bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecting a Novel Walking-Based Performance Fatigability Marker With Accelerometry in Older Adults
Authors: Qiao Yujia (Susanna) , Harezlak Jaroslaw , Boudreau Robert , Urbanek Jacek , Moored Kyle , Schrack Jennifer , Simonsick Eleanor , Glynn Nancy W
Published: December 2021

Walking-based performance fatigability measures (e.g., lap-time difference) may not adequately capture performance deterioration as self-pacing is a common compensatory strategy in those with low activity tolerance. To overcome this limitation, we developed a new approach with accelerometry (ActiGraph GT3X+, sampling=80 Hz, non-dominant wrist) during fast-paced 400m-walk (N=57, age=78.7±5.7 years, women=53%). Cadence (steps/second) was estimated using raw accelerometer data (R “ADEPT”). Penalized regression splines (R “mgcv”) were used to estimate the individual-level smoothed cadence trajectories. “Time-to-slow-down” was defined as first time-point where the full confidence interval of change in cadence<0. Five participants were censored at stopping time (not slowdown or complete walk). Median “time-to-slow-down” was 1.86 minutes (IQR=0.98-2.73, range=0.57-6.25). Participants with longer “time-to-slow-down” had slower starting cadence, longer 400m-walk time, and greater perceived fatigability (Pittsburgh Fatigability Scale), p’s<0.05 (linear regression). Our preliminary findings revealed that detecting accelerometry-based performance fatigability/deterioration in older adults is feasible and needs to account for initial pace.
Novel Approaches Examining Sleep Health as a Marker of Successful Aging
Authors: Lee Soomi , Wallace Meredith
Published: December 2021

Sleep is a modifiable determinant of health. It changes with advancing age and in response to diverse contexts (e.g., related to work or one’s health). Previous studies have often used single measures of sleep duration or sleep quality. However, a recent paradigmatic shift towards multidimensional sleep health emphasizes the importance of examining how multiple sleep measures are simultaneously associated with health. This approach presents many opportunities for understanding sleep phenotypes and their potential contributions to health. Yet it also presents methodological challenges in analyzing multidimensional sleep data. This symposium showcases the most recent approaches and novel ideas examining the role of sleep health in successful aging. Paper 1 examines sleep profiles (i.e., latent groups with varying sleep characteristics) in middle-aged adults and their linkages to psychological well-being and chronic conditions with differences by age groups. Paper 2 investigates 24-hour patterns of sleep-activity rhythms and their associations with physical functioning performance in older men and women. Paper 3 showcases the utility of a sleep health composite score in examining sleep disparities and their drivers in middle- and later-adulthood. Paper 4 examines whether and how a composite sleep health measure based on actigraphy data is associated with specific characteristics of adult bipolar disorder patients. These papers use different cohorts, such as the Midlife in the United States Study, Osteoporotic Fractures in Men study, and Multi-Ethnic Study of Atherosclerosis. At the end, Dr. Wallace will discuss key findings from these studies, their methodological contributions and implications for aging, and directions for future research.
Rest-Activity Rhythm Patterns and Physical Functional Performance in Community-Dwelling Older Men
Authors: Chen Dorothy , Tranah Gregory , Bradshaw Patrick , Blackwell-Hoge Terri , Zeitzer Jamie , Ancoli-Israel Sonia , Yaffe Kristine , Stone Katie
Published: December 2021

Sleep and activity patterns have been linked to physical performance in older adults. Traditional parametric models of 24-hour activity rhythms fail to adequately capture specific diurnal sleep and wake patterns; functional principal components analysis (fPCA) is a non-parametric approach that addresses this limitation. Using fPCA, we modeled accelerometry data from n = 2,960 participants in the Osteoporotic Fractures in Men (MrOS) ancillary sleep study (mean age 77y) and examined cross-sectional associations with gait speed and grip strength measurements. Lower daytime activity (expected difference = -0.049 [-0.072, -0.028] m/s), increased sleep duration and a reduced midday dip in activity (-0.015 [-0.035, 0.006] m/s) were modestly associated with worsening gait speed. A modest association between both later sleep and wake times and increased sleep duration with worsening grip strength outcomes was observed (-1.11 [-1.90, -0.32] kg). Specific daily activity patterns may serve as predictive biomarkers for changing physical function in aging populations.
Physical Activity and Sedentary Behavior Patterns Prior to and During the COVID-19 Pandemic
Authors: Gell Nancy , Rosenberg Dori , LaCroix Andrea
Published: December 2021

