bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPLEMENTING A STAKEHOLDER AND POLICY MAP TO TRACK FEDERAL CAREGIVER POLICY ACTIVITY
Authors: Wittke Michael
Published: December 2023

A top priority for family caregiver policy should be a focus on accountability and transparency regarding federal actions identified within the National Strategy to Support Family Caregivers. It is crucial to have accountability and transparency as the National Strategy is being updated and refined over the course of time that occurs between the release of the initial strategy and the publishing of the next version of the strategy. Increased accountability and transparency are especially important as stakeholders continue to champion and build on the foundation that has been established in the process of creating the 2022 National Strategy to Support Family Caregivers. Establishing outcomes measures will also inform how the stakeholder community may shift their priorities and operations to align with successes and challenges outlined in an updated National Strategy. To ensure that accountability and transparency are at the forefront of public interest, and as agency leadership communicates the intended outcomes of their critical contributions to America’s family caregivers, it is essential to establish a process to communicate the meaningful impact regarding federal actions on this population. As the National Strategy is being examined for future updates, NAC has facilitated a systematic process to map the actions that federal agencies have identified as core priorities and track their progress toward implementation. That mapping process will be revealed and analyzed during this presentation.
THE NATIONAL STRATEGY TO SUPPORT FAMILY CAREGIVERS: A STATE-LEVEL PERSPECTIVE ON IMPLEMENTATION
Authors: Teshale Salom
Published: December 2023

The 2022 National Strategy to Support Family Caregivers includes action steps that a wide range of non-federal organizations, including states, can take to support family caregivers. States have a variety of ways that they can approach supporting family caregiver policy via action steps, including but not limited to strengthening access to services, collaborating among agencies and organizations to coordinate activities, and tracking caregiver data to help ensure services are meeting caregiver needs. Several states are taking the lead in promoting use of caregiver assessment tools. States can monitor whether initiatives and activities are achieving their goals of supporting caregivers and care recipients through tracking the implementation of the state’s actions to support family caregivers. Drawing on the National Academy for State Health Policy’s role in supporting states through its Resource and Dissemination Center, this presentation will highlight ranges of action steps in the National Strategy that states can take to support family caregivers; note frameworks that states can consider using to track implementation of action steps; and highlight states’ initiatives aligning with action steps.
HIGH-INTENSITY WALKING EXERCISE REDUCES FRAILTY AMONG PREFRAIL AND FRAIL OLDER ADULTS
Authors: Danilovich Margaret , Corcos Daniel , Cheung Ying , Conroy David , Bonner Lauren Balmert
Published: December 2023

Exercise is the most recommended therapeutic intervention for frailty, yet the precise exercise prescription remains elusive. The purpose of this study was to use a cluster randomized controlled trial to evaluate the impact of exercise intensity on frailty in older adults. We tested a high (HIW) vs. low (LIW) intensity walking intervention among n=165 pre-frail and frail residents from n=12 independent living communities. The 3x/week, 4 month supervised intervention targeted >70% heart rate reserve for HIW participants and < 50% heart rate reserve for LIW participants. The primary outcome was frailty category improvement as assessed by the SHARE-FI. We measured usual and fast gait speed, 6-minute walk test, Timed Up and Go, SPPB, Berg Balance, Falls Efficacy, and PROMIS Global Health. Participants were on average 79 years of age, 79% female, and 75% white. We analyzed outcomes based on a modified intention-to-treat principle using a linear or generalized linear mixed model with fixed arm, baseline outcome measure score and random cluster effects. We found increased odds of improving at least one SHARE-FI frailty category in the HIW group (OR=2.91 [reference group=LIW], 95% CI 1.19,7.13, p=0.02, N=103). Among secondary outcomes, there was a significant difference in change in usual gait speed (mean difference = 0.078, 95% CI = 0.026, 0.131, Hochberg adjusted P-value = 0.0357), as well as 6-minute walk test (mean difference = 160.72, 95% CI = 69.2, 252.2, Hochberg adjusted P-value = 0.0075). Results suggest that older adults should engage in more intensive/higher heart rate cardiovascular exercise to reduce frailty.
PLASMA NEUROFILAMENT LIGHT CHAIN IS ASSOCIATED WITH PHYSICAL FRAILTY IN OLDER ADULTS WITHOUT DEMENTIA
Authors: LI Junxin , Gill Jessica , Huang Jing , Waszczuk Daniel , Szanton Sarah L
Published: December 2023

