bluuebunny/crossref_metadata_2025 huggingface dataset:
Facilitating mental health service use for older Chinese immigrants: a case study of community-based organizations
Authors: Hu Yuanyuan , Xu Qingwen
Published: December 2020

New York City has the largest older Chinese population of any city in the United States. Older Chinese adults in New York City often meet significant stress to fulfill their needs, and mental health issues are common among this population (Mui, 1996; Dong, 2012). Despite the high prevalence, Asian Americans have the lowest rates of mental health services use compared to other ethnic groups (Abe-Kim et al., 2007). Additional to wide disparities in mental health access, older immigrants experience additional factors that affect their decision making to use mental health services. Limited knowledge exists about community-based organizations facilitating mental health services use for this population. This study aimed to fill this gap by case study approach and conducted a qualitative analysis of data collected as part of a study that investigated the resilience of the Chinese communities in New York City in the context of aging and immigration. Data from five community-based organizations serving this population were examined, through reading agency history and program introduction, visiting agency location and observing its operation, and interviewing the agency staff and program directors. Data collected were integrated, synthesized, and analyzed. Findings represent organizational staff’s perceptions of the mental health issues among older Chinese immigrants, needs and accessibility of mental health services, and facilitation of access and utilization of services by screening, education and referral. The qualitative results address individual help-seeking behavior and pattern, organizational response to and coordination of mental health needs, and capacity building on the community level.
Personal Activities, Social Participation and Functional Disability in Aged Living Alone with Fall Experience
Authors: Jung SuJung , Tak Sunghee
Published: December 2020

Functional disability leads to limitations in the older adults’ personal activities and social participation. The purpose of this study was to examine the International Classification of Functioning Disability and Health(so called ICF) model in which personal activities and social participation influence functional disability in older adults who live alone and have experienced falls. The study used a secondary data analysis of the 2017 National Survey of Older Koreans. A total of 501 study participants met the inclusion criteria. The results of multiple linear regression indicated that gender and the number of acquaintances were significantly related to the functional disability of social participation while overnutrition, depressed symptom and cognitive dysfunction were related to the functional disability of personal activities. Lastly, poor muscle strength, old age and economic status were predictors of the functional disabilities of both personal activities and social participation. The findings of the study revealed that it is important to comprehensively evaluate not only personal activities but also social participation of older adults who live alone and have experienced falls. In addition, the ICF model may be useful in the development of intervention programs for preventing functional disability in the population.
Social Adversity Impacts on the Rhesus Macaque Immune System Resemble Those of Aging
Authors: Sanchez-Rosado Mitchell , Snyder-Mackler Noah , Brent Lauren , Higham James , Kimock Clare , Watowich Marina , Pavez-Fox Melissa , Pantoja-Maldonado Petraleigh
Published: December 2020

Social adversity can impact immune function and is associated with increased morbidity and mortality. Many of these immune-related changes resemble the effects of the natural aging process. To date, little is known about the effects of social adversity on the immune system change across the lifetime. Here, we investigated how aging and social adversity (measured as social status) impact immune cell proportions. We performed flow cytometry on peripheral whole blood from a population of free-ranging rhesus macaques to quantify changes on immune cell proportions across the lifespan (n=99) and across different social statuses (n=53). Overall, we found that high adversity recapitulated the effects of aging. We found significant shared decreases in CD3+/CD4+ T cell proportions and corresponding increases in CD3+/CD8+ T cell proportions between individuals of older ages and low social status. These findings suggest that social adversity has similar effects to aging on T cell proportions, possibly affecting the T cell component of the immune response. In contrast, CD3+/CD4+/CD25+ T regulatory cell proportions increased with age, which is typical of normal aging. Contrary to our expectations, these cells were less abundant in low status individuals, indicating some overall regulatory immune deficits specific to lower status individuals. CD3+/CD8+/CD25+ T regulatory cells, which contribute to self-tolerance, were higher in high status individuals, suggesting that overall primary immune regulatory cells can be affected by social adversity and impair the regulation of inflammation. We provide evidence that social adversity alters immune cell proportions, implicating it in the development of inflammatory and/or aging-related diseases.
Usability of Telemedicine in Relation to Acceptability, Psychosocial Impact, and Future Use
Authors: Prevodnik Katja , Hvalič-Touzery Simona , Dolničar Vesna , Škafar Maja , Petrovčič Andraž
Published: December 2020

