bluuebunny/crossref_metadata_2025 huggingface dataset:
LIPOPOLYSACCHARIDE BINDING PROTEIN IS ASSOCIATED WITH LOWER CVD RISK IN OLDER ADULTS
Authors: Roberts Lisa , Buford Thomas W
Published: November 2019

Intestinal (i.e. “gut”) permeability may be related to cardiovascular disease (CVD) risk, but biomarkers for gut permeability are limited and associations with CVD risk are unknown – particularly among older adults. This cross-sectional study aimed to determine if serum biomarkers related to gut permeability [intestinal fatty acid-binding protein (iFABP)] and bacterial toxin clearing [cluster of differentiation 14 (CD14), lipopolysaccharide binding protein (LBP)] are associated with CVD risk among older adults. Older adults (n = 38, 72.0 ± 7.1 years old) were stratified by CVD risk category (Adult Treatment Panel: moderate, high-moderate, high). One-way ANOVAs determined differences in each biomarker by risk category, and associations with risk score were evaluated via linear regression and/or Pearson correlations. LBP (p < 0.001), but not iFABP and CD14 (p’s > 0.05), was significantly different between CVD risk categories. Post-hoc tests indicated LBP was higher in the moderate risk compared to both higher risk categories (p < 0.005). LBP was a significant predictor of 10-year CVD risk (β = -0.629; p = 0.001) and evaluation of individual components in the risk score demonstrated a moderate, positive correlation of LBP with total cholesterol (r = 0.326, p = 0.046). Higher circulating concentrations of LBP were associated with lower CVD risk among older adults. Further, total cholesterol was positively associated with circulating levels of LBP. Importantly, cholesterol assists LBP in clearing bacterial toxins from circulation by transporting toxins for removal. These data suggest LBP may be a key component in reducing CVD risk in older adults.
THE ROLE OF FOXO3 TRANSCRIPTION FACTOR IN ALZHEIMER’S DISEASE PATHOLOGY
Authors: Du Shuqi , Maneix Laure , Zhang Qinghao , Wan Ying-Wooi , Zheng Hui
Published: November 2019

Alzheimer’s disease (AD) is a progressive and degenerative brain disease and age is one of its strongest risk factors. Aging is a complex process but it is reasonable that a delayed aging process may lower the risk of AD or postpone its pathogenesis. Studies in C. elegans revealed that the activity of DAF-16 is required for the life span extension in many long-lived strains. The mammalian homologs for DAF-16 are the Forkhead box O (FOXO) transcription factors. FOXO3, one of the members in the FOXO family, has been identified in several studies as a susceptibility gene for human longevity. I found that the expression level of Foxo3 in the mouse brain decreases with age or in an AD mouse model. To further study the role of Foxo3 in AD, I generated Foxo3 conditional knockout mice which depletes Foxo3 in neural cells. These mice have reactive astrogliosis in the cortex and also upregulation of some astrocytes specific markers like Gfap and Aqp4. In vitro culture of primary astrocytes from the knockout mice shows impaired respiratory capacity in the Seahorse mito stress test, which corresponds to the expression level change of metabolic genes like Acot1. When we bred the knockout mice with 5xFAD, a mouse model for amyloid pathology. I found increased plaque load and core plaque size in the cortex of the mice with Foxo3 deficiency. This study shows the critical function of FOXO3 in maintaining brain homeostasis and provide new insights into AD pathogenesis and drug discovery.
TELLING THE STORY OF ADULT PROTECTIVE SERVICES: CALIFORNIA’S IDENTIFICATION, SERVICES, AND OUTCOMES MATRIX
Authors: Liu Pi-Ju ( , Hass Zachary , Conrad Kendon , Conrad Karen , Yeh Jarmin C , Iris Madelyn , Stratton Sara , Butler Andrew
Published: November 2019

Adult Protective Services (APS) is responsible for investigating reports of abuse, exploitation, and neglect among vulnerable adults. California’s APS program investigates approximately 15% of all abuse, neglect, and exploitation reports in the country. Once abuse or neglect is substantiated, caseworkers design and implement a service plan for clients to reduce future risk; however, APS intervention effectiveness have not been extensively investigated. In partnership with San Francisco and Napa APS, risk and harm of abuse were measured by type using standardized items from the Identification, Services, and Outcomes Matrix, which is derived from the validated Elder Abuse Decision Support Short Form during case investigation (before APS interventions) and at case closure (after APS interventions). Data from 1,472 older adults’ (on average 78 years old; 57% females) served by APS during the six-month pilot demonstration showed the reduction of risk/harm in self-neglect (p<.001), neglect (p<.001), emotional abuse (p<.001), physical abuse (p=.002), and financial abuse (p<.001) after APS interventions. Effective interventions differ by type of abuse such that caregiver support (b=-.98, p<.10), emergency assistance (b=-1.14, p<.05), and client engagement (b=-1.85, p<.05) decreased self-neglect risk/harm; client engagement (b=-2.24, p<.05) decreased neglect by others risk/harm; case management services (b=-1.17, p<.05) decreased physical abuse risk/harm; and financial planning services (b=-3.99, p<.05) decreased financial abuse risk/harm. No services were identified as effective for emotional abuse. Since effective services differed by type of abuse, it is important to consider the etiology of abuse before implementing the services needed by older adults to effectively decrease harm/risk.
ADVANCE CARE PLANNING COMMUNICATION: AN INTERACTIVE WORKSHOP WITH ROLE-PLAY FOR STUDENTS AND PRIMARY CLINICIANS
Authors: Blomberg Ben A , Quintana Catherine , Hua Jingwen , Hargis-Fuller Leslie , Laux Jeff , Drickamer Margaret
Published: November 2019

