bluuebunny/crossref_metadata_2025 huggingface dataset:
JUMP AROUND, JUMP AROUND: TRANSPOSABLE ELEMENT ACTIVATION IN NEURODEGENERATIVE TAUOPATHY
Authors: Frost Bess E , Sun Wenyan , Samimi Hanie , Zare Habil
Published: November 2019

Transposable elements, or “jumping genes,” constitute ~45% of the human genome. We have identified transposable element activation as a key mediator of neurodegeneration in tauopathies, a group of disorders that are pathologically defined by deposits of tau protein in the brain. Cellular defenses that limit transposable element mobilization include 1) formation of silencing heterochromatin and 2) generation of piwi-interacting RNAs (piRNAs) that clear transposable element transcripts. Using genetic approaches in Drosophila models of tauopathy, we find evidence for a causal relationship between tau-induced heterochromatin decondensation and piRNA depletion, transposable element mobilization, and neurodegeneration. 3TC, an FDA-approved inhibitor of reverse transcriptase, suppresses transposable element mobilization and neuronal death in tau transgenic Drosophila. We detect a significant increase in transcripts of the human endogenous retrovirus class of transposable elements in postmortem human Alzheimer’s disease brains. Our data identify transposable element activation as a conserved, pharmacologically targetable driver of neurodegeneration in tauopathy.
MULTI-OMICS ANALYSIS IDENTIFIES GENE NETWORKS ASSOCIATED WITH COGNITIVE AGING AND ALZHEIMER’S DISEASE
Authors: Kaczorowski Catherine , Heuer Sarah , Gaiteri Chris , Kaczorowski Catherine
Published: November 2019

Alzheimer’s disease (AD) is the leading cause of age-related dementia, yet no treatment exists. AD is heterogeneous, and is resultant of the dysregulation of many genetic and biological processes. To decipher this complexity, we leveraged the first translational mouse population of AD to identify 15 gene networks related to individual differences in cognitive outcomes. Using QTL mapping, we also identified a novel putative driver of a module, Gstk1, highly conserved in humans that also significantly correlated with memory outcomes. Together, these transcriptional networks provide new mechanistic insight into the biological processes that regulate individual differences in cognitive function across a genetically diverse population. We could identify how demographics (age, sex, causal AD mutations) influence these modules and how they relate to cognitive outcomes. Finally, the high degree of conservation between our mouse modules to human modules reflects the translatability of our model to human AD, adding to its face validity.
RECRUITING OLDER ADULTS WITH DEMENTIA FOR NEUROIMAGING RESEARCH: BARRIERS AND SOLUTIONS
Authors: Atalla Sebastian , Wright Kathy , Anderson Alison , Moss Karen O , Cowan Ronald , McDaniel Ann , Monroe Todd
Published: November 2019

Recruiting participants with dementia for magnetic resonance imaging (MRI) research is prone to inherent barriers including caregiver schedules, mistrust, transportation, expertise of MRI technologists, claustrophobia, and MRI safety requirements. This pilot study aimed to identify barriers and develop strategies for increasing recruitment and retention of persons with dementia in neuroimaging studies and to gauge improvements in recruitment outcomes associated with dedicated recruitment staff. Over a period of five years of active recruitment, a dedicated recruitment specialist and a full-time research assistant screened and enrolled an average of eight participants with dementia per month (8.16), of which, approximately two participants (1.97) successfully completed the MRI testing. The most common barrier was difficulty obtaining surgical records for MRI safety clearance. The most common solutions were thorough prescreening and maintaining a positive rapport with MRI technologists. Our study findings will assist others with engaging persons with dementia and their caregivers in MRI research.
END-OF-LIFE DECISION SUPPORT NEEDS OF DEMENTIA FAMILY CAREGIVERS
Authors: Kwak Jung , Geshell Lisa
Published: November 2019

One third of older adults die with dementia. At the end of life (EOL), persons with dementia require surrogate decision-makers, often their family caregivers, to make important EOL decisions. However, only a handful of evidence-based interventions exist to guide dementia caregivers in surrogate-decision making. In order to examine the acceptability and appropriateness of a decision coaching intervention developed for dementia caregivers, we conducted cognitive interviews (n=4), and one focus group (n=9) with dementia caregivers, and two focus groups with healthcare professionals (n=14) from a large healthcare system and a managed long-term care organization. Guiding questions for interviews and focus groups included: (1) types of decisions (what), and circumstances or triggers (when and how) that call for decision-making support by healthcare professionals, (2) barriers to families receiving decision-making support, and (3) decision support needs of family caregivers. All face-to-face interviews were audio-recorded, transcribed verbatim, and verified for accuracy. Content analysis was conducted to identify and organize themes and patterns emerging from the interview transcripts. Two main themes and subthemes emerged: (1) decision-making challenges and barriers: lack of advance care planning, caregivers’ acquiescence with dementia progression and caregiving role, discontinuing life sustaining therapies, and lack of communication between providers; and (2) decision support for families: advance care planning at different stages of dementia, preparing caregivers for life after the patient’s death, and providing adequate information about benefits and harms of treatment options specific to the practical concerns of patient and family caregivers. These findings provide implications for practice and future research.
ETHNIC DIFFERENCES IN FACTORS INFLUENCING ATTITUDES TOWARD SUICIDE AND PHYSICIAN-ASSISTED SUICIDE AMONG ELDERS
Authors: Martinez Ruben
Published: November 2019

