bluuebunny/crossref_metadata_2025 huggingface dataset:
OUTCOMES OF DISCONTINUING CHOLINESTERASE INHIBITORS IN NURSING HOME RESIDENTS WITH SEVERE DEMENTIA
Authors: Niznik Joshua D , Zhao Xinhua , He Meiqi , Aspinall Sherrie , Hanlon Joseph , Nace David , Thorpe Joshua , Thorpe Carolyn
Published: November 2019

Some clinical guidelines advocate for the withdrawal of cholinesterase inhibitors (ChEIs) in patients with severe dementia. However, there have been no studies of the outcomes of deprescribing ChEIs specifically in patients with severe dementia, and concerns about subsequent worsening of behavioral symptoms may serve as a barrier to ChEI discontinuation. Our objective was to evaluate the impact of deprescribing ChEIs on aggressive behaviors and depression severity in older nursing home (NH) residents with severe dementia. We conducted a retrospective cohort study using Medicare claims, Part D prescriptions, Minimum Data Set (MDS) v3.0, Area Health Resource File, and Nursing Home Compare, for non-skilled NH residents aged 65+ with severe dementia receiving AChEIs with ≥2 MDS assessments in 2016 (n=30,788). The Aggressive Behavior Scale (ABS) and the Patient Health Questionnaire (PHQ-9) evaluated aggression and depression, respectively. Marginal structural models with inverse probability of treatment weights evaluated the association of deprescribing with outcomes, accounting for time-dependent confounding. The sample was primarily white (78.7%), female (76.6%), >80 years old (77.6%), and 22.8% were deprescribed ChEIs. In adjusted models, deprescribing was not associated with aggression (0.002 point increase in ABS, p=0.90) or depression (0.04 point increase in PHQ-9, p=0.50). Deprescribing ChEIs in NH residents with severe dementia did not lead to an increase in aggressive behaviors or depression severity. Our findings provide insight into the potential risks and benefits associated with deprescribing ChEIs and help inform decision-making in patients with severe dementia.
THE IMPACT OF A PLANT-BASED DIETARY PATTERN ON DEMENTIA RISK: A PROSPECTIVE COHORT STUDY.
Authors: Lin Ming-Nan , Chiu Tina H , Chang Chiao-Erh , Lin Ming-Nan
Published: November 2019

High antioxidants and phytochemicals from plant foods may protect against cognitive decline, while saturated fats from animal based foods considered as risk factors have been associated with dementia. Plant-based diets with limited animal products have been shown to improve glycemic control and reduce diabetes risk. The study aims to examine the association between vegetarian diet and dementia risk in a prospective cohort study. Quantitative data collected from 12,062 participants of Tzu Chi Vegetarian Study from 2005 to 2014 in Taiwan. Data included self-administered questionnaire on demographics, medical history, life-style, and a 57-item food frequency questionnaire (FFQ), National Health Insurance Database and the National Death Registry. Findings show that compared with non-vegetarians, vegetarians had 38% lower risk of dementia (HR = 0.62, 95% CI = 0.39, 0.98) after adjusting for age, sex, education, marital status, physical activities, smoking, alcohol drinking, hypertension, diabetes, hyperlipidemia, and ischemic heart diseases.
HOME ALONE REVISITED: FAMILY CAREGIVERS PROVIDING COMPLEX CARE
Authors: Reinhard Susan
Published: November 2019

In 2012, the Home Alone report brought to light the 46 percent of family caregivers that perform complex medical/nursing tasks. This presentation highlights new research conducted as part of a second Home Alone study to look closer at the family caregivers who perform these complex tasks with a specific focus on key medical/nursing tasks, including incontinence care, special diets, as well as certain sub-populations (e.g., multicultural communities, men, Millennials). An analysis of the increasing complexity of the challenges facing family caregivers who perform medical/nursing tasks in addition to assisting with instrumental activities of daily living and activities of daily living, will be shared. Presenters will also discuss its findings and the implications for individuals, their family caregivers and the healthcare providers who work with them.
NIH PATHWAYS TO PREVENTION WORKSHOP: RESEARCH GAPS FOR LONG-TERM DRUG THERAPIES FOR FRACTURE PREVENTION
Authors: Joseph Lyndon , Chen Faye
Published: November 2019

The NIH Pathways to Prevention Workshop was held on October 30-31, 2018 to present scientific evidence, as well as physician and patient perspectives to better understand the benefits and harms of drug therapies for osteoporosis fracture prevention. Osteoporotic fractures lead to substantial morbidity, mortality, and economic costs. The underlying medical condition, is a skeletal disorder characterized by compromised bone strength predisposing to increased fracture risk. Several medications approved by the U.S. Food and Drug Administration to prevent osteoporotic fractures have been effective when taken by people who are at high risk of fracture. These include bisphosphonates , denosumab, teriparatide, estrogens, and selective estrogen-receptor modulators. However, rare but serious adverse events, such as atypical femoral fractures and osteonecrosis of the jaw associated with bisphosphonates have raised questions regarding the safety of their use. There is limited evidence on the benefits and harms of long-term osteoporosis drug therapy, including the timing and duration of drug discontinuation or drug holidays. It is not clearly known which patients will benefit or may be harmed from continued drug intervention, who should and should not be put on drug holiday, how to identify such patients and properly treat them, and how to predict their outcomes. Key scientific areas covered by the workshop included: the benefits and risks of osteoporotic drugs with short-term and long-term use and factors that influence outcomes; the impact of drug discontinuation and drug holidays on outcomes; and patient and clinician factors that impact the use of and adherence to osteoporotic drugs.
REPORT ON SYSTEMATIC EVIDENCE REVIEW
Authors: Fink Howard
Published: November 2019

