bluuebunny/crossref_metadata_2025 huggingface dataset:
Older Adults’ Experiences in an Online Intervention for Managing Subjective Depressive Symptoms
Authors: Hudson Janella , Ungar Rachel , Albright Laurie , Tkatch Rifky , Schaeffer James , Wicker Ellen
Published: December 2021

Background: Many older adults struggle with late-life depression, stress, and anxiety, especially when facing age-related transitions including retirement, relocation, and the death of a spouse. Given the consequences of depression among older adults, which include higher rates of suicide, timely interventions that help to manage depressive symptoms are essential. Objective: The primary purpose of this study was to explore the perceived efficacy of an online program in improving subjective depressive feelings. Methods: Older adult participants were recruited for semi-structured interviews (n = 24) in a web-based intervention that included interactive games and activities undergirded by a cognitive behavioral therapy (CBT) approach. Participants were asked to provide feedback about program features, including weekly module content, games, interactive activities and community interactions, and any perceived effects on their health behaviors and/or emotional well-being. Participants’ responses were analyzed using qualitative content analysis. Results: Participants reported several gains, including developing the habit of forming ongoing, incremental goals, achieving wellness-related goals, and experiencing an overall positive shift in perspective. In addition, participants reported feeling greater gratitude, increased positivity, and improvement in mood. Featured games and activities helped to promote stress relief and entertainment, and mindfulness exercises were cited as the most helpful and/or enjoyable among participants. Participants expressed a preference for program content related to aging and aging-related transitions. Conclusions: This study demonstrated feasibility of an interactive web-based intervention for older adults with subjective depressive feelings, while also providing important findings about users’ preferences for personalized, aging-related feedback.
Mood Lifters: A Peer-Led Mental Health Program for Older Adults via Video Conferencing
Authors: Funk Courtney , Ferber Rebecca , Harrington Anne , Porte Jennifer , Connell Cathleen , Maixner Susan , Roberts Scott
Published: December 2021

Effective and scalable mental health programs are greatly needed for older adults, given the vast majority in need do not receive formal mental health services. In this study, we adapted Mood Lifters—a peer-led, community-based program promoting mental well-being—to address the unique needs of older adults. The 14 weekly program sessions were delivered via Zoom. Twelve older adults (mean age = 69.7 years; 4 men, 8 women) enrolled; 9 completed the program (2 of 3 dropouts were due to health issues). A battery of validated measures administered within one week before and after the program assessed domains including depression and anxiety, stress management, and health behaviors. Compared to baseline, participants who completed the program showed significant improvements in perceived stress (p=0.03), sleep quality (p=0.02), and emotion regulation via cognitive reappraisal (p=0.06). Depression and anxiety symptoms (assessed by the Geriatric Depression and Anxiety Scales, respectively) were lower at program completion, although improvements were not statistically significant. No significant changes from pre- to post-test were reported in loneliness and health behaviors. Participant ratings of program satisfaction were very high (mean = 4.78/5, with 1=poor, 5=excellent). Results from this pilot test of Mood Lifters for Seniors suggest it is feasible and acceptable for outreach to older adults, with preliminary evidence of benefits in several domains related to mental health and wellness. Future randomized trials with larger, more diverse samples will be necessary to confirm program benefits.
Comparisons Between Recruitment and Retention Strategies for Two Online RCTs
Authors: Webster Britney , Jeanblanc Alexandra , Smith Gregory , Infurna Frank
Published: December 2021

Custodial grandfamilies (CGF) comprise a small, diverse group of the US population which can make samples difficult to recruit and retain. Two online RCT studies (S1 & S2) for CGF used a variety of recruitment strategies with varying success. S1, for grandmothers (GM) only, successfully recruited from Facebook (47.95%) and community flyers (17.73%). S2, dyadic study for GM and adolescent grandchildren (AGC), recruited through emails to high school counselors (43.29%) and community (30.94%) and professional (17.13%) kinship support organizations. The advantages of online RCTs for hard-to-reach populations include expedited administration, buffering against social distancing, nationwide enrollment (S1-42 states; S2-43 states), and generalizability of findings. Challenges of online RCTs are establishing rapport and building trust with participants who are not comfortable with technology and designing screenings to identify false participants. Overall, these studies highlight the advantages of an online RCT, especially for hard-to-reach populations like custodial grandfamilies.
BMI Change After Parent’s Death in Adulthood: Examining Age and Race Differences With Time-Varying Effects Modeling
Authors: Chai Hye Won , Cha Hyungmin , Umberson Debra
Published: December 2021

