bluuebunny/crossref_metadata_2025 huggingface dataset:
Antecedents to Caregiving Differences in Black and White Families
Authors: Wood Kristie , Ng Yee To , Huo Meng , Fingerman Karen
Published: December 2020

Researchers have observed racial differences in midlife adults’ caregiving for aging parents. Black adults typically provide more parental caregiving and report greater rewards in doing so. We asked whether Black and White young adults differ in their support to midlife parents, and furthermore, whether this support differs based on parental gender. We also examined cultural beliefs and rewards of providing support underlying racial differences in support to parents. Black and White young adults from the Family Exchanges Study II (2013; aged 18–30 years; n=114 Black and, n=358 White) reported support provided to parents, and beliefs and rewards associated with support. We assessed 6 types of support (emotional, advice, listening to talk, socializing, practical, and financial) to each parent rated 1 = once a year or less often to 8 = everyday. Multilinear models revealed that Black young adults gave significantly more support to parents than White offspring, and these racial differences were mediated by filial obligation beliefs. Compared to White young adults, Black offspring provided more frequent support to their mothers and reported that it was more rewarding, and endorsed more negative relationship quality with mothers than with fathers. Research has shown that involvement correlates with conflict, which may underlie these findings. Further, compared to White offspring, Black young adults show significantly more behaviors that lead to caregiving in later life, and there are nuanced gender differences within Black parent-child relationships, which may need to be better understood to support Black caregivers.
Using Medicare Data to Inform Intervention and Care Delivery for the Most Expensive Patients
Authors: Amodeo Sam , Kowalkowski Henrik , Brantley Halley , Bangerter Lauren , Jones Nicholas , Cook David
Published: December 2020

Older adults with high medical spend require tailored interventions and care delivery models to meet their complex needs. Segmenting high-spend patients is a promising approach to designing such interventions. In this study we explored patient spend across 4 years (2016-2019) using claims from 799,205 patients continuously enrolled in UnitedHealth Group Medicare Advantage (mean age=73.7; S.E.=0.01). Patients with healthcare spend in the top decile were segmented into three subgroups: catastrophic, persistent, and semi-persistent. Catastrophic patients had more acute events (acute myocardial infarction and hip/pelvic fracture) driving their cost. Persistent patients were younger (mean age=67.8; S.E.=0.06) and had significantly more medications. Semi-persistent patients were older (mean age=76.6; S.E.=0.04) and had significantly more chronic conditions and frailty, indicating their cost was driven by medical complexity. These subgroups displayed different temporal stability in their healthcare costs over time. Each year, 79-81% of the catastrophic group dropped out of the top decile. In contrast, nearly 72% of the persistent group remained in the top decile whereas only 37% of the semi-persistent group remained year over year. As the global population continues to age, it will be necessary to design interventions and care delivery models that address the complex needs of older adults in the high-spend patient population. Our study suggests that segmenting high-spend patients into potentially actionable subgroups is an important first step in achieving these goals.
1-Year Rehospitalization and Mortality Rates in Geriatric Patients after Acute Hospitalization
Authors: Paek Sun , Volpi Elena , Deer Rachel
Published: December 2020

Hospitalization for an acute illness often leads to accelerated sarcopenia, debility, and loss of independence in geriatric patients. These post-hospitalization effects can further deteriorate health and lead to rehospitalizations and sometimes death. To improve health outcomes in these patients, it is important to determine predictive factors for increased readmission and mortality rates. Data regarding readmission and mortality within 1 year post-discharge were collected from the PACE and GRAMS studies (NCT02203656, NCT02990533) conducted at UTMB Galveston (Jan 2014 - Mar 2019). Readmission and mortality rates were analyzed to find associations with total days hospitalized and total number of readmissions within 1 year, demographics (age, highest education level, BMI, percent fat, baseline SPPB score), and interventions (exercise with protein supplementation, exercise with placebo, protein supplementation, placebo supplementation, and testosterone injection). Of the 175 subjects, 63.4% were rehospitalized and 9.7% died within 1 year. We found that patients who were rehospitalized within a year of their initial hospitalization were over 4 times more likely to die that year than patients who were not rehospitalized. Patients who died within one year had twice the amount of hospitalization within the year and spent three times the number of days hospitalized. Of the interventions studied, a single testosterone injection at discharge from the index admission appeared the most effective to reduce rehospitalizations.
Diet Quality and Biological Risk in a National Sample of Older Americans
Authors: Choi Yeon Jin , Ailshire Jennifer , Kim Jung Ki , Crimmins Eileen
Published: December 2020