During the workshop, results from a systematic evidence review prepared by an Agency for Healthcare Research and Quality Evidence-based Practice Center to inform the workshop were presented, focusing on long term osteoporosis drug treatment. This talk will describe the goals of the systematic review, which addressed four questions: (1) What are the effects of long-term (>3 years) osteoporosis drug treatment versus control on risks of incident fractures and harms; (2) Do effects of long-term osteoporosis drug treatment vary as a function of patient, bone, or osteoporosis drug characteristics; (3) Among individuals receiving osteoporosis drug treatment to prevent fracture, what are the benefits and harms of continuing versus discontinuing treatment (e.g., osteoporosis drug holiday); and (4) Do outcomes of drug discontinuation or drug holidays vary as a function of patient, bone, or osteoporosis drug characteristics?
UTILIZING TECHNOLOGY NETWORKS TO SUPPORT SOCIAL NETWORKS FOR PEOPLE AGING WITH DISABILITY
Authors: Remillard Elena T , Rogers Wendy , Ruiz Sarah
Published: November 2019

A growing number of new smart, internet-enabled technologies from smart phone applications, to teleconferencing, to the Internet of Things (IoT), provide great promise and potential to support successful aging-in-place for people with long-term disabilities. This symposium highlights ongoing research at the TechSAge Rehabilitation Engineering Research Center to identify technology needs and develop/adapt new technologies to promote independence, health, and participation of this population. To understand user needs, Harris et al. will present findings from a large-scale interview study with older adults with long-term vision and mobility disabilities (N=120) that explored specific task-based challenges with community activities (e.g., going to entertainment events, volunteering) as well as solutions and strategies to overcome them. Koon et al. will present findings on perceived facilitators and barriers to using digital assistants (e.g., Amazon Alexa) to facilitate a variety of everyday tasks at home, from shopping to communicating with others, among adults aging with mobility disabilities. Levy et al. will discuss findings from research driving the creation of augmented reality tools that can enable individuals to experience how IoT devices, such as smart thermostats and lightbulbs, could be used within the context of one’s own abilities and home. Mitzner et al., will describe the development of a Tele Tai Chi intervention for older adults with long-term mobility disabilities that employs teleconferencing software to translate an in-person, evidence-based class to an online, social experience. TechSAge Program Officer, Sarah Ruiz (National Institute on Disability, Independent Living, and Rehabilitation Research), will serve as the discussant.
PURSUING AGE-FRIENDLY UNIVERSITY PRINCIPLES AT A MAJOR UNIVERSITY: LESSONS IN GRASSROOTS ORGANIZING
Authors: Luz Clare C
Published: November 2019

Rapid population aging presents opportunities for higher education to address major aging-related public issues facing society that have a direct impact on students, faculty, and both local and global communities. Students in virtually all disciplines will be working within the context of an aging society post-graduation and need to be prepared as they make career choices and enter the workforce. Further, faculty and staff are not only aging themselves but may be caregivers, which has an impact on health, income and productivity. Michigan State University (MSU) is now addressing these needs through a new program guided by Age-Friendly University (AFU) principles called AgeAlive that grew out of five years of grassroots organizing. Large-scale, research-intensive institutions present special challenges to pursuing AFU status but the lessons learned by AgeAlive may help any organization that wishes to become more age friendly. This session will review AgeAlive’s path to a recognized program with a clear vision, a strategic plan, two crosscutting goals including AFU designation, and five focus areas with initiatives in each area. Tools to help achieve these goals include an inventory of aging-related activity on campus and a virtual hub for networking and information exchange. Key steps in the program development process will be described as will recommendations related to choosing a model, cultivating champions, making decisions based on data, and building infrastructure. It will allow others to understand what challenges they may face and potential approaches to minimizing and overcoming these challenges in their own AFU journey.
RURALITY, ALCOHOL, AND OPIOID USE AS PRECURSOR TO ELDER ABUSE
Authors: Zanjani Faika
Published: November 2019

Pain, alcohol, and opioid risk management is an increasingly important issue in the care of the older adult population. Older adults are at higher risk for pain and the negative outcomes associated with opioid and alcohol use due to higher prevalence of multimorbidity, polypharmacy, and the age-associated changes in metabolism and elimination. Evidence-based approaches for pain and substance use management exist and are effective for older adults, but underutilized and have limited availability in rural areas. Therein, undermanagement of pain and substance use becomes a risk factor for elder abuse. Improved dissemination and implementation in practice, as well as training for health professionals and the community is needed to better realize and prevent negative health outcomes from pain, alcohol, and opioid use. Community education and training tools for health professionals will be discussed, with suggestions for community initiatives to address pain, alcohol, and opioid risk management to prevent elder abuse.
GENDER-SPECIFIC APPROACHES TO HEALTHY AGING WITH HIV
Authors: Taylor Tonya N , Finkelstein Ruth
Published: November 2019

