bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of Remote Interventions in Older Adults: Lessons Learned During COVID-19 Isolation
Authors: Rincker Jamie , Wallis Jessica , Fruik Angela , King Alyssa , Young Kenlyn , Tucker Thoma , Bales Connie , Starr Kathryn Porter
Published: December 2020

Recommendations for older adults to socially isolate during the COVID-19 pandemic will have lasting impacts on body weight and physical activity. Due to the pandemic, two in-person RCT weight-loss interventions in obese older adults with prediabetes, Veterans Achieving Weight Loss and Optimizing Resilience-Using Protein (VALOR-UP, n=12) and the Egg-Supplemented Pre-Diabetes Intervention Trial (EGGSPDITE, n=7), were converted to remote formats and weekly nutrition (EGGSPDITE and VALOR-UP) and exercise (VALOR-UP only) classes were delivered using synchronous videoconference technology (Webex); classes were accessed via tablet/desktop/laptop or smart phone. Steps taken to transition participants to remote formats included technology training, implementation of staff tech-support, and delivery of nutrition education, tablets, scales, and exercise bands. The time to successfully transition participants was 1 week for early adopters (n=10) and up to 4 weeks for those with significant technology barriers (n=9); their difficulties included internet access, camera and microphone access and use, and electronic submission of weight and food records. Even with these challenges, in the first 3 months of remote delivery, participant dropout rate was low (10.5%, n=2), attendance was high (87.6% nutrition class (n=19); 76.4% exercise class (VALOR-UP, n=12)), and weight loss was successful (>2.5% loss (n=13); >5% loss (n=8)), showing that lifestyle interventions can be successfully adapted for remote delivery. Remote interventions also have potential for use in non-pandemic times to reach underserved populations who often have high drop-out rates due to caretaker roles, transportation limitations, and work schedules. These barriers were significantly reduced using a virtual intervention platform.
Loneliness during Covid-19: Does Living Situation or Ability to Access Information about Social Activities Matter?
Authors: Parker Patti , Menec Verena , Newall Nancy
Published: December 2020

Social isolation is deleterious for both mental and physical health (Coyle & Dugan, 2012; Hawkley et al., 2006). Conversely, social participation has mental and physical health benefits (Novek et al., 2013). In light of the current Covid-19 pandemic requiring social distancing, the present study examined whether living situation and ability to access information about social activities are associated with older adults’ loneliness during the pandemic. Specifically, we surveyed ninety-one adults aged 60 years or older in May and June of 2020, at a time when social distancing measures were still in place. We tested whether their living situation and having access to information about social activities was associated with loneliness. OLS regression analyses revealed living alone was associated with higher loneliness (b = .43, p = .050); and having access to information about social activities was associated with lower loneliness (b = -.18, p = .027) amidst the pandemic. The analyses controlled for participants’ age, gender, and education. Our findings highlight that during Covid-19, older adults’ living situation and access to information about social activities matter and may impact their social behavior. Thus, at this difficult time, it is recommended organizations that offer social activities find creative ways to reach those living alone who will benefit most from having access to such activities.
Long-Term Care Registered Dietitians’ Initial Response to the COVID-19 Pandemic
Authors: Beitel Julie , Cammer Allison
Published: December 2020

At the outset of the global pandemic, long-term care (LTC) homes in Canada were captured in media reports as the centre of Canada’s COVID-19 epidemic. An estimated 80% of all COVID-19 deaths in Canada were associated with LTC outbreaks as of May 25, 2020. Infection control measures have swiftly changed the environment in many LTC homes for residents, workers, loved ones, and other supports. Registered Dietitians (RDs) are among the many care professionals working in LTC affected by these changes. The aim of this qualitative study was to examine the roles of RDs in supporting LTC residents during the initial phases of the pandemic. RDs faced remote practice, redeployment to address pandemic priorities, or cohorting to a sole practice site, yet were responsible for resident nutritional health. In-depth, web-based, semi-structured interviews with thirteen RDs working in LTC in a prairie province of Canada were used to explore the changes to work, challenges faced, impact on residents, and innovations in practice. The findings from this study capture nutrition and wellness-related implications of the COVID-19 pandemic within LTC homes. Examining the initial response of LTC RDs to the COVID-19 pandemic can help in planning for opportunities to support or enhance delivery of nutrition care in LTC homes, both in the context of the ongoing pandemic as well as future practice.
Modern Ubasute: Public Discourse and Sentiment about Older Adults and COVID19 Using Machine Learning
Authors: Xiang Xiaoling , Lu Xuan , Halavanau Alex , Xue Jia , Sun Yihang , Lai Patrick Ho Lam , Wu Zhenke
Published: December 2020

