bluuebunny/crossref_metadata_2025 huggingface dataset:
TRANSITIONS TO LIVING ALONE AND PSYCHOLOGICAL WELL-BEING OF OLDER ADULTS IN THE U.S: ARE THERE ANY RACE DISPARITIES?
Authors: Dong Wuyi , Song Qian
Published: December 2023

We extend the existing literature on living alone and psychological well-being in older adults by focusing on the transition process from other living arrangements to living alone. We examine how transitioning to living alone is associated with psychological well-being scores (measured by 21-item Ryff Measures of Psychological Well-being) and how the associations vary across racial and ethnic groups. Using data from 2016 and 2020 Health and Retirement Study, we specify the transitions to living alone from four living arrangements: living with spouse/partner only, living with spouse/partner and older parents, living with a spouse/partner, children, and parents, and living with others. Respondents consistently living alone were the reference group. Our analysis involves adults aged 50 and above (n=3160). After controlling for final psychological well-being scores and adjusting for age, gender, marital status, and education in 2016, results from multiple linear regression models suggest that the transitions from living with spouse/partner only to living alone are associated with significantly lower scores of psychological well-being (β= -1.71, p<.01) than those consistently living alone. However, no statistically significant differences were observed between individuals transitioning from the other three living arrangements to living alone and those consistently living alone. The moderation effect shows that older Blacks experienced increased psychological well-being when transitioning from living with a spouse/partner to living alone (β=2.26) while their White counterparts had decreased psychological well-being during the same transition. This underscores the significance of the transition experience and emphasizes race disparities in its association with psychological health outcomes.
U.S. REMOTE CANCER CARE FOR OLDER ADULTS: A SYSTEMATIC REVIEW AND SOCIAL NETWORK ANALYSIS
Authors: Garces Edwin , Karakida Maki
Published: December 2023

Telemedicine and telehealth services are a promising solution for older cancer patients who are susceptible to infectious diseases, like COVID-19, and travel a longer distance to their closest hospital. To provide all-inclusive oncology care, understanding social disparities in access to remote cancer care is crucial. Yet, little is known about the accessibility of these technologies among US cancer patients in later life. The present study aimed to evaluate the main sociocultural factors associated with older patients of virtual oncology care interventions in the US. This systematic review explored the literature on telemedicine for geriatric oncology and patients’ accessibility to remote health technologies. PubMed, CINAHL, Scopus, and Web of Science databases were searched. Using Bibliometrix, Science of Science (Sci2) Tool, and Gephi, Social Network Analysis (SNA) was conducted to identify the central and intermediate factors linked to remote cancer care for older US adults. Among 427 retrieved articles, 19 articles, published between 2003 and 2023, met the eligibility criteria. The selected studies were focused on rural cancer patients (20%) and telehealth during COVID-19 outbreaks (20%), followed by lifestyle interventions (15%), ehealth literacy (10%), prostate or breast cancer (5%), older sexual minority men with prostate cancer (5%), and patients’ race, age, and region (5%). Findings also highlighted that gender, digital health literacy (technology readiness), and location are the key determinants of telemedicine access and use among older US cancer patients. Multiple socio-demographic aspects of older patients need to be considered for implementing equitable access to remote oncology care.
UNDERSTANDING “COMMUNITIES” IN COMMUNITY-BASED SENIOR HOUSING MODELS: A SCOPING REVIEW
Authors: Park Sojung , Baek Jihye , Ryu Byeongju , Ko Ahra , Kim Jeungkun , Amano Takashi , Kim Hyeji
Published: December 2023

Various community-based senior housing models have been developed to enhance social engagement and communal living among older adults, alongside their pursuit of independence and later life well-being. However, a comprehensive understanding of the efficacy of these housing models in cultivating “communities” which are integral to sustaining social ties in later life, remains limited. This scoping review investigated the conceptualization, establishment, and management of communities within diverse housing models, with an emphasis on community-related constructs. This scoping review examined empirical, peer-reviewed studies sourced from PsycINFO, CINAHL, MEDLINE, Scopus, and PubMed, resulting in the inclusion of twenty-one articles. Through thematic analysis, three predominant themes emerged: 1) residents’ well-being and lived experiences within the community (n=13), 2) engagement in communal activities and social programs (n=4), and 3) the spatial design and physical aspects of the community (n=4). We found that the way communities are defined and conceptualized differed across housing models. Also, residents’ individual characteristics (e.g., gender, age, income, health status) influenced their community lives and experiences. Community experiences were often conceptualized as a “sense of community” and “place attachment.” The majority of research focused on the experiences of residents’ communal living and their well-being. Still, some studies focused on how social and physical environments supported and facilitated community lives. This study underscores the need for further research into the dynamics of communities within diverse senior housing facilities. Also, more studies should be conducted on how those communities are formed and maintained to support older adults’ successful social lives in the community.
UNVEILING TENSIONS: CAREGIVING FOR OLDER ADULTS WITH CANCER IN THE COVID-19 ERA
Authors: Weiss Charlotte , Johnson-Koenke Rachel , Sousa Karen , Ulrich Connie , Hirschman Karen
Published: December 2023

