bluuebunny/crossref_metadata_2025 huggingface dataset:
PEOPLE LIVING WITH PARKINSON DISEASE WITH AND WITHOUT FREEZING: DIFFERENCES USING THE NEURO-QOL MEASUREMENT SYSTEM
Authors: Rawson Kerri , Duncan Ryan , DeAngelis Tamara , Nordahl Timothy , Cavanaugh Jim , Earhart Gammon , Ellis Theresa
Published: November 2019

Parkinson disease (PD) is the second most common neurodegenerative disease and approximately half of those diagnosed with PD will experience freezing of gait (FOG). FOG is a severe motor disturbance that prevents stepping despite the intention to do so and may be associated with anxiety, decreased cognitive functioning, depression, and poorer quality of life. In this study, we administered the short-form Quality of Life in Neurological Disorders (Neuro-QOL) measurement system to 43 people with PD (28 non-freezers and 15 freezers) and determined freezing status using the New Freezing of Gait-Questionnaire. Freezers had greater motor severity as measured with the MDS-UPDRS-III (p =.003) and poorer balance using the Mini-BESTest (p = .017). Data from the Neuro-QOL battery indicated freezers had greater difficulty with Lower Extremity Function (p = .019) and Upper Extremity Function (p = .027). Freezers also had poorer scores on the Positive Affect and Well-Being (p = .005), Satisfaction with Social Roles and Activities (p = .005), and Stigma (p = .026) scales, but less difficulty on the Communication scale (p = .005) than non-freezers. There were no differences between freezers and non-freezers on the Ability to Participate in Social Roles and Activities, Anxiety, Cognitive Function, Depression, Emotional and Behavioral Dyscontrol, Fatigue, or Sleep Disturbance scales. These findings suggest freezers are less likely to have a positive outlook and satisfaction with their daily lives in combination with poorer functioning. Interventions that target freezing with the potential to improve functioning may result in better quality of life among freezers.
VIDEODINING IN OLDER ADULTS AGING IN PLACE: A FEASIBILITY AND ACCEPTABILITY STUDY
Authors: Barre Laura K , Coupal Sarah , Young Tara
Published: November 2019

Loneliness and a loss of commensality contribute to the decline in nutritional status observed in older adults. The use of video chatting while dining, i.e. “VideoDining”, provides an opportunity for older adults to eat with another person virtually while dining at home. We tested the acceptability and feasibility of VideoDining in older adults receiving Meals on Wheels (MOW) and explored whether it changed meal intake. Participants were recruited from a rural county in NY and ate their MOW meal while VideoDining with a companion diner at a different location. To assess acceptability, we conducted semi-structured qualitative interviews with each participant and companion diners completed a written survey. The amount of the VideoDining meal consumed was compared to usual intake from three days of food records. 140 MOW clients were contacted,13 agreed to participate and 10 completed the VideoDining experience. Barriers to participation included being uncomfortable with the technology, lack of internet service and illness. Participants were 80% female, 100% white, and all lived alone. Average meal length was 39 minutes and 40% ate more than usual, 30% ate the same, and 30% ate less. Reasons for eating less included being nervous and eating when not their usual mealtime. All participants reported they would VideoDine again and companion diners rated the overall experience a 9.2 out of 10. Older adults are able to VideoDine with a new acquaintance and have a positive experience. Further study is needed to determine if VideoDining can increase dietary intake and decrease loneliness in older adults.
MISSING VALUE IMPUTATION VIA GRAPH COMPLETION IN QUESTIONNAIRE SCORES FROM PERSONS WITH DEMENTIA
Authors: Kan Chen , Kim Won Hwa , Xu Ling , Fields Noelle L
Published: November 2019

Background: Questionnaires are widely used to evaluate cognitive functions, depression, and loneliness of persons with dementia (PWDs). Successful assessment and treatment of dementia hinge on effective analysis of PWDs’ answers. However, many studies, especially pilot ones, are with small sample sizes. Further, most of them contain missing data as PWDs skip some study sessions due to their clinical conditions. Conventional imputation strategies are not well-suited as bias will be introduced because of insufficient samples. Method: A novel machine learning framework was developed based on harmonic analysis on graphs to robustly handle missing values. Participants were first embedded as nodes in the graph with edges derived by their similarities based on demographic information, activities of daily living, etc. Then, questionnaire scores with missing values were regarded as a function on the nodes, and they were estimated based on spectral analysis of the graph with a smoothness constraint. The proposed approach was evaluated using data from our pilot study of dementia subjects (N=15) with 15% data missing. Result: A few complete variables (binary or ordinal) were available for all participants. For each variable, we randomly removed 5 scores to mimic missing values. With our approach, we could recover all missing values with 90% accuracy on average. We were also able to impute the actual missing values in the dataset within reasonable ranges. Conclusion: Our proposed approach imputes missing values with high accuracy despite the small sample size. The proposed approach will significantly boost statistical power of various small-scale studies with missing data.
U-EXCEL’S “@ HOME” PROGRAM: STAFF SUPPORTED BALANCE EXERCISE INTERVENTION AND ADHERENCE FOR LIFE CARE RESIDENTS
Authors: Gugliucci Marilyn R , Robertson Erica , Cronkright Ashley , Jagannathan Sujaay
Published: November 2019