Parental bereavement in adulthood is a stressful event that can have adverse health consequences for middle and older adults, including weight gain. Considering that the impact of bereavement is found to vary depending on the timing of death as well as across race/ethnicity, changes in weight after a parent’s passing may also be contingent on the timing of parent’s death and the bereaved individual’s race/ethnicity. Using Time-Varying Effects Modeling (TVEM), this study examined whether changes in BMI following a parent’s death differed across respondent’s age when their parent passed away. We also tested whether these age differences varied by race. Data came the Health and Retirement Study (HRS) Waves 1 – 13 and we selected respondents who experienced passing of either parent while participating in HRS. Analyses were run separately for mother’s death (n = 6,191) and father’s death (n = 3,301). Results showed significant racial/ethnic differences in BMI change following a mother’s death, particularly during late midlife to early late life. Specifically, non-Hispanic White and Black adults showed a greater increase in BMI compared to Hispanic adults. These race differences were consistent for father’s death as well, but to a lesser extent compared to mother’s death. Results suggest that White and Black adults who lost their parents between late midlife and early late life gained more weight compared to their Hispanic counterparts. This may be attributed to the racial/ethnic differences in health behaviors in response to parent’s death.
An International Review of Motor Vehicle Collision Risk with Medical Conditions in Older Adults
Authors: Rapoport Mark , Wood Joanne , Dow Jamie , O'Neill Desmond , Charlton Judith , Koppel Sjannie
Published: December 2021

The objective was to examine the impact of seven categories of medical illness on risk of Motor Vehicle Collisions (MVC) in older adults. In late 2019, a systematic review of the MVC risk associated with alcohol use disorders, psychiatric disorders, epilepsy, diabetes, hearing loss, vision disorders and sleep disorders was conducted. A total of 64,720 titles were screened, and 138 articles were included. Of these, only thirteen pertained to older adults, only six showed increased MVC risk in at least one condition, and only seven were rated of “Good” quality. Hearing impairment was associated with MVC only if associated with visual acuity or contrast sensitivity impairments (RR 1.52, 95% CI 1.01-2.3 and RR 2.41, 95% CI 1.62-3.57, respectively). A high depression score was associated with increased MVC (RR 1.5, 95% CI 1.1-2.1) in one study, but a similar relationship was not found in two other studies. Glaucoma increased at-fault MVC risk (RR 1.65, 95% CI 1.20-2.28) in one study, but no relationship was found in another. Visual field loss increased MVC risk in three of four studies (RR or HR ranging from 1.31 to 2.32). One negative study each were identified for alcohol use disorders, age-related macular degeneration, any eye disease, or any psychiatric disorder, and four negative studies were identified for reduced visual acuity. No studies of older adults were found for epilepsy or sleep disorders. Interpretation of MVC risk in older drivers with medical illness is rendered challenging by the paucity and quality of studies.
Metabolic Syndrome and Objective Physical Performance Measures in Mid-to-Early Late Life Women: SWAN
Authors: Strotmeyer Elsa , Boudreau Robert , Lange-Maia Brittney , El Khoudary Samar , Ylitalo Kelly , Kriska Andrea , Karvonen-Gutierrez Carrie , Napoleone Jenna
Published: December 2021

Metabolic syndrome (MetS) is a cluster of factors (hypertension, abdominal obesity, impaired fasting glucose, low high-density lipoprotein, hypertriglyceridemia). How midlife MetS impacts future physical functioning is uncertain. We hypothesized that higher midlife MetS components are associated with poorer physical performance in early late life for multi-ethnic women. MetS status from 1996-2011 (8 visits) and objective physical performance (2015/16; short physical performance battery (SPPB; 0-12), 40-foot walk (m/s), 4-meter gait speed (m/s), chair stands (sec), stair climb (sec)) were assessed in the Study of Women’s Health Across the Nation (SWAN; n=1722; age 65.4±2.7 years; 26.9% Black, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified trajectory groups distinguishable by number of MetS components: none (23.9%), 1=low-MetS (28.7%), 2=mid-MetS (30.9%), >3=high-MetS (16.5%). High-MetS versus none had higher body mass index, pain, financial strain, and lower physical activity and self-reported health (p < 0.0001). Black and Hispanic women were more likely to be in high-MetS and had worse physical functioning, along with Chinese women, versus White (all p<0.05, except gait speed in Hispanic). Adjusted linear regression related MetS groups to physical performance. High-MetS versus none demonstrated adjusted worse 40-ft walk (β:-0.08; 95% CI:-0.13, -0.03), gait speed (β:-0.09; 95% CI:-0.15, -0.02), SPPB (β:-0.79; 95% CI: -1.15, -0.44), and chair stands (β:0.69; 95% CI: 0.09, 1.28), but not stair climb, with race significantly related to all except 40-ft walk. Midlife MetS trajectories related to poor physical performance in early late life multi-ethnic women. Managing midlife metabolic function may improve physical performance in late life.
Spirituality as an Essential Element of Person-Centered Care
Authors: Nathan Rachel , Zuercher Deborah , Eveland Steven , Chacko Anjana , Kheirbek Raya
Published: December 2021