The COVID-19 pandemic was traumatic for many individuals, including older adults with serious illness and their families. This qualitative study aimed to explore family caregiver narratives for the historical, societal, and institutional context of caring for older adults with advanced cancer during the COVID-19 pandemic. Using narrative inquiry alongside photo elicitation, 5 caregiver narratives were co-created during in-person semi-structured interviews or virtually through Zoom video conferencing. Each of the participant caregivers started caring for an older adult family member with cancer during the COVID-19 pandemic. Narratively derived thematic threads of COVID-19 emerged as short stories of tension woven throughout the cancer caregiver narratives. The themes within and across the narratives included: advocacy of quality healthcare for care recipients, protection of care recipients from COVID-19; protection of care recipients from medical institutional disregard; financial strain and uncertainty; lack of medical, emotional, social, and spiritual support; intention towards self-care; and saying goodbye in isolation. The backdrop of COVID-19 contributed to caregiver fear, anxiety, feelings of being alone, guilt, and emotional and physical exhaustion. Findings from this study highlight that cancer family caregivers experienced multiple layers of tension when caring for older adults with advanced cancer during COVID-19. By acknowledging tensions emergent through storytelling, researchers and clinicians contribute to valuing the diversity of individually and collectively lived human caregiving experiences and the uncertainty and turmoil in their lives.
USABILITY OF A SMARTPHONE APP DESIGNED TO COLLECT HEALTH INFORMATION IN OLDER ADULTS
Authors: Murabito Joanne , Faro Jamie , Zhang Yuankai , Demalia Angelo , Hamel Alexander , Agyapong Nakesha , McManus David , Borrelli Belinda
Published: December 2023

Few studies evaluate the usability of mobile-phone assessments in older adults. The aim of this study was to identify design-based barriers and facilitators to mobile app survey completion among two samples of older adults; those in the Framingham Heart Study (n=15, mean age 72 years, 40% women, 100% non-Hispanic, White) and, to aid with generalization, a more diverse sample (n=15, mean age 71 years, 47% women, 53% non-White, 20% Hispanic). We used mixed methods to ascertain information about challenging or beneficial features and functions of the mobile app. A variety of measures with different response formats were tested including self-reported surveys, pictorial format assessments (image of a body with checkboxes to indicate pain sites), and cognitive testing tasks, including Trail Making Test (TMT) and Stroop. Participants completed each of the measures using a think-aloud task, while being audio- and video-recorded. Recordings were coded for usability errors by two pairs of coders. Participants completed the Mobile App Rating Scale (MARS) to assess functionality and aesthetics of the app (range 1-5). In general, participants were satisfied with the app. In Framingham Heart Study participants, the average MARS functionality score was 3.6 (SD=0.7) and aesthetics score was 3.9 (SD=0.7) with no significant differences in the diverse sample. The majority of older adults did not have difficulty completing the self-report measures, unless there were lengthy instructions or the pictorial measure, but participants had usability issues with the Stroop and TMT. Our methods and results can guide app development and survey construction for older adults.
USING HEALTH INFORMATION EXCHANGE DATA FOR SOCIAL RESEARCH: CHALLENGES AND OPPORTUNITIES
Authors: Glicksman Allen , Ritter Ashley , Albert Steven , Davey Adam , Friedman Ari , Ring Lauren , Rodriguez Misha , Liebman Michael
Published: December 2023

Data collected in encounters between health providers and older adults can provide an important source of information regarding the experience of older persons with limited English Proficiency (LEP) in the health care system further enhancing our knowledge about health access in disadvantaged populations. Using data acquired from the local health information exchange (HIE) our team examined usage patterns of health services by Spanish and Chinese speaking older adults in Philadelphia. The data, which became available in July, represents one of the first opportunities to use HIE data to study these issues. HIE data link EMR records from providers across a defined geographic area to deliver information on patients served through participating organizations. The initial sample included reports on almost 200,000 persons with 7.7 million encounters. Each record contains information on type of encounter, diagnoses, insurance status, and related items. While availability of these data opens the opportunity to explore a variety of questions regarding health service use, methodological challenges to using HIE data are significant. These include (but are not limited to): 1) different coding schemes for key variables (e.g., encounter type, diagnosis); 2) LEP status, geography, and coding schemes may be confounded; 3) coding schemes used by providers may change over time so longitudinal data can include multiple coding types for the same patient; and 4) significant variation in coding race/ethnicity may be introduced for the same patient. We present examples of such challenges and approaches for resolution to enable and facilitate our analyses.
WHAT INTERFERES WITH OLDER ADULTS’ PARTICIPATION IN A MODIFIED PRESCRIBED EXERCISE PROGRAM?
Authors: Sefcik Justine , Harrison Sean , Skubic Marjorie , Richmond Therese , Hodgson Nancy , Demiris George
Published: December 2023

Exercise programs have great potential to help keep older adults active and independent in their homes. However, barriers to participation in a virtual coaching exercise program aimed at fall prevention is not well understood. This qualitative descriptive study with a conventional content analysis examined older adults’ perceptions of what interfered with their participation in a modified 3-month Otago exercise program. Ten older adults participated in five bi-weekly telephone coaching calls and interviews where they were asked about their last two weeks of exercise participation. Participants were mean age 71.3 (range 66 - 81), and mostly female (90%), Black (70%), and non-Hispanic (90%). While most of the participants routinely participated in their prescribed exercises, a few had difficulty completing the plan for some weeks. We identified two themes of what participants expressed had gotten in their way of routinely exercising: 1) distracted and busy (e.g., prepping for the holidays, death in the family, needing to clean home) and 2) physical problems (e.g., pain, being sick, injury). Only one participant said they lacked motivation, which resulted in them exercising less than their initial intention. These findings suggest that older adults want to participate in a routine exercise program, however, they sometimes have other priorities or physically cannot exercise. Program implementers should consider expanding timelines of physical training to account for weeks when older adults are unable to exercise and provide modifications for participants when ill, experiencing chronic pain, or have a new injury.
WORK-RELATED VIOLENCE OR HARASSMENT AND SICKNESS ABSENCE DUE TO COMMON MENTAL DISORDERS: A PROSPECTIVE TWIN STUDY
Authors: Hanson Linda Magnusson , Wijkander Maria , Narusyte Jurgita , Alaie Iman , Lindfors Petra , Xu Tianwei , Svedberg Pia
Published: December 2023