This study examines differences in attitudes toward suicide and physician-assisted suicide in chronic pain scenarios among Latino and White elders. Face-to-face interviews were conducted with 204 elders at four community-based, outpatient care sites in the metropolitan area of San Antonio, Texas. In addition to ethnicity and the suicide-related questions, the interviews collected data on age, gender, marital status, education, income level, acculturation (Latinos only), depression, self-reported health status, daily living functioning, and religiosity/spirituality. In general, there were no ethnic group differences in attitudes, however, the factors associated with those attitudes varied between ethnic groups. Among Whites, attitudes toward suicide and toward physician-assisted suicide were significantly and negatively associated with religiosity. Among Latinos, depression was significantly and positively associated with attitudes toward suicide in chronic pain scenarios, while acculturation was significantly and negatively associated with attitudes toward physician-assisted suicide in chronic pain scenarios. This study’s findings suggest that depression among Latino elders and religion among White elders are determinant factors of attitudes toward suicide in chronic pain scenarios. Future research is needed to confirm our findings with a more heterogeneous study sample, including Latinos from different countries of origin (e.g. Mexican Americans, Puerto Ricans, Cubans); and more heterogeneous ethnic groups in terms of socioeconomic status and educational level characteristics.
THE ART OF CARING: EXPLORING HOW DEMENTIA CARE PARTNERS MANAGE CARE CHALLENGES AND FIND RESILIENCE
Authors: Leggett Amanda N , Gitlin Laura N
Published: November 2019

Approximately 15 million Americans serve as family caregivers for a person with Alzheimer’s disease or another form of age-related dementia and this care can take a physical and emotional toll. Understudied is the process of how families actually provide care in response to care challenges, and how to find respite and resilience amidst care challenges. This symposium considers how caregivers handle daily challenges related to dementia including activities of daily living, behavioral and psychological symptoms of dementia, general health and medical comorbidities. In addition to characterizing care partner’s distinct styles of management (Leggett et al.) and knowledge and capacity to manage health care (Sadak et al.), the papers also provide perspective on positive aspects of care management such as the impact of respite on positive mood (Wylie et al.), the moderating role of relationship quality on responses to behavioral and psychological symptoms of dementia (Chunga et al.) and finally how caregivers’ problem-related, self-growth, and help-related behaviors compose their resilience to care challenges (Zhou et al.). To conclude, our discussant Dr. Laura Gitlin will offer insight on cross-cutting implications across studies and offer perspective on how research, intervention science, and clinical practice may better account for caregiver management styles to promote growth and resilience in caregivers and their care partners with dementia.
PRECISION IN HEALTH CARE FOR DEMENTIA: DO CARE PARTNERS KNOW WHAT THEY DON’T KNOW?
Authors: Sadak Tatiana , Ishado Emily , Borson Soo
Published: November 2019

Clinicians rely on care partners to provide health care at home for people with dementia, who typically have multiple chronic conditions in addition to progressive cognitive decline. We examined the accuracy of care partners’ knowledge of care recipients’ medical conditions and medications, using a benchmark of ≥ 80% match. Of 100 care partners of people with dementia who were recently hospitalized for a major medical illness, nearly all rated their knowledge as high, but about half did not correctly identify care recipients’ medical conditions or know medications, and one fourth did not understand the purpose for which medications were given. A key predictor of poor objective knowledge was care partners’ cognitive status. These findings highlight the importance of objective assessment of care partner knowledge and skills by clinicians who provide health care and advance care planning for people with dementia.
FAMILY CAREGIVERS’ RESPONSES TO DAILY BEHAVIORAL SYMPTOMS OF DEMENTIA: THE MODERATING ROLE OF RELATIONSHIP QUALITY
Authors: Chunga Richard E , Liu Yin , Kim Kyungmin , Zarit Steven H
Published: November 2019

Providing care for persons with dementia (PWD) is frequently regarded as highly stressful, but how caregivers perceive care-related stressors depends on a variety of contexts. Research has demonstrated that relationship quality between the caregiver and receiver – as an important dyadic context – can influence the magnitude of this perceived distress. Using 8-day diary data from 173 family caregivers of PWD (day N = 1,359), this study examined the moderating effect of relationship quality on caregivers’ stress responses to daily behavioral and psychological symptoms of dementia (BPSD), comparing within- and between-person effects. Multilevel models suggested differences in the association between BPSD occurrence and perceived distress of BPSD (i.e., negative within-person association, but positive between-person association). However, we found that both associations were moderated by relationship quality; that is, better dyadic relationship quality seemed to be protective against distress at both within- and between-person levels.
A SCOPING REVIEW OF KNOWLEDGE EVALUATION INSTRUMENTS FOR FORMAL AND INFORMAL DEMENTIA CAREGIVER PROGRAMS
Authors: Resciniti Nicholas V , Tang Weizhou , Tabassum Masroora , Al-Hasan Dana , Lohman Matthe C , Spencer Mindi , Friedman Daniela
Published: November 2019