This study examined public discourse and sentiment on social media regarding older adults in COVID-19. Twitter data (N=82,893) related to both older adults and COVID-19 and dated from January 23rd to May 20th, 2020, were analyzed. Classification of tweets involved supervised machine learning. Latent Dirichlet Allocation was used to identify dominant themes in public discourse using, accompanied by a qualitative thematic analysis. Sentiment analysis was conducted based on the NRC Emotion Lexicon. The most common category in the coded tweets was “personal opinions” (66.2%), followed by “informative” (24.7%), “jokes/ridicule” (4.8%), and “personal experiences” (4.3%). More than one in ten (11.5%) tweets implied that the life of older adults is less valuable or downplayed the pandemic because it mostly harms older adults. A small proportion (4.6%) explicitly supported the idea of just isolating older adults. Almost three-quarters (72.9%) within “jokes/ridicule” targeted older adults, half of which were “death jokes.” The daily average of ageist content was 18%, with the highest of 52.8% on March 11th, 2020. We extracted 14 themes, such as perceptions of lockdown and risk. A bivariate Granger causality test suggested that informative tweets regarding at-risk populations increased the prevalence of tweets that downplayed the pandemic. The COVID-19 pandemic has exposed and intensified ageism in our society. Information about COVID-19 on Twitter influenced public perceptions of risk and acceptable ways of controlling the pandemic. Public education on the risk of severe illness is needed to correct misperceptions.
The Impact of COVID-19 Safety Recommendations on Adults Age 60 and Older: A Qualitative Study
Authors: Emerson Kerstin , Kim Deborah , Mois George , Beer Jenay
Published: December 2020

In March 2020, the United States Centers for Disease Control (CDC) began recommending social distancing and sheltering in place, in particular for older adults. This resulted in many older adults staying at home for long periods of time in relative isolation. Because there is little prior evidence of the emotional impact that this has on older adults, we conducted an exploratory qualitative study on how older adults felt during the first three to five weeks of the CDC recommendations. We fielded a web-based cross-sectional survey. Our analytic sample consisted of 673 respondents aged 60 and older who respondent to the prompt: “How are you feeling during this time of social distancing?”. We used a thematic bottom-up qualitative analysis, via MAXQDA, to analyze segments into general affect codes and detailed emotion subcodes, as well as coping mechanisms. Results showed that while many older adults reported neutral (9%) or positive (9%) affect, a larger proportion reported negative affect (42%) or reported mixed affect (35%). The most common negative emotions mentioned were anxiety and loneliness/boredom, while the most common positive emotions mentioned were optimism and feeling grateful. The most common coping mechanisms reported by participants included making life adjustments, keeping busy, prayer/spirituality, and mediation/mindfulness. This study provides an initial understanding into how older adults experienced and coped with the first stages of restricting social interactions. If social distancing continues to be a recommended disease-containment strategy, information about how older adults are coping can be critical for public health interventions. Implications will be discussed.
Predictors of Precautionary Actions by Older Adults During COVID-19: A Daily Diary Study
Authors: Hughes MacKenzie , Coblenz Clara , Smith Emily , Neupert Shevaun , Pearman Ann
Published: December 2020

Slowing the spread of COVID-19 depends on public adherence to precautionary actions, such as wearing masks. The Health Belief Model (Rosenstock, 1974) suggests the likelihood of using precautionary measures depends on perceived susceptibility, the severity of a disease, and whether effective measures can be taken to reduce the perceived threat of a disease. This daily diary study focused on identifying predictors of daily precautionary behavior in older persons. Between April 1 and June 26, 2020, 261 adults ages 55-79 (M = 64.29, SD = 5.20) completed up to 30 consecutive days of online diaries. We examined whether perceived risk, COVID-19 knowledge, fake news beliefs, information seeking, disruption to routine, in-person interactions, and leaving the house predicted the number of daily precautions participants engaged in. Multilevel modeling was used to examine within-person fluctuations in precautions as well as change in precautions from one day to the next. People who reported higher education, scored higher on the COVID-19 knowledge quiz, had lower fake news beliefs, and perceived a higher risk of contracting COVID-19 endorsed more precautions. At the daily level, increases in the number of in-person interactions, leaving home, and disruption to daily routine were each associated with decreases in precautionary behaviors. Concurrent day and lagged models showed significant interactions between information seeking and perceived risk, suggesting increases in information seeking are related to increases in precautions for those who consider their risk to be low. Findings highlight potentially intervenable factors that influence older adults’ daily decision making related to precautionary actions.
Type of Cooking Fuel and Mortality Among Oldest-Old in China
Authors: Yao Yao , Gu Danan , Chen Huashuai , Zeng Yi
Published: December 2020

Studies have reported that elder adults are susceptible to the indoor pollution. However, evidences on the mortality risk of household air pollution (HAP) on the elderly, especially on vulnerable oldest-old population, are scarce. We aimed to estimate the association between HAP exposure from solid fuel combustion and 7-years all-cause mortality using a nationally representative dataset of oldest-old population in China. We used data from wave 2011 to wave 2018 of Chinese Longitudinal Healthy Longevity Survey. Household cooking fuel were dichotomized as solid fuel (including kerosene, charcoal, coal, wood, and biomass) and clean fuel (including electricity, solar, natural gas, and coal gas). The cohort contained 6,167 participants, totaling 21,357 person-years. There were 3,836 deaths between 2011 and 2014. About half of the participants (53.8%) used solid fuel for cooking. In the fully adjusted model, the mortality hazard ratio (HR) for solid fuel users was 1.10 (95% CI: 1.03-1.18). We observed significant interaction between HAP and urban/rural residency but not between HAP and gender. Our study showed exposure to HAP from solid fuel combustion was associated with higher risk of all-cause mortality in the male and female oldest-old population. This adverse effect was more pronounced in urban residence who use solid cooking fuels, suggesting attention should be paid on reducing HAP, particularly on susceptible population.
Age and Sex Differences of Comorbidities in Medicare Older Adults With Chronic Obstructive Pulmonary Disease
Authors: Le Tham , Simoni-Wastila Linda
Published: December 2020