The aim of the present study was to investigate the association between exposure to unacceptable behaviors and practices or threats thereof in working life that result in or aim to result in physical, psychological, sexual or economic harm, such as violence and harassment including unwelcome conduct based on e.g. sex or gender (gender-based harassment/discrimination), and future sickness absence due to common mental disorders among Swedish twins. The study included 8795 twins, from the Swedish Study of Twin Adults: Genes and Environment, asked to report exposure to work-related violence or threats of violence and harassment or bullying and whom were followed-up for certified sickness absence (min 12 years of follow-up). Standard logistic regression indicated that exposure increased the odds of sickness absence due to common mental disorders (adjusted OR 2.11; 95% CI 1.52-2.95 for violence/threats, adjusted OR 1.52; 95% CI 1.10-2.11 for harassment/bullying). A co-twin control analyses based on conditional logistic regression restricted to twin pairs discordant for exposure, in which a co-twin control was used as reference, however, resulted in attenuated ORs (2.0; 0.79-5.07 and 1.56; 0.66-3.66, respectively). This indicates that the relationships could be at least partially confounded by familial factors, such as genetics and shared environment. These results suggests that more work is needed to clarify whether there is a causal association between these types of unacceptable behaviors/practices and mental health outcomes considering familial/genetic factors, and whether prevention of such behaviors/practices can keep individuals increasingly healthy, active on the labor market and promote healthy aging.
EFFECTS OF THE COVID-19 ON MEDICAL USE OF ELDERLY PATIENTS WITH HYPERTENSION: A NATIONWIDE COHORT STUDY IN KOREA.
Authors: Cho Eunbyul
Published: December 2023

COVID-19 pandemic disrupted healthcare services, including chronic disease management for vulnerable groups like older individuals with hypertension. This study aims to evaluate hypertension management in South Korea’s elderly population during the pandemic using treatment consistency indices like Continuity of Care (COC), Modified, Modified Continuity Index (MMCI), Most Frequent Provider Continuity (MFPC). This study used the the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service (NHIS) between 2017 and 2021 The research included a total of 4,097,299 hypertensive patients aged 65 or older. We defined 2018 and 2019 as baseline period before COVID 19 pandemic, and 2020 and 2021 as COVID 19 period, and calculated the indices of medical continuity (Number of visits, COC, MMCI and MFPC) on a yearly basis were measured. The number of visits were decreased during COVID 19 period compared to baseline period ( 59.64 ±52.75 to 50.49 ± 50.33, p< 0.001) respectively. However COC, MMCI and MFPC were not decreased in baseline period compared to COVID-19 period ( 0.71 ± 0.21 vs. 0.71 ± 0.22, p< 0.001), (0.97 ± 0.05 vs. 0.96 ± 0.05, p< 0.001), and (0.8 ± 0.17 vs. 0.8 ± 0.17, p< 0.001) respectively. In conclusion, COVID-19 had no significant impact on continuity of care, but it did affect the frequency of outpatient visits of older hypertensive patients. However, this study highlights the importance of addressing healthcare inequalities, especially for older hypertensive patients, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.
MAKING OLDER ADULT FALL PREVENTION A ROUTINE PART OF HEALTHCARE IN TRIBAL CLINICAL SETTINGS
Authors: Bergen Gwen , Egashira Leo , Parker Myra , Causey Shakiera , Haddad Yara
Published: December 2023

Over one-third of American Indian and Alaska Native (AI/AN) elders (age 65+) report falling annually. This percentage is higher compared to other race/ethnic groups except for White non-Hispanic older adults. CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative provides guidance for making elder fall prevention a routine part of clinical care. The presentation will describe a survey of healthcare providers serving AI/AN populations to gauge their readiness to adopt STEADI. Additionally, it will focus on a culturally informed approach to implementing STEADI within tribal settings. The National Network of Public Health Institutes and Seven Directions, A Center for Indigenous Public Health, surveyed a convenient sample of healthcare providers in clinics serving AI/AN patients to assess providers’ knowledge and acceptability of fall prevention best practices, efforts to prevent falls, and receptiveness to receiving fall prevention training and support. The final sample included 94 healthcare providers from 27 clinics. Less than half of those surveyed reported screening elders for fall risk. Only 22% were familiar with STEADI. Most (84%) providers were willing to take part in fall prevention with additional training. Based on these findings CDC is funding two tribes to use an indigenous evaluation approach to improve their tribal health center’s elder fall prevention capacity through evidence-based clinical and clinical-community linked strategies. Results from these activities will be used to outline a best practices guide focused on coordinated care for fall prevention and tailored to the varied environments, governments, cultures, and capacity for public health action in tribal health centers.
THE VALUE OF TECHNOLOGY IN LGBT OLDER ADULTS’ SOCIAL NETWORKS: LESSONS LEARNED FROM COVID-19
Authors: Breder Kelseanne , Bockting Walter , Ziyalan Elvan , George Maureen
Published: December 2023

