bluuebunny/crossref_metadata_2025 huggingface dataset:
Do State Agency on Aging Strategic Plans Include Terms Related to Malnutrition?
Authors: Arensberg Mary Beth , Gahche Jaime , Dwyer Johanna
Published: December 2021

Demand for federal nutrition assistance programs is increasing as the older population grows and further accelerated with the COVID-19 pandemic. Older adult nutrition programs are based on federal nutrition guidelines that have traditionally focused on healthy populations, yet many older adults have multiple chronic conditions/advanced age. Some guidelines are changing; the 2020 Dietary Guidelines for Americans recognize older adults’ risk for malnutrition and also need for adequate protein to prevent lean muscle loss with age. The 2020 Older Americans Act (OAA) reauthorization included reduction of malnutrition in OAA’s official purpose and added program participant screening for malnutrition. The OAA requires State Agencies on Aging submit multiyear strategic plans to receive program funding, but it is unknown how the plans address risks for malnutrition, including overweight, underweight, and muscle loss (sarcopenia/frailty). We searched 51 State Agency on Aging strategic plans posted at advancingstates.org to determine their frequency of mentioning nutrition, malnutrition/underweight/undernutrition, obesity/overweight, frail/frailty, sarcopenia, and dietary supplements/oral nutrition supplements (DS/ONS)/meal replacements. Every state plan included nutrition but less than a third included malnutrition. There was wide variability in how nutrition and malnutrition were incorporated into state goals and strategies. Very few plans included obesity, frailty, and DS/ONS terms; none included sarcopenia. Although there has been some movement, there is need for many State Agencies on Aging plans to address all aspects of malnutrition including overweight, underweight/other factors related to muscle loss (sarcopenia/frailty) that adversely impact healthy aging. Wide disparities in plan structure/use of terms create opportunities for more common approaches/definitions.
Rural/Urban Differences in Sleep Disorders Among Older Adults in Ghana
Authors: Oladimeji Abolade
Published: December 2021

Sleep plays a significant role in the maintenance of the body, and experiences of sleep disorders may have adverse health outcomes on older adults. While a substantial number of studies have documented rural and urban differences in sleep quality and duration, none has examined rural/urban differences in sleep disorders among older adults in Ghana. The analytical sample included 2,142 older adults (65 years and above) who are part of the cross-national study of the Research on Early Life and Aging Trends and Effects (RELATE) conducted in Ghana in 2007 (µage = 74, female 54%). The analysis was based on multivariate logistic regression in predicting the odds of experiencing sleep difficulty among older adults and how this may differ based on rural/urban residence. Results reveal that net of other factors, older adults in rural Ghana are more likely to experience sleep disorders than their urban counterparts (OR=1.29, P<.05). Possession of Jewelry in Africa is a symbol of higher social status, the result shows that net of other factors, those who own jewelry are more likely to experience sleep disorder than those who do not possess jewelry (OR=1.69, P<.001), those who are obese show greater odds of sleep disorder than those with normal weight (OR=1.59, P<.01). Other significant differences were education, self-rated health, and feeling of happiness. These findings show that causal factors of sleep disorder among older adults are multifactorial and their underlying mechanisms may vary by geography(rural/urban)
Racial/ Ethnic and Gender Differences in Older Adults’ Chronic Stress Patterns
Authors: Wang Kun , Suntai Zainab
Published: December 2021

Chronic stress has been associated with several adverse psychological, physical, and cognitive outcomes. While there exists a baseline level of stress among all individuals, certain groups of people are at risk of developing chronic stress due to existing hardships and stressors. Black Indigenous and/or people of color (BIPOC) and women have historically experienced several inequities including higher rates of certain chronic illnesses, interpersonal discrimination, socioeconomic disparities, and several other adverse outcomes. In addition to stressors from racial/ethnic and gender identities, older adulthood is a major transitional period marked by changes in physical, emotional, and cognitive well-being, which have been shown to affect overall well-being and mental health. As such, this study aimed to examine the association between chronic stress and cognition among older adults, using the intersectionality of race and sex. Data from the 2016 Health and Retirement Study were used, resulting in a final sample of 6,015 adults aged 50 and older. Latent class analysis was used to determine chronic stress patterns by sex and race, and a three-step method was used to examine the effects of covariates on stress class memberships by race and sex subgroups. Results indicated that compared to White men, the high stress classes among White women, BIPOC men and BIPOC women contained more stressors. Interventions targeted towards the mitigation of chronic stress among older adults should consider how intersectional identities combine to create increased hardships and stressors.
Area Deprivation Share: A New Measure of Social Need Faced by Hospitals Serving Older Adults
Authors: Hansmann Kellia , Powell Ryan , Kind Amy
Published: December 2021

