bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Social Support on Dementia Caregivers’ Psychological Well-being: Is Online Comparable to Offline?
Authors: Yi Eun-Hye
Published: December 2021

Along with the groundbreaking development of communication technology, caregivers have migrated to online platforms to seek help. Social support theory, including main effect and moderation effect models, has provided a framework to understand the association among caregivers’ stress, support from others, and their well-being. Despite the prevalence of online use for seeking help among caregivers, studies on the use of online social support within the context of caregivers’ stressors and well-being are still underdeveloped. Guided by social support theory, this study aimed to examine the association of online social support (OnSS) and caregivers’ mental health (MH) as compared with offline social support (OffSS). A subsample of caregivers of persons with Alzheimer’s from the Health Information National Trends Survey from 2017-2018 was selected (n=264). For an analysis, ordered logistic regression models with Jackknife estimation methods were applied using Stata 15.1SE. First, OffSS had a positive direct association with caregivers’ MH (Odds Ratio=12.48, p<.05) while OnSS did not. Next, the moderation effect model analysis found that OffSS interacted with caregiving burden while OnSS interacted with life stressors. The MH of caregivers who are in less favorable situations, such as working part-time while caring for a person with Alzheimer’s, living with economic hardship, and having health problems, tended to be significantly affected by OnSS. Identifying the different roles of OnSS and OffSS for caregivers’ MH, the findings of this study call for more attention to developing novel strategies and sensitive approaches to support family caregivers, especially those who fall in underserved groups.
Caregiving Self-efficacy as a Mediator of Negative Emotional States and Potentially Harmful Behaviors
Authors: Hancock David , Czaja Sara , Schulz Richard
Published: December 2021

Potentially harmful behaviors (PHB), such as wanting to scream at or hit a care recipient, are more likely when caregivers experience higher levels of stress. The current study expands on this research and identifies caregiving self-efficacy (SE) for dealing with disruptive behaviors as a mediator of the relationship between caregiver distress and PHB. Multilevel mediation models were tested using a sample of 244 caregivers of persons with dementia assessed three times over a one year period. In two separate models, SE mediated the relationship between caregiving burden/depression and the frequency of wanting to yell or scream at the care recipient in the past six months. Individuals with higher levels of depression and burden had lower levels of SE for dealing with disruptive behaviors. As SE decreased, the risk of potentially harmful behaviors increased. This mediation effect occurred at the within and between subject levels of the model. A significant indirect effect at the within-person level suggests that at timepoints where caregivers experienced more distress, they had lower self-efficacy and increased PHBs. Similar effects were observed at the between person level. These data suggest that both caregiver distress and self-efficacy are important intervention targets for minimizing PHBs.
Cognitive-Behavioral Dementia Caregiving Styles: Associations With Care Stress and Well-Being
Authors: Leggett Amanda , Connell Cathleen , Gitlin Laura , Kales Helen
Published: December 2021

While Stress Process Models of family caregiving have been examined extensively, little focus has been placed on caregiver’s actual management of care. We consider whether caregiving style classified previously through k-modes machine learning models and based on cognitive-behavioral approaches to care impact caregivers’ experiences of care-related stress and well-being. The three previously identified styles include: Adapters- strong dementia understanding and adaptability, encouraging behavioral approach; Managers- poor dementia understanding and adaptability, critical behavioral approach; and Avoiders- moderate dementia understanding and adaptability, passive behavioral approach. Participants included 100 primary family caregivers for PWDs who were on average 64 years old, 74% female, and 18% non-White. Utilizing linear regressions, each caregiving style was considered a key predictor (reference: Adapters) of the Zarit Burden Interview (ZBI), Caregiver Assessment of Function and Upset (CAFU) upset score, Neuropsychiatric Inventory (NPI-C) distress scale, and Positive and Negative Affect scale (PANAS) controlling for dementia severity, care duration, co-residency, and demographics. Relative to Adapters, Managers had more CAFU upset (β=0.4, p<.001), more NPI-C distress (β=0.4, p<.001), and greater burden (ZBI) (β=0.3, p<.001). Avoiders showed significantly greater CAFU upset than Adapters (β=0.2, p<.05). Positive affect was not associated with caregiving style. Caregiving styles associated with less understanding and adaptability and a more critical behavioral approach showed worse caregiving outcomes accounting for dementia severity. Results can inform a nuanced approach to tailoring and targeting interventions based on caregiver styles with the goal of reaching caregivers at risk for poor outcomes and ultimately leading to significant public health impact.
Family Caregivers' Feelings of Preparedness for the Transition to End-Of-Life Caregiving
Authors: Fox Aimee , Sharp Julia , Fruhauf Christine
Published: December 2021