LGBT older adults maintain unique social networks. They are more likely to live alone, more likely to rely on peers for caregiving, and less likely to have intergenerational support to adopt technologies that help maintain relationships. This research explores how LGBT older adults used technology for social support during COVID-19 social distancing and identifies recommendations for improving social isolation and wellbeing in this population through telehealth guidelines and community programs. Semi-structured individual interviews were conducted with a racially and ethnically diverse sample of 15 LGBT older adults during the summer of 2020. Interview guides were designed according to The Convoy Model of Social Relations. Verbatim transcripts were coded using conventional content analysis. Three major themes were identified, highlighting ways LGBT older adults used technology to meet social support needs, and the perceived gaps in technological fluency that hinder social connectedness and telehealth acquisition: (I) Yearning for “The Hug Factor,” (II) Navigating Online Social Boundaries and (III) “Not for My Generation.” Findings emphasize resiliency strategies employed by LGBT adults during social distancing and quarantine mandates that may optimize social and psychological wellbeing among the general aging population, as well as other minority geriatric groups. Our finding may hold relevance during future periods of isolation due to aging, mobility limitations, and climate change. Recommendations for improving social support beyond the pandemic include talk therapies, telehealth policy initiatives, and targeted community programs.
DEVELOPMENT OF THE LONGITUDINAL STUDY OF HEALTH AND AGEING IN KENYA (LOSHAK)
Authors: Nagarajan Niranjani , Ehrlich Joshua , Ngugi Anthony , Mwangi Eunice , Riang’a Roselyter , Sayed Shaheen , Gichu Muthoni , Langa Kenneth
Published: December 2023

In Kenya, the number of adults aged ≥60 is expected to nearly quadruple by 2050, making it one of the most rapidly aging countries in Sub-Saharan Africa (SSA). Accordingly, we designed the Longitudinal Study of Health and Ageing in Kenya (LOSHAK) to generate novel data to address the health and economic consequences of this demographic transition. Modeled on the U.S. Health and Retirement Study (HRS), LOSHAK joins a network of harmonized studies on aging in >45 countries worldwide; however, LOSHAK will be only the second such study in SSA. LOSHAK will advance population aging research in low- and middle-income countries through the study of: (1) biomarkers and physiological measures; (2) the impacts of air pollution and climate vulnerability; (3) Alzheimer’s disease and related dementias, mental health, disability, caregiving, and psychosocial wellbeing; and (4) economic security, including the impact of social welfare. The current feasibility and initial pilot testing phase of LOSHAK is nested within the Kaloleni/Rabai Community Health and Demographic Surveillance System on the coast of Kenya and aims to validate measures and data collection procedures in a purposive sample of Kenyan adults aged ≥ 45 years. Among 205 participants surveyed, the mean age was 64 years, 58% were female, and 37% were currently employed. In the future, a full-scale Wave 1 LOSHAK will collect data from a nationally representative panel of Kenyans aged ≥45 years and will inform future public health and economic policy to address challenges related to rapid aging in Kenya and throughout SSA.
MACHINE-LEARNING-BASED INTERPRETABLE PREDICTION FOR MILD COGNITIVE IMPAIRMENT: FROM ADNI DATABASE
Authors: Wu Yafei , Jia Maoni , Fang Ya
Published: December 2023

Objective

An accurate prediction model was still lacking for mild cognitive impairment (MCI). Therefore, this study aimed to predict the 3- and 5-year MCI risk utilizing interpretable machine learning, and to identify possible biomarkers for intervention.

Methods

A total of 444 participants were obtained from the ADNI database. Sociodemographic, neuropsychological, ApoE gene, and structural MRI imaging information was used as predictors. Data was randomly divided into training (70%) and test sets (30%). Six machine learning methods were constructed to predict the risk of MCI. Model performance was assessed by area under the ROC curve (AUC). SHapley Additive exPlanations (SHAP) was used to select important predictors. We also constructed a simplified MCI prediction model for clinical practice.

Results

The mean age (standard deviation) of study population was 73.7 (6.1) years old. A total of 40, and 60 participants progressed into MCI within 3, and 5 years, respectively. Logistic regression (AUC: 0.97) and support vector machine (AUC: 0.93) are the optimal model for 3- and 5-year prediction. The simplified models based on top three neuropsychological test scores also showed high prediction accuracy (AUC > 0.90). APOE gene, intracranial volume, and Clinical Dementia Rating Scale Sum of Boxes (CDRSB) score were top three predictors for 3-year prediction, while CDRSB score, modified Preclinical Alzheimer’s Cognitive Composite Test with Follow-up Test scale (mPACCtrailsB) score, and Functional Activity Questionnaire (FAQ) score were top three predictors for 5-year prediction.