Medicare’s Hospital Readmissions Reduction Program (HRRP) places disproportionate penalties on hospitals serving populations with complex medical and social needs. Without measures to identify the social need intensity of populations cared for by these hospitals, the HRRP cannot account for these risk factors, leading to burdensome penalties that may inadvertently hinder the ability of such hospitals to care for vulnerable populations. The objective of this study is to characterize the social need intensity of US hospital acute care populations. Using the Area Deprivation Index (ADI), a validated measure that ranks neighborhood socioeconomic disadvantage based on income, employment, housing, and education factors, we determined an “Area Deprivation Share” (ADS) for hospitals with 25 or more discharges using 100% of national Medicare claims data from 2013-2014. Hospital ADS is the proportion of qualifying discharges residing in the most disadvantaged neighborhoods (ADI ≥ 80th percentile) out of all qualifying discharges during the study period. Of 4,603 hospitals, median ADS was 17% (Interquartile Range: 6% - 34%). Hospitals in the highest quintile of ADS (39% to 100%), were more frequently located in small towns or isolated rural areas (52.6%, comparted to 24.2% in lower quintiles) and served a higher percentage of Black patients (19.0%, comparted to 9.7% in lower quintiles). ADS is a potential tool to inform future Medicare policy decisions. Additional research will inform how hospitals target care processes to meet the needs of older adults with complex social needs. Further study can also explore overlapping disadvantage domains of socioeconomic status, race, and rurality.
Association of Home Based Primary Care Enrollment with Social Determinants of Health for Older Veterans
Authors: Montano Anna-Rae , Ge Augustus , Halladay Christopher , Edwards Samuel , Rudolph James , Cornell Portia
Published: December 2021

The Veterans Administration (VA) Home-based Primary Care (HBPC) program provides comprehensive primary care to older Veterans with multiple chronic conditions who may be at risk of adverse health outcomes due to their social determinants of health. Area Deprivation Index (ADI) can be used as a surrogate measure of a Veteran’s social needs. The objective of this study was to estimate the effect of neighborhood disadvantage, as measured by ADI, on HBPC enrollment for a sample of older Veterans. We estimated a linear multivariate model in which the exposure was ADI and the outcome was enrollment in HBPC. Controls included clinical and demographic characteristics. In a final sample of 12,005,453 observations (total Veteran months) on 353,485 individual Veterans, 18.4% lived in high-deprivation neighborhoods (ADI greater than or equal to 80). Mean monthly probability of new HBPC enrollment was 0.0061. Controlling for clinical characteristics, housing instability, and distance from the medical center, Veterans residing in high-deprivation neighborhoods were 1.4% to 14.8% less likely to enroll in HBPC, though the association was not statistically significant. The VA HBPC program provides beneficial comprehensive, primary care services to Veterans at risk of poor health outcomes. However, a Veteran’s social determinants of health could prevent enrollment. More research is needed to determine the relationship between Veterans’ social needs and HBPC enrollment.
COVID Pandemic Impact on Nevada Adult Protective Services
Authors: Ramsey-Klawsnik Holly
Published: December 2021

Empirical data regarding Covid pandemic impact on the Nevada Adult Protective Services (APS) Program clients, casework, and staff was gathered and analyzed as part of a multi-faceted program evaluation. Key findings include: 66% of the staff agreed or strongly agreed that the pandemic made their jobs more challenging. Respondents reported Covid-related challenges faced by clients, the program, and themselves as social workers serving older and vulnerable adults. Adverse client impacts observed included increased social and emotional isolation, loss of housing, exacerbation of symptoms of mental illness, necessary services being cut from clients subsequent to testing Covid positive, and fear and reluctance to allow needed visiting service providers, such as home health aides, into their homes. We will discuss the implications of the findings on APS services and clients, and on related health and human services designed to promote the wellness and independence of older and vulnerable adults.
Cross-Level Mediating Effects of Social Relationships between Religiosity and Successful Aging
Authors: Park Hayoung , Jun Hey Jung , Joo Susanna
Published: December 2021

This study aimed to analyze the cross-level mediating effects of social relationships on the association between religiosity and successful aging. The data was the 7th Korean Longitudinal Study of Ageing and the sample was 1,191 couples aged 65 and above. Independent variables were the level of participation in religious activities at the individual level and religious similarity between couples at the couple level. The dependent variable was successful aging at the individual level, which consisted of physical, cognitive, social, and psychological dimensions. Mediating variables were two social relationships: frequency of social interaction at the individual level and marital satisfaction at the couple level. We applied Full Information Maximum Likelihood estimation to include 8% of the sample with missing values in data. According to the multi-level mediation path analysis, both frequency of social interaction and marital satisfaction had mediating effects on the association between the level of participation in religious activities and successful aging; the more they participate in religious activities, the higher the frequency of social interaction and marital satisfaction, and this had positive effects on successful aging. Also, marital satisfaction had a mediating effect on the association between religious similarity and successful aging; when married couples have the same religion, marital satisfaction was higher than when they do not, and this had a positive effect on successful aging. This study is meaningful in presenting multi-dimensional discussions on religiosity and social relationships in later life and a new empirical model to promote successful aging at both individual and couple levels.
Transformations and Transmission – A Contextual Look at Religious Biographies of Older Adults
Authors: Spannari Jenni , Tervo-Niemela Kati , Kallatsa Laura
Published: December 2021

