bluuebunny/crossref_metadata_2025 huggingface dataset:
HOUSEHOLDS AND LIVING ARRANGEMENTS OF OLDER PERSONS AROUND THE WORLD
Authors: Kamiya Yumiko , Kamiya Yumiko , Hertog Sara
Published: November 2019

The household living arrangements of older persons – whether living alone, with a spouse or partner, with their children or in multi-generational households – can be an important factor associated with their health, economic status and overall well-being. Understanding the patterns and trends in older persons’ living arrangements is thus relevant for global efforts to achieve the sustainable development goals, in particular those targeting poverty, hunger and health. The United Nations Database on the Households and Living Arrangements of Older Persons 2018 presents evidence drawn from 672 unique data sources, including census and survey microdata samples archived at IPUMS-International and household rosters from Demographic and Health Surveys, among other sources. The resulting dataset describes older persons’ households across 147 countries or areas, representing approximately 97 per cent of persons aged 60 or over globally.
DISTRIBUTION, PREDICTORS, AND CLINICAL RELEVANCE OF 5-YEAR CHANGE IN FRAILTY MEASURES
Authors: Huisingh-Scheetz Megan , Wroblewski Kristen , Ferguson Mark , Huang Elbert , Waite Linda , Schumm L P
Published: November 2019

Implementing frailty assessment into routine clinical practice is a priority. Gait speed and performance on 5 repeated chair stands are two measures of frailty. We face a number of clinical implementation challenges: (1) We lack normative data for U.S. older adults and (2) The clinical relevance of change in frailty measures is unclear. The National Social Life, Health and Aging Project dataset allows an examination of the distribution of 3-meter gait and 5-repeated chair stands times as well as 5-year change in these measures in a nationally-representative, community-dwelling older adult sample. Dr. Huisingh-Scheetz will describe demographic predictors of change in these measures as well as determine whether baseline plus 5-year change in these measures predicts loss of independence in activities of daily living (ADLs).
FACTORS FACILITATING COLLABORATION AND ENGAGEMENT: BUILDING AND SUSTAINING STATEWIDE COALITIONS
Authors: Henage Cristine B , Schneider Ellen C , Roberts Ellen , Tilley Vicki , Busby-Whitehead Jan
Published: November 2019

Sustaining collaboration across multiple community-based organizations (CBOs) creates synergies and economies of scale to support age-friendly communities beyond the provision of direct services any single CBO can achieve. The Carolina Geriatrics Workforce Enhancement Program (CGWEP) created and sustained multiple statewide coalitions focused on geriatrics syndromes. More than 290 CBOs, including Area Health Education Centers, social services programs and nongovernmental organizations, meet quarterly to form linkages, promote education and build infrastructure to support rural and underserved older adults. Shared governance with pooled resources has been achieved because of a long history of partnership, mutually beneficial relationships, flexibility, and frequent communication. The strength of the partnership is evidenced by continued growth in number of CBOs, number of sponsored events, and number of referrals to CBOs. Two coalitions, focused on falls prevention and mental health respectively, have been adopted by partners and sustained beyond grant funding.
EVALUATION OF ART ON THE BRAIN, A HEALTH APP FOR OLDER ADULTS, IN LONG-TERM CARE
Authors: Howard Elizabeth P , Retalic Tammy , Rogan Jessica
Published: November 2019

ArtOn the Brain is a mobile application that incorporates art history education, play and socialization for older adults. This pilot project examined its health and social impact among long term care residents. A convenience sample of 48 residents, 60+ years, with borderline intact to moderate cognitive impairment were recruited. Residents with mild or better cognitive status used the app individually on a tablet while the remaining participated in therapist-led group sessions. One-hour intervention occurred twice weekly. Primary outcomes, health and well-being, were measured with 5Q-5D-5L and Warwick-Edinburgh Mental Well-being tools at baseline and after 6 weeks. Secondary outcomes were mood, cognition, function and overall satisfaction with activity options and personal relationships. Pre-post paired t-test analyses of data from EQ-5D-5L and Warwick tools did not show a significant difference. There were no notable declines with cognitive performance, functional ability and depression post-intervention. Four activity options and three personal relationship items had statistically significant improvements post-intervention. Activity options addressed engagement in enjoyable activities on weekends and evenings, and opportunity to, spend time with other like-minded residents and explore new skills, interests. Personal relationships items included engagement in activities helpful to others and having people to do things with. ArtOn the Brain is a novel application suitable for long term care residents. While 6 week intervention did not show improvement in overall health and well-being, there were significant improvements with residents’ reported engagement in activity options and improvement of personal relationships. Longitudinal evaluations are needed to examine changes in health status and well-being.
WHAT DETERMINES THE USE OF MEANING FOCUSED COPING IN DEMENTIA CAREGIVING?
Authors: Yu Doris , cheng Sheung Tak
Published: November 2019

