bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial Differences in the Pathway to Diagnosis of Alzheimer's Disease and Related Dementias
Authors: Xu Hanzhang , Burke James , Dupre Matthew , Min Se Hee , Anderson Ruth , Page David , Ostbye Truls
Published: December 2021

This study examined differences in the pathway to diagnosis of Alzheimer's disease and related dementias (ADRD) between Black and White older adults. Using electronic health records from a large health system, we included 2,085 non-Hispanic Black and 6,269 non-Hispanic White older adults with a final/primary diagnosis of ADRD between 2014 and 2020. Black older adults were more likely to receive the ADRD diagnosis from a primary care provider (35.4% vs. 29.8%), during a hospital admission (19.5% vs. 13.6%), or during an emergency department visit (4.2% vs. 2.0%); but were less likely to be diagnosed by an ADRD specialist (31.6% vs. 45.2%). Black older adults had nearly twice as many clinical encounters in the two years prior to the ADRD diagnosis than their White counterparts (43 vs. 26). Despite having more clinical encounters, Black older adults were more likely to be at a later stage when diagnosed than White older adults.
Older Adult Health and Remission of Risky Drinking and Alcohol Use Disorder: A Lifespan-Developmental Study
Authors: Lee Matthew , Yeung Ellen , Kwan Thomas , Sher Kenneth
Published: December 2021

Older-adult drinking is a growing public-health concern. As part of a larger project investigating older adulthood by contrasting this with other adult developmental periods, this study used longitudinal U.S.-representative data to test bidirectional associations between drinking and health, emphasizing aging-related health concerns as potential mechanisms of remission from risky/problem drinking. In multiple-group cross-lag models, we found that effects of poor self-reported health on drinking reductions increased with age, reached significance around midlife, and were strongest in older adulthood. However, a caveat revealed by additional Markov transition models was that these effects did not extend to relatively severe older-adult drinkers (indexed by DSM-5 AUD). In some instances, poor health even predicted less older-adult AUD remission. Altogether, findings support the notion of aging-related health concerns as important mechanisms of older-adult drinking reduction; but highlight a need to understand barriers to these mechanisms among severe older-adult drinkers, in part toward guiding lifespan-developmentally-informed interventions.
Presidential Symposium: Disruption to Transformation of Communities of Care: Key Issues and Opportunities in Health Sciences
Authors: Mueller Christine , Corazzini Kirsten , Wolff Jennifer
Published: December 2021

Consistent with the theme of the conference this year, this symposium explores the impact of the pandemic and our commitment to redress structural racism and health inequities on health of older adults, and our collective capacity to transform and innovate through our gerontological health sciences lens. Each presenter will focus on one sector of care: (1) the health system and healthcare workforce; (2) older persons; and (3) families and care partners. The first presenter provides a systems-level perspective on key disruptors in healthcare systems for care of older adults and the workforce, and emerging innovations to address increasingly transparent care inequities. Emerging research implications as a result of these disruptions will be highlighted. The second presenter highlights how the predominant features of the pandemic in older adults, loneliness and isolation, are co-occurring with significant resilience and innovation, and the resultant potential to create a paradigm shift in how we design and advance communities of care. The third presenter provides the perspective of family members and care partners of older adults during the time of the pandemic, focusing on disruptions that have informed changes going forward, innovations that have emerged, and implications for research to be addressed. Our discussant situates the presentations within the larger context of ‘the new normal’, with a particular focus on considering the global, inter-connected context of communities of care, a commitment to reducing inequities for older adults, and implications for health sciences education and policy.
Innovation During Disruption: Supporting What Matters Most to Older Adults Through Person-Environment Fit
Authors: Szanton Sarah
Published: December 2021

The fragile and improvised systems of care for older adults have been decimated by isolation and fragmented care during the pandemic. However, innovations are increasingly being offered to older adults to improve the fit between them and their environment. This includes fit within the home, the social environment, the policy environment, and with clinicians. Advancing these “fits” requires evidence-based solutions like CAPABLE, a 4 month self-efficacy and function program that provides an occupational therapist, nurse and handyworker to assess and address older adults’ functional goals. The older adult identifies what matters most and experiences a tailored program that taps into their purpose in life and supports engaging in meaningful activities. Starting in research sites, CAPABLE is now offered in 34 sites in 17 States and expanding through policy and insurers. Such efforts to leverage the strength of older adults and their families, builds capacity to evolve our communities of care.
Social Engagement and Well-Being Among Chinese Older Adults
Authors: Zhang Wei , Wu Bei , Wu Yan Yan
Published: December 2021

