bluuebunny/crossref_metadata_2025 huggingface dataset:
ENTERING MEDICARE ADVANTAGE FROM EMPLOYER-SPONSORED PLANS: CHANGE IN OUT-OF-POCKET COSTS AND UTILIZATION AT AGE 65
Authors: Hames Alexandra Glynn , Roberts Eric
Published: December 2022

An increasing proportion (nearly 40%) of older adults entering Medicare at age 65 are electing to enroll in private Medicare Advantage (MA) plans, which reflects more generous coverage relative to traditional Medicare and similarity to many features of employer sponsored plans. However, few studies have examined the impact of transitioning to MA from an employer-sponsored plan on out-of-pocket costs and health services utilization. We used longitudinal administrative data from Optum Insights between 2010 and 2021 to follow individuals from ages 62 through 67, spanning continuous enrollment in employer-sponsored insurance and MA. We employed an event-study design to estimate within-person changes in our outcomes after individuals entered to MA at age 65 (n=5,548), controlling for linear age trends. Relative to ages 62–64, MA enrollees at ages 66 and 67 had lower out-of-pocket spending on outpatient services (-$503/year, 95% CI: -$602, $404), emergency department visits (-$27/year, 95% CI: -$35, -$19), and prescription drugs (-$77/year, 95% CI: -$101, -$53). In contrast, utilization of outpatient services increased (1.4 visits/year, 95% CI: 0.8, 2.0), including physician evaluation and management visits (0.46 visits/year, 95% CI: 0.25, 0.68). After entering MA, individuals were more likely to have physician office visits with no out-of-pocket costs than at ages 62–64 (0.99 additional zero-cost visits/year, 95% CI: 0.81, 1.2). These results suggest MA may offer older adults more affordable care for routine and chronic conditions, compared to employer-sponsored insurance. These findings are timely as policymakers continue to deliberate proposals, such as expanding Medicare eligibility, to improve access to affordable insurance.
ASSESSING THE NEW INFLATION REDUCTION ACT’S IMPACT ON EXPANDING MEDICARE PART D LOW-INCOME SUBSIDIES
Authors: Loh Feng-Hua , Stuart Bruce
Published: December 2022

The recently enacted Inflation Reduction Act (IRA) of 2022 extends full low-income subsidies (LIS) to Medicare Part D recipients with limited assets and incomes up to 150% of the Federal Poverty level (FPL) beginning in 2024. Under current law, full Part D subsidies (no annual premiums and nominal cost sharing) are available only to those with incomes up to 135% of the FPL. Partial subsidies are available to those with incomes between 135% and 150% of FPL. Increasing the level of benefits to those currently only eligible for partial subsidies has the potential of significantly lowering out-of-pocket medication costs that pose a barrier to adherence for many low-income Medicare beneficiaries, but the outcome of the new policy will depend on how many enroll. Historically, enrollment among those eligible for partial subsidies has hovered around 30%, but the latest data on LIS participation rates are for 2014. We undertook this study to update LIS eligibility and enrollment numbers to 2019, with a particular emphasis on identifying characteristics of beneficiaries who may benefit from the new policy. Using data from the Medicare Current Beneficiary Survey, we determined that 73% of beneficiaries eligible for full subsidies under current law were enrolled, but only 25% eligible for partial subsidies were enrolled. We conclude that while the IRA will raise the overall level of Part D subsidies, it will be important to engage stakeholders and promote outreach to maximize participation in the leadup to implementation.
AGE DIFFERENCES IN DISTINCT TYPES OF SOCIAL INTERACTIONS AND EMOTIONAL WELL-BEING
Authors: Chen Yuxuan , Chi Kevin , Carstensen Laura
Published: December 2022

Social interaction is central to emotional well-being. However, less is known about how the surroundings of social interactions are associated with emotional well-being and whether they differ by age. The present study examined age differences in the predication of emotional well-being as a function of two aspects of social interactions: (1) the extent to which individuals would rather be interacting with someone else and (2) the degree of closeness to the interactant(s). A sample of 190 people, aged 18 to 94 years, participated in an experience sampling study where they reported emotional experience and aspects of the social interaction at five randomly selected times each day across a one-week period for a total of 35 randomly selected occasions. Across age groups, the greater the extent to which people would rather be interacting with someone else was associated with higher levels of negative emotion and lower levels of positive emotion. However, these associations were more pronounced for younger adults, who compared to older adults, experienced greater increases in negative emotions and greater decreases in positive emotion in these contexts. Furthermore, younger but not older adults experienced lower levels of negative emotion when interacting with someone they knew well. Results highlight the important role that age plays in the link between daily social interactions and emotional well-being. Age differences in social interactions, emotional resilience, and situation selection will be discussed.
PHOTO-ELICITATION- A VIEW OF DEEP OLD AGE AND SOCIAL INCLUSION
Authors: Eliopoulos Elaine
Published: December 2022

