bluuebunny/crossref_metadata_2025 huggingface dataset:
Loneliness and Changes in Cognitive Functioning Among Racially Diverse Older Adults in the United States
Authors: Camacho David , Pacheco Kelly , Henderson Charles , Reid M Cary , Wethington Elaine
Published: December 2021

Longitudinal studies examining the association of loneliness with cognitive decline rarely include older members of racial minorities. Guided by a Minority Stress Framework, we used Waves 2 and 3 from the National Social Life, Health, and Aging Project to assess whether loneliness (UCLA-3-items) at W2 predicts cognitive decline (Chicago Cognitive Functioning Measure) among US African-American, Latino, and white older adults (ages≥60). We included interactions of W2 loneliness with race in examining changes in cognitive functioning. Estimates were (N=1,950) adjusted for demographics, chronic disease, depression, and social connectedness. In all groups, loneliness was positively associated with greater global cognitive decline over the 5-year interval. However, analyses of different domains of cognitive functioning (e.g., executive functioning, memory) suggested that this association differs by cognitive domain and race. Future research on interventions to prevent cognitive decline should consider targeting loneliness, include diverse older adults, and examine global and specific domains of cognitive functioning.
Technological Interventions and Social Participation in Community-Dwelling Older Adults With or Without Dementia
Authors: Heins Pascale , Boots Lizzy , Koh Wei Qi , Neven An , Verhey Frans , de Vugt Marjolein
Published: December 2021

Social isolation is a growing health issue in community-dwelling older adults with and without dementia as it can negatively affect their health and well-being. Consequently, psychosocial interventions targeting their social participation are increasingly gaining importance. So far, however, little is known about the potential of technological interventions in this population. Therefore, this systematic review explored the effectiveness of technological interventions in improving social participation of community-dwelling older adults with and without dementia. Records identified through five scientific databases were independently screened by two reviewers. A total of 36 studies published between 2005 and 2020 were included in a narrative synthesis. Studies differed widely in study design, type of technology, used outcome measures, and methodological quality. However, the findings highlight the potential role of technological interventions in improving different dimensions of social participation. At the same time, barriers and facilitators of these interventions to social participation were identified.
Case Study of an Outbreak: Resident, Staff, and Community Indicators
Authors: Miles Toni
Published: December 2021

Outbreak investigation is not infection control. We present a self-study of factors influencing outcomes inside a single nursing home during the early stage of the outbreak - February to May 2020. We examine 3 sources of influence: Practice / Operations; Local, State & Federal Policies; Uncontrollable operational factors. Outcomes of interest include: mortality and resident / staff health. Data consists of clinical records, review of communications, and interviews with staff present during the critical period. Infection control is different from outbreak investigation. There must be a balance between staff empowerment and adherence to guidelines. In an outbreak, staff need the confidence to make decisions based on incomplete knowledge. The presentation concludes with lessons learned – what worked and what actions need improvement. There are areas requiring further analyses of policy and ethics.
Views of Aging During the Corona Pandemic
Authors: Bellingtier Jennifer , Kornadt Anna
Published: December 2021

In the Covid-19 pandemic, media stories and government reports have emphasized the heightened risk of being “old” and placed a spotlight on the way we think and talk about older adults and aging. In this symposium we investigate how the pandemic and the public discourse about older adults has shaped views of aging in different countries. Bellingtier et al. report on German children’s views of older adults before and during the pandemic. Children placed greater distance between themselves and older adults both before and after the pandemic, suggesting early ageism in children that predates the pandemic. Levy et al. provide experimental evidence that media stereotypes about aging and Covid-19 influence the mental health of older American adults, both in positive and negative. Schwartz and Ayalon found that greater perceptions of age-based discrimination in the healthcare system by Israeli adults 50+ were significantly related to greater Covid-19 worries. Greater worry can motivate older adults to take precautions, but be detrimental if it becomes too high. In line with this finding, Tingvold et al. found in a study with older adults from Luxembourg that more Covid-19 worry predicted feeling older four months later, but only for those in worse health. Finally, Terracciano examined longitudinal change in subjective age and found that American adults reported feeling younger after the emergence of Covid-19 than before, suggesting that perceptions of aging partly reflect a coping process to counter the negativity in the media.
Self- and Other-Directed Ageism and Worries Concerning COVID-19 Health Consequences
Authors: Ayalon Liat , Cohn-Schwartz Ella
Published: December 2021

Worries associated with COVID-19 health consequences are well-justified. They may motivate people to take safety precautions, but may hinder if they become too intense. Current research examined mainly age and gender as potentially associated with worries. This study instead, focuses on self-perceptions of ageing (SPA) and perceived age discrimination as potential predictors of worry, in light of the ageism pandemic which co-occurred with the COVID-19 outbreak. The study is based on a national representative sample of 1,092 adults aged 50+ in Israel. Phone interviews were conducted between March – May 2020, when Israel gradually moved from strict to partial lockdown. Our findings show that SPA and age-based discrimination in the healthcare system were significant predictors of worries. The findings point to the potentially negative impact of the ageism pandemic in relation to worries. Interventions that address ageism directed by self or others might alleviate people's worries in the COVID-19 pandemic.
Impact of Media-Based Age Stereotypes on Older Individuals’ Mental Health During the COVID-19 Pandemic
Authors: Levy Becca , Chang E-Shien , Lowe Sarah , Provolo Natalia , Slade Martin
Published: December 2021

