bluuebunny/crossref_metadata_2025 huggingface dataset:
Through Their Lens: Using Visual Methods to Illuminate the Lived Experiences of Diverse Older Adults
Authors: Yeh Jarmin , Perry Tam
Published: December 2020

Visual methods, like photovoice and photo-elicitation, have attracted modest attention in gerontological inquiry with diverse and vulnerable community-dwelling older adults. Visual methods are based on the idea of inserting images, produced by informants or not, into research interviews, allowing informants to be the experts of knowledge and meaning-making while the researcher becomes the student. The empowerment of informants as subject-collaborators in the research process is a distinctive feature of visual methods. Benefits include revealing unique insights into diverse phenomena by evoking elements of human consciousness, feelings, and memories that words may not easily express and surveys may not easily capture. This symposium presents qualitative research using visual methods to illuminate the lived experiences, voices, and perspectives of diverse and vulnerable older adults living in New Jersey, Connecticut, and California. Reyes’ research critiques how the operationalization of mainstream notions of civic participation becomes exclusionary and provides a more inclusive understanding of how civic participation is enacted and performed through the practices of Latinx and African American older adults living in New Jersey. Versey’s research with homeless older adults subverts the attention often focused within cities by interrogating the meaning of place with informants whose needs and desires are often overlooked or obscured by residing in a small, rural town in central Connecticut. Yeh’s research on aging in place inequalities chronicles the everyday lives of housed and unhoused older San Franciscans to reveal their tactics for negotiating a moving tension between the daily interiority of identity and contingencies of a changing environment. Qualitative Research Interest Group Sponsored Symposium.
Using a Performance Based Assessment Tool of Everyday IADL to Determine Driving Risk in Older Adults
Authors: Dickerson Anne
Published: December 2020

For older adults living in rural/suburban communities, driving is often their only means of transportation. Although considered safe drivers, drivers older than 70 years have higher crash rates with fatality rates amplified due to the increased frailty/fragility. However, research evidence clearly indicates that cognitive factors contribute to driving impairment in older adults. Occupational therapists, as experts in observation of functional performance, use the Assessment of Motor and Process Skills (AMPS), for measurement of performance in everyday activities using two scales (motor and process). Previously demonstrated as a sensitive tool for cognitive changes, this presentation will summarize the research outcomes between older adults with cognitive impairment (N=57+) and without (N=53) who completed a comprehensive driving evaluation. Analysis of the two samples using receiving operating curves suggests the AMPS has potentially excellent specificity and sensitivity, specifically AUC = 0.826(0.73-0.92) for motor, AUC = 0.909(0.84-0.98) for process, and AUC = 0.936(0.88-0.99) together. Part of a symposium sponsored by Transportation and Aging Interest Group.
Life Course Predictors of Allostatic Load Among LGBTQ Older Adults
Authors: Hoy-Ellis Charles , Kim Hyun , Goldsen Karen Fredriksen
Published: December 2020

LGBTQ older adults are at significantly increased risk for poor mental and physical health, likely consequential to lifelong bias. Allostatic load (AL), the net effect of “wear and tear” on the body resulting from repeated, chronic over-activation of the psychophysiological stress response system. Utilizing the Health Equity Promotion Model, the aim of this study was to test potential life course predictors of AL, including interpersonal violence, legal marriage, and identity management in a sample of LGBTQ adults 50 to 97 years of age (n=317). Results from a series of hierarchical linear regression models showed that adult physical abuse and late identity disclosure for those who had been in an opposite-sex marriage predicted higher AL in this sample of LGBTQ older adults, indicating need for increased research on bias over the life course as contributory to AL and biopsychosocial dysfunction among LGBTQ older adults.
Outpatient and Inpatient Service Use by Chinese Adults Living in Rural Low-Income Households
Authors: Lu Peiyi , Yao Jun , Yang Chunyu , Shelley Mack , Zhang Li
Published: December 2020

Background: This study applied the Andersen Model of Health Care Utilization to explore the variables associated with health service use among Chinese adults living in rural low-income households. Method: A survey of 2,429 adults living in 787 low-income households in Jiangsu, China was conducted. Respondents were asked the presence of outpatient service in the past one month and the amount of hospitalization in the past one year. Mixed effect logistic and negative binomial models were used to examine the relationship of individual-level and household-level characteristics with health service use. Results: Health condition was the predominant determinant of both outpatient and inpatient service use (Odds Ratio [OR] >1, p<0.001). Individuals living in a poor household were less likely to use outpatient service (OR=0.05, 95% confidence interval CI: 0.00, 0.71), and the longer in poverty status the less likely to use outpatient service (OR=0.92, CI: 0.86, 0.99). Age was associated with lower likelihood to use outpatient service (OR=0.93, CI: 0.93, 1.00), and this relationship was stronger for larger households (OR=1.01, CI: 1.00, 1.01). For inpatient service use, most household-level measures were insignificant. Conclusion: Rural Chinese health service use was influenced primarily by needs variables. Outpatient service use was constrained by household enabling variables. Older adults were at a disadvantage for using outpatient service when the family prioritized younger members in allocating resources. These results suggest the need for policy advocacy to expand insurance reimbursement and improve benefits for poor older adults.
Circadian Rhythms, Sleep, and Aging: New Visions on the Clock, Sleep, and Aging
Authors: Sehgal Amita
Published: December 2020

