bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of COVID-19 pandemic on senior-to-senior social engagement activities at a community space in Japan
Authors: Kazembe Neo , Kim Hongjik , Wang Cong , Higuma Shuichiro , Yang Yerim , Kim Taeeun , Ogino Ryogo , Takase Mai
Published: December 2020

A local community space in Japan, Chiki Kastudokan, has been hosting several senior-to-senior social activities for community-dwelling older adults with support from the University of Tokyo. The activities are aimed at fostering communication and social engagement through exercise, music, cafe, and craft. After the emergence of COVID-19 pandemic, these activities have been disrupted. We conducted a questionnaire survey between June and July 2020 to assess how the pandemic has affected 26 activities and identify support needs that can enable their continuity amid the pandemic (response rate: 77%). First, all 26 activities were suspended by the onset of COVID-19. Hosts of 8 (40%) activities devised alternative ways to engage participants at home. For instance, hosts of craft activities arranged and sent to participants crafting kits. Limited capacity in using online platforms like Skype or Zoom prevented virtual interaction of hosts and participants. Notably, hosts were anxious towards resuming activities amid the pandemic. They worried about their health (50%), of being criticized by friends and family(25%), and of infections spreading among participants (85%). Hosts wanted strategies to prevent infections during activities, and easy to understand infection prevention guidelines for participants. These findings reveal that COVID-19 pandemic has negatively affected senior-to-senior activities at Chiki Kastudokan. The University of Tokyo could help hosts identify effective infection prevention strategies to use when hosting activities amid the pandemic. It could also provide ICT training to hosts and participants to enhance their capacity in using online platforms in case of future waves of COVID-19.
Impact of the 2020 COVID-19 Pandemic on Older Adults’ Perceived Sedentary Behavior and Physical Activity
Authors: Greenwood-Hickman Mikael Anne , Dahlquist Jacklyn , Cooper Julie , Rosenberg Dori
Published: December 2020

Starting in March 2019, stay-at-home orders meant to control the spread of the COVID-19 pandemic have limited movement, activities, and services in Washington State. For older adults, who are the most sedentary age group, we hypothesized that these public health measures encouraged increased sedentary behavior (SB) and reduced physical activity (PA) levels. To explore this, we conducted 25 semi-structured interviews with a sub-sample of participants in an ongoing sedentary behavior reduction intervention. Interviews were recorded and transcribed, and an iterative coding process was used to extract key themes related SB changes, PA changes, and other impacts of COVID-19 social distancing measures. Most participants reported an increase in SB due to limitations on leaving their home, canceled activities, increased free time in which to pursue indoor hobbies traditionally done in a seated posture (reading, sewing, tv, etc.), and feelings of depression or lack of motivation. Some participants suggested that these restrictions also led to a decrease in their PA and exercise levels due to cancelled fitness classes, loss of social support around exercise routines, and fear of leaving the house. However, other participants reported that the social distancing measures have allowed them to increase their PA levels, giving them more time to walk outdoors or pursue active outdoor hobbies like tennis, gardening, or home improvement tasks. In conclusion, the COVID-19 pandemic and associated social distancing measures have had varying impacts on participant perceived SB and PA levels. It is unclear how these changes will be maintained when pandemic restrictions are lifted.
Influence of COVID-19 on dementia caregivers living in community
Authors: Hwang Yeji , Rajpara Anjali , Talwar Sonia , Connell LaShauna , Ramirez Katie , Hodgson Nancy
Published: December 2020

Community-residing persons living with dementia (PLWD) are a high-risk population for the Coronavirus Disease 2019 (COVID-19) because of advanced age, comorbidities, and impaired cognition. While family caregivers report additional anxiety symptoms by caring for PLWD at home, little is known about their caregiving experience during the current COVID-19 pandemic. The purpose of this study is to examine the influence of the COVID-19 on dementia caregivers. Study participants were recruited from parent study, the Healthy Patterns Clinical Trial (Hodgson; R01NR015226). Data were collected from June 13th to August 28th, 2020 via semi-structured telephone interviews. Thirty-four dementia caregivers participated in this study. Mean caregiver age was 59.2±12.7. Over 70% of the study participant reported worry about spreading COVID-19 to the PLWD and 41.2% reported that they have taken on additional caregiving duties for others in their family or network since COVID-19. In this sample, 61.8% of the dementia caregivers reported one or more anxiety symptoms. Independent t-tests were conducted to compare dementia caregivers who reported anxiety symptoms and those who did not report anxiety symptoms. Anxiety symptoms in dementia caregivers were related to poor physical function of their care recipients (p=0.036). However, anxiety symptoms of dementia caregivers were not related to either cognitive level (p=0.11) or number of neuropsychiatric symptoms of their care recipients (p=0.366). Health care professionals should be alert to the anxiety and concerns expressed by dementia caregivers in order to maintain and improve the well-being of both caregivers and their care recipients during this unprecedented pandemic.
Shifts in Older Adults’ Social Support during Early Months of the COVID-19 Pandemic
Authors: Fuller Heather , Huseth-Zosel Andrea , Sturn Emily , Carlson Shawn , Hofmann Brittany , Kinkade Emily , Van Vleet Bryce
Published: December 2020