Family caregivers are vulnerable to emotional, psychological, physical, and financial stress during their care receiver’s end-of-life (EOL), and often do not have the knowledge or skills to provide the care needed at EOL. Yet, few studies have examined how prepared caregivers feel for making the transition to EOL care. The purpose of this exploratory study was to investigate how family caregivers perceive their preparedness for the transition to providing EOL care, and factors that may be associated with feelings of preparedness. Family caregivers (N = 252) providing care to an adult family member for more than six months were recruited to complete an online, self-report survey. An exploratory factor analysis was conducted to break down the construct of caregiver preparedness. One-way ANOVAs and a multiple regression were conducted to examine factors associated with preparedness. Most caregivers feel less prepared for the transition to EOL care (M = 2.67, SD = 1.17) than for general caregiving responsibilities (M = 3.42, SD = 0.90). Factors associated with preparedness for EOL caregiving included the familial relationship between the family caregiver and care receiver, hours per week providing care, perceived burden of caregiving, and family conversations completed about advance care planning, legal and financial matters, and EOL wishes. Future studies should explore how to help family caregivers recognize the importance of seeking support from family members and community services and discussing EOL care wishes and plans with aging family members so they can provide effective care and protect their own well-being.
Sleep Quality in Family Caregivers and Matched Non-Caregiving Controls: The REGARDS Study
Authors: Blinka Marcela , Spira Adam , Sheehan Orla , Cidav Tansu , Rhodes J David , Howard Virginia , Roth David
Published: December 2021

The high levels of stress experienced by family caregivers may affect their physical and psychological health, including their sleep quality. However, there are few population-based studies comparing sleep between family caregivers and carefully-matched controls. We evaluated differences in sleep and identified predictors of poorer sleep among the caregivers, in a comparison of 251 incident caregivers and carefully matched non-caregiving controls, recruited from the national REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Incident caregivers and controls were matched on up to seven demographic and health factors (age, sex, race, education level, marital status, self-rated health, and self-reported serious cardiovascular disease history). Sleep characteristics were self-reported and included total sleep time, sleep onset latency, wake after sleep onset, time in bed, and sleep efficiency. Family caregivers reported significantly longer sleep onset latency, before and after adjusting for potential confounders, compared to non-caregiving controls (ps < 0.05). Depressive symptoms in caregivers predicted longer sleep onset latency, greater wake after sleep onset, and lower sleep efficiency. Longer total sleep time in caregivers was predicted by employment status, living with the care recipient, and number of caregiver hours. Employed caregivers and caregivers who did not live with the care recipient had shorter total sleep time and spent less time in bed than non-employed caregivers. Additional research is needed to evaluate whether sleep disturbances contributes to health problems among caregivers.
Frailty and Macronutrients Intake Among Older Brazilian Adults
Authors: Freiria Carolina , Silva Graziele , Hara Larissa , Brito Tábatta , Borim Flávia Arbex Silva , Corona Ligiana
Published: December 2021

The adequate nutrition has an important role in the prevent and treatment of frailty, however, there are only few studies showing the relationship between macronutrients intake and this geriatric syndrome, especially in Latin countries. The aim of this study was to analyze the association between macronutrients intake and frailty among older adults in Brazil. This study included 521 community-dwelling individuals aged 60 years old or older. Frailty was assessed using a self-reported instrument and individuals were categorized in two groups: frail and non-frail (robust + pre frail). Food consumption was evaluated using the 24-hour recall and the software NDSR®. Differences between groups was assessed using the Mann Whitney test. The prevalence of frailty was 42.0%. Older adults considered frails presented lower intake of calories (1510.9 kcal vs 1639.3 kcal; p = 0.016), carbohydrates (196.8 g vs 213.3 g; p = 0.011), proteins (60.7 g vs 68.5 g; p = 0.016) and fiber (15.1 g vs 17.5 g; p= 0.002). They also had lower intake of protein per kilograms of weight (0.88 g/kg vs 0.99 g/kg; p= 0.010). The findings demonstrate high prevalence of frail in our sample, and that intake of most macronutrients was significantly lower among older adults with frail, indicating the importance of the screening of frail as well the evaluation of macronutrients intake among community-based older adults, to prevent malnutrition, sarcopenia and frailty in this population.
Frailty in a Frailty Prevention Program Participants During COVID-19 pandemic: A Cross-Sectional Japanese Study
Authors: Kanamori Takuya , Suzuki Mizue , Naito Tomoyoshi , Inagaki Keigo , Umegaki Hiroyuki
Published: December 2021

Objective: Health conditions of older adults have deteriorated during the COVID-19 pandemic. Few studies have reported on the frailty of this group of people. The study aimed to investigate physical and social frailty in participants in a frailty prevention program during the COVID-19 pandemic. Methods: A cross-sectional survey was conducted in Japan from January 2021. Further, 863 participants of a frailty prevention program completed the survey. The frequency of program attendance in 2020, physical frailty (5-item frailty screening index), social frailty（diagnostic criteria of social frailty in NCGG-SGS), and depression (GDS-5) were assessed. A related factor of physical frailty was analyzed statistically by Welch's t test and the Chi-squared test. Results: The study participants’ mean age, proportion of women, and mean enrollment period in program were 86.8±4.9, 96.3%, 64.3±48.6 months, respectively. The program attendance ratio was 83.4% from January to March, 54.5% from April to June, 79.8% from July to September, and 80.0% from October to December. The prevalence of physical frailty was 20.3% non-frailty, 63.7% pre-frailty, and 15.6% frailty. The prevalence of social frailty was 10.0% non-frailty, 28.6% social pre-frailty, 61.8% social frailty, and the prevalence of depression was 36.8%. Participants with physical frailty were significantly older and showed higher prevalence of social frailty and depression, displaying significantly lower attendance program than non-frailty and pre-frailty older adults (p<0.05). Conclusions: The study results suggest that more than half of the participants of a frailty prevention program have social frailty and a high risk of physical frailty due to COVID-19.
Exercise Modality Affects Older Adult CT-Derived Muscle and Bone Loss During Caloric Restriction
Authors: Weaver Ashley , Madrid Diana , Greene Katelyn , Walkup Michael , Ambrosius Walter , Marsh Anthony , Rejeski W Jack , Beavers Kristen
Published: December 2021

