bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Mental Health Stigma and Ageism on Students’ Intention to Work with Older Adults: A Mixed Methods Design
Authors: Woolverton Cindy , Biccum Katelind , Yu Aiping , Xin Lanlan , Strong Jessica
Published: December 2021

Approximately 20% of older adults have a mental or neurological disorder which can cause significant disability. With a growing older adult population, there is a need for providers receiving specialized training in aging to provide quality care. However, there continues to be shortages of students seeking careers in geriatrics and especially in working with older individuals with mental health (MH) concerns. The present study explored the relationship between MH stigma, ageism and intention to work with older adults among undergraduate students. Undergraduate students (N=188) completed a battery of questionnaires including intention to work with older adults, positive and negative attitude towards older adults, and open-ended questions exploring MH stigma views. Regression results indicated that MH stigma, positive, and negative attitudes significantly predicted intention to work with older adults, (F(3, 182) = 8.51, p = .000). Examination of the coefficients revealed that positive attitudes significantly predicted intention to work with older adults (t=4.38, p=.000), and MH stigma demonstrated a trend towards significance (t=1.90, p=.059). Open-ended responses were analyzed using qualitative description methods which revealed themes consistent with negative and positive stereotypes, MH problems going undetected, and need for additional support in recognizing and treating MH conditions among older adults. Positive attitudes are an important predictor in students’ intention to work with older adults, and MH stigma may be an important factor to explore further. Qualitative themes also describe how MH concerns are an important area to focus on among older adults, although there continues to be evidence of aging stereotypes.
The Role of Aging Anxiety, Ageism, and Health Locus of Control on Middle-Aged Adults Health Outcomes and Behaviors
Authors: Bashian Hannah , Caskie Grace
Published: December 2021

Older adults with more ageist attitudes and aging anxiety and who endorse an external health locus of control (HLOC) have poorer mental and physical health and less engagement in healthy behaviors than those who report less ageist attitudes, aging anxiety, and endorse an internal HLOC. However, middle-aged adults have not been examined in this literature. Using Terror Management Theory as a framework, this study examined the relationship of middle-aged adults’ aging anxiety, ageist attitudes, and HLOC with health behaviors and mental and physical health outcomes. 391 middle-aged participants (40-55 years) completed measures of ageist attitudes, aging anxiety, HLOC (Internal, External, and Powerful Other), engagement in health behaviors, mental health, and physical health. The path analysis model demonstrated acceptable fit, χ2(2)=7.794, p=.02, CFI=.99, TLI=.92, RMSEA=.09). For health behaviors, eight of the 10 paths were significant; higher aging anxiety, higher ageist attitudes, and less endorsement of internal HLOC were related to less engagement in healthy behaviors. For mental health and physical health, five of the 10 paths were significant; in general, higher aging anxiety, higher ageist attitudes, and less endorsement of internal HLOC were related to poorer mental and physical health. This study demonstrated that middle-aged adults’ aging anxiety, ageist attitudes, and health locus of control are related to their health behaviors and mental and physical health. Furthermore, higher endorsement of specific forms of ageist attitudes and aging anxiety were related to worse reported mental and physical health and to less engagement in health behaviors. Implications of these findings will be discussed.
Bone-Active Medication Utilization from 2013-2017 Amid Beneficiaries Aged 65+ with Medicare Part D by Provider Type
Authors: Kirk Jennifer , Fleming Sean , Orwig Denise
Published: December 2021

As the United States’ population increasingly consists of older adults aged 65+, an increase is expected in the prevalence of osteoporosis and the number of osteoporotic fractures. Bone-active medications (BAM) delay osteoporosis progression and prevent fragility fractures, but historically low treatment persistence rates and drug utilization for BAM exist among at-risk older adults. This research assessed for differences in the BAM utilization rates over five-years in Medicare Part D by provider type: geriatric specialists (GERO), generalists, specialists, nurse practitioners (NP), and physicians’ assistants (PA). This longitudinal retrospective analysis included providers with at least one BAM prescription among beneficiaries aged 65+. An analysis of response profiles was used to model the mean BAM utilization rates overall and by provider group. Of the 50,249 providers included in this analysis, 88.15% were generalists, 5.76% specialists, 1.48% GERO, 2.73% NP, and 1.87% PA. From 2013-2017, the prevalence of BAM utilization was 6%. Over the five years, BAM utilization rates did not change significantly, but provider-specific rates were significantly different (F=12.53, p<.001). Provider-specific utilization rates were inconsistent with the highest utilization rates and most considerable variation observed among specialists (14.95%). PAs and NPs’ BAM utilization rates were stable at around 9.02% and 9.20%, but GERO and generalists exhibited the lowest utilization rates, 4.86% and 5.79%, respectively. While specialists had the higher-than-expected utilization rates, the overall and provider-specific BAM utilization rates were low and did not increase over time. Further research is needed to identify how provider-related factors, like geographic region and clinical training, influence underutilization.
Using Health-Related Quality of Life to Identify the Incident Cardiovascular Disease Risk
Authors: Phyo Aung Zaw Zaw , Ryan Joanne , Gonzalez-Chica David A , Stocks Nigel P , Reid Christopher M , Tonkin Andrew M , Woods Robyn , Freak-Poli Rosanne
Published: December 2021