In recent months, older adults have faced great health risks due to COVID-19, yet social distancing measures may also heighten risks to their social well-being. This mixed methods study explores changes in older adults’ social support satisfaction and interpersonal connections across the first few months of the COVID-19 pandemic. A Midwestern sample of 70 older adults aged 70-97 completed two phone interviews (April and June 2020) about their experiences with social distancing due to COVID-19. At both timepoints participants rated their satisfaction with social support and responded to open-ended questions about their interpersonal interactions, communication, and support in current daily life. Mean social support satisfaction significantly increased between the two interviews. Ensuing analysis of qualitative responses suggested this shift could reflect psychological adjustment to the circumstances or adaptation in methods of interpersonal connection over time. Emergent themes included: 1) increased family support and strain, 2) adaptable and flexible friendships, 3) isolation fatigue, and 4) communication through technology. Evaluation of change over time indicated divergent and shifting perceptions of social support as the pandemic endures. Findings suggest nuanced and diverse social support experiences amongst older adults, yet general patterns of initial shock to social support systems that subsided or adapted over time. Future research should build upon these findings to better understand older adults’ social support needs and seek to explore ways to best foster social connections during instances of forced social isolation or societal crises such as the current and ongoing global COVID-19 pandemic.
Social Isolation, Loneliness and Well-being in the Covid-19 Crisis: A Look at Nursing Home Residents in Luxembourg
Authors: Albert Isabelle , Hoffmann Martine , Kornadt Anna , Murdock Elke , Nell Josepha
Published: December 2020

During the COVID-19 crisis, older adults, in particular those with underlying health conditions, were at a special risk for severe illness and mortality, and efforts were made to shield them from exposure to the virus. While measures of physical distancing and reduction of in-person contacts were necessary to prevent contraction, they hit residents of care settings particularly hard since visits from family and friends were banned and the risk for loneliness and social isolation increased. In the present study, we therefore gave the voice to nursing home residents and focused on their perceived loneliness and subjective well-being during the crisis. We were both interested in difficulties but also in personal resources and resilience factors that might protect older adults from negative mental health outcomes and help to maintain subjective well-being. A sample of N = 76 residents in care homes in the Grand Duchy of Luxembourg were interviewed by use of a standardized questionnaire during July and August 2020. Participants reported on their loneliness and life satisfaction during the crisis, on their self-regulatory strategies as well as on personal and social resources (e.g. self-efficacy, generativity, social support). Data will be analyzed by use of regression analysis to predict loneliness and well-being by risk and protective factors. Results will be discussed applying a life-span developmental and systemic perspective to understand the mutual interplay of individual, social and institutional resources to mitigate negative side effects of protective measures on care home residents.
Successful Transitions to Remote Assessments and Technology Installations due to COVID-19: The I-CONECT Project
Authors: Nguyen Khoa , McDonald Mattie , Scavone Colton , Mattek Nora , Kaye Jeffrey , Dodge Hiroko
Published: December 2020

I-CONECT is a randomized controlled clinical trial to examine the impact of social interaction delivered via video-chat on cognitive function (clinicaltrials.gov number: NCT02871921, project website: www.I-CONECT.org ). We aimed to enroll 320 community-dwelling socially isolated older adults (age >=75 years). The recruitment of participants has started in 2018 and was ongoing when COVID-19 pandemic began. Video chat and telephone-based social interaction interventions did not change during COVID-19. However, new recruitment and cognitive assessments, which require in-person contact and deployment and retrieval of video chat devices in participant homes, were suspended due to the nature of our study population (i.e., older age, higher likelihood of comorbidities). Recently we were able to successfully switch to complete remote assessments including 1) telephone-based cognitive assessments using T-COG (Telephone Cognitive Assessment battery), and 2) contactless delivery of our study devices (Chrome books and electronic pill boxes) for subject self-installation. Our creative approach to self-installations includes color coded pictures and an easy-to-follow installation manual, accompanied by remote instruction and support via telephone. This poster introduces our remote assessment and installation protocol and participant and technical support team feedback regarding this new contactless protocol. This presentation provides useful guidance for future studies considering completely remote assessment and telemedicine approaches.
The First COVID-19 Stay-at-Home Restrictions: An Intergenerational Comparison of the Impacts
Authors: Glass Anne , Lawlor Lauretta
Published: December 2020