OBJECTIVES: Although comorbidity varies by sex and age, comorbidity variation among individuals with specific primary conditions is less well-understood. We sought to quantify chronic comorbidities in older adults with chronic obstructive pulmonary disease (COPD) using representative Medicare claims data. METHODS: This retrospective cohort study consisted of individuals aged 65+ with a COPD diagnosis identified in a 5% Medicare sample enrolled between 1/1/2012-1/1/2015. We quantified the prevalence of 40 comorbidities and sex and age variation (≥ or ≤ 85 years). RESULTS: Of 461,268 eligible beneficiaries, 60% were female, 86% were white, with mean (SD) age of 79 (8) years. The majority (89.2%) had at least 5 comorbidities; 50.4% had ≥ ten comorbidities. Most prevalent conditions included: hypertension (92.6%), hyperlipidemia (86.4%), anemia (74.9%), rheumatoid arthritis (RA) (68.0%), congestive heart failure (CHF) (49.6%), diabetes (46.7%), depression (43.7%), peripheral vascular disease (PVD) (42.9%), and chronic kidney disease (CKD) (38.6.) Male patients had higher prevalence of CHF, diabetes, CKD, atrial fibrillation (AFib), AMI, cancer, tobacco use disorder, and liver disease, while females had higher prevalence of hypertension, anemia, RA, depression, asthma, osteoporosis, pain, hypothyroid, obesity, dementia, and glaucoma. Compared to patients under 85, those aged ≥85 years had higher prevalence of cardiovascular disease, depression, musculoskeletal conditions, cancer, dementia, glaucoma, and CKD; but lower prevalence of asthma, anxiety, and metabolic disorders. CONCLUSIONS: Older adults with COPD encounter a high prevalence of comorbidities. Comorbidity patterns differs across age and sex spectrum, highlighting the significance of age and sex in developing individualized clinical care and epidemiological research.
DPP4 Gene Polymorphism Associates With Type 2 Diabetes Mellitus in Older Adults
Authors: Alves Elisa , Tonet-Furioso Audrey , Bastos Izabela D , Moraes Clayton , Nóbrega Otávio
Published: December 2020

Genetic variations of the dipeptidyl peptidase 4 enzyme (DPP-4) have been associated with glycemic disorders, especially among older adults. The objective of this study was to investigate the association of a single nucleotide polymorphism on the DPP4 gene with the occurrence of type 2 diabetes mellitus in a sample of older community-dwelling patients. Clinical, anthropometric and physiological characteristics as well as biochemical data related to lipidemia, glycemia and hormonal factors and variables related to the lifestyle were analyzed among 338 individuals aged 60 years and older from two general geriatric outpatient clinics in the Federal District, Brazil. Genotypes related to the polymorphism rs3788979 (A/G) of the DPP4 gene of these patients were determined by conventional polymerase chain reaction followed by enzymatic restriction, whereas the serum levels of DPP-4 were assessed by colorimetric immunoassay. Among the results obtained, there was clear variation in the glycemic levels both in terms of blood glucose and glycosylated hemoglobin according to DPP-4 genotypes, with increased levels between homozygotes for the G allele. However, no association was found between genotypes and occurrence of type 2 diabetes mellitus in patients. No other clinical, biochemical or anthropometric variables were influenced by the polymorphism. In our conditions, there was no association between genotypes and DPP-4 levels. Considering that DPP-4 is involved in the metabolism of incretins and directly interferes with glycemia in organisms, our result corroborates that genetic variations of this enzyme can affect glycemic homeostasis, despite not being determinant for the occurrence of type 2 diabetes mellitus.
Late-Onset Intermittent Fasting Decreases Aging-Related Frailty
Authors: Henderson Yoko , Bithi Nazmin , Link Christopher , Yang Jie , Hine Christopher
Published: December 2020

Global average life expectancy continues to rise. As aging increases likelihoods of exhibiting geriatric syndromes (a.k.a. frailty), there is a need for effective anti-aging treatments. Multiple studies have shown the positive effects of dietary restriction (DR) on lifespan in various model organisms. However, DR is not widely implemented in older adults due to issues with patient compliance and the overall lack of understanding on the effects of DR initiated later in life. Thus, the present study tested whether late-life DR, specifically Every-Other-Day (EOD) fasting, attenuates aging-related frailty using a modified and simplified frailty index in mice. Briefly, 20-month old male and female C57BL/6 mice (human equivalent of 65 years) that had been on a control chow diet ad libitum during adulthood were placed on EOD fasting or ad libitum feeding for 2.5 months. Their frailty index was identified using an indirect calorimeter, glucose tolerance test, novel object place recognition test, forelimb grip strength meter, and rotarod. We found that late-life EOD fasting decreased overall caloric intake in males but not in females. In addition, EOD fasting significantly improved metabolic, musculoskeletal, and cognitive endpoints in male mice, but enhanced only some of these in female mice. Furthermore, EOD fasting improved hydrogen sulfide (H2S) production capacity and its associated sulfhydration signaling in tissues, which positively correlated with improvements in frailty measures. We conclude that EOD fasting implemented late in life can have therapeutic potential in the clinic. We are currently investigating the necessity of H2S production for DR mediated benefits and longevity.
Elevated Growth Differentiation Factor-15 Is a Biomarker of Sarcopenia in Older Adults
Authors: Kim Miji , Won Chang Won
Published: December 2020