This poster presents the results of an intervention study exploring how engagement in telemedicine at home affects chronic patients’ perceptions of usability and acceptability of the employed equipment, perceptions of its psychosocial impact, and intention of future use in the context of population aging. A purposively selected sample of 103 patients (mean age: 58 years) with chronic conditions (diabetes and/or hypertension) recruited in a community health center in Slovenia tested a home telemedicine system (TMS). After three months of utilization, an assessment of the relative importance of the usability and acceptance of TMS as factors influencing the patients’ self-reported psychosocial perception of TMS and intention of future use was performed based on a proposed structural equation model explaining these interdependencies. The results confirmed four of eight tested hypotheses. Notably, the intensity of TMS use was found to affect the evaluation of its usability, the perception of its psychosocial impact, and the intent of future use. Usability was found to be the main factor directly influencing acceptability, perception of psychosocial impact and intent for future use, whereas acceptability did not significantly affect either the perception of the psychosocial impact of TMS or the intent of future use.
“When you are working in this environment, you’re more likely to get sick”: Mapping Care Relationships in LTC
Authors: Gregor Andreina Marquez de la Plata , Aubrecht Katie , Daly Tamara , Bourgeault Ivy , Braedley Susan , Owusu Prince , Armstrong Pat , Armstrong Hugh
Published: December 2020

The pandemic has shone a light on problems within the long-term care (LTC) sector. As was true prior to COVID-19, many of the present issues in LTC can be traced to challenging working conditions, such as persistent understaffing of care workers. Working short-staffed means rushing through care, while only satisfying the most basic bodily needs of the resident. This presentation shares early findings from a thematic analysis of interviews conducted with seven care workers as part of the “Mapping Care Relationships” stream of the Seniors –Adding Life to Years (SALTY) project, a pan-Canadian research program that maps how promising approaches to care relationships are organized and experienced in LTC. The purpose of the analysis was to understand how short-staffing is affecting the formation and preservation of meaningful staff-resident relations, and what the impact is on quality of care. Two overarching themes emerged: 1) a relationship between time and work-place illness, injury and violence; 2) a relationship between care worker autonomy and resident quality of care. When working conditions do not support workers in voicing and/or addressing challenges they experience in the workplace, whether this results from understaffing or hierarchical power structures, care workers’ ability to deliver even basic care is jeopardized, and resident and worker health and wellness are placed at risk. Themes are discussed in the context of COVID-19 in light of responses to outbreaks in LTC that have reduced the availability of care workers, family visitors and volunteers, and emphasized top-down and even militarized approaches to care management.
Age Variations in Perceived COVID-19 Threats, Negative Impacts, and Associations with Well-Being
Authors: Gruenewald Tara , Ong Anthony , Zahn Danielle
Published: December 2020

The COVID-19 pandemic represents an unprecedented threat to individual and public health, psychosocial, and economic well-being, although COVID-19 threats and impacts may vary by age and other demographic characteristics. Although greater age is a risk factor for greater COVID-19 disease severity, we know little about the association between age and perceived and experienced COVID-19 threats and their association to well-being. These associations were examined in an ongoing 3-wave investigation of over 1,700 U.S. adults (age 18-89; 53.1% female). Wave 1 analyses indicate no significant age variation in perceived threat of COVID-19 infection, with older and younger individuals reporting similar levels of COVID-19 infection threat. However, greater age was associated with lower perceived negative impact on financial and needed resources (r=-.10**), lower perceptions of COVID-19 induced harm to mental well-being (r=-.17**), and more favorable well-being profiles. Greater perceived COVID-19 threat and negative impact on resources and well-being were linked to greater feelings of stress (β’s=.45 to .68***), loneliness (β’s=.24 to .49***), social well-being (β’s=-.19 to -.36***), and poor sleep quality (β’s=.34 to .51***). These associations did not vary with age with the exception that older individuals showed stronger links between COVID-19 threat and impacts and poorer sleep quality. Ongoing analyses are examining whether these associations persist over time. Despite older adults’ greater risk of COVID-19 disease severity and mortality, older age did not appear to be linked to greater perceived COVID-19 threat or impacts, nor linkages to ill-being, with the possible exception of potential greater vulnerability to poor sleep quality.
Dementia care providers’ delivery of family caregiver support during COVID-19
Authors: Quach Emma , Franzosa Emily , Scali Rachael , Moo Lauren , Hartmann Christine
Published: December 2020

Family caregiver support is a cornerstone of dementia care. Yet the transition to virtual care during COVID raised questions about the ability of dementia care teams to maintain caregiver support services. We surveyed Veterans Affairs clinicians about dementia caregiver support delivery following the COVID surge in the six New England states. 38 out of 68 (55%) clinicians from 6 states responded in June and July 2020. We found: 1) Clinicians continued providing the same types of support services for family caregivers before and after COVID, with over 50% of providers interacting with caregivers daily or multiple times per week. The most prevalent services were caregiver needs assessments, information and referrals, and assistance with accessing services. Two-thirds reported continuing to offer caregiver skills training and counseling, including peer support groups. 2) Caregiver support modality changed, most frequently through the combined use of phone and video, followed by only phone, and rarely, by only video. 3) Providers indicated that phone, more than video, increased to replace in-person interactions, because of multiple factors: caregivers (who continued to call for support on an as-needed basis but declined video encounters), providers (who began to provide group support via phone), and service factors (ad hoc versus scheduled encounters). Results suggest clinicians continued providing caregiver support despite suspension of in-person interactions, but future research is needed to assess the impacts of caregiver support delivery mostly by phone and factors underlying the limited use of video in delivering caregiver support.
The Longitudinal Impact of Private Health Insurance on the Usage of Outpatient Services Among Aging Koreans
Authors: Kim Narae
Published: December 2020