Evidence suggests a link between brain biomarkers of neurodegeneration and physical function and frailty. However, the association of neurodegenerative biomarkers in the plasma with physical frailty in older adults remains unelucidated, as current evidence is limited and inconsistent. We tested the association between plasma neurofilament light chain (NFL), a plasma neurodegeneration biomarker, and physical frailty in a sample of community-dwelling older adults. We used baseline demographics, frailty, and plasma NFL data collected from 97 participants in a randomized controlled trial in community-dwelling, sedentary older adults without dementia [Montreal Cognitive Assessment (MoCA)>17]. Physical frailty was assessed using a composite measure of weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity. Participants’ frailty levels were categorized into robustness, pre-intermediate frailty, and frailty. Multiple linear regression and ordinal logistic regression models adjusting for age, sex, race, education, and comorbidities were conducted to test the associations of NFL with frailty and levels of frailty. The sample was 70.0 ± 6.0 years old, with 80% being females, 72% having intact cognition, and 28% having mild cognitive impairment (MCI). In the adjusted models, higher plasma NFL was associated with higher frailty scores (β=0.16, 95%CI [Confidence Interval] = [0.06,0.26]) and a higher likelihood of being in a higher level of frailty group (odds ratio=1.28, 95% CI =1.02, 1.61). In summary, plasma NFL was associated with greater frailty in our sample of non-demented older adults. Plasma NFL may be a sensitive and promising neurodegenerative biomarker for physical frailty in older adults without dementia.
MULTIMETHOD COMMUNITY-BASED DEMENTIA CARE EDUCATION TO EMPOWER CARE PARTNERS AND IMPROVE WELLNESS
Authors: Wright Rollin , Whitaker Janice , Chabala Peg
Published: December 2023

Inspired by the Medicare Cognitive Assessment and Care Plan Services visit, we describe an Age-Friendly 4Ms curriculum developed to empower informal dementia-care-partners to understand dementia, develop skills to communicate and work with people living with dementia (PLWD), and plan for the future with dementia. Curriculum was developed by an interdisciplinary team and included the integration of evidence-based approaches to care, such as the Positive Approach® to Care model. Through 4 interactive workshops (Understanding Dementia-related Brain Changes, Understanding Behaviors as a Form of Communication, Resources for Dementia Caregivers, Planning for the Future with Dementia) we introduced and had care partners process and practice material to help them navigate everyday challenges faced by PLWD with the aim of assisting them to find opportunities to help improve quality of life with the disease for both themselves and their PLWD. We reached a total of 146 attendees in 3 rural and suburban communities in Central Pennsylvania. Fifty-nine (40.4%) people attended 1 session, 39 (26.7%) people attended 2 sessions, 22 (15.1%) people attended 3 sessions, and 26 (17.8%) people attended all 4 sessions. Across all four sessions, more than 80% of attendees reported knowledge and skill gains, and most attendees reported meeting session objectives. Final evaluation results suggest attendees wanted a way to stay informed, stay connected, and remain supported by the program.
LIVING WITH DEMENTIA: COMMUNITY-BASED CARE PARTNER EDUCATION EVALUATION RESULTS
Authors: Husser Erica , Wright Rollin , Whitaker Janice , Berish Diane , Rubio Olivia , Fick Donna
Published: December 2023

A mixed methods overall series evaluation was administered at session four in each location to assess preparedness, perceived increase in caregiver self-efficacy and wellness, development and implementation of skills, and overall program value. Fifty-five participants (73% response rate) completed the evaluation; 44 (80%) were care partners of a person living with dementia (PLWD). Twenty-four (44%) participants attended all four sessions, 9 (16%) attended three, 8 (15%) attended two, and 11 (20%) attended one. Those who attended all four sessions were more likely to strongly endorse that they felt better prepared (96% vs. 75%; X2 = 3.7, p = 0.05). On a 5-point scale (1 = Strongly disagree, 2 = Disagree, 3 = Neither agree/disagree, 4 = Agree, 5= Strongly agree), 38 (85%) reported agree or strongly agree to improved preparedness to meet the needs of their PLWD, and 41 (93%) reported improved confidence as a care-partner. The top 5 communication skills learned: Using fewer words (89%); Slowing down speech (89%); Focusing on the relationship (86%); Ending an encounter with thank you (86%); and Going with the flow (84%). Content analysis of qualitative data suggest care-partners’ new understanding and improved communication skills were having a positive influence on the pace and quality of daily life and reported less conflict and improved mood; challenges persisted with activities of daily living, such as showering and toileting. Programs like LWD that provide care partners education, skill development and support for self-care can improve daily life for care-dyads living with dementia.
DISCRIMINATION AND MINORITY STRESS IN OLDER ADULTHOOD: NEW DIRECTIONS FOR PSYCHOLOGICAL RESEARCH
Authors: Wilson Megan
Published: December 2023

The experience of marginalization can be harmful to individuals, in part because of increased experiences of discrimination (cite) and stress related to minority identities (cite). While older adults do tend to report experiencing less discrimination, past work suggests that older adults may be more impacted by experiences of discrimination compared to younger adults. Considering older adults from marginalized groups specifically, these individuals may be particularly susceptible to negative effects of discrimination related to age and other group identities that may harm their well-being and health. Given the wide-ranging negative implications of experiences of discrimination for older adults in particular, there is a need to examine potential strategies for combatting these negative effects. Thus, this symposium will examine the roles of discrimination and marginalization across aspects of health and well-being, and how these effects may differ for different marginalized groups. In addition, the symposium will discuss potential strategies and tools to help reduce harmful effects of discrimination and marginalization on older adults’ lives. First, Danielle McDuffie will present work on bereavement and gratitude for Black adults. Next, Megan Wilson will discuss nuances in the relationship between discrimination and purpose and their implications for health. Next, Lydia Ong will examine the effects of daily discrimination on cortisol reactivity. Finally, Michael Vale will discuss minority stress and loneliness for sexual minority individuals.
DISCRIMINATION IN OLDER ADULTHOOD: UNDERSTANDING THE IMPACT ON PURPOSE IN LIFE
Authors: Wilson Megan , Spears Isaiah , Norton Sara , Bogdan Ryan , Oltmanns Thomas
Published: December 2023

