bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping With COVID: Does Prior Military Service Play a Role for Vietnam Veterans?
Authors: Stellman Jeanne , Stellman Steven , Kaiser Anica , Spiro Avron , Smith Brian
Published: December 2021

We investigated the impact of earlier military combat on ability to cope with the COVID-19 pandemic in 379 male Vietnam veterans who responded to surveys in 1984, 1998, and 2020. Combat exposure was scored with a validated scale, contrasting lowest tertile (8-15) vs. medium/high (16-40). About one-fourth of veterans (26%) reported that their military experience made it easier to cope with the pandemic, while over half (59%) said it had no effect. Medium/high-combat veterans were more likely to report that their military experience made coping easier (OR = 1.8, p = 0.03), but were less likely to report no effect of service on their coping than low-combat veterans (OR = 0.40, p<0.001). All 19 respondents (5%) who said military experience made coping more difficult were medium/high combat veterans. Military experience, and combat particularly, affected many of these veterans’ ability to cope with the pandemic decades after their service.
Intergenerational Relationships as a Resource for Resilience During the COVID-19 Pandemic
Authors: Turner Shelbie , Hooker Karen , Jarrott Shannon , Geldhof John
Published: December 2021

The intergenerational ties that offer support to older adults are likely useful for resilience during the COVID-19 pandemic. We analyzed whether positive and negative intergenerational contact was associated with positive pandemic-related personal change. We utilized data collected from 566 adults aged 50 and older between August 2020 and January 2021 via MTurk and a statewide research registry. Participants reported the quality of their contact with younger adults, and whether they experienced positive changes (i.e. new hobbies, healthier behavior, greater meaning in work) as a result of the pandemic. Higher positive, but not lower negative, non-familial intergenerational contact was associated with a higher number of positive pandemic-related changes (estimate = 0.07, SE = 0.03, p=0.02). The quality of familial intergenerational relationships were not associated with positive pandemic-related changes. Non-familial intergenerational relationships may be especially important for resilience, and should be supported during a time when they may be difficult to maintain.
A Social Ecological Model of Vulnerability and Resilience in Older Adults During the Covid-19 Pandemic
Authors: Aldwin Carolyn , Igarashi Heidi , Kurth Maria , Lee Hye Soo , Choun Soyoung , Lee Dylan
Published: December 2021

Objectives: We used a social ecological model to examine vulnerability and resilience among older adults during the COVID-19 pandemic. Methods: We analyzed two open-ended questions included in a survey of 235 respondents, 51–95 years old (M = 71.35; SD = 7.39; 74% female), which asked about COVID-19-related difficulties and positive experiences during the past week. We identified three different levels for difficulties and positives at the personal, interpersonal, and/or societal levels. Results: Fewer than half of the respondents reported on difficulties (41%) and positives (40%) just at the personal level. In terms of crossing levels, people were most likely to report events spanning the personal and interpersonal levels (14% and 18%, respectively). A few individuals reported difficulties and positives at the societal level. Discussion: Older individuals were acutely aware of challenges and positives existing at all three levels, and contributed to resources at the interpersonal and community levels.
Aging in Place: Social Connectedness and the Health of Older Subsidized Housing Residents
Authors: Cudjoe Thomas , Gonyea Judith , Stone Robyn
Published: December 2021

Findings on the prevalence and impacts of loneliness and social isolation on the lives of older adults have led to the lack of social connectedness being viewed as a major public health issue. Although an understudied population, emerging evidence suggests that for the nearly 3 million older low-income adults living in subsidized housing the impacts of lack of social connection may be especially profound. From a life course perspective, “cumulative economic disadvantage,” if combined with a “cumulative connectedness disadvantage,” may heighten exposure to health risk factors and negative health outcomes. Addressing social risk factors in this population thus may have the potential to reduce health disparities as well as improve quality of life. Decades of epidemiologic evidence suggest that social isolation is a key factor in disparate outcomes. Evidence-based interventions are needed to improve aging in place for this population, but little is known about the individual or contextual factors that influence social connectedness and health among this high-risk population of older adults. This symposium includes interdisciplinary perspectives and methods as well as present results from four studies that examine 1) perspectives on aging in place in subsidized housing, 2) relationship between social connection and food insecurity 3) relationship between social isolation and healthcare utilization and 4) between resident ties and links to health outcomes. Papers in this symposium will highlight the implications of study findings for informing future interventions to improve aging in place for older adults living in subsidized housing.
Blood Pressure Variability and Complexity in Nursing Home Residents Before Death
Authors: Graham Laura , Lee Sei , Steinman Michael , Peralta Carmen , Rubinsky Anna , Jing Bocheng , Fung Kathy , Odden Michelle
Published: December 2021