Social engagement is increasingly recognized as a protective factor to promote healthy aging. This symposium provides new findings on social participation and social isolation in relation to individuals’ health and well-being among the Chinese populations. Using the 2002¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬–2018 Chinese Longitudinal Healthy Longevity Survey, the first study examined the trends of leisure activity engagement among young-old adults aged 65–74 in China over a 16-year period. Findings revealed a general downward trend of engaging in any form of social leisure activity and upward trends for engaging in home-bound and solitary leisure activities. Similarly, the second study examined social participation patterns and individual factors associated with these patterns using three nationally representative data in China, UK, and US. Their findings highlighted several underlying participation patterns across these nations as well as differences in how socio-demographics were associated with these patterns. Using data collected among Chinese older adults in Hawaii, the third study examined the associations of social isolation with psychological well-being. Results showed that social isolation was positively related to psychological distress, and negatively related to life satisfaction and happiness. These associations were partially mediated by resilience. Their findings revealed the detrimental health effects of social isolation. Using the same dataset in Hawaii, the last study examined the associations between neighbourhood conditions and psychological well-being for Chinese older adults. Their findings revealed that both physical and social neighbourhood conditions were associated with psychological well-being, particularly for foreign-born older adults, and psychological resources such as self-management abilities could mediate the associations.
Correlates of Social Isolation Among Minority Older Adults During the COVID-19 Pandemic
Authors: Adepoju Omolola , Howard Daniel , Smith Kendra , Herrera Luz , Han Daikwon , Woodard LeChauncy
Published: December 2021

Background: Over the past year, engagement with older adults has been severely curtailed given the high rates of COVID-19 morbidity and mortality in this population. This study examined the correlates of social isolation among African American and LatinX older adults during the COVID-19 pandemic. Methods: Working with community-based organizations and senior living centers, we administered a survey to older adults 55+, in the Houston metroplex, between 11/2020 and 01/2021 (n=575). The survey assessed COVID-19 prevention behaviors and health-related social needs. Responses to “How often do you feel lonely or isolated from those around you?” were used to create a dichotomous social isolation dependent variable. The main independent variable, family/community support, was based on responses to the validated question "If for any reason you need help with day-to-day activities such as bathing, preparing meals, shopping, managing finances, etc., do you get the help you need?" Multivariate logistic regression adjusting for socioeconomic status, medical conditions, positive COVID test (for self or family), COVID-19 prevention behaviors, and emergency preparedness levels was used. Results: Limited family/community support was strongly associated with social isolation (OR=6.2; p<0.01), as was having any chronic condition (OR=2.9, p=0.02). Females and seniors who reported daily social distancing were more likely to report being socially isolated (OR=2.4, p=0.04; OR=1.09; p=0.09, respectively). Of all chronic conditions examined, diabetes was the single strongest predictor of social isolation (OR=2.49, p=0.02). Conclusion: Being female, having diabetes and limited family/community supports are associated with COVID-19-induced social isolation in African American and Latinx communities.
Stress Related to COVID-19 and Loneliness Among Middle-Aged and Older Adults in the United States
Authors: Yoon Sukyung , Mahapatra Neely
Published: December 2021

Intensified levels of stress and loneliness have been attributed to the COVID-19 pandemic (Havnen et al., 2020; Luchetti et al., 2020). Moreover, loneliness has been reported to exacerbate psychological and physical health issues (Holt-Lunstad et al., 2015). The current research aims to investigate the impact of stress-related to COVID-19 on loneliness. The roles of age, sex, living arrangements, health, and resilience were also investigated. Data was collected on 267 middle-aged and older adults (ages 45 through 88) living in the U.S during COVID-19. A path analysis was employed. For both the direct and indirect effects, 95% confidence intervals were estimated using bootstrapping (a bootstrap sample of 1,000 was specified). Model fit was acceptable. X2 (5) = 7.913, p > 0.05, CFI=0.972, RMSEA =0.047. Regarding direct effects, the results indicate that COVID-19 related stress (hereafter stress) was negatively associated with perceived good health (hereafter health) (β = -.213, p<0.001). It was also found that health was positively associated with resilience (β = .324, p<0.001). Being male was positively associated with resilience (β= .144, p<0.05), and resilience was negatively associated with loneliness (β= .230, p<0.001). Meanwhile, stress had negative indirect effects on resilience, whereas stress had positive indirect effects on loneliness. Finally, health and being male had negative indirect effects on loneliness. The findings indicate that health practitioners and service providers should develop programs to improve and maintain good health, resilience, and social support among middle-aged and older adults during the COVID-19 pandemic. Moreover, gender-based services are also needed.
Translational Geroscience: Human Models of Healthy Aging and Longevity
Authors: Milman Sofiya
Published: December 2021