With the increase in our older adult population there is a need for dementia training for informal and formal dementia caregivers. The objective of this scoping study was to assess dementia knowledge instruments utilized in educational programs and interventions intended for formal and informal dementia caregivers. Scoping review methodology was used to search PubMed, PsycInfo, CINAHL, and Web of Science with tailored database search terms. The search yielded 8,101 results, with 35 studies meeting inclusion criteria. Studies were conducted in eight countries, had varying study designs (RCTs=9, non-RCTs=6, one-group study design=20), and utilized previously published (19) and author-developed (16) instruments. Only two studies focused on minority populations. While author-developed instruments may be more relevant and time-saving, studies should strive to validate instruments or use previously published instruments to help standardize findings across studies and better understand the effects of education programs on caregiver knowledge.
THE TIPPING POINT STUDY: DIGITAL DETECTION AND DECISION SUPPORT FOR OLDER ADULTS AND FAMILIES
Authors: Shea Kimberly D , Shea Kimberly D
Published: November 2019

In 10 years, the United States will experience a “dependency” ratio of one working age adult (20-64 years old) to one non-working person (> 65 or 85 years old will comprise 19 million of the non-working people (US Census Bureau, 2008). Busy working adults will have to be vigilant to determine when to make life-changing decisions about health and safety issues for people that depend on them. Older adults have gradual and cumulative physical and/or psychological aging changes or can experience significant events. Knowing when to make a life-changing decision, such as when to intervene with independent living due to safety risks, is difficult even when situations have constant vigilance. Eventually, older adults experience a seemingly abrupt, sudden and absolute point where a life changing decision must be made. This is the Tipping Point. Health data, derived from unobtrusive wearable sensors, are algorithmically synthesized to provide critical information on impending concerns via an electronic portal will help the busy working adult to predict and prevent the Tipping Point. This application of precision health care results in targeted and personalized education thus avoiding a potentially catastrophic Tipping Point. This symposium provides insight into five aspects of the Tipping Point: 1) significance of identification, 2) theoretical foundation for environmental and cultural sensitivity, 3) feasibility outcomes from a Mexican American population, 4) methodology for synthesizing quantitative metrics from multivariate streams of data, 5) creation of a culturally sensitive electronic portal to display predictive information and education about consequences
LAWTON’S THEORY OF PERSON-ENVIRONMENT FIT: THEORETICAL FOUNDATIONS FOR DETECTING TIPPING POINTS
Authors: Crist Janice D , Lacasse Cheryl , Phillips Linda R , Liu Jian
Published: November 2019

Caregiving families often experience “tipping points,” changes that forever alter their lives, such as a fall with a fractured femur. Tipping points for older adults can be conceptualized as an interaction between individuals and their environments. According to Lawton’s theory of person-environment fit (Lawton, 1983, 1985), physical and social environments and the person’s behavior are shaped by one another in a dynamic, ever-changing process. For older adults, the relationship between “environmental press,” or the mismatch between the person and his/her environment, and adaptation to that environment is mediated through one’s ability to cope. When stressors in health, cognition, or caregiver availability occur, environmental press may heighten, leading to a tipping point. In this paper the authors clarify how environmental press theory provides a foundation for studying early detection of impending tipping points and facilitating decisional support of families for choosing the right long-term support services at the right time.
TIPPING POINTS PILOT STUDY: WEARABLE DEVICES AND ALGORITHMS
Authors: Peterson Rachel L , Shea Kim , Luque Kayla , Powell Jessica , Liu Jian , crist Janice
Published: November 2019

Little is known about the use and acceptability of fitness watches (e.g. Fitbit) by diverse older adults, or how data from affordable (<$40) devices could be triangulated with self-report data to predict adverse health outcomes. We investigated interest and acceptability of fitness watch technology among Mexican American older adults via a week-long trial. Participants were asked to consistently wear the watches and complete daily diaries of activity, questionnaires, and a semi-structured interview. The watch data was triangulated with data from the daily diaries and questionnaires to validate its usefulness in developing algorithms that could detect important physiological transitions that lead to tipping points. Interview data was qualitatively analyzed and coded for barriers and facilitators of watch use and acceptability. Preliminary results suggest that participants are eager and willing to wear a fitness device. Participants reported interest in monitoring their health and using the device to track and improve physical activity.
DEVELOPING COMPETENCE IN QUALITY IMPROVEMENT: A MODEL FOR GEROPSYCHOLOGY TRAINING
Authors: Jacobs Lindsey , Mlinac Michelle
Published: November 2019

Quality improvement (QI) efforts are imperative to ensuring patient-centered, safe, effective, timely, efficient, and equitable healthcare. QI training is well-established in the fields of geriatric medicine and nursing but is lacking in geropsychology. Clinical geropsychologists are in need of QI knowledge and skills, as the population they serve is often vulnerable to healthcare disparities due to complex medical, neurological, and/or psychiatric presentations, limited resources, and low social and/or instrumental support. This presentation will describe a developmental model of QI training, driven by initial pilot data from geropsychology trainees, analysis of geropsychology graduate program marketing materials, and expert opinion from geropsychologists who have QI implementation experience. Consistent with the Pikes Peak Competencies for Geropsychology Training, this model delineates aspirational QI knowledge and skills, as well as recommendations for incorporating QI training into geropsychology at progressing levels of competency from graduate school through independent clinical practice.
LONGITUDINAL HEALTH CONSEQUENCES OF CHILDHOOD ADVERSITY: THE MEDIATING ROLE OF PURPOSE IN LIFE
Authors: Homan Kristin J
Published: November 2019