Blood pressure (BP) is a complex dynamic system in the human body and an important determinant of healthy aging. Exploring BP as a dynamic data system may provide important insights into how BP patterns can provide complementary information to the static, one-time BP measurements that are more commonly used for clinical decision making. Thus, we sought to describe BP as a dynamic data system in older adults nearing death. Using a prospective cohort study design, we assessed BP measures 6 months before death in Veterans Health Administrative nursing home residents between 10/1/2006 and 9/30/2017. Variability was characterized using standard deviation and mean square error after adjusting for diurnal variations. Complexity (i.e., amount of novel information vs. redundancy) was examined using Shannon’s entropy (bits). Generalized linear models were used to examine factors associated with overall BP variability. We identified 17,953 patients (98.0% male, 82.5% White, mean age 80.2 years, and mean BP 125.7/68.6 mmHg). In the last 6 months of life, systolic BP decreased slightly (□-7.2mmHg). Variability was stable until the last month of life, at which point variability increased by as much as 30%. In contrast, complexity did not change in the 6 months before death (□0.02 bits). Factors associated with BP variability before death include hospitalizations, hospice care, and medication changes. Systolic BP decreases in the last 6 months before death, and BP variability increases in the last month of life. Further, the increase in BP variability may be driven by increasingly complex care patterns as one approaches death.
COVID-19 and Emancipatory Gerontology: Perspectives of Political Economy and the American Rescue Plan
Authors: Estes Carroll , DiCarlo Nicholas , Yeh Jarmin
Published: December 2021

The present historic moment – a pandemic worsened by far-right extremism – reveals how mounting individual and collective precarity across the lifecourse and in old age resides within societal institutions of colonialism, white supremacy, patriarchy, and capitalism. Contradictions between systems of democracy and capitalism construct an ageist society aligned with neoliberal ideologies attempting to dismantle and privatize Social Security, Medicare, and Medicaid. These issues confront the call for a critical inquiry that matters in the lives of those who daily experience social injustices (Denzin, 2017). This paper presents emancipatory gerontology (Estes & DiCarlo, 2019) as a critical praxis to challenge assumptions, frameworks, and delirium writ large in American society as it relates to how we conceive of age, aging, and generations. We elucidate how the $1.9 trillion 2021 American Rescue Plan represents a paradigm shift that aims to supplant austerity economics with human, public, and community benefit. This knock on the hegemonic commitment to austerity and its mantra is an opportunity to interrogate the effects of, and advance, emancipatory policies and practices. Gerontology is inadequate without a lens for examining how critical analysis and social action might inform one another. To shift from disruption to transformation in the “new normal,” scholars must bring the past and future into the present to engage realistic utopian pedagogies of hope. Emancipatory gerontology offers a theoretical framework and vocabulary for interrogating individual and social consequences of major policy and institutional forces in relation to aging and generations across the lifecourse.
How States Supported Older Adults and Persons With Disabilities During COVID-19 Through the Medicaid Program
Authors: Miller Edward , Beauregard Lisa , Nadash Pamela , Simpson Elizabeth , Wylie Molly , Gusmano Michael
Published: December 2021

COVID-19 has presented challenges for older adults who receive Medicaid home and community-based services. The federal government has allowed states to seek approval for certain flexibilities to better serve this population, including increasing provider payment rates, allowing family members to be caregivers, and permitting case management entities to provide direct services. This study uses cross-sectional data to identify factors associated with states’ adopting these Medicaid flexibilities using multivariate methods. The results indicate that the factors associated with state adoption varied depending on the flexibility. The findings suggest that states increased provider payment rates in response to prevalence of COVID-19 within their state. As cases increase, states may come under pressure to increase provider rates further which may not be feasible because of budget constraints. The results also suggest that demand for and supply of services may be a factor in whether states allowed family members to be paid caregivers. States with a higher proportion of individuals aged 85 years and older were more likely to permit caregivers to be paid which may suggest that these states may not have enough providers to care for the population. Lastly, the results suggest that provider supply was associated with whether a state allowed case management entities to provide direct care services. States with fewer home health agencies were more likely to allow this flexibility. Based on these results, states may be pursuing available Medicaid flexibilities to address provider and workforce shortages which existed prior to COVID-19 but have been exacerbated by the pandemic.
COVID-19 Lockdown Measures: Impact On Older Adults With Dementia And Their Caregivers In Singapore
Authors: Yow Quin W , Lokanathan Tharshini , Chen Hui-Ching
Published: December 2021

Family caregivers typically rely on community-based services and social support networks to supplement their caregiving of older adults with dementia (OAwD). In April 2020, the Singapore government implemented a partial lockdown to contain the spread of COVID-19. We assessed the policy's impact on the physical and mental health of caregivers and their OAwD. As part of a larger study, 30 caregivers were interviewed and rated the stress they experienced when caring for an OAwD during the partial lockdown. Qualitative analyses found significant behavioral changes in OAwD such as irritability, aggression and hallucinations, which led some caregivers to believe their dependents’ condition had deteriorated, as well as heightened levels of caregiving stress. Overall, our preliminary results suggested that although social distancing measures may be effective in containing the spread of COVID-19, these measures could lead to negative outcomes on vulnerable populations such as OAwD and their caregivers.
Community College Gerontology Programs: Revisiting and Re-Visioning Workforce, Career Pathways, and Transfer
Authors: Sasser Jennifer (Jenny) , Anunsen Roger , Faber Michael
Published: December 2021

