that grandparent caregivers experience emotional and physical reactivity to the daily challenges they experience. Future research should examine resources and supports to reduce the impact of daily stressors, as well as the particular challenges among underrepresented groups, particularly Black and Latino grandparents, who provide disproportionate levels of care for their grandchildren. The current study highlights the potential vulnerability and daily needs for support among grandparents who provide regular and custodial care for their grandchildren.
The Live Long Walk Strong Rehabilitation Program: What Features Improve Mobility Skills? Virtual Pilot
Authors: Harris Rebekah , Bean Jonathan , Ogawa Elisa , Middleton Addie , Kelly Catherine
Published: December 2021

To evaluate the feasibility of delivering the Live Long Walk Strong (LLWS) rehabilitation program among community dwelling, mobility limited older Veterans in the VA Boston Healthcare System. Community dwelling Veterans 50 years and older identified as being at high risk for mobility decline based on self-report task modification and AM-PAC mobility questions. All Veterans received 10 sessions over 8 weeks of LLWS Physical Therapy care focusing on novel impairments related to mobility decline and behavioral change strategies. Sessions were delivered 1:1 with a Physical Therapist over 45 minutes. To assess feasibility, we tracked recruitment and retention metrics. We assessed length of each session, number of sessions attended, and any reason for withdrawal. To examine technological feasibility, we recorded number and type of issue along with resolution of the issue. A total of 178 Veterans were contacted to participate. Twenty Veterans were enrolled into the LLWS virtual pilot between October 2020 – May 2021. Among our 20 enrolled, 5 did not complete the program. Reasons for not completing included: being enrolled in another exercise study simultaneously and non-related medical complications. Among those completing, an average of 9.7 out of 10 intervention sessions were completed. An average of 1.8 technology difficulties per Veteran was experienced within the intervention. The most frequent technology issues experienced were related to camera positioning and Wi-Fi bandwidth resulting in delayed video and audio. LLWS is feasible to deliver as a virtual mode of care in middle and older aged Veterans at high risk for mobility decline.
A Scoping Review of Psychological Sense of Community among Community Dwelling Older Adults
Authors: Buckley Thomas
Published: December 2021

Psychological sense of community (PSOC) is an important construct for health and well-being outcomes for older adults. Drawing on the Ecological Theory of Aging and the Age-Friendly Cities (AFC) framework, this scoping review explored how PSOC has been used in research with community dwelling older adults. I followed Arksey and O’Malley's (2005) scoping review guidelines. Initial database searches yielded 860 articles. I included 33 in the final sample. I grouped articles based on study populations and conceptualization and operationalization of PSOC. I used thematic analysis to explore topic areas and main findings. The AFC framework guided development of themes and others emerged during analysis. Results show most studies used Asian or White samples and focused on geographic community or neighborhoods. Among the several measures of PSOC, the Brief Sense of Community Scale performed best with older adults. Topical research areas in the thematic analysis were built (1) built environment and neighborhoods, (2) social participation and connection, (3) civic participation, (4) PSOC as a protective factor, (5) health and well-being, (6) relocation, and (7) scale development. PSOC was a consistent predictor of health and well-being and served as a mediator to link neighborhood or environmental characteristics with health and well-being. Future research needs to examine PSOC in geographically and culturally diverse samples and conduct further psychometric testing of PSOC scales with older adults. PSOC is conceptually related to the AFC framework and serves as a mechanism that links AFC features and well-being outcomes. These results can inform practice and refine theory.
Adverse Childhood Experiences Associated with Epigenetic Age and Depressive Symptoms in Older Adults
Authors: Klopack Eric , Carroll Judith , Crimmins Eileen , Cole Steve , Seeman Teresa
Published: December 2021

