bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPACT OF DEPRESSIVE SYMPTOMS ON ORAL HEALTH OF OLDER ADULTS WITH CHRONIC CONDITIONS BY GENDER
Authors: Hong Dahye , Kim Jennifer (Jeehyun) , Kang Bada
Published: December 2023

Oral health is crucial for the nutrition and well-being of older adults, especially those with chronic conditions. Although recent studies have demonstrated an association between depressive symptoms and oral health, little is known regarding the gender-specific association between symptoms of depression and oral health among older Korean adults with chronic conditions. Therefore, this study examined the gender-specific relationship between depressive symptoms and oral health, using data from the Korean Longitudinal Study of Aging (2018–2020). Study participants aged 65 or older with one or more chronic conditions were analyzed (N = 1,185 women and 1,919 men). The comprehensive aspects of oral health, including functional limitations, pain, discomfort, and psychological and behavioral impacts, were measured. Generalized Estimation Equation analyses were applied to two models presenting depressive symptoms dichotomously and the severity of depression, respectively. When considering depressive symptoms in dichotomous manner, such as present or absent, having three or more chronic conditions and experiencing cognitive decline were both significantly related to deteriorated oral health for both genders. Moreover, the association between depressive symptoms and deteriorated oral health was more robust in men. While categorizing the severity of depressive symptoms, the worse the depressive symptoms, the poorer the oral health in women. Therefore, this study suggests that interventions to alleviate depressive symptoms could benefit the oral health of both men and women with multiple chronic conditions. For women, targeted interventions based on the severity of depressive symptoms could effectively improve oral health.
IMPLEMENTATION OF VIRTUAL REALITY TO IMPROVE QUALITY OF LIFE FOR VETERANS IN HOSPICE AND PALLIATIVE CARE
Authors: Laffer Alexandra , Corle Melanie , Canell Anastasia , Moo Lauren , Gately Megan , Dillon Kristen
Published: December 2023

Virtual Reality (VR) is a safe and effective adjunctive care option with multiple clinical applications. An interdisciplinary VR program aimed at improving quality of life for veterans receiving inpatient hospice and palliative care was implemented at the VA Bedford Health Care System. Principles from the 4Ms of Geriatrics (Mentation, Mobility, Medications, and Matters Most) guided evaluation and outcomes. Implementation involved decision-making around hardware and software, learning about processes at other facilities, financing, and creating policies and procedures. Project development began in 2021 and data collection began in March 2023. Veteran residents enrolled in inpatient hospice and palliative care were invited to participate. As of August 2023, 22 VR visits were conducted with 13 veterans. Preliminary data suggests VR can be used with a wide range of individuals receiving hospice and palliative care. Analysis of pre-post measures indicate improvement in mood (62%) and overall day (81%), and reduced pain. Barriers to engagement include staffing (e.g., availability), technology (e.g., VR technical issues), hospital procedures/policies (e.g., infection control, COVID-19), and patient factors (e.g., interest, symptoms). Facilitators include hospital support, interdisciplinary collaboration, and understanding of the setting and patient preferences/ needs. Although conception to implementation took two years, a VR program to improve quality of life for veterans enrolled in hospice and palliative care appears to be feasible and clinically beneficial. Experience has shown that flexibility, adaptability, and an individualized approach facilitate engagement. Best practices in the application of VR within the hospice and palliative care setting will continue to be evaluated and honed.
IMPLEMENTING AN AREA AGENCY ON AGING COMMUNITY CARE TRANSITION INITIATIVE: FACILITATORS AND BARRIERS
Authors: Coe Antoinette , Chiang Hao-Ping , Rowell Brigid , Bergman Nathaniel
Published: December 2023

The Michigan Region VII Area Agency on Aging (AAA) implemented a Community Care Transition Initiative (CCTI) for rural hospitalized older adults at high risk for readmission. After discharge home, AAA CCTI participants received a home visit by an AAA-trained pharmacy technician community health worker (CHW), a telehealth AAA pharmacist medication review, assessments by the CHW and pharmacist, education, primary care follow-up coaching, and referrals. As part of a program evaluation, we conducted six interviews with AAA key informants (e.g., pharmacist, director, CHWs). A semi-structured interview guide was piloted and revised to assess implementation, processes, impact, and future directions. Interviews were conducted via Zoom, recorded, transcribed, and checked for accuracy. Thematic analysis was used to identify implementation facilitators, barriers, and areas for program refinement. Three researchers coded the transcripts, developed a codebook, and resolved discrepancies by consensus. NVivo 14® was used for data management and analysis. Barriers to AAA CCTI implementation included unknowns at project start and need for procedures, anxiety about entering a client’s house, client’s lack of familiarity with technology, lack of perceived pharmacist benefit, limited personnel, and billing or financial reimbursement. Facilitators identified were the AAA’s reputation and backing, relationships built between healthcare providers, referral processes (e.g., community mental health), and pharmacist telehealth visit efficiency. Program refinements included shortened follow-up time and tailored visits to different client situations and needs. The results provide insights into the design of implementation strategies to disseminate the AAA CCTI to meet rural older adults’ health and social needs after hospitalization.
IMPLEMENTING CARE COORDINATION WITH HOME DELIVERED MEALS AND HEALTHCARE: CHALLENGES AND LESSONS LEARNED
Authors: Orsega-Smith Elizabeth , O’Hanlon Julia , Karpyn Allison
Published: December 2023

