bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association Between Personality and Homebound Status in Older Adults: Results From the NHATS
Authors: Sun Xiaocao , Liu Minhui , Miyawaki Christina E , Li Yuxiao , Hou Tianxue , Tang Siyuan , Szanton Sarah
Published: December 2020

Personality is associated with predictors of homebound status like frailty, incident falls, and depression. It has been rarely investigated whether personality predicts homebound status among older adults. Using the combining cross-sectional data of the Year 2013 and Year 2014 data from the National Health and Aging Trends Study (NHATS), this study examined the association between personality traits and homebound status in a sample of community-dwelling older adults aged 65 years and older (N=2,788). Homebound status (non-homebound, semi-homebound, and homebound) was determined by the frequency, difficulty, and help of outdoor mobility. Personality traits, including conscientiousness, agreeableness, openness, extraversion, and neuroticism were assessed using the 10-item Midlife Development Inventory on a rating scale from 1 (not at all) to 4 (a lot). Each personality trait was included as a predictor in an ordinal logistic regression model to examine its association with homebound status after adjusting demographic and health-related covariates. The sample was on average 79±7.53 years old, non-Hispanic White (72.0%), female (58.6%), living alone (35.4%) or with spouse/partner only (37.4%). Seventy-four percent, 18%, and 8% of participants were non-homebound, semi-homebound, and homebound, respectively. Homebound participants tended to be less-educated older females. The average scores of conscientiousness, agreeableness, openness, extraversion, and neuroticism were 3.19±0.75, 3.57±0.56, 2.81±0.83, 3.13±0.75, and 2.22±0.86, respectively. Among these five personality traits, high conscientiousness (OR=1.34, p<0.001) and extraversion (OR=1.16, p=.03) were associated with a reduced likelihood of being homebound. These findings provided a basis for potential personality assessment to identify and protect individuals with high homebound risk.
Evaluation of Race as a Predictor of Fear of Falling in Black Older Adults
Authors: Washington Selena , Stark Susan , Synder Makenna , Hu Yi-Ling , Minor Brittany
Published: December 2020

Fear of falling (FOF) is a common issue and health concern reported by adults 65 years of age and older.There is mixed evidence about potential disparity in fall incident rates due to race and FOF, and it is unclear if and under what circumstance falls rates and risks differ by racial ethnicity. The purpose of this study is to determine if race predicts fear of falling in older adults at greater risk for falls; and to examine the relationship between activities of daily living (ADL) and mobility performance measures with FOF. A cross-sectional observational study was used to examine predictors of FOF among community dwelling-older adults using data from two longitudinal randomized clinical trials (RCT). Participants (N=259) had a mean age of 75.7 ±7.4, 78.8% female, 80.64% Black, and 77.03% White or Other, with ≥ 1 fall in the last 12 months. Subjects completed a demographic profile; the Tinetti and Short Falls Efficacy Scale to assess FOF; and activities of daily living (ADL) and mobility performance scales to assess function. The chi square analysis revealed Black older adults were two times more likely to report FOF (OR = 2.17, 95% CI = 1.14, 4.15; p=.05) in comparison to White older adults. The regression analysis demonstrated that race is a significant factor to predict FOF (OR = .67, 95% CI = 1.21, 3.24; p=.05); and the descriptive analysis revealed significantly worse ADL and mobility function scores within the high FOF group.
The Association of Early-Morning Eating Habits With High Nutrient Intake by Older Japanese Adults Living Alone
Authors: Matsuoka Yoko , Zhang Junhua , Lyu Weida , Aoyagi Kei , Takase Mai , Ogino Ryogo , Goto Jun
Published: December 2020

The consumption of essential nutrition is fundamental to maintain the health of older adults. Conventional studies report that community dwelling older adults who live alone have the tendency to skip meals and result in low nutrition intake. However, the details regarding the dietary behavior and its association with the status of nutrition intake remain unclear. In this study, a cross-sectional analysis was conducted to explore the association between the time of meals and nutrition balance. In October 2019, questionnaire surveys were distributed to 184 participants of a lunch event dedicated to older adults living alone (Kashiwa, Japan). The time of meals, number of meals per day, consumption status of 10 food groups, and self-rated health were used for the analysis (N=165). As a result, older adults who usually ate their first meal between 5 to 8 A.M. ate three meals/day, while those who ate their first meal after 8 A.M. ate two meals/day. Those who ate their meal between 5 to 8 A.M., frequently consumed meat, fish and seafood, milk, and green and yellow vegetables compared to those who ate after 8 A.M. Self-rated health score was also high. The consumption of early-morning meals was associated with good dietary behaviors. The importance of eating breakfast has been emphasized, however, the time of the breakfast could vary among individuals. This study proposed the importance of considering the time of the meal. Development of intervention programs which encourage early-morning meal consumption might be helpful to form healthy dietary behaviors of older adults.
Impact of Culture and Religion on End-of-Life Decisions Among Advanced Cancer Patients in Developing Countries
Authors: Johnson Justina Yevu , Popejoy Lori
Published: December 2020