Photo-elicitation- A View of Deep Old Age and Social Inclusion While visual methodologies have gained prominence in aging research, focus on deep old age has been uncommon. The variety of visual representations portraying a range of ‘ageless aging’ to frail older people may not fully capture daily lived experience. The inclusion of those in deep old age to depict their aging bodies is a crucial missing element enhancing our understanding of the nuances of deep old age. This study fills that gap. Photo-elicitation, followed by semi-structured interviews, was used to examine the role of the body for participants 80 years+ in three US island contexts to understand what impact, if any, their bodies had on their ability to be socially included in ways they chose. Digital cameras were provided to participants to photograph their lived bodily experience. Those who had visual challenges were assisted in taking photographs. Recent analysis of the photographs revealed important findings that will contribute to theoretical development of deep old age: participants who took photos without assistance did not take a single photograph of their bodies. They took photos primarily of their environment and places of community connections while minimising physical challenges. Their photos contextualised their experience of the physical challenges that played a role in their sense of inclusion within their communities. This finding questions current dominant models of the third and fourth age as dichotomous formulations related to embodied agency. In doing so it opens new possibilities for theoretical reflection on deep old age.
WOMEN AT RISK: SOCIOECONOMIC STATUS, LIFESTYLE FACTORS, AND BRAIN VULNERABILITY AMONG JAPANESE AND SWEDISH FEMALE
Authors: Liu Yingxu , Tatewaki Yasuko , Thyreau Benjamin , Liu Yinghao , Zhang Ye , Karalija Nina , Boraxbekk Carl-johan , Taki Yasuyuki
Published: December 2022

Background

While multiple modifiable lifestyle factors and disease management have been highlighted for preventing dementia and ameliorating neurodegeneration, women and the disadvantaged socioeconomic status (SES) population still bear disproportionate burdens. Objective: Investigate and compare the potential pathways of SES, lifestyle factors, imaging biomarkers, and cognition in two community dwelling cohorts in Japan and Sweden. Subjects: The Kumamoto Cohort included 576 cognitively healthy females (73.66 ± 5.96 years); the Betula Cohort included 195 cognitively healthy females (63.91 ± 13.41 years).

Methods

We constructed structural equational modeling by lifestyle factors including exercise, social activity, sleep, drinking, and smoking status; disease conditions included obesity, diabetes, hypertension, and depressive disorder; brain imaging biomarkers included regional gay matter volume (GMV) and cortical thickness obtained from T1 weighted magnetic resonance imaging scans and global cognition score. We also examined SES-related gray matter volume and cortical thickness map locations at the whole brain level.

Results

SES was positively associated with GMV of limbic lobe (not cortical thickness), Kumamoto Cohort: standardized direct β =0.21 (0.13;0.28); Betula Cohort: standardized direct β =0.27 (0.13; 0.41). This SES-GMV association was mediated by disease conditions and lifestyle in Kumamoto Cohort: indirect β =-0.013 (0.001; 0.054). We also found several regions, including the medial frontal gyrus, superior frontal gyrus, hippocampus, and thalamus, were commonly sensitive to SES status in two cohorts. Conclusions: Although the observational nature of the study precludes proof of causality, our findings suggest that promoting disease management is crucial to tackling the neurodegeneration burden in the female facing SES disparities.
THE EFFECTS OF VISUAL SEARCH ON POSTURAL SWAY COMPLEXITY IN OLDER ADULTS WITH AND WITHOUT TYPE 2 DIABETES
Authors: Jason Kellyn , Zhou Junhong , Yu Wanting , Manor Brad , Jor’dan Azizah
Published: December 2022

Type II diabetes mellitus (T2DM) is linked to impairments in the interconnecting and interacting components (e.g., cognitive-motor demand) essential for standing postural control. The temporal dynamics of postural sway are complex, thus higher complexity reflects the system’s capacity to adapt to cognitive-motor demands. We aimed to characterize the effects of T2DM on postural sway complexity during visual search tasks (VST). Twenty-four older adults without T2DM (OA) (age=67–93 years) and 20 older adults with T2DM (age=70–90 years) performed multiple trials of quiet standing with and without a VST. The VST consisted of low difficulty (LD) (i.e., counting the frequency of one designated letter in a random grid of letters) and high difficulty (HD) (i.e., counting two different letters). The complexity of the postural sway acceleration signals in the anterior-posterior (AP) and medial-lateral (ML) directions were quantified using multiscale entropy. Across participants, matched-pairs analyses revealed that both AP and ML sway complexity increased during the LD condition, compared to control (p < 0.007). During HD, only the AP sway complexity increased, compared to control (p=0.0001). Within the OA, both AP and ML sway complexity increased during the LD condition (p < 0.009), while performance of the HD task showed an increase in AP sway complexity compared to control (p=0.0002). Within the T2DM, AP sway complexity increased only during LD, compared to control (p=0.03). The multi-scale dynamics of postural control when standing while performing VSTs differ among older adults with and without T2DM, reflected by diminished capacity to increase complexity during the visual search conditions.
EFFECTS OF REMOVING VISUAL INPUTS ON POSTURAL SWAY COMPLEXITY IN YOUNG ADULTS AND OLDER ADULTS WITH AND WITHOUT T2D
Authors: Jason Kellyn , Zhou Junhong , Yu Wanting , Manor Brad , Jor’dan Azizah
Published: December 2022

