bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal Analyses Indicate Bidirectional Associations Between Loneliness and Self-Rated Health in Adulthood
Authors: Finkel Deborah , Phillips Dianna , Reynolds Chandra
Published: December 2021

Loneliness is a potent stressor that increases in prevalence with age in late life and has been linked with numerous adverse physical health outcomes and lower scores on measures of self-rated health (SRH). The association between loneliness and SRH is likely bidirectional—for example, experiencing loneliness may result in physiological changes that alter how individuals perceive their health, and worsening perceptions of one’s own health or mobility may act in an increasingly restrictive manner with respect to social interaction. Despite this, limited longitudinal work has examined temporal dynamics between loneliness and SRH. Recently completed harmonization of 9 loneliness items across three longitudinal twin studies of aging in Sweden resulted in sample of 1939 participants aged 40 to 98 at intake (mean age = 74.64) with up to 25 years of follow-up (mean = 7.63) across up to 8 waves (mean = 3.29). Univariate analysis indicated that SRH decreased with age up to age 82 and then leveled off, whereas loneliness continued to increase across the age span. Bivariate dual change score models were used to examine lead-lag relationships across time: which variable contributes to subsequent changes in the other variable. Results indicated a bi-directional relationship: loneliness does not increase after age 82 when SRH is included in the model, and SRH does not level off after age 70 when loneliness is included in the model. Thus, declining SRH may lead to reduced participation in social activities and also feelings of loneliness may intensify perceptions of poor health.
A Pilot of a Sustainability-Extending Intervention in Canadian Nursing Homes
Authors: MacEachern Lauren , Song Yuting , Ginsburg Liane , Wagg Adrian , Hoben Matthias , Doupe Malcolm , Estabrooks Carole , Berta Whitney
Published: December 2021

Understanding of intervention sustainability processes is limited. Failure to sustain evidence-based innovations means that intended improvements are short-lived, scale-up and spread are unlikely, and real losses are incurred on research investments. We explored the sustainability of a health care aide (HCA)-led quality improvement (QI) initiative, Safer Care for Older Persons (in residential) Environments (SCOPE), that was implemented in long-term care homes (LTCHs) in Manitoba, Canada. Based on our understanding of factors influencing post-implementation sustainability processes, we developed and piloted a “low-dose” and “high-dose” “Booster” intervention to extend the two-year post-implementation period over which SCOPE was naturally sustained. Both versions of the “Booster” involved the following components: a HCA-led team with management support, a workshop to review SCOPE QI approaches and tools, a binder of QI resources, and supports from an experienced Quality Advisor (QA). We collected data from various sources to depict the most accurate account of QI sustainability and conducted thematic analysis to understand each team’s experience with sustainability processes. We used a qualitative assessment rubric to evaluate the impact of the “Booster” conditions on the teams’ performance against core SCOPE components. Our results suggest that the “Booster” served to establish more relaxed expectations and generally renew interest in LTCH QI initiatives. The calibre of management support was associated with teams’ performance and management support varied with the level of QA support. These pilot results will inform the next study phase, which examines longer-term sustainability of QI initiatives in LTCHs beyond the initial 2-year post-implementation period.
Analysis of 29 Items of the Meaningful Activity Participation Assessment-Meaningful Scale Through Rasch Analysis
Authors: Nam Sanghun , Bae Suyeong , Hong Ickpyo
Published: December 2021

Individuals find meaning in their personal activities. Meaningful activities can improve an individual's emotional and physical health and quality of life. The Meaningful Activity Participation Assessment-Meaningful Scale (MAPA-M), which can measure these meaningful activities, is measured in 29 items. In this study, the psychometric properties of 29 items of MAPA-M were investigated through Rasch analysis. The data used in this study was the Well Elderly Study 2 data among public data provided by the Inter-university Consortium for Political and Social Research (ICPSR). We used 480 randomized samples from the Well Elderly Study 2 data. Before proceeding with the Rasch analysis, as a result of checking the unidimensionality assumption of 29 items, 19 items satisfied the unidimensionality assumption. As a result of Rasch analysis of 19 items, the Driving item was removed as misfit (infit mean-square = 2.04, infit z-standardized fit statistics = 9.90, outfit mean-square = 1.86, outfit z-standardized fit statistics = 8.99). The 18 items with the misfit items removed show a conceptual item-difficulty hierarchy, and there was no differential item functioning that worked for sex and age groups. The person strata value is 3.97, which corresponds to the confidence value of 0.88. These results indicate that the 18 items in MAPA-M show appropriate item-level psychometric properties. In other words, the modified MAPA-M 18 indicates that meaningful activities can be accurately and stably measured.
Sleep, Activity, and Well-Being In Persons With Dementia: Findings From the Healthy Patterns Trial
Authors: Hodgson Nancy , Petrovsky Darina
Published: December 2021