The symposium will highlight the reciprocal relationship between aging and sleep and circadian rhythms. Circadian rhythms and sleep deteriorate with age, but at the same time, disruptions in these processes can contribute too aging. Presenters will show how work in model organisms is providing insight into this relationship
Racial and Ethnic Differences in Perceptions of, and Barriers to, Cost-of-Care Conversations Among Older Adults in Florida
Authors: Conner Kyaien , Wiltshire Jacqueline , Anderson Erica , Colato Edlin Garcia , Carrion Iraida , Orban Barbara
Published: December 2020

Cost of care conversations (CoC) between patients and doctors have been shown to lower overall healthcare and patients’ costs. How, it is unclear why CoC are not occurring more frequently among high cost patients such as older adults. To address this important question, we conducted three race-stratified focus groups (n=10 Whites, n=9 African Americans, and n=8 Latino/Hispanics) to assess perceptions about, and barriers to, CoC in a convenient sample of adults ages ≥65 from Adult Centers in Tampa Bay, Florida. An inductive content analysis approach was utilized by research team members to analyze qualitative data. Findings indicated that CoC are not occurring. White participants perceived that CoC were not occurring because they did not have issues paying for care. African Americans perceived that CoC were not occurring because doctors are not trained to understand finances, insurance, and medical billing. Latinos/Hispanics perceived that doctors are meant to take care of patients, and receptionists, administrators and billing departments should handle CoC. Wait time and perceived stress/rush of doctors were identified as CoC barriers for whites, while doctors’ attitude was a barrier for Blacks/African Americans, and perceptions about CoC being “taboo” was a major barrier for Latinos/Hispanics. Overall, participants indicate that it is easier to have CoC if they had developed a good rapport with the doctor, had confidence in the doctor, and felt the doctor was interested in and cared about them. The findings suggest that promoting CoC among older adults will require addressing social and cultural concerns of racial/ethnic minority groups.
Sirtuins: New Roles for Sirtuins in Aging and Disease
Authors: Chua Katrin
Published: December 2020

Sirtuins are NAD+-dependent enzymes related to yeast silent information regulator-2, a histone deacetylase that prevents premature aging through chromatin silencing. Mammalian sirtuins, SIRT1-SIRT7, have key functions that protect against diverse aging-related pathologic states, from cancer to metabolic and neurodegenerative disease. In addition to chromatin regulation, mammalian sirtuins also govern myriad cellular processes through a growing list of enzymatic activities and substrates. This session will highlight new discoveries and directions in Sirtuin research.
Chromatin Regulation and Genome Maintenance by Mammalian SIRT7
Authors: Cho Joonseok
Published: December 2020

Members of the Sirtuin family of enzymes are important regulators of genomic stability, stress responses, and metabolic programs that impact on human physiology, aging, and age-related disease processes. We previously showed that the mammalian Sirtuins SIRT6 and SIRT7 have high-selectivity histone deacetylase activities at chromatin, and inactivation of SIRT6 or SIRT7 results in dysregulated histone acetylation states and gene expression programs, with pathological consequences at the cellular and whole organism levels. Recently, we have been exploring novel functions of SIRT6 and SIRT7 in silencing of heterochromatic regions of the genome, the deregulation of which has been linked to aging and cancer biology. We found that pericentric heterochromatin silencing by SIRT6 prevents acute cellular senescence that is triggered by pathologic pericentric transcripts. We also uncovered a second novel trigger of human cellular senescence, ribosomal DNA instability in nucleoli, and we showed that SIRT7 guards against senescence induced by this instability. In our studies, a long-term focus has been identifying substrates of SIRT6 and SIRT7 and their roles in aging and disease pathways. In new work, are studying a novel physiologic substrate of SIRT7 at chromatin, H3K36Ac, and we are characterizing the genomic landscape of this SIRT7-dependent deacetylation target, and its downstream chromatin and nuclear signaling mechanisms. We will also discuss mechanistic insights into the functions of SIRT6 and SIRT7 from new proteomic, cellular, and mouse model studies.
The Effects of Organizational-Level Factors on the National Disability Prevention Programs for Older Adults
Authors: Chen Ya-Mei , Chiu Wan-Yu , Mao Hui-Fen , Chang Ling-Hui
Published: December 2020

In 2017, Taiwan implemented nationwide disability preventive programs that aimed to maintain older adults’ function and prevent disability. This study aimed to evaluate the impact of organizational-level factors on older adults’ improvement through participating in the 2019 preventive disability programs. There were 202 disability preventive programs, which included a 2-hour sessions per week for 12 weeks, in Taiwan in 2019. Participants’ physical, mental, and social functions were assessed before and after participating the programs and reported to the government. A total of 7194 older adults’ assessments were received. This study administered survey by the end of 2019 in the 202 programs in Taiwan and 8 organizational-level factors were assessed, including effectiveness, efficiency, professional, support from the upper organization, and cooperation with community, adequacy, responsiveness, and sustainability. Multilevel analysis was conducted to assess the impacts of organizational-level factors on disability prevention programs. A total of 170 programs (84%) has responded to our survey. About 48.2% of the programs were implemented by local public health centers. The domains of responsiveness and sustainability are rated highest among these programs. Programs with the following characteristics were associated with better program outcomes among older adults: better ability to provide outreach services was associated with improved depression; higher level in profession domain was associated with improved f mobility; better program responsiveness was associated with improved in nutritional status and oral function, and depression risk. Our results shed lights on how to improve a national disability prevention programs from programs’ characteristics point of view.
Discovery of Novel Regulators of Autophagy in Animals
Authors: Baehrecke Eric
Published: December 2020