While insulin like growth factor-1 (IGF-1) is a well-established modulator of aging and longevity in model organisms, its role in humans is less well understood. Previous ambiguities in part have been attributed to cohort characteristics and unawareness of interactions between age and IGF-1. Centenarians have emerged as an ideal model of healthy aging because they delay the onset of age-related diseases and often remain disease free for the duration of their lifespan. In cohorts of centenarians and generally healthy older adults, we demonstrated that reduced IGF-1 is associated with extended lifespan and health-span. Additionally, we confirmed that IGF-1 interacts with age to modify risk in a manner consistent with antagonistic pleiotropy: younger individuals with high IGF-1 are protected from dementia, vascular disease, diabetes, cancer, and osteoporosis, while older individuals do not exhibit IGF-1-associated protection from disease. These findings offer evidence for IGF-1 modulating health-span and lifespan in humans.
Intergenerational Relationships, Social Support, and Psychological Well-Being Among Korean Older Adults
Authors: Lee Yooumi , Wilmoth Janet
Published: December 2021

Using longitudinal data from the 2006 to 2018 Korean Longitudinal Study of Aging, this study explores depression trajectories among individuals who are 60 or older with at least one living adult child at baseline. We estimated linear growth curve models of depression trajectories separately for married, unmarried and widowed using the Center for Epidemiologic Studies Depression Scale (CES-D). Results indicate that declining health and recent widowhood are positively related to depressive symptoms. Satisfactory intergenerational relationships and social support in the form of caregiving decrease depressive symptoms of older parents, especially among the widowed. Having at least one son and a first-born daughter positively impact psychological well-being of older parents. A son was particularly important for those who are widowed. We conclude that the psychological benefits of intergenerational relationships and social support are contingent upon the vulnerability of Korean older adults and discuss the implications for public policy.
Dementia Caregivers' Trajectories of Well-Being Before and During the COVID-19 Pandemic
Authors: Mitchell Lauren , Albers Elizabeth , Birkeland Robyn , Peterson Colleen , Drake Anna , Gaugler Joseph
Published: December 2021

Residents of long-term care settings and their family caregivers have been severely impacted by the COVID-19 pandemic. The present mixed-methods study examines trajectories of well-being pre- and post-pandemic onset for caregivers of persons with dementia living in residential long-term care. Participants were taking part in, or had recently completed, an ongoing intervention trial to support families transitioning a relative into long-term care. Beginning in summer 2020, we started assessing caregivers’ COVID-19-related experiences and added three surveys spanning 4-months beyond the 12-month parent study period to capture caregivers' adjustment throughout the pandemic. Using latent growth curve models, we estimated caregivers' (N = 104) trajectories of depressive symptoms, burden, and self-efficacy before and during the pandemic. We also tested whether the counseling intervention had protective effects for participants in the treatment group, and examined moderators including long-term care facility size, care recipient's dementia and health status, and quality of staff interactions.
Does Personality Shape COVID-19 Responses in Older Adults?
Authors: Aschwanden Damaris , Sutin Angelina , Sesker Amanda , Lee Ji Hyun , Luchetti Martina , Stephan Yannick , Terracciano Antonio
Published: December 2021

Knowing how personality plays out in a pandemic can provide guidance to improve public health messaging. In a sample of 2066 participants (Mage = 51.42; 48.5% female), we examined whether personality is associated with concerns, precautions, preparations, and duration estimates of the COVID-19 pandemic. Personality traits were measured before the pandemic; responses were assessed in late March 2020. We investigated whether age moderates the trait-response associations because older adults are at higher risk for severe complications of COVID-19. Among the 65-96-year-olds, higher conscientiousness was associated with more preparations, higher openness was associated with greater concerns, and both higher openness and agreeableness were related to more preparations and longer duration estimates. This pattern has implications: If all older adults took COVID-19 seriously, individual differences in personality should not matter; however, our findings indicate that they do matter and could be considered in the development of personality-tailored communication to older adults.
Childhood Lead Exposure and Cognitive Functioning Among Older Adults: Evidence From the Health and Retirement Study
Authors: Lee Haena , Lee Mark , Warren John Robert
Published: December 2021

Many children born in the early 20th century were exposed to water-borne lead, a neurotoxin that negatively impacts brain development. While lead exposure has been linked to poor cognition among children and young adults, no population-level research has examined the long-term implications of lead exposure for cognitive functioning in later life. Our study is the first to address this gap by utilizing novel data linkages between the 1940 U.S. Census and the Health and Retirement Study (HRS). Our sample includes respondents who were under age 17 (born 1924-1940) by the time of the decennial enumeration on April 1, 1940. Given that the dominant source of lead exposure was water during this period, we assessed lead exposure by using water chemistry and piping material data for each HRS respondent’s city of residence in 1940. Late-life cognitive functioning for HRS participants (observed 1998-2016) was measured using the Telephone Interview for Cognitive Status. We find that lead exposure during childhood is significantly and negatively associated with cognitive functioning in later life. HRS participants who lived in cities with lead pipes and acidic or alkaline water—the conditions required for lead to leech into municipal water—showed lower levels of cognitive functioning decades later as compared to other participants. This association persisted net of race, gender, childhood socioeconomic status and childhood health. However, the association was largely accounted for by adjusting for educational attainment. This implies that childhood lead exposure impacts later-life cognition via its effect on educational attainment.
Community Leaders’ Perspective of Strategies to Enhance Social Connectedness in Rural Communities
Authors: Oh Patricia , Kaye Len , Parham Lori
Published: December 2021