Adverse childhood experiences (ACEs) increase risk for depression in adolescents and older adults and have been linked to accelerated biological aging. We hypothesized that accelerated epigenetic aging may partially explain the link between ACEs and depression. This study examines second-generation epigenetic clocks (viz., GrimAge, PhenoAge, and DunedinPoAm38) as mediators of the link between ACEs and depressive symptoms in older adulthood. We utilize structural equation modeling to assess mediation in the Innovative Subsample of the Venous Blood Study from the Health and Retirement Study (N = 2672). Results indicate that experiencing more than 1 ACE is significantly associated with greater GrimAge and DunedinPoAm38, with limited evidence of increasing aging with increasing ACEs. GrimAge and DunedinPoAm38 were also significantly associated with more depressive symptoms. These associations were partially reduced by lifestyle factors. GrimAge explained between 9 and 13% of the association between ACEs and adult depressive symptoms, and DunedinPoAm38 explained between 2 and 7% of the association between ACEs and adult depressive symptoms. Findings indicate that accelerated aging, as measured by GrimAge and DunedinPoAm38, is strongly associated with ACEs in older Americans, that these clocks are highly associated with depressive symptoms in older Americans, and that these clocks mediate a proportion of the association between ACEs and adult depressive symptoms. Epigenetic clocks may represent a physiological mechanism underlying the link between early life adversity and adult depression. Lifestyle factors are a potential area for intervention.
Aging services workers in the pandemic: Voiced experience of senior center staff & case workers
Authors: Okang Esther , Aaron Siobhan , Supiano Katherine , Osman Abdul
Published: December 2021

The pandemic necessitated immediate shutdown of senior centers, requiring a rapid pivot in the delivery of services to older adults by direct care workers. We provided psychosocial support to older adult service personnel-including Aging and Adult Services case workers and Senior Center Staff, and conducted focus groups with staff at intervals to capture the mid-point of the pandemic (peak of older adult deaths), onset of vaccine availability and the re-entry phase as programs re-opened. We evaluated coping and self-efficacy of workers and discerned sustained high levels of coping and perceived job performance. Using a phenomenological lens, we analyzed transcribed recordings, generated codes, and created categories of experiences. Several themes emerged: personal and professional resilience, passion for serving older adults, motivation to perform their job well, stress of not having face-to-face contact with clients, insufficient resources-especially in rural areas, lack of essential training, feeling disjointed as a team, and work-life balance. Over the course of the pandemic, workers expressed increasing resiliency and skills to navigate the pandemic, oscillations in their fears for their clients’ well-being, and gratitude that they kept their jobs and gained additional State resources. As the vaccine was available and utilized, and as senior centers were reopening, senior center staff were enthusiastic, yet case workers remained apprehensive about long-term consequences of the pandemic. This study affirms the role of direct care workers as essential and valuable. Yet, their expressed need for more education, psychosocial support, and community awareness of their service remains to be addressed.
Association of Sedentary and Active Bout Frequency With Mortality in Older Men Using Accelerometry
Authors: Roe Lauren S , Harrison Stephanie , Cawthon Peggy , Moored Kyle , Ensrud Kristine , Stone Katie , Gabriel Kelley Pettee , Cauley Jane
Published: December 2021

BACKGROUND: Time spent sedentary increases with age and has several negative health consequences. We sought to examine associations between daily sedentary and active bout frequency with all-cause mortality. METHODS: Data are from 2,918 men in the Osteoporotic Fractures in Men (MrOS) study (mean age at Visit 3±SD: 79.0±5.1 years) with valid activity monitor data (5.1±0.3 days worn>90%) at Year 7 visit (Visit 3, 2007-2009). Sedentary and active bout frequencies are defined as the daily transition frequency from a sedentary bout lasting 5+ minutes to activity of any intensity, and the transition frequency from an active bout lasting 5+ minutes to sedentary. Deaths were centrally adjudicated using death certificates. Cox proportional hazard models were used to examine associations between quartiles of sedentary (Q1 referent, <13.6 bouts/day) or active (Q1 referent, <5 bouts/day) bout frequency and mortality. Models were repeated, stratifying by median daily total time spent sedentary and active. RESULTS: After 9.4±3.7 years of follow-up, 1,487 (51.0%) men died. Men averaged 16.9±5.1 and 8.2±4.2 sedentary and active bouts/day, respectively. After full covariate adjustment, each quartile reflecting a higher sedentary (Q4 vs Q1 HR: 0.68, 95%CI: 0.58-0.81, p-trend<0.001) and active bout (Q4 vs Q1 HR: 0.57, 95%CI: 0.48-0.68, p-trend<0.001) frequency was associated with lower mortality risk. There was no evidence that effects differed by total sedentary time (p-interaction for sedentary bout frequency and total sedentary time>0.05). CONCLUSIONS: More frequent, prolonged sedentary and active bouts are associated with a lower mortality risk in older men and is not moderated by total sedentary time.
Biopsychosocial Correlates of Cognitive Function Among Korean Older Adults: History of Hypertension and Diabetes
Authors: Cho Kyuyoung , Chai Hye Won
Published: December 2021