The session will focus on new and existing innovative ways that Community Colleges are effectively addressing workforce needs resulting from a rapidly aging population; the ever-expanding career pathways available to students in the field of gerontology; as well as the continuing higher education needs of students transferring to bachelor’s and graduate-level gerontology programs. A panel of Community College and University gerontology professionals, representing both the GSA Community College and Aging Workforce Interest Groups, will share the innovative ways that they are working to address the three focus areas of this symposium. We will also include opportunities for discussion with participants about their experiences with and ideas for addressing these issues.
COVID-19 Vaccine Hesitancy Among Older Adults: Evidence From the Medicare Current Beneficiary Survey
Authors: Bhagianadh Divya , Arora Kanika
Published: December 2021

Objective: Older adults have been the most enthusiastic cohort about the COVID-19 vaccine since its rollout. However, there is limited evidence on vaccine hesitancy, particularly among community-dwelling older adults. In this study, we examine the prevalence and predictors (especially information sources) of vaccine hesitancy in this group. Methods: We use the Medicare Current Beneficiary Survey (MCBS)- Fall 2020 supplement data and employ multivariable logistic regression models to explore this association. We study heterogeneous effects by gender, metro/non-metro residence status, race, and age. Results: Depending on healthcare providers (HCP), social media, the internet, and family/friends as the main COVID-19 information source was associated with higher odds of negative vaccine intent when compared to those who rely on regular news. We did not find any association of ‘unsure’ vaccine intent and different information sources. Discussion: Recommendation from an HCP is a strong predictor of any vaccine acceptance and higher negative intent for COVID-19 vaccine among those who depend on HCP for information is concerning. This could be due to vaccine hesitancy among HCPs themselves or due to other mechanisms like infrequent interactions with the health system.
Health Disparities in Delirium
Authors: Dicks Robert , Choi Jimmy , Waszynski Christine , Collins-Fletcher Kadesha , Taylor Beth , Martinez Catherine , O'Sullivan David
Published: December 2021

Racial and ethnic minority populations in the US experience greater cumulative disease burden, as well as social and economic barriers, stressors, and limited advocacy/access to culturally informed healthcare. This increased risk burden is expected to be associated with an increased risk for delirium during acute care encounters. Previous studies on health disparity and delirium are limited and report equivocal findings regarding delirium incidence, possibly related to sample bias or non-validated measures. Risk for delirium during acute care in health disparity populations (HDP) that include Black African Americans (BAA) and Hispanic-Latinx (HL) has not been systematically studied using validated measures. We conducted a retrospective analysis utilizing our delirium program (ADAPT) registry that systematically assessed all hospitalized patients through their entire hospital stay for the years 2018-2019 (36K patients, 80% NHW, 11% HL, 9% BAA). The Confusion Assessment Method (CAM and CAM-ICU) and Richmond Agitation Sedation Scale (RASS) were used as screening assessments to identify delirium. We know from previous studies that negative CAM results in our environment have high specificity. The incidence of delirium between populations was compared using a chi-square test. Delirium incidence was higher in HDP (BAA combined with HL) compared to NHW in 71-80yo (16.0% vs 12.6%, p=0.003). Delirium incidence was not different in all other age groups compared; <65yo (p=0.191), 61-70yo (p=0.223), 81-90yo (p=0.644). Understanding the association, or lack thereof, between health disparities, ethnic and race-based risks for delirium is expected to provide important insights into more focused delirium assessment, prevention and mitigation strategies in these populations.
Caregiving Intensity and Depressive Symptoms Among Older Adults After Partners’ Onset of Dementia
Authors: Harris Melissa , Ha Jinkyung , Hoffman Geoffrey
Published: December 2021

Caring for a partner with Alzheimer’s disease or related dementia (ADRD) can create tremendous care burdens. However, the extent to which onset of ADRD in a partner impacts caregiving intensity and emotional health, the relationship of increased care intensity to emotional health, and whether relationships vary across the older adult population, are less clear. We used 9 waves (years 2000-2016) of the nationally representative Health and Retirement Study dataset to examine the number of weekly caregiving hours provided and depressive symptoms for older (ages ≥51) individuals after partners' ADRD onset (measured with the Telephone Cognitive Interview Survey). We compared changes in outcomes from before to after partners' ADRD onset using zero-inflated negative binomial regression models, overall and among sub-populations with potential vulnerability to excess care burdens – women and racial/ethnic minorities. In our sample of 2,186 older Americans with 10,120 unique observations, we observed a 215% increase (p<0.001) in weekly caregiving hours provided and 21% increase (p<0.001) in depressive symptoms reported by older respondents after partners' ADRD onset. Even larger impacts were observed for women and for non-Hispanic whites. Increased amounts of caregiving were associated with increases in depressive symptoms after a partner's ADRD onset. In all, ADRD has substantial impacts on family. Improved support mechanisms, including enriched community resources, clinician focus on dyadic needs, respite care, and policy efforts such as tax credits for caregivers, will be needed to meet the needs of couples increasingly affected by ADRD.
Worse Self-Reported Hearing Ability Is Associated With Greater Perceived Physical and Mental Fatigability
Authors: Gmelin Theresa , Moored Kyle , Lin Frank , Golub Justin , Wojczynski Mary , Boudreau Robert , Galvin Angeline , Glynn Nancy W
Published: December 2021