The clearance of organelles by autophagy is important for cell health, and defects in this process have been associated with age-associated degenerative disorders. Ubiquitination of proteins enables their recognition by cargo receptors that facilitate the delivery of both protein aggregates and organelles to forming autophagosomes for degradation. We have investigated developmentally programmed autophagy to identify novel regulators of organelle clearance. We identified an Atg7-independent autophagy program that is required for cell size reduction and clearance of mitochondria. We have used this system to screen for new factors regulate ubiquitin-dependent autophagy and clearance of organelles. We screened a collection of putative ubiquitin binding domain encoding genes, and identified the novel gene Vps13D. Vps13D is an essential gene that is necessary for autophagy, mitochondrial size, mitochondrial clearance, and is associated with human movement disorders. We have used genetics and biochemistry to identify factors that link Vps13D, mitochondrial biology and autophagy.
Nurse Practitioner’s Role as 3D Team Leader
Authors: Obuchon Kathleen
Published: December 2020

The nurse practitioner’s (NP) clinical activities during the 12-month intervention period include 4 monthly in-home visits and 8 monthly telephone contacts. This presentation will detail the clinical assessments and activities conducted during the initial home visit, and how subsequent home visit activities and interventions are structured for older adults and their informal caregivers depending on whether older adults have dementia, depression, and/or recent delirium. Because the potential for medication-related problems is a critical concern for older adults with cognitive vulnerability, this presentation also will detail how the NP works with the 3D Team pharmacist to determine potential inappropriate medications through a review and reconciliation process, and how the NP and pharmacist summarize these results and correspond accordingly with the older adult’s primary care physician. Finally, this presentation will explain how the NP manages communication among members of the 3D Team who provide interventions to the same older adult and caregiver.
When Do Medical Doctors Recommend Less Expensive Medication Prescriptions in U.S. Adults 50 Years or Older?
Authors: Aravena Jose
Published: December 2020

The US is the country with the greatest average spending for prescription drugs per person (US$ 1,200). 85.0% of older people consume prescription medications, with high rates of polypharmacy. The aim was to analyze the factors related to the recommendation of a less expensive prescription by a medical doctor in US older adults. A cross-sectional analysis using the data from The National Poll on Healthy Aging (NPHA) 2017 was conducted, with a total sample of 1666 adults age 50 to 80 residing in the US. People were asked if they have received a less expensive prescription by a medical doctor in the last two years (yes/no). Sociodemographic and health variables, active patient medication-cost behaviors, and doctor active medication-costs actions were measured as covariates. Weighted and stratified by region logistic regression model was conducted in a 70% random sample. The model was validated in the 30% remaining using ROC curve and AUC. In the parsimonious model, ≥4 visits to the doctor (OR=2.06, 1.33 - 3.18), perception of medication costs as a burden (OR=1.76, 1.25 - 2.47), the doctor talked about medication costs (OR=5.54, 3.90 - 7.88), doctor awareness of medication costs (OR=1.81, 1.34 - 2.46), and being Non-Hispanic Black (OR=1.90, 1.20 - 3.03) were linked to a higher odd to receive a less expensive prescription. The model presented a moderate-high fit (AUC:0.71; sensitivity:84.4%, specificity:49.8%). Awareness and training in the active prescription of less expensive medications by the medical doctor seem fundamental to reduce drug costs burden in older adults.
Nurse Practitioner’s Clinical Triggers for Referral to Other 3D Team Members
Authors: Ladda Shawn
Published: December 2020

This presentation features how 3D Team nurse practitioners (NP) use results of clinical assessments to determine whether older adults and caregivers enrolled in the study are referred to other Team members; these assessment results are called “clinical triggers”. Other team members who receive referrals based on NP-generated clinical triggers include: Licensed Clinical Social Workers, who deliver Problem Solving Therapy to older adults with significant depressive symptoms; Occupational Therapists, who deliver an evidence-based dementia care intervention; Physical Therapists, who deliver an adapted Otago exercise program; Registered Dietician, who provides nutrition and dietary instruction; and Community Health Educator, who provides community resource information to address social determinants of health. All clinical triggers will be detailed in this presentation, along with a description of each intervention delivered by other team members except the Community Health Educator. Case studies will be presented to illustrate how study participants receive multiple interventions from the 3D Team.
Marital Status and Risk of Dementia: Does Race Matter?
Authors: Zhang Zhenmei , Liu Hui , Choi Seung-won
Published: December 2020

