bluuebunny/crossref_metadata_2025 huggingface dataset:
SOCIAL INTERACTION AND PSYCHOLOGICAL WELL-BEING OF PERSONS LIVING WITH DEMENTIA IN LONG-TERM CARE
Authors: Lee Kyung Hee , Lee Ji Yeon
Published: December 2022

Although social interaction might play a critical role to improve psychological well-being of old adults with dementia in long-term care, lack of social interaction between staff and residents has been reported. The purpose of this study was to examine whether social interaction is associated with psychological well-being of persons living with dementia during care in long-term care. We analyzed 258 videos from 30 participants with dementia. Each participant was taken nine videos at 0, 3, and 6 months at three care events (i.e., personal care, mealtime, and activity). Social interaction was assessed by quality (i.e., positive, neutral, and negative), type (i.e., verbal, nonverbal, and both), and presence of interaction (i.e., no and yes). Psychological well-being was measured by positive and negative emotional expressions. A mixed model was chosen for the data analysis since these repeatedly measured observation data were nested within subjects. Mixed models showed that positive and neutral interactions were significantly associated with positive emotional expressions of residents after controlling covariates while negative interaction was significantly associated with negative emotional expressions. There was no significance between interaction type and emotional expressions. This study highlights the importance of positive care staff interactions in dementia care. In addition, the institutional efforts to create an environment to reduce negative interactions can be of great help in promoting the psychological well-being of persons living with dementia.
HOSPITAL TRANSFERS: PERSPECTIVES OF NURSING HOME RESIDENTS AND NURSES
Authors: Ahmetovic Alma , Drucker Claire , Huber Lesa , Unroe Kathleen , Hickman Susan
Published: December 2022

Between 1 million and 2.2 million nursing home residents are transferred to a hospital emergency department each year. These transfers are costly, have negative health outcomes, and can increase the morbidity and mortality of residents. The purpose of this study was to examine the transfer process between the nursing home and the hospital from the perspective of nursing home residents and nurses, focusing on how decisions were made to transfer residents. Using a qualitative descriptive method, 22 participants were recruited from four nursing homes located in rural Indiana. Purposive sampling, semi-structured interviews, and conventional content analysis were used to collect and analyze narratives obtained from residents and nurses about their experiences with a recent transfer. The participants described four aspects of the transfer process: transfer decisions, transport experiences, hospital stays, and returns to the nursing home. The most common reason for transfers was an acute exacerbation of a chronic condition, and the decision to transfer was often made by a nurse. Most residents found aspects of the transfer aversive or upsetting. The return to the nursing home was typically welcomed but often challenging due to problems with mobility, medications, and cognitive changes. Participants also provided several recommendations for avoiding potentially preventable transfers including adding “in-house” diagnostic testing and treatment equipment, improving staff competencies in managing acute exacerbations, increasing staffing, improving communication among staff, and increasing staff familiarity with resident histories and preferences. The findings have several clinical and policy implications for preventing or decreasing the negative effects of hospital transfers.
EFFECTS OF DANCE INTERVENTIONS ON COGNITION IN OLDER ADULTS: A META-ANALYSIS
Authors: Rittiwong Tanapa , Wongyara Nattaya , Schneider Joanne
Published: December 2022

Background

Dance interventions have been shown to improve cognition in older adults. However, no meta-analysis evaluates that effect. Objective: We examined the effects of dance on cognition in older adults and examined the moderating effects of participant, methods, and intervention characteristics.

Methods

We searched 14 databases using the search terms: dance AND cognition AND older adults. Researchers of primary studies compared dance with control groups of adults≥60 years old, measured cognition, and wrote in English. Two researchers independently coded studies and discussed to achieve consensus. Using the random-effects model, we computed effect sizes (ES) using Hedges’ g with 95%CIs along with heterogeneity statistics and conducted moderator analyses.

Results

Twenty-five studies included 1,908 participants (70.9±5.2years old). Dance had a strong, positive effect on both global cognition (ES=0.52, 95%CI [0.25, 0.78], p=.000) and memory (ES=0.56, 95%CI [0.08, 1.04], p=.022) and a moderate effect on executive function (ES=0.35, 95%CI [0.06, 0.65], p=.019) and attention (ES=0.21, 95%CI [0.06, 0.36], p=.005). Several variables moderated the relationship including the country, dancing in pairs or not, or with partners vs. non-partners. Methodological quality indicators that moderated the relationship was computing a priori power and comparing participant characteristics at baseline. Weeks of dancing and minutes/session also moderated the relationship.

Conclusion

Dance can significantly improve cognition in older adults. Healthcare providers might use dance interventions as an alternative treatment to improve cognition in older adults. Future researchers should explore the effects of type of dances on cognition and measure outcome changes over time.
EMBRACING SPIRITUALITY IN THE WORK OF FRONTLINE NURSING HOME STAFF
Authors: Lopez Ruth Palan , Hendricksen Meghan , Roach Ashley , Rogers Anita Hendrix , Mitchell Susan
Published: December 2022