There is a need for increased clinician training on advance care planning (ACP). Common barriers to ACP include perceived lack of confidence, skills, and knowledge necessary to engage in these discussions. Furthermore, many clinicians feel inadequately trained in prognostication. There is evidence that multimodality curricula are effective in teaching ACP, and may be simultaneously targeted to trainees and practicing clinicians with success. We developed a 3-hour workshop incorporating lecture, patient-oriented decision aids, prognostication tools, small group discussion, and case-based role-play to communicate a values-based approach to ACP. Cases included discussion of care goals a patient with severe COPD and one with mild cognitive impairment. The workshop was delivered to 4th year medical students, then adapted in two primary care clinics. In the clinics, we added an interprofessional case applying ACP to management of dental pain in advanced dementia. We evaluated the workshops using pre-post surveys. 34 medical students and 14 primary care providers participated. Self-reported knowledge and comfort with ACP significantly improved; attitudes toward ACP were strongly positive both before and after. The workshop was well received. On a seven-point Likert scale, (1=Unacceptable, 7=Outstanding), the median overall rating was 6 (“Excellent”). In conclusion, we developed an ACP workshop applicable to both students and primary clinicians. We saw improvements in self-reported knowledge and comfort with ACP, though long-term effects were not studied. Participants found the role-play especially valuable. Most modifications for primary care clinics focused on duration rather than content. Future directions include expanding the interprofessional workshop content.
HEALTHCARE ENCOUNTERS AS PREDICTORS OF DEATH ANXIETY IN OLDER ADULTS
Authors: Becker Todd D
Published: November 2019

Literature suggests 10–15% of Americans experience death anxiety (DA). While DA is a response to heightened death awareness, research has not fully explored the link between DA and healthcare utilization. 2012 Health and Retirement Study data were used. Three binary logistic regressions analyzed hospitalization, ER admission, nursing facility placement, and outpatient visits’ abilities to predict DA (0 = “none,” 1 = “at least some”) over the past week. Model 1 included demographics and all four types of healthcare encounters. One item from the Beck Anxiety Inventory assessed DA. Most subjects in the sample (N = 7,185) were married (n = 4,302), and White (n = 5,479). Fifteen percent reported ER admissions, 24.6% reported hospitalizations, 1.1% reported nursing facility placements, and 91.5% reported outpatient visits. Regression results from each model showed nursing facility placement and outpatient visits to be statistically significant predictors of DA across all models (OR ranges = 2.23–2.38 and 1.23–1.25 respectively, p < .05 in all models). Hospitalization predicted DA in Models 1 (OR = 1.30, p = .004) and 2 (OR = 1.46, p < .001). Model 3 showed ER admission (OR = 1.52, p < .001) predicted DA. Results from each model indicated individuals who experienced nursing facility placements exhibited double the odds of experiencing DA, compared to those who did not. Outpatient visits were the weakest predictor of DA in each model. DA’s association with healthcare utilization provides implications for providers. Future research should explore the relation between DA and health outcomes.
NEUROTICISM PREDICTS INFORMANT-REPORTED COGNITIVE DECLINE THROUGH HEALTH BEHAVIORS
Authors: Best Rachel D , Cruitt Patrick J , Hill Patrick L
Published: November 2019

Our current study attempts to better understand the relationship between personality and cognitive decline. In this study, we analyzed whether health behaviors act as mediating variables for the relationship between personality and cognitive decline. Additionally, we were interested to see how personality influences different health behaviors, and which health behaviors in particular are predictive of cognitive decline. In addition to analyzing the composite score of health behaviors in relation to personality and cognitive decline, we analyzed each of its four components (wellness maintenance, accident control, traffic risk, and substance abuse; Vickers, Conway & Hervig, 1990). To measure cognitive decline, we used the Ascertain Dementia Eight Item Scale, an informant-report screening measure. Personality has consistently been linked to cognitive decline (Curtis, Windsor & Soubelet, 2015; Chapman, Duberstein, Tindle, Sink, Robbins, Tancredi & Franks, 2013; Low, Harrison & Lackersteen, 2013), but has not yet been analyzed with an informant report measure. Informant-report may be more reliable than self-report when measuring cognitive decline because participants who exhibit cognitive impairment may not be equipped or willing to report about their own cognitive ability. We found that neuroticism significantly predicted informant-reported cognitive decline and that this relationship was mediated by health behaviors, specifically, wellness maintenance. Wellness maintenance was the only category of health behavior that predicted informant-reported cognitive decline. Surprisingly, conscientiousness was unrelated to informant-reported cognitive decline as were extraversion, agreeableness, and openness to experience.
A COHORT LONGITUDINAL STUDY OF SOCIAL CAPITAL AND DEPRESSIVE SYMPTOMS IN THE WISCONSIN LONGITUDINAL STUDY
Authors: Carr Kyle A
Published: November 2019

