bluuebunny/crossref_metadata_2025 huggingface dataset:
Perception of Life-Control Is Associated With Medical Care Satisfaction in Chronically Ill Rural Older Adults
Authors: Halli-Tierney Anne , Noh Hyunjin , Lee Lewis
Published: December 2020

Prior studies show patient populations have varied experiences with healthcare systems, and this may influence satisfaction with medical care. Patients feeling control over life circumstances may have resilience and ability to adapt to adverse situations. Given socioeconomic and medical differences in older adults we examined factors influencing satisfaction with medical care in the setting of chronic conditions and pain. 100 older adults in rural West Alabama with chronic illnesses and pain were recruited from community senior centers and interviewed with a structured questionnaire. Participants were queried about medical interventions for chronic conditions and satisfaction with medical care. Overall assessment of life-control was measured by the West Haven Yale Multidimensional Pain Index (WHYMPI). Bivariate correlation and multivariate analysis were conducted. Correlations between satisfaction with medical intervention and life-control scores were significantly positive (r=.21, p<.05). Satisfaction with medical intervention and other covariates explained approximately 14.1% variance in life-control scores, R2=.141. Multivariate regression results confirmed those highly satisfied with medical intervention were marginally significantly likely to have increased life-control scores, b=.20, SE=.12, p=.088. Married persons were more likely to have higher life-control scores than those with other marital statuses, b=.84, SE=.34, p<.05. Income was positively associated with life-control scores, b=.18, SE=.08, p<.05. Older adults may perceive greater satisfaction from medical care if they feel greater control over life circumstances. Socioeconomic factors (marital status, income) are associated with life control. These findings can help predict satisfaction with healthcare and find ways to make healthcare more accessible to all.
A Preliminary Analysis of Hearing Loss and Its Association With Mild Cognitive Impairment
Authors: Yuk Mary Caroline , Allen Rebecca , Hay-McCutcheon Marcia , Carroll Dana , Halli-Tierney Anne
Published: December 2020

Age related hearing loss, or presbycusis, is a global condition that is increasing in its prevalence. Despite being one of the most common chronic conditions among the older population, there is much more to understand about its association with other aspects of physical and emotional health and well-being. Current research is suggesting that hearing loss is more prevalent in those with cognitive impairment compared to those without cognitive impairment. This study analyzed the incidence of hearing loss and its linkage to mild cognitive impairment in a community-dwelling geriatric population. With the increasing prevalence of this condition in both rural and urban communities of Alabama, it becomes a more pressing matter to understand comorbidities and risk factors for future decline in functioning. This study was conducted in an interdisciplinary geriatrics primary care outpatient clinic in a Family, Internal, and Rural Medicine department affiliated with a university medical center in the Deep South. Ninety-one participants completed the Montreal Cognitive Assessment (MoCA) and a hearing screening. Hearing screenings were conducted in quiet rooms in the medical center using Phonak hearing screening cards. Detection of 500, 1000, 2000, and 4000 Hz tones was assessed. Pearson correlation analyses demonstrated an association between hearing loss mild cognitive impairment. Poorer hearing was significantly associated with lower scores on the MoCA. Conducting behavioral health screenings like this in other primary geriatrics clinics and community settings could improve care and identification of patient needs by integrating important data regarding comorbidities and independent living.
Ain’t I Supposed to Be Doing Something?: Identifying and Discussing Cognitive Issues in Lupus
Authors: Vandenberg Ann , Drenkard Cristina , Goldstein Felicia , Dunlop-Thomas Charmayne , Lim S Sam , Bowling C Barrett , Plantinga Laura
Published: December 2020

Lupus is a complex chronic disease associated with a high prevalence geriatric syndromes and reduced cognitive functioning, consistent with accelerated aging. Although patients with lupus commonly report cognitive symptoms or “lupus fog,” cognitive assessment is not routine and little is known about day-to-day cognitive problems and their effect on chronic disease management. As part of a pilot exploring the use of a cognitive functioning report prototype for shared decision making in clinical encounters (Approaches to Positive Patient-Centered Experiences of Aging in Lupus study), we conducted four focus groups, two with lupus patients (n=18) and two with lupus providers (physicians and nurses; n=9) addressing cognition. We compared how the NIH Toolbox fluid cognition domains (episodic (retrospective) memory, working memory, processing speed, attention and inhibitory control, cognitive flexibility, and overall fluid cognition) matched with patient- and provider-identified cognitive problems and needs. In open questioning using a standard interview guide, patients identified all domains with rich experiential examples; providers identified fewer domains with less detail. An unanticipated additional domain was prospective memory, problems in remembering future actions, whether in the near future (e.g., forgetting what they needed to do on entering a room) or in the not-so-near future (e.g., forgetting about a medical appointment). Technological aids (e.g., smartphone alerts) were mentioned by some patients, but not providers, and represent a potential opportunity for medical care. Providers envisioned using cognitive assessment to distinguish cognitive issues (e.g., forgetting to take medication) from other problems (e.g., medication non-adherence) in order to tailor chronic disease management messaging.
Functional Disability in the Context of Cancer Diagnosis: Examining the Within- and Between-Person Associations
Authors: Yang Rumei , Liu Yin , Fauth Elizabeth
Published: December 2020

