bluuebunny/crossref_metadata_2025 huggingface dataset:
HEALTH EXP ERIENCES OF SEXUAL AND GENDER MINORITY PEOPLE LIVING WITH DEMENTIA AND THEIR CAREGIVERS: A SCOPING REVIEW
Authors: Harris Melissa , May Jennifer
Published: December 2022

People living with dementia and older adults who identify as sexual and gender minority (SGM - lesbian, gay, bisexual, transgender, queer individuals) both represent minoritized groups of older adults, but little is known about the health experiences of older adults who are at the intersection of having dementia and also identify as SGM. This review explored the extent and nature of research focused on health and healthcare experiences of SGM people with dementia and/or their informal caregivers. A scoping review framework was used given the exploratory nature of the project’s purpose. Health librarians comprehensively searched four databases (MEDLINE, CINAHL, PsycINFO, AgeLine) to identify relevant studies. A total of 8,137 unique titles and abstracts were reviewed by 2 independent reviewers. Forty citations were determined relevant and reviewed by full text. Eight studies met inclusion criteria and were analyzed thematically. Study methods were quantitative cross-sectional (n=2), qualitative exploratory (n=4), and a mixed methods case study (n=1). Studies were published from 2010–2022. Sample sizes ranged from 1 to 415 (M=113, SD=116). Four studies focused on caregivers, 2 on persons with dementia, and 1 on dyads. Themes emerged pertaining to caregiver health and well-being, identity, relationships, disclosure, discrimination, and safety. Findings highlight the significance of inclusive care that addresses intersecting psychosocial and health-related identities (e.g., cognitive status, SGM status, race/ethnicity, substance abuse history, multimorbidity) and that protects the rights of families of choice. More research is needed to better understand how sociopolitical structure influences dynamics between cognitive health and SGM status among older adults.
GERIATRICIAN PERSPECTIVES ON THE MANAGEMENT OF MILD COGNITIVE IMPAIRMENT/MILD ALZHEIMER’S DISEASE
Authors: Gopalakrishna Ganesh , Pruzin Jeremy , Alford Susan , Hamersky Carol , Sabharwal Anup , Brunton Stephen
Published: December 2022

Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia are characterized by cognitive impairment and in AD a progressive functional impairment. This study sought to understand the role of geriatricians in treating patients with MCI/mild AD dementia. An anonymous, online survey was conducted in the US with 301 healthcare professionals (HCPs), including 75 primary care providers who practice as board certified geriatricians, and treat ≥10 patients per month with MCI/mild AD dementia. Geriatricians reported that among their patients with MCI/mild AD dementia, they initially make this diagnosis 70% of the time. Geriatricians reported that the topics commonly discussed with patients at the time of diagnosis are treatment options (85%), care management strategies (81%) and disease progression (80%). When referring patients to other specialties for treatment, geriatricians most often referred to neurologists (41%). Most (83%) geriatricians considered themselves the coordinator of care for patients with MCI/mild AD dementia; however, only 5% of non-geriatrician HCP respondents view geriatricians as such. Geriatricians reported prescribing/recommending treatments for ongoing management of MCI/mild AD dementia, with the most common being mental exercises (76%), acetylcholinesterase inhibitors (75%), social interaction (73%), medications to manage comorbidities (72%), and lifestyle improvements (72%). Most (76%) geriatricians have received advanced formal training in MCI/mild AD dementia care with the majority (84%) expressing that they feel very confident in managing patients with MCI/mild AD dementia. Geriatricians are specialists that are well trained and confident in diagnosing, treating, and managing patients with MCI/mild AD dementia.
EXAMINING THE HEALTH EQUITY OF PEOPLE WITH DEMENTIA DURING THE COVID-19 PANDEMIC: FIRST INSIGHTS FROM A TWITTER STUDY
Authors: Bacsu Juanita-Dawne , O’Connell Megan E , Cammer Allison , Ahmadi Soheila , Berger Corinne , Azizi Mehrnoosh , Gowda-Sookochoff Rory , Grewal Karl
Published: December 2022

The COVID-19 pandemic has deepened issues of health inequity and social injustice against people with dementia. Despite having one of the highest mortality rates, little research focuses on the COVID-19 impact of people with dementia. This presentation aims to: 1) explore the COVID-19 experiences and key factors of health inequity among people with dementia during the pandemic; and 2) identify actions to improve the health equity of people with dementia in the pandemic. We collected 6,243 relevant tweets using the Twint application in Python from September 8, 2020, to December 8, 2021. Tweets were divided among eleven coders and analyzed using thematic analysis. Analysis identified three primary themes: structural inequities (e.g., restricted access to health and support services, ageism, social isolation, vaccination barriers, and inadequate staffing in care facilities); frustration and despair due to loss (e.g., loss of cognitive abilities, loss of time with loved ones, and loss of life); and resiliency and hope for the future (e.g., lifting of restrictions and COVID-19 vaccine). There is an urgent need for policymakers to improve the health equity of people with dementia in the pandemic. Tackling COVID-19 inequities requires revisiting infection control policies to improve access to health and support services, recognizing the essential role of family care partners, and providing resources to help support people with dementia during the pandemic. Moreover, it is essential that COVID-19 policy responses are informed by evidence-informed research and authentic partnerships that embrace the insight and lived experiences of people with dementia.
ENGAGING OLDER ADULTS WITH ALZHEIMER’S DISEASE IN EXERCISE: IMPACT ON CAREGIVERS
Authors: Sims Tai , Talley Kristine , Gaugler Joseph , Peden-McAlpine Cynthia , Kirk Laura , Yu Fang
Published: December 2022