During the COVID-19 pandemic, stigmatization of older persons has increased in traditional and social media. It was unknown whether this negative messaging could be detrimental to the mental health of older individuals, and whether the relatively uncommon positive messaging about older individuals could benefit their mental health. To address these gaps, we designed age-stereotype interventions based on actual news stories that appeared during the pandemic. As expected, the exposure of older individuals to the negative-age-stereotype-messaging interventions led to significantly worse mental health (more anxiety and less peacefulness), compared to a neutral condition; in contrast, the positive-age-stereotype-messaging interventions led to significantly better mental health (less anxiety and more peacefulness), compared to a neutral condition. The results demonstrate the need for media messaging aimed at empowering older individuals during the pandemic and beyond.
Documentation of Dementia as a Cause of Death Among Mexican-American Decedents With Dementia
Authors: Downer Brian , Chou Lin-Na , Snih Soham Al , Barba Cheyanne , Kuo Yong-Fang , Raji Mukaila , Markides Kyriakos , Ottenbacher Kenneth
Published: December 2021

There is lack of data on the frequency and correlates of dementia being documented as a cause of death in Hispanic populations. We investigated characteristics associated with dementia as a cause of death among Mexican-American decedents diagnosed with dementia. Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, Medicare claims files, and the National Death Index. Of the 744 decedents diagnosed with dementia before death, 26.9% had dementia documented as a cause of death. More health comorbidities (OR=0.38, 95% CI=0.25-0.57), older age at death (OR=1.05, 95% CI=1.01-1.08), and longer dementia duration (OR=1.09, 95% CI=1.03-1.16) were associated with dementia as a cause of death. In the last year of life, any ER admission with (OR=0.56, 95% CI=0.32-0.98) or without (OR=0.31, 95% CI=0.14-0.70) a hospitalization, more physician visits (OR=0.95, 95% CI=0.92-0.98) and seeing a medical specialist (OR=0.41, 95% CI=0.24-0.70) were associated with lower odds for dementia as a cause of death. In the last 30-days of life, any hospitalization with an ICU stay (OR=0.57, 95% CI=0.37-0.88) and ER admission with (OR=0.58, 95% CI=0.40-0.84) or without (OR=0.48, 95% CI=0.25-0.94) a hospitalization were associated with lower odds for dementia as a cause of death. Receiving hospice care in the last 30-days of life was associated with 2.09 (95% CI=1.38-3.16) higher odds for dementia as a cause of death. The possible under-documentation of dementia as a cause of death on death certificates may result in underestimation of healthcare resource need of dementia care for Mexican-Americans.
Older Adults’ Perceptions of Disposition Decisions from the Emergency Department
Authors: Valcheff Karen , Nancy Hoffart
Published: December 2021

Patient-centered care strives to improve older adult outcomes from the emergency department (ED). Appropriate disposition decisions from the ED for older adults are becoming increasingly complex and challenging. The purpose of this study was to explore the perceptions of older adults as to their disposition from the emergency department, the decision making process, and their engagement in that process. The Three-Talk Shared Decision Making (SDM) model guided the study. A qualitative approach was used to interview seven older adults two days after being treated in the ED. Transcribed data were thematically analyzed using MAXQDA to identify codes, patterns, and themes. Analysis revealed that the Three-Talk SDM model was not being used. Participants identified only one option regarding their disposition from the ED and perceived they had little voice in decision making. They reported a variety of emotional reactions, feelings of helplessness and empathy regarding the decision making process. Three factors that participants perceived as vital to them before making a disposition decision were safety, pain relief, and a definitive diagnosis. The findings of this small sample are clinically meaningful. These older adults wanted to be heard regarding their treatment and disposition decisions. Findings indicate the need for provider education about the use of a model such as the Three -Talk SDM. Further research is needed to look at both the older adult and provider’s perception of the ED disposition decision. Additional strategies and skills are warranted to enhance shared decision making in the ED with the growing aging population.
Geographic Disparities of Alzheimer’s Disease Mortality in Females With Breast Cancer
Authors: Akushevich Igor , Yashkin Arseniy , Kravchenko Julia
Published: December 2021