Older adults with HIV (OAH) evidence a significant burden of disease, characterized by high frequencies of non-HIV related comorbidities that result in multimorbidity and polypharmacy decades earlier than non-HIV infected older adults. Commonly observed comorbidities among OAH 50 years and older include cardiovascular disease, hypertension, diabetes, osteoporosis, and cancers. Geriatric conditions such as frailty, functional impairment, chronic inflammation, and cognitive dysfunction are also prevalent. Poverty, unemployment, housing, and food insecurity, as well as stigma-driven discrimination, persistent social isolation and high rates of depression, can make health-related challenges associated with aging overwhelming, resulting in a diminished capacity for self-care. Older men and women with HIV; however, are aging differently due to gender-specific differences in comorbidity profiles, polypharmacy burden, social networks, and intersectional stigmas (HIV/AIDS, ageism, racism, sexism, classism, homophobia, and transphobia). This symposium explores the impact of gender on healthy aging among OAH. Dr. Brennan-Ing and colleagues describe specific strategies for achieving healthy aging among female OAH in NYC and Oakland, CA. Dr. Rubtsova and colleagues explore multiple meanings of “successful aging” among older women in Atlanta and Brooklyn, and the role of resilience that empowers them as long-term HIV survivors. Dr. Taylor qualitatively examines the impact of biopsychosocial factors on notions of “Healthy HIV Aging” among older gay, bisexual and heterosexual men with HIV. Dr. Ruth Finkelstein will discuss the public health implications for developing equitable and gender-specific and intersectional HIV prevention and wellness interventions and suggest future areas of inquiry to improve HIV outcomes across the care continuum.
GRECCS AS A NETWORK TO ENHANCE THE VA PRIMARY CARE WORKFORCE
Authors: Kramer Josea , Shaughnessy Marianne
Published: November 2019

The VA Geriatric Scholars Program is a workforce development program to integrate geriatrics into primary care in all VA clinics. The program has increased career satisfaction among clinicians, improved quality of care for aging Veterans, changed provider prescribing behaviors and improved patient outcomes. The core curriculum is an intensive course in geriatrics, an intensive workshop in quality improvement (QI) and a micro QI project to demonstrate application of new knowledge to local needs of patients and clinic processes; this is a longitudinal program and alumni continue to develop skills over time through a series of elective activities that tailor learning to self-identified gaps in career development and training. The program is a collaboration among the Geriatric Research Education and Clinical Centers (GRECC), centers of excellence that have been leveraged to create a network of expertise and creativity to develop the core and elective educational activities. This symposium focuses on recent outcomes of three educational components that improve quality of care for older Veterans. The Palo Alto GRECC developed an intensive course in gerontological psychology to enhance the skills and competencies of psychologists leading to greater job effectiveness. The Bronx GRECC developed an interdisciplinary training program for all clinical and non-clinical staff in rural clinics, leading to improved recognition of functional and safety concerns among older veterans. The Tennessee Valley GRECC developed the core QI component and many of these micro-QI projects have been sustained, spread or recognized by VA as Promising Practices.
THE EFFECT OF GEROPSYCHOLOGY TRAINING ON JOB EFFECTIVENESS AMONG VA PSYCHOLOGISTS
Authors: Scales Ashley , Rodriguez Rachel , Gould Christine , Gregg Jeffrey , Huh Joung , Kramer Josea
Published: November 2019

Providing training to assist employees with excelling in their job role may increase their job effectiveness, which then translates to improvements in an organizations’ performance measures. In 2018, the Geriatric Scholars Psychology Program measured whether a multi-day course influenced the Psychologists’ perceived job effectiveness using modified questions from Godat and Brigham’s Reaction Measure. Ninety-two percent agreed the training assisted them with identifying and overcoming obstacles; helped them set goals to increase problem solving at their designated facilities; boosted their confidence in fulfilling their job duties; and the training should be made available to other employees who provide care to older Veterans on a regular basis. Findings from the 3-month follow-up assessment demonstrated that the positive effect on job effectiveness was sustained. Discussion will explore aspects of the course that may be key in improving perceived effectiveness and consider novel approaches to enhance this outcome.
ORGANIZATIONAL READINESS TO CHANGE AND NURSING HOME SAFETY: RESULTS FROM A NATIONAL SURVEY
Authors: Hartmann Christine W , Quach Emma , Zhao Shibei , Clark Valerie , McDannold Sarah , Ni Pengsheng , Kazis Lewis
Published: November 2019