Caloric restriction (CR) can exacerbate muscle and bone loss. We examined 18-month changes in computed tomography (CT)-derived trunk muscle, and volumetric bone mineral density (vBMD) and finite element-estimated bone strength of the spine and hip in 55 older adults randomized to CR alone or CR plus aerobic (CR+AT) or resistance (CR+RT) training. Trunk muscle area loss trended higher with CR+AT [−16.8 cm2 (95% CI: −26.4, −7.1) vs CR: -6.7 (−12.8, −0.5), CR+RT: −9.0 (−14.5, −3.4)]. Spine vBMD loss trended higher with CR+AT [−0.014 g/cm3 (−0.027,−0.001) vs. CR: −0.005 (−0.022,0.012), CR+RT: −0.004 (−0.019,0.011)], and similarly for vertebral bone strength. Hip vBMD losses trended lower with CR+RT [−0.015 g/cm3 (−0.024,−0.006) vs. CR: −0.027 (−0.036,−0.019), CR+AT: −0.029 (−0.037,−0.020)]. Hip vBMD and trunk muscle losses were positively correlated (r=0.53), and spine vBMD loss tended to increase with trunk muscle loss (r=0.21) and fat infiltration (r=0.17). Collectively, aerobic training was less effective at preserving muscle-bone health during CR.
Implementation of 4M Age-Friendly Care in Arkansas Rural Primary Care Clinics Led to Improved Advance Care Planning
Authors: Tobey Leah , McAtee Robin
Published: December 2021

The 4Ms Age-Friendly Framework has been introduced and implemented into nearly 2,000 primary care practices across the United States by Geriatric Workforce Enhancement Program’s (GWEP) educational efforts. The AR Geriatric Education Collaborative, the GWEP in Arkansas, has provided monthly trainings to a rural federally qualified healthcare clinic system and educated clinicians about how to complete a Medicare Annual Wellness Visit (AWV) that was inclusive of an advance care plan. Specific educational training including the two main components of an ACP: living will preferences and medical power of attorney were reviewed as their role into “What Matters” was explained. Before 4Ms Age Friendly training, baseline data showed only 7% of older adults (OAs) had an established ACP in site 1 and 33% in site 2. After training, the rate of ACP rose to 47% in site 1 and 59% in site 2. During the training, not only were the two main components reviewed but case studies were provided about what questions to ask surrounding the “What Matters” question as a guide to further discuss an OAs wishes, priorities and end-of-life care. This project demonstrated that implementation of 4Ms Age-Friendly Care not only improves the completion of advance care plans but also further enhances the overall care of the older adult when “what matters” most to the older adults is known and communicated.
Medical/Pharmacy Students Interprofessional Older Adult Medication Interactions/Contraindications Project
Authors: Gugliucci Marilyn , Thieme Victoria
Published: December 2021

The University of New England College of Osteopathic Medicine (UNECOM) Geriatrics Education Mentors [GEM] program, established in 2014, pairs UNECOM students with older community living adults. GEM assignments focus on health review, medical humanities, and geriatrics training. Each year approximately 90 older adults participate in GEMs. In 2019, the GEM program was expanded with Geriatrics Workforce Enhancement Program (GWEP) grant funding to: include first year medical students, include 2 additional assignments (4 assignments over 10 months to 6 assignments over 18 months), and to create interprofessional student collaboration. In the new GEM Assignment 4: Medication Interactions/Contraindications, UNECOM students with their GEM compiled details on the GEM’s medication list (prescriptions, herbal, OTC); one of 4 Ms of Age Friendly Health Care. UNECOM students (84 pairs) were then assigned to UNE School of Pharmacy (SOP) students (42 SOP students had 2 UNECOM pairs) to conduct a “Lexicomp” (App) medication interactions and Beers Criteria review. UNECOM students documented findings with the SOP student partner; discussed the processes of review with their GEM and the resultant findings; documented the GEM’s questions and how the UNECOM student answered those questions; and discussed next steps for the GEM regarding options for different medications - especially follow up with their prescribing physician(s) for any noted interactions/contraindications. For GEMs with few medications, a mock medication list was assigned to ensure student experiences with medication reviews and GEM discussion. Although time intensive preparation is required, UNECOM & SOP students attained significant learning as did the GEM mentors.
The 4Ms in a Pandemic: A Survey of Training Needs Among Healthcare Professionals, Older Adults, and Community Members
Authors: Crittenden Jennifer , Elwell Abigail , Wihry David , Kaye Lenard
Published: December 2021