Understanding patterns in the types of activities older adults engage in during physical activity and sedentary time could help shape intervention designs. Few studies have adequately described the physical activity and sedentary pursuits older adults undertake, including during the COVID-19 pandemic. To answer these questions, this symposium uses data from three recent studies: Adult Changes in Thought (ACT),an epidemiologic study with self-reported and device-based measures of physical activity and sedentary time including time spent in various domains of activity; Objective Physical Activity and Cardiovascular Disease Health in Older Women (OPACH), an epidemiologic study with device and self-report measures of sedentary behavior; and an ongoing clinical trial, the Healthy Aging Resources to Thrive (HART) study with device and self-reported data on sitting time and patterns as well as physical activity. The first session in this symposium will present a description of the rates of meeting the aerobic, strength, and balance recommendations among older adults in the ACT study. Next, we will have a presentation describing sedentary activities in older adults by age, sex and device-based sitting patterns in the ACT study. In the third presentation we will use OPACH data to examine patterns and context of sedentary in relation to aging-related outcomes. Finally, we will describe changes in physical activity and sedentary time in the HART trial in the cohort enrolled prior to the COVID-19 pandemic vs. those enrolled during the pandemic. Our Discussant will provide new insights on the roles of sedentary behavior and physical activity in aging and health.
Crime and Perceived Neighborhood Safety Across Racial-Ethnic Groups
Authors: Velasquez Alfredo , Guo Fangqi , Robinette Jennifer
Published: December 2021

Crime often increases safety concerns for residents, and safety concerns are generally associated with worse health. Despite that marginalized racial/ethnic groups are more likely than non-Hispanic Whites to live in areas with more crime, prior studies have documented that these groups differentially view crime as a threat to safety. Furthermore, older adults are more likely to report safety concerns than younger adults, despite a lesser chance of being victimized. Using multiple waves of data from the Health and Retirement Study, a representative sample of US adults aged 51 years and older (n= 11,161, mean age of 66 years), we conducted weighted repeated cross-sectional linear regressions to examine whether the association between crime and perceived neighborhood safety varies by racial/ethnic group, by age, or by wave of data collection. Study results indicated that higher crime rates consistently predicted more safety concerns among non-Hispanic Whites, Hispanics, and “Others,” but were inconsistently associated with safety concerns among non-Hispanic Blacks, adjusting for age, household wealth, and census tract-level concentrated disadvantage, population density, and racial/ethnic heterogeneity. Furthermore, among non-Hispanic Whites, greater crime predicted more safety concerns before, but not after including a measure of racial/ethnic heterogeneity. These patterns persisted across the full age span. Racial/ethnic differences in the crime-safety link could be explained by additional sociopolitical and environmental variables including diversity that vary over time. Follow-up analysis is needed to determine if the racial/ethnic differences in crime-safety links extend to health.
Testing Implementation of FFC-AL-EIT
Authors: Resnick Barbara , Boltz Marie
Published: December 2021

Residents in assisted living settings engage in limited amounts of physical activity and decline functionally more rapidly than peers in nursing homes. To address the persistent functional decline and increased time spent in sedentary activity Function Focused Care was developed. Function Focused Care involves teaching caregivers to evaluate residents’ underlying functional capability and physical activity and engage them in physical activity during all care interactions. Prior research has demonstrated that implementing function focused care improves or maintains function and increases physical activity, improves mood and decreases behavioral symptoms among residents. To optimize implementation of Function Focused Care a theoretically based implementation strategy, Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT), was developed. FFC-AL-EIT combines the social ecological model, social cognitive theory and the Evidence Integration Triangle. The social ecological model includes intrapersonal, interpersonal, environmental, and policy factors that influence behavior. Social cognitive theory guides the interpersonal interactions that motivate caregivers and residents to engage in function focused care. Lastly, the Evidence Integration Triangle facilitates systemic implementation of function focused care. A total of 85 facilities from three states were randomized (FFC-AL-EIT versus Education Only) and 794 residents consented. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model was used to evaluate outcomes. This symposium will provide the implementation outcomes and value of the Evidence Integration Triangle, the effectiveness of FFC-AL-EIT on function and physical activity and the effectiveness on psychosocial outcomes and care interactions.
Major Discrimination, Race-Ethnicity, and Inflammation Among Older Adults
Authors: Cobb Ryon , Parker Lauren , Thorpe, Jr. Roland
Published: December 2021

This study examines the relationship between self-reported instances of major discrimination and inflammation among older adults, and explores whether this relationship varies in accordance with race/ethnicity. Data from 2006/2008 Health and Retirement Study was used to collect measures of self-reported instances of major discrimination and high-risk C-reactive protein (CRP), which was assayed from blood samples. Modified Poisson regression with robust standard errors was applied to estimate the prevalence ratios of self-reported instances of major discrimination, as it relates to high-risk CRP (CRP ≥ 22 kg/m2), and test whether this relationship varies by race/ethnicity. Respondents who experienced any instances of major discrimination had a higher likelihood of high-risk CRP (prevalence ratio [PR]: 1.14, 95% confidence interval [CI] = 1.07–1.22) than those who did not report experiencing any instances of major discrimination. This relationship was weaker for blacks than whites (PR: 0.81, 95% CI = 0.69–0.95).
A Systems-Wide Approach for Early Detection and Management of Dementia in Primary Care
Authors: Fitzpatrick Annette , Belza Basia
Published: December 2021