Adverse childhood experiences have long-term detrimental effects on physical health. Although biological, behavioral, and social factors have been explored as intermediate mechanisms, little research has explored psychosocial factors as potential mediators. This study examined whether purpose in life longitudinally mediates the relationship between childhood adversity and two measures of adult health (self-rated health and functional limitations). Data were obtained from 3,871 participants in the Midlife in the United States (MIDUS) study. We tested a cross-lagged mediation model from childhood adversity to adult health via purpose in life, controlling for baseline measures of health and purpose in life. Good model fit was achieved indicating that childhood adversity is associated with poorer adult health through direct and mediated paths. Childhood adversity may restrict young people’s search for purpose in life, and reduced purpose in life is ultimately associated with poorer subjective health and increased functional limitations.
ESPO/BEHAVIORAL AND SOCIAL SCIENCES: SOCIAL RELATIONSHIPS, ISOLATION, AND WELL-BEING
Authors: Stokes Jeffrey E , Irani Elliane , Thomas Patricia A
Published: November 2019

The purpose of this symposium is twofold: (1) To present innovative research linking social relationships, isolation, and well-being among older adults, and (2) To highlight new and emerging scholars in the Behavioral and Social Sciences section of GSA. The papers in this symposium examine the repercussions of numerous relationships for well-being in later life. Huo and colleagues examine the impacts of contact with close and not-close social partners on physical activity, highlighting differences by gender. Polenick and colleagues focus on perhaps the closest of relationships in later life: marriage, analyzing longitudinal associations between discordant chronic conditions and depressive symptoms among older couples. Upenieks takes an intergenerational perspective, examining the embeddedness of adult children in older adults’ networks in the context of both depression onset and chronically high depressive symptomology. This paper also highlights the consequences of well-being for older adults’ social isolation, and not merely the reverse. Hladek and colleagues explore the subjective side of isolation among older adults with chronic disease, noting links between loneliness and self-efficacy that may have clinical and interventional significance. Lastly, Meinertz and Gilligan explore potential gaps in service provision that may increase rural older adults’ risk of isolation and abuse. Taken together, these five papers underscore the importance of various social relationships for older adults’ well-being, and suggest implications for how best to promote healthy aging. As discussant, Thomas will assess the strengths and limitations of these papers, and consider the contributions these studies – and new scholars – can make to the field.
AGING APPEARANCE AND ITS SIGNIFICANCE TO WELL-BEING
Authors: Woodspring Naomi
Published: November 2019

Ageing is a profoundly embodied process, yet elder’s concerns about appearance are perceived, by many, as trivial. Notions of appearance as a core human concern continues as a significant aspect throughout our lives. Self-presentation choices convey a sense of our identity. This paper is based on a qualitative study which aimed to explore current notions of beauty and age. A diverse group of postwar women (born between 1945 -1955) from the US and the UK were interviewed with a focus on their own self-presentation and the acts of seeing and being seen. This paper explores the some of the findings from this study. The majority of women, and the all women of colour, reported feeling more confident in their appearance and appreciative of other older women’s appearance. This led to a more robust sense of well-being and suggests that age and appearance may be significantly linked to well-being.
INTIMACY IN LATER LIFE: A POTENTIAL PATHWAY FOR IMPROVING WELL-BEING IN OLDER WOMEN
Authors: Flores Renee J
Published: November 2019

Despite benefits to overall health and well-being, healthcare professionals’ knowledge and research is limited in regards to older women’s sexuality and intimacy desires. There are barriers that impede fulfilling these desires and lack of understanding hinders ways to address this issue, which negatively affects the well-being of older women. A sexuality and intimacy survey of 29 women between the ages of 60-86 revealed that the majority were having sex at least once a month and expressed the desire to increase the frequency of sexual encounters. These data suggests that later-life sexuality and intimacy encounters are important for some women. Recognizing these desires could prompt responses that could greatly influence the quality of life in older women. A broader public health discussion needs to occur in order to promote awareness and optimize overall well-being.
THE QUALITY OF DENTAL CARE IN NURSING HOMES: VARIATION BY FACILITY AND MARKET CHARACTERISTICS
Authors: Ye Zhiqiu , Wu Bei
Published: November 2019

Nursing home (NH) residents are disproportionately affected by poor oral health. But little we known about the root causes. We analyzed the 2000-2016 national inspection survey data for all certified-NHs (n=248,975 facility-years). Dental care performance was measured by two designated deficiency citations. Generalized estimating equation models were used to predict if the NH facility and market characteristics were associated with low performance. The rates of deficiency citation tripled from 1.2% in 2000 to 3.4% in 2016 (p<0.001) with substantial variation across states. NHs with more minority residents and poorer resources (higher share of Medicaid and lack of registered nurse), and NHs with high competing priorities (larger, for profit, chain-affiliated and urban locations) were more likely to receive deficiency citations. Residents in these facilities are at greater risks of poor oral health. This presentation will provide discussion on relevant policy and practice to improve dental care quality in nursing homes.
THE MODERATING ROLE OF BIRTHPLACE ON DENTAL CLEANING SERVICE AMONG CHINESE OLDER ADULTS IN HAWAII
Authors: Liu Sizhe , Zhang Wei , Zhang Keqing , Wu Bei
Published: November 2019