Growth differentiation factor 15 (GDF-15) is associated with disease progression, mitochondrial dysfunction and mortality. Elevated GDF-15 level was recently reported to be associated with poorer physical performance in healthy community-dwelling adults. However, the relationship between serum GDF-15 concentration and sarcopenia in community-dwelling older adults has not been well characterized. We analyzed 929 participants (mean age 75.9±8.9 years, 48.0% men) from the Korean Frailty and Aging Cohort Study who underwent assessment of serum GDF-15 concentration and sarcopenia. Participants with an estimated glomerular filtration rate <60 ml/min/1.73 m2 were excluded from this analysis. Sarcopenia status was determined as per the Asian Working Group for Sarcopenia (AWGS) 2019 guidelines. As per the AWGS 2019 algorithm, 154 (16.6%) participants in the study population were classified as having sarcopenia. Median serum GDF-15 concentration was elevated in the sarcopenic group vs. the non-sarcopenic group (920 vs. 793 pg/ml, p<0.001). In the multivariate analysis adjusted for potential confounders, the highest GDF-15 tertile (≥1245 pg/ml) was associated with a higher risk of sarcopenia vs. the lowest tertile (<885 pg/ml) (odds ratio [OR] = 1.95, 95% confidence interval [CI] 1.15–3.31). This association remained unchanged (OR = 1.90, 95% CI 1.14–3.23) after further adjustment for potential biomarkers (myostatin, dehydroepiandrosterone, and insulin-like growth factor-1). The OR per unit increase in log-transformed GDF-15 concentration was 3.59 (95% CI 1.21–10.70). To conclude, our results suggest that higher circulating GDF-15 concentration was independently associated with a greater risk of sarcopenia in community-dwelling older adults. Serum GDF-15 concentration can be a promising biomarker for sarcopenia
Exosomes Derived From Senescent Cells Promote Cellular Senescence
Authors: Mao Genxiang , Xu Xiaogang
Published: December 2020

Exosomes are one type of small-cell extracellular vesicles (sEVs), which together with the senescence-associated secretory phenotype (SASP) mainly constitute the senescent microenvironment and perform remotely intercellular communication. However, the effects of senescence on exosomes biosynthesis and secretion and its role in the cell senescence are still obscure. Here, we used human fetal lung diploid fibroblasts (2BS) passaged to PD50 to construct the senescent cells model in vitro, which were confirmed by senescence-related β-galactosidase staining, cell cycle distribution, and intracellular ROS levels. PD30 2BS was used as young control. We evaluated the exosomes derived from senescence and young control group respectively and investigated their regulation of senescence. We found that exosomes released from 2BS had typical sizes and cup-shapes morphology and their surface presented typical exosome-associated proteins. The number of exosomes secreted by senescent cells was significantly higher than that of young cells. Moreover, exosomal markers Alix, TSG101, and CD63 were all more expressed than young cells. Furthermore, we treat young cells with exosomes secreted by senescent cells, which can induce senescence-like changes in young cells, including increased SA-β-Gal activity, up-regulated p16 protein expression, and activation of the Notch signaling pathway. The above results imply that exosomes derived from senescent cells can promote cell senescence. The ﬁndings expand the current knowledge on exosomes-mediated aging and provide a novel understanding of the relationship between SASP and senescence. This study is supported by National Natural Science Foundation of China (No. 81771520 and 31702144).
Low Serum Albumin in Patients With Coexisting Cognitive Impairment Predicts Surgical Complications
Authors: Tirambulo Coco Victoria , McFadden Caitlyn , Lieberman David , Fain Mindy
Published: December 2020

Cognitive impairment (CI, ~15-20%) and malnutrition (~38.7%) are common concerns among older adults ≥65 years. CI and malnutrition may be used as predictive risk factors for poor surgical outcomes. The 2012 ACS NSQIP/AGS Best Practice Guidelines for the preoperative assessment of geriatric surgical patients classify severe nutritional risk as either having a BMI < 18.5 kg/m2, serum albumin (SA) < 3.0 g/dL and/or unintentional weight loss > 10%-15% within 6 months. Using SA as a surrogate marker for malnutrition, we evaluated the relationship between CI, malnutrition, and risk for poor surgical outcomes in a geriatric population. Electronic medical record chart reviews of patients (≥65 years old) undergoing elective intermediate or high-risk surgery (IHRS), between 2016 and 2019 in Tucson, AZ, were conducted. Pre-and-post assessment factors such as cognitive status via mini-cog, laboratory markers (SA), and hospital complications were examined. Multivariate regression analyses were performed to determine the association between cognitive status, SA levels, and hospital complications. Of the 173 patients undergoing IHRS included in this assessment (mean age: 75.5±7.4 years, [60-93 years], 54.9% male), 42.8% experienced hospital complications. Multivariate regression analysis revealed cognitive impairment and low SA levels were significantly associated with this outcome (p<0.05), adjusted for age and gender. We demonstrated MCI and low SA levels are risk factors of postoperative hospital complications among older patients undergoing elective IHRS. Increased understanding of predictive factors can help enhance prevention efforts, aiding in improving patient experiences and reducing patient and hospital costs.
The Relationship Between Race and Ethnicity in Post-Surgical Discharge Disposition
Authors: McFadden Caitlyn , Tirambulo Coco Victoria , Lieberman David , Fain Mindy
Published: December 2020