Standing postural control is complex and involves sensory inputs from the visual, vestibular, and somatosensory systems. Postural sway complexity, as often assessed by multiscale entropy, has been linked to the ability of the postural control system to adapt to “stressors,” including the removal of visual inputs. We aimed to determine the effects of removing visual inputs (i.e., eyes closed, EC) on postural sway complexity in young adults (YA), and older adults (OA) with and without type 2 diabetes mellitus (T2DM). Twenty-five YA (age=21–30 years), 25 OA (age=70–90 years), and 19 T2DM (age=67–93 years) stood for 30 seconds under two conditions – eyes open (EO), and EC for three trials. Postural sway acceleration was measured in the medial-lateral (ML) and anterior-posterior (AP) direction during EO and EC conditions. Sway complexity was quantified using multi-scale entropy. The YA group had a significant reduction in ML and AP sway complexity during EC when compared to EO (p=0.04 and p < 0.001, respectively). Though not significant, the OA group exhibited a trend towards increased ML sway complexity during EC compared to EO standing (p=0.07). No significant changes in AP sway complexity were observed in OA or T2DM, or in ML sway complexity in T2DM. The dynamics of postural control differ between YA, OA, and T2DM groups. There was a significant difference in postural sway complexity between the EO and EC among YA, with no differences in OA and T2DM between conditions. The lack of change suggests maladaptation to stressors, such as vision loss.
SLEEP AND CAREGIVER BURDEN FOR CAREGIVERS OF PERSONS WITH DEMENTIA: A SCOPING REVIEW
Authors: Mattos Meghan , Bernacchi Veronica , Shaffer Kelly , Gallagher Virginia , Seo Shinae , Manning Carol
Published: December 2022

Caregivers of persons with dementia report worse sleep when compared to the general population. This scoping review synthesizes evidence regarding the link between caregiver burden and dementia caregivers’ sleep. A systematic search was completed in PubMed, CINAHL, PsycINFO, and Web of Science for pertinent literature published through March 2022. Included original research articles studied informal adult caregivers of persons living with mild cognitive impairment or dementia, documented the relationship between subjective caregiver burden and caregiver sleep, and were written in English. Extracted data were organized in tables, compared, and synthesized. The search yielded 540 non-duplicate articles screened by title and abstract; 118 full-text articles were reviewed; of these, 26 were included. Most studies were cross-sectional, with variable sample sizes (range n=40–669). Sleep was operationalized across the 25 quantitative studies in terms of subjective quality (n=19) and objective sleep parameters using actigraphy (n=4), and polysomnography (n=2). Of studies reporting subjective sleep quality, 16 reported a significant positive association between caregiver burden (84%) with the remaining found null results. Half of the studies that used objective measures of sleep (actigraphy and polysomnography) found a positive association between sleep and caregiver burden, while the other half did not (n=3). Results suggest that, while subjective sleep quality is commonly impacted by dementia caregiving burden, there is a lack of corresponding evidence on the relationship between burden and objective sleep metrics. Caregiver burden was also not measured consistently across studies, and future studies should focus on consistent measurement of caregiver burden and determination of directionality.
PATHWAYS OF IMPROVING SOCIAL CAPABILITY OF OLDER ADULTS WITH FUNCTIONAL LIMITATIONS: FINDINGS FROM MIXED METHODS
Authors: Zhang Yalu , Xiong Yiyi , Chen Gong
Published: December 2022

Objectives

Social capabilities are the opportunities to realize people’s potential. Despite an established positive link between health status and social capabilities among older adults, the relationship mechanisms are understudied.

Methods

Using the China Longitudinal Aging Social Survey data 2014–2018, this paper examined the possible mediating role of community participation through which older adults (aged 60 and above) in China with functional limitations improved or maintained their social capabilities. By conducting the 12 in-depth interviews, this study explores how community participation altered the negative associations between functional limitations and social capabilities among Chinese older adults.

Results

Findings from the quantitative study show that both physical (-.136, p < 0.001) and cognitive (-.149, p < 0.001) functional limitations showed consistent and negative effects on the social capabilities of older adults, and the effects varied between males and females. The mediation analysis results show that community participation accounted for a substantial proportion of the impact of functional limitations (36.33%) on social capabilities. However, functional limitations still had strong, negative direct effects of their own. Findings from the qualitative narrative synthesis show that peer companionship, regular physical activities, and reduced digital obstacles to accessing online social media during social participation are the self-perceived driving force in enhancing their sense of security, freedom of expression, and sense of social cohesion. Discussion: Findings from this study highlight the need for more social policies and services to encourage community participation among older adults.
SEX DIFFERENCES IN MITOCHONDRIAL RESILIENCE: EVIDENCE FROM BABOON HEPATOCYTES
Authors: Adekunbi Daniel , Li Cun , Nathanielsz Peter , Salmon Adam
Published: December 2022