Increasing lifespans are resulting in frail, isolated and food insecure older adults. Home Delivered meals (HDMs) are gateways into the homes of frail and vulnerable older adult, and this program will explore how HDMs can provide a natural opportunity to identify health issues potentially preventing unnecessary emergency rooms visits and hospitalizations. A daily wellness check and care coordination involved the use of a program coordinator, a nurse advocate, a local and predominately rural senior center (HDM provider and its HDM volunteers), and university evaluation team designed to support innovative health services provided to vulnerable older adults. The purpose was to examine the evaluation results 12 months after program. At baseline, clients reported high physical dependence (91.6%), hypertension (72.13% ), risk for falls (100%), and risk of food insecurity (48%). During the 12 month period, the nurse advocate team made 6,096 phone calls to participants with most phone calls (79.5%) categorized as a general client check-ins. Calls directly impacting quality of life included transportation support (6.1%), housing support (4.3%), and access to medical equipment (6.7%). Approximately 650 calls were service-related calls to outside agencies, organizations, and medical providers. This model exemplifies the increasing importance of clinicians and public health professionals, working collaboratively with community-based resources. The role of the nurse advocate team is critical in connecting resources to individuals based on specific circumstances and conditions, including geographic location and ability to access medical and social services. These efforts helped to avoid expensive treatments, manage living challenges, and facilitate medical care.
IMPROVING LONG-TERM CARE THROUGH GERIATRICS EDUCATION: A DEEP DIVE INTO GWEP AND GACA INITIATIVES
Authors: Tucker-Roghi Gina , Moone Rajean , Hernandez Christopher , Moerk Hannah , Edelman Linda , Towsley Gail
Published: December 2023

Formal geriatrics education remains limited for many of the numerous health care professionals working with older adults. A well-prepared long-term services and supports (LTSS) workforce is imperative to care for older adults with multiple chronic conditions, especially dementia. This study highlights the role of Geriatric Workforce Enhancement Programs (GWEPs) and Geriatrics Academic Career Awards (GACAs) in addressing this need. An online survey, conducted 5/2023-6/2023, captured data from GWEPs (n=18) and GACAs (n=11) about training offered towards age- and dementia-friendly care in LTSS settings. Results revealed that 13 GWEPS or GACAs provided 36 learning activities that addressed the first recommendation, “Delivering comprehensive, person-centered, equitable care that ensures residents’ health, quality of life and safety” of the National Imperative to Improve Nursing Home Quality (NASEM). Twelve GWEPS/GACAs provided 42 learning activities addressing the second NASEM report recommendation, “ensuring a well-prepared, empowered, and appropriately compensated workforce.” GWEPS/GACAs are also aiding LTSS settings in achieving Age-Friendly Health Systems Designations: one each supported level 1 or 2 designation, two supported achieving both levels. Additionally, four GWEP/GACAs are working with LTSS entities toward level 1 status, one toward level 2, and one toward achieving both levels. Our findings underscore the pivotal role of GWEPS/GACAs in enhancing geriatrics education, addressing challenges in LTSS, and the pressing need for continued support. Recommendations emphasize strengthening partnerships between LTSS settings and GWEPs/GACAs to bridge educational gaps. Implications indicate GWEPS and GACAs are playing a crucial role in helping LTSS settings achieve age-friendly standards and align with the NASEM report’s vision.
INCARCERATION AS A RISK FACTOR FOR IMPAIRMENT IN COGNITIVE FUNCTIONING
Authors: Daniel George , Williams Cedric , Wilkinson Joel , Mwendwa Denee
Published: December 2023

Background

Incarceration is a social determinant of health with public health implications, especially among minoritized communities of color. The experiences of incarcerated people have deleterious implications for mental and physical health outcomes. Research has demonstrated an association between incarceration and poorer global cognition in older adults. The current study examines the long-term impact of incarceration on cognitive functioning in older adults and examines whether this relationship is moderated by race, ethnicity, and sex.

Methods

Data were collected on participants (n=7,557) in the Health and Retirement Study (HRS). They completed a background questionnaire, psychosocial assessments, and a series of neuropsychological tests. T-tests and Chi-Squared analyses determined differences in demographic and health variables by incarceration status. Linear regression analysis determined if incarceration status predicts poorer cognitive functioning in older adults while controlling for age, race, sex, ethnicity, education, hypertension, diabetes status, wealth, depression, and stroke. Subgroup analyses determined whether associations were modified by race, ethnicity, or sex.

Results

Our sample is on average 74 years old, 13% Black, and 60% female. Formerly incarcerated people were younger, disproportionately Black, less wealthy and educated, and more unhealthy. Analyses indicated that incarceration predicted reduced performance in delayed verbal recall (B = -0.19, p = 0.047) and this relationship may be stronger in Non-Hispanics, African-Americans and Women.