Based on biopsychosocial perspectives on health, this study examined risk and protective factors of cognitive function among Korean older adults. Specifically, we focused on comparing the role of these factors based on the respondents' history of having hypertension or diabetes. This study used 2009 Korean National Health Insurance Service data that included a sample of older adults who maintained qualification for health insurance and medical aid in 2002 (n=26,242). Cognitive function was measured using KDSQ-C and biopsychosocial factors included metabolic syndrome, drinking, smoking, and walking. The sample was divided into two groups based on their medical history, and thus four sets of linear regression models were analyzed to explore the associations between biopsychosocial factors and cognitive functioning. Among individuals with a history of hypertension, metabolic syndrome, drinking, and walking were associated with cognitive functioning. For those without a history of hypertension, only drinking and walking were associated with cognitive functioning. For diabetes, smoking and walking were associated with cognitive functioning among older adults with a history of diabetes. For those without a history of diabetes, drinking and walking were associated with cognitive functioning. In sum, metabolic syndrome was a particularly significant correlate of cognitive function among Korean older adults with a history of hypertension. Walking was a consistently significant factor regardless of medical history. These results highlight the importance of considering medical history of chronic conditions such as hypertension and diabetes in identifying factors associated with older adults' cognitive function and further developing tailored prevention programs for cognitive decline.
Effectiveness Of A Staff Training Program To Stimulate Physical Activity In Homecare: A Cluster RCT
Authors: Metzelthin Silke , Rooijackers Teuni H , Zijlstra G A Rixt , van Rossum Erik , Koster Annemarie , Evers Silvia , Passos Valeria Lima , Kempen Gertrudis I J M
Published: December 2021

Reablement encourages older adults to do things themselves rather than having things done for them. To implement reablement in practice homecare staff needs the right knowledge, attitude, skills and support. This study evaluated the effectiveness of the “Stay Active at Home” reablement training program. A 12-month cluster-RCT was conducted, involving staff (n=313) and clients (n=264) from 10 homecare teams, five of which were trained. Effects were evaluated using data from accelerometers, physical performance tests, questionnaires and electronic patient records. No beneficial effects were observed in older adults for sedentary behavior; daily, physical, and psychological functioning; and falls. In homecare staff there were no statistically significant differences between study groups for self-efficacy and outcome expectations scores except for higher self-efficacy scores in more compliant staff (adjusted mean difference: 1.9 [95% CI 0.1, 3.7]). No differences were observed for any cost category except for domestic help costs in the intervention group (adjusted mean difference: €-173 [95% CI -299, -50]). The probability that “Stay Active at Home” is cost-effective compared to usual care at a willingness-to-pay of €20,000 was 19.7%/ daily minute of sedentary time averted, 19.2%/ percent of sedentary time averted as proportion of wake/wear time, and 5.9%/QALY gained, respectively. The reablement training program needs further development based on the lessons learned before wider implementation.
Fear, Resistance, or Anticipation? Older Truck Drivers’ Reactions to the Adoption of Automated Vehicles
Authors: Schuster Amy , Van Fossen Jenna , Sperry Danielle , Cotten Shelia
Published: December 2021