Data demonstrate that the majority of patients with serious or chronic illness would like their clinicians to address their spirituality but that the majority of clinicians do not provide such care. Reasons cited include lack of training. Palliative Medicine, built on the biopsychosocial-spiritual model of care, has long recognized the critical role of spirituality in the care of patients with complex, serious, and chronic illness. There is mounting evidence that spiritual care is a fundamental component of all high-quality compassionate health care, and it is most effective when it is recognized and reflected in the attitudes and actions of both patients and health care providers. We conducted focus groups as a first step in the process to arrive at a consensus definition of “spiritual care.” A second step involved collecting and comparing frameworks and models that recognize that providers cannot be made compassionate simply through the imposition of rules; methods were needed to achieve behavior change. The study group developed and piloted curriculum to train health care providers. The created curricula covered the definitions of a spiritual care, self-awareness, cultural sensitivity, assessment, and skills. As part of ongoing curriculum development processes, training included evaluation tools to accompany skill development . Our work demonstrated the need for compassionate presence during encounters, for applying the spirituality in professional life; and for identifying ethical issues in inter-professional spiritual care. We concluded that it is feasible to train clinicians to address spirituality and provide holistic and patient-centered care in an effort to minimize suffering.
Supporting Innovative Strategies to Reduce Opioid-Related Harms Among Older Adults in Primary Care
Authors: Bertrand Rosanna , Keane Nicole , Shoemaker-Hunt Sarah , Hsu Clarissa , Parchman Michael , Tong Sebastian , Bierman Arlene
Published: December 2021

Older adults are more likely to be prescribed opioids and to suffer from opioid-related harms. Despite growing concerns about opioid misuse in older adults, providers and health care systems often struggle with approaches that would effectively manage opioid use and reduce opioid misuse in older adults. To address this issue, the Agency for Healthcare Research and Quality funded a four-year project to work with primary care practices in developing and testing innovative strategies for opioid management in older adults. To develop a change package that will inform learning collaboratives where primary care practices will be encouraged to test new or modified strategies in managing opioids in older adults, Abt, the contractor, first completed an environmental scan to identify existing resources/tools. Identified resources/tools were vetted by an expert panel and appropriate items were used to develop a change package consisting of nine high-leverage change (HLC) strategies (e.g., Develop processes/workflows that clearly define roles/responsibilities and promote coordinated team-based care). In the change package, multiple key activities that accompany each HLC strategy are presented as examples of strategies that could be implemented to bring about the selected HLC. Primary care practices participating in learning collaboratives will use the change package to guide the development and testing of strategies to manage opioids in their older adults, which will inform the development and refining of a compendium of strategies to best reduce harms of opioid use in older adults.
The Moderating Role of Depression on Momentary Pain-Affect Associations in Osteoarthritis
Authors: Behrens Emily , Hill Kyrsten , Smith Dylan , DeCaro Jason , Cox Brian , Parmelee Patricia
Published: December 2021

Previous research has found a reciprocal relationship between pain and depression, in which each influences the severity of the other (Chou, 2007; Hawker et al., 2011, Kroenke et al., 2011; Schieir et al., 2009). Studies have found that depressed individuals exhibit stronger pain-mood associations than never-depressed individuals (Conner et al., 2006; Tennen et al., 2006). The current study investigated main and interactive effects of depressive symptoms on the momentary associations between pain and mood. Experience sampling (ESM) data was used from a multi-site study examining individuals with knee osteoarthritis (OA). Participants completed self-report measures of global depression and momentary pain, negative affect (NA), and positive affect (PA). Cross-sectional associations among momentary pain and affect were examined in a series of hierarchical multilevel models that nested the 28 ESM calls (Level 1) within participants (Level 2). A parallel set of multilevel models tested lagged associations among momentary variables. Depression significantly moderated the contemporaneous (p < .001) and lagged (p < .003) associations between pain and NA, suggesting that depression intensifies the momentary pain-NA linkage. There were no significant interaction effects for PA. These findings extend existing knowledge by illustrating how depressive symptoms influence the everyday experience of OA pain and its impact on affective well-being. (Supported by AG041655, P. Parmelee and D. Smith, Co-PIs)
Age and Gender Differences in Long-Term Exercise Behavior for Older Adults with Heart Disease
Authors: Graham Helen , Asakura Yuki , Prue-Owens Kathy
Published: December 2021

Exercise decreases mortality and hospital admissions. Exercise adherence is challenging, and little is known about exercise adherence especially in older adults with heart disease. To gain an understanding of long-term exercise behaviors in older adults we conducted a cross-sectional study of individuals diagnosed between 2016-2020 with myocardial infarction (MI)/angina. Emails were sent in 2020 to recruit participants. Exercise adherence was measured using the Exercise Adherence Rating Scale (EARS), Godin’s Leisure-Time Activity Scale (GLTEQ) for exercise intensity, and self-report for impact of COVID-19. Descriptive statistics and t-tests were used to analyze data. Eight-hundred and seven individuals (x ̅ age 67.3) responded to the on-line survey. The majority were males (68.8%), married, (68.9%), and retired (59.3%). Co-morbidities included hypertension (32%), hyperlipidemia (21%), diabetes (12%), and depression (6.2%). Long-term exercise behaviors were independently observed in participants ≥65yr (n=526) and <65yr (n=281). Females ≥65yo demonstrated higher exercise adherence scores compared with males ≥65yo (1.66 ± 1.1 vs. 1.30 ± 21.7; t = -2.59, p=.010). Conversely, males scored higher in exercise intensity (34.4 ± 24.7 vs. 22.6 ± 21.7; t = 3.84, p=.000). Gender related exercise adherence and exercise intensity did not differ significantly in <65yo (p=.278 & p=.282, respectively). Exercise frequency decreased in both age groups after COVID-19 Pandemic started, however the decrease was significant only in older adults (p=.014) indicating they were at greater risk for exercise problems when faced with environmental barriers. Additional research is recommended as to the impact of environmental factors on exercise adherence in older adults and potential interventions.
Daily Activity Engagement Predicts More Positive Affect Especially on Days When a Person Feels Young
Authors: O'Brien Erica , Neupert Shevaun
Published: December 2021