Racial and ethnic disparities have been reported regarding outcomes of intermediate or high-risk surgical (IHRS) procedures. This study aimed to assess whether or not these disparities exist with respect to post-procedural discharge disposition (DD). EMR chart reviews of patients (≥65 years old) undergoing IHRS were conducted, 2016-2019 in Tucson, AZ. Race and ethnicity were reported as American Indian/Alaskan Native; Black or African American; More-Than-One-Race; Native Hawaiian/Pacific Islander; White/Caucasian; Unknown/Not Reported, Hispanic/Latino; Non-Hispanic/Latino; or Unknown/Not Reported. DD was reported as to home, home with home health, rehabilitation center, skilled nursing facility (SNF), death, or other. Kruskal-Wallis tests were performed to determine the association with DD. Of the 161 patients (mean age: 74.7±6.9, [60-91], 53.4% male) assessed, 15.4% were discharged to a facility other than home or home with home health. Ethnicity was significantly associated with discharge disposition (p<0.005). Non-Hispanic/Latinos (66.1%) were more likely to be discharged home compared Hispanic/Latinos (14.8%), while those Unknown/Not Reported were more likely to be discharged to a SNF. Although race was not significantly associated with DD (p<0.062) due to sample size, it is clinically important to consider as 59.9% of White/Caucasians were more likely to be discharged home compared to 1.6% of American Indian/Alaskan Natives; 1.6% Black or African Americans; 5.7 of More-Than-One-Races; and 12.0% Unknown/Not Reported. We demonstrated ethnic disparities affect postoperative DD. Although racial disparities were not significantly associated with DD, anticipating the impact of race and ethnicity to facilitate discharge planning that meets the goals of the older patient is crucial to care.
Cognitive Reserve, Incident Cancer, and Rate of Memory Decline in Later Life
Authors: Romero Monica Ospina , Brenowitz Willa , Hayes-Larson Eleanor , Ackley Sarah F , Mayeda Elizabeth R , Glymour M Maria , Kobayashi Lindsay
Published: December 2020

Cognitive reserve (cognitive skills and abilities acquired before onset of brain pathology) helps maintain cognitive function during aging. Cognitive decline after cancer treatment, known as “chemobrain,” is a prevalent outcome among older cancer survivors. It is unknown whether cognitive reserve buffers against acute neuropathological events such as cancer-related cognitive decline. We examined acute and long-term rate of memory decline associated with incident cancer diagnosis by education levels as proxy for cognitive reserve (low: <12 years; intermediate: 12 to <16 years; high: ≥16 years) in 14,449 adults aged 50+ in the US Health and Retirement Study from 1998-2016. Memory (z-scored) was assessed biennially as immediate and delayed word recall combined with proxy assessments. We used adjusted linear mixed models to determine long-term rates of memory decline before and after cancer diagnosis, and acute memory decline immediately after diagnosis (3,248 incident cases), and compared them with corresponding memory trajectories in cancer-free participants. Acute memory decline immediately after diagnosis was larger in those with low (-0.098 SD units, 95% CI: -0.150, -0.045) versus high (-0.038 SD units, 95% CI: -0.084, -0.008) education. Long-term memory decline after cancer was faster in those with low (-1.16 SD units/decade, 95% CI: -1.25, -1.07) versus high (-0.89 SD units/decade, 95% CI: -0.96, -0.82) education. Consistent with previous research showing an inverse cancer-dementia relationship, individuals with cancer had more favorable memory trajectories than cancer-free individuals with similar age and education. Among those with cancer, lower cognitive reserve was associated with greater acute and long-term memory decline after diagnosis.
A Community Resource Referral Intervention for Informal Caregivers of People With Dementia
Authors: Boyd Kelly , Doyle Kate , Borson Soo , Huang Elbert , Lindau Stacy , Nathan Aviva , Thompson Katherine , Makelarski Jennifer
Published: December 2020

