bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Subacute Care Patients Living Longer?
Authors: Kejriwal Nidhi , Tello Samantha , Davis Brooke , Kubba Mira , Evans David , Gonzales Norma , Evans J Robert
Published: December 2021

In order to provide prognostic information for gerontologists who regularly counsel families, we determined to measure the longevity of subacute patients who have feeding tubes and tracheostomies. This study compares two cohorts of patients: 2002-2006 and 2015-2019. T-tests were performed to compare the total days in acute care, the total survival days, and the number of hospital admissions between the two groups. Results revealed (2002-2006, 2015-2019), some variance in the acute care days between the two groups (M= 15.4186, 21.49438) and p= .66. There is a wide difference in the total survival days between the two groups with individuals from 2015-2019 living longer than 2002-2006 (M= 229.8198, 644.0449), p< .001. However, there is no statistically significant difference in the number of hospital admissions between the two groups (M= 0.994186, 0.7752809), p= .09754. We hypothesize that advances in technology, medicine, and care over the span of 17 years contribute to increased longevity. On average, patients in the 2015-2019 group survived 414 days longer than the first group. Yet, even with such advances, more days were spent in acute care in the second group (2015-2019). Our data show subacute longevity has nearly tripled in the last decade. Although patients are living longer, they are often in a vegetative state; in most instances, there is no apparent improvement in quality of life. This study provides current data which will help gerontologists improve prognostication and allow them to form a more realistic long view of care.
Cognitive Stimulation Therapy in Outpatient Settings for Persons with Dementia
Authors: Zubatsky Max , Berg-Weger Marla , Amick Matthew , Blessing Debbie , Sansone Katelyn , Brende Anna , lundy Janice
Published: December 2021

Cognitive Stimulation Therapy (CST) is a non-pharmacologic evidence-based intervention for persons living with mild to moderate dementia. This clinical intervention therapy follows a structured protocol designed to connect people with memory loss to others by providing opportunities for social engagement and group discussion of current events and a different themed activity each session. This presentation will include findings from a multi-site study of the group intervention conducted in an urban and two rural out-patient settings with community-dwelling older adults. Pre- and post-assessments captured data on cognitive function, depression, quality-of-life, and mobility. While CST is offered in over 30 countries, this is the first large-scale CST study conducted in the U.S. Implications for future practice and research will be presented.
Covid-19 in Hospitalized Patients Admitted from Skilled Nursing Facilities: Factors Associated with Mortality
Authors: Zhan Rongfang , Yin Cheng , O'Neill Liam
Published: December 2021

Background: Nursing home residents were impacted disproportionately by the coronavirus because of their vulnerabilities. Although many studies concentrated on risk factors associated with mortality of hospitalized patients, there were limited studies epitomizing them from skilled nursing facilities to hospitals. The study aims to identify inpatients’ characteristics on demographics, hospital admission types, insurance types, and chronic diseases associated with mortality among our cohort patients in Texas. Methods: Individuals above 50 years, diagnosed with Covid-19, and admitted from skilled nursing facilities were included in the retrospective cohort study. Pearson’s Chi-Square and Mann-Whitney tests were applied to measure four major perspectives between survivors and non-survivors. Then, a binary logistic regression was employed to determine the association between independent variables and mortality. Results: A total of 218 patients were included in the study, of which 54 (24.8%) died during hospitalization. According to the univariate analysis, expired patients were more likely to be emergency admission (p = 0.001), elective admission (p = 0.02), Medicaid as primary payment (p = 0.034), heart disease (p = 0.027), CKD (p = 0.03), and hypertension (p = 0.002). The binary logistic regression revealed that hypertension (OR = 3.176, 95% CI: 1.200-8.409, p = 0.02) and Medicaid (OR = 2.637, 95% CI: 1.287-5.405, p = 0.008) as primary payment had significantly high odds of mortality. Conclusion: Hypertension and Medicaid as primary payment are the strongest predictive factors associated with mortality and suggest that hospitals in Texas distribute critical care and resources while prevent and treat them to increase survival rates.
Development and validation of a measure of supervisory best practices in gerontological social work
Authors: Kaplan Daniel , Chan Keith
Published: December 2021

Agency-based supervision is essential to skilled practice and staff retention, directly impacting the quality of services. The Supervisory Leaders in Aging (SLA) program was designed to strengthen supervision of the aging services workforce. SLA was implemented in four states and trained 134 social work supervisors. The purpose of this study was to develop a novel, comprehensive, and practice-informed measure of supervisory best-practices in gerontological social services. The primary outcome for the SLA program was the Practice Inventory for Supervision in Aging Services (PISAS), which evaluated the frequency of recent use of best practices as identified by the project team and vetted by instructors and an interdisciplinary advisory board. Reliability and confirmatory factor analyses were conducted to examine its psychometric properties. Findings demonstrated the scale had good internal consistency reliability (ɑ = 0.88). Confirmatory factor analyses indicated a three-factor solution, 1) Gerontological Social Work Skills, 2) Program Development Skills, and 3) Supervision and Leadership Skills, accounting for 72% of the variability in the 27 items. Gerontological Social Work Skills captured best practices regarding mental health in late life, heightening awareness of elder abuse, and working with families. Program Development Skills captured assessment, measuring outcomes, and translating evidence into practice. Supervision and Leadership Skills captured individual supervision, group supervision and leadership in interdisciplinary practice. Results indicated that PISAS is a reliable and valid measure of use of best practices in gerontological social work supervision. Further implications and limitations of this measure in assessing outcomes of gerontological education and training programs are discussed.
Answering the Call for Diversity and Racial Equity: The National Association for Geriatric Education
Authors: Bennett Katherine , Rosich Rosellen , Edelman Linda , Gordon Barbara , Goroncy Anna , Severance Jennifer
Published: December 2021