Informal caregivers provide the bulk of care for persons with Alzheimer’s dementia (PWAD) living at home, resulting in increased burden, and deteriorations in wellbeing and health. The stress process model hypothesizes characteristics of PWAD influence caregiver outcomes. Few studies have identified if engaging PWAD in exercise influences caregiver outcomes. This ancillary mixed methods study of a RCT evaluated the impact of a 6-month, moderate-intensity aerobic exercise intervention for community-dwelling PWAD on family caregiver burden, wellbeing and general health. Quantitative data was collected at baseline, 3, 6, 9 and 12 months using Zarit Burden Interview, Caregiver Strain Index, Caregiver Wellbeing Scale, and 36-item Short Form Health Survey. Qualitative data was collected at 6 and 9 months using semi-structured interviews. The convergent mixed methods design included ANCOVA analyses of quantitative and content analysis of qualitative data. Participants were 25 (17 intervention, 8 control) caregivers aged 34–86 years who were primarily white, females that lived with care-recipient. Based on group assignment, quantitative and qualitative results provided mixed insight on influence of intervention on burden and wellbeing, and found no influence on general health. Quantitative findings indicated caregiver characteristics of relationship with care-recipient, gender and education influenced wellbeing, and relationship with care-recipient, co-residence and education influenced general health; and caregiver characteristics did not influence burden. Qualitative findings suggest improved burden and wellbeing were consequences of respite and social support, rather than the exercise intervention. This study provides insight that integrating family caregiver components into community-based exercise programs may benefit PWAD and their family caregivers.
DESCRIBING THE EVOLUTION OF MEDICATION USE OVER TIME IN PEOPLE LIVING WITH DEMENTIA USING NETWORK ANALYSIS
Authors: Emdin Abby , Boblitz Alexa , Maclagan Laura , Bethell Jennifer , Watt Jennifer , Harris Daniel , Maxwell Colleen , Bronskill Susan
Published: December 2022

Prescribing for community-dwelling older adults living with dementia is complex. Multiple medications may be used to manage symptoms associated with dementia and/or co-existing chronic conditions, and can lead to problematic polypharmacy. Our objective was to use network analysis, a data science method, to provide a comprehensive description of co-prescribed medications in persons with dementia and describe whether these patterns change over time. We created a population-based cohort of community-dwelling older adults (aged 67+ years) in Ontario, Canada, newly diagnosed with dementia (between April 2014 and January 2019), from health administrative data, and developed medication networks at one year prior to, at, and for up to five years following dementia diagnosis. Among 136,292 individuals newly diagnosed with dementia, the mean age was 82.2 years and 59% were female. The most common medication subclasses dispensed at diagnosis were primarily cardiovascular medications: statins (45.6%), proton pump inhibitors (27.3%), beta-blockers (27.0%), calcium blockers (25.1%), and ACE inhibitors (24.6%). Similar proportions of medication subclasses were found at five years after diagnosis, except cholinesterase inhibitors (34.0% at five years were dispensed cholinesterase inhibitors compared to 16.9% at diagnosis). The most frequent co-prescribed medication pairs at diagnosis included statins and beta-blockers (16.0%), proton pump inhibitors (16.0%), and ace inhibitors (15.4%), respectively. Co-prescription was similar at five years, but also included higher frequency of co-prescribing with cholinesterase inhibitors (e.g., 19.4% were prescribed cholinesterase inhibitors and statins). Network diagrams demonstrate the complexity of prescribing in this population and highlight concurrent prescribing which may require careful monitoring or deprescribing.
DEMENTIA-FRIENDLY IN THE CONTEXT OF HOSPITALIZATION: A CONCEPT ANALYSIS
Authors: Munsterman Ellen , Cacchione Pamela , Hodgson Nancy , Perez G Adriana
Published: December 2022

Persons living with dementia experience more and longer hospitalizations when compared to those without dementia. In response, initiatives to address the hospital experience for individuals with dementia and their families are becoming more common. The term “dementia-friendly” attached to terms such as “hospital”, “ward”, “initiative”, “program”, etc. is being used to describe this response. Literature has begun to summarize current knowledge of dementia-friendly initiatives and define characteristics of dementia friendly hospitals, however, a formal definition of the concept of “dementia-friendly” is lacking. A concept analysis was completed using the 8-step Walker and Avant method including: selecting the concept and aim, identifying use of the concept in the literature, determining defining attributes, antecedents, consequences, and empirical referents, and developing cases that further distinguish the concept. The goal of this analysis was to clarify the definition of dementia-friendly in the context of hospitalization. Attributes of dementia-friendly in the hospital include dementia-specific staff education, use of person-centered care practices, environmental modification, and nursing-specific factors such as attitude, time to spend with patients and adapting responses based on patient need. Antecedents include recognition of the impact of hospitalization on older people with dementia. Consequences include enhanced staff knowledge and patient outcomes including decreased length of stay and decreased use of antipsychotic medication. Based on the above analysis, a conceptual definition for dementia-friendly in the context of hospitalization is proposed. This definition highlights the identified antecedents and attributes with a focus on the essential role of nursing in delivering dementia-friendly care.
ASSISTED LIVING ADMINISTRATORS’ JOB SATISFACTION, WORK STRESSORS, AND INTENT TO LEAVE DURING THE COVID-19 PANDEMIC
Authors: McSweeney-Feld Mary , Barry Teta , Yang Bo , Nelson H Wayne
Published: December 2022