Biomarkers are sensitive to current health status and capture aspects of health that may precede the development of disease and other health problems. Using comprehensive measures of biological risk, this study aims to investigate the relationship between intake of individual dietary components, overall diet quality, and biological dysregulation. For the analysis, we used nutrition and biomarker data from 3,641 older adults (over age 50) in the Health and Retirement Study. Eleven out of 13 individual dietary components were associated with lower biological risk. After controlling for SES, health behaviors, and access to health care, a high intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids and a low intake of sodium and saturated fat were still associated with lower biological risk. Respondents with poor/suboptimal quality diet had higher biological risk than those with good quality diet. After controlling for SES, health behaviors, and access to health care, respondents with poor/suboptimal quality diet continued to exhibit higher biological risk than those with good quality diet, though the differences in biological risk were reduced. Findings from this study emphasize the importance of healthy eating in improving health of older adults. Encouraging intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids, while limiting consumption of sodium and saturated fat would improve overall diet quality and contribute to the prevention of chronic diseases and morbidity.
Adult Personal Network Characteristics Associated with Early Life Adversity
Authors: Briggs Janae , Child Stephanie
Published: December 2020

Early life adversity (ELA) is associated with poor health through social and economic pathways. ELA also shapes cognitive and emotional development, including self-perception, social attachment and mental well-being. As such, ELA may shape later life health through social relationships, yet few studies have examined these associations. Data from the UC Berkeley Social Network Study were used to examine ELA measured retrospectively and current personal network characteristics among young (21-30 years) and older adults (50-70 years). ELA was operationalized as a summary of six experiences occurring before age 18 (e.g., parents’ divorce/separation, violence/drug use in the home, etc.). Personal network characteristics included objective measures, such as the number of ties who provide or receive various types of support, and subjective assessments about the adequacy of support received. Multivariate regression models adjusted for gender, race/ethnicity, and level of education. Among young adults, ELA was associated with more ties who rely upon the ego for support (b=0.15, 95% CI: 0.02, 0.28, p=0.02). Among older adults, ELA was associated with more ties named as either an advisor (b=0.14, 95% CI: 0.04, 0.21, p=0.02) or difficult/demanding (b=0.12, 95% CI: 0.04, 0.21, p<0.01). Furthermore, ELA was associated with less confidence in family support available (b= -0.09, 95% CI: -0.16, -0.03, p<0.01) and fewer emotionally close family members (b= -0.18, 95% CI: -0.32, -0.03, p=0.02) among older adults. In conclusion, clear differences emerged in network characteristics by exposure to ELA, particularly among older adults. The findings highlight potential pathways through which ELA patterns later life health.
Loneliness, isolation and living alone associate with psychological well-being among the older adults in Taipei
Authors: Hsu Hui-chuan
Published: December 2020

Purpose: The purpose of this study was to examine the clustering of loneliness, isolation, and living alone, the risk factors and the associations with psychological wellbeing. Methods: The data were from the 2019 Taipei City Senior Citizen Condition Survey collected by face-to-face interviews, which included aged 60 and above community-based and institution-based samples. The completed sample was 3,853 persons. Loneliness, isolation, and living arrangement were analysed by cluster analysis to define the Loneliness-Isolation-Living Alone clusters. Multinomial logistic regression was used to examine the related factors to LIL clusters. Results: Four clusters of the older adults were identified and named as following: Connected (44.1%), Alone /Institutionalized (9.2%); Lonely (10.7%); and Isolated (22.0%). Compared with the Connected cluster, the Alone/Institutionalized cluster was more likely to have higher education, more IADL difficulties, more diseases , lower economic satisfaction, more likely to be males, having no spouse, and no children; the Lonely cluster was more likely to poor self-rated health, lower financial satisfaction, feeling less age-friendliness, more likely to be older, female, and no spouse; the Isolated cluster was more likely to have lower education, reported poorer self-rated health, lower economic satisfaction, and being older. The Alone/Institutionalized cluster and the Lonely cluster had higher depressive symptoms; the Alone/Institutionalized, Lonely, and Isolated clusters reported lower life satisfaction and had higher risks of cognitive impairment. Discussion: Loneliness, isolation, and living alone jointly associate with psychological health and well-being. High risk older populations may need social care and encourage social participation to promote health and wellbeing.
An Action Research Method for Generating Human-Centered COVID-19 Caregiving Interventions
Authors: Leonard Natalie , Carmichael Alicia , Jackson Jeannette , Huang Linde , Doshi Aalap , Leggett Amanda , Robinson-Lane Sheria , Gonzalez Richard
Published: December 2020

Caregiving for post-intensive care COVID-19 patients is an important determinant of successful recovery, including the reduced likelihood of ICU readmission. With possible ICU readmissions coinciding with a second wave of the pandemic, researchers and clinicians at the University of Michigan sought to develop a patient and caregiver-informed intervention that was remote, accessible, and could be immediately delivered. The resulting study, Health Enhanced by Adjusting and Recovering Together, reinforces these imperatives common in action research frameworks. Action research, emerging itself from a tumultuous time (1930s-40s) paralleling the COVID-19 pandemic, is a pragmatic research approach with the explicit goal of resolving a community problem or enacting social change--and doing so quickly. Here, we demonstrate a unique method for rapid intervention development that intertwines elements of (a) Human-centered design, for the purpose of a people-focused outlook, (b) Action research, for the purpose of rapid intervention, and (c) Traditional qualitative analysis, for the purpose of knowledge creation. The result of this combined method is an efficiently developed intervention that, while imperfect, is a user-centered, contextually-relevant viable product that can be quickly disseminated, tested, and further refined. The method presented is timely and relevant to other clinical and research teams addressing caregiving during the COVID-19 pandemic.
COVID Transitions: Characteristics of older adults who engage or do not engage in virtual exercise
Authors: Mateas Catalin , Bettger Janet , Jennings Stephen , Manning Kenneth , Hall Katherine , Pearson Megan , Morey Miriam
Published: December 2020