Palliative care and end of life decisions are important components of quality care at the end-of-life. Individual’s perception of cancer diagnosis is affected by their customs and traditions, religious orientations and stigma. Culture and religion as a social determinant of health affects people’s interpretation of health and illness and is a major factor in deciding the type of care at end of life and death. The purpose of the review was to identify factors related to culture and/or religion that impact decision making at end of life among advanced cancer patients their primary family caregivers and healthcare providers. An extensive literature search was conducted in Psych Info, PubMed, Philosophy Index, Atlas Religion, and Academic Search Premier databases for primary studies on the topic. Primary studies conducted only in developing countries and among healthcare providers, advanced cancer patients and their primary family caregivers were included. Five studies met the inclusion criteria: two primary studies, one methodological paper, and two on perspectives. The studies reported economic status of the patient, family, culture, and religious beliefs as factors that affected decision making at the end of life. Improving cancer care in developing countries requires the accommodation of the culture, traditions, and religious beliefs of both healthcare providers, patients and family. Culturally appropriate care model is therefore needed to enhance palliative and end of life care in developing countries. Leininger’s Cultural Care Theory seem an appropriate path to take.
Midlife Plasma Aβ and Late-Life Risk of Cognitive Impairment: The Atherosclerosis Risk in Communities Study
Authors: Sullivan Kevin , Blackshear Chad , Sharrett A Richey , Gottesman Rebecca , Knopman David , Windham B Gwen , Griswold Michael , Mosley Thomas
Published: December 2020

Plasma-based biomarkers of amyloid beta (Aβ), a neuropathological hallmark of Alzheimer’s disease, show promise in predicting cognitive impairment and mapping onto cerebral amyloidosis, but little is known about how midlife plasma Aβ associates with late-life cognitive outcomes. Midlife plasma variants Aβ42 and Aβ40 were measured using a fluorimetric bead-based immunoassay in a subsample of visit 3 ARIC participants (1993-95; n=2585, mean age=59.4±5.2, 57% female, 23% African American). We investigated the relationship between midlife plasma Aβ and late-life mild cognitive impairment (MCI; n=923) and dementia (n=628) diagnosed from 2011-19. Multinomial logistic regressions estimated relative risk ratios (RRR) of MCI, dementia, and death vs normal cognitive status as a function of:(1) Aβ42:Aβ40 ratio, (2) Aβ42 and Aβ40 included as separate terms, and (3) Protected Aβ group (participants with Aβ42≥46 pg/ml and Aβ40 <233 pg/ml). Adjusters included age, sex, education, site-race, and APOE4. Every doubling of midlife plasma Aβ42:Aβ40 up to a threshold of 0.20 was associated with 41% lower risk of developing MCI/dementia in comparison to cognitively normal (RRR=0.59 [95% CI:0.42, 0.82]), with no association for ratio values ≥0.20. Every standard deviation increase in plasma Aβ42 was associated with 17% lower risk of dementia (RRR=0.83 [0.70, 0.99]), whereas every standard deviation increase in plasma Aβ40 was associated with 16% higher risk of MCI (RRR=1.16 [1.02, 1.31]). The protected midlife plasma Aβ group had 86% lower risk of late-life dementia vs all others (RRR=0.14 [0.04, 0.47]). Early measurement of plasma Aβ may prove an accessible and effective population screener for future cognitive impairment.
Perspectives of Family Caregivers Confronted With Care-Resistant Behavior From Persons With Dementia
Authors: Jablonski Rita , Winstead Vicki , Geldmacher David
Published: December 2020

Problem: Care-resistant behavior is often bundled with other behavioral symptoms of dementia, but it is a unique behavior requiring targeted interventions. Purpose: To describe the experiences of caregivers receiving online coaching to manage care-resistant behaviors exhibited by persons with dementia. Design: Qualitative. Sample & Procedure: 20 caregivers (12 female, 8 male) were recruited from Memory Disorders and Geriatrics clinics to participate in 6 weeks of online coaching sessions delivered by a doctorally prepared nurse practitioner. Coaching sessions were recorded and transcribed. NVivo12 software was used to manage the thematic analyses. Results: Caregivers followed a general trajectory. They initially reported feelings of anger, frustration, and guilt. They believed that the person with dementia was purposefully “being stubborn and mean.” As the coaching sessions progressed, these negative emotions and the attributions of intent altered. By the conclusion of the six weeks, caregivers expressed feelings of success and ingenuity in applying coaching strategies. Conclusion: Online coaching is an effective way to individualize strategies that enable the caregiver to manage and reduce care-resistant behavior. Implications: The use of a doctorally-prepared nurse practitioner to deliver coaching, while effective, is not sustainable. Next steps include developing a coaching training program that could be embedded into existing community resources for community-dwelling caregivers. Limitations: Participants were limited to referrals from two clinics in the same institution.
Emory Roybal Center for Dementia Caregiving Mastery: Diverse Responses to Letter of Intent Call
Authors: Hepburn Kenneth , Perkins Molly , Waldrop Drenna , Aflatoony Leila , Song Mi-Kyung , Clevenger Carolyn
Published: December 2020

