bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV MADE ME STRONGER: CONCEPTIONS OF SUCCESSFUL AGING AMONG OLDER WOMEN LIVING WITH HIV
Authors: Rubtsova Anna A , Taylor Tonya , Wingood Gina , Ofotokun Igho , Gustafson Deborah , Holstad Marcia
Published: November 2019

Little is known about successful aging (SA) among older (50+) women living with HIV (OWLH). Therefore, the purpose of this qualitative study was to examine subjective understandings of SA among OWLH. Participants were OWLH enrolled in the Women’s Interagency HIV Study (WIHS) and those not enrolled in WIHS: 8 in Atlanta, GA (3 WIHS and 5 non-WIHS) and 9 in Brooklyn, NY (6 WIHS and 3 non-WIHS). Semi-structured interviews ranged from 30 to 120 minutes. Several themes emerged in participants’ definitions of SA, e.g. self-care, taking HIV medications, and being resilient (“HIV made me stronger”). Both WIHS and non-WIHS participants emphasized life course perspective in their definitions of SA -- women viewed their aging successful as a more stable phase of life in contrast to hardships they experienced while being younger (e.g., drug use, incarceration). Data collection efforts are ongoing and will allow further characterization of SA among this population.
SPREAD OF QUALITY IMPROVEMENT PROJECTS IMPLEMENTED IN A GERIATRICS WORKFORCE DEVELOPMENT PROGRAM
Authors: OHanlon Claire E , O’Hanlon Claire E , Saliba Debra , Douglas Joseph , Mitchell Michael N , Callaway-Lane Carol , Kramer Josea
Published: November 2019

This project characterizes spread of quality improvement (QI) projects initiated in the U.S. Department of Veterans Affairs (VA) Geriatric Scholars Program (GSP) workforce development program. This mixed methods study analyzes a recent cross-sectional survey of GSP participants and program-level data on participant characteristics and QI project topics. We surveyed 578 scholars who had completed all program requirements to that point, and still worked for VA; 207 (35%) responded. The majority of respondents who had been in the program for at least six months (70%) reported sustainment of their QI project beyond initial implementation and nearly a third (30.4%) reported any spread beyond their own care team. QI project topics spanned many domains and percent of projects reporting spread varied across domains from 0% to 67%. A workforce development capstone activity in which participants demonstrate substantive and methodological competency can foster bottom-up QI activities in a large, diverse health care system.
AGE INDUCES AN EMERGENCE FROM MELANOMA DORMANCY
Authors: Fane Mitchell
Published: November 2019

Melanoma cell dormancy is regulated by intrinsic cues that maintain a slow-cycling state in cells and by extrinsic interactions with stromal and immune components of the microenvironment. A key factor is that a significant lapse of time occurs between initial diagnosis, and metastatic recurrence of dormant cells. During this time, the organism ages and age is a poor prognostic indicator for cancer. We have found that melanoma cells form lung metastases more efficiently in aged mice and remain dormant in young mice. Analysis of the immune-microenvironment of the lung reveals that healthy young and aged mice have little difference in infiltration of immune subpopulations; however aged tumor bearing mice have significantly increased immunosuppressive MDSCs and Tregs and decreased CD4+ and CD8+ t-cells in the lung compared with young mice. Our data indicates that aging induces an immunosuppressive lung microenvironment which allows immune-evasion and an emergence from melanoma dormancy.
DEVELOPING A COMMUNITY-BASED COMPREHENSIVE FALLS PREVENTION PROGRAM IN COLLABORATION WITH PRIMARY CARE
Authors: Pidgeon Dawna
Published: November 2019

Reducing falls in older adults requires a comprehensive screening program, a systems approach to refer those at risk and an evidence based community falls prevention programs. The Dartmouth Centers for Healthy & Aging has been the recipient of 2 Association of Community Living (ACL) Falls Prevention grants. This has enabled the development of a robust program for falls screening both in primary care and through community based balance screening events called “Balance Days”. At risk individuals receive coaching, based on the principles of motivational interviewing, focusing on enrolling in either “Matter of Balance” or “Tai Chi Quan: Moving for Better Balance”. Through the ACL grant we have built significant capacity across New England for these programs. This talk will focus on the “secret sauce” of implementing a robust community based falls prevention program in partnership with primary care.
R3 PROGRAM MANAGEMENT AND WELLNESS TEAM VIEWS ON BARRIERS AND FACILITATORS TO IMPLEMENTING THE R3 PROGRAM
Authors: Shellito Natalie , Nadash Pamela , Miller Edward , Simpson Elizabeth , Cohen Marc
Published: November 2019

Implementing programs such as R3, which adds health-focused supportive services into senior housing sites, can be complicated. This study aimed to understand program management and wellness team views on barriers and facilitators to implementation. Semi-structured interviews were conducted with managers, social workers, and wellness nurses who implemented the R3 program. Facilitating factors included monthly phone calls between wellness team members and program participants, which strengthened relationships and provided valuable information; top-level management support, which was critical in building community partnerships; and daily ambulance reports from local emergency responders, which provided actionable information about participants. Barriers included the need for more wellness team time at individual intervention sites, challenges connecting R3 staff with participants’ hospitals and insurance companies, and refining the technological approach used to facilitate work flow and information exchange. Although obstacles were encountered during implementation, the findings provide support for the beneficial effects of enhanced services within senior housing.
THE ROLE OF HOUSING MANAGEMENT AND STAFF IN ADMINISTERING THE R3 PROGRAM
Authors: Simpson Elizabeth , Miller Edward , Nadash Pamela , Jansen Taylor , Lin Yan , Cohen Marc
Published: November 2019