Conclusion

Incarceration may negatively impact long-term memory in older adults and varies by gender, race, and ethnicity. Future studies should investigate variables that influence this relationship, including SES, depression, and chronic illnesses.
INFLAMMATORY CYTOKINES MEDIATE EXECUTIVE FUNCTION AND STRESS AMONG AGING ADULTS
Authors: Kircher Julie , Charles Susan , Almeida David
Published: December 2023

Strong and consistent evidence demonstrates that a risk factor for poorer executive function is elevated levels of perceived stress. More recently, researchers have posited that inflammatory processes may contribute to the association between stress and cognitive declines. Similarly, research suggests that greater sustained inflammation can result from higher levels of stress. Furthermore, older adults are at a higher risk of experiencing cognitive decline when under greater stress. We hypothesized that inflammation, as measured by a composite of pro-inflammatory cytokines CRP, IL-6, and TNF-a, would mediate the relationship between perceived stress and executive function. Data were derived from the cognitive and biomarker projects in the second and third waves of the Midlife in the United States Study (MIDUS). The present study included 1,067 participants (Mage = 63.7; Range 39 - 94). The results showed a significant total effect between executive function and perceived stress (β = .05, p <.001). Furthermore, path analyses revealed significant pathways between stress on inflammation (β = 0.29 p <.001) and inflammation on executive function (β = .06, p <.001). Finally, when inflammation was entered into the relationship between perceived stress and executive function its direct effect was significant (β = 0.06, p <.001). These findings suggest that pro-inflammatory cytokines help to explain why perceived stress is related to lower capability in executive functions. Future research should focus on understanding and assessing the interactions between inflammation, stress, and cognitive functioning over time.
INNOVATION IN AGING & ACQUIRED BRAIN INJURY REHABILITATION: THE POTENTIAL OF MIXED REALITY TECHNOLOGIES
Authors: Figeys Mathieu , Koubasi Farnaz , Hwang Doyeon , Hunder Allison , Chan Andrew , Miguel-Cruz Antonio , Rincón Adriana Ríos
Published: December 2023

Background

Every 21 seconds an American experiences a Traumatic Brain Injury (TBI), and every 40 seconds, another endures a stroke. These events fall under Acquired Brain Injuries (ABI) with prevalence rates impacted by an aging population. ABI can lead to various physical, cognitive, and mental impairments, emphasizing the need for innovative rehabilitation strategies, including those specific to older adults. Mixed Reality (MR) technologies offer potential in enhancing ABI rehabilitation, yet face challenges such as methodological inconsistencies, differing clinical populations, and exaggerated efficacy claims.

Objectives

1) Review MR’s role in ABI rehabilitation among older adults, assessing the implications of aging, clinical, and technological considerations. 2) Present ongoing MR research at the Glenrose Rehabilitation Hospital (GRH, Edmonton, Canada).

Methods

1) A systematic review following PRISMA guidelines was performed across seven databases, with two independent reviewers analyzing the data. The analysis emphasized clinical objectives, MR systems, levels of evidence, and technology readiness levels. 2) QR codes that link to videos will highlight the ongoing research and development of MR-delivered ABI rehabilitation at the GRH.

Results

Twenty-six studies met the inclusion criteria, totalling 453 subjects with ABI (mean age: 60 ± 5.34 years). MR applications mainly targeted upper limb motor rehabilitation, revealing an overall low level of evidence and a median technology readiness level of 6 (prototypes tested in relevant environments).

Conclusion

Despite existing variability and technological challenges, the promising results stress the importance of ongoing research and innovation in MR rehabilitation. The GRH stands as a key research hub, actively advancing this field.
INTERPRETING PERSON-CENTEREDNESS IN RELATION TO CARE AND THE WORKFORCE FOR OLDER ADULTS
Authors: Saavedra Antonio , Sloane Philip , Zimmerman Sheryl , Fazio Sam
Published: December 2023

The concept of person-centeredness has been widely referenced and seemingly adopted as a gold standard practice, especially in relation to care for older persons. However, the concept of person-centeredness has evolved over time, resulting in a lack of definitional clarity. As part of a series of studies exploring person-centeredness, we investigated the meaning of person-centeredness as it relates to care and the workforce for older adults. Six think-tank meetings (two in-person; four virtual) were convened, including a national purposive sample of 33 participants selected for diversity and expertise, and including providers, consumers, policy makers, and researchers. Qualitative methods were used to analyze notes and transcripts, resulting in four overarching themes: (1) Different care settings (e.g., hospice, nursing home) tend to vary in the extent and manner of person-centeredness due to their inherent characteristics and goals of care. (2) Leadership tends to assign priority to quality citations and safety protocols, which creates dissonance between the desire to be more person-centered and a demanding organizational culture. (3) Person-centeredness can be conveyed through concrete practices (e.g., care for activities of daily living) or general principles; the former may be easier to implement. (4) The lack of an operationalized person-centeredness definition has created a gap in how to teach it. This presentation will tie together the four themes and address attitudes and approaches within organizations and toward care providers.
INTERPROFESSIONAL GERIATRIC ASSESSMENT CLINIC: STUDENT SKILL DEVELOPMENT AND PATIENT SATISFACTION
Authors: Butler Ryan , Phifer Lisa , Ehlman Katie , Leahy Suzanne , Keller Ashley , Jung Haneul
Published: December 2023