Age-Friendly communities are charged with fostering a social environment where social connections are available, accessible, and meaningful. Thematic content analysis of 67 interviews (representing 73 communities) conducted between 12/09/2019 and 01/24/2020) and 59 interviews (representing 71 communities) conducted between 12/14/2020 and 1/19/2021 with age-friendly leaders in rural Maine suggested the importance of expanding multi-sectoral collaborations and developing flexible strategies that allow older people to create and maintain social connections, even during COVID. Prior to the pandemic, common strategies were: (1) local partners and volunteers; (2) in-person activities; (3) accessibility; (4) reciprocity; and, (5) neighborhood-specific solutions. During the pandemic, there was an increased reliance on regional partners and funders to develop low or no-tech and tech-enabled social opportunities. Additional adaptive strategies included: (1) intergenerational ties; (2) emphasizing fun; and, (3) flexibility. The study has implications for understanding how rural age-friendly communities develop and grow multi-sectoral collaborations to enhance social connections.
Staff Perspectives on Lessons Learned From an Interdisciplinary Memory Care Coordination Program
Authors: Antonsdottir Inga , Samus Quincy , Reuland Melissa , Johnston Deirdre , Spliedt Morgan , Sloan Danetta
Published: December 2021

MIND at Home is a home-based care coordination program for persons living with dementia (PLWD) and their informal care partners (CP). Assessments, care planning and coordination is delivered by trained non-clinical Memory Care Coordinators (MCCs), working together on an interdisciplinary team with nurses and geriatric psychiatrists. We report qualitative results from program staff (two nurses and eight MCCs) who implemented the program in the context of two clinical trials. Care team respondents answered open-ended questions covering 5 domains pertaining to: helpful skillsets; positive and challenging factors aspects of care coordination; barriers to care coordination for clients; and improvements suggestions/resources to strengthen the program. Compassion, finding common ground, listening, organization, and time management were reported as critical skills. Staff enjoyed team collaboration, being in and learning about the community, increasing CP confidence and mastery when caring for a PLWD. Reported challenges included documentation in EHR, accessing/navigating resources, driving long distances, unsafe neighborhoods, ambiguous assessment tools, and working with low engagement clients. Common barriers faced by clients (as reported by staff) were financial struggles/poverty, and lack of insurance coverage for needed services. Staff suggested several improvements: better communication strategies, integration with LTSS services and medical providers, 24-hour program hotline, continuous education for staff, simplified data collection and care delivery tracking process. This presentation on the experience of MIND at Home trained nurses and MCCs provides deep insight on how this and similar care coordination programs might be successfully implemented or strengthened.
Teaching End-of-Life Decision Making to Undergraduate Nursing Students
Authors: Greenberg Sherry , Innella Nancy , Pilkington Bryan
Published: December 2021

This presentation highlights the development, implementation, and results of an educational session with undergraduate nursing students about end-of-life decision making. The purpose of this qualitative thematic analysis study was to explore student perspectives of end-of-life decision making following an education session. The aims were to 1) develop themes from student feedback on end-of-life decision making and 2) refine educational strategies to teach end-of-life decision making to nursing students. The study was conducted with 72 junior level baccalaureate nursing students enrolled in an undergraduate gerontological nursing course. An interactive lecture was developed, following short philosophical ethics readings, which brought the students up to date on the history of end-of-life discussions, key cases, and different frameworks to approach a cluster of ethical issues associated with end-of-life care. A debate pedagogical model was employed as an engaging activity in which students directly applied recently learned concepts. In the debate activity, students were divided into two teams. Each team was assigned a position, which was a specific response to the case question: Should practitioners assist in their patient’s committing suicide? Should practitioners offer medical aid in dying? Each team conferred, presented their position, responded to the arguments or reasons from the opposing position. The session ended with a debrief by the course instructors. In the first semester, 31 nursing students completed four open-ended questions following the class. Results included increased student confidence discussing end-of-life issues and identification of two concepts commonly referred to in end-of-life care discussions and in bioethics, autonomy and dignity.
Visual Impairment and Objectively Measured Physical Activity in Middle-Aged and Older Adults
Authors: Cai Yurun , Schrack Jennifer , E Jian-Yu , Wanigatunga Amal , Urbanek Jacek , Simonsick Eleanor , Swenor Bonnielin
Published: December 2021