The National Alzheimer’s Project Act (PL-111-375) calls for connecting dementia caregivers to community resources, but few caregiver interventions have focused on this component of support. CRx-D is a theory-driven, scalable intervention that addresses common caregiver needs through: (1) education to normalize needs, (2) coaching on resource activation and (3) tools to promote access, including a printed list of nearby resources (“HealtheRx-D”), an online resource finder, proactive and ongoing text message support. We pretested the intervention arm of CRx-D among 10 caregivers of PWD to assess appropriateness, feasibility and fidelity. Patients presenting for care at 3 outpatient clinics were screened for eligibility, enrolled and given the intervention (12/19-01/20). Of 1,038 patients approached, 12 were caregivers of PWD; 10/12 met all eligibility criteria. All 10 eligible caregivers were enrolled in the study. Caregivers were, on average, 49 years old (range, 29-65), primarily female (n=8), Black/African American (n=9), and half were children of PWD (n=5). At baseline, several caregivers indicated unmet caregiving or health needs (caregiving education [n=7], free/affordable meals [n=5] and financial assistance [n=5]) indicating the intervention’s appropriateness. Intervention components were delivered as intended to all caregivers, although one caregiver provided a landline so could not receive texts. A scalable resource referral intervention for caregivers is appropriate. Delivery is feasible with high fidelity. Identifying caregivers at the point of their own healthcare requires high volume screening. These findings will inform a randomized controlled trial of 344 caregivers of PWD to evaluate the impact of CRx-D on caregiver self-efficacy and satisfaction with care.
I Don’t Want to See It End: A Faith Community Nurse Intervention for Older Adults and Caregivers
Authors: Sessanna Loralee , Pomeroy Sherry , Askew Yvonne
Published: December 2020

The Faith Community Nurse (FCN) provides population-based and other nonclinical services in community settings that are not commonly available to the older adult population. The purpose of the FCN Connections (FCNC) study was to test the impact of the FCNC intervention on the health and well-being of clients (C) age 60 and older with chronic diseases and caregiver (CG) dyads (CCGD) by embedding a FCN in a primary care practice (PCP). A mixed method design was used with two cohorts over 18 months (N = 13 CCGD). Experienced FCNs led the components of the intervention in the CCGD home, including client health assessment, education and support while identifying their caregiver’s perceived needs, providing education and spiritual/emotional support, linking to resources, and connecting the CCGD with the PCP. The CCGD completed measurements at baseline, 6 and 12 weeks. CG knowledge, preparedness, self-efficacy with caregiving activities, and spirituality were measured with statistically significant CG improvement for handling emergencies, making caregiving activities pleasant, and taking care of emotional needs of the client. Spirituality, self-esteem, function, depression, and healthy living domains were measured for clients. At 12 weeks, semi-structured interviews with the CCGD were conducted and transcribed. An experiential/phenomenological framework and Reflexive Thematic Analysis were used to analyze data which generated one overarching theme, ‘I don’t want to see it [study] end’ and key themes, Theme 1 [client]: ‘She was always there to help’ and Theme 2 [caregiver]: ‘It’s like you took the pressure off me for a while’ describing the CCGD’s FCNC experience.
Use of Homecare Nursing and Sense of Security Among Family Caregivers of Older Adults
Authors: Igarashi Ayumi , Katayama Madoka , Sakka Mariko , Noguchi-Watanabe Maiko , Fukui Chie , Inagaki Asa , Kitamura Satomi , Yamamoto-Mitani Noriko
Published: December 2020

Having a sense of security for living at home is essential to continue living at home and it is important to develop a community care system that enables high sense of security. Because frail to dependent older adults often accompany various conditions that require medical attention, receiving homecare nursing might allow the family caregiver to feel safe in living at home. Therefore we examined whether receiving homecare nursing service contributes to a higher family caregiver sense of security. We conducted a questionnaire survey regarding older adults who were 75 years and older with at least some sort of community care services, and their family caregivers (n=776). Family sense of security was measured using 5 items (e.g., “I feel secure about my relative living at home with help of available services”), rated on 5-point Likert scales. Characteristics of older adults were obtained from their nurses or care managers. The mean age of the older adults was 85.8 years, 58% female, and 8 % living alone. The mean total family sense of security was 20.6 (standard deviation = 3.7) out of 25. In multiple regression analysis, the family sense of security was positively associated with the use of homecare nursing (β= 0.09, p=0.020), adjusting for participants’ age, stability of their medical conditions, level of activities of daily living, use of medical procedures, living arrangements, and house call physician services. Homecare provided by nurses could contribute to longer staying at home among older adults by way of the higher family sense of security.
Impact of Cognitive Functioning and Age on Patient-Reported Outcomes in Parkinson’s Disease
Authors: Gruber-Baldini Ann , Kim Haesung , Unick Jay , Shulman Lisa
Published: December 2020

Cognitive impairment is prevalent in Parkinson Disease (PD) and increasing age is a PD risk factor. Age and cognition may impact patient-reported outcome measures (PROMs) level, reliability, or validity of responses. This study investigated the relative impact of cognitive function and age on PROMs in PD. Cross-sectional data (n=676) included assessments of age, cognition (Montreal Cognitive Assessment; MoCA) and PROMIS-29 Profile (physical functioning, anxiety, depression, fatigue, sleep disturbance, social functioning, pain). Analyses examined differences by age and MoCA in: 1)Level—correlations, multivariable regressions controlling for disease severity (UPDRSmotor, PD duration), comorbidity (CIRS-G), demographics; 2)Reliability--Cronbach’s alpha, and 3)Validity--correlations of PROMIS physical function with physician assessments. Sample was age M=68.0(SD=9.1); range=36-93 years, 64% male, 87% white, 37% college educated, PD duration M=8.2(SD=6.1) years, and MoCA M=24.3(SD=4.9; range 2-30). Greater cognitive impairment was consistently associated with greater physical/mental impairment (r=.14-.45; p<.05), except for sleep disturbance (r=-.07, p=.08) Multivariable regressions found cognition remained a significant predictor of physical functioning, anxiety, and depression older age predicted anxiety and social functioning. Comorbidity was the greatest predictor across all the PROMs (r=.22-.45). Reliability for PROMIS measures was excellent (alpha>.8) across cognitive and age groups, except for Fatigue at MoCA.36) across cognition and age groups. Cognitive impairment in PD is associated with lower physical function and mental health levels. Reliability and validity of most PROMs in PD are neither impacted by cognition nor age.
Incident Cognitive Impairment During Aging in Rural South Africa: Evidence From the HAALSI Cohort, 2014 to 2019
Authors: Kobayashi Lindsay , Farrell Meagan , Langa Kenneth , Mahlahela Nomsa , Wagner Ryan , Berkman Lisa
Published: December 2020

