bluuebunny/crossref_metadata_2025 huggingface dataset:
MULTIMORBIDITY PATTERNS AND COGNITIVE CHANGE AMONG MEXICAN OLDER ADULTS IN THE MEXICAN HEALTH AND AGING STUDY
Authors: Bishop Nicholas , Botoseneanu Anda , Markwardt Sheila , Zambrano Priscilla , Walker Kealie , Quiñones Ana
Published: December 2023

Multimorbidity (≥ 2 chronic conditions) increases the risk of non-normative cognitive decline. Among Mexican older adults, little is known about 1) the prevalence of multimorbidity, 2) patterns of multimorbidity, and 3) the relationship between multimorbidity patterns and cognitive decline. We used representative data from the Mexican Health and Aging Study to estimate prevalence of multimorbidity, identify common multimorbidity patterns, and examine associations between multimorbidity patterns and cognitive change from 2012–2015 in Mexican adults aged ≥ 65 (n=5,079; mean age: 72.2 (SD=6.1)). Chronic conditions including hypertension, diabetes, cancer, lung disease, heart attack, stroke, and arthritis were measured in 2012, and cognitive function was assessed in 2012 and 2015 using the Cross Cultural Cognitive Examination (CCCE; range:3–96). We used descriptive analyses to estimate multimorbidity prevalence and identify disease patterns, then used weighted linear regression (adjusted for age, sex, martial/partnership status, education, literacy, and household income and wealth) to estimate associations between multimorbidity patterns and cognitive change (modeled as CCCE-2015 regressed on CCCE-2012). In 2012, 50.7% of respondents reported multimorbidity and average CCCE score was 46.6 (SD=17.2). From 2012–2015, CCCE decreased on average 2.7 units (SD=13.1). Disease patterns with ≥ 2% prevalence included hypertension+depression (6.0%), hypertension+arthritis (5.9%), hypertension+diabetes (5.8%), hypertension+arthritis+depression (5.4%), hypertension+diabetes+depression (2.8%), hypertension+diabetes+arthritis (2.7%), and arthritis+depression (2.1%). Compared to those reporting no conditions, respondents reporting arthritis+depression (b=-3.88, CI=-6.11:-1.66), hypertension+diabetes (b=-3.72, CI=-5.33:-2.11), or hypertension+diabetes+depression (b=-3.41, CI=-5.32:-1.21) experienced greater cognitive decline. Our results suggest diabetes and depression are common elements of multimorbidity associated with cognitive decline in Mexican older adults.
MULTI-OMICS INTEGRATION IDENTIFIES GENES INFLUENCING TRAITS ASSOCIATED WITH CARDIOVASCULAR RISKS
Authors: Acharya Sandeep , Liao Shu , Jung Woo Seok , Kang Edward , Moghaddam Vaha Akbary , Feitosa Mary , Province Michael , Brent Michael
Published: December 2023

The Long Life Family Study (LLFS) enrolled 4,953 participants in 539 pedigrees displaying exceptional longevity. To identify genetic mechanisms that protect LLFS participants against age-related cardiovascular risks, we developed a freely available multi-omics integration pipeline and applied it to 11 traits associated with cardiovascular risks. Using our pipeline, we aggregated gene-level statistics from Rare-Variant Analysis, GWAS, and gene expression-trait association by Correlated Meta-Analysis (CMA). Across all traits, CMA identified 51 significant genes after Bonferroni correction (P ≤ 2.8×10-7). CETP, NLRC5, SLC45A3, and TOMM40 lie within 50 Kb of a known trait-associated variant (previously associated genes). Analysis of protein-protein interaction (PPI) networks identified another 63 genes (passing genes) that (1) have CMA p-value ≤ 5×10-3, (2) lie in a PPI module (highly connected subnetwork) enriched for genes with low P-values, and (3) are annotated with a biological process that is enriched among module genes, ten of which were previously associated with the same traits. Permutation analysis showed that passing genes have a false positive rate of 1 in 14876 and are more likely to be previously known than non-passing genes with similar p-values. CMA improved on the 3 input analyses by producing the largest number of modules enriched for genes with low P-values and highly enriched for genes participating in shared biological processes. Overall, module analysis identified highly plausible candidate causal genes whose P-values after CMA alone were merely suggestive.
NARRATIVE-DRIVEN RECRUITMENT MESSAGING TO ENHANCE ETHNORACIAL DIVERSITY IN AD RESEARCH
Authors: Lingler Jennifer , Knox Melissa , Williams Ishan , Cameron Judy , Robinson Rena , Tamres Lisa , Terry Melita , Ren Dianxu
Published: December 2023