Previous research has shown that unmarried individuals (i.e., divorced, widowed, and never married) had a higher risk of dementia than their married counterparts. However, few studies examined whether the link between marital status and dementia varies by race. To fill the gap, we used data from the Health and Retirement Longitudinal Study (2000-2014) and analyzed 15,379 respondents (13,278 non-Hispanic whites and 2,101 non-Hispanic blacks) ages 50 and older in 2000 who had no dementia. Discrete-time event history models were estimated. Our preliminary analysis showed that marital status was significantly associated with the odds of dementia for both whites and blacks. Furthermore, the associations between unmarried status (i.e., cohabiting, widowed, and never married) and dementia were stronger among blacks than whites. The effect of divorce on odds of dementia did not differ by race. The results were robust after controlling for socioeconomic status, health and lifestyle factors, and social engagements. Part of a symposium sponsored by the Alzheimer’s Disease Research Interest Group.
Rising CNS Polypharmacy Among Older Adults in the United States
Authors: Maust Donovan
Published: December 2020

CNS-polypharmacy is defined by the AGS Beers Criteria as using 3 or more individual medications from the following classes: antidepressants, antipsychotics, benzodiazepines, other sedative/hypnotics, opioids, antiepileptics. Dr. Maust will review data suggesting that such prescribing has increased among older adults, along with the data suggesting there are associated harms. In addition, he will review recent evidence from the Department of Veterans Affairs, which suggests that older Veterans who use both Medicare and the VA system for medical care are at higher risk of potentially inappropriate CNS-active prescribing. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.
Do Gendered Psychosocial Factors Explain Sex Differences in White Matter Hyperintensities?
Authors: Shaaban C Elizabeth , Rosano Caterina , Shattuck-Heidorn Heather , Godina Sara , Wu Minjie , Rosso Andrea
Published: December 2020

Women have a greater burden than men of white matter hyperintensities (WMH), a marker of cerebral small vessel disease (cSVD). Psychosocial factors including education, household income, neighborhood socioeconomic status (nSES), happiness, and depression may differ by gender and could explain women’s higher burden of WMH. In a cohort of older adults (N=250, median age=82, 58% women, 39% Black), we found that women had lower education, household income, nSES and were less happy and more depressed. Race stratified Spearman correlations showed women had greater whole brain WMH volume in white participants only (white: rho=0.23, p=0.004; Black: rho=-0.05, p=0.64). In partial Spearman correlations, education, happiness, and depression attenuated but did not fully explain the relationship when added individually or all together to the model for whites (fully adjusted rho=0.19, p=0.03). Gendered psychosocial factors may partially explain sex differences in WMH; interventions targeting these factors may reduce cSVD burden, particularly in white women.
Senescence and Its Role in Fibrosis
Authors: Saux Claude Le
Published: December 2020

The presence of senescent cells (epithelial and mesenchymal) in fibrotic organs has been well established. Removal of senescent cells in animal models of fibrosis indicate an overall beneficial effect. The general consensus is that the senescent cells contribute to the fibrotic phenotype by the secretion of factors, mainly cytokines and chemokines. We recently demonstrated that senescent cells can also secreted eicosanoids. These lipids are implicated in the pathogenesis of fibrosis in multiple organs. Prostaglandins, especially PGE2, are generally regarded as anti-fibrotic, whereas leukotrienes are thought to be pro-fibrotic. Recent studies indicate that the senescence-associated secretory profile is a dynamic process and its composition is cell, tissue, and time-dependent. In this session I will discuss how senescent cells from specific origin have the potential to regulate fibro-genesis and its resolution by switching their eicosanoid profile expression over time. These findings have important implications for emerging senolytic drugs, which have the potential to provide novel therapeutic benefits for the treatment of fibrosis.
Honoring Preferences—The Consistency Between End-of-Life Care and a Veteran’s Goal for Comfort Care
Authors: Carpenter Joan , Scott Winifred , Ersek Mary , Levy Cari , Cohen Jennifer , Foglia Mary Beth , Phibbs Ciarian , Miller Susan
Published: December 2020

This study examined the alignment between Veterans’ end-of-life care and a Life-Sustaining Treatment (LST) goal “to be comfortable.” It includes Veterans with VA inpatient or community living center stays overlapping July 2018--January 2019, with a LST template documented by January 31, 2019, and who died by April 30, 2019 (N = 18,163). Using VA and Medicare data, we found 80% of decedents with a comfort care goal received hospice and 57% a palliative care consult (compared to 57% and 46%, respectively, of decedents without a comfort care goal). Using multivariate logistic regression, a comfort care goal was associated with significantly lower odds of EOL hospital or ICU use. In the last 30 days of life, Veterans with a comfort care goal had 43% lower odds (AOR 0.57; 95% CI: 0.51, 0.64) of hospitalization and 46% lower odds of ICU use (AOR 0.54; 95% CI: 0.48, 0.61).
Characterizing Physical Resilience in Older Adults: Insights From Secondary Analyses in Three Clinical Groups
Authors: Buta Brian , Newman Anne
Published: December 2020