Engagement in a wide array of mental, social, and physical leisure activities confers several health benefits. Indeed, theories of successful aging argue that an active lifestyle serves as an important criterion for maintaining high levels of psychological, functional, and physical well-being in old age. Findings from parallel studies also show that people who hold positive (self-)views of aging exhibit higher and maintained levels of well-being over time. Yet, whether views of aging enhances the link between activity engagement and well-being - and whether they do so on a daily basis – remains unknown. This study therefore sought to extend prior literature by examining the relationship between activity engagement, subjective age, and affective ratings within-person over several days. Old adults (N = 115; Age: Range = 60 – 90, M = 64.65, SD = 4.86) in the Mindfulness and Anticipatory Coping Every Day (MACED) study completed an 8-day daily diary. Participants reported on their positive and negative affect, the age they subjectively felt compared to their actual age, and the number and types of leisure activities in which they engaged. Results from multilevel analyses indicate that people felt more positive on days when they also engaged in more activities (total across mental, social, physical types) than usual. Moreover, the effect of activity engagement was most pronounced on days when people felt younger than usual. No effects were found for negative affect. Preliminary findings suggest that people benefit psychologically from daily leisure activities and a positive self-view of aging.
Changes in Consumption Expenditures among Baby-boomers and Young-olds: Latent Transition Analysis
Authors: Song Si Young , Jun Hey Jung , Joo Susanna , Yoon Do Kyung
Published: December 2021

The aim of this study was to examine the longitudinal transition of consumption expenditures among both baby-boomers and young-olds in South Korea. We used data from the 6th (2016) and the 7th (2018) waves of the Korean Longitudinal Study of Ageing (KLoSA). The final sample comprised 1,806 baby-boomers (age range=53-61 in 2016) and 1,483 young-olds (age range=65-74 in 2016). Consumption expenditures were observed with nine types of expenses: food, eating out, public education, private education, housing, health-care, clothing, cultural entertainment, and savings. According to the results from latent transition analysis (LTA), three consumption subgroups were identified among baby-boomers: “non-expenditure for education (NE, 69.7%)” group, “high-public education expenditures (PE, 10.7%)” group, and “high-public and private education expenditures (PPE, 19.6%)” group. For baby-boomers, NE and PE were more likely to remain the same type throughout the two waves, and PPE was most likely to move to NE two years later. Meanwhile, the consumption expenditures of young-olds were divided into “low-saving (LS, 63.7%)” group, “high-saving (HS, 40%)” group, and “education cost-centered (EC, 5.3%)” group. In the case of young-olds, the transition between the groups was unlikely to occur across the two waves which can be interpreted as having fewer life cycle changes than baby-boomers. This study suggests that it is necessary to take into account the difference between the generations when understanding longitudinal transition of consumption expenditures.
Financial Planning for Retirement: Developing an Integrated Model
Authors: Yeung Dannii , Ho Alvin , Lam Alfred
Published: December 2021

With higher life expectancy of the aging population, retirees nowadays will spend a prolonged period of time after retirement. Yet, past studies have consistently revealed a lack of retirement savings among working adults, implying an inadequacy to maintain the quality of life in late adulthood. This study therefore aims to identify the factors influencing the working adults’ intention to purchase financial products for retirement (such as deferred annuity and voluntary contribution to retirement fund) and develop an integrated model of financial planning for retirement. A total of 598 Hong Kong Chinese working adults from diverse age and income groups completed an online survey on intentions to save and purchase specific financial products for retirement. The results of MANCOVA reveal that compared to older workers, younger workers had lower intentions to save and purchase financial products for their retirement even after controlling for their monthly income [F(16,1797)=2.24, p=.003, partial n2=.015]. An integrated model of financial planning for retirement is proposed by incorporating the concepts of the interdisciplinary psycho-motivation model and Theory of Reasoned Actions (χ2 = 40.42, p<.001, CFI = .99, RMSEA = .07, SRMR = .02). In particular, the positive effects of financial literacy, subjective norms, social support, and future time perspective on intention to save and purchase financial products for retirement have been found to be mediated by retirement goal clarity but not attitudes towards retirement. Future direction on promoting younger and older workers’ retirement planning especially in the financial domain will also be discussed in the presentation.
What Are We Worried About? Mid-life Couples’ Financial Concerns About Their Retirement
Authors: Yorgason Jeremy , Segel-Karpas Dikla , Ermer Ashley , Weller Hailey , Owens Shenan , Wheeler Brandan
Published: December 2021