In nursing homes, safety climate (employee attitudes and beliefs about safety) is a key contributing factor to safety and a potential leverage point for improvement. Yet relatively little is known about how contextual factors such as organizational readiness to change affect safety climate. We sampled employees from 56 Department of Veterans Affairs (VA) Community Living Centers (CLCs—nursing homes) and conducted an anonymous, cross-sectional web-based survey using the previously validated CLC Employee Survey of Attitudes about Resident Safety (CESARS) and the Organizational Readiness to Change Assessment instrument. From hierarchical mixed random effects regression models, we calculated intraclass correlation coefficients (ICC) as the proportion of CLC-level variance over the sum of CLC-level plus residual variance. Each of the CESARS’ 7 safety climate domains was a dependent variable in separate models; employee- and CLC-level factors were independent variables. The survey had a 26% response rate; 1,397 respondents. Mean ORCA scores (1-5 scale, higher better) was 3.3. We began with models containing only employee-level variables. ICC values ranged from 2.34% to 9.85%, suggesting substantial variation in CESARS outcomes. As we dropped insignificant variables and added CLC-level variables to the models, the ICC decreased over 2% in six models, suggesting organizational-level variables accounted for substantial variability. The only independent variable with a significant effect in all 7 models was organizational-level: organizational readiness to change. Unlike many other organizational-level variables, organizational readiness to change is potentially amenable to low-cost interventions such as communication and teamwork interventions, providing viable opportunities to efficiently improve nursing home care.
A LONGEVITY PROMOTING FACTOR THAT SUPPRESSES IMMUNITY AND HEALTHSPAN
Authors: Ghazi Arjumand , Amrit Francis , Naim Nikki , Ratnappan Ramesh , Loose Julia , Wang Guoqiang , Driscoll Monica , Yanowitz Judith
Published: November 2019

A positive correlation exists between stress resistance and longevity, but emerging evidence suggests that lifespan and stress endurance are physiologically distinct. A major challenge in aging biology has been identifying factors that play distinct roles in these closely coupled processes because genes that promote longevity often enhance stress resistance. Here, we demonstrate that TCER-1, the Caenorhabditis elegans homolog of the human transcription elongation and splicing factor, TCERG1, has discrete and opposite effects on lifespan and stress resistance. We previously identified tcer-1 as a gene that promotes longevity in germline-less C. elegans and reproductive fitness in wild-type animals. Surprisingly, tcer-1 mutants exhibited exceptional resistance against multiple biotic and abiotic stressors, including infection by the human opportunistic pathogen Pseudomonas aeruginosa. Conversely, TCER-1 overexpression increased susceptibility to infection. TCER-1 acted cell non-autonomously to both enhance longevity and repress immunity. Interestingly, TCER-1 inhibited immunity only during the fertile stages of life and not in post-reproductive adults. Elevating its levels ameliorated the fertility loss that follows infection, suggesting that TCER-1 may repress immunity to augment fecundity. Mechanistically, TCER-1 acts through the inhibition of the conserved kinase, PMK-1, as well as through repression of PMK-1-independent, novel antibacterial factors critical for innate immunity. Overall, our data establish key roles for TCER-1 in coordinating immunity, longevity and fertility, and reveal the molecular mechanisms that distinguish length of life from functional aspects of aging.
ACCESS TO EVERYDAY ACTIVITIES IN PUBLIC SPACE - VIEWS OF PEOPLE WITH DEMENTIA
Authors: Brorsson Anna , Nygard Louise , Ohman annika
Published: November 2019

People with dementia value staying active and continuing with their everyday lives in public space, however there is a lack of knowledge about how they experience accessibility, problematic situations and how to manage these situations. The aim is to illuminate experiences of accessibility in public space in people with dementia with focus on places, activities and problematic situations. A Grounded theory approach was used in the thesis with multiple data collection methods (interviews, focus group interviews, observations and visual methods). Findings show that having access to everyday activities at different places in the neighbourhood was very important for the participants when they perceived themselves as being a part of the society and being active and independent persons. Engaging in familiar activities in familiar places was important. However, their activity radii in the community became smaller. The findings inspired the development of the questionnaire Participation in Activities and Places Outside Home.
LESSONS FROM THE RESIDENT EXPERIENCE WITH THE R3 PROGRAM
Authors: Miller Edward A , Nadash Pamela , Simpson Elizabeth , Shellito Natalie , Cohen Marc
Published: November 2019

Understanding the resident experience is a critical step to creating a sustainable and replicable model of affordable resident-centered housing with supportive services programs. This study thus draws lessons from focus groups with participants in the R3 program for designing and implementing such initiatives in affordable senior housing. Findings indicate that the R3 program brings value to residents: they benefit from reliable information on health-related issues, as well as emotional support and assistance with accessing appropriate care. By focusing on prevention and ensuring timely access to services, findings suggest how the intervention could promote seniors living independently longer and lower health system costs. Results also suggest ways to improve the effectiveness of housing with services programs, including providing clarity regarding the purpose of the program, its components and staffing, building trust between program staff and residents, addressing concerns about privacy and confidentiality, and implementing a multipronged marketing and promotion strategy.
PERSONALITY AND SELF-REPORTED AND ACTIGRAPHY-MEASURED SLEEP HEALTH IN ADULTHOOD
Authors: Sadeq Nasreen A , Sadeq Nasreen A , Lee Soomi , Gamaldo Alyssa , Almeida David M
Published: November 2019