Resilience is defined as the ability of a physiologic system to recover from a stressor that has pushed the system into a state far from its original state of equilibrium. The level of resilience can be understood by whether or not the system’s essential identity and function are retained following the stressor. The study of resilience in older adults has potential to provide clinically relevant insights into our understanding of who will or will not recover when encountering a stressful medical procedure, especially those common to older patients. The main Study of Physical Resilience and Aging (SPRING) at Johns Hopkins includes prospective data collection of determinants, phenotypes, surrogates, dynamic stimulation measures, and outcomes of resiliency among older persons undergoing knee replacement surgery, or the initiation of hemodialysis, or bone marrow transplantation. SPRING also includes analyses of existing data sources to inform these prospective studies. This symposium briefly presents the conceptual framework and design of SPRING, and focuses on the results of secondary analyses from three existing data sets that mirror the ongoing stressor studies: FORCE-TKR (knee/joint replacement, N=9006), CHOICE (dialysis initiation, N=487), and a database of patients undergoing treatment for hematologic malignancies (bone marrow transplantation, N=1011). For each clinical population, we present results on phenotypic and/or biomarker trajectories, as well as the factors associated with resilience phenotypes and how these are predictive of clinical outcomes. These analyses display the utility of resilience phenotypes for predicting risk of adverse outcomes and complement the new data being collected in our main study.
Predicting Survival After Bone Marrow Transplant Using Time Series of Routine Laboratory Biomarkers
Authors: Varadhan Ravi , Tang Bohao , Tsai Hua-Ling , Imus Phil
Published: December 2020

Bone marrow transplant (BMT) is a curative therapy for patients with hematologic malignancies. However, there is still a high rate of relapse and mortality after BMT. It would be tremendously valuable if we can identify older adults at high-risk for mortality using readily available information. A number of biomarkers are routinely collected during follow-up for clinical care, but this information is seldom used in prediction models. We examined the data from 1011 patients who had BMT at Johns Hopkins between 2013 and 2019. There were 364 death over a median follow-up of 431 days. We considered 4 biomarkers: albumin, hemoglobin, lymphocytes count, and platelets. Biomarker data from one week pre-BMT to 8 weeks post-BMT was used for prediction using a random survival forest model. The model performed quite well and had a 5-fold cross-validated c-index of 0.733 (95%CI: 0.724-0.739). Routine laboratory biomarkers can help identify poorly resilient older BMT patients.
Dopaminergic Vulnerability and Motor Impairments in Older Adults: Need for Targeted Pharmacotherapy
Authors: Bohnen Nicolaas
Published: December 2020

Motor impairments, including slow walking, are common in older age in the absence of prototypical Parkinson’s disease (PD). The etiology of such disturbances is heterogeneous and multi-system in nature. Dopamine is a key neurotransmitter involving motor, cognitive and behavioral circuitry. Normal aging is associated with substantial dopaminergic losses in the brain. Dopaminergic vulnerability of aging can be augmented by genotypic changes that may further compromise dopaminergic signaling, such as polymorphisms in the COMT gene. These observations may augur dopaminergic pharmacotherapy studies to treat gait disturbances in older adults. Prior dopaminergic therapy studies have shown overall limited effects in non-PD older adults. A major limitation of these studies is the non-targeted selection calling for personalized medicine approaches. Recent dopaminergic treatment studies targeting specific sub-groups of non-PD older adults conducted by us and others will be discussed.
The Meeting Centre Support Programme: International Evaluation of a Dyadic Intervention in Dementia
Authors: Szcześniak Dorota , Lion Katarzyna , Meiland Franka , Brooker Dawn , Farina Elisabetta , Chattat Rabih , Dröes Rose-Marie , Rymaszewska Joanna
Published: December 2020

In Europe, 10 million people are living with dementia. Most of them reside in their own home, cared for by their loved ones. As a consequence, there is a great need to provide both, people with dementia and their carers, tailored support. The Dutch Meeting Centres Support Programme (MCSP), adaptively implemented in three European countries within the JPND-MEETINGDEM project, is an excellent example of an effective dyadic psychosocial intervention, which seems to have no cultural barriers. The mixed-methods analysis showed that participant-dyads reported great satisfaction with MCSP. People with dementia experienced improvement of their quality of life, motivation and ability to participate in everyday activities, as well as improvement in their relationship with family members. Carers felt less burdened and highly appreciated the emotional and social support they received. Repeated user evaluation shows that this dyadic support effectively helps people with dementia and their families better deal with dementia.
Engaging Pharmacists in Interprofessional Programs to Support Older Residents of HUD-Assisted Housing
Authors: Slattum Patricia , Price Elvin
Published: December 2020