South Korea has a universal national health insurance system; however, its coverage is only about 65%. Consequently, many Koreans have supplemental private health insurance. This study aims to examine 1) how utilization of health care services and out-of-pocket expenditure of outpatient services varies by private health insurance status and 2) whether this relationship changes for these individuals over time. We analyze six waves of the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2016. Our primary outcomes of interest are the total number of outpatient visits and total out-of-pocket spending on outpatient services per year. Our independent variable of interest is private health insurance holding status. We use simple OLS regressions for each year to test if differences exist and change over time, controlling for age, sex, education, income, and various indicators of health conditions. The difference between those who never had private health insurance and those who always or sometimes had private health insurance becomes larger over time. When comparing total out-of-pocket expenditure, those who always had private health insurance have the lowest spending at the beginning of the study period (2006); however, their spending increases sharply by 2010 and remains higher than the other groups for the rest of the study period. Findings suggest that those who always had supplemental insurance use outpatient services more frequently and spend more out-of-pocket for services as a result. In addition, discrepancies become larger over time. As private health insurance holders age, the risk of higher utilization of outpatient services grows.
Trends in Hearing Aid Use Among Older Adults in the United States, 2011-2018
Authors: Reed Nicholas , Morales Emmanuel Garcia , Willink Amber
Published: December 2020

Hearing loss among older adults is prevalent and associated with dementia and health care utilization. However, cross-sectional data suggest less than 20% of adults with hearing loss use hearing aids. There is a paucity of studies examining trends in hearing aid ownership over time. This study analyzed data from the 2011, 2015, and 2018 cycles of the National Health Aging and Trends Study (NHATS), a nationally-representative longitudinal study of Medicare Beneficiaries. Participants were asked “in the last month, [have you/has [he/she]] use a hearing aid or other hearing device?” (“yes” or “no”). Among a weighted sample of Medicare Beneficiaries 70 years and older (26.47 million in 2011; 29.70 million in 2015; and 33.28 in 2018), the overall proportion who own and use hearing aids rose from 14.96% in 2011 to 16.90% in 2015 to 18.45% in 2018. As age increased so did the proportion of older adults who used hearing aids. A smaller proportion of Black Americans used hearing aids across time and experienced a smaller overall increase in the proportion in hearing aid ownership over the 8-year period compared to White Americans (+0.78% vs. +4.30%). Black women had the lowest rates of hearing aids use across the 8-year period. Notably, older adults at less than 100% of the federal poverty level experienced an overall decrease in proportion of hearing aid ownership and use. This study lays the groundwork to examine the impact of the Over-the-Counter Hearing Aid Act of 2017 across subpopulations when it takes effect in 2021.
Obesity Intervention Improves Outcomes in Socially Isolated Older Adults: Progress Despite a Pandemic
Authors: Starr Kathryn Porter , Borack Michael , Miller Marshall , Fruik Angela , Rincker Jamie , Wallis Jessica , Hakim Amir , Bales Connie
Published: December 2020

The extended social isolation necessitated by the COVID-19 pandemic will likely have a prolonged negative impact on the health of community-dwelling older adults. We studied the potential to counteract these negative effects, examining the before and after measurements of participants in two obesity intervention studies that were converted from in-person to remote delivery, due to COVID-19. The Veterans Achieving Weight Loss and Optimizing Resilience-Using Protein study (VALOR-UP; n=9) and the Egg-Supplemented Pre-Diabetes Intervention Trial (EGGSPDITE; n=6) enrolled obese (BMI = 34.2±3.8 kg/m2) older adults (age = 71.5±4.5 yrs; 80% male; 47% black) with prediabetes (fasting blood glucose 100-125 mg/dL and/or HbA1c of 5.7-6.4%). Participants followed a hypocaloric diet, attended weekly support groups, and weighed themselves weekly; VALOR-UP participants also attended a weekly exercise class delivered remotely. Outcomes were assessed at baseline (pre-COVID) and the end of a 4-month period coinciding with stay-at-home orders. Between baseline and 4 months, calorie intakes (3-day diet record) decreased by 402.1±529.3 kcal/day (p<0.05) and body weight by 6% (6.1±3.4 kg; p<0.0001). Physical function (Short Physical Performance Battery) improved by 1.1±1.4 units (p<0.01) and Short Form Health Survey (SF-36) physical and mental composite quality of life remained stable (p=0.63 and p=0.48, respectively). Thus, despite COVID-19 circumstances, most participants were able to benefit from an intervention to improve function and reduce obesity. The somewhat surprising findings for this small cohort offer promise not only for future lifestyle interventions during COVID-19 isolation but also for other isolated populations, including home-bound older adults.
Access to Information on Needed Services Mediates the Association Between Income and Self-Rated Health
Authors: Moss Sara , White Katie , Dabelko-Schoeny Holly
Published: December 2020