Dementia is frequently unrecognized and under-reported by health care providers. The needs of an aging population increase the burden on an already over-worked primary care system that is often without the appropriate training, resources, and reimbursement to address the growing number of people with cognitive decline in the US. In this symposium we present a systems-wide approach within University of Washington (UW) Primary Care to increase awareness of early signs and symptoms, detection of cognitive impairment, and support of providers, patients and caregivers that will ultimately improve outcomes of care. This quality improvement (QI) program integrates stakeholder-selected components of the GSA KAER (Kickstart-Assess-Evaluate and Refer) Model and Toolkit (2020 Edition), developed by the Gerontological Society of America (GSA), into primary care practice. We describe content and logistics of a continuing education intervention for primary care providers and clinical staff to increase skills for evaluation and management of dementia. Working with UW clinic managers and information technology (IT), we have developed a pragmatic system for streamlining operations and documenting care utilizing newly developed interdisciplinary workflows and electronic health record order sets. Using input from our Community Advisory Board, we explain development of a web-based resource directory to be used in-clinic and at home to support providers, staff, patients, families, and caregivers across cognitive changes. Strategies presented here are aimed to help other health care systems initiate steps to integrate KAER and other tools into a practical QI program for improving detection and management of dementia through support of primary care.
What Do Israeli Gerontology Students Think About Medical Marijuana Use for Alzheimer’s and Parkinson’s Disease?
Authors: Edelstein Offer , Isralowitz Richard , Wacht Oren , Reznik Alexander , Bachner Yaacov
Published: December 2021

Aims: The aims of the current study were as follows: 1) to assess gerontology graduate students’ beliefs about medical marijuana’s (MMJ) effectiveness for two common age-related conditions - Alzheimer’s (AD) and Parkinson’s disease (PD); 2) to assess students’ beliefs and attitudes toward MMJ; 3) to explore associations linking background characteristics, MMJ-related attitudes and beliefs, and beliefs about the MMJ effectiveness for AD and PD. Method: A sample of 104 (84 women and 20 men) gerontology graduate students voluntarily participated in an anonymous online survey. Results: The vast majority (95%) of the participants indicated they had no formal education about MMJ and reported being unprepared to answer clients’ MMJ-related questions (84.6%). Most of the participants believed that MMJ is effective for use with AD (70.2%) and PD (80.8%) patients. Participants reported favorable beliefs about MMJ benefits, concerns about risks, the need for training, and positive attitudes toward recreational marijuana use legalization. Prior marijuana use (e.g., self-use, friends or family) was found to be associated with more positive beliefs about MMJ benefits, risks, and its legalization for recreational purposes. Prior marijuana use was the only factor associated with the belief that MMJ is an effective therapy for use with individuals diagnosed with AD or PD. Conclusions: The study findings stress the need for students’ MMJ education in order to provide future gerontology service providers with the necessary knowledge and ability to address clients’ questions about MMJ use. Efforts to develop curricula and training programs need to be promoted.
Health, Quality of Life, and Economic Impacts of Home Care Vouchers for Middle-Income Adults
Authors: Spetz Joanne , Wagner Laura , Miller Jacqueline , Chapman Susan , Kwong Connie
Published: December 2021

The Support at Home pilot program provided financial support for home care services by middle-income adults with disabilities in San Francisco to support aging in place. This presentation reports the results of the mixed-methods evaluation of the program, which incorporated administrative records, surveys of clients and comparison group members, surveys of informal caregivers of clients, surveys of the care providers hired by clients, and focus groups with clients and with informal caregivers. Outcome measures included the Older People’s Quality of Life Questionnaire, Patient Health Questionnaire-2, an adapted Burden Scale for Family Caregivers, and self-reported falls, emergency department visits, and hospitalizations. Analyses included pre-post chi-squared and t-test comparisons and comparisons of changes between the client and comparison groups. Multivariate regression analyses were conducted to control for demographic differences between the groups. An economic analysis was conducted to learn whether changes in costs associated with medical appointments, emergency department visits, and hospitalizations were greater than the costs of the program, including both voucher and administrative costs. Results indicated statistically significant positive changes in personal stress and financial stress, but not in the composite quality of life score. There also were statistically significant reductions in attendance at medical appointments, falls, emergency department visits, and hospitalizations. The focus group data supported the findings regarding personal and financial stress, and also indicated that clients and their caregivers perceived positive quality of life benefits. The economic analysis indicated substantial cost savings from the program due to reduced use of medical services.
Whom Can I Rely on? The Impact of China's Public Pension Program Expansion on the Expectations for Old-Age Support
Authors: Zhang Qian
Published: December 2021