This new NIA-supported Roybal Center seeks to support Stage 1 pilot clinical trials of programs aimed at promoting caregiving competence and confidence in the great heterogeneity of dementia caregiving contexts. During our first cycle, we received 26 letters of intent (LOI) for full applications. Responses reaffirmed the Center’s premise that dementia caregiving is remarkably varied in nature. While most proposed programs focused on generic caregiving, a number addressed caregiving issues facing specific ethnic/racial groups (African American; Korean American; Native Alaskan/American Indian; Latino), and several focused on specific dementing conditions (MCI, Lewy Body Dementia,TBI-based dementia). Most described programs centered on knowledge development and daily management skill issues (e.g., management of behaviors); others specified development of physical care skills. Decision-making and communication constituted the second most common topic. Over 40% proposed adaptation of existing programs; more than 25% proposed apps or technology interventions. Investigators represented a wide range of disciplines: 45% each from Health sciences (nursing, medicine, and social work) and Social/Behavioral sciences (principally psychology) and the rest from engineering and communications. LOIs varied most in their readiness to complete a clinical trial within a year. About 40% were in very preliminary stages; 25% were clearly poised for a Stage 1 trial; 15% did not sufficiently address the Center’s aims. Key criteria for invitations to submit full applications (n=4) included: specificity of context; clinical trial readiness; reasonableness of proposed adaptation. These criteria should guide future LOIs addressing the diversity of important new research and intervention perspectives on the multifaceted work of caregiving.
Dual-Task Gait Cost and Frontal Lobe Integrity in Poststroke: Results From ONDRI
Authors: Pieruccini-Faria Frederico , McLaughlin Paula , Cornish Benjamin , Binns Malcolm , Bartha Robert , McIlroy Bill ,   ONDRI Collaborators, Odasso Manuel Montero , Faria Frederico
Published: December 2020

Dual-task gait performance is a marker of motor-cognitive interactions modulated by the frontal lobes. After a stroke, gait disturbances are more evident, particularly when concurrently completing a mental task and walking, an effect called high dual-task cost (DTC). Following a stroke, the potential association of high-DTC, integrity of the frontal lobes and cognitive functioning is unclear. This study screened 161 participants with stroke history from the Ontario Neurodegenerative Disease Research Initiative (ONDRI)-cerebrovascular disease cohort (69.2±7.41 years of age; 31.7% women). Individuals scoring zero in the National Institute of Health Stroke Scale were analyzed (n=102). DTC was the percentage change in gait speed from the single to dual-task condition. Standardized normal-appearing white matter (NAWM) and grey matter (NAGM) volumes from superior, middle and inferior frontal lobe were compared between DTC quartiles (adjusted for age, sex, and education) using a multivariate model (MANOVA), with total frontal lobe volume as a covariate. Another model compared group performance across 5 adjusted cognitive domains (attention, memory, language, visuospatial performance, and executive functioning). Univariate tests revealed that NAWM volume in the superior frontal lobe (F=4.50; p=0.005; partial eta-squared=0.122) was significantly different across DTC quartiles. Contrast tests suggested that the first quartile had larger NAWM than the second and fourth. DTC quartiles also showed differences in attention (F=2.93; p=0.03; partial eta-squared=0.083) and contrast tests indicated that the first quartile performed significantly better than second and fourth. DTC poststroke may be a proxy for structural integrity of superior frontal lobe regions and attention.
Life Course Socioeconomic Status and Late-Life Cognition and Cognitive Decline in the Rush Memory and Aging Project
Authors: Krasnova Anna , Tom Sarah , Valeri Linda , Glymour Maria , Crane Paul , Bennett David
Published: December 2020

The relationships among life course socioeconomic status (SES) measures with later life cognition and cognitive decline are unclear. We test the hypothesis that life-course SES is associated with late life level of cognition and rate of cognitive decline. The Rush Memory and Aging Project enrolled 1,864 dementia-free people aged ≥65 years between 1994 – 2018. Participants reported early life (parental education, number of siblings, and childhood financial need), mid-life (income at 40 years), and late life (baseline income) SES. Global cognitive function is a composite of 19 neuropsychological tests, administered annually. We utilized marginal structural models to assess the effect of SES (dichotomized at the median) at three life-course stages on late life global cognitive function and decline. We calculated inverse probability weights to adjust for socio-demographic confounders at each life-course stage. A total 1,063 participants had all relevant variables. Average follow-up was 4.4 years, and mean baseline age was 80.4 years. Most respondents were non-Hispanic white (89.7%) and female (74.1%). In the fully adjusted model, high childhood SES (coefficient 0.10; 95% CI 0.01, 0.20) and high late-life SES were associated with higher cognition intercept (coefficient 0.21; 95% CI 0.09, 0.32). High mid-life SES was associated with slower rate of cognitive decline (coefficient 0.02; 95% CI 0.001, 0.05). Childhood and late-life SES measures were not related to cognitive decline. Childhood and adult SES may reflect processes in building cognitive capacity, while midlife SES may reflect cognition maintenance. Interventions relating to SES across the life-course may benefit later life cognition.
Intention to Receive Cognitive Screening for Alzheimer’s Disease in Nondemented Older Adults
Authors: Park Juyoung , Tolea Magdalena , Besser Lilah , Galvin James
Published: December 2020