Physical functioning is essential for independent living and aging in place among older adults. Although older adults show a general trend of increasing functional disability, it was unclear how cancer diagnosis, which also has an increased incidence rate among older adults, may potentially aggravate the progress of functional decline at the within- and between-person levels. Using 3 waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015), the current study examined the trajectory of functional disability and associated factors over 5 years among older adults with (n = 139) and without cancer (n = 212), who were matched on key demographic characteristics. We considered four contributing factors to disability as specified in the Disablement Process model as covariates, in the context of cancer diagnosis timing at both the within- and between-person levels. These factors were psychological (i.e., depressive symptoms), physical limitations (i.e., pain, fall, and frailty), cognitive impairment (i.e., self-reported memory problems and word recall), and environmental constraints (i.e., social contact and availability of support). Consistent with the literature, there was a general trend of increasing functional disability among all participants over time. At the within-person level, although cancer diagnosis timing was associated with higher levels of functional difficulty, we found a slower increasing rate over time. At the between-person level, functional disability trajectory was not associated with cancer diagnosis timing. These findings suggest that maintenance of physical functioning should be considered at the within-person level, and personalized care is recommended for Chinese older adults with cancer.
Examining Nostalgia in Old Life: Antecedence and Outcome
Authors: Zhou Linming , Lu Minjie , Zhang Chaobin , Fung Helene
Published: December 2020

Nostalgia is a self-conscious, bittersweet but predominantly positive and fundamentally social emotion. The regulatory model of nostalgia suggests that experiencing nostalgia can buffer against social threat (e.g. social exclusion) by providing individuals with sense of social connectedness (Sedikides, et al., 2015). In the current research, we propose that this salutary effect of nostalgia may be stronger among older adults compared to younger adults because older adults value social meaningfulness to a greater extent. Fifty-nine younger adults (Mage = 20.15, SD = 0.215) and 56 older adults (Mage = 71.02, SD = 0.679) completed daily questionnaires three times a day for ten consecutive days, and reported their emotional experience and social activities. Results showed that perceiving social threat was positively correlated with nostalgia experience reported at the subsequent time point, and this association was stronger among older adults. In addition, nostalgia positively correlated with subsequent social activities among the older participants but not among the younger participants. These findings highlight that nostalgia brings beneficial psychological (sense of social connectedness) and behavioral (social engagement) outcomes to older adults.
Estimating the Frequency of Suicide Related to Driving Cessation Among Older Adults: A Data Science Approach
Authors: Ko Tomohiro , Kalesnikava Viktoryia , Mezuk Briana
Published: December 2020

Up to 35% of older adults in the United States engage in partial to complete driving cessation. Suicide risk is highest among older adults, and driving cessation can precipitate psychosocial changes linked with elevated risk of suicide, such as loss of independence, mobility, and socialization. Little is known about the association between suicide and driving cessation among older adults. We developed a supervised machine learning natural language processing algorithm to estimate the frequency of and characterize suicides associated with driving cessation from restricted-access case narratives in the National Violent Death Reporting System (NVDRS, 2003-2015) from suicides and undetermined deaths among adults 55 years and older in 27 states. Among 47,759 decedents, preliminary results identified 972 deaths associated with driving cessation, with a mean age of 71.4, 91.5% White, and 78.3% Male. 13.8% of the decedents of driving cessation-associated suicide had a crisis contributing to the suicide within 2 weeks of death. This analysis assesses the relationship between contextual geographic features such as population density and the distribution of driving cessation-associated suicides across the US. Government and clinical stakeholders should invest in public transportation infrastructure catered to older adults and implement policies to reduce the burden of driving cessation. Increased accessibility of technological innovations such as self-driving cars may also enhance quality of life for a growing older adult population.
Hearing Impairment and Risk of Depression in Older Adults in Health ABC
Authors: Powell Danielle , Betz Joshua , Yaffe Kristine , Kritchevsky Stephen , Strotmeyer Elsa , Simonsick Eleanor , Lin Frank , Deal Jennifer
Published: December 2020