Prior research has documented that individuals with fewer financial resources report lower self-rated health. The relationship between financial status and health is important to understand among older adults, for whom income is often fixed, and who face unique health stressors. In this study, we examined whether physical activity, connection to community, and access to information, variables which have demonstrated associations with financial resources and health in previous studies, accounted for unique variance in the association between income and self-rated health. We conducted a secondary data analysis of a community sample of 184 adults over the age of 50 in a large, Mid-western city. We tested a mediation model, entering income as a predictor of self-rated health with frequency of physical activity, feelings of being disconnectedness, and ability to find information about needed services as hypothesized mediators, controlling for the effects of race, education, and gender. Access to information about needed services, ab = .08, 95% CI [03, .15] accounted for unique variance in self-rated health scores beyond the direct effect of income, c’ = .38, p < .0001, 95% CI [.22, .53]. These findings suggest that higher perceived access to information about needed services may partially explain the association between income and self-rated health. Future researchers should track these variables across time to establish causal associations between access to information and health. Additionally, further study of perceived access to information and objective measures of access to information is warranted, as the role of health literacy in this study is unclear.
Social Participation, Social Support, and Social Policy Among Older Adults
Authors: Waite Linda
Published: December 2020

The social world is closely linked to other dimensions of health, including physical health and illness, physical functioning, cognition and emotional well-being, and these links may change across generations and may depend on social and policy context. The papers in this symposium focus on these links. Carr examines the associations between productive engagement in later life and perceptions of social support and interactions with friends and family. She finds that volunteer engagement is associated with greater perceived social support and interaction with friends and family but not with support from spouse. Waite, Duvoisin and Kotwal measure changes in social participation between the Silent Generation cohort, born between1938 and1947, and the Baby Boom cohort, born from1948-1958. They find find that the gender differences shown in the Silent Generation cohort are reduced among those born during the Baby Boom. Azar examines the moderating role of social policy, particularly defamilization, on the link between loneliness and health, using data from30 European countries and the U.S. Choi compares marital and partnership status, social support and strain in Silent Generation vs. Baby Boom cohorts. Her results suggest that those born during the Baby Boom are embedded in looser social relationships compared to their older counterparts. Together, these papers point to the importance of considering various dimensions of social life, gender, and context, including historical time and the life cycle, in understanding how the social world acts to affect well-being.
Time-Restricted Feeding and Caloric Restriction Impact on Spontaneous Neoplasms in Female Mice
Authors: Rudderow Annamaria , Duregon Eleonora , Bernier Michel , de Cabo Rafael
Published: December 2020

In older humans, multiple chronic diseases and increased life expectancy impose a disproportionate socioeconomic burden. Dietary interventions are valuable strategies for promoting healthy aging. Caloric restriction (CR) without malnutrition is a robust intervention able to delay disease onset and increase survival in model organisms. However, the impracticability of chronic CR outweighs the potential long-term benefits in humans. Time-restricted feeding (TRF), i.e. the limitation in the timing of food intake without necessarily reducing caloric intake, can protect against metabolic disorders through the synchronization of the circadian rhythm. This study compares whether limiting access to ad libitum (AL) food for a few hours per day mimics the beneficial effects of a CR diet. A large cohort of C57BL/6J female mice (n=250) was distributed into five feeding paradigms at midlife: AL, TRF for 8 hours, TRF for 4 hours, 20% CR and 20% CR fed twice a day (CRx2). Pathological analyses at death reveal a shift in fatal neoplasms toward an older age in TRF8 mice. AL mice had the highest prevalence of tumors (93%) and TRF4 had the lowest (77%). The highest tumor burden was observed in AL mice while CRx2 animals had the lowest number of neoplasms. Histiocytic sarcoma and lymphoma were the most represented malignancies, with CR mice exhibiting the highest rate of histiocytic sarcoma (75%) and the lowest rate of lymphoma (10%). These results indicate that time- and calorie-restricted feeding regimens can slow down malignant neoplasm progression and extend health span in female mice, even when started in adulthood.
Vaccination Improves CD4 T Helper Subset Balance in Aged Mice by Overcoming the Effects of the Senescent Environment
Authors: Torrance Blake , Lorenzo Erica , Keilich Spencer , Harrison Andrew , Al-Naggar Iman , Haynes Laura
Published: December 2020