Older adults with hearing loss often report higher fatigue due to effortful listening. We evaluated whether self-reported hearing ability is associated with perceived physical and mental fatigability (a more sensitive measure than fatigue) using the Pittsburgh Fatigability Scale (PFS). Older adults (N=2,558) from the Long Life Family Study Visit 2 (71.5±11.4 years; 54.8% women) completed PFS and self-reported hearing ability (worse=[fair,poor,very poor,deaf] or better=[good, excellent]). Age-adjusted PFS Physical and Mental scores were 2.3 and 2.5 lower, respectively, for worse vs. better hearing (p<.0001). Generalized estimating equations adjusted for family-relatedness, site, age, sex, cognitive function (Mini-Mental State Examination), education, and self-reported health. Compared to individuals with better hearing, those with worse hearing had a 42% and 44% greater odds of physical (≥15) (CI:1.12-1.80,p=0.0042) and mental(≥13) (CI:1.13-1.84,p=0.0034) fatigability, respectively. These observed associations may potentially be explained via complex psychosocial and cognitive aging pathways (e.g. effortful listening) to be examined in future work.
Age-Related Macular Degeneration and the Aging Brain
Authors: Whitson Heather , Badea Alexandra , Stout Jacques , Davis Simon , Zhuang Jie , Madden David
Published: December 2021

Age-related macular degeneration (AMD), a leading cause of vision loss in older Americans, is associated with cognitive decline and, particularly, worse performance on verbal fluency tasks. To determine whether AMD is associated with changes in brain structure that may underlie decline in cognition, we conducted a longitudinal, observational study of 39 visually impaired AMD patients and 33 age-matched peers with healthy eyes. Participants (mean age 74.3) underwent cognitive assessments and 3T magnetic resonance imaging (MRI) at baseline and two years. At baseline, AMD patients exhibited lower cortical volume and worse white matter tract integrity, especially in inter-hemispheric connections (FDR <0.05). Principal components analyses revealed faster white matter decline in the AMD group, especially in visual cortex and left hemisphere, which is implicated in language tasks. Understanding patterns of regional brain atrophy in AMD sheds light on mechanisms for the AMD-cognition link and opens windows of opportunity for intervention.
Utilization and Expenditures of High-Need, High-Cost Older Adults With Disabilities
Authors: Karon Sarita , Kordomenos Cleanthe , Knowles Molly , Segelman Micah
Published: December 2021

The factors that lead people to have high needs for care can vary greatly, with implications for the best approaches to serving their needs. One high need group of interest is older adults with disabilities and multiple comorbidities. There is variation in need within this group. Of particular interest is the subset that is both high need and high cost (HNHC). We present work describing Medicare and Medicaid utilization and expenditures for this high need group and the HNHC subset. Over 7.6 million people were identified as high need; 13.6% of them also were defined as HNHC. Patterns of utilization differed between these groups, with the HNHC group more likely to use inpatient care and nursing home care, but less likely to use community-based long-term services and supports. These findings have implications for the development of care models that might best meet the needs of this population.
Functional Trajectories for People With Dementia and Other Comorbidities in the Last Years of Life
Authors: Broyles Ila , Palmer Lauren , Graf Emily , Li Qinghua , Feng Zhanlian , Lamont Helen , Dey Judith , Oliveira Iara
Published: December 2021

A hallmark of end-of-life (EOL) is reduced functional ability. However, the impact of dementia and other comorbidities on EOL decline for older adults is less well understood. We estimated the effect of having dementia and comorbidities on activity of daily living (ADL) scores using the 2000-2012 Health and Retirement Study. We identified 5,853 people over age 65 who died and predicted monthly ADL impairments in the last 4 years of life controlling for dementia and other characteristics. Stroke and obesity were associated with significantly higher ADL scores, regardless of dementia status. However, if both dementia and either stroke or obesity were present, dementia was associated with significantly higher ADL scores approximately 1-4 years before death. Functional decline occurred closer to death if they had these conditions and no dementia. Differences in function when patients have dementia and comorbidities may affect understanding of survival time and access to appropriate care.
Staying in Touch During COVID-19: Long-Term Care Facility Communication Strategies and Family Perceptions
Authors: Straker Jane , Choi Mi Sun
Published: December 2021