This study examined the association between the two dimensions of social capital, structural and cognitive, and depression, as well as investigating their within- and between-effects. Using the Wisconsin Longitudinal Study, I applied a multi-level 2-wave longitudinal analysis, over a 7-year period, to examine these two dimensions of social capital influence on individual’s depressive symptoms at both the between- and within person levels. Results suggest both dimensions of social capital are negatively related with levels of depressive symptoms for individuals. The within-person changes for both self-efficacy and sense of belonging were larger than the estimates of between-effects, while trust and structural social capital effects were equal. These findings add to the growing body of literature examining depressive symptoms in late life, while also providing evidence for policymakers to hone in on key areas that can address depressive symptoms with social capital interventions.
KNOWLEDGE OF AGING, NEGATIVE AGE BIAS, AND POSITIVE AGE BIAS: AGE GROUP DIFFERENCES
Authors: Caskie Grace , Canell Anastasia E , Bashian Hannah M
Published: November 2019

Attitudes towards aging include both positive and negative beliefs about older adults (Iverson et al., 2017; Palmore, 1999). Palmore’s (1998) Facts on Aging Quiz, a widely used assessment of knowledge about aging, also identifies common societal misconceptions about aging. Findings regarding age group differences in attitudes toward aging are mixed (Bodner et al., 2012; Cherry & Palmore, 2008; Rupp et al., 2005). The current study compared knowledge of aging, negative age bias, and positive age bias between young adults (18-35 years, n=268) and middle-aged adults (40-55 years; n=277). Middle-aged adults reported significantly greater average knowledge of aging than young adults (p=.019), although both groups had relatively low knowledge (MA: M=13.0, YA: M=12.2). Middle-aged adults also showed significantly less negative age bias (p<.001) and significantly more positive age bias than young adults (p=.026). Although the total sample was significantly more likely to be incorrect than correct on 23 of the 25 facts (p<.001), young adults were significantly more likely than middle-aged adults (p<.001) to respond incorrectly for only 2 of 25 facts. Both facts reflected greater negative age bias among young adults than middle-aged adults. These facts concerned older adults’ ability to work as effectively as young adults (fact 9) and frequency of depression in older adults (fact 13). Results demonstrate that age bias is not limited to young adults and may continue through midlife, though negative age bias in particular may be lower for individuals approaching older adulthood, which could have implications for their psychological and physical well-being.
A RANDOMISED FEASIBILITY STUDY TO REDUCE SITTING IN OLDER ADULTS UNDERGOING ORTHOPAEDIC SURGERY
Authors: Aunger Justin A , Greaves Colin T , Asamane Evans A , Davis Edward T , Whittaker Anna C , Greig Carolyn A
Published: November 2019

Osteoarthritis is a prevalent condition in older adults that causes many patients to require a hip or knee replacement in order to improve quality of life and reduce pain. Reducing sedentariness prior to surgery may aid in improving physical function and post-operative outcomes. Thus, we performed a pragmatic randomised controlled feasibility study with 2:1 allocation into intervention or usual care in Birmingham, UK. The intervention involved multiple techniques to reduce sedentary behaviour, including motivational interviewing and action planning. The primary outcome was feasibility, assessed using mixed methods. We included exploratory measures to inform a future definitive trial, such as ActivPal3 objective measurement of physical activity and sedentariness, Short Physical Performance Battery (SPPB), Basic Psychological Needs questionnaire, and serum cardiometabolic biomarkers. Assessments were at baseline, one-week pre-surgery, and six-weeks post-surgery. We recruited 35 participants aged 64-87 years eight weeks before hip or knee arthroplasty. The study was found to be feasible with some modifications. Within-group comparisons showed that the intervention group significantly improved their physical function (SPPB) score by 0.71 points (95% CI 0.07 to 1.36, p=0.032), a clinically significant increase. Additionally, those in the intervention group retained to post-surgery trended towards a mean sedentary time reduction of 66 min.d-1 (p=0.497). In this older mobility-limited surgical population it is feasible to use behavioural techniques to displace sedentary time to activity. Future trials should further assess the effect of reducing sedentariness on health in larger samples of older adults with osteoarthritis undergoing orthopaedic surgery.
THE RELATIONSHIP BETWEEN PERSONAL AGING ANXIETY AND ATTITUDES TO OLDER PATIENTS AMONG HEALTHCARE PROFESSIONALS
Authors: Inker Jenny
Published: November 2019