Existing staff and management are central players in integrating enhanced services into affordable senior housing. This study describes the experience of housing providers in the implementation and operations of the R3 program. Semi-structured interviews were conducted with executives and direct service staff across the four intervention sites. Results indicate that staff served an important role in facilitating resident recruitment by operating as trusted sources of information about the R3 program. Top-level support for R3, acculturating R3 staff to the housing site, developing communication and data systems, and integrating new and existing staff were seen as crucial to the success of the program. Benefits noted by housing staff included freedom to redirect one’s energies/focus, production of actionable data/insights, reductions in resident turnover, and the addition of a nurse to the onsite services team. Housing management/staff experience with R3 can serve as a guide to moving to an enhanced services model.
RACE AND GENDER DIFFERENCES IN PHYSICAL FUNCTIONING AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Fabius Chanee D , Parker Lauren J , Thorpe Jr. Roland J
Published: November 2019

Prior work has demonstrated that there are race and gender disparities in the prevalence of need for assistance with tasks such as self-care, mobility, and household activities. Research has historically shown that older black Americans and women experience greater prevalence of physical functioning declines. It is unclear whether these differences persist among those receiving assistance. Using data from the 2015 National Health and Aging Trends Study (NHATS), a nationally representative study of Medicare beneficiaries aged 65 and older, and after adjusting for covariates, black men received less assistance with self-care and mobility activities, and white and black women received more help with mobility and household activities, compared to white men. Findings are critical to advancing our understanding of the needs of vulnerable older adults receiving assistance. More research is needed to understand the implications of these differences on long-term services and supports provided by both informal and formal caregivers.
THE ROLE OF GEOGRAPHIC-LEVEL RACE AND SOCIOECONOMIC FACTORS ON ACCESS TO HIGH QUALITY MEDICARE HOME HEALTH
Authors: Fashaw Shekinah A , Thomas Kali
Published: November 2019

Prior research suggests that neighborhoods with predominantly minority and low-income individuals have decreased access to high quality hospitals, primary care physicians, and nursing homes. The purpose of this study is to determine if low quality Home Health Agencies (HHAs) are concentrated within more disadvantaged neighborhoods, while high quality HHAs cluster in more affluent neighborhoods. We characterize neighborhoods by racial and ethnic composition, and the proportion of residents below the federal poverty line; and HHAs according to their star ratings. We conduct a national, observational descriptive study using data from the 2017 HH Compare and American Community Survey. Predominantly black neighborhoods are served by the highest proportion of unrated and low-rated HHAs, while predominantly white neighborhoods have the highest proportion of high quality HHAs. This study signals and potential explanation for why minorities and duals receive care from lower quality HHAs. Such knowledge may help inform reimbursement and incentive practices.
VIEWS ON AGING: NEW PERSPECTIVES FOR THEORY AND RESEARCH
Authors: Klusmann Verena , Kornadt Anna E
Published: November 2019

Over the past 20 years, research on views on aging has substantiated their importance for successful development and sustained quality of life over the full length of the life span. However, a deep understanding of the origins of views on aging and the underlying processes of their lifespan development and manifestation is lacking. Since 2017, the scientific network “Images of Aging” funded by the German Research Foundation (http://www.health.uni-konstanz.de/images-of-aging) assembles national and international renowned experts in the field. The network engages in empirical clarifications on both the distinctness and validity of the construct (contribution of Klusmann et al.) as well as in critically reviewing terminology and measures of views on aging (contribution of Notthoff et al.). The network aims to help clarifying the dynamic interplay of determinants and outcomes in the context of health (contribution of Wolff et al.) as well as disentangling intra- and intergenerational stereotypic perceptions (contribution of Kornadt et al.). Both of these are understudied issues with highly practical implications for two of the largest demographic challenges: shaping the coexistence of generations as well as providing adequate health care supply. Integrating both pertinent theoretical approaches and empirical findings the network regards views on aging under a lifespan perspective. Recently, it suggested three core principles of views on aging regarding lifelong bio-psycho-social development, their multidimensional nature, and their impact across life. These considerations provide a background for an integrative discussion of the symposium’s contributions.
COMPARISON OF A FRAILTY INDEX WITH CARDIOVASCULAR RISK SCORES IN PREDICTING CARDIOVASCULAR DISEASE MORTALITY
Authors: Kehler Dustin S , Theou Olga , Rockwood Kenneth
Published: November 2019