Background. Exercise is a crucial component of maintaining good health in older individuals. The COVID-19 stay-at-home orders forced Veterans actively engaged in facility-based exercise to stop attending in-person group exercise programs like Gerofit. Objective. To compare the characteristics of Veterans who enrolled (E) or declined enrollment (DE) in the transition from a facility-based exercise program, Gerofit, to a virtual Gerofit-to-Home (GTH) program. Methods. Gerofit is a supervised exercise “VA Best Practice” program for older Veterans implemented at 17 VA medical centers around the country. At the time of COVID-19 mandated closures, 1149 Veterans were actively engaged in facility-based programs and invited to attend GTH classes. Comparisons between those enrolling and those declining enrollment were performed by t-tests. Results. Three hundred and eight of 1149 (27%) Veterans made the transition to telehealth delivered classes, with several sites having enrolled participants aged in their mid-nineties. Age was not associated with GTH adoption rates (74.0 vs. 74.7, p=not significant for E vs. NE). Body mass index (31.3 vs. 30.5 kg/m2, p<0.05), gait speed (1.19 vs. 1.12 m/s, p<0.001), arm curls (20.8 vs. 19.5, p<0.001), and chair stands (14.7 vs. 13.2, p<0.05) were higher in individuals actively participating in GTH compared to those that never enrolled. Conclusions. Some older adults can adopt a virtual approach to group-based exercise, demonstrating its feasibility. Further research is needed to improve GTH implementation for lower functioning individuals. Virtual group-based exercise could reduce negative health effects associated with isolation due to lack of in-person exercise.
Impact of the COVID-19 Pandemic on Family Caregivers
Authors: Kilaberia Tina , Bell Janice , Bettega Kristen , Mongoven Jennifer , Kelly Kathleen , Young Heather
Published: December 2020

The COVID-19 pandemic has affected human life in unprecedented ways. Lives of older persons and their families have been especially adversely affected. Eleven Caregiver Resource Centers (CRCs) support family caregivers across the state of California, providing services such as assessment, counseling and respite. This presentation is part of a larger evaluation study and addresses the impact of the COVID-19 pandemic on family caregivers and systems supporting them. We interviewed directors, clinical staff and family consultants (n=35) from CRCs across diverse communities and geography in California, conducting semi-structured focus group interviews by Zoom. Questions explored perceptions of staff about effects on caregivers and implications for systems of support for caregivers. Interviews were transcribed and analyzed using the Dedoose software. Caregiver effects included increased isolation, higher stress, loss of support, neglected health needs, and accelerated technology adoption. Caregivers at particular risk were those facing multiple demands and experiencing compromised resources under the pandemic, such as closure of adult day care. System effects included challenges with hastened virtual delivery, disruption in services, and new opportunities to serve clients virtually. Community resources, such as internet connectivity, exacerbated disparities for family caregivers. We make recommendations to mitigate these challenges including technology platforms to support service delivery and education, training and preparedness for both caregivers and providers. These recommendations are relevant to the ongoing COVID-19 pandemic and adaptable to other crisis situations such as natural disasters.
A Scoping Review of How Financial Hardship Is Measured Among Older Adults in the United States
Authors: Tucker-Seeley Reginald , DoyLoo Ryan , Steinberg Leora
Published: December 2020

The association between socioeconomic status and health/healthcare related outcomes across the life course is well established; however, the specific mechanisms that underlie this complex association are not well understood. There have been calls in the health disparities literature for greater explication of the socioeconomic factors associated with differential outcomes for racial/ethnic minorities and socioeconomic groups. Recent research offers an expanded notion of socioeconomic circumstances by including indicators of financial hardship; however, there has been little conceptual and measurement clarity for gerontology research. To fill this gap, we conducted a scoping review of how financial hardship has been defined and measured in research with older adults. Using an adapted version of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol, N=25 articles were identified through the following indexes: PubMed, CINAHL, PsycInfo, Sociological Abstracts, and Embase. Articles were included if they were published after January 1, 2000, published in the United States, and conducted with adults aged 50 and older. Our study found neither a consistently used term for nor a definition of the financial hardship experience; however, two key domains were consistently measured across studies with older adults: food insecurity and medical expenses were measured in N=9 and N=13 studies, respectively. Greater conceptual and measurement clarity in research on financial hardship among older adults helps to unpack the complex ways in which socioeconomic circumstance are experienced, make comparisons across studies measuring the financial hardship experience, and to identify the specific aspects of financial hardship for intervention.
Safe Exercise at Home Website: Keeping Older People Active during COVID-19
Authors: Hill Anne-Marie , Said Cathy , Sherrington Cathie , Hill Keith , Batchelor Frances , West Courtney , Mackintosh Shylie , Callisaya Michele
Published: December 2020