Vision loss is associated with restricted physical activity (PA), yet the relationship between multiple domains of vision measures and objectively measured PA, especially activity patterns, in mid-to-late life remains unclear. In 603 BLSA participants (mean age=73.5±11 years; 56% women; 69% white), best-corrected and presenting visual acuity (VA), contrast sensitivity, visual fields (VF), stereo acuity were assessed from 2015 to 2019. Free-living PA was assessed using a wrist-worn ActiGraph accelerometer for 7 days. Linear regression models showed that participants with vs. without best-corrected VA impairment had 29.3 fewer active minutes/day (p=0.03) and trended towards fewer activity counts (p=0.05), adjusting for sociodemographic and health characteristics. VF impairment was associated with 268,636 fewer activity counts (p=0.02), 46.2 fewer active minutes/day (p=0.02), and a 3% greater activity fragmentation (p=0.009). Older adults with visual impairment have restricted and more fragmented activity patterns. Longitudinal studies are warranted to examine causality between visual impairment and PA decline.
Free-Living Gait Cadence Measured by Wearable Accelerometers for Assessing Fall Risk
Authors: Urbanek Jacek , Roth David , Karas Marta , Wanigatunga Amal , Juraschek Stephen , Appel Lawrence , Schrack Jennifer
Published: December 2021

Accelerometers are widespread in research applications, yet whether they are superior to structured clinic-based assessments is unknown. Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-meter gait speed) with free-living gait cadence from wrist accelerometers (Actigraph GT9X) in predicting fall rates in 432 older adults (age 77.29±5.46 yrs, 59.1% men, 80.2% White) participating in the Study to Understand Fall Reduction and Vitamin D in You (STURDY). Accelerometry-based gait cadence was estimated with the Adaptive Empirical Pattern Transformation algorithm. Across all participants, every 10 steps/min higher cadence was associated with a 13.2% lower fall rate (p=0.036). Mobility measures were not related to falls (p>0.05). Among higher-functioning participants (cadence ≥100 steps/min), every 10 steps/min higher free-living cadence (p=0.01) was associated with a 27.7% lower fall rate. Data collected from accelerometers may provide a more sensitive indicator of fall risk than in-clinic tests.
Multidimensional Sleep Health: Concepts, Advances, and Implications for Research and Intervention
Authors: Chung Joon , Goodman Matthew , Huang Tianyi , Bertisch Suzanne , Redline Susan
Published: December 2021

Sleep is a complex process, sensitive to aging, with theoretical and evidentiary basis for influence on multiple health outcomes. Recent scholarship has argued for a ‘multi-dimensional’ approach to sleep health, that is, a recognition that healthy sleep consists of more than its quantity (duration) and is more than the absence of sleep disorders. This new conception of sleep health acknowledges sleep’s complexity yet presents challenges for methodological treatment. How do we operationalize/analyze multiple dimensions of sleep, some of which are correlated due to physiological reasons, common measurement tools, or sensitivity to common stressors? Is it sensible to talk about ‘sleep health’ as a single, composite entity with multiple components, akin to a dietary pattern rather than a collection of individual nutrients? Exemplar data from a racial-ethnic disparities project in aging adults suggest the utility of a composite approach, and the value of considering inter-correlations among sleep metrics.
Comparison of Recruitment Strategies for Engaging Older Minority Adults: Results From Take Heart
Authors: Ramsay Jessica , Hogan Cainnear , Janevic Mary , Courser Rebecca , Allgood Kristi , Connell Cathleen
Published: December 2021

Few studies report best practices for recruiting older adults from minority, low SES communities for behavioral interventions. In this presentation, we describe recruitment processes and numbers for Take Heart, a randomized controlled trial testing the effectiveness of an adapted heart disease self-management program for primarily African American, low SES adults 50 years or older in Detroit. Community-based (CB), electronic medical record (EMR), and in-person hospital clinic (HC) recruitment methods were implemented. Within 22 months, 453 participants were enrolled, with an overall recruitment yield of 37%. The CB method had the highest yield (49%), followed by HC (36%) and EMR (16%). The average cost of recruiting and enrolling one participant was $142. Face-to-face interactions and employing a community health worker were particularly useful in engaging this population. Further research is needed to confirm these findings in other minority and low SES populations and share lessons learned about recruitment challenges and successes.
Response Efficacy and Action to Prepare for Disasters With Different Lead Time: Age Differences
Authors: Chen Zhirui , Cong Zhen
Published: December 2021