The University of New England, in collaboration with the University of Maine, received a five-year grant from the Health Resources and Services Administration (HRSA) to improve the health and well-being of Maine’s older adults through enhanced training under HRSA’s Geriatrics Workforce Enhancement Program (GWEP). As part of these efforts, stakeholder training needs assessment data were collected via a statewide electronic survey that was distributed to community members and providers throughout Maine. The survey, which focused on the 4M’s of Age-Friendly Healthcare, received 68 responses from older adults/community members (N = 26), program administrators (N = 12), along with community leaders, and those working in the public and non-profit sector (N = 13). A significant emphasis on social isolation, mental health, and grief and loss issues was noted and dominating themes centering on two dimensions of the 4M framework: “What Matters” and “Mentation.” Findings reflect an overriding priority by providers and consumers to keep older adults socially connected (28%, N = 34) and maintaining mental health and well-being during the pandemic (21%, N = 14). Qualitative response analysis identified additional COVID-19-related training topics such as: what to do if you or a loved one contracts coronavirus, how to handle grief and loss related to COVID-19, strategies for supporting loved ones during COVID-19, and socially distanced bereavement support. Results indicate a need to focus on meeting the emotional and mental health needs of older adults, as well as the importance of encouraging connections and mitigating the effects of social isolation during COVID-19.
Geroscience approaches to obesity
Authors: Bitto Alessandro , Kaeberlein Matt
Published: December 2021

Besides aging, obesity is the greatest risk factor for numerous chronic pathologies, including metabolic syndrome, type 2 diabetes, cardiovascular disease, hypertension, and cancer. Preventing and treating obesity would greatly reduce healthcare costs and the impact of the aging process, with estimated savings up to $145,000,000,000. Pharmacological interventions identified by geroscience may prove effective against diet-induced obesity. To test this hypothesis, we fed a 66% kcal/fat diet to nine-month-old C57Bl6/N mice for 6 weeks and treated them with either rapamycin, acarbose, or a combination thereof. Rapamycin, and to a lesser extent acarbose, prevented weight gain and fat accumulation in these mice. We detected increased expression of the Liver Activating Protein (LAP) isoform of the transcription factor CCAT/Enhancer Binding Protein β (C/EBPβ) in the liver of mice treated with rapamycin. C/EBPβ-LAP mediates some of the effects of caloric restriction on nutrient metabolism and increases lifespan in a mouse transgenic model. We tested whether independent activation of C/EBPβ-LAP would recapitulate the effects of rapamycin by treating mice on a high-fat diet with adefovir dipivoxil, a reverse transcriptase inhibitor that can activate LAP in vitro independently of mTOR inhibition. Adefovir dipivoxil reduced weight and fat mass accumulation in mice over the course of 6 weeks. Mice treated with adefovir dipivoxil showed increased expression of genes involved in β-oxidation and lipids mobilization, and reduced activation of fatty acid biosynthesis and lipid storage pathways. Our results identify C/EBPβ-LAP as a potential new target to improve lipid homeostasis in both aging and obesity.
A Cross Sectional Survey of Factors Influencing Healthcare Access in Older Women of South India
Authors: Sudhakar Sreejith , Jose Justin , Cherayi Shanuga
Published: December 2021

We examined the determinants of healthcare access barriers, treatment-seeking, and self-medication in older women aged 60 years and more, using a cross-sectional survey design. Using a structured interview format, we interviewed 1005 older women from 7 out of 14 districts in the state through a stratified random sampling procedure. Multiple linear regression analysis results reveal that older women's healthcare access barriers significantly increased when they experienced a long duration of multimorbidity alongside poor recognition of autonomy and basic amenities available at health facilities. However, confidentiality, the ability to pay for healthcare expenditure, and the type of health care significantly improved healthcare access. In factors influencing older women's delay in treatment-seeking, optimal instrumental functionality in daily living, optimal quality of life and access to healthcare services significantly reduced delay in treatment initiation. Whereas poor health-seeking behaviors, long duration of multimorbidity, and the quality of basic amenities at hospitals significantly increased treatment initiation delay and explained 13.6% of the variance. In factors influencing older women's use of self-medication, advancing age, living in rural areas, optimal functionality, perception of providers' respect for confidentiality were associated with increased self-medication frequency. Whereas, better wealth status, prompt attention to older women's health needs, and basic amenities at hospitals significantly reduced their self-medication practice. Therefore, the optimal functional abilities, fewer morbidities, and optimal health system responsiveness significantly reduce healthcare access barriers and self-medication while improving older women's treatment-seeking behaviors.
Patterns of Healthcare Costs Among Older Adults: Demographics, Health Personality, and Resilience
Authors: Arieli Rotem , Martin Peter
Published: December 2021