Our estimates showed significant gaps in mortality rates between the West and East parts of the U.S. when these rates are based on death certificate data. These geographic disparities were persistent over time and could not be fully explained by differences in demographic and socioeconomic characteristics, comorbidities, and/or differences in AD coding between these regions. However, incidence and incidence-based mortality rates based on Medicare data do not reproduce these geographic disparities. Death certificate-based patterns hold for the subset of the population with breast cancer, e.g., for subpopulation for which breast cancer was listed as a secondary cause of death. Therefore, SEER-Medicare data, which contains both death-certificate records and Medicare administrative claims for the same individuals can be used to resolve this inconsistency in findings. Analysis of breast cancer patients from two SEER registries in NJ and WA states in SEER-Medicare data (2000-2013) showed that the fraction of deceased individuals with an underlying cause AD among those who had a Medicare diagnosis of AD is 2.5-3.5 times (depending on the Medicare ascertainment algorithm) higher in WA comparing to NJ (p<0.0001). The odds ratio of not-having AD as an underlying cause is 1.3 for WA vs. NJ and increases with age, for non-white races, and unmarried individuals. Our findings do not support the hypothesis of higher rates of AD in WA state but show that AD is likely underrepresented in death certificate in NJ and possibly other East coast states.
Retirement Financial Planing and Life Satisfaction
Authors: Wang Mengya , Bartholomae Suzanne , Fox Jonathan
Published: December 2021

Abstract#8232; Retirement has been considered as a major transition in one’s life. Financial security in retirement is a major concern for many Americans. Evidence has shown that being financially#8232;prepared for retirement could has a significant, positive impact on one’s life satisfaction. Employing data from the 2012 and 2018 National Financial Capability Study (N=1023), this#8232;study analyzes the relationship between participants’ retirement planning in 2012 and their financial satisfaction in 2018. An Ordinary Least Squares regression is used in the current study.#8232;This study found relatively low retirement preparedness levels (retirement planning, retirement#8232;saving, retirement plan: employer-based or individually held, investment) among the participants#8232;in 2012. Based on the descriptive results, adults closest to retirement (ages 55 to 64) are more#8232;likely to be planning compared to the other groups, as are adults who were married, highly#8232;educated, males, and white. According to the liner regression results, this study found that adults#8232;who had a retirement savings goal, had a retirement plan (employer- based or individually held),#8232;made regular contributions to retirement plans, and owned investments in 2012 are more likely#8232;to be satisfied with their personal financial condition in 2018. As expected, individuals with#8232;higher incomes, larger net worth, and those who are older are significantly more likely to be#8232;financial satisfied. However, even after controlling for these variables, results show that planning#8232;does indeed impact the level of financial satisfaction. Our findings highlight the importance of#8232;policies and programs to support Americans with retirement planning.
Narrative Imagination: Dismantling Old Age Through The Literary Foodscape In Lore Segal's "The Arbus Factor"
Authors: Trinkaus Eva-Maria
Published: December 2021

Being able to take another person's perspective and understanding the Other is a crucial element of reading, understanding, and processing literature. Especially in the context of old age, many literary texts play into the culturally constructed (cf. Gullette 2004) and biased understanding of old age as decline narrative, rather than reading an old person's story as a narrative of possibility. In her short story "The Arbus Factor" which was first published in The New Yorker in 2007, Lore Segal offers a different perspective on aging. Through creating a space, coming into existence through foodways and food practices, which in my dissertation I will refer to as 'literary foodscape,' she offers a setting and backdrop for the characters to construct a discourse of possibility, creation, and new opportunities at a later stage in life. Segal wittily dismantles age-related stereotypes and opens up a discourse that goes beyond an easy categorization. This paper is going to analyze the ways in which a literary text, through the 'literary foodscape' is able to rewrite a culturally engrained perspective, and offers a different and more accurate understanding of what it means to be old. Gullette, Margaret Morganroth. Aged By Culture. The University of Chicago Press. 2004.
“Especially for People Our Age”: Exploring the Correlates of Ageism During the COVID-19 Pandemic
Authors: Sublett Jennifer , Vale Michael , Bisconti Toni
Published: December 2021

The COVID-19 pandemic has presented an unprecedented context for older adults where they may feel patronized, isolated, and fearful because of their greater risk of getting COVID-19 and being targets of ageism. Previous researchers have linked ageism negatively with health and well-being; although, the majority of this research has highlighted the negative, or hostile, aspects of ageism, and excluded the overaccommodative and patronizing qualities of benevolent ageism. Since the start of the pandemic, both forms of ageism have been noted to be more salient with claims of an ageism outbreak (Ayalon et al., 2020). The correlates of ageism during the COVID-19 pandemic are widely unknown, and the goal of this study was to explore whether experiences of ageism were related to different affective and health-related responses to the pandemic. In a sample of older adults (N=65) collected in September 2020, we found that benevolent ageism positively correlated with pandemic specific experiences of pity (r=.27, p<.05), loneliness (r=.30, p<.05), worry (r=.40, p<.01), and negatively related to self-reported physical health (r=-.31, p<.05) and emotional well-being (r=-.26, p<.05). Hostile ageism did not relate to pity, but positively correlated with loneliness (r=.25, p<.05) and worry (r=.37, p<.01), and negatively related to physical health (r=-.27, p<.05) and emotional well-being (r=-.38, p<.01). This work provides preliminary evidence of how the lives of older adults have been influenced by COVID-19 and the resulting ageism outbreak. Future research should continue this avenue of study with more expansive and inclusive samples and approaches as the pandemic is not over.
Media Portrayals of Emerging and Older Adults during COVID-19: Perceptions of Bias Among College Students
Authors: Pestritto Taylor , Mikrut Mikala , Graham Kirsten , King Katherine
Published: December 2021