We compared the predictive and discriminative ability of frailty with traditional cardiovascular risk scores to estimate 10-year cardiovascular disease (CVD) mortality risk. Individuals aged 20-79 years old from the National Health and Nutrition Examination Survey who were free from CVD were included (n= 32,066). A 33-item frailty index (FI) which excluded CVD and diabetes-related variables was calculated. We calculated the Framingham Disease Risk (FDR) Hard Coronary Heart Disease and General CVD risk scores, the American Heart Association/American College of Cardiology (AHA/ACC) atherosclerotic cardiovascular disease risk equation, and the European Systematic Coronary Risk Estimation tool. A total of 322 individuals died (1.0%) from CVD. There was a low correlation between the FI and CVD risk scores (spearman’s r= 0.19-0.33; p<0.0001) and a weak to strong correlation between CVD risk scores (spearman’s r=0.19-0.88; p<0.0001). The competing-risks hazard ratio for CVD mortality for every 1% increase in the FI was 1.040 (95% CI: 1.032-1.048; p<0.0001) in an age and sex-adjusted model. The FI was independently predictive of CVD mortality when the other CVD risk scores were added to the model. The area under the receiving operating characteristic (ROC) curve was 0.800 (95% CI: 0.789-0.808; p<0.0001) for the FI. ROC values for the CVD risk scores ranged from 0.710 (95% CI: 0.700-0.721; p<0.0001) for the AHA/ACC risk score to 0.779 (95% CI: 0.770-0.789; p<0.0001) for the FDR General CVD risk score. An FI calculated with non-CVD and diabetes variables can predict 10-year CVD mortality risk independently of traditional CVD risk scores.
HYPERTENSION TREATMENT IN U.S. LONG-TERM NURSING HOME RESIDENTS WITH AND WITHOUT DEMENTIA
Authors: Boockvar Kenneth , Song Wei , Lee Sei , Intrator Orna
Published: November 2019

Background: Treatment of hypertension in individuals with dementia has benefit-harm tradeoffs. The objectives of this study were to describe patterns of antihypertensive treatment in U.S. nursing home (NH) residents and determine the association between intensity of antihypertensive treatment and outcomes important for persons with dementia. Methods: Medicare claims and Minimum Data Set (MDS) assessments were used to capture information on dementia, hypertension, comorbid conditions, cognitive function, activities of daily living (ADLs), and hospitalizations in Medicare-enrolled long-term care residents in 2013. Intensity of hypertension treatment was defined as number of antihypertensive drugs received on the date of an index MDS according to Medicare part D claims. Outcomes ascertained were hospitalizations, ADL decline, and mortality within 180 days of the index MDS. Results: A total of 262,285 residents had both hypertension and dementia. Residents were 85.7 years old on average and 77% female. At baseline, 30%, 40%, and 30% were receiving 0, 1, and 2+ antihypertensive medications, respectively. In multivariable logistic regression models, increased intensity of antihypertensive treatment was associated with increased hospitalization among residents with dementia (OR 1.03 per added medication; 95%CI 1.01-1.04), but decreased hospitalization among residents without dementia (OR .98 per added medication; 95%CI .97-1.00; p-value for interaction < .0001). In residents with and without dementia, increased intensity of antihypertensive treatment was associated with increased hospitalization for cardiovascular diseases, but small decreases in ADL decline and mortality. Conclusion: Study findings suggest that long-term NH residents with hypertension and dementia may not experience benefit from more intensive blood pressure control.
PHENOTYPES OF CARDIOVASCULAR DAMAGE AND THE RELATIONSHIP WITH COGNITIVE DECLINE: LATENT CLASS ANALYSIS
Authors: Miller Lindsay , Wu Chenkai , Hirsch Calvin , Lopez Oscar , Cushman Mary , Odden Michelle
Published: November 2019

The association between subclinical cardiovascular disease (SCVD) and cognitive function is well established, however, current tools for addressing subgroups of SCVD have focused on the overall burden of disease. Identifying risky combinations of characteristics may lead to a better understanding of pathophysiologic changes that underlie cognitive decline. Participants included 5,072 older adults from the Cardiovascular Health Study without cardiovascular disease at baseline and followed for 6 years. Using latent class analysis, we identified cardiovascular damage phenotypes based on vascular (internal intima-media thickness, ankle-arm index, white matter grade, and brain infarctions), cardiac (major echocardiogram abnormalities, ST2, and N-terminal pro-brain natriuretic peptide) and inflammatory (interleukin-6, galectin-3, and cystatin C) markers. Using the maximum probability assignment rule, participants were assigned to phenotypes based on the highest posterior probability of membership. We used adjusted linear mixed effects models to evaluate the association between phenotype and cognitive decline, measured annually using the Modified Mini-Mental State Exam. The analysis yielded 5 prevalent phenotypes: healthy (65%), cardiac (10%), inflammatory (10%), multisystem morbidity (11%), and vascular (4%). The vascular phenotype had the greatest rate of decline at 0.88 points per year (95% CI= -1.33, -0.44), followed by the multisystem morbidity phenotype (β=-0.72, 95% CI= -1.07, -0.38), the inflammatory phenotype (β=-0.67, 95% CI= -0.95, -0.38), and the cardiac phenotype (β=-0.45, 95% CI= -0.70, -0.21) compared to the healthy phenotype. Among patterns of cardiovascular damage, vascular damage appears to have the greatest influence on cognitive decline. Identification of these phenotypes may give rise to more informed clinical interventions.
LONG-TERM CARE IV A REVIEW OF THE LONG-TERM CARE INSURANCE PROGRAMS IN 15 PILOT CITIES IN CHINA
Authors: Lin Yan , Miller Edward A , Cohen Marc A , Nadash Pamela , Du Peng
Published: November 2019