Previous studies have revealed that poor health-related quality of life (HRQoL) is associated with a higher risk of hospital readmission and mortality in patients with cardiovascular disease (CVD). The association between HRQoL and incident CVD is still limited for general older people. This study explored the associations between baseline HRQoL and incident and fatal CVD in community-dwelling Australian and the United States older people enrolled in ASPREE clinical trial. A cohort of 19,106 individuals aged 65 to 98 years, who were initially free of CVD, dementia, or disability, were followed between March 2010 and June 2017. The SF-12 questionnaire was used to assess HRQoL, and the physical (PCS) and mental component scores (MCS) of SF-12 were derived using norm-based methods. Incident major adverse CVD events included fatal CVD (death due to atherothrombotic CVD), hospitalizations for heart failure, myocardial infarction or stroke. Analyses were performed using Cox proportional-hazard regression. Over a median 4.7 follow-up years, there were 922 incident CVD events, 203 fatal CVD events, 171 hospitalizations for heart failure, 355 fatal or nonfatal myocardial infarction and 403 fatal or nonfatal strokes. A 10-unit higher PCS, but not MCS, was associated with a lower risk of incident CVD (HR=0.86, 95%CI 0.79-0.92), hospitalization for heart failure (HR=0.72, 95%CI 0.60-0.85), and myocardial infarction (HR=0.85, 95%CI 0.75-0.96). Neither PCS nor MCS was associated with fatal CVD events or stroke. Physical HRQoL can be used in combination with clinical data to identify the incident CVD risk among community-dwelling older people.
Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014)
Authors: Quiñones Ana , Markwardt Sheila , Allore Heather , Newsom Jason , Nagel Corey , Dorr David , Botoseneanu Anda
Published: December 2021

Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1% in youngest age category [67-69] vs. 50.3% for incident and 66.7% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6% CIND/dementia vs. 15.4% for incident and 16.8% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4%) than in the incident (11.8%) and no multimorbidity groups (13.4%). Non-Hispanic White beneficiaries were more represented in the incident (83.5%) than the prevalent (77.2%) and the no multimorbidity (77.7%). Hispanic beneficiaries were more represented in the no (8.9%) than the prevalent (7.4%) and incident multimorbidity groups (4.7%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status.
The Association Between Medicare Annual Wellness Visits and Detection and Management of Diabetes Among Older Adults
Authors: Dassel Kara , Alsulami Abdulrahman , He Yao , Allen Nancy
Published: December 2021

The rising prevalence of diabetes mellitus (DM) among older adults is an increasing concern in the U.S. and is expected to nearly triple within the next 40 years. The purpose of this study is to investigate the effectiveness of Medicare Annual Wellness Visits (AWV) utilization on the management of DM among Medicare beneficiaries using data from 26,703 Medicare beneficiaries seen at 13 primary care community clinics (clinic visits between 2017 and 2019). A total of 34% of Medicare beneficiaries participated in an AWV. The total sample was, on average, 72.6 years old (SD=7.0), 57% female, 84% White, and 91% non-Hispanic and had between zero and three co-morbid conditions. The AWV group was significantly younger (mean difference 2.0 years; p<.001) and had fewer comorbid conditions (mean difference 0.1; p<.001) than the non-AWV group at their initial visits. Comparing AWV and non-AWV groups at the first patient visit and last patient visit, there were significantly fewer patients with DM in the AWV group compared to the non-AWV groups (19.2% vs. 24.7%; p<.001 and 53.5% vs. 59.2%; p<.001). DM management was better in the AWV group compared to the non-AWV group at both the first and last patient visits, as exhibited by lower A1C levels (M= 5.9(SD=0.8) vs. M=6.2(SD=1.1); p<.001 and M= 6.6(SD=0.8) vs. M=6.9(SD=1.4); p=.013), lower glucose levels (M=114.0(SD=34.0) vs. M=123.0(SD=51.0); p<.001), and fewer DM medications (M=0.1(SD=.4) vs. M=0.2(SD=0.5); p<.001 and M=0.2(SD=0.6) vs. M=0.3(SD=0.6); p<.001). These results suggest that AWV are effective managing diabetes in older adults Medicare beneficiaries.
Life-Space Constriction in Aging Adults
Authors: Arms Tamatha
Published: December 2021