Aging is a global trend and China is no exception. Older people in China mostly rely on their adult children for old-age support. This traditional provision pattern of old-age support, however, is challenged by hundreds of millions of internal migrant workers. They relocate from rural to urban regions for better employment and are no longer able to provide old-age support to their older parents in rural areas. The aim of this study was to determine the impacts of China’s public pension program expansion in rural areas on older people’s expectations for old-age support. Utilizing the natural experiment of program expansion, this study identified an instrumental variable as the county adoption of the pension program. In addition, the study analyzed a nationally representative longitudinal dataset CHARLS with fixed effects model. Results from the statistical model showed that given the participation in the pension program, older adults reported more reliance on pension for old-age support financially and less reliance on children. Heterogeneous effects were found for older adults living together with children and older adults living independently. These important findings suggest that the government partially assumes the responsibility for the old-age support of adult children in the traditional sense. The potential benefits of this study provide a policy implication for developing countries to alleviate old-age support problems and enable internal migration for economic development.
Perceptions of Healthy Aging Among Community-Dwelling Older Persons in an Urban Slum in Ibadan, Nigeria
Authors: Omobowale Olubukola
Published: December 2021

Background: Healthy Ageing is the process of the development and maintenance of functional capacity which allows well-being at an older age. This understanding is comprehensive and relevant for all older persons. Despite the global attention being given to healthy ageing, there is limited information on the perceptions of this concept among older persons in low resource settings like Nigeria, hence the need for this study. Methods: In depth interviews were conducted among older persons aged 60 years and above residing in Idikan Community, an urban slum area in Ibadan, Nigeria. Using an interview guide, perceptions of older persons on meanings of healthy ageing, factors related to healthy ageing and experience of ageing were explored. Results: A total number of 24 interviews were conducted. Slightly more than half of the respondents were females. The majority of the respondents were of the opinion that healthy ageing is about being “ strong” and able to move around, without being dependent on anyone for mobility and activities of daily living. In their opinion, healthy ageing is related to different health dimensions: biological (adoption of healthy habits and behaviors with self-responsibility, psychological (feelings of optimism and happiness), spiritual (faith and religiosity) and family and social support (healthy and well children, friends and family). Conclusion: Urban Community dwelling older persons’ perception of healthy ageing was positive and incorporating their opinions on healthy aging from the perspective of the older persons can support the activities of professionals who work with this population group.
Students’ Attitude Change: Virtual vs. In-Person Intergenerational, Arts-Based Courses
Authors: Young Meghan , Lokon Elizabeth , Li Yue
Published: December 2021

When higher education classes went virtual at the start of the COVID-19 pandemic, converting an in-person, arts-based, service-learning course into a meaningful, virtual experience seemed impossible. However, the Opening Minds through Art (OMA) program developed online courses where students met older adults weekly over Zoom to create and discuss art. Undergraduate and graduate students at Miami and Marian Universities (n=47) came from more than 20 different areas of study and had varying knowledge of gerontology and dementia. Pre- and post-assessments were administered at the start and end of the academic semester. Paired-samples t-tests were conducted to examine pre-post changes in students’ attitudes toward people living with dementia (PLWD) using the Dementia Attitude Scale (DAS) (O’Connor & McFadden, 2010) and the extent students actually like PLWD using the Allophilia scale (Pittinsky et al, 2011). Students in virtual OMA courses showed significant improvement in overall DAS and Allophilia scores and all subdomain scores (i.e., general knowledge about dementia, affection, social comfort level, kinship, and engagement and enthusiasm when interacting with PLWD), with moderate to high effect sizes (Cohen’s d range between 0.39 and 1.10). The magnitudes of these effect sizes for virtual OMA are comparable to previous studies examining students’ participation in face-to-face OMA sessions, where Cohen’s d on DAS and Allophilia scales ranged between 0.48 and 1.07 (Lokon et al, 2017, 2018). Overall, we found that it is possible to design virtual service-learning courses that improve students’ attitudes toward PLWD as effectively as face-to-face courses.
Associations Between Comorbidity and Depressive Symptoms During COVID-19: Variation by Social Isolation?
Authors: Cheng Jianjia , Kobayashi Lindsay
Published: December 2021