China is now making all the efforts to solve the problem of who pays the bill for the rapidly increasing long-term care services. Since 2016, 15 cities in China have begun their pilot programs in long-term care insurance. Each city designed its own program. Some cities finance their long-term care services from medical insurance funding solely. Others supplement it with individual and/or employer contributions. This study documents the nature and extent of implementation of long-term care insurance across the 15 pilot cities to draw lessons for subsequent implementation nationally. This study used qualitative methods, including document review and key informant interviews with long-term care insurance administrators, medical insurance administrators, service providers in different settings and families and individuals who use long-term care services. Results reveal considerable variation in the specific attributes of the long-term care insurance programs implemented across the 15 participating cities, with respect to such characteristics as the target population, policy coverage, and payment methods, etc. Results also shed light on the achievements and challenges in implementing the long-term care insurance program. This study’s examination of long-term care insurance adoption in 15 Chinese cities serves as an important base with which to inform future national long-term care insurance design and implementation. It suggests that successful adoption of long-term care insurance across China will require administering jurisdictions to anticipate and address policy bottlenecks and implementation barriers that might otherwise inhibit program impact and effectiveness in addressing the growing long-term care needs of China’s aging population.
HEALTHY RESIDENCE IN RICHARDSVILLE: A PHOTOVOICE PROJECT ON AGING IN PLACE
Authors: Lewinson Terri , Simpson Gaynell M
Published: November 2019

Based on AARP’s domains of community livability, this presentation presents findings from a photovoice study of residents in an urban community in Atlanta, Georgia. Richardsville (pseudonym) is one of many communities in Atlanta’s inner city that has transformed from a blighted, long-derelict area to a hotbed of high rent apartment units, mixed with quarter-million-dollar-plus homes. With property values skyrocketing and rents soaring, it has becoming increasingly difficult for longtime, older residents of this historically African-American community to remain in the vicinity. Richardsville Senior Residences, an affordable rental unit, was built to provide housing for a mix of incomes and ages and retain longtime residents in Atlanta’s neighborhoods. Therefore, from this qualitative study, we share about residents’ motivations for moving into Richardsville Senior Residences and their perceived livability of the environment that influence healthy aging in place.
THE ROLE OF GERONTOLOGISTS IN CONTRIBUTING TOWARD PUBLIC POLICY TO ACHIEVE THE UN’S SUSTAINABLE DEVELOPMENT GOALS
Authors: Finkelstein Ruth
Published: November 2019

The UN SDGs are aspirational goals whose achievement requires intentional policy-making at each level of government. Advocates for older people argued for goals specifically addressing older people, the fastest growing segment of the world’s population. While unsuccessful, we did achieve a targets monitoring template that reports outcomes separately by age. This innovation will bring helpful attention to generational differences in needs and progress, but gerontologists must play a critical role for this innovation to be realized as a benefit. Gerontologists must actively prevent SDG implementation for older people from being siloed into aging services departments. Aging services agencies do not have the resources or skills to achieve the SDGs – they do not control policy levers to end poverty, ensure gender equity or sustainable urban development. Yet, too often, once a population is separately counted, responsibility for its wellbeing follows. Gerontologists must help governments adopt an “age in everything” lens.
THE ASSOCIATION BETWEEN COGNITIVE FUNCTION AND TAI-CHI: FINDINGS FROM THE PINE STUDY
Authors: Chao Ying-Yu , Chao Ying-Yu , Zha Peijia , Dong Xinqi
Published: November 2019

The study examined the association between cognitive function and Tai Chi practice among older Chinese Americans. Data from the Population Study of Chinese Elderly in Chicago (N=3,157) was analyzed by multivariate logistic regression. Cognitive function was assessed by global cognition, episodic memory, executive function, working memory, and Chinese Mini-Mental State Examination (C-MMSE). The results showed that cognitive function was significantly associated with Tai Chi practice. Participants with higher scores of global cognition (OR = 1.44, 95% CI: 1.20–1.73, p = 0.00), episodic memory (OR =1.27, 95% CI: 1.10–1.47, p = 0.00), executive function (OR = 1.017, 95% CI:1.00–1.03, p = 0.01), working memory (OR = 1.07, 95% CI: 1.02–1.12, p = 0.01), and C-MMSE (OR = 1.06, 95% CI: 1.03–1.09, p = 0.00) were more likely to practice Tai Chi. This study demonstrated that Tai Chi may benefit cognitive function in Chinese older adults.
RACIAL-ETHNIC DISPARITIES IN HEALTHCARE SATISFACTION
Authors: Mueller Collin , Farmer Heather
Published: November 2019