The study explored factors associated with intention to receive cognitive screening for Alzheimer’s disease (AD). It also examined whether self-efficacy mediates the relationship between knowledge about screening and the intention to be screened. A population-based, random-digit dialing survey was performed; 1,043 responses were collected from a sample of nondemented older adults living in urban, suburban, and rural areas. A majority were female (66.8%, n = 697) and White (82.7%, n = 863) with a mean age 62.6 years (SD = 10.2). Findings from regression analysis identified that being female (β = .080), being depressed (β = .149), and having a positive life orientation (β = .120) were significantly associated with the intention to receive cognitive screening, p < .05. Results indicated that older adults with a positive life orientation reported greater intention to be screened for AD, whereas depressed participants were more likely to plan to be screened for AD. Bootstrapping results identified a mediating effect of self-efficacy (β = .2668, t = 7.3137, p < .0005). Self-efficacy mediated the relationship between knowledge about screening and intention to be screened. Using self-efficacy as a mediation effect indicated that older adults with knowledge about screening understand the benefits of early screening and diagnosis and are more likely to have self-efficacy (i.e., confidence to consult with a physician), and thus are more likely to show intention to be screened. Intention to be screened for AD could increase public awareness by defining effective ways to assist older adults to seek a cognitive screen.
Disentangling and Quantifying Mechanisms of Increased Fall Risk Among Older Adults With Depression
Authors: Lohman Matthew , Resciniti Nicholas , Merchant Anwar
Published: December 2020

Background: Older adults with depression are up to four times more likely to fall, yet the mechanisms by which depression increases fall risk are unclear. This study sought to quantify and compare the relative strength of selected mechanisms mediating the association between depression and falls. Methods: We used longitudinal linked data (2006 – 2010) from the Health and Retirement Study and Prescription Drug Study. The analytic sample included non-institutionalized adults age > 65 with data on physical functioning and medication use (n=3,565). Falls and injurious falls over the past two years were self-reported outcomes. Depression was measured using the Composite International Diagnostic Interview (CIDI). We used causal mediation analysis to estimate the total and direct associations between depression and falls and compared strength of three potential mediating mechanisms – frailty, cognition, and antidepressant (AD) use. Results: Of 190 participants reporting depression in 2006, 85 (44.7%) fell and 30 (15.8%) were injured from a fall between 2008 and 2010. Depressed individuals were 92% more likely to fall compared to non-depressed (OR=1.92, p<.01). We found significant indirect effects of AD use (indirect OR=1.17, p<.01) and frailty (OR=1.12, p=.013) representing 19% and 13% of the total effect of depression on falls, respectively. Cognition was not a significant mediator. Results were similar for falls leading to injury. Discussion: Results suggest that AD use and frailty explain a significant portion of the elevated risk for falls among depressed individuals. Identification of these and other mechanisms may inform clinical treatment decisions for older adults with depression.
Mobility Screening for Fall Risk Assessment in a Population-Based Sample of Older Adults: An Analysis From the CLSA
Authors: Beauchamp Marla , Kuspinar Ayse , Sohel Nazmul , Mayhew Alexandra , Griffith Lauren , Raina Parminder
Published: December 2020

Existing guidelines for fall prevention in older adults recommend mobility screening for fall risk assessment; however, there is no consensus on which test to use and at what cut-off. This study aimed to determine the accuracy and optimal cut-off values of commonly used mobility tests for predicting falls in the Canadian Longitudinal Study on Aging (CLSA). Mobility tests at baseline included the Timed Up and Go (TUG), Single Leg Stance (SLS), chair-rise, and gait speed test. Inclusion criteria were: age ≥ 65 years and history of a fall or mobility problem at baseline. Accuracy of fall prediction at 18-months for each mobility test was measured by the area under the receiver operating curve (AUC). Of 1,121 participants that met inclusion criteria (mean age 75.2 ± 5.9 years; 66.6% women), 218 (19.4%) participants reported ≥1 fall at 18-months. None of the mobility tests achieved acceptable accuracy for identifying individuals with ≥1 fall at follow-up. Among women 65-74 and 75-85 years, the TUG identified recurrent fallers (≥2 falls) with optimal cut-off scores of 14.1 and 12.9 seconds (both AUCs 0.70), respectively. Among men 65-74 years, only the SLS showed acceptable accuracy (AUC 0.85) for identifying recurrent fallers with an optimal cut-off of 3.6 seconds. Our findings indicate that for a population-based sample of community-dwelling older adults, commonly used mobility tests do not have sufficient accuracy for identifying fallers. The TUG and SLS can identify older adults at risk for recurrent falls, however their accuracy and cut-off values vary by age and sex.
Intersection of Sex and Frailty in Humoral Immune Responses to Influenza Vaccine in Community-Dwelling Older Adults
Authors: Shapiro Janna , Kuo Helen , Morgan Rosemary , Li Huifen , Klein Sabra , Leng Sean
Published: December 2020