Examination of religious biographies tend to show increase of religiosity towards old age, most often in the context of a previously familiar religious community. These changes in individuals do not happen in a vacuum. Religious landscapes are also in transformation, characterized by a steady decline of institutional religiosity and religious practice in most European countries and more recently in the US and Canada, too. However, there is a dire lack of detailed knowledge on how these changes in individuals and societies are intertwined. This paper presents findings of the Finnish sub-project of the five-country research project “Transmission of religion across generations.” The paper utilizes both three-generation interviews, and the contextual information gathered in the families about the past and present generations. The narratives about religious biographies of the oldest (gen.1) interviewees are discussed, and set in the context of the changes in the surrounding social sphere and the interviewees’ role in the family. Key findings include a general trend of increased flexibility, openness and communication over time – both in the religious views of the individuals, the roles different generations take in the family, and the cultural atmosphere in the society. Also, the results suggest that this flexibility is an essential factor in successful transmission of religion or other convictions across generations. The findings illustrate the complexity and contextuality of building and researching narratives of religious biographies. Thus, the results contribute to future examinations on how changes in societies and families affect the religious styles and convictions of older adults.
Association between anticholinergic burden and dementia in UK Biobank
Authors: Mur Jure , Cox Simon , Marioni Riccardo , Russ Tom , Muniz-Terrera Graciela
Published: December 2021

Previous studies on the association between the long-term use of anticholinergic drugs and dementia report heterogenous results. This variability could be due to, among other factors, different anticholinergic scales used, and differential effects of distinct classes of anticholinergic drugs. Here, we use 171,775 participants of UK Biobank with linked GP prescription records to calculate the cumulative annual anticholinergic burden (ACB) and ascertain dementia diagnoses through GP- and inpatient records. We then use Cox proportional hazards models to compare 13 anticholinergic scales and anticholinergic burden (ACB) due to different classes of drugs in their association with dementia. We find dementia to be more strongly predicted by ACB than by polypharmacy across most anticholinergic scales (standardised ORs range: 1.027-1.125). Furthermore, not only the baseline ACB, but the slope of the longitudinal trajectory of ACB (HR=1.094; 95% CI: 1.068-1.119) is predictive of dementia. However, the association between ACB and dementia holds only for some classes of drugs – especially antidepressants, antiepileptics, and high-ceiling antidiuretics. Moreover, we do not find a clear relationship between reported anticholinergic potency and dementia risk. The heterogeneity in findings on the association between ACB and dementia may in part be due to different effects for different classes of drugs. Future studies should establish such differences in more detail and further examine the practicality of using a general measure of anticholinergic potency as it relates to the risk of dementia.
Caregiving and COVID-19: Perspectives from a Care Coach
Authors: Marnfeldt Kelly , Estenson Lilly , Rowan Julia , Wilber Kathleen
Published: December 2021

Family caregivers of community-dwelling older adults have faced unprecedented caregiving challenges during the COVID-19 pandemic. Examining the accumulated impact on family caregivers can help health and aging service providers design resources and supports that are resilient to emergency situations, and reduce negative psychological and physical consequences and risk of abuse within caregiving dyads. Data was collected as part of a pilot intervention in which “Care Coaches” provided telephonic coaching sessions to family caregivers of older adults. We examined Care Coach observations documented after coaching sessions with 24 family caregivers between March 2020 and February 2021. Two coders employed thematic analysis to generate codes and themes. The sample was 70% female, 80% were the spouse or significant other of their care receiver, the mean age was 61, and 53% were Non-Hispanic White. Themes and sub-themes included: (1) increased caregiver burden and diminished care networks due to fear of exposure to or contraction of COVID-19, (2) barriers to accessing in-home personal assistance services and home-delivered meals despite intervention efforts, and (3) the exacerbation of caregiver social isolation due to COVID-19 lockdown policies. Findings highlight the ways in which COVID-19 has amplified caregiver burden through the breakdown of formal and informal support systems. Potential adaptations of community-based services for older adults and their caregivers include remote service liaisons and need assessment of caregiver dyads to assure access to home-based personal assistance services and nutrition support for those at greatest risk of negative consequences during emergency service lapses.
Comparison of Older Adult and Healthcare Provider Beliefs About Fall Prevention Strategies
Authors: Bergen Gwen , Henry Ankita , Haddad Yara
Published: December 2021