Good end-of-life care for nursing home (NH) residents and their families provides for spiritual support, however, the role that spirituality plays in the work of NH staff has not been well described. To understand more about spirituality and NH staff, we examined interview data generated from the Assessment of Disparities and Variation for Alzheimer Disease Nursing Home Care at End of Life (ADVANCE) study, a large qualitative study conducted in 14 NHs to examine differences in end-of-life care for residents with advanced dementia. We examined semi-structured interview data from nurses (Registered Nurses and Licensed Practical Nurses) (n=45) and certified nursing assistants (CNAs) (n=25) who described the role of spirituality or God in response to questions around their experience caring for residents with advanced dementia. Data were analyzed using the constant comparative method. Most participants were female (93%). Thirty-four identified as Black, 29 as white, and 7 as other racial groups. The average age was 47.8 years, and the average years of experience was 16.2 years. Participants reported several religious affiliations including Baptist (23); Agnostic/Atheist (2), Catholic (7), Methodist (4), Muslim (1), Other/Unaffiliated/Refused (18), Pentecostal (4), and Christian (9). We found that for many nurses and CNAs, God played an important role in their work including providing meaning and purpose, providing them with resilience to cope with frequently losing residents that they consider “family.” The voices of the participants were powerful and provide important insights into potential strategies to retain and support these essential, front-line providers.
THE ASSOCIATION BETWEEN ACCESS TO MEDICAL CARE AND RESIDENT OUTCOMES IN NURSING HOMES
Authors: Bali Krittika
Published: December 2022

The nursing home population is vulnerable and medically complex, yet little is known about models of medical service provision and associated quality outcomes. The goal of this study is to examine the association between physician (MD) and nurse practitioner (NP) accessibility and practice sensitive outcomes. This project used data from the Translating Research in Elder Care (TREC) longitudinal study and the routinely collected Resident Assessment Instrument – Minimum Data Set version 2.0 (RAI-MDS 2.0) to test the association between the availability of MDs and NPs in nursing homes (NH) and clinically-relevant resident outcomes of antipsychotic medication (APM) use without indication of psychosis, physical restraint use, hospitalization and emergency department (ED) transfers, and polypharmacy. Eight models were created using logistic regression to test the association between the access measures of daily presence of MD or NP on unit and MDs being involved in care planning and each of the four resident outcomes. The sample consisted of 10,888 residents across 320 units in 92 facilities. Staff from 277 (86%) units reported an MD or NP visited daily and 318 (99%) units reported that the MD or NP could be reached when needed. Following adjustment for multiple confounding variables, there were no associations between either measure of access and any of the resident outcomes. Although we did not find any associations between our measures of access and resident outcomes, additional research which more directly measures physician and NP activities in the NH is required.
LONGITUDINAL CHANGES IN LEADERSHIP, JOB STRAIN, AND SOCIAL SUPPORT OVER FIVE YEARS IN NURSING HOMES
Authors: Backman Annica , Lindkvist Marie , Lovheim Hugo , Edvardsson David
Published: December 2022

Nursing home leadership has been described as crucial for staff job strain and social support but longitudinal data are lacking. This study aimed to explore changes in nursing home managers’ leadership, staff characteristics, job strain and social support by comparing matched units in a five-year follow-up study. Repeated cross-sectional, valid and reliable, measures of leadership, person-centered care, psychosocial climate and demographic variables were collected from managers and staff n=3605 in 2014 and n=2985 staff in 2019. Descriptive statistics and regression analyses with generalized estimating equations were used. The results showed that associations between leadership and staff job strain and social support increased in strength over time. This indicates that leadership has the potential to reduce staff job strain and increase the perception of social support among staff, and the significance of leadership increases over time. It was also shown that workforce characteristics had changed with higher proportion of enrolled nurses and a smaller proportion of nurse’s assistants at follow-up. An increase was also shown in staff reporting that the job required too much work effort, and perceived deteriorating collegiality and work atmosphere at follow-up.
HEALTH BENEFITS OF TAEKWONDO INTERVENTION IN OLDER ADULTS LIVING IN NURSING HOMES
Authors: Kim Yongseop , Kim Junhyoung , Seo Dongchul , Han Sua
Published: December 2022

Physical inactivity is prevalent among nursing home residents, and it contributes to loss of lower body muscle mass, which raises the risk of falling for the older adult population. Accumulative evidence shows that engaging in leisure-time physical activity improves physical functions, mental health, and cognitive capacities and provides social benefits in older adults. Taekwondo, a form of Korean traditional martial arts, has the potential to improve the health benefits among nursing home residents in the United States. Thus, the aim of this study was to explore the health advantages for nursing home residents of participation in a Taekwondo program modified to accommodate their physical and cognitive conditions. An observational research method was incorporated to explore the health benefits of Taekwondo. 10 prospective participants (5 females, 5 males; mean age = 80 years) from the local nursing home facility participated in in-depth semi-structured interviews. The researchers employed Strauss and Corbin's (1998) grand-tour and mini-tour question strategies, as well as Creswell's (2009) five phases of data gathering and analysis. The constant comparative approach was utilized to analyze the data in this study. As a consequence of participating in Taekwondo, four key themes were recognized as health benefits: (a) supporting mental health, (b) increasing physical functions, (c) stimulating cognitive capacities, and (d) facilitating healthy social connection. The findings of this study suggest that Taekwondo might be utilized as a therapeutic intervention to improve physical activity and reduce the negative psychological effects of nursing home confinement.
COMPANIONSHIP TO ADDRESS QUALITY OF LIFE AND LONELINESS AMONG OLDER ADULTS WITH SEVERE LONELINESS
Authors: McNamara Kelsey , Rudy Ellen
Published: December 2022