Adults with comorbidities are at high COVID-19 risk and may experience elevated depressive symptoms during the pandemic. We aimed to investigate the associations between comorbidity at pandemic onset and subsequent depressive symptoms and whether social isolation modified this association. Data were from monthly online questionnaires in the COVID-19 Coping Study of US adults aged ≥55 from April/May-September/October 2020 (n=4,383). Depressive symptoms were measured by the 8-item CES-D, and social isolation as “high” vs. “low” based on contact with family, friends, social organizations, and living alone. In multivariable mixed-effects models, comorbidity (≥2 vs. <2 chronic conditions) was associated with greater depressive symptoms at baseline (β=0.50; 95% CI: 0.36-0.64), this association varied negligibly by social isolation. Differences in depressive symptoms by comorbidity status at pandemic onset were consistent over the six-month follow-up. This study indicates that middle-aged and older US adults with comorbidities experienced persistently elevated depressive symptoms during the COVID-19 pandemic.
Factors Influencing Resident Responsive Behaviors Toward Staff in Nursing Homes: A Systematic Review
Authors: Weeks Lori , Nassur Abubakar Mohamed , Haq Fajr , Rupasinghe Viraji , Estabrooks Carole , Song Yuting
Published: December 2021

When staff experience various types of resident responsive behaviors, this can lead to decreased quality of work-life and lower quality of care. We synthesized empirical quantitative and qualitative evidence on factors associated with resident responsive behaviors directed towards staff in nursing homes. We searched 12 bibliographic databases and "grey" literature with two key words: long-term care and responsive behaviors resulting in 7671 sources. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. Based on extracted data, we developed a coding scheme of factors utilizing the ecological model as an organizational structure. We then applied the coding scheme to quantitative and qualitative articles and prepared narrative summaries for each factor. From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training about responsive behaviors (individual level); staff approaches to care (interpersonal level); leadership, staffing resources, and physical environment (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of responsive behaviors, and quantitative findings on the impact of staff approaches to care on responsive behaviors. By synthesizing both quantitative and qualitative evidence, this review provides a comprehensive overview of factors associated with resident responsive behaviors towards staff. Our findings offer insights into promising factors for long-term care system and nursing home managers to address to strive to reduce responsive behaviors of residents toward staff in nursing homes.
Partnership With Families During Hospitalization of Persons With Dementia: Intervention and Measurement Strategies
Authors: Boltz Marie , Resnick Barbara , Tate Judith
Published: December 2021

Persons with dementia have high rates of hospitalization and are at risk for complications including psychological distress, and functional and cognitive decline. In turn, their family caregivers often face increased stress related to lack of preparedness to meet the complex needs of the patient during hospitalization and in the post-acute period. Hospitalization provides an opportunity to reframe the role of family caregivers from the traditional passive one to that of partners with the hospital team. The aim of the Family-centered, Function-focused Care (Fam-FFC) clinical trial is to test a nurse-family partnership model that incorporates a four step approach to optimize behavioral, functional, and cognitive outcomes in hospitalized persons with dementia and increase preparedness of caregivers to continue to optimize these outcomes in in the acute and post-acute recovery period. In this symposium we provide a description of the intervention with regard to theoretical support, four step process, and cultural appropriateness of the process. Two presentations describe, among Black and white dyads, evidence to support the psychometric properties of major outcome measures, caregiving preparedness and neuropsychiatric symptoms, in hospitalized dyads living with dementia. The final presentation describes a strategy to engage the dyad in goal development and evaluation, and its effect upon hospital readmissions. Findings from this symposium will help to identify intervention and measurement resources for those working with hospitalized persons with dementia and their family caregivers, and guide ongoing research needs in this area. Our discussant will synthesize the research findings and discuss implication for research, policy, and practice.
Effects of the COVID-19 Pandemic on Place in End-of-Life Care: Insights From a Homeless Mobile Palliative Care Team
Authors: Johnson Ian
Published: December 2021

The effects of the COVID-19 pandemic on both those experiencing homelessness (Tsai & Wilson, 2020) and those with life-limiting illnesses (Abbott et al., 2020) is of great public health concern. This presentation details the findings from an organizational case study (Yin, 2014) aimed at investigating COVID-related changes to the service environments in which unhoused palliative care patients receive care. Through ethnographic field observation (Phillippi & Lauderdale, 2017) and interviews with a homeless palliative care team and their community partners (Turner, 2005), findings included 1) decreased staff capacity due to de-congregated care; 2) efforts to extend care in community settings due to relocation barriers; 3) conflict between reducing viral risk and honoring unique population needs; and 4) provider perceptions of COVID-19 as an “equalizer.” Findings illustrate the impact of emergency response within housing and healthcare systems on unhoused patients’ care and offer potential pathways to quality end-of-life care for homeless populations.
Get In and Get Out: The Impact of COVID-19 on the Emotional Health of Home Care Workers
Authors: Janssen Leah
Published: December 2021