Experiences of discrimination negatively impact individuals across a variety of outcomes, and may similarly impact individuals’ sense of purpose, meaning the feeling that one has meaningful goals and direction in life (Ryff et al., 2003). However, counter to a deficit perspective on marginalization, research also suggests that discrimination may be less negatively associated with sense of purpose for minority groups (Wilson & Hill, 2023a). One possible reason is that members of minority groups may be more likely to find purpose through discrimination (Wilson & Hill, 2023b). Thus, the current study examined a sample of 1630 older adults (Mean Age = 73.08) in order to understand the relationship between discrimination and sense of purpose, and moderators of this association. Results indicate that discrimination is negatively associated with sense of purpose. Contradicting past work, this effect did not differ for racial minority group members. However, we do find that individuals with higher education show a less negative association between discrimination and sense of purpose, suggesting education as a potential pathway to overcome discrimination in the pursuit of meaningful life goals. Moreover, while discrimination was negatively associated with health, sense of purpose moderated this relationship, suggesting a potential for sense of purpose to serve as a resilience factor to protect individuals from harmful effects of discrimination. Findings will be discussed in terms of how we may help older adults foster a sense of purpose and life direction, and in terms of the broader implications on older adults’ well-being and health.
AGE DIFFERENCES IN EVERYDAY DISCRIMINATION AND CORTISOL DYNAMIC RANGE IN DAILY LIFE
Authors: Ong Lydia , Klaiber Patrick , Wen Jin , Stuart Nicole , Sin Nancy
Published: December 2023

Extensive work has linked everyday discrimination with poorer health. However, research testing age differences in this relationship is limited. The current study examined everyday discrimination and cortisol dynamic range, and whether the association differed by age. Cortisol dynamic range is believed to reflect physiological responsiveness to external demands such as stressors, with a compressed range indicating less responsiveness. Participants were 250 community-based adults living in British Columbia (ages 25-88, mean=46 years, 64% White, 68% women). At baseline, participants completed the Everyday Discrimination Scale, followed by four days of at-home saliva collection 3x per day: upon waking, 30 minutes post-waking, and before bed. Cortisol dynamic range was calculated as the log-cortisol peak minus log-cortisol nadir across the four days. Multiple regression controlled for race/ethnicity, education, gender, medications, average length of waking day, and depressive symptoms. Results showed a negative association between age and cortisol dynamic range, such that older age was associated with a smaller range (b=-0.01, SE=0.003, p<0.001). There was no main effect of everyday discrimination on cortisol dynamic range. However, there was a significant interaction between age and everyday discrimination. Among younger adults, more frequent everyday discrimination was associated with a smaller cortisol dynamic range. In contrast, among middle-aged adults, more frequent everyday discrimination was associated with a larger range (b=0.37, SE=0.08, p<0.001). There was no significant association between discrimination and cortisol dynamic range among older adults. Findings indicate differing patterns in discrimination and cortisol dynamic range between younger, middle-aged, and older adults.
EXCLUSION FROM MULTIDIMENSIONAL CIVIC ENGAGEMENT OF DIVERSE OLDER ADULTS: A PAN-EUROPEAN PERSPECTIVE
Authors: Nyqvist Fredrica , Dury Sarah
Published: December 2023

Despite decades of research on social exclusion, the understanding of the intersection between ageing and exclusion from civic engagement remains limited, both theoretically and empirically. Moreover, the research on civic engagement, including volunteering or political participation, has received unequal attention in research and the study of multidimensional civic engagement has scarcely been addressed. This symposium therefore brings together qualitative and quantitative research on multidimensional civic engagement in later life, as a part of the pan-European CIVEX-project, devoted to critically assess multidimensional civic engagement of diverse and potentially marginalized groups of older adults in a European context. The objective is to explore the main dimensions of exclusion from multidimensional civic engagement in later life and older adults’ experiences of such exclusion. Toon Vercauteren starts with a study using data from the European Quality of Life Survey (EQLS) in 33 European countries to examine multidimensional civic engagement of older adults in Europe and its key risk and support factors. Bas Dikmans will use a life course perspective to study features of exclusion from civic engagement in disadvantaged neighbourhoods in Belgium, using data collected within the international CIVEX-project. Subsequently, Fredrica Nyqvist will present results based on EQLS data on social capital and political participation in younger as well as older adults. Sandra Torres will close the symposium with a presentation on civic engagement amongst older migrants based on interview data collected in Belgium, Finland, Spain and Sweden.
MULTIDIMENSIONAL CIVIC ENGAGEMENT OF OLDER PEOPLE: A LATENT CLASS ANALYSIS
Authors: Vercauteren Toon , Näsman Marina , Nyqvist Fredrica , Brosens Dorien , Serrat Rodrigo , Sarah Dury
Published: December 2023