The National Association for Geriatric Education (NAGE) is a non-profit organization representing geriatric and gerontology programs, including Health Services and Resource Administration funded Geriatric Workforce Enhancement Programs (GWEPs), and Geriatric Academic Career Awardees (GACAs). NAGE responded to the renewed call to address systemic racism and racial inequities by forming a Diversity and Racial Equity Workgroup. The Workgroup explored ways to disseminate educational resources, support members to address racial inequities among older adults, promote increased diversity of the geriatrics/gerontology workforce, and support public policy initiatives that address racism and health disparities. Initial outputs include creating a Diversity and Racial Equity resource page, identifying liaisons to the Workgroup from each NAGE Committee to ensure impact across the organization, and organizing collaborations across GWEPs and GACAs to share successful initiatives. Future plans include education and advocacy with members and collaborating organizations to address systemic racism and racial health inequities impacting older adults.
Intergenerational Tutoring: Older Adults Supporting Children’s Academic Needs via Video Conferencing
Authors: Hoffman Jessica , Miller Edward , Burr Jeffrey , Mutchler Jan , Hermelbracht James , Volpe Robert , Codding Robin , Briesch Amy
Published: December 2021

COVID-19 resulted in societal disruptions across the lifespan. School (K-12) closures were among the most challenging impacts of the virus, leaving many parents with the burden of schooling their children at home. Another major impact of the virus was the social isolation and loneliness felt by many retired, older adults, who were sheltering at home. The disruptions of COVID-19 led our inter-professional team to develop the Intergenerational Tutoring program. Intergenerational Tutoring addresses a service delivery gap in schools because tutors expand schools' capacity to implement evidence-based instruction with students in need of individual support. At the same time, research shows that meaningful volunteering supports the well-being of older adults across physical, psychosocial and cognitive dimensions of health. The aim of the Intergenerational Tutoring program is to pair older adults with kindergarten children in high needs schools to implement early literacy interventions remotely via Zoom. Our poster will describe the Intergenerational Tutoring program including tutor training and tutoring implementation. We will summarize the initial findings from our pilot study conducted in spring and summer 2021 with tutors and children. Data will include (1) themes from tutor interviews regarding the personal meaningfulness of the program and the program’s associated benefits and challenges; (2) implementation fidelity data; (3) impact of tutoring on children’s early literacy skills; and (4) parent feedback. We will summarize lessons learned and next steps for the program.
Management challenges faced by administrators at dementia care nursing homes in China
Authors: Jiang Lin , Sun Fei , Bonifas Robin , Hodge David
Published: December 2021

Currently, more than 10 million Chinese older adults have been diagnosed with dementia, a number that is expected to increase as the population in China rapidly ages. Yet, little research exists on dementia care in Chinese long-term care facilities. Our research addresses this gap in the knowledge-base by examining the challenges nursing home directors encounter as well as the coping strategies they employ to deal with these challenges. Twenty-one facility directors employed by faith-based nursing homes across 14 provinces in China participated in this study. Semi-structured interviews were conducted in respondents’ native language via phone or in person. Most respondents reported a religious affiliation, and about half were female and had been facility directors for more than four years. Two researchers fluent in Mandarin and English coded interview transcripts; thematic analysis was conducted to identify patterns in the data. The results indicated four primary challenges, which pertained to recruiting and retaining nursing staff, funding, lacking support from the government, and conflicts with family members. The coping strategies included obtaining and using external resources such as volunteer visitors, operationalizing personal spiritual beliefs, and providing training to improve skills and empathy among employees. This study contributes to nursing home practice by expanding our knowledge of culturally relevant dementia management strategies in China. Suggestions to address management challenges from a policy and practical perspective include clear and sustainable financial support from the government, staff training, and staff-resident ratio regulations, seeking external resources, and integrating spiritual strategies into problem management and service quality improvement.
Passive Infrared Motion Sensors Improved the Detection Accuracy of Nocturnal Agitation
Authors: Au-Yeung Wan-Tai , Miller Lyndsey , Beattie Zachary , Kaye Jeffrey
Published: December 2021