Irregular sleep-wake patterns are common in persons living with dementia (PLWD), pose a great burden to caregivers, and are the principal causes of distress and institutionalization of PLWD. A growing body of research supports the importance of activity-based interventions to reduce the frequency and intensity of sleep wake disruption, reduce neuropsychiatric symptoms, and improve quality of life. To date, there are no studies linking sleep disruption and well-being with the nature and timing of activity. This session focuses on lessons learned from the Healthy Patterns Study - a randomized trial of a home-based activity intervention in 200 dyads of PLWD and their caregivers (NCT03682185). Session 1 focuses on the main findings from the clinical trial. Session 2 focuses on the cultural adaptation of the timed activity protocol to improve quality of life (QOL), improve sleep and reduce neuropsychiatric symptoms in older Latinos Session 3 describes the community outreach efforts used over a one-year period to recruit a diverse sample of PLWD and their caregivers for the Healthy Patterns trial. Session 4 examine the relationship between caregiver mastery and neuropsychiatric symptoms in PLWD. Together these findings highlight the complex role of sleep and wake activity in promoting well-being in persons with dementia.
Virtual Interdisciplinary Collaboration in Statewide Implementation of the MIND at Home Dementia Care Program
Authors: Johnston Deirdre , Bourquin Jennifer , Spliedt Morgan , Antonsdottir Inga , Stringer Cody , Smithroat Noemi , Reuland Melissa , Samus Quincy
Published: December 2021

MIND at Home, a well-researched holistic, family-centered dementia care coordination program, provides collaborative support to community-dwelling persons living with dementia (PLWD) and their informal care partners (CP). Through comprehensive home-based assessment of 13 memory-care domains covering PLWD and CPs, individualized care plans are created, implemented, monitored, and revised over the course of the illness. Non-clinical Memory Care Coordinators (MCCs) working with an interdisciplinary team provide education and coaching to PLWD and their identified CP, and serve as a critical liaison and resource and between families, medical professional, and formal and informal community resources. This paper will describe a statewide pilot implementation of the program within a health plan across diverse sites in Texas and will present qualitative and quantitative descriptions of a key component of the program's effective translation to practice, the virtual collaborative case-based learning sessions. Health plan teams completed online interactive training modules and an intensive in-person case-based training with the Johns Hopkins team prior to program launch, and then engaged in weekly, hour-long virtual collaborative sessions that included health plan teams (site-based field teams, health plan clinical supervisory and specialty personnel [RNs, pharmacists, a geriatric psychiatrist, behavioral health specialists] and Johns Hopkins MIND program experts and geriatric psychiatrists. To date, the program has enrolled 350 health plan members, conducted 65 virtual collaborative sessions, and provided 423 CME/CEU units to team members. We will provide an overview of virtual collaborative session structure, participant contributions and discussion topics, case complexity, as well as didactic learning topics covered.
The Impacts of the COVID-19 Pandemic on Family Caregivers' Care Work, Anxiety, and Loneliness
Authors: Parmar Jasneet , Anderson Sharon
Published: December 2021

Our study examined the effects of COVID-19 pandemic and public health measures on family caregivers (FCGs) of frail older adults; specifically, their care work, anxiety, and loneliness all of which are associated with decreased wellbeing. Approximately 604 FCGs completed the survey and findings evidenced COVID-19 creating two solitudes. First, 73% of FCGs for individuals living with them were providing significantly more care during COVID-19. Second, those caring for residents in congregate settings were unable to care. Both situations, community-dwelling and congregate care, increased FCG distress and decreased wellbeing. Anxiety significantly increased from 36% pre COVID-19 to 54% during COVID-19. Loneliness increased from 46% to 85%. FCGs report their mental (58%) and physical (48%) health deteriorated. The detrimental impact of the pandemic and public health measures on FCGs caring at home and in congregate care, and their related needs, need immediate attention from both the health and social systems of care.
Beyond the Lockdown Binary: Family Caregiver Needs for Creative Solutions During a Global Pandemic
Authors: McGhan Gwen , Flemons Kristin , McCaughey Deirdre , Hindmarch Whitney
Published: December 2021

As COVID-19 lockdowns began in Canada last spring, family caregivers (FCGs) of people living with dementia (PLWD) found themselves facing a catch-22: they and their family members were often most at risk of severe outcomes should they contract the virus, yet the public health measures put in place also detrimentally affected their ability to continue providing care. To understand the nuances of caregiver experiences during the pandemic, we conducted 9 focus groups with 19 FCGs of PLWD in the Calgary region in summer 2020. Caregivers reported negative outcomes resulting from decreased services for both themselves and the PLWD, including increased isolation, poor mental health, and accelerated dementia progression. Caregivers also emphasized the importance thinking beyond the binary of either locking down or opening up; rather, we must find creative solutions to safely continue providing supports to caregivers. This presentation explores FCG suggestions for balancing COVID-19 risk against caregiver needs.
Control Beliefs, Age, and Objectification Experiences in Younger and Older Women
Authors: Sherman Aurora
Published: December 2021