Introduction: The University of New England College of Osteopathic Medicine U-ExCEL Program was established in 2006 and specializes in older adult fitness and balance programming. Falls account for $54 billion costs in direct and Indirect costs. Methods: This randomized control single blinded pilot project included an 8 week intervention to measure the impact of supported consistent individual balance programming in individuals’ apartments for a select group of older adults residing in a life care living environment. Twenty residents (75-92 y/o) were recruited, however 12 participants (6 intervention/6 control group) participated in the study. The remaining 8 participants were pulled from the wait list as attrition occurred. Demographic data collection and 6 validated assessments were conducted at baseline and at study completion. The intervention group conducted the Balancing Act (Falls Prevention) Program 3 times/week with social support. The control group only received social support. Data analysis included descriptive statistics, SAS 5.1 was used for non-parametric Mann-Whitney U Test (Wilcoxon Rank Sum Test); a repeated measures ANOVA was also conducted. Results: The effects of the intervention (Balancing Act Program) on Oxygen Saturation (p=0.009), Wong Baker Score (p=0.008), and the Rapid Assessment of Physical Activity (RAPA) 2 (p=0.008) test were statistically significant. The effect of the intervention on all other variables was not statistically significant including validated balance measures. Conclusion: Quantitative measures failed so show significant improvement in balance from the start to the end of the intervention; however improvements were experienced and expressed by the intervention group. Social Support is necessary for adherence.
UNDERSTANDING BARRIERS TO PALLIATIVE CARE USE AMONG ASIAN AMERICANS: A SYSTEMATIC REVIEW
Authors: Rhee Min Kyoung , Jang Yuri , Liu Mona , Haley William E , Enguidanos Susan
Published: November 2019

Despite the well-documented clinical and public health impacts of palliative care on older patients’ end of life experiences, racial and ethnic disparities in palliative care use still remain. However, empirical evidence on the sources of disparities is lacking, particularly for Asian Americans. Given the rapid growth and increasing cultural diversity of the older Asian population in the United States, a systematic review was conducted to provide a comprehensive overview of the best available evidence on the barriers to palliative care use among Asian Americans. Search was conducted using six electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, Cochrane Library, and Google Scholar), and all procedures of the study have been guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). A total of 23 studies published in the U.S. since 1998 were included. Individual level barriers to palliative care service use among Asian Americans identified by the study included lack of palliative care knowledge, lack of insurance, cultural beliefs, language barrier, attitude toward death, family centered decision-making. Provider level barriers included lack of training and experience about palliative care, patient-provider discordance in language and culture, and absence of policy or guidance for providers. Although racial disparities in palliative care for Asian Americans were evident, Asian Americans were underrepresented in palliative research. Future research effort should be directed toward the development of culturally sensitive palliative care services and policies that reduce racial and ethnic specific barriers.
THE ASSOCIATION BETWEEN PHYSICAL FRAILTY AND DEPRESSIVE SYMPTOMS: DOES SOCIAL SUPPORT MATTER?
Authors: Liang Shuting , Kong Dexia , Dong XinQi
Published: November 2019

This research will present the association between physical frailty and depressive symptoms among U.S. Chinese older adults, and the extent to which social support moderates the relationship. Cross-sectional data were obtained from the Population Study of Chinese Elderly in Chicago collected between 2011 and 2013 (N=3,157). Physical frailty was assessed by the Short Performance Physical Battery (range=0-15). A cut-off point of 6 was used to define physical frailty as suggested by prior research. Depressive symptoms were assessed by the nine-item Patient Health Questionnaire. Social support was measured by a scale assessing positive support and negative strain from spouse, family members, and friends. Logistic regression analyses with interaction terms were conducted. In our sample, 1,682 (54.3%) had depressive symptoms, and 16.1% had physical frailty. Having physical frailty was positively associated with depressive symptoms (Odds Ratio [OR] 1.15, 1.11-1.18). Additionally, female gender (OR 1.39, 1.20-1.61), education (OR 1.03, 1.01-1.04), and chronic conditions (OR 1.18, 1.12-1.25) were positively associated with depressive symptoms. Social support (OR 0.85, 0.83-0.87) and children (OR=0.92, 0.87-.97) were negatively associated with depressive symptoms. Furthermore, family members (OR 0.96, 0.94-0.98) and friends (OR 0.96, 0.94-0.98) has moderating effect on the relationship between physical frailty and depressive symptoms. However, the interaction between social support from spouse and physical frailty was not significant. The findings highlight the interconnections among physical frailty, social support, and depressive symptoms. Intervention strategies focusing on social support may have the potential to reduce depressive symptoms among frail U.S. Chinese older adults.
CAENORHABDITIS ELEGANS AS A MODEL OF AIR POLLUTION TOXICITY DURING DEVELOPMENT AND LIFESPAN
Authors: Haghani Amin , Dalton Hans M , Safi Nikoo , Shirmohammadi Farimah , Sioutas Constantinos , Morgan Todd E , Finch Caleb E , Curran Sean P
Published: November 2019