Medications are one of the pillar 4Ms of an age-friendly healthcare system. Ensuring that benefits of a medication regimen outweigh the risks and that medications are not contributing to meaningful outcomes such as functional or cognitive decline is a challenge for our healthcare system, particularly for older persons experiencing adverse social determinants of health, health disparities or uncoordinated care. More fully engaging pharmacists in the older person’s health care team is one strategy to improve clinical, humanistic and economic outcomes. This workshop reports findings on medication management capacity among older residents of five low-income apartment buildings in urban Richmond, VA, indicating that this population experiences challenges in managing medications as measured by MedMaIDE. The second presentation describes a pilot partnership between an independent community pharmacy and a local area agency on aging to provide medication coaching to residents of six affordable housing buildings in Seattle, WA, demonstrating feasibility of engaging pharmacists in the healthcare team and resulting in an average of five interventions per resident. The third presentation describes an interprofessional educational intervention based in two low-income apartment buildings for older persons in underserved West Baltimore, MD involving pharmacy students, to better prepare pharmacists to engage in interprofessional team care and meet the needs of a low income culturally diverse older adult population. Discussion will focus on barriers and opportunities to more fully engage pharmacists to support urban residents of low-income housing buildings to optimize medication outcomes and reduce medication-related harm.
Focus on Function in Hospitalized Persons With Dementia: The Impact of Hospital-Acquired Complications
Authors: Boltz Marie , Mion Lorraine
Published: December 2020

Persons with dementia (PWD) are two-three times more likely to be hospitalized as persons without dementia and comprise one fourth of hospitalized older adults. Hospitalization often has a dramatic impact upon the health and disposition of the older PWD. They are at increased risk for hospital acquired complications (HAC) such as functional decline, behavioral symptoms of distress, and delirium, all of which contribute to increased disability, mortality, and long-term nursing home stays. Despite the unprecedented number of PWD admitted to acute care, little attention has focused on their specialized needs and HAC, and how they impact functional recovery. The purpose of this symposium is to describe the incidence of common HACs, and factors that influence their occurrence and presentation in PWD. Utilizing baseline findings from the Family-centered Function-focused Care (Fam-FFC) trial, the presentations will address this objective and discuss the ramifications for functional and cognitive post-acute recovery in PWD. The first presentation will describe the incidence and pharmacologic management of pain in PWD, and its association with common HACs. The second presentation will describe physical activity in PWD on medical units and the validity of the Motionwatch8 actigraphy. The third session will describe differences in common HACs between white and black PWD. The final presentation will examine function-focused goals developed in collaboration with family caregivers and patients, and the functional outcomes associated with goal attainment. Our discussant, Dr. Lorraine Mion, will synthesize the research findings and lead a discussion of future directions for policy and practice in dementia-capable acute care.
Physical Activity in Hospitalized Persons With Dementia: Feasibility and Validity of the Motionwatch 8
Authors: Kuzmik Ashley , Resnick Barbara , Boltz Marie
Published: December 2020

Interventions to prevent functional decline in hospitalized persons with dementia (PWD) require objective measures of physical activity (PA). This secondary analysis described PA using MotionWatch 8 actigraphy and considered the feasibility and validity of the MotionWatch 8 in hospitalized PWD. In the first 320 PWD enrolled in the Fam-FFC study, 261 agreed to wear a MotionWatch for 24 hours within 48 hours of admission. Minutes were recorded in sedentary ( x̄ =1767.35, SD= 1327.43), low (x̄ = 202.52, SD=127.78), moderate (x̄ =7.93, SD=25.80 ), and vigorous activity ( x̄ = .85, SD=4.50). Controlling for age, gender, race and comorbidity, counts of activity were significantly associated with ADL function (t =4.3, p <.001). Sedentary (t =-3.9, p<.001), low (t =2.8, p =.006), and moderate (t =3.0, p =.003) activity, but not vigorous activity were significantly associated with ADL function. MotionWatch 8 appears feasible and valid when evaluating PA among hospitalized PWD.
Post-Diagnostic Support and Occupational Therapy Program for Community-Based Dementia Services
Authors: Shivers Stephani , Robison Julie , DeFrancesco Erica , Keefe Caroline Kate , Sommerer Deidre , Bailey Christine , Ohlheiser Alis
Published: December 2020

Service gaps and the absence of a clear-cut care/symptom management pathway for people recently diagnosed with dementia and their family carepartners motivated LiveWell Dementia Specialists to implement a multi-service post diagnostic support program including three occupational therapy (OT) interventions. Program services include an education series on ‘Resilient Living with Dementia’, family coaching and topical education sessions, and OT services including Care of Persons with Dementia in their Environments (COPE), Skills2Care®, and Home Based Memory Rehabilitation. Program services promote adoption of adaptive strategies and action steps to increase carepartner capacity and enhance quality of life among people with dementia. Participants complete assessments at baseline, program completion, and 4- and/or 10-month follow-up. Carepartners show improvements in dementia knowledge (mean baseline score = 24.6, 4-month = 26.0) and preparedness for caregiving (mean baseline score = 18.1, 4-month = 21.9). Program elements and adaptations of COPE for real world practice are discussed.
Medial Temporal Tau Pathology Is Associated With Verbal Memory
Authors: Bilgel Murat , Ziontz Jacob , Shafer Andrea , Ferrucci Luigi , Wong Dean , Resnick Susan
Published: December 2020