We estimated the incidence of cognitive impairment and its key sociodemographic, social, and health-related predictors at the first longitudinal follow-up of the population-representative “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) cohort of adults aged ≥40 in rural Agincourt, South Africa. Cognitive impairment was defined as scoring ≥1.5 SD below the baseline mean composite time orientation and episodic memory score, or requiring a proxy interview with “fair” or “poor” proxy-reported memory. Activity of daily living (ADL) limitations were compared according to incident cognitive impairment status. Incidence rates (IRs) and rate ratios (IRRs) for cognitive impairment according to sociodemographic, social, and health-related predictors were estimated using Poisson regression with robust standard errors, and weighted to account for mortality. Over a 3.7-year mean follow-up, 309/3,861 at-risk participants newly developed cognitive impairment (IR=24.0/1000 person-years (PY); 95% CI: 21.6-26.8). Incidence increased from IR=9.1/1000 PY (95% CI: 5.5-16.1) among those aged 40-44 at baseline to IR=76.5/1000 PY (95% CI: 63.2-93.4) among those aged 80+. At least one ADL limitation was prevalent in 39% of those with incident cognitive impairment, compared to 7% of non-impaired participants. Incident cognitive impairment did not vary by sex/gender, HIV status, or cardiovascular factors, but was strongly graded according to education, literacy, household assets, employment, marital status, and frequency of alcohol consumption. This study presents one of the first incidence rate estimates for cognitive impairment in sub-Saharan Africa. Social disparities in cognitive impairment were apparent in patterns similar to many high-income countries.
Association of Loneliness and Social Isolation With Healthspan and Lifespan in the U.S. Health and Retirement Study
Authors: Crowe Christopher , Kwon Dayoon , Belsky Daniel
Published: December 2020

Loneliness and social isolation present emerging public health challenges for aging populations. To inform efforts against loneliness and social isolation, research is needed to evaluate impacts of these conditions on patterns of adverse aging outcomes. We used longitudinal, repeated measures data to isolate effects of loneliness and social isolation from effects of socioeconomic circumstances and psychological vulnerabilities, rule out reverse-causation, and test dose-response in associations with morbidity, disability, and mortality. We also explored the biological basis of relationships by testing associations with biological aging. We analyzed data from more than 12,000 adults aged 50-95 in the US Health and Retirement Study (HRS) who reported on symptoms of loneliness and social isolation at 2-3 time points during 2006-2014. We measured loneliness using the 3-item Revised UCLA Loneliness Scale and social isolation using a 6-item scale. We tested associations with chronic disease, disability, and biological aging in 2016 and with mortality through 2018. We found (1) associations of loneliness and social isolation with adverse aging outcomes are not fully explained by socioeconomic circumstances and psychological vulnerabilities; (2) the direction of relationships with disability indicates temporal precedence of loneliness and social isolation; (3) there is a dose-response in associations with loneliness; and (4) there is evidence of a biological mechanism explaining associations with loneliness and social isolation. Findings add to the emerging literature on health sequelae of loneliness and social isolation. Assessment of loneliness and social isolation in surveillance and intervention with older adults can enhance risk assessment for adverse aging outcomes.
Depressive Symptoms Among Older, Sexual Minority Adults and the Influence of Marital Status
Authors: Mezuk Briana , Bergmans Rachel , Schoebel Victoria
Published: December 2020

Adverse health outcomes, including poor mental health and depression, tend to be more common among those who are lesbian, gay, or bisexual (LGB). Minority stress theory posits that chronic minoritization contributes to disparities in depression. Factors like social support and income can improve mental health outcomes, and these resilience-promoting factors can be gained through marriage. However, whether marriage improves mental health outcomes in old age regardless of sexual orientation is not well established. This study aims to determine if depressive symptoms differ by sexual orientation in old age, and to test whether the association between depression and sexual orientation was moderated by marital status. The 2016 Health and Retirement Study, a nationally representative sample of U.S. adults older than 50 years (n=4,253), was the first wave to include respondent sexual orientation. Depressive symptoms were measured on the 8-item Center for Epidemiologic Studies Depression Scale (CES-D). Those with a score greater than or equal to 3 were considered to have elevated depressive symptoms. When testing main effects in the adjusted model, depression was not more common among LGB persons than heterosexual persons (OR=0.95; 95% CI=0.46-2.00). Yet, marital status significantly moderated the relationship between sexual orientation and depression (p=0.034). Among heterosexual adults, being married was protective against depression (OR=0.48; 95% CI=0.32-0.71) when compared to being never married, whereas marriage was not protective among LGB adults (OR=0.95; 95% CI=0.26-3.45). Findings indicate that LGB adults do not experience the same mental health benefits of marriage as heterosexual individuals.
Geographic Regional Variation in Patterns of Racial and Ethnic Disparities in Late-Life Depression
Authors: Vyas Chirag , Reynolds Charles , Mischoulon David , Chang Grace , Okereke Olivia
Published: December 2020