Civic engagement of older people remains an understudied topic in gerontological research, focusing for the biggest part on formal activities, such as volunteering and political engagement. This research proposes a more inclusive definition referring to multidimensional civic engagement which includes associational engagement, formal and informal volunteering, digital engagement, and formal and informal political engagement. Additionally, research fails to address whether older people combine different civic activities or are only engaged in one. Using EQLS data (2016) collected in 33 European countries, this research examined the multidimensional civic engagement of older people and whether they combine civic activities. Descriptive analysis was used to map the multidimensional civic engagement of those over 65 years (n = 9,031). Latent class analysis was conducted to create profiles among those who are civically engaged to study whether activities are combined and to explore the socio-structural and social capital resources of each profile (n = 6,142). The results indicate that over two-thirds of older Europeans are engaged in minimally one civic activity. Five profiles can be differentiated, ranging from low diversity profiles to a high diversity profile regarding the chance of engaging in a multitude of civic activities in later life. The results clearly show that having more resources enables diverse civic engagement in later life. This study appropriately appreciates the multidimensional civic engagement of older people and identifies the resources that must be considered when promoting multidimensional civic engagement.
DOES SOCIAL CAPITAL ENHANCE POLITICAL PARTICIPATION? A MULTILEVEL ANALYSIS OF YOUNGER AND OLDER ADULTS IN EUROPE
Authors: Nyqvist Fredrica , Nygård Mikael , Serrat Rodrigo , Näsman Marina
Published: December 2023

Political participation encompasses institutionalised activities such as attending meetings of a political organisation as well as non-institutionalised activities including contacting politicians, signing petitions or boycotting. Both forms of activities tend to be dependent upon birth cohort, political socialisation, and period effects like changes in the welfare state design. Furthermore, it is also connected with other domains of civic engagement as well as trust. Social capital theory focuses on social connections and roles fostering civic engagement, including political participation, however, the relationship between social capital and political participation might look different for different types of political activities. The aim of this study was, therefore, to test the importance of social capital for different types of political participation in younger and older adults by analysing cross-national data from the European Quality of Life Survey (EQLS) in 2016. Data was collected in 33 European countries and includes more than 36,000 individuals aged 18 and over. Multilevel regression analysis was used to explore individual-level and country-level social capital on different measures of institutionalised and non-institutionalised political participation in younger and older adults. The results showed that a third of the sample participated in non-institutionalised activities whereas 11 percent participated in institutionalised activities. Both forms of political participation were lower among older adults as compared to younger age groups. While social capital was identified as an important predictor of political participation, it was also shown that these associations were conditioned by larger cultural, political and welfare institutional contexts.
RUN FOR ANTI-AGING: EXERCISE TIMING SPECIFIES METABOLIC RESPONSES
Authors: Sato Shogo
Published: December 2023

Exercise has been widely recognized as an effective non-pharmacological intervention to delay aging and reduce the onset of chronic metabolic diseases such as type 2 diabetes and cardiovascular diseases. The metabolic response to exercise is influenced by factors such as frequency, intensity, duration, and modality. However, the role of the timing of exercise in activating metabolic pathways has remained an outstanding question. The circadian clock allows the organism to adapt to the cyclic environmental changes imposed by the earth’s rotation, thereby placing temporal boundaries on physiological functions, including metabolic responses to exercise. Our recent studies performed unbiased high-throughput metabolomics of 8 different metabolic tissues in response to a single-bout acute treadmill exercise at different times of the day in mice, revealing that daily timing of exercise is a critical variable for the metabolic impact on different metabolic tissues. This indicates that timing is key to unlocking the benefits of exercise on metabolic health and anti-aging. Therefore, optimizing exercise outcomes following when to exercise is essential to establishing personalized exercise interventions aiming at health improvement and reducing the risk of chronic diseases associated with aging. Our ongoing research is studying the time-of-day-dependent metabolic responses to exercise in aged mice compared to young mice. The ultimate goal is to identify the best time for exercise to promote longevity and healthy aging.
THE ROLE OF COMMUNITY COLLEGES IN TRAINING HEALTH CARE WORKERS FOR AN AGING POPULATION
Authors: Cummins Phyllis , Taylor Philip
Published: December 2023