Underrepresentation of persons of color in research on Alzheimer’s disease (AD) is a longstanding issue that is receiving unprecedented attention following reports of severely inadequate racial and ethnic diversity in clinical trials of the field’s first anti-amyloid therapies to secure Food and Drug Administration approval. The Recruitment Innovations for Diversity Enhancement (RIDE) Study is one of several federally supported initiatives to address key aspects of this complex and multi-faceted challenge facing the AD research community. RIDE is a multi-phase study to determine the effect of a culture-centric narrative campaign on recruitment of African American adults into clinical research on AD and related disorders. This presentation aims to contrast the RIDE study’s “narrative driven approach” to “traditional research messaging” with approaches typically found in research recruitment materials. Narrative driven messaging draws on the words, perspectives and stories from members of a culture-sharing group themselves, while traditional approaches aim to educate research candidates about potential benefits and risks of participation using language scripted from investigators’ perspectives. We will demonstrate how the narrative driven approach in RIDE focuses on a) prioritizing information that active research participants from a given culture-sharing group identify as most important and b) sharing that information in the form of culturally relevant stories. The potential benefits of this approach include a concrete, replicable strategy that can be readily implemented by other researchers. This is significant because recruiting representative samples in AD research is foundational to conducting the studies necessary to understand and combat race-based cognitive health disparities.
NAVIGATING CAREWORKER CURRICULUM REVISION IN SOUTH KOREA: CHARTING COURSES FOR ELEVATING PRACTICE COMPETENCIES
Authors: Park Jihyun , Kim Jinhak , Sung Mira
Published: December 2023

The purpose of this study is to comprehensively investigate and analyze the process of revising the careworker curriculum in South Korea with a primary focus on augmenting practice competencies. This research involved an analysis of the existing 240-hour curriculum, complemented by a comprehensive literature review. Additionally, Focus Group Interviews were conducted with a cohort of 20 present careworkers to effectively identify the prevailing needs within the practice field. This study expanded the curriculum duration from 240 to 320 hours. Subsequently, pilot courses were executed, incorporating enhanced content related to dementia care, humanity in caregiving, and infectious disease management. These modifications were delivered via webinars to 64 active care workers, a method chosen due to the constraints imposed by the COVID-19 pandemic. This study employed a pre-post design to inquire about the perceptions of older adults and their job skills. Fifty-four female care workers (84.2%) and eleven male care workers (15.8%) participated in the study, with an average age of 52 years, experiencing 3 years and 8 months. Several areas exhibited statistical significance; understanding and managing depression and anxiety (2.175*), supporting leisure activities(2.956**), implementing abuse prevention behaviors (3.187**), creating a safe environment(2.496**), assisting with mobility(2.978**), aiding in illness management(2.805**), transferring responsibilities(2.726**), documenting cases(2.238*), and overseeing caregiver health and safety(2.805*). Based on our findings, we have devised a plan to incorporate the following content within the additional 80 hours. In a broader context, this study contributes to the ongoing discourse on caregiver education and training in South Korea.
NAVIGATING LIFE’S PHASES: CONTROL PERCEPTIONS AND GOAL ORIENTATION IN YOUNGER AND OLDER AGE GROUPS
Authors: Muskin Ryan , Allard Eric , Suri Sachin
Published: December 2023

This study examines age-related differences in the perceptions of control and goal orientation among younger adults (ages 18-35) and older adults (aged 60+). A cohort of 57 younger adults and 51 older adults were exposed to a series of emotionally evocative videos portraying diverse scenarios involving varying levels of control and distinct growth or preservation goals. Participants evaluated perceived control, growth orientation, and preservation orientation using 10-point Likert scales. Our findings reveal significant disparities between the two age groups. Older adults exhibited diminished perceptions of control across all videos (p < .001) compared to their younger counterparts. Conversely, younger adults consistently displayed a heightened sense of growth orientation across the videos (p < .001), without significant age-based variations in perceptions of preservation goals. These outcomes contribute to our comprehension of developmental trajectories in perception and relevance appraisal, along with emotion evaluation. Our hypothesis posits that the disparity in control perceptions stems from age-related losses such as diminished cognitive and physical capabilities, as well as experiences like bereavements. In contrast, the robust growth, competition, and development characteristic of younger adulthood may foster the tendency to perceive the world through these lenses. By shedding light on the intricate interplay between age, control perceptions, and goal orientations, this study advances our understanding of cognitive and emotional dynamics across the lifespan. The implications are far-reaching, offering insights into potential interventions for age-related emotional well-being and adaptive coping strategies.
NEIGHBORHOOD STRESSORS AND EPIGENETIC AGING AMONG OLDER ADULTS IN THE U.S
Authors: Choi Eunyoung , Ailshire Jennifer
Published: December 2023