Influenza (flu) infection is a leading cause of morbidity and mortality in older adults. Although vaccination is the best strategy to combat the effects of flu infection, there is a marked decline in vaccine efficacy in older adults. We hypothesized that an increased level of basal inflammation, a hallmark of the aging, plays a role in this decreased vaccine efficacy and that a vaccination strategy designed to augment the aged response to flu would be beneficial. Adjuvanted vaccination with a conserved influenza protein enhanced viral clearance, antibody production, and protected against weight loss in both young and aged mice. Vaccination also decreased levels of inflammation brought about by leukocyte infiltration and induced a strong type 2 cytokine environment in the lung. Additionally, vaccination reduced the proportion of flu-specific FoxP3+ T regulatory cells (Tregs) and decreased levels of TGF-β in aged lungs following infection. Accumulation of senescent cells, another hallmark of aging, can contribute to the inflammatory environment via their senescent associated secretory phenotype (SASP). Supporting a role for senescent cells in exacerbating age-related deficits in the response to vaccination, treatment of aged mice with the senolytic drugs Dasatinib and Quercetin also decreased levels of Tregs and TGF-β in the lungs following flu infection. These findings give insight to how vaccination responses can be ameliorated in older adults by targeting both inflammatory and regulatory signals and how accumulation of senescent cells could influence the dysregulation of the immune response with age.
Association of Sleep Quality and Nutritional Status in Middle-Aged and Older Adults: Findings From the WCHAT Study
Authors: Zhao Wanyu , Zhang Yan , Dong Birong
Published: December 2020

Poor sleep quality and malnutrition are two common symptoms which are closely related to the health of middle-aged and older people, but few studies focus on the association between them. In this study, we aimed to identify associations between sleep quality and nutritional status in middle-aged and older adults. A total of 6792 community-dwelling adults aged 50 and older from the baseline of the West China Health and Aging Trend (WCHAT) study were analyzed in the present study. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI). Scores <=5, 6-10,11-15 and >=16 were categorized as good/mild impaired/moderate impaired/severe impaired sleep quality, respectively. Mini Nutritional Assessment Short Form (MNA-SF) was used to assess the nutritional status and a score<12 was identified as at risk of malnutrition. Logistic regression models were conducted to explore the associations. Of 6792 participants (mean age 62.41 ± 8.26 years, 62.49% women), 1831 (26.96%) had risk of malnutrition. The prevalence of participants with good/mild impaired/moderate impaired/severe impaired sleep quality were 53.72%, 35.54%, 9.61%, and 1.12%, respectively. In the logistic regression model, there were significant association between mild/moderate/severe impaired sleep quality and the presence of risk of malnutrition (OR=1.49, 95% CI=1.32, 1.68; OR=2.15, 95% CI=1.79, 2.59; OR=2.52, 95% CI=1.56, 4.06; all p<0.05) after adjusting for potential confounders. Sleep quality was significantly associated with malnutrition risk with a dosage effect among middle-aged and older adults. Our results highlight the importance of maintaining good sleep quality and nutritional status in middle-aged and older adults.
Nurse-Driven Transitions Program Provides High Value End-of-Life Care to Veterans With Serious Illness
Authors: Driver Jane , Hayes Barbara , Chen Li , Gosian Jeffrey , Skarf Lara , Paik Julie , Kind Amy
Published: December 2020

We developed the Supportive Coordinated Transitions of Care (SC-TraC) pathway at VA Boston to improve the quality of end-of-life (EOL) care. A nurse case manager (NCM) with training and experience in geriatrics and palliative care enrolled hospitalized patients with advanced illness (life expectancy < 2 years) who were not enrolled in hospice, and provided phone-based care coordination after discharge for up to 1 year. Our prior work found that SC-TraC patients were more likely to receive goal-concordant care, 60% more likely to enroll in hospice, twice as likely to die at home with hospice, and half as likely to die in an ICU, with no difference in survival. We worked with VA Geriatrics and Extended Care Data Analytics Center to calculate VA and Medicare/Medicaid cost data for a cohort of 104 SC-TraC cases and 104 carefully matched controls enrolled January 2017-June 2018, with follow-up through December 2019. Total cost data (VA + non-VA) was available for all patients up to 6 months following initial discharge. Difference in total cost per-patient was higher in SC-TraC patients at 30 days post-discharge (+ $3,258), but lower at 90 days (-$1,686) and 6 months (-$1,267). SC-TraC cost was substantially less in the last 30 days of life (-$-4,057). Cost differences were due to more home-based and less inpatient/institutional care in the SC-TraC cohort. This data suggests that the SC-TraC program promotes high value EOL care and is a financially sustainable model.
Palliative Care Consult for Clinician Distress Through the Philosophical Lenses of Gender Norms and Phenomenology
Authors: Foxwell Anessa , Meghani Salimah , Ulrich Connie
Published: December 2020