During the COVID-19 pandemic, family concerns regarding residents in long-term care facilities (LTCFs) increased dramatically due to the higher proportion of deaths in LTCFs and an inability to visit, observe care, or easily communicate with residents. However, little is known about how these facilities communicated with families and how communications were related to family perceptions about the facility. To address these knowledge gaps, we implemented an online survey of family members or friends of residents in LTCFs from April 28 to June 19, 2020. A total of 174 responses nationwide reported the types of communications used, frequency of communication and alternative visits, and whether the families had peace of mind, would recommend the facility and whether they were considering removing the resident from the facility. We performed chi-square and t-tests to identify differences in perception among families. Results showed that respondents had more negative perspectives of a facility when they were not informed about confirmed COVID cases. There were no differences in family members’ perceptions of a facility based on the frequency of alternative visits. When respondents could communicate with their family members in an LTCF by telephone, email, mail, and window visits, they had more peace of mind. Respondents were more likely to recommend the facility to others when they were able to communicate via mail with the facility. Our findings suggest multiple communications and transparency about COVID status were most effective in keeping positive family perceptions about the facility. Our results can inform future facility communication protocols.
Perspectives Toward Person-Centered Long-Term Care in China
Authors: Wang Jing , Corazzini Kirsten , Wu Bei
Published: December 2021

Health care aides provide direct care for older residents with advanced dementia in long-term care facilities. This study aims to understand care aides’ perceptions of what is ‘good’ care, what is person-centered care, and how to provide person-centered care for older residents with advanced dementia, as preparatory work of the WE-THRIVE consortium’s efforts to develop internationally-relevant common data elements of person-centered dementia care and launch comparative research in LMICs. Semi-structured interviews were conducted with health care aides (N=35) from 2 government-owned and 2 private long-term care facilities in urban China. Directed and conventional content analysis were used, drawing upon core constructs of person-centered dementia care and Nolan’s (2006) senses framework. We found that although care aides were not trained in person-centered care, they did incorporate person-centeredness in their work by tailoring their care to the needs of older residents and facilitating interactions with residents and their peers through communication cues.
Cognition Moderates the Relationship Between Hearing and Mobility in Cognitively Normal Older Adults
Authors: Pupo Daniel , Small Brent , Deal Jennifer , Armstrong Nicole , Resnick Susan , Lin Frank , Ferrucci Luigi , Tian Qu
Published: December 2021

Recent data has shown a consistent but modest association between hearing impairment and poor mobility; both are strongly associated with cognition. Cognitive function may moderate the relationship between hearing and mobility. We analyzed 601 cognitively normal older participants from the Baltimore Longitudinal Study of Aging who had concurrent data on cognition (attention, executive function, sensorimotor function), hearing (pure-tone average, PTA), and mobility (6-meter gait speed, 400-meter time). We performed multivariable-adjusted linear regression to test two-way interactions between each cognitive measure and PTA. There were significant PTA interactions with all cognitive measures on 400-meter time. There was a significant interaction between PTA and sensorimotor function on 6-meter gait speed. Among cognitively normal older adults, poorer hearing is more strongly associated with poor mobility in those with low cognition, especially sensorimotor function. Future studies are needed to understand how cognition may moderate the relationship of hearing impairment with mobility decline over time.
Resilience as a Determinant of Healthspan and Lifespan in Mice
Authors: LeBrasseur Nathan
Published: December 2021

Dynamic measures of physical resilience—the ability to resist and recover from a challenge—may be informative of biological age far prior to overt manifestations such as age-related diseases and geriatric syndromes (i.e., frailty). If true, physical resilience at younger or middle ages may be predictive of future healthspan and lifespan, and provide a unique paradigm in which interventions targeting the fundamental biology of aging can be tested. This seminar will discuss research on the development of clinically relevant measures of physical resilience in mice, including anesthesia, surgery, and cytotoxic drugs. It will further highlight how these measures compare between young, middle-aged, and older mice, and how mid-life resilience relates to later-life healthspan and even lifespan. Finally, it will provide insight into whether interventions targeting the biology of aging can modify physical resilience in mice.
Remotely Supervised Cranial Electrical Stimulation and Clinical Pain for Older Adults With Knee Osteoarthritis
Authors: Ahn Hyochol , Miao Hongyu , Ali Yumna
Published: December 2021