Community-dwelling aging adults desire to maintain independence and prevent or delay a sequela of declining function and ultimate frailty. Early indicators of potential declines in function and frailty, such as life-space constriction (LSC), are important to identifying early. The purpose of this study was to examine factors associated with LSC and the influence of these factors and LSC on function and frailty. A cross-sectional study using a convenience sample of community dwelling persons 55 and older living in the South was conducted. Results indicated most participants (N = 72) were female (69%; n = 50) and half were White (53.5%; n = 38). LSC explained 34% variance in function (F = 3.805 (8, 59); p = .001) when environmental supports (social network), challenges (driving time it took the participant to get to the nearest full-service grocery store) and individual factors were controlled for. There was a significant difference between Black and White participants with environmental challenges (p = .001) and function (p = .001). Individual factors included challenges (age-related physiological changes, disease burden, and mental health limitations) and buoy (assistive devices), these explained 22% variance in self-reported frailty (F= 3.099 (6, 65); p = .01). Number of assistive devices was the only significant predictor of self-reported frailty.
Rural Residents’ Hopes and Fears about Aging in Place: The Need to Improve Access to Aging Resources
Authors: Brothers Allyson , Jiao Yuquin , Schneider Sue , Wright Kaitlyn
Published: December 2021

To support older adults’ preferences to age in place, home and community-based aging-related resources are available, but are often under-utilized. Many barriers prevent individuals from accessing aging-related resources, especially in rural and geographically isolated locations. Therefore, we set out to better understand the perspectives of community members who plan to age in place in rural areas. We administered a survey as part of a broader university-community partnership called Senior Access Points (SAP), which addresses aging-related resource access. Participants were N = 210 individuals living in rural regions across Northern Colorado, ranging from 37 to 94 years old (mean age = 68.91, SD = 8.85). We assessed hopes and worries about growing older at home, and awareness of available resources. Two independent coders applied a pre-determined coding scheme, then achieved consensus ratings. An overwhelming majority of participants affirmed the importance of being able to remain in their current home (94.8%) or community (95.3%) as they age. Top hopes for aging in place centered around health/medical; housing/home services; and independent rural lifestyle. The top worries were related to health/medical; housing/home services, and transportation. Resource awareness was low: 43.3% of all participants were not aware of any available resources. Overwhelmingly, rural residents hope to grow older at home, but may not know how to connect to resources that support this goal. The resource needs we identified are being used to inform community-driven approaches to improve both awareness and availability of community resources in these rural communities.
An Evaluation of the Service Intensity Add-On Payment Policy Reform in the Medicare Hospice Benefit
Authors: Christian Thomas , Gozalo Pedro , Teno Joan , Plotzke Michael
Published: December 2021

In 2016, the Centers for Medicare & Medicaid Services (CMS) implemented the Service Intensity Add-On (SIA) payment, which incentivized skilled nurse and medical social worker (SN/MSW) visits in the last seven days of life. Little is known about the impact of this initiative. Using 100% Medicare hospice claims, we identified a 10% random sample of Medicare hospice beneficiaries utilizing routine home care service during calendar years 2012-2018. We compared the provision of SN/MSW visits on service dates before and after the SIA’s implementation relative to beneficiaries’ date of death. We also determined hospice providers’ success in providing SN/MSW visits in the last days of life and categorized all providers into quintiles according to the average rate of these visits in the period prior to the SIA’s implementation. Cumulative over the last seven days of life, we calculated an increase of 15.7 SN/MSW minutes (95% confidence internal [CI] 14.9-16.5 minutes) per beneficiary after the SIA was implemented. The per-minute increase was greatest on days nearer to death (4.0 minutes day of death, 95% CI 3.6-4.2). There was no detectable visit increase on days which were ineligible for the SIA. Additionally, those providers in the quintile providing the lowest rate of SN/MSW visits pre-SIA exhibited a 14-percentage point increase in rates of these visits, the third, fourth, and fifth quintiles exhibited little change over time. Further monitoring is needed to ensure beneficiaries receive adequate end-of-life care.
Residential Environment, Depressive Symptoms, and Anxiety Symptoms Among Community-Living Older Adults
Authors: Cheung Ethan Siu Leung , Liu Jinyu
Published: December 2021