This study explores media consumption and perceptions of media bias against both older adults and emerging adults during the COVID-19 pandemic. As part of a larger study, 99 students with a mean age of 20.54 (SD = 2.97) completed an online survey in early 2020. Individuals whose media consumption had increased were significantly more likely to report that young adults have been portrayed worse, and older adults better, since the start of COVID-19. Qualitative responses demonstrated broad awareness of ageist and adultist themes in media portrayals of both age groups, e.g., that young adults are careless and reckless whereas older adults are vulnerable and in need of protection. Results suggest that the media is perceived to be perpetuating age-related biases and may be enhancing intergenerational discord at a time when generational unity is needed.
People Internalized More Attitudes Toward Aging During the Pandemic
Authors: Fung Helene , Tsang Hiu Ling Vivian , Mai Chunyan
Published: December 2021

Older adults are viewed as being vulnerable to COVID-19. Previous research revealed that individuals would internalize or dissociate with attitudes toward aging when they aged. In this study, data collected before the COVID-19 pandemic were compared with those collected during the pandemic to assess whether the pandemic might make older adults internalize or dissociate with attitudes toward aging to a greater extent.123 Hong Kong participants (50.4% females, M=60.59±13.28 years old) were recruited in a two-wave survey (wave 1 in 2018 and wave 2 in 2020) on attitudes toward aging and future self-views. After comparing the correlations between attitudes toward aging and future self-views in the two waves, we found stronger positive correlations between these 2 variables in wave 2 than in wave 1 in the personality and finance domains, but not in the family, independence, or health domains. These findings suggest that internalization of attitudes toward aging might be domain-specific. The pandemic might make older adults more likely to internalize positive personality attitudes toward aging and negative finance attitudes toward aging into their future self-views. Professionals may consider utilizing the internalization process to promote a positive attitude toward aging during the pandemic.
“Spend your spoons wisely”: Conceptualizations of time, energy and aging invisibly with Crohn’s Disease
Authors: Natale Ginny , Pai Manacy
Published: December 2021

An increasing number of people with chronic medical disabilities are living longer and into old age due to the growing medical and technological advancements over the past half century. We used grounded theory to examine the lived experience of aging “with” a disability in a non-elderly population. On average, participants were 37 years of age at the time of interview. The average time since diagnosis was 17 years and ranged from 3 to 34 years. Many worked full-time outside of the home and some held advanced or graduate degrees. Of the 35 participants interviewed, three-quarters expressed worries about the future and aging, specifically related to physical limitations of having CD. The other 25% talked about learning to accept the diagnosis and ‘moving forward’ with their life as they age. All participants described the difficulties of fatigue and energy limitations. Planning of life was limited to 24 hours — a direct consequence of functional limitations of a relapsing-remitting disease. The most prominent theme that emerged from participants’ narratives to explain aging invisibly with a chronic illness was quantifying energy into ‘spoons’, a way of measuring the stock of their energy on any given day. These findings translate into important insights into the process of aging for those who live and age “with” Crohn’s as their everyday lives are immersed in managing the varying whims of this illness.
C-Reactive Protein Mediates the Association Between Subjective Aging and Incident Heart Disease
Authors: Skoblow Hanamori , Proulx Christine
Published: December 2021

Recent studies have shown that negative perceptions of subjective aging are associated with a heightened risk of cardiovascular events (Stephan et al., 2020) and increased C-reactive protein (CRP), a biomarker associated with inflammation (Stephan et al., 2014). Because inflammation is deleterious to cardiovascular health, CRP might mediate the association between subjective aging and cardiovascular disease. The purpose of this study was to examine the association between subjective aging (i.e., negative self-perceptions of aging [SPA] and subjective age) and incident cardiovascular disease (e.g., heart attack, angina, congestive heart failure), and to determine whether CRP mediates this relation. We used up to five waves of repeated measures data from the Health and Retirement Study (HRS, 2008 - 2016) with adults aged 50 to 101 (n = 9,531). Two separate models were conducted in MPlus with bias-corrected bootstrap confidence intervals and controls for respondent age, sex, education, race, ethnicity, body mass index (BMI), diabetes, hypertension, depressive symptoms, and physical inactivity. There were significant indirect effects of both SPA and subjective age on incident cardiovascular disease through CRP (indirect effect SPA model = .02, CIs [.01, .03], p < .05; indirect effect subjective age model = .05, CIs [.02, .10], p < .05). In both models, CRP fully mediated the association between subjective aging and incident cardiovascular disease. Taken together, these findings underscore the importance of considering older adults’ views of aging for understanding physical health and suggest that interventions aimed at improving views on aging may reduce inflammation and promote cardiovascular health.
Daily Perceived Stress and Physical Health Symptoms: Moderation by Self-Perceptions of Aging
Authors: Witzel Dakota , Turner Shelbie , Hooker Karen
Published: December 2021