Events that occur in utero set the trajectory for later-life diseases and longevity. Compelling data exist for interactions between developmental programming and aging, but the underlying mechanisms are not clearly defined. Fetal exposure to glucocorticoids (GC) is associated with alteration in hepatic enzymes and metabolic function in later life. We previously reported increased hepatic lipid accumulation and obese phenotype in middle-age male baboons exposed to GC as fetuses. The mitochondria play significant roles in cellular processes including stress responses and possibly a nexus between developmental programming and aging. The present study investigated the long-term effects of in utero GC exposure on mitochondrial bioenergetics using hepatocytes derived from aging baboons (16–18 years, average lifespan 21 years). Mitochondrial bioenergetics of both left and right lobe liver hepatocytes were examined as well as potential sex differences in mitochondrial function. Cell viability following isolation was similar among sexes and liver lobes but hepatocytes from males were highly energetic compared to females. Significant bioenergetic differences were observed in hepatocytes isolated from female baboons’ left and right liver lobes, with higher basal, maximal, and ATP-linked respiration in left lobe hepatocytes compared to the right lobe. These lobe-specific bioenergetic differences were absent in males. Interestingly, H2O2-induced oxidative stress significantly modified male baboon hepatocyte bioenergetics but females were unaffected, suggesting mitochondrial resilience in females compared to males. These data demonstrate that early life exposure to GC elicits a sex-specific effect on mitochondrial function. These mitochondrial differences might drive differences in cell senescence between males and females.
GLYNAC SUPPLEMENTATION IN OLDER ADULTS PROTECTS FROM MEAL DRIVEN OXIDATIVE STRESS AND INFLAMMATION: RESULTS OF A RCT
Authors: Sekhar Rajagopal , Taffet George , Kumar Premranjan
Published: December 2022

Elevated oxidative stress (OxS) and inflammation are linked to many age-associated abnormalities, but underlying contributing factors are not well understood. In a randomized clinical trial (RCT) in older adults (OA), we investigated the contribution of a single carbohydrate-meal on OxS and inflammation, and tested the protective effect of supplementing GlyNAC (combination of glycine+N-acetylcysteine) from the meal-driven rise in OxS and inflammation. We studied 20 OA and 10 YA (young-adults) to (1) compare the impact of a 75g oral glucose-meal on plasma markers of OxS (as TBARS) and inflammation (as IL-6); (2) re-assess these outcomes after supplementing OA with either GlyNAC or isonitrogenous placebo (alanine) for 16-weeks, and YA with GlyNAC for 2-weeks. We found that (1) 2-hours after a glucose-meal, compared to YA the OA had higher increases (expressed as percent-change over baseline) of OxS (TBARS –0.1 +/- 0.6 vs. 5.6 +/- 0.6, p < 0.0000) and inflammation (IL-6 3.5 +/- 1.2 vs. 11.2 +/- 0.7, p < 0.0000); (2) GlyNAC supplementation in OA protected against the glucose meal-driven increase in OxS (TBARS pre vs post: 4.8 +/- 0.9 vs. -0.4 +/- 0.8, p=0.002) and inflammation (IL-6 pre vs. post: 10.8 +/- 3.2 vs. 4.2 +/- 2.3, p=0.0001). No improvements occurred in OA receiving placebo or YA receiving GlyNAC. These findings suggest that: (1) In OA, a single carbohydrate-meal significantly increases OxS and inflammation; (2) GlyNAC supplementation protects from carbohydrate meal-driven increases in OxS and inflammation. Additional research to investigate the implications of supplementing GlyNAC on improving meal-related health in aging are warranted.
EDUCATION AND COGNITIVE ABILITY: EXPLORING DIRECT AND INDIRECT EFFECTS IN THE UNITED STATES AND MEXICO
Authors: Saenz Joseph , Khan Amina
Published: December 2022

Education positively relates with cognition, which may be explained by enhanced cognitive reserve. However, education may also impact cognition indirectly by improving health, health behaviors, and life-course socioeconomic status (SES). This analysis explores the associations between education and cognition in the US and Mexico and quantifies the extent to which associations are direct versus indirect through health and SES. We use data from two studies: the MexCog in Mexico (n=2,042) and US Harmonized Cognitive Assessment Protocol (HCAP, n=3,267). Cognitive domains included Memory, Executive Function, Language, Visuospatial, and Orientation. Karlson-Holm-Breen (KHB) methods were used in linear regression models to quantify how much of the associations between years of education and cognitive domains were direct versus indirect through chronic conditions, income, wealth, smoking, and exercise. In regression models, years of education related positively with all cognitive domains in both studies, even when controlling for health and SES. KHB mediation analyses suggested that most of the education-cognition association was direct. In MexCog, estimates of the percent of the education-cognition association that was indirect through health and SES ranged from 4.17% (Memory) to 5.15% (Executive Function). In HCAP, indirect effects ranged from 8.95% (Orientation) to 12.15% (Language). Education was associated with better cognitive abilities in the US and Mexico regardless of cognitive domain or adjustment for late-life health and SES. Results suggested that education primarily related with cognition directly and that effects of education on cognitive abilities are not eliminated by reducing educational disparities in the late-life health and SES factors we analyzed.
REIMAGINING AGING: EXAMINING THE IMPACT OF LIFETIME DISCRIMINATION EXPERIENCES ON EVERYDAY METAMEMORY
Authors: Ly Timothy , Cundiff Jeanne , DeCaro Jason , Allen Rebecca
Published: December 2022