Research indicates that loneliness is a powerful predictor of premature mortality. Less is known about those who experience “severe loneliness” and their responsiveness to companionship as a means to clinically improve. We sought to understand the epidemiology of a cohort of lonely older adults and the impact of companion care on severe loneliness and quality of life. Companion care was provided through Papa Inc., a national service that pairs older adults with “Papa Pals” who provide companionship and assistance with everyday tasks. Participants have free access if their Medicare Advantage plan offers it. The sample included adults ages 65+, active in Papa in 2021, and provided follow-up data (UCLA-3 Loneliness Scale; CDC's Healthy Days Measures) as of September 2021. Analysis utilized t-tests and Chi-square tests with significance set at p< 0.05. A total of 2650 participants were identified as lonely at baseline, 435 were successfully contacted to collect complete follow-up data. Of the follow-up cohort, 22% were classified as severely lonely at baseline reporting mean UCLA score of 8, and 15 mentally and 14 physically unhealthy days on average. Of those severely lonely, 62% were female, 11% were ages 85+. Sixty percent of severely lonely participants experienced clinical improvements and moved to a lower category of loneliness (mean change in UCLA: –3.37) and reduced their unhealthy days (–6.20 mental; –2.09 physical). This real-world evidence suggests a companionship program can improve loneliness and quality of life among severely lonely older adults. Earlier interventions to prevent chronic loneliness should be explored.
THE ATTITUDES OF CHINESE AMERICAN FAMILY CAREGIVERS OF OLDER PEOPLE WITH DEMENTIA TOWARD TUBE FEEDING
Authors: Pei Yaolin , Qi Xiang , Cong Zhen , Wu Bei
Published: December 2022

The aim of this study is to examine the attitudes toward feeding in Chinese American dementia family caregivers. 53 Chinese American dementia caregivers were interviewed in 2021-2022. The survey included their anticipated decisions for tube feeding if their care recipients are at the end of life, goals of care, and knowledge of tube feeding. 32.7% of them would choose tube feeding for individuals with dementia at the end of life; however, 53.9% are confident that the patient would not choose tube feeding if patients are able to make decisions. 92.3% prepared to relieve pain and discomfort as much as possible. 42.3 % of them thought tube feeding are recommended to use if oral feeding difficulties arise. More than 60% thought tube feeding can improve survival and nutrition status. More education is needed for the decision-making regarding tube feeding at the end of life for Chinese American dementia caregivers.
SOCIAL CONNECTIONS AND HEALTH AMONG OLDER ADULTS LIVING IN SUBSIDIZED HOUSING: LOCAL STAKEHOLDERS PERSPECTIVES
Authors: Bullock Avery , Gallo Joseph , Latkin Carl , Boyd Cynthia , Cudjoe Thomas
Published: December 2022

Social isolation among older adults living in the United States is a major public health problem that disproportionately affects those living below the poverty line. Though decades of epidemiological studies have provided important insights on the impact of social isolation on health, there have been limited qualitative studies on the dynamics of social connections among older adults in subsidized housing. This study aims to advance our understanding of the perspectives of local stakeholders in the field of subsidized housing on the social connections of older adults and how to enhance social connection. Semi-structured interviews were conducted between July 2021 and October 2021 with local stakeholders in Baltimore’s subsidized housing community to better understand social connections among older adults. Stakeholders included, but were not limited to, the following positions: service coordinators, property managers, maintenance staff, and security guards. Interviews were imported and analyzed using NVIVO12 software and a qualitative content analytic approach. Preliminary themes identified included: barriers and facilitators of connection, engagement with family, and ideas about interventions. Mental and physical health challenges, access to and use of communications technology, and lack of transportation were barriers while food incentives, gift card giveaways, and resident champions were facilitators of social connection. Social isolation among older adults is an important concern among stakeholders in subsidized housing. To promote social connection in older adults, interventions must adopt a multi-pronged approach that addresses the barriers and leverage existing facilitators within subsidized housing communities.
WITHIN- AND BETWEEN-PERSON EFFECTS OF HEALTH AND SOCIAL RELATIONSHIPS WITH FAMILY AND NEIGHBORS ON WELL-BEING
Authors: Takayama Midori , Ishioka Yoshiko , Sugawara Ikuko
Published: December 2022

Good health and positive social relationships are significant resources in well-being. However, little is known about how intrapersonal changes and interpersonal differences in health and social relationships are associated with well-being in later life. This study aimed to examine within- and between-person effects of physical health and social relationships with family, friends, and neighbors (social support and companionship) on well-being. We analyzed longitudinal data from a representative sample of older Japanese adults aged 74 to 86 years (N=1388). The results from multilevel models showed that decline in health (intrapersonal changes) was associated with lower well-being. Nevertheless, there was the interaction effect of social relationships with family and neighbors (between-person differences) in the relationship between health and well-being change. Among participants with lower social support from family and neighbors, the negative association between decline of health and well-being was stronger. Conversely, participants with higher social support reported higher well-being regardless of physical health change. Contrastingly, among participants with higher companionship with family and neighbors, participants reported higher well-being at the time of maintaining or increasing physical health. For participants with lower companionship, health change was not associated with well-being. These findings suggest social support has a preventive effect on well-being in the face of declining health, while companionship has a facilitative impact on well-being in good health. The results also suggest relationships with neighbors as well as family play an important role in well-being in very late life.
IMPACT OF BEHAVIORAL ACTIVATION ON COMORBID DEPRESSION AND TYPE 2 DIABETES IN LOW-INCOME ADULTS
Authors: Griffith Christopher , Feliciano Leilani
Published: December 2022