Medial temporal tau pathology is frequently observed in individuals over 70 regardless of cognitive status. To understand the link between tau and cognitive performance, we evaluated tau pathology using 18F-flortaucipir positron emission tomography among 95 cognitively normal participants from the Baltimore Longitudinal Study of Aging. We examined tau levels in early Braak regions (entorhinal cortex and hippocampus) in relation to verbal episodic memory performance concurrent with and prior to the tau scan using linear mixed effects models adjusted for age, sex, amyloid status, and time from PET scan. Higher hippocampal tau burden had a trend-level association with lower concurrent memory performance (p=0.05). Greater tau pathology in the hippocampus and entorhinal cortex was associated with steeper decline in memory performance prior to tau scan (p=0.013 and 0.026, respectively). These findings suggest that therapeutic interventions targeting tau pathology may need to be administered early among cognitively normal individuals to prevent memory decline.
Leveraging Digital Methods to Engage Sexual and Gender Minority Caregivers of People With Dementia
Authors: Anderson Joel , Flatt Jason , Tree Jennifer Jabson , Gross Alden , Rose Karen
Published: December 2020

Digital methods are a way to engage marginalized populations, such as sexual and gender minority (SGM) adults. No study to date has leveraged these methods to engage SGM caregivers of people with dementia. We used digital methods to access SGM caregivers of people with dementia in our study of psychosocial measures of caregiving for recruitment and data collection. Posts on social media and online registries targeted SGM caregivers. The study landing page received 2201 views; 285 caregivers completed the survey. Participants learned of the study most frequently from Facebook (45%). The sample was 84% white, with gay (52%), lesbian (32%), bisexual (11%), and other sexual orientations (5%) and transgender (17%) caregivers represented. While we exceeded goals for inclusion of Latinx (26%) and Native American (4%) caregivers, the number of African American SGM caregivers was lower than projected (7%). Digital methods are effective for engaging SGM caregivers of people with dementia.
Comparing Longitudinal Changes in Physical Activity and Fear of Falling in Non-Fallers, Fallers, and Injurious Fallers
Authors: E Jian-Yu , Schrack Jennifer , Mihailovic Aleksandra , Li Tianjing , Friedman David , West Sheila , Gitlin Laura , Ramulu Pradeep
Published: December 2020

Older adults with visual impairments experience a higher risk of falling, and are more vulnerable to associated adverse health consequences than those with normal vision. We investigated the onset and magnitude of declines in physical activity (PA), and corresponding changes in self-reported fear of falling (FoF) in 234 visually impaired persons (mean age=69.8, 48.7% women) over three years. PA was measured using the Actical hip-worn accelerometer and falls were reported using a calendar. In fully adjusted linear models, PA declined 426 steps/year (p<0.01) and 15.1 active minutes/year (p<0.01) among injurious fallers compared to non-fallers; PA did not change among non-injurious fallers. No longitudinal declines in FoF scores were observed. Among visually impaired older adults, an injurious fall contributed to subsequent declines in activity, although FoF remained unchanged. Further longitudinal research is warranted to better understand how different groups respond to falls, either by behavioral changes and/or changes in FoF.
Older Veterans With Chronic Pain Who Persist in Group Exercise Show Improved Mobility
Authors: Addison Odessa , Giffuni Jamie , Kelly Megan , Hogans Beth , Katzel Leslie , Morey Miriam
Published: December 2020

Approximately 50% of older adults receiving care at VA are Veterans with chronic pain (V-CP). While physical activity can reduce chronic pain and increase mobility, little is known about group exercise (GE) effects for V-CP. We hypothesized that attrition may limit GE effectiveness. In this study, we retrospectively compared program attrition and participant mobility at three-months of Gerofit GE. At baseline, Older V-CP (N=21) had lower mobility assessment scores (gait speed, 6MW, chair stands, TUG: 1.04 m/s, 443 yd, 11, 9.35s vs. 1.09 m/s, 463 yd, 12, 8.19s respectively) compared to unaffected Veterans. Three-month attrition was higher for older V-CP (54% vs 39%). For those completing three months GE, gains in mobility were similar. We conclude that Veterans with chronic pain are less likely to persist in group exercise but those who persist benefit much like those without pain. Further study is needed to understand successful exercise adherence.
Implementing Effective, Evidence-Based Older Adult Fall Prevention
Authors: Bergen Gwen
Published: December 2020

Over one in four older adults (65 years and older) in the US reports falling annually with estimated medical costs of $50 billion. Evidence-based strategies exist that can reduce falls with one of the most promising being multifactorial, clinically-based initiatives such as the Centers for Disease Control and Prevention’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Initiative. STEADI includes three core components for health care providers: screen for risk factors, assess modifiable factors, and intervene to reduce falls with evidence-based strategies. Barriers to implementation include competing patient demands and limited time during patient visits. Efficient, effective implementation of clinical fall prevention is important to increase the use of multifactorial interventions. In addition, understanding older adult attitudes about the preventability of falls is needed to increase patient adherence to prescribed interventions. This symposium will cover:1. Background data on older adult falls over time,2. Description of an initial implementation of STEADI in an outpatient, Southeastern clinical practice including lessons learned,3. Attitudes of older adults toward fall prevention with implications for health promotion,4. Process evaluation of an ongoing implementation of STEADI in New York State with lessons learned. Understanding practical methods of implementing the three core components of fall prevention into practice supports wider dissemination of evidence-based fall prevention, while understanding patient attitudes toward falls informs the design of health promotion approaches to increase patient uptake of prescribed interventions. Wider dissemination and increased patient adherence in combination can reduce older adult falls and their associated medical costs.
Implications of Older Adult Attitudes Toward the Preventability of Falls for Health Promotion
Authors: Bergen Gwen , Mark Janice , Henry Ankita
Published: December 2020