“Social distancing” and stay-at-home orders were enacted in many states in response to the spread of COVID-19. We sought to understand intergenerational differences in the impact of the initial COVID-19 restrictions on interactions, loneliness, and stress. Data was collected via online survey from individuals ages 18 and above during the period April 7-May 8, 2020. The predominantly female, White, and well-educated sample (n = 962) included 245 younger adults (YAs) ages 18-34, 374 middle-aged adults (MAs) ages 35-64, and 343 older adults (OAs) ages 65+, with overall mean age 51.67 (SD=20.257; range 18-96). Before the restrictions, 41% of these OAs infrequently/never interacted face-to-face with children, increasing to 74% after restrictions. Three quarters (77%) of YAs reported seeing OAs less often, but 42% reported increasing their connections with OAs via technology. About a third of MAs (35%) and OAs (36%) were lonely, compared to 48% of YAs (p = .003), and a higher percentage of YAs (57%) reported being “more lonely” now, compared to MAs (36%) and OAs (41%). OAs reported the least stress; 42% reported low/very low levels of stress compared to YAs (9%) and MAs (20%). All generations most often identified “being able to go places” as the thing they missed most, but it increased significantly with age (p < .001), from YAs (32%), MAs (37%), to OAs (44%). More YAs (20%) than OAs (7%) reported missing “structure to their day.” Results of these intergenerational comparisons suggest the resilience of older adults is helping them during the current pandemic.
Risk Factors for Older Pedestrian Injuries and Fatalities Among Communities in Massachusetts
Authors: Wang Shuangshuang , Silverstein Nina , Lee Chae Man , Porell Frank , Dugan Beth
Published: December 2020

The number of pedestrian crashes in the United States has increased by 35 percent from 2008 to 2017. Among all pedestrian fatalities in 2017, 48% were pedestrians aged 50 and older, which suggests a disproportionate threat to older residents’ health and safety. Massachusetts has a large older population and is experiencing increased numbers of older pedestrian crashes. This research identified risk factors and community characteristics contributing to older pedestrian crashes and suggests leveraging the state’s age-friendly efforts to speed the implementation of countermeasures. Based on ten-year statewide crash data (2006-2015) and community indicators from the 2018 Massachusetts Healthy Aging Data Report, this study examined 4,472 crashes across Massachusetts that involved pedestrians age 55 and over. The leading reasons for crashes were driver’s inattention, driver’s failure to yield right of way, and driver’s issues with visibility. Older pedestrians were hit while walking in the road, often in crosswalks at intersections. Many factors were found to contribute to older pedestrian crashes: time of day (rush hour), time of year (winter), and community factors (higher rates of disabilities, higher percentage of racial minority residents, higher number of cultural amenities, and lack of dementia-friendly community efforts. Greater awareness of older pedestrian safety risks is needed. Communities highlighted in this research warrant priority attention from planning, health, aging services, and transportation authorities to improve older pedestrian safety.
Does Inflammation Mediate the Association Between Sleep Duration and Incident Dementia Among Older Adults?
Authors: Wu Chenkai , Xu Weihao
Published: December 2020

Sleep duration is a risk factor for multiple health outcomes. Growing attention has been directed to the association between sleep duration and dementia; however, results were inconsistent and the mechanisms remained largely unknown. We hypothesized that elevated levels of inflammation markers— C reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)—would mediate the association between sleep duration and dementia among older adults. Data were from the Health, Aging, and Body Composition Study; 3,010 participants free of dementia at baseline were included. Sleep duration was classified into: short (<6 hours), normal (6-8 hours), and long (>8 hours). Incident dementia was defined as (i) use of prescribed dementia medications, (ii) adjudicated dementia diagnosis, or (iii) a race-stratified cognitive decline >1.5 SDs from the baseline mean. We used Cox models to examine the associations among sleep duration, inflammation, and dementia. The average age was 73.6 years (SD=2.9); 49% were male and 41% were black. During 10 years of follow-up, 515 participants (17.1%) developed dementia. Long sleep duration was associated with higher hazard of dementia than normal sleep duration (HR=1.50, 95%CI=1.02-2.21). This association was attenuated by approximately 10% when CRP or IL-6 was added in the model. When all three inflammation markers were included in the model, the hazard ratio of long sleep duration was reduced by nearly 30% and no longer significant (HR=1.36, 95%CI=0.89-2.08). Long sleep duration was associated with high risk of incident dementia among older adults and the association was partly explained by elevated levels of inflammation markers.
Decreasing Emergency Room Utilization in High Risk Geriatric Patients
Authors: Fani Shamsi , Munoz Lizette , Lavayen Susana , McKenzie Blair , Chun Audrey , Cao Jeff , Chow Stephanie
Published: December 2020

Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.
Gene Expression Profiling Suggests Downregulation of Wnt Pathway Signaling With Aging
Authors: Kuipers Allison , Nestlerode Cara , Wheeler Victor , Miljkovic Iva , Zmuda Joseph
Published: December 2020