Retirement is an expected stage of life that couples plan for far in advance. Despite knowing that years of life without regular income are anticipated, some underprepare, leading to financial uncertainty in later years. In this study we explore financial concerns for retirement expressed by a sample of 335 midlife (Mage=44) couples that participated in the Flourishing Families study. We also examined predictors of those concerns across a 1-year period. Results suggested that both husbands and wives worried about insufficient income, excess spending, and heavy debt in retirement. Minor concerns included being worried about paying for their children’s education, net worth, and general expenses. Lower income was predictive of both husbands and wives being worried about having insufficient income in retirement. Higher income was predictive of husbands having concerns about excess spending. Although having retirement benefits was not predictive of any worries, having retirement savings was associated with wives having a greater likelihood of reporting worries about heavy debt and net worth in retirement. Better financial communication was associated with fewer husbands reporting concerns about excess spending and fewer wives reporting concerns about heavy debt. Having concerns about a spouse not being financially responsible were associated with more husbands reporting worries about excess spending and heavy debt in retirement. When wives reported higher social connection with a child, they also were more likely to report worries about expenses. Findings suggest that saving for retirement, communicating well about finances, and being financially responsible are associated with fewer financial concerns in retirement.
The Role of Social Connection/engagement Predicts Changes in Depressive Symptoms and IADL in Stroke
Authors: Elayoubi Joanne , Nelson Monica
Published: December 2021

Social connections/engagement have been found to be potentially protective against depression and declines in physical functioning. We examined whether social connection/engagement was protective against depression and functional decline after stroke. Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998-2012. Multilevel modeling was used to examine how social connection/engagement were associated with trajectories of depressive symptoms and limitations with instrumental activities of daily living (IADLs). Models controlled for age, gender, education, and race. In addition, analyses with depressive symptoms as outcome controlled for functional limitations with ADLs. Participants who were lonely and did not have friends in their neighborhood pre-stroke had more depressive symptoms at the time of stroke. Participants with close children pre-stroke showed less increase in depressive symptoms over time. Within-person increase in loneliness and within-person decline in providing help were related to more depressive symptoms post-stroke. Participants who felt lonely and did not provide help pre-stroke had more IADL limitations at the time of stroke. Smaller pre-stroke household size and pre-stroke volunteering were associated with less increase in IADL limitations with stroke. Within-person increase in having friends and providing help after stroke were associated with fewer IADL limitations post-stroke. Taken together, these findings suggest that social connection/engagement may buffer the negative psychological and physical outcomes of a stressful event such as stroke.
Loneliness, Social Isolation and All-Cause Mortality in Older Adults
Authors: Barnes Timothy , Tkatch Rifky , Ahuja Manik , Albright Laurie , Schaeffer James , Yeh Charlotte
Published: December 2021

As distinct constructs, loneliness and social isolation have both been associated with mortality in older adults. Many studies have examined each construct separately; however, few have examined their impact together, especially within the U.S. Using data from a large sample of U.S. adults age 65+ (N=7,982), the effect of loneliness and social isolation on all-cause mortality was examined considering their separate and joint effects. Measures were based on the UCLA-3 Loneliness Scale and the Social Network Index (SNI). Loneliness was categorized as: Severe, moderate, or no loneliness. Social isolation (defined by the SNI) was categorized as: Limited, medium, or diverse social networks (SN). Cox proportional hazards regression models were performed. Among participants, there were 328 deaths after data collection (4.1%). In separate, adjusted models, loneliness (severe, HR=1.86, 95% CI: 1.43-2.41 and moderate, HR=1.51, 95% CI: 1.16-1.98) and social isolation (limited SN, HR=2.37, 95% CI: 1.72-3.27 and moderate SN, HR=1.55, 95% CI: 1.12-2.14) were both associated with mortality. Modeled together, loneliness (severe, HR=1.55, 95% CI: 1.18-2.04 and moderate, HR=1.40, 95% CI: 1.07-1.83) and social isolation (limited SN, HR=2.08, 95% CI: 1.49-2.89 and moderate SN, HR=1.46, 95% CI: 1.05-2.02) both remained significantly associated with all-cause mortality with limited SN as the stronger indicator. Results demonstrate that both loneliness and social isolation contribute to greater risk of mortality among older adults. Furthermore, individuals with limited SN are at greatest risk. As the COVID-19 pandemic continues, loneliness and social isolation should be targeted safely in efforts to reduce mortality risk among older adults.
Social Support Moderates the Impact of Marital Transitions on Depression for Older Adult Women
Authors: Tucker Julia , Bishop Nicholas , Wang Kaipeng , Phillips Farya
Published: December 2021