This study examines how job satisfaction in six sub-scales and selected stressors and demographic covariates influenced assisted living administrators’ (ALF) intentions to quit during the COVID-19 pandemic. Quantitative and qualitative data were collected from 103 ALF administrators as part of a national study of long-term care administrators’ intent to quit during the COVID-19 pandemic funded by the Foundation of the National Association of Long-Term Care Administrator Boards in Washington, DC. Descriptive statistics were collected for the sample, and correlations between variables were examined, as well as responses from 3 open-ended questions that were coded for analysis. Although generally satisfied, roughly 41 percent of ALF administrators reported that they were intending to quit. Qualitative data suggested that job satisfaction was influenced by a more nuanced interpretation of job characteristics and work environment intrinsic factors such as adequacy of staffing and resources, changing regulations during the COVID-19 pandemic, and external supports such as family and friends. Given the limited research on the impact of the COVID-19 pandemic on assisted living communities and their administrators, the results of this study can help to inform policies and strategies for providing support for this segment of long-term services and its workforce during widespread disasters.
COMPARTMENTAL FEMUR CORTICAL THICKNESS IN OLDER ADULTS DIFFERS BY DEMOGRAPHICS AND PHYSICAL FUNCTION
Authors: Lam Justin , Lynch Delanie , Fuentes Diana Madrid , Devane Karan , Howard Marjorie , Beavers Kristen , Weaver Ashley
Published: December 2022

Previous studies have examined the relationship between cortical bone properties and fracture risk in older populations, but they have yet to examine how these properties change within the femur. Most hip fractures are classified by their location: femoral neck, intertrochanteric, or subtrochanteric fractures. Since cortical thickness can vary throughout the femur, a quantitative method of examining thickness by region was developed using a cortical mapping approach applied to computed tomography (CT) scans. Subject-specific finite element (FE) models of proximal femurs were created from baseline CT scans of 107 older adults (ages 60 – 85; 70% White; 72% Female) with obesity as classified by BMI (33.8 ± 4 kg/m2). An existing FE model was morphed to the segmented geometry of each subject’s proximal femur. A nearest neighbor search assigned cortical thickness values to the nearest finite element model node. Cortical thickness was grouped into four femoral compartments: femoral head, femoral neck, intertrochanteric and subtrochanteric regions. Pairwise paired t-tests indicated that cortical thickness differed between femoral compartments (p < 0.05). Multivariate regression models showed greater cortical thicknesses in femoral head, neck, and intertrochanteric regions in African Americans compared to Whites (p < 0.05). Additionally, these models suggest an association between cortical thickness and physical function assessments, such as the timed up-and-go test and leg muscle strength test. Since cortical thickness is not constant throughout the femur, future studies can use the framework developed here to assess each compartment individually and investigate the relationships between cortical thickness, demographics, and functional assessments.
PANCREATIC CANCER PROLIFERATION IS INDUCED BY GLI2-COL1 SIGNALING IN FIBROBLASTS IN THE TUMOR MICROENVIRONMENT
Authors: Ross Madeline , Vera Renzo , Fernandez-Barrena Maite , Toruner Murat , Tolosa Ezequiel , Almada Luciana , Brekken Rolf , Fernandez-Zapico Martin
Published: December 2022

Pancreatic ductal adenocarcinoma (PDAC) affects many older adults in the United States. This aggressive type of pancreatic cancer is resistant to many chemotherapies, resulting in a poor prognosis and a five-year survival rate of less than ten percent. To study PDAC progression and develop novel therapies, it is important to better understand the tumor microenvironment (TME) and the contributing cell populations and molecular mechanisms. Despite the well-described role of soluble Type I collagen in the regulation of pancreatic cancer TME, the molecular events modulating its expression/activity remain elusive. Here, we describe a novel mechanism controlling the levels of soluble collagen in cancer associated fibroblasts (CAFs), a major producer of Type I collagen in pancreatic cancer TME. Specifically, we provide evidence that the transcription factor GLI2 is required for the expression of COL1A1, a key component of the Type I collagen fiber, stimulated by the transforming growth factor β (TGFβ). Our methodology included expression studies from patient samples, ChIP-qPCR, qPCR, RNA-seq analysis, gene set enrichment analysis, biological assays, and gene ontology analysis. Our results confirm that the TGFβ-GLI2 axis in CAFs is able to activate EGR1-proliferative signaling downstream of collagen signaling in pancreatic cancer cells contributing to our understanding of the molecular underpinnings of pancreatic cancer TME. Further studies that define the complete role of EGR1 in PDAC may lead to the development of novel therapies targeting EGR1 or CAFs to promote enhanced quality of life following a PDAC diagnosis.
OLDER CANCER SURVIVORS’ POST-TRAUMATIC GROWTH DURING THE COVID-19 PANDEMIC
Authors: Ligus Kaleigh , Fritzson Emily , Salafia Caroline , Park Crystal , Bellizzi Keith
Published: December 2022