The National Academy of Medicine has raised significant concerns on clinician health and well-being as many experiencing burnout, post-traumatic stress, and depression. Indeed, clinicians experience a range of human emotions when caring for older adults with severe, life-limiting illnesses. These emotions may manifest in multiple ways and from various sources. Uncertain of how to attend to such distress, clinicians may consult a trusted resource, including the palliative care team. Palliative care specialists are trained to support the complexities and needs of patients and families; increasingly, however, palliative care consults are rooted in clinician distress. This session uses clinical case examples to explore the palliative care consult for distressed clinicians from two different philosophical perspectives: (1) phenomenology and (2) the social construct of gender norms. A phenomenological lens respects the unique, subjective lived experience of each individual in their day-to-day interactions with patients, families, and health care systems. Therefore, when caring for seriously ill older adults, clinicians may bring their own subjective experiences to the patient encounter and react differently to ethical dilemmas and conflicts that arise. The social construct of gender norms asks us to examine clinician distress from a different perspective. Here, the postmodern rejection of gender binarism allows clinicians to experience a spectrum of emotions and distress regardless of gender. Exploration through clinical cases will highlight the unique, varied experience of clinician distress and offer opportunities for future research into the role of palliative care teams in supporting distressed clinicians who care for seriously ill older adults.
Multimorbidity and Depression Incidence Among Middle-Aged and Older Adults in China
Authors: Tang Fei , Vasquez Elizabeth
Published: December 2020

Previous studies suggested that multimorbidity (co-occurrence of two or more chronic conditions) is associated with increased risk of depression. However, limited studies have examined the relationships between multimorbidity and depression among Chinese middle-aged and older adults. The current study aimed to evaluate the associations between multimorbidity and incidence of depression and the potential mediation effect of functional limitation among Chinese middle–aged and older adults. Data of 8,093 individuals who participated in both wave 1 (2011) and wave 4 (2015) of China Health and Retirement Longitudinal Study (CHARLS) and were free of depression in wave 1 were included in the study. Multiple log-binomial regression models were used to evaluate the associations between multimorbidity and incident depression. Mediation analysis was conducted to examine the effect of functional limitation. A third of participants in our study were identified as having multimorbidity in wave 1 (N=2,479) and 23% participants were free of depression in wave 1 but had depression in wave 4 (N=1,827). After adjusting for potential confounders, multimorbidity was observed to be associated with depression incidence (RR: 1.31; 95% CI: 1.21 – 1.42). In addition, functional limitation mediated the relationship between multimorbidity and depression incidence. Our findings add to the literature on the potential associations between multimorbidity and depression incidence among Chinese middle-aged and older adults. Furthermore, the relationship between multimorbidity and depression incidence was observed to be mediated by functional limitation. Interventions that improve functional ability among Chinese middle-aged and older adults could potentially attenuate the effect of multimorbidity on depression incidence.
Body Measurement and Health Risk Education Effects on Older Adults’ Health Beliefs and Behaviors
Authors: Gaynor Beatrice
Published: December 2020

Waist circumference (WC) measurement is an indicator of central obesity related disease risk that is rarely used in primary care (PC). The current PC practice of body mass index (BMI) calculation to screen for disease risk lacks specificity to the older adult habitus. Guided by the Health Belief Model, this study utilized a one-way analysis of covariance to examine the effect of experimental cues, WC measurement and central obesity disease risk education, compared to control cues, BMI and obesity classification, on older adults’ health beliefs (perceived susceptibility and health benefits) and behaviors (diet and exercise) 6 weeks post cues/intervention. Of the 99 participants (control group [N=49]; experimental group [N=50]) 92% reported ‘never’ having WC measurement and 76% reported ‘never’ having BMI calculation in PC. Both groups reported high levels of perceived susceptibility and exercise at baseline. Changes in perceived susceptibility, diet, and exercise were non-significant in either group. There was a significant increase in perceived health benefits of WC measurement (p=0.01) and BMI calculation (p=0.01) in the experimental group compared to the control group. Willingness to exercise (p=0.007) significantly increased in the experimental group compared to the control group. The lack of BMI experience in both groups may have caused control cues to function as experimental cues in both groups. Thus, this study provides evidence that combined use of WC measurement, central obesity health risk education, BMI calculation, and obesity classification increase perceived benefits of body measurements and motivate physical activity in older adults over BMI and obesity classification alone.
Association of Affect and Gait Performance in Dual-Task Walking in Non-Demented Older Adults
Authors: Guharajan Deepan , Holtzer Roee
Published: December 2020

Aging populations are at increased risk to experience mobility disability, which is associated with falls, frailty, and mortality. Previous studies have not examined the concurrent associations of both positive and negative affect with gait velocity. We examined whether individual differences in positive and negative affect predicted dual-task performance decrements in velocity in a dual-task (DT) paradigm in non-demented older adults. We hypothesize that positive affect would be associated with lower DT costs, and negative affect would be associated with higher DT costs. Participants (N = 403; mean age, = 76.22 (6.55); females = 56%) completed the Positive and Negative Affect Schedule (PANAS) and a DT paradigm that involved three task conditions: Single-Task-Walk (STW), Alpha (cognitive interference requiring participants to recite alternate letters of the alphabet), and Dual-Task-Walk (DTW) requiring participant to perform the two single tasks concurrently. Gait velocity was assessed via an instrumented walkway. As expected, results of a linear mixed effects model (LME) showed a significant decline in gait velocity (cm/s) from STW to DTW (estimate = -11.79; 95%CI = -12.82 to -10.77). LME results further revealed that negative affect was associated with greater decline in gait velocity from STW to DTW (ie., worse DT cost) (estimate = -0.38; 95%CI = -0.73 to -0.03). Positive affect did not, however, predict DT costs in gait velocity (estimate = -0.09; 95%CI = -0.23 to 0.05). These findings suggest that increased negative affect interferes with the allocation of attentional resources to competing task demands inherent in the DT paradigm.
The Impact of Bilingualism on Cognitive Functioning in Older Adults
Authors: Rouse Hillary , Small Brent , Schinka John
Published: December 2020