Past literature has suggested significant relationships between neighborhood environment and mental health of older adults. However, the effect of residential environments is underexplored. The present study aims to study: (Q1) how residential built environments are associated with depressive and anxiety symptoms among community-living older adults, and (Q2) whether the associations of their physical and cognitive health status with mental health vary by residential environments. We analyzed data from Round 9 of National Health and Aging Trends Study. Residential environments were indicated by home despair, cluttered home, and existence of entrance ramp. Covariates included age, gender, race, living arrangement, ADL limitations, physical capacity, and cognitive status. The logistic regression results show that higher levels of clutter at home and the lack of entrance ramp were significantly associated with more depressive symptoms and that levels of clutter were positively associated with anxiety symptoms. Residential environments significantly moderated the association between physical health and mental health. With similar physical capacity, older adults with higher levels of home despair and clutter had more depressive and anxiety symptoms. Older adults who had more cluttered home reported significantly higher levels of anxiety than those who had similar ADL limitations, but lived in a less cluttered housing environment. However, we didn’t find any moderating effect of residential environments on cognitive impairment and mental health. Our findings promote the necessity for practitioners and policymakers to consider the effect of residential environments on mental health among both physically healthy and impaired older adults in the United States.
Social Roles of Family and Friends Differ in Social Networks of Older Adults Who Live Alone
Authors: Ashida Sato , Schafer Ellen , Thompson Lena
Published: December 2021

Social networks consisting of family and friends tend to better facilitate older adults’ emotional well-being than networks consisting of only family or only friends. This study assessed the heterogeneity of older adults’ network compositions based on the network members’ relationship (family vs. friends) and proximity (local vs. non-local) and evaluated the types of interactions between older adults and types of members. Adults 60 years and older living in a U.S. Midwestern city participated in a one-time structured survey (n=133), and reported about 1,730 social network members. Compared to participants who lived with others, those who lived alone reported more depressive symptoms and higher frequency of feeling lonely (p=0.002). Those who lived alone also had higher proportions of local friends in their networks than those who lived with others (p=0.02). Whereas the social roles of family and friends were similar in networks of older adults who lived with others, those who lived alone were less likely to identify family as who they co-engaged in social activities with (local family OR=0.55, non-local family OR=0.27) and who provided companionship (local family OR=0.33, non-local family OR=0.11) compared to their local friends. Having more members who co-engaged in activities was associated with lower depressive symptoms (p=0.05) and less frequency of feeling lonely (p<0.01). Providing supportive infrastructure for community-based older adults to develop and maintain co-engaging relationships with local friends may be beneficial. Network approaches can be used to identify existing network members who may be inspired to play this role.
Addressing the Social and Medical determinants of Health for Safe Medicines Use
Authors: Simmons June , Woosley Raymond , Sefilyan Ester
Published: December 2021

Both social and medical factors can negatively affect health outcomes, especially in vulnerable populations. To address these two types of factors in a hospital post-discharge population, two non-profit organizations collaborated to combine their novel decision support programs to address the question: could combined programs have greater potential for improved health outcomes? HomeMeds (HM), a social health program in which trained social services staff make home visits to vulnerable clients, was combined with MedSafety Scan (MSS), a medical health, clinical decision support tool. Data captured in the home visits were entered into the HM and MSS programs to detect those patients at greatest risk of adverse health outcomes due to medications. Patients received a post-discharge home visit by trained social services staff. The number of drugs reported as being taken was on average 10.4, which was less than prescribed at discharge in 62% of patients. Both programs detected serious risk of medication-induced harm, mostly from different causes such as drug-drug interactions or for use not recommended in older adult. Combined analysis of data from two novel decision support programs yielded complementary findings that together address both medical and social determinants of health. These have the potential to reduce medication-induced harm, costly re-hospitalization and/or emergency room visits and support the further evaluation of this combined approach in other vulnerable populations such as the seriously mentally ill, frail, those confined to home, opioid-dependent or otherwise impaired.
Challenges in Implementing an Explicit Protocol for Live Discharge From Hospice
Authors: Wladkowski Stephanie , Enguidanos Susan , Schroepfer Tracy , Pabst Keegan
Published: December 2021

A live discharge from hospice can occur when a patient stabilized under hospice care and no longer meets the life expectancy hospice eligibility criteria. In 2018, 220,000 hospice patients across the United States were discharged alive from hospice care, with 1 in 6 discharges due to stabilization, with a life expectancy exceeding hospice’s six-month criteria. Hospice practitioners prepare patients and their caregivers upon enrollment for the possibility of a live discharge should their condition stabilize, however, there is no explicit discharge process available within hospice to guide practitioners in transitioning patients (and caregivers) out of hospice care. This transition process largely falls within the domain of hospice social workers, yet there is no research documenting the challenges and facilitators to conducting a live discharge from hospice. This study aimed to understand social workers' perspectives on the live discharge process. To better understand challenges and facilitators to the live discharge process, we conducted focus group interviews with hospice social workers at four hospice agencies across the U.S. We asked participants to discuss specific tasks associated with the live discharge process for a patient and their caregiver including identifying concrete services needed post-discharge; assessing the psychosocial and grief risk of patient and caregiver; and developing a post-discharge follow-up plan. Using constant comparison analysis we identified several themes including the need for clear professional roles during a live discharge, interprofessional education, and the need for dedicated time for live discharge follow-up. Policy implications and opportunities also will be discussed.
Strengthening Strategies to Recruit Racial/Ethnic Minority Populations for Health Research Studies
Authors: Thompson Roy , Konrad Thomas , Xu Hanzhang
Published: December 2021