Older adults and immune-compromised individuals (e.g., cancer survivors) were quickly identified as high-risk groups during the COVID-19 pandemic. Research has examined adverse psychological consequences due to the pandemic in older adults with chronic conditions. However, no research has examined the potential for positive consequences of COVID-19 in older adults with cancer. The current study examined the association between COVID-19 risk, stress, exposure, and perceived post-traumatic growth (PPTG) in adults with cancer. Cancer survivors (n = 231) enrolled in an ongoing longitudinal study completed a one-time COVID-19 experience assessment, including PPTG as a result of the COVID pandemic. Participants (mean age = 68 years) had completed primary treatment for breast, prostate, or colorectal cancer within the past two years. On average, survivors reported modest PPTG related to COVID-19 (mean = 6.03, range = 0–20). Using linear regression, we found that gender, cancer type, and marital status were related to PPTG. Higher COVID-19 risk, more COVID-19 stressors, and higher illness exposure (e.g., having had COVID-19) were significantly positively associated with PPTG scores (ps < .05). In spite of the potential adverse psychological consequences of the COVID-19 pandemic, these results suggest adults with cancer, in our sample, report modest PPTG. Higher COVID-19-related perceived risk, stress, and exposure predicted higher PPTG scores. These findings are interesting in light of studies that suggest PPTG occurs only after time passes from the stressor. Future research could examine how coping with cancer may influence coping with a co-existing or subsequent stressor and its relationship to PPTG.
LESSONS FROM THE IMPLEMENTATION OF THE TRANSITIONAL CARE MODEL DURING THE COVID-19 PANDEMIC
Authors: McHugh Molly , Hirschman Karen , Morgan Brianna , Ahrens Monica , Hanlon Alexandra , Osokpo Onome , Naylor Mary
Published: December 2022

Multiple randomized controlled trials (RCTs) evaluating the Transitional Care Model (TCM)- an advanced practice registered nurse-led (APRN), team-based, care management strategy- have shown improved outcomes for older adults transitioning from hospital to home. In the current RCT, enrollment of older adults hospitalized with heart failure, chronic obstructive pulmonary disease, or pneumonia began in February 2020, just as the COVID-19 pandemic developed across the U.S. The COVID-19 pandemic dramatically impacted healthcare delivery across diverse local contexts. This parallel convergent mixed methods study aimed to explore the implementation of the TCM intervention as intended during Year 2 of the RCT (February 2021 to January 2022). This mixed-methods analysis presents the challenges and strategies to a key TCM component, “hospital-to-home,” which focuses on delivering in-person visits to patients, as identified through a qualitative descriptive analysis of 63 clinical team and leadership meetings combined with implementation fidelity data collected simultaneously on 188 TCM participants. In Year 2 of the trial, COVID-19-specific challenges continued, including COVID-19 exposure, policy changes, patients declining services, and limited safety equipment. Some challenges to the hospital-to-home TCM component occurred regardless of COVID-19, including patient (e.g., lack of engagement), nurse provider (e.g., TCM learning curve), and system (e.g., reduced primary care access) barriers. Collectively, these challenges resulted in lower fidelity to APRNs visit patterns during TCM delivery. Strategies to address these challenges were identified. The findings provide critical insight into how to target quality improvement strategies to improve the delivery of services, such as the TCM, from hospital to home settings.
INVESTIGATING THE ROLE OF STRESS PATHWAY ACTIVATION IN MEIOTIC DIFFERENTIATION AND REJUVENATION IN BUDDING YEAST
Authors: Biritwum Akosua , Bishop Alena
Published: December 2022

Sexually reproducing organisms undergo meiosis to produce gametes for the next generation. In budding yeast, meiosis resets replicative lifespan as gametes produced by aged progenitors are born young and devoid of any senescence-associated factors. In addition, certain transcription factors that are involved in stress response are expressed when yeast cells undergo meiosis. The overarching goal of this project is to determine the role of stress transcription factors in meiotic rejuvenation. As part of this goal, I set out to develop an assay to measure the fitness of yeast gametes that were depleted of a given stress response transcription factor. I focused on Yap1 and Skn7, two transcription factors involved in oxidative stress, and characterized gamete fitness by measuring survival in response to environmental stressors, including acid and alkaline. I found that gametes depleted for Yap1 have mild sensitivity to acid and dramatic sensitivity to alkaline. These findings implicate a role of Yap1 in gamete fitness in a physiologically relevant context since acidic and alkaline environments exist in the digestive tract of fruit flies, which are natural predators of yeast. Further investigation of how stress response transcription factors affect meiotic rejuvenation can help us develop strategies to counteract cellular aging in different contexts.
MEASURING BARRIERS TO LONG-TERM CARE RESIDENT PREFERENCES: DEVELOPMENT AND CONTENT VALIDITY TESTING
Authors: Block Laura , Greenhalgh Ella , Roberts Tonya
Published: December 2022