Nearly 20% of adults age 50 and older report experiencing age discrimination by a healthcare professional. Numerous harmful health consequences flow from ageism in healthcare encounters, including failure to accurately diagnose and respond to treatable conditions such as pain and depression. Despite this, little is known about ageism among healthcare professionals, including whether job role and work setting influences attitudes to older patients. This study aims to use relational ageism theory to explore the relationship between personal aging anxiety among healthcare professionals and their attitudes to older patients, including potential moderating factors of job role and work setting. A convenience sample of healthcare professionals working for a small regional health system in the US (N = 145) completed an online survey using the Aging Anxiety Scale to measure personal aging anxiety and the Geriatric Attitudes Scale to measure negative attitudes to older patients. Regression analyses demonstrated that personal aging anxiety significantly predicted attitudes to older patients, with greater anxiety associated with more negative attitudes. Job role significantly predicted attitudes to older patients with physicians’ attitudes being more negative compared to other disciplines, while work setting was not predictive of attitudes toward older patients. This research confirms the need to provide ageism awareness training for healthcare professionals and to include in this training an exploration of internalized attitudes to aging. Further research with a larger, more representative sample is indicated to test replication and to better understand how to overcome job role risks of ageism among healthcare professionals.
EFFECTS OF FUNCTIONAL BRAIN NETWORKS AND WHITE MATTER DISEASE ON MOBILITY OF OLDER ADULTS IN AN EXERCISE INTERVENTION
Authors: Neyland Blake R , Kraft Robert , Lyles Mary , Kritchevsky Stephen , Laurienti Paul J , Nicklas Barbara M , Hugenschmidt Christina
Published: November 2019

Declining mobility is associated with increased accumulation of white matter hyperintensities (WMH). However, a high WMH burden is not always accompanied by impaired mobility. Our previous work demonstrates that some variance in mobility may be explained by brain network connectivity. Here, we extended this work by measuring WMHs and brain networks in older adults participating in a lifestyle intervention. The Short Physical Performance Battery (SPPB) and resting state functional magnetic resonance imaging (fMRI) were collected before and after a 5-month caloric restriction plus aerobic exercise intervention in 57 obese, sedentary adults aged 65-78. Participants were categorized based on median splits of baseline SPPB scores and WMH burden: Expected Healthy (EH: low WMH, SPPB≥11, n=16), Expected Impaired (EI: high WMH, SPPB≤10, n=17), Unexpected Healthy (UH: high WMH, SPPB≥11, n=12), and Unexpected Impaired (UI: low WMH, SPPB≤10, n=12). Graph theory-based methods were used to characterize brain networks and compare the four groups. At baseline, the somatomotor cortex community structure (SMC-CS) was less consistent in EI (p=0.05) and UI (p=0.23) compared to EH. The EI (mean=1.25, p=0.003) and UI (mean=1.57, p=0.001) significantly improved their SPPB scores following the intervention. Although both groups had equivalent SPPB scores, SMC-CS was less consistent in the UH than EH (p=0.16). However, UH displayed a significant (p=0.004) increase in second-order connections to the precuneus compared to EH. These data suggest that studying brain networks could improve the understanding of the development of mobility disability and the CNS contributions to mobility independent of white matter disease.
IMPROV FOR CARE: TEACHING CAREGIVERS IMPROVISATION IMPROVES MOOD AND SENSE OF BURDEN
Authors: Almen Ruth , Caldwell Jessica Z Kirkland
Published: November 2019

There is a growing need for novel intervention for caregivers of family members with dementia. Improv for Care is a six-week program designed to teach improvisation (“improv”) skills to caregivers to practice flexible communication, build social support, and process the demands of caregiving through humor and play. This study aimed to examine changes in caregiver depression (Beck Depression Inventory-II), perception of burden (Zarit Burden Interview), qualitative experiences related to caregiving, and their cared-for person’s neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire). Fifteen caregivers completed questionnaires before and after the Improv for Care program. Wilcoxon signed rank tests for related samples revealed significant declines in both caregivers’ depressive symptoms, Z = -2.64, p = .008, and sense of burden, Z = -2.16, p = .031, after completing the program. Caregivers reported that their loved ones’ neuropsychiatric symptoms increased during the course of the intervention, Z = -2.10, p = .036, though associated distress did not also increase, Z = -1.12, p = .265. Of the 15 caregivers, 12 completed follow up questionnaires three months after course completion, which showed that their post-intervention reduction in depressive symptoms remained stable, Z = -1.02, p = .306. The Improv for Care program shows promise as an intervention for caregivers to improve stress, mood, and coping skills.
CAREGIVERS OF OLDER ADULTS: AN ANALYSIS OF THE PCORI FUNDED RESEARCH PORTFOLIO
Authors: Rurka Marissa , Khan Carly P , Witsaman Rachel , Susana-Castillo Steven , Gummi Sindhura , Moscou-Jackson Gyasi , Clauser Steven B , Arora Neeraj K
Published: November 2019