With the current spotlight on systemic racism and the need to address health inequities, it is critical to develop culturally appropriate strategies for recruiting research study participants from racial/ethnic minority groups. Empirical studies have highlighted that people from racial/ethnic minority groups have poorer health outcomes compared to non-Hispanic Caucasians. However, racial/ethnic minority groups remain underrepresented in healthcare research. Several factors may contribute to the lower participation of racial/ethnic minority groups. Sequelae of atrocities in healthcare research on African American/Black people in the US during slavery and Jim Crow eras were widespread and persistent. Discrimination against people of Hispanic descent and increased anti-Asian discrimination have also been documented. Fear and mistrust of the health system and researchers have been identified as critical barriers to participation in clinical research for these populations. Further, health research teams rarely reflect the racial/ethnic diversity of the US population, hindering diversity in recruiting study participants. Inadequate ethnic/racial minority groups participation in study populations not only weakens external validity of empirical studies, but research interventions and policies being implemented may not be culturally appropriate to all populations. Therefore, systemic strategies to improve recruitment of racial/ethnic minority groups should: 1) increase preferential funding to incentivize research teams becoming more racially/ethnically diverse; 2) increase recruitment of racial/ethnically diverse healthcare researchers; 3) use community-based participatory research designs to build trust among racial/ethnic minority populations; 4) provide training on culturally appropriate research study recruitment strategies to the academic communities; 5) apply a prism of intersectionality for representation throughout the research cycle.
Supportive Homes as Mediator between Rural Status and Disability of Older Adults
Authors: Steinman Bernard , Whitlock Bremen , Mittlieder Casandra , Overton Julie , Pynoos Jon
Published: December 2021

By definition, older adults living in rural communities have fewer formal resources available to address aging-related functional needs. Supportive environments are frequently relied on in rural settings to help address this discrepancy. The purpose of this study was to assess the role of supportive housing features and home modifications in mediating the association between rurality and disability. We hypothesized that environmental supports would be more crucial in rural settings than non-rural settings. We analyzed data from the National Health and Aging Trends Study (NHATS). Variable selection was guided by the International Classification of Functioning, Disability and Health (ICF), including covariates for sociodemographics, chronic conditions, mobility functioning, and participation. A series of regression models tested mediation by environmental variables of the association between rurality (as determined by the metro/nonmetro file indicator) and ADL/IADL disability. Supportive home environments were operationalized using indicators of whether participants had access to homes from the outside without having to use stairs; presence of a bedroom, kitchen, and full bathroom with a shower or tub on the same floor; and whether bathroom fixtures had been modified with features such as grab bars. Results suggest a statistical relationship between rurality and disability that is explained in part by the presence or lack of supportive home features, and these effects were greater in rural settings. Implications are that older adults who live in rural settings can benefit greatly by supportive environments and modifications in areas of the home that are known to cause difficulty.
Technology for Healthy Aging: Use of Electronic Communication among Older Adults
Authors: Yang Rumei , Du Yan , Wang Haocen , Nie Zuoting , Ji Chumin , Jiang Yun
Published: December 2021

In the digital era, many electronic platforms have been established to facilitate patient-provider communication, such as e-mail, text messaging, and patient portal. The use of these electronic platforms is termed as electronic-communication (e-communication). E-communication has a variety of personalized healthcare functions, such as exchanging information, reviewing lab results, and facilitating patient engagement. However, little is known about the actual use of e-communication among older adults who are potentially major users of e-communication considering their high-level health care needs. Understanding their use of e-communication is critical in improving the application of e-communication in older adults. Using data from American Health Information National Trends Survey (HINTS2019-Cycle3; n=1,961; meanage =74.10, range=65-98), we explored: 1) the prevalence of e-communication use among older adults, and 2) factors affecting their use of e-communication. Variables were measured by self-reports. Weighted logistic regression with replicate weights provided by the HINTS was performed for data analysis. We found that 50% older adults reported the use of e-communication in the last year. Factors associated with higher likelihood of older adults’ e-communication use included younger age (OR=09.96, 95%CI=0.93-0.98, p<0.001), higher education (OR=4.82, 95%CI=2.32-10.02, p<0.001 for college graduate or higher), higher income (OR=1.58, 95%CI=1.05-2.38, p=0.030), comorbid conditions (OR=1.64, 95%CI=1.02-2.64, p<0.001), and having a regular provider (OR=2.06, 95%CI=1.31-3.22, p=0.002). This study provided nationally representative results demonstrating a great potential use of e-communication in older adults. Special attention is needed to focus on socially vulnerable older adults (e.g., those with older age, lower education and income, and having comorbidity).
Obese Body Mass Index in late-life as a protective factor for Mild Cognitive Impairment, Dementia and Death
Authors: Natale Ginny , Zhang Yun , Hanes Douglas , Clouston Sean
Published: December 2021