Knee osteoarthritis (KOA) is one of the most prominent causes of chronic pain, functional impairment, and disability in older adults. The current standards of care for KOA are aimed toward reducing pain and are largely comprised of analgesic medications, but existing pharmacologic approaches often produce significant adverse effects. Moreover, recent evidence suggests that KOA pain is characterized by alterations in pain-related brain mechanisms. Cranial electrical stimulation (CES), which delivers a low-amplitude alternating electric current to the brain, can facilitate the reversal of maladaptive brain function. Portable CES devices can be used at home with real-time monitoring through a secure videoconferencing platform to facilitate high adherence. Thus, the purpose of this pilot clinical study was to examine the preliminary efficacy of remotely supervised CES on clinical pain severity in older adults with KOA. Thirty participants with KOA were randomly assigned to receive 10 daily sessions of remotely supervised CES with 0.1 mA at a frequency of 0.5 Hz for 60 minutes (n=15) or sham CES (n=15). We measured clinical pain severity using the numeric rating scale (NRS; range, 0 – 100). Participants (67% female) had a mean age of 59 years. Active CES significantly reduced scores on the NRS (Cohen’s d = 1.43, P < 0.01). Participants tolerated CES well without any adverse events. Our findings demonstrate the promising clinical efficacy of remotely supervised CES for older adults with KOA. Future studies with larger-scale randomized controlled trials with follow-up assessments are needed to validate and extend our findings.
Barriers to and Recommendations for Research Recruitment of Individuals Affected by Serious Illness
Authors: Cardenas Valeria , Rahman Anna , Giulioni Jenna , Kogan Alexis Coulourides , Enguidanos Susan
Published: December 2021

Researchers are encountering increasing challenges in recruiting participants for healthcare research. We conducted semi-structured individual interviews to identify participant barriers to research and recommendations for overcoming these challenges. We recruited 17 patients and eight caregivers who were approached to participate in a randomized control trial. We also recruited 31 primary care physicians. Using grounded theory, three researchers independently coded the transcripts and then met to compare codes and reconcile discrepancies. Themes from patient and caregiver interviews included time constraints, privacy concerns, lack of research familiarity, disconnect with research institution, self-perceived health status, and concerns with study randomization and repetitive questions. Physician-identified barriers focused on time constraints and study randomization. Patient and caregiver recommendations for study recruitment included various recruitment techniques. Physician recommendations were related to incentives. Although patients and caregivers prefer that their physicians recruit them for health-related research studies, physicians identified time constraints as a barrier to research involvement.
Premenopausal Bilateral Oophorectomy Effects on Clinical and Real-World Physical Function Measures
Authors: Fortune Emma , Jahanian Omid , Morrow Melissa , Miller Virginia , Mielke Michelle
Published: December 2021

Women with premenopausal bilateral oophorectomy (PBO) are at increased risk for physical function (PF) declines. This study investigated the relationships of field-based physical activity measures with clinical PF and strength parameters in post-menopausal women with and without PBO. Women with (n=21; age=64±4 years; BMI=32±8 kg.m-2) and without (n=15; age=67±6 years; BMI=28±6 kg.m-2) PBO performed PF and strength tests (walking speed, distance walked, short physical performance battery (SPBB), leg and chest strength), and wore ankle accelerometers for 7 days (daily step count and loading index [the cumulative sum of each step’s skeletal loading]). Age, BMI, step count and loading index were entered into stepwise multiple regression to identify significant predictors of PF and strength parameters. Step count was a predictor of SPBB score in both groups. In women without PBO, step count was a predictor of walking speed; loading index was a predictor of leg strength; step count and loading index were predictors of distance; and step count and age were predictors of chest strength. For PBO women, loading index and BMI were predictors of walking speed and distance; BMI was a predictor of leg strength; and there were no predictors of chest strength. These data suggest while field-based physical activity was strongly and positively associated with clinical PF and strength measures for women without PBO, BMI was a dominant negative factor for PF in women with PBO. Future work will include a larger sample size and additional confounders to further elucidate underlying factors of reduced PF and mobility after PBO.
Caring During COVID-19: Inequalities in Resource- and Information-Sharing by Race, Ethnicity, and Nativity
Authors: Park Sung
Published: December 2021

Americans experienced significant challenges as a result of the pandemic, further magnifying the weak U.S. social safety net. With few institutional supports available, individuals turned to each other for assistance. Relying on multiple nationally representative surveys, this study examines resource-sharing by race, ethnicity, and nativity over a one-year period during COVID-19. Furthermore, this study examines knowledge-related behaviors, such as information-seeking and information-sharing, which were also important tools utilized during the pandemic. Differences in both resource- and information-sharing contributed to disparities in the perceptions of risk, the reported levels of need, and concomitant behaviors linked to well-being. This research emphasizes the importance of personal relationships during times of crisis, and the role of social connections in shaping health and economic inequalities between minority- and non-minority populations.
Using a Theoretical Framework in a Qualitative Metasummary About Fatigue Adaptation After Stroke
Authors: Teng Chiao-Hsin , Anderson Ruth , Davis Leslie
Published: December 2021