Control beliefs show age-related patterns; mastery decreases in adulthood, while constraints beliefs often increase. However, there is a great deal of individual variation. This paper addresses antecedents of control beliefs, with attention to experiences and beliefs related to sexual objectification, which have particular impact for women. In this study, younger women (N = 132, M = 20.93) and older women (N = 86, M = 67.83) were surveyed regarding their experiences with sexual objectification and constraints beliefs. Multiple regression analyses revealed higher self-objectification was associated with higher constraints (R2 = .09**) and lower mastery (R2 = .11**) but reports of body evaluation and sexual advances were not associated with control beliefs. Further, there were no interactions of either objectification scale with age. These results suggest that objectification may be an important part of the aging experience across the life course, not just in young adulthood.
Older Adults’ Perceptions of Smart City Initiatives to Age in Community
Authors: Kim Jongwoong
Published: December 2021

This project explores older American adults’ perceptions of smart city initiatives for them to “age in community” particularly in the northeast region. As the U.S. population is aging, it is imperative that the American cities can support their citizens to live in their preferred community environments for as long as they want. While there are many definitions of a smart city, some exemplary smarty city initiatives can be characterized as actively utilizing information and sensor technologies to promote efficiency and sustainability of city-wide systems, ultimately enhancing the quality of citizens' life. This project examines, in particular, seven smart city initiatives that are implemented globally: smart streetlights, health and fall monitoring system, community ridesharing, enhanced CCTVs, "age-friendly map," contact tracing app, and smart traffic system. By surveying those age 55 and older, with a representative sampling from the nine states in the northeast region, this project found that the vast majority of older Americans in this region would prefer to age in rural and suburban communities, and depending on where they prefer to age in (rural-exurban-suburban communities vs. urban-urban center communities) and gender (female vs. male), they perceive particular sets of smart city initiatives as more important for them to age in community. Furthermore, regardless of the community/location preference and demographic (gender, income level, and age) differences, 40% of the respondents expressed no concern of data or information privacy issues from these initiatives, opening some doors for the municipalities that plan to adopt some of these initiatives in the near future.
Age-Related Neuroprotection by Dietary Restriction Requires OXR1-Mediated Retromer Function
Authors: Wilson Kenneth , Bar Sudipta , Brownridge George , Beck Jennifer , Brem Rachel , Bellen Hugo , Ellerby Lisa , Kapahi Pankaj
Published: December 2021

Dietary restriction (DR) is the most robust method to delay aging and the onset of neurogenerative disorders across multiple species, though the mechanisms behind this phenomenon remain unknown. To elucidate how DR mediates lifespan extension, we analyzed natural genetic variants that associate with increased longevity under DR conditions in the Drosophila Genetic Reference Panel. We found that neuronal expression of the fly homolog of human Oxidation Resistance 1 (OXR1) is necessary for DR-mediated lifespan extension. Neuronal knockdown of OXR1 also accelerated visual decline but not physical decline, arguing for a specific role of OXR1 in neuronal signaling. Further, we find that overexpression of the TLDc domain from human OXR1 is sufficient for lifespan extension in a diet-dependent manner. Studies from the Accelerating Medicines Partnership - Alzheimer's Disease network show that patients with reduced OXR1 protein levels are more prone to Alzheimer's disease diagnosis, and we find that overexpression of human OXR1 is protective in animal and cell Alzheimer's models. In seeking the mechanism by which OXR1 protects against age-related neuronal decline, we discovered that it provides a necessary function in regulating the neuronal retromer complex, which is essential for the recycling of transmembrane receptors and for maintenance of autophagy. We further discovered that OXR1 deficiency can be rescued by genetic or pharmacological enhancement of retromer function, and that this enhancement extends lifespan and healthspan. Understanding how OXR1 operates could help uncover novel mechanisms to slow neurodegeneration including Alzheimer's disease.
Cultural Consistency in Late-Life Declines in Positive Personality Traits
Authors: Chopik William
Published: December 2021

Personality has elements of both stability and change across the adult lifespan. There has also been evidence for terminal decline—late-life decreases in positive psychological characteristics. However, many of these studies have examined these patterns in primarily Western populations. The current study examined the consistency of age differences in positive personality traits (i.e., character strengths) across cultures. I examined 2,895,051 participants ranging in age from 13 to 100 (Mage = 34.31; 65.3% women) from 90 different countries. I reproduced patterns of terminal decline across cultures. In addition to mean differences between cultures (e.g., focusing on the present is associated with more positive traits [Mr = .45]), cultural characteristics often moderated the effects of age on positive personality traits. For example, terminal decline was more dramatic among people from collectivistic cultures and flatter among people from individualistic cultures. Results will be discussed in the context of cultural variation developmental processes.
Association of Frailty and Suicide in Adults 65 Years and Older
Authors: Kuffel Randall , Morin Ruth , Covinsky Kenneth , Boscardin John , Li Yixia , Byers Amy
Published: December 2021