Meaning-focused coping has been identified as an important factor contributing to more positive adjustment and health outcomes for family caregivers of persons with dementia. Yet, there is less evidence about what determines the use of this coping strategy. Based on the Meaning Making Model, this quantitative exploratory study identified the relationship between meaning focused coping and intrinsic motivation towards caregiving, quality of relationship between the care dyads and level of religiosity. Two hundreds and five family caregivers of PWD were recruited from a geriatric clinic from March 2018 – Feb 2019. A battery of questionnaires including the Meaning-Focused Coping Scale, Relationship Quality Scale, the Duke University Religion Index and Intrinsic Motivations to Care was administered in face-to-face interview. By using hierarchical regression analysis to control the effects of caregivers’ demographic profile, caregiving history, clinical severity of dementia, and level of neuro-psychiatric symptoms, the results indicated that a higher intrinsic motivation to caregiving (β = 1.457, p = 0.044), better dyadic relationship quality (β = 0.768, p = 0.004) and a higher level of religiosity (β = 0.969, p = 0.001) are independently related to a higher likelihood of using meaning-focused coping. The findings shift the paradigm of caregiver support from a deficit model to helping them to appraise the meaning of caregiving in dyadic relational, spiritual and motivational perspectives. The application of strength-based and person-centered approach to caregiver supportive program will be discussed.
USING MOBILE TECHNOLOGY TO ELUCIDATE PSYCHOSOCIAL AND COGNITIVE FUNCTION IN OLDER ADULTS
Authors: Roque Nelson A , Hyun Jinshil , Scott Stacey B
Published: November 2019

Ambulatory methods (AM) improve the reliability and ecological validity of cognitive assessments, and help to elucidate psychological influences through concurrent reports of pain, stress, and other psychosocial outcomes. Ecological momentary assessment (EMA) involves sampling of daily experiences in natural settings, including completing cognitive assessments, and answering questions related to, for example, social interactions and sleep. The purpose of this symposium is to present innovative methods and results, exploring questions at the intersection of intensive longitudinal data collection, cognition, and psychosocial influences, using data from two EMA studies, the Einstein Aging Study (EAS) and the Effects of Stress on Cognitive Aging, Physiology, and Emotion (ESCAPE) Study. The EAS (ages >= 70) and ESCAPE (ages 25 - 65) protocols, ask participants to complete an annual 14-day EMA measurement burst. A unique value of these methods is the ability to explore effects from moment-to-moment (or day-to-day; within-person effects) as we will present. We will also contrast these with conventional analyses of between-person differences, typical of clinic and in-person studies. Dickens (using ESCAPE data) examines end-of-day perceived stress and anticipation of next-day stress in predicting sleep quality. Hyun and colleagues (using EAS data) discuss the effects of affectionate physical touch on mitigating pain and emotional distress. Using a model-based cluster analysis approach (with EAS data), Roque unpacks differences in psychosocial factors, as a function of cognitive status risk groups. Stacey Scott will discuss these papers in the context of using ambulatory methods to improve the characterization of risk status in older adults.
AFFECTIONATE PHYSICAL TOUCH MITIGATES PAIN AND EMOTIONAL DISTRESS IN OLDER ADULTS
Authors: Hyun Jinshil , Lipton Richard B , Zhaoyang Ruixue E , Graham-Engeland Jennifer E , Pavlovic Jelena M , Sliwinski Martin J
Published: November 2019

Although research suggests that social interactions can decrease pain and emotional distress, it is unclear what produces these salubrious effects. We examined whether older adults experienced lower pain and emotional distress after two types of social interactions (affectionate physical contact and non-physical pleasant interactions) using data from the Einstein Aging Study (N=193, age=70-92). Participants completed a 14-day ecological momentary assessment protocol via which they reported the quality of recent social interaction, types of physical touch, levels of current stress, negative affect, and pain intensity five times a day. Multilevel models indicated that, following affectionate physical contact, individuals reported low levels of current pain intensity, negative affect, and stress (ps<.05). Following a pleasant non-physical interaction, individuals reported low negative affect (p<.05); pleasant interactions did not predict current pain or stress. Results highlight the potential unique utility of affectionate physical contact versus mere pleasant social interactions in older adults’ daily lives.
DAILY EFFECTS OF PERCEIVED AND ANTICIPATED STRESS ON SUBJECTIVE SLEEP QUALITY
Authors: Dickens Chelsea N , Sliwinski Martin J
Published: November 2019

Prior studies of stress and sleep have postulated that anticipation of future stress may have a greater impact on sleep quality than stress experienced during the day. We examined this possibility using data collected over 14 consecutive days. Participants (Npersons=257, age=25-65) rated each evening how stressful the day was and how stressful they expected the next day would be. Each morning, participants rated their subjective sleep quality. After adjusting for the effect of the previous night’s sleep, on days when individuals reported feeling more stressed, they also reported not sleeping as well that night. However, expectations of stress the next day did not have an effect on sleep quality, suggesting that stress experienced during the day impacts sleep quality more so than anticipation of future stress. Despite previous findings that older age is associated with sleep complaints, age did not act as a moderator in our analysis.
CLINICAL TRIALS IN GEROSCIENCE
Authors: Kaeberlein Matt , Kaeberlein Matt
Published: November 2019

This session will focus on clinical trials in geroscience.
AGING INTERVENTIONS GET HUMAN: CAN WE EXTEND HEALTHSPAN?
Authors: Kennedy Brian
Published: November 2019