This study investigated how disaster types, namely those with short and longer warning lead time, contextualized individuals’ preparatory action, especially as associated with their response efficacy and age. The working sample included 1,467 respondents from the 2017 U.S. National Household Survey. Logistic regressions showed that individuals with higher levels of response efficacy were more likely to prepare after learning information about how to prepare. Respondents in areas prone to short lead-time disasters were less likely to prepare than those in longer lead-time disasters areas. Response efficacy was more important for action taking for short lead-time disasters, which was observed only among older adults when older and younger adults were examined separately. These findings revealed the impacts of disaster types and response efficacy on disaster preparedness and older adults’ unique vulnerability and resilience, which could guide policymaking and interventions to promote national disaster preparedness tailored to regional peculiarities.
Integrating Assessment for Social Disconnectedness Into Aging Services: Charting a Path Forward
Authors: Prendergast Alice , Fuller Kristi
Published: December 2021

Social disconnectedness poses a serious threat to the health and well-being of older adults. Although research demonstrates that social disconnectedness was prevalent among older adults long before the COVID-19 pandemic, the crisis has brought significant attention to this issue, as well as resources to address it. The crisis also shed light on the current gap in evidence and guidance on how best to assess for and address social disconnectedness, especially in practice settings. Researchers from the Georgia Health Policy Center conducted a review of existing assessment tools and processes for social disconnectedness and formulated recommendations for the Georgia Division of Aging Services (DAS) in November 2020. These recommendations involve the use of evidence-based assessments paired with person-centered counseling to address social disconnectedness among at-risk individuals. In this session, researchers from Georgia State University will define social disconnectedness, explain how it differs from related constructs, and discuss the necessity of a holistic approach to assessment; summarize the review and recommendations made to DAS; and present preliminary data from DAS’s initial implementation of the assessment process.
The Journal of Applied Gerontology: An International Forum for Information
Authors: Robison Julie
Published: December 2021

The mission of applied gerontology is to bridge science and practice to benefit the health and well-being of older persons, their families, their communities, and other contexts. This presentation will provide insights from the Journal of Applied Gerontology and its attempts to publish and disseminate scholarship that has international application. Following an overview of the growing internationalization of peer-reviewed submissions to the Journal of Applied Gerontology on a variety of topics and from a range of perspectives, the presentation will highlight key achievements as well as ongoing concerns and opportunities to better achieve the goals of applying gerontological scholarship to aging contexts worldwide. Concluding comments will examine how outlets for dissemination and authors themselves can better position their work to enhance their influence on aging in an international context.
Families as Valued Contributors to LTC Residents' Quality of Life: Policy Perspectives
Authors: Keefe Janice
Published: December 2021

Family members are essential contributors to Q0L of LTC residents. This paper analyzes how the system views family’s role in residents’ QoL and enables or inhibits family involvement. Our analysis of 21 policies that regulate LTC in four Canadian Provinces reveal differences in their portrayal of residents’ families. In many policies, family roles are characterized procedurally (task-oriented) or relationally (interactive) by policy type. Operational standards (regulatory policies) linked to licensing employ more formal terminology, while LTC program guidelines use facilitative language to engage families and build relationships through voluntary means. Specific examples of orientation and admission procedures, care protocols including use of restraints, right to live at risk, and end-of-life care are presented to reveal inter-provincial variations. We argue there are opportunities to further engage families within the current regulatory framework.
Tracing the Expression of Resident Quality of Life Policies in Canadian Long-Term Care Settings
Authors: Keefe Janice , Irwin Pamela
Published: December 2021

Policies favouring safety, security, and order are expressed in preference to those oriented towards person-centred resident quality of life in Canadian long-term care settings. Factors impacting the expression of these latent (under-utilised) rules were uncovered through an analysis of long-term care related policies in four provinces. 84 policies relating to resident quality of life in long-term care were analysed in three sequences, incorporating jurisdictions, policy types, and quality of life domains, over time. The analysis revealed three policy levers: situations–providing explicit and implicit examples of resident oriented quality of life policy suppression in each jurisdiction; structures–identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories–confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. Although these policies exist, their potentiality remains dormant in the dominant policy discourse, thereby signaling a positive post-pandemic possibility.
Energy and Fatigue Predict Gait Speed and Mood Decline: Results From the Health, Aging and Body Composition Study
Authors: Ehrenkranz Rebecca , Zhu Xiaonan , Glynn Nancy W , Rosano Caterina
Published: December 2021

Older adults may report high energy alongside tiredness or vice versa; little is known about whether discordant self-reported energy (SEL) and tiredness predict trajectories of mood, cognition, or gait speed. SEL (0-10 scale dichotomized at median) and tiredness (present/absent) were obtained in 2,613 older adults (aged 74.6± 2.87 years) and used to create four groups (energized/not tired, low energy/tired, energized/tired, low energy/not tired). Center for Epidemiologic Studies Depression Scale (CES-D) and gait speed were measured over 10 years; mixed effect models compared trajectories in these domains across each group with low energy/tired group as referent. Each group was significantly associated with CES-D and gait. Adjusting for demographics, the high SEL/not tired group showed the least decline in mood (ß = -0.17, p<0.01); the high SEL/tired group showed the least decline in rapid gait (ß = 0.008, p = 0.02). High SEL may indicate resilience for mood and gait speed decline.
Deep Learning Methods Capture Non-Linear Brain Aging Patterns Underlying Alzheimer’s Disease and Resilience
Authors: Thrush Kyra , Higgins-Chen Albert , Markov Yaroslav , Sehgal Raghav , Levine Morgan
Published: December 2021