Research suggests increased daily perceived stress is related to worse physical health outcomes such as poor eating and exercise behavior (Li et al., 2019) and lower perceived health (Whitehead & Blaxton, 2020). While long-term implications for increased perceptions of stress on physical health are becoming clear (e.g., Rueggeberg et al., 2012), less is known about associations between daily perceptions of stress and subjective levels of physical health symptoms. Moreover, positive perceptions of one’s own aging may buffer perceived stress’s impact on physical health. Indeed, self-perceptions of aging (SPA) impact how people prepare for age-related stressors (Kornadt et al., 2015), and are associated with physical health trajectories (Luo & Li, 2020). Using a 100-day microlongitudinal study of 103 older adults, we examined the 1.) impact of both between- and within-persons associations of perceived stress on physical health symptoms and 2.) the potential moderating associations of SPA on perceived stress and physical health symptom associations. Preliminary models suggest that on days when people perceived more stress, they show a .03 increase in reporting physical health symptoms compared to days when they do not report more perceived stress (p<.0001). Further, people who experience more perceived stress on average, reported .06 more physical symptoms across the study period (p <.0001). While SPA did significantly predict physical health symptoms (p=.004), the association between perceived stress and physical health symptoms was not dependent on SPA (p>.05). Future directions may include exploring associations between daily stressful experiences, perceptions of stress, and valence of SPA.
The Effects of a VR Teaching Tool on Understanding, Comfortability, Compassion, and Empathy of Students and Caregivers
Authors: Elzie Carrie
Published: December 2021

Empathetic care giving is associated with improved patient satisfaction, compliance and outcomes; clinical competence, career satisfaction, and burnout reduction; as well as diminished medical errors and litigation claims. Unfortunately, recent studies have shown erosion in empathy and compassion across the health professions. Virtual reality shows promise as a teaching tool to combat this decline as it has been dubbed the ultimate empathy machine, allowing users to vividly and viscerally experience any situation from any perspective. Embodied Labs allows users to virtually walk in the shoes of different patients, experiencing symptoms, family dynamics, support networks and various components of the health care systems. We have demonstrated that the high level of immersion and presence afforded by these virtual labs are effective pedagogical tools to increase understanding, comfortability, compassion and empathy within various populations including informal caregivers, high school students, health professional students and medical students.
Association of Obesity, Multiple Chronic Conditions, and Frailty: the National Health and Aging Trends Survey
Authors: Batsis John , Haudenschild Christian , Kahkoska Anna , Crow rebecca , Lynch David , Petersen Curtis , Lohman Matthew
Published: December 2021

As life expectancy increases, so does the risk of developing multiple chronic conditions (MCC). This is concerning as there is a growing obesity epidemic in older adults which is also associated with developing chronic diseases. Both obesity and MCC also increase the risk of frailty, yet the intersection of the three is not well understood. We evaluated the relationship between obesity, multimorbidity, and frailty using data from adults ≥65 years from the National Health and Aging Trends Survey. Obesity was classified using standard body mass index categories (e.g., ≥30kg/m2) and waist circumference (WC; females≥88cm; males≥102cm). MCC was classified as having ≥2 chronic conditions. Adjusted logistic regression models evaluated the association of BMI or WC categories on MCC (yes/no). An analysis limited to persons with obesity evaluated the relationship between frailty phenotypes (e.g, robust, pre-frail, frail) and MCC. Of the 4,967 participants (59.7% female), 79% resided in a private residence. The 70-79 age category was most prevalent. In those with MCC, there were 1,511 (30.4%) classified as having obesity using BMI, and 3,358 (67.6%) using WC. In those without MCC, there were 287 (17.6%) and 744 (51.7%). Compared to normal BMI, the odds of MCC was 0.71 [0.46,1.09], 1.25 [1.08,1.45] and 2.59 [2.15,3.11] in underweight, overweight and obesity. In pre-frailty and frailty, the odds of MCC were 2.52 [1.77,3.59] and 8.35 [3.7,18.85] in BMI-defined obesity. Using WC, the odds were 2.38 [1.94,2.91], and 5.89 [3.83,9.06]. Obesity using both BMI and WC are both strongly associated with multimorbidity and frailty.
Case Study - Candida auris in Skilled Nursing Facility
Authors: Vo Nancy , Tokumitsu Sayaka , Melik-Abramians Armen , John S Chen
Published: December 2021