Objective The goal of the current study was to estimate the hazards of conversion from unimpaired to mild cognitive impairment (MCI) to probable dementia and death for underweight, normal, overweight and obese older adults in an aging cohort where the timing of examinations may be associated with the severity of dementia. Methods We analyzed six waves of the National Health and Aging Trends Study (NHATS); a longitudinal aging cohort. Participants were classified into mutually exclusive cognitive statuses: cognitively unimpaired, MCI, probable dementia and death. Time-to-event ratios and cognitive transitions were examined with multistate survival models accounting for misclassification. BMI was computed from height and weight measurements and expressed in kg/m2 and categorized into underweight, normal, overweight and obese. Results Participants (n=6,078) were 77 years old, on average, and the majority were white, females and high school graduates. About one third (32.68%) of the sample has normal BMI, one third is overweight (35.59%), the rests are obese (26.41%) or underweight (5.33%). After adjusting for the effects of diabetes, CVD, vigorous physical activity, age and race/ethnicity, the protective effect of obesity in late-life against developing dementia (HR=0.44; 95%CI[0.29-0.67]) and dying from dementia (HR=0.63; 95%CI[0.42-0.95). Discussion Prior research shows the risk of dementia associated with obesity at older ages is either attenuated or reversed. Our findings support a protective factor of obesity in late-life against conversion to dementia and death.
The Effects of Multi-Component Interventions on Cognition: A Systematic Review
Authors: Ahn Sangwoo , Anderson Joel
Published: December 2021

Given the lack of a cure for Alzheimer’s disease (AD), the number of people with AD is expected to surge unless the onset is delayed. Although there have been efforts to examine the effects of single-domain neuroprotective interventions on cognition, no conclusive results have been found so far. Due to the multifactorial causes of AD, interventions combining multiple neuroprotective components may induce more beneficial effects. However, there are few comprehensive reviews evaluating the effects of multi-domain programs on cognition. Thus, the purpose of this systematic review was to evaluate the effects of currently available multi-component interventions on cognition such as global cognition, episodic memory, and/or executive function affected early in AD. The literature search was conducted using PubMed, CINAHL, Web of Science, Scopus, and PsycINFO up to September 2020. Of the 1,445 articles located, 17 met eligibility criteria (n = 10,056, mean age = 72.8 years). According to the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies, 8 and 9 studies had strong and moderate overall quality, respectively. The effect sizes of each included study were calculated using Cohen’s d. Multi-component interventions comprising physical activity, cognitive exercise, cardioprotective nutrition, and/or cardiovascular health consultation/education exerted beneficial effects on cognition (very small to moderate effect sizes; Cohen’s d = 0.16 to 0.77). Clinically, health care providers are recommended to consider those elements to potentially stave off AD. There is a pressing need for researchers to identify optimally effective doses of neuroprotective multi-component interventions.
Comparison of methods to classify ADRD in claims and cancer registry data
Authors: Nalawade Vinit , Murphy James , Schempp Tim , Yakuta Melissa , Moore Alison , Gilbert Paul , Schiaffino Melody
Published: December 2021

Alzheimer’s disease and related dementias(ADRD) affects 10.3% of older Americans (65+), among these 15-30% go on to be diagnosed with cancer. The highest burden of ADRD is experienced by Latino/a (12.2%) and African-American (13.8%) older adults. Older patients with pre-existing ADRD are less likely to receive guideline-concordant cancer care due to lack of consideration of cognitive status, and underestimation of ADRD diagnosis is an issue in secondary data. Our study compares two validated algorithms for classifying ADRD in a sample of cancer patients, the NCI-Charlson and CMS-Chronic Conditions Warehouse (CCW) index. We used existing claims from NCI’s SEER-Medicare linked database (2004-2013, N=37,932). Patients were selected based on cancer diagnosis at any stage with at least 36 months of data prior to diagnosis to identify ADRD. We analyzed breast, lung, prostate, cervix, head & neck(HNC), and colorectal(CRC) cancers(CA). We found a prevalence of 2.8% (9549 cases of ADRD+CA) using the NCI-index compared with a prevalence of 5.6% (18989 cases) with the CCW-index. ADRD+CA numbers differed significantly in all cancers for all races, however, we observed the greatest magnitude of difference among Latino/a and African-American patients. The NCI index significantly underestimated prevalence compared with the CCW: 1.21% vs 3.28% Breast; 2.29% vs 4.60% CRC; 2.88% vs 6.44% Lung; 1.36% vs 8.62% Prostate, and 4.21% vs 11.61% HNC. Our findings suggest a need to develop validated algorithms for classification, using an evidence-base generated by incorporating information and decision-making theories from the expertise of clinicians currently diagnosing ADRD using clinical assessments in diverse populations.
Information and Communication Technology Use in Community-Dwelling Persons Living with Dementia
Authors: Lee Kyung Hee , Lee Ji Yeon , Kim Bora
Published: December 2021