Background Physical distancing restrictions, including recommendations to ‘stay home’ during the COVID-19 pandemic has restricted exercise opportunities for older adults. Our group of academic and clinical physiotherapists and a communications expert identified the need to support safe exercise at home to minimise the impact of these restrictions. The project aimed to develop an online, publicly available resource to support older adults to exercise at home. We met virtually and: a) developed home exercise programs for people at three levels of functional ability; b) developed simple advice about exercising safely, exercise intensity, and staying motivated; and c) reviewed and selected online exercise programs and resources for consumers and health professionals to access. Examples of older adults keeping active during the pandemic were sourced to provide motivation. Website content was made available to download and print to increase accessibility. Modifications were made after consumer and international advisor feedback, the website was endorsed by the Australian Physiotherapy Association. Content is updated as restrictions are modified and in response to feedback received. Google Analytics was used to evaluate website usage. The website was launched on 5 May 2020, 35 days after the group’s initial meeting. In the first 9 weeks of website availability 20,608 users accessed the website, with 14.6% being returning users. There were 27,513 sessions and 74,927 page views. Most users were from Australia (80.74%), followed by Denmark (5.15%) and USA (3.85%) We present this example of the benefits of time-critical collaboration to facilitate rapid translation of evidence into practice.
Social Distancing with Older Adults: Comparing Pre- and Post-Pandemic Preferences in Children
Authors: Lapp Juliana , Bauer Jenny , Scholz Lea , Steltmann Sonja , Lange Marit , Schenker Lena-Emilia , Bellingtier Jennifer
Published: December 2020

The Covid-19 pandemic has made age more salient, and the media has included numerous ageist messages (Bronwen, 2020), included messages aimed at children (e.g., “stay home to protect grandma and grandpa!”). When the pandemic reached Germany in March, we halted data collection on a project assessing ageism in children ages 4 to 8. In July, the situation had improved and testing resumed following hygiene protocols. We report findings from a simulated-behavioral measure where 45 children were asked to plan a party. One task involved asking the children to place pictures of ten party guests, plus themselves, around two party tables. We then assessed how many seats away the younger and older adult guests were placed, on average, from the child (i.e., social distance). Although, we anticipated that the pandemic might lead children to further distance themselves from older adults, our results, thus far, indicate similarity between pre- and post-pandemic preferences. At both occasions older adult guests were seated, on average, one seat further away from the child then younger adult guests. The guest chosen to sit closest to the child was younger on 88% of occasions, whereas the guest chosen to sit farthest away from the child was older on 64% of occasions. Preference for younger adults was confirmed in a second task where children selected teammates for a game. On average, children’s teams consisted of 70% younger guests versus 30% older guests. Findings indicate a social preference for younger, versus older, adults in children irrespective of the pandemic.
Views on Aging and Well-Being in the Covid Crisis – A Longitudinal Study in Luxembourg
Authors: Kornadt Anna , Hoffmann Martine , Murdock Elke , Nell Josepha , Albert Isabelle
Published: December 2020

During the Covid-Crisis, stereotypes of older adults as helpless and vulnerable were spread, and intergenerational conflict was stirred more or less openly. We thus focused on perceived ageism during the crisis and its effects on well-being and health of older adults. Since views on aging are multifaceted and can be both, risk and resource for individual development, we assessed people’s self-perceptions of aging (SPA) as social loss, continued growth and physical decline and subjective age (SA). We hypothesized that people with SPA of social loss and physical decline would be more susceptible to negative effects of perceived ageism, whereas those with SPA of continued growth and younger SA would be less affected. NT1 = 611 community-dwelling adults aged 60 – 98 (Mage = 69.92 years) were recruited in June 2020 online and via phone in Luxembourg. In September 2020, participants will be contacted again for a follow-up. Analyses with cross-sectional data show that participants who felt more discriminated reported lower life satisfaction after the onset of the crisis (r = -.35) and worse subjective health (r = -.14). SPA of social loss and higher SA increased the negative effect of ageism on well-being (beta = -.57) and subjective health (beta = -.53), respectively. Our results point to mid- and long-term consequences of age discriminatory and stereotype-based crisis communication for the well-being of older adults and the importance of individual SPA in critical situations.
Working Conditions Supporting Person-Centered Care of Persons Living with Dementia in Long-Term Care Homes
Authors: Savundranayagam Marie , Docherty-Skippen Susan , Basque Shalane
Published: December 2020