We describe how we used a theoretical framework, Adaptive Leadership Framework for Chronic Illness (ALFCI), to complete a qualitative metasummary in a scoping review of 26 articles. We abstracted and grouped qualitative findings relevant to fatigue adaptation in stroke survivors using constructs of the ALFCI as 4 main themes: 1) adaptive challenges, 2) adaptive work, 3) adaptive leadership and collaborative work, and 4) technical challenges and technical work. We found that stroke survivors encountered different aspects of challenges (e.g., physical dysfunction vs. mental distress) and utilized various adaptive work (e.g., conserving energy vs. restructuring normality) as well as what stroke survivors needed from healthcare professionals (e.g., basic knowledge about fatigue). The ALFCI provides a useful lens to synthesize qualitative findings regarding fatigue adaptation and therefore researchers can target different problems that need to be tackled for stroke survivors, care partners, or healthcare professionals, respectively.
Loneliness, Sleep Quality, and Cognitive Function in Community-Dwelling Older Adults
Authors: Yu Kexin , Fausto Bernadette
Published: December 2021

Loneliness is a risk factor for cognitive decline in older adults, however, the underlying mechanisms are less understood. Individuals who experience frequent loneliness tend to have poorer sleep quality. Empirical evidence supports the influence of sleep on cognitive health. This study examined the possible mediating effect of sleep characteristics on the relationship between loneliness and cognition. The study sample included 557 participants from wave 2 of the National Social Life, Health, and Aging Project who had actigraphy sleep measures (mean age = 73.17, 52.6% female). Loneliness was assessed with the 3-item UCLA Loneliness Scale. Cognitive function was measured with the Montreal Cognitive Assessment. Five sleep quality indicators were objectively recorded with wearable devices: assumed sleep time; actigraphy sleep time; time spent awake after sleep onset (WASO); sleep fragmentation; and sleep percentage (actigraphy sleep/(assumed sleep + WASO)). Path analysis model results show that WASO, fragmentation, and sleep percentage mediate the link between loneliness and cognitive function. Loneliness was positively related to WASO, and WASO was negatively associated with cognition. Loneliness correlated with increased sleep fragmentation which was associated with worse cognitive function. Individuals who had more frequent loneliness had a lower sleep percentage, and sleep percentage was positively associated with cognitive function. Nonetheless, the path from loneliness to these three sleep characteristics became insignificant after controlling for depressive symposiums. Depressive symptoms and fragmentation were found to double mediate the association between loneliness and cognitive function. Sleep and depression could be underlying pathways for the association between loneliness and cognition.
The Longitudinal Relationships Between Social Isolation, Frailty, and Health Outcomes Among Canadian Older Adults
Authors: Mehrabi Fereshteh , Béland François
Published: December 2021

Social isolation and frailty are global public health issues that may lead to poor health outcomes. We tested the two following hypotheses: 1) changes in social isolation and frailty are associated with adverse health outcomes over two years, 2) the associations between social isolation and health vary across different levels of frailty. We estimated a series of latent growth models to test our hypotheses using data from the FRéLE longitudinal study among 1643 Canadian community-dwelling older adults aged 65 years and over. Missing data were handled by pattern mixture models with the assumption of missing not at random. We measured social isolation through social participation, social networks, and social support from different social ties. We assessed frailty using Fried’s criteria. Our results revealed that higher frailty at baseline was associated with a higher rate of comorbidity, depression, and cognitive decline over two years. Less social participation at baseline was associated with comorbidity, depression, and changes in cognitive decline. Less social support from friends, children, partner, and family at baseline was associated with comorbidity, cognitive decline, and changes in depression. Fewer contacts with grandchildren were related to cognitive decline over time. The associations of receiving less support from partner with depression and participating less in social activities with comorbidity, depression, and cognitive decline were higher among frail or prefrail than robust older adults over time. This longitudinal study suggests that intimate connectedness and social participation may ameliorate health status in frail older populations, highlighting the importance of age-friendly city policies.
Aging LGBT Adults’ Access to Social Resources According to LGBT Identity and Sociodemographics
Authors: Kittle Krystal , Boerner Kathrin , Kim Kyungmin
Published: December 2021

Research suggests that social resources positively influence the health and well-being of lesbian, gay, bisexual, and transgender (LGBT) aging adults, but their access to social resources may vary according to LGBT identity. Using data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N=2,536), multivariate models tested how access to social resources varied by LGBT identity and whether the effect of LGBT identity showed additional variations by sociodemographic characteristics (i.e., age and education) among aging LGBT adults. Lesbian respondents had larger social networks than gay respondents, while gay respondents had smaller networks than transgender respondents. Lesbian respondents had more social support and community belonging than other identity groups. Bisexual male respondents and transgender respondents had less support than gay respondents and bisexual male respondents reported less community belonging than gay respondents. Education and age moderated the association between LGBT identity and social support. Findings highlight the importance of considering social support separately from social network size with the understanding that large social networks do not necessarily provide ample social support and this distinction was particularly relevant for transgender respondents who had larger social networks, but less social support than gay respondents. Results also suggest that feelings of LGBT community belonging vary among LGBT identity groups. Health and human service professionals should not only consider the sexual and gender identity of their aging LGBT clients, but also consider the clients’ additional sociodemographic characteristics when assessing their access to social resources.
The Role of Minority Stress and Social Resources in the Healthcare Utilization of Aging LGBT Adults
Authors: Kittle Krystal , Boerner Kathrin , Kim Kyungmin
Published: December 2021