Older age is a significant risk factor for type 2 diabetes mellitus (T2DM), and depression risk increases with comorbid illnesses such as T2DM. Older adults with depression have increased risk of developing somatic symptoms and decreased interest in activities, which impacts diabetes self-care. This makes depression an important target for treatment alongside T2DM. Behavioral activation (BA) is a therapeutic intervention shown to be effective in the treatment of moderate to severe depression. The current study examined the utility of brief BA treatment (once weekly for 4 weeks) across older adults aged 60-80, middle-aged adults aged 45-59, and younger adults aged 18-44. Fifty-six adults with diabetes participated in an in-home diabetes management program with BA to treat depression in low-income adults. Participants completed weekly measures of well-being and depressive symptoms. Two mixed-subjects analyses of variance (3 x 2 ANOVAs) found that BA was significantly effective at improving subjective well-being, F (1, 53) = 38.24, p < .001, ηp2 = .42, and reducing depressive symptoms, F (1, 38) = 27.25, p < .001, ηp2 = .42, but found no interaction effects between either age group and well-being or depressive symptoms (p = .173 and .302, respectively). Results indicate that BA is effective for treating depression in adults with comorbid T2DM regardless of age, making it a useful therapeutic tool for both the high number of older adults with T2DM and their younger counterparts. Further research should examine other outcomes (diabetes management) to evaluate the full extent of BA’s effectiveness.
DECISION-AID INTERVENTIONS TO SUPPORT DEMENTIA CAREGIVERS' DECISION-MAKING ABOUT FEEDING OPTIONS
Authors: Qi Xiang , Pei Yaolin , Schulman-Green Dena , Hu Mengyao , Wang Kaipeng , Wu Bei
Published: December 2022

We sought to provide an overview of the literature on decision aid interventions for family caregivers of older adults with advanced dementia regarding decision-making around tube feeding. The process was guided by Arksey and O’Malley’s methodological framework. Six publications reporting on four unique decision aid interventions were included. All the interventions targeted caregivers of older adults with advanced dementia. Three of decision aids were culturally adapted from existing ones. The Ottawa Decision Support Framework and the International Patient Decision Aid Standards Framework were used in these studies. Interventions aimed to improve decision-making regarding tube feeding for caregivers through static delivery methods. Caregivers rated these decisions as helpful and acceptable. Reduction in decisional conflict and increase in knowledge were consistently found among dementia caregivers, but no intervention effects were found on preferences for use of tube feeding. Culturally adapted decision aids effectively improve decision-making regarding tube feeding among the target population.
LEVERAGING THE NDUFS4-/- MOUSE AS A PLATFORM FOR TESTING LONGEVITY INTERVENTIONS
Authors: Bitto Alessandro , Tobey Cara , Sharma Ayush , Grillo Anthony , Kaeberlein Matt
Published: December 2022

Mitochondrial dysfunction is one of the hallmarks of biological aging, as well as the driving factor for mitochondrial diseases. Up to 30% of mitochondrial disorders are due to mutations affecting the activity of Complex I in the electron transport chain. Loss of the Complex I subunit Ndufs4 recapitulates symptoms of Leigh Syndrome, a pediatric mitochondrial disease, in mouse. Ndufs4-/- mice suffer developmental delays, early onset of neurological symptoms and extremely reduced lifespan. Several studies have now shown that Ndufs4-/- mice are exquisitely responsive to treatments and interventions of interest in the biology of aging, such as rapamycin, NAD+ precursors, reduced oxygen tension, alpha-keto-glutarate precursors, and the antidiabetic drug acarbose. These results point to common mechanisms underlying both aging and mitochondrial disorders. To put this hypothesis to the test, we show that Ndufs4-/- mice are responsive to a wide range of longevity interventions previously tested in worms, mice, and by the National Institute on Aging’s Intervention Testing Program. These observations support the hypothesis that mitochondrial and metabolic dysfunction induced by Complex I deficiency may be a key component of biological aging as well as mitochondrial disease. Furthermore, we propose that the Ndufs4-/- mice provide an affordable testing ground for candidate longevity interventions.
LOSS OF HYPOXIA SIGNALING IMPAIRS RESPONSE TO AEROBIC EXERCISE IN AGED MICE
Authors: Sinha Indranil , Endo Yori , Karvar Mehran
Published: December 2022