The current era of multi-omics data collection has enabled researchers to obtain exceptionally comprehensive profiling of disease subjects. However, exceptionally high dimensionality can ultimately be an obstacle to biological insight. Previously, we presented a method in which penalized regression of methylation principal components reduces noise and improves prediction of age, disease, and Alzheimer’s Disease (AD) pathophysiology. However, strictly linear methods may overly simplify the complex epigenetic aging landscape. We hypothesized that non-linear deep learning methods could identify molecular signatures that better reflect individual resilience to AD. Through the use of an autoencoder to represent high dimensional methylation array data, and supplemental machine learning methods, we connect latent nonlinear representations of the brain to aging, resilience, and indications of AD. In particular, resultant age-predicting representations of methylation were correlated with enrichment of methylation regions and biological pathways. Contextualized within AD pathology, this work provides valuable, ongoing insight into resilience in AD.
The Relationship Between Leadership Styles, Job Satisfaction, and Tenure Among Nursing Home Administrators
Authors: Peerman Carey
Published: December 2021

Long-term care is considered a subset of health care administration as the characteristics and leadership skills needed differ from other areas of health care. Leadership style directly relates to organizational development, success, and effectiveness. For study purposes, specific focus was placed upon determining the degree to which nursing home administrators (NHAs) perceived styles of leadership determined job satisfaction with tenure as an NHA. Perceptions of leadership style and levels of job satisfaction were determined using a non-experimental, quantitative design, specifically employing a survey research approach. The research instrument in this study, the MLQ, provided the data essential to addressing the research questions and accompanying hypotheses. The effect of study participant response to items on the MLQ associated with the research questions was assessed using univariate analysis of descriptive factors and inferential statistical techniques for statistical significance testing purposes. A total of 87% of study participants indicated that they perceived their leadership style as Nursing Home Administrators (NHA’s) was reflective of Transformational Leadership. However, findings indicated that participants who had a Transactional Leadership style were more likely than other types of leadership styles to select an NHA as a career path if given the opportunity to choose this line of work in the future.
East Meets West: Home and Community Based Care to Enhance Aging in Place
Authors: Amano Takashi , Inoue Megumi
Published: December 2021

Although the magnitude and rate of aging in Japan and the United States differ, the drastic change in population structure has resulted in common challenges in both countries. One challenge is assisting older people in staying in the community. Enhancement of home- and community-based care allows older people to remain in their homes or spaces of their choice without moving into an institution to receive necessary care. This symposium includes four presentations (two from Japan and two from the U.S.) examining various efforts surrounding home- and community-based care designed to strengthen older people’s abilities to stay in the community. The presenters will cover a wide range of strategies that have been implemented in both countries. The first presenter will describe the development and delivery of a project to expand Arizona’s dementia capable system. The second presenter will describe initiatives of a professional association of geriatrics to promote the concept of aging in place. The third presenter will discuss the Home Hazard Removal Program (HARP), a new home hazard removal and fall risk self-management program delivered in the home by occupational therapists. The fourth presenter will discuss Japan’s national policy priority of promoting the use of home health care within the community-based integrated care system. The symposium will conclude with a review of similarities and differences of various efforts, summarize common goals and challenges, and identify best practices.
A Home Hazard Removal Program to Reduce Falls in Community-Dwelling Older Adults
Authors: Stark Susy
Published: December 2021

The majority of falls experienced by older adults occur in the home with home hazards associated with an increased risk of falling. Low-income older adults, who have more disability and live in substandard housing, need feasible interventions to help them safely age in place. The Home Hazard Removal Program (HARP) is a new home hazard removal and fall risk self-management program delivered in the home by occupational therapists to prevent falls. To evaluate the program, a randomized control trial was conducted with 310 community-dwelling older adults receiving aging services in the community. HARP had high acceptability with older adults and was feasible to deliver in the community. Adjusted for fall risk, individuals in the HARP group fell 1.4 times versus 2.2 times in the control group over 12 months. This low-cost home hazard removal program demonstrated acceptability, feasibility, and a significant reduction in falls for at-risk community-dwelling older adults.
Terrie Fox Wetle Award (2021): Advancing multidisciplinary health services science: Developments in a Dementia-Focused Program of Research
Authors: Bykovskyi Andrea Gilmore
Published: December 2021