This research explores the emotional health of home care workers (HCWs) during the coronavirus pandemic. In-depth, qualitative interviews were conducted with 17 home care workers in the fall of 2020. Thematic analysis revealed important connections between emotional health and success on the job. Perception of time and appreciation emerged as key elements that impacted emotional health. HCWs expressed the pressure to perform as usual while simultaneously taking on extra tasks as distracting from direct client care and reinforcing a task-oriented care approach. As a result of these tensions, HCWs experienced a loss of appreciation by the client, who prioritized personal safety and a “get in and get out” attitude, leaving the HCW feeling less fulfilled in their work. Implications of this research highlight the importance of HCW emotional health needs when retaining HCWs as valuable members of the long-term care workforce is paramount.
The Pandemic and Nursing Home Care
Authors: Smetanka Lori
Published: December 2021

This session will provide updates on how the pandemic led to horrific situations in long-term care facilities and how the pandemic influenced major federal efforts to address elder abuse, neglect, and exploitation.
Older Adults as Co-Creators in the Research Process: An Overview of Concepts, Methods, and Approaches
Authors: Wanka Anna
Published: December 2021

Participatory approaches have a long-standing tradition in the social sciences and approaches have diversified across multiple research domains. Also in ageing, there is a growing interest in involving older adults, particularly in fields like gerontechnology development, environmental gerontology or patient involvement. In this contribution, ask what participatory approaches and co-creation means in the context of ageing research. What are the benefits and challenges of involving older adults in different research domains, stages of the research process and deploying various participatory methods and approaches? To approach this question, we present preliminary results of a comprehensive scoping review of the literature and provide examples of how older adults can be involved in developing research questions together with researchers, collecting and analysing the data, as well as validating and disseminating study results.
Relational Approaches in Patient-Oriented Research During the COVID-19 Pandemic
Authors: Hung Lillian
Published: December 2021

The COVID-19 pandemic has exposed the fragile state of patient involvement in research. The involvement of the most vulnerable population (older people with dementia) in research was even more challenging. This presentation outlines challenges my research team encountered in patient-led projects (older people with dementia) and describes how we found creative strategies to set up and complete research during the time of pandemic. I will describe how the team applied collaborative participatory principles to engage a team with diverse backgrounds in the lockdown time to maintain research progress. Patient partners in my research team actively led recruitment, research planning and decision-making, team analysis and knowledge exchange. University students in our research team helped to make technology easy to use for our patient partners. The friendly, flexible and accessible exchange between students and patient partners reinforced the importance of a respectful relational approach in patient-oriented research.
A Longitudinal Study of Older Adults’ Acceptance of Robot Companions and Their Effects on Well-Being
Authors: Rebola Claudia , Malle Bertram
Published: December 2021

Robotic animal-like companions for older adults are promising technologies that have shown to have health benefits, especially for individuals with dementia, and good adoption rates in some previous studies. Our project, Affordable Robotic Intelligence for Elderly Support, aims to design new capabilities for companionship and smart care, but at high affordability. In a 6-month longitudinal study of baseline acceptance and well-being, we assessed the impact of an Ageless Innovation Joy for All™ robotic pet on user acceptance and emotional well-being (depression, loneliness, positive emotions). Nineteen participants from independent and assisted living facilities completed three standardized in-person surveys, each 3 months apart, including the CES-D, measures of Loneliness, Emotions, Attitude towards Technology (ATI), and various measures of evaluation of and engagement with robotic technology. The measures showed modest to very good reliability and meaningful construct validity. Participants in this sample showed little depression or loneliness, and these levels did not further decrease over the six months. People welcomed the pet and expressed positive evaluations of it, and these sentiments were stable over time. Attitudes toward technology varied but were unrelated to well-being measures and to robot evaluations. Our current conclusion, on the basis of a small sample, is that the selected robotic pet companion is appreciated and seen as beneficial, and for adults who are already low in depression and loneliness, the robot companion helps maintain the adult’s emotional well-being but does not further increase it.
Design Thinking as a Method for Developing Caregiver (and Other) Interventions
Authors: Aflatoony Leila , Perkins Molly , Waldrop Drenna , Hepburn Kenneth
Published: December 2021