The wingless (Wnt) pathway is involved in many age-related diseases and conditions, including cancer and cardiovascular disease. However, the impact of aging on Wnt pathway signaling remains largely unknown. Therefore, we surveyed peripheral blood expression of 43 Wnt pathway genes and tested for association with age in 369 Afro-Caribbean men recruited from the population of Tobago (mean age 64 years, range 51-89 years). Gene expression was measured in counts per sample, then normalized and background subtracted. All expression counts were transformed to normality after excluding any extreme outliers. Fourteen Wnt genes showed detectable expression in our sample and were examined further for association with age using linear regression both individually and using stepwise selection models to identify independent signals. A Bonferroni-corrected alpha for the 14 tested genes (α=0.0036) was used. Six of the 14 tested genes showed significant univariate correlation with greater age [r (gene): 0.169 (APC), 0.179 (AXIN1), 0.222 (CTNNB1), 0.211 (GSK3b), -0.178 (LEF1), -0.166 (TCF1)]. When combined, expression of four genes was determined to be marginally (P<0.05) independently associated with age (AXIN1, CDH2, CTNNB1, TCF1). After correction for multiple testing, a 10-year greater age was independently associated with 4% greater CTNNB1 expression and 8% lower TCF1 expression respectively (both P<0.0001), and this association accelerated after age ≥60 years (p-interaction 0.01 and 0.07, respectively). Greater expression of CTNNB1 and lower expression of TCF1 may indicate decreased Wnt pathway signaling. These results are the first to suggest that aging may be associated with alterations in Wnt pathway signaling.
Interactions Between Genes From Aging Pathways Significantly Influence Risk of Alzheimer’s Disease
Authors: Ukraintseva Svetlana , Arbeev Konstantin , Duan Hongzhe , Akushevich Igor , Feitosa Mary , Christensen Kaare , Stallard Eric , Yashin Anatoliy
Published: December 2020

Age is major risk factor for AD; however, relationships between aging and AD are not well understood. Decline in physiological resilience is universal feature of human aging that may also play role in AD. Aging-related pathways (such as IGF-I/P53/mTOR-mediated) that are involved in tissue resilience work in concert to decide outcomes of cell responses to stress/damage, such as survival, apoptosis, autophagy, etc. We hypothesized that interplay among genes in these pathways may influence AD risk as result of epistasis (GxG). We estimated effects of pairwise epistasis between SNPs in 53 genes from respective pathways on AD risk in the LLFS compared with other data (HRS, CHS, LOADFS). We found significant (fdr<0.05) GxG effects on AD risk in older adults across datasets. The SNP rs11765954 in CDK6 gene was involved in top GxG effects on AD in all datasets, when paired with SNPs in BCL2 and PPARGC1A. The CDK6 role in AD could be pleiotropic, depending on its activity in neurons: CDK6 expression is needed for DNA repair and neuronal survival; however, CDK6 overexpression may lead to the cell cycle reentry in postmitotic neurons resulting in apoptosis, which may contribute to neurodegeneration. CDK6 was earlier found to interfere with BCL2 effects on apoptosis, and with PPARGC1A effects on energy metabolism, which might contribute to observed GxG between these genes. We conclude that interactions among genes from biologically connected aging pathways may significantly influence AD risk. Uncovering such GxG effects has a potential to yield new genetic targets for AD prevention/treatment.
Interventions to Enhance Resilience Among Family Caregivers: A Systematic Review
Authors: Chi Nai-Ching , Han Soojeong , Fu Ying-Kai , Nakad Lynn , Demiris George
Published: December 2020

Long-term caregiving can negatively impact caregivers’ physical and psychological well-being and are associated with increased morbidity and mortality among caregivers. A more positive caregiving experience is associated with increased coping skills and resilience. Caregiver-targeted interventions designed to promote caregivers’ resilience may lead to improved caregivers’ well-being, the quality of caregiving, and care recipients’ outcome. However, a comprehensive evaluation of effective interventions that enhance resilience among caregivers is lacking. Therefore, the purpose of this study is to critically evaluate existing training programs to inform clinical practice and future program design. A literature review was conducted to search available articles published before June 2018 in databases including PubMed, CINAHL, PsycINFO, and Scopus. Search strategies used index and keyword methods. The inclusion criteria were peer-reviewed, research studies published in English that evaluated an intervention primarily aimed to improve family caregivers of adult patients’ resilience or had a primary outcome of resilience. Seven studies fit the criteria identified. Six studies used psychosocial therapy and one used pharmacological therapy to promote caregivers’ resilience. Several effective resources were identified, such as counseling, self-help manuals, psychoeducation, cognitive behavioral therapies, and the use of an antidepressant. All studies reported positive improvements in caregivers’ outcomes and six studies reported caregivers had improved resilience after receiving interventions. However, most interventions require health professionals to train patients and caregivers for multiple sessions. Future studies should develop feasible, effective, and less labor-intensive interventions, such as self-help manuals, telehealth interventions, or interventions delivered during routine visits.
Palliative Care Research: Successful Recruitment and Retention Strategies of Patient-Caregiver Dyads
Authors: Hansen Lissi , Hiatt Shirin , Lyons Karen
Published: December 2020