Air pollution (AirPoll) is among the leading human mortality risk factors and yet little is known about the molecular mechanisms of this global environmental toxin. Our recent studies using mouse models even showed genetic variation and sex can alter biological responses to air pollution. To expand genetic studies of AirPoll toxicity throughout the lifespan, we introduced Caenorhabditis elegans as a new AirPoll exposure model which has a short lifespan, high throughput capabilities and shared longevity pathways with mammals. Acute exposure of C. elegans to airborne nanosized AirPoll matter (nPM) caused similar gene expression changes to our prior findings in cell culture and mouse models. Initial C. elegans responses to nPM included antioxidant, inflammatory and Alzheimer homolog genes. The magnitude of changes was dependent on the developmental stage of the worms. Even short term exposure of C. elegans to nPM altered developmental and lifespan hormetic effects, with pathways that included skn-1/Nrf family antioxidant responses. We propose C. elegans as a new and complementary model for mouse and cultured cells to study AirPoll across the lifespan. Future chronic nPM exposure and high throughput genetic screening of C. elegans can identify other major regulators of the developmental and lifespan effects of air pollution. This work was supported by grants R01AG051521 (CEF); R21AG05020 (CEF); Cure Alzheimer’s Fund (CEF); R01GM109028 (SPC), F31AG051382 (HMD) and T32AG000037 (HMD), T32AG052374 (AH).
THE LONGEVITY ASSOCIATED ALLELE OF FOXO3 PROTECTS AGAINST TELOMERE ATTRITION DURING AGING
Authors: Allsopp Richard , Davy Philip , Willcox Craig , Chen Randi , Shimabukuro Michio , Vivo Immaculata de , Willcox Bradley J
Published: November 2019

Telomere attrition in proliferative tissues is a hallmark feature of human aging. To date, the genetic influence on the rate of telomere attrition is poorly understood. Previously we discovered a variant of the FOXO3 gene that is strongly associated with human longevity, an observation that has been now reproduced in over a dozen independent studies. In the present study, we sought to assess the effect of the longevity associated variant of FOXO3 (rs2802292 - G allele) on the rate of telomere attrition during aging. The results from a cohort of Okinawan-Japanese (N=121), ranging in age from 25 – 94 years, demonstrates carriers of 1 or 2 copies of the longevity-associated G allele of FOXO3 showed markedly reduced rates of telomere loss in peripheral blood leucocytes as compared to carriers of the more common FOXO3 variant (TT – common genotype, m= -33bp/year, P=0.008). Interestingly, telomere shortening was not observed as a function of age for G allele carriers (m= -2bp/year, P>0.1). In an independent study of women (N=6,565) from the Nurses’ Health Study cohort, ranging in age from 40 to 70 years, a similar observation was found. Notably, carriers of the TT or GT FOXO3 genotype showed a significant decline in telomere length with age (m= -15.5 bp/year, P0.1). These results mark the first validated longevity gene variant showing an association with negligible loss of telomere length with age in humans.
DEVELOPING THE COMMON MARMOSET AS A TRANSLATIONAL MODEL OF AGE-RELATED OSTEOARTHRITIS
Authors: Minton Dennis M , Marolf Angela J , Santangelo Kelly S , Salmon Adam B , Konopka Adam R
Published: November 2019

Age is a primary risk factor for osteoarthritis (OA). The mechanisms that contribute to OA are poorly understood and disease modifying treatments have not been identified. A critical shortcoming in developing therapies is the limited number of translational models available to identify the causes of naturally occurring OA. Our goal is to use the common marmoset as a non-human primate (NHP) model of age-related OA. NHP are the closest evolutionary relative to humans and share many characteristics of human aging. The marmoset has advantages over other NHP for aging research because of their relatively short maximal lifespan and small size. Micro-computed tomography (uCT) was performed on whole-knee joints obtained from young (10 yrs, n=3) marmosets at necropsy. OA was evaluated using a clinical uCT scoring system and quantitative assessments of subchondral bone structure and ossified meniscal volume. Advancing age was positively correlated to increased uCT OA score (p<0.05, r=0.59 ), mainly through increased number and size of osteophytes and progressive subchondral bone sclerosis from the medial to both medial and lateral compartments. For marmosets displaying meniscal ossification, older marmosets had greater (p<0.05) ossified meniscal volume than middle-aged and younger marmosets, respectively. Trabecular (p=0.05) and cortical bone thickness (p<0.05) were also lower in older marmosets. These data are the first to indicate that the marmoset develops naturally occurring, age-related OA and support the pursuit of additional studies using the marmoset to identify OA mechanisms and test potential interventions.
AGED MICE ARE SUSCEPTIBLE TO CARDIAC HYPERTROPHY AFTER 1 WEEK OF CONSUMING A HIGH SUGAR DIET
Authors: Valencia Ana P , Whitson Jeremy , Stuppard Rudolph , Valencia Gustavo , Rabinovitch Peter , Marcinek David
Published: November 2019