Whether hearing impairment (HI) is associated with depressive symptoms remains disputed for older adults, in part due to varying definition employed, use of subjective hearing measures, or cross-sectional analysis. We studied 1936 men and women (mean age 74.1 years, 41.7% black race) enrolled in the prospective Health, Aging and Body Composition study Hearing thresholds at 500-4000 Hz were averaged to create a pure tone average (PTA) and HI was defined using clinical cutpoints in the better-hearing ear. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D) or the CES-D 10, a revised 10 question scale depending on visit. Linear mixed effects models with random intercepts and slopes were used to estimate difference in rates of change in depressive symptomatology by hearing status over nine years. Cox proportional hazard models were used to examine the association between HI and incident depression defined as change in CES-D score >=10 points. In models adjusted for demographic and clinical covariates, participants with HI demonstrated a higher baseline prevalence of depressive symptoms compared to those with normal hearing (20.7% vs. 8.4%).Rates of change did not differ by HI status. Participants with moderate or greater HI had an increased risk of 9-year incident depression (HR=1.28, 95% CI: 1.00-1.62) compared to participants with normal hearing. HI is associated with increased risk of incident depression and a greater overall prevalence of depression compared to normal hearing, underscoring the importance of further research on whether rehabilitative therapies can mitigate this association.
Psychiatric History and Trajectories of Cognitive Change Predict Risk of Nursing Home Residence
Authors: Brown Maria , Mutambudzi Miriam
Published: December 2020

Previous research indicates that a history of psychiatric, emotional or nervous problems can affect cognitive function at age 65 and cognitive trajectories over time. To explore the potential impact of this relationship on nursing home use, we applied latent class growth curve models to five waves (1998-2008) of Health and Retirement Study data to identify four classes of cognition trajectories, defined by baseline cognitive function scores (low, medium, high) and rate of change (stable or declining). We then ran survival analyses using HRS years 2008 to 2016 to determine risk of nursing home residence based on psychiatric history and cognition trajectory class. We hypothesized that self-reported history of psychiatric, emotional or nervous problems will be associated with greater risk of nursing home residence, and that self-reported history of psychiatric, emotional and nervous problems will interact with cognition trajectories to predict level of risk of nursing home residence. Results indicate that psychiatric history is independently associated with greater risk of nursing home residence, net the effects of a variety of life course variables in the model. Further, psychiatric history interacts with “low cognition declining” and “medium cognition declining” trajectories to increase the risk of nursing home residence. Evidence of the relationship between psychiatric history, cognitive decline, and nursing home residence can be used to enhance public understanding of the impact psychiatric history has on the long-term care system, and to educate policy-makers and providers about the need for appropriate psychiatric training for staff in community-based and residential long term care programs.
Polysomnographic Sleep Is Associated With Time to Develop Dementia: A Study Using 19-Year VA National EHR Data
Authors: Nowakowski Sara , Razjouyan Javad , Sharafkhaneh Amir , Kunik Mark , Naik Aanand
Published: December 2020

Few studies have longitudinally investigated the association between objectively measured sleep and time to develop dementia. This study leverages polysomnography (PSG) sleep data extracted from the VA national electronic health records (VA-EHR) to assess the association between sleep and time to develop dementia. We identified 61,165 PSG reports from the VA-EHR from 2000 to 2019 using CPT codes. Patients who developed dementia were identified using all-cause dementia ICD-9/10 codes documented on two separate visits starting one year after the PSG study until the end of 2019 in a 1-year sliding period (n=1,534). Using the first appearance of ICD-9/10 code as dementia onset time, patients were clustered into 3 groups of early-, mid-, and late time to develop dementia (mean = 2.7, 7.5, 12.8 years, respectively). Natural language processing was used to extract sleep efficiency (SE) and sleep onset latency (SOL). Univariate analysis was used to compare the groups. After adjusting for age, SE was significantly higher in the late (76%) vs early (69%) group and SOL was significantly shorter in late (21m) versus early (33m) group. SE was higher and SOL was shorter in patients who developed dementia later compared to those who developed dementia earlier. Greater sleep continuity in late dementia onset group suggests that sleep may be a modifiable risk factor that could potentially delay the onset of dementia.
Disparities in EOL Care by Dementia Status and Race
Authors: Reinhardt Joann
Published: December 2020

Prior research shows that minority and dementia status are associated with suboptimal end-of-life (EOL) care quality; care that is more aggressive, invasive, and futile. We conducted a retrospective study of EOL care for 300 decedents of varied race/ethnicity in a skilled nursing facility. The purpose of this secondary analysis was to test whether the EOL experience (medical orders in place, treatments, distressing symptoms, discussions with providers) differed by dementia status for different race/ethnic groups (Black, White, Hispanic). Chi-square tests were used to examine the relation between these four sets of EOL variables and dementia status (yes/no) separately for the three groups. Findings showed that for White decedents, PWD were less likely to have had a DNR or a DNI discussion with a provider in the nursing home. Also for White decedents, PWD were less likely to have had shortness of breath or pain. For Black decedents, PWD were more likely to have a DNR order. Also, for Black decedents, PWD were less likely to have been hospitalized. For Hispanic decedents, EOL variables and dementia status were not significantly associated. Overall, findings showed differences by race/ethnic groups in EOL experience based on dementia status. Black decedents with dementia were more likely to have escaped the acute care default. Findings for White decedents with dementia were mixed for aggressive versus comfort care. The EOL experience did not differ by dementia status for Hispanic decedents. Thus, efforts to promote positive EOL care for persons with dementia need to account for differences by race/ethnicity.
Social Integration and Risk of Dementia Among Older Adults
Authors: Zhang Yan , Shen Shannon , Yang Yulin
Published: December 2020