There is evidence of racial/ethnic disparities in late-life depression (LLD) burden and treatment in the US. Geographic region may be a novel social determinant; yet, limited data exist regarding the interplay of geographic region with racial/ethnic differences in LLD severity, item-level symptom burden and treatment. We conducted a cross-sectional study among 25,503 men aged 50+ years and women aged 55+ years in VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary study to the VITAL trial. Racial/ethnic groups included Non-Hispanic White, Black, Hispanic, Asian, and other groups (Native American/Alaskan Native and other/multiple/unspecified-race/ethnicity). We assessed depression status using: the Patient Health Questionnaire-8 (PHQ-8); self-reported clinician/physician diagnosis of depression; medication and/or counseling treatment for depression. In the full sample, Midwest region was significantly associated with 12% lower severity of LLD, compared to Northeast region (rate ratio (RR) (95% confidence interval (CI)): 0.88 (0.83-0.93)). However, racial/ethnic differences in LLD varied by region. For example, in the Midwest, Blacks and Hispanics had significantly higher depression severity compared to non-Hispanic Whites (RR (95% CI): for Black, 1.16 (1.02-1.31); for Hispanic, 2.03 (1.38-3.00)). Furthermore, in multivariable-adjusted logistic regression models, minority vs. non-Hispanic White adults had 2- to 3-fold significantly higher odds of several item-level symptoms across all regions, especially in the Midwest and Southwest. Finally, among those endorsing PHQ-8≥10, Blacks had 60-80% significantly lower odds of depression treatment, compared to non-Hispanic Whites, in all regions. In summary, we observed significant geographic variation in patterns of racial/ethnic disparities in LLD outcomes. This requires further longitudinal investigation.
The Absence of Close Social Network Connections: A Case Study Investigation in Social Isolation
Authors: LeBlanc Raeann , Walker Rachel
Published: December 2020

Social isolation is an emerging phenomenon known to significantly influence health outcomes and carries specific risk in older age. As part of a larger study exploring the social network effects on health among persons age 65 and above, it was found that four cases from a larger sample (n=89) could not name any one from their social relationships supportive to them in managing their health while living with complex chronic health needs. In addressing these findings, these cases, bounded spatially by individual social networks and temporally by the time of the study interview, served the basis for intensive analysis using multiple data points from in-depth interviews and survey measures. Measures included descriptive data (social networks, demographics) and measures of health (SF-12), and social support (MOS-SSS). Each participant case identified as female gender and single, three lived alone, had a high burden of chronic conditions and poor health. All had recent hospitalizations (1 or more within the past year). The structures of their social networks varied in type of relationship roles and size. Social support was perceived overall as low. This study offers a specific contribution to research on social connection/isolation. This phenomenon is relative to specific contexts. Findings emphasize that social isolation can be specific to certain aspects of identity and poorer health in older age. Additional research on the functions and qualities of social networks, in addition to the structure, are important to specify in future research and knowledge development for practice assessment to determine social connection and isolation.
The Mental Health of Older Veterans Ages 58-99 Years: 2016-2017 VE-HEROeS Findings
Authors: Cypel Yasmin , Schnurr Paula , Bossarte Robert , Culpepper William , Schneiderman Aaron , Akhtar Fatema , Morley Sybil , Davey Victoria
Published: December 2020

Mental health and its correlates were examined in U.S. Vietnam War veterans approximately fifty years after the War. The 2016-2017 VE-HEROeS (Vietnam Era Health Retrospective Observational Study) was a mail survey of the health of U.S. Vietnam War veterans who served between February 28, 1961 and May 7, 1975 and matched US non-veteran controls. ‘Veteran status’ represented wartime experience for three cohorts: ‘theater’ veterans with service in Vietnam, Cambodia, or Laos, non-theater veterans with service elsewhere, and non-veterans with no military service. Veterans and non-veterans, aged 58-99 years, were randomly selected from a veteran sampling frame (n=9.87 million) derived from the Department of Veterans Affairs’ USVETS dataset and a commercial address database, respectively. Questionnaires were mailed to 42,393 veterans and 6,885 non-veterans; the response rate for veterans was 45% (n=18,866) and 67% (n=4,530) for non-veterans. Weighted bivariate and multivariable analyses were conducted to examine poor overall mental health, via the SF-8TM Mental Health Component Summary score (MCS), and other mental health measures by veteran status and socioeconomic, health, and other military characteristics. Nearly 50% of all theater veterans reported poor overall mental health (MCS<50). Prevalence of mental health measures was greatest for theater veterans and successively decreased for non-theater veterans and non-veterans. Key correlates significantly (P< 0.02) associated with poor MCS included veteran status, race/ethnicity, income, physical health, health perception, trauma, distress, depression, posttraumatic stress disorder (Primary Care DSM-5 PTSD screen), and drug use. Results indicate a high burden of poor mental health among those who served in-theater.