Research shows that the well-being of patients with serious illness and their family caregivers is significantly associated. Thus, to build the scientific knowledge upon which to establish high quality palliative and end-of-life care practices for these patients and their caregivers, research studies should include successful recruitment and retention strategies that focus on the patient-caregiver dyad. Aims: To review the literature focusing on successful dyadic recruitment and retention strategies and to describe successful recruitment and retention strategies, and attrition in a longitudinal study of end-stage liver disease (ESLD) patient-caregiver dyads. Methods: A five-year prospective longitudinal study of dyads included quantitative and qualitative data collected at 5 time points over 1 year: at baseline, 3, 6, 9, and 12 months. Results: Over a 32-month period 336 dyads were approached and 241 were enrolled. The refusal rate was 27 dyads (8.0%). Over the course of the study, 31 patients or caregivers withdrew for various reasons (too sick, liver transplantation). The attrition due to death of patients was 53 dyads (20.2%). Successful strategies used for recruitment and retention included tailoring to provider preference for referral, accommodating patient preference for data collection method, and having predictable and ongoing contact between a specific study staff and dyads. Conclusions: Less than 10 studies address recruitment and retention strategies most effective in dyadic research in various serious illnesses and clinical settings. Recruitment of ESLD patient-caregiver dyads is challenging. Future longitudinal dyadic studies of serious illnesses and palliative care may benefit from strategies learned from the current ESLD study.
Are Urban Home Health Agencies More Likely to Achieve Improvement in Care Quality?: A Cohort Study
Authors: Ma Chenjuan
Published: December 2020

Home health care (HHC) is a core source of home- and community-based services to older adults “aging in place.’ HHC quality is under increasing scrutiny. This study aimed to examine urban vs. rural disparities in HHC quality in the US. This is a cohort study using 2014-2019 national Home Health Compare data linked to Providers of Services (POS) files. Quality of HHC was measured by agency rates of 1) timely initiation of care and 2) hospitalization. We examined 6,448 home health agencies or 38,688 agency-years. At baseline, the mean rate of timely initiation of care was 91.3% (SD: 7.6; range: 28.0-100.0), with urban agencies performing worse (urban vs. rural: 91.0% vs. 92.3%); and the mean rate of hospitalization was 15.6% (SD: 3.7; range: 0.0-37.0), with urban agencies performing better (urban vs. rural: 15.3% vs. 16.4%). Estimates from multivariate hierarchical linear regressions showed that while the rates of timely initiation of care increased annually over time (β= 0.62, p=0.000), this improvement trends did not differentiate between urban and rural agencies (urban: β= 0.087, p=0.086). There was slight annual improvement in hospitalization rates over time (β= -0.07, p=0.0.003) and the trends in annual reduction in hospitalization rates were more significant in rural agencies than urban agencies (urban: β= 0.10, p=0.000). Our findings indicate urban (vs. rural) disparities in HHC quality and the trends of quality improvement.
Identifying the Role of Spatial Transitions in the Palliative Care Experiences of Unhoused Older Adults
Authors: Johnson Ian , Light Michael
Published: December 2020

The national population of unhoused older adults is predicted to nearly triple by 2030. Unhoused older adults have a mortality rate four to nine times higher than housed populations, and face structural barriers during illness trajectory that likely influence both where care takes place and processes around attaining psychosocial later-life goals. This study aimed to (1) document patterns in the healthcare trajectories of unhoused older adults and (2) examine the role of care transitions in psychosocial goal attainment. Retrospective chart review was completed in partnership with a mobile homeless palliative care team; additional data was gathered from provider focus group. Through a content analysis of this data, it was discovered that older unhoused palliative care patients experienced more transitions, and that numerous care transitions were associated with disruptions to goals. The type of care transitions patients experienced also did not reflect their later-life goals. Patients’ movements impacted the role of formal and informal care networks in care and highlighted the implications of place in common psychosocial goals, such as family reconciliation. Unconventional neighborhood supports were found to help facilitate treatment adherence. These findings offer translational opportunities for further research, including “rapid respite” models and other innovations in mobile palliative care for unhoused and precariously-housed people with life-limiting illness.
Concomitant Cholinesterase Inhibitor and Anticholinergic Drug Use Among Older Adults With Dementia
Authors: Carter Elizabeth , Tan Erwin
Published: December 2020