We examine the relationship between social integration and cognitive impairment and dementia among older adults using longitudinal data from Waves 1-8 of the National Health and Aging Trends Study (NHATS). The sample includes 7,492 respondents age 65 and older at baseline. We test multidimensional measures of social integration and cognitive well-being using discrete-time hazard models. The risk of dementia is calculated by a series of performance-based tests. Measures include levels of dementia: no dementia, cognitive impairment not dementia (CIND), and dementia, and three domains of cognition functioning: orientation, executive function, and memory. Social integration is an additive index measured by several questions, including marital status, living arrangement, social network, social contact, and social participation. Our results indicate that people with higher social integration have a lower risk of both cognitive impairment (not dementia) and dementia compared to those with lower social integration. This pattern continued across specific domains of cognitive functioning, including lower risk of orientation impairment, executive function impairment, and memory impairment for those with higher social integration. Tests of both gender and racial interactions did not yield any significant differences. Our findings demonstrate the strong association between social integration and lower risk of dementia among older adults. This study can speak to policy makers as the life expectancy of Americans increases and the aging population grows, highlighting the importance of giving support to older adults who are lack of social connectedness.
Who Wants to Be Alone? Antecedents of Motivation for Solitude in Adulthood
Authors: Yuan Jing , Grühn Daniel
Published: December 2020

Objectives: As an inevitable part of daily life, solitude has both positive and negative consequences which are moderated by one’s motivation for solitude. Self-determined motivation correlates with few psychological risks, whereas other-determined motivation correlates with higher risks (e.g., loneliness, depression, lower well-being). However, little is known about the antecedents of different motivations for solitude. The purpose of this study is to investigate the antecedents of motivation for solitude in a sample with younger, middle-aged, and older adults. Methods: We recruited 468 participants from Amazon Mechanical Turk and Introduction to Psychology class (age range: 17-70, M = 30.7, 50.4 % females). Preference and motivation for solitude were measured with the Preference for Solitude Scale and Motivation for Solitude Scale-Short Form. Age, sex, marital status, education level, living arrangement, instrumental activities of daily living (IADLs), civic engagement, social contact frequency, introversion, and empathy were measured as antecedents. Results: People with older age, higher empathy for fictional characters, lower personal distress, higher introversion, and females tended to have higher general preference for solitude. People with higher empathy for fictional characters tended to have higher self-determined motivation. People with higher empathy for fictional characters, lower empathic concern, higher personal distress, higher IADLs, and higher introversion were more likely to have higher other-determined motivation. Discussion: A person with an introverted personality, functional limitation, more negative empathic reactions towards others are likely to have maladaptive motivation for solitude and may need intervention. Future research should further investigate other antecedents for self-determined motivation.
Suicidal Ideation in Dementia Family Caregivers
Authors: Puga Frank , Wang Danny , Pickering Carolyn
Published: December 2020

Family caregivers of individuals living with Alzheimer’s disease or related dementias (ADRDs) are exposed to unique stressors that put them at risk for depression and suicidal ideation. To date, little is known about contextual factors surrounding suicidal ideation among ADRD family caregivers. We investigated individual caregiver characteristics (gender, age, relationship to care-recipient, history of depression and anxiety) and daily environmental stressors (behavioral symptoms of dementias; BSDs) associated with daily suicidal ideation using a micro-longitudinal design and ecological momentary assessment methods. Data were collected from a national sample of family caregivers (N=51) who completed daily diaries over 21 days (n=911). Suicidal ideation was endorsed on forty-seven days (5.16%) during the sampling period, with 11 participants (22%) endorsing suicidal ideation at least once. Suicidal ideation did not differ based on the caregiver’s age and relationship to the care-recipient (spouse or child). Participants with a history of mild depression and anxiety endorsed more days with suicidal ideation. Finally, family caregivers were more likely to endorse suicidal ideation on a day when more than one type of BSD was reported (OR = 1.25, 95% CI: 1.04-1.50, p = 0.018) and when BSDs were perceived as more bothersome than average (OR = 1.12, 95% CI: 1.05-1.19, p < 0.001). In this investigation, we identified descriptive and predictive factors that will inform the development of targeted interventions for ADRD caregivers at high risk of suicidal ideation.
Neighborhood Disadvantage, Cognition, and Health Self-Efficacy of Older Adults in a Clinical Population
Authors: Berg Kristen , Krieger Nikolas I , Einstadter Douglas , Shamakian Lorella , Dalton Jarrod , Perzynski Adam
Published: December 2020