Exposure to stressful neighborhood environments is a well-established risk factor for health deterioration and premature death. However, the underlying biological underpinnings driving these associations are not fully understood. Epigenetics may function as a key molecular pathway to adverse health outcomes among residents of high-stress neighborhoods. This study examines the association of neighborhood stressors (i.e., socioeconomic deprivation, disorder, and low social cohesion) with three epigenetic aging measures (i.e., DunedinPACE and Principal component adjusted (PC) PCPhenoAge and PCGrimAge) based on DNA methylation levels. Further, we identify sub-populations that are particularly vulnerable to the detrimental effects of neighborhood stressors. Data were from the 2016 Health and Retirement Study (HRS) DNA Methylation Sample, merged with neighborhood stressors measured in the HRS 2012/2014 and the 2012-2016 American Community Survey (N=3,201). Multilevel regression models adjusting for confounders showed that perceived high disorder was associated with accelerated DNAm aging for DunedinPACE (β=0.13, 95%CI=0.04-0.23). Perceived low cohesion was associated with accelerated DNAm aging for DunedinPACE (β=0.21, 95%CI=0.08-0.35) and PCGrimAge (β=0.09, 95%CI=0.04-0.14). High deprivation did not have any significant associations. In models of interactions, associations of low cohesion were more pronounced for females in DunedinPACE (β=0.36, 95%CI=0.13-0.60) and PCPhenoAge (β=0.21, 95%CI=0.07-0.35). No other interaction effects were found for race/ethnicity, living arrangement, and education. Our findings indicate that neighborhood stressors can speed up epigenetic aging, with older females being particularly vulnerable to the effects of low cohesion. This study provides insights into the biological foundations of health disparities rooted in neighborhood environments.
NURSING HOME INVESTMENT IN HEALTH INFORMATION TECHNOLOGY – AN ORGANIZATIONAL SLACK PERSPECTIVE
Authors: McHugh John , Alexander Gregory
Published: December 2023

Organizational slack refers to excess resources (e.g., financial, social capital, human capital) an organization accumulates to adapt to changing internal and external contexts. Nursing homes operate in a severely resource-constrained environment, and therefore have limited ability to accumulate organizational slack. However, nursing homes that do accumulate slack may be more likely to invest in health information technology (HIT). To test this, we examine associations between organizational slack and HIT maturity. HIT maturity is the level of IT capabilities, extent of use, and integration in resident care, clinical support, and administration. We linked 2018 data from a national nursing home HIT maturity survey (N=525) to nursing home characteristics from LTCfocus.org, CMS data, National Center for Health Statistics, Medicare cost reports, and other county-level statistics. We incorporated Simple Linear Regression, controlling for facility-level sex, race, case-mix, and urban/rural location. Average 3-year operating income for Stage 0 nursing homes was -$4,387 per bed (n=7) compared to $42,768 per bed in Stage 6 nursing homes (n=17). Higher HIT maturity was associated with greater percentages of Medicare patients and shorter distances to the closest hospital. Our regression model also demonstrated significant associations with operating income per bed, chain affiliation, total beds, occupancy percentage, moderately concentrated counties and case-mix adjusted staffing. In this sample, larger, more financially stable organizations (i.e., those with more slack) may be able to invest more in HIT. As HIT maturity has been shown to be associated with improved patient outcomes, disparities may widen in organizations with lower levels of slack.
NURSING STUDENTS’ EXPERIENCES REGARDING PHYSICAL RESTRAINTS: AN INTEGRATIVE REVIEW
Authors: Shin Juh Hyun , Kong Eun-Hi
Published: December 2023

Many harmful effects related to the use of physical restraints have been reported and restraint-free care has been advocated for in many countries. However, the prevalence of physical restraint use is still high in many care settings around the world. There has been no systematic review study focused on nursing students regarding physical restraints. This study aimed to critically review the existing studies targeting nursing students related to physical restraint using an integrative review method. This study was registered in PROSPERO(CRD42023414410). Eleven electronic databases were searched by two authors: CINAHL, PubMed, EMBASE, PsycINFO, ERIC, Education Source, SCOPUS, RISS, DBpia, Cochrane, and KoreaMed from the earliest year to 2023. A total of 19 studies including diverse research designs were selected. For quality appraisal, both the Mixed Methods Appraisal Tool (MMAT) and the Joanna Briggs Institutes (JBI) checklist were employed. Most studies were conducted in acute clinical care settings. Many studies used a cross-sectional study design, convenience sampling method, small number of participants, and weak measurements. There was a lack of experimental studies, mixed methods studies, and financially funded studies. The main outcomes were nursing students’ attitude, knowledge, perception, or practice regarding physical restraints. This integrative review provided new knowledge and understanding about nursing students’ experiences regarding physical restraints. Future studies must use more robust research design, sample size, and measurements with research funding. This study showed that more research and education targeting nursing students are needed to achieve restraint-free care.
NUTRITIONAL STATUS AS A RISK FACTOR FOR DEPRESSION AMONG OLDER ADULTS RECEIVING COMMUNITY-BASED AGING SERVICES
Authors: Goldsworthy Mary , Boaz Timothy , Gum Amber , Schonfeld Lawrence
Published: December 2023

Nutritional status is a significant determinant of overall health and well-being among older adults and is linked to adverse mental health outcomes, such as depression. This study examined nutritional status as a risk factor for depression among 4,469 older adults receiving home- and community-based services from agencies overseen by a five-county Area Agency on Aging in west central Florida. It was hypothesized that older adults with a higher nutritional score (i.e., increased risk of malnourishment) would be more likely to have elevated depressive symptoms compared to those with lower nutritional risk. The cross-sectional study used secondary data from the AAA, including demographic and social variables, a 20-point nutritional risk score, and the Patient Health Questionnaire-9 (PHQ-9; not depressed = 0-9, depressed = >10) from clients in the AAA planning and service area. In logistic regression, the most significant predictor of depression was the client’s nutrition score (OR= 1.22, p < 0.0001). This OR suggests that, for every 1-point increase of the nutrition score, the odds of being depressed increases by 22%. The findings suggest that older adults receiving aging services with worse nutritional status are at increased risk of depression, consistent with other studies. The findings suggest that programs focused on improving nutritional status among older adults may reduce depressive symptoms may improve and may potentially improve long-term physical and mental health outcomes and decrease healthcare burden.
OFFSPRING EDUCATIONAL (DIS)ADVANTAGE, MECHANISMS, AND COGNITIVE FUNCTION IN KOREA
Authors: Cha Hyungmin
Published: December 2023