Regular dental cleaning is vital to maintaining good oral health. This study aims to identify socio-demographic characteristics that are associated with the use of dental cleaning services among Chinese older adults in Honolulu, Hawai’i. In addition, we examine if birth-place moderates these associations. The data for this study were collected from 398 Chinese older adults living in Honolulu. Results from multivariate logistic regressions showed that those who were married and with higher levels of education were more likely to have their teeth cleaned within the past year compared to those who were not married or with lower levels of education. These significant associations were only found salient for the foreign-born when the moderating role of birth place was accounted for in the model. These differences may be partially due to the impact of acculturation and the knowledge of oral health and dental services.
THE IMPACT OF DIABETES AND POOR ORAL HEALTH ON COGNITION: IMPLICATIONS TO IMPROVE DENTAL CARE ACCESS
Authors: Wu Bei , Luo Huabin
Published: November 2019

This study examined the joint effects of diabetes and poor oral health on cognitive function among older adults aged 60 years or older in the U.S. We analyzed data of 2,937 participants from the National Health and Nutrition Examination Survey (2011-2014). We investigated the interaction effects between diabetes and significant tooth loss, i.e. differences among the following four groups: 1=neither of the two conditions, 2=non-diabetic but with tooth loss, 3=diabetic but no tooth loss, and 4=both conditions. Significant interaction effects were found in our study. Having either diabetes or significant tooth loss was associated with lower cognitive function. When the two conditions were both present, the negative effects were much stronger than the total effects from either one of the two conditions. The additional loss of cognitive function resulting from multiple health conditions illustrates the importance of improving access to dental care for older adults in the U.S.
THE UNINTENDED CONSEQUENCES OF SEAMLESS IMPLEMENTATION OF A RURAL TELEMEDICINE CLINIC
Authors: Solimeo Samantha , Steffen Melissa J , Seaman Aaron , Miller Karla L
Published: November 2019

Osteoporosis is largely undetected and untreated in older men who are at-risk, with even lower rates of detection and treatment in rural communities. In this presentation we report the consequences for primary care providers (PCPs) of the implementation of an osteoporosis telemedicine clinic that targeted rural patients and is purposefully designed to minimize PCP workload. Analysis of qualitative interviews with PCPs who co-managed patients with the telemedicine clinic confirmed that implementation strategies used by the telemedicine clinic were successful at minimizing workload and had a positive impact on PCPs’ work. However, the clinic’s seamless approach may have contributed to unintended consequences of low PCP awareness of program care processes and selection criteria and a missed opportunity for PCPs to reinforce osteoporosis care goals in the primary care setting.
IMPROVING ACCESS AND OUTCOMES FOR RURAL CAREGIVERS USING THE TELEPHONE
Authors: Nichols Linda , Martindale-Adams Jennifer
Published: November 2019

Many caregivers of older rural veterans have limited access to services. In 2017, VA’s Office of Rural Health and Caregiver Support Program funded the Memphis Caregiver Center to deliver Resources for Enhancing All Caregivers Health (REACH VA) as a national behavioral intervention to improve access to care. To date, 438 caregivers of older Veterans have enrolled. REACH is a proven 4-session caregiver intervention, structured and easily replicated. Rural internet service is often problematic. Offering REACH by telephone provides many benefits, including access to service not available in the rural area, almost universal technology penetration, ease and familiarity of use, and removal of barriers of travel and care for the loved one. Through this enhanced service, caregivers of older veterans with dementia, PTSD, ALS, MS, and other conditions have shown statistically and clinically significant improvements in managing concerns and safety relating to their loved one and their own stress and coping.
ARE THERE BIDIRECTIONAL ASSOCIATIONS BETWEEN COGNITION AND BALANCE ABILITY: EVIDENCE FROM A BRITISH BIRTH COHORT
Authors: Blodgett Joanna M , Cooper Rachel , Davis Daniel , Kuh Diana , Hardy Rebecca
Published: November 2019

Age-related changes in cognitive and balance abilities are well-established, as is their correlation with one another. There is, however, limited evidence regarding the directionality of associations and whether or not common biological processes may underlie their age-related declines. The main aim was to explore bidirectional associations between balance and cognitive abilities in mid-later life using data from the MRC National Survey of Health and Development, the 1946 British birth cohort (n=2735). Cognition was assessed at ages 43, 53, 60-64 and 69 with verbal memory and search speed tasks. One-legged standing balance time (eyes closed) was assessed at ages 53, 60-64 and 69. Two autoregressive cross-lagged models simultaneously assessed bidirectional associations of balance with verbal memory and search speed over time. Results suggest a unidirectional association between verbal memory and subsequent balance in both sexes, decreasing with age from 0.14 SD balance (95%CI: 0.10,0.17) per 1SD verbal memory to 0.06 (0.01,0.10) to 0.05 (0.01,0.09). Search speed at age 43 was associated with balance at age 53 [men: 0.11(0.06,0.16); women: 0.09 (0.03,0.13)]; additionally, in men, there was evidence of a bidirectional association between ages 60-64 and 69 [balance to search speed: 0.05 (0.00,0.10); search speed to balance: 0.09 (0.02,0.16)]. These findings support the notion that successful balance relies mainly upon cognitive processing to successfully integrate vestibular, visual and proprioceptive input with motor output. Including a cognitive component in balance and fall risk intervention programs could have an additive benefit in improving neural pathways involved in balance and thus reducing fall risk.
OUTCOMES OF FIT & STRONG! PLUS: A GROUP EXERCISE AND WEIGHT LOSS PROGRAM TO TREAT OSTEOARTHRITIS
Authors: DeMott Andrew , Hughes Susan
Published: November 2019