Person-centered care (PCC), or delivery of care consistent with preferences, can improve outcomes for residents in long-term care (LTC). However, PCC has not been universally adopted. Few studies focus on measuring specific barriers to meeting resident preferences, hindering identification of actionable targets to improve PCC delivery. The purpose of this study was to develop and test the content validity of a survey that measures staff barriers to fulfilling resident preferences for daily care and activities. Item sets comprised of barriers and preferences were informed by a review of literature and a descriptive, qualitative study with 19 LTC staff. An expert panel (n=8) was convened to test content validity, and content validity indices (CVI) were calculated. The initial survey consisted of 12 item sets assessing whether knowledge gaps, resident characteristics (e.g. health needs), family, facility rules/policies, availability of options, or staffing/workload functioned as barriers to meeting resident preferences for daily care and activities (CVI = 0.76 barriers; CVI = 0.89 preferences). Revisions informed by expert feedback resulted in a total of 17 items sets. Second round testing with experts (n=10) revealed overall improved item sets (CVI = 0.77 barriers; CVI = 0.96 preferences). These findings indicate that the survey items have initial content validity in measuring staff barriers to meeting resident daily care and activity preferences. Further psychometric testing with LTC staff is needed prior to implementing the survey, which will represent the first tool of its kind for supporting measurement of staff-derived targets for PCC interventions and policy change.
AFFORDABILITY, PERCEIVED RACISM, AND HEALTHCARE SYSTEM DISTRUST AMONG AFRICAN AMERICAN WOMEN AGED 45 AND OVER
Authors: Wiltshire Jacqueline , Sampson Carla , Elder Keith , Musey Paul
Published: December 2022

Unaffordable healthcare costs—a major concern for Americans--disproportionately affect African Americans (AA), who are more likely to distrust the healthcare system due to past mistreatment and discrimination. However, the relationships between affordability, mistreatment, discrimination, and healthcare system distrust are unclear. Using cross-sectional survey data from a community-based sample of 313 African American women aged 45 and over, we assessed the relationships between the ability to get needed care due to costs, negative healthcare experiences, perceived racism, and healthcare system distrust. Linear regression and mediation analyses were conducted to assess relationships. Approximately 23% of women reported the inability to get needed care because of costs, and 44% had a negative experience with a healthcare provider. Healthcare system distrust was higher among women unable to get healthcare because of costs (β = 2.66; p = 0.005) or had a negative experience with a healthcare provider (β = 3.02; p < 0.001). However, perceived racism in the healthcare system, a significant predictor of distrust (β = 0.81; p < 0.001), attenuated the relationships between inability to get health care because of costs (β = 1.74; p = 0.051) and negative experience with a healthcare provider (β = 1.79; p = 0.013). Perceived racism explains 34% and 46%, respectively, of the relationships between affordability, negative experience with healthcare provider, and healthcare system distrust. These findings are important given the relevance of building trust and understanding needs to address health inequities. Future research should explore whether these findings hold for AA men and other minoritized groups.
NEITHER HERE NOR THERE, YOU BECOME A STRANGER FOR BOTH SIDES: SUCCESSFUL AGING IN CHINESE AMERICAN OLDER ADULTS
Authors: Khan Mushira , Li Chien-Ching , Kang Ezer
Published: December 2022

Previous studies have critiqued the inordinate emphasis on high physical and cognitive functioning and a relative absence of cultural factors in our understanding of the aging process. The multi-year Perceptions of Aging Well in Diverse Populations study explores (1) the meanings attached to aging well across cultures and (2) similarities and differences in these perceptions within diverse racial and/or ethnic groups. This presentation highlights findings from in-depth, semi-structured qualitative interviews with Chinese Americans 50 years and older (n=25; 10 male, 15 female; mean age 58.3 years). Thematic analysis of the data showed that generation status, age at arrival, density of social networks, and level of acculturation were key determinants of successful aging. Specifically, those who were born in the United States or had immigrated at an early age appeared to value their independence and were actively making retirement plans. Late-life immigrants were often lonely and more dependent on their adult children. Financial security and healthcare access were important considerations for mid-life immigrants. Several participants felt like an ‘outsider’ in the US but also felt like they were regarded as ‘foreigners’ in their country of origin, resulting in feelings of ambivalence and alienation. Many participants, particularly women, reported feeling less safe in their neighborhoods given the increasing prevalence of violence against Asian Americans in recent years and some were even contemplating moving to another country post-retirement. These findings provide insights into how aging is experienced among Chinese Americans and may help inform initiatives to support successful aging in this population sub-group.
ACTIVITY GOAL SETTING ON CHRONIC LOWER BACK PAIN FOR OLDER VETERANS RECEIVING CHIROPRACTIC CARE
Authors: Rogers Casey , Hackney Madeleine , Zubkoff Lisa , Echt Katharina
Published: December 2022