Although many persons living with dementia still remain living in the community, they encounter many difficulties due to cognitive and physical impairment. Information and Communication Technology (ICT) could be helpful to protect persons living with dementia from risky events and monitor changes in physical function. This study aimed to review studies regarding ICT usage to monitor physical activity and safety in community-dwelling persons living with dementia. We searched quantitative studies that utilized ICT to monitor physical activity and safety published from 2011 to 2020 through five databases; 24 studies were included in the systematic review. Most studies (79%) were observational studies and conducted in North America or Europe (75%). In terms of ICT usage, the most frequently used type was a wearable device (96%); data such as physical activity, gait, and circadian rhythms were gathered. The ICT data were utilized for: 1) comparing ICT data within dementia group or with normal cognition group; 2) exploring a relationship with other variables in observational studies; 3) measuring an outcome of the experimental studies; and 4) determining feasibility of a sensor itself. Less than half of the studies met all five criteria in quality assessment. We found the ICT is being used in various ways in research for community-dwelling persons living with dementia. However, we are uncertain about the effectiveness of ICT use and the quality of studies. Future studies with rigorous study design are needed to provide better evidence for ICT use in persons living with dementia.
Prevalence of MCI and Dementia Prior to Incarceration
Authors: Kuffel Randall , Byers Amy , Williams Brie , Fortinsky Richard , Boscardin John , Li Yixia , Barry Lisa
Published: December 2021

As the number of older, incarcerated persons increases, prevalence of dementia and mild cognitive impairment (MCI) in this population will likely grow, with implications for healthcare costs and advance care planning within the prison setting. This study is the first to determine the prevalence of dementia or MCI in later-life adults prior to incarceration. We leveraged a national cohort of Veterans aged 50+ whose most recent incarceration was ≤10 years in length and who were released between 10/1/2012 and 9/30/2018 (N=17,962). We linked VA and CMS healthcare records to determine diagnosis of dementia or MCI within 3 years prior to incarceration. The overall sample had a mean age of 62.4 (±7.6) years at the start of their incarceration, were largely male (97%), and were 65% White and 30% Black. Before incarceration, 445 (2.5%) and 152 (0.8%) Veterans were diagnosed with dementia and MCI, respectively. Compared to those without a diagnosis of dementia or MCI prior to incarceration, those with dementia or MCI were older at incarceration start (66.1 [±8.3] vs. 62.3 [±7.9]), had more chronic medical conditions (4.0 [±2.2] vs. 2.2 [±1.9]), were more likely to experience homelessness (21.6% vs. 9.1%), have a TBI (24.5% vs. 9.1%), and have serious mental illness (81.7% vs. 49.1%). All comparisons were significant (p<.001). Our findings indicate that later-life adults with dementia or MCI are being incarcerated. Improved understanding of pathways linking cognitive impairment to later-life incarceration is needed to both prevent unnecessary incarceration and to help provide appropriate healthcare for this vulnerable group.
Adapting Training and Use of an Application for Cognitively Impaired Older Adults Amidst COVID-19
Authors: Falzarano Francesca , Weingast Sarah , Gladstone-Groth Gabriel , Ceruso Marco , Czaja Sara
Published: December 2021

The emergence of COVID-19 and social distancing requirements have resulted in disruptions to daily life, reduced opportunities for social engagement, and diminished resource access for millions of older adults. Individuals with cognitive impairments (CI) are particularly vulnerable to risk for social isolation. This presentation will discuss the PRISM-CI pilot trial, which aims to examine the feasibility and potential efficacy of the PRISM-CI software system on enhancing connectivity and quality of life among a diverse sample of 50 older adults aged 65 and over with a CI. PRISM-CI, adapted from the PRISM system (developed by the Center for Research and Education on Aging and Technology Enhancement) for this population, is intended to support social engagement, memory, and access to resources and information. We will present data regarding the feasibility and perceived value of PRISM-CI and discuss the challenges, and strategies used, to adapt the PRISM-CI trial during the pandemic. We used a multi-modal approach to provide remote training and specialized tablet instruction that includes individualized training sessions tailored to individuals’ learning needs, hobbies, and prior technology use. The adapted protocol also involves the use of remote access software for troubleshooting. We will also discuss how participant feedback guided the inclusion of additional features, such as Zoom videoconferencing and virtual library access, for the PRISM-CI application. Finally, we will demonstrate how the adaptation of the PRISM-CI protocol holds promise for the use of flexible, remote technology approaches to reach socially isolated older adults to foster psychosocial well-being.
Frailty Status Moderates the Association Between Self-Efficacy and the Intention to Technology Use
Authors: Kang Miseon , Song Si Young , Jung Inhye , Kim YoonMyung , Kim Chang Oh , Jun Hey Jung
Published: December 2021