The purpose of this study was to examine healthcare costs of older adults in relation to demographic characteristics, individual health personality traits, and resilience. Data included 3,907 participants, 65 and older, collected by a large provider of Medicare Supplemental Health Insurance. The Health Personality Assessment*, Brief Resilience Scale, total healthcare cost, and demographic information were used. In our sample, the average healthcare cost was $13,283.69 (SD=30,784.87), ranging from $0–$989,084, and higher healthcare costs were found among older, male, and less health-neurotic (i.e., lower health-related anxiety) adults. Configural frequency analyses were conducted to identify “types” and patterns of healthcare costs by age and gender. The following significant patterns emerged: Women in the oldest group with high healthcare costs and women in the young-old age group who had low healthcare costs occurred significantly more than expected by chance, p<.01. Next, we hypothesized configuration patterns for resilience, health personality, and healthcare costs. Results confirmed the following “types” or patterns occurring more often than expected by chance: less-resilient individuals with high health neuroticism and high healthcare costs, p<.001, and less-resilient, less-health-conscientious adults with high healthcare costs, p<.001. The results suggest higher healthcare costs for individuals who are less resilient, more neurotic about their health, and less disciplined in their health practices. Future intervention programs may benefit from promoting resilience, reducing health neuroticism, and increasing health conscientiousness. *The Health Personality Assessment (HPA) is © 2021 United HealthCare Services, Inc. All rights reserved.
Insufficient Sleep and Health Care Utilization: A Scoping Review
Authors: Olatunde Kolade , Patton Susan
Published: December 2021

Insufficient sleep is a common problem among older adults with 26% over the age of 65 reporting less than seven hours sleep in a 24 hour time period. Evidence indicates that untreated sleep disorders are associated with osteoarthritis, heart disease, hypertension, diabetes, obesity, falls, decreased cognitive performance, and decreased health related quality of life in older adults. A scoping review was undertaken to determine what is known about the association between insufficient sleep or insomnia and health care utilization. The Joanna Briggs Institute, Methodology for JBI Scoping Reviews was used to guide the review. Searches were conducted in PubMed, HINARI, Google Scholar and Cochrane databases. Twenty nine studies were included. Overall, the review indicates that reduced sleep is associated with a greater odds of difficulties in daily activities, higher rates of health care utilization and costs, and poly pharmacy. Findings also reveal sociodemographic and geographic variations in prevalence of healthy sleep duration. Although the majority of studies focused on the causes and consequences of insomnia and recommended clinical and behavioral health promotion interventions, there is a gap in studies related to the public health or economic impact of insufficient sleep. Research in this area will provide perspectives on the need to raise awareness of the importance of sleep and to incorporate the awareness into policies that improve sleep health.
Dependency, Mortality, Invisibility: Linking Childhood Disability with Life Course Health Outcomes
Authors: Hoyle Jessica , Laditka James , Laditka Sarah
Published: December 2021

People who experienced disability in childhood are living longer. It is not clear if longer lives indicate better health and less dependency, or if longer life is accompanied by increased dependency. We addressed that question by studying the joint dynamics of mortality and dependency. This population is “invisible” in most national surveys, which do not ask about childhood disability. We evaluated special education history as an indicator of childhood disability, and used that indicator to estimate dependency and life expectancy throughout adult life. Data: Panel Study of Income Dynamics and the Health and Retirement Study (n=20,563). Activities of daily living (ADLs), instrumental ADLs, and cognition defined five functioning levels including dependency and death. Multinomial logistic Markov models estimated probabilities for transitioning among the levels, with or without a history of childhood disability, adjusted for demographics. We used the probabilities in microsimulations, creating large populations of completed lives, identifying dependency at each age for each individual. Analysis showed special education history was a valid indicator of childhood disability; 13% had such history. With parent education less than high school, remaining life at age 20 was 46.0 years for people with that history, 58.3 for others; corresponding results with parent’s bachelor’s degree: 48.3 and 60.7 (p < 0.05). Corresponding population percentages dependent 5+ years were: 15.2% and 3.8%, 13.1% and 3.8% (all p<0.05). Special education history can indicate childhood disability. People with that history had significantly more dependency than others, and shorter lives. Accommodations and interventions can improve their health and functioning.
Health Behaviors in the LGB+ Population: Variation Across Adulthood
Authors: Noblitt Jessica , Barrett Anne
Published: December 2021

Health behaviors, which predict physical and mental health, are patterned by social factors, with some groups engaging in more health-enhancing behaviors than others. LGB+ people face more economic and social barriers to participation in healthy behaviors, along with the stress of discrimination that could lead to unhealthy behaviors to cope. Although some studies have examined variation in health behaviors by sexual identity, they focus almost exclusively on adolescents and young adults. However, such differences may decline across adulthood, as stress related to sexual identity declines with age among LGB+ individuals. Addressing this issue, we use data from the National Health Interview Survey (2016-2018) to examine differences by sexual identity in substance use, weight-related behaviors, healthcare utilization, and sleep. We compare the patterns across three age groups – young, middle-aged, and older adults. Results for each health behavior reveal that differences by sexual identity are indeed greatest among young adults. The magnitude is smaller in middle age, and no significant differences by sexual minority status are observed at older ages.
Failing to Complain: Do Nursing Homes with more Residents with Dementia have Fewer Complaints?
Authors: Bhattacharyya Kallol Kumar , Peterson Lindsay , Bowblis John , Hyer Kathryn
Published: December 2021