There is currently no literature addressing the impact that chiropractic services have on older adults achieving individualized specific goals throughout a course of care for chronic low back pain. This study aims to explore the impact of setting a self-determined, “what matters most” activity/goal of rehabilitation care with relevant activities as part of standard chiropractic care on the self-rated pain and disability of older Veterans. Participants were randomized into two groups. The first, an experimental group where participants identified a goal and received standard chiropractic care. The second, a control group that received standard chiropractic care only. Participants underwent six sessions of care. Outcome assessment tools were utilized at pre- and post-treatment for both groups as primary measures and an individualized goal setting measurement tool was utilized for those randomized to the experimental group. After treatment, all participants had self-reported improvement in their condition and all participants assigned to a “goal setting group” achieved their desired goal. Despite some outcome measures remaining unchanged, this self-reported improvement may be important in the future of chiropractic services for the older Veteran population suffering with chronic low back pain in achieving self-determined goals of importance.
THE RELATION BETWEEN PROVIDER RESPONSES AND PATIENT AND CARE PARTNER SELF-EFFICACY IN PALLIATIVE CARE APPOINTMENTS
Authors: Silverstein Hannah , McDarby Meghan , Carpenter Brian
Published: December 2022

Person-centered palliative care (PC) fosters patient and care partner participation during medical appointments. The current study used Bandura’s Social Cognitive Theory to examine whether the manner in which healthcare providers respond to patient and care partner questions during initial PC appointments is associated with their self-efficacy in question asking. We analyzed provider responses to direct and embedded questions during initial outpatient PC appointments at a large academic medical center. Provider responses were coded in terms of timeliness (number of dialogue exchanges between a question and a response) and completeness (how fully providers answered questions). Provider responses to direct questions were more timely (M = 1.91, SD = 3.55) compared to responses to embedded questions (M = 4.05, SD = 6.13), t(127) = -3.55, p < 0.001, whereas completeness was similar for both direct (M = 1.43, SD = 0.71) and embedded questions (M = 1.59, SD = 0.96), t(127) = -1.59, p = 0.114. On average, receiving more timely responses was not significantly correlated with self-efficacy, r(49) = -0.038, p = 0.791, nor was receiving more complete responses ρ(49) = -0.178, p = 0.211. These findings suggest that timeliness and completeness of responses may not be factors that affect self-efficacy, thus future research should continue to explore other factors, such as empathy present in provider responses. These findings also suggest that future research should investigate the role and effectiveness of embedded questions as an information-seeking behavior in patients and care partners given that providers took longer to respond to them.
MUSCLE GROUP SPECIFIC SKELETAL MUSCLE AGING: A FIVE YEAR LONGITUDINAL STUDY IN SEPTUAGENARIANS
Authors: Naruse Masatoshi , Fountain William , Claiborne Alex , Finch Holmes , Trappe Scott , Trappe Todd
Published: December 2022

Most of the scientific literature on human skeletal muscle aging has focused on the quadriceps femoris, with the remaining few hundred skeletal muscles receiving limited specific investigation. This longitudinal investigation compared changes in skeletal muscle size via computed tomography of the quadriceps (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius), hamstrings (biceps femoris short and long heads, semitendinosus, semimembranosus), psoas, rectus abdominis, lateral abdominals (obliques and transversus abdominus), and paraspinal muscles (erector spinae and multifidi) of older individuals from the Health ABC study at baseline and 5.0±0.1 years later (n=469, 73±3y & 78±3y, 49% women, 33% black). Skeletal muscle size decreased (p < 0.05) in quadriceps (-3.3%), hamstrings (-5.9%), psoas (-0.4%), and rectus abdominus (-7.0%). The hamstrings and rectus abdominus atrophied approximately twice as much as the quadriceps (p < 0.05), while the quadriceps atrophied substantially more than the psoas (p < 0.05). The paraspinals (+4.3%) and lateral abdominals (+5.9%) hypertrophied (p < 0.05) to a similar degree (p>0.05) over the 5 years. These data suggest that skeletal muscle mass in older individuals changes in a muscle group specific fashion in the eighth decade, a critical time period in the aging process. A broader understanding of muscle group specific skeletal muscle aging is needed to better guide exercise programs and other interventions that mitigate decrements in physical function with aging.
EVALUATING AGE-FRIENDLY COMMUNITY INITIATIVES FROM A SOCIAL NETWORK PERSPECTIVE
Authors: Greenfield Emily , Pestine-Stevens Althea
Published: December 2022

Age-friendly community initiatives (AFCIs) as community interventions systematically cultivate inter-organizational partnerships toward making policies, systems, and environments more supportive of healthy aging, aging in community, and aging equity. Building from a multi-year, university-community partnership to spur the development of AFCIs in New Jersey, we drew on social network theory and research methods to examine the networks of AFCI core teams and their key partners across diverse community settings. Data collection involved administering questionnaires to both AFC core teams and their key organizational partners. We report on the presence and strengths of dyadic relationships that comprise the networks, analyzed by sector, organizational function, and geographic service area of each network node. We discuss implications of the findings concerning policies and practices around sustainability planning for AFCIs as well as future directions for using network theory to understand AFC progress at various levels of geographic scope.
PARKINSON’S DISEASE AND STIGMA: A MULTIPLE CASE STUDY
Authors: Mastel-Smith Beth , Hermanns Melinda
Published: December 2022