“Design Thinking,” an innovative, human-centric approach to problem-solving, seeks to ensure that design efforts “solve the right problem.” This presentation describes the Design Thinking process and illustrates its use in the context of three design studio sessions with of family caregivers of patients at the Integrated Memory Care Clinic (IMCC), a comprehensive medical home for persons living with dementia. The Design Thinking process entails five steps – Empathize, Define, Ideate, Prototype, Test – that engage consumers/end-users to identify, as precisely as possible, the issues or concerns that are most important to them and to further identify the possible solutions that seem to most fully address these concerns. The process can be described as one of divergent and convergent thinking. In the first session, the Empathize phase, IMCC caregivers were asked to think as broadly as possible about needs not being met by IMCC. These topics were reviewed more convergently in the second session, the Define phase; here the participants agreed on a shorter, prioritized list of needs to be addressed. In the third session (that combined the Ideate and pre-Prototype stages), participants identified 14 topics (interventions) they felt should be included in this program. Finally, in the Test phase, they assessed the topics and agreed that the most important need IMCC could address would be to provide a comprehensive orientation program for new caregivers. IMCC clinicians concurred with the salience of the problem to be solved and saw addressing it as contributing substantially to the improvement of IMCC clinical care.
Friendship and Loneliness Among People Living With Dementia: Toward Community and Shared Humanity
Authors: Gan Daniel R Y , Chaudhury Habib , Mann Jim
Published: December 2021

An increasing number of people living with dementia (PLWD) age in community. In North America, this number ranges from 61-81% of the total number of PLWD. As many as one in three PLWD do not live with a care partner. Since most PLWD do not drive, many may spend a significant proportion of time within half a mile of their homes. Yet, the neighbourhood may or may not provide “ways of being in the world that are more accepting and embracing of the kinds of disruptions that dementia can produce” (Hillman & Latimer, 2017). To support continued social participation, meaningful everyday networks are required. PLWD and care partners may identify more or less strongly with a community depending on their position in the network, its spaces, and activities. According to Nancy (1991), “community” has been conjured as an antidote to the loneliness of the human condition, which explains its allure. In response, Costello (2014) argued that “community” requires one to constantly try and “fall short” in caring for another’s changing experiences. The value of a community thus depends on the quality of its friendships – the ability of otherwise lonely individuals to empathize – which may be threatened by challenges to PLWD’s personhood. This symposium brings together expertise in community gerontology, philosophy, and neuropsychology to advance current conceptualizations of personhood in community amid cognitive decline. These will be discussed in relation to lived experiences, with the aim to inform future research and practice of dementia care and prevention in community.
Testing the John Henryism Hypothesis on Cardiometabolic Health Among Older African Americans
Authors: Jiang Yanping , Gómez Jennifer , Rodriguez-Stanley Jacqueline , Zilioli Samuele
Published: December 2021

In the context of racism, the John Henryism Hypothesis posits that prolonged high-effort coping, which is referred to as John Henryism, may take a toll on physical health among individuals from low socioeconomic status (SES) backgrounds, particularly low SES African Americans. This study aimed to test the John Henryism Hypothesis among older African Americans by examining the combined effect of John Henryism and childhood SES on cardiometabolic health indexed by metabolic syndrome and systemic inflammation. Data were drawn from a sample of 170 urban older African Americans (Mage = 67.4 years, 75.9% female), who completed questionnaires assessing John Henryism and childhood SES (i.e., parental education). Blood pressure, waist circumference, and fasting blood were also collected to assess metabolic syndrome and systemic inflammation. Results indicated that John Henryism was significantly associated with elevated metabolic syndrome symptoms among older African Americans reporting low childhood SES (b = 0.42, 95%CI = [0.02, 0.83]), but not among those with high childhood SES (b = -0.33, 95%CI = [-0.78, 0.13]). This result was robust to a variety of demographic variables, lifestyle behavioral factors, and health conditions that are known to be associated with metabolic syndrome. A similar pattern of results, however, did not emerge for systemic inflammation. Our findings highlight the importance of considering the joint impact of early childhood socioeconomic backgrounds and individual psychological proclivities in explaining the elevated cardiovascular disease risk among older African Americans.
An Integrative Approach to Promoting Wellness in Older Adults: An Online Undergraduate Course
Authors: Majeski Robin
Published: December 2021

As gerontology and geriatric programs look to grow their connections with health and allied health areas, examining emerging health care areas is important. Thus, this session will present key concepts and pedagogical strategies from an innovative online undergraduate course, An Integrative Approach to Promoting Wellness in Older Adults, that is taught in the Erickson School at the University of Maryland at Baltimore County. The course brings together a conventional western allopathic approach and a holistic, patient-centered, integrative approach which includes complementary therapies, to promote wellness in older adults. Specifically, the session will present a comparison of the philosophical premises of conventional western and integrative approaches to health promotion. It will present a holistic model of health, an overview of the effectiveness and safety of different complementary therapies, and examples of how an integrative approach with conventional western and complementary therapies can be used in to promote health in older adults with particular chronic conditions. Also, a discussion of the incorporation of diversity content in the course, an integrative approach to health promotion for underserved populations, and specific pedagogical strategies used to facilitate learning in synchronous and asynchronous online learning environments are included. Session presentation techniques include a PowerPoint presentation, demonstration of examples of conventional western and integrative approaches to health promotion in older adults through case studies, and audience participation.
Keeping Intergenerational Programming Alive During the Pandemic Through Collaboration and Technology
Authors: Leedahl Skye , Estus Erica , Taylor Catherine
Published: December 2021