A family-centered approach to care is vital, and caregivers play an important role in patient-centered care for older adults. This analysis of the Patient-Centered Outcomes Research Institute’s (PCORI) portfolio of clinical comparative effectiveness research (CER) trials explores the extent to which caregiving for older adults is a focus within our funded studies and examines how these studies incorporate interventions and outcomes related to caregivers. Of 116 studies in the portfolio with a caregiving component, only 35 studies focus on caregivers of older adults. Approximately half of these studies (16) were not focused on a specific disease, but rather included older adults with a variety of diseases. Caregivers were the target of a delivered intervention in 18 studies. Among these studies, all but one included caregivers as part of a multicomponent intervention. The most common intervention components were caregiver training (14 studies) and inclusion of caregivers in the delivery of health services, notably coordination of care (17), home visits (9), integrated care (9), multidisciplinary care teams (9), and clinical decision tools (8). Caregiver-focused outcomes were assessed in 26 studies. The most frequently assessed domains include measures of health and well-being (most commonly psychosocial status; n=20), evaluation of care (most commonly satisfaction; n=8), and health behavior (most commonly attitudes; n=6). In general, given stakeholder interest in family-centered research on older adults, future CER research should include caregivers and/or compare interventions focused solely on the unique needs of caregivers of older adults. Inclusion of caregiver-related outcomes should also be promoted.
DIABETES AS A RISK FACTOR FOR MILD COGNITIVE IMPAIRMENT IN OLDER RESIDENTS OF RURAL WEST TEXAS
Authors: Arandia Gabriela , Boles Annette , Lopez Veronica , Neugebauer Volker
Published: November 2019

While a growing body of evidence suggests a link between diabetes and Alzheimer’s disease, few studies have examined the impact of diabetes on mild cognitive impairment, the precursor to Alzheimer’s disease, especially among older, rural, and ethnically diverse populations. Using data from Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education, & Research), a longitudinal cohort aging study in rural West Texas, the aim of this study was to compare the risk for mild cognitive impairment among participants who, according to blood sugar levels, were pre-diabetic/diabetic versus normal. This study uses baseline and 3-year follow-up data from a subsample (recruited from Cochran County) of the larger, four-county sample of Project FRONTIER. The study sample (n=206) ranged from 40 to 87 years old (mean age: 58.3 + 11.7 years old), was predominantly female (73.3%), White (88.4%), with slightly over half self-reporting as Hispanic (51.0%). Logistic regression results revealed that those who had prediabetes/diabetes had 1.81 times the risk for developing mild cognitive impairment compared to those who had normal blood sugar levels. These findings indicate the need for earlier intervention for improved diabetes prevention, self-management, and control (diet, physical activity, treatments) to help offset the development of mild cognitive impairment, which could progress to Alzheimer’s disease later in life. More research is needed to confirm the link between pre-diabetes/diabetes and mild cognitive impairment in other populations and settings.
PREVALENCE AND PREDICTORS OF STATIN USE IN LONG-STAY NURSING HOME RESIDENTS WITH LIFE-LIMITING ILLNESSES
Authors: Mack Deborah S , Lapane Kate L
Published: November 2019

Statins are one of the most commonly prescribed medications in the United States. While statin use has been studied extensively in the general population, national data on statin use in US nursing homes do not exist. This study estimated the point prevalence of statin use on September 1, 2016 and identified predictors of statin use in nursing home residents with life limiting illness. We conducted a cross-sectional analysis using national MDS 3.0 data linked to Medicare claims. We identified 424,312 long-stay residents with life limiting illnesses defined as a palliative care consultation (ICD-10 Z51.5), prognosis <6 months on MDS, the Veterans Health Administration palliative care index (PCI), or a diagnosis of a serious illness (e.g., cancer, stroke, heart failure, etc.). Poisson models accounted for clustering of residents within facilities. Overall, 34% were on statins which varied by age (65-75 years: 44.1%; >75 years: 31.5%). The strongest positive predictor of statin use was hyperlipidemia, while coronary artery disease and stroke were only marginally predictive across age. The strongest negative predictors were a palliative care consultation or a prognosis <6 months, while PCI was not strongly associated with use. A substantial proportion of long stay nursing home residents with life limiting illnesses continue statin therapy despite evidence of net harm. Efforts to deprescribe statins in the nursing home setting may be warranted. These findings can be used to help identify and target missed opportunities to reduce the therapeutic burden and improve end-of-life care for the US nursing home population.
EDUCATIONAL OUTREACH IN ALZHEIMER’S DISEASE AMONG OLDER AFRICAN AMERICANS
Authors: Shaw Ashley R , Bright Briana , Puchalt Jaime Perales , Vidoni Eric , Amparan Gabriela , Crawford Broderick
Published: November 2019

Alzheimer’s disease (AD) is a growing public health problem that continues to disproportionally impact African Americans. African Americans are twice as likely to be afflicted with AD compared to non-Latino Whites. However, continued lack of inclusion of African Americans in clinical research trials may reduce the generalizability of future treatments. We investigated how culturally tailored prevention education impacted knowledge, attitudes, and beliefs of AD among older African Americans. We also assessed how culturally tailored prevention education impacted participation in clinical research trials among older African Americans. Researchers delivered “Aging with Grace,” a culturally tailored dementia program to community and faith-based organizations. Demographic information, knowledge of AD, and beliefs of clinical research trials were collected using pre- and post-surveys. In addition, information from community members interested in enrolling in a clinical research study was acquired. A total of 66 community members attended “Aging with Grace” from March to August 2019. 32% of participants perceived an increase in AD knowledge. Most participants (89.1%) believed that more African Americans should participate in research and 29 (44%) expressed interest in enrolling in clinical trials (observational – 73.2%, prevention – 68.2%, treatment – 24.4%). Most participants (93.1%) rated the presentation highly informative and 78% reported that the presentation was very applicable to their daily life. Overall knowledge of AD and interest in participating clinical trials improved with culturally tailored education. Future research should explore ways of enhancing knowledge and participation to enhance inclusion in prevention and treatment trials.
WHAT DOES SUCCESS MEAN IN THE CONTEXT OF ELDER ABUSE INTERVENTION FROM THE PERSPECTIVE OF VICTIMS?
Authors: Burnes David , Hsieh Jessica , Scher Clara , Zanotti Paula , Burchett Chelsie O , Sirey Jo Anne , Lachs Mark
Published: November 2019