The COVID-19 pandemic has underscored the importance of person-centered dementia care and working conditions that support such care in long-term care (LTC) home settings. Personal support workers (PSWs), known also as certified nursing assistants, provide the most direct formal care for persons living with dementia. However, little is known about the working conditions that enable person-centered care. Accordingly, the purpose of this study was to examine the working conditions and the impact of those conditions on PSWs in LTC homes. PSWs (N=39) employed at one of five LTC homes in southwestern Ontario, Canada participated in a series of one-hour focus groups before, during, and after Be-EPIC, a person-centred communication training program for formal caregivers of persons living with dementia. Using an interpretive description investigative framework, textual data from focus group conversation transcripts were open-coded into categories. Overarching themes were interpreted inductively. Study credibility was enhanced through investigator triangulation. Three themes emerged related to working conditions of PSWs: dementia care is complex, lack of trained staff to provide person-centered dementia care, and residents’ families are not situated in the residents’ care circle. Four themes emerged related to the impact of current working conditions of PSWs: occupational burnout, poor resident care, frustrated and disengaged families, and PSWs leave their role. The findings offer opportunities for employers to ameliorate working conditions to support person-centered care. We conclude with specific workplace recommendations that respond to the complexity of dementia care and the associated occupational stresses PSWs experience in the current LTC environment.
An Exploration of Online Exercise Participation of Older Manitobans During the COVID-19 Pandemic
Authors: Porter Michelle , Lee Mikyung , Barclay Ruth , Cornish Stephen , Dunn Nicole , Ripat Jacquie , Sibley Kathryn , Webber Sandra
Published: December 2020

During the COVID-19 pandemic, in-person exercise programs for older people were temporarily closed, and some were replaced with online exercise. We explored the online exercise experiences of older people in Manitoba, Canada, using an online survey. We recruited a convenience sample (≥ 65 years), primarily through community organizations, and 745 people (57.5% female) consented. About 38.2% reported participating in online exercise during the pandemic. Most used pre-recorded classes (80.4%), from their local community (79.7%), and YouTube was the most used platform (57.4%). Almost all (82.7%) found the classes had the right variety and intensity. Of those who had participated in online exercise, 67.0% said they would participate in an online exercise class outside of a pandemic time. Participants like the following aspects better about online exercise: no transportation arrangements, it doesn’t matter what they wear, no travel time, and they like to exercise without others seeing them. However, they also miss being with and socializing with others, and they reported feeling unsafe when the instructor cannot see them. Of those who did not participate online, several reasons were given: they prefer to exercise with others in the same room, they prefer to exercise with an instructor directly present, no appropriate device, and their internet is not reliable. Many also provided examples of future circumstances when they might participate online, including: when the weather is not conducive to outdoor exercise, and if they can overcome technical issues. Lessons learned from this study can help those delivering online exercise in the future.
Predictors of Hospitalization in Veterans with COVID 19 Infection
Authors: Ruiz Jorge , Ruiz Sergio , Fernandez Marlena , Cevallos Victor , Jumani Yaseen , Morisetti Manasa , Hasanain Sahar , Mintzer Michael
Published: December 2020

Frailty, a clinical syndrome characterized by vulnerability to stressors resulting from a loss of physiological reserve across multiple systems, is a common condition that affects older adults. In patients with COVID 19 infection, frailty may place older adults at higher risk for poor clinical outcomes including hospitalizations. The aim of this study was to determine independent variables associated with all-cause hospitalization in Veterans with COVID 19 infection. This was a cross-sectional study nested within a retrospective cohort study of Veterans who contracted COVID 19 as detected by PCR. A VA Frailty Index (VA-FI) was generated at baseline as a proportion of morbidity, function, sensory loss, cognition and mood and other variables from electronic health records. The VA-FI categorized Veterans into non-frail (FI<.21) and frail (FI≥.21). At the time or after the COVID 19 testing, hospitalization data was aggregated, and proposed variables were subjected to stepwise backward logistic regression. Likelihood ratios were obtained, and those with p<0.05 were identified as independent risk factors for hospitalization. A total of 2621 Veterans with COVID 19 infection were identified during the study period with a total of 650 hospitalizations. Mean age was 54.99 (SD=16.71) years, 59.80% White, 87.60% male, 25.10% frail. The independent factors associated with hospitalization upon backward logistic regression were age (OR=1.049, 95%CI:1.041-1.057), frailty (OR=2.350, 95%CI: 1.797-3.074), African American race (OR=1.467, 95%CI:1.188-1.812), schizophrenia (OR=0.401, 95%CI:0.235-0.686), and substance abuse (OR=0.602, 95%CI:0.476-0.762). In veterans with COVID 19 infection, age, frailty, race (African American), schizophrenia, and substance abuse were predictors of all-cause hospitalization.
Health equity impacts of COVID-19 policies on dementia-relevant community services: A SGBA+ policy scan
Authors: Aubrecht Katie , Burke Rosanne , Gahagan Jacqueline , Dowling Laura , Hande Christine Kelly Mary Jean , Hardie Susan , Keefe Janice
Published: December 2020