Personality may be associated with sleep health, however, the majority of existing studies rely on self-reported measures of sleep (often focusing on sleep duration). The purpose of this study is to examine the associations between Big Five personality traits and self-reported and actigraphy measured sleep. This study included 3928 participants and a subsample of 441 participants from the Midlife in the United States study. Linear regressions were used to analyze the relationships between personality traits and sleep. Neuroticism was associated with more frequent actigraphy-measured waking after sleep onset, and several self-reported measures of sleep quality, including shorter sleep duration, longer sleep latency, and a greater number of insomnia symptoms. Agreeableness was associated with shorter actigraphy-measured sleep duration and more self-reported insomnia symptoms. Our findings support an association between Neuroticism and poor sleep, and suggest that Agreeableness may be associated with worse sleep health.
INTERVENTIONS FOR LONELINESS AMONG OLDER ADULTS IN FACILITIES: A SYSTEMATIC REVIEW
Authors: Quan Nicolas , Lohman Matthew
Published: November 2019

Loneliness affects an estimated 1 in 3 older adults ages 65 and over in America. According to a 2017 report by AARP, a lack of meaningful social contact among older adults is associated with $6.7 billion dollars of federal healthcare spending. Research suggests that interventions such as social facilitation and skills development may decrease loneliness; however, the effectiveness of such interventions for older adults living in long-term care facilities is unclear. Articles matching search criteria were collected from PubMed, PsycInfo and Web of Science from 2009 to 2019. Inclusion criteria were: 1) intervention studies, 2) individuals age >= 65, 3) participants living in a long-term care facility such as a nursing home, assisted-living, or hospice facility. Randomized controlled trials, quasi-experimental and single-group studies were included. Title and abstract screening, as well as full text extraction followed PRISMA guidelines. A total of 16 articles that met inclusion criteria were identified. The interventions included video chatting with family members, human-volunteer interaction, human-robot interaction, humor therapy, a reminiscent radio program, laughter therapy and gardening education. Fourteen studies demonstrated a statistically significant decrease in loneliness from baseline to post-intervention. Laughter therapy showed the greatest reduction in loneliness. Diversity of intervention types and loneliness measures meant we could not estimate a pooled measure of effectiveness. Results suggest that there are several effective interventions to reduce loneliness among older adults in facilities; however, lack of standardized measures and high-quality studies limits comparisons between intervention types and generalizability to different populations.
THE BLUES AND OLDER MINORITY MUSICIANS: MORE THAN JUST MUSIC XXVI
Authors: Migliaccio John N
Published: November 2019

This 26th annual symposium again showcases a world-wide musical genre in a regional setting with local performers. Texas Blues has emanated from a pantheon of talented artists beginning in the earliest days of Roots and Blues music to the present day, and Austin has become the epicenter of this talent and music. With legendary classic blues musicians from the early 2oth century to emerging younger musicians who re-energize and re-invent this uniquely American musical genre, to legendary music labels and venues like Antone’s which continue to engage blues music artists of all ages, Austin continues to be the home of Texas Blues. Lifetime Achievement Award -winning 89-year-young, Miss Lavelle White epitomizes the resilience and energy interchange of both the performer and the music, and their mutual contribution to longevity and continued engagement. Still performing after 70 years, she has influenced generations of younger prominent blues performers and continues to appear weekly at local blues mecca Antone’s along with her Grammy Award winning band and is preparing her fourth album release. This session will celebrate her music, her artistry, and her continued success as an older blues performer. A visit to a local blues venue later in the evening will allow for a true appreciation of the blues music scene in Austin.
OLDER BLUES MUSICIANS
Authors: Sheets Debra J
Published: November 2019

Older female musicians face challenges and advantages from longevity
ELDER MISTREATMENT FOLLOW-UP: CONNECTING EMERGENCY DEPARTMENTS AND COMMUNITIES
Authors: Bonner Alice , Lees-Haggerty Kristin , Lang Debi , Cunningham Bree , Burnett Jason , Greenlee Kathy
Published: November 2019

To effectively address elder mistreatment (EM) in the emergency department (ED) hospitals must have mechanisms that promote and, to the extent possible, ensure patient safety post-discharge. However, the realities of working within busy hospitals--limited staff time, financial resources, and EM-specific expertise--prevent many EDs from being able to dedicate staff for patient follow up or develop EM multi-disciplinary teams. The fourth core element of the NCAEM’s ED Care Model aims to address this need with a roadmap for leveraging existing community resources. The roadmap provides streamlined tools to help hospitals assess their needs, identify existing teams and resources in their community, and connect with Adult Protective Services and other organizations. In this presentation we will present these tools and share case examples from beginning stages of feasibility testing in hospitals across the US. We will discuss specific strategies for implementing the model in hospitals of differing types, sizes, and resource levels.
LIFE-SPACE MOBILITY AS A PREDICTOR OF MEDICARE UTILIZATION AMONG COMMUNITY-DWELLING OLDER MEXICAN AMERICANS
Authors: Johnson Jason P , Chou Lin-Na , Kuo Yong-Fang , Ottenbacher Kenneth , Snih Soham Al
Published: November 2019