Parkinson’s disease (PD) is a neurodegenerative disorder caused by dopamine deficiency. PD affects emotional and physical health and causes people with PD and caregivers to experience stigma. Four types of stigma have been described: public, associated, self-, and structural. The aims of this study were to explore (a) how stigma is experienced by people with PD and caregivers, (b) whether stigma towards people with PD and caregivers is represented in the literature and social media and (c) examine whether findings support Stigma Theory and theoretical propositions. This was a multi-case qualitative study. Cases included a literature review, interviews with people with PD and caregivers, and examination of social media posts. A purposive sample included seven people with PD and five caregivers who were interviewed online using an interview guide. The study was approved by the University IRB and participants signed consent. Thematic analysis identified codes which aligned with conceptual definitions of Stigma Theory. Findings revealed that public stigma was presented in all four cases. Self- and structural stigma were represented in the literature and interviews with people with PD and caregivers. Associated stigma appeared in the literature and from caregivers’ descriptions. Three of six theoretical propositions were supported. Four types of stigma toward people with PD were prevalent and interrelationships between types of stigma noted. A multi-pronged approach to reducing stigma is needed at the individual, organizational and community levels. Research regarding stigma experienced by diverse populations and the health effects of stigma for people with PD is recommended.
CONTEMPLATING TEMPORAL LANDMARKS, SENSING TIME, AND PURSUING A MEANINGFUL LIFE IN ADULTHOOD
Authors: Kim DaEun , Liao Hsiao-Wen
Published: December 2022

Research has shown that experiencing and anticipating temporal landmarks affect one’s goal priorities and motivation. Particularly, milestone birthdays (MBD) remind people of where they stand in life timeline, prompting time experience that has consequences for pursuit of meaning. The current study examines this thesis in the context of adult development and aging. We tested whether (1) thinking about past and future MBDs (vs. a regular birthday) affects young, middle-aged, and older adults’ possession of and search for meaning in life and (2) sense of time, and (3) the association between contemplating MBDs and meaning in life is, at least in part, explained by sense of time. Participants (N = 239) were randomly assigned to one of the three conditions to verbally visualize a past MBD, a future MBD, or an upcoming regular birthday. They then completed a meaning in life questionnaire, which assessed presence of and search for meaning (Steger et al., 2016). Future time perspective (Lang & Carstensen, 1996) and time savoring (Carstensen et al. in prep) were also measured. We found that thinking about past and future MBDs (vs. regular birthdays) prompted people to search for meaning. Thinking about past MBDs (vs. regular birthdays) also elicited a sense that time left in life is limited. Mediation analysis indicated that perceived future time constraints helped explain the relation of recalling past MBDs to search for meaning. Results held when age effects were considered. We draw on motivation theories of temporal landmarks and socioemotional selectivity to discuss the findings.
CARING FOR CHILDREN WITH DISABILITIES, WORKING, AND SAVING FOR RETIREMENT OVER THE LIFE COURSE
Authors: Porterfield Shirley , Kwon Eunsun
Published: December 2022

In the US, financial security in retirement depends on having savings and other assets accumulated during the pre-retirement years. Pension savings accrue over the working life, in defined-benefit or defined-contribution retirement plans. Mothers with children with disabilities experience different life-course work trajectories than mothers without children with disabilities, though data used in previous studies primarily examine a single point in time or a short span of years. This paper draws longitudinal data from the nationally-representative 1979 National Longitudinal Survey of Youth for the years 1987 through 2018, using a life-course perspective and sequence analysis to identify long-term work patterns among women with children who do and do not have disabilities with an explicit focus on variations in occupational class and employment status. We found a distinctive pattern of long-term work history with five types: Full-time semi-professional to not working, Constantly not working, Semi-professional full time, Professional full time, and Not working to full time work. Results from regression analyses revealed variation in mothers’ household financial preparation for retirement at late mid-adulthood. Compared with mothers who held professional full-time jobs throughout their adulthood, mothers who started full time jobs in middle age and have children with disabilities were less likely to have pension plans. Mothers of children with disabilities who left the labor force in early middle age tended to have lower retirement savings. Policy interventions to address these mothers’ caregiving ability to stay engaged in the workforce and prepare for their retirement need to be explored.
THE RISE OF LONELINESS: TRENDS AMONG A LARGE MEDICARE ADVANTAGE COHORT OVER THE COVID-19 PANDEMIC
Authors: McNamara Kelsey , Rudy Ellen
Published: December 2022

Loneliness is an established risk factor for premature mortality, especially among older adults. National trends are indicating an increase in loneliness after the COVID-19 pandemic. We sought to explore annual trends in loneliness and quality of life among a large dataset of Medicare Advantage (MA) members. Papa Inc. is a national service that pairs older adults with “Papa Pals” who provide companionship and assistance with everyday tasks. Participants have free access if their health plan offers it. Analysis included members from MA plans that were active with Papa January 2020 through March 2022. Members (n=11,037) were assessed at enrollment screening (UCLA Three-Item Loneliness Scale, CDC’s Healthy Days Measure). Analysis used Chi-square tests, significance set at p < 0.05. Among the sample, 81% were aged 65+, 14% were from a majority non-white community. Analysis revealed the following trends in annual prevalence rates (2020; 2021; 2022): lonely (43.2%; 39.3%; 40.9%), severely lonely (9.2%; 12.1%; 15.1%), 14+ physically unhealthy days (24.3%; 19.9%; 39.3%). In regression analysis, loneliness score increased by 0.05 (95CI: 0.02 - 0.07) per quarter over the 27 months. Our data mimics other sources highlighting a slow and steady increase in loneliness suggesting older adults’ hesitancy to engage in “normal activities.” Changes in unhealthy days follow COVID-19 trends with a significant increase during the height of the Omicron variant. The prolonged effects of isolation and loneliness are profound, thus greater emphasis should be placed on population level interventions, especially those connected to the healthcare system, to help address loneliness.
LONELINESS AMONG OLDER IMMIGRANTS LIVING IN SUBSIDIZED SENIOR HOUSING: DOES PERCEIVED SOCIAL COHESION MATTER?
Authors: Baek Jihye , Kim BoRin , Park Sojung , Ryu Byeongju
Published: December 2022