Candida Auris (C. auris), is a multidrug-resistant organism, first described in Japan 2009, and now a serious, emerging global health threat1. C. auris pathogen can potentiate morbidity and mortality, i.e. lifelong contact precaution isolation, intravenous antifungal treatment, hospitalization and mortality rate of 30-60%1. Los Angeles County (LAC) developed 15 new cases in May 2020, and 73 cases in July 2020, amidst COVID-19 pandemic2. A 88 year old Black female had a positive skin test for C. auris by LAC Department of Public Health (DPH) during skilled nursing facility (SNF) admission for hip fracture in September 2020. Patient’s risk factors for C. auris included: age, kidney transplantation (1998) immunosuppression on tacrolimus, fungal infection on fluconazole, drug-drug interaction between tacrolimus-fluconazole including nephrotoxicity and neurotoxicity, malnutrition, bedbound, Stage 4 sacrococcyx pressure ulcer, osteomyelitis on broad-spectrum antibiotics, chronic indwelling catheter, and healthcare setting. Our multimorbid and frail patient remained asymptomatic with C. auris under an interdisciplinary team approach, including geriatricians, infectious disease, pharmacists, SNF team and local DPH. Our patient’s psychosocial isolation and family distress with local DPH guidelines for COVID-19 SNF visitation restrictions were compounded by multifaceted coordination of patient-centered care between SNF team and specialists via telehealth. Further research in the prevention, detection, and management of C. auris is warranted to protect our vulnerable SNF residents. 1. Centers for Disease Control and Prevention. (2020). Tracking Candida auris. https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html 2. Los Angeles County Health Alert Network. (2020). CDPH Health Advisory: Resurgence of Candida auris in Healthcare Facilities in the Setting of COVID-19. http://publichealth.lacounty.gov/eprp/lahan/alerts/CAHANCauris082020.pdf
Social Support and Living Situation of Older Adults With Hip-Fracture: A Retrospective Cohort Study
Authors: Krassikova Alexandra , Stewart Steven , Bethell Jennifer , Davis Aileen , McGilton Katherine
Published: December 2021

Sustaining a hip-fracture is a life-changing event negatively affecting older adults. Although, social support is a known determinant of health outcomes, the relationship between social support and living situation of older adults with hip fracture remains under researched. For this study social support is conceptualized using the Finfgeld-Connett framework, where social support is seen as being composed of emotional and instrumental support. The objectives were to examine the relationship between two domains of social support and living situation: 1) after discharge; 2) 3-months after discharge; and 3) 6-months after discharge from an inpatient rehabilitation facility in a sample of older adults with hip fracture. Emotional support was measured as frequency of interaction with someone one week prior to hip fracture, whereas instrumental support was measured as help received in instrumental activities of daily living. Logistic regression was performed to examine the association between social support and living situation. Majority of study participants (N=139) were older (mean age 81.31), female (77.70%), had no cognitive impairment (68.35%), were not married (58.99%), and lived with someone (51.80%) in their own house (71.95%). Older adults with more emotional support were more likely to be discharged home, however little can be said about the effect of the association (OR 6.80, 95% CI 1.08, 22.31, P<.001). Persons receiving more instrumental support had less odds of living at home 3-months (OR 0.41, 95% CI 0.21, 0.78; P=.007) and 6-months after discharge (OR 0.59, 95% CI 0.38, 0.91, P=0.017). Social support is important for older adults during recovery.
Environmental Features Supporting Non-transportation Walking in Older Dwellers in a Hilly Neighbourhood
Authors: Nitanai Ryoichi , Ogino Ryogo , Umemoto Daisuke , Goto Jun , Okata Junichiro
Published: December 2021

Walking is the basic mode of transportation; however, it is also considered as a recreational and physical activity. For elderly people, non-transportation walking (NTW) is necessary to maintain a good health; thus, irrespective of topography, living in an environment conducive to NTW is essential for the ageing community. This case study explores the features of the physical environment supporting NTW in older people, living in a hilly Japanese neighbourhood. We conducted semi-structured interviews with 23 older participants, with 6 being in their seventies, 13 in their eighties, and 4 in their nineties. We investigated the destinations and routes of their outings for a week, as well as their perception of walkability. Thereafter, we analysed the location of the NTW and the rationale behind the location choice. Consequently, four groups of people were identified based on their walking location: those who walked within a 1 km radius zone (N=6), those who walked outside the zone (N=8), those who walked both within and outside the zone (N=3), and those who did not walk (N=6). Moreover, each group had varied expectations regarding the physical environment, which is determined by their motivations and physical conditions, relating to the land use of the location of NTW. This implies the necessity of target identification and a suitable environmental approach for the target to promote NTW among older people in a hilly residential neighbourhood, such as improving comfort and connectedness by installing rest spots for the within-and-outside the zone walking group.
A Food Box Intervention to Reduce Blood Pressure in Native American Adults With Hypertension: The CHEERS Study
Authors: Taniguchi Tori , Standridge Joy , Shackleford Tyra , Brookins Hilary , Jacob Tvli , Jernigan Valarie Blue Bird
Published: December 2021