Over 80% of American adults exceed their daily recommended intake of sugar (<10% kcal). While habitual sugar consumption is associated with an increased risk for diabetes and cardiovascular disease, less is known about the effects of short-term sugar consumption on metabolic health, particularly in the elderly. The purpose of this study was to test whether aged hearts are more susceptible to pathology following a short-term high sucrose (HS) diet. Specific goals were to: A) determine the effects of a 1-week HS diet exposure on the hearts of 5 month-old and 24 month-old mice; and B) test if the mitochondrial targeted peptide SS-31 can protect against HS-diet induced effects. Male CB6F1 mice were placed either on standard chow or HS diet after 1 week of receiving saline (control) or SS-31 through osmotic pumps. Heart function was assessed in vivo through echocardiography before and after treatments. One week of HS induced significant cardiac hypertrophy in the old mice compared to age-matched chow controls. Treatment with SS-31 prevented this HS induced hypertrophy. Young hearts were smaller than in the old, but size was unaffected by diet or SS-31. We observed no effect of HS (with or without SS-31) on respiration or H2O2 production in isolated mitochondria from hearts using high-resolution respirometry. These data indicate that only 1-week exposure to HS diet is enough to exacerbate cardiac hypertrophy in aging mice, but factors other than heart mitochondrial ROS may mediate this effect.
A HEALTHY LIFE FOR AFRICAN AMERICAN WOMEN CARING FOR OLDER ADULTS: A CONCEPT MAPPING STUDY
Authors: Keller Abiola O
Published: November 2019

Achieving optimal health and well-being among African American older adults with chronic conditions requires addressing the needs of their caregivers. This study aimed to elucidate how African American females caring for older adults view health and the factors that influence health. We identified African American women ages 24 to 64 caring for an adult 60 years or older for group concept mapping (GCM), a mixed-methods approach. Participants (N=25) first completed idea generation by providing unlimited short, free-text responses to the focus prompt, “A healthy life for a caregiver includes: ___.” The 512 identified factors were reduced to 99 unique ideas. Participants then sorted the 99 ideas into clusters based on conceptual similarity and rated each idea on desirability and familiarity. Ratings were recorded on a 5-point Likert scale, ranging from very undesirable to extremely desirable and not at all familiar to extremely familiar. Data were analyzed and mapped via CS Global Max software. A cluster map with 12 outcome domains best fits the data. Identified clusters included: (1) Spirituality, (2) Maintaining relationships, (3) Good character, (4) Action to cope, (5) Preserving self, (6) Support, (7) Personal empowerment, (8) Resources, (9) Release (10) Striving for peace, (11) Wellness, (12) Self-care. Seven of the 99 ideas (representing 5 of 12 domains) were rated as desirable but unfamiliar (“go zone”). We identified elements necessary for health and wellbeing from the perspective of African American caregivers. Go-zone items represent opportunities to intervene to promote the health of African American women caring for older adults.
DEMENTIA FAMILY CAREGIVERS’ EXPERIENCES WITH A NURSE-LED MEMORY CARE CLINIC
Authors: Kovaleva Mariya A , Jennings Bonnie M , Clevenger Carolyn , Song Mi-Kyung , Griffiths Patricia C , Hepburn Ken
Published: November 2019

The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide both dementia care and primary care. We explored the experiences of informal caregivers of persons living with dementia at the IMCC during their first year post-enrollment. Twelve caregivers completed semi-structured telephone interviews that lasted 29 minutes on average. The data were analyzed via directed content analysis guided by attention only to caregivers’ accounts of their experience at the IMCC. Caregivers’ experiences clustered around two major considerations: the strengths of the IMCC, and ways to enhance the IMCC. Overall, caregivers’ viewed the IMCC as their wished-for care model. Caregivers felt a sense of belonging to the IMCC team, as they understood that the IMCC personnel incorporate caregivers’ input to deliver care. Participants valued APRNs’ competence in dementia care and having direct telephone access to an on-duty APRN around the clock. Caregivers appreciated the care organization at the IMCC with adequate time dedicated for in-person visits. Areas for the IMCC improvement included clarifying the IMCC scope of practice, explaining dementia progression, involving physicians, and providing more medical and non-medical resources at the IMCC. Caregivers’ willingness to have more resources provided by the IMCC emphasizes how many unmet needs caregivers and their persons have. Clarification of the clinics’ scope of practice – what can be done to manage dementia, its symptoms, and comorbidities – highlighted the need to educate caregivers about ways in which dementia, albeit incurable, can be managed.
ADVERSE CONSEQUENCES OF UNMET NEEDS AMONG INDIVIDUALS WITH DEMENTIA: THE ROLE OF PAID CAREGIVING
Authors: Reckrey Jennifer M , Hua Peiying , Ornstein Katherine
Published: November 2019

Individuals with dementia may enlist help from paid caregivers (i.e. home health aides, personal care attendants) to address increasingly complex care needs. Yet it is unclear what specific tasks paid caregivers help with and how this is related to the individual’s experience of unmet care needs. We used data from the 2015 National Health and Aging Trends Study (NHATS) to examine the association between type and intensity of individual paid caregiver tasks and adverse consequences of unmet needs among community-dwelling adults with dementia. Nearly one half (46%) of those with any functional impairment reported an adverse consequence of an unmet need (e.g., inability to go outside because of lack of help). Individuals who experienced adverse consequences were more likely to receive paid caregiving (37.9% vs. 21.4%, p<0.01). Those who received paid care with an individual task (e.g. toileting) were more likely to report an adverse consequence related to that task (e.g. remaining in wet or soiled clothes 50.2% vs. 41.0%, p=0.21). Paid caregivers provided a median of 15 hours of care per week. For those persons with dementia receiving less hours of care weekly, paid caregivers rarely helped with unscheduled or frequently recurring functional tasks like toileting or eating (<10% of the time). The help received by individuals with dementia was inadequate to meet their care needs. Paid caregiving will only be able to prevent adverse consequences of unmet care needs when the level of paid care provided is better matched to the care needs of the individual with dementia.
EFFECTIVENESS OF DIFFERENT INTERGENERATIONAL LEARNING PROGRAMS FOR ELDERS WITH MILD COGNITIVE IMPAIRMENT
Authors: Lin Li-Chan
Published: November 2019