To assess the differential effects of exercise with age, Young (Y, 10-12 weeks) and Old (O, 23-25 months) mice were subjected to regimented treadmill running or no regimented exercise. Y, trained mice experienced a significant increase in maximal distance running, maximal speed of running, and lean muscle mass in comparison to age-matched, untrained controls. O mice did not improve significantly in any of these measures following training. Transcriptome analysis of gastrocnemius from Y mice demonstrated differential regulation of 120 genes with exercise. None of these genes were similarly regulated in the O group. Genes most upregulated following exercise in Y mice were direct targets of the hypoxia signaling pathway. Immunoblotting demonstrated that aryl hydrocarbon receptor nuclear translocator (ARNT), a critical regulator of hypoxia signaling, increased 3-fold with exercise in Y mice, but this increase was absent in O mice following exercise. To assess whether this loss of ARNT in O muscle impaired the exercise response, we generated a mouse with inducible, skeletal muscle-specific knockout of ARNT (ARNT muscle (m) KO). Following regimented exercise, ARNT mKO mice did not improve maximal distance running, maximal running speed, or lean muscle mass in comparison to untrained ARNT mKO mice. Littermate, age-matched ARNT wild type mice increased significantly in all of these measures following training. Administration of ML228, an ARNT agonist, increased maximal running distance and speed in response to exercise training in O mice. These results suggest that restoration of ARNT and hypoxia signaling may restore the physiologic response to exercise in aging.
SINGLE-CELL ANALYSIS OF SKELETAL MUSCLE MACROPHAGES REVEALS AGE-ASSOCIATED FUNCTIONAL SUBPOPULATIONS
Authors: Cui Chang-Yi , Krasniewski Linda , Chakraborty Papiya , Mazan-Mamczarz Krystyna , Ferrucci Luigi , Gorospe Myriam
Published: December 2022

Tissue-resident macrophages represent a group of highly responsive innate immune cells that acquire diverse functions by polarizing towards distinct subpopulations. The subpopulations of macrophages that reside in skeletal muscle (SKM) and their changes during aging are poorly characterized. By single-cell transcriptomic analysis with unsupervised clustering, we found eleven distinct macrophage clusters in male mouse SKM with enriched gene expression programs linked to reparative, proinflammatory, phagocytotic, proliferative, and senescence-associated functions. Using a complementary classification, membrane markers LYVE1 and MHCII identified four macrophage subgroups: LYVE1-/MHCIIhi (M1-like, classically activated), LYVE1+/MHCIIlo (M2-like, alternatively activated), and two new subgroups, LYVE1+/MHCIIhi and LYVE1-/MHCIIlo. Notably, one new subgroup, LYVE1+/MHCIIhi, had traits of both M2 and M1 macrophages, while the other new subgroup, LYVE1-/MHCIIlo, displayed strong phagocytotic capacity. Flow cytometric analysis validated the presence of the four macrophage subgroups in SKM, and found that LYVE1- macrophages were more abundant than LYVE1+ macrophages in old SKM. A striking increase in proinflammatory markers (S100a8 and S100a9 mRNAs) and senescence-related markers (Gpnmb and Spp1 mRNAs) was evident in macrophage clusters from older mice. In sum, we have identified dynamically polarized SKM macrophages and propose that specific macrophage subpopulations contribute to the proinflammatory and senescent traits of old SKM.
CARDIOVASCULAR CONSEQUENCES OF COVID-19 INFECTION IN OLDER ADULTS WITH A HISTORY OF HEART FAILURE
Authors: Beatriz Claudia , Ocasio Marcano , Crawford Andrew , Parianos Mary , Stukova Marina , Wong Alan , Zadeh Ali Vaeli , Collado Elias , Larned Joshua
Published: December 2022

Background

COVID-19 frequently affects the cardiovascular system. Advanced age and pre-existing heart failure HF are considered risk factors for a poor prognosis. However, the cardiovascular consequences of COVID-19 in older adults with a history of HF have not been clearly depicted.

Methods

A retrospective review was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD codes, patients aged 65–75 and Elixhauser Comorbidity Score(ECI)>4 with a history of HF admitted for COVID-19 were identified. This cohort was propensity score matched with a group of patients without HF by age, gender, other cardiovascular diseases, and ECI. Records from both groups were reviewed for new onset of cardiovascular-related conditions, including myocardial infarction(MI), arrhythmias, and hypertension, within one year following the admission. Pearson’s chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant.

Results

4,014 members in each group were identified. A history of HF was associated with an increased risk of MI(RR=1.18, CI95% =1.005–1.37, p=0.04), and arrhythmias (RR=1.17, CI95% =1.08–1.26, p < 0.00001). No differences present in risk of myocarditis(RR=0.05, CI95%=0.12–1.99, p=50) across groups.

Conclusion

Older adults with a history of HF are more likely to experience MI and arrhythmias over a year after hospitalization for COVID-19.
USING TELEPRESENCE ROBOTS TO SUPPORT FAMILY VIRTUAL VISITS DURING THE COVID-19 PANDEMIC
Authors: Hung Lillian
Published: December 2022

In this project, virtual family visits were made to residents of four Canadian long-term care homes using a telepresence robot. Guided by the Consolidated Framework of implementation Research (CFIR), we conducted an online survey, interviews, focus groups, and observations to explore the participants’ experience. Analysis identified three themes: (a) relative advantage (easy to visit), (b) capacity for change (readiness and organizational support), and (c) cultural safety (champions leading the way during challenging times). Preliminary results indicate that staff, residents, and families accepted the robot for easy connection but had concerns about privacy issues. Future research should apply inclusive methods to bring relevant stakeholders together to explore user experiences fully: who is affected in what ways and the benefits, risks, and burdens of emerging technologies.
UNCOVERING THE POSITIVE ASPECTS OF CAREGIVING: A PROFILE OF CAREGIVERS’ DEMOGRAPHIC AND CARE CONTEXTS
Authors: Lee Yeonjung , Bierman Alex
Published: December 2022