The aging population in the U.S. has resulted in an increased need for healthcare workers in multiple health settings (e.g., home healthcare, nursing homes, hospitals, medical laboratories). Community colleges play an important role in educating healthcare workers that are critical to an aging population. Many of these occupations focus on home healthcare, empowering adults to remain at home rather than in a long-term care setting. This session will focus on novel ways that community colleges are effectively addressing workforce needs in multiple settings, including hospitals, home healthcare, long-term care, and medical laboratories. A panel of community college and university gerontology and education professionals representing GSA’s Community College and the Aging Workforce Interest Groups will share the innovative ways in which they are addressing the needs of an aging population. Yamashita and Narine will discuss the current and future demand for employees in healthcare occupations, especially those in long-term and home healthcare settings, and will focus on careers that do not require a bachelor’s degree. Velazquez’s presentation will focus on the impact COVID had on training healthcare workers in healthcare related occupations and how one community colleges adapted their curriculum. Cummins et al. will discuss a study that focused on the role literacy, numeracy, and problem-solving skills play in community college students’ success in the classroom and the healthcare workplace, focusing on employer interviews. Finally, Kaur will discuss the role Hillsborough Community College plays in training medical laboratory scientists and in providing employees for critical medical services to an aging society This is a collaborative symposium between the Aging Workforce and Community College Interest Groups.
ROLES OF COMMUNITY COLLEGES IN TRAINING THE HEALTH CARE WORKFORCE IN THE AGING SOCIETY
Authors: Yamashita Takashi
Published: December 2023

As population aging advances, the need for health, medical and long-term, care necessarily increases. On one hand, certain occupations mostly with routine tasks are likely to be automated by computers and technology over time. On the other hand, the previously estimated job automation risks clearly suggest that health care occupations are less likely to be automated, compared to other industries. For example, while 12-45% of health care occupations could be replaced by technology, over 80% of simple food preparation and entry-level customer service is projected to be automated within a few decades. Thus, the demand to train the health care workforce for the aging population will continue to be high, despite the advancement in computers and technology. Certain health care occupations such as licensed practical nurses, nurse assistants, medical technicians, and home health aides, do not require bachelor’s degrees. Considering the current and projected health care workforce shortage, education and training of the future health care workforce is a critical issue when preparing for growing older populations in the U.S. This study triangulated data on health care occupations, literature on workforce development, and emerging trends on aging-related health and long-term care needs, and critically analyzed the role of community colleges to meet the demands for health care workforce in the U.S. Results showed that the history, geographic locations, and existing health care programs position community colleges as one of the most effective and efficient health care workforce development institutions. Specific examples of health care professional training programs are also evaluated.
EFFECTS OF THE WALK ON! PROGRAM ON PHYSICAL FUNCTION IN COMMUNITY-DWELLING OLDER ADULTS
Authors: Foxworth Judy , Heinrich Allison , Holley Kynleigh , Bauguess Caleb , Deputy Amanda , Ludwig Lindsay , Coco-Ripp Jo Ann , Nicklas Barb
Published: December 2023

The objective of this study was to determine the effects of the Walk On! program on pain, strength, gait speed, gait endurance, and balance in community-dwelling, African American older women. Data presented are from those who could ambulate greater than 200 feet independently and who completed one 11-week session of the Walk On! program offered at a local church. Participants walked laps around a large multi-purpose room and completed balance challenges and leg strengthening exercises. The participants completed a battery of physical functional tests including gait speed (self-selected and fast speed), 6-minute walk distance (6MWT), 5 sit to stand time (STS), timed up and go (TUG), and single leg stance (SLS). Participants who completed both the pre- and post-tests and at least 75% of the intervention sessions were included in the analysis (n=14). Paired sample t-test was used to determine significant differences in the physical function tests with alpha level set at 0.05. The mean age of the those who completed the study was 75.8 ± 7.3 years. Both the TUG (p = .018) and pain scores (p = .009) significantly improved. There was no significant improvement in other physical function measures. Older African American women who participated in a bi-weekly supervised walking program had improvements in functional mobility and reduced pain. Further research is necessary to generalize these results for all older adults.
IMPACT OF THE WALK ON! COMMUNITY WALKING PROGRAM ON PSYCHOSOCIAL ATTRIBUTES OF OLDER AFRICAN-AMERICAN WOMEN
Authors: Coco-Ripp Jo Ann , Heinrich Allison , Maxwell-Crudup Kasual , Hill Kaliya , Foxworth Judy
Published: December 2023

Walking in a structured community setting can improve function for older adults with functional limitations. In collaboration with others, recreation therapy (RT) and physical therapy (PT) students and faculty implemented the Walk On! program at a community church. Twenty-four African American females initially started the 11-week program and agreed to engage in the research aspect by completing pre/post-tests focused on physical function and quality of life, loneliness, and a geriatric depression scale. The hour-long biweekly intervention included warm up/cool down stretching, music, group motivation, walking around the large multipurpose room, and various balance activity stations interspersed. PT and RT students as well as faculty and community partners provided leadership and encouragement. Results were analyzed for 14 participants who completed all tests, as well as 75% of sessions. Data for the Geriatric Depression Scale and UCLA Loneliness Scale were analyzed using the Wilcoxon Signed Rank test. No statistical differences between pre/post-test scores were found. Visual inspection of GDS scores showed four participant scores increased slightly, meaning reporting more elements of depression, and one score decreased by 50%, indicating a drop from depression to not an issue. No changes were found in the other nine scores. The Loneliness Scale had slight changes for five participants with two increasing and three decreasing slightly. On the SF-36 Health Survey, Vitality increased or fatigue decreased (p=0.009) and Mental health or wellbeing increased (p=0.041). Further research on the psychosocial aspects of the Walk On! program in other populations will be conducted.
LONG-TERM IMPACT OF A LIFESTYLE INTERVENTION: THE ACTION FOR HEALTH IN DIABETES (LOOK AHEAD) TRIAL AND FOLLOW-UP
Authors: Houston Denise , Espeland Mark , Espinoza Sara
Published: December 2023