Understanding biologic aging will afford opportunities for novel interventions to enhance human healthspan. If ageing can be slowed, the effect would be simultaneous protection from many of the chronic diseases. One strategy is to use animal model organisms to find common pathways that modulate ageing and then to seek methods for their human manipulation. The TOR pathway is one point of convergence and a clinically approved drug targeting the TOR kinase, rapamycin, extends murine lifespan and healthspan. Many more small molecules are being added to the list of anti-ageing compounds. Here, I use examples of interventions to conceptualize how agents extending healthspan might improve human health. We are entering a stage in aging research where it is imperative to test ageing interventions in humans and several strategies are contemplated. The potential to directly impact human healthspan is emerging from ageing research and this approach, if successful, will have global impact.
ACTIVITY SELECTION AND ENGAGEMENT IN OLD AGE: MOTIVATIONAL AND GOAL-BASED INFLUENCES
Authors: Hess Thomas M , Hertzog Christopher
Published: November 2019

Research from a variety of perspectives has emphasized the central role played by activity in supporting a variety of positive outcomes in later life. For example, participation in activities that place demands on personal resources has been shown to be beneficial in promoting brain, cognitive, and physical health. From another perspective, older adults may also engage in certain activities to promote specific outcomes (e.g., emotional) in service of psychological well-being. Such findings highlight the adaptive significance of activity selection and engagement processes. Using a variety of approaches, the presentations in this symposium focus specifically on goal-based and motivational factors that may facilitate or impede such processes. Moored and colleagues examine adaptive characteristics—including motivational ones—of individuals whose activity patterns are protective against dementia. Using longitudinal data from the Health and Retirement Study, Lothary and colleagues explore the degree to which intrinsic motivation to engage cognitive resources mediates the effect of personal resources (e.g., physical and emotional health) on participation in challenging everyday activities. Growney and colleagues present research demonstrating that subjective perceptions of difficulty affect decisions to engage in challenging activities, but that such perceptions may reflect biases associated with negative aging attitudes as opposed to actual effort expenditure. Finally, Lind and Isaacowitz examine selection associated with affective aspects of the activities, finding that both middle-aged and older adults exhibited similar biases toward positive activities in congruence with emotion-regulation goals, though age differences were observed in non-affective aspects of the activities. The discussion by Hertzog will highlight common themes.
EXAMINING WHETHER LIFESTYLE ACTIVITY PATTERNS PREDICT DEMENTIA INCIDENCE AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Moored Kyle , Moored Kyle , Parisi Jeanine , Carlson Michelle
Published: November 2019

Engagement in lifestyle activities can be neuroprotective, but it remains unclear what aspects of engagement are most beneficial. Examining activity patterns may better characterize both quantitative (e.g., number) and qualitative (e.g., characteristic/motivational) differences in engagement. We used a novel, latent class analysis (LCA) to characterize subgroups with distinct activity patterns and examined whether they have differential risk of incident dementia. We compared these findings to models including standard activity frequency and variety metrics. Using the Ginkgo Evaluation of Memory Study (N=3,069), we fit Cox regressions of each activity metric on time to dementia, adjusting for intervention group and demographics. For the LCA, we derived group/class indicators for Cox regression. Variety predicted incident dementia and will be compared to LCA activity metrics in predicting risk. Activity metrics that are most protective against dementia inform intervention design. Unlike standard activity metrics, LCA may further identify subgroups with common motivations to sustain activity.
CHARACTERIZING THE PATHWAYS UNDERLYING THE ASSOCIATION BETWEEN PSYCHOLOGICAL WELL-BEING AND HEALTH
Authors: Kim Eric S , Ong Anthony
Published: November 2019

As populations age, identifying factors that foster the maintenance of health is crucial for improving the health and well-being of older adults. Yet, most psychological, biomedical, and public health efforts have focused on reducing harmful risk factors. While the risk management approach has contributed greatly to prevention and treatment programs, our aging society continues to grapple with the steadily rising tide of chronic conditions. Expanding the focus to include upstream, health-promoting psychosocial assets may help inform a more comprehensive response effort. Mounting research suggests that different dimensions of psychological well-being are uniquely associated with reduced risk of chronic conditions. However, the mechanisms underlying these associations remain understudied. This symposium presents 4 studies evaluating potential mechanisms. The first talk presents research evaluating how a spouse’s level of optimism may be uniquely associated with an individual’s cognitive health over time (above and beyond that own individual’s level of optimism). A second talk, draws upon a multi-burst daily diary study and focuses on affective stress response as a potentially modifiable target that could explain the health benefits of optimism. A third talk evaluates how baseline levels purpose in life might be associated with repeated measures of five key health behaviors over time. A fourth talk discusses results from a longitudinal-burst daily diary study determining the reciprocal relationships among optimism, pain interference, and goal-directed activity among older women who experience pain. Overall, these studies add to the growing research on psychological well-being and physical health by providing evidence around potential biobehavioral pathways.
COGNITIVE AND HEARING IMPAIRMENTS IN OLDER ADULTS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Authors: West Jessica S , Lynch Scott
Published: November 2019