Burden and benefits of caregiving experiences can coexist. The objective of this research is to describe and compare the predictors of the two intertwined caregiving experiences. This study examines how the variations in caregiving experiences can be explained in terms of both positive and negative aspects of caregiving, respectively by demographic characteristics and care related contexts. The Caregiving, Aging, and Financial Experiences study is a national survey intended to examine social conditions and well-being among a representative sample of 4,010 Canadians between age 65 and 85. Within the sample, 1,641 informal caregivers are the focus of the current analysis. Scales of positive and negative caregiving experiences are employed. Findings based on principal axis factor analysis shows that there is clear separate factor loadings between the positive and negative caregiving experiences. Subsequent seemingly unrelated regression analysis shows that there are similarities as well as differences in predictors between the two caregiving experiences. Lastly, the variance explained differs markedly between the two measures, with over 26% of the variance in negative caregiving accounted for by demographic and caregiving factors, but less than 4% of the variance in positive caregiving. This study demonstrates that positive aspects of caregiving is not simply the flip-side of negative caregiving. Standard predictors do not sufficiently explain positive caregiving as well as negative caregiving. Consequently, greater attention to factors that account for positive aspects of caregiving is warranted for an inclusive understanding of caregiving experiences.
TECHNOLOGY AND GROUP EXERCISE INTERVENTIONS FOR PEOPLE WITH DEMENTIA OR MILD COGNITIVE IMPAIRMENT: A SCOPING REVIEW
Authors: Levine Hannah , Randhawa Paavan , Park JuYoung , Hung Lillian
Published: December 2022

We conducted a scoping review to analyze evidence about online group-based exercise programs. We searched six electronic databases and conducted team analysis with patient and family partners. Of 1,166 screened articles, the final review included 8 publications. Results identified three types of technology-based group exercise interventions for people with dementia or mild cognitive impairment (MCI): (a) exergames, (b) virtual cycling, and (c) video-conferencing platforms. These studies used psychosocial, physical function, biomarker, and cognitive outcome measures. The review identified three key impacts: (a) feasibility and accessibility; (b) physical, psychosocial, and cognitive benefits; and (c) adaptations necessary for persons with dementia or MCI. Over all, technology-based group exercise interventions were found to be accessible, feasible, and acceptable to persons with dementia or MCI. However, a “one-size-fits-all” game approach often did not work, suggesting that exercise interventions should be adaptable to meet the various needs of individual participants.
MOTIVATING CHANGE IN OLDER ADULTS: MOTIVATIONAL CIGARETTE SMOKING CESSATION MESSAGE TESTING
Authors: Johnson Adrienne , Kaye Jesse
Published: December 2022

Cigarette smoking remains the leading preventable cause of death and disability in the U.S., resulting in ~480,000 deaths annually. Older adults who smoke bear a disproportionate weight of the health consequences of smoking, including cancer, mortality, and the greatest health-related fear of older adults: dementia. Compared to younger adults, older adults who smoke are half as likely to make a quit attempt, but more likely to stay quit using evidence-based treatments. Research suggests the increased risk of dementia among people who currently smoke may motivate adults ages >50 to quit smoking, particularly if given a clear/actionable strategy. Research also suggests Fear-based messages may perform differently than Hope-based messages. 820 adults (ages 50–80) without dementia who smoke, completed an online survey evaluating time-matched messages (randomly assigned between-subjects: Control Nf266, Fear of dementia Nf274, Hope from quitting Nf280) on motivation and intentions to quit smoking. Participants’ demographics were Mage=61.1 years (SD=7.4), 48.0% cisgender women, 66.6% White, 23.3% Black. Mann-Whitney U Tests were use to examine change scores for each variable due to non-normal distributions. Compared to control message (water ad), the Fear message showed greater increase in motivation to quit U(Ncontrol=266, Nfear=274)=30391, z=-3.33, p=.001. The Hope message did not differ from the control or Fear message (p’s>.05). Intention to quit did not differ between messages (p’s>.05). A Fear-based message highlighting that smoking increases the risk of developing dementia, motivated quitting more than a control message. Future work should examine the feasibility, acceptability, and behavioral impact of this motivational message in healthcare settings.
THE BOLD PUBLIC HEALTH CENTERS OF EXCELLENCE ON DEMENTIA: MOBILIZING PUBLIC HEALTH ACTION TO ADDRESS DEMENTIA
Authors: Baumgart Matthew , Super Nora
Published: December 2022

Under the BOLD Infrastructure for Alzheimer’s Act, passed by Congress in 2018, the Centers for Disease Control and Prevention (CDC) established three Public Health Centers of Excellence (PHCOEs) to address Alzheimer’s disease and related dementias. Awarded in the Fall of 2020, the three PHCOEs are: (1) Dementia Caregiving; (2) Dementia Risk Reduction; and (3) Early Detection of Dementia. Each PHCOE is charged with identifying, translating, and disseminating research findings and evidence-based public health best practices in their particular area of focus – and then working with state, local, and tribal public health agencies across the country to undertake dementia-related activities in their communities. This Symposium will feature an overview by Dr. McGuire of the BOLD Act and CDC’s efforts to address Alzheimer’s and related dementia, followed by presentations on the work and the plans of each of the PHCOEs. Dr. Gaugler will discuss the Caregiving PHCOE’s efforts to support unpaid caregivers of those living with dementia, including how best to meet the caregiving needs of diverse communities. Mr. Baumgart will present the Risk Reduction PHCOE’s findings on the state of the evidence on risk reduction and how that evidence is being translated to public health action. Dr. Chodosh/Dr. Borson will review the plans of the Early Detection PHCOE to increase awareness of the value of earlier detection and the best ways of conducting detection strategies. Finally, Ms. Super will discuss how this public health work complements the work of the aging community in addressing Alzheimer’s and related dementias.
FRAILTY INDEX AT THE BEGINNING OF ELDERHOOD AND HEALTHCARE COSTS AND UTILIZATION OVER 10 YEARS
Authors: Jang Jieun , Kim Dae
Published: December 2022

Background

We assessed whether the frailty index measured at the beginning of elderhood can predict healthcare costs over 10 years in a nationwide Korean population.