Hispanics are a large and growing group of older adults, with higher rates of morbidity and disability than other racial/ethnic groups. Mexican Americans make up more than half of this population and are well represented in the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) survey, a longitudinal study of community-dwelling older Mexican Americans. The University of Alabama Birmingham Life-Space Assessment (LSA) is a measure assessing patterns of functional mobility in and around the home, neighborhood, and community. This study addresses the gap in research of life-space mobility and healthcare utilization with linked insurance claims data. Four hundred eight participants with 1-year continuous Medicare enrollment from wave 7 (2010) of the HEPESE were linked with Medicare claims. Logistic regression analysis was used to estimate the odds ratio of hospitalization and ER admissions. Negative binomial regression was used to estimate the rate ratio of physician visits. LSA score ranges 0 to 120, with higher scores indicating greater life-space mobility; LSA was analyzed as a 10-point decrease or dichotomously as restricted ≤59 or not restricted ≥60. A restricted LSA score among older Mexican American Medicare beneficiaries was associated with OR of 2.73 for hospitalizations (95% CI= 1.18-6.31). In addition, a 5-point decline in LSA score was associated with OR of 1.12 for hospitalizations (95% CI= 1.04-1.22). LSA score was not significantly associated with ER admission or physician visit. Interventions aimed to increase mobility in the home and the community may reduce the risk of hospitalizations in this population.
PREFRONTAL CORTICAL ACTIVITY DIFFERENCES WHILE DUAL-TASK WALKING IN OLDER ADULTS WITH IMPAIRED MOBILITY
Authors: Hernandez Manuel E
Published: November 2019

Mobility impairments are prevalent in older adults. Whereas walking had traditionally been viewed as an autonomous process, evidence over the last decade has shown that cognitive processes such as attention and executive function have a significant impact on gait function in older adults. However, the exact neural mechanisms underlying difficulties in the control of mobility in older adults remains an open question. We examine the changes in the executive control of mobility in older adults with mobility impairments using functional near-infrared spectroscopy, as operationalized by performance in the community balance and mobility scale (CB&M). We hypothesized that prefrontal cortical (PFC) activity increases would be higher in older adults with mobility impairments, compared with older adults without mobility impairment, as dual-task walking difficulty increased. Older adults with (n=10, mean±SD age: 77±8 years, 8 females, CB&M= 58±12) and without mobility impairment (n=14, mean±SD age: 63±9 years, 11 females, CB&M= 87±6) were recruited from the local community. Dual-task walking was performed at a comfortable pace, while the difficulty of the concurrent cognitive task was increased using the modified Stroop test. PFC activity was measured using measures of oxygenated hemoglobin across the PFC. Older adults with mobility impairments demonstrated disproportionate increases in PFC activity, in comparison to those without mobility impairments, as the difficulty of the concurrent cognitive task increased (P<.001), even after controlling for age. In conclusion, these data suggest that older adults with mobility impairments may require greater attentional resources than those without mobility impairments when concurrently performing thinking and walking tasks.
TARGETED TRANSCRANIAL DIRECT CURRENT STIMULATION IMPROVES DUAL-TASK WALKING PERFORMANCE IN OLDER ADULTS
Authors: Manor Brad , Zhou Junhong , Lo On-Yee , Katz Racheli , Brozgol Marina , Thumm Pablo Cornejo , Ruffini Giulio , Hausdorff Jeffrey M
Published: November 2019

In older adults, the ability to walk while engaged in an unrelated cognitive task (i.e., dual tasking) depends upon activation of both motor and cognitive brain networks. Noninvasive transcranial direct current stimulation (tDCS) can facilitate the excitability of specific brain regions and their connected neural networks. In this multi-site, randomized controlled within-subject cross-over study, we tested the effects of single, 20-minute sessions of tDCS targeting 1) the primary motor cortex (M1), 2) the left dorsolateral prefrontal cortex (dlPFC, a primary region subserving cognitive function), 3) both M1 and left dlPFC, or 4) neither region (sham). Forty-eight older adults free of overt illness or disease (mean±SD age=75±6 years, 35 women) completed four study visits at least 72 hours apart, during which dual task gait was assessed before and after tDCS administration. Stimulation was delivered using the Starstim™ system (Neuroelectrics Corp) and the same array of six gel electrodes to ensure double-blinding. Participants were successfully blinded to tDCS condition and reported no unexpected tDCS side effects. Repeated-measures ANOVAs adjusted for age and sex revealed that the dual task cost to gait speed was smaller (i.e., better and closer to zero) following tDCS that targeted both M1 and the left dlPFC, as well as the left dlPFC alone, compared to all other time points (condition-time interaction: F=3.0, p=0.04). The dual task costs following these two types of stimulation were similar. These results suggest that noninvasive facilitation of cognitive-motor brain network excitability leads to acute improvement in dual task performance in older adults.
THE PORCHLIGHT PROJECT: PARTNERING WITH VOLUNTEERS TO ENHANCE COMMUNITY-BASED DEMENTIA CARE AND OUTREACH
Authors: Gaugler Joseph E , Rosebush Christina , Bustamante Gabriela , Schoonover Jeri , Jenkins Roxanne , Bauer Nicole , Beardsley Lisa , Rowe Laura
Published: November 2019