As the number of older adults increases, increased prevalence of cognitive and sensory impairments pose growing public health challenges. Research on the relationship between hearing impairment and cognition, however, is minimal and has yielded mixed results, with some studies finding that hearing impairment is associated with cognitive decline, and others reporting that the association is weak or non-existent. Most of this research has been conducted outside of the U.S., and the few U.S.-based longitudinal studies have relied mostly on small, non-representative samples involving short follow-up periods. Further, despite known gendered patterns in cognitive and hearing impairments, no studies to date have examined whether the relationship between the two varies by gender. Our study addresses these weaknesses in the literature by utilizing nine waves of the Health and Retirement Study (1998-2014; n=14,169), a large, nationally representative, longitudinal study that facilitates examination of long-term interrelationships between hearing and cognitive impairments. In this study, we use autoregressive latent trajectory (ALT) methods to model: 1) the relationship between hearing impairment and cognitive decline, and 2) sex differences in the relationship. ALT models enable us to determine whether hearing impairment and cognitive impairment are associated, net of their common tendency simply to co-trend with age. Results indicate that hearing and cognitive impairments are strongly interrelated processes that trend together over time. Moreover, hearing impairment has an increasing impact on cognitive impairment across age while the effect of cognitive impairment on hearing impairment levels out over time. Sex differences in these patterns are discussed.
PSYCHOLOGICAL WELL-BEING AND CHANGE OF COGNITIVE FUNCTION OVER 4 YEARS
Authors: Kong Dexia , Kong Dexia , Dong XinQi
Published: November 2019

This study aims to examine the relationship between psychological-wellbeing (including depressive symptoms, loneliness, anxiety, hopelessness, and stress) and cognitive function during a 4-year period among U.S. Chinese older adults. Data were from 2,300 PINE participants who completed in-home interviews at baseline, 2-year and 4-year follow-up. Cognitive function was assessed by five individual cognition tests at baseline and follow-up interviews. Mixed-effects regression models were conducted. A trend of decline in global cognition and multiple cognitive domains was observed. The study findings showed that depressive symptoms (Estimate= -0.03, p<0.001), anxiety (Estimate = -0.02, p<0.001), hopelessness (Estimate = -0.01, p<0.01), and stress (Estimate = -0.01, p<0.001) were associated with poorer global cognitive function at baseline. Baseline psychological well-being was not associated with changes in cognitive function during a 4-year period. Significant predictors of rate of change in cognitive function will be discussed. Potential explanations and implications of these findings will be presented.
PHYSICAL FUNCTION AND LONGITUDINAL CHANGES IN COGNITIVE FUNCTION
Authors: Wang Jinjiao , Wang Jinjiao , Kong Dexia , Dong XinQi
Published: November 2019

Among 2,038 older Chinese adults in the U.S., we examined the relationship between physical function (Short Performance Physical Battery [SPPB], [instrumental] activities of daily living [ADL/IADL] limitations) at baseline (2011-2013) and changes in cognitive function in the two-year follow-up (2013-2015). Cognitive function was measured by the East Boston Memory Test (EBMT), the Digit Span Backwards assessment (DSB), the Symbol Digit Modalities Test (SDMT), and the Mini-Mental State Examination (MMSE). During the two-year follow-up, 41.8%-50.88% of the participants decreased in cognitive function and 32.88%-44.8% increased. In linear regression that adjusted for baseline cognitive function, education, age, and other covariates, baseline SPPB and ADL/IADL limitations were significantly associated with changes in cognitive function in the two-year follow-up (SPPB: βEBMT=0.0149, p<0.05; βDSB=0.0253, p>0.05; βSDMT=0.2742, p<0.01; βMMSE=0.1070, p<0.001; ADL/IADL limitations: βEBMT= -0.0401, p<0.0001; βDSB= -0.0410, p<0.05; βSDMT= -0.3027, p<0.01; βMMSE= -0.2566, p<0.0001). This suggests that better physical function predicts positive changes in cognitive function.
BODY MASS INDEX AND COGNITIVE FUNCTION DECLINE
Authors: Hua Yingxiao , Hua Yingxiao , Kong Dexia , Dong XinQi
Published: November 2019

Body composition has been proposed as an important modifiable risk factor of cognitive decline in multiple epidemiological studies. However, the relationship between body mass index (BMI) and cognitive function remains controversial and conflicting in diverse populations. This study aims to investigate the association between BMI and cognitive decline in U.S. Chinese older adults. Classifications of BMI are based on Asian criteria recommended by WHO (underweight: BMI<18.5, normal weight: 18.5≤BMI<23, overweight: 23≤bmi<27.5, obesity: bmi≥27.5). Logistic regression models were conducted. Compared with normal-weight participants, underweight participants were more likely to experience decline in episodic memory (OR=1.68, p=0.002) and work memory (OR=1.38, p=0.05). Being overweight and obesity were not associated with cognitive function decline. The findings indicate that underweight could potentially be a risk factor of cognitive function decline among U.S. Chinese older adults. Perspective studies may further investigate the association between weight loss and cognitive decline for the development of prevention strategies.
DISCERNING STATUS: SUBJECTIVE SOCIAL POSITION AND COGNITIVE HEALTH AMONG OLDER ADULTS IN RURAL SOUTH AFRICA
Authors: Kobayashi Lindsay C , Harling Guy , Farrell Meagan T , Wagner Ryan G , Berkman Lisa F
Published: November 2019