Given the rapid growth of older Americans and the increased incidence of divorce among this population, it is paramount to identify negative health outcomes following marital transition and investigate the potential protective role of social support. Our study aims to identify relationships between change in depression and marital transitions, test whether social support moderates this association, and to examine variation by gender. The sample included 3,705 participants from the Health and Retirement Study, who reported being married or partnered in 2012. Changes in marital status were measured between 2012 and 2014 (remained married/partnered (reference), divorced/separated, and widowed). Depression was measured using the Center for Epidemiological Studies Depression short form (CESD-8). Three types of social support from family, friends, and children were assessed: social support, social strain, and social contact. Autoregressive multiple regression was used to examine the relationship between change in depression, marital transitions, social support, and gender. Widowhood and social strain were independently associated with an increase in CESD-8 scores between 2012 and 2014. Significant interactions between social support and social strain, and separation/divorce were identified, and the relationship between social support, depression, and divorce varied by gender. Change in depression was positively associated with social support for separated/divorced females, but not separated/divorced males. These results indicate that social support may modify the influence of divorce on changes in depression among recently divorced older females. These findings can help mental health service providers more effectively target older adults at the greatest risk of depression after experiencing a marital transition.
Understanding Technology Anxiety by the Interaction between Social Support and Educational Context
Authors: Joo Susanna , Lee Changmin , Kim YoonMyung , Kim Chang Oh , Lim Yun Mook , Jun Hey Jung
Published: December 2021

The purpose of this study was to examine the interaction effects of social support from family and educational contexts on technology anxiety among Korean older adults. We collected data by online recruiting in February 2021, and the sample was Korean older adults without dementia (N=310; 65-89 years old). The dependent variable was technology anxiety, which meant the expected degree of worry under the assumption that a wearable robot for exercise was used. Independent variables were four types of social support (emotional, instrumental, physical, and financial support) provided by family members, such as spouse, children, or siblings. The moderating variable was the binary educational context (high school and under=0; college level and over=1). Interaction effects were estimated by bootstrapping and PROCESS macro with four regression models about each type of social support. Results showed the interaction effect between physical support and educational context was significant on technology anxiety. Concretely, getting more physical support was significantly associated with a lower level of technology anxiety for highly educated older adults, while it was not significant for less-educated older adults. There was no additional type of social support which had not only significant interaction effects with educational context but also main effects on technology anxiety. It suggested that providing direct physical help, including daily care or assistance, could decrease feeling technology anxiety, especially not for less-educated seniors but for highly educated Korean older adults.
Action Planning Checklist for Social Determinants of Health: Older Adults with Chronic Conditions
Authors: Ilardo Joan , Zell Angela
Published: December 2021

Medical residents need training to assess social determinants of health (SDOH) related to chronic conditions. We created a checklist to identify SDOH affecting residency clinic patients’ ability to manage chronic conditions. The tool: 1) involves resident training; 2) provides decision support checklist; 3) influences patient activation; and 4) increases provider and patient communication through shared decision making. Action Planning Guide checklist (APG) includes questions pertaining to SDOH preventing patients from managing their chronic conditions and actions patients will take. Areas identified are discussed between patient and resident, increasing patient activation. The clinic’s nurse care facilitator guides referrals to community-based resources. Fifty-two patients were enrolled, with 75% of patients responding they would like to be better managers of their chronic conditions. This information is used to develop patient’s goals of care. Over 90% of patients said their conditions affect their lives and discussed ways better to care for themselves. Over 80% discussed medication management, health goals to improve their quality of life, and made a plan that maps out ways to reach their goals. All of these are essential for achieving positive health outcomes for older patients with chronic conditions. These attributes promote effective patient/provider partnerships. Seventy referrals were made; food through 2-1-1 (47%); monthly commodity food program (30%); utility payments (11%), and transportation (9%). Twenty-seven referrals were made to agencies serving older adults; 25 to the local AAA information and assistance services, and 2 to Senior Project Fresh Voucher Program.
Association of Shoulder Dysfunction with Mobility Limitation in Older Adults of the BLSA
Authors: Davis Derik , Sun Kai , Magder Laurence , Simonsick Eleanor
Published: December 2021