Nearly 10,000 adults aged 65 years and older die by suicide in US annually. Although prior studies have linked individual diagnostic factors to late-life suicide risk, to our knowledge none have examined how accumulated health burden affects suicide risk. Such a metric could be studied utilizing a frailty index (FI). Our primary study objective was to determine the relationship of FI to risk of suicide. We examined a longitudinal cohort of 2,858,876 veterans 65 years and older from fiscal year 2012-2013 (baseline) through 12/31/2017, linking the VA’s suicide and mortality databases with medical record data. FI was defined by 31 variables, including morbidity, function, cognition, mood, sensory loss, chronic pain, and failure to thrive. We used Fine-Gray proportional hazards regression to examine time to suicide attempt (fatal and non-fatal). Our sample’s average age was 75 (SD 8), 88% White, 9% Black, and 98% male. Thirty-seven percent of veterans were non-frail, 30% were pre-frail, 17% mildly frail, 9% moderately frail, and 7% severely frail. Over the course of the study, 9,043 veterans had a documented suicide attempt with >60% fatal. After adjusting for race, gender, region, substance use disorder, and PTSD, risk of suicide attempt increased across frailty categories: Hazard ratios increased from 1.37 (95%CI: 1.30-1.45) for pre-frail individuals to 1.57 (1.43-1.72) for severely frail individuals. We found similar results after further adjustment for the Charlson Comorbidity Index, suggesting cumulative deficit FI may be a strong prognostic marker for risk of suicide in adults over 65; informing late-life suicide prevention efforts.
An Evaluation of Social Bridging and Bonding Mechanisms in the Association of Social Networks and Cognitive Function
Authors: Peng Siyun , Perry Brea , Roth Adam , Coleman Max , Sheean Hope
Published: December 2021

Background and Objectives: Substantial evidence links social connectedness prospectively to cognitive aging outcomes, but there is little agreement about the social processes or mechanisms that drive this relationship. This study evaluated nine measures of social connectedness, focusing on two distinct forms of social enrichment – access to an expansive and diverse set of loosely connected individuals (i.e., social bridging) and integration in a supportive network of close ties (i.e., social bonding). Research Design and Methods: This study used egocentric social network and clinical cognitive data from 311 older adults in the first wave of the Social Networks in Alzheimer Disease (SNAD) study. Linear regressions adjusting for gender, age, education, and depression symptoms were used to estimate the association between nine measures of social connectedness and global cognitive function, verbal memory, and attention. Results: Measures indicative of social bridging (larger network size, lower density, presence of weak ties, and proportion non-kin) were consistently associated with better cognitive outcomes, while measures of social bonding largely produced null effects. Discussion and Implications: These findings suggest that the protective benefits of social connectedness for cognitive function and memory may operate primarily through a cognitive reserve mechanism that is driven by irregular contact with a larger and more diverse group of peripheral others. Population-level interventions that promote the cultivation of social bridging relationships and activities may have benefits for cognition later in life.
Positive and Negative Affect Mediate the Relationship Between Memory Lapses and Life Satisfaction
Authors: Turner Jennifer , Mogle Jacqueline , Hill Nikki , Bharhava Sakshi , Rabin Laura
Published: December 2021

Aging is associated with declines and challenges, yet better subjective well-being. Life satisfaction is one aspect of well-being that may be sensitive to daily challenges. Daily memory lapses (e.g., forgetting words or meetings) are common and relevant for many adults. How individuals emotionally respond to challenges like memory lapses is a factor that could determine whether these experiences affect well-being. In a coordinated analysis of two datasets (N=561; ages 25-93 years) using multilevel modeling, we examined whether affective changes related to memory lapses mediated the relationship between memory lapses and life satisfaction. Results were similar across datasets: memory lapses were associated with reduced positive affect and increased negative affect. These associated affective changes also mediated the relationship between lapses and life satisfaction. We discuss the potential implications of our findings for linking proximal events and distal outcomes, and potentially intervening and identifying common challenges to mitigate broad reductions in well-being.
Novel Positional Candidate Gene for Gait Speed Change in Older Adults: The Long Life Family Study
Authors: Santanasto Adam , Wojczynski Mary , Cvejkus Ryan , Thyagarajan Bharat , Christensen Kaare , Schupf Nicole , Daw E Warwick , Zmuda Joseph
Published: December 2021

Gait speed is a heritable, robust predictor of longevity in older adults. Using genome-wide linkage analysis in 2379 individuals from 509 families (64±12 years; 45% men), we identified a locus on chromosome 16p linked to gait speed change over 7±1 years (logarithm of the odds score [LOD]=4.2). Gait speed change was calculated using a two-stage growth curve mixed-model. DNA sequencing was completed to identify single nucleotide variants (SNVs) in the linkage region. Association analyses between the 24039 SNVs in the ~1.6mBP region (3.7-5.3mBP) and gait speed change were performed adjusting for age, age2, sex, height, field center, familial relatedness and population substructure. Eleven families (188 individuals) accounted for most of the linkage signal (LOD=6.06). Associations between SNVs flanking the Mesothelin (MSLN) gene and gait speed change were identified (lead SNV rs56850119: β = -0.5±0.1, p = 6.4*10-7). Thus, MSLN is a potential positional candidate gene for mobility decline with aging.
Physical and Mental Health, Technology Use, and Loneliness in Older Adults During the COVID-19 Pandemic
Authors: DiMaria-Ghalili Rose Ann , Coates Martha , Hathaway Zachary , Moore Katelyn , Park Yaegin , Tsui Jenny , Sefcik Justine
Published: December 2021