Rapid population aging in high absolute poverty settings, such as much of South Africa, demands new research on the social context factors that affect cognitive aging in these settings. We investigated the relationships between subjective social position within one’s village and cognitive function and impairment, with the rationale that psychosocial stress induced by low relative social position may affect cognitive aging outcomes independently of absolute socioeconomic conditions. Data were from the population-representative HAALSI study of 5,059 adults aged 40+ in rural Agincourt, South Africa. Subjective social position was assessed using the MacArthur Network social ladder, which asks respondents to indicate how high up a ladder they stand, relative to others, in their village. Cognitive function was a composite z-score of time orientation and word recall tests; scores ≤1.5 standard deviations (SD) below the mean indicated cognitive impairment. Twenty percent of those on the bottom rung had cognitive impairment, declining to 2% on the top rung. In regression models adjusted for age, sex, country of birth, education, literacy, marital status, employment, and asset-based household wealth, each ladder rung increase was associated with an 0.05 SD increase in cognitive z-score (95% CI: 0.04-0.06), and a 17% decrease in odds of cognitive impairment (OR=0.83; 95% CI: 0.79-0.88); these associations were greater in magnitude than those for years of education with these cognitive outcomes. Future work should examine if these relationships persist longitudinally, and investigate the mechanisms of these relationships, including village-level contextual factors that may contribute to subjective social position in this setting.
DEPRESSION, FUNCTIONAL DISABILITY, AND ACCESSING HEALTH CARE AMONG OLDER MEN AND WOMEN IN GHANA AND SOUTH AFRICA
Authors: Nwakasi Candidus C , Brown J Scott
Published: November 2019

Objectives. To inform a preventive approach to mild depression among older Ghanaians and South Africans, this study will investigate the association and possible variabilities between mild depression, functional disability, accessing health care, sociodemographic, and socioeconomic factors across genders in both countries. Methods. Cross-sectional wave 1 (2007-2010) data from WHO’s Study on Global Ageing and Adult Health (SAGE) are used, and a sample of 3871 for Ghana and 3076 for South Africa are analyzed. Binary multiple logistic regression is used to identify the association between mild depression, functional disability status, socioeconomic and sociodemographic factors, and health status. Results. The proportion of mild depression (MD) is 3.78% and 8.15% for older Ghanaian men and women, and 2.29% and 11.91% for South African older men and women, respectively. At 95% CI, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older men and women. Apart from South African older men, older people in the study who do not receive healthcare when needed have increased odds of MD. Sociodemographic and socioeconomic factors are also associated with MD. Discussion. An untreated, persistent MD may lead to worse conditions with fatal outcomes. Since, mental health care is lacking in both countries, this study recommends policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression. Thus, this study’s findings may provide relevant information for managing depression among older Ghanaians and South Africans.
PROMOTING KNOWLEDGE OF COGNITIVE DYSFUNCTION IN MINORITY COMMUNITY-DWELLING OLDER ADULTS
Authors: Alexander Koshy , Manna Ruth , Gangai Natalie , Muniz Rosario Costas , Korc-Grodzicki Beatriz
Published: November 2019

Minorities and older adults represent an intersection of populations that are particularly vulnerable to suboptimal care. The US population is aging and growing more diverse. Dementia afflicts minority populations more than Caucasians. Many people in the community with mild cognitive impairment (MCI) and Alzheimer’s disease do not recognize cognitive, functional or behavioral impairment as abnormal. Several barriers to treatment exist within both the older and minority populations. The Health Resources and Services Administration (HRSA), is the primary Federal agency for improving health and achieving health equity. Queens County in New York City is a multicultural, ethnically diverse urban area with 48% of its population being foreign born. Funded by a grant from HRSA, in collaboration with the South Asian Council for Social Services (SACSS), the Geriatric Resource Interprofessional Program (GRIP) at Memorial Sloan Kettering Cancer Center (MSKCC) developed and conducted educational lectures on “Memory Loss & Dementia” at 7 different community centers in Queens. Between November 2015 and January 2019 eight sessions were conducted. A total of 182 people attended. Their mean age was 68, 59% were women. 71% were born in South Asia. Consecutive interpretation of the lecture was performed; the written materials were translated beforehand. Pre and post-test questionnaires were administered to measure understanding of the topic, and qualitative comments collected. The developmental process, results of the study and challenges we faced in developing and applying the educational initiative will be presented.
RACIAL DIFFERENCES IN ELEVATED C-REACTIVE PROTEIN AMONG U.S. OLDER ADULTS
Authors: Farmer Heather R , Farmer Heather R , Wray Linda A , Xu Hanzhang , Xian Ying , Pagidipati Neha , Peterson Eric D , Dupre Matthew E
Published: November 2019