Families often remain unaware of long-term services and supports (LTSS) that could help to mitigate the negative effects of Alzheimer’s disease and related dementias (ADRDs). Approaches that: a) identify community-residing older persons with potential memory impairment; b) assist their families in navigating the healthcare system; and c) facilitate the identification of appropriate community-based LTSS could result in more effective management of ADRD. The Porchlight Project is a multicomponent training approach for lay volunteers in Minnesota (i.e., Senior Companions) that enhances their capability to deliver dementia care and support to underserved older persons in need. Mixed methods analysis of qualitative and quantitative data among 20 Senior Companions and up to 25 persons with ADRD and their family caregivers suggest the potential success of the Porchlight Project, as well as areas to refine and enhance prior to large-scale evaluation throughout Minnesota.
THE STUDY OF KNOWLEDGE AND ATTITUDE ABOUT LONG-TERM CARE AMONG HISPANICS
Authors: Baniya Ganesh , Moore Ami
Published: November 2019

Attitudes towards long-term care can help policymakers tailor policies considering different racial and ethnic experiences of the elderly population. The theory of Proactive Coping can help elderly people to better prepare for aging and minimize stressors related to aging by identifying potential sources of stress before they occur and help gather resources and skills for successful aging. The data from the “Long-term care in America: views on who should bear the responsibilities and costs of care” (2017) study showed that Hispanics generally perceived their health to be in a better status and Hispanic women perceived that they had better health compared to males. Similarly, Hispanic males generally thought that they would not need assistance at old age whereas women anticipated that they would require assistance at old age. Similarly, there was a gender difference on who should bear the caregiving responsibility. More Hispanic women thought it would be their responsibility to provide care than males. Women were more prepared than males to provide the care needed to family members of friends. In regards to financial preparation, males reported being more financially capable than females to bear expenses during the old age. Similarly, women were more likely to solely depend on using governmental assistance such as Medicare and Medicaid during old age for needed care. Most of the respondents thought that the US was not well prepared to meet the needs of the aging population and suggested that the government needs to do more before it would be too late.
THE MULTIPLE DIMENSIONS OF THE RACE EXPERIENCE AND ASSOCIATIONS WITH HEALTH IN OLDER ADULTS
Authors: Kaufman Jerry
Published: November 2019

Race is experienced along a number of dimensions. In the United States, education, family background (e.g., parents’ education), skin shade, experiences of racial discrimination, neighborhood racial composition, state/region of birth, and interracial marriage help to define the “race experience.” Many of these factors have been individually associated with adverse outcomes for African Americans relative to Whites, but little research has examined how these factors cohere within individuals. Using a national survey of African American and White older adults, we employed latent class analysis and, in preliminary analyses, identified three clusters of individuals who were characterized by unique race experiences. We then assessed and determined that these clusters were also unique in their differential associations with health outcomes. This data-driven approach will provide insight into the profiles of individuals whose race experience contributes to health inequities among older Americans.
THE RESOURCE EXCHANGE NETWORK: A MODEL FOR TRANSFORMATIVE CHANGE IN GERIATRIC CARE
Authors: Clark Phillip G , Clark Phillip , Ferrone Christine , Helm Faith , Morelli Alexandra
Published: November 2019

Transformational efforts to redesign the care system for older adults call for the development of novel partnership models incorporating academic institutions, primary care networks, and community-based organizations. The Rhode Island Geriatric Workforce Enhancement Program (RI-GWEP) has utilized the “resource exchange model” to develop innovative, interdisciplinary, and integrated projects combining educational resources, clinical expertise, programmatic experience, and impact evaluation. With particular emphasis on the challenges of developing interprofessional education spanning the traditional gaps between disciplines and departments, this presentation emphasizes the critical conditions, components, and capacities of such a collaborative network. These include: (1) mission dominance, (2) barter exchange, (3) partnership investment, and (4) interpersonal relationships. RI-GWEP’s experience provides insights into the conceptual foundation of geriatrics networks and specific, concrete examples of projects incorporating these principles. Implications for the development of networks in other settings include consideration of particular: (1) projects, (2) people, (3) places, (4) personalities, and (5) possibilities.
TORC1 INHIBITION AS AN IMMUNOTHERAPY TO DECREASE INFECTIONS IN THE ELDERLY
Authors: Mannick Joan
Published: November 2019

Inhibition of TORC1 has extended lifespan in multiple preclinical species. Thus drugs inhibiting TORC1 may have therapeutic benefit for aging-related conditions in humans. An aging-related condition that improves with TORC1 inhibition in old mice is immunosenescence (the aging-related decline in immune function). Immunosenescence leads to increased rates of infections including respiratory tract infections (RTIs) in the elderly. In two Phase 2 clinical trials in over 900 elderly subjects, the TORC1 inhibitor RTB101 was observed to improve immune function and decrease the incidence of RTIs. Decreasing the incidence of RTIs is important because RTIs are the fourth leading cause of hospitalization in people age 65 and above. Based on these findings, two Phase 3 studies are underway to determine whether RTB101 given for 16 weeks during winter cold and flu season decreases relative to placebo the percentage of elderly subjects with illnesses associated with RTIs.
AGING TREATMENT BY COUNTERACTING INTRINSIC DNA DAMAGE AND IMMUNOSENESCENCE
Authors: Gudkov Andrei
Published: November 2019