Overweight older adults with osteoarthritis (OA) face increased risk for disability; however, no evidence-based programs target weight and OA simultaneously. Fit & Strong! (F&S!) is an 8-week evidence-based exercise program for persons with OA that improves lower extremity (LE) strength and mobility out to 18 months. F&S! Plus, a weight loss version of F&S! was tested against standard F&S! in a comparative effectiveness trial. Two and six-month trial outcomes were previously presented, this session will present maintenance outcomes at 12 and 18 months. This trial randomized 413 participants, 210 to F&S! and 203 to F&S! Plus. The mean sample age was 67.9, 86% female, and 92% African American. At 12 months, significant and marginally significant between-group differences favoring F&S! Plus were seen in several outcomes, including weight (p=.049), BMI (p=.04), waist circumference (p=.004), LE physical function (p=.09), 6-minute distance walk (mobility) (p=.08), 30-second chair stands (LE strength) (p=.46), and anxiety & depression (p=.08). At 18 months, only LE strength remained significantly improved for the F&S! Plus group (p=.045), however several within-group improvements remained statistically significant for both groups out to 18 months, including weight, BMI, waist circumference, LE pain & physical function, 30-second chair stands (LE strength), anxiety & depression, and self-efficacy for weight-management. F&S! Plus showed significant improvements over standard F&S! for several outcomes at the conclusion of the intervention (2 months) and many were maintained out to 12 months, with LE strength continuing to 18 months. Both groups showed significant within-group improvements out to 18 months.
THE ASSOCIATION OF LONELINESS AND CHRONIC CLINICALLY SIGNIFICANT PAIN AMONG AFRICAN AMERICAN AND WHITE OLDER ADULTS
Authors: Camacho David , Burnette Denise , Aranda Maria P , Lukens Ellen
Published: November 2019

Loneliness and pain are significant public health problems in later life, yet limited research has examined how these factors interact among racially diverse older adults. Guided by the Biopsychosocial Model of Pain, we used data from Waves 2 and 3 of the National Social Life, Health, and Aging Project to investigate the relationship between loneliness and chronic pain among 1,102 African-American and White adults aged 50 and over. Using logistic regression analyses, our final models considered demographics, physical and mental health, functioning, medication, health behaviors and social factors. Approximately 32% of African Americans and 28% of Whites reported chronic loneliness. Compared to Whites African-Americans were 2.5 times more likely to experience chronic pain. Among White participants, loneliness was not associated with chronic pain; however, the interaction of being African-American and lonely was associated with decreased odds of chronic pain in main and gendered analyses. African American women were 4 times more likely than White women to report chronic pain. Our results address the objectives of the National Pain Strategy (2016) to elucidate the experiences of chronic pain among diverse elders in the US. Future work should seek a deeper understanding of loneliness and chronic pain among African Americans elders and how cultural dynamics may help explain our counter intuitive findings (e.g., “Superwoman Schema”).
LIFE COURSE ORIGINS OF FRAILTY IN LATER LIFE
Authors: Williams-Farrelly Monica , Ferraro Kenneth F
Published: November 2019

Frailty, generally characterized as a clinical state of increased vulnerability resulting from age-related decline in reserve and function across multiple physiologic systems, has been gaining attention in recent years due to its high correlates with a number of poor health outcomes including falls, hospitalization, and mortality. Similar to other adult health outcomes, research on the etiology of frailty has begun to move from proximal risk factors only to those more distal in time. This research uses data from the Health and Retirement study (2004-2016) to examine whether childhood exposures predict developing frailty in later life. A series of ordinal logistic regression models were estimated to test whether six domains of childhood exposures (socioeconomic status, infectious disease, chronic disease, impairments, risky adolescent behavior, and risky parental behavior) were associated with frailty, composed of five components: unintentional weight loss, weakness, slowness, exhaustion, and low energy expenditure (Fried et al., 2001). After adjusting for demographic factors, experiencing multiple SES misfortunes or risky adolescent behaviors in childhood are associated with higher odds of frailty in later life (OR= 1.24 and 2.37, respectively), while experiencing any infectious diseases is associated with lower odds of frailty (OR= 0.67 and 0.72). After further adjusting for adult characteristics, experiencing 2 or more chronic diseases in childhood is associated with a 1.35 higher odds of incident frailty over an 8-year period. These results reveal some of the early exposures that may raise frailty risk in later life but also the mid-life factors that mediate those risks.
ASSOCIATIONS BETWEEN CHRONIC PHYSICAL CONDITIONS, MEDICATIONS AND MENTAL HEALTH IN AN AGING COHORT
Authors: Stirland Lucy , Stirland Lucy E , Russ Tom C , Ritchie Craig W , Terrera Graciela Muniz
Published: November 2019