C-reactive protein (CRP) is a marker of inflammation linked to numerous acute and chronic conditions. Studies have not considered racial differences in elevated CRP among older adults at the national level. We investigate racial differences in elevated CRP and the socioeconomic, psychosocial, behavioral, and physiological factors that contribute to these differences overall and by gender using a nationally-representative prospective cohort of 14,700 non-Hispanic black and white participants in the Health and Retirement Study followed from 2006 to 2014. Random effects logistic regression models showed that blacks were more likely to have elevated levels of CRP than whites. In men, the racial differences in elevated CRP were attributed to a combination of socioeconomic, psychosocial, and behavioral factors. In women, the racial differences in elevated CRP were primarily attributable to physiological factors. The findings from this work have potentially important implications for clinical practice and interventions targeting vulnerable segments of the population.
FACTORS ASSOCIATED WITH MORTALITY AMONG LONG-TERM CARE RESIDENTS TRANSITIONING TO AND FROM EMERGENCY DEPARTMENTS
Authors: Tate Kaitlyn C , Reid Colin , McLane Patrick , Cummings Garnet E , Rowe Brian H , Cummings Greta G
Published: November 2019

Studies examining risk of death during acute care transitions have highlighted potential predictors of death during transition. However, they have not closely examined the relationships and directional effects of organizational context, care processes, resident demographics and health conditions on death during transition. By employing structural equation modeling, we aimed to 1) identify predictive factors for residents who died during transitions from long term care (LTC) to emergency departments (EDs) and back; 2) examine relationships between identified organizational, process and resident factors with resident death during these transitions; and 3) identify areas for further investigation and improvement in practice. We tracked every resident transfer from 38 participating LTC facilities to two included EDs in two Western Canadian provinces from July 2011 to July 2012. Overall, 524 residents were involved in 637 transfers of whom 63 residents (12%) died during the transition. Sustained dyspnea (in both LTC and the ED), sustained change in level of consciousness (LOC) and severity measured by triage score were direct and significant predictors of resident death during transition. The model fit the data, (x2 = 83.77, df = 64, p = 0.049) and explained 15% variance in resident death. Dyspnea and change in LOC in both LTC and ED needs to be recognized regardless of primary reason for transfer. More research is needed to determine the specific influences of LTC ownership models, family involvement in decision-making, LTC staff decision-making on resident death during transition, and interventions to prevent pre-death transfers.
READMISSION FOR HEALTHCARE-ACQUIRED INFECTIONS: DOES PATIENT DISPOSITION MATTER?
Authors: Hoffman Geoffrey J , Min Lillian , Liu Haiyin J , Mody Lona
Published: November 2019

Both common and preventable, healthcare-acquired infections (HAI) are nevertheless associated with high risk for hospital readmission. However, whether these infection-related readmissions are more common among older adults discharged from the hospital to a nursing facility as opposed to home is unknown. We used 2013-14 HCUP data and multivariable logistic regression models to retrospectively examine the relationship of patient disposition (home, nursing facility, home health care) with an unplanned readmission for the same HAI observed at the index admission, among older Medicare beneficiaries, controlling for patient sociodemographics, comorbidity score, and length of stay during index hospitalization. Of 8.4 million index admissions, 323,332 (3.9%) involved an index HAI, of which 15,870 (4.9%) resulted in a linked HAI readmission. HAI readmissions were more common for Clostridium difficile infections (4.0%) and urinary tract infections (UTI, 2.3%) than for ventilator-acquired pneumonia (1.4%) or surgical site infections (1.1%) (p<0.001). Being discharged home or to home health care, compared to a post-acute care setting, was associated with increased odds (OR: 1.63 and 1.62, p<0.001) of HAI readmission, particularly for patients with higher comorbidity scores. For home discharges, HAI readmission risk was doubled for patients with the most compared to fewest comorbidities while nursing facility discharges were equally protective across comorbidity levels. We conclude that Clostridium difficile and UTIs result in higher risk for readmission than other HAIs. Patients discharged to nursing facilities are protected from readmission. Further research into identifying modifiable mechanisms for HAI readmission, in order to improve post-hospital care of infection at home, is needed.
ISSUES IN HOME CARE AND CAREGIVING ARE MEDICAL FOSTER HOMES SERVING VETERANS WHO HAVE SIMILAR FUNCTIONAL IMPAIRMENT AS TYPICAL NURSING HOME RESIDENTS?
Authors: Levy Cari , Magid Kate , Manheim Chelsea , Thomas Kali S , Haverhals Leah M , Saliba Debra
Published: November 2019

The Veterans Health Administration’s (VHA’s) Medical Foster Home (MFH) program was developed as a community-based alternative to institutional care. This study compares the clinical and functional characteristics of Veterans in the VHA MFH program to residents in nursing homes to understand whether MFHs substitute for nursing home care or serve a population with different care needs. All data were derived from Minimum Data Set (MDS) 3.0 assessments. Nurses collected MDS assessments from Veterans (n=92) in 4 MFHs between April 2014-December 2015. Data for nursing home residents were from a national nursing home dataset of residents with an annual MDS assessment in 2014 (n=818,287). We found that MFH Veterans were more likely to be male, have higher functional status, and perform more activities of daily living (ADLs) independently relative to nursing home residents (p<0.01 for all comparisons). Yet, a similar proportion of MFH Veterans and nursing home residents required total assistance in 9 of the 11 measured ADLs. Cognitive impairment, neurological comorbidity, and psychiatric comorbidity were similar in both cohorts; however, MFH Veterans were more likely to have traumatic brain injury (p<0.01), higher Patient Health Questionnaire (PHQ)-9 depression scores (p=0.04) and less likely to have anxiety (p=0.05). Our results suggest there are two distinct MFH populations, one with lower-care needs and another with Veterans completely dependent in performing ADLs. Given these findings, MFHs may be an ideal setting for both low-care nursing home residents with less functional impairment as well as residents with higher care needs who desire community-based long-term care.
THE EFFECTS OF THE NAMASTE CARE FAMILY PROGRAM ON QUALITY OF LIFE OF PEOPLE WITH ADVANCED DEMENTIA
Authors: Steen Jenny T van der , Joling Karlijn J , Francke Anneke L , Achterberg Wilco P , Smaling Hanneke J A
Published: November 2019