Conclusion

Interpretable machine learning showed promise in early identification of MCI, and would be valuable for targeted prevention.
AGE-RELATED KYNURENINE PATHWAY METABOLITES DRIVE SENESCENT-LIKE CHANGES IN NEURONS: POTENTIAL NOVEL AD MECHANISM
Authors: Kondrikov Dmitry , Kondrikova Galina , Dixon Steven , Krieg Carsten , Wang Gavin , Hill William
Published: December 2023

Kynurenine pathway (KP) metabolites are emerging as important factors of aging-related pathologies. Kynurenine (KYN) and its metabolites increase with age and are known to affect multiple organ systems including CNS, musculoskeletal, and vascular systems. Our group has previously shown that KYN and sub-KYN metabolites below the enzyme Kynurenine monooxygenase (KMO) can act to inhibit osteogenesis of bone marrow MSCs via senescence induction. However, inhibition of KMO, blocks KYN induced senescence and restores osteogenic potentials of MSCs. We are now expanding this work to see if KYN metabolites act on cells of the aging CNS in a similar fashion potentially helping to drive cognitive decline and Alzheimer’s disease (AD) progression. We report for the first time that treatment of neuroblastoma-like SH-SY5Y cells with KYN, and sub-KMO metabolites 3-hydroxykynurenine (3HK), or quinolinic acid (QA) significantly increased senescence-associate beta-galactosidase activity, and expression of senescence associated secretory phenotype (SASP) markers, p21, PAI-1, TIMP2 as well as Histone 3 K9methylation. Treatment of SH-SY5Y cells with KMO inhibitors prevented elevated expression of SASP proteins and histone methylation. This makes KMO an attractive target to inhibit kynurenine pathway effects. Taken together, these data suggest that KYN and its metabolites may contribute to pathogenesis of AD via inducing senescence-like changes and SASP-mediated neuroinflammation in neuronal cells. Inhibition of KMO may allow rescue of brain microenvironment, limit cognitive decline and AD progression in older persons. Blocking KYN downstream metabolite formation, by inhibiting KMO, presents a novel therapeutic target for a potential novel AD mechanism.
FEASIBILITY OF AEROBIC FITNESS TESTING IN AMNESTIC MILD COGNITIVE IMPAIRMENT FROM THE ACT TRIAL
Authors: Yu Fang , Salisbury Dereck , Lin Feng
Published: December 2023

Aerobic fitness has been postulated as a physiological mechanism of action for aerobic exercise to modify Alzheimer’s disease, but it has not been adequately studied in older adults with (MCI). The purpose of this study is to evaluate the feasibility of a gold-standard, laboratory-based, symptom-limited cycle-ergometer exercise testing (GXT) in older adults with amnestic mild cognitive impairment (aMCI) to assess peak oxygen consumption (VO2max [ml/kg/min]) using baseline data from the ACT Trial. The test was categorized as a submax, near-max, and max test based on if 0, 1, and ≥2 of the American College of Sports Medicine criteria was met: >90% of age-predicted maximum heart rate, plateau in VO2Peak, respiratory exchange ratio >1.10, and rating of perceived exertion >17. VO2max was predicted as 3.5*maximal metabolic equivalents (METs). Among 146 enrolled participants (73.8±5.7 years old with 16.9±2.9 years of education, 51.4% men, and 91.8% Caucasian), 145 completed GXTs. Sixteen GXTs (11.0%) were submax (VO2Peak 13.5±4.4), 53 (36.6%) were near-max (VO2Peak 16.5±4.1), and 76 (52.4%) were max (VO2Peak 18.4±5.1). Predicted VO2max were 21.6±6.8, 28.7±26.3, and 30.0±20.5 from submax, near-max, and max tests, respectively. Among max GXTs, VO2max was 19.5±4.9 in men (n=37) and 17.4±5.1 in women (n=39). In conclusion, GXTs was feasible for ~52% of the participants. METs-based prediction overly inflates VO2max estimates, in comparison to VO2max obtained from max GXTs. VO2max levels are substantially lower in older adults with aMCI than peers (23.1±6.3 in men and 21.1±3.4 in women), suggesting aerobic exercise as an important intervention for this population.
LONGITUDINAL CHANGES IN PROTEOMIC BIOMARKERS IN ALZHEIMER’S DISEASE AND CARDIOVASCULAR DISEASE
Authors: Theeke Laurie , Liu Ying , Wang Silas , Navia R Osvaldo , Xiao Danqing , Xu Chun , Wang Kesheng
Published: December 2023

Alzheimer’s disease (AD) and cardiovascular diseases (CVDs) commonly co-occur in older adults. This correlation prompts an investigation into the potential shared risk factors linking AD and CVDs, and the potential direct causative role of cardiovascular risk factors in AD. The cohort comprised 566 older adults including 111 individuals with AD, 58 without AD, 383 with mild cognitive impairment (MCI), 410 with CVD and 156 without CVD from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). The multivariable linear mixed model (LMM) was used to investigate the associations of AD and CVD on longitudinal changes of 146 proteomic biomarkers (measured at baseline and 12-month follow-up), while adjusted for age, gender, education, racial groups, and APOE-ε4 alleles. The LMM showed that AD and CVD were associated with longitudinal changes in 48 and 46 proteomic biomarkers, respectively (p< 0.05). Interestingly, both AD and CVD were associated with longitudinal changes in 14 proteomic biomarkers (A1Micro, ApoH, B2M, BNP, Complement C3, Cystatin C, KIM1, NGAL, PPP, TIM1, THP, TFF3, TM, and VEGF). Furthermore, the single biggest risk gene for sporadic AD, APOE-ε4 was associated with 22 proteomic biomarkers. Moreover, MCI and CVD were associated with 13 proteomic biomarkers (A1Micro, ApoD, AXL, BNP, Calcitonin, CD40, C-peptide, pM, PPP, THP, TNFR2, TTR, and VEGF), while MCI, CVD and APOE-ε4 were associated with four proteomic biomarkers (A1Micro, Calcitonin, THP, and TNFR2). This study provides valuable insights into the shared and distinct pathophysiological mechanisms at play, offering a stepping-stone towards a deeper comprehension of the interrelationship between AD and CVDs.
PLASMA BIOMARKERS FOR ALZHEIMER’S DISEASE AND RELATED NEUROPATHOLOGY IN RELATION TO MCI AND DEMENTIA: THE ARIC STUDY
Authors: Sullivan Kevin , Blackshear Chad , Walker Keenan , Mielke Michelle , Windham B Gwen , Griswold Michael , Mosley Thomas , Palta Priya
Published: December 2023