Mobility limitation affects one-third of older adults; yet, the impact of shoulder dysfunction which effects roughly 20%, is inadequately documented. As arm swing is a fundamental component of ambulation, we investigated the cross-sectional association between shoulder range of motion (ROM) and walking endurance using time to walk 400m as quickly as possible and lower extremity performance using the expanded Short Physical Performance Battery (e-SPPB). Data are from 614 men (50.5%) and women aged ≥ 60 years (mean 71.8 ±8 years) in the Baltimore Longitudinal Study of Aging (BLSA) who performed bilateral shoulder elevation and/or bilateral shoulder external rotation (ER) during nurse-administered physical examination. We examined odds of poor 400m-walk and e-SPPB performance defined as the worst quartile associated with abnormal shoulder elevation (≤9%) relative to bilateral normal shoulder elevation and abnormal shoulder external rotation (≤5%) relative to bilateral normal shoulder external rotation (ER) in separate analyses. Analyses were adjusted for age, sex, weight and height. Adjusted odds (95% confidence interval) of poor 400m-walk performance associated with abnormal shoulder elevation (N=254) were 4.7 (1.1-19.5;p=0.035) and with abnormal shoulder ER (n=401) were 4.8 (1.4-16.7;p=0.010). Adjusted odds of poor e-SPPB performance associated with abnormal shoulder elevation (N=462) were 3.5 (1.6-7.7;p=0.002) and with abnormal shoulder ER (n=457) were 2.9 (1.1-7.4;p=0.030). Results suggest abnormal shoulder ROM is associated with poorer walking endurance capacity and lower-extremity functional performance in the relatively healthy older adults. Future research is warranted to develop novel screening paradigms that mitigate mobility limitation and functional decline in older adults with shoulder dysfunction.
CBOs’ Capacity and Resilience on Serving Older AA and NHPI Adults During the Pandemic
Authors: Lee Eun Jeong , Hara-Hubbard KeliAnne , Bishop Sonia , Lim Jae , Ko Linda
Published: December 2021

Community-based organizations (CBOs) are essential settings for older Asian American (AA) and Native Hawaiian Pacific Islander (NHPI) adults for accessing culturally and linguistically appropriate services and connecting with and support each other. This study examined the impact of the COVID-19 pandemic on CBOs’ ability to serve older AA & NHPI adults. This mixed methods study (survey and semi-structured interviews) used a sequential exploratory design. We recruited 65 leaders and staff members from 40 CBOs serving older AA & NHPI adults nationally. Descriptive analysis was conducted with the survey data followed by thematic analysis of the interview data. Many CBOs were impacted by the increased demands for services (80%) and created new services (75%) while experiencing programming disruption (69%), decreased staffing (55%), and loss of revenue (38%). Some CBOs temporarily closed their organizations (38%), while others closed permanently (3%). To remain in operation, many CBOs (65%) increased their online presence, hired staff (52%), and recurred to financial reserves (20%). The semi-structured interviews identified four themes: 1) CBOs resourcefulness to acquire and share resources, 2) technology as a connector for CBOs and an isolator for older adults, 3) heightened racial discrimination against Asians, and 4) emergence of multi-level resilience (personal/ community/organizational). CBOs experienced disruption in their operation, and heightened racial discrimination during the pandemic. Yet, CBO’s ability to remain resilient was critical to continue to provide key programs for older adults. Future studies may want to examine evolving needs of CBOs as they adjust to new public health challenges during the pandemic.
Effects of a Web-based Intervention on Cardiovascular and Physical Health of Korean Older Adults During the Pandemic
Authors: Kwon Soonhyung , Shin Oejin
Published: December 2021

During the lockdown, 97.5% of Korean senior centers in South Korea were closed to prevent the spread of the coronavirus disease 2019 (COVID-19). The threat of the COVID-19 presented the need for alternative interventions for Korean older adults to maintain cardiovascular and physical health. Korean senior centers implemented web-based interventions to provide physical health services, but their effectiveness was not yet assessed. Thus, our study aimed to identify the effects of a web-based intervention using a smartwatch and mobile app in older adults when compared to center-based intervention during the pandemic. This study collected 117 Korean older adults (≥ 60) who participated in the 12-week web-based and center-based physical interventions using a smartwatch and mobile app. This quasi-experimental study was conducted between August and December in 2020. We analyzed the pre-posttest of cardiovascular and physical health across two intervention types. Our regression results indicated that participants in the 12-week web-based intervention reported better cardiovascular (systolic blood pressure: b = -13.77, p < .001; cholesterol: b = -11.71, p < .05) and physical health (muscular function: b = 2.99, p < .001; body balance: b = -1.31, p < .001; cardiopulmonary endurance: b = 33.33, p < .001) than those in center-based intervention at posttest. The findings imply a web-based intervention is likely to become an innovative therapeutic strategy for older adults' health to respond to the rapidly changing social service systems amid the pandemic.
Generational Multimorbidity Disease Clusters for British Cohorts Born 1921 – 1960
Authors: Voll Stacey , Muniz-Terrera Graciela , Hofer Scott
Published: December 2021