The Medicare Annual Wellness Visit (MWV) includes an assessment of health risks for older adults in the United States. Research suggests that neighborhood-level social inequality influences multiple health outcomes. We sought to examine the association between neighborhood socioeconomic position and older adults’ cognition, health management self-efficacy, and other health risks. We identified a cohort of 12,434 adults aged 65 and over from the NEOCARE Learning Health Registry who attended a routine MWV between 2011 and 2019. NEOCARE includes electronic health record and neighborhood data from 1999-2017 on over 3 million unique Northeast Ohio individuals. The study population was 60% White, 32% Black or African American, 64% female, and 90% non-Hispanic. Over 60% were ages 65-74, 29% 75-84, and 10% 85 years or older (range from 65 to 101). We used ANOVA and chi square tests to examine variation in health risks by quintile of census tract area deprivation index. Cognitive functioning differed across quintiles of area deprivation and Bonferroni-corrected tests indicated that adults in the most socioeconomically disadvantaged neighborhoods had lower average cognitive screening scores as compared to older adults in less disadvantaged areas (F=53.50, df=4, n=12,204, p<.001). The proportion of adults feeling efficacious in managing their health differed according to area deprivation, with adults in more disadvantaged neighborhoods having slightly lower self-efficacy, (x2=11.01, df=8, n=11,937, p<.001). Better understanding of the relationship between cognitive functioning and health self-efficacy and neighborhood environment is critical for designing programmatic and policy interventions aimed at supporting proactive aging in older adulthood.
Hearing and Cognitively Impaired Life Expectancies in the United States
Authors: West Jessica , Lynch Scott
Published: December 2020

As the population ages, increased prevalence of cognitive and sensory impairments may pose growing public health challenges. Among the nine modifiable risk factors for dementia, the highest percentage (9%) of dementia cases are attributed to hearing impairment. While much research has examined the relationship between hearing impairment and cognition, almost none has translated these relationships into a meaningful, life course metric: how many years of life individuals can expect to live with both impairments and how hearing impairment affects years lived with cognitive impairment. Our study fills this gap by using Bayesian multistate life table methods applied to nine waves of the Health and Retirement Study (1998-2014) to estimate years of life to be spent (1) with/without hearing and cognitive impairment, and (2) with/without cognitive impairment, conditional on having versus not having hearing impairment. Preliminary results for aim 1 reveal that at age 50, individuals will live 18.9 (18.7-19.2) years healthy, 4.3 (4.2-4.5) years hearing impaired but cognitively intact, 4.2 (4.0-4.3) years hearing unimpaired but cognitively impaired, and 2.3 (2.2-2.6) years with both impairments. Women will spend more years healthy, hearing unimpaired but cognitively impaired, or with both impairments; men will spend more years hearing impaired but cognitively intact. People with more education will spend more years hearing impaired but cognitively intact; people with less education will spend more years hearing unimpaired but cognitively impaired or with both impairments. Our study is one of the first to investigate the implications of hearing impairment for years of cognitively impaired life.
Intergenerational Communication as Non-Pharmacological Care in a Japanese Nursing Home
Authors: Hamaguchi Toshiko
Published: December 2020

Statistics shows that Japan now has 28.4% of population aged over 65, which marks the highest in the world. Moreover, one in four over 65 is said to have ADRD or MCI. Traditional family caregiving derived from filial piety is giving way to moving to care facilities in order to reduce a burden on children or get professional care. This suggests that everyday communication for older adults involves younger conversational partners with varying degrees of shared knowledge and experiences. Such intergenerational communication can be challenging and stressful on both sides. To date, empirical studies that observe interactional strategies of both younger caregivers and older adults is unknown. Using 21 recordings of weekly conversational activities (45-60 minutes) led by recreation workers (female, 40s) taken at a nursing home in Japan, this qualitative study demonstrates how (1) sharing of the past and present becomes a learning opportunity for both recreation workers and older participants with ADRD (aged 87-95) , (2) reference to nursing-home living establishes and reaffirms their interpersonal relationship, and (3) intergenerational conversation becomes a tool to express life satisfaction for the older participants. This evidence-based study proposes mundane conversations during recreational activities as part of non-pharmacological person-centered care which serves to improve the quality of life and life satisfaction of older adults at care facilities. It is therefore important to study communicative strategies of professional caregivers since they affect social engagement as well as emotional and psychological well-being of those at the end-of-life stage.
Factors Associated with Frailty Status in Relatively Healthy Community-Dwelling Older Adults
Authors: Ekram A R M Saifuddin , Ryan Joanne , Espinoza Sara , Murray Anne , Ernst Michael , Woods Robyn
Published: December 2020