This study examined how the status of frailty moderated the association between the self-efficacy about gerontechnology use and the intention to use gerontechnology (IUG) among Korean older adults. In this study, gerontechnology devices referred to exoskeleton robots for exercise. The data was collected through an online survey in February 2021, and 324 Korean older adults aged 65 and above were included in the analysis (Women: 50.9%, Men: 49.1%). The dependent variable was the intention to use gerontechnology from the Almere model (Heerink, 2010) and the independent variable was self-efficacy about gerontechnology use from the Senior Technology Acceptance Model(Chen & Chan, 2014). Both were measured as continuous variables. The moderating variable was the status of frailty (Non-frail=0, Frail=1). Age, gender, education level, and log-transformed household income were controlled for. Multiple linear regression to examine moderation effect was conducted using PROCESS Macro model 1. The findings showed that frailty status moderates the association between self-efficacy and IUG among Korean older adults. Concretely, the higher self-efficacy about gerontechnology use, the lower IUG for non-frail Korean older adults. However, the main effect of self-efficacy was non-significant for the frail sample. Even though self-efficacy has been known to affect the variables related to technology use or acceptance positively, the results suggest that there may exist differences in research results depending on participants' health status. The type of gerontechnology devices may also have affected the results. Further exploration is needed to the interaction effects of potential influencing factors on the gerontechnology acceptance model.
The Role of Age-Friendly Environment between Cognitive Ability and Attitude towards Gerontechnology
Authors: Jung Inhye , Kang Miseon , Song Si Young , Lim Yun Mook , Jun Hey Jung
Published: December 2021

This study examined the impact of the age-friendly environment on the association between cognitive ability and the attitude towards gerontechnology. The participants were 277 Korean young-old age 65 through 74. The data were collected by an online survey conducted in February 2021. The dependent variable was the attitude towards gerontechnology sum of perceived usefulness, perceived ease of use, and perceived adaptability (Heerink et al., 2010; Xu et al., 2015). The independent variable was the cognitive ability of participants to report on their own. The moderating variable was the age-friendly environment sum of physical, service-side, and cultural conditions. Multiple regression analysis was conducted to determine the relation between cognitive ability and the attitude towards gerontechnology. The moderating effect was then analyzed using PROCESS macro and bootstrapping. Results show that cognitive ability has a positive effect on the attitude towards gerontechnology, and the age-friendly environment has softened its effectiveness. When participants were living in a more age-friendly environment, their attitude toward gerontechnology was less affected by their cognitive ability. However, when age-friendly environmental condition scores above 62 (out of 75), the environmental aspect did not affect the association between cognitive ability and attitudes to gerontechnology. This study suggests that the age-friendly environment can narrow the disparity of the attitude towards gerontechnology depending on the cognitive capability levels under certain conditions. Regarding the attitude towards technology may affect the actual use, the possibility of environmental help is meaningful.
Voices of Caregivers: Key Demands Towards AI-driven Home Monitoring in Community-based Dementia Care
Authors: Wrede Christian , Braakman-Jansen Annemarie , van Gemert-Pijnen Lisette
Published: December 2021

While most people with dementia prefer to live at home for as long as possible, this also puts more pressure on both their informal and formal care network. To provide support in home-based dementia care, there is growing interest in technology that allows caregivers to remotely monitor health and safety of people with dementia. Novel generations of these technologies are using non-wearable, pervasive sensors coupled with algorithms to continuously collect and model meaningful in-home information. However, while these self-learning monitoring systems develop rapidly, their target users’ views and demands are still insufficiently mapped out. To identify possible barriers to acceptance and ways to overcome these, we conducted a scenario-based study, including semi-structured interviews with informal caregivers (n=19) and focus groups with home care professionals (n=16) of community-dwelling people with dementia. Inductive qualitative content analysis revealed that both groups of caregivers were concerned about the informational privacy of their care recipient with dementia, information overload, and ethical issues related to dehumanizing care. Identified demands mainly centered around how to overcome these barriers. We identified several demands related to specific functionalities, user experience factors, services surrounding the technology, and integration into the existing work context. Most notably, caregivers highlighted the importance of introducing AI-driven in-home monitoring technologies in a way it prevents them from feeling undervalued. In conclusion, our findings can help to inform the development of more acceptable and unobtrusive in-home monitoring technologies to support home-based dementia care.