Methods

This retrospective cohort study included 215,887 individuals who underwent a standardized comprehensive geriatric assessment at the age of 66 years as part of the National Screening Program for Transitional Ages in 2007–2009 and participants were followed up until December 31, 2019, from the Korean National Health Insurance database. Frailty status was defined based on a 39-item frailty index: robust (< 0.15), pre-frail (0.15 to < 0.25), frail (≥0.25). Generalized linear model was used to examine any changes in healthcare cost among pre-frail group, frail group following 10 years from the age of 66 years, relative to changes in healthcare cost of the robust group. This study constructed an interaction term between the frail group and age.

Results

Frailty status at age 66 years was associated with an increased annual total healthcare cost per NHI beneficiary (robust * age vs frail * age: β = 89.5, SE = 4.0, P < .0001), annual inpatient healthcare cost per NHI beneficiary (robust * age vs frail * age: β = 70.3, SE = 4.1, P < .0001) over 10 years, but not significant in annual outpatient cost per NHI beneficiary after adjusting for frailty category, demographic factor, socioeconomic factor, and time fixed effect. Conclusions: The frailty index at the age of 66 years was associated with an accelerated increase in healthcare costs over 10 years.
A PSYCHOMETRICALLY ROBUST LONGITUDINAL RESEARCH MEASURE OF FRAILTY: FIVE DIMENSIONS ACROSS AGE AND TIME
Authors: Voll Stacey , Terrera Graciela Muniz , Hofer Scott
Published: December 2022

The research construct of frailty in aging requires a measure with sound psychometric properties, that is stable across longitudinal points of observation. Using Exploratory Factor Analysis and Longitudinal Mixed Methods, we developed a five-factor research measures of frailty that is robust across time. Standardized regression scores for each factor allow us to estimate the change in severity of dysfunction as individuals age. We propose a system for developing research tools for the concept of frailty in large longitudinal data sets, and present our findings of five factors of frailty for females and males from the English Longitudinal Study on Ageing.
DATA-DRIVEN IMPROVEMENTS TO DEMENTIA DISEASE DETECTION STRATEGIES IN AN FQHC SETTING
Authors: Sivers-Teixeira Theresa M , Tabon Patrick , Yuan Jessie , Thayer Erin , Matta Sonali , Olsen Bonnie
Published: December 2022

Despite higher prevalence of dementing illnesses in Latina/o populations, detection is lower compared to white populations, compounding racial/ethnic and economic disparities. Undetected illness compromises effective delivery of primary care and impedes linkages to much needed services. Development of robust detection and culturally sensitive management of cognitive impairment is critical for adequate care of this population. The Geriatric Workforce Enhancement Program at the University of Southern California (USC) partnered with Eisner Health, a Federally Qualified Health Center, serving a primarily immigrant, Spanish-speaking, uneducated, urban older adult population, to help achieve their goal of becoming an Age-Friendly Health System to prioritize identification and management of cognitive impairment. Over 14 months, a sustainable clinic workflow was developed and implemented to detect, evaluate, diagnose, and develop care plans for patients and their care partners. Staff and provider education was delivered through didactics, workshops, case reviews, and at-elbow training. Additional efforts focused on EHR optimization and alignment of existing clinical resources. Frequency data was extracted using i2iTracks software reflecting pre and post-implementation. Results show a higher percentage of patients diagnosed with cognitive impairment in the post-implementation period (7.35%) compared to pre-implementation (4.05%). Detailed data tracking the volume of patients engaged at each step of the workflow supports meaningful analysis of barriers and opportunities for optimization, such as how and where additional resources and efforts will yield the greatest effects. Data-driven strategies such as these, strengthen efficiency and effectiveness of the collaborative process and result in sustainable outcomes for this underserved population.
PUTTING IT TOGETHER: THE COMPLEMENTARY EFFORTS OF PUBLIC HEALTH AND AGING TO ADDRESS DEMENTIA
Authors: Super Nora
Published: December 2022

The Public Health Centers of Excellence are part of a larger effort by the Centers for Disease Control and Prevention (CDC), through the BOLD Infrastructure for Alzheimer’s Act and the Healthy Brain Initiative, to advance cognitive health and dementia as public health issues – and to expand the public health response to the Alzheimer’s crisis. These efforts are designed to complement, not supplant, the long-standing work of the aging community to help people with dementia and their families. This presentation will discuss how the new and expanded public health work corresponds with the efforts of the aging community and will illustrate the unique roles of the public health and aging communities in the fight against Alzheimer’s. In addition, the presentation will review initiatives – such as the Milken Institute’s Alliance to Improve Dementia Care – that seek to bring both communities together on a common dementia agenda.
TRENDS IN OSTEOPOROSIS DRUG USE AMONG MEDICARE BENEFICIARIES WITH & WITHOUT ALZHEIMER’S DISEASE/RELATED DEMENTIAS
Authors: Armstrong Peyton , Kuo Yong-Fang , Westra Jordan , Raji Mukaila
Published: December 2022

Background

Osteoporotic fractures are a leading cause of disability and premature death in the elderly. Patients with Alzheimer’s and related dementia (ADRD) have high rates of osteoporosis (OP) and substantial risk of osteoporotic fractures. Yet research is sparse on trends and predictors of OP medication use in ADRD.