Older adults bear the highest burden of severe disease and complications associated with seasonal influenza, with annual vaccination serving as the best option for protection. Variability in vaccine efficacy exists, yet the host factors that affect immune responses to inactivated influenza vaccines (IIV) are incompletely understood. We hypothesized that sex and frailty interact to affect vaccine-induced humoral responses among older adults. To test this hypothesis, community-dwelling adults above 75 years of age were recruited yearly, assessed for frailty (as defined by the Cardiovascular Health Study criteria), and vaccinated with the high-dose trivalent IIV. Humoral immune responses were evaluated via hemagglutination inhibition titers. The study began during the 2014-2015 influenza season, with yearly cohorts ranging from 76-163 individuals. A total of 617 vaccinations were delivered from 2014-2019. In preliminary analyses, the outcome of interest was seroconversion, defined as ≥ 4-fold rise in titers. Crude odds ratios suggest that females are more likely to seroconvert to influenza A strains (H1N1: OR = 1.39, (0.98-1.96) ; H3N2: 1.17 (0.85 – 1.62)), while males are more likely to seroconvert to the B strain (OR = 0.85 (0.60 – 1.22)). Furthermore, this sex difference was modified by frailty – for example, the odds of seroconversion to H1N1 were 65% higher for females than males among those who were nonfrail, and only 30% higher among females who were frail. Together, these results suggest that sex and frailty interact to impact immune responses to influenza vaccines. These findings may be leveraged to better protect vulnerable populations.
Initial Translation of a Dementia Caregiver Intervention Into a Mobile Health Application
Authors: Maynard Taylor , Frink Travis , Mankodiya Kunal , Davis Jennifer , Ott Brian , Uebelacker Lisa , Tremont Geoffrey
Published: December 2020

Caring for a person with dementia is associated with negative outcomes. Few caregiver interventions have been implemented in community settings. Mobile technology is one method for reaching many caregivers. This project translated two empirically-supported interventions for dementia caregivers into a mobile health application. A team of clinical researchers and computer engineers developed an App called CARE-Well (Caregiver Assessment, Resources, and Education) over 6 months. The group worked closely to do the following: 1). translate interventional content to be compatible with a mobile platform; 2). create new materials; 3). determine App components that captured key intervention areas; 4). troubleshoot formatting, technology, and data security; and 5). educate each other about respective areas of expertise. We developed a beta version of the App that included: 1). assessment of caregiver stress and care recipient behavioral problems; 2). psychoeducation; 3). goal diary; 4). managing behavior problems; 5). online message forum; and 6). video library. Several challenges arose during the App development process, such as how to create navigation paths and goal lists based off users’ assessment responses, data storage and usage tracking, enlarging text, and how to ensure privacy and confidentiality in the online message forum. Our experience developing the CARE-Well App showed that translating behavioral interventions into mobile health applications is feasible and dependent upon regular communication among multidisciplinary team members. Next steps for the App include beta testing with dementia caregivers and conducting a pilot randomized trial to determine feasibility for a future trial and its effects on caregiver stress.
Lead It!: An App to Enable Persons With Dementia to Lead Group Activities for Their Peers
Authors: Skrajner Michael , Gorzelle Gregg
Published: December 2020

LEAD IT! is an app that enables persons with early and middle stage dementia to lead activities for their peers—i.e., other persons with dementia (PWD). An alpha version of the app was tested in a Phase 1 SBIR project. The alpha version included three Montessori-inspired activities. While PWD ostensibly view LEAD IT! as a set of enjoyable activities, it is actually an evidenced-based intervention aimed at reducing responsive behaviors and enabling PWD to fill meaningful social roles. A total of 24 PWD participated in the Phase 1 study: five leaders and 19 players. LEAD IT! Programming was implemented for six weeks, twice per week. LEAD IT! produced higher levels of positive engagement and affect, and lower levels of negative engagement, as compared to standard, baseline activities—i.e., non-digital activities led by staff. More specifically, when compared to baseline programming, players exhibited an 82% increase in Constructive Engagement (P=0.000), 80% increase in Passive Engagement (P=0.000), 60% reduction in Other Engagement (P=0.035), and 171% increase in Pleasure (P=0.000). One limitation of the Phase 1 study is that, at least insofar as the intervention is only implemented twice per week for six weeks, the positive outcomes seem to be limited to the period of time during which PWD are participating in the activity—i.e., changes on global measures, such as quality of life and depression were not detected. Still, the promising results of this study suggest that LEAD IT! is worthy of further development and evaluation in a planned Phase 2 study.
Psychometric Properties of the Chinese Wayfinding Effectiveness Scale
Authors: Chiu Yi-Chen , Algase Donna
Published: December 2020