Anticholinergic medications (ACh) are frequently prescribed to older adults despite being associated with impaired physical functioning. Moreover, the concomitant use of ACh and cholinesterase inhibitors (ChEI) reduces the body’s response to both drugs, thereby diminishing the modest effectiveness of ChEI at slowing the progression of dementia symptoms. The objective of this study was to assess the risk of concomitant ACH/ChEI use on functional outcomes, including fall, fracture, and traumatic brain injury (TBI). We conducted a retrospective review of data from the OptumLabs® Data Warehouse, a de-identified administrative claims database for commercially insured and Medicare Advantage (MA) enrollees, representing a diverse mixture of ages, ethnicities, and geographical regions across the U.S. Our cohort included adults 65 and older enrolled in MA between 1998 and 2017. Subjects were required to have dementia (by a diagnosis and/or prescription for a dementia drug (memantine or ChEI)) and at least one claim for ChEI during 12 months of follow-up. Subjects had to be enrolled in MA 6 months prior to the dementia index date. We defined concomitant ACh/ChEI use as an overlap of 30 days or more. Nearly one-third (29%) were concomitantly prescribed ACh and ChEI. Half (51%) of concomitant users were prescribed ChEI first, 46% were prescribed ACh first, and 3% received prescriptions on the same day. Results from multiple logistic regression analyses show that older adults with dementia who had concomitant ACh/ChEI use were 18%, 16%, and 25% more likely to experience a fall, fracture, or TBI, respectively, than those taking ChEI alone.
A Short, Valid, and Flexible Web-Based Screener for Mild Cognitive Impairment
Authors: Schmidt Nicole , Germine Laura , Grodsky Eric , Muller Chandra , Warren John Robert , Manly Jennifer
Published: December 2020

Clinical assessments for identifying mild cognitive impairment (MCI) can be costly and time-consuming. Few screeners for MCI exist that can be implemented quickly and outside of the clinic using flexible, cost-effective methods, such as web-based, mobile device-friendly assessments. Using data from middle-aged, racially and ethnically diverse Offspring Study participants (N=34 with MCI, N=54 without MCI; mean age: 53.9±3.4), we analyzed the sensitivity and specificity of several web- and telephone-based measures to identify MCI, after accounting for age and education. Web assessments included the Verbal Paired Associates (PA) and Visual PA tests. Phone assessments included the Number Series, Letter and Category Fluency, Number Span Forward & Backward, the AD8, and self-reported memory complaints. The discriminant ability of the web-based Visual PA test for MCI (ROC Area = .69) was comparable to phone-based measures, including the Category Fluency (ROC Area = .69), Number Span Forward (ROC Area = .61) and Backward (ROC Area = .67), and Letter Fluency (ROC Area = .68). Visual PA strongly predicted MCI, with a 98% reduction in the odds of MCI for every additional correct answer (OR=0.02), but our results are imprecise (95%CI: .000 to .76). A web-based Visual PA measure appears comparable to phone assessments in detection of MCI, although substantial uncertainty in its diagnostic precision remains. However, it is short, easily administered on a large-scale, and our evidence suggests that it can provide a sensitive and specific test to refer racially and ethnically diverse individuals for more thorough clinical assessment.
An Innovative Model of Dementia Programming for Community-Dwelling Older Adults With Family Caregivers
Authors: Gorzelle Gregg , Skrajner Michael , Best Cassie , Walker Drew
Published: December 2020

Decide, Discover, and Do!TM (D3) is an alpha-version iPad application developed and evaluated in a National Institute on Aging-funded Phase 1 SBIR project. The goal of D3 is to enhance the quality of life and care for community-dwelling persons living with dementia whose primary care partners are family members. D3 consists of (1) evidence-based activities for care partners to facilitate with their loved ones and (2) video-based interactive training on best practices in dementia care, for care partners. The activities are unique in that they create an overarching narrative for daily activities that creates a consistent routine capitalizing on procedural memory. The activities build upon one another, starting with the persons living with dementia choosing a topic (e.g., nature) early in the day, followed by the dyad engaging in a tablet-based activity related to the topic (e.g., reading an article about forests), and culminating in an experiential activity (e.g., tasting various foods found in nature, e.g. wild raspberries). A total of 18 participants took part in the this feasibility study. The study examined the impact of D3 training modules on knowledge transfer (16% mean increase in care partner knowledge across three courses); satisfaction with the training modules (96% satisfaction across three courses); and satisfaction with the activities programming (91% satisfaction across all items for persons living with dementia and 99% for care partners). No distal changes related to care partner stigma nor caregiver burden were seen in this short study.
Study Protocol: Partners at Meals Telehealth Intervention for Caregivers of Persons With Dementia
Authors: Qanungo Suparna , Krug Elaine Amella , Martin Kelly , Mueller Martina , Madisetti Mohan , Kelechi Teresa
Published: December 2020

Background: As the aging population continues to increase, it is estimated that persons with dementias (PWDs) will reach 13 million by 2050. Lack of caregiver skills related to mealtime planning and the ability to cope with dysfunctional behaviors are well-documented factors that influence nutritional outcomes for PWDs, leading to social isolation, and negatively impacting their home stay. The aim of this study protocol is to test the effectiveness of a train-the-trainer program in which non-paid volunteers in respite care centers deliver a telehealth mealtime intervention for caregivers of PWDs, Partners at Meals. The program is based on the C3P Model of Changing the Place, People and Person. Methods: A cluster-randomized controlled trial with parallel mixed methods evaluation processes is being conducted. Caregivers and PWD dyads, receiving respite services are randomized to receive Partners at Meals or enhanced-usual-care for six months. Within the intervention group, dyads are partnered with a C3P-trained volunteer who works with caregivers to devise monthly mealtime plans. Under enhanced-usual-care, dyads receive standardized educational materials modified from The Savvy Caregiver Program for Alzheimer’s caregiving. Primary outcomes include weight, calorie, protein and fluid intake of the PWDs and quality of life of the caregiver. Respite center administrators, program directors, volunteers and caregivers are evaluated for intervention fidelity, acceptability and sustainability. Implications: In this trial, we lay the groundwork to examine effectiveness and sustainability of a train-the-trainer telehealth program that could be widely disseminated for managing mealtimes in-the-home, while promoting quality of life of both the caregiver and PWDs.
The Effects of Pain on Brain and Behavior During Cognitive and Motor Performances in Older Adults
Authors: Pakray Hannah , Seng Elizabeth , Izzetoglu Meltem , Holtzer Roee
Published: December 2020