Older adults’ behavioral stage of change for adopting fall prevention interventions, and their use of evidence-based interventions are not well understood. A survey was administered to older adults (65 years+) (n=1063) to understand their stage of change and fall prevention behaviors. Descriptive statistics were calculated and logistic regression conducted to determine factors most related to stage. The distribution of subjects by stage was precontemplation (17%), contemplation (2%), preparation (5%), action (15%), and maintenance (61%). The strongest variable related to being in an action stage (preparation, action, maintenance) was screening positively for fall risk (Risk Ratio: 8.7, 95% CI: 5.4, 14.1). The most common preventive actions for those in an action stage were taking Vitamin D (37%), and having vision tested (30%). Older adults at risk for a fall are ready to take action to prevent falls; health promotion should focus on increasing knowledge and use of different evidence-based interventions.
Changes in the Age-Adjusted Rate of Older Adults Dying From a Fall and Reporting a Fall and Fall Injury, 2012–2018
Authors: Burns Elizabeth , Kakara Ramakrishna , Moreland Briana , Henry Ankita
Published: December 2020

Falls are a leading cause of injury among older men and women (≥65 years) in the United States. Vital Statistics and Behavioral Risk Factor Surveillance System data were analyzed to determine the age-adjusted fall death rate, the rates of older adults reporting a fall and fall injury, and associated trends. The fall death rate increased 16% from 55.3/100,000 in 2012 to 64.4/100,000 in 2018 (p≤0.05). Like the rates in 2012, the rate of falls reported in 2018 was 713/1000 older adults and the rate of fall injuries reported was 171/1000 older adults. When assessing the rates of older adults reporting a fall or fall injury by sex, the rates among men increased from 2012 to 2016 from 637/1000 to 773/1000 (21% increase, p≤0.05) for falls and from 120/1000 to 153/1000 (28% increase, p≤0.05) for fall injuries. Understanding how these data change over time can inform targeted interventions to reduce falls.
STEADI in Primary Care: A Process Evaluation of the New York State Implementation
Authors: Johnston Yvonne , Reome-Nedlik Chelsea
Published: December 2020

This session presents findings from a STEADI process evaluation that was conducted within a primary care setting in New York State. This process evaluation used mixed methods including quantitative analysis of surveys with clinic staff as well as qualitative methods such as intercept interviews with healthcare providers and clinic staff, and structured interviews with key stakeholders. The RE-AIM framework guided development of the process evaluation tools. The process evaluation was conducted over a 2-month period approximately 18 months post-implementation. Facilitators included: (a) Adoption - physician champion and administrative support; (b) Implementation - wellness coordinators, preparation and training, and organizational quality measures; (c) Maintenance - feedback from patients, local and national recognition, and impact on fall-related outcomes. Barriers included: (a) Adoption – organizational priorities and complexity of electronic health records; (b) Implementation – resistance to change and competing patient care demands; (c) Maintenance - staff turnover and follow through of referrals.
Artificial Intelligence for ADRD Caregivers: A Systematic Literature Review
Authors: Xie Bo , Tao Cui , Li Juan , Hilsabeck Robin , Aguirre Alyssa
Published: December 2020

Artificial intelligence (AI) may improve the care for persons with Alzheimer’s disease and related dementias (ADRD) and caregivers’ quality of life. To examine existing research on this topic, we searched 5 publication databases using keywords related to Alzheimer’s, dementia, caregiver, and artificial intelligence, and found 113 relevant results. We then screened the titles, abstracts, and full texts, and excluded studies not including family caregivers, not involving providing information to users, screening/diagnosis of dementia, caregiver anxiety/burnout, or lacking empirical data. Thirty results remained. These studies included technologies such as robots to facilitate social engagement and assist with daily activities. Most were qualitative or cross-sectional with small samples. These studies generally reported positive outcomes in favor of AI tools but levels of evidence were low. These findings suggest the need for systematic designs that can generate high levels of evidence for the feasibility and efficacy of AI-based interventions for ADRD caregivers.
A Delphi Study on Dementia Care Technology Use and How to Mitigate Risks: Design to Implementation
Authors: Berridge Clara , Demiris George
Published: December 2020

What information is needed to navigate person-centered technology use in dementia care? The threefold aim of this Delphi study was to learn which technologies will be most prevalent in dementia care in 5 years, understand benefits and risks, and identify specific options to mitigate risks. Twenty-one interdisciplinary domain experts from academia and industry in aging and technology in the U.S. and Canada participated, an 84% response rate. Technologies rated most likely to cause value tensions were also predicted to be most prevalent and will be described, along with the identified risks. Suggestions to mitigate the risks are categorized as follows: intervene during design; make specific technical choices; build in choice and control; require data transparency; place restrictions on data use and ensure security; enable informed consent; and proactively educate users. The specific recommendations that are relevant to designers, clinicians, researchers, ethicists, and policy makers will be presented and discussed.