This paper explores how perceptions of unfair treatment shape healthcare satisfaction across race/ethnicity. We investigate the overall impact of life course exposure to healthcare discrimination on current healthcare satisfaction across race/ethnicity among a sample of midlife and older Black, Latinx, and White Americans age 50+ in the Health and Retirement Study. We then test whether everyday healthcare discrimination mediates the impact of major medical discrimination on healthcare satisfaction, controlling for sociodemographic factors, mental and physical health characteristics, functional status, life course stress exposure, and lifetime and everyday discrimination in contexts beyond healthcare settings. Black Americans had poorer healthcare satisfaction than White Americans. Everyday discrimination in healthcare settings mediated a modest amount of the relationship between lifetime healthcare discrimination and healthcare satisfaction, and this association varied in strength across White, Black, and Latinx Americans. Results underscore the need for future work identifying and addressing mechanisms shaping healthcare satisfaction.
AN INFLAMMATORY SIGNATURE OF POSTOPERATIVE DELIRIUM
Authors: Vasunilashorn Sarinnapha , Ngo Long H , Dillon Simon , Otu Hasan , Tripp Bridget , Inouye Sharon , Libermann Towia A , Marcantonio Edward R
Published: November 2019

Delirium is a common, morbid, and costly geriatric syndrome, yet its pathophysiology remains poorly understood. In a nested matched case-control study within the Successful Aging after Elective Surgery (SAGES) study, a cohort of adults age ≥70 without dementia undergoing major non-cardiac surgery, we previously identified inflammatory proteins to be associated with delirium. Using the entire SAGES cohort, the current study examines the independent associations of these inflammatory proteins with postoperative delirium. Plasma was collected preoperatively (PREOP) and on postoperative day 2 (POD2). Neuroinflammatory marker chitinase-3-like protein [CHI3l1 or YKL-40]; PREOP and POD2) and systemic inflammatory markers interleukin [IL]-6 (POD2 only) and C-reactive protein (CRP; PREOP and POD2) were measured using enzyme-linked immunosorbent assays. Generalized linear models were used to determine the independent (multivariable) associations between the inflammatory markers, measured in sample-based quartiles (Q). All models adjusted for age, sex, baseline cognition, surgery type, Charlson comorbidity index, and medical complications. Among the 555 patients (mean age 77 years, standard deviation, SD 5.2), 58% were female and 86% underwent orthopedic surgeries. Postoperative delirium occurred in 24%. High YKL-40 PREOP and IL-6 at POD2 (Q4 vs. Q1) were significantly associated with an increased risk of delirium: relative risk (RR) [95% confidence interval (CI)] 2.2[1.1-4.4] and 2.7[1.3-5.7], respectively. CRP (PREOP and POD2) was not significantly associated with delirium (p=0.37 and p=0.73, respectively). This work underscores the importance of inflammation (YKL-40 and IL-6) in the pathophysiology of postoperative delirium.
SNF TO HOME: OUTCOMES OF THE SNF RE-ENGINEERED (RED) DISCHARGE PROCESS
Authors: Popejoy Lori L , Wang Yan , Mehr David , Vogelsmeier Amy A , Wakefield Bonnie , Galambos Colleen M , Petroski Greg
Published: November 2019

Re-engineered (RED) Discharge Process has been effective in hospitals but little tested in SNFs. This study tested the effect of an 18-month adapted RED implementation in four Midwestern SNFs on 30, 60, 180 day hospital, SNF, and emergency department (ED) readmissions. The sample included 1026 SNF residents discharged to the community during 2013 (n = 526) and 2015 (n = 500). We used Medicare claims Data and Minimum Data Set (3.0) File to identify SNF admissions and readmissions to SNF, acute care, or ED. Data were linked across all four facilities by year and compared using appropriate statistics for descriptive, comparison, and regression tests. Residents discharged in 2013 had statistically significantly higher Charlson Comorbidity Scores 4.65 vs 3.97 in 2015 (p < 0.01), while those discharged in 2015 had significantly worse cognitive status, mood, and ADL self-performance. Overall, rates and number of 30, 60-day, 180 rehospitalization, SNF readmission, ED visits with rehospitalization were lower for all 2015 compared to 2013, but not statistically significantly different, except for the number of 180-day rehospitalizations in 2015. Likewise, the only statistically significantly different result was in the regression model was 180 day rehospitalizations. However, in the two facilities that had the best uptake of the intervention, numbers of readmissions were lower at 60 and 180 days (p=.0106 and .0013, respectively for regression results). SNF RED may be a useful tool for SNFs to use to reduce rehospitalizations after discharge; however, benefit depends on the degree of adoption of the intervention.
THE INFLUENCE OF LONELINESS AND RURAL RESIDENCE ON DEPRESSION IN LATER LIFE
Authors: Sun Na , Hua Cassandra , Qiu Xiao , Brown J Scott
Published: November 2019

Loneliness is associated with depression among older adults. Limited research has examined the role of rurality in relationship to loneliness and depression; the extant research has mixed findings. The socioemotional selectivity theory states that as people age the quality of relationships become more important than the quantity (English & Carstensen, 2016). Individuals in rural areas may have a low quantity of relationships but deeper social ties within the community; thus, they may be less likely to become depressed over time. The association between loneliness and depression may be amplified for people in non-rural areas because they are surrounded by other people but lack close relationships that are most important during the aging process. This study examines the effect of living in rural areas on loneliness on predicting baseline depression and loneliness, as well as changes in these outcomes over time. Data are from the 2006-2014 waves of Health Retirement Study. Regression models examine the relationship between depression loneliness and rural residence controlling for health conditions and demographic characteristics. Latent curve models examine the disparity in trajectories of loneliness and depressive symptoms by urban and rural residence. Older adults who feel lonely (p<.001) and in urban areas (p<.0.05) are more likely to be depressed. Furthermore, the effect of loneliness on depression is weakened by rural residence (p<.05). It is salient to understand the protective effect of rural residency on depression among older adults in the U.S. We discuss implications for policy.
COMMUNITY CAPACITY AND SOCIAL PARTICIPATION AMONG COMMUNITY-DWELLING MIDDLE-AGED AND OLDER CHINESE
Authors: Li Min , Huang Fang-Yi
Published: November 2019