Research on bilingualism has found inconsistent results regarding its potential benefit on the cognitive abilities of older adults. The goal of the current study was to evaluate differences in cognition on a wide array of neuropsychological assessments between monolingual and bilingual cognitively healthy older adults who specifically speak only English and/or Spanish. The sample included cognitively intact older adults who were either monolingual (n=247) English speakers or bilingual (n=42) in English and Spanish. Performance was compared between groups from a battery of neuropsychological assessments that measured executive function, attention, short-term memory, and episodic memory. Compared to English and Spanish bilinguals, monolingual English speakers performed significantly better on a variety of tasks within the domains of executive function, attention, and short-term memory. No significant differences were found in favor of the bilinguals on any domain of cognitive performance. In the present study, we failed to observe a significant advantage for English and Spanish bilingual speakers on the cognitive performance of older adults when compared to monolingual English speakers. This study suggests that the bilingual advantage may not be as robust as originally reported, and the effects of bilingualism on cognition could be significantly impacted by the languages included in the study.
Pornography: How Does the Boomer Generation and Older Predict Others’ Viewing Time?
Authors: Sakel Katie , Grubbs Joshua
Published: December 2020

The increase of exposure to online pornography has decreased the age of initial exposure to pornography. However, very little is known about the outcomes resulting from increased pornography exposure in the Baby Boomer generation and beyond. The current study asked what predictors were significant in individuals born in 1965 and earlier when predicting the perceived pornography viewing time for the average man and woman. To answer this question, a nationally representative population (N = 1073, 510 males) completed a web-based survey measuring the age of the participant, gender of the participant, self-directed sexual behaviors (“How frequently have you masturbated while viewing pornography alone?”), partner-directed sexual behaviors (“How frequently have you viewed pornography with a partner?”), a religiosity index (“How important is your religion?”), and the predicted perceived time that a woman and man watches pornography, Results showed that perceived time that the average man spent viewing pornography was significantly predicted by age of the participant, gender of the participant, self-motivated sexual behaviors and partner-motivated sexual behaviors. Religiosity was not a significant predictor. In the regression predicting perceived time that the average woman viewed pornography were age of the participant, self-motivated sexual behaviors, and partner-motivated sexual behaviors. Gender of the participant and religiosity of the participant were not significant predictors. Further research should expand this work to a lifespan perspective and longitudinal studies.
Bringing Transdisciplinary Aging Research From Theory to Practice
Authors: Sargent Lana , Slattum Patricia , Brooks Marshall , Gendron Tracey , Mackiewicz Marissa , Diallo Ana , Waters Leland , Winship Jodi , Battle Kimberly , Ford Gregory , Falls Katherine , Chung Jane , Zanjani Faika , Pretzer-Aboff Ingrid , Price Elvin T , Prom-Wormley Elizabeth , Parsons Pamela ,   iCubed Health and Wellness in Aging Transdisciplinary Core
Published: December 2020

There is a growing emphasis to use a transdisciplinary team approach to accelerate innovations in science to solve complex conditions associated with aging. However, the optimal organizational structure and process for how to accomplish transdisciplinary team science is unclear. In this forum, we illustrate our team’s experience using transdisciplinary approaches to solve challenging and persistent problems for older adults living in urban communities. We describe our challenges and successes using the National Institutes of Health four-phase model of transdisciplinary team-based research. Using a de-identified survey, the team conducted an internal evaluation to identify features that created challenges including structural incongruities, interprofessional blind spots, group function, and group dynamics. This work resulted in the creation of the team’s Transdisciplinary Conceptual Model. This model became essential to understanding the complex interplay between societal factors, community partners, and academic partners. Conducting internal evaluations of transdisciplinary team processes is integral for teams to move beyond the multi- and interdisciplinary niche and to reach true transdisciplinary success. More research is needed to develop measures that assess team transdisciplinary integration. Once the process of transdisciplinary integration can be reliably assessed, the next step would be to determine the impact of transdisciplinary team science initiatives on aging communities.
Narrative review on endovascular techniques for left subclavian artery revascularization during thoracic endovascular aortic repair and risk factors for postoperative stroke
Authors: D’Oria Mario , Mani Kevin , DeMartino Randall , Czerny Martin , Donas Konstantinos P , Wanhainen Anders , Lepidi Sandro
Published: December 2020

OBJECTIVES

The aim of this study was to present a narrative review on endovascular techniques (ET) for revascularization of the left subclavian artery (LSA) during zone 2 thoracic endovascular aortic repair (TEVAR) and on risk factors for postoperative stroke following TEVAR procedures.