Mid-life weight loss and maintenance is often recommended as a means to improve health later in life, however its long-term benefits have not been rigorously established. The Look AHEAD randomized controlled trial compared an intensive lifestyle intervention (ILI) designed to induce and maintain a 7% weight loss through caloric restriction and increased physical activity with a control condition of diabetes support and education (DSE) in 5,145 individuals aged 45-76 years with type 2 diabetes and overweight/obesity over up to 11 years of follow-up beginning in 2001. Compared to DSE, ILI had greater initial improvements in cardiovascular disease risk factors; however, there were no overall differences in the incidence of the trial’s primary and secondary cardiovascular outcomes between the ILI and DSE groups. ILI did, though, have a positive impact on diabetes control and complications, depression, physical health–related quality of life, and health care use and costs. Subsequently, the Look AHEAD trial transitioned to an observational study in 2012 to assess the long-term benefits and potential harms of ILI, which continued for 10 years. This symposium will describe the design of the Look AHEAD trial and transition to the Look AHEAD Aging study, the most recent phone-only observational follow-up begun in 2022, and the long-term impact of the lifestyle intervention on sleep (Spira and colleagues), cognitive resilience (Espeland and colleagues), multi-morbidity and frailty assessed by the deficit accumulation model (Simpson and colleagues), and medical care utilization and costs (Davis and colleagues).
LONG-TERM ASSOCIATION OF AN INTENSIVE LIFESTYLE INTERVENTION ON FRAILTY AND MULTIMORBIDITY
Authors: Simpson Felicia , Espeland Mark , Evans Joni , Johnson Karen , Bahnson Judy , Houston Denise , Yang Mia , Wagenknecht Lynne
Published: December 2023

Multidomain lifestyle interventions may slow aging as captured by deficit accumulation frailty indices (FIs) and multimorbidity. We previously reported that the 10-year Look AHEAD multidomain intensive lifestyle intervention (ILI) that focused on caloric restriction, increased physical activity, improved diet, and cardiometabolic risk factor monitoring, significantly slowed the progression of both FI and a multimorbidity index during intervention delivery. We assessed whether these benefits endured after ILI delivery was terminated and the degree to which these benefits may be interrelated. The Look AHEAD Aging study enrolled N=1606 individuals, ages 63-94 years, who had been assigned a median of 20 years earlier (i.e., 10 years after ILI was terminated) to either the Look AHEAD ILI or its control condition of diabetes support and education (DSE). At the original Look AHEAD randomization, they had a mean (SD) 39-component FI score of 0.128 (0.056) and mean (SD) 9-component multimorbidity index of 1.63 (1.01), both balanced across intervention groups. When enrolled in the Look AHEAD Aging study, participants who had been assigned to ILI, compared with those assigned to DSE, averaged 6% lower FI scores (p<0.0001). They had also accrued 0.14 fewer additional age-related chronic diseases from baseline (p<0.0001). Relative benefits associated with ILI for these indices were similar for both genders and across the full cohort’s age range. Increases in FI and multimorbidity were highly correlated (r=0.55; p<0.001), similarly in both arms. Multidomain lifestyle interventions can result in persistent long-term benefits in two common markers of aging.
DYING WITH DEMENTIA IN NURSING HOMES: A POPULATION-BASED PERSPECTIVE OF DECEDENTS AND THEIR FAMILIES
Authors: Stephens Caroline , Goodwin Rebecca , Iacob Eli , Hollingshaus Michael , Smith Ken , Tay Djin , Utz Rebecca , Ornstein Katherine
Published: December 2023

Families play a critical role in person-centered end-of-life (EOL) care for nursing home (NH) residents with dementia. Many NH residents, however, do not have any family to advocate for care, which may contribute to poorer EOL outcomes. Little is known about the characteristics of families of persons with dementia who die in a NH despite the importance of family at EOL. This study aimed to describe the size and composition of first-degree families (FDF) of Utah NH residents with dementia who died 1998-2016 (n=18,842). Using the Utah Population Caregiving Database, we linked NH decedents with dementia to their FDF (n=54,174; spouses=11.3%; children=57.6%; siblings=30.7%) and compared characteristics of those with and without FDF. Compared to NH decedents with FDF (78.5%), those without (21.5%) were more likely to be older (median 87.3 vs 85.9), female (64.7% vs 57.1%), non-white/Hispanic (10.3% vs 3.4%), less educated (<9th grade; 42.2% vs 33.4%); die in a rural/frontier NH (24.8% vs. 23.2%); and less likely to have 2+ hospitalizations in the last 6 months of life (14.3% vs. 16.5%, all p<.001). Findings highlight social determinants of health that may increase the risk of poor EOL outcomes in an already vulnerable population. Understanding the nature of FDF relationship type on EOL outcomes for NH residents with dementia is an important next step in clarifying the role of families and understanding the supports they may need.
THE PROMISE OF DIGITAL INCLUSION FOR OLDER ADULTS: BUILDING BRIDGES FOR UNDERSERVED OLDER ADULTS IN TWO STATES
Authors: Leedahl Skye , Wilber Kathleen , Choi Namkee
Published: December 2023