Lifetime and recent experiences of discrimination (based on race, gender, religion, sexual orientation, etc.) contribute to impaired performance on cognitive assessments. However, the underlying mechanism by which discrimination negatively impacts cognition is unclear. Recent research investigating stress-induced impairment of metamemory may address the relationship between discrimination experiences and cognitive impairment. The aim of this study was to determine the relationship between lifetime experiences of discrimination, especially recent experiences, and everyday metamemory from a lifespan perspective (ages 20–75), using data collected from the Midlife in the United States (MIDUS Refresher 1) Daily Diary Project (N = 782). Results from a 2-level multilevel model showed that the relationship between recent experiences of discrimination explained unique variance in impaired metamemory accuracy (25%; β = .377, σ = .052, 95% CI [.275, .479]), suggesting that individuals with recent discrimination experiences reported more cognitive complaints. Furthermore, the relationship between age, recent experiences of discrimination, and impaired metamemory showed that younger individuals reported more complaints after experiencing discrimination than older individuals (β = .192, σ = .092, 95% CI [.011, .373]. Individual differences accounted for 45% of the variance in the number of cognitive complaints. These findings demonstrate the need for more research into understanding metamemory accuracy as an underlying mechanism by which the psychosocial stressor of discrimination impacts cognition across the lifespan. Moreover, understanding the experiences of diverse aging populations, including experiences of discrimination, and their impact on cognition will inform research on interventions to promote positive cognitive health outcomes across the lifespan.
AAA WORKFORCE CHALLENGES AND THEIR IMPACT ON OLDER ADULTS: RESULTS FROM A NATIONAL POLL AND AGENCY INTERVIEWS
Authors: Blair Elizabeth , Wilson Traci
Published: December 2022

Area Agencies on Aging (AAAs) play a critical role in addressing social needs that enable older adults to live independently. In 2022, over 90% of AAAs reported that the number of consumers seeking services and the complexity of consumer needs have increased. At the same time, the nation faces a shortage of direct care workers. Existing AAAs workforce challenges, such as worker shortages and staff burnout, have been exacerbated by the COVID-19 pandemic. We will share the results of a USAging poll of AAAs on the challenges facing their agency and provider workforce, reductions in volunteer staffing, and the impacts of workforce shortages on clients and services provided. Top impacts include clients not receiving the frequency of services needed, if at all. Services most impacted include personal care, respite, and transportation. Presenters will conclude by sharing innovative solutions that AAAs have developed to address these challenges.
PROLONGED NIGHTLY FASTING AMONG OLDER ADULTS: A PILOT STUDY EXPLORING CHANGES IN COGNITIVE FUNCTION
Authors: James Dara , Sears Dorothy , Larkey Linda , Maxfield Molly , Ofori Edward , Han Seung Yong , Alperin Kate , Osha Peyton
Published: December 2022

Aging is significantly associated with cognitive decline. A growing number of US adults ages ≥ 65 years have neurocognitive impairment resulting in compromised immediate and/or long-term health outcomes. Interventions to mitigate cognitive decline and promote healthy aging are needed. Research in intermittent fasting (IF) suggests positive health outcomes related to improvements in circadian rhythm and metabolism, which influence cognition. IF regimens may therefore result in improved neurocognitive health. We conducted an IF single-group, pre/post pilot study to explore changes in neurocognitive. Older adults (≥65 years of age; Nf18) with self-reported memory decline engaged in an 8-week, remotely-delivered, prolonged nightly fasting (PNF) intervention (14-hour nightly fasting, 10-hour daytime eating window). Our primary exploratory outcome was 8-week change in neurocognitive function assessed via composite score of the Memory and Attention Phone Screener (MAPS). Trends in outcome change were assessed with paired t-tests. Participants were mean age 69.7 years, non-Hispanic White, predominantly female (94%), married (50%), and employed (65%). Completion defined as percentage of participants that completed the intervention from those that started the intervention; completion rate was 90%. Paired t-test indicated a significant increase in scores on a neurocognitive screen (MAPS) pre/post-intervention (p=0.02) with a medium effect size (Cohen’s d=0.58). Findings suggest that PNF, a type of IF regimen targeted to align food intake with circadian rhythms, may significantly improve neurocognitive function among older adults with self-reported memory decline. These promising pilot results suggest a need for fully-powered, randomized controlled trials to test the efficacy of this non-pharmacological, low cost-to-burden ratio intervention.
PHYSICAL ACTIVITY TOGETHER FOR COUPLES WITH MILD COGNITIVE IMPAIRMENT: A FEASIBILITY STUDY
Authors: Ahn Sangwoo , Cobb Sandy , Crouter Scott , Lee Chung Eun , Anderson Joel
Published: December 2022

Spouses often assume the role of informal caregivers for older adults living with mild cognitive impairment (MCI). These couples represent a population with low levels of physical activity, however, there is limited research regarding promotion of physical activity among these dyads. The purpose of this study was to evaluate the feasibility of a dyadic intervention, hypothesized to enhance physical activity via mutual support. We recruited three dyads (mean age: 66 [MCI] and 67 [spouse] years) from a local memory clinic. The dyads were asked to engage in physical activity together for 16 weeks. The weekly intervention consisted of 150 minutes of moderate-to-vigorous physical activity (MVPA) on their own and two lower body strength training sessions per week, one videoconferencing-supervised and one on their own. The adherence rate to the weekly MVPA and strength training was 88% and 83%, respectively. However, the percentage meeting the goal of 150 minutes/week of MVPA as measured using a Fitbit was 31% and 73% among those with MCI and spouses, respectively. There were no issues with the retention rate (100%) or safety; satisfaction scores were high (MCI = 93%, spouses = 98%). Exit interviews revealed three key themes: (1) value of the program (accountability, togetherness), (2) difficulties (differences in physical capacity between spouses), and (3) suggestions to improve the program (incorporating various types of strength training). Our dyadic intervention was feasible to support regular physical activity for older adults living with MCI and their spouses. Future work will incorporate participants’ feedback to optimize the intervention.
COGNITIVE-FOCUSED INTERVENTIONS FOR ADULTS WITH DIABETES: AN INTEGRATIVE REVIEW
Authors: Kim Bohyun , Hu Jie
Published: December 2022