The majority of nursing home (NH) residents have Alzheimer’s Disease or Related Dementias (ADRD). However, the association of ADRD prevalence and NH quality is unclear. The objective of the current study is to understand the association of NH characteristics, including the proportion of ADRD residents, with the prevalence of NH complaints as an indicator of quality of care and quality of life. We merged data from the ASPEN Complaints/Incident Tracking System with national NH data from the Certification and Survey Provider Enhanced Reports, the Minimum Data Set, the Area Health Resource File, and zip-code level rural-urban codes in 2017. Three groups of NHs were created, including those whose proportion of residents with ADRD was in the top decile (i.e., high-dementia NHs (N=1,473)) and those whose proportion of ADRD residents was in the lowest decile (i.e., low-dementia NHs (N=1,524)). Bivariate results revealed high-ADRD NHs had higher percentages of Medicaid-paying residents, were less likely to be for-profit and chain-affiliated, had lower staffing hours and lower percentages of Black, Hispanic, and Asian residents. Using NHs in the middle deciles as reference, negative binomial regression models showed that having a low proportion of ADRD residents was significantly associated with higher numbers of total complaints (p<.001) and substantiated complaints (p<.001), whereas having a high proportion of ADRD residents was significantly associated with lower numbers of substantiated complaints (p=.001). The findings suggest the proportion of residents with ADRD in NHs is associated with quality, as measured by complaints. Policy implications of these findings will be discussed.
Who is Coming to Japan Under The New Status of Residence “Specified Skilled Care Workers”?
Authors: Tsukada Noriko
Published: December 2021

The Japanese government created a new status of residence called “Specified Skilled Workers” encompassing 14 job categories that have laborer shortages, including long-term care (LTC) workers on April 1, 2019. A survey of students (N=79) at a language institute in Manila, Philippines was conducted in February, 2020 to explore characteristics of future foreign LTC workers in Japan under this new status of residence and identify factors that may help facilitate worker retention. At the time of data collected, these students were studying both Japanese and LTC practices in order to pass skill evaluation tests to enter Japan. Students were asked their perceptions of long-term care, planned lengths of stay, concerns about staying in Japan, and future career plans. Preliminary analyses revealed that 67 (88%) were single, 74(93.7%) had graduated from universities, and a half of them had a nursing background. Most students (93.7%) showed interest in an extended stay in Japan, with some interested in taking the national certified care worker examination which permits extended work in Japan. The most cited concern about being in Japan was “weather, climate and typhoons” (28.1%), followed by “language proficiency” and “living expenses” (21.9%) respectively. As Japan has limited immigration policies but a large need for LTC workers, it is imperative to understand how to attract and retain foreigners who obtain the Specified Skilled Worker status. This includes addressing both work-related and living-related concerns and needs.
The Influence of Staff-Resident Interactions on Resistiveness to Care Behavior in Assisted Living
Authors: McPherson Rachel , Resnick Barbara , Galik Elizabeth
Published: December 2021

Resistiveness to care (RTC) is a behavioral and psychological symptom of dementia that is common among dementia residents in assisted living facilities. RTC encompasses verbal and nonverbal behaviors that oppose care, such as crying, grabbing, hitting, or yelling, among many other resistive behaviors. The quality of care interactions which can be positive, neutral or negative, have been associated with increased RTC. The purpose of this study was to test the association between quality of care and RTC. This was a secondary data analysis using baseline data from the Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) implementation study. Controlling for cognition, age, gender, medication use, and comorbidities, it was hypothesized that quality of care interactions would be associated with resistiveness to care. A linear regression analysis was conducted to test the hypothesis. The sample included 794 participants the majority of whom were white women with a mean age of 89.48 (SD=7.61). The mean RTC was .09 (SD=.41, range 0-13) and the mean quality of care interactions were 5.96 (SD=1.44, range 0-7). Based on the regression analysis there was no significant association between quality of care and RTC. These findings may be due to the high quality of care provided and limited RTC in this sample. Ongoing research is needed, however, to continue to explore these relationships and assure that all RTC is being reported among staff and that there is no evidence of negative quality of care interactions in these settings.
Age, Emotion Regulation, and Well-Being after the 2016 Flood
Authors: Cherry Katie , Bordes Piper , Calamia Matthew , Elliott Emily
Published: December 2021

In 2016, catastrophic flooding in south Louisiana claimed 13 lives with billions of dollars in damage to homes and communities in the decade after Hurricanes Katrina and Rita devastated the US Gulf Coast. In this study, we tested the inoculation hypothesis which predicts that older adults will be less distressed than younger adults due to their prior experience with severe weather events. Participants were 218 predominately middle-aged and older adults who varied in current and prior flood experience: less than half (40%) did not flood in 2016, 31% had flood damage, and 29% had relocated permanently inland after catastrophic losses in the 2005 Hurricanes Katrina and Rita and they flooded again in 2016. Depression symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9). Emotion regulation strategies were measured using the Cognitive Emotion Regulation Questionnaire-Short Form. Results indicated that the older adults had fewer symptoms of depression and were less likely to report self blame for flood-related adversities compared to younger adults. The two age groups did not differ significantly on the emotion regulation strategies of acceptance, reappraisal, positive refocusing, other blame, and perseveration. Age was inversely associated with symptoms of depression and the maladaptive strategies of self blame for flood-related misfortune and perseveration over losses. These data support the inoculation hypothesis and suggest that prior severe weather experiences, which are likely for older adults living in hurricane prone areas, are important for post-flood resilience. Implications of these findings for disaster planning and age-sensitive interventions to mitigate adversity are considered.
Comparing Cognitive and Physical Limitations as Predictors of Depression Among Older Adults
Authors: Scher Clara , Nepomnyaschy Lenna , Amano Takashi
Published: December 2021