Frailty is gaining importance as a predictor of disability and mortality in older people, and becoming frail poses a challenge for healthy aging. We investigated the prevalence and factors associated with pre-frail and frail status in a large study cohort of community-dwelling healthy older adults from Australia and the United States. A total of 19,114 individuals (87% Australian and 56% women) aged 65 years or older enrolled in a primary prevention clinical trial were evaluated. Frailty status was classified using the modified Fried phenotype criteria comprising of exhaustion, body mass index, grip strength, gait speed and physical activity. Prevalence and factors associated with frailty status (e.g. demographic characteristics and lifestyle factors) were reported using descriptive statistics along with a logistic regression model. At baseline, 2.3 % (95% CI, 2.1-2.5) of older trial participants were frail and 39.2% (95% CI, 38.5-39.9) were pre-frail, respectively. Women were more likely to be frail (65.1% vs 36.9%) and prefrail (58.0% vs 42.0%) than men. Lower levels of education (<12 years), living alone, ethnic minorities, current smoking and past alcohol use were some of the factors which were common among frail or prefrail. Despite being a relatively healthy cohort, more than one-third of the older trial participants were pre-frail, which was more prevalent among specific subgroups of individuals. This study emphasizes the high burden of the prefrailty status even among an apparently healthy cohort of community-dwelling older people.
Obstacle negotiation in older adults: prefrontal activation interpreted through conceptual models of brain aging
Authors: Clark David , Chatterjee Sudeshna , Seidler Rachael , Skinner Jared , Rose Dorian , Lysne Paige , Woods Adam
Published: December 2020

Age-related decline in executive function is associated with walking deficits in older adults. The main objective of this study was to better understand the cognitive control of obstacle negotiation in older adults by identifying predictors of prefrontal recruitment during the task. The study also examined the association between prefrontal recruitment and walking performance as well as interpretation of prefrontal activity relative to cognitive models of brain aging. Prefrontal oxygenated hemoglobin concentration (O2Hb) was measured by functional near-infrared spectroscopy during typical walking (Typical) and obstacle negotiation (Obstacles) tasks in older adults. The primary outcome was change in prefrontal recruitment (∆PFR), measured as Obstacles ∆O2Hb minus Typical ∆O2Hb. Stepwise regression was used to identify potential predictors of ∆PFR. Additional analyses were conducted to further examine the relationship between ΔPFR and the identified predictors. Greater ∆PFR was predicted by lower age, worse executive function, and their interaction (R2=0.19 , p=0.02). Particularly, the effect of executive function on ∆PFR was more pronounced for “early aging” than for “late aging” older adults (p<0.001). Greater ∆PFR was significantly associated with a smaller reduction in walking speed during Obstacles compared to Typical. In conclusion, age, executive function, and their interaction predict prefrontal recruitment during obstacle negotiation in older adults. These findings are generally consistent with existing cognitive models of brain aging including neural inefficiency, compensatory overactivation, and capacity-limitation with a recruitment ceiling effect.
Restricted Mean Survival Time in Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure
Authors: Shi Sandra , Wei Lee-Jen , Kim Dae
Published: December 2020

Background: Restricted mean survival time (RMST) provides mean time lost or gained by an intervention. This may be a more intuitive way to understand treatment effect. Objective: To determine overall and subgroup treatment effects from blood pressure targets in older adults with diabetes. Methods: We analyzed the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial data. Our outcome was cardiovascular disease free survival. We measured 5-year RMST (days) between standard and intensive blood pressure control, and compared the difference by age (≥70 or <70 years old) and glycemic control (standard vs. intensive). Results: Over 5 years, those with intensive treatment lived, on average, 1716 days compared to 1714 days with standard treatment, with a RMST difference of 1.3 days (95% confidence interval, -22.1, 12.4). Among adults ≥70 years old, compared to standard treatment, intensive treatment resulted in an additional 13.6 (95% CI, -43.2, 70.3) days, where the difference was -0.5 (-20.8, 19.7) days for those aged <70 years old (p-for-interaction=0.673). Compared to standard treatment, intensive treatment resulted in 28.1 (0.4, 55.9) more days for those assigned to standard glycemic control, but it appeared to result in 25.2 fewer days (-52.3, 1.9) for those assigned to intensive glycemic control (p-for-interaction=0.007). Discussion: The benefit of intensive treatment over standard treatment varies by age and glycemic control. RMST difference may allow for more intuitive and personalized weighing of benefits and risks of intensive blood pressure control.
Thalamic Volume Mediates Associations Between Cardiorespiratory Fitness and Memory in People With Parkinson’s
Authors: Petkus Andrew , Gomez Megan , Schiehser Dawn , Filoteo Vincent , Hui Jennifer , Jarrahi Behnaz , McEwen Sarah , Petzinger Giselle
Published: December 2020