Adults with diabetes and impaired memory and executive functions are more likely to experience difficulties in diabetes self-management resulting in poor glycemic control. Cognitive-focused interventions are widely accepted as an effective way to improve cognitive function in individuals at high risk of mild to severe cognitive dysfunction. This review synthesizes the effects of cognitive-focused interventions on cognitive ability, diabetes self-management, and glycemic control in adults with diabetes. A systematic review of randomized controlled/clinical trials studies published in English between 2012–2022 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. PubMed, CINAHL, Embase, and Web of science were searched. Cochrane Collaboration’s Risk of Bias tool was used to evaluate the bias and quality of the studies. Nine studies met the inclusion criteria. Cognitive ability and diabetes self-management were assessed using different measurements and glycemic control was measured with A1C. Seven studies applied cognitive training, one provided working memory training, and one used occupational therapy. Seven studies combined cognitive training with a co-intervention including self-efficacy, lifestyle management, physical training, chronic disease self-management program, square-stepping exercise, psychoeducational intervention, and empowerment. Two studies provided a cognitive-focused intervention only. All nine studies showed statistically significant improvements in at least one outcome variable. Cognitive-focused interventions have a positive effect on improving memory and executive function. However, the evidence of cognitive-focused interventions on self-management and glycemic control has not been established. Future studies to improve cognitive using effective strategies to improve cognitive function enhancing diabetes self-management behaviors and glycemic control are warranted.
COGNITIVE FUNCTION AND LONELINESS AMONG OLDER ADULTS: DYNAMICS OF SOCIAL NETWORK AND PERCEIVED SOCIAL SUPPORT
Authors: Park Soobin , Park Sojung , Kim BoRin , Baek Jihye , Amano Takashi
Published: December 2022

As cognitive reserves diminish with age, older adults become aware of age-related losses and allocate their resources accordingly. Drawing on the selective optimization with compensation and socioemotional selectivity theory, older adults may select emotionally close social relationships to manage emotional distress caused by deterioration in cognitive functions. This study investigates whether different levels of cognitive functions [no impairment (NI), cognitive impairment no dementia (CIND), and dementia] influence the degree of loneliness among older adults, and how heterogeneous patterns of social relations affect this association. We used data from the 2018 Health and Retirement study, which included 4,500 respondents over 51 years of age who completed a modified Telephone Interview for Cognitive Status. Using comprehensive social-relational indicators for the structure and quality of four relational sources (spouse or partner, children, family, and friends), we applied latent class analysis and identified five subgroups of social relations: restricted–limited support (Nf190, 4.22%), family and friends focused–ambivalent (Nf1,252, 27.82%), diverse–positive (Nf2,203, 48.96%), negative (Nf500, 11.11%), and spouse focused–ambivalent (Nf355, 7.89%). Hierarchical regression showed that those in the CIND (p < .032) and dementia group (p < .037) were more likely to experience loneliness than those in the NI group, and those with dementia who were in the category of spouse focused–ambivalent support (p < .001) had relatively lower levels of loneliness. Reliance on spousal support may be due to people selecting and adapting increasingly on closer relations to counter their vulnerability and feel less lonely. Interventions to sustain this core relationship should be encouraged, including spousal-caregiving relief programs.
TELEMEDICINE TRENDS IN THREE NURSING HOMES DURING THE COVID-19 PANDEMIC
Authors: Sandell Lindsay , Baar Tena , Haque Raza , Zell Angela
Published: December 2022

Physical distancing and visiting restrictions during the COVID-19 pandemic posed significant challenges in providing timely medical care in nursing homes. The rising number of new COVID-19 cases created hardship in providing scheduled and non-urgent care visits. Virtual visits were pivotal in providing patient care. However, the additional responsibility of facilitating virtual visits for both social and clinical purposes further constrained the ability of nursing home staff to provide care. The critical deficiency of the workforce, rising numbers of new cases, and required triage of patients have been significant barriers to regularly scheduled care. We hypothesize that regular non-COVID-19 services in the evaluated nursing home facilities were lower than COVID-19 visits during this period. Our goal is to show the types of services affected during the pandemic. In this study, we analyzed 563 virtual visits during the COVID-19 pandemic in three nursing home facilities in Michigan from December 2020 through February 2022. Upon analyzing the types of services and trends, our results revealed that the number of COVID-19 related visits (68) was significantly lower than non-COVID-19 related visits (485), refuting our hypothesis. This illustrates that routine care could still be delivered during the pandemic. Additionally, the overall number of virtual visits declined steadily over the study period. This trend could suggest an increase of in-person services or a decrease in COVID-19 cases. The decline could also be related to the barriers faced by the nursing home workforce considering the time and additional responsibility of monitoring a virtual visit.
INFLAMMATORY BIOMARKERS DIFFER AMONG HOSPITALIZED VETERANS INFECTED WITH COVID-19 VARIANTS
Authors: Park Catherine , Seligman Benjamin , Hicken Bret , Tavakoli-Tabasi Shahriar , Sharafkhaneh Amir , Amos Christopher , Chou Andrew , Razjouyan Javad
Published: December 2022