Blood-biomarkers for Alzheimer’s Disease and related neuropathological processes, including amyloidosis, tau deposition, and neurodegeneration, may revolutionize the monitoring of risk and progression of neurocognitive outcomes in older adults. At visit 5 (2011-13) of the ARIC study, a multi-center longitudinal cohort study, amyloid-beta (Aβ42:Aβ40), ptau-181, glial fibrillary acidic protein (GFAP), and neurofilament light (NFL) were measured in plasma using an ultrasensitive single-molecule array (Simoa; Quanterix N4PE + p-tau-181 single-plex) in a sample of 1,711 participants (Age=76±5 years, 60% Female, 28% Black). Neurocognitive outcomes included adjudicated dementia and mild cognitive impairment (MCI) through 2019 for a median follow-up of 5.6 years. Multinomial logistic regressions estimated Relative Risk Ratios (RRR) of the four-category outcome of MCI (n=543), dementia (n=371), and death (n=59) vs. cognitively unimpaired (n=736) for each base(2) log-transformed biomarker, adjusted for age, sex, education, site-race, hypertension, diabetes, BMI, APOE, and eGFR. When estimates appeared similar for MCI and dementia, an additional analysis modeled RRR of a three-category outcome of combined MCI/dementia, death, and cognitively unimpaired. Higher plasma Aβ42:Aβ40 ratio was associated with lower MCI/dementia risk (RRR=0.48, 95%CI: 0.32,0.73). Higher levels of all other biomarkers were associated with higher risk of MCI [p-tau181 (RRR=1.57, 95%CI: 1.23,2.00); GFAP (RRR=1.31, 95%CI: 1.03,1.67); NFL (RRR=1.64, 95%CI: 1.26,2.13)] and dementia [p-tau181 (RRR=3.16, 95%CI: 2.43,4.11); GFAP (RRR=2.40, 95%CI: 1.80,3.20); NFL (RRR=3.62, 95%CI: 2.58,5.09)]. These results indicate blood-biomarkers representative of multiple neuropathological processes were strongly associated with both MCI and all-cause dementia outcomes, emphasizing their potential role as tools in risk identification, early diagnosis, and possibly guiding interventions.
EMPLOYING PHOTOVOICE TO MAP ADOLESCENT LIFE TRAJECTORIES AMID MATERNAL YOUNG-ONSET DEMENTIA: A CASE STUDY
Authors: Tang Xueting , Wang Junqiao , Wu Bei , Cui Xiaoyan , Wang Jing
Published: December 2023

The impact of parental dementia on family dynamics and roles can be substantial, presenting notable challenges for their offspring. Research concerning the life trajectory of adolescents having parents diagnosed with Young-Onset Dementia (YOD) remains limited. This study employs a combination of semi-structured interviews and photovoice through life course lens to delve into the experiences of an adolescent (Alice), exploring how her mother’s condition shapes her life journey and providing novel insights for the development of supportive services. Over a three-month period, Alice captures daily-life moments through photography and selects meaningful photos for sharing. Regular bi-weekly sessions are dedicated to photo-sharing, during which these chosen photos are regarded as pivotal subjects for in-depth exploration in subsequent interview sessions. This approach facilitates gaining insight into her life experience from a nuanced perspective. Thematic analysis reveals four key themes: Firstly, the adaptation of her future ambitions in response to her mother’s condition and increased family responsibilities, resulting in a curtailment of her educational and career prospects; secondly, building a stronger connection with her father and collaborating in shouldering responsibilities. Thirdly, her mother’s prolonged absence during critical phases of personal development impacts her understanding of interpersonal interactions and relationships, prompting a pressing need to establish empathetic connections with others; and lastly, the emergence of Alice’s distinct self-identity and resilience shaped by her unique experiences. These findings underscore the importance of establishing a family-centered support system that addresses the emotional, social, and educational challenges faced by adolescents like Alice as they navigate complex family circumstances.
SOCIAL BRIDGING NETWORKS AND COGNITIVE AGING AMONG OLDER ADULTS: ORIGINS IN SOCIAL CONTEXTS, ROLES, AND ACTIVITIES
Authors: Perry Brea , Peng Siyun , Krendl Anne
Published: December 2023