Being unable to find one’s way is a terrifying experience accompanied by feelings of fear or frustration. Persons with cognitive impairment (PWCIs) are apt to get lost and show difficulty in wayfinding effectiveness. Therefore, it is important to develop an instrument to measure the wayfinding effectiveness in PWCIs in northern Taiwan. This was a cross-sectional design with 180 PWCIs to examine the psychometric properties of the Chinese Wayfinding Efficient Scale (CWE) developed by Algase. An exploratory Factor Analysis with varimax rotation was computed to explore the underline conceptual structure of the CWE. The results derived 6 factors: FDPFE = Finding a destination and a path in familiar environments; FDPUFE=Finding a destination and a path in unfamiliar environments; SDAS = Sense of direction and analytic strategies; SDGS = Sense of direction and global strategies; LMD = Landmark and distance in familiar/unfamiliar environments; MAP = Using a map in familiar/unfamiliar environments. This solution explained 66.50% of variance. The internal consistency values for the total and subscales were excellent. Item 25 was single loaded, therefore, deleted. One-week test-retest reliability of the CWE total scale and subscales were estimated using a subset of data (n = 15) by calculating ICC. One subscale, Finding a distance and a path in familiar environments (FDPFE), did not have significant test-retest reliability but the rest of the subscales and total scale had excellent test-retest reliability (.81-1.00). The initial psychometric properties of the CWE were acceptable. Further research should explore the possible associate factors.
Accelerated Decline in Sense of Purpose in Life Years Prior to Dementia Diagnosis
Authors: Lewis Nathan , Rush Jonathan , Hill Patrick
Published: December 2020

Research has pointed to sense of purpose in life as an important individual difference that promotes successful aging, predicting greater psychological wellbeing, physical functioning, and cognitive health in older adulthood. Despite such benefits, it is unclear how major life challenges such as the onset of cognitive impairment may impact the sense of purpose of older adults. Building on this, the present study examined long-term change in sense of purpose in a longitudinal sample of older adults who would later develop dementia. Data were from 341 participants without dementia at study intake who were subsequently diagnosed with dementia during the follow-up period (Mage = 81.92 years at intake, Mage = 89.19 years at diagnosis, 72.72% female). Participants completed annual assessments of purpose in life up to 17 years prior to dementia diagnosis (M = 6.99 assessments prior to diagnosis). Piecewise growth modeling examined change in sense of purpose in life with time structured as years to diagnosis. Results suggested a period of accelerated decline distinct from normative age-related change beginning around 5.60 years prior to dementia onset. Discussion will focus on two potential explanations: that perceiving declines in cognition may lead to diminished sense of purpose in life or that underlying changes in the brain may impact both cognition and sense of purpose resulting in concurrent decline over time.
Trajectories of Walking Speed and Cause-Specific Mortality: Evidence From England
Authors: Gessa Giorgio Di , Zaninotto Paola
Published: December 2020

Decreased walking speed can predict adverse health-related outcomes such as falls and admissions to hospital. Experiencing fast decline in walking speed has also been associated with increased risk of ‘all-cause’ mortality. In this study, we investigate the links between walking speed trajectories and specific causes of death. We used data from the English Longitudinal Study of Ageing, a large nationally representative survey which collects information biennially on people aged 50 and over in England since 2002. The sample consisted of 4,112 respondents eligible for a walking speed test at baseline who had not died before 2006. Rate of change in walking speed was derived from growth curve models and categorised in three trajectories (slow, moderate, and fast decline). We used competing risk analysis to explore the relationships between these trajectories and mortality, and their interactions with baseline wealth. During a mean of 9.5 years of follow-up, 1543 participants (37%) died (639 from cardiovascula disease -CVD, 311 from respiratory disease -RD, and 593 from cancer). Results suggest a significant difference in mortality across walking speed trajectories (with increased risk of death among those with fast declines) for CVD and RD deaths (P<0.001), even after controlling for baseline characteristics. There was no significant difference for cancer deaths (p=0.44). Further stratified analyses suggested that fast decline was associated with higher CVD and RD mortality even among those with an initial fast walking speed (>1.22 m/s). Strategies to maintain motor performances in later life have the potential to preserve life.
Adaptive Causal Thinking About Mobility Challenges: Implications for Quality of Life
Authors: Chipperfield Judith , Hamm Jeremy , Parker Patricia , Krylova Maria , Chuchmach Loring , Perry Raymond , Krause Cheliza , Hoppmann Christiane
Published: December 2020

Weiner’s attribution theory posits that it is adaptive to ascribe challenges to controllable causes (e.g., insufficient effort, bad strategies) and maladaptive to ascribe them to uncontrollable causes (e.g., old age). This is supported by our prior research that showed a heightened risk of mortality when mobility challenges were attributed to old age. The present pilot study randomly assigned older adults (N=36) in a day hospital to either an attributional retraining (AR) intervention group that viewed a video intended to shift causal thinking regarding mobility challenges (uncontrollable→controllable causes), or to a comparison group (No-AR). Participants completed a Time1 survey, the AR intervention (one week later), and a Time2 follow-up survey two weeks later. A manipulation-check revealed that AR was effective in shifting causal thinking away from maladaptive causes; a decline in the endorsement of the old age attribution was observed in the AR group (Ms=2.61 vs. 2.06; p=.02), but not in the No-AR group (Ms=2.45 vs. 2.35, p=.30). The AR and No-AR groups were equivalent at Time 1 on two quality-of-life outcomes: helplessness and perceived control (PC) over health. However, helplessness declined (Time1-Time2) in the AR group (Ms=1.13 vs. 0.73, p=.03), whereas it was relatively stable in the No-AR group (Ms=1.42 vs. 1.26, p>.20). Moreover, PC increased marginally in the AR group (Ms=6.50 vs. 6.69; p=.06), but declined in the No-AR group (Ms=6.20 vs 5.45, p=.05). Together, these findings suggest that attributions can be shifted away from uncontrollable causes and that this shift can have a protective effect that benefits quality-of-life.
Changes in Leisure Self-Efficacy and Fall Risk: One-Year Results of N’Balance, a Fall Prevention Intervention Program
Authors: Payne Laura , Headley Cathy , Katzenmeyer Christine , Lee Chungsup
Published: December 2020