Methods

Medicare beneficiaries with OP aged ≥67 years with Medicare parts A/B/D without HMO from 2016–2018. Outcome was receipt of OP medications in 2018. A multivariable logistic regression assessed association between ADRD and OP drug prescribing, adjusted for age, sex, race, region, Medicare entitlement, dual Medicaid eligibility, chronic conditions, number of provider visits/hospitalizations, and nursing home (NH) resident status. Age/ADRD and NH residency/ADRD interactions were tested.

Results

Sample consisted of 47,871 people with OP and ADRD and 201,840 with OP without ADRD. OP drug use was 38.6% in ADRD patients vs. 52.7% in non-ADRD. After adjustment for demographics, chronic conditions, previous hospitalizations/physician visits, the OR for OP drug in ADRD vs. Non-ADRD was 0.85 (95% CI: 0.83–0.87). NH residents had lower odds for OP medication (OR: 0.61, 95% CI: 0.58–0.64). There were significant interactions between ADRD/age and between ADRD/NH residency. The OR for OP drug use associated with ADRD was 0.88 (95% CI: 0.86–0.90) among community-dwelling elders and 0.66 (95% CI: 0.64–0.69) among NH residents. Conclusions: ADRD patients received OP drugs at lower rates than non-ADRD counterparts. More research is needed on prescribing or deprescribing OP drugs in context of ADRD severity, patient preferences, remaining life expectancy and time-to-benefit from OP drugs.
THE ROLE OF SLEEP DISTURBANCE IN COGNITIVE OUTCOMES AMONG LONELY ADULTS IN THE HEALTH AND RETIREMENT STUDY
Authors: Grudzien Adrienne
Published: December 2022

Both sleep disturbance and loneliness have been linked to poorer cognitive performance and increased risk of dementia in older adults. Loneliness is believed to influence cognitive functioning directly and indirectly through the HPA axis dysfunction, which increases systemic inflammation through endocrine, immune system, and genetic pathways which produce a range of negative effects on brain tissue. Higher levels of HPA axis activity associated with lonely feelings may lead to poorer sleep quality, which decreases beta-amyloid and tau clearance, as well as memory consolidation, which may further disrupt sleep through alterations in brain tissue. Despite the growing body of research, little is known about how sleep disturbance and loneliness, both modifiable risk factors, interact to effect cognition and dementia risk over time. Secondary analysis of the 2006, 2010, 2014, and 2018 waves of the Health and Retirement Study was completed using data from 1,092 participants (mean age: 66.24; SE: .1366). Mixed effects regression modeling was used to evaluate the role of sleep disturbance in the relation between loneliness (R-UCLA loneliness scale, 11 item) and four cognitive performance measures: Immediate and Delayed Word Recall, Serial 7s, and Backward Count, and cognitive status category (cognitively normal, cognitively impaired, and dementia) across a 12-year period. Sleep disturbance moderated the relation between loneliness and Immediate Word Recall (p=.048) and Serial 7s (p=.032) outcomes even after controlling for demographic covariates and depression. Findings suggest that sleep disturbance may exacerbate the negative physiological effects of loneliness on episodic memory and executive functioning in older adults.
POSITIVE EMOTION EXPRESSION AND ADAPTIVE COPING BEHAVIORS FOR ADULT CHILDREN OF PARENTS WITH MEMORY LOSS
Authors: Gad Dustin , Piechota Amanda , Monin Joan
Published: December 2022

The broaden-and-build theory suggests that experiences of positive emotion may lead to enhanced utilization of adaptive coping strategies, and a decrease in maladaptive coping strategies (Gloria & Steinhardt, 2016). This relationship between positive emotion and adaptive coping has yet to be studied directly in a sample of adult child caregivers of a parent with memory loss. As part of a larger study investigating relationship dynamics between adult children and their parents with memory loss, adult children 18 years of age and older (n= 67) responded to self-report surveys and engaged in a 6 minute, video recorded, positive interaction session, playing “name that tune” with each other. The session was observationally coded by two coders for “enjoyment/enthusiasm/fun” (k= .516), “laughter” (k= .631), and “positive affect displayed towards partner” (k=.464), using a reliable and valid support-seeking and caregiving behavior coding system (Collins & Feeney, 2000). Spearman’s rank correlations between these behavior codes and the self-reported Brief COPE Inventory (BCI) scores suggested positive correlations between “laughter” and the emotional support subscale of the BCI (rs=.259, p= .034), and between “positive affect displayed towards partner” and the venting subscale of the BCI (rs= .256, p= .036). These findings suggest that the expression of positive emotions in the caregiving process might yield important psychological benefits to the caregiver, through increased utilization of specific coping mechanisms. More research in this area is needed to determine whether positive emotion expression is associated with the use of adaptive coping more so than maladaptive coping mechanisms in this population.