There is a strong link between social connectedness and cognitive aging, with recent research pointing to social bridging being a primary underlying mechanism. Social bridging may provide cognitive enrichment through interactions with expansive, heterogeneous, and loosely interconnected social networks of weaker, peripheral ties. Drawing on egocentric social network data and cognitive assessments of 436 older adults from the Social Networks and Alzheimer’s Disease (SNAD) study, this paper explores where social bridging networks come from. We used multivariate regression to examine whether a latent social bridging factor comprised of six structural variables (network size, density, effective size, diversity, strength of weakest tie, and sole bridging status) was associated with cognitive function and social conditions. Results indicate that social bridging is significantly associated with global cognitive function (B= 0.19; p<.0001), verbal memory (B=0.26; p<.0001), and episodic memory (B=0.21; p<.0001), consistent with prior studies. Older adults who are women (b=0.40; p<.001) and have more years of education (b=0.05; p<.05) have more access to social bridging. Among community and housing characteristics, only perceived community integration is significantly correlated with higher bridging (b=0.22; p<.05). With respect to social roles, being currently married (b=0.39; p<.001) and being a volunteer (b=0.58; p<.0001) were positively associated with bridging, while being a veteran predicted lower bridging (b=-0.86; p<.0001). Among indicators of social engagement, only number of contacts in one’s phone (in 100’s) was associated with bridging (b=.16; p<.0001). Findings provide insight into social roles and activities that can be leveraged to expand bridging and improve cognitive aging outcomes.
STRESSORS & COPING STRATEGIES OF ADMINISTRATORS IN CHINESE FAITH-BASED DEMENTIA CARE FACILITIES
Authors: Jiang Lin , Hodge David , Bonifas Robin , Sun Fei
Published: December 2023

Objectives

Identifying and meeting the spiritual needs of older adults is a central component of holistic service provision. China has more older adults than any other nation, yet a paucity of research exists on the spiritual needs of Chinese older adults. The purpose of this study was to identify: 1) common spiritual needs among Chinese nursing home residents, including the needs of residents with dementia, 2) the process staff use to identify these needs when residents are unable to verbalize them, and 3) the strategies staff use implement to meet the identified needs.

Methods

To perform this qualitative study, semi-structured interviews were conducted with 21 administrators of faith-based nursing homes, representing facilities that may be disproportionately likely to have residents with dementia. The nursing homes spanned 14 Chinese provinces. Interviews were conducted in the study participants’ native language, translated into English, and analyzed using a constant comparative methodology to identify themes.

Results

Analysis produced five interrelated themes regarding older adults’ spiritual needs, which included the need to: express their faith, receive love and care, have contact with their children, interact with others, and participate in activities. Regarding For residents with dementia who are unable to verbalize their concerns, staff used two strategies to identify spiritual needs: careful observation, and communication with family members. To address the identified needs, staff drew from local resources and attempted to personalize services whenever possible.

Discussion

The findings offer guidance to individuals providing holistic care that addresses Chinese older adults’ spiritual needs.
THE QUALITY OF DAY SCALE AND THE LIVING WELL INVENTORY: TWO NEW MEASURES FOR INDIVIDUALS WITH DEMENTIA AND CAREGIVERS
Authors: Molony Sheila , Fazio Sam , VanHaitsma Kimberly , Feinn Rich , Zimmerman Sheryl
Published: December 2023

Background

Differences in adaptive strategies used by individuals living with dementia have the potential to impact wellbeing. Two new measures were developed using human-centered design to capture daily adaptive strategies and outcomes. The Living Well Inventory for Dementia (LWI-D) and the Quality of Day Scale (QODS) capture important aspects of wellbeing that illuminate options for care and support. Purpose: To provide results from the initial evaluation of the LWI-D and the QODS for face validity, content validity and user acceptability.

Methods

Acceptability and feasibility testing was conducted with a sample of 17 community-dwelling individuals with early stage dementia (MOCA scores 12-30). After measure optimization, a second pilot test was conducted with 30 dyads (persons living with dementia and family caregivers) in community and residential settings.

Results

Persons with dementia can use and accurately interpret the QODS, preferring a version with graphic icons. Of the 31 items on the development version of the LWI-D, 17 items were acceptable, meaningful, and easily answered. Additional items yielded meaningful qualitative responses but needed minor revision. Some participants disliked the Likert-type response format, and new administration guidelines were used for the second pilot. Additional outcomes include convergent validity between the LWI-D and the QODS with measures of positive affect-balance, quality of life and wellbeing.

Conclusion

The LWI-D and the QODS are rigorously developed promising measures that warrant further testing and may enhance the ability to a) identify strengths in living well with dementia and b) identify and test news interventions to bolster care and support.
A SYSTEMS APPROACH ON THE IMPACT OF ENVIRONMENTAL RACISM AND CLIMATE CHANGE ON RESIDENTS OF VINE CITY IN ATLANTA GA
Authors: Mayfield Kellie , Akintola Kehinde , Foley Sophia , Willis Angelique , Cook Miranda
Published: December 2023