Social isolation is a negative outcome of COVID-19. This study examined patterns of physical and mental health and technology use in older adults, and loneliness during the COVID-19 pandemic. We recruited 115 community-dwelling older adults 65 and older (72% female) from the Pennsylvania region via Research Match (N=84) or from a retirement community (N=31). A significant association between loneliness and worsening of health during the pandemic was observed, Fisher’s Exact Test 6.90, p=.03. Those who were lonely demonstrated significantly lower Mental Component Summary Scores (M = 42.75, SD = 11.55) compared to those who were not lonely (M= 55.34, SD= 7.66), t(49) = 5.84, p <.01. Those reporting loneliness were more likely to use a new electronic device to communicate with family during COVID-19 pandemic, X2, (1, N= 107) = 6.24, p =.01. These findings suggest the important role of technology to decrease loneliness in older adults during a pandemic.
Disparity on Online Patient-Provider Communication and Implications for a Post-COVID Era
Authors: Huh-Yoo Jina , LeVasseur Michael , Coates Martha , Sefcik Justine , DiMaria-Ghalili Rose Ann
Published: December 2021

Online patient-provider communication (OPPC) increases access to health-related information, enhances self-care, and reduces healthcare expenditures. We investigated OPPC and technology use changes during 6 years. This descriptive cohort analysis involved data collected from the National Health and Aging Trends Study (NHATS) between 2011-2016 and during the pandemic (2020). NHATS consist of a nationally representative sample of Medicare beneficiaries. From a total of N=2,389, we assigned cohorts as those who: (1) own computers (High-Tech, 56.1%), (2) own cell phone only or don’t own computer nor cell phones (Low-Tech, 20.2%), and (3) just adopted cell phone or computers (Transition, 23.7%). Only the High-Tech users increased OPPC by 75% over 2011-2016; others remained the same. During the pandemic more participants used mobile technology and internet. Newly adopting technology on its own does not automatically increase OPPC. It is important for Transition users to access training and support to benefit from OPPC.
The Impact and Response to Climate Change as Lived by Older Adults
Authors: Fenley Robin , Antonucci Toni , Fenley Robin
Published: December 2021

A growing body of literature documents the domino effects of climate change on the planet and all life. Chief among these changes is the rise in global temperatures, triggering record numbers of heatwaves, and stronger, more dangerous hydrologic events. While climate change looms as a preeminent threat to our planet and future, the public health and human rights ramifications are already apparent. As with many issues in this realm, the effects are felt to a greater degree by our aging populations. As disasters grow in frequency, the more vulnerable populations are at greater risk for more serious outcomes – and will suffer disproportionately from the effects of climate change – resulting in greater inequalities. With the consequences of climate change growing more drastic, these outcomes can be expected to climb unless sufficient measures are enacted to combat global warming. In this symposium we will highlight the link between climate change and its impact on the human rights of older adults, and how climate change threatens progress across the Sustainable Development Goals (SDG) - a blueprint for a more equitable and healthier planet - if decisive actions are not taken. This symposium will demonstrate what valuable opportunities exist to accelerate progress by leveraging the links between SDGs to combat inequalities and climate change. Panelists will discuss the adverse effects of climate change, the human rights and psychological impacts on older adults, and potential action steps and strategies for older persons to become empowered as advocates for climate change reform.
Pain Assessment and Documentation for Older Adults Presenting with Non-surgical Conditions in Emergency Room
Authors: Haque Raza , Bezerko Mara , Tibbits Lauren , Tate Karen
Published: December 2021

Pain is one of the most common reasons for Emergency Department (ED) visits among older adults. However, timely pain assessment and management in this population in ED is a challenging task due to many factors ranging from; sensory, cognitive impairments, chronic pain, reliability of assessment tools, multimorbidity and system factors such as triage-based dynamic ED workflow. Where the implementation of the EMR was anticipated to improve patientcare, literature has indicated the barriers in effective utilization of the EMR for this purpose. We posit that pain assessment and documentation could be variable among older adults presenting with non-surgical conditions. Objectives:1. To examine the proportion of documented initial pain assessment of nonsurgical older adults visiting emergency department 2. To examine the number of initial pain assessments documented in the chart by the five major categories of ICD-10 diagnoses upon discharge. Methods: A retrospective exploratory chart review of 4613 emergency room visits for first pain assessment in the EMR conducted for all adults 65 years or older, presenting with non-surgical conditions, who were discharged same day at an urban teaching hospital. Results: In our study 75.72% of encounters reviewed had a documented pain assessment. Completed pain assessments for the corresponding five most common non-surgical diagnostic categories presenting to our ED: Abdominal pain (92.59%), MSK (92.11 %), chest pain (83.92%), dyspnea (80%) and falls (79.46%). Conclusion: Frequency of pain assessment and the management process of older adults presenting with non-surgical conditions in the institution studied was variable and differed based on presenting conditions.
An Aging Nursing Workforce: Thematic Analysis from the Nurstory Project
Authors: LeBlanc Raeann
Published: December 2021