Older adults reported about 36 million falls in 2018. Although effective strategies are available to minimize fall risk, little is known about older adults’ and healthcare providers’ awareness of these strategies. This study describes and compares older adults’ and healthcare providers’ beliefs about fall prevention strategies. Demographic and fall-related data for older adults were obtained from the 2019 fall cohort of Porter Novelli ConsumerStyles. Similar data from primary care practitioners, nurse practitioners, and physician assistants, were gathered from the 2019 cohort of DocStyles. Percentages and 95% confidence intervals were calculated to compare older adults and providers. Most providers (91.3%) and older adults (85.1%) believed falls can be prevented. High percentages of providers and older adults identified strength and balance exercises (90.7% and 82.8% respectively) and making homes safer (90.5% and 79.9% respectively) as strategies that help prevent falls. More providers reported that Tai Chi (45.7%) and managing medications (84.2%) can prevent falls compared to older adults (21.7% and 24.0% respectively; p<0.0001). Sizable percentages of providers and older adults endorsed less evidence-based strategies including aerobic exercise (70.7% and 58.4% respectively) and being more careful (69.3% and 81.6% respectively). Among older adults, lower endorsement of evidence-based strategies (e.g., Tai Chi, medication management) coupled with higher endorsement of limited evidence-based strategies (e.g., being careful, aerobic exercise) suggest some older adults lack awareness of effective fall prevention interventions. Increased patient and provider communication can increase awareness about the benefits of evidence-based strategies for fall prevention.
Policy Series: Building Momentum for Diversity, Equity, and Inclusion in Geriatrics and Gerontology Education
Authors: Severance Jennifer , Gordon Barbara , Lindberg Brian
Published: December 2021

With an increasingly multicultural and diverse older adult population, health care professionals must be prepared to serve older adults from varied backgrounds and marginalized communities; address health determinants and disparities; and promote diversity, equity, inclusion, and empathy within systems of care. The National Association for Geriatrics Education (NAGE) is a non-profit organization representing geriatric and gerontology education and training programs, including Health Services and Resource Administration (HRSA) funded Geriatric Workforce Enhancement Programs (GWEPs), and Geriatric Academic Career Awardees (GACAs). The 44 GWEPs focus on improving health outcomes for older adults by enhancing geriatrics and primary care training of the healthcare workforce. The 26 GACA awards support leaders in Age-Friendly health care transformation and interprofessional clinical geriatrics training. This symposium examines the role both programs have in reducing racial health disparities in older adults by promoting increased diversity of the geriatrics/gerontology workforce and advancing public policies for racial equity and inclusion. First, presenters will introduce the NAGE Diversity and Racial Equity Workgroup that supports a broader and unified effort across GWEPs and GACAs for equity and inclusion in geriatrics and gerontology education. Presenters will then share strategies to mobilize system-level changes within their institutions. Finally, examples of progress showcase individual GWEP and GACA projects and partnerships aimed at reducing racial health disparities within a multidimensional and local context. Presenters discuss strategies and opportunities to disrupt and transform health professions education at multiple levels and implications for policies supporting optimal aging for all older adults.
Factors Influencing Brain Healthy Diets Among Older Midwestern African Americans
Authors: Shaw Ashley , Fikru Samantha , Berkley-Patton Jannette , Goode Chris , Perales Jaime , Vidoni Eric
Published: December 2021

Emerging evidence suggests that up to half of Alzheimer’s disease (AD) cases are a result of modifiable risk factors related to poor diet such as blood pressure and diabetes, disproportionately affecting African Americans. Adherence to brain healthy diets remains low among African Americans. Therefore, it is important to understand needs, preferences, and barriers to inform intervention designs aimed to reduce AD risk among African Americans. Using a qualitative community-based research approach, we conducted six semi-structured focus group discussions (n= 30) to explore older African American experiences with brain healthy diets, preferences, and barriers to eating healthy. Secondly, we assessed the feasibility and acceptability of collecting biomarkers of health status and dietary behaviors among African Americans. A thematic analysis was conducted to identify emerging themes and biomarkers of health status were analyzed using descriptive statistics. We identified four themes: “Knowledge and Beliefs about Brain Healthy Diets,” “Eating Practices,” “Ways to Improve Dietary Practices,” and “Preferences for Enhancing Awareness about Brain Healthy Diets.” Themes indicated that older African Americans are receptive to healthy dietary consumption but perceived lack of education, cost, access, and perception of losing one’s culture as barriers to adherence. A total of 87.5% of participants completed biomarker assessments and 82% tested positive for 1 or more cardiovascular risk factor. Our study identified ways to enhance brain healthy dietary practices to reduce dementia risk. Also, our study demonstrated feasibility and acceptability in collecting AD related biomarkers in the African American community.
Feasibility of an Innovative Rehabilitation Program Adapted for the Post-acute Nursing Home Setting
Authors: Middleton Addie , Driver Jane , Ruopp Marcus , Lefers Lindsay , Rawlins Jessica , Harris Rebekah , Bean Jonathan
Published: December 2021