There are three interlocking factors impacting the health of older-adults. First is food access, the ecologies of their community and the systems they interact with. In the community of this study the local grocery store closed limiting food access. The ecology of the environment is a heat island; which leads to the incidence of higher mortality amongst other health effects. The interacting systems are the economy, ageism, classism, racism, and, sexism. This conceptual model encapsulates the environment impacting one community of older adults in Atlanta, GA from a mixed methods study employing survey and photoelicitation with the purpose of examining the facilitators and barriers to healthy eating by senior-center clients served by Open Hand Atlanta; a meals and nutrition education provider. Descriptive statistics showed food insecurity to be double that of older adults statewide (19%), 7.9 % reporting consuming at least 5 cups of fruit and vegetables per day, and participants were mostly black women (79 %) . Additionally, residents also live in a community where a portion has been deemed a toxic Superfund site because of elevated levels of lead in soil. The model, therefore, contributes to a comprehensive understanding of how the health of older adults is impacted by a multitude of systems and climate change. It can be used as a guide for other communities, community-dwelling older adults, and older-adult service providers. Furthermore, this model illustrates the systems impacting the health of older southern adults.
CLIMATE CHANGE AND EMERGENCY PREPAREDNESS FOR HURRICANES AMONG NURSING HOMES IN TEXAS
Authors: Downer Brian , Holland Alexandra , Kang Yejin , Lacy Briana , Xu Huiwen
Published: December 2023

Hurricanes are a major threat to nursing homes along the Texas Gulf Coast, and climate change will increase inland nursing homes’ risk of catastrophic winds and flooding. The Centers for Medicare & Medicaid Services (CMS) uses twenty-five regulations to assess nursing homes’ emergency preparedness. This study compares the prevalence of any deficiencies in emergency preparedness regulations between Texas nursing homes in coastal and non-coastal counties. We also investigate the risk of future flood and wind events for nursing homes in non-coastal counties with any emergency preparedness deficiencies. Information for emergency preparedness deficiencies came from CMS inspection surveys. We used data from the First Street Foundation for the percentage of properties in a census tract with severe-extreme risk of flooding and damaging winds in 30 years. We used quartiles to define our highest risk categories as the census tracts with >7% of properties with severe-extreme risk for flooding and >50% with severe-extreme risk for damaging winds. The final sample included 1,153 nursing homes. The percentage of nursing homes with any deficiencies was significantly higher in non-coastal (13.9%) than coastal (8.7%) counties. This difference remained statistically significant after adjusting for ownership type, overall rating, and number of beds (OR=0.57, 95% CI=0.33-0.94). Among the 131 non-coastal nursing homes with any emergency preparedness deficiencies, 21.4% and 12.2% were in the highest risk categories for future flood and wind damage. Texas nursing homes, especially those in non-coastal counties, must be aware of their increasing hurricane risk and prepare to keep residents safe.
SUPPORTING A MOTHER WITH DEMENTIA WHO MISTREATED ME: CAREGIVING EXPERIENCES OF STRAINED MOTHER-DAUGHTER DYADS
Authors: Nemec Mary , Girling Laura
Published: December 2023

Providing care to an aging parent is a normative expectation within most modern societies. Research steadily demonstrates that around two-thirds of caregivers are women, and over one-third of dementia caregivers are adult daughters. Often there is an assumption of natural attachment between mother and daughter—unconditional loyalty and permanent availability. However, overlooked in the literature is the notion that some adult daughters struggle with caregiving decisions regarding a parent with whom they have been maltreated. To date, little research has focused on dementia caregiving dynamics within strained mother-daughter dyads. To address this knowledge gap, data were drawn from the Aging at Home Alone with Alzheimer’s Disease study, an interview-based protocol with a purported sample of 120 community dwelling persons with dementia and their study partner. Thematic analyses were conducted on the subsample of daughters and their mothers with dementia (n=10) who reported a history of maltreatment (e.g., childhood neglect, childhood abuse). Thematic analyses were conducted on all case material for the subsample (e.g., interview data, case notes). Findings indicate four overarching themes: 1. Begrudging caregiving, 2. Fragmentary support, 3. Resurfacing childhood trauma, and 4. Post-traumatic growth and forgiveness. These themes stress the importance of how childhood maltreatment can shape emotional bonds early in life and affect dementia caregiving trajectories. Findings will be discussed in relation to support recommendations for caregiving dyads with a history of parental maltreatment.
ADDRESSING THE COMPLEX DRIVING NEEDS OF AN AGING POPULATION: THE RISE OF AUTONOMOUS VEHICLES
Authors: Carr David , Devos Hannes , Akinwuntan Abiodun , Babulal Ganesh
Published: December 2023

Eighty-eight million Americans will be age 65 or older by 2050 and 25% of all drivers will be ≥ 65 years old. Technology has the potential to address some issues such as the inability to drive in advanced age. We postulate that continuing to drive with the use of Advanced Driver Assistance Systems (ADAS) and/or maintaining social connectedness with the use of autonomous vehicles (AVs) have the potential to slow down or reduce the impact of age-related diseases and enhance social mobility. ADAS are electronic technologies that assist drivers in safely operating a vehicle by detecting crash risk stimuli and reducing driver error. Older drivers’ willingness to use ADAS depends on individual perceived usefulness, safety, ease-of-learning, and anxiety. Based on the SAE levels of automation (0-5) , level 3-5 AVs can detect, evaluate, and respond to the vehicle environment without human involvement. Still, ADAS and AV technology cannot completely supplant all human driving and it cannot independently determine crash risk and safety. Comprehensive studies are needed to prove the effectiveness of ADAS in reducing crash risk among older drivers, especially those who are most vulnerable. In addition, AV manufacturers need to take into account the requirements and needs of providing this type of mobility service to older adults, especially those with chronic neurodegenerative diseases like dementia. If these technologies are eventually shown to be safe and embraced by older adults, they have the potential to delay driving cessation, prolong quality of life and maintain social connectedness.