This presentation shares the methodology and early findings from a policy scan conducted to understand and assess the impact of COVID-19 policies on dementia care in the community for diverse populations in the province of Nova Scotia, Canada. The scan provided baseline information on: 1) Provincial legislative and regulatory policies related to dementia care in the community; 2) Orders and legislation enacted in response to COVID-19 that potentially impact those policies. Information was obtained from publicly accessible databases and government websites. Searches were also conducted using Google. 135 Acts were collected and reviewed. A specific aim of the scan was to generate knowledge about the impact of these layered policies in the context of a public health crisis from the perspective of local socially and geographically marginalized communities. A Sex and Gender Based Analysis Plus analytical approach was used to assess potential health equity impacts of COVID-19 policies on dementia care in the community. Information was organized using an adapted Health Equity Impact Assessment tool and Systems Health Equity Lens. Strengths and limitations of the approach and tools are discussed.
Air Travel Concerns and Complaints of Persons Living With Dementia and Their Travel Companions
Authors: Peterson Colleen , Statz Tamara , Barsel Sara , Birkeland Robyn , Gaugler Joseph , Finlay Jessica
Published: December 2020

Air travel is increasingly accessible and rising numbers of older adults choose to fly. The prevalence of Alzheimer’s disease and related dementias (ADRD) is also expected to increase due to advances in longevity and the aging Baby Boomer population. An ADRD diagnosis does not necessarily end the desire to travel for leisure, and air travel may be necessary for family and/or care reasons. Taken together, more persons living with ADRD are expected to use air travel. This is concerning since adverse outcomes, including confusion and delirium, can be exacerbated by unfamiliar environments, such as airports and in-flight situations. Yet there is little research on air travel with this population. The current study seeks to 1) understand air travel experiences, issues, and needs of persons living with ADRD and their travel companions; and 2) identify facilitators and barriers to safe and comfortable air travel for persons living with ADRD. Persons living with ADRD (n=49)and ADRD travel companions (n=176) provided information on their air travel experiences through a nationally distributed web-survey. They traveled for family visits (80.0%) and leisure (38.0%). Both persons living with ADRD and travel companions indicated anxiety (50% and 60.7%, respectively), difficulty understanding announcements and signage (39.1%, 55.2%) and getting lost or separated (37.5%, 53.2%) as primary travel concerns. Qualitative comments identified themes of frustration with locating family restrooms and quiet spaces. Results from this study will inform ongoing efforts to develop dementia-friendly airports and improve older adult travel experiences, independence, and quality of life.
Spatial Cluster Analysis of Fatal Road Accidents From Non-Use of Seat Belts Among Older Drivers
Authors: Adeyemi Oluwaseun , Paul Rajib , Arif Ahmed
Published: December 2020

Identifying county-level spatial clusters of fatal accidents due to non-use of seatbelt among drivers 65 years and older can help with injury prevention policies and targeted place-based interventions. We estimated the odds and identified hotspots of fatal accidents among drivers 65 years and older (n=57,715) based on a cross-sectional analysis of data from 2010 to 2018 from the Fatality Analysis Reporting System. The outcome variable was fatality status (fatal/non-fatal), and the main independent variable was seatbelt use (not used/used). Other covariates were drunk driving, distracted driving, and speeding while age, gender, and airbag deployment were used as confounders. Rural-urban status of accident location was used as an effect modifier. Odds ratios were calculated from logistic regression. The age-adjusted fatality rate was computed as the crude fatality rate per 100,000 population weighted by the average population composition by age-groups. Spatial autocorrelation was assessed by local Moran’s I, and cluster analysis was performed using the Moran’s I index-derived Z-scores. The median age-adjusted seatbelt-related fatality rate per county was 2.35 per 100,000 population (IQR: 5.60). Not wearing a seatbelt was associated with an 11-fold (Adjusted OR: 11.37; 95% CI: 10.18-12.70) increased odds of a fatal event in metropolitan counties and a 7-fold (Adjusted OR: 7.43; 95% CI: 6.10-9.04) increased odds in rural counties and small towns. Hot spots for seatbelt-related fatal road accidents were found in multiple counties in Texas, South Dakota, and Mississippi. Study findings can be used for county-specific interventions tailored to 65 and older for preventing fatal road accidents.
Effect of Osteoarthritis on Prefrontal Cortical Activation Patterns During Downward Reaching in Older Women
Authors: Hernandez Manuel , Hu Yang , Bishnoi Alka
Published: December 2020

Downward reaching may lead to falls in older adults, but the underlying mechanisms are poorly understood, particularly in older women with osteoarthritis. Given the importance of attentional resources when maintaining balance in balance-demanding conditions, functional near-infrared spectroscopy may provide a lens to the attentional resource allocation needed to maintain balance while reaching down to the ground with or without full contact with the floor. We examined the changes in the executive control of downward reaching movements in older women with osteoarthritis. We hypothesized that prefrontal cortical activation would be higher in older women with osteoarthritis, compared to age-matched controls, particularly as the balance demands increased. Older women with osteoarthritis (n=7, mean±SD age: 66±3 years) and age-matched controls (n=10, mean±SD age: 67±6 years) were recruited from the local community. The effect of the base of support and target position (toe or maximal forward distance along ground) on attentional resources in older women with osteoarthritis were evaluated using the average oxygenated hemoglobin levels as a measure of prefrontal cortical (PFC) activation. Significant base of support by cohort and target by cohort interactions were observed on average PFC activation levels (P<0.005). As expected, PFC activation levels increased as the contact with the floor decreased and as the target distance increased, but older women with osteoarthritis were unable to increase their PFC activation levels as much as age-matched controls. In conclusion, these data suggest that older women with osteoarthritis may not be adequately modulating attentional resources to meet high-balance demanding tasks.
A Prospective Study of Frailty and 30-Day Functional Outcomes of Hospitalized Older Adults With Pneumonia
Authors: Park Chan Mi , Kim Wonsock , Kim Jong Hun , Kim Dae
Published: December 2020

Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. A prospective cohort study was conducted to investigate the clinical and functional outcomes of pneumonia in older adults with different levels of frailty. Between November 2019 and March 2020, we enrolled 92 adults who were 65 years or older and hospitalized for pneumonia at an academic medical center in Seoul, Korea. A deficit-accumulation frailty index (FI) was calculated using 50 items from comprehensive geriatric assessment (range: 0-1; higher values indicate greater frailty). The ability to perform 21 daily activities and physical tasks prior to the illness and after 30 days was self-reported. Primary outcome was death or functional decline from prior level at 30 days. The study cohort had a mean age of 79.4 (standard deviation [SD], 7.11) years, 38 (41.3%) women, and 20 (21.7%) nursing home residents. The mean FI was 0.29 (SD, 0.19), with 27 (29.4%) robust (FI<0.15), 21 (22.8%) pre-frail (FI, 0.15-0.24), 19 (20.7%) mild-to-moderately frail (FI, 0.25-0.44), and 25 (27.2%) severely frail (FI≥0.45) categories. Among 71 patients without maximum disability at baseline, 8 (11.3%) died and 39 (54.9%) experienced functional decline. The 30-day risk of primary outcome for increasing frailty categories were 47.8%, 57.9%, 77.8%, and 81.8%, respectively (p-for-trend=0.022). Our results indicate that pneumonia is a major disabling illness in older adults with frailty. A proactive geriatric evaluation and multidisciplinary intervention are needed to improve functional recovery in these patients.
Delayed Hospital Discharge–The Effect of Dementia and GP Contacts Prior to Hospitalization
Authors: Aaltonen Mari , El Adam Shiraz , Sakamoto Mariko , Martin-Matthews Anne , McGrail Kimberlyn
Published: December 2020

Delayed hospital discharge, also known as alternate level of care (ALC) in Canada, refers to a stay in hospital when acute services are no longer needed but the patient occupies a hospital bed while waiting to be discharged to an appropriate care setting. ALC has negative consequences for both the service system (high costs, inappropriate use of hospital resources) and individuals (feelings of uncertainty, functional loss). Extensive administrative health care data from British Columbia, Canada, were employed to study differences in ALC between people with and without dementia in 2001/02, 2005/06, 2010/11 and 2015/16, and whether continuity in physician–patient relationships prior to hospitalization is associated with ALC. We analyzed designation of ALC and length of stay in ALC, using generalized estimating equations logistic regression and negative binomial regression analysis. Of all individual, residential area and health care related factors, dementia was the single most important factor increasing the odds of designation of ALC (OR 4.76, 95%CI 4.59, 4.93). Dementia also added to the length of stay in ALC. Proportion of patients designated to ALC increased over the study years. Higher number of visits to the same general practitioner (GP) prior to hospitalization decreased the odds of ALC, especially in people with dementia. As populations age, the number of people with dementia is increasing. Efforts to control ALC have resulted in greater concentration of ALC among people with dementia. Higher continuity GP care may be a way to help understand and control these trends.
Electronic Health Record Data Can be Used at the Bedside to Identify Older Hospitalized Patients With Delirium
Authors: Khan Ariba , Heslin Kayla , Simpson Michelle , Malone Michael
Published: December 2020

Delirium is a serious condition that is often underrecognized. Several delirium predictive rules can assist in early detection. The coupling of prediction rules with features of the EHR are in their infancy but hold potential. This study aimed to determine variables within the EHR that can be used to identify older hospitalized patients with delirium. This is a prospective study among patients >=65 years admitted to the hospital. Researchers screened daily for delirium using the 3-D CAM. Predictive variables were extracted from the EHR. Basic descriptive statistics were conducted. Chi-squared and Fischer’s exact tests were used to compare differences among those diagnosed with or without delirium as appropriate; binary logistic regression was used for multivariate modeling. Among 408 participants, mean age was 75 years, 61% were female, and 83% were black. The overall rate of delirium was 16.7% (prevalent delirium 10.5%; incident delirium 6.1%). There was no statistical difference in 30-day mortality (2.9% vs. 2.7%) or 30-day readmission (13.2% vs. 14.7%) rates between those with and without delirium (both P>0.05). Even so, patients with delirium were older, more likely to have a diagnosis of infection and/or cognitive impairment, as well as increased severity of illness (all P’s <0.05). Moreover, patients with delirium had a lower Braden score and higher Morse fall score (both P’s <0.01). In multivariate analysis, cognitive impairment (OR 5.49; 95% CI 2.77-10.87) and lower Braden scores (OR 1.29; 95% CI 1.18-1.41) remained significant predictors of delirium. Further research is needed to develop an automated EHR prediction model.
Genome-Wide Linkage Analysis Identifies a Novel Locus for Grip Strength: The Long Life Family Study
Authors: Santanasto Adam , Wojczynski Mary , Cvejkus Ryan , Thygarajan Bharat , Christensen Kaare , Zmuda Joseph
Published: December 2020