Adult protective services (APS) and other community-based agencies respond to hundreds of thousands of elder abuse cases each year in the United States; however, little is known about what constitutes success in the context of elder abuse response intervention. This study explored the meaning of elder abuse intervention success from the perspective of victims themselves toward the development of a victim-centric taxonomy of outcomes. Guided by a phenomenological qualitative methodology, this study conducted in-person, semi-structured interviews with a sample of elder abuse victims (n = 30) recruited from APS in the states of Maine, New York, and California, as well as a community-based elder abuse social service program in New York City. To enhance trustworthiness, two researchers independently analyzed transcript data to identify key transcript statements into themes. Outcomes of success were identified across broad domains related to the victim, perpetrator, victim-perpetrator relationship, family system, and home environment. Specifically, common themes represented outcomes related to victim safety, autonomy, social support, and state of mind; perpetrator independence and accountability; and victim-perpetrator separation. For decades, the field of elder abuse has struggled to understand how to define success in the context of community-based intervention from a client-centered perspective. The taxonomy developed in this study provides a comprehensive and conceptually organized range of successful outcomes to serve as infrastructure for the development of meaningful intervention outcome measures. This study represents one of the largest efforts to understand and integrate the perspectives and needs of victims into elder abuse intervention practice/research to date.
AN INTEGRATED TRANSITIONAL CARE MODEL FOR OLDER ADULTS WITH MULTIMORBIDITY AND DEPRESSIVE SYMPTOMS
Authors: Markle-Reid Maureen , McAiney Carrie , Ganann Rebecca , Fisher Kathryn , Bartholomew Amy , Janet McElhaney , Alain Gauthier , Gafni Amiram
Published: November 2019

This pragmatic randomized controlled trial examined the implementation, effectiveness and costs of a nurse-led transitional care intervention to improve hospital-to-home transitions for 127 older adults (≥ 65 years) with depressive symptoms and multimorbidity in three Ontario communities. Participants were randomly allocated to receive the intervention plus usual care (n=63) or usual care alone (n=64). The intervention included an average of 5 in-home visits and 6 phone calls from a Registered Nurse (RN) over a 6-month period. The RN provided system navigation, patient education, medication review, and management of depressive symptoms and chronic conditions. Implementation outcomes included engagement rate, intervention dose, and feasibility of intervention implementation. Effectiveness outcomes included quality of life, depressive symptoms, anxiety, social support, and health and social service use and costs. Participants were an average of 76 years and had an average of 8 chronic conditions. Findings suggest that the intervention was feasible and acceptable to participants and providers. Intention-to-treat analyses using ANCOVA models showed no statistically significant group differences for the outcomes. However, the upper 95% confidence interval for the mean group difference showed greater clinically significant improvements in physical functioning in the intervention group. Quantile regression showed that the intervention may result in greater improvements in physical functioning for individuals with low to average physical functioning values compared to the control group. The intervention may also result in higher levels of perceived social support for individuals with a range of social support values. No statistically significant group differences were observed for service use or costs.
PET VISITATION AS NARRATIVE CARE FOR OLDER ADULTS IN THERAPEUTIC SETTINGS
Authors: Yamasaki Jill , Murfin Kelley
Published: November 2019

A growing body of research highlights the physiological and psychosocial benefits of pet visitation programs in therapeutic settings. These programs utilize the profound connection between humans and animals to promote holistic healing, foster greater quality of life, and influence meaningful communication between patients and providers. For older adults in hospitals or long-term care, these benefits are often correlated with moments of pleasure, comfort, relaxation, and entertainment. The current study builds on this prior knowledge by examining pet visitation programs as a novel form of narrative care that can also help preserve biographical continuity and promote the sharing of lived stories. We worked with two volunteer pet visitation programs in Houston and one in Los Angeles. Our research included a variety of ethnographic methods, including participant observation; informal interviews with providers, patients (or residents, depending on the context), and their families; semi-structured interviews with volunteers; and discourse review of organizational materials. We employed a method of constant comparison to identify and thematically analyze recurrent patterns of behavior and overarching meanings across the data. Three primary themes emerged from the data: (a) compassion, (b) connection, and (c) response. Collectively, the presence of pets prompted stories and behaviors that foster healing relationships characterized by empathy and mutual understanding between patients (or residents), family members, and providers. Pet visitation programs facilitate storied conversations, increased autonomy, and alternative ways of knowing that promote greater understandings of the patient’s (or resident’s) psychosocial context and biographical history, leading to more personalized care and improved well-being.
PSYCHOSOCIAL CHARACTERISTICS AND DEPRESSIVE SYMPTOMATOLOGY AMONG MEXICAN OLDER ADULTS
Authors: Downer L Paige B , Wong Rebeca
Published: November 2019