People with advanced dementia often die in nursing homes. Family caregivers frequently feel that their loved one’s quality of life and dying is suboptimal. The daily Namaste Care Family program -derived from the US Namaste Care program- involves family caregivers and integrates personalized care with meaningful activities for people with advanced dementia. A cluster-randomized controlled trial (December 2016 - December 2018) examined effects of the Namaste Care Family program on resident and family caregiver outcomes. Ten Dutch nursing homes implemented Namaste Care Family for 117 residents, while nine nursing homes provided usual care for 114 residents in the study. Nursing staff assessed quality of life over the last week with the Quality of Life in Late-Stage Dementia (QUALID, the primary resident outcome measure). Research assistants observed discomfort during the sessions with the Discomfort Scale-Dementia of Alzheimer Type (DS-DAT). Assessments were at baseline and after 1, 3, 6, and 12 months. We found a significant difference in QUALID score at 12 months favoring quality of life in the intervention group. Further, the intervention group showed less signs of discomfort at 3, 6, and 12 months compared with the control group. The Namaste Care Family program can improve quality of life of people with advanced dementia in the long run. These study findings support sustained implementation of the daily program in nursing homes. Further analyses of effects on the other outcomes will include blinded DS-DAT assessments, more secondary outcome measures and family caregiver outcomes.
PHYSICAL CONDITIONS ASSOCIATED WITH SUICIDE ATTEMPTS: DO RISKS DIFFER AMONG OUR OLDER VETERANS?
Authors: Bower Emily S , Simons Kelsey , Walsh Patrick G , Ashrafioun Lisham , Orden Kimberly A Van , Bishop Todd M
Published: November 2019

Physical illness confers risk for late-life suicide, yet few studies report whether risks differ with older age and among Veterans. We examined age-stratified associations between physical illness and suicide attempt among Veterans 65+ years (n=8452, 97% male) from a larger retrospective case-control study that utilized secondary data from the Veterans Affairs Corporate Data Warehouse and Suicide Prevention Applications Network. Controls were matched by age, sex, and mental health treatment utilization. Risk estimates for 15 conditions and a combined comorbidity score were stratified by young-old (65-74), middle-old (75-84), and oldest-old (85+), adjusting for age and sex within strata. Neurodegenerative disorder (ORs=4.5, 6.0, 6.5) or dementia (ORs=5.0, 5.7, 4.4) diagnosis within 180 days conferred the highest risks across young-, middle-, and oldest-old. Cerebrovascular disorder was associated with higher risk among the oldest-old versus young-old (ORs=6.1 vs 2.2). Findings differ from reported risks for suicide death. Illness may be experienced differently across later-life.
SOCIAL ISOLATION MEASUREMENT AND OLDER ADULT HEALTH: A REVIEW
Authors: Pohl Janet S
Published: November 2019

The objectives were to examine social isolation research literature, investigate reports of associations with health, and explore the numerous approaches to operationalize social isolation in gerontological research. While associated with negative health outcomes and mortality, the interpretation of social isolation research is hampered by a lack of conceptual clarity and the use of numerous ad hoc measures of the concept. A systematic search was conducted for published empiric studies regarding social isolation health outcomes in older adult samples. The electronic databases: Medline, CINAHL, and PsycINFO were utilized. Reports including social isolation as an independent variable and health outcomes at the individual level were extracted. Of 2,614 studies initially identified, 14 met study criteria. Study outcomes recognized smoking cessation, sleep disruption, inadequate diet, risk for malnutrition, health-related quality of life, subjective well-being, cognitive function, psychological distress, depression, functional decline, stroke, myocardial infarction, and mortality as related to social isolation. Measurement strategies revealed numerous definitions of social isolation reporting to evaluate objective and subjective social isolation, loneliness, engagement, social disconnectedness, and perceived isolation. Measures utilized: eight ad hoc, three versions of the Lubben Social Network Scale, two versions of the Social Network Index, and one question from the Rand Social Battery. Continuing to develop knowledge regarding the predictive power of social isolation on health is important for the care of older adults. Distinguishing social isolation from related but distinctly different social concepts will facilitate the forward movement of the science. Reliably measuring social isolation will enable the comparison of results across studies.
INNOVATIVE POLICIES AND TECHNOLOGIES TO INCREASE ACCESS TO HEARING AIDS FOR ADULTS
Authors: Yong Michael , Willink Amber , McMahon Catherine , McPherson Bradley , Nieman Carrie L , Reed Nicholas , Lin Frank
Published: November 2019