Digital inclusion refers to activities completed to ensure that all individuals, especially those who are underserved, have access to and are able to utilize technology and needed support. This includes affordable, robust internet service; devices; digital literacy training; technical support; and applications/online content (National Digital Inclusion Alliance, 2022). Recognizing digital exclusion among older adults as a major public health and social equity concern, particularly during the pandemic, two states (California and Rhode Island) partnered with their respective state units on aging to offer technological devices (e.g., iPads) and intergenerational support to underserved older adults who speak multiple languages across the states. The university-based programs worked with their local Areas Agencies on Aging (CA) and senior centers (RI) through the State units on Aging to recruit and support older participants. This symposium will describe findings from three research projects within these large, ongoing research initiatives and discuss some of the lessons learned for conducting this type of applied research. The first paper by Marnfeldt and colleagues describes factors associated with digital readiness among participants. The second paper by Leedahl and colleagues examines predictors of digital competence among those interested in the program. The third paper by Tsotsoros and colleagues examines the influence of technological growth on various social well-being measures.The fourth paper by Batista-Malat and colleagues describes the strengths and barriers in working with community partners when completing applied research.
PREDICTORS OF DIGITAL COMPETENCE AMONG OLDER ADULTS INTERESTED IN AN INTERGENERATIONAL TECHNOLOGY PROGRAM
Authors: Leedahl Skye , Tsotsoros Cindy , Capolino Alexandria , Santilli Josie
Published: December 2023

The Rhode Island Office of Healthy Aging initiated a digiAGE collaborative. As a major part of this initiative, the University of Rhode Island launched the Engaging Generations: Cyber-Seniors digiAGE iPad Program and research project. We analyzed participants who took part in the study in 2021 and 2022 (N=324; age range=50-92; 77.2% female, 22.5% male; 65.1% White, 16.4% Hispanic, 11.4% Black, 4.9% Native American or Alaska Native, 1.2% Asian, 1.9% Multiple races; 83.6% English, 15.4% Spanish as primary language). In this study, we examined demographic characteristics (e.g., income, marital status, employment status, primary language, living alone status, education, gender, race/ethnicity, and Wifi access), and social well-being characteristics (e.g., depression, social isolation, loneliness, quality of life) as predictors of digital competence using structural equation modeling. Overall, this model showed excellent fit (𝜒2(53, N=324)=104.29, p<.05, with CFI = .96, TLI = .92, RMSEA = .06,CMIN/df = 1.97). The model indicated several direct and indirect effects. For indirect effects, income status predicted depressive symptoms, depressive symptoms predicted quality of life, and quality of life predicted digital competence. For direct effects, having access to a wireless internet connection within the home and education level predicted digital competence (Adj. R Square = 0.112). As technology becomes increasingly integrated into our daily lives, examining predictors of digital competence among older adults is important to identify whom to target for digital inclusion initiatives and how to provide support appropriately.
PATIENT-CLINICIAN RELATIONSHIPS IN HOME HEALTH CARE
Authors: Bankole Ayomide , Girdwood Tyra , Addo-Mensah Dorothy , Toles Mark
Published: December 2023

Patient-clinician relationships are fundamental attributes of high-quality home health care (HHC); yet little is known about patient-clinician relationships in HHC (where 5 million Medicare beneficiaries receive care annually). The objective of the study was to describe perspectives of HHC patients and HHC clinicians about patient-clinician relationships in HHC. We conducted a secondary qualitative analysis of semi-structured interviews (n=34) from a completed qualitative study investigating perspectives of older adult HHC patients (or caregivers as proxy) and their HHC clinicians (17 pairs) on discharge preparedness in a large HHC organization in North-Carolina. A conceptual model of patient-clinician relationships guided content analysis of the interview data. HHC patients identified as White (65%) and black (35%). Most HHC patients reported female sex (53%) and average age was 83 years (range= 69-93). Clinicians were registered nurses and physical therapists. Across the patient-clinician pairs, HHC patients valued relationships with clinicians with shared commonalities and those who provided reciprocal informational exchange and respected their autonomy. HHC clinicians valued relationships in which they felt helpful and respected as a healthcare professional. Relational conflicts arose when there was discordance in expectations of care (e.g., type of HHC services provided). Conflicts also arose when organizational constraints, such as disruptive scheduling, limited HHC visit time, and when limited continuity of care prevented the formation of patient-clinician relationships. Relational conflicts and organizational constraints influence patient-clinician relationships in HHC. Multi-level interventions (targeting modifiable factors at the patient, clinician, and organizational levels) are needed to improve the patient-clinician relationships and the quality of HHC.
THE IMPACT OF A NATIONWIDE PHYSICAL ACTIVITY INTERVENTION FOR DIABETES AND HYPERTENSION PREVENTION
Authors: Chen Cynthia , Ang Gregory , Tan Chuen Seng , Müller-Riemenschneider Falk , Teerawattananon Yot
Published: December 2023