The University of Southern Indiana Interprofessional Geriatric Assessment Clinic (IGAC) provides interprofessional clinical experience to medical residents and health profession students using the Institute for Healthcare Improvement’s Age-Friendly 4 Ms model while addressing the complex health conditions of medically underserved older adult patients. This study examines student skill development and patient satisfaction. A nursing student, medical resident, Area Agencies on Aging (AAA) case manager, and an occupational therapy or physical therapy student utilize evidence-based assessment tools to examine the four elements of Age-Friendly 4 Ms care, including high risk medications, mobility, mentation, and what matters. Students (N=56) completed a retrospective pre-posttest measuring six skills related to IGAC activities. In addition, patients (N=42) completed a posttest measuring satisfaction of the IGAC visit. “Administering standardized health assessments” and “using information about patient social needs to develop healthcare recommendations” were the two IGAC skills wherein students perceived the largest gains, based on paired samples t-tests of significance and Cohen’s d measurement of effect size. Students also reported statistically significant, moderately sized gains in “documenting patient measurements in a medical chart”, “communicating medical information to other health professionals”, and “conducting clinical visits with older adult patients”. Ninety-two percent of patients were satisfied with the overall actions of the care team for their visits. This research indicates that the USI IGAC both increases student skill development and supports patient satisfaction.
INTERVENTIONS FOR PERSONS WITH YOUNG-ONSET DEMENTIA AND THEIR FAMILIES: A SCOPING REVIEW
Authors: Cui Xiaoyan , Wang Junqiao , Wu Bei , Zhao Qianhua , Tang Xueting , Thompson Roy , Wang Jing
Published: December 2023

Young Onset Dementia (YOD) poses unique challenges for individuals and their families globally by impacting their working-age years and family responsibilities. The paucity of effective treatments emphasizes the need for tailored interventions and support services to enhance quality of life and social engagement. Dementia care services oftentimes fail to meet YOD-specific needs, necessitating customized approaches. This review aims to synthesize non-pharmacological intervention studies for YOD individuals and families to inform future targeted interventions. We conducted a systematic literature search across four databases. Included articles were carefully screened, categorized, and synthesized. This review examined 12 studies focused on persons with YOD. Interventions targeted daily life support, cognitive decline, and social engagement, using quantitative, qualitative, or mixed methods designs. Nine studies addressed interventions for families focused on self-efficacy, burden, anxiety, depression, quality of life, post-traumatic stress, and well-being. This review revealed a dearth of family-centered intervention studies, emphasizing the need for more comprehensive and tailored interventions for families of individuals with YOD. There is urgent need for more large-scale intervention studies, especially from Low and Middle income countries, which should adopt family-centered and life course perspectives. For future interventions , more extensive incorporation of stakeholder involvement is essential for successful implementation. Moreover, the integration of new technologies shows promise as a potential avenue for intervention advancement.
INVESTIGATING THE USE OF FORMAL AND INFORMAL SUPPORTS BY OLDER ADULTS LIVING ALONE WITH MULTIPLE CHRONIC CONDITIONS
Authors: Minyo Morgan , Bass David , Judge Katherine , McCarthy Catherine
Published: December 2023

Older adults living alone with multiple chronic health conditions and/or functional limitations are at an increased risk for experiencing unmet needs and associated negative outcomes. Formal and informal support services benefit older adults by addressing unmet needs, making this population a common target among clinical interventions aiming to increase levels of support. To further our understanding of this vulnerable population, this investigation describes unmet needs and assistance with tasks in a sample of older adults living alone with chronic conditions (n=38). Baseline data collected from a randomized controlled pilot study was used for descriptive analyses. Participants average age was 77.1 (SD=11.6), 42.1% identify as Black, and 68.4% identify as female. On average, participants reported 6.0 (SD=3.7) chronic health conditions and 52.6% reported difficulty with two or more daily living tasks. Nearly 90% of participants reported at least one unmet need, with 60.5% having four or more (M=6.1, SD=5.2). Interestingly, 71.1% of participants reported receiving assistance from family/friends (M=2.8, SD=2.9) and 86.8% reported receiving assistance from service providers (M=3.1, SD=2.4) with at least one task in the past 3 months. Only one participant reported receiving no assistance. Family/friends most frequently assisted with household chores (47.4%), transportation (44.7%), and emotional support (39.5%). Service providers most frequently assisted with transportation (50.0%), emotional support (31.6%), and getting information about a health problem (31.6%). These findings provide insight on the formal and informal support services used by older adults who live alone and the individual characteristics that could make specific sub-groups successful clinical intervention targets.
JOB EXPECTATIONS VS. REALITY: WORKPLACE EXPERIENCES FROM THE NURSING HOME FRONTLINES
Authors: Miller Vivian , Wagner Jennifer , Maziarz Lauren , Burek Melissa , Bell Julia , Perry Kaley
Published: December 2023

Nursing assistants have been at the frontlines of nursing home care, providing direct resident care and services to aging adults. The U.S. Bureau of Labor Statistics projects an increased employment need for nurse aides over the next ten years. However, the annual rate of nurse aide turnover is over 120 percent. To better understand the unique factors that contribute to nurse aide turnover in nursing homes and assisted livings, this sequential mixed-methodological study design reports findings of activities, relationships, and job interactions that contribute to nurse aide turnover. Guided by a socio-ecological model, qualitative findings from 17 nurse aides (N=17) reveal interpersonal factors, such as relationships with others at the workplace and relationships with residents, as impacting turnover. Institutional and Community factors were also found to impact turnover, including staffing levels, resources, education, and compensation. Informed by the interview findings, there were 239 nursing home or assisted living nurse aides (N=239) that participated in the quantitative portion of this study. Over one-quarter of nurse aides (27.80%) reveal that getting to know the residents was one of the best things about working in a nursing home or assisted living. Of direct care tasks, nurse aides reported physical injury or strain (20.16%), and the physical demands of the job (20.16%) as the greatest challenges. Taken together, findings from this study reveal that using community-engaged research methods in nursing home research may lead to a more nuanced understanding of the workplace needs and desires of nursing assistants.
KYNURENINE METABOLITES INDUCE MICROGLIAL CELL SENESCENCE AND STIMULATE NEUROINFLAMMATION
Authors: Bonaparte Jimeace , Cook Maxwell , Dixon Steven , Wright Cynthia , Hill William , Wang Gavin
Published: December 2023