As the proportion of older adults in the world’s total population continues to grow, the deleterious downstream health economic outcomes of age-related hearing loss are steadily becoming more prevalent. While recent research has shown that age-related hearing loss is the single greatest modifiable risk factor for dementia, the rate of hearing aid use remains low in many countries across the globe. Reasons for poor uptake are multifactorial and likely involve a combination of factors, ranging from increasing costs of hearing aid technology to lack of widespread insurance coverage. This paper aims to first identify the current state of hearing aid access across the world using eight representative countries as examples. We then provide recommendations on how to facilitate greater access to hearing aids for consumers by addressing areas in regulation, technology, reimbursement, and workforce.
STRENGTH IN AGE-FRIENDLY HEALTH SYSTEMS: AN INNOVATIVE INTEGRATED INTERPROFESSIONAL MODEL
Authors: Kennedy Teri
Published: November 2019

This paper presents an innovative conceptual approach to health care policy for older adults: the Age-Friendly Health Systems Integrated Interprofessional Model. In 2017, the John A. Hartford Foundation and Institute for Healthcare Improvement, in partnership with the American Hospital Association and Catholic Health Association of the United States, advanced the concept of an Age-Friendly Health System. This initiative is designed to respond to the needs of a burgeoning U.S. older adult population, expected to double from 2012 to 2050, largely due to the aging of Baby Boomers and increased life expectancy. These Baby Boomers will demand a well-coordinated, communicative health system responsive to their values and preferences. In an Age-Friendly Health System, all older adults receive the best possible care, without care-related harms, and with satisfaction of care received. Essential elements include what matters, mentation, mobility, and medications, with a focus on patient-directed, family-engaged care. While a solid framework for improving healthcare for older adults, this model is further strengthened by incorporating the essential elements of person-, family-, and community-centered approaches to care; interprofessional team-based competencies, and Quadruple Aim outcomes. This enhanced model, referred to as the Age-Friendly Health System Integrated Interprofessional Model, combines elements essential to quality healthcare within the framework of an Age-Friendly Health System. This paper will present the original Age-Friendly Health System framework, the proposed Age-Friendly Health System Integrated Interprofessional Model, then compare and contrast each model’s essential principles. Implications for adoption of this enhanced model for policy, education, and practice will be explored.
SUCCESSFUL AGING IN ALASKA NATIVE ELDERS ACROSS DIVERSE REGIONS
Authors: Kim Steffi M , Wortman Eric , Boyd Keri
Published: November 2019

Existing conceptualizations of successful aging are mainly based on Western cultures, ignoring the inclusion or exploration of culturally-relevant knowledge within the experience of successful aging. Lewis (2011) drew on the experiences of Elders and identified four elements of Eldership (successfully aging elders) in the Bristol Bay region of Alaska: “a) emotional well-being, b) community engagement, c) spirituality, and d) physical health” (p. 544). Given the unique and distinct environmental locations of this study, this presentation builds upon Lewis previous research and will highlight similarities and differences of Alaska Native successful aging between three rural geographic areas of Alaska. 42 Alaska Native Elders were interviewed from the Norton-Sound subregion, 21 Alaska Native Elders from the Aleutian Pribilof Islands, and 26 Elders from the Bristol Bay region. A community-based, exploratory, qualitative research methodology was used to allow for the collaboration of researchers and communities as equal partners. Qualitative interviews explored the participant’s life, influences on aging well, and their aging process. Thematic analysis was used to establish codes and main themes based on the three different cultural regions of Alaska. Results argue for the expansion and emphasize on social components, historical perspectives, and the importance of place (cultural and geographic differences), as well as generativity and gerotranscendence. Findings will be used to develop community-specific health promotion and prevention programs to help Elders find meaningful activities that promote health and teach individuals to cope with aging-related changes.
A FEASIBILITY STUDY: THE DEVELOPMENT OF WEARABLE TECHNOLOGY FOR INJURY PREVENTION AMONG DIRECT CARE WORKERS
Authors: Young Yuchi , Young Yuchi , Leventhal Mitch , Muckell Jonathan , Raymond Peter E , Erlich Fred , Paynter Christopher
Published: November 2019

Objectives: 1) create metrics for lifting techniques and transferring mechanisms, 2) calibrate sensors for data collection 3) identify potential injurious posture among home health aides (HHAs) while transferring patients. Participants: 7 HHAs and a physical therapist. Interview and sensor data were collected. Outcome variables included improper lifting techniques and improper body mechanisms. Obesity of HHAs was associated with worse scores of body mechanics (p < 0.0001), while fear of injury with better body mechanics (p < 0.0001). GEE results identified that twisting the spine during transfers (OR = 6.3; 95% CI: 1.09–36.7) and not using a wide support base when lifting from supine to sitting (OR= 6.0, 95% CI: 2.03–17.7) were associated with improper lifting technique and body mechanics. Results show it is viable to use sensor technology to collect HHAs’ data to design intervention for injury prevention. A larger-scale study is needed to validate the results.