Fear of falling can prevent people from engaging in valued leisure activities. Yet few studies have examined the role of leisure self-efficacy in fall prevention (Datillo, Martire, Proctor, 2012). The purpose of this study was to assess how participation in a fall prevention program affected worrying about falls, self-reported falls, and leisure self-efficacy in older adults over a 1-year fall prevention intervention. N ’Balance is an 8-week community-based multi-modal fall prevention program. This community intervention study included a treatment (N=50) and control group (N=42). Data were collected in four waves: 1) pre-program physical assessment and survey, 2) post-program physical assessment and survey, 3) six month follow-up survey, and 4) 12 month follow-up survey. Measures included the Activities-Specific Balance Confidence Scale (Powell, Myers 1995), self-reported worry about falling and the leisure self-efficacy scale. Analysis of covariance was used to assess the group x time effects of N ‘Balance on worry about falling, leisure self-efficacy and the number of falls in the last 12 months, while controlling for age and subjective health. From baseline to six months post intervention, fall worry decreased significantly for the treatment group and increased for the control group (p< .05). However, there was no significant change over time in the number of self-reported falls by either group. Leisure self-efficacy was higher at baseline for the treatment group and decreased significantly from 6 to 12-months post N Balance participation, whereas the control group had lower leisure self-efficacy at baseline and increased significantly over the 1-year study period (p<.05).
Patient-Reported Outcome Measures in Older Veterans Initiating a New Episode of Mental Health Care
Authors: Jedele Jenefer , Austin Karen , Resnick Sandra
Published: December 2020

The VA Measurement Based Care (MBC) in Mental Health (MH) Initiative supports implementing patient reported outcome measures (PROMs) for MH treatment planning and shared decision-making as a routine aspect of care. Using VHA administrative data, we identified Veterans initiating a new MH treatment episode (index encounter), i.e. prior 6-months without VHA MH encounters. We compare MH diagnoses, medications, and encounters during the 6-months from and including the index encounter by age (50-64; 65-79; 80+) between Veterans receiving 1 or more measures (PROM) to those receiving none (noPROM). The percentage of PROM Veterans decreased with age: 26.7% (50-64); 18.5% (65-79); 12.5% (80+). Consistent across age, PROM Veterans had more encounters than noPROM Veterans. In the year before treatment initiation, a smaller percentage of PROM Veterans had multiple MH diagnoses (21.0% v. 29.1%). At treatment initiation, both groups were equally likely to have multiple diagnoses (20.7% v. 20.1%); a higher percentage of the noPROM group were diagnosed with schizophrenia (3.8% v. 1.0%), bipolar (4.5% v. 2.2%), or PTSD (29.2% v. 21.8%). Substance use disorder and major depression were more prevalent in the PROM group. These patterns held across age categories. A smaller percentage of PROM Veterans had been prescribed psychotropic medication during the index encounter (32.8% v. 42.8%). For PROM Veterans, an average of 3 measures were received 1.5 months apart. The number of measures declined and the interval between measures increased with age. Potential barriers and possible efforts to target the use of PROMs with older Veteran patients are discussed.
National Courts Step Up
Authors: Van Schaack Beth
Published: December 2020

Following the discussion of the options for invoking the International Criminal Court (ICC) or creating a new international institution to address the crimes in Syria, chapter 7 explores the potential for domestic courts to fill this impunity gap. Principles of complementarity, including the incorporation of international crimes into the world’s domestic penal codes, have contributed to the emergence of more empowered and aggressive domestic courts when it comes to the prosecution of grave crimes of international concern. The chapter demonstrates the way in which classic principles of domestic criminal jurisdiction—territoriality, effects, nationality (active and passive), protective, and universal jurisdiction—could all be, and are all being, activated to address the presence of perpetrators and victims found outside the Syrian battlespace. This chapter offers a taxonomy of the criminal cases proceeding to date in domestic courts around the world, some involving the state’s own nationals, some involving perpetrators found within the territorial state, and some proceeding in various ways while the defendant is still in absentia. This chapter offers explanations for the developments afoot within states—and the European Union in particular—that have enabled domestic courts to emerge as the most promising venue for justice. While compiling a number of overarching observations about this collection of cases, the chapter also acknowledges their inherent limitations, in general and when it comes to Syria in particular, as well as sources of resistance to the expansion of these forms of extraterritorial jurisdiction.
Innovations in ICL Documentation Methodologies and Institutions
Authors: Van Schaack Beth
Published: December 2020