Background: Nursing in the United States of America is an aging workforce. This study sought to better understand the lived experience of aging nurses. Because nurses work in systems where other forms of interpersonal power dynamics may influence internalized and external stereotype an approach based on intersectional theory was applied. Methods: A qualitative thematic narrative analysis of an existing data set of first-person digital stories in the Nurstory project, authored by a group of nurses, was the data source. An emergent coding method was applied. The collection of five digital stories were analyzed. Results: All stories were first person accounts of experiences that represented their internalized reflections and elements of ageism in how their age interacted with their work environment. Dominant themes included: 1) Role constriction 2) Strength 3) Tired and (re)Tired 4) Age perceived and 5)Loneliness. Conclusions: These aging nursing stories add to the contextual layers of the aging healthcare workplace and aging nursing workforce. These individual experiences offer a nuanced understanding of the internalized responses to aging and ageism. These stories highlight socially constructed and socially reinforced attitudes that are complicated by the personal and occupational expectations of nurse’s work, their role and embedded hierarchies in healthcare. Stories such as these are important individual and collective indicators of lived experiences that offer a deeper understanding into the intersections of social identity and aging, that when listened to, can offer insight and a way forward in addressing the stereotype, discrimination and social inequities of ageism.
Self-Perceptions of Aging Among Dementia Caregivers: Evidence from the UK Protect Study
Authors: Turner Shelbie , Sabatini Serena , Brooker Helen , Corbett Anne , Hampshire Adam
Published: December 2021

Contact with older adults impact the perceptions people have towards their own aging self (Jarrott & Savla, 2015) and how they prepare for their own age-related change (Kornadt et al., 2015). Caregivers have close, intimate contact with older adults, yet no research explores how that contact may impact caregivers’ perceptions of their own aging. In this exploratory study, we compare perceptions of one’s own aging between current and previous formal caregivers, non-formal caregivers, and never-caregivers. We utilized data from 1978 informal caregivers, 247 formal caregivers, and 5586 never-caregivers of the 2019 wave of the UK Protect Study. We conducted ANCOVA tests to compare global levels of Awareness of Age-Related Change (AARC) gains and losses, AARC gains and losses specific to cognition, attitudes towards one’s own aging, and felt age across the three subgroups of participants with different caregiving roles. Omnibus results suggested that there were significant group differences (p<.05) in global levels of AARC gains and losses, AARC gains specific to cognition, and attitudes towards one’s own aging (p<.05) for female, but not male, caregivers. However, effect sizes were either small or negligible. Therefore, despite frequent contact with older adults, dementia caregivers may not have better or worse self-perceptions of aging than non-caregivers. Such findings may be reflective of intergenerational ambivalence, and future work should consider how the nature of the caregiving situation (i.e. relationship quality, intensity of the care, caregiver burden) shapes caregivers’ perceptions of their own aging, especially over time as caregivers navigate their own aging processes.
Changes in the Use of Intensive and Supportive Care with Heart Failure in the Last Month of Life Between 2001 and 2013
Authors: Chou Piling , Lin Peichao
Published: December 2021

Background: Heart failure (HF) is a global epidemic affecting the elder globally. It is uncertain what care patients with heart failure receive at their end of life and what care trends are in the last month of life. OBJECTIVES: This study's objective was to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with heart failure in their last month of life during 2001-2013. METHODS: Analysis of claims data of 25,375 patients with heart failure obtained from the National Health Insurance Research Database was performed to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with heart failure in their last month of life during 2001-2013. RESULTS: Over the whole study period, 53.3% of patients with heart failure were admitted to intensive care units in their last month of life. The percentages of patients receiving mechanical ventilation (54.3%-41.5%), cardiopulmonary resuscitation (41.5%-16.7%), decreased over time. The percentages of patients receiving artificial hydration and nutrition (52.5.9%-56.8%) and extracorporeal membrane oxygenation(ECMO) (0.52%-1.78%) increased over time. Patients under 75 years old were more likely to be admitted to intensive care units. CONCLUSION: Over time, supportive procedures increased, and intensive procedures decreased in patients with heart failure in the last month of life. This study highlights a need for research, guidelines, and training in how to provide palliative care for end-stage patients with heart failure.
Hypertension Diagnosis, Treatment, and Control among Older Chinese: Trends in the Hypertension Care Cascade
Authors: Zhao Erfei , Wu Qiao , Crimmins Eileen , Zhang Yuan
Published: December 2021