Objectives. This study investigates how social participation of the aging population is associated with the community capacity, measured by the number of amenities and organizations within the community. Method. Using nationally representative survey data from the China Health and Retirement Longitudinal Study (2011), this study examines the availability of community amenities and organizations in rural and urban areas, and investigates the associations between community capacity and social participation among the middle aged and older Chinese using multilevel analysis. Results. The results of this study indicate that both community amenities and community organizations are positively associated with the social participation of the middle-aged and older Chinese. Additionally, the association between community organizations and the frequency of formal social participation is stronger among urban communities than rural ones, even after controlling for the individual-level socioeconomic status and health conditions. Conclusion. This study highlights the importance of building the community capacity by developing community-based grassroots organizations to promote the social engagement and participation of the aging population.
NEW ACCELEROMETRY PATTERNS IN FRAILTY: HOURLY ACTIVITY AND VARIANCE.
Authors: Huisingh-Scheetz Megan , Wroblewski Kristen , Waite Linda , Huang Elbert , Hedeker Donald , Schumm L P
Published: November 2019

Wearable sensors may improve our ability to identify frailty in the community. Frailty has been historically defined, in part, by reduced average activity; however, new analytic methods of aggregate, free-living accelerometry data suggest that frailty may be more fully characterized above and beyond reduced average activity. Using mixed-effect regression models of awake hourly activity from the National Social Life, Health and Aging Project dataset, we have shown that frail adult activity is most reduced in the morning relative to pre- and non-frail adults rather than the afternoon or evening. High residual between- and within-subject activity variance in this model prompted further study of activity variance. A follow-up analysis using a mixed-effect location-scale model of hourly activity data revealed that increasing frailty in older adults is associated with greater between-subject as well as within-subject hourly activity variability, particularly in the morning and afternoon. Study implications and future directions will be discussed.
USING AN INTERGENERATIONAL RELATIONSHIP TEACHING STRATEGY AND REFLECTION IN ON-GROUND AND ONLINE COURSES
Authors: Thurlow Christine B
Published: November 2019

Contact or experiences with older adults by college-level students is varied in nature and duration but is often reported as minimal and negative. By pairing groups from different generations, these relationships may influence established attitudes, beliefs, and behaviors of the groups. Research has shown that intergenerational relationships between older adults and college students through interviews within gerontology courses may influence college students’ views on aging and older adults towards the more positive. Specific steps in the development of an intergenerational relationship teaching strategy begin with locating an elder to interview and guidance for how relationship development can change from beginning to end. Role play may help prepare for first interview. Interview questions correspond to course content. Reflections are represented via discussion board if online, and group process forums if on-ground. Intergenerational relationship strategies can be flexible in the amount of contact time with the elder and the student. Reflection strategies can be utilized in several ways: discussion board, journal entries, presentations to classmates, and a culminating paper/PowerPoint. The opportunity for students to tell stories of their own past experiences, relationships with their elders, care and concerns for their elders, and how personal views about older adults and aging may be changing supports the effectiveness of this teaching strategy. Further research into the amount of time needed for effective intergenerational relationship development between student and elder may assist in course planning. Need clearer understanding of the benefits for the elder mentors and if their views about young people have been altered.
THE CURRENT SITUATION AND INFLUENTIAL FACTORS OF FRAILTY IN ELDERLY PATIENTS WITH DIABETES IN CHINA
Authors: Dai Fumin , Jia Wenwen , Jiang Mengdie
Published: November 2019

Patient with diabetes may increase the incidence of frailty. Frailty cause chronic inflammation and insulin resistance. The purpose of this study is to investigate the current situation of frailty and its influencing factors in elderly patients with diabetes. Totally 300 elderly patients with diabetes were selected from a tertiary hospital in Zhengzhou of China via convenience sampling method，and were investigated by self-designed general information questionnaire，TFI (Tilburg Frailty Indicator) and SDSCA(Scale of Diabetes Self-care Activities). Totally 296 valid questionnaires were collected. A total of 137 elderly patients with diabetes suffered from frailty and the prevalence was 46.3%. The mean score of total frailty was (5.26±2.87) and the scores for each dimension were as follows: physical frailty (2.79±2.08), psychological frailty (1.40±0.94) and social frailty (1.07±0.75). Multiple linear regression showed that comorbidity, self-management behavior, glycosylated hemoglobin, educational degree, polypharmacy and smoking were the major influential factors (P<0.05). The prevalence of frailty in elderly patients with diabetes was at a high level, containing different degrees of physical, psychological and social frailty. Medical staff should attach great importance to the assessment of frailty among elderly patients with diabetes, take targeted and holistic interventions timely to prevent or delay the development of frailty.
HIPPOCAMPAL GLUTAMATE MODULATION DURING MEMORY ENCODING: ASSOCIATION WITH AGE AND SUBFIELD VOLUMES
Authors: Anand Chaitali , Homayouni Roya , Yu Qijing , Ramesh Sruthi , Khatib Dalal , Dahle Cheryl , Stanley Jeffrey , Raz Naftali
Published: November 2019