Actigraphy has been used to detect agitation in persons with dementia, although this technology must be worn by participants. Another promising sensing methodology is passive infrared (PIR) motion, which provides continuous, low-cost, and unobtrusive data, and may also improve the detection of agitated periods. Using data from the MODERATE (Monitoring Dementia-Related Agitation Using Technology Evaluation) study, we compared the predictive value of detecting agitation in a male participant, who was 64 years old with Alzheimer’s disease (AD), living in a memory care unit, and monitored with actigraphy on his wrist and four PIR motion sensors within his living quarters. The participant’s medical record indicated that he experienced agitation during 17 nights over 96 consecutive days. 929,037 data points were captured for analysis. From each night, the features extracted from the actigraphy wearable included total and standard deviation of activity counts, activity counts in the most and the least active hours, and median activity counts in one hour. Features extracted from the PIR motion sensors included dwell durations in the areas around bed, sofa, front door and bathroom, and the number of transitions between these areas. Using logistic regression to predict agitated periods, comparable classification performances were achieved using these two sets of features (AUC = 0.74 for wearable and AUC = 0.71 for PIR motion sensors). When these two sets of features were combined, the classification performance showed notable improvement (AUC = 0.83). This study points to the value of utilizing PIR motion sensors for detecting dementia-related agitation.
Personal and Environmental Challenges of Aging in Place with Long-Term Mobility Disabilities
Authors: Ramadhani Widya , Rogers Wendy
Published: December 2021

Maintaining independence while aging in place at home requires support, especially for older adults aging with long-term mobility disabilities. As age-related changes progress, individuals with long-term mobility disabilities experience more challenges engaging with daily living activities (ADLs) and instrumental activities of daily living (IADLs). To understand the activity challenges of these older adults, we analyzed the interview data from the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study, a comprehensive user needs assessment of 60 older adults who have had mobility disabilities for at least ten years (Koon et al. 2019). We selected interview data that focused on the conduct of ten activities at home: bathing, dressing, moving around, toileting, transferring, doing hobbies, housekeeping, home maintenance, managing diet and nutrition, and caring for others. This archival study used the coding schemes from the ACCESS study that were developed using both conceptual- and data-driven approaches (Koon et al., 2019). The ecological theory of adaptation and aging (Nahemow and Lawton, 1973) was the underlying framework to identify the challenges related to older adults' functional capacity (personal) and physical environmental barriers (environmental). We identified five main challenges: physical strength, general health limitations, mobility limitations, physical access, and transferring. Older adults' responses to overcoming the challenges involved personal, environmental, and person-environment interaction strategies. This study provides insights into the relationship between the source of environmental barriers and personal coping strategies to guide the design of appropriate aging in place supports for older adults with mobility disabilities.
Predictors of Food Insecurity Before and During COVID-19 Among Middle-Aged and Older Adults
Authors: Cheng Jianjia , Nicklett Emily
Published: December 2021

The indirect impact of COVID-19 on food security of middle aged and older adults is not well understood. This study examines changes in risk factors for food security from 2018-2020 in a population-based sample. Using data from the Health and Retirement Study (2018 and 2020 waves), we utilized generalized estimating equations (GEE) with repeated measures to examine factors associated with food insecurity among US adults aged 50 and older (n=3170) before COVID-19 and since COVID-19. The prevalence of food insecurity doubled from 2018 (4.83%) to 2020 (9.54%). In multivariate analyses, the population-averaged odds of experiencing food insecurity was 81% higher in 2020 compared to 2018. Other factors significantly associated with higher odds of food insecurity included being female (OR: 1.29), Black (OR: 1.46), lowest quintile for wealth (OR: 1.82), not working due to a disability (OR: 3.29), renting (OR: 2.04), greater IADL limitations (OR: 1.32), and greater number of chronic illness comorbidities (OR: 1.14). Factors significantly associated with lower odds of food insecurity included older age (65-74: OR: 0.73; 75+: OR: 0.56) and being above the median income level (OR: 0.47). Partnership status, education level, and ADL limitations were not significantly associated with the population-averaged odds of experiencing food insecurity. This study identified factors related to food insecurity among a community-dwelling sample of middle aged and older adults in the U.S. Future research should examine the impact of policies and intervention strategies to address the disproportionate impact of COVID-19 on populations at increased risk of experiencing food insecurity.
Relying on Myself: The Lived Experience of Being at Risk for Falling in the Hospital Among Older Adults
Authors: Dolan Hanne , Rishel Cindy , Rainbow Jessica , Taylor-Piliae Ruth
Published: December 2021

Inpatient falls are a persistent problem and despite research efforts during the last decade, inpatient fall rates have not significantly decreased. Older adults have an estimated 50% greater inpatient fall rate than younger adults. How older adults perceive their own fall risk affects their adherence to fall prevention recommendations. The aim of this phenomenological study was to gain a deeper understanding of the lived experiences of being at risk for falling in the hospital among older adults aged 65 years and older (N=9). Participants (female=55%, age range=67 – 86) were interviewed twice using video conferencing within two weeks of hospital discharge. The audio-recorded interviews were transcribed, and then analyzed using van Manen’s interpretive phenomenological method. The Health Belief Model expanded with the concepts of independence, fear of falling, embarrassment, dignity, and positivity effect served as the theoretical framework. Five major interpretive themes emerged: Relying on Myself, Managing Balance Problems in an Unfamiliar Environment, Struggling to Maintain Identity, Following the Hospital Rules, and Maintaining Dignity in the Relationships with Nursing Staff. These themes describe how the participants thoughtfully planned their mobilization to avoid falls. This process was influenced by their struggling to remain independent, following the hospital fall prevention rules out of politeness, and experiencing both positive and negative relationships with nursing staff. Hospitalized older adults employed their self-efficacy to manage balance problems in the hospital. These findings have not been previously documented in the literature. Fall prevention interventions supporting hospitalized older adults’ self-management of fall risk are needed.
Mitigating Implicit Racial Bias in the Clinical Setting: A Qualitative Study of Family Medicine Residents
Authors: Goroncy Anna
Published: December 2021