Diet-related chronic diseases, such as hypertension and obesity, are prevalent in Native American (NA) communities where poor food environments are prominent and healthy food access is limited. The Chickasaw Healthy Eating Environments Research Study (CHEERS) is an NIH-funded study aimed to improve Body Mass Index and blood pressure control among NA adults with uncontrolled hypertension. This multi-level randomized trial, guided by a community-based participatory research orientation, was co-created by tribal and university partners and is implemented within the Chickasaw Nation of Oklahoma. We created hypertension-specific food boxes that contained DASH diet foods, coupons for purchasing vegetables and fruits, educational materials, and heart-healthy recipes for supporting healthy eating. Food boxes were packed and shipped monthly to intervention participants with a 30-day supply of: one fruit serving/day, one vegetable serving/day, one serving of unsalted nuts or seeds/day, one serving of beans or lentils/day, and two servings of fatty fish/week. We will present our participatory approach in co-developing the CHEERS study methods, findings with a focus on older adults, and lessons learned. CHEERS is the first innovative food box intervention to be conducted in NA communities. Food box interventions show promise in improving dietary intake and reducing hypertension and obesity in rural and poor food environments.
Impacts of Social Capital Factors on Blood Glucose Control and Depressive Symptoms
Authors: Xue Tingzhong (Michelle) , Rahmaty Zahra , McConnell Eleanor , Xu Yingzhi (Lindsay) , Corazzini Kirsten
Published: December 2021

Social capital, conceptualized as resources arising from social networks, is receiving increased attention for its role in prevention and management of chronic conditions such as diabetes and depression that commonly co-occur. Although social capital has been linked to control of blood glucose and depression, previous research has not considered these two outcomes simultaneously while distinguishing between cognitive (i.e., perceived social support, shared values and trust in community) and structural (i.e., social connectedness and participation) domains. This study examined how these two domains of social capital relate to glucose control and depressive symptoms, and whether physical exercise and care access mediate those relationships, using structural equation modeling. The sample included 3,043 older adults aged 57 and above from wave 2 of the National Social Life, Health and Aging Project. Although a higher level of cognitive social capital was associated with higher levels of physical exercise (b=.38, p<.001), access to care (b=.40, p=.007), lower levels of blood glucose (b=-.43, p<.001) and depressive symptoms (b=-.84, p<.001), a higher level of structural social capital was associated only with a higher level of physical exercise (b=.16, p=.002). The mediating effects of physical exercise and access to care were not significant. Findings suggest that cognitive social capital may have greater influence on blood glucose and depressive symptoms than structural social capital, and therefore have different implications for practice, especially in the context of pandemic-related disruptions to social capital. Future research should examine other mediators and investigate how promotion of cognitive social capital might improve health outcomes.
Construction and Performance of the Hospice Care Index Claims-Based Quality Measure
Authors: Plotzke Michael , Christian Thomas , Groover Kim , Harrison Zinnia , Abdur-Rahman Ihsan , Massuda Cindy
Published: December 2021

As part of the Medicare Hospice Benefit (MHB), hospices submit claims containing information that allows policy makers to assess hospice quality, help policy makers improve the MHB, and increase patients’ experiences of care. We examine ten different hospice quality indicators related to the provision of services and patterns of live discharge. We calculated indicators using 100% Medicare fee-for-service (FFS) claims from October 1, 2018 through September 30, 2019. A hospice’s total score among all ten indicators is referred to as their Hospice Care Index (HCI), with a possible high score of 10. We examined all hospices with at least 20 discharges. After exclusion, we examined 4,155 hospices representing 1,562,003 beneficiaries. Most hospices earn a high HCI score: over 85% of hospices had scores of eight or more. At the same time, there were some lower scoring hospices: one in ten hospices scored seven on the index, and the remaining 4.9% scored six or lower. We find that on average hospices with higher HCI scores have better Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice ratings. Among hospices with a score of ten, 85.1% of caregivers reported they would definitely recommend the hospice vs. 82.9% of caregivers of patients receiving treatment from hospices with a score of seven or less. Using the HCI, the Centers for Medicare and Medicaid Services and hospice patient caregivers can assess hospices across a broad set of indicators. Policymakers and hospices should monitor these ten indicators to understand their performance relative to peers.
Needs Assessment of Perimenopause Resources and Services
Authors: Losinski Genna , Hicks Hilary , Thangwaritorn Pilar , Engel Ilana , Laffer Alexandra , Berkley Amy , Watts Amber
Published: December 2021

Studies show that women lack knowledge about perimenopause and feel unprepared to make healthcare decisions during this life transition. Most women want to be involved in their healthcare decisions and need timely, free, and accurate information. We conducted a needs assessment in Douglas County, Kansas by systematically reviewing regional organizations that might offer services and resources related to women’s health in midlife. We compared these resources to a benchmark for menopausal care available online nationwide (Gennev.com). We documented the primary purpose of each organization (e.g., cosmetic, wellness, medical care), services and resources offered (e.g., hormone therapy, counseling, non-pharmacological treatments), methods of outreach (e.g., blogs, classes), target audience, costs, and types of service providers (e.g., physician, counselor). We surveyed 9 regional websites: 5 offered medical care, 3 cosmetic and wellness services, 2 were municipal organizations, 2 offered mental health/social support. Four organizations offered services targeted specifically towards perimenopausal women. The most commonly offered services were hormone replacement therapy (44%), nutritional supplements (33%), and weight loss programs (33%). Very few offered educational resources (1) or menopause assessments (1) and none offered tailored psychosocial support for the perimenopause transition. The services offered were expensive with no free services and very few free resources. Organizations were primarily staffed by medical providers, only 1 organization had Menopause Practitioners certified by the North American Menopause Society. Our results demonstrate a need for comprehensive educational and support services for perimenopausal women to fulfill the need for timely, accessible, and accurate information during this understudied health transition.
Self-Reported Physical Limitations Among U.S. Veterans Compared to Non-Veterans: Findings from NHANES
Authors: Robbins Ronna , Serra Monica , Addison Odessa
Published: December 2021