Grip strength declines with aging, is an indicator of overall health, and predicts mortality among older adults. Herein, we quantified the genetic contributions to grip strength among 4534 individuals, belonging to 574 families in the Long Life Family Study (age 70.3 ± 15.7, range 24–110 years; 56% women). Grip strength was measured using a handheld dynamometer, and the maximum value of two trials in the stronger hand was used. Quantitative trait linkage analysis was completed using pedigree-based maximum-likelihood methods with logarithm of the odds (LOD) scores >3.0 indicating genome-wide significance. Linkage analysis in the top 10% of families contributing to LOD scores was also performed to allow for heterogeneity among families (HLOD). All analyses were adjusted for age, sex, height and field center. Grip strength was lower per one year of older age (β: -0.34 ± 0.01kg, p <0.01), and overall: 24.3% of men and 19.3% of women had “low” grip strength according to European Working Group on Sarcopenia definitions. Grip strength was highly heritable (h2 = 0.37, p<0.05). We identified a potentially novel locus for grip strength on chromosome 18p (LOD 3.18) with 26 families contributing to this linkage peak (HLOD = 10.94). Deep sequencing of the chromosome 18 region may yield fundamental insight on the biology of muscle weakness with aging, and may help identify novel therapeutic targets for treatment and prevention of this common condition.
Family Caregivers’ Self-Efficacy and Its Relations to Well-Being: Gender and Age Differences
Authors: Chang Yu-Ping , Seo Young , Von Visger Tania
Published: December 2020

Family caregivers of older adults perceive their roles as beneficial as well as burdensome. They also report physical and psychological symptoms affecting their well-being. Research indicates that caregiver self-efficacy leads to positive outcomes such as decreased caregiver burden and stress. However, it is unclear how self-efficacy is related to their well-being, and how this association might differ by age and gender. We aim to explore the relationships between family caregiver self-efficacy and well-being, and determine if age or gender moderates these relationships. We analyzed responses of 2,652 family caregivers (68% female and 32% male; mean age= 61.2) from the National Study of Caregiving (NSOC) III (2017) cross-sectional survey. We used three composite variables measuring self-efficacy: feeling confident, adjusting changes, and recovering quickly. We used five composite variables measuring well-being: pain, sleep problems, positive and negative affects, and depression/anxiety. We conducted a design-based weighted logistic regression analysis to examine the relationships among variables of interest. Results indicated that low self-efficacy was associated with increased pain, sleep problems, positive and negative affects, controlling for caregivers’ age, sex, and race/ethnicity. Examination of interactions indicated that the relationship between self-efficacy and pain and the relationship between self-efficacy and depression/anxiety were stronger in female caregivers, whereas age did not serve as a moderator in the relationship between self-efficacy and well-being. Our findings provide insight that can guide intervention development to improve family caregiver self-efficacy and well-being. Furthermore, future research may involve interventions with the consideration of family caregivers’ gender.
Rural Residence, Nutrition Risk, and Falls In Community-Dwelling Older Adults
Authors: Gell Nancy , Eckert Caitlin , Schollmeyer Jennifer , Wingood Mariana , Tarleton Emily
Published: December 2020

Decreasing fall risk and maintaining independence is vital for community dwelling older adults. Nutritional status and rural residence may be independent predictors of falls. The aim of this study was to evaluate if nutritional status and rurality are positively associated with fall risk and predictive of future falls in community-dwelling older adults. We used data from a health risk assessment conducted by the Support and Services at Home organization serving Medicare beneficiaries in Vermont in 2017-2019 (N=3109; 79.6 years ±8.4, 75% female). Measures included the Fall Risk Questionnaire, Determine Nutrition Risk questionnaire, and fall history. Descriptive statistics from baseline measures and logistic regression analyses were used to identify predictors of a new fall with respect to rurality, fall risk, and nutritional status. At baseline, 67% of participants lived in rural communities, 37% had high nutrition risk, and 60% had elevated fall risk. Independently, rurality and high nutrition risk were significantly associated with fall risk (p<0.001) and high nutrition risk was associated with rurality (p<0.001). In the adjusted model, rural residence was not significantly associated with a fall within one year from baseline, whereas participants at high nutrition risk had a 50% higher odds of falling (p= 0.001). These findings suggest that falls may be associated with nutrition risk, but not living in a rural setting. Community-based initiatives should consider including nutrition screens as part of fall risk assessments. Further research is needed to understand the relationship between nutrition status and falls risk.