The incidence of mental health problems, specifically depression, are increasing among older adults. Previous research identified psychosocial characteristics related to mental resiliency, such as increased conscientiousness and internal locus of control, as contributing to improved health behaviors and better physical and mental health outcomes. This study identifies the association between these psychosocial traits and depressive symptomatology among Mexican adults aged 50 and older using Wave 4 of the Mexican Health and Aging Study (2015). We hypothesize that psychosocially ‘strong’ older Mexican adults, those with higher levels of conscientiousness and an internal locus of control, will report fewer depressive symptoms; we theorize that gender moderates this relationship. Older Mexican adults’ mental health status was measured through depressive symptomatology using a 9-item version of the Centers for Epidemiologic Studies-Depression (CES-D) scale. Conscientiousness was measured using a 6-item sub-dimension of the “Big 5” personality scale. Locus of control was measured using an 8-item scale adapted from Rotter (1966). Multivariable linear regression was performed and adjusted for socio-demographic characteristics and comorbid chronic health conditions. Depressive symptoms were lower with higher age and formal education; however, older adults in rural environments who are divorced/separated or widowed exhibit higher depressive symptoms. The association between conscientiousness and depressive symptoms differed by gender. Locus of control and conscientiousness influenced depressive symptomatology in men, however, only conscientiousness impacted women’s depressive symptoms. Continued research is needed to assess psychosocial changes over the life-course as they contribute to resilience from adverse life-events that influence mental health in old age.
EXPLORING HOW “TELE-SAVVY” INFLUENCES SELF-CARE BEHAVIORS FOR DEMENTIA FAMILY CAREGIVERS
Authors: Epps Fayron , Maloch Elizabeth , Griffiths Patricia , Hepburn Ken
Published: November 2019

Tele-Savvy is a 3-arm randomized controlled trial (RCT) of a psychoeducation intervention that equips dementia family caregivers with the knowledge and skills they need to provide care to their person, while also caring for themselves. This RCT is currently underway, with cohorts rotating through over a period of 12 months. The purpose of this presentation is to explore the effectiveness of Tele-Savvy (active) versus Healthy Living Intervention (attention control) or usual care (waitlist) on self-care behaviors among dementia family caregivers. We conducted semi-structured interviews with 16 caregivers after their initial participation in either the active, attention control, or usual care groups. Interviews elicited caregivers’ perceptions regarding the program’s influence on their self-care behaviors and engagement in self-care activities. The overall emerging theme for the family caregivers who participated in the Tele-Savvy and Healthy Living programs was “increased awareness of self-care activities”. Family caregivers in the Healthy Living program spoke mainly about engaging more in physical activities and improving their nutrition by eating healthier and keeping track of foods. Across all study groups, social engagement and having a support system were common self-care activities. Various limitations to engaging in self-care activities while in enrolled in the study included time and caregiving responsibilities. Suggestions were made for more respite services to become available to allow for family caregivers to engage in self-care activities. These findings provide researchers and practitioners with pertinent information to develop and refine programs for family caregivers to improve their self-care practices.
EFFECTS OF AN INTERGENERATIONAL EXERCISE BUDDY PROGRAM ON PARTICIPANTS
Authors: Kim Eun hae , Chee Kyong Hee , DeStefano Clay , Broome Anna
Published: November 2019

Structured social support may enhance the benefits of an exercise class for participants. This study examined the effects of an intergenerational exercise buddy program on participant well-being. A convenience sampling was used to recruit participants from Central Texas (N = 51): 34 were community-dwelling adults aged 65 and above, and 17 were university students aged 18-25 years. The study used a pretest-posttest, quasi-experimental design and focus group interviews. Randomly selected 18 older-adult participants were paired with young-adult participants as an exercise buddy for each other to attend 8 weekly Tai Chi or Chair Yoga classes at a community center. Meanwhile, 16 older-adult participants formed a control group attending different exercise classes without young-adult buddies. The survey results show that, compared to the control group, the intervention group (n = 35) had significantly greater satisfaction with life (p < .09 ) and a more positive attitude towards aging (p < .01) after attending exercise classes with their buddies. In focus group interviews, the participants most frequently mentioned that commitment to their buddies as a key factor for class attendance. The participants typically perceived that their buddies were pleasant and did not judge or treat them based on their age. They stressed the positive effects of building relationships with all involved in the program, including the exercise instructors. Meanwhile, control-group participants wished that they, too, had buddies. Although the study should be replicated with a larger sample, its findings suggest that an intergenerational exercise program offers added benefits for participants.
IMPROVED HEALTHSPAN AND LIFESPAN WITH LATE ONSET PHARMACOLOGICAL OR DIETARY INTERVENTIONS IN MICE
Authors: Mitchell Sarah , MacArthur Michael , Kane Alice , Torrence Margaret , Manning Brendan , mItchell James
Published: November 2019