Progressive systemic poisoning by gradually accumulated damaged cells has been proposed as a major contributor to mammalian aging. Our preclinical studies support the hypothesis that this process results from a failure of innate immunity-mediated eradication of cells with DNA damaged by intrinsic mechanisms caused by the epigenetic desilencing of endogenous retroelements. This model suggests two translational approaches to improve the counteract accumulation of damaged cells: (i) by pharmacological suppression of LINE1 reverse transcriptase activities – the main driver of expansion of “retrobiome” and the trigger of damaged cell-associated inflammation and (ii) by counteracting immunosenescence by innate immunity stimulation. Preclinical proofs of concept have been obtained for both using nucleoside reverse transcriptase inhibitors and immunostimulators acting via TLR5 activation. Preparations for clinical testing of these agents in the context of age-related pathologies is in underway.
COMMUNITY-LEVEL SOCIAL CAPITAL AND COGNITIVE FUNCTION AMONG OLDER ADULTS IN FIVE LOW- AND MIDDLE-INCOME COUNTRIES
Authors: Jiang Nan , Lu Nan , Wu Bei
Published: November 2019

This study aims to investigate which community social capital components are associated with a higher likelihood of cognitive functions across economically and culturally distinctive low- and middle-income countries (LMICs). We used cross-sectional survey data from the World Health Organization’s Study on global AGEing and adult health (SAGE) 2007-2010. Associations between community-level social capital indicators and global cognitive scores were examined using ordinary least squares regressions and random-effects meta-analyses. The pooled analysis and meta-analyses of within-country effects indicated that trust in neighbors and coworkers were positively associated with cognitive functions for all these countries, whereas the significant effect of perceived neighborhood safety was only found in South Africa and China. Community participation approached a null effect only in South Africa. This finding explains how community social capital may contribute to better cognitive function through community environments, heath systems, and availability of public resources.
EXTENDED WORKING LIFE POLICIES: INTERNATIONAL GENDER AND HEALTH PERSPECTIVES, EMPIRICAL AND POLICY LANDSCAPE
Authors: Rasticova Martina , Ogg Jim
Published: November 2019

As populations age, extending the working life appears to be widely accepted and promoted by governments (OECD 2006; 2017). Without exception, all countries with modern economies have responded in one way or another to the financial challenges arising from increased life expectancy and ageing populations. Policies to extend working life are ubiquitous, each based on the premise that unsustainable pension systems must be reformed, and public spending reduced. Although there are diverse perspectives on extended working life, gender and health consistently prevail as key dimensions. To date, policies extending working life have not taken sufficiently into account these two dimensions. A clear example in the case of gender concerns the shift towards equality in retirement ages between men and women. In this presentation, we set the stage by presenting the empirical and policy landscapes across 34 countries that characterise the trend of extended working life from gender and health perspectives.
RESILIENCY PHENOTYPES FOLLOWING HIP FRACTURE IN OLDER ADULTS
Authors: Colon-Emeric Cathleen , Whitson Heather E , Pieper Carl , Sloane Richard , Orwig Denise , Huffman Kim , Parker Daniel C , Magaziner Jay S
Published: November 2019

Defining common patterns of recovery after an acute health stressor (resiliency phenotypes) has clinical and research implications. We examined groups of patients with similar recovery patterns across 10 outcomes following hip fracture to determine the most important predictors of resiliency group membership. This study is a secondary analysis of three prospective cohort studies. Participants, community-dwelling adults aged >65 with recent surgical repair of a hip fracture (n=541), were recruited from eight hospitals near Baltimore and followed for up to one year. Self-reported function and activity measures were collected using validated scales at baseline, 2, 6, and 12 months. Physical performance tests were administered at all follow-up visits. Stressor characteristics, co-morbidities, psychosocial and environmental factors were collected at baseline, and latent class profile analysis was used to identify resiliency phenotypes and logistic regression models to identify associated factors. Three resiliency phenotypes had similar patterns across the 10 outcome measures and were defined as “high resilience” (n=163, 30.1%), “medium resilience” (n=242, 44.7%), and “low resilience” (n=136, 25.2%). Recovery trajectories for outcome measures were plotted for each resiliency group. Self-reported pre-fracture function was by far the strongest predictor of resilience group membership (AUC 0.84). Demographic factors, co-morbidities, stressor characteristics, environmental factors, and psychosocial characteristics were less predictive, but several factors remained significant in a fully adjusted model (AUC 0.88). These three resiliency phenotypes have immediate utility for clinical decision-making. They can be measured in future studies with a more parsimonious set of variables, and may prove useful for understanding mediators of physical resilience.