Hippocampal glutamatergic activity plays a pivotal role in memory consolidation, including the ability to form novel associations that declines with age. To test whether glutamatergic dysfunction may underpin age-related memory declines, we examined in vivo age differences in hippocampal glutamate modulation during encoding of associations, and its relationship with hippocampal subfield volumes. Proton functional magnetic resonance spectroscopy was performed on 32 young (25.1±2.8 years; 18 females) and 16 older (65.9±2.7 years; 7 females) adults to measure changes in hippocampal (randomly assigned right or left) glutamate during an object-location paired association learning task (with 12 cycles of encoding-retrieval epochs). Volumes of the dentate gyrus&CA3, CA1, subiculum, and entorhinal cortex were manually measured from T2-weighted MRI images. Memory performance differed between the age-groups [F(1, 46)=8.56, p<.01], with the older attaining a lower asymptote [t(46)=2.93, p<.05] compared to the younger. Age differences in glutamate were observed only during encoding (age-group x epoch: F(3,137)=5.28, p<.01), and varied over the epochs. Young adults showed increased glutamate during the first four encoding epochs of each cycle, with levels remaining high thereafter. Old adults evidenced a decrease in glutamate during the first four epochs, and a slow, sustained ramping-up afterwards. Including both age-groups, the maximum change in glutamate, calculated using the maximum and minimum levels during encoding, was positively associated with CA1 [F(2,39)=4.28, p<.05] and the dentate gyrus&CA3 volume [F(2,39)=4.4, p<.05], after correcting for multiple comparisons. Glutamate modulation specific to encoding may underlie age-related memory declines and be related to selected hippocampal subfield volumes.
TRANSITION TO A MORE EVEN DISTRIBUTION OF PROTEIN INTAKE IS ASSOCIATED WITH ENHANCED FAT LOSS IN OBESE OLDER ADULTS
Authors: Farsijani Samaneh , Cauley Jane A , Santanasto Adam J , Glynn Nancy W , Boudreau Robert M , Newman Anne B
Published: November 2019

Background: Optimization of intentional weight loss in obese older adults, through preferential fat mass reduction, is challenging, as the concomitant lean mass loss may exacerbate sarcopenia. Here, we assessed whether changes in within-day protein intake distribution are related to improvements in body composition in overweight/obese older adults during a hypocaloric and exercise intervention. Methods: Thirty-six community-dwelling, overweight-to-obese (BMI 28.0-39.9 kg/m2), sedentary older adults (aged 70.6±6.1 years) were randomized into either physical activity plus successful aging health education (PA+SA; n=15) or physical activity plus weight loss (PA+WL; n=21) programs. Body composition (by CT and DXA) and dietary intake (by three-day food records) were determined at baseline, 6-month, and 12-month follow-up visits. Within-day protein distribution was calculated as the coefficient of variation of protein ingested at breakfast [5:00–10:59], lunch [11:00–16:59] and dinner [17:00–1:00]. Secondary analysis was performed to determine associations between changes in protein intake distribution and body composition. Results: In both groups, baseline protein intake was skewed towards dinner. The pattern of protein intake changed towards a more even within-day distribution in PA+WL, but it remained unchanged in PA+SA. Transition towards a more even pattern of protein intake was independently associated with a greater decline in BMI (P<0.05) and abdominal subcutaneous fat (P<0.05) in PA+WL. However, changes in protein CV were not associated with weight loss in PA+SA. Conclusion: Our results show that mealtime distribution of protein intake throughout the day was associated with improved weight and fat loss under hypocaloric diet combined with physical activity.
ANGIOTENSIN (1-7) EXPRESSING LACTOBACILLUS DOSE-DEPENDENTLY BENEFITS THE GUT-BRAIN AXIS IN AGED RATS
Authors: Sun Yi , Li Qiuhong , Verma Amrisha , Carter Christy , Buford Thomas W
Published: November 2019