Cognitive deficits occur in patients with Parkinson’s disease (PD), and cardiorespiratory fitness (CRF) is associated with both current and future cognitive decline in this disease. The underlying neurobiological factors explaining this relationship, however, are not well known. In this cross-sectional study we examined the associations between CRF and cognitive performance and whether such associations were mediated by grey matter volumes of basal ganglia structures. A total of 33 individuals with PD underwent structural magnetic resonance imaging (sMRI), CRF evaluation (VO2max), and neuropsychological assessment. Composite scores of episodic memory, executive functioning, attention, language, and visuospatial functioning were generated. Brain MRI morphological measurements was performed with the Freesurfer image analysis suite. Structural equation models were constructed to examine whether sMRI volume estimates of basal ganglia structures, specifically the thalamus and pallidum, mediated associations between VO2 max and cognitive performance while adjusting for age, education, PD disease duration, sex, and intracranial volume. Higher VO2max was associated with better episodic memory (Standardized β=0.390; p=0.009), executive functioning (Standardized β=0.263; p=0.021), and visuospatial performance (β=0.408; p=0.004). Higher VO2max was associated with larger thalamic (Standardized β=0.602; p<0.001) and pallidum (Standardized β=0.539; p<0.001) volumes. Thalamic volume significantly mediated the association between higher VO2max and better episodic memory (indirect effect=0.209) and visuospatial ability (indirect effect=0.178) performance (p<.05). The pallidum did not significantly mediate associations between VO2 max and cognitive outcomes. These results suggest the thalamus plays an important role in the association between CRF episodic memory and visuospatial functioning in individuals with PD.
The Role of Attentional Control in Attention to Emotional Stimuli Among Middle-Aged and Older Adults
Authors: Ho Yuen Wan , Isaacowitz Derek
Published: December 2020

Prior studies have examined age differences in attention to emotional stimuli; in the current study, we considered how this might relate to dispositional measures of attentional control across age groups. Participants were 116 middle-aged (aged 35 – 64 years) and 39 older (aged 65-86 years) adults in the United States. In the study, participants filled in the Emotional Attentional Control Scale. Then participants watched fearful, happy, neutral, and disgusting videos. The gaze time for each video was measured by an eye tracker. Results did not show significant age difference in attention to happy and neutral videos. However, middle-aged adults gazed relatively more to the disgusting video and relatively less to the fearful video, t (115) =2.16, p =.03. The opposite pattern was found among older adults, t (38) =5.85, p<.001. Self-reported emotional attentional control was not significantly related to attention in either age group. These findings suggest that different stimuli may yield age differences in fixation that are a less consistent pattern with the age-related positivity effect reported in previous studies, and also that self-reported emotional attentional control may not relate to gaze patterns.
Cumulative Adversity and Depressive Symptoms: Optimism as a Moderator
Authors: Dong Gabriella , Li Mengting
Published: December 2020

Older immigrants encountered a wide range of traumatic events across the life span, before and after immigration, in the origin and host countries. Prior studies have shown that traumatic events were associated with depression, but less is known about what are the resilience factors against depression related to traumatic events. Optimism is one of resilience assets reflecting the extent to which people hold generalized favorable expectancies for their future. This study aims to examine whether optimism could moderate the negative impact of exposure to natural disasters, traumatic personal events, and historical events on depressive symptoms. The data were drawn from the Population Study of Chinese Elderly in Chicago (PINE) in 2017-2019, with a sample size of 3,125. Traumatic life events were evaluated by natural disasters (typhoon, earthquake, and tornado), personal events (e.g. death of a loved one, physical assault) and historical events (e.g. Japanese invasion of China). Depressive symptoms were measured by PHQ-9. Optimism was assessed by Revised Life Orientation test. Linear regression with interaction terms was used. Older adults with one additional exposure to natural disaster (b=0.34, SE=0.07, p <.001), personal event (b=0.32, SE=0.05, p <.001), and historical event (b=0.14, SE=0.04, p <.001) were associated with higher depressive symptoms. Optimism could buffer the negative impacts of natural disasters (b=-0.03, SE=0.01, p <.05), personal events (b=-0.05, SE=0.01, p <.001), and historical events (b=-0.02, SE=0.01, p <.01) on depressive symptoms. Psychological interventions are suggested to increase optimism of older adults with exposure to lifetime traumatic events to reduce their depressive symptoms.
Racial Disparities in Cognitive Function: The Roles of Cumulative Stress Exposures Across the Life Course
Authors: Chen Ruijia , Weuve Jennifer , Kubzansky Laura , Williams David
Published: December 2020

Introduction: Racial disparities in cognitive function have been well-documented in the literature, but factors driving the disparities remain under explored. This study aims to quantify the extent to which cumulative stress exposures across the life course explain Black–White disparities in executive function and episodic memory. Method: Data were drawn from the 2004–2006 wave of the Midlife Development in the United States (MIDUS) and the MIDUS refresher study (N=5,967, 5,277 White, 690 Black). Cumulative stress exposures were assessed by using 10 domains of stressors (e.g., financial stress, childhood adversity). Cognitive function was assessed using the Brief Test of Adult Cognition by Telephone. Marginal structural models were conducted to quantify the proportion of the effect of race/ethnicity status on cognitive function that can be explained by cumulative stress exposures. Result: Blacks reported higher levels of cumulative stress exposures and lower average levels of executive function and episodic memory than Whites. Cumulative stress exposures explained 8.43% of the disparities in executive function and 13.21 % of the disparities in episodic memory. Cumulative stress exposures had stronger effects on racial disparities in cognitive function in the older age group (age≥ 55 years old) than in the younger age group (age < 55 years old). Conclusion: Cumulative stress exposures explain modest proportions of racial disparities in levels of cognitive function. Interventions that focus on reducing stress exposures or improving coping resources among Blacks may help lessen racial disparities in cognitive function at the population level.
Evaluating the International Classification of Functioning, Health, and Disability Model as an Aging Model
Authors: Li Qiwei , Knight Becky
Published: December 2020