Live Long Walk Strong is a rehabilitation program that produces large clinically meaningful improvements in mobility when implemented as an outpatient program for older adults. We adapted Live Long Walk Strong for the post-acute nursing home setting within the Veterans Health Administration as a clinical demonstration project. The adapted version includes novel elements and bridges the inpatient stay and three months post-discharge. The inpatient phase focuses on maximizing functional recovery and includes activities focused on timing and coordination of gait, leg strength and power, and trunk muscle endurance. The care transition and virtual (telehealth) post-discharge phase focuses on case management and engagement in physical activity programs. Coaching and behavior change are a consistent focus throughout the program. To date, 13 Veterans (mean age 67.9, SD 11.7 years) have completed the inpatient phase, and of those Veterans, six have completed the entire program, five are still active, one was lost to follow-up, and one was rehospitalized. The program demonstrates feasibility, 91% of all inpatient sessions and 81% of all post-discharge sessions were completed. Regarding preliminary efficacy, 83% of Veterans who completed the program exceeded the minimal detectable change score (4 points) on the Activity Measure for Post-Acute Care (AM-PAC) Mobility scale from program enrollment to completion (mean change 6.5, SD 6.9 points). Based on findings from this clinical demonstration project, the program is feasible. However, future research is needed to further examine the program’s impact on mobility and other outcomes important to older Veterans receiving post-acute nursing home care.
Feasibility trial of an integrated treatment "Activate for Life" for physical and mental well-being in older adults
Authors: Hernandez-Tejada Melba , Nagel Alexis , Madisetti Mohan , Balasubramanian Sundaravadivel , Kelechi Teresa
Published: December 2021

This study describes the feasibility and patient satisfaction for an integrated treatment to address multiple health outcomes in a sample of older adults living in a low-income independent residence facility and their own homes in the community. Specifically, 30 older adults were offered the opportunity to participate in a feasibility study of different components of Activate for Life treatment targeting balance and physical strength (Otago Exercise Program), breathing retraining (Gentle Yoga and Yogic Breathing), and mental health (Behavioral Activation for Depression). Three treatment combinations were compared in a randomized repeated measures design to determine if adding components to the existing Otago program were feasible and if this affected patient satisfaction. Arm1: the Otago strength and balance program alone (n = 10); Arm 2: Otago + Gentle Yoga and Yogic Breathing (n = 10); and Arm 3: Otago + Gentle Yoga and Yogic Breathing + Behavioral Activation (we named this combination ‘Activate for Life’ n = 10). Dependent measures included recruitment rate, session completion characteristics, and satisfaction with the program. Overall, study and treatment components proved feasible, and participants reported high satisfaction with all 3 Arms.
GWEP TAG-TEAM Response: COVID-19 Health Disparities in Orange County, California
Authors: Lee Jung-Ah , Rousseau Julie , Saville Neika , Sehgal Sonia , Gibbs Lisa
Published: December 2021

Health disparities follow zip codes, and in Orange County, CA, both COVID-19 cases and deaths are highly concentrated in our diverse geriatric populations in Santa Ana (44,075) and Anaheim (40,984) where our two UCI Federally Qualified Health Centers (FQHCs) are located, and Garden Grove (16,174) and Buena Park (7,581), where University of California Irvine (UCI) TAG-TEAM GWEP community partner FQHCs are located. Collectively, our FQHCs serve diverse populations, with 83-88% of patients identifying as Hispanic/Latino or Asian. As we support these clinics in becoming Age-Friendly Health Systems, UCI’s GWEP pivoted to provide COVID-19 education in the form of multi-lingual materials and videos available in Spanish, Vietnamese, Korean, Mandarin, and Farsi. Additionally, through our Age-Friendly Geriatrics Tele-ECHO Series we are working to build Mental Health care competencies among these FQHC providers since the pandemic morbidity and mortality disparities have resulted in a profound mental health crisis in our communities.
Self-Reported Frailty Concerns in Older Breast Cancer Survivors During the COVID-19 Pandemic
Authors: Crouch Adele , Von Ah Diane
Published: December 2021

Frailty among older adults is common, especially those who have undergone breast cancer treatment; however, we do not know how frailty among this group presented during the COVID-19 pandemic. The purpose of this descriptive, cross-sectional study was to examine self-reported frailty among older breast cancer survivors (BCS) during the pandemic. This IRB-approved study recruited BCS who were at least 1-year post-treatment and 60 years of age or older, via online advertisements (e.g., Dr. Susan Love Foundation). BCS completed demographic and Tilburg Frailty Indicator (TFI) RedCap questionnaires from 11/2020 to 05/2021. The TFI, is a 15-item measure with 3 sub-scales with published cut points indicating frailty: total (5), physical (3), psychological (2), and social (2). Descriptive statistics were used. Older BCS (n=203) who were on average 65.5 (SD=4.7) years of age, white (93.6%; n=190) and had stage II breast cancer at diagnosis (39.9%; n=81) participated. The average total (M=5.4, SD=2.5) and physical (M=3.2, SD=1.5) frailty scores were above the threshold for frailty. Overall, 58.6% (n=119) and 63.1% (n=128) scored at or above the threshold on the total and physical sub-scales, respectively. In addition,78.8% (n=160) responded that they ‘missed having people around’ on the social frailty sub-scale. Research has shown that higher TFI scores (more frailty) are associated with increased healthcare utilization, poorer quality of life, and even mortality. Thus, frailty among older BCS is an important health concern within the context of the pandemic. Further research is needed to understand the lasting effects of self-reported frailty for BCS including COVID-19 survivors.
Shoulder Function and Fatty Infiltration on MRI in Older Adults During Rehabilitation for Rotator Cuff Tear
Authors: Davis Derik , Almardawi Ranyah , Awan Omer , Lo Lawrence , Ahmed Sagheer , Jubouri Shams , Gullapalli Rao
Published: December 2021