METHODS

Non-systematic search of the literature from the PubMed, Ovid and Scopus databases to identify relevant English-language articles fully published in the period 1 January 2010–1 August 2020.

RESULTS

Current general agreement is that LSA revascularization should be always attempted in the elective setting. Under urgent circumstances, it can be delayed but might be considered during the same session on a case-by-case basis. Three ET are currently available: (i) chimney/snorkels (also known as parallel grafts), (ii) fenestrations or branches and (iii) proximal scallops. The main issue with ET is the potential for increased peri-operative stroke risk owing to increased manipulation within the aortic arch. Also, they are relatively novel and further assessment of their long-term durability is needed. Intra-operative embolism and loss of left vertebral artery perfusion are hypothesized as the main causes of stroke in patients undergoing TEVAR.

CONCLUSIONS

The overall risk of stroke seems higher without LSA revascularization during zone 2 TEVAR. As LSA revascularization might have a direct effect in preventing posterior stroke, it should be routinely performed in elective cases, while a case-by-case evaluation can be made under urgent circumstances. While ET can provide effective options for LSA revascularization during zone 2 TEVAR, they are novel and need further durability assessment. Stroke after TEVAR is a multifactorial pathological process and preventing TEVAR-related cerebral injury remains a significant unmet clinical need.
Opportunities and Challenges in Development of Live Biotherapeutic Products to Fight Infections
Authors: Ducarmon Quinten R , Kuijper Ed J , Olle Bernat
Published: December 2020

Treatment of bacterial infections with broad-spectrum antibiotics is a strategy severely limited by the decreased ability of the perturbed resident microbiota to control expansion of antibiotic-resistant pathogens. Live biotherapeutic products (LBPs) could provide an alternative to antibiotics in infection control by restoring gut colonization resistance and controlling expansion of resistant strains, an important therapeutic need not being addressed with existing anti-infective drug modalities. We review opportunities and challenges in developing LBPs for multidrug-resistant organisms colonization and infection control, with a focus on commercial fecal microbiota transplantation-like products and defined bacterial consortia, and spanning considerations related to availability of models for rational drug candidate selection and dose regimen selection, good manufacturing practice, intellectual property, and commercial viability.
The impact of anti-mould prophylaxis onAspergillusPCR blood testing for the diagnosis of invasive aspergillosis
Authors: Cruciani M , White P L , Mengoli C , Löffler J , Morton C O , Klingspor L , Buchheidt D , Maertens J , Heinz W J , Rogers T R , Weinbergerova B , Warris A , Lockhart D E A , Jones B , Cordonnier C , Donnelly J P , Barnes R A ,   the Fungal PCR Initiative, Klingspor L , Buchheidt D , Maertens J , Heinz W J , Rogers T R , Weinbergerova B , Warris A , Lockhart D E A , Jones B , Cordonnier C , Donnelly J P , Barnes R A
Published: December 2020

Background

The performance of the galactomannan enzyme immunoassay (GM-EIA) is impaired in patients receiving mould-active antifungal therapy. The impact of mould-active antifungal therapy on Aspergillus PCR testing needs to be determined.

Objectives

To determine the influence of anti-mould prophylaxis (AMP) on the performance of PCR blood testing to aid the diagnosis of proven/probable invasive aspergillosis (IA).

Methods

As part of the systematic review and meta-analysis of 22 cohort studies investigating Aspergillus PCR blood testing in 2912 patients at risk of IA, subgroup analysis was performed to determine the impact of AMP on the accuracy of Aspergillus PCR. The incidence of IA was calculated in patients receiving and not receiving AMP. The impact of two different positivity thresholds (requiring either a single PCR positive test result or ≥2 consecutive PCR positive test results) on accuracy was evaluated. Meta-analytical pooling of sensitivity and specificity was performed by logistic mixed-model regression.

Results

In total, 1661 (57%) patients received prophylaxis. The incidence of IA was 14.2%, significantly lower in the prophylaxis group (11%–12%) compared with the non-prophylaxis group (18%–19%) (P < 0.001). The use of AMP did not affect sensitivity, but significantly decreased specificity [single PCR positive result threshold: 26% reduction (P = 0.005); ≥2 consecutive PCR positive results threshold: 12% reduction (P = 0.019)].

Conclusions

Contrary to its influence on GM-EIA, AMP significantly decreases Aspergillus PCR specificity, without affecting sensitivity, possibly as a consequence of AMP limiting the clinical progression of IA and/or leading to false-negative GM-EIA results, preventing the classification of probable IA using the EORTC/MSGERC definitions.