Aging is the greatest known risk factor for Alzheimer’s disease (AD) and other forms of dementia. Aging is associated with increased inflammation, which stimulates the activation of the kynurenine pathway and the production of kynurenine metabolites, including kynurenine (KYN), kynurenic acid (KYNA), 3-hydroxykynurenine (3HK), and quinolinic acid (QA). Previous studies have shown an elevated level of KYN and its metabolites in age-related diseases, including AD. Growing evidence suggests that age-associated accumulation of senescent cells plays a critical role in brain aging and AD pathogenesis. However, it remains to be determined how KYN or its metabolites affect neural cell senescence. The goal of this study was to investigate the effects of KYN and its metabolites on senescence induction in HMC3 human microglial cells. HMC3 cells were treated with a range of doses of KYN metabolites over multiple time points (3-48 hrs). Results showed that multiple independent senescent biomarkers were increased in 3HK-treated HMC3 cells, including SA-β-gal, whereas KYN-treated cells exhibited only a low level of SA-β-gal. The senescence induction effect of 3HK was further confirmed by increased expression of the p21 and p19 senescence markers. Furthermore, our data reveals that 3HK is the most potent metabolite to stimulate the secretion of the neuroinflammatory cytokine interleukin-6 (IL-6) by microglia compared to other KYN metabolites, and this result also demonstrates the SASP phenotype of 3HK-treated HMC3 cells. Taken together, these new findings suggest that KYN and its metabolites may contribute to the pathogenesis of AD via stimulating glial cell senescence and SASP-mediated neuroinflammation.
KYNURENINE PATHWAY INHIBITORS COMBINED WITH NAD+ PRECURSORS INCREASES LONGEVITY GENE EXPRESSION IN DROSOPHILA
Authors: Said Adam , Huang Qiao , Wu Yuqiong , Walston Jeremy , Westbrook Reyhan , Abadir Peter M
Published: December 2023

With rates of aging-related functional decline rising, the need for novel intervention strategies to extend lifespan has increased. In humans, the kynurenine pathway (KP) metabolizes tryptophan and produces nicotinamide adenine dinucleotide (NAD+). KP is correlated negatively with longevity and increased KP metabolite concentrations decrease the average and maximum lifespans in flies. However, genetic and pharmacological inhibition of tryptophan metabolism and dietary supplementation of NAD+ precursors increase the average and maximum lifespans in flies. To comprehensively explore the effects of KP manipulation, we fed DGRP_229 Drosophila males diets infused with ⍺-MT (KP inhibitor), nicotinamide (NAM, an NAD+ precursor), or the combination of NAM and ⍺-MT. We found that all treatments resulted in increased average and maximum lifespans, with the combination treatment displaying the greatest increase compared to the control of 30% (P< 0.0001). The combination treatment resulted in an average lifespan increase of 15% in relation to ⍺-MT alone (P< 0.0001) and 18% in comparison to NAM alone (P< 0.0001). To gain more insight into the biological mechanisms through which different treatments affect lifespan, we performed qRT-PCR on 11 longevity genes in Drosophila. We found that the combination treatment significantly increased the expression of gigas (Gig) (P=0.03), which interacts with Tsc1 to control cellular growth by regulating insulin and TOR signaling pathways, and sirtuin 1 (Sirt1) (P=0.03), an NAD+-dependent histone deacetylase. Our results demonstrate that the combined treatment of KP inhibition and NAD+ precursor elicits a transcription response similar to other lifespan-enhancing treatments and could be used as an alternative intervention method.
LONELINESS AMONG UNDER-REPRESENTED OLDER ADULTS IN THE UK: A STUDY OF MINORITY ETHNIC AND LGBTQ+ POPULATIONS
Authors: Victor Christina , Rippon Isla
Published: December 2023

Internationally loneliness has been identified as a major public health problem. Although there is a substantial body of research about loneliness in older adults in the UK, there is a significant evidence gap reporting experiences of loneliness of older people from ethnic minorities and those who identify as lesbian, gay, or bisexual and transgender (LGBT). These two groups, under-represented in UK gerontological research, are included in our recently funded project, Socially Inclusive Ageing across the Lifecourse. In this poster we explicitly focus upon the experiences of loneliness for older adults, aged 50+, from the LGBTQ+ and minority ethnic communities. Using wave 9 data from the UK Household Longitudinal Study (UKHLS/Understanding Society) we measured loneliness using the three-item UCLA scale with a score of 6+ out of 9 defining loneliness. Of our total sample of 16,805 who completed the loneliness measure, 1.5% of respondents identified as LGB and 5.4% as Asian, 2.9% as black and 1.5% as other or mixed ethnicity. Overall, 21.7% of the population aged 50+ were lonely. Participants from a black, Asian or other ethnic minority reported higher loneliness than white respondents: 25.8%, 29.6%, 31.0% and 21.0% respectively. Respondents identifying as gay or lesbian (29.1%) or as bisexual (35.2%) reported greater loneliness in comparison to those who identified as heterosexual (21.3%). Our study is novel and timely in demonstrating the higher prevalence of loneliness in two under-represented groups of older adults with the potential consequences this may have for their health and wellbeing in later life.
LONGEVITY DETERMINANTS IN AFRICAN AMERICANS: AN INTRA-GROUP ANALYSIS FROM THE HEALTH AND RETIREMENT STUDY
Authors: Nicholson Meneka Johnson , Martin Peter
Published: December 2023