Research suggests that minority stress can influence the healthcare utilization of aging LGBT adults, and that social resources can buffer the effect of stress on healthcare utilization. Using data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N = 2,560), multiple logistic regression assessed the associations between minority stress (i.e., internalized stigma and LGBT identity disclosure) and healthcare utilization (i.e., health screenings, emergency room use, routine checkups, and regular provider). We also examined the moderating effect of social resources, including social network size, social support, and LGBT community belonging, in these associations. Internalized stigma was negatively associated with having a routine checkup in the previous year (OR = 0.82, p = .038). Disclosure was positively associated with having a health screening within the past 3 years (OR = 1.52, p = .000) and having a regular provider (OR = 1.33, p = .021). Further, we found that social support moderated the association between disclosure and health screenings (OR = 1.52, p < .001); thus, having higher levels of social support and disclosure in tandem increased the likelihood of getting a health screening in the last three years. Health and human service professionals should provide information about internalized stigma and LGBT identity disclosure to educate their clients about the ways in which these minority stressors can impact their healthcare experiences. Providers should assess the social support of their aging LGBT clients and inform them about the added benefit that social support can have in their healthcare experiences.
Transforming Dementia Care: Implementation Challenges Moving Evidence-Based Programs to Health Care
Authors: Gitlin Laura , Hepburn Kenneth , Czaja Sara
Published: December 2021

Although evidence for dementia care programs continues to grow, families and health providers do not have ready access to programs, nor have they been widely disseminated and routinized in healthcare. Understanding implementation considerations when embedding evidence-based programs in healthcare systems can inform ways to effectively transform dementia care. This symposium will examine similarities and differences in implementation challenges encountered and strategies used when implementing four evidence-based programs being tested in different healthcare environments using distinct study designs. Dr. Gaugler et al., will discuss implementation challenges encountered with a staff-delivered intervention (ADS Plus) to support caregivers in adult day services that is being tested using a mixed methods hybrid trial design in >50 sites nationally. Dr. Hodgson et al., will discuss adaptions and their measurement to COPE, a home-based dyadic support program being embedded in 10 PACEs of a large healthcare system using a noninferiority trial testing staff training strategies. Dr. Forester et al., will examine implementation of the Care Ecosystem for dementia patients in a high-risk, integrated care management program using a pilot embedded pragmatic trial. Dr. Hepburn et al., will explore tactical challenges of implementing Tele-Savvy, an online caregiver psychoeducation program, within the context of a pilot pragmatic clinical trial. Drawing upon implementation science, themes discussed include balancing adaptations and fidelity, measurement of implementation outcomes and organizational readiness, and staff training implications. Also highlighted are research design considerations. Dr. Czaja, an expert in the design and implementation of dementia care interventions from in-person to technology-based will be the discussant.
Addressing Tactical Challenges in Embedding Tele-Savvy in a Pilot Pragmatic Trial
Authors: Hepburn Kenneth , Clevenger Carolyn , Berg Karina , Fortinsky Richard
Published: December 2021

This presentation describes how we plan to address the challenges of testing an evidence-based caregiver program in a real-world setting without the infrastructure and personal contact of a typical RCT. Instead of screening participants for eligibility, clinic staff will pre-identify participants whom clinicians then confirm. Each clinic will include Tele-Savvy as standard of care; we will thus be able to obtain IRB approval for a waiver of consent. By securing agreement from each clinic to incorporate a small set of standard instruments (e.g., Pearlin Caregiver Competence scale) into their standard operating procedure of routinely collecting caregiver data gathering, we will be able to eliminate the need for a central research staff to conduct baseline and follow-up interviews and will, instead, collect key outcome data through the electronic health record. Instead of in person training of Tele-Savvy facilitators, we will rely on an online training program and facilitator manuals.
Tracking Adaptation and Fidelity When Embedding COPE, Evidence-Based Dementia Care, in PACE Sites
Authors: Hodgson Nancy , Gitlin Laura
Published: December 2021

One essential question in moving dementia care interventions to practice is, “What is the optimal balance between fidelity to, and adaptation of, a proven program in “real world” settings?" We present a protocol for measuring the adaptation/fidelity and implementation of an evidence-based dementia care program (Care of Persons in their Environment, COPE) in PACE settings. During pre-implementation, science-based elements of COPE were documented including the theory of change, logic model and core components. Possible adaptations to COPE in its delivery were identified and included program structure (sequence of sessions), content (assessments), and delivery methods (online). During implementation, documentation of implementation strategies is captured using an evidence-informed checklist derived from the Expert Recommendations for Implementing Change (ERIC) workgroup. Ongoing documentation of fidelity/adaptation aspects of program implementation is conducted using the FRAME framework. Understanding methods and measures deployed in adaptation and implementation of evidence-based dementia programs can help guide future translation efforts.