The study compared the level of loneliness among older immigrants living in subsidized senior housing to non-immigrant residents. Also, the role of perceived social cohesion on loneliness was investigated, focusing on the differential influence among older immigrants and non-immigrants. Residents of subsidized senior housing in St. Louis and the Chicago area were recruited, and 182 responses were used in the analysis (126 immigrants and 56 non-immigrants). Descriptive analysis examined the difference in loneliness between immigrants and non-immigrants. Also, multiple regression models estimated the association between 1) immigrant status and loneliness, 2) perceived social cohesion and loneliness, and 3) the moderating role of immigrant status. Linear regression model showed that there was no significant difference between loneliness levels between immigrants and non-immigrants. However, perceived social cohesion was negatively associated with loneliness (β=-.338, SE= .025, p < .001). Additionally, immigration status moderated the relationship between perceived social cohesion and loneliness (β=-1.143, SE= .052, p < .01), which implies that immigrants may benefit more from higher perceived social cohesion in terms of loneliness compared to their non-immigrant counterparts. High perceived social cohesion might be an important community-level protective factor against loneliness in old age, especially for low-income older adults living in subsidized senior housing. Creating socially cohesive environments, particularly for this subgroup, would be crucial for mitigating loneliness and facilitating aging-in-place.
COMPANION CARE ASSOCIATED WITH REDUCTION IN ADMISSIONS AND EMERGENCY DEPARTMENT USE AMONG OLDER ADULTS
Authors: McNamara Kelsey , Rudy Ellen , Armao Anne , Towsley Kerri , Lang Samantha , Perissinotto Carla
Published: December 2022

Older adults with unmet social needs, including social isolation and loneliness, have higher rates of hospital readmission and emergency department (ED) use. Our objective was to determine if Papa Inc., a nationwide service that pairs older adults with “Papa Pals” for companionship and assistance, was associated with reductions in readmissions and ED visits. SummaCare, a Medicare Advantage Organization in Ohio, partnered with Papa to offer free companion care to their members. We explored changes in inpatient admission rates and ED high-utilizers (defined as members with 4+ ED visits in a calendar year) from 2018 through 2021 using a claims-based analysis. Analysis included members who used 30+ minutes of Papa services in 2021 and had historical claims data from 2019 (n=1,420), matched 1:1 to a non-Papa comparison group (n=1,420) using a validated risk scoring model. Overall, average age was 78, 62% were female, 2% were ED high-utilizers in 2021. Increased enrollment in Papa occurred post hospitalization. The case-mix adjusted 30-day readmission rate in 2021 was 12.6% for Papa users (compared to 14.1% for non-Papa; and 14.5% for Papa users before enrollment), revealing a 1.5% to 2% decline in readmission rate after enrollment in Papa. Using case-mix adjusted relativities, Papa members had 0.89 readmissions for every 1.00 readmission for non-Papa users. Compared to the matched cohort, the Papa cohort had 34% fewer ED high-utilizers during the intervention year. Results provide preliminary evidence that a social companionship service may reduce readmissions and frequent ED use, and can inform future trials on companion-based interventions.
FACTORS AFFECTING ANHYDROBIOSIS SURVIVAL IN EUTARDIGRADE PARAMACROBIOTUS EXPERIMENTALIS (MACROBIOTIDAE)
Authors: Nagwani Amit Kumar
Published: December 2022

Background

Tardigrades, considered among animals the most resistant to complete loss of body water (desiccation) occurring during anhydrobiosis, are also interesting because of their place between the two primary invertebrate model organisms (Caenorhabditis elegans and Drosophila melanogaster). The effect of anhydrobiosis intensification on tardigrades’ age-specific survival has rarely been studied. The eutardigrade Paramacrobiotus experimenatlis is an excellent model of the study because their remarkable capacity for anhydrobiosis. This gives also possibility to apply the species in research on anhydrobiosis as an anti-aging strategy. Aim: Main goal of present study was to determine the effect of anhydrobiosis intensification, due to application of different duration and numbers of desiccation episodes, on the age-specific survival of Pam. experimenatlis.

Methods

Tardigrades were cultured under laboratory conditions, divided according to their age and sex, and subjected to several short and long desiccation episodes (3 and 30 days, respectively). The revival from desiccation was evaluated after 2-48h following rehydration.

Results

Individuals` age and anhydrobiosis intensity affected tardigrades` survival. Young adult animals survived the best, and the oldest ones the worst. The number of desiccation episodes affected animal survival stronger than desiccation duration.

Conclusion

The results are important for anhydrobiosis study as an-anti aging strategy. The work was supported by the research grants of the National Science Centre, Poland, NCN: 2016/21/B/NZ4/00131 and 2021/41/N/NZ3/01165.