Utilizing the Health and Retirement Study data, this research exclusively centered on a sample of 2953 African-American participants to discern longevity predictors, emphasizing the importance of intra-group analysis. This targeted approach is essential as it provides a nuanced understanding of factors affecting longevity within a specific demographic group, avoiding broad generalizations derived from diverse populations. Two analytical models were developed in Mplus. The initial fully saturated model was subsequently trimmed to exclude non-significant paths. Key findings include: Education showed a positive correlation with cognition and a negative association with subjective health. Age had a negative impact on cognition and on subjective health. Depression was negatively associated with cognition and subjective health, and positively with age. Notably, age at death was majorly influenced by age, with subjective health, cognition, and education also playing significant roles. The model demonstrated an exemplary fit with Chi^2 (df=2) = 3.12, RMSEA = .01, and CFI = 1.0. Ultimately, age was identified as the primary predictor of age at death. Moreover, subjective health, education, and cognitive abilities emerged as vital contributors to longevity among African Americans. In essence, this study, with its focus on African Americans, underscores the profound importance of demographic-centric research, charting a path for custom-made interventions that resonate deeply with the African-American community’s inherent health dynamics.
LONGITUDINAL ASSOCIATION OF SERUM CREATININE- AND CYSTATIN-C–BASED INDICES WITH INCIDENT SARCOPENIA
Authors: Jang Jae Young , Shin Hyung Eun , Won Chang Won , Kim Miji
Published: December 2023

Although a cross-sectional link between serum creatinine- and cystatin-C-based indices and sarcopenia has been established, the longitudinal association remains unclear. This study explored the longitudinal association between serum creatinine- and cystatin-C-based indices and the incidence of sarcopenia in community-dwelling older adults. Using a 2–4 year follow-up data from the Korean Frailty and Aging Cohort Study, 690 participants (mean age: 75.2±3.7 years; 45.9% men) without sarcopenia at baseline were analyzed. The association between the incidence of sarcopenia during a 4-year follow-up and serum creatinine-to-cystatin-C ratio, estimated glomerular filtration rate (eGFR) ratio (eGFRcystatin-C/eGFRcreatinine), sarcopenia index (serum creatinine×eGFRcystatin-C), predicted skeletal muscle mass index (pSMI), and total-body muscle mass index (TBMM) from baseline were compared. During the 4-year follow-up period, the incidence of sarcopenia was 21.5% in men and 14.7% in women. The pSMI and TBMM showed a higher area under the receiver operating characteristics curves (AUC) for predicting the incidence of sarcopenia in men (pSMI, AUC:0.616, p=0.003; TBMM, AUC:0.613, p=0.001) and women (pSMI, AUC:0.714, p=0.003; TBMM, AUC:0.714, p=0.001) than other indices. After adjusting potential confounders, higher pSMI and TBMM were associated with sarcopenia onset in men (pSMI, odds ratio [OR]: 0.417, 95% confidence interval [CI]: 0.237–0.733; TBMM, OR: 0.937, 95%CI: 0.901–0.975) and women (pSMI, OR: 0.166, 95%CI: 0.072–0.380; TBMM, OR: 0.906, 95%CI: 0.862–0.952). In conclusion, pSMI and TBMM demonstrated accurate predictive capabilities for sarcopenia. Higher pSMI and TBMM values were associated with sarcopenia incidence. These findings suggest pSMI and TBMM could be potential predictive biomarkers of sarcopenia in community-dwelling older adults.
LONGITUDINAL ASSOCIATIONS OF LONELINESS AND FRAILTY IN COMMUNITY DWELLING OLDER ADULTS
Authors: Pollak Chava , Verghese Joe , Buchman Aron , Blumen Helena
Published: December 2023

Loneliness is highly prevalent among older adults and is associated with poor health outcomes. This study examined longitudinal associations between loneliness and frailty and the influence of other objective and subjective social measures on these associations. We analyzed data from 1,3111 older adults without dementia at baseline from the Rush Memory and Aging Project (mean age 78.3 ±7.5 years, 72.5% female). Loneliness was assessed using the de Jong Gierveld Loneliness Scale. Frailty was defined using a 39-item cumulative deficit frailty index. Linear mixed effects models were used to examine the association of baseline loneliness and change in frailty over time adjusted for baseline age, gender, education, depressive symptoms, global cognition, social network, marital status, social support, and social, cognitive, and physical activity. Loneliness and frailty both increased significantly over a mean follow-up period of 4.6 years. Baseline loneliness was associated with an additional increase in frailty by 0.3 deficits per year compared to those who were not lonely (p< 0.001, CI 0.2, 0.5). The 0.3 increase in frailty per 1-point increase in loneliness equaled a 27% increase in frailty per year. Loneliness is associated with accelerated frailty and should be considered in the design of interventions to prevent frailty and promote healthy aging.
MENTAL HEALTH RISKS SIGNIFIED BY THE CO-EXPERIENCE OF ELDER MISTREATMENT AND SOCIAL ISOLATION
Authors: Park Juyoung , Jang Yuri , Aranda Maria , Wu Shinyi , Oh Hans , Wilber Kathleen
Published: December 2023