The purposes of this study was to investigate the efficacy of interpersonal relationships, cognition, instrumental activities of daily living, depression for elderly with cognitive impairment through intervention using the intergenerational somatosensory video game and company. The experimental design was used for this study. Eighty-nine elders with mild cognitive impairement and 180 adolescents were from nine junior and senior high school were recruited in this study. Eight day care centers were randomly assigned to the experimental group I (EGI) (5-week intergenerational somatosensory video game), the experimental group II (EGII) (8-week intergenerational somatosensory video game), the experimental group III (EGIII) (5-week intergenerational company), the experimental group IV (EGIV) (8-week intergenerational company) and control group for eight weeks of routine activities. Subjects were interviewed using structured instruments, including the Instrumental Activities of Daily Living (IADL), Token test, and Geriatric Depression Scale. Obtained data was analyzed using the Generalized Estimate Equation (GEE). The results revealed that there was no significant difference of eldsers’ characteristics among five groups. After intervention, instrumental activities of daily living scores in 8-week intergenerational somatosensory video game (EGII) and 8-week intergenerational company groups (EGIV) were significantly better than the control group. Token test score in 8-week intergenerational company (EGIV) were significant higher than that in the control group; while depression in 5-week intergenerational company (EGIII) was significantly lower thatn that in the control group. Based on the research findings, to arrange intergenerational action video game and intergenerational company to enhance elders’ attention, instrumental activities of daily living and decrease depression.
GREATER DEMENTIA SEVERITY IS ASSOCIATED WITH INCREASED RISK OF POTENTIALLY PREVENTABLE READMISSIONS DURING HOME HEALTH CARE
Authors: Knox Sara , Downer Brian , Haas Allen , Middleton Addie , Ottenbacher Kenneth
Published: November 2019

Approximately 14.0% of Medicare beneficiaries are readmitted to a hospital within 30-days of home health admission. Individuals with dementia account for 30% of all home health care admissions and are at high-risk for rehospitalizations. Our primary objective was to determine the association between dementia severity at admission to home health and 30-day potentially preventable readmissions (PPR) during home health care. A secondary objective was to develop a dementia severity category from OASIS items based on the Functional Assessment Staging Tool (FAST). Retrospective cohort study of 124,119 Medicare beneficiaries receiving home health (7/2013 – 6/2015) and diagnosed with dementia (ICD-9 codes). The primary outcome was 30-day PPR during home health. The predictor variable of dementia severity was categorized into six levels (non-affected to severe). The overall rate of 30-day PPR was 7.6% (95% CI 7.4, 7.7) but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, patients classified as stage 6 and stage 7 had 1.36 (95% CI 1.28, 1.45) and 1.90 (95% CI 1.59, 2.26) times higher odds to experience a 30-day PPR compared to patients classified as stage 1-2. Dementia severity in the later stages is associated with increased risk for PPR. Development of a dementia severity category based on OASIS items and the FAST is feasible. Future research is needed to determine effective strategies for decreasing PPR during home health for individuals with severe dementia. Future research is needed to validate the proposed dementia severity categories used in this study.
PATIENT PRIORITIES CARE: GOAL-ALIGNED CARE FOR VETERANS WITH DEMENTIA AND THEIR CAREGIVERS
Authors: Freytag Jennifer , Dindo Lilian , Catic Angela , Naik Aanand
Published: November 2019

Patient Priorities Care (PPC) is an approach to clinical conversations that focuses on aligning care with patient priorities. This approach involves identifying and incorporating patient values, goals, and preferences into care for patients with multiple comorbid conditions. We have previously described how this clinically feasible and sustainable approach has been implemented in VA and private healthcare settings, and how this approach results in documented care aligned with patient goals. In this paper, we describe the way PPC has been adapted and implemented in a VA geriatrics clinic for Veterans with dementia and their caregivers. We discuss results from a funded pilot project in which we investigated the role of caregivers in patient goal setting; assessed patient functioning using self-reported and sensor measures; and examined clinical conversations and interviews. We use these results to discuss implementation strategies targeting: (1) caregiver activation and involvement in clinical conversation and decision-making, (2) patient and caregiver education about the disease trajectory of dementia, (3) life space function and using physical sensor data in dementia care, (4) measures of community integration for patients and caregivers, and (5) features of successful clinical conversations in this context.
INDOOR AND OUTDOOR FALLS AMONG ADULTS AGING WITH A PHYSICAL DISABILITY
Authors: Eagen Thomas J , Mroz Tracy , Chippendale Tracy , Karvonen-Gutierrez Carrie , Battalio Sam , Singsank Katie , Molton Ivan
Published: November 2019