Implicit racial bias (IB) in physicians contributes to racial health inequities. Health profession trainees are not consistently trained to address IB. This phenomenological study explored Family Medicine (FM) residents’ experience of applying strategies to mitigate IB during home visits (HVs) to homebound older adults. FM residents completed pre-work related to IB, applied strategies to mitigate IB during HVs, then completed written reflections and commitments-to-change (CTC). A two-month survey assessed completion of targeted changes and barriers faced. Researchers completed a thematic analysis identifying five themes: Response to IAT, barriers, strategies, value of HVs and mindfulness. All residents’ stated level of CTC remained the same (9/9, 100%) and 8/9 residents (89%) had partially or fully implemented their intended change at 2 months. Residents continued applying newly-learned strategies two months after training with transference to other clinical settings and bias types. These findings can facilitate development of clinically-based IB curricula with lasting impacts.
The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia.
Authors: Gavin Nicole , Shan Mu , Johns Shelly , Judge Katherine , Fowler Nicole
Published: December 2021

Anticipatory grief is the process of experiencing normal bereavement before the physical death of a significant person. To date, anticipatory grief has been related to higher levels of caregiver depression, anxiety, subjective burden, and poorer problem solving. Additionally, higher levels anticipatory grief are observed in caregivers of those with Alzheimer’s Disease and Related Dementias (ADRD) compared to caregivers of those with mild cognitive impairment, implying a relationship between disease severity and caregiver anticipatory grief. Analyses were performed on data for ADRD caregivers (n=56) enrolled in the IU Telephone Acceptance and Commitment Therapy for Caregiver (TACTICs) trial; an RCT evaluating an ACT intervention for ADRD caregivers with anxiety. Inclusion criteria included identifying as the primary caregiver of an ADRD patient, and clinically significant anxiety (GAD7 score >10). The average age of caregivers was 61.9 years, 41.1% were spouses, 83.9% were white and 14.3% were black. Mean anticipatory grief scores were notably higher (84.6) compared to the previously reported means across the literature (74.9). Using multiple regression models, we determined a caregivers’ anticipatory grief, as measured by the anticipatory grief scale, is not significantly associated with the patients’ dementia severity, as measured by the Dementia Severity Rating Scale (DSRS) (p=0.66), Results revealed that higher levels of caregiver burden, as measured by the Zarit Burden Index, are significantly associated with more anticipatory grief (p< 0.01). Understanding these relationships contributes to a better understanding of ADRD caregivers, identifying “high-risk” caregivers, and informing future interventions and care.
A Student-Led Community Outreach Telehealth Program for COVID Education and Health Promotion (COACH)
Authors: Yang Michelle , Clayton Cam , Harris Devin , Pelletier Chelsea , Schmidt Julia , Zwicker Jill , Sakakibara Brodie
Published: December 2021

While public health measures of quarantining, socially isolating, and physical distancing are important to minimize the spread of coronavirus (COVID-19), these actions may also compromise the ability to manage one’s own health, thereby increasing the risk of adverse health events. The purpose of this study was to evaluate a student-delivered Community Outreach teleheAlth program for Covid education and Health promotion (COACH) to community-living adults (age ≥65 years). We hypothesized that COACH would improve health promoting behaviour as measured by the Health Directed Behaviour subscale of the Health Education Impact Questionnaire. We also anticipated COACH would improve secondary outcomes of perceived stress, depressive and anxiety (Depression, Anxiety, and Stress Scale-21), social support (Medical Outcomes Study Social Support Survey), health-related quality of life (Short Form-36), and health promotion self-efficacy (Self-Rated Abilities for Health Practices Scale). In this single-group pre-post study, we recruited 75 community-living adults with access to telephone/video-conferencing technology to participate in six 30-45 minute sessions with trained medical students over a two-month period. The mean age of participants was 72.4 years (58.7% female), with 80% reporting two or more chronic conditions. No participants were diagnosed with COVID-19 during participation. Paired sample t-tests showed significant improvement in health directed behaviour (p < .001, d = 0.45) and self-efficacy (p <.001, d = 0.44), but significant decrease in mental health-related quality of life (p < .001, d = -1.69). Overall, COACH may help improve health directed behaviour and health promotion self-efficacy, despite decreases in mental health possibly associated with COVID-19 restrictions.
Association of Dual Sensory Impairment with Long-term Depressive and Anxiety Symptoms
Authors: Armstrong Nicole , Teixeira Camila Vieira Ligo , Brenowitz Willa , Swenor Bonnielin , Powell Danielle , Simonsick Eleanor , Jones Richard , Gendron Colby
Published: December 2021