The forecasted adoption of autonomous vehicles (AVs) will lead to major changes to the job of truck driving. These changes may be particularly challenging for drivers, as the population of truck drivers skews much older than that of other occupations. In this study we sought to understand truck drivers’ attitudes towards AVs and the longevity of their job. We conducted focus groups with truck drivers, their supervisors, and upper-level managers of trucking companies. We relate supervisors’ and managers’ experiences working with drivers through the rollout of new technologies to further understand drivers’ initial reactions to automation and how their attitudes may develop. Based on qualitative open coding our analysis uncovered two overarching themes. The first theme is the unknown. With AVs, companies expect that experience will be less important, so they can hire younger workers. In response, drivers have expressed fear of being displaced and anxiety over the uncertainty of not knowing how their jobs will be affected. The second theme is adaptability, and desire to adapt. Older drivers have expressed resistance to adapting to AVs and to their job changing. Concerningly however, managers envision the need for a driving workforce that has experience working with technology and is adaptable. Our study identifies key challenges concerning older workers’ reactions and career decisions in response to automation. Accounting for driver reactions to AVs is necessary not only to build theory and understanding on worker reactions to automation, but also for workforce planning and to support employees, particularly older workers.
How Gender Shapes the Effects of Immediate Family Members’ Deaths on Adults’ Psychological Well-Being
Authors: Suitor J Jill , Gilligan Megan , Stepniak Catherine , Hou Yifei , Frase Robert
Published: December 2021

The deaths of family members constitute one of the most serious negative life events experienced in adulthood. The impact of these losses on psychological well-being may differ considerably by the structural relationship between the deceased and the survivors, and by the genders of both family members; however, few studies have been able to explore these variations by generation, gender, and time since death. In this paper, we use mixed-methods data to explore how depressive symptoms are affected differentially in adulthood by the deaths of mothers, fathers, and siblings, as well as by the gender of survivors. We address these questions using data collected from approximately 600 adult children nested within 250 later-life families, in which approximately 55% experienced the death of at least one parent and 15% experienced the death of a sibling in the previous decade. Preliminary multilevel regression analyses showed that deaths of siblings predicted sisters’ but not brothers’ depressive symptoms. In the case of parents, only mothers’ deaths were found to predict daughters’ depressive symptoms, whereas neither parents’ deaths predicted sons’ well-being. Further, these patterns differed little by time since death. Qualitative data revealed that women were more likely to report that both their mothers’ and siblings’ deaths had led to higher conflict within the sibling network, which previous research has shown predicts psychological well-being. Taken together, these findings demonstrate the salient role of gender in shaping well-being in the face of events of deaths of parents and siblings in adulthood.
Psychosocial Mentorship Needs: Promoting Diversity in Aging and Alzheimer’s Disease Research and Clinical Careers
Authors: Thompson Sheri , Pineda Lauren , Gamboa Savannah , Santiago Gisselle
Published: December 2021

The UC San Diego MADURA Mentorship Program, funded by an R25 National Institute on Aging grant, has goals to improve diversity in Aging and Alzheimer’s Disease (ADRD) research and clinical practice. MADURA strives to improve retention and academic success of its URM trainees, and to increase graduate/medical school applications and/or entry into Aging/ADRD careers. Mentees receive paid research experience, skills training, peer support, seminars, and additional professional development opportunities. Given local demographics and Co-Investigator expertise, MADURA recruits primarily Hispanic/Latinx (H/L) students, and other URM students. Non-exclusive racial identifications of 32 Year 1 mentees were: 69% H/L, 9% Black/African American, 22% Asian and 31% other race. 72% met NIH criteria for Disadvantaged Backgrounds. As of June 2021, 100% of students completed surveys assessing Racial Microaggressions and Imposter Syndrome experiences, and Professional Self-efficacy. This poster will define the concepts, discuss relevance for URM student success and retention, and present student data on each topic. As examples, 56% of trainees experienced overt discrimination and 72% reported having experienced microaggressions at least occasionally, as undergraduates. As related to Imposter Syndrome, 62% secretly worried that others would find out that they are not as bright and capable as others think. Half attributed accomplishments to being a “fluke,” or due to reasons other than true merit. Still, in terms of Professional Self-efficacy, 62% of mentees thought it moderately or very likely that they would succeed as an Aging/ADRD researcher. The authors will make specific suggestions for optimized URM training and mentorship program content, and provide resources.
Safety and Efficacy of Repeat Doses of Allogeneic Mesenchymal Stem Cells in Patients with Age Related Frailty
Authors: Saltzman Russell , Schulman Ivonne , Khan Aisha , Hare Joshua
Published: December 2021