Pain is prevalent and associated with adverse outcomes in older adults. The moderating effect of pain on cortical control of locomotion has not been assessed. This study examined the effects of subjective pain on changes in fNIRS-derived oxygenated hemoglobin (HbO2), gait velocity, and cognitive accuracy from single to dual-task walking conditions among older adults. Participants (n=383; 55% female; mean age=76) were community-residing older adults. Participants completed two single tasks [Single-Task-Walk (STW) and Cognitive Interference (Alpha)] and the Dual-Task-Walk (DTW), during which participants performed the two single tasks simultaneously. The MOS- PSS and PES were used to assess pain severity and interference. Gait velocity was assessed with an electronic gait mat, cognitive accuracy was measured using the rate of correct letter generation. Linear mixed effects models revealed that HbO2 increased in DTW compared to STW (p < .001) and Alpha (p < .05). The presence of perceived pain was associated with an attenuated increase in HbO2 from Alpha to DTW (p < .05). Amongst those with pain, worse pain severity was associated with an attenuated increase in HbO2 from STW to DTW (p < .001). Pain interference did not moderate the increase in HbO2 from single to dual tasks. Pain did not have a moderating effect on behavioral outcomes. These results indicate that task-related changes in the hemodynamic response in the prefrontal cortex during walking may be a sensitive marker to the effects of subjective pain on brain function in older adults.
Predicting Hospital Outcomes Using the Reported Edmonton Frail Scale-Thai Version
Authors: Roopsawang Inthira , Thompson Hilaire , Zaslavsky Oleg , Belza Basia , Aree-Ue Suparb
Published: December 2020

Backgrounds Frailty is a common geriatric condition leading to poor surgical outcomes. Having a valid frailty measure has the potential to improve surgical care quality. Objectives To test the ability of the Reported Edmonton Frailty Scale-Thai version (REFS-Thai) in predicting hospital outcomes compared with the American Society of Anesthesiologists physical status classification (ASA) and the Elixhauser Comorbidity Measure (EMC) in older Thai orthopedic patients. Methods A prospective study was conducted on hospitalized older adults scheduled for elective orthopedic surgery. Multiple Firth logistic regression modeled the effect of frailty on postoperative complications, postoperative delirium (POD), and discharge disposition, while the length of stay (LOS) was examined by Poisson regression. The area under the receiver operating characteristic curve (AUC) and mean squared errors (MSE) were used to compare the predictive ability of the instruments. Results Two hundred participants with mean age of 72 (range 60-94 years) were mostly female, 23% were frail. Adjusting for other variables, frailty was significantly associated with postoperative complications (OR = 2.38, p = 0.049), POD (OR = 3.52, p = 0.034), and prolonged LOS (relative risk [RR] = 1.42, p = 0.043). The REFS-Thai alone shows good performance in predicting postoperative complications (AUC = 0.81, 95% CI = 0.74-0.88) and POD (AUC = 0.81, 95% CI = 0.72-0.90). The combination of REFS-Thai with ASA and EMC demonstrates an improved predictability. Conclusion The REFS-Thai was useful in predicting adverse outcomes in surgical orthopaedic older adults. Integrating the REFS-Thai for preoperative assessment may be useful for enhancing care quality.
Predictors for Confidence in Self-Management of Falls and the Role of Fear of Falls
Authors: Li Qiwei , Knight Becky
Published: December 2020

Falls have been a crucial threat for older adults to stay independent. Once they have fallen, older adults are more likely to receive injuries and become people with disabilities. Conventionally, the measurement of fall efficacy focused on the capacity of performing certain activities such as walking or bathing without a fall. However, given the fact that one out of five older adults fall every year, self-efficacy in self-protection when falls do happen calls for a better understanding of confidence in self-management of a fall. Among predictors for fall prevention outcomes, “fear of falls” has received attention. However, “fear of falls” was largely missing in studies exploring self-management of falls in scenarios where falls do happen. This study explores the predictors for CSMoF including “fear of falls”. A series of simultaneous and hierarchical regression analyses with related interaction analyses and a path model were applied to determine the contribution of each predictor variable and the mediating role of “fear of falls”. The findings of the study reported that demographic characteristics, chronic conditions, and perceptions of falls were associated with CSMoF. The path analysis confirmed the mediating role of “fear of falls” as the indirect effects were occupying substantial percentages in the total identified effects. “Fear of falls” should continue to be a core of fall prevention programs and is particularly important for programs that aim to teach older adults what to do when they fall, whom to call for help, and how to avoid injuries upon falling.
The Link of Three-Dimensional Frailty Index With Quality of Life and Fear of Falling Among Taiwanese Older Adults
Authors: Chen Duan-Rung , Kuo Chun-Tung , Chen Peng-Yu
Published: December 2020