The aim of this study is the first step in our understanding of the uniqueness and stability of multmorbdity disease patterns for different generations. The unique historical context that each generation has been exposed to is thought to have systemic health impacts and differences in epidemiological make-up (Clouston et al. 2021). Literature suggests that multimorbidity disease patterns, are similar across countries (Hernandez et al, 2021 – in press) and observational points, and that migration into complex disease clusters is more common as people age (Cassell et al, 2018, Kingston et al. 2018). Most commonly reported are Cardiovascular and Metabolic disease clusters which lead to lower quality of life, mortality and morbidity (Kudesia, 2021). We asked: Do multimorbidity disease patterns differ for unique generations? Using the ELSA, the disease clusters of three cohorts were examined; an older cohort, born 1921-1930, a middle cohort born 1931-1940 a younger cohort born 1941-1950 and the ”newest” cohort, born 1951-1960. Self-reported dementia and memory problems lead a specific cluster for the middle cohort, those born in 1931-1940, but not for the other cohorts. While disease patterns were different between sex for other clusters, the disease cluster of dementia and memory problems held similar disease patterns for males and females, with a prevalence of 3%. The dementia/memory problem cluster loaded with cardio/metabolic diseases. This suggests that complex multimorbidity for the British 1931-1940 cohort has had an impact related to dementia and memory problem diagnoses for this specific generation, for males and females alike.
How Lonely are Older Americans Act National Family Caregiver Support Program Participants?
Authors: Pendergrast Claire , Menne Heather
Published: December 2021

Older Americans Act (OAA) family caregiver services connect family members caring for older adults with a diversity of community-based resources and supports. Social isolation and loneliness are known public health threats, and family caregivers may face greater vulnerability to loneliness given the often-intensive time demands of care provision. Policy stakeholders and aging services providers are increasingly focused on combating loneliness among older adults and family caregivers. To inform efforts to reduce loneliness, we conducted descriptive analyses to identify characteristics of the participants in the OAA National Family Caregiver Support Program associated with higher rates of loneliness, measured with the 3-item UCLA Loneliness Scale. Using data from the 2019 National Survey of Older Americans Act Participants, we examined how caregiver loneliness varied based on caregiver age, gender, income, race and ethnicity, living alone, rurality, and self-reported health, as well as care recipients’ health status and difficulties with ADLs. Among our sample of 1,824 family caregivers, rates of loneliness were high overall (70%). Loneliness was significantly higher for caregivers with poor health (71.4%), incomes less than $20,000 (75.3%), living alone (75.4%), aged 65 or older (73.2%), Hispanic caregivers (82.2%) and caregivers for care recipients with 3 or more ADLs (76.0%). Findings underscore the importance of increasing social engagement opportunities for family caregivers. Policies and programs focused on reducing caregiver loneliness should be accessible to all family caregivers but should prioritize outreach and engagement for groups at higher risk of loneliness.
Racial disparities in hospitalization expenditures of older adults in Singapore
Authors: Chen Cynthia , Guo Xueying , Wee Hwee Lin , Tan Kelvin Bryan
Published: December 2021

The World Population Prospects 2019 reports that the proportion of people who aged 65 and above takes up 9 per cent globally in 2019, reaching up to 16 per cent by 2050. Asia has the fastest rise: from 1 in 9 people aged 65 and above to 1 in 4 in 2050. Rapid growth in older adults has strong implications for diseases and healthcare expenditure. For Singapore, the transition from ‘ageing society’ (7% seniors) in 1999 to ‘super-aged society’ (20% seniors) in 2026 is projected to take 27 years, much faster than Japan’s 36 years. We used the Singapore Multi-Ethnic Cohort (MEC) of 14,465 subjects aged 21 to 94, and the Future Elderly Model (FEM) microsimulation model to project disease burden and hospitalization expenditures to 2050. We found that Chinese females had the highest life expectancy of 86.0 years, followed by Indian and Malay females with 80.4 and 75.6 years respectively. In all racial groups, women lived longer than men by 5-7 years. Cumulative hospitalization expenditures of older adults aged 51+ was US$69,500 for Chinese, US$67,600 for Malays and US$86,100 for Indians; US$71,200 for males and US$70,700 for females. The increased hospitalization spending for all three ethnic groups was due to the underlying manifestation of chronic diseases, including diabetes, hypertension, heart disease and stroke. Variations in environmental risk factors such as diet, cigarette smoking and physical activity across ethnic groups may contribute to racial differences in chronic diseases and disability. Therefore, targeted interventions are needed to reduce racial disparities.
Relationship Quality Predicts Advance Care Planning Engagement In Families Experiencing Cognitive Decline
Authors: Bloom Rachel , Fisher Celia
Published: December 2021

Although clinical guidelines recommend that people showing signs of cognitive decline engage in Advance Care Planning (ACP) while they still have decision-making capacity, too often this opportunity to clarify values and treatment preferences is missed among patients and their families. In reflection of the paucity of empirical data on factors influencing how this planning process begins for families experiencing cognitive decline, this study explored facilitators and barriers to ACP among adult children of parents showing signs of early- to mid-stage dementia, with a particular focus on relationship quality. Among this sample (N = 315), relationship quality positively and significantly predicted advance care planning engagement (r = .349, p < .001). Financial burden weakly and positively predicted ACP engagement (r = .123, p <.05), while both psychological burden (-.614, p < .001) and financial burden (-.290, p < .001) negatively and significantly predicted relationship quality. This study validates the use of the ACP Engagement Survey (ACPES) adapted for surrogates among adult children of people experiencing cognitive decline and contributes to a scarce literature on the impact of relationship quality on ACP engagement.