Rotator cuff tear is highly prevalent in older adults, with supraspinatus tendon tear (STT) the most common. Shoulder rehabilitation is a major treatment strategy, but supraspinatus-muscle-fatty infiltration (FI) and shoulder function in older adults with rotator cuff tear primarily managed by physical therapy (PT) is inadequately documented. We tested the hypothesis that older adults receiving usual-care PT when stratified by supraspinatus tear-status differ in supraspinatus FI [by quantitative Dixon fat fraction (FF) and semi-quantitative Goutallier grade (GG) on MRI] and shoulder function [by the American Shoulder and Elbow Surgeons score (ASES-score)] over time. Longitudinal cohort study (pilot): adults 60-85 years, PT-cohort (n=15) and control-cohort (n=25). Participants completed both shoulder MRI and ASES survey at baseline and follow-up visits. Kruskal-Wallis test compared within cohort among 3 groups: no tear (no-STT), partial-thickness tear (pt-STT), full-thickness tear (ft-STT). Mann-Whitney U test compared equivalent groups between cohorts. Baseline PT-cohort groups differed for GG (p=0.033) [no tear, 0.50±0.50;pt-STT, 1.11±0.22;ft-STT, 1.50±0.50] without difference in age, BMI, comorbidity, or ASES-score. Baseline control-cohort groups differed for FF (p=0.034) [no-tear, 5.77%±1.16%;pt-STT, 7.14%±6.26%;ft-STT, 21.44%±10.44%], without difference in age, BMI, comorbidity, or ASES-score. Baseline no-tear groups for ASES-score (p=0.049) differed between cohorts: PT-cohort (58.87±8.21) versus control-cohort (83.98±21.89). Both cohorts showed no difference in Δ-FF or Δ-GG over time. PT-cohort groups differed for Δ-ASES-score over time (p=0.042)[no-tear, 16.65±4.69;pt-STT, -7.24±0.94;ft-STT, 4.48±3.45], but control-cohort groups did not (p>0.050). Our results suggest differences exist for supraspinatus FI and self-reported shoulder function among older adults receiving PT for rotator cuff tear when stratified by supraspinatus tear-status.
Social Determinants of Health among Older Korean Immigrants in the United States: A Systematic Review
Authors: Lee Sojeong , Rizzo Victoria
Published: December 2021

The visible impact of the SDoHs on health and behavioral health as well as health disparities among minority populations is heightened due to COVID-19. One group about which little is known in relation to SDoHs is the older Korean immigrant population in the U.S. To examine the impact of SDoHs on the health, mental health, and health care utilization, a systematic review of studies focused on SDoHs for this population was conducted. Using multiple indexing terms, databases were searched for articles published in English between January 1, 2011 and December 2020. Articles were included in the search if they examined social determinants of health of older Korean immigrants defined as foreign-born Koreans aged 60 or older who live in the United States regardless of citizenship or legal immigration status. A total of 1090 articles were identified in the search. A review of abstracts for inclusion criteria resulted in 118 articles for review. Seventy-one articles were excluded during the review process. A total of 47 articles met inclusion criteria and were evaluated. The review revealed that SDoHs, including education level, financial resources, access to health insurance, level of acculturation and level of social support, influenced cognitive status, depressive symptoms, health status and quality of life. These findings validate the need for interventions to address the social care needs of older Korean immigrants and can be used to identify the role of social workers in addressing the SDoHs that result in health disparities for older Korean immigrants.
The Growing Burden of Informal Caregivers During COVID-19
Authors: MacLeod Stephanie
Published: December 2021

Caregiver burden has negative effects on health outcomes and quality of life. Meanwhile, safety protocols during the COVID-19 pandemic created immediate impacts on informal caregiving with increasing burden on family caregivers. Our primary purpose was to describe the impacts of the pandemic on caregiver burden among informal caregivers, and their sudden shift in roles as a result. This review describes emerging effects on various aspects of health and explores future directions to support informal caregivers. A streamlined search was conducted to fit the scope of this review, with key terms determined to identify relevant publications. Common research databases and mainstream resources were utilized. We focused on research published since March 2020 to align with the timing of the pandemic in the US. Early research suggests that the pandemic has worsened caregiver burden among informal family caregivers. Reported health impacts include greater stress, pain, depression, sleep problems, and irritability, decreased social connectedness and quality of life. Informal family caregivers face negative health outcomes and distress as a result of greater caregiver burden and intensity during the COVID-19 pandemic. Immediate solutions are needed to alleviate this growing burden and provide ongoing support. Future work should explore the potential of boosting positive resources such as resilience and purpose to ease caregiver burden.
Understanding Functional Mobility and Quality of Life Among Isolated Aging Population in the US
Authors: Dayrit Jessika , Pasatiempo Ana maria , Hitosis Kevin
Published: December 2021