Aging is associated with gut dysbiosis – a condition linked with altered central nervous system function (i.e the “gut-brain axis”). Age-related health benefits have been ascribed to the renin-angiotensin system (RAS), mediated partially via the angiotensin (1-7) or Ang(1-7) axis. This pre-clinical study explored dosing of a genetically modified probiotic expressing Ang(1-7) – which we previously showed to induce dose-dependent increases in circulating Ang(1-7) – in modulating the gut-brain axis. Twenty-nine male F344BN rats were randomized at 24 months of age to receive oral gavage of Ang(1-7) Lactobacillus paracasei (LP) zero (control), one, three, or seven times/week over 28 days. At day 29, samples of feces, serum and pre-frontal cortex (PFC) were collected. Microbiome taxonomic analysis of fecal samples was performed via 16S-based PCR. Serum samples were analyzed for tryptophan and downstream metabolites via LC-MS. PFC was evaluated for mRNA expression of select inflammatory cytokines. PCoA revealed that groups differed in the overall fecal microbiota community structure as determined by Unweighted UniFrac. Indices of alpha-diversity, including richness and phylogenetic diversity, displayed significant group differences – with the most dramatic effects observed in the 3-times/week group. Compared to control, serum serotonin and 2-Picolinic Acid were significantly increased in the 3-times/week group. The 3-times/week regimen also significantly reduced COX2, IL1β, and TNFα mRNA expression, and 7-times/week reduced COX2 and IL1β expression in PFC. Therefore, we conclude that short-term treatment with Ang(1-7) LP dose-dependently benefits the gut-brain axis in aged rats, with 3-times/week appearing to be the optimal dosing regimen.
COMMUNITY-BASED SERVICES AND OLDER ADULTS: A COMBINATION IN MENTAL HEALTH PROMOTION
Authors: Salgado Glaucia , Koehn Sharon
Published: November 2019

Mental health promotion among older adults has been considered an important goal by the World Health Organization (WHO, 2017). Mental health has been understood as not necessarily the absence of mental illness, but in fact, points on a continuum that although are not mutually exclusive, and it may intersect at times (Cowen, 1991; Keyes & Westerhof, 2012). With such complex health component, medical practices—although extremely critical in many cases—are often one factor of in the equation. Other practices, such as positive relationships among individuals and measures to tackle isolation are relevant and successful when planning practice for mental health promotion (Wister & McPherson 2014; Newall & Menec, 2019). A study done at a community-based seniors service in Vancouver – Canada shows that these spaces are considered a critical resource for visible minority older adults. Two focus groups were conducted at a community-based senior service with visible minority older adults between ages 55 to 80 years old. Results show that visible minority older adults strongly rely on this sector to maintain the connection with the society, and to the services provided in the wider community. Community-based seniors service provide opportunities for social inclusion and interactions, learning new things, and it has an inverse association with feeling isolated and lonely at home—a constant issue stated in the research. These findings indicate the critical role of this sector in ameliorating and promoting the mental health of visible minority older adults.
YOU DON’T KNOW WHAT YOU DON’T KNOW: A SURVEY OF CAREER MENTORING NEEDS IN CLINICAL GEROPSYCHOLOGY
Authors: Spalding Rachael , Renn Brenna N , Allen Rebecca S , Birdsall Jennifer , Edelstein Barry
Published: November 2019

Mentorship carries the potential to improve the placement, persistence, and success of those working in geriatric mental health. We sought to explore the career preferences and perceived barriers to obtaining desired jobs in the field of clinical geropsychology using an online survey of trainees and etablished professional geropsychologists. This cross-sectional observational cohort study recruited 96 respondents .Both trainees (n = 42) and professional geropsychologists (n = 54) completed an online survey. Trainees endorsed a variety of characteristics to describe their ideal jobs in geropsychology; particularly interdisciplinary teamwork and jobs in medical settings, palliative/hospice care facilities, long-term care, and geriatric outpatient care. The most commonly endorsed perceived barrier to trainees’ ideal jobs was the location of the position. Responses from professional geropsychologists elucidated factors that influenced their first job and resources that were helpful, or would have been helpful, during their job search process. The majority of respondents described the role of mentoring in career development, specifically with skill development, decision-making assistance, and personal support. Mentorship is instrumental throughout one’s training and career and offers instrumental and emotional support in job-searching and defining one’s career. Results should be considered with respect to training and retention of clinical geropsychologists given the workforce shortage, particularly in academia.
FINANCIAL HARDSHIP IN OLDER CHINESE CANCER SURVIVORS
Authors: Su Mingzhu , Yao Nengliang , Sun Xiaojie
Published: November 2019

Purpose: To estimate the proportion of Chinese cancer survivors experienced financial hardship and then examine whether older age was associated with financial hardship. Methods: We surveyed 965 cancer survivors 30 to 64 years of age and 643 cancer survivors age >=65 years in China. Cancer survivors were asked whether (1) they have borrowed money because of cancer, its treatment, and lasting effects of treatment and (2) they have forgone some cancer-related medical care because of cost. Multi-variable logistic regression models were used to examine factors associated with financial hardship. Results: About 44% of cancer survivors older than 65 borrowed money because of cancer, and 18% had borrowed more than 20,000 CNY (about 2,900USD, the disposable personal income in China in 2015 was about 22,000 CNY). In contrast, 54% of younger patients (P<0.01) had cancer-related debts, and 32% had to borrow more than 20,000 CNY. About 11% of cancer survivors have forgone cancer care in both age groups. The logistic regression analyses show that being 65 or older was 43% less likely to report cancer-related debts than younger patients (OR=0.57, 95% CI: 0.44-0.73). Among older cancer survivors, those who were older than 75, female, and had Urban Employee Medical Insurance and higher family income were less likely to report financial hardship. Conclusion: Older cancer survivors in China experience significant financial hardship, but not as striking as younger patients. Additional research is needed to analyze whether the finding is associated with the Chinese family structure and traditional filial piety culture.