This chapter moves from this matrix of accountability to the emergent evidentiary landscape for atrocity crimes litigation. Chapter 9 thus surveys the various multilateral, national, and civil society documentation projects underway with an eye toward capturing new technological developments, analytical outputs, and public-private partnerships that have given rise to an unprecedented cache of potential evidence of international crimes in Syria, making it the most documented crime base in human history. The Syrian conflict coincided with the explosion of social media and digital technologies that render ordinary people capable of capturing the commission of international crimes on their cellphones. This surfeit of potential evidence has created both opportunities and challenges to accountability. Although not all this information will be admissible in a court of law, it has the potential to contribute to a range of transitional justice processes, including restitution and lustration efforts. This chapter is premised on the observation that when the Syrian conflict ends—which it must at some point—the documentation exists to undergird a comprehensive set of transitional justice processes if there is political will to undertake such an endeavor.
Spherical Alliances
Authors: Rochat Philippe
Published: December 2020

We all navigate through multiple social spheres, staging ourselves and adopting various roles depending on circumstances dictating particular alliances. We are all under the weight of guilt and the psychic pressure of keeping them tightly compartmentalized. The alliance within a sphere represents an interpersonal moral norm of trust and expectations. This exists in contrast to dissociative identity disorder, whereby individual experience distinct personality states, each marked by compartmentalized and deep differences in affect, cognition, perception, memory, sensory-motor functioning, and, ultimately, experienced identity. Instead, we are able to apply radically different standards and moral norms across varying spheres and still maintain a united “self.”
Self-Deception in Development
Authors: Rochat Philippe
Published: December 2020

The social life of children in their development is made up of novel attachments, intimacy, and self-defining social affiliation, beyond the first family bonding or attachment to primary caretaker(s). But it is also a life made of conflicts, prejudices, and fears, particularly the fear of being rejected and not recognized by others. In this context, self-assertion, or the need to affirm and make room for self in relation to others, plays a central role in shaping and driving self-concept development. It is also the source, from an early age, of budding self-deception. Self-conceptualizing is primarily the process by which we situate ourselves in relation to others: how close or how estranged we are in relation to them and what impact and power we have on others. In this respect, children show us that conceiving ourselves might serve a primary social function: the function of asserting who we are in relation to others, an important process by which we capture identifiable characteristics that shape our behaviors, intentions, and social decisions.
Introduction: There Was a Moment
Authors: Patey Luke
Published: December 2020

China views the decline of the United States and the West as signal to advance its interests, norms, and values on the world stage. But sentiments that one superpower will replace another miss the bigger picture. China’s rise to the commanding heights of the global economy and world affairs is not preordained. Its potential evolution into a global superpower, with a deep presence and strong influence over economic, political, military, and culture abroad, will rather be conditioned by how China behaves toward the rest of the world, and how the world responds. The world’s other large economies, major militaries, technology leaders, and cultural hubs will be significant in shaping the future world. For developed and developing countries alike, there is recognition that economic engagement with China produces strategic vulnerabilities to their own competitiveness and foreign policy and defense autonomy. China will struggle to realize its political, economic, and military global ambitions.
What’s Covered
Authors: Chambers Robert G.
Published: December 2020

Six figures that illustrate the subject matter of the book are presented. The reader is asked to take a short quiz to determine their familiarity with the figures and the underlying microeconomic concepts. Background material necessary for reading the text is discussed, and a brief précis of the remaining chapters is presented.
Democracy as Civilizing Mission
Authors: Ciancia Kathryn
Published: December 2020

As the First World War ended, new borderland conflicts erupted in Volhynia. At the Paris Peace Conference, Polish statesmen tapped into broader global ideas of civilization in order to show that the Polish nation had the right to rule Volhynia’s “backward” populations, particularly its Ukrainian-speaking majority. At the same time, Polish nationalist activists in the Borderland Guard (Straż Kresowa) attempted to implement their vision of anti-imperial democracy on the ground. This chapter explores how the Borderland Guard’s activists reconfigured “civilization” in Volhynia’s war-torn, resource-starved, and fractured local communities, where conflict played out along national, social, and economic lines. The contention that there were civilizational hierarchies both between Poles and non-Poles and within the ranks of “Poles” coexisted with rhetoric about national inclusivity. Indeed, hierarchy and exclusion directly emerged from attempts to import a Polish version of democracy into the borderlands.
Blacks and Jews in the Western Imaginaire
Authors: Parfitt Tudor
Published: December 2020

Jews and Blacks considered outside the normal human framework. The color black had long had negative connotations.
Rassenwahn
Authors: Parfitt Tudor
Published: December 2020

German science in early twentieth century was sophisticated, and Nazi theorists had to pay it lip service as they constructed their racial empire. Definitions of key terms like blood or race were never arrived at. Who or what was a Jew? Hans F. K. Günther and other Nazi race theorists were poorly trained and vague. The same was true of Alfred Rosenberg, one of the most influential race ideologues of the Nazi Party. Their works were taken seriously by Nazi bureaucracy. Throughout the Reich, race theorists helped the bureaucracy. George-Alexis Montandon, the Swiss-born, naturalized French physician and polygenist anthropologist, selected Jews in France for deportation using utterly dubious criteria. Exhibitions on race and centers of study were set up to promote Nazi race policies. Relatively little new physical anthropological research was conducted on Jews because it would have undermined the basis of racial laws. Attempts were made to see if Jewish blood was different. Non-somatic research into Jewish difference was carried out by Ludwig Ferdinand Clauss. Nazi Jewish studies had to engage with the black Jews who had troubled polygenists.