Falls among community-dwelling adults are a significant public health concern. Adults aging with a physical disability report a high number of falls, recurrent falls, and injuries caused by falls. Prevention strategies are needed to reduce the incidence of falls among this population; however, the location of the fall may influence which strategies will be most effective. The purpose of this project was to examine falling indoors versus outdoors was associated with fall related psychological concerns (e.g., self-efficacy), self-reported physical activity levels, physical function and sociodemographic characteristics (e.g., sex, age, education, employment), using survey data of adults aging with four conditions: muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), and spinal cord injury (SCI). Of the 1381 participants who completed the survey in 2017, 52% (n=719) reported at least one fall in the past 6 months. When asked about their worst fall, 32% of falls (n=233) occurred outdoors and 68% (n=486) occurred indoors. Participants with MS were significantly more likely to report falling outdoors (MS=35%, MD = 21%, PPS = 21%, SCI = 24%). Factors significantly associated with outdoor falls included living in an urban environment (OR = 1.59; 95%CI:1.06, 2.39), being more physically active (OR = 1.01; 95%CI:1.001, 1.02) and having better physical function (OR = 1.05; 95%CI:1.03, 1.08). These results fill a critical gap in the falls literature on fall location and have important implications for tailoring fall prevention interventions for individuals aging with a physical disability.
ASSOCIATION OF ATTITUDES WITH ECONOMIC WELL-BEING AND HEALTH: A FOUNDATION FOR PUBLIC POLICY
Authors: Laditka Sarah B , Laditka James N , Gunn Laura
Published: November 2019

The 1960s War on Poverty was based on expectations that certain attitudes could improve health and economic well-being: aspiration and ambition, propensity to plan, personal efficacy, avoidance of unnecessary risk, connectedness to information and help, and trust. If true, promoting those attitudes might improve lives. The nationally representative Panel Study of Income Dynamics (PSID) developed scales to repeatedly measure associations of those attitudes with income and well-being. After five annual measurements, researchers found few associations. Acknowledging more data might be needed, researchers concluded that changing attitudes was unlikely to help. We studied those same associations using five decades of PSID measures on income and work disability, physical or “nervous” health problems limiting work (1968-present; n=5,027; 170,583 person-years; mean baseline age 34.2), with multinomial logistic Markov models and dynamic microsimulation, modelling three levels of each outcome plus death. We also examined persistence of the attitudes (measurement reliability). Results suggested the attitudes were persistent (intraclass correlations > 0.87). Controlling for age, sex, race, education, and baseline income, attitudes were strongly associated with the outcomes. For example, with above-median baseline income, 19.4% in the top baseline self-efficacy quintile had incomes below 150% of poverty at age 70, compared with 27.0% in quintile 1 (p<0.001). Similarly, 5.5% in the highest quintile reported severe work disability (could not work, or limited “a lot”) at age 70 compared to 23.7% in the lowest (p<0.001). Other attitudes showed similar significant patterns. Attitudes in early- to mid-adulthood may contribute importantly to economic well-being and health throughout later life.
PSYCHOLOGICAL MECHANISMS THAT UNDERLIE GOAL EXPECTANCY AMONG RETIREES
Authors: Tsotsoros Cindy , Mooney Anna , Earl Joanne , Hershey Douglas
Published: November 2019

The way individuals envision, formulate, and strive to meet retirement goals is poorly understood. In particular, few studies have focused on the goal setting process of individuals who have already retired. In this investigation, the authors replicate and extend Hershey and Jacobs-Lawson’s (2009) model of retirement goal expectancy across five retirement resource domains. Their (path) model posits individuals’ perceptions of the consequence of failing to achieve a goal determines the perceived importance of the goal. Perceived goal importance, in turn, determines the effort individuals allocate toward achieving the goal (goal striving). And goal striving, in turn, predicts the perceived likelihood the goal will be achieved (goal expectancy). This basic model was empirically tested across five key retirement resource domains (health, physical, social, cognitive and emotional) identified by Wang and Shi (2013). The sample of 698 American retirees (Mage=77.14 years, SD=6.00) was divided into four subgroups: males and females, aged 66-77 and 78-94. Twenty theoretically-driven path analysis models were tested using AMOS (i.e., four subgroup models across five retirement domains). Differences were observed across subgroups and domains in terms of the magnitude of path coefficients and the amount of accounted variance in goal expectancy criterion measures (R2 values ranged from .26-.67). Overall, the path model was effective at capturing variability in retirement goal expectancy. Findings not only provide a synthesis of the 2009 goal model with Wang and Shi’s Dynamic Resource Theory, but they also suggest areas in which retirement intervention specialists can intercede to increase the likelihood of goal attainment.
RETIREMENT ADJUSTMENT: COMPARISON AMONG CHINESE, JAPANESE, AND KOREAN RETIREES
Authors: Yeung Dannii , Nakagawa Takeshi , Cho Jinmyoung
Published: November 2019