Hypertension is a major risk factor for cardiovascular disease, which is the leading cause of death in China. Older persons are at higher risk of elevated blood pressure and are more likely to have insufficient hypertension care, including delayed diagnosis and poor management. However, we know little about hypertension care among older Chinese at a population level. We use a nationally representative sample of older adults from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015 (n = 9,083), to clarify the hypertension care cascade for the older population in China by specifying the level of diagnosis, treatment, and control of hypertension. We then examine the characteristics of those (1) who received appropriate hypertension care and (2) whose care improved over time. Diagnosis and care improved between 2011 and 2015. Among those with hypertension, 55% and 67% were diagnosed in 2011 and 2015 respectively; 46% and 60% were treated with modern medication; and 20% and 29% were effectively controlled. Those who had higher income (OR=1.52; P<0.01) or obese (OR=2.43; P<0.001) were relatively more likely to be diagnosed, while those living in the western region (OR=0.65; P<0.01) or living in urban areas with a rural hukou (OR=0.54; P<0.01) were less likely. Persons age 75+ (OR=0.55; P<0.05) were less likely to have their blood pressure controlled, while those who had higher income (OR=1.50; P<0.05) were more likely. The improvement from 2011 to 2015 in hypertension care was concentrated among those that are obese or living in the West.
Associations Between Meal Program Participation and Protein Intake in People Over 65 (NHANES 2013-2018)
Authors: Collins Sarah , Blanco Robert , Hines Anika
Published: December 2021

Protein plays a critical role in healthy aging. Little research exists regarding the association between meal program participation and protein consumption among individuals 65 and older. The objective of this research is to provide health professionals with a better understanding of how meal program participation through delivery services or congregate sites may relate to nutritional status. We analyzed cross-sectional data on 2845 individuals ≥65 years old who participated in the National Health and Nutrition Examination Survey (NHANES) during 2013-2018. Using linear regression models, we explored relationships between meal participation and covariates ( sex, race, marital status, income, and age) on protein intake. Protein intake did not differ significantly between individuals who participated in meal programs and those who did not. However, among individuals who answered whether or not they participated in meal programs, race was significantly associated with decreased protein intake. Non-Hispanic Blacks experienced a two-day average 8.82 grams lower [SE:1.48; p<.0001] that their white counterparts. Similarly, Hispanic/Latinos’ two-day protein average was 4.29 grams lower [SE:2.05; p=0.0426]. The association between earning an income of <$20,000 per year and protein intake was also statistically significant [β: -8.44. SE:2.4, p=0.0014]. Understanding protein intake among older adults who utilize meal programs is a gap in current literature. Results from this research may inform questions that health professionals should include in their assessments of older adults and provide guidance for nutrition policies and meal programs for people over 65.
Hearing Loss and Health Care Seeking
Authors: Reed Nicholas
Published: December 2021

Hearing loss is common among older adults. Hearing loss is associated with increased health care expenditures, risk of 30-day readmission, and longer length of hospital stay. However, little is known about behaviors and attitudes in seeking care. In this cross-sectional analysis, we examined data from the 2016 Medicare Current Beneficiary Survey (MCBS) datasets. Participants are asked to describe their self-perceived trouble hearing. Health care seeking attitudes were assessed on all study participants in 2016 via self-report avoidance or delay of care, personal health concerns, and sharing health status. Multivariate regression models adjusted for demographic/socioeconomic characteristics and general health determinants were used to explore the association between trouble hearing and outcomes. In the 2016 MCBS, 12,140 Medicare beneficiaries, representing 51 million with survey weights, answered questions on help-seeking attitudes. In the sample, 55.6% reported no trouble hearing, while 38.8% and 5.5% reported a little trouble and a lot of trouble hearing, respectively. Those with a lot of trouble hearing were more likely to report avoiding doctors (Odds Ratio [OR] = 1.35; 95% Confidence Interval [CI] = 1.09 – 1.67) and delaying care (OR = 1.47; 95% CI = 1.19 – 1.82). However, no differences were found in personal health concerns or willingness to share health status with others. Poorer health care seeking behaviors may help explain higher costs associated with hearing loss as avoidance of care can exacerbate health problems. Further work is needed to understand underlying reasons and whether addressing hearing loss modifies the observed association.
Remote Delivery of Virtual Reality Patient Simulations for Nursing Education
Authors: Hannans Jaime
Published: December 2021