The SARS-CoV-2 infection pathogenesis reported a complex interplay between virus and host immune response. In this study, we hypothesized that Omicron variant causes less inflammation and cytokine release than Delta and Alpha variants as measured by the first laboratory biomarkers during hospitalization. This is a retrospective cohort study of veterans who tested positive for COVID-19 and were hospitalized at the Veterans Health Administration due to COVID-19 infection. We defined three groups of patients based on highly likely period representing variants: Alpha (12/01/2020-05/31/2021), Delta (09/01/2021-11/30/2021), and Omicron (02/01/2022-07/11/2022). The risk of abnormality levels in biomarkers (C-reactive protein [CRP], ferritin, albumin, alanine aminotransferase [ALT], aspartate transaminase [AST], and lactate), as well as in-hospital mortality, were calculated using logistic regression adjusted by age, sex, body-mass-index, race, Charlson comorbidity index, VA frailty index, and vaccine record status. Of 414,213 Veterans tested for COVID-19, 74,342 Veterans (age: 67.8±14.3 years, BMI: 29.4±7.1 kg/m2) met the criteria: Alpha, 18,159 (34.4%); Delta, 23,414 (44.4%); Omicron, 11,207 (21.2%). Compared with Omicron, we observed significantly higher odds of abnormality levels in CRP (Alpha, adjusted odds ratio (aOR)=1.38; Delta, aOR=1.74), ferritin (Alpha, aOR=2.02; Delta, aOR=2.33), albumin (Alpha, aOR=1.16; Delta, aOR=1.15), ALT (Alpha, aOR=1.13; Delta, aOR=1.12), AST (Alpha, aOR=1.31; Delta, aOR=1.57), and lactate (Alpha, aOR=1.62; Delta, aOR=2.27) as well as mortality (Alpha, aOR=2.19; Delta, aOR=2.95). Veterans infected with Omicron showed less severe biomarkers’ responses compared to Alpha and Delta and lower mortality risk. Understanding the biomarkers’ responses of each patient across the different variants could be used to enhance acute patients’ management.
BUILDING BRIDGES: AN AGE-FRIENDLY CONFERENCE FOR THE GEROPSYCHOLOGY WORKFORCE
Authors: Carpenter Brian , Moye Jennifer , Dzierzewski Joseph
Published: December 2022

As in other disciplines, there is a high demand for psychologists who have specialized training in aging, but the demand far outstrips the supply, with only 1% of clinical/counseling psychologists identifying aging as their area of focus. The field of geropsychology has held a series of training conferences, the last in 2006, to define a training model and aging-related competencies. Fifteen years later, the field gathered again for a conference focusing specifically on the pipeline, with the goals of 1) understanding the recent shortage of applicants for positions in academic settings, 2) addressing underrepresentation of individuals from diverse racial and ethnic backgrounds across clinical and academic geropsychology, and 3) implementing concrete solutions. In this symposium we describe our two-day, four-hour virtual national conference held in 2021, attended by more than 150 psychologists nationwide, including the structure and outcomes of the conference and the progress of several ongoing working groups. The first paper summarizes quantitative and qualitative findings of a pre-conference survey on perceptions of the geropsychology workforce. The second paper describes a career pathways webinar aimed at graduate students, interns, and fellows to attract students to diverse careers in aging. The third paper describes discussions about the impact of the pandemic on geropsychology training. The fourth paper presents a survey and efforts of a working group focused on post-licensure training. This presentation offers a possible model for others considering ways to galvanize interest and training in aging.
HOW DOES THE COVID-19 PANDEMIC AFFECT LATE WORKING LIFE? EUROPEAN EMPLOYMENT TRAJECTORIES FROM 2011 TO 2021
Authors: Schmitz Wiebke
Published: December 2022

Background

One of the immediate impacts of the pandemic was the increase in unemployment and the reduction of working hours - especially among women, those with lower job security and in countries with a weaker social welfare system. The aging society is at further risk, which is already challenged by a growing shortage of workers and the rising costs of pensions. To understand the long-term consequences of COVID-19 for the aging workforce, this paper advances existing research by exploring from a life-course perspective how employment after the COVID-19 outbreak is anchored in larger employment histories (2011–2021).

Methods

Sequence-analyses are applied using retrospective life history data combined with both COVID-19 Surveys (2020–2021) from SHARE including respondents aged 50+. Using cluster-analyses, the resulting sequences are classified into six groups. By applying descriptive-analyses, I examine how these groups differ by gender, work quality, and country.