Hearing (HI) and vision impairment (VI) are each independently associated with long-term depressive and anxiety symptoms, but the joint effects of both (DSI) may be associated with a greater risk of belonging to long-term chronically high depressive and anxiety trajectory classes. Multinomial logistic regression models adjusted by demographics and depressive symptoms were used to examine the associations of dual hearing (pure-tone average >25 dB) and vision impairment (impaired visual acuity and/or contrast sensitivity) with long-term depressive and anxiety symptom trajectory classes among 2,102 participants of the Health, Aging and Body Composition Study, a cohort of older adults without mobility difficulty aged 70-79 years. An additional model evaluated the two-way interaction between DSI and social contact. Elevated depressive symptoms were defined as ≥8 on the 10-item Center for Epidemiologic Studies-Depression Scale, and anxiety symptoms were defined as present on the Hopkins Symptom Checklist. DSI was associated with increased risk of being chronically depressed (Risk Ratio, RR=1.86, 95% Confidence Interval, CI: 1.19, 2.92), not periodically depressed (RR=1.24, 95% CI: 0.91, 1.69). Those with DSI were at an increased risk of belonging to the periodically anxious (RR=1.56, 95% CI: 1.14, 2.13) and chronically anxious (RR=1.79, 95% CI: 1.02, 3.12) groups, as compared to the other groups. Single sensory impairments were not associated with increased risk of being periodically or chronically anxious. Social contact did not modify any associations. Synergistic effects between HI and VI were present. Those with DSI may be at greater risk for mood disorders, so sensory evaluations may mitigate these.
Diabetes, Obesity, and Osteoporosis in an Ethnically Diverse Population of Women Receiving Osteoporosis Screening
Authors: Kahsay Feven , Yang Wendy , Chandra Malini , Lee Catherine , Thompson Nailah , Lo Joan
Published: December 2021

Osteoporosis screening by bone density (BMD) testing is recommended for women aged 65-75 years. However, patients with diabetes, a risk factor for fracture, often have higher body mass index (BMI) which contributes to higher BMD. These factors may vary by race/ethnicity. The relationship of diabetes (≥2 diagnoses and treatment), obesity (BMI ≥30), and BMD-defined osteoporosis (femoral neck BMD T-score ≤ -2.5) was examined in a diverse primary care population of 44,313 non-Hispanic White, 6,103 Black, 7,777 Hispanic, and 12,634 Asian women aged 65-75 years who underwent BMD screening. Those with recent fracture, osteoporosis treatment, bone disorders, and metastatic cancer were excluded. Modified log-Poisson regression was used to examine the association of diabetes and BMD-osteoporosis. Among 70,827 women, 18% had diabetes. The prevalence of diabetes was 2-fold higher in Black, Hispanic and Asian women compared to White women. Overall, women with diabetes (versus no diabetes) were more likely to be obese and, except for Hispanic women, less likely to have BMD-osteoporosis. In unadjusted analyses, diabetes was associated with lower risk of BMD-defined osteoporosis in White, Black, and Asian women, but not Hispanic women. However, the association was attenuated or no longer evident after adjusting for BMI, suggesting that the lower burden of BMD-osteoporosis in women with diabetes is mediated in part by higher BMI. These findings support consideration of diabetes when assessing fracture risk in women undergoing osteoporosis screening. However, more studies in non-White populations with a high burden of diabetes are important since these relationships appear to differ by race/ethnicity.
Impact of APOE Genotype on Diet-induced Mitochondrial Adaptations in Mouse Skeletal Muscle
Authors: James Niaya , Shonde Oyinkansola , Jones Nahdia , Mulgrave Verona E , Rebeck G William , Allard Joanne
Published: December 2021

Apolipoprotein E (APOE), a component of lipoproteins that facilitates cholesterol transportation, has three variants in the human genome: APOE2, E3, and E4. Prior research found that carriers of APOE4 are more susceptible to developing Alzheimer's disease (AD) and other brain disorders than those who possess other APOE alleles, and that these carriers are also predisposed to mitochondrial impairment– an early characteristic of neuronal dysfunction. Peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1ɑ) is a major biomarker for mitochondrial biogenesis and function and cytochrome c oxidase subunit IV (COX4) is the terminal enzyme of the mitochondrial respiratory chain. Decreased measures of these proteins indicate reduced mitochondrial function. Aside from genetic inheritance, lifestyle factors such as diet and exercise significantly impact one’s risk for mitochondrial dysfunction and AD. In these studies, we examined the impact of APOE variance on physiological adaptations induced by either exercise or a high-fat diet, with a focus on biomarkers of mitochondrial function. Western blots were used to measure COX4 and PGC-1ɑ levels in skeletal muscle tissue from female APOE3 and APOE4 knock-in transgenic mice. Based on performance on a motorized rotating rod and voluntary wheel-running, we deduced that female APOE4 mice exhibit reduced motor coordination and activity relative to APOE3 mice. APOE4 mice also had reduced COX4 levels that were increased by the high-fat diet. In contrast, COX4 levels in APOE3 mice were reduced in the high-fat diet group. Our data show that diet and APOE genotype interact to produce adaptations in mitochondrial proteins in skeletal muscle.
Impact of Neighborhood Socioeconomic Disadvantage on Staffing Hours in US Nursing Homes
Authors: Falvey Jason , Hade Erinn , Friedman Steven , Deng Rebecca , Travers Jasmine
Published: December 2021