Moving into retirement is a stressful life event. However, recent research findings suggest that not every retiree experiences maladjustment. This paper investigated longitudinal changes in depressive symptoms during the retirement transition utilizing harmonized data of CHARLS, JSTAR, and KLoSA. Participants were selected for examination if meeting the following criteria: They were working in Wave 1 and had retired in Wave 2 (China=1053; Japan=184; Korea=706). These participants were categorized into two subgroups based on their status in Wave 3, either remained retired or reemployed. The proportion of retirees who were reemployed in Wave 3 is significantly higher in Korea (49.3%) and China (41.1%) than in Japan (17.4%). In each wave, the level of depressive symptoms was measured by the 10-item CES-D scale. Results of the repeated measures analyses show that, even after controlling for gender, mean level of depression increased over time among Korean retirees [F(2,702)=3.65,p=.026,η2=.010], whereas Japanese retirees’ depressive symptoms only increased in Wave 2 (Mean Difference =.83,SE=.39,p=.034) but not in Wave 3. Among Chinese, depressive symptoms did not significantly worsen after retirement, but the changes varied between retired persons and those who were reemployed in Wave 3 [F(1,1030)=4.25, p=.040, η2=.004]. Specifically, individuals who were reemployed after retirement experienced a reduction in depressive symptoms between Wave 1 and 3, whereas a reverse pattern is shown among retirees. This suggests that reemployment is beneficial to the well-being of Chinese retirees. The effects of socioeconomic factors (e.g., private and public health insurance and pension support) on depressive symptoms will be discussed.
EVALUATING THE FEASIBILITY AND EFFICACY OF A PILOT INTERVENTION TARGETING UNEMPLOYED OLDER WORKERS
Authors: Yang Jie
Published: November 2019

The great recession of 2007–2009 has led to historically high unemployment rates, and almost half of the unemployed population was long-term unemployed in 2010. Both discriminations against the long-term unemployed and ageism hinders older unemployed workers reentering the workforce, and they risk severe mental health deterioration. However, traditional job training programs are shown to be ineffective in protecting their participants’ mental health. Hence, adopting Jahoda’s Latent Deprivation Theory, the author worked with a non-profit in the Greater Boston area on developing an innovative intervention targeting older unemployed older workers’ mental health and income generation outcomes. The pilot intervention (lasting three months) created a quasi-office environment where participants can have a time structure, engage with peers, work on projects, and receive training. The current study evaluates the effect of this pilot program on multiple mental health outcomes. Pre-and-post comparisons were conducted using quantitative analysis (N=13). Participants’ depressive symptoms dropped significantly, and they reported having a better time structure of the day as well as higher scores in extraversion in terms of personality change. Qualitative analyses were conducted to analyze the pre-and-post interviews. Participants reported overwhelming approval of the intervention in helping them better cope with unemployment and being productive in seeking jobs or generating incomes. One example of quotes is “…compared to three months ago, I’m in a very different place. Before the Collaboratory, I had become extremely depressed and withdrawn…The Collaboratory has helped make a massive difference in my sense of well being right now.”
PRECARIOUS PATHWAYS INTO RETIREMENT AND NEW RISKS FOR GENDERED ECONOMIC EXCLUSION IN SWEDEN, 1990-2015
Authors: Motel-Klingebiel Andreas , Kelfve Susanne
Published: November 2019

The ability and disposition of ageing people to maintain their labour market activity and/or to retire from work structurally depend on pension systems, activation policies, ageism, changing for labor demand and economic shifts. Structural conditions are changing, but social change does not mature homogeneously and neither do the institutional shifts induced by it. Gains in opportunities and resources do not benefit all people, groups and even societies in the same way. Changes increase insecurities and life course inhomogeneity, create unequally distributed challenges and show asynchrony in shifts and outcomes. They generate new precarity in ageing and socially structured risks for exclusion in work and retirement and refer to existing later life inequalities by cohort, gender, region, education, class and ethnicity. From this perspective of ageing and social change, the paper deals with shifts in late work and retirement patterns and later-life outcomes under changing institutional conditions, focusing on gendered risks for economic exclusion and later life precarity in Sweden. Swedish registry data comprising individual work and health histories as well as employer, regional and neighborhood information on the total population 50+ ever living in Sweden 1990-2015 is used in a cohort sequential perspective. Analyses focus on gender inequalities and concentrate on occupational activities, retirement transitions and pension revenues under changing social conditions. Models find increasingly heterogeneous preretirement and transition patterns, new gender gaps and increasing risks of economic exclusion in retirement with disadvantaged groups as forerunners in overall relative declines in later-life economic positions.
DOES CAREGIVING MATTER? THE RELATIONSHIPS BETWEEN CAREGIVING EXPERIENCE AND ADVANCE CARE PLANNING IN OLD AGE
Authors: Shen Huei-wern
Published: November 2019