Both elder mistreatment (EM) and social isolation are widely known to pose a significant risk to mental health of older individuals. Despite the general agreement that EM should be addressed in consideration of social contexts, there has been limited attention to the potential harm of the co-experience of EM and social isolation. The issue is of particular concern in older Asian immigrants. Using a sample of older Korean Americans (N = 2,150, Mean age = 73.4), we examined the direct and interactive effect of EM and social isolation on mental distress. In a measure including psychological, physical, and financial mistreatment, 32% reported a single EM exposure and 12% multiple EM exposure in the past year. The rate of social isolation, measured with Lubben Social Network Scale-6, was 24%. About 30% were in the category of mental distress measured with Kessler 6. The direct effects of a single EM or multiple EM exposure in reference to no EM and social isolation were significant. In addition, the interaction between multiple EM exposure and social isolation was significant. The odds of mental distress associated with multiple EM exposure were substantially higher when experienced in social isolation (OR = 7.23, [CI: 3.65, 14.3]) than in non-isolation (OR = 2.68, [CI: 1.66, 4.32]). Findings suggest the signified mental health risk of the co-experience of EM and social isolation and call attention to those who might silently suffer from EM in isolation. Comprehensive interventions that encompass both preventive measures and targeted support systems are in need.
MIND, BODY, AND SOUL: PURPOSE IN LIFE AS A MEDIATOR BETWEEN PHYSICAL ACTIVITY AND COGNITIVE AGING
Authors: Sadeqi Farima , Best Ryan
Published: December 2023

Recent guidelines from the WHO stress the benefits of physical activity and harm of sedentary behavior across the lifespan. Physical activity is associated with multiple positive life outcomes, both physical and psychological, across adulthood and into old age. Previous studies have shown engaging in aerobic physical activity buffers cognitive decline and can even enhance cognition in older adulthood. Compared to the growing literature on physiological links between physical activity and cognitive aging, there is a gap in the literature investigating psychological pathways. Empirical research suggests a positive bidirectional association between purpose in life and engagement in physical activity across adulthood. Furthermore, recent research has provided some evidence that purpose in life, both subjectively and objectively, is a positive predictor of cognitive functioning. Merging these areas of research, we investigated purpose in life as a mediator in the relationship between physical activity and cognitive aging. Using the MIDUS study, a representative sample of adults aged 25 to 74 years, a mediation model was fit to the data to test a psychological mechanism explaining the relationship between physical activity and cognition in adults. Physical activity was categorized into three groups based on the intensity of the activity—light, moderate, and vigorous. A small, significant mediation was present across all levels of activity with light physical activity showing a slightly stronger indirect effect when compared to the other two. Results will be discussed considering levels of physical activity and the implication of differential psychological and physiological pathways describing downstream effects on cognitive aging.
MINDFULNESS ENHANCES PROACTIVE BENEFITS OF REAPPRAISAL USE FOR YOUNGER BUT NOT OLDER ADULTS
Authors: Martins-Klein Bruna , Chen Ziyuan , Shanahan Mabel , Theos Gregory , Heideman Kristin , Orlovsky Irina , DeFontes Clara , Alwan Elizabeth
Published: December 2023

Reappraisal and mindfulness are associated with enhanced mood and emotion regulation. Cognitive control is key to both processes, and despite age-related declines in cognitive control, older adults report greater use of both compared to younger adults. The Dual mechanisms of control (DMC) framework posits that cognitive control can be engaged, either in anticipation of a task (proactive control) to enhance task performance, or in-the-moment (reactive control). In classic cognitive tasks, older adults show limited benefits from proactive control and intact reactive control, while mindful individuals show similar performance using both control modes. However, the role of trait mindfulness on proactive versus reactive control of reappraisal has never been explored across the lifespan. In this study, 41 younger (18-29) and 40 older adults (60-85) were cued to reappraise or view 80 negative images following a 4-s proactive or a 500-ms reactive delay, tracking pupil response as a measure of physiological arousal and effort. Multilevel models revealed that mindfulness was associated with greater proactive reappraisal benefits in younger adults. In contrast, mindfulness was associated with diminishing benefits of proactive versus reactive reappraisal in older adults; for low mindfulness, proactive benefits were found, and for high mindfulness, reactive control benefitted reappraisal more than proactive control (p < .001). For image viewing, proactive control benefitted older but not younger adults. Findings highlight the importance of considering the interaction of mindfulness and age in emotion regulation, and highlight the need of optimizing the temporal dynamics of reappraisal-based strategies in mental health interventions across the lifespan.
MISSED INSIGHTS FOR EARLIER MANAGEMENT OF PARKINSON’S DISEASE AND THE VALUE OF DOPAMINE TRANSPORTER (DAT) SCANS
Authors: Hafeez Mohib , Pangle Amanda , Wei Jeanne , Azhar Gohar
Published: December 2023