Severe socioeconomic disadvantage in neighborhoods where nursing homes (NH) are located may be an important contributor to disparities in resident quality of care. Disadvantaged neighborhoods may have undesirable attributes (e.g., poor public transit) that make it challenging to recruit and retain qualified staff. Lower NH staffing could subsequently leave residents vulnerable to adverse events. Thus, the purpose of this study was to evaluate whether NHs located in socioeconomically disadvantaged neighborhoods had lower healthcare provider staffing levels. We linked publicly available NH data geocoded at the Census block-group level with the Area Deprivation Index, a measure of neighborhood socioeconomic factors including poverty, employment, and housing quality (percentiles: 1-100). Consistent with prior literature on threshold effects of neighborhood poverty on outcomes, we characterized NHs as being located in a disadvantaged neighborhood if the census-block group ADI score was ≥85/100. We used generalized estimating equations clustered at the county level with fixed effects for state and rural location to evaluate relationships between ADI score and staffing. NHs located in socioeconomically disadvantaged neighborhoods had 12.1% lower levels of staffing for registered nurses (mean: 5.8 fewer hours/100 resident-days, 95% CI: 4.4-7.1 hours), 1.2% lower for certified nursing assistants (2.9 fewer hours/100 resident days; 95% CI 0.6-5.1 hours), 20% lower for physical therapists (1.4 fewer hours/100 resident-days; 95% CI 1.1-1.8 hours), and 19% lower for occupational therapists (1.3 fewer hours/100 resident-days; 95% CI 1.0-1.6 hours). These findings highlight disparities that could be targeted with policy interventions focused on recruiting and retaining staff in socioeconomically disadvantaged neighborhoods.
Low Cognitive Performance Increases The Risk Of Hospital-Associated Complications In Older Adults
Authors: Souza-Talarico Juliana , Yamaguti Siomara , Dutra Adriana , Apolinario Daniel
Published: December 2021

Considering the limited evidence regarding the factors that contribute to long-term consequences after hospitalization of older people, we analysed the relationship between cognitive performance and hospital-associated complications (HAC). One thousand, three hundred Individuals aged 60 and older (mean age 82.3, 53.3% female), not assigned to palliative care and admitted in medical and surgical wards from a private hospital, were followed up from admission to 30 days after discharge. HAS was evaluated using a multicomponent measure that combines 12 hospital-associated complications (delirium, functional decline, falls, pressure injuries, bronchoaspiration, non-planned ICU transfer, physical restraints, hospital stay > 30 days, death, long-term care transfer, and readmission). Cognitive performance was assessed using the "10-point cognitive screener (10-CS)", which combines temporal orientation, category fluency, and word recall evaluation. Results: Overall, 464 (35.7%) participants had one or more HAC during their admission. Patients with HAC showed lower 10-CS scores than those with in HAC (p <0.001). Adjusting for sociodemographic data, medication, chronic diseases, delirium screening, functional performance, each 10-CS point decreased the HAC changes by 19.2% (odds ratio = 0.808; 95% CI = 0.660 – 0.990). Conclusion: These findings show that low cognitive performance was significantly associated with the risk of developing HAC during hospitalization and within 30 days after discharge. That evidence forms the critical foundation for the next steps towards validating the accuracy of these models in predicting vulnerability to HAC and developing screening tools to be used at the point of care.
Maintenance of Physical Function in Adult and Older Adult Mice Using Aerobic Exercise
Authors: Graber Ted , Pajski Megan , Byrd Christopher , Nadigama Nainika , Fennel Alyssa , Seguin Emily , Seguin Anna
Published: December 2021

As we age, physical and neuromuscular function declines gradually. Exercise is a therapy to improve neuromuscular ability. Pre-clinical models are needed to understand molecular mechanisms contributing to age-associated functional decline and how exercise affects that downward trajectory. Our goal was to compare the differences in effects of two validated mouse models of endurance exercise designed to mimic human training studies: high intensity interval training (HIIT) and voluntary wheel running (VWR). We hypothesized that both adult and older adults (10 and 26 months old at end, respectively: 10m and 26m) would respond to both exercise regimens by improving or maintaining exercise/physical capacity, but that adult mice would benefit more. We randomly assigned male C57BL/6 mice into experimental groups: 10m: (VWR, HIIT, sedentary control, CON, n=8 per group), and 26m (VWR, n=8, HIIT, n=10). We measured functional ability (pre- and post-intervention) using CFAB (comprehensive functional assessment battery), our composite scoring system (grip strength, inverted cling, treadmill endurance, activity rate, rotarod), tracked body composition (EchoMRI), and measured muscle wet mass. We found that significant retention of ability (CFAB difference, repeated measures ANOVA, p<0.05) and fat percentage (ANOVA., %change: 10m: CON +125%, HIIT +101%, VWR +52%; 26m: VWR -42%, HIIT +26%, p<0.05) was promoted by both exercise modalities compared to control, and furthermore HIIT may have better efficacy in the adult versus the older mice. In conclusion, both exercises are valid models with derived benefits as expected in similar human studies. We anticipate future work using these models to undertake mechanistic investigations.
Normalized grip strength is inversely associated with DNAm age in middle age and older adults.
Authors: peterson Mark , Collins Stacey , Meier Helen , Faul Jessica
Published: December 2021