The Terrie Fox Wetle Rising Star Award in health Services and Aging Research is an award named in honor of Fox Wetle, PhD, who is internationally recognized for her contributions to aging, public health, and health care research. The award recognizes health services researchers in early or middle-career phases who have made significant contributions that embody the value of multidisciplinary health services science and are likely to have a sustained, high impact on practice and research. This aware lecture will be presented by the 2021 Award Recipient, Andrea Gilmore-Bykovskyi, PhD, RN, and will highlight emergent findings and foci in her dementia-focused health services research program. In particular, the award lecture will discuss progress in investigating social and behavioral communication patterns among individuals with moderate to advanced dementia; and the role of temporally situated observational measures and inclusion of persons with dementia and their caregivers in this line of research. The lecture will conclude with a discussion of next steps for this area of investigation surrounding assessment of episodes of lucidity in advanced dementia; and considerations for strengthening progress in outcome evaluation among persons living with dementia through multidisciplinary and community-informed health services research.
Protective and Exacerbating Cognition and Attribution Factors From the Cognitive Discrepancy Theory of Loneliness
Authors: Zucchetto Jillian Minahan
Published: December 2021

According to the cognitive discrepancy theory, although the discrepancy between actual and desired social resources may result in loneliness, Perlman and Peplau (1998) suggested that cognitive processing and attributional style also impact the interpretation of social information. Previous empirical research investigating predictors of loneliness have not assessed a wide range of cognition and attribution factors, so this study filled this gap by examining how protective (optimism, sense of mastery, and purpose in life) and exacerbating (depression, control constraints, negative self-perceptions of aging (SPA), and experiences of age-based discrimination) factors influence and moderate the experience of loneliness cross-sectionally and longitudinally using a sample of 3,345 Americans aged 50 years and older from the 2008 and 2012 waves of the Health and Retirement Study. Optimism (βs = -.15, -.13), mastery (βs = -.08, -.07), purpose in life (βs = -.19, -.18), depression (βs = .22,.14), control constraints (βs = .18, .17), negative SPA (βs = .13, .14), and experiences of ageism (βs = .07, .06) were significantly related to loneliness cross-sectionally and longitudinally, respectively. Optimism buffered the negative impact of poor functional social resources (e.g., low social support) on loneliness cross-sectionally while control constraints, negative SPA, and experiencing ageism exacerbated the relationship between low functional social resources and loneliness cross-sectionally. None of the protective or exacerbating factors modulated the relationship between functional social resources and loneliness longitudinally. These findings have important implications for the development of interventions that target loneliness. Targeting maladaptive cognitions may be particularly effective in reducing loneliness.
Reducing Pessimism About Social Security’s Future Through Gerontological Education
Authors: Koss Catheryn
Published: December 2021

A recent Pew Research Center poll found less than half of non-retired U.S. adults believe they will receive Social Security benefits when they retire. Pessimism about Social Security’s future is even stronger among people under 50, raising concerns about political support for the program. The current study examined to what extent education about how Social Security functions and strategies to address program funding shortfalls could increase optimism about Social Security’s future. In Fall 2020, twenty-two undergraduate students enrolled in an on-line aging and social policy course were asked how likely they would receive Social Security income when they retired. Consistent with national polling data, only 38% believed they would probably or definitely receive Social Security retirement income. Students were also asked to briefly explain why they answered the way they did. Common reasons given for pessimism about receiving Social Security retirement income included having heard Social Security will run out of money and believing only U.S. citizens are eligible for Social Security benefits. Over a two-week period, students completed asynchronous on-line activities covering Social Security retirement eligibility, worker and spousal benefits, current funding, and proposed changes to address funding shortfalls. Upon completion, 67% of students stated they would probably or definitely receive Social Security retirement income when they retired (p = .07). These preliminary results suggest that education about the program can reduce pessimism about Social Security’s future. Additional data will be collected from 45 students enrolled in the same course in Spring 2021.
Impact of Housing and Neighborhood on Depression Among Older Adults in the Health and Retirement Study
Authors: Wilkie Rachel , Osuna Margarita , Ailshire Jennifer
Published: December 2021

Prior research has suggested that poor neighborhood and housing conditions can lead to worse psychological wellbeing. Most studies examine either neighborhood or housing conditions, but not both. Since neighborhood and housing conditions may be correlated it raises the question of whether one is a proxy for the other. We use data from the 2006 and 2008 waves of the Health and Retirement Study to examine associations between perceived neighborhood and housing conditions in 2006 and depressive symptoms (CES-D 8) score in 2008. We find that worse housing conditions and neighborhood safety are associated with more depressive symptoms two years later, even when controlling for prior depressive symptoms. Furthermore, housing and neighborhood conditions are independently related to increased depression symptoms over time. Our research contributes to a deeper understanding of the relationship between home and neighborhood environments and psychological wellbeing in older adults.