While late-onset dietary (e.g. calorie restriction) or pharmacological (e.g. rapamycin) interventions can extend longevity in rodents, whether or not they can be used to reverse or forestall onset of aging-related symptoms (i.e. frailty) remains untested. Here, we employed methionine restriction (MR), a dietary intervention associated with weight loss and longevity extension, or a fumagillin derivative, ZGN-1062, as a pharmacological agent associated with weight loss across multiple species. 21mo Male and female C57BL/6 mice were randomized to one of three groups: control, 0.1% MetR, or ZGN-1062 (1.5mg/kg). There was no difference in frailty index (FI) amongst groups at baseline (21 mo age). MetR and ZGN-1062 treatments resulted in modest weight loss independent of sex. After 6 months, FI increased consistent with reduced healthspan in control males (0.23+/-0.01 to 0.34+/-0.01 A.U, p<0.0001) and females at this age (0.19+/-0.03 to 0.24+/-0.01, p<0.0001). Male MetR and ZGN-1062 mice had significantly lower FI scores after 6 mo of treatment (MetR: 0.28+/-0.04, p<0.0001; ZGN-1062: 0.29+/-0.05, p=0.0002). While female mice were not significantly different from controls, they were, overall, less frail than males at 26 months, suggesting sexual dimorphism in the timing frailty onset in mice. Although the end points of this study have not been reached (survival studies are ongoing), the data obtained to date suggest that late-life treatments can improve healthspan markers, at least in male mice. Such treatments include a pharmacological intervention associated with weight loss, which may be a more practical therapeutic strategy towards mitigation of age-related healthspan decline than dietary restriction-based interventions.
ASSOCIATION BETWEEN NEIGHBORHOOD CHARACTERISTICS AND DEMENTIA: AN ECOLOGICAL ANALYSIS
Authors: AlHasan Dana M , Lohman Matthew , Miller Maggi , Hirsch Jana A , Cai Bo
Published: November 2019

Research has examined the relationship between neighborhood environments and cognitive decline, yet few have investigated the role of neighborhood characteristics specifically on dementia. This ecologic study examined the geographic distribution of dementia incidence and investigated ecologic associations between census-tract neighborhood characteristics and diagnosed dementia case incidence from 2010-2014 in the South Carolina (SC) Alzheimer’s Disease Registry. Analyses took place on the census-tract level (n=1089) with population ≥1. Neighborhood measures came from the Decennial Census, American Community Survey, Rural Commuting Area Code, and County Health Rankings. To estimate the ecologic association between neighborhood characteristics and dementia incidence, we conducted a zero-inflated, negative binomial mixed-effects model. The overall age-sex standardized dementia incidence rate was 2,885.4 per 100,000 people per census tract from 2010-2014 in SC (95% CI: 2857-2913.7). In an adjusted model, neighborhood characteristics had a significant association with dementia incidence. Rural and small urban census tracts had 62% (IRR=0.38; 95% CI= 0.27-0.54) and 58% (IRR=0.42; 95% CI= 0.29-0.60) lower dementia incidence, respectively, among ≥50 years old compared to urban census tracts while adjusting for neighborhood median-household income, racial composition, commute time, and age structure. The results from this study show a negative relationship between rural neighborhoods and dementia, contrary to previous findings. However, lower access to care in rural neighborhoods can result in lower detection rates and thus could present a reporting bias. Future research should investigate additional census-tract neighborhood characteristics (e.g. green space, pollution rates or psychosocial stress) that contribute to lower dementia rates in rural areas.
AGE-RELATED CHANGES TO MACROPHAGES AFFECT FRACTURE HEALING
Authors: Clark Daniel , Miclau Theodore , Nakamura Mary , Marcucio Ralph
Published: November 2019

Fracture healing follows a strict temporal sequence characterized by an initial inflammatory phase. Perturbation of the inflammatory phase may be responsible for the poorer fracture healing outcomes in older adults. Herein, we examine age-related changes to the macrophage during fracture healing. Macrophages regulate inflammation through pro-inflammatory (M1) and anti-inflammatory (M2) phenotypes. Anti-inflammatory activity is promoted via activation of triggering receptor expressed on myeloid cells 2 (TREM2). Tibia fractures were made in old (24 months) and young (3 months) mice. Immune cells from the fracture callus were analyzed via RNAseq and FACS, and fracture healing was evaluated histologically. Old mice demonstrated significantly delayed fracture healing compared to young (p<0.05). The quantity of infiltrating macrophages into the fracture callus was similar in young and old mice. However, 1222 genes were significantly differentially regulated (FDR<0.1) in callus macrophages from old mice compared to young, and old macrophages demonstrated a more pro-inflammatory phenotype. TREM2 expression was increased in macrophages after fracture in both groups but was significantly less in old mice compared to young via RNAseq and FACS (FDR<0.1, p<0.05). TREM2-/- mice demonstrated increased pro-inflammatory cytokine expression within the callus with resulting significant delays in fracture healing compared to age-matched controls (p<0.05). Inhibition of macrophage infiltration into the fracture callus significantly improved fracture healing in old mice compared to age-matched controls. Age-related changes to macrophages, including increased pro-inflammatory cytokine expression and dysregulated TREM2 expression, may explain fracture healing deficits observed in older adults. Therapeutically targeting macrophages may improve management of fractures in older adults.