Adult children’s education plays a significant role in parental cognitive well-being later in the life course. However, there is limited evidence in rapidly changing societies, leaving several key questions unanswered, including (1) whether the effects of offspring educational disadvantage can also flow upward, (2) whether these effects operate through similar explanatory mechanisms, such as financial, social, and informational support from their children, as seen in educational advantage, and (3) whether gender moderates these associations. Focusing specifically on Korea, a society where education has expanded rapidly and support from children is increasingly crucial, this study utilizes longitudinal data from the Korean Longitudinal Study of Aging (2006-2018) to demonstrate the role of offspring education in cognitive function during mid-to-late life. First, having adult children with a college degree or higher is associated with elevated levels of cognition and slower cognitive decline, whereas having adult children with less than a high school education is linked to lower levels of cognition and faster cognitive decline during mid-to-late life. Second, the association between adult children’s education and cognitive health, regardless of whether they have a college degree or less than a high school education, remains robust even after accounting for various other mediators. Third, while the effect of adult children’s education is more pronounced for mothers compared to fathers, children’s gender does not moderate the association. Together, I offer a novel explanation for the association between offspring educational advantage and disadvantage, and their connection to parental cognition and its subsequent decline in rapidly changing society.
ORGANIZATIONAL COMMUNICATION STRATEGIES IN NURSING HOMES: A SCOPING REVIEW
Authors: Gordon Julie , Smith Patsy
Published: December 2023

A scoping review was conducted to learn more about strategic organizational communication within long-term care. Strategic organizational communication is a purposeful, system-wide, and system-level effort to transform the organization and delivery of care and services to make it easier to navigate, understand, and coordinate care. Care in nursing homes is complex and must consider residents’ goals, values, and preferences. Communication strategies enacted at the system-level may include direct care staff, human resources, nursing-to-resident and family interactions, and care planning. Strategies at the institutional or system-wide level also include corporate stakeholders, administration, and employee leadership. The aim of the literature search was to locate evidence of communication strategies that reflect corporate and organizational goals, and that exemplify the processes by which communication influences administrative policy. Key words in the search were entered in varying iterations and combinations with the guidance of a skillful research librarian. Key words were long-term care, communication, feedback, nursing homes, patient-centered care, quality improvement. Returns were greater than 2,000, yet seemingly relevant abstracts were fewer than 300, and selected articles were fewer than 30. The research reports reviewed were explanatory or explorative and just one article was found to explore the role of communication strategies and the impact on organizational outcomes. Further, no research reports were found to discuss strategic organizational communication and a combination of resident and organizational outcomes. Rather, most work described specific communication interventions among key groups, many of which lacked sustainable impact. Study results, limitations, and examples of communication strategies are presented herein.
PERCEPTIONS OF OLDER ADULTS ON YOGA-BASED INTERVENTIONS FOR MULTIMORBIDITY IN MYSORE, INDIA
Authors: Muralidhar Kiranmayee , Madhivanan Purnima , Behal Anil , Srinivas Vijaya , Ningaiah Nagalambika , Jaykrishna Poornima , Shidhaye Rahul , Krupp Karl
Published: December 2023

Globally, over half of older adults suffer from ≥2 chronic diseases. In India, proven exercise interventions are limited by individual, social, environmental and policy-level factors. We aimed to qualitatively explore perceptions about yoga interventions for healthy aging in Mysore, India. In collaboration with the Community Advisory Board, we developed a qualitative assessment of knowledge, attitudes and behaviors around yoga among seniors. Between August-September 2022, we conducted focus group discussions (FGDs) with older adults, after obtaining informed consent. Interviews were recorded, transcribed, and translated from the local language Kannada. Data were coded manually, and emerging themes were identified. We conducted 4 FGDs of 7-8 participants each; 14 male and 13 female older adults participated, and their average age was 66.1±4.3 years; 88.9% had at least 10 years of education. Most participants expressed interest in yoga for health maintenance, specially mentioning its Indian roots, but did not prioritize it for routine practice. Yoga practice was also a means to reduce social isolation for many. Reported challenges in adopting yoga practice included inaccessibility to instructors and dependence on family members. Cultural barriers especially affected women, including ageism and gender role expectations. Women reported hesitancy to express their desire to learn yoga due to perceived negative reactions from their younger family members and their community. Promoting health promotion practices among older Indian adults is challenging primarily due to cultural norms and changing family dynamics with age. Promoting healthy behaviors among them through yoga will first involve family education and consent.
PERSON-CENTERED DEMENTIA TRAINING ONLINE FOR BSN STUDENTS: A PILOT STUDY
Authors: Sturdevant Diana , Broussard Kimetha , Kleszynski Keith , Jennings Lee
Published: December 2023