There is a large body of evidence linking muscular weakness, as determined by low grip strength, to a host of negative aging-related health outcomes. Given these links, grip strength has been labeled a “biomarker of aging”; and yet, this metric provides no biological plausibility. The objective of this study was to determine the association between grip strength and DNA methylation (DNAm) age acceleration. Middle age and older adults from the 2006-2008 waves of the Health and Retirement Study with 8-years of follow-up were included. Cross sectional and longitudinal modeling were performed to examine the association between grip strength (normalized to body mass: NGS) and DNAm age acceleration, adjusting for cell composition, sociodemographic variables, and smoking. Three DNAm clocks were incorporated for estimating age acceleration including the established DunedinPoAm, Levine, and GrimAge clocks. There was a robust and independent cross sectional association between NGS and DNAm age for men (β:-0.36; p<0.001) and women (β:-0.36; p<0.001) using the DunedinPoAm clock, and for men only using the Levine (β:-8.04; p=0.01) and GrimAge (β:-4.76; p=0.01) clocks. There was also an independent longitudinal association between baseline NGS and DNAm age for men (β:-0.27; p<0.001) and women (β:-0.36; p<0.001) using the DunedinPoAm clock, and for women only using the Levine (β:-8.20; p<0.001) and GrimAge (β:-6.04; p<0.001) clocks. Our findings provide some evidence of age acceleration among men and women with lower NGS. Future research is needed to understand the extent to which DNAm age mediates the association between grip strength and chronic disease, disability, and mortality.
Perceived Partner Responsiveness and Depression: The Moderating Role of Age and Gender
Authors: Urganci Betul
Published: December 2021

A growing body of research suggests that greater perceived partner responsiveness- the extent to which individuals feel cared for, understood, and validated by their romantic partner- leads to longer, healthier, and happier life in adulthood, yet little is known about possible moderating factors between responsiveness and well-being. Using a longitudinal design, the current study tested the moderating roles of age and gender in association between perceived partner responsiveness and depression symptoms. The data for the present study came from the National Survey of Midlife in the United States (MIDUS I and II) which is a longitudinal study on health and aging. A life span sample of 2856 married or cohabiting individuals (1402 Female, Mage= 47.16) completed measures of perceived partner responsiveness, depression, age, and gender in two waves (T1 and T2). The results showed that greater perceived partner responsiveness at T1 predicted lower depressive symptoms at T2 controlling for depressive symptoms at T1. This finding remained when controlling for potential confounders including demographics and health covariates. The moderation analysis demonstrated that participants’ age was not a significant moderator in the association between perceived partner responsiveness and depression. Yet, gender significantly was a significant moderator such that the association of perceived partner responsiveness and depression was significant for female but not for male participants. These findings can have implications for mental health and relational well-being.
Pilot Testing of the UB-CAM Delirium Screening App
Authors: Kuzmik Ashley , Hannan John Joseph , Ngo Long , Boltz Marie , Shrestha Priyanka , Inouye Sharon , Fick Donna , Marcantonio Edward
Published: December 2021

Systematic screening improves delirium detection among hospitalized older adults. This poster describes the development and pilot testing of an iOS-based app that incorporates the Ultra-Brief Confusion Assessment Method (UB-CAM), a two-step, delirium detection protocol that combines the UB-2 (2-item screener) and 3D-CAM. Previous work tested a RedCAP-based UB-CAM app in 527 patients with 399 physicians, nurses, and certified nursing assistants (CNAs) showing it can be successfully completed by all three disciplines in 97% of eligible patients in 80 seconds on average with over 85% accuracy relative to a gold standard. To improve accessibility to the clinical setting, our research team now collaborated with a computer scientist to develop and refine an iOS-based UB-CAM app for the iPhone and iPad through iterative “laboratory” testing. The app was piloted by non-clinician, research testers in hospitalized older adults (age x̄ =83, SD= 8.0) with dementia (Clinical Dementia Rating Scale x̄ =1.1, SD= .30); 64% were assessed to be delirium positive. The app demonstrated preliminary efficiency (90 seconds on average), high acceptability (100% satisfaction of users), and reliability (100% inter-rater). This project underscores the need for close collaboration between researchers, clinicians, and computer scientists with iterative testing of bedside-facing apps prior to testing with patients. Next steps include testing effectiveness in a pragmatic trial with clinician users (physicians, nurses, CNAs), integrating the UB-CAM app into the routine hospital care of all older patients. Having rapid, accurate bedside delirium detection has the potential to transform care.
Please Do Something: What Caregivers for Family Members with FTD Need
Authors: Smith Samantha , Tran Leslie , Lindauer Allison
Published: December 2021