Age-related frailty is a common geriatric condition characterized by a decline in physical and immunological capacity that is associated with depletion of endogenous stem cells and leads to increased vulnerability for adverse health outcomes. Allogeneic mesenchymal stem cells (allo-MSCs) exert immunomodulatory effects and promote tissue repair, which may be able to impede the negative effects of the aging process. The objective of this study was to explore the safety and efficacy of repeated infusions of allo-MSCs in subjects with aging-frailty. Mean age at time of first and second infusions was 75.5 and 77 years of age, respectively. In this open-label clinical trial, 24 participants received two intravenous infusions of allo-MSCs with an average interval of 17.6 months between doses. Safety endpoints included incidence of treatment-emergent serious adverse events (TE-SAEs) within 1-month post-infusion and increase in Panel Reactive Antibodies (PRAs) at 6-months post-infusion. Primary efficacy endpoint was change in 6-minute walk test (6MWT) distance at 6-months post-infusion. No TE-SAEs occurred within 1-month post-infusion. PRAs remained stable throughout the study, indicating no evidence of immune rejection. 6MWT increased by 42 meters after the first infusion (P=0.018). Eighteen months later elevation persisted (P=0.026), but did not increase further after the second infusion. In summary, repeated intravenous infusions of allo-MSCs were safe in participants with age-related frailty and showed remarkable improvement in physical performance. Given the excellent safety and efficacy profiles demonstrated in this study, larger clinical trials are warranted to further quantify the efficacy of repeated dosing of allo-MSCs in this multisystem disorder.
Social Isolation, Caregiving Alone, and Caregiving Stress in Family Caregivers of Older Adults in Korea
Authors: Baik Sol , Jun Jiweon
Published: December 2021

The tendency of caregiving alone is increasing, and these solo caregivers often perceive caregiving responsibilities as a burden. Still, literature on positive aspects of caregiving shows that not all caregivers experience severe distress. Little is known on which factors make a difference in experiencing caregiving distress among solo caregivers. We focused on the empirical findings on the negative impact of social isolation on caregiver’s mental health, examining if and how the intersection of solo caregiving and social isolation is related to severe caregiving stress among caregivers of older adults in Korea. We analyzed 501 family caregivers of older adults in Korea using survey data from the Care Work and the Economy research project (2018). We conducted ordinal logistic regression analysis. The findings show that solo caregivers with a lack of social time fall under the most at-risk group of caregivers in terms of experiencing severe stress (OR=3.72, SE=0.93) whereas solo caregivers with enough social time did not show significantly higher stress compared to the reference group (OR=1.50, SE=0.43). Being socially isolated caregivers still had high levels of stress despite the division of care (OR=2.16, SE=0.55), implying the need to provide caregivers more time for social interaction with others. The current public long-term care insurance in Korea provides limited hours of in-home care aide services to enable aging in place of older adults. To reduce the social isolation of caregivers, it is necessary to extend the service hours and provide support, such as creating online caregiver networks.
The Experiences of Older Adults with Cannabis and Mental Health: A Scoping Review of the Literature
Authors: Mirza Raza , Bull Amanda , Gardiola Andrea , Mirza Sabina , Hynes Mary , Hsieh Jessica
Published: December 2021

Following the 2018 federal legalization of cannabis in Canada, there was a drastic increase in older adults reporting marijuana use. Most cannabis research today focuses on children and young adults, however, it is important to acknowledge the potential harms in seniors as well. Aging and substance use presents unique considerations, such as the interactions between cannabis and chronic conditions, multiple comorbidities, polypharmacy, and mental health. The goal of this scoping review was to analyze the literature that addresses mental health outcomes of seniors who use cannabis, in order to answer the main research question: What is the relationship between older adults’ use of cannabis and mental health? Following Arksey and O’Malley’s five-stage framework, 10 electronic databases were searched along with a hand search of references. The search revealed 7000+ peer-reviewed and grey literature sources. 233 full-text sources were assessed for eligibility, with a total of 25 articles included. Thematic content analysis produced four major themes which addressed: (1) Usage characteristics; (2) User characteristics; (3) Outcomes; and (4) Physical and mental health considerations. Findings from this scoping review are positioned in terms of their implications for research, practice, and policy. While more in-depth, qualitative methods are required to develop further research, several harm-reduction strategies may be immediately utilized by both users and healthcare practitioners. It is critical that older adults and their physicians are able to make cannabis-related decisions with evidence-informed guidance to prevent problematic cannabis use and ensure positive mental health outcomes.