We launched a Person-Centered Dementia Training in March 2023, focused on Four interactive modules were offered via an Online Learning Platform. Topics included: Introduction to Dementia, Communication Process and Approach, Environmental and Cultural Implications in Dementia Care, and Best Practices in Responding to Difficult Behaviors. Subtopics included: Introduction to Age-Friendly and Dementia-Friendly Care, High-risk Medications and Dementia Care, Dementia vs Delirium, and Reframing Aging—Understanding and Recognizing Ageism Specific to People Living with Dementia. BSN students were recruited via (3) email blasts and (1) in-person announcement of participation opportunity. A total of (n=33) participants were recruited from 4 nursing programs, Traditional BSN Junior (34%), Traditional BSN Senior (48%), Degree Completion LPN to BSN (3%) and Accelerated BSN (14%). Most participants were female (96%), between the ages of 18-24 (60%). 24 participants completed the pre-/post-test and Final Program Evaluation. Participants rated the course content and structure as 4.5/5 on 5pt-likert scale. Common themes from evaluations included: need for additional content, more interactive activities, and inclusion as a required course for all nursing students. Future steps to include revising course content based on participant feedback, offer revised course over the next 2 academic semesters, and expand reach by offering course to practicing nurses to improve care of people living with dementia (PLWD).
PLANT PROTEIN BUT NOT ANIMAL PROTEIN CONSUMPTION IS ASSOCIATED WITH FRAILTY THROUGH PLASMA METABOLITES
Authors: Toshiko Tanaka , Das Jayanta , Tian Qu , Moaddel Ruin , Moore Ann Zenobia , Tucker Katherine , Talegawkar Sameera , Ferrucci Luigi
Published: December 2023

There is evidence that the association of protein intake and frailty may depend on the source of dietary protein. The mechanism underlying these associations are not clear. In this study, we explore circulating metabolites as mediators of the relationship between dietary protein and of frailty in participants of the Baltimore Longitudinal Study of Aging (BLSA). Cross-sectional analyses in 735 BLSA participants of associations between plant and animal protein intake and frailty. Usual protein intake from plant and animal sources were estimated with a Food Frequency Questionnaire (FFQ) and frailty was assessed with a 44-item Frailty Index (FI). Compared with the lowest quartile, higher quartiles of plant, but not animal, protein were associated with lower FI. Twenty-five plasma metabolites were associated with plant protein intake; of these, 15, including phosphatidylcholines, cholesterol esters, sphingomyelins, and indole metabolites mediated the association between plant protein intake and FI. The protective association between plant protein consumption and FI is mediated by lower abundance of lipid metabolites and higher abundance of tryptophan-related metabolites.
PREVALENCE AND CORRELATES OF DEPRESSION IN OLDER ADULTS: FINDINGS FROM THE LONGROAD STUDY
Authors: Xi Yitao
Published: December 2023

As an important public health issue, depression has been studied extensively in children and young adults. Epidemiologic data on depression for older adults are scant. The Longitudinal Research on Aging Drivers (LongROAD) project was a prospective cohort study of 2990 drivers aged 65-79 years at baseline and recruited between July 2015 and March 2017 from five sites (Ann Arbor, Baltimore, Cooperstown, Denver, and San Diego) in the contiguous United States. Study participants were assessed at baseline with the Patient-Reported Outcomes Measurement Information System (PROMIS). The objective of this study was to examine the prevalence and correlates of depression in older adults participating in the LongROAD project. Of the 2990 older adults studied, 186 (6.2%) participants had depression at the time of enrollment, with the lifetime prevalence of depression being 20.3%. Only 21.9% of the older adults with depression were taking antidepressants. A significantly higher prevalence of depression was found among those who were female (7.2%), not currently married (9.1%), with annual household income less than $20000 (11.9%), having diabetes (9.1%), having anxiety disorder (15.5%), with exercising routine (6.9%), and without doing volunteering work (7.9%). No significant difference was found between urban and rural residents, but urban residents had slightly higher depression prevalence (6.4%). About 1 in 16 older adults has depression. The majority (78%) of older adults with depression are not treated with antidepressants. Depression screening and treatment programs are needed for older adults, particularly women, those living alone, and those in poverty. Volunteering work could potentially decrease depression prevalence.
PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY ORGANIZATIONS FLIP THE SCRIPT IN RESPONSE TO COVID-19
Authors: Perry Morgan , McCall Stephen , Dorris Joseph , Nardone Michael , Turner Ani , Obbin Samuel , Stanik Christine
Published: December 2023