This retrospective study focused on the role of Dopamine Transporter (DAT) scans in diagnosing Parkinson’s disease (PD) in older adults with cognitive impairment (CI). We reviewed brain imaging of 6,483 individuals, aged 60 and above with CI. 332 had a DAT scan of which 203 were positive and 80/203 (39%) were subsequently started on treatment with carbidopa-levodopa. On the other hand, 243 patients showed Parkinson’s (PD) associated structural changes on CT or MRI including mineral deposition, hypodensities, and lacunar infarcts in dopamine-rich regions such as the caudate, putamen, and basal ganglia but none of these patients had a DAT scan, or treatment with carbidopa-levodopa therapy. 71/243 (29%) of these patients had also experienced falls or had gait disorders. This points towards a potential missed diagnosis of PD, which can respond to therapy in the early stages. Our results suggest that providers may overlook subtle signs of Parkinsonism in patients with CI. This could result in symptom worsening and treatment delay. Since CI is often first brought to the attention of PCPs, our findings call for an increased effort to inform PCPs on the role of DAT scans to aid in the diagnosis of dopamine deficiency states. By having a better understanding of PD-related structural changes seen on brain imaging and then using a DAT scan to confirm dopamine deficiency, treatment for PD might be started earlier or timely referral made to a specialist for comprehensive care, reduction of disability, and improvement of the quality of life of patients.
MISSED OPPORTUNITIES IN PREVENTING COGNITIVE DECLINE: UNDERDIAGNOSIS OF POLYCYTHEMIA IN OLDER ADULTS
Authors: Eddington Blake , Wei Jeanne , Pangle Amanda , Azhar Gohar
Published: December 2023

Polycythemia is a hematologic disorder characterized by an abnormally high red blood cell count which can result in serious complications. Microvascular clotting or emboli in polycythemia can reduce brain oxygenation levels with transient ischemic attacks or strokes and lead to subsequent development of vascular dementia. However, the impact of polycythemia on the brain health of older adults may be under-appreciated by primary care providers. The aim of this retrospective study was to investigate the prevalence of missed diagnoses of polycythemia in older adults with cognitive impairment. Electronic medical records (EMR) of patients with cognitive impairment, aged 60-100 years, inclusive of all races, ethnicities, and genders, seen between January 2018-January 2021, were obtained through the University of Arkansas for Medical Sciences database. Cognitive impairment included all subtypes of dementia and delirium with either primary or secondary polycythemia. A total of 9700 patients with cognitive impairment were analyzed for hemoglobin and hematocrit cut-off values for polycythemia. We found 696 instances of comorbid polycythemia of which only 88 (12.6%) had a correct polycythemia diagnosis on record. However, 608 instances (87.4%) had never been identified as having polycythemia either in the problem list or diagnosis. This study highlights the high prevalence of undiagnosed polycythemia in patients with delirium and dementia and underscores the importance of considering polycythemia as a potential etiology, when evaluating cognitive impairment. Early detection and appropriate management of polycythemia in older adults may have implications for reducing the incidence of vascular dementia and improving overall patient outcomes and quality of life.
MULTI OMICS LANDSCAPE OF INSULIN SENSITIVITY IN HEALTHY OLDER PEOPLE FROM THE LONG LIFE FAMILY STUDY COHORT
Authors: Moghaddam Vaha Akbary , Liao Shu , Thyagarajan Bharat , Christensen Kaare , Patti Gary , Brent Michael , Province Michael , An Ping
Published: December 2023

Insulin sensitivity (HOMA-S), which measures the body’s response to insulin, is a crucial indicator of glucose homeostasis, particularly in healthy people. The present study utilizes MultiOmics profiling and integration to explore molecular processes crucial for maintaining healthy HOMA-S. To this end, 3783 non-diabetic individuals from 567 pedigrees in Long Life Family Study Cohort were selected (Average age = 70±16). Upon adjustment of HOMA-S for relevant covariates, linear mixed models were employed to analyze the genome sequence, blood transcriptome, and metabolome associations with HOMA-IS. Moreover, using STAAR and Pascal packages, rare and common variants were collapsed to genomic co-ordinates. The results highlight 10 genes, 2 soluble metabolites, and 2 lipids (phosphatidylcholine 35:1 and 40:6), significantly associated with HOMA-S. Integrative module enrichment analysis with PascalX package, identified multiple significant networks for HOMA-S. Notably, immune response in asthma is one of the processes with most genes (57%) displaying a positive correlation with HOMA-S (module p-val = 1.89 × 10E-6). The network contains 2 novel genes from transcriptome analysis, FCER1A and MS4A2 (p-vals = 1.32 × 10E-8 and 1.42 × 10E-6). Interestingly, one of the key metabolites, N-acetylglycine, also has a strong association with MS4A2 (p-val = 0.001034). Furthermore, SNP colocalization for gene expression, metabolome peak intensities, and HOMA-S, revealed multiple significant signals simultaneously associated with PC 35:1 and two members of this network, HLA-DQA1 and HLA-DQB1. The results of the study underscore the intricate interplay of genetic and metabolic factors for healthy HOMA-S with aging and their potential protective role for glycemic implications.