Increasing physical inactivity is a primary risk factor for diabetes and hypertension, contributing to rising healthcare expenditure and productivity losses. We examined the cost-effectiveness of the National Steps Challenge (NSC), an annual nationwide mHealth intervention to increase physical activity in Singapore. We used a Markov model to assess the long-term impact of increased physical activity from NSC on adults. Conducting NSC yearly for 10 years on a mean cohort size of 654,500 participants is projected to prevent 6,120 diabetes cases (95% credible interval: 3,690 to 9,040), 10,300 hypertension cases (6,260 to 14,700) hypertension cases and 4,950 death cases (3,280 to 7,040), leading to 78,800 QALYs (56,500 to 102,000) gained. From the health system perspective, assuming no differentiation of cost among different physical activity levels within each health state, the healthcare cost savings from the averted cases is estimated to be SGD674 million (239 million to 1.48 billion), with SGD364 million (57.8 million to 1.04 billion) for diabetes and SGD311 million (95.0 million to 690 million) for hypertension. Using a willingness to pay threshold of SGD10,000, NSC was cost-saving at -SGD4,510 (-14,000 to 1,430) per QALY gained. We project that increasing physical activity from a yearly nationwide physical activity intervention delays the incidence of diabetes and hypertension. Our results suggest that the intervention is cost-saving and improves the quality of life. The estimated cost savings are more significant when indirect costs are considered, hence providing important information for decision-making in countries when considering similar large-scale physical activity programmes.
GENDER AND HOUSEWORK IN THE POSTRETIREMENT CONTEXT
Authors: Hwang In Jeong , Svec Joseph , Lee Jeong Eun
Published: December 2023

In recent years, social scientists have noted an uptick in “unretirement” of older adults as a large number of retirees have reentered the labor force. Not only do older Americans’ labor-force reentry have implications for our economy as a whole, this also raises important questions regarding the social and interpersonal relationships within households. Specifically, women, compared to men, might be disproportionately subject to work-family conflicts, due to the gendered expectation that women take primary responsibility for household labor. In this study, we examine 758 American couples aged 65 and above from the 2005-2019 Health and Retirement Study (HRS) core survey and the supplemental Consumption and Activities Mail Survey. We examine whether and to what extent couple’s retirement and re-entry into the labor force correspond with changes in the distribution of household labor. Specifically, we expect that while both men and women shift their household labor contributions in accordance to changes in their formal work statuses, changes in men’s contributions are attenuated relative to women’s. The results show that while both male and female retirees spend more time housework when their spouses work, women tend to perform more housework when they re-enter the labor force whereas men’s contributions decline significantly upon their re-entry. These patterns are increasingly evident from the analysis focused on routine tasks, typically done by women. These results highlight how gender ideological scripts can frame relational contributions and expectations as well as their persistence despite shifts in economic contributions to the household.
GENDER, SEXUAL ORIENTATION, AND SPOUSAL CAREGIVING FOR THOSE WITH DEMENTIA: A FOCUS ON EMOTION WORK
Authors: Calasanti Toni , Giles Sadie , Geng Jing
Published: December 2023

This study draws upon and expands three research streams. The first relates to spousal caregiving for those with dementia, and gender differences in stress. Based on gender divisions of labor, men are more likely to take a task-oriented approach to caregiving; women take a more holistic, empathetic approach. The second strand relates to emotion work, wherein caregivers manipulate their own emotions to produce a desired outcome in another (Hochschild, 2003). Research shows that spouses find performing emotion work “draining” (Umberson, et al., 2020), and that women do it more. Finally, we draw upon research that finds that same-sex couples are more egalitarian in their division of labor than are straight couples; how this impacts caregiving approaches or emotion work is unclear. Weaving these together, our study explores how inequalities of gender and sexuality intersect in shaping caregiving by older adults who care for their demented spouses. Our analysis of in-depth interviews conducted among 69 straight, gay, and lesbian caregivers finds that, first, heterosexual men rarely engage in emotion work, though they do manage their own feelings. Second, heterosexual wives overwhelmingly manipulate their feelings in attempts to gain compliance from their spouses, calm them, and/or make them happy. Finally, both gay men and lesbians perform emotion work, and they tend to combine the task-oriented and holistic approaches to care. These findings make clear that gender differences found in previous caregiving research are not “natural,” and suggest that straight men’s lower stress levels may result from their tendency to skip emotion work.