The Program of All-Inclusive Care for the Elderly (PACE) is a unique care delivery model providing comprehensive, community-based, person-centered services to older adults. The COVID-19 pandemic posed unprecedented challenges for PACE organizations to continue providing services while mitigating infection risk, and they were agile and creative in their response. This study leveraged two national surveys and six interviews with PACE directors to examine how PACE organizations met these challenges. The response rate was 71.2% for the first survey and 67.8% for the second. Results revealed a rapid transition of the PACE model from primarily center-based to home-based care. To aid this transition, PACE organizations redeployed staff, repurposed day centers, and leveraged technology, among other strategies. Most PACE organizations plan to continue delivering more services in the home, consistent with participant preferences. The findings from this study indicate that PACE organizations continued to keep participants at the forefront as they transitioned to a home-based model. These findings highlight PACE organizations’ ability to empower nursing-home-eligible older adults to remain living in their preferred residential setting and could inform lasting changes in PACE service delivery.
PROSPECTIVE ASSOCIATION OF INTRINSIC CAPACITY WITH FALLS AND MULTIPLE FALLS IN OLDER ADULTS (NHATS)
Authors: Shi Kewei , He Lingxiao , Chen Xiaodong , Fang Ya
Published: December 2023

Background

Intrinsic capacity (IC) is a recently proposed novel metric of evaluating the overall health condition of older people. The IC has been associated with multiple adverse health outcomes while its associations with falls and multiple falls in community-dwelling older adults are not well studied.

Methods

2113 community-dwelling older adults (aged 68-97 years) were selected from two waves of the National Health and Aging Trends Study (NHATS). Data of five IC domains (cognitive, sensory, locomotion, vitality, psychological), falls and multiple falls were collected via questionnaires at baseline and a 4-year follow-up. The IC was evaluated as an IC score calculated by averaging the Z-score in each IC domain. Logistic regression was used to analyze the associations between falls and IC scores with controls for age, gender, marital status, comorbidity index and social activity index.

Results

A higher baseline IC score was associated with a lower risk of falls (OR= 0.459, 95%CI [0.309,0.681]) and multiple falls (OR= 0.278, 95%CI [0.154, 0.502]). Participants with smaller IC score change demonstrated greater risk of fall (OR= 0.512, 95%CI [0.336, 0.777]) and multiple falls (OR= 0.238, 95%CI [0.128, 0.435]). In terms of interactive effects, there were also no significant interactions between baseline IC score and IC score change in their associations with fall outcomes.

Conclusions

The IC is longitudinally associated with falls and multiple falls in older adults. Our findings emphasize the potential role of IC as a valuable marker for predicting fall risk in the older population.
PSYCHOSOCIAL PHENOTYPES OF OLDER ADULTS WITH PAIN AND THEIR ASSOCIATED CLINICAL OUTCOMES
Authors: Holmes Ashleigh , Wang Weijun , Chang Yu-Ping
Published: December 2023

Older adults experience higher rates of pain than any other age group, with a domino effect on quality of life and well-being. Existing literature reveals associations between pain and adverse psychosocial, physical, and cognitive outcomes, with psychosocial variables linking all other aspects of well-being in older adults. Therefore, a comprehensive understanding of the associations of psychosocial variables with clinical outcomes in older adults with pain is needed. Grounded in the Biopsychosocial Model of Chronic Pain for Older Adults, we analyzed cross-sectional 2021 data from the nationally representative survey conducted by the National Health and Aging Trends Study. We performed latent class analysis to identify psychosocial clusters (including anxiety, depression, affect, self-realization, resilience, and social participation) of older adults with pain and then used multiple regression analyses to compare pain characteristics, physical health, and cognition among different clusters. We identified four clusters: “Intermediate Psychosocial Phenotype,” “Favorable Psychosocial Phenotype,” “Adverse Psychosocial Phenotype,” and “Compensated Psychosocial Adversity.” Clusters with more psychosocial adversity had worse pain, physical, and cognitive outcomes while controlling for race/ethnicity, gender, and age. Increased self-realization and resilience were seen in clusters with better clinical outcomes. Our findings provide important information for precision pain management interventions for older adults based on their psychosocial phenotypes. Further research should analyze longitudinal trajectories of psychosocial phenotypes as older adults’ pain experience progresses. Clinically, pain treatment decisions should include a comprehensive evaluation of psychosocial factors, with associated health policy initiatives aimed at assessing differences in care utilization and cost among older adults based on phenotype.
PTSD IS ASSOCIATED WITH LONGITUDINAL CHANGES IN DOMAIN-SPECIFIC COGNITIVE FUNCTION IN OLDER ADULTS
Authors: Lawrence Karen , Speaks Hannah , Abner Erin , Schmitt Frederick , Vasterling Jennifer , Smith Brian , Segerstrom Suzanne
Published: December 2023