Depression in older adults is associated with loss of functioning and increased mortality. While many factors contribute to depression among this population, activities of daily living (ADL) limitations and cognitive impairment have been identified as key risk factors. However, no study, to our knowledge, has examined the extent to which physical and cognitive limitations independently and jointly contribute to the risk of depression. The current study describes the prevalence and compares the independent and joint associations of these limitations with depression in a nationally representative sample of adults aged 51 and older in the US. Analyses are based on a sample of 17,044 repeated observations on 6,636 unique primary respondents from three waves of pooled data from the Health and Retirement Study. We estimate linear and logistic multivariate regression models investigating the association between ADL limitations (any limitation on Katz ADL scale), cognitive impairment (<12 on the TICS-27 scale), and depressive symptoms (8-item CES-D), controlling for a standard set of socioeconomic and health factors. First, we find that 66% of respondents report no limitations, 16% report only cognitive impairment, 11% report only ADL limitations, and 7% report both types of limitations. Multivariate analyses suggest that ADL limitations have a much stronger association with depression compared to cognitive impairment, and this association is robust across alternative specifications. In next steps, we will take advantage of the longitudinal nature of these data to estimate changes in these characteristics over time and within individuals and explore heterogeneity in associations across relevant groups.
Depressive Symptoms Mediate the Influence of Fibromyalgia Status on Physical Performance and BMI in Aging Adults
Authors: Serpas Dylan , Zettel-Watson Laura , Cherry Barbara
Published: December 2021

Fibromyalgia is a chronic pain condition that is frequently accompanied by comorbid conditions, including depression. Depression is associated with reduced physical functioning and health disproportionately affecting middle-aged and older adults with fibromyalgia. This study examined depressive symptoms as a mechanism through which FM status is associated with BMI and physical performance among adults in mid-to-late-life. Participants included 250 community-dwelling middle-aged and older adults (82% female) with (59%) or without (41%) fibromyalgia (M age = 64.44, SD = 9.16). Depressive symptoms were measured using the Beck Depression Inventory-II, BMI was objectively assessed, and physical performance was measured using the Fullerton Advanced Balance scale, 6-Minute Walk Test, 30-Second Chair Stand, and 8-Foot Up and Go Test. Physical performance measure analyses were adjusted for age. Asymptotic mediation analyses revealed that fibromyalgia status was indirectly associated with higher BMI (95% CI [.18, 16.74]), and poorer performance in the Fullerton Advanced Balance (CI [-2.93, -1.24]), 6-Minute Walk Test (CI [-73.75, -35.35]), 30-Second Chair Stand (CI [-2.45, -1.16]), and 8-Foot Up and Go test (CI [.35, .92]) via depressive symptoms. Participants with fibromyalgia reported greater depressive symptoms which was subsequently associated with greater BMI and reduced physical performance. Findings support depressive symptoms as one factor through which fibromyalgia status is associated with higher obesity risk and reduced physical function in middle-aged and older adults with fibromyalgia. This study supports fibromyalgia status as a critical consideration when evaluating the health and disability risk of aging adults.
Effective recruitment strategies for home-living vulnerable older adults with depression into a psychotherapy RCT
Authors: Kessler Eva-Marie , Hoppmann Fee , O’Sullivan Julie L , Gellert Paul , Tegeler Christina
Published: December 2021

Objectives: Vulnerable older adults, such as physically impaired or care-dependent individuals, are vastly underrepresented in psychotherapy research. Improving their inclusion in randomized controlled trials is necessary to determine the effectiveness of psychotherapy in this population. This study is the first to systematically evaluate strategies to recruit home-living vulnerable older adults with clinically significant depression into a large randomized controlled psychotherapy trial. Potential participants were approached directly (self-referral) or via cooperation with gatekeepers (gatekeeper-referral). Methods: The initiator of the first contact with the study team and successful recruitment strategies were recorded. Referral strategies were compared with respect to number of inquiries and inclusion rates; study personnel’s time investment; and participant characteristics (sociodemographics, functional and cognitive status, depression and anxiety scores). Results: Most of the N=197 participants were included via gatekeeper-referral (80.5%, 95%CI=[74.9%,86.1%], but time investment for gatekeeper-referrals was five times higher than for self-referral by media reports. Clinical psychologists and medical practitioners referred the largest proportion of participants (32.3% each) and referral by medical practitioners led to highest inclusion rates (55.6%; χ²(3)=8.964, p<.05). Most participants were referred from a hospital setting (50.3%), whereas referral numbers by medical practices were low (15.9%). Participants who initiated the first contact themselves had higher inclusion rates and were less functionally and cognitively impaired. Conclusions: Including home-living vulnerable older adults into psychotherapy trials requires simultaneous implementation of diverse recruitment strategies. Medical practitioners and psychologists, especially in hospitals, are the most effective recruitment strategy, but self-referral via media is most cost-efficient in terms of time investment.
Unique Opportunities and Challenges From Two Online Psychosocial Randomized Clinical Trials
Authors: Musil Carol , Webster Britney , Pruchno Rachel
Published: December 2021