In the midst of rapid transfers to online teaching for experiential learning opportunities in nursing clinical labs this past spring due to the pandemic, nursing simulations with immersive virtual reality (VR) in VR headsets were deemed impossible. In partnership with Embodied Labs, nursing faculty pivoted to facilitating VR using remote learning approaches in groups. In this new VR approach nursing students engaged in active learning, critical discourse, and reflection guided by faculty delivered VR scenarios remotely with in-session debriefing during discussion pause points. Complex scenarios focused on patient or family perspectives (e.g. during end-of-life care or navigating community and healthcare needs as a LGBTQ individual). These were valuable online learning opportunities for undergraduate nursing education. Student feedback was positive, and faculty perceptions indicated using VR remote learning offers rich, engaging discussion through complex topics important to nursing clinical practice.
Geographic distribution of availability of adult day services in Missouri
Authors: Amano Takashi , Chun Yung , Park Sojung , Wang Yi
Published: December 2021

Adult day service (ADS) is an important component of long-term supportive services. Geographic availability of ADS is an essential factor for aging in place especially for people with assistance needs. This study aims to examine the geographic distribution of availability of ADS and its relationship with the disadvantaged characteristics of neighborhoods. Data from the Missouri Department of Health and Senior Services and the American Community Survey were utilized. Geographic availability of ADS was measured as capacity (number of clients served) of ADS centers per week divided by the number of people who were 65 or older and under poverty at the census tract level. To examine neighborhood disadvantaged characteristics, principal component analysis was applied to construct a socioeconomic deprivation index (SDI). Using geographic information systems, we mapped ADS centers, geographic availability of ADS, and SDI scores. Pearson correlation coefficient was calculated between geographic availability of ADS and SDI scores. In 92.3% of the census tracts in Missouri, ADS centers are not available. Further, ADS centers are less likely to locate in rural areas or census tracts with higher numbers of residents 65 or older and poor. Also, lower availability of ADS was associated with higher levels of neighborhood disadvantage at a marginal level (r = - 0.163). Our findings suggested that strategies should be identified to provide ADS in rural areas, especially in the areas with higher levels of neighborhood disadvantage. Further investigation on the geographic distribution of ADS accessibility and its association with neighborhood characteristics is warranted.
Healthcare Disparity and Comorbidity Burden in Heart Failure Patients Over the Age of 80
Authors: Blach Anna , Pangle Amanda , Wei Jeanne , Azhar Gohar
Published: December 2021

The healthcare industry is currently struggling with providing access and coverage for a rapidly ageing and increasingly diverse population with multiple co-morbid conditions. This retrospective study analyzed the electronic health records of elderly heart failure patients (age range 80-103; mean 87 ±4.9) for common co-morbid conditions of hypertension, hyperlipidemia, dementia and diabetes mellitus. Chart review analysis of 316 patients showed a racial distribution of 251 White vs. 65 Black patients (79% vs. 21%). Male patients were under-represented (B= 13.8% and W= 26.3%). Females patients predominated (B= 86.2% and W= 73.7%). Overall, the prevalence of all four comorbidities was approximately three times higher in Blacks (18.5%) vs. White (7.2%). The proportion of Blacks and Whites with HTN and was comparable at 98.5 and 92.4% respectively. Hyperlipidemia was present in 84.6% Black and 63.3% White. The diagnosis of diabetes was higher in Blacks, 41.5% compared to Whites, 21.9%. The greatest disparity was in the diagnosis of dementia which was higher in Blacks, 61.5% vs Whites, 44.6%. Our study is unique for studying healthcare disparity in octogenarian and nonagenarian residing in a rural setting. Our results also highlight the importance of making a special effort to engage older Black patients in seeking healthcare in addition to designing strategies to reduce barriers that impede access and availability of resources and clinical care, especially in economically underserved regions of the country.
Development & Testing of a Comprehensive Digital Self-Care Support System for Older Adults With Chronic Conditions
Authors: Nambisan Priya , Stange Kurt , Lyytinen Kalle , Kahana Eva , Duthie Edmund , Potnek Michael
Published: December 2021

This 3-phase study involves the conceptualization and design, development and usability testing of a Comprehensive Digital Self-care Support System (CDSSS) named myHESTIA for older adults with multiple chronic conditions (MCC). The objective of this study was to test whether a CDSSS can be developed for those who are dealing with MCC and whether such a system that is specifically developed for older adult patients will enable daily capture of self-care data. Participants for this 3-phase study included: 10 older adults (age>60) and 10 caregivers in Phase 1; 15 Geriatrics clinicians and 25 community-dwelling low-income older adults in Phase 2; and, 10 older adults (age>60) with MCC in Phase 3. Agile method of system development was used for the design and development of the system. The first two phases involved collecting data for designing and developing myHESTIA. The third phase involved small group usability and feasibility testing, in which the participants used myHESTIA trackers for 4 weeks. Results from phase 3 shows daily inputs were possible and the self-reported data shows that it was not at all difficult for older adults to track their symptoms daily. User experience data (n=10) shows overall positive experience along pragmatic (5.8 out of 7), hedonic (4.6 out of 7), sociability (5.5 out of 7) and usability (6.3 out of 7) experience dimensions. Finally, all the participants (n=10) who completed the phase 3 study reported intention to continue using myHESTIA. Results indicate that it is feasible to design a CDSSS for older adults with MCC.