Approximately 43% of males over the age of 65 years are Veterans. Veterans may be at elevated risk for functional declines due to barriers to health care access leading to accelerated loss of independence. This compared the prevalence of functional limitations in Veterans and non-Veterans. Data from two National Health and Examination Survey collection periods, administered 2013-2014 and 2015-2016, were used to compare physical functioning data between male Veterans (N=369) and non-Veterans (N=738) matched 1:2 for sex, race, and BMI. Individuals were considered a Veteran if they self-reported having “served in active duty in the U.S. Armed forces.” Pearson’s chi-square tests were used to assess differences in the prevalence of various self-reported functional limitations between groups. Veterans (mean±SEM: age: 64.5±0.54 years; BMI: 30.0±0.3 kg/m2) were disproportionately affected by self-reported functional limitations caused by long-term physical, mental, or emotional illnesses (8% vs. 3%, p<0.004). Twenty-five % of Veterans reported that these limitations kept them from working compared to 18% of non-Veterans (p<0.003). Veterans (38%) were also more likely to report being limited in the amount of work they could perform compared to non-Veterans (27%) (p<0.01). Additionally, Veterans (20%) were more likely to report the use of special healthcare equipment (i.e. cane, wheelchair) than non-Veterans (12%) (p<0.001). These data suggest that Veterans are at greater risk for functional limitations caused by self-reported long-term physical, mental or emotional illness. Therefore, further research is needed to determine if home- and community-based services could prevent further functional decline, ultimately allowing Veterans to maintain independence.
Assessment of Sleep Duration Based on Ankle and Wrist Actigraphy in Hospitalized Older Patients.
Authors: Smichenko Juliana , Shochat Tamar , Gur-Yaish Nurit , Zisberg Anna
Published: December 2021

Poor sleep at time of hospitalization is associated with undesirable outcomes. Most studies performed in the hospital assess sleep by self-report, while only few rely on actigraphy. Although wrist actigraphy is commonly used for sleep assessment in field studies, in-hospital assessment may be challenging and cumbersome due to other more necessary monitoring devices that are often attached to patients’ upper limbs, that may in turn affect interpretation of wrist activity-data. Placement on the ankle may be a viable solution. In this pilot study, we aimed to compare total sleep time (TST) using concomitant wrist and ankle actigraphy as well as self-report. Twenty-one older adults (65+) hospitalized in medical units wore ankle and wrist actigraphy devices and subjectively estimated their TST for an average of (2.15±1.01) nights. A total of 45 nights were available for analysis. Average TST in minutes was 332.06±81.58, 427.05±97.74 and 374.28±124.96 based on wrist, ankle, and self-report, respectively. Repeated measure mixed models analysis was performed adjusting for age, gender, and sleep medications. TST was significantly lower using wrist compared to ankle actigraphy (F(2,102)=7.63, p=0.0008), and both were not different from self-report. No significant within subjects variation and no interaction between device and repeated measures were found. Despite differences between ankle and wrist assessments, all three provide consistent TST estimation within subjects. Self-report provides a stable and accessible assessment of TST, representing a good approximation of ankle and wrist actigraphy. Findings provide preliminary support for the use of ankle actigraphy for sleep assessment in hospital settings.
Spatial Usage and Circadian Rhythm for Older Adults in the Community in Taiwan
Authors: Wang Chih-Liang , Chiu Ching-Ju
Published: December 2021

Objective measure of lifestyle of the older adults living in the community is void in the literature. To obtain both objective and subjective measurements to ascertain mobile and day and night lifestyle of older adults living in the community, and to build lifestyle model of older adults in the community by sociodemographic character. This study is a cross-sectional research. 200 over-50-year older adults who own smartphone and live in southern Taiwan were interviewed. Wrist accelerometers to detect behavioral circadian rhythm, GPS app in smartphone to survey mobility, and questionnaire to assess psychological and social status. Preliminary finding of six participants (2 men and 4 women) was analyzed. Data show that participants about 60 years old have large discrepancies in comparison with participants in their 50s: lower sleep efficiency (73 vs 83), earlier Most active 10 hour midpoint (11.48vs 14.13 hour), higher interdaily variability (0.84 vs 0.75), wake after sleep onset (100.39vs 47.78 minutes), and higher exercise frequency (4.33 vs 1.66 times per week). In addition, men have more chronic disease, bigger waistline (103.5 vs 77.5 cm), higher BMI (30 vs 22.5), lower middle to vigorous physical activity time (39 vs 79 minutes), and more total sleep time (356 vs 317 minutes). Age and sex seem to be significant factors determining lifestyle of older adults. Other sociodemographic parameters will be further analyzed.