Research aimed at testing readily delivered online psychosocial interventions for addressing the needs of custodial grandfamilies (CGF) has been scarce. This symposium reports on two NIH-funded randomized clinical trials (RCT) involving fully online interventions: Study 1 (S1)-dyadic social Intelligence training for custodial grandmothers and their adolescent grandchildren, and Study 2 (S2)-4 week resourcefulness training with daily journaling intervention for grandmothers only. We presented here on the unique advantages and challenges of online RCTs as they apply to CGFs and similar hard-to-reach populations. First, in a cross-study collaboration, Jeanblanc et al. report data from both studies on how COVID-19 influenced coping habits, grandchild’s remote learning, household conflict, uncertainty, and finances. Second, Castro et al. investigate how baseline positive and negative affect were reported in daily diaries completed by both grandmothers and grandchildren across 14 days at pretest in S1. Third, Musil et al. describe the challenges and benefits of using an entirely online design for the distribution and collection of longitudinal data, as exemplified by 4 weeks of qualitative daily journals from S2. Lastly, Webster et al. report on the benefits and challenges of recruitment and retention strategies encountered across S1 and S2. As discussant, Rachel Pruchno considers how the specific methodological advantages and disadvantages of online RCTs covered in the above papers apply to family caregiving research in general.
Group-Based Smoking Cessation Program for Older Adults with Serious Mental Illness
Authors: Leutwyler Heather , Hubbard Erin
Published: December 2021

Smoking is one of the most important modifiable risk factors for excess morbidity and mortality in older adults with serious mental illness (SMI). Many older smokers with SMI are reportedly motivated to quit, however evidence-based treatment targeting this vulnerable group is limited. To address an urgent need to identify interventions that assist smoking cessation efforts, we are conducting a pilot two-arm randomized controlled trial (RCT) targeting adults with SMI. Our VIdeogame-based Physical activity (“VIP”) smoking cessation intervention includes: a) group videogame-based physical activity intervention (50 minutes, 3X/week for 12 weeks), b) pharmacotherapy (bupropion or nicotine replacement therapy), and c) smoking cessation counseling. Upon completion of the 12 week program, participants in the VIP and control groups completed a semi-structured interview in order to determine how the program impacted their smoking cessation. To date, six participants completed an interview. Participants described how the program helped with smoking cessation because it allowed them to “face their addiction” and learn more about why they smoke and how to quit. The program provided the structure, resources, and encouragement needed to start the process of quitting. Finally, they enjoyed having the game time as a distraction from smoking. Older adults with SMI need support, resources, and group-based exercise as they begin quitting and practice the skills needed to quit.
Increasing mixed-berry flavonoid intake may reduce depressive symptoms in older adults: Framingham Heart Study
Authors: Millar Courtney , Dufour Alyssa , Hannan Marian , Sahni Shivani
Published: December 2021

Depression affects more than 250 million people worldwide. Although epidemiological studies have linked higher dietary flavonoids with depression prevention in older women, it is unknown if increasing dietary flavonoids could effectively reduce depression. Mixed berries (blueberry, blackberry, and raspberry) are a rich source of flavonoids, particularly anthocyanin, flavanol, and flavan-3-ol subclasses. Our aim was to determine the association of mixed-berry flavonoid intake with change in depressive symptoms over ~8 years in older adults from the Framingham Heart Study. This community-based prospective longitudinal study included 1,278 adults with assessments on diet (food frequency questionnaire) and depressive symptoms (Center for Epidemiologic Studies Depression, CES-D) at baseline (1998-2001) and follow-up (2005-2008). Absolute change in mixed-berry flavonoid intake (defined as sum of anthocyanin, flavanol, and flavon-3-ols, mg/day) and change in CES-D scores were calculated. Linear regression estimated beta and standard error (SE) for change in CES-D scores per 250 mg/day increase in mixed-berry flavonoids (obtained from ~3/4 cup of mixed berries), adjusting for baseline age, sex, energy-intake, current smoking, body mass index, physical activity, cardiovascular disease, and non-melanoma cancer. Mean age was 59±9 years (range: 33-81), 57% female and mean change in mixed-berry flavonoid intake was 15.0±72.8 mg/day over ~8 years. In adjusted models, each 250 mg/day increase in mixed-berry flavonoid intake was associated with a 1-point reduction in depressive symptoms (beta: -1.06, SE: 0.61, p=0.08) over ~8 years, although this was not statistically significant. These data highlight the need for randomized clinical trials of flavonoid-rich berries to target depressive symptoms in older adults.