Older people increasingly live with multiple chronic conditions and medications. We explored their interactions with mental health in the PREVENT Dementia study participants. Using logistic and linear regression, we investigated the association between increasing self-reported chronic physical conditions and current medications with self-reported depression and anxiety disorder, and scores on the Center for Epidemiologic Studies Depression (CES-D) scale and Spielberger State-Trait Anxiety Inventory (STAI) state subtest. Among 210 participants, each additional condition was associated with increased odds of depression (adjusted OR, 95% CI: 1.41, 1.11-1.80; P=0.005) and anxiety (1.71, 1.35-2.21; P<0.001). Each additional medication was associated with depression (1.36, 1.07-1.73; P=0.010) but not anxiety. For each additional condition, CES-D scores increased by 0.62 (0.04-1.20, P=0.035) and for each medication, by 0.66 (0.12-1.21, P=0.017). There was no significant association between conditions or medications and STAI scores. These findings provide crucial information on the future brain health of these individuals.
PERCEPTIONS OF EXERGAMES FOR FALLS PREVENTION AMONG SENIORS AND THERAPISTS IN ASSISTED LIVING FACILITIES
Authors: Stanmore Emma K , de jong Lex D , Skelton Dawn A , Meekes Wytske , Mavroeidi Alexandra , Todd Chris
Published: November 2019

Strength and balance exercise programmes are effective in reducing the rate and risk of falls but uptake and adherence to community based programmes are low. Exergaming technology may be a promising tool to increase exercise uptake and adherence among seniors due to their motivational features. As yet, there is little published on the views of older people and therapists of their experiences of using Exergames to reduce falls in assisted living facilities that may inform implementation. This study is the qualitative component of a cluster randomized controlled trial that investigated the use of purpose-built strength and balance Exergames in community-dwelling older people in 18 assisted-living facilities in the UK. Data collection included 36 hours’ observation, semi-structured interviews with 5 physiotherapists, assistants and researchers, and 13 focus groups with residents of assisted living facilities who had participated in a 12 week Exergame programme. Transcribed data were analysed using thematic content analysis to identify themes arising from older users’ and therapists’ experiences of using the Exergames. Findings suggest that the senior users enjoyed using the strength and balance Exergames and reported physical, psychological and social benefits. Although some games were generally favoured, there was no overall consensus on game preferences although social components, feedback, music and colourful animation appeared to increase the appeal of the Exergames. This is the first study exploring older users and therapists’ perceptions of exergames in assisted living facilities and provides valuable insight into the barriers, facilitators, contextual factors and perceived benefits or drawbacks following 12 weeks use.
GENOMIC ANALYSIS OF HUMAN ISOGENIC APOE IPSC-DERIVED INHIBITORY GABAERGIC NEURONS
Authors: Ellerby Lisa , Song Sicheng , Mooney Sean , Scheeler Stephen , Naphade Swati
Published: November 2019

Isoforms of ApoE modify the risk for Alzheimer’s disease (AD), cardiovascular disease and are also associated with exceptional longevity. Specifically, the ApoE E2 allele is associated with lower risk of AD-related neurodegeneration and with exceptional longevity, while the E4 allele is a major risk factor for AD and is associated with higher levels of Abeta deposition in the brain. The mechanisms modulating extended lifespan/healthspan mediated by E2 compared to E3 and E4 genotypes are not clear. One hypothesis is that the E2 allele is neuroprotective and compensates for neuronal dysfunction induced by misfolded protein expression in aging and disease. To understand the molecular basis of the protective effect of the E2 allele we performed transcriptomic analysis of isogenic iPSCs with E2E2 and E4E4 genotypes differentiated into inhibitory GABAergic neurons. Our analysis revealed that ApoE2 inhibitory GABAergic neurons regulate genes involved in nuclear division, DNA integrity and DNA damage checkpoint.
AN EMOTION REGULATION THERAPY FOR LATER-LIFE PAIN: EVIDENCE OF EARLY TREATMENT EFFECTS
Authors: Petti Emily , Kiosses Dimitris , Ravdin Lisa , Henderson Charles , Meador Lauren , Maisano Julianna , Reid Cary
Published: November 2019