Background: Social isolation among older adults linked to serious health conditions. However, little is known if functional mobility among isolated aging adults impacts quality of life. Objectives: This study will examine the association between levels of functional mobilities and risks for developing depression, poor health status, and physical inactivity by controlling socioeconomic factors. Methods: This is a cross-sectional study, using Behavioral Risk Factor Surveillance System (BRFSS) data 2017. Target population are over age 65 who are living alone (N=50,784). Outcome variables are depression, self-reported health status, and physical inactivity whereas main predictors are activities of daily living (ADL) and instrumental activities of daily living (IADL) controlling for gender, race, marital status, employment status, annual income, and educational level. Weight adjustment analysis and logistic regression were conducted. Results: Depression, self-reported poor health status, and physical inactivity are higher among isolated aging adults who have limitations with ADL/IADL. Specifically, those with difficulties concentrating/decision making (OR=3.62; CI=3.35-3.91) have higher chance of developing depression than those who do not have this limitation. Female are at risk for developing depression (OR=1.41-1.61; CI=1.51), yet they are likely to report for better health status (OR=1.54; CI=1.45-1.64) than males. Asian (OR=0.56; CI=0.39-0381), Black or African American (OR=0.54; CI=0.48-0.60) are less likely to be diagnosed with depressive disorder than White. Discussion/Recommendation: Physical and cognitive changes that come with aging can pose challenge, as functional capacity diminishes in home environment. Further research should be explored in longitudinal studies on mobility and improving quality of living among isolated aging population.
Virtual Testing of Seniors: The Feasibility of Research with Online Neuropsychological Tests (FRONT)
Authors: Pauley Chris , Yetman Linda , Lupo Jody-Lynn , Slack Penelope , Jacobs Diane , McGibbon Chris , Jarrett Pamela , Odasso Manuel Montero
Published: December 2021

Synergic@Home is a feasibility study evaluating the effects of exercise and cognitive interventions for the prevention of dementia in at-risk individuals over age 60. The COVID-19 pandemic changed the study’s methods, with standardized neuropsychological tests needing to be administered virtually. Experience and research into the viability of neuropsychological assessments administered virtually is limited. After receiving permission to adapt the tests for virtual administration, a neuropsychologist, project managers, and research coordinators developed their approach. A PowerPoint presentation using text and visual stimuli from the tests was developed with on-screen instructions for the raters. An iterative development process involved feedback from the team in order to maximize the fidelity of these methods compared to in-person administration. Mock assessments supervised by a neuropsychologist further refined the methods and confirmed rater adherence to standardized procedures. A secure videoconferencing platform meeting privacy requirements was used. Dual monitors for the raters provided instructions on one monitor while stimuli for the participant was on the second monitor. The participant could only see the stimuli. This method of administering neuropsychological assessment, the Feasibility of Research with Online Neuropsychological Testing (FRONT), is being used to evaluate older adult participants in Synergic@Home. Results from this feasibility study may set the stage for new research methodologies and/or clinical evaluations in the future. This project is funded by the New Brunswick Healthy Seniors Pilot Project and the Canadian Consortium on Neurodegeneration in Aging (with grants from Public Health Agency of Canada and the Canadian Institutes of Health Research, with additional funding partners).
Age-Related Changes in Posture Steadiness in the Companion Dog
Authors: Vero Alejandra Mondino , Wagner Grant , Lobaton Edgar , Russell Katharine , Olby Natasha
Published: December 2021

Aging is associated with changes in the sensory-motor system that could lead to dynamic instability. In fact, postural control deficits have been proposed as an early indicator of frailty. Measurements of the displacement of the center of pressure (COP) using pressure mat data are useful tools to determine postural steadiness. Companion dogs represent a powerful model to study aging in people because they share our environment and experience similar age-related diseases. To date, the effect of aging on postural control in dogs has not yet been evaluated. The aim of this study was to determine the correlation between age and the displacement of the COP in dogs during quiet standing. Due to the diversity of life expectancy in dogs according to their body size, age was normalized as a fraction of the predicted life expectancy. Dogs older than 75% of their life expectancy (n=18) were asked to stand on a pressure mat for 8 seconds per trial during at least five trials. Only the frames where the dogs were standing still and facing forward were analyzed. Age as a fraction of life expectancy was significantly correlated (p<0.05) with the Medio-lateral Range, Root-Mean-Square Distance, 95% Confidence Ellipse, and Total Sway Area of the COP. These results show that, as in humans, aging in dogs is associated with postural control deficits and therefore reinforce the dog as a suitable model for translational studies of aging and postural steadiness.
Care Recipient Diagnosis Moderates the Relationship Between Caregiver Worry and Vigilance
Authors: Craig Katherine , Kamil-Rosenberg Shirit , Fairchild J Kaci
Published: December 2021