Posttraumatic stress disorder (PTSD) is associated with an increased risk for all-type dementia yet whether PTSD is associated with domain-specific cognitive decline, that may lead to dementia, is unknown. Using existing data from the National Alzheimer’s Coordinating Center, we tested the hypothesis that PTSD is associated with cognitive decline in episodic memory, working memory and attention, and executive function. After exclusion for history of dementia, stroke, Down syndrome, Parkinson’s and Alzheimer’s diseases, schizophrenia, and neurodevelopmental disorders, 130 (1.25%) participants with PTSD and 10,261 (98.75%) without PTSD remained. Prior to analysis, inverse probability of treatment weighting was used to adjust for confounding. Inverse probability estimates were based on PTSD status and conditional on covariates for age, sex, race, ethnicity, APOE ɛ4 status, anxiety, depression, TBI status, diabetes, and hypertension. Generalized estimating equations (GEE)-type linear regression models with robust standard errors were fit to the weighted data for z-scores for each cognitive domain. During the study, unexpectedly, PTSD was associated with an additional .043 standard deviations of improvement in episodic memory (b = .043, 95%CI: .020, .066) compared to the same population without PTSD. Expectedly, PTSD was associated with an additional .143 standard deviations of decline in working memory and attention (b = -.143, 95% CI: -.225, -.062) and an additional .415 standard deviations of decline in executive function (b = -.415, 95%CI: -.563, -.267). Investigations are ongoing to probe the unexpected finding for episodic memory. These findings suggest that PTSD should potentially be a target for early prevention of cognitive decline.
QUALITY OF LIFE AND NUTRITION SCREENING: OVERLAPS, OPPORTUNITIES, AND IMPLICATIONS FOR HEALTHY AGING
Authors: Arensberg Mary Beth , Gahche Jaime , Pemau Raquel Clapés , Kerr Kirk , Dwyer Johanna
Published: December 2023

Quality of life (QoL) is important for healthy aging, both for older adults themselves and healthcare providers/systems caring for them. Eating/nutritious food are essential for maintaining good nutrition status, provide pleasure, help older adults remain healthy/independent, and contribute to important QoL domains. Yet research on nutrition and QoL is limited. This study describes connections between QoL and nutrition by examining QoL instruments and nutrition screening tools used with community-living older adults. 20 validated QoL instruments were evaluated to determine if they included nutrition-related items involving 8 previously identified QoL domains. 75% of QoL screening tools included at least 1 nutrition-related item, most commonly in autonomy (n=11), physical health (n=7), social connection (n=3), environment (n=3), emotional state (n=2), mental health (n=2), and personhood (n=1) domains; none in spiritual feeling domain. 16 validated nutrition screening tools were evaluated to determine how their nutrition items related to the same specific QoL domains; all tools included at least 1 nutrition item related to physical health (n=16). Other domains represented by nutrition items were autonomy (n= 9), emotional state (n=5), social connection (n=5), environment (n=4), and mental health (n=3). Although commonalities existed between QoL instruments and nutrition screening tools in types of nutrition-related items included, there were many inconsistencies/gaps. Only 1 QoL instrument and no nutrition screening tools included items in the personhood domain that were related to enjoyment in eating. Nutrition is a potentially modifiable factor benefiting healthy aging and QoL outcomes; these gaps represent opportunities for further research and policy and program development.
RACISM AND DISCRIMINATION EXPERIENCES AMONG STAFF IN LONG TERM CARE HOMES
Authors: Nerayo Liwam , Travers Jasmine , Wagner Laura
Published: December 2023

In long term care facilities (LTCFs), there is a growing population of people with dementia and an increasingly racially and ethnically minoritized care workforce. Previous research has shown that relationships between residents with dementia and minoritized care workers have been contentious, involving several racial and discriminatory acts (e.g., racial slurs, physical abuse). This has led to an unsupported and burnt out care workforce. The aim of this study is to develop a survey tool, aimed at examining experiences and understanding the prevalence of racism and discrimination in the LTC care workforce. We pilot tested the study in two LTCFs and performed content validity with experts. We then deployed the survey across 560 facilities in racially and ethnically diverse states. When analyzing responses from the first 113 nursing assistants and vocational nurses, we found that many of the respondents reported having positive perceptions of residents with dementia and no experiences with racism. However, among the one-third of care workers who did experience racism, we discovered that respondents primarily experienced racism through verbal insults (48%) and care refusal (23%). Over 87% of victims of this experience felt supported by their manager, yet only 50% reported getting reassigned. Finally, almost 80% responded that it is more challenging to care for residents who exhibit racist behavior. This feedback on the perspectives and experiences of the care workers who did experience racism can inform improvements for dementia care training and offer discussions among stakeholders and families. Additional data from more diverse LTCFs is forthcoming.
REAL EXPERIENCE OF FRONT-LINE NURSING HOME STAFF DURING COVID-19: A SYSTEMATIC REVIEW AND META-SYNTHESIS
Authors: Yang Xiufen , Qu Chaoran , Peng Weisi , Xiong Lile , Guan Hua , Luo Weixiang , Cheng Yiping
Published: December 2023

Objective

The COVID-19 has become less of a threat around the world. However, the threat to nursing homes and older adult still exists. The study aimed to explore the challenges and coping strategies of front-line nursing home staff during COVID-19 and provide recommendations for coping strategies and measures for public health of emergency in nursing homes in future. Design: Qualitative Meta-synthesis. Date sources: From the beginning until 30 May 2023, searches were conducted in five international databases (CINAHL, PubMed, Web of Science, PsycINFO and Cochrane library). The studies were screened and reviewed separately by two reviewers using the checklist from Joanna Briggs Instifor assessing qualitative research. A pragmatic meta-aggregator approach was applied to synthesise the findings.