Frontotemporal dementia (FTD) often presents with pronounced behavioral symptoms that contribute to family Care Partner (CP) burden and psychological strain. FTD-specific interventions that support the unique challenges of FTD-CPs are lacking. The present focus group study (Phase 1), elicited feedback from twelve CPs of persons with FTD on the multi-component video-based STELLA intervention (Support via TEchnology: Living and Learning with Advancing ADRDs), to inform the revision and adaptation of STELLA for FTD-CPs (Phase 2). Using Thomas’s (2006) analytic approach to evaluation data, the investigators reviewed the raw text from two focus groups and used an inductive approach to create categories that informed future STELLA adaptation and revision. To address trustworthiness, each investigator independently analyzed the transcripts and CP-annotated STELLA booklets. Six commonalities emerged. Three address the caregiver experience: Burden and living with complex behaviors; Difficulties in getting a diagnosis; and Barriers to participation. The other three reflect specific intervention adaptations: Make a Roadmap, STELLA-FTD Structure, and Booklet edits. The focus group findings offer practical suggestions to create a revised STELLA intervention to address the needs of families living with FTD. The suggestions are nested in the intense caregiving experience of living with complex behavioral symptoms, feeling burdened, isolated, and “living in darkness.” Both the investigators and caregivers appreciate the difficulty in crafting an intervention that meets the needs of all families living with FTD, but the caregivers encouraged the team to develop “something”: “…You won't be able to solve every problem or meet every need… [but] please, please do something.”
Prefrontal Activation is Associated With Gait Quality During an Attentional Task in Older Adults
Authors: Baillargeon Emma , Suri Anisha , Chen Nemin , Zhu Xiaonan , Rosano Caterina , Sejdic Ervin , Huppert Theodore , Rosso Andrea
Published: December 2021

Prefrontal cortical activation varies by walking task and is a marker of attentional demand. We compared prefrontal activation by functional near-infrared spectroscopy (fNIRS) to accelerometry-derived gait quality. We hypothesized greater activation with lower gait quality (greater step-time coefficient-of-variation, decreased cadence, smoothness, regularity, and signal variability). Participants (n=114; age 74.4±6.0 years, 59.6% female) were independently ambulating individuals >64 years. Attentional (reciting every-other alphabet letter) and physical (uneven surface) challenges mimicked community mobility and provided four 15m walking conditions: even, uneven, ABC-even, and ABC-uneven. fNIRS data were referenced to quiet standing and averaged within left and right hemispheres. Gait metrics from a tri-axial accelerometer at the lower-back included cadence (steps/min), step-time coefficient-of-variation, signal variability (standard deviation), smoothness (harmonic ratio), and regularity (entropy). Associations between fNIRS and gait were quantified using Pearson correlations (α=0.05). Results were consistent across hemispheres, gait axes, and robust to adjustment for age and gait speed; we report unadjusted coefficients for left hemisphere and anterior-posterior gait direction. Greater prefrontal activation was associated with slower cadence (r=-0.220, p=0.019), lower signal variability (r=-0.228, p=0.015), and reduced smoothness (r=-0.194, p=0.039) during ABC-even. No relation was observed for step-time coefficient-of-variation or regularity. Results were similar for the ABC-uneven condition, except there was no association with gait smoothness but was with step-time coefficient-of-variation (r=0.25, p=0.007). Prefrontal activation was not correlated to gait quality in non-ABC conditions. Our findings support our hypothesis only during the ABC challenge, suggesting that older adults may rely on prefrontal activation to complete attentional but not physical challenges during gait.
Translating and Adapting the Modified Mini Mental State (3MS) Test for Multiple Cultural Populations
Authors: Rose Tara , Teng Evelyn , Erickson Katherine , Chen Chia Ying , Manzo Elyse , Chui Helena
Published: December 2021

Within healthcare settings, screening of cognitive abilities in older adults is routinely conducted for the detection, early intervention, and management of cognitive impairments. The Modified Mini Mental State (3MS) test takes approximately 10 minutes to administer and has a score range of 0 - 100. It can provide an estimated MMSE score, and has been used in multiple countries since 1987 with approximately 1,900 publications. The United States has many diverse populations with different languages and cultural backgrounds. How to appropriately translate and adapt the original 3MS test in English for each minority group in order to better serve them is an important issue. Cross-cultural assessment involves much more than accurate translation of test items across languages. One needs to know not only the oral and written languages involved, but also the life experiences and circumstances of the target populations. This presentation first covers some general considerations in test translation and adaptation, including attention to cultural, ecological, and language specifics. We shall then present Chinese, Korean, and Hindi 3MS record forms to illustrate the reasons and ways for modification of some of the test items. To accommodate different writing systems, for example, 3MS test versions with an alphabet are different from ones with logographic character representations. Modifications of the 3MS items include those on temporal orientation, spatial orientation, naming, and repetition. In summary, cultural, ecological, and linguistic differences must be taken into account for cognitive screening in order to enhance cross-population comparability and be more inclusive for aging ethnic minorities.