Chronic pain (CP) is a common, morbid, and costly disorder in older adults. Guidelines encourage clinicians to employ non-pharmacologic therapies for its management, but current psychological interventions (e.g., CBT for pain) have modest treatment benefits and their effects are largely unknown in older cognitively impaired adults. We developed PATH-Pain, an emotion regulation therapy focused on reducing negative emotions and augmenting positive emotions. PATH-Pain is appropriate for use by older adults with CP, negative emotions, and a wide range of cognitive functioning. Treatment consists of 8 weekly individual sessions followed by 4 monthly booster sessions. One hundred older adults (ages 60+) with CP (≥ 3 months) and at least mild-to-moderate levels of negative emotions (per the Positive and Negative Affect Schedule) were randomized to receive PATH-Pain versus Usual Care (UC). Cognitive screening revealed that 44 participants were cognitively intact (Montreal Cognitive Assessment (MoCA) score ≥26), while 56 evidenced mild-to-moderate cognitive impairment (MoCA=16-25). Participants completed follow-ups at 5 (n=89) and 10 weeks (n=84), while 24-week assessments are ongoing. Examination of the treatment × time interaction in a repeated-measures mixed model indicate the presence of treatment effects. PATH-Pain (vs. UC) participants experienced significant reductions in pain intensity (p<0.044) and pain-related disability (p<0.003). Reductions in pain-related disability score were more pronounced among cognitively impaired individuals. The PATH-Pain group also demonstrated significant reductions in emotional suppression (p<0.019) and depression (p<0.009) scores. These results suggest that PATH-Pain is an effective treatment for the management of pain in cognitively intact and cognitively impaired older adults.
PSYCHOLOGICAL PREDICTORS OF FALLS EFFICACY AMONG FILIPINO OLDER ADULTS IN AN ELDERLY DEVELOPMENT PROGRAM
Authors: Torres Godfrey Josef R , Jolejole Katrina Marie , Botor Nephtaly Joel , Laude Teri-Marie
Published: November 2019

Falls, common among aging persons, typically lead to catastrophic health consequences. Studies show several factors influencing an older person’s risk to falling. Depression, a psychological condition, was identified as one of these factors. With the goal of determining potential psychosocial interventions for older persons, the present study explores what other psychological variables may explain falls efficacy, i.e., perceived concern about falling. 81 older adults who were participants in an elderly development program answered a socio-demographic survey and several scales (i.e., Satisfaction with Life Scale, Flourishing Scale, Geriatric Depression Scale – Short Form, Falls Efficacy Scale – International) to measure falls efficacy and other psychological variables. Bivariate correlation revealed that falls efficacy significantly increases as family problems (r=.228, p=.045), health concerns (r=.231, p=0.040), financial difficulties (r=.345, p=.002), and depression (r=.403, p<.001) increase. Conversely, it significantly decreases as psychological well-being (r=-.255, p=.022) and perceived resilience (r=-.459, p<.001) decrease. Multiple regression analysis confirmed that while depression is a significant positive predictor, F (1,79)=15.31, p<.001, R=.403, explaining 16.2% of falls efficacy variance, anxiety-provoking situations (i.e., family problems, health worries, financial worries) also explain additional falls efficacy (6.6% variance), F (4, 71)= 5.234, p<.001, R=.477, wherein financial worry is a significant positive predictor. Furthermore, entering psychological well-being and resilience in the model adds an additional variance of 6.6%, F (6, 69)=4.533, p<.001, R=.532, but only resilience is a significant negative predictor. This paper culminates with recommendations on potential research on the psychosocial dimension of falls and possible interventions to mitigate falls among older persons.
PAIN AMONG OLDER MEXICANS: FINDINGS FROM THE MEXICAN HEALTH AND AGING STUDY
Authors: Milani Sadaf A , Samper-Ternent Rafael , Rodriguez Martin , Wong Rebeca
Published: November 2019

In Mexico, palliative care and pain relief was recently added to the essential health services offered through Seguro Popular. Pain is more frequent in older adults, a growing segment of this population, and is a major contributor to decreased quality of life and increased morbidity. However, Mexico only has enough opioid analgesics to treat 36% of those in need. We used logistic regression models to examine correlates of pain using data from the 2012 wave of the Mexican Health and Aging Study, which includes Mexicans aged 50 and older (n=13,727). Overall, 38.2% of individuals reported that they often suffered from pain. Those who reported pain were more likely to be female (OR: 1.56; 95% CI: 1.41, 1.72), insured (OR: 1.17; 95% CI: 1.03, 1.33), live in a semi-rural locality (OR: 1.18; 95% CI: 1.04, 1.34), report their health as fair or poor (OR: 2.99; 95% CI: 2.73, 3.29), be a past smoker (OR: 1.17; 95% CI: 1.06, 1.29), have at least one ADL limitation (OR: 2.58; 95% CI: 2.27, 2.93), report depression (OR: 2.19; 95% CI: 2.02, 2.37), or report arthritis (OR: 2.74; 95% CI: 2.45, 3.07). Those who did not report pain were more likely to be widowed or have higher education. Diabetes, stroke, and cancer were not significantly associated with pain. Given that Mexico does not have the resources to treat over half of individuals living with pain, understanding the high burden of pain in this population is important to inform interventions and improve quality of life.
EXPERIENCE OF LGBT PATIENTS AND FAMILY WITH HOSPICE AND PALLIATIVE CARE
Authors: Stein Gary L , Berkman Cathy
Published: November 2019

This study examines the degree to which hospice and palliative care staff observe or perceive inadequate, disrespectful, or abusive care to LGBT patients and family members. A cross-sectional study using an online survey completed by 865 providers, including social workers, physicians, nurses, and chaplains. Among respondents, 55% reported that LGB patients were more likely to experience discrimination at their institution than non-LGB patients; 24% observed discriminatory care; 65% reported that transgender patients were more likely than non-transgender patients to experience discrimination; 20% observed discrimination to transgender patients; 14% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 13% observed the spouse/partner being treated disrespectfully. Findings reported also include: institutional non-discrimination policy, staff training, intake procedures, and comfort in assessing LGBT status. Implications for future research, policy, and practice will be presented.