Results

The meta-synthesis included 16 qualitative studies and four mixed studies, which included 642 participants were analyzed to identify 199 findings that were organized into 15 categories and combined into three syntheses. Three synthesised findings were concluded: ①The challenge of the front-line nursing home staff during the COVID-19, ②The coping strategies of the front-line nursing home staff during the COVID-19, and ③Suggestions for future nursing homes to deal with public health of emergency. Conclusion(s): Social/Health organizations and government, especially health organization, should make joint efforts to provide guidance knowledge and practice, and long-term material and mental support for nursing homes. To improve the quality of life of residents and staffs in nursing homes, further research should implement high-quality interventions based on the victory fighting epidemic experience and clinical treatment.
RECOGNIZING THE ROLE OF PETS IN HOME ASSESSMENTS FOR OLDER ADULTS
Authors: Keeler Carlyn Ellison , Struckmeyer Linda , Applebaum Jennifer
Published: December 2023

To support aging in place, health professionals may identify safety and accessibility concerns via home assessments. Although 50% of older adults share their homes with pets, standardized home assessments often overlook pet care, an instrumental activity of daily living (IADL). To bridge this gap in existing knowledge, we conducted four focus group sessions with older adult pet owners to identify potential elements for a novel assessment tool. We utilized directed content and thematic analysis, informed by the International Classification of Functioning, Disability and Health model. Researchers recruited a purposive sample of older adults (65 years or older) who were the primary caretakers of a dog or cat. Participants (N=30) discussed age-related changes to their body’s function that hindered their participation in pet care activities (e.g., the strength needed to pick up a pet). Participants explained how the interaction of their pets and housing features (e.g., stairs) contributed to falls and injuries. Further, personal factors (e.g., restricted income) may contribute to home safety issues (e.g., unable to afford needed modifications). The results indicate that pets’ behavior, care needs, and caregiving activities may impact home safety, thereby influencing the potential for aging in place. Findings support the development of holistic approaches when evaluating older adults’ functioning in their homes and emphasize the importance of pet care within home assessments.
RECONSTRUCTING PERSON-CENTEREDNESS FROM A SYSTEMS PERSPECTIVE: IMPLICATIONS FOR THE CARE OF OLDER ADULTS
Authors: Syed Ayesha , Sloane Philip , Zimmerman Sheryl , Fazio Sam
Published: December 2023

Person-centeredness has become a common, almost hackneyed phrase in the context of care for older adults, despite a lack of consensus regarding its definition, measurement, and application. As part of a series of studies aimed at better understanding person-centeredness, we sought to identify key themes about person-centeredness as it applies to the system (macro) level, as opposed to the setting (meso) and interpersonal (micro) levels. Four think-tank meetings (two in-person; two virtual) were held and results analyzed; the 32 participants included researchers, providers, policy makers, ethicists, and consumers. Think-tank meeting prompts addressed a range of systems, including education, government, workplace, and healthcare. Analyses identified themes associated with variation in person-centeredness. Five key themes emerged: (1) The goals and manifestation of person-centeredness vary depending on the type of system, level within a system, and the role of the individual within the system. (2) Principles of person-centeredness from the hospitality industry can be applied to other settings, including healthcare and long-term care. (3) Some limits on person-centeredness are necessary for system success. (4) The amount of person-centeredness provided in a setting depends on available resources such as time and money. (5) Societal inequities, such as discrimination, bias, and language barriers, hinder person-centeredness. Presentation of results will draw parallels between a variety of systems, demonstrating universal applicability, including to healthcare and long-term care for older adults. The themes identified may help guide future policy and practice regarding realistic and effective application and evaluation of person-centeredness in relation to the care of older adults.
REENGAGING AFRICAN AMERICAN AND BLACK OLDER ADULTS DURING THE COVID-19 ERA: A FOCUS GROUP STUDY
Authors: Parekh Rupal , Tocchi Christine
Published: December 2023

Churches and senior centers are social engagement hubs for older Black and African Americans (BAA) that can positively impact well-being. Although these facilities re-opened after the COVID-19 pandemic, engagement with these facilities has not returned to pre-pandemic levels. Our long-term goal is to develop a behavioral intervention to address the re-engagement needs/concerns of BAA older adults as a means of preventing/reducing depressive symptoms and disability. In the first phase of this work, we used a community-based participatory research approach to determine barriers to, and facilitators of, activity reengagement through the perspectives of leaders of BAA churches and senior centers around Hartford, Connecticut. We conducted three focus groups with key stakeholders (n=4 senior center staff; n=4 senior center staff; n=5 church staff) between May 2023 and July 2023. Using a Framework Method approach and semi-structured interviews, participants were asked to define engagement as it relates to senior center and church involvement since re-opening and to quantify, in their own words, the problem of disengagement. Participants were also asked about the effectiveness of online engagement vs. in-person engagement and members experience(s) with social isolation and loneliness. Line-by-line thematic analysis of the transcriptions was used to identify and group meaningful phrases and responses into major themes. Three organizing themes emerged: “transportation” concerns impacting members during COVID-19 pandemic, increased health issues among members; and issues and concerns related to family support. Leaders from churches and senior centers provided valuable insights into the overarching issues affecting re-engagement among older BAA senior center and church members.