The University of Rhode Island Cyber-Seniors’ in-person intergenerational programming was quickly shut down during the Spring 2020 semester due to the pandemic. Since then, we have worked diligently and collaboratively with partners to offer creative intergenerational options for university students and older adults living in the community. We partnered with Age-Friendly RI and the Census Outreach to provide phone-based wellness checks to 11,500 older adults, and this evolved into a statewide weekly call with partners (n=34 calls) focused on reducing social isolation for older adults. Our students moved to offering phone or Zoom-based appointments with 21 community organizations across Rhode Island and became mentors for the new Cyber-Seniors ® organization digital offerings (n=90 students). In this presentation, we will share our experiences with the pivot from in-person to mostly technology-based interactions. We will discuss challenges and lessons learned, some of which will be retained regardless of the pandemic situation.
Person- and Task-Centered Mealtime Care: Impact on Positive, Neutral, and Challenging Behaviors in People With Dementia
Authors: Liu Wen , Williams Kristine , Batchelor Melissa , Perkhounkova Yelena , Hein Maria
Published: December 2021

Mealtime is an important daily activity to ensure intake. Person-centered and task-centered care may influence individual positive, neutral, and challenging mealtime behaviors. Yet, little work has fully examined their relationships. This study aimed to examine the association between person-centered and task-centered care approaches and individuals’ positive, neutral, and challenging mealtime behaviors. This secondary analysis of 110 videotaped mealtime observations involved 29 staff and 25 residents with dementia (42 unique staff-resident dyads) in 9 nursing homes. Videos were coded using the refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme. Logistic regression models were fit to four dependent variables representing resident mealtime behaviors: 1) positive/neutral behaviors (nonverbal), 2) positive utterances (verbal), 3) functional impairments (nonverbal), and 4) resistive behaviors (verbal and nonverbal). Independent variables were staff person-centered care modifications (nonverbal), person-centered utterances (verbal), and task-centered behaviors (verbal and nonverbal). Covariates included resident age, gender, eating function, and video duration. Resident positive utterances were associated with staff person-centered care utterances (OR =1.38, 95% CI = 1.09,1.76). Resident functional impairments were associated with staff person-centered care modifications (OR=1.33, 95% CI=1.02, 1.74) and fewer staff person-centered utterances (OR=0.81, 95% CI=0.66, 1.00). Resident resistive behaviors were associated with more staff person-centered utterances (OR=1.65, 95% CI=1.18, 2.31). Findings provided preliminary information supporting the role of staff person-centered care on resident positive and challenging mealtime behaviors. Findings inform use of verbal and nonverbal person-centered care strategies to improve positive communication and reduce challenging behaviors during mealtime in people with dementia.
LGBTQIA+ Caregiving and Care Needs of Persons Living With Alzheimer’s Disease and Related Dementias
Authors: Flatt Jason , Wharton Whitney , Anderson Joel
Published: December 2021

Lesbian, gay, bisexual, transgender, queer, intersex, and/or asexual (LGBTQIA+) older adults are a growing population. LGBTQIA+ persons living with Alzheimer’s disease and related dementias (ADRD) face unique challenges in terms of accessing care and support compared with their non-LGBTQIA+ counterparts. The care challenges faced by LGBTQIA+ people living with ADRD may be compounded by the fact they are more likely to be single, more likely to live alone, and less likely to have children. Several studies have started to explore the unique needs of LGBTQIA+ caregivers and persons living with ADRD. In this symposium, we highlight current research addressing the psychosocial and health-related needs of LGBTQIA+ caregivers and persons living with ADRD. Two presentations address psychosocial factors and health among LGBTQIA+ caregivers of persons with ADRD. Krystal Kittle will present analyses using population-based data on LGBTQIA+ caregivers in terms of caregiving burden and mental health. Shana Stites will present results from the Health and Retirement Study highlighting differences among same-sex spouses in terms of caregiving patterns and research participation. Next, Ethan Cicero will present prevalence estimates of care needs and challenges among diverse transgender adults living with memory problems. Finally, we will highlight a promising intervention for LGBTQIA+ caregivers of persons with ADRD. Jason Flatt will describe the adaptation and feasibility of the Savvy Caregiver program for LGBTQIA+ caregivers. Joel Anderson, an expert in LGBTQIA+ caregiving for persons with ADRD, will facilitate a conversation about these results and place them in the context of current LGBTQIA+ and ADRD research.