Family members of persons diagnosed with dementia or a traumatic brain injury (TBI) are often relied upon to provide daily support to their care recipients. However, research on the differing experiences of caregivers based on care recipient diagnosis is limited. The aim of this study was to examine the impact of worry and feelings of vigilance among caregivers of people with cognitive impairment due to either TBI or dementia. This sample included 61 caregivers (88.5% female, mean age 57.3±15.5) of persons with either a TBI (n = 32) or dementia (n = 29). Worry was assessed with the Penn State Worry Questionnaire and Vigilance was assessed with the Caregiver Vigilance Scale. Linear regressions revealed that after controlling for age, care recipient diagnosis moderated the relationship between worry and caregiver vigilance. Specifically, worry was significantly associated with caregiver vigilance in those caring for someone with dementia; however, a similar relationship was not seen in those caring for someone with a TBI. This suggests caregivers of people with TBIs have a different experience of worry and vigilance than caregivers of people with dementia. These findings demonstrate the need for more research on the unique needs of caregivers of people with TBIs. Additionally, this research suggests interventions targeting worry may be particularly effective in supporting caregivers of people with TBIs.
Receipt of Training Among Family Caregivers Assisting With a Post-Hospital Care Transition
Authors: Burgdorf Julia , Fabius Chanee , Riffin Catherine , Wolff Jennifer
Published: December 2021

Medicare Conditions of Participation require hospitals to provide training to family and unpaid caregivers when their support is necessary to enact the post-discharge care plan. However, caregivers often report feeling unprepared for this role. We perform a cross-sectional analysis of the 2017 National Health and Aging Trends Study and its linked National Study of Caregiving (nationally representative surveys of older adults and their family and unpaid caregivers, respectively) to assess the prevalence of, and factors associated with, caregiver receipt of adequate transitional care training. Our analytic sample includes 795 (weighted n=7,083,222) family caregivers who assisted an older adult during a post-hospital care transition in the past year. The outcome of interest caregiver-reported receipt of the training needed to manage this transition (“adequate transitional care training”) from hospital staff. Six in ten (59.1%) caregivers who assisted during a post-hospital care transition reported receiving adequate transitional care training. In weighted, multivariable logistic regression models, caregivers were half as likely to report receiving adequate transitional care training if they were black compared to white (Adjusted Odds Ratio (aOR): 0.52; 95% CI: 0.31-0.89) or experienced financial difficulty (aOR: 0.50; 95% CI: 0.31-0.81). Findings suggest that socially vulnerable family caregivers of older adults are less likely to report receiving adequate transitional care training. Changes to the discharge process, such as using standardized caregiver assessments, may be necessary to ensure equitable support of family caregivers.
Influences of Prejudice and Stereotyping in the Direct Care Workforce
Authors: May Jennifer
Published: December 2021

Direct Care Workers (DCW; nursing assistants, personal care aides, home health aides) have the most one on one care with sexual and gender minority (SGM) older adults who reside in residential care facilities or use home health services. DCWs make up a vast majority of the healthcare workforce, holding almost five million jobs in 2019, with approximately 70% of the positions held being in residential care facilities. In a qualitative design study, 11 DCWs were interviewed using an open-ended, semi-structured format to describe their perceptions of care provided to SGM older adults in residential care facilities and the home health setting. These results were part of a larger qualitative study which found there were cues of stereotyping and prejudice in DCW narratives toward SGM older adults. The category DCWs’ care and social system referred to characteristics of the DCWs’ work environment and the perspectives, attitudes, and reported care toward SGM older adults and diverse populations. It was determined that there are synergies among SGM older adults’ care and DCW along with DCW workforce issues (short staffed, low wages, lack of health benefits) that may prevent the DCW from being accepting of implicit bias training or culture change within these facilities/agencies. Implications for practice, policy, and future research are discussed.
Recruiting Resident Participants from Nursing Homes During the COVID Pandemic: Challenges and Solutions
Authors: Almasri Leena , Carlson Barbara , Myers Julie , Koszalinski Rebecca , Franklin Melissa , Kelsh Alysa , Sturdevant Diana
Published: December 2021

Recruiting nursing home residents as participants in research is challenging. In early 2021, Covid-19 cases rose rapidly in nursing homes, prompting the rapid deployment of infectious disease protocols and ultimately, facility lockdowns to control the spread of the virus. By September, 2020, many research projects were delayed or cancelled, and future research was jeopardized. During this period, as well as prior to and after the administration of the COVID vaccine, we enrolled residents in a complex protocol involving administration of two Shingles vaccines (0- and 90 days) and three separate blood samples. Here, we present the strategies we used to recruit 216 residents, from 23 homes, over a 9-month period. We faced many challenges. Our research staff faced weekly COVID-19 antigen tests prior to entering the facility, adhering to strict protocols on travel, as well as packaging of materials that entered and left the facility. N95 masks and face shields further made it difficult to communicate with residents. For homes, COVID protocols required residents to be transported to specified areas to meet with research staff. Daily monitoring of COVID and Shingrix vaccine symptoms became part of daily care. To minimize resident harm and interruption of workflow in nursing homes, we utilized principles of stakeholder engagement, healthcare leadership, infectious disease/immunology, and staff (research and nursing homes) empowerment. In the face of crisis, like the COVID-19 pandemic, we have gained the trust and commitment of these facilities; thus, establishing a sustainable partnership that is prepared for what comes next.