Advanced care planning (ACP) is encouraged as the completion of ACP increases the likelihood for patients to receive their preferable end-of-life care and for caregivers to be less stressed. Common approaches to increase the engagement of ACP target on intervention or information provision to patients in the very late stage of life. Arguing that caregiving experience may influence how people plan their own end-of-life care, the present study focuses on caregiving roles. Using seven waves of data (2002, 2004, 2006, 2008, 2010, 2012, and 2014) from the Health and Retirement Study (HRS), 863 older people who were 65+ and alive in 2012 but passed away prior to 2014 were included in this study to examine the relationships between an individual’s caregiving experience (2002-2012) and his/her completion of ACP (2014). Findings from logistic regression showed that caregiving experience did not influence older adults’ (65+) ACP completion in 2014. When considering different types of caregiving experience (none, spousal, parental) among older cohort (75+), the odds of completing ACP for those with spousal caregiving experience were 2.47 times more likely than those without any caregiving experience. However, no relationship was detected among those with parental caregiving experience. Other factors relating to ACP completion were poorer health, death being expected, death due to cancer, older age and being racial minorities. Practitioners and policymakers could consider encouraging older adults (65+) who provide spousal care to engage in ACP. Future research taking longitudinal approaches to identify reasons behind the existence of the relationship is urged.
A COMMUNITY HEALTH EDUCATION PROGRAM TO ENCOURAGE EXERCISE AND PROPER NUTRITION IN LATINOS
Authors: Kopera-Frye Karen , Graboski-Bauer Ashley , Gonzalez-Marquez Ana Luisa
Published: November 2019

New Mexico now has the 32nd highest adult obesity rate (28.8% for 2015). Thirty one percent of this obesity rate encompasses Latinos; rates are the highest among the 26-44 years age group. Obesity rates in NM for children aged 2-11 range from 11 – 14%. Healthy Kids New Mexico adopted the 5-2-1-0 challenge. (American Academy of Pediatrics) which refers to eating 5+ vegetables, reducing screen time to 2 hours, 1 hour+ daily activity, and daily water intake (H20). Therefore, project I’M HIP2’s main goal was to educate parents and children, within an intergenerational context, on improving diet and activity levels to reduce obesity. The Intergenerational Mentoring on Health Information Pathways 2 (I’M HIP2) program involved 74 Hispanic families including one target child, one parent, and one other relative, e.g., aunt or grandparent. Monthly educational sessions focused on physical activity and adapting meals to be healthy. Project outcomes included exercise frequency, Body Mass Index (BMI), and a knowledge quiz assessing healthy meal facts, exercise knowledge via a 10-item quiz; all assessments pre- and post-program. Paired t-test analyses revealed significant changes in knowledge quiz total scores (t 70 = 5.03, p < .0001), increased exercise frequency (t 72 = 2.106, p < .05); no significant change in BMI from pre- to post-assessments. The families reported overwhelmingly positive responses to how the program had changed their eating styles and activity levels. This study has implications for how we can harness this invaluable resource of the generations to affect health impacts on Hispanic families.
AN ACADEMIC-COMMUNITY PARTNERSHIP FOR IMPROVING ORAL HEALTH OF ADULTS 75-PLUS YEARS IN RURAL SOUTHEASTERN OREGON
Authors: rose tamara , mize darcy
Published: November 2019

This presentation describes a series of research projects undertaken by a school of nursing to develop and test a model for interprofessional (IPE) practice and education. A pilot study and two funded projects have been completed and one funded project is currently underway. A goal has been to build an academic-community partnership to address health disparities for people 75 years and older living in rural areas of the state. This population is growing and more apt to be living in poverty. Low oral health literacy and limited dental health services in rural areas contribute to the likelihood of oral health problems impacting overall health. IPE supports the development of teamwork to improve health outcomes for patients by raising awareness about the relationship of oral health to overall health. This evolving IPE model has joined baccalaureate nursing and dental hygiene students in shared learning and practice. After classroom and simulation-based learning, student teams provided screening and education in primary care settings. The current study has expanded team membership by adding medical, dental and/or nutrition students. They are training and practicing together to be a “mobile oral health team” for older adults living in a rural community 100 miles from campus. Community stakeholders are helping to organize a day-long oral health screening clinic. Looking forward, this IPE model supported by an academic-community partnership will routinely visit chronically underserved areas with a mobile oral health team. Funding for a fully-equipped mobile unit are being sought to sustain this effort.
GAINING INTERPROFESSIONAL COMPETENCE THROUGH A GERIATRICS CASE CONFERENCE
Authors: McIlwain Amber S , Backus Danielle , Marcus Kristine , Fortner Jeff
Published: November 2019

There is increased demand to provide health professions students with interprofessional education and practice experience. Interprofessional Case Conferences (ICC) allow students to work in teams to learn about different professions while exploring a topic through the lens of an interprofessional core competency. The goal of this particular ICC was to provide students an experience to witness and discuss team-based, person-centered care for a common geriatric disorder. The case was designed to develop the interprofessional competency of teams and teamwork. Students were divided into teams and observed live vignettes of a care conference involving an 80-year old female admitted to a rehabilitation facility following a hip fracture and replacement. Students witnessed how patients, families, and healthcare providers work together during a stressful time. After each vignette, students discussed questions related to miscommunications, motivations of the different actors involved, and how the healthcare team should respond. In the first offering, 93 students participated, increasing to 150 in the next year. Students completed a post-survey to determine if the session delivered a positive interprofessional experience. The average positive response rate was 92.5% (92-94%, n = 53) in year-1 and 93.5% (90-97%, n = 71) in year-2. By allowing students to witness a simulated live care conference, they had a tangible event to dissect instead of discussing hypotheticals. By discussing a geriatrics case in a rehabilitation setting, students witnessed how numerous healthcare professions coordinate care for a patient and her family, thereby demonstrating competence in teamwork.