The study provides a possible theoretical framework for future aging studies focusing on a comprehensive understanding of the relationship between physical functions, social participation, and context factors including environmental and personal variables. The International Classification of Functioning, Health, and Disability (ICF) model has received considerable studies in rehabilitation counseling fields as it bridges the gap between functional limitations and overall health status for social participation. The ICF model focuses beyond physical conditions and embraces social supports and personal coping styles. This study verifies the validity of the ICF model with a data set collected from a fall prevention program. For the methods, a structural equation modeling was estimated with latent variables including body structure, body functions, activities, and personal factors. The latent variables were suggested by the ICF framework. The results showed that the estimation outcome exhibited an acceptable goodness of fit, χ2(11) = 30.401, p = .001 (due to the large sample size of 691), RMSEA= .051 [.030, .072], CFI = .968, TLI = .919, SRMR = .029. The equation level good of fit also was great with an overall R squared of .828. In conclusion, the ICF model was valid and has been tested in the aging studies with the data set collected from a fall prevention program for older adults. As the ICF model includes more variables than medical models such as personal attributions, a holistic understanding regarding aging experience among older adults from various backgrounds will become possible, which is an urgent need for diverse America.
Grandparent Resilience: Improving Self-Efficacy in Grandparents Raising Grandchildren
Authors: Fox Aimee , Riggs Nathaniel , Yancura Loriena , Fruhauf Christine
Published: December 2020

Grandparents often protect against childhood trauma and promote resilience through their nurturance, love, and support when raising grandchildren. Despite the beneficial role grandparents have on their grandchildren, grandparents may experience challenges of their own, including physical, mental, and emotional health issues, lack of resources, and social isolation. Few interventions exist to help grandparents successfully adapt to the challenges they face as primary parenting figures. The purpose of this study was to test preliminary efficacy of a strengths-based intervention for grandparents raising grandchildren aimed at increasing self-care behaviors, managing emotions, and connecting to community resources. Grandparents (N = 137) providing primary care to grandchildren were recruited to participate in a single-group, pre- and post-test design, 6-week intervention. Self-efficacy was assessed at baseline, post-intervention, and at a 6-month follow-up. To evaluate who the intervention might be most beneficial for, grandparents’ service knowledge, perceived support from others, and length of care provided, measured at baseline, were analyzed for moderating effects. Results of paired-samples t-tests reveal significant increases in self-efficacy (p = .013) from baseline to post-test, which were maintained at the 6-month follow-up (p = .010). Hierarchical multiple regression showed interaction effects of the hypothesized moderators were not significant, indicating improvements in self-efficacy regardless of individual variability at baseline. As demonstrated, interventions can be effective at increasing self-efficacy in grandparents raising grandchildren and strengths-based approaches have the potential to provide universal benefits to grandparents, thus improving functioning in grandfamilies and promoting the health and well-being of grandparents and their grandchildren.
Caring for Dying Parents in the Shadow of Childhood Maltreatment: Gendered Agency, Constraint, and Health
Authors: Tarter Robin , Hassouneh Dena , Rosenkranz Susan
Published: December 2020

Adult daughters represent the largest and fastest growing population of providers of unpaid care labor (UCL) to older adults with life limiting illness. Providing UCL to parents at the end of life is associated with significant and lasting risks of morbidity and mortality, especially for women with negative relationships with care recipients, and those who provide UCL based on constraining gendered expectations rather than agentic choice. While nearly one quarter of US women experience some form of maltreatment from parents during childhood, few studies have examined, or even acknowledged, the effect of trauma on the experience and health impact of family UCL. We used feminist poststructuralist informed dialogic narrative analysis to explore discursive constructions of agency and constraint in co-constructed life histories from 21 women who provided end of life UCL to older adult parents who maltreated them in childhood. For these women, parental childhood maltreatment influenced identity construction, social position, intersubjectivity, and vulnerability to victimization. For some, providing end-of-life UCL to the parents who maltreated them facilitated the mobilization of relational agency and identity validation. For others, providing UCL potentiated lifelong constraint, reinforcing their positions as non-agents and leading to significant psychical and emotional harm. End of life UCL for older adult parents represents a crucible out of which either healing or re-traumatization can arise. Our findings will be leveraged to inform clinical practice and policy to support the growing population women trauma survivors providing UCL to older adult parents, reducing negative outcomes for those at the greatest risk.