Results

Older workers – especially men – with continuous full-time employment histories are less frequently affected by unemployment and fewer working hours during COVID-19. Whereas those – especially women – with disruptive employment and part-time work histories are more frequently affected by unemployment after the outbreak of COVID-19. Respondents in countries characterized by social democratic welfare compared to liberal welfare regimes are less likely affected by unemployment during the pandemic. Discussion: The pandemic particularly puts older workers with disruptive employment histories at additional risk of labor market exit. Therefore policymakers need to address inequalities in earlier life to prevent long-term consequences of social inequality caused by the pandemic.
THE ROLE OF MEDITERRANEAN DIET IN THE PRIMARY AND SECONDARY PREVENTION OF ATRIAL FIBRILLATION: A SCOPING REVIEW
Authors: Su Yan , Wu Kuan-Ching , Zaslavsky Oleg , Prasun Marilyn
Published: December 2022

Atrial fibrillation (AF) is the most common cardiac arrhythmia, especially in patients older than 65. The prevalence of AF increased 3-fold over the last 50 years. All treatments, such as cardioversion, ablation, and anticoagulation, are associated with risks and relapses. Besides, these strategies may not apply to all patients with AF. Adherence to the Mediterranean dietary pattern is assumed as an ideal nutritional model for AF. Yet, there is a gap on 1) how adherence to the Mediterranean diet prevents AF and 2) how the Mediterranean diet affects complications in patients with AF. A scoping review was performed in June 2022 to identify studies focusing on the Mediterranean diet and AF. A total of 334 articles were retrieved and 12 met inclusion criteria. Six studies were interventions (n=6) and six were observational studies (n=6). In the six intervention studies, five were nested within the PREDIMED (Prevención con Dieta Mediterránea) study. In AF occurrence (n=6), the results were inconsistent. The Mediterranean diet plus extra virgin olive oil was significantly and favorably related to AF, however, Mediterranean diet plus nuts was not, when compared with the low-fat diet; Mediterranean diet modified how long chain acylcarnitine affected development of AF but not how tryptophan or arginine metabolites affected AF. In patients diagnosed with AF (n=6), Mediterranean diet favorably related to adverse cardiovascular events, oxidative stress, and Mediterranean diet adherence, and did not affect anticoagulation for those taking anticoagulants. Further research is needed to examine how the Mediterranean diet affects the development of AF.
DECREASING PAIN, ANXIETY, AND CONFUSION IN TERMINALLY ILL VETERANS
Authors: Kresevic Denise , Pallaki Muralidhar , Wasil Bridgette , Swanson Marilyn , Burant Christopher
Published: December 2022

Terminally ill patients often receive medications for pain and anxiety that result in sedation that may inhibit communication with their loved ones. Balancing comfort while maintaining meaningful communications is a common dilemma for patients, staff, and families. Many patients report confusion and a decreased ability to communicate with families and health care providers, resulting in fear, anger, and frustration. Additionally, family members (25 to 33%) also feel frustrated and angry not being able to communicate with their loved ones needs and wishes. Delirium, a distressing syndrome characterized by disturbed consciousness, reduced ability to focus attention, altered cognition is experienced by 62–88% of terminally ill patients. Unfortunately, it is often underdiagnosed and undertreated. While not all delirium can be prevented it is estimated that 50% of terminal delirium may be ameliorated. This project was designed to proactively identify terminally ill veteran preferences for nonpharmacological interventions to reduce pain, anxiety, and prevent delirium. In the sample of Veterans from an inpatient VAMC Hospice (n=31) the mean age was 79.46 (sd=10.69); 60.7% were Black and 39.3% were white; 60.9% had cancer and 27.6% had heart failure. The most common patient delirium related behaviors were verbal agitation, physical agitations, physical aggression, anxiety, and confusion. Veterans identified the following comfort priorities: decreased noise (82.6%) and lighting (82.6%), warm blankets (78.3%), music (65.2%), emotional support (73.9%), increased family involvement (43.5%) and (20.8%) going outdoors. Preventative individualized nonpharmacological interventions decreased disruptive delirium related behaviors over 95% of the time and should be incorporated into routine hospice care.
SERVED BY SYSTEMS: AGING WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES AND INEQUITIES IN HEALTHCARE
Authors: Waldron Danielle , Hartford Emily , Sauer Jacquelin , Stokes Jeffrey
Published: December 2022

Adults and older adults with intellectual and developmental disabilities (I/DD) often experience medical complexity, accelerated aging, and shortened life expectancy. This project explores health service utilization (HSU) of adults with I/DD receiving state services in the U.S. over the adult lifespan before and after the implementation of the Affordable Care Act (ACA). Three waves of cross-sectional data (2008–2019) from the National Core Indicators-In Person Survey were analyzed using multilevel mixed effects logistic regression (n=46,284). Older adults with I/DD were more likely to receive a physical exam, flu vaccine, eye exam, hearing test, and a dental exam compared to younger individuals, although these differences were small. Compared to non-Hispanic whites, non-Hispanic blacks were less likely to receive physical exams, flu vaccines, and dental exams; non-Hispanic other were less likely to receive eye exams and dental exams; and Hispanic persons were less likely to receive eye exams, flu vaccines, and dental exams. Individuals with I/DD living in states that expanded Medicaid were at 68% greater odds of receiving a physical exam than those who did not. Our research indicates that overall adults with I/DD are not yet reaching HSU of pre-ACA times, perhaps due to the oversaturation of existing providers. National and state policies, along with individual case management each play a role in ensuring healthy aging of individuals with I/DD. A call to action to better understand and integrate these three entities may help improve the potential for healthy aging of this group.