Objective. Frailty has received increasing attention as a way of understanding gradual losses in one or more domains of human functioning (physical, psychological, and social) in older adults. Studies suggested that frailty is related to lower quality of life (QoL) and the fear of falling (FoF). The most commonly used frailty criteria is the Fried Phenotype, which solely focuses on physical dimension of frailty. This study aims to evaluate the three-dimensional frailty index (namely, physical, psychological and social), and its association with QoL and FoF in a sample of community-dwelling Taiwanese older people. Methods. A total of 751 older adults aged 65 years and older (mean age 73.69 yrs ; SD=6.6) were included from May 2019 to Jan 2020 in Taipei City. The 8-Item Short-Form Health and the Falls Efficacy Scare International (FES-I) were used. Structural equation models (SEM) were employed to examine the association of the three-dimensional frailty index with QoL and FoF. Results. The SEM results confirmed a three-dimensional frailty index (physical, psychological and social frailty), and it is significantly associated with OoL and FoF. Physical frailty had the strongest association with PCS and FES-I, yet social frailty with MCS. Conclusion. Public health efforts to prevent elderly frailty should not solely focusing on physical aspect of frailty.
Preliminary Findings of Needs of Older Cambodians in Three Provinces
Authors: Kuy Kakada
Published: December 2020

The most recent national survey of older Cambodians was conducted in 2004. To further our understanding of Cambodia’s older adults, new data are required. This primary data collection study aimed to assess physical, psychological and social needs of older Cambodians and examine gender differences in those needs. We collected data in 2019 in three provinces in the northwestern region of Cambodia (N=210). Due to older Cambodians’ higher level of illiteracy, research assistants filled out paper surveys for them during individual interviews. Then responses were transferred into an e-survey database for data management. Physical needs were examined with self-rated health and health complaints. Psychological wellbeing and depression scores were used to measure psychological needs. For social needs, we examined social support using Social Network and Social Support scale. More than half of older Cambodians had less than good physical health and reported numerous health symptoms. Yet, three quarter reported higher than average psychological wellbeing and a low level of depression. Some of the samples showed modest level of social support in their family and community. Furthermore, independent two-sample T-tests showed that older men and women did not differ in physical and social needs (p<.001). Older women, however, did poorly in psychological needs compared to men (p<.001). Men also had lower level of depression and better psychological wellbeing (p<.001). Future studies shall further investigate other aspects of Cambodia’s aging population in which gender differentials may also exist.
Deep mantle structure and origin of Cenozoic intraplate volcanoes in Indochina, Hainan and South China Sea
Authors: Zhao Dapeng , Toyokuni Genti , Kurata Kenkichi
Published: December 2020

Cenozoic basalts with ages ranging from 28.5 to < 0.1 Ma are widely distributed in the Indochina block, the South China Sea basin and the Leiqiong area in South China including the Leizhou Peninsula and the northern Hainan Island, which form the southeastern Asian basalt province (SABP). These Cenozoic basalts share common petrological and geochemical characteristics. However, the origin of the Cenozoic intraplate volcanism in the SABP is still a controversial issue. In this work, we apply a novel technique of multiscale global tomography to study the whole-mantle 3-D P-wave velocity (Vp) structure beneath the SABP. Our results show that low-Vp anomalies prevail in the whole mantle beneath the SABP. Although the strongest low-Vp zones exist beneath Hainan, significant low-Vp anomalies are also visible in the mantle beneath other parts of the SABP. These low-Vp anomalies appear somehow independent, rather than deriving from a single plume. We deem that a cluster of plumes rather than a single plume existed in the Cenozoic and may still exist now in the mantle beneath the SABP, though the Hainan plume may be the strongest one. A geochemical study suggested that the Hainan plume upwelling might be slowing down and close to exhausting its source zone. This geochemical inference is supported by our tomographic images showing that the low-Vp zones under Hainan are weak and intermittent in the lower mantle (∼700–2889 km depths). The low-Vp zones in the mantle beneath other SABP Cenozoic volcanoes are also weak, suggesting that those mantle plumes, if any, are also dying or already dead. As compared with a strong single plume, each member in a plume cluster should be small and weak, and so hard to exist long. The SABP is surrounded by subduction zones. The hot mantle upwelling beneath the SABP might be caused by collapsing of subducted slabs down to the lowermost mantle.